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**Chapter 8: Manifestations of Yangming Disease**

**Proof 75, Formulas 11**

The fundamental characteristic of Yangming disease is cold in the stomach.

Question: Diseases are categorized into Taiyang-Yangming, Zhengyang-Yangming, and Weiyang-Yangming. What do these terms mean? Answer: Taiyang-Yangming refers to Pi Yue (Spleen Constraint), where insufficient Spleen Yin leads to intestinal dryness and difficulty defecating. Zhengyang-Yangming refers to Wei Jia Shi (Stomach House Excess), characterized by dry-heat accumulation in the gastrointestinal tract. Weiyang-Yangming refers to conditions caused by excessive sweating or excessive diuresis, leading to dryness in the stomach and difficulty defecating.

Question: How does one contract Yangming disease? Answer: When suffering from a Taiyang disease, if sweating is induced excessively or purgatives are used improperly, body fluids are depleted, causing dryness in the stomach, which transforms into Yangming disease. Alternatively, even if there is no complete constipation but difficulty in defecation, it is also classified as Yangming disease.

Question: What are the exterior manifestations of Yangming disease? Answer: The body feels hot, there is sweating, no aversion to cold, but rather an aversion to heat.

Question: Some patients exhibit fever and aversion to cold on the first day of illness. Why is this? Answer: Indeed. Even on the second day, the aversion to cold will cease spontaneously, followed by sweating and aversion to heat. Question: Why does the aversion to cold stop spontaneously? Answer: The Yangming meridian resides in the center and corresponds to Earth; all pathogens tend to converge here and do not transmit further. Thus, although there may be initial aversion to cold, it stops by the second day. This usually occurs because when Taiyang disease begins, sweating is induced but is incomplete, allowing pathogens to transfer to Yangming.

If a patient has fever without sweating, vomiting, inability to eat, yet experiences profuse sweating over the whole body, this indicates the pathogen has transferred to Yangming.

After three days of Shanghan (Cold Damage), if the pulse becomes large, it indicates transmission to Yangming.

If the pulse is floating and slow, with warm hands and feet, the disease is associated with Taiyin (Spleen). Taiyin disease typically presents with jaundice; however, if urination is free, jaundice will not occur. By the seventh or eighth day, if the stool becomes hard, it belongs to Yangming.

When Shanghan pathogens transmit and bind to Yangming, the patient initially feels slightly irritable before sweating.

Yangming Wind Strike presents with bitter taste in the mouth, dry throat, abdominal fullness, slight wheezing, fever, aversion to cold, and a floating or tight pulse. If purgatives are mistakenly used, abdominal fullness worsens, and urination becomes difficult.

In Yangming disease, the ability to eat indicates Wind Strike (pathogenic wind), while the inability to eat indicates Cold Strike (pathogenic cold).

In Yangming disease due to Cold Strike, where the patient cannot eat, has difficulty urinating, and sweats slightly on the hands and feet, this indicates the impending formation of a hard mass (Jia). There will likely be hard stool at the beginning and loose stool at the end. This occurs because of cold in the stomach, causing improper separation of water and grain.

In the early stage of Yangming disease, the patient desires food, urination frequency is low, stool is normal, but bone joints ache, and there is a sensation of mild heat. Suddenly, the patient goes mad, then sweats profusely and recovers. This happens because the water-dampness fails to overcome the Gu Qi (Grain Qi), and they exit together with sweat; the hardened part heals.

The time for Yangming disease to resolve is from Shen hour to Xu hour (3 PM to 7 PM).

In Yangming disease, if the patient cannot eat and purgatives fail to resolve symptoms, and the patient still cannot eat, attacking the heat will inevitably cause hiccups. This is due to deficiency-cold in the stomach; since the patient is fundamentally deficient, attacking heat causes hiccups.

In Yangming disease, if the pulse is slow, food cannot be consumed to satiety, and slight irritability and dizziness occur after eating, urination will likely be difficult. This indicates impending Gu Dan (Grain Jaundice). Even if purgatives are used, abdominal fullness will persist. This is due to the slow pulse indicating cold.

