按阳明提纲，以里症为主。虽有表症，仲景意不在表，为有诸中而形诸外也。或兼经病，仲景意不在经，为
标在经而根于胃也。太阴
阳明同处中州，而太阴为开，阳明为阖也。故阳明必以阖病为主，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。自汗盗汗，表开而里阖也。反无汗，内外皆阖也。种种阖病，或然或否，故提
纲独以胃实为主。胃实不竟指燥粪坚硬，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，不
称阳明病。如胃中虚而不下利者，便属阳明，即初硬后溏，水谷不别，虽死而不下利者，总为阳明病也。盖阳明
太阴，同为仓廪之官，而所司各别。胃司纳，故以阳明主实；脾司输，故太阴主利。同一胃病，而分治如此，是
二经所由分也。按阳明为传化之府，当更实更虚，食入胃实而肠虚，食下肠实而胃虚，若但实不虚，斯阳明病根
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，有妄吐汗下、重亡津液而实者，有从本
经热盛而实者，有从他经热盛转属而实者。此只举其病根在实，勿得即以胃实为可下之症。
身热汗自出，不恶寒反恶热，是阳明表症之提纲。故胃中虚冷，亦得称阳明病，因其表症如此也。然此为内
热发外之表，非中风伤寒之表。此时表寒已散，故不恶寒；里热闭结，故反恶热。只因有胃家实之病根，即见此
身热自汗之外症、不恶寒反恶热之病情。然此但言病机发见，非即可下之症也，必谵语、潮热、烦躁、胀痛诸症
兼见，才可下耳。
太阳总纲示人以正面，阳明总纲反示人以底板。其正面与太阳之表同，又当看出阳明之表与太阳不同矣。如
阳明病，脉迟汗出多，微恶寒者，是阳明之桂枝症；阳明病，脉浮无汗而喘者，是阳明之麻黄症。本论云“病得
之一日，不发热而恶寒”者，即此是也。后人见太阳已得此脉症，便道阳明不应有此脉症，故有尚在太阳将入阳
明之说。不知仲景书，多有本条不见，而他条中发见者，若始虽恶寒与反无汗等句是也。以阳明表症本自汗出不
恶寒，故加“虽、反”字耳。有本经未宣而他经发见者，若太阳之头项强痛、少阳之脉弦细者是也。若头痛而项
不强，脉大而不弦细，便是阳明之表矣。太阳行身之后，阳明行身之前，所受风寒，俱在营卫之表。太阳营卫有
虚实，阳明营卫亦有虚实。虚则桂枝，实则麻黄，是仲景治表邪之定局也。仲景之方，
因症而设，非因经而设，见此症便与此方，是仲景活法。后人妄以方分经络，非惟阳明不敢用二方，即太阳亦弃
之久矣。阳明之表有二∶有外邪初伤之表，有内热达外之表。外邪之表，只在一二日间，其症微恶寒汗出多，或
无汗而喘者是也。内热之表，在一二日后，其症身热汗自出，不恶寒反恶热是也。表因风寒外束，故仲景亦用麻、
桂二汤汗之；表因内热外发，故仲景更制栀豉汤，因其势而吐之。后人认不出阳明表症，一二日既不敢用麻、桂，
二三日后，又不知用栀豉。不识仲景治阳明之初法，所以废弃仲景之吐法，必待热深实极，始以白虎、承气投之，
是养虎贻患也。六经伤寒，惟阳明最轻，以阳明为水谷之海，谷气足以胜邪气；阳明为十二经脉之长，血气足以
御寒气；阳明寓两阳合明之地，阳气足以御阴气也。阳明阴邪一日恶寒与太阳同，二日便不恶寒反恶热。故《内
经》曰∶“二日阳明受之，”以阳明之症在二日见，非谓阳明之病在太阳受交也。仲景曰∶“伤寒三日，阳明脉
大。”要知阳明伤寒，在一日二日，即寒去热生，三日见阳明之大脉，则全无寒气，便是阳明病热，而非复前日
之伤寒。始虽由于伤寒，今不得再称伤寒，以伤寒之剂治之矣。阳明之恶寒，二日自止，固与他经不同，其恶寒
微，又不若太阳之甚。阳明在肌肉中蒸蒸发热，但热无寒，与太阳翕翕发热，寒束于皮毛之上者不同。阳明自汗，
亦异于太阳中风之自汗。太阳虽自汗，而出之不利，有执持之意，故其状曰 ，阳明自汗，多有波澜摇动之状，
故名曰 。太阳之脉浮而紧者，热必不解；阳明病脉浮而紧者，必潮热，太阳脉但浮者，必无汗；阳明脉但浮
者，必盗汗出。二经表症表脉不同如此。
今伤寒书，以头痛分三阳，阳明之头痛在额，理固然也。然阳明主里，头痛非其本症。《内经》曰∶“伤寒
一日，巨阳受之，以其脉连风府，故头项痛。七日太阳病衰，头痛少愈也。二日阳明受之，其脉夹鼻络于目，故
身热、目痛、鼻干不得眠。”是《内经》以头痛属太阳，不属阳明矣。仲景有阳明头痛二条∶一曰阳明病，反无
汗而小便利，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。此头痛在二三日，而不
在得病之一日，且因于呕咳，而不因于外邪也。一曰伤寒不大便六七日，头痛身热者，与承气汤。此头痛反在太
阳病衰时，而因于不大便，即《内经》所谓 胀而头痛，非因于风寒也。其中风伤寒诸条，俱不及头痛症，在阳
明头痛，又与太阳迥别矣。
本论云“阳明病，脉浮而紧，咽燥口苦，腹满而喘，发热汗出，不恶寒，反恶热，身重”，此处当直接“栀
子豉汤主之”句。若发汗三段，因不用此方而妄治所致，仍当栀子豉汤主之。仲景但于结句一见，是省文法也。
后人竟认栀子豉汤为汗下后救逆之剂，请问未汗下前，仲景何法以治之乎？要知咽燥口苦，腹满而喘，是阳明里
热；发热汗出，不恶寒，反恶热，是阳明表热。因阳明之热自内达表，则里症为重，故此条序症，以里症列表症
之前。任栀子以清里热，而表热亦解；用香豉以泻腹满，而身重亦除。后人不能于仲景书中寻出阳明之表，而遽
引《内经·热病论》之目痛鼻干不得卧以当之；不得仲景阳明治表之法，妄用痘科中葛根升麻汤以主之；不知《内
经》因论热病，而只发明阳明经病之一端，仲景立阳明一经，是该内外症治之主治；又不知目痛鼻干是阳盛阴虚，
法当滋阴清火，而反发阳明之汗，上而鼻衄，下而便难，是引邪入内矣。要知是风寒之表，则用麻桂而治。如是
内热之表，即荆芥、薄荷，皆足亡津液而成胃实。是在用者何如耳。
治阳明之表热有三法∶热在上焦用栀豉汤吐之，上焦得通，津液得下，胃家不实矣；热在中焦，用白虎汤清
