阳明。大意在经腑之别。而在经者当属表证。虽有中风能食伤寒。不能食之分。然邪既犯中焦。则又不必辨其风寒
营卫。但须以太阳证未尽。自汗脉缓者可用桂枝汤无汗脉浮者。可用麻黄汤少阳证渐见潮热脉弦浮大而短。气腹满者可
用大小柴胡。分提表里之邪必头项强KT 元脉长而大者。可用葛根汤大开肌肉以汗之故以经证另自为篇。其腑证虽有三
阳明之辨。而所重尤在能食为胃强不能食为胃衰大都能食者皆可攻下。但有缓急之殊。惟是胃弱不能食者。乃有挟虚寒。
挟热结之不同。虚寒则自利发黄呕哕而脉迟。当用理中四逆。热结则腹满谵语不大便而脉涩当用蜜煎胆导。不可拘于腑
病为阳概用寒下。而禁用温剂也。
阳明病若能食名中风不能食名中寒。
风为阳。阳能消谷。故能食。寒为阴。阴不能消谷。故不能食并邪入阳明。已至中焦营卫交会之处浑然一气似难分
辨。惟能食不能食差有据耳。
伤寒三日阳明脉大。
阳明气血俱多。故其脉长而大。
脉浮大应发汗。医反下之。此为大逆。
阳明病脉迟汗出多。微恶寒者。表未解也可发汗。宜桂枝汤。
阳明病脉浮无汗而喘发汗则愈宜麻黄汤。
此二条言太阳之邪初入阳明未离太阳故仍用桂枝汤解肌。则风邪仍从卫分而出用麻黄汤发汗。则寒邪仍从营分而出
矣。阳明营卫难辨。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。若传入于腑则迟者必数浮者必实矣。设不数不实定为胃虚。不胜攻下之证也。
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。
此胃热协风邪上攻之证以风主运动故也。风邪攻胃。胃气上逆则咳咽门者。胃之系咳甚则咽伤故必咽痛宜茯苓桂枝
白术甘草汤以散风邪。祛胃湿。若胃气不逆则不咳咽亦不痛也。
阳明病法多汗。反无汗。其身如虫行皮中状者。此以久虚故也。
此胃热协寒邪。郁于皮肤之证也。言久虚者明所以不能透出。册表之。故宜用桂枝二越脾一汤主之。非谓当用补也。
阳明病反无汗小便利。二三日呕而咳手足厥者。必苦头痛。若不咳不呕。手足不厥者头不痛。
阳明无汗。呕咳手足厥者得之营卫俱伤而邪热入深也。然小便利则邪热不在内而在外。不在下。而在上。故知必苦
头痛。仍宜小青龙主之。若不呕不咳不厥而小便利者。邪热必顺水道而出岂有逆攻巅顶之理哉。
阳明病口燥但欲漱水。不欲咽者。此必衄也。
漱水不欲咽知邪入血分血为阴。故不能消水也。阳明之脉起于鼻血得热而妄行。必由清道出也。
脉浮发热。口干鼻燥能食者则衄。
能食者知邪不在里而在经。故必衄。
阳明病脉浮而紧者。必潮热发作有时。但浮者必盗汗出。
脉浮紧而潮热者。太阳寒邪。欲入阳明之腑。而未入也。邪虽未入而潮热之证预形矣。脉但浮而盗汗出者。太阳风
邪将传少阳之经而未传也。经虽未传而盗汗之证先见矣盖少阳气血俱少本不主汗以其邪热在里薰蒸阳明而阳明肉腠自
固。故不得出。乘合目时脾气不运。肉腠疏豁。则邪热得以透出所以盗汗。虽为少阳证而实不外乎阳明也。
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。脉但浮无余证者。与麻黄汤若不尿。腹满加
哕者不治。
此条阳明中风之证。居七八。而中寒之证。亦居二三观本文不得汗。及用麻黄汤。其义自见也。然此一证为阳明。
第一重证以太阳之脉证。既未罢。而少阳之脉证。亦兼见是阳明所主之位前后皆邪不能传散故也。夫伤寒之诀起先惟恐
传经。经传则变生表邪传里消烁津气也。其后。惟恐不传经。不传经则势笃虚不能传邪无从泄也。仲景于此段中。特挈
不传之妙理千古无人看出总不识其所言者为何事。讵知脉弦浮大而气反短连腹都满者。邪不传也胁下及心痛乃至久按之
气不通者。邪不传也。鼻干不得汗嗜卧。表里俱困。乃至一身及面目悉黄者。邪不传也。小便难。有潮热时时哕。胃热
炽盛。上下道穷邪不传也耳前后肿。刺之小瘥者。内邪不传乃致外挟其血亦不散但其肿小瘥也外不解。过经十日。留连
极矣所谓万物所归。无所复传者。原为美事。孰知病邪归之而不传反成如此危候耶。要知阳明之邪来。自太阳去。自少
阳所以脉续浮者。与小柴胡汤推其邪。使速往少阳去路也。脉但浮无余证者。与麻黄汤推其邪。使速还太阳来路也。若
不尿腹满则胃邪内壅不下行矣。而更加哕。胃气将竭愈逆上矣。再在何法可以驱其邪。而使之传耶。不然岂有十余日后。
无故张皇。反用麻黄之理哉。
食谷欲呕者。属阳明也。吴茱萸汤主之。得汤反剧者。属上焦也。
