凡七十七条方十
阳明者。胃经也。其法不以经病为例。而例以胃家实为正。不以经病为例者。阳明路接太阳。
经病。由传从太阳过而后受。多则太阳未除。故须仍从太阳例。如几几合病之类是也。过此再入
阳明。胃实当之。病一入胃。胃为五脏六腑之海。而吉凶生死几焉。不复有经可言矣。故经无例
可出。而凡胃实者不得不出例。此阳明所以与余经不同也。彼以一经再经循经越经。规规于数日
以论证者。乌足与语圣贤言外之意哉。
（一）阳明之为病。胃家实也。
阳明。经也。胃。腑也。实者。大便结为硬满。而不得出也。作于迟早不同。非日数所可拘。
所谓二日阳明者。以经言也。经主三阳。传路之中。不专病。而专病在胃实。故胃实反得以揭阳
明之总。与太阳之揭总者。经病虽不同。要之所以为揭例则一也。余经皆有总揭。其例则通乎二
者而同推。以此观之。则非全书之言。不出于轻视而漫易哉。
（二）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。
此条三节。此节三问一答。通下文二节乃三答词。盖原三阳所以入胃之殊因也。太阳阳明者。
谓太阳受病经入胃而成胃实也。脾约见第六十一条。此举大意。详见后。
正阳阳明者。胃家实是也。
正。谓本经也。以病到本经遂入胃而成胃实。故指首条谓即此是也。然大概亦只是如此。
少阳阳明者。发汗利小便已。胃中燥烦。实。大便难是也。
少阳阳明者。以病到少阳。方才入胃而成胃实者言也。发汗以下。三阳皆然。乃独于少阳发
者。以少阳主半表半里。表里皆不可攻故也。然三者之因虽少殊。要亦不过互明耳。
（三）问曰。阳明病。外证云何。答曰。身热。汗自出。不恶寒反恶热也。
身热汗自出。起自中风也。不恶寒。反恶热。邪过荣卫入里而里热甚也。此以太阳传入中风
阳明之外证言。
（四）问曰。何缘得阳明病。答曰。太阳病。发汗。若下。若利小便。此亡津液。胃中干燥。
因转属阳明。不更衣。内实。大便难者。此名阳明也。
亡转皆见太阳篇。中风本自汗。故发汗已下皆致传阳明。势易也。古人大便必更衣。不更衣。
言不大便也。此以太阳中风传入阳明之表证言。
（五）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。
不发热而恶寒。起自伤寒也。恶寒将自罢。邪过表也。即自汗出。邪热郁于阳明之肌肉。腠
理反开。津液反得外泄也。恶热。里热甚也。此以太阳伤寒传入阳明之外证言。
（六）问曰。恶寒何故自罢。答曰。阳明居中。土也。万物所归。无所复传。始虽恶寒。二
日自止。此为阳明病也。
此承上条之答词。复设问答而以其里证言。无所复传者。胃为水谷之海。五脏六腑四体百骸
皆资养于胃。最宜通畅。实则秘固。复得通畅则生。止于秘固则死。死生决于此矣。尚何复传。
恶寒二日自止者。热入里而将反恶热。以正阳阳
明言也。以病二日而其几有如此。则斯道之精微。岂专专必于谈经论日所能窥测哉。
（七）伤寒发热无汗。呕不能食。而反汗出 然者。是转属阳明也。
。照吉切。发热无汗。追言太阳之时也。呕不能食。热入胃也。反汗出者肌肉着热。肤腠
反开也。 。热而汗出貌。
（八）伤寒。转系阳明者。其人 然微汗出也。
此承上条复以微汗申言。重致叮咛也。
（九）本太阳。初得病时。发其汗。汗先出不彻。因转属阳明也。
彻。除也。言汗发不对。病不除也。此言由发太阳汗不如法。致病入胃之大意。以为总结上文。
（十）伤寒三日。阳明脉大。
伤寒三日。该中风而大约言也。凡类此者。皆仿此。脉大。阳明气血俱多也。
（十一）阳明病欲解时。从申至戌上。
申酉戌。阳明之王时也。正气得其王时。则邪不能胜。故退而自解也。
（十二）阳明病。脉迟。汗出多。微恶寒者。表未解也。可发汗。宜桂枝汤。
迟者。缓之变。汗出多微恶寒者。风邪犹有在表者。故曰未解也。可发汗。例也。宜桂枝汤。
谓仍须解其肌。则入胃之路自绝也。方见太阳上。
（十三）阳明病。脉浮。无汗而喘者。发汗则愈。宜麻黄汤。
浮者。紧之转。邪外向也。无汗而喘者。寒邪在表未全除也。故曰发汗则愈。言当仍从解外也。宜
麻黄汤者。言当散穷寇于境界也。方见太阳中。
（十四）阳明病。若能食者。名中风。不能食者。名中寒。
此以食之能否。喻人验风寒之辨。盖阳明主水谷。风能食。阳能化谷也。寒不能食。阴不杀谷
也。名犹言为也。中寒即伤寒之互词。大意推原风寒传太阳而来。其辨验有如此者。非谓阳明自
中而然也。玉机微义谓。惜乎仲景不言中寒。经言中寒殆不止此。何尝不言。彼以经为不言者。
其意将以为中之与伤。有各别之分也。殊不知经称中伤二字。于风寒者。要亦从来之通称。经因
通称以为称。非经之称始也。想从来通称之意。大约不过以风寒本天之二气。中伤是以人之被之
而为称。譬如称人之中于箭伤于刃。只可在刀箭疮上认病。岂可向中伤上摸影。由此言之。则中
风与伤寒之说。必须于风寒二病上认得证候分晓。不当在中伤上各别寻头脑也。且以经文大义考
之。措词多是互相发。则中伤二字亦是互相为用。不言可知矣。通篇虽无伤风一说。然以伤寒复
