人参（三两○肘后方。作一两。） 生姜（六两切） 吴茱萸（一升洗○肘后。作半斤。外台。洗。作
炒。） 大枣（十二枚擘）
上四味。以水七升。煮取二升。去滓。温服七合。日三服。（金匮。七升。作五升。二升。作三升。外台。
亦作五升。）
〔汪〕呕为气逆。气逆者必散之。吴茱萸辛苦。味重下泄。治呕为最。兼以生姜。又治呕圣药。非若四逆
中之干姜。守而不走也。武陵陈氏云。其所以致呕之故。因胃中虚生寒。使温而不补。呕终不愈。故用人参补
中。合大枣。以为和脾之剂焉。
钱氏云。吴茱萸一升。当是一合。即今之二勺半。人参三两。当是一两。即宋之二钱七分。生姜六两。
当是二两。即宋之五钱余。大枣当是四五枚。水七升。亦当是三升。观
小承气汤。止用水四升。调胃承气。只用水三升。此方以辛热补剂。而用之于表里疑似之间。岂反过之。大约
出之后人之手。非仲景本来升合分两。学人当因时酌用。○案此说未知然否。姑举于此。
金匮要略。呕而胸满者。茱萸汤主之。
肘后方。治人食毕噫醋。及醋心。（即本方）
医方集解曰。服汤反剧者。宜葛根加半夏汤。小柴胡汤。栀子豉汤。黄芩汤。又云。吴茱萸。为厥阴本
药。故又治肝气上逆。呕涎头痛。本方加附子。名吴茱萸加附子汤。治寒疝腰痛。牵引睾丸。尺脉沉迟。
太阳病。寸缓关浮尺弱。其人发热汗出。复恶寒。不呕。但心下痞者。此以医下之也。如其不下者。病
人不恶寒而渴者。此转属阳明也。小便数者。大便必硬。不更衣十日。无所苦也。渴欲饮水。少少与之。但以
法救之。渴者。宜五苓散。（玉函。关下。有小字。如其以下十三字。作若不下其人复不恶寒而渴十二字。）
〔成〕太阳病。脉阳浮阴弱。为邪在表。今寸缓关浮尺弱。邪气渐传里。则发热汗出。复恶寒者。表未解
也。传经之邪入里。里不和者。必呕。此不呕。但心下痞者。医下之早。邪气留于心下也。如其不下者。必渐
不恶寒而渴。太阳之邪。转属阳明也。若吐若下若发汗后。小便数。大便硬者。当与小承气汤和之。此不因吐
下发汗后。小便数。大便硬。若是无满实。虽不更衣十日。无所苦也。候津液还入胃中。小便数少。大便必自
出也。渴欲饮水者。少少与之。以润胃气。但审邪气所在。以法攻之。如渴不止。与五苓散是也。〔吴〕寸缓。
风伤卫也。关浮。邪犹在经。未入腑也。尺弱。其人阴精素亏也。
王三阳云。此处。五苓散难用。不然。经文渴字上。当
有缺文也。金鉴云。但以法救之五字。当是若小便不利。方与上文小便数。下文渴者之义。相合。此条病势不
急。救之之文。殊觉无谓。必有遗误。汪氏云。渴欲饮水。至救之十三字。当在小便数者之前。不恶寒而渴者。
者字可删。吴仪洛删渴欲以下十九字。注云。旧本多衍文。今删之。○案此条难解。以上四家。各有所见。未知
何是。姑存而举于此。
脉阳微而汗出少者。为自和（【原注】一作如。）也。汗出多者为太过。阳脉实。因发其汗。出多者。亦
为太过。太过者。为阳绝于里。亡津液。大便因硬也。（成本。太过下。无者字。阳脉实以下。为别条。方本。
周本。钱本。汪本。魏本。并同）
〔鉴〕脉阳微。谓脉浮无力而微也。阳脉实。谓脉浮有力而盛也。凡中风伤寒。脉阳微则热微。微热蒸表
作汗。若汗出少者。为自和欲解。汗出多者。为太过不解也。阳脉实则热盛。因热盛而发其汗出多者。亦为太
过。则阳极于里。亡津液。大便因硬。而成内实之证矣。〔汪〕阳明病。阳脉不微而实。实者。按之搏指而有
力也。〔魏〕经文阳绝之义。似是阻绝。盖谓阳盛阻阴也。非断绝之绝。内经言绝。多如此。〔程〕阳绝于里
者。燥从中起。阳气闭绝于内。而不下通也。下条其阳则绝。同此。
汪氏云。总于后条。用麻仁丸以主之。补亡论。议用小柴胡汤。又柴胡桂枝汤。以通津液。如大便益坚。
议用承气等汤。大误之极。
脉浮而芤。浮为阳。芤为阴。浮芤相搏。胃气生热。其阳则绝。（二为字下。玉函。有则字。）
〔钱〕浮为阳邪盛。芤为阴血虚。阳邪盛则胃气生热。阴血虚则津液内竭。故其阳则绝。绝者。非断绝败
绝之绝。言阳邪独治。阴气虚竭。阴阳不相为用。故阴阳阻绝。而不相
流通也。即生气通天论所谓。阴阳离决。精气乃绝之义也。注家俱谓阳绝。乃无阳之互词。恐失之矣。〔沈〕
此辨阳明津竭之脉也。若见此脉。当养津液。不可便攻也。
趺阳脉浮而涩。浮则胃气强。涩则小便数。浮涩相搏。大便则硬。其脾为约。麻子仁丸主之。（成本。无
子字。仁。作人。柯本。无此条。及麻仁丸方。）
〔成〕趺阳者。脾胃之脉。诊浮为阳。知胃气强。涩为阴。知脾为约。约者。俭约之约。又约束之约。
内经曰。饮入于胃。游溢精气。上输于脾。脾气散精。上归于肺。通调水道。下输于膀胱。水精四布。五经并
行。是脾主为胃行其津液者也。今胃强脾弱。约束津液。不得四布。但输膀胱。致小便数大便难。与脾约丸。
通肠润燥。〔汪〕趺伤者。胃脉也。在足趺上五寸骨间。去陷谷三寸。即足阳明经。冲阳二穴。按之其脉应手
而起。按成注。以胃强脾弱。为脾约作解。推其意。以胃中之邪热盛为阳强。故见脉浮。脾家之津液少为阴弱。
故见脉涩。〔程〕脾约者。脾阴外渗。无液以滋。脾家先自干槁了。何能以余阴。荫及肠胃。所以胃火盛而肠
枯。大便坚而粪粒小也。麻仁丸。宽肠润燥。以软其坚。欲使脾阴从内转耳。
案喻氏讥成氏脾弱之说云。脾弱。即当补矣。何为麻仁丸中。反用大黄枳实浓朴乎。汪氏则暗为成注解
纷。大是。又案。胃强脾弱。究竟是中焦阳盛而阴弱之义。不必拘拘脾与胃也。
伤寒选录曰。愚案趺阳脉。一名会元。又名冲阳。在足背上去陷谷三寸。脉动处。是也。此阳明胃脉之
用由出。夫胃者。水谷之海。五脏六腑之长也。若胃气以惫。水谷不进。谷神以去。脏腑无所禀受。其脉不动
而死也。故诊趺阳脉。
以察胃气之有无。仲景又谓趺阳脉。不惟伤寒。虽杂病危急。亦当诊此以察其吉凶。
麻子仁丸方
麻子仁（二升） 芍药（半斤） 枳实（半斤炙○千金翼。芍药。枳实。各八两。） 大黄（一斤去皮）
浓朴（一尺去皮○玉函。作一 。） 杏仁（一升去皮尖熬别作脂○玉函。作一 。）
上六味。蜜和丸如梧桐子大。饮服十丸。日三服。渐加。以知为度。（六味下。成本。玉函。有为末炼三
字。和。作为。成本。无梧字。证类本草。饮服十丸。作以浆水饮下十丸。）
