阳明之为病，胃家实也。
阳明为传化之府，当更实更虚。食入胃实而肠虚，食下肠实而胃虚。若但实不虚，斯为阳明之病根矣。胃
实不是阳明病，而阳明之为病，悉从胃实上得来。故以胃家实，为阳明一经之总纲也。然致实之由，最宜详审，
有实于未病之先者，有实于得病之后者，有风寒外束热不得越而实者，有妄汗吐下重亡津液而实者，有从本经热
盛而实者，有从他经转属而实者。此只举其病根在实，而勿得以胃实即为可下之症。按阳明提纲，与《内经·热
论》不同。《热论》重在经络，病为在表。此以里证为主，里不和即是阳明病。他条或有表证，仲景意不在表；
或兼经病，仲景意不在经。阳明为阖，凡里证不和者，又以阖病为主。不大便固阖也，不小便亦阖也。不能食，
食难用饱，初欲食，反不能食，皆阖也。自汗出，盗汗出，表开而里阖也。反无汗，内外皆阖也。种种阖病，
或然或否，故提纲独以胃实为正。胃实不是竟指燥屎坚硬，只对下利言。下利是胃家不实矣。故汗出解后，胃中
不和而下利者，便不称阳明病。如胃中虚而不下利者，便属阳明。即初硬后溏者，总不失为胃家实也。所以然
者，阳明太阴同处中州而所司各别。胃司纳，故以阳明主实；脾司输，故以太阴主利。同一胃腑而分治如此，
是二经所由分也。
问曰∶“阳明病外证云何？”答曰∶“身热，汗自出，不恶寒，反恶热也。”
阳明主里，而亦有外证者，有诸中而形诸外，非另有外证也。胃实之外见者，其身则蒸蒸然，里热炽而达
于外，与太阳表邪发热者不同；其汗则 然，从内溢而无止息，与太阳风邪为汗者不同。表寒已散，故不恶
寒；里热闭结，故反恶热。只因有胃家实之病根，即见身热自汗之外证，不恶寒反恶热之病情。然此但言病机
发现，非即可下之证也，宜轻剂以和之。必谵语、潮热、烦躁、胀满诸证兼见，才为可下。
四证是阳明外证之提纲。故胃中虚冷，亦得称阳明病者，因其外证如此也。
阳明病，脉浮而紧者，必潮热，发作有时；但浮者，必盗汗出。
阳明脉证，与太阳脉证不同。太阳脉浮紧者，必身疼痛、无汗、恶寒、发热不休。此则潮热有时，是恶寒
将自罢，将发潮热时之脉也。此紧反入里之谓，不可拘紧则为寒之说矣。太阳脉但浮者，必无汗。今盗汗出；
是因于内热。且与本经初病但浮无汗而喘者不同，又不可拘浮为在表之法矣。脉浮紧，但浮而不合麻黄证，身
热汗出而不是桂枝证。麻、桂下咽，阳盛则毙耳。此脉从经异，非脉从病反。要知仲景分经辨脉，勿专据脉谈
证。
伤寒三日，阳明脉大。
脉大者，两阳合明，内外皆阳之象也。阳明受病之初，病为在表，脉但浮而未大，与太阳同，故亦有麻黄、
桂枝证。至二日恶寒自止，而反恶热。三日来，热势大盛，故脉亦应其象而洪大也。此为胃家实之正脉。若小
而不大，便属少阳矣。
《内经》云∶“阳明之至短而涩。”此指秋金司令之时脉。又曰∶“阳明脉象大浮也。”此指两阳合明之病脉。
脉浮而大，心下反硬，有热，属藏者，攻之，不令发汗；属府者，不令溲数，溲数则大便硬。汗多则热愈，
汗少则便难，脉迟尚未可攻。
此治阳明之大法也。阳明主津液所生病，津液干则胃家实矣。津液致干之道有二∶汗多则伤上焦之液，溺
多则伤下焦之液。一有所伤，则大便硬而难出，故禁汗与溲。夫脉之浮而紧、浮而缓、浮而数、浮而迟者，皆不
可攻而可汗。此浮而大，反不可汗而可攻者，以为此阳明
三日之脉，当知大为病进，不可拘浮为在表也。心下者，胃口也。心下硬，已见胃实之一班。以表脉不当见里
证，故曰反硬耳。有热属藏，是指心肺有热，不是竟指胃实。攻之是攻其热，非攻其实，即与黄芩汤彻其热之
义也。不令者，禁止之辞，便见泻心之意。上焦得通，津液自下，胃气因和耳。属府指膀胱，亦不指胃。膀胱热，
故溲数。不令处，亦见当滋阴之义矣。属府是陪说，本条重在藏热。汗多句，直接发汗句来。盖汗为心液，汗
出是有热属藏之征也。所以不令发汗者何？盖汗出多津液亡，而火就燥，则愈热而大便难。即汗出少，亦未免便硬而
难出，故利于急攻耳。仲景治阳明，不患在胃家实，而患在藏有热，故急于攻热而缓以下。其实禁汗与溲，所以
存其津，正以和其实耳。然证有虚实，脉有真假，假令脉迟，便非藏实。是浮大皆为虚脉矣。仲景特出此句，正
发明心下硬一证有无热属藏者，为妄攻其热者禁也，其慎密如此。
阳明病心下硬满者，不可攻之。攻之，利遂不止者死，利止者愈。
阳明证具而心下硬，有可攻之理矣。然硬而尚未满，是热邪散漫胃中，尚未干也。妄攻其热，热去寒起，移
寒于脾，实反成虚，故利遂不止也。若利能自止，是其人之胃不虚而脾家实，腐秽去尽而邪不留，故愈。上条热
既属藏，利于急攻，所以存津液也。此条热邪初炽，禁其妄攻，所以保中气也。要知腹满已是太阴一班，阳明太
阴相配偶，胃实则太阴转属于阳明，胃虚则阳明转属于太阴矣。此仲景大有分寸处，诊者大宜着眼。
伤寒呕多，虽有阳明证，不可攻之。
呕多是水气在上焦，虽有胃实证，只宜小柴胡以通液，攻之恐有利遂不止之祸。要知阳明病津液未亡者，慎
不可攻。盖腹满呕吐，是太阴阳明相关证；胃实胃虚，是阳明太阴分别处。胃家实，虽变证百出，不失为生阳；
下利不止，参、附不能挽回，便是死阴矣。
阳明病，自汗出，若发汗，小便自利，此为津液内竭。大便虽硬，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。
本自汗，更发汗，则上焦之液已外竭；小便自利，则下焦之液又内竭。胃中津液两竭，大便之硬可知。虽
硬而小便自利，是内实而非内热矣。盖阳明之实，不患在燥而患在热。此内既无热，只须外润其燥耳。连用三自
字，见胃实而无变证者，当任其自然，而不可妄治。更当探苦欲之病情，于欲大便时，因其势而利导之，不欲
便者，宜静以俟之矣。此何以故？盖胃家实，固是病根，亦是其人命根，禁攻其实者，先虑其虚耳。
阳明病，本自汗出，医更重发汗，病已瘥，尚微烦不了了者，此必大便硬故也。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。
治病必求其本。胃者，津液之本也。汗与溲皆本于津液。本自汗出，本小便利，其人胃家之津液本多。仲
景提出亡津液句，为世之不惜津液者告也。病瘥，指身热汗出言。烦即恶热之谓。烦而微，知恶热将自罢，以尚
不了，故大便硬耳。数少，即再行之谓。大便硬，小便少，皆因胃亡津液所致，不是阳盛于里也。因胃中干燥，
则饮入于胃，不能上输于肺，通调水道，下输膀胱，故小便反少。而游溢之气，尚能输精于脾，津液相成，还归
于胃。胃气因和，则大便自出，更无用导法矣。以此见津液素盛者，虽亡津液而津液终自还。正以见胃家实者，
每踌躇顾虑，示人以勿妄下与勿妄汗也。历举治法，脉迟不可攻，心下满不可攻，呕多不可攻，小便自利与小便数