称中寒论之。则中风得称伤风。亦可推也。世俗又有感冒之称。盖由愚夫愚妇。不知中伤与感本
素灵之互文。乃讳中伤为重。而起趋感冒为轻。以便慰问之风。遂成弊习耳。原无关轻重之义。
读书贵格致穷理。明道以正俗。乃舍古不稽。一从流俗。直欲于虚文上争差分。不究事实而
求多于往哲。可不正谓之冥行索涂。东西一听候于呼叱哉。
（十五）脉阳微而汗出少者。为自和也。汗出多者。为太过。
轻高而上前者为阳微。以中风之缓言。中风本自汗。故言出少为自和。和对太过言。谓未至
太过耳。非直谓平和。大过者。以其失于不治。与凡治之不对。致出不已者言也。
阳脉实。因发其汗。出多者亦为太过。太过为阳绝于里。亡津液。大便因硬也。
实以伤寒之紧言。伤寒本无汗。故曰因发其汗。发而出之过多。则与自出过多者同一致。故曰
亦为太过。自此以下。乃总结上文以申其义。阳绝即亡阳。盖汗者血之液。血为阴。阴主静。本不
自出。盖所以出者阳气之动鼓之也。故汗多则阳绝。岂惟阳绝。亡津液即亡阴也。读者最宜究识。
（十六）太阳病。三日。发汗不解。蒸蒸发热者属胃也。调胃承气汤主之。
此概言阳明发热之大意。三日举大纲言也。蒸蒸热气上行貌。言热自内腾达于外。犹蒸炊然。
故曰属胃也。调胃。和阳明之正也。方见太阳下编。
（十七）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。胃中干燥。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。
差。与瘥同。穿介切。令。平声。为。去声。瘥。小愈也。以亡津液至大便硬。是申释上文。
当问其小便日几行。至末。是详言大便出不出之所以然。盖水谷入胃。其清者为津液。粗者成楂滓。
津液之渗而外出者则为汗。潴而下行者为小便。故汗与小便出多。皆能令人亡津液。所以楂滓之
为大便者。干燥结硬而难出也。然二便者。水谷分行之道路。此通则彼塞。此塞则彼通。小便出
少。则津液还停胃中。胃中津液足。则大便润。润则软滑。此其所以必出可知也。
（十八）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。及与大猪胆汁。皆可为导。
蜜煎导方
蜜七合。一味内铜器中。微火煎之。稍凝似饴状。搅之。勿令焦者。欲可丸。并手捻作梃子。
令头锐大如指。长二寸许。当热时急作。冷则硬。以内谷道中。以手急按。欲大便时。乃去之。
猪胆汁方
大猪胆一枚。泻汁。和醋少许。以灌谷道中。如一食顷。当大便出。
虽。上或下。当有大便二字。竭。亦亡也。上条以小便数少。故知大盒饭自出。此以小便自
利而用导。反复互相发也。然皆不用下者。以非热也。
（十九）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 然而汗出者。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。
大承气汤方
大黄（四两酒洗） 浓朴（半斤炙去皮） 枳实（五枚炙） 芒硝（三合）
上四味。以水一斗。先煮二物取五升。去滓。内大黄煮取二升。去滓内芒硝。更上火。微一两
沸。分。温再服。得下。余勿服。
小承气汤方
大黄（四两酒洗） 浓朴（二两炙去皮） 枳实（三枚炙大者）
以上三味。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。
脉迟不恶寒。表罢也。身必重。阳明主肌肉也。短气腹满而喘。胃实也。潮热。阳明王于申
酉戌。故热作于此时。如潮之有信也。手足 然汗出者。脾王四肢而胃为之合。胃中热甚而蒸发。
腾达于四肢。故曰此大便已硬也。承气者。承上以逮下。推陈以致新之谓也。曰大者。大实大满。
非此不效也。枳实泄满也。浓朴。导滞也。芒硝。软坚也。大黄荡热也。陈之推新之所以致也。
汗多。微发热恶寒。皆表也。故曰。外未解也。其热不潮。胃中未定热。阳明信不立也。小承气
者。以满未硬。不须软也。故去芒硝而未复致大下之戒也。更衣。古人致大便之恭也。夫胃实。
一也。以有轻重缓急之不同。故承气有大小调胃之异制。汤有多服少服之异度。盖称物平施。由
义之谓道也。然则窃三益而滥称承气者冒也。恶足与语道哉。
（二十）阳明病。潮热。大便微硬者。可与大承气汤。不硬者不与之。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。乃可攻之。若不转失气。此
但初头硬。后必溏。不可攻之。攻之必胀满不能食也。欲饮水者。与水则哕。其后发热者。必大
便硬而少也。以小承气汤和之。不转失气者。慎不可攻也。
黄氏曰。失。汉书作屎。古屎失通。矢传写误。上条诀人以手足汗出为当下之时。此以潮热转
矢气次第而详言。亦诀人当下之二候也。转矢气。反屁出也。胀满。药寒之过也。哕。亦寒伤胃
也。硬而少。重下故也。末句重致叮咛之意。
