【集注】
喻昌曰：阳微者，中风之脉，阳微缓也；阳实者，伤寒之脉，阳紧实也；阳绝，即亡
津液之互辞。仲景每于亡津液者，悉名无阳。玩本文阳绝于里，亡津液，大便因□甚
明。伤寒发太阳膀胱经之汗，即当顾虑阳气，以膀胱主气化故也。发阳明胃经之汗，
即当顾虑阴津，以胃中藏津液故也。所以阳明多有热越之证，谓胃中津液，随热而尽
越于外，汗出不止耳。然则阳明病，不论中风，伤寒，脉微，脉实，汗出少而邪将自
解，汗出多则阴津易致竭绝也。
@@@
阳明病法多汗，反无汗，其身如虫行皮中状者，此以久虚故也。
【注】
阳明病法当汗多，反无汗，其身如虫行皮中状者，以其人胃气久虚，邪郁于太阳之表
，阳明肌腠不能宣发作汗故也。宜葛根汤小剂微汗，和其肌表，自可愈也。
【集注】
汗琥曰：按此条论仲景无法治。常器之云：可用桂枝加黄耆汤。郭雍云：宜用桂枝麻
黄各半汤。不知上二汤，皆太阳经药，今系阳明无汗证，仍宜用葛根汤主之。
魏荔彤曰：阳明病法应多汗，今反无汗，但见身如虫行皮中状者，此邪热欲出表作汗
，而正气衰弱不能达之也。
@@@
阳明病，初欲食，小便反不利，大便自调，其人骨节疼，翕翕如有热状，奄然发狂，
濈然汗出而解者，此水不胜谷气，与汗共并，脉紧则愈。
【注】
阳明病，初欲食，知其从中风热邪传来也。阳明受邪，当小便数，大便□，今小便反
不利，大便自调，知津未伤而胃自和，不成里实也。既不成实，则在经之邪本轻，可
自愈也。若其人骨节疼，翕翕如有热状，是太阳之表未除也。奄，忽也。忽然发狂，
濈然汗出而解者，盖以太阳传来之邪本轻，阳明所受之邪自浅，津未伤而胃自和，仍
当还表作解也。然必待发狂而解者，此胃中水气不胜，初欲食之谷气，谷气长阳化热
，水不胜热，酿汗共并而出，所以发狂作解也。凡将汗解，脉必先浮，今言脉紧则愈
者，亦邪还于表，欲解应见之脉也。
@@@
伤寒，发热无汗，呕不能食，而反汗出濈濈然者，是转属阳明也。
【注】
伤寒，发热无汗，呕不能食，为太阳之邪欲传也。若无汗，为太阳阳明之表尚在，汗
之可也。今反汗出濈濈然者，是邪已转属阳明之府，可下不可汗也。
【集注】
成无己曰：伤寒发热无汗，呕不能食者，太阳受病也。若反汗出濈濈然者，是太阳之
邪转属阳明也。故经曰：阳明病法多汗。
方有执曰：呕不能食，热入胃也。反汗出者，肌肉着热，肤腠反开也。
程应旄曰：太阳本证现在，而反汗出濈濈然者，虽表证未罢，已是转属阳明也。濈濈
，连绵之意，即俗云：汗一身不了又一身，是也。
@@@
伤寒脉浮，发热无汗，其表不解，不可与白虎汤；渴欲饮水，无表证者，白虎加人参
汤主之。
【注】
伤寒之邪，传入阳明，脉浮，发热无汗，其表不解者，虽有燥渴，乃大青龙汤证，不
可与白虎汤。即有阳明渴欲饮水热证，应与白虎者，亦必审其无太阳表证，始可与也
。加人参者，以其脉浮不滑，非有余也，且欲于大解热中，速生其津液也。
【集注】
郑重光曰：此申明用白虎汤之法。以白虎但能解热而不解表，若稍带外感，有无汗、
恶寒、身痛、头疼之表证，慎不可用也。
【集注】
喻昌说：脉象寸部微弱，是中风病的脉象，表现为寸部微缓；脉象寸部充实有力，是伤寒病的脉象，表现为寸部紧实；“阳绝”，就是津液亡失的同义互称。张仲景每当遇到津液亡失的情况，都称之为“无阳”。细读本文“阳绝于里，亡津液，大便因……”可知其理甚明。治疗太阳膀胱经的伤寒发汗时，就应当顾护阳气，因为膀胱主管气化功能；治疗阳明胃经的伤寒发汗时，就应当顾护阴津，因为胃中贮藏津液。所以阳明病多有热邪外越的证候，意思是胃中的津液随着热势完全向外蒸腾，导致汗出不止。既然这样，那么阳明病，无论是中风还是伤寒，如果脉象微或实，出汗少则邪气将自行解除，出汗多则阴津容易枯竭断绝。
@@@
阳明病通常应当多汗，反而无汗，身体感觉像有虫子在皮肤中爬行一样，这是因为久病体虚的缘故。
【注】
阳明病按理应当多汗，反而无汗，身体感觉像有虫子在皮肤中爬行一样，是因为此人胃气长期虚弱，邪气郁结在太阳之表，阳明肌腠不能宣通发作汗液所致。适宜用小剂量的葛根汤（Gegen Tang, Pueraria Decoction）微微发汗，调和肌表，自然可以痊愈。
【集注】
汗琥说：按此条论述，张仲景没有给出治法。常器之说：可以用桂枝加黄耆汤（Guizhi Jia Huangqi Tang, Cinnamon Twig Decoction with Astragalus）。郭雍说：适宜用桂枝麻黄各半汤（Guizhi Mahuang Ban Tang, Half-and-Half Decoction of Cinnamon Twig and Ephedra）。不知道上述两种汤剂，都是治疗太阳经的药物，现在是阳明病无汗的证候，仍然适宜用葛根汤主治。
