【纲】仲景曰。阳明病。法多汗。反无汗。其身如虫行皮中状者。此以久虚故也。
【目】赵嗣真曰。虫行皮中状者。即太阳症言身痒是也。久虚者。以表气不足。津液不充于皮
肤。使腠理枯涩。汗难出也。若谓虚则当补。毕究阳明受邪。为病邪可补乎。如活人用术附汤、黄
建中汤辈。皆收汗药。则荣卫郁闭。邪无从出。内热发矣。何况又无吐利胃虚等症。病不在里。
但皮肤中表气虚乏。理宜和解可也。莫若借用合半汤。或有热者。柴胡桂枝汤。庶几甘辛之剂。可
以和其荣卫。通行津液而解也。
程郊倩曰。此胃热协寒邪而郁于肌肤之症也。言久虚者。明所以不能透出肌表之故也。
方中行曰。阳明主肌肉。腠理开。宜多汗。故以无汗为反也。无汗则寒胜而腠理秘。所以身如虫行
状也。
魏荔彤曰。如虫行皮中状者。此邪热欲出表作热作汗。而正气衰弱不能达之也。所以胃亦不能
成实也。明以久虚。治者欲其热透表。必令其汗透表。然阳明已成里症。且中气虚。又无发汗法。
惟有清其热。补其虚而已。但此汗非发汗也。亦非解肌也。乃补虚清热。两解表里。喻氏谓如人参
白虎汤是也。此症言胃虚热则可。言胃寒则无据。太阳篇病将入里成胃实。多言胃未成实。不可遽下。合此可知病初传
入阳明。亦多在经而不归腑。不可遽谓除下法无他治也。
【纲】张仲景说：阳明病，按照常理应当多汗，反而无汗，身体感觉像有虫子在皮肤中爬行一样，这是因为长期虚弱所致。
【目】赵嗣真说：身体像有虫子在皮肤中爬行的感觉，就是太阳病所说的身体发痒的症状。所谓“久虚”，是指表气不足，津液不能充盈于皮肤，导致腠理（皮肤纹理及汗孔）干枯涩滞，汗液难以排出。如果说因为虚就应当补益，但究其根本，这是阳明经受邪，病邪难道可以用补法吗？如果像《活人书》中使用的术附汤、黄芪建中汤之类的方剂，都是收敛止汗的药物，那么营卫之气就会更加郁闭，病邪无从排出，内热就会发作。何况这里又没有呕吐、腹泻、胃虚等症状，病位不在里，仅仅是皮肤表面的表气虚乏，理应使用和解的方法。不如借用小柴胡汤，如果有热象的，可用柴胡桂枝汤，这样或许可以用甘辛性质的药物，调和营卫，通行津液从而解除病邪。
程郊倩说：这是胃热夹杂寒邪郁结在肌肤的症状。说“久虚”，是明确说明病邪不能透达肌表的原因。
方中行说：阳明经主司肌肉，腠理开泄，本应多汗，所以以无汗为反常。无汗则寒气胜而腠理闭塞，因此身体感觉像有虫子爬行一样。
魏荔彤说：身体像有虫子在皮肤中爬行的感觉，这是邪热想要透出体表化作热和汗，但正气衰弱无法推动它。所以胃也不能形成实证。明确指出是因为长期虚弱，治疗者希望热邪透达体表，必须让汗液透达体表。然而阳明已经形成里证，且中气虚弱，又没有发汗的法度，只有清解热邪、补益虚损而已。但这汗并非通过发汗药得出，也不是通过解肌药得出，而是通过补虚清热，双向解除表里之邪。喻嘉言认为如人参白虎汤就是这样的方子。这个症状说胃虚热是可以的，说胃寒就没有依据了。太阳篇中提到病即将入里形成胃实，大多说胃未成实，不可急于攻下。结合此条可知，病初传入阳明，也多在经络而不归入腑脏，不可急于认为除了攻下法之外没有其他治法。
[General Principle] Zhang Zhongjing stated: In Yangming disease, profuse sweating is the norm. If there is a lack of sweating and the body feels as if insects are crawling under the skin, this is due to long-standing deficiency.
[Commentary] Zhao Sizhen said: The sensation of insects crawling under the skin corresponds to the symptom of body itching described in Taiyang disease. "Long-standing deficiency" refers to insufficiency of Wei Qi (Defensive Qi) at the exterior, leading to a lack of Jin-Ye (Body Fluids) nourishing the skin. This causes the Cou-Li (pores and skin texture) to become dry and astringent, making it difficult for sweat to be excreted. If one argues that deficiency requires tonification, one must consider that Yangming has been invaded by pathogenic factors; can pathogens be treated with tonification? Formulas such as Shu Fu Tang (Atractylodes and Aconite Decoction) or Huang Jian Zhong Tang (Astragalus Middle-Warming Decoction), as used in *The Living Manual*, are astringent and stop-sweating agents. Using them would further stagnate Ying (Nutritive) and Wei (Defensive) Qi, preventing the pathogen from exiting and causing internal heat to arise. Moreover, since there are no symptoms of vomiting, diarrhea, or stomach deficiency indicating an interior condition, but rather only a deficiency of exterior Qi in the skin, the appropriate method is harmonization. It is advisable to borrow Xiao Chai Hu Tang (Minor Bupleurum Decoction); if there is heat, Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) may be used. Thus, sweet and acrid formulas can harmonize Ying and Wei, promote the circulation of fluids, and resolve the condition.
Cheng Jiaoqian said: This is a syndrome where Stomach Heat combines with Cold Pathogens and becomes stagnant in the muscle layer. The mention of "long-standing deficiency" clarifies the reason why the pathogen cannot penetrate out to the muscular surface.
Fang Xingzhong said: The Yangming channel governs the muscles. Since the Cou-Li are open, profuse sweating is expected; therefore, the absence of sweating is considered abnormal. The lack of sweating allows Cold to prevail and the Cou-Li to close, resulting in the sensation of insects crawling on the body.
Wei Litong said: The sensation of insects crawling under the skin indicates that Pathogenic Heat desires to exit the exterior as heat and sweat, but the Healthy Qi is too weak to facilitate this. Consequently, the Stomach cannot form a solid excess pattern. It is explicitly stated that this is due to long-standing deficiency. To allow the heat to penetrate the exterior, sweat must be allowed to penetrate the exterior. However, since Yangming has already formed an interior syndrome and the Middle Qi is deficient, and there is no indication for diaphoresis (sweating-inducing therapy), the treatment should solely focus on clearing heat and tonifying deficiency. This sweat is not induced by diaphoretics nor by muscle-releasing agents, but rather by tonifying deficiency and clearing heat, thereby resolving both exterior and interior aspects simultaneously. Yu Jia Yan suggested that Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction) is an example. It is accurate to describe this syndrome as Stomach Deficiency with Heat, but inaccurate to describe it as Stomach Cold. In the Taiyang chapter, when discussing diseases about to enter the interior to form Stomach Excess, it is often emphasized that if the Stomach has not yet formed excess, purgation should not be rushed. From this, we can understand that when a disease initially transmits to Yangming, it often remains in the channels rather than entering the fu organs. One should not hastily conclude that purgation is the only treatment option.