（二十一）阳明病下之。心中懊 而烦。胃中有燥屎者可攻。腹微满。初头硬。后必溏。不
可攻之。若有燥屎者。宜大承气汤。
可攻以上。以转矢气言。懊 。悔 痛恨之意。盖药力未足以胜病。燥硬欲行而搅作。故曰
可攻。言当更服汤以促之也。腹微满以下。以不转矢气言。头硬后溏。里热轻也。故曰不可攻之。
言当止汤勿服也。末二句。乃申上节以决治意。
（二十二）阳明病。谵语。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。勿更与之。明日不大便。脉反微涩者。里虚也。为难治。不可
更与承气汤也。
此承上文又以谵语并脉言。亦诀人下候及斟酌用汤度数之意。滑以候食。故为大便硬之诊。
疾。里热甚也。然滑疾有不宁之意。不可不知。微者阳气不充。涩者阴血不足。故曰里虚也。难
治者。气不充则无以为营运。血不足则无以为润送。故曰阳微不可下。无血不可下。此之谓也。
（二十三）夫实则谵语。虚则郑声。郑声。重语也。
实以邪言。谵语。呢喃不了之妄语也。虚以正言。以重语释郑声者。谓语声之出。由于邪实
正虚。浊恶而厌听也。
（二十四）直视。谵语。喘满者。死。下利者。亦死。
直视。精不荣于目也。谵语。神不主乎心也。喘则阳争于上。利则阴夺于下。胃。中土也。
阴阳争夺于上下。而中气不守。故无法可治。而皆主死也。
（二十五）发汗多。若重发汗者。亡其阳。谵语脉短者。死。脉自和者。不死。
汗本血之液。阳亡则阴亦亏。脉者血气之道路。短则其道穷矣。故亦无法可治而主死也。和
则病虽竭。而血气则未竭。故知生可回也。此疑太阳篇错简。
（二十六）阳明病。发热。汗多者。急下之。宜大承气汤。
胃实本由于无津液而内燥。汗多则津液益亡矣。急下者。竭则不可治也。
（二十七）发汗不解。腹满痛者。急下之。宜大承气汤。
发汗不解者。失之过度也。腹满痛者。胃不和也。急下者。满去则痛止也。
There are seventy-seven clauses in total, comprising ten formulas.
The Yangming channel is the Stomach channel. Its diagnostic principle does not take "channel disease" (disease of the meridian) as the primary example, but rather takes "Stomach-Home Excess" (excess heat and accumulation in the stomach and intestines) as the standard syndrome. The reason for not taking channel disease as an example is that the Yangming channel connects with the Taiyang channel. The so-called channel disease is transmitted from the Taiyang channel; after passing through Taiyang, it receives pathogenic factors. If the transmission is extensive, the Taiyang exterior syndrome may not yet be resolved, thus requiring adherence to the Taiyang principles. This is seen in cases such as "Jijiu" (stiffness of the neck) and combined diseases. Once this stage is passed and the disease enters Yangming, it becomes a Stomach Excess syndrome. Once pathogens enter the Stomach, which is the sea of the five zang and six fu organs, fortune and misfortune, life and death depend upon it, and there is no longer talk of channel pathology. Therefore, the classics do not list examples of channel pathology, but must list examples for all Stomach Excess conditions. This is why Yangming differs from other channels. Those who rigidly adhere to one or two channels, following or crossing meridians, and strictly use days to argue syndromes, how can they understand the profound meaning beyond the words of the sages?