之，胃火得清，胃家不实矣；热陷下焦，用猪苓汤利之，火从下泄，胃家不实矣。要知阳明之治表热，即是预治
其里，三方皆润剂，所以存津液而不令胃家实也。后人因循升麻葛根之谬，不察仲景治阳明表症之法。
太阳以心胸为里，故用辛甘发散之剂，助心胸之阳而开玄府之表，不得用苦寒之剂，以伤上焦之阳也，所以
宜汗而不宜吐。阳明以心胸为表，当用酸苦涌泄之剂，引胃脘之阳而开胸中之表，不当用温散之剂，以伤中宫之
津液也，故法当吐而不当汗。阳明当吐而反行汗、下、温针等法，以致心中愦愦、怵惕、懊 、烦躁、谵语、舌苔
等症，然不离阳明之表。太阳当汗而反吐，便见自汗出，不恶寒，饥不能食，朝食暮吐，不欲近衣，欲饮冷食等
症，此为太阳转属阳明之表，皆是栀子豉汤症。盖阳明以胃实为里，不特发热、恶寒、汗出、身重、目痛、鼻干
为之表，一切虚热，如口苦、咽干、舌苔、喘满、不得卧、消渴而小便不利，凡在胃之外者，悉属阳明之表。但
除胃口之热，便解胃家之实，此栀子豉汤为阳明解表之圣剂矣。
按伤寒脉浮，自汗出，微恶寒，是阳明表症；心烦，小便数，脚挛急，是阳明里之表症。斯时用栀子豉汤吐
之，则胃阳得升，恶寒自罢，心
烦得止，汗自不出矣；上焦得通，津液得下，小便自利，其脚自伸。反用桂枝发表，所以亡阳，其咽中干、烦躁、
吐逆，是栀子生姜豉汤症。只以亡阳而厥，急当回阳。其改用甘草干姜汤，阳复后，仍作芍药甘草以和阴，少与
调胃承气以和里，皆因先时失用栀豉，如此挽回费力耳。
按仲景云“病如桂枝症，”则便不得凿定为太阳中风。凡恶风、恶寒、发热而汗自出者，无论太阳、阳明、
中风、伤寒，皆是桂枝症矣。太阳病，头项强痛，而此云头不痛、项不强，便非太阳症。《内经》曰∶“邪中于
膺，则入阳明。”此云胸中痞硬，气上冲咽喉不得息，是阳明受病无疑也。虽外症象桂枝，而病在胸中，不在营
卫，便不是桂枝症。故立瓜蒂散，所谓在上者因而越之也。此与前条本阳明病，仲景不冠于阳明者，以不关胃实，
而未见不恶寒之病情耳。
上越、中清、下夺，是治阳明三大法；发汗、利小便，是阳明经两大禁。然于风寒初入阳明之表，即用麻黄
桂枝发汗者，以急于除热而存津液，与急下之法同。若脉浮烦渴，小便不利，用猪苓汤利小便者，亦以清火而存
津液。而又曰汗多者，不可与猪苓汤。要知发汗利小便，是治阳明权巧法门，非正治法。
阳明之病在热实，宜无温补法矣，而食谷欲呕者，是胃口虚寒，故不主内热也。然胃口虽虚，胃中犹实，仍
不失为阳明病，与吴茱萸汤散胃口之寒，上焦得通，津液得下，胃气因和，则温补又是阳明之从治法。若胃口虚
热者，用白虎加参，是阳明又有凉补法也。此二义又是治阳明权巧法门。
本论云∶“伤寒三日，三阳为尽，三阴当受邪。其人反能食不呕，此为三阴不受邪矣。”盖阳明为三阴之表，
故三阴皆看阳明之转旋，三阴之不受邪者，藉胃为之蔽其外也。胃气和则能食不呕，故邪自解而三阴不病。胃阳
虚，邪始得入三阴。故太阴受邪，腹满而吐，食不下；少阴受邪，欲吐不吐；厥阴受邪，饥不欲食，食即吐蛔。
若胃阳亡，则水浆不入而死。要知三阴受邪，关系不在太阳少阳，而全在阳明。阳明以太阴为里，是指牝藏言；
太阴亦以阳明为里，是指转属言也。肾者胃之关，水者土之贼，故三阴亦得以阳明为里。三阴为三阳之里，而三
阴反得转属阳明为里，故三阴皆得从阳明而下，则阳明又是三阴经实邪之出路也。既为三阴之表以御邪，又为三
阴之里以逐邪，阳明
之关系三阴重矣。
根据阳明病的提纲，以里证为主。虽然可能有表证，但张仲景的意图并不在解表，因为这是内在病变反映于外在的表现。如果兼有经病（经络层面的病变），张仲景的意图也不在治经，因为症状表现在经络，但根源在于胃腑。太阴和阳明都位于中焦，但太阴主开，阳明主阖。因此，阳明病必须以“阖”（闭合、不通）的病机为主：大便秘结固然是“阖”，小便不利也是“阖”；不能进食、难以吃饱、起初想吃后来反而不能吃，这些都是“阖”。自汗或盗汗，是表开而里阖；反而无汗，则是内外皆阖。各种各样的“阖”病，或有或无，所以提纲特别强调“胃实”作为核心。所谓“胃实”不仅仅指燥屎坚硬，而是相对于下利而言，下利意味着胃家不实。因此，发汗解表后，因胃中不和导致下利的，不称为阳明病。如果胃中虚寒但不出现下利的，就属于阳明病；即使是初头硬后溏稀、水谷不分，或者即使病情危重但不出现下利的，总归都属于阳明病。大概太阴和阳明，同为负责饮食运化的脏腑，但职能各不相同。胃主管受纳，所以阳明主实证；脾主管输布，所以太阴主下利。同样是胃病，治疗却如此区分，这就是这两条经脉的区别所在。按阳明是传化之腑，应当虚实交替，食物进入胃中则胃实而肠虚，食物下行至肠中则肠实而胃虚，如果只有实而没有虚，这就是阳明病的根本原因。胃实本身不是阳明病的全部定义，但阳明病的所有表现，都源于胃实，所以以“胃家实”作为阳明一经的总纲。然而，导致“实”的原因，最需要详细审察：有的在未发病之前就已经存在实邪，有的在患病之后才形成实邪，有的是风寒外束、热邪无法宣泄而导致实，有的是误用吐法、汗法、下法，严重耗伤津液而导致实，有的是本经热盛而导致实，有的是从他经热盛转属而来而导致实。这里只列举了病根在于“实”，不要立刻就把“胃实”当作可以使用攻下法的指征。
身热、自然出汗、不怕冷反而怕热，这是阳明表证的提纲。所以，胃中虚冷，也可以称为阳明病，因为其表证表现符合这一提纲。然而，这属于内热发散到体表的表证，而不是中风或伤寒那种外感表证。此时表寒已经消散，所以不怕冷；里热闭结，所以反而怕热。仅仅因为有“胃家实”的病根，才会出现这种身热自汗的外症、不怕冷反而怕热的病情。然而，这里只是说明病机的显现，并不是立即就可以使用攻下法的指征，必须等到谵语、潮热、烦躁、胀痛等症状同时出现时，才可以考虑攻下。
