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Yang Qi alone becomes hyperactive, while Yin Qi suddenly declines. Yin is overcome by Yang, resulting in a state where both the interior and exterior are dominated by Yang, thus forming Yang Du (Yang Toxin) Shanghan (Cold Damage). Some patients develop Yang Du immediately upon contracting the disease; others, after taking herbal decoctions, fail to recover after five or six days and instead transform into Yang Du. This occurs because the disease fundamentally belongs to Yang patterns, or due to forced sweating via fire therapy, or stimulation from moxibustion, causing Yang Qi to become even more excessive and Yin Qi to dissipate internally. Clinical manifestations include: flushed face, restlessness, mania with running about, delirious speech, skin eruptions resembling brocade patterns, sore throat, purulent blood in nasal discharge and saliva, or diarrhea with yellow-red stools. The pulse is characterized as洪 (Surging), 实 (Full), 滑 (Slippery), and 促 (Rapid with intermittent pauses).

The verse states: When Yang Du is deep, the pulse is Surging; heat binds within and outside, the tongue coating is scorched black, and the nostrils appear soot-like. The water immersion method (cold wet compress) is suitable.

In Shanghan (Cold Damage), if Yang Du forms within one or two days, or transforms into Yang Du after emesis or purgation following medication, symptoms include heavy body, back pain, mental distress and uneasiness, delirium, running about, hallucinations of seeing ghosts, hematemesis, or diarrhea with red-yellow stool. The pulse is Floating, Large, and Rapid. The face is red with mottled eruptions like brocade, the throat hurts, and pus-blood is expectorated. It is treatable within five to six days, but difficult to cure by the sixth or seventh day. For Yang Du, Shengma Tang (Cinnamon Twig and Cimicifuga Decoction) is the primary formula. If there is a sore throat, Xuanshen Shengma Tang (Scrophularia and Cimicifuga Decoction) is used. In severe cases, patients may exhibit behaviors such as climbing walls or roofs. If the pulse is Wiry, Surging, Rapid with intermittent pauses, and Rapid, accompanied by fever and absence of sweat, Shengma Tang is also indicated. Other options include Tingli Kujiu Tang (Descurainia Seed and Vinegar Decoction), Dahuang Tang (Rhubarb Decoction), Zhizi Ren Tang (Gardenia Seed Decoction), Heinu Wan (Black Slave Pill), and Taiyi Niuhuang Gao (Taiyi Calculus Bovis Ointment, taken with Zhuye Tang (Bamboo Leaf Decoction)). Alternatively, grind three large earthworms (Dilong), add ginger juice, mint juice, raw honey, and a small amount of Borneolum Syntheticum (Naozi), mix with fresh well water, and administer orally. These methods aim to restore Yin Qi, allowing resolution through profuse sweating. For Yang Du with high fever, thirst, delirium, red macules, and persistent epistaxis, one dose of Baihu Tang (White Tiger Decoction) is effective. If Yang Du is deep, with a Surging pulse, internal-external heat binding, curled black tongue, and soot-like nostrils, use fresh well water to soak multiple layers of cloth, apply to the chest, and continuously replace with cold soaked cloth until the heat subsides slightly, then stop.

*Ben Shi Fang* records: Moxibustion for Jie Xiong (Chest Binding), using seven seeds of Crotonis Fructus (Badou) and seven cun of Coptidis Rhizoma (Huanglian), ground fine, mixed with saliva into a paste, applied to the umbilicus, and moxibusted above without limiting the number of cones. Effectiveness is indicated by bowel sounds in the abdomen. After moxibustion, wipe clean with warm damp cloth to prevent ulceration. This method, along with Ji Yan Shen Gong San, can be used for Yin-Yang Er Du (Yin and Yang Toxins) provided there is faint vital energy. If sound is heard at the umbilicus, sweating will resolve the condition.

