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Zhengyang Yangming (Positive Yang Brightness Syndrome) does not discuss "Wei Shi" (Stomach Excess), but rather "Wei Jia Shi" (Excess in the Stomach Family). What is the significance of "Wei Jia" (Stomach Family)? Chinese people have a strong concept of "family" (Jia, meaning household/family unit), and almost everyone can explain its meaning. If you are single, even if you live in a 100-square-meter apartment with three bedrooms and two living rooms, this cannot be called a "family"; returning there would only mean going back to your dormitory, not going home. Therefore, to establish a family, at least two people are needed, such as a couple or a family of three; of course, in the past, families could consist of more than ten members. Zhang Zhongjing's use of "Wei Jia" here clearly indicates that, besides the stomach, there must be other factors and other members. Otherwise, it could not be termed "Wei Jia." Thus, "Wei Jia Shi" in Yangming disease, apart from the stomach, must at least include the intestines. Otherwise, one would be unable to understand clauses such as "there must be five or six dry stools in the stomach," which would make one a laughingstock.

③ Shi (Excess/Fullness)

What does "Shi" (Excess) mean in "Wei Jia Shi"? Here, "Shi" has two meanings. The *Suwen: Tong Ping Xu Shi Lun* states: "When pathogenic qi is abundant, it is Shi (Excess); when essential qi is depleted, it is Xu (Deficiency)." Abundant pathogenic qi is called Shi, while depleted essential qi is called Xu. Does "Wei Jia Shi" here refer to this meaning? Most predecessors held this view. When a disease develops to the Yangming stage, pathogenic qi is abundant, and essential qi is not yet deficient; thus, "Wei Jia Shi" should refer to the abundance of pathogenic qi. This explanation is reference-worthy but incomplete. The *Guangyun* defines Shi as: "True/Sincere, Full." The *Zengyun* defines it as: "Replete, the opposite of Empty." Therefore, Shi also implies fullness, repletion, and opposition to deficiency, collectively meaning solid/fullness. Which of the two meanings of Shi is more accurate and precise? Let us look at the first meaning: abundant pathogenic qi. This discusses from the perspective of etiology (cause). If we view "Wei Jia Shi" from an etiological perspective, it obviously does not fit. Why? Because the outline clauses of the Six Channels all discuss syndromes (manifestations), focusing on effects/outcomes. For example, Taiyang disease features floating pulse and stiffness/pain in the head and neck; Shaoyang disease features bitter taste, dry throat, and vertigo; Taiyin disease features abdominal fullness with vomiting and inability to eat; Shaoyin disease features faint and fine pulse and desire to sleep; Jueyin disease features excessive thirst and Qi rushing up to the heart. These all describe syndromes/effects, seeking causes from outcomes. Why would Yangming be an exception? Therefore, interpreting "Wei Jia Shi" as the first meaning (abundant pathogenic qi) contradicts logic. It should still describe a syndrome/effect. Thus, from the perspective of fullness/repletion, the second meaning seems more accurate and logical. The *Suwen: Wu Zang Bie Lun* states: "The Six Fu organs transmit and transform substances without storing, hence they become Shi (full/excess) but not Man (replete/full of essence); the Five Zang organs store essence and Qi without draining, hence they become Man (replete) but not Shi (excess/solid)." It further states: "The Six Fu organs alternate between Xu and Shi; when the stomach is Shi, the intestines are Xu, and when the intestines are Shi, the stomach is Xu." The Five Zang organs store essence and Qi without draining, so they can only be Man (replete) but not Shi (solid/excess). The Six Fu organs transmit and transform substances without storing, playing a main role in conduction, so they can only be Shi (solid/excess) but not Man (replete). It is normal for the Six Fu organs to be Shi but not Man. The Stomach is the master of the Six Fu organs; thus, "Wei Jia Shi" discussed here seems consistent with the "Six Fu Shi" mentioned in the *Suwen: Wu Zang Bie Lun*. Consistency implies normality. Why do Clause 179 and subsequent Yangming pathogenesis clauses treat "Shi" as pathology? The subtlety lies in Zhang Zhongjing's use of the character "Jia" (Family). As discussed earlier, "Jia" requires at least two members. Thus, using "Wei Jia" clearly implies more than just the stomach; it at least includes the intestines. Only when the stomach and intestines are combined can they be called a "Jia." Therefore, "Wei Jia Shi" becomes "Intestine Shi and Stomach Shi," fundamentally breaking the normal physiological pattern of "alternating Shi and Xu" described in the *Suwen: Wu Zang Bie Lun* ("when the stomach is Shi, the intestines are Xu..."). Once the normal physiological pattern is broken, it is naturally a pathological state. In Chapters 1 and 5, we devoted considerable space to discussing the significance of classical texts. Classical texts are extremely cautious, with little room for arbitrariness. Predecessors said, "The placement of a single character is firm as a rock." Classical words are as solid as rocks, showing that this caution is no small matter. Take the character "Jia" above; isn't it firm as a rock? Having a "Jia" versus not having a "Jia" yields entirely different meanings. Having a "Jia" means disease, because both stomach and intestines are Shi. Not having a "Jia" means no disease; not having a "Jia" is the norm, where the stomach is Shi and the intestines are Xu. With this "placement of a single character, firm as a rock," naturally comes "the emergence of a single meaning, brilliant as stars."

