有承气症。脉弦长。小便不利。大便乍难乍易。微热。喘冒不得卧者。燥屎也。
邵评∶燥屎内结不眠。必兼有腹胀硬之症。宜以小承气汤加川连清下之。有栀豉汤症。发热汗出。不恶
寒。反恶热。咽燥口苦而喘。烦躁不眠者。内热欲出也。
又有汗吐下后。虚烦不得眠。反复颠倒。心中懊 。亦栀子豉汤。或竹叶石膏汤。
发黄头汗出者。热不得外越而上泄也。背强恶寒。头汗出者。寒湿客搏经络也。
下血谵语。头汗出者。热入血室也。虚烦懊 。头汗出者。邪客胸中。热气蒸于上也。水结胸。头汗出者。
水气停蓄。不得外行也。往来寒热。头汗出者。火邪熏灼上炎也。皆当分门施治。
邵评∶少阳木火上炎而头汗。亦屡见之。
关格症。不得尿。头无汗者生。有汗者死。湿家误下。额上汗出微喘。小便不利者死。（以上参准绳）
邵评∶微喘额汗。阳从上脱。小便不利。阴已下竭。阴阳离决。安得不死。
按阳明热不得越。上蒸于首而头汗出者。不恶寒而恶热。寒湿客抟于经。而头汗出者。必恶风恶寒。（参金鉴）
邵评∶此辨寒热湿邪在表在里之法。语最简当。
胃主四肢。为热聚于胃。其津液旁达于手足也。阳明病。手足汗。潮热谵语。便硬者可下。若阳明胃
土中寒。脾不约束。津液横溢四肢。犹如阴盛霪雨滂沱。故汗出而冷也。阳虚失运。中寒不化。故不能食。而小
便不利也。大便必先硬后溏。今虽便硬。手足汗出。非阳明实热者比。不可攻。攻之必作固瘕。宜浓朴甘
草生姜半夏人参汤。（以上合参准绳金鉴）
固瘕。硬屎下后。即泻清水也。
有承气汤证。脉象弦长。小便不通畅。大便时而困难时而容易。轻微发热。气喘且头昏目眩不能平卧的，是燥屎内结。
邵评：燥屎内结导致不眠，必定兼有腹部胀满硬痛的症状。适宜用小承气汤加黄连以清热攻下。有栀子豉汤证，发热出汗。不恶寒。反而怕热。咽喉干燥口苦且气喘。烦躁不眠的，是内热欲向外发散。
又有经过发汗、催吐或泻下治疗后，出现虚烦不得安眠。翻来覆去。心中烦闷懊恼的，也用栀子豉汤。或者用竹叶石膏汤。
身体发黄且头部出汗的，是热邪不能向外发散而向上宣泄。背部僵硬怕冷的，头部出汗的，是寒湿之邪客居搏结于经络。
便血且胡言乱语，头部出汗的，是热邪陷入血室。虚烦懊恼，头部出汗的，是邪气客居胸中。热气蒸腾于上部。水饮结聚于胸，头部出汗的，是水气停蓄。不能向外运行。寒热往来，头部出汗的，是火邪熏灼上炎。这些都应当分类施治。
邵评：少阳木火上炎导致的头汗，也屡见不鲜。
关格证。小便不通。头部无汗的预后良好。有汗的预后不良（主死）。湿病患者误用泻下法，额头出汗微喘。小便不通畅的预后不良（主死）。（以上参考《医宗必读》）
邵评：微喘且额头出汗，是阳气从上脱失。小便不通畅，是阴液已从下枯竭。阴阳离决，怎么能不死呢。
按：阳明热邪不得外越。上蒸于头部而致头汗出的，不恶寒而恶热。寒湿之邪客居搏结于经脉，而致头汗出的，必定怕风怕冷。（参考《医宗金鉴》）
邵评：这是辨别寒热湿邪在表在里的方法，语言最为简练恰当。
胃主管四肢。因为热邪聚集于胃。津液旁达于手足。阳明病。手足出汗。潮热胡言乱语。大便干硬的可以攻下。如果阳明胃土中寒。脾脏不能约束。津液横溢于四肢。犹如阴盛时大雨滂沱。所以出汗且寒冷。阳虚失去运化。中焦寒凝不化。所以不能进食。而小便不通畅。大便一定是先干硬后稀溏。现在虽然大便干硬。但手足出汗。不同于阳明实热的情况。不可攻下。攻下必然导致固瘕（一种积聚病证）。适宜用浓朴甘草生姜半夏人参汤。（以上综合参考《医宗必读》和《医宗金鉴》）
固瘕。指大便干硬排出后。随即腹泻清水。
There is a Chengqi Tang syndrome. The pulse is string-like and long. Urination is difficult. Bowel movements are alternately difficult and easy. There is slight fever, panting, and dizziness preventing sleep; this indicates dry feces (dry stool) accumulation.
