179．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（一云络）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。
180．阳明之为病，胃家实（一作寒）是也。
181．问曰∶何缘得阳明病，答曰∶太阳病，若发汗、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。
182．问曰∶阳明病外证云何？答曰∶身热、汗自出、不恶寒反恶热也。
183．问曰∶病有得之一日，不发热而恶寒者，何也？答曰∶虽得之一日，恶寒将自罢，即汗出而恶热也。
184．问曰∶恶寒何故自罢？答曰∶阳明居中，主土也。万物所归，无所复传。始虽恶寒，二日自止，此
为阳明病也。
185．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。
186．伤寒三日，阳明脉大。
187．伤寒脉浮而缓，手足自温者，是为系在太阴。
太阴者，身当发黄；若小便自利者，不能发黄；至七八日，大便硬者，为阳明病也。
188．伤寒转系阳明者，其人 然微汗出也。
189．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。
190．阳明病，若能食，名中风；不能食，名中寒。
191．阳明病，若中寒者，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。
192．阳明病，初欲食，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
者，此水不胜谷气，与汗共并，脉紧则愈。
193．阳明病，欲解时，从申至戌上。
194．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，攻其热必哕。
195．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。
196．阳明病，法多汗，反无汗，其身如虫行皮中状
者，此以久虚故也。
197．阳明病，反无汗而小便利，二三日呕而咳，手足厥者，必苦头痛；若不咳、不呕、手足不厥者，头不痛。
（一云冬阳明。）
198．阳明病，但头眩，不恶寒。故能食而咳，其人咽必痛；若不咳者，咽不痛。（一云冬阳明）
199．阳明病，无汗、小便不利、心中懊 者，身必发黄。
200．阳明病，被火，额上微汗出，而小便不利者，必发黄。
201．阳明病，脉浮而紧者，必潮热发作有时；但浮者，必盗汗出。
202．阳明病，口燥但欲漱水，不欲咽者，此必衄。
203．阳明病，本自汗出。医更重发汗，病已瘥，尚微烦不了了者，此必大便硬故也。以亡津液，胃中干
燥，故令大便硬。当问其小便日几行，若本小便日三四行，今日再行，故知大便不久出。今为小便数少，以津
液当还入胃中，故知不久必大便也。
204．伤寒呕多，虽有阳明证，不可攻之。
205．阳明病，心下硬满者，不可攻之。攻之，利遂不止者死；利止者愈。
206．阳明病，面合色赤，不可攻之。必发热，色黄者，小便不利也。
207．阳明病，不吐、不下、心烦者，可与调胃承气汤。方一。
甘草（炙，二两） 芒硝（半斤） 大黄（清酒洗，四两）
上三味，切，以水三升，煮二物至一升，去滓；内芒硝，更上微火一二沸，温顿服之，以调胃气。
208．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；（一法与桂枝汤）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，勿令至大泄下。大承气汤。方二。
大黄（酒洗，四两） 浓朴（炙，去皮，半斤） 枳实（炙，五枚） 芒硝（三合）
上四味，以水一斗，先煮二物，取五升，去滓；内大黄，更煮取二升，去滓；内芒硝，更上微火一两
沸，分温再服。得下，余勿服。
小承气汤方∶
大黄（酒洗，四两） 浓朴（去皮，炙，二两） 枳实（大者，炙，
三枚）
上三味，以水四升，煮取一升二合，去滓，分温二服。初服汤当更衣，不尔者尽饮之；若更衣者，
勿服之。
209．阳明病，潮热、大便微硬者，可与大承气汤；不硬者，不可与之。若不大便六七日，恐有燥屎，欲知
之法，少与小承气汤，汤入腹中，转失气者，此有燥屎也，乃可攻之；若不转失气者，此但初头硬，后必溏，
不可攻之，攻之必胀满不能食也。欲饮水者，与水则哕，其后发热者，必大便复硬而少也，以小承气汤和之；不
转失气者，慎不可攻也。小承气汤。方三。（用前第二方。）
210．夫实则谵语，虚则郑声。郑声者，重语也；直视、谵语、喘满者死，下利者亦死。
211．发汗多，若重发汗者，亡其阳，谵语，脉短者死；脉自和者不死。
212．伤寒若吐、若下后不解，不大便五六日，上至十余日，日晡所发潮热，不恶寒，独语如见鬼状；若剧
者，发则不识人，循衣摸床，惕而不安，（一云顺衣妄撮怵惕不安）微喘直视，脉弦者生，涩者死。微者，但
发热谵语
者，大承气汤主之。若一服利，则止后服。方四。（用前第二方。）
213．阳明病，其人多汗，以津液外出，胃中燥，大便必硬，硬则谵语，小承气汤主之。若一服谵语止者，
更莫复服。方五。（用前第二方。）
214．阳明病，谵语、发潮热、脉滑而疾者，小承气汤主之。因与承气汤一升，腹中转气者，更服一升；
若不转气者，勿更与之。明日又不大便，脉反微涩者，里虚也，为难治，不可更与承气汤也。方六。（用前第二
方。）
215．阳明病，谵语、有潮热、反不能食者，胃中必有燥屎五六枚也；若能食者，但硬耳。宜大承气汤下
之。方七。（用前第二方。）
