阳明病。若能食。名中风。不能食。名中寒。
阳明腑病。有传经自受之异。传经者。风寒已变。其病多热。自受者。风寒初入。其病多冷。
而风之与寒。则又有辨。此条盖阳明胃腑自中风寒之辨也。太阳主肌表。故有有汗无汗之分。阳明
为胃府。故有能食不能食之辨。风为阳而寒为阴。阳能消谷而阴不能消谷之意也。夫风寒中人。无
有常经。是以伤寒不必定自太阳。中寒不必定自三阴。论中凡言阳明中风。阳明病。若中寒。及少阳中风
。太阴少阴厥阴中
风等语。皆是本经自受风寒之证。非从太阳传来者也。学人辨诸。
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。
手足 然汗出。于法为胃家实。而寒邪适中。小便复不利。则是胃有坚积。而水寒胜之。所以
知其欲作固瘕。固瘕者。胃寒成聚。久泄不已也。以下四条。并阳明胃府自中寒邪之证。
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。与水则哕。
脉迟为寒。而病系阳明。则脉不沉而浮也。寒中于里。故下利清谷。而阳为阴迫。则其表反热
也。四逆汤为复阳散寒之剂。故得主之。而阳明土也。土恶水而喜温。若胃虚且冷。不能纳谷者。
土气无权。必不能胜水而禁冷。设与之水。水与寒搏。必发为哕。哕、呃逆也。
食谷欲呕者。属阳明也。吴茱萸汤主之。得汤反剧者。属上焦也。
食谷欲呕。有中焦与上焦之别。盖中焦多虚寒。而上焦多火逆也。阳明中虚。客寒乘之。食谷
则呕。故宜吴茱萸汤。以益虚而温胃。若得汤反剧。则仍是上焦火逆之病。宜清降而不宜温养者矣
。仲景于疑似之间。细心推测如此。
吴茱萸汤方
吴茱萸（一斤洗） 人参（三两） 生姜（六两切） 大枣（十二枚擘）
上四味。以水七升。煮取二升。去滓。温服七合。日三服。
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。
口苦咽干。阳邪内侵也。腹满微喘。里气不行也。发热恶寒。表邪方盛也。夫邪在里者已实。
而在表者犹盛。于法则不可下。下之则邪气尽陷。脾乃不化。腹加满而小便难矣。此阳明自中风邪
。而表里俱受之证。是以脉浮而紧。盖太阳脉紧。为表有寒。阳明脉紧。为里有实。前第三十三条
云、阳明病。脉浮而紧者。必潮热。发作有时。意可参考。
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
面目悉黄。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。脉但浮。无余证者。与麻黄汤。若不尿。腹满加哕者。不治。
此条虽系阳明。而已兼少阳。虽名中风。而实为表实。乃阳明少阳邪气闭郁于经之证也。阳明
闭郁。故短气腹满。鼻干不得汗。嗜卧。一身及面目悉黄。小便难。有潮热。少阳闭郁。故胁下及心
痛。久按之气不通。时时哕。耳前后肿。刺之小瘥。外不解者。脉证少平。而大邪不去也。病过十
日。而脉续浮。知其邪犹在经。故与小柴胡和解邪气。若脉但浮。而无少阳证兼见者。则但与麻黄
汤发散邪气而已。盖以其病兼少阳。故不与葛根而与柴胡。以其气实无汗。故虽中风而亦用麻黄。
若不得尿。故腹加满。哕加甚者。正气不化。而邪气独盛。虽欲攻之。神不为使。亦无益矣。故曰
不治。
阳明病。但头眩不恶寒。故能食而咳。其人必咽痛。若不咳者。咽不痛。
但头眩不恶寒。能食而咳者。阳明风邪变热。聚于胃而逆于肺也。咽居肺上。故必咽痛。若不
咳者。肺不受热。则咽必不痛。不恶寒而头眩者。气方外淫而不内炽。亦何至能食而咳哉。
阳明病。能食。小便反不利。大便自调。其人骨节疼。翕然如有热状。奄然发狂。 然汗出而
解者。此水不胜谷气。与汗共并。脉紧则愈。
此阳明风湿为痹之证。金匮云、湿痹之候。小便不利。大便反快。又湿病关节疼痛而烦是也。
奄然发狂者。胃中阳胜。所谓怒狂生于阳也。 然汗出者。谷气内盛。所为汗出于谷也。谷气盛而
水湿不能胜之。则随汗外出。故曰与汗共并。汗出邪解。脉气自和。故曰脉紧则愈。前第四十三条
中寒不能食。所以虽有坚积。而病成固瘕。此条胃强饮食。所以虽有水湿而忽从汗散。合而观之。
可以知阴阳进退之机。
Yangming disease. If the patient can eat, it is named Wind-Strike (Zhong Feng); if they cannot eat, it is named Cold-Strike (Zhong Han).