魏荔彤说：阳明病按理应当多汗，现在反而无汗，只见到身体像有虫子在皮肤中爬行的症状，这是邪热想要外出体表作汗，而正气衰弱不能推动它所致。
@@@
阳明病，起初想进食，小便反而不通利，大便正常，这个人骨节疼痛，轻微发热像是有热状，忽然发狂，接着连续出汗而病解的，这是因为水湿之气不胜谷气，与汗液共同并出，脉象紧则病愈。
【注】
阳明病，起初想进食，知道是从中风热邪传来。阳明受邪，应当小便频数，大便……，现在小便反而不通利，大便正常，知道津液未受伤且胃气自和，不成里实证。既然不成里实证，那么在经之邪本来轻浅，可自行痊愈。如果这个人骨节疼痛，轻微发热像是有热状，这是太阳之表证未除。奄，即忽然。忽然发狂，接着连续出汗而病解的，大概是因为从太阳传来的邪气本轻，阳明所受的邪气自浅，津液未伤且胃气自和，仍然应当还归于表而解除。但是必须等到发狂才解除的，这是因为胃中水气不胜，起初想吃的谷气，谷气属长阳化热，水不胜热，酿成汗液共同并出，所以发狂而病解。凡是将要通过发汗解除病邪，脉象必先浮，现在说脉紧则愈的，也是邪气还归于表，欲解除时应见的脉象。
@@@
伤寒，发热无汗，呕吐不能进食，反而连续出汗的，这是转属阳明病。
【注】
伤寒，发热无汗，呕吐不能进食，是太阳之邪欲传变。如果无汗，说明太阳阳明的表证尚在，可以发汗。现在反而连续出汗的，是邪气已转属阳明腑证，可下不可汗。
【集注】
成无己说：伤寒发热无汗，呕吐不能进食，是太阳受病。如果反而连续出汗的，是太阳之邪转属阳明。所以经文说：阳明病通常多汗。
方有执说：呕吐不能进食，是热入胃中。反而出汗的，是肌肉着热，肤腠反而开泄。
程应旄说：太阳本证现在，而反而连续出汗的，虽然表证未罢，已是转属阳明了。濈濈，连绵不断的意思，即俗话所说：汗一身不了又一身，就是这样。
@@@
伤寒脉浮，发热无汗，其表证不解，不可给予白虎汤；口渴想喝水，没有表证的，白虎加人参汤主治。
【注】
伤寒之邪，传入阳明，脉浮，发热无汗，其表证不解的，虽然有燥渴，乃是大青龙汤证，不可给予白虎汤。即使有阳明口渴想喝水的热证，应与白虎汤者，也必须审察其没有太阳表证，才可以给予。加入人参的，是因为其脉浮而不滑，不是有余之邪，且希望在大幅清热中，迅速滋生津液。
【集注】
郑重光说：这是申述使用白虎汤的方法。因为白虎汤只能解热而不能解表，如果稍带外感，有无汗、恶寒、身痛、头疼等表证，千万不可使用。
[Collected Annotations]
Yu Chang stated: A weak pulse at the cun position indicates the pulse pattern of wind-stroke, characterized by a mild and moderate quality at the cun position; a full and solid pulse at the cun position indicates the pulse pattern of cold damage, characterized by a tight and solid quality at the cun position. "Yang exhaustion" is a synonymous term for the loss of body fluids. Zhang Zhongjing often referred to cases of fluid loss as "absence of Yang." Careful reading of the text "Yang exhausted internally, fluids lost, stool becomes..." reveals this principle clearly. When inducing sweat to treat Taiyang (Bladder Meridian) cold damage, one must protect Yang Qi, because the Bladder governs Qi transformation. When inducing sweat to treat Yangming (Stomach Meridian) cold damage, one must protect Yin fluids, because the Stomach stores fluids. Therefore, Yangming diseases often present with heat venting