少不可攻，总见胃家实，不是可攻证。
蜜煎方∶
蜜七合。
上一味，于铜器内煎凝如饴状，搅之，勿令焦着。欲可丸，并手捻作挺，令头锐，大如指，长二寸许。当热
时急作，冷则硬。以内谷道中，欲大便时乃去之。
猪胆汁方∶
大猪胆一枚，沩汁，加醋少许，灌谷道中，如一食顷，当大便出宿食恶物甚效。
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。”
阳明受病，当二三日发。上条是指其已发热言，此追究一日前未发热时也。初受风寒之日，尚在阳明之表，
与太阳初受时同，故阳明亦有麻黄、桂枝证。二日来表邪自罢，故不恶寒。寒止热炽，故汗自出而反恶热。两阳合
明之象见矣。阳明病多从他经转属。此因本经自受寒邪，胃阳中发，寒邪即退，反从热化故耳。若因亡津液而
转属，必在六七日来，不在一二日间。本经受病之初，其恶寒虽与太阳同，而无头项强痛为可辨。即发热汗出，亦
同太阳桂枝证。但不恶寒反恶热之病情，是阳明一经之枢纽。本经受邪，有中面、中膺之别。中面则有目疼鼻干，
邪气居高，即热反胜寒。寒邪未能一日遽止，此中于膺部，位近于胃，故退寒最捷。
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。”
太阳病八九日，尚有恶寒证。若少阳寒热往来，三阴恶寒转甚，非发汗温中，何能自罢？惟阳明恶寒，未经
表散，即能自止，与他经不同。始虽恶寒二句，语意在阳明居中句上。夫知阳明之恶寒易止，便知阳明为病之本
矣。胃为戊土，位处中州，表里寒热之邪，无所不归，无所不化，皆从燥化而为实。实则无所复传，此胃家实所
以为阳明之病根也。
上论胃实证。
问曰∶“太阳缘何而得阳明病？”答曰∶“太阳病，若发汗，若下，若利小便，亡津液，胃中干燥，因转属
阳明。胃实大便难，此名阳明也。”
此明太阳转属阳明之病。因有此亡津液之病机，成此胃家实之病根也。按仲景阳明病机，其原本经脉篇主津
液所生病句来。故虽有热论中身热、鼻干等症，总归重在津液上。如中风之口苦、咽干、鼻干、不得汗、身目黄、
小便难，皆津液不足所致。如腹满、小便不利、水
谷不别等症，亦津液不化使然。故仲景谆谆以亡津液为治阳明者告也。
阳脉微而汗出少者，为自和也；汗出多者，为太过。阳脉实，因发其汗，出多者亦为太过。太过为阳实于
里，亡津液，大便因硬也。
阳明主津液所生病者也。因妄汗而伤津液，致胃家实耳。桂枝证本自汗，自汗多则亡津。麻黄证本无汗，发
汗多亦亡津。此虽指太阳转属，然阳明表证亦有之。
本太阳病，初得时发其汗，汗先出不彻，因转属阳明也。
彻，止也，即汗出多之互辞。
伤寒转属阳明者，其人 然微汗出也。
此亦汗出不止之互辞。概言伤寒，不是专指太阳矣。
伤寒发热无汗，呕不能食，而反汗出 然者，是转属阳明也。
胃实之病机在汗出多，病情在不能食。初因寒邪外束，故无汗；继而胃阳遽发，故反汗多。即呕不能食时，
可知其人胃家素实，与干呕不同。而反汗出，则非太阳之中风，是阳明之病实矣。
太阳病，寸缓、关浮、尺弱，其人发热汗出，复恶寒不呕，但心下痞者，此以医下之也。如不下者，病患不
恶寒而渴者，此转属阳明也。小便数者大便必硬，不大便十日无所苦也。渴欲饮水者，少少与之。但以法救之，
宜五苓散。
此病机在渴，以桂枝脉证而兼渴，其人津液素亏可知。小便数则非消渴矣。以此知大便虽硬，是津液不足，不
是胃家有余，即十日不便而无痞满硬痛之苦，不得为承气证。饮水利水，是胃家实而脉弱之正治也。不用猪苓汤
用五苓散者，以表热未除故耳。此为太阳阳明之并病。余义见五苓证中。
伤寒脉浮缓，手足自温者，系在太阴。太阴者，身当发黄。若小便自利者，不能发黄。至七八日大便硬者，为阳明
病也。
太阴受病转属阳明者，以阳明为燥土，故非经络表里相关所致，总因亡津液而致也。此病机在小便，小便不
利，是津液不行，故湿土自病，病在肌肉；小便自利，是津液越出，故燥土受病，病在胃也。
客曰∶“病在太阴，同是小便自利，至七八日暴烦下利者，仍为太阴病，大便硬者，转为阳明病。其始则同，
其终则异，何也？”曰∶“阴阳异位，阳道实，阴道虚。故脾家实，则腐秽自去，而从太阴之开；胃家实，则地
道不通，而成阳明之阖。此其别也。”
上论他经转属证。
问曰∶“脉有阳结、阴结，何以别之？”答曰∶“其脉浮而数，能食，不大便者，此为实，名曰阳结也。
期十七日当剧。其脉沉而迟，不能食，身体重，大便反硬，名曰阴结也。期十四日当剧。”
脉以浮为阳，为在表；数为热，为在府；沉为阴，为在里；迟为寒，为在藏。证以能食者为阳，为内热；不
能食者为阴，为中寒。身轻者为阳，重者为阴。不大便者为阳，自下利者为阴。此阳道实阴道虚之定局也。然阳
证亦有自下利者，故阴证亦有大便硬者。实中有虚，虚中有实，又阴阳更盛更虚之义。故胃实因于阳邪者，为阳
结；有因于阴邪者，名阴结耳。然阳结能食而不大便，阴结不能食而能大便，何以故？人身腰以上为阳，腰以下为
阴。阳结则阴病，故不大便；阴结则阳病，故不能食。此阳胜阴病，阴胜阳病之义也。凡三候为半月，半月为一
阳明病的特征，是胃家实（指胃肠邪热炽盛、燥屎内结的实证）。
阳明经属于传化之腑，应当虚实交替。食物进入胃中，胃充实而肠道空虚；食物下行至肠道，肠道充实而胃空虚。如果只有充实而没有空虚，这就是阳明病的病根所在。单纯的“胃实”并不等同于阳明病，但阳明病的所有表现，都源于“胃实”。因此，将“胃家实”作为阳明一经的总纲。然而，导致“实”的原因，需要详细审察：有在发病之前就存在的实邪，有在发病之后形成的实邪；有因风寒外束、热邪不得宣泄而导致的实邪，有因误用汗法、吐法、下法导致津液严重耗伤而形成的实邪，有因本经热势亢盛而导致的实邪，也有从他经传变而来的实邪。这里只是列举了病根在于“实”，但不能认为只要有“胃实”就可以使用攻下法。对照《黄帝内经·热论》中的阳明提纲，两者有所不同。《热论》侧重于经络，病位在表；而本书以里证为主，里气不和就是阳明病。其他条文中虽有表证，张仲景的本意不在治表；或有兼及他经的病证，张仲景的本意也不在他经。阳明主“阖”（闭合），凡是里气不和的病证，又以“阖病”为主。不大便固然是“阖”，不小便也是“阖”。不能进食、饮食难以饱足、起初想吃饭后来反而不能吃，这些都是“阖”的表现。自汗出、盗汗出，是表开而里阖。反而无汗，则是内外皆阖。种种“阖病”，或出现或不出现，所以提纲独以“胃实”为正解。“胃实”并不是专指燥屎坚硬，而是相对于下利而言的。下利说明胃家不实。所以，发汗解表后，因胃中不和而下利的，就不称为阳明病。如果是胃虚而不下利的，就属于阳明病。即使是初头硬后溏的情况，总体上也未脱离“胃家实”的范围。之所以这样，是因为阳明和太阴同处中焦，但职能各异。胃主受纳，所以阳明主实；脾主运化输布，所以太阴主利。同样是胃腑，却如此分工，这就是两经区别的原因。