〔徐〕即小承气。加芍药二仁也。〔方〕麻子杏仁。能润干燥之坚。枳实浓朴。能导固结之滞。芍药敛液
以辅润。大黄推陈以致新。脾虽为约。此之疏矣。
吴仪洛方论曰。此治素惯脾约之人。复感外邪。预防燥结之法。方中用麻杏二仁。以润肠燥。芍药以养阴
血。枳实大黄。以泄实热。浓朴以破滞气也。然必因客邪加热者。用之为合辙。后世以此。概治老人津枯血燥
之闭结。但取一时之通利。罔顾愈伤其真气。得不速其咎耶。
案明理论。即名脾约丸。
张氏缵论曰。云丸者。如理中陷胸抵当。皆大弹丸。煮化而和滓服之也。云丸者。和麻仁乌梅。皆用小丸。
取达下焦也。盖丸圆后世互用。今据张说考论中。其言不诬。然论中丸字。千金外台。多作圆。不知其义如何。
拈而存疑。
案本草序例。浓朴一尺无考。医心方。引短剧方云。浓朴一尺。及数寸者。浓三分。广一寸半为准。
太阳病。三日发汗不解。蒸蒸发热者。属胃也。调胃承气汤主之。（外台。作发其汗病不解。玉函。作蒸
蒸然。脉经。无调胃二字。）
〔程〕何以发汗不解便属胃。盖以胃燥素盛。故他表证虽
罢。而汗与热不解也。第征其热。如炊笼蒸蒸而盛。则知其汗必连绵 而来。此即大便已硬之征。故曰属胃
也。热虽聚于胃。而未见潮热谵语等证。主以调胃承气汤者。于下法内。从乎中治。以其为日未深故也。表热
未除。而里热已待。病势久蕴于前矣。只从发汗后。一交替耳。凡本篇中云太阳病。云伤寒。而无阳明病字者。
皆同此病机也。要之脉已不浮而大。可必。〔钱〕蒸蒸发热。犹釜甑之蒸物。热气蒸腾。从内达外。气蒸湿润
之状。非若翕翕发热之在皮肤也。
伤寒吐后。腹胀满者。与调胃承气汤。
〔程〕吐法为膈邪而设。吐后无虚烦等证。必吐其所当吐者。只因胃家素实。吐亡津液。燥气不能下达。
遂成土郁。是以腹胀。其实无大秽浊之在肠也。调胃承气汤。一夺其郁可耳。
太阳病。若吐若下若发汗后。微烦小便数。大便因硬者。与小承气汤和之愈。（成本。玉函。无后字。）
〔鉴〕太阳病。若吐若下。若发汗后不解。入里微烦者。乃栀子豉汤证也。今小便数。大便因硬。是津
液下夺也。当与小承气汤和之。以其结热未甚。入里未深也。
得病二三日。脉弱。无太阳柴胡证。烦躁心下硬。至四五日。虽能食。以小承气汤。少少与微和之。令
小安。至六日。与承气汤一升。若不大便。六七日。小便少者。虽不受食。（【原注】一云。不大便。）但初
头硬。后必溏。未定成硬。攻之必溏。须小便利屎定硬。乃可攻之。宜大承气汤。（受。成本。玉函。作能。
千金翼。不受食。作不大便。无大承气汤之大字。）
〔汪〕得病二三日。不言伤寒与中风者。乃风寒之邪皆有。不须分辨之病也。脉弱者。谓无浮紧等在表
之脉也。无太阳柴胡证。谓无恶寒发热。或往来寒热在表。及半表半里之证
也。烦躁心下硬者。全是阳明腑热邪实。经云。肠实则胃虚。故能食。能食者。其人不痞不满。结在肠间。而
胃火自盛。止须以小承气汤。少少与微和之。因其人烦躁必不大便。令其小安也。至六日。仍烦躁不安。而不
大便者。前用小承气汤。可加至一升。使得大便而止。此言小承气汤。不可多用之意。若不大便句。承上文烦
躁心下硬而言。至六七日不大便。为可下之时。但小便少。乃小水不利。此系胃中之水谷不厘清。故不能食。
非谵语潮热有燥屎之不能食也。故云虽不能食。但初头硬后必溏。未定成硬。而攻之。并硬者。必化而为溏矣。
须待小便利。屎定成硬。乃可用大承气汤攻之。此言大承气亦不可骤用之意。〔方〕太阳不言药。以有桂枝麻
黄之不同也。柴胡不言证。以专少阳也。凡似此为文者。皆互发也。以无大小。故知诸证属阳明。以脉弱。故
宜微和。至六日已下。历叙可攻不可攻之节度。〔喻〕此段之虽能食。虽不能食。全与辨风寒无涉。另有二义。
见虽能食者。不可以为胃强而轻下也。虽不能食者。不可以为胃中有燥屎而轻下也。前条云。谵语有潮热。反
不能食者。胃中必有燥屎五六枚。与此互发。
案脉弱。非微弱虚弱之弱。盖谓不浮盛实大也。钱氏云。虚寒之候。柯氏云无阳之征。并误矣。
伤寒六七日。目中不了了。睛不和。无表里证。大便难。身微热者。此为实也。急下之。宜大承气汤。
〔钱〕六七日。邪气在里之时也。外既无发热恶寒之表证。内又无谵语腹满等里邪。且非不大便。而曰大
便难。又非发大热。而身仅微热。势非甚亟也。然目中不了了。是邪热伏于里。而耗竭其津液也。经云。五脏
六腑之精。皆上注于目。热邪内烁。津液枯燥。则精神不得上注于目。故目中不了了。
睛不和也。〔汪〕不了了者。病患之目。视物不明了也。睛不和者。乃医者视病患之睛光。或昏暗。或散乱。
是为不和。〔鉴〕目中不了了。而睛和者。阴证也。睛不和者。阳证也。此结热神昏之渐。危恶之候。急以大承
气汤下之。泻阳救阴。以全未竭之水可也。睛不和者。谓睛不活动也。〔方〕了了。犹 也。
活人指掌曰。目中不了了。了了。谓明了也。或谓之病瘥。案汪氏云。无表里证。里字。当是传写错误。
宜从删。此说大误。
伤寒选录。删里字云。无表里证。则无病。何以用承气汤下之。里实者病可见矣。○案此说却非是。
阳明病。发热汗多者。急下之。宜大承气汤。（【原注】一云。大柴胡汤。○成本。脱病字。张本。汗下。补出字。）
〔钱〕潮热自汗。阳明胃实之本证也。此曰汗多。非复阳明自汗可比矣。里热炽盛之极。津液泄尽。故当
急下。然必以脉症参之。若邪气在经。而发热汗多。胃邪未实。舌苔未干浓而黄黑者。未可下也。〔程〕发热
而复汗多。阳气大蒸于外。虑阴液暴亡于中。虽无内实之兼证。宜急下之。以大承气汤矣。此等之下。皆为救
阴而设。不在夺实。夺实之下可缓。救阴之下。不可缓。不急下。防成五实。经曰。五实者死。
发汗不解。腹满痛者。急下之。宜大承气汤。
人参（三两○《肘后方》记载为一两。）生姜（六两，切片）吴茱萸（一升，洗净○《肘后方》记载为半斤。《外台秘要》记载需洗净并炒制。）大枣（十二枚，掰开）
以上四味药，用水七升，煎煮至二升，滤去药渣。每次温服七合，每日服用三次。（《金匮要略》中水用七升改为五升，二升改为三升。《外台秘要》也作五升。）
〔汪〕呕吐是由于气机上逆。气机上逆的病症必须用发散的方法治疗。吴茱萸味辛、苦，气味厚重，具有下行泄降的作用，是治疗呕吐的最佳药物。配合生姜，生姜也是治疗呕吐的神圣药物，不像四逆汤中的干姜那样守中而不走散。武陵陈氏说：导致呕吐的原因，是因为胃中虚寒，如果只用温中而不补益的药物，呕吐终究不会痊愈。所以用人参来补益中气，配合大枣，作为调和脾气的方剂。