此条辨呕有太阳。亦有阳明本自不同。若食谷欲呕则属胃寒与太阳恶寒呕逆之热证相反。正恐误以寒药治呕也。然
服吴茱萸汤转剧者。仍属太阳热邪。而非胃寒明矣。
伤寒呕多。虽有阳明证。不可攻也。
呕多为邪在上焦总有阳明证戒不可攻。攻之必邪气乘虚内犯也。设有少阳证兼见亦当从和解例。断不可行攻下法也。
夫病阳多者热。下之则硬。
阳热证多则有阳明证见亦。属经证不可下也。不当下而误下之。则阳邪乘虚内陷也。不作结胸则为痞硬也。
无阳阴强大便硬者。下之必清谷腹满。
无阳阴强言其人津液内亡胃中阳气空虚。阴邪上逆所以痞满不食此与误下成痞同意。若因其痞而复下之。必致便利
清谷而腹满也。少阴中风腹满不食误下。亦有此证然阳明无阳阴强。误下而清谷腹满。可用泻心汤例治。若少阴中风。
误下而清谷腹满者。即用四逆汤恐亦不能挽回也。
以上俱阳明经证。
阳明病欲解时从申至戌上。
上条阳明经证自解候。
阳明病。大意在于区分经证与腑证的不同。其中属于经证的，应当归属于表证范畴。虽然经证中有中风（能进食）和伤寒（不能进食）的区别，但既然邪气已经侵犯中焦，就不必再刻意分辨是风邪还是寒邪，也不必拘泥于营卫的细微差别。只需根据情况判断：如果太阳病的症状尚未完全消退，表现为自汗、脉象缓弱的，可以使用桂枝汤；如果没有汗出、脉象浮紧的，可以使用麻黄汤；如果少阳病的症状逐渐显现，出现潮热、脉象弦浮大而短促、腹部胀满的，可以使用大柴胡汤或小柴胡汤，以分别提取在表和在半表半里的邪气。必须等到头项强痛消失、脉象变得长而大的时候，才可以使用葛根汤，通过大发汗来解除肌肉层面的邪气。因此，经证单独列为一个篇章。至于腑证，虽然也有三种阳明病的辨析，但重点更在于辨别患者能否进食：能进食说明胃气强盛，不能进食说明胃气衰弱。大多数能进食的患者都可以使用攻下法，只是有缓急之分。唯独那些胃气虚弱、不能进食的患者，才有夹带虚寒或夹带热结的不同区别。如果是虚寒证，会出现自利、发黄、呕吐呃逆且脉象迟缓的症状，应当使用理中汤或四逆汤；如果是热结证，会出现腹部胀满、说胡话、不大便且脉象涩滞的症状，应当使用蜜煎导法或胆导法，不可拘泥于腑病属于阳证就一概使用寒凉攻下的药物，而禁用温补药剂。
阳明病如果能进食，称为中风；如果不能进食，称为中寒。
风属于阳邪，阳邪能够消化谷物，所以患者能进食；寒属于阴邪，阴邪不能消化谷物，所以患者不能进食。当邪气并入阳明，已经到达中焦营卫交会的地方，浑然一体似乎难以分辨，只有“能食”与“不能食”这一差异是有据可查的。
伤寒三天后，出现阳明脉象宏大。
因为阳明经的气血都很充盛，所以其脉象长而大。
脉象浮大，本应发汗，医生反而使用攻下法，这是严重的错误（大逆）。
阳明病，脉象迟缓，出汗多，轻微怕冷的，说明表证未解，可以发汗，适宜用桂枝汤。
阳明病，脉象浮，无汗且喘息的，发汗后即可痊愈，适宜用麻黄汤。
这两条条文说的是太阳的邪气初入阳明，尚未离开太阳经，所以仍然用桂枝汤解肌发表，那么风邪就从卫分排出；用麻黄汤发汗，那么寒邪就从营分排出。阳明的营卫很难辨别，辨别它们全凭脉象和症状。风邪的脉象传到阳明，如果自汗已经很多，脉象就会由缓变迟；寒邪的脉象传到阳明，如果发热已经很严重，脉象就会由紧变浮。在这里都是邪气还在经表的征象。如果邪气传入腑中，那么迟缓的脉象一定会变成数脉，浮脉一定会变成实脉。如果不数不实，必定是胃气虚弱，承受不了攻下法的证候。
阳明病，只是头晕目眩，不怕冷，所以能进食并且咳嗽，这个人一定咽喉疼痛；如果不咳嗽，咽喉就不痛。
这是胃热配合风邪上攻的证候，因为风性主动的缘故。风邪攻击胃部，胃气上逆就会咳嗽；咽门是胃的系连之处，咳嗽剧烈就会损伤咽喉，所以一定咽喉疼痛。适宜用茯苓桂枝白术甘草汤来疏散风邪，祛除胃中的湿气。如果胃气不逆，就不会咳嗽，咽喉也不会痛。
阳明病通常应该多汗，反而无汗，身体像有虫子在皮肤里爬行一样的感觉，这是因为久病体虚的缘故。
这是胃热配合寒邪郁结在皮肤的证候。说“久虚”，是明确说明为什么邪气不能透出体表，所以适宜用桂枝二越婢一汤主治，并不是说要使用补益药。
阳明病反而无汗，小便通畅，两三天后出现呕吐且咳嗽，手脚冰冷的，一定痛苦于头痛；如果不咳嗽、不呕吐，手脚不冰冷，头就不痛。