216．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。
217．汗（汗一作卧）出谵语者，以有燥屎在胃中，此为风也。须下者，过经乃可下之；下之若早，语言必
乱，以表虚里实故也。下之愈，宜大承气汤。方八。（用前第二方，一云大柴胡汤。）
218．伤寒四五日，脉沉而喘满。沉为在里，而反发其汗，津液越出，大便为难；表虚里实，久则谵语。
219．三阳合病，腹满、身重，难以转侧，口不仁、面垢、（又作枯，一云向经）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。方九。
知母（六两） 石膏（碎，一斤） 甘草（炙，二两） 粳米（六合）
上四味，以水一斗，煮米熟，汤成去滓。温服一升，日三服。
220．二阳并病，太阳证罢，但发潮热，手足 汗出、大便难而谵语者，下之则愈，宜大承气汤。方十。
（用前第二方。）
221．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
（公对切）反谵语；若加温针，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。方十一。
肥栀子（擘，十四枚） 香豉（绵裹，四合）
上二味，以水四升，煮栀子取二升半，去滓；内豉，更煮取一升半，去滓，分二服。温进一服，得快
吐者，止后服。
222．若渴欲饮水，口干舌燥者，白虎加人参汤主之。方十二。
知母（六两） 石膏（碎，一斤） 甘草（炙，二两） 粳米（六合） 人参（三两）
上五味，以水一斗，煮米熟，汤成去滓，温服一升，日三服。
223．若脉浮、发热、渴欲饮水、小便不利者，猪苓汤主之。方十三。
猪苓（去皮） 茯苓 泽泻 阿胶 滑石（碎，各一两）
上五味，以水四升，先煮四味，取二升，去滓；内阿胶烊消。温服七合，日三服。
224．阳明病，汗出多而渴者，不可与猪苓汤。以汗多胃中燥，猪苓汤复利其小便故也。
225．脉浮而迟，表热里寒，下利清谷者，四逆汤主之。方十四。
甘草（炙，二两） 干姜（一两半） 附子（生用，去皮，破八片，一枚）
上三味，以水三升，煮取一升二合，去滓，分温二服。强人可大附子一枚，干姜三两。
226．若胃中虚冷，不能食者，饮水则哕。
227．脉浮、发热，口干、鼻燥、能食者则衄。
228．阳明病，下之，其外有热，手足温，不结胸，心中懊 ，饥不能食，但头汗出者，栀子豉汤主之。
方十五。（用前第十一方。）
229．阳明病，发潮热、大便溏、小便自可、胸胁满不去者，与小柴胡汤。方十六。
柴胡（半斤） 黄芩（三两） 人参（三两） 半夏（洗，半升） 甘草（炙，三两） 生姜（切，三两）
大枣（擘，十二枚）
上七味，以水一斗二升，煮取六升，去滓，再煎取三升。温服一升，日三服。
230．阳明病，胁下硬满，不大便而呕，舌上白苔者，可与小柴胡汤。上焦得通，津液得下，胃气因和，身
然汗出而解。方十七。（用上方。）
231．阳明中风，脉弦浮大，而短气，腹都满，胁下及心痛，久按之气不通，鼻干，不得汗，嗜卧，一身及
目悉黄，小便难，有潮热，时时哕，耳前后肿，刺之小瘥，外不解。病过十日，脉续浮者，与小柴胡汤。方十八。
（用上方。）
232．脉但浮，无余证者，与麻黄汤。若不尿，腹满加哕者，不治。麻黄汤。方十九。
麻黄（去节，三两） 桂枝（去皮，二两） 甘草（炙，一两） 杏仁（去皮尖，七十个）
上四味，以水九升，煮麻黄减二升，去白沫；
内诸药，煮取二升半，去滓。温服八合，覆取微似汗。
233．阳明病，自汗出。若发汗，小便自利者，此为津液内竭，虽硬不可攻之；当须自欲大便，宜蜜煎导而
通之。若土瓜根及大猪胆汁，皆可为导。方二十。蜜煎导方。
食蜜（七合）
上一味，于铜器内微火煎，当须凝如饴状，搅之勿令焦着，欲可丸，并手捻作挺，令头锐，大如
指，长二寸许。当热时急作，冷则硬。以内谷道中，以手急抱，欲大便时乃去之。疑非仲景意，已试甚良。
又大猪胆一枚，泻汁，和少许法醋，以灌谷道内，如一食顷，当大便出宿食恶物，甚效。
234．阳明病，脉迟、汗出多、微恶寒者，表未解也，可发汗，宜桂枝汤。方二十一。
桂枝（去皮，三两） 芍药（三两） 生姜（三两） 甘草（炙，二两） 大枣（擘，十二枚）
上五味，以水七升，煮取三升，去滓，温服一升。须臾，啜热稀粥一升，以助药力取汗。
235．阳明病，脉浮、无汗而喘者，发汗则愈，宜麻黄汤。方二十二。（用前第十九方）
236．阳明病，发热、汗出者，此为热越，不能发黄也。但头汗出，身无汗，剂颈而还，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。方二十三。
茵陈蒿（六两） 栀子（擘，十四枚） 大黄（去皮，二两）
上三味，以水一斗二升，先煮茵陈，减六升；内二味，煮取三升，去滓，分三服。小盒饭利，尿如皂
荚汁状，色正赤，一宿腹减，黄从小便去也。
237．阳明证，其人喜忘者，必有蓄血。所以然者，本有久瘀血，故令喜忘；屎虽硬，大便反易，其色
必黑者，宜抵当汤下之。方二十四。
水蛭（熬） 虻虫（去翅足，熬，各三十个） 大黄（酒洗，三两） 桃仁（去皮尖及两仁者，二十个）
上四味，以水五升，煮取三升，去滓，温服一升；不下更服。
238．阳明病，下之，心中懊 而烦，胃中有燥屎者，可攻。腹微满，初头硬，后必溏，不可攻之。若有燥
屎者，宜大承气汤。方二十五。（用前第二方。）
239．病患不大便五六日，绕脐痛、烦躁、发作有时者，此有燥屎，故使不大便也。
240．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
之与大承气汤，发汗宜桂枝汤。方二十六。（大承气汤用前第二方，桂枝汤用前第二十一方。）
