阳明主里，内候胃中，外候肌肉，故有病经、病腑之分。如论中身热烦渴，目痛鼻
干不得眠，不恶寒，反恶热者，此阳明经病也；潮热谵语，手足腋下 然汗出，腹满痛，
大便硬者，此阳明腑病也。而其候各有三∶经病则有邪已传阳明而太阳之表未罢，兼见头
痛，恶寒，无汗之太阳证者；有太阳之邪已罢，悉传阳明，但见壮热有汗，心烦不眠，口
渴引饮之阳明证者；有阳明之邪未已，复转少阳，兼见胸胁痛，寒热往来，口苦而呕，目
眩耳聋之少阳证者。腑病则有太阳阳明，谓太阳病，或发汗，或吐，或下，或利小便，亡
其津液，胃中干燥，太阳之邪，乘胃燥而转属阳明，致小便反数，大便硬者，所为脾约
是也；有正阳阳明，谓阳气素盛，或有宿食，太阳之邪，一传阳明，遂入胃腑，致大便不
通者，所为胃家实是也；有少阳阳明，谓病已到少阳，法当和解，而反发汗，利小便，亡
其津液，胃中燥热，复转属阳明，致大便结燥者，所为大便难者是也。其治阳明经病，则
以葛根汤或桂枝加葛根汤发之，或以白虎汤清之，或以柴胡白虎汤和之，随其证而施之
可也。其治阳明腑病，虽均为可下，然不无轻重之分，故或以三承气汤下之，或麻仁丸
通之，或蜜煎胆汁导之，量其病而治之可也，此阳明病之大略也。兹以在经、在腑二者，详
疏于篇，俾读者易为分别，则临证施治，自不紊矣。
阳明之为病，胃家实是也。
【注】阳明经，内以候胃，外以候肌。言阳明之为病，由太阳之邪，传于其经，则为
阳明病外证；由太阳之邪，传入胃腑，则为胃家实也。
【集注】方有执曰∶阳明，经也；胃，腑也；实者，大便结为硬满而不得也。虽则迟
早不同，而非日数所可拘也。
伤寒三日，阳明脉大。
【注】伤寒一日太阳，二日阳明，三日少阳，乃《内经》言传经之次第，非必以日数
拘也。此云三日阳明脉大者，谓不兼太阳阳明之浮大，亦不兼少阳阳明之弦大，而正见
正阳阳明之大脉也。盖由去表传里，邪热入胃，而成内实之诊，故其脉象有如此者。
【集注】方有执曰∶伤寒三日，该中风而大约言也。脉大者，阳明气血俱多也。
沈明宗曰∶此正阳明之正脉也。仲景谓三日阳明脉大，因阳明乃多气多血之腑，风
寒传入，邪盛于中，故脉显大，是为阳明邪实之正脉。但病阳明务具此脉，方可下夺，或
兼太阳之浮紧，少阳之弦细，或迟疾滑涩虚弱，乃属气血阴阳之虚，虽见大实大满，亦
当详审顾虑，或以小承气汤试之，或用蜜煎导法，不得直施攻下也。
本太阳初得病时，发其汗，汗先出不彻，因转属阳明也。
【注】阳明之病，本自太阳初得病时，发其汗，汗先出而不透彻，乃为汗不如法，故
未尽之邪，因而转属阳明也。邪在经则为外证；邪入腑则为胃家实矣。
【集注】方有执曰∶此言由发太阳汗不如法，致病入胃之大意。
阳明病，若能食，名中风；不能食，名中寒。
【注】太阳之邪传阳明病，有自中风传来者，有自伤寒传来者，当于食之能否辨之。若
能食，名中风，是自中风传来者，以风乃阳邪，阳能化谷，故能食也。不能食，名中寒，
是自伤寒传来者，以寒乃阴邪，不能化谷，故不能食也。
【集注】方有执曰∶此以食之能否，验风寒之辨。盖阳明主水谷，风能食，阳能化谷
也；寒不能食，阴不杀谷也。名，犹言为也。中寒，即伤寒之互词，大意推原风寒自太阳
传来，其辨验有如此者，非谓阳明自中而然也。
汪琥曰∶仲景云∶中寒与伤寒同义，非真寒证也。若系真中寒，是胃家虚冷，药宜
理中汤之类。今不能食，是胃气实，但邪未入腑，不作郁热耳。因名中寒，实与伤寒无异。
问曰∶阳明病，外证云何？答曰∶身热汗自出，不恶寒反恶热也。
【注】阳明病有外证有内证。潮热、自汗、不大便，内证也；身热、汗自出、不恶寒、反
恶热，外证也。今汗自出，是从中风传来，故与中风之外证同；而身热、不恶寒反恶热，则
知为阳明外证，故不与中风外证同也。然阳明之热，发于肌肉，必蒸蒸而热，又不似太
阳之阵阵发热，可知矣。
【集注】方有执曰∶此以太阳中风，传入阳明之外证言。
魏荔彤曰∶病有太阳中风不解，传入阳明者，何以辨之？故设问曰∶阳明未知其里
之何时传来？必先验其外之何所见证？答曰∶太阳病，有身热，汗自出而恶风者，此太阳
中风之本证也；若身热，汗自出，竟不恶风寒而反恶热，则病已去太阳而入阳明矣。此
阳明病，由太阳中风而传入者也。
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。
【注】太阳病当恶寒，阳明病当恶热。今阳明病，有初得之一日，不发热而恶寒者，是
太阳去表之邪未尽，故仍恶寒也。然去表未尽之邪，欲传阳明，不能久持，故恶寒必将
自罢，即日当自汗出而恶热矣。
【集注】方有执曰∶此以太阳伤寒，传入阳明之外证言。
程应旄曰∶阳明恶寒，终时带表，至于腑病则恶热矣；表之罢否，须于此验之。
郑重光曰∶此辨阳明伤寒之外证，不发热而恶寒，起自伤寒也。恶寒将自罢，邪过
表也。即自汗出，邪热郁于肌肉，腠理开，汗外泄也。
魏荔彤曰∶太阳伤寒亦有传入阳明者，又何以辨之？故设问曰∶病有得之一日，起初
之时，不见发热，而但见恶寒者，何病也？答曰∶得之一日恶寒，虽为太阳伤寒之证，而
恶寒亦将自罢，即自汗出而恶热，此是阳明病由太阳伤寒而传入者也。可知太阳中风，则
发热恶风，汗自出为正病；太阳伤寒，则恶寒无汗为正病。若传入阳明，则必以汗出、恶热为正病也。
问曰∶恶寒何故自罢？答曰∶阳明居中，主土也。万物所归，无所复传，始虽恶寒，二
日即止，此为阳明病也。
【注】此释上条阳明恶寒自罢之义。阳明属胃居中，土也。土为万物所归，故邪热归
胃则无所复传，亦万物归土之义。阳明初病一日，虽仍恶寒，是太阳之表未罢也。至二
日恶寒自止，则是太阳之邪已悉归并阳明，此为阳明病也。
【集注】方有执曰∶恶寒二日自止者，热入里而将恶热，此以正阳阳明言也。