阳明无汗，呕吐咳嗽，手脚冰冷，是因为营卫都受伤而邪热深入所致。然而小便通畅，说明邪热不在体内而在体表，不在下部而上部，所以知道一定痛苦于头痛。仍然适宜用小青龙汤主治。如果不呕吐、不咳嗽、不手脚冰冷而小便通畅的，邪热必然顺着水道排出，哪里有逆冲头顶的道理呢？
阳明病，口干燥只想含水漱口，不想吞咽的，这一定会发生鼻出血。
想漱口不想吞咽，知道邪气进入血分。血属于阴，所以不能消解水液。阳明的经脉起于鼻子，血受热妄行，必然从清道（鼻腔）流出。
脉象浮，发热，口干，鼻燥，能进食的，会发生鼻出血。
能进食，知道邪气不在里而在经表，所以一定会发生鼻出血。
阳明病，脉象浮而紧的，一定有潮热，发作有定时；只有脉浮的，一定在睡梦中出汗（盗汗）。
脉象浮紧且有潮热的，是太阳寒邪想要进入阳明腑，但还没有进入。邪气虽然未入，但潮热的症状已经预先显现了。脉象只浮且有盗汗的，是太阳风邪将要传变到少阳经，但还没有传变。经气虽然未传，但盗汗的症状先出现了。大概少阳的气血都很少，本来不主汗症，但因为邪热在体内熏蒸阳明，而阳明的肌肉腠理自然固密，所以汗不得出。趁着闭眼睡觉时脾气不运化，肌肉腠理疏松豁开，邪热得以透出，所以出现盗汗。这虽然是少阳证，但实际上并不外乎阳明病。
阳明中风，脉象弦、浮、大且短促，气短，腹部胀满，胁下及心口疼痛，长时间按压气机不通畅，鼻子干燥，无法出汗，嗜睡，全身及面目都发黄，小便困难，有潮热，时常呃逆，耳前耳后肿胀，针刺后稍微好转。如果外部表证未解，病程超过十天，脉象依然浮的，给予小柴胡汤。脉象只浮没有其他症状的，给予麻黄汤。如果不排尿，腹部胀满加上呃逆的，属于不治之症。
这一条讲的是阳明中风的证候，占七八成，而中寒的证候也占二三成。看原文提到“不得汗”以及使用“麻黄汤”，其中的含义自然可见。然而这一证候是阳明病的第一重危证，因为太阳的脉证既未罢休，而少阳的脉证也兼见，这是阳明所主的部位前后都有邪气，导致邪气无法传散。大凡伤寒的关键，起初只怕邪气传经，因为经气传变则变化丛生，表邪传入里会消烁津液和气机。后来只怕邪气不传经，因为不传经则病情深重，正气虚弱，邪气无从宣泄。张仲景在这段文字中，特别提出了“不传经”的微妙道理，千古以来无人看出，总不知道他说的是什么事情。哪里知道脉象弦浮大且气反而短促，连同腹部胀满的，是邪气不传经；胁下及心口疼痛乃至长时间按压气机不通畅的，是邪气不传经；鼻子干燥无法出汗，嗜睡，表里都困顿，乃至全身及面目都发黄的，是邪气不传经；小便困难，有潮热，时常呃逆，胃热炽盛，上下通道穷尽，邪气不传经；耳前耳后肿胀，针刺后稍微好转的，是内邪不传经，导致外挟带的血气也不消散，只是肿胀稍微好转。外部表证未解，经过十日以上，留连极久，所谓“万物所归，无所复传”，原本是一件好事，谁知道病邪归聚而不传变，反而形成如此危急的证候呢？要知道阳明的邪气来自太阳，去往少阳。所以脉象持续浮的，给予小柴胡汤推荡邪气，使其快速前往少阳的去路；脉象只浮没有其他症状的，给予麻黄汤推荡邪气，使其快速返回太阳的来路。如果不排尿，腹部胀满，则是胃中邪气内壅，不下行；再加上呃逆，胃气即将衰竭，更加逆上。还有什么方法可以驱除邪气并使其传变呢？否则，哪有在十多天后，无故惊慌，反而使用麻黄汤的道理呢？
进食就想呕吐的，属于阳明病，吴茱萸汤主治。服用汤药后反而加重的，属于上焦病。
这一条辨析呕吐，有太阳病的也有阳明病的，本源完全不同。如果进食就想呕吐，则属于胃寒，与太阳病恶寒、呕吐逆上的热证相反。正担心误用寒药治疗呕吐。然而服用吴茱萸汤后转剧的，仍然属于太阳热邪，而不是胃寒，这很明显。
伤寒呕吐频繁，即使有阳明病的症状，也不可攻下。
呕吐频繁是因为邪气在上焦，纵然有阳明病的症状，切记不可攻下。攻下必然导致邪气乘虚内犯。如果设有少阳病的症状兼见，也应当遵循和解的方法，断不可行攻下法。
凡是阳热证多的，如果使用攻下法，大便就会硬结。
阳热证多，则有阳明证出现，但也属于经证，不可攻下。不当下而误用攻下，则阳邪乘虚内陷。不形成结胸，就会形成痞硬。
没有阳证，阴邪强盛，大便硬的，攻下必然导致完谷不化的腹泻和腹部胀满。
“无阳阴强”是说此人津液在内耗亡，胃中阳气空虚，阴邪上逆，所以痞满不食。这与误用攻下导致痞证同意。如果因为痞满而再次攻下，必然导致便利清谷（完谷不化）而腹部胀满。少阴中风，腹满不食，误用攻下，也有这种证候。然而阳明病“无阳阴强”，误用攻下导致清谷腹满，可以用泻心汤的法则治疗；如果是少阴中风，误用攻下导致清谷腹满的，即使用四逆汤恐怕也不能挽回。
