凡七十七条方十
阳明者。胃经也。其法不以经病为例。而例以胃家实为正。不以经病为例者。阳明路接太阳。
经病。由传从太阳过而后受。多则太阳未除。故须仍从太阳例。如几几合病之类是也。过此再入
阳明。胃实当之。病一入胃。胃为五脏六腑之海。而吉凶生死几焉。不复有经可言矣。故经无例
可出。而凡胃实者不得不出例。此阳明所以与余经不同也。彼以一经再经循经越经。规规于数日
以论证者。乌足与语圣贤言外之意哉。
（一）阳明之为病。胃家实也。
阳明。经也。胃。腑也。实者。大便结为硬满。而不得出也。作于迟早不同。非日数所可拘。
所谓二日阳明者。以经言也。经主三阳。传路之中。不专病。而专病在胃实。故胃实反得以揭阳
明之总。与太阳之揭总者。经病虽不同。要之所以为揭例则一也。余经皆有总揭。其例则通乎二
者而同推。以此观之。则非全书之言。不出于轻视而漫易哉。
（二）问曰。病有太阳阳明。有正阳阳明。有少阳阳明。何谓也。答曰。太阳阳明者。脾约是也。
此条三节。此节三问一答。通下文二节乃三答词。盖原三阳所以入胃之殊因也。太阳阳明者。
谓太阳受病经入胃而成胃实也。脾约见第六十一条。此举大意。详见后。
正阳阳明者。胃家实是也。
正。谓本经也。以病到本经遂入胃而成胃实。故指首条谓即此是也。然大概亦只是如此。
少阳阳明者。发汗利小便已。胃中燥烦。实。大便难是也。
少阳阳明者。以病到少阳。方才入胃而成胃实者言也。发汗以下。三阳皆然。乃独于少阳发
者。以少阳主半表半里。表里皆不可攻故也。然三者之因虽少殊。要亦不过互明耳。
（三）问曰。阳明病。外证云何。答曰。身热。汗自出。不恶寒反恶热也。
身热汗自出。起自中风也。不恶寒。反恶热。邪过荣卫入里而里热甚也。此以太阳传入中风
阳明之外证言。
（四）问曰。何缘得阳明病。答曰。太阳病。发汗。若下。若利小便。此亡津液。胃中干燥。
因转属阳明。不更衣。内实。大便难者。此名阳明也。
亡转皆见太阳篇。中风本自汗。故发汗已下皆致传阳明。势易也。古人大便必更衣。不更衣。
言不大便也。此以太阳中风传入阳明之表证言。
（五）问曰。病有得之一日。不发热而恶寒者。何也。答曰。虽得之一日。恶寒将自罢。即
自汗出而恶热也。
不发热而恶寒。起自伤寒也。恶寒将自罢。邪过表也。即自汗出。邪热郁于阳明之肌肉。腠
理反开。津液反得外泄也。恶热。里热甚也。此以太阳伤寒传入阳明之外证言。
（六）问曰。恶寒何故自罢。答曰。阳明居中。土也。万物所归。无所复传。始虽恶寒。二
日自止。此为阳明病也。
此承上条之答词。复设问答而以其里证言。无所复传者。胃为水谷之海。五脏六腑四体百骸
皆资养于胃。最宜通畅。实则秘固。复得通畅则生。止于秘固则死。死生决于此矣。尚何复传。
恶寒二日自止者。热入里而将反恶热。以正阳阳
明言也。以病二日而其几有如此。则斯道之精微。岂专专必于谈经论日所能窥测哉。
（七）伤寒发热无汗。呕不能食。而反汗出 然者。是转属阳明也。
。照吉切。发热无汗。追言太阳之时也。呕不能食。热入胃也。反汗出者肌肉着热。肤腠
反开也。 。热而汗出貌。
（八）伤寒。转系阳明者。其人 然微汗出也。
此承上条复以微汗申言。重致叮咛也。
（九）本太阳。初得病时。发其汗。汗先出不彻。因转属阳明也。
彻。除也。言汗发不对。病不除也。此言由发太阳汗不如法。致病入胃之大意。以为总结上文。
（十）伤寒三日。阳明脉大。
伤寒三日。该中风而大约言也。凡类此者。皆仿此。脉大。阳明气血俱多也。
（十一）阳明病欲解时。从申至戌上。
申酉戌。阳明之王时也。正气得其王时。则邪不能胜。故退而自解也。
（十二）阳明病。脉迟。汗出多。微恶寒者。表未解也。可发汗。宜桂枝汤。
迟者。缓之变。汗出多微恶寒者。风邪犹有在表者。故曰未解也。可发汗。例也。宜桂枝汤。
谓仍须解其肌。则入胃之路自绝也。方见太阳上。
（十三）阳明病。脉浮。无汗而喘者。发汗则愈。宜麻黄汤。
浮者。紧之转。邪外向也。无汗而喘者。寒邪在表未全除也。故曰发汗则愈。言当仍从解外也。宜
麻黄汤者。言当散穷寇于境界也。方见太阳中。
（十四）阳明病。若能食者。名中风。不能食者。名中寒。
此以食之能否。喻人验风寒之辨。盖阳明主水谷。风能食。阳能化谷也。寒不能食。阴不杀谷
也。名犹言为也。中寒即伤寒之互词。大意推原风寒传太阳而来。其辨验有如此者。非谓阳明自
中而然也。玉机微义谓。惜乎仲景不言中寒。经言中寒殆不止此。何尝不言。彼以经为不言者。
其意将以为中之与伤。有各别之分也。殊不知经称中伤二字。于风寒者。要亦从来之通称。经因
通称以为称。非经之称始也。想从来通称之意。大约不过以风寒本天之二气。中伤是以人之被之
而为称。譬如称人之中于箭伤于刃。只可在刀箭疮上认病。岂可向中伤上摸影。由此言之。则中
风与伤寒之说。必须于风寒二病上认得证候分晓。不当在中伤上各别寻头脑也。且以经文大义考
之。措词多是互相发。则中伤二字亦是互相为用。不言可知矣。通篇虽无伤风一说。然以伤寒复
称中寒论之。则中风得称伤风。亦可推也。世俗又有感冒之称。盖由愚夫愚妇。不知中伤与感本
素灵之互文。乃讳中伤为重。而起趋感冒为轻。以便慰问之风。遂成弊习耳。原无关轻重之义。
