问曰。病有太阳阳明。有正阳阳明。有少阳阳明。何谓也。答曰。太阳阳明者。脾
约是也。
阳明。胃也。邪自太阳经传之入腑者。谓之太阳阳明。经曰。太阳病。若吐。若下。
若发汗后微烦。小便数。大便因硬者。与小承气汤。即是太阳阳明、脾约病也。
正阳阳明者。胃家实是也。
邪自阳明经传入腑者。谓之正阳阳明。经曰。阳明病脉迟。虽汗出。不恶寒。其身
必重。短气。腹满而喘。有潮热者。外欲解。可攻里也。手足 然汗出者。此大便已
硬也。大承气汤主之。即是正阳阳明胃家实也。
少阳阳明者。发汗。利小便已。胃中燥、烦、实、大便难。是也。
邪自少阳经。传之入腑者。谓之少阳阳明。经曰。伤寒脉弦细。头痛。发热者。属少
阳。少阳不可发汗。发汗则谵语。此属胃。即是少阳阳明病也。
阳明之为病。胃家实也。
邪传入胃。热毒留结。则胃家为实。华佗曰。热毒入胃。要须下去之。不可留于胃
中。是知邪在阳明。为胃家实也。
问曰。何缘得阳明病。答曰。太阳病。发汗。若下。若利小便。此亡津液。胃中干
燥。因转属阳明。不更衣。内实。大便难者。此名阳明也。
本太阳病。不解。因汗利小便亡津液。胃中干燥。太阳之邪入腑。转属阳明。古人
登厕必更衣。不更衣者。通为不大便。不更衣。则胃中物不得泄。故为内实。胃无
津液。加之蓄热。大便则难。为阳明里实也。
问曰。阳明病外证云何。答曰。身热、汗自出。不恶寒。反恶热也。
阳明病。为邪入腑也。邪在表。则身热汗出而恶寒。邪既入腑。则表证已罢。故不
恶寒。但身热汗出而恶热也。
问曰。病有得之一日。不发热而恶寒者。何也。答曰。虽得之一日。恶寒将自罢。即
自汗出而恶热也。
邪客在阳明。当发热而不恶寒。今得之一日。犹不发热而恶寒者。即邪未全入腑。尚
带表邪。若表邪全入。则更无恶寒。必自汗出而恶热也。
问曰。恶寒何故自罢。答曰。阳明居中。土也。万物所归。无所复传。始虽恶寒。二
日自止。此为阳明病也。
胃为水谷之海。主养四旁。四旁有病。皆能传入于胃。入胃。则更不复传。如太阳
传之入胃。则更不传阳明。阳明病传之入胃。则更不传少阳。少阳病传之入胃。则更不
传三阴。
本太阳初得病时。发其汗。汗先出不彻。因转属阳明也。
伤寒传经者。则一日太阳。二日阳明。此太阳传经。故曰转属阳明。
伤寒发热。无汗。呕不能食。而反汗出 然者。是转属阳明也。
伤寒发热无汗。呕不能食者。太阳受病也。若反汗出 然者。太阳之邪。转属阳
明也。经曰。阳明病。法多汗。
伤寒三日。阳明脉大。
伤寒三日。邪传阳明之时。经日。尺寸俱长者。阳明受病。当二三日发。阳明气血
俱多。又邪并于经。是以脉大。
伤寒。脉浮而缓。手足自温者。是为系在太阴。太阴者。身当发黄。若小便自利者。
不能发黄。至七八日。大便硬者。为阳明病也。
浮为阳邪。缓为脾脉。伤寒脉浮缓。太阴客热。邪在三阳。则手足热。邪在三阴。则
手足寒。今手足自温。是知系在太阴也。太阴。土也。为邪蒸之。则色见于外。当发身
黄。小便自利者。热不内蓄。不能发黄。至七八日。大便硬者。即太阴之邪入腑。转属
阳明也。
伤寒转系阳明者。其人 然微汗出也。
伤寒则无汗。阳明法多汗。此以伤寒邪。转系阳明。故 然微汗出。
阳明中风。口苦。咽干。腹满。微喘。发热恶寒。脉浮而紧。若下之。则腹满小便
难也。
脉浮在表。紧为里实。阳明中风。口苦、咽干、腹满、微喘者。热传于里也。发热
恶寒者。表仍未解也。若下之。里邪虽去。表邪复入于里。又亡津液。故使腹满而小便
难。
娄氏云。阳明宜下。先列在经与里虚不宜下者于前。仲景慎重之意可见。
阳明病。若能食。名中风。不能食。名中寒。
阳明病。以饮食别受风寒者。以胃为水谷之海。风为阳邪。阳杀谷。故中风者能食。
寒为阴邪。阴邪不杀谷。故伤寒者不能食。
阳明病。若中寒不能食。小便不利。手足 然汗出。此欲作固瘕。必大便初硬后溏。所以然者。以胃中冷。水谷不
别故也。
阳明中寒不能食者。寒不杀谷也。小便不利者。津液不化也。阳明病。法多汗。则
周身汗出。此手足 然而汗出。而身无汗者。阳明中寒也。固瘕者。寒气结积也。胃中
寒甚。欲留结而为固瘕。则津液不得通行。而大便必硬者。若汗出。小便不
利者。为实也。此以小便不利。水谷不别。虽大便初硬。后必溏也。
阳明病。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。 然汗出而解者。此
水不胜谷气。与汗共并。脉紧则愈。
阳病客热。初传入胃。胃热。则消谷而欲食。阳明病。热为实者。则小盒饭数。大便
当硬。今小便反不利。大便自调者。热气散漫。不为实也。欲食。则胃中谷多。内经曰。
食入于阴。长气于阳。谷多则阳气胜。热消津液。则水少。经曰。水入于经。其血乃成。
水少。则阴血弱。金匮要略曰。阴气不通。即骨疼。其人骨节疼者。阴气不足也。热甚
于表者。翕翕发热。热甚于里者。蒸蒸发热。此热气散漫。不专着于表里。故翕翕如有
热状。奄、忽也。忽然发狂者。阴不胜阳也。内经曰。阴不胜其阳者。则脉流薄疾。并
乃狂。阳明蕴热为实者。须下之愈。热气散漫。不为实者。必待汗出而愈。故云 然而
汗出解也。水谷之等者。阴阳气平也。水不胜谷气。是阴不胜阳也。汗出。则阳气衰。
脉紧。则阴气生。阴阳气平。两无偏胜。则愈。故云与汗共并。脉紧则愈。
阳明病。欲解时。从申至戌止。
四月为阳。土旺于申酉戌。向旺时。是为欲解。
阳明病。不能食。攻其热。必哕。所以然者。胃中虚冷故也。以其人本虚。故攻其
热必哕。
不能食。胃中本寒。攻其热。复虚其胃。虚寒相搏。故令哕也。经曰。关脉弱。胃