④ Pathogenesis Formatting

Here, Zhengyang Yangming discusses "Wei Jia Shi," and the pathogenesis clause in Clause 180 below also discusses "Wei Jia Shi." This illustrates that a focal point of Yangming pathogenesis lies in "Wei Jia Shi." Just as the pathogenesis of Heart disease in the Five Zang focuses on "pain and itching," the pathogenesis of Yangming disease in the Six Channels focuses on "Wei Jia Shi." "Wei Jia Shi" is the effect/outcome; Zhengyang (positive Yang), i.e., Fire-Heat, is the cause; and Yangming is the mechanism. Cause, mechanism, and outcome are interconnected yet have different emphases; they must be integrated but not confused. If we format the generally recognized Yangming disease outline clause into a pathogenesis formula, it can be written as "All Wei Jia Shi belong to Yangming." The discussion of Zhengyang Yangming and the Yangming outline clause ends here.

4. Shaoyang Yangming

(1) Treatment Methods of the Three Yang

"Shaoyang Yangming refers to cases where, after sweating and promoting urination, dryness, vexation, excess in the stomach, and difficulty in defecation occur." Under the premise of Shaoyang Yangming, the mention of sweating and promoting urination indicates that these methods are associated with the development of Shaoyang Yangming. Why do sweating and promoting urination lead to dryness, vexation, and excess in the stomach? Why do they lead to the difficulty in defecation characteristic of Shaoyang Yangming? Obviously, treatment methods like sweating and promoting urination are not suitable for Shaoyang disease. This prompts us to understand and reflect on the differences in treating the Three Yang diseases.

① Treatment Methods of Taiyang Disease

The treatment methods for Taiyang disease mainly involve sweating and promoting urination, along with emesis. Sweating primarily targets Taiyang channel syndromes and exterior syndromes, corresponding to the treatment method described in the *Suwen: Yin Yang Ying Xiang Da Lun*: "For those with pathogenic factors, soak the body to induce sweat; for those in the skin, induce sweat to release them." Representative formulas are Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction). Promoting urination primarily targets Taiyang fu-organ syndromes; promoting urination is a good method for unblocking Yang. As Ye Tianshi said: "Unblocking Yang does not lie in warming, but in promoting urination." Thus, promoting urination is not only a method of "drawing out and exhausting" but also includes the method of "sweating to release." Additionally, emesis is also a treatment method for Taiyang disease. From the perspective of lesion site, the location of Taiyang disease is not only exterior but also high and upper, which is very important. As stated in the aforementioned discourse: "For those high up, induce vomiting to expel them." Emesis is such an "expelling method." Its representative formula is Goudi San (Melon Seed Powder) from the Taiyang chapter. In Chapter 1, I introduced the old TCM practitioner Mr. Zeng Rongxiu. He told me about his personal experience. More than ten years ago, he suffered from trigeminal neuralgia, which was excruciating, making him want to bang his head against the wall. No medicine worked. Mr. Zeng used to smoke heavily and had much phlegm, coughing up sputum every morning. However, since developing trigeminal neuralgia, his phlegm suddenly decreased, and there was no sputum to cough up in the morning. This change prompted Mr. Zeng to ponder: smoking continued, diet unchanged, where did the phlegm go? It must have moved to the trigeminal nerve. Phlegm blocked the meridians in the area innervated by the trigeminal nerve, causing pain due to "blockage leading to pain." Yes! It must be this problem. How to draw out the phlegm? Mr. Zeng adopted Zhang Xichun's method, stimulating the Tian Tu (CV 22) acupoint to induce vomiting. He vomited half a chamber of sticky sputum. After the phlegm was expelled, the headache immediately subsided. After inducing vomiting a few more times, the pain never recurred. Everyone knows trigeminal neuralgia is a stubborn disease. Although many imported Western medicines exist, their efficacy is still unsatisfactory. Some patients, with no other option, resort to surgery to cut the nerve root. Cutting nerves to relieve pain is indeed not a good method. Such a stubborn disease was cured by emesis in minutes, costing nothing. Thus, some TCM treatment methods are truly not to be underestimated. They may seem rustic, but they effectively solve problems. In summary, the treatment methods for Taiyang disease—whether sweating, promoting urination, or emesis—are all open methods, which correspond well with the characteristic of Taiyang governing opening.