读书贵格致穷理。明道以正俗。乃舍古不稽。一从流俗。直欲于虚文上争差分。不究事实而
求多于往哲。可不正谓之冥行索涂。东西一听候于呼叱哉。
（十五）脉阳微而汗出少者。为自和也。汗出多者。为太过。
轻高而上前者为阳微。以中风之缓言。中风本自汗。故言出少为自和。和对太过言。谓未至
太过耳。非直谓平和。大过者。以其失于不治。与凡治之不对。致出不已者言也。
阳脉实。因发其汗。出多者亦为太过。太过为阳绝于里。亡津液。大便因硬也。
实以伤寒之紧言。伤寒本无汗。故曰因发其汗。发而出之过多。则与自出过多者同一致。故曰
亦为太过。自此以下。乃总结上文以申其义。阳绝即亡阳。盖汗者血之液。血为阴。阴主静。本不
自出。盖所以出者阳气之动鼓之也。故汗多则阳绝。岂惟阳绝。亡津液即亡阴也。读者最宜究识。
（十六）太阳病。三日。发汗不解。蒸蒸发热者属胃也。调胃承气汤主之。
此概言阳明发热之大意。三日举大纲言也。蒸蒸热气上行貌。言热自内腾达于外。犹蒸炊然。
故曰属胃也。调胃。和阳明之正也。方见太阳下编。
（十七）阳明病。本自汗出。医更重发汗。病已差。尚微烦不了了者。此大便必硬故也。以
亡津液。胃中干燥。故令大便硬。当问其小便日几行。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。以津液当还入胃中。故知不久必大便也。
差。与瘥同。穿介切。令。平声。为。去声。瘥。小愈也。以亡津液至大便硬。是申释上文。
当问其小便日几行。至末。是详言大便出不出之所以然。盖水谷入胃。其清者为津液。粗者成楂滓。
津液之渗而外出者则为汗。潴而下行者为小便。故汗与小便出多。皆能令人亡津液。所以楂滓之
为大便者。干燥结硬而难出也。然二便者。水谷分行之道路。此通则彼塞。此塞则彼通。小便出
少。则津液还停胃中。胃中津液足。则大便润。润则软滑。此其所以必出可知也。
（十八）阳明病。自汗出。若发汗。小便自利者。此为津液内竭。虽硬。不可攻之。当须自
欲大便。宜蜜煎导而通之。若土瓜根。及与大猪胆汁。皆可为导。
蜜煎导方
蜜七合。一味内铜器中。微火煎之。稍凝似饴状。搅之。勿令焦者。欲可丸。并手捻作梃子。
令头锐大如指。长二寸许。当热时急作。冷则硬。以内谷道中。以手急按。欲大便时。乃去之。
猪胆汁方
大猪胆一枚。泻汁。和醋少许。以灌谷道中。如一食顷。当大便出。
虽。上或下。当有大便二字。竭。亦亡也。上条以小便数少。故知大盒饭自出。此以小便自
利而用导。反复互相发也。然皆不用下者。以非热也。
（十九）阳明病。脉迟。虽汗出不恶寒者。其身必重。短气腹满而喘。有潮热者。此外欲解。
可攻里也。手足 然而汗出者。此大便已硬也。大承气汤主之。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。勿令大泄下。
大承气汤方
大黄（四两酒洗） 浓朴（半斤炙去皮） 枳实（五枚炙） 芒硝（三合）
上四味。以水一斗。先煮二物取五升。去滓。内大黄煮取二升。去滓内芒硝。更上火。微一两
沸。分。温再服。得下。余勿服。
小承气汤方
大黄（四两酒洗） 浓朴（二两炙去皮） 枳实（三枚炙大者）
以上三味。以水四升。煮取一升二合。去滓。分。温二服。初服汤当更衣。不尔者。尽饮之。
若更衣者。勿服之。
脉迟不恶寒。表罢也。身必重。阳明主肌肉也。短气腹满而喘。胃实也。潮热。阳明王于申
酉戌。故热作于此时。如潮之有信也。手足 然汗出者。脾王四肢而胃为之合。胃中热甚而蒸发。
腾达于四肢。故曰此大便已硬也。承气者。承上以逮下。推陈以致新之谓也。曰大者。大实大满。
非此不效也。枳实泄满也。浓朴。导滞也。芒硝。软坚也。大黄荡热也。陈之推新之所以致也。
汗多。微发热恶寒。皆表也。故曰。外未解也。其热不潮。胃中未定热。阳明信不立也。小承气
者。以满未硬。不须软也。故去芒硝而未复致大下之戒也。更衣。古人致大便之恭也。夫胃实。
一也。以有轻重缓急之不同。故承气有大小调胃之异制。汤有多服少服之异度。盖称物平施。由
义之谓道也。然则窃三益而滥称承气者冒也。恶足与语道哉。
（二十）阳明病。潮热。大便微硬者。可与大承气汤。不硬者不与之。若不大便六七日。恐有
燥屎。欲知之法。少与小承气汤。汤入腹中。转失气者。此有燥屎。乃可攻之。若不转失气。此
但初头硬。后必溏。不可攻之。攻之必胀满不能食也。欲饮水者。与水则哕。其后发热者。必大
便硬而少也。以小承气汤和之。不转失气者。慎不可攻也。
黄氏曰。失。汉书作屎。古屎失通。矢传写误。上条诀人以手足汗出为当下之时。此以潮热转
矢气次第而详言。亦诀人当下之二候也。转矢气。反屁出也。胀满。药寒之过也。哕。亦寒伤胃
也。硬而少。重下故也。末句重致叮咛之意。
（二十一）阳明病下之。心中懊 而烦。胃中有燥屎者可攻。腹微满。初头硬。后必溏。不
可攻之。若有燥屎者。宜大承气汤。
可攻以上。以转矢气言。懊 。悔 痛恨之意。盖药力未足以胜病。燥硬欲行而搅作。故曰
可攻。言当更服汤以促之也。腹微满以下。以不转矢气言。头硬后溏。里热轻也。故曰不可攻之。
言当止汤勿服也。末二句。乃申上节以决治意。
