问曰。病有太阳阳明。有正阳阳明。有少阳阳明。何谓也。答曰太阳阳明者。脾约是也。正阳阳明者。胃家实是也。
少阳阳明者。发汗利小便已。胃中燥烦实大便难是也。
脾约者。其人津液素槁。邪热在太阳时。大便即难是也。太阳阳明者。太阳经邪热不俟。入阳明经而便入胃腑也。
正阳阳明者。经邪传腑表邪并里故云胃家实也。少阳阳明者。发汗利小便已。胃中燥烦实大便难津液耗竭也。尚论以阳
明经传少阳经即为少阳阳明非也。若经邪传经则胃中未必便燥而大便难。如果阳明经传少阳证。即当言阳明少阳不得谓
之少阳阳明矣。
阳明之为病胃家实也。
问曰何缘得阳明病。答曰。太阳病发汗。若下若利小便。此亡津液胃中干燥。因转属阳明不更衣内实大便难者。此
名阳明也。
问曰阳明病外证云何。答曰。身热汗自出。不恶寒。反恶热也。
问曰病有得之一日。不恶寒而发热者。何也答曰。虽得之一日恶寒。将自罢即自汗出。而恶热也。
问曰。恶寒何故自罢。答曰。阳明居中土也。万物所归无所复传。始虽恶寒二日自止。此为阳明病也。
本太阳初得病时发其汗。汗先出不彻。因转属阳明也。
伤寒发热无汗。呕不能食。而反汗出。 然者。是转属阳明也。
伤寒转系阳明者。其人 然微汗出也。
既 然汗出。则热除呕止可知。
脉阳微而汗出少者为自和也。汗出多者为太过。阳脉实因发其汗出多者。亦为太过。太过为阳绝于里亡津液大便因
硬也。
中风之脉轻微而缓者。为风邪本微。汗出少而不为过也。伤寒之脉。已至于实。即将去太阳而成可下之证也。况过
发其汗。宁无亡津液。大便因鞭。致传阳明之证乎。
以上统论阳明腑证传受。
阳明中风。口苦咽干腹满微喘。发热恶寒。脉浮而紧。若下之。则腹满小便难也。
此虽曰阳明中风。而证俱见伤寒太阳。未除之候但以腹满一端。知认为热入阳明。然终与大实大满不同。若误下则
邪愈陷。而腹愈满矣。小便难者。亡津液也。
阳明病脉迟。食难用饱。饱则微烦头眩。必小便难。此欲作谷瘅。虽下之腹满如故。所以然者。脉迟故也。
脉迟则表证将除。然得食而微烦。仍是外邪助其内热也。头眩者。风邪上攻也。小便难者。湿郁水道也。水谷之湿。
得热蒸而遍身发黄。下之腹满如故盖腹满。已是邪陷脉迟。则胃不实徒下其糟粕病既不除。而反害之耳。夫阳明证本当
下。阳明而至腹痛。尤当急下。独此一证下之。腹腔满必如故者。缘脉迟则胃气空虚。津液不充其满不过虚热内壅非结
热当下之比也。可见脉迟胃虚。下之无益则发汗利小便之法用之无益惟当用和法如甘草干姜汤先温其中。然后少与调胃。
微和胃气是也。
阳明病。若中寒不能食。小便不利。手足 然汗出此欲作固瘕。必大便初硬后溏。所以然者。以胃中冷。水谷不别
故也。
溏泄久而不止。则曰固瘕。言如 瘕固结不散也。
阳明病欲食。小便反不利。大便自调其人骨节疼。翕翕如有热状。奄然发狂。 然汗出而解也。此本不胜谷气。与
汗共并。脉紧则愈。
其人骨节疼。湿胜也。翕然如有热状热胜也。湿热相交。乃忽然发狂 然汗出解也。以其人能食。胃气有权。能驱
阳明之水与热。故水热不能胜。与汗共并而出也。脉紧则愈者。以先前失汗。所以脉紧未去。今幸胃气强盛。所以得肌
腠开。 然大汗而解。则脉之紧亦自和也。
阳明病不能食。攻其热必哕所以然者。胃中虚冷故也以其人本虚故攻其热必哕。（哕于月切）
脉浮而迟。表热里寒下利清谷者。四逆汤主之若胃中虚冷不能食者。饮水则哕。
表热里寒。法当先救其里。太阳经中。已用四逆汤其在阳明更可知矣。此条比前条虚寒更甚。故不但攻其热必哕。
即饮水亦哕矣。
此五条一云食难用饱。一云欲食似乎指中风而言。一云中寒不能食。及后二条又明指中寒而言。所以后人拘执其说
而误为注释也。不知此五条辨胃气之强弱。非辨外邪也。故五证中。惟水不胜谷气。脉紧则愈一证为胃气胜。其四条。
俱是脉迟胃冷。反为水热所胜之证。夫伤寒皆热证也。而其人胃中虚冷者。又未可一例。而推盖胃既虚冷则水谷混然无
别。热邪传入。必不能遽变为实也。胃不实。则不可下。即下之而水热不去徒令胃气垂绝而哕也。仲景一一挈出。而于
下利清谷一证。主以四逆汤其有较轻者。宜主以温胃。更不待言矣胃气素虚之人外邪入之。必转增其热。胃热故膀胱亦
热。气化不行。小便因之不行。则尽注太阳。而为洞泄下利清谷也。小便不利乘胃热而渗于脾。则四肢先见色黄。乃至
遍身发黄。而成谷瘅也。手足 然得汗。则脾中之湿热行。而色黄谷瘅可免但汗从手足而出。水谷之气。未得遍泄于周
