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医宗金鉴卷四

<<Yi Zong Jin Jian>>  Chapter 4

辨阳明病脉证并治全篇

Yangming stage, its condition, pulse and treatment

阳明主里,内候胃中,外候肌肉,故有病经、病府之分。如论中身热烦渴,目痛鼻乾不得眠,不恶寒,反恶热者,此阳明经病也;渐热谵语,手足腋下 然汗出,腹满痛,大便硬者,此阳明府病也。而其候各有三:经病则有邪已传阳明而太阳之表未罢,兼见头痛恶寒无汗之太阳证者;有太阳之邪已罢,悉传阳明,但见壮热有汗,心烦不眠,口渴引饮之阳明证者;有阳明之邪未已,复转少阳,兼见胸胁痛,寒热往来,口苦而呕,目眩耳聋之少阳证者。府病则有太阳阳明,谓太阳病,或发汗,或吐,或下,或利小便,亡其津液,胃中乾燥,太阳之邪,乘胃燥而转属阳明,致小便反数,大便硬者,所为脾约是也;有正阳阳明,谓阳气素盛,或有宿食,太阳之邪,一传阳明,遂入胃府,致大便不通者,所为胃家实是也;有少阳阳明,谓病已到少阳,法当和解,而反发汗,利小便,亡其津液,胃中燥热,复转属阳明,致大便结燥者,所为大便难者是也。其治阳明经病,则以葛根汤或桂枝加葛根汤发之,或以白虎汤清之,或以柴胡白虎汤和之,随其证而施之可也。其治阳明府病,虽均为可下,然不无轻重之分,故或以三承气汤下之,或麻仁丸通之,或蜜煎胆汁导之,量其病而治之可也,此阳明病之大略也。兹以在经、在府二者,详疏於篇,俾读者易为分别,则临证施治,自不紊矣。

Yangming is a stage, which connect and associated with stomach inside and muscle outside. Xieqi in the Yangming stage can also stay only in the meridian level, or in the inside organ level. If the person has hot, heavy thirsty, eye pain, dry nose and hard to sleep, no chilly, but dislike hot, the disease is in the meridian level; If he has hot, Chattering syndrome, sweat in the hands and feet and arm pitch, fullness and pain in the stomach, hard stool, it is in inside organ level. In clinic, there are also various combination of the meridian conditions: the Xieqi has passed into the Yangming but there is still some extent of Xieqi remains in the Taiyang stage, the person has also headache, chilly, no sweat – such Taiyang conditions; the Xieqi is mainly in the Yangming stage, the person has high fever, sweat, annoyed so not to be able to fall into sleep, dry mouth and thirsty; the Xieqi can also stay mostly in the Yangming stage, but starts to develop partly into the Shaoyang stage, the person pain in the chest and side of upper stomach, cold-hot shift, bitter taste in mouth, nausea, dizziness in eyes, deaf in ears; 

In the organ level, there is three different conditions: Taiyang Yangming. It means the person during the Taiyang stage, has had sweat therapy, vomiting therapy, bowel-cleansing therapy, or urine therapy, that caused depletion of body Jinye to make it dry in the stomach, so that the bowel movement becomes hard (but the urine becomes frequent). This is called Piyue condition. The second is the Zhengyang Yangming. The person has strong stomach function before the disease, or has old stool in the intestines, the Xieqi comes in to bind with the dead stool to block the Weiqi movement in the Stomach. It is called Weijia Shi condition. The third is the Shaoyang Yangming. It means that the Xiexi has developed into the Shaoyang stage. It supposes to have a harmonizing therapy but a sweat therapy, or a urine therapy has been given, that depleted the body Jinye, making the stomach dry, so making the Xieqi back to the Yangming again, making the stool is hard to pass. To solve the problem in the meridian level, use the Gegeng Tang, or Guizhi jia Gegeng Tang to evaporate the Fire, or use Baihu Tang to clear the Fire; to use Chaihu Baihu Tang to harmonizing the Fire. To solve the organ level Yangming diseases, use various Chengqi Tang, or use Maren wan; or Midao Jian to conduct the stool. The readers have to be careful to understand the difference.  

01 阳明之为病,胃家实是也。

It is in the Yangming stage, if the person has fullness, hard and pain in stomach and has hard to have bowel movement. [1]

02 伤寒三日,阳明脉大。

On the third day of the Coldl-invasion Yangming stage, the person’s pulse is big. [2]

03 本太阳初得病时,发其汗,汗先出不彻,因转属阳明也。

The reason for a person to have such Yangming stage is that an incomplete sweat therapy used in the early Taiyang stage. [3]

04 阳明病,若能食,名中风;不能食,名中寒。

In the Yangming stage, if the person remains pretty normal appetite, his Yangming stage is due to the deeper invasion of the Wind Xie (Wind invasion); if he lose appetite, it is due to the deeper invasion of Cold Xie (Cold invasion). [4]

05 问曰:阳明病,外证云何?答曰:身热汗自出,不恶寒反恶热也

Asked: what’s the out symptom for the Yangming stage? Master: the person feels hot, sweat, no chilly[5] but dislike hot. [6]

06 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。

Asked: there is a disease that is on the first day. The person feels chilly but no hot feeling. What will happen? Master: though it is only one day for the disease, the chilly will stop by it self and the person will have his own sweat and dislikes hot.

07 问曰:恶寒何故自罢?答曰:阳明居中,主土也。万物所归,无所复传,始虽恶寒,二日即止,此为阳明病也。

Asked: why the chilly can stop by it self? Master: Yangming is associated to the middle of the body[7], associated to soil[8]. Soil is the home, the final destination of everything on the earth. Therefore, when the Xieqi transports further, it will move into the Yangming stage. [9]

08 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,胃中乾燥,因转属阳明。不更衣,内实,大便难者,此名阳明也。

Asked: how comes the Yangming stage? Master: when in Taiyang stage, the person was given a sweat therapy, bowel-cleansing therapy, or a urine therapy, all of which may cause loss of Jinye[10], make the Stomach dry, so that the Xieqi comes into the Yangming stage. Yangming means the person has no or has hard bowel movement and the Stomach is full. 

09 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;正阳阳明者,胃家实是也;少阳阳明者,发汗利小便已,胃中燥烦实,大便难是也。

Asked: what’s the difference between Taiyang Yangming; Zhengyang Yangming, and Shaoyang Yangming? Master: Taiyang Yangming means Piyue syndrome[11]; Zhengyang Yangming means the Stomach Fullness[12]; Shaoyang Yangming means difficult in bowel movement. The Shaoyang Yangming is caused due to improper sweat therapy and too much urination therapy.[13]  

10 阳明病,脉浮而紧者,必潮热,发作有时,但浮者,必自汗出[14]

In the Yangming stage[15], if the person has floating and tight pulse[16], he will have wave-hot[17], which comes and goes regularly. If his pulse is only floating, he must have sweat[18].

11 阳明病,脉迟,汗出多, 发热[19],微恶寒者,表未解也,可发汗,宜桂枝汤。

In the Yangming stage, if the person feels hot[20], large sweat, slight chilly with slow pulse, it suggests that the Xieqi remains partly in the Taiyang stage. The sweat therapy can be used. Use herb Guizhi Tang. [21]

12 阳明病,脉浮,无汗而喘者,发汗则愈,宜麻黄汤。

In the Yangming stage, if the person has floating pulse, now sweat but asthma, a sweat therapy will improve the condition. Use Mahuang Tang. [22]

13 阳脉微而汗出少者,为自和也;汗出多者,为太过;阳脉实,因发其汗,出多者,亦为太过。太过者,为阳绝於 ,亡津液,大便因硬也

If a person has weak pulse and mild sweat, it means he will get recovery by himself. If the pulse is weak but the sweat is big, it means that the sweat therapy is improperly too much. If his pulse is floating and tight (stronger), it is also improper with too much sweat. Over sweat exhausts Yang Qi, loss Jingye[23], so the stool will be hard to pass.

14 阳明病法多汗,反无汗,其身如虫行皮中状者,此以久虚故也。

Yangming stage should have big sweat. If the person has no sweat but feel as worms moving in the skin, it means he is weak for a long time. (Herb Gegeng Tang should be used).

15 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。

In Yangming stage, if the person has normal appetite[24], but the urination is hard and the bowel movement is normal[25], and if he feels pain in the joints, feels mild hot[26], has sudden mad emotion, but the emotion disorder subsides after a sweat, it means that his Gugi [27]is strong while Shuiqi is relatively weak, so the Guqi, that belongs to hot to Yang Qi, push the Shuiqi out as a sweat. With the emotional onset and tight pulse, he will get recovery.

16 伤寒,发热无汗,呕不能食,而反汗出濈濈然者,是转属阳明也。

For Cold-invasion Shanhang stage, if the person has hot and no sweat first[28], now nausea and continuous very mild sweat, it suggests that the disease is to transfer into the Yangming stage.