(1) The characteristic of Yangming disease is Stomach-Home Excess.
Yangming refers to the channel; Stomach refers to the fu organ. "Excess" means stool becomes hardened and full, unable to pass. Onset varies in time and cannot be restricted by days. When it is said "Yangming on the second day," it refers to the channel. Channels govern the three yang phases. In transmission, it does not specifically refer to a disease of a specific channel, but specifically to the disease location being Stomach Excess. Thus, "Stomach Excess" serves as the general outline for revealing Yangming, similar to how Taiyang reveals its general outline. Although the channel diseases differ, the method of revealing the principle is the same. All other channels have a general outline, and their principles can be applied universally and inferred. From this, we see that if these were not words from the complete book, would they not be considered disrespectful and casual?
(2) Question: There is Taiyang-Yangming, Zhengyang-Yangming, and Shaoyang-Yangming. What does this mean? Answer: Taiyang-Yangming is Pi Yue (Spleen Constriction).
This clause has three sections; this section has three questions and one answer, combining with the next two sections to form three answers. This originally explains the different causes for the three yang channels entering the Stomach. Taiyang-Yangming means the Taiyang channel receives disease and transmits to the Stomach forming Stomach Excess. Pi Yue is seen in Clause 61. Here only the general idea is stated; details follow later.
Zhengyang-Yangming is Stomach-Home Excess.
"Zheng" means the original channel. Because the pathogen reaches the original channel and directly enters the Stomach to form Stomach Excess, the first clause is cited as referring to this. However, generally, it is just like this.