身。不过少分大肠奔迫之势。故不为洞泄而为瘕泄耳。无病之人。小便不行尚渍为他病况伤寒极赤极热之小便。停蓄不
行。能无此三种之变乎。
伤寒大吐大下之。极虚复极汗出者。以其人外气怫郁。复与之水。以发其汗。因得哕。所以然者胃中寒冷故也。
伤寒哕而腹满视其前后知何部不利。利之则愈。
一为胃气虚寒。一为胃中实热不可不辨。虚寒者温之四逆理中是也。实热者利之承气五苓是也。
○二条旧在厥阴末。今入此。
得病六七日。脉迟浮弱。恶风寒。手足温医二三下之。不能食而胁下满痛面目及身黄颈项强小便难者。与柴胡汤后
必下重。本渴而饮水呕者。柴胡汤不中与也。食谷者哕。
六七日无大热。手足温。邪气将入于里也。以脉迟浮弱。故尚留连肌表恶风未除。反二三下之致太阳之邪。内陷胃
气虚寒不能食胁下满痛似痞非痞面目及身黄颈项强小便难者上下寒饮停结也。止宜五苓散解利。若认少阳。又与柴胡寒
剂必下重呕哕。皆亡津液胃寒之征也。
病患脉数。数为热。当消谷引食。而反吐者。此以发汗令阳气微膈内虚脉乃数也。数为客热。不能消谷。以胃中虚
冷。故吐也。
凡脉见阳盛则数。阴盛则迟。其人阳气既微。何得脉反数。脉既数可得胃反冷。此不可不求其故也。盖脉之数由于
误用辛温发散而遗其客热胃之冷由于阳气不足而生其内寒也医见其脉数。反以寒剂泻其无过。必致上下之阳俱损其后脉
从阴而变为弦。胃气无余。变为反胃也。
阳明病发热汗出。此为热越。不能发黄也。但头汗出身无汗。剂颈面还小便不利。渴引水浆者。此为瘀热在
里。身必发黄茵陈蒿汤主之。
瘀热在里而用茵陈蒿汤与太阳寒湿身黄如橘者同意然彼因腹微满此因渴饮水浆所以用大黄佐茵陈驱热利湿也。
阳明病面合赤色。不可攻之。攻之必发热色黄。小便不利也。
下虚之人。才感外邪则挟虚火而面色通红。在太阳时。即不可妄用发汗。况在阳明可妄下乎。总由真阳素虚。无根
之火随表药之性上升。即咽干烦躁足冷随里药之性下降。则发热色黄。小便不利也。
阳明病无汗。小便不利心中懊 者。身必发黄。
外不得汗。下不得溺而热郁胸中不得泄热必蒸身为黄也。
阳明病被火。额上微汗出。小便不利者。必发黄。
合四条观之。阳明病湿停热郁而烦渴有加。势必发黄然汗出热从外越。则黄可免小便多热从下泄则黄可免若误下之。
则热邪愈陷。津液愈伤。而汗与小便。愈不可得矣误火之则热邪愈炽津液上奔额虽微汗。而周身之汗与小便愈不得矣发
黄之变安。能免乎。发黄与前谷瘅本同一证。但彼因脉迟胃冷而得。则与固瘕及哕同源异派。
阳明病下血谵语者。此为热入血室。但头汗出者。刺期门。随其实而泻之。 然汗出则愈。
妇人经水。适来适断。则邪热乘之。而入于血室男子阳明经下血而谵语者亦为热入血室总是邪热乘虚而入也。尝见
大吐血后停食。感寒发热至夜谵语者。亦以热入血室治之而愈。明理论曰。冲是血室妇人则随经而入。男子由阳明而入
也。
阳明病。其人善忘者。必有蓄血。所以然者。本有久瘀血故令善忘屎虽硬。大便反易。其色必黑宜抵当汤主之。
太阳热结膀胱轻者如狂。桃核承气汤。重则发狂。用抵当汤。此阳明善忘之证。本差减于如狂。乃用用抵当汤。峻
攻之者。以阳明多血阳明之血结。则较太阳为难动故也。○按大便色黑虽曰瘀血而热邪燥结之色。未尝不黑也。但瘀血
则粘黑如漆燥结则晦。黑如煤。此为明辨也。
病患无表里证发热七八日。虽脉浮数者可下之。假令已下脉数不解。合热则消谷善饥。至六七日。不大便者。有瘀
血。宜抵当汤。若脉数不解。而下不止必协热便脓血也。
病虽七八日尚发热脉浮数仍属太阳表证。因误下引邪入内。所以脉数不解内外合邪。而见消谷善食谷入既多。反至
六七日。不大便且不烦 。是知其证。非气结而为血结以其表证误下。尚兼太阳随经之热。未尽故以抵当为至当也。若
脉数不解而下利不止。乃对假令已下。脉数不解五句之文见已下脉数不解。六七日不大便则宜抵当。若下利不止。又当
随其下血不下血而异治。倘血分之热邪不除。必协热而便脓血也。○详此条系仲景揣度庸工之设辞。意谓治病。无问表
里证但发热至七八日。虽脉浮数。意谓皆可下之。谓其日数即久。邪气已入于腑。可下而已。非实谓。此证有可下也。
仲景立法之至圣。断无脉浮发热表证表脉而教人可下之理。尚论以为七八日。为时既久。势不得不用下法。殊觉昧昧。
太阳病寸缓关浮尺弱。其人发热汗出。复恶寒不呕。但心下痞者。此以医下之也。如其未下者。病患不恶寒而渴。
此转属阳明也。小便数者。大便必硬不更衣。十日无所苦也。渴欲饮水。少少与之。但以法救之。渴者宜五苓散。
