【纲】仲景曰。阳明病。面合赤色。不可攻之。必发热。色黄。小便不利也。病患小便不利。
大便乍难乍易。时有微热。喘冒不能卧者。有燥屎也。宜大承气汤。
得病二三日。脉弱。无太阳柴胡症。烦躁。心下硬。至四五日。虽能食。以小承气汤少少与微
和之。若不大便。六七日小便少者。虽不能食。但初头硬。后必溏。须小便利。屎定硬。乃可用大
承气攻之。阳明病。小便不利。若中寒。不能食。手足 然汗出。大便初硬后溏者。此欲作痼瘕。
【目】成无己曰。发黄与痞及热病小便不利者。热郁所致。风湿相搏。与阳明中风。其小便不
利。寒邪所乘。其小便难者。亦多由汗下而然。
【纲】仲景曰。若脉浮。发热。渴欲饮水。小便不利者。猪苓汤主之。
【目】王肯堂曰。此浮字误也。活人云。脉浮者五苓散。脉沉者猪苓汤。则知此症。若脉二字
下。脱一不字也。按五苓散。乃茯苓、猪苓、泽泻加桂、术也。猪苓汤。乃猪苓、茯苓泽泻加阿胶、
滑石也。桂术味甘辛为阳。主外。胶滑味甘寒为阴。主内。南阳之言。可为不失仲景之旨矣。但
南阳欲区别二药。分明以沉对浮。遂使后人致疑。三阳症中不当言脉沉。更不复致疑经文之有缺
也。更详太阳症。固当脉浮。而阳明为表之里。故其浮不曰浮而曰长。盖长者。不浮不沉之中脉也。
成氏直以脉浮释之。而朱氏却以脉沉言之。皆失之矣。若曰。脉浮者五苓散。脉沉者猪苓汤。则
得旨。
【纲】张仲景说：阳明病，面部呈现赤红色，不可使用攻下法。如果误用攻下，必然导致发热、面色发黄、小便不利。患者小便不利，大便时而困难时而容易，偶尔有轻微发热，气喘且头目昏眩不能平卧的，这是体内有燥屎积滞。适宜使用大承气汤。
患病两三天，脉象虚弱，没有太阳病或少阳病的症状，出现烦躁、胃脘部硬满。到了第四五天，虽然能够进食，但只给予少量小承气汤以微微调和肠胃。如果仍然不大便，到了第六七天，小便量少，虽然不能进食，但大便开头硬，后面必定稀溏。必须等到小便通利，大便确定变硬后，才可以使用大承气汤进行攻下。阳明病，小便不利，如果是中寒证，不能进食，手足濈然汗出，大便开头硬后面稀溏的，这是将要形成顽固性的积聚包块（痼瘕）。
【目】成无己说：发黄、痞证以及热病引起的小便不利，都是由热邪郁结所致。风湿相互搏结，以及阳明中风引起的小便不利，是寒邪侵袭所致。小便困难的，也多是由发汗或攻下之后导致的。
【纲】张仲景说：如果脉浮，发热，口渴想喝水，小便不利的，用猪苓汤主治。
【目】王肯堂说：这里的“浮”字是错误的。《活人书》说：脉浮的用五苓散，脉沉的用猪苓汤。由此可知此症原文在“脉”字下脱漏了一个“不”字。按五苓散，是由茯苓、猪苓、泽泻加上桂枝、白术组成。猪苓汤，是由猪苓、茯苓、泽泻加上阿胶、滑石组成。桂枝和白术味道辛甘属阳，主要作用于体表；阿胶和滑石味道甘寒属阴，主要作用于体内。南阳（指朱肱）的话，可以说没有违背张仲景的本意。但是南阳想要明确区分这两种药，刻意用“沉”对“浮”，致使后人产生疑惑。在三阳病证中不应该说脉沉，也就不再怀疑经文是否有缺失了。再详细分析太阳病，确实应当脉浮，而阳明病位于表之里，所以其脉象不称为浮而称为长。所谓长脉，是不浮不沉之间的脉象。成无己直接用脉浮来解释，而朱肱却用脉沉来说明，都失之偏颇。如果说“脉浮者用五苓散，脉沉者用猪苓汤”，那就得其真意了。
[General Principle] Zhang Zhongjing said: In Yangming disease, if the face appears reddish, purgation must not be used. If purgation is mistakenly applied, it will inevitably lead to fever, yellowing of the skin, and difficult urination. When a patient presents with difficult urination, stool that is occasionally difficult and occasionally easy, slight fever at times, wheezing, and dizziness preventing them from lying down, this indicates the presence of dry fecal impaction (dry shit). Da Cheng Qi Tang (Great Order the Qi Decoction) is appropriate.
