故也。（此系胃中冷实之证。阳明中寒者。谓寒邪初入于经。未全入胃。不作郁热也。胃为阳。主气。胃中阳气胜。则能
营运水谷。使出入不失其常度。今者。胃中寒。遏其阳气。以故谷不能入。水不能出。所以不能食。而小便亦不利也。
手足 然汗出者。四肢为诸阳之本。又阳明胃府。复主四肢胃府之阳。既为寒气所遏。不得内发。郁蒸于外。以故手足
然而汗出也。固瘕者。寒气固结。犹如瘕聚而不散。故云。此欲作固瘕。非真欲成瘕聚也。其人大便。虽初硬而后必
溏。盖手足 然汗出者。其人必大便硬。其所以初硬后溏者。以胃中所入之寒气。已固结而成冷。中焦阳气不运。不能
泌别水谷。以故小便不利。而大便必溏也。按此条论。仲景无治法。补亡论常器之云。可理中汤。愚以寒气固瘕。水谷
不别。此为冷实之证。理中汤太补。不宜用也。又云。猪苓汤。推常氏之意。以小便不利。故用此汤。但仲景既云胃中
冷。水谷不别。以致小便不利。复用猪苓泽泻滑石等寒药何也。盖胃中虽冷而实。胃实必作郁热。故常氏用猪苓汤。以
利其小便。俟小便利则大便自硬。然后议用承气等下药。）
阳明病初欲食。小便反不利。大便自调。其人骨节疼。翕翕如有热状。奄然发狂。 然汗出而解者。此水不胜谷气。
与汗共并。脉紧则愈（此系阳明经热未全入府之证。阳明病欲食者。谓风邪初传入胃。胃气本强。不为病夺也。胃强。
则能游溢精气。通调水道。是小便宜利矣。今反不利者。以胃气挟邪热而过强。水气升发于表。势欲作汗。故不下而为
溺也。大便自调。知非水谷不别。胃中冷实之证可比。其人骨节疼。翕翕如有热状者。风邪郁于阳明之表也。但此骨节
疼。非比太阳伤寒。寒气拘急而疼。乃阳明中风。热气蒸发而疼。以故热伏于肌肉之间。在表则但翕翕然如有热。而又
若无热之状也奄忽也。奄然发狂者。乃邪热初入于胃。胃气强。不受热邪所困。正与邪争。邪气还表。以故发狂汗出而
解也。 然义注已见前。水以小便言。谷气以欲食言胃能食。则谷气胜。水气不胜谷气。必相与作汗而共并于表。则前
此未汗而脉紧者。至此则紧脉去。而阳明经病必自愈。按脉紧则愈。补亡论阙疑常器之云。一本作脉去则愈。郭白云云。
千金作坚者。则愈无脉字。是误以脉紧为去为坚者。或漏脉字。或漏者字。当云。脉紧者则愈愚今校正。当云脉紧去则
愈。或云脉紧宜用麻黄汤。愚以仲景法。太阳病脉紧者。宜麻黄汤。此条系阳明病。当改用葛根汤也。况上正文云。汗
出而解。以故不及治法。）
阳明病欲解时从申至戌上。（注已见前第三卷太阳上编）
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。（寒中阳明。胃中虚冷。无热
可攻。成注云。热去寒起。竟认作有热之证。其误甚矣。其人虽不能食。以胃气本虚。故不食。非胃中实而食不下也。
此条系真寒证。正文与注俱见中寒论中。）
阳明病脉迟。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。（此系
阳明中风。初入于胃。里未全实之证。脉迟者为阴。主里。阳明病。至脉迟。则邪已离经。渐入于府。但府中郁热未甚。
故其脉尚迟。食难用饱者。以中风证。其初本能食。至此。则邪已入胃。势必于于难用饱矣。饱则谷气与热邪相搏。郁
蒸成湿湿热之气。上攻则微烦而头眩。小便必难者。湿热上攻。则水道必不下顺也。湿热郁于中焦。上不得越。下不得
泄。此其势又必至蒸发于外。欲作谷疸之证。疸黄病也。以此证。本因阳明中风。不能禁其食。故成谷疸。而身发黄色
也。湿热内积而成谷疸。则其人腹满可知。腹满者。下之则愈。今下之而腹满如故。何也。所以然者。以脉迟。则表邪
未全入里。热气尚未敛实。故其病不因下而少衰。成注引经云。脉迟尚未可攻。正此谓也。按此条论。仲景无治法。补
亡论常器之云。宜猪苓汤。五苓散。愚以上二方未成谷疸时加减出入。可随证选用。郭白云云。已发黄者。茵陈蒿汤。
此为不可易之剂。）
阳明病法多汗。反无汗其身如虫行皮中状者。此以久虚故也。（此系阳明经有寒邪。郁热不能透发。可见阳明之为病。
亦以无汗为伤寒也。阳明多气多血。寒中阳明热郁肌肉法当多汗。今反无汗者。此以经中阳气虚。不能升发于表。以故
皮中如虫行之状也。如虫行者。痒也。皮中者。肌肉之间。汗欲出而不得。以故肌肉作痒。如虫行皮中状。犹之太阳病。
得之八九日。以其不得小汗出。身必痒。当用桂枝麻黄各半汤。以小发其汗。故尚论篇云。言久虚者。此明汗所以不能
透出于肌表之故。非谓当用补也。按此条论。仲景无治法。补亡论。常器之云。可桂枝。加黄 汤。郭白云云。以无汗