17 伤寒脉浮,发热无汗,其表不解,不可与白虎汤;渴欲饮水,无表证者,白虎加人参汤主之。

For Cold-invasion Shanghan stage, if the person feels hot, no sweat but his pulse is floating, it suggests that the Xieqi is still in the Taiyang stage[29]. Herb Baihu Tang should not be given. If he feels thirsty and wants to drink, and no signs for Taiyang stage, herb Baihu jia Renshen Tang is used mostly.

白虎加人参汤方

Baihu jia Renshen Tang

於白虎汤方内加人参三两,馀依白虎汤方

Add herb Renshen 45 gram into the Baihu Tang. Cook and drink as Baihu Tang.

18 伤寒脉浮滑,此以表有热,里有寒,白虎汤主之。

If Cold-invasion Shanghan has floating and slippery pulse, it suggests the person has hot both inside and outside. [30] Herb Baihu Tang is used.

白虎汤方

Baihu Tang

知母六两, 石膏(碎)一 斤,甘草(炙)二两, 粳米六合

Zhimu 90 gram, Shigao 248 gram, Gancao (processed) 30 gram, Genmi 124 gram.

右四味,以水一斗,煮米熟汤成去滓,温服一升,日三服。

Add the ingredients and 2500 ml water into a herbal pot until the Genmi is eatable. Remove the herbal residue. Drink 250 ml of the supernatant. Repeat three times a day.   

19 病人烦热,汗出则解,又如疟状,日晡所发热者,属阳明也。脉实者,宜下之;脉浮虚者,宜发汗。下之与大承气汤,发汗宜桂枝汤。

If the person feels very hot and sweat, his hot subsides after the sweat, such condition repeated again and again as a malaria. If he also feels hot in the evening (about the sunset time), it indicates the disease is in Yangming stage already. If his pulse is strong, use herb Da Chengqi Tang; if his pulse is weak and floating, use sweat therapy: Guizhi Tang. [31]

20 太阳病,若吐、若下、若发汗後,微烦小便数,大便因硬者,与小承气汤和之愈。

During Taiyang stage, and after a vomiting therapy, bowel-cleansing therapy, or a sweat therapy, if the person feels mild annoyed emotionally and hard stool, herb Xiao Chengqi Tang should be used to harmonize the inside. [32]

小承气汤方

Xiao Chengqi Tang

大黄 四两, 厚朴(去皮,炙)二两, 枳实(大者,炙)三枚

Dahuang 60 gram, Houpo (remove skin, processed) 30 gram, Zhishi (processed) 45 gram.

已上三味,以水四升,煮取一升二合,去滓,分温二服。初服汤当更衣,不尔者,尽饮之。若更衣者,勿服之。

Add the herbs and 1000 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is about 300 ml liquid left in the pot. Collect the herbal tea, drink half of the tea to have a bowel movement. If yes, stop to drink the remaining tea, if not, repeat the remaining half.

21 趺阳脉浮而涩,浮则胃气强,涩则小便数,浮涩相搏,大便则硬,其脾为约,麻仁丸主之。

If the pulse in front of the ankle is floating and harsh (not slippery), floating pulse suggests that the Stomach Qi is strong, harsh means frequent urine. With both floating and harsh pulse, the person will have hard stool, which is called Piyue syndrome. Herb Maren Wan should be used.

麻仁丸方

Maren Wan

麻仁二升, 芍药半斤, 枳实半斤, 大黄(去皮)一斤, 厚朴(去皮)一斤, 杏仁(去皮、尖,熬,别作脂)一升.

Maren 260 gram, Shaoyao 90 gram, Zhishi 90 gram, Dahuang (remove skin) 150 gram, Houpo (remove skin) 150 gram, Xinren (remove skin and tips, processed but not to oil) 130 gram.  

右六味,蜜合丸,如桐子大。饮服十丸,日三服,渐加、以和为度。

Grind all ingredients into powder, mix with honey to make herbal pill, a size of 1 diameter. Drink ten pills each time, three times a day. Increase the number of the pills taken each time, until the bowel movement becomes normal.

22 伤寒吐後,腹胀满者,与调胃承气汤。

After vomiting therapy for a Cold-invasion Shanghan disease, and if the person feels bloating or fullness in the Stomach, herb Tiaowei Chengqi Tang shold be given.[33] 

调胃承气汤方

TiaoWei Chengqi Tang

大黄(去皮,酒浸)四两 甘草(炙)二两 芒硝半升

Dahuang (remove skin, rinsed with liquor) 60 gram, Gancao (processed) 30 gram, Manxiao 60 gram.

右三味,以水三升,煮取一升,去滓,内芒硝,更煮两沸,少少温服之。

Add the Dahuang, Gancao and 750 ml water into a herbal pot. Bring to boil then keep in mild boiling until there is about 250 ml liquid left. Remove the herbal residue, add Manxiao in. Bring to boil for 1 min until it is dissolved. Drink little.

23 阳明病,不吐不下,心烦者,可与调胃承气汤。

In a Yangming stage, if the person feels annoyed emotionally without vomiting or diarrhea, herb Tiaowei Chengqi Tang should be used. [34]

24 阳明发热汗多者,急下之,宜大承气汤。

For person in the Yangming stage has hot and big sweat, try to remove the Fire from the stool by using Da Chengqi Tang. [35]

大承气汤方

Da Chengqi Tang

大黄(酒洗)四两, 厚朴(炙,去皮)半斤, 枳实(炙)五枚, 芒硝三合

Dahuang (washed with liquor) 60 gram, Houpo (processed, remove skin), 60 gram, Zhishi (processed) 72 gram, Manxiao 30 gram.

右四味,以水一斗,先煮二物,取五升去滓,内大黄更煮,取二升去滓,内芒硝,更上微火一两沸,分温再服,得下,馀勿服。

Add Houpo, Zhishi, and 2500 ml water into a herbal pot. Bring to boil then keep in mild boiling until there is 1250 ml water in it left. Remove the residue, add the Dahuang continue to boiling until there is 500 ml left. Add the Manxiao in, bring to mild boiling for minutes until it is dissolved. Separate it into several parts. Drink one part. Wait for one to two hours see if there is bowel movement. If yes, stop to drink. If not, drink another part until there is bowel movement.

25 阳明病,下之,心中懊倄而烦,胃中有燥屎者,可攻。腹微满,初头硬,後必溏,不可攻之。若有燥屎者,宜大承气汤。

In the Yangming stage, and after the bowel-cleansing therapy, the person feels annoyed emotionally, has frequent urine but no bowel movement, Da Chengqi Tang can be used. If he feels milk fullness in the Stomach, and stool is hard in beginning part but loss in the later part, this herb tea should not be used.

26 得病二、三日,脉弱,无太阳柴胡证,烦躁心下硬,至四、五日,虽能食,以小承气汤,少少与微和之,令小安。至六日,与承气汤一升,若不大便六、七日,小便少者,虽不能食,但初头硬,硬後必溏,未定成硬,攻之必溏,须小便利,屎定硬,乃可攻之,宜大承气汤。

If a disease has been for two to three days, the pulse is weak and there is no sign for Taiyang or Shaoyang stages, if the person feels annoyed emotionally and physically, hard in the upper stomach area, and if on the day six or seven he has no bowel movement, even if he can still eat (has appetite), herb Xiao Chengqi Tang should be used little by little to harmonize the Stomach inside[36]. If the condition lasts to six days, give Xiao Chengqi Tang. If there is no bowel movement for six to seven days, the urine is little too, even if the person cannot eat, but the stool is hard in the beginning part, the latter part must be loss one. If the stool is not hard, the use of Chengqi Tang will cause diarrhea like stool (this is not a proper treatment). If the urine is easy and smooth, the stool then is hard. Then the Da Chengqi Tang can be used.

27 阳明病,脉迟,虽汗出,不恶寒者,其身必重,短气腹满而喘,有潮热者,此外欲解,可攻里也,手足濈然汗出者,此大便已硬也,大承气汤主之。若汗多,微发热恶寒者,外未解也,其热不潮,未可与承气汤。若腹大满不通者,可与小承气汤,微和胃气,勿令大泄下。

In Yangming stage, slow pulse, though sweat, no chilly, the body will be heavy, the person will feel short of breath, fullness in Stomach that cause asthma, if he has hot-wave, it means the disease is to recover from Taiyang stage. Bowel cleansing therapy can be used to clear the inside. Sweat in hands or feet suggest that the stool is hard, so the Da Chengqi Tang can be used. If the sweat is very heavy, the person feels mild hot and chilly, it means the disease is still in the Taiyang stage. If the hot is not as a wave, the Da Chengqi Tang should not be used. If the person feels strong fullness in the Stomach area without bowel movement at all, try Xiao Chengqi Tang first to harmonize the Stomach inside. Heavy bowel movement should be prevented.