程应旄曰∶六经虽分阴阳，而宰之者胃五脏六腑，皆朝宗而禀令焉。一有燥热，无
论三阳传来之邪，从而化热，即三阴传来之邪，亦转属而变热。阴阳之邪，皆归胃土，故
曰∶万物所归无所复传也。
问曰∶何缘得阳明病？答曰∶太阳病，若发汗、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。
【注】问曰∶何缘得阳明胃实之病？答曰∶由邪在太阳时，发汗，若下，若利小便，皆
为去邪而设，治之诚当，则邪解而愈矣。如其不当，徒亡津液，致令胃中干燥，则未尽
之表邪，乘其燥热，因而转属阳明。为胃实之病者有三∶曰不更衣，即太阳阳明脾约是
也；曰内实，即正阳阳明胃家实是也；曰大便难，即少阳阳明大便难是也。三者虽均为
可下之证，然不无轻重之别，脾约自轻于大便难，大便难自轻于胃家实。盖病脾约大便
难者，每因其人津液素亏，或因汗下利小便，施治失宜所致。若胃实者，则其人阳气素盛，
胃有宿食，即未经汗下，而亦入胃成实也。故已经汗下者，为夺血致燥之阳明，以滋燥为
主；未经汗下者，为热盛致燥之阳明，以攻热为急。此三承气汤、脾约丸及蜜煎、土瓜
根、猪胆汁导法之所由分也。
【集注】方有执曰∶古人大便必更衣；不更衣，言不大便也。
程应旄曰∶转属层次，不止有表罢、不罢之分；而表罢入里，复有燥实、燥不实之
辨，所以有不更衣之阳明病，有内实之阳明病，有大便难之阳明病也。其中有属表、属
里，所以下法有禁、有宜；受气有里实、里燥，所以下法有应大、应小。
汪琥曰∶或问太阳病若下矣，则胃中之物已去，纵亡津液，胃中干燥，未必复成内
实。答云∶方其太阳初病时，下之不当，徒亡津液，胃中之物去之不尽，邪传阳明而成
燥粪，故有内实之证。
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；正阳阳明者，胃家实是也；少阳阳明者，发汗利小便已，胃中燥烦实，大便难是也。
【注】阳明可下之证，不止于胃家实也。其纲有三，故又设问答以明之也。太阳之邪，
乘胃燥热，传入阳明，谓之太阳阳明，不更衣无所苦，名脾约者是也；太阳之邪，乘胃
宿食与燥热结，谓之正阳阳明，不大便，内实满痛，名胃家实者是也；太阳之邪已到少
阳，法当和解，而反发汗利小便，伤其津液，少阳之邪复乘胃燥，转属阳明，谓之少阳阳
明，大便涩而难出，名大便难者是也。
【集注】程知曰∶言三阳皆有入胃腑之证也。阳明为水谷之海，中土为万物所归，故
三阳经皆能入其腑。邪自太阳传入胃腑者，谓之太阳阳明；即经所谓太阳病，若吐、若下、
若发汗后，微烦，小便数，大便因硬者是也；由脾之敛约，故用小承气微下以和之。邪自
阳明经传入胃腑者，谓之正阳阳明；即经所谓发热汗出，胃中燥硬谵语者是也，乃胃中
邪实；故用大承气以攻下之。邪自少阳转属胃腑者，谓之少阳阳明；即经所谓少阳不可
发汗，发汗则谵语，此属胃者是也；系津液内竭，故用麻仁丸润下，以和其津液也。若
三阳外证未除，则阳明正治之法，又不可用矣。
阳明病，脉浮而紧者，必潮热，发作有时；但浮者，必盗汗出。
【按】自汗是阳明证，盗汗是少阳证，盗汗当是自汗，文义始属。
【注】阳明病在经，脉当浮长，入腑；脉当实大。今脉浮而紧，潮热有时者，是阳明
病而见太阳伤寒脉也，则知是从伤寒传来。太阳伤寒之邪未罢，必无汗，故虽见阳明潮热
发作有时之证，仍当从太阳阳明伤寒治之，宜麻黄加葛根汤汗之。若见潮热发作有时之证，
而脉但浮不紧，是阳明病而见太阳中风脉也，则知是从中风传来。太阳中风之邪未罢，必
自汗出，当从太阳阳明中风治之，宜桂枝加葛根汤解之。
【集注】沈明宗曰∶此阳明证而见太阳脉也。脉浮而紧，太阳表寒未罢之脉；潮热发
作有时，则阳明里证已具；但浮者，太阳风伤卫脉，故必汗出也。
阳明病，脉迟，汗出多，微恶寒者，表未解也，可发汗，宜桂枝汤。
【按】汗出多之下，当有“发热”二字；若无此二字，脉迟，汗出多，微恶寒，乃是
表阳虚，桂枝附子汤证也，岂有用桂枝汤发汗之理乎？必是传写之遗。
【注】阳明病脉当数大，今脉迟汗出多，设不发热恶寒，是太阳表邪已解矣。今发热
微恶寒，是表犹未尽解也，故宜桂枝汤解肌以发其汗，使初入阳明之表邪，仍还表而出也。
【集注】程知曰∶此言中风传阳明，表邪未解，仍宜用桂枝汤以解肌也。
汪琥曰∶此太阳病初传阳明经，中有风邪也。脉迟者，太阳中风缓脉之所变，传至
阳明，邪将入里，故脉变迟，汗出多者，阳明热而肌腠疏也。微恶寒者，在表风邪未尽
也。故仍从太阳中风例治之。又曰∶虽从太阳例治，但既云阳明病，仲景法还宜用桂枝
加葛根汤为是。
阳明病，脉浮，无汗而喘者，发汗则愈，宜麻黄汤。
【注】阳明病，脉应浮大，证应汗出。今脉但浮，表病脉也；无汗而喘，表实证也。是
太阳之邪，未悉入阳明，犹在表也。当仍从太阳伤寒治之，发汗则愈，宜麻黄汤。
【集注】张璐曰∶阳明荣卫难辨，辨之全藉于脉证。风邪之脉，传至阳明，自汗已多，
则缓去而迟在；寒邪之脉，传至阳明，发热已甚，则紧去而浮在。此皆邪气在经之征。若
入腑，则迟者必数，浮者必实矣。设不数不实，非胃实也，必不胜攻下矣。
汪琥曰∶无汗而喘，但浮不紧，何以定其为阳明病？必其人目痛鼻干，身热不得眠，
故云阳明病也。
魏荔彤曰∶此太阳阳明之证，入阳明未深，故令其邪仍自表出，不至归于胃而无所复传也。
阳脉微而汗出少者，为自和也；汗出多者，为太过。阳脉实，因发其汗，出多者，亦
为太过。太过者，为阳绝于里，亡津液，大便因硬也。
【注】此承上条互详其脉，以出其证也。脉阳微，谓脉浮无力而微也；阳脉实，谓脉
浮有力而盛也。凡中风伤寒脉，阳微则热微，微热蒸表作汗；若汗出少者，为自和欲解，汗
出多者，为太过不解也。阳脉实则热盛，因热盛而发其汗，出多者，亦为太过；汗出太