Sun Yonghe, Imperial Physician, created Po Jie Dan (Breaking Knots Pill) to treat inverted stagnation of Yin and Yang Qi transforming into Jie Xiong. After five to six days, if stool is dry and hard, making purgation ineffective and ventilation impossible, this formula is used. Ingredients: Chen Sha (Cinnabar), Silver Foil, Qing Meng Shi (Mica), Bei Ting Zhi (Litharge?), Rou Dou Kou (Nutmeg), Mu Xiang (Aucklandiae Radix), Guan Gui (Cassia Bark), Qian Niu Zi (Pharbitidis Semen), Sheng Hei Fu Zi (Raw Black Aconite Root, processed), Ba Dou Rou (Croton Seed flesh, oil not removed), each half liang; Qing Fen (Calomel), half fen; She Xiang (Moschus), half qian; Jin Bo (Gold Foil), five sheets. Take half sheng of aged vinegar, boil Chen Sha, Fu Zi, and Qian Niu Zi into a paste, then add remaining herbs, mix well, and form pills the size of soap pods, coated with Qing Fen. Take two pills per dose, washed down with honey water.

Yang patterns presenting as Yin cold: cold limbs, deep pulse, red urine, loose stool, flushed face, irritability, slight fever. Yin patterns presenting as Yang deficiency: deeper and weaker deep pulse, extreme Yin causes dryness, extreme heat causes厥 (Jue - collapse/convulsion), things reverse when they reach extremes. Extreme Yang must transform into Yin, extreme Yin into Yang; this is the variation of cold and heat. Cold limbs, red urine, constipation, or black stool, closed eyes, sluggish speech/movement, deep and Slippery pulse is called "Yang pattern resembling Yin". Flushed face, irritability, slight fever, closed eyes with fever, deep and weak pulse is called "Yin pattern resembling Yang". To confirm, trace back to the root, observe complexion, listen to voice, differentiate by Six Channels, and refer to external signs. Calmly verify via pulse. Rapid pulse indicates heat, slow pulse indicates cold; Yin and Yang are distinguished. Yang nature is light, Yin nature is heavy. Yin disease pulses are heavy, Yang disease pulses are light. Yang excess brings quietness during the day, Yin excess brings peace at night; Yang deficiency brings chaos at dusk, Yin deficiency brings struggle at night. Yang pattern resembling Yin uses Baihu Tang; extreme heat generating cold causes cold limbs, use Chengqi Tang. Yin pattern resembling Yang uses Sini Tang plus Cong Bai (Green Onion White). Yin excess causes dryness, lower deficiency causes facial flushing, interior cold causes slight fever. Yin excess repelling Yang presents with thin, deep, rapid pulse, cold body, extreme irritability, desire to lie in mud/water, desire to drink but unwillingness to swallow. Those who want to drink are different. Pili San (Thunderbolt Powder), Shaoyan San (Little Flame Powder), Dansha Wan (Cinnabar Pill) are effective. Sun Yonghe used one half-liang Hei Fu Zi (Black Aconite), roasted to retain properties, cooled and powdered, mixed with one qian of Zhen La Cha (True Lhasa Tea), divided into two doses. Each dose boiled with one sheng water and half spoon honey to six parts, taken cold. Cessation of irritability, sleep, and sweating indicate efficacy. Yang patterns include Taiyang, Yangming, Shaoyang. Taiyang corresponds to Bladder, symptoms: fever, aversion to cold, headache, back pain, Floating pulse. Yangming corresponds to Stomach, no aversion to cold, aversion to heat, sweating, constipation, tidal fever, Long pulse. Shaoyang corresponds to Gallbladder, bitter taste, dry throat, hypochondriac fullness, fever with vomiting, alternating chills and fever, Wiry pulse. Mahuang Tang (Ephedra Decoction), Da Qinglong Tang (Major Green Dragon Decoction), Guizhi Tang (Cinnamon Twig Decoction) treat Taiyang channel Wind-Cold. Da Chaihu Tang (Major Bupleurum Decoction), Tiao Wei Chengqi Tang (Regulate Stomach and Order the Qi Decoction), Xiao Chengqi Tang (Minor Order the Qi Decoction), Da Chengqi Tang (Major Order the Qi Decoction) treat Yangming Shanghan. Xiao Chaihu Tang (Minor Bupleurum Decoction) treats Shaoyang Shanghan. Other formulas address post-emetic/purgative conditions. If Yang Qi alone is excessive and Yin Qi abruptly ceases, it is Yang Du, manifesting as manic running, delirium, flushed face, sore throat, brocade-like rashes, or red-yellow diarrhea, with Surging/Full or Slippery/Rapid pulses. Use sour-bitter drugs to restore Yin and resolve via sweating. Ancients said: Sour and bitter induce vomiting and purgation, belonging to Yin. Ku Shen (Sophorae Root), Da Qing (Isatidis Folium), Ting Li (Descurainiae Semen), Ku Jiu (Vinegar) can restore Yin Qi. Mild heat uses bitter drugs; severe heat combines sour and bitter to reduce heat and restore Yin. If extreme heat causes Jue, resembling Yang pattern, differentiate by pulse.

