猪苓（去皮） 茯苓 阿胶 泽泻 滑石（碎）各一两
右五味，以水四升，先煮四味，取二升，去滓，内阿胶烊消，温服七合，日三服。
【集解】
赵羽皇曰：仲景制猪苓一汤，以行阳明、少阴二经水热。然其旨全在益阴，不专利水
。盖伤寒表虚，最忌亡阳，而里虚又患亡阴。亡阴者，亡肾中之阴，与胃家之津液也
。故阴虚之人，不但大便不可轻动，即小水亦忌下通，倘阴虚过于渗利，则津液反致
耗竭。方中阿胶质膏，养阴而滋燥；滑石性滑，去热而利水；佐以二苓之渗泻，既疏
浊热而不留其壅瘀，亦润真阴而不苦其枯燥，是利水而不伤阴之善剂也。故利水之法
，于太阳用五芩者，以太阳职司寒水，故加桂以温之，是暖肾以行水也；于阳明、少
阴用猪苓者，以二经两关津液，特用阿胶、滑石以润之，是滋养无形以行有形也。利
水虽同，寒温迥别，惟明者知之。
@@@
脉浮而大，心下反□，有热，属藏者攻之，不令发汗；属府者不令溲数。溲数则大便
□，汗多则热愈，汗少则便难，脉迟尚未可攻。
【注】
属藏，谓属里也；属府，谓属表也。溲，谓小便也。脉浮而大，太阳、阳明脉也。浮
属表，大属里，今太阳脉浮之表未解，而心下反□，阳明之里又急，权乎汗、下可也
。设里有热实，攻之无疑，不须先汗以解外也。如无热实，而有脉浮之表，不但不令
攻之，即小便不利，亦不令利小便，仍当解外也。盖恐溲数汗多，亡其津液，致大便
□，则热愈实也。若汗少脉迟，即有便□，里尚未实，亦未可攻也。
【集注】
王肯堂曰：论言脉浮大，反发汗反下之为逆。此以心下□有热，知传邪入里，故舍脉
而从证也。大便则许攻之，小便则不许利何也？曰：攻大便则内热除，利小便则津液
伤也。
林澜曰：心下□与腹□满不同。腹□邪已结聚成实，此但在心下，自与非下不可者异
矣。腑与脏对举而言，见一为入里，一犹属表之义也。
@@@
阳明病，脉迟，食难用饱，饱则微烦头眩，必小便难，此欲作谷疸。虽下之，腹满如
故，所以然者，脉迟故也。
【注】
阳明病不更衣，已食如饥，食辄腹满脉数者，则为胃热，可下证也。今脉迟，迟为中
寒，中寒不能化谷，所以虽饥欲食，食难用饱，饱则烦闷，是健运失度也。清者阻于
上升，故头眩；浊者阻于下降，故小便难。食郁湿瘀，此欲作谷疸之征，非阳明热湿
，腹满发黄者比。虽下之腹满暂减，顷复如故，所以然者，脉迟中寒故也。
【集注】
方有执曰：迟为寒不化谷，故食难用饱。湿郁而蒸，气逆而不下行，故微烦头眩。小
便难也，疸黄病也。谷疸，水谷之湿蒸发而身黄也。
张璐曰：下之腹满如故，盖腹满已是邪陷，脉迟则胃不实，徒下其糟粕，病既不除，
而反害之耳！夫阳明证本当下，阳明而至腹痛，尤当急下。独此一证下之，腹满必如
故者，缘脉迟则胃气空虚，津液不充，其满不过虚热内壅，非结热当下之比也。可见
脉迟胃虚，不但下之无益，即发汗利小便之法，亦不可用，惟当用和法，如甘草干姜
汤，先温其中，然后少与调胃微和胃气可也。
程应旄曰：热畜成黄之腹满，下之可去。此则谷气不得宣泄，属胃气虚寒使然，下之
益虚其虚矣。故腹满如故。
@@@
阳明病，若中寒者，不能食，小便不利，手足濈然汗出，此欲作固瘕，必大便初□后
溏，所以然者，以胃中冷，水谷不别故也。
【注】
阳明病内热，则不大便，能食，小便利，手足濈然汗出，是可下之证也。今中寒不能
食，小便不利，虽手足濈然汗出，不可下也，此为中寒欲作固瘕。何以知之？以大便
必初□而后溏也。所以然者，胃中虚冷，水谷不分，故小便不利而大便必溏也。
【按】
不能食与上条食难用饱，同一不能腐熟水谷也。小便不利与上条小便难，同一不能下
输膀胱也。惟手足濈然汗出，与上条饱则微烦、头眩不同，彼欲作谷疸，此欲作固瘕
，皆胃中寒冷。一以微烦头眩，阳在中上，故不病泻而病疸；一以手足汗出，阳在四
肢，故不病疸而病泻也。再上条中寒食难用饱，无汗小便难，欲作谷疸，以其尚能少
食微烦，犹有阳气故也。此条中寒不能食，手足冷汗，小便不利，欲作固瘕，则是寒
湿不化，纯阴故也。固瘕者、大瘕泻也，俗谓之溏泻。固者，久而不止之谓也。
【按】
人之汗以天地之雨名之，阴阳和而后有雨，阳亢则热而雨少，阴盛则寒而雨多，人之
汗亦若是也。四肢手足属土，土主脾胃，若脉大其汗蒸蒸而热，则为阳盛可下之证也
；若脉迟其汗□□而寒，则为阴盛可温之证也。
【集注】
程应旄曰：水谷不别，属湿热偏渗者多。此点出胃中冷，欲人知病本于寒，宜从寒治
，不在小便也。
@@@
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□，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。
【按】
「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。王三阳亦云；此处五苓散难用，不然经
文「渴者」之下，当有阙文也。
【注】
太阳病脉浮缓而弱，中风脉也；发热汗出恶寒，中风证也。不呕则里气和，缘何而有
心下痞证？此必以医下之故也。如其不经医下，邪热自传于里，病人不恶寒而渴者，
此邪去太阳，已转属阳明也。若小便数者，大便必□，然使不更衣十余日，而无或满
或痛之苦，是仍属虚燥不实之□，不可议下，俟之可也。如或渴欲饮水，必是胃中干
燥，当少少与之以滋其胃可耳。其或小便不利而渴者，是又为水停不化，宜五苓散以
导其所停之水矣。盖病在膀胱，故仍治太阳而不治阳明也。
【集注】
张兼善曰：十日不更衣，而不用攻伐何也？曰：此非结热，虽不大便，而无潮热谵语
可下之证，当须审慎，勿以日数久而辄为攻下也。
喻昌曰：寸缓、关浮、尺弱，发热汗出恶寒，纯是太阳中风未罢之证，设非误下，何
得心下痞结耶？如不误下，而太阳证必渐传经，乃至不恶寒而渴，邪入阳明审矣。然
阳明津液既偏渗于小便，则大肠失其润而大便□，与肠中热结自是不同，所以旬日不
更衣无所苦也。
汪琥曰：小便数大便□，仲景论中何以无治法耶？盖此正是仲景不须用药处，俟其阴
阳自和，则小便渐少，大便必自出也。
@@@
阳明病，心下□满者，不可攻之，攻之利遂不止者死，利止者愈。
【注】
此申上条痞□不更衣十日无所苦，误攻之变也。阳明病非胃家实，而心下□满者，不
可攻之。若攻之，其人利不止者，则正脱而死。其人利自止者，邪退则犹可愈也。
【集注】
汪琥曰：或问结胸证同是心下□满，又属可下何也？盖结胸证，心下□满而痛者，为
胃中实，故可下；此证不痛，当是虚□虚满，与半夏泻心汤之心下痞□略同，故云：
不可攻也。
@@@
诸虚者，不可下，下之则大渴，求水者易愈，恶水者剧。
【注】
虚者下之，是为重虚，阴津消亡，自然大渴。其求水者，阳气犹存，故易愈；若恶水
者，阳气已绝，则难愈矣。
【集注】
程应旄曰：诸虚者，阳津阴液，必有所亡，故下之则大渴；求水者亡阴，恶水者亡阳
，故有愈剧之分。观此知仲景虑误下之助阴，甚于虑误下之亡阴矣。
@@@
大下之后，复发汗，小便不利者，亡津液故也，勿治之，得小便利，必自愈。
【注】
大下之后，复发其汗，重亡津液，小盒饭少，以水液内竭故也。勿治之，言勿利其小
