病患烦热。汗出则解。又如疟状。日晡所发热者。属阳明也。脉实者。宜下之。脉浮虚者。宜
发汗。下之与大承气汤。发汗宜桂枝汤。
烦热、热而烦也。是为在里。里则虽汗出不当解。而反解者。知表犹有邪也。如疟者。寒热
往来。如疟之状。是为在表。表则日晡所不当发热。而反发热者。知里亦成实也。是为表里错杂之
候。故必审其脉之浮沉。定其邪之所在。而后从而治之。若脉实者。知气居于里。故可下之。使从
里出。脉浮而虚者。知气居于表。故可汗之。使从表出。而下药宜大承气汤。汗药宜桂枝汤。则天
然不易之法矣。
阳明病。脉浮而紧。咽燥口苦。腹满而喘。发热汗出。不恶寒。反恶热。身重。若发汗则躁。
心愦愦。反谵语。若加烧针。必怵惕烦躁不得眠。若下之。则胃中空虚。客气动膈。心下懊 。舌上
苔白者。栀子豉汤主之。若渴欲饮水。口干舌燥者。白虎加人参汤主之。若脉浮发热。渴欲饮水。
小便不利者。猪苓汤主之。
浮而紧。阳明表里之脉然也。咽燥口苦。腹满而喘。发热汗出。不恶寒。反恶热。身重。阳明
入里之证然也。是为邪已入里。而气连于表。内外牵制。汗下俱碍。是以汗之而邪不能出于表。则
躁。心愦愦然昏乱而谵语。火之而热且扰于中。则怵惕烦躁不得眠。下之而邪不尽于里。则胃气徒
虚。客气内动。心中懊 。若舌上苔白者。邪气盛于上焦。故与栀子豉汤。以越胸中之邪。所谓病
在胸中。当须吐之是也。若渴欲饮水。口干舌燥者。则邪气不在上而在中。故以白虎加人参。以清
胃热益胃液。所谓热淫于内。治以甘寒也。若脉浮发热。渴欲饮水。小便不利者。邪热不在上中。
而独在下。故与猪苓汤。以利水泄热。兼滋阴气。所谓在下者。引而竭之也。
猪苓汤方
猪苓（去皮） 茯苓 阿胶 滑石（碎） 泽泻（各一两）
上五味。以水四升。先煮四味。取二升。去滓。纳阿胶。烊消。温服七合。日三服。
阳明病。汗出多而渴者。不可与猪苓汤。以汗多。胃中燥。猪苓汤复利小便故也。
上条于脉浮发热。渴而小便不利之证。既着猪苓汤之用矣。此条复示猪苓汤之戒。谓虽渴欲饮
水。而汗出多者。则不可以猪苓利其小便。所以然者。汗之与溺。同出而异归者也。灵枢云、水谷入
于口。输于肠胃。其液别为五。天寒衣薄。则为溺与气。天暑衣浓则为汗。故虽清浊不同。其为腑
中之液则一也。汗出既多。胃液已耗。而复以猪苓利之。是已燥而益燥也。故曰不可与猪苓汤。
阳明病。下之。其外有热。手足温。不结胸。心中懊 。饥不能食。但头汗出者。栀子豉汤主
之。
阳明下后。其邪既不从里而出。又不因下而结。其外有热。手足温者。邪虽陷而未深也。心中
懊。饥不能食者。热客胸中。而胃虚不能纳谷也。但头汗出者。胸中之热。熏蒸于上。而阳受邪
气。复不能降而下行也。是为邪气入里。而未成聚之证。故宜栀子豉汤以彻胸中之邪。亦高者因而
越之之意也。
阳明病。法多汗。反无汗。其身如虫行皮中状者。此以久虚故也。
阳明者。津液之腑也。热气入之。津为热迫。故多汗。反无汗。其身如虫行皮中状者。气内
蒸而津不从之也。非阳明久虚之故。何致是哉。
夫实则谵语。虚则郑声。郑声、重语也。
实者。邪气盛也。虚者。精气夺也。邪盛则狂妄多言。变乱不测。正夺者。语不能多。惟平时
心事。言讫复言而已。故曰重语。重、犹叠也。
直视谵语。喘满者。死。下利者。亦死。
直视谵语。为阴竭热盛之候。此为邪气日损。或阴气得守。犹或可治。若喘满。则邪内盛。或
下利。则阴内泄。皆死证也。
发汗多。若重发汗者。亡其阳。谵语脉短者。死。脉自和者。不死。
汗多复汗。阳气重伤。而邪复不解。为谵语而脉短。谵语为邪之盛。脉短为气之少。病盛胜脏
