伤寒不大便六七日，不恶寒反恶热，头痛身热者，与承气汤。
受病后，便不大便，胃家实也。至六七日而头痛身热不解，足见阳气之重，其不恶寒反恶热更可知矣。此太
阳阳明合病，已合阳数之期而不愈者，当知不大便之病为在里，不必拘头痛身热之表为未解也。所谓阳盛阴虚，
汗之则死，下之即愈，可不知要害乎？
病患烦热，汗出则解，又如疟状。日晡所发热者，属阳明也。脉实者宜下之，与承气汤。
烦热自汗似桂枝证，寒热如疟似柴胡证。然日晡潮热，期属阳明。而脉已沉实，确为可下，是承气主证主脉
也。当与不大便六七日，互相发明。
太阳病三日，发汗不解，头不痛，项不强，不恶寒，反恶热，蒸蒸发热者，属胃也，调胃承气汤主之。
病经三日，已经发汗，阳气得泄则热当解而内热反炽，与中风翕翕发热不同。必其人胃家素实，因发汗亡
津液，而转属阳明也。三日正阳明发汗之期。此太阳证已罢，虽热未解，而头不痛、项不强、不恶寒、反恶热，
可知热已入胃，便和其胃，调胃之名以此。日数不必拘，要在脉证上讲求。
发汗后恶寒者，虚故也，不恶寒反恶热者，实也。当和胃气，与调胃承气汤。
虚、实俱指胃言。汗后正气夺则胃虚，故用附子、芍药，邪气盛则胃实，故用大黄、芒硝。此自用甘草，是
和胃之意。此见调胃承气，是和剂而非下剂也。
若胃气不和谵语者，少与调胃承气汤。
承者，顺也。顺之则和。少与者，即调之之法。
伤寒吐后腹胀满者，与调胃承气汤。
妄吐而亡津液，以致胃实而腹胀，吐后上焦虚可知。腹虽胀满，病在胃而不在胸，当和胃气，而枳、朴非
其任矣。
阳明病，不吐不下心烦者，可与调胃承气汤。
言阳明病则身热汗出不恶寒反恶热矣。若吐下后而烦为虚邪，宜栀子豉汤。未经吐下而烦，是胃火乘心，
从前来者为实邪，调其胃而心自和。此实则泻子之法。
太阳病，过经十余日，心下温，温欲吐，而胸中痛，大便反溏，腹微满，郁郁微烦，先其时极吐下者，与调
胃承气汤。
过经不解十余日，病不在太阳矣。仍曰太阳病者，以此为太阳之坏病也。心中不烦而心下温，腹中不痛而
胸中痛，是上焦因极吐而伤矣。心下者，胃口也。心下温，温时即欲吐，胃口有遗热。腹微满，而郁郁时便微烦，
是胃家尚未虚，胃中有燥屎矣。大盒饭硬而反溏，是下焦因极下而伤也。欲吐而不得吐，当利而不利，总因胃气
不和，大便溏而胃家仍实也。少与调胃承气汤微和之，三焦得和矣。
伤寒十三日不解，过经谵语者，以有热故也，当以汤下之。若小便利者，大盒饭硬，而反下利、脉调和者，
知医以丸药下之，非其治也。若自下利者，脉当微，今反和者，此为内实也，调胃承气汤主之。
经者常也，过经是过其常度，非经络之经也。发于阳者七日愈∶七日以上自愈，以行其经尽故也。七日不
愈，是不合阴阳之数，便为过经，非十三日不解为过经也。凡表解而不了了者，十二日愈。此十三日而尚身热
不解，便见其人之阳有余。过经而谵语，足征其人之胃家实。此内外有热，自阳盛阴虚也。当以承气汤下之。而
医以丸药下之，是因其病久，不敢速下，恐伤胃气之意，而实非伤寒过经之治法也。下之不利，今反下利，疑为
胃虚。而身热谵语未除，非虚也。凡下利者，小盒饭不利；小便利者，大盒饭硬。今小便利而反下利，疑为胃
虚，恐热为协热而语为郑声也。当以脉别之，诸微亡阳，若胃虚而下利者脉
当微。今调和而不微，是脉有胃气，胃实可知也。是丸药之沉迟，利在下焦，故胃实而肠虚，调其胃则利自止
矣。
上条大便反溏，此条反下利，从假不足处得其真实。
上论调胃承气证。
太阳病，若吐、若下、若发汗，微烦，小便数，大便因硬者，小承气汤和之愈。
此亦太阳之坏病，转属阳明者也。微烦、小便数，大便尚不当硬，因妄治亡津液而硬也。用小承气和之，润
其燥也。此见小承气亦和剂，不是下剂。
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，后必溏，未定成硬，攻之必溏。须小
便利，屎定硬，乃可攻之，宜大承气汤。
得病二三日，尚在三阳之界。其脉弱，恐为无阳之征。无太阳桂枝证，无少阳柴胡证，则病不在表。而烦
躁心下硬，是阳邪入阴，病在阳明之里矣。辨阳明之虚实，在能食不能食。若病至四五日尚能食，则胃中无寒，而
