杨郎中之内五十一岁。身体肥盛。己酉春。患头目昏闷。面赤热多。服清上药不效。请予治之
。诊其脉洪大而有力。内经云。面热者。足阳明病。脉经云。阳明经气盛有余。则身以前皆热。况
其人素膏粱。积热于胃。阳明多血多气。本实则风热上行。诸阳皆会于头。故面热之病生矣。先以
调胃承气汤七钱、黄连二钱、犀角一钱。疏利三两行。彻其本热。次以升麻加黄连汤。去经络中风
热上行。如此则标本之病邪俱退矣。
【升麻加黄连汤】
升麻 葛根（各一钱） 白芷 黄连（各七分）
甘草（炙） 草豆蔻仁 人参（各五分） 黑附（炮。七分）
益智（三分）
上九味 咀。作一服。水三盏。连须葱白同煎至一盏。去渣。温服。数服良愈。
或曰。升麻汤加黄连治面热。加附子治面寒。有何根据。答曰。出自仲景。云岐子注仲景伤寒
论中辨葛根汤云。尺寸脉俱长者。阳明经受病也。当二三日发。以其脉夹鼻络目。故身热目疼鼻干
不得卧。此阳明经受病也。始于鼻交额中。从头至足。行身之前。为表之里。阳明经标热本实。从
标脉浮而长。从本脉沉而实。阳明为病。主蒸蒸而热。不恶寒。身热为标。阳明本实者。胃中燥。
鼻干目疼。为肌肉之本病。兀兀而热。阳明
禁不可发汗。在本者不禁下。发之则变黄证。太阳主表。荣卫是也。荣卫之下。肌肉属阳明。二阳
并病。葛根汤主之。卫者桂枝。荣者麻黄。荣卫之中。桂枝麻黄各半汤。荣卫之下肌肉之分者。葛
根汤主之。又名解肌汤。故阳明为肌肉之本。非专于发汗止汗之治。桂枝麻黄两方互并为一方。加
葛根者。便作葛根汤。故荣卫。肌肉之次也。桂枝、芍药、甘草、生姜、大枣止汗。麻黄、桂枝、
甘草、生姜发汗。葛根味薄。独加一味。非发汗止汗。从葛根以解肌。故名葛根汤。钱仲阳制升麻
汤。治伤寒温疫风热壮热。头痛体痛。疮疹已发未发。用葛根为君。升麻为佐。甘草、芍药安其中
气。朱奉议活人书。将升麻汤列为阳明经解。若予诊杨氏妇阳明标本俱实。先攻其里。后泻经络中
风热。故升麻汤加黄连。以寒治热也。尼长老阳明标本俱虚寒。先实其里。次行经络。升麻汤加附
子。以热治寒也。仲景群方之祖。信哉。
杨郎中的妻子，五十一岁。身体肥胖壮实。己酉年春天，出现头目昏沉闷胀、面部发红发热较多的症状，服用清上焦的药物无效，于是请我诊治。诊察她的脉象洪大且有力。《内经》说：面部发热，是足阳明经的病证。《脉经》说：阳明经气盛有余，则身体前部都会发热。况且此人平素饮食肥甘厚味，导致胃中积热。阳明经多血多气，本气实则风热上行，诸阳经都交会于头部，所以产生了面部发热的病症。先用调胃承气汤七钱、黄连二钱、犀角一钱，疏通利导三两次，以清除根本的热邪。接着用升麻加黄连汤，去除经络中风热上行的病邪。这样标本的病邪就都退去了。
【升麻加黄连汤】
升麻 葛根（各一钱） 白芷 黄连（各七分）
甘草（炙） 草豆蔻仁 人参（各五分） 黑附子（炮制，七分）
益智仁（三分）
以上九味药切碎，作为一服。用水三盏，连同葱白一起煎煮至一盏，去渣，温服。服用几剂后痊愈。
有人问：升麻汤加黄连治疗面部发热，加附子治疗面部发寒，有什么依据？回答说：出自张仲景。云岐子在注释张仲景《伤寒论》中辨别葛根汤时说：寸脉和尺脉都长的，是阳明经受病。应当在发病二三天时发作，因为该经脉夹鼻络目，所以身体发热、眼睛疼痛、鼻子干燥、不能安卧。这是阳明经受病。起始于鼻端交于额中，从头到脚，行走在身体前部，属于表之里。阳明经标热本实，从标看脉浮而长，从本看脉沉而实。阳明为病，主要表现为蒸蒸发热，不恶寒。身体发热是标，阳明本实是指胃中干燥，鼻子干、眼睛痛，是肌肉层面的本病。头部昏沉发热，对于在“本”的实证不禁用发汗法，发汗则会转变为黄疸证；对于在“本”的实证不禁用下法。太阳主表，即营卫。营卫之下，肌肉属阳明。二阳并病，用葛根汤主治。卫分用桂枝，营分用麻黄。在营卫之中，用桂枝麻黄各半汤。在营卫之下、肌肉之分者，用葛根汤主治。又名解肌汤。所以阳明是肌肉的本位，不是专门用于发汗或止汗的治疗。桂枝汤和麻黄汤两方合并为一方的基础上，加入葛根，就成为葛根汤。所以营卫、肌肉是有次级的。