问曰∶不得眠，何以是阳明腑证？答曰∶不得眠，阴阳皆有之，其狂乱不得眠者，阳明
胃热故也。经云∶胃不和，则卧不安。胃受热邪，故不和，不和故不眠也。若初时目痛、鼻
干、不得眠者，阳明经病也，葛根汤主之。若蒸热自汗，燥渴脉洪，不得眠者，阳明经腑同
病，散漫之热也，白虎加人参汤主之。若潮热自汗，便闭谵语，不得眠者，阳明腑病，结聚
之热也，调胃承气汤下之。若伤寒邪气已解，或因食复，遂至烦闷、干呕、口燥、呻吟、不
得眠者，以保和汤加芩、连主之。又问曰∶不眠固属热证，有投寒药转甚者，何也？答曰∶
因汗下重亡津液，心蕴虚烦，致不得眠，宜用酸枣仁汤，或真武汤主之。不眠似属寻常，若
少阴脉沉细，自利、厥逆、烦躁不得眠者，为难治也。
问曰∶燥渴何以属阳明腑证？答曰∶寒邪在表，则不渴；邪气传里，化而为热，则渴。
太阳证有口渴者，膀胱腑病也，其渴微。阳明经病，但漱水尔，不为渴也，入腑则大渴矣。
少阳证，但口苦，亦无渴，其有渴者，将转入阳明也。仲景云服柴胡汤已，而渴者，属阳明
也。三阴皆有渴，因其连于胃腑，故渴也。是知燥渴的属阳明证。余详辨厥阴证消渴条下。
问曰∶自汗何以是阳明腑病？答曰∶伤寒在表，则腠理致密而无汗；入腑，则热气发越
而汗自出矣。今无汗忽变为有汗者，乃热邪入腑，熏蒸如鼎沸然，故令汗出也。又问曰∶
自汗有用桂枝，乃桂枝加附子汤者，何也？答曰∶自汗用桂枝者，太阳伤风症也；用桂枝加
附子汤者，因发汗太多，遂漏不止，恶风寒而为表虚也。若阳明腑病，燥渴谵语，孰敢用桂
枝者？仲景于桂枝加附子条下，注曰不呕不渴。可见阳明燥渴，则无用桂枝之理矣。大抵头
痛发热悉具者，伤风自汗也；因发汗遂漏不止者，阳虚自汗也；烦躁口渴，能消水，不恶风
寒而反恶热者，阳明腑病自汗也。又问曰∶直中证，亦自汗，何也？答曰∶直中证，冷汗自
出，脉沉迟，手足厥冷，乃真阳衰微之象，与阳明胃热自汗，熏蒸腾沸之状，天渊相隔矣。
又问曰∶中暑自汗，亦口渴，何以别之？答曰∶中暑自汗，口虽渴，脉必弦细芤迟也。经云
∶脉盛身热，得之伤寒，脉虚身热，得之伤暑。实者、人参白虎汤，虚者、十味香薷饮主之
问：为什么“不得眠”（失眠）属于阳明腑证？答：失眠，阴阳两经的病变都可能出现。那些出现神志狂乱、无法入睡的情况，是因为阳明胃中有热邪所致。医经说：“胃不和，则卧不安。”胃受到热邪侵袭，所以功能失调；功能失调，就会导致失眠。如果起初出现眼睛疼痛、鼻子干燥、无法入睡，这是阳明经病，用葛根汤主治。如果出现蒸蒸发热、自汗出、口干燥渴、脉象洪大、无法入睡，这是阳明经病和腑病同时发生，属于弥漫散漫的热邪，用白虎加人参汤主治。如果出现潮热、自汗出、大便闭塞不通、胡言乱语、无法入睡，这是阳明腑病，属于结聚集中的热邪，用调胃承气汤攻下治疗。如果伤寒的邪气已经解除，但因为饮食不当导致复发，进而出现心烦闷乱、干呕、口燥、痛苦呻吟、无法入睡，用保和汤加入黄芩、黄连主治。又问：失眠确实多属热证，但有时服用寒凉药物后病情反而加重，这是什么原因？答：这是因为发汗或攻下过度，导致津液严重耗伤，心中蕴藏虚烦，从而导致失眠，适宜用酸枣仁汤，或者真武汤主治。失眠看似寻常，但如果少阴脉象沉细，伴有腹泻、四肢厥冷、烦躁不安、无法入睡，这就属于难治之症。
问：为什么“燥渴”（极度口渴）属于阳明腑证？答：寒邪在体表时，人不会口渴；邪气传入体内，转化为热邪，才会口渴。太阳病证中有口渴的，是膀胱腑病，其口渴程度较轻。阳明经病，只是想要含水漱口而不欲咽下，不算真正的口渴；邪气进入腑中，才会出现大渴。少阳病证，只是口苦，也没有口渴；如果有口渴症状，说明病邪将要转入阳明。张仲景说，服用柴胡汤之后出现口渴的，属于阳明病。三阴经病变都有可能出现口渴，因为它们与胃腑相连，所以会口渴。由此可知，燥渴确切地归属于阳明证。其余详细辨析见厥阴病消渴条下。
问：为什么“自汗”（不因运动或炎热而自然出汗）属于阳明腑病？答：伤寒邪气在体表时，腠理致密，所以没有汗；邪气传入腑中，热气向外发散，就会自然出汗。现在从无汗突然变为有汗，这是热邪传入腑中，像鼎中水沸腾一样熏蒸身体，所以导致出汗。又问：自汗有用桂枝汤治疗的，比如桂枝加附子汤，这是什么原因？答：自汗使用桂枝汤的，是太阳中风证；使用桂枝加附子汤的，是因为发汗过多，导致汗漏不止，恶风怕冷，属于表虚证。如果是阳明腑病，出现口干燥渴、胡言乱语，谁还敢用桂枝呢？张仲景在桂枝加附子汤的条文下注明“不呕不渴”。可见阳明燥渴，就没有使用桂枝的道理了。大致来说，头痛发热具备的，是伤风导致的自汗；因为发汗导致汗漏不止的，是阳虚导致的自汗；烦躁口渴，能喝水，不怕风寒反而怕热的，是阳明腑病导致的自汗。又问：直中证（寒邪直中脏腑），也有自汗，这是什么原因？答：直中证，冷汗自出，脉象沉迟，手脚冰凉，这是真阳衰微的表现，与阳明胃热导致的自汗那种熏蒸腾沸的状态，相差如天地之别。又问：中暑导致的自汗，也伴有口渴，如何区分？答：中暑导致的自汗，虽然口渴，但脉象一定是弦细芤迟。医经说：“脉盛身热，得之伤寒；脉虚身热，得之伤暑。”实证用人参白虎汤，虚证用十味香薷饮主治。