故如虫行皮中状。须小汗乃解。宜桂枝麻黄各半汤。以此汤解身痒。能小汗故也。愚以上二汤。皆太阳经药。今系阳明
无汗证。仲景法。还当用葛根汤主之。）
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。（此亦阳明经伤寒也。小便
利者邪不在里也。此为阳明经初得之病至二三日。经中郁热不得外泄。渐入于胃则呕而咳。或以咳为肺病。然肺之系。
与胃口相附。胃热既上冲而作呕。则肺气亦上逆而为咳也。四肢者。诸阳之本。阳明受寒邪所伤。经中阳气不能外达肌
肤而为汗。焉能横走手足而温其四肢邪。厥逆也冷也。逆冷既甚。则郁热愈深。热气上攻。必苦头痛若不咳。不呕。不
厥者。经中郁热。尚未深也。故头不痛盖诸阳之经。皆上头。即头痛一候。可见手足厥之为热厥。而非真寒证矣。按此
条论仲景无治法。补亡论常器之云。类要用小建中汤。误矣。可小柴胡汤。推常氏之意。以呕而咳。建中为呕家。所禁
故改用小柴胡。殊不知此系阳明病胃口郁热作呕。气逆作咳。与柴胡证之喜呕。或咳者。实无与。郭白云云。手足厥者。
宜小建中汤。要之此证。非中气虚寒而发厥。乃表寒郁其经中阳热之气而发厥也。愚以仲景法。还当用葛根汤加减。以
发其汗。）
阳明病但头眩不恶寒。故能食而咳。其人必咽痛。若不咳者咽不痛（此系阳明经中风也。风主动摇故头眩。眩者。
头旋而目运也。风为阳邪。故不恶寒能食而咳。其义见前。凡风寒之邪。皆能郁热而作咳。风比寒邪其热尤甚。故其人
必咽痛。咽门者。胃之系也。咳甚。则咽伤而痛。若不咳。则咽不伤。故不痛或问云。咳出于肺。其人当病喉痛。何以
伤咽。余答云。经云。脏腑皆令人咳。今者。阳明病当是胃有风热而咳。故云。必咽痛也。按此条论。仲景无治法。补
亡论常器之云。可服茯苓甘草白术生姜汤。愚以头眩而咳。纯是风热。反用茯苓白术等补气之药。其误甚矣。又云。咽
痛者。宜桔梗汤。此本少阴病咽痛之药。盖少阴之脉。循喉咙。咽痛者胃热。甚侵及少阴之经。上汤可相借用之。）
阳明病无汗。小便不利。心中懊 者身心发黄（此系阳明经有郁热兼入于府之证。无汗而小便不利。则热郁湿停。
湿热内积其气上熏。则心中懊 。此为土郁之证可知。身必发黄者。盖言湿热郁蒸势所必至也。）
阳明病被火。额上微汗。出小便不利者必发黄（此条病与上条大同小异阳明无汗。因以火强迫其汗。热邪被火。周身之
气燥极。而热不外越。但上攻于额而微汗出。此与太阳病。但头汗出同义。经中邪热。既不得外越又不得下泄。而小便
不利。此为湿热交蒸。身亦必至发黄也。按上二条论。仲景无治法。补亡论常器之皆云。可与茵陈蒿汤。调下五苓散。
愚以茵陈蒿汤固宜用。但五苓散。乃太阳经利小便。兼解表之药。今阳明经无汗。
若用五苓。宜去桂枝。加葛根为妥。又白术一味。当改用苍术。缘上二条证。皆湿胜发黄湿热内盛故也。）
阳明病脉浮而紧者。必潮热。发作有时。但浮者。必盗汗出（此系太阳风寒之邪。传入阳明之证。阳明病当见目
疼鼻干。不得卧矣。其脉浮而紧者。仍见太阳伤寒之脉也。阴寒之邪。束其经中之阳气。阳气被郁。不得发。故乘其经
气王时。必潮热发作也。若其脉但浮者。此是太阳经风邪。传于阳明。其人必盗汗出盗汗者。睡而汗出也。阳邪入于阴
分。以故睡则汗出。愚按此条论当分作两截看。脉浮紧。潮热。此是阳明伤寒。仲景法。宜葛根汤主之。脉浮。盗汗出。
此是阳明中风。仲景法。宜桂枝加葛根汤主之。补亡论与柴胡桂枝汤误矣。）阳明病口燥。但欲漱水。不欲咽者。此必衄
（此系阳明经燥热之证成注云。阳明之脉起于鼻络于口。阳明里热。则渴欲饮水。此口燥。但欲饮水。不欲咽者。是热
在经。而里无热也。阳明气血俱多经中热甚。迫血妄行。必作衄也。按此条论。仲景无治法。补亡论常器之云。可黄芩
芍药地黄汤。一云当作黄芩芍药甘草汤。愚以此二汤。乃衄后之药于未衄时还宜用葛根等汤。加减主之。）
阳明病。本自汗出。医更重发汗。病已瘥尚微烦不了了者。此大便必硬故也。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。（当还二字。作还当其义乃顺。此条病。可见阳明府实大便硬之证。亦有不必下
者。医人不可以不知也。阳明病。本自汗出者。表中风也。医更重发汗。谓过用葛根汤。以大发其汗。阳明经表病
已瘥。瘥者。病小愈也。病虽小愈。必尚微烦。烦者里有热也。病已瘥而尚烦。是即谓不了了。若此者。大便必硬。其
所以大便硬之故。以重发汗亡津液。津液者。为胃所主。胃亡津液而干燥。则大肠无以滋养。故令大便硬也。大便虽硬。
