Library

In cases of Yin syndrome presenting with restlessness, the patient may appear similar to one suffering from mania (madness), but it is not true mania. At the onset, there is no headache; instead, the patient experiences irritability and a desire to sit in muddy wells or in cool places, exhibiting chaotic restlessness without mental clarity. This is termed "restlessness due to extreme Yin" (extreme Yin leading to floating Yang). The distinguishing features are cold extremities, a deep and fine pulse, and despite feelings of irritability and thirst, an inability or unwillingness to drink water. Treat this with Pili San (Thunderbolt Powder), which must be taken cold. In severe cases, slight fever, facial redness (floating Yang syndrome), cold feet, restlessness, and a rapid but forceless pulse occur. This results from interior cold and deficiency at the lower jiao, causing deficient Yang to be trapped within Yin. Ren Shen Si Ni Tang (Ginseng Decoction for Reversing Cold) should be administered cold. Some physicians mistakenly diagnose facial redness and body heat as Yang mania or excess heat, causing great harm. A diagnostic test involves offering half a cup of cool water; if the patient vomits it immediately upon entering the mouth and refuses to swallow, it confirms Yin restlessness. Furthermore, carefully examine the pulse to determine if it is forceful or forceless. This is a sound method.

Erythema (macules/rash) generally arises because Shaoyang disease required purgation but was not treated with it, allowing pathogenic heat to accumulate in the Stomach. Alternatively, premature purgation allows pathogenic heat to enter the Stomach via deficiency. It can also result from administering hot medicines erroneously to Yang syndrome cases, where extreme heat causes tissue corruption. If fever persists after sweating or purging, accompanied by cold feet, deafness, irritability, and nausea, these are symptoms of erythema. There are two types of erythema: one caused by Warm Toxicity (Wen Du) and the other by Febrile Disease. Both result from pathogenic heat injuring the Blood level, causing blood heat to stagnate and manifest on the skin. Mild cases present as urticaria-like rashes (yin zhen), while severe cases present as brocade-patterned macules. Huaban Tang (Macule-Transforming Decoction) is the primary formula for both. Sweating methods must strictly be avoided, as they further open the pores and exacerbate the rash. Generally, warmth of the body and feet with a surging and rapid pulse indicates a favorable prognosis (Shun). Coolness of the body and feet with a faint and fine pulse indicates an unfavorable prognosis (Ni). Red, raised, and bright macules are auspicious; dense, confluent macules are ominous. Mild red macules suggest a mortality rate of five deaths to one survival; severe black macules suggest ten deaths to one survival. When first appearing, macules resemble mosquito bites, but macules typically appear on the chest and abdomen, whereas mosquito bites are limited to the hands and feet. Additionally, if the pulse is surging and large, the patient is confused, and the spots turn from red to dark red, it is erythema. If the pulse is not surging and large, the patient is calm, and the marks turn from red to yellow, they are merely mosquito bites.