钱氏说：吴茱萸一升，应当是一合，即现在的二勺半。人参三两，应当是一两，即宋代的二钱七分。生姜六两，应当是二两，即宋代的五钱多。大枣应当是四五枚。水七升，也应当是三升。观察小承气汤，只用水四升；调胃承气汤，只用水三升。这个方子虽然是辛热补益之剂，却用在表里疑似难辨的情况下，难道反而过量了吗？大概出自后人之手，不是张仲景原本的升、合、分、两剂量。学习的人应当根据时代酌情使用。○按语：此说不知是否如此，姑且列举于此。
《肘后方》记载：治疗人吃完饭后打嗝泛酸，以及醋心症状。（即本方）
《医方集解》说：服药后病情反而加重的，适宜用葛根加半夏汤、小柴胡汤、栀子豉汤、黄芩汤。又说：吴茱萸是厥阴经的本药，所以又治疗肝气上逆引起的呕吐涎沫、头痛。本方加入附子，名为吴茱萸加附子汤，治疗寒疝腰痛，牵引睾丸，尺脉沉迟。
太阳病，寸脉缓、关脉浮、尺脉弱，其人发热汗出，又恶寒，不呕吐，只是心下痞塞的，这是因为医生误用攻下法所致。如果未经过攻下，病人不恶寒而口渴的，这是病邪转属阳明。小便频数的，大便必然干硬。即使十天不大便，也没有什么痛苦。想喝水，少量给予饮水，只要依法救治即可。口渴的，适宜用五苓散。（《玉函经》在“关”字下有注脚文字，“如其以下十三字”作“若不下其人复不恶寒而渴”十二字。）
〔成〕太阳病，脉象阳部浮、阴部弱，说明邪气在表。现在寸脉缓、关脉浮、尺脉弱，说明邪气逐渐传入里，出现发热汗出，又恶寒，说明表证未解。传经的邪气入里，如果里气不和，必定呕吐。这里不呕吐，只是心下痞塞，是因为医生过早攻下，邪气留滞于心下。如果没有经过攻下，必定逐渐变得不恶寒而口渴，太阳的邪气转属于阳明。如果在吐、下、发汗之后，小便频数，大便干硬的，应当与小承气汤调和它。这里不是因为吐、下、发汗后导致的小便频数、大便干硬。如果是没有胀满结实的情况，即使十天不大便，也没有痛苦。等到津液回归胃中，小便次数减少，大便自然会排出。想喝水的，少量给予饮水，以滋润胃气。只要审察邪气所在的位置，依法攻治。如果口渴不止，给予五苓散就是这样的道理。〔吴〕寸脉缓，是风邪伤及卫气。关脉浮，邪气还在经络，未入腑。尺脉弱，说明此人阴精素来亏虚。
王三阳说：此处五苓散难以使用，否则，经文“渴”字上面应当有缺文。《医宗金鉴》说：“但以法救之”五个字，应当是“若小便不利”，这样才与上文“小便数”、下文“渴者”的意义相符合。此条病势不急，救治的文字，殊觉无意义，必有遗漏错误。汪氏说：“渴欲饮水”至“救之”十三字，应当在“小便数者”之前。“不恶寒而渴者”的“者”字可以删除。吴仪洛删除了“渴欲”以下十九字，注释说：旧本多有衍文，现在删除。○按语：此条难以理解，以上四家各有见解，不知谁是对的，姑且保存并列举于此。
脉象阳部微而汗出少的，是自和（【原注】一作“如”）。汗出多的为太过。阳脉实，因为发其汗，汗出多的，也为太过。太过的情况，会导致阳气绝于里，亡失津液，大便因此干硬。（成本本：在“太过”下没有“者”字。“阳脉实”以下为别一条。方本、周本、钱本、汪本、魏本，都相同。）
〔鉴〕脉象阳部微，是指脉浮而无力且微弱。阳脉实，是指脉浮而有力且盛大。凡是中风伤寒，脉象阳微则热微，微热蒸腾体表作汗，如果汗出少的，是自和欲解的表现；汗出多的，是太过不解的表现。阳脉实则热盛，因为热盛而发汗，汗出多的，也为太过，则阳极于里，亡失津液，大便因此干硬，形成内实的证候。〔汪〕阳明病，阳脉不微而实。实，是指按之搏指而有力。〔魏〕经文“阳绝”的意思，似乎是阻绝。意思是阳盛阻绝阴气，并非断绝的绝。《内经》所说的“绝”，大多像这样。〔程〕阳绝于里，是燥气从中而起，阳气闭绝于内，而不能向下通达。下一条“其阳则绝”，与此相同。
汪氏说：总括到后条，用麻仁丸来主治。《补亡论》建议用小柴胡汤，或者柴胡桂枝汤，以通利津液。如果大便更加坚硬，建议用承气等汤。这是极大的错误。
脉象浮而芤，浮为阳，芤为阴。浮与芤相互搏结，胃气生热，其阳则绝。（两个“为”字下，《玉函经》有“则”字。）
〔钱〕浮为阳邪盛，芤为阴血虚。阳邪盛则胃气生热，阴血虚则津液内竭。所以其阳则绝。绝，不是断绝败绝的绝，而是说阳邪独治，阴气虚竭，阴阳不能互相为用，所以阴阳阻绝，而不相流通。这就是《生气通天论》所说的“阴阳离决，精气乃绝”的意思。注家都认为“阳绝”是“无阳”的互词，恐怕失之偏颇。〔沈〕这是辨别阳明津液枯竭的脉象。如果见到这种脉象，应当滋养津液，不可立即攻下。
趺阳脉浮而涩，浮则胃气强，涩则小便频数。浮与涩相互搏结，大便则干硬，其脾被约束，用麻子仁丸主治。（成本本：无“子”字，“仁”作“人”。柯本：无此条及麻仁丸方。）
〔成〕趺阳脉是脾胃的脉。诊得脉浮为阳，知道胃气强；脉涩为阴，知道脾被约束。“约”字，是俭约的意思，又是约束的意思。《内经》说：饮食进入胃，游溢精气，上输于脾。脾气散精，上归于肺，通调水道，下输膀胱。水精四布，五经并行，这是脾主为胃运行津液。现在胃强脾弱，约束津液，不得四布，只输送到膀胱，导致小便频数、大便困难。给予脾约丸，通肠润燥。〔汪〕趺阳穴，是胃脉所在。在足背上五寸骨间，距离陷谷穴三寸，即足阳明经的冲阳二穴。按压时脉搏应手而起。按照成无己的注解，以胃强脾弱解释脾约。推测其意，认为胃中的邪热盛为阳强，所以见脉浮；脾家的津液少为阴弱，所以见脉涩。〔程〕脾约，是脾阴外渗，没有津液滋润，脾家先自干枯了，怎么能以剩余的阴气荫及肠胃。所以胃火盛而肠枯，大便坚硬而粪粒小。麻仁丸，宽肠润燥，以软化坚结，想要使脾阴从内部转化。
按语：喻嘉言讥讽成无己的“脾弱”说法，说：脾弱，就应当补益，为什么麻仁丸中反而用大黄、枳实、厚朴呢？汪氏则暗中为成无己的解释纷乱辩护，这很不对。又按语：胃强脾弱，究竟是中焦阳盛而阴弱的含义，不必拘泥于脾与胃。