气虚。有热。不可大攻之。热去则寒起。此之谓也。
阳明病。脉迟。食难用饱。饱则微烦。头眩。必小便难。此欲作谷疸。虽下之。腹
满如故。所以然者。脉迟故也。
阳明病。脉迟。则邪方入里。热未为实也。食入于阴。长气于阳。胃中有热。食难
用饱。饱则微烦而头眩者。谷气与热气相搏也。两热相合。消搏津液。必小便难。利者。
不能发黄。言热得泄也。小便不利。则热不得泄。身必发黄。疸、黄也。以其发于谷气
之热。故名谷疸。热实者。下之则愈。脉迟为热气未实。虽下之。腹满亦不减也。经曰。
脉迟尚未可攻。
张卿子云。此条同愈后损谷则愈症。由胃虚食郁致热。故曰谷疸。成注先云胃中有
热。食难用饱。则与脉迟故也句似失之。
阳明病。法多汗。反无汗。其身如虫行皮中状者。此以久虚故也。
胃为津液之府。气虚津液少。病则反无汗。胃候身之肌肉。其身如虫行皮中者。知
胃气久虚也。
阳明病。反无汗而小便利。二三日。呕而咳。手足厥者。必苦头痛。若不咳。不呕。
手足不厥者。头不痛。
阳明病法多汗。反无汗而小便利者。阳明伤寒而寒气内攻也。至二三日呕咳而支厥
者。寒邪发于外也。必苦头痛。若不咳。不呕。手足不厥者。是寒邪但攻里而不外发。
其头亦不痛也。
阳明病。但头眩。不恶寒。故能食而咳。其人必咽痛。若不咳者。咽不痛。
阳明病。身不重痛。但头眩而不恶寒者。阳明中风而风气内攻也。经曰。阳明病。
若能食。名中风。风邪攻胃。胃气上逆。则咳。咽门者。胃之系。咳甚则咽伤。故必咽
痛。若胃气不逆。则不咳。其咽亦不痛也。
阳明病。无汗。小便不利。心中懊 者。身必发黄。
阳明病。无汗而小便不利者。热蕴于内而不得越。心中懊 者。热气郁蒸。欲发
于外而为黄也。
阳明病。被火。额上微汗出。小便不利者。必发黄。
阳明病。则为内热。被火。则火热相合而甚。若遍身汗出而小便利者。热得泄越。
不能发黄。今额上微汗出。而小便不利。则热不得越。郁蒸于胃。必发黄也。
阳明病。脉浮而紧者。必潮热。发作有时。但浮者。必盗汗出。
浮为在经。紧者里实。脉浮而紧者。表热里实也。必潮热。发作有时。若脉但浮而
不紧者。止是表热也。必盗汗出。盗汗者。睡而汗出也。阳明病。里热者自汗。表热者
盗汗。
阳明病。口燥。但欲漱水。不欲咽者。此必衄。
阳明之脉。起于鼻。络于口。阳明里热。则渴欲饮水。此口燥。但欲漱水。不欲咽
者。是热在经而里无热也。阳明气血俱多。经中热甚。迫血妄行。必作衄也。
阳明病。本自汗出。医更重发汗。病已瘥。尚微烦。不了了者。此大便必硬故也。
以亡津液。胃中干燥。故令大便硬。当问其小便日几行。若本小便日三四行。今日再行。
故知大便不久出。今为小便数少。以津液当还入胃中。故知不久必大便也。
先亡津液。使大便硬。小便数少。津液分别。大便必自下也。
伤寒呕多。虽有阳明证。不可攻之。
呕者。热在上焦。未全入腑。故不可下。
阳明病。心下硬满者。不可攻之。攻之。利遂不止者死。利止者愈。
阳明病。腹满者。为邪气入腑。可下之。心下硬满。则邪气尚浅。未全入腑。不可
便下之。得利止者。为邪气去。正气安。正气安则愈。若因下利不止者。为正气脱而死。
阳明病。面合赤色。不可攻之。必发热色黄。小便不利也。
合、通也。阳明病。面色通赤者。热在经也。不可下之。下之。虚其胃气。耗其津
液。经中之热。乘虚入胃。必发热。色黄。小便不利也。
阳明病。不吐。不下。心烦者。可与调胃承气汤。
吐后心烦。谓之内烦。下后心烦。谓之虚烦。今阳明病。不吐不下。心烦。则是胃有
郁热也。与调胃承气汤。以下郁热。
阳明病。脉迟。虽汗出。不恶寒者。其身必重。短气。腹满而喘。有潮热者。此外
欲解。可
攻里也。手足 然而汗出者。此大便已硬也。大承气汤主之。若汗多。微发热恶寒者。
外未解也。其热不潮。未可与承气汤。若腹大满不通者。可与小承气汤。微和胃气。勿
令大泄下。
阳明病。脉迟。若汗出多。微发热恶寒者。表未解也。若脉迟。虽汗出而不恶寒者。
表证罢也。身重短气。腹满而喘。有潮热者。热入腑也。四肢。诸阳之本。津液足。为
热之。则周身汗出。津液不足。为热 之。其手足 然而汗出。知大便已硬也。与大
承气汤。以下胃热。经曰。潮热者实也。其热不潮。是热未成实。故不可便与大承气汤。
虽有腹大满不通之急。亦不可与大承气汤。与小承气汤。微和胃气。
问：疾病有太阳阳明、正阳阳明、少阳阳明，这是什么意思？答：太阳阳明，是指脾约证。
阳明，就是胃。邪气从太阳经传入腑的，称为太阳阳明。医经说：太阳病，如果用吐法、下法或发汗法治疗后，出现轻微心烦，小便频数，大便因此干硬，给予小承气汤治疗，这就是太阳阳明、脾约病。
正阳阳明，是指胃家实证。
邪气从阳明经传入腑的，称为正阳阳明。医经说：阳明病，脉象迟缓，虽然出汗，但不怕冷，身体必定沉重，气短，腹部胀满且喘息，如果有潮热，说明表证将解，可以攻里。如果手足濈然（持续不断地）出汗，这说明大便已经干硬，以大承气汤为主治方剂。这就是正阳阳明胃家实。
少阳阳明，是指经过发汗、利小便治疗后，胃中干燥、烦闷、实热、大便困难的情况。
邪气从少阳经传入腑的，称为少阳阳明。医经说：伤寒病，脉象弦细，头痛，发热的，属于少阳病。少阳病不可发汗，如果发汗则会出现谵语，这属于胃（阳明），这就是少阳阳明病。
阳明病的提纲是：胃家实。
邪气传入胃，热毒留结，导致胃家成为实证。华佗说：热毒入胃，必须将其祛除，不可留在胃中。由此可知，邪在阳明，表现为胃家实。