28 阳明病,潮热,大便微硬者,可与大承气汤,不硬者,不可与之。若不大便六、七日,恐有燥屎,欲知之法,少与小承气汤,汤入腹中,转失气者,此有燥屎也,乃可攻之。若不转失气者,此但初头硬,後必溏,不可攻之,攻之必胀满不能食也。欲饮水者,与水则哕,其後发热者,必大便复硬而少也,以小承气汤和之,不转失气者,慎不可攻也。

In Yangming stage, wave-hot, if the stool is mild hard (the whole part of the stool), the Da Chengqi Tang can be used. Otherwise it should not be used. If there is no bowel movement for six to seven days, it may suggest hard stool in Stomach. How to know it? Try Xiao Chengqi Tang. After drinking the it, the person has fart (from anus), it indicates the stool is hard inside, so Da Chengqi Tang can be used. If there is no gas, or the stool is only hard in the beginning, Da Chengqi Tang should not be given. Otherwise its use will cause big fullness in Stomach and affect the appetite. In this case, only use Xiao Chengqi Tang little by little to harmonize the Stomach. In addition, if the person wants to drink, drink will cause Yue syndrome[37]. If he later feels hot, his stool must turn to hard and little in amount. Try Xiao Chengqi Tang only. [38]

29 阳明病,曕语,发潮热,脉滑而疾者,小承气汤主之。因与承气汤一升,腹中转失气者,更服一升,若不转失气者,勿更与之。明日又不大便,脉反微涩者, 虚也,为难治,不可更与承气汤也。

In Yangming stage, if the person has chattering under unconsciousness, wave-hot, fast and slippery pulse[39], Xiao Chengqi Tang is to be used. After drinking, if the person has fart, drink one more times; if no fart, stop to take it. Wait to next day, if there is no stool, and the pulse is mild harsh, it suggests that the body condition is weak, it is hard to treat. Any Chengqi Tang should not be given.  

30 伤寒若吐、若下後不解,不大便五、六日,上至十馀日,日晡所发潮热,不恶寒,独语如见鬼状。若剧者,发则不识,循衣摸床,惕而不安,微喘直视,脉滑[40]者生,涩者死。微者但发热曕语者,大承气汤主之,若一服利,则止後服。[41]

With Cold-invasion Shanghan disease, after using vomiting or bowel-cleansing therapy, the disease remains no improvement. The person has no bowel movement for five to six days, even up to ten days. He also has wave-hot in the evening (sunset time), no chilly, chattering as see a ghost. For severe case, the person may loss recognition to person, touch surrounding material, irritable and restless, mild asthma, and eye staring forwards[42]. For such person, if his pulse is as slippery, he will live. If it is harsh, die. For mild case, if the person only has hot and chattering under unconsciousness, give him Da Chengqi Tang to drink. If he has bowel movement, stop to drink it.

31 阳明病,本自汗出,医更重发汗,病已差,尚微烦不了了者,此大便必硬故也。以亡津液,胃中乾燥,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。

Yangming disease should have continuous sweat. The person however was given sweat therapy again. The disease seems quiet down but the person still feels annoyed emotionally suggesting that it is actually not improved. This person must have hard stool that makes him annoyed, that again is due to the sweat therapy (depleted the Jingye in the stomach). At this movement, his urination should be checked. If the urine is usually 3 to 4 times a day but now it is the same, the stool will not come out soon. If the urine is reduced, the stool will come out soon, since the water will come back to the Stomach to help the stool movement.(so no treatment is needed)[43]

32 阳明病,自汗出,若发汗,小便自利者,此为津液内竭,虽硬不可攻之,当须自欲大便,宜蜜煎导而通之。若土瓜根及大猪胆汁,皆可为导。

In Yangming stage, the person should have sweat himself. If the sweat therapy is used and he has frequent urine, the Jingye inside will be depleted. In this case, bowel-cleansing therapy should not be used even if there may have strong evidence for an exist of hard stool in the Stomach[44]. Try conducting therapy by using Mijian Dao. Tuguagen or pig gall bladder can be used as a guider.

蜜煎导方

Mijian Dao[45]

蜜七合,一味纳铜器中,微火煎之,稍凝似饴状,搅之勿令焦者,欲可丸,并手捻作挺子,令头锐大如指,长二寸许。当热时急作,冷则硬,以内谷道中,以手急抱,欲大便时乃去之。

Add honey 175 ml into a cupper pot. Bing to mild boiling until it turns sticky. Stir it to prevent being char. Make it into a bar, when it is still warm,[46] in shape with the tip as thick as a finger. The honey bar should be two inch long. Insert it in anus and hold it until the person feels very urgent to have bowel movement.

『内台方』用蜜五合,煎凝时,加皂角末五钱,蘸捻作挺,以猪胆汁、或油润谷道内之。

In another book <<Nai Tai Fang>>, it introduces to use 125 ml honey. When the honey becomes sticky, add Zaojiaoci 1.3 gram. Then make it into a bar. Smear pig gall bladder or other oil on the surface of the bar. Insert the bar into anus.

猪胆汁方

Pig Gall Bladder

大猪胆一枚,泻汁和法醋少许,以灌谷道内,如一食顷,当大便,出宿食恶物甚效。

Mix the juice from a big pig gall bladder with little vinegar. Fill it into the colon. After about half hour, the person should have bowel movement. It works well to remove very dirty, strong odor old stool.

『内台方』不用醋,以小竹管插入胆口,留一头用油润,内入谷道中,以手将胆捻之,其汁自入内,此方用之甚便。

In the book <<Nai Tai Fang>>, it does not use vinegar. In stead, it introduces to use a small bamboo tube. Its one end is insert into the gall bladder and another end insert into the anus (smear with oil). Press the bladder to make the juice into the anus. It is pretty easy and simple to use.

土瓜根方

Tuguagen Formula (missed).

(缺)

Tugua is also called Shibao. It is introduced in book <<Zhou Hou Fang>> to release stool. Grind the Tugua roots into juice. Blow the juice into the anus through a tube.

33 伤寒六、七日,目中不了了,睛不和,无表 证,大便难,身微热者,此为实也,急下之,宜大承气汤。

With Cold-invasion Shanghan disease for six or seven days, the person feels stirring and smear in eyes, even the eye does not move, has no sign for a Taiyang stage, but has hard bowel movement and feels mild hot. This is a Shi condition[47], an urgent bowel-cleansing therapy should be used – use Da Chengqi Tang. [48]

34 病人小便不利,大便乍难乍易,时有微热,喘冒不能卧者,有燥屎也,宜大承气汤。

If a person has difficulty in urine, bowel movement sometimes easy but sometimes hard, mild hot sometimes, asthma or cough or nausea that makes him hard to lie down, it means that he has hard stool in Stomach. Da Chengqi Tang should be used. [49]

35 病人不大便五、六日,绕脐痛,烦躁,发作有时者,此有燥屎,故使不大便也。

If the person has no bowel movement for five to six days, has pain around naval, feels annoyed emotionally, it suggests that he has hard stool in Stomach. It is the hard stool block the intestine to stop the bowel movement. (in this case, no need to try Xiao Chengqi Tang, try the Da Chengqi Tang right away)

36 大下後,六、七日不大便,烦不解,腹满痛者,此有燥屎也,所以然者,本有宿食故也,宜大承气汤。

If the person has had strong bowel-cleansing therapy and had big bowel movement, but stop bowel movement for six to seven days, has continuous annoyed feeling, has fullness and pain in the Stomach, it indicates there is hard stool due to previous hidden stool in the Stomach. Da Chengqi Tang should be used.  

37 阳明病,下之,其外有热,手足温,不结胸,心中懊倄,饥不能食,但头汗出者,栀子豉汤主之。

In Yangming stage after bowel-cleansing therapy, if the person feels hot, has warm hands and feet, no Jiexiong syndrome, feels annoyed, feels hunger but cannot eat,[50] has sweat but only on head, the herb Zhizi Zhi Tang should be used.[51]

38 伤寒呕多,虽有阳明证,不可攻之。

For person in Cold-invasion Yangming stage with frequent nausea, the bowel-cleaning therapy should not be used even if there is clear indication to a Yangming stage. [52]

39 阳明中风,口苦咽乾,腹满微喘,发热恶寒,脉浮而紧,若下之,则腹满小便难也。

For Wind-invasion Yangming stage, if the person has better taste in mouth, dry throat, fullness in Stomach, slight asthma, hot and chilly, floating and tight pulse, bowel-cleansing therapy should not be used. Otherwise, the Stomach will be full and the urine will be difficult. [53]

40 阳明病,脉浮而紧,咽燥口苦,腹满而喘,发热汗出,不恶寒反恶热,身重。若发汗则躁,心愦愦反? y。若加温 ,必怵惕烦躁不得眠。若下之,则胃中空虚,客气动膈,心中懊倄,舌上胎者,栀子豉汤主之。若渴欲饮水,口乾舌燥者,白虎加人参汤主之。若脉浮发热,渴欲饮水,小便不利者,猪苓汤主之。阳明病,汗出多而渴者,不可与猪苓汤,以汗多胃中燥,猪苓汤复利其小便故也。

In Yangming stage, if the person has floating and tight pulse, dry mouth and throat, fullness in Stomach and asthma, hot and sweat, no chilly but dislike hot, and heavy feeling in the body, sweat therapy will cause annoyed and irritable physically (due to depletion of Jingye); a warm therapy will cause annoyed emotionally and physically, and a phobia, scaring feeling; bowel-cleansing therapy will cause empty in the stomach, reverse pushing feeling to the diagram, annoyed in the upper stomach. For such complex condition, if the person has thick tongue covering, use Zhizi Zhi Tang; if he feel dry in mouth and want to drink water, use Baihu Tang jia Renshen Tang; if his pulse is floating and he feels hot, thirsty and want to drink, but has hard in urine, Zhuling Tang should be used. For Yangming stage, if person’s thirsty is due to big sweat, Zhuling Tang should not be given, because the sweat caused dryness in stomach, a depletion of Jingye in the body. The use of Zhuling Tang will further more deplete the Jingye to make the condition worse. 

