治有患心下硬痛。下利纯清水。谵语。发渴。身热。庸医不识此证。但见下利。便呼为漏底伤寒。而用热药止之。
就如抱薪救火。误人死者多矣。殊不知此因热邪传里。胃中燥屎结实。此利非内寒而利。乃日逐自饮汤药而利也。直急
下之。名曰结热利证。身有热者。宜用此方。
大黄 芒硝 枳实 浓朴 甘草 人参 当归 年老气血虚者。去芒硝。
水二钟。姜三片。枣子二枚。煎之后再加桔梗。一沸。热服为度。
琥按上方。即前三一承气汤中。加人参当归也。以病患气血虚。故加此二味药。方后再加桔梗者。以其能引大黄
等药。上至胸中至高之分而成功。此洁古法也。虽然。愚曾细评此方。为不可用之剂。及见今医用之。而病患无一效者。
何也。夫人身之中。一阴阳耳。阴阳之分。一气血耳病热之人。皆阳有余。而阴不足。乃知其气。必实。其血必虚。所
以病机气宜中。有当归承气汤方者。用之以补血而益阴也。若加人参。则徒助有余之阳气。而邪热愈盛。故少则无济于
病。多则必致杀人。问或有用之而效者。必参少而诸泻药之力也。俗医不晓此义。至有用此汤。而人参加至一二两者。
此正所云抱薪投火。误人于必死也。
或问气虚人。岂无患热病者。余答云。气虚者。阳虚也。阳虚之人。多病中寒。其病伤寒者。皆精血少而水虚。是
为阴虚。故不胜伤寒之邪热耳。据上主疗云。谵语发渴身热。胃中燥屎结实。此数者。皆阳有余而阴不足之证。陶氏犹
以为气虚而用人参。抑何不明理。而自相矛盾欤。
（琥）总按上古今诸名家。治阳明病方论。虽与仲景之法。互相变通。然亦不可执用。须临证。参合加减施之。则
庶乎其不瘥矣。
治疗那些出现心下部位硬满疼痛、腹泻排出纯清水、说胡话（谵语）、口渴、身体发热的患者。庸医不认识这种证候，只看到腹泻，就称之为“漏底伤寒”，并使用热性药物来止泻。
这就像抱着柴草去救火一样，因此误死人很多。殊不知这是因为热邪传入体内，胃中燥屎结实所致。这种腹泻并非因为内寒引起的，而是因为每天不断服用汤药导致的腹泻。应当立即使用攻下法，称为“结热利证”。如果身体发热，适宜使用此方。
大黄、芒硝、枳实、厚朴、甘草、人参、当归。年老且气血虚弱者，去掉芒硝。
用水两钟，生姜三片，大枣二枚，煎煮后，再加入桔梗，煮沸一次，趁热服用为度。
琥按：上述方子，就是在前文提到的三一承气汤中加入人参和当归。因为患者气血虚弱，所以加入这两味药。方剂后面再加桔梗的原因，是因为它能引导大黄等药物上行至胸中最高之处而取得疗效，这是张洁古的方法。虽然如此，我曾仔细评价此方，认为它是不可使用的方剂。以及见到当今医生使用它，没有一位患者有效的。为什么呢？人身之中，不过是阴阳罢了。阴阳的区分，不过是气血罢了。患热病的人，都是阳气有余，而阴气不足，从而知道其气必实，其血必虚。所以在《病机气宜》中有当归承气汤一方，用它来补血而益阴。如果加入人参，则白白地助长有余的阳气，而使邪热更加旺盛。所以用量少对病情没有帮助，用量多则必然导致死亡。问或许有用此方而见效的，一定是人参用量少，而其他泻下药物的力量起效了。世俗医生不懂这个道理，甚至有用此汤时，将人参加到一两多的。这正是所说的抱薪投火，使人陷入必死的境地。
有人问：气虚的人，难道没有患热病的吗？我回答说：气虚就是阳虚。阳虚的人，多患中寒证。他们患伤寒病的，都是因为精血少而水液虚，这属于阴虚，所以不能承受伤寒的邪热。根据上述主治描述：谵语、口渴、身体发热、胃中燥屎结实，这几项，都是阳气有余而阴气不足的证候。陶氏仍然认为是气虚而用人参，这多么不明理，而自相矛盾啊。
（琥）总评以上古今各位名家治疗阳明病的方论，虽然与仲景的方法互相变通，然而也不可固执使用。必须结合临床实际，参考并加减施用，这样才差不多不会出错。
To treat patients presenting with hardness and pain in the epigastrium, diarrhea of pure clear water, delirium (delirious speech), thirst, and fever. Quack doctors fail to recognize this syndrome; seeing only the diarrhea, they call it "Leaking Bottom Taiyang Disease" (Lou Di Shang Han) and use hot-natured drugs to stop the diarrhea.
