【纲】仲景曰。阳明病。脉迟。虽汗出。不恶寒者。其身必重。短气腹满而喘。有潮热者。此
外欲解。可攻里也。手足 然而汗
出者。此大便已硬也。大承气汤主之。若汗多。微发热恶寒者。外未解也。其热不潮。未可与承气
汤。若腹大满不通者。可与小承气汤微和胃气。勿令大泄下。阳明病。脉浮而紧。咽燥口苦。腹满而喘。发热汗出。不
恶寒。反恶热。身重。若发汗。则躁。心愦愦。反谵语。若加烧针。必怵惕。烦躁不得眠。若下之。则胃中空虚。客气
动膈。心中懊 。舌上苔者。栀子豉汤主之。
【目】成无己曰。身重之由。有风湿。有风寒。有风寒湿俱见。有火逆。有易病。有三阳合病。
虽所得不一。然悉属三阳。非但若身疼兼有里寒也。坏病有矣。寒则无之。识者鉴之。
魏荔彤曰。潮热二字。原兼汗出而言。太阳发热汗出。自是汗。阳明大热汗出。自是潮。潮者。
潮润。汗者。汗漫。各有意象。谚谓潮湿即此。乃由热气薰蒸。郁闷而作潮湿者。热也。湿既潮矣。
无不兼热。不兼热则寒湿矣。方喻谓潮热在申酉戌三时燥气盛行而作。误也。潮热若必于此三时至。
不又为少阳之病乎。不几为太阳如疟状乎。何取于阳明也。他条曰。太阳病三日。发汗不解。蒸蒸
发热者。属胃也。详蒸蒸之意。潮热之义可见。盖三日发汗不解。必发汗不如法。乃表症转属于里
而蒸蒸发热也。太阳发热。自表而入里之热。阳明发热。自里而出表之热。太阳汗出而热。汗自汗。
热自热。阳明汗出而热。热揣之有似汗。汗揣之有似热。大约其热经胃腑郁闷而出。与在表卫疏自
出之汗。形状迥异。粘滞湿腻。着于衣被必粘。按之手足如蒸。此乃汗热二症各为一症。以此验胃
热。洵要诀也。观此而三时作热之非明矣。脉经云。沾汗者。即潮热也。
【纲】仲景曰。三阳合病。腹满身重。难以转侧。口不仁而面垢。谵语。遗尿。发汗则谵语。
下之则额上生汗。手足逆冷。若自汗出者。白虎汤主之。伤寒八九日。下之。胸满烦惊。小便不利。
谵语。一身尽重。不可转侧者。柴胡加龙骨牡蛎汤。风湿相搏。身体烦疼。不能自转侧。不呕不
渴。脉浮虚而涩者。桂枝附子汤。
【目】成无己曰。腹满身重难转侧。口不仁谵语者。阳明也。针经曰。少阳病甚。则面微尘。此
面垢者。少阳也。遗尿者。太阳也。以阳明症多。故出阳明篇中。三阳合病。为表里有邪。若发汗攻
表。则燥热益甚。必愈谵语。若下之。表热乘虚内陷。必额汗肢冷。自汗出者。三阳经热甚也。
张元素曰。身重难转侧者。下后血虚。津液不荣于身也。身疼不能转侧者。风湿搏于经。而里
无邪也。故二汤各有所主。
鳌按。太阳少阳少阴。皆有身重。然非三经主病。故专列款于阳明。其余诸款有特见于一经者
亦从此例。有二经并举。三经并举者。则以其款在三经二经中。俱为主病之故。阅者以意会之可也。如身
重难转侧。为阳明主病。因列阳明经。其太阳少阳少阴。虽亦有身重难转侧症。而不但不于三经中
各举此款。并不烦赘于阳明经者。以所主为重也。其他各经各款皆然。可以类推。
[Outline] Zhang Zhongjing stated: In Yangming disease, the pulse is slow. Although there is sweating, there is no aversion to cold, and the body must feel heavy. There is shortness of breath, abdominal fullness, and wheezing. If there is tidal fever (Chao Re, fever that peaks in the afternoon/evening), it indicates that the exterior syndrome is about to resolve, and purging the interior is permissible. If there is continuous sweating on the hands and feet, it indicates that the stool has already hardened; Da Cheng Qi Tang (Great Order the Qi Decoction) should be administered. If there is excessive sweating with slight fever and aversion to cold, the exterior has not yet resolved. If the fever does not present as tidal fever, Cheng Qi Tang formulas should not be given. If the abdomen is significantly full and obstructed, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) may be given to gently harmonize the stomach qi, without causing severe purgation. In Yangming disease, if the pulse is floating and tight, with dry throat, bitter taste, abdominal fullness and wheezing, fever, sweating, no aversion to cold but rather aversion to heat, and body heaviness: if sweating methods are misused, restlessness, mental confusion, and delirium will occur. If burning needle therapy is misused, frightfulness, irritability, and insomnia will definitely result. If purgation is misused, the stomach becomes empty, pathogenic qi disturbs the diaphragm, causing inner annoyance; if there is coating on the tongue, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) should be administered.
