饮食者胃家之能事也胃气右降上脘清虚而善容受是以能食阳莫盛于阳明阳盛而土燥则胃降而善纳阳虚而土湿则胃逆
而不食不能食者是胃土湿而肾水寒也土克水土性湿而水寒阳盛则土燥而克水阴盛则水寒而侮土以肾家之寒移于土位则病
中寒中寒者水胜而土负胃败而气逆故不能食胃主受盛脾主消克食谷不化者脾家之弱绝粒不食者胃家之虚凡病一见不食则
责阳明而不责太阴以其受盛之失职也
阳明病若能食名中风不能食名中寒
阳明之为病胃家实也胃实则当能食若能食者名为中风是风中于表也不能食者名为中寒是寒生于里也阳明承气之证来
自中风者多能食者腑中阳旺乃异日胃家燥热之根不能食者是阳虚而中寒胃阳已不用事脾阴将司其权不得与实家之中风并
论也 下编胃中虚冷与上编胃家实也虚实相对实者阳明之始基虚者太阴之初气也
阳明病若中寒不能食小便不利手足 然汗出此欲作固瘕大便初硬后溏所以然者胃中冷水谷不别故也
阳明病若中寒不能食土湿而小便不利手足阳泄而 然汗出此寒气凝结欲作坚固之 瘕大便必初硬后溏所以然者胃中
寒冷不能蒸化水谷水谷不别俱入二肠而成泄利故也凡水寒土湿阴气凝结瘕块坚硬多病溏泄服暖水燥土之剂阳回泄止寒消
块化续从大便而出滑白粘联状如痰涕是即固瘕之泮解而后行者也五十七难所谓大瘕泄者即此
饮食是胃腑的主要生理功能。胃气向右下降，上脘部位保持清虚状态而善于容纳受纳，因此能够进食。阳气没有比阳明经更旺盛的了，阳明阳气旺盛则脾土干燥，胃气得以顺利下降而善于接纳食物；若阳气虚弱则脾土湿盛，导致胃气上逆而不能进食。不能进食的原因，是胃土湿气过重且肾水寒冷。五行中土克水，若土性湿而水性寒，当阳气旺盛时，土燥从而克制水；当阴气旺盛时，水寒反过来侮犯土。将肾家中的寒气转移到脾土之位，就会发生“中寒”病。“中寒”是指水气胜而土气负，胃气衰败而上逆，所以不能进食。胃主受纳和盛装食物，脾主消化和运化。食物不消化是脾家虚弱所致，完全不想吃东西则是胃家虚损所致。凡是疾病出现不能进食的症状，就责求于阳明（胃）而不是太阴（脾），因为这是胃受纳失职的表现。
阳明病如果还能进食，称为“中风”；如果不能进食，称为“中寒”。
阳明病的特征是“胃家实”。胃实则应当能进食。如果能进食，称为“中风”，这是风邪侵袭体表；如果不能进食，称为“中寒”，这是寒邪生于体内。阳明承气汤证多来源于中风病，这类患者通常能进食，其腑中阳气旺盛，成为日后胃家燥热的根源。不能进食者，是阳气虚弱而患中寒，胃阳已经不起作用，脾阴即将占据主导，这种情况不能与实证中的“中风”相提并论。下编所述的“胃中虚冷”与上编所述的“胃家实”相对立。实证是阳明病的起始基础，虚证是太阴病的初起气机。
阳明病如果患中寒而不能进食，小便不利，手足濈然汗出，这是想要形成“固瘕”的征兆。大便起初干硬而后稀溏。之所以这样，是因为胃中有冷水，导致水谷不能分离。
阳明病如果患中寒而不能进食，由于土湿而导致小便不利，手足阳气外泄而濈然汗出，这是寒气凝结、想要形成坚固的瘕块。大便必定是先干硬后稀溏。之所以这样，是因为胃中寒冷，不能蒸腾气化水谷，水谷不分，一起流入大肠和小肠而形成泄利。凡是水寒土湿、阴气凝结形成的坚硬瘕块，多伴有溏泄症状。服用暖水燥土的药剂后，阳气回复，泄泻停止，寒气消散，瘕块化解，随后从大便排出，呈现滑白黏连状，如同痰涕一样，这就是“固瘕”分解后随大便排出的现象。《难经·五十七难》所说的“大瘕泄”，指的就是这种情况。
Dietary intake is the primary physiological function of the Stomach (Wei). When Stomach Qi descends to the right, the upper Jiao remains clear and empty, facilitating reception and containment; thus, one is able to eat. Yang Qi is most vigorous in the Yangming channel. When Yang is abundant, Earth becomes dry, allowing Stomach Qi to descend smoothly and accept food well. Conversely, when Yang is deficient, Earth becomes damp, causing Stomach Qi to rebel upward, resulting in an inability to eat. The inability to eat stems from dampness in Stomach Earth and cold in Kidney Water. In Five Phase theory, Earth controls Water. If Earth is damp and Water is cold, abundant Yang causes dry Earth to control Water, while abundant Yin causes cold Water to insult Earth. Transferring the cold from the Kidney home to the Earth position results in "Zhong Han" (Interior Cold Syndrome). "Zhong Han" signifies that Water overcomes and Earth yields; Stomach function fails and Qi rebels, hence the inability to eat. The Stomach governs receiving and storing, while the Spleen governs digestion and transformation. Failure to digest food indicates weakness in the Spleen home, while total loss of appetite indicates deficiency in the Stomach home. Whenever a disease presents with an inability to eat, blame is placed on Yangming (Stomach) rather than Taiyin (Spleen), due to the failure of its receiving function.
