胃中无燥屎，但肠间少硬尔，止初头硬，后必溏，攻之则虚其胃气，致腹胀满不能食也。胃中干燥，
则欲饮水，水入胃中，虚寒相搏，气逆则哕。其后却发热者，则热气乘虚还复聚于胃中，胃燥得热，必大便
复硬，而少与小承气汤，微利与和之，故以重云不转失气，不可攻内，慎之至也。
夫实则谵语，虚则郑声。郑声（赵本有“者”字）重语也。
《内经》曰∶邪气盛则实，精气夺则虚。谵语由邪气盛，而神识昏也；郑声，由精气夺而声不全也。谵
语者，言语不次也；郑声者，郑音不正也。《论语》云∶恶郑声之乱雅乐。又曰∶放郑声，远佞人。郑声淫，
佞人殆。言郑声不正也。今新瘥气虚，人声转者，是所谓重语者也。若声重亦声转之。
直视谵语，喘满者死。下利者亦死。
直视谵语，邪胜也。喘满为气上脱；下利为气下脱，是皆主死。
发汗多，若重发汗者，亡其阳，谵语脉短者死；脉自和者不死。
亡阳胃燥，谵语者脉短，津液已绝，不可复治；脉自和，为正气未衰而犹可生也。
伤寒若吐、若下后，不解，不大便五六日，上至十余日，日晡所发潮热，不恶寒，独语如见鬼状。若剧
者，发则不识人，循衣摸床，惕而不安，（赵本注∶“一云∶顺衣妄撮，怵惕不安”）微喘直视，脉弦者生，
涩者死，微者但发热谵语者，大承气汤主之。若一服利，（赵本有“则”字）止后服。
若吐、若下，皆伤胃气，不大便五六日上至十余日者，亡津液，胃气虚，邪热内结也。阳明王于申酉戌，
日晡所发潮热者，阳明热甚也；不恶寒者，表证罢也。独语如见鬼状者，阳明内实也，以为热气有余。若剧者，
是热气甚大也，热大甚于内，昏冒正气，使不识人，至于循衣摸床，惕而不安，微喘直视。伤寒阳胜而阴绝
者死，阴胜而阳绝者死。热剧者，为阳胜。脉弦为阴有余，涩为阴不足。阳热虽剧，脉弦，知阴未绝而犹可生；
脉涩则绝阴，（医统本作“阴绝”）故不可治。其邪热微而未至于剧者，但发热谵语，可与大承气汤，以下
胃中热。经曰∶凡服下药，中病即止，不必尽剂。此以热未剧，故云若一服利，则止后服。
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，（赵本有
“者”字）更莫复服。
亡津液胃燥，大便硬而谵语，虽无大热内结，亦须与小承气汤和其胃气。得一服谵语止，则胃燥以润，更
莫复与承气
汤，以本无实热故也。
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，腹中转失（赵本无“失”字）气者，
更服一升；若不转失气，（赵本作“转气者”）勿更与之。明日（赵本有“又”字）不大便，脉反微涩者，里
虚也，为难治，不可更与承气汤也。
阳明病谵语，发潮热，若脉沉实者，内实者也，则可下；若脉滑疾，为里热未实，则未可下，先与小承气
汤和之。汤入腹中转失气者，中有燥屎，可更与小承气汤一升以除之；若不转失气者，是无燥屎，不可更与
小承气汤。至明日邪气传时，脉得沉实紧牢之类，是里实也；反得微涩者，里气大虚也。若大便利后，脉微
涩者，止为里虚而犹可，此不曾大便，脉反微涩，是正气内衰，为邪气所胜，故云难治。
阳明病，谵语有潮热，反不能食者，胃中必有燥屎五六枚也。若能食者，但硬耳，宜大承气汤下之。
谵语潮热为胃热，当消谷引食；反不能食者，胃中有燥屎，而胃中实也。若能食者，胃中虚热，虽硬不
得为有燥屎。杂病虚为不欲食，实为欲食；伤寒则胃实热甚者，不能食，胃中虚热甚者能食，与杂病为异也。（
医统本有“与”字）大承气汤以下燥屎，逐结热。
阳明病，下血谵诸者，此为热入血室；但头汗出者，刺期门，随其实而泻（赵本作“写”字）之， 然
汗出则愈。
阳明病热入血室，迫血下行，使下血谵语。阳明病法多汗，以夺血者无汗，故但头汗出也。刺期门以
散血室之热，随其实而泻之，以除阳明之邪热，散邪除热，荣卫得通，津液得复， 然汗出而解。
汗（赵本注∶“一作卧”）出谵语者，以有燥屎在胃中，此为风也，须下之，（赵本作“者”）过经乃
可下之。下之若早，语言必乱，以表虚里实故也。下之则（赵本无“则”字）愈，宜大承气汤。
胃中有燥屎则谵语，以汗出为表未罢，故云风也。燥屎在胃则当下，以表未和则未可下，须过太阳经，
无表证，乃可下之。若下之早，燥屎虽除，则表邪乘虚复陷于里，为表虚里实，
胃虚热甚，语言必乱。与大承气汤，却下胃中邪热则止。
伤寒四五日，脉沉而喘满。沉为在里，而反发其汗，津液越出，大便为难，表虚里实，久则谵语。
邪气入内之时，得脉沉而喘满，里证具也，则当下之；反发其汗，令津液越出，胃中干燥，大便必难，
久则屎燥胃实，必发谵语。
三阳合病，腹满身重，难以转侧，口不仁而（赵本无“而”字）面垢，（赵本注∶“又作枯，一云向经”）
谵语遗尿。发汗则谵语，下之则额上生汗，手足逆冷。若自汗出者，白虎
汤主之。（赵本有“白虎汤方”详见卷四）
腹满身重，难以反侧，口不仁谵语者，阳明也。《针经》曰∶少阳病甚则面微尘。此面垢者，少阳也；
