鄭論：論陽明病，汗出多，脈應長大，今脈遲而汗出多，殊屬不合。又到微惡寒，表未解，可發汗，明是太陽寒邪，初入陽明，寒邪尚未化盡，故宜以桂枝湯導之也。
【闡釋】此太陽風傷衛，傳至陽明，寒邪尚未化盡，故仍可用桂枝湯，以外解表邪，但必須是裏熱不甚者。此仲景從證不從脈而用桂枝湯解表。
二、陽明病，脈浮，無汗而喘者，發汗則愈，宜麻黃湯。原文235
鄭論：按此條，乃太陽之病，太陽之方，並未有陽明脈象病情，實屬不合，理應例入太陽篇為式。
【闡釋】前條是太陽中風與陽明並病，這條是太陽傷寒與陽明並病，無汗惡寒為表實，肺氣郁而不宣的喘證，麻黃湯為對症之方。此條毫無陽明脈象病情，故應如鄭氏所說，列入太陽篇。
三、陽明病，〔若〕能食（者），（為）〔名〕中風；不能食（者），（為）〔名〕中寒。原文190
鄭論：按能食為中風，風為陽，陽能消穀也。不能食為中寒，寒為陰，陰不能消穀也。但陽明病，果是何等病情，而見此能食不能食也。
【闡釋】此節言陽明自受風寒之證也。蓋陽明居中土，外之風寒幹之，故俱言中。又陽明胃腑，以納穀為務，風寒既內中，風為陽邪，陽能化穀，故能食也，寒乃陰邪，不能化穀，故不能食也。此以能食、不能食來辨別陽明所受之風、或寒也。
四、脈陽微而汗出少者①，為自和也；汗出多者，為太過。陽（邪）〔脈〕實②因發其汗，出多者，亦為太過。太過〔者〕，為陽絕於裏③。亡津液，大便因鞭也。原文245
①脈陽徽：指脈浮而徽軟。
②陽脈實：指脈浮有力而盛。
③陽絕於裏：指陰液耗攝，陽氣盛極於裏
鄭論：論陽明而見脈微，汗出少為自和者，邪衰之征也；汗出多為太過者，又慮陽之外亡也。陽脈實，因發其汗，出多者，亦為太過，太過則津液太虧，大非吉事，故原文謂陽絕於內者，明明言汗之太過也，汗出則陽必與之俱出，而津液有立亡之機，大便因鞭之所由生，而危亡之機，亦於此見也。
【闡釋】本節指津液外亡，陽無陰制則燥熱益甚，腸中乏液以潤，大便因而鞕結。故無論是自汗或發汗，皆不可太過，而使津液耗損，腸中乾燥，造成大便鞭的變證。鄭氏更進一層指出“汗出則陽必與之俱出，………而危亡之機，亦於此見也”的卓識。
五、問曰：陽明病，外證④雲何？答曰：身熱，汗自出，（而）不惡寒，反惡熱也。原文182
④外證：就是表現在外面的證候。
鄭論：太陽症，發熱惡寒，惟陽明病發熱不惡寒，以此別之。
【闡釋】身熱汗出，為太陽、陽明共有證狀，在臨床鑒別上，鄭氏說。“太陽症發熱惡寒，陽明病發熱不惡寒”，僅言其大概，而應補充。太陽脈浮，陽明脈洪大；太陽無裏實證，陽明有裏實證；太陽證的發熱是翕翕發熱，而熱在體表，陽明病的發熱是蒸蒸發熱，是熱從內蒸。以此別之，更為精審。
六、問曰：何緣得陽明病？答曰：太陽病，若發汗、若下、若（到）〔利〕小便，〔此〕亡津液，胃中乾燥，因轉屬陽明，不更衣⑤，內實⑥，大便難〔者〕，此名陽明也。原文181
⑤不更衣：即不大便，古人入廁，雅言更衣，因此更衣又為大便的通。
⑥內實：腸中有燥屎結滯。
鄭論：此由太陽病，因汗、吐、下後津液大傷，胃中乾燥，遂成內實，不更衣，大便難之症作，故稱之曰陽明病，的確不易。
【闡釋】陽明腑證，有因本經熱盛，自然化燥而成的；有因誤治傷津，病邪化熱化燥內傳而成的。本條即由太陽病誤治而轉屬陽明腑實證。既言內實，必然有腹滿痛，便閉燥煩等實象。
七、問曰：病有（一日得之）〔得之一日〕，不發熱而惡寒者，何也？答曰：雖得之一日，惡寒將自罷，即自汗出而惡熱也。原文183
鄭論：發熱惡寒，太陽症也，而雲陽明，是太陽之寒邪已至陽明，而寒邪尚未化盡耳。若化盡，轉瞬即獨發熱不惡寒，而為陽明之本症也。時稱瘟疫獨發熱不惡寒，仍是一陽明證也。時書紛紛聚訟，以為仲景只知有傷寒，而不知仲景之陽明證，即溫熱之柱腳也。
【闡釋】鄭氏指出“瘟疫獨發熱不惡寒，仍是一陽明證也”，是有其獨特見解。溫病總是一個熱病，麻杏石甘湯、白虎湯、白虎加人參湯、大、小承氣湯，皆治溫病之方也。
八、問曰：“惡寒何故將自罷？”答曰：“陽明居中，〔主〕土也①，萬物所歸，無所複傳，始雖惡寒，二日自止（者），此為陽明病也”。原文184
①主土：土是五行之一，脾胃隸屬於土。由於脾和胃的生理機能以及病態表現的不同，所以有脾屬陰土，胃屬陽土的分別，又因土的方位在中央，所以說陽明居中主土。
鄭論：按惡寒將自罷者，是這太陽之寒邪，至陽明地界，陽明主燥，乃多氣多血之府，邪至而從燥化，則寒變為熱，遂不寒，而獨發熱也。
【闡釋】此承上條說明陽明病惡寒自罷的原因，亦即揭出胃家邪實之所由成也。原文在未答惡寒何故自罷之前，先敘陽明的部位、功能、性質、病理並隱寓治法，言脾胃同屬中土，胃居體之中部，有納水穀的功能，其性主燥，胃燥太過，則三焦之邪，皆聚於胃，邪入之必成燥化，因燥成實，邪即留中不去，必待下之而後愈。惡寒一證，雖初病時見之，至二日邪從燥化後，必然自罷，此即陽明病惡寒自罷之理。
九、本太陽（病）初得〔病〕時，發其汗，汗先出不徹，因轉屬陽明也。原文185前段
鄭論：太陽病，本應汗解，汗發不透，是寒邪阻滯氣機，逆而不出，遂傳至陽明，而成陽明症也.
【闡釋】此節說明太陽病轉屬陽明的另一原因為發汗而汗出不徹，以致表邪不得外解，反而內傳化燥，因而轉屬陽明。與前4條太陽病轉屬陽明是發汗而汗出過多，津傷化燥而邪內傳，顯然不同。故證候的傳變與治療的得當與否，實有密切關係。
十、若汗多，微發熱惡寒者，（則）外未解也，其熱不潮，（又）未可與承氣湯（主之）；若腹大滿不通者，可與小承氣湯〕，微和胃氣，勿令〔至〕大泄下。原文208後段
鄭論：按汗多微發熱、惡寒，在久病陽虛之人見此，則為亡陽之征。若新病太陽症之人，而見此者，則為邪將去之兆，並未見潮熱，是邪未入陽明，未可與承氣湯。若陽明症見，而又有腹滿不通，可與小承氣湯，是斟酌元氣、邪氣之盛衰，而令其勿大泄，慎重之意也。