Formulas:
Shengma San (Cimicifuga Powder): Treats Shanghan becoming Yang Du on day one, or after emesis/purgation with unresolved toxin, heavy body, stiff back, distress, delirium.
Chuan Shengma, She Gan (each 1 liang), Dang Gui (crushed, lightly fried), Xi Jiao Xie (Rhinoceros Horn powder), Gan Cao (roasted red, crushed, 0.5 liang), Huang Qin, Huang Lian (devoid of stamens), Di Gu Pi (each 3 qian). Grind and sieve into powder. Take 4 qian per dose, boil in one zhong zhan water to 6 parts, strain, take anytime.

Maimen Dong San (Ophiopogon Powder): Treats Yang Du Shanghan, body pain, head/face like fire, chest/heart distress, heat, thirst, red-yellow urine, insomnia.
Maimen Dong (devoid of heart, baked), Ge Gen (crushed), Chai Hu (devoid of seedling), Chi Shao Yao, Zhi Mu, Ma Ya Xiao (each 1 liang), Zi Qin, Xuan Shen, Gan Cao (roasted red, crushed, 3 qian), Chuan Shengma, Xi Jiao Xie (each 0.5 liang). Grind and sieve. Take 4 qian, boil in one zhong zhan water to 6 parts, strain, take warm anytime.

Xi Jiao San (Rhinoceros Horn Powder): Treats Yang Du Shanghan, delirious running, flushed mottled face, dry/sore throat, chest/heart distress, limb stiffness, red-yellow urine.
Xi Jiao Xie, Gan Cao (roasted red, crushed, 0.5 liang each), She Gan, Chuan Da Huang (crushed, lightly fried), Huang Qin (3 qian each), Chai Hu (devoid of seedling), Chuan Shengma, Chuan Mang Xiao, Maimen Dong (devoid of heart, baked, 1 liang each). Coarsely grind and sieve. Take 4 qian, boil in one zhong zhan water with 37 bamboo leaves and 50 wheat grains to 6 parts, strain, take warm anytime.

Shi Gao San (Gypsum Powder): Treats Yang Du Shanghan, high fever headache, heavy limbs, dry mouth, restless heart.
Shi Gao (1 liang), Zhi Mu, Chai Hu (devoid of seedling), Ma Huang (devoid of roots), Gan Cao (roasted red, crushed), Huang Qin, Chi Shao Yao, Fang Feng (devoid of rhizome), Chi Fu Ling, Chuan Shengma, Gan Ju Hua (above each 0.5 liang). Grind and sieve. Take 4 qian, boil in one zhong zhan water to 6 parts, strain, take warm anytime.

Da Huang San (Rhubarb Powder, from *Huoren Shu*): Treats unresolved Yang Du Shanghan, internal heat binding,恍惚 (trance-like) madness.
Chuan Da Huang (1.5 liang, crushed, lightly fried), Gui Xin (3 qian), Chuan Mang Xiao (2 liang), Gan Cao (roasted red, crushed), Mu Tong (crushed), Da Fu Pi (crushed, 1 liang each), Tao Ren [20 seeds, soaked in water, peeled, kernels double, bran-fried lightly]. Coarsely grind and sieve. Take 4 qian, boil in one zhong zhan water to 6 parts, strain, take warm anytime. Stop when bowels move.

