（此系仲景原文）
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。（此一节。连下二节。乃
仲景设为问答。以见三阳经皆有入府之证也。阳明者。胃府也。成注云。邪自太阳经传入于府者。谓之太阳阳明邪自阳
明经传入于府者。谓之正阳阳明。邪自少阳经传入于府者。谓之少阳阳明经云。此三经受病。已入于府者。可下而已。
即此谓也。太阳阳明者。庞安时云。本太阳病。若发汗若下若利小便。此亡津液。胃中干燥。因转属阳明。而成脾约之
证。愚以胃中干燥。则脾气亢热。其人于未病时。胃中所受水谷。虽变为糟粕而下入于大肠。要之脾既亢热。则水之精
气不能四布。肠中无水气以滋之。若为之围绕束缚。所以大便欲出而甚难。则是肠之约。实脾气亢热而为之约也。愚按
此条论。仲景自有麻仁丸主之。成注又引小承气汤。殊出不解。盖成注所以引太阳病。若吐若下若发汗后。微烦。小便
数。大便因硬者。此未成脾约证。故与小承气汤。若云。即是脾约证。误矣。）
正阳阳明者。胃家实是也。（方氏条辩云。正谓本经也。以病到本经。遂入胃而成胃实是也。庞安时云。病患本风盛
气实。津液消铄。或始恶寒。汗出后。恶寒既罢。而反发热。或始得病。便发热狂言者。名曰正阳阳明。乃知其入府之
由。有两道焉。恶寒者。自太阳经传来。便发热者。由本经入府也。武林陈亮斯亦云。有从阳明经自受病。而入胃府者。
如素问云。中于面。则下阳明是也。有从他经传入阳明。而后入府者。如后文转属阳明之类是也。盖太阳既转属阳明。
亦是正阳阳明。而非太阳阳明矣。此不可不辩也。愚以少阳阳明入府之由。亦仿此。或问前条证。庞氏引后节。何缘得
阳明病之文而云。太阳病若发汗云云。因转属阳明。为太阳阳明病。今陈氏于此条。又引其文而云。太阳既转属阳明。
此亦是正阳阳明病。二者孰是孰非。余答云。二者之言皆是学人须临证辩之。转属阳明而犹带太阳表证。或头项强痛。
或恶寒者。此即是太阳阳明。若头不痛。项不强。太阳表证毫无者。此即是正阳阳明也。少阳阳明亦然。以寒热往来等
候之有无辩之。）
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。本少阳经病。少阳不可发汗。及利小便。
如误发其汗。则津液既亡于表。误利其小便。则津液复夺于前。津液既去。因传入阳明之府。则胃中燥烦且实。而大便
难。盖胃无津液故燥。燥则生烦热也。夫仲景虽云胃中实。愚以其云实者。本兼大肠之府而言。惟大肠府实。以故大便
难况大肠亦属阳明之府也。庞安时云。本传到少阳。因发汗利小便。胃中燥。大便难者。名曰少阳阳明。按成注于前条
胃家实之证。引阳明病脉迟云云。大承气汤以主之。于此条大便难。独无治法。后之人。有以三承气汤。分治上三条证
者。愚以其说亦非切当。大抵太阳阳明证。宜桂枝加大黄汤。正阳阳明证。宜三承气汤选用。少阳阳明证。宜大柴胡汤。
此为不易之法。）
阳明之为病。胃家实也。（武林陈氏注云。此节承上三节而言。三阳明之为病。其入胃之涂。虽有不同。而邪在胃家。
其实则一而已故正阳阳明。固为胃家实矣。而太阳之脾约。少阳之大便难。又何尝非胃家实乎。以其均入阳明。均为胃
实。故总结之曰。阳明之为病。胃家实也。条辩云。实者。大便结。为硬满而不得出也。愚按此言。则是仲景云。胃家
实。当兼大肠府实合看。以肠与胃。上下实相通也。所以海藏辩胃中有燥屎五六枚云。此非在胃中也。通言阳明也。言
胃。是连及大肠也。今者。大便结为硬满。则大肠火燥之气。逆而上行。故名曰胃中实。要之胃中非有物也。据海藏此
言。实与上文胃家实之义。互相发明。学人细玩其说。斯义自见。）
问曰。何缘得阳明病。答曰。太阳病若发汗。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。（此一节。乃设为问答。以明阳明府病也。问曰。何由而得阳明府病。答曰。由太阳病。若发汗。
若下。若利小便。治之不当。徒亡津液。津液者。胃中之所聚也。津液既亡。则胃中干燥。太阳之邪不解。因转属阳明
之府。不更衣者。不大便也。注已。见前太阳中篇。成注云。不更衣。则胃中物不得泄。故为内实。内实者。大肠以内
坚结也。肠内坚结。以故大便难若此者。乃阳明府实之病也。愚按此条论。虽由太阳病不解。转属阳明之府。然曰不更
衣。内实。大便难毫无太阳经病。所以尚论篇云。此属正阳阳明。为可下之证。或问太阳病若下矣。则胃中之物已去。
纵亡津液。胃中干燥。未必复成内实。余答云。方其太阳初病时。下之不当。徒亡汗液。胃中之物。依然不泄。必转属
阳明而成燥粪。故成内实之证。此条仲景但示人以认证。以故不及治法。）问曰。阳明病。外证云何。答曰。身热。汗自
出。不恶寒。反恶热也。（上言阳明病系胃家内实。其外见证。从未言及。故此条又设为问答云。阳明入府之病。其外证
云何。答曰阳明外证。则身热。身热者。身以前热也。夫身热与发热异。以其热在肌肉之分。非若发热之翕翕然。仅在
皮肤以外也。汗自出者。府中实热。则津液受其蒸迫。故其汗则自出也。又此条汗自出。与太阳中风汗自出亦有异。太
阳病。则汗虽出而不能透。故其出亦甚少。此条病。则汗由内热蒸出。其出必多而不能止也。不恶寒者。邪不在表也。
反恶热者。明其热在里也。伤寒当恶寒。故以恶热为反。然邪既入胃寒化为热。夫恶热虽在内之证。愚以其状必见于外。
或扬手掷足。迸去覆盖。势所必至。因外以证内。其为阳明府实证无疑矣。尚论篇以此条病。辩阳明中风证兼太阳。若
以其邪犹在于经。大误之极。大抵此条病。乃承气汤证。）
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（此节连下节。
申言阳明病亦有恶寒之证。故复设为问答以明之。问曰。阳明病皆身热不恶寒。今病有始得之一日。身不发热而恶寒。
此恶寒者。非比太阳病之恶寒。夫太阳为寒水之经。其表寒必甚。此为阳明病恶寒。阳明为燥金之经。其表寒自微。惟
其微。故答云。虽得之一日。恶寒将自罢。自罢者。从未发表而寒自已。即自汗出而恶热。自汗出恶热。乃阳明病入府