【闡釋】本條可分兩節。第一節“若汗多微發熱惡寒者”……未可與承氣湯，此表證未盡解，不可使用下法。第二節“若腹大滿不通者，……勿令至大泄下。”說明裏實證固應攻下，但燥結未甚，只宜小承氣湯微和胃氣，不宜大承氣湯峻攻。
小承氣湯方（校補）
大黃四兩（酒洗）厚樸二兩（炙去皮）枳實三枚大者（炙）上三味，以水四升，煮取一升二合，去渣，分溫二服。初服湯當更衣，不爾者盡飲之，若更衣者，勿服之。
【方解及其應用範圍】此大承氣湯去芒硝，積、樸用量亦少，藥力自比大承氣為輕，則勢緩矣。治痞滿實而不燥的症候。大黃可瀉下實熱；枳實、厚樸消腹脹痞滿。其臨床證候與大承氣湯類似，但較輕。各種急性熱病，治之皆有效。
十一、太陽病，若吐、若下、若發汗〔後〕，微煩，小便數，大便因鞭者，與小承氣湯（主之），〔和之愈〕。原文250
鄭論：按汗、吐、下三法，無論何法，皆是損元氣，亡津液之道，津液傷，則燥氣立作，故有微煩，二便數、鞭之症，與以小承氣，和其胃氣，除其煩熱，其病自已。
【闡釋】太陽病治之不當，津液受傷，熱邪入裏，致見心煩，小便數，大便鞭等，此津傷氣滯，以小承氣湯和之則諸症自愈。
十二、傷寒吐後，腹脹滿者，與調胃承氣湯。原文249
鄭論：按腹脹滿，胃家未大實者，可與小承氣湯，俾和其胃氣，以泄其邪熱，乃為合法。若因吐後而中州大傷，以致脹滿者，此是胸中胃陽，因吐而傷，宣佈失職，濁陰僭亂，堵塞中宮，宜溫中健脾，俾胃氣宣暢，而脹滿自消，此又非調胃承氣所宜也，學者臨證，宜細求之。
【闡釋】若因吐後，見到腹部脹滿，有兩種情況。其一在上之邪，雖得到排除，而在下之病邪，卻化燥成實，此時應用下法，但究因吐後，中氣必然受傷，雖有實邪內聚，又不宜峻下，調胃承氣湯是為最適當的方劑。其後有如鄭氏所雲：“若因吐後，而中州大傷，以致脹滿者，…宜溫中健脾，俾胃氣宣暢，而脹滿自消。”豈可複用下法，以重傷其正，調胃承氣決不可用。筆者認為當用理中湯加砂仁、公丁香治之。
謂胃承氣湯方（校補）
大黃四兩（去皮，清酒洗）甘草二兩（炙）芒硝半升上三味，以水三升，煮取一升，去渣，內芒硝，更上火微煮令沸，少少溫服之。
【方解及其應用範圍】本方係大承氣湯去厚樸、枳實，加甘草而成。大黃瀉下實熱，芒硝潤燥軟堅，佐甘草以和胃氣，用以治療腹中有實熱，大便燥結的症候。其藥力比小承氣還輕，對各種急性熱病之輕者為宜。治消渴證之中消，即渴而飲食多者，亦有效。
十三、陽明病，心下鞭滿者，不可攻之；攻之利遂不止者，死；利止者愈。原文205
鄭論：按心下鞭滿，有可攻者，有不可攻者，有熱結者，有寒結者，總之詳（虎）〔辨〕的確，可攻則攻，可攻則勿妄攻，攻之利不止者，死，以其利甚則亡陰，陰亡而陽與之俱亡，故斷其必死。若下利而能自止者，是中氣猶存，陽不即亡，故知其必生。
【闡釋】心下是胃脘部位，心下鞕滿，不同于腹部鞕滿，可知病邪偏於上。此心下鞭滿而不痛，是胃氣不實，客氣上逆所致。裏實腹滿可攻，今心下鞭滿而非腹鞭滿，乃未成實，故不可攻。腹部鞭滿是腸中有燥屎內結，可以用承氣湯攻下，一下而愈。若此證有虛、實、寒、熱之不同，實證、熱證可以攻下，可用承氣湯；虛證、寒證則不可妄攻，若攻之則脾胃受損，邪氣內陷，形成下利不止，甚至胃氣敗絕而亡。筆者認為可用附子理中湯溫補脾腎之陽以救之。若利能自止，是胃氣漸複，為病有自愈之機。
十四、傷寒嘔多，雖有陽明證，不可攻之①。原文204
①攻之：此處是指瀉下而言。
鄭論：嘔多二字，有熱嘔寒嘔之別，雖有陽明證，不可妄加指責攻，務要審慎的確為是。
【闡釋】惡寒發熱之嘔屬太陽，寒熱往來之嘔屬少陽，但惡熱不惡寒之嘔屬陽明，此三陽嘔吐之辨證也。鄭氏雲：“嘔多二字，有熱嘔、寒嘔之別”。嘔多是病機向上，若用攻法，是逆其所治，最易造成變證。筆者于寒嘔者，可用理中湯加吳茱萸以溫降之；熱嘔者，可用黃連吳萸湯以清之降之。至三陽症之嘔證，必結合三陽病之其他證狀，選用三陽之方治之，斯為得矣。
十五、食穀欲（吐者）〔嘔〕②，屬陽明也③，吳茱萸湯主之。得湯反劇者，屬上焦（熱）也。原文243
②食穀欲嘔：當進餐時氣逆作嘔。
③屬陽明：指胃家虛寒。
鄭論：按吳茱萸湯，乃治少陰吐利之方，非陽明之正方也。此刻食穀欲嘔，乃屬陽明，必是胃中邪熱彌漫，隔拒上焦，故得吳萸辛燥之品而反劇，可知非虛寒也明甚。原文如此模糊，何不先判明陰陽，而曰食穀欲嘔，喜飲熱湯者，可與吳茱萸湯。嘔而欲飲冷者，此屬上焦有熱，以此推去、方不負立法之意。
【闡釋】食穀欲嘔，這是胃家虛寒的特徵，虛則不能納穀，寒則胃氣上逆，所以決診為陽明虛寒，溫中降逆之吳茱萸湯，自為對症之方。若上焦有熱，服吳茱萸湯相反使病情增劇。鄭氏以飲熱、飲冷判寒熱，以定吳茱萸湯之可用不可用，乃簡明扼要之法矣。吳茱萸湯方，載少陰前篇。
十六、陽明中風，口苦咽幹，腹滿微喘，發熱惡寒，脈浮而緊，若下之，則腹滿，小便難也。原文189
鄭論：此陽明而兼太、少證，何也？口苦咽幹，所現者少陽之經證；微喘，發熱惡寒，所現者太陽之表邪；脈現浮緊，風寒之征。此證雖雲陽明，而陽明胃實之證未見，故曰：若下之，則腹滿、小便難，此是教人不可下。若下則引邪入太陰，故見腹滿，中樞失職，轉輸必乖，故見小便難，此刻總宜照三陽並病法治之可也。
【闡釋】本條是三陽合病，但以太陽和陽明證最重，所以稱做陽明中風。
重點在於陽明，邪熱在經，禁用下法，否則引邪深入。仲景未出方治，鄭氏說：總宜照三陽並病法治之可也。筆者認為三陽經症同見，即以三陽之方治之，一舉祛邪外出，桂麻各半湯加柴、葛、苓、夏主之。
