病如桂枝证。头不痛。项不强。寸脉微浮。胸中痞硬。气上冲咽喉不得息者。此为胸有寒也。
当吐之。宜瓜蒂散。
此痰饮类伤寒证。寒为寒饮。非寒邪也。活人云、痰饮之为病。能令人憎寒发热。状类伤寒。
但头不痛。项不强为异。正此之谓。脉浮者。病在膈间。而非客邪。故不盛而微也。胸有寒饮。足
以阻清阳而碍肺气。故胸中痞硬。气上冲咽喉。不得息也。经曰、其高者因而越之。千金云、气浮
上部。顿塞心胸。胸中满者。吐之则愈。瓜蒂散能吐胸中与邪相结之饮也。
瓜蒂散方
瓜蒂（熬黄） 赤小豆（各一分即粮食中蟹眼紧细之赤豆是也）
上二味。各别捣筛为散。合治之。取一钱匕。以香豉一合。用热汤七合。煮作稀糜。去滓。取
汁。和散。温顿服之。不吐者。少少加。得快吐乃止。诸亡血虚家。不可与之。
太阳病从外入。是以经病多于腑病。若阳明则腑病多于经病。以经邪不能久留。而腑邪常聚而
不行也。故仲师以胃家实为阳明正病。本篇先列腑病于前。次列经病于后。遵先圣之法也。而经病有
传经自受之不同。腑病有宜下宜清宜温之各异。详见各条。要皆不出为正治之法也。此为上编。凡
四十九条。其次则为明辨法。盖阳明以胃实为病之正。以攻下为法之的。而其间有经腑相连。虚实
交错。或可下。或不可下。或可下而尚未可下。及不可大下之时。故有脉实。潮热。转失气。小便
少等辨。及外导润下等法。又其次为杂治法。谓病变发黄。蓄血诸候。非复阳明胃实。及经邪留滞
之时。所可比例。或散或下。所当各随其证。而异其治者也。此为下编。凡三十三条。
病症表现类似桂枝汤证，但头部不痛，项部不强硬，寸脉微微浮起，胸中痞塞坚硬，气逆上冲至咽喉导致呼吸不畅。这是胸中有寒饮（此处指寒性痰饮邪气）的缘故。
这是痰饮类同于伤寒的证候。“寒”指的是寒饮，而非外感寒邪。《活人书》说：痰饮作为疾病，能使人恶寒发热，症状类似伤寒。只是头部不痛、项部不强硬是不同之处，正是说的这种情况。脉象浮，说明病位在膈间，而不是外来的邪气客居，所以脉势不盛而微。胸中有寒饮，足以阻碍清阳之气并妨碍肺气宣降，所以出现胸中痞塞坚硬，气逆上冲咽喉，呼吸不畅的情况。《内经》说：病位在高处的，应当用涌吐的方法使邪气排出。《千金方》说：气浮越于上部，突然堵塞心胸，胸中胀满的，通过涌吐治疗就能痊愈。瓜蒂散能够吐出胸中与邪气相结聚的饮邪。
瓜蒂散方剂组成：
瓜蒂（炒至黄色）、赤小豆（各一分，即粮食中蟹眼般紧细的赤豆）。
以上两味药，分别捣碎筛成散剂，混合均匀。取一钱匕的药量，用香豉一合，热汤七合，煮成稀粥状，滤去渣滓，取汁液，与药散混合，温服，一次顿服。如果不呕吐，就少量增加剂量，直到引起快速呕吐为止。凡是失血患者及体质虚弱的人，不可服用此方。
太阳病是从外部侵入的，所以经病多于腑病。如果是阳明病，则腑病多于经病。因为经邪不能长久停留，而腑邪常常聚集而不行。所以张仲景以“胃家实”作为阳明的正病。本篇先列出腑病在前，后列出经病在后，这是遵循先圣的法度。而且经病有传经自受的不同，腑病有宜用下法、清热法或温法的差异，详见各条文。总之都不超出正治之法的范围。这是上编，共四十九条。其次则是明辨法。大概阳明以胃实为病的根本，以攻下为治疗的靶点。而其中有经腑相连、虚实交错的情况，有的可以下，有的不可以下，有的可以下但尚未到可下的时候，以及不可大下的时机。所以有脉实、潮热、转失气、小便少等辨证要点，以及外导、润下等方法。再次是杂治法，指病变出现发黄、蓄血等各种证候，不再属于阳明胃实，也不是经邪留滞的时候所能类比推断的。或者用散法，或者用下法，都应当根据具体证候，采取不同的治疗方法。这是下编，共三十三条。
The symptoms resemble those of the Guizhi Tang (Cinnamon Twig Decoction) pattern, yet there is no headache or stiffness in the nape. The cun (inch) pulse is slightly floating. There is a sensation of fullness and hardness in the chest, with qi rushing upward to the throat causing dyspnea. This indicates the presence of cold-phlegm-fluid (cold-type phlegm-fluid pathogen) in the chest.
