节。凡病之不及、太过，斯皆见矣。能食不大便者，是但纳不输，为太过。十七日剧者，阳主进，又合乎阳数之
奇也。不能食而硬便仍去者，是但输不纳，为不足。十四日剧者，阴主退，亦合乎阴数之偶也。脉法曰∶“计其余
命生死之期，期以月节克之。《内经》曰∶“能食者过期，不能食者不及期。”此之谓也。
此条本为阴结发论。阳结即是胃实，为阴结作伴耳。阴结无表证，当属之少阴，不可以身重不能食为阳明应
有之证，沉迟为阳明当见之脉。大便硬为胃家实，而不敢用温补之剂也。且阴结与固瘕、谷疸有别。彼溏而不便，
是虚中有实；此硬而有便，是实中有虚。急须用
参、附以回阳，勿淹留期至而不救。
上论阴阳结证。
阳明病，脉迟，汗出多，微恶寒者，表未解也，可发汗，宜桂枝汤。
阳明病，脉浮，无汗而喘者，发汗则愈，宜麻黄汤。
此阳明之表证、表脉也。二证全同太阳，而属之阳明者，不头项强痛故也。要知二方专为表邪而设，不为太阳
而设。见麻黄证，即用麻黄汤，见桂枝证，即用桂枝汤，不必问其为太阳阳明也。若恶寒一罢，则二方所必禁
矣。
阳明病，脉浮而紧者，必潮热发作有时；但浮者，必盗汗出。
上条脉证与太阳相同，此条脉证与太阳相殊。此阳明半表半里之脉证，麻、桂下咽，阳盛则毙耳。故善诊者，
必据证辨脉，勿据脉谈证。全注解见本篇之前。
脉浮而迟，面热赤而战惕者，六七日当汗出而解。迟为无阳，不能作汗，其身必痒也。
此阳明之虚证、虚脉也。邪中于面，而阳明之阳上奉之。故面热而色赤。阳并于上，而不足于外卫，寒邪切肤，
故战惕耳。此脉此证，欲其恶寒自止于二日间，不可得矣。必六七日胃阳来复，始得汗出溱溱而解。所以然者，
汗为阳气，迟为阴脉，无阳不能作汗，更可以身痒验之，此又当助阳发汗者也。
阳明病，法多汗，反无汗，其身如虫行皮肤中，此久虚故也。
阳明气血俱多，故多汗；其人久虚，故反无汗。此又当益津液、和营卫，使阴阳自和而汗出也。
阳明病，反无汗而小便利，二三日呕而咳，手足厥者，必苦头痛。若不咳不呕，手足不厥者，头不痛。
小便利，则里无瘀热可知。二三日无身热汗出恶热之表，而即见呕咳之里，似乎热发乎阴。更手足厥冷，
又似病在三阴矣。苦头痛，又
似太阳之经证。然头痛必因咳呕厥逆，则头痛不属太阳。咳呕厥逆则必苦头痛，是厥逆不属三阴。断乎为阳明半
表半里之虚证也。此胃阳不敷布于四肢故厥，不上升于额颅故痛。缘邪中于膺，结在胸中，致呕咳而伤阳也。当
用瓜蒂散吐之，呕咳止，厥痛自除矣。两者字作时字看，更醒。
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。
不恶寒，头不痛但眩，是阳明之表已罢。能食而不呕不厥但咳，乃是咳为病本也。咽痛因于咳，头眩亦因于
咳。此邪结胸中而胃家未实也，当从小柴胡加减法。
阳明病，口燥，但欲漱水，不欲咽者，此必衄。
脉浮发热，口干鼻燥，能食者则衄。
此邪中于面，而病在经络矣。液之与血，异名而同类。津液竭，血脉因之而亦伤。故阳明主津液所生病，亦
主血所生病。阳明经起于鼻，系于口齿。阳明病则津液不足，故口鼻干燥。阳盛则阳络伤，故血上溢而为衄也。
口鼻之津液枯涸，故欲漱水、不欲咽者，热在口鼻，未入乎内也。能食者胃气强也。以脉浮发热之证，而见口干鼻
燥之病机，如病在阳明，更审其能食、不欲咽水之病情，知热不在气分而在血分矣。此问而知之也。
按∶太阳阳明皆多血之经，故皆有血症。太阳脉当上行，营气逆不循其道，反循巅而下至目内 ，假道于阳
明，自鼻 而出鼻孔，故先目瞑头痛。阳明脉当下行，营气逆而不下，反循齿环唇而上循鼻外至鼻 而入鼻，故
先口燥鼻干。异源而同流者，以阳明经脉起于鼻之交 中，旁纳太阳之脉故也。
二条但言病机，不及脉法主治，宜桃仁承气、犀角地黄辈。
上论阳明在表脉证。
伤寒四五日，脉沉而喘满，沉为在里，而反发其汗，津液越出，大便为难，表虚里实，久则谵语。
喘而胸满者，为麻黄证。然必脉浮者，病在表，可发汗。今脉沉为
在里，则喘满属于里矣。反攻其表则表虚，故津液大泄。喘而满者，满而实矣，因转属阳明，此谵语所由来也。
宜少与调胃。汗出为表虚，然是谵语，归重只在里实。
发汗多，若重发汗者，亡其阳。谵语脉短者死，脉自和者不死。
上条论谵语之由，此条论谵语之脉。亡阳即津液越出之互辞。心之液为阳之汗，脉者血之府也。心主血脉，汗
多则津液脱，营血虚。故脉短是营卫不行，脏腑不通，则死矣。此谵语而脉自和者，虽津液妄泄，而不甚脱，一
惟胃实，而营卫通调，是脉有胃气，故不死。此下历言谵语不因于胃者。
谵语，直视喘满者死，下利者亦死。
上条言死脉，此条言死证。盖谵语本胃实，而不是死证。若谵语而一见虚脉虚证，则是死证，而非胃家实矣。
脏腑之精气，皆上注于目。目不转睛，不识人，脏腑之气绝矣。喘满见于未汗之前，为里实；见于谵语之时，是
肺气已败。呼吸不利，故喘而不休。脾家大虚，不能为胃行其津液，故满而不运。若下利不止，是仓禀不藏，门
