阳明病无汗小便不利而心中懊 者身必发黄
饮入于胃胃阳蒸动化而为气气降则水化阳气升发则化水之气外泄而为汗阳气收藏则气化之水下注而为尿汗出水利湿
热发泄故不发黄无汗而小便不利湿气莫泄郁而生热薰蒸于上则心中懊 身必发黄也
阳明病被火额上微汗出小便不利者必发黄
阳明病无汗是阳虚而土湿者以火薰发汗但额上微汗出而身上无汗小便不利者湿无泄路郁而生热必发黄也
阳明病发热汗出者此为热越不能发黄也但头汗出身无汗剂颈而还小便不利渴饮水浆者此为瘀热在里身必发黄茵陈蒿
汤主之(方在太阴十二)
汗出而湿热发泄则不发黄但头汗而身无汗湿热莫泄而小便又复不利故身必发黄茵陈蒿汤茵陈利水而泄湿栀子大黄除
烦而荡热也
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
阴胜则脉迟阳虚胃逆饮食不甘故难以至饱饱则脾不能化中焦郁满浊气不降故心烦头眩土湿木郁必小便艰难此欲作谷
疸缘谷气陈宿是以郁而发黄也虽下之而腹满不减以其阴盛而脉迟故也
阳明中风脉弦浮大而短气腹都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病过十日脉续浮者与小柴胡汤(方在少阳二)脉但浮无余证者与麻黄汤(方在太阳二十)若不尿腹
满加哕者不治
阳明病脉弦浮大弦为少阳浮为太阳大为阳明脉是以三阳合病而气短腹都满则太阴证少阳之脉自胃口而布胁肋胆胃郁
遏故胁下及心作痛经气痞塞故久按之而气不通表寒外束相火郁升而刑肺金故鼻干不得汗(肺窍于鼻)胆木刑胃土气困乏
故嗜卧湿土贼于甲木土木皆郁故一身及面目悉黄土湿木郁疏泄不行故小便难胃气壅遏故发潮热胃腑郁迫浊气上逆故时呕
哕少阳脉循两耳经气逆行壅塞不降故耳前后肿经郁热盛故刺之小瘥而外证不解病过十日之外脉自里达表续续外浮者是未
传阳明之腑太阴之脏犹在少阳之经也宜小柴胡汤柴胡黄芩清半表之火参甘大枣补半里之阳生姜半夏降胃逆而止呕哕也若
脉但浮而不弦又无少阳诸证者则全是太阳病与麻黄汤以泄表郁中风而用麻黄者发汗以泄太阴之湿也(金匮风湿诸证俱用
麻黄)若不尿腹满而愈加呕哕者水贼土败不可治也
水饮进入胃中,被胃阳蒸腾气化而变为气;气机下降则水液转化为阳气,气机升发则化生的水气向外宣泄成为汗;气机收藏则气化之水向下注入成为尿液。汗出且小便通利,湿热得以发泄,所以不会发黄;若无汗且小便不利,湿气无法排泄,郁结而生热,熏蒸于上则导致心中烦闷懊恼,身体一定会发黄。
阳明病无汗,是阳气虚弱兼有脾土湿盛的表现。若用火薰法强行发汗,仅额头微汗而出而身上无汗,加之小便不利,湿气没有排泄的路径,郁结而生热,必定发黄。
阳明病发热且汗出的,这是热邪向外发散(热越),不能发黄。但若仅头部出汗,身上无汗,汗止于颈部而回,小便不利,口渴想喝水浆的,这是瘀热蕴结在体内,身体一定会发黄,用茵陈蒿汤主治(方剂见太阴篇第十二)。
汗出则湿热得以发泄,故不发黄;但仅头部出汗而身上无汗,湿热无法排泄,且小便又不通利,因此身体一定会发黄。茵陈蒿汤中,茵陈能利水泄湿,栀子和大黄能除烦荡热。
阳明病脉象迟缓,进食难以吃饱,饱食后则轻微心烦、头晕目眩,必定小便困难,这是将要发生谷疸的迹象。即使使用下法,腹部胀满依然如故,之所以这样,是因为脉迟的缘故。
阴气偏胜则脉象迟缓,阳气虚弱致胃气上逆,饮食不甘美,故难以吃至饱足。饱食后脾气不能运化,中焦郁滞胀满,浊气不降,故心烦、头晕;脾土湿盛、肝木郁结,必然导致小便艰难,这是将要发生谷疸的原因,源于谷气停滞宿留,因而郁结发黄。即使使用下法,腹满也不减退,因为阴气盛而脉迟的缘故。
阳明中风,脉象弦、浮、大,伴有短气、腹部都满、胁下及心痛,久按之气不通畅,鼻干不得汗,嗜睡,全身及面目均发黄,小便难,有潮热,时时呃逆,耳前后肿胀,针刺后稍好转,但表证未解。病程超过十日,若脉象继续浮起,给予小柴胡汤(方剂见少阳篇第二);若脉仅浮而无其他症状的,给予麻黄汤(方剂见太阳篇第二十);若不排尿、腹部胀满并加重呃逆的,属于不治之症。
阳明病脉象弦、浮、大:弦脉属少阳,浮脉属太阳,大脉属阳明。因此是三阳合病,气短、腹部都满,提示太阴证候。少阳之脉自胃口布散至胁肋,胆胃郁遏,故胁下及心作痛;经气痞塞,故久按之气不通。表寒外束,相火郁升而刑克肺金,故鼻干不得汗(肺窍开于鼻)。胆木刑克胃土,胃气困乏,故嗜卧;湿土贼害甲木,土木皆郁,疏泄不行,故全身及面目悉黄;土湿木郁,疏泄功能失常,故小便难;胃气壅遏,故发潮热;胃腑郁迫,浊气上逆,故时发呕哕。少阳经脉循行于两耳,经气逆行壅塞不降,故耳前后肿胀;经气郁热盛,故针刺后稍好转,但外证未解。病程超过十日,脉象由里达表,持续外浮,说明病邪未传入阳明之腑、太阴之脏,仍在少阳之经,宜用小柴胡汤。柴胡、黄芩清半表之火,人参、甘草、大枣补半里之阳,生姜、半夏降胃逆而止呕哕。若脉仅浮而不弦,又无少阳诸证,则是纯粹的太阳病,给予麻黄汤以泄表郁。中风证用麻黄,是为了发汗以泄太阴之湿(《金匮要略》风湿诸证俱用麻黄)。若不排尿、腹部胀满且更加呕哕的,是水邪贼害、土气败坏,不可治愈。