241．大下后，六七日不大便，烦不解，腹满痛者，此有燥屎也。所以然者，本有宿食故也，宜大承气汤。
方二十七。（用前第二方。）
242．病患小便不利，大便乍难乍易，时有微热，喘冒（一作息）不能卧者，有燥屎也，宜大承气汤。方二
十八。（用前第二方。）
243．食谷欲呕，属阳明也，吴茱萸汤主之。得汤反剧者，属上焦也。吴茱萸汤。方二十九。
吴茱萸（洗，一升） 人参（三两） 生姜（切，六两） 大枣（擘，十二枚）
179. Question: There are Taiyang-Yangming, Zhengyang-Yangming, and Shaoyang-Yangming patterns. What do these terms mean? Answer: Taiyang-Yangming refers to Pi Yue (Spleen Constraint, a condition where spleen function is constrained, failing to distribute fluids, leading to dry stools); Zhengyang-Yangming refers to Wei Jia Shi (Stomach Home Excess, characterized by dryness and excess in the stomach and intestines); Shaoyang-Yangming refers to a condition where, after diaphoresis (inducing sweating) and promoting urination, the stomach becomes dry, causing vexation, excess, and difficult defecation.
180. The characteristic of Yangming disease is Wei Jia Shi (Stomach Home Excess, alternatively interpreted as Cold).
181. Question: What causes Yangming disease? Answer: In Taiyang Disease (Taiyang Pattern), if diaphoresis, purgation, or promotion of urination is used, it leads to the loss of Body Fluids (Jin Ye), causing dryness in the stomach, thereby transforming into Yangming Disease. If there is no bowel movement, with internal excess and difficult defecation, this is called Yangming Disease.
182. Question: What are the external manifestations of Yangming Disease? Answer: Fever, spontaneous sweating, absence of aversion to cold, and aversion to heat.
183. Question: Why does some disease present with aversion to cold but no fever on the first day? Answer: Although it has only been one day, the aversion to cold will cease spontaneously, followed by sweating and aversion to heat.
184. Question: Why does the aversion to cold cease spontaneously? Answer: Yangming resides in the middle burner and corresponds to the Earth element. As earth is the destination for all things, pathogenic factors entering Yangming do not transmit further. Although there is initial aversion to cold, it stops naturally on the second day; this is Yangming Disease.
185. Originally a Taiyang pattern, diaphoresis was administered at the onset, but the sweating was incomplete, leading to transformation into Yangming. In Cold Damage (Shang Han), if there is fever, absence of sweating, vomiting with inability to eat, and instead continuous sweating, this indicates transformation into Yangming.