以上都是阳明经证。
阳明病欲缓解的时间是从申时到戌时（下午3点到晚上7点）。
上一条讲的是阳明经证自行缓解的时辰。
Yangming Disease. The general principle lies in distinguishing between the Meridian syndrome (Jing Zheng) and the Fu-organ syndrome (Fu Zheng). Those belonging to the Meridian syndrome should be classified as exterior syndromes. Although there is a distinction between Wind-stroke (Zhong Feng, characterized by the ability to eat) and Cold-injury (Zhong Han, characterized by inability to eat), once the pathogen has invaded the Middle Jiao, it is unnecessary to differentiate strictly between Wind and Cold, or to focus on Ying and Wei (Defensive and Nutritive Qi). One only needs to judge based on the following: if Taiyang symptoms have not yet fully resolved, presenting with spontaneous sweating and a slow pulse, Guizhi Tang (Cinnamon Twig Decoction) can be used; if there is no sweating and the pulse is floating, Mahuang Tang (Ephedra Decoction) can be used; if Shaoyang symptoms are gradually appearing, presenting with tidal fever, a string-taut, floating, large, and short pulse, abdominal fullness, Da Chaihu Tang (Major Bupleurum Decoction) or Xiao Chaihu Tang (Minor Bupleurum Decoction) can be used to separately extract pathogens from the exterior and the half-exterior/half-interior. Only when the stiffness of the head and neck disappears and the pulse becomes long and large can Gegen Tang (Kudzu Root Decoction) be used to greatly induce sweating to release pathogens from the muscle layer. Therefore, Meridian syndromes are treated in a separate chapter. As for Fu-organ syndromes, although there are three types of Yangming distinctions, the emphasis is particularly placed on whether the patient can eat: ability to eat indicates strong Stomach Qi, while inability to eat indicates weak Stomach Qi. Most patients who can eat are suitable