其人但微烦。而无躁渴谵语狂乱等急证。故无可下之法。当问其小便之多少。以候其津液之自回。若其人于自汗出之日。
小便本三四行。今于微烦之日。小便止再行。知大便不久将出。何也。盖汗与小便皆津液所化。汗虽重发而津液亡矣。
今者小便药。之次数。得少于前。其时津液。不偏渗于膀胱。胃中得以少留。故云。还当入胃。非云。既渗于膀胱以内。
当还而入于胃中也。胃有津液。则大肠得以充润。故知不久。必大便下也。愚按此条阳明病。当兼手足而言。盖大便硬。
不尽属胃。实出之大肠府也。病家如欲用药宜少与麻仁丸。）
伤寒呕多。虽有阳明证。不可攻之。（此承上文而言。不可攻之证。复有数条。医人不可以不知也。此条伤寒。当是
太阳证。呕多者。风寒之邪方盛于表。胸中阳气。为寒所郁。于是上逆而作呕。故云虽有阳明胃家实。不大便之证。不
可攻之。成注云。呕者。热在上焦。未全入府。故不可下。按此条论。仲景无治法。补亡论常器之云。小柴胡汤。愚以
呕而口苦者。为少阳经证方。宜用小柴胡汤。今者太阳伤寒未罢。呕多。兼有阳明证。仲景法。还宜用葛根加半夏汤也。）
阳明病。心下硬满者。不可攻之。攻之利。遂不止者死。利止者愈。（阳明病心下硬满。心下者。胸膈之间也。此为
邪气初聚。府未全实慎不可攻。攻之。则肠胃中真气受伤。利遂不止。成注云。正气脱而死者此也。利止者。成注云邪
气去正气安则愈。或问云。同是误攻。何以其利。有止与不止之分。愚答云。其不止者。必其人肠胃素虚。或医反用大
承气。故利不止而死。其止者。必其人肠胃素实。或医止用小承气。故利止而愈。或又问云。结胸证同是心下硬满。又
属可下。何也。余答云。结胸当是虚硬虚满。与半夏泻心汤证。心下痞满略同故云不可攻也。补亡论常器之云。未攻者。
可与生姜泻心汤即是此意。又云。利不止者。四逆汤愚意云。止须以理中汤救之。）
阳明病面合赤色。不可攻之。攻之必发热。色黄小便不利也。（此条言阳明病。必胃家实。不大便之证。合。通也。
成注云。阳明病。面色通赤者。风热之邪。犹在经也。如误下之。则表邪不解。胃气徒虚。津液大耗。表不解。故其发
热。必愈盛。胃气虚。以故面色赤者。转而为黄。此系燥热。但致面色微黄。非若湿热之通身发黄也。津液燥。以故小
便不利。此系水竭而不利。非水瘀而不利也。后条辩云。一误攻之。截热于外。耗液于里。胃气燥而成黄者。此之谓欤。
按此条论。仲景无治法。补亡论郭白云云。既不可攻。但茵陈蒿汤。调五苓散服之。推郭氏之意。以发热为里热。小便
不利为停湿。竟认作湿热发黄。大谬之极。况此发热色黄。小便不利。系误攻以后变证。方其面合赤色之时。未必先有
是证也。愚意以面合赤色。与二阳并病。面色缘缘正赤相同。此为阳气怫郁于表。可小发汗。仲景法。还宜桂枝加葛根
汤。以微汗之。）
这是胃中寒冷且实邪内结的病证。阳明经受寒，是指寒邪刚刚侵入经脉，尚未完全传入胃腑，因此不会形成郁热。胃属阳，主司气机运行。若胃中阳气充盛，就能正常运化水谷，使饮食的摄入与排泄保持常态。如今胃中受寒，遏制了阳气，导致食物无法进入，水分无法排出，所以出现不能进食、小便也不利的症状。
手足濈然汗出（手脚持续出汗），是因为四肢是诸阳经的根本，同时阳明胃腑也主管四肢。胃府的阳气既然被寒气遏制，不能向内发散，就会郁积蒸腾于体表，因此手足会持续出汗。“固瘕”是指寒气凝结不散，就像积聚的肿块一样不消散，所以说“这想要形成固瘕”，并非真的已经形成了固定的癥瘕积聚。病人的大便，虽然开头干硬，但后面必定稀溏。大概因为手足濈然汗出的人，其大便通常会变硬；之所以出现开头硬后面稀的情况，是因为进入胃中的寒气已经凝结成冷，中焦阳气无法运化，不能分别清浊水谷，所以小便不利，而大便必然稀溏。按此条论述，张仲景没有给出治疗方法，《补亡论》中常器之说可以用理中汤。我认为寒气凝结成实，水谷不分，这是冷实证，理中汤过于温补，不宜使用。又说用猪苓汤，推测常氏的意思是因为小便不利，所以用此汤。但是张仲景既然说了胃中寒冷、水谷不分导致小便不利，为什么还要再用猪苓、泽泻、滑石等寒凉药物呢？大概是因为胃中虽然寒冷但实质是实邪，胃实必然会形成郁热，所以常氏用猪苓汤来利小便，等待小便利后大便自然变硬，然后再考虑使用承气汤等下药。
