腑病连经 病患烦热汗出则解又如疟状日晡发热者属阳明脉实宜下之浮虚宜发汗下之与大承气汤发汗宜桂枝汤阳明
病脉迟汗出多微恶寒者表未解也可发汗（桂枝症）阳明病脉浮无汗而喘者发汗则愈（麻黄症）太阳与阳明合病喘而胸满
者不可下（麻黄症）太阳病项背强KT KT 反汗出恶风（桂枝葛根症）太阳病项背强KT KT 无汗恶风（葛根症）太
阳与阳明合病者必自下利（葛根症）太阳与阳明合病不下利但呕（葛根半夏症）
腑病 阳明之为病胃家实也伤寒三日阳明脉大身热汗自出不恶寒反恶热（阳明外症）病有得之一日不发热而恶寒何
也曰虽得之一日恶寒将自罢即自汗出而恶热也（阳明外症）恶寒何故自罢曰阳明居中土无所复传始虽恶寒二日自止也（阳
明外症）伤寒发热无汗呕不能食反汗出 然（阳明外症）伤寒脉浮缓手足自温者是为系在太阴身当发黄若小便自利不
发黄至七八日大便硬者转系阳明其人 然微汗出也（阳明外症）太阳阳明者脾约正阳阳明者胃家实少阳阳明者发汗利
小便已胃中燥烦热大便难（阳明来路）太阳病若发汗若下若利小便此亡津液胃中干燥转属阳明不更衣内实大便难（阳明
来路）太阳病初得时发其汗汗出不彻因转属阳明（阳明来路）二阳并病太阳初得时发其汗汗出不彻因转属阳明续自微汗
出不恶寒若太阳证不罢不可下下之为逆可小发汗面色缘缘正赤者阳郁在表当解之熏之若发汗不彻阳郁不得越其人烦躁不
知痛处乍在腹中乍在四肢按之不可得短气但坐以汗出不彻故也更发汗则愈何以知汗不彻脉涩故也（阳明来路）太阳病三
日发汗不解蒸蒸发热者属胃也（调胃承气症）二阳并病太阳证罢但发潮热手足 汗出大便难而谵语下之则愈（大承气
症）阳明病脉迟虽汗出不恶寒者身必重短气腹满而喘有潮热者此外欲解可攻里也手足 然汗出者此大便已硬大承气主之
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（小承气症）阳明病若吐若
下若发汗微烦小便数大便因硬（小承气症）阳明病不吐不下心烦（调胃承气症）阳明病本汗出重发汗病瘥尚微烦不了了
者大便必硬以亡津液胃干燥故硬当问其小便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胃中也
（亡津便硬症）阳明病自汗出若发汗小便自利者此津液内竭虽硬不可攻之当须自欲大便宜蜜煎导通之土瓜根大猪胆汁皆
可为导（蜜煎导症）趺阳脉浮而涩浮则胃气强涩则小便数浮涩相搏大便难其脾为约（麻仁大症）得病二三日脉弱无太阳
柴胡症烦躁心下硬至四五日虽能食与小承气汤少少和之令小安至六日与承气汤一升若不大便六七日小便少者虽不能食初
硬后必溏未成硬攻之必溏须小便利屎定硬乃可攻宜大承气汤（大承气症）阳明病潮热大便微硬可与大承气汤不硬不可与
之若不大便六七日恐有燥屎欲知之少与承气汤腹中转失气者可攻不转失气初硬后必溏攻之必胀满不能食也欲饮水者与水
则哕其后热者必大便硬而少以小承气和之（小承气症）阳明病谵语发潮热脉滑而疾小承气主之因与承气汤一升腹中转失
气更服一升若不转失气勿更与之明日不大便脉反微涩者里虚也为难治不可更与承气汤也（小承气症）伤寒吐下后不解不
大便五六日至十余日潮热不恶寒独语如见鬼剧者发则不识人循衣摸床惕而不止微喘直视脉弦者生微者但发谵语大承气主
之若一服利止后服（大承气症）伤寒四五日脉沉而喘满沉为在里而反发汗津液越出大便难表虚里实久则谵语（亡津谵语
症）汗出谵语以有燥屎在胃此为风也过经乃可下之下之若早语言必乱表虚里实故也（大承气症）伤寒十三日不解过经谵
语者以有热也当下之若小便利者大盒饭硬而反下利胃脉调和知医以丸药下之非其治也若自下利者脉当微厥今反和者此内
实也调胃承气汤主之（调胃承气症）阳明病下之懊 而烦胃中有燥屎者可攻腹微满初硬后必溏不可攻（大承气症）阳明
病谵语有潮热反不能食胃中必有燥屎五六枚宜大承气若能食者但硬耳（大承气症）小便不利大便乍难乍易时有微热喘冒
不得卧者有燥屎也（大承气症）不大便五六日绕脐痛烦躁发作有时者此有燥屎（大承气症）大下后六七日不大便烦不解
腹满痛者此有燥屎本有宿食也（大承气症）阳明少阳合病必下利脉不负者顺也负者失也互相克贼为负也脉滑而数者有宿
食也当下之（大承气症）三阳合病脉浮大上关上但欲眠睡目合则汗（三阳合病症）脉阳微汗出少者为自和也汗出多为太
过阳脉实因发汗多出亦太过为阳绝于里亡津液大便因硬（汗多亡津症）脉浮而芤浮为阳芤为阴浮芤相搏胃气生热其阳则
绝（胃热阳绝症）发汗不解腹满痛者急下之（大承气症）阳明病发热汗多者急下之（大承气症）伤寒六七日目中不了睛
不和无表里症大便难身微热此为实也急下之（大承气症）阳明病喜忘者必有蓄血屎虽硬大便反易色必黑宜下之（抵当症）
病患无表里症发热七八日虽脉浮数者可下之已下脉数不解合热则消谷善饥至七八日不大便有瘀血也宜抵当汤脉不解利不
止必协热而便脓（抵当症）阳明病下血谵语此为热入血室但头汗出者刺期门随其热而泄之（热入血室症）阳明病欲解时
从申至戌上
虚证 阳明病若能食名中风不能食名中寒 阳明病若中寒不能食小便不利手足汗出此欲作固瘕大便初硬后溏以胃中
冷水谷不别故也（中寒瘕泄症）脉浮而迟表热里寒下利清谷者四逆主之若胃中虚冷不能食者饮水则哕（四逆症）阳明病
不能食攻其热必哕胃中虚冷故也（胃中虚冷症）伤寒大吐下之极虚复极汗出者以外气拂郁复与水发其汗因得哕胃中寒冷
故也（胃中寒冷症）伤寒哕而腹满视其前后知何部不利利之愈（哕而腹满症）阳明病反无汗身如虫行皮中此久虚故（身
