in this pattern, the exterior has not been completely released and in the interior the heat is already blazing. this condition can arise when an exterior condition this inappropriately treated with laxatives. purging drives the external pathogenic influence deeper into the yang ming stage where it gives rise to dysenteric diarrhea with heat, characterized by very foul-smelling stools and a burning sensation around the anus.

there is also irritability and a sensation of heat in the chest. the presence of interior heat is reflected in the fever, thirst, the red tongue with a yellow coating, and the rapid pulse. as the condition progresses inward from the exterior, it causes ‘steaming’ of the muscle layer which manifests as sweat. when fire in the interior attacks the lungs, wheezing results.

(bensky & barolet)