便也。须俟津液回而小便利，必自愈矣。
【集注】
程知曰：言下后复发汗，有俟津液自回之法。若强责其小便，则膀胱之气化不行，有
增□满喘胀明矣，故宜以不治治之。
@@@
阳明病，下血谵语者，此为热入血室，但头汗出者，刺期门，随其实而泻之，濈然汗
出则愈。
【注】
妇人病伤寒，经血适至，则有热入血室之证，宜刺期门；男子病伤寒，有下血谵语者
，亦为热入血室也。若热随血去，必通身汗出而解矣。若血已止，其热不去，蓄于阳
明，不得外越而上蒸，但头汗出而不解者，亦当刺期门，随其实而泻之，则亦必通身
濈然汗出而愈也。
【集注】
方有执曰：血室、头汗、期门，注皆见太阳篇中。阳明之脉其直者，从缺盆下乳内廉
下，侠脐入气街中。血室之脉起于气街，上行至胸中而散。所以妇人经来，热入血室
，则似结胸而谵语，从阳明里也。男子下血，热入血室，但头汗出亦谵语，从阳明外
也，故并宜刺期门。
程应旄曰：下血则经脉空虚，热得乘虚而入血室，谵语以血室虽冲脉所属，而心经实
血室之主，室被热扰，故心神不清也。但头汗出者，血下夺则无汗，热上扰则汗蒸也
。刺期门者，热入阴分，实在阴，随其实而泻之，则荣气和而心气下通，故濈然汗出
而解。
@@@
阳明病，口燥，但欲漱水不欲咽者，此必□。
【注】
阳明属胃，开窍于口，阳明有热，故口燥也。但欲漱水不欲咽者，虽燥而不渴，知热
在经而不在府，在血而不在气也。热在经血，迫血妄行，必致□也。
【集注】
喻昌曰：口中干燥与渴异，漱水不欲咽，知不渴也。阳明病，口燥但漱水不欲咽，知
邪入血分，阳明之脉起于鼻，故知血得热而妄行，必由鼻而出也。
沈明宗曰：阳明病，口燥漱水而不欲咽，乃邪郁于经，未入于府也。
@@@
脉浮发热，口干鼻燥，能食者，则□。
【注】
此承上条详出脉证，以互发其义也。阳明病，脉浮发热，口鼻干燥，热在经也。若其
人能食，则为胃和，胃和则邪当还表作解也。然还表作解，不解于卫，则解于荣。汗
出而解者，从卫解也；衄血而解者，从荣解也。今既能食、衄血，则知欲从荣解也。
【集注】
张锡驹曰：此论阳明经脉燥热也。夫热在经脉，故脉浮发热，热循阳明经脉而上，故
口干鼻燥，不伤胃气，故能食。能食者则衄，言病不在胃府，非因能食而致衄也。
@@@
阳明证，其人喜忘者，必有畜血。所以然者，本有久瘀血，故令喜忘，屎虽□，大便
反易，其色必黑者，宜抵当汤下之。
【注】
经曰：血并于下，乱而喜忘；喜忘者，好忘前言往事也。今阳明病，其人喜忘者，本
有久瘀之血，与热上并于心，故令喜忘也。畜血之屎虽□，然大便反易，其色必黑，
盖以血与糟粕共并，故反易而色黑也。不用桃仁承气汤，而用抵当汤大下之者，以其
人本有久瘀之血故也。
【集注】
张志聪曰：太阳畜血在膀胱，故验其小便之利与不利；阳明畜血在肠胃，故验其大便
之黑与不黑。
张璐曰：大便色黑，虽曰瘀血，而燥结亦黑，但瘀血则粘如漆，燥结则晦如煤，此为
明辨也。郑重光曰：太阳热结膀胱证，轻者如狂，重者发狂。如狂者血自下，故用桃
仁承气汤，因势而利导之，发狂者血不下，须用抵当汤。此条喜忘差减于狂，乃用发
狂之重剂，何也？盖太阳经少血，阳明经多血，所以宜用抵当汤峻攻。太阳云主之，
乃确然不易之法，此云宜用，则证有轻重，在于临时酌量耳。
@@@
病人无表里证，发热七、八日，虽脉浮数者，可下之。假令已下，脉数不解，合热则
消谷善饥，至六、七日，不大便者，有瘀血，宜抵当汤。若脉数不解，而下不止，必
协热便脓血也。
【注】
此承上条言畜血喜忘，热结而无表里证者，当下之义也。病人无表里证，是无太阳表
、阳明里证也，但发热而无恶寒，七、八日，虽脉浮数不可汗也。若屎□可下之，假
令已下，脉不浮而数不解，是表热去里热未去也。至六、七日又不大便，若不能消谷
善饥，是胃实热也，以大承气汤下之。今既能消谷善饥，是胃和合热，非胃邪合热，
故屎虽□色必黑，乃有瘀血热结之不大便也，宜用抵当汤下之。若脉数不解，不大便
□而下利不止，必有久瘀，协热腐化而便脓血也，则不宜用抵当汤下之矣。
【集注】
张璐曰：病虽七、八日，尚发热脉浮数，仍属太阳表证。因误下引邪内入，所以脉数
不解，内外合邪而见消谷善饥，谷入既多，反至六、七日不大便，且不烦渴，是知其
证非热结在胃，乃热结在血。以其表证误下，尚兼太阳随经之热未尽，故以抵当为至
当也。若脉数不解而下利不止，又当随其下血与不下血而异治之，倘血分之热邪不除
，必协热而便脓血也。
@@@
伤寒发汗已，身目为黄。所以然者，以寒湿在里不解故也，以为不可下也，于寒湿中
求之。
【注】
猪苓（去皮） 茯苓 阿胶 泽泻 滑石（碎）各一两
以上五味药，用水四升，先煮前四味药，取二升药液，滤去药渣，加入阿胶使其溶化，每次温服七合，每日服用三次。
【集解】
赵羽皇说：张仲景创制猪苓汤，用来疏通阳明、少阴两经的水热之邪。然而其主旨全在于益养阴液，并非专门为了利水。大概伤寒表虚证，最忌讳亡阳，而里虚证又担心亡阴。所谓亡阴，是指肾中的阴液和胃中的津液耗竭。所以阴虚的人，不仅大便不可轻易攻下，就连小便也忌用通利之法。倘若对阴虚之人过度使用渗湿利水药，那么津液反而会导致枯竭。方中阿胶质地如膏，能养阴润燥；滑石性质滑利，能清热利水；配合茯苓、猪苓的渗湿泄浊作用，既能疏通浊热而不留滞瘀阻，又能滋润真阴而不致枯燥，这是利水而不伤阴的良方。所以利水的方法，在太阳病用五苓散，是因为太阳职司寒水，所以加桂枝以温之，这是暖肾以行水；在阳明、少阴病用猪苓汤，是因为这两经关乎津液，特意用阿胶、滑石来滋润，这是滋养无形之气以推动有形之水。虽然都是利水，但一寒一温截然不同，只有明理者才知道。
@@@
脉象浮大，心下反而痞硬，有热，属于脏（里）的应当攻下，不令发汗；属于腑（表/外）的不令小便频数。小便频数则大便干结，汗多则热更甚，汗少则大便难，脉迟则尚不可攻下。
【注】
属脏，是指病位在里；属腑，是指病位在表（此处指病势偏外或尚未完全入里成实）。溲，指小便。脉浮而大，是太阳、阳明的脉象。浮主表，大主里，现在太阳脉浮说明表证未解，而心下反而痞硬，说明阳明之里急迫，权衡汗、下法是可以的。如果里有热实证，攻下无疑，不需要先发汗解表。如果没有热实证，而有脉浮的表证，不仅不能攻下，即使小便不利，也不宜利小便，仍应当解表。大概是担心小便频数、汗出过多，导致津液亡失，致使大便干结，那么热邪会更实。如果汗少脉迟，即使大便干结，里尚未结实，也不可攻下。
【集注】
王肯堂说：经文说脉浮大，误用发汗、误用攻下为逆证。这里因为心下痞硬且有热，知道邪气传入里，所以舍脉而从证。大便干结允许攻下，小便不利不允许利小便，为什么呢？回答说：攻下大便则内热除，利小便则津液伤。
林澜说：心下痞硬与腹部痞满不同。腹部痞满是邪气已经结聚成实，这里仅在心下，自然与非用下法不可的情况不同。腑与脏相对举而言，见一个为入里，一个犹属表的含义。
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阳明病，脉迟，进食难以吃饱，饱则轻微烦闷头眩，必定小便难，这是将要发生谷疸。即使攻下，腹满依旧，之所以这样，是因为脉迟的缘故。