太阳病的总纲展示给人看的是正面，阳明病的总纲反过来展示给人看的是底板（基础）。阳明的正面与太阳的表证相同，但也应当看出阳明的表证与太阳不同。例如，阳明病，脉迟、汗出多、轻微恶寒的，这是阳明病的桂枝汤证；阳明病，脉浮、无汗且喘息的，这是阳明病的麻黄汤证。《伤寒论》原文说“得病第一天，不发热而恶寒”，指的就是这种情况。后人看到太阳病已有这些脉症，就说阳明病不应有这些脉症，因此有了“病尚在太阳，即将转入阳明”的说法。不知道张仲景的书中，有很多条文在本条未出现，而在其他条文中出现的，比如开始时的恶寒和反无汗等语句就是例子。因为阳明表证本来应该是自汗且不恶寒，所以加上“虽”、“反”字来强调。有本经症状未完全显现而其他经症状先出现的，比如太阳病的头项强痛、少阳病的脉弦细就是例子。如果头痛但项部不强硬，脉大但不弦细，那就是阳明病的表证。太阳行于身体背部，阳明行于身体前部，所受的风寒，都在营卫的表层。太阳的营卫有虚实之分，阳明的营卫也有虚实之分。虚证用桂枝汤，实证用麻黄汤，这是张仲景治疗表邪的定法。张仲景的方剂，是根据症状设立的，不是根据经脉设立的，见到这个症状就给这个方子，这是张仲景的活法。后人错误地用方剂来划分经络，不仅不敢在阳明病中使用这两个方子，就连太阳病也抛弃很久了。阳明病的表证有两种：一种是外邪刚侵袭的表证，一种是内热发散到体表的表证。外邪的表证，只在一两天内，症状是轻微恶寒、汗出多，或者无汗而喘息。内热的表证，在一两天后出现，症状是身热、自汗、不怕冷反而怕热。因为表证是由于风寒外束，所以张仲景也用麻黄汤、桂枝汤发汗；因为表证是由于内热外发，所以张仲景另外制定了栀子豉汤，顺应病势采用涌吐法。后人认不出阳明病的表证，一两天时不敢用麻黄、桂枝，两三天后，又不知道用栀子豉汤。不认识张仲景治疗阳明病的初期方法，所以废弃了张仲景的吐法，一定要等到热邪极深、实邪至极，才开始用白虎汤、承气汤投治，这是养虎为患。六经伤寒中，只有阳明病最轻，因为阳明是水谷之海，谷气足以战胜邪气；阳明是十二经脉之长，血气足以抵御寒气；阳明处于两阳合明之地，阳气足以抵御阴气。阳明病感受阴邪，第一天恶寒与太阳病相同，第二天就不恶寒反而怕热。所以《内经》说：“第二天阳明受邪”，是因为阳明病的症状在第二天出现，并不是说阳明病是在太阳经受邪时交接过来的。张仲景说：“伤寒第三天，阳明脉大。”要知道阳明伤寒，在第一二天，寒去热生，第三天出现阳明的大脉，就完全没有寒气了，这就是阳明病的热证，而不是前一天的伤寒了。开始时虽然由于伤寒，现在不能再称伤寒，不能用治疗伤寒的药剂来治疗它。阳明病的恶寒，第二天自然停止，确实与其他经不同，而且其恶寒轻微，不像太阳病那么严重。阳明病在肌肉中蒸蒸发热，只有热没有寒，与太阳病翕翕发热、寒束于皮毛之上不同。阳明病的自汗，也与太阳中风病的自汗不同。太阳病虽然自汗，但汗出不畅，有一种拘谨的感觉，所以形容为“濈然微汗”；阳明病自汗，多有波澜摇动之状，所以名曰“漐漐汗出”。太阳病脉浮紧的，热必不解；阳明病脉浮紧的，必有潮热；太阳病脉仅浮的，必无汗；阳明病脉仅浮的，必盗汗出。两经的表证和表脉差异如此之大。
现在的伤寒书，用头痛来区分三阳病，阳明病的头痛在前额，道理固然如此。然而阳明主里，头痛不是它的本证。《内经》说：“伤寒第一天，巨阳（太阳）受邪，因为它的经脉连接风府，所以头项痛。第七天太阳病衰退，头痛减轻。”这是《内经》认为头痛属于太阳，不属于阳明。张仲景有两条例文涉及阳明头痛：一条说阳明病，反而无汗且小便通利，两三天后呕吐且咳嗽，手脚厥冷的，必定痛苦于头痛；如果不咳嗽不呕吐，手脚不厥冷，头就不痛。这条头痛出现在第二三天，而不是得病的第一天，并且是因为呕吐咳嗽引起的，而不是因为外邪。另一条说伤寒不大便六七天，头痛身热的，给予承气汤。这条头痛反而出现在太阳病衰退的时候，并且是因为不大便引起的，也就是《内经》所说的腹胀而头痛，不是因为风寒引起的。其中关于中风伤寒的各条，都没有提及头痛症，在阳明病头痛方面，又与太阳病截然不同。
《伤寒论》原文说“阳明病，脉浮而紧，咽燥口苦，腹满而喘，发热汗出，不恶寒，反恶热，身重”，此处应当直接接“栀子豉汤主之”一句。如果发汗三段文字，是因为没用此方而误治导致的，仍然应当用栀子豉汤主治。张仲景只在结尾处提到一次，这是省文的写法。后人竟然认为栀子豉汤是发汗、攻下后的救逆之剂，请问在未发汗、攻下之前，张仲景用什么方法治疗呢？要知道咽燥口苦、腹满而喘，是阳明里热；发热汗出、不恶寒、反恶热，是阳明表热。因为阳明之热从内达表，则里证为重，所以这条叙述症状，把里证列在表证之前。任栀子清里热，而表热也随之解除；用香豉泻腹满，而身重也随之消除。后人不能在张仲景书中找出阳明病的表证，就匆忙引用《内经·热病论》中的目痛鼻干不得卧来对应它；得不到张仲景治疗阳明表证的方法，胡乱使用痘科中的葛根升麻汤来主治；不知道《内经》因为论述热病，只阐明了阳明经病的一个方面，张仲景确立阳明一经，是该涵盖内外症状治疗的主体；又不知道目痛鼻干是阳盛阴虚，法当滋阴清火，反而发阳明之汗，上则鼻衄，下则大便困难，这是引邪入内了。要知道如果是风寒之表，就用麻黄、桂枝治疗。如果是内热之表，即使是荆芥、薄荷，也足以耗伤津液而成胃实。这取决于使用者的运用罢了。
治疗阳明表热有三种方法：热在上焦，用栀子豉汤涌吐它，上焦通畅，津液得以下行，胃家就不会实了；热在中焦，用白虎汤清解它，胃火得以清除，胃家就不会实了；热陷在下焦，用猪苓汤利小便，火邪从下泄出，胃家就不会实了。要知道治疗阳明的表热，就是预先治疗其里，这三个方子都是润剂，所以能保存津液而不令胃家实。后人沿袭升麻葛根的谬误，不考察张仲景治疗阳明表证的方法。
太阳病以心胸为里，所以用辛甘发散的药剂，助心胸之阳而开玄府之表，不能用苦寒的药剂，以免损伤上焦之阳，所以宜发汗而不宜涌吐。阳明病以心胸为表，应当用酸苦涌泄的药剂，引胃脘之阳而开胸中之表，不当用温散的药剂，以免损伤中宫之津液，所以法当涌吐而不当发汗。阳明病应当涌吐而反而发汗、攻下、温针等法，导致心中烦闷懊恼、恐惧惊惕、懊憹、烦躁、谵语、舌苔异常等症状，然而这些都不离开阳明之表。太阳病应当发汗而反而涌吐，便见自汗出、不恶寒、饥而不能食、朝食暮吐、不欲近衣、想喝冷饮等症状，此为太阳病转属阳明之表，都是栀子豉汤证。大概阳明以胃实为里，不仅发热、恶寒、汗出、身重、目痛、鼻干为之表，一切虚热，如口苦、咽干、舌苔、喘满、不得卧、消渴而小便不利，凡在胃之外的，都属阳明之表。只要去除胃口之热，就能解决胃家之实，这就是栀子豉汤作为阳明解表圣剂的原因。