痒无汗症）阳明病反无汗而小便利二三日咳呕手足厥者必苦头痛若不咳不呕手足不厥者头不痛（咳呕厥逆症）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（咳逆咽痛症）食谷欲呕者属阳明吴茱萸汤主之得汤反剧属上焦（吴
茱萸症）伤寒呕多虽有阳明症不可攻（呕多忌攻症）太阳病寸缓关浮尺弱发热汗出复恶寒不呕但心下痞者医下之也如不
下者不恶寒而渴者此转属阳明小便数者大便必硬不更衣十日无所苦也渴欲饮水少与之但以法救之渴者宜五苓散（五苓散
症）阳明病心下硬满不可攻攻之利止者愈（心下硬满症）阳明中风口苦咽干腹满微喘发热恶寒脉浮紧若下之则腹满小便
难也（寒热脉紧症）阳明病脉浮紧咽燥口苦腹满而喘发热汗出不恶寒反恶热身重若发汗则躁心愦愦反谵语若加烧针必怵
惕烦躁不得眠若下之则胃中空虚客气动膈心中懊 舌上苔者栀子豉汤主之若渴欲饮水口干舌燥白虎加人参汤主之若脉浮
发热渴欲饮水小便不利猪苓汤主之（栀子白虎猪苓症）发汗多重发汗亡阳谵语脉自和者不死（汗多亡阳症）实则谵语虚
则郑声（谵语郑声症）阳明病下之外有热手足温不结胸懊 饥不能食但头汗出（栀子豉症）三阳合病腹满身重难以转侧
口不仁面垢谵语遗尿发汗则谵语下之则额上生汗手足逆冷（入太阴）若自汗者白虎汤主之（白虎症）阳明病汗多而渴者
不可与猪苓汤以汗多胃中燥猪苓复利小便故也（汗多胃燥症）阳明病口燥但欲漱水不欲咽此必衄（口燥欲衄症）脉浮发
热口干鼻燥能食者则衄（鼻燥欲衄症）阳明病脉浮紧必潮热发作有时但浮必盗汗（脉浮盗汗症）阳明病初欲食小便反不
利大便调骨节疼如有热状奄然发狂汗出 然解者此水不胜谷气与汗共并脉紧则愈（汗解紧愈症）阳明病面合赤色不可攻
必发热色黄小便不利也（发热色黄症）阳明病无汗小便不利而懊 者必发黄（无汗发黄症）阳明病被火额微汗小便不利
必发黄（微汗发黄症）阳明病发热汗出此为热越不发黄但头汗出剂颈而还小便不利渴饮水浆者此瘀热在里必发黄茵陈蒿
汤主之（茵陈蒿症）阳明病脉迟食饱则微烦头眩必小便难此欲作谷疸虽下之腹满如故脉迟故也（脉迟发黄症）阳明中风
脉弦浮大短气腹满胁下及心痛久按之气不通鼻干不得汗嗜卧一身及面目悉黄小便难有潮热时时哕耳前后肿刺之小瘥外不
解过十日脉续浮者与小柴胡脉但浮无余症者与麻黄汤（柴胡麻黄症）阳明病潮热大便溏小便自可胸胁满不去者（小柴胡
症）阳明病胁下硬满不大便而呕舌上白苔者可与小柴胡汤上焦通津液下胃气和 然汗出解（小柴胡症）
不治病 伤寒吐下后不解不大便五六日至十余日日晡潮热不恶寒独语如见鬼剧者发则不识人循衣摸床惕而不安微
喘直视脉涩者死 阳明病心下硬满攻之利逆不止者死（硬满症）发汗多重发汗亡阳谵语脉短者死（汗多亡阳症）直视谵
语喘满者死下利者亦死（谵语喘满症）阳明中风脉弦浮大短气腹满胁下及心痛久按之气不通鼻干不得汗嗜卧一身及面目
悉黄小便难有潮热时时哕耳前后肿刺之小瘥外不解若不尿腹满加哕者不治（柴胡麻黄症）
方药
桂枝加葛根汤
桂枝 芍药 甘草 大枣 生姜 葛根
葛根汤
葛根 麻黄 桂枝 芍药 甘草 生姜 大枣
葛根加半夏汤
葛根 麻黄 桂枝 芍药 甘草 生姜 大枣 半夏
调胃承气汤
大黄 甘草 芒硝
大承气汤
大黄 芒硝 枳实
小承气汤
大黄 浓朴 枳实
蜜煎导方
煎凝作挺纳谷道
猪胆汁方
和醋灌谷道
麻仁丸
麻子 芍药 杏仁 大黄 浓朴 枳实 炼蜜丸
吴茱萸汤
吴茱萸 生姜 人参 大枣
猪苓汤
猪苓 茯苓 泽泻 滑石 阿胶
【阳明病篇】
腑病连经：患者出现烦热，出汗后症状缓解；又如疟疾般发作，在日晡时分（下午3-5点）发热的，属于阳明病。脉象实者适宜用攻下法，脉象浮虚者适宜用发汗法。攻下法使用大承气汤，发汗法使用桂枝汤。
阳明病脉象迟缓，出汗多且轻微恶寒的，说明表证未解，可以发汗（对应桂枝汤证）。阳明病脉象浮、无汗且喘息的，发汗后即可痊愈（对应麻黄汤证）。太阳与阳明合病，出现喘息且胸部胀满的，不可用攻下法（对应麻黄汤证）。太阳病项背部强直不舒，反而出汗、恶风的，用桂枝加葛根汤治疗。太阳病项背部强直不舒、无汗、恶风的，用葛根汤治疗。太阳与阳明合病的，必然会出现自发性腹泻，用葛根汤治疗。太阳与阳明合病，不下利但呕吐的，用葛根加半夏汤治疗。
腑病：阳明病的提纲是“胃家实”。伤寒发病三天，脉象变大，身体发热，自然出汗，不恶寒反而恶热，这是阳明病的外证。有的病人在得病第一天不发热而恶寒，为什么呢？回答说：虽然得病第一天恶寒，但很快就会自行停止，随即会自然出汗并厌恶热邪。为什么恶寒会自行停止？因为阳明居中属土，病邪不再传变，起初虽然恶寒，到第二天就会自行停止，这也是阳明病的外证表现。伤寒发热、无汗、呕吐、不能进食，却反而出汗、头额部汗出连绵不断的，是阳明病的外证。伤寒脉象浮缓，手足自然温暖，这是病系于太阴，身体应当发黄；如果小便自利，则不会发黄。到了七八天，大便变硬的，转属于阳明病，此时病人头额部会有微汗出，这也是阳明病的外证。
太阳阳明病，是指脾约证；正阳阳明病，是指胃家实证；少阳阳明病，是指经过发汗或利小便治疗后，胃中干燥、烦热、大便困难的情况，这是阳明病的来路。太阳病如果经过发汗、攻下或利小便治疗，导致津液耗损，胃中干燥，转为阳明病，表现为不大便、内实、大便困难，这是阳明病的来路。太阳病初起时发汗，若汗出不透彻，因而转属阳明病，这是阳明病的来路。二阳并病（太阳与阳明同时患病），太阳病初起时发汗，若汗出不透彻，因而转属阳明病，继续出现微汗出、不恶寒。如果太阳证未罢，不可攻下，攻下为逆治，可用小发汗法。面色持续通红，是阳气郁滞在体表，应当用解表熏蒸的方法。如果发汗不透彻，阳气郁滞不得发散，病人烦躁、不知道疼痛的具体位置，有时在腹部，有时在四肢，按压又找不到痛点，短气只能端坐，这是因为汗出不透彻的缘故。再次发汗即可痊愈。如何知道汗出不透彻？通过脉象涩可知。太阳病三天发汗后病不解，出现蒸蒸发热（如热气从内向外蒸发），属于胃热，适用调胃承气汤证。二阳并病，太阳证已罢，只出现潮热、手足濈然汗出、大便困难且谵语，攻下后即可痊愈，适用大承气汤证。