阳明病初期想吃饭，小便反而不利，大便正常。病人骨节疼痛，微微发热像是有发热的样子，突然发狂，随后濈然汗出而病解，这是因为水气不胜谷气，随着汗液一起排出，脉象紧则痊愈。（这是阳明经热邪未完全入腑的病证。阳明病想吃饭，说明风邪刚传入胃，胃气本来强盛，没有被病邪夺去。胃气强，就能游溢精气，通调水道，小便本该通利。如今反而不利，是因为胃气挟带邪热而过强，水气升发到体表，势必要作汗，所以下行成为溺液的量减少。大便正常，说明不是水谷不分、胃中寒冷实结的病证可比。病人骨节疼痛，微微发热像是有热状，是风邪郁滞在阳明之表。但这骨节痛，不同于太阳伤寒因寒气拘急而痛，而是阳明中风因热气蒸发而痛。所以热伏在肌肉之间，在表则只是微微发热，好像若无热状。“奄然”意为忽然。突然发狂，是邪热刚初入胃，胃气强盛，不受热邪困扰，正气与邪气相争，邪气退还到体表，所以发狂并随汗出而解。“濈然”的含义注脚已见前文。水指小便，谷气指想吃饭。胃能进食，则谷气胜，水气不胜谷气，必定共同作汗并合并于体表，那么此前未出汗时脉紧，到此脉紧消失，阳明经病必自愈。按“脉紧则愈”，《补亡论》阙疑部分常器之说，一本作“脉去则愈”。郭白云说，《千金方》作“坚者则愈”，没有“脉”字，这是误将“脉紧”理解为“去”或“坚”，或者是漏了“脉”字或“者”字，应当说是“脉紧者则愈”。我如今校正，应当说是“脉紧去则愈”，或者说“脉紧宜用麻黄汤”。我认为按张仲景的法度，太阳病脉紧者，宜用麻黄汤；此条属于阳明病，应当改用葛根汤。况且正文说“汗出而解”，所以不涉及治法。）
阳明病欲解的时间是从申时到戌时。（注脚已见于前第三卷太阳上编）
阳明病不能进食，如果攻伐其热，一定会发生呃逆（哕）。之所以这样，是因为胃中虚冷的缘故。因为病人本身虚弱，所以攻伐其热一定会发生呃逆。（寒邪中伤阳明，胃中虚冷，没有热可攻。成无己注云：热去寒起，竟认作有热的病证，错误很大。病人虽然不能进食，是因为胃气本虚，所以不吃，并非胃中实邪导致食不下。此条是真寒证，正文与注脚均见于《中寒论》中。）
阳明病脉迟，吃东西难以吃饱，饱了就轻微心烦，头晕目眩，必定小便困难，这是将要发生谷疸（因饮食不当引起的黄疸）。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。（这是阳明中风，刚初入胃，里证未完全实结的病证。脉迟属阴，主里。阳明病出现脉迟，说明邪气已离开经脉，逐渐传入腑中。但腑中郁热尚不严重，所以脉象还迟。吃东西难以吃饱，是因为中风证初期本能食，到了此时，邪气已入胃，势必难以吃饱。饱食后谷气与热邪相搏，郁蒸成湿。湿热之气上攻，则轻微心烦而头晕目眩。小便必难，是因为湿热上攻，水道不能下行顺接。湿热郁结在中焦，上不能发越，下不能泄出，这种形势又必须蒸发于外，将要形成谷疸的病证。疸即黄病。因为这个病证本因阳明中风，不能节制饮食，所以形成谷疸，身体发黄。湿热内积形成谷疸，那么病人腹部胀满是显而易见的。腹满通常用下法可以治愈，如今用了下法而腹满依旧，为什么呢？之所以这样，是因为脉迟，说明表邪未完全入里，热气尚未敛集成实，所以病情不因下法而稍减。成注引用经文说：脉迟尚不可攻，正是这个意思。按此条论述，张仲景没有给出治疗方法，《补亡论》常器之说：宜用猪苓汤、五苓散。我认为以上两方在未形成谷疸时可加减选用。郭白云说：已经发黄者，茵陈蒿汤，这是不可更改的方剂。）
阳明病通常多汗，反而无汗，身体像虫子在皮肤中爬行一样的感觉，这是因为久虚的缘故。（这是阳明经有寒邪，郁热不能透发。可见阳明之为病，也有无汗属于伤寒的情况。阳明多气多血，寒中阳明，热郁肌肉，法当多汗。如今反而无汗，这是因为经中阳气虚，不能升发到体表，所以皮肤中有像虫子爬行的感觉。如虫行者，就是痒。皮中，就是肌肉之间。汗欲出而不得，所以肌肉作痒，像虫子在皮肤中爬行。就像太阳病，得病八九日，因为不能得到微汗，身体必定痒，应当用桂枝麻黄各半汤，以小发其汗。所以《尚论篇》说：说“久虚”，是阐明汗之所以不能透出于肌表的缘故，并不是说应当用补益药。按此条论述，张仲景没有给出治疗方法，《补亡论》常器之说：可用桂枝加黄芪汤。郭白云说：因为无汗所以像虫子在皮肤中爬行，需要小汗才能解，宜用桂枝麻黄各半汤，以此汤解身痒，能小汗的缘故。我认为以上两汤都是太阳经的药物，如今是阳明无汗证，按张仲景的法度，还应当用葛根汤主治。）
