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（赵本注∶“一云
络”）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（赵本注∶“一作寒”）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（赵本有“是”字）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（赵本有“若”字）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，（赵本有“主”字）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（医统本有“病”字）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。经曰∶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。
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（医统本有“邪”字）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，（赵本有“者”字）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
（医统本无“而”字）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，（赵本有“初”字）饮食，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，大盒饭硬，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（医统
本作“汗出而”）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，从申至戌上。
四月为阳，土旺于申、酉、戌向王时，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（赵本无“故”字）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。
阳明病法多汗，反无汗，其身如虫行皮中状者，此以（医统本作“以此”）久虚故也。
胃为津液之府，（医统本作“本”）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。（赵本注∶“一云∶冬阳明”）
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，呕咳而肢厥者，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（赵本作“咽必”）痛；若不咳者，咽不痛。（赵本
注∶“一云冬阳明”）
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，（赵本有“而”字）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（赵本作“此必大便”）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，（赵本作“色赤”）不可攻之，必发热色黄，（赵本有“者”字）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。（赵本有“调胃承气汤方”详见卷二）
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（医统本作“即”）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（赵本无“而”字）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，（赵本注∶“
一法与桂枝汤”）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（赵本有“至”字）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，为热蒸之，则周身汗出；津液不足，为热蒸
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。
大承气汤方∶
大黄（四两，酒洗。苦寒） 浓朴（半斤，炙，去皮。苦温） 枳实（五枚，炙。苦寒） 芒硝（三合。咸寒）
《内经》曰∶燥淫所胜，以苦下之。大黄、枳实之苦，以润燥除热。又曰∶燥淫于内，治以苦温。浓朴之
苦，下结燥。又曰∶热淫所胜，治以咸寒，芒硝之咸，以攻蕴热。
上四味，以水一斗，先煮二物，取五升，去滓，内大黄，（赵本有“更”字）煮取二升，去滓，内
芒硝，更上微火一两沸，分温再服。得下，余勿服。
小承气汤方∶
大黄（四两。赵本有“酒洗”二字） 浓朴（二两，炙，去皮。） 枳实（三枚，大者，炙）
大热结实者，与大承气汤；小热微结者，与小承气汤。以热不大甚，故于大承气汤去芒硝；又以结不至
坚，故不（熊校记∶故亦减浓朴、枳实也，汪本亦改不。按汪以方内仍有枳实，故云不减，殊不思
改半斤或二两，五枚为三枚，乃所谓减也，且以上句文义推之，正是亦，非不减浓朴、枳实也。）
以上（赵本作“右”）三味，以水四升，煮取一升二合，去
滓，分温二服。初服汤，当更衣，不尔者，尽饮之；若更衣者，勿服之。