桂枝、芍药、甘草、生姜、大枣用于止汗；麻黄、桂枝、甘草、生姜用于发汗。葛根气味轻薄，单独加入一味，并非为了发汗或止汗，而是通过葛根来解肌，所以名叫葛根汤。钱乙（钱仲阳）创制升麻汤，治疗伤寒温疫风热壮热、头痛体痛、疮疹已发或未发，用葛根为君药，升麻为佐药，甘草、芍药安定其中气。朱肱（朱奉议）在《活人书》中，将升麻汤列为阳明经解表方。如果我诊断杨氏妇是阳明标本俱实，先攻其里，后泻经络中风热，所以用升麻汤加黄连，以寒治热。尼长老是阳明标本俱虚寒，先充实其里，其次调理经络，用升麻汤加附子，以热治寒。张仲景是群方之祖，确实可信啊。
Ms. Yang, the wife of Physician Yang, was fifty-one years old. She had a robust and obese physique. In the spring of the Jiyi year, she suffered from dizziness and heaviness in the head and eyes, along with significant facial redness and heat. After taking medicines to clear the upper jiao without effect, she sought my treatment. Her pulse was surging (Hong) and forceful. The *Neijing* states: "Facial heat indicates disease of the Foot-Yangming channel." The *Maijing* states: "When Qi of the Yangming channel is excessive and surplus, the anterior aspect of the body becomes hot." Moreover, this person habitually consumed rich and sweet foods, leading to accumulated heat in the Stomach. The Yangming channel is abundant in blood and Qi; when the root is excess, wind-heat ascends. All Yang channels converge at the head, thus giving rise to the condition of facial heat. Initially, I administered Tiaowei Chengqi Tang (Regulate the Stomach and Order the Large Intestine Decoction) 7 qian, Huanglian (Coptidis Rhizoma) 2 qian, and Xijiao (Rhinocerotis Cornu) 1 qian to promote unblocking and purgation two or three times, thereby eliminating the root heat. Subsequently, Shengma Jia Huanglian Tang (Cimicifugae Decoction with Added Coptidis Rhizoma) was used to dispel wind-heat ascending through the collaterals. In this manner, both the root and branch pathogenic factors were resolved.
