鄭論：論陽明證，而揭出數端，學者當細體求，探其病情，相機施治。但身重二字有誤，必是身輕，與陽明證方符，若是身重，則又屬少陰也，與此不合，原文變換太冗，俱宜按病治去，不可固執。
【闡釋】此條亦三陽並病也。然冠以陽明病者，以其中陽明病居多也。脈浮而緊，表邪未罷，太陽也；咽燥口苦者，少陽也；發熱汗出，不惡寒，反惡熱，腹滿而喘者，陽明也。若汗、下、燒針，俱不可用。如誤用之，就發生原文所說病變。這些病變都是由於裏熱加劇，則當用梔豉湯治之。若前證外，更加渴欲飲水，口乾舌燥者為陽明經氣之燥熱，則用白虎加人參湯以解熱生津。若渴欲飲水，小便不利者，是陽明飲熱並盛，津液不得下通，豬苓湯利小便，以瀉下焦之熱也。故鄭氏曰：“原文變換太冗，俱宜按病治去。”是教人細心體求，不可粗心大意。
豬苓湯方（校補）
豬苓（去皮）、茯苓、澤瀉、阿膠、滑石（碎）各一兩上五味，以水四升，先煮四味，取二升，去渣，納阿膠烊消，溫服七合，日三服。
【方解及其應用範圍】本方滋燥利水，豬苓、澤瀉都能利小便以瀉腎與膀胱之濕；茯苓利小便以滲脾肺之濕；滑石利竅泄熱；阿膠育陰潤燥去煩渴。治療陰液不足，發熱水氣不利的疾患，有很好療效。近代推廣本方以治膀胱炎、尿道炎、血尿、淋病等，以其利尿作用來治療上述諸病有顯效。
十八、太陽病，寸緩關浮尺弱，其人發熱汗出，複惡寒，不嘔，但心下痞者，此以醫下之也。（若）〔如〕其不病人不惡寒（但）〔而〕渴者，此轉屬陽明也。小便數者，大便必鞭，不更衣十日，無所苦也。
渴欲飲水，少少與之，但以法救之。渴者，宜五苓散。原文244
鄭論：據脈象病情，乃太陽經證，本桂枝湯法，非可下之法，若未下而見不惡寒，獨發熱而渴，此陽明的候，乃白虎湯法。至小便數，大便鞭，不更衣，十餘日無所苦，雖在胃腑，其邪未實，故不言下。所雲渴欲飲水，亦非五苓的候，當是小便短數而渴，方是五苓的候，學者須知。
【闡釋】本條整個內容都是辨證，可分為四節，自“太陽病”至“此以醫下之也”為第一節，此表證與裏證之辨；自“如其不下者”至“此轉屬陽明也”為第二節，此誤下成痞與未誤下邪傳陽明之辨；自“小便數者”至“無所苦也”為第三節，此承氣證與脾約證之辨；自“渴欲飲水”至“五苓散”為第四節，此胃燥口渴與停水口渴之辨。總之治病必求其本，必須審證精確，才能施治無誤。
十九、陽明病，脈浮而緊者，（自）必潮熱①，發作有時；但浮者，必盜汗出②。原文201
①潮熱：有定時的發熱，有如潮汛一樣。
②盜汗：睡眠中出汗，猶盜賊之出沒于夜間，故名盜汗。
鄭論：按脈浮緊，乃風寒之征，陽明之脈，應見長、大、洪、實，乃為的候。此言浮緊，自必潮熱，但浮者，必盜汗出，是亦憑脈而定病，未必盡當。潮熱，亦必審其虛實，盜汗，亦必究其源委，若執脈而言，恐非正法。
【闡釋】脈浮緊、發熱、惡寒，是太陽病。若陽明病脈浮緊而見潮熱，是熱蒸於外，邪實於裏，故潮熱發作有時；脈但浮而不緊，此為熱越在外，盜汗乃出。故鄭氏說：＂憑脈而定病，未必盡當。”故臨床診斷上，必須脈證合參，不能輕率。
二十、陽明中風，脈弦浮大而短氣，腹都滿①，脅下及心痛，久按之氣不通②，鼻幹，不得汗，嗜臥，一身及（面）目悉黃，小便難，有潮熱，時時噦③，耳前後腫，刺之小差，外不解，病過十日，脈續浮者，與小柴胡湯。脈但浮，無餘證者，與麻黃湯；若不尿，腹滿加噦者，不治。原文231、232
鄭論：稱陽明中風，是邪已確在陽明，至所現病情脈象，實陽明而兼少陽、太陽兩經之證，三陽病勢彌漫已極，理應照三陽並病法治之。至所主柴胡、麻黃二方，皆是相機而行之法。
①腹都滿：作腹部滿解。
②久按之氣不通：言不按氣已短，若久按之氣愈不通，蓋言其邪氣充斥也。
③噦（yuě月，上三聲）：嘔吐。
【闡釋】此節稱陽明中風，而兼及太陽少陽之證也。而曰陽明者，以陽明症居多。本節證情比較複雜，不論是辨證或治療，都存在著一定的困難，必須針對著病情的趨勢而因勢利導，故先刺足陽明三裏穴，宣洩經絡閉鬱之熱。原文“刺之小差，外不解”，是知針刺後裏熱已解。至所主小柴胡湯、麻黃湯，誠如鄭氏所說：“皆是向機而行之法也”。又原文中有“耳前後腫”即《內經》所謂發頤。
俗所謂痄腮也，鄉間稱寸耳寒，西醫稱流行性腮腺炎。此病小兒患者很多，筆者常用麻桂各半湯治之，一、二劑即愈。
二十一、陽明病，脈遲④，食難用飽，飽則微煩頭眩，必小便難，此欲作穀癉⑤。雖下之，腹滿如故，所以然者，脈遲故也。原文195
④脈遲：即脈搏跳動得慢。
⑤穀癉（dàn淡）：指食不消化症。
鄭論：此論而推其所以然之故，曰脈遲。遲則為寒，寒甚即不消穀，理之常也。本非熱結可下之證，即下之，而脹仍如故，是下之更失宜，欲作穀癉，亦陰黃之屬也。小便難者，亦中宮轉輸失職之所致，學者當于遲字處理會可也。
【闡釋】下之腹滿如故，此不當下也。脈遲則寒，陽明虛寒，其滿不過虛熱內壅，非結熱當下之候。法當先行溫中，如理中湯、甘草乾薑湯，然後少與調胃承氣，微和胃氣可也。谷癉，水穀之濕，蒸發而身黃也，亦即陰黃證，可用附子理中湯加茵陳治之。此條亦見於《金匱》黃癉病篇。
二十二、陽明病，若中寒（而）〔者〕，不能食，小便不利，手足濈然汗出①，此欲作固瘕②，必大便初鞭後溏；所以然者，以胃中冷③，水穀不別故也④。原文191