根据《伤寒论》，阳明病，脉浮而紧，自汗出，轻微恶寒，是阳明表证；心烦，小便频数，脚挛急，是阳明里的表证。此时如果用栀子豉汤涌吐它，则胃阳得以升发，恶寒自然罢止，心烦得以停止，汗自然不出；上焦通畅，津液得以下行，小便自利，脚自然伸展。反而用桂枝汤发表，所以导致亡阳，出现咽中干、烦躁、吐逆，这是栀子生姜豉汤证。只是因为亡阳而四肢厥冷，急当回阳。改用甘草干姜汤，阳气恢复后，仍用芍药甘草汤调和阴液，少量给予调胃承气汤调和里气，都是因为先前未能及时使用栀豉汤，如此挽回十分费力。
根据张仲景所说“病像桂枝证”，就不能死板地定为太阳中风。凡是恶风、恶寒、发热而自汗出的，无论太阳、阳明、中风、伤寒，都是桂枝汤证。太阳病，头项强痛，而这里说头不痛、项不强，就不是太阳病。《内经》说：“邪气中于膺部，则传入阳明。”这里说胸中痞塞坚硬，气上冲咽喉导致呼吸不畅，是阳明受病无疑。虽然外症象桂枝证，但病在胸中，不在营卫，就不是桂枝证。所以设立瓜蒂散，所谓“在上者，因而越之”。这与前一条本是阳明病，张仲景不冠以阳明名称的原因一样，因为不涉及胃实，且未见不恶寒的病情。
上越（涌吐）、中清（清热）、下夺（攻下），是治疗阳明的三大法则；发汗、利小便，是阳明经的两大禁忌。然而对于风寒初入阳明之表的情况，立即使用麻黄、桂枝发汗的，是因为急于除热而保存津液，与急下存阴的方法相同。如果脉浮、烦渴、小便不利，使用猪苓汤利小便的，也是为了清火而保存津液。但又说汗多的，不可与猪苓汤。要知道发汗、利小便，是治疗阳明的权巧法门，不是正治法。
阳明病的病机在于热实，按理说不应该有温补法了，但如果进食就想呕吐的，这是胃口虚寒，所以不主内热。然而胃口虽虚，胃中犹实，仍不失为阳明病，用吴茱萸汤散胃口之寒，上焦通畅，津液下行，胃气因而调和，那么温补又是阳明病的从治法。如果胃口虚热的，用白虎加人参汤，说明阳明又有凉补法。这两种意义又是治疗阳明的权巧法门。
《伤寒论》原文说：“伤寒第三天，三阳经的病邪已尽，三阴经应当受邪。其人反而能吃不呕吐，这说明三阴经不受邪了。”大概阳明是三阴经的表，所以三阴经都看阳明的转旋，三阴经之所以不受邪，是借助胃来遮蔽外部。胃气调和就能吃且不呕吐，所以邪气自解而三阴不病。胃阳虚，邪气才得以进入三阴。所以太阴受邪，腹满而吐，食不下；少阴受邪，想吐又吐不出来；厥阴受邪，饥饿不想吃东西，吃了就吐蛔虫。如果胃阳亡失，则水浆不入而死。要知道三阴受邪，关系不在于太阳、少阳，而全在于阳明。阳明以太阴为里，是指牝藏（阴脏）而言；太阴也以阳明为里，是指转属而言。肾是胃的关隘，水是土的贼害，所以三阴也能以阳明为里。三阴是三阳的里，而三阴反而能转属阳明为里，所以三阴都能通过阳明而下，那么阳明又是三阴经实邪的出路。既作为三阴的表以抵御邪气，又作为三阴的里以驱逐邪气，阳明对三阴的关系重大了。
According to the outline of Yangming disease, the focus is on interior syndromes. Although exterior syndromes may exist, Zhang Zhongjing's intent is not on treating the exterior, because this represents internal pathology manifesting externally. If there are concomitant meridian diseases (pathological changes at the level of meridians), Zhang Zhongjing's intent is also not on treating the meridians, because the symptoms manifest in the meridians but the root lies in the Stomach organ. Taiyin and Yangming both reside in the Middle Jiao, but Taiyin governs opening (Kai), while Yangming governs closing (He). Therefore, Yangming disease must primarily be characterized by "closing" (closure, obstruction): constipation is certainly "closing"; oliguria is also "closing"; inability to eat, difficulty in feeling full after eating, initial desire to eat followed by an inability to eat—all these are "closing". Spontaneous sweating or night sweats indicate that the exterior is open while the interior is closed; conversely, absence of sweating indicates that both interior and exterior are closed. Various