outward, meaning that fluids in the Stomach are completely vaporized and vented outward due to heat, resulting in continuous sweating. Thus, in Yangming disease, whether wind-stroke or cold damage, if the pulse is mild or solid, slight sweating will allow pathogenic factors to resolve spontaneously; excessive sweating will easily lead to the depletion of Yin fluids.
@@@
Yangming disease typically presents with profuse sweating; conversely, if there is no sweating, and the body feels as if insects are crawling under the skin, this is due to long-standing deficiency.
[Annotation]
Yangming disease should theoretically present with profuse sweating; conversely, if there is no sweating, and the body feels as if insects are crawling under the skin, it is because the person's Stomach Qi has been deficient for a long time, causing pathogenic factors to stagnate at the exterior of Taiyang, preventing the Yangming muscle and interstices from dispersing and producing sweat. It is appropriate to use a small dose of Gegen Tang (Pueraria Decoction) to induce slight sweating, harmonize the muscle layer, and achieve recovery naturally.
[Collected Annotations]
Han Hu stated: Regarding this clause, Zhang Zhongjing did not provide a treatment method. Chang Qizhi said: Guizhi Jia Huangqi Tang (Cinnamon Twig Decoction with Astragalus) can be used. Guo Yong said: Guizhi Mahuang Ban Tang (Half-and-Half Decoction of Cinnamon Twig and Ephedra) is suitable. However, these two decoctions are medicines for the Taiyang meridian. Since this is a case of Yangming disease without sweating, Gegen Tang should still be used as the primary treatment.
Wei Litong stated: Yangming disease should theoretically present with profuse sweating; now there is no sweating, only the symptom of feeling like insects crawling under the skin. This indicates that pathogenic heat desires to exit the exterior through sweating, but righteous Qi is too weak to drive it out.