【注】
阳明病不大便，已食如饥，食后腹满脉数的，则是胃热，是可下的证候。现在脉迟，迟主中寒，中寒不能消化谷物，所以虽然饥饿想吃，但进食难以吃饱，饱则烦闷，这是脾胃健运失常。清气阻滞于上升，所以头眩；浊气阻滞于下降，所以小便难。食物郁积湿瘀，这是将要发生谷疸的征象，不是阳明湿热、腹满发黄的那种情况。即使攻下，腹满暂时减轻，片刻后又恢复原状，之所以这样，是因为脉迟主中寒的缘故。
【集注】
方有执说：迟脉为寒，不能化谷，所以进食难以吃饱。湿气郁蒸，气逆不下行，所以轻微烦闷头眩。小便难，疸即黄病。谷疸，是水谷之湿蒸发而身黄。
张璐说：攻下后腹满依旧，大概腹满已是邪气内陷，脉迟则胃不实，徒然攻下其糟粕，病既不能去除，反而伤害身体！阳明证本应攻下，阳明而至腹痛，尤当急下。唯独这一个证候攻下后，腹满必依旧，是因为脉迟则胃气空虚，津液不充，其满不过是虚热内壅，不是结热当下那种情况。可见脉迟胃虚，不但攻下无益，就是发汗利小便的方法，也不可用，只当用和法，如甘草干姜汤，先温其中，然后少量给予调胃承气汤微和胃气即可。
程应旄说：热邪蓄积成黄的腹满，攻下可去。这则是谷气不得宣泄，属于胃气虚寒所致，攻下更加虚其虚了。所以腹满依旧。
@@@
阳明病，如果是中寒者，不能进食，小便不利，手足濈然汗出，这是将要发生固瘕，必定大便初硬后溏，之所以这样，是因为胃中冷，水谷不分的原因。
【注】
阳明病内热，则不大便，能进食，小便利，手足濈然汗出，这是可下的证候。现在中寒不能进食，小便不利，虽然手足濈然汗出，也不可攻下，这是中寒将要发生固瘕。怎么知道呢？因为大便必定初硬而后溏。之所以这样，是因为胃中虚冷，水谷不分，所以小便不利而大便必溏。
【按】
不能进食与上一条“食难用饱”，同是不能腐熟水谷。小便不利与上一条“小便难”，同是不能下输膀胱。只有手足濈然汗出，与上一条“饱则微烦、头眩”不同，那条将要发生谷疸，这条将要发生固瘕，都是胃中寒冷。一条因微烦头眩，阳气在中上，所以不病泻而病疸；一条因手足汗出，阳气在四肢，所以不病疸而病泻。再上一条中寒食难用饱，无汗小便难，欲作谷疸，因为其尚能少食微烦，还有阳气。这一条中寒不能食，手足冷汗，小便不利，欲作固瘕，则是寒湿不化，纯阴的缘故。固瘕者，即大瘕泻，俗称溏泻。固者，指久而不止的意思。
【按】
人的汗以天地之雨命名，阴阳调和而后有雨，阳亢则热而雨少，阴盛则寒而雨多，人的汗也是如此。四肢手足属土，土主脾胃，若脉大其汗蒸蒸而热，则为阳盛可下的证候；若脉迟其汗冷冷而寒，则为阴盛可温的证候。
【集注】
程应旄说：水谷不分，属于湿热偏渗的多。这里点出胃中冷，想让人知道病本于寒，应从寒治，不在小便方面治疗。
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太阳病，寸脉缓、关脉浮、尺脉弱，其人发热汗出，又恶寒不呕，只是心下痞，这是医生误用下法造成的；如果没下过，病人不恶寒而渴的，这是转属阳明。小便频数的，大便必干结，十天不大便，也没有痛苦，想喝水，少量给其饮水，只依法救治，口渴的，适宜五苓散。
【按】
“但以法救之”五个字，应当是“若小便不利”，才与上文的小便数、下文渴者的意义相合。这条病势不急，不用急救的文字，觉得毫无意义，必有遗漏错误。王三阳也说：此处五苓散难用，不然经文“渴者”之下，应当有缺文。
【注】
太阳病脉浮缓而弱，是中风脉；发热汗出恶寒，是中风证。不呕则里气和，为何有心下痞证？这一定是医生误用下法造成的。如果不经过医生误下，邪热自传于里，病人不恶寒而渴的，这是邪气离开太阳，已转属阳明。如果小便频数的，大便必干结，然而即使十天不大便，而没有胀满疼痛的痛苦，这仍属于虚燥不实，不可议下，等待即可。如果渴欲饮水，必定是胃中干燥，应当少量给其饮水以滋润胃。或者小便不利而渴的，又是水停不化，适宜五苓散以引导所停之水。因为病在膀胱，所以仍治太阳而不治阳明。
【集注】
张兼善说：十天不大便，而不用攻伐为什么呢？回答说：这不是结热，虽然不大便，而没有潮热谵语等可下的证候，应当审慎，不要因为日子久就随意攻下。
喻昌说：寸缓、关浮、尺弱，发热汗出恶寒，完全是太阳中风未罢的证候，如果不是误下，怎么会心下痞结呢？如果不误下，而太阳证必渐传经，乃至不恶寒而渴，邪入阳明确定了。然而阳明津液既然偏渗于小便，则大肠失其润而大便干结，与肠中热结自然不同，所以旬日不大便也没有痛苦。
汪琥说：小便数大便干结，仲景论中为什么没有治法呢？盖这正是仲景不须用药的地方，等待其阴阳自和，则小便渐少，大便必自出。
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阳明病，心下痞硬的，不可攻下，攻下后利不止的会死，利止的痊愈。
【注】
这是申述上一条痞硬、十天不大便无所苦，误攻后的变证。阳明病非胃家实，而心下痞硬的，不可攻下。如果攻下，其人利不止的，则正气脱而死。其人利自止的，邪退则还可以愈。
【集注】
汪琥说：有人问结胸证同样是心下痞硬，又属于可下，为什么呢？回答说：结胸证，心下痞硬而痛的，是胃中实，故可下；这个证不痛，应当是虚痞虚满，与半夏泻心汤的心下痞略同，所以说：不可攻下。
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各种虚证，不可攻下，攻下则大渴，求水的易愈，恶水的病重。
【注】
虚证攻下，是为重虚，阴津消亡，自然大渴。那些求水的，阳气犹存，所以易愈；如果恶水的，阳气已绝，则难愈了。
【集注】
程应旄说：各种虚证，阳津阴液，必有所亡，所以攻下则大渴；求水是亡阴，恶水是亡阳，所以有愈剧之分。观此可知仲景顾虑误下助阴，甚于顾虑误下亡阴。
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大下之后，又发汗，小便不利的，是亡津液的原因，不要治疗它，得到小便利，必定自愈。
【注】
大下之后，又发其汗，重伤津液，小便必然减少，因为水液内竭的缘故。不要治疗它，意思是不要利其小便。必须等待津液回复而小便利，必定自愈。
【集注】
程知说：说下后复发汗，有等待津液自回的方法。如果强行责其小便，则膀胱的气化不行，增加痞满喘胀很明显，所以宜以不治治之。
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阳明病，下血谵语的，这是热入血室，只有头汗出的，刺期门穴，随其实而泻之，濈然汗出则愈。
【注】
妇人患伤寒，经血适至，则有热入血室的证候，宜刺期门；男子患伤寒，有下血谵语的，也是热入血室。如果热随血去，必通身汗出而解。如果血已止，其热不去，蓄于阳明，不得外越而上蒸，只有头汗出而不解的，也当刺期门，随其实而泻之，则也必通身濈然汗出而愈。
【集注】
方有执说：血室、头汗、期门，注解都见于太阳篇中。阳明的脉，直的从缺盆下乳内廉下，夹脐入气街中。血室的脉起于气街，上行至胸中而散。所以妇人经来，热入血室，则似结胸而谵语，从阳明里也。男子下血，热入血室，只有头汗出亦谵语，从阳明外也，所以都宜刺期门。
