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The Yangming channel governs the interior; internally it reflects the stomach, and externally it reflects the muscles. Therefore, there is a distinction between channel disease (Jing Bing) and fu-organ disease (Fu Bing). As stated in the Treatise, symptoms such as body heat, vexation, thirst, eye pain, nasal dryness, inability to sleep, aversion to cold being absent, and instead an aversion to heat, constitute Yangming channel disease. Symptoms such as tidal fever (Chao Re), delirium (Chan Yu), sweating on the hands, feet, and axillae, abdominal fullness and pain, and hard stools constitute Yangming fu-organ disease. Each of these categories has three variations:

For channel diseases, there are cases where the pathogenic factor has already transmitted to Yangming but the exterior syndrome of Taiyang has not yet resolved, presenting simultaneously with headache, aversion to cold, and anhidrosis characteristic of Taiyang. There are cases where the Taiyang pathogen has completely resolved and fully transmitted to Yangming, presenting solely with high fever, sweating, mental restlessness, insomnia, and intense thirst with a desire to drink, which are pure Yangming syndromes. There are also cases where the Yangming pathogen has not yet subsided but has re-transmitted to Shaoyang, presenting simultaneously with hypochondriac pain, alternating chills and fever, bitter taste in the mouth, vomiting, dizziness, and deafness characteristic of Shaoyang.

For fu-organ diseases, there is "Taiyang-Yangming," referring to when a Taiyang disease, after treatment with diaphoresis, emesis, purgation, or promoting urination, results in fluid depletion and dryness in the stomach. The Taiyang pathogen takes advantage of this gastric dryness to transmit to Yangming, causing frequent urination and hard stools; this is known as "Spleen Constraint" (Pi Yue). There is "Zhengyang-Yangming" (True Yang-Yangming), referring to when a person's yang qi is naturally robust or has retained food stagnation. Upon transmission from Taiyang to Yangming, the pathogen enters the stomach fu-organ, causing constipation; this is known as "Stomach Fullness and Excess" (Wei Jia Shi). There is "Shaoyang-Yangming," referring to when the disease has reached Shaoyang, where reconciliation should be the method, but erroneous use of diaphoresis or promoting urination depletes fluids, causing dryness and heat in the stomach. The pathogen re-transmits to Yangming, causing hard and difficult defecation; this is known as "Difficulty in Defecation" (Da Bian Nan).

Treatment for Yangming channel disease involves using Gegen Tang (Kudzu Decoction) or Guizhi Jia Gegen Tang (Cinnamon Twig plus Kudzu Decoction) to induce sweating, Baizhu Tang (White Tiger Decoction) to clear heat, or Chaihu Baizhu Tang (Bupleurum White Tiger Decoction) to harmonize, depending on the specific syndrome. Treatment for Yangming fu-organ disease, while generally suitable for purgation, varies in severity. Thus, one may use the Three Chengqi Decoctions (San Chengqi Tang) to purge, Maren Wan (Hemp Seed Pill) to unblock, or honey suppositories/pig bile enemas to guide out stool, treating according to the condition. This outlines the general principles of Yangming disease. Here, channel and fu-organ diseases are detailed separately to facilitate distinction, ensuring orderly clinical practice.

The defining syndrome of Yangming disease is Wei Jia Shi (Stomach Fullness and Excess).
[Annotation] The Yangming channel internally reflects the stomach and externally reflects the muscles. If the Taiyang pathogen transmits to its channel, it becomes the exterior syndrome of Yangming disease; if it transmits into the stomach fu-organ, it becomes Wei Jia Shi.
[Collected Annotations] Fang Youzhi states: Yangming is the channel; Stomach is the fu-organ; "Shi" (Excess) refers to hard and full feces that cannot be passed. Although timing varies, it cannot be rigidly bound by days.

