阳明以戊土而化气于燥金阳明者胃之经胃者阳明之腑阳明病有经有腑经主传输而腑主受盛病在太阳之经若胃阳非旺
则二日阳明三日少阳六日经尽汗解不入阳明之腑此总统于太阳一经不论二三四日俱系桂枝麻黄之证虽二日阳明之时亦不
得谓之阳明病以其明日则传少阳后日则传太阴非阳明中土无所复传之证也若胃阳素盛经邪内传此方谓之阳明病盖正阳当
令则太少无权而三阴退避自此而永留胃腑终始不迁所谓阳明中土无所复传也方其腑热未实经病不罢是为葛根汤证及其胃
热郁蒸汗出表解潮热痛满但用承气攻下别无余事使非下早里虚万无意外之变感病之百不一失甚可庆慰者也然而物忌盛满
亢则害生于此迁延失下久而阴为阳并精液消亡土焦水涸亦归于死仲景所以示早攻之戒而又垂急下之条早攻则阳去而入阴
缓下则阴尽而阳亢迟速均失也是故承气之法妙在缓急恰宜之交使夫病去而人存是在良工焉
胃为燥土燥则生热病在三阳不论何经之感郁其内热胃病即作以胃家之阳实也顾阴易盛而阳易亏故胃有实热而非无虚
冷实热则阳神用事并阴而归阳虚冷则阴邪司权出阳而入阴非一致也然名为阳明以其两阳合明而极盛也居阳实之名而有阳
虚之实则阳明不成为阳明徒负虚声矣是以胃家之实可曰阳明之为病至于胃中之虚是名为阳明而实为太阴尚可曰阳明之为
病乎仲景于阳明之为病冷热虚实两立而俱存之而提纲则曰胃家实也其崇阳黜阴之意具见于文本之外矣
阳明之为病胃家实也
胃者阳明之腑阳明之为病全缘胃家之阳实阳实则病至阳明腑热郁发病邪归胃而不复他传非他经之不病也三阳之阳莫
盛于阳明阳明之邪独旺不得属之他经也胃家之实而病归胃腑终始不迁故曰阳明之为病若胃阳非实则今日在阳明之经明日
已传少阳之经后日已传太阴之经未可专名一经曰阳明之为病也
阳明经以戊土之气在燥金之中化生。阳明是胃的经脉，胃是阳明的腑脏。阳明病分为经证和腑证：经证主要主管气血的传输，腑证主要主管受纳和盛藏。如果病邪在太阳经，而患者的胃阳不够旺盛，那么经过两天到阳明、三天到少阳，六天经气传变完毕，通过发汗即可解除，病邪不会传入阳明的腑脏。这种情况统属于太阳一经的病证，不论发病是第二天还是第三天，都属于桂枝汤或麻黄汤的证候。即使是第二天的阳明时段，也不能称为阳明病，因为到了明天就会传给少阳，后天就会传给太阴，这不属于“阳明中土无所复传”的证候。
如果患者胃阳素来旺盛，外感经邪内传入里，这才称为阳明病。这是因为正值阳明当令，太阳和少阳的势力无权，三阴经退避，病邪从此永久留在胃腑，始终不转移，这就是所谓的“阳明中土无所复传”。当腑热尚未结实，而经表之邪未解时，这是葛根汤的证候；等到胃热郁蒸、出汗且表邪已解，出现潮热、腹痛胀满时，只需使用承气汤类方剂攻下，没有其他多余的治疗事项。如果不是过早攻下导致里气虚弱，几乎不会有意外的变故。治疗疾病能百无一失，是非常值得庆幸安慰的。
然而，事物忌讳过于盛满，亢盛则会产生危害。如果拖延病情未能及时攻下，久而久之阴液被阳气兼并消耗，津液枯竭，脾胃焦枯，水源干涸，最终也会归于死亡。张仲景因此警示要尽早攻下，又设立急下证的条文。早攻则阳气消退转入阴分，缓下则阴液耗尽而阳气亢逆，迟了或快了都失去了平衡。所以，承气汤法的精妙之处在于把握缓急适宜的时机，使病邪去除而人体得以保全，这取决于高明医生的水平。
胃属于燥土，燥则生热。病在三阳经，不论哪一经感受外邪，郁滞在内引起胃热，胃病就会发作，这是因为胃家阳气充实的缘故。但是阴气容易盛而阳气容易亏，所以胃有实热时并非没有虚冷的时候。实热时阳气神机用事，兼并阴气而归向阳；虚冷时阴邪司权，出阳而入阴，这不是一致的。然而之所以称为阳明，是因为它是两阳合明而极盛的阶段。如果居于阳实之名却有着阳虚的实质，那么阳明就不能成为真正的阳明，只是徒负虚名罢了。因此，胃家的实证可以称为“阳明之为病”，至于胃中的虚证，虽然名义上叫阳明，实际上是太阴，还可以称为“阳明之为病”吗？张仲景在论述“阳明之为病”时，将冷、热、虚、实两方面并列存在，但在提纲中却说“胃家实也”，其尊崇阳气、贬抑阴气的意旨体现在文本之外了。
阳明之为病，表现为胃家实。
胃是阳明的腑脏，阳明病完全是由于胃家阳气充实所致。阳气充实则病至阳明，腑热郁积发病，病邪归入胃腑而不再传变到其他经络，并不是其他经络不生病。三阳经的阳气没有比阳明更盛的，阳明的邪气独自旺盛，不能归属于其他经络。胃家的实证使得病邪归入胃腑，始终不转移，所以说“阳明之为病”。如果胃阳不是实证，今天还在阳明经，明天已经传到少阳经，后天已经传到太阴经，就不能专门称某一经为“阳明之为病”了。
Yangming transforms its qi into dryness within the Metal element. Yangming is the meridian of the Stomach, and the Stomach is the fu-organ of Yangming. Yangming disease includes both meridian (jing) and fu-organ syndromes: the meridian primarily governs transmission and circulation, while the fu-organ primarily governs reception and storage. If the pathogen remains in the Taiyang meridian and the patient's Stomach Yang is not vigorous, then after two days it reaches Yangming, after three days Shaoyang, and after six days the meridian cycle completes; sweating can resolve the condition without the pathogen entering the Yangming fu-organs. This situation is collectively categorized under the Taiyang meridian syndrome. Regardless of whether it is the second or third day, it belongs to Guizhi Tang (Cinnamon Twig Decoction) or Mahuang Tang (Ephedra Decoction) syndromes. Even during the Yangming time frame on the second day, it cannot be called Yangming disease, because by the next day it will transmit to Shaoyang, and by the day after to Taiyin. This does not constitute a syndrome where "the central Earth of Yangming has nowhere else to transmit."