户不要也。与大便难而谵语者，天渊矣。
夫实则谵语，虚则郑声。郑声，重语也。
同一谵语，而有虚实之分。邪气盛则实，言虽妄诞，与发狂不同，有庄严状，名曰谵语。正气夺则虚，必目见
鬼神，故郑重其语，有求生求救之状，名曰郑声。此即从谵语中分出，以明谵语有不因胃实而发者。更释以重语二
字，见郑重之谓，而非郑重之音也。若造字出于喉中，与语多重复叮咛不休等义，谁不知其虚，仲景乌庸辨？
阳明病下血、谵语者，此为热入血室。但头汗出者，刺期门，随其实而泻之， 然汗出则愈。
血室者，肝也。肝为藏血之脏，故称血室。女以血用事，故下血之病最多。若男子非损伤则无下血之病。惟
阳明主血所生病，其经多血多气，行身之前，邻于冲任。阳明热盛，侵及血室，血室不藏，溢出前阴，故男女俱
有是证。血病则魂无所归，心神无主，谵语必发。要知此
非胃实，因热入血室而肝实也。肝热心亦热，热伤心气，既不能主血，亦不能作汗。但头有汗，而不能遍身，此
非汗吐下法可愈矣。必刺肝之募，引血上归经络，推陈致新，使热有所泄，则肝得所藏、心得所主、魂有所归、
神有所根据，自然汗出周身，血不妄行，谵语自止矣。按∶蓄血便脓血，总是热入血室，入于肠胃，从肛门而下者，
谓之便血脓血。盖女子经血出自子户，与溺道不同门。男子精、血、溺三物，内异道而外同门，精道由肾，血道
由肝，水道由膀胱。其源各别，而皆出自前阴。
期门，肝之募也，又足太阴厥阴阴维之会。太阴阳明为表里，厥阴少阳为表里。阳病治阴，故阳明少阳血病，
皆得刺之。
妇人中风，发热恶寒，经水适来。得之七八日，热除而脉迟身凉，胸胁下满，如结胸状，谵语者，此为热入血
室也。当刺期门，随其实而泻之。
人之十二经脉，应地之十二水，故称血为经水，女子属阴而多血。脉者，血之府也。脉以应月，故女子一月经
水溢出，应时而下，故人称之为月事也。此言妇人适于经水来时，中于风邪，发热恶寒。此时未虑及月事矣，病从外
来，先解其外可知。至七八日热除身凉脉迟为愈，乃反见胸胁苦满而非结胸，反发谵语而非胃实，何也？脉迟故也。迟
为在藏，必其经水适来时，风寒外来，内热乘肝，月事未尽之余，其血必结。当刺其募以泻其结热，满自消而谵语
自止，此通因塞用法也。
妇人伤寒发热，经水适来，昼则明了，暮则谵语，如有所见，此为热入血室。无犯胃气，及上下焦，必自愈。
前言中风，此言伤寒者，见妇人伤寒中风，皆有热入血室证也。然此三条，皆因谵语而发，不重在热入血室，更
不重在伤寒中风。要知谵语多有不因于胃者，不可以谵语为胃实而犯其胃气也。发热不恶寒，是阳明病。申酉谵语，疑
为胃实。若是经水适来，固知热入血室矣。此经水未断，与上条血结不同。是肝虚魂不安而妄见，本无实可泻，固
不得妄下以伤胃气。亦不得刺之令汗，以伤上焦之阳，刺之出血，以伤下焦之阴也。俟其经尽，则谵语自除，而身
热自退矣。当以不治治之。
热入血室，寒热如疟而不谵语者，入柴胡证。
上论阳明谵语脉证。
节律。凡是疾病出现不及或太过，都会表现出相应的症状。能够进食但大便不通畅的，这是只摄入不排泄，属于阳气太过。到了第十七天病情加重，是因为阳主进取，且符合阳数（奇数）的规律。不能进食而大便虽硬却仍排出的，这是只排泄不摄入，属于阳气不足。到了第十四天病情加重，是因为阴主退守，也符合阴数（偶数）的规律。脉法说：“推算病人剩余寿命和生死的时间期限，是以月令节气相克来推断。”《黄帝内经》说：“能进食的病人会超过预期的期限，不能进食的病人则达不到预期的期限。”说的就是这种情况。
这一条原本是为了论述阴结证而发论的。阳结就是胃家实证，它是作为阴结证的伴随情况出现的。阴结证没有表证，应当归属于少阴病，不能把身体沉重、不能进食当作阳明病应有的症状，也不能把沉脉、迟脉当作阳明病应当出现的脉象。大便坚硬属于胃家实，因此不敢使用温补的药物。况且阴结证与固瘕、谷疸是有区别的。那些大便溏薄而不通畅的，是虚中有实；这里大便坚硬而有排便感，是实中有虚。急需用人参、附子来回阳救逆，不要拖延到期限到来时无法救治。
以上论述了阴阳结证。
阳明病，脉象迟缓，出汗多，轻微怕冷的，说明表证未解，可以发汗，适宜用桂枝汤。
阳明病，脉象浮，无汗且喘息的，发汗后就会痊愈，适宜用麻黄汤。
这是阳明病的表证和表脉。这两个证候完全同于太阳病，但归属于阳明病的原因，是因为没有头项强痛的症状。要知道这两张方剂是专门为了治疗表邪而设立的，不是为了太阳病而设立的。见到麻黄汤证，就用麻黄汤；见到桂枝汤证，就用桂枝汤，不必问它是太阳病还是阳明病。如果恶寒一消失，那么这两张方剂就是必须禁忌的了。
阳明病，脉象浮而紧的，一定会有潮热，且发作有定时；如果脉象只是浮的，一定会盗汗出。
上一条的脉证与太阳病相同，这一条的脉证与太阳病不同。这是阳明病半表半里的脉证，如果使用麻黄汤、桂枝汤发汗，会导致阳气过盛而致死。所以善于诊察的医生，一定依据症状来辨别脉象，而不是依据脉象来谈论症状。全篇注解见本篇之前。
