夫病阳多者热，下之则□。
【注】
阳病里热多者，宜乎下；表热多者，宜乎汗。若表里热多，当两解也。若单下之，表
不解则里虚，表热内陷，因作□也。
【集注】
张璐曰：阳热证多，即有阳明证见，亦属经证，不可下也。不当下而误下之，则阳邪
乘虚内陷，不作结胸，则为痞□也。
程应旄曰：阳病，谓表里热俱多，下之则胃中水竭。其□也，非转属阳明之□也。
@@@
无阳，阴强大，便□者，下之必清谷腹满。
【注】
亡阳阴盛，燥而无热，虽大便□者，此乃不大便无所苦之□也，下之则中寒犹盛，故
必利清谷腹满矣。
【集注】
成无己曰：无阳者，亡津液也。阴多者，寒多也。大便□，则为阴结。下之虚胃，阴
寒内甚，故清谷腹满。
方有执曰：阴，以寒言。强，犹言多也。清谷，阴不能化也。腹满阴寒，凝滞而内胀
也。
@@@
伤寒发热。头痛，微汗出，发汗则不识人，熏之则喘，不得小便，心腹满；下之则短
气，小便难，头痛背强；加温针则衄。
【注】
伤寒发热，头痛背强，微汗出，若不恶寒，非温病即邪传阳明也。若误发汗，不成风
温，外热如灼，必成阳明，热甚神昏不识人也。以火熏、温针劫之，火气入里，壅塞
于胸则喘，于腹则满也。火伤卫分津液，则不得小便，火伤荣分血脉，则必作衄也。
若下之，则中气伤，故气短；津液伤，故小便难也。
【集注】
程应旄曰：此证近于温，有热无寒，汗下温针，均在所禁也。
@@@
下利脉大者，虚也，以强下之故也。设脉浮革，因尔肠鸣者，属当归四逆汤。
【注】
下利脉大，里虚也，以其不当下而强下之故也。设脉浮革者，谓脉浮大，按之空虚，
表急里虚，因尔肠鸣，属当归四逆汤，和其表而温其里也。
【集注】
成无己曰：浮为虚，革为寒，寒虚相搏，则肠鸣，与当归四逆汤。
音切
漓林知切 嘶先齐切 萎于危切 怅丑亮切 怏于亮切 勃蒲没切 嘤于更切 囓鱼
结切 握乙角切
Where the disease is characterized by an excess of Yang, there is heat; if purgation is applied, it leads to [missing character].
[Annotation]
In Yang diseases where interior heat predominates, purgation is appropriate; where exterior heat predominates, diaphoresis (sweating) is appropriate. If both exterior and interior heat are excessive, a simultaneous resolution of both exterior and interior is indicated. If purgation is used exclusively, the exterior pathogen remains unresolved while the interior becomes deficient, causing exterior heat to sink inward, thereby resulting in [missing character].
[Collected Notes]
Zhang Lu stated: When Yang-heat syndromes are predominant, even if Yangming symptoms appear, they still belong to the meridian stage and should not be purged. If purgation is mistakenly applied when inappropriate, the Yang pathogen sinks inward taking advantage of the deficiency. It will either form Jie Xiong (Chest Binding) or Pi [missing character] (Fullness/Blockage).
Cheng Yingmao stated: "Yang disease" refers to conditions where both exterior and interior heat are excessive. Purgation depletes the fluids in the stomach. The resulting [missing character] is not a transformation into Yangming [missing character].
@@@
In the absence of Yang, with Yin cold being strong, and hard [missing character] stools, purgation will inevitably lead to diarrhea of undigested food and abdominal fullness.
[Annotation]
Loss of Yang and excess Yin-cold manifest as dryness without heat. Although the stool may be hard [missing character], this constitutes a type of [missing character] where constipation exists without discomfort. If purgation is applied, the middle-jiao cold remains severe, thus inevitably causing diarrhea of clear, uncooked grains and abdominal fullness.
[Collected Notes]
Cheng Wuji stated: "Absence of Yang" refers to the depletion of body fluids. "Excess Yin" refers to an abundance of cold. Hard [missing character] stools indicate Yin-Jie (Yin Constipation). Purgation weakens the Stomach Qi, allowing Yin-cold to become severe internally, leading to diarrhea of clear grains and abdominal fullness.
Fang Youzhi stated: "Yin" refers to cold. "Strong" means abundant. "Clear grains" refers to the inability of Yin-cold to transform and digest food. Abdominal fullness results from Yin-cold stagnation causing internal distension.
@@@
In Cold Damage (Shanghan), presenting with fever, headache, and slight sweating: forcing diaphoresis leads to confusion and inability to recognize people; applying moxibustion or fire therapy causes asthma/dyspnea, inability to urinate, and fullness of the heart and abdomen; purgation leads to shortness of breath, difficulty urinating, headache, and stiffness of the back; adding warm needle therapy causes epistaxis (nosebleed).
[Annotation]
Cold Damage presenting with fever, headache, and back stiffness, with slight sweating and no aversion to cold, indicates either Warm Disease (Wenbing) or transmission of pathogenic factors to the Yangming channel. Mistakenly inducing diaphoresis may result in Wind-Warmth, with external heat burning like fire, inevitably transforming into Yangming disease. Extreme heat causes mental confusion and inability to recognize persons. Using fire therapy or warm needles to force sweating allows fire qi to enter the interior, obstructing the chest causing dyspnea, and obstructing the abdomen causing fullness. Fire damage to the Wei (Defensive) level and body fluids prevents urination; fire damage to the Ying (Nutritive) level and blood vessels causes epistaxis.
If purgation is applied, the Middle Qi is injured, causing shortness of breath; body fluids are damaged, causing difficulty urinating.
[Collected Notes]
Cheng Yingmao stated: This syndrome resembles Warm Disease, having heat but no cold. Diaphoresis, purgation, and warm needle therapy are all contraindicated.
@@@
Diarrhea accompanied by a large pulse indicates deficiency, caused by forced purgation. If the pulse is floating and wiry (Ge pulse), accompanied by borborygmus (bowel sounds), it belongs to the Danggui Sini Decoction pattern.
[Annotation]
Diarrhea with a large pulse indicates interior deficiency, caused by forced purgation when it was not indicated. A floating and wiry (Ge) pulse implies a pulse that is floating and large but empty upon pressure, indicating exterior urgency and interior deficiency. Consequently, borborygmus occurs. This pattern belongs to Danggui Sini Decoction, which harmonizes the exterior and warms the interior.
[Collected Notes]
Cheng Wuji stated: Floating indicates deficiency; Ge (wiry/hollow) indicates cold. The combination of cold and deficiency leads to borborygmus. Treat with Danggui Sini Decoction.
Phonetic Notation
Li: Lin-zhi cut
Si: Xian-qi cut
Wei: Yu-wei cut
Chang: Chou-liang cut
Yang: Yu-liang cut
Bo: Pu-mo cut
Ying: Yu-geng cut
Nie: Yu-jie cut
Wo: Yi-jue cut