遗尿者，太阳也。三者以阳明证多，故出阳明篇中。三阳合病，为表里有邪，若发汗攻表，则燥热益甚，必愈
谵语；若下之攻里，表热乘虚内陷，必额上汗出，手足逆冷；其自汗出者，三阳经热甚也。《内经》
曰∶热则腠理开，荣卫通，汗大泄，与白虎汤，以解内外之热。
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。
本太阳病并于阳明，名曰并病。太阳证罢，是无表证；但发潮热，是热并阳明。一身汗出为热越，今
手足 汗出，是热聚于胃也，必大便难而谵语。经曰∶手足 然而汗出者，必大便已硬也，与大承气汤，以
下胃中实热。
阳明病，脉浮而紧，咽燥口苦，腹满而喘，发热汗出，不恶寒，反恶热，身重。若发汗则躁，心愦愦，
反谵语。若加烧（赵本作“温”）针，必怵惕烦躁，不得眠；若下之，则胃中空虚，客气动膈，心中懊 ，
舌上苔者，栀子豉汤主之。（赵本有“栀子豉汤方”详见卷三）
脉浮发热，为邪在表；咽燥口苦，为热在经；脉紧腹满而喘，汗出，不恶寒，反恶热，身重，为邪在里。
此表里俱有邪，犹当双（医统本作“和”）解之。若发汗攻表，表热虽除，而内热益甚，故
躁而愦愦，反谵语。愦愦者，心乱。经曰∶荣气微者，加烧针则血不行，更发热而躁烦。此表里有热，若加烧
针，则损动阴气，故怵惕烦躁不得眠也；若下之，里热虽去，则胃中空虚，表中客邪之气乘虚陷于上焦，烦
动于膈，使心中懊 而不了了也。舌上苔黄者，热气客于胃中；舌上苔白，知热气客于胸中，与栀子
豉汤，以吐胸中之邪。
若渴欲饮水，口干舌燥者，白虎加人参汤主之。（赵本有“白虎加人参汤方”详见卷十）
若下后，邪热客于上焦者为虚烦；此下后，邪热不客于上焦而客于中焦者，是为干燥烦渴，与白虎加人
参汤，散热润燥。
若脉浮发热，渴欲饮水，小便不利者，猪苓汤主之。
此下后，客热客于下焦者也。邪气自表入里，客于下焦，
三焦俱带热也。脉浮发热者，上焦热也；渴欲饮水者，中焦热也；小便不利者，邪客下焦，津液不得下通也。
与猪苓汤利小便，以泻下焦之热也。
猪苓汤方∶
猪苓（去皮。甘平） 茯苓（甘平） 阿胶（甘平） 滑石（碎。甘寒） 泽泻（各一两。甘咸寒）
甘甚而反淡，淡味渗泄为阳，猪苓、茯苓之甘，以行小便；咸味涌泄为阴，泽泻之咸，以泄伏水；滑
利窍，阿胶、滑石之滑，以利水道。
上五味，以水四升，先煮四味，取二升，去滓，内下（赵本无“下”字）阿胶烊消，温服七合，日三服。
阳明病，汗出多而渴者，不可与猪苓汤，以汗多胃中燥，猪苓汤复利其小便故也。
《针经》曰∶水谷入于口，输于肠胃，其液别为五，天寒衣薄则为溺，天热衣浓则为汗，是汗溺一液也。
汗多为津液外泄，胃中干燥，故不可与猪苓汤利小便也。
脉浮而迟，表热里寒，下利清谷者，四逆汤主之。（赵本有“四逆汤方”详见卷二）
浮为表热，迟为里寒。下利清谷者，里寒甚也，与四逆汤，温里散寒。
若胃中虚冷，不能食者，饮水则哕。
哕者，咳逆是也。《千金》曰∶咳逆者，哕逆之名。胃中虚冷，得水则水寒相搏，胃气逆而哕。
脉浮发热，口干鼻燥，能食者则衄。
脉浮发热，口干鼻燥者，热在经也；能食者里和也。热甚于经，迫血为衄。胃中虚冷阴胜也，水入于经，
其血乃成，饮水
者助阴，气逆为哕。发热口干阳胜也，食入于阴，长气于阳，能食者助阳，血妄为衄。三者偏阴偏阳之疾也。
阳明病下之，其外有热，手足温，不结胸，心中懊 ，饥不能食，但头汗出者，栀子豉汤主之。
表未罢而下者，应邪热内陷也。热内陷者，则外热而无手足寒；今外有热而手足温者，热虽内陷，然而
不深，故不作结胸也。心中懊 ，饥不能食者，热客胸中为虚烦也。热自胸中熏蒸于上，故但头汗出而
身无汗。与栀子豉汤，以吐胸中之虚烦。
阳明病，发潮热，大便溏，小便自可，胸胁满不去者，小柴胡汤主之。（赵本作“与小柴胡汤”，又有“小
柴胡汤方”详见卷三）
阳明病潮热，为胃实，大便硬而小便数；今大便溏，小便自可，则胃热未实，而水谷不别也。大便溏者，
应气降而胸胁满去；今反不去者，邪气犹在半表半里之间，与小柴胡汤，以去表里之邪。
阳明病，胁下硬满，不大便而呕，舌上白苔者，可与小柴胡汤。上焦得通，津液得下，胃气因和，身 然
而汗出解也。（赵本作“汗出而解”）
阳明病，腹满，不大便，舌上苔黄者，为邪热入腑可下；若胁下硬满，虽不大便而呕，舌上白苔者，为邪
未入腑，在表里之间，与小柴胡汤以和解之。上焦得通，则呕止；津液得下，则胃气因和，汗出而解。
阳明中风，脉弦浮大而短气，腹都满，胁下及心痛，久按之气不通，鼻干不得汗，嗜卧，一身及面（赵本无
“面”字）目悉黄，小便难，有潮热，时时哕，耳前后肿，刺之
小瘥。外不解，病过十日，脉续浮者，与小柴胡汤。
脉但浮，无余证者，与麻黄汤；若不尿，腹满加哕者，不治。（赵本有“麻黄汤方”详见卷三）
浮大为阳，风在表也；弦则为阴，风在里也。短气腹满，胁下及心痛，风热壅于腹中而不通也。若寒客
于内而痛者，按之则寒气散而痛止；此以风热内壅，故虽久按而气亦不通。阳明病，鼻干不得卧，自汗出者，