阳明病，潮热，大便微硬者，可与大承气汤；不硬者，不（赵本有“可”字）与之。若不大便六七日，恐有燥屎，
欲知之法，少与小承气汤，汤入腹中，转失气者，此有燥屎，（赵本有“也”字）乃可攻之；若不转失气者，此
但初头硬，后必溏，不可攻之，攻之，必胀满不能食也。欲饮水者，与水则哕。其后发热者，必大便复硬而
少也，以小承气汤和之。不转失气者，慎不可攻也。
潮热者实，得大便微硬者，便可攻之；若便不硬者，则热未成实，虽有潮热亦未可攻。若不大便六七
日，恐有燥屎，当先与小承气汤渍之，如有燥屎，小承气汤药势缓，不能宣泄，必转气下失；若不转失气，是
问：疾病有太阳阳明、正阳阳明、少阳阳明之分，这是什么意思？答：所谓太阳阳明，就是脾约证。
阳明即胃。邪气从太阳经传入腑的，称为太阳阳明。经典记载：太阳病，经过吐法、下法或发汗治疗后，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。
邪气从阳明经传入腑的，称为正阳阳明。经典记载：阳明病，脉象迟缓，虽然出汗但不恶寒，身体必然沉重，呼吸短促，腹部胀满且喘息，如果有潮热症状，说明表证已解，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证。
所谓少阳阳明，是发汗、利小便后，导致胃中干燥、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。经典记载：伤寒病，脉象弦细，头痛发热的，属于少阳病。少阳病不可发汗，若误用发汗法，会出现谵语，这属于胃（阳明），即是少阳阳明病。
邪气传入胃中，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、攻下或利小便治疗，导致津液耗伤，胃中干燥，从而转属为阳明病。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、利小便导致津液耗伤，胃中干燥，太阳之邪传入腑，转属阳明。古人上厕所必换衣服，不更衣就是指不大便。不排便，则胃中的食物残渣无法排出，所以形成内实。胃中没有津液，加上蓄积的热邪，大便就会困难，形成阳明里实证。
问：阳明病的外在表现是什么？答：身体发热，自然出汗，不恶寒，反而恶热。
阳明病是邪气入腑。邪气在表时，身体发热，出汗且恶寒；邪气既已入腑，表证已罢，所以不恶寒，只是身体发热，出汗，而恶热。
问：有的病发病第一天，不发热却恶寒，这是为什么？答：虽然发病一天，但恶寒症状将自行停止，随即会自然出汗并恶热。
邪气客居在阳明，应当发热而不恶寒。现在发病一天，仍然不发热而恶寒，说明邪气尚未完全入腑，还带有表邪；如果表邪全部入里，就不再恶寒，必定自然出汗而恶热。
问：恶寒为什么会自动停止？答：阳明居中，属土，是万物归聚之所，不再传变。开始虽然恶寒，第二天自然会停止，这就是阳明病。
胃是水谷之海，主滋养四周脏腑。四周脏腑有病，都能传入胃。进入胃后就不再传变，如太阳病传入胃，就不再传向阳明；阳明病传入胃，就不再传向少阳；少阳病传入胃，就不再传向三阴。
伤寒传经，通常是一日太阳，二日阳明。这是太阳经传变，所以说转属阳明。
伤寒发热，无汗，呕吐不能进食，是太阳受病；如果反而濈然汗出，说明太阳之邪转属阳明。经典记载：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刻。经典记载：寸关尺三部脉都长的，是阳明受病，应当在二三日发作。阳明气血俱多，加之邪气并入经脉，所以脉象大。
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，手足发热；邪气在三阴经，手足寒冷。现在手足自温，知道是系在太阴。太阴属土，被邪气熏蒸，颜色外现，应当发身黄。小便自利的，热邪不内蓄，不能发黄。到了七八天，大便干硬的，就是太阴之邪入腑，转属阳明。
伤寒本来无汗，阳明病通常多汗，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，腹部胀满轻微气喘，发热恶寒，脉浮而紧；如果误用下法，会导致腹部胀满、小便困难。
脉浮在表，紧脉代表里实。阳明中风，口苦咽干，腹部胀满轻微气喘，是热邪传于里；发热恶寒，说明表证仍未解除。如果误用下法，里邪虽去，表邪复入于里，又耗伤津液，所以导致腹部胀满而小便困难。
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，通过饮食情况辨别受风寒者，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，如果是中寒，不能进食，小便不利，手足濈然汗出，这是想要形成固瘕（一种寒性积聚病），必定大便初头硬而后溏。之所以这样，是因为胃中寒冷，水谷不分的原因。
阳明中寒不能食的，是寒邪不能消化谷物。小便不利的，是津液不化。阳明病通常多汗，若是周身汗出，这里是手足濈然而汗出，身上无汗，这是阳明中寒。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；如果汗出且小便不利，为实证。这里因为小便不利，水谷不分，虽然大便初头硬，后边必定溏薄。
阳明病，饮食正常，小便反而不利，大便自调，病人骨节疼痛，像有发热样子，忽然发狂，濈然汗出而病解的，这是水不胜谷气，与汗共并，脉紧则愈。
阳病客热，初传入胃，胃热则消谷欲食。阳明病热为实证，则小便频数，大便干硬。现在小便反而不利，大便自调，说明热气散漫，不为实证。想吃饭，则胃中谷多，《内经》说：食入于阴，长气于阳。谷多则阳气胜，热消津液则水少。经典说：水入于经，其血乃成，水少则阴血弱。《金匮要略》说：阴气不通，即骨疼。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，所以翕翕如有热状。奄，忽也。忽然发狂，是阴不胜阳。《内经》说：阴不胜其阳，则脉流薄疾，并乃狂。阳明蕴热为实证，须用下法痊愈；热气散漫，不为实证，必须等待汗出而愈，所以说濈然而汗出解。水谷相等，阴阳气平。水不胜谷气，是阴不胜阳。汗出则阳气衰，脉紧则阴气生。阴阳气平，两无偏胜则愈，所以说与汗共并，脉紧则愈。