程应旄说：下血则经脉空虚，热得乘虚而入血室，谵语是因为血室虽冲脉所属，而心经实为血室之主，室被热扰，所以心神不清。只有头汗出的，血下夺则无汗，热上扰则汗蒸。刺期门的，热入阴分，实在阴，随其实而泻之，则营气和而心气下通，所以濈然汗出而解。
【注】
阳明属胃，开窍于口，阳明有热，所以口燥。只想漱水不想咽的，虽然燥但不渴，知道热在经而不在府，在血而不在气。热在经血，迫血妄行，必定导致鼻衄。
【集注】
喻昌说：口中干燥与渴异，漱水不欲咽，知道不渴。阳明病，口燥但漱水不欲咽，知道邪入血分，阳明之脉起于鼻，所以知道血得热而妄行，必由鼻而出。
沈明宗说：阳明病，口燥漱水而不欲咽，乃邪郁于经，未入于府。
【注】
这是承接上一条详细列出脉证，以互相发挥其义。阳明病，脉浮发热，口鼻干燥，热在经。如果其人能食，则为胃和，胃和则邪当还表作解。然而还表作解，不解于卫，则解于荣。汗出而解的，从卫解；衄血而解的，从荣解。现在既能食、衄血，则知欲从荣解。
【集注】
张锡驹说：此论阳明经脉燥热。夫热在经脉，故脉浮发热，热循阳明经脉而上，故口干鼻燥，不伤胃气，故能食。能食者则衄，言病不在胃府，非因能食而致衄。
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阳明证，其人喜忘的，必有畜血。之所以这样，本来有久瘀血，所以令喜忘，屎虽硬，大便反易，其色必黑的，适宜抵当汤攻下。
【注】
经说：血并于下，乱而喜忘；喜忘的，好忘前言往事。现在阳明病，其人喜忘的，本来有久瘀之血，与热上并于心，所以令喜忘。畜血的屎虽硬，然大便反易，其色必黑，盖以血与糟粕共并，所以反易而色黑。不用桃仁承气汤，而用抵当汤大下之的，是因为其人本来有久瘀之血的缘故。
【集注】
张志聪说：太阳畜血在膀胱，故验其小便之利与不利；阳明畜血在肠胃，故验其大便之黑与不黑。
张璐说：大便色黑，虽曰瘀血，而燥结亦黑，但瘀血则粘如漆，燥结则晦如煤，此为明辨。郑重光说：太阳热结膀胱证，轻者如狂，重者发狂。如狂者血自下，故用桃仁承气汤，因势而利导之，发狂者血不下，须用抵当汤。此条喜忘差减于狂，乃用发狂之重剂，为什么呢？盖太阳经少血，阳明经多血，所以宜用抵当汤峻攻。太阳云主之，乃确然不易之法，此云宜用，则证有轻重，在于临时酌量耳。
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病人无表里证，发热七、八日，虽脉浮数的，可下之。假如已下，脉数不解，合热则消谷善饥，至六、七日，不大便的，有瘀血，适宜抵当汤。如果脉数不解，而下不止，必协热便脓血。
【注】
这是承接上一条言畜血喜忘，热结而无表里证的，当下之义。病人无表里证，是无太阳表、阳明里证，但发热而无恶寒，七、八日，虽脉浮数不可汗。如果屎硬可下之，假如已下，脉不浮而数不解，是表热去里热未去。至六、七日又不大便，若不能消谷善饥，是胃实热，以大承气汤下之。现在既能消谷善饥，是胃和合热，非胃邪合热，故屎虽硬色必黑，乃有瘀血热结的不大便，适宜用抵当汤下之。如果脉数不解，不大便硬而下利不止，必有久瘀，协热腐化而便脓血，则不宜用抵当汤下之。
【集注】
张璐说：病虽七、八日，尚发热脉浮数，仍属太阳表证。因误下引邪内入，所以脉数不解，内外合邪而见消谷善饥，谷入既多，反至六、七日不大便，且不烦渴，是知其证非热结在胃，乃热结在血。以其表证误下，尚兼太阳随经之热未尽，故以抵当为至当。若脉数不解而下利不止，又当随其下血与不下血而异治之，倘血分之热邪不除，必协热而便脓血。
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伤寒发汗已，身目为黄。之所以这样，是因为寒湿在里不解的缘故，认为不可下，于寒湿中求之。
【注】
Zhu Ling Tang (Polyporus Decoction) consists of Zhu Ling (Polyporus, with skin removed), Fu Ling (Poria), E Jiao (Donkey-hide Gelatin), Ze Xie (Alisma Rhizome), and Hua Shi (Talcum, crushed), each one tael.
These five herbs are boiled in four sheng of water. First, boil the first four herbs until two sheng remain, remove the dregs, add E Jiao and melt it into the liquid. Take seven he of the decoction warm, three times a day.
[Collected Explanations]
Zhao Yuhuang stated: Zhang Zhongjing formulated Zhu Ling Tang to circulate water-heat in the Yangming and Shaoyin meridians. However, its main purport lies in nourishing Yin, not merely in promoting urination. Generally, in Taiyang disease with exterior deficiency, loss of Yang is most feared, while in interior deficiency, loss of Yin is a concern. Loss of Yin refers to the depletion of Yin within the Kidney and the fluids of the Stomach. Therefore, in individuals with Yin deficiency, not only should the bowels not be lightly purged, but diuresis is also contraindicated. If Yin-deficient patients undergo excessive diuresis, body fluids will instead be exhausted. In this formula, E Jiao has a gelatinous quality that nourishes Yin and moistens dryness; Hua Shi is slippery in nature, clearing heat and promoting