栀子（一十五个擘） 甘草（一两炙） 黄柏（二两）
上三味。以水四升。煮取一升半。去滓。分温再服。（内台方议云。伤寒身黄发热者。为表里有热。其热未实。不可
汗下。故以栀子为君。能泻相火。去胃热。利小便。黄柏为臣。能去郁滞之热。甘草为佐。使能缓其中。以泻经中之热
也。武林陈氏云。发热。表证也。何不兼用麻黄桂枝葛根等发表之剂乎。答曰。身黄兼发热者。乃黄证中之发热。而非
麻黄桂枝证之发热也。热既郁而为黄。虽表而非纯乎表证。但当清其郁。以退其黄。则发热自愈）
或问下条发黄证。何以又用麻黄。余答云。下条言身必发黄者。乃瘀热在经络之里。黄欲发而尚未发出。故用麻黄
连轺赤小豆汤。若既发黄。则麻黄在所不用矣。
伤寒瘀热在里。身必发黄麻黄连轺赤小豆汤主之。（此条系阳明湿热。在半表半里之证。成注云。湿热相交。民多病
瘅瘅黄也。今者。伤寒瘀热在里夫寒邪自外而来。则必挟湿。湿瘀于经络之中。则郁而变热。湿热既盛。其人遍身必将
发黄。与麻黄连轺赤小豆汤者。以湿热方盛于在表之里。治宜仍从表。以散其湿而除其热也。）
麻黄（二两去节） 赤小豆（一升） 连轺（二两连翘根也） 杏人（四十个去皮尖） 大枣（十二枚擘） 生梓
白皮（一斤） 生姜（二两切） 甘草（二两炙）
上八味。以潦水一斗。先煮麻黄。再沸。去上沫。内诸药。煮取三升。分温。三服。半日服尽。
成注引内经曰。湿上甚而热。治以苦温。佐以甘辛。以汗为故正。此之谓也。又煎用潦水者。亦取其水味薄。则不
助湿气。故字疑有误当从删。
或问瘀热在里。身必发黄。仲景法。当用茵陈蒿汤。今不用大黄。以下里热。反用麻黄汤。加减。以发其汗何也。
余答云。此条病。当是太阳经传来者。太阳伤寒。理宜用麻黄汤。止因邪传阳明。热郁于里。里非胃府。以阳明经居太
阳之里。即尚论篇所云。躯壳之里是也。惟其里热。所以上方中用麻黄汤。而去桂枝之辛热。更加赤小豆姜枣之甘辛。
以祛散在表之寒湿。复加连轺生梓白皮之苦寒。以清解肌里之瘀热。内台方议云。伤寒汗不尽。则阳明经为瘀热所凝。
身必发黄。其脉当浮。取此汤以微汗之。此即成注所云以汗为正同一义也。
（琥）按以上阳明病脉证并治法。仲景原论中止一篇。列之第五卷。然其方亦不可尽执。须合昔贤方论。通变而行。
则医之为道。庶乎其近之矣。
栀子（十五个，掰开） 甘草（一两，炙烤） 黄柏（二两）
以上三味药。用水四升。煮取一升半。去渣。分两次温服。（《内台方议》说：伤寒导致身体发黄且发热的，属于表里都有热邪。此时热邪尚未结实，不可使用发汗或攻下法。所以用栀子作为君药，能泻相火，清胃热，利小便；黄柏作为臣药，能去除郁滞的热邪；甘草作为佐药，使药力缓和其中焦之气，以泻经络中的热邪。武林陈氏说：发热是表证的表现，为什么不兼用麻黄、桂枝、葛根等发表的药物呢？回答说：身体发黄兼有发热，是黄疸病证中的发热，而不是麻黄汤、桂枝汤证那种发热。热邪既然郁结而变成黄疸，虽然涉及体表，但并非纯粹的表证。只应当清解其郁热，以消退黄疸，那么发热自然就会痊愈。）
有人问：下一条关于发黄的证候，为什么又用到麻黄？我回答说：下一条说“身体必定发黄”，是因为瘀热在经络的深处，黄色欲发而未完全发出。所以用麻黄连轺赤小豆汤。如果已经明显发黄，那么麻黄就不在使用的范围内了。
伤寒瘀热在体内，身体必定发黄，用麻黄连轺赤小豆汤主治。（这一条属于阳明湿热，处于半表半里的证候。成无己注解说：湿与热相互交结，百姓多患黄疸病。如今，伤寒瘀热在体内，寒邪从外而来，必然挟带湿气。湿气瘀阻在经络之中，郁结而化热。湿热既已旺盛，病人全身必将发黄。给予麻黄连轺赤小豆汤，是因为湿热正盛于在表的里层，治疗适宜仍从表论治，以发散湿气并清除热邪。）
麻黄（二两，去节） 赤小豆（一升） 连轺（二两，即连翘根） 杏仁（四十个，去皮尖） 大枣（十二枚，掰开） 生梓白皮（一斤） 生姜（二两，切片） 甘草（二两，炙烤）
以上八味药。用雨水一斗，先煮麻黄，水再次沸腾时，去掉上面的浮沫，加入其他药物。煮取三升，分三次温服。半天内服完。
成无己注引用《内经》说：“湿气上部严重而有热，用苦温药治疗，辅以甘辛药，以出汗为治愈标准。”说的就是这个道理。另外煎药使用雨水，也是取其水质淡薄，不助长湿气。故“字”疑有误，应当删除。
