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9. Stomach excess with a large pulse indicates Yangming Fu syndrome; difficulty in defecation is similar to Spleen Constraint. With surging tidal fever and profuse sweating, only when there is fullness and pain can one discuss the use of the Three Chengqi formulas.

[Note] A large pulse in Yangming Fu syndrome refers to heat pathogens entering the Fu organs, where Yangming typically presents with a large pulse. Terms such as "Stomach Excess," "difficulty in defecation," and "Spleen Constraint" indicate different ways in which the Fu organs are affected by pathogens. "Spleen Constraint" belongs to Taiyang-Yangming syndrome. "Stomach Excess" belongs to Zhengyang (True Yang) Yangming syndrome. "Difficulty in defecation" belongs to Shaoyang-Yangming syndrome. All these are indications for purgative therapy, though they differ in severity. However, one must observe surging tidal fever, profuse sweating over the body and limbs, or abdominal fullness and pain, before discussing the mildness or severity of the condition and prescribing the Three Chengqi Decoctions (San Cheng Qi Tang) or Mahuang Wan (Pill of Hemp Seed) for purgation. For details, see the Yangming Chapter.

10. In Yangming Exterior Syndrome, sweat appears contrary to expectation; this suggests transmission from Wind Pathogen, treatable with Guizhi Jia Gegen Tang (Cinnamon Twig plus Kudzu Root Decoction). In Heat Syndromes, absence of sweat indicates loss of Body Fluids; if dryness and thirst persist, recover using Baihu Tang (White Tiger Decoction). Stomach Excess with sweat and heat originally requires purgation; but if chills and a floating-slow pulse indicate an exterior pattern, resolve the exterior first. To know if stool is firmly hardened, observe the passage of flatus; without flatus or with a faint-choppy pulse, purgation is a grievous error. Slippery tongue coating and clear urine with frequent urination suggest that although stool is hard, do not attack it directly; use suppository methods for self-resolution. Frequent uritation indicates likely hard stool; if there is no discomfort and frequency decreases, Body Fluids are returning to the Stomach.

[Note] Yangming Exterior Syndrome should present without sweat; the presence of sweat indicates transmission from Wind Pathogen, requiring treatment from the exterior, suitable for Guizhi Jia Gegen Tang (Cinnamon Twig plus Kudzu Root Decoction). Yangming Heat Syndrome should present with sweat; the absence of sweat may result from prior vomiting, sweating, or purgation leading to loss of Body Fluids. If there is no dryness and thirst, treat from the exterior; if dryness and thirst exist, treat as a Heat Syndrome, suitable for Baihu Tang (White Tiger Decoction). Stomach Excess presenting with spontaneous sweating and tidal fever originally warrants purgation. However, if exterior signs such as chills and a floating-slow pulse are present, the exterior must be resolved first; only after the exterior is cleared can interior purgation proceed. To determine if stool has become firmly hardened, administer a small dose of Xiaochengqi Tang (Minor Order the Qi Decoction). If the patient passes flatus (Zhuan Shiqi), the stool is confirmed hard, and Dachengqi Tang (Major Order the Qi Decoction) should be used for purgation. If flatus does not pass, the stool is not yet firmly hardened; purgation will cause diarrhea, so do not administer again. If the pulse is faint and choppy, purgation is also contraindicated, as it would lead to severe consequences. A slippery tongue coating and clear urine indicate mild interior heat. Even with frequent urination and hard stool, if the heat is located in the Changchang (large intestine/rectum), purgation is contraindicated; using Honey Suppository (Mi Jian Dao) or Pig Gallbladder Suppository (Zhu Dan Dao) methods will ensure safety. Generally, frequent urination indicates likely hard stool. Although the stool is hard, if there is no discomfort such as fullness or pain, observe the number of daily urinations. If the frequency gradually decreases, it indicates that Body Fluids are returning to the Stomach. Do not use purgation; the stool will naturally pass soon. For details, see the Yangming Chapter.