〔成〕阳病客热。初传入胃。胃热则消谷而欲食。阳明病热为实者。则小盒饭数大盒饭硬。今小便反不利。
大便自调者。热气散漫。不为实也。欲食则胃中谷多。谷多则阳气胜。热消津液则水少。水少则阴血弱。金匮
要略曰。阴气不通即骨疼。其人骨节疼者。阴气不足也。热甚于表者。翕翕发热。热甚于里者。蒸蒸发热。此
热气散漫。不专着于表里。故翕翕如有热状。奄。忽也。忽然发狂者。阴不胜阳也。阳明蕴热为实者。须下之
愈。热气散漫。不为实者。必待汗出而愈。
故云 然而汗出解也。水谷之等者。阴阳气平也。水不胜谷气。是阴不胜阳也。汗出则阳气衰。脉紧则阴气生。
阴阳气平。两无偏胜则愈。故曰。与汗共并。脉紧则愈。
汪氏云。脉紧则愈。补亡论。阙疑。常器之云。一本作脉去则愈。郭白云云。千金作坚者则愈。无脉字。
是误以脉紧为去。为坚者。或漏脉字。或漏者字。当云脉紧者则愈。愚今校正。当云脉紧去则愈。喻氏云。脉
紧则愈。言不迟也。脉紧疾。则胃气强盛。周氏柯氏并同。程氏云。脉紧则愈者。言脉紧者得此则愈也。张氏
成无己注：阳病客居之热，初传入胃。胃中有热则消谷善饥而欲食。若阳明病热邪属实证，则小便应频数且大便干硬。如今小便反而不利，大便自调（正常），说明热气散漫分布，并未结成实证。患者想进食，说明胃中谷物多；谷物多则阳气偏胜；热邪消耗津液导致水液减少；水液少则阴血虚弱。《金匮要略》说：“阴气不通则骨痛。”此人骨节疼痛，是因为阴气不足。若热势盛于体表，表现为翕翕发热（如羽毛覆盖般的轻微发热）；若热势盛于体内，表现为蒸蒸发热（如蒸汽外蒸般的持续高热）。此处热气散漫，不专着于表或里，所以表现为翕翕如有热状。“奄”，意为忽然。突然发狂，是阴不能制约阳的表现。若阳明蕴热形成实证，必须用下法才能痊愈；若热气散漫未成实证，必定等待汗出才能痊愈。所以说“然而汗出解也”。水与谷的平衡，代表阴阳之气平和。水不能胜过谷气，即是阴不胜阳。汗出则阳气衰减，脉紧则阴气滋生。阴阳之气平和，双方无一方偏胜，疾病即可痊愈。所以说：“与汗共并，脉紧则愈。”
汪氏云：“脉紧则愈。”《补亡论》对此存疑。常器之说：另一版本作“脉去则愈”。郭白云说：《千金方》作“坚者则愈”，没有“脉”字。这是误将“脉紧”当作“去”或“坚者”，或者是漏掉了“脉”字，或者是漏掉了“者”字。应当说是“脉紧者则愈”。我如今校正，应当说是“脉紧去则愈”。喻嘉言说：“脉紧则愈”，意思是说不迟缓。脉紧疾，表示胃气强盛。周氏、柯氏观点相同。程氏说：“脉紧则愈者”，意思是脉紧的人得到此证则愈。张氏……
Cheng Wuji's commentary: The pathogenic heat of a Yang disease, residing temporarily, initially transmits to the Stomach. When there is heat in the Stomach, it digests food rapidly, leading to hunger and a desire to eat. If the heat in Yangming disease is an excess pattern (Shi), urination should be frequent and stool hard. Now, however, urination is instead obstructed or scanty, and the stool remains normal, indicating that the pathogenic heat is diffusely distributed and has not formed an excess accumulation. The patient's desire to eat indicates abundant grain in the Stomach; abundant grain leads to an excess of Yang Qi; heat consumes body fluids (Jin-Ye) resulting in fluid deficiency; fluid deficiency leads to weakness of Yin blood. The *Jingui Yaolue* states: "When Yin Qi is obstructed, bone pain occurs." The joint pain experienced by this person is due to insufficiency of Yin Qi. If heat predominates at the exterior, it manifests as *xi xi fa re* (a mild fever feeling like feathers covering the body); if heat predominates at the interior, it manifests as *zheng zheng fa re* (sustained high fever feeling like steam radiating outward). Here, the pathogenic heat is diffuse, not localized specifically in the exterior or interior, hence presenting as a mild feverish sensation. "Yan" means suddenly. Sudden onset of mania indicates that Yin fails to control Yang. If Yangming accumulated heat forms an excess pattern, purgation (Xia method) is required for cure; if the pathogenic heat is diffuse and has not formed an excess pattern, recovery depends on sweating (Han method). Thus it is said, "However, it resolves through sweating." Balance between water and grain represents the peace of Yin and Yang Qi. Water failing to overcome grain signifies Yin failing to overcome Yang. Sweating depletes Yang Qi, while a tight pulse generates Yin Qi. When Yin and Yang Qi are balanced, with neither side predominant, the disease resolves. Thus it is said: "Combined with sweating, a tight pulse indicates recovery."
Wang stated: "A tight pulse indicates recovery." The *Buwang Lun* expresses doubt regarding this. Chang Qizhi noted: Another version reads "pulse disappearing indicates recovery." Guo Baiyun stated: The *Qianjin Fang* reads "if firmness persists, then recovery," omitting the character for "pulse." This is an error confusing "tight pulse" with "disappearing" or "firmness," possibly due to the omission of the character "pulse" or the character "zhe" (one who/that which). It should read "If the pulse is tight, then recovery." I hereby correct it to read "If the tight pulse disappears, then recovery." Yu Jiayan stated: "A tight pulse indicates recovery" means it does not indicate slowness. A rapid and tight pulse indicates strong Stomach Qi. Zhou Shi and Ke Shi share this view. Cheng Shi stated: "Those with a tight pulse recover upon obtaining this condition." Zhang Shi...