urination; assisted by the draining properties of Fu Ling and Zhu Ling, it disperses turbid heat without retaining stagnation and blood stasis, and moistens true Yin without causing excessive dryness. Thus, it is an excellent preparation that promotes urination without damaging Yin. Therefore, regarding methods of promoting urination, Wu Ling San (Five-Poria Powder) is used for Taiyang disease because Taiyang governs cold water, so Gui Zhi (Cinnamon Twig) is added to warm it, which is warming the Kidney to move water; Zhu Ling Tang is used for Yangming and Shaoyin diseases because these two meridians relate to body fluids, specifically using E Jiao and Hua Shi to moisten them, which is nourishing the formless Qi to move the formed water. Although both promote urination, one is cold and the other warm, differing significantly; only those who understand clearly know this.
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The pulse is floating and large, the epigastrium feels full and stiff, there is heat, if it belongs to the Zang organs, purge it and do not induce sweating; if it belongs to the Fu organs, do not allow frequent urination. Frequent urination leads to dry stool, excessive sweating increases heat, insufficient sweating makes stool difficult, and if the pulse is slow, purging is not yet appropriate.
[Note]
Belonging to Zang means belonging to the Interior; belonging to Fu means belonging to the Exterior. "Sou" refers to urination. A floating and large pulse is characteristic of Taiyang and Yangming. Floating indicates the Exterior, large indicates the Interior. Now, the Taiyang pulse is floating indicating the Exterior is not resolved, while the epigastrium feels full and stiff, and the Yangming Interior is urgent. Weighing between sweating and purging may be considered. If there is interior heat-excess, purging is unquestionable, and there is no need to sweat first to resolve the exterior. If there is no heat-excess, but there is a floating pulse indicating the Exterior, not only should purging be avoided, but even if urination is difficult, diuresis should not be used; instead, the exterior should still be resolved. This is to fear that frequent urination and excessive sweating will cause loss of body fluids, leading to dry stool, thereby making the heat more excess. If sweating is scanty and the pulse is slow, even if the stool is dry, the Interior is not yet excess, and purging is not appropriate.
[Collected Notes]
Wang Kentang stated: The treatise says that for a floating and large pulse, inducing sweating or purging is contrary to treatment. Here, because the epigastrium is full/stiff with heat, we know the pathogen has entered the Interior, so we abandon the pulse and follow the symptoms. Dry stool allows for purging, but frequent urination does not allow for diuresis. Why? Purging the dry stool removes internal heat, while diuresis damages body fluids.
