经曰。二日阳明受之。阳明主肉。其脉挟鼻络于目。故身热目疼而鼻干不
得卧也。三日少阳受之。少阳主胆。其脉循胁络于耳。故胸胁痛而耳聋。夫
同是受寒。不日一日。独日二日三日者。盖传经之邪居多。而自感者少。自
感则寒。传经则热。仲景用葛根汤小柴胡汤主二经之病。节庵一曰解肌。
一曰和解。又谓不从标本从乎中治。固知非若太阳汗之而愈也。学人其
可执乎。然二经亦有自感者。如阳明为邪。首面大肿。少阳为邪。耳前后肿。
此不从太阳传入。而发热与伤寒无异。东垣用普济消毒饮子。及鼠粘子
汤。治之。盖阳明主燥。少阳主火。非比太阳属寒水之司。故治各不同也。
按寒邪入里。未有不传阳明。乃阳明腑病。非阳明之经也。阳明者胃也。
胃为水谷之海。一受寒邪。则水谷不行。为热。为渴。为胀满。甚则谵语狂
言。皆其邪也。治之者。不可过汗以竭其液。一也不可早下以伤其阴。二
也。不可寒凉以阻其化。三也。宜以葛根平胃加减调之。若少阳一经。属
木有火。为呕。为声。为寒热往来。则以小柴胡汤为主。女子临经即谓热
入血室。甚则谵语。加生地丹皮。乃至正之法也。尤不可汗下。
一阳明传变至多。治之贵乎得宜。寒则凝而食不化。热则燥而液愈亡。故
止渴用葛粉以鼓舞胃气。胜于花粉知母。平胃用浓朴以温中州。非比
木香豆蔻。如在上用桔梗枳壳。在下用枳实青皮。而甘草调中。陈皮理
气。山楂莱菔消滞之类。虽极平和。实至当不易之常理也。然有饮食伏
于中。而不显于脉症者。有脉症似乎饮食。而实非饮食为患。乃中气虚
所致。则又当细问其病因。察其脉色舌苔。按其胸腹有无痛处。大便曾
解不解。或补或泻。出一定之见以疗之。方为得耳。
葛根汤
葛根（一钱半） 麻黄（一钱） 桂枝 芍药 甘草（各六分）
加姜枣水煎。此方治太阳无汗恶风。太阳阳明合病。如阳明腑病。不可概用。
小柴胡汤
柴胡（二钱） 黄芩 人参 半夏（各一钱） 甘草（五分）
加姜枣水煎服。
加味小柴胡汤（即前方加生地丹皮各一钱）
普济消毒饮子
黄芩（酒炒） 黄连（各八分焙） 人参 橘红 玄参
甘草（生用） 连翘 牛蒡子（炒研） 桔梗 柴胡
僵蚕（炒） 薄荷（各五分） 板蓝根 马屁勃 升麻（各二分）
水煎服。（便秘酒煨大黄一钱）
鼠粘子汤
牛蒡子（焙研） 枳壳 甘草（炙） 柴胡 连翘 黄芩 桔梗（各一钱） 薄荷叶（二钱）
水煎
《黄帝内经》说：第二天阳明经受邪。阳明经主管肌肉，其经脉夹行于鼻旁并联络眼部，所以出现身体发热、眼睛疼痛、鼻子干燥且无法安卧的症状。第三天少阳经受邪。少阳经主管胆腑，其经脉循行于胁肋部并联络耳部，所以出现胸胁疼痛和耳聋的症状。同样是感受寒邪，不说是第一天受邪，而特别说是第二天、第三天，这是因为多是邪气由一经传入另一经（传经），而直接感受外邪（自感）的情况较少。直接感受外邪则表现为寒证，传经而来的邪气则多化为热证。张仲景用葛根汤和小柴胡汤来主治这两经的病证。节庵先生（戴元礼）说，一个是解肌发表，一个是和解枢机，又说不从标本论治而从“中治”（调和）。这确实说明这两经的病不像太阳病那样通过发汗就能痊愈。学习中医的人难道可以固执己见吗？然而这两经也有直接感受外邪的情况。比如阳明经受邪，会出现头面部大面积肿胀；少阳经受邪，会出现耳朵前后肿胀。这种情况不是从太阳经传入的，但发热症状与伤寒无异。李东垣用普济消毒饮子和鼠粘子汤来治疗。这是因为阳明经主燥，少阳经主火，不像太阳经属于寒水之司，所以治疗方法各不相同。
按：寒邪侵入体内，没有不传入阳明的，但这指的是阳明腑病，而不是阳明经病。阳明经对应的是胃。胃是受纳水谷的海，一旦受到寒邪侵袭，水谷运化就会停滞，进而产生热象、口渴、腹胀满，严重时甚至出现说胡话、狂言乱语等症状，这些都是邪气作祟所致。治疗时，不可过度发汗以耗竭津液，这是第一点禁忌；也不可过早使用泻下法以损伤阴液，这是第二点禁忌；更不可滥用寒凉药物以阻碍阳气的气化功能，这是第三点禁忌。适宜用葛根平胃散加减来调理。至于少阳一经，五行属木，内寄相火，症状表现为呕吐、有声息异常、寒热往来等，应以小柴胡汤为主方。女子在经期若感受邪气，称为“热入血室”，严重时会出现说胡话的症状，此时在小柴胡汤基础上加入生地黄、牡丹皮，这是符合正法的治法。尤其不可使用发汗或泻下法。
阳明经的病传变非常多，治疗贵在得当。寒邪会导致凝滞而食物不消化，热邪会导致燥结而津液更加亡失。所以止渴用葛根粉来鼓舞胃气，比天花粉、知母更好；平胃（调和脾胃）用厚朴来温运中焦，不同于木香、豆蔻。如果病位在上，用桔梗、枳壳；病位在下，用枳实、青皮；再用甘草调和中间，陈皮理气，山楂、莱菔子消除食滞等等。这些方法虽然极其平和，但实际上是恰当且不易改变的常理。然而，有的患者饮食积滞伏留于中焦，但在脉象和症状上并不明显；有的脉症看似饮食积滞，实际上并非饮食为患，而是中气虚弱所致。这时就应当仔细询问病因，观察脉象、面色和舌苔，按压胸腹部看是否有痛点，大便是否曾排出等。根据情况决定是用补法还是泻法，拿出确定的见解来治疗，这才是得法。
葛根汤
葛根（一钱半） 麻黄（一钱） 桂枝 芍药 甘草（各六分）
加生姜、大枣，用水煎煮。此方用于治疗太阳病无汗恶风，以及太阳阳明合病。如果是阳明腑病，不可一概使用。
小柴胡汤
柴胡（二钱） 黄芩 人参 半夏（各一钱） 甘草（五分）
加生姜、大枣，用水煎煮服用。
普济消毒饮子
黄芩（酒炒） 黄连（各八分焙干） 人参 橘红 玄参
甘草（生用） 连翘 牛蒡子（炒后研碎） 桔梗 柴胡
僵蚕（炒） 薄荷（各五分） 板蓝根 马屁勃 升麻（各二分）
用水煎煮服用。（若便秘，加酒煨大黄一钱）
The *Classic of Medicine* (Huangdi Neijing) states: On the second day, the Yangming channel is affected. The Yangming channel governs the flesh and its vessels run alongside the nose and connect to the eyes. Therefore, symptoms include fever, eye pain, dryness of the nose, and inability to lie down comfortably. On the third day, the Shaoyang channel is affected. The Shaoyang channel governs the Gallbladder, and its vessels follow the hypochondrium and connect to the ears. Therefore, symptoms include pain in the chest and hypochondrium, and deafness. Although both are caused by cold pathogenic factors, the text specifies