阳明病欲解时，从申时至戌时。
四月为阳，土旺于申、酉、戌向王时，是为欲解。
阳明病，不能进食，攻其热必呃逆。之所以这样，是因为胃中虚冷。因为病人本虚，所以攻其热必呃逆。
不能进食，胃中本寒，攻其热，又虚其胃，虚寒相搏，所以令呃逆。经典说：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，进食难以吃饱，饱则轻微心烦，头晕，必定小便难，这是想要形成谷疸，即使使用下法，腹部胀满依旧。之所以这样，是因为脉迟的缘故。
阳明病脉迟，则邪气方入里，热未成实。食入于阴，长气于阳。胃中有热，进食难以吃饱，饱则轻微心烦而头晕，是谷气与热气相搏。两热相合，消搏津液，必定小便难。小便通利的，不能发黄，是说热得以宣泄。小便不利，则热不得泄，身体必定发黄。疸，黄也。因其发于谷气之热，故名谷疸。热实者，下之则愈；脉迟为热气未实，即使下之，腹满也不减。经典说：脉迟尚未可攻。
阳明病通常多汗，反而无汗，身体像虫子在皮肤中爬行一样，这是因久虚的缘故。
胃是津液之府，气虚津液少，生病则反而无汗。胃候身之肌肉，身体像虫子在皮肤中爬行，知道胃气久虚。
阳明病，反而无汗，而小便通利，二三天后，呕吐且咳嗽，手足厥冷的，必定痛苦于头痛；如果不咳不呕，手足不厥冷，头不痛。
阳明病通常多汗，反而无汗，而小便通利的，是阳明伤寒，寒气内攻。到了二三天，呕吐咳嗽而四肢厥冷，是寒邪发于外，必定痛苦头痛；如果不咳不呕，手足不厥冷，是寒邪只攻里而不外发，头部也不痛。
阳明病，只是头晕，不恶寒，所以能进食且咳嗽，病人必定咽喉痛；如果不咳嗽，咽喉不痛。
阳明病，身体不沉重疼痛，只是头晕而不恶寒，是阳明中风而风气内攻。经典说：阳明病，若能食，名中风。风邪攻胃，胃气上逆则咳。咽门是胃之系，咳甚则咽伤，所以必定咽痛；如果胃气不逆，则不咳，其咽也不痛。
阳明病无汗，而小便不利，热蕴于内而不得宣泄；心中懊憹，是热气郁蒸，欲发于外而为黄。
阳明病则为内热，被火，则火热相合而更甚。如果遍身汗出而小便通利，热得宣泄不能发黄。现在额头微汗出，而小便不利，则热不得宣泄，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。只有浮脉的，必定盗汗出。
浮脉在经，紧脉代表里实。脉浮而紧，是表热里实，必定潮热，发作有时。如果脉仅浮而不紧，仅是表热，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。
阳明经脉起于鼻，络于口。阳明里热，则渴欲饮水。这里口燥只想漱水不想吞咽，是热在经而里无热。阳明气血俱多，经中热甚，迫血妄行，必定发生鼻衄。
阳明病，本来自汗出，医生更重发汗，病已好转，尚轻微心烦不清爽的，这是大便必硬的原因。因为亡失津液，胃中干燥，所以令大便硬。应当询问其小便，每天几次。如果原本小便每天三四次，今天两次，故知大便不久会排出；现在小便次数减少，因为津液应当还入胃中，故知不久必大便。
阳明病，心下硬满的，不可攻下。攻之，利遂不止者死，利止者愈。
阳明病腹满，是邪气入腑，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。
合，通也。阳明病面色通赤，是热在经，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。
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，与调胃承气汤，以下郁热。
阳明病脉迟，虽出汗，不恶寒，身体必沉重，短气腹满而喘，有潮热的，这是表证欲解，可攻里。手足濈然而汗出的，是大便已硬，大承气汤主之；如果汗多微发热恶寒，是表未解，（一法用桂枝汤）其热不潮，未可与承气汤；如果腹大满不通的，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，是表未解；若脉迟，虽汗出而不恶寒，是表证罢。身重、短气、腹满而喘，有潮热，是热入腑。四肢诸阳之本，津液足，为热蒸之，则周身汗出；津液不足，为热蒸之，其手足濈然而汗出，知大便已硬，与大承气汤，以下胃热。经典说：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。
大承气汤方：
大黄（四两，酒洗。苦寒） 浓朴（半斤，炙，去皮。苦温） 枳实（五枚，炙。苦寒） 芒硝（三合。咸寒）
《内经》说：燥淫所胜，以苦下之。大黄、枳实之苦，以润燥除热。又说：燥淫于内，治以苦温。浓朴之苦，下结燥。又说：热淫所胜，治以咸寒，芒硝之咸，以攻蕴热。
以上四味，用水一斗，先煮二物（浓朴、枳实），取五升，去滓，内大黄，煮取二升，去滓，内芒硝，更上微火一两沸，分温再服。得下，余勿服。
小承气汤方：
大黄（四两。赵本有“酒洗”二字） 浓朴（二两，炙，去皮。） 枳实（三枚，大者，炙）
大热结实者，与大承气汤；小热微结者，与小承气汤。以热不大甚，故于大承气汤去芒硝；又以结不至坚，故亦减浓朴、枳实也。
以上三味，用水四升，煮取一升二合，去滓，分温二服。初服汤，当更衣，不尔者，尽饮之；若更衣者，勿服之。
阳明病，潮热，大便微硬的，可与大承气汤；不硬的，不与。若不大便六七日，恐有燥屎，欲知之法，少与小承气汤，汤入腹中，转失气者，此有燥屎，乃可攻之；若不转失气者，此但初头硬，后必溏，不可攻之，攻之，必胀满不能食也。欲饮水者，与水则哕。其后发热者，必大便复硬而少也，以小承气汤和之。不转失气者，慎不可攻也。