186. On the third day of Cold Damage, the Yangming pulse becomes large.
187. In Cold Damage, if the pulse is floating and moderate, and the hands and feet are naturally warm, the disease is tied to Taiyin. In Taiyin patterns, the body should develop jaundice; if urination is free, jaundice will not develop. If the stool becomes hard by the seventh or eighth day, it transforms into Yangming Disease.
188. When Cold Damage transforms into Yangming, the patient exhibits continuous slight sweating.
189. In Yangming Wind Strike (Zhong Feng), there is bitter taste in the mouth, dry throat, abdominal fullness, slight panting, fever, aversion to cold, and a pulse that is floating and tight. If purgation is mistakenly used, it will result in abdominal fullness and difficult urination.
190. In Yangming Disease, if the patient can eat, it is named Wind Strike (Zhong Feng); if unable to eat, it is named Cold Strike (Zhong Han).
191. In Yangming Disease, if there is Cold Strike, the patient cannot eat, has difficult urination, and continuous sweating of the hands and feet. This indicates the formation of Gu Jia (Solid Mass, a condition of abdominal hardness or diarrhea due to cold accumulation), and the stool will initially be hard and then loose. This occurs because of cold in the stomach, preventing the separation of water and grain.
192. In Yangming Disease, if there is an initial desire to eat, but urination is difficult, and defecation is normal, accompanied by pain in the bones and joints, fever resembling a covering of feathers, sudden madness, and resolution through continuous sweating, this is because dampness cannot overcome Grain Qi (Gu Qi), and is expelled with sweat. A tight pulse indicates recovery.
193. The time when Yangming Disease tends to resolve is from Shen to Xu hours (3 PM to 9 PM).
194. In Yangming Disease, if the patient cannot eat, attacking the heat will inevitably cause hiccup (Yue). This is due to deficiency and cold in the stomach. Since the patient is originally deficient, attacking the heat will inevitably cause hiccup.
195. In Yangming Disease, if the pulse is slow (Chi), the patient cannot eat to fullness. Eating to fullness causes slight vexation and dizziness, and inevitably leads to difficult urination. This indicates the formation of Gu Dan (Grain Jaundice, jaundice-like condition due to food stagnation). Even if purgation is used, abdominal fullness remains. This is because the pulse is slow (indicating cold/deficiency).
196. In Yangming Disease, although profuse sweating is expected, if there is no sweating and the body feels as if insects are crawling under the skin, this is due to long-term deficiency.
197. In Yangming Disease, if there is no sweating but urination is free, and after two or three days there is vomiting, coughing, and cold reversal of the hands and feet, severe headache is inevitable. If there is no coughing, no vomiting, and no cold reversal of the hands and feet, there is no headache. (One version says Winter Yangming.)
198. In Yangming Disease, if there is only dizziness and no aversion to cold, the patient can eat. If there is coughing, the throat will definitely be painful; if there is no coughing, the throat will not be painful. (One version says Winter Yangming.)
199. In Yangming Disease, if there is no sweating, difficult urination, and vexation/regret in the heart, the body will inevitably develop jaundice.
200. In Yangming Disease, if treated with fire therapy, resulting in slight sweating on the forehead and difficult urination, jaundice will inevitably develop.
201. In Yangming Disease, if the pulse is floating and tight, tidal fever will occur at regular intervals; if the pulse is only floating, night sweating will occur.
202. In Yangming Disease, if the mouth is dry and the patient only wants to rinse with water without swallowing, epistaxis (nosebleed) is inevitable.
203. In Yangming Disease, if there was originally spontaneous sweating, and the physician heavily induced sweating again, although the disease improved, slight vexation and discomfort remain. This is necessarily due to hard stool. Because body fluids were lost, the stomach became dry, causing hard stool. One should ask about the frequency of urination. If the patient originally urinated three or four times a day, and today only twice, it indicates that stool will soon be passed. The decrease in urination frequency means fluids are returning to the stomach, so defecation is imminent.
204. In Cold Damage, if vomiting is frequent, even if Yangming signs are present, purgation must not be used.
205. In Yangming Disease, if there is hardness and fullness below the heart (epigastrium), purgation must not be used. If purged, incessant diarrhea leads to death; if diarrhea stops, recovery occurs.
206. In Yangming Disease, if the face is uniformly red, purgation must not be used. If purged, fever will occur, and yellow discoloration with difficult urination will follow.
207. In Yangming Disease, if there is no vomiting, no purgation, and vexation in the heart, Tiao Wei Cheng Qi Tang (Stomach-Regulating Order the Qi Decoction) may be given. Formula 1.