Di Gu Pi San (from *Shenghui Fang*): Treats Yang Du Shanghan, dizziness, heavy body, dry throat/lips, red cheeks, delirious running, chest fullness, vomiting.
Chai Hu (1 liang, devoid of seedling), Di Gu Pi, Mu Xiang, Ma Huang (devoid of roots/joints), Gan Cao (roasted red, crushed), Chuan Shengma, Gua Lou Gen, Ren Shen (devoid of rhizome), Chi Fu Ling, Mu Tong (crushed, above each 0.5 liang). Coarsely grind and sieve. Take 4 qian, boil in one zhong zhan water to 6 parts, strain, take warm anytime.

Chai Hu San (aka Zhizi Ren Tang, from *Huoren Shu*): Treats Yang Du Shanghan, high fever, joint pain.
Chai Hu (1.5 liang, devoid of seedling), Chuan Shengma, Huang Qin, Shi Gao, Xing Ren [soaked, peeled, double kernel, bran-fried, above each 3 liang], Chi Shao Yao, Da Qing, Zhi Mu, Zhizi Ren (1 liang each), Gan Cao (0.5 liang, roasted red, crushed). Coarsely grind and sieve. Take 4 qian, boil in one zhong zhan water with half liang ginger and 100 fermented soybeans to 6 parts, strain, take anytime.

Guizhi Mahuang San (from *Shenghui Fang*): Treats Yang Du Shanghan, sweating on neck/back, stiffness, aversion to wind.
Guizhi, Ma Huang (devoid of roots/joints), Gan Cao (roasted red, crushed), Chi Shao Yao, Ge Gen (crushed), Xing Ren [soaked, peeled, double kernel, bran-fried, 1 liang each]. Grind and sieve. Take 4 qian, boil in one zhong zhan water with half liang ginger to 6 parts, strain, take hot anytime, cover with clothes to sweat. If no sweat after walking ten li, repeat. Later feed green onion and fermented bean porridge.

Baihu Tang (from *Sanyin Fang*): Treats Yang Du Shanghan, after Guizhi Tang caused profuse sweating, great thirst, unresolved irritability, Surging pulse.
Zhi Mu, Gan Cao (roasted red, crushed, 1 liang each), Ma Huang (2 liang, crushed), Jing Mi (1 he). Finely crush, boil in two large zhong zhan water until rice is cooked, strain, take warm in three doses anytime.

Treats Yang Du Shanghan, strong heat in four limbs, chest/heart irritability, incessant vomiting. (From *Shenghui Fang*)
Chai Hu (devoid of seedling), Huang Qin, Ren Shen (devoid of rhizome), Gan Cao (roasted red, crushed), Maimen Dong (devoid of heart, baked, 1 liang each), Ban Xia (0.5 liang, soaked in water seven times, washed to remove slipperiness). Coarsely grind and sieve. Take 4 qian, boil in one zhong zhan water with 37 bamboo leaves and half liang ginger... (text cuts off).

Gua Lou San (from *Shenghui Fang*): Treats Yang Du Shanghan after five-six days, chest heat, dry retching.
Gua Lou, Chai Hu (devoid of seedling), Zhi Mu, Huang Qin, Gan Cao (roasted red, crushed, 1.5 liang each), Lu Gen (2 liang, crushed). Grind and sieve. Take 4 qian, boil in one zhong zhan water with half liang ginger to 6 parts, strain, take warm anytime.

Gan Cao San (from *Shenghui Fang*): Treats Yang Du Shanghan, Surging pulse, palpitations.
Gan Cao (roasted red, crushed), Gui Xin, Fu Shen, Ren Shen (devoid of rhizome), E Jiao (crushed, fried yellow-dry), Maimen Dong (devoid of heart, 1 liang each), Sheng Gan Di Huang, Ma Huang (devoid of roots/joints, 2 liang each). Grind and sieve. Take 4 qian, boil in one zhong zhan water with half liang ginger to 6 parts, strain, take warm anytime.