Shao's commentary: Insomnia caused by internal accumulation of dry feces must be accompanied by abdominal distension and hardness. It is appropriate to use Xiao Cheng Qi Tang (Minor Order the Qi Decoction) with added Huang Lian (Coptidis Rhizoma) to clear heat and purge downward. There is also Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) syndrome: fever with sweating, aversion to cold is absent, but there is aversion to heat, dry throat, bitter taste in the mouth, panting, irritability, and insomnia; this indicates internal heat attempting to exit.
Furthermore, after treatment with sweating, vomiting, or purging methods, if there is deficiency-induced vexation and inability to sleep, tossing and turning, and mental restlessness and regretfulness (Ao Nu), Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) should be used. Alternatively, Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) may be used.
Jaundice accompanied by head sweating indicates that heat cannot diffuse outward and instead vents upward. Back stiffness with aversion to cold, accompanied by head sweating, indicates cold-dampness invading and binding the meridians. Hematochezia with delirium, accompanied by head sweating, indicates heat entering the Blood Chamber (Xue Shi). Deficiency-induced vexation and regretfulness, accompanied by head sweating, indicates pathogenic factors residing in the chest, with hot qi steaming upward. Water retention in the chest (Shui Jie Xiong) with head sweating indicates water qi stagnation and accumulation, unable to move outward. Alternating chills and fever with head sweating indicates fire pathogen scorching and flaming upward. All these cases require treatment based on their specific categories.
Shao's commentary: Head sweating due to the flaming upward of Shaoyang Wood-Fire is also frequently seen.
Guan Ge syndrome (Obstruction and Repletion): Inability to urinate. If there is no sweat on the head, life can be preserved; if there is sweat, death ensues. If a patient with dampness is mistakenly treated with purgatives, and presents with sweating on the forehead, slight panting, and inability to urinate, death ensues. (Referenced from *Yi Zong Bi Du*)
Shao's commentary: Slight panting and sweating on the forehead indicate Yang Qi escaping from above. Inability to urinate indicates Yin fluids exhausted from below. With the separation of Yin and Yang, how can one not die?
Note: When Yangming heat cannot diffuse outward and steams upward to the head causing head sweating, there is no aversion to cold but rather aversion to heat. When cold-dampness invades and binds the meridians causing head sweating, there is definitely aversion to wind and cold. (Referenced from *Yi Zong Jin Jian*)
Shao's commentary: This distinguishes the methods for identifying cold, heat, and damp pathogens in the exterior versus interior. The language is concise and appropriate.
The Stomach governs the four limbs. When heat gathers in the Stomach, body fluids reach the hands and feet peripherally. In Yangming disease, if there is sweating on the hands and feet, tidal fever, delirium, and hard stools, purgation is indicated. However, if there is cold in the Yangming Stomach Earth, and the Spleen fails to constrain, body fluids overflow to the four limbs like heavy rain during Yin excess, resulting in cold sweating. Yang deficiency leads to loss of transportation, and middle-jiao cold prevents transformation, resulting in an inability to eat and difficulty urinating. Stool will typically be hard first and then loose. Although the stool is currently hard, the presence of hand and foot sweating distinguishes this from Yangming excess-heat; it should not be purged. Purging would inevitably lead to Gu Jia (a type of abdominal mass/accumulation). Nong Po Gan Cao Sheng Jiang Ban Xia Ren Shen Tang (Aconite-free formula focusing on Magnolia Bark, Licorice, Ginger, Pinellia, and Ginseng) is appropriate. (Synthesized from *Yi Zong Bi Du* and *Yi Zong Jin Jian*)
Gu Jia refers to the condition where, after hard stool is passed, watery diarrhea immediately follows.