成无己曰：汗后水药不得入口，为之吐逆。发汗亡阳，胃中虚冷也；若更发汗，则愈
损阳气，胃气大虚，故吐不止。
程应旄曰：发汗后见此者，由未汗之先，其人已是中虚而寒，故一误不堪再误也。
@@@
脉浮而迟，表热里寒，下利清谷者，四逆汤主之。
【注】
阳明病，脉浮而迟，浮主表热，迟主里寒。今其证下利清谷，则为里寒太甚，法当温
之，宜四逆汤主之。
【集注】
汪琥曰：阳明经病，脉当从长，今脉但浮，此在表之热凝也。腑病脉当从数，今脉过
迟，此在里之寒甚也，故见下利清谷。其所利之谷食，色不变气不臭，即完谷不化也
，此里寒已极，故与四逆汤也。
@@@
阳明病，欲解时，从申至戌上。
【注】
凡阳明病，无论在经在府，必乘其旺时而解，申、酉、戌，阳明旺时也。经气旺，则
邪气自退，故解也。
【集注】
张志聪曰：经云：日西而阳气衰，阳明之所主也。从申至戌上，乃阳明主气之时，表
里之邪欲出，必随旺时而解。
音切
奄音厌 趺音夫 抟音团 屎音豕 摸音莫 捻音聂 蘸庄陷切 挺庭上声 绕音扰
愦占对切 怵□律切 疸音旦 瘕匣牙切 漱音瘦 轺时饶切 蘖音伯 潦郎到切
沸音芾 尿同溺 转株恋切 □音噎 蛔音回
Cheng Wuji stated: After sweating, water and medicine cannot be taken orally, leading to vomiting and reflux. Sweating causes the loss of Yang Qi, resulting in deficiency-cold in the Stomach; if sweating is induced again, it will further damage Yang Qi, causing extreme deficiency of Stomach Qi, hence the persistent vomiting.
Cheng Yingmao stated: The appearance of these symptoms after sweating occurs because the patient already had middle-jiao deficiency and cold before the sweating was induced. Therefore, one misstep is unbearable, and a second error must not be made.
@@@
If the pulse is floating and slow, with exterior heat and interior cold, accompanied by diarrhea with undigested food (xia li qing gu), Si Ni Tang (Four Counterflow Decoction) should be administered as the primary treatment.
[Note]
In Yangming disease, a floating and slow pulse indicates that floating represents exterior heat, while slow represents interior cold. Given the symptom of diarrhea with undigested food, this signifies extreme interior cold. According to therapeutic principles, warming is required, and Si Ni Tang (Four Counterflow Decoction) is appropriate for primary treatment.
[Collected Annotations]
Wang Hu stated: In Yangming channel disease, the pulse should typically be long and moderate. The current observation of only a floating pulse suggests condensation of exterior heat. In fu-organ diseases, the pulse should typically be rapid; the current excessive slowness indicates severe interior cold, thus presenting as diarrhea with undigested food. The excreted grain remains unchanged in color and odorless, which is termed "complete undigested stool" (wan gu bu hua). This indicates that interior cold has reached its extreme, hence Si Ni Tang (Four Counterflow Decoction) is prescribed.
@@@
Yangming disease tends to resolve during the hours from Shen (15:00–17:00) to Xu (19:00–21:00).
[Note]
For any Yangming disease, whether involving the channels or the fu-organs, resolution occurs when the organ's qi is at its peak. The hours of Shen, You, and Xu are when Yangming qi is vigorous. When channel qi is vigorous, pathogenic factors recede naturally, leading to resolution.
[Collected Annotations]
Zhang Zhicong stated: The classics state: "When the sun sets, Yang Qi declines," which is the period governed by Yangming. From Shen to Xu is the time when Yangming governs the qi. Pathogenic factors in the exterior and interior seek to exit and must do so following the time of peak qi vigor.
Phonetic Guide
Yan pronounced as Yan Fu pronounced as Fu Tuan pronounced as Tuan Shi pronounced as Shi Mo pronounced as Mo Nian pronounced as Nie Zhan pronounced as Zhuang Xian Qie Ting pronounced as Ting Shang Sheng Rao pronounced as Rao Kui pronounced as Zhan Dui Qie Chu pronounced as □ Lü Qie Dan pronounced as Dan Jia pronounced as Xia Ya Qie Shu pronounced as Shou Yao pronounced as Shi Rao Qie Nie pronounced as Bo Liao pronounced as Lang Dao Qie Fei pronounced as Fu Niao same as Ni Zhuan pronounced as Zhu Lian Qie □ pronounced as Ye Hui pronounced as Hui