麻黄汤。桂枝汤。瓜蒂散。栀子豉汤。白虎汤。猪苓汤。大承气汤。小承气汤。调胃承气汤。茵陈蒿汤。
胃实不便。自汗。不眠。头汗出。手足汗。潮热。谵语。狂乱。循衣摸床。渴。
凡身热微恶寒。舌苔白。头额目痛。脉浮洪微滑。无汗而微喘者。此风寒客于阳明营卫而表实也。宜发汗。
麻黄汤主之。如脉浮而迟。汗出。微恶寒者。此风邪客于阳明营卫而表虚也。宜解肌。桂枝汤主之。
此外邪初入阳明之表。即在营卫之间。当同太阳施治。不得以阳明正病治之。以外症犹有微恶寒也。
若发热汗出。恶风鼻鸣干呕。如桂枝症。而头不痛。项不强。寸脉微浮。胸中痞硬。气上冲咽喉。
不得息者。此为胸有寒也。宜瓜蒂散吐之。
邵评∶寒抑胸中之阳。病在阳明之表。此即痰饮类伤寒症。
此病机在胸中痞硬。不头痛项强。余症虽似桂枝。非太阳中风可知。胸中为阳明之表。寒邪结而不散。
胃阳抑而不升。故成痞象。惟用酸苦涌泄之味越之。则胃阳得升。胸寒自散。里之表和。表之表自解矣。
此邪不在营卫而在胸中。故不用汗法。而用吐法。
若二三日后。外症身热。自汗出。不恶寒。反恶热。身重鼻干不眠。内症咽干口苦。烦渴饮水。心中懊
。胸满而喘。舌苔白刺。或兼微黄。脉象洪滑。此阳明内热欲出之表。为阳明半表半里之症。斯时汗
下两忌。惟宜吐法。以越胸中之邪。栀子豉汤主之。呕加半夏。腹满加枳实。身黄加黄柏、茵陈。如大热
汗出。大烦大渴。脉洪大浮滑。不恶寒。反恶热。舌苔黄燥者。宜白虎汤主之。胃火一清。则津液生而
烦渴解。汗止身凉矣。
若发热脉浮。渴欲饮水。小便不利者。猪苓汤主之。使热从下泄。诸症自除矣。
以上三症。俱阳明内热欲出之表症。分三焦主治。热在上焦。栀子豉汤越之。热在中焦。白虎汤清之。
热在下焦。猪苓汤利之。
若潮热自汗。不恶寒。反恶热。六七日不大便。腹胀满。绕脐痛。烦躁谵语。喘冒不得
卧。腹中转矢气。或自利纯清水。咽燥口渴。舌苔燥黄起刺。脉沉实滑数者。阳明实热里症。地道不通。
燥矢为患也。其脉沉实滑数。心下痛满坚硬及脐腹者。大承气汤急下之。如大便不甚坚燥。腹满硬痛不甚
者。小承气汤微和之。如大便燥硬而证未剧。心下不甚胀满者。调胃承气汤。润燥以和之。若恶寒未罢。
腹未坚满。屎未燥硬。脉弱不实。均不可用承气。
邵评∶若恶寒未罢。腹未坚满。屎未燥硬。脉弱不实。均不可妄用承气。
如身热发黄。但头汗出。而身无汗。小便不利。渴欲饮水。此为郁热在里。茵陈蒿汤主之。
邵评∶阳明郁热发黄。阳黄也。便实者。茵陈蒿汤。便溏。茵陈五苓散。
Mahuang Tang (Ephedra Decoction). Guizhi Tang (Cinnamon Twig Decoction). Gouti San (Melon Seed Powder). Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction). Baihu Tang (White Tiger Decoction). Zhuling Tang (Polyporus Decoction). Dachengqi Tang (Major Order the Qi Decoction). Xiaochengqi Tang (Minor Order the Qi Decoction). Tiaoweichengqi Tang (Regulate the Stomach Order the Qi Decoction). Yinchenhao Tang (Artemisiae Scopariae Decoction).
Stomach excess leading to constipation. Spontaneous sweating. Insomnia. Head sweating. Hand and foot sweating. Tidal fever. Delirium. Manic confusion. Grasping at clothes and bedrails. Thirst.
Whenever there is body heat, slight aversion to cold. White tongue coating. Pain in the head, forehead, and eyes. Pulse floating, surging, slightly slippery. No sweat with slight panting. This is wind-cold pathogenic factors invading the Ying and Wei of the Yangming channel, constituting an exterior excess syndrome. Sweating therapy should be employed.
Mahuang Tang (Ephedra Decoction) is the primary treatment. If the pulse is floating and slow, with sweating and slight aversion to cold. This is wind pathogenic factors invading the Ying and Wei of the Yangming channel, constituting an exterior deficiency syndrome. Muscle-releasing therapy should be employed. Guizhi Tang (Cinnamon Twig Decoction) is the primary treatment.
Furthermore, when external pathogens initially enter the exterior of Yangming, i.e., between Ying and Wei. Treatment should follow that for Taiyang disease. It must not be treated as a proper Yangming disease. Because the exterior symptoms still include slight aversion to cold.