问：为什么会得阳明病？答：太阳病，经过发汗、攻下或利小便，导致津液耗伤，胃中干燥，因而转属阳明。如果不排便，体内实热，大便困难，这就叫阳明病。
原本的太阳病未愈，因发汗和利小便导致津液耗伤，胃中干燥，太阳的邪气传入腑，转属阳明。古人上厕所必换衣服，“不更衣”通指不大便。不更衣，则胃中的糟粕无法排泄，所以形成内实。胃中没有津液，加上蓄积的热邪，大便就困难，这是阳明里实证。
问：阳明病的外在证候是什么？答：身体发热，自然出汗，不怕冷，反而怕热。
阳明病，是邪气传入腑。邪气在表时，身体发热出汗且怕冷；邪气既已入腑，则表证已罢，所以不怕冷，只是身体发热出汗而怕热。
问：有的病得病一天，不发热却怕冷，这是什么原因？答：即使得病一天，怕冷症状将会自行消失，随即自然出汗而怕热。
邪气客居在阳明，应当发热而不怕冷。现在得病一天，仍然不发热而怕冷，是因为邪气尚未完全入腑，还带有表邪。如果表邪完全入里，就不再怕冷，必然自然出汗而怕热。
问：怕冷为什么会自动停止？答：阳明居中，属土，是万物归聚之所，不再传变。开始虽然怕冷，到第二天就会自行停止，这就是阳明病。
胃是水谷之海，主滋养四周。四周有病，都能传入于胃。进入胃后，就不再传变。如太阳病传入胃，就不再传给阳明；阳明病传入胃，就不再传给少阳；少阳病传入胃，就不再传给三阴。
原本太阳病初起时，发汗不彻底，因而转属阳明。
伤寒传经，是一天太阳，两天阳明。这是太阳传经，所以说转属阳明。
伤寒发热，无汗，呕吐不能进食，反而濈然（持续地）出汗的，是转属阳明。
伤寒发热无汗，呕吐不能进食，是太阳受病。如果反而濈然出汗，是太阳的邪气转属阳明。医经说：阳明病，通常多汗。
伤寒三天，阳明脉大。
伤寒三天，是邪气传至阳明的时候。医经说：寸关尺三部脉都长的，是阳明受病，应当在二三天发作。阳明气血俱多，加上邪气并入经脉，所以脉大。
伤寒，脉浮而缓，手足自温的，这是系在太阴。太阴病，身体应当发黄。如果小便自利，就不能发黄。到了七八天，大便干硬的，就是阳明病。
浮脉代表阳邪，缓脉代表脾脉。伤寒脉浮缓，是太阴客热。邪气在三阳经，则手足热；邪气在三阴经，则手足寒。现在手足自温，可知系在太阴。太阴属土，被邪气蒸腾，颜色见于外表，应当发身黄。小便自利的，热不内蓄，不能发黄。到了七八天，大便干硬的，就是太阴的邪气入腑，转属阳明。
伤寒转系阳明的，病人濈然微汗出。
伤寒本来无汗，阳明通常多汗。这是因为伤寒邪气转系阳明，所以濈然微汗出。
阳明中风，口苦，咽干，腹满，微喘，发热恶寒，脉浮而紧。如果误用下法，会导致腹满和小便困难。
脉浮在表，紧脉代表里实。阳明中风，口苦、咽干、腹满、微喘，是热传于里。发热恶寒，说明表仍未解。如果误用下法，里邪虽去，表邪复入于里，又耗伤津液，所以导致腹满和小便难。
娄氏说：阳明病宜用下法，先列出在经与里虚不宜下法的情况在前面，可见张仲景慎重之意。
阳明病，如果能吃东西，名叫中风；如果不能吃东西，名叫中寒。
阳明病，以饮食情况来辨别受风寒。因为胃是水谷之海，风为阳邪，阳邪能消化谷物，所以中风者能食。寒为阴邪，阴邪不能消化谷物，所以伤寒者不能食。
阳明病，如果中寒不能进食，小便不利，手足濈然出汗，这是将要形成固瘕（一种寒性积聚病），必定大便初硬后溏。之所以这样，是因为胃中寒冷，水谷不分。
阳明中寒不能进食，是因为寒邪不消化谷物。小便不利，是因为津液不化。阳明病，通常多汗，如果是周身汗出，这是阳明中寒的表现，但这里只有手足濈然而汗出，身上无汗。固瘕是寒气结积。胃中寒甚，想要留结而形成固瘕，则津液不得通行，大便必定干硬。如果出汗，小便不利，这是实证。但因为小便不利，水谷不分，虽然大便初硬，后来必定溏薄。
阳明病，想吃饭，小便反而不利，大便正常。病人骨节疼痛，像有发热感，忽然发狂，濈然出汗而痊愈的，这是水不胜谷气，与汗并出。脉紧则愈。
阳病客热，初传入胃，胃热，则消谷而想吃饭。阳明病，热成为实证的，则小便应当频数，大便应当干硬。现在小便反而不利，大便正常，说明热气散漫，没有成为实证。想吃饭，说明胃中谷多。《内经》说：食物进入阴分，助长阳气。谷多则阳气胜，热消津液，则水少。医经说：水进入经脉，血液乃成。水少，则阴血弱。《金匮要略》说：阴气不通，即骨痛。病人骨节疼，是阴气不足。热盛于表的，翕翕发热；热盛于里的，蒸蒸发热。这里热气散漫，不专着于表里，所以像有发热感。“奄”，是忽然的意思。忽然发狂，是阴不胜阳。《内经》说：阴不胜其阳，则脉流急迫，并发为狂。阳明蕴热成为实证，须用下法才能痊愈。热气散漫，没有成为实证的，必须等待出汗才能痊愈。所以说濈然出汗而解。水谷相等，阴阳气平。水不胜谷气，是阴不胜阳。出汗，则阳气衰；脉紧，则阴气生。阴阳气平，两无偏胜，则痊愈。所以说与汗并出，脉紧则愈。
阳明病，欲解的时间，从申时到戌时结束。
四月为阳，土旺于申、酉、戌时。趋向旺盛的时候，就是病欲解之时。
阳明病，不能进食，攻其热，必定呃逆。之所以这样，是因为胃中虚冷。因为病人本身体虚，所以攻其热必定呃逆。
不能进食，胃中本寒，攻其热，又使胃更虚，虚寒相搏，所以导致呃逆。医经说：关脉弱，胃气虚，有热，不可大攻之。热去则寒起，说的就是这个道理。
阳明病，脉迟，吃东西难以吃饱，饱了则轻微心烦，头晕，必定小便难，这是将要形成谷疸。即使使用下法，腹满依旧。之所以这样，是因为脉迟的缘故。