In Shanghan (Cold Damage) on the third day, the pulse becomes large.
[Annotation] "Day 1 Taiyang, Day 2 Yangming, Day 3 Shaoyang" describes the sequence of transmission in the Neijing, not a rigid chronological rule. Saying "Yangming pulse is large on the third day" means it does not combine the floating-large pulse of Taiyang-Yangming nor the string-large pulse of Shaoyang-Yangming, but directly presents the large pulse of Zhengyang-Yangming. This occurs because the pathogen moves from exterior to interior, heat enters the stomach, forming an internal excess diagnosis, hence the pulse appears thus.
[Collected Annotations] Fang Youzhi states: "Third day" broadly includes wind-strike. A large pulse indicates abundant Qi and Blood in Yangming.
Shen Mingzong states: This is the true pulse of Yangming. Zhang Zhongjing notes the large pulse on the third day because Yangming is a fu-organ rich in Qi and Blood. When wind-cold transmits, pathogen excess in the middle jiao manifests as a large pulse, the true pulse of Yangming pathogenic excess. However, only when this pulse is present can purgative methods be used. If combined with Taiyang floating-tight or Shaoyang string-thin pulses, or if slow, rapid, slippery, choppy, weak, or deficient, it indicates deficiency of Qi, Blood, Yin, or Yang. Even with severe excess and fullness, careful examination is required; one might trial Xiao Chengqi Tang or use honey suppositories, avoiding direct aggressive purgation.

When Taiyang disease is first contracted, if diaphoresis is applied but sweat is not thorough, the pathogen may transmit to Yangming.
[Annotation] Yangming disease often originates from improper diaphoresis at the onset of Taiyang disease. Incomplete sweating fails to expel all pathogens, allowing residual pathogen to transmit to Yangming. Pathogen in the channel manifests as exterior syndrome; pathogen entering the fu-organ manifests as Wei Jia Shi.
[Collected Annotations] Fang Youzhi states: This explains the general idea that improper diaphoresis in Taiyang leads to pathogen entering the stomach.

In Yangming disease, if the patient can eat, it is called Wind-Strike (Zhong Feng); if unable to eat, it is called Cold-Strike (Zhong Han).
[Annotation] When Taiyang pathogen transmits to Yangming, it may come from Wind-Strike or Cold-Damage. Differentiation relies on appetite. Ability to eat indicates Wind-Strike transmission; wind is a Yang pathogen, and Yang aids digestion, hence appetite remains. Inability to eat indicates Cold-Damage transmission; cold is a Yin pathogen, impairing digestion, hence loss of appetite.
[Collected Annotations] Fang Youzhi states: This uses appetite to distinguish Wind from Cold. Yangming governs water and grain; wind aids eating, Yang transforms grain; cold hinders eating, Yin fails to kill grain ("kill grain" refers to digestion). "Ming" means "called." "Zhong Han" is synonymous with Shanghan here, implying transmission from Taiyang, not primary Yangming cold injury.
Wang Hu states: Zhang Zhongjing equates Zhong Han with Shanghan, not a true cold syndrome. True cold would involve Stomach deficiency-cold, treated with Lizhong Tang. Current inability to eat indicates Stomach excess, with pathogen not yet in the fu-organ and no郁热 (stagnant heat) formed. Thus, Zhong Han is effectively identical to Shanghan.

Q: What are the exterior syndromes of Yangming disease?
A: Body heat, spontaneous sweating, absence of aversion to cold, and presence of aversion to heat.
[Annotation] Yangming disease has exterior and interior syndromes. Tidal fever, spontaneous sweating, and constipation are interior syndromes; body heat, spontaneous sweating, no aversion to cold, and aversion to heat are exterior syndromes. Spontaneous sweating suggests transmission from Wind-Strike, sharing features with Wind-Strike exterior syndromes. However, body heat without aversion to cold but with aversion to heat identifies it as Yangming exterior syndrome, distinguishing it from Wind-Strike. Yangming heat arises from the muscles, manifesting as steaming heat, unlike the intermittent fever of Taiyang.
[Collected Annotations] Fang Youzhi states: This describes the exterior syndrome of Yangming transmitting from Taiyang Wind-Strike.
Wei Litong states: How to differentiate Yangming transmitting from unresolved Taiyang Wind-Strike? One must verify the exterior manifestations. Taiyang Wind-Strike presents with heat, spontaneous sweating, and aversion to wind. If heat and spontaneous sweating occur with aversion to heat rather than cold/wind, the disease has left Taiyang and entered Yangming.