《伤寒选录》说：我考证趺阳脉，一名会元，又名冲阳，在足背上去陷谷穴三寸，脉搏跳动处，就是这里。这是阳明胃脉的用武之地。胃是水谷之海，五脏六腑之长。如果胃气疲惫，水谷不进，谷神离去，脏腑无所禀受，脉搏不动就会死亡。所以诊察趺阳脉，用来考察胃气的有无。张仲景又说，诊察趺阳脉，不仅用于伤寒，即使是杂病危急，也应当诊察此处以考察吉凶。
麻子仁丸方
麻子仁（二升） 芍药（半斤） 枳实（半斤，炙○《千金翼方》：芍药、枳实各八两。） 大黄（一斤，去皮） 厚朴（一尺，去皮○《玉函经》：作一尺。） 杏仁（一升，去皮尖，熬，别作脂○《玉函经》：作一升。）
以上六味药，蜂蜜和丸，如梧桐子大。饮服十丸，每日三次。逐渐增加，以见效为度。（“六味”下，成本本、玉函本有“有为末炼”三字。“和”，成本本作“作”。成本本无“梧”字。《证类本草》：饮服十丸，作“以浆水饮下十丸”。）
〔徐〕即小承气汤，加上芍药和二仁（麻子仁、杏仁）。〔方〕麻子、杏仁，能润干燥之坚结；枳实、厚朴，能导固结之滞气；芍药敛液以辅助润燥；大黄推陈以致新。脾虽然被约束，至此得以疏解。
吴仪洛《方论》说：这是治疗素来习惯脾约之人，又感受外邪，预防燥结的方法。方中使用麻仁、杏仁以润肠燥，芍药以养阴血，枳实、大黄以泄实热，厚朴以破滞气。然而必须是因为客邪加热者，使用才合适。后世以此方概治老人津枯血燥之闭结，只取一时之通利，不顾愈伤其真气，岂不是加速招致祸患吗？
张氏《缵论》说：所谓丸，如理中丸、陷胸丸、抵当丸，都是大弹丸，煮化后连同药渣一起服用。所谓丸，如麻仁丸、乌梅丸，都是用小丸，取达下焦之意。大概丸和圆在后世互用。现在根据张氏的说法考证，其中所言不虚。然而《伤寒论》中的“丸”字，《千金方》、《外台秘要》多作“圆”，不知其义如何，拈出存疑。
按语：《本草序例》中，厚朴一尺无法考证。《医心方》引用《短剧方》说：厚朴一尺，以及数寸者，以浓三分、广一寸半为准。
太阳病，经过三天发汗，病不解，出现蒸蒸发热的，属于胃（阳明），用调胃承气汤主治。（《外台秘要》作“发其汗病不解”。《玉函经》作“蒸蒸然”。《脉经》无“调胃”二字。）
〔程〕为什么发汗不解就属于胃？大概是因为胃燥素盛，所以其他表证虽罢，而汗与热不解。只需征验其热，如炊笼般热气蒸腾而盛，就知道汗必连绵而来。这就是大便已硬的征兆，所以说属于胃。热虽然聚于胃，但未见潮热、谵语等证，主以调胃承气汤，是在下法之中，从乎中治，因为病程未深。表热未除，而里热已待，病势久蕴于前了。只是从发汗后，一次交替而已。凡本篇中云太阳病、云伤寒，而无阳明病字的，皆同此病机。总之，脉已不浮而大，可以确信。〔钱〕蒸蒸发热，如同釜甑蒸物，热气蒸腾，从内达外，气蒸湿润的样子，不像翕翕发热那样仅在皮肤表面。
〔程〕吐法是为膈邪而设。吐后若无虚烦等证，必定是吐出了应当吐出的东西。只因胃家素实，吐后亡失津液，燥气不能下达，遂成土郁，所以腹胀。其实肠道内并无大秽浊之物。调胃承气汤，一举解除其郁结即可。
太阳病，如果经过吐、下、发汗后，微烦，小便频数，大便因此干硬的，与小承气汤调和即可痊愈。（成本本、玉函本：无“后”字。）
〔鉴〕太阳病，如果经过吐、下、发汗后病不解，入里微烦的，是栀子豉汤证。现在小便频数，大便因此干硬，是津液下夺所致。应当与小承气汤调和它，因为结热未甚，入里未深。
得病二三日，脉弱，无太阳病、少阳柴胡证，烦躁，心下硬，至四五日，虽能食，以小承气汤，少量给予，微微调和它，令其稍安。至六日，给予承气汤一升。如果不大便，六七日，小便少的，虽然不能食（【原注】一说：不大便），但初头硬，后必溏，未定成硬，攻之必溏。须待小便利，屎定硬，才可攻之，宜大承气汤。（“受”字，成本本、玉函本作“能”。《千金翼方》：“不受食”作“不大便”，无“大承气汤”的“大”字。）
〔汪〕得病二三日，不言伤寒与中风，是风寒之邪皆有，无须分辨的病。脉弱，是指无浮紧等在表之脉。无太阳、柴胡证，是指无恶寒发热，或往来寒热在表，及半表半里之证。烦躁、心下硬，全是阳明腑热邪实。经云：肠实则胃虚，故能食。能食者，其人不痞不满，结在肠间，而胃火自盛。只需以小承气汤，少量给予，微微调和它，因其人烦躁，必定不大便，令其稍安。至六日，仍烦躁不安，而不大便，前用小承气汤，可加至一升，使得大便而止。这是说小承气汤不可多用的意思。“若不大便”句，承接上文“烦躁心下硬”而言。至六七日不大便，为可下的时机。但小便少，乃小水不利，此系胃中之水谷不清，故不能食，非谵语、潮热、有燥屎之不能食。所以说虽不能食，但初头硬后必溏。未定成硬而攻之，并硬者，必化而为溏矣。须待小便利，屎定成硬，才可用大承气汤攻之。这是说大承气亦不可骤用的意思。〔方〕太阳病不言药，因为有桂枝、麻黄的不同。柴胡不言证，因为专主少阳。凡类似此种行文者，皆是互发其义。以无大小之分，故知诸证属阳明。以脉弱，故宜微和。至六日已下，历叙可攻不可攻的节度。〔喻〕此段之“虽能食”、“虽不能食”，全与辨风寒无关，另有二义。见“虽能食者”，不可以为胃强而轻下；“虽不能食者”，不可以为胃中有燥屎而轻下。前条云：谵语有潮热，反不能食者，胃中必有燥屎五六枚，与此互发。
按语：脉弱，不是微弱虚弱的弱，而是指不浮盛实大。钱氏说是虚寒之候，柯氏说是无阳之征，都错了。
伤寒六七日，目中不了了，睛不和，无表里证，大便难，身微热者，此为实也，急下之，宜大承气汤。
〔钱〕六七日，是邪气在里的时期。外既无发热恶寒的表证，内又无谵语腹满等里邪，且非不大便，而曰大便难，又非发大热，而身仅微热，势非甚亟。然而“目中不了了”，是邪热伏于里，而耗竭其津液。经云：五脏六腑之精，皆上注于目。热邪内烁，津液枯燥，则精神不得上注于目，故目中不了了，睛不和也。〔汪〕不了了者，病患的眼睛，视物不明了。睛不和者，是医者看病患的眼珠光泽，或昏暗，或散乱，是为不和。〔鉴〕目中不了了，而睛和的，是阴证；睛不和的，是阳证。这是结热神昏的渐趋，危恶之候。急以大承气汤下之，泻阳救阴，以保全未竭之水可也。睛不和者，谓眼珠不活动。〔方〕了了，犹明明也。
《活人指掌》说：目中不了了，了了，谓明了也。或谓之病瘥。按汪氏说：无表里证，里字，当是传写错误，宜从删。此说大误。
《伤寒选录》删去“里”字说：无表里证，则无病，何以用承气汤下之？里实者病可见矣。○按语：此说却不是对的。