Yangming disease, characterized by anhidrosis (absence of sweating), difficulty in urination, and mental restlessness with inner vexation (Xin Zhong Ao Nao), will inevitably result in jaundice.
When fluids enter the stomach, they are steamed and transformed by Stomach Yang into Qi; when Qi descends, water transforms into Yang Qi, and when Qi ascends, the generated water vapor is excreted outward as sweat; when Qi stores, the Qi-transformed water flows downward to become urine. When sweat is excreted and urination is smooth, damp-heat is vented, thus jaundice does not occur. If there is no sweat and urination is difficult, dampness cannot be excreted, leading to stagnation and heat generation. This heat steams upward, causing mental restlessness and inner vexation, and the body will inevitably develop jaundice.
In Yangming disease, if fire therapy is applied, resulting in only slight sweating on the forehead and difficulty in urination, jaundice will inevitably occur.
Yangming disease with anhidrosis indicates deficient Yang and dampness in the Spleen-Earth. If fire fumigation is used to force sweating, but only slight sweat appears on the forehead while the body remains dry, combined with difficulty in urination, dampness has no outlet for excretion. It stagnates and generates heat, inevitably leading to jaundice.
In Yangming disease, fever accompanied by sweating indicates that heat is venting outward (Re Yue), so jaundice cannot occur. However, if there is sweating only on the head, no sweating on the body, stopping at the neck, along with difficulty in urination and thirst desiring fluids, this indicates stagnant heat trapped inside. Jaundice will inevitably occur, and Yinchen Hao Tang (Artemisia Capillaris Decoction) should be administered (formula see Taiyin Chapter 12).