过，则阳极于里，亡津液，大便因硬而成内实之证矣。势不得不用下法。故欲发其汗者，
不可不早虑及此也。
【集注】喻昌曰∶阳微者，中风之脉，阳微缓也；阳实者，伤寒之脉，阳紧实也；阳
绝，即亡津液之互辞。仲景每于亡津液者，悉名无阳。玩本文阳绝于里，亡津液，大便因
阳明经主管体内，内部反映胃的情况，外部反映肌肉的情况，因此有经络病和腑病的区别。如《伤寒论》中所述的身体发热、心烦口渴、眼睛疼痛、鼻子干燥、无法安睡、不恶寒反而恶热的症状，这是阳明经病；出现定时发热（潮热）、说胡话（谵语）、手足及腋下出汗、腹部胀满疼痛、大便干硬的症状，这是阳明腑病。而这两类病症各有三种情况：经病方面，有邪气已经传入阳明但太阳表的证候尚未解除，同时伴有头痛、恶寒、无汗等太阳证的情况；有太阳的邪气已经完全解除，全部传入阳明，仅表现为高热有汗、心烦失眠、口渴想喝水的纯阳明证的情况；有阳明的邪气尚未结束，又转属少阳，同时伴有胸胁疼痛、忽冷忽热、口苦呕吐、头晕目眩耳聋等少阳证的情况。腑病方面，有太阳阳明，指的是太阳病经过发汗、催吐、泻下或利小便治疗后，津液耗损，胃中干燥，太阳的邪气趁着胃燥转入阳明，导致小便频数、大便干硬的情况，这就是所谓的“脾约”；有正阳阳明，指的是患者阳气素来旺盛，或者有宿食停滞，太阳的邪气一经传入阳明，就进入胃腑，导致大便不通的情况，这就是所谓的“胃家实”；有少阳阳明，指的是病邪已经到了少阳阶段，本应采用和解法治疗，却错误地使用了发汗或利小便的方法，导致津液耗损，胃中燥热，邪气再次转属阳明，导致大便结燥难出的情况，这就是所谓的“大便难”。治疗阳明经病，可以使用葛根汤或桂枝加葛根汤来发汗解表，或者用白虎汤来清热，或者用柴胡白虎汤来和解，根据具体证候灵活施治即可。治疗阳明腑病，虽然都适用泻下法，但也有轻重之分，所以有的用三承气汤来泻下，有的用麻仁丸来通便，有的用蜜栓或猪胆汁灌肠来导便，根据病情轻重进行治疗即可，这是阳明病的大致概况。现在将经病和腑病详细分疏在篇章中，使读者容易区分，那么在临床施治时自然就不会混乱了。
阳明病的提纲证，就是胃家实。
【注】阳明经，内部候察胃，外部候察肌肉。所谓阳明病，如果是太阳的邪气传入其经络，就成为阳明病的外证；如果是太阳的邪气传入胃腑，就成为胃家实。
【集注】方有执说：阳明是经络，胃是腑脏；实，是指大便结聚成硬满而无法排出。虽然有早晚时间的不同，但不能拘泥于日数。
伤寒发病三天，脉象变大。
【注】伤寒第一天太阳，第二天阳明，第三天少阳，这是《内经》中讲述邪气传经的顺序，并不是必然以日数来拘限。这里说三天出现阳明脉大，是指既不兼有太阳阳明那种浮大的脉象，也不兼有少阳阳明那种弦大的脉象，而是直接呈现正阳阳明那种洪大的脉象。这是因为邪气由表入里，热邪进入胃中，形成了内实的诊候，所以脉象如此。
【集注】方有执说：伤寒三日，大概包括中风在内而言。脉大，是因为阳明气血俱多。
沈明宗说：这是正阳明病的正脉。张仲景说三天阳明脉大，因为阳明是多气多血的腑脏，风寒传入，邪气盛于中焦，所以脉象显大，这是阳明邪实的正脉。但是患阳明病必须具备这种脉象，才可以采用攻下法，如果兼有太阳的浮紧脉、少阳的弦细脉，或者迟、疾、滑、涩、虚、弱等脉象，则属于气血阴阳的虚证，即使见到极大的实证和满证，也应当详细审察顾虑，可以用小承气汤试探性服用，或者用蜜煎导法，不能直接施用攻下法。
原本太阳病刚得病时，医生发了汗，但汗出得不透彻，因此邪气转属阳明。
【注】阳明病，原本是太阳初得病时，医生发汗，汗先出来但不透彻，这是发汗方法不当，所以未尽的邪气因而转属阳明。邪气在经络就表现为外证；邪气进入腑脏就表现为胃家实。
【集注】方有执说：这是说因发太阳之汗方法不当，导致病邪入胃的大意。
阳明病，如果能吃东西，名叫中风；如果不能吃东西，名叫中寒。
【注】太阳的邪气传入阳明病，有从中风传来的，有从伤寒传来的，应当通过能否进食来辨别。如果能吃东西，名叫中风，是从中风传来，因为风是阳邪，阳能消化水谷，所以能吃东西。如果不能吃东西，名叫中寒，是从伤寒传来，因为寒是阴邪，不能消化水谷，所以不能吃东西。
【集注】方有执说：这是通过能否进食来验证风寒的区别。因为阳明主管水谷，风能助消化，阳能化谷；寒不能助消化，阴不能杀谷。“名”，相当于“叫做”的意思。中寒，即伤寒的互词，大意是推究风寒从太阳传来，其辨别验证如此，并不是说阳明自行感受寒邪。
汪琥说：张仲景说：中寒与伤寒同义，不是真正的寒证。如果是真正中寒，那是胃家虚冷，用药宜用理中汤之类。现在不能吃东西，是胃气实，只是邪气未入腑，没有形成郁热罢了。所以叫中寒，实际上与伤寒没有区别。
问：阳明病的外证是什么？答：身体发热，自然出汗，不恶寒反而恶热。
【注】阳明病有外证和内证。潮热、自汗、不大便，是内证；身体发热、汗自出、不恶寒、反恶热，是外证。现在汗自出，是从中风传来，所以与中风的外证相同；而身热、不恶寒反恶热，就知道是阳明外证，所以不与中风外证相同。然而阳明的热，发于肌肉，一定是蒸蒸而热，不像太阳病那样阵阵发热，由此可知。
【集注】方有执说：这是讲述太阳中风传入阳明后的外证。
魏荔彤说：病有太阳中风不解，传入阳明的，如何辨别呢？所以设问说：阳明病不知道其里证是何时传来的？必须先验证其外在有什么见证？回答：太阳病，有身体发热、汗自出且恶风的，这是太阳中风的本证；如果身体发热、汗自出，竟然不恶风寒反而恶热，那么病已经离开太阳而入阳明了。这个阳明病，是由太阳中风传入的。
问：有的病得病一天，不发热而恶寒，为什么呢？答：虽然得病一天，恶寒将会自行停止，随即就会自汗出而恶热。
