（胃实不大便 自汗 不得卧 潮热 谵语 狂乱 循衣摸床 渴 呕）
黄 阳明之为病胃家实是也谓之正阳阳明属下证轻则大柴胡汤重则大小承气汤此邪自阳明经传入腑者经曰阳
明病
脉迟虽汗出不恶寒者其身必重短气腹满有潮热者此欲解可攻里也手足 然汗出者此是大便已硬也大承气汤主之若汗多
微发热恶寒者外未解也其热不潮未可与承气汤若腹满不通者可与小承气汤微和胃气勿令大泄下谓阳明亦有在经者未全
入腑犹宜解外纵有大满大府不通亦不过小承气汤微下之入胃在经犹宜两审也其阳明一证少有自病多因太阳传入兼与太
阳阳明合病用葛根汤者是也少阳阳明合病用黄芩芍药汤者是也自少阳传入阳明及未合并病者亦然阳明经治法有汗吐下
温和解刺
汗 桂枝汤 麻黄汤 五苓散（此亦作汗剂） 麻黄连翘赤小豆汤
吐 栀子豉汤
下 调胃承气汤 大承气汤 抵当汤 麻仁丸 茵陈蒿汤 小承气汤
温 吴茱萸汤 四逆汤
和解 白虎汤 白虎加人参汤 猪苓汤 小柴胡汤 蜜导煎 猪胆汁 土瓜根 栀子柏皮汤
刺 热入血室刺期门
问曰病有太阳阳明有正阳阳明有少阳阳明何谓也答曰太阳阳明者脾约是也（经曰趺阳脉浮而涩浮则胃气强涩则小便
数浮涩相搏大便则难其脾为约麻仁丸主之 太阳病三日发汗不解蒸蒸发热者属胃也调胃承气汤主之）正阳阳明者胃家实
是也少阳阳明者发汗利小便已胃中躁烦热大便难是也（宜小承气汤微溏之盖少阳复不可下也按本草大黄酒浸入太阳经酒
洗入阳明经病之高下全在酒之多少以引之耳又按太阳阳明正阳阳明承气汤中俱用酒浸惟少阳阳明为下经故小承气汤中
不用酒浸也以此推之则太阳阳明当用调胃承气汤盖以调胃承气既附在太阳篇中而大黄下注曰酒浸正阳阳明当用大承气
其大黄注曰酒洗少阳阳明当用小承气汤不惟大黄不用酒浸洗而少阳禁汗下故去芒硝之峻剂而且当少少与之也书此以驳
成氏之误又须识太阳阳明脾约丸少阳阳明又可大柴胡也又有说在不大便之条）问曰何缘得阳明病答曰太阳病发汗若下若
利小便此亡津液胃中干燥因转属阳明不更衣内实大便难者此名阳明也（成 本太阳病不解因发汗利小便亡津液胃中干燥
太阳之邪入腑转属阳明古人登厕必更衣不更衣者通为不大便不更衣则胃中物不得泄故为内实胃无津液加之蓄热大便则
难为阳明里实也）伤寒脉浮而缓手足自温者是系在太阴太阴者身当发黄若小便自利者不能发黄至七八日大便硬者为阳明
病也（成 浮为阳邪缓为脾脉伤寒脉浮缓太阴客热邪在三阳则手足热邪在太阴则手足温邪在少阴厥阴则手足寒今手足自
温是知系在太阴也太阴土也为邪蒸之则色见于外当发身黄小便自利者热不内蓄不能发黄至七八日大便硬者即太阴之邪
入腑转属阳明也）阳明病若能食名中风不能食名中寒（成 阳明病以饮食别受风寒者以胃为水谷之海风为阳邪阳气杀谷
故中风者能食寒为阴邪阴邪不杀谷故伤寒者不能食）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（按目
眩之眩其字从目从玄谓其眼中黑暗也头眩之眩当作若药不瞑眩之眩训之谓眩愦乱也谓其头岑岑然愦乱而不宁也凡书皆
当活看不可拘执成 阳明病身不重痛但头眩而不恶寒者阳明中风而风气上攻也经曰阳明病若能食名中风风邪攻胃胃气
上逆则咳咽门者胃之系咳甚则咽伤故必咽痛若胃气不逆则不咳其咽亦不痛也 胃气主呕肺气主咳成氏以胃气上逆则咳
恐非盖风邪侵肺也肺虽不为足经肺主气风为气类）阳明病不能食攻其热必哕所以然者胃中虚冷故也以其人本虚故攻其热
必哕（成 不能食胃中本寒攻其热复虚其胃虚寒相搏故令哕也经曰关脉弱胃气虚有热不可大攻之热去则寒起此之谓也）
阳明病脉迟食难用饱饱则微烦头眩必小便难此欲作谷疸虽下之腹满如故所以然者脉迟故也（成 阳明病脉迟则邪方入里
未化为热也胃中有寒食难用饱饱则微烦而头眩者谷气与寒气相搏也寒热相搏必小便难利者不能发黄言谷热得泄也小便
不利则谷气酝酿成热不得泄出身必发黄胆黄也以其发于谷气之热故名谷疸热实者下之则愈脉迟为寒故虽下之只益其寒
腹满亦不减也经曰脉迟尚未可攻）阳明病欲解时从申至酉止（阳明燥 金旺于申酉戌向旺时是为欲解）伤寒呕多虽有阳
