阳明中风，口苦咽干，腹满微喘，发热恶寒，脉浮而紧，若下之，则腹满小便难也。
本条无目疼鼻干之经病，又无尺寸俱长之表脉。微喘恶寒，脉浮而紧，与太阳麻黄证同。口苦咽干，又似太
阳少阳合病。更兼腹满，又似太阳太阴两感。他经形证互呈，本经形证未显，何以名为阳明中风耶？以无头项强
痛，则不属太阳；不耳聋目赤，则不属少阳；不腹痛自利，则不关太阴。是知口为胃窍，咽为胃门，腹为胃室，喘
为胃病矣。今虽恶寒，二日必止，脉之浮紧，亦潮热有时之候也。此为阳明初病在里之表，津液素亏，故有是证。
若以腹满为胃实而下之，津液既竭，腹更满而小便难，必大便反易矣。此中风转中寒，胃实转胃虚，初能食而
致反不能食之机也。伤寒中风，但见有柴胡一证便是。则口苦咽干，当从少阳证治。脉浮而紧者，当曰弦矣。
阳明中风，脉弦浮大而短气，腹部满，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，脉弦浮者，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。
本条不言发热。看中风二字，便藏表热在内。外不解，即指表热而言。即暗伏内已解句。病过十日，是内已解
之互文也，当在外不解句上。无余证句，接外不解句来。刺之，是刺足阳明，随其实而泻之。少瘥句，言内证俱减，
但外证未解耳，非刺耳前后，其肿少瘥之谓也。脉弦浮者，向之浮大减小而弦尚存。是阳明之脉证已罢，惟少阳之
表邪尚存，故可用小柴胡以解外。若脉但浮而不弦大，则非阳明少阳脉。无余证，则上文诸证悉罢，是无阳明少阳
证。惟太阳之表邪未散，故可
与麻黄汤以解外。所以然者，以阳明居中，其风非是太阳转属，即是少阳转属，两阳相熏灼，故病过十日而表
热不退也。无余证可凭，只表热不解，法当凭脉。故弦浮者，可知少阳转属之遗风；但浮者，是太阳转属之余风
也。若不尿腹满加哕，是接耳前后肿来。此是内不解，故小便难者竟至不尿，腹部满者竟不减，时时哕者更加
哕矣。非刺后所致，亦非用柴胡麻黄后变证也。太阳主表，故中风多表证；阳明主里，故中风多里证。弦为少阳
脉，耳前后胁下为少阳部。阳明中风，而脉证兼少阳者，以胆为风府故也。若不兼太阳少阳脉证，只是阳明病，
而不名中风矣。参看口苦咽干，知阳明中风从少阳转属者居多。
本条多中风而不言恶风，亦不言恶热。要知始虽恶寒，二日自止，风邪未解，故不恶热。是阳明中风与太、
少不同，而阳明过经留连不解之风，亦与本经国中迥别也。
上论阳明中风证。
阳明病，若能食名中风，不能食名中寒。
太阳主表，病情当以表辨。阳明主里，证虽在表，病情仍以里辨。此不特以能食不能食别风寒，更以能食
不能食审胃家虚实也。要知风寒本一体，随人胃气而别。此条本为阳明初受表邪，先辨胃家虚实，为诊家提纲。
使其着眼处，不是为阳明分中风伤寒之法也。
阳明病，若中寒不能食，小便不利，手足 然汗出，此欲作痼瘕，必大便初硬后溏。所以然者，以胃中冷，
水谷不别故也。
胃实则中热，故能消谷；胃虚则中寒，故不能食。阳明以胃实为病根，更当以胃寒为深虑耳。凡身热、汗出、
不恶寒、反恶热称阳明病。今但手足汗出，则津液之泄于外者尚少，小便不利，则津液不泄于下。阳明所虑在亡津
液，此更虑其不能化液矣。
痼瘕，即初硬后溏之谓。肛门虽固结，而肠中不全干也。溏即水谷不别之象，以 瘕作解者谬矣。按∶大肠
小肠，俱属于胃。欲知胃之虚实，必于二便验之。小便利，屎定硬；小便不利，必大便初硬后溏。今人但知大便
硬、大便难、不大便者为阳明病。亦知小便难、小便不利、小便数少或不尿者皆阳明病乎？
阳明病，不能食，攻其热必哕。所以然者，胃中虚冷故也。以其人本虚，故攻其热必哕。
初受病便不能食，知其人本来胃虚，与中有燥屎而反不能食者有别也。哕为胃病，病深者其声哕矣。
若胃中虚冷不能食者，饮水则哕。
要知阳明病不能食者，虽身热恶热，而不可攻其热。不能食，便是胃中虚冷。用寒以彻表热，便是攻，非指
用承气也。伤寒治阳明之法利在攻，仲景治阳明之心全在未可攻，故谆谆以胃家虚实相告耳。
阳明病，脉迟，腹满，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。
