士人陈彦夫病伤寒八九日。身热无汗。喜饮。时时谵语。因下利后。大便不通三日。非烦非
躁。非寒非痛。终夜不得眠。但心没晓会处。或时发一声如叹息之状。医者不晓是何证。但以宁
心宽膈等药。不效。召予诊视。两手关脉长。按之有力。乃曰懊 怫郁证也。此胃中有燥屎。宜
与承气汤。服之。下燥屎二十枚。次复下溏粪。得利而解。
论曰。仲景云阳明病下之。心中懊 而微烦。胃中有燥屎。可攻。宜承气汤。又云病者小便
不利。大便乍难乍易。时有微热。怫郁不得眠者。有燥屎也。承气汤主之。盖屎在胃则胃不和。
素问曰。胃不和则卧不安。此所以夜不得眠也。仲景云胃中燥。大便坚者。必谵语。此所以时时
谵言也。非烦非躁。非寒非痛。所谓心中懊 也。声口叹息。而时发一声。所谓水气怫郁也。燥屎得除。大便通利。阴
阳交和。是以其病得除。
市人张某。年可四十。病伤寒。大便不利。日晡发热。手循衣缝。两手撮空。目直视急。更
三医矣。皆曰伤寒最恶证也。不可治。后召予。予不得已往诊之。曰此诚恶候。染此者十中九死。
仲景虽有证而无治法。但云脉弦者生。涩者死。况经吐下。难于用药。谩以药与。若大便得通。
而脉强者。庶可料理也。遂用小承气汤与之。一投而大便通利。诸疾渐退。脉且微弦。半月得瘥。
论曰。或问下之而脉得弦者生。何也。答曰。金匮玉函经云循衣摸床。妄撮。怵惕不安。微喘直
视。脉弦者生。涩者死。微者但发热谵语。承气汤与之。余尝观钱仲阳小儿诀法。手循衣领。及
乱捻物者。肝热也。此证玉函列在阳明部。阳明胃也。肝有邪热。淫于胃经。故以承气汤泻肝。
而得强脉。则平而和。胃且坚不受。此百生之理也。予尝谓仲景论。不通诸医书。以发明隐奥。
而专一经者。未见其能也。须以古今方书。发明仲景余意。
士人陈彦夫患伤寒症已八九日。身体发热，无汗，喜欢喝水，时常说胡话。因为在腹泻之后，大便三天没有通畅。既不是烦闷也不是躁动，既不是怕冷也不是疼痛，整夜无法入睡，只是心中有一种难以言喻的难受感觉，偶尔发出像叹息一样的声音。医生们不明白这是什么证候，只用了宁心宽膈之类的药物，没有效果。于是请我诊治。诊得两手关脉长，按之有力，便说这是懊憹怫郁证。这是因为胃中有燥结的粪便，适宜给予承气汤。服用后，排出了二十枚燥屎，接着又排出稀粪，得利后病愈。
论述说：张仲景说阳明病经过攻下治疗后，心中懊憹且轻微烦躁，胃中有燥结的粪便，可以攻下，适宜用承气汤。又说病人小便不通利，大便时而难解时而易解，有时有轻微发热，怫郁不得睡眠的，是有燥结的粪便，应用承气汤主治。大概粪便在胃中则胃气不和，《素问》说：胃不和则卧不安。这就是夜间不能入睡的原因。张仲景说胃中干燥，大便坚硬的，必定说胡话。这就是时常说胡话的原因。既不是烦闷也不是躁动，既不是怕冷也不是疼痛，所说的就是心中懊憹。口中发出叹息声，偶尔发出一声，所说的就是水气怫郁。燥结的粪便得以清除，大便通畅，阴阳交和，所以疾病得以消除。
集市中的张某，年龄大约四十岁。患伤寒症，大便不通利，傍晚时分发热，手在衣缝间摸索，两手空抓（撮空），眼睛直视不动，已经换了三位医生，都说是伤寒最严重的证候，不可治愈。后来请我去，我不得已前往诊治。我说这确实是危重征象，染上此症的十人中九人会死。张仲景虽然有此证候描述但没有给出治疗方法，只是说脉象弦的能生，脉象涩的会死。况且已经经过吐法和下法治疗，用药困难，随便给些药吧，如果大便能够通畅，而脉象有力的，或许还可以调理。于是用小承气汤给他服用。一次服药后大便通畅，各种病症逐渐消退，脉象变得微弦，半个月后痊愈。
论述说：有人问攻下后脉象变弦为什么能生？回答说：《金匮玉函经》说循着衣角摸床、胡乱抓取、惊恐不安、轻微喘息、眼睛直视，脉象弦的能生，脉象涩的会死。轻的只是发热说胡话，给予承气汤。我曾经观察钱乙的小儿诀法，手循衣领以及乱捻东西的，是肝热。此证在《玉函经》中列在阳明部，阳明指胃。肝有邪热，淫溢于胃经，所以用承气汤泻肝火，而出现强脉，则平和调和，胃气坚固不受邪侵。这是百病求生的道理。我曾说研究张仲景的论述，如果不通晓其他医书来阐明其中的隐奥，而只专攻一经的，未见其能有所成就。必须利用古今方书，来阐发张仲景的余意。
A scholar named Chen Yanfu suffered from *Shanghan* (Cold Damage) for eight or nine days. His body was hot, he had no sweat, desired to drink, and occasionally spoke deliriously. After suffering from diarrhea, his stool remained unpassed for three days. He felt neither vexation nor restlessness, neither aversion to cold nor pain, yet could not sleep throughout the night. He only experienced a vague sense of discomfort in the heart region, occasionally emitting a sound like a sigh. Physicians did not understand what syndrome this was and merely administered medicines for calming the heart and widening the diaphragm, but with no effect. They summoned me to examine him. I found the pulse at both Guan positions long and forceful upon pressure, and said, "This is the *Ao Fu Yu Zheng* (Agitation and Oppression Syndrome)." This indicates dry feces in the stomach; one should administer *Chengqi Tang* (Purgative Decoction). After taking it, twenty pieces of dry feces were discharged, followed by loose stools. Upon obtaining relief through purgation, he recovered.