邪在表也；此鼻干不得汗而嗜卧者，风热内攻，不干表也。一身面目悉黄，小便难，有潮热，时
时哕者，风热攻于胃也。阳明之脉出大迎，循颊车，上耳前过客主人，热胜则肿，此风热在经，故耳前后肿，
刺之经气通，肿则小瘥。如此者，外证罢则可攻。若外证不解，虽过十日，脉续浮者，邪气犹在半表半里，与
小柴胡汤以和解之；若其脉但浮而不弦大，无诸里证者，是邪但在表也，可与麻黄汤以发其
汗；若不尿腹满加哕者，关格之疾也，故云不治，《难经》曰∶关格者，不得尽其命而死。
阳明病，自汗出，若发汗，小便自利者，此为津液内竭，虽硬不可攻之，当须自欲大便，宜蜜煎导而通
之。若土瓜根及与（赵本无“与”字）大猪胆汁，皆可为导。
津液内竭，肠胃干燥，大便因硬，此非结热，故不可攻，宜以药外治而导引之。
蜜煎导（赵本无“导”字）方∶
蜜（赵本作“食蜜”）七合（赵本“七合”作小字）一味，内铜器中微火煎之，稍凝似饴状，（赵本作“
右一味，于铜器内，微火煎，当须凝如饴状”）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。（赵本有“疑非仲景意，已试甚良”九字）
猪胆汁方（赵本无此四字∶）
大（赵本大上有“又”字）猪胆一枚，泻汁，和醋少许，以灌谷道中，（赵本作“和少许法醋，以灌谷道
内”）如一食顷，当大便出。（赵本有“宿食恶物，甚效”六字）
阳明病脉迟，汗出多，微恶寒者，表未解也，可发汗，宜桂枝汤。（赵本有“桂枝汤方”详见卷二）
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，（赵本有“者”字）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（赵本医统本并有“蒿”字）汤主之。
If there is no dry stool in the stomach, but only slight hardness in the intestines, the stool will be hard at first and then loose. Attacking with purgatives will weaken the Stomach Qi, leading to abdominal fullness and inability to eat. Dryness in the Stomach causes thirst for water; when water enters the Stomach, deficiency-cold and water contend, causing Qi rebellion resulting in hiccups (Yue). If fever occurs later, it means heat has gathered back into the Stomach due to deficiency. The Stomach dryness combined with heat will cause the stool to become hard again. In this case, a small amount of Xiao Cheng Qi Tang (Minor Order the Chest Decoction) should be given to mildly promote bowel movement and harmonize the Stomach. Therefore, if there is no passage of gas after taking medicine, internal attacking methods must not be used; utmost caution is required.
Excess conditions lead to delirious speech (Zhenyu), while deficiency conditions lead to repetitive speech (Zhengsheng). Zhengsheng refers to repetitive speech.