阳明病，脉迟，则邪气正在入里，热尚未成为实证。食物进入阴分，助长阳气。胃中有热，吃东西难以吃饱，饱了则轻微心烦而头晕，是谷气与热气相搏。两热相合，消耗津液，必定小便难。如果小便通利，不能发黄，意思是热得以宣泄。小便不利，则热不得宣泄，身体必定发黄。疸，就是黄。因为发于谷气的热，所以名叫谷疸。热实者，下之则愈。脉迟表示热气未实，即使下之，腹满也不减。医经说：脉迟尚可攻。
张卿子说：此条同愈后损谷则愈症，由胃虚食郁致热，所以叫谷疸。成无己注解说“胃中有热，食难用饱”，这与“脉迟故也”一句似乎失当。
阳明病，通常多汗，反而无汗，身体像虫子在皮肤中爬行一样的感觉，这是因为久虚的缘故。
胃是津液的府库，气虚津液少，生病则反而无汗。胃反映身体的肌肉，身体像虫子在皮肤中爬行，可知胃气久虚。
阳明病，反而无汗而小便通利，两三天后，呕吐且咳嗽，手足厥冷的，必定痛苦于头痛。如果不咳嗽，不呕吐，手足不厥冷，头就不痛。
阳明病通常多汗，反而无汗而小便通利，是阳明伤寒而寒气内攻。到了两三天呕吐咳嗽且手足厥冷，是寒邪发于外。必定痛苦于头痛。如果不咳嗽，不呕吐，手足不厥冷，是寒邪只攻里而不外发，头也不痛。
阳明病，只是头晕，不怕冷，所以能进食且咳嗽，病人必定咽痛。如果不咳嗽，咽就不痛。
阳明病，身体不重痛，只是头晕而不怕冷，是阳明中风而风气内攻。医经说：阳明病，如果能进食，名叫中风。风邪攻胃，胃气上逆，则咳嗽。咽门是胃的系带，咳得厉害则咽受伤，所以必定咽痛。如果胃气不逆，则不咳嗽，咽也不痛。
阳明病，无汗，小便不利，心中懊憹（烦闷不适）的，身体必定发黄。
阳明病，无汗而小便不利，热蕴结于内而不能发散。心中懊憹，是热气郁蒸，想要发于外而发黄。
阳明病，被火疗，额头微微出汗，小便不利的，必定发黄。
阳明病，则是内热。被火疗，则火热相合而更甚。如果遍身出汗而小便通利，热得以宣泄，不能发黄。现在额头微微出汗，而小便不利，则热不得发散，郁蒸于胃，必定发黄。
阳明病，脉浮而紧的，必定有潮热，发作有时。如果脉只浮而不紧的，必定盗汗出。
浮脉代表在经，紧脉代表里实。脉浮而紧，是表热里实。必定有潮热，发作有时。如果脉只浮而不紧，只是表热。必定盗汗出。盗汗，是睡觉时出汗。阳明病，里热者自汗，表热者盗汗。
阳明病，口燥，只想含水漱口，不想吞咽的，这必定会鼻衄（流鼻血）。
阳明的经脉，起于鼻，络于口。阳明里热，则渴欲饮水。现在口燥，只想含水漱口，不想吞咽，是热在经脉而里没有热。阳明气血俱多，经中热甚，迫血妄行，必定发生鼻衄。
阳明病，本来自己出汗，医生更重发汗，病已好转，尚且轻微心烦，神志不清，这是因为大便必定干硬。
因为耗伤津液，胃中干燥，所以令大便干硬。应当询问他每天小便几次。如果原本每天小便三四次，今天只有两次，就知道大便不久会排出。现在小便次数减少，因为津液应当回归胃中，所以知道不久必定大便通畅。
先前耗伤津液，使大便干硬。小便次数减少，津液分别（回归），大便必定自行排出。
伤寒呕吐多的，虽然有阳明证，不可攻下。
呕吐，是热在上焦，未完全入腑，所以不可下。
阳明病，心下硬满的，不可攻下。攻下后，腹泻不止的死亡，腹泻停止的痊愈。
阳明病，腹满的，是邪气入腑，可下之。心下硬满，则邪气尚浅，未完全入腑，不可立即下之。得利止者，为邪气去，正气安，正气安则痊愈。如果因下法导致腹泻不止，为正气脱而死。
阳明病，面色通红，不可攻下。必定发热色黄，小便不利。
“合”，通“全”。阳明病，面色全红的，热在经脉。不可下之。下之，虚其胃气，耗其津液，经中之热，乘虚入胃，必定发热，色黄，小便不利。
阳明病，没有经过吐法、下法，心烦的，可与调胃承气汤。
吐后心烦，叫内烦；下后心烦，叫虚烦。现在阳明病，没有经过吐下，心烦，则是胃有郁热。给予调胃承气汤，以下除郁热。
阳明病，脉迟，虽然出汗，不怕冷，身体必定沉重，气短，腹部胀满且喘息，有潮热的，这是表证将解，可以攻里。手足濈然出汗的，这是大便已经干硬，以大承气汤为主治方剂。如果汗多，轻微发热恶寒的，表证未解。其热不潮，不可给予承气汤。如果腹部大满不通的，可给予小承气汤，轻微调和胃气，不要令其大泄下。
阳明病，脉迟，如果汗出多，轻微发热恶寒的，表未解。如果脉迟，虽然出汗而不怕冷，表证已罢。身重短气，腹满而喘，有潮热的，是热入腑。四肢，是诸阳之本，津液充足，被热所蒸，则周身出汗；津液不足，被热所蒸，则手足濈然而汗出。知道大便已经干硬，给予大承气汤，以下胃热。医经说：潮热者是实证。其热不潮，是热未成实，所以不可立即给予大承气汤。虽然有腹部大满不通的急症，也不可给予大承气汤。给予小承气汤，轻微调和胃气。
Question: There are Taiyang Yangming, Zhengyang Yangming, and Shaoyang Yangming in diseases. What does this mean? Answer: Taiyang Yangming refers to the Pi Yue (Spleen Constriction) syndrome.
Yangming is the Stomach. When pathogenic factors transmit from the Taiyang meridian into the Fu organs, it is called Taiyang Yangming. The Classics state: In a Taiyang disease, if after emesis, purgation, or sweating, there is slight irritability, frequent urination, and consequently hard stools, Xiao Chengqi Tang should be administered. This is exactly the Taiyang Yangming Pi Yue disease.