Question: Why is "insomnia" (bu de mian) considered a Yangming Fu-organ syndrome? Answer: Insomnia can occur in both Yin and Yang channels. Cases involving delirium and inability to sleep are caused by heat in the Yangming Stomach. The Classics state: "When the Stomach is disharmonious, sleep is restless." When the Stomach is invaded by pathogenic heat, it becomes disharmonious; due to this disharmony, insomnia occurs. If initially there is eye pain, nasal dryness, and insomnia, this is a Yangming Channel disease, treated primarily with Gegen Tang (Kudzu Decoction). If there is steaming fever, spontaneous sweating, dry thirst, a flooding pulse, and insomnia, this is a simultaneous disease of the Yangming Channel and Fu-organ, characterized by diffuse heat, treated primarily with Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng). If there is tidal fever, spontaneous sweating, constipation, delirious speech, and insomnia, this is a Yangming Fu-organ disease, characterized by concentrated heat, treated by purging with Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction). If the pathogenic factors of Cold Damage have been resolved, but recurrence occurs due to dietary indiscretion, leading to mental restlessness, dry retching, oral dryness, groaning, and insomnia, treat primarily with Baohe Tang (Harmonize the Middle Decoction) added with Huangqin (Scutellariae Radix) and Lianzi (Coptidis Rhizoma). Another question arises: Insomnia generally belongs to heat syndromes, yet sometimes administering cold medicines worsens the condition. Why? Answer: This is because excessive sweating or purging has severely depleted body fluids, leaving empty heat harassing the Heart, causing insomnia. Suanzaoren Tang (Ziziphus Seed Decoction) or Zhenwu Tang (True Warrior Decoction) should be used. Although insomnia seems common, if the Shaoyin pulse is deep and fine, accompanied by diarrhea, cold extremities, irritability, and insomnia, it is difficult to treat.