Glycyrrhizae Radix et Rhizoma Praeparata cum Melle (Zhi Gancao, 2 liang), Natrii Sulfas (Mangxiao, 0.5 jin), Rhei Radix et Rhizoma (Dahuang, washed with clear wine, 4 liang).
Cut the above three ingredients. Boil two ingredients in 3 sheng of water until 1 sheng remains. Remove dregs. Add Mangxiao and boil gently for one or two boils. Take the warm decoction in one dose to regulate stomach qi.
208. In Yangming Disease, if the pulse is slow (Chi), and although there is sweating, there is no aversion to cold, the body will feel heavy, with shortness of breath, abdominal fullness, and panting. If there is tidal fever, the exterior pattern is resolving, and interior attack is permissible. If there is continuous sweating of the hands and feet, the stool is already hard; Da Cheng Qi Tang (Major Order the Qi Decoction) governs. If there is profuse sweating, slight fever, and aversion to cold, the exterior is not resolved; (another method suggests Gui Zhi Tang). If the fever is not tidal, Cheng Qi Tang should not be given. If there is severe abdominal fullness and obstruction, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) may be given to mildly harmonize stomach qi, avoiding severe purgation. Da Cheng Qi Tang. Formula 2.
Rhei Radix et Rhizoma (Dahuang, wine-washed, 4 liang), Magnoliae Officinalis Cortex (Houpo, honey-fried, peeled, 0.5 jin), Aurantii Fructus Immaturus (Zhishi, honey-fried, 5 pieces), Natrii Sulfas (Mangxiao, 3 ge).
Boil the above four ingredients in 1 dou of water. First boil two ingredients to obtain 5 sheng, remove dregs. Add Dahuang and boil to 2 sheng, remove dregs. Add Mangxiao and boil gently for one or two boils. Divide into two warm doses. Stop taking the remainder if defecation occurs.
Xiao Cheng Qi Tang Formula:
Rhei Radix et Rhizoma (Dahuang, wine-washed, 4 liang), Magnoliae Officinalis Cortex (Houpo, peeled, honey-fried, 2 liang), Aurantii Fructus Immaturus (Zhishi, large, honey-fried, 3 pieces).
Boil the above three ingredients in 4 sheng of water to obtain 1 sheng and 2 ge. Remove dregs. Divide into two warm doses. Defecation should occur after the first dose; if not, drink the rest. If defecation occurs, do not continue.
209. In Yangming Disease, if there is tidal fever and slightly hard stool, Da Cheng Qi Tang may be given; if not hard, it must not be given. If there is no defecation for six or seven days, fearing dry stool, administer a small amount of Xiao Cheng Qi Tang. If flatus passes after ingestion, dry stool is present, and purgation is permissible. If no flatus passes, only the initial part is hard, and the rest will be loose; purgation is forbidden, as it will cause abdominal distension and inability to eat. If the patient desires water, giving water causes hiccup. Subsequent fever indicates stool becoming hard again but scanty; harmonize with Xiao Cheng Qi Tang. If no flatus passes, purgation is strictly forbidden. Xiao Cheng Qi Tang. Formula 3. (Use previous Formula 2.)
210. Excess patterns manifest as Delirium (Zhan Yu); deficiency patterns manifest as Rhen Sheng (repetitive, low-volume speech). Rhen Sheng is repetitive speech. Staring, delirium, panting, and fullness lead to death; diarrhea also leads to death.
211. If excessive sweating occurs, or if sweating is heavily induced again, Yang collapse occurs, leading to delirium. A short pulse indicates death; a harmonious pulse indicates survival.
212. If Cold Damage is not resolved after emesis or purgation, and there is no defecation for five or six days, up to ten days, with tidal fever in the late afternoon, no aversion to cold, and solitary speech as if seeing ghosts, the condition is severe. If the patient does not recognize people, picks at clothes and bed sheets, is startled and uneasy, (one version says picking clothes wildly, startled and uneasy), has slight panting and staring, a wiry pulse indicates life, while a choppy pulse indicates death. In mild cases, with only fever and delirium, Da Cheng Qi Tang governs. If defecation occurs after one dose, stop subsequent doses. Formula 4. (Use previous Formula 2.)
213. In Yangming Disease, if the patient sweats profusely, fluids escape externally, drying the stomach, leading to hard stool and delirium. Xiao Cheng Qi Tang governs. If delirium stops after one dose, do not repeat. Formula 5. (Use previous Formula 2.)
214. In Yangming Disease, with delirium, tidal fever, and a slippery and rapid pulse, Xiao Cheng Qi Tang governs. Administer 1 sheng of Cheng Qi Tang. If flatus passes, give another 1 sheng. If no flatus passes, do not give more. If there is still no defecation the next day, and the pulse becomes faint and choppy, it indicates interior deficiency, which is difficult to treat; do not give Cheng Qi Tang again. Formula 6. (Use previous Formula 2.)