In Yangming disease, if the patient can eat, it is named "Zhong Feng" (Wind Strike); if they cannot eat, it is named "Zhong Han" (Cold Strike).
The hallmark of Yangming disease is "Wei Jia Shi" (Fullness/Excess in the Stomach Home). Fullness implies the ability to eat. If one can eat, it is called "Zhong Feng," indicating wind pathogen attacking the exterior. If one cannot eat, it is called "Zhong Han," indicating cold pathogen arising from within. Yangming Chengqi Decoction patterns often originate from Zhong Feng; such patients usually can eat, and their vigorous Fu-organ Yang becomes the root for future dryness-heat in the Stomach home. Those who cannot eat suffer from Yang deficiency and interior cold; Stomach Yang is no longer functional, and Spleen Yin is about to take charge. This condition cannot be discussed alongside the "Zhong Feng" of excess patterns. The "Stomach Middle Cold Deficiency" described in the Lower Section contrasts with the "Stomach Home Excess" in the Upper Section. Excess is the foundational basis of Yangming disease, while deficiency is the initial Qi state of Taiyin disease.
If Yangming disease involves Zhong Han, leading to an inability to eat, difficulty in urination, and continuous sweating from the hands and feet, this indicates the impending formation of "Gu Xia" (Solidified Mass). The stool will initially be hard and later loose. This occurs because cold water in the Stomun prevents the separation of grain and fluids.
If Yangming disease involves Zhong Han, leading to an inability to eat, dampness of Earth causes difficulty in urination, and leakage of Yang Qi from the hands and feet causes continuous sweating. This indicates congealed cold Qi intending to form a solid mass. The stool must be initially hard and later loose. This is because cold in the Stomach prevents the steaming and transformation of grain and fluids; without separation, both enter the Large and Small Intestines, resulting in diarrhea. Generally, hard masses formed by the condensation of Yin Qi due to cold-water and damp-earth are accompanied by loose stools. After administering formulas that warm water and dry earth, Yang returns, diarrhea stops, cold dissipates, and the mass dissolves. It subsequently passes out through the stool, appearing as slippery, white, viscous clumps resembling phlegm or mucus. This is the dissolution and subsequent passage of the "Gu Xia." What the *Nan Jing* (Classic of Difficult Issues), Chapter 57, refers to as "Da Xia Xie" (Great Mass Diarrhea) is precisely this condition.