Q: Some patients have aversion to cold without fever on the first day. Why?
A: Although aversion to cold appears on the first day, it will cease spontaneously, followed by spontaneous sweating and aversion to heat.
[Annotation] Taiyang disease typically involves aversion to cold; Yangming involves aversion to heat. Initial aversion to cold in Yangming indicates residual Taiyang exterior pathogen. However, this residual pathogen cannot persist long as it seeks to transmit to Yangming; thus, aversion to cold ceases quickly, replaced by spontaneous sweating and aversion to heat.
[Collected Annotations] Fang Youzhi states: This describes exterior syndrome of Yangming transmitting from Taiyang Cold-Damage.
Cheng Yingmao states: Yangming aversion to cold retains exterior characteristics initially; fu-organ disease involves aversion to heat. Resolution of exterior signs confirms the transition.
Zheng Zhongguang states: This differentiates exterior syndrome of Yangming Cold-Damage. Initial aversion to cold without fever originates from Cold-Damage. Cessation of aversion to cold indicates pathogen passing the exterior. Subsequent spontaneous sweating results from pathogenic heat stagnating in muscles, opening pores, and leaking sweat.
Wei Litong states: Taiyang Cold-Damage can also transmit to Yangming. Initial aversion to cold without fever mimics Taiyang Cold-Damage, but cessation of aversion to cold and emergence of sweating/aversion to heat confirm Yangming transmission via Cold-Damage. Note: Taiyang Wind-Strike's true syndrome is heat, aversion to wind, and sweating; Taiyang Cold-Damage's true syndrome is aversion to cold and anhidrosis. Upon transmitting to Yangming, sweating and aversion to heat become the true syndrome.

Q: Why does aversion to cold cease spontaneously?
A: Yangming resides in the center and corresponds to Earth. It is the destination of all things and does not transmit further. Although aversion to cold begins initially, it stops by the second day, marking Yangming disease.
[Annotation] This explains the cessation of aversion to cold. Yangming (Stomach) is central and Earth-element. Earth receives all things; thus, pathogenic heat entering the Stomach has nowhere else to transmit. Initial aversion to cold on day one indicates unresolved Taiyang exterior. Cessation on day two indicates complete transmission of Taiyang pathogen to Yangming.
[Collected Annotations] Fang Youzhi states: Cessation of aversion to cold by day two indicates heat entering the interior and impending aversion to heat, describing Zhengyang-Yangming.
Cheng Yingmao states: Although Six Channels divide Yin/Yang, the Stomach governs them. Any dryness-heat causes pathogens from any channel to transform into heat. Yin/Yang pathogens all return to Stomach Earth, hence "destination of all things, no further transmission."

Q: How does one acquire Yangming disease?
A: In Taiyang disease, if diaphoresis, purgation, or promoting urination deplete fluids causing gastric dryness, the pathogen transmits to Yangming. Failure to defecate, internal excess, and difficulty in defecation name this Yangming disease.
[Annotation] Q: How does Yangming Stomach Excess arise?
A: During Taiyang, diaphoresis, purgation, or diuresis aim to expel pathogen. Correct treatment resolves disease. Incorrect treatment depletes fluids, drying the Stomach. Residual pathogen exploits dryness-heat to transmit to Yangming. Three types of Stomach Excess exist: 1. "Bu Geng Yi" (Not changing clothes/i.e., no bowel movement), corresponding to Taiyang-Yangming Pi Yue (Spleen Constraint); 2. "Nei Shi" (Internal Excess), corresponding to Zhengyang-Yangming Wei Jia Shi (Stomach Fullness); 3. "Da Bian Nan" (Difficulty in Defecation), corresponding to Shaoyang-Yangming. While all are purgable, severity differs: Pi Yue is mildest, Da Bian Nan moderate, Wei Jia Shi most severe. Pi Yue/Da Bian Nan often stem from inherent fluid deficiency or iatrogenic damage. Wei Jia Shi stems from inherent robust Yang/Qi and retained food, becoming excess even without prior mistreatment. Mistreated cases require moistening; untreated heat-excess cases require clearing heat. This distinguishes the indications for San Chengqi Tang, Pi Yue Wan, and suppository/enema methods.
[Collected Annotations] Fang Youzhi states: Ancients said "change clothes" for defecation; "not changing clothes" means no defecation.
Cheng Yingmao states: Transmission levels include exterior resolution status and degree of dryness/excess, explaining the three types. Indications for purgation depend on exterior/interior involvement and nature of excess/dryness.
Wang Hu states: If Taiyang was purged, stomach contents are gone, so why excess? Answer: Improper early purgation depletes fluids without fully removing pathogen/residue. Pathogen transmits to Yangming, forming dry feces and internal excess.