①濈（jǐ及）然：汗出貌，濈，本義為水外流。
②固瘕（jiǎ甲）：是一種寒氣結積的病證，其特徵為大便先鞕後溏。腹中結塊謂之瘕。
④水穀不別：水濕停滯，不能從小便而去，而與穀物相混。
鄭論：按中寒故不能食，不食則中宮氣衰，轉輸失職，故小便不利.手足自汗者，脾主四肢，不能收束脾中血液也，（具）〔其〕所以然之故，曰胃冷，其所現一切，俱胃冷所致，毋庸別議.至於固瘕者，蓋溏泄久而不止之謂也。
【闡釋】本條是胃陽不足，複感寒邪的陽明中寒證。不能食、手足汗出、大便初鞭後溏等，俱胃冷所致。法當扶脾胃之陽，陽旺則諸症自愈。筆者認為可選用理中湯加砂仁治之。
二十三、陽明病，初欲食，小便反不利，大便自調，其人骨節疼，翕翕如有熱狀，奄然發狂⑤，濈然汗出而解者，此水不勝穀氣⑥，與汗共並，脈緊則愈。原文192
⑤奄然：忽然。
⑥穀氣：即水穀的精氣，在這裏可作正氣解。
鄭論：其所稱陽明病，初欲食者，是胃中尚有權也。胃中有權，轉輸自不失職，何以小便反不利？不利者，是病在膀胱，而不在胃也。觀胃與大腸相為表裏，胃氣尚健，故見大便自調，骨節疼，翕然如熱狀者，是氣機鼓動，邪從骨節而出，翕然如狂，濈然汗出，是邪從汗出而解也。書雲：“戰汗而解，狂汗而解”，即此。其中全賴水穀之氣勝，而邪並水穀之氣而出。脈緊者，言氣機盛。非指邪盛也。
【闡釋】此承前條，而論陽明中風證也。骨節疼，翕翕如有熱狀，皆是表證，而裏熱未成，所以始終病從表解，一汗而愈。鄭氏所論極是，筆者從之。
二十四、陽明病，不能食，攻其熱必噦，所以然者，胃中虛冷故也。以其人本虛，故攻其熱必噦，原文194
鄭論：經雲：胃熱則能消穀。此雲不能食，明是胃寒不能消穀也。即或有挾熱情形，當于溫中藥內，稍加一二苦寒，則得調燮之妙。若專於攻熱，而不溫中，豈非雪地加霜，能不致噦乎？
【闡釋】陽明病不能食，既有屬於實熱的，也有屬於虛寒的。此條之不能食，實由陽明胃腑虛冷，若誤攻其熱，則病呃逆，必犯虛虛之禍。這時的救逆，原文中未出方法，可用附子理中湯加吳茱萸，以祛寒降逆而止呃逆。
二十五、脈浮而遲，表熱裏寒，下利清穀〔者〕，四逆湯主之。
若胃中虛冷，〔不能食者〕，飲水必噦。原文225、
鄭論：按外熱內寒不利，法主四逆，頗為合宜。又曰胃冷，飲水必噦，胃冷已極，而又以水滋之，陰氣更為上僭，烏得不噦？
【闡釋】脈浮為表熱，遲為裏寒，寒者胃中虛也。胃中虛寒，下利清穀，此時手足厥逆，冷汗出，胃中陽氣垂絕，必用大劑四逆湯以回陽，乃得轉危為安。
若胃中虛冷，不能食者，則中陽自敗，較前證更重，飲水則呃逆，非重劑附子理中湯加吳茱萸以救之不可。若投以尋常治噦之橘皮生薑湯、橘皮竹茹湯，決不能奏功也。
二十六、陽明病，法多汗，反無汗，其身如蟲行皮中狀者①，此以久虛故也。原文196
①於“其身……”句：形容身癢之狀。
鄭論：陽明法多汗者，以其內有熱也。熱蒸於內則汗出。其無汗，身如蟲行狀者，內無大熱，而氣機拂郁於皮膚，由表陽太弱，不能運化而出也。
【闡釋】陽明病因是熱薰蒸，津液被迫，本應多汗，今反無汗，此不但陰虧，津液不足，更兼陽虛失其溫化之力，不能使汗達表，致汁液欲出不得，故有身癢如蟲行皮膚的感覺。此證宜用《金匱》防己黃芪湯略加麻黃，使汗從皮中外泄則愈。
二十七、陽明病，但頭眩，不惡寒，故能食而咳，其人咽必痛，若不咳者，咽不痛。原文198
鄭論：按頭眩，能食而咳，咽痛，皆緣邪火上攻，若不咳、不咽痛、是邪火雖盛，而未上攻也，更宜察之。
【闡釋】本條不惡寒而能食，其為陽明證中風無疑。由於風熱之邪上幹，所以頭眩，犯肺所以咳嗽，咽喉為呼吸之門戶，肺受熱侵，自必影響及咽，故咽痛。若不咳，說明肺未受熱侵，故咽亦不痛。
二十八、陽明病，反無汗，而小便利，二三日嘔而咳，手足厥者，必苦頭痛；若不咳不嘔，手足不厥者，頭不痛。原文197
鄭論：陽明病固屬多汗，今無汗而小便利，雖雲陽明病，其實內無熱也。二三日嘔而咳，至手足厥，苦頭痛者，必是陰邪上幹清道，閉其運行之機耳。果係陽厥，則脈息聲音，大有定憑。又曰：不嘔不咳不厥者，頭不痛，可知全係陰邪上幹清道無疑。學者切不可執定一陽明而即斷為熱證一邊看去，則得矣。
【闡釋】本條是陽明中寒，陽虛陰盛，挾有飲邪。有如鄭氏所雲：“必是陰邪上幹清道，閉其運行之機耳”。由於胃陽衰弱，水飲內聚，胃失降下，上逆則嘔，射肺則咳，胃主四肢，不能溫於四末，則手足厥冷；水寒上逆，必患頭痛；小便自利，正反映本病陽虛陰盛的真相。筆者認為可用溫中化飲降逆之理中湯加吳茱萸、半夏治之，則咳嘔、手足厥冷、頭痛等證自愈。
二十九、陽明病，下之，其外有熱，手足溫，不結胸，心中懊憹饑不能食，但頭汗出者，梔子豉湯主之。原文228
鄭論：既雲下之，其邪熱必由下而解，自然脈靜身涼。，方可全瘳。茲稱其外有熱，手足尚溫，必然肌肉之間，而邪未盡解，雖未結胸，是邪熱未伏於隔間耳。其人心中懊憹，是裏氣雖因下而稍舒，但表分之邪氣拂鬱未暢，暢則曠怡，不暢則心煩不安，此懊憹之所由來也。饑不欲食者，是脾氣已虛，而胃氣不運。兼之頭汗出者，陽氣發洩於上，有從上解之機也。但梔豉湯，雖曰交通水火，似覺未恰。