② Treatment Methods of Yangming Disease

The treatment methods for Yangming disease have traditionally been summarized as clearing and purging. Clearing methods mainly refer to those encompassed by Baihu Tang (White Tiger Decoction); subdivided, clearing methods should also include Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) and Zhu Ling Tang (Polyporus Decoction). Purging methods are represented by the Three Chengqi Decoctions (Chengqi Formulas). However, according to Zhang Zhongjing himself, purging methods have strict distinctions. Among the Three Chengqi Decoctions, only Dachengqi Tang (Major Order the Qi Decoction) can be called a purging method and is the representative formula for purging. Zhang Zhongjing does not call Xiaochengqi Tang (Minor Order the Qi Decoction) a purging method but rather a harmonizing method. For example, Clause 208 states: "Yangming disease, pulse slow, although sweating occurs and there is no aversion to cold, the body is heavy, shortness of breath, abdominal fullness, and wheezing. If there is tidal fever, the exterior is likely resolved, and interior attack is possible. If sweat persists on the hands and feet, the stool is already hard; Dachengqi Tang governs. If sweat is profuse, with slight fever and aversion to cold, the exterior is not resolved; if fever is not tidal, Chengqi Tang should not be given. If abdominal fullness and obstruction are severe, Xiaochengqi Tang may be given to slightly harmonize stomach Qi, preventing excessive purging." Similarly, Clause 209 states: "...If fever occurs later, the stool will likely become hard again but in smaller amounts; harmonize with Xiaochengqi Tang." And Clause 250 states: "Taiyang disease, after vomiting, purging, or sweating, if there is slight vexation, frequent urination, and hard stool, give Xiaochengqi Tang to harmonize and cure." From these clauses, it is known that Zhang Zhongjing used Xiaochengqi Tang originally for harmonizing, not purging; thus, Xiaochengqi Tang should be the representative of harmonizing methods, not purging. Then there is Tiaoweichengqi Tang (Regulate the Stomach Order the Qi Decoction). Zhang Zhongjing also does not call this a purging method; the post-prescription note says: "Take warm in one dose to regulate stomach Qi." Thus, as its name suggests, the purpose of Tiaoweichengqi Tang is to regulate the stomach; it is a stomach-regulating agent, not a purgative. Reviewing these three formulas, all mention "Chengqi" (Order the Qi). What Qi do they order? Naturally, the Qi of Wei Jia (Stomach Family). The Qi of Wei Jia follows descending and unblocking; therefore, all three formulas have the function of descending and unblocking. However, the degree of this descending/unblocking differs, leading to different names for the treatment methods. At the degree of Tiaoweichengqi Tang, its function is regulating stomach Qi; at the degree of Xiaochengqi Tang, its function is harmonizing stomach Qi; and at the degree of Dachengqi Tang, it becomes a purgative and attacking agent. Therefore, different degrees of "Chengqi" and descending/unblocking result in completely different functions and treatment names. Thus, mastering this degree becomes a key technical issue. Looking at the post-prescription notes of the Three Chengqi Decoctions: Tiaoweichengqi Tang is "Take warm in one dose to regulate stomach Qi." Dachengqi Tang is "Divide into two warm doses; if stool passes, stop taking the remainder." Xiaochengqi Tang is "After the first dose, expect bowel movement; if not, drink the rest. If bowel movement occurs, do not take the rest." Among the three, Tiaoweichengqi Tang mentions neither purging nor bowel movement, only "regulating stomach Qi"; Dachengqi Tang explicitly says "stool passes"; Xiaochengqi Tang says "expect bowel movement." "Bowel movement" (Gengyi, changing clothes) is a euphemism; ancients did not say "defecate" or "poop," but "change clothes" to imply the act. Thus, "Gengyi" refers to normal bowel movements. If normal, smooth bowel movements cease, Xiaochengqi Tang should be used; after taking it, bowel movements will normalize. Therefore, "Gengyi" and "stool passes" differ significantly. From these three post-prescription notes, we see that Zhang Zhongjing's wording was precise, leaving no ambiguity. The distinctions here are based on rigorous theory and logic, as well as solid clinical practice. Here we feel again the "placement of a single character, firm as a rock."

