阳明之为病,胃家实也。伤寒三日,阳明脉大。阳明外证,身热,汗自出,不恶寒,反恶热也。病虽得
之一日,恶寒将自罢,即自汗出而恶热也。阳明居中土也,万物所归,无所复传。始虽恶寒,二日自止,
此为阳明病也。伤寒发热无汗,呕不能食,而反汗出 然者,是转属阳明也。
有太阳阳明,有正阳阳明,有少阳阳明。太阳阳明者,脾约是也。正阳阳明者,胃家实是也。少阳阳明者
,发汗利小便已,胃中躁烦实,大便难是也。太阳病若发汗,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,是名阳明也。本太阳病,初得时发其汗,汗先出不彻因转属阳明
也。病患烦热,汗出则解,又如疟状,日晡时发热者,属阳明也。脉实者,宜下之。脉浮虚者,宜发汗。
按阳明从燥金化气,其经在太阳之次,肌肉之分,起于鼻之交 ,挟口环唇,行身之前,下膈挟脐,
循胫外,由足跗而走大指。阳明为三阳之长,太阳经病不解,营卫内郁,二日必传阳明之经。阳气盛满,
故脉大而身热。若腑阳素实,则自经入腑,表热里传,里热则桂麻解表之法,更为承气攻里之方。仲景立
阳明之法,专为入腑者设,非第二日阳明之经病也。
按阳明病,太阳经证未罢,中风,仍以桂枝汤主之,伤寒,仍以麻黄汤主之。太阳未解,而将入阳明,
以桂枝加葛根汤主之。太阳未解,而已入阳明,以葛根汤主之。二阳表未解,而里有郁,以葛根加半夏汤
主之,表解而里热,以调胃承气汤主之。表解而里微实,以小承气汤主之。表解而里大实,以大承气汤主之
。里实而津竭,以密煎导方、猪胆汁方主之。里实而脾约,以麻仁丸方主之。里实而血瘀,以抵当汤主之。
阳明病的特征,是胃家实(胃肠邪气盛实)。伤寒病经过三天,出现阳明脉象大。阳明的外部证候,表现为身体发热,自然出汗,不恶寒,反而怕热。即使患病才一天,恶寒的症状也会自行停止,随即出现自汗出和怕热的症状。阳明在五行中居中属土,是万物归聚之所,病邪至此不再传变他经。起初虽然恶寒,到第二天就会自行停止,这就是阳明病。伤寒发热无汗,伴有呕吐、不能进食,却反而汗出濈然(连绵不断)的,这是病邪转属于阳明。
有太阳阳明、正阳阳明、少阳阳明三种类型。所谓太阳阳明,是指脾约(脾阴不足,约束津液,导致大便干结)。所谓正阳阳明,是指胃家实。所谓少阳阳明,是指经过发汗或利小便治疗后,胃中干燥烦躁、大便困难的证候。太阳病如果经过发汗、攻下或利小便治疗,导致津液耗伤,胃中干燥,从而转属于阳明,出现不大便、内实、大便困难的情况,这就称为阳明病。原本患太阳病,初起时发汗不彻底,因而转属于阳明。患者烦热,出汗后缓解,但像疟疾一样定时发作,下午申酉时(日晡)发热的,属于阳明病。脉象实的,适宜用攻下法;脉象浮而虚的,适宜用发汗法。
按:阳明从燥金化气,其经脉位于太阳经之后,行于肌肉之间,起始于鼻旁交汇之处,挟口环绕嘴唇,沿身体前面下行,穿过膈肌,挟脐两旁,沿小腿外侧,经过足背,走向大脚趾。阳明是三阳经之长,若太阳经病不解,营卫之气内郁,第二天必定传入阳明经。阳气盛大充盈,所以脉大而身热。如果腑阳素来充实,则病邪由经入腑,表热传入里,对于里热证,桂枝汤、麻黄汤等解表的方法就不再适用,而应改用承气汤等攻里的方剂。张仲景确立的阳明治法,专门针对病邪入腑的情况,并非针对第二天的阳明经病。
按:患阳明病时,若太阳经证尚未解除,若是中风证,仍以桂枝汤为主治;若是伤寒证,仍以麻黄汤为主治。太阳证未解,且病邪即将传入阳明,以桂枝加葛根汤为主治。太阳证未解,且病邪已经传入阳明,以葛根汤为主治。两阳表证未解,且里有郁滞,以葛根加半夏汤为主治。表证已解而里有热,以调胃承气汤为主治。表证已解而里微实,以小承气汤为主治。表证已解而里大实,以大承气汤为主治。里实而津液枯竭,以蜜煎导方、猪胆汁方为主治。里实而脾约,以麻仁丸方为主治。里实而血瘀,以抵当汤为主治。
The manifestation of Yangming disease is characterized by "Stomach-Fu Excess" (excess pathogenic factors in the stomach and intestines). After three days of a cold damage syndrome, the pulse becomes large. The external manifestations of Yangming include bodily heat, spontaneous sweating, absence of aversion to cold, and a preference for coolness (aversion to heat). Even if the disease has been present for only one day, the aversion to cold will cease spontaneously, followed immediately by spontaneous sweating and aversion to heat. Yangming corresponds to Earth in the center, serving as the gathering place for all things, where pathogens do not transmit further. Although there may be initial aversion to cold, it stops on the second day; this constitutes Yangming disease. In cold damage with fever, no sweating, vomiting, inability to eat, yet accompanied by continuous profuse sweating, the pathogen is transferring to Yangming.