余意當於脈息處探其盛衰，熱之微盛，審其真假，心之懊憹，究其虛實，汗之解病與不解病，詳其底蘊，又於口之飲熱飲冷，二便之利與不利處搜求，自然得其要也。此以梔豉湯，是為有熱者言之，而非為虛寒者言之也。學者不可專憑原文一二語，以論藥論方，則得一貫之旨矣。
【闡釋】鄭氏對此條之論釋，與歷代注家不同，著重陽虛一面，故說：“此以梔豉湯，是為有熱者言之，而非為虛寒者言之也。”若脈息不足，目瞑倦臥，聲低息短，少氣懶言，喜飲熱湯，二便自利等情，此下傷脾胃，心中懊憹，饑不能食，頭汗出者，乃陽虛也，梔豉湯不可用也。法當扶陽，交通水火，白通湯為適當之方劑；或理脾開胃，兼以扶陽，附子理中湯可用。
鄭論：據口燥而漱水，乃火炎之征，漱水而不嚥，又非實火之驗，斷為必衄者，邪實之候說法也。漱水而不嚥者，斷無有必衄之證也。此證似非陽明，乃少陰之證也。姑言之，以待高明。
【闡釋】口中乾燥與口渴不同，漱水不欲嚥，知不渴也，可知非實火。而又曰“此必衄，邪實之候也。”其說兩相矛盾。歷代注家，牽強注釋，殊不可從。
鄭氏說：“此證似非陽明，乃少陰之證也。”舒馳遠《傷寒集注》雲：“漱水不欲嚥，當是裏陽衰乏，不能熏騰津液之故，此屬少陰。奈何指為陽明病乎？”可與鄭說互參。
三十一、脈浮發熱，口幹鼻燥，能食〔者〕，則衄。原文227
[Zheng's Discussion] Discussing Yangming syndrome manifestations, several key points are highlighted. Scholars should carefully contemplate and investigate the disease condition to apply treatment according to specific circumstances. However, the term "body heaviness" (shen zhong) in the original text is erroneous; it must be "body lightness" (shen qing) to correspond with Yangming syndrome. If it were body heaviness, it would belong to Shaoyin syndrome, which does not fit here. The variations in the original text are too verbose; all should be treated based on the actual disease condition, without rigid adherence.
[Explanation] This clause also refers to a concurrent disease of the three Yang meridians. It is titled as a Yangming disease because Yangming symptoms predominate. A floating and tight pulse indicates that exterior pathogenic factors have not yet subsided, characterizing Taiyang disease; dry throat and bitter taste in the mouth characterize Shaoyang disease; fever, sweating, aversion to cold absent but aversion to heat present, abdominal fullness, and panting characterize Yangming disease. Methods such as inducing sweating, purging, or burning needles are contraindicated. Misapplication of these methods will result in the complications described in the original text. These complications arise from intensified interior heat and should be treated with Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction). If, in addition to the preceding symptoms, there is excessive thirst for water, dry mouth and tongue, this indicates dryness-heat in the Qi level of the Yangming channel, and Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) should