之外证。注已见前。按成注云。不发热恶寒。即邪未全入府。尚带表邪。此表邪者。乃阳明经在表之邪。其人必外病头
额痛而恶寒。内病胃府实。随即自汗出而恶热。后条辩评云。初得阳明。表气被阻。故亦有不发热而恶寒证。须臾即化
热矣。邪不关表故也。斯言深得仲景立论之意。）
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。
（此承上文发明恶寒自罢之故。其所以自罢者。以阳明胃府。居人身之中。主养四旁。成注云。凡四旁有病。皆能
传入于胃。胃属土。土为万物所归。万物归于土中。则其化衰息。无复变动。故云。无所复传。始虽恶寒。二日自止者。
譬之冬寒已极。一遇土王。则寒化衰息。是即止之义也。此为正阳阳明。乃可下之证。后条辩注万物所归。无所复。传
二句云。阳明以下法为正。必五脏六腑之邪。皆归结于此。别无去路。方是下证之阳明。等闲莫教错了。）
本太阳初得病时。发其汗。汗先出不彻。因转属阳明也。（此条系太阳病。转属阳明经之证。按前第五节云。太阳病。
若发汗。亡津液。胃中干燥。因转属阳明。此为发汗太过。邪已离表。乃阳明府病也。今此太阳初得病之时。发汗不彻。
转属阳明。此为发汗不及。邪还在表。愚故云。此系阳明经病。若议用药。仲景法。当以葛根汤主之。汗出不彻义。注
见前太阳中篇。）
伤寒发热。无汗。呕不能食。而反汗出 然者。是转属阳明也。（发热无汗。呕不能食。此伤寒自太阳经起也。太
阳伤寒。其人本不能食。所以仲景于麻黄汤后云。不须 粥。其义可以相推。然呕已见阳明府实证。伤寒当无汗。今反
汗出 然。 者。汗出凝聚之貌。外既汗出。则阳明胃府实热内蒸可知。此太阳经病。转而属于阳明之府也。）
伤寒三日。阳明脉大（脉大者。指下洪长也。成注引经云。阳明受病。当二三日发。伤寒至三日。乃邪传阳明之时。
阳明气血居多。气血为热所搏。以故脉大。愚以阳明脉大有二义。邪并于经。则脉大。邪入于府。亦脉大。成注言经而
不言府。犹为未尽其义。大抵脉大而浮者。邪并于经也。脉大而实者。邪入于府也。脉不单行。须于兼至之脉。辩其在
经在府之证。）
伤寒脉浮而缓。手足自温者。是为系在太阴。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。（此条言太阴病。亦有转属阳明之证。既云伤寒。则脉当浮而紧。今则云。浮而缓者。何也。寒邪之气。透
三阳经而入于太阴。则其来既迟。不若太阳之邪急而脉紧。且以缓为脾家之本脉也。寒入太阴。而其脉仍浮者。何也。
以其邪犹在经也。脾主四末。太阴之寒气。将化而为热。故手足自温。是为系在太阴。 。系同。此系太阴伤寒之证。
可无疑矣。太阴为湿土之经。寒湿相搏。郁蒸成热。身当发黄。黄者。土郁之色也。若其人小便自利。则脾湿去而热不
内郁。不能发黄。至八九日。则小便所利既多。而胃中燥热已极。胃燥则肠干。大便必硬。此为转属阳明病。乃府实之
证也。愚按此条证。与脾约无异。但初起时。系太阴伤寒耳。若论治法。亦宜仲景麻仁丸。）
伤寒转系阳明者。其人 然微汗出也。（此承上文而申言之。上言伤寒系在太阴。要之既转而系于阳明。其人外证。
不但小便利。当 然微汗出。盖热蒸于内。汗润于外。汗虽微。而府实之证的矣。愚按太阴转系阳明。若非汗出。恐太
阴经证未罢。虽小便利。大便硬。何敢轻用下药。）
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。（此条阳明病。乃风寒之邪。
犹在于经。兼太阳表证而言。既云。阳明中风。则但当发热。不当恶寒。而脉浮紧矣。其发热恶寒。脉浮而紧者。乃太
阳之寒邪。犹未尽也。阳明之脉。挟口。然口苦者。为胆汁上溢。此阳明邪热。侵入少阳之经也。又阳明之脉。循喉咙。
惟太阴之脉。始挟咽。今咽干者。为脾热亢甚。此阳明邪热。复侵入太阴之经也。阳明之脉。复循腹里。风寒之邪。中
于阳明。经中郁热。则腹满。热盛气壅。则肺气上逆。而作微喘也。阳明之风热。兼挟太阳之寒邪。纯是表证兼挟表脉。
虽云。腹满此非大实腹满。为可下之证也。若误下之。则内亡津液。外邪乘虚。尽入于里。故腹满不减。而小便复难此
为胃与膀胱齐病。后条辩云。病在阳明太阳之经者。累及太阳阳明之府。医人不可不知谨也。愚按此条论。仲景无治法。
补亡论常器之云。可桂枝麻黄各半汤。又小柴胡汤。推常氏之意。以阳明中风证。得太阳伤寒脉。此比仲景大青龙证。
只少烦躁耳。以故用麻桂各半汤也。愚以仲景法。还宜用葛根汤。又推常氏之意以口苦。用小柴胡汤。愚以兼见之证。
若口苦。若咽干。总宜以葛根汤为主。加黄芩等凉药以治之。至其既下之后。另宜随证用汤药。或下其腹满。或利其小
便可耳。）
阳明病若能食。名中风。不能食。名中寒。（此言阳明病。乃风寒之邪在经。其人必身热。目疼。鼻干。不得卧者。
是也。阳明主水谷。成注云。风为阳邪。阳邪杀谷。故中风者。能食。寒为阴邪。阴邪不能杀谷。故伤寒者不能食。愚
按仲景云。中寒者。与伤寒同义。非真寒证也。若系真中寒。是胃家虚冷药。宜用五积散。理中汤之类。今者不能食。
是胃气实。但邪未入府。不作郁热耳。因名中寒。实与伤寒无异。又按成注云。阳邪杀谷。阴邪不杀谷。此风寒之邪。
未全入胃。犹在于经。故以能食不能食。辩中风与伤寒耳。若邪全入胃。胃府郁热。必大实大满虽能食者。亦尽归于不
能食矣。
由是而知。能食者俗名火嘈。非胃中虚。切莫与食。大抵阳明受病。总不食为主。此为最妙之法。又按此条言阳明
病。乃阳明经自中之风寒。非自太阳经传来者。以故风自为风寒。自为寒也。若自太阳经传来者。则在太阳虽有风寒之
辩。传至阳明经已莫能别矣。且也。太阳经中风。服桂枝汤已。须 热稀粥一升余。乃知太阳病。亦以能食为中风也。
又太阳经伤寒。服麻黄汤后。不须 粥。乃知太阳病。亦以不能食为伤寒也。所以风寒之邪。初入阳明。亦以能食不能
食。为中风伤寒之别。）
阳明病若中寒。不能食小便不利。手足 然汗出。此欲作固瘕。必大便初硬后溏。所以然者。以胃中冷。水谷不别。
（这是张仲景的原文）