寸缓关浮尺弱。发热汗出复恶寒。纯是太阳中风未罢之证。设非误下。何得心下痞结耶。如不误下。则心下亦不痞。
而太阳证必渐传经。乃至不恶寒而渴。邪入阳明审矣。然阳明津液既随湿热偏渗。于小便。则大肠失其润。而大便之硬。
与肠中结热。自是不同。所以旬日不更衣。亦无所苦也以法救之。去其湿热。救其津液。言与水及用五苓法也。今世用
五苓。但知水谷偏注于大肠。用之利水而止泄至于津液。偏渗于小便用之消渴而回津者。非仲景不能也。○更衣言易衣
而如厕也。
病患烦热。汗出则解。又如疟状。日晡所发热者。属阳明也。脉实者宜下之。脉浮虚者。宜发汗。下之与承气汤。
发汗宜桂枝汤。
病患得汗。后烦热解。以太阳经之邪将尽未尽其人复如疟状日晡时发热。则邪入阳明审矣。发热即潮热。乃阳明之
本候也。然虽入阳明。尚恐未离太阳故必重辨其脉。脉实者。方为阳明腑证宜下之。若脉浮虚者。仍是阳明而兼太阳经
证。更宜汗而不宜下矣。
阳明病。心下硬满者。不可攻之。攻之利遂不止者死利止者愈。
心下硬满邪聚阳明气分证兼太阳也。故不可攻。攻之利不止。则邪气未尽真气先脱。故死。利止则邪气去。而正气
犹存故愈也。
脉浮而大。心下反硬。有热属脏者攻之不令发汗。
伤寒以脉浮为表证。胸满为阳邪。此脉浮为热气内蒸达表。必五六日后脉反浮大要非初病表证脉浮之比。心下硬为
燥结逆攻。必先腹胀。而后变心下硬亦非初病阳邪。上结之比。故仲景特申之。曰有热属脏。言内有实热。燥屎逆攻脾
脏也且戒之曰不令发汗。急当攻之此所谓证书不凭脉也。
属腑者。不入溲数。溲数则大便硬。汗多则热愈。汗少则便难。脉迟尚未可攻。
邪入阳明之腑。必自汗小便多。以其实热内结。津液滂渗。也是以仲景有阳明病汗多。禁利小便之戒。此热邪虽入
阳明而未作里实犹宜和解。如小柴胡热服亦能出汗。汗多则邪从汗解而热愈汗少则邪热内结。而便难若脉迟为热尚少。
结水定硬须俟脉数结定然后攻之。○二条旧在脉法篇中今归此。
太阳病二日而发汗不解。蒸蒸发热者。属胃也调胃承气汤主之。
本太阳中风。误用麻黄发汗。汗出过多。反伤胃中津液。所以不解。热邪乘虚内入。而为表里之证也。蒸蒸者热则
有内胜达于外也。惟热在胃故用承气以调其胃。胃调则病涣然除矣。
伤寒吐后腹胀满者。与调胃承气汤。
吐后腹满。则邪不在胸其为里实可知。但腹满而不痛。终属表邪入里未实。故不宜峻下。少与调胃承气和之可也。
阳明病不吐不下。心烦者。可与调胃承气汤。
胃气及津液。既不由吐下而伤则心烦明系胃中热炽。故可与调胃承气以安胃而全津液也。可与者。欲人临病裁酌不
可竟行攻击也。
太阳病过经十余日。心下温温欲吐而胸中痛大便反溏腹微满郁郁微烦先此时自极吐下者。与调胃承气汤。若不尔者
不可与。但欲呕胸中痛微溏者。此非柴胡证而呕。故知极吐下也。
太阳病过经十余日。心下温温欲吐而不吐。其人胸中痛。大便反溏腹微满郁郁微烦者。此有二辨若曾经大吐大下。
Question: There are Taiyang Yangming, Zhengyang Yangming, and Shaoyang Yangming. What does this mean?
Answer: Taiyang Yangming refers to the Pi Yue (Spleen Constriction) syndrome. Zhengyang Yangming refers to the Wei Jia Shi (Stomach House Excess) syndrome.
Shaoyang Yangming refers to the condition where, after sweating or promoting urination, the stomach becomes dry, irritable, and excess, leading to difficult defecation.
Pi Yue (Spleen Constriction) occurs because the patient's body fluids were originally depleted. When the pathogenic heat was in the Taiyang channel, defecation was already difficult. Taiyang Yangming means that the pathogenic heat of the Taiyang channel did not wait to resolve but directly entered the Yangming channel and transmitted into the Stomach Fu organ.
