Heat (Qi level) is basically the same, the only difference being that it is characterized by more
Heat. Thus, there will be a prevalence of heat sensation and the tongue coating will be yellow.
From a channel perspective, most of the Lesser Yang manifestations are symptoms of
Gall-Bladder channel Heat (fullness of hypochondrium, dry throat, nausea, bitter taste, blurred
vision and Wiry pulse).

The Lesser Yang is the hinge between Greater Yang which opens onto the Exterior and Bright
Yang which opens onto the Interior. The pathogenic factor, in this case Heat, can remain lodged
in between the Exterior and Interior for a long time, months or even years. This happens when
the person's body condition is particularly weak at the time of invasion of the exterior pathogenic
factor.

Both Wind-Heat and Latent-Heat can manifest with the above Lesser Yang pattern.

To summarize, three factors can give rise to ME:

1. A residual pathogenic factor (usually Heat or Damp-Heat) after an invasion of an
   exterior pathogenic factor


2. Latent Heat, in the way described above


3. A pathogenic factor lodged between the Exterior and Interior, i.e. Lesser Yang
   pattern.

Treatment

In all these three cases, it is crucial to diagnose exactly the relative strength of pathogenic factor
vs. deficiency of body's Qi. To treat ME properly, it is most important to be able to distinguish
whether the predominant aspect is the pathogenic factor (i.e. Excess pattern) or the deficiency of
body's Qi (i.e. Deficiency pattern). Of course, almost all cases are characterized by a mixture of
Excess (of Heat or Damp-Heat) and Deficiency (usually of Qi and/or Yin). For this reason to
treat ME one nearly always needs to combine tonification with expelling, and expelling with
tonification. One of these conditions, however, is always predominant and treatment should be
clearly aimed at either clearing a pathogenic factor or tonifying the body's Qi. If we tonify when
a pathogenic factor is predominant, or if we clear when a deficiency is predominant, the patient
will definitely be worse.

One of the main factors which enables us to distinguish whether the condition is predominantly
one of Deficiency or Excess is the pulse. Quite simply, if the pulse is very Fine or Weak,
Deficiency is predominant; if the pulse is of the Full-type (which could be Wiry or Slippery), an
Excess is predominant. Another symptom which allows us to differentiate between a
pedominantly Deficienct or predominantly Full condition, is the muscle ache: if this is very