阳明病谵语发潮热脉滑而疾者小承气汤主之因与承气一升腹中转失气更服一升若不转失气勿更与之明日不大便脉反
微涩者里虚也为难治不可更与承气汤也
脉滑而疾者血热而阳旺也脉反微涩者血寒而阳虚也
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
安微喘直视脉弦者生涩者死微者但发热谵语耳大承气汤主之若一服利止后服
烦躁之极则循衣摸床木燥风生则惕而不安气阻肺热则微喘血枯绑定则直视弦则木气犹存故生涩则营血已槁故死
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
热在里则脉沉胃气壅遏则肺阻而为喘气滞而为满误汗亡津表阳虚而里热实久则神气烦乱而为谵语
汗出谵语者以有燥屎在胃中此为风也须下之过经乃可下之下之若早语言必乱以表虚里实故也下之则愈宜大承气汤
汗多耗其胃津糟粕失润结为燥屎阻塞胃气胃热不泄消耗心液故作谵语此为木燥而风生也胃热宜下俟六日之外已过经
期而后下之下之若早里热未实语言必乱而为郑声以其汗多津亡表虚里实经中清气不敌腑中邪火之旺原有谵语之根里实未
至而遽下之故实家之谵语变为虚家之郑声也
伤寒十三日不解过经谵语者以有热也当以汤下之若小便利者大盒饭硬而反下利胃脉调和者知医以丸药下之非其治也
若自下利者脉当微厥今反和者此为内实也调胃承气汤主之
十三日已过再经之期而作谵语是有内热当下若小便利者其大盒饭硬而反下利而脉又调和者知医以丸药下之内热未泄
非其治也若内虚而自下利者脉当微厥而不调（脉法厥者初来大渐渐小更来渐渐大是也）今反调和者此为内实也内实宜汤
不宜丸当服调胃承气汤也
阳明病出现胡言乱语、定时发热，脉象滑而快速，用小承气汤主治。因此给予承气汤一升，如果腹中转动排气（放屁），再服用一升；如果不排气，就不要继续给服。到了第二天仍然不大便，脉象反而微弱且涩滞，这是里虚的表现，属于难治之症，不可再给予承气汤。
脉象滑而快速，说明血分有热且阳气旺盛；脉象反而微弱且涩滞，说明血分有寒且阳气虚弱。
伤寒病经过催吐或泻下治疗后，病情未解，五六天甚至十余天不大便，在傍晚时分（日晡所）出现定时发热，不恶寒，独自说话如同看见鬼怪一样。如果病情严重，发作时不认识人，手抓衣被和床沿，惊恐不安，轻微气喘，眼睛直视不能转动，若脉象弦长表示生机尚存可生，若脉象涩滞表示营血枯竭则死。病情较轻者，仅表现为发热和胡言乱语，用大承气汤主治。如果第一次服药后大便通畅，就停止后续服药。
烦躁到极点就会手抓衣被和床沿，肝木燥盛而生风，所以惊恐不安；肺气受阻且肺中有热，所以轻微气喘；血液枯竭导致筋脉拘急，所以眼睛直视。脉弦说明肝木之气尚存，所以能生；脉涩说明营血已经干枯，所以死。
伤寒四五天后，脉象沉且伴有气喘胸满，沉脉主病在里，此时反而发汗，导致津液外越，大便变得困难，表虚里实，时间久了会出现胡言乱语。热邪在里故脉沉，胃气壅遏阻碍肺气故气喘，气机阻滞故胸满。误用发汗法导致津液亡失，表阳虚而里热实，时间久了神气烦乱而出现胡言乱语。
出汗且胡言乱语的，是因为胃中有燥屎，这是风邪所致。必须使用攻下法，但需等待病邪离开太阳经传入阳明经之后才可攻下。如果攻下过早，语言必然错乱，这是因为表虚里实的缘故。攻下后病愈，宜用大承气汤。汗多耗伤胃中津液，糟粕失去滋润结成燥屎，阻塞胃气，胃热无法宣泄，消耗心液，所以发生胡言乱语。这是肝木燥盛而生风。胃热适宜攻下，但要等到六天之外，过了传经的期限后再攻下。如果攻下过早，里热尚未结实，语言必然错乱而变为郑声（声音低微重复）。因为汗多津亡，表虚里实，经中的清气不敌腑中邪火的旺盛，原本就有胡言乱语的基础，里实尚未完全形成就急于攻下，所以实证患者的胡言乱语变成了虚证患者的郑声。
伤寒十三天未解，病邪已过经界出现胡言乱语，是因为体内有热，应当用汤剂攻下。如果小便通利，大便应当干硬却反而腹泻，且胃脉调和，可知是医生用丸药攻下导致的，这不是正确的治疗方法。如果是患者自行腹泻，脉象应当微弱厥逆，现在反而调和，这是体内实热的表现，用调胃承气汤主治。
十三天已过，进入第二个传经周期而出现胡言乱语，说明有内热需要攻下。如果小便通利，大便应当干硬却反而腹泻，且脉象又调和，可知是医生用丸药攻下，内热未泄，这不是正确的治疗方法。如果是内虚而自行腹泻，脉象应当微弱厥逆而不调和（脉法中说：厥脉初来时盛大，渐渐变小，再来时又渐渐变大）。现在反而调和，这是体内实热的表现。体内实热适宜用汤剂，不宜用丸药，应当服用调胃承气汤。
In Yangming disease, if delirium and tidal fever occur with a slippery and rapid pulse, Xiao Chengqi Tang (Minor Order the Qi Decoction) is the primary treatment. Therefore, administer one sheng of Chengqi Tang; if intestinal peristalsis occurs (passing gas), administer another sheng. If no peristalsis occurs, do not administer further. On the following day, if there is still no bowel movement but the pulse becomes faint and choppy, this indicates interior deficiency, which is difficult to treat, and Chengqi Tang should not be administered again.