明证不可攻也（见呕）阳明病面合赤色不可攻攻必发热色黄小便不利也（成 合通也阳明病面色通赤者热在经也不可下
之下之虚其胃气耗其津液经中之热乘虚入胃必发热色黄小便不利也 张 夫阳明病理必近于可下但以面赤其热犹在经
故云不可攻若攻之则经中之热悉入于胃郁蓄而发黄色譬如下之太早成结胸之类）阳明病心下硬满者不可攻之攻之利遂不
止者死利止者愈（阳明病腹满者为邪气入腑可下之心下硬满则邪气尚浅未全入腑不可便下之得利止者为邪气去正气安正
气安则愈若因下利不止者为正气脱而死 尚浅浅字不如高字）
（胃腑实热导致的大便不通、自汗、无法安卧、潮热、说胡话、狂乱躁动、循衣摸床、口渴、呕吐）
阳明病的特征，就是“胃家实”，这被称为正阳阳明。病情轻的可用大柴胡汤，病情重的用大承气汤。这是邪气从阳明经传入腑脏的情况。经文说：阳明病，脉象迟，虽然有汗出但不恶寒，身体必定沉重，短气，腹部胀满，有潮热症状，这说明表证已解，可以攻里了。如果手足濈然汗出，说明大便已经坚硬，应用大承气汤主治。如果汗出多，伴有轻微发热和恶寒，说明表证未解，此时若热势不呈潮热状，不可给予承气汤。如果腹部胀满不通，可给予小承气汤，轻微调和胃气，不要令其剧烈泻下。这说明阳明病也有在经的情况，尚未完全入腑，仍宜解表。即使有大满大腑不通的情况，也不过用小承气汤轻微通下。邪气入胃或在经，都应当仔细审察。阳明这一类证候，很少是自身直接发病，多因太阳病传入所致。兼与太阳病合病的，用葛根汤治疗；兼与少阳病合病的，用黄芩芍药汤治疗。从少阳传入阳明及未合并其他病证的，也是如此。阳明经的治疗方法包括汗、吐、下、温、和、解、刺等法。
汗法：桂枝汤、麻黄汤、五苓散（这也作为发汗剂使用）、麻黄连翘赤小豆汤。
吐法：栀子豉汤。
下法：调胃承气汤、大承气汤、抵当汤、麻仁丸、茵陈蒿汤、小承气汤。
温法：吴茱萸汤、四逆汤。
和解法：白虎汤、白虎加人参汤、猪苓汤、小柴胡汤、蜜导煎、猪胆汁、土瓜根、栀子柏皮汤。
刺法：热入血室，针刺期门穴。
问：疾病有太阳阳明、正阳阳明、少阳阳明之分，这是什么意思？
答：太阳阳明，是指脾约证。（经文说：趺阳脉浮而涩，浮则胃气强，涩则小便数，浮涩相搏，大便则难，此为脾约，主用麻仁丸。太阳病经过三天，发汗后病不解，出现蒸蒸发热的症状，属于胃家实，主用调胃承气汤。）
正阳阳明，就是胃家实。
少阳阳明，是指发汗或利小便后，胃中燥热烦躁，大便困难的情况。（适宜用小承气汤轻微通便。因为少阳病也不可直接攻下。按本草记载，大黄酒浸则入太阳经，酒洗则入阳明经，病位的高下全在于酒的多少来引导。又按，太阳阳明和正阳阳明在承气汤中都使用酒浸大黄，唯独少阳阳明因为是下经，所以小承气汤中不用酒浸大黄。以此推断，太阳阳明应当用调胃承气汤，因为调胃承气汤附在太阳篇中，且大黄注解说酒浸；正阳阳明应当用大承气汤，其大黄注解说酒洗；少阳阳明应当用小承气汤，不仅大黄不用酒浸洗，而且少阳禁汗下，所以去掉芒硝这种峻烈之品，并且应当少量给予。写下这些是为了驳斥成无己的错误。另外必须知道，太阳阳明的脾约丸，少阳阳明也可以用大柴胡汤。另有说法见於不大便的条目中。）
问：为什么会得阳明病？
答：太阳病发汗，或者误下，或者利小便，导致津液亡失，胃中干燥，因而转属阳明。如果不排便，内实，大便困难，这就叫阳明病。（成无己注：原本太阳病不解，因发汗利小便亡失津液，胃中干燥，太阳之邪入腑转属阳明。古人上厕所必更衣，不更衣即通指不大便。不更衣则胃中食物不得排泄，故为内实。胃无津液，加之蓄积热邪，大便则难，成为阳明里实证。）
伤寒脉象浮而缓，手足自然温暖，这是病系在太阴。太阴病的人应当发黄，如果小便自利，则不能发黄。到了七八天，大便变硬，就成为阳明病了。（成无己注：浮为阳邪，缓为脾脉。伤寒脉浮缓，太阴客热。邪在三阳则手足热，邪在太阴则手足温，邪在少阴厥阴则手足寒。现在手足自温，可知病系在太阴。太阴属土，被邪气蒸迫则颜色见于外，应当发身黄。小便自利者，热不内蓄，不能发黄。到了七八天大便硬，即是太阴之邪入腑转属阳明。）
