this is a concurrent shao yang (lesser yang)- and yang ming (brightness)-stage disorder.

the alternating fever and chills, sensation of fullness in the chest and hypochondria, bitter taste in the mouth, vomiting, and wiry pulse are indicative of a shao yang-stage disorder.

the sensation of firm masses or distention and pain in the epigastrium, absence of bowel movements or hot, burning diarrhea, yellow coating on the tongue, and forceful pulse are indicative of a yang ming organ-stage disorder.

it is not uncommon to find a flooding or excessive pulse. the symptoms of uncontrolled vomiting, despondency, and irritability will be more severe than the occasional vomiting and irritability associated with a purely shao yang condition. in terms of organ-pattern differentiation, this condition is viewed as heat excess in the gallbladder and stomach. one of the key symptoms from this perspective is the continuous vomiting. this reflects the concept that vomiting is not an intrinsic problem of the stomach, but only occurs when the stomach is attacked by gallbladder qi.