七十五证 方一十一首
阳明之为病，胃中寒是也。
问曰∶病有太阳阳明，有正阳阳明，有微阳阳明，何谓也？答曰∶太阳阳明者，脾约是
也。正阳阳明者，胃家实是也；微阳明明者，发其汗，若利其小便，胃中燥便难是也。
问曰∶何缘得阳明病？答曰∶太阳病，发其汗，若下之，亡其津液，胃中干燥，因为阳
明；不更衣而便难，复为阳明病也。
问曰∶阳明病外证云何？答曰∶身热，汗出，而不恶寒，但反恶热。
问曰∶病有得之一日，发热恶寒者，何？答曰∶然。虽二日，恶寒自罢，即汗出恶热也
。曰∶恶寒何故自罢？答曰∶阳明处中主土，万物所归，无所复传，故始虽恶寒，二日自止，
是
太阳初得病时，发其汗，汗先出复不彻，因转属阳明。
病发热无汗，呕不能食，而反汗出 然，是为转在阳明。
伤寒三日阳明脉大。
病脉浮而缓，手足温，是为系在太阴，太阴当发黄，小便自利者，不能发黄，至七八日
而坚，为属阳明。
伤寒传系阳明者，其人 然后汗出。
阳明中风，口苦咽干，腹满微喘，发热恶寒，脉浮若紧，下之则腹满，小便难也。
阳明病，能食为中风，不能食为中寒。
阳明病，中寒不能食，而小便不利，手足然汗出，此为欲作坚瘕也，必头坚后溏。所以
然者，胃中冷，水谷不别故也。
阳明病，初为欲食之，小便反不数，大便自调，其人骨节疼，翕翕如有热状，奄然发狂
，然汗出而解。此为水不胜谷气，与汗共并，坚者即愈。
阳明病，欲解时，从申尽戍。
阳明病，不能食，下之不解，其人不能食，攻其热必哕，所以然者，胃中虚冷故也；其
人本虚，攻其热必哕。
阳明病，脉迟，食难用饱，饱即微烦头眩者，必小便难，此欲作谷疸，虽下之，其腹必
满如故耳，所以然者，脉迟故也。
阳明病，久久而坚者，阳明病，当多汗，而反无汗，其身如虫行皮中之状，此为久虚故
也。
冬阳明病，反无汗，但小便利，二三日呕而咳，手足若厥者，其人头必痛，若不呕不咳
，手足不厥者，头不痛。
冬阳明病，但头眩，不恶寒，故能食而咳者，其人咽必痛，若不咳者，咽不痛。
阳明病，脉浮而紧，其热必潮，发作有时，但浮者，必盗汗出。
阳明病，无汗，小便不利，心中懊 ，必发黄。
阳明病被火，额上微汗出而小便不利，必发黄。
阳明病，口燥，但欲漱水，不欲咽者，必衄。
阳明病，本自汗出，医复重发其汗，病已瘥，其人微烦不了了，此大便坚也。必亡津液
，胃中燥，故令其坚。当问小便日几行，若本日三四行，今日再行者，必知大便不久出，今
为小便数少，津液当还入胃中，故知必当大便也。
夫病阳多者，热下之则坚，汗出多极，发其汗亦坚。
伤寒呕多，虽有阳明证，不可攻也。
阳明病，当心下坚满，不可攻之，攻之遂利不止者，利止者愈。
阳明病，合色赤，不可攻之，必发热，色黄者，小便不利也。
阳明病，不吐下，而烦者，可与承气汤。
阳明病，其脉迟，虽汗出，不恶寒，其体必重，短气，腹满而喘，有潮热，如此者，其
外为解，可攻其里，手足 然汗出，此为已坚，承气汤主之。
若汗出多，而微恶寒，外为未解，其热不潮，勿与承气汤，若腹大满，而不大便者，可
与小承气汤，微和其胃气，勿令至大下。
阳明病，潮热微坚，可与承气汤，不坚勿与之。
若不大便六七日，恐有燥屎，欲知之法，可与小承气汤，若腹中转矢气者，此为有燥屎
，乃可攻之。若不转矢气者，此但头坚后溏，不可攻之，攻之必腹胀满，不能食。欲饮水者
即哕。其后发热者，必复坚，以小承气汤和之。若不转矢气者，慎不可攻之。
夫实则谵语，虚则郑声。郑声者，重语是也。直视谵语，喘满者死，下利者亦死。
阳明病，其人多汗，津液外出，胃中燥，大便必坚，坚者则谵语，承气汤主之。
阳明病，谵语妄言，发潮热其脉滑疾，如此者，承气汤主之，因与承气汤一升，腹中转
气者，复与一升，如不转气者，勿与之。明日又不大便，脉反微涩，此为里虚，为难治，不
得复与承气汤。
阳明病，谵语，有潮热，反不能食者，必有燥屎五六枚，若能食者，但坚耳，承气汤主
之。
阳明病，下血而谵语者，此为热入血室，但头汗出者，当刺期门，随其实而泻之， 然
汗出者则愈。
汗出而谵语者，有燥屎在胃中，此风也。过经乃可下之。下之若早，语言必乱。以表虚
里实，下之则愈，宜承气汤。
伤寒四五日，脉沉而喘满，沉为在里，而反发其汗，津液越出，大便为难，表虚里实，
久则 语。
阳明病下之，心中懊 而烦，胃中有燥屎者，可攻。其人腹微满，头坚后溏者，不可不
下之，有燥屎者，宜承气汤。
病者五六日不大便，绕脐痛，躁烦，发作有时，此为有燥屎，故使不大便也。
病者烦热，汗出即解，复如疟状，日晡所发者，属阳明，脉实者当下之；脉浮虚者当，
发其汗，下之，宜承气汤。发汗宜桂枝汤。（方见桂枝汤门）
大下后，六七日不大便，烦不解，腹满痛者，此有燥屎，所以然者，本有宿食故也，宜
承气汤。
病者小便不利，大便乍难乍易，时有微热，怫郁不能卧，有燥屎故也，宜承气汤。
得病二三日，脉浮弱，无太阳柴胡证，而烦心下坚，至四日虽能食，以小承气汤少与微
和之，令小安，至六日，与承气汤一升，不大便六七日，小便少者，虽不大便，但头坚后溏，
未
伤寒七八日，目中不了了，睛不和，无表里证，大便难，微热者，此为实，急下之，宜
承气汤。
阳明病，发热汗多者，急下之，宜承气汤。
发汗不解，腹满痛者，急下之，宜承气汤。
腹满不减，减不足言，当下之，宜承气汤。
阳明与少阳合病而利，脉不负者为顺，滑而数者，有宿食，宜承气汤。（方并见承气汤
门）
阳明病，脉浮紧，咽干口苦，腹满而喘，发热汗出，不恶寒，反偏恶热，其身体重。发
汗即躁，心中愦愦，而反谵语。加温针，必怵惕，又烦躁不得眠。下之，胃中空虚，客气动
膈，心中懊 ，舌上苔者栀子汤主之。