Q: What are Taiyang-Yangming, Zhengyang-Yangming, and Shaoyang-Yangming?
A: Taiyang-Yangming is Pi Yue; Zhengyang-Yangming is Wei Jia Shi; Shaoyang-Yangming is difficulty in defecation after erroneous sweating/diuresis causing gastric dryness/vexation/excess.
[Annotation] Purgative indications in Yangming extend beyond Wei Jia Shi. Three main categories exist: 1. Taiyang-Yangming: Taiyang pathogen exploits gastric dryness-heat to transmit, causing infrequent bowel movements without distress, named Pi Yue. 2. Zhengyang-Yangming: Taiyang pathogen combines with gastric retained food and dryness-heat, causing constipation, internal fullness/pain, named Wei Jia Shi. 3. Shaoyang-Yangming: Pathogen at Shaoyang treated wrongly with sweating/diuresis damages fluids; Shaoyang pathogen exploits gastric dryness to transmit to Yangming, causing difficult, sticky stools, named Da Bian Nan.
[Collected Annotations] Cheng Zhi states: All Three Yang channels can enter the Stomach fu. Taiyang pathogen entering Stomach is Taiyang-Yangming (e.g., post-emesis/purgation/sweating with mild vexation, frequent urination, hard stool); treated with mild purgation (Xiao Chengqi Tang) due to Spleen constraint. Yangming channel pathogen entering Stomach is Zhengyang-Yangming (e.g., fever, sweating, dry/hard stomach, delirium); treated with strong purgation (Da Chengqi Tang) due to Stomach excess. Shaoyang pathogen transferring to Stomach is Shaoyang-Yangming (e.g., Shaoyang contraindicates sweating; sweating causes delirium indicating Stomach involvement); treated with moistening purgation (Maren Wan) due to fluid exhaustion. If exterior symptoms of Three Yang persist, standard Yangming treatments are contraindicated.

In Yangming disease, if the pulse is floating and tight, tidal fever occurring at fixed times is certain; if only floating, night sweating is certain.
[Note] Spontaneous sweating is a Yangming sign; night sweating is a Shaoyang sign. "Night sweating" here likely implies "spontaneous sweating" for textual coherence.
[Annotation] Yangming channel pulse should be floating-long; fu-organ pulse should be solid-large. Floating-tight pulse with timed tidal fever indicates Yangming disease with Taiyang Cold-Damage pulse, suggesting transmission from Cold-Damage. Unresolved Taiyang Cold-Damage implies anhidrosis. Despite Yangming tidal fever, treat as Taiyang-Yangming Cold-Damage with Mahuang Jia Gegen Tang (Ephedra plus Kudzu Decoction) to sweat. If tidal fever occurs with only floating (not tight) pulse, it indicates Yangming with Taiyang Wind-Strike pulse, suggesting transmission from Wind-Strike. Unresolved Taiyang Wind-Strike implies spontaneous sweating. Treat as Taiyang-Yangming Wind-Strike with Guizhi Jia Gegen Tang (Cinnamon Twig plus Kudzu Decoction) to resolve.
[Collected Annotations] Shen Mingzong states: Yangming syndrome with Taiyang pulse. Floating-tight indicates unresolved Taiyang exterior cold; timed tidal fever indicates established Yangming interior syndrome. Only floating indicates Taiyang wind injuring Wei, hence sweating.