215. In Yangming Disease, with delirium, tidal fever, and inability to eat, there must be five or six pieces of dry stool in the stomach. If the patient can eat, the stool is merely hard. Da Cheng Qi Tang is appropriate for purgation. Formula 7. (Use previous Formula 2.)
216. In Yangming Disease, with bloody stool and delirium, this is Heat Entering the Blood Chamber (Re Ru Xue Shi). If only the head sweats, needle Qimen (LR14) to drain the excess. Continuous sweating leads to recovery.
217. Sweating and delirium indicate dry stool in the stomach, caused by Wind. Purgation is required, but only after the channel stage has passed. Early purgation causes disordered speech due to exterior deficiency and interior excess. Recovery follows purgation; Da Cheng Qi Tang is appropriate. Formula 8. (Use previous Formula 2; one version says Da Chai Hu Tang.)
218. Four or five days into Cold Damage, the pulse is deep, with panting and fullness. A deep pulse indicates interior location. Mistaken diaphoresis causes fluid loss and difficult defecation. Exterior deficiency and interior excess lead to delirium over time.
219. In Combined Three Yang Patterns, there is abdominal fullness, body heaviness, difficulty turning, loss of taste, facial grime, (also described as withered, one version says towards menstruation), delirium, and enuresis. Diaphoresis worsens delirium; purgation causes forehead sweating and cold reversal of hands and feet. If there is spontaneous sweating, Bai Hu Tang (White Tiger Decoction) governs. Formula 9.
Anemarrhenae Rhizoma (Zhimu, 6 liang), Gypsum Fibrosum (Shigao, crushed, 1 jin), Glycyrrhizae Radix et Rhizoma Praeparata cum Melle (Zhi Gancao, 2 liang), Oryzae Semen (Jingmi, 6 ge).
Boil the above four ingredients in 1 dou of water until the rice is cooked. Remove dregs. Take 1 sheng warm, three times a day.
220. In Combined Two Yang Patterns, when Taiyang signs cease, and only tidal fever, continuous sweating of hands and feet, difficult defecation, and delirium remain, purgation leads to recovery. Da Cheng Qi Tang is appropriate. Formula 10. (Use previous Formula 2.)
221. In Yangming Disease, with a floating and tight pulse, dry throat, bitter taste, abdominal fullness and panting, fever, sweating, no aversion to cold but aversion to heat, and body heaviness, diaphoresis causes agitation, mental confusion, and conversely delirium. Adding warm needling causes fright, vexation, and insomnia. Purgation empties the stomach, allowing guest qi to disturb the diaphragm, causing vexation/regret in the heart. If there is coating on the tongue, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) governs. Formula 11.
Gardeniae Fructus (Zhizi, broken, 14 pieces), Sojae Semen Preparatum (Xiangchi, wrapped in cotton, 4 ge).
Boil the above two ingredients in 4 sheng of water. Boil Zhizi to 2.5 sheng, remove dregs. Add Chi and boil to 1.5 sheng, remove dregs. Divide into two doses. Take one warm dose. If rapid vomiting occurs, stop subsequent doses.
222. If there is thirst with desire to drink, dry mouth, and dry tongue, Bai Hu Jia Ren Shen Tang (White Tiger Plus Ginseng Decoction) governs. Formula 12.
Anemarrhenae Rhizoma (Zhimu, 6 liang), Gypsum Fibrosum (Shigao, crushed, 1 jin), Glycyrrhizae Radix et Rhizoma Praeparata cum Melle (Zhi Gancao, 2 liang), Oryzae Semen (Jingmi, 6 ge), Ginseng Radix et Rhizoma (Renshen, 3 liang).
Boil the above five ingredients in 1 dou of water until the rice is cooked. Remove dregs. Take 1 sheng warm, three times a day.
223. If the pulse is floating, with fever, thirst with desire to drink, and difficult urination, Zhu Ling Tang (Polyporus Decoction) governs. Formula 13.
Polyporus (Zhu Ling, peeled), Poria (Fuling), Alismatis Rhizoma (Zexie), Asini Corii Colla (Ejiao), Talcum (Huashi, crushed, 1 liang each).
Boil the above five ingredients in 4 sheng of water. First boil the first four to obtain 2 sheng, remove dregs. Add Ejiao and dissolve. Take 7 ge warm, three times a day.
224. In Yangming Disease, if there is profuse sweating and thirst, Zhu Ling Tang must not be given. Profuse sweating causes stomach dryness, and Zhu Ling Tang further promotes urination, depleting fluids.