This is like carrying firewood to save a fire; many have been misled to death by such errors. They do not realize that this condition arises from heat pathogens transmitting inward, resulting in dry feces impaction in the stomach. This diarrhea is not caused by interior cold but is induced by the daily administration of decoctions. Immediate purgation is required, termed "Heat-Binding Diarrhea Syndrome" (Jie Re Li Zheng). If there is fever, this formula is suitable.
Rhubarb Radix et Rhizoma (Dahuang, 大黄), Mirabilite (Mangxiao, 芒硝), Immature Bitter Orange Fructus (Zhishi, 枳实), Magnolia Bark Cortex Magnoliae Officinalis (Houpo, 厚朴), Licorice Root Radix Glycyrrhizae (Gancao, 甘草), Ginseng Radix et Rhizoma (Renshen, 人参), Angelica Sinensis Radix (Danggui, 当归). For elderly patients with Qi and Blood deficiency, remove Mirabilite.
Use two zhong of water, three slices of ginger, and two jujubes. Decoct, then add Platycodon Root Radix Platycodi (Jiegeng, 桔梗), boil once more, and take warm.
Hu notes: The above formula is essentially the San Yi Cheng Qi Tang (Three-One Purgative Decoction) with the addition of Ginseng Radix et Rhizoma (Renshen, 人参) and Angelica Sinensis Radix (Danggui, 当归). Because the patient has Qi and Blood deficiency, these two herbs are added. The reason for adding Platycodon Root Radix Platycodi (Jiegeng, 桔梗) later in the prescription is that it guides Rhubarb Radix et Rhizoma (Dahuang, 大黄) and other drugs upward to the highest part of the chest to achieve efficacy; this is the method of Zhang Jiegu (Zhang Congzheng). Although so, I have carefully evaluated this formula and consider it unusable. Furthermore, observing contemporary physicians using it, no patient has shown efficacy. Why? Within the human body, there is merely Yin and Yang. The distinction between Yin and Yang lies in Qi and Blood. Patients with heat diseases possess excess Yang and deficient Yin, implying that their Qi must be excess and their Blood must be deficient. Therefore, in *Bing Ji Qi Yi* (Pathogenesis and Qi Suitability), there is a formula called Dang Gui Cheng Qi Tang (Angelica Sinensis Radix Purgative Decoction), used to tonify Blood and benefit Yin. If Ginseng Radix et Rhizoma (Renshen, 人参) is added, it vainly assists the excess Yang Qi, causing the pathogenic heat to flourish further. Thus, a small dose helps nothing, while a large dose inevitably causes death. Perhaps some cases show efficacy; this must be because the Ginseng Radix et Rhizoma (Renshen, 人参) dose was small, and the power of the other purgative drugs took effect. Vulgar doctors do not understand this principle, sometimes adding up to one or two liang of Ginseng Radix et Rhizoma (Renshen, 人参) to this decoction. This is exactly what is meant by "carrying firewood to throw into the fire," leading people to inevitable death.
One asks: Do those with Qi deficiency never suffer from heat diseases? I reply: Qi deficiency is Yang deficiency. Those with Yang deficiency often suffer from Interior Cold (Zhong Han). Those among them who contract Shang Han disease do so because their essence and blood are scant and fluids are deficient, constituting Yin deficiency; thus, they cannot withstand the pathogenic heat of Shang Han. According to the aforementioned indications—delirium, thirst, fever, and dry feces impaction in the stomach—all these are signs of excess Yang and deficient Yin. Tao still considers it Qi deficiency and uses Ginseng Radix et Rhizoma (Renshen, 人参); how ignorant of principles and self-contradictory!
(Hu) General comment on the formulas and discussions of ancient and modern experts treating Yangming Disease: Although they vary flexibly from Zhongjing's methods, they should not be rigidly applied. One must combine clinical presentation and adjust accordingly; only then can errors be avoided.