十七、陽明病，脈浮而緊，咽燥口苦，腹滿而喘，發熱汗出，不惡寒，（而）反惡熱，身重。若發汗則（燥）〔躁〕，心憒憒①，反譫語；若加溫針，必休惕②，煩〔躁〕不得眠；若下之，則胃中空虛，客氣動隔，心中懊憹③，舌上苔者④，（宜）梔子豉湯主之。若渴欲飲水，口乾舌燥者，白虎加人參湯主之。若脈浮發熱，渴欲飲水，小便不利者，豬苓湯主之。原文221、222、223
①憒憒：煩亂貌。
②休惕：恐懼貌。
③懊憹：煩悶不舒。
④舌上苔者：是舌上有黃白薄膩的苔垢。
Zheng's Commentary: Discussing Yangming disease, if there is profuse sweating, the pulse should be large (Hong). Now, with a slow (Chi) pulse and profuse sweating, this is highly inconsistent. Furthermore, mentioning slight aversion to cold indicates that the exterior syndrome has not been resolved, and diaphoresis can be used. This clearly indicates Taiyang cold pathogen entering Yangming for the first time, where the cold pathogen has not yet completely transformed into heat; therefore, it is appropriate to use Guizhi Tang (Cinnamon Twig Decoction) to guide the treatment.
[Explanation] This refers to Taiyang wind-strike injuring the Wei (Defensive) level, transmitting to Yangming, but the cold pathogen has not yet completely transformed. Thus, Guizhi Tang (Cinnamon Twig Decoction) can still be used to resolve the exterior pathogen, provided that the interior heat is not severe. This illustrates Zhang Zhongjing’s method of selecting Guizhi Tang (Cinnamon Twig Decoction) to resolve the exterior based on symptoms rather than pulse alone.
2. In Yangming disease, if the pulse is floating (Fu), there is no sweating, and there is wheezing, resolving via diaphoresis will lead to recovery; Mahuang Tang (Ephedra Decoction) is indicated. Original Text 235
Zheng's Commentary: According to this clause, it belongs to Taiyang disease and uses a Taiyang formula, without presenting any Yangming pulse characteristics or clinical manifestations. This is logically inconsistent and should ideally be categorized under the Taiyang chapter as an example.
[Explanation] The previous clause describes the concurrent disease of Taiyang wind-strike and Yangming, while this clause describes the concurrent disease of Taiyang cold-injury and Yangming. No sweating and aversion to cold indicate exterior excess syndrome, and wheezing results from Lung Qi stagnation and failure to diffuse. Mahuang Tang (Ephedra Decoction) is the symptomatic formula. Since this clause lacks any Yangming pulse or clinical signs, it should, as Zheng suggests, be included in the Taiyang chapter.
3. In Yangming disease, if the patient can eat, it is named Wind-strike; if the patient cannot eat, it is named Cold-injury. Original Text 190
