9.胃实脉大腑阳明, 大便难兮脾约同, 蒸蒸潮热濈濈汗, 满痛始可议
三承.
【注】脉大腑阳明, 谓热邪入腑, 阳明当脉大也. 曰胃实, 曰大便难,
曰脾约, 谓腑病受邪之不同也. 脾约者, 太阳阳明也. 胃实者, 正阳
阳明也. 大便难者, 少阳阳明也. 皆为可之下证, 不无轻重之别. 然
必蒸蒸潮热, 身肢濈濈然汗出, 或满或痛, 始可议其微、 甚, 以三承
气汤、麻仁丸下之可也. 详阳明篇.
10. 阳明表证反有汗, 桂枝加葛中风传. 热证无汗亡津液, 燥渴仍从
白虎痊. 胃实汗热原应下, 恶寒浮缓表为先. 欲知定硬识失气, 不转
微涩下之冤. 舌滑尿白小便数, 便硬休攻导自安. 小便数多知便硬,
无苦数少是津还.
【注】阳明表证应无汗, 反有汗, 是从风邪传来, 仍从表治, 宜用桂
枝加葛根汤. 阳明热证应有汗, 反无汗, 是或吐, 或汗, 或下亡其津
液,若无燥渴, 则从表治, 若有燥渴, 仍从热治, 宜用白虎汤. 胃实
自汗潮热, 原应下之, 若有恶寒浮缓之表, 宜先解表, 表解已, 乃可
攻之. 欲知大便硬定未定, 当稍与小承气汤, 转失气者, 己成定硬,
当与大承气汤攻之. 若不转矢气者, 未成定硬, 攻之必溏, 勿更与也.
若脉微涩者, 亦不可下, 下之则冤死也. 舌滑, 尿白, 里热微也, 虽
小便数、 大便硬, 其热远在广肠, 亦不可下, 用蜜煎猪胆导法自可安
也.凡小便数多, 知大便必硬, 虽大便硬而无或满、 或痛之苦, 当审
其小便日几行, 日减数少, 是津液还于胃中, 慎不可攻, 不久必自大
便出也. 详阳明篇.
9. 胃实脉大腑阳明，大便难兮脾约同，蒸蒸潮热濈濈汗，满痛始可议三承。
【注】脉大腑阳明，是指热邪进入腑中，阳明经应当出现脉大的症状。称为“胃实”、称为“大便难”、称为“脾约”，是说明腑病受邪的不同情况。“脾约”属于太阳阳明证。“胃实”属于正阳阳明证。“大便难”属于少阳阳明证。这些都属于可以使用下法治疗的证候，但仍有轻重的区别。然而，必须见到蒸蒸而出的潮热，身体和四肢濈濈然出汗，或者腹部胀满疼痛，才可以讨论其病情的微甚，从而使用三承气汤或麻仁丸进行攻下治疗。详细内容参见阳明篇。
10. 阳明表证反有汗，桂枝加葛中风传。热证无汗亡津液，燥渴仍从白虎痊。胃实汗热原应下，恶寒浮缓表为先。欲知定硬识失气，不转微涩下之冤。舌滑尿白小便数，便硬休攻导自安。小便数多知便硬，无苦数少是津还。
【注】阳明表证本应无汗，反而有汗，这是风邪传入所致，仍应从表证治疗，适宜使用桂枝加葛根汤。阳明热证本应有汗，反而无汗，是因为之前呕吐、发汗或攻下导致津液耗伤，如果没有燥渴的症状，则从表证治疗；如果有燥渴的症状，仍按热证治疗，适宜使用白虎汤。胃实证见自汗、潮热，原本应当使用下法，但如果伴有恶寒、脉浮缓等表证，应当先解除表证，表证解除后，才可以攻里。想要知道大便是否已经形成硬结，可以稍许给予小承气汤，如果病人放屁（转失气），说明大便已经形成硬结，应当给予大承气汤攻下。如果不放屁，说明大便尚未形成硬结，攻下会导致腹泻，不要再给。如果脉象微涩，也不可使用下法，否则会导致严重后果。舌苔滑腻、尿液清白，说明里热轻微，即使小便频数、大便干硬，也是热邪在广肠（直肠），也不可使用下法，使用蜜煎导法或猪胆导法即可安然无恙。凡是小便频数多，可知大便必然干硬，虽然大便干硬但没有胀满或疼痛的痛苦，应当观察其一天小便几次，如果次数逐渐减少变少，说明津液回归胃中，千万不要攻下，不久大便自然会排出。详细内容参见阳明篇。
9. Stomach excess with a large pulse indicates Yangming Fu syndrome; difficulty in defecation is similar to Spleen Constraint. With surging tidal fever and profuse sweating, only when there is fullness and pain can one discuss the use of the Three Chengqi formulas.