In prolonged Yangming disease with hard stool, Yangming disease should present with profuse sweating. If there is no sweating, and the skin feels like insects crawling, it is due to long-term deficiency.

In winter, Yangming disease may present with no sweating but free urination. After two or three days, vomiting and coughing occur, and if the hands and feet are cold, the head will surely hurt. If there is no vomiting, coughing, or cold extremities, the head will not hurt.

In winter, Yangming disease presenting only with dizziness, no aversion to cold, ability to eat, and coughing, will result in sore throat. If there is no cough, the throat will not hurt.

In Yangming disease, if the pulse is floating and tight, the fever will be tidal, occurring at specific times. If the pulse is only floating, night sweats will occur.

In Yangming disease, if there is no sweating, difficulty urinating, and mental restlessness (Ao Nu), jaundice will develop.

If Yangming disease is treated with fire therapy, resulting in slight sweating on the forehead and difficulty urinating, jaundice will develop.

In Yangming disease, if the mouth is dry and the patient only wants to rinse their mouth with water without swallowing, epistaxis (nosebleed) will occur.

In Yangming disease, if the patient already has spontaneous sweating, and the physician induces sweating again, although the illness improves, the patient remains slightly irritable and mentally unclear. This is due to hard stool. Body fluids have been lost, causing dryness in the stomach, leading to hardness. One should ask how many times the patient urinates daily. If they usually urinate three or four times a day but only twice today, it indicates that stool will pass soon. Since urine output has decreased, fluids return to the stomach, ensuring bowel movement.

For diseases with excess Yang, using purgatives causes hardness; excessive sweating followed by inducing more sweating also causes hardness.

In Shanghan, if vomiting is frequent, even if Yangming symptoms exist, purgatives must not be used.

In Yangming disease, if there is hardness and fullness below the heart, purgatives must not be used. If purgatives cause unceasing diarrhea, cessation of diarrhea indicates recovery.

In Yangming disease, if the face is red, purgatives must not be used. Doing so will cause fever; if yellowing occurs, it is due to difficulty urinating.

In Yangming disease, if there is irritability without prior emesis or purgation, Chengqi Tang can be administered.

In Yangming disease, if the pulse is slow, there is sweating but no aversion to cold, the body is heavy, there is shortness of breath, abdominal fullness, and wheezing, accompanied by tidal fever, the exterior is resolved, and the interior can be attacked. With slight sweating on the hands and feet indicating hard stool, Chengqi Tang is the primary formula.

If there is profuse sweating and slight aversion to cold, the exterior is unresolved, and the fever is not tidal; do not give Chengqi Tang. If there is significant abdominal fullness without bowel movement, Xiao Chengqi Tang can be given to mildly harmonize the Stomach Qi, avoiding severe purgation.

In Yangming disease, if there is tidal fever and slight stool hardness, Chengqi Tang can be given; if not hard, do not give it.

If there is no bowel movement for six or seven days, suspecting dry feces (Zao Shi), the method to confirm is to give Xiao Chengqi Tang. If flatus (Zhuan Shi Qi) occurs in the abdomen, it indicates dry feces, and purgation is permissible. If no flatus occurs, it is merely hard stool at the beginning and loose at the end; do not purge, as it will cause abdominal fullness and loss of appetite. Thirst will lead to hiccups. Subsequent fever indicates recurrence of hardness; use Xiao Chengqi Tang to harmonize. If no flatus occurs, absolutely do not purge.

Excess conditions cause Zhenyu (delirious speech); deficiency conditions cause Zhensheng (repetitive speech). Zhensheng means repetitive talking. Fixed gaze with delirium and wheezing/fullness indicates death; diarrhea also indicates death.

In Yangming disease, if the patient sweats profusely, body fluids escape, the stomach becomes dry, and stool becomes hard, delirium ensues. Chengqi Tang is the primary formula.

In Yangming disease, if there is delirious speech, tidal fever, and a slippery-rapid pulse, Chengqi Tang is the primary formula. Administer one sheng of Chengqi Tang. If flatus occurs, administer another sheng. If no flatus occurs, do not administer. If the next day there is still no bowel movement and the pulse becomes weak and choppy, this indicates interior deficiency and is difficult to treat; do not give Chengqi Tang again.