阳明病脉象迟缓，虽然出汗但不恶寒，身体必定沉重、短气、腹满且喘息，有潮热的，说明表证将解，可以攻里。手足濈然汗出的，说明大便已经坚硬，主方为大承气汤。如果出汗多、微发热恶寒，说明表证未解，其热不呈潮热状，不可给予承气汤。如果腹部大满不通，可给予小承气汤，轻微调和胃气，适用小承气汤证。阳明病如果经过吐、下或发汗治疗，出现轻微心烦、小便频数，大便因此变硬，适用小承气汤证。阳明病未经过吐下治疗却心烦，适用调胃承气汤证。阳明病本应出汗，若重发汗，病虽愈但仍轻微心烦、神志不清的，大便必然变硬，这是因为津液耗损、胃干燥所致。此时应当询问病人的小便情况，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。现在因为小便次数减少，津液应当回归胃中，故知大便将通，此为亡津液致大便硬证。
阳明病自汗出，或者发汗后小便自利，这是津液在内枯竭，即使大便硬也不可攻下，应当等待病人自己想排便时，用蜜煎导法通便。土瓜根和大猪胆汁也可作为导引剂，适用蜜煎导证。趺阳脉浮而涩，浮表示胃气强，涩表示小便频数，浮涩相搏，大便困难，脾脏功能受限称为脾约，适用麻子仁丸证。
得病两三天，脉弱，没有太阳病或少阳病的症状，烦躁、心下硬，到了四五天，如果能进食，给予少量小承气汤，稍微调和使其稍安。到了第六天，给予一升承气汤。如果六七天不大便，小便少的，即使不能进食，开始大便硬后来必溏，未成硬结，攻下必致溏泄。必须等到小便通利，屎定硬，才可攻下，宜用大承气汤，适用大承气汤证。阳明病潮热，大便微硬，可给大承气汤；如果不硬，不可给。如果六七天不大便，担心有燥屎，想确认的话，可少量给予承气汤。如果服药后腹中转矢气（放屁），说明可以攻下；如果不转矢气，开始大便硬后来必溏，攻下必致胀满、不能进食。想喝水的人给水，会引起哕逆。之后出现发热，大便必然变硬而少，用小承气汤调和，适用小承气汤证。
阳明病谵语、发潮热，脉滑而疾，主方为小承气汤。因给予承气汤一升，腹中转矢气，再服一升；若不转矢气，勿再给予。明天仍不大便，脉反微涩，说明里虚，为难治之证，不可再给承气汤，适用小承气汤证。
伤寒吐下后病不解，不大便五至十余日，日晡潮热，不恶寒，独语如见鬼状，发作时不认识人，循衣摸床，惊恐不安，微喘直视，脉弦者生，脉微者但发谵语，主方为大承气汤。如果一次服药后大便通利，停服后续药物，适用大承气汤证。
伤寒四五日，脉沉而喘满，沉表示病在里，反而发汗，津液外越，大便困难，表虚里实，久则谵语，适用亡津谵语证。出汗且谵语，是因为胃中有燥屎，此为风邪所致。过了经期才可攻下。如果过早攻下，语言必乱，因为表虚里实，适用大承气汤证。
伤寒十三日不解，过经谵语，是因为有热，当下之。如果小便利，大便应当硬，反而下利，胃脉调和，知道是医生误用丸药攻下，非其治也。如果是自下利，脉当微厥，现在反和，这是内实，主方为调胃承气汤，适用调胃承气汤证。
阳明病攻下后懊憹而烦，胃中有燥屎者可攻；腹部微满，开始硬后来必溏，不可攻，适用大承气汤证。阳明病谵语、有潮热，反而不能食，胃中必有燥屎五六枚，宜用大承气汤；如果能食，只是大便硬而已，适用大承气汤证。小便不利，大便乍难乍易，时有微热，喘冒不得卧，是有燥屎，适用大承气汤证。不大便五六日，绕脐痛，烦躁发作有时，是有燥屎，适用大承气汤证。大下后六七天不大便，烦不解，腹满痛，是有燥屎，本有宿食，适用大承气汤证。
阳明少阳合病，必然下利。脉不负者为顺，负者为失，互相克贼为负。脉滑而数，有宿食，当下之，适用大承气汤证。三阳合病，脉浮大上关上，但欲眠睡，目合则汗，适用三阳合病症。
脉阳微，汗出少，为自和；汗出多为太过。阳脉实，因发汗多出亦太过，为阳绝于里，亡津液，大便因硬，适用汗多亡津症。脉浮而芤，浮为阳，芤为阴，浮芤相搏，胃气生热，其阳则绝，适用胃热阳绝症。发汗不解，腹满痛，急下之，适用大承气汤证。阳明病发热汗多者，急下之，适用大承气汤证。伤寒六七日，目中不了了，睛不和，无表里症，大便难，身微热，此为实，急下之，适用大承气汤证。
阳明病喜忘者，必有蓄血，屎虽硬，大便反易，色必黑，宜下之，适用抵当汤证。病患无表里症，发热七八日，虽脉浮数，可下之。已下脉数不解，合热则消谷善饥，至七八日不大便，有瘀血也，宜抵当汤。脉不解，利不止，必协热而便脓，适用抵当汤证。阳明病下血、谵语，此为热入血室，但头汗出者，刺期门穴，随其热而泄之，适用热入血室症。阳明病欲解时，从申时至戌时。
【虚证】
阳明病若能食，名中风；不能食，名中寒。阳明病若中寒，不能食，小便不利，手足汗出，此欲作固瘕，大便初硬后溏，因为胃中冷水，谷水不别，适用中寒瘕泄症。脉浮而迟，表热里寒，下利清谷者，主方为四逆汤。如果胃中虚冷不能食，饮水则哕，适用四逆汤证。阳明病不能食，攻其热必哕，因为胃中虚冷，适用胃中虚冷症。伤寒大吐下之后，极虚，复极汗出，因为外气拂郁，复与水发其汗，因得哕，因为胃中寒冷，适用胃中寒冷症。伤寒哕而腹满，视其前后，知何部不利，利之愈，适用哕而腹满症。阳明病反无汗，身如虫行皮中，此因久虚，适用身痒无汗症。阳明病反无汗而小便利，二三日咳呕、手足厥者，必苦头痛；若不咳不呕、手足不厥者，头不痛，适用咳呕厥逆症。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，适用咳逆咽痛症。食谷欲呕者，属阳明，主方为吴茱萸汤。得汤反剧，属上焦，适用吴茱萸汤证。伤寒呕多，虽有阳明症，不可攻，适用呕多忌攻症。