Shaoyang-Yangming refers to the condition where, after sweating and promoting urination, the Stomach becomes dry, vexed, solid, and defecation is difficult.
Shaoyang-Yangming means the pathogen reaches Shaoyang and then enters the Stomach to form Stomach Excess. Sweating and promoting urination apply to all three yang channels, but are mentioned specifically for Shaoyang because Shaoyang governs half-exterior and half-interior, where neither exterior nor interior should be purged. Although the causes of these three are slightly different, they essentially illuminate each other.
(3) Question: What are the external manifestations of Yangming disease? Answer: Body fever, spontaneous sweating, aversion to cold is absent but aversion to heat is present.
Body fever and spontaneous sweating originate from Wind Strike. Absence of aversion to cold and presence of aversion to heat indicate that pathogens have passed Ying and Wei and entered the interior, causing intense interior heat. This describes the external signs of Yangming disease transmitted from Taiyang Wind Strike.
(4) Question: How does one contract Yangming disease? Answer: In Taiyang disease, after sweating, purging, or promoting urination, fluids are depleted, the Stomach becomes dry, and it transforms into Yangming. Failure to defecate, internal excess, and difficulty in defecation constitute Yangming disease.
"Wang" (loss) and "Zhuan" (transformation) are seen in the Taiyang chapter. Wind Strike naturally involves spontaneous sweating, so sweating or purging easily leads to transmission to Yangming. Ancients referred to defecation as "changing clothes"; "not changing clothes" means not defecating. This discusses the exterior signs of Taiyang Wind Strike transmitting to Yangming.
(5) Question: Some patients, one day after contracting the disease, do not have fever but have aversion to cold. Why? Answer: Even if it is one day after onset, aversion to cold will cease spontaneously, followed by spontaneous sweating and aversion to heat.
No fever but aversion to cold originates from Cold Damage. Aversion to cold ceasing indicates pathogens have passed the exterior. Spontaneous sweating occurs because pathogenic heat stagnates in the muscles of Yangming, causing pores to open and fluids to leak out. Aversion to heat indicates intense interior heat. This discusses the external signs of Taiyang Cold Damage transmitting to Yangming.
(6) Question: Why does aversion to cold cease spontaneously? Answer: Yangming is central and belongs to Earth. All things return to it and do not transmit further. Initially there may be aversion to cold, but it stops on the second day. This is Yangming disease.
This continues the answer to the previous clause, setting up another Q&A using interior signs. "Does not transmit further" means the Stomach is the sea of water and grain, nourishing all zang-fu and limbs. It must remain unobstructed. Excess leads to blockage; restoration of flow brings life, while persistent blockage brings death. Life and death are decided here, so what is there to transmit? Aversion to cold stopping on the second day refers to heat entering the interior and turning to aversion to heat, specifically regarding Zhengyang-Yangming. If the signs are such by the second day, the subtlety of this art cannot be fathomed merely by discussing channels and days.
(7) In Cold Damage, with fever, no sweat, vomiting, inability to eat, but instead profuse sweating (Ji Ran), this is transformation into Yangming.
"Ji" sounds like Ji. Fever and no sweat refer back to the Taiyang stage. Vomiting and inability to eat indicate heat entering the Stomach. Profuse sweating indicates muscle heat causing pores to open. "Ji Ran" describes the appearance of heat with continuous sweating.
(8) In Cold Damage, transforming into Yangming, the person has Ji Ran slight sweating.
This continues the previous clause, reiterating slight sweating to emphasize caution.
(9) Originally Taiyang disease, at initial onset, sweating was induced, but the sweat was incomplete, leading to transformation into Yangming.
"Che" means removal. It means improper sweating failed to remove the pathogen. This summarizes the main point that improper treatment of Taiyang sweating leads to pathogen entering the Stomach, concluding the above text.
(10) After three days of Cold Damage, the pulse is large.