有人问：瘀热在体内，身体必定发黄，按照张仲景的法度，应当用茵陈蒿汤。现在不用大黄来攻下里热，反而用麻黄汤加减来发汗，为什么呢？我回答说：这一条的病，应当是从太阳经传变而来的。太阳伤寒，按理应该用麻黄汤。只是因邪气传入阳明，热邪郁结在体内。这里的“里”不是胃腑，因为阳明经位于太阳经之里，也就是《尚论篇》所说的“躯壳之里”。正因为是里热，所以上方的方剂中使用麻黄汤，但去掉桂枝的辛热之性，更加上赤小豆、姜、枣的甘辛之品，以祛散在表的寒湿；再加上连轺、生梓白皮的苦寒之性，以清解肌理深处的瘀热。《内台方议》说：伤寒汗出不彻底，则阳明经被瘀热凝滞，身体必定发黄。其脉象应当浮。取此汤以微微发汗。这与成无己注所说的“以出汗为治愈标准”是同一含义。
（琥）按：以上阳明病的脉证并治方法，张仲景的原论中只有一篇，列在第五卷。然而其中的方剂也不能完全拘泥执守，必须结合古代贤人的方论，通权达变地运用，那么医学之道，就差不多接近正道了。
Zhi Zi (Gardeniae Fructus, 15 fruits, broken) Gan Cao (Licorizia Radix et Rhizoma Praeparata cum Melle, 2 liang, honey-fried) Huang Bo (Phellodendri Cortex, 2 liang)
Take the above three herbs. Add four sheng of water. Decoct to obtain one and a half sheng. Remove the dregs. Divide into two doses and take warm. (*Nei Tai Fang Yi* states: In Shanghan [Cold Damage] presenting with jaundice and fever, this indicates heat in both the exterior and interior. Since the heat is not yet consolidated, neither sweating nor purging methods should be used. Therefore, Zhi Zi is used as the sovereign herb to drain ministerial fire, clear stomach heat, and promote urination; Huang Bo is used as the minister herb to remove stagnant heat; Gan Cao is used as an assistant herb to moderate the middle jiao and drain heat from the meridians. Chen Shi of Wulin stated: Fever is a sign of the exterior syndrome. Why not combine it with exterior-releasing agents like Ma Huang, Gui Zhi, or Ge Gen? The answer is: Jaundice accompanied by fever refers to fever within the context of jaundice syndromes, not the fever associated with Ma Huang Tang or Gui Zhi Tang syndromes. When heat becomes constrained and transforms into jaundice, although it involves the exterior, it is not a pure exterior syndrome. One should only clear the constrained heat to resolve the jaundice, whereupon the fever will subside spontaneously.)