（二十二）阳明病。谵语。发潮热。脉滑而疾者。小承气汤主之。因与承气汤一升。腹中转
失气者。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。
此承上文又以谵语并脉言。亦诀人下候及斟酌用汤度数之意。滑以候食。故为大便硬之诊。
疾。里热甚也。然滑疾有不宁之意。不可不知。微者阳气不充。涩者阴血不足。故曰里虚也。难
治者。气不充则无以为营运。血不足则无以为润送。故曰阳微不可下。无血不可下。此之谓也。
（二十三）夫实则谵语。虚则郑声。郑声。重语也。
实以邪言。谵语。呢喃不了之妄语也。虚以正言。以重语释郑声者。谓语声之出。由于邪实
正虚。浊恶而厌听也。
（二十四）直视。谵语。喘满者。死。下利者。亦死。
直视。精不荣于目也。谵语。神不主乎心也。喘则阳争于上。利则阴夺于下。胃。中土也。
阴阳争夺于上下。而中气不守。故无法可治。而皆主死也。
（二十五）发汗多。若重发汗者。亡其阳。谵语脉短者。死。脉自和者。不死。
汗本血之液。阳亡则阴亦亏。脉者血气之道路。短则其道穷矣。故亦无法可治而主死也。和
则病虽竭。而血气则未竭。故知生可回也。此疑太阳篇错简。
（二十六）阳明病。发热。汗多者。急下之。宜大承气汤。
胃实本由于无津液而内燥。汗多则津液益亡矣。急下者。竭则不可治也。
（二十七）发汗不解。腹满痛者。急下之。宜大承气汤。
发汗不解者。失之过度也。腹满痛者。胃不和也。急下者。满去则痛止也。
凡七十七条，共十个方剂。
阳明经，就是胃经。其辨证法则不以经络受邪的“经病”作为主要示例，而是以“胃家实”（胃肠燥热积滞）作为正证。之所以不以经病为例，是因为阳明经与太阳经相接。所谓的经病，是由太阳经传变而来，经过太阳之后才受到邪气侵袭。如果传变较多，太阳表证尚未解除，因此必须仍然遵循太阳病的法则。例如“几几”项强及合病等情况就是这样。越过这个阶段再传入阳明，就是胃实证了。病邪一旦进入胃，胃是五脏六腑的海，吉凶生死都取决于此，就不再有所谓经络病变可言了。所以经文没有列出经络病变的示例，而凡是胃实证都必须列出示例。这就是阳明病与其他各经不同的原因。那些拘泥于一经、二经，沿着经络或跨越经络，死板地用日数来论证的人，哪里懂得圣人在言词之外的深意呢？
（一）阳明病的特征，就是胃家实。
阳明，指经络；胃，指脏腑。所谓“实”，是指大便结聚成硬块且胀满，无法排出。发病有早有晚，不能拘泥于日数。所说的“第二日出现阳明病”，是从经络角度说的。经络主管三阳经，在传变过程中，并不专指某一经的病，而是专指病位在胃实。所以“胃实”反而可以作为揭示阳明病总纲的依据。这与太阳病揭示总纲的方式虽然不同，但作为揭示示例的方法是一致的。其他各经都有总的揭示，其法则可以通用于两者并类推。由此看来，如果不是全书之言，难道不是出于轻视和随意吗？
（二）问：病有太阳阳明、正阳阳明、少阳阳明，这是什么意思？答：太阳阳明，就是脾约证。
这一条分为三节，这一节是三问一答，结合下文两节才是三个回答。这原本是说三阳经入胃的不同原因。所谓太阳阳明，是指太阳经受病后传入胃中形成胃实。脾约证见第六十一条。这里只是举出大意，详细内容在后面。
正阳阳明，就是胃家实。
“正”，指本经。因为病邪到了本经就直接入胃形成胃实，所以指出第一条所说的就是这种情况。然而大体上也不过如此。
少阳阳明，是指发汗、利小便后，胃中干燥、烦闷、结实，大便困难的情况。
所谓少阳阳明，是指病邪到了少阳，然后才入胃形成胃实。发汗、利小便等方法，三阳经都适用，但唯独在少阳病中提到，是因为少阳主半表半里，表和里都不宜攻下。然而这三种情况的原因虽然略有不同，总体上也不过是互相阐明罢了。
（三）问：阳明病的外证是什么？答：身体发热，自然出汗，不恶寒反而恶热。
身热、汗自出，起于中风证。不恶寒、反恶热，说明邪气已过营卫进入体内，里热炽盛。这是从太阳传入中风的阳明病外证。
（四）问：为什么会得阳明病？答：太阳病，经过发汗，或者攻下，或者利小便，导致津液耗伤，胃中干燥，因而转属阳明。不大便，内实，大便困难的，这就叫阳明病。
“亡”、“转”都在太阳篇见过。中风本来就有自汗，所以发汗、攻下后容易传变到阳明，势态容易变化。古人称解大便为“更衣”，“不更衣”就是说不大便。这是从太阳中风传入阳明的表证角度说的。
（五）问：有的病得病一天，不发热却恶寒，为什么呢？答：即使得病一天，恶寒也会自行停止，随即会自然出汗并且恶热。
不发热而恶寒，起于伤寒证。恶寒将自行停止，说明邪气已过表。随即自然出汗，是因为邪热郁结在阳明的肌肉，腠理反而开放，津液反而向外泄出。恶热，说明里热炽盛。这是从太阳伤寒传入阳明的外证角度说的。
（六）问：恶寒为什么会自动停止？答：阳明居中，属土。万物归附于此，不再传变。开始虽然恶寒，第二天自然会停止，这就是阳明病。
这是承接上一条的回答，又设问答并用里证来解释。“不再传变”，是因为胃是水谷之海，五脏六腑四肢百骸都依赖胃的滋养，最宜通畅。如果实证则闭塞坚固，若能恢复通畅则生，若止于闭塞坚固则死。生死决断于此，还有什么可传变的呢？恶寒第二天自动停止，是因为热入里而将转为恶热，这是针对正阳阳明而言的。如果病至第二天其征兆已如此，那么医道的精微之处，岂是专门谈论经络和日数所能窥测的呢？