【注】太阳病应当恶寒，阳明病应当恶热。现在阳明病，有刚得病的一天，不发热而恶寒的，这是太阳去表之邪未尽，所以仍然恶寒。然而去表未尽的邪气，想要传入阳明，不能长久维持，所以恶寒必将自行停止，当天就会自汗出而恶热了。
【集注】方有执说：这是讲述太阳伤寒传入阳明后的外证。
程应旄说：阳明恶寒，最终带有表证的特点，至于腑病则是恶热；表证是否解除，必须在此验证。
郑重光说：这是辨别阳明伤寒的外证，不发热而恶寒，起自伤寒。恶寒将自行停止，说明邪气已过表。随即自汗出，是邪热郁于肌肉，腠理开泄，汗液外泄。
魏荔彤说：太阳伤寒也有传入阳明的，又如何辨别呢？所以设问说：有病得病一天，起初的时候，不见发热，只见到恶寒的，是什么病？回答：得病一天恶寒，虽然是太阳伤寒的证候，但恶寒也将自行停止，随即自汗出而恶热，这是阳明病由太阳伤寒传入的。可知太阳中风，发热恶风、汗自出是正病；太阳伤寒，恶寒无汗是正病。如果传入阳明，则必须以汗出、恶热为正病。
问：恶寒为什么自行停止？答：阳明居中，属土。万物所归，不再传变，开始虽然恶寒，到第二天就停止了，这就是阳明病。
【注】这是解释上一条阳明恶寒自罢的含义。阳明属胃居中，属土。土为万物所归，所以邪热归胃则不再传变，也是万物归土的意思。阳明初病一天，虽然仍恶寒，是太阳的表证未解除。到第二天恶寒自行停止，则是太阳的邪气已全部归并阳明，这就是阳明病。
【集注】方有执说：恶寒两天自行停止，是热入里而将要恶热，这是指正阳阳明。
程应旄说：六经虽然分阴阳，但主宰者是胃，五脏六腑都朝宗于此并禀受命令。一旦有燥热，无论三阳传来的邪气，都会随之化热，即使是三阴传来的邪气，也会转属而变热。阴阳的邪气，都归胃土，所以说：万物所归，无所复传。
问：为什么会得阳明病？答：太阳病，如果发汗、如果泻下、如果利小便，这些都会导致津液亡失，胃中干燥，因而转属阳明；如果不排便，内实，大便困难的，这就名叫阳明病。
【注】问：为什么会得阳明胃实的病？答：由邪气在太阳时，发汗、泻下、利小便，都是为祛除邪气而设，治疗得当，则邪解而愈。如果不恰当，徒然亡失津液，致使胃中干燥，那么未尽的表邪，乘着燥热，因而转属阳明。成为胃实病的有三种：叫不更衣，即太阳阳明脾约；叫内实，即正阳阳明胃家实；叫大便难，即少阳阳明大便难。这三种虽然都适用泻下证，但也有轻重的区别，脾约比大便难轻，大便难比胃家实轻。大概患脾约、大便难的病人，往往因为其人津液素亏，或因汗下利小便，治疗失宜所致。如果是胃实者，则是其人阳气素盛，胃有宿食，即使未经过汗下，也会入胃成实。所以已经汗下的，是夺血致燥的阳明，以滋润燥热为主；未经汗下的，是热盛致燥的阳明，以攻热为急。这就是三承气汤、脾约丸以及蜜煎、土瓜根、猪胆汁导法之所以区分的原因。
【集注】方有执说：古人大便必更衣；不更衣，指不大便。
程应旄说：转属的层次，不止有表证罢与不罢的区别；而且表证罢入里，又有燥实与燥不实的辨别，所以有不更衣的阳明病，有内实的阳明病，有大便难的阳明病。其中有属表、属里的区别，所以下法有禁忌、有适宜；受气有里实、里燥的区别，所以下法有应该大下、应该小下的区别。
汪琥说：有人问太阳病如果已经泻下，那么胃中的东西已经去除，纵然亡失津液，胃中干燥，未必再形成内实。回答说：在太阳初病时，误用下法，徒然亡失津液，胃中之物去之不尽，邪气传阳明而成燥粪，所以有内实的证候。
问：病有太阳阳明，有正阳阳明，有少阳阳明，是什么意思？答：太阳阳明，就是脾约；正阳阳明，就是胃家实；少阳阳明，就是发汗利小便后，胃中燥烦实，大便难。
【注】阳明可下的证候，不仅仅限于胃家实。其纲领有三，所以又设问答来阐明它。太阳的邪气，乘着胃燥热，传入阳明，称为太阳阳明，不排便但没有痛苦，名叫脾约；太阳的邪气，乘着胃宿食与燥热结聚，称为正阳阳明，不大便，内实满痛，名叫胃家实；太阳的邪气已到少阳，本应和解，却反而发汗利小便，损伤津液，少阳的邪气又乘着胃燥，转属阳明，称为少阳阳明，大便涩滞难出，名叫大便难。
【集注】程知说：说的是三阳都有入胃腑的证候。阳明是水谷之海，中土为万物所归，所以三阳经都能入其腑。邪气从太阳传入胃腑的，称为太阳阳明；即经文中所说的太阳病，如果吐、如果下、如果发汗后，微烦，小便数，大便因硬的就是；因为脾的敛约，所以用小承气汤轻微泻下以调和它。邪气从阳明经传入胃腑的，称为正阳阳明；即经文中所说的发热汗出，胃中燥硬谵语的就是，这是胃中邪实；所以用大承气汤攻下它。邪气从少阳转属胃腑的，称为少阳阳明；即经文中所说的少阳不可发汗，发汗则谵语，这属于胃的就是；因为津液内竭，所以用麻仁丸润下，以调和它的津液。如果三阳外证未除，那么阳明的正治之法，又不可用了。
阳明病，脉浮而紧的，一定会有潮热，发作有定时；如果只浮，一定有盗汗出。
【按】自汗是阳明证，盗汗是少阳证，这里的盗汗应当是自汗，文义才通顺。
【注】阳明病在经络，脉应当浮长，进入腑脏；脉应当实大。现在脉浮而紧，潮热有时的，是阳明病见到太阳伤寒的脉，则知道是从伤寒传来。太阳伤寒的邪气未解除，必定无汗，所以虽然见到阳明潮热发作有时的证候，仍应当从太阳阳明伤寒治疗，宜用麻黄加葛根汤发汗。如果见到潮热发作有时的证候，而脉只浮不紧，是阳明病见到太阳中风的脉，则知道是从中风传来。太阳中风的邪气未解除，必定自汗出，应当从太阳阳明中风治疗，宜用桂枝加葛根汤解表。
【集注】沈明宗说：这是阳明证而见太阳脉。脉浮而紧，是太阳表寒未罢的脉；潮热发作有时，则阳明里证已具备；只浮，是太阳风伤卫的脉，所以必定汗出。
阳明病，脉迟，汗出多，微微恶寒的，是表证未解，可以发汗，宜用桂枝汤。
【按】“汗出多”之下，应当有“发热”二字；如果没有这两个字，脉迟，汗出多，微恶寒，乃是表阳虚，是桂枝附子汤的证候，哪里有用桂枝汤发汗的道理呢？必然是传写遗漏。