be used to clear heat and generate fluids. If there is thirst for water accompanied by difficulty in urination, this indicates simultaneous abundance of fluid retention and heat in Yangming, preventing the downward flow of body fluids. Zhu Ling Tang (Polyporus Decoction) promotes urination to drain heat from the Lower Jiao. Therefore, Zheng stated: "The variations in the original text are too verbose; all should be treated based on the actual disease condition." This teaches people to investigate carefully and avoid carelessness.
Zhu Ling Tang Formula (Corrected and Supplemented)
Zhu Ling (Polypori Sclerotium, peeled), Fu Ling (Poria), Ze Xie (Alismatis Rhizoma), E Jiao (Colla Corii Asini), Hua Shi (Talcum, crushed) — each 1 liang. Take the above five herbs, add four sheng of water, first decoct the first four herbs until two sheng remain, remove the dregs, dissolve E Jiao into the liquid, and take seven he of the warm decoction three times daily.
[Formula Analysis and Scope of Application] This formula moistens dryness and promotes diuresis. Zhu Ling and Ze Xie promote urination to drain dampness from the Kidney and Bladder; Fu Ling promotes urination to leach out dampness from the Spleen and Lungs; Hua Shi opens orifices and drains heat; E Jiao nourishes Yin, moistens dryness, and relieves irritability. It has good efficacy in treating diseases characterized by deficiency of Yin fluids, fever, and impaired water metabolism. In modern times, this formula has been widely applied to treat cystitis, urethritis, hematuria, gonorrhea, etc., showing significant effects due to its diuretic action.
18. In Taiyang disease, if the Cun position pulse is slow/loose, Guan is floating, and Chi is weak, and the patient has fever, sweating, recurrent aversion to cold, no vomiting, but only epigastric stuffiness, this is caused by the physician's inappropriate use of purgation. [If] the patient does not have aversion to cold [but] thirst, this indicates a transition to Yangming disease. Frequent urination implies the stool will likely be hard; even if ten days pass without defecation, there may be no distress.