问：“阳明病的外在证候是什么？”答：“身体发热，自然汗出，不恶寒，反而怕热。”
阳明主里，但也有外在证候，这是内部病变反映于外部，并非另有独立的外在证候。胃实的外在表现，其身体热度如蒸腾一般，里热炽盛达于体表，这与太阳病表邪发热不同；其汗出淋漓不止，从体内溢出而无休止，这与太阳病风邪致汗不同。表寒已散，所以不恶寒；里热闭结，所以反恶热。只因有“胃家实”的病根，就出现了身热自汗的外在证候，以及不恶寒反恶热的病情。然而，这仅说明病机显露，并非立即可以使用攻下法，宜用轻剂调和。必须见到谵语、潮热、烦躁、胀满等证候同时出现，才可以攻下。
以上四点是阳明外证的提纲。所以胃中虚冷，也能称为阳明病，因为其外在证候与此相同。
阳明病，脉象浮而紧的，必定有潮热，发作有定时；如果脉象只浮而不紧，必定有盗汗。
阳明的脉证与太阳脉证不同。太阳病脉浮紧的，必定伴有身体疼痛、无汗、恶寒、发热不退。此处脉浮紧而有潮热且有时发作，说明恶寒即将自行停止，这是在将要发生潮热时的脉象。这就是所谓的“紧反入里”，不可拘泥于“紧脉即为寒”的说法。太阳病脉只浮的，必定无汗。此处却有盗汗，这是因为内有热邪。况且与本经初起时脉浮无汗而喘的情况不同，也不可拘泥于“浮脉即在表”的方法。脉浮紧，但不符合麻黄汤证；身热汗出，也不符合桂枝汤证。如果服用麻黄汤、桂枝汤，阳气过盛会导致死亡。此处的脉象变化是从经脉异变而来，并非脉象与病情相反。要知道张仲景分经辨脉，不能专门依据脉象来谈论证候。
伤寒三日，阳明脉大。
脉大，是两阳合明，内外皆阳的征象。阳明病初起，病在表，脉象仅浮而未大，与太阳病相同，所以也有麻黄汤、桂枝汤证。到了第二天，恶寒自行停止，反而怕热。第三天，热势大盛，所以脉象也相应地变得洪大。这是“胃家实”的正脉。如果脉小而不大，就属于少阳病了。
《黄帝内经》说：“阳明脉短而涩。”这是指秋季金气当令时的正常脉象。又说：“阳明脉象大且浮。”这是指两阳合明的病脉。
脉浮而大，心下反而硬满，有热邪，属于脏（心肺）的，应用攻法，不要发汗；属于腑（膀胱/肠胃）的，不要使小便频数，小便频数则大便变硬。汗出多则热更甚，汗出少则大便难解，脉迟的还不可以攻下。
这是治疗阳明病的大法。阳明主管津液所生的疾病，津液干枯则形成“胃家实”。津液导致干枯的途径有两种：汗出过多会损伤上焦的津液，溺出过多会损伤下焦的津液。一旦有所损伤，就会大便硬结难出，所以要禁止发汗和利尿。至于脉浮紧、浮缓、浮数、浮迟的，都不可攻下而可发汗。此处脉浮大，反而不可发汗而可攻下，因为这是阳明第三天的脉象，要知道脉大为病势进展，不可拘泥于浮脉即在表。心下，即胃口部位。心下硬满，已经显示出胃实的一部分迹象。因为表脉不应见里证，所以说“反硬”。有热属脏，是指心肺有热，并非专指胃实。攻之，是攻其热邪，不是攻其实邪，即给予黄芩汤清除热邪的意思。“不令”，是禁止的意思，可见泻心的意图。上焦通畅，津液自然下行，胃气因而调和。属腑指膀胱，也不指胃。膀胱有热，所以小便频数。“不令”之处，也可见滋阴之意。属腑是陪衬说法，本条重在脏热。汗多句，直接承接发汗句。因为汗为心之液，汗出是有热属脏的征象。为什么不令发汗呢？因为汗出多则津液亡失，火性就燥，则热更甚而大便更难。即使汗出少，也难免大便硬结难出，所以利于急攻。张仲景治疗阳明病，不担心胃家实，而担心脏有热，所以急于攻热而缓于攻下。其实禁止发汗与利尿，是为了保存津液，正是为了调和其实邪。然而证候有虚实，脉象有真假，假如脉迟，就不是脏实。那么浮大都是虚脉了。张仲景特意提出这句话，正是阐明心下硬满一证，如果有热属脏，是禁止妄攻其热的，其谨慎严密如此。
阳明病，心下硬满的，不可攻下。攻下后，腹泻不止的死亡，腹泻停止的痊愈。
阳明证具备而心下硬满，按理可有攻下的理由。然而硬满尚未完全形成，说明热邪散漫于胃中，尚未干结成实。妄攻其热，热去寒起，寒气移于脾，实邪反成虚证，所以腹泻不止。如果腹泻能自行停止，说明此人胃不虚而脾家实，腐秽去尽而邪气不留，所以痊愈。上一条热邪属脏，利于急攻，是为了保存津液。此条热邪初起炽盛，禁止妄攻，是为了保护中气。要知道腹满已是太阴病的一类，阳明与太阴相配偶，胃实则太阴转属于阳明，胃虚则阳明转属于太阴。这是张仲景用药分寸精妙之处，诊者应特别注意。
伤寒呕吐频繁，即使有阳明证，也不可攻下。
呕吐频繁是水气在上焦，即使有胃实证，只宜用小柴胡汤通调津液，攻下恐怕会导致腹泻不止的祸患。要知道阳明病津液未亡者，千万不可攻下。因为腹满呕吐，是太阴与阳明相关的证候；胃实胃虚，是阳明与太阴的区别所在。胃家实，虽然变证百出，仍不失为生阳之证；下利不止，人参、附子不能挽回，便是死阴之证。
阳明病，自汗出，如果再发汗，小便自利，这是津液在内枯竭。大便虽然硬，不可攻下。应当等待患者自己想排便时，用蜜煎导法通便，或者土瓜根及灌服大猪胆汁，都可以作为导引。
本来就有自汗，再发汗，则上焦津液已在外竭尽；小便自利，则下焦津液又在内枯竭。胃中津液两竭，大便硬结可知。虽然硬结但小便自利，是内实而非内热。因为阳明之实，不担心燥结而担心热邪。此处内既无热，只需外用润燥之法。连用三个“自”字，说明胃实而无变证者，应当顺应自然，不可妄治。更应探求患者的苦欲之情，在想要大便时，顺其势而利导之，不想大便者，宜静待时机。这是什么原因呢？因为胃家实，固然是病根，也是人的命根，禁止攻其实邪，是先顾虑其虚损。
阳明病，本来就有自汗出，医生又重发汗，病虽好转，但仍轻微烦闷不适，这必定是大便硬结的缘故。因为津液亡失，胃中干燥，所以导致大便硬结。应当询问患者一天小便几次，如果原本一天小便三四次，今天只两次，就知道大便不久就会排出。现在小便次数减少，因为津液应当回归胃中，所以知道不久必然大便排出。
治病必求其本。胃，是津液的根源。汗与小便都源于津液。本来就有自汗出，本来小便通利，说明此人胃中之津液原本充足。张仲景提出“亡津液”一句，是为世上不爱惜津液的人告诫。病瘥，指身热汗出而言。烦即恶热的意思。烦而轻微，知道恶热即将自行停止，因为尚未尽除，所以大便硬结。数少，即两次的意思。大便硬结，小便减少，都是因为胃亡津液所致，不是因为阳盛于里。因为胃中干燥，饮入的水在胃中，不能上输于肺，通调水道，下输膀胱，所以小便反而减少。而游溢之气，尚能输精于脾，津液相生，归还于胃。胃气因而调和，则大便自然排出，更不需要导法了。由此看出，津液素盛者，虽然亡失津液，但津液最终会自行归还。这正是显示胃家实者，往往犹豫顾虑，示人以不要妄下和不要妄汗。历举治法，脉迟不可攻，心下满不可攻，呕多不可攻，小便自利与小便数少不可攻，总归说明胃家实，不是可攻下的证候。