A slippery and rapid pulse indicates blood heat and flourishing Yang. A faint and choppy pulse indicates blood cold and deficient Yang.
After vomiting or purging in Shaoyang disease, if the condition remains unresolved and there is no bowel movement for five to six days, or even up to ten or more days, tidal fever occurs at dusk (Shen hour), without aversion to cold, and the patient speaks alone as if seeing ghosts. In severe cases, the patient may become unrecognizable during episodes, grasp at clothing and bedrails, feel terrified and restless, have slight panting, and stare fixedly. If the pulse is wiry, survival is possible; if the pulse is choppy, death is likely due to exhaustion of Ying blood. In milder cases, only fever and delirium are present, treated with Da Chengqi Tang (Major Order the Qi Decoction). If the first dose results in relief (bowel movement), discontinue subsequent doses.
Extreme restlessness leads to grasping at clothing and bedrails; dryness of Liver Wood generating Wind causes terror and restlessness. Obstruction of Lung Qi with Lung Heat causes slight panting. Exhaustion of Blood leading to binding of sinews causes fixed staring. A wiry pulse indicates that Liver Wood Qi still exists, hence survival. A choppy pulse indicates that Ying blood has dried up, hence death.
In Shaoyang disease, after four or five days, if the pulse is deep and accompanied by panting and chest fullness, the deep pulse indicates the pathogen is in the interior. If sweating is incorrectly induced, fluids escape outward, making bowel movements difficult. This results in exterior deficiency and interior excess, eventually leading to delirium. Heat in the interior causes a deep pulse; stagnation of Stomach Qi obstructs Lung Qi causing panting; Qi stagnation causes fullness. Incorrect sweating depletes fluids, leaving exterior Yang deficient and interior heat excessive. Over time, mental agitation leads to delirium.
Sweating accompanied by delirium indicates dry feces retained in the Stomach, caused by Wind. Purging is required, but it should only be performed after the pathogen has passed through the meridians (entered the Yangming stage). If purging is done too early, speech will become chaotic due to exterior deficiency and interior excess. Purging will cure the condition; Da Chengqi Tang is appropriate. Excessive sweating consumes Stomach fluids, causing waste matter to lose lubrication and form dry feces. These block Stomach Qi, preventing the discharge of Stomach heat, which consumes Heart fluids, resulting in delirium. This is due to dryness of Liver Wood generating Wind. Stomach heat requires purging, but one must wait until after the sixth day, beyond the period of meridian transmission, before purging. If purged too early, when interior heat is not yet solidified, speech will become chaotic and turn into Zhengsheng (monotonous repetition of words). This is because excessive sweating depletes fluids, causing exterior deficiency and interior excess. The clear Qi in the meridians cannot withstand the flourishing evil fire in the fu organs. There is already a root for delirium; if purged hastily before interior excess is fully established, the delirium of an excess pattern transforms into the Zhengsheng of a deficiency pattern.
If Shaoyang disease persists for thirteen days without resolution and delirium occurs after passing through the meridians, it is due to internal heat, and decoctions should be used for purging. If urination is free, the stool should be hard, yet diarrhea occurs, and the Stomach pulse is harmonious. This indicates the physician incorrectly used pill-based purgatives, which is not the correct treatment. If the patient has spontaneous diarrhea, the pulse should be faint and cold (Jue). However, if the pulse is now harmonious, this indicates interior excess. Tiao Wei Chengqi Tang (Regulate the Stomach Order the Qi Decoction) is indicated.
Thirteen days have passed, exceeding the period of two meridian cycles, and delirium indicates internal heat requiring purging. If urination is free, the stool should be hard, yet diarrhea occurs, and the pulse is harmonious. This indicates the physician incorrectly used pill-based purgatives, failing to resolve internal heat, which is incorrect treatment. If there were internal deficiency with spontaneous diarrhea, the pulse would be faint and Jue (not harmonious). Since the pulse is now harmonious, this confirms interior excess. Interior excess requires decoctions, not pills; therefore, Tiao Wei Chengqi Tang should be administered.