阳明脉浮而弦大，为中风。若脉迟，为中寒、为无阳矣。食难用饱，因于腹满，腹满因于小便难，烦眩又因
于食饱耳。食入于胃，浊气归心，故烦。阳虚不能化液，则清中清者不上升，故食谷则头眩；浊中清者不下输，故
腹满而小便难。胃脘之阳，不达于寸口，故脉迟也。《金匮》曰∶“谷气不消，胃中苦满，浊气下流，小便不通，
身体尽黄，名曰谷疸，”当用五苓散调胃利水，而反用茵陈汤下之，腹满不减，而除中发哕所由来矣。所以然者，
盖迟为在藏，脾家实则腐秽自去。食难用饱者，脾不磨也。下之则脾家愈虚，不化不出，故腹满如故。
伤寒脉迟，六七日而反与黄芩汤彻其热。脉迟为寒，今与黄芩汤，复除其热，腹中应冷，当不能食。今反
能食，此名除中，必死。
凡首揭阳明病者，必身热汗出、不恶寒反恶热也。此言伤寒则恶寒可知，言彻其热，则发热可知。脉迟为无
阳，不能作汗，必服桂枝汤啜稀热粥，令汗生于谷耳。黄芩汤本为协热下利而设，不为脉迟表热而设。今不知脉迟
为里寒，但知清表之余热。热去寒起，则不能食者为中寒，反能食者为除中矣。除中者，胃阳不支，假谷气以自
救，凡人将死而反强食者是也。
阳明病，初欲食，小便反不利，大便自调。其人骨节疼，
翕然如有热状，奄然狂发， 然汗出而解者，此水不胜谷，气与汗共并，脉紧则愈。
初欲食，则胃不虚冷。小便不利，是水气不宣矣。大便反调，胃不实可知。骨节疼者，湿流关节也。翕翕如
有热而不甚热者，燥化不行，而湿在皮肤也。其人胃本不虚，因水气怫郁，郁极而发，故忽狂。汗生于谷，
然汗出者，水气与谷气并出而为汗也。脉紧者，对迟而言，非紧则为寒之谓。
若脉迟，至六七日不欲食，此为晚发，水停故也，为未解；食自可者，为欲解。
初能食，至六七日阳气来复之时，反不欲食，是胃中寒冷，因水停而然，名曰晚发，因痼瘕、谷疸等为未
除也。食自可，则胃阳已复，故欲解。
伤寒，大吐大下之，极虚，复极汗者，以其人外气怫郁。复与之水，以发其汗，因得哕。所以然者，胃中虚
冷故也。
阳明居中，或亡其津而为实，或亡其津而为虚，皆得转为阳明。其传为实者可下，其传为虚者当温矣。
上论阳明中寒症。
阳明病欲解时，从申至戌上。
申酉为阳明主时，即日晡也。凡称欲解者，俱指表而言，如太阳头痛自止，恶寒自罢，阳明则身不热不恶热也。
上论阳明病解时。
阳明中风，出现口苦、咽干、腹部胀满、轻微气喘、发热并伴有恶寒、脉象浮而紧的症状。如果误用攻下法，会导致腹部胀满加重和小便困难。
本条文中没有目痛、鼻干的经络病证，也没有尺寸两部脉俱长的表证。轻微气喘、恶寒、脉浮而紧，与太阳病的麻黄汤证相同。口苦、咽干，又类似于太阳少阳合病。再加上腹部胀满，又似乎像太阳太阴两感病。其他经的病证交错呈现，本经（阳明经）的病证尚未明显显现，为什么称为阳明中风呢？因为没有头项强痛，所以不属于太阳病；没有耳聋、目赤，所以不属于少阳病；没有腹痛、自利（腹泻），所以不关涉太阴病。由此可知，口是胃的窍道，咽是胃的门户，腹是胃的居室，气喘是胃病的表现。现在虽然恶寒，但两天内必定停止；脉象的浮紧，也是潮热发作时的征候。这是阳明初病在里的表证，因为患者津液素来亏虚，所以出现这些症状。如果把腹满当作胃实热证而使用攻下法，津液枯竭后，腹部会更胀满且小便困难，大便反而容易排出。这是中风转化为中寒，胃实转化为胃虚，从起初能进食转变为后来不能进食的关键机理。伤寒或中风，只要见到柴胡汤证的一个症状即可按少阳病治疗。那么口苦咽干，应当从少阳病证治。脉象浮而紧，应当说是弦脉。
阳明中风，脉象弦、浮、大且短气，腹部胀满，胁下及心胸部疼痛，长时间按压感觉气机不通畅，鼻干，无汗，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。针刺后病情稍有好转，但表证仍未解除。病程超过十天，脉象仍见弦浮的，给予小柴胡汤；脉象仅见浮，没有其他余证的，给予麻黄汤。如果不排尿，腹部胀满且呃逆加重的，属于不治之症。
