【注】病患有寒，谓胃中寒也。复发汗，谓汗而复汗也。胃寒复汗，阳气愈微，胃中冷甚，蛔不能安，故
必吐蛔也，宜理中汤送乌梅丸可也。
【集注】程应旄曰∶汗生于谷精，胃中阳气所酿也。有寒复发汗，知胃阳不复存于内矣，蛔何能安？
发汗后，水药不得入口为逆，若更发汗，必吐下不止。
【按】必吐下不止之“下”字，当是衍文。
【注】此承上条误而又误，必变而成逆也。胃中虚冷，本因误汗，水药不得入口，入口即吐而为逆也。若
更发其汗，则胃逆益甚，不能司纳。不特水药入口方吐，且必无时而不吐逆也。
【集注】成无己曰∶汗后水药不得入口，为之吐逆。发汗亡阳，胃中虚冷也；若更发汗，则愈损阳气，胃
气大虚，故吐不止。
程应旄曰∶发汗后见此者，由未汗之先，其人已是中虚而寒，故一误不堪再误也。
脉浮而迟，表热里寒，下利清谷者，四逆汤主之。
【注】阳明病，脉浮而迟，浮主表热，迟主里寒。今其证下利清谷，则为里寒太甚，法当温之，宜四逆汤主之。
【集注】汪琥曰∶阳明经病，脉当从长，今脉但浮，此在表之热凝也。腑病脉当从数，今脉过迟，此在里
之寒甚也，故见下利清谷。其所利之谷食，色不变气不臭，即完谷不化也。此里寒已极，故与四逆汤也。
阳明病，欲解时，从申至戌上。
【注】凡阳明病，无论在经在腑，必乘其旺时而解。申、酉、戌，阳明旺时也。经气旺，则邪气自退，故解也。
【集注】张志聪曰∶经云∶日西而阳气衰，阳明之所主也。从申至戌上，乃阳明主气之时，表里之邪欲出，
必随旺时而解。
【注】患者体内有寒，指的是胃中寒冷。再次发汗，指的是已经发过汗又再次发汗。胃中本寒，又经发汗，导致阳气更加微弱，胃中寒冷至极，蛔虫无法安宁，所以必然会出现吐蛔虫的症状，适宜用理中汤送服乌梅丸进行治疗。
【集注】程应旄说：汗液由水谷精微化生，是胃中阳气酝酿而成的。体内有寒却再次发汗，说明胃中的阳气已不能留存于体内，蛔虫怎么能安宁呢？
发汗之后，水药无法入口，这属于逆证；如果再次发汗，必然会导致呕吐和腹泻不止。
【按】“必吐下不止”中的“下”字，应当是衍文（多余的字）。
【注】这是承接上一条，指出误治而又再误，病情必然演变为逆证。胃中虚冷，原本是因为误用发汗法，导致水药无法入口，入口即吐，这就构成了逆证。如果再次发汗，那么胃气上逆会更加严重，无法行使受纳的功能。不仅仅是水药入口才吐，而且必定会无时不刻地发生呕吐逆乱。
【集注】成无己说：发汗后水药不得入口，称为吐逆。发汗导致亡阳，造成胃中虚冷；如果再次发汗，则会进一步损伤阳气，使胃气极度虚弱，所以呕吐不止。
程应旄说：发汗后出现这种情况，是因为在发汗之前，患者本身就是中焦虚寒，所以一次误治已不堪忍受，不能再误治了。
脉象浮而迟，表现为表热里寒，伴有下利清谷（排出未消化的食物）症状的，以四逆汤为主治方剂。
【注】阳明病，脉象浮而迟，浮脉主表热，迟脉主里寒。现在的症状是下利清谷，这说明里寒极甚，按照法则应当温补，适宜用四逆汤主治。
【集注】汪琥说：阳明经病，脉象应当从容长缓，现在脉象仅见浮，这是表热郁结的表现。腑病脉象应当数急，现在脉象过于迟缓，这是里寒极盛的表现，所以出现下利清谷。所排出的谷物颜色不变、气味不臭，这就是完谷不化。这说明里寒已经到了极点，所以给予四逆汤治疗。
阳明病，欲缓解的时间，是从申时到戌时这段时间。
【注】凡是阳明病，无论是在经还是在腑，必定趁着其旺盛的时辰而解除。申、酉、戌三个时辰，是阳明经气旺盛的时候。经气旺盛，邪气自然消退，所以病愈。
【集注】张志聪说：医经中说：太阳西下时阳气衰退，这是阳明所主的时间段。从申时到戌时，正是阳明主气的时候，表里之邪欲外出，必定随着经气旺盛的时机而解除。
[Annotation] The patient having cold refers to cold in the stomach. Repeated sweating refers to sweating again after an initial sweat. With stomach cold compounded by sweating, yang qi becomes increasingly deficient, and cold in the stomach becomes severe; ascarids cannot remain tranquil, hence vomiting of ascarids is inevitable. It is appropriate to administer Lizhong Tang (Regulate the Middle Decoction) with Wumei Wan (Mume Pill).