猪苓汤方

Zhuling Tang

猪苓(去皮), 茯苓, 阿胶, 泽泻, 滑石(碎)各一两

Zhuling (remove skin) 15 gram, Fuling 15 gram, Ajiao 15 gram, Zexie 15 gram, Huashi (broken) 15 gram.

右五味,以水四升,先煮四味,取二升,去滓,内阿胶烊消,温服七合,日三服。

Add the herbs except Ajia and 1000 ml into a herb pot. Bring to boil and keep in mild boiling until there is about 500 ml liquid left. Remove the herb residue, add the Ajiao into the herb tea, bring to boiling with stirring until the Ajiao dissolved. Drink 175 ml. Repeat three times a day.

41 脉浮而大,心下反硬,有热,属藏者攻之,不令发汗;属府者不令溲数。溲数则大便硬,汗多则热愈,汗少则便难,脉迟尚未可攻。

If person’s pulse is floating and big but he feels hot, and feels hard in the upper stomach, if the disease belongs to inside level disorder (of the Yangming stage), use the bowel-cleansing therapy but not sweat therapy; if it belongs to outside level (of the Yangming stage), no therapy used should cause frequent urine, since frequent and large amount of urine will cause production of hard stool. Too much sweat will makes the hot develops deeper, and too little sweat is associated with the difficult in urine. If the pulse is slow, the bowel-cleansing therapy should not be used. [54]

42 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。

In Yangming stage, if the person’s pulse is slow, and if he feels hard to eat to full, since full eating makes mild annoyed and dizziness, he must also feel difficult in urine. All of these conditions suggesting to a Gudan. If the bowel-cleansing therapy is used, the fullness will remain. The reason is that the pulse is slow. [55]

43 阳明病,若中寒者,不能食,小便不利,手足濈然汗出,此欲作固瘕,必大便初硬後溏,所以然者,以胃中冷,水谷不别故也。

In Yangming stage, if the person has Cold in the stomach, cannot eat, has difficult in urine, sweat in hands and feet, it indicating the development to a condition called Gujia. For this person, he must have his stool hard in the beginning part, but loss in the later parts. The reason for this is: the Cold in the stomach, prevents the separation of water and the food. [56]

44 太阳病,寸缓关浮尺弱,其人发热汗出,复恶寒不呕,但心下痞者,此以医下之也;如其不下者,病人不恶寒而渴者,此转属阳明也。小便数者,大便必硬,不更衣十日,无所苦也,渴欲饮水,少少与之,若小便不利[57],渴者,宜五苓散。

In Taiyang stage, if the person’s pulse is slow in Chun position, floating in Guan position, and weak in Chi position, and if he feels hot and sweat, feels chilly again but no nausea, feels Fullness syndrome, it is all caused due to a wrong bowel-cleansing therapy. If the person has no bowel-cleansing therapy, has no chilly feeling but has thirsty, it has developed into Yangming stage. For such person, if he has frequent urine, will has hard stool. He may feel nothing painful even if he has no bowel movement for more than ten days. If he feels thirsty, give him water to drink by sip (no need to use herbs). If he has difficulty in urine and feels thirsty, use Wuling San. [58]

45 阳明病,心下硬满者,不可攻之,攻之利遂不止者死,利止者愈。

In Yangming stage, if the person feels hard and fullness in the upper stomach[59], bowel-cleansing therapy should not be used. Other wise, the cleansing will cause continuous diarrhea to die. If the diarrhea can stop, the person will survice. 

46 诸虚者,不可下,下之则大渴,求水者易愈,恶水者剧。

For any weakness condition, the bowel-cleansing therapy should not be used. If the therapy has been used and the person want to drink, he may have chance to survive. If he dislike water drink, his condition is worse. [60]

48 阳明病,下血谵语者,此为热入血室,但头汗出者,刺期门,随其实而泻之, 然汗出则愈。

In Yangming stage, if the person has bleeding in stool and has delirium, it indicates Fire in the women’s system (the uterus)[61]. If she has sweat on heat, use acupuncture on Qimen point (depletion manner). Then she will have more sweat on whole body to cure.

49 阳明病,口燥,但欲漱水不欲咽者,此必衄.

In Yangming stage, the person feels dryness in mouth, want to drink water but has no desire to swallow. He will has bleeding in nose. [62]

50 脉浮发热,口乾鼻燥,能食者,则衄.

In Yangming stage, if the person has floating pulse, feels hot, dry nose and mouth, and no problem in eating, he will have bleeding in nose. [63]

51 阳明证,其人喜忘者,必有蓄血。所以然者,本有久瘀血,故令喜忘,屎虽硬,大便反易,其色必黑者,宜抵当汤下之。

In Yangming stage, if the person has easy forget syndrome, he must has accumulated dead blood in the body. The accumulated dead blood in the Stomach causes poor in memory. His stool is hard, though, the bowel movement is easy and the color of the stool is black. Herb Didang Tang is used to remove the dead blood down. [64]

52 病人无表里证,发热七、八日,虽脉浮数者,可下之。假令已下,脉数不解,合热则消谷善饥,至六、七日,不大便者,有瘀血,宜抵当汤。若脉数不解,而下不止,必协热便脓血也。

In Yangming stage, if the person has no other evidence for Taiyang stage or further inside Yangming (organ) stage, has hot/fever for seven to eight days. Even if his pulse is floating and fast, a bowel-cleansing therapy can be used. After the bowel movement, if the pulse is till fast, the Fire will cause hungry feeling and the person has too much appetite and craving for eat. If until the six to seven days, he has no bowel movement again, it indicates accumulated dead blood in his body. Didang Tang is needed. If the fast pulse remains, and the diarrhea continues, he will have pus and blood in the stool. (the Didang Tang is not to be used).

53 伤寒发汗已,身目为黄。所以然者,以寒湿在里不解故也,以为不可下也,於寒湿中求之。

With Cold-invasion Shanghan disease, the person turns yellow in color in skin and in the eyes after a sweat therapy. This is due to a Cold in the body surface and Wet in the side both has not been depleted yet. In this case, bowel-cleansing therapy should not be used. A therapy that depletes the Cold and Wet should be used.

54 伤寒瘀热在里,身必发黄,麻黄连轺赤小豆汤主之。

If a Cold-invaison Shanghan disease has accumulated Fire inside, the person will have jaundice. Herb Mahuang Lianqiao Chixiaodou Tang is the main choice. [65]

麻黄连轺赤小豆汤方

Mahuang Lianqiao Chixiaodou Tang

麻黄(去节)二两, 赤小豆一升, 杏仁(去皮、尖)四十枚, 生姜(切)二两, 大枣(擘)十二枚, 甘草(炙)二两, 生梓白皮(切)一升, 连轺二两

Mahuang (remove stem joints) 30 gram, Chixiaodou 124 gram, Xinren (remove skin and tips) 16 gram, Fresh ginger 30 gram, Chinese date 62 gram, Gancao (precessed) 30 gram, Xingbaipi 124 gram[66], Lianqiao 30 gram.

以上八味,以潦水一斗,先煮麻黄,再沸去上沫,内诸药,煮取三升,分温三服,半日则尽。

Add Mahuang and 2500 ml water into a herbal pot. Bring to boil and keep in mild boiling for about 5 to 10 min. Remove the floating herb residue from time to time. Add the remaining herbs in, continue the mild boiling until the total liquid in the pot is about 750 ml. Collect the herbal tea. Drink one third of the tea each time, three times a day. 

55 伤寒七、八日,身黄如橘子色,小便不利,腹微满者,茵陈蒿汤主之。

With Cold-invasion Shanghan disease for seven to eight days, the person has fresh yellow skin, difficult in urine, mild fullness in Stomach, herb Yinchenhao Tang should be the main choice. [67]

茵陈蒿汤方

Yinchenhao Tang

茵陈蒿六两, 栀子(擘)十四枚, 大黄(去皮)二两

Yinchenhao 90 gram, Zhizi 22 gram, Dahuang (remove skin) 30 gram.

右三味,以水一斗二升,先煮茵陈,减六升,纳二味,煮取三升,去滓,分三服,小便当利,尿如皂荚汁状,色正赤,一宿腹减,黄从小便出也。

Add yinchenhao and 1750 ml water into a herbal pot. Bring to boil and keep in mild boiling until the total liquid in the pot is about 1500 ml. Add the remaining two herbs in, continue to boil until there is about 750 ml left. Collect the herbal tea. Drink one third each time, three times a day.