（七）伤寒发热无汗，呕吐不能进食，反而汗出濈然（连续不断貌）的，这是转属阳明。
“濈”音吉。发热无汗，是追述太阳病时的情况。呕吐不能进食，说明热邪入胃。反而汗出，是因为肌肉受热，肤腠反而开放。“濈然”，形容热而汗出的样子。
（八）伤寒，转系阳明的，其人濈然微汗出。
这是承接上一条，再用微汗进一步申说，着重致意叮咛。
（九）原本是太阳病，初得病时，发其汗，汗出先出不透彻，因而转属阳明。
“彻”，除也。意思是发汗不对症，病邪未除。这是说由发太阳汗不如法，导致病邪入胃的大意，以此总结上文。
（十）伤寒三日，脉象大。
“伤寒三日”，包括中风在内，大约而言之。凡是类似的情况，都仿照此例。脉大，说明阳明气血俱多。
（十一）阳明病欲解的时间，从申时到戌时。
申、酉、戌时，是阳明旺相之时。正气得到旺时的帮助，就能战胜邪气，所以病邪退去而自愈。
（十二）阳明病，脉迟，汗出多，轻微恶寒的，表证未解。可以发汗，适宜用桂枝汤。
“迟”，是缓的变象。汗出多且微恶寒，说明风邪仍有留在体表的，所以说未解。可以发汗，这是常规法则。适宜用桂枝汤，意思是仍须解肌，那么入胃的路径自然断绝。方剂见太阳篇上编。
（十三）阳明病，脉浮，无汗而喘的，发汗则愈，适宜用麻黄汤。
“浮”，是紧脉的转变，邪气趋向于外。无汗而喘，说明寒邪在表未完全清除。所以说发汗则愈，意思是应当仍从解表入手。适宜用麻黄汤，意思是应当在边界散尽穷寇。方剂见太阳篇中编。
（十四）阳明病，如果能吃东西的，名叫中风；不能吃东西的，名叫中寒。
这是以能否进食，比喻用来验证风寒的区别。大概阳明主水谷，风能食，阳气能化谷。寒不能食，阴气不能杀谷。“名”犹言“为”。“中寒”即“伤寒”的互词。大意是推究风寒传变到太阳而来的情况，其辨别验证有如此区别。并不是说阳明自己直接感受风寒。玉机微义说：“可惜仲景不说中寒。”经文说中寒大概不止于此，何尝不说？那些人认为经文没说，是想把“中”与“伤”区分开来。殊不知经文称“中伤”二字，对于风寒来说，向来也是通称。经文因通称而称为通称，并非经文始创。想来从来通称的意思，大约不过是以风寒本是天之二气，人遭受它而称为“中伤”。譬如称人被箭射中、被刀砍伤，只能在刀箭疮上认病，岂可向“中伤”上摸影。由此说来，中风与伤寒的说法，必须在风寒二病上认清证候区别，不应当在“中伤”上各自寻找头绪。况且以经文大义考察，措辞多是互相发明，那么“中伤”二字也是互相为用，不言可知。通篇虽然没有“伤风”一说，但以伤寒复称中寒来讨论，那么中风得称伤风，也可以推知。世俗又有“感冒”之称，大概是由于愚夫愚妇，不知道“中伤”与“感”本是素问、灵枢中的互文，于是忌讳“中伤”为重，而起而趋附“感冒”为轻，以便慰问的风气，遂成弊习罢了。原本无关轻重之义。读书贵在格物致知穷理，明道以纠正习俗，却舍弃古书不考证，一味顺从流俗，简直想在虚文上争辨差异，不探究事实而向往哲求多，这不正是叫做盲行索途，东西方向只听凭呼叱吗？
（十五）脉象阳部微弱而汗出少的，是自和的状态。汗出多的，是太过。
轻高而上前的为阳微，这是从中风脉缓来说的。中风本来自汗，所以说汗出少为自和。“和”是对“太过”而言，指未至于太过而已，并非直接指平和。所谓“大过”，是指因为失治，以及凡是治疗不对症，导致汗出不止的情况。
阳脉实，因发其汗，汗出多的也为太过。太过会导致阳绝于里，津液亡失，大便因而坚硬。
“实”是以伤寒脉紧来说的。伤寒本来无汗，所以说“因发其汗”。发汗而出汗过多，则与自汗出过多者一致，所以说“亦为太过”。自此以下，乃总结上文以申说其义。“阳绝”即亡阳。盖汗是血的液体，血属阴，阴主静，本来不自出。之所以出，是因为阳气的鼓动。所以汗多则阳绝。岂止是阳绝，亡津液即是亡阴。读者最应深入研究认识。
（十六）太阳病，三天，发汗后病不解，蒸蒸发热的，属于胃，用调胃承气汤主治。
这是概言阳明发热的大意。“三日”举大纲而言。“蒸蒸”，热气上行貌。说热自内腾达于外，如同蒸炊一般，所以说“属胃”。“调胃”，是调和阳明正气。方剂见太阳篇下编。
（十七）阳明病，本来自汗出，医生更重发汗，病虽已好转，但仍轻微心烦不爽快的，这是因为大便必硬。由于津液亡失，胃中干燥，所以令大便硬。应当问病人每天小便几次。如果原来小便每天三四次，今天只有两次，所以知道大便不久就会排出。现在小便次数减少，是因为津液应当回归胃中，所以知道不久必然大便排出。
“差”，同“瘥”，音穿介切。“令”，平声。“为”，去声。“瘥”，小愈。从“以亡津液”到“大便硬”，是申释上文。从“当问其小便”到末尾，是详言大便出或不出的原因。盖水谷入胃，清的部分成为津液，粗的部分成为渣滓。津液渗入外出则为汗，潴留下行则为小便。所以汗与小便出多，都能令人亡津液。因此渣滓成为大便时，干燥结硬而难出。然而大小便是水谷分行的道路，此通则彼塞，此塞则彼通。小便出少，则津液还停胃中。胃中津液充足，则大便润。润则软滑，这就是必然排出的原因。