Zheng's Commentary: The ability to eat is due to Wind-strike; Wind is Yang, and Yang energy can digest grain. The inability to eat is due to Cold-injury; Cold is Yin, and Yin energy cannot digest grain. However, what specific clinical condition in Yangming disease leads to these differences in appetite?
[Explanation] This section discusses the symptoms of Yangming disease directly contracting Wind or Cold. Because Yangming resides in the central Earth element, external Wind and Cold invade it, hence both are termed "Zhong" (struck/entered). Additionally, the Yangming Stomach Fu organ is responsible for receiving and digesting grain. Once Wind and Cold have entered internally, Wind, being a Yang pathogen, can transform grain, allowing the patient to eat; Cold, being a Yin pathogen, cannot transform grain, leading to an inability to eat. This distinguishes whether Yangming has contracted Wind or Cold based on the ability to eat.
4. If the pulse at the Cun position is subtle (Wei) and sweating is scant, this indicates self-harmony; if sweating is profuse, it indicates excess. If the pulse is full and forceful (Yang Mai Shi) and diaphoresis causes profuse sweating, this is also excess. Excess leads to the exhaustion of Yang within the interior (Yang Jue Yu Li). The loss of body fluids results in hard stool. Original Text 245
① Pulse Yang Wei: Refers to a floating and weakly soft pulse.
② Yang Mai Shi: Refers to a floating, forceful, and vigorous pulse.
③ Yang Jue Yu Li: Refers to the consumption of Yin fluids and extreme excess of Yang within the interior.
Zheng's Commentary: Discussing Yangming disease but observing a subtle pulse, stating that scant sweating indicates self-harmony is a sign of declining pathogen; stating that profuse sweating indicates excess raises concern for the outward loss of Yang. With a full Yang pulse, causing profuse sweating through diaphoresis is also excess. Excess leads to severe depletion of body fluids, which is far from auspicious. Thus, the original text states "Yang exhaustion within," clearly meaning excessive sweating. When sweat exits, Yang inevitably exits with it, creating an immediate risk of fluid loss, which explains the origin of hard stool, and the mechanism of critical danger is revealed here.