56 伤寒身黄发热,栀子柏皮汤主之。

In Cold-invasion Shanghan disease, if the person has jaundice and hot, Zhizi Bopi Tang is used mainly. [68]

栀子柏皮汤方

Zhizi Bopi Tang

栀子(擘)十五枚, 茵陈蒿 一两[69], 黄柏二两

Zhizi 23 gram, Yinchenhao 15 gram, Huangbo 30 gram.

右三味,以水四升,煮取一升半,去滓,分温再服。

Add the herbs and 1000 ml water into a herb pot. Bring to boil and keep in mild boiling until the total liquid volume in the pot is about 300 to 400 ml. Collect the herbal tea, drink one third of the herbal tea each time, three times a day.

57 阳明病被火,额上微汗出,而小便不利者,必发黄。

In Yangming stage, if the person is facing fire or too hot material so that he has mild sweat in the front head, and if he at the same time has difficult in urine, he will has jaundice. [70]

58 阳明病,无汗,小便不利,心中懊倄者,身必发黄。

In Yangming stage, if the person has no sweat, but has difficult urine and annoyed, impatience, he will have jaundice. [71]

59 阳明病,面合色赤,不可攻之,必发热色黄;小便不利也。

In Yangming stage, if the person’s face is red in color[72], the bowel-cleansing therapy should not be applied, even if there is hard stool. Other wise, he will have fever and jaundice and difficult urine.

60 阳明病,发热汗出,此为热越,不能发黄也。但头汗出,身无汗,剂颈而还,小便不利,渴饮水浆者,此为瘀热在里,身必发黄,茵陈蒿汤主之。

If the person is in Yangming stage and feels hot and sweat, it means the Xieqi is depleting through the hot. He will have no jaundice. If the person has sweat only on the head but not in other part of the body, the sweat stops on the neck level, and if he has difficulty in urine[73], feels thirsty and want to drink water, it means the Hot is accumulated in the inside. He then will have jaundice. In this case, herb Yinchinhao Tang is the main choice.

61 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。

In Cold-invasion Shanghan disease, if the person has floating and slow pulse[74], has warm hands and feet, the disease is in Taiyin stage. In the Taiyin stage, the person should have jaundice too. But if he has easy urine, he will have no jaundice. If he has no bowel movement for seven to eight days, it indicates that his disease has changed to the Yangming stage.[75]

62 伤寒转系阳明者,其人濈然微汗出也。

Whenever a Cold-invasion disease transfers from other stages into the Yangming stage, the person will have mild sweat.

63 太阳病吐之,但太阳病当恶寒,今反不恶寒,不欲近衣,此为吐之内烦也。

When in (Cold-invasion) Taiyang stage, the person should feel chilly. If he does not feel chilly, but dislike to be covered, after a vomiting therapy, it suggests that he feels annoyed emotionally that is caused by the vomiting therapy. [76]

64 太阳病,当恶寒发热,今自汗出,反不恶寒发热,关上脉细数者,以医吐之过也。一、二日吐之者,腹中饥,口不能食;三、四日吐之者,不喜糜粥,五日六日吐之者[77],欲食冷食,朝食暮吐,以医吐之所致也,此为小逆。

The person with Taiyang stage should feel chilly and hot. If he does not feel hot and chilly, but has sweat[78] and has thin and fast pulse in the Guan position[79], it is due to vomiting therapy. If he has vomiting on the first and second day, he will feel hungry but cannot eat[80]; if he has vomiting on the third and fourth day, he will lose appetite[81]; if he has vomiting on the fifth and sixth day[82], he will has willing to eat cold food but vomiting out the food that he ate several hours ago. These conditions belong to a mild mistake.

65 食谷欲呕,属阳明 (寒)也,吴茱萸汤主之,得汤反剧者,属上焦(热)也。

If the person has vomiting after eat food, this condition belongs to Yangming. Wuzhuyu Tang should be used mainly. If the condition becomes worse after drinking of the herbal tea, the condition belongs to disorder in the Upper Jiao Cavity. [83]

66 病人脉数,数为热,当消谷引食,而反吐者,此以发汗令阳气微,膈气虚,脉乃数也,数为客热,不能消谷,以胃中虚冷,故吐也。

If a person has fast pulse, the fast means Fire. He should have good appetite to eat. However he has easy vomiting. This is because he has weak in the Yangqi in the stomach or there is weak and Cold in the stomach that contributes to the vomiting. The Fire in this condition is a floating Fire on the surface of the body, not in the stomach. The weak and cold in the stomach is due to over done of a sweat therapy.

67 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,攻其热必哕。

If a person is in Yangming stage and cannot eat, and if a bowel-cleansing therapy causes Yue syndrome, the reason for this is the Cold and weakness in the stomach.[84] Whenever a person has weak and Cold stomach, bowel-cleansing therapy will cause Yue syndrome. [85]

68 若胃中虚冷,不能食者,饮水则哕。

If a person has weakness and Cold in the stomach, and cannot eat, he will have Yue syndrome. [86]

69 趺阳脉浮,浮则为虚,浮虚相搏,故令气侷,言胃气虚竭也。脉滑则为哕,此为医咎,责虚取实,守空迫血。脉浮,鼻中燥者,必衄血也。

If the pulse in front of ankle is floating, the floating means weak. The combination of floating and weakness makes the energy movement stagnated and depleted. Slippery pulse indicates Yue syndrome (dry nausea), it is due to the mistake in the treatment. If a person has floating pulse in front of ankle and has dry nose, he will also has bleeding in the nose.

70 寸口脉浮大,而医反下之,此为大逆。浮则无血,大则为寒,寒气相搏,则为肠鸣。医乃不知,而反饮冷水[87],水得寒气,冷必相搏,其人必哕.

If the pulse in the Chun position is floating and big, the use of bowel-cleansing therapy is a big mistake. Floating suggests short of blood, big pulse suggests Cold. Both make big noise in the intestine. If the doctor does not know this, and continue to give patient cold water to drink, the person will have Yue syndrome.

71 伤寒哕而腹满,视其前後,知何部不利,利之则愈。

In Cold-invasion Shanghan disease, if the person has Yue syndrome and Stomach Fullness syndrome, the treatment depends on the exact reason (not only give Warm herbs). [88]

72 夫实则谵语,虚则郑声,郑声者重语也。

If a person is chattering with high voice, under unconsciousness, his condition belongs to Shi condition[89]. If he is chattering with low and very weak voice, under unconsciousness, his condition belongs to weak.

73 伤寒四、五日,脉沉而喘满,沉为在里,而反发其汗,津液越出,大便为难,表虚里实,久则谵语。[90]

With Cold-invasion Shanghan for four to five days, if the person has deep pulse, asthma and full chest, the deep pulse means the disease is inside. In this case, if sweat therapy is used, the Jingye is depleted, making the stool hard to pass. All of this creates a weak surface but Shi condition inside. The person will have chattering syndrome after a while.

74 阳明病,其人多汗,以津液外出,胃中燥,大便必硬,硬则谵语,小承气汤主之。若一服谵语止者,更莫复服。

With Yangming stage, if the person has lots of sweat, the depletion of Jingye through the sweat will cause dryness in the Stomach and hard stool that again causes Chattering syndrome. Xiao Chengqi Tang is used to harmonize the Stomach Qi. If the Chattering syndrome stops after one drinking, stop to drink more.

75 汗出谵语者,以有燥屎在胃中,此为风也,须下者,过经乃可下之。下之若早,语言必乱,以表虚里实故也。下之愈,宜大承气汤。

If a sweat causes Chattering syndrome, it suggests a hard stool in the Stomach. It belongs to a Windinvasion condition. It must be waited until there is no sign of the Wind in the Taiyang stage, to start a bowel-cleansing therapy. If the bowel-cleansing therapy is used too early, the one will have confused mind to Chattering syndrome. For such surface weak but inside Shi condition, Da Chengqi Tang is used.

76 阳明病,谵语有潮热,反不能食者,胃中必有燥屎五六枚也,宜大承气汤下之,若能食者,但硬尔 (不必用药)。

With the Yangming disease, if the person has Chattering syndrome and wave-hot, he should remain appetite. If he loses appetite, it indicates the exist of several dry stools in the Stomach. Da Chengqi Tang should be used. If he still has appetite, the stool is only hard.

77 下利谵语者,有燥屎也,宜小承气汤。

If a person in the Yangming stage, has diarrhea[91] and Chattering syndrome, it suggests dead food residue (dry stools)[92] in the Stomach. Xiao Chengqi Tang should be used.

78 直视谵语,喘满者死,下利者亦死。

If a person in the Yangming stage has staring forwards eyes and Chattering syndrome but also asthma and full chest and stomach, he may die. If he has the eye syndrome and the Chattering syndrome, and also diarrhea, he may also die.