types of "closing" syndromes may or may not be present; thus, the outline specifically emphasizes "Stomach Excess" (Wei Shi) as the core. The term "Stomach Excess" does not solely refer to dry, hard feces, but stands in contrast to diarrhea; diarrhea implies that the Stomach is not in a state of excess. Therefore, after resolving the exterior through sweating, if diarrhea occurs due to disharmony in the Stomach, it is not classified as Yangming disease. If the Stomach is deficient and cold but does not present with diarrhea, it belongs to Yangming disease; even if the stool is initially hard and later loose, water and grain are not separated, or even if the condition is critical without diarrhea, it is generally categorized under Yangming disease. Essentially, Taiyin and Yangming are both officials responsible for food processing, yet their functions differ. The Stomach governs reception, so Yangming governs excess syndromes; the Spleen governs transportation, so Taiyin governs diarrhea. Although both involve the Stomach, treatments are distinguished thus, marking the differentiation between these two meridians. As Yangming is a fu-organ of transmission and transformation, it should alternate between fullness and emptiness: when food enters the Stomach, the Stomach is full and the Intestines empty; when food moves to the Intestines, the Intestines are full and the Stomach empty. If there is only fullness without emptiness, this constitutes the root of Yangming disease. "Stomach Excess" itself is not the entirety of Yangming disease, but all manifestations of Yangming disease stem from Stomach Excess; hence, "Excess in the Stomach House" (Wei Jia Shi) serves as the general outline for the Yangming channel. However, the causes leading to "excess" require careful examination: some cases have excess pathogenic factors prior to illness onset, others develop excess after contracting the disease, some result from external constriction by wind-cold preventing heat dispersion leading to excess, some arise from reckless use of vomiting, sweating, or purging methods causing severe fluid depletion leading to excess, some stem from intense heat within the primary channel leading to excess, and others result from heat intensifying in other channels transferring over leading to excess. Here, only the pathological root lying in "excess" is cited; one must not immediately consider "Stomach Excess" as an indication for purgative therapy.