太阳病寸缓关浮尺弱，发热汗出复恶寒，不呕但心下痞者，医下之也。如下不者，不恶寒而渴者，此转属阳明。小便数者，大便必硬。不更衣十日，无所苦也。渴欲饮水，少与之，但以法救之。渴者宜五苓散，适用五苓散症。阳明病心下硬满，不可攻，攻之利止者愈，适用心下硬满症。阳明中风口苦咽干，腹满微喘，发热恶寒，脉浮紧，若下之则腹满小便难也，适用寒热脉紧症。
阳明病脉浮紧，咽燥口苦，腹满而喘，发热汗出，不恶寒反恶热，身重。若发汗则躁、心愦愦、反谵语；若加烧针必怵惕、烦躁、不得眠；若下之则胃中空虚，客气动膈，心中懊憹，舌上苔者，栀子豉汤主之。若渴欲饮水、口干舌燥，白虎加人参汤主之。若脉浮、发热、渴欲饮水、小便不利，猪苓汤主之，适用栀子白虎猪苓症。发汗多重，重发汗亡阳，谵语，脉自和者不死，适用汗多亡阳症。实则谵语，虚则郑声，适用谵语郑声症。阳明病下之，外有热，手足温，不结胸，懊憹，饥不能食，但头汗出，适用栀子豉汤证。
三阳合病，腹满身重，难以转侧，口不仁面垢，谵语遗尿。发汗则谵语，下之则额上生汗，手足逆冷（入太阴）。若自汗者，白虎汤主之，适用白虎汤证。阳明病汗多而渴者，不可与猪苓汤，以汗多胃中燥，猪苓复利小便故也，适用汗多胃燥症。阳明病口燥但欲漱水不欲咽，此必衄，适用口燥欲衄症。脉浮发热，口干鼻燥，能食者则衄，适用鼻燥欲衄症。阳明病脉浮紧，必潮热，发作有时；但浮，必盗汗，适用脉浮盗汗症。阳明病初欲食，小便反不利，大便调，骨节疼，如有热状，奄然发狂，汗出濈然解者，此水不胜谷气，与汗共并，脉紧则愈，适用汗解紧愈症。阳明病面合赤色，不可攻，必发热色黄，小便不利也，适用发热色黄症。阳明病无汗，小便不利而懊憹者，必发黄，适用无汗发黄症。阳明病被火，额微汗，小便不利，必发黄，适用微汗发黄症。阳明病发热汗出，此为热越，不发黄。但头汗出，剂颈而还，小便不利，渴饮水浆者，此瘀热在里，必发黄，茵陈蒿汤主之，适用茵陈蒿汤证。阳明病脉迟，食饱则微烦，头眩，必小便难，此欲作谷疸，虽下之腹满如故，脉迟故也，适用脉迟发黄症。
阳明中风，脉弦浮大，短气，腹满，胁下及心痛，久按之气不通，鼻干不得汗，嗜卧，一身及面目悉黄，小便难，有潮热，时时哕，耳前后肿，刺之小瘥。外不解，过十日脉续浮者，与小柴胡汤。脉但浮无余症者，与麻黄汤，适用柴胡麻黄症。阳明病潮热，大便溏，小便自可，胸胁满不去者，适用小柴胡汤证。阳明病胁下硬满，不大便而呕，舌上白苔者，可与小柴胡汤。上焦通，津液下，胃气和，濈然汗出解，适用小柴胡汤证。
【不治症】
伤寒吐下后不解，不大便五六日至十余日，日晡潮热，不恶寒，独语如见鬼状，剧者发则不识人，循衣摸床，惕而不安，微喘直视，脉涩者死。阳明病心下硬满，攻之利逆不止者死，适用硬满症。发汗多重，重发汗亡阳，谵语，脉短者死，适用汗多亡阳症。直视谵语，喘满者死，下利者亦死，适用谵语喘满症。阳明中风，脉弦浮大，短气，腹满，胁下及心痛，久按之气不通，鼻干不得汗，嗜卧，一身及面目悉黄，小便难，有潮热，时时哕，耳前后肿，刺之小瘥。外不解，若不尿，腹满加哕者，不治，适用柴胡麻黄症。
【方药】
桂枝加葛根汤：桂枝、芍药、甘草、大枣、生姜、葛根。
葛根汤：葛根、麻黄、桂枝、芍药、甘草、生姜、大枣。
葛根加半夏汤：葛根、麻黄、桂枝、芍药、甘草、生姜、大枣、半夏。
调胃承气汤：大黄、甘草、芒硝。
大承气汤：大黄、芒硝、枳实。
小承气汤：大黄、厚朴、枳实。
蜜煎导方：煎凝作挺纳谷道。
猪胆汁方：和醋灌谷道。
麻仁丸：麻子、芍药、杏仁、大黄、厚朴、枳实、炼蜜丸。
吴茱萸汤：吴茱萸、生姜、人参、大枣。
猪苓汤：猪苓、茯苓、泽泻、滑石、阿胶。
[Chapter on Yangming Disease]
Fu-Bing Lian-Jing (Disease of the Fu Organ involving the Meridian): The patient experiences irritability, fever, and sweating, after which symptoms resolve. Or it manifests like malaria with fever occurring at Rib-Shu hours (3-5 PM). This belongs to Yangming disease. If the pulse is excess, purgation is indicated; if the pulse is floating and deficient, diaphoresis is indicated. For purgation, use Da Cheng Qi Tang (Major Order the Qi Decoction); for diaphoresis, use Gui Zhi Tang (Cinnamon Twig Decoction).