潮热者实，得大便微硬者，便可攻之；若便不硬者，则热未成实，虽有潮热亦未可攻。若不大便六七日常，恐有燥屎，当先与小承气汤渍之，如有燥屎，小承气汤药势缓，不能宣泄，必转气下失；若不转失气，是
Question: There are Taiyang Yangming, Zhengyang Yangming, and Shaoyang Yangming. What does this mean? Answer: Taiyang Yangming refers to Pi Yue (Spleen Confinement).
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, after emesis, purgation, or sweating, if there is slight irritability, frequent urination, and consequently hard stool, Xiao Chengqi Tang should be administered. This is Taiyang Yangming Pi Yue disease.
Zhengyang Yangming refers to Wei Jia Shi (Stomach Excess Syndrome).
When pathogenic factors transmit from the Yangming meridian into the Fu organs, it is called Zhengyang Yangming. The Classics state: In Yangming disease, with a slow pulse, although sweating occurs, there is no aversion to cold. The body must feel heavy, there is shortness of breath, abdominal fullness, and wheezing. If tidal fever is present, indicating that the exterior syndrome has resolved, interior purgation can be performed. If sweat continuously oozes from the hands and feet, this indicates that the stool has already become hard; Da Chengqi Tang is the primary treatment. This is Zhengyang Yangming Wei Jia Shi.
Shaoyang Yangming refers to the condition where, after sweating and promoting diuresis, the stomach becomes dry, irritable, and excess, leading to difficult defecation.
When pathogenic factors transmit from the Shaoyang meridian into the Fu organs, it is called Shaoyang Yangming. The Classics state: In cold damage, with a string-taut and fine pulse, headache, and fever, it belongs to Shaoyang. Shaoyang disease should not be treated with sweating; if sweating is induced, delirium may occur. This belongs to the Stomach, which is Shaoyang Yangming disease.
The general principle of Yangming disease is Wei Jia Shi (Stomach Excess Syndrome).
When pathogens enter the stomach and heat toxins remain and knot, the Stomach becomes excess. Hua Tuo said: Heat toxins entering the stomach must be expelled; they cannot remain in the stomach. Thus, we know that when pathogens are in Yangming, it manifests as Wei Jia Shi.
Question: How does one contract Yangming disease? Answer: After treating Taiyang disease with sweating, purgation, or promoting diuresis, if body fluids are depleted and the stomach becomes dry, the condition transforms into Yangming. If one does not change clothes (i.e., does not defecate), has internal excess, and difficult defecation, this is named Yangming disease.
