阳明主里，内候胃中，外候肌肉，故有病经、病府之分。如论中身热烦渴，目痛鼻干
不得眠，不恶寒，反恶热者，此阳明经病也；渐热谵语，手足腋下濈然汗出，腹满痛
，大便□者，此阳明府病也。而其候各有三：经病则有邪已传阳明而太阳之表未罢，
兼见头痛恶寒无汗之太阳证者；有太阳之邪已罢，悉传阳明，但见壮热有汗，心烦不
眠，口渴引饮之阳明证者；有阳明之邪未已，复转少阳，兼见胸□痛，寒热往来，口
苦而呕，目眩耳聋之少阳证者。府病则有太阳阳明，谓太阳病，或发汗，或吐，或下
，或利小便，亡其津液，胃中干燥，太阳之邪，乘胃燥而转属阳明，致小便反数，大
便□者，所为脾约是也；有正阳阳明，谓阳气素盛，或有宿食，太阳之邪，一传阳明
，遂入胃府，致大便不通者，所为胃家实是也；有少阳阳明，谓病已到少阳，法当和
解，而反发汗，利小便，亡其津液，胃中燥热，复转属阳明，致大便结燥者，所为大
便难者是也。其治阳明经病，则以葛根汤或桂枝加葛根汤发之，或以白虎汤清之，或
以柴胡白虎汤和之，随其证而施之可也。其治阳明府病，虽均为可下，然不无轻重之
分，故或以三承气汤下之，或麻仁丸通之，或蜜煎胆汁导之，量其病而治之可也，此
阳明病之大略也。兹以在经、在府二者，详疏于篇，俾读者易为分别，则临证施治，
自不紊矣。
@@@
阳明之为病，胃家实是也。
【注】
阳明经，内以候胃，外以候肌。言阳明之为病，由太阳之邪，传于其经，则为阳明病
外证；由太阳之邪，传入胃府，则为胃家实也。
【集注】
方有执曰：阳明经也，胃府也。实者，大便结为□满而不得出也。虽则迟早不同，而
非日数所可拘也。
@@@
伤寒三日，阳明脉大。
【注】
伤寒一日太阳，二日阳明，三日少阳，乃『内经』言传经之次第，非必以日数拘也。
此云：三日阳明脉大者，谓不兼太阳阳明之浮大，亦不兼少阳阳明之弦大，而正见正
阳阳明之大脉也。盖由去表传里，邪热入胃，而成内实之诊，故其脉象有如此者。
【集注】
方有执曰：伤寒三日，该中风而大约言也。脉大者，阳明气血俱多也。
沈明宗曰：此正阳明之正脉也。仲景谓三日阳明脉大，因阳明乃多气多血之府，风寒
传入，邪盛于中，故脉显大，是为阳明邪实之正脉。但病阳明务具此脉，方可下夺，
或兼太阳之浮紧，少阳之弦细，或迟疾滑涩虚弱，乃属气血阴阳之虚，虽见大实大满
，亦当详审顾虑，或以小承气汤试之，或用蜜煎导法，不得直施攻下也。
本太阳初得病时，发其汗，汗先出不彻，因转属阳明也。
【注】
阳明之病，本自太阳初得病时，发其汗，汗先出而不透彻，乃为汗不如法，故未尽之
邪，因而转属阳明也。邪在经则为外证，邪入府则为胃家实矣。
【集注】
方有执曰：此言由发太阳汗不如法，致病入胃之大意。
@@@
阳明病，若能食，名中风；不能食，名中寒。
【注】
太阳之邪传阳明病，有自中风传来者，有自伤寒传来者，当于食之能否辨之。若能食
，名中风，是自中风传来者，以风乃阳邪，阳能化谷，故能食也。不能食，名中寒，
是自伤寒传来者，以寒乃阴邪，不能化谷，故不能食也。
【集注】
方有执曰：此以食之能否，验风寒之辨。盖阳明主水谷，风能食，阳能化谷也；寒不
能食，阴不杀谷也。名，犹言为也。中寒，即伤寒之互词。大意推原风寒自太阳传来
，其辨验有如此者，非谓阳明自中而然也。
汪琥曰：仲景云：中寒与伤寒同义，非真寒证也。若系真中寒，是胃家虚冷，药宜理
中汤之类。今不能食，是胃气实，但邪未入府，不作郁热耳。因名中寒，实与伤寒无
异。
@@@
问曰：阳明病，外证云何？答曰：身热汗自出，不恶寒反恶热也 。
【注】
阳明病有外证有内证。潮热、自汗、不大便、内证也；身热、汗自出、不恶寒、反恶
热，外证也。今汗自出，是从中风传来，故与中风之外证同，而身热、不恶寒反恶热
，则知为阳明外证，故不与中风外证同也。然阳明之热，发于肌肉，必蒸蒸而热，又
不似太阳之阵阵发热，可知矣。
【集注】
方有执曰：此以太阳中风，传入阳明之外证言。
魏荔彤曰：病有太阳中风不解，传入阳明者，何以辨之？故设问曰：阳明未知其里之
何时传来？必先验其外之何所见证？答曰：太阳病，有身热，汗自出而恶风者，此太
阳中风之本证也；若身热，汗自出，竟不恶风寒而反恶热，则病已去太阳而入阳明矣
。此阳明病，由太阳中风而传入者也。
@@@
问曰：病有得之一日，不发热而恶寒者，何也？答曰：虽得之一日，恶寒将自罢，即
自汗出而恶热也。
【注】
太阳病当恶寒，阳明病当恶热。今阳明病，有初得之一日，不发热而恶寒者，是太阳
去表之邪未尽，故仍恶寒也。然去表未尽之邪，欲传阳明，不能久持，故恶寒必将自
罢，即日当自汗出而恶热矣。
【集注】
方有执曰：此以太阳伤寒，传入阳明之外证言。
程应旄曰：阳明恶寒，终是带表，至于府病则恶热矣。表之罢否，须于此验之。
郑重光曰：此辨阳明伤寒之外证，不发热而恶寒，起自伤寒也。恶寒将自罢，邪过表
也。即自汗出，邪热郁于肌肉，腠理开，汗外泄也。
魏荔彤曰：太阳伤寒亦有传入阳明者，又何以辨之？故设问曰：病有得之一日，起初
之时，不见发热，而但见恶寒者，何病也？答曰：得之一日恶寒，虽为太阳伤寒之证
，而恶寒亦将自罢，即自汗出而恶热，此是阳明病由太阳伤寒而传入者也。可知太阳
中风，则发热恶风，汗自出为，正病，太阳伤寒，则恶寒无汗为正病。若传入阳明，
则必以汗出、恶热为正病也。
@@@
问曰：恶寒何故自罢？答曰：阳明居中，主土也。万物所归，无所复传，始虽恶寒，
二日即止，此为阳明病也。
【注】
此释上条阳明恶寒自罢之义。阳明属胃居中，土也。土为万物所归，故邪热归胃则无
所复传，亦万物归土之义。阳明初病一日，虽仍恶寒，是太阳之表未罢也。至二日恶
寒自止，则是太阳之邪已悉归并阳明，此为阳明病也。
【集注】
方有执曰：恶寒二日自止者，热入里而将恶热，此以正阳阳明言也。
程应旄曰：六经虽分阴阳，而宰之者胃，五藏六府，皆朝宗而禀令焉。一有燥热，无
论三阳传来之邪，从而化热，即三阴传来之邪，亦转属而变热。阴阳之邪，皆归胃土
，故曰：万物所归无所复传也。
@@@
问曰：何缘得阳明病？答曰：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，此名阳明也。
【注】
问曰：何缘得阳明胃实之病？答曰：由邪在太阳时，发汗，若下，若利小便，皆为去
邪而设，治之诚当，则邪解而愈矣。如其不当，徒亡津液，致令胃中干燥，则未尽之
表邪，乘其燥热，因而转属阳明，为胃实之病者有三：不更衣，即太阳阳明脾约是也
；内实，即正阳阳明胃家实是也；大便难，即少阳阳明大便难是也。三者虽均为可下
之证，然不无轻重之别，脾约自轻于大便难，大便难自轻于胃家实。盖病脾约大便难
者，每因其人津液素亏，或因汗下利小便，施治失宜所致。若胃实者，则其人阳气素