Lin Lan stated: Epigastric fullness/stiffness differs from abdominal fullness/stiffness. Abdominal fullness/stiffness indicates pathogens have aggregated into excess; here it is only in the epigastrium, naturally different from cases where purging is absolutely necessary. Fu and Zang are mentioned in opposition, showing one has entered the Interior and the other still belongs to the Exterior.
@@@
Yangming disease, with a slow pulse, difficulty eating to fullness, slight irritability and dizziness after eating to fullness,必定 difficulty in urination, this is about to become Grain Jaundice (Gu Dan). Even if purged, abdominal fullness remains as before. The reason for this is the slow pulse.
[Note]
In Yangming disease, if one does not defecate, feels hungry after eating, experiences abdominal fullness immediately after eating, and has a rapid pulse, this is Stomach Heat, a sign suitable for purging. Now the pulse is slow; slow indicates Cold in the Middle. Cold in the Middle cannot transform grain, so although hungry and wanting to eat, one cannot eat to fullness. After eating to fullness, there is irritability and stuffiness, indicating impaired transportation and transformation. Clear Qi is blocked from ascending, causing dizziness; Turbid Qi is blocked from descending, causing difficulty in urination. Food stagnation and dampness stasis are signs of impending Grain Jaundice, distinct from Yangming Damp-Heat with abdominal fullness and jaundice. Even if purged, abdominal fullness temporarily decreases but returns to normal shortly. The reason is the slow pulse indicating Middle Cold.
[Collected Notes]
Fang Youzhi stated: Slow pulse indicates Cold unable to transform grain, hence difficulty eating to fullness. Dampness stagnates and steams, Qi rebels and fails to descend, hence slight irritability and dizziness. Difficulty in urination; Dan is jaundice. Grain Jaundice is yellowing of the body caused by evaporation of dampness from food and drink.
Zhang Lu stated: Abdominal fullness remaining after purging occurs because abdominal fullness already indicates pathogen sinking. With a slow pulse, the Stomach is not excess. Merely purging the feces does not remove the disease but causes harm! Yangming syndrome generally requires purging, and abdominal pain in Yangming especially warrants urgent purging. Only in this specific case does purging fail to relieve abdominal fullness because a slow pulse indicates empty Stomach Qi and unfulfilled body fluids. The fullness is merely empty heat stagnating internally, not comparable to heat accumulation requiring purging. Thus, with a slow pulse and Stomach deficiency, not only is purging useless, but sweating and diuresis are also contraindicated. One should use harmonizing methods, such as Gan Cao Gan Jiang Tang (Licorice and Ginger Decoction), to first warm the Middle, then give Tiao Wei Cheng Qi Tang (Regulate the Stomach and Order the Large Intestine Decoction) in small amounts to mildly harmonize Stomach Qi.
Cheng Yingmao stated: Abdominal fullness caused by heat accumulating into jaundice can be removed by purging. This case involves Grain Qi failing to vent and disperse, caused by Stomach Qi deficiency and Cold. Purging would further deplete the deficiency. Hence, abdominal fullness remains.
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Yangming disease, if affected by Cold, results in inability to eat, difficulty in urination, and continuous sweating on the hands and feet. This is about to form Gu Jia (Solid Mass), and the stool will certainly be hard at first and loose later. The reason is Cold in the Stomach causing failure to separate water and grain.
[Note]
Yangming disease with internal heat results in constipation, ability to eat, free urination, and continuous sweating on the hands and feet, which are signs suitable for purging. Now, due to Cold affecting the Middle, eating is impossible, and urination is difficult. Even with continuous sweating on the hands and feet, purging is not appropriate; this is Cold affecting the Middle about to form Gu Jia. How do we know? Because the stool will certainly be hard initially and loose subsequently. The reason is deficiency-cold in the Stomach causing failure to differentiate water and grain, leading to difficulty in urination and loose stools.
[Commentary]
Inability to eat is the same as "difficulty eating to fullness" in the previous paragraph, both indicating inability to rot and ripen water and grain. Difficulty in urination is the same as "difficulty in urination" in the previous paragraph, both indicating inability to transmit downward to the Bladder. Only continuous sweating on the hands and feet differs from "slight irritability and dizziness after fullness" in the previous paragraph. The former is about to develop Grain Jaundice, this one is about to form Gu Jia; both are due to Cold in the Stomach. The former, with slight irritability and dizziness, has Yang in the upper-middle, so it develops jaundice rather than diarrhea; the latter, with sweating on the hands and feet, has Yang in the four limbs, so it develops diarrhea rather than jaundice. Furthermore, the previous paragraph's Cold affecting the Middle with difficulty eating to fullness, no sweating, and difficulty in urination, about to develop Grain Jaundice, still has some Yang Qi because it can eat slightly and feel slight irritability. This paragraph's Cold affecting the Middle with inability to eat, cold sweating on the hands and feet, and difficulty in urination, about to form Gu Jia, indicates untransformed Cold-Dampness and pure Yin. Gu Jia is Da Xia Xie (Great Diarrhea), commonly known as loose stool. "Gu" means persistent and unceasing.
[Commentary]
Human sweat is named after rain in heaven and earth. Rain occurs only when Yin and Yang harmonize. When Yang is hyperactive, it is hot and rain is scarce; when Yin is abundant, it is cold and rain is abundant. Human sweat is similar. The four limbs and hands/feet belong to Earth, and Earth governs the Spleen and Stomach. If the pulse is large and sweat is steaming and hot, it is Yang excess, a sign suitable for purging; if the pulse is slow and sweat is cold, it is Yin excess, a sign suitable for warming.
[Collected Notes]
Cheng Yingmao stated: Failure to separate water and grain is mostly due to damp-heat leaking unevenly. Here, pointing out Cold in the Stomach intends to make people know the disease originates from Cold and should be treated as Cold, not focusing on urination.
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Taiyang disease, with a slow pulse at the Cun position, floating at the Guan position, and weak at the Chi position. The person has fever, sweating, and aversion to cold, no vomiting, but only epigastric stuffiness. This is caused by the physician's erroneous purgation. If not purged, and the patient is not averse to cold but thirsty, this has transferred to Yangming. If urination is frequent, the stool will certainly be dry. Even if ten days pass without defecation, there is no discomfort. If thirsty and wanting to drink water, give small amounts. Rescue only according to the method. For thirst, Wu Ling San (Five-Poria Powder) is suitable.
[Commentary]
The phrase "rescue only according to the method" likely should be "if urination is difficult" to align with the preceding text on frequent urination and the following text on thirst. This passage describing a non-urgent condition seems meaningless without rescue, suggesting a textual error. Wang Sanyang also said: Wu Ling San is difficult to apply here; otherwise, there must be missing text after "thirst."