阳明病，下之，其外有热，手足温，不结胸，心中懊 ，若饥不能食，但头汗出，栀子
汤主之。方∶
栀子（十四枚，擘） 香豉（四合，绵裹）
上二味，以水四升，先煮栀子取二升半，纳豉，煮取一升半，去滓，分再服，温进一服
，得快吐止后服。
三阳合病，腹满身重，难以转侧，口不仁，言语向经，谵语遗尿。发汗则谵语。下之则
额上生汗，手足厥冷。白虎汤主之。（按诸本皆云“向经”，不敢刊改。）
若渴欲饮水，口干舌燥者，白虎汤主之。（方见杂疗中。）
若脉浮发热，渴欲饮水，小便不利，猪苓汤主之。方∶
猪苓（去黑皮） 茯苓 泽泻 阿胶 滑石（碎，各一两）
上五味，以水四升，先煮四味，取二升，去滓，纳胶烊消，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，猪苓汤复利其小便故也。
胃中虚冷，其人不能食者，饮水即哕。
脉浮发热，口干鼻燥，能食者即衄。
若脉浮迟，表热里寒，下利清谷，四逆汤主之。方∶
甘草（二两，炙） 干姜（一两半） 附子（一枚，生，去皮，破八片）
上三味，以水三升，煮取一升二合，去滓，分温再服，强人可大附子一枚，干姜三两。
阳明病发潮热，大便溏，小便自可，而胸胁满不去，小柴胡汤主之。
阳明病，胁下坚满，不大便而呕，舌上苔者，可以小柴胡汤，上焦得通，津液得下，胃
气因和，身 然汗出而解。
阳明中风，脉弦浮大，而短气，腹都满，胁下及心痛，久按之气不通，鼻干，不得汗，
其人嗜卧，一身及目悉黄，小便难，有潮热，时时哕，耳前后肿。刺之小瘥，外不解，病过
十日，脉续浮，与小柴胡汤。但浮，无余证，与麻黄汤。不溺，腹满加哕，不治。（方见柴
胡汤门）
阳明病，其脉迟，汗出多，而微恶寒，表为未解，可发汗，宜桂枝汤。
阳明病，脉浮，无汗，其人必喘，发汗即愈，宜麻黄汤（方并见上。）
阳明病汗出，若发其汗，小便自利，此为内竭，虽坚不可攻，当须自欲大便，宜蜜煎导
而通之，若土瓜根、猪胆汁皆可以导。方∶
蜜（七合）
上一味，纳铜器中，微火煎之，稍凝如饴状，搅之勿令焦着，欲可丸捻如指许长二寸，
当热时急作令头锐，以纳谷道中，以手急抱，欲大便时乃去之。
又方∶
大猪胆一枚，泻汁，和少法醋以灌谷道中如一食顷，当大便，出宿食恶物。已试甚良。
阳明病，发热而汗出，此为热越，不能发黄也，但头汗出，其身无有，齐颈而还，小便
不利，渴引水浆，此为瘀热在里，身必发黄，茵陈汤主之。
伤寒七八日，身黄如橘，小便不利，其腹微满，茵陈汤主之。方∶
茵陈（六两） 栀子（十四枚，擘） 大黄（二两）
上三味，以水一斗二升，先煮茵陈减六升，纳二味，煮取三升，去滓，分温三服。小便
当利，溺如皂荚沫状，色正赤。一宿黄从小便去。
阳明证，其人喜忘，必有蓄血，所以然者，本有久瘀血，故令喜忘，虽坚，大便必黑，
抵当汤主之。
病者无表里证，发热七八日，虽脉浮数，可下之，假令下已，脉数不解，而合热消谷喜
饥，至六七日，不大便者，有瘀血，抵当汤主之。若数不解而下不止，必挟热便脓血。（方
见杂疗中。）
食谷而呕者，属阳明，茱萸汤主之。方∶
吴茱萸（一升） 人参（三两） 生姜（六两，切） 大枣（十二枚，擘）
上四味，以水七升，煮取二升，去滓，温服七合，日三服。得汤反剧者，属上焦也。
阳明病，寸口缓，关上小浮，尺中弱，其人发热而汗出，复恶寒，不呕，但心下痞，此
为医下之也。若不下，其人复不恶寒而渴者，为转属阳明，小便数者，大便即坚，不更衣十
日，无所苦也。渴欲饮水者，但与之，当以法救渴，宜五苓散。（方见疗痞门。）
脉阳微而汗出少者，为自如∶汗出多者，为太过。太过者阳绝于内，亡津液，大便因坚
脉浮而芤，浮为阳，芤为阴，浮芤相搏，胃气则生热，其阳则绝。趺阳脉浮而涩，浮则
胃气强，涩则小便数，浮涩相搏，大便即坚，其脾为约，麻子仁丸主之。方∶
麻子仁（二升） 芍药 枳实（炙，各八两） 大黄（一斤） 浓朴（一尺，） 杏仁
（一升，
去皮尖两仁者，熬，别作脂）
上六味，蜜和丸，如梧桐子大，饮服十丸，日三服，渐加，以知为度。
伤寒发其汗，则身目为黄，所以然者，寒湿相搏，在里不解故也。伤寒其人发黄，栀子
柏皮汤主之。方∶
栀子（十五枚，擘） 甘草 黄柏（十五分）
上三味，以水四升，煮取二升，去滓，分温再服。
伤寒瘀热在里，身体必黄，麻黄连翘赤小豆汤主之。方∶
麻黄（去节） 连翘（各一两） 杏仁（三十枚，去皮尖） 赤小豆（一升） 大枣（十
二枚，
擘） 生梓 白皮（切，一斤） 甘草（二两，炙） 一方生姜（二两，切）
上七味，以水一斗，煮麻黄一二沸，去上沫，纳诸药，煮取三升，去滓，温服一升。
第七十五证，方十一首。
问：疾病有太阳阳明、正阳阳明、微阳阳明之分，这是什么意思？答：太阳阳明，是指脾约（脾阴不足导致肠道干燥，大便困难）；正阳阳明，是指胃家实（胃肠燥热积滞）；微阳阳明，是指发汗过度或利小便过度，导致胃中干燥、大便困难的情况。
问：为什么会得阳明病？答：患太阳病时，若发汗太过，或用下法攻里，导致津液耗伤，胃中干燥，从而转化为阳明病；或者虽然不大便但排便困难，也属于阳明病。
问：阳明病的表证表现是什么？答：身体发热，出汗，且不恶寒，反而怕热。
问：有的病人患病一天就出现发热、恶寒，这是为什么？答：确实如此。即使到了第二天，恶寒也会自然停止，接着就是出汗、怕热。问：恶寒为什么会自动停止？答：阳明经居中属土，万物皆归附于它，病邪不再传变他经，所以起初虽有恶寒，到第二天就会自行停止。这通常是因为太阳病初起时，发汗不彻底，汗出而不畅，病邪因此转入阳明。
如果病人发热无汗，呕吐不能进食，却反而全身大汗淋漓，这就是病邪转入阳明。