For thirst desiring water, give small amounts at a time, and treat according to principles. For thirst, Wu Ling San (Five-Ingredient Powder with Poria) is appropriate. Original Text 244
[Zheng's Discussion] Based on the pulse and symptoms, this is a Taiyang channel syndrome, originally following the method of Guizhi Tang, not a method suitable for purgation. If purgation was not performed but aversion to cold is absent, with isolated fever and thirst, this is a sign of Yangming syndrome, indicating the method of Baihu Tang. Regarding frequent urination, hard stool, and no distress after more than ten days without defecation, although the pathogen is in the Stomach-Fu organ, it is not yet solid/excess, so purgation is not indicated. The so-called "thirst desiring water" is not indicative of Wu Ling San syndrome; rather, short and frequent urination with thirst constitutes the indication for Wu Ling San. Scholars must understand this.
[Explanation] The entire content of this clause involves differentiation of syndromes, which can be divided into four sections. From "Taiyang disease" to "caused by the physician's purgation" is the first section, differentiating exterior and interior syndromes. From "if not purged" to "transition to Yangming" is the second section, differentiating epigastric stuffiness caused by mistaken purgation versus transmission to Yangming without mistaken purgation. From "frequent urination" to "no distress" is the third section, differentiating Chengqi syndrome from Pi Yue (Splee Restriction) syndrome. From "thirst desiring water" to "Wu Ling San" is the fourth section, differentiating stomach-dryness thirst from water-retention thirst. In summary, treating disease requires seeking the root; precise syndrome differentiation is necessary to ensure correct treatment.
19. In Yangming disease, if the pulse is floating and tight, there will [necessarily] be tidal fever①, occurring at fixed times; if the pulse is only floating, there will necessarily be night sweats②. Original Text 201
① Tidal Fever: Fever occurring at regular intervals, like the tide.
② Night Sweats: Sweating during sleep, likened to a thief appearing at night, hence the name.
[Zheng's Discussion] A floating and tight pulse is a sign of Wind-Cold. The Yangming pulse should typically be long, large, surging, and excess to be definitive. Stating that floating and tight pulses lead to tidal fever, and only floating leads to night sweats, relies solely on pulse diagnosis, which may not always be accurate. Tidal fever must be assessed for deficiency or excess; night sweats require investigation into their origin. Relying solely on the pulse is likely not the orthodox method.
[Explanation] Floating and tight pulse, fever, and aversion to cold indicate Taiyang disease. If Yangming disease presents with a floating and tight pulse and tidal fever, it means heat steams outward while pathogens are solidified internally, causing tidal fever at fixed times. If the pulse is only floating and not tight, heat escapes outward, leading to night sweats. Thus, Zheng said: "Relying solely on pulse to determine disease is not always accurate." In clinical diagnosis, pulse and symptoms must be combined; one cannot be rash.
20. In Yangming Wind-Strike, the pulse is wiry, floating, large, with shortness of breath, generalized abdominal fullness①, pain under the costal margin and heart region, obstruction of Qi upon prolonged pressing②, dry nose, inability to sweat, lethargy, yellowing of the whole body including face and eyes, difficulty in urination, tidal fever, occasional hiccups③, swelling around ears and temples. After acupuncture, slight improvement occurs, but exterior symptoms persist. If the disease lasts over ten days and the pulse remains floating, administer Xiao Chai Hu Tang (Minor Bupleurum Decoction). If the pulse is only floating without other symptoms, administer Ma Huang Tang (Ephedra Decoction); if there is no urination, increased abdominal fullness, and added hiccups, it is untreatable. Original Texts 231, 232
[Zheng's Discussion] Calling it Yangming Wind-Strike confirms the pathogen is firmly in Yangming. The manifested symptoms and pulse indicate Yangming combined with Shaoyang and Taiyang syndromes. The momentum of the three-Yang diseases is extremely widespread, so it should be treated according to the method for concurrent three-Yang diseases. The prescribed formulas, Chai Hu and Ma Huang, are methods applied according to opportunity.
① Generalized Abdominal Fullness: Interpreted as abdominal fullness.
② Obstruction of Qi upon prolonged pressing: Indicates that even without pressing, Qi is short; prolonged pressing makes Qi more obstructed, implying pathogenic factors fill the space.
③ Hiccups (Yue): Vomiting.
[Explanation] This section mentions Yangming Wind-Strike combined with Taiyang and Shaoyang symptoms. It is called Yangming because Yangming symptoms predominate. The condition is complex, posing difficulties in both differentiation and treatment. One must guide the treatment according to the trend of the disease. Thus, first puncture Zusanli (ST36) of the Foot-Yangming Meridian to vent heat blocked in the collaterals. The original text "slight improvement after acupuncture, exterior unresolved" indicates interior heat resolved after needling. The prescription of Xiao Chai Hu Tang and Ma Huang Tang, as Zheng said, are "methods applied according to opportunity." Also, "swelling around ears and temples" in the original text refers to "Fa Yi" mentioned in *Neijing*, commonly known as mumps (parotitis), or epidemic parotitis in Western medicine. Many children suffer from this; I often treat it with Mahuang Guizhi Banxia Tang (Ephedra, Cinnamon Twig, and Pinellia Decoction), cured in one or two doses.