"Cold Damage three days" includes Wind Strike and is a general statement. Similar cases follow this pattern. Large pulse indicates abundant Qi and Blood in Yangming.
(11) Yangming disease resolves from Shen hour to Xu hour.
Shen, You, and Xu hours are when Yangming is prosperous. When righteous Qi is supported by its prosperous time, it overcomes pathogens, so the disease resolves spontaneously.
(12) In Yangming disease, with slow pulse, profuse sweating, and slight aversion to cold, the exterior is unresolved. Sweating may be used; Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
"Chi" (slow) is a variation of "Huan" (moderate). Profuse sweating and slight aversion to cold indicate wind pathogen remains in the exterior, hence unresolved. Sweating is indicated as a standard method. Guizhi Tang is appropriate to release the muscle layer, cutting off the path to the Stomach. Formula seen in Taiyang Upper Chapter.
(13) In Yangming disease, with floating pulse, no sweat, and wheezing, sweating will cure; Mahuang Tang (Ephedra Decoction) is appropriate.
"Floating" is a transformation of "Jin" (tight), indicating pathogen moving outward. No sweat and wheezing indicate cold pathogen remains in the exterior. Sweating is indicated to resolve the exterior. Mahuang Tang is appropriate to scatter the remaining pathogens. Formula seen in Taiyang Middle Chapter.
(14) In Yangming disease, if able to eat, it is named Wind Strike; if unable to eat, it is named Cold Injury.
This uses ability to eat to distinguish Wind from Cold. Yangming governs water and grain. Wind allows eating because Yang can transform grain. Cold prevents eating because Yin cannot kill grain. "Ming" means "is called." "Zhong Han" (Cold Injury) is synonymous with "Shang Han" (Cold Damage). The intent is to trace back Wind-Cold transmission from Taiyang, showing differentiation. It does not mean Yangming contracts Wind/Cold directly. Yuji Wei Yi states: "It is a pity Zhongjing did not speak of Zhong Han." The classics mention Zhong Han more than this. Those who claim the classics don't mention it intend to distinguish "Zhong" (penetrating) from "Shang" (injuring). However, "Zhong Shang" is a common term for Wind-Cold. The distinction between Wind Strike and Cold Damage must be recognized in the diseases themselves, not in the terms "Zhong Shang." Furthermore, textual analysis shows mutual explanation; "Zhong Shang" are interchangeable. Although "Shang Feng" is not explicitly used, since "Shang Han" is called "Zhong Han," "Zhong Feng" can be inferred as "Shang Feng." Modern people use "Gan Mao" (Common Cold), avoiding "Zhong Shang" as heavy and preferring "Gan Mao" as light for social courtesy, creating a bad habit unrelated to severity. Studying requires investigating principles to correct customs, not blindly following trends.
(15) Pulse superficially weak with little sweating indicates self-harmony. Profuse sweating indicates excess.
Superficial weakness refers to the moderate pulse of Wind Strike. Since Wind Strike naturally sweats, little sweating is self-harmony (not excessive). "Excess" refers to lack of treatment or incorrect treatment causing continuous sweating.
If the superficial pulse is excess, and sweating is induced resulting in profuse sweat, this is also excess. Excess leads to Yang exhaustion in the interior, depletion of fluids, and hardening of stool.
"Excess" refers to the tight pulse of Cold Damage. Since Cold Damage has no sweat, inducing sweating excessively is similar to natural excessive sweating. Below summarizes the previous text. Yang exhaustion is Yang collapse. Sweat is fluid of blood; blood is Yin, quiet, and does not sweat spontaneously. Yang Qi drives it. Thus, profuse sweating exhausts Yang. Depletion of fluids is also depletion of Yin. Readers must study this carefully.
(16) Taiyang disease, after three days, sweating fails to resolve it; steaming fever indicates involvement of the Stomach. Tiaowei Chengqi Tang (Regulate the Stomach Order the Qi Decoction) is the main treatment.