@@@
In Yangming disease, if initially there is an appetite, urination is conversely obstructed, stools are normal, the person experiences joint pain, slight fever resembling heat, sudden onset of mania, followed by continuous sweating leading to resolution, this is because water-dampness cannot overcome grain Qi. The grain Qi combines with sweat and exits together; if the pulse is tight, the disease will heal.
[Annotation]
In Yangming disease, initial appetite indicates transmission from wind-stroke heat pathogens. When Yangming is affected, frequent urination and loose stools are expected; now urination is conversely obstructed and stools are normal, indicating that fluids are not injured and Stomach Qi is harmonious, failing to form interior excess syndrome. Since interior excess does not form, the pathogen in the meridians is light and can resolve spontaneously. If the person has joint pain and slight fever resembling heat, this means the Taiyang exterior syndrome remains unresolved. "Yan" means suddenly. Sudden mania followed by continuous sweating and resolution occurs because the pathogen transmitted from Taiyang is light, the pathogen received by Yangming is shallow, fluids are not injured, and Stomach Qi is harmonious, so the pathogen should return to the exterior to resolve. However, resolution occurring only after mania happens because water-Qi in the Stomach is insufficient to counteract the Grain Qi desired initially. Grain Qi generates heat through Yang transformation; water cannot overcome heat, brewing sweat to exit together, thus causing mania and resolution. Whenever resolution via sweating is anticipated, the pulse must first become floating. Now stating that a tight pulse indicates healing refers to the pathogen returning to the exterior, which is the pulse pattern seen when resolution is imminent.
@@@
In cold damage, if there is fever, no sweating, vomiting, inability to eat, but conversely continuous sweating, this indicates transmission to Yangming.
[Annotation]
In cold damage, fever, no sweating, vomiting, and inability to eat indicate that Taiyang pathogenic factors are attempting to transmit. If there is no sweating, it means the exterior of Taiyang-Yangming is still present, and sweating therapy is applicable. Now, conversely, there is continuous sweating, indicating that pathogenic factors have transmitted to the Yangming Fu organs; purgation is applicable, not sweating therapy.
[Collected Annotations]
Cheng Wuji stated: Fever, no sweating, vomiting, and inability to eat in cold damage indicate Taiyang disease. If conversely there is continuous sweating, it means Taiyang pathogenic factors have transmitted to Yangming. Hence, the classic states: Yangming disease typically presents with profuse sweating.
Fang Youzhi stated: Vomiting and inability to eat indicate heat entering the Stomach. Conversely, sweating indicates that heat adheres to the muscles, causing the skin pores to open.
Cheng Yingmao stated: Although the primary symptoms of Taiyang are present, conversely having continuous sweating means that although the exterior syndrome has not ceased, it has already transmitted to Yangming. "Jiji" means continuous and unbroken, as commonly said: sweat on one part of the body is not finished before another part sweats.
@@@
In cold damage, if the pulse is floating, there is fever and no sweating, and the exterior syndrome is not resolved, Baihu Tang (White Tiger Decoction) should not be given. If there is thirst desire to drink water and no exterior syndrome, Baizhu Jia Renshen Tang (White Tiger Decoction with Ginseng) is the primary treatment.
[Annotation]
When cold damage pathogens transmit to Yangming, presenting with floating pulse, fever, and no sweating, if the exterior syndrome is not resolved, even if there is dryness and thirst, it is a Da Qinglong Tang (Major Green Dragon Decoction) syndrome, and Baihu Tang should not be given. Even if there are Yangming heat symptoms such as thirst desire to drink water requiring Baihu Tang, one must verify the absence of Taiyang exterior syndrome before administering it. Ginseng is added because the pulse is floating rather than slippery, indicating not an excess condition, and to rapidly generate fluids amidst significant heat clearance.
[Collected Annotations]
Zheng Zhongguang stated: This clarifies the method of using Baihu Tang. Baihu Tang can clear heat but does not release the exterior. If there is any external contraction with exterior symptoms such as no sweating, aversion to cold, body pain, and headache, it must strictly not be used.