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When the tongue coating appears slightly yellow, if this occurs at the onset of illness, the patient will exhibit delirious speech (delirium). This is caused by the failure to induce sweating, allowing exterior pathogens to penetrate inward. Treatment must employ simultaneous diaphoresis and purgation. The primary formula is Shuangjie San (Double-Release Powder) modified with Jiedu Tang (Detoxification Decoction).

[Commentary by Jie] A slightly yellow and thin tongue coating indicates that external pathogens have just entered the Yangming channel, still retaining exterior syndrome characteristics, accompanied by slight aversion to cold. Treatment should utilize acrid-cool dispersing methods. If the coating is yellow and dry, and the external symptoms show aversion to heat rather than aversion to cold, it signifies that pathogens have just entered the interior of Yangming, or that warm-heat pathogens are stirring internally attempting to emerge to the exterior of Yangming. Treatment should employ cooling methods to resolve interior heat. Therefore, whether in the case of exterior syndromes of wind-heat, warm diseases, or summerheat, or in Fu-organ syndromes where Cold Damage has transmitted to Yangming, the tongue coating will necessarily present as slightly yellow. If treatment is delayed, the yellow color will deepen from thin to thick, even becoming scorched yellow. External symptoms manifest as high fever, severe thirst, delirium, constipation, or anhidrosis, or spontaneous sweating. This is due to heat pathogens moving from the exterior to the interior. Treatment should combine diaphoresis and purgation, but must be supplemented with clearing heat, detoxifying, and cooling-dispersing agents. Since Shuangjie San contains acrid-warm ascending and dispersing herbs, Jiedu Tang is added to assist and harmonize. In treating such syndromes, medication must be carefully adjusted according to specific symptoms. If the tongue coating is yellow and dry, or develops prickles, accompanied by abdominal distension, fullness, hardness, and pain around the umbilicus, the treatment method should urgently employ purgation to preserve body fluids.

Shuangjie San (Double-Release Powder) Modified with Jiedu Tang (Detoxification Decoction)
Fangfeng (Saposhnikoviae Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix), Dahuang (Rhei Radix et Rhizoma), Mahuang (Ephedrae Herba), Lianqiao (Forsythiae Fructus), Mangxiao (Natrii Sulfas) (each 0.5 liang), Shigao (Gypsum Fibrosum), Huangqin (Scutellariae Radix), Jiegeng (Platycodonis Radix) (each 1 liang), Huashi (Talcum) (3 liang), Gancao (Glycyrrhizae Radix et Rhizoma) (2 liang), Jingjie (Schizonepetae Spica), Baizhu (Atractylodis Macrocephalae Rhizoma), Shanzhi (Gardeniae Fructus) (each 0.5 liang).

Crush the above ingredients. Take 1 liang per dose, add 1.5 zhong of water and 3 slices of ginger, decoct until 0.8 zhong remains, then administer. Time of administration is not restricted. Another version states the inclusion of Guizhi (Cinnamomi Ramulus) 2 liang.

[Commentary by Jie] Shuangjie San (Double-Release Powder) is essentially Fangfeng Tongsheng San (Wind-Protecting Universal Rescue Powder) without Mangxiao (Natrii Sulfas) and Dahuang (Rhei Radix et Rhizoma). This current formula contains Mangxiao and Dahuang but lacks Bohe (Menthae Haplocalycis Herba). It is named "Shuangjie San Modified with Jiedu Tang," presumably intending to double-release heat and toxins from both the exterior and interior. Wu Hegao stated: For releasing the exterior, there are Fangfeng (Saposhnikoviae Radix), Mahuang (Ephedrae Herba), Bohe (Menthae Haplocalycis Herba), Jingjie (Schizonepetae Spica), and Chuanxiong (Ligustici Chuanxiong Rhizoma); for resolving the interior, there are Shigao (Gypsum Fibrosum), Huashi (Talcum), Huangqin (Scutellariae Radix), Zhizi (Gardeniae Fructus), and Lianqiao (Forsythiae Fructus). Additionally, Danggui (Angelicae Sinensis Radix) and Shaoyao (Paeoniae Radix) harmonize the blood, while Jiegeng (Platycodonis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), and Gancao (Glycyrrhizae Radix et Rhizoma) regulate qi. When Ying (Nutritive Qi) and Wei (Defensive Qi) are harmonized, and both exterior and interior are unobstructed, it is called "double-release."