阳明病，如果能进食，名叫中风；如果不能进食，名叫中寒。（成无己注：阳明病以饮食情况辨别受风寒的性质。因为胃为水谷之海，风为阳邪，阳气杀谷，所以中风者能食。寒为阴邪，阴邪不杀谷，所以伤寒者不能食。）
阳明病，仅头眩，不恶寒，所以能食且咳嗽，其人必定咽痛。如果不咳嗽，咽就不痛。（按：目眩之眩，字从目从玄，谓眼中黑暗。头眩之眩当作“药不瞑眩”之眩，训诂意为眩愦乱，谓头部昏沉愦乱而不宁。凡读书都应灵活看待，不可拘执。成无己注：阳明病身体不重痛，仅头眩且不恶寒，这是阳明中风，风气上攻。经文说阳明病若能食名中风，风邪攻胃，胃气上逆则咳。咽门是胃的系联，咳甚则咽伤，所以必定咽痛。若胃气不逆则不咳，其咽亦不痛。胃气主呕，肺气主咳。成氏认为胃气上逆则咳，恐怕不对，应该是风邪侵肺。虽然肺不是足经，但肺主气，风为气类。）
阳明病不能进食，攻其热必然发生哕逆。之所以这样，是因为胃中虚冷。因为病人本身体虚，所以攻其热必然导致哕逆。（成无己注：不能食是因为胃中本寒，攻其热又使胃更虚，虚寒相搏，所以令哕。经文说：关脉弱，胃气虚，有热不可大攻，热去则寒起，说的就是这个道理。）
阳明病，脉迟，吃不下饱饭，饱则微烦、头眩，必定小便难，这是将要发作谷疸。即使攻下，腹满依旧，之所以这样，是因为脉迟的缘故。（成无己注：阳明病脉迟，说明邪气刚入里，尚未化为热。胃中有寒，吃不下饱饭，饱则微烦头眩，是谷气与寒气相搏。寒热相搏，必定小便难。利者不能发黄，是说谷热得以泄出。小便不利则谷气酝酿成热，不得泄出，身必发黄，即胆黄。因其发于谷气之热，故名谷疸。热实证攻下则愈。脉迟为寒，所以即使攻下，只增加其寒，腹满也不减。经文说：脉迟尚未可攻。）
阳明病欲解的时间，是从申时到酉时止。（阳明燥金旺于申酉戌，向旺之时是为欲解。）
阳明病面色通红，不可攻下。攻下必然发热、色黄、小便不利。（成无己注：合即通。阳明病面色通赤，说明热在经，不可下。下之则虚其胃气，耗其津液，经中之热乘虚入胃，必发热、色黄、小便不利。张元素注：夫阳明病理必近于可下，但以面赤，其热犹在经，故云不可攻。若攻之，则经中之热悉入于胃，郁蓄而发黄色，譬如下之太早成结胸之类。）
阳明病心下硬满者，不可攻下。攻下后利遂不止者死，利止者愈。（阳明病腹满是邪气入腑，可下。心下硬满则邪气尚浅，未全入腑，不可便下。得利止者为邪气去，正气安，正气安则愈。若因下利不止者为正气脱而死。尚志德注：浅字不如高字好。）
(Stomach excess with constipation, spontaneous sweating, inability to sleep, tidal fever, delirium, mania/restlessness, picking at bedclothes and air, thirst, vomiting)
The characteristic of Yangming disease is "excess in the stomach-intestines" (Wei Jia Shi), which is called Zheng Yang Yangming. For mild cases, Da Chai Hu Tang (Major Bupleurum Decoction) may be used; for severe cases, Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated. This occurs when pathogenic factors transmit from the Yangming channel into the fu organs. The classic states: In Yangming disease, if the pulse is slow, there is sweating but no aversion to cold, the body will feel heavy, there is shortness of breath, abdominal