This generally discusses Yangming fever. "Three days" is a general outline. "Zheng Zheng" describes heat rising internally to externally like steaming. Hence "involvement of the Stomach." "Tiaowei" harmonizes Yangming righteousness. Formula seen in Taiyang Lower Chapter.
(17) Yangming disease, originally with spontaneous sweating, doctor induces heavy sweating again. Disease improves, but slight vexation persists. This indicates stool must be hard due to fluid depletion and dry Stomach. Ask about daily urine frequency. If originally 3-4 times/day, now only twice, stool will pass soon. Reduced urine means fluids return to Stomach, moistening stool for passage.
"Cha" is same as "Chai" (minor recovery). From fluid depletion to hard stool explains the previous text. Asking about urine explains why stool passes or not. Water/grain in Stomach: clear part becomes fluids, turbid part becomes dregs. Fluids exiting as sweat or urine. Excessive loss depletes fluids, making dregs hard. Urine and stool are paths for water/grain separation; open one blocks the other. Less urine means fluids stay in Stomach, moistening stool.
(18) Yangming disease, spontaneous sweating, or induced sweating, with free urination, indicates internal depletion of fluids. Though stool is hard, purge not. Wait for desire to defecate; use Honey Suppository (Mi Jian Dao) to guide. Or Trichosanthes Root (Tugua Gen) or Pig Bile (Da Zhu Dan Zhi) can be used as guides.
Honey Suppository Formula:
Seven he of honey, simmered in copper vessel over low heat until thick like malt syrup, stirring to avoid burning. Shape into suppositories sharp at head, finger-thick, two cun long. Insert into anus while warm; hardens when cold. Press firmly. Remove when urge to defecate arises.
Pig Bile Formula:
One large pig gallbladder, juice mixed with small amount of vinegar,灌 into anus. After one meal time, stool should pass.
"Although" implies "stool" missing above/below. "Jie" means depletion. Previous clause used reduced urine to predict stool passage; this uses free urination to justify suppository. Both avoid purgatives because it is not heat.
(19) Yangming disease, slow pulse, sweating without aversion to cold, body heaviness, shortness of breath, abdominal fullness, wheezing, tidal fever indicates exterior resolving, interior can be attacked. Profuse sweating on hands and feet indicates hard stool. Dachengqi Tang (Major Order the Qi Decoction) is main treatment. If profuse sweat, slight fever/aversion to cold, exterior unresolved. If no tidal fever, do not give Chengqi Tang. If abdominal fullness/blockage, give Xiaochengqi Tang (Minor Order the Qi Decoction) to mildly harmonize Stomach Qi, avoid severe purging.
Dachengqi Tang Formula:
Dahuang (Rhubarb Root, 4 liang, wine-washed) Nongpo (Magnolia Bark, 8 liang, roasted, skin removed) Zhishi (Immature Bitter Orange, 5 pieces, roasted) Mangxiao (Mirabilite, 3 he)
Boil first two in one dou water to five sheng, strain. Add Dahuang, boil to two sheng, strain. Add Mangxiao, boil briefly. Warm and drink twice. If bowel moves, stop remaining dose.
Xiaochengqi Tang Formula:
Dahuang (4 liang, wine-washed) Nongpo (2 liang, roasted, skin removed) Zhishi (3 pieces, roasted, large ones)
Boil three in four sheng water to one sheng two he, strain. Warm and drink twice. First dose should cause bowel movement. If not, drink all. If moved, stop.
Slow pulse/no aversion to cold means exterior resolved. Body heaviness because Yangming governs muscles. Shortness of breath/fullness/wheezing is Stomach Excess. Tidal fever occurs at Shen/You/Xu hours when Yangming prospers. Hand/foot sweating indicates Stomach heat evaporating to limbs (Spleen governs limbs, Stomach is partner). "Chengqi" means inheriting upper to reach lower, pushing out old to bring new. "Da" (Major) is for major excess/fullness. Zhishi drains fullness, Nongpo directs stagnation, Mangxiao softens hardness, Dahuang sweeps heat. Small Chengqi is for fullness without hardness, so Mangxiao is omitted. "Gengyi" is polite term for defecation. Variations in Chengqi formulas match severity.