盛，胃有宿食，即未经汗下，而亦入胃成实也。故已经汗下者，为夺血致燥之阳明，
以滋燥为主；未经汗下者，为热盛致燥之阳明，以攻热为急。此三承气汤、脾约丸及
蜜煎、土瓜根、猪胆汁导法之所由分也。
【集注】
方有执曰：古人大便必更衣；不更衣，言不大便也。
程应旄曰：转属层次，不止有表罢、不罢之分，而表罢入里，复有燥实、燥不实之辨
。所以有不更衣之阳明病，有内实之阳明病，有大便难之阳明病也。其中有属表属里
，所以下法有禁有宜。受气有里实里燥，所以下法有应大应小。
汪琥曰：或问太阳病若下矣，则胃中之物已去，纵亡津液，胃中干燥，未必复成内实
。答云：方其太阳初病时，下之不当，徒亡津液，胃中之物去之不尽，邪传阳明而成
燥粪，故有内实之证。
@@@
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；正阳阳明者，胃家实是也；少阳阳明者，发汗利小便已，胃中燥烦实，大便难
是也。
【注】
阳明可下之证，不止于胃家实也。其纲有三，故又设问答以明之也。太阳之邪，乘胃
燥热，传入阳明，谓之太阳阳明，不更衣无所苦，名脾约者是也。太阳之邪，乘胃宿
食与燥热结，谓之正阳阳明，不大便，内实满痛，名胃家实者也；太阳之邪已到少阳
，法当和解，而反发汗利小便，伤其津液，少阳之邪复乘胃燥，转属阳明，谓之少阳
阳明，大便涩而难出，名大便难者是也。
【集注】
程知曰：言三阳皆有入胃府之证也。阳明为水谷之海，中土为万物所归，故三阳经皆
能入其府。邪自太阳传入胃府者，谓之太阳阳明，即经所谓太阳病，若吐、若下、若
发汗后，微烦，小便数，大便因□者是也，由脾之敛约，故用小承气微下以和之。邪
自阳明经传入胃府者，谓之正阳阳明，即经所谓发热汗出，胃中燥□□语者是也，乃
胃中邪实，故用大承气以攻下之。邪自少阳转属胃府者，谓之少阳阳明，即经所谓少
阳不可发汗，发汗则□语，此属胃者是也，系津液内竭，故用麻仁丸润下，以和其津
液也。若三阳外证未除，则阳明正治之法，又不可用矣。
@@@
阳明病，脉浮而紧者，必潮热，发作有时，但浮者，必盗汗出。
【按】
自汗是阳明证，盗汗是少阳证，盗汗当是自汗，文义始属。
【注】
阳明病在经，脉当浮长，入府，脉当实大。今脉浮而紧，潮热有时者，是阳明病而见
太阳伤寒脉也，则知是从伤寒传来。太阳伤寒之邪未罢，必无汗，故虽见阳明潮热发
作有时之证，仍当从太阳阳明伤寒治之，宜麻黄加葛根汤汗之。若见潮热发作有时之
证，而脉但浮不紧，是阳明病而见太阳中风脉也，则知是从中风传来。太阳中风之邪
未罢，必自汗出，当从太阳阳明中风治之，宜桂枝加葛根汤解之。
【集注】
沈明宗曰：此阳明证而见太阳脉也。脉浮而紧，太阳表寒未罢之脉，潮热发作有时，
则阳明里证已具，但浮者，太阳风伤卫脉，故必汗出也。
@@@
阳明病，脉迟，汗出多，微恶寒者，表未解也，可发汗，宜桂枝汤。
【按】
汗出多之下，当有「发热」二字，若无此二字，脉迟，，汗出多，微恶寒，乃是表阳
虚，桂枝附子汤证也，岂有用桂枝汤发汗之理乎？必是传写之遗。
【注】
阳明病脉当数大，今脉迟汗出多，设不发热恶寒，是太阳表邪已解矣。今发热微恶寒
，是表犹未尽解也，故宜桂枝汤解肌以发其汗，使初入阳明之表邪，仍还表而出也。
【集注】
程知曰：此言中风传阳明，表邪未解，仍宜用桂枝汤以解肌也。
汪琥曰：此太阳病初传阳明经，中有风邪也。脉迟者，太阳中风缓脉之所变，传至阳
明，邪将入里，故脉变迟。汗出多者，阳明热而肌腠疏也。微恶寒者，在表风邪未尽
也。故仍从太阳中风例治之。又曰：虽从太阳例治，但既云阳明病，仲景法还宜用桂
枝加葛根汤为是。
@@@
阳明病，脉浮，无汗而喘者，发汗则愈，宜麻黄汤。
【注】
阳明病，脉应浮大，证应汗出。今脉但浮，表病脉也；无汗而喘，表实证也。是太阳
之邪，未悉入阳明，犹在表也。当仍从太阳伤寒治之，发汗则愈，宜麻黄汤。
【集注】
张璐曰：阳明荣卫难辨，辨之全藉于脉证。风邪之脉，传至阳明，自汗已多，则缓去
而迟在；寒邪之脉，传至阳明，发热已甚，则紧去而浮在，此皆邪气在经之征。若入
府，则迟者必数，浮者必实矣。设不数不实，非胃实也，必不胜攻下矣。
汪琥曰：无汗而喘，但浮不紧，何以定其为阳明病？必其人目痛鼻干，身热不得眠，
故云阳明病也。
魏荔彤曰：此太阳阳明之证，入阳明未深，故令其邪仍自表出，不至归于胃而无所复
传也。
@@@
阳脉微而汗出少者，为自和也；汗出多者，为太过；阳脉实，因发其汗，出多者，亦
为太过。太过者，为阳绝于里，亡津液，大便因□也。
【注】
此承上条互详其脉，以出其证也。脉阳微，谓脉浮无力而微也；阳脉实，谓脉浮有力
而盛也。凡中风伤寒脉，阳微则热微，微热蒸表作汗；若汗出少者，为自和欲解，汗
出多者，为太过不解也。阳脉实则热盛，因热盛而发其汗，出多者，亦为太过；汗出
太过，则阳极于里，亡津液，大便因□而成内实之证矣。势不得不用下法。故欲发其
汗者，不可不早虑及此也。
阳明经主里，内部候察胃腑，外部候察肌肉，因此有在经和在腑的区分。如《伤寒论》中所述：身体发热、心烦口渴、眼睛疼痛、鼻子干燥、无法安睡，不恶寒，反而恶热，这是阳明经病；逐渐出现发热、胡言乱语，手足及腋下持续出汗，腹部胀满疼痛，大便不通畅的，这是阳明腑病。而它们的证候各有三种：经病则有邪气已传入阳明但太阳表证未解，兼见头痛、恶寒、无汗等太阳证候的；有太阳邪气已解，完全传入阳明，仅见高热、有汗、心烦失眠、口渴想喝水等阳明证候的；有阳明邪气未除，又转属少阳，兼见胸部疼痛（注：原文缺字，据理补为“胸”）、寒热往来、口苦且呕吐、头晕目眩、耳聋等少阳证候的。腑病则有太阳阳明，指太阳病，经过发汗、催吐、泻下或利小便后，津液耗损，胃中干燥，太阳邪气乘着胃燥转入阳明，导致小便频数，大便干结难解的，这就是所谓的“脾约”；有正阳阳明，指患者阳气素来旺盛，或有宿食停滞，太阳邪气一经传入阳明，随即进入胃腑，导致大便不通的，这就是所谓的“胃家实”；有少阳阳明，指病已到少阳阶段，本应和解，却误用发汗、利小便，耗伤津液，导致胃中燥热，又转属阳明，导致大便干结燥硬的，这就是所谓的“大便难”。治疗阳明经病，可用葛根汤或桂枝加葛根汤发汗解表，或用白虎汤清热生津，或用柴胡白虎汤和解少阳与阳明，根据具体证候施治即可。治疗阳明腑病，虽然都属于可下之证，但也有轻重之分，所以有的用三承气汤攻下，有的用麻子仁丸润下通便，有的用蜜栓或猪胆汁灌肠导便，根据病情轻重施治即可，这是阳明病的概况。现在将在经和在腑两种情况详细分述于本篇，使读者容易分辨，那么临证施治，自然就不会混乱了。
@@@
阳明病的本质，就是胃家实（胃肠邪热炽盛，燥屎内结）。
【注】
阳明经，内部候察胃腑，外部候察肌肤。说阳明病，如果是太阳邪气传入其经，则为阳明病的外证；如果是太阳邪气传入胃腑，则为胃家实。