便硬可知。少与小承气微和其胃，令烦躁少安。不竟除之者，以其人脉弱，恐大便之易动故也。犹太阴脉弱，当
行大黄、芍药者减之之意。至六日复与小承气一升。至七日仍不大便，胃家实也。欲知大便之燥硬，既审其能食
不能食，又当问其小便之利不利。而能食必大便硬，后不能食，是有燥屎。小便少者，恐津液还入胃中，故虽不
能食，初头硬后必溏。小便利者，胃必实，屎定硬，乃可攻之。所以然者，脉弱是太阳中风。能食是阳明中风。
非七日后不敢下者，以此为风也。须过经乃可下之，下之若早，语言必乱，正此谓也。
阳明病，脉迟，微汗出，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。
脉迟而未可攻者，恐为无阳，恐为在藏。故必表证悉罢，里证毕具，方为下证。若汗虽多而微恶寒，是表
证仍在，此本于中风。故虽大满不通，只可微和胃气，令小安，勿使大泄，过经乃可下耳。胃实诸证，以手足汗
出为可据，而潮热尤为亲切。以四肢为诸阳之本，而日晡潮热，为阳明主时也。
阳明病，潮热，大便硬者，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，汤入腹中转矢气者，此有燥屎，乃可攻之。若不转矢气者，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，不转矢气者，
慎不可攻也。
此必因脉之迟弱，即潮热尚不足据，又立试法。如胃无燥屎而攻之，胃家虚胀，故不能食。虽复潮热、便
硬而少者，以攻后不能食故也。要知不转矢气者，即渴欲饮水，尚不可与，况攻下乎？以小承气为和，即以小承
气为试。仍与小承气为和，总是慎用大承气耳。
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，腹中转矢气者，更服一升，若不转
矢气者，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。
脉滑而疾者，有宿食也。谵语潮热，下证具矣。与小承气试之，不转矢气，宜为易动。明日而仍不大便，其
胃家似实。而脉反微涩，微则无阳，涩则少血，此为里虚，故阳证反见阴脉也。然胃家未实，阴脉尚多，故脉
迟脉弱者，始可和而久可下。阳脉而变为阴脉者，不惟不可下，更不可和。脉滑者生，脉涩者死，故为难治。
然滑有不同，又当详明。夫脉弱而滑，是有胃气。此脉来滑疾，是失其常度，重阳必阴，仲景早有成见，故少与
小承气试之。若据谵语潮热，而与大承气，阴盛已亡矣。此脉证之假有余，小试之而即见真不足。凭脉辨证，可
不慎哉！宜蜜煎导而通之。虚甚者，与四逆汤，阴得阳则解矣。
伤寒若吐下后，不解，不大便五六日，上至十余日，日晡所发潮热，不恶寒，独语如有所见。若剧者，发
则不识人，循衣摸床，惕而不安，微喘直视，脉弦者生，涩者死。微者但发热谵语。大承气汤主之，若一服利，
止后服。
坏病有微、剧之分。微者是邪气实，当以下解。若一服利，止后服，只攻其实，无乘其虚也。剧者，邪正
交争，当以脉断其虚实。弦者是邪气实，不失为下证，故生；涩者是正气虚，不可更下，故死。如有所见独语，
与郑声谵语不同。潮热不恶寒，不大便，是可下证。目直视不识人∶循衣摸床等证，是日晡发热时事，不发时
自安，故勿竟断为死证。还将脉推之，凡谵语脉短者死。涩者短也，短则气病；弦者长也，长则气治。凡直视、
谵语、喘满者死。此微喘而不满，只是气之不承，非气之不治耳。
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，更莫复
服。
阳明主津液所生病，故阳明病多汗。多汗是胃燥之因，便硬是谵语之根。一服谵语止，大便虽未利，而胃
濡可知矣。
下利谵语者，有燥屎也，宜小承气汤。
下利是大肠虚，谵语是胃气实。胃实肠虚，宜大黄以濡胃，无庸芒硝以润肠也。
汗出谵语者，以有燥屎在胃中。此为风也，须下之。过经乃可下之，下之若早，语言必乱，表虚里实故也。
下之则愈，宜大承气汤。
首二句是冒头，末二句是总语。言汗出必亡津，谵语因胃实，则汗出谵语，以胃中有燥屎也，宜大承气汤