(20) Yangming disease, tidal fever, slightly hard stool, may give Dachengqi Tang. If not hard, do not give. If no stool for 6-7 days, suspect dry stool. Test by giving small amount of Xiaochengqi Tang. If gas passes after ingestion, dry stool exists, can purge. If no gas, stool is hard at start, loose at end, do not purge. Purging causes fullness, inability to eat. Thirsty patient given water may hiccup. Subsequent fever indicates hard, scant stool; harmonize with Xiaochengqi Tang. If no gas,慎不可攻 (do not purge).
Huang says: "Shi" is "Shi" (feces) in Han Book. Ancient Shi/Shi interchangeable. "Shi" is copy error. Previous clause used hand/foot sweat as indication; this uses tidal fever and gas passage. Gas passage is farting. Fullness is side effect of cold medicine. Hiccup is cold injuring Stomach. Hard/scant stool is result of heavy purging. Last sentence emphasizes caution.
(21) Yangming disease, after purging, mental anguish and vexation. If dry stool in Stomach, can purge. Slight abdominal fullness, hard start/loose end, do not purge. If dry stool, Dachengqi Tang is appropriate.
Above "can purge" based on gas passage. "Ao Nao" is regret/vexation. Medicine insufficient to overcome disease, dry stool moving causing agitation, so "can purge" means take more medicine. Below "slight fullness" based on no gas. Hard start/loose end means mild interior heat, so "do not purge" means stop medicine. Last two sentences decide treatment intent.
(22) Yangming disease, delirium, tidal fever, slippery and rapid pulse, Xiaochengqi Tang is main treatment. Give one sheng of Chengqi Tang. If gas passes, give another sheng. If no gas, do not give. Next day no stool, pulse becomes faint and choppy, interior deficiency, difficult to treat, do not give Chengqi Tang.
Continues previous with delirium and pulse. Slippery indicates food/stool retention (hard stool). Rapid indicates intense interior heat. Slippery/rapid implies unrest. Faint means deficient Yang; Choppy means deficient Yin blood. Interior deficiency makes treatment difficult. Deficient Yang cannot circulate; deficient Yin cannot moisten. Hence "Yang deficiency cannot be purged, blood deficiency cannot be purged."
(23) Excess causes delirium; deficiency causes Zheng Sheng (repetitive speech). Zheng Sheng is repetitive speech.
Excess refers to pathogen. Delirium is incoherent nonsense. Deficiency refers to righteous Qi. Repetitive speech explains Zheng Sheng: voice is turbid and unpleasant due to pathogen excess and righteous deficiency.
(24) Fixed gaze, delirium, wheezing and fullness: death. Diarrhea: also death.
Fixed gaze: essence not nourishing eyes. Delirium: spirit not governing heart. Wheezing: Yang struggling above. Diarrhea: Yin draining below. Stomach is central Earth. Yin/Yang struggle above/below, central Qi fails to hold, incurable, both lead to death.
(25) Profuse sweating or repeated sweating exhausts Yang. Delirium with short pulse: death. Pulse self-harmonious: survival.
Sweat is fluid of blood. Yang exhaustion implies Yin deficit. Pulse is path of Qi/Blood. Short means path exhausted, incurable, death. Harmonious means although disease exhausted, Qi/Blood not exhausted, life recoverable. This clause suspected to be misplaced from Taiyang chapter.
(26) Yangming disease, fever, profuse sweating: urgently purge with Dachengqi Tang.
Stomach Excess due to fluid depletion/internal dryness. Profuse sweating worsens fluid loss. Urgent purge because depletion is untreatable otherwise.
(27) Sweating fails to resolve, abdominal fullness and pain: urgently purge with Dachengqi Tang.
Sweating failure is excessive treatment. Abdominal fullness/pain is Stomach disharmony. Urgent purge removes fullness, stopping pain.