尺寸俱长者，阳明受病也。当二三日发，以其脉夹鼻，络于目，故身热，目痛鼻干，不得卧。
（此证恶寒可发汗，若恶寒罢，反自汗恶热者，为胃家实，属正阳明，宜调胃承气汤，方在太阳证
下。）
庞曰∶有三阳阳明者，其太阳阳明，本太阳病，若发汗，若下，若利小便，此
亡津液，胃中干燥，因转属阳明也；少阳阳明者，本传到少阳，因发汗，利小便已，胃中燥，大便
难也；正阳阳明者，病患本风盛气实，津液消铄，或始恶寒，汗出多，寒罢而反发热，或始得病便
发热狂言也。
凡阳明证俱宜下，唯中寒恶寒为病在经，与太阳合病属表，可发其汗。
二阳合病，脉必浮大而长，外证必头痛腰疼，肌热目疼鼻干也。浮大者，太阳受病也；长者，
阳明也。头腰太阳也，肌目鼻阳明也。
二阳并病，太阳证罢，但发潮热，手足 汗出，大便难而谵语者，大承气汤下之则愈。（方
在可下证中。）
二阳并病，太阳初得时，发其汗，汗先出复不彻，因转属阳明，自微汗不恶寒。若太阳证不罢，
不可下，下之为逆，如此者可小发其汗。设面色正赤者，阳气怫郁在表，当解之蒸之。若汗出不彻，
当短息，不足言，阳气怫郁不得越，当汗出而不汗，其人短气但坐，以汗出不彻故也，宜麻黄汤更
发其汗即愈。何以知其汗不彻，其脉涩故知也。（方在可汗证中。古本字多差误，以从来所见病患
证候中，符合如此，故改正。）阳明病，能食为中风，不能食为中寒。
阳明病中寒，脉浮无汗，其人必喘，发汗则愈，宜麻黄汤。（方在可汗证中。）
阳明病，脉迟，汗出多，微恶寒者，表未解，发汗则愈，宜桂枝汤。（方在可汗证中。）若不
恶寒，为外欲解，手足 然汗出者，大便已硬，宜大承气汤。（方在可下证中。）
阳明病有不可攻者，谓阳明病，心下硬满者，不可攻，攻之利不止者死，利止者愈。
阳明病，或发汗，或自汗，大便虽硬，小便少者，未可攻，津液恐还入胃，必先硬后溏也。小
便自如，乃可攻之。
阳明中风，口苦咽干，腹满微喘，发热恶寒，其脉浮紧。若下之，则腹满小便难也。（此证必
无汗，与后证相似，且恶寒无汗为异，以咽干腹满，亦不宜正与汗药，别与消详也。）
阳明病，脉浮而紧，咽干口苦，腹满而喘，发热汗出，不恶寒而反恶热，身重。若发汗则烦躁
愦愦，反谵语；若加温针，必怵惕烦躁不得眠；若下则胃中空虚，客气动膈，心中懊 ，苔生舌上
者，栀子香豉汤主之。
肥栀子（十枚） 香豉（二合）
水二升，煮栀子减半，下豉再煮八合，去滓，温服一盏。得快吐者，止后服。
脉浮紧，必无汗，而反有汗，咽燥，腹满，恶热，法当下之；而又脉浮紧，不当下，此恐变风
温，宜细详。
阳明病，口鼻燥，但漱水而不欲咽者，必衄。
When both the Cun (inch) and Chi (cubit) pulses are long, it indicates that the Yangming channel is affected. Symptoms typically manifest on the second or third day of onset. Since the Yangming channel runs alongside the nose and connects to the eyes, symptoms include fever, eye pain, nasal dryness, and inability to rest.
(This syndrome, if accompanied by aversion to cold, can be treated with diaphoresis. If aversion to cold subsides and is replaced by spontaneous sweating and heat intolerance, it constitutes "Stomach Excess" (Wei Jia Shi), representing true Yangming disease. The appropriate formula is Tiaowei Chengqi Tang (Regulate the Stomach Order Qi Decoction); see the Taiyang chapter for the prescription.)
Pang Anshi stated: There are three types of Yangming involvement among the Three Yang channels.
1. Taiyang-Yangming: Originally a Taiyang disease. After treatment with diaphoresis, purgation, or promoting urination, body fluids are depleted, causing dryness in the stomach, leading to a transformation into Yangming disease.
2. Shaoyang-Yangming: Originally transmitted to the Shaoyang channel. After diaphoresis and promoting urination, the stomach becomes dry, resulting in difficult defecation.
3. Zhengyang-Yangming (True Yangming): The patient originally had strong wind pathogenic factors and robust qi, leading to the consumption of body fluids. Alternatively, initial aversion to cold with profuse sweating, followed by the cessation of aversion to cold and the onset of fever; or immediate fever and delirious speech upon contracting the disease.
Generally, all Yangming syndromes are suitable for purgation. However, if there is cold damage with aversion to cold, indicating the pathogen is in the channels and combined with Taiyang as a exterior syndrome, diaphoresis may be used.