[Explanation] This section points out that when body fluids are lost externally, Yang lacks Yin control, causing dryness-heat to intensify. The intestines lack fluid lubrication, leading to hard stool. Therefore, whether spontaneous sweating or induced diaphoresis, one must not be excessive, to avoid fluid depletion and intestinal dryness causing hard stool. Zheng further highlights the profound insight that "when sweat exits, Yang inevitably exits with it... revealing the mechanism of critical danger."
5. Question: What are the exterior manifestations of Yangming disease? Answer: Body heat, spontaneous sweating, no aversion to cold, but rather aversion to heat. Original Text 182
④ Exterior Manifestations: Symptoms manifested on the exterior.
Zheng's Commentary: Taiyang syndrome presents with fever and aversion to cold. Only Yangming disease presents with fever without aversion to cold; this distinguishes them.
[Explanation] Fever and sweating are common to both Taiyang and Yangming. For clinical differentiation, Zheng stated: "Taiyang syndrome has fever and aversion to cold; Yangming disease has fever without aversion to cold." This is general and should be supplemented. Taiyang pulse is floating; Yangming pulse is洪大 (large and vigorous). Taiyang has no interior excess syndrome; Yangming has interior excess syndrome. Taiyang fever is like a bird covering itself (Xi Xi), located on the body surface; Yangming fever is steaming (Zheng Zheng), emanating from within. Differentiating by these means is more precise.
6. Question: How does one contract Yangming disease? Answer: In Taiyang disease, if diaphoresis, purgation, or promoting urination is used, resulting in the loss of body fluids, dryness in the Stomach, and subsequent transmission to Yangming, constipation (Bu Geng Yi), interior excess (Nei Shi), and difficult defecation occur. This is named Yangming disease. Original Text 181
⑤ Bu Geng Yi: Literally "changing clothes," a polite term for defecation, thus referring to constipation.
⑥ Nei Shi: Dry feces impaction in the intestines.
Zheng's Commentary: This arises because after diaphoresis, emesis, or purgation in Taiyang disease, body fluids are severely damaged, causing dryness in the Stomach, leading to interior excess, constipation, and difficult defecation. Hence, it is called Yangming disease, which is indeed accurate.
[Explanation] Yangming Fu syndrome can arise naturally from intense heat in the channel transforming into dryness, or from mismanagement damaging fluids, causing the pathogen to transform into heat and dryness and transmit inward. This clause results from mismanagement of Taiyang disease transmitting to Yangming Fu excess syndrome. Given "interior excess," there must be signs of excess such as abdominal fullness and pain, constipation, and irritability.
7. Question: There is a case where, after one day of illness, there is no fever but aversion to cold. Why? Answer: Although it has been one day, the aversion to cold will cease spontaneously, followed by spontaneous sweating and aversion to heat. Original Text 183
Zheng's Commentary: Fever and aversion to cold are Taiyang symptoms. Mentioning Yangming implies that Taiyang cold pathogen has reached Yangming, but the cold has not yet fully transformed. If it transforms completely, it will soon present with isolated fever without aversion to cold, becoming the fundamental symptom of Yangming. Contemporary plague presentations of isolated fever without aversion to cold are still Yangming syndromes. Contemporary books argue that Zhang Zhongjing only knew of Cold Injury, not realizing that his Yangming syndrome is the foundation of Warm Heat diseases.
[Explanation] Zheng’s point that "plague isolated fever without aversion to cold is still a Yangming syndrome" shows unique insight. Warm diseases are essentially heat diseases. formulas such as Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction), Bai Hu Tang (White Tiger Decoction), Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng), Da Cheng Qi Tang (Major Order the Qi Decoction), and Xiao Cheng Qi Tang (Minor Order the Qi Decoction) are all treatments for warm diseases.
8. Question: "Why will the aversion to cold cease spontaneously?" Answer: "Yangming resides in the center, governing Earth. It is the destination of all things and transmits nowhere. Initially, there may be aversion to cold, but it stops spontaneously by the second day; this is Yangming disease." Original Text 184
① Governing Earth: Earth is one of the Five Phases; Spleen and Stomach belong to Earth. Due to different physiological functions and pathological manifestations, Spleen is Yin Earth and Stomach is Yang Earth. Since Earth is central, Yangming is said to reside centrally and govern Earth.
Zheng's Commentary: Regarding the cessation of aversion to cold, when the Taiyang cold pathogen reaches the Yangming territory, Yangming governs Dryness. It is a reservoir abundant in Qi and Blood. When the pathogen arrives, it transforms according to Dryness; thus, Cold changes to Heat, ceasing aversion to cold and presenting with isolated fever.