79 发汗多,若重发汗者,亡其阳,谵语。脉短者死;脉自和者不死。

If the person has too much sweat after a sweat therapy, and has sweat therapy again, he will lose Yangqi to have Chattering syndrome. If his pulse is short, he will die, if the pulse is evenly distributed, he may survive.

80 发汗多,亡阳谵语者,不可下,与柴胡桂枝汤和其荣卫,以通津液後自愈。

If the person has too much sweat after a sweat therapy, has depleted Yanggi and Chattering syndrome, bowel-cleansing therapy should not be used. In this case, use Chaihu Guizhi Tang to harmonize his Rongqi and Weiqi, to harmonize his Jingye to cure.

81 阳明中风,脉弦浮大而短气,腹部满,胁下及心痛,久按之气不通,鼻乾,不得汗,嗜卧,一身及目悉黄,小便难,有潮热,时时哕,耳前後肿,刺之小差,外不解,病过十日,脉续弦[93]者,与小柴胡汤。脉但浮,无馀证者,与麻黄汤,若不尿,腹满加哕者,不治。

In Wind-invasion Yangming stage, the person has floating and string and big pulse,[94] has short of breath, full stomach, pain in upper and side stomach area, stagnation feeling when pressed for a longer time, dry nose, hard to have sweat, tends and willing to lie down, yellow in color in whole body and eyes, hard in urine, wave-hot, Yue syndrome from time to time, swelling in front and in rear of the ears, and if acupuncture only helps little bit for the whole conditions but the Taiyang condition remains. If after ten days the conditions remain, the pulse is string, Xiao Chaihu Tang is used. If the pulse is only floating after the ten days, and no other new symptoms, Mahuang Tang is used. If he has no urine, feels fullness in Stomach and the Yue syndrome, it is difficult to treat. 

82 脉浮而芤脉,浮为阳,芤为阴,浮芤相抟,胃气生热,其阳则绝。

If the pulse feels floating and hollow, the floating suggests Yang condition (Qi floating), and the hollow pulse suggests Yin condition (depletion of blood). When the Yang and Yin condition co-exit, overwhelming Yang produce Fire and overwhelming Yin causes sweat to lose Jingye, which creates Fire in the Stomach Qi, burning down the Stomach Jingye more, so that the Stomach Yin and Yang turn to exhausted completely (to die). [95]

83 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。

In Yangming stage, the person should have more and continuous sweat. Now the person has no sweat and has easy or frequent urine, suggesting a Cold Xieqi invasion inside. If the Cold goes verse up, the one will feel nausea and cough; if the Cold expands to the hands or feet, the one will feel cold in the hands and feet. If the person has the Cold expands to the head, he should have strong headache. If he has no nausea, cough or Jue condition, he should have no headache. [96]

84 阳明病,但头眩,不恶寒,故能食而咳,其人咽必痛,若不咳者,咽不痛。

In the Yangming stage, the person should dislike hot but no cold. If he remains appetite, it suggests that the disease is the Wind-invasion, so that he may feel dizziness. [97] If he has cough, he will also have sour throat, if no cough, there will no sour throat. [98]

85 病人有寒,复发汗,胃中冷,必吐

In the Yangming stage, if the person has Cold in the Stomach, repeated sweat therapy[99] will make the Cold worse, to cause vomiting. [100]

86 发汗後,水药不得入口为逆,若更发汗,必吐[101]不止。

In the Yangming stage, if the person has Cold in the Stomach, and if he cannot drink any water or herbs after having had a sweat therapy, it suggests he has had an improper treatment. If the sweat therapy is used again, the person will have continuous vomiting (hard to stop).

87 脉浮而迟,表热里寒,下利清谷者,四逆汤主之。

In Yangming stage, if the pulse is floating and slow, it suggests Fire in surface of the body, but a Cold inside. If the person has diarrhea with undigested food, Sini Tang should be used. [102]

88 阳明病,欲解时,从申至戌上。

For a disease in the Yangming stage, it may be improved from any time between 3 pm and 9 pm, or it may be worse from any time of this time period.[103]

With a proper treatment, or if the disease is in cure by itself, or if the disease belongs to a weak condition, the disease is improved from any time during this time period[104]. With an improper treatment, or if the disease is progressing, or if the nature of the disease belongs to a Shi condition, it will be worse from any time during this time period.[105]



[1] In TCM, Yangming meridian connect to stomach in side, and to muscle out. It means that, whenever a disease involves the stomach and/or muscle, we should try to identify if the disease is in the Yangming stage. Here, be careful that the stomach includes the concept of stomach, small and large intestine and colon in the western medicine. Therefore in this book, whenever we use the word Stomach, it means the whole bully, or whole tummy. The person with previously introduced Fullness syndrome and Jiexiong syndrome also feels fullness in the Stomach. The Fullness syndrome has fullness but no pain even when press the Stomach and the Jiexiong syndrome has pain even without press on the Stomach. But both have no major disorder in bowel movement.

[2] The pulse in the Yangming stage is big, since the Yangming meridian contains more blood and Qi compared with other meridians. Once the Xieqi comes into this stage or this meridian, the pulse will become big.

[3] The sweat is incomplete, so the Xieqi comes deeper into the Yangming stage.

[4] Wind Xieqi belongs to Yang Xie, that can warm up and digest the food, so the person can keep appetite. The Cold Xieqi belongs to Yin Xie, that prevents the warm and the digestion of food, so the person loses appetite.

[5] If the person still feels chilly, his disease is at least partly in the Taiyang stage. Also, in the Taiyang stage, the person has no feeling of dislike hot. The hot in the Yangming stage comes from muscle, so the hot is continuous hot, not as the hot in the Taiyang stage, which is from time to time.

[6] Fullness, hard, pain and hard for bowel movement is the inside symptoms of the Yangming stage. The feeling hot, heavy sweat, and dislike-hot are the outside symptoms of the Yangming stage. Pain, or stiff, or numb or any discomfort along the hand Yangming meridian or feet Yangming meridian are the meridian symptoms of the Yangming Stage. Each Stage has its own inside, outside and the meridian symptoms. The outside symptoms for the Taiyang stage is chilly, hot, pain and tightness in the neck. Its inside symptom is the problems in the urine bladder and lower stomach fullness or pain.

[7] That the Yangming is located in the middle of the body, is the concept of the Five-element theory. If we compare the Yangming and the Taiyang, the Taiyang is the surface level of the body, the Yangming is the inside of the body.

[8] The soil is the concept of the Five-element theory. The five element talks about the relationship between Wind, Fire, Soil, Metal, and Water. In some books, the Soil is translated into the Earth. We don’t think it is a proper word. The earth is a concept corresponds to the Sun, the Moon and other planets in the universe, whereas the Soil, the Fire, the Water, the Wind, the Metal are all the elements on the earth. 

[9] No matter the Xieqi comes from the Taiyang, or from the Shaoyang, or from Taiyin, Shaoyin or Jueyin stage, when it comes into the Yangming stage, the person will feel hot.

[10] Yingye in TCM means liquid part of the body, including water, blood, gall bladder juice, bone marrow, etc. It is a broad concept.

[11] Taiyang Yangming: the Yangming stage comes after the Taiyang stage due to improper treatment. It is also called Piyue. The meaning of the Piyue is various among literatures.  For treatment, herb Xiao Chengqi Tang is used.

[12] The Stomach Fullness is not we previously mentioned stomach Fullness syndrome. The stomach Fullness syndrome means the fullness in the stomach per se. The Stomach Fullness means the fullness and hard in whole tummy, including the stomach, small and large intestine, and colon. Whenever the stomach is written as the Stomach, it means the whole tummy. For the treatment, Da Chengqi Tang is needed.

[13] Shaoyang Yangming is caused by improper sweat therapy. The person with the Shaoyang Yangming has had bowel movement. Hard bowel movement can be seen in many person with high blood pressure with anti-pressure therapy as diuretics. The proper herb is Maren Wan.

 

If there is still Xieqi in the Taiyang stage, the Xieqi in the Taiyang stage should be expelled before the treatments for the Taiyang Yangming, Zhengyang Yangming and the Shaoyang Yangming.

[14] In original version, it is “night sweat”.

[15] When in the Yangming stage means that the person has hard bowel movement, or no bowel movement, or the Stomach Fullness syndromes.

[16] The floating and tight pulse is the Taiyang pulse. It means that the Yangming stage comes from the Taiyang stage and there is still Xieqi in the Taiyang stage, though the Xieqi has invaded deep into the Yangming stage. For treatment, Mahuang Tang jie Gegeng should be used.

[17] Wave-hot means hot as a flash hot that lasts very short, say, several seconds or minutes only, then reduces to normal. The person will the hot as a hot wave.

[18] In one book version, it is night sweat.

[19] In original version, there is no “feels hot”.

[20] In one book version, there is no “feel hot”. If there is no hot, the large sweat and chilly suggest the surface weakness, the herb Guizhi jia Fuzi Tang is needed, not the Guizhi Tang alone.

[21] The pulse in the Yangming stage should be big and long. If the pulse is slow and the person has no chilly, it means the Xieqi has come into the Yangming stage completely. Here, the person still feel hot and chilly, indicating that the Xieqi is partly in the Taiyang stage. So, remove the Xieqi from the Taiyang stage first. 