In Yangming disease, if there is delirium, tidal fever, and inability to eat, there are likely five or six pieces of dry feces. If the patient can eat, it is merely hard stool. Chengqi Tang is the primary formula.

In Yangming disease, if there is bloody stool and delirium, this is Heat entering the Blood Chamber. If only the head sweats, puncture Qimen (LR14) to drain excess. General slight sweating indicates recovery.

If there is sweating and delirium, there is dry feces in the stomach due to Wind. Purge only after the pathogen has left the meridians (Guo Jing). Premature purging causes chaotic speech. Due to exterior deficiency and interior excess, purging leads to recovery; use Chengqi Tang.

In Shanghan, on the fourth or fifth day, if the pulse is deep with wheezing and fullness, deep indicates interior location. Inducing sweating erroneously causes fluid loss and difficult stool, resulting in exterior deficiency and interior excess. Over time, delirium occurs.

After purgation in Yangming disease, if there is mental restlessness (Ao Nu), and dry feces are present in the stomach, purging is allowed. If the abdomen is slightly full with hard initial/loose final stool, purging is necessary; if dry feces are present, use Chengqi Tang.

If a patient has not had a bowel movement for five or six days, has periumbilical pain, irritability, and periodic attacks, this indicates dry feces causing constipation.

If a patient has irritability and fever, relief upon sweating, recurring like malaria with evening exacerbation (Ribang Suo), this belongs to Yangming. If the pulse is excess, purge; if floating and deficient, induce sweating. For purging, use Chengqi Tang; for sweating, use Guizhi Tang. (Formula see Guizhi Tang section.)

After severe purgation, if there is no bowel movement for six or seven days, unresolved irritability, and abdominal fullness/pain, this indicates dry feces due to retained food. Use Chengqi Tang.

If a patient has difficulty urinating, alternating difficulty and ease of defecation, slight fever, and郁热 (depressed heat) preventing sleep, this indicates dry feces. Use Chengqi Tang.

On the second or third day of illness, if the pulse is floating and weak, without Taiyang or Shaoyang symptoms, but with irritability and hardness below the heart, even if the patient can eat on the fourth day, give a small amount of Xiao Chengqi Tang to mildly harmonize and provide relief. On the sixth day, give one sheng of Chengqi Tang. If there is no bowel movement for six or seven days and urine is scanty, although there is no bowel movement, if the stool is hard at the beginning and loose at the end, it is not yet fully formed dry feces.

In Shanghan, on the seventh or eighth day, if vision is blurred and eyes are unresponsive, without obvious exterior or interior symptoms, but with difficult stool and slight fever, this is excess. Urgently purge with Chengqi Tang.

In Yangming disease, if there is fever and profuse sweating, urgently purge with Chengqi Tang.

If sweating fails to resolve the condition and abdominal fullness/pain persists, urgently purge with Chengqi Tang.

If abdominal fullness does not decrease, or decreases insignificantly, purge with Chengqi Tang.

In combined Yangming and Shaoyang disease with diarrhea, if the pulse is "not negative" (favorable), it is smooth. If slippery and rapid, there is retained food; use Chengqi Tang. (Formulas see Chengqi Tang section.)

In Yangming disease, if the pulse is floating and tight, with dry throat, bitter taste, abdominal fullness, wheezing, fever, sweating, no aversion to cold, but aversion to heat, and heavy body, inducing sweating causes irritability, mental confusion, and delirium. Adding moxibustion causes fearfulness and insomnia. Purging empties the stomach, allowing hostile qi to disturb the diaphragm, causing mental restlessness (Ao Nu). If there is coating on the tongue, Zhizi Tang is the primary formula.

After purgation in Yangming disease, if there is exterior heat, warm hands and feet, no chest binding, mental restlessness (Ao Nu), hunger but inability to eat, and only head sweating, Zhizi Tang is the primary formula. Formula: Zhizi (14 pods, broken) and Xiangchi (4 he, wrapped in silk). Boil these two ingredients in four sheng of water, first boiling Zhizi to obtain two and a half sheng, then add Xiangchi and boil to obtain one and a half sheng. Strain and divide into two doses. Take one dose warm. Stop subsequent doses if rapid vomiting occurs.