问：疾病有太阳阳明、正阳阳明、少阳阳明，这是什么意思？答：太阳阳明，指的是脾约证。（这一节连同下面两节，是张仲景设立的问答，以说明三阳经都有邪气传入腑证的病机。阳明，指胃腑。成无己注解说：邪气从太阳经传入腑的，称为太阳阳明；邪气从阳明经传入腑的，称为正阳阳明；邪气从少阳经传入腑的，称为少阳阳明。经文说：“这三经受病，已经传入腑的，可以用下法治疗。”就是这个意思。关于太阳阳明，庞安时说：原本是太阳病，如果发汗、攻下或利小便，导致津液耗伤，胃中干燥，因而转属阳明，形成脾约证。我认为，胃中干燥，脾气亢盛化热，患者在未病时，胃中受纳的水谷，虽然变为糟粕下入大肠，但既然脾气亢热，水液的精气就不能正常布散，肠中没有水气滋润，如同被围绕束缚一样，所以大便想排却非常困难，这就是肠道的约束，实际上是脾气亢热造成的约束。我按语：此条论述，张仲景自有麻子仁丸主治。成无己又引用小承气汤，实在令人不解。大概成无己引用的“太阳病，若吐、若下、若发汗后，微烦，小便数，大便因硬者”，这是尚未形成脾约证的情况，所以用小承气汤。如果说这就是脾约证，那就错了。）
正阳阳明，指的是胃家实。（方有执《伤寒论条辨》说：正，指本经。因为病邪到了本经，遂进入胃腑而成胃实。庞安时说：病人原本风气盛、正气实，津液消损，或者起初恶寒，出汗后，恶寒停止，反而发热；或者刚得病，就发热、胡言乱语，这叫正阳阳明。由此可知邪气传入腑的途径有两条：恶寒的，是从太阳经传来；便发热的，是由本经传入腑。武林人陈亮斯也说：有从阳明经直接受病而进入胃腑的，如《素问》所说：“中于面部，则下行至阳明”是也。有从其他经传入阳明，而后进入腑的，如下文所说的转属阳明之类是也。大概太阳病既已转属阳明，也是正阳阳明，而不是太阳阳明了。这一点不可不辨析清楚。我认为少阳阳明传入腑的途径，也仿照上述道理。有人问：前一条证候，庞氏引用后一节，为什么会有阳明病的文字而说“太阳病若发汗……”因而转属阳明，成为太阳阳明病？现在陈氏在此条，又引用这段文字说“太阳既转属阳明，这也是正阳阳明病”。这两种说法谁对谁错？我回答说：两种说法都是对的，学者需要临证辨析。转属阳明而还带有太阳表证，或者头痛项强，或者恶寒的，这就是太阳阳明。如果头不痛，项不强，完全没有太阳表证的，这就是正阳阳明。少阳阳明也是如此，通过寒热往来等症状的有无来辨析。）
少阳阳明，指的是发汗、利小便后，胃中燥热、烦闷、实，大便困难。（少阳阳明，本是少阳经病。少阳病不可发汗及利小便。如果误发其汗，则津液已在体表亡失；误利其小便，则津液又在之前被夺走。津液既去，邪气因而传入阳明之腑，则胃中燥热且实，而大便困难。大概是因为胃中没有津液所以干燥，干燥则生烦热。虽然仲景说胃中实，但我认为他说“实”，本来兼指大肠腑而言。只有大肠腑实，所以大便困难。况且大肠也属于阳明之腑。庞安时说：病本传到少阳，因发汗、利小便，导致胃中干燥，大便困难的，叫作少阳阳明。按成无己在前条“胃家实”的证候中，引用“阳明病脉迟……”用大承气汤主治。在此条“大便难”中，唯独没有治疗方法。后世有人用三承气汤分别治疗上三条证候，我认为这种说法也不够确切。大体上，太阳阳明证，宜用桂枝加大黄汤；正阳阳明证，宜选用三承气汤；少阳阳明证，宜用大柴胡汤。这是不可改变的方法。）
阳明病的纲领，是胃家实。（武林陈氏注解说：这一节承接上面三节而言。三种阳明病，邪气进入胃的途径虽然不同，但邪气在胃家，其实质是一样的。所以正阳阳明固然是胃家实，那么太阳的脾约、少阳的大便难，又何尝不是胃家实呢？因为它们都进入阳明，都是胃实，所以总结说：阳明之为病，胃家实也。《条辨》说：实，指大便结聚，坚硬胀满而不能排出。我按语：这样说，那么仲景说的“胃家实”，应当结合大肠腑实一起看，因为肠与胃上下相通。所以海藏辩解说：“胃中有燥屎五六枚”，这不在胃中，而是通称阳明。说胃，是连带提及大肠。如今大便结聚为坚硬胀满，则是大肠火燥之气逆而上行，所以名叫胃中实。总之胃中并没有实物。依据海藏这番话，实字与上文“胃家实”的含义，互相发明，学者仔细玩味他的说法，其中的义理自然显现。）
问：为什么会得阳明病？答：太阳病如果发汗、攻下或利小便，这会耗伤津液，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。（这一节，是设立问答，以阐明阳明腑病。问：如何得到阳明腑病？答：由太阳病，如果发汗、攻下、利小便，治疗不当，白白耗伤津液。津液，是聚集在胃中的。津液既亡，则胃中干燥。太阳的邪气不解，因而转属阳明之腑。“不更衣”，即不大便。注文已见前文太阳中篇。成无己注解说：不更衣，则胃中的东西不得排泄，所以为内实。内实，是大肠内部坚结。肠内坚结，所以大便困难如此。这种情况，乃是阳明腑实之病。我按语：此条论述，虽然是由太阳病不解，转属阳明之腑，但说不更衣、内实、大便难，毫无太阳经病症状，所以《尚论篇》说：这属于正阳阳明，是可下的证候。有人问：太阳病如果攻下了，那么胃中的东西已经去除，纵然耗伤津液，胃中干燥，未必会再形成内实。我回答说：在其太阳初病时，攻下不当，白白耗伤汗液，胃中的东西，依然没有排泄，必然转属阳明而形成燥粪，所以形成内实的证候。此条仲景只是指示人们如何辨证，所以不及治疗方法。）
问：阳明病的外证是什么？答：身体发热，汗自出，不恶寒，反而恶热。（上面说阳明病系胃家内实，其外见证，从未提及。所以此条又设问答说：阳明入腑的病，它的外证是什么？答：阳明外证，则是身体发热。身热，指身体前面发热。夫身热与发热不同，因为热在肌肉之间，不像发热那样仅在皮肤表面。汗自出，是因为腑中实热，蒸迫津液，所以汗自出。另外，此条的汗自出，与太阳中风证的汗自出也有不同。太阳病，汗虽出但不能透彻，所以出的也很少。此条病，汗由内热蒸出，出的必然多而且不能止。不恶寒，是因为邪气不在表。反恶热，明确表明热在里。伤寒应当恶寒，所以以恶热为反常。然而邪气既入胃，寒化为热。夫恶热虽然是内部的证候，但我认为其表现必定见于外部，或者扬手掷足，推开覆盖物，这是势所必至的。因此通过外部表现来验证内部，这无疑是阳明腑实证。《尚论篇》以此条病，辨析阳明中风证兼太阳，如果认为邪气还在经，那是极大的错误。大体上此条病，是承气汤证。）