If original Taiyang disease does not resolve, and due to sweating and promoting diuresis, body fluids are depleted and the stomach becomes dry, Taiyang pathogens enter the Fu organs and transform into Yangming. Ancients changed clothes when using the toilet; "not changing clothes" generally means no defecation. If one does not defecate, stomach contents cannot be discharged, resulting in internal excess. With no body fluids in the stomach plus accumulated heat, defecation becomes difficult, forming Yangming Interior Excess.
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, sweating, and aversion to heat.
Question: Some diseases present on the first day with no fever but aversion to cold. Why? Answer: Although it has been one day, the aversion to cold will cease spontaneously, followed 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, indicating that pathogens have not fully entered the Fu organs and still carry exterior pathogens; if exterior pathogens fully enter the interior, there will be no more aversion to cold, and certainly spontaneous sweating with aversion to heat.
Question: Why does aversion to cold cease spontaneously? Answer: Yangming resides in the center and belongs to Earth; it is the gathering place for all things and does not transmit further. Initially, there may be aversion to cold, but it stops 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; e.g., Taiyang disease transmitting to the Stomach does not transmit to Yangming; Yangming disease transmitting to the Stomach does not transmit to Shaoyang; Shaoyang disease transmitting to the Stomach does not transmit to the Three Yin.
When Taiyang disease is first contracted, if sweating is induced but not thorough, it transforms into Yangming.
In cold damage transmission of meridians, it is usually Taiyang on the first day, Yangming on the second. This is transmission from Taiyang, hence "transforming into Yangming."
In cold damage with fever, no sweat, vomiting, inability to eat, but instead continuous sweating, it is transforming into Yangming.
Cold damage with fever, no sweat, vomiting, and inability to eat indicates Taiyang involvement; if instead there is continuous sweating, Taiyang pathogens are transforming into Yangming. The Classics state: Yangming disease typically presents with much sweating.
On the third day of cold damage, the Yangming pulse is large.
On the third day of cold damage is when pathogens transmit to Yangming. The Classics state: If the Cun, Guan, and Chi pulses are all long, it is Yangming disease, which should manifest on the second or third day. Yangming has abundant Qi and Blood, and with pathogens merging into the meridian, the pulse is large.
In cold damage, if the pulse is floating and moderate, and hands and feet are warm, it is related to Taiyin. Taiyin disease should present with jaundice; if urination is free, jaundice cannot develop. By the seventh or eighth day, if stool becomes hard, it is Yangming disease.
Floating indicates Yang pathogens; moderate indicates Spleen pulse. Cold damage with floating and moderate pulse indicates Taiyin guest heat. Pathogens in the Three Yang meridians cause hot hands and feet; pathogens in the Three Yin meridians cause cold hands and feet. Now, hands and feet are warm, indicating relation to Taiyin. Taiyin belongs to Earth; steamed by pathogens, color appears externally, leading to jaundice. Free urination means heat does not accumulate internally, so no jaundice. By the seventh or eighth day, hard stool indicates Taiyin pathogens entering the Fu organs and transforming into Yangming.
When cold damage transforms into Yangming, the patient has slight continuous sweating.
Cold damage normally has no sweat; Yangming disease typically has much sweat. Because cold damage pathogens transform into Yangming, there is slight continuous sweating.
Yangming Wind Strike, with bitter taste in mouth, dry throat, abdominal fullness, slight wheezing, fever, aversion to cold, floating and tight pulse; if purged, abdominal fullness and difficult urination will result.
Floating pulse is at the exterior; tight pulse indicates interior excess. Yangming Wind Strike with bitter taste, dry throat, abdominal fullness, and slight wheezing indicates heat transmitting to the interior; fever and aversion to cold indicate the exterior is not yet resolved. If purged, although interior pathogens are removed, exterior pathogens re-enter the interior, depleting body fluids, causing abdominal fullness and difficult urination.
In Yangming disease, if one can eat, it is named Wind Strike; if one cannot eat, it is named Cold Strike.
In Yangming disease, distinguishing wind vs. cold via diet: The Stomach is the sea of water and grain. Wind is a Yang pathogen; Yang pathogens digest grain, so those with Wind Strike can eat; Cold is a Yin pathogen; Yin pathogens do not digest grain, so those with Cold Strike cannot eat.
In Yangming disease, if it is Cold Strike, inability to eat, difficult urination, and continuous sweating from hands and feet indicate an impending Gu Jia (solid accumulation due to cold). Stool will likely be hard initially then loose. This is because the stomach is cold, failing to separate water and grain.