21. In Yangming disease, the pulse is slow④, eating leads to fullness easily; after eating, mild vexation and dizziness occur, and urination becomes difficult. This is about to become Grain Jaundice⑤. Even if purged, abdominal fullness remains unchanged. The reason is the slow pulse. Original Text 195
④ Slow Pulse: Pulse beating slowly.
⑤ Grain Jaundice (Gu Dan): Refers to indigestion syndrome.
[Zheng's Discussion] This discusses the reason behind it, stating the pulse is slow. Slow indicates Cold; severe Cold fails to digest grain, which is logical. This is not a heat-solidification syndrome suitable for purgation. Even if purged, bloating remains, meaning purgation was inappropriate. About to develop Grain Jaundice, it also belongs to Yin Jaundice. Difficulty in urination is caused by the failure of the Middle Jiao's transportation function. Scholars should comprehend this through the character "slow."
[Explanation] Purging results in unchanged abdominal fullness, indicating purgation was incorrect. Slow pulse indicates Cold. Yangming Deficiency-Cold causes fullness due to internal stagnation of deficient heat, not solid heat requiring purgation. The method should first warm the middle, using Lizhong Tang (Regulate the Middle Decoction) or Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction), then slightly administer Weitiao Chengqi Tang (Stomach-Regulating Major Purge Decoction) to mildly harmonize Stomach Qi. Grain Jaundice is dampness from food and water evaporating to cause yellowing, i.e., Yin Jaundice, treatable with Fuzi Lizhong Tang plus Yinchern (Artemisiae Scopariae Herba). This clause also appears in the Jaundice chapter of *Jinkui Yaolue*.
22. In Yangming disease, if affected by Cold, the patient cannot eat, urination is difficult, hands and feet sweat continuously①. This is about to form Gu Jia②, and stools will initially be hard then loose. The reason is Cold in the Stomach③, where water and grain are not separated④. Original Text 191
① Continuously (Ji Ran): Appearance of sweating; Ji originally means water flowing out.
② Gu Jia (Solid Mass): A syndrome of cold accumulation, characterized by stools that are initially hard then loose. A mass in the abdomen is called Jia.
③ Cold in Stomach: Refers to insufficient Stomach Yang and dysfunction of digestion.
④ Water and Grain Not Separated: Water-dampness stagnates and cannot exit via urine, mixing with grain.
[Zheng's Discussion] Affected by Cold, thus unable to eat. Lack of eating leads to decline of Qi in the Middle Jiao and failure of transportation, hence difficulty in urination. Continuous sweating of hands and feet: Spleen governs the four limbs; inability to control blood in the Spleen. The reason is Cold in the Stomach; everything manifested is caused by Stomach Cold, requiring no further discussion. As for Gu Jia, it refers to chronic loose stools that do not stop.
[Explanation] This clause describes Yangming Cold-Attack due to Stomach Yang deficiency compounded by external Cold. Inability to eat, sweating of hands and feet, and stools initially hard then loose are all caused by Stomach Cold. The method should support Spleen and Stomach Yang; when Yang is strong, symptoms resolve. I believe Lizhong Tang plus Sharen (Amomi Fructus) is suitable.
23. In Yangming disease, initially desiring to eat, urination is unexpectedly difficult, stools are normal. The person has bone and joint pain, feels hot like having a fever⑤, suddenly becomes manic⑥, sweats continuously and resolves. This is because Water cannot overcome Grain Qi⑦, combining with sweat. If the pulse is tight, recovery occurs. Original Text 192
⑤ Suddenly (Yan Ran): Suddenly.
⑥ Grain Qi: The essence of food and drink; here interpreted as Healthy Qi (Zheng Qi).
[Zheng's Discussion] Regarding Yangming disease initially desiring to eat, this means the Stomach still has authority/power. With authority in the Stomach, transportation naturally functions. Why is urination difficult? Difficulty implies the disease is in the Bladder, not the Stomach. Observing Stomach and Large Intestine are interior-exterior partners, Stomach Qi is still healthy, hence normal stools. Bone/joint pain and feeling hot indicate Qi mechanism stirring, expelling pathogens from bones/joints. Manic appearance and continuous sweating indicate pathogens exiting via sweat. Books say: "Resolving via battle-sweat or manic-sweat," referring to this. It entirely relies on Grain Qi overcoming pathogens, with pathogens exiting together with Grain Qi. Tight pulse indicates vigorous Qi mechanism, not pathogen excess.