In the combination of Two Yangs (Taiyang and Yangming), the pulse must be floating, large, and long. Exterior symptoms must include headache, lower back pain, muscle heat, eye pain, and nasal dryness. A floating-large pulse indicates Taiyang involvement; a long pulse indicates Yangming involvement. The head and waist belong to Taiyang; muscles, eyes, and nose belong to Yangming.
In the concurrent disease of Two Yangs, if the Taiyang syndrome has resolved, but tidal fever, continuous sweating on the hands and feet, difficult defecation, and delirium occur, Da Chengqi Tang (Major Order the Qi Decoction) should be administered via purgation for cure. (See the "Suitable for Purgation" chapter for the prescription.)
In the concurrent disease of Two Yangs, if at the initial stage of Taiyang disease, diaphoresis was applied but the sweat was not thorough, transforming into Yangming, presenting with slight sweating and no aversion to cold. If the Taiyang syndrome has not resolved, purgation is contraindicated; doing so is an error. In such cases, mild diaphoresis should be induced. If the face appears distinctly red, it indicates Yang qi stagnating in the exterior, requiring resolution through steaming/diaphoretic methods. If sweat is not thorough, shortness of breath and inability to speak fully may occur due to stagnant Yang qi failing to vent. The patient experiences shortness of breath and prefers sitting because sweat was not thorough. Ma Huang Tang (Ephedra Decoction) should be used to induce further sweating for recovery. How do we know sweat was not thorough? By observing a choppy pulse. (See the "Suitable for Diaphoresis" chapter for the prescription. Ancient texts contain many errors; these corrections are based on observed clinical presentations matching this pattern.)
In Yangming disease, the ability to eat indicates Wind Strike (Zhong Feng), while inability to eat indicates Cold Strike (Zhong Han).
For Yangming disease with Cold Strike, if the pulse is floating and there is no sweat, the patient will likely have asthma/wheezing. Diaphoresis will lead to recovery; Ma Huang Tang (Ephedra Decoction) is appropriate. (See the "Suitable for Diaphoresis" chapter for the prescription.)
In Yangming disease, if the pulse is slow, there is profuse sweating, and slight aversion to cold, the exterior syndrome has not resolved. Diaphoresis will lead to recovery; Gui Zhi Tang (Cinnamon Twig Decoction) is appropriate. (See the "Suitable for Diaphoresis" chapter for the prescription.) If there is no aversion to cold, the exterior is resolving. Continuous sweating on the hands and feet indicates hardened stool; Da Chengqi Tang (Major Order the Qi Decoction) is appropriate. (See the "Suitable for Purgation" chapter for the prescription.)
There are cases in Yangming disease where attack/purgation is contraindicated. If a Yangming patient presents with hardness and fullness in the epigastrium, purgation is contraindicated. If purgation leads to unceasing diarrhea, death ensues; if diarrhea stops, recovery occurs.
In Yangming disease, whether from induced sweating or spontaneous sweating, if the stool is hard but urine volume is low, purgation is premature. Body fluids may return to the stomach, causing the stool to be initially hard and later loose. Only when urination is normal can purgation be considered.
Yangming Wind Strike presents with bitter taste in the mouth, dry throat, abdominal fullness, slight wheezing, fever, aversion to cold, and a floating-tight pulse. If purgation is mistakenly used, abdominal fullness and difficulty urinating will result. (This syndrome necessarily lacks sweat, resembling subsequent syndromes, but is distinguished by aversion to cold and lack of sweat. Due to dry throat and abdominal fullness, standard diaphoretic herbs are unsuitable; careful differentiation is required.)
In Yangming disease, if the pulse is floating and tight, with dry throat, bitter taste, abdominal fullness, wheezing, fever, sweating, aversion to heat rather than cold, and heavy body:
- Mistaken diaphoresis causes irritability, confusion, and delirium.
- Adding moxibustion/heat therapy causes fright, irritability, and insomnia.
- Mistaken purgation empties the stomach, allowing pathogenic qi to disturb the diaphragm, causing mental restlessness and agitation, with coating on the tongue. Zhi Zi Chi Dou Tang (Gardenia and Fermented Soybean Decoction) is the primary treatment.
Ingredients: Fei Zhi Zi (Gardeniae Fructus, 10 pieces), Xiang Chi (Sojae Seminis Praeparatum, 2 he).
Boil in 2 sheng of water until reduced by half, add Xiang Chi, boil again to obtain 8 he. Strain and take warm. If rapid vomiting occurs, stop subsequent doses.
A floating-tight pulse usually indicates no sweat, but here sweat is present, along with dry throat, abdominal fullness, and heat intolerance. Legally, this suggests purgation; however, the floating-tight pulse argues against it. This may transform into Wind-Warmth disease; careful analysis is required.
In Yangming disease, if the mouth and nose are dry, and the patient rinses water in the mouth but does not swallow, epistaxis (nosebleed) will inevitably occur.