Body heat, spontaneous sweating, aversion to cold being absent but aversion to heat appearing—these constitute the outline of Yangming exterior syndromes. Thus, even cold deficiency in the Stomach can be termed Yangming disease, because its exterior presentation fits this outline. However, this represents an exterior syndrome caused by internal heat radiating outward, rather than the exterior syndrome of Wind-Stroke or Cold Damage. At this stage, exterior cold has dissipated, hence no aversion to cold; interior heat is constrained, hence aversion to heat. Merely having the pathological root of "Excess in the Stomach House" leads to these external signs of body heat and spontaneous sweating, and the clinical picture of no aversion to cold but aversion to heat. Nevertheless, this merely describes the manifestation of the disease mechanism, not an immediate indication for purgation. Purgation is only appropriate when symptoms such as delirium, tidal fever, irritability, and distending pain appear concurrently.
The general outline of Taiyang disease presents the "frontal" aspect, whereas the general outline of Yangming disease presents the "base" or foundation. The frontal aspect of Yangming shares similarities with the exterior of Taiyang, yet one must discern how Yangming's exterior differs from Taiyang's. For instance, in Yangming disease, if the pulse is slow, sweating is profuse, and there is slight aversion to cold, this is the Guizhi Tang (Cinnamon Twig Decoction) pattern of Yangming; if the pulse is floating, there is no sweating accompanied by wheezing, this is the Mahuang Tang (Ephedra Decoction) pattern of Yangming. The Treatise states, "On the first day of illness, without fever but with aversion to cold," referring to this situation. Later scholars, seeing these pulse and symptom patterns in Taiyang disease, argued that Yangming disease should not exhibit them, leading to theories that the disease remains in Taiyang before transitioning to Yangming. They fail to recognize that in Zhang Zhongjing's work, many conditions described in one section may appear in another; examples include initial aversion to cold and contrary absence of sweating. Since Yangming exterior syndromes naturally involve spontaneous sweating and no aversion to cold, words like "although" and "contrary" are added for emphasis. There are instances where primary channel symptoms are not fully manifested but symptoms from other channels appear first, such as head and nape stiffness in Taiyang or wiry-thin pulses in Shaoyang. If there is headache but no nape stiffness, and a large pulse rather than a wiry-thin one, this indicates the exterior of Yangming. Taiyang runs along the posterior body, while Yangming runs along the anterior body; the wind-cold they receive affects the Ying and Wei levels of the exterior. Both Taiyang and Yangming Ying-Wei levels have deficiency and excess patterns. Deficiency calls for Guizhi Tang, excess calls for Mahuang Tang; this is Zhang Zhongjing's standard approach for treating exterior pathogens. Zhang Zhongjing's formulas were established based on symptoms, not strictly on meridians; prescribing a formula upon observing specific symptoms represents his flexible methodology. Later practitioners erroneously divided formulas by meridians, refusing to use these two formulas in Yangming disease and abandoning them even in Taiyang disease. Yangming exterior syndromes fall into two categories: one is the exterior affected by initial external pathogens, and the other is the exterior resulting from internal heat radiating outward. The former occurs within one or two days, presenting with slight aversion to cold, profuse sweating, or absence of sweating with wheezing. The latter appears after one or two days, presenting with body heat, spontaneous sweating, no aversion to cold, but aversion to heat. Because the exterior constraint is due to wind-cold, Zhang Zhongjing uses Mahuang Tang and Guizhi Tang to induce sweating; because the exterior manifestation is due to internal heat radiating outward, he devised Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) to induce vomiting according to the pathogen's trend. Later practitioners failed to identify Yangming exterior syndromes; they dared not use Mahuang or Guizhi in the first two days, and did not know to use Zhizi Chi Tang in the next few days. Unfamiliar with Zhang Zhongjing's initial treatment methods for Yangming, they abandoned the vomiting method, waiting until heat was deep and excess extreme before administering Baihu Tang (White Tiger Decoction) or Chengqi Tang (Descending Qi Decoction), which is akin to nurturing a tiger only to invite disaster. Among the Six Channels' Cold Damage, Yangming is the mildest, because Yangming is the sea of water and grain, where grain qi suffices to overcome pathogenic qi; Yangming is the leader of the twelve meridians, where blood and qi suffice to resist cold qi; Yangming resides in the realm of combined Yang brightness, where Yang qi suffices to resist Yin qi. When Yangming contracts Yin pathogenic factors, aversion to cold on the first day is similar to Taiyang; by the second day, aversion to cold ceases and aversion to heat begins. Thus, the *Neijing* states, "On the second day, Yangming receives the pathogen," meaning Yangming symptoms appear on the second day, not that Yangming disease originates from transmission during Taiyang contraction. Zhang Zhongjing stated, "On the third day of Cold Damage, the Yangming pulse is large." One must understand that in Yangming Cold Damage, after the first two days, cold dissipates and heat arises; the appearance of the large Yangming pulse on the third day indicates the complete absence of cold, signifying Yangming heat disease rather than the previous day's Cold Damage. Although initially caused by Cold Damage, it can no longer be termed Cold Damage, nor treated with Cold Damage remedies. Yangming's aversion to cold subsides spontaneously on the second day, differing from other channels, and is mild compared to Taiyang. Yangming features steaming heat within the muscles, characterized by heat without cold, distinct from Taiyang's fluttering heat with cold constricting the skin and hair pores. Yangming's spontaneous sweating differs from Taiyang Wind-Stroke spontaneous sweating. In Taiyang, although there is spontaneous sweating, the flow is obstructed, giving a sense of restraint, described as "profuse slight sweating"; in Yangming, spontaneous sweating often has a rippling motion, hence termed "dripping sweat." In Taiyang disease, a floating-tight pulse ensures heat will not resolve; in Yangming disease, a floating-tight pulse必然 accompanies tidal fever; in Taiyang, a merely floating pulse必然 means no sweating; in Yangming, a merely floating pulse必然 results in night sweats. The differences in exterior syndromes and pulses between these two channels are thus significant.
