（有大便不通有大便难有大便硬皆阳明胃实之候）
六七日不大便。头痛有热。与承气汤。小便清者。知不在里。仍在表也。（桂枝汤）阳明
病
（小柴胡汤）阳明病。自汗若发汗。小便自利者。津液内竭。虽硬不可攻（蜜煎导之）阳明病。
潮热不大便。少与小承气。不转失气者。无燥屎不可攻。转失气者。有燥屎可攻。（大承气
汤）阳明病。不吐不下。心烦。（调胃承气汤）阳明小便不利。大便乍难乍易。时有微热喘冒
不卧。有燥屎也。（大承气汤）伤寒六七日。目中不了了。睛不和。无表里症大便难。身微热
。（大承气汤急下之）脉浮则胃气强。脉涩则小便数。浮涩相搏。大便则难。其脾为约。（麻
仁丸）阳明症喜忘。大便色黑必有蓄血。（抵当汤）无表里证。下后脉数。不解。善饥。六七
日不大便者。有瘀血。
按仲景或曰。阳明潮热不大便。与小承气。不转失气者。初硬后必溏。不可攻之。此胃
中初热。未作实者也。或曰。太阳病下之腹满。初硬后必溏。此虚热在上。无燥屎者也。或曰阳
明病。中寒不能食。小便不利。手足 然汗出。欲作痼瘕。初硬后必溏。以水谷不分也。或
曰。小便少者。服承气汤。若不大便六七日。小便少者。初硬后必溏。须小便利屎必硬。乃
可攻之。乃知仲景测大便法。皆以小便验之。然小便利。屎必硬。固为可攻。亦有小便利。
大便硬。而不可攻者。何也。阳明自汗。或发汗。小便自利。此津液内竭。虽硬不可攻。待
其自欲大便。与蜜煎导之。夫胃虽实。有表者汗之。半表半里者和之。不因胃实便下也。此
仲景心法。精考详求。自无妄下之误矣。
（有大便不通、大便困难、大便干硬，这些都是阳明胃实证的候象。）
六七天不大便，头痛伴有发热。给予承气汤。（若）小便清澈，知道病邪不在里，仍在表。（用桂枝汤治疗。）这是阳明病。（或用小柴胡汤治疗。）
阳明病，自汗出或者经过发汗治疗后，小便自然通利，导致体内津液枯竭。虽然大便干硬，也不可用攻下法（可用蜜煎导法通便）。
阳明病，出现潮热且不大便。先少量给予小承气汤。如果不转放屁，说明没有燥屎，不可攻下；如果转放屁，说明有燥屎，可以攻下。（用大承气汤治疗。）
阳明病，未经过催吐或泻下，却出现心烦。（用调胃承气汤治疗。）
阳明病，小便不利，大便时而困难时而容易，偶尔有轻微发热、气喘、头昏目眩不能安卧。这是有燥屎的表现。（用大承气汤治疗。）
伤寒病六七天，眼睛视物不清，眼球转动不灵活。没有表证和里证，只是大便困难，身体微热。（急用大承气汤攻下。）
脉浮说明胃气强盛，脉涩说明小便频数。浮脉与涩脉相搏结，导致大便困难。这是因为脾的功能被约束所致。（用麻仁丸治疗。）
阳明病症表现为健忘，大便颜色发黑，必定是有瘀血蓄积。（用抵当汤治疗。）
没有表证和里证，经过攻下后脉象仍然数动，病未解除，容易饥饿，六七天不大便的，是有瘀血。
按：仲景有时说，阳明病出现潮热且不大便，给予小承气汤。如果不转放屁，说明大便初头硬后必溏，不可攻下。这是因为胃中初起有热，尚未形成实证。
有人说，太阳病误用下法导致腹满，大便初头硬后必溏，这是虚热在上，没有燥屎。
有人说，阳明病中有寒邪不能进食，小便不利，手足濈然汗出，想要形成痼瘕，大便初头硬后必溏，这是因为水谷不分。
有人说，小便少的患者，服用承气汤后，如果六七天不大便，且小便依然少，说明大便初头硬后必溏。必须等到小便变多，大便才会变硬，那时才可以攻下。
由此可知，仲景判断大便的方法，都是通过观察小便来验证的。然而，小便通利，大便必然干硬，这固然是可以攻下的指征；但也有小便通利，大便干硬，却不可攻下的情况，为什么呢？
如果是阳明病自汗出，或者经过发汗治疗，导致小便自然通利，这是体内津液枯竭所致。虽然大便干硬，也不可用攻下法。应等待其自行产生便意时，使用蜜煎导法辅助排便。
胃腑虽然实证，但有表证的用汗法解表，在半表半里的用和解法调和。不会因为胃实就随意使用下法。这是仲景的心法，经过精密考证和详细探求，自然就不会有妄用下法的错误了。
(There are conditions of unpassable stool, difficult stool, and hard stool; all these are manifestations of Yangming Stomach Excess Syndrome.)