for purgative therapy, differing only in urgency. However, those with weak Stomach Qi and inability to eat may have accompanying deficiency-cold or heat-binding. If it is deficiency-cold, symptoms such as spontaneous diarrhea, jaundice, vomiting, and hiccups with a slow pulse will occur, requiring Lizhong Tang (Regulate the Middle Decoction) or Sini Tang (Frigid Extremities Decoction). If it is heat-binding, symptoms such as abdominal fullness, delirium, constipation, and a choppy pulse will occur, requiring Honey Suppository or Gallbladder Suppository methods. One must not rigidly assume that all Fu-organ diseases being Yang syndromes require cold purgatives exclusively, nor forbid warm agents.
In Yangming disease, the ability to eat is named Wind-stroke; the inability to eat is named Cold-injury.
Wind is Yang; Yang can digest grain, hence the ability to eat. Cold is Yin; Yin cannot digest grain, hence the inability to eat. When pathogens merge into Yangming, reaching the junction of Ying and Wei in the Middle Jiao, they become indistinguishable as a unified whole. The only reliable differentiator is the ability or inability to eat.
After three days of Cold-injury, the Yangming pulse is large.
Because Qi and Blood in Yangming are abundant, its pulse is long and large.
A floating and large pulse should indicate the need for sweating; if the physician mistakenly uses purgation, this is a major error (Da Ni).
In Yangming disease, if the pulse is slow, sweating is profuse, and there is slight aversion to cold, the exterior is unresolved. Sweating is appropriate, and Guizhi Tang (Cinnamon Twig Decoction) is indicated.
In Yangming disease, if the pulse is floating, there is no sweating, and wheezing occurs, sweating will lead to recovery, and Mahuang Tang (Ephedra Decoction) is indicated.