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。（这一节连同下一节，申述阳明病也有恶寒的证候，所以再次设问答以阐明它。问：阳明病皆身热不恶寒，现在有病始得之一日，身不发热而恶寒，这种恶寒，不同于太阳病的恶寒。夫太阳为寒水之经，其表寒必然很甚。此为阳明病恶寒，阳明为燥金之经，其表寒自然轻微。正因为轻微，所以回答中说：虽然得病一日，恶寒将自行停止。自罢，指未经发表而寒自已。随即自汗出而恶热。自汗出恶热，乃阳明病入腑的外见证。注文已见前文。按成无己注解说：不发热恶寒，即邪气未完全入腑，还带有表邪。此表邪，是阳明经在表的邪气。其人必定外有头额痛而恶寒，内有胃腑实，随即自汗出而恶热。后《条辨》评注说：初得阳明，表气被阻，所以也有不发热而恶寒的证候，片刻即化为热了。邪气不关乎表的原因。这番话深得仲景立论之意。）
问：恶寒为何自行停止？答：阳明居中土，万物所归，无所复传。开始虽然恶寒，二日自行停止，这就是阳明病。（这承接上文发明恶寒自罢的缘故。之所以自罢，是因为阳明胃腑，居于人身之中，主养四旁。成无己注解说：凡四旁有病，都能传入于胃。胃属土，土为万物所归。万物归于土中，则其变化衰息，不再变动。所以说：无所复传。开始虽然恶寒，二日自止，好比冬寒已极，一遇土旺之时，则寒化衰息，这就是停止的意思。此为正阳阳明，是可下的证候。后《条辨》注“万物所归，无所复传”两句说：阳明以下法为正治。必须五脏六腑之邪，都归结于此，别无去路，这才是可下之证的阳明。轻易不要弄错。）
本太阳初得病时，发其汗，汗先出不透彻，因而转属阳明。（此条是太阳病，转属阳明经的证候。按前第五节说：太阳病，如果发汗，耗伤津液，胃中干燥，因而转属阳明，此为发汗太过，邪气已离表，乃阳明腑病。如今此太阳初得病之时，发汗不彻，转属阳明，此为发汗不及，邪气还在表。所以我说是：此系阳明经病。如果议用药，仲景之法，当以葛根汤主治。汗出不彻的含义，注文见前太阳中篇。）
伤寒发热，无汗，呕不能食，而反汗出漐漐然者，是转属阳明也。（发热无汗，呕不能食，这是伤寒自太阳经起。太阳伤寒，其人本来不能食，所以仲景在麻黄汤后说：不需喝粥。其义可以类推。然而呕已见阳明腑实证，伤寒应当无汗，现在反汗出漐漐然。漐漐然，是汗出凝聚的样子。外既汗出，则阳明胃腑实热内蒸可知。此太阳经病，转而属于阳明之腑也。）
伤寒三日，阳明脉大。（脉大，指指下洪长。成无己引经书说：阳明受病，当在二三日发作。伤寒至三日，乃邪气传入阳明之时。阳明气血居多，气血为热所搏，所以脉大。我认为阳明脉大有两层含义：邪气并并于经，则脉大；邪气入于腑，亦脉大。成无己只言经不言腑，犹为未尽其义。大体上脉大而浮者，邪气并并于经；脉大而实者，邪气入于腑。脉不单行，须于兼至之脉，辨析其在经在腑的证候。）
伤寒脉浮而缓，手足自温者，是为系在太阴。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。（此条言太阴病，也有转属阳明的证候。既云伤寒，则脉当浮而紧，现在却说：浮而缓，为什么呢？寒邪之气，透三阳经而入于太阴，则其来既迟，不像太阳之邪急而脉紧，且以缓为脾家之本脉。寒入太阴，而其脉仍浮，为什么呢？因为邪气还在经。脾主四末，太阴之寒气，将化而为热，故手足自温，是为系在太阴。“系”同“係”。此系太阴伤寒之证，可无疑矣。太阴为湿土之经，寒湿相搏，郁蒸成热，身当发黄。黄，是土郁之色。如果其人小便自利，则脾湿去而热不内郁，不能发黄。至八九日，则小便所利既多，而胃中燥热已极。胃燥则肠干，大便必硬。此为转属阳明病，乃腑实之证。我按语：此条证候，与脾约无异，只是初起时，系太阴伤寒耳。若论治法，也宜用仲景麻子仁丸。）
伤寒转系阳明者，其人漐漐然微汗出也。（这承接上文而申述。上面说伤寒系在太阴，要之既转而系于阳明，其人外证，不但小便利，当漐漐然微汗出。盖热蒸于内，汗润于外，汗虽微，而腑实之证确矣。我按语：太阴转系阳明，若非汗出，恐怕太阴经证未罢，虽小便利，大便硬，怎敢轻用下药？）
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。（此条阳明病，乃风寒之邪，犹在于经，兼太阳表证而言。既云：阳明中风，则但当发热，不当恶寒，而脉浮紧矣。其发热恶寒，脉浮而紧者，乃太阳之寒邪，犹未尽也。阳明之脉，挟口，然口苦者，为胆汁上溢，此阳明邪热，侵入少阳之经也。又阳明之脉，循喉咙，惟太阴之脉，始挟咽。今咽干者，为脾热亢甚，此阳明邪热，复侵入太阴之经也。阳明之脉，复循腹里，风寒之邪，中于阳明，经中郁热，则腹满。热盛气壅，则肺气上逆，而作微喘也。阳明之风热，兼挟太阳之寒邪，纯是表证兼挟表脉，虽云：腹满，此非大实腹满，为可下之证也。若误下之，则内亡津液，外邪乘虚，尽入于里，故腹满不减，而小便复难。此为胃与膀胱齐病。后《条辨》说：病在阳明太阳之经者，累及太阳阳明之府，医人不可不知谨也。我按语：此条论述，仲景无治法。补亡论常器之说：可用桂枝麻黄各半汤，又小柴胡汤。推常氏之意，以阳明中风证，得太阳伤寒脉，此比仲景大青龙证，只少烦躁耳。以故用麻桂各半汤。我认为仲景之法，还宜用葛根汤。又推常氏之意以口苦，用小柴胡汤。我认为兼见之证，若口苦，若咽干，总宜以葛根汤为主，加黄芩等凉药以治之。至于既下之后，另宜随证用汤药，或下其腹满，或利其小便即可。）
阳明病若能食，名中风。不能食，名中寒。（此言阳明病，乃风寒之邪在经，其人必身热，目疼，鼻干，不得卧者，是也。阳明主水谷。成无己注解说：风为阳邪，阳邪杀谷，故中风者，能食。寒为阴邪，阴邪不能杀谷，故伤寒者不能食。我按语：仲景说：中寒者，与伤寒同义，并非真寒证。若系真中寒，是胃家虚冷，药宜用五积散、理中汤之类。如今不能食，是胃气实，但邪未入腑，不作郁热耳。因名中寒，实与伤寒无异。又按成无己注：阳邪杀谷，阴邪不杀谷。此风寒之邪，未全入胃，犹在于经，故以能食不能食，辨析中风与伤寒耳。若邪全入胃，胃腑郁热，必大实大满，虽能食者，亦尽归于不能食矣。由此而知，能食者俗名火嘈，非胃中虚，切莫与食。大体阳明受病，总不食为主，此为最妙之法。又按此条言阳明病，乃阳明经自中之风寒，非自太阳经传来者。以故风自为风寒，自为寒也。若自太阳经传来者，则在太阳虽有风寒之辨，传至阳明经已莫能别矣。且也，太阳经中风，服桂枝汤已，须喝热稀粥一升余，乃知太阳病，亦以能食为中风也。又太阳经伤寒，服麻黄汤后，不需喝粥，乃知太阳病，亦以不能食为伤寒也。所以风寒之邪，初入阳明，亦以能食不能食，为中风伤寒之别。）
