病如桂枝证。头不痛。项不强。寸脉微浮。胸中痞硬。气上冲咽喉不得息者。此为胸有寒也。
当吐之。宜瓜蒂散。
此痰饮类伤寒证。寒为寒饮。非寒邪也。活人云、痰饮之为病。能令人憎寒发热。状类伤寒。
但头不痛。项不强为异。正此之谓。脉浮者。病在膈间。而非客邪。故不盛而微也。胸有寒饮。足
以阻清阳而碍肺气。故胸中痞硬。气上冲咽喉。不得息也。经曰、其高者因而越之。千金云、气浮
上部。顿塞心胸。胸中满者。吐之则愈。瓜蒂散能吐胸中与邪相结之饮也。
瓜蒂散方
瓜蒂（熬黄） 赤小豆（各一分即粮食中蟹眼紧细之赤豆是也）
上二味。各别捣筛为散。合治之。取一钱匕。以香豉一合。用热汤七合。煮作稀糜。去滓。取
汁。和散。温顿服之。不吐者。少少加。得快吐乃止。诸亡血虚家。不可与之。
太阳病从外入。是以经病多于腑病。若阳明则腑病多于经病。以经邪不能久留。而腑邪常聚而
不行也。故仲师以胃家实为阳明正病。本篇先列腑病于前。次列经病于后。遵先圣之法也。而经病有
传经自受之不同。腑病有宜下宜清宜温之各异。详见各条。要皆不出为正治之法也。此为上编。凡
四十九条。其次则为明辨法。盖阳明以胃实为病之正。以攻下为法之的。而其间有经腑相连。虚实
交错。或可下。或不可下。或可下而尚未可下。及不可大下之时。故有脉实。潮热。转失气。小便
少等辨。及外导润下等法。又其次为杂治法。谓病变发黄。蓄血诸候。非复阳明胃实。及经邪留滞
之时。所可比例。或散或下。所当各随其证。而异其治者也。此为下编。凡三十三条。
The symptoms resemble those of the Guizhi Tang (Cinnamon Twig Decoction) pattern, yet there is no headache or stiffness in the nape. The cun (inch) pulse is slightly floating. There is a sensation of fullness and hardness in the chest, with qi rushing upward to the throat causing dyspnea. This indicates the presence of cold-phlegm-fluid (cold-type phlegm-fluid pathogen) in the chest.
One should employ the emetic method for treatment; Gouti San (Melon Seed Powder) is appropriate.
This is a syndrome resembling Taiyang disease caused by phlegm-fluid accumulation. The "cold" here refers to cold-phlegm-fluid, not an external cold pathogen. The *Huoren Shu* states: Phlegm-fluid as a pathogen can cause aversion to cold and fever, presenting similarly to Taiyang disease. However, the absence of headache and nape stiffness distinguishes it, which is precisely what is meant here. A floating pulse indicates the pathology is located between the diaphragm, rather than being an exogenous pathogen lodged there; thus, the pulse is not forceful but slight. Cold-phlegm-fluid in the chest obstructs the clear yang qi and impedes lung qi descent, resulting in chest fullness and hardness, upward rushing of qi to the throat, and dyspnea. The *Classic of Internal Medicine* states: "Where the pathology is high, use the method of raising and evacuating [emesis]." The *Qianjin Fang* states: "When qi floats to the upper part, suddenly blocking the chest and heart, if the chest is full, emesis will cure it." Gouti San can expel the fluid pathogen bound with evil in the chest through emesis.
**Gouti San Formula**
* Gualti (Aged Yellow Melon Seed, *Cucumis melo var. conomon* seed, stir-fried until yellow)
* Chixiaodou (Red Adzuki Bean, *Vigna angularis*, one fen each, specifically referring to the tight, fine red beans found among grains)
Process the above two ingredients separately by pounding and sifting into powder, then mix them thoroughly. Take one qianbi (a small spoonful measure) of the powder. Use Xiangchi (Prepared Soybean, *Sojae Semen Praeparatum*) one he, and hot water seven he. Boil until a thin porridge consistency is reached, strain to remove dregs, and take the decoction. Mix with the powder and administer warm in one dose. If vomiting does not occur, gradually increase the dosage until rapid vomiting ensues, then stop. This formula is contraindicated for patients who have suffered blood loss or those with deficiency constitutions.
Taiyang disease enters from the exterior; therefore, Jing-meridian syndromes are more common than Fu-organ syndromes. In contrast, for Yangming disease, Fu-organ syndromes are more common than Jing-meridian syndromes. This is because pathogenic factors in the meridians cannot remain long-term, whereas pathogens in the fu-organs tend to accumulate and stagnate. Therefore, Zhang Zhongjing considers "stomach-fullness-excess" (Wei Jia Shi) as the primary pathology of Yangming. This chapter lists Fu-organ syndromes first and Jing-meridian syndromes later, adhering to the methods of the Sages. Furthermore, Jing-meridian syndromes vary in their transmission and spontaneous acquisition, while Fu-organ syndromes differ in their suitability for purgation, clearing heat, or warming. These details are elaborated in respective articles. Ultimately, all fall within the scope of standard treatment methods. This constitutes the Upper Compilation, comprising forty-nine articles. Next follows the section on distinguishing differentiation. Generally, Yangming pathology centers on stomach excess, making purgation the targeted therapeutic approach. However, there are instances where meridian and organ pathologies interconnect, and deficiency and excess intermingle. Some cases require purgation, some do not, some are suitable for purgation but not yet ready for it, and there are times when heavy purgation is contraindicated. Thus, differentiation relies on indicators such as a solid pulse, tidal fever, passing flatus, and scanty urination, along with methods like external guidance and moistening purgation. Finally, there are miscellaneous treatment methods, addressing conditions such as jaundice transformation and blood stasis syndromes, which no longer belong to Yangming stomach excess nor simple meridian pathogen stagnation that could be inferred by analogy. Whether using dispersing or purging methods, treatment must be tailored to the specific syndrome. This constitutes the Lower Compilation, comprising thirty-three articles.