In San Yang combined disease, with abdominal fullness, body heaviness, difficulty turning, oral numbness, slurred speech, and enuresis, inducing sweating causes delirium. Purging causes sweating on the forehead and cold extremities. Baihu Tang is the primary formula. (Note: All versions read "Xiang Jing", so it is not corrected.)

If thirsty for drinking water with dry mouth and tongue, Baihu Tang is the primary formula. (Formula see Miscellaneous Treatments.)

If the pulse is floating with fever, thirst for water, and difficulty urinating, Zhuling Tang is the primary formula. Formula: Zhuling (deprived of black skin), Fuling, Zexie, Ejiao, Huashi (crushed, each one liang). Boil these five ingredients in four sheng of water, first boiling the first four to obtain two sheng. Strain, add Ejiao until melted, and take seven ge warm, three times daily.

In Yangming disease, if there is profuse sweating and thirst, Zhuling Tang must not be given, as profuse sweating causes stomach dryness, and Zhuling Tang promotes urination, further damaging fluids.

In deficiency-cold of the stomach, if the patient cannot eat, drinking water causes hiccups.

If the pulse is floating with fever, dry mouth and nose, and the patient can eat, epistaxis will occur.

If the pulse is floating and slow, with exterior heat and interior cold, and diarrhea with undigested food, Sini Tang is the primary formula. Formula: Gancao (two liang, roasted), Ganjiang (one and a half liang), Fuzi (one raw piece, peeled, broken into eight slices). Boil these three ingredients in three sheng of water to obtain one and two he. Strain and divide into two warm doses. Strong individuals may use one large Fuzi and three liang of Ganjiang.

In Yangming disease with tidal fever, loose stool, normal urination, but persistent chest and hypochondriac fullness, Xiaochaihu Tang is the primary formula.

In Yangming disease, with hardness and fullness below the hypochondrium, constipation, vomiting, and tongue coating, Xiaochaihu Tang can be used. Once the Upper Jiao is open and fluids descend, Stomach Qi harmonizes, and the patient sweats slightly and recovers.

In Yangming Wind Strike, with string-taut-floating-large pulse, shortness of breath, generalized abdominal fullness, hypochondriac and cardiac pain unrelieved by pressure, dry nose, inability to sweat, lethargy, generalized and ocular jaundice, difficulty urinating, tidal fever, intermittent hiccups, and swelling around the ears, acupuncture provides slight relief. If exterior symptoms persist beyond ten days and the pulse remains floating, give Xiaochaihu Tang. If only floating without other symptoms, give Mahuang Tang. If unable to urinate, with worsening abdominal fullness and hiccups, it is untreatable. (Formulas see Chaihu Tang section.)

In Yangming disease, if the pulse is slow, with profuse sweating and slight aversion to cold, the exterior is unresolved. Induce sweating with Guizhi Tang.

In Yangming disease, if the pulse is floating, with no sweating and inevitable wheezing, inducing sweating leads to recovery. Use Mahuang Tang. (Formulas see above.)

In Yangming disease with sweating, if sweating is induced again and urination is free, this indicates internal exhaustion. Although stool is hard, it must not be purged. Wait for the natural desire to defecate. Use Mi Jian Dao (Honey Suppository) to facilitate passage, or Shu Gagua Gen (Trichosanthes root) or Zhu Dan Ye (Pig bile) can also be used. Formula: Honey (seven he). Simmer honey in a copper vessel over low heat until it thickens like malt syrup. Do not let it burn. While hot, shape into pills finger-thick and two cun long, with a sharp tip. Insert into the anus immediately while hot. Hold buttocks tightly. Remove when the urge to defecate arises.

Another formula: One large pig gallbladder, extract juice, mix with a little vinegar, and enema into the anus. After about one meal's time, stool containing retained food and foul matter will pass. This method is very effective.