如果病脉浮而缓，手足温暖，这是病系在太阴（脾）。太阴病应当发黄，但如果小便通畅，就不会发黄。到了七八天，大便变硬，这就归属于阳明病了。
伤寒病邪传入并系结于阳明，病人会先感到轻微烦躁，然后才出汗。
阳明中风，表现为口苦、咽干、腹部胀满、轻微气喘、发热、恶寒，脉象浮或紧。此时若误用下法，会导致腹部胀满加重、小便困难。
阳明病中，能进食的属于中风（风邪致病），不能进食的属于中寒（寒邪致病）。
阳明病中寒而不能进食，且小便不利，手足微微出汗，这是即将形成坚硬的积聚物（瘕块），必然会出现头部大便干硬、后部稀溏的现象。之所以这样，是因为胃中寒冷，水谷不分所致。
阳明病初期，病人想进食，小便次数反而不多，大便正常，但病人感觉骨节疼痛，像是有低热，突然发狂，随后全身出汗而病愈。这是因为水湿之邪不胜谷气，与汗液一同排出，大便干硬的部分随即痊愈。
阳明病欲缓解的时间，是从申时到戌时（下午3点至晚上7点）。
阳明病，不能进食，使用下法后症状未解，病人仍不能进食，若再攻伐其热邪，必然会发生呃逆。之所以这样，是因为胃中虚冷；病人本身体质虚弱，攻伐热邪必然导致呃逆。
阳明病，脉象迟，食物难以吃饱，吃饱后就轻微心烦、头晕目眩的，必然小便困难，这是将要发生谷疸（因饮食不当引起的黄疸），即使使用下法，腹部依然会胀满如故。之所以这样，是因为脉迟（主寒）的缘故。
阳明病，病程长久且大便干硬，阳明病应当多汗，反而无汗，身体感觉像有虫子在皮肤里爬行，这是因为久病体虚的缘故。
冬季患阳明病，反而无汗，只有小便通利，两三天后出现呕吐和咳嗽，手脚发凉的，病人头部必然疼痛；如果不呕吐、不咳嗽，手脚不发凉，头部就不痛。
冬季患阳明病，仅感到头晕，不怕冷，能进食且咳嗽的，病人的咽喉必然疼痛；如果不咳嗽，咽喉就不痛。
阳明病，脉象浮而紧，热势必然呈潮热状，发作有定时；如果脉象仅浮，必然出现盗汗（夜间睡着时出汗）。
阳明病，口干燥，只想含水漱口而不愿咽下的，必然会出现鼻衄（流鼻血）。
阳明病，原本就有自汗出，医生又重复发汗，病虽已好转，但病人仍有轻微心烦、神志不清，这是因为大便干硬。必然耗伤了津液，胃中干燥，所以导致大便干硬。应当询问病人每天小便几次，如果平时每天三四次，今天只两次，必然知道大便不久就要排出，现在因为小便次数减少，津液应当回归胃中，所以知道必然会大便通畅。
凡是阳气偏盛的病，用下法会使大便干硬；出汗过多，再用发汗法也会使大便干硬。
阳明病，心下部坚硬胀满，不可攻下，若攻下导致腹泻不止的，腹泻停止则愈；若腹泻停止的，则病情好转。
阳明病，面色红赤，不可攻下，否则必然发热，若面色发黄，是小便不利的缘故。
阳明病，脉象迟，虽然出汗，但不恶寒，身体必然沉重，气短，腹部胀满且气喘，有潮热，像这样的情况，表证已解，可以攻里，手足微微出汗，说明大便已经干硬，以承气汤为主治方。
如果出汗多，且有轻微恶寒，说明表证未解，热势不呈潮热，不要给承气汤。如果腹部显著胀满，但大便不通，可以给小承气汤，轻微调和胃气，不要让它导致剧烈泻下。
阳明病，潮热且大便轻微干硬，可以给承气汤；若不干硬，不要给。
如果六七天不大便，担心有燥屎（干硬的粪便），想要确认的方法，可以先给小承气汤，如果腹部有转矢气（放屁）的现象，这说明有燥屎，才可以攻下。如果不转矢气，这只是头硬后溏，不可攻下，攻下必然导致腹胀满、不能进食。想喝水的就会发生呃逆。其后如果出现发热，大便必然再次干硬，用小承气汤调和。如果不转矢气，千万不可攻下。
实证会胡言乱语（谵语），虚证会语言重复（郑声）。郑声，就是说话重复啰嗦。眼睛直视且胡言乱语，伴有喘促胸满的会死，伴有腹泻的也会死。
阳明病，病人多汗，津液外泄，胃中干燥，大便必然干硬，大便干硬就会胡言乱语，以承气汤为主治方。
阳明病，胡言乱语、妄言，伴有潮热，脉象滑疾，像这样的情况，以承气汤为主治方。于是给予承气汤一升，如果腹部有转矢气，再给一升；如果不转矢气，不要给。第二天又不大便，脉象反而微弱涩滞，这是里虚，难治，不能再给承气汤。
阳明病，胡言乱语，有潮热，反而不能进食的，必然有五六枚燥屎；如果能进食的，只是大便干硬而已，以承气汤为主治方。
阳明病，便血且胡言乱语的，这是热邪陷入血室，只有头部出汗的，应当针刺期门穴，随其实证而泻之，全身微微出汗就会痊愈。
出汗且胡言乱语的，胃中有燥屎，这是风邪所致。必须等到病邪离开经络（过经）才可以下法。如果下法过早，语言必然混乱。因为表虚里实，下法之后就会痊愈，宜用承气汤。
伤寒四五天，脉沉且喘促胸满，沉脉表示病在里，反而发汗，津液越出体外，大便变得困难，表虚里实，时间久了就会胡言乱语。
阳明病经过下法治疗后，心中烦闷懊恼，胃中有燥屎的，可以攻下。如果病人腹部轻微胀满，头硬后溏的，不可不下法，有燥屎的，宜用承气汤。
病人五六天不大便，绕脐疼痛，烦躁不安，发作有定时，这是有燥屎，所以导致不大便。
病人烦热，出汗后暂时缓解，又像疟疾一样发作，在傍晚时分（日晡所）发作的，属于阳明病，脉实者应当攻下；脉浮虚者应当发汗，攻下宜用承气汤，发汗宜用桂枝汤。（方剂见桂枝汤篇）
大泻下之后，六七天不大便，烦躁不解，腹部胀满疼痛的，这是有燥屎，之所以这样，是因为本来就有宿食，宜用承气汤。
病人小便不利，大便时而困难时而容易，有时有轻微发热，郁热不能安卧，这是有燥屎的缘故，宜用承气汤。
得病二三天，脉浮弱，没有太阳病或少阳病的证候，但心烦、心下部坚硬，到了第四天虽然能进食，用小承气汤少量给予以轻微调和，让病人稍微安宁，到了第六天，给承气汤一升。如果六七天不大便，小便少的，虽然不大便，但头硬后溏，尚未完全形成燥屎。
