（有大便不通有大便难有大便硬皆阳明胃实之候）
六七日不大便。头痛有热。与承气汤。小便清者。知不在里。仍在表也。（桂枝汤）阳明
病
（小柴胡汤）阳明病。自汗若发汗。小便自利者。津液内竭。虽硬不可攻（蜜煎导之）阳明病。
潮热不大便。少与小承气。不转失气者。无燥屎不可攻。转失气者。有燥屎可攻。（大承气
汤）阳明病。不吐不下。心烦。（调胃承气汤）阳明小便不利。大便乍难乍易。时有微热喘冒
不卧。有燥屎也。（大承气汤）伤寒六七日。目中不了了。睛不和。无表里症大便难。身微热
。（大承气汤急下之）脉浮则胃气强。脉涩则小便数。浮涩相搏。大便则难。其脾为约。（麻
仁丸）阳明症喜忘。大便色黑必有蓄血。（抵当汤）无表里证。下后脉数。不解。善饥。六七
日不大便者。有瘀血。
按仲景或曰。阳明潮热不大便。与小承气。不转失气者。初硬后必溏。不可攻之。此胃
中初热。未作实者也。或曰。太阳病下之腹满。初硬后必溏。此虚热在上。无燥屎者也。或曰阳
明病。中寒不能食。小便不利。手足 然汗出。欲作痼瘕。初硬后必溏。以水谷不分也。或
曰。小便少者。服承气汤。若不大便六七日。小便少者。初硬后必溏。须小便利屎必硬。乃
可攻之。乃知仲景测大便法。皆以小便验之。然小便利。屎必硬。固为可攻。亦有小便利。
大便硬。而不可攻者。何也。阳明自汗。或发汗。小便自利。此津液内竭。虽硬不可攻。待
其自欲大便。与蜜煎导之。夫胃虽实。有表者汗之。半表半里者和之。不因胃实便下也。此
仲景心法。精考详求。自无妄下之误矣。
(There are conditions of unpassable stool, difficult stool, and hard stool; all these are manifestations of Yangming Stomach Excess Syndrome.)
After six or seven days without defecation, accompanied by headache and fever. Administer Chengqi Decoction. If the urine is clear, it indicates that the pathogen is not in the interior but remains in the exterior. (Use Guizhi Tang [Cinnamon Twig Decoction].) This is a Yangming disease. (Or use Xiaochaihu Tang [Minor Bupleurum Decoction].)
In Yangming disease, if there is spontaneous sweating or after diaphoresis has been induced, and urination occurs naturally, this depletes the internal fluids (Jinye). Although the stool is hard, purgative methods should not be used (use Honey Suppository for guidance).
In Yangming disease, tidal fever occurs with constipation. First, administer a small dose of Xiao Chengqi Tang [Minor Order the Qi Decoction]. If there is no passage of flatus, there is no dry feces, and purgation is contraindicated. If flatus passes, there are dry feces, and purgation is indicated. (Use Da Chengqi Tang [Major Order the Qi Decoction].)
In Yangming disease, without prior emesis or purgation, mental restlessness occurs. (Use Tiaowei Chengqi Tang [Regulate the Stomach Order the Qi Decoction].)
In Yangming disease, with difficulty in urination, alternating difficulty and ease in defecation, occasional slight fever, panting, dizziness, and inability to lie down, this indicates the presence of dry feces. (Use Da Chengqi Tang [Major Order the Qi Decoction].)
In Cold Damage disease, after six or seven days, the eyes appear unclear and the pupils are unresponsive. Without exterior or interior syndromes, only difficulty in defecation and slight body heat exist. (Urgently use Da Chengqi Tang [Major Order the Qi Decoction] to purge.)
A floating pulse indicates strong Stomach Qi, while a choppy pulse indicates frequent urination. The combination of floating and choppy pulses leads to difficulty in defecation. This is due to the Spleen being constrained. (Use Maren Wan [Semen Cassiae Pill].)
Yangming syndrome presents with forgetfulness and black-colored stool, indicating blood stasis accumulation. (Use Didang Tang [Mighty To Reach Decoction].)
Without exterior or interior syndromes, after purgation, the pulse remains rapid, the illness is unresolved, hunger is prominent, and there is no defecation for six or seven days; this indicates blood stasis.
Commentary: Zhang Zhongjing sometimes states that in Yangming disease with tidal fever and constipation, Xiao Chengqi Tang [Minor Order the Qi Decoction] is given. If there is no passage of flatus, it indicates that the stool is initially hard but will become loose later, so purgation is contraindicated. This is because the heat in the Stomach is initial and has not yet formed an excess condition.
Some say that after incorrect purgation in Taiyang disease leading to abdominal fullness, where the stool is initially hard but becomes loose later, this is due to deficient heat in the upper jiao, with no dry feces present.
Some say that in Yangming disease with cold pathogens preventing food intake, difficulty in urination, and continuous sweating on the hands and feet, intending to form a chronic mass, the stool is initially hard but becomes loose later due to the failure to separate water and grain.
Some say that for patients with scanty urine who take Chengqi Decoction, if there is no defecation for six or seven days and urine remains scanty, it indicates the stool is initially hard but will become loose. One must wait until urination increases and the stool becomes hard before purging can be performed.
Thus, it is known that Zhang Zhongjing’s method of assessing stool always verifies through urine observation. However, while clear urination and hard stool are indeed indications for purgation, there are cases where urination is clear and stool is hard, yet purgation is still contraindicated. Why?
If Yangming disease involves spontaneous sweating or post-diaphoretic natural urination, this depletes internal fluids. Although the stool is hard, purgation is contraindicated. One should wait for the patient's natural urge to defecate and use Honey Suppositories for guidance.
Although the Stomach is in an excess state, if there is an exterior syndrome, use sweating methods; if it is half-exterior half-interior, use harmonizing methods. Do not use purgation simply because of Stomach excess. This is Zhang Zhongjing’s core methodology, derived from precise examination and detailed inquiry, ensuring no errors in reckless purgation.