The *Nei Jing* states: "When pathogenic factors are vigorous, it is excess; when essence and Qi are depleted, it is deficiency." Delirious speech arises from vigorous pathogenic factors causing confusion of the spirit; Zhengsheng arises from depletion of essence and Qi causing incomplete voice. Those with delirious speech speak out of order; those with Zhengsheng have an improper tone. The *Analects* says: "Detest Zhengsheng for disrupting elegant music." It also says: "Discard Zhengsheng, stay away from flatterers." Zhengsheng is licentious, and flatterers are dangerous. This indicates that Zhengsheng is improper. Now, after a new recovery, Qi is deficient, and the voice repeats; this is what is called Zhengsheng. If the voice is heavy, it is also considered repetitive speech.
Fixed gaze with delirious speech, accompanied by asthma and chest fullness, indicates death. Diarrhea also indicates death.
Fixed gaze and delirious speech indicate victorious pathogenic factors. Asthma and chest fullness represent Qi escaping upward; diarrhea represents Qi escaping downward. Both are signs of impending death.
Excessive sweating, or repeated sweating, leads to loss of Yang Qi. If delirious speech occurs with a short pulse, it indicates death; if the pulse is self-harmonious, survival is possible.
Loss of Yang leads to Stomach dryness. Delirious speech with a short pulse indicates exhaustion of body fluids, which cannot be treated further. A self-harmonious pulse indicates that righteous Qi is not yet exhausted, so life is still possible.
After vomiting or purging in Shanghan, if the disease does not resolve, and there is no bowel movement for five to six days, up to ten or more days, tidal fever occurs at dusk (Shen, You, Xu hours), without aversion to cold, and the patient speaks alone as if seeing ghosts. In severe cases, the patient becomes unrecognizable, grasps at clothing and bedrails, feels terrified and uneasy, has slight asthma, fixed gaze. If the pulse is wiry, there is hope; if the pulse is choppy, it indicates death. In milder cases, with only fever and delirious speech, Da Cheng Qi Tang (Major Order the Chest Decoction) is the primary treatment. If one dose results in bowel movement, stop administering subsequent doses.