本条文没有提及发热。看“中风”二字，便隐含了表热在内。“外不解”，即指表热而言。这暗伏了内证已解的意思。“病过十日”，是内证已解的互文说法，应当联系到“外不解”这一句上来理解。“无余证”一句，承接“外不解”而来。所谓“刺之”，是指针刺足阳明经，根据其实证情况予以泻法。“少瘥”一句，是说内证全部减轻，只是外证未解罢了，并不是说耳前后肿胀稍微好转的意思。脉象弦浮，说明之前的浮大脉减小而弦脉尚存。这表明阳明的脉证已经罢去，只有少阳的表邪尚存，所以可以用小柴胡汤来解外。如果脉象仅见浮而不弦大，那就不是阳明或少阳的脉象。“无余证”，则上文的各种证候都已消失，也就是没有阳明和少阳的证候。只有太阳的表邪未散，所以可以与麻黄汤来解外。之所以这样，是因为阳明居中焦，其风邪如果不是从太阳转属而来，就是从少阳转属而来，两阳相互熏灼，所以病程超过十天而表热不退。如果没有其他证候可凭据，只有表热不解，治法应当依据脉象。所以脉弦浮的，可知是少阳转属遗留的风邪；脉仅见浮的，是太阳转属残留的风邪。如果不排尿、腹部胀满且呃逆加重，是承接前文的耳前后肿胀而来。这是内证未解，所以小便难竟然发展到不排尿，腹部胀满竟然不减轻，时常呃逆更加严重了。这不是针刺后导致的，也不是用小柴胡汤或麻黄汤后产生的变证。太阳主表，所以中风多表现为表证；阳明主里，所以中风多表现为里证。弦脉是少阳脉，耳前、耳后、胁下是少阳部位。阳明中风，而脉证兼有少阳特征，是因为胆为风府的缘故。如果不兼有太阳和少阳的脉证，仅仅是阳明病，就不称为中风了。参考口苦咽干，可知阳明中风从少阳转属的情况居多。
本条文多讲中风却不提恶风，也不提恶热。要知道开始虽有恶寒，两天后自然停止，风邪未解，所以不恶热。这说明阳明中风与太阳、少阳不同，而且阳明经过传变后留连不解的风邪，也与本经原发的病证截然不同。
以上论述阳明中风的证候。
阳明病，如果能进食的叫中风，不能进食的叫中寒。
太阳主表，病情应当以表证来辨别。阳明主里，证候虽然在表，病情仍以里证来辨别。这里不仅通过能食与否来区分风寒，更通过能食与否来审察胃家的虚实。要知道风寒本是一体，随人体胃气的不同而有所区别。本条原本是为阳明初受表邪，先辨别胃家虚实，作为诊断的提纲。使其着眼点，不是为了给阳明病分中风和伤寒的方法。
阳明病，如果是中寒不能进食，小便不利，手足濈然汗出，这是将要形成痼瘕，必然大便初硬后溏。之所以这样，是因为胃中寒冷，水谷不分的原因。
胃实则中焦热盛，所以能消化食物；胃虚则中焦寒盛，所以不能进食。阳明病以胃实为病根，更应当警惕胃寒。凡是身体发热、出汗、不恶寒反而恶热的称为阳明病。现在只是手足出汗，那么津液向外泄出的还较少；小便不利，那么津液不从下面排泄。阳明病所担忧的是亡失津液，这里更担忧的是不能化生津液。
痼瘕，就是指初硬后溏的大便状态。肛门虽然固结，但肠中并不完全干燥。溏便是水谷不分的现象，把痼瘕解释为积聚是错误的。按：大肠小肠，都属于胃。想要知道胃的虚实，必须通过二便来验证。小便利，屎定硬；小便不利，必然大便初硬后溏。现在的人只知道大便硬、大便难、不大便的是阳明病。也知道小便难、小便不利、小便次数少或不排尿的都是阳明病吗？
阳明病，不能进食，如果攻伐其热，必然发生呃逆。之所以这样，是因为胃中虚冷的缘故。因为病人本来虚弱，所以攻伐其热必然导致呃逆。
如果是胃中虚冷不能进食的，喝水就会发生呃逆。
要知道阳明病不能进食的，虽然身体发热、恶热，但不可攻伐其热。不能进食，就是胃中虚冷。用寒凉药来清除表热，就是攻伐，并非特指使用承气汤。伤寒治疗阳明病的方法利于攻下，仲景治疗阳明病的心法全在于不可攻下时严禁攻下，所以谆谆告诫要分辨胃家的虚实。
阳明病，脉迟，腹部胀满，吃东西难以吃饱，饱了就轻微心烦，头晕目眩，必然小便困难，这是将要发生谷疸。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。
阳明脉浮而弦大，是中风。如果脉迟，是中寒、是无阳。饮食难以吃饱，是因为腹部胀满；腹部胀满是因为小便困难；心烦眩晕又是由于吃饱饭引起的。食物进入胃中，浊气归于心，所以心烦。阳虚不能化生津液，那么清中之清者不能上升，所以吃谷物就头晕目眩；浊中之清者不能向下输布，所以腹部胀满且小便困难。胃脘的阳气不能达于寸口，所以脉迟。《金匮要略》说：“谷气不消，胃中苦满，浊气下流，小便不通，身体尽黄，名叫谷疸。”应当用五苓散调理胃气、通利水道，却反而用茵陈蒿汤攻下，导致腹部胀满不减，除中和发哕的情况也就由此产生了。之所以这样，大概是因为迟脉主脏寒，脾家实才能腐秽自去。饮食难以吃饱，是脾不运化的表现。攻下则脾家更虚，不化不出，所以腹部胀满依旧。