[Note] A large pulse in Yangming Fu syndrome refers to heat pathogens entering the Fu organs, where Yangming typically presents with a large pulse. Terms such as "Stomach Excess," "difficulty in defecation," and "Spleen Constraint" indicate different ways in which the Fu organs are affected by pathogens. "Spleen Constraint" belongs to Taiyang-Yangming syndrome. "Stomach Excess" belongs to Zhengyang (True Yang) Yangming syndrome. "Difficulty in defecation" belongs to Shaoyang-Yangming syndrome. All these are indications for purgative therapy, though they differ in severity. However, one must observe surging tidal fever, profuse sweating over the body and limbs, or abdominal fullness and pain, before discussing the mildness or severity of the condition and prescribing the Three Chengqi Decoctions (San Cheng Qi Tang) or Mahuang Wan (Pill of Hemp Seed) for purgation. For details, see the Yangming Chapter.
10. In Yangming Exterior Syndrome, sweat appears contrary to expectation; this suggests transmission from Wind Pathogen, treatable with Guizhi Jia Gegen Tang (Cinnamon Twig plus Kudzu Root Decoction). In Heat Syndromes, absence of sweat indicates loss of Body Fluids; if dryness and thirst persist, recover using Baihu Tang (White Tiger Decoction). Stomach Excess with sweat and heat originally requires purgation; but if chills and a floating-slow pulse indicate an exterior pattern, resolve the exterior first. To know if stool is firmly hardened, observe the passage of flatus; without flatus or with a faint-choppy pulse, purgation is a grievous error. Slippery tongue coating and clear urine with frequent urination suggest that although stool is hard, do not attack it directly; use suppository methods for self-resolution. Frequent uritation indicates likely hard stool; if there is no discomfort and frequency decreases, Body Fluids are returning to the Stomach.
[Note] Yangming Exterior Syndrome should present without sweat; the presence of sweat indicates transmission from Wind Pathogen, requiring treatment from the exterior, suitable for Guizhi Jia Gegen Tang (Cinnamon Twig plus Kudzu Root Decoction). Yangming Heat Syndrome should present with sweat; the absence of sweat may result from prior vomiting, sweating, or purgation leading to loss of Body Fluids. If there is no dryness and thirst, treat from the exterior; if dryness and thirst exist, treat as a Heat Syndrome, suitable for Baihu Tang (White Tiger Decoction). Stomach Excess presenting with spontaneous sweating and tidal fever originally warrants purgation. However, if exterior signs such as chills and a floating-slow pulse are present, the exterior must be resolved first; only after the exterior is cleared can interior purgation proceed. To determine if stool has become firmly hardened, administer a small dose of Xiaochengqi Tang (Minor Order the Qi Decoction). If the patient passes flatus (Zhuan Shiqi), the stool is confirmed hard, and Dachengqi Tang (Major Order the Qi Decoction) should be used for purgation. If flatus does not pass, the stool is not yet firmly hardened; purgation will cause diarrhea, so do not administer again. If the pulse is faint and choppy, purgation is also contraindicated, as it would lead to severe consequences. A slippery tongue coating and clear urine indicate mild interior heat. Even with frequent urination and hard stool, if the heat is located in the Changchang (large intestine/rectum), purgation is contraindicated; using Honey Suppository (Mi Jian Dao) or Pig Gallbladder Suppository (Zhu Dan Dao) methods will ensure safety. Generally, frequent urination indicates likely hard stool. Although the stool is hard, if there is no discomfort such as fullness or pain, observe the number of daily urinations. If the frequency gradually decreases, it indicates that Body Fluids are returning to the Stomach. Do not use purgation; the stool will naturally pass soon. For details, see the Yangming Chapter.