【集注】
方有执说：阳明包括经和腑。所谓“实”，是指大便干结形成痞满而不能排出。虽然发病迟早不同，但不能拘泥于日数。
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伤寒第三天，出现阳明脉象大。
【注】
伤寒第一天太阳，第二天阳明，第三天少阳，这是《内经》所说的传经次序，并非一定拘泥于日数。这里说“第三天阳明脉大”，是指不兼有太阳阳明的浮大脉，也不兼有少阳阳明的弦大脉，而是正阳阳明特有的洪大脉。这是因为邪气由表入里，邪热入胃，形成内实的诊候，所以脉象如此。
【集注】
方有执说：伤寒三天，泛指中风在内的大概情况。脉大，是因为阳明气血俱多。
沈明宗说：这是正阳阳明的正脉。张仲景说“三日阳明脉大”，因为阳明是多气多血的腑，风寒传入，邪气盛于中焦，所以脉象显大，这是阳明邪实的正脉。但患阳明病必须具备此脉，才可考虑攻下；如果兼有太阳的浮紧脉、少阳的弦细脉，或者迟、疾、滑、涩、虚、弱等脉，则属于气血阴阳之虚，即使见到大实大满的症状，也应当详审顾虑，可以用小承气汤试探，或用蜜煎导法，不能直接施用攻下法。
本为太阳病初起时，发汗治疗，汗出先出不透彻，因而转属阳明。
【注】
阳明病，原本是在太阳初得病时，发汗治疗，汗先出但不透彻，这是发汗不得法，所以未尽的邪气，因而转属阳明。邪气在经则为外证，邪气入腑则为胃家实。
【集注】
方有执说：这是说因发太阳汗不得法，导致病邪入胃的大意。
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阳明病，如果能进食，名叫中风；如果不能进食，名叫中寒。
【注】
太阳邪气传入阳明病，有从中风传来的，有从伤寒传来的，应当通过能否进食来辨别。如果能进食，名叫中风，是从中风传来，因为风是阳邪，阳能化谷，所以能进食。如果不能进食，名叫中寒，是从伤寒传来，因为寒是阴邪，不能化谷，所以不能进食。
【集注】
方有执说：这是通过能否进食来验证风寒的区别。因为阳明主水谷，风能食，阳能化谷；寒不能食，阴不杀谷。“名”在这里相当于“为”的意思。中寒，即伤寒的互称。大意是推究风寒自太阳传来，其辨别验证有如此情况，并不是说阳明自身直接受中寒邪所致。
汪琥说：张仲景说：中寒与伤寒同义，并非真正的寒证。如果是真正中寒，那是胃家虚冷，用药宜用理中汤之类。现在不能进食，是胃气实，只是邪气未入腑，没有形成郁热罢了。所以名为中寒，实际上与伤寒无异。
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问：阳明病的外证是什么？答：身体发热，自然出汗，不恶寒，反而恶热。
【注】
阳明病有外证和内证。潮热、自汗、不大便，是内证；身体发热、自然出汗、不恶寒、反而恶热，是外证。现在自然出汗，是从中风传来，所以与中风的外证相同，但身体发热、不恶寒反而恶热，就知道是阳明外证，所以不与中风外证相同。然而阳明的热，发于肌肉，一定是蒸蒸发热，又不像太阳病那样阵阵发热，由此可知。
【集注】
方有执说：这是以太阳中风传入阳明之外证来说明。
魏荔彤说：病有太阳中风不解，传入阳明的，如何辨别？所以设问说：阳明病不知道其里证何时传来？必须先验证其外证表现什么？回答：太阳病，有身体发热、自然出汗而恶风的，这是太阳中风的本证；如果身体发热、自然出汗，竟然不恶风寒反而恶热，那么病已离开太阳而入阳明了。这种阳明病，是由太阳中风传入的。
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问：病有得之一日，不发热而恶寒的，是什么原因？答：虽然得病一日，恶寒将会自行停止，随即自然出汗而恶热。
【注】
太阳病应当恶寒，阳明病应当恶热。现在阳明病，有初得病一日，不发热而恶寒的，这是太阳去表之邪未尽，所以仍然恶寒。然而去表未尽之邪，想要传入阳明，不能长久维持，所以恶寒必将自行停止，当天就会自然出汗而恶热。
【集注】
方有执说：这是以太阳伤寒传入阳明之外证来说明。
程应旄说：阳明恶寒，终究带有表证，至于腑病则恶热了。表证是否解除，必须在此验证。
郑重光说：这是辨别阳明伤寒的外证，不发热而恶寒，起因于伤寒。恶寒将自行停止，说明邪气已过表。随即自然出汗，是邪热郁于肌肉，腠理开泄，汗液外泄。
魏荔彤说：太阳伤寒也有传入阳明的，又如何辨别？所以设问说：病有得之一日，起初之时，不见发热，而只见到恶寒的，是什么病？回答：得病一日恶寒，虽然表现为太阳伤寒的证候，但恶寒也将自行停止，随即自然出汗而恶热，这是阳明病由太阳伤寒传入的。可知太阳中风，则发热恶风、自然出汗为正病；太阳伤寒，则恶寒无汗为正病。若传入阳明，则必然以汗出、恶热为正病。
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问：恶寒为什么自行停止？答：阳明居中，主土。万物所归，无所复传，开始虽然恶寒，到第二天就停止，这就是阳明病。
【注】
这是解释上一条阳明恶寒自行停止的含义。阳明属胃居中，五行属土。土为万物所归，所以邪热归胃则无所复传，也是万物归土的意思。阳明初病一日，虽然仍恶寒，是太阳表证未解。到第二天恶寒自行停止，则是太阳邪气已全部归并阳明，这就是阳明病。
【集注】
方有执说：恶寒二日自行停止，是热入里而将要恶热，这是指正阳阳明而言。
程应旄说：六经虽分阴阳，但主宰者是胃，五脏六腑都朝宗并禀受其命令。一旦有燥热，无论三阳传来的邪气，随之化热，即三阴传来的邪气，也转属而变热。阴阳之邪，都归胃土，所以说：万物所归，无所复传。
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问：为什么得阳明病？答：太阳病，如果发汗、如果泻下、如果利小便，这会导致津液亡失，胃中干燥，因而转属阳明。不大便，内实，大便困难的，这就叫阳明病。
【注】
问：为什么得阳明胃实之病？答：由邪气在太阳时，发汗，如果泻下，如果利小便，都是为祛邪而设，治疗得当，则邪解而愈。如果不恰当，徒然亡失津液，致使胃中干燥，则未尽的表邪，乘着燥热，因而转属阳明，成为胃实之病的有三种：不大便，即太阳阳明脾约；内实，即正阳阳明胃家实；大便困难，即少阳阳明大便难。这三种虽然都属于可下之证，但也有轻重之别，脾约比大便难轻，大便难比胃家实轻。大概患脾约、大便难的，往往因为其人津液素亏，或因汗下利小便，施治失宜所致。如果是胃实者，则其人阳气素盛，胃有宿食，即使未经汗下，也会入胃成实。所以已经汗下的，是夺血致燥的阳明，以滋润燥热为主；未经汗下的，是热盛致燥的阳明，以攻热为急。这就是三承气汤、脾约丸以及蜜煎、土瓜根、猪胆汁导法之所以区分的原因。
