阳明病，自汗出，若发汗，小便自利者，此为津液内竭，虽□不可攻之，当须自欲大
便，宜蜜煎导而通之。若土瓜根及大猪胆汁，皆可为导。
【注】
此承上条详其义、以明其治也。阳明病，自汗出，或发汗、小便自利者，此为津液内
竭，虽大便□而无满痛之苦，不可攻之，当待津液还胃，自欲大便，燥屎已至直肠，
难出肛门之时，则用蜜煎润窍滋燥，导而利之。或土瓜根宣气通燥；或猪胆汁清热润
燥，皆可为引导法，择而用之可也。
【集注】
成无己曰：津液内竭，肠胃干燥，大便因□，此非结热，故不可攻，宜以润药外治而
导引之。
张璐曰：凡系多汗伤津，及屡经汗下不解，或尺中脉迟弱，元气素虚之人，当攻而不
可攻者，并宜导法。
程应旄曰：小便自利者，津液未还入胃中，津液内竭而□，故自欲大便，但苦不能出
耳。须有此光景时，方可从外导法，渍润其肠，肠润则水流就湿，津液自归还于胃，
故不但大便通，而小便亦从内转矣。
蜜七合，一味纳铜器中，微火煎之，稍凝似饴状，搅之勿令焦者，欲可丸，并手捻作
挺子，令头锐大如指，长二寸许。当热时急作，冷则硬，以内谷道中，以手急抱，欲
大便时乃去之。
『内台方』用蜜五合，煎凝时，加皂角末五钱，蘸捻作挺，以猪胆汁、或油润谷道内
之。
Yangming disease, with spontaneous sweating; if diaphoresis is applied, and urination is free and abundant, this indicates exhaustion of body fluids internally. Although the stool is dry, purgatives should not be used. One should wait for the patient's natural urge to defecate, and then use Honey Suppository (Mijian Dao) to guide the passage of stool. Radix Trichosanthis Kirilowii (Tugua Gen) or bile of a large pig may also be used as guiding agents.
[Annotation]
This passage elaborates on the meaning of the preceding clause to clarify the treatment method. In Yangming disease, with spontaneous sweating, or after diaphoresis and free urination, this signifies exhaustion of internal body fluids. Although the stool is dry, there is no suffering from abdominal fullness and pain, so purgation is contraindicated. One must wait until body fluids return to the Stomach, the natural urge to defecate arises, and the dry feces have reached the rectum but are difficult to pass through the anus. At this time, Honey Suppository (Mijian Dao) is used to moisten the orifice and nourish dryness, guiding the stool out. Alternatively, Radix Trichosanthis Kirilowii (Tugua Gen) can circulate Qi and unblock dryness; or Pig Bile (Zhudan Zhi) can clear heat and moisten dryness. Both can serve as guiding methods, chosen according to the situation.
[Collected Annotations]
Cheng Wuji stated: Exhaustion of internal body fluids leads to dryness of the intestines and stomach, causing the stool to become dry. This is not due to accumulated heat, so purgation is inappropriate. It is suitable to use moistening medicines for external treatment to guide defecation.
Zhang Lu stated: For cases involving excessive sweating damaging body fluids, or those unresolved after repeated diaphoresis and purgation, or in patients with a slow and weak Chi pulse and constitutionally deficient Yuan Qi, where purgation is indicated but cannot be directly applied, guiding methods are appropriate.
Cheng Yingmao stated: Free urination indicates that body fluids have not yet returned to the Stomach. With internal exhaustion of body fluids leading to dryness, the patient has an urge to defecate but suffers from the inability to expel it. Only when this condition presents can external guiding methods be employed to soak and moisten the intestines. Once the intestines are moistened, water flows towards dampness (following the path of least resistance), and body fluids naturally return to the Stomach. Thus, not only will the stool pass, but urination will also transform and recover internally.
Take seven he of honey, place it alone in a copper vessel, and simmer over a low fire until it slightly thickens to a consistency resembling maltose syrup. Stir constantly to prevent burning. When it cools enough to be molded, shape it by hand into suppositories, with one end pointed and thick like a finger, approximately two cun long. Shape them while hot, as they harden when cold. Insert into the anus, hold the buttocks tightly with hands, and remove only when the urge to defecate arises.
The Neitai Fang uses five he of honey, adding five qian of powdered Gleditsia Sinensis Fruit (Zaojiao) when it thickens. Dip and mold into suppositories, lubricating the anus with Pig Bile (Zhudan Zhi) or oil before insertion.