蜜煎方：
蜂蜜七合。
以上一味药，在铜器内煎煮至凝结如饴糖状，搅拌它，不要让锅底烧焦。可以做成丸状时，用手捻成条状，头部尖细，直径如手指，长约二寸左右。趁热急做，冷了就会变硬。纳入肛门中，想要大便时再去掉。
猪胆汁方：
大猪胆一枚，取汁，加少许醋，灌入肛门中，约一顿饭的时间，大便排出宿食恶物，效果很好。
问：“有的病得之一日，不发热而恶寒，为什么呢？”答：“虽然得病一日，恶寒将会自行停止，随即自汗出而恶热。”
阳明受病，应当在二三日发作。上一条是指已经发热而言，此条追究一日前未发热的时候。初受风寒之日，尚在阳明之表，与太阳初受时相同，所以阳明也有麻黄汤、桂枝汤证。两天后表邪自罢，所以不恶寒。寒止热炽，所以汗自出而反恶热。两阳合明的景象出现了。阳明病多从他经转属。此因本经自受寒邪，胃阳中发，寒邪即退，反从热化所致。如果因亡津液而转属，必定在六七日，不在一二日间。本经受病之初，其恶寒虽与太阳相同，但无头项强痛可辨别。即使发热汗出，也与太阳桂枝汤证相同。但不恶寒反恶热的病情，是阳明一经的枢纽。本经受邪，有中面、中膺的区别。中面则有目疼鼻干，邪气居高，即热反胜寒。寒邪未能一日遽止，此中于膺部，位近于胃，所以退寒最捷。
问：“恶寒为何会自行停止？”答：“阳明居中土，是万物所归，无所复传，开始虽然恶寒，二日自止，此为阳明病。”
太阳病八九日，尚有恶寒证。若少阳寒热往来，三阴恶寒转甚，非发汗温中，怎能自止？唯独阳明恶寒，未经表散，即能自止，与其他经不同。开始虽恶寒二句，语意在阳明居中句上。夫知阳明之恶寒易止，便知阳明为病之本矣。胃为戊土，位处中州，表里寒热之邪，无所不归，无所不化，皆从燥化而为实。实则无所复传，此胃家实所以为阳明之病根也。
以上论述胃实证。
问：“太阳为何会变成阳明病？”答：“太阳病，若发汗，若下，若利小便，亡津液，胃中干燥，因转属阳明。胃实大便难，此名阳明也。”
此明太阳转属阳明之病。因有此亡津液之病机，成此胃家实之病根也。按仲景阳明病机，其原本经脉篇主津液所生病句来。故虽有热论中身热、鼻干等症，总归重在津液上。如中风之口苦、咽干、鼻干、不得汗、身目黄、小便难，皆津液不足所致。如腹满、小便不利、水谷不别等症，亦津液不化使然。故仲景谆谆以亡津液为治阳明者告也。
阳脉微而汗出少者，为自和也；汗出多者，为太过。阳脉实，因发其汗，出多者亦为太过。太过为阳实于里，亡津液，大便因硬也。
阳明主津液所生病者也。因妄汗而伤津液，致胃家实耳。桂枝证本自汗，自汗多则亡津。麻黄证本无汗，发汗多亦亡津。此虽指太阳转属，然阳明表证亦有之。
本太阳病，初得时发其汗，汗先出不彻，因转属阳明也。
彻，止也，即汗出多之互辞。
伤寒转属阳明者，其人濈然微汗出也。
此亦汗出不止之互辞。概言伤寒，不是专指太阳矣。
伤寒发热无汗，呕不能食，而反汗出濈然者，是转属阳明也。
胃实之病机在汗出多，病情在不能食。初因寒邪外束，故无汗；继而胃阳遽发，故反汗多。即呕不能食时，可知其人胃家素实，与干呕不同。而反汗出，则非太阳之中风，是阳明之病实矣。
太阳病，寸缓、关浮、尺弱，其人发热汗出，复恶寒不呕，但心下痞者，此以医下之也。如不下者，病患不恶寒而渴者，此转属阳明也。小便数者大便必硬，不大便十日无所苦也。渴欲饮水者，少少与之。但以法救之，宜五苓散。
此病机在渴，以桂枝脉证而兼渴，其人津液素亏可知。小便数则非消渴矣。以此知大便虽硬，是津液不足，不是胃家有余，即十日不便而无痞满硬痛之苦，不得为承气证。饮水利水，是胃家实而脉弱之正治也。不用猪苓汤用五苓散者，以表热未除故耳。此为太阳阳明之并病。余义见五苓证中。
伤寒脉浮缓，手足自温者，系在太阴。太阴者，身当发黄。若小便自利者，不能发黄。至七八日大便硬者，为阳明病也。
太阴受病转属阳明者，以阳明为燥土，故非经络表里相关所致，总因亡津液而致也。此病机在小便，小便不利，是津液不行，故湿土自病，病在肌肉；小便自利，是津液越出，故燥土受病，病在胃也。
客曰：“病在太阴，同是小便自利，至七八日暴烦下利者，仍为太阴病，大便硬者，转为阳明病。其始则同，其终则异，何也？”曰：“阴阳异位，阳道实，阴道虚。故脾家实，则腐秽自去，而从太阴之开；胃家实，则地道不通，而成阳明之阖。此其别也。”
上论他经转属证。
问：“脉有阳结、阴结，何以别之？”答：“其脉浮而数，能食，不大便者，此为实，名曰阳结也。期十七日当剧。其脉沉而迟，不能食，身体重，大便反硬，名曰阴结也。期十四日当剧。”
脉以浮为阳，为在表；数为热，为在府；沉为阴，为在里；迟为寒，为在藏。证以能食者为阳，为内热；不能食者为阴，为中寒。身轻者为阳，重者为阴。不大便者为阳，自下利者为阴。此阳道实阴道虚之定局也。然阳证亦有自下利者，故阴证亦有大便硬者。实中有虚，虚中有实，又阴阳更盛更虚之义。故胃实因于阳邪者，为阳结；有因于阴邪者，名阴结耳。然阳结能食而不大便，阴结不能食而能大便，何以故？人身腰以上为阳，腰以下为阴。阳结则阴病，故不大便；阴结则阳病，故不能食。此阳胜阴病，阴胜阳病之义也。凡三候为半月，半月为一
Yangming disease is characterized by "Wei Jia Shi" (Stomach Family Excess, referring to the excess syndrome of intense pathogenic heat in the stomach and intestines with accumulation of dry feces).