脉象浮而迟缓，面部发热发红且颤抖惊惕的，六七天应当出汗而病解。迟脉代表无阳，不能作汗，身体一定会发痒。
这是阳明病的虚证和虚脉。邪气侵袭面部，而阳明之阳上奉于此。所以面部发热且颜色发红。阳气并聚于上部，而体表卫外之气不足，寒邪切肤，所以出现颤抖惊惕。这种脉象和这种症状，想要它在两天内恶寒自行停止，是不可能的。必须等到六七天胃阳恢复，才能大汗淋漓而病解。之所以这样，是因为汗由阳气化生，迟脉是阴脉，无阳就不能作汗，更可以通过身体发痒来验证，这又是应当助阳发汗的情况。
阳明病，按照常理应该多汗，反而无汗，身体像有虫子在皮肤中爬行一样，这是因为久病体虚的缘故。
阳明经气血俱多，所以多汗；如果人久病体虚，所以反而无汗。这又应当补充津液、调和营卫，使阴阳自然调和而汗出。
阳明病，反而无汗而小便通利，两三天后出现呕吐和咳嗽，手脚冰冷的，一定痛苦于头痛。如果不咳嗽不呕吐，手脚不冰冷，头就不痛。
小便通利，就知道里没有瘀热。两三天没有身热、出汗、怕热的表证，就立即出现呕吐咳嗽的里证，似乎热发自阴分。再加上手脚冰冷，又似乎病在三阴经。痛苦于头痛，又似乎像太阳经的证候。然而头痛必然因为咳嗽、呕吐、四肢厥逆引起，那么头痛就不属于太阳经。咳嗽、呕吐、四肢厥逆必然导致头痛，那么四肢厥逆就不属于三阴经。断然属于阳明病半表半里的虚证。这是因为胃阳不能敷布于四肢所以手足厥冷，不能上升于额颅所以头痛。原因是邪气侵袭膺部，结聚在胸中，导致呕吐咳嗽而损伤阳气。应当用瓜蒂散催吐，呕吐咳嗽停止，厥冷和头痛自然消除。“两者”二字读作“此时”之意，更加醒目。
阳明病，只是头晕目眩，不怕冷，所以能进食且咳嗽，这个人一定咽喉痛。如果不咳嗽，咽喉就不痛。
不怕冷，头不痛只是眩晕，说明阳明表的病邪已罢。能进食而不呕吐、不四肢厥冷只是咳嗽，乃是咳嗽为疾病的根本。咽喉痛是因为咳嗽，头晕目眩也是因为咳嗽。这是邪气结聚在胸中而胃家尚未结实，应当根据小柴胡汤的加减法治疗。
阳明病，口干燥，只想含水漱口，不想咽下的，这一定会发生鼻出血。
脉象浮、发热，口干鼻燥，能进食的就会发生鼻出血。
这是邪气侵袭面部，而病在经络。津液与血，名称不同但同类。津液枯竭，血脉因此也受伤。所以阳明经主管津液所生的病，也主管血所生的病。阳明经起于鼻旁，联系口齿。患阳明病则津液不足，所以口鼻干燥。阳气过盛则阳络受伤，所以血液上溢而发生鼻衄。口鼻的津液枯涸，所以想含水漱口、不想咽下，说明热在口鼻，未进入体内。能进食说明胃气强。以脉浮发热的证候，而出现口干鼻燥的病机，如病在阳明，再审察其能食、不欲咽水的情况，就知道热不在气分而在血分了。这是通过询问而知晓的。
按语：太阳和阳明都是多血的经脉，所以都有血症。太阳脉应当上行，营气逆乱不循其道，反而顺着头顶下行至目内眦，借道于阳明，从鼻孔出来，所以先出现眼睛昏花、头痛。阳明脉应当下行，营气逆乱不下行，反而顺着牙齿环绕嘴唇而上行至鼻外侧进入鼻孔，所以先出现口燥鼻干。源头不同但流向相同的，是因为阳明经脉起于鼻翼交会的中间，旁边接纳太阳的经脉。
这两条只说了病机，没涉及脉法和主治，适宜用桃仁承气汤、犀角地黄汤之类的方剂。
以上论述阳明病在表的脉证。
伤寒四五日，脉象沉而气喘胸闷，沉脉表示病在里，反而发其汗，津液外越，大便变得困难，表虚里实，时间久了会出现谵语。
气喘而胸部满闷的，是麻黄汤证。但是必须脉象浮的，病在表，才可以发汗。现在脉象沉表示病在里，那么气喘胸闷属于里证了。反而攻治表证则导致表虚，所以津液大量泄出。气喘而满，满而结实了，于是转属阳明，这就是谵语产生的原因。适宜少量给予调胃承气汤。出汗是表虚，但这谵语，重点只在里实。
发汗过多，或者再次发汗的，会导致亡阳。出现谵语且脉象短的会死，脉象自和的不会死。
上一条论述谵语的成因，这一条论述谵语的脉象。亡阳就是津液外越的另一种说法。心的液体是阳之汗，脉是血的府库。心主血脉，汗多则津液脱失，营血虚弱。所以脉短表示营卫不行，脏腑不通，就会死亡。这种谵语而脉象自和的，虽然津液妄泄，但不甚脱失，只要胃实，营卫通调，脉中有胃气，所以不死。以下列举谵语不是由于胃实引起的情况。
上一条说死脉，这一条说死证。大概谵语本是胃实，而不是死证。如果谵语一见虚脉虚证，那就是死证，而不是胃家实了。脏腑的精气，都上注于眼睛。眼睛不转动，不认识人，说明脏腑之气绝了。气喘胸闷出现在未发汗之前，是里实；出现在谵语之时，是肺气已败。呼吸不利，所以气喘不停。脾家大虚，不能为胃运行津液，所以满闷而不运化。如果腹泻不止，是仓廪不藏，门户不守。这与大便难而谵语的情况，相差如天地之别。
同样是谵语，但有虚实之分。邪气盛则实，言语虽然荒诞，但与发狂不同，有庄严的神态，名叫谵语。正气夺则虚，必定看见鬼神，所以郑重其语，有求生求救的神态，名叫郑声。这是从谵语中区分出来，以说明谵语有不因胃实而发的。再用“重语”二字解释，见郑重之意，而非郑重之音。如果造字出于喉中，与话语多重复叮咛不休等意义，谁不知道是虚证，仲景何必分辨？