fullness, and tidal fever. This indicates that the exterior syndrome has resolved and interior purgation can be performed. If there is continuous sweating on the hands and feet, it indicates that the feces have hardened, and Da Cheng Qi Tang should be administered. If there is profuse sweating accompanied by slight fever and aversion to cold, the exterior has not yet resolved; if the fever is not tidal, Cheng Qi Tang formulas should not be given. If there is abdominal fullness and obstruction, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) may be given to gently harmonize the stomach qi, avoiding drastic purgation. This illustrates that Yangming disease can also remain in the channel stage before fully entering the fu organs, and exterior resolution is still appropriate. Even with significant fullness and obstruction, only gentle purgation with Xiao Cheng Qi Tang is warranted. Whether the pathogen is in the stomach or the channel, careful examination is required. Yangming syndromes rarely arise spontaneously but are often transmitted from Taiyang. When combined with Taiyang disease, Ge Gen Tang (Kudzu Decoction) is used; when combined with Shaoyang disease, Huang Qin Shao Yao Tang (Scutellaria and White Peony Decoction) is used. Transmission from Shaoyang to Yangming without combination follows similar principles. Treatment methods for Yangming channel diseases include diaphoresis, emesis, purgation, warming, harmonizing, resolving, and acupuncture.
Diaphoresis: Gui Zhi Tang (Cinnamon Twig Decoction), Ma Huang Tang (Ephedra Decoction), Wu Ling San (Five-Ingredient Powder with Poria), Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Red Bean Decoction).