Current Shanghan texts differentiate the three Yang channels by headache, placing Yangming headache in the forehead, which is logical. However, Yangming governs the interior, and headache is not its primary symptom. The *Neijing* states, "On the first day of Cold Damage, Juyang (Taiyang) receives the pathogen; because its meridians connect to Fengfu, head and nape pain occur. On the seventh day, Taiyang disease declines, and headache lessens." This indicates the *Neijing* attributes headache to Taiyang, not Yangming. Zhang Zhongjing provides two clauses regarding Yangming headache: one states that in Yangming disease, contrary absence of sweating with free urination, followed by vomiting and coughing with cold extremities on the second or third day, inevitably involves severe headache; if there is no coughing or vomiting, and extremities are not cold, the head does not hurt. This headache occurs on days two or three, not the first day, and is caused by vomiting and coughing, not external pathogens. Another clause states that in Cold Damage with constipation for six or seven days, accompanied by headache and body heat, administer Chengqi Tang. This headache appears when Taiyang disease declines, caused by constipation, corresponding to the *Neijing*'s description of abdominal distension causing headache, not due to wind-cold. Other clauses on Wind-Stroke and Cold Damage do not mention headache; Yangming headache is distinctly different from Taiyang.
The Treatise states, "Yangming disease, floating-tight pulse, dry throat, bitter taste, abdominal fullness and wheezing, fever, sweating, no aversion to cold, contrary aversion to heat, heaviness of the body." Here, it should directly follow with "Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) governs." The subsequent paragraphs on sweating represent mismanagement due to failing to use this formula; thus, Zhizi Chi Tang should still be administered. Zhang Zhongjing mentions this only at the conclusion, employing ellipsis. Later practitioners mistakenly regarded Zhizi Chi Tang solely as a rescue formula post-sweating or purging. One must ask: what method did Zhang Zhongjing use prior to sweating or purging? Understand that dry throat, bitter taste, abdominal fullness, and wheezing indicate Yangming interior heat; fever, sweating, no aversion to cold, and aversion to heat indicate Yangming exterior heat. Because Yangming heat radiates from interior to exterior, the interior syndrome is heavier; hence, the symptom sequence lists interior signs before exterior ones. Let Gardenia clear interior heat, thereby resolving exterior heat; let Fermented Soybean drain abdominal fullness, thereby eliminating heaviness. Later practitioners failed to identify Yangming exterior syndromes in Zhang Zhongjing's text, hastily citing the *Neijing*'s eye pain, nasal dryness, and insomnia from the *Heat Disease Treatise*; lacking Zhang Zhongjing's method for treating Yangming exterior, they recklessly used Ge Gen Sheng Ma Tang (Kudzu and Cimicifuga Decoction) from smallpox clinics; unaware that the *Neijing*, discussing heat diseases, only elucidated one aspect of Yangming channel disease, whereas Zhang Zhongjing established the Yangming channel to encompass comprehensive internal and external treatment principles; furthermore, unaware that eye pain and nasal dryness indicate Yangming excess and Yin deficiency, requiring nourishment of Yin and clearing of fire, yet instead inducing Yangming sweating, leading to epistaxis above and constipation below, thereby drawing pathogens inward. One must know that if it is a wind-cold exterior, use Mahuang and Guizhi. If it is an interior heat exterior, even herbs like Jingjie (Schizonepeta) and Bohe (Mint) can deplete fluids and lead to Stomach excess. It depends entirely on the practitioner's application.
There are three methods for treating Yangming exterior heat: if heat is in the Upper Jiao, use Zhizi Chi Tang to induce vomiting; once the Upper Jiao is unblocked, fluids descend, and the Stomach House avoids excess. If heat is in the Middle Jiao, use Baihu Tang (White Tiger Decoction) to clear it; once stomach fire is cleared, the Stomach House avoids excess. If heat sinks to the Lower Jiao, use Zhuling Tang (Polyporus Decoction) to promote urination; once fire drains downward, the Stomach House avoids excess. Understand that treating Yangming exterior heat is essentially preemptive treatment of the interior; all three formulas are moistening agents, preserving fluids and preventing Stomach excess. Later practitioners followed the error of Ge Gen and Sheng Ma, neglecting Zhang Zhongjing's methods for Yangming exterior syndromes.
In Taiyang disease, the chest and heart constitute the interior; thus, acrid-sweet dispersing agents are used to assist Heart-Chest Yang and open the Xuanfu (mysterious gate) exterior, avoiding bitter-cold agents that would damage Upper Jiao Yang; hence, sweating is indicated, not vomiting. In Yangming disease, the chest and heart constitute the exterior; thus, sour-bitter draining agents are used to guide Stomach-Writh Yang and open the Chest exterior, avoiding warm-dispersing agents that would damage Middle Jiao fluids; hence, vomiting is indicated, not sweating. If Yangming disease requires vomiting but sweating, purging, or moxibustion are incorrectly applied, resulting in mental confusion, fearfulness, restlessness, irritability, delirium, and abnormal tongue coating, these symptoms remain within the Yangming exterior. If Taiyang disease requires sweating but vomiting is incorrectly applied, resulting in spontaneous sweating, no aversion to cold, hunger but inability to eat, morning food vomited in evening, aversion to clothing, desire for cold drinks, this represents Taiyang transitioning to Yangming exterior, all constituting Zhizi Chi Tang patterns. Essentially, Yangming regards Stomach Excess as the interior; not only fever, aversion to cold, sweating, body heaviness, eye pain, and nasal dryness constitute the exterior, but all deficiency-heat conditions such as bitter taste, dry throat, tongue coating, wheezing/fullness, insomnia, thirst with oliguria, anything outside the Stomach, belong to Yangming exterior. Removing heat from the Stomach mouth resolves Stomach House excess; thus, Zhizi Chi Tang is the supreme agent for resolving Yangming exterior.