阳明病下血、谵语的，这是热入血室。只有头部出汗的，针刺期门穴，随着其实证而泻之，濈然汗出就会痊愈。
血室就是肝。肝是藏血的脏器，所以称为血室。女子以血为主，所以下血的病最多。如果男子非损伤则没有下血的病。只有阳明主管血所生的病，其经多血多气，行走在身前，邻近冲任二脉。阳明热盛，侵及血室，血室不藏，溢出前阴，所以男女都有这个证候。血病则魂无所归，心神无主，谵语必然发生。要知道这不是胃实，而是因为热入血室导致肝实。肝热心也热，热伤心气，既不能主血，也不能作汗。只有头部出汗，而不能遍身出汗，这不是汗、吐、下法可以治愈的。必须针刺肝之募穴，引血上归经络，推陈致新，使热有所宣泄，则肝得所藏、心得所主、魂有所归、神有所根据，自然周身汗出，血不妄行，谵语自然停止。按语：蓄血便脓血，总是热入血室，进入肠胃，从肛门而下的，叫做便血脓血。大概女子经血出自子宫，与尿道不同门。男子精、血、尿三物，内部通道不同而外部出口相同，精道由肾，血道由肝，水道由膀胱。它们的源头各不相同，但都出自前阴。
期门穴，是肝之募穴，又是足太阴、厥阴、阴维脉的交会处。太阴与阳明为表里，厥阴与少阳为表里。阳病治阴，所以阳明、少阳的血病，都可以针刺此穴。
妇人中风，发热恶寒，月经适来。得了七八天，热退而脉迟身凉，胸胁下满，像结胸的样子，谵语的，这是热入血室。应当针刺期门穴，随着其实证而泻之。
人的十二经脉，对应地的十二水，所以称血为经水，女子属阴而多血。脉是血的府库。脉对应月亮，所以女子一个月经水溢出，应时而下，所以人称之为月事。这里说妇人适逢月经来时，中于风邪，发热恶寒。此时还未考虑到月事，病从外来，先解其外可知。到了七八天热退身凉脉迟为愈，反而出现胸胁苦满而非结胸，反而发谵语而非胃实，为什么呢？因为脉迟。迟脉表示在脏，必然是其经水适来时，风寒外来，内热乘袭肝脏，月经未尽之余血必结。当刺其募穴以泻其结热，满自消而谵语自止，这是通因塞用的方法。
妇人伤寒发热，月经适来，白天神志清楚，晚上则谵语，好像看见了什么，这是热入血室。不要侵犯胃气，以及上焦和下焦，必定自愈。
前面说中风，这里说伤寒，是见妇人伤寒中风，都有热入血室的证候。然而这三条，都是因为谵语而发论，不重在热入血室，更不重在伤寒中风。要知道谵语多有不因于胃实的，不可以谵语为胃实而侵犯其胃气。发热不恶寒，是阳明病。申酉时谵语，怀疑为胃实。如果是月经适来，固然知道是热入血室了。这经水未断，与上一条的血结不同。是肝虚魂不安而妄见，本无实可泻，固然不得妄下以伤胃气。也不得刺之令汗，以伤上焦之阳，刺之出血，以伤下焦之阴。等到经尽，则谵语自除，而身热自退矣。应当以不治治之。
Jie (rhythm/pulse phase). Whenever a disease presents with deficiency or excess, corresponding manifestations will appear. The ability to eat but inability to defecate indicates intake without discharge, representing an excess of Yang. If the condition worsens on the 17th day, it is because Yang governs advancement, aligning with the odd numbers associated with Yang. Inability to eat while hard stools are still passed indicates discharge without intake, representing a deficiency of Yang. If the condition worsens on the 14th day, it is because Yin governs retreat, aligning with the even numbers associated with Yin. Pulse methodology states: "To calculate the remaining lifespan and the time of death, one must consider the mutual overcoming by monthly solar terms." The *Neijing* (Yellow Emperor's Inner Canon) states: "Those who can eat will exceed the expected period; those who cannot eat will not reach the expected period." This is what is meant.
