治阳明病发热汗出。此为热越。不能发黄也。但头汗出。身无汗。剂颈而还。小
渴欲饮水浆者。此为瘀热在里。身必发黄。此方主之。又伤寒七八日。身黄如橘子
不利腹微满者。此方主之。
茵陈蒿（六两） 栀子（十四枚） 大黄（二两 去皮。）
上三味。以水一斗。先煮茵陈。减六升。内二味煎取三升。去滓。分温三服。小盒饭利。
尿
歌曰 二两大黄十四栀。茵陈六两早煎宜。身黄尿短腹微满。解自前阴法最奇。
柯韵伯曰。太阳阳明俱有发黄证。但头汗出而身无汗。则热不得外越。小便不利则热不
得下
亦
黄。若小便自利者不能发黄也。张令韶之说最妙。）然里有不同。肌肉是太阳之里。当汗而
发之。故用麻黄连翘赤小豆汤。（按柯韵伯移此方于太阳篇。亦有见解。然原本系是阳明。
圣经必不可擅改。）心胸是太阳之里阳明之表。当寒以胜之。故用栀子柏皮汤。乃清火法。
肠胃是阳明之里。当泻之于内。故立本方。是逐秽法。茵陈禀北方之色。经冬不凋。傲霜凌
雪。遍受大寒之气。故能除热邪留结。率栀子以通水源。大黄以调胃实。令一身内外瘀热悉
从小便而出。腹满自减。肠胃无伤。乃合引而竭之之法。此阳明利水之圣剂也。又按仲景治
阳明渴饮有三法。太阳篇之五苓散微发汗以散水气者不与焉。若大渴烦躁小便自利者。白虎
汤加参清火而生津。脉浮发热小便不利者。猪苓汤滋阴以利水。若小便不利而发黄腹满者。
茵陈汤以泄热令黄从小便出。病情治法。胸有成竹矣。窃思仲景利小便。必用气化之品。通
大便。必用承气之品。以小便由于气化也。兹小便不利。不用二苓者何。本论云。阳明病汗
出多而渴者。不可与猪苓汤。以汗多胃中燥猪苓汤复利小便故也。须知阳明汗出多而渴者。
不可用。则汗不出而渴者。津液先虚。更不可用明矣。此主以推陈致新之茵陈。佐以屈曲下
行之栀子。不用枳、朴以承气。与芒硝之峻利。则大黄但能润肠泄热。缓缓而行。故必一宿
而腹始减。黄从小便去。而不由大肠去。仲景立法之奇。匪夷所思耳。
治疗阳明病，出现发热、汗出。这是热邪向外发散的表现，因此不会发生发黄的症状。如果只有头部出汗，身上没有汗，汗水仅到颈部即止，且患者想喝稀粥或汤水，这是瘀滞的热邪在体内，身体一定会发黄，此方主治。另外，伤寒病经过七八天，身体发黄像橘子颜色一样，小便不通利，腹部轻微胀满的，也以此方主治。
以上三味药，用水一斗，先煮茵陈蒿，水量减少六升后，再加入另外两味药，煎取三升药液，去掉药渣，分三次温服。小便利则病愈。
歌诀说：二两大黄十四枚栀子，茵陈六两宜早煎。身黄尿短腹微满，从前阴解湿热法最奇。
柯韵伯说：太阳病和阳明病都有发黄的证候。但如果是只有头部出汗而身上无汗，那么热邪就不能向外发散；如果小便不通利，热邪就不能向下排泄，也会导致发黄。如果小便自利通畅，就不会发生发黄。张令韶的说法最为精妙。（然而体内的病位有所不同。肌肉是太阳经的里层，应当用发汗的方法治疗，所以使用麻黄连翘赤小豆汤。（按：柯韵伯将此方移至太阳篇，也有其见解，但原本属于阳明病，经典原文不可擅自更改。）心胸部位是太阳经的里层、阳明经的表层，应当用寒凉药物来胜热，所以使用栀子柏皮汤，这是清火的方法。肠胃是阳明经的里层，应当从内部泻下，所以创立本方，这是逐除秽浊的方法。茵陈禀受北方的黑色，经历冬天不凋谢，傲霜凌雪，遍受大寒之气，所以能清除热邪的留结，率领栀子以通调水源，配合大黄以调理胃中的实热，使全身内外的瘀热都从小便排出，腹部胀满自然减轻，肠胃不受损伤，这符合“引而竭之”的治疗方法。这是治疗阳明病利水的圣剂。另外，按仲景治疗阳明病口渴饮水有三种方法：太阳篇中的五苓散通过微微发汗来疏散水气，这里不予考虑。如果是大渴、烦躁、小便自利的，用白虎加人参汤清火并生津液；如果是脉浮、发热、小便不利的，用猪苓汤滋阴以利水。如果是小便不利且发黄、腹部胀满的，用茵陈蒿汤泄热，使黄色从小便排出。病情与治法，心中已有定见。我私下认为，仲景治疗利小便，必定使用气化作用的药物；治疗通大便，必定使用承气汤类的药物，因为小便的产生依赖于气化作用。现在小便不利，为什么不用茯苓、猪苓呢？本论中说：“阳明病，汗出多而口渴者，不可给予猪苓汤，因为汗多导致胃中干燥，猪苓汤再次利小便的缘故。”需要知道，对于阳明病汗出多而口渴的情况，不可使用猪苓汤，那么不出汗而口渴的人，津液已经先虚，更不可使用了。此处主要使用推陈致新的茵陈，佐以屈曲下行的栀子，不使用枳实、厚朴来构成承气汤，也不使用芒硝的峻猛利下，那么大黄只能润肠泄热，缓缓而行，所以必须过一夜腹部才减轻，黄色从小便去除，而不是从大肠排出。仲景立法的奇妙，真是匪夷所思啊。
Treats Yangming disease (Yangming disorder) presenting with fever and sweating. This indicates that the heat is dissipating outward, so jaundice will not develop. If there is only sweating on the head, no sweating on the body, and the sweat stops at the neck, accompanied by a desire to drink thin gruel or soup, this signifies stagnant heat in the interior, and jaundice will inevitably occur; this formula is indicated. Additionally, in Shanghan (Cold Damage) disease after seven or eight days, if the body is yellow like an orange peel, urination is difficult, and the abdomen is slightly full, this formula is also indicated.