One should employ the emetic method for treatment; Gouti San (Melon Seed Powder) is appropriate.
This is a syndrome resembling Taiyang disease caused by phlegm-fluid accumulation. The "cold" here refers to cold-phlegm-fluid, not an external cold pathogen. The *Huoren Shu* states: Phlegm-fluid as a pathogen can cause aversion to cold and fever, presenting similarly to Taiyang disease. However, the absence of headache and nape stiffness distinguishes it, which is precisely what is meant here. A floating pulse indicates the pathology is located between the diaphragm, rather than being an exogenous pathogen lodged there; thus, the pulse is not forceful but slight. Cold-phlegm-fluid in the chest obstructs the clear yang qi and impedes lung qi descent, resulting in chest fullness and hardness, upward rushing of qi to the throat, and dyspnea. The *Classic of Internal Medicine* states: "Where the pathology is high, use the method of raising and evacuating [emesis]." The *Qianjin Fang* states: "When qi floats to the upper part, suddenly blocking the chest and heart, if the chest is full, emesis will cure it." Gouti San can expel the fluid pathogen bound with evil in the chest through emesis.
**Gouti San Formula**
* Gualti (Aged Yellow Melon Seed, *Cucumis melo var. conomon* seed, stir-fried until yellow)
* Chixiaodou (Red Adzuki Bean, *Vigna angularis*, one fen each, specifically referring to the tight, fine red beans found among grains)
Process the above two ingredients separately by pounding and sifting into powder, then mix them thoroughly. Take one qianbi (a small spoonful measure) of the powder. Use Xiangchi (Prepared Soybean, *Sojae Semen Praeparatum*) one he, and hot water seven he. Boil until a thin porridge consistency is reached, strain to remove dregs, and take the decoction. Mix with the powder and administer warm in one dose. If vomiting does not occur, gradually increase the dosage until rapid vomiting ensues, then stop. This formula is contraindicated for patients who have suffered blood loss or those with deficiency constitutions.
Taiyang disease enters from the exterior; therefore, Jing-meridian syndromes are more common than Fu-organ syndromes. In contrast, for Yangming disease, Fu-organ syndromes are more common than Jing-meridian syndromes. This is because pathogenic factors in the meridians cannot remain long-term, whereas pathogens in the fu-organs tend to accumulate and stagnate. Therefore, Zhang Zhongjing considers "stomach-fullness-excess" (Wei Jia Shi) as the primary pathology of Yangming. This chapter lists Fu-organ syndromes first and Jing-meridian syndromes later, adhering to the methods of the Sages. Furthermore, Jing-meridian syndromes vary in their transmission and spontaneous acquisition, while Fu-organ syndromes differ in their suitability for purgation, clearing heat, or warming. These details are elaborated in respective articles. Ultimately, all fall within the scope of standard treatment methods. This constitutes the Upper Compilation, comprising forty-nine articles. Next follows the section on distinguishing differentiation. Generally, Yangming pathology centers on stomach excess, making purgation the targeted therapeutic approach. However, there are instances where meridian and organ pathologies interconnect, and deficiency and excess intermingle. Some cases require purgation, some do not, some are suitable for purgation but not yet ready for it, and there are times when heavy purgation is contraindicated. Thus, differentiation relies on indicators such as a solid pulse, tidal fever, passing flatus, and scanty urination, along with methods like external guidance and moistening purgation. Finally, there are miscellaneous treatment methods, addressing conditions such as jaundice transformation and blood stasis syndromes, which no longer belong to Yangming stomach excess nor simple meridian pathogen stagnation that could be inferred by analogy. Whether using dispersing or purging methods, treatment must be tailored to the specific syndrome. This constitutes the Lower Compilation, comprising thirty-three articles.