Yangming disease with a slow pulse, profuse sweating, and slight aversion to cold indicates that the exterior syndrome has not yet resolved; diaphoresis may be used (Gui Zhi Tang pattern). Yangming disease with a floating pulse, no sweating, and wheezing will resolve with diaphoresis (Ma Huang Tang pattern). In combined Taiyang and Yangming disease presenting with wheezing and chest fullness, purgation is contraindicated (Ma Huang Tang pattern). In Taiyang disease, stiffness and discomfort in the nape and back with sweating and aversion to wind are treated with Gui Zhi Jia Ge Gen Tang (Cinnamon Twig Decoction plus Kudzu Root). In Taiyang disease, stiffness and discomfort in the nape and back without sweating and with aversion to wind are treated with Ge Gen Tang (Kudzu Root Decoction). In combined Taiyang and Yangming disease with spontaneous diarrhea, Ge Gen Tang is used. In combined Taiyang and Yangming disease without diarrhea but with vomiting, Ge Gen Jia Ban Xia Tang (Kudzu Root Decoction plus Pinellia) is used.
Fu-Bing (Disease of the Fu Organ): The general principle of Yangming disease is "Wei Jia Shi" (Excess in the Stomach and Intestines). After three days of Shang Han (Cold Damage), the pulse becomes large, the body is hot, there is spontaneous sweating, no aversion to cold, but rather aversion to heat; this is the external manifestation of Yangming disease. Some patients on the first day do not have fever but have aversion to cold. Why? It is said that although there is aversion to cold on the first day, it will cease spontaneously, followed by spontaneous sweating and aversion to heat. Why does the aversion to cold cease? Because Yangming resides in the center and belongs to Earth, the pathogen does not transmit further. Although there is initial aversion to cold, it stops by the second day; this is also an external manifestation of Yangming disease. Shang Han with fever, no sweating, vomiting, inability to eat, yet with sweating and continuous sweating on the forehead is an external manifestation of Yangming disease. Shang Han with a floating and slack pulse, warm hands and feet naturally, indicates the disease is related to Taiyin; jaundice should develop. If urination is normal, jaundice will not develop. By the seventh or eighth day, if the stool becomes hard, it has transferred to Yangming; the patient will have slight sweating on the forehead, which is also an external manifestation of Yangming disease.