Yinchen Hao (Herba Artemisiae Scopariae, 6 liang), Zhizi (Fructus Gardeniae, 14 pieces), Dahuang (Radix et Rhizoma Rhei, 2 liang, peeled).
The above three herbs are decocted with one dou of water. First, boil Yinchen Hao until the volume reduces by six sheng. Then add the other two herbs and decoct to obtain three sheng of liquid. Strain the dregs. Divide into three warm doses. Recovery occurs when urination becomes smooth.
Song verse: Two liang of Dahuang and fourteen Zhizi, Yinchen Hao six liang should be boiled early. Yellow body, short urine, slight abdominal fullness, resolving damp-heat via the anterior orifice is the most miraculous method.
Ke Yunbo stated: Both Taiyang disease (Taiyang disorder) and Yangming disease can present with jaundice. However, if there is only head sweating without body sweating, the heat cannot vent outward; if urination is obstructed, the heat cannot drain downward, leading to jaundice. If urination is free and unobstructed, jaundice will not develop. The explanation by Zhang Lingshao is particularly exquisite. (However, the location of the pathogen within the interior differs. The muscles constitute the interior of Taiyang, requiring diaphoresis (inducing sweating); thus, Mahlian Lianqiao Chixiaodou Tang (Mahuang, Forsythia, and Red Bean Decoction) is used. [Note: Ke Yunbo moved this formula to the Taiyang chapter, showing insight, but the original text belongs to Yangming, and canonical texts should not be arbitrarily altered]. The chest and heart region constitute the interior of Taiyang and the exterior of Yangming, requiring cooling to overcome heat; thus, Zhizi Bopi Tang (Gardenia and Phellodendron Bark Decoction) is used, which is a method of clearing fire. The intestines and stomach constitute the interior of Yangming, requiring purgation from within; thus, this formula was established, which is a method of expelling turbidity. Yinchen Hao inherits the color of the North, does not wither in winter, braves frost and snow, and absorbs extensive cold qi; therefore, it can eliminate lingering heat pathogens. It leads Zhizi to open the water source and pairs with Dahuang to regulate gastric excess, causing all internal and external stagnant heat to exit via urination. Abdominal fullness naturally decreases, and the intestines and stomach remain undamaged. This aligns with the method of "drawing out and exhausting." This is the supreme agent for promoting diuresis in Yangming disease. Furthermore, regarding Zhang Zhongjing's treatment of thirst and drinking in Yangming disease, there are three methods: Wuling San (Five-Ling Powder) in the Taiyang chapter induces mild sweating to disperse water qi, which is not applicable here. For severe thirst, irritability, and free urination, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) clears fire and generates fluids. For floating pulse, fever, and obstructed urination, Zhu Ling Tang (Polyporus Decoction) nourishes yin and promotes diuresis. For obstructed urination with jaundice and abdominal fullness, Yinchen Hao Tang drains heat, allowing the yellow pigment to exit via urine. The pathology and treatment principles are clear. I privately believe that Zhang Zhongjing always uses agents that promote qi transformation for promoting diuresis, and agents of Chengqi Tang (Purgative Decoction) class for promoting defecation, because urination depends on qi transformation. Now, why are Fuling (Poria) and Zhuling (Polyporus) not used for obstructed urination? The text states: "In Yangming disease, if there is much sweating and thirst, Zhu Ling Tang must not be given, because profuse sweating causes dryness in the stomach, and Zhu Ling Tang would further deplete fluids through diuresis." It must be understood that if Zhu Ling Tang is contraindicated for those with profuse sweating and thirst in Yangming disease, then for those without sweating but with thirst, whose fluid reserves are already deficient, its use is even more contraindicated. Here, Yinchen Hao, which pushes out the old and brings forth the new, is the main herb, assisted by Zhizi, which directs downward. Zhi Shi (Immature Bitter Orange) and Houpo (Magnolia Bark) are not used to form a Chengqi Tang, nor is Mangxiao (Mirabilite) used for its harsh purgative action. Thus, Dahuang merely moistens the intestines and drains heat, acting slowly. Therefore, abdominal fullness decreases only after overnight passage. The yellow pigment exits via urine, not via the large intestine. The ingenuity of Zhang Zhongjing's legislative methods is beyond imagination.