阳明病，发热汗多者，急下之，宜大承气汤。（【原注】一说：大柴胡汤。○成本本：脱“病”字。张本：汗下，补出“字”。）
〔钱〕潮热自汗，是阳明胃实的基本证候。这里说汗多，不再是阳明自汗可比了。里热炽盛之极，津液泄尽，故当急下。然而必须以脉症参合。如果邪气在经，而发热汗多，胃邪未实，舌苔未干浓而黄黑者，不可下。〔程〕发热而复汗多，阳气大蒸于外，虑阴液暴亡于中。虽无内实之兼证，宜急下之，以大承气汤。此类之下法，皆为救阴而设，不在夺实。夺实之下可缓，救阴之下，不可缓。不急下，防成五实。经云：五实者死。
Ren Shen (San Liang ○ *Zhou Hou Fang* records as One Liang.) Sheng Jiang (Liu Liang, sliced) Wu Zhu Yu (One Sheng, washed ○ *Zhou Hou Fang* records as Ban Jin. *Wai Tai Mi Yao* records to wash and stir-fry.) Da Zao (Twelve pieces, split open)
The above four herbs, with seven Sheng of water, decoct to obtain two Sheng. Remove the dregs. Take seven Ge warm, three times a day. (*Jin Gui Yao Lue*: water seven Sheng changed to five Sheng; two Sheng changed to three Sheng. *Wai Tai Mi Yao* also uses five Sheng.)
[Wang] Vomiting is due to rebellious Qi. Rebellious Qi must be dispersed. Wu Zhu Yu is acrid and bitter, with heavy scent, possessing descending and purging properties, making it the best herb for treating vomiting. Combined with Sheng Jiang, which is also a holy herb for treating vomiting, unlike Gan Jiang in Si Ni Tang (Four Reversal Decoction) which stays central and does not move outward. Chen Shi from Wuling said: The reason for vomiting is deficiency-cold in the Stomach. If only warming without tonifying is used, vomiting will never heal. Therefore, Ren Shen is used to tonify the Middle, combined with Da Zao, to form a formula harmonizing the Spleen.
Qian Shi said: One Sheng of Wu Zhu Yu should be one Ge, i.e., two and a half spoons today. Three Liang of Ren Shen should be One Liang, i.e., two Qian and seven Fen in Song dynasty. Six Liang of Sheng Jiang should be Two Liang, i.e., over five Qian in Song dynasty. Da Zao should be four or five pieces. Seven Sheng of water should be three Sheng. Observing Xiao Cheng Qi Tang (Minor Order the Qi Decoction), it uses only four Sheng of water; Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction) uses only three Sheng. This formula, although a pungent-warm tonifying agent, is used when exterior and interior are doubtful. Could it be excessive? It probably comes from later hands, not the original measurements of Zhang Zhongjing. Students should use it according to the times. ○ Note: It is unknown if this is correct; it is listed here tentatively.
*Jin Gui Yao Lue* records: For vomiting with chest fullness, Zhu Yu Tang (Evodia Decoction) is the main treatment.
*Zhou Hou Fang* records: Treating belching with sour taste after eating, and acid regurgitation. (This is the same formula.)