阳明病反而无汗而小便通利，二三天后呕吐且咳嗽，手脚冰凉的人必定头痛剧烈。如果不咳不呕，手脚不冰凉，头就不痛。（这也是阳明经伤寒。小便通利，说明邪气不在里。这是阳明经初得的病，到了二三天，经中郁热不能向外宣泄，逐渐传入胃则呕吐且咳嗽。有人或许认为咳嗽是肺病，然而肺的系连与胃口相连附，胃热既上冲导致呕吐，肺气也会上逆导致咳嗽。四肢是诸阳的根本，阳明受寒邪伤害，经中阳气不能外达肌肤而为汗，怎么能横走手足而温暖四肢呢？厥逆就是冷。逆冷既严重，则郁热更深，热气上攻，必定痛苦于头痛。如果不咳、不呕、不厥，说明经中郁热尚未深重，所以头不痛。盖诸阳经都上头，仅凭头痛这一症状，可见手足厥逆属于热厥，而非真寒证。按此条论述，张仲景没有给出治疗方法，《补亡论》常器之说：类要用小建中汤，是错误的。可用小柴胡汤。推测常氏的意思是因为呕吐且咳嗽，建中汤是呕家所禁，所以改用小柴胡。殊不知这是阳明病胃口郁热导致呕吐，气逆导致咳嗽，与小柴胡证的喜呕或咳者，实在没有关系。郭白云说：手脚厥逆者，宜用小建中汤。总之此证，不是中气虚寒而发厥，而是表寒郁遏经中阳热之气而发厥。我认为按张仲景的法度，还应当用葛根汤加减，以发其汗。）
阳明病只有头晕目眩，不恶寒，所以能进食且咳嗽，病人必定咽痛。如果不咳嗽，咽部就不痛。（这是阳明经中风。风主动摇，所以头晕目眩。眩，就是头旋而眼晕。风为阳邪，所以不恶寒。能进食且咳嗽，含义见前文。大凡风寒之邪，都能郁热而致咳。风比寒邪的热势更甚，所以病人必定咽痛。咽门，是胃的系连。咳得厉害，则咽部受伤而痛。如果不咳，则咽部不受伤，所以不痛。有人问：咳出于肺，病人应当病喉痛，为何伤及咽部？我回答：经文说脏腑皆令人咳。如今阳明病应当是胃有风热而咳，所以说必定咽痛。按此条论述，张仲景没有给出治疗方法，《补亡论》常器之说：可服茯苓甘草白术生姜汤。我认为头晕目眩且咳嗽，纯粹是风热，反而用茯苓、白术等补气药，错误很大。又说：咽痛者，宜用桔梗汤。这本是少阴病咽痛的药。盖少阴之脉循喉咙，咽痛若是胃热甚侵及少阴之经，上述汤药可相互借用。）
阳明病无汗，小便不利，心中烦闷懊恼的，身体和眼睛都会发黄。（这是阳明经有郁热兼传入腑的病证。无汗而小便不利，则热郁湿停，湿热内积。其气上熏，则心中烦闷懊恼。此为土郁的病证可知。身体必定发黄，是说湿热郁蒸是必然的趋势。）
阳明病被火疗，额头微微出汗，小便不利的，必定发黄。（此条病与上一条大同小异。阳明无汗，因为用火强迫其出汗，热邪被火所迫，周身之气燥极，而热不外越，只上攻于额头而微微出汗。这与太阳病但头汗出的意义相同。经中邪热，既不能向外发散，又不能向下泄出，加上小便不利，此为湿热交蒸，身体也必定至发黄。按以上两条论述，张仲景没有给出治疗方法，《补亡论》常器之说皆云：可与茵陈蒿汤，调下五苓散。我认为茵陈蒿汤固然适宜用，但五苓散是太阳经利小便兼解表的药。如今阳明经无汗，若用五苓散，宜去掉桂枝，加入葛根为妥。另外白术一味，应当改用苍术。缘于以上两条证候，皆是湿胜发黄，湿热内盛的缘故。）
阳明病脉浮而紧的，必定有潮热，发作有定时。只有脉浮的，必定盗汗出。（这是太阳风寒之邪，传入阳明的病证。阳明病应当见到目疼、鼻干、不得卧。其脉浮而紧，仍见太阳伤寒的脉象。阴寒之邪，束其经中之阳气，阳气被郁，不能发散，所以乘其经气旺盛之时，必定潮热发作。若其脉只有浮象，这是太阳经风邪传于阳明，病人必定盗汗出。盗汗，就是睡着时出汗。阳邪入于阴分，所以睡着则汗出。我按：此条论述应当分作两段看。脉浮紧、潮热，这是阳明伤寒，张仲景法度，宜用葛根汤主治。脉浮、盗汗出，这是阳明中风，张仲景法度，宜用桂枝加葛根汤主治。《补亡论》与柴胡桂枝汤是错误的。）阳明病口干燥，只想漱口喝水，不想吞咽的，这必定会发生鼻衄（出血）。（这是阳明经燥热的病证。成注云：阳明之脉起于鼻，络于口。阳明里热，则渴欲饮水。此口干燥，只想饮水，不想吞咽，是热在经脉，而里没有热。阳明气血俱多，经中热甚，迫血妄行，必定发生鼻衄。按此条论述，张仲景没有给出治疗方法，《补亡论》常器之说：可用黄芩芍药地黄汤。一说当作黄芩芍药甘草汤。我认为这两汤，是衄后的药，在未衄时还应当用葛根等汤，加减主治。）
阳明病，本来就有自汗出，医生再次强力发汗，病虽已好转但仍轻微心烦、神志不清的，这大便必定硬结。这是因为津液耗损，胃中干燥，所以令大便硬结。应当询问病人每天小便几次。如果原本小便一天三四次，今天只有两次，就知道大便不久将会排出。现在因为小便次数减少，津液应当回归胃中，所以知道不久必定大便通畅。（“当还”二字，作“还当其义乃顺”理解。此条病，可见阳明腑实大便硬的病证，也有不必用下法的。医人不可以不知道。阳明病，本来就有自汗出，是表中风邪。医生再次强力发汗，谓过用葛根汤以大发其汗。阳明经表病已好转。瘥，就是病小愈。病虽小愈，必定还有轻微心烦。烦，就是里有热。病已好转而尚烦，就是所说的“不了了”。如果是这种情况，大便必定硬结。其所以大便硬的原因，是因为强力发汗耗损津液。