下之。然汗出谵语有二义，有阳明本病多汗亡津而谵语者，有中风汗出早下而谵语者。如脉滑曰风，其谵语潮
热下之，与小承气汤，不转矢气，勿更与之。如能食曰风，其烦躁心下硬，少与小承气微和之，令小安。非七
日后屎定硬不敢妄下者，以此为风也。七日来行经已尽，阳邪入阴，乃可下之。若不知此义而早下之，表以早
下而虚热不解，里以早下而胃家不实。如十三
日不解，过经下利而谵语，与下后不解，至十余日不大便、日晡潮热、独语如有所见者是也。
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，但硬耳。
初能食，反不能食，胃实可知。若能食而大便硬，是肠实而胃未实，恐本于中风，未可下也。谵语、潮热、
屎有燥硬之辨。
阳明病下之，心中懊 而烦，胃中有燥屎者，可攻之。宜大承气汤。腹微满，初头硬后必溏，不可攻之。
下后心中懊 而烦，栀子豉证。若腹大满不通，是胃中燥屎上攻也。若微满，犹是栀子浓朴汤证。
病患不大便五六日，绕脐痛，烦躁，发作有时者，此有燥屎故也。
发作有时，是日晡潮热之时。二肠附脐，故绕痛，痛则不通矣。
病患小便不利，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。
小便不利，故大便有乍易。津液不得还入胃中，故喘冒不得卧。时有微热，即是潮热。
大下后，六七日不大便，烦不解，腹满痛者，此有燥屎也。所以然者，以本有宿食故也，宜大承气汤。
未病时本有宿食，故虽大下之后，仍能大实，痛随利减也。
脉滑而数者，有宿食也，当下之，宜大承气汤。
数为在府，故滑为有食。数以至数言，是本来面目。疾以体状言，在谵语潮热时见，故为失度。
腹满不减，减不足言，当下之，宜大承气汤。
下后无变证，则非妄下。腹满如故者，下之未尽耳，故当更下之也。
二阳并病，太阳证罢，但发潮热，手足 汗出，大便难
而谵语者，下之则愈，宜大承气汤。
太阳证罢，是全属阳明矣。先揭二阳并病者，见未罢时便有可下之证。今太阳一罢，则种种皆下证矣。
发汗不解，腹满痛者，急下之，宜大承气汤。
表虽不解，邪甚于里，急当救里，里和而表自解矣。
阳明病，发热汗多者，急下之，宜大承气汤。
前条若汗多微发热恶寒者，外未解也，未可与承气，总为脉迟者言耳。若脉大而不恶寒、蒸蒸发热、汗多
亡阳者，当急下以存津液，而勿以潮热为拘也。
伤寒六七日，目中不了了，睛不和，无表里证，大便难，身微热者，此为实也，急下之，宜大承气汤。
伤寒七日不愈，阳邪入阴矣。目不了了，目睛不和，何以故？身微热，是表证已罢，不烦躁，是里证未见，无
表里证也。惟不大便为内实，斯必浊邪上升，阳气闭塞。下之，而浊阴出下窍，清阳走上窍矣。
少阴病，得之二三日，不大便，口燥咽干者，急下之，宜大承气汤。
热淫于内，肾水枯涸，因转属阳明，胃火上炎，故口燥咽干。急下之，火归于坎，津液自升矣。此必有不大
便证，若非本有宿食，何得二三日盒饭急下？
少阴病，自利清水，色纯青，心下必痛，口干舌燥者，急下之，宜大承气汤。
自利而渴者，属少阴。今自利清水，疑其为寒矣，而利清水时，必心下痛，必口燥舌干，是土燥火炎，脾
气不濡，胃气反浓，水去而谷不去，故纯青也。虽曰通因通用，仍是通因塞用。
少阴病六七日，腹胀不大便者，急下之，宜大承气汤。
六七日当解不解因转属阳明，是藏气实而不能入，还之于府也。
急攻之，所谓已入于府者可下也。
三阳惟少阳无承气证。三阴惟少阴有承气证。盖少阳为阳枢，阳
After contracting cold damage, if there is no bowel movement for six or seven days, and the patient does not feel aversion to cold but instead feels aversion to heat, accompanied by headache and body fever, administer Chengqi Tang (Cassia Twig Decoction).