伤寒七八天，眼睛昏花不明，眼球转动不灵活，没有明显的表证或里证，大便困难，有轻微发热的，这是实证，急需攻下，宜用承气汤。
腹部胀满不减，即使减轻也不足为道的，应当攻下，宜用承气汤。
阳明病与少阳病合病而下利，脉象不负（即脉象符合病情预期）的为顺证，脉滑而数的，有宿食，宜用承气汤。（方剂并见承气汤篇）
阳明病，脉象浮紧，咽干口苦，腹部胀满且气喘，发热出汗，不怕冷，反而特别怕热，身体沉重。发汗就会导致烦躁，心中郁闷，反而胡言乱语。加用温针，必然惊恐惕惧，又烦躁不得睡眠。如果用下法，胃中空虚，客气扰动膈间，心中烦闷懊恼，舌上有苔的，用栀子汤主治。
阳明病，经过下法治疗后，体表有热，手足温暖，没有结胸，心中烦闷懊恼，像饥饿但不能进食，只有头部出汗的，用栀子汤主治。方剂：
栀子（十四枚，掰开） 香豉（四合，用绵布包裹）
以上两味药，用水四升，先煮栀子取二升半，加入香豉，煮取一升半，去渣，分两次服用，温服一次，如果引起快速呕吐，则停止后续服用。
三阳合病，腹部胀满，身体沉重，难以翻身，口舌麻木不知滋味，言语错乱，遗尿。发汗会导致胡言乱语。攻下会导致额上出汗，手脚厥冷。用白虎汤主治。（按各种版本都写“向经”，不敢擅自修改。）
如果口渴想喝水，口干舌燥的，用白虎汤主治。（方剂见杂疗中。）
如果脉象浮、发热，口渴想喝水，小便不利的，用猪苓汤主治。方剂：
猪苓（去掉黑皮） 茯苓 泽泻 阿胶 滑石（捣碎，各一两）
以上五味药，用水四升，先煮前四味，取二升，去渣，加入阿胶烊化消溶，温服七合，每日三次。
阳明病，出汗多且口渴的，不可给猪苓汤，因为出汗多导致胃中干燥，猪苓汤又会利尿，进一步损伤津液。
如果脉象浮迟，表热里寒，下利清谷（拉出未消化的食物），用四逆汤主治。方剂：
甘草（二两，炙烤） 干姜（一两半） 附子（一枚，生用，去皮，破成八片）
以上三味药，用水三升，煮取一升二合，去渣，分两次温服，体质强壮的人可以用大附子一枚，干姜三两。
阳明病发潮热，大便稀溏，小便正常，但胸胁部胀满不去，用小柴胡汤主治。
阳明病，胁下坚硬胀满，不大便且呕吐，舌上有苔的，可以用小柴胡汤，上焦通畅，津液下行，胃气因而调和，身体微微出汗而病愈。
阳明中风，脉象弦、浮、大，且气短，腹部全面胀满，胁下及心部疼痛，长时间按压气机不通，鼻干，无汗，病人嗜睡，全身及眼睛都发黄，小便困难，有潮热，时时呃逆，耳前后肿胀。针刺后稍有好转，但表证未解，病过十天，脉象持续浮，给小柴胡汤。如果仅脉浮，没有其他证候，给麻黄汤。如果不排尿，腹部胀满加重且呃逆，属于不治之症。（方剂见柴胡汤篇）
阳明病，脉象迟，出汗多，且有轻微恶寒，表证未解，可以发汗，宜用桂枝汤。
阳明病，脉象浮，无汗，病人必然气喘，发汗即可痊愈，宜用麻黄汤（方剂并见上文）。
阳明病出汗，如果再发汗，小便自利，这是体内津液枯竭，虽然大便干硬也不可攻下，应当等待病人自己想大便的时候，宜用蜜煎导法通便，或者土瓜根、猪胆汁都可以用来导便。方剂：
蜂蜜（七合）
将这一味药放入铜器中，用微火煎煮，稍微凝固像饴糖状，搅拌不要让它焦糊，趁热做成丸子，捻成手指粗细、长约二寸的形状，头部要做得尖锐，趁热塞入肛门中，用手紧紧抱住臀部，想大便时再取出。
又一方：
大猪胆一枚，挤出汁液，混合少许醋，灌入肛门中，大约一顿饭的时间，大便排出宿食和污物。此法试过非常有效。
阳明病，发热且出汗，这是热邪向外发散，不会发黄。只有头部出汗，身体无汗，汗止于颈部，小便不利，口渴想喝浆水，这是瘀热在体内，身体必然发黄，用茵陈汤主治。
伤寒七八天，身体黄得像橘子皮，小便不利，腹部轻微胀满，用茵陈汤主治。方剂：
茵陈（六两） 栀子（十四枚，掰开） 大黄（二两）
以上三味药，用水一斗二升，先煮茵陈减少六升，加入另外两味药，煮取三升，去渣，分三次温服。小便应当通畅，尿液像皂荚沫一样，颜色正红。一夜之间黄色从小便去除。
阳明证，病人喜欢忘事，必然有蓄血，之所以这样，是因为本来就有久瘀血，所以导致喜欢忘事，虽然大便干硬，但大便必然发黑，用抵当汤主治。
病人没有表证和里证，发热七八天，虽然脉象浮数，可以攻下。假如攻下后，脉数不解，反而合并热邪，消谷善饥，到了六七天，不大便的，有瘀血，用抵当汤主治。如果脉数不解且腹泻不止，必然夹杂热邪导致便脓血。（方剂见杂疗中。）
吃食物就呕吐的，属于阳明病，用茱萸汤主治。方剂：
吴茱萸（一升） 人参（三两） 生姜（六两，切片） 大枣（十二枚，掰开）
以上四味药，用水七升，煮取二升，去渣，温服七合，每日三次。服药后反而加重的，病位在上焦。
阳明病，寸口脉缓，关上脉小浮，尺中脉弱，病人发热且出汗，又恶寒，不呕吐，只是心下部痞塞，这是医生误用下法导致的。如果没有下法，病人又不恶寒且口渴的，是转属阳明，小便频数的，大便就会干硬，十天不大便，也没有痛苦。想喝水的，直接给他喝，应当用方法解救口渴，宜用五苓散。（方剂见疗痞门。）
脉象阳微且出汗少的，是正常的；出汗多的，是太过。太过会导致阳气绝于内，亡失津液，大便因此干硬。
脉象浮而芤，浮为阳，芤为阴，浮芤相搏，胃气产生热邪，其阳气则绝。趺阳脉浮而涩，浮则胃气强，涩则小便频数，浮涩相搏，大便立即干硬，脾的功能受限（脾约），用麻子仁丸主治。方剂：
麻子仁（二升） 芍药 枳实（炙，各八两） 大黄（一斤） 浓朴（一尺） 杏仁（一升，去皮尖，双仁者，炒熟，另作脂）
以上六味药，用蜜和丸，如梧桐子大小，饮服十丸，每日三次，逐渐增加，以见效为度。
伤寒发汗，则身体面目发黄，之所以这样，是因为寒湿相搏，在体内不解的缘故。伤寒病人发黄的，用栀子柏皮汤主治。方剂：