津液，由胃所主。胃亡津液而干燥，则大肠无以滋养，所以令大便硬结。大便虽硬，病人只是轻微心烦，而没有躁渴、谵语、狂乱等急证，所以没有可下的方法。应当询问其小便的多少，以观察津液是否自行恢复。如果病人在自汗出之日，小便本来三四次，如今在微烦之日，小便停止变为两次，就知道大便不久将排出。为什么呢？盖汗与小便皆由津液所化。汗虽强力发出而津液亡失。如今小便的次数少于从前，此时津液不偏渗于膀胱，胃中得以少量留存，所以说“还当入胃”。不是说既已渗入膀胱以内，应当再返回入于胃中。胃有津液，则大肠得以充润，所以知道不久必定大便下排。我按：此条阳明病，应当兼谈手足而言。盖大便硬，不尽属于胃，实际出自大肠腑。病家如果想用药，宜少量给予麻仁丸。）
伤寒呕吐多，虽然有阳明证，不可攻下。（这是承接上文而言，不可攻下的证候，又有数条，医人不可以不知道。此条伤寒，应当是太阳证。呕吐多，说明风寒之邪正盛于表，胸中阳气被寒所郁，于是上逆而作呕。所以说虽然有阳明胃家实、不大便的证候，也不可攻下。成注云：呕者，热在上焦，未全入腑，故不可下。按此条论述，张仲景没有给出治疗方法，《补亡论》常器之说：小柴胡汤。我认为呕吐且口苦者，为少阳经证，才宜用小柴胡汤。如今太阳伤寒未罢，呕吐多，兼有阳明证，张仲景法度，还宜用葛根加半夏汤。）
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。（阳明病心下硬满，心下，就是胸膈之间。此为邪气初聚，腑未全实，慎不可攻。攻下，则肠胃中真气受伤，腹泻遂不止。成注云：正气脱而死者，就是这个。腹泻停止，成注云：邪气去，正气安则愈。有人问：同样是误攻，为什么其腹泻有止与不止的区别？我回答：不止者，必定其人肠胃素虚，或者医生反用大承气汤，所以腹泻不止而死。止者，必定其人肠胃素实，或者医生只用小承气汤，所以腹泻止而愈。又有人问：结胸证同样是心下硬满，又属下法可治，为什么呢？我回答：结胸应当是虚硬、虚满，与半夏泻心汤证的心下痞满略同，所以说不可攻。《补亡论》常器之说：未攻者，可与生姜泻心汤，即是此意。又说：腹泻不止者，四逆汤。我的意见是：只需以理中汤救之。）
阳明病面色通红，不可攻下。攻下必定发热，面色发黄，小便不利。（此条言阳明病，必定是胃家实、不大便的证候。合，通也。成注云：阳明病，面色通赤者，风热之邪，犹在经也。如误下之，则表邪不解，胃气徒虚，津液大耗。表不解，所以其发热必定更盛。胃气虚，所以面色赤者，转而为黄。此为燥热，只导致面色微黄，不像湿热之通身发黄。津液燥，所以小便不利。此为水竭而不利，非水瘀而不利。后条辨析说：一误攻之，截热于外，耗液于里，胃气燥而成黄者，说的就是这个。按此条论述，张仲景没有给出治疗方法，《补亡论》郭白云说：既然不可攻，只用茵陈蒿汤，调五苓散服之。推测郭氏的意思，以发热为里热，小便不利为停湿，竟认作湿热发黄，大谬之极。况且此发热色黄、小便不利，是误攻以后的变证，在其面合赤色之时，未必先有此证。我的意见是：面合赤色，与二阳并病、面色缘缘正赤相同。此为阳气怫郁于表，可小发其汗。张仲景法度，还宜用桂枝加葛根汤，以微汗之。）
This is a syndrome of cold and excess in the stomach. Yangming disease with cold indicates that cold pathogenic factors have just entered the meridians but have not fully entered the stomach, thus failing to generate stagnant heat. The stomach belongs to Yang and governs Qi movement. If stomach Yang Qi is abundant, it can properly transform food and fluids, maintaining normal intake and excretion. Now, cold in the stomach inhibits Yang Qi, preventing food from entering and water from exiting, resulting in an inability to eat and difficulty urinating.