Regarding the Treatise: "Yangming disease, floating-tight pulse, spontaneous sweating, slight aversion to cold" constitutes Yangming exterior syndrome; "mental irritability, frequent urination, leg cramping" constitutes the interior-exterior syndrome of Yangming. At this time, using Zhizi Chi Tang to induce vomiting allows Stomach Yang to rise, aversion to cold to cease, mental irritability to stop, and sweating to halt; with the Upper Jiao unblocked and fluids descending, urination becomes normal, and legs extend. Conversely, using Guizhi Tang to release the exterior causes loss of Yang, leading to dry throat, irritability, and vomiting/retching, constituting Zhizi Shengjiang Chi Tang (Gardenia, Fresh Ginger, and Fermented Soybean Decoction). Due to loss of Yang and cold extremities, urgent restoration of Yang is required. Switching to Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) restores Yang; afterwards, Shaoyao Gancao Tang (Peony and Licorice Decoction) harmonizes Yin, and small doses of Tiaowei Chengqi Tang (Regulate and Nourish Stomach Descending Qi Decoction) harmonize the interior. These measures are necessary due to the earlier failure to use Zhizi Chi Tang, making recovery laborious.
Zhang Zhongjing stated, "The illness resembles the Guizhi pattern," meaning it cannot rigidly be diagnosed as Taiyang Wind-Stroke. Any case involving aversion to wind/cold, fever, and spontaneous sweating, regardless of Taiyang/Yangming or Wind-Stroke/Cold Damage, constitutes a Guizhi pattern. Taiyang disease features head and nape stiffness; here, the absence of headache and nape stiffness rules out Taiyang. The *Neijing* states, "Pathogens striking the chest enter Yangming." Here, chest oppression and hardness, with Qi rushing to the throat causing breathing difficulty, confirms Yangming disease. Although external signs resemble Guizhi pattern, the pathology is in the chest, not in Ying-Wei, thus it is not a Guizhi pattern. Hence, Gouti San (Melon Seed Powder) is prescribed, following the principle, "Those above, cause them to ascend/vomit." This aligns with the previous clause where Yangming disease is not explicitly labeled as such because it does not involve Stomach Excess nor the characteristic lack of aversion to cold.
Superior ascending (vomiting), middle clearing (clearing heat), and inferior purging (draining down) are the three major methods for treating Yangming; inducing sweating and promoting urination are the two major prohibitions for Yangming channel. However, for wind-cold initially affecting Yangming exterior, immediately using Mahuang and Guizhi to induce sweating is done to urgently remove heat and preserve fluids, similar to urgent purging methods. If the pulse is floating with irritability and thirst, and urination is difficult, using Zhuling Tang to promote urination is also to clear fire and preserve fluids. Yet, it is stated that those with profuse sweating should not receive Zhuling Tang. Understand that sweating and promoting urination are expedient methods for treating Yangming, not standard treatments.
Yangming disease involves heat and excess, theoretically excluding warming tonification. However, if eating induces vomiting, this indicates deficiency-cold at the Stomach mouth, not internal heat. Although the Stomach mouth is deficient, the Stomach interior remains excess, still qualifying as Yangming disease. Using Wuzhuyu Tang (Evodia Decoction) to disperse Stomach mouth cold, unblock the Upper Jiao, allow fluids to descend, and harmonize Stomach Qi makes warming tonification a compliant treatment method for Yangming. If the Stomach mouth has deficiency-heat, using Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) shows Yangming also employs cooling tonification. These two meanings represent expedient methods for treating Yangming.
The Treatise states, "On the third day of Cold Damage, the Three Yang channels are exhausted, and the Three Yin channels should receive pathogens. If the person can eat and not vomit, this indicates the Three Yin channels do not receive pathogens." Essentially, Yangming is the exterior of the Three Yin channels; thus, the Three Yin channels depend on Yangming's rotation. The Three Yin channels avoid pathogens because the Stomach shields the exterior. Harmonized Stomach Qi allows eating without vomiting, so pathogens resolve and Three Yin remain healthy. If Stomach Yang is deficient, pathogens enter the Three Yin. Thus, Taiyin receiving pathogens causes abdominal fullness, vomiting, and inability to eat; Shaoyin receiving pathogens causes desire to vomit but inability to do so; Jueyin receiving pathogens causes hunger without desire to eat, and vomiting roundworms upon eating. If Stomach Yang perishes, ingestion of fluids fails, leading to death. Understand that the transition of pathogens to the Three Yin depends not on Taiyang or Shaoyang, but entirely on Yangming. Yangming regards Taiyin as its interior, referring to the Yin organs; Taiyin also regards Yangming as its interior, referring to transition. The Kidney is the gate of the Stomach; Water is the thief of Earth; thus, the Three Yin can also regard Yangming as their interior. The Three Yin are the interior of the Three Yang, yet the Three Yin can transition to Yangming as their interior; therefore, the Three Yin can exit via Yangming, making Yangming the outlet for excess pathogens of the Three Yin. Acting as the exterior of the Three Yin to resist pathogens and the interior of the Three Yin to expel pathogens, Yangming's relationship with the Three Yin is profound.