[22] The pulse in the Yangming should be big and floating. If it is only floating, it means that the Xieqi is remains partly in the Taiyang stage, so does the “no sweat but asthma”. Therefore, the principle is to remove the Xieqi from the Taiyang stage. Herb Mahuang Tang is used (since it works for the no sweat asthma).

[23] Jingye: liquid part of the body. It is an opposite concept to the Yang Qi.

[24] That the person in the Yangming stage has normal appetite suggests that the Xieqi comes from Wind-invasion in Taiyang stage.

[25] In Yangming stage, the bowel movement is hard but the urine should be normal. Now, the urine is hard (the Xieqi influences the Taiyang inside organ: urine bladder), but the bowel movement is normal, suggests the Xieqi is mild, not cause typical Yangming stage yet.

[26] Joint pain and mild hot feeling suggests that the Xieqi is partly stage in the Taiyang stage.

[27] Guqi: the absorbed nutrition- or energy-like material from digestion. Shuiqi: water-, liquid-, vapor-like material in the body. Sometimes it is called Shiqi.

[28] Feeling hot but no sweat suggests a Cold-invasion in the Taiyang stage.

[29] If the disease is in both Taiyang stage (the person feels hot, not sweat, but the pulse is floating), and Yangming stage (very thirsty and madness), herb Da Qinglong Tang is needed. If he is in pure Yangming stage, and has thirsty, herb Baihu jia Rensheng Tang is used.

[30] In original version, it said the person has hot outside but cold inside with the floating-slippery pulse. Most later scholars believe that it might be a wrong written. Slippery pulse suggests hot, floating-slippery pulse indicates hot in both inside and outside.

[31] For a malaria-like hot-sweat feeling, it can be in a Yangming stage or in a Wind-invasion Taiyang stage. It should be told from the pulse: if the pulse is strong and big, it is in Yangming stage; if it is floating and weak, it is in Taiyang stage. So the herbal formula is different. In clinic, there are lots of patients with such malaria-like hot-sweat symptoms.

[32] That frequent urine but a hard stool suggests that the Taiyang stage is to be deeper to the Yangming stage.  If after such various therapy, the person feels annoyed but no disorder in the urine or stool, Zhizi Zhi Tang is to be used.

[33] The herb Da Chengqi Tang or Xiao Chengqi Tang are not used, since there is no hard or pain in the Stomach.

[34] For people with constipation and annoyed, depression or anxiety or similar emotional disorders, pay attention to the Tiaowei Chengqi Tang condition. (the conditions supporting the use of this herb formula). Previously we have introduced that (1), when after sweat therapy or bowel-cleansing therapy, the person feels hot, annoyed emotionally, fullness and pressing feeling in the chest, herb Zhizi Zhi Tang should be used mostly. (2), After bowel-cleansing therapy, if the person feels more annoyed emotionally, if the stomach area is soft when press, the annoyed is weak/hollow annoyed, herb Zhizi Zhi Tang should be used.

 

[35] Clearing the Fire through stool is one of very important way to remove the big Fever.

[36] If the person feels annoyed, hard in the upper stomach area, and there is no bowel movement for four to five days, the pulse is strong, not weak, the Da Chengqi Tang is to be used. If the pulse is weak, as indicated here, try the Xiao Chengqi Tang first. Da means big, strong; Xiao here means small, mild. Whenever the stool is hard in its beginning part, not in whole stool, the Da Chengqi Tang should not be used.

[37] Yue means an air/gas pushing from stomach.

[38] Wave-hot plus mild hard in stool is the indication to use Da Chengqi Tang. If only no bowel movement for six to seven days, Xiao Chengqi Tang should be tried first. If there is fart, Da Chengqi Tang can be followed, if not, it should not be used, just continue the Xiao Chengqi Tang, little by little.

[39] Slippery pulse indicates remaining food/stool in the Stomach; fast pulse indicates Fire inside.

[40] In original version, the pulse here is “string”.

[41] In TCM, once a patient has problem in consciousness, doctor should check his bowel movement, see if he is in the Yangming stage.  Yangming stage is associated with the disorders in the Stomach area, that is believed the second “brain” of the body. This concept is only recently accepted by Western Medicine.

[42] That chattering as see a ghost, loss recognition to person, touch surrounding material, irritable and restless, mild asthma, and eye staring forwards all suggest a severe condition. The Yang Qi in the body is to floating out of the body, it is not bind to the body Yin.

[43] This paragraph tells what will happen to use sweat therapy during the Yangming stage.

[44] Sweat therapy and the person’s own frequent urine will promote the production of hard stool.

[45] Mi here means honey. Dao means conduction. 

[46] It will be hard after cool and will be difficult to make it as a bar.

[47] Shi Condition: not a weak condition. It means there are some disease mass in the body. The mass here means hard stool.

[48] If a person with Shanghan disease has had such eye syndrome and difficulty in bowel movement, it suggests there is hard stool in the Stomach now. 

[49] In the Yangming stage, if the urine is easy, the stool tends to be hard. If the urine is difficult, the stool tends to be easy. However, if the urine is difficult but the stool is not constantly hard, but the person already has asthma that makes the person hard to sleep, air reverse pushing syndrome, it also suggests that there is inside Fire. In this case, even if the person does not lose conscience yet, it suggests a hard stool ready in the Stomach. So, urgent bowel cleansing therapy should be used.

[50] In clinic, not every people who feet hungry can eat. Hungry feeling and eating is different things. Also, To feel dry mouth and feel thirsty is different clinic phenomenon. To feel thirsty and to drink is different thing too. TCM doctor mush distinguish them clearly.

[51] The annoyed feeling, hunger but cannot eat, sweat only on head, all indicate Yangming hot steaming in upper part of the body, not a indication for hard stool in the Stomach. It indicates a Yangming surface level disorder, not a organ level disorder.

[52] For the three Yang zheng, e.g. Taiyang, Shaoyang and Yangming, all have nausea symptom. It is caused by stroke of Yang Qi by the Xieqi. Hot, chilly and nausea suggests a Taiyang stage; chilly and hot shift, nausea suggests a Shaoyang stage, Here nausea with hard stool suggests that the Xieqi reverse up. 

[53] In this situation, dry mouth and throat, bitter taste in mouth suggests a Shaoyang stage; asthma, hot and chilly, floating and tight pulse suggests Taiyang stage; Full Stomach suggests Yangming stage. So, it is a mixed clinic condition. If there is more indications to the Taiyang and Yangming, herb Guizhi jia Dahuang Tang should be used; if it is mostly Shaoyang and Yangming stages, herb Da Chaihu Tang should be used. After clearing the Taiyang and Shaoyang stage, then focus on the treatment of Yangming. Othewise, the Xieqi from the Taiyang or Shaoyang will shrink deep into the Yangming stage.

[54] This paragraph is difficult to understand somehow.

[55] Slow pulse indicates middle Cold syndrome, e.g. it is Cold in the Stomach area. The Cold condition of course is not proper for food digestion (normal digestion require warm). So, eating does not supply digested food to absorb into the body, there fore the person still feels hungry. If he try to eat more to combat the hungry feeling, the over ate food block the Qi moves down the body, so it moves reverse to the head to cause dizziness. The Qi is also hard to moving down to leave body as urine, so the urine is hard. The blocked food tends to cause a jaundice – e.g. the Gudan.  For such Cold Yangming, herb Gancao Ganjiang should be used first to warm the stomach, then use Tiaowei Chengqi Tang to push the stool movement.

[56] This is another kind of Cold syndrome in the Stomach, that inhibit the use of bowel-cleansing therapy, even if the person has other indications to a Yangming stage.

[57] In original version, there is no “if he has difficulty in urine”.

[58] This paragraph is also hard to explain.

[59] Be careful that it is indicated as “upper stomach”, not the Stomach that means the whole tummy area. Here the person feels fullness and hard, but no pain. It is a weak fullness, a condition indicating the use of Banxia Xiexin Tang. If he has also pain, the condition is Jiexiong, and the bowel-cleansing can be used.

[60] After bowel movement and loss Jingye, if the person want to drink, it suggests that he still has little Yang Qi to save himself. If he has no desire to drink, it suggests that there is no Yang Qi in the body any more, it is only the Yin overwhelming – very dangerous condition.

[61] For women, the accumulated Fire could release through the period blood, so to recover. If it is a man, the Fire may accumulate in the Lower Jiao cavity. The Fire cannot deplete from the body so to steam up in the head as sweat. So, Master asked to use acupuncture treatment to solve this problem.

[62] Yangming belongs to Stomach, associates to mouth. So, if there is Fire, the mouth will feel dry. However, feels dry but not to swallow suggests that the Fire is in the meridian, not in the Organ (the Stomach), and the Fire is in the blood not in the Qi. Fire in the meridian so causes the blood movement out of order. Nose is the starting point of the Yangming meridian, so the bleeding could come to the nose.