[Explanation] This continues the previous clause to explain why aversion to cold ceases spontaneously in Yangming disease, revealing the formation of Stomach-Gut excess. Before answering why aversion to cold ceases, the original text first describes Yangming's location, function, nature, and pathology, implying treatment. Spleen and Stomach both belong to Central Earth; Stomach is in the middle of the body, receiving water and grain, with a nature governing Dryness. If Stomach Dryness is excessive, pathogens from the Triple Burner gather in the Stomach. Once entering, they transform into Dryness, forming Excess. The pathogen stays in the middle, requiring purgation for resolution. Aversion to cold appears initially but ceases spontaneously after two days as the pathogen transforms into Dryness. This is the principle behind the spontaneous cessation of aversion to cold in Yangming disease.
9. Originally, when Taiyang disease was just acquired, diaphoresis was applied, but the sweat did not come out thoroughly, leading to transmission to Yangming. Original Text 185 (First part)
Zheng's Commentary: Taiyang disease should be resolved by diaphoresis. If sweat is not thorough, it is because cold pathogen obstructs Qi mechanism, reversing and failing to exit, thus transmitting to Yangming and forming Yangming syndrome.
[Explanation] This section explains another reason for Taiyang transmitting to Yangming: diaphoresis that is not thorough, preventing exterior pathogen resolution and causing internal transmission and transformation into Dryness. This differs significantly from the previous four clauses where Taiyang transmitted to Yangming due to excessive sweating damaging fluids and transforming into Dryness. Thus, the progression of syndromes is closely related to the appropriateness of treatment.
10. If there is profuse sweating, slight fever, and aversion to cold, the exterior is not yet resolved. If the fever is not tidal (Chao Re), Do Cheng Qi Tang (Order the Qi Decoction) should not be given. If there is significant abdominal fullness and obstruction, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) may be given to gently harmonize Stomach Qi, avoiding severe purgation. Original Text 208 (Second part)
Zheng's Commentary: Profuse sweating with slight fever and aversion to cold in a chronic patient with Yang deficiency indicates Yang collapse. In a new Taiyang syndrome patient, it indicates the pathogen is departing. Without tidal fever, the pathogen has not entered Yangming, so Do Cheng Qi Tang should not be given. If Yangming syndrome appears with abdominal fullness and obstruction, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) can be given. This reflects careful consideration of the balance between healthy Qi and pathogenic factors, advising against severe purgation.
[Explanation] This clause has two parts. The first part ("If profuse sweating, slight fever, and aversion to cold...") indicates unresolved exterior syndrome; purgation is contraindicated. The second part ("If significant abdominal fullness and obstruction... do not cause severe purgation") explains that while interior excess requires purgation, if dryness-impaction is not severe, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) should be used to gently harmonize Stomach Qi, rather than Da Cheng Qi Tang (Major Order the Qi Decoction) for aggressive purgation.
Xiao Cheng Qi Tang Formula (Corrected and Supplemented)
Da Huang (Rhubarb Root and Rhizome) 4 liang (washed with wine)
Hou Po (Magnolia Bark) 2 liang (roasted, bark removed)
Zhi Shi (Immature Bitter Orange) 3 large pieces (roasted)
Boil the above three ingredients in 4 sheng of water to obtain 1.2 sheng. Remove dregs. Divide into two warm doses. After the first dose, if bowel movement occurs, stop taking the medicine. If not, drink the remainder. If bowel movement occurs, do not take the rest.
[Formula Analysis and Scope of Application] This formula is Da Cheng Qi Tang (Major Order the Qi Decoction) without Mang Xiao (Mirabilite), with reduced amounts of Zhi Shi (Immature Bitter Orange) and Hou Po (Magnolia Bark), making its action milder. It treats patterns of fullness and excess without dryness. Da Huang (Rhubarb Root and Rhizome) purges excess heat; Zhi Shi (Immature Bitter Orange) and Hou Po (Magnolia Bark) reduce abdominal distension and fullness. Its clinical presentation is similar to Da Cheng Qi Tang (Major Order the Qi Decoction) but milder. It is effective for various acute febrile diseases.
11. After Taiyang disease is treated with emesis, purgation, or diaphoresis, if there is mild irritability, frequent urination, and hard stool, give Xiao Cheng Qi Tang (Minor Order the Qi Decoction) to harmonize and achieve recovery. Original Text 250
Zheng's Commentary: Diaphoresis, emesis, and purgation all damage Healthy Qi and deplete body fluids. Fluid injury leads to immediate Dryness, causing mild irritability and frequent, hard urination and defecation. Giving Xiao Cheng Qi Tang (Minor Order the Qi Decoction) harmonizes Stomach Qi and removes irritability-heat, leading to natural recovery.
[Explanation] Improper treatment of Taiyang disease damages fluids, allowing heat pathogen to enter the interior, causing heart irritability, frequent urination, and hard stool. This is fluid injury with Qi stagnation; harmonizing with Xiao Cheng Qi Tang (Minor Order the Qi Decoction) resolves all symptoms.