Emesis: Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction).
Purgation: Tiao Wei Cheng Qi Tang (Regulate the Stomach and Order the Qi Decoction), Da Cheng Qi Tang, Di Dang Tang (Resist the Awaiting Decoction), Ma Ren Wan (Hemp Seed Pill), Yin Chen Hao Tang (Artemisia Capillaris Decoction), Xiao Cheng Qi Tang.
Warming: Wu Zhu Yu Tang (Evodia Decoction), Si Ni Tang (Four Reversal Decoction).
Harmonizing/Resolving: Bai Hu Tang (White Tiger Decoction), Bai Hu Jia Ren Shen Tang (White Tiger plus Ginseng Decoction), Zhu Ling Tang (Polyporus Decoction), Xiao Chai Hu Tang (Minor Bupleurum Decoction), Mi Dao Jian (Honey Suppository), Pig Gallbladder Juice, Tu Gua Gen (Trichosanthes Kirilowii Root), Zhi Zi Bai Pi Tang (Gardenia and Phellodendron Decoction).
Acupuncture: For heat entering the blood chamber, puncture Qi Men (Liv 14).
Question: There are Taiyang Yangming, Zheng Yang Yangming, and Shaoyang Yangming. What do these mean?
Answer: Taiyang Yangming refers to Pi Yue (Spleen Confinement). The classic states: At the foot pulse, floating and choppy; floating indicates strong stomach qi, choppy indicates frequent urination. The interaction of floating and choppy leads to difficult defecation, known as Spleen Confinement, treated with Ma Ren Wan. After three days of Taiyang disease, if sweating fails to resolve the condition and steaming fever appears, it belongs to the stomach and is treated with Tiao Wei Cheng Qi Tang.
Zheng Yang Yangming is Wei Jia Shi (Excess in the Stomach-Intestines).
Shaoyang Yangming occurs after sweating or diuresis, leading to dryness, irritability, heat in the stomach, and difficulty passing stool. It is treated with Xiao Cheng Qi Tang to induce mild diarrhea, as Shaoyang disease contraindicates direct purgation. According to materia medica, Rhubarb soaked in wine enters the Taiyang channel, while washed in wine enters the Yangming channel; the depth of treatment depends on the amount of wine used. Furthermore, Taiyang and Zheng Yang Yangming use wine-soaked Rhubarb in Cheng Qi Tangs, whereas Shaoyang Yangming does not, as it is a lower channel. Thus, Taiyang Yangming should use Tiao Wei Cheng Qi Tang (Rhubarb wine-soaked); Zheng Yang Yangming should use Da Cheng Qi Tang (Rhubarb wine-washed); Shaoyang Yangming should use Xiao Cheng Qi Tang, omitting wine processing and Mirabilite due to Shaoyang contraindications against sweating and purging, administering it in small doses. These notes refute errors by Cheng Wuji. Additionally, Pi Yue Wan is for Taiyang Yangming, and Da Chai Hu Tang may be used for Shaoyang Yangming. Further details are found under the section on constipation.
Question: How does one contract Yangming disease?
Answer: If Taiyang disease is treated with sweating, purgation, or diuresis improperly, fluids are depleted, the stomach becomes dry, and the condition transforms into Yangming. Failure to defecate, internal excess, and difficulty passing stool constitute Yangming disease. Cheng Wuji notes: Untreated Taiyang disease, exacerbated by sweating/diuresis, depletes fluids and dries the stomach. Pathogens enter the fu organs and transform into Yangming. Ancient people changed clothes when using the toilet; failure to do so implies constipation. Without excretion, stomach contents accumulate, causing internal excess. Lack of stomach fluids combined with accumulated heat makes defecation difficult, resulting in Yangming interior excess.