the second and third days rather than the first because this usually indicates transmission of pathogens from one channel to another (transmission disease), whereas direct contraction (self-infection) is less common. Direct contraction manifests as cold syndromes, while transmitted pathogens tend to transform into heat. Zhang Zhongjing used Gegen Tang (Kudzu Decoction) and Xiaochaihu Tang (Minor Bupleurum Decoction) to treat diseases of these two channels. Jie'an (Dai Yuanli) stated that one method resolves the muscle layer (jieji), while the other harmonizes the pivot (hejie). He also mentioned treating according to the "middle" rather than following the root or branch strictly. This indeed indicates that these conditions do not heal simply through sweating like Taiyang diseases. Can students of medicine be dogmatic? However, there are cases of direct infection in these two channels. For instance, when the Yangming channel is invaded, massive swelling of the head and face occurs; when the Shaoyang channel is invaded, swelling occurs around the ears. These cases do not transmit from the Taiyang channel, yet the fever is indistinguishable from Shanghan (cold damage). Li Dongyuan treated such conditions with Puji Xiaodu Yinzi (Universal Benefit Detoxification Decoction) and Shuniuzi Tang (Arctostaphyli Seed Decoction). This is because the Yangming channel governs dryness, and the Shaoyang channel governs fire, unlike the Taiyang channel which is governed by cold water. Thus, treatments differ accordingly.
Note: When cold pathogens enter the interior, they invariably transmit to the Yangming, but this refers to Yangming Fu-organ disease, not Yangming Jing-channel disease. The Yangming channel corresponds to the Stomach. The Stomach is the sea of water and grain. Once invaded by cold pathogens, the digestion and transportation of water and grain stagnate, leading to heat, thirst, abdominal distension, and in severe cases, delirium and manic speech. These are all manifestations of the pathogen. In treatment, one must not induce excessive sweating to deplete fluids (Taboo 1); one must not use purgatives too early to injure Yin (Taboo 2); and one must not use overly cold and bitter substances to obstruct physiological transformation (Taboo 3). It is appropriate to regulate using Gegen Pingwei San (Pueraria and Stomach-Ping Powder) with modifications. As for the Shaoyang channel, it belongs to Wood and contains Ministerial Fire. Symptoms include vomiting, abnormal sounds, and alternating chills and fever. The primary formula should be Xiaochaihu Tang (Minor Bupleurum Decoction). If a woman contracts the pathogen during her menstrual period, it is termed "Heat Entering the Blood Chamber," which may lead to delirium in severe cases. Adding Shengdihuang (Rehmanniae Radix) and Mudanpi (Moutan Cortex) constitutes orthodox treatment. Sweating and purging are particularly contraindicated.