In Yangming Cold Strike, inability to eat is due to cold failing to digest grain. Difficult urination is due to failure to transform body fluids. Yangming disease typically has much sweat; here, only hands and feet sweat continuously while the body has no sweat, indicating Yangming Cold Strike. Gu Jia is cold qi accumulation. Severe stomach cold desires to knot and form Gu Jia, blocking body fluid circulation, making stool hard; if sweating and difficult urination occur, it is excess. Here, due to difficult urination and failure to separate water and grain, although stool is hard initially, it will later be loose.
In Yangming disease, if digestion is normal, urination is unexpectedly difficult, stool is normal, joints ache, there is a feeling of heat, sudden madness occurs, and continuous sweating leads to resolution, this is because Water cannot overcome Grain Qi, combining with sweat, and a tight pulse indicates recovery.
Guest heat in Yang disease, initially transmitting to the Stomach, causes Stomach heat to digest grain and desire food. In Yangming disease, if heat is excess, urine is frequent and stool is hard. Now, urination is difficult and stool is normal, indicating heat is scattered, not excess. Desire to eat means much grain in the Stomach. The Neijing states: Food enters Yin, generates Qi in Yang. Much grain means Yang Qi prevails; heat consumes body fluids, reducing Water. The Classics state: Water enters the meridians, blood is formed; less water means weak Yin Blood. The Jingui Yaolue states: Blocked Yin Qi causes bone pain. Joint pain indicates insufficient Yin Qi. Heat severe at the exterior causes mild fever; heat severe in the interior causes steaming fever. Here, heat is scattered, not fixed in exterior or interior, hence mild fever sensation. Yan means suddenly. Sudden madness is Yin unable to overcome Yang. The Neijing states: When Yin cannot overcome Yang, pulses flow rapidly, leading to madness. If Yangming heat is excess, purgation cures it; if heat is scattered and not excess, sweating cures it. 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; tight pulse generates Yin Qi. Balanced Yin and Yang Qi, neither prevailing, leads to recovery. Hence, combining with sweat and tight pulse leads to recovery.
Yangming disease resolves from Shen hour to Xu hour.
The fourth month is Yang; Earth prospers during Shen, You, and Xu hours, marking the time of resolution.
In Yangming disease, inability to eat; attacking the heat will cause hiccups. This is because the stomach is deficient and cold. Since the person is originally deficient, attacking heat causes hiccups.
Inability to eat indicates original stomach cold; attacking heat further deficiences the stomach. Deficient cold combats, causing hiccups. The Classics state: Weak Guan pulse, deficient Stomach Qi; if heat exists, do not purge heavily. Removing heat raises cold. This is what is meant.
In Yangming disease, with a slow pulse, difficulty eating to fullness, slight irritability and dizziness after eating, and difficult urination, this is impending Gu Dan (Grain Jaundice). Even if purged, abdominal fullness remains. This is due to the slow pulse.
Yangming disease with slow pulse means pathogens are just entering the interior, heat is not yet excess. Food enters Yin, generates Qi in Yang. Heat in the Stomach makes it hard to eat to fullness; slight irritability and dizziness after eating result from Grain Qi combating Heat Qi. Two heats combine, consuming body fluids, causing difficult urination. Free urination prevents jaundice, meaning heat is vented. Difficult urination means heat cannot vent, leading to jaundice. Dan means yellow. Named Grain Jaundice because it arises from Grain Qi heat. If heat is excess, purgation cures it; slow pulse means heat is not yet excess, so even if purged, abdominal fullness does not decrease. The Classics state: Slow pulse means purgation is not yet appropriate.
Yangming disease typically has much sweat; if there is no sweat and the body feels like insects crawling under the skin, this is due to long-term deficiency.
The Stomach is the residence of body fluids. Qi deficiency and low body fluids lead to no sweat. The Stomach governs muscles; feeling like insects crawling under the skin indicates long-term Stomach Qi deficiency.
In Yangming disease, if there is no sweat but urination is free, and after two or three days, vomiting, coughing, and cold limbs occur, there will be painful headache; if no vomiting/coughing and limbs are not cold, the head will not hurt.
Yangming disease typically has much sweat; if no sweat but urination is free, it is Yangming Cold Damage with internal attacking cold. By two or three days, vomiting, coughing, and limb cold indicate cold pathogens emerging externally, causing painful headache; if no vomiting/coughing and limbs are not cold, cold pathogens attack only the interior without emerging externally, so the head does not hurt.