Zhengyang Yangming means that the pathogen from the channels transmitted to the Fu organs, with exterior pathogens merging into the interior, hence called Wei Jia Shi (Stomach House Excess).
Shaoyang Yangming occurs after sweating and promoting urination, depleting body fluids, causing dryness, irritability, excess heat in the stomach, and difficult defecation. The Shanglun school incorrectly believes that transmission from the Yangming channel to the Shaoyang channel constitutes Shaoyang Yangming. If a channel pathogen transmits to another channel, the stomach may not necessarily become dry with difficult defecation. If Yangming channel pathology transmits to Shaoyang syndrome, it should be called "Yangming-Shaoyang," not "Shaoyang Yangming."
The general principle of Yangming disease is: Wei Jia Shi (Stomach House Excess).
Question: How does one contract Yangming disease?
Answer: After treating Taiyang disease with sweating, purging, or promoting urination, if body fluids are lost, causing dryness in the stomach, it transforms into Yangming disease. If one does not defecate, there is internal excess and difficult defecation; this is named Yangming disease.
Question: What are the external manifestations of Yangming disease?
Answer: Fever, spontaneous sweating, aversion to cold is absent, but there is aversion to heat.
Question: Some patients develop fever without aversion to cold on the first day. Why?
Answer: Although it has been only one day, any initial aversion to cold will soon cease spontaneously, followed by spontaneous sweating and aversion to heat.
Question: Why does aversion to cold cease spontaneously?