栀子（十五枚，掰开） 甘草 黄柏（十五分）
以上三味药，用水四升，煮取二升，去渣，分两次温服。
伤寒瘀热在体内，身体必然发黄，用麻黄连翘赤小豆汤主治。方剂：
麻黄（去节） 连翘（各一两） 杏仁（三十枚，去皮尖） 赤小豆（一升） 大枣（十二枚，掰开） 生梓白皮（切片，一斤） 甘草（二两，炙） 一方生姜（二两，切片）
以上七味药，用水一斗，先煮麻黄一二沸，去掉上面的泡沫，加入其他药物，煮取三升，去渣，温服一升。
**Chapter 8: Manifestations of Yangming Disease**
**Proof 75, Formulas 11**
The fundamental characteristic of Yangming disease is cold in the stomach.
Question: Diseases are categorized into Taiyang-Yangming, Zhengyang-Yangming, and Weiyang-Yangming. What do these terms mean? Answer: Taiyang-Yangming refers to Pi Yue (Spleen Constraint), where insufficient Spleen Yin leads to intestinal dryness and difficulty defecating. Zhengyang-Yangming refers to Wei Jia Shi (Stomach House Excess), characterized by dry-heat accumulation in the gastrointestinal tract. Weiyang-Yangming refers to conditions caused by excessive sweating or excessive diuresis, leading to dryness in the stomach and difficulty defecating.
Question: How does one contract Yangming disease? Answer: When suffering from a Taiyang disease, if sweating is induced excessively or purgatives are used improperly, body fluids are depleted, causing dryness in the stomach, which transforms into Yangming disease. Alternatively, even if there is no complete constipation but difficulty in defecation, it is also classified as Yangming disease.
Question: What are the exterior manifestations of Yangming disease? Answer: The body feels hot, there is sweating, no aversion to cold, but rather an aversion to heat.
Question: Some patients exhibit fever and aversion to cold on the first day of illness. Why is this? Answer: Indeed. Even on the second day, the aversion to cold will cease spontaneously, followed by sweating and aversion to heat. Question: Why does the aversion to cold stop spontaneously? Answer: The Yangming meridian resides in the center and corresponds to Earth; all pathogens tend to converge here and do not transmit further. Thus, although there may be initial aversion to cold, it stops by the second day. This usually occurs because when Taiyang disease begins, sweating is induced but is incomplete, allowing pathogens to transfer to Yangming.
If a patient has fever without sweating, vomiting, inability to eat, yet experiences profuse sweating over the whole body, this indicates the pathogen has transferred to Yangming.