【集注】
方有执说：古人大便必更衣；不更衣，指不大便。
程应旄说：转属层次，不止有表罢、不罢之分，而且表罢入里，还有燥实、燥不实的辨别。所以有不更衣的阳明病，有内实的阳明病，有大便难的阳明病。其中有属表属里，所以下法有禁忌有适宜。受气有里实里燥，所以下法有大用小。
汪琥说：有人问太阳病如果已经泻下，那么胃中之物已去，纵然亡失津液，胃中干燥，未必再成内实。回答说：当其太阳初病时，泻下不当，徒然亡失津液，胃中之物去之不尽，邪气传阳明而成燥粪，所以有内实的证候。
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问：病有太阳阳明，有正阳阳明，有少阳阳明，是什么意思？答：太阳阳明，就是脾约；正阳阳明，就是胃家实；少阳阳明，就是发汗利小便后，胃中燥烦实，大便困难。
【注】
阳明可下之证，不仅仅限于胃家实。其纲有三，所以又设问答来阐明。太阳邪气，乘胃燥热，传入阳明，称为太阳阳明，不大便而无痛苦，名为脾约的；太阳邪气，乘胃宿食与燥热结聚，称为正阳阳明，不大便，内实满痛，名为胃家实的；太阳邪气已到少阳，本应和解，却反用发汗利小便，损伤津液，少阳邪气又乘胃燥，转属阳明，称为少阳阳明，大便涩滞而难出，名为大便难的。
【集注】
程知说：说三阳都有入胃腑的证候。阳明为水谷之海，中土为万物所归，所以三阳经都能入其腑。邪气自太阳传入胃腑的，称为太阳阳明，即经文中所说太阳病，如果吐、如果下、如果发汗后，微烦，小便数，大便因干结的是，由脾的敛约，所以用小承气汤微下以调和。邪气自阳明经传入胃腑的，称为正阳阳明，即经文中所说发热汗出，胃中干燥谵语的是，乃胃中邪实，所以用大承气汤攻下。邪气自少阳转属胃腑的，称为少阳阳明，即经文中所说少阳不可发汗，发汗则谵语，这属于胃的是，系津液内竭，所以用麻子仁丸润下，以调和津液。如果三阳外证未除，则阳明正治之法，又不可用了。
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阳明病，脉浮而紧的，必定有潮热，发作有时，如果脉只浮，必定有盗汗出。
【按】
自汗是阳明证，盗汗是少阳证，盗汗应当是自汗，文义才通顺。
【注】
阳明病在经，脉应当浮长，入腑，脉应当实大。现在脉浮而紧，潮热有时的，是阳明病而见太阳伤寒脉，则知道是从伤寒传来。太阳伤寒邪气未解，必定无汗，所以虽然见到阳明潮热发作有时的证候，仍当从太阳阳明伤寒治疗，宜用麻黄加葛根汤发汗。如果见到潮热发作有时的证候，而脉只浮不紧，是阳明病而见太阳中风脉，则知道是从中风传来。太阳中风邪气未解，必定自汗出，当从太阳阳明中风治疗，宜用桂枝加葛根汤解表。
【集注】
沈明宗说：这是阳明证而见太阳脉。脉浮而紧，是太阳表寒未解之脉，潮热发作有时，则阳明里证已具备，脉但浮，是太阳风伤卫之脉，所以必定汗出。
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阳明病，脉迟，汗出多，轻微恶寒的，表证未解，可发汗，宜用桂枝汤。
【按】
“汗出多”之下，应当有“发热”二字，如果没有这两个字，脉迟，汗出多，微恶寒，乃是表阳虚，桂枝附子汤证，岂有用桂枝汤发汗的道理？必定是传写遗漏。
【注】
阳明病脉应当数大，现在脉迟汗出多，假设不发热恶寒，是太阳表邪已解。现在发热微恶寒，是表邪尚未完全解除，所以宜用桂枝汤解肌发汗，使初入阳明之表邪，仍还表而出。
【集注】
程知说：这是说中风传阳明，表邪未解，仍宜用桂枝汤解肌。
汪琥说：这是太阳病初传阳明经，中有风邪。脉迟，是太阳中风缓脉之所变，传至阳明，邪将入里，所以脉变迟。汗出多，是阳明热而肌腠疏泄。微恶寒，是在表风邪未尽。所以仍从太阳中风例治疗。又说：虽从太阳例治疗，但既云阳明病，仲景法还宜用桂枝加葛根汤为宜。
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阳明病，脉浮，无汗而喘的，发汗则愈，宜用麻黄汤。
【注】
阳明病，脉应浮大，证应汗出。现在脉但浮，是表病脉；无汗而喘，是表实证。这是太阳邪气，未全部入阳明，仍在表。应当仍从太阳伤寒治疗，发汗则愈，宜用麻黄汤。
【集注】
张璐说：阳明荣卫难辨，辨别全靠脉证。风邪之脉，传至阳明，自汗已多，则缓去而迟在；寒邪之脉，传至阳明，发热已甚，则紧去而浮在，这都是邪气在经的征象。若入腑，则迟者必数，浮者必实。假设不数不实，不是胃实，必定不胜攻下。
汪琥说：无汗而喘，但浮不紧，何以定为阳明病？必定其人目痛鼻干，身热不得眠，所以云阳明病。
魏荔彤说：这是太阳阳明之证，入阳明未深，所以令其邪仍自表出，不至归于胃而无所复传。
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阳脉微而汗出少的，为自和；汗出多的，为太过；阳脉实，因发其汗，出多的，也为太过。太过的，为阳绝于里，亡津液，大便因干结。
【注】
这是承接上一条互详其脉，以出其证。脉阳微，指脉浮无力而微；阳脉实，指脉浮有力而盛。凡中风伤寒脉，阳微则热微，微热蒸表作汗；如果汗出少的，为自和欲解，汗出多的，为太过不解。阳脉实则热盛，因热盛而发其汗，出多的，也为太过；汗出太过，则阳极于里，亡津液，大便因干结而成内实之证。势不得不用下法。所以欲发其汗者，不可不早虑及此。
The Yangming channel governs the interior, internally reflecting on the Stomach Fu organ, and externally reflecting on the muscles. Therefore, there is a distinction between disease in the channel (Jing) and disease in the Fu organ. As stated in the Treatise: if there is body heat, vexation, thirst, eye pain, nasal dryness, inability to sleep, aversion to cold is absent but aversion to heat is present, this is Yangming channel disease; if there is gradually increasing fever, delirium, continuous sweating in the hands, feet, and