伤寒脉迟，六七天时反而给予黄芩汤清除其热。脉迟为寒，现在给予黄芩汤，再次清除其热，腹中应当寒冷，应当不能进食。现在反而能进食，这叫除中，必死。
凡是首揭阳明病的，必然身体发热出汗、不恶寒反而恶热。这里说伤寒则可知恶寒，说彻其热则可知发热。脉迟为无阳，不能作汗，必须服用桂枝汤并喝热稀粥，让汗液从谷气中产生。黄芩汤本是用于协热下利的，不是用于脉迟表热的。现在不知道脉迟是里寒，只知道清除表之余热。热去寒起，那么不能进食的是中寒，反而能进食的是除中。除中，是胃阳不支，假借谷气来自救，就像人临死前反而强行进食一样。
阳明病，起初想进食，小便反而不利，大便正常。其人骨节疼痛，微微好像有发热的样子，忽然狂躁发作，濈然汗出而病解的，这是水气不胜谷气，气与汗共同并出，脉紧则愈。
起初想进食，说明胃不虚冷。小便不利，是水气不宣通。大便反调，说明胃不实。骨节疼痛，是湿气流注关节。微微好像有热但不甚热，是燥化不行，而湿在皮肤。其人胃本不虚，因为水气怫郁，郁极而发，所以忽发狂躁。汗生于谷，濈然汗出，是水气与谷气并出而为汗。脉紧，是对迟脉而言，不是指紧脉为寒。
如果脉迟，到了六七天不想进食，这叫晚发，是水停的缘故，病未解；如果饮食正常，是欲解。
初能食，到了六七天阳气来复的时候，反而不想进食，是胃中寒冷，因水停所致，名叫晚发，因为痼瘕、谷疸等病未除。饮食正常，则胃阳已恢复，所以欲解。
伤寒，经过大吐大下，极度虚弱，又极度发汗的，因为病人外气怫郁。又给他喝水以发其汗，因而导致呃逆。之所以这样，是因为胃中虚冷的缘故。
阳明居中，或者亡失津液而成实证，或者亡失津液而成虚证，都能转为阳明病。其传变为实的可以攻下，其传变为虚的应当温补。
以上论述阳明中寒的证候。
阳明病欲解时，从申时至戌时。
申酉时为阳明主时，即日晡时分。凡是称欲解的，都指表证而言，如太阳病头痛自止，恶寒自罢，阳明病则是身不热、不恶热。
以上论述阳明病欲解的时间。
Yangming Wind-Strike (Yangming Zhongfeng) presents with bitter taste in the mouth, dryness of the throat, abdominal fullness, slight panting, fever accompanied by aversion to cold, and a floating and tight pulse. If purgation is mistakenly applied, it will result in aggravated abdominal fullness and difficulty in urination.
This clause lacks the meridian symptoms of eye pain and nasal dryness, as well as the superficial pulse that is long at both the Cun and Chi positions. The slight panting, aversion to cold, and floating-tight pulse are identical to the Mahuang Tang Syndrome (Ephedra Decoction Syndrome) of the Taiyang (Greater Yang) disease. The bitter taste and dry throat resemble a combined disease of Taiyang and Shaoyang (Lesser Yang). Furthermore, with the addition of abdominal fullness, it seems