12. After Cold Injury with vomiting, if there is abdominal fullness, give Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction). Original Text 249
Zheng's Commentary: For abdominal fullness without severe Stomach excess, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) can be used to harmonize Stomach Qi and drain pathogenic heat, which is correct. However, if vomiting severely injured the Middle Jiao, causing fullness, this indicates injury to Chest/Stomach Yang, leading to dysfunction of distribution and turbid Yin invading the center. Treatment should warm the Middle and strengthen the Spleen to promote Stomach Qi diffusion, resolving fullness naturally. Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction) is not suitable. Clinicians should investigate carefully.
[Explanation] Abdominal fullness after vomiting has two scenarios. First, upper pathogens are expelled, but lower pathogens transform into dryness-excess. Purgation is needed, but since the Middle Qi is injured by vomiting, aggressive purgation is unsuitable. Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction) is most appropriate. Second, as Zheng states: "If vomiting severely injures the Middle Jiao causing fullness... warm the Middle and strengthen the Spleen." Using purgation again would further damage Healthy Qi; Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction) is absolutely contraindicated. I believe Li Zhong Tang (Regulate the Middle Decoction) added with Sha Ren (Amomum Fruit) and Gong Ding Xiang (Clove) should be used.
Tiao Wei Cheng Qi Tang Formula (Corrected and Supplemented)
Da Huang (Rhubarb Root and Rhizome) 4 liang (peeled, washed with clear wine)
Gan Cao (Licorice Root) 2 liang (roasted)
Mang Xiao (Mirabilite) half sheng
Boil the above three ingredients in 3 sheng of water to obtain 1 sheng. Remove dregs. Add Mang Xiao (Mirabilite). Boil lightly until boiling. Take small amounts warm.
[Formula Analysis and Scope of Application] This formula is Da Cheng Qi Tang (Major Order the Qi Decoction) without Hou Po (Magnolia Bark) and Zhi Shi (Immature Bitter Orange), adding Gan Cao (Licorice Root). Da Huang (Rhubarb Root and Rhizome) purges excess heat; Mang Xiao (Mirabilite) moistens dryness and softens hardness; Gan Cao (Licorice Root) harmonizes Stomach Qi. It treats interior excess heat with dry, hard stool. Its power is lighter than Xiao Cheng Qi Tang (Minor Order the Qi Decoction), suitable for mild cases of acute febrile diseases. It is also effective for Zhong Xiao (Middle Consumption) in Xiao Ke (Wasting-Thirst Syndrome), characterized by thirst and polyphagia.
13. In Yangming disease, if there is hardness and fullness in the epigastrium, do not purge. If purging leads to unceasing diarrhea, death ensues; if diarrhea stops, recovery occurs. Original Text 205
Zheng's Commentary: Epigastric hardness and fullness may be purgable or non-purgable, involving Heat binding or Cold binding. One must distinguish accurately. If purgable, purge; if not, do not purge recklessly. Purging leading to unceasing diarrhea causes death because severe diarrhea exhausts Yin, and when Yin is exhausted, Yang collapses with it, predicting certain death. If diarrhea stops spontaneously, Middle Qi remains, Yang does not immediately collapse, predicting survival.
[Explanation] The epigastrium is the Stomach region. Epigastric hardness/fullness differs from abdominal hardness/fullness, indicating the pathogen is superior. This epigastric hardness/fullness without pain is caused by deficient Stomach Qi and rebellious Guest Qi. Interior excess abdominal fullness can be purged. Here, epigastric hardness/fullness is not abdominal hardness/fullness, meaning Excess has not formed, so purging is contraindicated. Abdominal hardness/fullness indicates dry feces impaction in intestines, treatable with Cheng Qi Tang (Order the Qi Decoction) for cure. If this syndrome varies by Deficiency, Excess, Cold, or Heat, Excess/Heat can be purged with Cheng Qi Tang (Order the Qi Decoction); Deficiency/Cold must not be purged recklessly. Purging would damage Spleen/Stomach, trap pathogen inward, cause unceasing diarrhea, and potentially lead to Stomach Qi collapse and death. I believe Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction) should be used to warm and tonify Spleen/Kidney Yang. If diarrhea stops spontaneously, Stomach Qi is recovering, indicating potential for self-healing.
14. In Cold Injury, if vomiting is frequent, even if Yangming symptoms exist, do not purge. Original Text 204
① Purge: Refers to catharsis/purgation here.
Zheng's Commentary: "Frequent vomiting" distinguishes between Heat vomiting and Cold vomiting. Even with Yangming symptoms, do not recklessly purge. Caution and accuracy are essential.