In Yangming disease, if there is fever and sweating, heat disperses outward, and jaundice does not occur. If only the head sweats, stopping at the neck, with difficulty urinating and thirst for liquids, this is stagnant heat in the interior, leading to jaundice. Yinchin Tang is the primary formula.

In Shanghan, on the seventh or eighth day, if the body is yellow like an orange peel, with difficulty urinating and slight abdominal fullness, Yinchin Tang is the primary formula. Formula: Yinchin (six liang), Zhizi (14 pods, broken), Dahuang (two liang). Boil these three ingredients in twelve sheng of water, first boiling Yinchin to reduce by six sheng. Add the other two and boil to obtain three sheng. Strain and divide into three warm doses. Urination should become free, with urine resembling soap pod foam, reddish in color. The yellowness disappears via urination overnight.

In Yangming syndrome, if the patient is forgetful, there is likely accumulated blood. This is due to long-standing blood stasis. Although stool is hard, it will be black. Didang Tang is the primary formula.

If a patient has no exterior or interior symptoms, with fever for seven or eight days, and a floating-rapid pulse, purging is permissible. If after purging the rapid pulse persists, combined heat causes increased appetite. By the sixth or seventh day, if there is no bowel movement, there is blood stasis. Didang Tang is the primary formula. If the rapid pulse persists and diarrhea continues, there will be pus and blood mixed with heat. (Formula see Miscellaneous Treatments.)

Vomiting after eating belongs to Yangming. Wuyu Tang is the primary formula. Formula: Wuzhuyu (one sheng), Renshen (three liang), Shengjiang (six liang, sliced), Dazao (12 pods, broken). Boil these four ingredients in seven sheng of water to obtain two sheng. Strain and take seven ge warm, three times daily. If symptoms worsen after taking the decoction, the pathology is in the Upper Jiao.

In Yangming disease, if the Cun Kou pulse is slow, Guan pulse slightly floating, and Chi pulse weak, with fever, sweating, and aversion to cold, no vomiting, but only epigastric stuffiness, this is due to erroneous purgation by the physician. If not purged, and the patient has no aversion to cold but thirst, it transfers to Yangming. Frequent urination leads to hard stool. Ten days without bowel movement causes no distress. If thirsty for water, provide it. To relieve thirst properly, use Wu Ling San. (Formula see Pishi Treatment section.)

If the Yang pulse is micro and sweating is scanty, bowel movements are normal. Profuse sweating is excessive. Excessive sweating causes Yang depletion internally and fluid loss, leading to hard stool.

If the pulse is floating and Kou (hollow), floating indicates Yang, Kou indicates Yin. Their interaction generates heat in the Stomach Qi, leading to Yang depletion.

The Zuyang pulse is floating and choppy. Floating indicates strong Stomach Qi; choppy indicates frequent urination. Their interaction leads to hard stool and Spleen Constraint (Pi Yue). Maziren Wan is the primary formula. Formula: Maziren (two sheng), Shaoyao, Zhishi (roasted, each eight liang), Dahuang (one jin), Houpo (one chi), Xingren (one sheng, peeled, double-kernel, roasted, made into paste). Mix these six ingredients with honey into pills the size of wutong seeds. Take ten pills with water, three times daily, gradually increasing until effective.

In Shanghan, inducing sweating causes jaundice of the body and eyes due to cold-dampness binding internally. For Shanghan with jaundice, Zhizi Bopi Tang is the primary formula. Formula: Zhizi (15 pods, broken), Gancao, Huangbai (15 fen). Boil these three ingredients in four sheng of water to obtain two sheng. Strain and divide into two warm doses.

In Shanghan with stagnant heat in the interior, the body becomes yellow. Mahlian Qiao Chixiaodou Tang is the primary formula. Formula: Mahuang (deprived of nodes), Lianqiao (each one liang), Xingren (30 seeds, peeled), Chixiaodou (one sheng), Dazao (12 pods, broken), Shengzi Baipi (sliced, one jin), Gancao (two liang, roasted). Alternative: Shengjiang (two liang, sliced). Boil these seven ingredients in ten sheng of water. First boil Mahuang for one or two boils, remove foam. Add remaining herbs and boil to obtain three sheng. Strain and take one sheng warm.