。故死。脉自
和者。邪气虽盛。而正气犹足相持。故得不死。
阳明病欲解时。从申至戌上。
申酉戌时。日晡时也。阳明潮热。发于日晡。阳明病解。亦于日晡。则申酉戌为阳明之时。其
病者。邪气于是发。其解者。正气于是复也。
患者出现烦热症状。出汗后症状缓解，但病情又像疟疾一样发作。如果在下午3点到5点（日晡时）发热，属于阳明病。脉象实大的，适宜用泻下法；脉象浮而虚的，适宜用发汗法。泻下法使用大承气汤，发汗法使用桂枝汤。
“烦热”，指发热且伴有心烦，这是病邪在里的表现。病在里，虽然出汗通常不应缓解，但如果反而缓解了，说明表证仍有邪气未解。“像疟疾一样”，指寒热往来，如同疟疾的症状，这是病邪在表的表现。病在表，下午3点到5点本不应发热，如果反而发热，说明里证也已成实。这是表里错杂的证候。因此必须仔细审查脉象的浮沉，确定邪气所在的位置，然后顺势治疗。如果脉象实大，说明气机郁结在里，所以可以用泻下法，使邪气从里排出；如果脉象浮而虚弱，说明气机郁结在表，所以可以用发汗法，使邪气从表排出。泻下药宜用大承气汤，发汗药宜用桂枝汤，这是自然不变的治疗法则。
阳明病，脉象浮紧，咽喉干燥，口苦，腹部胀满且气喘，发热出汗，不恶寒，反而怕热，身体沉重。如果误用发汗法，患者会出现烦躁、心中昏乱郁闷，反而说胡话（谵语）。如果误用烧针疗法，一定会出现惊恐不安、烦躁无法入睡。如果误用泻下法，会导致胃中空虚，客气（非正常的邪气）扰动膈部，心中懊恼烦闷，舌苔白的，用栀子豉汤主治。如果口渴想喝水，口干舌燥的，用白虎加人参汤主治。如果脉象浮、发热，想喝水，小便不利的，用猪苓汤主治。
“浮而紧”是阳明病表里脉象的特征。“咽喉干燥、口苦、腹部胀满气喘、发热出汗、不恶寒反恶热、身体沉重”是阳明病邪入里的证候特征。这说明邪气已经入里，但气机牵连于表，内外相互牵制，发汗和泻下都有禁忌。因此，如果发汗，邪气不能从表排出，就会导致烦躁、心中昏乱郁闷并说胡话；如果用火疗，热气扰乱体内，就会导致惊恐烦躁无法入睡；如果泻下，邪气不能完全从里清除，就会导致胃气徒然空虚，客气内动，心中懊恼烦闷。如果舌苔白，说明邪气盛于上焦，所以给予栀子豉汤，以涌吐胸中的邪气，这就是所谓“病在胸中，应当用吐法”的意思。如果口渴想喝水，口干舌燥，说明邪气不在上焦而在中焦，所以用白虎加人参汤，以清胃热、益胃液，这就是所谓“热邪淫溢于内，用甘寒之法治疗”的意思。如果脉象浮、发热，想喝水，小便不利，说明邪热不在上中二焦，而独在下焦，所以用猪苓汤，以利水泄热，兼滋阴气，这就是所谓“病在下焦，用引导竭尽的方法治疗”的意思。
猪苓汤方
猪苓（去皮）、茯苓、阿胶、滑石（捣碎）、泽泻（各一两）
以上五味药，用水四升，先煮前四味药，取药液二升，去渣，加入阿胶，烊化溶解，每次温服七合，每日三次。
阳明病，出汗多且口渴的，不可给予猪苓汤。因为出汗多，胃中已干燥，猪苓汤又会利小便，故禁用。
上一条论述了脉象浮、发热、口渴且小便不利的证候，已经明确了猪苓汤的用法。这一条再次提示猪苓汤的禁忌，指出虽然口渴想喝水，但如果出汗多的，就不可以用猪苓汤来利小便。之所以这样，是因为汗与尿，同源而异流。《灵枢》说：水谷进入口中，输送到肠胃，其津液分为五种。天气寒冷衣服单薄时，就化为尿和气；天气炎热衣服厚重时，就化为汗。所以虽然清浊不同，但它们都是腑中的津液。出汗既多，胃中津液已耗损，如果再使用猪苓汤利小便，就是使已经干燥的更加干燥。所以说不可给予猪苓汤。