The Yangming channel belongs to the Fu organs responsible for transmission and transformation; it should alternate between fullness and emptiness. When food enters the stomach, the stomach is full and the intestines are empty; when food moves down into the intestines, the intestines are full and the stomach is empty. If there is only fullness without emptiness, this constitutes the root cause of Yangming disease. Simple "stomach excess" does not equate to Yangming disease, but all manifestations of Yangming disease originate from "stomach excess." Therefore, "Wei Jia Shi" serves as the general outline for the Yangming channel. However, the causes leading to "excess" require careful examination: there is excess present before the onset of illness, excess formed after the onset; excess caused by external constraint of wind-cold preventing heat dissipation, excess resulting from severe fluid depletion due to erroneous use of sweating, vomiting, or purging methods, excess due to hyperactivity of heat within the primary channel, and excess transmitted from other channels. This text merely lists that the root cause lies in "excess," and one must not assume that "stomach excess" automatically indicates a condition suitable for purgation. Comparing the Yangming outline here with that in *Neijing·Re Lun* (Treatise on Cold Damage), they differ. *Re Lun* emphasizes meridians, placing the pathology at the exterior; whereas this text focuses on interior syndromes, where interior disharmony constitutes Yangming disease. Although other clauses may mention exterior symptoms, Zhang Zhongjing's intent is not primarily on treating the exterior; nor is his intent on other channels when complications arise. Yangming governs "closing" (He); thus, for any interior disharmony, the focus is on "closing disease." Constipation is indeed "closing"; oliguria is also "closing." Inability to eat, difficulty in consuming large meals, initial desire to eat followed by inability to eat, are all manifestations of "closing." Spontaneous sweating and night sweats indicate the exterior is open while the interior is closed. Conversely, absence of sweating indicates both interior and exterior are closed. Various "closing diseases" may or may not appear; hence, the outline uniquely identifies "stomach excess" as the standard. "Stomach excess" does not exclusively refer to hard, dry feces, but is defined in contrast to diarrhea. Diarrhea indicates the stomach family is not in excess. Therefore, after resolving via sweating, if diarrhea occurs due to stomach disharmony, it is not termed Yangming disease. If there is stomach deficiency without diarrhea, it belongs to Yangming. Even cases starting with hard stool followed by loose stool generally fall under "Wei Jia Shi." The reason is that Yangming and Taiyin share the middle jiao but have distinct functions. The stomach governs reception, so Yangming governs excess; the spleen governs transportation and distribution, so Taiyin governs diarrhea. Although both involve the stomach organ, their division of labor distinguishes the two channels.
