问曰。阳明府病。攻之宜矣。然不大便岂皆属阳明病乎。答曰。不大便。不必尽属阳明
病。
阳明病亦不必悉皆不大便。按脉法云。脉有阴结阳结者。何以别之。曰其脉浮而数。能食不
大便者。此为实。名曰阳结也。其脉沉而迟。不能食。身体重。大便反硬。名曰阴结也。即
此可见不大便之病因。内有阴结阳结之不同。不必尽属阳明可攻之证。又仲景于阳明病提纲
。既揭明云。阳明之为病。胃家实是也。又云有太阳阳明。有正阳阳明。有少阳阳明。太阳
阳明者。脾约是也。正阳阳明者。胃家实是也。少阳阳明者。发汗利小便已。胃中燥烦实。
大便难是也。此在仲景恐人误以阳明病概属胃实可攻之证。故于阳明之来路去路。别出太阳
少阳两条。以示下法不宜孟浪之意。必于阳明病发热汗多不大便腹满痛。或绕脐痛烦躁谵语
者。此当急下之证。然或大便乍难乍易。喘冒不能卧。或自利清水。色纯青。心下痛。口干
燥者。亦宜急下之证。由此观之。则所谓阳明之为病胃家实者。更不得泥定不大便矣。不此
之察。或不应下而下。或应下而反失下。其弊正相等。安得呆执下法。以治阳明府病哉。
问曰。阳明病。其传入之路。皆从太阳乎。答曰。不然。太阳病不解。潮热。汗自出。
不恶
寒。反恶热者。此太阳传入阳明之候。然温热之病。汗出而渴。其初起多由阳明而太阳者。
已不侔矣。更有太阳病甫传阳明。只在于经。腹中矢未定成硬。慎不可攻。久之矢定硬。乃
可攻之。此邪由经入府。此谓本经自相传。又少阳病。服柴胡汤已渴者。属阳明也。此少阳
亦有转属阳明之候。此在三阳经中。其传入之路已别。然犹显而易辨者。至三阴经病。多有
寒热错杂之证。若热邪之传入三阴者。亦有从阳明下夺之法。如太阴病之大实痛。宜取桂枝
大
黄。微利以约脾阴。少阴病之口燥咽干，当用大承气。急下以救肾水。至厥阴病热深厥深之
后。下利谵语者。亦主有燥矢。则可见三阴经病。亦有还返阳明者。故曰阳明居中土。万物所归
。一入阳明之府。则邪自无所复传。惟有下夺而解。然则阳明病之来路。种种不齐。于何辨之
。
亦先辨之于经与府而已矣。经与府之辨。亦辨之于脉与证而已矣。而益信计日以定经者。诚
谬说也。
问：阳明腑病，使用攻下法是适宜的。然而，不大便就一定属于阳明病吗？答：不大便，并不一定全属于阳明病。
阳明病也不一定全都表现为不大便。查阅脉法记载说：脉象有阴结和阳结两种，如何区分它们呢？回答说：脉象浮而数，能进食但大便不通的，这属于实证，称为阳结。脉象沉而迟，不能进食，身体沉重，大便反而干硬的，称为阴结。从这一点就可以看出，不大便的病因，内部有阴结和阳结的不同，不一定全都是属于阳明病可以用攻下法治疗的证候。另外，张仲景在阳明病的提纲中，既然明确说明：“阳明病，就是胃家实。”又说：有太阳阳明，有正阳阳明，有少阳阳明。所谓太阳阳明，是指脾约（脾的功能受限导致津液不足，大便干硬）。所谓正阳阳明，是指胃家实。所谓少阳阳明，是指经过发汗或利小便治疗后，胃中干燥、烦闷、结实，大便困难的证候。这是因为张仲景担心人们错误地将所有阳明病都一概归为胃实可攻的证候，所以在阳明病的来路和去路上，特别分出太阳和少阳两条路径，以显示使用下法不宜轻率冒进的意思。必须是阳明病出现发热、汗多、不大便、腹部胀满疼痛，或者绕脐痛、烦躁、说胡话的情况，这才是应当急下的证候。然而，如果大便时而困难时而容易，气喘、头晕目眩不能平卧，或者自行泻出清水，颜色纯青，心下疼痛，口干燥的，也属于应当急下的证候。由此看来，所谓的“阳明之为病，胃家实”，更不应该死板地认为只有不大便才算。如果不仔细考察这些情况，要么不该用下法却用了下法，要么该用下法反而延误了时机，这两种弊病是一样的。怎么能固执地拘泥于下法，来治疗阳明腑病呢？
问：阳明病，其传入的途径，都是从太阳经传来的吗？答：不是这样的。太阳病如果不解，出现定时发热（潮热），自然出汗，不恶寒，反而怕热的，这是太阳病传入阳明的征候。然而，温热性质的疾病，出汗且口渴，其初起多由阳明经开始，这与从太阳传入阳明的情况已经不相同了。更有太阳病刚刚传入阳明，邪气还只在经络层面，腹中的燥屎尚未确定形成坚硬状态，千万不可攻下。时间久了，燥屎确定变硬后，才可以攻下。这是邪气由经入腑，称为本经自相传变。另外，少阳病，服用小柴胡汤之后出现口渴的，属于转属阳明。这也是少阳病有转属阳明的征候。这三阳经中，其传入的途径已经区别开来，而且还是比较明显容易辨别的。至于三阴经的病，多有寒热错杂的证候。如果热邪传入三阴经，也有从阳明经采取攻下夺实的方法。比如太阴病出现大实痛，适宜选用桂枝大黄汤，轻微通利以约束脾阴；少阴病出现口燥咽干，应当使用大承气汤，急下以救肾水。到了厥阴病热深厥深之后，如果出现下利并伴有说胡话的症状，也主诉有燥屎存在。由此可见，三阴经的病，也有回转传向阳明的情况。所以说阳明居中土，万物所归。一旦邪气进入阳明之腑，邪气就无处再传变，只有通过攻下夺实才能解除。那么，阳明病的来路，种种不一，该如何辨别呢？也是先辨别是在经还是在腑而已。经与腑的辨别，也是通过脉象和证候来辨别罢了。从而更加相信那种按天数来确定经络传变的说法，确实是错误的理论。
Question: For Yangming fu-organ disease, the use of purgation is appropriate. However, does constipation always belong to Yangming disease? Answer: Constipation does not necessarily all belong to Yangming disease.