After three days of Shanghan (Cold Damage), if the pulse becomes large, it indicates transmission to Yangming.
If the pulse is floating and slow, with warm hands and feet, the disease is associated with Taiyin (Spleen). Taiyin disease typically presents with jaundice; however, if urination is free, jaundice will not occur. By the seventh or eighth day, if the stool becomes hard, it belongs to Yangming.
When Shanghan pathogens transmit and bind to Yangming, the patient initially feels slightly irritable before sweating.
Yangming Wind Strike presents with bitter taste in the mouth, dry throat, abdominal fullness, slight wheezing, fever, aversion to cold, and a floating or tight pulse. If purgatives are mistakenly used, abdominal fullness worsens, and urination becomes difficult.
In Yangming disease, the ability to eat indicates Wind Strike (pathogenic wind), while the inability to eat indicates Cold Strike (pathogenic cold).
In Yangming disease due to Cold Strike, where the patient cannot eat, has difficulty urinating, and sweats slightly on the hands and feet, this indicates the impending formation of a hard mass (Jia). There will likely be hard stool at the beginning and loose stool at the end. This occurs because of cold in the stomach, causing improper separation of water and grain.
In the early stage of Yangming disease, the patient desires food, urination frequency is low, stool is normal, but bone joints ache, and there is a sensation of mild heat. Suddenly, the patient goes mad, then sweats profusely and recovers. This happens because the water-dampness fails to overcome the Gu Qi (Grain Qi), and they exit together with sweat; the hardened part heals.
The time for Yangming disease to resolve is from Shen hour to Xu hour (3 PM to 7 PM).
In Yangming disease, if the patient cannot eat and purgatives fail to resolve symptoms, and the patient still cannot eat, attacking the heat will inevitably cause hiccups. This is due to deficiency-cold in the stomach; since the patient is fundamentally deficient, attacking heat causes hiccups.
In Yangming disease, if the pulse is slow, food cannot be consumed to satiety, and slight irritability and dizziness occur after eating, urination will likely be difficult. This indicates impending Gu Dan (Grain Jaundice). Even if purgatives are used, abdominal fullness will persist. This is due to the slow pulse indicating cold.
In prolonged Yangming disease with hard stool, Yangming disease should present with profuse sweating. If there is no sweating, and the skin feels like insects crawling, it is due to long-term deficiency.
In winter, Yangming disease may present with no sweating but free urination. After two or three days, vomiting and coughing occur, and if the hands and feet are cold, the head will surely hurt. If there is no vomiting, coughing, or cold extremities, the head will not hurt.
In winter, Yangming disease presenting only with dizziness, no aversion to cold, ability to eat, and coughing, will result in sore throat. If there is no cough, the throat will not hurt.
In Yangming disease, if the pulse is floating and tight, the fever will be tidal, occurring at specific times. If the pulse is only floating, night sweats will occur.
In Yangming disease, if there is no sweating, difficulty urinating, and mental restlessness (Ao Nu), jaundice will develop.
If Yangming disease is treated with fire therapy, resulting in slight sweating on the forehead and difficulty urinating, jaundice will develop.
In Yangming disease, if the mouth is dry and the patient only wants to rinse their mouth with water without swallowing, epistaxis (nosebleed) will occur.
In Yangming disease, if the patient already has spontaneous sweating, and the physician induces sweating again, although the illness improves, the patient remains slightly irritable and mentally unclear. This is due to hard stool. Body fluids have been lost, causing dryness in the stomach, leading to hardness. One should ask how many times the patient urinates daily. If they usually urinate three or four times a day but only twice today, it indicates that stool will pass soon. Since urine output has decreased, fluids return to the stomach, ensuring bowel movement.
For diseases with excess Yang, using purgatives causes hardness; excessive sweating followed by inducing more sweating also causes hardness.
In Shanghan, if vomiting is frequent, even if Yangming symptoms exist, purgatives must not be used.
In Yangming disease, if there is hardness and fullness below the heart, purgatives must not be used. If purgatives cause unceasing diarrhea, cessation of diarrhea indicates recovery.
In Yangming disease, if the face is red, purgatives must not be used. Doing so will cause fever; if yellowing occurs, it is due to difficulty urinating.
In Yangming disease, if there is irritability without prior emesis or purgation, Chengqi Tang can be administered.
In Yangming disease, if the pulse is slow, there is sweating but no aversion to cold, the body is heavy, there is shortness of breath, abdominal fullness, and wheezing, accompanied by tidal fever, the exterior is resolved, and the interior can be attacked. With slight sweating on the hands and feet indicating hard stool, Chengqi Tang is the primary formula.
If there is profuse sweating and slight aversion to cold, the exterior is unresolved, and the fever is not tidal; do not give Chengqi Tang. If there is significant abdominal fullness without bowel movement, Xiao Chengqi Tang can be given to mildly harmonize the Stomach Qi, avoiding severe purgation.
In Yangming disease, if there is tidal fever and slight stool hardness, Chengqi Tang can be given; if not hard, do not give it.
If there is no bowel movement for six or seven days, suspecting dry feces (Zao Shi), the method to confirm is to give Xiao Chengqi Tang. If flatus (Zhuan Shi Qi) occurs in the abdomen, it indicates dry feces, and purgation is permissible. If no flatus occurs, it is merely hard stool at the beginning and loose at the end; do not purge, as it will cause abdominal fullness and loss of appetite. Thirst will lead to hiccups. Subsequent fever indicates recurrence of hardness; use Xiao Chengqi Tang to harmonize. If no flatus occurs, absolutely do not purge.
Excess conditions cause Zhenyu (delirious speech); deficiency conditions cause Zhensheng (repetitive speech). Zhensheng means repetitive talking. Fixed gaze with delirium and wheezing/fullness indicates death; diarrhea also indicates death.
In Yangming disease, if the patient sweats profusely, body fluids escape, the stomach becomes dry, and stool becomes hard, delirium ensues. Chengqi Tang is the primary formula.
In Yangming disease, if there is delirious speech, tidal fever, and a slippery-rapid pulse, Chengqi Tang is the primary formula. Administer one sheng of Chengqi Tang. If flatus occurs, administer another sheng. If no flatus occurs, do not administer. If the next day there is still no bowel movement and the pulse becomes weak and choppy, this indicates interior deficiency and is difficult to treat; do not give Chengqi Tang again.