A question arises: Regarding the following clause on jaundice, why is Ma Huang used again? I reply: The following clause states "the body must become yellow," indicating that blood-heat is lodged deep within the collaterals, and the jaundice is about to emerge but has not fully manifested. Hence, Ma Huang Lian Yao Chi Xiao Dou Tang is used. If jaundice has already clearly appeared, then Ma Huang is no longer indicated.
Shanghan with constrained heat lodged internally results in inevitable jaundice; treat with Ma Huang Lian Yao Chi Xiao Dou Tang. (This clause pertains to Yangming damp-heat, situated in the half-exterior half-interior stage. Cheng Wuji's commentary notes: When dampness and heat interact, people often suffer from jaundice. Here, Shanghan constrained heat resides internally. As cold pathogenic factors originate from the exterior, they inevitably carry dampness. Dampness stagnates within the collaterals, becoming constrained and transforming into heat. Once damp-heat becomes excessive, the patient's entire body will turn yellow. Ma Huang Lian Yao Chi Xiao Dou Tang is administered because the damp-heat is flourishing in the layer internal to the exterior; treatment should still proceed via the exterior to disperse dampness and eliminate heat.)
Ma Huang (Ephedrae Herba, 2 liang, nodes removed) Chi Xiao Dou (Adzuki Bean, 1 sheng) Lian Yao (Forsythiae Caulis / Root of Forsythia suspensa, 2 liang) Xing Ren (Prunus Armeniaca Seed, 40 seeds, skin and tips removed) Da Zao (Jujubae Fructus, 12 fruits, broken) Sheng Zi Bai Pi (Broussonetiae Alburnum, 1 jin) Sheng Jiang (Zingiberis Rhizoma Recens, 2 liang, sliced) Gan Cao (Licorizia Radix et Rhizoma Praeparata cum Melle, 2 liang, honey-fried)
Take the above eight herbs. Add ten dou of rainwater (Liao Shui). First decoct Ma Huang until boiling again, then remove the foam on the surface. Add the remaining herbs. Decoct to obtain three sheng. Divide into three warm doses. Finish within half a day.
Cheng Wuji cites the *Neijing*: "When dampness is severe in the upper part accompanied by heat, treat with bitter-warm herbs, assisted by sweet-acrid herbs, aiming for sweating as the cure." This applies here. Furthermore, using rainwater for decoction is intended to utilize its thin taste so as not to aggravate dampness. The character "zi" is suspected to be an error and should be deleted.
A question arises: Constrained heat lodged internally leads to inevitable jaundice. According to Zhang Zhongjing's method, Yin Chen Hao Tang should be used. Why is Da Huang not used to purge interior heat, but instead a modified Ma Huang Tang is used to induce sweating? I reply: This condition likely transmitted from the Taiyang meridian. Taiyang Shanghan typically requires Ma Huang Tang. However, due to the pathogen transmitting to Yangming, heat becomes constrained internally. This "interior" is not the Stomach Fu organ, because the Yangming meridian lies internal to the Taiyang meridian, which corresponds to what the *Shang Lun Pian* calls the "interior of the shell." Precisely because of this interior heat, the aforementioned formula employs Ma Huang Tang but removes the acrid-warm Gui Zhi, adding sweet-acrid Chi Xiao Dou, Sheng Jiang, and Da Zao to dispel cold-dampness at the exterior, and adds bitter-cold Lian Yao and Sheng Zi Bai Pi to clear and resolve the constrained heat in the muscle layer. *Nei Tai Fang Yi* states: If sweating from Shanghan is incomplete, the Yangming meridian becomes congealed by constrained heat, leading to inevitable jaundice. The pulse should be floating. This formula induces mild sweating. This aligns with Cheng Wuji’s statement that "sweating is the standard for cure."
(Hu) Note: The section on pulse and syndrome differentiation and treatment for Yangming disease in Zhang Zhongjing’s original text consists of only one chapter, listed in Volume Five. However, the formulas therein should not be rigidly adhered to. One must integrate them with ancient experts' commentaries and apply them flexibly. Only then can the Way of Medicine approach perfection.