This clause originally discusses Yin Jie (Yin Knotting/Constipation). Yang Jie (Yang Knotting/Constipation) is essentially Stomach Excess (Wei Shi), serving as a companion to Yin Jie. Yin Jie has no exterior syndrome and should be attributed to Shaoyin disease. One cannot regard heavy body and inability to eat as symptoms that Yangming disease should have, nor sinking and slow pulse as pulses that Yangming disease should show. Hard stool belongs to Stomach Excess, so warming and tonifying agents must not be used. Furthermore, Yin Jie differs from Gu Jia (Solid Masses) and Gu Dan (Grice Jaundice). Those with loose stools but difficulty in defecation have excess within deficiency; here, hard stools with the urge to defecate indicate deficiency within excess. It is urgent to use Ginseng and Aconite to restore Yang and rescue from collapse; do not delay until the deadline passes without being able to save the patient.
The above discusses Yin and Yang Jie syndromes.
In Yangming disease, if the pulse is slow, sweating is profuse, and there is slight aversion to cold, the exterior is unresolved. Sweating may be induced, and Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
In Yangming disease, if the pulse is floating, there is no sweating and wheezing, inducing sweating will lead to recovery, and Mahuang Tang (Ephedra Decoction) is appropriate.
These are the exterior syndromes and exterior pulses of Yangming disease. These two conditions are identical to Taiyang disease, but are attributed to Yangming because there is no stiffness and pain of the head and neck. One must understand that these two formulas are specifically designed for exterior pathogens, not for Taiyang disease per se. When Mahuang Tang syndrome is seen, use Mahuang Tang; when Guizhi Tang syndrome is seen, use Guizhi Tang; there is no need to ask whether it is Taiyang or Yangming. Once aversion to cold ceases, these two formulas become strictly contraindicated.
