蜜七合。一味内铜器中。微火煎之。稍凝似饴状。搅之。勿令焦着。欲可丸。并手
捻作挺。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。
大猪胆一枚。泻汁。和醋少许。以灌谷道中。如一食顷。当大便出。
阳明病。脉迟。汗出多。微恶寒者。表未解也。可发汗。宜桂枝汤。
阳明病。脉迟。汗出多。当责邪在里。以微恶寒。知表未解。与桂枝汤和表。
阳明病。脉浮。无汗而喘者。发汗则愈。宜麻黄汤。
阳明伤寒。表实脉浮。无汗而喘也。与麻黄汤以发汗。
阳明病。发热。汗出。此为热越。不能发黄也。但头汗出。身无汗。剂颈而还。小
便不利。渴引水浆者。此为瘀热在里。身必发黄。茵陈汤主之。
但头汗出。身无汗。剂头而还者。热不得越也。小便不利。渴饮水浆者。热甚于胃。
津液内竭也。胃为土而色黄。胃为热蒸。则色夺于外。必发黄也。与茵陈汤。逐热退黄。
王三阳云。此与头汗出。小便不通难治条。当细辨之。
茵陈蒿（六两味苦微寒） 栀子（十四枚擘苦寒） 大黄（二两去皮苦寒）
上三味。以水一斗。先煮茵陈。减六升。内二味。煮取三升。去滓。分温三服。小
盒饭利。尿如皂角汁状。色正赤。一宿复减。黄从小便去也。
小热之气。凉以和之。大热之气。寒以取之。茵陈栀子之苦寒。以逐胃燥。宜下必
以苦。宜补必以酸。大黄之苦寒。以下瘀热。
阳明证。其人喜忘者。必有蓄血。所以然者。本有久瘀血。故令喜忘。屎虽硬。大
便反易。其色必黑。宜抵当汤下之。
内经曰。血并于下。乱而喜忘。此下本有久瘀血。所以喜忘也。津液少。大便硬。以
蓄血在内。屎虽硬。大便反易。其色黑也。与抵当汤。以下瘀血。
王海藏云。初便褐色者重。再便。深褐色者愈重。三便。黑色者为尤重。色变者。以
其火燥也。如羊血在日色中。须臾变褐色。久则渐变而为黑色。即此意也。
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。
下后心中懊 而烦者。虚烦也。当与栀子豉汤。若胃中有燥屎者。非虚烦也。可与
大承气汤下之。其腹微满。初硬后溏。是无燥屎。此热不在胃而在上也。故不可攻。
病患不大便。五六日。绕脐痛。烦躁。发作有时者。此有燥屎。故使不大便也。
不大便五六日者。则大便必结为燥屎也。胃中燥实。气不得下通。故绕脐痛。烦躁。
发作有时也。
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。脉浮
虚者宜发汗。下之与大承气汤。发汗宜桂枝汤。
虽得阳明证。未可便为里实。审看脉候。以别内外。其脉实者。热已入腑为实。可
与大承气汤下之。其脉浮虚者。是热未入腑。犹在表也。可与桂枝汤。发汗则愈。
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。本有宿食故也。宜大承
气汤。
大下之后。则胃弱。不能消谷。至六七日不大便。则宿食已结不消。故使烦热不解
而腹满痛。是知有燥屎也。与大承气汤以下除之。
娄氏云。此大下之后。又下之也。反用大承气者。以津液渐竭故也。须审虚实用之。
不如栀子枳实稳当。
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。
小便利。则大便硬。此以有燥屎。故小便不利。而大便乍难乍易。胃热者。发热。喘
冒无时。及嗜卧也。此燥屎在胃。故时有微热喘冒不得卧也。与大承气汤。以下燥屎。
王三阳云。此证不宜妄动。必以手按之。大便有硬块。喘冒不能卧。方可攻之。何
也。乍难乍易故也。
食谷欲呕者。属阳明也。吴茱萸汤主之。得汤反剧者。属上焦也。
上焦主内。胃为之市。食谷欲呕者。胃不受也。与吴茱萸汤。以温胃气。得汤反剧
者。上焦不内也。以治上焦法治之。
[Melted Honey Suppository Formula]
Take seven he of honey. Place it in a copper vessel. Simmer over low heat until it slightly thickens and resembles maltose syrup, stirring constantly to prevent burning or sticking. When it can be molded into pills, while still hot, roll it by hand into suppositories. The shape should have a pointed head, be as thick as a finger, and about two cun long. It must be shaped while hot; otherwise, it will harden. Insert into the anus and hold tightly with the hand. Remove only when there is an urge to defecate.
[Pig Bile Formula]
Take one large pig gallbladder, extract the bile. Mix with a small amount of vinegar. Enema into the anus. After approximately the time it takes to eat one meal, stool should be expelled.
Yangming disease, with a slow pulse, profuse sweating, and slight aversion to cold, indicates that the exterior syndrome has not yet resolved. Sweating therapy may be employed; Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
In Yangming disease, with a slow pulse and profuse sweating, pathology should be sought in the interior. However, due to the presence of slight aversion to cold, it is known that the exterior syndrome remains unresolved. Administer Guizhi Tang to harmonize the exterior.
In Yangming disease, with a floating pulse, absence of sweating, and wheezing, recovery follows sweating therapy; Mahuang Tang (Ephedra Decoction) is appropriate.
Yangming cold damage, presenting as exterior excess with a floating pulse, no sweating, and wheezing. Administer Mahuang Tang to induce sweating and release the exterior.
In Yangming disease, fever and sweating indicate that heat is venting outward, so jaundice will not occur. However, if there is sweating only on the head, no sweating on the body, limited to the neck, accompanied by dysuria and thirst for fluids, this indicates stagnant heat trapped in the interior, leading to jaundice. Yinchen Hao Tang (Artemisiae Scopariae Decoction) is the primary treatment.