In Yangming disease, if there is only dizziness, no aversion to cold, ability to eat, and coughing, the throat will surely hurt; if no coughing, the throat will not hurt.
Yangming disease without heavy body pain, only dizziness and no aversion to cold, is Yangming Wind Strike with internal attacking wind. The Classics state: In Yangming disease, if one can eat, it is Wind Strike. Wind pathogens attack the Stomach, causing Stomach Qi to rebel upward, leading to coughing. The throat gate is connected to the Stomach; severe coughing injures the throat, causing pain; if Stomach Qi does not rebel, there is no cough, and the throat does not hurt.
In Yangming disease, if there is no sweat and urination is difficult, with mental restlessness (Ao Nao), jaundice will develop.
No sweat and difficult urination in Yangming disease mean heat is trapped internally and cannot vent; mental restlessness indicates heat stagnation steaming, attempting to emerge externally as jaundice.
In Yangming disease, if fire therapy is applied, with slight sweating on the forehead and difficult urination, jaundice will develop.
Yangming disease implies internal heat; fire therapy combines with heat, making it severe. If whole-body sweating and free urination occur, heat vents and jaundice does not develop. Now, slight sweating on the forehead and difficult urination mean heat cannot vent, stagnates in the Stomach, and jaundice develops.
In Yangming disease, if the pulse is floating and tight, there will certainly be tidal fever occurring at specific times. If the pulse is only floating, there will certainly be night sweats.
Floating indicates the meridian; tight indicates interior excess. Floating and tight pulse means exterior heat and interior excess, causing tidal fever at specific times. If the pulse is only floating and not tight, it is merely exterior heat, causing night sweats. Night sweats are sweating during sleep. Yangming disease with interior heat has spontaneous sweating; exterior heat has night sweats.
In Yangming disease, if the mouth is dry and one only wants to rinse the mouth without swallowing, epistaxis will certainly occur.
The Yangming meridian originates at the nose and connects to the mouth. Interior heat in Yangming causes thirst and desire to drink water. Here, dry mouth with desire to rinse but not swallow indicates heat in the meridian but not in the interior. Yangming has abundant Qi and Blood; severe heat in the meridian forces blood to move recklessly, causing epistaxis.
In Yangming disease, if there was originally spontaneous sweating, and the doctor induces heavy sweating again, even if the illness has improved, slight irritability and unclear comfort persist; this is because the stool is hard. Due to depletion of body fluids and dry stomach, stool becomes hard. One should ask about urination frequency. If originally urinating three or four times a day, now only twice, it is known that stool will pass soon; now, reduced urination means body fluids return to the stomach, so stool will pass soon.
Originally depleted body fluids made stool hard; reduced urination separates body fluids, and stool will pass naturally.
In cold damage, if there is much vomiting, even with Yangming symptoms, purgation is contraindicated.
Vomiting indicates heat in the Upper Jiao, not fully entered the Fu organs, so purgation is contraindicated.
In Yangming disease, if there is hardness and fullness below the heart, purgation is contraindicated. If purged and diarrhea continues unceasingly, death results; if diarrhea stops, recovery occurs.
Abdominal fullness in Yangming disease indicates pathogens have entered the Fu organs, allowing purgation. Hardness and fullness below the heart indicate pathogens are shallow, not fully in the Fu organs, so purgation is contraindicated. If diarrhea stops, pathogens are gone, Zheng Qi is safe, and recovery occurs; if diarrhea continues unceasingly, Zheng Qi collapses, leading to death.
In Yangming disease, if the face is completely red, purgation is contraindicated; fever and jaundice with difficult urination will result.
He means connected. Complete redness of the face in Yangming disease indicates heat in the meridian, so purgation is contraindicated. Purgation deficiences Stomach Qi and depletes body fluids; heat from the meridian enters the Stomach through deficiency, causing fever, jaundice, and difficult urination.
In Yangming disease, if there is no emesis or purgation but irritability occurs, Tiao Wei Chengqi Tang can be given.
Irritability after emesis is called Internal Irritability; irritability after purgation is called Deficient Irritability. Now, in Yangming disease without emesis or purgation, irritability indicates stagnant heat in the Stomach; Tiao Wei Chengqi Tang is given to purge stagnant heat.