There are three types: Taiyang-Yangming, Zhengyang-Yangming, and Shaoyang-Yangming. Taiyang-Yangming refers to "Splee Constriction" (constrained spleen function leading to dry stool). Zhengyang-Yangming refers to "Stomach-Fu Excess." Shaoyang-Yangming refers to conditions resulting from excessive sweating or diuresis, leading to gastric dryness, irritability, and difficulty in defecation. If a Taiyang disease is treated with sweating, purging, or diuresis, causing fluid depletion and gastric dryness, it transfers to Yangming, presenting as constipation, internal excess, and difficult defecation; this is named Yangming disease. If an initial Taiyang disease was treated with sweating that was incomplete, it may also transfer to Yangming. Patients experiencing irritability and heat, who feel relieved after sweating but then have paroxysmal symptoms resembling malaria, specifically with fever during the Shen-You hours (3 PM - 7 PM), belong to Yangming. If the pulse is solid, purgation is indicated; if the pulse is floating and deficient, sweating is indicated.
Note: Yangming transforms according to the Qi of Dry Metal. Its meridian follows that of Taiyang, traversing the muscle layer, originating at the intersection beside the nose, flanking the mouth and encircling the lips, descending along the anterior aspect of the body, passing through the diaphragm and flanking the umbilicus, running down the lateral aspect of the lower leg, crossing the dorsum of the foot, and terminating at the big toe. Yangming is the leader of the Three Yang meridians. If Taiyang meridian disease remains unresolved, Ying and Wei Qi become internally constrained, and by the second day, it must transmit to the Yangming meridian. With abundant and full Yang Qi, the pulse becomes large and the body hot. If the Fu-Yang is naturally robust, the pathogen moves from the meridian to the Fu organs, transmitting surface heat inward. For internal heat, exterior-releasing methods like Guizhi Tang (Cinnamon Twig Decoction) or Mahuang Tang (Ephedra Decoction) are replaced by interior-purging formulas like Chengqi Tang (Gut-Clearing Decoction). Zhang Zhongjing's laws for Yangming are specifically designed for pathogens entering the Fu organs, not for the meridian disease of the second day.
Note: In Yangming disease, if the Taiyang meridian syndrome has not yet resolved, for Wind Strike patterns, Guizhi Tang (Cinnamon Twig Decoction) should be used primarily; for Cold Damage patterns, Mahuang Tang (Ephedra Decoction) should be used primarily. If Taiyang is unresolved and the pathogen is about to enter Yangming, Ge Gen Jia Gui Zhi Tang (Kudzu and Cinnamon Twig Decoction) is indicated. If Taiyang is unresolved and the pathogen has already entered Yangming, Ge Gen Tang (Kudzu Decoction) is indicated. If both Yang meridians' exterior is unresolved and there is internal stagnation, Ge Gen Jia Ban Xia Tang (Kudzu and Pinellia Decoction) is indicated. If the exterior is resolved but there is internal heat, Tiao Wei Cheng Qi Tang (Regulate the Stomach Gut-Clearing Decoction) is indicated. If the exterior is resolved and there is slight internal excess, Xiao Cheng Qi Tang (Minor Gut-Clearing Decoction) is indicated. If the exterior is resolved and there is severe internal excess, Da Cheng Qi Tang (Major Gut-Clearing Decoction) is indicated. If there is internal excess with exhausted fluids, Mi Jian Dao Fang (Honey Suppository Formula) or Zhu Dan Zhi Fang (Pig Bile Formula) is indicated. If there is internal excess with Splee Constriction, Ma Ren Wan (Hemp Seed Pill) is indicated. If there is internal excess with Blood Stasis, Di Dang Tang (Blood-Thunder Decoction) is indicated.