In cold damage, if the pulse is floating and slow, and the hands and feet are naturally warm, the disease is associated with Taiyin. Taiyin patients typically develop jaundice; however, if urination is free, jaundice will not occur. By the seventh or eighth day, if the stool hardens, it becomes Yangming disease. Cheng Wuji notes: Floating indicates pathogenic yang, slow indicates spleen pulse. Cold damage with floating/slow pulse suggests Taiyin guest heat. Pathogens in the three yang channels cause hot extremities; in Taiyin, warm extremities; in Shaoyin/Jueyin, cold extremities. Warm extremities indicate association with Taiyin. Taiyin is earth; when steamed by pathogens, color manifests externally as jaundice. Free urination prevents heat accumulation and jaundice. Hard stool by day seven-eight indicates Taiyin pathogens entering the fu organs and transforming into Yangming.
In Yangming disease, the ability to eat distinguishes Wind Strike (Zhong Feng) from Cold Strike (Zhong Han). Those who can eat have contracted Wind (Yang pathogen, which aids digestion); those who cannot eat have contracted Cold (Yin pathogen, which hinders digestion).
Yangming disease presenting with only vertigo, no aversion to cold, allowing eating, and accompanied by coughing, will necessarily involve throat pain. If there is no cough, there is no throat pain. Vertigo here refers to mental confusion rather than visual darkness. Cheng Wuji explains: Yangming wind strike causes wind-cold to attack the stomach, causing rebellious stomach qi and coughing. The throat is connected to the stomach; severe coughing injures the throat. If stomach qi does not rebel, there is no cough or throat pain. While stomach qi governs vomiting and lung qi governs coughing, Cheng Wuji’s attribution of cough solely to stomach rebellion is questionable; it is likely wind invading the lungs, as the lung governs qi and wind is a qi-related pathogen.
If a Yangming patient cannot eat and heat-clearing measures are applied, hiccups will result because the stomach is deficient and cold. Attacking heat in a deficient stomach exacerbates the condition. Cheng Wuji notes: Deficiency cold in the stomach combined with heat-clearing drugs creates a conflict of deficiency and cold, causing hiccups. The classic warns against aggressive treatment in cases of weak pulse and stomach deficiency with heat, as removing heat leaves cold behind.
Yangming disease with a slow pulse, inability to eat large meals, postprandial mild vexation and vertigo, and difficult urination suggests impending Grain Jaundice (Gu Dan). Purging will not relieve abdominal fullness because the slow pulse indicates cold. Cheng Wuji notes: Slow pulse means pathogens have entered the interior but not yet transformed into heat. Cold in the stomach causes postprandial vexation and vertigo due to grain qi clashing with cold. If urination is unobstructed, heat escapes and jaundice does not form. If urination is obstructed, grain heat accumulates, leading to jaundice. Since this is cold-type jaundice, purging increases cold and fails to reduce fullness. The classic states: Slow pulse indicates purgation is not yet appropriate.
Yangming disease tends to resolve between Shen (3-5 PM) and You (5-7 PM), times when Yangming Dry Metal is prosperous.
In cold damage, if vomiting is frequent, even if Yangming symptoms exist, purgation is contraindicated.
If a Yangming patient has a red face, purgation is contraindicated. Purging will cause fever, yellow complexion, and difficult urination. Cheng Wuji explains: Generalized redness indicates heat in the channel, not the fu organs. Purging damages stomach qi and fluids, allowing channel heat to invade the stomach, causing fever, jaundice, and urinary difficulty. Zhang Yuansu adds: Although Yangming often requires purgation, facial redness indicates heat remains in the channel. Aggressive purging drives channel heat into the stomach, causing郁accumulation and jaundice, similar to early purging leading to Chest Bind.
If a Yangming patient has hardness and fullness below the heart (epigastrium), purgation is contraindicated. If purged and diarrhea persists until death, it is fatal; if diarrhea stops, recovery occurs. Abdominal fullness indicates pathogens in the fu organs (purgable), but epigastric hardness/fullness indicates shallow pathogens not yet fully in the fu organs. Stopping diarrhea indicates pathogen elimination and qi restoration. Persistent diarrhea indicates qi collapse. Shang Zhide notes: "Shallow" is better understood as "high" or superficial.