阳明病，经过泻下治疗后，体表仍有发热，手足温暖，没有形成结胸，心中懊恼烦闷，感到饥饿但不能进食，只有头部出汗的，用栀子豉汤主治。
阳明病泻下后，邪气既不从里外出，也不因泻下而结聚，体表有热，手足温暖的，说明邪气虽陷入但未深重。心中懊恼烦闷，感到饥饿但不能进食的，说明热邪客居胸中，而胃气虚弱不能受纳食物。只有头部出汗的，说明胸中的热气熏蒸于上，阳气受邪气干扰，不能下降下行。这是邪气入里但未结成积聚的证候，所以适宜用栀子豉汤来透达胸中的邪气，这也是“病位在高者，顺势涌越之”的意思。
阳明病，按常理应当多汗，反而无汗，身体感觉像虫子在皮肤中爬行一样的，这是因为久病体虚的缘故。
阳明经是津液之腑。热气侵入，津液被热气逼迫，所以多汗。反而无汗，身体像虫子在皮肤中爬行，这是因为气在体内蒸腾而津液不能随之而出。如果不是阳明久虚的原因，怎么会导致这种情况呢？
实证会说胡话（谵语），虚证会重复言语（郑声）。“郑声”是指重复说话。
实证，是指邪气盛。虚证，是指精气被剥夺。邪气盛则狂妄多言，变化莫测；正气被夺则话语不多，只是重复平时的心事，说完又说。所以说叫“重语”。“重”，就是重叠的意思。
眼睛直视且说胡话，伴有气喘胸满的，预后不良（死证）。伴有腹泻的，也是死证。
眼睛直视且说胡话，是阴液枯竭、热邪炽盛的征象。此时如果邪气日渐消退，或者阴气能够守持，或许还可以治疗。如果出现气喘胸满，说明邪气内盛；如果出现腹泻，说明阴气内泄，这些都是死证。
发汗过多，或者再次发汗的，会导致亡阳。出现说胡话且脉象短的，预后不良（死证）。脉象自和的，不会死亡。
出汗多又再出汗，阳气受到严重损伤，而邪气仍未解除，出现说胡话且脉象短。说胡话代表邪气盛，脉象短代表正气少。病势强盛胜过脏气，所以死亡。脉象自和的，说明邪气虽然盛，但正气仍然足以抗衡，所以不会死亡。
阳明病欲解之时，从申时到戌时（下午3点到晚上7点）。
申、酉、戌时，即下午3点到晚上7点（日晡时）。阳明病的潮热，发生在日晡时；阳明病的缓解，也发生在日晡时。所以申、酉、戌时是阳明经当令之时。患病的人，邪气在这个时候发作；缓解的人，正气在这个时候恢复。
The patient presents with vexatious heat (vexatious heat). Sweating leads to relief, yet the condition resembles malaria. If fever occurs in the late afternoon (daytime malarial fever), it belongs to Yangming disease (Yangming syndrome). If the pulse is excess (Excess pulse), purgation (Purgative method) is indicated; if the pulse is floating and deficient (Deficient pulse), diaphoresis (Diaphoretic method) is indicated. For purgation, Da Cheng Qi Tang (Major Order the Qi Decoction) is used; for diaphoresis, Gui Zhi Tang (Cinnamon Twig Decoction) is used.