Zhengyang Yangming refers to the Wei Jia Shi (Stomach House Excess) syndrome.
When pathogenic factors transmit from the Yangming meridian into the Fu organs, it is called Zhengyang Yangming. The Classics state: In a Yangming disease with a slow pulse, although there is sweating, there is no aversion to cold; the body must feel heavy, there is shortness of breath, abdominal fullness, and wheezing. If there is tidal fever, it indicates that the exterior syndrome is about to resolve, and interior attack is permissible. If there is continuous sweating on the hands and feet, this indicates that the feces have already become hard, and Da Chengqi Tang should be used as the main treatment. This is exactly the Zhengyang Yangming Wei Jia Shi.
Shaoyang Yangming refers to the condition where, after sweating and promoting diuresis, the stomach becomes dry, irritable, excess, and difficult to defecate.
When pathogenic factors transmit from the Shaoyang meridian into the Fu organs, it is called Shaoyang Yangming. The Classics state: In a Shanghan (Cold Damage) disease, if the pulse is wiry and thin, accompanied by headache and fever, it belongs to Shaoyang. Shaoyang disease should not be treated with sweating; if sweating is induced, delirium will occur. This belongs to the Stomach (Yangming), which is exactly the Shaoyang Yangming disease.
The general manifestation of Yangming disease is Wei Jia Shi (Stomach House Excess).
When pathogens enter the Stomach and heat toxins remain and knot, the Stomach House becomes excess. Hua Tuo said: Heat toxins entering the Stomach must be expelled downward and cannot remain in the Stomach. Thus, we know that when pathogens are in Yangming, they manifest as Wei Jia Shi.
Question: How does one contract Yangming disease? Answer: In Taiyang disease, if sweating, purgation, or promoting diuresis causes the loss of body fluids, leading to dryness in the Stomach, it subsequently transfers to Yangming. If one does not change clothes (a euphemism for defecating), has internal excess, and difficulty passing stool, this is named Yangming disease.
