伤寒三日阳明脉大
伤寒一日太阳二日阳明三日少阳阳明之脉大少阳之脉弦细若三日正传少阳之时不见少阳弦细之脉而见阳明之大脉知
其传于阳明之腑矣
问曰阳明病外证云何答曰身热汗自出不恶寒反恶热也
里热外发则身热热气薰蒸则汗自出汗出表解但热无寒故不恶寒反恶热此后全是内热为害与外寒无关也
问曰病有得之一日不发热而恶寒者何也答曰虽得之一日而寒将自罢即自汗出而恶热也
得阳明病之一日太阳表证未罢则犹见恶寒以胃热未盛故也迟则胃热隆盛孔窍蒸泄恶寒将自罢即自汗出而恶热也
问曰恶寒何故自罢答曰阳明居中土也万物所归无所复传始虽恶寒二日自止此为阳明病也
感伤三阳则为热传之三阴则为寒以阳盛于腑阴盛于脏腑病则热脏病则寒也感证一传胃腑则胃热日增不复再传三阴而
为寒缘阴盛之人三阳方病于外三阴即应于中传阴则后之恶寒无有止期此但入三阴为寒不入胃腑为热者也阳盛之人太阳被
感腑热郁生其始热未极盛犹见恶寒俟至二日热盛之极气蒸汗泄则恶寒自止此但入胃腑为热不入三阴为寒者也阳盛则生阴
盛则死阴莫盛于少阴阳莫盛于阳明病入三阴死多生少虽用姜附回阳难保十全无失最可虑也一传胃腑则正阳司气三阴无权
万不一死至为吉兆俟其胃热盛实一用承气攻下自无余事阳贵阴贱正为此也
伤寒病经过三天，出现阳明脉象洪大。
伤寒第一天病在太阳经，第二天传至阳明经，第三天传至少阳经。阳明经的脉象是洪大，少阳经的脉象是弦细。如果到了第三天，本该传入少阳的时候，却没有见到少阳经弦细的脉象，反而见到了阳明经洪大的脉象，就知道病邪已经传入阳明的腑了。
问：阳明病的外部证候是怎样的？
答：身体发热，自然出汗，不恶寒，反而怕热。
这是因为体内的热邪向外发散，所以身体发热；热气熏蒸，所以自然出汗。汗出之后，表证已解，只有热而没有寒，所以不恶寒，反而怕热。这后面的情况全是内部热邪为害，与外部的寒邪无关。
问：有的病得病一天，不发热却恶寒，这是为什么呢？
答：虽然得病才一天，但恶寒的症状将会自行停止，随即就会自然出汗并且怕热。
刚得阳明病的一天，如果太阳经的表证还没有完全解除，那么还会见到恶寒的症状，这是因为胃中的热势还没有旺盛。过一段时间后，胃热隆盛，孔窍被热气蒸腾而泄出汗水，恶寒的症状就会自行停止，随即就会自然出汗并且怕热。
问：恶寒为什么会自动停止？
答：因为阳明属土，位居中央，万物皆归于它，病邪不再向其他地方传变。开始虽然恶寒，但到第二天就会自动停止，这就是阳明病。
感受邪气侵犯三阳经则表现为热证，传入三阴经则表现为寒证。阳气盛于腑，阴气盛于脏。腑病则热，脏病则寒。邪气一旦传入胃腑，胃热就会日益增加，不再继续传入三阴经转化为寒证。这是因为阴气盛的人，当三阳经在外受病时，三阴经就会在体内响应。如果传入阴经，那么之后的恶寒就没有停止的时候。但这只是传入三阴经才表现为寒证，传入胃腑则表现为热证。阳气盛的人，太阳经受邪，腑中热郁而生，起初热势未至极盛，还能见到恶寒；等到第二天，热势极盛，气机蒸腾，汗液排泄，恶寒就会自动停止。这也是只传入胃腑表现为热证，而不传入三阴经表现为寒证。阳气盛则生，阴气盛则死。阴气没有比少阴更盛的，阳气没有比阳明更盛的。病邪传入三阴经，死的居多，活的很少，即使使用姜、附子回阳救逆，也难以保证完全没有失误，这是最让人担忧的。一旦传入胃腑，则是正阳之气主事，三阴之气无权，万无一失，是非常吉利的征兆。等到胃热盛实，使用承气汤攻下，就再也没有什么可担心的了。阳气尊贵，阴气卑贱，正是说的这种情况。
After three days of Taiyang disease, the pulse becomes large (Da), characteristic of Yangming.
