治有患心下硬痛。下利纯清水。谵语。发渴。身热。庸医不识此证。但见下利。便呼为漏底伤寒。而用热药止之。
就如抱薪救火。误人死者多矣。殊不知此因热邪传里。胃中燥屎结实。此利非内寒而利。乃日逐自饮汤药而利也。直急
下之。名曰结热利证。身有热者。宜用此方。
大黄 芒硝 枳实 浓朴 甘草 人参 当归 年老气血虚者。去芒硝。
水二钟。姜三片。枣子二枚。煎之后再加桔梗。一沸。热服为度。
琥按上方。即前三一承气汤中。加人参当归也。以病患气血虚。故加此二味药。方后再加桔梗者。以其能引大黄
等药。上至胸中至高之分而成功。此洁古法也。虽然。愚曾细评此方。为不可用之剂。及见今医用之。而病患无一效者。
何也。夫人身之中。一阴阳耳。阴阳之分。一气血耳病热之人。皆阳有余。而阴不足。乃知其气。必实。其血必虚。所
以病机气宜中。有当归承气汤方者。用之以补血而益阴也。若加人参。则徒助有余之阳气。而邪热愈盛。故少则无济于
病。多则必致杀人。问或有用之而效者。必参少而诸泻药之力也。俗医不晓此义。至有用此汤。而人参加至一二两者。
此正所云抱薪投火。误人于必死也。
或问气虚人。岂无患热病者。余答云。气虚者。阳虚也。阳虚之人。多病中寒。其病伤寒者。皆精血少而水虚。是
为阴虚。故不胜伤寒之邪热耳。据上主疗云。谵语发渴身热。胃中燥屎结实。此数者。皆阳有余而阴不足之证。陶氏犹
以为气虚而用人参。抑何不明理。而自相矛盾欤。
（琥）总按上古今诸名家。治阳明病方论。虽与仲景之法。互相变通。然亦不可执用。须临证。参合加减施之。则
庶乎其不瘥矣。
To treat patients presenting with hardness and pain in the epigastrium, diarrhea of pure clear water, delirium (delirious speech), thirst, and fever. Quack doctors fail to recognize this syndrome; seeing only the diarrhea, they call it "Leaking Bottom Taiyang Disease" (Lou Di Shang Han) and use hot-natured drugs to stop the diarrhea.
This is like carrying firewood to save a fire; many have been misled to death by such errors. They do not realize that this condition arises from heat pathogens transmitting inward, resulting in dry feces impaction in the stomach. This diarrhea is not caused by interior cold but is induced by the daily administration of decoctions. Immediate purgation is required, termed "Heat-Binding Diarrhea Syndrome" (Jie Re Li Zheng). If there is fever, this formula is suitable.
Rhubarb Radix et Rhizoma (Dahuang, 大黄), Mirabilite (Mangxiao, 芒硝), Immature Bitter Orange Fructus (Zhishi, 枳实), Magnolia Bark Cortex Magnoliae Officinalis (Houpo, 厚朴), Licorice Root Radix Glycyrrhizae (Gancao, 甘草), Ginseng Radix et Rhizoma (Renshen, 人参), Angelica Sinensis Radix (Danggui, 当归). For elderly patients with Qi and Blood deficiency, remove Mirabilite.
Use two zhong of water, three slices of ginger, and two jujubes. Decoct, then add Platycodon Root Radix Platycodi (Jiegeng, 桔梗), boil once more, and take warm.
Hu notes: The above formula is essentially the San Yi Cheng Qi Tang (Three-One Purgative Decoction) with the addition of Ginseng Radix et Rhizoma (Renshen, 人参) and Angelica Sinensis Radix (Danggui, 当归). Because the patient has Qi and Blood deficiency, these two herbs are added. The reason for adding Platycodon Root Radix Platycodi (Jiegeng, 桔梗) later in the prescription is that it guides Rhubarb Radix et Rhizoma (Dahuang, 大黄) and other drugs upward to the highest part of the chest to achieve efficacy; this is the method of Zhang Jiegu (Zhang Congzheng). Although so, I have carefully evaluated this formula and consider it unusable. Furthermore, observing contemporary physicians using it, no patient has shown efficacy. Why? Within the human body, there is merely Yin and Yang. The distinction between Yin and Yang lies in Qi and Blood. Patients with heat diseases possess excess Yang and deficient Yin, implying that their Qi must be excess and their Blood must be deficient. Therefore, in *Bing Ji Qi Yi* (Pathogenesis and Qi Suitability), there is a formula called Dang Gui Cheng Qi Tang (Angelica Sinensis Radix Purgative Decoction), used to tonify Blood and benefit Yin. If Ginseng Radix et Rhizoma (Renshen, 人参) is added, it vainly assists the excess Yang Qi, causing the pathogenic heat to flourish further. Thus, a small dose helps nothing, while a large dose inevitably causes death. Perhaps some cases show efficacy; this must be because the Ginseng Radix et Rhizoma (Renshen, 人参) dose was small, and the power of the other purgative drugs took effect. Vulgar doctors do not understand this principle, sometimes adding up to one or two liang of Ginseng Radix et Rhizoma (Renshen, 人参) to this decoction. This is exactly what is meant by "carrying firewood to throw into the fire," leading people to inevitable death.
One asks: Do those with Qi deficiency never suffer from heat diseases? I reply: Qi deficiency is Yang deficiency. Those with Yang deficiency often suffer from Interior Cold (Zhong Han). Those among them who contract Shang Han disease do so because their essence and blood are scant and fluids are deficient, constituting Yin deficiency; thus, they cannot withstand the pathogenic heat of Shang Han. According to the aforementioned indications—delirium, thirst, fever, and dry feces impaction in the stomach—all these are signs of excess Yang and deficient Yin. Tao still considers it Qi deficiency and uses Ginseng Radix et Rhizoma (Renshen, 人参); how ignorant of principles and self-contradictory!
(Hu) General comment on the formulas and discussions of ancient and modern experts treating Yangming Disease: Although they vary flexibly from Zhongjing's methods, they should not be rigidly applied. One must combine clinical presentation and adjust accordingly; only then can errors be avoided.