Question: Why does "dry thirst" (zao ke) belong to Yangming Fu-organ syndrome? Answer: When cold pathogens are on the exterior, there is no thirst; when pathogens transmit inward and transform into heat, thirst occurs. In Taiyang syndrome cases with thirst, it is a Bladder Fu-organ disease, and the thirst is mild. In Yangming Channel disease, one may only want to rinse the mouth with water without swallowing, which is not true thirst; upon entering the Fu-organ, severe thirst occurs. In Shaoyang syndrome, there is only bitter taste in the mouth and no thirst; if thirst appears, it indicates the pathogen is about to transmit to Yangming. Zhang Zhongjing stated that if thirst occurs after taking Chaihu Tang (Bupleurum Decoction), it belongs to Yangming. All three Yin channels may present with thirst because they connect to the Stomach Fu-organ. Thus, dry thirst definitively belongs to Yangming syndrome. For further details, refer to the section on Jueyin syndrome and Xiao Ke (Wasting-Thirst).
Question: Why is "spontaneous sweating" (zi han) considered a Yangming Fu-organ disease? Answer: When Cold Damage pathogens are on the exterior, the pores are closed and dense, so there is no sweat; when they enter the Fu-organ, heat radiates outward, causing spontaneous sweating. The sudden change from no sweat to sweating indicates that heat pathogens have entered the Fu-organ, steaming the body like boiling water in a cauldron, thus causing sweat. Another question arises: Spontaneous sweating is treated with Guizhi Tang, such as Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite Root), why? Answer: Using Guizhi Tang for spontaneous sweating refers to Taiyang Wind Strike syndrome; using Guizhi Jia Fuzi Tang refers to cases where excessive sweating led to unceasing leakage of sweat, aversion to wind and cold, indicating exterior deficiency. If it is a Yangming Fu-organ disease with dry thirst and delirious speech, who would dare use Guizhi? Zhang Zhongjing noted under the Guizhi Jia Fuzi Tang section "no vomiting, no thirst." It is evident that with Yangming dry thirst, there is no rationale for using Guizhi. Generally speaking, headache and fever present together indicate Wind Strike spontaneous sweating; sweating leaking continuously after sweating therapy indicates Yang deficiency spontaneous sweating; irritability, thirst, ability to drink water, aversion to heat rather than wind and cold, indicate Yangming Fu-organ spontaneous sweating. Another question arises: Zhi Zhong Zheng (Direct Transmission Syndrome) also presents with spontaneous sweating, why? Answer: In Zhi Zhong Zheng, cold sweat occurs spontaneously, the pulse is deep and slow, and the hands and feet are cold, which is a sign of衰竭 of True Yang. This is worlds apart from the steaming and boiling appearance of spontaneous sweating caused by Yangming Stomach heat. Another question arises: Heatstroke-induced spontaneous sweating also involves thirst, how to distinguish it? Answer: In spontaneous sweating due to heatstroke, although there is thirst, the pulse must be wiry, thin, hollow, and slow. The Classics state: "Pulse surging and body hot comes from Cold Damage; pulse deficient and body hot comes from Heatstroke." Excess patterns are treated with Ren Shen Baihu Tang (Ginseng White Tiger Decoction); deficiency patterns are treated primarily with Shiwei Xiangru Yin (Ten-Ingredient Mosla Drink).