"Vexatious heat" refers to fever accompanied by mental restlessness, indicating the pathogen is in the interior (Interior). In interior conditions, sweating should not typically bring relief; if it does, it indicates that exterior pathogens remain. "Resembling malaria" refers to alternating chills and fever, characteristic of exterior conditions. In exterior conditions, fever should not occur in the late afternoon; if it does, it indicates that interior excess has formed. This represents a complex pattern of exterior-interior involvement. Therefore, one must carefully examine whether the pulse is floating or deep to determine the location of the pathogen before treating accordingly. An excess pulse indicates qi stagnation in the interior, so purgation may be used to expel the pathogen from the interior. A floating and deficient pulse indicates qi stagnation in the exterior, so diaphoresis may be used to expel the pathogen from the exterior. The purgative formula should be Da Cheng Qi Tang (Major Order the Qi Decoction), and the diaphoretic formula should be Gui Zhi Tang (Cinnamon Twig Decoction); this is an unchangeable natural principle.
In Yangming disease, if the pulse is floating and tight, with dry throat, bitter taste, abdominal fullness, panting, fever, sweating, aversion to cold absent but aversion to heat present, and heavy body: if diaphoresis is mistakenly applied, the patient will become irritable, feel mentally confused and distressed, and develop delirious speech (Delirium). If moxibustion or burning needles are mistakenly applied, the patient will certainly experience fear, palpitations, irritability, and insomnia. If purgation is mistakenly applied, the stomach becomes empty, rebellious qi disturbs the diaphragm, causing mental distress and stifled feelings (Mental distress), and if there is a white coating on the tongue, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is the primary treatment. If there is thirst desire to drink water and dry mouth/tongue, Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng) is the primary treatment. If the pulse is floating, there is fever, thirst desire to drink water, and dysuria, Zhu Ling Tang (Polyporus Decoction) is the primary treatment.
Floating and tight pulses are characteristic of Yangming exterior-interior patterns. Dry throat, bitter taste, abdominal fullness with panting, fever, sweating, absence of aversion to cold but presence of aversion to heat, and heavy body are characteristics of Yangming interior transformation. This indicates the pathogen has entered the interior, yet qi connects to the exterior, creating mutual constraint between interior and exterior, making both diaphoresis and purgation difficult. Thus, if diaphoresis is used, the pathogen cannot exit via the exterior, leading to irritability, mental confusion, and delirium. If fire therapy is used, heat disturbs the interior, leading to fear, irritability, and insomnia. If purgation is used, the pathogen is not fully cleared from the interior, leaving stomach qi vainly deficient and rebellious qi moving internally, causing mental distress. If the tongue has a white coating, it indicates pathogenic excess in the upper jiao (Upper Burner); therefore, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is given to vent the pathogen from the chest, following the principle "when disease is in the chest, vomiting should be induced." If there is thirst desire to drink water and dry mouth/tongue, the pathogen is in the middle jiao (Middle Burner), not the upper; thus, Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng) is used to clear stomach heat and nourish stomach fluids, following the principle "for heat overflowing within, treat with sweet-cold methods." If the pulse is floating, there is fever, thirst desire to drink water, and dysuria, the pathogenic heat is not in the upper or middle jiao, but exclusively in the lower jiao (Lower Burner); thus, Zhu Ling Tang (Polyporus Decoction) is used to promote urination to drain heat and simultaneously nourish yin qi, following the principle "for disease in the lower, use guiding methods to exhaust it."
Zhu Ling Tang (Polyporus Decoction) Formula:
Zhu Ling (Polypori Sclerotium, peeled), Fu Ling (Poria), E Jiao (Colla Corii Asini), Hua Shi (Talcum, crushed), Ze Xie (Alismatis Rhizoma) — each 1 liang.
Take these five herbs, add four sheng of water, first decoct the first four herbs to obtain two sheng of liquid, remove the dregs, add E Jiao (Colla Corii Asini), melt it, and take seven ge warm, three times daily.
In Yangming disease, if sweating is profuse and there is thirst, Zhu Ling Tang (Polyporus Decoction) must not be given. Because profuse sweating causes dryness in the stomach, and Zhu Ling Tang (Polyporus Decoction) further promotes urination.