Following the onset of illness, the inability to defecate indicates "Wei Jia Shi" (Excess in the Stomach and Intestines, specifically accumulation of pathogenic heat in the GI tract). By the sixth or seventh day, if the headache and body fever have not resolved, it sufficiently demonstrates severe Yang excess; consequently, the aversion to heat without aversion to cold is also understandable. This represents a combined syndrome of Taiyang (Greater Yang) and Yangming (Yang Brightness). Having passed the typical Yang cycle period (usually seven days) without recovery, one should understand that the pathology of constipation lies in the interior (Li), and one should not rigidly adhere to the presence of exterior symptoms like headache and fever as evidence that the exterior has not yet resolved. It is said: "Yang is excessive, Yin is deficient." Administering sweating methods will lead to death, whereas purging will lead to cure. Must one not recognize this critical point?
If the patient experiences vexation and heat, relief may come with sweating, yet the symptoms may resemble malaria (alternating chills and fever). Fever occurring at dusk (Shi hour, 3-5 PM) belongs to Yangming. If the pulse is solid (Shi), purging is appropriate; administer Chengqi Tang.
Vexation and heat with spontaneous sweating resembles Guizhi Tang Syndrome (Cinnamon Twig Decoction Syndrome); chills and fever resembling malaria resembles Chaihu Syndrome (Bupleurum Decoction Syndrome). However, tidal fever at dusk indicates a Yangming timeframe. With a deep and solid pulse, it is definitively a case suitable for purging; this constitutes the primary syndrome and pulse for Chengqi Tang. This should be cross-referenced with the previous case of "no bowel movement for six or seven days."
In a Taiyang disease, after three days of treatment with sweating methods, if the disease remains unresolved, and there is no headache, neck stiffness, aversion to cold, but instead aversion to heat, and the fever feels like steaming heat (Zheng Zheng Fa Re), the pathogen has entered the Stomach. Tiaowei Chengqi Tang (Regulate the Stomach Cassia Twig Decoction) is the primary formula.
After three days of illness, sweating has already been administered. Since Yang Qi escapes with sweat, the heat should resolve; however, internal heat becomes rampant. This differs from the slight fever (Xi Xi Fa Re) seen in Wind Strike (Zhong Feng). The patient likely had a constitutionally full Stomach and Intestines, and the sweating depleted body fluids, causing a shift to Yangming. Three days is the typical timeframe for Yangming sweating. At this point, Taiyang symptoms have ceased. Although heat persists, the absence of headache, neck stiffness, and aversion to cold, coupled with aversion to heat, indicates heat has entered the Stomach. Harmonizing the Stomach gives rise to the name "Tiaowei" (Regulate the Stomach). The number of days should not be rigidly applied; rather, one must seek understanding through pulse and symptoms.
Sweating leading to aversion to cold indicates deficiency; lack of aversion to cold but presence of aversion to heat indicates excess. One should harmonize the Stomach Qi and administer Tiaowei Chengqi Tang.
Here, "deficiency" and "excess" both refer to the Stomach. After sweating, if healthy Qi is depleted, the Stomach becomes deficient (hence the use of Fuzi and Shaoyao in some interpretations, though standard Tiaowei Chengqi Tang uses Da Huang, Mang Xiao, and Gan Cao); if pathogenic Qi is abundant, the Stomach becomes excess (hence the use of Da Huang and Mang Xiao). The specific use of Gan Cao (Licorice Root) here reflects the intent to harmonize the Stomach. Thus, Tiaowei Chengqi Tang is a harmonizing agent, not a harsh purgative.
If disharmony of Stomach Qi leads to delirious speech (Zhen Yu), administer a small amount of Tiaowei Chengqi Tang.
"Cheng" means to follow or obey. Following [the pathogen's exit] brings harmony. "Administering a small amount" is the method of regulation.
After vomiting following cold damage, if abdominal distension and fullness occur, administer Tiaowei Chengqi Tang.
Indiscriminate vomiting depletes body fluids, leading to Stomach excess and abdominal distension. Post-vomiting upper Jiao deficiency is evident. Although the abdomen is distended, the pathology is in the Stomach, not the chest. One should harmonize Stomach Qi; Zhi Shi (Immature Bitter Orange) and Hou Po (Magnolia Bark) are not indicated.