Taiyang-Yangming disease refers to Pi Yue (Spleen Constraint); Zheng Yang Yangming disease refers to Wei Jia Shi (Stomach Excess); Shao Yang-Yangming disease refers to dryness in the stomach, irritability, and difficulty defecating after sweating or promoting urination; these are origins of Yangming disease. In Taiyang disease, if sweating, purgation, or promoting urination depletes fluids, causing dryness in the stomach and transfer to Yangming, manifesting as infrequent bowel movements, internal excess, and difficulty defecating, this is an origin of Yangming disease. If initial treatment of Taiyang disease involves insufficient sweating, leading to transfer to Yangming, this is an origin of Yangming disease. In Bing Yang (Combined Taiyang and Yangming) disease, if initial sweating is insufficient, leading to transfer to Yangming with continued slight sweating and no aversion to cold: if the Taiyang syndrome persists, purgation is contraindicated as it is adverse; mild diaphoresis may be used. Persistent redness of the face indicates Yang Qi stagnation in the exterior; resolution via fumigation is appropriate. If sweating is insufficient and Yang Qi cannot disperse, the patient becomes irritable, unable to locate pain, sometimes in the abdomen, sometimes in the limbs, with shortness of breath requiring sitting; this is due to insufficient sweating. Re-sweating will cure it. How to know sweating was insufficient? A choppy pulse indicates this. If Taiyang disease persists after three days of sweating with steaming fever, it belongs to the Stomach; Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction) is indicated. In Bing Yang disease, if Taiyang syndrome resolves but tidal fever, continuous sweating on hands and feet, difficulty defecating, and delirium occur, purgation cures it; Da Cheng Qi Tang is indicated.
In Yangming disease, a slow pulse with sweating but no aversion to cold indicates heavy body, shortness of breath, abdominal fullness, and wheezing. With tidal fever, the exterior is resolving, and interior attack is possible. Continuous sweating on hands and feet indicates hardened stool; Da Cheng Qi Tang is the main formula. If there is profuse sweating, slight fever, and aversion to cold, the exterior is unresolved; if fever is not tidal, Cheng Qi Tang formulas are contraindicated. If abdominal fullness and obstruction are severe, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) may be used to mildly harmonize Stomach Qi. If Yangming disease follows emesis, purgation, or sweating with slight irritability and frequent urination leading to hard stool, Xiao Cheng Qi Tang is indicated. If Yangming disease presents with irritability without prior emesis or purgation, Tiao Wei Cheng Qi Tang is indicated. If Yangming disease originally had sweating but heavy sweating was applied, leaving slight irritability and unclear mental state, the stool must be hard due to fluid depletion and stomach dryness. Check urination frequency; if it decreases from 3-4 times to 2 times daily, stool will pass soon as fluids return to the stomach; this is a pattern of fluid depletion causing hardness.
If Yangming disease has spontaneous sweating or sweating followed by free urination, fluids are internally exhausted. Even if stool is hard, purgation is contraindicated; wait for the urge to defecate and use Mi Jian Dao (Honey Suppository). Tu Gua Gen (Trichosanthes Kirilowii Root) and Da Zhu Dan Zhi (Large Pig Bile) can also be used as suppositories. At the Yuyang pulse, floating and choppy: floating indicates strong Stomach Qi, choppy indicates frequent urination; their interaction causes difficulty defecating, known as Pi Yue (Spleen Constraint); Ma Ren Wan (Hemp Seed Pill) is indicated.
On the second or third day, with a weak pulse, no Taiyang or Shao Yang symptoms, irritability, and epigastric hardness: by the fourth or fifth day, if the patient can eat, give a small amount of Xiao Cheng Qi Tang to harmonize slightly. By the sixth day, give one sheng of Cheng Qi Tang. If no bowel movement for six or seven days and urine is scanty, even if unable to eat, the initial stool may be hard but later loose; do not purge until urine flows freely and stool is definitely hard; Da Cheng Qi Tang is suitable. In Yangming disease with tidal fever and slightly hard stool, Da Cheng Qi Tang may be given; if not hard, do not give. If no bowel movement for six or seven days and suspicion of dried feces exists, give a small amount of Cheng Qi Tang. If flatus occurs, purgation is indicated; if not, initial hardness followed by looseness will result in bloating and anorexia upon purging. Giving water to a thirsty patient may cause hiccups. Subsequent fever indicates hard, scanty stool; harmonize with Xiao Cheng Qi Tang.
In Yangming disease with delirium and tidal fever, a slippery and rapid pulse indicates Xiao Cheng Qi Tang. Give one sheng; if flatus occurs, give another sheng. If no flatus, do not give again. If no bowel movement the next day and the pulse becomes faint and choppy, indicating interior deficiency, it is difficult to treat; do not give Cheng Qi Tang again.
After emesis and purgation in Shang Han, if unresolved with no bowel movement for five to ten days, tidal fever at Rib-Shu hours, no aversion to cold, talking alone as if seeing ghosts, confusion, picking at clothes, fearfulness, slight wheezing, and fixed gaze: a wiry pulse indicates survival; slight delirium only indicates Da Cheng Qi Tang. If one dose relieves, stop subsequent doses.