[Shengma Jia Huanglian Tang]
Shengma (Cimicifugae Rhizoma), Gegen (Puerariae Lobatae Radix) [each 1 qian]; Baizhi (Angelicae Dahuricae Radix), Huanglian (Coptidis Rhizoma) [each 0.7 qian]; Zhigancao (Glycyrrhizae Radix et Rhizoma Preparatum), Caodoukou (Amomi Fructus Rotundus), Renshen (Ginseng Radix et Rhizoma) [each 0.5 qian]; Heifu (Aconiti Lateralis Radix Praeparata) [processed, 0.7 qian]; Yizhi (Alpiniae Oxyphyllae Fructus) [0.3 qian].
The above nine herbs are cut into pieces. Prepare as one dose. Add three cups of water and the white parts of green onion roots (Congbai). Simmer until one cup remains, strain, and take warm. Several doses lead to good recovery.
Someone asked: "What is the basis for using Shengma Tang added with Huanglian to treat facial heat, and added with Fuzi to treat facial cold?" I replied: "It originates from Zhang Zhongjing. Yunqizi, in his commentary on the differentiation of Gegen Tang in Zhang Zhongjing's *Shanghan Lun*, stated: 'When both Cun and Chi pulses are long, it indicates disease of the Yangming channel. It should manifest after two or three days because the channel connects the nose and orbits the eyes; thus, there is body heat, eye pain, nasal dryness, and inability to lie down comfortably. This is disease of the Yangming channel.' The channel starts at the nose, meets at the forehead, and runs from the head to the feet along the anterior aspect of the body, representing the interior of the exterior. Yangming has heat at the branch and excess at the root. From the branch perspective, the pulse is floating and long; from the root perspective, it is deep and excess. Diseases of Yangming are characterized by steaming heat (Zhengzheng re), aversion to cold being absent. Body heat is the branch manifestation; Yangming root excess refers to dryness in the Stomach. Nasal dryness and eye pain are diseases of the muscle layer (the root of the muscles). Severe internal heat implies that if the pathology is at the 'root' (excess), sweating is contraindicated; inducing sweat may transform the condition into Jaundice. However, purgation is not contraindicated for root excess. Taiyang governs the exterior, which is Ying and Wei. Below Ying and Wei, the muscles belong to Yangming. When Taiyang and Yangming diseases occur simultaneously (Er Yang Bing), Gegen Tang is indicated. For Wei, Guizhi Tang is used; for Ying, Mahuang Tang is used. Within Ying and Wei, Guizhi Mahuang Ge Ban Tang is used. Below Ying and Wei, in the muscle layer, Gegen Tang is used, also known as Jiemi Tang (Muscle-Releasing Decoction). Thus, Yangming is the root of the muscles, and its treatment is not solely focused on inducing or stopping sweat. Combining Guizhi Tang and Mahuang Tang creates a unified formula; adding Gegen transforms it into Gegen Tang. Therefore, Ying/Wei and muscles have a hierarchical relationship. Guizhi, Shaoyao, Gancao, Shengjiang, and Dazao stop sweat; Mahuang, Guizhi, Gancao, and Shengjiang induce sweat. Gegen has a thin aroma and is added singly not to induce or stop sweat, but to release the muscles via Gegen, hence the name Gegen Tang. Qian Yi (Qian Zhongyang) formulated Shengma Tang to treat severe heat from wind-heat in Shanghan and Wenyi, headache, body ache, and eruptive diseases before or after eruption. He used Gegen as the Sovereign herb, Shengma as the Assistant herb, and Gancao and Shaoyao to stabilize the Middle Qi. Zhu Gongyi listed Shengma Tang in his *Huoren Shu* as a solution for the Yangming channel. In my diagnosis of Ms. Yang, since both the root and branch of Yangming were excess, I first attacked the interior, then drained wind-heat from the collaterals. Hence, I used Shengma Tang added with Huanglian, employing cold to treat heat. In contrast, Elder Ni presented with deficiency-cold in both root and branch of Yangming; I first fortified the interior, then regulated the collaterals, using Shengma Tang added with Fuzi, employing heat to treat cold. Zhang Zhongjing, the ancestor of all formulas, is indeed trustworthy."