33. 阴盛格阳色浅赤, 发热不渴厥而烦, 下痢尿清爪青白, 浮微通脉
复阳还.
【注】经曰: 阴气太盛, 阳气不得相营也. 不相营者, 不相入也. 既
不相入, 则格阳于外, 故曰阴盛格阳也. 色浅赤, 谓面色见浮浅之红
赤色也. 其外证面赤发热而烦, 颇类阳热, 其内则不渴, 下痢清谷,
小便清白, 爪甲青白, 四肢厥冷, 脉浮微欲绝, 一派阴寒虚证. 宜通
脉四逆汤冷服之, 从其阴而复其阳也. 痢止脉不出, 加倍人参. 下痢
无脉, 宜白通加猪胆汁人尿汤. 厥烦欲死, 宜吴茱萸汤.
34. 阳毒热极失汗下, 舌卷焦黑鼻煤烟, 昏噤发狂如见鬼, 咽疼唾血
赤云斑. 六七日前尚可治, 表里俱实黑奴丸, 热盛解毒里实下, 表实
三黄石膏煎.
【注】阳毒, 谓阳热至极之证也. 失汗下, 谓应汗不汗, 应下不下,
失其汗下之时也. 热毒炎炎不巳, 故舌卷焦黑, 鼻内生煤烟也. 热毒
内攻乘心, 故神昏噤栗, 发狂如见鬼神, 咽疼唾血也. 热毒外薄肌肤,
故发赤色如锦云之斑也. 六, 七日前, 谓日浅毒未深入, 故尚可治.
表里俱实, 谓有是证, 无汗不大便者, 宜黑奴丸两解之. 无表里实证
热盛者, 宜黄连解毒汤, 兼燥渴者, 合白虎汤清之. 里实不便者, 宜
解毒承气汤下之. 表实无汗者, 宜三黄石膏汤发之.
33. 阴盛格阳证表现为面色淡红，发热但不口渴，四肢厥冷且心烦，下痢清谷、小便清长、指甲青白，脉象浮而微弱，可用通脉四逆汤来回复阳气。
【注】《内经》说：阴气过盛，阳气无法与之相互营运。所谓“不相营”，就是不能相互交融。既然不能交融，就会将阳气格拒于体表之外，所以称为“阴盛格阳”。所谓“色浅赤”，是指面色呈现浮浅的红赤色。其外在症状见面部发红、发热且烦躁，颇像阳热证；但其内在表现是不口渴，下痢完谷不化，小便清白，指甲青白，四肢厥冷，脉象浮微欲绝，这是一派阴寒虚证的征象。适宜用通脉四逆汤冷服，以顺从其阴寒之性从而回复阳气。如果痢止但脉搏仍不出，应加倍使用人参。如果下痢且无脉，适宜用白通加猪胆汁人尿汤。如果四肢厥冷、心烦欲死，适宜用吴茱萸汤。
34. 阳毒证因热极而失于发汗或攻下，出现舌体卷缩焦黑、鼻孔内如煤烟状，神志昏迷、牙关紧闭、发狂如见鬼神，咽喉疼痛、唾血及皮肤出现红色云斑。若在发病六七天之前尚可治疗，若表里俱实，可用黑奴丸；热盛解毒且里有实邪者，宜用承气类方剂攻下；表实者，宜用三黄石膏汤解表。
【注】阳毒，是指阳热至极的证候。“失汗下”，是指应当发汗而未发汗，应当攻下而未攻下，错过了汗下的时机。热毒炽盛不止，所以舌体卷缩焦黑，鼻孔内生有煤烟样物质。热毒内攻侵犯心脏，所以神志昏迷、牙关紧闭战栗、发狂如见鬼神，咽喉疼痛、唾血。热毒外迫肌肤，所以皮肤出现如锦云般的红色斑疹。发病六七天之前，是指病程尚短，毒邪未深入，所以尚可治疗。所谓“表里俱实”，是指具备上述证候，且无汗、大便不通的患者，适宜用黑奴丸表里双解。若无表里实证但热盛者，适宜用黄连解毒汤清热；兼有燥渴者，合用白虎汤以清解。若有里实便秘者，适宜用解毒承气汤攻下。若表实无汗者，适宜用三黄石膏汤发汗解表。
33. Yin-Excess Repelling Yang manifests as a pale red complexion, fever without thirst, cold limbs with irritability, diarrhea with clear urine and cyanotic nails, and a floating, faint pulse. Tongmai Sini Decoction (Pulse-Recovering Cold-Treating Decoction) is used to restore Yang.
[Note] The Classic says: "When Yin Qi is excessively abundant, Yang Qi cannot circulate mutually." Mutual non-circulation means they do not enter each other. Since they do not enter each other, Yang is repelled to the exterior, hence it is called "Yin-Excess Repelling Yang." "Pale red" refers to a superficial reddish hue on the face. Externally, symptoms include facial flushing, fever, and irritability, resembling Yang-Heat; internally, however, there is no thirst, diarrhea of undigested food, clear urine, cyanotic nails, cold limbs, and a floating, faint pulse nearly imperceptible—a full picture of Yin-Cold deficiency. It is appropriate to administer Tongmai Sini Decoction cold, following the Yin nature to restore Yang. If diarrhea stops but the pulse does not return, double the dosage of Renshen (Ginseng Radix et Rhizoma). If diarrhea occurs with no pulse, Baitong Zhu Danzhi Renao Tang (Baitong Decoction with Pig Gallbladder Bile and Human Urine) is indicated. For severe cold limbs and irritability bordering on death, Wuzhuyu Tang (Evodia Decoction) is indicated.
34. Yang-Toxin results from extreme heat where sweating or purgation was missed, presenting with a curled, scorched-black tongue, soot-like deposits in the nose, coma, trismus, mania seeing ghosts, sore throat, hemoptysis, and red cloud-like rashes. If treated within six or seven days, it is still manageable. If both exterior and interior are excess, Heinu Wan (Black Slave Pill) is used. For intense heat requiring detoxification and interior excess requiring purgation, [purgative formulas] are used. For exterior excess, Sanhuang Shigao Jian (Three-Yellow Gypsum Decoction) is used.
[Note] Yang-Toxin refers to a syndrome of extreme Yang-Heat. "Missed sweating/purgation" means failing to sweat when sweating was indicated, or failing to purge when purgation was indicated, thus missing the proper timing. The blazing heat-toxin persists, causing the tongue to curl and turn scorched-black, and soot-like matter to form in the nose. Heat-toxin attacking inward affects the Heart, causing coma, trismus with shivering, mania seeing spirits, sore throat, and hemoptysis. Heat-toxin pressing outward on the skin causes red rashes like brocade clouds. Within six or seven days indicates a short duration where toxin has not deeply penetrated, so it is still treatable. "Exterior and Interior Excess" refers to having these symptoms with anhidrosis and constipation; Heinu Wan is indicated for simultaneous resolution of both. For those without exterior-interior excess patterns but with intense heat, Huanglian Jiedu Tang (Coptis Detoxification Decoction) is indicated; if accompanied by dryness and thirst, Baihu Tang (White Tiger Decoction) is combined to clear heat. For interior excess with constipation, Jiedu Chengqi Tang (Detoxification and Bowel-Unblocking Decoction) is indicated for purgation. For exterior excess with anhidrosis, Sanhuang Shigao Tang (Three-Yellow Gypsum Decoction) is indicated to induce sweating.