[Explanation] Continuing from the previous clause, discussing Yangming Wind-Strike. Bone/joint pain and feeling hot are exterior signs, while interior heat is not formed. Thus, the disease resolves from the exterior, cured by one sweat. Zheng's discussion is excellent, and I agree.
24. In Yangming disease, inability to eat; attacking the heat will cause hiccups. The reason is Deficiency-Cold in the Stomach. Because the person is fundamentally deficient, attacking heat will inevitably cause hiccups. Original Text 194
[Zheng's Discussion] Classics state: Heat in Stomach allows digestion of grain. Here, inability to eat clearly indicates Cold in Stomach failing to digest grain. Even if there is accompanying heat, adding one or two bitter-cold herbs to warming medicines achieves harmonious adjustment. If focusing solely on attacking heat without warming the middle, is it not adding frost to snow? How can hiccups be avoided?
[Explanation] Inability to eat in Yangming disease can be due to Excess-Heat or Deficiency-Cold. This clause's inability to eat is due to Deficiency-Cold in the Yangming Stomach-Fu. Mistakenly attacking heat will cause hiccuping, committing the error of weakening the deficient. The original text does not provide a rescue method; Fuzi Lizhong Tang plus Wuzhuyu (Evodiae Fructus) can be used to dispel Cold, descend rebellious Qi, and stop hiccups.
25. Pulse floating and slow, exterior heat interior cold, diarrhea with undigested food [patients], Si Ni Tang (Four Reversal Decoction) is the main treatment.
If Stomach is Deficiency-Cold [and unable to eat], drinking water will cause hiccups. Original Texts 225,
[Zheng's Discussion] Exterior heat, interior cold, and diarrhea are appropriately treated with Si Ni Tang. It also says Cold Stomach and drinking water causes hiccups; Stomach Cold is extreme, and nourishing it with water makes Yin Qi rebel upward even more. How can hiccups not occur?
[Explanation] Floating pulse indicates exterior heat; slow pulse indicates interior cold; Cold implies Stomach Deficiency. Stomach Deficiency-Cold with diarrhea of undigested food, cold limbs, cold sweat, and nearly exhausted Stomach Yang requires a large dose of Si Ni Tang to restore Yang and turn danger into safety.
If Stomach is Deficiency-Cold and unable to eat, Middle Yang has failed, which is more severe than the previous condition. Drinking water causes hiccuping; only a heavy dose of Fuzi Lizhong Tang plus Wuzhuyu can save it. Ordinary hiccup treatments like Chupi Shengjiang Tang (Tangerine Peel and Fresh Ginger Decoction) or Chupi Zhuru Tang (Tangerine Peel and Bamboo Shaving Decoction) will definitely fail.
26. In Yangming disease, normally prone to sweating, but conversely no sweating, body feels like insects crawling under the skin①. This is due to long-term deficiency. Original Text 196
① "Body...": Describes the sensation of itching.
[Zheng's Discussion] Yangming disease normally involves sweating because there is internal heat. Heat steaming internally causes sweating. No sweating and body feeling like insects crawling means there is no major internal heat, but Qi mechanism is frustrated/stagnant in the skin due to weak Exterior Yang failing to transform and release.
[Explanation] Yangming disease, due to heat steaming and forcing fluids, should involve sweating. Conversely, no sweating indicates not only Yin deficiency and insufficient fluids, but also Yang deficiency failing to warm and transform, preventing sweat from reaching the surface. Fluids desire to exit but cannot, causing an itching sensation like insects crawling on the skin. This syndrome should be treated with Fangji Huangqi Tang (Aristolochia and Astragalus Decoction) from *Jinkui* slightly modified with Mahuang (Ephedra), allowing sweat to escape from the skin to cure.
27. In Yangming disease, only dizziness, no aversion to cold, therefore able to eat and cough. The person's throat will surely hurt; if not coughing, throat will not hurt. Original Text 198
[Zheng's Discussion] Dizziness, ability to eat, cough, and sore throat are all due to Pathogenic Fire attacking upward. If not coughing and no sore throat, it means although Pathogenic Fire is abundant, it has not attacked upward. Further observation is needed.
[Explanation] This clause, lacking aversion to cold but able to eat, is undoubtedly Yangming Wind-Strike. Due to Wind-Heat pathogens attacking upward, dizziness occurs; invading Lung causes cough. Throat is the gateway of respiration; Lung heat invasion affects the throat, causing sore throat. If not coughing, it indicates Lung is not invaded by heat, hence no sore throat.