Originally, a Taiyang disease that did not resolve, due to sweating and promoting diuresis causing fluid loss and Stomach dryness, allows Taiyang pathogens to enter the Fu organs and transfer to Yangming. In ancient times, changing clothes was necessary when using the toilet; "not changing clothes" generally refers to not having a bowel movement. Not defecating means the contents in the Stomach cannot be discharged, resulting in internal excess. With no body fluids in the Stomach and accumulated heat, defecation becomes difficult, constituting an interior excess syndrome of Yangming.
Question: What are the external manifestations of Yangming disease? Answer: Fever, spontaneous sweating, no aversion to cold, but aversion to heat.
Yangming disease involves pathogens entering the Fu organs. When pathogens are at the exterior, there is fever, sweating, and aversion to cold. Once pathogens have entered the Fu organs, the exterior syndrome has ceased, so there is no aversion to cold, only fever, spontaneous sweating, and aversion to heat.
Question: Some patients, on the first day of illness, do not have fever but have aversion to cold. Why is this? Answer: Even if it is the first day, the aversion to cold will cease spontaneously, followed immediately by spontaneous sweating and aversion to heat.
Pathogens lodging in Yangming should cause fever without aversion to cold. Now, on the first day, there is still no fever but aversion to cold because the pathogens have not fully entered the Fu organs and still carry exterior pathogens. If the exterior pathogens fully enter the interior, there will be no more aversion to cold, and there will certainly be spontaneous sweating and aversion to heat.
Question: Why does the aversion to cold cease spontaneously? Answer: Yangming resides in the center and belongs to Earth; it is where all things return and no further transmission occurs. Although there may be initial aversion to cold, it stops spontaneously on the second day. This is Yangming disease.
The Stomach is the sea of water and grain, nourishing the four peripheries. Diseases in the four peripheries can all transmit to the Stomach. Once in the Stomach, it does not transmit further. For example, if Taiyang transmits to the Stomach, it does not transmit to Yangming; if Yangming transmits to the Stomach, it does not transmit to Shaoyang; if Shaoyang transmits to the Stomach, it does not transmit to the Three Yin meridians.
Originally, when Taiyang disease first occurred, if sweating was induced but not thorough, it subsequently transferred to Yangming.
In the transmission of meridians in Shanghan, it is one day Taiyang, two days Yangming. This is Taiyang transmitting through meridians, hence it is said to transfer to Yangming.
In Shanghan with fever, no sweating, vomiting, inability to eat, but instead continuous sweating, this is transferring to Yangming.
Shanghan with fever, no sweating, vomiting, and inability to eat indicates Taiyang involvement. If instead there is continuous sweating, the Taiyang pathogens are transferring to Yangming. The Classics state: Yangming disease typically presents with much sweating.
Three days into Shanghan, the Yangming pulse is large.
Three days into Shanghan is when pathogens transmit to Yangming. The Classics state: If the pulses at Cun, Guan, and Chi are all long, Yangming is affected, and symptoms should appear on the second or third day. Yangming has abundant Qi and Blood, and since pathogens merge into the meridians, the pulse is large.
In Shanghan, if the pulse is floating and moderate, and the hands and feet are naturally warm, this is related to Taiyin. In Taiyin disease, the body should develop jaundice. If urination is normal, jaundice cannot develop. By the seventh or eighth day, if the stool becomes hard, it is Yangming disease.
A floating pulse indicates exterior pathogens; a moderate pulse indicates the Spleen pulse. In Shanghan, a floating and moderate pulse indicates latent heat in Taiyin. When pathogens are in the Three Yang meridians, the hands and feet are hot; when in the Three Yin meridians, the hands and feet are cold. Now, the hands and feet are naturally warm, indicating relation to Taiyin. Taiyin belongs to Earth; steamed by pathogens, color appears externally, leading to jaundice. If urination is normal, heat does not accumulate internally, so jaundice does not develop. By the seventh or eighth day, if the stool becomes hard, it means Taiyin pathogens have entered the Fu organs and transferred to Yangming.
When Shanghan transfers to Yangming, the patient has continuous slight sweating.
Shanghan typically has no sweating, while Yangming typically has much sweating. Because Shanghan pathogens transfer to Yangming, there is continuous slight sweating.
Yangming Fengzhong (Wind Strike), with bitter taste in the mouth, dry throat, abdominal fullness, slight wheezing, fever, aversion to cold, and a floating, tight pulse. If purgation is used, it will result in abdominal fullness and difficulty urinating.
A floating pulse indicates the exterior; a tight pulse indicates interior excess. In Yangming Fengzhong, bitter taste, dry throat, abdominal fullness, and slight wheezing indicate heat transmitting to the interior. Fever and aversion to cold indicate the exterior is not yet resolved. If purgation is used, although interior pathogens are removed, exterior pathogens re-enter the interior, and body fluids are lost, causing abdominal fullness and difficulty urinating.
Lou stated: Yangming disease is suitable for purgation. Listing cases unsuitable for purgation (those in the meridians or with interior deficiency) first shows Zhang Zhongjing's prudence.
In Yangming disease, if the patient can eat, it is named Fengzhong (Wind Strike); if unable to eat, it is named Zhonghan (Cold Strike).
In Yangming disease, dietary intake distinguishes wind vs. cold strike. Since the Stomach is the sea of water and grain, and Wind is a Yang pathogen that aids digestion, those struck by Wind can eat. Cold is a Yin pathogen that does not aid digestion, so those struck by Cold cannot eat.
In Yangming disease, if struck by Cold and unable to eat, with difficulty urinating and continuous sweating on the hands and feet, this is about to form Gujia (solid accumulation). The stool will likely be hard initially and loose later. This is because the Stomach is cold, failing to separate water and grain.