[Note]
Taiyang disease with a floating-slow and weak pulse is the pulse of Wind Strike; fever, sweating, and aversion to cold are symptoms of Wind Strike. No vomiting means the Interior Qi is harmonious. Why is there epigastric stuffiness? This must be due to the physician's erroneous purgation. If not erroneously purged by the physician, and pathogenic heat transmits to the Interior spontaneously, and the patient is not averse to cold but thirsty, this means the pathogen has left Taiyang and transferred to Yangming. If urination is frequent, the stool will certainly be dry. However, if ten days pass without defecation without any discomfort of fullness or pain, this still belongs to deficiency-dryness and non-excess. Do not discuss purging; waiting is acceptable. If thirsty and wanting to drink water, it must be Stomach dryness; give small amounts to moisten the Stomach. If urination is difficult and thirsty, this is water retention failing to transform; Wu Ling San (Five-Poria Powder) should be used to guide the retained water. Since the disease is in the Bladder, treat Taiyang, not Yangming.
[Collected Notes]
Zhang Jianshan stated: Ten days without defecation, why not use attacking drugs? Answer: This is not heat accumulation. Although there is no defecation, there are no signs suitable for purging like tidal fever or delirium. Caution is required; do not purge simply because the number of days is long.
Yu Chang stated: Slow pulse at Cun, floating at Guan, weak at Chi, fever, sweating, aversion to cold—these are purely Taiyang Wind Strike signs not yet resolved. If not erroneously purged, how could there be epigastric knotting? If not erroneously purged, Taiyang signs will gradually transmit through the meridians, eventually becoming non-aversion to cold and thirst, confirming pathogen entry into Yangming. However, since Yangming body fluids leak unevenly into urination, the Large Intestine loses moisture and the stool becomes dry. This is different from heat accumulation in the intestines, hence no discomfort after ten days without defecation.
Wang Hu stated: Frequent urination and dry stool—why is there no treatment method in Zhang Zhongjing's treatise? This is precisely where Zhang Zhongjing deemed medication unnecessary. Wait for Yin and Yang to self-harmonize, then urination will gradually decrease, and stool will naturally pass.
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Yangming disease, with epigastric fullness/stiffness, must not be purged. If purged and diarrhea continues unceasingly, death ensues; if diarrhea stops, recovery occurs.
[Note]
This elaborates on the previous paragraph's epigastric stuffiness and ten days without defecation without discomfort, detailing the changes from erroneous purging. In Yangming disease, if it is not Stomach-Excess, but there is epigastric fullness/stiffness, purging is contraindicated. If purged, and diarrhea continues unceasingly, Zheng Qi (Upright Qi) collapses, leading to death. If diarrhea stops spontaneously, the pathogen retreats, and recovery is possible.
[Collected Notes]
Wang Hu stated: Someone asks: Jie Xiong (Knotted Chest) syndrome also presents with epigastric fullness/stiffness, yet it is suitable for purging. Why? Answer: In Jie Xiong syndrome, epigastric fullness/stiffness with pain indicates Stomach excess, so purging is suitable; this syndrome has no pain, indicating deficiency-stuffiness and deficiency-fullness, similar to the epigastric stuffiness in Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Epigastrium), hence it says: purging is contraindicated.
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All deficiency syndromes must not be purged. Purging causes severe thirst. Those seeking water recover easily; those repulsed by water worsen.
[Note]
Purging deficiency syndromes creates double deficiency, consuming Yin fluids, naturally causing severe thirst. Those seeking water still have Yang Qi, so they recover easily; those repulsed by water have exhausted Yang Qi, so they are difficult to cure.
[Collected Notes]
Cheng Yingmao stated: In all deficiency syndromes, Yang fluids and Yin liquids must be depleted, so purging causes severe thirst. Seeking water indicates loss of Yin; repulsed by water indicates loss of Yang, hence the difference between recovery and worsening. From this, we know Zhang Zhongjing feared that erroneous purging aids Yin evil more than it fears erroneous purging depletes Yin.
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After severe purgation followed by sweating, if urination is difficult, it is due to loss of body fluids. Do not treat it. When urination becomes free, it will surely heal itself.
[Note]
After severe purgation followed by sweating, body fluids are doubly depleted, and urine volume should decrease due to internal exhaustion of fluids. "Do not treat it" means do not promote urination. Wait for body fluids to return and urination to become free; it will surely heal itself.
[Collected Notes]
Cheng Zhi stated: This describes the method of waiting for body fluids to return after purgation and sweating. If one forces urination, Bladder Qi transformation will fail, leading to increased epigastric fullness, wheezing, and distension. Thus, treating by not treating is appropriate.
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Yangming disease, with hematochezia and delirium, is Heat entering the Blood Chamber. If only the head sweats, puncture Qi Men (Liv 14). Drain according to its excess. Continuous sweating indicates recovery.
[Note]
In women suffering from Cold Damage, if menstruation coincides, there is a sign of Heat entering the Blood Chamber, suitable for puncturing Qi Men (Liv 14). In men suffering from Cold Damage, with hematochezia and delirium, it is also Heat entering the Blood Chamber. If Heat leaves with the blood, whole-body sweating will resolve the condition. If bleeding stops but Heat remains, accumulating in Yangming, unable to exit outward and steaming upward, resulting in only head sweating without resolution, puncture Qi Men (Liv 14) is also indicated. Drain according to its excess, and continuous whole-body sweating will lead to recovery.
[Collected Notes]
Fang Youzhi stated: Blood Chamber, head sweating, and Qi Men (Liv 14) are explained in the Taiyang chapter. The direct branch of the Yangming meridian descends from the Supraclavicular Fossa, down the inner aspect of the breast, alongside the navel, into the Qichong area. The Blood Chamber meridian originates in the Qichong area, ascends to the chest, and disperses. Thus, when a woman menstruates and Heat enters the Blood Chamber, it resembles Jie Xiong (Knotted Chest) with delirium, coming from the Yangming Interior. In men, hematochezia with Heat entering the Blood Chamber, only head sweating and delirium, comes from the Yangming Exterior. Both are suitable for puncturing Qi Men (Liv 14).
Cheng Yingmao stated: Hematochezia empties the meridians, allowing Heat to enter the Blood Chamber vacantly. Delirium occurs because although the Blood Chamber belongs to the Chong Mai, the Heart Meridian is the master of the Blood Chamber. Heat disturbing the chamber confuses the Spirit. Only head sweating occurs because blood loss prevents general sweating, while Heat steaming upward causes sweating. Puncturing Qi Men (Liv 14): Heat enters the Yin portion, residing in Yin. Draining according to its excess harmonizes Ying Qi and allows Heart Qi to descend, resulting in continuous sweating and resolution.
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Yangming disease, with dry mouth, desiring only to rinse with water without swallowing, will certainly result in epistaxis.