In Yangming disease, if there is vexation without prior vomiting or purging, Tiaowei Chengqi Tang may be administered.
Yangming disease implies body heat, sweating, no aversion to cold, and aversion to heat. Vexation appearing after vomiting or purging indicates empty pathogenic factors, suitable for Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction). Vexation appearing without prior vomiting or purging indicates Stomach Fire harassing the Heart. Pathogens arriving from the source are excess pathogens. Regulating the Stomach harmonizes the Heart. This is the method of "draining the son when the mother is excess."
In Taiyang disease, after more than ten days, if there is warmth in the epigastrium, desire to vomit, chest pain, loose stools, mild abdominal fullness, and depressed mild vexation, and if extreme vomiting or purging was used previously, administer Tiaowei Chengqi Tang.
Illness persisting beyond the meridian cycle for over ten days indicates the pathogen is no longer in Taiyang. Calling it "Taiyang disease" identifies it as a damaged condition (Huai Bing) originating from Taiyang. Lack of mental vexation but epigastric warmth, and lack of abdominal pain but chest pain, indicate upper Jiao injury from extreme vomiting. The epigastrium is the stomach gate. Epigastric warmth with desire to vomit suggests residual heat at the stomach gate. Mild abdominal fullness with depressed mild vexation suggests the Stomach and Intestines are not yet deficient and dry feces (Zao Shi) exist in the Stomach. Hard stool should be present but is loose, indicating lower Jiao injury from extreme purging. Desire to vomit without success, and need for purgation without relief, all stem from Stomach Qi disharmony. Although stools are loose, Stomach excess persists. A small amount of Tiaowei Chengqi Tang gently harmonizes, allowing the Three Jiao to harmonize.
Cold damage persisting for thirteen days without resolution, with delirium appearing after passing the meridian cycle, is due to heat and requires purgation with decoction. If urination is clear and frequent, stool should be hard, yet diarrhea occurs, and the pulse is harmonious, it indicates the physician used pill-based purgatives, which is incorrect treatment. If self-induced diarrhea occurs, the pulse should be faint; since it is harmonious now, this indicates internal excess. Tiaowei Chengqi Tang is primary.
"Jing" refers to the normal cycle. "Passing the Jing" means exceeding the normal duration, not referring to meridians. Diseases arising from Yang heal in seven days; if healing takes longer, it is because the meridian cycle has completed. Failure to heal in seven days means it does not conform to Yin-Yang numbers, becoming "passing the Jing." It is not that thirteen days of non-resolution defines "passing the Jing." Generally, if the exterior resolves but the patient feels unwell, healing occurs in twelve days. Here, thirteen days of unresolved fever indicates Yang excess. Delirium after passing the Jing confirms Stomach excess. Internal and external heat stems from Yang excess and Yin deficiency. Purging with Chengqi Tang is indicated. However, the physician used pill purgatives, fearing rapid purgation would damage Stomach Qi due to the prolonged illness, but this is not the correct treatment for Yangming passing the Jing. Purgation should not cause diarrhea; current diarrhea suggests suspected Stomach deficiency. Yet persistent fever and delirium rule out deficiency. Generally, diarrhea implies difficult defecation; clear urination implies hard stool. Current clear urination with diarrhea suggests suspected Stomach deficiency, possibly heat-collateral diarrhea or Zheng Sheng (repetitive low-volume speech). Differentiate via pulse: faint pulses indicate Yang loss. If Stomach deficiency causes diarrhea, the pulse should be faint. The current harmonious, non-faint pulse indicates Stomach Qi presence, confirming Stomach excess. Pill purgatives are heavy and slow, affecting the lower Jiao, causing Stomach excess and intestinal deficiency. Regulating the Stomach stops diarrhea.
The previous case mentioned loose stools; this case mentions diarrhea. Both reveal true excess from apparent deficiency.
The above discusses Tiaowei Chengqi Tang syndromes.
In Taiyang disease, if vomiting, purging, or sweating results in mild vexation, frequent urination, and consequent hard stool, Xiao Chengqi Tang (Minor Cassia Twig Decoction) harmonizes and cures.
This is also a Taiyang damaged condition shifting to Yangming. Mild vexation and frequent urination do not typically cause hard stool; hard stool results from fluid depletion due to improper treatment. Xiao Chengqi Tang harmonizes and moistens dryness. This shows Xiao Chengqi Tang is a harmonizing agent, not a harsh purgative.