In Yangming Zhonghan, inability to eat is because Cold does not digest grain. Difficulty urinating is because body fluids are not transformed. Yangming disease typically has much sweating; if it were whole-body sweating, it would be Yangming Zhonghan. Here, only the hands and feet sweat continuously while the body is dry, indicating Yangming Zhonghan. Gujia is cold qi accumulation. Severe Stomach cold desires to remain and knot to form Gujia, preventing body fluids from circulating, making the stool hard. If sweating occurs and urination is difficult, it is excess. However, due to difficult urination and failure to separate water and grain, although the stool is hard initially, it will eventually become loose.
In Yangming disease, if the patient desires food, but urination is unexpectedly difficult and the stool is normal, and the patient experiences bone joint pain, feels like having a fever, suddenly goes mad, and then resolves with continuous sweating, this is because Water cannot overcome Grain Qi, merging with sweat. A tight pulse indicates recovery.
Exterior pathogens' heat initially enters the Stomach; Stomach heat digests grain and causes desire to eat. In Yangming disease, if heat becomes excess, urination should be frequent and stool hard. Now, urination is difficult and stool is normal, indicating heat is scattered and not excess. Desire to eat means much grain in the Stomach. The Inner Canon states: Food enters Yin and boosts Yang. Much grain means Yang Qi prevails; heat consumes body fluids, reducing Water. The Classics state: Water enters the meridians, and blood is formed. Less Water means weak Yin Blood. Jingui Yaolue states: Obstruction of Yin Qi causes bone pain. Bone joint pain indicates insufficient Yin Qi. Heat severe at the exterior causes mild fever; heat severe at the interior causes steaming fever. Here, heat is scattered, not fixed at exterior or interior, hence feeling like mild fever. "Yan" means sudden. Sudden madness indicates Yin cannot overcome Yang. The Inner Canon states: If Yin cannot overcome Yang, the pulse flows rapidly, leading to madness. If Yangming heat is excess, purgation cures it. If heat is scattered and not excess, resolution requires sweating. Hence, resolving with continuous sweating. Equal amounts of water and grain mean balanced Yin and Yang Qi. Water not overcoming Grain Qi means Yin not overcoming Yang. Sweating reduces Yang Qi; a tight pulse generates Yin Qi. Balanced Yin and Yang Qi, with neither prevailing, leads to recovery. Hence, merging with sweat and a tight pulse indicates recovery.
Yangming disease tends to resolve from Shen hour (3-5 PM) to Xu hour (7-9 PM).
The fourth month is Yang; Earth prospers at Shen, You, and Xu hours. Approaching prosperity is when the disease tends to resolve.
In Yangming disease, if the patient cannot eat and heat is attacked, hiccups will definitely occur. This is because the Stomach is deficient and cold. Since the person is originally deficient, attacking heat will definitely cause hiccups.
Inability to eat indicates original Stomach cold. Attacking heat further weakens the Stomach; deficiency and cold contend, causing hiccups. The Classics state: A weak Guan pulse indicates deficient Stomach Qi. If there is heat, do not attack heavily. Removing heat leaves cold behind; this is what is meant.
In Yangming disease, with a slow pulse, eating makes one unable to finish a meal; fullness brings slight irritability and dizziness, and definitely difficulty urinating. This is about to form Gudanz (Grain Jaundice). Even if purgation is used, abdominal fullness remains. This is because of the slow pulse.
In Yangming disease, a slow pulse means pathogens are entering the interior, and heat is not yet excess. Food enters Yin and boosts Yang. Stomach heat makes it hard to eat until full; fullness brings slight irritability and dizziness because Grain Qi contends with Heat Qi. Two heats combine, consuming body fluids, causing difficulty urinating. If urination is free, jaundice does not develop, meaning heat is vented. If urination is difficult, heat cannot vent, and jaundice develops. Dan means yellow. Because it arises from Grain Qi heat, it is named Gudanz. If heat is excess, purgation cures it. A slow pulse indicates heat is not yet excess; even with purgation, abdominal fullness does not decrease. The Classics state: A slow pulse means purgation is not yet appropriate.
Zhang Qingzi said: This clause is similar to post-recovery symptoms cured by reducing food intake, caused by Stomach deficiency and food stagnation generating heat, hence named Gudanz. Cheng Wuji's commentary says "heat in the Stomach makes it hard to eat," which seems inconsistent with "because of the slow pulse."
In Yangming disease, typically there is much sweating; if there is no sweating, and the skin feels like insects crawling, this is due to long-term deficiency.
The Stomach is the residence of body fluids. Qi deficiency and low body fluids cause lack of sweating in disease. The Stomach governs the muscles of the body; the sensation of insects crawling in the skin indicates long-term Stomach Qi deficiency.
In Yangming disease, if there is no sweating but urination is free, and after two or three days, there is vomiting, coughing, and cold extremities, there will definitely be painful headache. If there is no coughing, no vomiting, and extremities are not cold, the head will not hurt.
Typically, Yangming disease has much sweating; if there is no sweating but urination is free, it is Yangming Shanghan with cold pathogens attacking inward. After two or three days, vomiting, coughing, and cold extremities indicate cold pathogens emerging outward, causing painful headache. If no coughing, no vomiting, and no cold extremities, it means cold pathogens only attack the interior without emerging outward, so the head does not hurt.
In Yangming disease, if there is only dizziness, no aversion to cold, so the patient can eat and cough, the patient will definitely have a sore throat. If there is no coughing, the throat will not hurt.