similar to a simultaneous contraction of Taiyang and Taiyin (Greater Yin). Since manifestations from other meridians are intermixed while the symptoms of this meridian (Yangming) are not yet prominent, why is it named Yangming Wind-Strike? Because there is no stiffness of the head and neck, it does not belong to Taiyang; because there is no deafness or red eyes, it does not belong to Shaoyang; because there is no abdominal pain and spontaneous diarrhea, it does not involve Taiyin. From this we know that the mouth is the orifice of the Stomach, the throat is the gate of the Stomach, the abdomen is the chamber of the Stomach, and panting is a manifestation of Stomach disease. Although there is currently aversion to cold, it will cease within two days; the floating-tight pulse is also a sign of impending tidal fever. This represents the exterior aspect of the interior disease at the initial stage of Yangming, caused by a constitutional deficiency of body fluids (Jin-Ye), hence these symptoms. If abdominal fullness is mistaken for excess heat in the Stomach and purged, the exhaustion of body fluids will lead to further abdominal fullness and difficulty in urination, while the stool may become easier to pass. This marks the transition from wind-strike to cold-strike, from stomach excess to stomach deficiency, and the mechanism behind the shift from initial ability to eat to later inability to eat. In cases of Cold Damage (Shanghan) or wind-strike, if even one symptom of the Chaihu Tang (Bupleurum Decoction) pattern appears, it should be treated according to the Shaoyang syndrome. Thus, bitter taste and dry throat should be treated as a Shaoyang syndrome. A floating and tight pulse should be described as wiry (Xian).