In Yangming disease, if the pulse is floating and tight, tidal fever (Chao Re) occurring at specific times is inevitable; if the pulse is only floating, night sweats (Dao Han) are inevitable.
The pulse and symptoms in the previous clause are the same as Taiyang disease, whereas those in this clause differ from Taiyang disease. These are the half-exterior, half-interior pulse and symptoms of Yangming disease. If Mahuang Tang or Guizhi Tang are swallowed, excessive Yang will lead to death. Therefore, skilled diagnosticians must differentiate pulse based on symptoms, not discuss symptoms based on pulse. Full annotations are found earlier in this chapter.
If the pulse is floating and slow, with facial heat, redness, trembling, and fearfulness, sweating and resolution should occur after six or seven days. Slow pulse indicates lack of Yang, inability to produce sweat, and the body will likely itch.
This is the deficiency syndrome and deficiency pulse of Yangming disease. Pathogens strike the face, and Yangming Yang rises to support it. Thus, the face is hot and red. Yang gathers upward, leaving the exterior defense deficient; cold pathogens cut into the skin, causing trembling and fearfulness. With this pulse and symptom, it is impossible for aversion to cold to cease spontaneously within two days. It is necessary to wait for the recovery of Stomach Yang after six or seven days, allowing for profuse sweating and resolution. The reason is that sweat is generated by Yang Qi, and slow pulse is a Yin pulse; without Yang, sweat cannot be produced. This can also be verified by body itching. This situation requires assisting Yang to induce sweating.
In Yangming disease, according to the method, there should be profuse sweating. If there is instead no sweating, and the body feels like insects crawling in the skin, this is due to long-standing deficiency.
Yangming has abundant Qi and Blood, hence profuse sweating; if the person has been deficient for a long time, there is instead no sweating. In this case, one should replenish fluids and harmonize Ying and Wei (Nutritive and Defensive levels), allowing Yin and Yang to naturally harmonize and sweat to occur.
In Yangming disease, if there is no sweating but urination is free, and after two or three days vomiting and coughing occur with cold limbs, severe headache will ensue. If there is no coughing or vomiting, and limbs are not cold, the head will not hurt.
Free urination indicates no stasis-heat in the interior. After two or three days, without the exterior signs of fever, sweating, and aversion to heat, internal signs of vomiting and coughing appear immediately, suggesting heat originating from Yin. Coupled with cold limbs, it seems the disease is in the Three Yin meridians. Severe headache seems like a Taiyang meridian syndrome. However, since the headache is caused by coughing, vomiting, and limb reversal, the headache does not belong to Taiyang. Since coughing, vomiting, and limb reversal inevitably cause headache, the limb reversal does not belong to Three Yin. It is definitively a deficiency syndrome of the half-exterior, half-interior aspect of Yangming disease. This is because Stomach Yang cannot distribute to the four limbs, causing cold limbs, and cannot rise to the forehead, causing headache. The pathogen struck the chest area, knotting in the chest, leading to vomiting and coughing which damaged Yang. Genti San (Thistle Powder) should be used to induce vomiting; once vomiting and coughing stop, the cold limbs and headache will naturally resolve. Read "Liang Zhe" (Both) as "Shi Zi" (At this time) for greater clarity.
In Yangming disease, if there is only dizziness, no aversion to cold, thus the ability to eat and coughing, the person will definitely have a sore throat. If there is no coughing, the throat will not hurt.
No aversion to cold, no headache but only dizziness indicates the Yangming exterior has resolved. Ability to eat without vomiting or cold limbs, but only coughing, indicates coughing is the root of the disease. Sore throat is caused by coughing; dizziness is also caused by coughing. This is pathogen knotting in the chest while the Stomach is not yet solid. Treatment should follow the modification methods of Xiaochaihu Tang (Minor Bupleurum Decoction).
In Yangming disease, if there is dry mouth, only wanting to rinse water in the mouth without swallowing, epistaxis (nosebleed) will certainly occur.
If the pulse is floating, there is fever, dry mouth and nose, and the person can eat, epistaxis will occur.
Pathogens strike the face, and the disease is in the meridians. Fluids and blood are different names but of the same category. When fluids are exhausted, blood vessels are consequently injured. Thus, Yangming governs diseases generated by fluids and diseases generated by blood. Yangming meridian begins at the nose and connects to the teeth and mouth. In Yangming disease, fluids are insufficient, causing dry mouth and nose. Excessive Yang injures the Yang collaterals, causing blood to overflow upwards resulting in epistaxis. Dryness of fluids in the mouth and nose causes the desire to rinse water but not swallow, indicating heat is in the mouth and nose, not having entered the interior. Ability to eat indicates strong Stomach Qi. Given the pulse floating and fever, along with the pathology of dry mouth and nose, if the disease is in Yangming, further examining the condition of eating and not wanting to swallow water reveals that heat is in the Blood level, not the Qi level. This is known through inquiry.