Answer: Because Yangming belongs to Earth in the center, receiving all things, the pathogen does not transmit further. Initially, there may be aversion to cold, but it stops by the second day; this is Yangming disease.
Originally Taiyang disease, when sweating was induced at the onset but was incomplete, it transformed into Yangming disease.
In Cold Damage, if there is fever, no sweat, vomiting, inability to eat, yet suddenly profuse sweating (Ji Ran), this indicates transformation into Yangming disease.
When Cold Damage transforms to involve Yangming, the patient exhibits Ji Ran (continuous) slight sweating.
Once Ji Ran sweating occurs, it can be inferred that the heat is resolved and vomiting stops.
If the pulse is superficially weak (Cun position) and sweating is scant, it indicates self-harmonization. If sweating is excessive, it is an overreaction. If the Yang pulse is solid due to excessive sweating, this is also an overreaction. Overreaction leads to Yang deficiency internally and loss of body fluids, resulting in hard stool.
In Wind Strike, a pulse that is slightly slow and moderate indicates mild wind pathogen; scant sweating is not excessive. In Cold Damage, a pulse reaching solidity indicates the imminent transition from Taiyang to a condition suitable for purging. Moreover, excessive sweating surely causes loss of body fluids and hard stool, transmitting to Yangming.
The above generally discusses the transmission of Yangming Fu syndromes.
Yangming Wind Strike presents with bitter taste, dry throat, abdominal fullness, slight panting, fever, aversion to cold, and a floating-tight pulse. If purged, abdominal fullness worsens and urination becomes difficult.
Although called Yangming Wind Strike, the symptoms show unresolved Taiyang Cold Damage signs. However, based on abdominal fullness, we know heat has entered Yangming. Yet it differs from severe excess/fullness. Mis-purging causes deeper entrapment of pathogens and increased fullness. Difficult urination results from fluid depletion.
In Yangming disease, a slow pulse, inability to eat to satiety, slight irritability and dizziness after eating, and difficult urination indicate impending Gu Dan (Grain Jaundice). Purging will not relieve abdominal fullness because of the slow pulse.
A slow pulse suggests the exterior syndrome is resolving, but postprandial irritability indicates external pathogens aiding internal heat. Dizziness is caused by wind attacking upward. Difficult urination is due to dampness obstructing water passages. Water-dampness steamed by heat causes generalized yellowing. Purging fails to relieve fullness because the slow pulse indicates non-solidity of the stomach; purging only waste harms the body. While Yangming usually requires purging, especially with abdominal pain, this specific case with a slow pulse and empty stomach qi (fluid insufficiency) involves virtual heat obstruction, not solid heat requiring purging. Thus, purging is ineffective. Sweating and diuresis are also ineffective. One should use harmonizing methods, such as Gan Cao Gan Jiang Tang (Licorice and Ginger Decoction) to warm the middle, followed by small amounts of Tiao Wei Cheng Qi Tang (Modify the Stomach and Direct Downward Decoction) to gently harmonize stomach qi.
In Yangming disease, if cold invades the stomach causing inability to eat, difficult urination, and Ji Ran sweating on the hands and feet, this indicates impending Gu Jia (Fixed Mass/Chronic Diarrhea). Defecation will likely be hard initially then loose. This is due to cold in the stomach and failure to separate water and grain.
Prolonged loose stools are called Gu Jia, implying a fixed mass that does not disperse.
In Yangming disease, if the patient desires food, urination is difficult, defecation is normal, bone joints ache, there is a slight feeling of heat, sudden madness occurs, and Ji Ran sweating resolves the condition, this is because the stomach qi could not handle the grain qi, which expelled together with sweat. A tight pulse indicates recovery.
Bone joint pain indicates dampness excess. Slight heat sensation indicates heat excess. The interaction of dampness and heat causes sudden madness and resolution via Ji Ran sweating. Since the patient can eat, stomach qi is strong enough to drive out water and heat from Yangming, preventing them from overwhelming the body. The tight pulse resolves because previous lack of sweating left the pulse tight; now strong stomach qi opens the skin pores, allowing profuse sweating and pulse normalization.
In Yangming disease, inability to eat combined with clearing heat leads to hiccups (Yue) because of cold deficiency in the stomach. Due to underlying deficiency, clearing heat causes hiccups. (Yue refers to hiccups).