In Yangming disease, with a slow pulse, although sweating occurs and there is no aversion to cold, the body feels heavy, there is shortness of breath, abdominal fullness, wheezing, and tidal fever, indicating the exterior is resolving and interior purgation is possible. Continuous sweating from hands and feet indicates hard stool; Da Chengqi Tang is the primary treatment. If there is much sweating, slight fever, and aversion to cold, the exterior is not resolved (one method uses Guizhi Tang). If there is no tidal fever, Chengqi Tang is contraindicated. If there is significant abdominal fullness and obstruction, Xiao Chengqi Tang can be given to gently harmonize Stomach Qi, avoiding severe purgation.
Yangming disease with slow pulse, much sweating, slight fever, and aversion to cold indicates unresolved exterior; slow pulse with sweating but no aversion to cold indicates resolved exterior. Heavy body, shortness of breath, abdominal fullness, wheezing, and tidal fever indicate heat entering the Fu organs. Hands and feet are the root of Yang Qi; sufficient body fluids steamed by heat cause whole-body sweating; insufficient body fluids steamed by heat cause continuous sweating from hands and feet, indicating hard stool; Da Chengqi Tang is given to purge Stomach heat. The Classics state: Tidal fever indicates excess. No tidal fever means heat has not formed excess, so Da Chengqi Tang is contraindicated. Even with urgent abdominal fullness, Da Chengqi Tang is contraindicated; Xiao Chengqi Tang is given to gently harmonize Stomach Qi.
Da Chengqi Tang Formula:
Dahuang (Cortex Rhei Preparata) 4 liang, washed in wine. Bitter, Cold.
Nongpo (Cortex Magnoliae Officinalis) 8 liang, roasted, bark removed. Bitter, Warm.
Zhishi (Fructus Aurantii Immaturus) 5 pieces, roasted. Bitter, Cold.
Mangxiao (Natrii Sulfas) 3 he. Salty, Cold.
The Neijing states: When Dryness overcomes, use Bitter to purge. The bitterness of Dahuang and Zhishi moistens dryness and removes heat. It also states: When Dryness is internal, treat with Bitter-Warm. The bitterness of Nongpo descends knotted dryness. It also states: When Heat overcomes, treat with Salty-Cold. The salinity of Mangxiao attacks accumulated heat.
Take the above four ingredients, boil in 10 dou of water. First boil Nongpo and Zhishi, obtain 5 sheng, remove dregs. Add Dahuang, boil to obtain 2 sheng, remove dregs. Add Mangxiao, boil briefly over low fire for one or two boils. Divide into two warm doses. If bowel movement occurs, do not take the remainder.
Xiao Chengqi Tang Formula:
Dahuang (Cortex Rhei Preparata) 4 liang.
Nongpo (Cortex Magnoliae Officinalis) 2 liang, roasted, bark removed.
Zhishi (Fructus Aurantii Immaturus) 3 pieces, large ones, roasted.
For major heat and solid excess, give Da Chengqi Tang; for minor heat and slight knot, give Xiao Chengqi Tang. Because heat is not severe, Mangxiao is removed from Da Chengqi Tang; because the knot is not hard, Nongpo and Zhishi are also reduced.
Take the above three ingredients, boil in 4 sheng of water, obtain 1.2 sheng, remove dregs. Divide into two warm doses. After the first dose, if defecation occurs, stop taking; if not, drink the rest. If defecation occurs, do not take the remainder.
In Yangming disease, with tidal fever and slightly hard stool, Da Chengqi Tang can be given; if not hard, do not give. If no defecation for six or seven days, fearing dry stool, the method to verify is to give a small amount of Xiao Chengqi Tang. If gas passes after ingestion, there is dry stool, and purgation can be performed; if gas does not pass, the stool is hard only at the beginning and loose later, so purgation is contraindicated. Purging will cause abdominal fullness and inability to eat. If desiring water, giving water causes hiccups. Subsequent fever indicates stool becomes hard again but scanty; Xiao Chengqi Tang is used to harmonize. If gas does not pass, purgation must be strictly avoided.
Tidal fever indicates excess; if stool is slightly hard, purgation can be performed; if stool is not hard, heat has not formed excess, and even with tidal fever, purgation is contraindicated. If no defecation for six or seven days, fearing dry stool, first soak with Xiao Chengqi Tang. If there is dry stool, the gentle force of Xiao Chengqi Tang cannot vent it, and gas will pass downward; if gas does not pass, it is