On the first day of cold damage, the pathogen is in the Taiyang channel; on the second day, it moves to the Yangming channel; on the third day, it reaches the Shaoyang channel. The pulse of the Yangming channel is large (Hongda), while the pulse of the Shaoyang channel is wiry and fine (Xianxi). If, on the third day, when the disease should theoretically transmit to Shaoyang, the wiry and fine pulse of Shaoyang is not seen, but instead the large pulse of Yangming appears, it indicates that the pathogen has transmitted to the Yangming Fu organs.
Question: What are the external manifestations of Yangming disease?
Answer: There is feverishness of the body, spontaneous sweating, aversion to cold is absent, and there is an aversion to heat.
This occurs because internal heat radiates outward, causing feverishness; the steaming of heat causes spontaneous sweating. Once sweating occurs, the exterior condition resolves, leaving only heat without cold; therefore, there is no aversion to cold, but rather an aversion to heat. Subsequently, all harm arises from internal heat, having nothing to do with external cold.
Question: In some cases, one day after contracting the disease, there is no fever but there is aversion to cold. Why is this?
Answer: Although it has been only one day since contraction, the aversion to cold will cease spontaneously, followed by spontaneous sweating and an aversion to heat.
On the first day of Yangming disease, if the exterior syndrome of the Taiyang channel has not yet resolved, aversion to cold may still be observed because the stomach heat has not yet become vigorous. Later, as stomach heat becomes abundant, the pores are steamed and sweat is excreted; the aversion to cold ceases spontaneously, followed by spontaneous sweating and an aversion to heat.
Question: Why does the aversion to cold cease spontaneously?
Answer: Because Yangming belongs to Earth and occupies the central position; it is where all things return, and there is no further transmission. Initially, there may be aversion to cold, but it stops spontaneously by the second day; this constitutes Yangming disease.
When contracted pathogens affect the Three Yang channels, they manifest as heat; when transmitted to the Three Yin channels, they manifest as cold. Yang abundance resides in the Fu organs, and Yin abundance resides in the Zang organs. Fu diseases present with heat, and Zang diseases present with cold. Once the pathogen transmits to the Stomach Fu organ, stomach heat increases daily, and it no longer transmits to the Three Yin channels to transform into cold. This is because in individuals with Yin abundance, when the Three Yang channels are diseased externally, the Three Yin channels respond internally. Transmission to the Yin channels means subsequent aversion to cold would have no end. However, this refers only to transmission to the Three Yin channels presenting as cold, whereas transmission to the Stomach Fu organ presents as heat. In individuals with Yang abundance, when the Taiyang channel is affected, heat stagnates and generates within the Fu organs. Initially, when heat is not at its peak, aversion to cold may still be seen. By the second day, when heat reaches its extreme, Qi steams and sweat is excreted, so aversion to cold ceases spontaneously. This also refers only to transmission to the Stomach Fu organ presenting as heat, not to the Three Yin channels presenting as cold. Yang abundance leads to life; Yin abundance leads to death. Yin is most abundant in Shaoyin, and Yang is most abundant in Yangming. When disease enters the Three Yin channels, death is common and survival rare; even using Shengjiang (Fresh Ginger) and Fuzi (Prepared Aconite Root) to restore Yang, perfection cannot be guaranteed, which is most worrying. Once transmitted to the Stomach Fu organ, the Righteous Yang governs, and the Three Yin have no authority; death is virtually impossible, which is a very auspicious sign. Once stomach heat becomes full and solid, using Chengqi Decoction (Chengqi Tang) for purgation leaves nothing else to worry about. Yang is noble and Yin is base, which is precisely what is meant here.