Sweating allows damp-heat to vent, preventing jaundice. But if only the head sweats while the body does not, damp-heat cannot vent, and if urination is also difficult, jaundice will inevitably occur. In Yinchen Hao Tang, Yin Chen (Herba Artemisiae Scopariae) promotes diuresis and drains dampness, while Zhi Zi (Fructus Gardeniae Jasminoidis) and Da Huang (Radix et Rhizoma Rhei Palmati) relieve vexation and purge heat.
In Yangming disease, a slow pulse, inability to eat to fullness, mild irritability and dizziness after eating, and inevitable difficulty in urination indicate impending Gu Dan (Grain Jaundice). Even if purgatives are used, abdominal fullness remains unchanged because of the slow pulse.
Excess Yin leads to a slow pulse; deficient Yang causes Stomach Qi to rebel, making food unappetizing, hence one cannot eat to fullness. After eating, the Spleen fails to transform, causing middle Jiao stagnation and fullness, with turbid Qi failing to descend, leading to irritability and dizziness. Spleen Earth dampness and Liver Wood stagnation inevitably cause difficult urination. This is impending Grain Jaundice, caused by retained grain Qi stagnating and generating jaundice. Even with purgation, abdominal fullness persists due to Yin excess and the slow pulse.
Yangming Wind Strike presents with a wiry, floating, and large pulse, shortness of breath, abdominal fullness, pain in the hypochondrium and heart region, obstruction of Qi upon prolonged pressing, dry nose, anhidrosis, lethargy, generalized and facial jaundice, difficult urination, tidal fever, occasional hiccups, and swelling around the ears. Acupuncture provides slight relief, but exterior symptoms persist. If more than ten days pass and the pulse continues to float, Xiao Chai Hu Tang (Minor Bupleurum Decoction) should be given (formula see Shaoyang Chapter 2). If the pulse is merely floating without other symptoms, Ma Huang Tang (Ephedra Decoction) should be given (formula see Taiyang Chapter 20). If there is anuria, abdominal fullness, and worsening hiccups, it is incurable.
A wiry, floating, and large pulse in Yangming disease: Wiry belongs to Shaoyang, Floating to Taiyang, Large to Yangming. Thus, it is a combination of all three Yang channels. Shortness of breath and abdominal fullness suggest Taiyin involvement. The Shaoyang channel spreads from the stomach opening to the hypochondrium; Gallbladder and Stomach stagnation cause pain in the hypochondrium and heart; Qi blockage causes obstruction upon pressing. Exterior cold binds the surface, causing Dependent Fire to stagnate and ascend, attacking Lung Metal, leading to a dry nose and anhidrosis (Lung orifices open at the nose). Wood of the Gallbladder attacks Earth of the Stomach, causing gastric fatigue and lethropy. Damp Earth harasses Jia Wood, causing stagnation of both Wood and Earth, leading to generalized and facial jaundice. Dampness and Wood stagnation impair drainage, causing difficult urination. Stomach Qi congestion causes tidal fever. Stomach organ stagnation forces turbid Qi upward, causing hiccups. The Shaoyang channel circulates around the ears; rebellious Qi stagnation causes swelling around the ears. Severe stagnation heat makes acupuncture provide slight relief, but exterior signs remain. After ten days, if the pulse floats continuously from interior to exterior, the pathogen has not entered the Yangming Fu organs or Taiyin Zang organs but remains in the Shaoyang channel. Xiao Chai Hu Tang is appropriate. Chai Hu and Huang Qin clear half-exterior fire; Ren Shen, Gan Cao, and Da Zuo nourish half-interior Yang; Sheng Jiang and Ban Xia descend Stomach Qi and stop hiccups. If the pulse is only floating without wiriness and without Shaoyang symptoms, it is purely a Taiyang disease. Ma Huang Tang is given to vent exterior stagnation. Using Ma Huang for Wind Strike aims to induce sweating to drain Taiyin dampness (Rheumatism cases in Jin Gui Yao Lue use Ma Huang). If there is anuria, abdominal fullness, and worsening hiccups, Water harasses Earth and Earth collapses, rendering it incurable.