225. If the pulse is floating and slow (Chi), with exterior heat and interior cold, and diarrhea with undigested food, Si Ni Tang (Frigid Extremities Decoction) governs. Formula 14.
Glycyrrhizae Radix et Rhizoma Praeparata cum Melle (Zhi Gancao, 2 liang), Zingiberis Rhizoma (Ganjiang, 1.5 liang), Aconiti Lateralis Radix Praeparata (Fuzi, raw, peeled, broken into 8 pieces, 1 piece).
Boil the above three ingredients in 3 sheng of water to obtain 1.2 sheng. Remove dregs. Divide into two warm doses. Strong individuals may use 1 large Fuzi and 3 liang Ganjiang.
226. If the stomach is deficient and cold, causing inability to eat, drinking water causes hiccup.
227. If the pulse is floating, with fever, dry mouth, dry nose, and ability to eat, epistaxis will occur.
228. In Yangming Disease, after purgation, if there is exterior heat, warm hands and feet, no Chest Bind, vexation/regret in the heart, hunger but inability to eat, and only head sweating, Zhi Zi Chi Tang governs. Formula 15. (Use previous Formula 11.)
229. In Yangming Disease, with tidal fever, loose stool, free urination, and persistent fullness in the chest and hypochondrium, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is given. Formula 16.
Bupleuri Radix (Chaihu, 0.5 jin), Scutellariae Radix (Huangqin, 3 liang), Ginseng Radix et Rhizoma (Renshen, 3 liang), Pinelliae Rhizoma (Banxia, washed, 0.5 sheng), Glycyrrhizae Radix et Rhizoma Praeparata cum Melle (Zhi Gancao, 3 liang), Zingiberis Rhizoma Recens (Shengjiang, sliced, 3 liang), Jujubae Fructus (Dazao, broken, 12 pieces).
Boil the above seven ingredients in 1.2 dou of water to obtain 6 sheng. Remove dregs. Re-boil to 3 sheng. Take 1 sheng warm, three times a day.
230. In Yangming Disease, with hardness and fullness below the ribs, no defecation, vomiting, and white tongue coating, Xiao Chai Hu Tang may be given. This unblocks the Upper Burner, allows fluids to descend, harmonizes stomach qi, and resolves the disease through continuous sweating. Formula 17. (Use above formula.)
231. In Yangming Wind Strike, the pulse is wiry, floating, and large, with shortness of breath, general abdominal fullness, pain in the hypochondrium and heart, obstruction of qi upon prolonged pressure, dry nose, inability to sweat, lethargy, yellowing of the whole body and eyes, difficult urination, tidal fever, frequent hiccup, and swelling before and behind the ears. Acupuncture provides slight relief, but the exterior is not resolved. If the disease persists for ten days and the pulse remains floating, give Xiao Chai Hu Tang. Formula 18. (Use above formula.)
232. If the pulse is only floating, with no other signs, give Ma Huang Tang (Ephedra Decoction). If there is anuria, abdominal fullness, and added hiccup, it is incurable. Ma Huang Tang. Formula 19.
Ephedrae Herba (Mahuang, nodes removed, 3 liang), Cinnamomi Ramulus (Guizhi, peeled, 2 liang), Glycyrrhizae Radix et Rhizoma Praeparata cum Melle (Zhi Gancao, 1 liang), Armeniacae Semen Amarum (Xingren, peeled and tips removed, 70 pieces).
Boil the above four ingredients in 9 sheng of water. First boil Mahuang, reducing by 2 sheng, and remove white foam.
Add other ingredients and boil to 2.5 sheng. Remove dregs. Take 8 ge warm. Cover to induce slight sweating.
233. In Yangming Disease, with spontaneous sweating, if diaphoresis is used and urination is free, this indicates exhaustion of internal fluids. Although stool is hard, purgation is forbidden. Wait for the urge to defecate, and use Mi Jian Dao (Honey Suppository) to unblock. Tu Gua Gen (Trichosanthes Root) and large pig bile can also be used as guides. Formula 20. Mi Jian Dao Formula.
Edible Honey (7 ge).
Boil this single ingredient in a copper vessel over gentle heat until it congeals like maltose. Stir to prevent burning. Form into a suppository shape by hand, sharp at the tip, finger-sized, about 2 cun long. Make quickly while hot, as it hardens when cold. Insert into the anus, hold buttocks tightly, and remove when the urge to defecate arises. It is suspected this is not Zhongjing's original intent, but it has been tested with good results.
Alternatively, take one large pig gallbladder, extract the juice, mix with a little vinegar, and灌 (guan, irrigate) into the anus. Within the time of a meal, old food and foul matter will be expelled, which is very effective.