In Yangming Fu-organ disease, there are differences between transmission from other meridians and direct acquisition. Transmission refers to pathogenic wind-cold that has already transformed into heat after entering the Yangming, so such diseases mostly present as heat syndromes. Direct acquisition refers to pathogenic wind-cold initially invading the Yangming without transformation, so such diseases mostly present as cold syndromes.
Furthermore, there is a distinction between Wind and Cold. This clause discusses the differentiation of direct Wind or Cold invasion of the Yangming Stomach Fu. The Taiyang meridian governs the muscle layer and exterior, so differentiation is made based on the presence or absence of sweating. The Yangming belongs to the Stomach Fu, so differentiation is made based on the ability or inability to eat. Wind is Yang and Cold is Yin; this implies that Yang energy can digest food while Yin energy cannot. Generally, when wind-cold invades humans, there is no fixed meridian pathway. Therefore, Shanghan (Cold Damage) does not necessarily start from Taiyang, and Zhonghan (Cold Strike) does not necessarily start from the Three Yin meridians. All mentions in the Treatise of "Yangming Wind-Strike," "Yangming Disease," "If Cold-Strike," as well as "Shaoyang Wind-Strike" and "Taiyin, Shaoyin, Jueyin Wind-Strike" refer to conditions where the respective meridian directly acquires wind-cold, not those transmitted from Taiyang. Students should distinguish these carefully.
Yangming disease, if it involves Cold-Strike, presents with an inability to eat, dysuria (difficulty urinating), and persistent sweating on the hands and feet. This indicates the impending formation of Gujia (a chronic accumulation or diarrhea caused by cold stagnation). There will inevitably be stool that is initially hard and later loose. The reason for this is coldness in the stomach, causing water and grain to fail to separate properly.
Persistent sweating on the hands and feet typically indicates a Shih (Excess) syndrome of the Stomach and Intestines. However, if cold pathogen strikes moderately and dysuria persists, it indicates solid accumulation in the stomach overcome by cold-water. Thus, it is known to be forming Gujia. Gujia refers to qi aggregation due to stomach cold, resulting in prolonged, unceasing diarrhea. The following four clauses all describe syndromes of the Yangming Stomach Fu directly struck by cold pathogen.
A pulse that is floating and slow, accompanied by superficial heat and interior cold, and diarrhea with undigested food residues, is treated with Sini Tang (Four Reversal Decoction). If the stomach is deficient and cold, unable to accept food, giving water induces hiccups (Yue).
A slow pulse indicates cold. Since the disease is in Yangming, the pulse floats rather than sinks. Cold striking the interior causes diarrhea with undigested food. When yang is forced outward by yin-cold, the exterior appears hot. Sini Tang is a formula to restore yang and dissipate cold, hence it is indicated. Yangming corresponds to Earth; Earth dislikes water-dampness and prefers warmth. If the stomach is deficient and cold, unable to receive grain, the Qi of Earth lacks authority and cannot control water or resist cold. If water is given, water and cold clash, inducing hiccups. Yue refers to hiccups.
Desire to vomit after eating food belongs to Yangming disease, treated with Wuzhuyu Tang (Evodia Decoction). If symptoms worsen after taking the decoction, the pathology lies in the Upper Jiao.
Desire to vomit after eating distinguishes between Middle Jiao and Upper Jiao disorders. Generally, Middle Jiao disorders involve deficiency-cold, while Upper Jiao disorders involve fire-rebellion. Yangming middle-jiao deficiency allows guest-cold to invade; eating triggers vomiting. Thus, Wuzhuyu Tang is suitable to tonify deficiency and warm the stomach. If symptoms worsen after taking the decoction, it remains an Upper Jiao fire-rebellion disorder, requiring clearing and descending methods rather than warming and nourishing. Zhang Zhongjing deduces such ambiguous cases with great care.
Formula: Wuzhuyu Tang
Wuzhuyu (Evodiae Fructus, 1 jin, washed)
Renshen (Ginseng Radix et Rhizoma, 3 liang)
Shengjiang (Zingiberis Rhizoma Recens, 6 liang, sliced)
Dazao (Jujubae Fructus, 12 pieces, split)
These four ingredients are boiled in 7 sheng of water to obtain 2 sheng of liquid. Remove the dregs. Take 7 ge warm, three times daily.