【注】阳明病脉应当数大，现在脉迟汗出多，假设不发热恶寒，是太阳表邪已解了。现在发热微恶寒，是表邪还没有完全解除，所以宜用桂枝汤解肌发汗，使初入阳明的表邪，仍然回归表而出。
【集注】程知说：这是说中风传阳明，表邪未解，仍宜用桂枝汤解肌。
汪琥说：这是太阳病初传阳明经，中有风邪。脉迟，是太阳中风缓脉的变化，传至阳明，邪将入里，所以脉变迟，汗出多，是阳明热而肌腠疏松。微恶寒，是在表的风邪未尽。所以仍从太阳中风例治疗。又说：虽从太阳例治疗，但既然说是阳明病，张仲景的法度还宜用桂枝加葛根汤为宜。
阳明病，脉浮，无汗而喘的，发汗则痊愈，宜用麻黄汤。
【注】阳明病，脉应浮大，证应汗出。现在脉只浮，是表病的脉；无汗而喘，是表实证。这是太阳的邪气，未完全入阳明，还在表。应当仍从太阳伤寒治疗，发汗则痊愈，宜用麻黄汤。
【集注】张璐说：阳明荣卫难辨，辨别全靠脉证。风邪的脉，传至阳明，自汗已多，则缓去而迟在；寒邪的脉，传至阳明，发热已甚，则紧去而浮在。这都是邪气在经络的征象。如果入腑，则迟的必数，浮的必实。如果不数不实，不是胃实，一定承受不住攻下。
汪琥说：无汗而喘，只浮不紧，怎么确定它是阳明病？一定是那人眼睛痛鼻子干，身体发热无法睡觉，所以说阳明病。
魏荔彤说：这是太阳阳明的证候，入阳明未深，所以令邪气仍从表出，不至于归于胃而无所复传。
阳脉微而汗出少的，是自和；汗出多的，是太过。阳脉实，因发其汗，出多的，也是太过。太过的，是阳绝于里，亡失津液，大便因此变硬。
【注】这是承接上一条互相详述其脉，以引出其证。脉阳微，指脉浮无力而微；阳脉实，指脉浮有力而盛。凡是中风伤寒脉，阳微则热微，微热蒸腾体表作汗；如果汗出少的，是自和欲解，汗出多的，是太过不解。阳脉实则热盛，因热盛而发其汗，出多的，也是太过；汗出太过，则阳极于里，亡失津液，大便因此变硬而成内实的证候。势必要用下法。所以想要发汗的，不可不早考虑到这一点。
【集注】喻昌说：阳微，是中风的脉，阳微缓；阳实，是伤寒的脉，阳紧实；阳绝，即亡津液的互词。张仲景每当遇到亡津液的，都命名为无阳。玩味本文“阳绝于里，亡津液，大便因...”
The Yangming channel governs the interior; internally it reflects the stomach, and externally it reflects the muscles. Therefore, there is a distinction between channel disease (Jing Bing) and fu-organ disease (Fu Bing). As stated in the Treatise, symptoms such as body heat, vexation, thirst, eye pain, nasal dryness, inability to sleep, aversion to cold being absent, and instead an aversion to heat, constitute Yangming channel disease. Symptoms such as tidal fever (Chao Re), delirium (Chan Yu), sweating on the hands, feet, and axillae, abdominal fullness and pain, and hard stools constitute Yangming fu-organ disease. Each of these categories has three variations:
For channel diseases, there are cases where the pathogenic factor has already transmitted to Yangming but the exterior syndrome of Taiyang has not yet resolved, presenting simultaneously with headache, aversion to cold, and anhidrosis characteristic of Taiyang. There are cases where the Taiyang pathogen has completely resolved and fully transmitted to Yangming, presenting solely with high fever, sweating, mental restlessness, insomnia, and intense thirst with a desire to drink, which are pure Yangming syndromes. There are also cases where the Yangming pathogen has not yet subsided but has re-transmitted to Shaoyang, presenting simultaneously with hypochondriac pain, alternating chills and fever, bitter taste in the mouth, vomiting, dizziness, and deafness characteristic of Shaoyang.