With a floating-slow pulse, exterior heat and interior cold presenting as diarrhea of undigested food, Si Ni Tang (Frigid Extremities Decoction) is indicated. If cold deficiency in the stomach prevents eating, drinking water causes hiccups.
Exterior heat and interior cold require rescuing the interior first. Si Ni Tang was used in Taiyang; its use in Yangming is even more appropriate. This case is colder than the previous one; thus, not only does clearing heat cause hiccups, but drinking water also triggers them.
These five clauses discuss stomach qi strength rather than external pathogens. Only "water cannot overcome grain qi, tight pulse indicates recovery" shows strong stomach qi. The other four show slow pulse and cold stomach, overwhelmed by water and heat. Although Cold Damage is typically a heat syndrome, patients with cold-deficient stomachs differ. A cold-deficient stomach mixes water and grain; incoming heat cannot immediately become excess. Non-excess stomach precludes purging; purging would fail to remove water-heat and endanger stomach qi, causing hiccups. Zhang Zhongjing listed these clearly, using Si Ni Tang for diarrhea of undigested food, and warming formulas for milder cases. Patients with deficient stomach qi attract external pathogens that increase heat. Stomach heat affects the Bladder, impairing Qi transformation and urination, leading to clear diarrhea. If urination is impaired, heat seeps into the Spleen, causing yellowing of limbs and body (Gu Dan). Sweating from hands and feet moves Spleen damp-heat, avoiding jaundice, but since sweat is limited, it causes Gu Jia rather than severe diarrhea. Even healthy people suffer if urine stops; certainly, stagnant hot urine in Cold Damage causes these variations.
After severe vomiting and purging in Cold Damage, extreme weakness and profuse sweating occur due to exterior stagnation and giving water to induce sweat, causing hiccups due to stomach cold.
In Cold Damage, hiccups with abdominal fullness require examining the anterior and posterior orifices to identify blockage; relieving the blockage cures it.
One type is stomach qi cold deficiency (treat with warming: Si Ni Tang, Li Zhong Tang); the other is stomach excess heat (treat with draining: Cheng Qi Tang, Wu Ling San).
○ These two clauses were formerly at the end of the Jueyin chapter; now included here.
After six or seven days of illness, with a slow-floating-weak pulse, aversion to wind and cold, and warm hands and feet, if the physician purges two or three times, leading to inability to eat, hypochondriac fullness/pain, yellowing of face/body, stiff neck, and difficult urination, administering Chai Hu Tang will cause heaviness in the rectum. If thirsty and vomiting after drinking water, Chai Hu Tang is contraindicated. Eating causes hiccups.
Six or seven days without high fever but with warm hands indicates pathogen entering interior. Slow-floating-weak pulse keeps pathogen in muscles; aversion to wind remains. Repeated purging traps Taiyang pathogen inward, damaging stomach qi. Hypochondriac fullness resembles Pi (glomus) but isn't. Yellowing, stiff neck, and difficult urination indicate cold-fluid retention above and below. Wu Ling San (Five Ingredient Powder with Poria) should be used to resolve and drain. Mistaking this for Shaoyang and using cold Chai Hu Tang causes rectal heaviness and vomiting/hiccups, signs of fluid loss and stomach cold.
If the patient's pulse is rapid (Shu), indicating heat, digestion should be enhanced, but vomiting occurs instead. This is because sweating weakened Yang qi, causing interior deficiency and a rapid pulse representing transient heat. The stomach is cold-deficient, causing vomiting.
Generally, Yang excess yields rapid pulse, Yin excess yields slow pulse. With weak Yang, why is the pulse rapid? Rapid pulse implies cold stomach; one must seek the cause. Rapid pulse results from misusing acrid-warm dispersants leaving transient heat; stomach cold results from insufficient Yang generating interior cold. Physicians seeing rapid pulse might wrongly use cold purgatives, damaging both upper and lower Yang, leading to a wiry pulse and Fan Wei (regurgitation/vomiting).
In Yangming disease, fever and sweating allow heat to vent outward, preventing jaundice. If only the head sweats, body has no sweat up to the neck, urination is difficult, and thirst drives fluid intake, this is Yu Re Zai Li (Stagnant Heat in the Interior), causing jaundice. Yin Chen Hao Tang (Artemisia Capillaris Decoction) is indicated.