Vomiting and purging both injure Stomach Qi. Lack of bowel movement for five to ten days indicates loss of body fluids, weak Stomach Qi, and internal binding of pathogenic heat. Yangming peaks during Shen, You, and Xu hours; tidal fever at dusk indicates intense Yangming heat. Absence of aversion to cold indicates the exterior syndrome has resolved. Speaking alone as if seeing ghosts indicates Yangming interior excess due to surplus heat. In severe cases, heat is extremely abundant, disturbing righteous Qi internally, causing unrecognizability, grasping behaviors, terror, slight asthma, and fixed gaze. In Shanghan, Yang victory with Yin exhaustion leads to death; Yin victory with Yang exhaustion leads to death. Intense heat indicates Yang victory. A wiry pulse indicates Yin is still sufficient; a choppy pulse indicates Yin insufficiency. Although Yang heat is intense, a wiry pulse shows Yin is not exhausted, so survival is possible; a choppy pulse indicates Yin exhaustion, making it untreatable. If pathogenic heat is mild and not severe, presenting only as fever and delirious speech, Da Cheng Qi Tang can be used to purge heat from the Stomach. The classics state: "When using purgatives, stop once the illness is addressed; do not necessarily finish the dosage." Since the heat here is not severe, it says if one dose promotes bowel movement, stop subsequent doses.
In Yangming disease, patients often sweat profusely. Due to fluid loss, the Stomach becomes dry, and the stool becomes hard, leading to delirious speech. Xiao Cheng Qi Tang is the primary treatment. If delirious speech stops after one dose, do not administer further.
Loss of body fluids causes Stomach dryness, hard stool, and delirious speech. Even without severe interior excess heat, Xiao Cheng Qi Tang is needed to harmonize Stomach Qi. Once delirious speech stops after one dose, Stomach dryness is moistened; do not give Cheng Qi decoctions again, as there was no real heat initially.
In Yangming disease, with delirious speech and tidal fever, if the pulse is slippery and rapid, Xiao Cheng Qi Tang is the primary treatment. Administer one sheng of Cheng Qi Tang. If gas passes in the abdomen, administer another sheng; if no gas passes, do not give more. If the next day there is still no bowel movement and the pulse becomes faint and choppy, it indicates interior deficiency, making it difficult to treat; do not give Cheng Qi Tang again.
In Yangming disease with delirious speech and tidal fever, if the pulse is deep and solid, it is interior excess and can be purged; if the pulse is slippery and rapid, interior heat is not yet solid, so purging is not yet appropriate. First, give Xiao Cheng Qi Tang to harmonize. If gas passes after taking the decoction, there is dry stool, and another sheng of Xiao Cheng Qi Tang can be given to remove it; if no gas passes, there is no dry stool, and Xiao Cheng Qi Tang should not be given. By the next day, when pathogenic factors transmit, if the pulse becomes deep, solid, tight, or firm, it is interior excess; if it becomes faint and choppy, it is severe interior Qi deficiency. If bowel movement occurs and the pulse is faint and choppy, it is merely interior deficiency and can be treated; here, without bowel movement, the pulse is faint and choppy, indicating internal decline of righteous Qi overcome by pathogenic factors, hence "difficult to treat."
In Yangming disease, with delirious speech and tidal fever, if the patient cannot eat, there must be several pieces of dry stool in the Stomach. If the patient can eat, the stool is merely hard, and Da Cheng Qi Tang should be used to purge.
Delirious speech and tidal fever indicate Stomach heat, which should digest food and stimulate appetite. Inability to eat indicates dry stool and Stomach excess. Ability to eat indicates Stomach deficiency-heat; although hard, it is not dry stool. In miscellaneous diseases, deficiency leads to lack of appetite, excess leads to desire to eat; in Shanghan, severe Stomach excess-heat leads to inability to eat, while severe Stomach deficiency-heat leads to ability to eat, differing from miscellaneous diseases. Da Cheng Qi Tang purges dry stool and drives out bound heat.
In Yangming disease, with bleeding from the lower orifices and delirious speech, this is Heat entering the Blood Chamber. If only the head sweats, puncture Qimen (LR14) and drain according to its excess condition. General sweating will lead to recovery.
Heat entering the Blood Chamber in Yangming disease forces blood downward, causing bleeding and delirious speech. Yangming disease typically involves much sweating, but since blood loss prevents sweating, only the head sweats. Puncturing Qimen dissipates heat in the Blood Chamber, draining excess to remove Yangming pathogenic heat. Dispersing pathogen and removing heat allows Ying and Wei to flow freely and body fluids to recover, leading to general sweating and resolution.
Sweating followed by delirious speech indicates dry stool in the Stomach, attributed to Wind. Purging is necessary, but only after passing the Taiyang stage (exterior resolution). Premature purging will cause chaotic speech due to exterior deficiency and interior excess. After proper purging, recovery occurs; Da Cheng Qi Tang is indicated.