[Explanation] Vomiting with aversion to cold and fever belongs to Taiyang; alternating chills and fever belongs to Shaoyang; vomiting with aversion to heat but no aversion to cold belongs to Yangming. This distinguishes vomiting among the Three Yang channels. Zheng stated: "Frequent vomiting distinguishes Heat and Cold vomiting." Frequent vomiting indicates upward-moving pathogenic mechanism. Using purgation opposes this direction and easily causes complications. For Cold vomiting, I suggest Li Zhong Tang (Regulate the Middle Decoction) added with Wu Zhu Yu (Evodia Fruit) to warm and descend. For Heat vomiting, Huang Lian Wu Zhu Yu Tang (Coptis and Evodia Decoction) clears and descends. Vomiting in Three Yang syndromes must be combined with other symptoms of the respective Yang diseases to select appropriate formulas.
15. Desire to vomit after eating belongs to Yangming, treated with Wu Zhu Yu Tang (Evodia Decoction). If symptoms worsen after taking the decoction, it belongs to Upper Jiao Heat. Original Text 243
② Desire to vomit after eating: Nausea/vomiting reflex during meals.
③ Belongs to Yangming: Indicates Stomach-Gut Deficiency-Cold.
Zheng's Commentary: Wu Zhu Yu Tang (Evodia Decoction) is a formula for Shaoyang vomiting/diarrhea, not the primary formula for Yangming. Current desire to vomit after eating, belonging to Yangming, implies rampant Stomach pathogenic heat rejecting the Upper Jiao, hence worsening with acrid-dry Wu Zhu Yu (Evodia Fruit). This clearly indicates it is not Deficiency-Cold. The original text is vague. Why not first determine Yin/Yang? If desire to vomit after eating prefers hot drinks, Wu Zhu Yu Tang (Evodia Decoction) can be given. If vomiting desires cold drinks, it indicates Upper Jiao Heat. Deduce accordingly to honor the legislative intent.
[Explanation] Desire to vomit after eating is a characteristic of Stomach-Gut Deficiency-Cold. Deficiency prevents receiving grain; Cold causes Stomach Qi rebellion. Thus, diagnosing Yangming Deficiency-Cold, Wu Zhu Yu Tang (Evodia Decoction) for warming the Middle and descending rebellion is symptomatic. If Upper Jiao Heat exists, Wu Zhu Yu Tang (Evodia Decoction) exacerbates the condition. Zheng’s method of distinguishing Cold/Heat by preference for hot/cold drinks to determine the usability of Wu Zhu Yu Tang (Evodia Decoction) is concise and essential. Wu Zhu Yu Tang (Evodia Decoction) is recorded in the preceding Shaoyang chapter.
16. Yangming Wind-strike, with bitter taste in mouth, dry throat, abdominal fullness, slight wheezing, fever, aversion to cold, floating-tight pulse. If purged, abdominal fullness and difficult urination result. Original Text 189
Zheng's Commentary: This is Yangming concurrent with Taiyin and Shaoyang syndromes. Why? Bitter taste and dry throat manifest Shaoyang channel symptoms; slight wheezing, fever, and aversion to cold manifest Taiyang exterior pathogen; floating-tight pulse indicates Wind-Cold. Although named Yangming, Yangming Stomach Excess symptoms are absent. Thus, "if purged, abdominal fullness and difficult urination result," teaching that purgation is contraindicated. Purging draws pathogen into Taiyin, causing abdominal fullness, and disrupts transport, causing difficult urination. Treatment should follow methods for concurrent Three Yang diseases.
[Explanation] This clause is concurrent disease of the Three Yang channels, but Taiyang and Yangming symptoms are heaviest, hence named Yangming Wind-strike. The focus is on Yangming; pathogenic heat is in the channel, contraindicating purgation to avoid drawing pathogen deeper. Zhong Jing did not provide a formula. Zheng suggested following methods for concurrent Three Yang diseases. I believe when symptoms of all Three Yang channels appear simultaneously, use formulas for all Three Yang channels to expel pathogen in one stroke. Gui Ma Ge Ban Tang (Half Gui Zhi Half Ma Huang Decoction) added with Chai Hu (Bupleurum Root), Ge Gen (Kudzu Root), Fu Ling (Poria), and Ban Xia (Pinellia Tuber) should be used.
17. Yangming disease, pulse floating and tight, dry throat, bitter taste, abdominal fullness and wheezing, fever, sweating, no aversion to cold, but aversion to heat, heavy body. If diaphoresis is used, restlessness (Zao), mental confusion (Kui Kui), and delirium (Zhan Yu) occur. If moxibustion with warm needle is added, fearfulness (Xiu Ti) and irritability (Fan Zao) with insomnia occur. If purged, Stomach becomes empty, Guest Qi agitates the Diaphragm, causing internal restlessness (Ao Nao). If there is coating on the tongue, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is indicated. If thirsty for water, dry mouth and tongue, Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng) is indicated. If pulse is floating, fever, thirst for water, and difficult urination, Zhu Ling Tang (Polyporus Decoction) is indicated. Original Texts 221, 222, 223
① Kui Kui: Appearance of mental confusion/restlessness.
② Xiu Ti: Appearance of fearfulness.
③ Ao Nao: Internal restlessness/discomfort.
④ Coating on tongue: Yellow-white thin greasy coating on the tongue.