阳明病若中寒，不能食，小便不利，手足漐漐然汗出，此欲作固瘕，必大便初硬后溏。所以然者，以胃中冷，水谷不别。
(This is the original text of Zhang Zhongjing.)
Question: There are Taiyang Yangming, Zhengyang Yangming, and Shaoyang Yangming. What does this mean? Answer: Taiyang Yangming refers to Pi Yue (Spleen Constraint). (This section, along with the following two sections, is a Q&A set up by Zhang Zhongjing to illustrate that all three Yang meridians have syndromes where pathogenic factors enter the Fu organs. Yangming refers to the Stomach Fu organ. Cheng Wuji's commentary states: When pathogenic factors transmit from the Taiyang meridian into the Fu organ, it is called Taiyang Yangming; when they transmit from the Yangming meridian into the Fu organ, it is called Zhengyang Yangming; when they transmit from the Shaoyang meridian into the Fu organ, it is called Shaoyang Yangming. The classic states: "For diseases of these three meridians that have entered the Fu organ, purgation may be used." This is what is meant. Regarding Taiyang Yangming, Pang Anshi says: Originally a Taiyang disease, if sweating, purgation, or diuresis is applied, this depletes body fluids (Jin Ye), causing dryness in the stomach, thereby transforming into Yangming and forming the Pi Yue syndrome. I believe that dryness in the stomach leads to hyperactive heat in the Spleen Qi. Before illness, although water and grain received by the stomach transform into dregs and descend into the Large Intestine, since Spleen Qi is hyperactive and hot, the essence of water cannot distribute properly. Without qi of water to moisten the intestines, it is as if surrounded and bound, so although stool desires to pass, it is very difficult. This is the constraint of the intestines, actually caused by hyperactive heat in the Spleen Qi. My note: For this discussion, Zhang Zhongjing naturally uses Hemp Seed Pill (Maziren Wan) for treatment. Cheng Wuji also cites Minor Order the Five Viscera Decoction (Xiao Chengqi Tang), which is incomprehensible. Probably, the case Cheng Wuji cited—"After Taiyang disease, if vomiting, purgation, or sweating was applied, resulting in slight vexation, frequent urination, and consequently hard stool"—is a case where Pi Yue has not yet formed, hence Xiao Chengqi Tang is used. To say this is Pi Yue would be an error.)