The previous clause described the application of Zhu Ling Tang (Polyporus Decoction) for symptoms of floating pulse, fever, thirst, and dysuria. This clause reiterates the contraindication: although there is thirst desire to drink water, if sweating is profuse, Zhu Ling Tang (Polyporus Decoction) should not be used to promote urination. The reason is that sweat and urine share the same source but have different outlets. The *Ling Shu* states: Water and grain enter the mouth and are transported to the intestines and stomach; their fluids divide into five types. In cold weather with thin clothing, they become urine and qi; in hot weather with thick clothing, they become sweat. Although clear and turbid differ, they are all fluids of the fu organs. Since profuse sweating has already consumed stomach fluids, using Zhu Ling Tang (Polyporus Decoction) to promote urination would dryness upon dryness. Hence, it is stated that Zhu Ling Tang (Polyporus Decoction) must not be given.
In Yangming disease, after purgation, if there is exterior heat, warm hands and feet, no formation of chest binding (Jie Xiong), mental distress and stifled feelings (Mental distress), hunger but inability to eat, and only sweating on the head, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is the primary treatment.
After purgation in Yangming disease, if the pathogen neither exits from the interior nor binds due to purgation, and there is exterior heat with warm hands and feet, the pathogen has sunk but not deeply. Mental distress and stifled feelings (Mental distress), hunger but inability to eat, indicate heat lodging in the chest while stomach qi is deficient and unable to receive food. Only sweating on the head indicates chest heat steaming upward, where yang qi is affected by pathogen and cannot descend. This is a pattern where pathogen enters the interior but has not formed accumulation; thus, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is suitable to vent the pathogen from the chest, also reflecting the principle "for high-seated disease, induce venting."
In Yangming disease, which normally involves profuse sweating, if there is instead no sweating, and the body feels as if insects are crawling in the skin, this is due to long-standing deficiency.
Yangming is the fu organ of fluids. When heat qi enters, fluids are forced by heat, resulting in profuse sweating. If there is instead no sweating, and the body feels like insects crawling in the skin, it is because qi steams internally while fluids do not follow. Without long-standing Yangming deficiency, how could this occur?
Excess conditions lead to delirious speech (Delirium); deficiency conditions lead to Zheng Sheng (repetitive speech). "Zheng Sheng" refers to repetitive speech.
Excess means pathogenic excess; deficiency means essence/qi depletion. Pathogenic excess leads to wild, excessive speech unpredictable in nature; qi depletion leads to inability to speak much, repeating only past concerns over and over. Hence it is called "repetitive speech." "Repetitive" implies overlapping.
Fixed gaze with delirious speech (Delirium), accompanied by panting and chest fullness, indicates death. Accompanied by diarrhea, it also indicates death.
Fixed gaze with delirious speech (Delirium) indicates exhaustion of yin and flourishing heat. If pathogen declines day by day, or if yin qi can maintain itself, there may still be hope for treatment. If panting and chest fullness occur, pathogen is internally flourishing; if diarrhea occurs, yin leaks internally; both are fatal signs.
Profuse sweating, or repeated sweating, leads to loss of yang. Delirious speech (Delirium) with a short pulse indicates death; a self-harmonious pulse indicates survival.
Profuse sweating followed by more sweating severely injures yang qi, while pathogen remains unresolved. Delirious speech (Delirium) with a short pulse: delirious speech (Delirium) indicates pathogenic excess, short pulse indicates qi deficiency. Disease excess overwhelms the zang organs, hence death. A self-harmonious pulse indicates that although pathogen is excess, righteous qi is sufficient to contend, hence survival.
Yangming disease resolves from Shen hour to Xu hour (3 PM to 7 PM).
Shen, You, and Xu hours correspond to the late afternoon (daytime malarial fever period). Yangming tidal fever occurs in the late afternoon; Yangming disease resolution also occurs in the late afternoon. Thus, Shen, You, and Xu hours belong to Yangming. When diseased, pathogen flares at this time; when resolving, righteous qi recovers at this time.