【纲】仲景曰。阳明病。被火。额上微汗出。而小便不利者。为发黄。三阳合病。腹满身重。
难以转侧。口不仁而面垢。遗尿。发汗。则谵语。下之。则额上出汗。手足冷。若自汗出者。白虎
汤主之。
【目】鳌按。此条之上。曰三阳合病。脉浮大。上关上。但欲睡眠。合目则汗。乃详病脉病情
及病机也。本条乃言病状及治方也。必两条合参。而三阳合病之大要始得。合目则卫气行阴。更兼
汗出。热淫于内也。
【纲】仲景曰。阳明病。若中寒。不能食。小便不利。手足 然汗出。此欲作痼瘕。必大便初
硬后溏。所以然者。以胃中冷。水谷不别故也。
三阳并病。太阳症罢。但发潮热。手足 汗出。大便难而谵语。下之则愈。大承气汤。
【目】王肯堂曰。胃主四肢。为津液之主。故病则手足汗出也。手足汗出为热聚于胃。是津液
之旁达也。
二者俱手足汗出。一则大便初硬后溏。胃中冷不别水谷。故不可下。一则大便难、谵语。阳明症
具。故宜下。
陶华曰。四肢者诸阳之本。热聚于胃。则津液旁达于手足也。蕴热则烦躁谵语。挟寒则水谷不
分。此则承气理中之不同处也。
柯琴曰。但手足汗出。则津液之泄于外者尚少。小便不利。则津液不泄于下。阳明所虑者亡津
液。此更虑其不能化液也。
阳明以胃实为病根。更当以胃寒为深虑。
[General Principle] Zhang Zhongjing stated: In Yangming disease, if treated with fire therapy (fire treatment), resulting in slight sweating on the forehead and difficulty in urination, jaundice (yellowing of skin and eyes) will occur. In San-Yang combined disease (disease involving Taiyang, Yangming, and Shaoyang meridians simultaneously), symptoms include abdominal fullness, heaviness of the body, difficulty in turning over, numbness of the mouth (loss of taste sensation) with a dirty appearance of the face, and urinary incontinence. If diaphoresis (sweating-inducing method) is mistakenly used, it leads to delirium; if purgation is mistakenly used, it leads to sweating on the forehead and cold hands and feet. If spontaneous sweating occurs, Baihu Tang (White Tiger Decoction) should be administered as the primary treatment.
[Commentary] Shen Jin'ao noted: The preceding text mentions "San-Yang combined disease," with a floating and large pulse, particularly at the Guan position, where the patient desires sleep and sweats when closing the eyes; this details the pulse, condition, and pathogenesis. This specific clause describes the clinical manifestations and treatment formulas. Both clauses must be consulted together to grasp the essentials of San-Yang combined disease. When closing the eyes, Wei Qi (Defensive Qi) enters the Yin, combined with sweating, indicating that heat is rampant within.
[General Principle] Zhang Zhongjing stated: In Yangming disease, if caused by Cold invasion, leading to inability to eat, difficulty in urination, and continuous sweating on the hands and feet (Ji Ran Han Chu), this indicates the impending formation of an accumulation or mass (Gu Jia). The stool will likely be initially hard and subsequently loose. This is because the Stomach is cold, failing to separate clear turbid fluids from food.
In San-Yang concurrent disease, after the Taiyang syndrome has ceased, only tidal fever appears, accompanied by continuous sweating on the hands and feet, difficult defecation, and delirium. Purgation will cure it; Da Cheng Qi Tang (Great Order the Qi Decoction) is indicated.
[Commentary] Wang Kentang said: The Stomach governs the four limbs and is the master of Body Fluids; thus, when diseased, sweating occurs on the hands and feet. Sweating on the hands and feet indicates heat gathering in the Stomach, causing Body Fluids to reach laterally.
Both cases involve sweating on the hands and feet. In one case, the stool is initially hard and then loose due to cold in the Stomach failing to separate water and grain; therefore, purgation is contraindicated. In the other case, there is difficult defecation and delirium, presenting complete Yangming Fu-organ syndrome; therefore, purgation is appropriate.
Tao Hua said: The four limbs are the root of all Yang meridians. When heat gathers in the Stomach, Body Fluids reach the hands and feet laterally. Accumulated heat causes irritability and delirium, while cold mixed with heat causes failure to distinguish water and grain. This distinguishes the use of Cheng Qi Tang from Li Zhong Tang.
Ke Qin said: If only sweating on the hands and feet occurs, the loss of Body Fluids externally is still relatively small. If urination is difficult, Body Fluids are not excreted downward. What Yangming disease fears is the depletion of Body Fluids; here, there is further concern about the inability to transform fluids.
Yangming disease takes Stomach Excess (Wei Shi) as its root, but Stomach Cold must also be deeply feared.