In Yangming disease, if the pulse is slow, sweating is profuse, and there is slight aversion to cold, the exterior is unresolved. Diaphoresis is indicated; Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
[Note] "Fever" is likely missing after "profuse sweating." Without fever, slow pulse, profuse sweating, and slight aversion to cold indicate exterior Yang deficiency, requiring Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction), not Guizhi Tang. Likely a transcription error.
[Annotation] Yangming pulse should be rapid-large. Slow pulse with profuse sweating, assuming no fever/cold, would mean resolved Taiyang. However, with fever and slight aversion to cold, the exterior is incompletely resolved. Use Guizhi Tang to release the muscle layer and induce sweating, returning the newly entered Yangming exterior pathogen to the surface.
[Collected Annotations] Cheng Zhi states: Wind-strike transmitting to Yangming with unresolved exterior still requires Guizhi Tang to release the muscle layer.
Wang Hu states: Early transmission of Taiyang to Yangming channel with wind pathogen. Slow pulse is a variation of Taiyang Wind-Strike's slow pulse as pathogen prepares to enter interior. Profuse sweating indicates Yangming heat loosening muscle pores. Slight aversion to cold indicates residual exterior wind. Treat per Taiyang Wind-Strike protocol. However, since it is Yangming disease, Guizhi Jia Gegen Tang is more appropriate per Zhang Zhongjing's method.

In Yangming disease, if the pulse is floating, there is no sweating, and wheezing, diaphoresis leads to recovery; Mahuang Tang (Ephedra Decoction) is appropriate.
[Annotation] Yangming pulse should be floating-large, syndrome should feature sweating. Floating pulse alone indicates exterior disease; anhidrosis with wheezing indicates exterior excess. Taiyang pathogen has not fully entered Yangming but remains in the exterior. Treat as Taiyang Cold-Damage; diaphoresis cures. Use Mahuang Tang.
[Collected Annotations] Zhang Lu states: Distinguishing Ying/Wei in Yangming relies on pulse/syndrome. Wind pathogen pulse in Yangming: excessive sweating removes slowness, leaving laggardness. Cold pathogen pulse in Yangming: high fever removes tightness, leaving floating. These indicate pathogen in channel. If entering fu, slow becomes rapid, floating becomes solid. If not rapid/solid, it is not Stomach excess and cannot withstand purgation.
Wang Hu states: Anhidrosis with wheezing, floating without tightness—how to confirm Yangming? The patient must have eye pain, nasal dryness, body heat, and insomnia, confirming Yangming.
Wei Litong states: This is a Taiyang-Yangming syndrome. Since entry into Yangming is shallow, allow pathogen to exit via exterior, preventing retention in Stomach.

If the Yang pulse is faint and sweating is scant, it indicates self-harmonization; if sweating is profuse, it indicates excess. If the Yang pulse is solid, and diaphoresis causes profuse sweating, it also indicates excess. Excess leads to Yang isolation in the interior, fluid depletion, and hard stools.
[Annotation] This elaborates on pulses and syndromes. "Yang pulse faint" means floating, weak, and subtle; "Yang pulse solid" means floating, forceful, and vigorous. In Wind/Cold pulses, faint Yang indicates mild heat, steaming exterior to produce sweat. Scant sweating indicates self-resolution; profuse sweating indicates failure to resolve due to excess. Solid Yang indicates heat excess. Inducing sweat due to heat excess causing profuse sweating is also excess. Excessive sweating isolates Yang in the interior, depletes fluids, hardens stools, and creates internal excess, necessitating purgation. Those inducing sweat must consider this risk early.
[Collected Annotations] Yu Chang states: Faint Yang is Wind-Strike pulse (faint-slow); Solid Yang is Cold-Damage pulse (tight-solid). "Yang isolation" is synonymous with fluid depletion. Zhang Zhongjing often terms fluid depletion as "No Yang." Examining "Yang isolated in interior, fluid depletion, hard stools..."