Dry stool in the Stomach causes delirious speech. Sweating indicates the exterior is not resolved, hence termed Wind. Dry stool requires purging, but if the exterior is not harmonized, purging is delayed until after the Taiyang stage and absence of exterior signs. Premature purging removes dry stool but allows exterior pathogen to sink inward due to deficiency, creating exterior deficiency and interior excess with severe Stomach deficiency-heat, leading to chaotic speech. Da Cheng Qi Tang purges Stomach pathogenic heat to stop this.
In Shanghan, on the fourth or fifth day, if the pulse is deep with asthma and fullness, deep indicates interior involvement. Counterproductively inducing sweating causes body fluids to escape, making stool difficult. Exterior deficiency and interior excess eventually lead to delirious speech.
When pathogen enters the interior, presenting with deep pulse and asthma/fullness, interior signs are complete, requiring purging. Inducing sweating instead causes fluid escape, Stomach dryness, and difficult stool. Over time, dry stool and Stomach excess lead to delirious speech.
In Combined Disease of the Three Yang, there is abdominal fullness, body heaviness, difficulty turning, insensitivity of the mouth, greasy facial appearance, delirious speech, and urinary incontinence. Inducing sweating worsens delirious speech; purging causes sweating on the forehead and cold extremities. If there is spontaneous sweating, Bai Hu Tang (White Tiger Decoction) is the primary treatment.
Abdominal fullness, body heaviness, difficulty turning, insensitivity of the mouth, and delirious speech indicate Yangming. The *Zhen Jing* states: "Severe Shaoyang disease presents with a dusty face." Greasy face indicates Shaoyang; urinary incontinence indicates Taiyang. Since Yangming signs predominate, it is listed in the Yangming chapter. Combined Disease of the Three Yang involves exterior and interior pathogens. Inducing sweating exacerbates燥热 (dry-heat), worsening delirious speech. Purging allows exterior heat to sink inward, causing forehead sweating and cold extremities. Spontaneous sweating indicates intense heat in the Three Yang channels. The *Nei Jing* states: "Heat opens pores, Ying and Wei flow freely, causing profuse sweating." Bai Hu Tang resolves interior and exterior heat.
In Combined Disease of Two Yang, if Taiyang signs cease and only tidal fever, continuous sweating of hands and feet, difficult stool, and delirious speech occur, purging leads to recovery; Da Cheng Qi Tang is indicated.
Original Taiyang disease combining with Yangming is called Combined Disease. Cessation of Taiyang signs means no exterior syndrome; tidal fever indicates heat combining with Yangming. General sweating is heat venting; hand and foot sweating indicates heat gathering in the Stomach, leading to difficult stool and delirious speech. The classics state: "Continuous sweating of hands and feet indicates hard stool." Da Cheng Qi Tang purges Stomach excess heat.
In Yangming disease, if the pulse is floating and tight, with dry throat, bitter taste, abdominal fullness, asthma, fever, sweating, no aversion to cold, aversion to heat, and body heaviness: Inducing sweating causes irritability, mental confusion, and delirious speech. Adding burning needle therapy causes terror, restlessness, and insomnia. Purging leads to empty Stomach, guest Qi disturbing the diaphragm, mental restlessness (Ao Nao), and tongue coating. Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is the primary treatment.
Floating pulse and fever indicate exterior pathogen; dry throat and bitter taste indicate heat in the channel; tight pulse, abdominal fullness, asthma, sweating, no aversion to cold, aversion to heat, and body heaviness indicate interior pathogen. With pathogen in both exterior and interior, dual resolution is needed. Inducing sweating removes exterior heat but intensifies interior heat, causing irritability, confusion, and delirious speech. Confusion means mental disorder. The classics state: "Deficient Ying Qi, adding burning needle stops blood flow, causing more fever and irritability." Interior-exterior heat plus burning needle damages Yin Qi, causing terror, restlessness, and insomnia. Purging removes interior heat but leaves Stomach empty, allowing exterior guest Qi to sink to upper Jiao, disturbing the diaphragm and causing mental restlessness. Yellow tongue coating indicates heat in Stomach; white coating indicates heat in Chest. Zhi Zi Chi Tang expels pathogen from the Chest.
If thirsty for water with dry mouth and tongue, Bai Hu Jia Ren Shen Tang (White Tiger Plus Ginseng Decoction) is the primary treatment.