If there is fever, sweating, aversion to wind, nasal congestion sound, and dry retching. Symptoms resembling Guizhi Tang syndrome, but without headache or neck stiffness. The cun pulse is slightly floating. The chest feels obstructed and hard. Qi rushes upward to the throat.
Difficulty breathing. This indicates cold-fluid retention in the chest. Gouti San (Melon Seed Powder) should be used to induce vomiting.
Shao's Commentary: Cold inhibits the Yang qi in the chest. The pathology is at the exterior of Yangming. This is essentially a phlegm-fluid type of Shanghan syndrome.
The pathological mechanism lies in chest obstruction and hardness, without headache or neck stiffness. Although other symptoms resemble Guizhi Tang syndrome, it is clearly not Taiyang Wind Strike. The chest is the exterior of Yangming. Cold pathogenic factors knot and do not disperse.
Stomach Yang is inhibited and cannot ascend. Thus, an obstructive image forms. Only by using sour and bitter purgative-emetic agents to vent them upwards, can Stomach Yang ascend, and chest cold naturally dissipate. When the interior harmony is achieved, the exterior naturally resolves.
Since this pathogen is not in Ying and Wei but in the chest. Sweating therapy is not used. Instead, emesis therapy is used.
If after two or three days, the exterior symptoms are body heat, spontaneous sweating, no aversion to cold, but rather aversion to heat. Body heaviness, dry nose, insomnia. Interior symptoms include dry throat and bitter taste. Mental restlessness and thirst for water. Oppressive discomfort in the heart region.
Chest fullness with panting. Tongue coating white with prickles, or slightly yellowish. Pulse surging and slippery. This is the exterior stage where Yangming internal heat desires to emerge, representing a half-exterior, half-interior syndrome of Yangming. At this time, both sweating and purging therapies are contraindicated. Only emesis therapy is suitable to vent the pathogen from the chest. Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is the primary treatment. Add Banxia (Pinelliae Rhizoma) for vomiting. Add Zhishi (Aurantii Fructus Immaturus) for abdominal fullness. Add Huangbai (Phellodendri Cortex) and Yinchen (Artemisiae Scopariae Herba) for jaundice. If there is high fever, profuse sweating, extreme restlessness, extreme thirst. Pulse surging, large, floating, and slippery. No aversion to cold, but rather aversion to heat. Tongue coating yellow and dry. Baihu Tang (White Tiger Decoction) should be the primary treatment. Once Stomach fire is cleared, body fluids are generated, and restlessness and thirst resolve. Sweating stops, and the body cools.
If there is fever, floating pulse, desire to drink water, and difficult urination. Zhuling Tang (Polyporus Decoction) is the primary treatment. This allows heat to drain downward, and all symptoms will naturally disappear.
The above three syndromes are all exterior manifestations where Yangming internal heat desires to emerge. They are treated according to the Three Jiao. Heat in the Upper Jiao is vented by Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction). Heat in the Middle Jiao is cleared by Baihu Tang (White Tiger Decoction).
Heat in the Lower Jiao is drained by Zhuling Tang (Polyporus Decoction).
If there is tidal fever, spontaneous sweating, no aversion to cold, but rather aversion to heat. No bowel movement for six or seven days. Abdominal distension and fullness. Periumbilical pain. Restlessness and delirium. Panting and dizziness preventing lying down. Flatus passing in the abdomen. Or spontaneous diarrhea of pure clear water. Dry throat and mouth, thirst. Tongue coating dry, yellow, and prickle-like. Pulse deep, solid, slippery, and rapid. This is a Yangming excess-heat interior syndrome. The pathways are blocked.
Dry feces are causing the problem. With a pulse deep, solid, slippery, and rapid; pain, fullness, hardness below the heart and around the umbilicus/abdomen. Dachengqi Tang (Major Order the Qi Decoction) should be used for urgent purging. If stools are not very hard and dry. Abdominal fullness and painful hardness are not severe.
Xiaochengqi Tang (Minor Order the Qi Decoction) is used to gently harmonize. If stools are dry and hard but symptoms are not severe. And subcardiac area is not very distended. Tiaoweichengqi Tang (Regulate the Stomach Order the Qi Decoction) is used to moisten dryness and harmonize. If aversion to cold has not ceased.
Abdomen is not hard and distended. Stools are not dry and hard. Pulse is weak and not solid. Chengqi formulas must not be used.
Shao's Commentary: If aversion to cold has not ceased. Abdomen is not hard and distended. Stools are not dry and hard. Pulse is weak and not solid. Chengqi formulas must not be recklessly used.
If body heat with jaundice. Only head sweating. While the body has no sweat. Difficult urination. Desire to drink water. This indicates stagnant heat in the interior. Yinchenhao Tang (Artemisiae Scopariae Decoction) is the primary treatment.
Shao's Commentary: Yangming stagnant heat causing jaundice. This is Yang Jaundice. For solid stools, use Yinchenhao Tang (Artemisiae Scopariae Decoction). For loose stools, use Yinchen Wuling San (Artemisiae Scopariae and Five-Ingredient Poria Powder).