Zhengyang Yangming refers to Wei Jia Shi (Stomach House Excess). Fang Youzhi's *Shanghan Lun Tiaobian* states: "Zheng" means the primary meridian. Because the disease reaches the primary meridian, it enters the Stomach Fu to form Stomach Excess. Pang Anshi says: If a patient originally has abundant wind and strong qi, leading to depletion of body fluids, or initially experiences aversion to cold, and after sweating, the aversion to cold ceases but fever returns; or upon onset, immediately experiences fever and delirious speech, this is named Zhengyang Yangming. From this, we know there are two pathways for pathogenic factors to enter the Fu organ: aversion to cold indicates transmission from the Taiyang meridian; immediate fever indicates entry into the Fu from the primary meridian. Chen Liangsi from Wulin also said: There are cases where one contracts disease directly from the Yangming meridian and enters the Stomach Fu, such as stated in *Suwen*: "Struck on the face, then descends to Yangming." There are also cases where pathogenic factors transmit from other meridians to Yangming before entering the Fu, such as the subsequent transformation into Yangming mentioned later. Generally, once Taiyang transforms into Yangming, it becomes Zhengyang Yangming, not Taiyang Yangming. This distinction must be clarified. I believe the pathway for Shaoyang Yangming entering the Fu follows similar logic. A question arises: In the previous section, Pang cited a later section regarding why there is text about Yangming disease saying "Taiyang disease if sweating..." leading to transformation into Yangming as Taiyang Yangming. Now, Chen cites this same text here saying "Once Taiyang transforms into Yangming, this is also Zhengyang Yangming." Which is correct? I answer: Both statements are correct; scholars must differentiate based on clinical presentation. If transformed into Yangming but still carrying Taiyang exterior symptoms, such as headache and stiff neck, or aversion to cold, this is Taiyang Yangming. If there is no headache, no stiff neck, and absolutely no Taiyang exterior symptoms, this is Zhengyang Yangming. Shaoyang Yangming is differentiated similarly by the presence or absence of alternating chills and fever.)
Shaoyang Yangming refers to sweating and diuresis having been performed, resulting in dryness, vexation, excess in the stomach, and difficulty passing stool. (Shaoyang Yangming originates from Shaoyang meridian disease. Shaoyang disease should not be treated with sweating or diuresis. If sweating is mistakenly induced, body fluids are lost at the surface; if diuresis is mistakenly induced, body fluids are further depleted. Once body fluids are gone, pathogenic factors transmit to the Yangming Fu organ, causing dryness, vexation, and excess in the stomach, leading to difficult defecation. This is because the stomach lacks fluids, causing dryness, which generates vexing heat. Although Zhang Zhongjing mentions "excess in the stomach," I believe his use of "excess" inherently includes the Large Intestine Fu. Only when the Large Intestine Fu is excess does stool become difficult to pass. Moreover, the Large Intestine belongs to the Yangming meridian. Pang Anshi said: When disease transmits to Shaoyang, and due to mistaken sweating and diuresis, causing stomach dryness and difficult defecation, it is called Shaoyang Yangming. Cheng Wuji, in his commentary on the previous section regarding "Wei Jia Shi," cited "Yangming disease with slow pulse..." and prescribed Major Order the Five Viscera Decoction (Da Chengqi Tang). However, for this section on "difficult defecation," he provided no treatment method. Later practitioners used the three Chengqi Decoctions to treat the upper three conditions respectively, but I find this explanation inadequate. Generally, Taiyang Yangming syndromes suit Cinnamon Twig Decoction with Added Rhubarb (Guizhi Jiada Huang Tang); Zhengyang Yangming syndromes suit the selective use of the three Chengqi Decoctions; Shaoyang Yangming syndromes suit Major Bupleurum Decoction (Da Chaihu Tang). This is an unchangeable principle.)
The definition of Yangming disease is Wei Jia Shi (Stomach House Excess). Chen's commentary from Wulin states: This section follows the previous three sections. Although the pathways for the three types of Yangming disease to enter the stomach differ, the nature of pathogenic factors in the Stomach House is essentially the same. Thus, Zhengyang Yangming is indeed Wei Jia Shi, but Pi Yue of Taiyang and difficult defecation of Shaoyang are also forms of Wei Jia Shi. Since they all enter Yangming and constitute Stomach Excess, it is summarized as: The manifestation of Yangming disease is Wei Jia Shi. *Tiaobian* states: "Excess" refers to hardened stool, fullness, and inability to pass. My note: This implies that "Wei Jia Shi" should be viewed together with Large Intestine Fu excess, as the intestine and stomach are connected above and below. Therefore, Haizang argued: "Having five or six pieces of dry feces in the stomach" does not mean they are literally in the stomach, but refers generally to Yangming. Saying "stomach" implies including the Large Intestine. Currently, when stool is hardened and causes fullness, the fire-dryness qi of the Large Intestine reverses and ascends, hence named "excess in the stomach." Essentially, there is no physical object in the stomach. Based on Haizang's words, the meaning of "excess" elucidates the concept of "Wei Jia Shi" mentioned earlier. Scholars should study this carefully to understand the principle.)
Question: How does one contract Yangming disease? Answer: If Taiyang disease is treated with sweating, purgation, or diuresis, this depletes body fluids, causing dryness in the stomach, thereby transforming into Yangming. Failure to defecate, internal excess, and difficulty passing stool constitute Yangming disease. (This section sets up a Q&A to clarify Yangming Fu disease. Question: How is Yangming Fu disease contracted? Answer: It arises from Taiyang disease where improper treatment via sweating, purgation, or diuresis白白ly depletes body fluids. Body fluids gather in the stomach. Once depleted, the stomach becomes dry. The unresolved Taiyang pathogen transforms into the Yangming Fu organ. "Not changing clothes" means failure to defecate. Cheng Wuji's commentary notes: Failure to defecate means stomach contents cannot be excreted, leading to internal excess. Internal excess refers to hardness and binding within the Large Intestine. Due to this internal binding, defecation is difficult. Such cases are Yangming Fu excess syndromes. My note: Although this condition arises from unresolved Taiyang disease transforming into Yangming Fu, the absence of any Taiyang meridian symptoms alongside failure to defecate, internal excess, and difficult defecation classifies it as Zhengyang Yangming, a purgative indication according to *Shanglun Pian*. A question arises: If Taiyang disease is purged, stomach contents should be removed. Even if fluids are depleted and the stomach is dry, why would internal excess form again? I answer: During the initial stage of Taiyang disease, improper purgation only depletes sweat. The stomach contents remain unexcreted, eventually transforming into Yangming and forming dry feces, thus creating internal excess. Here, Zhang Zhongjing only demonstrates how to identify the syndrome, omitting treatment methods.)