Using Yin Chen Hao Tang for stagnant heat in the interior parallels treatment for Taiyang cold-damp jaundice. The difference is abdominal fullness versus thirst-driven fluid intake; Da Huang (Rhubarb) assists Yin Chen to drain heat and dampness.
In Yangming disease, if the face is entirely red, do not purge. Purging causes fever, yellowing, and difficult urination.
Deficient individuals contracting external pathogens carry deficient fire, reddening the face. In Taiyang, sweating should not be abused; in Yangming, purging is even less appropriate. True Yang deficiency allows rootless fire to rise with exterior medicines (causing dry throat, irritability, cold feet) and fall with interior medicines (causing fever, yellowing, difficult urination).
In Yangming disease, no sweat, difficult urination, and Ao Nao (restlessness) indicate impending jaundice.
Inability to sweat externally and urinate internally traps heat in the chest, steaming the body yellow.
In Yangming disease, if treated with fire therapy, slight sweating on the forehead and difficult urination lead to jaundice.
Considering these four clauses: Yangming disease with damp-stagnation and heat-retention causes irritability and thirst, inevitably leading to jaundice. Sweating vents heat outward, preventing jaundice; frequent urination vents heat downward, preventing jaundice. Mis-purging deepens heat and damages fluids, making sweat and urination impossible. Fire therapy intensifies heat, forcing fluids upward; although forehead sweats slightly, body sweat and urination remain blocked. Jaundice is unavoidable. Jaundice and Gu Dan share origins but differ in etiology (cold stomach vs. heat); they branch from the same source as Gu Jia and hiccups.
In Yangming disease, bleeding from the anus with delirium indicates Re Ru Xue Shi (Heat Entering the Blood Chamber). Head-only sweating is treated by puncturing Qi Men (LR14) to drain excess. Ji Ran sweating indicates recovery.
In women, during menstruation, heat enters the Blood Chamber. In men, Yangming channel bleeding with delirium also indicates Heat Entering the Blood Chamber, always due to heat exploiting deficiency. Post-hematemesis food stagnation with night delirium is also treated as Heat Entering the Blood Chamber. Ming Theory states the Chong Mai is the Blood Chamber; in women, pathogens enter via channels; in men, via Yangming.
In Yangming disease, forgetfulness indicates Xu Xue (Blood Stasis) due to long-standing blood stasis. Stool may be hard but passes easily with black color. Di Dang Tang (Di Dang Decoction) is indicated.
Taiyang heat binding in the Bladder causes mild mania (Tao He Cheng Qi Tang) or severe mania (Di Dang Tang). Yangming forgetfulness is milder than mania but uses Di Dang Tang because Yangming blood is abundant and harder to move than Taiyang blood. Note: Black stool indicates blood stasis (sticky like lacquer) or dry heat accumulation (dull like coal); this distinguishes them.
Patients with no exterior/interior signs, fever for 7-8 days, and floating-rapid pulse may be purged. If purged and pulse remains rapid, combined heat causes hunger. By day 6-7, constipation indicates blood stasis; Di Dang Tang is indicated. If purged and diarrhea persists with rapid pulse, bloody pus in stool occurs.
Although fever and floating-rapid pulse suggest Taiyang, mis-purging draws pathogens inward, causing rapid pulse. Combined exterior-interior pathogens cause hunger. Constipation without irritability indicates blood stasis, not Qi stagnation, due to residual Taiyang heat. Di Dang Tang is appropriate. If diarrhea persists, treat according to presence/absence of blood. Unremoved blood heat causes bloody pus. This clause is hypothetical advice against unskilled physicians who might purge based solely on duration and pulse. Zhang Zhongjing would never advise purging with floating pulse and exterior signs. Shanglun's view that duration necessitates purging is mistaken.
In Taiyang disease, Cun slow, Guan floating, Chi weak pulse with fever, sweating, aversion to cold, no vomiting, but epigastric fullness indicates iatrogenic purging. Without purging, absence of aversion to cold and thirst indicate transformation to Yangming. Frequent urination causes hard stool. Ten days without defecation causes no discomfort. Thirst treated with small sips of water or Wu Ling San (Five Ingredient Powder with Poria) resolves it.
