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The *Shanghan Lun* (Treatise on Cold Pathogenic Diseases) states: In Yangming disease, the pulse is floating and tight; there is dryness in the throat and bitterness in the mouth, abdominal fullness with panting, fever with sweating, aversion to cold is absent but aversion to heat is present, and the body feels heavy. If diaphoresis (sweating-inducing treatment) is erroneously applied, restlessness ensues, the heart feels confused and distressed, and delirium occurs; if burning needle therapy is added, frightfulness and palpitations will definitely occur, accompanied by irritability and insomnia; if purgation is erroneously applied, the stomach becomes empty and deficient, pathogenic qi moves to the diaphragm, causing mental depression and irritability (*ao nao*); if a coating appears on the tongue, *Zhizi Chi Tang* (Gardenia and Fermented Soybean Decoction) should be administered as the primary formula. If there is thirst desire to drink water, with dry mouth and parched tongue, *Baitu Jia Renshen Tang* (White Tiger Plus Ginseng Decoction) should be administered. If the pulse is floating, fever is present, thirst desire to drink water exists, and urination is difficult or obstructed, *Zhu Ling Tang* (Polyporus Decoction) should be administered.

Zhou Yuzai stated: Floating and tight pulses are characteristic of cold damage (*shanghan*). Why is this considered a heat disease? Because it originates in summer, where there is no aversion to cold but rather an aversion to heat. Furthermore, why is only the Yangming channel mentioned? Because in summer, damp-heat steams upward, and pathogens emerge from the Stomach; symptoms such as abdominal fullness and panting are all signs of Yangming disease. However, is not dry throat a sign of Shaoyin disease? It must be understood that Yangming is the pathway for pathogens to exit, while Shaoyin is the place where pathogens lie dormant. Since this is a Yangming heat disease, why does the pulse appear floating and tight? Precisely because in summer, the skin pores (*maocou*) are naturally open, and people sweat profusely; when wind pathogens invade, they cause the pores to close abnormally without sweating. Thus, the wind pulse in summer often resembles the cold pulse in winter. Now, regarding the case where sweating occurs yet the pulse remains floating and tight, this is precisely because the floating pulse is forceful, indicating abundant heat pathogens. Those who do not understand this may use acrid-warm diaphoretics, which consume essential fluids, inevitably leading to agitation, madness, and stupor. Fire-induced warm needles dry out Yin blood, inevitably causing alarm and sleeplessness. Purgation destroys Yin, inevitably leading to Stomach deficiency and pathogen sinking, resulting in mental distress (*ao nao*). These are all erroneous treatments; how can they be remedied? Observing a slippery coating on the tongue indicates that external pathogens remain; using Gardenia (*Zhizi*) to clear heat and Fermented Soybean (*Chidou*) to dispel pathogens is the correct method. If one desires to drink sweet liquids, with dry mouth and parched tongue, it is known that external pathogens have entered the interior; generally, *Baitu Tang* (White Tiger Decoction) is used, adding Ginseng (*Renshen*) because previous erroneous treatments have severely damaged essential fluids. Suppose the tight pulse disappears leaving only a floating pulse, with fever, thirst, and difficulty urinating; then the floating pulse indicates deficiency, and heat has entered the Bladder. Since heat has entered the Bladder, why not administer *Siling San* (Four-Powder Powder) and primarily use *Zhu Ling Tang*? In cold damage, difficulty urinating stems from Qi level obstruction; in heat diseases, difficulty urinating arises from Blood level involvement. Because pathogens are deeply constrained and fluid consumption has lasted long, *Ejiao* (Donkey-Hide Gelatin) is necessary to tonify deficiency, and *Huashi* (Talcum) to dispel heat, while *Baizhu* (Atractylodes Macrocephala Rhizome) is not utilized.

Shen Yaofeng stated: Before any erroneous treatment, this condition was originally within the indication for *Baitu Tang*.
In Yangming disease, if sweating is profuse and thirst is present, *Zhu Ling Tang* must not be given. This is because profuse sweating causes dryness in the Stomach, and *Zhu Ling Tang* further promotes urination.

Zhou Yuzai stated: Thirst combined with difficulty urinating warrants *Zhu Ling Tang*; however, profuse sweating is a contraindication. This aligns with the principle in cold damage where pathogens entering the Fu organs prohibit frequent urination. Essentially, pathogens emerging from Yangming have already depleted Jin-Ye (body fluids); profuse sweating further consumes these fluids. How much Jin-Ye remains to be further drained by purgation? One should use *Baitu Jia Renshen Tang* to clear heat; once Jin-Ye recovers, urination will normalize spontaneously.

Shen Yaofeng stated: Food in the Stomach relies entirely on sufficient Jin-Ye to slide down smoothly; if Jin-Ye dries up, food becomes dry and difficult to pass. Therefore, Yangming disease arises from dryness. Dryness is one of the Five Qi, but among the Five Qi, Wind and Heat can also cause dryness. The *I Ching* (Book of Changes) states: "Nothing dries things more than Fire." It also says: "Wind emerges from Fire." These three principles derive from heavenly influences. As for human causes of dryness, there are two: sweating and urination. If either is excessive, dryness inevitably results.

In combined disease of the Three Yang channels, there is abdominal fullness, body heaviness, difficulty turning over, insensitivity of taste in the mouth, facial greasiness, delirium, and urinary incontinence. Diaphoresis leads to aggravated delirium. Purgation leads to sweating on the forehead and cold extremities. If spontaneous sweating occurs, *Baitu Tang* (White Tiger Decoction) should be administered.

Wang Shiyong noted: After "diaphoresis leads to delirium," the character "severe" (*shen*) seems to be missing.

Ma Yuanyi stated: In this condition, diaphoresis biases toward Yang and damages Jin-Ye; purgation biases toward Yin and depletes True Qi. Only *Baitu Tang* offers a method to clear heat without hindering the exterior or interior. Although the pulse in Three Yang diseases should be floating and large, it may sometimes be weak and unrising; this is due to pathogenic heat suppressing the pulse, preventing it from reaching the exterior. Once the congestion is cleared, the pulse will rise naturally; do not mistake this for Yang deficiency causing a micro pulse.

Wang Shiyong noted: One must not mistakenly interpret this as a Yang disease presenting with Yin pulses.

Zhang Xugu stated: In this clause, the pathogenic heat is heavier, pervading the Three Yang channels, causing abdominal fullness, body heaviness, and difficulty turning. "Insensitivity of taste" means inability to perceive flavors. Due to turbid stagnation in the Stomach steaming upward, the face appears greasy. Severe heat causes spiritual confusion, leading to delirium and urinary incontinence. If spontaneous sweating occurs without prior erroneous treatment, *Baitu Tang* is the primary prescription.

Wang Shiyong noted: Zhongchun said: *Baihe* (Lily Bulb) should be added. This is a rhetorical inversion; it means the sweating is not caused by erroneous diaphoresis, hence termed "spontaneous sweating."

Wang Shiyong noted: You Zaijing's commentary states: The phrase "if spontaneous sweating occurs" refers back to the preceding four phrases: "abdominal fullness, body heaviness..." If erroneous diaphoresis leads to delirium...

Wang Shiyong noted:
*Baitu Jia Renshen Tang* might offer salvation. However, if purgation is misapplied, resulting in sweating on the forehead, this is "extreme sweating" (*jue han*). Cold extremities indicate impending loss of Yang Qi; this is what is referred to as "repeated errors hastening death," a condition not treatable by *Baitu Tang*.