Question: What are the exterior manifestations of Yangming disease? Answer: Feverish body, spontaneous sweating, no aversion to cold, but aversion to heat. (Previously, it was stated that Yangming disease involves internal excess in the stomach, but its exterior manifestations were not mentioned. Hence, this section asks: What are the exterior signs of Yangming disease entering the Fu? Answer: The exterior signs of Yangming are feverish body and spontaneous sweating. "Feverish body" refers to heat in the anterior body. Feverish body differs from "fa re" (fever); the heat lies in the muscle layer, unlike "fa re" which is merely superficial on the skin. Spontaneous sweating occurs because internal excess heat steams and forces body fluids out. Furthermore, this spontaneous sweating differs from that in Taiyang Wind Strike syndrome. In Taiyang disease, sweat is scanty and does not penetrate fully. In this condition, sweat is driven out by internal heat, flowing profusely and uncontrollably. No aversion to cold indicates the pathogen is not at the exterior. Aversion to heat confirms heat is at the interior. Since cold damage typically involves aversion to cold, aversion to heat is considered contrary. Although aversion to heat is an internal sign, its manifestations appear externally, such as throwing hands and feet or pushing away covers. Thus, observing external signs confirms Yangming Fu excess. *Shanglun Pian* uses this section to discuss Yangming Wind Strike combined with Taiyang; believing the pathogen remains in the meridian is a grave error. Generally, this section describes a syndrome suitable for Chengqi Decoction.)
Question: Some patients experience one day of illness without fever but with aversion to cold. Why? Answer: Although it has been one day, the aversion to cold will cease spontaneously, followed by spontaneous sweating and aversion to heat. (This section, linked with the next, elaborates that Yangming disease can also present with aversion to cold, using Q&A to clarify. Question: Yangming disease usually presents with fever and no aversion to cold. Why is there a case of initial aversion to cold without fever? This aversion to cold differs from Taiyang aversion to cold. Taiyang is the Water Meridian, so its exterior cold is severe. Yangming is the Dryness-Metal Meridian, so its exterior cold is mild. Because it is mild, the answer states: Although present for one day, aversion to cold will cease spontaneously. "Cease spontaneously" means the cold resolves without exterior-releasing treatment. It is followed by spontaneous sweating and aversion to heat, which are the exterior signs of Yangming disease entering the Fu. Cheng Wuji commented: Lack of fever and presence of aversion to cold indicate the pathogen has not fully entered the Fu and still carries exterior pathogen. This exterior pathogen belongs to the Yangming meridian. The patient likely has headache and frontal pain with aversion to cold externally, and stomach Fu excess internally, soon followed by spontaneous sweating and aversion to heat. *Tiaobian* critiques this: Initially contracting Yangming, the exterior qi is blocked, causing non-febrile aversion to cold, which quickly transforms into heat because the pathogen does not primarily concern the exterior. This insight aligns well with Zhang Zhongjing's intent.)
Question: Why does the aversion to cold cease spontaneously? Answer: Yangming resides in the center, Earth element. It is the destination of all things, with nowhere else to transmit. Although initially experiencing aversion to cold, it stops by the second day. This constitutes Yangming disease. (This explains the reason for the spontaneous cessation of aversion to cold. It ceases because the Yangming Stomach Fu resides in the center of the body, nourishing the four peripheries. Cheng Wuji noted: Diseases in the four peripheries can all transmit to the Stomach. Stomach belongs to Earth, and Earth is the destination of all things. When all things return to Earth, their transformation decays and ceases, becoming static. Hence, "nowhere else to transmit." Although initially aversive to cold, it stops by the second day, analogous to extreme winter cold subsiding when Earth energy prevails. This refers to Zhengyang Yangming, a purgative indication. *Tiaobian* comments on "destination of all things, nowhere else to transmit": Yangming's correct treatment is purgation. Only when pathogenic factors from the five Zang and six Fu organs all converge here, with no other exit, does it become a purgative Yangming syndrome. Do not mistake this lightly.)
When Taiyang disease is first contracted, if sweating is induced but the sweat is incomplete, it transforms into Yangming. (This section describes Taiyang disease transforming into Yangming meridian syndrome. As stated in Section 5: If Taiyang disease is sweated excessively, depleting fluids and causing stomach dryness, it transforms into Yangming. This is excessive sweating, where the pathogen leaves the exterior, becoming Yangming Fu disease. Here, during early Taiyang, insufficient sweating leads to transformation into Yangming. This is insufficient sweating, where the pathogen remains at the exterior. Therefore, I state this is Yangming meridian disease. Following Zhang Zhongjing's method, Pueraria Decoction (Gegen Tang) should be used. The meaning of "incomplete sweating" is noted in the Taiyang Middle section.)
Cold damage presenting with fever, no sweat, vomiting, inability to eat, but conversely with persistent dripping sweat, indicates transformation into Yangming. (Fever, no sweat, vomiting, and inability to eat originate from Cold Damage starting in the Taiyang meridian. Taiyang Cold Damage patients normally cannot eat, which is why Zhang Zhongjing states after Mahuang Decoction that drinking warm porridge is unnecessary. However, vomiting indicates Yangming Fu excess. Cold damage should have no sweat. Now, persistent dripping sweat appears. "Zhi zhi ran" describes condensed sweat. External sweating indicates internal steaming of Yangming Stomach Fu excess heat. Thus, Taiyang meridian disease transforms into Yangming Fu disease.)
On the third day of cold damage, the Yangming pulse is large. ("Large" pulse refers to a surging and long quality under the fingers. Cheng Wuji cites classics: Yangming disease manifests on the second or third day. By the third day of cold damage, pathogenic factors transmit to Yangming. Yangming has abundant qi and blood. When qi and blood are constrained by heat, the pulse becomes large. I believe "large pulse" in Yangming has two meanings: when pathogen merges with the meridian, the pulse is large; when pathogen enters the Fu, the pulse is also large. Cheng Wuji only mentioned the meridian, missing the Fu aspect. Generally, a large and floating pulse indicates pathogen merging with the meridian; a large and excess pulse indicates pathogen entering the Fu. Pulses do not occur alone; one must analyze combined pulses to distinguish meridian vs. Fu syndromes.)
