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*Ling Shu · Kou Wen* records: Why does a person bite their own tongue? What qi causes this? It is said: This is due to *Jue Ni* (Rebellious Qi) moving upward, with the pulse qi arriving together (*Jia Yi Jing* reads "all"). When *Shao Yin* (Lesser Yin) qi arrives, one bites the tongue; when *Shao Yang* (Lesser Yang) qi arrives, one bites the cheek; when *Yang Ming* (Greater Yang) qi arrives, one bites the lips.

*Sù Wèn · Yang Ming Mai Jie* states: The *Yang Ming* channel governs the flesh, and its vessels are rich in blood and qi. When pathogenic factors invade, heat arises. Severe heat causes the patient to discard clothing and run about, climbing high and shouting; or even after several days without food, they may leap over walls and climb onto roofs. The four limbs are the root of all yang channels. When yang is excessive, the limbs become solid and strong, enabling one to climb heights. Heat overwhelming the body causes discarding clothes and running. Excessive yang leads to delirious speech, cursing others regardless of intimacy, and loss of appetite, resulting in manic running. These manifestations appear in the qi level, but the root disease lies in the blood level. Why? When blood heat reaches its extreme, fluids dry up causing dryness, muscles itch unbearably. Even scratching until bleeding occurs cannot stop it; one wishes for knife cuts or needle pricks to relieve it. If heat subsides slightly, pain ensues.

Human blood is like rouge, possessing both color and substance, capable of becoming powder or liquid. Human blood can also coagulate or liquefy. The liquefied aspect is harmonized by body fluids. If fluids are scorched and exhausted by fire, blood flow becomes stagnant. As fire-heat intensifies, qi movement becomes fierce. Blood stagnates ahead while qi surges behind. Normally, qi moves in a cycle where leading qi departs and following qi follows. Now, however, leading qi stagnates and fails to move forward, while following qi surges violently. Qi presses against qi, forcing itself into the blood vessels. Consequently, pressure within the vessels becomes obstructed, causing unbearable distension and fullness. Remaining qi spills laterally into fine collaterals, conflicting with qi outside the vessels. This causes hidden itching under the skin, leading to unconscious self-biting, tearing flesh into ring shapes that cannot be stopped.

Zhang Zhongjing also stated: This is akin to striking hard objects forcefully, or holding blades in hand, resulting in sores even while sitting. Thus, some patients die from biting their tongues; others scratch their entire bodies until skin breaks and blood flows, leaving not an inch of intact skin, tossing on bedsheets until qi exhausts and death occurs. The world attributes this to karmic retribution or demonic possession. Who knows that in cold damage and seasonal diseases, such cases are numerous, truly caused by heart and spleen blood heat! This is indeed due to excessive pathogenic heat, but even more frequently results from mistakenly administering warming herbs to induce sweating. Cases originally indicated for *Cheng Qi Tang* (Purge the Intestines Decoction) or *Bai Hu Tang* (White Tiger Decoction) were wrongly treated with *Si Ni Tang* (Frigid Extremities Decoction) or *Li Zhong Wan* (Regulate the Middle Pill), inevitably leading to this state. Physicians attribute it to ghosts to cover their errors; families attribute it to past sins to slander the dead. Is this not unjust? Once at this stage, no remedy remains. However, if before the condition peaks, heavy doses of *Shi Gao* (Gypsum Fibrosum), *Da Huang* (Rhei Radix et Rhizoma), *Sheng Di Huang* (Rehmanniae Radix), *Dan Pi* (Moutan Cortex), and *Zhi Zi* (Gardeniae Fructus) are administered in large quantities, it might still be saved.

For seasonal heat diseases, initial treatment should clear heat and nourish fluids using *Bai Shao* (Paeoniae Radix Alba), *Dong Tian* (Asparagi Radix), *Dong Bai* (Ophiopogonis Radix), *Mao Gen* (Imperatae Rhizoma), *Zhu Ye* (Bambusae Folium), *Shi Gao*, and *Zhi Mu* (Anemarrhenae Rhizoma) to draw out pathogenic heat. If bowel obstruction exists and *Yang Ming* signs appear, one must prevent heat entering the blood level; the three *Cheng Qi Tang* formulas must not be delayed. Blood is like a boat; fluids are like water. Physicians here must understand the principle of increasing water to float the boat. Ye Tianshi’s saying, "Nourishing yin does not lie in tonifying blood, but in nourishing fluids," embodies this meaning. Ignorance of this leads to reckless warming and tonification or dispersing, causing blood dryness and qi excess. Excess qi leads to congestion. Congestion in small collaterals causes biting; congestion in major meridians causes manic running. Mild congestion in muscle interstices manifests as *Yin Zhen* (Urticaria), wanting to erupt but failing, ultimately leading to death. The classic states: "Pulse qi arriving in pairs" means arriving side-by-side. Because they arrive together, yang is excessive and qi is solid, causing vessel distension and rupture.