Sustained sweating on the hands and feet occurs because the four limbs are the root of all Yang meridians, and the Yangming stomach also governs the limbs. Since the stomach's Yang Qi is inhibited by cold and cannot diffuse inward, it stagnates and steams outward, causing sustained sweating on the hands and feet. "Gu Jia" (solidified mass) refers to cold qi condensing and not dispersing, resembling a fixed accumulation; thus, it is said that this condition "wants to form Gu Jia," meaning it has not truly formed a fixed mass. The patient's stool may be hard at the beginning but loose later. Generally, patients with sustained hand and foot sweating tend to have hard stools; the reason for initial hardness followed by looseness is that the cold qi entering the stomach has condensed into cold, middle Jiao Yang Qi fails to transport, and clear turbid separation is impaired, leading to difficult urination and loose stools. Regarding this clause, Zhang Zhongjing provides no treatment method. Chang Qizhi in *Bu Wang Lun* suggests Lizhong Tang. I believe that for cold excess with indistinguishable food and fluids, Lizhong Tang is too tonifying and inappropriate. Another suggestion is Zhu Ling Tang; inferring Chang's intent, he used it for difficult urination. However, since Zhang stated that cold stomach and indistinguishable food/fluids cause difficult urination, why use cold herbs like Zhu Ling, Ze Xie, and Shi Gao? Likely, although the stomach is cold, there is excess, which inevitably generates stagnant heat. Thus, Chang used Zhu Ling Tang to promote urination, waiting for urine flow to restore before considering Chengqi Decoction or similar purgatives.
In early Yangming disease, if the patient desires food, yet urination is unexpectedly difficult while stool remains normal, accompanied by bone joint pain, slight feverish sensation, sudden mania, followed by sustained sweating and resolution, this indicates that Water Qi cannot overcome Grain Qi, and both exit via sweat. A tight pulse resolving signifies recovery. This represents Yangming meridian heat not fully entering the fu organs. Desire for food implies wind pathogen just entered the stomach, where stomach Qi is strong and not depleted. Strong stomach Qi should regulate water passages, making urination smooth. Difficulty here arises because stomach Qi, carrying pathogenic heat, is overly strong, causing Water Qi to rise to the exterior, attempting to sweat rather than become urine. Normal stool rules out cold-excess syndromes. Bone joint pain and slight fever indicate wind pathogen stagnating in the Yangming exterior. Unlike Taiyang cold-stagnation pain, this is Yangming wind-heat evaporation pain. Heat lies in muscles; externally, it feels slightly warm, almost without heat. Sudden mania occurs when pathogenic heat enters the stomach; strong stomach Qi resists, righteous Qi fights pathogen, driving it back to the exterior, causing mania resolved by sweating. "Water" refers to urine; "Grain Qi" refers to appetite. When stomach eats well, Grain Qi prevails over Water Qi, forcing them together as sweat. Previously tight pulse disappears, indicating self-recovery. *Bu Wang Lun* notes variations: some texts say "pulse leaves then recovers"; Guo Baiyun cites *Qian Jin Fang* as "firmness leads to recovery," missing "pulse." Correction suggests "tight pulse leaving leads to recovery" or "tight pulse warrants Mahuang Tang." However, per Zhang's method, Taiyang tight pulse uses Mahuang Tang; this Yangming case requires Gegen Tang. Since text says "resolved by sweating," no specific treatment is given.
Yangming disease resolves between Shen (3-5 PM) and Xu (7-9 PM). Note seen previously.
Yangming disease with inability to eat, attacking heat causes hiccups (Yue). This is due to deficiency-cold in the stomach. Because the person is originally deficient, attacking heat induces hiccups. Cold strikes Yangming, causing deficiency-cold with no heat to attack. Cheng Wuji notes error in treating as heat. Inability to eat stems from weak stomach Qi, not excess blocking food. This is a true cold syndrome.
Yangming disease with slow pulse, difficulty eating full meals, slight vexation and dizziness after eating, and difficult urination indicates impending Gu Dan (grain jaundice). Purging will not relieve abdominal fullness because of the slow pulse. This is Yangming wind-strike entering stomach, interior not fully solid. Slow pulse indicates Yin/interior. Pathogen moves from meridian to fu, but heat is not severe, hence slow pulse. Fullness exacerbates heat-dampness interaction. Damp-heat attacks upward causing vexation/dizziness and blocks water passages. Stagnant damp-heat in Middle Jiao steams outward, forming yellow disease (Dan Jaundice). Due to uncontrolled eating in Yangming wind-strike, grain jaundice forms. While purging usually treats fullness, here it fails because slow pulse means exterior pathogen hasn't fully entered interior, and heat isn't consolidated. Cheng note cites: "Slow pulse, do not attack." Chang Qizhi suggests Zhu Ling Tang or Wu Ling San. Guo Baiyun recommends Yinchen Hao Tang for established jaundice.
Yangming disease typically involves profuse sweating; lack thereof with a sensation like insects crawling on skin indicates chronic deficiency. Cold pathogen in Yangming meridian traps heat. Yangming has abundant Qi and Blood; cold trapping heat should cause sweating. Lack of sweating implies deficient meridian Yang Qi failing to reach exterior. Itching/crawling sensation results from sweat trying to emerge but failing. Similar to Taiyang 8-9 day syndrome requiring Guizhi Mahuang Banxia Tang for mild sweating. *Shanglun Pian* clarifies "chronic deficiency" explains failure of sweat to emerge, not indication for tonification. Chang Qizhi suggests Guizhi plus Huangqi Tang. Guo Baiyun suggests Guizhi Mahuang Banxia Tang. I argue these are Taiyang formulas; for Yangming non-sweating, Gegen Tang is appropriate.
Yangming disease with no sweating but free urination, progressing over 2-3 days to vomiting, cough, and cold extremities, implies severe headache. Absence of these symptoms means no headache. This is Yangming cold-strike. Free urination indicates pathogen not in interior. After 2-3 days, trapped meridian heat enters stomach, causing vomiting/cough. Lung connects to stomach; stomach heat rising affects lung Qi. Limbs are root of Yang; Yangming cold prevents Yang Qi from warming limbs, causing cold extremities (Jue). Severe cold deepens heat, which attacks head causing pain. All Yang meridians ascend to head. Thus, cold extremities indicate heat-Jue, not true cold. Chang Qizhi wrongly suggests Xiaojianzhong Tang. Guo Baiyun suggests Xiaochaihu Tang. I argue this is stomach heat/qi rebellion, unrelated to Shaoyang. Ge Gen Tang modification is correct.