If cold damage presents with a floating and moderate pulse, and spontaneous warmth of the hands and feet, it is associated with Taiyin. Taiyin disease typically causes jaundice. However, if urination is free, jaundice will not occur. By the seventh or eighth day, if stool becomes hard, it is Yangming disease. (This section discusses Taiyin disease transforming into Yangming. Although termed cold damage, the pulse should be floating and tight. Here it is floating and moderate. Why? Cold pathogen penetrates the Three Yang meridians to enter Taiyin, arriving slowly, unlike the urgent Taiyang pathogen with a tight pulse. Moderate is the native pulse of the Spleen. Cold enters Taiyin, yet the pulse remains floating because the pathogen is still in the meridian. Spleen governs the four extremities. Taiyin cold qi transforms into heat, causing spontaneous warmth of hands and feet. This is "associated with Taiyin." Taiyin is the Damp-Earth meridian. Cold-damp binding stagnates and generates heat, causing jaundice. Yellow is the color of stagnant Earth. If urination is free, spleen dampness is removed, heat does not stagnate internally, and jaundice does not occur. By the seventh/eighth day, frequent urination depletes fluids, making stomach dry-heat extreme. Dry stomach leads to dry intestines, causing hard stool. This is transformation into Yangming disease, a Fu excess syndrome. My note: This syndrome is similar to Pi Yue, except it begins as Taiyin cold damage. Treatment should also follow Zhang Zhongjing's Hemp Seed Pill.)
When cold damage transforms and associates with Yangming, the patient exhibits persistent, slight sweating. (This elaborates on the previous point. Previously, it was stated that cold damage associated with Taiyin. Now, having transformed to associate with Yangming, the exterior signs include not only free urination but also persistent, slight sweating. Heat steams internally, moistening the exterior. Although sweat is slight, the Fu excess syndrome is confirmed. My note: If Taiyin transforms to Yangming without sweating, the Taiyang meridian syndrome might not have resolved. Even with free urination and hard stool, one dare not lightly use purgatives.)
Yangming Wind Strike presents with bitter taste in the mouth, dry throat, abdominal fullness, slight panting, fever, aversion to cold, floating and tight pulse. If purged, abdominal fullness worsens and urination becomes difficult. (This Yangming disease involves wind-cold pathogen remaining in the meridian, combined with Taiyang exterior symptoms. Although termed Yangming Wind Strike, it should feature fever but not aversion to cold or floating-tight pulse. The presence of fever, aversion to cold, and floating-tight pulse indicates residual Taiyang cold pathogen. Yangming meridian encircles the mouth; bitter taste indicates bile reflux, showing Yangming heat invading the Shaoyang meridian. Yangming meridian follows the throat; only Taiyin meridian encircles the pharynx. Dry throat indicates excessive Spleen heat, showing Yangming heat invading the Taiyin meridian. Yangming meridian follows the abdomen. Wind-cold striking Yangming causes stagnation heat in the meridian, leading to abdominal fullness. Heat excess and qi congestion cause lung qi rebellion, resulting in slight panting. Yangming wind-heat combined with Taiyang cold is purely exterior syndrome with exterior pulse. Although abdominal fullness is present, it is not severe excess requiring purgation. Mistaken purgation depletes internal fluids, allowing exterior pathogen to enter deeply, worsening abdominal fullness and causing difficult urination. This affects both Stomach and Bladder. *Tiaobian* warns: Physicians must be cautious when treating Yangming/Taiyang meridian diseases affecting the Fu organs. My note: Zhang Zhongjing provides no treatment here. Chang Qizhi in *Bu Wang Lun* suggests Guizhi Mahuang Ge Ban Tang and Xiao Chaihu Tang. Chang's reasoning: Yangming Wind Strike with Taiyang Cold Damage pulse resembles Zhang Zhongjing's Da Qing Long Tang minus irritability, hence Ge Ban Tang. I believe Zhang Zhongjing's method prefers Gegen Tang. Following Chang's logic for bitter taste, Xiao Chaihu Tang is added. I suggest that for accompanying symptoms like bitter taste and dry throat, Gegen Tang should be the main formula, supplemented with cooling herbs like Scutellaria Root (Huang Qin). After mistaken purgation, treatment should follow specific symptoms, either purging abdominal fullness or promoting urination.)
In Yangming disease, ability to eat is named Wind Strike; inability to eat is named Cold Strike. (This refers to Yangming disease where wind-cold pathogen is in the meridian, presenting with fever, eye pain, nasal dryness, and insomnia. Yangming governs water and grain. Cheng Wuji noted: Wind is yang pathogen, yang pathogens digest food, so Wind Strike patients can eat. Cold is yin pathogen, yin pathogens do not digest food, so Cold Strike patients cannot eat. My note: Zhang Zhongjing's "Cold Strike" is synonymous with Cold Damage, not true cold syndrome. True cold syndrome involves deficient-cold stomach, treated with Wu Ji San or Lizhong Tang. Inability to eat here indicates excess stomach qi, with pathogen not yet entering Fu and no stagnating heat generated. Hence named Cold Strike, effectively identical to Cold Damage. Cheng Wuji also noted: Yang pathogens digest food, yin pathogens do not. Since wind-cold pathogen has not fully entered the stomach and remains in the meridian, eating ability distinguishes Wind Strike from Cold Damage. If pathogen fully enters stomach causing stagnating heat and severe excess/fullness, even those who could eat will lose appetite. Thus, "ability to eat" colloquially called "fire hunger" is not stomach deficiency; do not feed them. Generally, for Yangming disease, fasting is best. This section refers to wind-cold directly striking Yangming meridian, not transmitting from Taiyang. If transmitted from Taiyang, the distinction between wind and cold becomes indistinguishable by the time it reaches Yangming. Note that Taiyang Wind Strike treated with Guizhi Tang requires warm porridge to induce sweat, indicating Taiyang Wind Strike is associated with ability to eat. Taiyang Cold Damage treated with Mahuang Tang does not require porridge, indicating Taiyang Cold Strike is associated with inability to eat. Thus, upon initial entry into Yangming, eating ability distinguishes Wind Strike from Cold Strike.)
If Yangming disease involves Cold Strike, with inability to eat, difficult urination, and persistent dripping sweat from hands and feet, this is developing into Gu Jia (fixed mass). Stool will be initially hard and finally loose. This is because the stomach is cold, failing to separate water and grain.