After purging, if pathogenic heat resides in the upper Jiao, it is false irritability; here, after purging, heat resides in the middle Jiao, causing dryness, irritability, and thirst. Bai Hu Jia Ren Shen Tang clears heat and moistens dryness.
If floating pulse, fever, thirst for water, and difficult urination occur, Zhu Ling Tang (Polyporus Decoction) is the primary treatment.
This is post-purging, with guest heat in the lower Jiao. Pathogen moves from exterior to interior, lodging in lower Jiao, affecting all three Jiaos with heat. Floating pulse and fever indicate upper Jiao heat; thirst indicates middle Jiao heat; difficult urination indicates lower Jiao pathogen blocking fluid descent. Zhu Ling Tang promotes urination to drain lower Jiao heat.
Zhu Ling Tang Formula:
Zhu Ling (Poria, peeled. Sweet, Neutral) Fu Ling (Poria, Sweet, Neutral) E Jiao (Donkey-hide Gelatin, Sweet, Neutral) Hua Shi (Talcum, crushed. Sweet, Cold) Ze Xie (Alisma, each 1 liang. Sweet, Salty, Cold)
Sweetness turns to blandness; bland flavor drains and leaks, belonging to Yang. Zhu Ling and Fu Ling's sweetness promotes urination. Saltiness surges and drains, belonging to Yin. Ze Xie's saltiness drains retained water. Slipperiness opens orifices; E Jiao and Hua Shi's slipperiness benefits water passages.
These five ingredients: Use four sheng of water. Boil the first four ingredients first to obtain two sheng, remove dregs, add E Jiao and melt it. Warm take seven ge, three times daily.
In Yangming disease, with profuse sweating and thirst, Zhu Ling Tang must not be given because profuse sweating causes Stomach dryness, and Zhu Ling Tang further promotes urination.
The *Zhen Jing* states: "Food and drink enter the mouth, transport through stomach and intestines, their fluids divide into five. In cold weather with thin clothes, it becomes urine; in hot weather with thick clothes, it becomes sweat. Sweat and urine are from the same source." Profuse sweating depletes fluids externally, drying the Stomach; thus, Zhu Ling Tang for urination is contraindicated.
If the pulse is floating and slow, with exterior heat and interior cold, and diarrhea with undigested food, Si Ni Tang (Frigid Extremities Decoction) is the primary treatment.
Floating indicates exterior heat; slow indicates interior cold. Diarrhea with undigested food indicates severe interior cold. Si Ni Tang warms the interior and disperses cold.
If the Stomach is deficient and cold, unable to eat, drinking water causes hiccups.
Hiccups (Yue) are reverse coughing. The *Qian Jin* states: "Reverse coughing is the name for hiccups." Deficient-cold Stomach combined with water causes water-cold contention, Stomach Qi rebellion, and hiccups.
If the pulse is floating with fever, dry mouth, and nasal dryness, and the patient can eat, epistaxis (nosebleed) may occur.
Floating pulse with fever, dry mouth, and nasal dryness indicate heat in the channel; ability to eat indicates interior harmony. Intense heat in the channel forces blood upward causing epistaxis. Deficient-cold Stomach with Yin excess: water enters the channel, blood forms; drinking water aids Yin, Qi rebels causing hiccups. Fever and dry mouth indicate Yang excess; food enters Yin, nourishes Yang; ability to eat aids Yang, blood wanders causing epistaxis. These are diseases of Yin-Yang imbalance.
In Yangming disease, after purging, if there is exterior heat, warm hands and feet, no chest binding, mental restlessness (Ao Nao), hunger but inability to eat, and only head sweating, Zhi Zi Chi Tang is the primary treatment.
Exterior unresolved with purging should lead to internal sinking of pathogenic heat. Internal sinking means exterior heat without cold hands/feet. Here, exterior heat with warm hands/feet means heat sank but not deeply, so no chest binding. Mental restlessness, hunger, inability to eat indicate heat in Chest causing false irritability. Heat steaming upward from Chest causes only head sweating. Zhi Zi Chi Tang expels false irritability from the Chest.
In Yangming disease, with tidal fever, loose stool, normal urination, and persistent chest/hypochondriac fullness, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment.
Yangming tidal fever indicates Stomach excess, hard stool, and frequent urination. Here, loose stool and normal urination indicate Stomach heat is not yet solid, and water/grain are not separated. Loose stool should allow Qi descent and resolve chest fullness; persistence indicates pathogen remains between exterior and interior. Xiao Chai Hu Tang resolves exterior-interior pathogen.