In Yangming disease, if there is delirium, tidal fever, and inability to eat, there are likely five or six pieces of dry feces. If the patient can eat, it is merely hard stool. Chengqi Tang is the primary formula.
In Yangming disease, if there is bloody stool and delirium, this is Heat entering the Blood Chamber. If only the head sweats, puncture Qimen (LR14) to drain excess. General slight sweating indicates recovery.
If there is sweating and delirium, there is dry feces in the stomach due to Wind. Purge only after the pathogen has left the meridians (Guo Jing). Premature purging causes chaotic speech. Due to exterior deficiency and interior excess, purging leads to recovery; use Chengqi Tang.
In Shanghan, on the fourth or fifth day, if the pulse is deep with wheezing and fullness, deep indicates interior location. Inducing sweating erroneously causes fluid loss and difficult stool, resulting in exterior deficiency and interior excess. Over time, delirium occurs.
After purgation in Yangming disease, if there is mental restlessness (Ao Nu), and dry feces are present in the stomach, purging is allowed. If the abdomen is slightly full with hard initial/loose final stool, purging is necessary; if dry feces are present, use Chengqi Tang.
If a patient has not had a bowel movement for five or six days, has periumbilical pain, irritability, and periodic attacks, this indicates dry feces causing constipation.
If a patient has irritability and fever, relief upon sweating, recurring like malaria with evening exacerbation (Ribang Suo), this belongs to Yangming. If the pulse is excess, purge; if floating and deficient, induce sweating. For purging, use Chengqi Tang; for sweating, use Guizhi Tang. (Formula see Guizhi Tang section.)
After severe purgation, if there is no bowel movement for six or seven days, unresolved irritability, and abdominal fullness/pain, this indicates dry feces due to retained food. Use Chengqi Tang.
If a patient has difficulty urinating, alternating difficulty and ease of defecation, slight fever, and郁热 (depressed heat) preventing sleep, this indicates dry feces. Use Chengqi Tang.
On the second or third day of illness, if the pulse is floating and weak, without Taiyang or Shaoyang symptoms, but with irritability and hardness below the heart, even if the patient can eat on the fourth day, give a small amount of Xiao Chengqi Tang to mildly harmonize and provide relief. On the sixth day, give one sheng of Chengqi Tang. If there is no bowel movement for six or seven days and urine is scanty, although there is no bowel movement, if the stool is hard at the beginning and loose at the end, it is not yet fully formed dry feces.
In Shanghan, on the seventh or eighth day, if vision is blurred and eyes are unresponsive, without obvious exterior or interior symptoms, but with difficult stool and slight fever, this is excess. Urgently purge with Chengqi Tang.
In Yangming disease, if there is fever and profuse sweating, urgently purge with Chengqi Tang.
If sweating fails to resolve the condition and abdominal fullness/pain persists, urgently purge with Chengqi Tang.
If abdominal fullness does not decrease, or decreases insignificantly, purge with Chengqi Tang.
In combined Yangming and Shaoyang disease with diarrhea, if the pulse is "not negative" (favorable), it is smooth. If slippery and rapid, there is retained food; use Chengqi Tang. (Formulas see Chengqi Tang section.)
In Yangming disease, if the pulse is floating and tight, with dry throat, bitter taste, abdominal fullness, wheezing, fever, sweating, no aversion to cold, but aversion to heat, and heavy body, inducing sweating causes irritability, mental confusion, and delirium. Adding moxibustion causes fearfulness and insomnia. Purging empties the stomach, allowing hostile qi to disturb the diaphragm, causing mental restlessness (Ao Nu). If there is coating on the tongue, Zhizi Tang is the primary formula.
After purgation in Yangming disease, if there is exterior heat, warm hands and feet, no chest binding, mental restlessness (Ao Nu), hunger but inability to eat, and only head sweating, Zhizi Tang is the primary formula. Formula: Zhizi (14 pods, broken) and Xiangchi (4 he, wrapped in silk). Boil these two ingredients in four sheng of water, first boiling Zhizi to obtain two and a half sheng, then add Xiangchi and boil to obtain one and a half sheng. Strain and divide into two doses. Take one dose warm. Stop subsequent doses if rapid vomiting occurs.
In San Yang combined disease, with abdominal fullness, body heaviness, difficulty turning, oral numbness, slurred speech, and enuresis, inducing sweating causes delirium. Purging causes sweating on the forehead and cold extremities. Baihu Tang is the primary formula. (Note: All versions read "Xiang Jing", so it is not corrected.)
If thirsty for drinking water with dry mouth and tongue, Baihu Tang is the primary formula. (Formula see Miscellaneous Treatments.)
If the pulse is floating with fever, thirst for water, and difficulty urinating, Zhuling Tang is the primary formula. Formula: Zhuling (deprived of black skin), Fuling, Zexie, Ejiao, Huashi (crushed, each one liang). Boil these five ingredients in four sheng of water, first boiling the first four to obtain two sheng. Strain, add Ejiao until melted, and take seven ge warm, three times daily.
In Yangming disease, if there is profuse sweating and thirst, Zhuling Tang must not be given, as profuse sweating causes stomach dryness, and Zhuling Tang promotes urination, further damaging fluids.
In deficiency-cold of the stomach, if the patient cannot eat, drinking water causes hiccups.
If the pulse is floating with fever, dry mouth and nose, and the patient can eat, epistaxis will occur.
If the pulse is floating and slow, with exterior heat and interior cold, and diarrhea with undigested food, Sini Tang is the primary formula. Formula: Gancao (two liang, roasted), Ganjiang (one and a half liang), Fuzi (one raw piece, peeled, broken into eight slices). Boil these three ingredients in three sheng of water to obtain one and two he. Strain and divide into two warm doses. Strong individuals may use one large Fuzi and three liang of Ganjiang.
In Yangming disease with tidal fever, loose stool, normal urination, but persistent chest and hypochondriac fullness, Xiaochaihu Tang is the primary formula.