In Yangming disease, if the body is not heavy or painful, only dizzy without aversion to cold, it is Yangming Fengzhong with wind pathogens attacking inward. The Classics state: In Yangming disease, if the patient can eat, it is named Fengzhong. Wind pathogens attack the Stomach, Stomach Qi rebels upward, causing coughing. The throat is connected to the Stomach; severe coughing injures the throat, hence sore throat. If Stomach Qi does not rebel, there is no coughing, and the throat does not hurt.
In Yangming disease, if there is no sweating, urination is difficult, and there is mental restlessness (Ao Nao), the body will definitely develop jaundice.
In Yangming disease, no sweating and difficult urination mean heat is trapped inside and cannot diffuse. Mental restlessness indicates heat qi steaming and fermenting, wanting to emerge externally as jaundice.
In Yangming disease, if fire therapy is applied, with slight sweating on the forehead and difficult urination, jaundice will definitely develop.
Yangming disease implies interior heat. Fire therapy combines with fire heat, making it severe. If there is whole-body sweating and free urination, heat is vented, and jaundice does not develop. Now, only slight sweating on the forehead and difficult urination mean heat cannot diffuse, steaming in the Stomach, leading to jaundice.
In Yangming disease, if the pulse is floating and tight, there will definitely be tidal fever occurring at specific times. If the pulse is only floating and not tight, there will definitely be night sweats.
Floating indicates pathogens in the meridians; tight indicates interior excess. Floating and tight pulse indicates exterior heat and interior excess, leading to tidal fever at specific times. If the pulse is only floating and not tight, it is merely exterior heat, leading to night sweats. Night sweats are sweating during sleep. In Yangming disease, interior heat causes spontaneous sweating; exterior heat causes night sweats.
In Yangming disease, if the mouth is dry, and the patient only wants to rinse water in the mouth without swallowing, epistaxis (nosebleed) will definitely occur.
The Yangming meridian originates at the nose and connects to the mouth. Interior Yangming heat causes thirst and desire to drink water. Now, dry mouth with only rinsing and no swallowing indicates heat in the meridians but not in the interior. Yangming has abundant Qi and Blood; severe heat in the meridians forces blood to move recklessly, causing epistaxis.
In Yangming disease, if there was originally spontaneous sweating, and the doctor induces heavy sweating again, and although the illness has improved, there is still slight irritability and confusion, this is because the feces are definitely hard.
Due to loss of body fluids and Stomach dryness, the stool becomes hard. One should ask how many times the patient urinates daily. If originally urinating three or four times a day, but now only twice, it is known that the stool will pass soon. Now, reduced frequency of urination indicates body fluids returning to the Stomach, so it is known that defecation will occur soon.
Previously, loss of body fluids made the stool hard. Reduced urination separates body fluids, and the stool will definitely pass spontaneously.
In Shanghan, if there is much vomiting, even if there are Yangming signs, purgation is contraindicated.
Vomiting indicates heat in the Upper Jiao, not fully entered the Fu organs, so purgation is not allowed.
In Yangming disease, if there is hardness and fullness below the heart, purgation is contraindicated. If purged and diarrhea continues uncontrolled, death ensues; if diarrhea stops, recovery occurs.
In Yangming disease, abdominal fullness indicates pathogens have entered the Fu organs, and purgation is permissible. Hardness and fullness below the heart indicate pathogens are shallow and not fully in the Fu organs, so immediate purgation is not allowed. If diarrhea stops, it means pathogens are gone and Zheng Qi is safe; safety leads to recovery. If purgation causes uncontrolled diarrhea, Zheng Qi collapses, leading to death.
In Yangming disease, if the face is completely red, purgation is contraindicated. It will definitely lead to fever, yellow complexion, and difficult urination.
"He" means complete. Complete redness of the face in Yangming disease indicates heat in the meridians. Purgation is not allowed. Purgation weakens Stomach Qi and consumes body fluids; heat from the meridians enters the Stomach via deficiency, causing fever, yellow complexion, and difficult urination.
In Yangming disease, if there has been no emesis or purgation, but there is irritability, Tiaowei Chengqi Tang can be given.
Irritability after emesis is called Neifan (Internal Irritability); irritability after purgation is called Xufan (Deficiency Irritability). Now, in Yangming disease, without emesis or purgation, irritability indicates stagnant heat in the Stomach. Tiaowei Chengqi Tang is given to purge stagnant heat.
In Yangming disease, with a slow pulse, although there is sweating and no aversion to cold, the body must feel heavy, there is shortness of breath, abdominal fullness, and wheezing. If there is tidal fever, the exterior is about to resolve, and interior attack is permissible. Continuous sweating on the hands and feet indicates the stool is already hard, and Da Chengqi Tang should be used. If there is much sweating, slight fever, and aversion to cold, the exterior is not resolved. If the fever is not tidal, Chengqi Tang should not be given. If there is significant abdominal fullness and obstruction, Xiao Chengqi Tang can be given to mildly harmonize Stomach Qi, avoiding drastic purgation.
In Yangming disease, if the pulse is slow, and there is much sweating with slight fever and aversion to cold, the exterior is not resolved. If the pulse is slow, although there is sweating and no aversion to cold, the exterior syndrome has ceased. Heavy body, shortness of breath, abdominal fullness, wheezing, and tidal fever indicate heat entering the Fu organs. The four limbs are the root of all Yang meridians; sufficient body fluids steamed by heat cause whole-body sweating; insufficient body fluids steamed by heat cause continuous sweating on the hands and feet. Knowing the stool is hard, Da Chengqi Tang is given to purge Stomach heat. The Classics state: Tidal fever indicates excess. Non-tidal fever means heat has not formed excess, so Da Chengqi Tang should not be given immediately. Even with urgent significant abdominal fullness and obstruction, Da Chengqi Tang should not be given. Xiao Chengqi Tang is given to mildly harmonize Stomach Qi.