Yangming diseases have numerous variations, so treatment must be appropriate. Cold causes stagnation and indigestion; heat causes dryness and further fluid loss. Therefore, using Gegen Fen (Puerariae Radix Powder) to quench thirst and stimulate Stomach Qi is superior to Huafen (Trichosanthis Radix) and Zhimu (Anemarrhenae Rhizoma). To calm the stomach, Houpo (Magnoliae Officinalis Cortex) is used to warm the middle jiao, differing from Muxiang (Aucklandiae Radix) and Doukou (Amomi Fructus Rotundus). For upper body issues, Jiegeng (Platycodonis Radix) and Zhike (Aurantii Fructus Immaturus) are used; for lower body issues, Zhishi (Aurantii Fructus Immaturus) and Qingpi (Citri Reticulatae Pericarpium Viride) are used. Gancao (Glycyrrhizae Radix et Rhizoma) harmonizes the center, Chenpi (Citri Reticulatae Pericarpium) regulates Qi, and ShanZha (Crataegi Fructus) and Laifuzi (Raphani Semen) eliminate food stagnation. Although these methods are extremely mild, they represent sound and unchangeable principles. However, some patients have food retention hidden in the middle jiao without obvious pulse or symptom manifestations. Conversely, some pulse and symptom patterns resemble food retention but are actually caused by deficiency of Middle Qi. In such cases, one must carefully inquire about the cause, observe the pulse, complexion, and tongue coating, palpate the chest and abdomen for tenderness, and check bowel movements. Based on these findings, decide whether to tonify or purge, forming a definitive judgment to treat the patient. This is the correct approach.
Gegen Tang (Kudzu Decoction)
Gegen (Puerariae Radix) (1.5 qian) Mahuang (Ephedrae Herba) (1 qian) Guizhi (Cinnamomi Ramulus) Shaoyao (Paeoniae Radix) Gancao (Glycyrrhizae Radix et Rhizoma) (each 0.6 qian)
Decoct with Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus) in water. This formula treats Taiyang syndrome with no sweat and aversion to wind, as well as combined Taiyang-Yangming disease. It should not be used indiscriminately for Yangming Fu-organ disease.
Xiaochaihu Tang (Minor Bupleurum Decoction)
Chaihu (Bupleuri Radix) (2 qian) Huangqin (Scutellariae Radix) Renshen (Ginseng Radix) Banxia (Pinelliae Rhizoma) (each 1 qian) Gancao (Glycyrrhizae Radix et Rhizoma) (0.5 qian)
Decoct with Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus) in water and take orally.
Jiawei Xiaochaihu Tang (Modified Minor Bupleurum Decoction)
(Add Shengdihuang (Rehmanniae Radix) and Mudanpi (Moutan Cortex) each 1 qian to the above formula)
Puji Xiaodu Yinzi (Universal Benefit Detoxification Decoction)
Huangqin (Scutellariae Radix) (wine-fried) Huanglian (Coptidis Rhizoma) (each 0.8 qian, roasted) Renshen (Ginseng Radix) Juhong (Citri Reticulatae Pericarpium Rubrum) Xuanshen (Scrophulariae Radix)
Gancao (Glycyrrhizae Radix et Rhizoma) (raw) Lianqiao (Forsythiae Fructus) Niubangzi (Arctostaphyli Fructus) (fried and crushed) Jiegeng (Platycodonis Radix) Chaihu (Bupleuri Radix)
Jiangcan (Bombyx Batryticatus) (fried) Bohe (Menthae Haplocalycis Herba) (each 0.5 qian) Banlangen (Isatidis Radix) Mapibo (unknown, likely a local herb variant) Shengma ( Cimicifugae Rhizoma) (each 0.2 qian)
Decoct in water and take orally. (If constipated, add Dahuang (Rhei Radix et Rhizoma) fried with wine, 1 qian).
Shuniuzi Tang (Arctostaphyli Seed Decoction)
Niubangzi (Arctostaphyli Fructus) (roasted and crushed) Zhike (Aurantii Fructus Immaturus) Gancao (Glycyrrhizae Radix et Rhizoma) (honey-fried) Chaihu (Bupleuri Radix) Lianqiao (Forsythiae Fructus) Huangqin (Scutellariae Radix) Jiegeng (Platycodonis Radix) (each 1 qian) Boheye (Menthae Haplocalycis Herba) (2 qian)
Decoct in water.