If the patient's Stomach Yang is inherently vigorous, and the exterior meridian pathogen transmits inward, this is termed Yangming disease. This occurs because when Yangming is in command, Taiyang and Shaoyang lose their authority, and the Three Yin meridians retreat. The pathogen remains permanently in the Stomach fu-organ, never shifting, which is referred to as "the central Earth of Yangming has nowhere else to transmit." When the fu-organ heat is not yet solidified but the exterior meridian pathogen has not resolved, this is a Gegen Tang (Kudzu Root Decoction) syndrome. Once the Stomach heat steams and condenses, sweat appears, the exterior resolves, and tidal fever with abdominal pain and fullness occur, one should simply use Chengqi Tang formulas (Gut-Purging Decoctions) to purge downward, with no other treatments needed. Provided that purgation was not administered too early causing interior deficiency, there would rarely be unexpected complications. Treating diseases with such precision, resulting in near-perfect outcomes, is indeed something to be celebrated and comforted by.
However, things are忌 (averse to) being overly full; hyperactivity brings harm. If the condition is prolonged and purgation is delayed, over time Yin fluids are consumed by Yang, essence and fluids are depleted, the Earth becomes scorched, and water sources dry up, leading inevitably to death. Zhang Zhongjing therefore issued warnings for early purgation and established guidelines for urgent purgation. Early purgation causes Yang to recede into Yin; delayed purgation causes Yin to exhaust while Yang hyperacts. Both delay and haste result in failure. Thus, the subtlety of the Chengqi Tang method lies in balancing slowness and urgency appropriately, ensuring the disease is eliminated while the person survives; this depends on the skill of the physician.
The Stomach is Dry Earth; dryness generates heat. In diseases of the Three Yang meridians, regardless of which meridian is affected, if internal stagnation generates Stomach heat, the Stomach disease arises due to the solidity of Stomach Yang. However, Yin tends to flourish while Yang tends to decline. Therefore, although the Stomach may have excess heat, it is not devoid of cold deficiency. When there is excess heat, Yang spirit dominates, merging Yin into Yang; when there is deficiency cold, Yin pathogens take control, moving from Yang into Yin. These states are not uniform. Nevertheless, it is named Yangming because it represents the convergence of two Yangs reaching extreme prosperity. If one bears the name of Yang excess but possesses the reality of Yang deficiency, Yangming fails to be true Yangming, holding only an empty reputation. Therefore, Stomach excess can be called "Yangming zhi wei bing" (the manifestation of Yangming disease), but Stomach deficiency, though nominally Yangming, is actually Taiyin. Can this still be called "Yangming zhi wei bing"? Zhang Zhongjing presents both cold/heat and deficiency/excess in his discussion of "Yangming zhi wei bing," yet his summary statement is "Wei jia shi ye" (Stomach house excess). His intention to revere Yang and dismiss Yin is evident beyond the text itself.
Yangming zhi wei bing is Wei jia shi ye (The manifestation of Yangming disease is Stomach excess).
The Stomach is the fu-organ of Yangming. Yangming disease arises entirely from the solidity of Stomach Yang. Solidity leads to disease at Yangming, where fu-organ heat stagnates and manifests; the pathogen enters the Stomach fu-organ and does not transmit elsewhere. This does not mean other meridians do not get sick. Among the Three Yang meridians, none possess more Yang than Yangming. The pathogen in Yangming is uniquely prosperous and cannot be attributed to other meridians. Because Stomach excess causes the pathogen to remain in the Stomach fu-organ without shifting, it is said that "Yangming zhi wei bing." If Stomach Yang were not excessive, today it might be in the Yangming meridian, tomorrow already transmitted to the Shaoyang meridian, and the day after to the Taiyin meridian. In such cases, one could not exclusively name a single meridian as "Yangming zhi wei bing."