Cun slow, Guan floating, Chi weak pulse with fever, sweating, and aversion to cold indicates unresolved Taiyang Wind Strike. Epigastric fullness results from mis-purging. Without purging, Taiyang transforms to Yangming (no aversion to cold, thirst). Fluids drain to bladder via damp-heat, drying intestines. Hard stool differs from intestinal heat accumulation. Ten days without defecation causes no discomfort. Treatment removes damp-heat and restores fluids using water and Wu Ling San. Modern use of Wu Ling San focuses on stopping diarrhea by directing water to large intestine, missing Zhang Zhongjing's intent to restore fluids by directing water away from bladder.
Patient with irritability and heat resolves with sweating. Recurrence like malaria, afternoon fever (Ri Bu Suo) indicates Yangming. Solid pulse requires purging (Cheng Qi Tang); floating-weak pulse requires sweating (Gui Zhi Tang/Cinnamon Twig Decoction).
After sweating, irritability resolves. Residual Taiyang pathogen causes malaria-like symptoms and afternoon fever (tidal fever), confirming Yangming involvement. Solid pulse confirms Yangming Fu syndrome requiring purging. Floating-weak pulse indicates Yangming with concurrent Taiyang channel syndrome, requiring sweating, not purging.
In Yangming disease, epigastric hardness/fullness prohibits purging. If purged and diarrhea continues endlessly, death ensues; if diarrhea stops, recovery occurs.
Epigastric hardness/fullness involves Yangming Qi level and concurrent Taiyang. Purging exhausts true Qi before eliminating pathogens, causing death. Stopping diarrhea indicates pathogen removal and preserved Qi.
Floating-large pulse with epigastric hardness and heat belonging to Zang organs requires purging, not sweating.
Floating pulse usually indicates exterior syndrome; chest fullness indicates Yang pathogen. Here, floating pulse reflects internal heat steaming outward, appearing days later, unlike initial exterior floating pulse. Epigastric hardness follows abdominal distension, differing from initial Yang pathogen knotting. Zhang Zhongjing emphasizes "heat belonging to Zang," meaning internal solid heat and dry feces attacking Spleen. He warns against sweating, urging immediate purging. This prioritizes symptoms over pulse.
Belonging to Fu organs involves no frequent urination. Frequent urination causes hard stool. Profuse sweating increases heat; scant sweating causes difficult defecation. Slow pulse indicates purging is premature.
Pathogens entering Yangming Fu cause sweating and frequent urination due to internal heat drawing fluids. Zhang Zhongjing warns against diuretics in Yangming with profuse sweating. If heat enters Yangming but hasn't formed solid excess, harmonizing (e.g., Xiao Chai Hu Tang) is suitable. Hot administration induces sweating, resolving heat. Scant sweating traps heat, causing constipation. Slow pulse indicates insufficient heat for solidification; wait for rapid pulse before purging.
○ These two clauses were formerly in Pulse Methods; now moved here.
Taiyang disease on day two, sweating fails to resolve steaming fever, indicating Stomach involvement. Tiao Wei Cheng Qi Tang (Modify the Stomach and Direct Downward Decoction) is indicated.
Original Taiyang Wind Strike treated with Ma Huang Tang (Ephedra Decoction) caused excessive sweating, damaging stomach fluids. Heat entered deficiency, creating exterior-interior syndrome. Steaming heat indicates internal heat reaching exterior. Since heat is in Stomach, Cheng Qi formula harmonizes Stomach, resolving disease.
After vomiting in Cold Damage, abdominal fullness is treated with Tiao Wei Cheng Qi Tang.
Abdominal fullness after vomiting indicates interior excess, not chest pathology. Fullness without pain suggests exterior pathogen entering interior but not fully solid; harsh purging is inappropriate. Small doses of Tiao Wei Cheng Qi Tang harmonize.
In Yangming disease, without prior vomiting or purging, irritability indicates intense stomach heat. Tiao Wei Cheng Qi Tang soothes Stomach and preserves fluids. "Ke Yi" (may be given) advises clinical discretion, not blind aggression.
Taiyang disease persisting over ten days, with epigastric nausea, chest pain, loose stool, mild abdominal fullness, and slight irritability, following extreme vomiting/purging, is treated with Tiao Wei Cheng Qi Tang. Otherwise, it is contraindicated. Nausea, chest pain, and loose stool without history of extreme treatment are not Chai Hu syndrome.
Taiyang disease persisting over ten days, with epigastric nausea (not vomiting), chest pain, loose stool, mild abdominal fullness, and slight irritability, has two differentiations. If preceded by severe vomiting/purging...