*Yi Fang Ji Jie* says: If the condition worsens after taking the decoction, Ge Gen Jia Ban Xia Tang (Kudzu Root plus Pinellia Decoction), Xiao Chai Hu Tang (Minor Bupleurum Decoction), Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction), Huang Qin Tang (Scutellaria Decoction) are suitable. Also, Wu Zhu Yu is the principal herb of the Jue Yin channel, so it also treats Liver Qi rebelling upward causing vomiting of saliva and headache. Adding Fu Zi (Aconite Root) to this formula creates Wu Zhu Yu Jia Fu Zi Tang (Evodia plus Aconite Decoction), treating cold Hernia with lower back pain radiating to the testicles, and Chi pulse sinking and slow.
Tai Yang disease (Disease of the Tai Yang Channel), with Cun (Cun position) pulse slow, Guan (Guan position) pulse floating, and Chi (Chi position) pulse weak. The patient has fever, sweating, and aversion to cold again, no vomiting, but epigastric stuffiness. This is due to the physician's premature purgation. If no purgation was done, and the patient is not averse to cold but thirsty, this indicates the pathogen has transferred to Yang Ming (Yang Ming Channel/Organ). Frequent urination leads to hard stool. Even if no bowel movement for ten days, there is no distress. If thirsty for water, give small amounts. Rescue according to the method. For thirst, Wu Ling San (Five-Ingredient Powder with Poria) is suitable. (*Yu Han Jing*: under "Guan", there is small text; the thirteen characters following "Ru Qi" are written as twelve characters: "Ruo Bu Xia Qi Ren Fu Bu E Han Er Ke".)
[Cheng] Tai Yang disease, with Yang pulse floating and Yin pulse weak, indicates pathogen at the exterior. Now Cun slow, Guan floating, Chi weak, indicating pathogen gradually transmitting inward. Fever and sweating with aversion to cold indicate the exterior is not resolved. Pathogen transmitting channels enters the interior; if interior is discordant, vomiting must occur. Here, no vomiting, only epigastric stuffiness, means the physician purged too early, leaving pathogen in the epigastrium. If not purged, it would gradually become non-averse-to-cold and thirsty, Tai Yang pathogen transferring to Yang Ming. After vomiting, purging, or sweating, if urine is frequent and stool is hard, Xiao Cheng Qi Tang should be given to harmonize. This case is not due to post-vomit/purge/sweat fluid loss causing hard stool. If there is no fullness and hardness, even ten days without bowel movement causes no distress. Wait for fluids to return to the Stomach, urine frequency decreases, and stool will pass naturally. For thirst, give small amounts of water to moisten Stomach Qi. Examine where the pathogen is and attack according to the method. If thirst persists, give Wu Ling San. [Wu] Cun slow indicates Wind damaging Wei (Defensive Qi). Guan floating indicates pathogen still in the channels, not yet in the Fu organs. Chi weak indicates innate deficiency of Yin essence.
Wang Sanyang said: Wu Ling San is difficult to use here; otherwise, there should be missing text above the character "Ke" (thirst). *Yi Zong Jin Jian* states that the five characters "Dan Yi Fa Jiu Zhi" (Only rescue by method) should be "Ruo Xiao Bian Bu Li" (If urination is difficult), which aligns with the preceding "Xiao Bian Shu" (frequent urination) and following "Ke Zhe" (those who are thirsty). The disease progression here is not urgent, making the rescue text meaningless; there must be omissions. Wang Shi said the thirteen characters from "Ke Yu Yin Shui" to "Jiu Zhi" should precede "Xiao Bian Shu Zhe". The character "Zhe" in "Bu E Han Er Ke Zhe" can be deleted. Wu Yiluo deleted nineteen characters from "Ke Yu" onwards, noting old editions have many superfluous characters. ○ Note: This passage is hard to understand; the above four scholars have different views. It is kept here tentatively.
Yang pulse micro and sweat output less indicates self-harmony (Original note: one reading is "Ru"). Sweat output much indicates excess. Yang pulse solid, caused by inducing sweat, output much also indicates excess. Excess leads to Yang being cut off in the interior, loss of Jin Ye (Body Fluids), and stool becomes hard. (Cheng Ben edition: no "Zhe" after "Tai Guo". "Yang Mai Shi" below is a separate section. Fang Ben, Zhou Ben, Qian Ben, Wang Ben, Wei Ben all agree.)
[Jian] Yang pulse micro means floating, forceless, and weak. Yang pulse solid means floating, forceful, and vigorous. In Wind Strike or Cold Damage, Yang pulse micro means heat is slight. Slight heat steams the exterior causing sweat. If sweat is little, it is self-harmony and resolving. If sweat is much, it is excess and unresolved. Yang pulse solid means heat is abundant. Inducing sweat due to abundant heat resulting in much sweat is also excess. Then Yang reaches extreme in the interior, Jin Ye is lost, and stool becomes hard, forming an interior excess syndrome. [Wang] In Yang Ming disease, Yang pulse is not micro but solid. Solid means beating against the finger with force upon palpation. [Wei] The meaning of "Yang Jue" in the text seems to be obstruction. It means Yang abundance obstructs Yin, not absolute severance. In *Nei Jing*, "Jue" often means this. [Cheng] Yang Jue in the interior means dryness arises from the center, Yang Qi is closed and cut off internally, unable to descend. The next line "Qi Yang Ze Jue" is the same.
Wang Shi said: Summarizing the next section, Ma Ren Wan (Hemp Seed Pill) is used. *Bu Wang Lun* suggests Xiao Chai Hu Tang or Chai Hu Gui Zhi Tang to unblock Jin Ye. If stool becomes harder, suggest Cheng Qi decoctions. This is extremely wrong.
Pulse floating and Kou (hollow). Floating is Yang, Kou is Yin. Floating and Kou interact, Stomach Qi generates heat, its Yang is cut off. (*Yu Han Jing* has "Ze" after both "Wei" characters.)
[Qian] Floating indicates abundant Yang pathogen; Kou indicates deficient Yin blood. Abundant Yang pathogen makes Stomach Qi generate heat; deficient Yin blood causes internal exhaustion of Jin Ye. Thus its Yang is cut off. "Jue" here does not mean absolute severance or decay, but that Yang pathogen acts alone, Yin Qi is exhausted, Yin and Yang cannot function together, thus they are obstructed and do not circulate. This is the meaning of "Yin Yang Li Jue, Jing Qi Nai Jue" in *Sheng Qi Tong Tian Lun*. Commentators all say "Yang Jue" is a mutual term for "No Yang", which is likely mistaken. [Shen] This distinguishes the pulse of Yang Ming Jin Ye exhaustion. Seeing this pulse, one should nourish Jin Ye, not attack immediately.
Fu Yang pulse floating and Se (choppy). Floating indicates strong Stomach Qi; Se indicates frequent urination. Floating and Se interact, stool becomes hard. The Spleen is constrained (Yue). Ma Zi Ren Wan is the main treatment. (Cheng Ben: no "Zi" character, "Ren" written as "Ren". Ke Ben: lacks this section and Ma Zi Ren Wan formula.)