In Shang Han on the fourth or fifth day, a deep pulse with wheezing and fullness indicates interior pathology. Incorrect sweating causes fluid loss and hard stool, leading to exterior deficiency and interior excess, eventually causing delirium. Sweating with delirium indicates dried feces in the Stomach due to Wind. Purge only after the meridian cycle passes; premature purgation causes speech disorder due to exterior deficiency and interior excess.
After thirteen days of unresolved Shang Han with delirium, heat requires purgation. If urination is free, stool should be hard; if diarrhea occurs but the Stomach pulse is harmonious, it indicates incorrect pill-based purgation by the physician. If spontaneous diarrhea occurs with a normally harmonious pulse (instead of faint/cold), it indicates interior excess; Tiao Wei Cheng Qi Tang is indicated.
In Yangming disease, post-purgation irritability with dried feces in the Stomach allows purgation; if abdominal fullness is slight and stool is initially hard then loose, purgation is contraindicated. In Yangming disease with delirium, tidal fever, and inability to eat, dried feces are present; Da Cheng Qi Tang is indicated. If able to eat, only stool is hard. Urinary difficulty with alternating hard/loose stool, slight fever, wheezing, dizziness, and inability to lie down indicates dried feces. No bowel movement for five to six days with periumbilical pain, irritability, and periodic onset indicates dried feces. After severe purgation, if no bowel movement for six to seven days with persistent irritability and abdominal fullness/pain, this indicates dried feces and retained food.
In combined Yangming and Shaoyang disease with diarrhea, a non-deficient pulse is favorable; a deficient pulse indicates failure and mutual overcoming. A slippery and rapid pulse indicates retained food requiring purgation; Da Cheng Qi Tang is indicated. In combined San Yang disease, a floating-large pulse at Guan position, somnolence, and sweating upon closing eyes are noted.
A superficial pulse with slight sweating indicates harmony; excessive sweating indicates excess. A solid superficial pulse with excessive sweating leads to interior Yang exhaustion and fluid depletion, causing hard stool. A floating and knotted pulse indicates Yang-Yin interaction generating Stomach heat and interior Yang exhaustion. Unresolved sweating with abdominal fullness/pain requires urgent purgation. Yangming disease with fever and profuse sweating requires urgent purgation. Shang Han on the sixth or seventh day with unclear vision, incoherent eyes, no exterior-interior syndrome, difficulty defecating, and slight fever indicates excess requiring urgent purgation.
Yangming disease with forgetfulness indicates blood stasis; stool may be hard but passage is easy with black color; purgation with Di Dang Tang (Resist the Pill) is indicated. Patients with no exterior-interior syndrome, fever for seven to eight days, floating-rapid pulse, may be purged. If pulse remains rapid after purgation with heat combining to cause hunger, and no bowel movement for seven to eight days with blood stasis, Di Dang Tang is indicated. If pulse remains rapid with unceasing diarrhea, heat combines with pus in stool.
In Yangming disease, bleeding and delirium indicate Heat entering the Blood Chamber; sweating only on the head requires puncturing Qi Men (LR14) to drain heat. Yangming disease resolves between Shen and Xu hours (3-7 PM).
[Deficiency Patterns]
In Yangming disease, ability to eat indicates Wind Strike; inability to eat indicates Cold Strike. If Cold Strike prevents eating, with urinary difficulty and sweating on hands/feet, Gu Jia (Solid Mass) may form with hard-then-loose stool due to cold water in the Stomach. A floating-slow pulse with exterior heat and interior cold, with clear undigested food in diarrhea, requires Si Ni Tang (Frigid Extremities Decoction). If Stomach deficiency-cold prevents eating, drinking water causes hiccups. In Yangming disease, attacking heat when unable to eat causes hiccups due to Stomach deficiency-cold. After severe emesis/purgation in Shang Han, extreme deficiency with excessive sweating and subsequent water-induced sweating causes hiccups due to Stomach cold. Hiccups with abdominal fullness require checking anterior/posterior obstructions and relieving them. Yangming disease with lack of sweating and sensation of insects crawling on skin indicates long-term deficiency. Lack of sweating with free urination, cough, vomiting, and cold extremities within two to three days causes headache; absence of these symptoms means no headache. Yangming disease with vertigo, no aversion to cold, ability to eat, and cough causes sore throat; absence of cough means no sore throat. Desire to vomit after eating belongs to Yangming; Wu Zhu Yu Tang (Evodia Decoction) is indicated. Worsening after taking the decoction indicates Upper Jiao pathology. In Shang Han, frequent vomiting contraindicates purgation even with Yangming symptoms.
In Taiyang disease with Cun-Huan, Guan-Fu, Chi-Ruo pulses, fever, sweating, aversion to cold, no vomiting but epigastric痞 (fullness/stagnation) caused by physician's purgation: if not purged, no aversion to cold but thirst indicates transfer to Yangming. Frequent urination causes hard stool. Ten days without bowel movement causes no distress. Thirst for water requires small amounts and methodical rescue; Wu Ling San (Five-Ling Powder) is indicated for thirst. Epigastric fullness/hardness in Yangming disease contraindicates purgation; if purged and diarrhea stops, it cures. Yangming Wind Strike with bitter taste, dry throat, abdominal fullness, slight wheezing, fever, aversion to cold, and tight pulse: purgation causes abdominal fullness and urinary difficulty.
Yangming disease with floating-tight pulse, dry throat, bitter taste, abdominal fullness, wheezing, fever, sweating, no aversion to cold but aversion to heat, and heavy body: sweating causes irritability and delirium; fire needle causes fearfulness and insomnia; purgation empties the Stomach, allowing hostile Qi to move the Diaphragm causing irritability and tongue coating. Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is indicated. Thirst with dry mouth/tongue requires Bai Hu Jia Ren Shen Tang (White Tiger Plus Ginseng Decoction). Floating pulse, fever, thirst, and urinary difficulty require Zhu Ling Tang (Polyporus Decoction). Heavy sweating leading to Yang collapse with delirium and a harmonious pulse is not fatal. Excess causes delirium; deficiency causes Zheng Sheng (repetitive speech). Post-purgation Yangming disease with exterior heat, warm hands/feet, no chest binding, irritability, hunger, inability to eat, and head-only sweating indicates Zhizi Chi Tang.