In discussion: Zhang Zhongjing stated that in *Yangming Bing* (Yangming Disease), after purgation, if the patient feels *ao* (agitation/unease) in the heart with slight vexation, and there are dry feces in the stomach, attack may be undertaken using *Chengqi Tang*. He also stated that if a patient has difficulty urinating, stool that is alternately difficult and easy to pass, occasional slight fever, and oppression preventing sleep, this indicates dry feces, and *Chengqi Tang* should be the primary treatment. Generally, if feces remain in the stomach, the Stomach Qi becomes disharmonious. The *Suwen* says, "When the Stomach is not harmonious, sleep is uneasy." This explains why he could not sleep at night. Zhang Zhongjing said that when the Stomach is dry and stool is hard, delirium must occur. This explains why he spoke deliriously. Neither vexation nor restlessness, neither aversion to cold nor pain—this is what is meant by *ao* in the heart. Emitting sighs and occasionally making a sound—this is what is meant by water Qi being oppressed. Once the dry feces are removed and bowel movements become smooth, Yin and Yang interact harmoniously, thus the disease is eliminated.
A market vendor named Zhang, approximately forty years old, contracted *Shanghan*. His stool was difficult to pass, he developed fever in the late afternoon, traced the seams of his clothes with his hands, grasped at empty air with both hands, and stared fixedly ahead. He had already seen three physicians, all of whom declared it the most malignant syndrome of *Shanghan*, incurable. Later, they summoned me. Reluctantly, I went to examine him and said, "This is indeed a critical sign. Nine out of ten who contract this will die. Although Zhang Zhongjing described this syndrome, he provided no treatment method, only stating that those with a Xian (Wiry) pulse will live, and those with a Se (Choppy) pulse will die. Moreover, since he has already undergone emesis and purgation, medication is difficult to administer. I will casually give some medicine; if his stool becomes smooth and his pulse becomes strong, perhaps he can be managed." Thus, I administered *Xiao Chengqi Tang* (Minor Purgative Decoction). After one dose, his stool became smooth, various ailments gradually receded, and his pulse became slightly wiry. Half a month later, he recovered.
In discussion: Someone asked, "Why does a Xian pulse indicate survival after purgation?" I answered: The *Jingui Yufan Jing* states that tracing clothes, touching the bed, random grasping, fearfulness and unrest, slight panting, and fixed staring—with a Xian pulse indicate survival, while a Se pulse indicates death. In milder cases involving only fever and delirium, *Chengqi Tang* should be given. I once observed Qian Zhongyang's pediatric methods: hand-tracing collars and randomly pinching objects indicate Liver Heat. This syndrome is listed in the Yangming section of the *Yufan*. Yangming refers to the Stomach. When pathogenic heat exists in the Liver and overflows into the Stomach Meridian, *Chengqi Tang* is used to purge the Liver fire. If a strong pulse appears, harmony is restored, and the Stomach Qi becomes firm, resisting pathogens. This is the principle of seeking life in hundred diseases. I have often said that studying Zhang Zhongjing's treatises without consulting other medical texts to elucidate hidden profundities, and focusing solely on one classic, is unlikely to yield success. One must utilize ancient and modern formularies to expound upon Zhang Zhongjing's residual intent.