In Yangming wind-strike, the pulse is wiry, floating, and large, accompanied by shortness of breath, abdominal fullness, pain in the hypochondrium and heart region, obstruction of qi upon prolonged palpation, nasal dryness, absence of sweating, lethargy, jaundice affecting the whole body and face, difficulty in urination, tidal fever, frequent hiccups, and swelling around the ears. Acupuncture provides slight relief, but the exterior syndrome remains unresolved. If the disease persists beyond ten days and the pulse remains wiry and floating, administer Xiao Chaihu Tang (Minor Bupleurum Decoction); if the pulse is only floating without other residual symptoms, administer Mahuang Tang (Ephedra Decoction). If there is anuria, aggravated abdominal fullness, and worsening hiccups, the condition is incurable.
This clause does not mention fever. The term "wind-strike" implies latent exterior heat. "Exterior unresolved" refers to this exterior heat, implicitly suggesting that the interior has resolved. "Disease persisting beyond ten days" is a rhetorical variation indicating the interior has resolved, which should be linked to the phrase "exterior unresolved." The phrase "no residual symptoms" follows "exterior unresolved." "Acupuncture" here refers to needling the Foot-Yangming Meridian to drain excess. "Slight relief" means the interior symptoms have all subsided, but the exterior symptoms remain; it does not mean the swelling around the ears has merely decreased slightly. A wiry-floating pulse indicates that the previous large-floating pulse has diminished, leaving only the wiry quality. This shows that the Yangming pulse and symptoms have ceased, leaving only Shaoyang exterior pathogenic factors, so Xiao Chaihu Tang can be used to resolve the exterior. If the pulse is only floating without wiry or large qualities, it is neither a Yangming nor a Shaoyang pulse. "No residual symptoms" means all previous symptoms have vanished, indicating no Yangming or Shaoyang syndromes. Only Taiyang exterior pathogenic factors remain unscattered, so Mahuang Tang can be given to resolve the exterior. The reason is that Yangming resides in the center; its wind pathogen either transfers from Taiyang or Shaoyang. The mutual scorching of two Yangs causes the exterior heat to persist beyond ten days. With no other symptoms to rely on, treatment must depend on the pulse. Therefore, a wiry-floating pulse indicates residual wind transferring from Shaoyang; a purely floating pulse indicates residual wind transferring from Taiyang. Anuria, aggravated abdominal fullness, and worsening hiccups follow the symptom of swelling around the ears. This indicates unresolved interior conditions: difficulty in urination progresses to anuria, abdominal fullness does not subside, and hiccups worsen. This is not caused by acupuncture, nor is it a transformation after using Chaihu or Mahuang Tang. Taiyang governs the exterior, so wind-strike often presents with exterior symptoms; Yangming governs the interior, so wind-strike often presents with interior symptoms. The wiry pulse is the Shaoyang pulse; the area around the ears, hypochondrium, and lower ribs belongs to Shaoyang. Yangming wind-strike presenting with Shaoyang pulse and symptoms occurs because the Gallbladder is the residence of wind. If it does not combine with Taiyang and Shaoyang pulse/symptoms, but is solely a Yangming disease, it is not named wind-strike. Referencing bitter taste and dry throat, most Yangming wind-strikes transfer from Shaoyang.
This clause discusses wind-strike extensively but omits aversion to wind and aversion to heat. One must understand that although there is initial aversion to cold, it ceases naturally after two days. Since the wind pathogen is not yet resolved, there is no aversion to heat. This distinguishes Yangming wind-strike from Taiyang and Shaoyang, and shows that lingering wind after passing through meridians differs significantly from primary Yangming diseases.
