【纲】仲景曰。病患小便不利。大便乍难乍易。时有微热。喘冒不能卧。有燥屎也。宜大承气
汤。
【目】王好古曰。伤寒传至五六日间。渐变神昏不语。或睡中独语一二句。目赤唇焦舌干。不
饮水。稀粥与之则咽。不与则不思。六脉细数而不洪大。心下不痞。腹中不满。大小便如常。或传
至十日以来。形貌如醉。若用大承气则误矣。不知此热传少阴心经也。然又未知自何经而来。答曰。
本太阳经伤风。风为阳邪伤卫。则阴血自燥。热结膀胱。壬病逆传于丙。丙丁兄妹。由是传心。
心火自上迫熏肺。所以神昏也。盖肺为清肃之脏。内有邪。故令神昏。宜栀子黄连黄芩汤。若脉在
丙者导赤散。脉在丁者。泻心汤。若误用凉膈散。此乃气中之血药也。如右手寸脉沉滑有力者。则
可用之。或用犀角地黄汤。如无犀角。以升麻代之。是阳明经药也。解阳明经血中之热。若脉沉俱有力
者。是丙丁俱有热。可以导赤泻心各半服之。
【纲】仲景曰。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。大承气汤主之。若一服利。止后服。谵语直视。喘满者死。下利者亦死。
【目】成无己曰。此皆邪气盛而正气脱也。其或有目中不了了。睛不和。无表里症。大便难。
身微热者。是非直视也。此为内实也。可用大承气大柴胡下之。直视为不治之疾。目中不了了。为
可治之候。二者形症相近。宜熟审之。
陈士铎曰。伤寒阳明症中。有直视谵语。喘满者死。下利者亦死之文。此必诸症一齐同见。苟
有一症未兼。尚不直视。倘三症皆见。必死症矣。虽然直视谵语。多由胃火之盛。自焚其心。而肾
水不能来济。火愈盛而无制。喘满者。火炎而气欲上脱。下利者。火降而气欲下脱也。此犹属欲脱
未脱之危症。治之得法。犹可望生。急以援脱散救之。人参、麦冬、白芍各一两。石膏五钱。竹茹
三钱。水煎服。此方用人参以救脱。石膏平火。麦冬平喘。白芍止利。竹茹清心。自然气不绝而可
救。真奇方也。
【纲】张仲景说：病人小便不通畅，大便时而困难时而容易，偶尔有轻微发热，气喘且头昏目眩无法平卧，这是体内有燥屎积结。适宜使用大承气汤。
【目】王好古说：伤寒病传变到五六天期间，逐渐出现神志昏迷、不说话，或者在睡眠中独自说一两句话，眼睛发红、嘴唇焦枯、舌头干燥，但不想喝水；如果给稀粥喝则能吞咽，不给则不想吃。六脉细数而不洪大，心下（胃脘部）不痞塞，腹部不满胀，大小便正常。如果病情传变到十天左右，人的神态容貌像喝醉了一样。如果此时误用大承气汤就错了。这是因为不知道此热邪传入少阴心经了。然而又不知道它从哪条经络传来？回答是：原本太阳经受风邪侵袭，风为阳邪损伤卫气，导致阴血自然干燥，热邪结聚于膀胱。壬水（肾/膀胱）的病逆传于丙火（小肠），丙丁（小肠与心）如同兄妹关系，因此病邪传至心脏。心火从上方向下逼迫熏蒸肺脏，所以导致神志昏迷。因为肺是清肃的脏器，内有邪气干扰，所以令神志昏迷。适宜使用栀子黄连黄芩汤。如果脉象显示病位在小肠（丙），可用导赤散；脉象显示病位在心（丁），可用泻心汤。如果误用凉膈散，这是针对气分中的血药。如果右手寸脉沉滑有力，则可以使用凉膈散。或者使用犀角地黄汤。如果没有犀角，可以用升麻代替，这是治疗阳明经的药物，用于解除阳明经血分中的热邪。如果脉象沉而都有力，说明丙（小肠）和丁（心）都有热，可以导赤散和泻心汤各半服用。
【纲】张仲景说：伤寒病经过催吐或攻下治疗后，病仍未解，不大便，从五到六天甚至长达十余天，每天下午申时（约15-17点）发作潮热，不怕冷，独自说话好像看见鬼怪一样。如果病情严重，发作时不认识人，手抓衣被摸床沿，惊恐不安，轻微气喘且两眼直视。脉象弦的预后良好（生），脉象涩的预后不良（死）。症状较轻的，只是发热和胡言乱语，以大承气汤为主治方剂。如果服一次后大便通畅，就停止后续服药。出现胡言乱语、两眼直视、气喘胸满的，预后死亡；出现腹泻的，也预后死亡。
【目】成无己说：这些都是邪气盛实而正气脱失的表现。其中如果有眼睛看起来模糊不清、眼球转动不灵活，没有表证也没有里证，大便困难，身体微热的，这不是直视。这是体内实热积滞，可以使用大承气汤或大柴胡汤攻下。直视属于不治之症，眼睛模糊不清则是可治的征候。这两种形态症状相近，应当仔细审察辨别。
陈士铎说：在伤寒阳明病证中，有“直视谵语，气喘胸满者死，腹泻者亦死”的记载。这一定是多种症状同时出现。假如有一种症状未兼见，尚不至于出现直视。倘若三种症状全部出现，必然是死症了。虽然如此，直视和谵语，多由胃火旺盛，自我焚烧心神，而肾水不能上来济助，火势更加旺盛而没有制约。气喘胸满，是火炎上冲导致气欲向上脱失；腹泻，是火降下行导致气欲向下脱失。这还属于气将脱未脱的危险重症。治疗方法得当，仍然有望存活。紧急使用援脱散来抢救。人参、麦冬、白芍各一两，石膏五钱，竹茹三钱，水煎服。此方用人参来挽救气脱，石膏平息火势，麦冬平息气喘，白芍止住腹泻，竹茹清心安神，自然气息不绝从而得以救治。真是奇妙的方子啊。
[Outline] Zhang Zhongjing stated: When a patient presents with difficulty in urination, alternating difficulty and ease in defecation, occasional slight fever, wheezing, dizziness, and inability to lie down, this indicates the presence of dry fecal impaction. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.