Huang Qin San (from *Shenghui Fang*): Treats Yang Du Shanghan, drowsy like drunk, heat/restlessness/thirst, bitter taste, dry tongue.
Huang Qin, Chuan Shengma, Chai Hu (devoid of seedling, 1 liang each), Shi Gao (2 liang), Chi Shao Yao, Maimen Dong (devoid of heart), Gan Cao (roasted red, crushed, 0.5 liang each). Grind and sieve. Take 4 qian, boil in one zhong zhan water to 6 parts, strain, take anytime.

Niuhuang Wan (Calculus Bovis Pill, from *Shenghui Fang*): Treats Yang Du Shanghan, heart irritability/distress, trance-like madness, unresolving heat.
Niuhuang (fine powder), Tian Zhu Huang (fine powder), Fang Feng (devoid of rhizome), Zhen Zhu (fine powder, above each 0.5 liang), Long Nao, Gan Cao (roasted red, crushed, 1 liang each), She Xiang (1 qian, fine powder), Xi Jiao Xie, Ling Yang Jiao Xie, Zhu Sha (fine powder, water-washed), Huang Qin, Chuan Shengma (1 liang each). Grind all to powder, mix thoroughly. Bind with refined honey, pound 300-200 times, form pills size of paulownia seeds. Take... (text cuts off).

Treats Yang Du Shanghan, heat/restlessness, constipation.
Chuan Da Huang (1 liang, crushed, lightly fried), Chuan Mang Xiao (0.5 liang). Grind and sieve, boil in one large zhong zhan water to 7 parts, strain, take warm in two doses anytime. Repeat after walking 5-7 li. Expect purgation of evil matter.

Treats Yang Du Shanghan, toxin in organs, delirium, desire to run/rise.
Long Dan (1 liang, devoid of rhizome), Tie Fen (2 liang). Grind fine and sieve. Take 1 qian anytime, mixed with knife-sharpening water.

Shengma San (from *Huoren Shu*): Treats Shanghan becoming Yang Du in 1-2 days, or after emesis/purgation. Back pain, distress, flushed face, delirium, running/hallucinations, diarrhea, Floating-Large-Rapid pulse, mottled red face, sore throat, pus-blood.
Shengma, Xi Jiao (shaved), She Gan, Huang Qin (devoid of black skin), Ren Shen, Gan Cao (roasted, crushed, 1 fen each). Six ingredients, cut like hemp seeds. Take 5 qian bi, boil in 1.5 sheng water to 8 parts, strain, take warm. Repeat after eating time. Cover warmly to sweat. If no sweat, repeat. Severe cases: Da Chengqi Tang, remove Hou Po, add Mu Tong, Gan Cao, Da Fu Pi, Tao Ren (1 liang each), stop when purged.

Xie Xin Tang (Heart-Purging Decoction, from *Shengji Zonglu*): Treats Yang Du Shanghan, headache/high fever, delirium, hallucinations.
Shi Gao (1 liang), Shao Yao, Ge Gen (crushed), Huang Qin (devoid of black heart, 0.5 liang each), Da Huang, Huang Lian (devoid of stamens, 3 qian each). Coarsely grind and sieve. Take 5 qian bi, boil in 1.5 sheng water with ginger (date-sized, smashed) to 8 parts, strain, take warm. Twice daily, anytime.

Shengma Tang (Cimicifuga Decoction, from *Shengji Zonglu*): Treats Yang Du Shanghan, back pain, distress, flushed face, delirious running/hallucinations, irregular diarrhea.
Shengma, Xiong Huang (vinegar-boiled, ground, 0.5 liang each), Dang Gui (cut, baked), Gui (devoid of rough bark, 1 liang each), Gan Cao [roasted, crushed, 2-3 fen], Bie Jia (vinegar-roasted, devoid of skirt, 1 liang). Coarsely grind and sieve. Take 5 qian bi, boil in 1.5 sheng water to 8 parts, strain, take warm. Twice daily, anytime.