[Cheng] Fu Yang is the pulse of Spleen and Stomach. Floating pulse indicates Yang, knowing Stomach Qi is strong; Se pulse indicates Yin, knowing Spleen is constrained. "Yue" means frugal/restrained, and also constraint. *Nei Jing* says: Drink enters Stomach, essence floats up, transports to Spleen. Spleen scatters essence, returns to Lung, regulates water passages, transports to Bladder. Water essence distributes four ways, five channels run together. This is Spleen transporting Jin Ye for Stomach. Now Stomach is strong, Spleen is weak, constraining Jin Ye, preventing distribution, only transporting to Bladder, causing frequent urination and difficulty defecating. Give Pi Yue Wan (Spleen Constraint Pill) to unblock intestines and moisten dryness. [Wang] Fu Yang point is Stomach pulse. Located on dorsum of foot, five cun above, between bones, three cun from Xian Gu, i.e., Chong Yang points of Foot Yang Ming channel. Pulse rises upon pressing. Following Cheng's annotation, interpreting Pi Yue as Stomach strong and Spleen weak. Inferring intent, evil heat in Stomach is Yang strong, hence floating pulse; Jin Ye in Spleen is Yin weak, hence Se pulse. [Cheng] Pi Yue means Spleen Yin渗es outward, lacking fluid to nourish. Spleen itself dries first, how can it nourish intestines and stomach? Thus Stomach fire is abundant and intestines dry, stool hard and pellets small. Ma Ren Wan widens intestines and moistens dryness to soften hardness, aiming to transform Spleen Yin from within.
Note: Yu Jia Yan criticized Cheng's "Spleen weak" theory, saying: If Spleen is weak, it should be tonified. Why use Da Huang, Zhi Shi, Hou Po in Ma Ren Wan? Wang Shi defends Cheng's explanation confusingly, which is incorrect. Another note: Stomach strong and Spleen weak essentially means Middle Jiao Yang abundance and Yin deficiency, not strictly limited to Spleen and Stomach organs.
*Shang Han Xuan Lu* says: My research indicates Fu Yang pulse, also known as Hui Yuan or Chong Yang, located three cun above Xian Gu on the dorsum of the foot where the pulse beats. This is the domain of Yang Ming Stomach pulse. Stomach is the sea of water and grain, leader of five Zang and six Fu organs. If Stomach Qi is exhausted, water and grain do not enter, Grain Spirit leaves, organs receive nothing, pulse stops, and death occurs. Thus diagnosing Fu Yang pulse examines the presence of Stomach Qi. Zhang Zhongjing also stated that for Fu Yang pulse, not only in Shang Han, but in critical miscellaneous diseases, it should be diagnosed to ascertain auspiciousness or inauspiciousness.
Ma Zi Ren Wan Formula
Ma Zi Ren (Two Sheng) Shao Yao (Half Jin) Zhi Shi (Half Jin, roasted ○ *Qian Jin Yi Fang*: Shao Yao and Zhi Shi each eight Liang.) Da Huang (One Jin, peeled) Hou Po (One Chi, peeled ○ *Yu Han Jing*: writes One Chi.) Xing Ren (One Sheng, peeled and tip removed, roasted, made into fat separately ○ *Yu Han Jing*: writes One Sheng.)
The above six herbs, mix with honey and make pills like wu-tong seeds. Take ten pills with water, three times a day. Gradually increase until effect is achieved. (After "six herbs", Cheng Ben and Yu Han Jing have "you wei mo lian" three characters. "He", Cheng Ben writes "zuo". Cheng Ben lacks "Wu" character. *Zheng Lei Ben Cao*: "Take ten pills with water" writes "xia shi wan yi jiang shui xia".)
[Xu] This is Xiao Cheng Qi Tang plus Shao Yao and two Ren (seeds). [Fang] Ma Zi and Xing Ren can moisten dry hardness; Zhi Shi and Hou Po can guide stuck stagnation; Shao Yao collects fluids to assist moistening; Da Huang pushes out the old to bring forth the new. Although Spleen is constrained, this unblocks it.
Wu Yiluo *Fang Lun* says: This treats those habituated to Pi Yue who contract external pathogens, preventing dryness accumulation. Formula uses Ma Ren and Xing Ren to moisten intestinal dryness, Shao Yao to nourish Yin blood, Zhi Shi and Da Huang to drain excess heat, Hou Po to break stagnant Qi. However, it must be used when guest heat adds to the condition. Later generations used it generally for elderly with Jin枯 and Blood dryness constipation, seeking only temporary relief, disregarding further damage to True Qi, hastening disaster.
Note: *Ming Li Lun* names this Pi Yue Wan.
Zhang Shi *Zuan Lun* says: "Wan" (pill) refers to large pellets like Li Zhong, Xiong Xiong, Di Dang, boiled and taken with dregs. "Wan" also refers to small pills like Ma Ren and Wu Mei, reaching the Lower Jiao. "Wan" and "Yuan" were used interchangeably later. Based on Zhang's research, his words are not false. However, in the Treatise, "Wan" is often written as "Yuan" in *Qian Jin* and *Wai Tai*. The meaning is unknown; noted for doubt.
Note: In *Ben Cao Xu Lie*, Hou Po "one Chi" cannot be verified. *Yi Xin Fang* cites *Duan Ju Fang*: Hou Po one Chi or several Cun, standardized to thickness three Fen and width one and a half Cun.
Tai Yang disease, after three days of sweating, disease unresolved, with steaming fever, belongs to Stomach (Yang Ming). Tiao Wei Cheng Qi Tang is the main treatment. (*Wai Tai Mi Yao*: writes "fa qi han bing bu jie". *Yu Han Jing*: writes "zheng zheng ran". *Mai Jing*: lacks "Tiao Wei" characters.)
[Cheng] Why does unresolved sweating belong to Stomach? Probably because Stomach dryness is inherently abundant. Thus, although other exterior symptoms cease, sweat and heat do not resolve. Observe the heat: steaming like a cooking basket, abundant. Knowing sweat must come continuously. This is a sign of hard stool. Hence, belongs to Stomach. Heat gathers in Stomach, but no tidal fever or delirium seen. Mainly using Tiao Wei Cheng Qi Tang, within purgative methods, treating from the middle, because days are not deep. Exterior heat not removed, interior heat waits. Disease momentum has been accumulating. Just one alternation after sweating. Whenever this chapter says Tai Yang disease or Shang Han, without Yang Ming disease, the pathology is the same. Ultimately, pulse is no longer floating but large, certain. [Qian] Steaming fever is like steaming food in a pot, heat steaming upwards from inside to outside, moist vapor state, not like Xi Xi fever on skin surface.
Shang Han after vomiting, abdominal fullness and distension, give Tiao Wei Cheng Qi Tang.
