The patient presents with vexatious heat (vexatious heat). Sweating leads to relief, yet the condition resembles malaria. If fever occurs in the late afternoon (daytime malarial fever), it belongs to Yangming disease (Yangming syndrome). If the pulse is excess (Excess pulse), purgation (Purgative method) is indicated; if the pulse is floating and deficient (Deficient pulse), diaphoresis (Diaphoretic method) is indicated. For purgation, Da Cheng Qi Tang (Major Order the Qi Decoction) is used; for diaphoresis, Gui Zhi Tang (Cinnamon Twig Decoction) is used.

"Vexatious heat" refers to fever accompanied by mental restlessness, indicating the pathogen is in the interior (Interior). In interior conditions, sweating should not typically bring relief; if it does, it indicates that exterior pathogens remain. "Resembling malaria" refers to alternating chills and fever, characteristic of exterior conditions. In exterior conditions, fever should not occur in the late afternoon; if it does, it indicates that interior excess has formed. This represents a complex pattern of exterior-interior involvement. Therefore, one must carefully examine whether the pulse is floating or deep to determine the location of the pathogen before treating accordingly. An excess pulse indicates qi stagnation in the interior, so purgation may be used to expel the pathogen from the interior. A floating and deficient pulse indicates qi stagnation in the exterior, so diaphoresis may be used to expel the pathogen from the exterior. The purgative formula should be Da Cheng Qi Tang (Major Order the Qi Decoction), and the diaphoretic formula should be Gui Zhi Tang (Cinnamon Twig Decoction); this is an unchangeable natural principle.

In Yangming disease, if the pulse is floating and tight, with dry throat, bitter taste, abdominal fullness, panting, fever, sweating, aversion to cold absent but aversion to heat present, and heavy body: if diaphoresis is mistakenly applied, the patient will become irritable, feel mentally confused and distressed, and develop delirious speech (Delirium). If moxibustion or burning needles are mistakenly applied, the patient will certainly experience fear, palpitations, irritability, and insomnia. If purgation is mistakenly applied, the stomach becomes empty, rebellious qi disturbs the diaphragm, causing mental distress and stifled feelings (Mental distress), and if there is a white coating on the tongue, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is the primary treatment. If there is thirst desire to drink water and dry mouth/tongue, Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng) is the primary treatment. If the pulse is floating, there is fever, thirst desire to drink water, and dysuria, Zhu Ling Tang (Polyporus Decoction) is the primary treatment.

Floating and tight pulses are characteristic of Yangming exterior-interior patterns. Dry throat, bitter taste, abdominal fullness with panting, fever, sweating, absence of aversion to cold but presence of aversion to heat, and heavy body are characteristics of Yangming interior transformation. This indicates the pathogen has entered the interior, yet qi connects to the exterior, creating mutual constraint between interior and exterior, making both diaphoresis and purgation difficult. Thus, if diaphoresis is used, the pathogen cannot exit via the exterior, leading to irritability, mental confusion, and delirium. If fire therapy is used, heat disturbs the interior, leading to fear, irritability, and insomnia. If purgation is used, the pathogen is not fully cleared from the interior, leaving stomach qi vainly deficient and rebellious qi moving internally, causing mental distress. If the tongue has a white coating, it indicates pathogenic excess in the upper jiao (Upper Burner); therefore, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is given to vent the pathogen from the chest, following the principle "when disease is in the chest, vomiting should be induced." If there is thirst desire to drink water and dry mouth/tongue, the pathogen is in the middle jiao (Middle Burner), not the upper; thus, Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng) is used to clear stomach heat and nourish stomach fluids, following the principle "for heat overflowing within, treat with sweet-cold methods." If the pulse is floating, there is fever, thirst desire to drink water, and dysuria, the pathogenic heat is not in the upper or middle jiao, but exclusively in the lower jiao (Lower Burner); thus, Zhu Ling Tang (Polyporus Decoction) is used to promote urination to drain heat and simultaneously nourish yin qi, following the principle "for disease in the lower, use guiding methods to exhaust it."

Zhu Ling Tang (Polyporus Decoction) Formula:
Zhu Ling (Polypori Sclerotium, peeled), Fu Ling (Poria), E Jiao (Colla Corii Asini), Hua Shi (Talcum, crushed), Ze Xie (Alismatis Rhizoma) — each 1 liang.
Take these five herbs, add four sheng of water, first decoct the first four herbs to obtain two sheng of liquid, remove the dregs, add E Jiao (Colla Corii Asini), melt it, and take seven ge warm, three times daily.

