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Ms. Yang, the wife of Physician Yang, was fifty-one years old. She had a robust and obese physique. In the spring of the Jiyi year, she suffered from dizziness and heaviness in the head and eyes, along with significant facial redness and heat. After taking medicines to clear the upper jiao without effect, she sought my treatment. Her pulse was surging (Hong) and forceful. The *Neijing* states: "Facial heat indicates disease of the Foot-Yangming channel." The *Maijing* states: "When Qi of the Yangming channel is excessive and surplus, the anterior aspect of the body becomes hot." Moreover, this person habitually consumed rich and sweet foods, leading to accumulated heat in the Stomach. The Yangming channel is abundant in blood and Qi; when the root is excess, wind-heat ascends. All Yang channels converge at the head, thus giving rise to the condition of facial heat. Initially, I administered Tiaowei Chengqi Tang (Regulate the Stomach and Order the Large Intestine Decoction) 7 qian, Huanglian (Coptidis Rhizoma) 2 qian, and Xijiao (Rhinocerotis Cornu) 1 qian to promote unblocking and purgation two or three times, thereby eliminating the root heat. Subsequently, Shengma Jia Huanglian Tang (Cimicifugae Decoction with Added Coptidis Rhizoma) was used to dispel wind-heat ascending through the collaterals. In this manner, both the root and branch pathogenic factors were resolved.

[Shengma Jia Huanglian Tang]
Shengma (Cimicifugae Rhizoma), Gegen (Puerariae Lobatae Radix) [each 1 qian]; Baizhi (Angelicae Dahuricae Radix), Huanglian (Coptidis Rhizoma) [each 0.7 qian]; Zhigancao (Glycyrrhizae Radix et Rhizoma Preparatum), Caodoukou (Amomi Fructus Rotundus), Renshen (Ginseng Radix et Rhizoma) [each 0.5 qian]; Heifu (Aconiti Lateralis Radix Praeparata) [processed, 0.7 qian]; Yizhi (Alpiniae Oxyphyllae Fructus) [0.3 qian].
The above nine herbs are cut into pieces. Prepare as one dose. Add three cups of water and the white parts of green onion roots (Congbai). Simmer until one cup remains, strain, and take warm. Several doses lead to good recovery.

Someone asked: "What is the basis for using Shengma Tang added with Huanglian to treat facial heat, and added with Fuzi to treat facial cold?" I replied: "It originates from Zhang Zhongjing. Yunqizi, in his commentary on the differentiation of Gegen Tang in Zhang Zhongjing's *Shanghan Lun*, stated: 'When both Cun and Chi pulses are long, it indicates disease of the Yangming channel. It should manifest after two or three days because the channel connects the nose and orbits the eyes; thus, there is body heat, eye pain, nasal dryness, and inability to lie down comfortably. This is disease of the Yangming channel.' The channel starts at the nose, meets at the forehead, and runs from the head to the feet along the anterior aspect of the body, representing the interior of the exterior. Yangming has heat at the branch and excess at the root. From the branch perspective, the pulse is floating and long; from the root perspective, it is deep and excess. Diseases of Yangming are characterized by steaming heat (Zhengzheng re), aversion to cold being absent. Body heat is the branch manifestation; Yangming root excess refers to dryness in the Stomach. Nasal dryness and eye pain are diseases of the muscle layer (the root of the muscles). Severe internal heat implies that if the pathology is at the 'root' (excess), sweating is contraindicated; inducing sweat may transform the condition into Jaundice. However, purgation is not contraindicated for root excess. Taiyang governs the exterior, which is Ying and Wei. Below Ying and Wei, the muscles belong to Yangming. When Taiyang and Yangming diseases occur simultaneously (Er Yang Bing), Gegen Tang is indicated. For Wei, Guizhi Tang is used; for Ying, Mahuang Tang is used. Within Ying and Wei, Guizhi Mahuang Ge Ban Tang is used. Below Ying and Wei, in the muscle layer, Gegen Tang is used, also known as Jiemi Tang (Muscle-Releasing Decoction). Thus, Yangming is the root of the muscles, and its treatment is not solely focused on inducing or stopping sweat. Combining Guizhi Tang and Mahuang Tang creates a unified formula; adding Gegen transforms it into Gegen Tang. Therefore, Ying/Wei and muscles have a hierarchical relationship. Guizhi, Shaoyao, Gancao, Shengjiang, and Dazao stop sweat; Mahuang, Guizhi, Gancao, and Shengjiang induce sweat. Gegen has a thin aroma and is added singly not to induce or stop sweat, but to release the muscles via Gegen, hence the name Gegen Tang. Qian Yi (Qian Zhongyang) formulated Shengma Tang to treat severe heat from wind-heat in Shanghan and Wenyi, headache, body ache, and eruptive diseases before or after eruption. He used Gegen as the Sovereign herb, Shengma as the Assistant herb, and Gancao and Shaoyao to stabilize the Middle Qi. Zhu Gongyi listed Shengma Tang in his *Huoren Shu* as a solution for the Yangming channel. In my diagnosis of Ms. Yang, since both the root and branch of Yangming were excess, I first attacked the interior, then drained wind-heat from the collaterals. Hence, I used Shengma Tang added with Huanglian, employing cold to treat heat. In contrast, Elder Ni presented with deficiency-cold in both root and branch of Yangming; I first fortified the interior, then regulated the collaterals, using Shengma Tang added with Fuzi, employing heat to treat cold. Zhang Zhongjing, the ancestor of all formulas, is indeed trustworthy."