Yangming Wind-Strike presents with bitter taste in the mouth, dry throat, abdominal fullness, slight panting, fever, aversion to cold, and a floating-tight pulse. If purgatives are used incorrectly, abdominal fullness will worsen and urination will become difficult.
Bitter taste and dry throat indicate internal invasion by Yang pathogen. Abdominal fullness and slight panting indicate obstruction of interior Qi flow. Fever and aversion to cold indicate the pathogen is still strong at the exterior. When pathogens are excess in the interior and still strong at the exterior, purgation is contraindicated. Incorrect purgation causes pathogens to sink entirely, spleen transformation fails, leading to increased abdominal fullness and dysuria. This is a case of Yangming directly struck by Wind, affecting both exterior and interior. Hence, the pulse is floating and tight. A tight pulse in Taiyang indicates exterior cold; a tight pulse in Yangming indicates interior excess. Clause 33 states: "In Yangming disease, if the pulse is floating and tight, tidal fever must occur at regular intervals." Refer to this.
Yangming Wind-Strike presents with a string-like, floating, and large pulse, shortness of breath, generalized abdominal fullness, pain under the ribs and in the heart region, obstruction of Qi upon long pressure, dry nose with inability to sweat, lethargy, jaundice of the whole body and face, dysuria, tidal fever, frequent hiccups, and swelling around the ears. Acupuncture provides slight relief, but the exterior condition remains unresolved. After ten days, if the pulse continues to float, administer Xiaochaihu Tang (Minor Bupleurum Decoction). If the pulse is only floating without other accompanying signs, administer Mahuang Tang (Ephedra Decoction). If there is anuria, worsening abdominal fullness, and severe hiccups, it is untreatable.
Although this clause concerns Yangming, it involves Shaoyang. Although named Wind-Strike, it is essentially an exterior excess syndrome where pathogens of Yangming and Shaoyang are closed and depressed in the meridians. Yangming depression causes shortness of breath, abdominal fullness, dry nose, inability to sweat, lethargy, jaundice, dysuria, and tidal fever. Shaoyang depression causes rib/heart pain, Qi obstruction upon pressure, hiccups, and ear swelling. Slight improvement after acupuncture indicates mild relief of pulse/symptoms but persistence of major pathogens. After ten days, continuous floating pulse indicates pathogens remain in the meridians; thus, Xiaochaihu Tang is used to harmonize and resolve pathogens. If the pulse is only floating without Shaoyang signs, Mahuang Tang is used to disperse pathogens. Because it involves Shaoyang, Gegen Tang is not used but Chaihu formulas are preferred. Because Qi is excess and there is no sweat, even in Wind-Strike, Mahuang is used. If anuria occurs, worsening abdominal fullness, and severe hiccups, Zheng Qi fails to transform while Xie Qi dominates. Even attempting to attack pathogens, the Shen (Spirit) cannot respond, rendering treatment useless. Hence, it is called untreatable.
Yangming disease presenting only with vertigo/dizziness, no aversion to cold, ability to eat, and coughing, implies the patient will definitely have a sore throat. If there is no cough, the throat will not hurt.
Vertigo, no aversion to cold, ability to eat, and cough indicate Yangming Wind transforming into heat, gathering in the Stomach and rebelling against the Lung. The throat is located above the Lung, so it definitely hurts. If there is no cough, the Lung is not affected by heat, so the throat will not hurt. Vertigo without aversion to cold indicates Qi dispersing outward without internal blazing; otherwise, how could one eat and cough?
Yangming disease where the patient can eat, yet urine is unusually scanty, bowel movements are normal, bone joints ache, there is a vague sensation of heat, sudden onset of mania, followed by persistent sweating and resolution of the disease. This occurs because Water-Dampness cannot overcome Grain Qi; Grain Qi combines with dampness and exits via sweat. As the pulse tightens (or returns to normal tension), recovery ensues.
This is a Yangming Wind-Damp Bi syndrome. The Jingui Yaolue states: In damp-Bi, urine is scanty, stools are loose, and joint pain is accompanied by irritability. Sudden mania indicates stomach Yang dominance ("Manic anger arises from Yang"). Persistent sweating indicates abundant Grain Qi ("Sweat originates from Grain"). When Grain Qi is strong and cannot be overcome by dampness, it exits with sweat, hence "combining with sweat." Sweating resolves pathogens, pulse Qi harmonizes, hence "pulse tightening indicates recovery." Clause 43 discussed Cold-Strike preventing eating, leading to Gujia despite solid accumulation. This clause discusses strong Stomach function allowing eating, so dampness disperses suddenly via sweat. Comparing both reveals the mechanism of Yin-Yang advance and retreat.