234. In Yangming Disease, with a slow pulse, profuse sweating, and slight aversion to cold, the exterior is not resolved. Diaphoresis is permissible; Gui Zhi Tang (Cinnamon Twig Decoction) is appropriate. Formula 21.
Cinnamomi Ramulus (Guizhi, peeled, 3 liang), Paeoniae Radix Alba (Baishao, 3 liang), Zingiberis Rhizoma Recens (Shengjiang, 3 liang), Glycyrrhizae Radix et Rhizoma Praeparata cum Melle (Zhi Gancao, 2 liang), Jujubae Fructus (Dazao, broken, 12 pieces).
Boil the above five ingredients in 7 sheng of water to obtain 3 sheng. Remove dregs. Take 1 sheng warm. Shortly after, drink 1 sheng of hot thin porridge to assist the medicinal power in inducing sweating.
235. In Yangming Disease, with a floating pulse, no sweating, and panting, diaphoresis leads to recovery. Ma Huang Tang is appropriate. Formula 22. (Use previous Formula 19.)
236. In Yangming Disease, fever and sweating indicate heat venting outward, preventing jaundice. If only the head sweats, with no body sweating (stopping at the neck), difficult urination, and thirst with desire for fluids, this is Stasis Heat in the Interior, and jaundice is inevitable. Yin Chen Hao Tang (Capillaris Decoction) governs. Formula 23.
Artemisiae Scopariae Herba (Yinchenhao, 6 liang), Gardeniae Fructus (Zhizi, broken, 14 pieces), Rhei Radix et Rhizoma (Dahuang, peeled, 2 liang).
Boil the above three ingredients in 1.2 dou of water. First boil Yinchen, reducing by 6 sheng. Add the other two ingredients and boil to 3 sheng. Remove dregs. Divide into three doses. Urination should become free, with urine resembling soap pod juice, bright red in color. Abdominal distension reduces overnight, and jaundice is eliminated through urine.
237. In Yangming Pattern, if the patient is forgetful, there must be Accumulated Blood. This is due to pre-existing long-standing blood stasis, causing forgetfulness. Although stool is hard, defecation is easy, and the color is black. Di Dang Tang (Resist Dang Decoction) is appropriate for purgation. Formula 24.
Hirudo (Shuizhi, roasted), Tabanus (Mengchong, wings and legs removed, roasted, 30 each), Rhei Radix et Rhizoma (Dahuang, wine-washed, 3 liang), Persicae Semen (Taoren, peeled, tips and double kernels removed, 20 pieces).
Boil the above four ingredients in 5 sheng of water to obtain 3 sheng. Remove dregs. Take 1 sheng warm. If no purgation occurs, take another dose.
238. In Yangming Disease, after purgation, if there is vexation/regret in the heart and irritability, and dry stool in the stomach, purgation is permissible. If abdominal fullness is slight, with initial hardness and subsequent looseness, purgation is forbidden. If dry stool is present, Da Cheng Qi Tang is appropriate. Formula 25. (Use previous Formula 2.)
239. If a patient has not defecated for five or six days, with periumbilical pain, irritability, and episodic attacks, dry stool is present, causing constipation.
240. If a patient has vexing heat, resolution occurs with sweating. If fever recurs like malaria in the late afternoon, it belongs to Yangming. A solid pulse indicates purgation is appropriate; a floating and deficient pulse indicates diaphoresis is appropriate. Purgation uses Da Cheng Qi Tang; diaphoresis uses Gui Zhi Tang. Formula 26. (Da Cheng Qi Tang uses previous Formula 2; Gui Zhi Tang uses previous Formula 21.)
241. After major purgation, if there is no defecation for six or seven days, unresolved irritability, and abdominal fullness and pain, dry stool is present. This is due to pre-existing retained food. Da Cheng Qi Tang is appropriate. Formula 27. (Use previous Formula 2.)
242. If a patient has difficult urination, alternating difficult and easy defecation, occasional slight fever, panting and dizziness (one version says resting), and inability to lie down, dry stool is present. Da Cheng Qi Tang is appropriate. Formula 28. (Use previous Formula 2.)
243. Vomiting after eating belongs to Yangming. Wu Zhu Yu Tang (Evodia Decoction) governs. If symptoms worsen after taking the decoction, it belongs to the Upper Burner. Wu Zhu Yu Tang. Formula 29.
Evodiae Fructus (Wuzhuyu, washed, 1 sheng), Ginseng Radix et Rhizoma (Renshen, 3 liang), Zingiberis Rhizoma Recens (Shengjiang, sliced, 6 liang), Jujubae Fructus (Dazao, broken, 12 pieces).