Yangming disease does not necessarily always manifest as constipation. According to pulse methodology: "There are Yin knot and Yang knot pulses; how to distinguish them?" It is said: "When the pulse is floating and rapid, and the patient can eat but has no bowel movement, this is excess, named Yang knot." When the pulse is deep and slow, the patient cannot eat, feels heavy in the body, and the stool is conversely hard, it is named Yin knot. From this, it can be seen that the etiology of constipation differs internally between Yin knot and Yang knot, and it is not necessarily all syndromes of Yangming disease suitable for purgation. Furthermore, Zhang Zhongjing, in the outline of Yangming disease, clearly states: "The essence of Yangming disease is stomach-home excess (Wei Jia Shi)." He also says: "There is Taiyang-Yangming, Zhengyang-Yangming, and Shaoyang-Yangming." Taiyang-Yangming refers to Pi Yue (Spleen Confinement). Zhengyang-Yangming refers to Wei Jia Shi. Shaoyang-Yangming refers to the condition where, after sweating or promoting urination, the stomach becomes dry, vexed, and solid, leading to difficult defecation. This was done by Zhang Zhongjing because he feared people would mistakenly generalize all Yangming diseases as stomach-excess conditions suitable for purgation. Thus, regarding the origin and progression of Yangming disease, he specifically distinguished Taiyang and Shaoyang pathways to indicate that the use of downward-draining methods should not be rash. Only when Yangming disease presents with fever, profuse sweating, constipation, abdominal fullness and pain, or periumbilical pain, restlessness, and delirium, is it a syndrome requiring urgent purgation. However, if stool is alternatively difficult and easy, accompanied by asthma, dizziness, inability to lie flat, or spontaneous diarrhea of clear water, purely green in color, epigastric pain, and dry mouth, these are also syndromes requiring urgent purgation. From this perspective, the statement "The essence of Yangming disease is stomach-home excess" must not be rigidly interpreted as only involving constipation. If one fails to observe this, either purging when not indicated, or failing to purge when indicated, results in equal detriment. How can one stubbornly adhere to purgation to treat Yangming fu-organ disease?
Question: Regarding the transmission pathway of Yangming disease, does it always come from Taiyang? Answer: Not so. When Taiyang disease remains unresolved, presenting with tidal fever, spontaneous sweating, aversion to cold ceasing, and aversion to heat instead, this is the sign of Taiyang transmitting to Yangming. However, warm-heat diseases, characterized by sweating and thirst, often originate from Yangming at the onset, which is already different from the case of transmission from Taiyang. Moreover, when Taiyang disease just begins to transmit to Yangming, if the pathogen is still only in the channels (Jing), and the hardened feces in the abdomen have not yet been determined to be solid, one must strictly avoid purgation. Only after time passes and the hardened feces are confirmed can purgation be used. This is the pathogen entering the fu-organ from the channel, known as self-transmission within the same meridian system. Additionally, when Shaoyang disease patients develop thirst after taking Xiao Chai Hu Tang, it belongs to Yangming. This is another sign of Shaoyang transferring to Yangming. Among the three Yang meridians, their transmission pathways are distinct and relatively obvious and easy to distinguish. As for diseases of the three Yin meridians, they often present with mixed cold and heat syndromes. If heat pathogens transmit to the three Yin meridians, there are also methods of downward draining from Yangming. For example, in Taoyin disease presenting with severe abdominal pain and tenderness, Guizhi Dahuang Tang should be selected to mildly promote bowel movement and constrain Spleen Yin. In Shaoyin disease presenting with dry mouth and throat, Da Cheng Qi Tang should be used to urgently purge and rescue Kidney Water. After Jueyin disease progresses to deep heat and deep cold extremities, if diarrhea is accompanied by delirium, it indicates the presence of hardened feces. Thus, it can be seen that diseases of the three Yin meridians can also return and transmit to Yangming. Therefore, it is said that Yangming resides in the center (Earth), and all things return to it. Once the pathogen enters the Yangming fu-organ, there is nowhere else for it to transmit; resolution is achieved only through downward draining. Then, given that the origins of Yangming disease vary, how should they be distinguished? One must first distinguish whether the pathogen is in the channel (Jing) or the fu-organ (Fu). The distinction between channel and fu-organ is made based on pulse and symptoms. This further confirms that determining meridians by counting days is indeed a fallacious theory.