In Yangming disease, if sweating is profuse and there is thirst, Zhu Ling Tang (Polyporus Decoction) must not be given. Because profuse sweating causes dryness in the stomach, and Zhu Ling Tang (Polyporus Decoction) further promotes urination.

The previous clause described the application of Zhu Ling Tang (Polyporus Decoction) for symptoms of floating pulse, fever, thirst, and dysuria. This clause reiterates the contraindication: although there is thirst desire to drink water, if sweating is profuse, Zhu Ling Tang (Polyporus Decoction) should not be used to promote urination. The reason is that sweat and urine share the same source but have different outlets. The *Ling Shu* states: Water and grain enter the mouth and are transported to the intestines and stomach; their fluids divide into five types. In cold weather with thin clothing, they become urine and qi; in hot weather with thick clothing, they become sweat. Although clear and turbid differ, they are all fluids of the fu organs. Since profuse sweating has already consumed stomach fluids, using Zhu Ling Tang (Polyporus Decoction) to promote urination would dryness upon dryness. Hence, it is stated that Zhu Ling Tang (Polyporus Decoction) must not be given.

In Yangming disease, after purgation, if there is exterior heat, warm hands and feet, no formation of chest binding (Jie Xiong), mental distress and stifled feelings (Mental distress), hunger but inability to eat, and only sweating on the head, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is the primary treatment.

After purgation in Yangming disease, if the pathogen neither exits from the interior nor binds due to purgation, and there is exterior heat with warm hands and feet, the pathogen has sunk but not deeply. Mental distress and stifled feelings (Mental distress), hunger but inability to eat, indicate heat lodging in the chest while stomach qi is deficient and unable to receive food. Only sweating on the head indicates chest heat steaming upward, where yang qi is affected by pathogen and cannot descend. This is a pattern where pathogen enters the interior but has not formed accumulation; thus, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is suitable to vent the pathogen from the chest, also reflecting the principle "for high-seated disease, induce venting."

In Yangming disease, which normally involves profuse sweating, if there is instead no sweating, and the body feels as if insects are crawling in the skin, this is due to long-standing deficiency.

Yangming is the fu organ of fluids. When heat qi enters, fluids are forced by heat, resulting in profuse sweating. If there is instead no sweating, and the body feels like insects crawling in the skin, it is because qi steams internally while fluids do not follow. Without long-standing Yangming deficiency, how could this occur?

Excess conditions lead to delirious speech (Delirium); deficiency conditions lead to Zheng Sheng (repetitive speech). "Zheng Sheng" refers to repetitive speech.

Excess means pathogenic excess; deficiency means essence/qi depletion. Pathogenic excess leads to wild, excessive speech unpredictable in nature; qi depletion leads to inability to speak much, repeating only past concerns over and over. Hence it is called "repetitive speech." "Repetitive" implies overlapping.

Fixed gaze with delirious speech (Delirium), accompanied by panting and chest fullness, indicates death. Accompanied by diarrhea, it also indicates death.

Fixed gaze with delirious speech (Delirium) indicates exhaustion of yin and flourishing heat. If pathogen declines day by day, or if yin qi can maintain itself, there may still be hope for treatment. If panting and chest fullness occur, pathogen is internally flourishing; if diarrhea occurs, yin leaks internally; both are fatal signs.

Profuse sweating, or repeated sweating, leads to loss of yang. Delirious speech (Delirium) with a short pulse indicates death; a self-harmonious pulse indicates survival.

Profuse sweating followed by more sweating severely injures yang qi, while pathogen remains unresolved. Delirious speech (Delirium) with a short pulse: delirious speech (Delirium) indicates pathogenic excess, short pulse indicates qi deficiency. Disease excess overwhelms the zang organs, hence death. A self-harmonious pulse indicates that although pathogen is excess, righteous qi is sufficient to contend, hence survival.

Yangming disease resolves from Shen hour to Xu hour (3 PM to 7 PM).

Shen, You, and Xu hours correspond to the late afternoon (daytime malarial fever period). Yangming tidal fever occurs in the late afternoon; Yangming disease resolution also occurs in the late afternoon. Thus, Shen, You, and Xu hours belong to Yangming. When diseased, pathogen flares at this time; when resolving, righteous qi recovers at this time.