These two clauses state that Taiyang pathogens have just entered Yangming but have not left the Taiyang meridian. Thus, Guizhi Tang (Cinnamon Twig Decoction) is still used to resolve the muscle layer, allowing Wind pathogens to exit via the Wei level; Mahuang Tang (Ephedra Decoction) is used to induce sweating, allowing Cold pathogens to exit via the Ying level. Differentiating Ying and Wei in Yangming is difficult and relies entirely on pulse and symptoms. For Wind pathogens transmitting to Yangming, if spontaneous sweating is profuse, the pulse changes from slow to delayed. For Cold pathogens transmitting to Yangming, if fever is severe, the pulse changes from tight to floating. These are signs of pathogens remaining in the Meridian. If pathogens transmit to the Fu organs, a delayed pulse will become rapid, and a floating pulse will become excess. If neither rapid nor excess, it is definitely Stomach deficiency, unsuitable for purgation.
In Yangming disease, if there is only dizziness, no aversion to cold, hence the ability to eat, and coughing, the person will certainly have a sore throat. If there is no coughing, the throat will not hurt.
This is a syndrome of Stomach Heat combining with Wind pathogens attacking upward, due to the moving nature of Wind. Wind pathogens attack the Stomach, causing Stomach Qi to rebel upward, resulting in coughing. The pharynx is connected to the Stomach; severe coughing damages the pharynx, hence the sore throat. Fuling Guzhi Baizhu Gancao Tang (Poria, Cinnamon Twig, Atractodes, and Licorice Decoction) is indicated to disperse Wind pathogens and remove Dampness from the Stomach. If Stomach Qi does not rebel, there will be no coughing or sore throat.
Yangming disease typically involves profuse sweating. If there is instead no sweating, and the body feels like insects crawling under the skin, this is due to prolonged deficiency.
This is a syndrome of Stomach Heat combined with Cold pathogens stagnating in the skin. "Prolonged deficiency" explains why pathogens cannot be expelled from the exterior. Guizhi Er Yuespi Yi Tang (Two Parts Cinnamon Twig and One Part Ephedra and Magnolia Bark Decoction) is indicated, not implying the use of tonics.
In Yangming disease, if there is no sweating, urination is clear, and after two to three days, vomiting, coughing, and cold extremities occur, the person will certainly suffer from headache. If there is no vomiting, no coughing, and no cold extremities, the head will not hurt.
Yangming with no sweating, vomiting, coughing, and cold extremities results from injury to both Ying and Wei with deep penetration of pathogenic heat. However, clear urination indicates that pathogenic heat is not internal but external, not lower but upper. Hence, headache is certain. Xiao Qinglong Tang (Minor Green Dragon Decoction) is indicated. If there is no vomiting, coughing, or cold extremities, and urination is clear, pathogenic heat will likely exit via the water passages; there would be no reason for it to attack the vertex inversely.
In Yangming disease, if the mouth is dry and the patient desires to rinse water in the mouth but not swallow, epistaxis (nosebleed) will certainly occur.
Desiring to rinse but not swallow indicates pathogens have entered the Blood level. Blood is Yin and cannot dissolve water. The Yangming meridian originates at the nose; blood heated recklessly will flow from the nasal passage.
If the pulse is floating, there is fever, dry mouth, dry nose, and the patient can eat, epistaxis will occur.
The ability to eat indicates pathogens are not in the interior but in the meridian, hence epistaxis will occur.
In Yangming disease, if the pulse is floating and tight, there will certainly be tidal fever occurring at specific times. If the pulse is only floating, there will certainly be night sweats.
A floating, tight pulse with tidal fever indicates Taiyang Cold pathogens desire to enter the Yangming Fu organs but have not yet done so. Although not entered, tidal fever symptoms appear prematurely. A floating pulse with night sweats indicates Taiyang Wind pathogens are about to transmit to the Shaoyang meridian but have not yet done so. Although not transmitted, night sweat symptoms appear first. Generally, Shaoyang has little Qi and Blood and does not primarily govern sweating. However, because pathogenic heat steams internally affecting Yangming, and Yangming's muscle pores are naturally firm, sweat cannot exit. During sleep, when Spleen Qi is inactive and muscle pores open, pathogenic heat escapes, causing night sweats. Although this is a Shaoyang syndrome, it essentially relates to Yangming.
