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A fellow townsman, Li Xindao, fell ill. His six pulses were deep and imperceptible; upon pressing deeply to the bone, they felt forceful. Note: In Zhou's edition, the character "ruo" (if/seeming) is written as "xian jin" (wiry and tight). Symptoms included headache, warm body, irritability, cold fingertips, epigastric fullness, and nausea. Two physicians had treated him but failed to identify the condition, prescribing only Qi-regulating herbs. Upon examination, I said: This is a syndrome of Yang hidden within Yin (Yin Zhong Fu Yang). This syndrome is not recorded in Zhang Zhongjing's methods, yet many people suffer from it today. If hot-natured herbs are used to assist Yang, it will cause Yin pathogens to block the pathway, preventing the guidance of True Yang, and instead generating external heat (Ke Re); if cold-natured herbs are used, the hidden True Fire will be further depleted. It is necessary to use herbs that break up Yin Qi and guide/activate True Fire, allowing Fire to rise and Water to descend, so that resolution through sweating can occur. I prescribed two hundred pills of Po Yin Dan (Break Yin Pill), to be taken at once, with cold salt water. Within half an hour, the patient became irritable and feverish, with restless limbs (Note: In Zhou's edition, "zao" [restless] is written as "zao" [dry]). His family was greatly alarmed. I said: This is what laypeople call "changing Yang" (Huan Yang); do not fear. After a short while, symptoms subsided slightly, he slept briefly, and then broke into sweat. This continued from dusk until dawn, after which his body cooled and the illness resolved. Po Yin Dan consists of four ingredients: Huangqi (Sulfur), Shuiyin (Mercury), Chenpi (Tangerine Peel), and Qingpi (Green Tangerine Peel), made into pills with flour, taken with cold water.

(The various arguments cited in this chapter are all derived from Zhang Shiwan's *Yi Tong*.)

The *Neijing* states: Excess Yin generates internal cold; Yin deficiency generates internal heat. Their clinical manifestations differ. The pulse of Yin deficiency is rapid, scattered, and choppy; the pulse of Yin excess is slow, wiry/tight, and choppy. Their pulse characteristics differ. Yin deficiency should be treated with sweet and moistening herbs to tonify Yin; Yin excess should be treated with pungent and warm herbs to invigorate Yang. Their treatment methods are even more distinct. Moreover, the mechanism of Yin excess repelling Yang to the exterior differs significantly from Yin deficiency causing Yang to float outward. When Yin occupies the interior, disrupting ascending and descending functions, Yang desires to return inward but cannot; this is the power of Yin to repel Yang. When Yin is deficient and cannot sustain Yang, rootless Yang cannot return inward and wanders outside; this is the natural floating outward of weak Yang. However, former experts often regarded a floating and large pulse that feels empty upon pressure as indicative of severe internal Yin-cold; and facial flushing, Dai Yang (floating Yang), and irritability as signs of severe internal Yin-cold. Yu Jiayan criticized this view as unclear lineage transmission, unaware that this is precisely the case of Yin deficiency with floating Yang. The appropriate treatment is to use warm and moistening herbs to fill Yin and calm Yang, rather than using intensely hot herbs to warm meridians and restore Yang. As for cases where the pulse is deep, fine, and rapid, accompanied by thirst, irritability, and confusion, these are signs of Yin stagnating externally and Yang being constrained internally. To label this as Yin excess repelling Yang or "water extreme resembling fire" is erroneous. Even when using hot formulas, such as Xu's Po Yin Dan, the intent is to clear external Yin to reveal hidden Yang, not to expel hidden Yin. Regarding cases described as having internal and external heat, with a deep and hidden pulse that is neither surging nor rapid, but feels deep, choppy, small, and urgent upon palpation, this is hidden heat. It must not be mistaken for deficiency-cold and treated with warm-hot herbs, as this would exacerbate the heat. This scenario involves Yin deficiency with sinking Yang entering the Yin level, known as exhaustion of Ying (Nutritive Qi) and descent of Wei (Defensive Qi). This is worlds apart from the Yin-excess Yang-constraint syndrome mentioned above. Generally, Yin excess in the interior constitutes internal excess; its pulse will never feel hollow (Kou) upon pressure, but will be firm (Lao), hard (Jian), or fine and wiry (Xi Jin). Only in Yin deficiency, where essence and blood are empty internally and Yang is forced outward, does the pulse become floating, large, and hollow. Furthermore, among those with Yin excess, some have Yang deficiency, while others do not; among those with Yin deficiency, some have Yang excess, while others do not. Yu Jiayan proposed theories on drawing Yang from Yin and Yin from Yang, including proportions and timing of administration, but these specifically apply to consumptive diseases (Xu Lao). For ordinary miscellaneous diseases, one merely adjusts the primary formula with slight biases toward cold/hot, ascending/descending, dispersing/astringing, etc. For instance, in Yin excess patients with Yang deficiency, direct warming of meridians and restoration of Yang is used; if Yang is not deficient, warming-transforming herbs are combined with slightly bitter and sour herbs to clear and settle floating Yang, guiding it inward. In Yin deficiency patients with Yang excess, this indicates internal heat, treated with sweet/moist and salty/moist herbs to fill Yin, assisted by Ginseng, Atractylodes, Bupleurum, and Cimicifuga to tonify Qi and build the center, lifting Yang back to its proper position. If Yang is not excessive, it represents floating Yang escaping outward, treated with warm-moistening herbs that tonify Spleen and Kidney, combining sour and pungent flavors. These are the general principles for treating internal injury. One must carefully examine the pulse to determine the pathogenesis, avoiding confusion caused by the notion that "a pulse disappearing completely upon heavy pressure indicates hidden Yin," thereby preventing the misapplication of cold/hot or attacking/tonifying therapies.

Dong Yuan treated a patient with flaccidity of the legs and knees, coldness in the lower buttocks, foul-smelling genital sweating, and seminal emission without retention. The pulse was deep, rapid, and forceful. This indicated Fire constrained internally, forcing Yin outward. The seminal instability was due to damp-heat mixing in the marrow. He treated this with Xiao Chai Hu Tang (Minor Bupleurum Decoction), removing Ren Shen (Ginseng), adding Fu Ling (Poria), Long Dan Cao (Gentian Root), and Huang Bai (Phellodendron Bark) to drain with bitter-cold herbs, resulting in recovery.

Jie An treated a young man who, after summer labor and consuming cold food, experienced nocturnal emission followed by fever and chest/epigastric stuffiness. By evening, he suffered intermittent frontal headaches, indicating Fire rising upward; his feet were cold, indicating Spleen Qi failing to descend. Physicians diagnosed external contraction complicated by Yin involvement and administered Wu Ji San (Five Accumulations Powder) to induce sweating, leading to irritability, thirst, red eyes, and constipation. The next day, Cheng Qi Tang (Order the Qi Decoction) was used to purge, yielding only yellow fluid. The patient developed rigidity resembling spasm, worsened irritability, abdominal distension, wheezing, and yellow-black tongue coating, persisting for six or seven days. Palpation revealed a pulse rate of 6-7 beats per breath, wiry and forceful. Urgently, Huang Long Tang (Yellow Dragon Decoction) was administered, evacuating much black stool. Abdominal distension immediately eased, and irritability decreased. However, fever persisted at night, and the tongue coating remained. Jie An then prescribed Jie Du Tang (Detoxification Decoction) combined with Sheng Mai San (Generate the Pulse Powder), adding Di Huang (Rehmannia Root). After two doses, the fever subsided. The patient recovered after a month of balanced regulation.