The above discusses Yangming wind-strike syndromes.
In Yangming disease, the ability to eat is termed wind-strike, while the inability to eat is termed cold-strike.
Taiyang governs the exterior, so syndromes are distinguished by exterior signs. Yangming governs the interior, so even if symptoms appear on the exterior, the condition is distinguished by interior signs. Here, the distinction between wind and cold is not only based on the ability to eat, but also to assess the deficiency or excess of the Stomach. Wind and cold are essentially one entity, differentiated by the patient's Stomach Qi. This clause addresses the initial reception of exterior pathogens in Yangming, prioritizing the differentiation of Stomach deficiency/excess as a diagnostic guideline. Its focus is not merely on dividing Yangming into wind-strike and cold-strike.
In Yangming disease, if cold-strike prevents eating, accompanied by difficulty in urination and continuous sweating from the hands and feet, this indicates the impending formation of a stubborn mass (Gu-Jia). The stool will likely be hard initially and loose later. This occurs because of cold in the Stomach and the failure to separate water and grain.
Stomach excess leads to middle-jiao heat, enabling digestion; Stomach deficiency leads to middle-jiao cold, preventing eating. Yangming disease takes Stomach excess as its root, but Stomach cold must be deeply guarded against. Generally, fever, sweating, absence of aversion to cold, and preference for heat define Yangming disease. Here, only hand-and-foot sweating occurs, meaning less fluid loss externally; difficulty in urination means fluid is not lost downward. Yangming disease worries about fluid depletion; here, there is greater concern about the inability to generate fluids.
"Gu-Jia" refers to stools that are hard initially and loose later. Although the anus is constipated, the intestines are not completely dry. Loose stool is a sign of undigested food and water; interpreting Gu-Jia as a fixed accumulation is erroneous. Note: The Large and Small Intestines belong to the Stomach. To know the deficiency or excess of the Stomach, one must examine the bowels and urine. If urination is free, stool is definitely hard; if urination is difficult, stool is hard initially and loose later. People today only recognize hard stool, difficult defecation, and constipation as Yangming disease. Do they also recognize difficult urination, oliguria, infrequent urination, or anuria as Yangming disease?
In Yangming disease, if the patient cannot eat, attacking the heat will inevitably cause hiccups. This is due to deficiency-cold in the Stomach. Because the person is constitutionally deficient, attacking the heat will cause hiccups.
If deficiency-cold in the Stomach prevents eating, drinking water will trigger hiccups.
One must understand that in Yangming disease where eating is impossible, despite fever and aversion to heat, one must not attack the heat. Inability to eat indicates deficiency-cold in the Stomach. Using cold herbs to clear exterior heat constitutes an attack, not necessarily referring to Chengqi Decoctions. The treatment principle for Yangming in Cold Damage favors purgation, but Zhang Zhongjing’s core philosophy emphasizes caution against purgation when inappropriate. Thus, he repeatedly advises distinguishing Stomach deficiency and excess.
In Yangming disease, a slow pulse, abdominal fullness, difficulty in eating until full, mild irritability after eating, dizziness, and inevitable difficulty in urination indicate the impending development of Grain Jaundice (Gu-Dan). Even if purgation is used, abdominal fullness remains unchanged because of the slow pulse.
A floating, wiry, and large pulse in Yangming indicates wind-strike. A slow pulse indicates cold-strike and lack of Yang. Difficulty in eating until full is due to abdominal fullness; abdominal fullness is due to difficulty in urination; irritability and dizziness are triggered by overeating. Food entering the Stomach sends turbid Qi to the Heart, causing irritability. Yang deficiency fails to transform fluids, so clear-yang does not ascend, causing dizziness upon eating; turbid-clear fluids do not descend, causing abdominal fullness and urinary difficulty. Stomach-Warmth fails to reach the Cun position, resulting in a slow pulse. The *Jin Gui Yao Lue* states: "When grain Qi fails to digest, the Stomach suffers from fullness, turbid Qi flows downward, urination is blocked, and the body becomes yellow, this is called Grain Jaundice." One should use Wuling San (Five-Ingredient Poria Pill) to regulate the Stomach and promote diuresis, rather than using Yinchen Hao Tang (Artemisia Capillaris Decoction) to purge. Purging would leave abdominal fullness unchanged and lead to Chu-Zhong (Elimination of the Middle) and hiccups. The reason is that a slow pulse indicates cold in the Zang organs. Spleen Excess allows rotting filth to depart spontaneously. Difficulty in eating until full indicates the Spleen fails to grind and transport. Purging further weakens the Spleen, leading to failure to transform and expel, hence persistent abdominal fullness.