（十八）阳明病，自汗出，若发汗，小便自利的，这是津液内竭。虽然大便硬，不可攻下。应当等待病人自己想大便时，适宜用蜜煎导法通便。或者土瓜根，以及给予大猪胆汁，都可以作为导引。
蜜煎导方：
蜜七合，单味放入铜器中，微火煎煮，稍凝固似饴糖状，搅拌，不要让烧焦。想要做成丸药形状时，用手捻作梃子（栓剂），头部尖锐粗如手指，长约二寸左右。趁热急做，冷则硬。纳入肛门中，用手急按。想大便时，再去掉它。
猪胆汁方：
大猪胆一枚，取汁，加少许醋，灌入肛门中。一顿饭功夫，大便应当排出。
“虽”，上面或下面，应当有“大便”二字。“竭”，也是亡。上一条因小便数少，故知大便必自出。这一条因小便自利而用导法，反复互相发明。然而都不用泻下药，因为不是热证。
（十九）阳明病，脉迟，虽然汗出但不恶寒的，身体必定沉重，短气、腹满而喘，有潮热的，这是表证将解，可以攻里。手足濈然汗出的，这是大便已硬。用大承气汤主治。如果汗多，微发热恶寒的，表证未解。其热不潮，不可给承气汤。如果腹大满不通的，可以给小承气汤，轻微调和胃气，不要令大泄下。
大承气汤方：
大黄（四两酒洗） 浓朴（半斤炙去皮） 枳实（五枚炙） 芒硝（三合）
以上四味，用水一斗，先煮浓朴、枳实取五升，去渣，内大黄煮取二升，去渣，内芒硝，再上火，微煮一两沸。分温再服。得下，余勿服。
小承气汤方：
大黄（四两酒洗） 浓朴（二两炙去皮） 枳实（三枚炙大者）
以上三味，用水四升，煮取一升二合，去渣，分温二服。初服汤应当更衣（排便）。如果不排便，饮完所有药汤。如果已排便，勿服。
脉迟不恶寒，说明表证罢。身体必重，因为阳明主肌肉。短气、腹满而喘，是胃实。潮热，阳明旺于申酉戌时，所以热作于此时，如潮水般有信期。手足濈然汗出，因为脾旺于四肢而胃为之合，胃中热甚而蒸发，腾达于四肢，所以说这是大便已硬。“承气”，是承上逮下，推陈致新的意思。曰“大”，是因为大实大满，非此方无效。枳实泄满，浓朴导滞，芒硝软坚，大黄荡热。推陈致新之所以达到，靠的是这些药物。汗多、微发热恶寒，都是表证，所以说外未解。其热不潮，说明胃中热未定，阳明证不立。小承气汤，是因为满未硬，不需要软坚，所以去掉芒硝而未重申大下的戒律。“更衣”，古人解大便的恭敬说法。胃实是一回事，但因有轻重缓急的不同，所以承气汤有大、小、调胃的不同制剂。汤剂有多服、少服的不同剂量。这叫称物平施，合乎义理即为道。然而窃取三益之名而滥称承气的人是欺骗，哪里值得与之谈论道呢？
（二十）阳明病，潮热，大便微硬的，可以给大承气汤。不硬的不给。如果不大便六七天，恐怕有燥屎。想知道的方法，少量给小承气汤。汤入腹中，转矢气（放屁）的，这是有燥屎，才可以攻下。如果不转矢气，这只是开头硬，后面必溏，不可攻下。攻下必致胀满不能食。想喝水的，给水则哕（呃逆）。其后发热的，必大便硬而少。用小承气汤调和。不转矢气的，慎不可攻下。
黄氏说：“失”，汉书作“屎”，古时屎、失通用，“矢”是传写误。上一条诀示人以手足汗出为当下之时，这一条以潮热、转矢气次第详细言说，也是诀示人当下的两个征候。转矢气，即反屁出。胀满，是药性寒凉的过错。哕，也是寒伤胃。硬而少，是重下所致。末句重在致意叮咛。
（二十一）阳明病下之，心中懊憹而烦，胃中有燥屎者可攻。腹微满，初头硬，后必溏，不可攻之。若有燥屎者，宜大承气汤。
“可攻”以上，是根据转矢气而言。“懊憹”，悔恨痛恨之意。盖药力不足以胜病，燥硬欲行而搅动，所以说“可攻”，意思是应当更服汤药以催促它。“腹微满”以下，是根据不转矢气而言。头硬后溏，里热轻，所以说“不可攻之”，意思是应当止汤勿服。末两句，乃申上节以决定治疗意图。
（二十二）阳明病，谵语，发潮热，脉滑而疾的，小承气汤主治。因给承气汤一升，腹中转矢气的，更服一升。若不转矢气，勿更给。明日不大便，脉反微涩的，是里虚，为难治，不可更给承气汤。
这是承接上文又以谵语和脉象言说，也是诀示人下法的征候及斟酌用药剂量的意思。滑以候食，所以是大便硬的诊脉。疾，说明里热甚。然而滑疾有不宁之意，不可不知。微，说明阳气不充；涩，说明阴血不足，所以说里虚。难治，是因为气不充则无以为营运，血不足则无以为润送，所以说阳微不可下，无血不可下，就是这个意思。
（二十三）实则谵语，虚则郑声。郑声，是重复语言。
实，指邪气盛。谵语，是呢喃不清的妄语。虚，指正气虚。以重复语言解释郑声，是说语音发出，由于邪实正虚，声音浊恶而令人厌听。
（二十四）直视，谵语，喘满的，死。下利的，也死。
直视，精气不能荣养于目。谵语，神志不能主宰于心。喘则阳气争于上，利则阴气夺于下。胃，属中土。阴阳争夺于上下，而中气不守，所以无法可治，都主死。
（二十五）发汗多，若重发汗的，亡其阳，谵语脉短的，死。脉自和的，不死。
汗本是血的液体，阳亡则阴亦亏。脉是血气的道路，短则其道穷尽，所以也无法可治而主死。和，则病虽竭，而血气未竭，所以知道生机可回。此条疑似太阳篇错简。
（二十六）阳明病，发热，汗多的，急下之，宜大承气汤。
胃实本来由于无津液而内燥，汗多则津液更加亡失。急下，是因为枯竭则不可治。
There are seventy-seven clauses in total, comprising ten formulas.
