29. 里证宜下不大便, 恶热潮热汗蒸蒸, 燥干谵语满硬痛, 便溏为虚
不可攻.
【注】里证, 谓热邪内结, 不大便, 恶热潮热, 自汗蒸蒸, 口燥舌干
谵语, 腹满硬痛也. 阳明腑主里, 故曰里证. 里实者, 有脾约, 有胃
实,有大便难, 三者均为可下之证, 然不无轻重之别. 三承气汤、 脾
约丸, 量其可者而与之, 庶乎无过也. 若便溏为里虚, 即有是证不可
攻也. 论中有急下数证, 不待便实而下之者, 是下其热也, 非下其结
也. 义详阳明少阴篇.
30. 阳证身轻气高热, 目睛了了面唇红, 热烦口燥舌干渴, 指甲红兮
小便同.
【注】阳证, 谓阳热之证也. 不论三阴、 三阳, 凡见是证者, 均为阳
热有余也. 阳主动, 故身轻也. 阳气盛, 故气高而喘也. 阳主热, 故
口鼻气热也. 阳主寤, 故目睛了了而不眠也. 目睛不了了, 亦有热极
朦胧似不了了, 然必目赤多眵, 非若阴证之不了了而神短无光也. 阳
气热, 故身热, 面唇红, 指甲红也. 阳热入里, 故心烦, 口燥, 舌干
而渴, 小便红也. 表实者, 三黄石膏汤发之. 里实者, 三承气汤下之.
表里不实而热盛者, 白虎解毒等汤清之可也. 详三阳篇.
29. 里证适宜使用攻下法的情况：不大便，恶寒（怕冷）伴潮热（定时发热），汗出蒸蒸（大汗淋漓），口燥咽干，胡言乱语，腹部胀满、坚硬且疼痛。若大便溏薄则属虚证，不可使用攻下法。
【注】所谓里证，是指热邪内结，表现为不大便，恶寒伴潮热，自汗淋漓，口燥舌干，胡言乱语，腹部胀满、坚硬且疼痛。阳明腑（指大肠等消化器官的功能系统）主司里证，所以称为里证。里实证中，有脾约（脾阴不足导致肠道干燥便秘）、胃实（胃中积热导致便秘）、大便难三种情况，这三者都属于可以使用攻下法的证候，但病情轻重有所不同。三承气汤（调胃承气汤、小承气汤、大承气汤的统称）、脾约丸，应根据具体情况选择适用的方剂给予治疗，这样才不至于过度治疗。如果大便溏薄则是里虚证，即使出现上述症状也不可攻下。医论中有几种急下证，不需要等到粪便完全结实就进行攻下，这是为了泻除热邪，而非仅仅泻除积滞。具体义理详见阳明病和少阴病篇。
30. 阳证的表现：身体轻健，气息粗重且高热，眼睛明亮有神，面部和嘴唇红润，心中烦热，口燥舌干且口渴，指甲颜色红，小便颜色也红。
【注】所谓阳证，是指阳热性质的证候。不论属于三阴经还是三阳经，凡是出现这些症状的，都属于阳热有余。阳主动，所以身体轻健。阳气旺盛，所以呼吸急促而喘息。阳主热，所以口鼻呼出的气是热的。阳主清醒（寤），所以眼睛明亮有神且难以入睡。眼睛昏暗不明，也有因热极导致神志朦胧似昏沉的情况，但必然伴有眼红、眼屎多，不像阴证的昏暗不明那样精神短少、目光无神。阳气热盛，所以身体发热，面部、嘴唇、指甲发红。阳热侵入体内，所以心烦，口燥，舌干且口渴，小便发红。表实（体表邪气盛）者，用三黄石膏汤发散解表。里实（体内邪气盛）者，用三承气汤攻下泄热。表里均不实但热势炽盛者，用白虎汤、解毒汤等清热即可。详细内容见三阳病篇。
29. Indications for purgation in Interior Syndromes: Constipation, aversion to cold (fear of cold) accompanied by tidal fever (fever at fixed times), profuse sweating, dry mouth and throat, delirium, abdominal distension, hardness, and pain. If the stool is loose, it indicates a Deficiency syndrome, and purgation must not be used.
[Note] The term "Interior Syndrome" refers to internal binding of heat pathogens, manifesting as constipation, aversion to cold with tidal fever, spontaneous profuse sweating, dry mouth and tongue, delirium, and abdominal distension, hardness, and pain. The Yangming Fu-organs (the functional system of the large intestine and other digestive organs) govern the Interior, hence it is called an Interior Syndrome. Among Interior Excess syndromes, there are Pi Yue (constipation due to insufficient Spleen Yin causing intestinal dryness), Wei Shi (gastric excess/heat accumulation leading to constipation), and Da Bian Nan (difficulty in defecation). These three conditions all fall under indications for purgation, though their severity differs. San Cheng Qi Tang (a collective name for Tiao Wei Cheng Qi Decoction, Xiao Cheng Qi Decoction, and Da Cheng Qi Decoction) and Pi Yue Wan should be selected according to the specific condition to avoid overtreatment. If the stool is loose, it indicates an Interior Deficiency syndrome; even if the aforementioned symptoms appear, purgation is contraindicated. The treatises mention several urgent purgation indications where purgation is administered without waiting for the stool to become completely solid; this is done to purge heat, not merely to remove stagnation. For detailed principles, see the chapters on Yangming and Shaoyin syndromes.
30. Manifestations of Yang Syndromes: The body feels light, breathing is rapid with high fever, eyes are clear and bright, face and lips are red, mental restlessness, dry mouth and tongue with thirst, red fingernails, and red urine.
[Note] The term "Yang Syndrome" refers to syndromes characterized by Yang-Heat. Regardless of whether they involve the Three Yin or Three Yang meridians, the presence of these symptoms indicates an excess of Yang-Heat. Yang governs movement, hence the body feels light. Abundant Yang Qi leads to rapid breathing and panting. Yang governs Heat, hence the breath from the mouth and nose is hot. Yang governs wakefulness, hence the eyes are clear and bright with difficulty sleeping. Cloudiness of vision can also occur when heat is extreme, causing a state of confusion resembling cloudiness, but this is necessarily accompanied by red eyes and excessive discharge, unlike the cloudiness of Yin syndromes which presents with shortness of spirit and lackluster gaze. Due to abundant Yang-Heat, the body is hot, and the face, lips, and nails are red. When Yang-Heat enters the interior, it causes mental restlessness, dry mouth, dry tongue, thirst, and red urine. In cases of Exterior Excess (excess pathogens at the exterior), San Huang Shi Gao Tang is used to disperse and resolve the exterior. In cases of Interior Excess (excess pathogens inside), San Cheng Qi Tang is used to purge and drain. In cases where neither the exterior nor interior is excess but heat is blazing, Bai Hu Tang (White Tiger Decoction) and Jie Du Tang (Detoxification Decoction) etc., are used to clear heat. For details, see the chapters on the Three Yang syndromes.