axillae, abdominal fullness and pain, and unrelieved defecation, this is Yangming Fu disease. Their manifestations each have three types: For channel disease, there is the case where pathogenic factors have transmitted to Yangming but the Taiyang exterior syndrome has not yet resolved, accompanied by Taiyang symptoms such as headache, aversion to cold, and anhidrosis; there is the case where Taiyang pathogenic factors have resolved and completely transmitted to Yangming, presenting only with Yangming symptoms such as high fever, sweating, mental restlessness, insomnia, and thirst with desire to drink; there is the case where Yangming pathogenic factors are unresolved and re-transmit to Shaoyang, accompanied by Shaoyang symptoms such as chest pain, alternating chills and fever, bitter taste in the mouth, vomiting, dizziness, and deafness. For Fu disease, there is Taiyang-Yangming, referring to when a Taiyang disease, after diaphoresis, emesis, purgation, or promoting urination, results in loss of body fluids, dryness in the Stomach, and Taiyang pathogenic factors taking advantage of the gastric dryness to transmit to Yangming, causing frequent urination and difficult defecation; this is called "Splee Constriction" (Pi Yue). There is Zheng-Yang-Yangming (True Yangming), referring to when a patient's Yang qi is inherently abundant, or there is retained food, and Taiyang pathogenic factors, upon transmitting to Yangming, immediately enter the Stomach Fu, causing constipation; this is called "Stomach House Excess" (Wei Jia Shi). There is Shaoyang-Yangming, referring to when the disease has reached Shaoyang, where harmonization should be used, but diaphoresis and promoting urination were mistakenly applied, damaging body fluids, leading to dry-heat in the Stomach, and re-transmitting to Yangming, causing hard and dry stools; this is called "Difficulty in Defecation" (Da Bian Nan). To treat Yangming channel disease, one may use Ge Gen Tang (Kudzu Decoction) or Gui Zhi Jia Ge Gen Tang (Cinnamon Twig Decoction plus Kudzu Root) to induce sweating, or Bai Hu Tang (White Tiger Decoction) to clear heat, or Chai Hu Bai Hu Tang (Bupleurum White Tiger Decoction) to harmonize, according to the specific syndrome. To treat Yangming Fu disease, although all are suitable for purgation, there are degrees of severity. Thus, one may use the Three Cheng Qi Decoctions (San Cheng Qi Tang) to purge, Ma Ren Wan (Hemp Seed Pill) to moisten and unblock, or honey suppositories/pig bile enemas to guide out stagnation, treating according to the condition. This is the general overview of Yangming disease. Now, the cases in the channel and in the Fu are detailed in this chapter to facilitate differentiation for readers, ensuring that clinical treatment proceeds without confusion.
