有承气症。脉弦长。小便不利。大便乍难乍易。微热。喘冒不得卧者。燥屎也。
邵评∶燥屎内结不眠。必兼有腹胀硬之症。宜以小承气汤加川连清下之。有栀豉汤症。发热汗出。不恶
寒。反恶热。咽燥口苦而喘。烦躁不眠者。内热欲出也。
又有汗吐下后。虚烦不得眠。反复颠倒。心中懊 。亦栀子豉汤。或竹叶石膏汤。
发黄头汗出者。热不得外越而上泄也。背强恶寒。头汗出者。寒湿客搏经络也。
下血谵语。头汗出者。热入血室也。虚烦懊 。头汗出者。邪客胸中。热气蒸于上也。水结胸。头汗出者。
水气停蓄。不得外行也。往来寒热。头汗出者。火邪熏灼上炎也。皆当分门施治。
邵评∶少阳木火上炎而头汗。亦屡见之。
关格症。不得尿。头无汗者生。有汗者死。湿家误下。额上汗出微喘。小便不利者死。（以上参准绳）
邵评∶微喘额汗。阳从上脱。小便不利。阴已下竭。阴阳离决。安得不死。
按阳明热不得越。上蒸于首而头汗出者。不恶寒而恶热。寒湿客抟于经。而头汗出者。必恶风恶寒。（参金鉴）
邵评∶此辨寒热湿邪在表在里之法。语最简当。
胃主四肢。为热聚于胃。其津液旁达于手足也。阳明病。手足汗。潮热谵语。便硬者可下。若阳明胃
土中寒。脾不约束。津液横溢四肢。犹如阴盛霪雨滂沱。故汗出而冷也。阳虚失运。中寒不化。故不能食。而小
便不利也。大便必先硬后溏。今虽便硬。手足汗出。非阳明实热者比。不可攻。攻之必作固瘕。宜浓朴甘
草生姜半夏人参汤。（以上合参准绳金鉴）
固瘕。硬屎下后。即泻清水也。
There is a Chengqi Tang syndrome. The pulse is string-like and long. Urination is difficult. Bowel movements are alternately difficult and easy. There is slight fever, panting, and dizziness preventing sleep; this indicates dry feces (dry stool) accumulation.
Shao's commentary: Insomnia caused by internal accumulation of dry feces must be accompanied by abdominal distension and hardness. It is appropriate to use Xiao Cheng Qi Tang (Minor Order the Qi Decoction) with added Huang Lian (Coptidis Rhizoma) to clear heat and purge downward. There is also Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) syndrome: fever with sweating, aversion to cold is absent, but there is aversion to heat, dry throat, bitter taste in the mouth, panting, irritability, and insomnia; this indicates internal heat attempting to exit.
Furthermore, after treatment with sweating, vomiting, or purging methods, if there is deficiency-induced vexation and inability to sleep, tossing and turning, and mental restlessness and regretfulness (Ao Nu), Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) should be used. Alternatively, Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) may be used.
Jaundice accompanied by head sweating indicates that heat cannot diffuse outward and instead vents upward. Back stiffness with aversion to cold, accompanied by head sweating, indicates cold-dampness invading and binding the meridians. Hematochezia with delirium, accompanied by head sweating, indicates heat entering the Blood Chamber (Xue Shi). Deficiency-induced vexation and regretfulness, accompanied by head sweating, indicates pathogenic factors residing in the chest, with hot qi steaming upward. Water retention in the chest (Shui Jie Xiong) with head sweating indicates water qi stagnation and accumulation, unable to move outward. Alternating chills and fever with head sweating indicates fire pathogen scorching and flaming upward. All these cases require treatment based on their specific categories.
Shao's commentary: Head sweating due to the flaming upward of Shaoyang Wood-Fire is also frequently seen.
Guan Ge syndrome (Obstruction and Repletion): Inability to urinate. If there is no sweat on the head, life can be preserved; if there is sweat, death ensues. If a patient with dampness is mistakenly treated with purgatives, and presents with sweating on the forehead, slight panting, and inability to urinate, death ensues. (Referenced from *Yi Zong Bi Du*)
Shao's commentary: Slight panting and sweating on the forehead indicate Yang Qi escaping from above. Inability to urinate indicates Yin fluids exhausted from below. With the separation of Yin and Yang, how can one not die?
Note: When Yangming heat cannot diffuse outward and steams upward to the head causing head sweating, there is no aversion to cold but rather aversion to heat. When cold-dampness invades and binds the meridians causing head sweating, there is definitely aversion to wind and cold. (Referenced from *Yi Zong Jin Jian*)
Shao's commentary: This distinguishes the methods for identifying cold, heat, and damp pathogens in the exterior versus interior. The language is concise and appropriate.
The Stomach governs the four limbs. When heat gathers in the Stomach, body fluids reach the hands and feet peripherally. In Yangming disease, if there is sweating on the hands and feet, tidal fever, delirium, and hard stools, purgation is indicated. However, if there is cold in the Yangming Stomach Earth, and the Spleen fails to constrain, body fluids overflow to the four limbs like heavy rain during Yin excess, resulting in cold sweating. Yang deficiency leads to loss of transportation, and middle-jiao cold prevents transformation, resulting in an inability to eat and difficulty urinating. Stool will typically be hard first and then loose. Although the stool is currently hard, the presence of hand and foot sweating distinguishes this from Yangming excess-heat; it should not be purged. Purging would inevitably lead to Gu Jia (a type of abdominal mass/accumulation). Nong Po Gan Cao Sheng Jiang Ban Xia Ren Shen Tang (Aconite-free formula focusing on Magnolia Bark, Licorice, Ginger, Pinellia, and Ginseng) is appropriate. (Synthesized from *Yi Zong Bi Du* and *Yi Zong Jin Jian*)
Gu Jia refers to the condition where, after hard stool is passed, watery diarrhea immediately follows.