Q: "What are the external manifestations of Yangming disease?" A: "Body fever, spontaneous sweating, aversion to cold is absent, but aversion to heat is present."
Yangming governs the interior, yet has external manifestations because internal pathology manifests externally; these are not separate external symptoms. The external manifestation of stomach excess involves body heat feeling like steaming, where intense interior heat reaches the surface, differing from the fever of exterior pathogens in Taiyang disease. Sweating is profuse and continuous, overflowing from the interior without cessation, differing from sweating caused by wind pathogens in Taiyang disease. Since exterior cold has dispersed, there is no aversion to cold; since interior heat is constrained, there is aversion to heat. Due to the root cause of "Wei Jia Shi," external signs of body fever and spontaneous sweating appear, along with the clinical picture of no aversion to cold but aversion to heat. However, this only indicates the emergence of pathological mechanisms, not an immediate indication for purgation; mild agents should be used to harmonize. Purgation is only appropriate when delirium, tidal fever, irritability, and abdominal distension occur simultaneously.
These four points constitute the outline of Yangming external symptoms. Thus, even cold deficiency in the stomach can be called Yangming disease because its external presentation matches this description.
In Yangming disease, if the pulse is floating and tight, tidal fever will definitely occur at regular intervals; if the pulse is only floating, night sweating will definitely occur.
Yangming pulse patterns differ from Taiyang. In Taiyang, a floating and tight pulse is accompanied by body pain, absence of sweating, aversion to cold, and persistent fever. Here, tidal fever occurring intermittently indicates that aversion to cold is about to cease; this is the pulse pattern just before tidal fever develops. This is what is meant by "tightness entering the interior"; one cannot rigidly adhere to the notion that "tight pulse equals cold." In Taiyang, a purely floating pulse implies absence of sweating. Here, night sweating occurs due to interior heat. Furthermore, it differs from the initial stage of this channel where floating pulse accompanies absence of sweating and wheezing; thus, one cannot rigidly apply the rule that "floating pulse indicates exterior." A floating and tight pulse does not fit the Mahuang Tang syndrome; body fever with sweating does not fit the Guizhi Tang syndrome. Administering Mahuang or Guizhi decoctions when yang is abundant leads to death. These pulse changes stem from meridian variations, not a contradiction between pulse and disease. One must understand that Zhang Zhongjing differentiates channels and pulses, and one should not rely solely on pulse to diagnose.
After three days of cold damage, the Yangming pulse becomes large.
A large pulse represents the convergence of two yangs, indicating yang abundance inside and out. At the beginning of Yangming disease, when the pathology is still at the exterior, the pulse is merely floating and not yet large, similar to Taiyang, allowing for Mahuang or Guizhi treatments. By the second day, aversion to cold ceases spontaneously, replaced by aversion to heat. By the third day, heat intensity peaks, causing the pulse to become surging and large accordingly. This is the correct pulse for "Wei Jia Shi." If the pulse is small rather than large, it belongs to Shaoyang.
*Neijing* states: "When Yangming prevails, the pulse is short and choppy." This refers to the normal pulse during autumn when metal qi dominates. It also states: "The Yangming pulse image is large and floating." This refers to the pathological pulse of converging yangs.
If the pulse is floating and large, the epigastrium feels hard despite heat, and the pathology belongs to the Zang organs, purgation should be used, avoiding sweating; if the pathology belongs to the Fu organs, frequent urination should be avoided, as frequent urination leads to hard stools. Profuse sweating exacerbates heat; scant sweating makes defecation difficult. If the pulse is slow, purgation is not yet indicated.
This outlines the major principles for treating Yangming disease. Yangming governs diseases arising from fluids; when fluids dry up, "Wei Jia Shi" forms. There are two ways fluids dry up: excessive sweating damages upper jiao fluids, and excessive urination damages lower jiao fluids. Once damaged, stools become hard and difficult to pass, hence sweating and diuresis are prohibited. Pulses that are floating-tight, floating-slow, floating-rapid, or floating-slow are not suitable for purgation but for sweating. Here, a floating-large pulse is unsuitable for sweating but suitable for purgation because it represents the third-day Yangming pulse; a large pulse indicates disease progression, so one must not rigidly hold that "floating means exterior." "Epigastrium" refers to the stomach opening. Epigastric hardness reveals aspects of stomach excess. Because exterior pulses should not show interior signs, it is said to be "reversely hard." "Heat belonging to Zang" refers to heat in the heart and lungs, not specifically stomach excess. "Purgation" here means clearing heat, not attacking excess, akin to using Huangqin Tang to remove heat. "Do not allow" is prohibitive language, implying the intention to clear heat from the heart. Once the upper jiao is unblocked, fluids descend naturally, and stomach qi harmonizes. "Belonging to Fu" refers to the bladder, not the stomach. Bladder heat causes frequent urination. The prohibition implies the need to nourish yin. "Belonging to Fu" is supplementary; the main point is Zang heat. The sentence on profuse sweating directly follows the sweating clause. Sweat is the fluid of the heart; sweating indicates heat in the Zang. Why prohibit sweating? Because profuse sweating depletes fluids, and fire seeks dryness, worsening heat and making stools harder. Even slight sweating may lead to hard stools, favoring urgent purgation. Zhang Zhongjing treats Yangming not fearing stomach excess but fearing Zang heat, prioritizing clearing heat over purging. Prohibiting sweating and diuresis preserves fluids, thereby harmonizing excess. However, syndromes have deficiency/excess, and pulses have true/false qualities. If the pulse is slow, it is not Zang excess; thus, floating-large pulses are deficient. Zhang Zhongjing highlights this to clarify that epigastric hardness with heat in the Zang prohibits reckless purgation, demonstrating extreme caution.