In Yangming Wind-stroke, the pulse is string-taut, floating, large, and short, with shortness of breath, abdominal fullness, pain in the hypochondrium and heart region, obstruction of Qi upon long pressure, dry nose, inability to sweat, lethargy, generalized and facial jaundice, difficulty in urination, tidal fever, frequent hiccups, and swelling around the ears. Acupuncture provides slight relief. If the exterior remains unresolved and the condition persists beyond ten days, and the pulse continues to float, give Xiao Chaihu Tang (Minor Bupleurum Decoction). If the pulse is only floating without other symptoms, give Mahuang Tang (Ephedra Decoction). If there is no urination, abdominal fullness, and added hiccups, it is untreatable.
This clause describes Yangming Wind-stroke syndromes, comprising seven or eight parts, while Cold-injury syndromes comprise two or three parts. The text mentions "inability to sweat" and the use of "Mahuang Tang," revealing the intent. This is a critical Yangming syndrome where Taiyang symptoms have not resolved and Shaoyang symptoms are concurrent. Pathogens cannot transmit or dissipate from the Yangming position. The key to Cold-injury is initially fearing transmission, as transmission generates changes and consumes fluids/Qi. Later, one fears non-transmission, as stagnation leads to severity and lack of venting. Zhang Zhongjing highlights the subtlety of "non-transmission." A string-taut, floating, large pulse with shortness of breath and abdominal fullness indicates non-transmission. Hypochondriac pain and obstruction indicate non-transmission. Dry nose, no sweat, lethargy, and jaundice indicate non-transmission. Difficulty urinating, tidal fever, and hiccups indicate Stomach Heat blazing and blocked pathways, hence non-transmission. Swelling around ears resolving slightly with acupuncture indicates internal pathogens do not transmit, but external blood stasis remains. After ten days, if the exterior is unresolved and the pulse floats, giving Xiao Chaihu Tang (Minor Bupleurum Decoction) pushes pathogens toward Shaoyang. If only floating, Mahuang Tang (Ephedra Decoction) pushes them back to Taiyang. No urination, abdominal fullness, and hiccups indicate Stomach pathogens obstructed internally and Qi failing upward. There is no method to drive them out then. Otherwise, why use Mahuang Tang after ten days?
Desire to vomit after eating belongs to Yangming, treated with Wuzhuyu Tang (Evodia Decoction). If symptoms worsen after taking the decoction, it belongs to the Upper Jiao.
This clause distinguishes vomiting: Taiyang and Yangming origins differ. Desire to vomit after eating indicates Stomach Cold, opposite to Taiyang aversion to cold and hot vomiting. One must fear mistaking cold for heat. If worsening after Wuzhuyu Tang (Evodia Decoction), it is clearly Taiyang Heat, not Stomach Cold.
In Cold-injury, if vomiting is frequent, even with Yangming symptoms, purgation is contraindicated.
Frequent vomiting indicates pathogens in the Upper Jiao. Even with Yangming symptoms, purgation is forbidden as it allows pathogens to invade inward. If Shaoyang symptoms are present, harmonization is required; purgation is absolutely contraindicated.
Diseases with excess Yang-Heat, if purged, result in hardness.
Excess Yang-Heat presents Yangming symptoms but belongs to the Meridian syndrome, which is not suitable for purgation. Mistaken purgation allows Yang pathogens to sink inward, forming Pi Hardness (Stagnant Hardness) rather than Jie Xiong (Chest Binding).
Absence of Yang, Excess Yin, with hard stool: purgation will cause undigested food in stool and abdominal fullness.
"Absence of Yang, Excess Yin" means internal fluid depletion and empty Stomach Yang, with Yin pathogens rebelling upward, causing Pi Fullness and anorexia. Similar to mistaken purgation leading to Pi. Re-purgating will cause undigested food and abdominal fullness. In Shaoyang Wind-stroke with abdominal fullness and anorexia, mistaken purgation causes similar symptoms. However, in Yangming "Absence of Yang, Excess Yin," mistaken purgation causing undigested food/fullness can be treated with Xiexin Tang (Gallbladder Decoction variants). In Shaoyang Wind-stroke, even Sini Tang (Frigid Extremities Decoction) may fail to rescue.
The above are all Yangming Meridian syndromes.
Yangming disease tends to resolve from Shen hour to Xu hour (3 PM to 7 PM).
The previous clause refers to the time of self-resolution for Yangming Meridian syndromes.