The general principle of Yangming disease is: Excess in the Stomach organ system (Wei Jia Shi).

The Stomach (Wei), meaning "gathering," is the sea of water and grain, belonging to the Fu organs of the Yangming channel. "Excess in the Stomach organ system" refers to pathogenic heat entering the Stomach and binding with fecal matter to form excess. This "excess" is not due to natural hyperactivity of Stomach Qi. Symptoms such as abdominal fullness, constipation, tidal fever, passing flatus, and continuous sweating on the hands and feet are all manifestations of Yangming Stomach excess.

Question: There are three types of Yangming disease: Taiyang-Yangming, Zhengyang-Yangming, and Shaoyang-Yangming. What do these mean? Answer: Taiyang-Yangming refers to the Pi Yue (Spleen Constraint) syndrome. Zhengyang-Yangming refers to Wei Jia Shi (Excess in the Stomach organ system). Shaoyang-Yangming refers to a condition where, after sweating or promoting urination, the Stomach becomes dry, causing irritability and solidification, leading to difficult defecation.

Taiyang-Yangming occurs when the disease is in the Taiyang stage but simultaneously involves internal excess in the Yangming stage. This happens because the patient's Stomach Yang is naturally robust, preventing the Spleen Yin from distributing properly, resulting in small and hard stools, forming Pi Yue (Spleen Constraint). At this point, while the Taiyang channel is just receiving pathogenic factors, the Yangming stage has already developed internal excess. Zhengyang-Yangming occurs when pathogenic heat directly enters the Stomach and binds with internal fecal matter, constituting a primary Yangming disease, as described in the *Huo Ren Shu* (Book of Life-Preserving Physicians): the patient originally had abundant food intake and robust Qi. Shaoyang-Yangming arises when the disease transfers from the Shaoyang stage to the Yangming stage. After sweating or promoting urination, body fluids are depleted, leading to dryness and excess in the Stomach. For example, as stated in the main text, if ten days have passed since the onset of cold damage, heat is bound internally, accompanied by alternating chills and fever, the Da Chai Hu Tang (Major Bupleurum Decoction) is indicated. These three variations illustrate different causes for Yangming disease, yet their essence remains Wei Jia Shi (Excess in the Stomach organ system).

Question: What are the external manifestations of Yangming disease? Answer: Fever, spontaneous sweating, aversion to cold is absent, and there is an aversion to heat.

Question: In some cases, on the first day of illness, there is no fever but aversion to cold. Why? Answer: Although it is only the first day, the aversion to cold will cease spontaneously, followed by spontaneous sweating and aversion to heat.

Question: Why does the aversion to cold cease spontaneously? Answer: Yangming resides in the center and corresponds to Earth; it is where all things return, and pathogens do not transmit further. Initially, there may be aversion to cold, but it stops by the second day. This constitutes Yangming disease.

Pathogens in the exterior channels remain unchanged, hence aversion to cold; upon entering the Fu organs, they transform into heat, losing the aversion to cold. Exterior pathogens cannot accumulate, so upon entering the Fu organs, they gather and stop transmitting. Saying "where all things return" means that pathogens leave the channels and enter the Fu organs, gathering without moving, similar to how all things return to the earth. Therefore, aversion to cold is the definitive sign of cold damage in the exterior, while aversion to heat is the definitive sign of Yangming disease entering the Fu organs. Although aversion to cold may occur initially, it ceases shortly thereafter, unlike Taiyang disease which persists with chills throughout. These three passages collectively discuss the manifestations of Yangming disease acquisition.

Question: How does one contract Yangming disease? Answer: If Taiyang disease is treated incorrectly with sweating, purging, or promoting urination, body fluids are lost, the Stomach becomes dry, and the condition transforms into Yangming disease. Failure to pass stool, internal excess, and difficulty in defecation characterize this as Yangming disease.