In Yangming disease, if the epigastrium is hard and full, do not purge. If purged and diarrhea persists uncontrollably, death ensues; if diarrhea stops, recovery occurs.
Although Yangming symptoms are present and epigastric hardness might suggest purgation, if it is hard but not fully distended, heat pathogens are scattered in the stomach and not yet consolidated. Recklessly purging heat causes cold to rise after heat leaves, transferring cold to the spleen, turning excess into deficiency, leading to uncontrollable diarrhea. If diarrhea stops spontaneously, it indicates the stomach is not deficient and the spleen is solid; rotting filth is expelled, and pathogens remain, leading to recovery. The previous clause involved heat in the Zang, favoring urgent purgation to preserve fluids. This clause involves early intense heat, prohibiting reckless purgation to protect middle qi. Note that abdominal distension belongs to Taiyin; Yangming and Taiyin are paired. Stomach excess causes Taiyin to transfer to Yangming; stomach deficiency causes Yangming to transfer to Taiyin. This precision in Zhang Zhongjing’s treatment requires careful attention by diagnosticians.
In cold damage, if vomiting is frequent, even if Yangming symptoms exist, do not purge.
Frequent vomiting indicates water qi in the upper jiao. Even with stomach excess, Xiaochaihu Tang should be used to regulate fluids; purging risks uncontrollable diarrhea. Note that in Yangming disease, if fluids are not depleted, purgation must be strictly avoided. Abdominal distension and vomiting are related Taiyin-Yangming syndromes; stomach excess and deficiency distinguish Yangming and Taiyin. Although "Wei Jia Shi" produces myriad changes, it remains a vital yang state; uncontrollable diarrhea, unresponsive to Renshen and Fuzi, is a dead yin state.
In Yangming disease, with spontaneous sweating, if sweating is induced again and urination is free, this indicates internal exhaustion of fluids. Although stools are hard, do not purge. Wait until the patient desires defecation, then use Honey Suppository to facilitate passage. Radix Trichosanthis (Tianguagen) or large pig bile enemas can also serve as guides.
Spontaneous sweating followed by induced sweating exhausts upper jiao fluids externally; free urination exhausts lower jiao fluids internally. With both upper and lower fluids exhausted, stomach fluids are depleted, explaining hard stools. Hard stools with free urination indicate interior excess without interior heat. Yangming excess worries about dryness less than heat. Since there is no interior heat here, external moistening of dryness suffices. The repetition of "spontaneous" emphasizes that for stomach excess without transformation, natural processes should be allowed, avoiding reckless treatment. One must probe the patient's preferences; guide them when they wish to defecate, and wait quietly otherwise. Why? "Wei Jia Shi" is the disease root but also the life root. Prohibiting purgation considers potential deficiency first.
In Yangming disease, originally with spontaneous sweating, if the doctor induces heavy sweating, and although the illness improves, mild vexation persists, this is due to hard stools. Fluid depletion and stomach dryness cause hard stools. Ask how many times the patient urinates daily. If previously 3-4 times and now only twice, stools will likely pass soon. Now, with reduced urination frequency, fluids return to the stomach, ensuring stools will pass soon.
Treating disease requires addressing the root. The stomach is the root of fluids. Sweat and urine derive from fluids. Original spontaneous sweating and normal urination indicate abundant stomach fluids. Zhang Zhongjing mentions "fluid depletion" to warn those who neglect fluids. "Illness resolved" refers to cessation of fever and sweating. Vexation implies aversion to heat. Mild vexation suggests aversion to heat will cease; persistence indicates hard stools. Reduced frequency refers to twice daily. Hard stools and reduced urine result from stomach fluid depletion, not interior yang excess. Due to stomach dryness, ingested water cannot ascend to the lung to regulate water passages and descend to the bladder, causing reduced urine. However, ascending qi can still transport essence to the spleen; fluids generate each other and return to the stomach. Stomach qi harmonizes, and stools pass naturally, requiring no suppositories. This shows that those with abundant baseline fluids will recover fluids even after depletion. It demonstrates that for "Wei Jia Shi," hesitation is advised, warning against reckless purgation or sweating. Listing treatments: slow pulse forbids purgation, epigastric fullness forbids purgation, frequent vomiting forbids purgation, free urination and reduced frequency forbid purgation. All illustrate that "Wei Jia Shi" is not an indication for purgation.
Honey Suppository Formula:
Seven he of honey.
Cook one ingredient in a copper vessel until it thickens like malt syrup. Stir constantly to prevent burning. When moldable, shape by hand into suppositories, pointed at one end, finger-thick, about two inches long. Form while hot; they harden when cold. Insert into the anus; remove when defecation is desired.
Pig Bile Formula:
One large pig gallbladder, extract juice, add a little vinegar, instill into the anus. After approximately one meal time, stools containing old food and waste will pass, with excellent effect.
Q: "Some patients develop aversion to cold without fever on the first day. Why?" A: "Even if developed on the first day, aversion to cold will cease spontaneously, followed by spontaneous sweating and aversion to heat."
Yangming disease typically manifests on the second or third day. The previous clause referred to existing fever; this traces back to the pre-fever stage. On the first day of wind-cold invasion, the pathology is still at the Yangming exterior, similar to Taiyang onset, allowing Mahuang or Guizhi treatments. By the second day, exterior pathogens dissipate, so aversion to cold ceases. Cold stops, heat intensifies, causing spontaneous sweating and aversion to heat. The image of converging yangs appears. Yangming disease often transfers from other channels. Here, the primary channel absorbs cold pathogens; stomach yang activates, expelling cold and transforming into heat. Transfer due to fluid depletion usually takes six to seven days, not one or two. Initially, Yangming aversion to cold resembles Taiyang but lacks head and neck stiffness. Fever and sweating resemble Taiyang Guizhi syndrome. However, "no aversion to cold but aversion to heat" is the pivot of Yangming. Primary channel invasion varies: affecting the face causes eye pain and nasal dryness (pathogen high, heat wins over cold); affecting the chest (Yin region) near the stomach allows rapid resolution of cold.