Two or three days after contracting the disease, if the pulse is weak, there are no symptoms of Taiyang disease or Shaoyang disease (Chaihu syndrome), but rather irritability and hardness in the epigastrium. By the fourth or fifth day, even if the patient can eat, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) should be given in small amounts to gently harmonize the stomach and intestines. If there is still no bowel movement, by the sixth or seventh day, if urine output is scanty, and even if the patient cannot eat, but the stool is hard at the beginning and loose at the end, one must wait until urination becomes smooth and the stool is confirmed to be hard before using Da Cheng Qi Tang for purgation. In Yangming disease, if there is difficult urination due to cold invasion, inability to eat, sweating on the hands and feet, and stool that is hard initially but loose later, this suggests the impending formation of a stubborn mass (Gu Jia).
[Commentary] Cheng Wuji stated: Yellowing of the skin, Pi syndrome (fullness and obstruction), and difficult urination caused by heat diseases are all due to the stagnation of heat. Difficult urination caused by the binding of wind-dampness or Yangming wind-strike is due to the assault of cold pathogens. Difficulty in urination often results from prior sweating or purgation therapies.
[General Principle] Zhang Zhongjing said: If the pulse is floating, there is fever, thirst with a desire to drink water, and difficult urination, Zhu Ling Tang (Polyporus Decoction) is the primary treatment.
[Commentary] Wang Kentang stated: The character "floating" here is erroneous. *Huo Ren Shu* (The Book That Saves Lives) states: For a floating pulse, use Wu Ling San (Five-Ingredient Powder with Poria); for a sinking pulse, use Zhu Ling Tang. From this, we know that the original text likely omitted the character "not" after the word "pulse." Wu Ling San consists of Fu Ling (Poria), Zhu Ling (Polyporus), Ze Xie (Alisma), plus Gui Zhi (Cinnamon Twig) and Bai Zhu (Atractylodes Macrocephala Rhizome). Zhu Ling Tang consists of Zhu Ling (Polyporus), Fu Ling (Poria), Ze Xie (Alisma), plus E Jiao (Donkey-Hide Gelatin) and Hua Shi (Talcum). Gui Zhi and Bai Zhu have acrid-sweet flavors and belong to Yang, primarily acting on the exterior; E Jiao and Hua Shi have sweet-cold flavors and belong to Yin, primarily acting on the interior. Zhu's words can be said to faithfully reflect Zhongjing's intent. However, because Zhu wished to clearly distinguish between the two formulas, he deliberately contrasted "sinking" with "floating," causing later generations to doubt. It is inappropriate to mention a sinking pulse in the context of the Three Yang diseases, which would otherwise prevent suspicion of textual omission in the classic. Furthermore, while Taiyang diseases indeed present with a floating pulse, Yangming disease is interior to the exterior; thus, its pulse is described as "long" rather than "floating." A long pulse is neither floating nor sinking. Cheng Wuji interpreted it directly as a floating pulse, whereas Zhu Gong discussed it as a sinking pulse; both were mistaken. If one says, "For a floating pulse, use Wu Ling San; for a sinking pulse, use Zhu Ling Tang," then the true meaning is captured.