For fu-organ diseases, there is "Taiyang-Yangming," referring to when a Taiyang disease, after treatment with diaphoresis, emesis, purgation, or promoting urination, results in fluid depletion and dryness in the stomach. The Taiyang pathogen takes advantage of this gastric dryness to transmit to Yangming, causing frequent urination and hard stools; this is known as "Spleen Constraint" (Pi Yue). There is "Zhengyang-Yangming" (True Yang-Yangming), referring to when a person's yang qi is naturally robust or has retained food stagnation. Upon transmission from Taiyang to Yangming, the pathogen enters the stomach fu-organ, causing constipation; this is known as "Stomach Fullness and Excess" (Wei Jia Shi). There is "Shaoyang-Yangming," referring to when the disease has reached Shaoyang, where reconciliation should be the method, but erroneous use of diaphoresis or promoting urination depletes fluids, causing dryness and heat in the stomach. The pathogen re-transmits to Yangming, causing hard and difficult defecation; this is known as "Difficulty in Defecation" (Da Bian Nan).
Treatment for Yangming channel disease involves using Gegen Tang (Kudzu Decoction) or Guizhi Jia Gegen Tang (Cinnamon Twig plus Kudzu Decoction) to induce sweating, Baizhu Tang (White Tiger Decoction) to clear heat, or Chaihu Baizhu Tang (Bupleurum White Tiger Decoction) to harmonize, depending on the specific syndrome. Treatment for Yangming fu-organ disease, while generally suitable for purgation, varies in severity. Thus, one may use the Three Chengqi Decoctions (San Chengqi Tang) to purge, Maren Wan (Hemp Seed Pill) to unblock, or honey suppositories/pig bile enemas to guide out stool, treating according to the condition. This outlines the general principles of Yangming disease. Here, channel and fu-organ diseases are detailed separately to facilitate distinction, ensuring orderly clinical practice.
The defining syndrome of Yangming disease is Wei Jia Shi (Stomach Fullness and Excess).
[Annotation] The Yangming channel internally reflects the stomach and externally reflects the muscles. If the Taiyang pathogen transmits to its channel, it becomes the exterior syndrome of Yangming disease; if it transmits into the stomach fu-organ, it becomes Wei Jia Shi.
[Collected Annotations] Fang Youzhi states: Yangming is the channel; Stomach is the fu-organ; "Shi" (Excess) refers to hard and full feces that cannot be passed. Although timing varies, it cannot be rigidly bound by days.
In Shanghan (Cold Damage) on the third day, the pulse becomes large.
[Annotation] "Day 1 Taiyang, Day 2 Yangming, Day 3 Shaoyang" describes the sequence of transmission in the Neijing, not a rigid chronological rule. Saying "Yangming pulse is large on the third day" means it does not combine the floating-large pulse of Taiyang-Yangming nor the string-large pulse of Shaoyang-Yangming, but directly presents the large pulse of Zhengyang-Yangming. This occurs because the pathogen moves from exterior to interior, heat enters the stomach, forming an internal excess diagnosis, hence the pulse appears thus.
[Collected Annotations] Fang Youzhi states: "Third day" broadly includes wind-strike. A large pulse indicates abundant Qi and Blood in Yangming.
Shen Mingzong states: This is the true pulse of Yangming. Zhang Zhongjing notes the large pulse on the third day because Yangming is a fu-organ rich in Qi and Blood. When wind-cold transmits, pathogen excess in the middle jiao manifests as a large pulse, the true pulse of Yangming pathogenic excess. However, only when this pulse is present can purgative methods be used. If combined with Taiyang floating-tight or Shaoyang string-thin pulses, or if slow, rapid, slippery, choppy, weak, or deficient, it indicates deficiency of Qi, Blood, Yin, or Yang. Even with severe excess and fullness, careful examination is required; one might trial Xiao Chengqi Tang or use honey suppositories, avoiding direct aggressive purgation.
When Taiyang disease is first contracted, if diaphoresis is applied but sweat is not thorough, the pathogen may transmit to Yangming.
[Annotation] Yangming disease often originates from improper diaphoresis at the onset of Taiyang disease. Incomplete sweating fails to expel all pathogens, allowing residual pathogen to transmit to Yangming. Pathogen in the channel manifests as exterior syndrome; pathogen entering the fu-organ manifests as Wei Jia Shi.
[Collected Annotations] Fang Youzhi states: This explains the general idea that improper diaphoresis in Taiyang leads to pathogen entering the stomach.
In Yangming disease, if the patient can eat, it is called Wind-Strike (Zhong Feng); if unable to eat, it is called Cold-Strike (Zhong Han).
[Annotation] When Taiyang pathogen transmits to Yangming, it may come from Wind-Strike or Cold-Damage. Differentiation relies on appetite. Ability to eat indicates Wind-Strike transmission; wind is a Yang pathogen, and Yang aids digestion, hence appetite remains. Inability to eat indicates Cold-Damage transmission; cold is a Yin pathogen, impairing digestion, hence loss of appetite.
[Collected Annotations] Fang Youzhi states: This uses appetite to distinguish Wind from Cold. Yangming governs water and grain; wind aids eating, Yang transforms grain; cold hinders eating, Yin fails to kill grain ("kill grain" refers to digestion). "Ming" means "called." "Zhong Han" is synonymous with Shanghan here, implying transmission from Taiyang, not primary Yangming cold injury.
Wang Hu states: Zhang Zhongjing equates Zhong Han with Shanghan, not a true cold syndrome. True cold would involve Stomach deficiency-cold, treated with Lizhong Tang. Current inability to eat indicates Stomach excess, with pathogen not yet in the fu-organ and no郁热 (stagnant heat) formed. Thus, Zhong Han is effectively identical to Shanghan.
Q: What are the exterior syndromes of Yangming disease?
A: Body heat, spontaneous sweating, absence of aversion to cold, and presence of aversion to heat.