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Yangming disease is essentially Wei Jia Shi (Excess in the Stomach House).
[Annotation]
The Yangming channel internally reflects on the Stomach Fu and externally reflects on the skin and muscles. When Taiyang pathogenic factors transmit to the channel, it manifests as external signs of Yangming disease; when they transmit to the Stomach Fu, it manifests as Wei Jia Shi.
[Collected Notes]
Fang Youzhi states: Yangming includes both the channel and the Fu. "Shi" (Excess) refers to dry stool forming obstruction and fullness, unable to pass. Although onset times vary, one cannot rigidly adhere to the number of days.
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In Sanitation Disease (Shang Han), on the third day, the pulse becomes large.
[Annotation]
"The first day Taiyang, second day Yangming, third day Shaoyang" describes the sequence of transmission in the *Nei Jing*, not a rigid rule based on days. Saying "third day Yangming pulse large" means the pulse is neither the floating-large pulse of Taiyang-Yangming nor the string-large pulse of Shaoyang-Yangming, but specifically the large pulse of Zheng-Yang-Yangming. This occurs because pathogenic heat enters the interior and the Stomach, forming an internal excess diagnosis, hence the pulse appears thus.
[Collected Notes]
Fang Youzhi states: "Third day" broadly covers wind-strike as well. A large pulse indicates abundant Qi and Blood in Yangming.
Shen Mingzong states: This is the true pulse of Yangming. Zhang Zhongjing said "third day Yangming pulse large" because Yangming is a Fu organ of abundant Qi and Blood. When wind-cold transmits, pathogenic factors become excessive in the middle, making the pulse appear large; this is the true pulse of Yangming pathogenic excess. However, one must confirm this pulse before considering purgation. If accompanied by Taiyang floating-tight or Shaoyang string-thin pulses, or slow-rapid-slippery-rough-deficient-weak pulses, it indicates deficiency of Qi, Blood, Yin, or Yang. Even with signs of great excess and fullness, one must examine carefully, perhaps testing with Xiao Cheng Qi Tang (Minor Order the Qi Decoction) or using honey suppositories, and must not directly apply aggressive purgation.
Originally a Taiyang disease at onset, diaphoresis was attempted, but sweat did not come out thoroughly, leading to transmission to Yangming.
[Annotation]
Yangming disease often originates from Taiyang onset. If diaphoresis is performed but sweat does not emerge thoroughly, the method is incorrect, leaving residual pathogenic factors that transmit to Yangming. Pathogens in the channel manifest as external signs; pathogens entering the Fu manifest as Wei Jia Shi.
[Collected Notes]
Fang Youzhi states: This explains the main idea that improper diaphoresis in Taiyang leads to pathogen entering the Stomach.
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In Yangming disease, if the patient can eat, it is named Wind-Strike (Zhong Feng); if unable to eat, it is named Cold-Strike (Zhong Han).
[Annotation]
When Taiyang pathogens transmit to Yangming, they may come from Wind-Strike or Cold-Strike. One distinguishes them by appetite. If the patient can eat, it is named Wind-Strike, indicating transmission from Wind-Strike. Wind is a Yang pathogen, and Yang can transform grain, so the patient can eat. If unable to eat, it is named Cold-Strike, indicating transmission from Cold-Strike. Cold is a Yin pathogen and cannot transform grain, so the patient cannot eat.
[Collected Notes]
Fang Youzhi states: This uses appetite to distinguish Wind from Cold. Yangming governs water and grain; Wind allows eating, Yang transforms grain; Cold prevents eating, Yin fails to kill grain. "Ming" here means "is". "Zhong Han" is synonymous with Shang Han. The gist is to trace Wind-Cold transmitted from Taiyang, distinguishing them as such, not implying Yangming itself is directly struck by Cold.
Wang Hu states: Zhang Zhongjing says "Zhong Han" has the same meaning as "Shang Han", not a true Cold syndrome. If it were true Cold, it would be Stomach House deficiency-cold, treated with Li Zhong Tang (Regulate the Middle Decoction). Now, inability to eat indicates Stomach Qi excess, with pathogen not yet in the Fu and no stagnant heat formed. Thus named Zhong Han, it is actually no different from Shang Han.
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Question: What are the external signs of Yangming disease? Answer: Body heat, spontaneous sweating, absence of aversion to cold, and presence of aversion to heat.
[Annotation]
Yangming disease has external and internal signs. Tidal fever, spontaneous sweating, and constipation are internal signs; body heat, spontaneous sweating, absence of aversion to cold, and aversion to heat are external signs. Spontaneous sweating here indicates transmission from Wind-Strike, sharing external signs with Wind-Strike. However, body heat, no aversion to cold but aversion to heat identifies it as Yangming external signs, distinct from Wind-Strike. Yangming heat arises in the muscles, manifesting as steaming heat, unlike the intermittent fever of Taiyang.
[Collected Notes]
Fang Youzhi states: This explains external signs of Yangming disease transmitted from Taiyang Wind-Strike.
Wei Litong states: How to distinguish Taiyang Wind-Strike unresolved transmitting to Yangming? Question: How do we know when the interior syndrome arrives? We must verify the external manifestations. Answer: Taiyang Wind-Strike presents with body heat, spontaneous sweating, and aversion to wind. If body heat and spontaneous sweating occur without aversion to wind-cold but with aversion to heat, the disease has left Taiyang and entered Yangming. This is Yangming disease transmitted from Taiyang Wind-Strike.