In Yangming disease, with hardness and fullness below the hypochondrium, constipation, vomiting, and tongue coating, Xiaochaihu Tang can be used. Once the Upper Jiao is open and fluids descend, Stomach Qi harmonizes, and the patient sweats slightly and recovers.
In Yangming Wind Strike, with string-taut-floating-large pulse, shortness of breath, generalized abdominal fullness, hypochondriac and cardiac pain unrelieved by pressure, dry nose, inability to sweat, lethargy, generalized and ocular jaundice, difficulty urinating, tidal fever, intermittent hiccups, and swelling around the ears, acupuncture provides slight relief. If exterior symptoms persist beyond ten days and the pulse remains floating, give Xiaochaihu Tang. If only floating without other symptoms, give Mahuang Tang. If unable to urinate, with worsening abdominal fullness and hiccups, it is untreatable. (Formulas see Chaihu Tang section.)
In Yangming disease, if the pulse is slow, with profuse sweating and slight aversion to cold, the exterior is unresolved. Induce sweating with Guizhi Tang.
In Yangming disease, if the pulse is floating, with no sweating and inevitable wheezing, inducing sweating leads to recovery. Use Mahuang Tang. (Formulas see above.)
In Yangming disease with sweating, if sweating is induced again and urination is free, this indicates internal exhaustion. Although stool is hard, it must not be purged. Wait for the natural desire to defecate. Use Mi Jian Dao (Honey Suppository) to facilitate passage, or Shu Gagua Gen (Trichosanthes root) or Zhu Dan Ye (Pig bile) can also be used. Formula: Honey (seven he). Simmer honey in a copper vessel over low heat until it thickens like malt syrup. Do not let it burn. While hot, shape into pills finger-thick and two cun long, with a sharp tip. Insert into the anus immediately while hot. Hold buttocks tightly. Remove when the urge to defecate arises.
Another formula: One large pig gallbladder, extract juice, mix with a little vinegar, and enema into the anus. After about one meal's time, stool containing retained food and foul matter will pass. This method is very effective.
In Yangming disease, if there is fever and sweating, heat disperses outward, and jaundice does not occur. If only the head sweats, stopping at the neck, with difficulty urinating and thirst for liquids, this is stagnant heat in the interior, leading to jaundice. Yinchin Tang is the primary formula.
In Shanghan, on the seventh or eighth day, if the body is yellow like an orange peel, with difficulty urinating and slight abdominal fullness, Yinchin Tang is the primary formula. Formula: Yinchin (six liang), Zhizi (14 pods, broken), Dahuang (two liang). Boil these three ingredients in twelve sheng of water, first boiling Yinchin to reduce by six sheng. Add the other two and boil to obtain three sheng. Strain and divide into three warm doses. Urination should become free, with urine resembling soap pod foam, reddish in color. The yellowness disappears via urination overnight.
In Yangming syndrome, if the patient is forgetful, there is likely accumulated blood. This is due to long-standing blood stasis. Although stool is hard, it will be black. Didang Tang is the primary formula.
If a patient has no exterior or interior symptoms, with fever for seven or eight days, and a floating-rapid pulse, purging is permissible. If after purging the rapid pulse persists, combined heat causes increased appetite. By the sixth or seventh day, if there is no bowel movement, there is blood stasis. Didang Tang is the primary formula. If the rapid pulse persists and diarrhea continues, there will be pus and blood mixed with heat. (Formula see Miscellaneous Treatments.)
Vomiting after eating belongs to Yangming. Wuyu Tang is the primary formula. Formula: Wuzhuyu (one sheng), Renshen (three liang), Shengjiang (six liang, sliced), Dazao (12 pods, broken). Boil these four ingredients in seven sheng of water to obtain two sheng. Strain and take seven ge warm, three times daily. If symptoms worsen after taking the decoction, the pathology is in the Upper Jiao.
In Yangming disease, if the Cun Kou pulse is slow, Guan pulse slightly floating, and Chi pulse weak, with fever, sweating, and aversion to cold, no vomiting, but only epigastric stuffiness, this is due to erroneous purgation by the physician. If not purged, and the patient has no aversion to cold but thirst, it transfers to Yangming. Frequent urination leads to hard stool. Ten days without bowel movement causes no distress. If thirsty for water, provide it. To relieve thirst properly, use Wu Ling San. (Formula see Pishi Treatment section.)
If the Yang pulse is micro and sweating is scanty, bowel movements are normal. Profuse sweating is excessive. Excessive sweating causes Yang depletion internally and fluid loss, leading to hard stool.
If the pulse is floating and Kou (hollow), floating indicates Yang, Kou indicates Yin. Their interaction generates heat in the Stomach Qi, leading to Yang depletion.
The Zuyang pulse is floating and choppy. Floating indicates strong Stomach Qi; choppy indicates frequent urination. Their interaction leads to hard stool and Spleen Constraint (Pi Yue). Maziren Wan is the primary formula. Formula: Maziren (two sheng), Shaoyao, Zhishi (roasted, each eight liang), Dahuang (one jin), Houpo (one chi), Xingren (one sheng, peeled, double-kernel, roasted, made into paste). Mix these six ingredients with honey into pills the size of wutong seeds. Take ten pills with water, three times daily, gradually increasing until effective.
In Shanghan, inducing sweating causes jaundice of the body and eyes due to cold-dampness binding internally. For Shanghan with jaundice, Zhizi Bopi Tang is the primary formula. Formula: Zhizi (15 pods, broken), Gancao, Huangbai (15 fen). Boil these three ingredients in four sheng of water to obtain two sheng. Strain and divide into two warm doses.
In Shanghan with stagnant heat in the interior, the body becomes yellow. Mahlian Qiao Chixiaodou Tang is the primary formula. Formula: Mahuang (deprived of nodes), Lianqiao (each one liang), Xingren (30 seeds, peeled), Chixiaodou (one sheng), Dazao (12 pods, broken), Shengzi Baipi (sliced, one jin), Gancao (two liang, roasted). Alternative: Shengjiang (two liang, sliced). Boil these seven ingredients in ten sheng of water. First boil Mahuang for one or two boils, remove foam. Add remaining herbs and boil to obtain three sheng. Strain and take one sheng warm.