In Cold Damage with a slow pulse, if Huangqin Tang (Scutellaria Decoction) is incorrectly administered to clear heat after six or seven days, death is certain. A slow pulse indicates cold; administering Huangqin Tang removes heat, causing cold in the abdomen and inability to eat. If the patient suddenly eats, this is called Chu-Zhong (Elimination of the Middle), a fatal sign.
Cases introducing Yangming disease typically present with fever, sweating, no aversion to cold, and aversion to heat. Mentioning Cold Damage implies aversion to cold; mentioning clearing heat implies fever. A slow pulse indicates lack of Yang and inability to sweat; one must take Guizhi Tang (Cinnamon Twig Decoction) with warm rice gruel to generate sweat from grain Qi. Huangqin Tang is designed for dysentery with concurrent heat, not for slow-pulse exterior heat. Failing to recognize the slow pulse as interior cold and instead clearing residual exterior heat causes heat to vanish and cold to arise. The previously unable-to-eat patient now suffers from cold-strike, while the sudden ability to eat indicates Chu-Zhong. Chu-Zhong means Stomach-Yang cannot sustain itself and falsely borrows Grain Qi for self-rescue, akin to a dying person forcibly eating.
In Yangming disease, if the patient initially desires to eat, but urination is obstructed while stool remains normal, and they experience joint pain, a slight feeling of heat, sudden manic outbursts, and profuse sweating leading to resolution, this is because Water Qi fails to overcome Grain Qi. Qi and sweat emerge together; if the pulse is tight, recovery occurs.
Initial desire to eat indicates the Stomach is not deficient-cold. Obstructed urination indicates stagnant Water Qi. Normal stool indicates the Stomach is not excess. Joint pain indicates dampness flowing into joints. Slight heat sensation indicates failed drying transformation and dampness in the skin. The Stomach is originally not deficient; due to stagnation of Water Qi, extreme depression leads to sudden mania. Sweat is generated from Grain Qi; profuse sweating indicates Water Qi and Grain Qi exiting together as sweat. A tight pulse contrasts with a slow pulse; here, it does not refer to cold.
If the pulse is slow, and by the sixth or seventh day the patient loses appetite, this is called late onset (Wan-Fa), caused by water retention, indicating the disease is unresolved. If appetite is normal, the disease is resolving.
From initial ability to eat to the sixth/seventh day (when Yang Qi recovers), loss of appetite indicates Stomach cold due to water retention, termed late onset, as stubborn masses or Grain Jaundice remain unresolved. Normal appetite indicates restored Stomach-Yang, signaling resolution.
In Cold Damage, excessive vomiting and purging cause extreme deficiency. Subsequent excessive sweating, combined with exterior Qi stagnation, followed by administering water to induce sweating, results in hiccups. This is due to deficiency-cold in the Stomach.
Yangming resides in the center; fluid depletion can lead to excess or deficiency, both transforming into Yangming disease. Transformations to excess can be purged; transformations to deficiency require warming.
The above discusses Yangming cold-strike syndromes.
Yangming disease tends to resolve from Shen hour (3-5 PM) to Xu hour (7-9 PM).
Shen and You hours are governed by Yangming, known as dusk. "Tendency to resolve" always refers to the exterior. For Taiyang, headache stops and aversion to cold ceases; for Yangming, fever and aversion to heat cease.
The above discusses the time of resolution for Yangming disease.