[Annotation] Yangming disease has exterior and interior syndromes. Tidal fever, spontaneous sweating, and constipation are interior syndromes; body heat, spontaneous sweating, no aversion to cold, and aversion to heat are exterior syndromes. Spontaneous sweating suggests transmission from Wind-Strike, sharing features with Wind-Strike exterior syndromes. However, body heat without aversion to cold but with aversion to heat identifies it as Yangming exterior syndrome, distinguishing it from Wind-Strike. Yangming heat arises from the muscles, manifesting as steaming heat, unlike the intermittent fever of Taiyang.
[Collected Annotations] Fang Youzhi states: This describes the exterior syndrome of Yangming transmitting from Taiyang Wind-Strike.
Wei Litong states: How to differentiate Yangming transmitting from unresolved Taiyang Wind-Strike? One must verify the exterior manifestations. Taiyang Wind-Strike presents with heat, spontaneous sweating, and aversion to wind. If heat and spontaneous sweating occur with aversion to heat rather than cold/wind, the disease has left Taiyang and entered Yangming.
Q: Some patients have aversion to cold without fever on the first day. Why?
A: Although aversion to cold appears on the first day, it will cease spontaneously, followed by spontaneous sweating and aversion to heat.
[Annotation] Taiyang disease typically involves aversion to cold; Yangming involves aversion to heat. Initial aversion to cold in Yangming indicates residual Taiyang exterior pathogen. However, this residual pathogen cannot persist long as it seeks to transmit to Yangming; thus, aversion to cold ceases quickly, replaced by spontaneous sweating and aversion to heat.
[Collected Annotations] Fang Youzhi states: This describes exterior syndrome of Yangming transmitting from Taiyang Cold-Damage.
Cheng Yingmao states: Yangming aversion to cold retains exterior characteristics initially; fu-organ disease involves aversion to heat. Resolution of exterior signs confirms the transition.
Zheng Zhongguang states: This differentiates exterior syndrome of Yangming Cold-Damage. Initial aversion to cold without fever originates from Cold-Damage. Cessation of aversion to cold indicates pathogen passing the exterior. Subsequent spontaneous sweating results from pathogenic heat stagnating in muscles, opening pores, and leaking sweat.
Wei Litong states: Taiyang Cold-Damage can also transmit to Yangming. Initial aversion to cold without fever mimics Taiyang Cold-Damage, but cessation of aversion to cold and emergence of sweating/aversion to heat confirm Yangming transmission via Cold-Damage. Note: Taiyang Wind-Strike's true syndrome is heat, aversion to wind, and sweating; Taiyang Cold-Damage's true syndrome is aversion to cold and anhidrosis. Upon transmitting to Yangming, sweating and aversion to heat become the true syndrome.
Q: Why does aversion to cold cease spontaneously?
A: Yangming resides in the center and corresponds to Earth. It is the destination of all things and does not transmit further. Although aversion to cold begins initially, it stops by the second day, marking Yangming disease.
[Annotation] This explains the cessation of aversion to cold. Yangming (Stomach) is central and Earth-element. Earth receives all things; thus, pathogenic heat entering the Stomach has nowhere else to transmit. Initial aversion to cold on day one indicates unresolved Taiyang exterior. Cessation on day two indicates complete transmission of Taiyang pathogen to Yangming.
[Collected Annotations] Fang Youzhi states: Cessation of aversion to cold by day two indicates heat entering the interior and impending aversion to heat, describing Zhengyang-Yangming.
Cheng Yingmao states: Although Six Channels divide Yin/Yang, the Stomach governs them. Any dryness-heat causes pathogens from any channel to transform into heat. Yin/Yang pathogens all return to Stomach Earth, hence "destination of all things, no further transmission."
Q: How does one acquire Yangming disease?
A: In Taiyang disease, if diaphoresis, purgation, or promoting urination deplete fluids causing gastric dryness, the pathogen transmits to Yangming. Failure to defecate, internal excess, and difficulty in defecation name this Yangming disease.
[Annotation] Q: How does Yangming Stomach Excess arise?
A: During Taiyang, diaphoresis, purgation, or diuresis aim to expel pathogen. Correct treatment resolves disease. Incorrect treatment depletes fluids, drying the Stomach. Residual pathogen exploits dryness-heat to transmit to Yangming. Three types of Stomach Excess exist: 1. "Bu Geng Yi" (Not changing clothes/i.e., no bowel movement), corresponding to Taiyang-Yangming Pi Yue (Spleen Constraint); 2. "Nei Shi" (Internal Excess), corresponding to Zhengyang-Yangming Wei Jia Shi (Stomach Fullness); 3. "Da Bian Nan" (Difficulty in Defecation), corresponding to Shaoyang-Yangming. While all are purgable, severity differs: Pi Yue is mildest, Da Bian Nan moderate, Wei Jia Shi most severe. Pi Yue/Da Bian Nan often stem from inherent fluid deficiency or iatrogenic damage. Wei Jia Shi stems from inherent robust Yang/Qi and retained food, becoming excess even without prior mistreatment. Mistreated cases require moistening; untreated heat-excess cases require clearing heat. This distinguishes the indications for San Chengqi Tang, Pi Yue Wan, and suppository/enema methods.
[Collected Annotations] Fang Youzhi states: Ancients said "change clothes" for defecation; "not changing clothes" means no defecation.
Cheng Yingmao states: Transmission levels include exterior resolution status and degree of dryness/excess, explaining the three types. Indications for purgation depend on exterior/interior involvement and nature of excess/dryness.
Wang Hu states: If Taiyang was purged, stomach contents are gone, so why excess? Answer: Improper early purgation depletes fluids without fully removing pathogen/residue. Pathogen transmits to Yangming, forming dry feces and internal excess.
Q: What are Taiyang-Yangming, Zhengyang-Yangming, and Shaoyang-Yangming?
A: Taiyang-Yangming is Pi Yue; Zhengyang-Yangming is Wei Jia Shi; Shaoyang-Yangming is difficulty in defecation after erroneous sweating/diuresis causing gastric dryness/vexation/excess.
[Annotation] Purgative indications in Yangming extend beyond Wei Jia Shi. Three main categories exist: 1. Taiyang-Yangming: Taiyang pathogen exploits gastric dryness-heat to transmit, causing infrequent bowel movements without distress, named Pi Yue. 2. Zhengyang-Yangming: Taiyang pathogen combines with gastric retained food and dryness-heat, causing constipation, internal fullness/pain, named Wei Jia Shi. 3. Shaoyang-Yangming: Pathogen at Shaoyang treated wrongly with sweating/diuresis damages fluids; Shaoyang pathogen exploits gastric dryness to transmit to Yangming, causing difficult, sticky stools, named Da Bian Nan.