The Yangming channel is the Stomach channel. Its diagnostic principle does not take "channel disease" (disease of the meridian) as the primary example, but rather takes "Stomach-Home Excess" (excess heat and accumulation in the stomach and intestines) as the standard syndrome. The reason for not taking channel disease as an example is that the Yangming channel connects with the Taiyang channel. The so-called channel disease is transmitted from the Taiyang channel; after passing through Taiyang, it receives pathogenic factors. If the transmission is extensive, the Taiyang exterior syndrome may not yet be resolved, thus requiring adherence to the Taiyang principles. This is seen in cases such as "Jijiu" (stiffness of the neck) and combined diseases. Once this stage is passed and the disease enters Yangming, it becomes a Stomach Excess syndrome. Once pathogens enter the Stomach, which is the sea of the five zang and six fu organs, fortune and misfortune, life and death depend upon it, and there is no longer talk of channel pathology. Therefore, the classics do not list examples of channel pathology, but must list examples for all Stomach Excess conditions. This is why Yangming differs from other channels. Those who rigidly adhere to one or two channels, following or crossing meridians, and strictly use days to argue syndromes, how can they understand the profound meaning beyond the words of the sages?
(1) The characteristic of Yangming disease is Stomach-Home Excess.
Yangming refers to the channel; Stomach refers to the fu organ. "Excess" means stool becomes hardened and full, unable to pass. Onset varies in time and cannot be restricted by days. When it is said "Yangming on the second day," it refers to the channel. Channels govern the three yang phases. In transmission, it does not specifically refer to a disease of a specific channel, but specifically to the disease location being Stomach Excess. Thus, "Stomach Excess" serves as the general outline for revealing Yangming, similar to how Taiyang reveals its general outline. Although the channel diseases differ, the method of revealing the principle is the same. All other channels have a general outline, and their principles can be applied universally and inferred. From this, we see that if these were not words from the complete book, would they not be considered disrespectful and casual?
(2) Question: There is Taiyang-Yangming, Zhengyang-Yangming, and Shaoyang-Yangming. What does this mean? Answer: Taiyang-Yangming is Pi Yue (Spleen Constriction).
This clause has three sections; this section has three questions and one answer, combining with the next two sections to form three answers. This originally explains the different causes for the three yang channels entering the Stomach. Taiyang-Yangming means the Taiyang channel receives disease and transmits to the Stomach forming Stomach Excess. Pi Yue is seen in Clause 61. Here only the general idea is stated; details follow later.
Zhengyang-Yangming is Stomach-Home Excess.
"Zheng" means the original channel. Because the pathogen reaches the original channel and directly enters the Stomach to form Stomach Excess, the first clause is cited as referring to this. However, generally, it is just like this.
Shaoyang-Yangming refers to the condition where, after sweating and promoting urination, the Stomach becomes dry, vexed, solid, and defecation is difficult.
Shaoyang-Yangming means the pathogen reaches Shaoyang and then enters the Stomach to form Stomach Excess. Sweating and promoting urination apply to all three yang channels, but are mentioned specifically for Shaoyang because Shaoyang governs half-exterior and half-interior, where neither exterior nor interior should be purged. Although the causes of these three are slightly different, they essentially illuminate each other.
(3) Question: What are the external manifestations of Yangming disease? Answer: Body fever, spontaneous sweating, aversion to cold is absent but aversion to heat is present.
Body fever and spontaneous sweating originate from Wind Strike. Absence of aversion to cold and presence of aversion to heat indicate that pathogens have passed Ying and Wei and entered the interior, causing intense interior heat. This describes the external signs of Yangming disease transmitted from Taiyang Wind Strike.
(4) Question: How does one contract Yangming disease? Answer: In Taiyang disease, after sweating, purging, or promoting urination, fluids are depleted, the Stomach becomes dry, and it transforms into Yangming. Failure to defecate, internal excess, and difficulty in defecation constitute Yangming disease.
"Wang" (loss) and "Zhuan" (transformation) are seen in the Taiyang chapter. Wind Strike naturally involves spontaneous sweating, so sweating or purging easily leads to transmission to Yangming. Ancients referred to defecation as "changing clothes"; "not changing clothes" means not defecating. This discusses the exterior signs of Taiyang Wind Strike transmitting to Yangming.
(5) Question: Some patients, one day after contracting the disease, do not have fever but have aversion to cold. Why? Answer: Even if it is one day after onset, aversion to cold will cease spontaneously, followed by spontaneous sweating and aversion to heat.
No fever but aversion to cold originates from Cold Damage. Aversion to cold ceasing indicates pathogens have passed the exterior. Spontaneous sweating occurs because pathogenic heat stagnates in the muscles of Yangming, causing pores to open and fluids to leak out. Aversion to heat indicates intense interior heat. This discusses the external signs of Taiyang Cold Damage transmitting to Yangming.
(6) Question: Why does aversion to cold cease spontaneously? Answer: Yangming is central and belongs to Earth. All things return to it and do not transmit further. Initially there may be aversion to cold, but it stops on the second day. This is Yangming disease.
This continues the answer to the previous clause, setting up another Q&A using interior signs. "Does not transmit further" means the Stomach is the sea of water and grain, nourishing all zang-fu and limbs. It must remain unobstructed. Excess leads to blockage; restoration of flow brings life, while persistent blockage brings death. Life and death are decided here, so what is there to transmit? Aversion to cold stopping on the second day refers to heat entering the interior and turning to aversion to heat, specifically regarding Zhengyang-Yangming. If the signs are such by the second day, the subtlety of this art cannot be fathomed merely by discussing channels and days.
(7) In Cold Damage, with fever, no sweat, vomiting, inability to eat, but instead profuse sweating (Ji Ran), this is transformation into Yangming.
"Ji" sounds like Ji. Fever and no sweat refer back to the Taiyang stage. Vomiting and inability to eat indicate heat entering the Stomach. Profuse sweating indicates muscle heat causing pores to open. "Ji Ran" describes the appearance of heat with continuous sweating.