Q: "Why does aversion to cold cease spontaneously?" A: "Yangming resides in the center earth, the destination of all things, with no further transmission. Starting with aversion to cold, it stops by the second day; this is Yangming disease."
Taiyang disease may have aversion to cold for eight to nine days. Shaoyang features alternating chills and fever; Yin channels have worsening chills. Without sweating or warming the center, how can they cease? Only Yangming aversion to cold ceases spontaneously without exterior release, unlike other channels. The phrase "starting with aversion to cold" emphasizes "Yangming resides in the center." Knowing Yangming aversion to cold stops easily reveals the nature of Yangming disease. The stomach is Wu Earth, located in the middle jiao. Exterior, interior, cold, and heat pathogens all converge and transform here, drying into excess. Excess has nowhere else to transmit, making "Wei Jia Shi" the root of Yangming disease.
Above discusses stomach excess syndrome.
Q: "How does Taiyang become Yangming disease?" A: "In Taiyang disease, if sweating, purging, or promoting urination depletes fluids, causing stomach dryness, it transfers to Yangming. Stomach excess and difficult defecation constitute Yangming."
This clarifies Taiyang transferring to Yangming. This fluid depletion mechanism creates the "Wei Jia Shi" root. Zhang Zhongjing’s Yangming pathology originates from the *Ling Shu* statement that Yangming governs diseases of fluids. Thus, despite symptoms like body fever and nasal dryness in *Re Lun*, the focus remains on fluids. Symptoms like bitter taste, dry throat/nose, inability to sweat, jaundice, and difficult urination in wind-stroke are due to fluid insufficiency. Abdominal distension, urinary difficulty, and indistinguishable food/water are due to fluid metabolism failure. Hence, Zhang Zhongjing earnestly warns practitioners about fluid depletion in treating Yangming.
If the yang pulse is faint and sweating is scant, it indicates self-harmonization; profuse sweating indicates excess. If the yang pulse is solid and sweating is induced, profuse sweating is also excess. Excess leads to yang excess in the interior, fluid depletion, and hard stools.
Yangming governs diseases of fluids. Erroneous sweating damages fluids, causing "Wei Jia Shi." Guizhi syndrome involves original sweating; excessive sweating depletes fluids. Mahuang syndrome involves original absence of sweating; excessive sweating depletes fluids. Although this refers to Taiyang transfer, Yangming exterior syndromes can also exhibit this.
In original Taiyang disease, if sweating is induced initially but is incomplete, it transfers to Yangming.
"Complete" means stopping; it is synonymous with profuse sweating.
In cold damage transferring to Yangming, the patient has continuous slight sweating.
This is another synonym for continuous sweating. It broadly refers to cold damage, not specifically Taiyang.
In cold damage with fever, absence of sweating, vomiting, inability to eat, but suddenly profuse sweating, this indicates transfer to Yangming.
The mechanism of stomach excess lies in profuse sweating; the clinical sign is inability to eat. Initially, cold constraint prevents sweating; subsequently, sudden stomach yang activation causes profuse sweating. Vomiting and inability to eat indicate inherent stomach excess, differing from dry heaving. Sudden sweating distinguishes it from Taiyang wind-stroke, confirming Yangming excess.
In Taiyang disease, cun pulse slow, guan pulse floating, chi pulse weak, with fever, sweating, recurrent aversion to cold, no vomiting, but epigastric stuffiness, this results from physician-induced purgation. If not purged, and the patient has no aversion to cold but thirst, this indicates transfer to Yangming. Frequent urination leads to hard stools; ten days without defecation causes no distress. For thirst wanting water, give small amounts. Treat according to method, using Wuling San.
The pathology lies in thirst. Combined with Guizhi pulse/symptoms, it indicates baseline fluid deficiency. Frequent urination rules out Xiao Ke (wasting-thirst). Thus, hard stools result from fluid insufficiency, not stomach excess. Ten days without defecation without distension/pain/hardness does not constitute Chengqi syndrome. Drinking water and promoting urination is the correct treatment for stomach excess with weak pulse. Wuling San is chosen over Zhuling Tang because exterior heat remains. This is concurrent Taiyang-Yangming disease. See Wuling syndrome discussion for details.
In cold damage, floating-slow pulse and warm hands/feet indicate connection to Taiyin. Taiyin disease typically causes jaundice. If urination is free, jaundice does not occur. By the seventh/eighth day, if stools become hard, it becomes Yangming disease.
Taiyin transferring to Yangming occurs because Yangming is dry earth. It is not due to meridian/exterior-interior relationships but always due to fluid depletion. The pathology hinges on urination. Urinary difficulty means fluids do not circulate, causing damp-earth disease in muscles. Free urination means fluids escape, causing dry-earth disease in the stomach.
Guest asks: "In Taiyin disease, with free urination, sudden irritability and diarrhea on day 7-8 remains Taiyin, but hard stools become Yangming. Why start same but end different?" Answer: "Yin and yang occupy different positions; yang pathways are excess, yin pathways are deficient. Thus, spleen excess eliminates rotting filth, following Taiyin 'opening'; stomach excess blocks earth pathways, forming Yangming 'closing'. This is the distinction."
Above discusses transfer syndromes from other channels.
Q: "How to differentiate Yang Jie (Yang Knotting) and Yin Jie (Yin Knotting) pulses?" A: "Floating-rapid pulse, ability to eat, constipation indicates excess, named Yang Jie. Expected severity on day 17. Deep-slow pulse, inability to eat, heavy body, reverse hard stools indicates Yin Jie. Expected severity on day 14."
Floating is yang/exterior; rapid is heat/Fu. Deep is yin/interior; slow is cold/Zang. Ability to eat is yang/interior heat; inability to eat is yin/middle cold. Light body is yang; heavy body is yin. Constipation is yang; spontaneous diarrhea is yin. This is the fixed pattern of yang excess and yin deficiency. However, yang syndromes can have spontaneous diarrhea, and yin syndromes can have hard stools. Excess contains deficiency, deficiency contains excess, reflecting yin/yang fluctuation. Thus, stomach excess due to yang pathogens is Yang Jie; due to yin pathogens is Yin Jie. Yang Jie eats but does not defecate; Yin Jie cannot eat but can defecate. Why? Upper body is yang, lower body is yin. Yang Jie affects yin, causing constipation; Yin Jie affects yang, causing anorexia. This reflects yang overcoming yin and yin overcoming yang. Three pentads equal half a month...