Two to three days after illness, with a weak pulse, absence of Taiyang or Chaihu symptoms, restlessness, and epigastric hardness: by four to five days, even if the patient can eat, administer a small amount of Xiao Chengqi Tang to gently harmonize and provide slight relief. By the sixth day, administer one sheng of Chengqi Tang. If there is no bowel movement for six or seven days and urination is scanty, even if the patient cannot eat, if the stool is hard at the beginning but loose at the end, it is not yet fully hardened; purging will cause diarrhea. Only when urination is clear and stool is definitely hard should one purge, using Da Chengqi Tang (Major Cassia Twig Decoction).
Two to three days after illness is still within the boundary of the Three Yang. A weak pulse suggests potential Yang deficiency. Absence of Guizhi or Chaihu symptoms places the disease outside the exterior. Restlessness and epigastric hardness indicate Yang pathogen entering Yin, locating in the interior of Yangming. Differentiating Yangming excess/deficiency depends on appetite. If eating is possible by day four or five, there is no Cold in the Stomach, and stool hardness is confirmed. Small amounts of Xiao Chengqi Tang gently harmonize the Stomach, alleviating restlessness. Complete elimination is avoided due to the weak pulse, fearing easy disturbance of stool. Similar to reducing Da Huang and Shaoyao in Taiyin with weak pulses. By day six, another sheng of Xiao Chengqi Tang is given. By day seven, if still no bowel movement, Stomach excess is confirmed. To determine if stool is dry and hard, assess appetite and urination. Ability to eat implies hard stool; inability to eat later implies dry feces. Scanty urination suggests fluids returning to the Stomach, so even if unable to eat, stool is hard initially and loose later. Clear urination implies Stomach excess and definite hard stool, permitting purging. Weak pulse indicates Taiyang Wind Strike. Ability to eat indicates Yangming Wind Strike. The restriction against purging before day seven applies to Wind patterns. Purging must wait until passing the meridian cycle; premature purging causes disordered speech.
In Yangming disease, with a slow pulse, slight sweating, no aversion to cold, heavy body, shortness of breath, abdominal fullness, and wheezing: if tidal fever is present, the exterior is resolving, and interior purging is possible. Continuous sweating on hands and feet indicates hard stool; Da Chengqi Tang is primary. If sweating is profuse with slight fever and aversion to cold, the exterior is unresolved. Without tidal fever, Chengqi Tang is contraindicated. If abdominal fullness and obstruction are severe, Xiao Chengqi Tang may be used to gently harmonize Stomach Qi, avoiding drastic purgation.
A slow pulse precludes immediate purging, suggesting Yang deficiency or Zang involvement. Exterior symptoms must completely resolve, and interior symptoms must be complete before purging. Profuse sweating with slight aversion to cold indicates lingering exterior symptoms (Wind Strike). Even with severe fullness, only gentle harmonization is allowed; drastic purgation must wait until passing the meridian. For Stomach excess, hand/foot sweating is key, and tidal fever is definitive. Limbs are the root of Yang; tidal fever at dusk corresponds to Yangming's ruling time.
In Yangming disease, with tidal fever and hard stool, Da Chengqi Tang may be given; if soft, it is contraindicated. If no bowel movement for six or seven days and dry feces are suspected, test with a small amount of Xiao Chengqi Tang. If gas passes after ingestion, dry feces are present, and purging is allowed. If no gas passes, stool is hard initially and loose later; purging is contraindicated. Purging will cause abdominal fullness and anorexia. Thirst followed by water intake may cause hiccups. Subsequent fever indicates hard, scanty stool; treat with Xiao Chengqi Tang. If no gas passes, absolutely do not purge.
Due to slow/weak pulses, tidal fever alone is insufficient evidence; a test method is established. Purging without dry feces causes Stomach deficiency and blooming, leading to anorexia. Even with tidal fever and hard/scanty stool post-purge, anorexia persists. If no gas passes, even thirst precludes administration, let alone purging. Using Xiao Chengqi Tang as a harmonizer/test reflects caution with Da Chengqi Tang.
In Yangming disease, with delirium and tidal fever, if the pulse is slippery and rapid, Xiao Chengqi Tang is primary. Administer one sheng of Chengqi Tang. If gas passes, administer another sheng. If no gas passes, do not continue. If no bowel movement the next day and the pulse becomes faint and choppy, this indicates interior deficiency, making it difficult to treat; do not administer Chengqi Tang again.