[Cheng] Vomiting method is set for Chest/Ge pathogen. After vomiting, if no empty irritability etc., it must have vomited what should be vomited. Only because Stomach family is inherently solid, vomiting loses Jin Ye, dry Qi cannot descend, becoming Earth depression, hence abdominal fullness. Actually, no great filth in intestines. Tiao Wei Cheng Qi Tang can seize and relieve this depression.
Tai Yang disease, if after vomiting, purging, or sweating, slight irritability, frequent urination, stool becomes hard, give Xiao Cheng Qi Tang to harmonize and cure. (Cheng Ben, Yu Han Jing: no "Hou" character.)
[Jian] Tai Yang disease, if after vomiting, purging, or sweating unresolved, entering interior with slight irritability, is Zhi Zi Chi Tang syndrome. Now frequent urination, stool hard, is Jin Ye downward depletion. Should give Xiao Cheng Qi Tang to harmonize, because accumulated heat is not severe, entering interior not deep.
Getting sick two or three days, pulse weak, no Tai Yang or Chai Hu signs, irritability, epigastric hardness. By fourth or fifth day, although able to eat, give Xiao Cheng Qi Tang, little by little, slightly harmonizing, letting it feel slightly better. By sixth day, give Cheng Qi Tang one Sheng. If no bowel movement, by sixth or seventh day, if urine is little, although unable to eat (Original note: one says "no bowel movement"), but head hard, tail must be loose. Not definitely hardened. Attacking will cause loose stool. Must wait for urine free, stool definitely hard, then can attack, suitable for Da Cheng Qi Tang. ("Shou", Cheng Ben, Yu Han Jing write "Neng". *Qian Jin Yi Fang*: "Bu Shou Shi" writes "Bu Da Bian", lacks "Da" in "Da Cheng Qi Tang".)
[Wang] Getting sick two or three days, not specifying Shang Han or Feng Zhong, means wind-cold pathogens are both present, no need to distinguish. Weak pulse means no floating/tight exterior pulses. No Tai Yang or Chai Hu signs means no aversion-to-cold/fever, or alternating chills/fever at exterior, nor half-exterior/half-interior signs. Irritability and epigastric hardness are entirely Yang Ming Fu organ heat and pathogen excess. Classic says: Intestines excess means Stomach deficiency, hence able to eat. Able to eat means no epigastric blockage or fullness, knot is in intestines, Stomach fire is abundant. Only need Xiao Cheng Qi Tang, little by little, slightly harmonizing. Because of irritability, must be no bowel movement, letting it feel slightly better. By sixth day, still irritable and no bowel movement, previous Xiao Cheng Qi Tang can increase to one Sheng, getting bowel movement to stop. This means Xiao Cheng Qi Tang should not be used excessively. "If no bowel movement" sentence connects to previous "irritability and epigastric hardness". By sixth/seventh day no bowel movement is time for purgation. But little urine means difficult urination, this is unclear water/grain in Stomach, hence unable to eat, not delirium/tidal fever/dry stool inability to eat. So says although unable to eat, head hard, tail loose. Not definitely hardened, attacking will turn to loose. Must wait for urine free, stool definitely hard, then use Da Cheng Qi Tang to attack. This means Da Cheng Qi Tang should not be used suddenly. [Fang] Tai Yang disease doesn't mention medicine because of differences in Gui Zhi and Ma Huang. Chai Hu doesn't mention signs because it specializes in Shaoyang. Similar writing styles mutually develop meanings. Without distinction of big/small, know signs belong to Yang Ming. Because pulse weak, suitable for slight harmony. From sixth day down, lists degrees of attackable and unattackable. [Yu] "Although able to eat" and "although unable to eat" in this section have nothing to do with distinguishing wind/cold, having two other meanings. Seeing "although able to eat", do not consider Stomach strong and lightly purge. Seeing "although unable to eat", do not consider dry stool in Stomach and lightly purge. Previous line says: Delirium with tidal fever, reverse unable to eat, means five or six pieces of dry stool in Stomach, mutually developing with this.
Note: Pulse weak is not weak/faint deficiency, but means not floating/vigorous/solid/large. Qian Shi said it is deficiency-cold sign, Ke Shi said it is sign of no Yang, both mistaken.
Shang Han six or seven days, eyes not clear, pupils not harmonious, no exterior-interior signs, difficulty defecating, body slightly hot, this is excess. Urgently purge, suitable for Da Cheng Qi Tang.
[Qian] Six or seven days, pathogen is in interior. Exterior no fever/aversion-to-cold exterior signs, interior no delirium/abdominal fullness interior pathogens. Not no bowel movement, but difficulty defecating. Not high fever, but body slightly hot. Situation not very urgent. However, "eyes not clear" means pathogen heat hiding in interior, exhausting Jin Ye. Classic says: Essence of five Zang and six Fu organs all ascend to eyes. Heat pathogen scorches internally, Jin Ye dry, spirit cannot ascend to eyes. Hence eyes not clear, pupils not harmonious. [Wang] "Bu Liao Liao" means patient's eyes see things unclearly. "Jing Bu He" means doctor sees patient's pupil luster dim or scattered, called not harmonious. [Jian] Eyes not clear, pupils harmonious, is Yin syndrome. Pupils not harmonious, is Yang syndrome. This is gradual onset of heat-knot confusion spirit, dangerous sign. Urgently purge with Da Cheng Qi Tang, drain Yang save Yin, preserve unexhausted water. Pupils not harmonious means pupils not active. [Fang] Liao Liao means bright/clear.
*Huo Ren Zhi Zhang* says: Eyes not clear, Liao Liao means clear. Or called disease recovery. Note Wang Shi said: No exterior-interior signs, "Li" character is copying error, should delete. This view is greatly mistaken.
*Shang Han Xuan Lu* deletes "Li" character saying: No exterior-interior signs, then no disease, why use Cheng Qi Tang to purge? Interior excess signs would be visible. ○ Note: This view is incorrect.
Yang Ming disease, fever and much sweat, urgently purge, suitable for Da Cheng Qi Tang. (Original note: one says Da Chai Hu Tang. ○ Cheng Ben: misses "Bing" character. Zhang Ben: adds character under "Han Xia".)
[Qian] Tidal fever and spontaneous sweating are basic signs of Yang Ming Stomach excess. Here says much sweat, not comparable to Yang Ming spontaneous sweating. Interior heat blazing extreme, Jin Ye exhausted, hence urgent purge. However, must combine pulse and signs. If pathogen in channels, fever and much sweat, Stomach pathogen not solid, tongue coating not dry/thick yellow/black, cannot purge. [Cheng] Fever and much sweat, Yang Qi steams heavily outside, fear Yin fluid sudden loss inside. Although no interior excess accompanying signs, should urgently purge with Da Cheng Qi Tang. Such purgations are all set to save Yin, not to seize excess. Seizing excess purgation can be slow; saving Yin purgation cannot be slow. Not urgent purge, prevent Five Excesses. Classic says: Five Excesses die.
Sweating unresolved, abdominal fullness and pain, urgently purge, suitable for Da Cheng Qi Tang.