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Question: In some cases, on the first day of illness, there is no fever but aversion to cold. Why? Answer: Although on the first day, aversion to cold will cease spontaneously, followed by spontaneous sweating and aversion to heat.
[Annotation]
Taiyang disease involves aversion to cold; Yangming disease involves aversion to heat. In Yangming disease, if on the first day there is no fever but aversion to cold, it is because residual pathogenic factors from the Taiyang exterior have not fully resolved. However, these residual factors cannot persist long as they seek to transmit to Yangming; thus, aversion to cold will cease, and spontaneous sweating with aversion to heat will appear.
[Collected Notes]
Fang Youzhi states: This explains external signs of Yangming disease transmitted from Taiyang Cold-Strike.
Cheng Yingmao states: Yangming aversion to cold still carries exterior characteristics; Fu disease involves aversion to heat. Whether the exterior resolves must be verified here.
Zheng Zhongguang states: This distinguishes external signs of Yangming Cold-Strike. No fever but aversion to cold originates from Cold-Strike. Cessation of aversion to cold indicates pathogen passing the exterior. Spontaneous sweating indicates pathogenic heat stagnating in muscles, opening pores, and leaking sweat.
Wei Litong states: Taiyang Cold-Strike can also transmit to Yangming. Question: On the first day, initially seeing no fever but only aversion to cold, what disease is this? Answer: First-day aversion to cold, though resembling Taiyang Cold-Strike, will cease spontaneously, followed by spontaneous sweating and aversion to heat. This is Yangming disease transmitted from Taiyang Cold-Strike. Taiyang Wind-Strike's true disease is fever, aversion to wind, and spontaneous sweating; Taiyang Cold-Strike's true disease is aversion to cold and anhidrosis. Upon transmitting to Yangming, the true disease becomes sweating and aversion to heat.
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Question: Why does aversion to cold cease spontaneously? Answer: Yangming resides in the center and governs Earth. It is the destination of all things, with nowhere further to transmit. Initially there may be aversion to cold, but it stops by the second day; this is Yangming disease.
[Annotation]
This explains the cessation of aversion to cold in the previous clause. Yangming belongs to the Stomach, resides in the center, and corresponds to Earth. Earth is the destination of all things; thus, pathogenic heat returning to the Stomach has nowhere further to transmit, mirroring the concept of all things returning to Earth. On the first day of Yangming onset, aversion to cold persists because the Taiyang exterior is unresolved. By the second day, aversion to cold ceases, indicating Taiyang pathogens have fully merged into Yangming, constituting Yangming disease.
[Collected Notes]
Fang Youzhi states: Cessation of aversion to cold by the second day indicates heat entering the interior and impending aversion to heat, referring to Zheng-Yang-Yangming.
Cheng Yingmao states: Although the Six Channels are divided into Yin and Yang, the Stomach governs them. All Zang-Fu organs submit to its command. Once dry-heat exists, regardless of whether pathogens come from the Three Yang or Three Yin channels, they transform into heat. Yin and Yang pathogens all return to Stomach Earth, hence "destination of all things, nowhere further to transmit."
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Question: How does one acquire Yangming disease? Answer: In Taiyang disease, if diaphoresis, purgation, or promoting urination causes loss of body fluids and dryness in the Stomach, pathogenic factors transmit to Yangming. Constipation, internal excess, and difficulty in defecation constitute Yangming disease.
[Annotation]
Question: Why does Yangming Stomach Excess occur? Answer: When pathogens are in Taiyang, diaphoresis, purgation, or promoting urination are intended to expel pathogens. If treatment is appropriate, pathogens resolve and health returns. If inappropriate, body fluids are lost, causing Stomach dryness. Residual exterior pathogens take advantage of the dry-heat to transmit to Yangming, forming Stomach Excess in three ways: Constipation ("Bu Geng Yi") is Taiyang-Yangming Pi Yue; Internal Excess ("Nei Shi") is Zheng-Yang-Yangming Wei Jia Shi; Difficulty in Defecation ("Da Bian Nan") is Shaoyang-Yangming Da Bian Nan. Though all are purgable, severity varies: Pi Yue is milder than Da Bian Nan, which is milder than Wei Jia Shi. Pi Yue and Da Bian Nan often result from inherent fluid deficiency or improper treatment (sweating/purgation/diuresis). Wei Jia Shi results from inherent Yang abundance and retained food, becoming excess even without prior treatment. Previously treated cases involve blood/fluid loss causing dryness, requiring moistening. Untreated cases involve heat excess causing dryness, requiring clearing heat. This explains the differentiation among the Three Cheng Qi Decoctions, Pi Yue Wan, and honey/solanum/pepig bile guides.
[Collected Notes]
Fang Youzhi states: Ancients changed clothes for bowel movements; "Bu Geng Yi" means no bowel movement.
Cheng Yingmao states: Transmission levels include not just resolved/unresolved exterior, but also dry-excess vs. dry-non-excess upon entering the interior. Hence, there are Yangming diseases of Bu Geng Yi, Nei Shi, and Da Bian Nan. Exterior/Interior status dictates purgation contraindications/appropriateness. Interior excess/dryness dictates major/minor purgation.
Wang Hu states: If Taiyang disease is purged, stomach contents are gone; why would dryness cause internal excess? Answer: Improper purgation in early Taiyang loses fluids but leaves incomplete removal of stomach contents. Pathogens transmit to Yangming, forming dry feces, resulting in internal excess.
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Question: What are Taiyang-Yangming, Zheng-Yang-Yangming, and Shaoyang-Yangming? Answer: Taiyang-Yangming is Pi Yue; Zheng-Yang-Yangming is Wei Jia Shi; Shaoyang-Yangming is dryness, vexation, and excess in the Stomach after diaphoresis and diuresis, leading to difficulty in defecation.
[Annotation]
Purgable conditions in Yangming extend beyond Wei Jia Shi. There are three main categories, clarified here. Taiyang pathogens exploiting Stomach dry-heat transmit to Yangming as Taiyang-Yangming (Bu Geng Yi, no discomfort, named Pi Yue). Taiyang pathogens combining with retained food and dry-heat form Zheng-Yang-Yangming (Constipation, internal excess, fullness-pain, named Wei Jia Shi). Shaoyang pathogens, after mistaken diaphoresis/diuresis damages fluids, exploit Stomach dryness to transmit to Yangming as Shaoyang-Yangming (Hard, difficult defecation, named Da Bian Nan).