[Commentary] Wang Haogu stated: During the fifth to sixth day of Shaoyang disease transmission, symptoms may gradually evolve into unconsciousness and muteness, or speaking alone for one or two sentences during sleep. The eyes may be red, lips scorched, and tongue dry, yet the patient does not desire water. If given thin gruel, they will swallow; if not offered, they show no interest. The six pulses are fine and rapid but not surging and large. There is no epigastric fullness or abdominal distension, and bowel and bladder functions remain normal. If the condition persists for ten days or more, the patient's demeanor may resemble intoxication. In such cases, using Da Cheng Qi Tang would be an error. This occurs because the heat has transmitted to the Shaoyin Heart Meridian, though its origin from another meridian remains unclear. The answer is that it originated from Wind pathogen injuring the Taiyang meridian. As Wind is a Yang pathogen damaging the Wei (Defensive) qi, Yin blood naturally becomes dry. Heat accumulates in the Bladder. The pathology of Ren Water (Kidney/Bladder) transmits inversely to Bing Fire (Small Intestine). Since Bing and Ding (Small Intestine and Heart) are like siblings, the disease transmits to the Heart. Heart fire forces and steams the Lung from above, causing unconsciousness. Since the Lung is a clear and descending organ, internal pathogens cause this state. Zhi Zi Huang Lian Huang Qin Tang (Gardenia, Coptis, and Scutellaria Decoction) is suitable. If the pulse indicates involvement of Bing (Small Intestine), Dao Chi San (Guide Out the Red Powder) may be used; if the pulse indicates involvement of Ding (Heart), Xie Xin Tang (Drain the Epigastrium Decoction) is indicated. Misusing Liang Ge San (Cool the Diaphragm Powder) is inappropriate as it acts on blood within the Qi level. However, if the Cun position of the right hand pulse is deep, slippery, and forceful, it may be used. Alternatively, Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) can be employed. If Rhinoceros Horn is unavailable, Sheng Ma (Cimicifugae Rhizoma) may substitute it; this is a medicine for the Yangming Meridian, resolving heat in the Blood level of the Yangming Meridian. If all pulses are deep and forceful, indicating heat in both Bing and Ding, Dao Chi San and Xie Xin Tang may be taken in equal halves.
[Outline] Zhang Zhongjing stated: After vomiting or purgation in Shaoyang disease, if the condition remains unresolved, constipation persists for five to six days or even over ten days. Tidal fever occurs around Shen hour (3-5 PM), without aversion to cold. The patient speaks alone as if seeing ghosts. In severe cases, upon onset, they fail to recognize people, grasp at clothing and bed rails, feel terrified and uneasy, exhibit slight wheezing, and stare fixedly. A wiry pulse indicates survival; a choppy pulse indicates death. In milder cases, there is only fever and delirium, treated primarily with Da Cheng Qi Tang. If relief occurs after one dose, discontinue further administration. Delirium combined with fixed staring, wheezing, and chest fullness indicates death; diarrhea under these conditions also indicates death.
[Commentary] Cheng Wuji stated: These scenarios reflect excessive pathogenic factors and depletion of righteous qi. If the patient has blurred vision and unsteady eyeballs, without exterior or interior syndromes, difficulty in defecation, and slight body heat, this is not fixed staring. This represents internal excess, treatable with Da Cheng Qi Tang or Da Chai Hu Tang via purgation. Fixed staring is considered incurable, whereas blurred vision is a sign of treatability. Although their manifestations are similar, careful differentiation is required.
Chen Shiduo stated: In Yangming syndrome of Shaoyang disease, texts mention that fixed staring with delirium, accompanied by wheezing and chest fullness, or diarrhea, leads to death. This implies simultaneous occurrence of all symptoms. If any single symptom is absent, fixed staring may not occur. If all three coexist, it is inevitably fatal. Nevertheless, fixed staring and delirium often result from excessive Stomach fire burning the Heart, while Kidney Water fails to ascend to nourish it, allowing the fire to rage unchecked. Wheezing and chest fullness indicate fire flaring upward causing Qi to attempt escape upwards; diarrhea indicates fire sinking downward causing Qi to attempt escape downwards. These represent critical conditions where Qi is about to deplete but has not yet done so. With proper treatment, survival is possible. Urgently administer Yuan Tuo San (Rescue Collapse Powder): Ren Shen (Ginseng Radix), Mai Dong (Ophiopogonis Radix), and Bai Shao (Paeoniae Radix Alba) each 1 liang, Shi Gao (Gypsum Fibrosum) 5 qian, Zhu Ru (Bambusae Caulis in Taenia) 3 qian. Decoct in water and drink. This formula uses Ren Shen to rescue collapse, Shi Gao to calm fire, Mai Dong to stop wheezing, Bai Shao to stop diarrhea, and Zhu Ru to clear the Heart and calm spirit. Naturally, Qi remains intact, allowing for rescue. It is truly a miraculous prescription.