(8) In Cold Damage, transforming into Yangming, the person has Ji Ran slight sweating.
This continues the previous clause, reiterating slight sweating to emphasize caution.
(9) Originally Taiyang disease, at initial onset, sweating was induced, but the sweat was incomplete, leading to transformation into Yangming.
"Che" means removal. It means improper sweating failed to remove the pathogen. This summarizes the main point that improper treatment of Taiyang sweating leads to pathogen entering the Stomach, concluding the above text.
(10) After three days of Cold Damage, the pulse is large.
"Cold Damage three days" includes Wind Strike and is a general statement. Similar cases follow this pattern. Large pulse indicates abundant Qi and Blood in Yangming.
(11) Yangming disease resolves from Shen hour to Xu hour.
Shen, You, and Xu hours are when Yangming is prosperous. When righteous Qi is supported by its prosperous time, it overcomes pathogens, so the disease resolves spontaneously.
(12) In Yangming disease, with slow pulse, profuse sweating, and slight aversion to cold, the exterior is unresolved. Sweating may be used; Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
"Chi" (slow) is a variation of "Huan" (moderate). Profuse sweating and slight aversion to cold indicate wind pathogen remains in the exterior, hence unresolved. Sweating is indicated as a standard method. Guizhi Tang is appropriate to release the muscle layer, cutting off the path to the Stomach. Formula seen in Taiyang Upper Chapter.
(13) In Yangming disease, with floating pulse, no sweat, and wheezing, sweating will cure; Mahuang Tang (Ephedra Decoction) is appropriate.
"Floating" is a transformation of "Jin" (tight), indicating pathogen moving outward. No sweat and wheezing indicate cold pathogen remains in the exterior. Sweating is indicated to resolve the exterior. Mahuang Tang is appropriate to scatter the remaining pathogens. Formula seen in Taiyang Middle Chapter.
(14) In Yangming disease, if able to eat, it is named Wind Strike; if unable to eat, it is named Cold Injury.
This uses ability to eat to distinguish Wind from Cold. Yangming governs water and grain. Wind allows eating because Yang can transform grain. Cold prevents eating because Yin cannot kill grain. "Ming" means "is called." "Zhong Han" (Cold Injury) is synonymous with "Shang Han" (Cold Damage). The intent is to trace back Wind-Cold transmission from Taiyang, showing differentiation. It does not mean Yangming contracts Wind/Cold directly. Yuji Wei Yi states: "It is a pity Zhongjing did not speak of Zhong Han." The classics mention Zhong Han more than this. Those who claim the classics don't mention it intend to distinguish "Zhong" (penetrating) from "Shang" (injuring). However, "Zhong Shang" is a common term for Wind-Cold. The distinction between Wind Strike and Cold Damage must be recognized in the diseases themselves, not in the terms "Zhong Shang." Furthermore, textual analysis shows mutual explanation; "Zhong Shang" are interchangeable. Although "Shang Feng" is not explicitly used, since "Shang Han" is called "Zhong Han," "Zhong Feng" can be inferred as "Shang Feng." Modern people use "Gan Mao" (Common Cold), avoiding "Zhong Shang" as heavy and preferring "Gan Mao" as light for social courtesy, creating a bad habit unrelated to severity. Studying requires investigating principles to correct customs, not blindly following trends.
(15) Pulse superficially weak with little sweating indicates self-harmony. Profuse sweating indicates excess.
Superficial weakness refers to the moderate pulse of Wind Strike. Since Wind Strike naturally sweats, little sweating is self-harmony (not excessive). "Excess" refers to lack of treatment or incorrect treatment causing continuous sweating.
If the superficial pulse is excess, and sweating is induced resulting in profuse sweat, this is also excess. Excess leads to Yang exhaustion in the interior, depletion of fluids, and hardening of stool.
"Excess" refers to the tight pulse of Cold Damage. Since Cold Damage has no sweat, inducing sweating excessively is similar to natural excessive sweating. Below summarizes the previous text. Yang exhaustion is Yang collapse. Sweat is fluid of blood; blood is Yin, quiet, and does not sweat spontaneously. Yang Qi drives it. Thus, profuse sweating exhausts Yang. Depletion of fluids is also depletion of Yin. Readers must study this carefully.
(16) Taiyang disease, after three days, sweating fails to resolve it; steaming fever indicates involvement of the Stomach. Tiaowei Chengqi Tang (Regulate the Stomach Order the Qi Decoction) is the main treatment.
This generally discusses Yangming fever. "Three days" is a general outline. "Zheng Zheng" describes heat rising internally to externally like steaming. Hence "involvement of the Stomach." "Tiaowei" harmonizes Yangming righteousness. Formula seen in Taiyang Lower Chapter.
(17) Yangming disease, originally with spontaneous sweating, doctor induces heavy sweating again. Disease improves, but slight vexation persists. This indicates stool must be hard due to fluid depletion and dry Stomach. Ask about daily urine frequency. If originally 3-4 times/day, now only twice, stool will pass soon. Reduced urine means fluids return to Stomach, moistening stool for passage.
"Cha" is same as "Chai" (minor recovery). From fluid depletion to hard stool explains the previous text. Asking about urine explains why stool passes or not. Water/grain in Stomach: clear part becomes fluids, turbid part becomes dregs. Fluids exiting as sweat or urine. Excessive loss depletes fluids, making dregs hard. Urine and stool are paths for water/grain separation; open one blocks the other. Less urine means fluids stay in Stomach, moistening stool.
(18) Yangming disease, spontaneous sweating, or induced sweating, with free urination, indicates internal depletion of fluids. Though stool is hard, purge not. Wait for desire to defecate; use Honey Suppository (Mi Jian Dao) to guide. Or Trichosanthes Root (Tugua Gen) or Pig Bile (Da Zhu Dan Zhi) can be used as guides.
Honey Suppository Formula:
Seven he of honey, simmered in copper vessel over low heat until thick like malt syrup, stirring to avoid burning. Shape into suppositories sharp at head, finger-thick, two cun long. Insert into anus while warm; hardens when cold. Press firmly. Remove when urge to defecate arises.
Pig Bile Formula:
One large pig gallbladder, juice mixed with small amount of vinegar,灌 into anus. After one meal time, stool should pass.