In Yangming disease, with hardness/fullness under hypochondrium, constipation, vomiting, and white tongue coating, Xiao Chai Hu Tang can be given. Upper Jiao becoming free, fluids descending, Stomach Qi harmonizing, leads to general sweating and resolution.
Yangming disease with abdominal fullness, constipation, and yellow tongue coating indicates pathogenic heat entered the Fu organs and can be purged. If hardness/fullness under hypochondrium, constipation, vomiting, and white tongue coating occur, pathogen has not entered Fu organs but remains between exterior and interior. Xiao Chai Hu Tang harmonizes. Upper Jiao free stops vomiting; fluids descend harmonize Stomach Qi, leading to sweating and resolution.
Yangming Wind Strike, with wiry-floating-large pulse, shortness of breath, generalized abdominal fullness, hypochondriac and heart pain, unrelieved by long pressure, dry nose, inability to sweat, lethargy, jaundice of whole body and face, difficult urination, tidal fever, occasional hiccups, swelling around ears and temples. Acupuncture brings slight relief. If exterior unresolved, disease persists over ten days, pulse continues floating, Xiao Chai Hu Tang is given.
Only floating pulse, no other signs, Ma Huang Tang (Ephedra Decoction) is given; if no urination, abdominal fullness plus hiccups, it is untreatable.
Floating-large is Yang, wind in exterior; wiry is Yin, wind in interior. Shortness of breath, abdominal fullness, hypochondriac/heart pain indicate wind-heat congesting abdomen. Cold pain relieves with pressure; wind-heat congestion does not. Yangming disease, dry nose, no sleep, spontaneous sweating indicates exterior pathogen; here, dry nose, no sweat, lethargy indicate internal attack by wind-heat, not exterior. Jaundice, difficult urination, tidal fever, hiccups indicate wind-heat attacking Stomach. Yangming channel exits Daying, follows Jiache, goes to ear front passing Guest Master; heat excess causes swelling. Wind-heat in channel causes ear/temporal swelling; acupuncture unblocks channel Qi, reducing swelling. If exterior signs cease, purging is possible. If exterior unresolved, past ten days, pulse still floating, pathogen remains between exterior-interior, Xiao Chai Hu Tang harmonizes. If pulse only floating, not wiry-large, no interior signs, pathogen only in exterior, Ma Huang Tang induces sweating. If no urination, abdominal fullness, hiccups, it is Guan Ge disease, hence untreatable. *Nan Jing* states: "Guan Ge dies before completing life span."
In Yangming disease, spontaneous sweating, or induced sweating, with free urination, indicates internal exhaustion of body fluids. Although stool is hard, it cannot be attacked. Wait for desire to defecate, use Mi Jian Dao (Honey Suppository) to guide passage. Tu Gua Gen (Trichosanthes Root) or Da Zhu Dan Dan (Large Pig Gallbladder) can also be used as guides.
Internal fluid exhaustion causes intestinal dryness and hard stool. This is not bound heat, so purging is contraindicated. External medication guidance is suitable.
Mi Jian Dao Formula:
Honey seven ge. One ingredient, put in copper vessel, simmer gently until slightly congealed like malt syrup. Stir to prevent burning. When moldable, shape into suppositories with sharp head, finger-sized, two cun long. Make while hot; hardens when cold. Insert into anus, hold tightly with hand, remove when urge to defecate arises.
Zhu Dan Dan Formula:
One large pig gallbladder, extract juice, mix with small amount of vinegar,灌 (instill) into anus. After one meal time, stool should pass.
In Yangming disease, slow pulse, profuse sweating, slight aversion to cold, indicates exterior unresolved. Sweating is appropriate; Gui Zhi Tang (Cinnamon Twig Decoction) is indicated.
Yangming slow pulse, profuse sweating usually indicates interior pathogen, but slight aversion to cold shows exterior unresolved. Gui Zhi Tang harmonizes exterior.
In Yangming disease, floating pulse, no sweat, asthma, resolving with sweating; Ma Huang Tang is indicated.
Yangming Shanghan exterior excess, floating pulse, no sweat, asthma. Ma Huang Tang induces sweating.
In Yangming disease, fever and sweating indicate heat venting, preventing jaundice. Only head sweating, no body sweat, stopping at neck, difficult urination, thirst for fluids indicates stagnant heat in interior, leading to jaundice. Yin Chen Tang (Artemisiae Scopariae Decoction) is the primary treatment.