In combined San Yang disease, abdominal fullness, heavy body, difficulty turning, incoherent speech, facial dirtiness, delirium, and urinary incontinence: sweating worsens delirium; purgation causes sweating on the forehead and cold extremities (entering Taiyin). Spontaneous sweating requires Bai Hu Tang (White Tiger Decoction). Profuse sweating with thirst in Yangming disease contraindicates Zhu Ling Tang as it further depletes fluids in a dry Stomach. Dry mouth desiring to rinse but not swallow indicates impending epistaxis. Floating pulse, fever, dry mouth/nose, and ability to eat indicate impending epistaxis. Floating-tight pulse in Yangming disease indicates tidal fever; floating only indicates night sweats. Initial desire to eat with urinary difficulty, normal stool, joint pain, and sudden madness with sweating indicates Grain Qi overcoming Water; tight pulse indicates recovery. Red face in Yangming disease contraindicates purgation, leading to fever, yellow complexion, and urinary difficulty. Lack of sweating, urinary difficulty, and irritability indicate jaundice. Fire therapy with slight forehead sweating and urinary difficulty indicates jaundice. Fever and sweating allow Heat to vent, preventing jaundice. Head-only sweating up to the neck, urinary difficulty, and thirst indicate Stagnant Heat in the Interior causing jaundice; Yin Chen Hao Tang (Artemisia Capillaris Decoction) is indicated. Slow pulse with fullness after eating, vertigo, and urinary difficulty indicates Grain Jaundice; purgation fails due to slow pulse.
Yangming Wind Strike with wiry-floating-large pulse, shortness of breath, abdominal fullness, hypochondriac pain, nasal dryness, inability to sweat, somnolence, whole-body/jaundice, urinary difficulty, tidal fever, occasional hiccups, and swelling around ears: acupuncture provides slight relief. If exterior remains unresolved after ten days with continuing floating pulse, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is given. If only floating pulse without other symptoms, Ma Huang Tang is given. Tidal fever with loose stool and normal urination with persistent hypochondriac fullness indicates Xiao Chai Hu Tang. Hypochondriac fullness/hardness, constipation, vomiting, and white tongue coating indicate Xiao Chai Hu Tang; opening the Upper Jiao harmonizes the Stomach, leading to sweating and resolution.
[Untreatable Conditions]
Shang Han after emesis/purgation with no bowel movement for five to ten days, tidal fever, no aversion to cold, talking alone, confusion, picking at clothes, fearfulness, slight wheezing, fixed gaze, and choppy pulse indicates death. Epigastric fullness/hardness in Yangming disease with unceasing reverse diarrhea after purgation indicates death. Heavy sweating leading to Yang collapse, delirium, and short pulse indicates death. Fixed gaze, delirium, wheezing/fullness, or diarrhea indicates death. Yangming Wind Strike with complex symptoms including inability to urinate, abdominal fullness, and added hiccups is untreatable.
[Formulas]
Gui Zhi Jia Ge Gen Tang (Cinnamon Twig Decoction plus Kudzu Root): Gui Zhi (Cinnamon Twig), Shao Yao (Peony Root), Gan Cao (Licorice Root), Da Zao (Jujube), Sheng Jiang (Fresh Ginger), Ge Gen (Kudzu Root).
Ge Gen Tang (Kudzu Root Decoction): Ge Gen (Kudzu Root), Ma Huang (Ephedra), Gui Zhi (Cinnamon Twig), Shao Yao (Peony Root), Gan Cao (Licorice Root), Sheng Jiang (Fresh Ginger), Da Zao (Jujube).
Ge Gen Jia Ban Xia Tang (Kudzu Root Decoction plus Pinellia): Ge Gen (Kudzu Root), Ma Huang (Ephedra), Gui Zhi (Cinnamon Twig), Shao Yao (Peony Root), Gan Cao (Licorice Root), Sheng Jiang (Fresh Ginger), Da Zao (Jujube), Ban Xia (Pinellia Tuber).
Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction): Da Huang (Rhubarb Root), Gan Cao (Licorice Root), Mang Xiao (Mirabilite).
Da Cheng Qi Tang (Major Order the Qi Decoction): Da Huang (Rhubarb Root), Mang Xiao (Mirabilite), Zhi Shi (Bitter Orange).
Xiao Cheng Qi Tang (Minor Order the Qi Decoction): Da Huang (Rhubarb Root), Hou Po (Magnolia Bark), Zhi Shi (Bitter Orange).
Mi Jian Dao Fang (Honey Suppository Formula): Boiled into suppositories inserted into the rectum.
Zhu Dan Zhi Fang (Pig Bile Formula): Mixed with vinegar and灌 (instilled) into the rectum.
Ma Ren Wan (Hemp Seed Pill): Ma Zi (Hemp Seed), Shao Yao (Peony Root), Xing Ren (Apricot Seed), Da Huang (Rhubarb Root), Hou Po (Magnolia Bark), Zhi Shi (Bitter Orange), refined honey pills.
Wu Zhu Yu Tang (Evodia Decoction): Wu Zhu Yu (Evodia Fruit), Sheng Jiang (Fresh Ginger), Ren Shen (Ginseng Root), Da Zao (Jujube).
Zhu Ling Tang (Polyporus Decoction): Zhu Ling (Polyporus), Fu Ling (Poria), Ze Xie (Alisma), Hua Shi (Talcum), E Jiao (Donkey-hide Gelatin).