Note: Both Taiyang and Yangming are meridians with abundant blood, so both have blood syndromes. Taiyang pulse should ascend; when Ying Qi rebels and does not follow its path, it descends along the vertex to the inner canthus, borrowing the way through Yangming, exiting from the nostrils, hence eye dimness and headache occur first. Yangming pulse should descend; when Ying Qi rebels and does not descend, it ascends along the teeth, circles the lips, and goes up the lateral nose to enter the nostrils, hence dry mouth and nose occur first. They have different sources but the same flow because the Yangming meridian begins at the intersection of the nose, laterally accepting the Taiyang meridian.
These two clauses only discuss pathology, not pulse methods or treatment, so Tao Ren Cheng Qi Tang (Peach Kernel Modifying the Stomach Decoction) or Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) types are appropriate.
The above discusses Yangming exterior pulse and symptoms.
In Shanghan (Cold Damage) after four or five days, if the pulse is sinking with wheezing and chest fullness, sinking indicates the disease is in the interior. Inducing sweating in error causes fluids to escape, making stool difficult. Exterior deficiency and interior excess, over time, lead to delirious speech (Chan Yu).
Wheezing and chest fullness are Mahuang syndrome. However, the pulse must be floating for the disease to be in the exterior, allowing for sweating. Now, the sinking pulse indicates the disease is in the interior, so wheezing and fullness belong to the interior. Attacking the exterior in error causes exterior deficiency, leading to massive fluid loss. Wheezing and fullness become fullness and excess, transferring to Yangming, which is the origin of delirious speech. Administer a small amount of Tiao Wei Cheng Qi Tang (Modifying the Stomach Decoction). Sweating indicates exterior deficiency, but for delirious speech, the emphasis is solely on interior excess.
Profuse sweating, or repeated sweating, leads to loss of Yang. Delirious speech with a short pulse indicates death; delirious speech with a self-harmonious pulse indicates survival.
The previous clause discusses the cause of delirious speech; this clause discusses the pulse of delirious speech. Loss of Yang is a synonymous expression for fluid escape. The fluid of the Heart is Yang sweat; the pulse is the mansion of blood. The Heart governs blood vessels. Profuse sweating depletes fluids and weakens Ying Blood. Thus, a short pulse indicates Ying and Wei do not circulate, and Zang-Fu are blocked, leading to death. For delirious speech with a self-harmonious pulse, although fluids are wasted, they are not severely depleted. As long as Stomach excess exists, Ying and Wei are regulated, and the pulse contains Stomach Qi, so death does not occur. The following lists cases where delirious speech is not due to Stomach excess.
Delirious speech with fixed staring, wheezing, and chest fullness indicates death; diarrhea also indicates death.
The previous clause mentions the fatal pulse; this clause mentions fatal symptoms. Generally, delirious speech is due to Stomach excess and is not inherently fatal. If delirious speech presents with deficiency pulse and deficiency symptoms, it is fatal, not Stomach excess. The essence and Qi of all Zang-Fu organs ascend to the eyes. If the eyes do not move and the person does not recognize others, the Qi of the Zang-Fu organs has exhausted. Wheezing and fullness appearing before sweating indicate interior excess; appearing during delirious speech indicates Lung Qi has failed. Difficulty in breathing causes continuous wheezing. Spleen deficiency prevents the transport of fluids for the Stomach, causing fullness without movement. If diarrhea continues unceasingly, the granary is not stored, and the gates are not guarded. This is worlds apart from difficulty in defecation with delirious speech.
Excess leads to delirious speech (Chan Yu); deficiency leads to Zheng Sheng (repetitive speech). Zheng Sheng refers to repetitive speech.
Although both are called delirious speech, there is a distinction between excess and deficiency. When pathogens are vigorous, it is excess; speech is absurd but differs from mania, possessing a solemn demeanor, named Chan Yu. When healthy Qi is depleted, it is deficiency; the person sees ghosts and spirits, speaking with gravity, showing a state of seeking life and help, named Zheng Sheng. This distinguishes from Chan Yu to clarify that Chan Yu can occur without Stomach excess. Explaining "Zhong Yu" (heavy/repetitive words) shows the meaning of gravity, not just the sound. If the character originated from the throat, implying repetitive and lingering speech, who would not know it is deficiency? Why did Zhang Zhongjing distinguish it?
In Yangming disease, if there is bleeding from the lower orifices and delirious speech, this is Heat entering the Blood Chamber (Xue Shi). If only the head sweats, puncture Qimen (Liv 14), draining the excess according to its reality, and profuse sweating will lead to recovery.