Yangming disease with only dizziness, no aversion to cold, ability to eat, and cough implies sore throat. Wind moves, causing dizziness. Wind is Yang pathogen, so no aversion to cold. Cough and sore throat result from wind-heat damaging throat (stomach connection). If no cough, no sore throat. Question: Why throat instead of larynx? Answer: Zang-Fu all cause cough; here stomach wind-heat causes cough and throat pain. Chang Qizhi suggests Fuling Gancao Baizhu Shengjiang Tang, which is wrong for wind-heat. For sore throat, Jiegeng Tang (Shaoyin formula) might be borrowed if heat invades Shaoyin meridian.
Yangming disease with no sweating, difficult urination, and mental restlessness (Ao Nao) leads to yellowing of body and eyes. Heat stagnation and damp retention accumulate internally, steaming upward. This is Earth stagnation. Yellowing is inevitable outcome of damp-heat steaming.
Yangming disease treated with fire therapy, with slight forehead sweating and difficult urination, leads to yellowing. Similar to previous clause. Fire forces sweat; heat becomes dry, unable to escape except slightly on forehead (similar to Taiyang head-only sweat). Heat trapped internally and externally, combined with difficult urination, causes damp-heat steaming and yellowing. Chang Qizhi suggests Yinchen Hao Tang plus Wu Ling San. I agree with Yinchen Hao Tang but advise modifying Wu Ling San: remove Guizhi, add Gegen. Replace Baizhu with Cangzhu due to damp-heat excess.
Yangming disease with floating-tight pulse implies tidal fever at regular times. Floating pulse alone implies night sweats. This is Taiwind-wind-cold transmitting to Yangming. Floating-tight resembles Taiyang cold-strike; Yin-cold constrains Yang Qi, causing tidal fever during peak meridian time. Floating pulse indicates wind-transmission, causing night sweats (sweating during sleep due to Yang pathogen entering Yin). Analysis splits clause: Floating-tight/tidal fever = Yangming cold-strike, treat with Gegen Tang. Floating/night sweat = Yangming wind-strike, treat with Guizhi plus Gegen Tang. Chaihu Guizhi Tang is incorrect.
Yangming disease with dry mouth, desire to rinse mouth but not swallow, implies epistaxis (nosebleed). Cheng note: Yangming vessel starts at nose/mouth. Interior heat causes thirst/drinking. Dry mouth/rinsing-not-swallowing indicates heat in meridian, not interior. Abundant Yangming Qi/Blood with intense meridian heat forces blood recklessly, causing bleeding. Chang Qizhi suggests Huangqin Shaoyao Dihuang Tang or Huangqin Shaoyao Gancao Tang. These are post-bleeding formulas; pre-bleeding should use Gegen modifications.
Yangming disease originally with spontaneous sweating, further induced sweating by physician, residual mild vexation and confusion indicates hard stool. Loss of fluids and dry stomach cause hardness. Check urine frequency. If urine drops from 3-4 times/day to 2 times, stool will pass soon as fluids return to stomach. Fluids transform into sweat and urine. Reduced urine means fluids stay in stomach/intestines, moistening colon. Mild vexation without severe agitation means no immediate purging needed. Monitor fluid recovery. If medication desired, small dose of Maren Wan.
Taiyang disease with frequent vomiting, even with Yangming signs, prohibits purging. Vomiting indicates pathogen still in exterior/chest, obstructing Yang Qi upward. Even with Yangming excess constipation, do not purge. Cheng note: Heat in upper Jiao, not fully in fu. Chang Qizhi suggests Xiaochaihu Tang. I argue Xiaochaihu is for Shaoyang (vomiting + bitter taste). Here Taiyang cold persists with Yangming signs; Gegen plus Banxia Tang is indicated.
Yangming disease with epigastric hardness/fullness prohibits purging. Purging causing unceasing diarrhea leads to death; stopping diarrhea indicates recovery. Epigastric area is chest/diaphragm. Early pathogen aggregation, not full fu-solidity. Purging damages true Qi. Unceasing diarrhea = Qi collapse. Stopping = pathogen gone, Qi restored. Difference depends on original constitution (deficient vs. solid) and severity of purgative used. Jie Xiong (knotted chest) also has epigastric hardness but is "false fullness," treated with Banxia Xiexin Tang. Chang Qizhi suggests Shengjiang Xiexin Tang. For unceasing diarrhea, Sini Tang suggested, but I prefer Lizhong Tang.
Yangming disease with flushed face prohibits purging. Purging causes fever, yellow face, difficult urination. Flushed face indicates wind-heat still in meridian. Incorrect purging fails to resolve exterior, empties stomach Qi, depletes fluids. Exterior unresolved causes fever. Empty stomach Qi turns red face yellow (dry heat, not damp-heat jaundice). Depleted fluids cause difficult urination (water exhaustion, not obstruction). Guo Baiyun suggests Yinchen Hao Tang plus Wu Ling San, mistaking post-purging complications for primary damp-heat. I compare flushed face to Two-Yang concurrent disease (continuous redness), indicating Yang Qi stagnation in exterior. Mild sweating with Guizhi plus Gegen Tang is appropriate.