[Collected Annotations] Cheng Zhi states: All Three Yang channels can enter the Stomach fu. Taiyang pathogen entering Stomach is Taiyang-Yangming (e.g., post-emesis/purgation/sweating with mild vexation, frequent urination, hard stool); treated with mild purgation (Xiao Chengqi Tang) due to Spleen constraint. Yangming channel pathogen entering Stomach is Zhengyang-Yangming (e.g., fever, sweating, dry/hard stomach, delirium); treated with strong purgation (Da Chengqi Tang) due to Stomach excess. Shaoyang pathogen transferring to Stomach is Shaoyang-Yangming (e.g., Shaoyang contraindicates sweating; sweating causes delirium indicating Stomach involvement); treated with moistening purgation (Maren Wan) due to fluid exhaustion. If exterior symptoms of Three Yang persist, standard Yangming treatments are contraindicated.
In Yangming disease, if the pulse is floating and tight, tidal fever occurring at fixed times is certain; if only floating, night sweating is certain.
[Note] Spontaneous sweating is a Yangming sign; night sweating is a Shaoyang sign. "Night sweating" here likely implies "spontaneous sweating" for textual coherence.
[Annotation] Yangming channel pulse should be floating-long; fu-organ pulse should be solid-large. Floating-tight pulse with timed tidal fever indicates Yangming disease with Taiyang Cold-Damage pulse, suggesting transmission from Cold-Damage. Unresolved Taiyang Cold-Damage implies anhidrosis. Despite Yangming tidal fever, treat as Taiyang-Yangming Cold-Damage with Mahuang Jia Gegen Tang (Ephedra plus Kudzu Decoction) to sweat. If tidal fever occurs with only floating (not tight) pulse, it indicates Yangming with Taiyang Wind-Strike pulse, suggesting transmission from Wind-Strike. Unresolved Taiyang Wind-Strike implies spontaneous sweating. Treat as Taiyang-Yangming Wind-Strike with Guizhi Jia Gegen Tang (Cinnamon Twig plus Kudzu Decoction) to resolve.
[Collected Annotations] Shen Mingzong states: Yangming syndrome with Taiyang pulse. Floating-tight indicates unresolved Taiyang exterior cold; timed tidal fever indicates established Yangming interior syndrome. Only floating indicates Taiyang wind injuring Wei, hence sweating.
In Yangming disease, if the pulse is slow, sweating is profuse, and there is slight aversion to cold, the exterior is unresolved. Diaphoresis is indicated; Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
[Note] "Fever" is likely missing after "profuse sweating." Without fever, slow pulse, profuse sweating, and slight aversion to cold indicate exterior Yang deficiency, requiring Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction), not Guizhi Tang. Likely a transcription error.
[Annotation] Yangming pulse should be rapid-large. Slow pulse with profuse sweating, assuming no fever/cold, would mean resolved Taiyang. However, with fever and slight aversion to cold, the exterior is incompletely resolved. Use Guizhi Tang to release the muscle layer and induce sweating, returning the newly entered Yangming exterior pathogen to the surface.
[Collected Annotations] Cheng Zhi states: Wind-strike transmitting to Yangming with unresolved exterior still requires Guizhi Tang to release the muscle layer.
Wang Hu states: Early transmission of Taiyang to Yangming channel with wind pathogen. Slow pulse is a variation of Taiyang Wind-Strike's slow pulse as pathogen prepares to enter interior. Profuse sweating indicates Yangming heat loosening muscle pores. Slight aversion to cold indicates residual exterior wind. Treat per Taiyang Wind-Strike protocol. However, since it is Yangming disease, Guizhi Jia Gegen Tang is more appropriate per Zhang Zhongjing's method.
In Yangming disease, if the pulse is floating, there is no sweating, and wheezing, diaphoresis leads to recovery; Mahuang Tang (Ephedra Decoction) is appropriate.
[Annotation] Yangming pulse should be floating-large, syndrome should feature sweating. Floating pulse alone indicates exterior disease; anhidrosis with wheezing indicates exterior excess. Taiyang pathogen has not fully entered Yangming but remains in the exterior. Treat as Taiyang Cold-Damage; diaphoresis cures. Use Mahuang Tang.
[Collected Annotations] Zhang Lu states: Distinguishing Ying/Wei in Yangming relies on pulse/syndrome. Wind pathogen pulse in Yangming: excessive sweating removes slowness, leaving laggardness. Cold pathogen pulse in Yangming: high fever removes tightness, leaving floating. These indicate pathogen in channel. If entering fu, slow becomes rapid, floating becomes solid. If not rapid/solid, it is not Stomach excess and cannot withstand purgation.
Wang Hu states: Anhidrosis with wheezing, floating without tightness—how to confirm Yangming? The patient must have eye pain, nasal dryness, body heat, and insomnia, confirming Yangming.
Wei Litong states: This is a Taiyang-Yangming syndrome. Since entry into Yangming is shallow, allow pathogen to exit via exterior, preventing retention in Stomach.
If the Yang pulse is faint and sweating is scant, it indicates self-harmonization; if sweating is profuse, it indicates excess. If the Yang pulse is solid, and diaphoresis causes profuse sweating, it also indicates excess. Excess leads to Yang isolation in the interior, fluid depletion, and hard stools.
[Annotation] This elaborates on pulses and syndromes. "Yang pulse faint" means floating, weak, and subtle; "Yang pulse solid" means floating, forceful, and vigorous. In Wind/Cold pulses, faint Yang indicates mild heat, steaming exterior to produce sweat. Scant sweating indicates self-resolution; profuse sweating indicates failure to resolve due to excess. Solid Yang indicates heat excess. Inducing sweat due to heat excess causing profuse sweating is also excess. Excessive sweating isolates Yang in the interior, depletes fluids, hardens stools, and creates internal excess, necessitating purgation. Those inducing sweat must consider this risk early.
[Collected Annotations] Yu Chang states: Faint Yang is Wind-Strike pulse (faint-slow); Solid Yang is Cold-Damage pulse (tight-solid). "Yang isolation" is synonymous with fluid depletion. Zhang Zhongjing often terms fluid depletion as "No Yang." Examining "Yang isolated in interior, fluid depletion, hard stools..."