[Collected Annotations] Cheng Yingmao stated: Sweat is generated from the essence of grain and water, brewed by the yang qi of the stomach. Having cold yet inducing sweat indicates that stomach yang qi no longer resides within; how can ascarids remain tranquil? After sweating, if water and medicine cannot enter the mouth, this is considered a reversal syndrome (ni zheng); if sweating is induced again, it will inevitably lead to continuous vomiting and diarrhea.
[Commentary] The character "diarrhea" (xia) in "inevitably continuous vomiting and diarrhea" should be considered a superfluous character (yan wen).
[Annotation] This follows the previous clause regarding misdiagnosis compounded by further error, inevitably transforming into a reversal syndrome. Stomach deficiency-cold originates from erroneous sweating; water and medicine cannot enter the mouth, and upon entry, are vomited immediately, constituting a reversal. If sweating is induced again, stomach rebellion worsens, and the capacity for reception is lost. Not only will water and medicine be vomited upon entry, but vomiting and rebellion will occur incessantly.
[Collected Annotations] Cheng Wuji stated: After sweating, if water and medicine cannot enter the mouth, it is termed vomiting and rebellion. Sweating causes loss of yang, leading to stomach deficiency-cold; if sweating is induced again, it further damages yang qi, causing extreme stomach qi deficiency, hence continuous vomiting.
Cheng Yingmao stated: The appearance of these symptoms after sweating indicates that prior to sweating, the person already had middle jiao deficiency and cold; thus, one error is unbearable, let alone a second.
If the pulse is floating and slow, indicating exterior heat and interior cold, accompanied by diarrhea with undigested food, Sini Tang (Frigid Extremities Decoction) is the primary formula.
[Annotation] In Yangming disease, a floating and slow pulse: floating indicates exterior heat, while slow indicates interior cold. Given the symptom of diarrhea with undigested food, interior cold is extremely severe. According to the principle, warming is indicated; Sini Tang (Frigid Extremities Decoction) is appropriate.
[Collected Annotations] Wang Hu stated: In Yangming channel disease, the pulse should be long and moderate. The current floating pulse indicates condensation of exterior heat. In fu-organ disease, the pulse should be rapid; the current excessively slow pulse indicates extreme interior cold, hence diarrhea with undigested food. The discharged grain remains unchanged in color and odorless, which is known as complete undigested stool. This indicates extreme interior cold, hence Sini Tang (Frigid Extremities Decoction) is administered.
Yangming disease tends to resolve between Shen (3 PM - 5 PM) and Xu (7 PM - 9 PM) hours.
[Annotation] For all Yangming diseases, whether in the channels or fu-organs, resolution occurs during their peak time. Shen, You, and Xu hours are when Yangming qi is prosperous. When channel qi is prosperous, pathogenic factors naturally recede, leading to resolution.
[Collected Annotations] Zhang Zhicong stated: The classics state: "When the sun sets, yang qi declines," which is governed by Yangming. From Shen to Xu hours is the time when Yangming governs qi. Pathogens in the exterior and interior seeking to exit must resolve following the peak time of qi prosperity.