[Collected Notes]
Cheng Zhi states: All Three Yang channels can enter the Stomach Fu. Yangming is the Sea of Water and Grain, Earth receives all things. Pathogens from Taiyang entering Stomach Fu are Taiyang-Yangming (Taiyang disease after emesis/purgation/sweating, slight vexation, frequent urination, dry stool); Spleen constriction requires Minor Cheng Qi Tang to gently harmonize. Pathogens from Yangming Channel entering Stomach Fu are Zheng-Yang-Yangming (Fever, sweating, Stomach dryness, delirium); Stomach excess requires Major Cheng Qi Tang to purge. Pathogens from Shaoyang transferring to Stomach Fu are Shaoyang-Yangming (Shaoyang contraindicates sweating; sweating causes delirium, belonging to Stomach); Fluid exhaustion requires Hemp Seed Pill to moisten and harmonize. If exterior signs of Three Yang persist, standard Yangming treatments are contraindicated.
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In Yangming disease, if the pulse is floating and tight, tidal fever occurring at fixed times is certain; if the pulse is only floating, night sweating is certain.
[Commentary]
Spontaneous sweating is a Yangming sign; night sweating is a Shaoyang sign. "Night sweating" should likely be "spontaneous sweating" for textual coherence.
[Annotation]
Yangming channel disease pulse should be floating-long; Fu disease pulse should be solid-large. Floating-tight pulse with timed tidal fever indicates Yangming disease with Taiyang Cold-Strike pulse, suggesting transmission from Cold-Strike. Unresolved Taiyang Cold-Strike implies anhidrosis; thus, despite Yangming tidal fever, treat as Taiyang-Yangming Cold-Strike with Ma Huang Jia Ge Gen Tang (Ephedra Decoction plus Kudzu Root) to sweat. If tidal fever occurs with only floating (not tight) pulse, it indicates Yangming disease with Taiyang Wind-Strike pulse, suggesting transmission from Wind-Strike. Unresolved Taiyang Wind-Strike implies spontaneous sweating; treat as Taiyang-Yangming Wind-Strike with Gui Zhi Jia Ge Gen Tang (Cinnamon Twig Decoction plus Kudzu Root) to resolve.
[Collected Notes]
Shen Mingzong states: This is Yangming syndrome with Taiyang pulse. Floating-tight indicates unresolved Taiyang exterior cold; timed tidal fever indicates established Yangming interior syndrome. Only floating indicates Taiyang wind injuring Wei, hence sweating.
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In Yangming disease, if the pulse is slow, sweating is profuse, and there is slight aversion to cold, the exterior is unresolved. Diaphoresis is indicated; Gui Zhi Tang (Cinnamon Twig Decoction) is appropriate.
[Commentary]
"Fever" should follow "profuse sweating". Without it, slow pulse, profuse sweating, and slight aversion to cold indicate exterior Yang deficiency, a Gui Zhi Fu Zi Tang (Cinnamon Twig and Aconite Decoction) pattern. Using Gui Zhi Tang to sweat would be illogical; likely a transcription error.
[Annotation]
Yangming pulse should be rapid-large. Slow pulse with profuse sweating, assuming no fever/aversion to cold, would mean resolved Taiyang exterior. Here, fever and slight aversion to cold indicate unresolved exterior. Thus, Gui Zhi Tang should be used to release the muscle layer and induce sweating, driving the pathogen newly entering Yangming back to the exterior.
[Collected Notes]
Cheng Zhi states: Wind-strike transmitting to Yangming with unresolved exterior still requires Gui Zhi Tang to release the muscle layer.
Wang Hu states: Early transmission of Taiyang to Yangming Channel with wind pathogen. Slow pulse is a variation of Taiyang Wind-Strike slow pulse; as pathogen approaches interior, pulse slows. Profuse sweating indicates Yangming heat and loose pores. Slight aversion to cold indicates residual exterior wind. Treat per Taiyang Wind-Strike example. However, since it is Yangming disease, Zhang Zhongjing's method suggests Gui Zhi Jia Ge Gen Tang is more appropriate.
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In Yangming disease, if the pulse is floating, there is no sweating, and wheezing, diaphoresis leads to recovery; Ma Huang Tang (Ephedra Decoction) is appropriate.
[Annotation]
Yangming disease pulse should be floating-large, symptoms should include sweating. Floating pulse alone indicates exterior disease; anhidrosis and wheezing indicate exterior excess. Taiyang pathogens have not fully entered Yangming but remain in the exterior. Treat as Taiyang Cold-Strike; diaphoresis cures; Ma Huang Tang is appropriate.
[Collected Notes]
Zhang Lu states: Distinguishing Ying and Wei in Yangming relies entirely on pulse and symptoms. Wind pathogen pulse in Yangming: after profuse sweating, slowness replaces speed. Cold pathogen pulse in Yangming: after high fever, floating replaces tightness. These indicate pathogen in the channel. If entering Fu, slow becomes rapid, floating becomes solid. If not rapid/solid, it is not Stomach excess, and cannot withstand purgation.
Wang Hu states: Anhidrosis and wheezing with floating (not tight) pulse: how to define as Yangming? Because the patient has eye pain, nasal dryness, body heat, and insomnia, hence Yangming disease.
Wei Litong states: This is a Taiyang-Yangming syndrome, not deeply entered Yangming, allowing pathogen to exit via exterior, preventing return to Stomach.
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If the Yang pulse is faint and sweating is scant, it indicates self-harmonization; if sweating is profuse, it indicates excess. If the Yang pulse is solid, and diaphoresis causes profuse sweating, it also indicates excess. Excess leads to Yang isolation in the interior, loss of body fluids, and dry stool.
[Annotation]
This elaborates on the pulse and symptoms from the previous clause. Faint Yang pulse means floating and weak; Solid Yang pulse means floating and strong. In Wind/Cold strike, faint Yang pulse means mild heat, steaming exterior to produce sweat. Scant sweating indicates self-harmonization/resolution. Profuse sweating indicates failure to resolve due to excess. Solid Yang pulse means intense heat; inducing sweat due to heat causing profuse sweating is also excess. Excessive sweating leads to Yang extreme in the interior, fluid loss, and dry stool forming internal excess. Purgation becomes necessary. Thus, when inducing sweat, one must anticipate this risk.