Sweating only on the head, no sweating on the body, limited to the neck, indicates that heat cannot vent. Dysuria and thirst for fluids indicate excessive heat in the Stomach and depletion of body fluids internally. The Stomach belongs to Earth and its color is yellow. When steamed by heat, the yellow color manifests externally, resulting in jaundice. Administer Yinchen Hao Tang to purge heat and resolve jaundice.
Wang Sanyang stated: This condition must be carefully distinguished from the clause regarding "head sweating with difficult urination."
Yin Chen Hao (Six liang, bitter, slightly cold) Zhi Zi (Fourteen seeds, broken open, bitter, cold) Da Huang (Two liang, peeled, bitter, cold)
These three ingredients are boiled in ten dou of water. First, boil Yin Chen Hao until the volume reduces by six sheng. Then add the other two ingredients and boil to obtain three sheng of decoction. Strain and divide into three warm doses. Urine will become copious and dark red like soapberry juice. After one night, urine volume decreases. The yellow pigment is eliminated via urination.
Mild pathogenic factors are harmonized with cool-natured herbs. Severe pathogenic factors are purged with cold-natured herbs. The bitter-cold nature of Yin Chen Hao and Zhi Zi clears stomach dryness. Purging requires bitter flavors. Tonifying requires sour flavors. The bitter-cold nature of Da Huang purges stagnant heat.
In Yangming syndrome, if the patient suffers from forgetfulness, blood stasis is present. This is because pre-existing old blood stasis causes forgetfulness. Although stool is hard, defecation is surprisingly easy, and the stool color is necessarily black. Didang Tang (Didang Decoction) is appropriate to purge.
The *Neijing* states: "Blood pooling below causes confusion and forgetfulness." This is due to pre-existing old blood stasis below. With depleted fluids and hard stool, but with internal blood stasis, defecation is easy despite hardness, and the color is black. Administer Didang Tang to purge blood stasis.
Wang Haizang stated: Initial brown stool indicates severe condition; deep brown stool upon second passage indicates greater severity; black stool upon third passage indicates extreme severity. Color changes result from fire-dryness. Like sheep blood exposed to sunlight, turning brown quickly and then black over time, this illustrates the principle.
Following purgation in Yangming disease, if there is mental restlessness and epigastric dry feces, purgation is indicated. If there is mild abdominal fullness with hard initial stool followed by loose stool, purgation is contraindicated. If dry feces are present, Da Chengqi Tang (Major Order the Qi Decoction) is appropriate.
Post-purgation mental restlessness indicates empty irritability (*Xu Fan*), treated with Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction). If dry feces exist in the Stomach, it is not empty irritability; Da Chengqi Tang may be used to purge. Mild abdominal fullness with hard initial and loose final stool indicates no dry feces; heat is above, not in the Stomach, so purgation is contraindicated.
If a patient has constipation for five to six days, periumbilical pain, irritability, and periodic exacerbations, dry feces are present, causing constipation. Constipation for five to six days leads to hardened dry feces. Dry-heat excess in the Stomach obstructs qi descent, causing periumbilical pain, irritability, and periodic symptoms.
If a patient has irritability and heat, relief follows sweating. If symptoms resemble malaria with afternoon fever (around Shen hour), it belongs to Yangming. A solid pulse indicates suitability for purgation; a floating-deficient pulse indicates suitability for sweating. Use Da Chengqi Tang for purgation; use Guizhi Tang for sweating.
Even with Yangming signs, interior excess cannot be assumed immediately. Examine the pulse to distinguish between exterior and interior. A solid pulse indicates heat has entered the Fu organs becoming excess; Da Chengqi Tang may be used to purge. A floating-deficient pulse indicates heat remains in the exterior; Guizhi Tang may be used to sweat, leading to recovery.
After strong purgation, if constipation persists for six to seven days with unresolved irritability and abdominal fullness/pain, dry feces are present. This is due to retained food. Da Chengqi Tang is appropriate.
After strong purgation, Stomach qi is weak and unable to digest food. By day six or seven, retained food congeals, causing unresolved irritability and abdominal fullness/pain, indicating dry feces. Da Chengqi Tang is used to purge and eliminate them.
Lou Shi stated: This involves purging again after strong purgation. Da Chengqi Tang is used because fluids are gradually depleted. One must assess deficiency and excess. Zhizi and Zhi Shi San is safer.
If a patient has dysuria, alternating difficulty and ease in defecation, occasional slight fever, wheezing, dizziness, and inability to lie down, dry feces are present. Da Chengqi Tang is appropriate.
Normally, free urination leads to hard stool. Here, due to dry feces, urination is restricted, and defecation alternates. Stomach heat causes continuous fever, wheezing, dizziness, and somnolence. Here, dry feces in the Stomach cause intermittent slight fever, wheezing, dizziness, and inability to lie down. Da Chengqi Tang is used to purge dry feces.
Wang Sanyang stated: This condition should not be treated recklessly. Palpate the abdomen; if hard fecal masses are felt, along with wheezing, dizziness, and inability to lie down, purgation is justified. This is due to the alternating nature of defecation.
Food intake triggering vomiting belongs to Yangming. Wuzhuyu Tang (Evodia Decoction) is the primary treatment. If symptoms worsen after taking the decoction, the pathology lies in the Upper Jiao.
The Upper Jiao governs reception; the Stomach is like a market. Vomiting after eating indicates the Stomach rejects food. Wuzhuyu Tang warms Stomach qi. If symptoms worsen after administration, the Upper Jiao fails to receive; treat according to Upper Jiao protocols.