28. In Yangming disease, conversely no sweating, but urination is free. After two or three days, vomiting and coughing, cold limbs, will surely suffer headache; if not coughing/vomiting, limbs not cold, head will not hurt. Original Text 197
[Zheng's Discussion] Yangming disease usually involves sweating. Now no sweating but free urination; although called Yangming disease, actually there is no internal heat. Vomiting and coughing after two or three days, leading to cold limbs and suffering headache, must be Yin Pathogens attacking the clear pathways, closing the mechanism of movement. If it were Yang Reversal, pulse and voice would provide definite evidence. Also, if no vomiting, coughing, or cold limbs, head does not hurt, confirming it is entirely Yin Pathogens attacking clear pathways. Scholars must not rigidly assume Yangming always equals Heat Syndrome.
[Explanation] This clause is Yangming Cold-Attack, Yang Deficiency with Yin Excess, complicated by Fluid Retention. As Zheng said: "Must be Yin Pathogens attacking clear pathways, closing the movement mechanism." Due to weak Stomach Yang, water-fluids accumulate internally. Stomach fails to descend, rebelling upward causes vomiting; invading Lung causes cough. Stomach governs four limbs; inability to warm extremities causes cold limbs. Cold water-fluids rebelling upward cause headache. Free urination reflects the truth of Yang Deficiency and Yin Excess. I believe Lizhong Tang plus Wuzhuyu and Banxia (Pinelliae Rhizoma) to warm middle, transform fluids, and direct rebellion downward can cure cough, vomiting, cold limbs, and headache.
29. In Yangming disease, after purgation, exterior heat remains, hands and feet are warm, no Chest Bind, mental restlessness (Ao Nao), hunger but inability to eat, only sweating on the head. Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is the main treatment. Original Text 228
[Zheng's Discussion] Since purgation was used, pathogenic heat should resolve from below, naturally resulting in quiet pulse and cool body, leading to full recovery. Now claiming exterior heat and warm hands/feet implies pathogens remain in muscles, not fully resolved. Although no Chest Bind, pathogenic heat has not settled in the diaphragm. Mental restlessness indicates interior Qi is slightly relieved by purgation, but exterior pathogenic Qi is frustrated/unsmooth. Smoothness brings joy; unsmoothness brings vexation, hence restlessness. Hunger but no desire to eat indicates Spleen Qi is deficient and Stomach Qi fails to transport. Combined with head sweating, Yang Qi exudes upward, offering a chance to resolve from above. However, Zhizi Chi Tang, though said to communicate Water and Fire, seems imprecise.
I suggest exploring pulse strength/weakness, heat intensity, true/false nature, investigating the deficiency/excess of mental restlessness, analyzing whether sweating resolves the disease, and searching through preferences for hot/cold drinks and bowel/bladder function. Naturally, the essence will be found. Using Zhizi Chi Tang is for those with Heat, not Deficiency-Cold. Scholars should not rely solely on one or two sentences of the original text to discuss medicines and formulas, thereby grasping the consistent principle.
[Explanation] Zheng's interpretation differs from历代 commentators, emphasizing Yang Deficiency. He says: "Zhizi Chi Tang is for Heat, not Deficiency-Cold." If pulse is insufficient, eyes close, weary lying down, low voice, short breath, little energy, reluctance to speak, preference for hot drinks, normal bowels/bladder, etc., this purgation injured Spleen/Stomach. Mental restlessness, hunger but inability to eat, head sweating indicate Yang Deficiency; Zhizi Chi Tang is contraindicated. The method should support Yang and communicate Water/Fire; Baitong Tang (White Pass Decoction) is appropriate; or regulate Spleen, open Stomach, and support Yang, using Fuzi Lizhong Tang.
30. In Yangming disease, dry mouth, only wanting to rinse water in mouth, not swallowing. This will surely result in nosebleed. Original Text 202
[Zheng's Discussion] Dry mouth rinsing water is a sign of Fire flaming up. Rinsing but not swallowing is not proof of Excess Fire. Concluding it will surely cause nosebleed is a theory of Excess Pathogen signs. Rinsing but not swallowing definitely does not imply inevitable nosebleed. This syndrome seems not Yangming, but Shaoyin. I mention this tentatively for experts to judge.
[Explanation] Dry mouth differs from thirst. Rinsing without swallowing indicates no thirst, thus not Excess Fire. Yet it says "surely nosebleed, sign of Excess Pathogen." This is contradictory. Commentators' forced explanations are unacceptable.
Zheng said: "This syndrome seems not Yangming, but Shaoyin." Shu Chiyuan's *Shanghan Jizhu* states: "Rinsing without swallowing should be due to deficiency of Interior Yang failing to vaporize fluids, belonging to Shaoyin. Why point to Yangming?" This can be cross-referenced with Zheng's view.
31. Pulse floating, fever, dry mouth, dry nose, able to eat [patient], then nosebleed. Original Text 227
[Zheng's Discussion] Floating pulse and fever indicate Wind-Heat at the exterior. Dry mouth and nose indicate Heat entering Yangming. Ability to eat then nosebleed means Stomach Qi is robust and stirring, allowing resolution via nosebleed.