[Note]
Yangming belongs to the Stomach, opening into the mouth. Yangming Heat causes dry mouth. Desiring only to rinse with water without swallowing indicates dryness without thirst, knowing Heat is in the Meridian, not the Organ, in the Blood, not the Qi. Heat in the Meridian and Blood forces blood to move recklessly, inevitably causing epistaxis.
[Collected Notes]
Yu Chang stated: Dry mouth differs from thirst. Rinsing with water without swallowing indicates no thirst. In Yangming disease, dry mouth with rinsing but no swallowing indicates pathogen entering the Blood level. The Yangming meridian originates at the nose, so knowing blood moves recklessly due to Heat, it will certainly exit from the nose.
Shen Mingzong stated: In Yangming disease, dry mouth, rinsing with water without swallowing, indicates pathogen stagnating in the Meridian, not yet entering the Organ.
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Floating pulse, fever, dry mouth and nose, ability to eat, indicates epistaxis.
[Note]
This follows the previous paragraph to detail pulse and symptoms, mutually expounding their meaning. In Yangming disease, floating pulse, fever, dry mouth and nose indicate Heat in the Meridian. If the person can eat, the Stomach is harmonious. When the Stomach is harmonious, the pathogen should return to the Exterior to resolve. However, returning to the Exterior to resolve, if not resolving via Wei (Defensive) Qi, it resolves via Ying (Nutritive) Qi. Resolving via sweating is resolving via Wei; resolving via epistaxis is resolving via Ying. Now, being able to eat and having epistaxis indicates desire to resolve via Ying.
[Collected Notes]
Zhang Xiju stated: This discusses Yangming Meridian Dry-Heat. Heat in the meridians causes floating pulse and fever. Heat follows the Yangming meridian upward, causing dry mouth and nose. It does not damage Stomach Qi, so eating is possible. Ability to eat leads to epistaxis, indicating the disease is not in the Stomach Organ, nor caused by eating.
@@@
Yangming syndrome, with forgetfulness,必定 has Blood Stasis. The reason is pre-existing old Blood Stasis, causing forgetfulness. Although stool is dry, defecation is surprisingly easy, and the color is必定 black. Use Di Dang Tang (Di Dang Decoction) to purge.
[Note]
The Classics state: Blood pooling below causes confusion and forgetfulness. Forgetfulness means forgetting past words and deeds. Now in Yangming disease, forgetfulness is due to pre-existing old Blood Stasis combining with Heat ascending to the Heart, causing forgetfulness. In Blood Stasis, although stool is dry, defecation is surprisingly easy, and the color is必定 black, because blood mixes with feces, making it easy to pass and black in color. Di Dang Tang (Di Dang Decoction) is used for severe purging instead of Tao Ren Cheng Qi Tang (Persimmon Seed Decoction to Order the Stomach) because of the pre-existing old Blood Stasis.
[Collected Notes]
Zhang Zhicong stated: In Taiyang, Blood Stasis is in the Bladder, so check if urination is free or difficult. In Yangming, Blood Stasis is in the Intestines, so check if stool is black or not.
Zhang Lu stated: Black stool indicates Blood Stasis, but dry accumulation is also black. However, Blood Stasis is sticky like lacquer, while dry accumulation is dull like coal. This is a clear distinction. Zheng Zhongguang stated: In Sun Yang Heat Accumulation in the Bladder syndrome, mild cases resemble madness, severe cases involve actual madness. In resembling madness, blood drains spontaneously, so Tao Ren Cheng Qi Tang (Persimmon Seed Decoction to Order the Stomach) is used to guide the pathogen. In actual madness, blood does not drain, requiring Di Dang Tang (Di Dang Decoction). This paragraph mentions forgetfulness, which is less severe than madness, yet uses the heavy agent for madness. Why? Because the Taiyang Meridian has little blood, while the Yangming Meridian has much blood, so Di Dang Tang (Di Dang Decoction) for severe attack is appropriate. Taiyang says "mainly governs," a fixed method; this says "suitable for," indicating severity varies and requires temporary judgment.
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The patient has no Exterior or Interior signs, fever for seven or eight days. Although the pulse is floating and rapid, purging may be used. If purged and the rapid pulse does not resolve, combined Heat causes efficient digestion and hunger. By six or seven days, if no defecation, there is Blood Stasis. Use Di Dang Tang (Di Dang Decoction). If the rapid pulse does not resolve and diarrhea continues,必定 dysentery with pus and blood will occur.
[Note]
This follows the previous paragraph on Blood Stasis and forgetfulness, discussing the indication for purging in Heat accumulation without Exterior or Interior signs. "No Exterior or Interior signs" means no Taiyang Exterior or Yangming Interior signs. There is fever without aversion to cold. For seven or eight days, although the pulse is floating and rapid, sweating is contraindicated. If stool is dry, purging is appropriate. If purged and the pulse is no longer floating but rapid persists, Exterior Heat is gone but Interior Heat remains. By six or seven days, if no defecation, if unable to digest food efficiently and feeling hungry, it is Stomach Excess Heat, purged with Da Cheng Qi Tang (Major Order the Qi Decoction). Now, being able to digest food efficiently and feel hungry indicates Stomach Harmony combined with Heat, not Stomach Pathogen combined with Heat. Thus, although stool is dry, the color is必定 black, indicating Blood Stasis and Heat accumulation causing no defecation. Use Di Dang Tang (Di Dang Decoction) to purge. If the rapid pulse does not resolve, dry stool is accompanied by unceasing diarrhea, there must be old Blood Stasis, decomposing with Heat into pus and blood in the stool. Di Dang Tang (Di Dang Decoction) should not be used.
[Collected Notes]
Zhang Lu stated: Although seven or eight days have passed, fever and floating-rapid pulse still belong to Taiyang Exterior signs. Erroneous purging drew the pathogen inward, so the rapid pulse does not resolve. Internal and external pathogens combine, causing efficient digestion and hunger. With increased food intake, by six or seven days, there is no defecation, and no irritability or thirst. This indicates the syndrome is not Heat accumulation in the Stomach, but Heat accumulation in the Blood. Due to erroneous purging of Exterior signs, residual Heat from Taiyang following the meridians remains, so Di Dang Tang (Di Dang Decoction) is most appropriate. If the rapid pulse does not resolve and diarrhea continues, treatment should vary based on whether blood is passed or not. If Blood-level Heat pathogen is not removed, it will必定 cause dysentery with pus and blood.
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After Cold Damage and sweating, the body and eyes turn yellow. The reason is unresolved Cold-Dampness in the Interior. It is considered unsuitable for purging; seek treatment within the context of Cold-Dampness.
[Note]