The Stomach is the Fu organ of body fluids. Sweating, purging, or promoting urination causes body fluids to escape externally, leading to dryness in the Stomach. At this stage, cold pathogens have transformed into heat. Heat behaves like fire, which naturally moves toward dryness; thus, pathogens transfer to the Yangming stage. The transformation from Taiyang to Yangming has two origins: First, during the initial Taiyang stage, incomplete sweating leaves residual pathogens, causing transmission while the disease remains in the channels. Second, incorrect treatment (sweating, purging, diuresis) depletes body fluids, dries the Stomach, transforms pathogens into heat, and transmits the disease into the Fu organs. These are the causes of Yangming disease acquisition.

In cold damage lasting four to five days, if the pulse is deep and accompanied by wheezing and fullness, a deep pulse indicates interior involvement. Incorrectly inducing sweating causes body fluids to leak out, making defecation difficult, resulting in exterior deficiency and interior excess. Prolonged, this leads to delirious speech.

A deep pulse indicates interior disease; wheezing and fullness result from abdominal distension causing breathlessness, indicating excess. In cold damage of four to five days, with interior excess, purgation should be used. Inducing sweating instead causes fluid loss and intestinal dryness, inevitably leading to difficult defecation. "Exterior deficiency and interior excess" implies harmony at the exterior but pathology within. Delirium develops over time as heat exploits the deficiency, converging on Yangming to form Stomach excess.

If the radial pulse is superficial and fine, with slight sweating, the condition is self-regulating. Profuse sweating indicates excessiveness. If the pulse is superficial and firm, and profuse sweating follows induction, this is also excessive. Excessiveness leads to Yang exhaustion in the interior and fluid depletion, causing hard stools.

A superficial and fine pulse indicates weak Yang Qi. Slight sweating means pathogens are departing without damaging healthy Qi, representing self-regulation. Profuse sweating indicates that although pathogens retreat, healthy Qi declines, representing excessiveness. A superficial and firm pulse indicates pathogenic excess. However, profuse sweating after induction is excessive because fluids are lost externally, leading to Yang exhaustion in the interior. Yang is the source of fluids, and fluids are the root of Yang. Profuse sweating exhausts fluids; although Yang Qi remains, its root is severed, termed "Yang exhaustion." With exhausted Yang and depleted fluids, stools inevitably become hard.

A floating and knifelike (Kou) pulse: Floating indicates Yang, Kou indicates Yin. When floating and Kou interact, Stomach Qi generates heat, leading to Yang exhaustion.

A floating pulse indicates abundance in the exterior; a Kou pulse indicates deficiency in the interior. Floating represents exclusive Yang abundance; Kou represents Yin insufficiency. Their interaction signifies Yang excess and Yin deficiency. Depletion of Stomach fluids causes internal heat generation. Although Yang Qi exists, it lacks Yin to pair with, similar to the previous passage. Hence, "Yang exhaustion."

The above three passages elaborate on the causes of Yangming disease. The following three passages elaborate on its manifestations.

In cold damage, if there is fever, no sweat, vomiting, inability to eat, yet continuous sweating occurs, the disease is transferring to Yangming.

When cold damage transfers to Yangming, the patient exhibits continuous, slight sweating.

Fever and no sweat indicate Taiyang disease in the exterior. Vomiting and inability to eat indicate pathogens attempting to enter the interior while healthy Qi resists. Once continuous sweating occurs, it signifies that the Taiyang pathogen has been accepted by Yangming. Thus, it is called "transferring to Yangming." Taiyang cold binds in the skin and hair follicles, closing the pores, hence no sweat. Yangming heat resides in the muscles, opening the pores and leaking fluids, hence continuous sweating.

If a patient has not defecated for five to six days, experiences periumbilical pain, irritability, and periodic exacerbations, this indicates dry feces causing the constipation.

Heat binding in Yangming causes constipation for five to six days, periumbilical pain, irritability, and periodic symptoms, all signs of dry feces in the Stomach. "Periodic" refers to the peak time of Yangming, which is Shen hour (3-5 PM). With Yangming dryness and obstruction preventing defecation, unless Da Cheng Qi Tang (Major Order the Qi Decoction) is used, efficacy is unlikely.