After six or seven days without defecation, accompanied by headache and fever. Administer Chengqi Decoction. If the urine is clear, it indicates that the pathogen is not in the interior but remains in the exterior. (Use Guizhi Tang [Cinnamon Twig Decoction].) This is a Yangming disease. (Or use Xiaochaihu Tang [Minor Bupleurum Decoction].)
In Yangming disease, if there is spontaneous sweating or after diaphoresis has been induced, and urination occurs naturally, this depletes the internal fluids (Jinye). Although the stool is hard, purgative methods should not be used (use Honey Suppository for guidance).
In Yangming disease, tidal fever occurs with constipation. First, administer a small dose of Xiao Chengqi Tang [Minor Order the Qi Decoction]. If there is no passage of flatus, there is no dry feces, and purgation is contraindicated. If flatus passes, there are dry feces, and purgation is indicated. (Use Da Chengqi Tang [Major Order the Qi Decoction].)
In Yangming disease, without prior emesis or purgation, mental restlessness occurs. (Use Tiaowei Chengqi Tang [Regulate the Stomach Order the Qi Decoction].)
In Yangming disease, with difficulty in urination, alternating difficulty and ease in defecation, occasional slight fever, panting, dizziness, and inability to lie down, this indicates the presence of dry feces. (Use Da Chengqi Tang [Major Order the Qi Decoction].)
In Cold Damage disease, after six or seven days, the eyes appear unclear and the pupils are unresponsive. Without exterior or interior syndromes, only difficulty in defecation and slight body heat exist. (Urgently use Da Chengqi Tang [Major Order the Qi Decoction] to purge.)
A floating pulse indicates strong Stomach Qi, while a choppy pulse indicates frequent urination. The combination of floating and choppy pulses leads to difficulty in defecation. This is due to the Spleen being constrained. (Use Maren Wan [Semen Cassiae Pill].)
Yangming syndrome presents with forgetfulness and black-colored stool, indicating blood stasis accumulation. (Use Didang Tang [Mighty To Reach Decoction].)
Without exterior or interior syndromes, after purgation, the pulse remains rapid, the illness is unresolved, hunger is prominent, and there is no defecation for six or seven days; this indicates blood stasis.
Commentary: Zhang Zhongjing sometimes states that in Yangming disease with tidal fever and constipation, Xiao Chengqi Tang [Minor Order the Qi Decoction] is given. If there is no passage of flatus, it indicates that the stool is initially hard but will become loose later, so purgation is contraindicated. This is because the heat in the Stomach is initial and has not yet formed an excess condition.
Some say that after incorrect purgation in Taiyang disease leading to abdominal fullness, where the stool is initially hard but becomes loose later, this is due to deficient heat in the upper jiao, with no dry feces present.
Some say that in Yangming disease with cold pathogens preventing food intake, difficulty in urination, and continuous sweating on the hands and feet, intending to form a chronic mass, the stool is initially hard but becomes loose later due to the failure to separate water and grain.
Some say that for patients with scanty urine who take Chengqi Decoction, if there is no defecation for six or seven days and urine remains scanty, it indicates the stool is initially hard but will become loose. One must wait until urination increases and the stool becomes hard before purging can be performed.
Thus, it is known that Zhang Zhongjing’s method of assessing stool always verifies through urine observation. However, while clear urination and hard stool are indeed indications for purgation, there are cases where urination is clear and stool is hard, yet purgation is still contraindicated. Why?
If Yangming disease involves spontaneous sweating or post-diaphoretic natural urination, this depletes internal fluids. Although the stool is hard, purgation is contraindicated. One should wait for the patient's natural urge to defecate and use Honey Suppositories for guidance.
Although the Stomach is in an excess state, if there is an exterior syndrome, use sweating methods; if it is half-exterior half-interior, use harmonizing methods. Do not use purgation simply because of Stomach excess. This is Zhang Zhongjing’s core methodology, derived from precise examination and detailed inquiry, ensuring no errors in reckless purgation.