Slippery and rapid pulses indicate retained food. Delirium and tidal fever constitute purging indications. Testing with Xiao Chengqi Tang: no gas passage suggests ease of movement. Next day, no bowel movement suggests Stomach excess, but faint/choppy pulses indicate Yang deficiency and Blood deficiency (interior deficiency). Yang syndrome showing Yin pulse. While Stomach excess usually allows harmonizing/purging with slow/weak pulses, a shift from Yang to Yin pulse prohibits both purging and harmonizing. Slippery pulse indicates life; choppy pulse indicates death, hence difficulty. Slippery pulses vary; weak/slippery indicates Stomach Qi. Rapid/slippery indicates loss of normalcy, "Extreme Yang transforms to Yin." Zhang Zhongjing prescribes small doses of Xiao Chengqi Tang for testing. Using Da Chengqi Tang based solely on delirium/tidal fever would exhaust Yin. This apparent excess reveals true deficiency upon testing. Pulse differentiation requires caution. Honey suppositories may be used for guidance. For severe deficiency, Sini Tang (Frigid Extremities Decoction) restores balance via Yang.
After vomiting/purging in cold damage, if unresolved, with no bowel movement for five to ten days, tidal fever at dusk, no aversion to cold, and solitary speech resembling hallucinations: if severe, the patient may lose recognition, grasp at clothing/bedrails, feel terrified and restless, exhibit slight wheezing and fixed gaze. String-taut pulse indicates survival; choppy pulse indicates death. Mild cases involve only fever and delirium. Da Chengqi Tang is primary. If one dose causes diarrhea, stop subsequent doses.
Damaged conditions have mild and severe forms. Mild cases involve excess pathogen, treated with purging. Stopping after one dose prevents attacking deficiency. Severe cases involve pathogen/healthy Qi struggle; pulse determines excess/deficiency. String-taut pulse indicates excess pathogen (survival); choppy pulse indicates healthy Qi deficiency (death). Solitary speech differs from Zheng Sheng. Tidal fever, no aversion to cold, and constipation are purging indications. Fixed gaze and grasping behaviors occur during dusk fever; calm otherwise, so not immediately fatal. Pulse analysis: short pulse in delirium indicates death. Choppy equals short, indicating Qi disease. String-taut equals long, indicating Qi recovery. Fixed gaze, delirium, and wheezing/fullness indicate death. Here, slight wheezing without fullness indicates Qi failure, not Qi disorder.
In Yangming disease, profuse sweating depletes fluids, drying the Stomach and hardening stool, leading to delirium. Xiao Chengqi Tang is primary. If delirium ceases after one dose, do not continue.
Yangming diseases affect fluids, causing profuse sweating. Sweating causes Stomach dryness; hard stool causes delirium. Cessation of delirium after one dose indicates Stomach moisture, even if stool is not yet loose.
Diarrhea with delirium indicates dry feces; Xiao Chengqi Tang is suitable. Diarrhea indicates large intestine deficiency; delirium indicates Stomach excess. Stomach excess/intestine deficiency requires Da Huang to moisten Stomach, avoiding Mang Xiao to lubricate intestines.
Sweating with delirium indicates dry feces in the Stomach due to Wind. Purging is required after passing the meridian cycle. Premature purging causes disordered speech due to exterior deficiency and interior excess. Cure follows purging with Da Chengqi Tang.
The first two sentences introduce the topic; the last two summarize. Sweating depletes fluids; delirium stems from Stomach excess. Thus, sweating/delirium implies dry feces in Stomach, requiring Da Chengqi Tang. Two meanings exist: Yangming original disease (sweating/fluid loss/delirium) vs. Wind Strike with premature purging (sweating/delirium). Slippery pulse/Wind with delirium/tidal fever uses Xiao Chengqi Tang; no gas passage means stop. Eating ability/Wind with restlessness/epigastric hardness uses small amounts of Xiao Chengqi Tang. Restriction against purging before day seven applies to Wind. Seven days completes the meridian cycle; Yang pathogen enters Yin, permitting purging. Premature purging fails to resolve exterior heat or establish interior excess. Examples include thirteen-day unresolved illness with diarrhea/delirium, or post-purge unresolved illness with ten-plus days of constipation/dusk fever/hallucinations.
In Yangming disease, with delirium, tidal fever, and inability to eat, there are likely five or six pieces of dry feces in the Stomach; Da Chengqi Tang is suitable. If able to eat, only stool hardness exists.
Initial ability to eat turning to inability indicates Stomach excess. Ability to eat with hard stool indicates intestine excess/Stomach non-excess, possibly Wind Strike, precluding purging. Differentiation exists between delirium, tidal fever, and dry/hard stool.