"Although" implies "stool" missing above/below. "Jie" means depletion. Previous clause used reduced urine to predict stool passage; this uses free urination to justify suppository. Both avoid purgatives because it is not heat.
(19) Yangming disease, slow pulse, sweating without aversion to cold, body heaviness, shortness of breath, abdominal fullness, wheezing, tidal fever indicates exterior resolving, interior can be attacked. Profuse sweating on hands and feet indicates hard stool. Dachengqi Tang (Major Order the Qi Decoction) is main treatment. If profuse sweat, slight fever/aversion to cold, exterior unresolved. If no tidal fever, do not give Chengqi Tang. If abdominal fullness/blockage, give Xiaochengqi Tang (Minor Order the Qi Decoction) to mildly harmonize Stomach Qi, avoid severe purging.
Dachengqi Tang Formula:
Dahuang (Rhubarb Root, 4 liang, wine-washed) Nongpo (Magnolia Bark, 8 liang, roasted, skin removed) Zhishi (Immature Bitter Orange, 5 pieces, roasted) Mangxiao (Mirabilite, 3 he)
Boil first two in one dou water to five sheng, strain. Add Dahuang, boil to two sheng, strain. Add Mangxiao, boil briefly. Warm and drink twice. If bowel moves, stop remaining dose.
Xiaochengqi Tang Formula:
Dahuang (4 liang, wine-washed) Nongpo (2 liang, roasted, skin removed) Zhishi (3 pieces, roasted, large ones)
Boil three in four sheng water to one sheng two he, strain. Warm and drink twice. First dose should cause bowel movement. If not, drink all. If moved, stop.
Slow pulse/no aversion to cold means exterior resolved. Body heaviness because Yangming governs muscles. Shortness of breath/fullness/wheezing is Stomach Excess. Tidal fever occurs at Shen/You/Xu hours when Yangming prospers. Hand/foot sweating indicates Stomach heat evaporating to limbs (Spleen governs limbs, Stomach is partner). "Chengqi" means inheriting upper to reach lower, pushing out old to bring new. "Da" (Major) is for major excess/fullness. Zhishi drains fullness, Nongpo directs stagnation, Mangxiao softens hardness, Dahuang sweeps heat. Small Chengqi is for fullness without hardness, so Mangxiao is omitted. "Gengyi" is polite term for defecation. Variations in Chengqi formulas match severity.
(20) Yangming disease, tidal fever, slightly hard stool, may give Dachengqi Tang. If not hard, do not give. If no stool for 6-7 days, suspect dry stool. Test by giving small amount of Xiaochengqi Tang. If gas passes after ingestion, dry stool exists, can purge. If no gas, stool is hard at start, loose at end, do not purge. Purging causes fullness, inability to eat. Thirsty patient given water may hiccup. Subsequent fever indicates hard, scant stool; harmonize with Xiaochengqi Tang. If no gas,慎不可攻 (do not purge).
Huang says: "Shi" is "Shi" (feces) in Han Book. Ancient Shi/Shi interchangeable. "Shi" is copy error. Previous clause used hand/foot sweat as indication; this uses tidal fever and gas passage. Gas passage is farting. Fullness is side effect of cold medicine. Hiccup is cold injuring Stomach. Hard/scant stool is result of heavy purging. Last sentence emphasizes caution.
(21) Yangming disease, after purging, mental anguish and vexation. If dry stool in Stomach, can purge. Slight abdominal fullness, hard start/loose end, do not purge. If dry stool, Dachengqi Tang is appropriate.
Above "can purge" based on gas passage. "Ao Nao" is regret/vexation. Medicine insufficient to overcome disease, dry stool moving causing agitation, so "can purge" means take more medicine. Below "slight fullness" based on no gas. Hard start/loose end means mild interior heat, so "do not purge" means stop medicine. Last two sentences decide treatment intent.
(22) Yangming disease, delirium, tidal fever, slippery and rapid pulse, Xiaochengqi Tang is main treatment. Give one sheng of Chengqi Tang. If gas passes, give another sheng. If no gas, do not give. Next day no stool, pulse becomes faint and choppy, interior deficiency, difficult to treat, do not give Chengqi Tang.
Continues previous with delirium and pulse. Slippery indicates food/stool retention (hard stool). Rapid indicates intense interior heat. Slippery/rapid implies unrest. Faint means deficient Yang; Choppy means deficient Yin blood. Interior deficiency makes treatment difficult. Deficient Yang cannot circulate; deficient Yin cannot moisten. Hence "Yang deficiency cannot be purged, blood deficiency cannot be purged."
(23) Excess causes delirium; deficiency causes Zheng Sheng (repetitive speech). Zheng Sheng is repetitive speech.
Excess refers to pathogen. Delirium is incoherent nonsense. Deficiency refers to righteous Qi. Repetitive speech explains Zheng Sheng: voice is turbid and unpleasant due to pathogen excess and righteous deficiency.
(24) Fixed gaze, delirium, wheezing and fullness: death. Diarrhea: also death.
Fixed gaze: essence not nourishing eyes. Delirium: spirit not governing heart. Wheezing: Yang struggling above. Diarrhea: Yin draining below. Stomach is central Earth. Yin/Yang struggle above/below, central Qi fails to hold, incurable, both lead to death.
(25) Profuse sweating or repeated sweating exhausts Yang. Delirium with short pulse: death. Pulse self-harmonious: survival.
Sweat is fluid of blood. Yang exhaustion implies Yin deficit. Pulse is path of Qi/Blood. Short means path exhausted, incurable, death. Harmonious means although disease exhausted, Qi/Blood not exhausted, life recoverable. This clause suspected to be misplaced from Taiyang chapter.
(26) Yangming disease, fever, profuse sweating: urgently purge with Dachengqi Tang.
Stomach Excess due to fluid depletion/internal dryness. Profuse sweating worsens fluid loss. Urgent purge because depletion is untreatable otherwise.
(27) Sweating fails to resolve, abdominal fullness and pain: urgently purge with Dachengqi Tang.
Sweating failure is excessive treatment. Abdominal fullness/pain is Stomach disharmony. Urgent purge removes fullness, stopping pain.