Da Qing Tang (Isatis Decoction, from *Shengji Zonglu*): Treats Yang Du Shanghan, unresolved irritability, or diarrhea, critical condition.
Da Qing (2 liang), Qin Jiao (devoid of seedling/earth, 1 liang), Xi Jiao (shaved), Shan Zhi Zi Ren, Gan Cao (roasted, crushed), Huang Lian (devoid of stamens, 0.5 liang each). Coarsely grind and sieve. Take 5 qian bi, boil in 1.5 sheng water with 100 fermented soybeans and 7 cun Xie Bai to 8 parts, strain, take warm before meals.

Jie Yang Tang (Resolving Yang Decoction, from *Shengji Zonglu*): Treats Yang Du Shanghan, dry mouth/tongue.
Ma Huang (devoid of roots/joints), Ren Shen, Chi Fu Ling (devoid of black skin), Gui (devoid of rough bark, 0.5 liang each), Maimen Dong (devoid of heart, baked), Ge Gen (crushed, 3 qian each), Xing Ren (soaked, peeled, double kernel, fried), Gan Cao (roasted, crushed, 1 liang each). Coarsely grind and sieve. Take 5 qian bi, boil in 1.5 sheng water... (text cuts off).

Wu Jie Tang (Five-Resolving Decoction, from *Shengji Zonglu*): Treats Yang Du Shanghan, fever/irritability.
Shan Zhi Zi Ren, Huang Qin (devoid of black skin), Gan Cao (roasted, crushed), Da Huang (crushed, vinegar-fried, 1 fen each), Po Xiao (2 qian). Coarsely grind and sieve. Take 5 qian bi, boil in 1.5 sheng water to 8 parts, strain, take warm on empty stomach.

Xi Jiao Tang (Rhinoceros Horn Decoction, from *Shengji Zonglu*): Treats initial Yang Du Shanghan, high body heat, red eyes, yellow urine, chest oppression/headache, incessant thirst.
Xi Jiao (shaved, 1 liang), Ren Shen (3 qian), Chi Fu Ling (devoid of black skin), Yin Chen Hao, Xi Xin (devoid of seedling/leaf), Chen Pi (soaked, white part removed, fried), Ma Huang (devoid of roots/joints), Gan Cao (roasted, crushed, 0.5 liang each). Coarsely grind and sieve. Take 5 qian bi, boil in 1.5 sheng water with ginger (date-sized, smashed) to 8 parts, strain, take warm.

Ge Gen Tang (Pueraria Decoction, from *Shengji Zonglu*): Treats Yang Du Shanghan, unresolved headache/high fever, body pain.
Ge Gen (crushed), Long Dan, Da Qing (3 qian each), Gui (devoid of rough bark), Wei Rui, Shao Yao, Huang Qin (devoid of black heart), Shengma, Shi Gao (crushed), Ma Huang (devoid of roots/joints), Gan Cao (roasted, crushed, 0.5 liang each). Coarsely grind and sieve. Take 5 qian bi, boil in 1.5 sheng water with ginger (date-sized, smashed) to 8 parts, strain, take warm anytime.

Ge Gen San (Pueraria Powder, from *Shengji Zonglu*): Treats Yang Du Shanghan, body heat like fire, headache/dry thirst, sore throat.
Ge Gen (crushed, stir-fried three times), Shan Zhi Zi Ren, Huang Qin (devoid of black heart), Da Huang (crushed, vinegar-fried), Gan Cao (roasted, crushed, 0.5 liang each), Po Xiao (1 liang). Grind and sieve. Take 2 qian bi, anytime, take warm mixed with cooked water.

Qin Jiao Tang (Qin Jiao Decoction, from *Shengji Zonglu*): Treats Yang Du Shanghan, heart irritability/confusion, heat/restlessness/delirium, incessant dry mouth.
Qin Jiao (devoid of seedling/earth), Huang Qin (devoid of black heart), Gan Cao (roasted, crushed), Mu Tong, Zhi Ke (devoid of pulp, bran-fried), Xuan Shen (0.5 liang each).