[63] Here, floating pulse and hot, dry nose and mouth all suggest that the Fire is in the Yangming meridian, not in the organ level. The person has normal appetite, since the Fire in the meridian, not in the organ level.

[64] For people with dementia, always check his bowel movement and the color. If there is accumulated dead blood in Taiyang stage, it is in urine bladder, the person tends to be mad, Taohe Chengqi Tang is used; if it is in Yangming stage, it is in the Stomach (intestines) and the person tends to be poor memory. Di Dang Tang is used. Di Dang Tang is stronger than the Taohe Chengqi Tang, since the Taiyang meridian is short of blood, while the Yangming meridian is rich of both blood and Qi.

[65] If a person has Wet syndrome inside, then an attack by Cold may cause jaundice after coming into the Yangming stage and mixed with the Wet there.  This herb tea works to remove the Xieqi from the skin and urine. 

[66] Xingbaipi can be replaced by herb Yinchen.  

[67] Fresh yellow, or bright yellow skin suggests the presence of Wet and Fire in the body. Dark, not bright yellow skin suggests the jaundice is the combination of Wet and Cold. Yinchenhao Tang is used for the Wet-Fire jaundice. It removes the Wet and Fire through the urine and stool.

[68] Mahuang Lianqiao Chixiaodou Tang, Yinchenhao Tang and this Zhizi Bopi Tang all are used in jaundice. The mahuang Lianqiao Chixiaodou Tang is used for the jaundice person with more evidence of Taiyang surface conditions; the Yinchenhao Tang is used with inside disorders (fullness, hard stool, etc.), whereas this Zhizi Popi Tang is used for person without either Taiyang evidence or inside organ conditions of the Yangming stage.

[69] In original version, it is herb Gancao.

[70] For Yangming out level syndrome, the person typically has fever and sweat. For Yangming organ level disorders, such as the Stomach Fullness syndrome, the person may have no sweat. For Yangming early stage in the meridian level, the person may has no sweat either. If there is no sweat, herb Gegen Tang should be used to create sweat to deplete Xieqi out of the body. If he is exposed to fire, the fire will stimulate Fire inside the body that make the yellow couldn’t deplete from the urine.

[71] If the person in Yangming stage has no sweat, the jaundice can deplete from urine. If the urine is not easy, the jaundice cannot be depleted, so the jaundice happens. Annoyed and impatience suggest that the Fire has already accumulated inside.

[72] Red face suggests that the Yangming stage is in its meridian level, not in the organ level, so the bowel-cleansing therapy should not be used.

[73] No sweat but urine difficulty means Wet and Fire. No sweat and easy urine suggests Cold.

[74] Floating and slow pulse indicates Taiyang stage. Deep and slow suggests Taiyin stage. I doubt the floating and slow pulse here should be deep and slow.

[75] A disease can transfer from Yangming stage further into the Taiyin stage and it can also transfer reversely back from Taiyin to Yangming stage. Generally speaking, transfer from Yang stage into Yin stage suggests progressing while that from a Yin stage back to a Yang stage suggests a regression of the disease.

[76] This is a condition that the Jingye has been lost through the vomiting. For such annoyed, herb Zhuye Shigao Tang should be used. Generally speaking, if there is no Jingye loss, a condition of no sweat but annoyed needs Da Qinglong Tang (the Fire is in surface); a condition of sweat and annoyed needs Baihu Tang (the Fire is in inside); a condition of no sweat but annoyed after vomiting or bowel-cleansing therapy needs Zhizi Zhi Tang (the Fire is inside and even if the stool might be hard); a condition of sweat and annoyed and hard stool needs Tiaowei Chengqi Tang.

[77] In original version, there is no “vomiting on the fifth and sixth day”.

[78] Feeling no hot or chilly, but sweat means the surface Xieqi has been depleted.

[79] Fast and thin pulse on the Guan position suggests that the condition in the stomach is not in a harmony. Thin pulse suggests weakness and fast suggests Fire.

[80] During the first and second day, the disease is in the Taiyang stage, so the person can still feel hungry but cannot eat, since the stomach function is weak. 

[81] During the third and the forth day, the disease is in the Yangming stage, vomiting causes loss of Yingye, so the person has not appetite, since the Yangming is related to food digestion.

[82] During the fifth and sixth day, the disease has transferred to a Yin stage, such as in Taiyin stage. Vomiting causes Cold in the Stomach, so he has the later vomiting.

[83] Yangming is associated to the stomach to hold food. Now there is Cold in the Stomach so it cannot hold food to cause vomiting. Wuzhuyu Tang works to warm the Stomach. If the person has worse condition after drinking of the herbs, it indicates that the condition does not belong to Cold in the stomach, but a Fire in the chest. In this case, use Gegen jia Banxia Tang. Upper Jiao Cavity: the cavity above the diagram, including the organs in the chest: lung and heart.

[84] For the Yangming stage, loss of appetite can happen when the Stomach has Fire, or the Stomach has Cold. Bowel-cleansing therapy should be used when the person has Fire in the Stomach, has wave-hot and delirium.

[85] Yue syndrome: an air- or gas-reverse from stomach, a kind of dry nausea, but not a hiccup or belch.

[86] In such stomach Cold and weakness, Lizhong Tang jia Wuzhuyu and Dingxiang Tang is used.

[87] In original version, there is “allow him to have big sweat” after the “give patient cold water to drink”.

[88] Yue syndrome only can be due to either stomach weakness or Cold in it. The co-exist of the Yue syndrome and the Stomach suggests the Qi movement is blocked in the Stomach. If it is blocked in the front urine, Wuling San is used; if it is blocked in the bowel movement system, Chengqi Tang is chosen.

[89] Shi condition: not weak condition. It can be due to Fire burning inside, that disturb the spirit and conscious ness to mad.

[90] This condition is caused by over sweat, the Stomach is not a really Fullness. So, Xiao Chengqi Tang is used, not a Da Chengqi Tang.

[91] The stool that comes through the diarrhea must be very odor, sticky, thick, so to indicates the combination of a Fire and the dead food (dry stool) in the Stomach. The person should also have urgent feeling to have the diarrhea.

[92] The dead food residue block the Qi moves down, so the Stomach Qi moves reverse up to the brain to cause the loss of consciousness condition.

[93] In original version, the pulse here is “floating”.

[94] All of the conditions here suggests the co-exist of various Yang and Yin stages: floating pulse suggests Taiyang stage;  string pulse, Shaoyang stage; big pulse, Yangming stage. Again, no sweat, Taiyang condition; hard urine, Taiyang organ stage; pain in upper stomach and side of stomach and Qi stagnation feeling when press, swelling around the ears, Shaoyang stage;  dry nose, and fullness in stomach, wave-hot, Yangming stage, willing to lie down, Shaoyin stage; jaundice, Taiyin stage. In such complex condition, a proper treatment is to work on the Shaoyang stage, so the Xiao Chaihu Tang is used.

[95] In this condition, sweat therapy, vomiting therapy or bowel-cleansing therapy none should be used to cause more depletion of the Yin and Yang. Rather, the Yin ye should be supplied urgently.

[96] The point for this condition is the Cold in the Yangming stage. The Cold moves reverse up to causes nausea, cough or headache; or to block the Yangqi moves to the hands and feet to cause cold feeling in the hands and feet. Herb Xiao Qinglong Tang should be used.  Cough and nausea can be seen in Taiyang and Shaoyang stage. It is needed to distinguish. The Jue condition can usually be seen in Jueyin, Taiyin condition. Here the Master remind us it can also happen in the Yangming stage.

[97] If the Yangming comes from the Cold-invasion, the person should have less appetite and tends to feel headache, not the dizziness.

[98] If it is due to the Cold invasion, the person tends to have cough and nausea and headache. If it is Wind-invasion, the person tends to have cough, dizziness and sour throat. Note: if the sour throat is due to heavy cough. The sour throat is more seen in Shaoyin condition, in which the person has sour throat independent of cough.

[99] Sweat therapy could deplete Yangqi through the sweat.

[100] The Cold blocks the Weiqi moves down as normally it does, or the Weiqi goes reverse up to cause the vomiting. In this case, try Lizhong Tang and take Wumei Wan the same time.

[101] In original version, there is “diarrhea” after the “vomiting”.

[102] This paragraph tells a extreme condition with the Cold in the Stomach. The floating pulse here is not due to the co-exist of a Taiyang stage, but due to the expel of inside Yangqi to the body out layer by the too strong Yinqi inside.

[103] This is a time period which corresponding to the reduction of a Yangqi in the nature and the shrinking, contracting, or storing of Yangqi in the body. The trends of the Yangqi in the Nature helps, vibrates with the Yangqi in the body, so to cause corresponding trends of the Yangqi in the body: to move deeper from body surface layer to the inside core. This is a time period of Sun set. Therefore in winter, it starts close to the 3 pm and in Summer, it starts to the 9 pm.

[104] Proper treatment plus the Yangqi movement in the Nature helps the cure of the disease.

[105] It is a very important way to distinguish the Yangming stage from other stages by checking its improvement time period or a worse period.