[Commentary] Cheng Wuji said: The causes of body heaviness include wind-dampness, wind-cold, simultaneous presence of wind-cold-dampness, fire-induced injury, susceptibility after illness resolution, and concurrent disease of the three yang meridians. Although the origins differ, they all belong to the three yang meridians, not merely body pain accompanied by interior cold. There are also cases of complicated diseases (Huai Bing); pure cold syndromes do not exhibit these signs, so discerning practitioners should be vigilant.
Wei Litong said: The term "tidal fever" inherently implies sweating. Fever with sweating in Taiyang disease is simply sweating; high fever with sweating in Yangming disease is termed "tidal." "Tidal" refers to moisture like the tide; "sweat" refers to profuse perspiration. Each has its specific imagery. As the proverb says, "dampness," this is due to heat steaming and stagnation creating a damp sensation, which is essentially heat. Once dampness is present, it invariably accompanies heat; without heat, it would be cold-dampness. Fang Youzhi claimed that tidal fever occurs during the Shen, You, and Xu hours when dry qi prevails, which is incorrect. If tidal fever strictly occurred at these three times, would it not be Shaoyang disease? Would it not resemble the malaria-like state of Taiyang disease? What relevance does this have to Yangming? Another clause states: After three days of Taiyang disease, if sweating fails to resolve the condition and steaming fever ensues, it belongs to the Stomach. Examining the meaning of "steaming" reveals the meaning of "tidal." Generally, after three days of improper sweating, the exterior syndrome transforms into an interior syndrome, resulting in steaming fever. Taiyang fever is heat entering from the exterior into the interior; Yangming fever is heat emerging from the interior to the exterior. In Taiyang, sweating and fever are distinct; in Yangming, heat resembles sweat, and sweat resembles heat. This heat emerges from the stifling in the Stomach fu-organ, differing greatly from sweat naturally released by loose defensive qi at the exterior. It is sticky, greasy, adheres to clothing and bedding, and feels like steaming when touching the hands and feet. These are two distinct symptoms used to verify stomach heat, truly a key diagnostic principle. From this, it is clear that attributing heat to specific hours is wrong. *Mai Jing* states: Profuse sweating is tidal fever.
[Outline] Zhang Zhongjing stated: In concurrent disease of the three yang meridians, there is abdominal fullness, body heaviness, difficulty turning the side, insensitivity of the mouth (Kou Bu Ren), facial dirtiness, delirium, and urinary incontinence. If sweating is induced, delirium worsens. If purgation is applied, sweating appears only on the forehead, and the limbs become cold. If there is spontaneous sweating, Bai Hu Tang (White Tiger Decoction) should be administered. In cold damage lasting eight or nine days, if purgation is misapplied, leading to chest fullness, vexation, fright, urination difficulty, delirium, whole-body heaviness, and inability to turn the side, Chai Hu Jia Long Gu Mu Li Tang (Bupleurum Plus Dragon Bone and Oyster Shell Decoction) should be used. If wind-dampness combats each other, causing painful body sensations and inability to turn the side spontaneously, without vomiting or thirst, and with a floating, deficient, and choppy pulse, Gui Zhi Fu Zi Tang (Cinnamon Twig and Aconite Root Decoction) should be used.
[Commentary] Cheng Wuji said: Abdominal fullness, body heaviness, difficulty turning, insensitivity of the mouth, and delirium indicate Yangming disease. *Zhen Jing* states: When Shaoyang disease is severe, the face looks like dust; this facial dirtiness indicates Shaoyang disease. Urinary incontinence indicates Taiyang disease. Since Yangming symptoms are predominant, it is listed in the Yangming chapter. Concurrent disease of the three yang meridians involves pathogens in both the exterior and interior. Misusing sweating to attack the exterior exacerbates dryness and heat, worsening delirium. Misusing purgation allows exterior heat to sink inward due to deficiency, causing forehead sweating and cold limbs. Spontaneous sweating indicates intense heat in the three yang meridians.
Zhang Yuansu said: Body heaviness and difficulty turning the side result from blood deficiency after purgation, where fluids fail to nourish the body. Body pain and inability to turn the side result from wind-dampness combing in the meridians without interior pathogens. Thus, the two decoctions address different conditions respectively.
Shen Jin'ao commented: Taiyang, Shaoyang, and Shaoyin meridians all feature body heaviness, but it is not their primary disease, so it is specifically categorized under Yangming. Other conditions appearing in one meridian follow this example. Conditions involving two or three meridians are listed because they are primary diseases in those meridians. Readers should understand this logic. For instance, body heaviness and difficulty turning the side are primary Yangming symptoms, hence listed here. Although Taiyang, Shaoyang, and Shaoyin also present with these symptoms, they are not repeated in their respective chapters nor redundantly detailed in Yangming, as the focus differs. Other meridians and conditions can be inferred similarly.