③ The Six Fu Organs Function Through Unblocking

Above, we discussed the sweating, promoting urination, and emesis methods of Taiyang, and the purging, harmonizing, regulating, and clearing methods of Yangming. Among these treatments, sweating unblocks the interstices and pores; promoting urination opens Qi transformation and benefits the Bladder; emesis vents the Upper Jiao; and purging, harmonizing, and regulating methods focus on the descending and unblocking of Wei Jia. Although these methods differ, none depart from the character "Tong" (Unblocking/Flowing). One can say these methods revolve around "Tong." The method of "Tong" is essentially the standard treatment for the Six Fu organs, because the Six Fu organs function through unblocking. Only by restoring the common function of the Six Fu organs can their role of transmitting and transforming substances without storing be realized. Therefore, the treatment methods for Taiyang and Yangming are essentially unblocking methods, targeting the Six Fu organs.

④ Shaoyang Does Not Primarily Govern Unblocking

At the beginning of "Shaoyang Yangming," we discussed that sweating and promoting urination are not suitable for Shaoyang disease. Now, turning to the Shaoyang chapter, we find that Shaoyang disease cannot be treated with sweating, promoting urination, emesis, or purging. Sweating, emesis, purging, and promoting urination are all unblocking methods, used in Taiyang and Yangming because the Six Fu organs function through unblocking. Why must these "unblocking" methods be forbidden for Shaoyang? Does Shaoyang not need to function through unblocking? Shaoyang governs the pivot mechanism and belongs to the Gallbladder among the Six Fu organs. Besides the attribute of being a Fu organ, the Gallbladder has another special attribute, specifically noted in the *Suwen: Wu Zang Bie Lun*: "Brain, marrow, bones, vessels, Gallbladder, and uterus—these six are generated by Earth Qi, all stored in Yin and resembling Earth, hence they store without draining, named Strange-Fu Organs (Qi Heng Zhi Fu)." Fu organs are supposed to drain without storing; since they drain without storing, they must function through unblocking. Imagine if the Six Fu organs were blocked, how could they drain without storing? Thus, unblocking methods are indeed the standard treatment for the Six Fu organs. Now, the other attribute of the Gallbladder tells us it stores without draining. Fu organs should drain without storing, while storage organs should store without draining. Now, reversed, the Fu organ acts like a storage organ. A Fu organ performing storage functions—isn't that strange? Indeed, rare! Hence it is called a "Strange-Fu Organ." Since it stores without draining, "unblocking" methods cannot be used. Therefore, the sweating, emesis, purging, and promoting urination methods applicable to the Six Fu organs cannot be used in the treatment of Shaoyang disease. Misuse will cause problems. The "dryness, vexation, excess in the stomach, and difficulty in defecation" of Shaoyang Yangming is one end of the consequences of misusing the aforementioned methods. Therefore, in treating Shaoyang disease and the Gallbladder, one must fully consider the characteristics of this Strange-Fu organ, specifically its nature of storing without draining. This characteristic of the Gallbladder as a Strange-Fu organ is visible everywhere in clinical practice. For example, there is a significant difference in the difficulty of treating gallbladder/liver system stones versus urinary system stones. Urinary stones are often easier to treat because unblocking and promoting methods can be fully utilized. In contrast, gallbladder/liver stones are harder to treat. Why? Because within the system of Strange-Fu organs, it is difficult to achieve efficacy with unblocking and promoting methods. For stones, if unblocking methods cannot be used or are unsuitable, what other methods are available?

III. Timing of Yangming Disease Resolution

This section's explanation is mainly based on Clause 193: "Yangming disease resolves from Shen to Xu hours."

1. From Shen to Xu Hours