Post-purge Yangming disease with ao nan (restless discomfort) and vexation, if dry feces are in the Stomach, purging is allowed using Da Chengqi Tang. If abdominal fullness is mild and stool is hard initially/loose later, purging is contraindicated.
Post-purge ao nan/vexation indicates Zhizi Chi Tang syndrome. Severe abdominal fullness/obstruction indicates dry feces attacking upward. Mild fullness indicates Zhizi Houpo Tang syndrome.
Patient with no bowel movement for five to six days, periumbilical pain, vexation, and periodic exacerbation has dry feces. Periodic exacerbation coincides with dusk tidal fever. Large and small intestines attach to the navel; pain indicates obstruction.
Patient with difficult urination, alternating hard/loose stool, occasional slight fever, wheezing, dizziness, and inability to lie down has dry feces; Da Chengqi Tang is suitable. Difficult urination causes alternating stool. Fluids not returning to Stomach cause wheezing/dizziness/insomnia. Occasional slight fever is tidal fever.
After drastic purging, if six to seven days pass with no bowel movement, unresolved vexation, and abdominal fullness/pain, dry feces are present. This is due to pre-existing retained food; Da Chengqi Tang is suitable. Pre-existing retained food allows for significant excess even after purging; pain decreases with evacuation.
Slippery and rapid pulses indicate retained food; purging is indicated with Da Chengqi Tang. Rapid pulse indicates Fu organ involvement; slippery indicates food retention. Rapid refers to rate (normal state); rapid/fast refers to quality (abnormal in delirium/tidal fever contexts).
Abdominal fullness that does not decrease, or decreases insignificantly, requires purging with Da Chengqi Tang. No change post-purge indicates incomplete purgation, necessitating further purging.
In combined Taiyang/Yangming disease, once Taiyang symptoms cease, presenting only with tidal fever, hand/foot sweating, difficult defecation, and delirium, purging cures; Da Chengqi Tang is suitable. Cessation of Taiyang symptoms means full Yangming involvement. Highlighting combined disease shows purging indications existed before cessation. Once Taiyang ceases, all symptoms become purging indications.
Unresolved sweating with abdominal fullness/pain requires urgent purging with Da Chengqi Tang. Despite unresolved exterior, interior pathogen is severe; rescue interior first, then exterior resolves spontaneously.
Yangming disease with fever and profuse sweating requires urgent purging with Da Chengqi Tang. Previous mention of profuse sweating with slight fever/aversion to cold referred to slow pulses and unresolved exterior. Here, large pulse, no aversion to cold, steaming heat, and profuse sweating depleting Yang require urgent purging to preserve fluids, not relying solely on tidal fever.
Cold damage for six to seven days with blurred vision and immobile eyes, no exterior/interior symptoms, difficult defecation, and slight body heat indicates excess; urgent purging with Da Chengqi Tang is required. Unresolved cold damage after seven days implies Yang pathogen entering Yin. Blurred vision/immobile eyes result from interior excess blocking clear Yang. Constipation indicates interior excess, causing turbid pathogen to ascend and block Yang. Purging allows turbid Yin to exit lower orifices and clear Yang to ascend upper orifices.
Shaoyin disease for two to three days with constipation, dry mouth/throat requires urgent purging with Da Chengqi Tang. Heat invading interior depletes Kidney Water, shifting to Yangming. Stomach Fire flares upward, causing dry mouth/throat. Urgent purging returns Fire to Kan (Water), restoring fluids. Constipation is necessary; without pre-existing retained food, urgent purging at day two/three is unwarranted.
Shaoyin disease with spontaneous watery diarrhea, pure green color, epigastric pain, dry mouth/tongue requires urgent purging with Da Chengqi Tang. Diarrhea with thirst belongs to Shaoyin. Watery diarrhea suggests Cold, but accompanying epigastric pain and dry mouth/tongue indicate Earth Dryness/Fire Flaring, Spleen Qi failure to moisten, and Stomach Qi thickening. Water leaves, grain remains, causing green color. Though termed "treat diarrhea with draining," it effectively treats diarrhea with astringing/clearing excess.
Shaoyin disease for six to seven days with abdominal distension and constipation requires urgent purging with Da Chengqi Tang. Failure to resolve by day six/seven shifts to Yangming. Zang excess prevents entry, transferring to Fu. Urgent attack follows the principle: "Entered Fu, may purge."
Among Three Yang, only Shaoyang lacks Chengqi indications. Among Three Yin, only Shaoyin has Chengqi indications. Shaoyang is the Yang pivot...