The Blood Chamber is the Liver. The Liver stores blood, hence called Blood Chamber. Women rely on blood, so bleeding disorders are most common. Men, unless injured, do not have bleeding disorders. Only Yangming governs diseases generated by blood; its meridian has abundant blood and Qi, running along the front of the body, adjacent to Chong and Ren meridians. When Yangming heat is excessive, invading the Blood Chamber, the Blood Chamber fails to store, and blood overflows from the anterior orifice, so both men and women can have this syndrome. Blood disorder means Hun (Ethereal Soul) has no return, and Shen (Spirit) has no master, so delirious speech occurs. Understand that this is not Stomach excess, but Liver excess due to heat entering the Blood Chamber. Liver heat causes Heart heat; heat damages Heart Qi, which neither governs blood nor produces sweat. Only the head sweats, not the whole body; this cannot be cured by sweating, vomiting, or purging methods. One must puncture the Front-Mu point of the Liver, drawing blood back to the meridians, pushing out the old and generating the new, allowing heat to vent. Then the Liver is stored, Heart is mastered, Hun has a return, and Shen has a basis. Naturally, the whole body sweats, blood does not flow recklessly, and delirious speech stops. Note: Accumulated blood causing pus and blood in stool is always heat entering the Blood Chamber, entering the intestines and stomach, and exiting from the anus, called bloody pus stool. Women's menstrual blood comes from the uterus, differing from the urinary tract. In men, semen, blood, and urine have different internal pathways but share an external opening; semen pathway is Kidney, blood pathway is Liver, water pathway is Bladder. Their sources are distinct but all exit from the anterior orifice.
Qimen is the Front-Mu point of the Liver and the meeting point of Foot Taiyin, Foot Jueyin, and Yinwei Mai. Taiyin and Yangming are exterior-interior pairs; Jueyin and Shaoyang are exterior-interior pairs. Treating Yin for Yang diseases, therefore, blood diseases of Yangming and Shaoyang can be treated by puncturing this point.
In a woman with Fengzhong (Wind Strike), fever and aversion to cold, menstruation happens to arrive. After seven or eight days, heat subsides, pulse becomes slow, body cools, but there is fullness under the chest and hypochondrium, resembling Jie Xiong (Chest Binding), and delirious speech. This is heat entering the Blood Chamber. Puncture Qimen, draining the excess according to its reality.
The twelve meridians of the human body correspond to the twelve waters of the earth, hence blood is called Jing Shui (Menstrual Water). Women belong to Yin and have abundant blood. The pulse is the mansion of blood. Pulses correspond to the moon, so women's menstrual water overflows monthly, coming down on time, hence called Yue Shi (Monthly Affairs). Here, a woman contracts wind pathogen during menstruation, presenting with fever and aversion to cold. At this time, menstruation is not yet considered; since the disease comes from outside, resolving the exterior first is known. By the seventh or eighth day, heat subsides, body cools, and pulse slows, indicating recovery. Instead, chest and hypochondriac distress appears, not Jie Xiong, and delirious speech occurs, not Stomach excess. Why? Because of the slow pulse. Slow pulse indicates disease in the Zang. It must be that when menstruation arrived, external wind-cold combined with internal heat attacking the Liver, and residual blood from incomplete menstruation must knot. Puncturing the Mu point drains the knotted heat; fullness dissipates and delirious speech stops. This is using obstruction to treat obstruction (Tong Yin Sai Yong).
In a woman with Shanghan (Cold Damage) and fever, menstruation happens to arrive. During the day she is lucid; at night she deliriously speaks, seeing things. This is heat entering the Blood Chamber. Do not violate Stomach Qi, nor the Upper and Lower Jiao; it will heal itself.
The previous text mentioned Fengzhong; this mentions Shanghan, indicating that both Fengzhong and Shanghan in women can present with heat entering the Blood Chamber. However, these three clauses all originate from delirious speech, not emphasizing heat entering the Blood Chamber, nor Shanghan/Fengzhong. Understand that delirious speech often does not stem from Stomach excess; one must not assume Stomach excess and violate Stomach Qi. Fever without aversion to cold is Yangming disease. Delirium at Shen and You hours (3-7 PM) suggests Stomach excess. But if menstruation is arriving, it is certainly heat entering the Blood Chamber. This menstruation has not stopped, differing from the blood knotting in the previous clause. It is Liver deficiency causing Hun insecurity and hallucinations; there is no excess to drain. One must not blindly purge to damage Stomach Qi. Nor should one puncture to induce sweating, damaging Upper Jiao Yang; nor puncture to bleed, damaging Lower Jiao Yin. Wait for menstruation to end, then delirious speech will cease and fever will recede. Treat by not treating.
Heat entering the Blood Chamber, with chills and fever like malaria but without delirious speech, belongs to Chaihu syndrome.
The above discusses Yangming delirious speech pulse and symptoms.