再论三焦不得从外解，必致成里结。里结于何在？阳明与胃肠也。亦须用下法，不可以
气血
之分，就不可下也。但伤寒热邪在里，劫烁津液，下之宜猛。此多湿邪内搏，下之宜轻。伤
寒大便溏，为邪已尽，不可再下。湿温病，大便溏，为邪未尽，必大便硬，慎不可再攻也，以
屎燥为无湿矣。人之体脘在腹上，其地位处于中，按之痛，或自痛，或痞胀，当用苦泄，以
其入腹近也。然必验之于舌，或黄或浊，可与小陷胸汤或泻心汤，随症治之。倘或白不燥，
或黄白相兼，或灰白不渴，慎不可乱投苦泄。其中有外邪未解，里先结者，或邪郁未伸，或
素属中冷者，虽有脘中痞痛，宜从开泄，宣通气滞，以达归于肺。如近俗之杏、蔻、橘、桔
、等，是轻苦微辛，具流动之品可耳。再前之舌黄或浊，须要有地之黄。若光滑者，乃无形
湿热，中有虚象，大忌前法。其脐以上为大腹，或满或胀或痛，此必邪已入里矣，表症必无
，或十只存一，亦要验之于舌。或黄甚，或如沉香色，或如灰黄色，或老黄色，或中有断纹
，皆当下之。如小承气汤，用槟榔、青皮、枳实、元明粉、生首乌等，若未现此等舌，不宜
用此等法。恐其中有湿聚太阴为满，或寒湿错杂为痛，或气壅为胀，又当以别法治之。再黄
苔不甚浓而滑者，热未伤津，犹可清热透表，若虽薄而干者，邪虽去而津受伤也，苦寒之药
当禁，宜甘寒轻剂可也。
再论述三焦的病邪不能从体表解除，必然导致形成内部的结滞。内部结滞发生在哪里呢？是在阳明经与胃肠部位。此时也必须使用下法（通过泻下通便来祛除病邪），不能因为病位涉及气血之分，就认为不可使用下法。但是，伤寒病的热邪在体内，会灼烧消耗津液，使用下法时力度应当猛烈。而湿温病多是湿邪在内搏结，使用下法时力度应当轻微。伤寒病患者大便溏稀，说明病邪已经排尽，不可以再次使用下法。湿温病患者大便溏稀，说明病邪尚未排尽，必须等到大便变硬，才谨慎地不再使用攻下法，因为大便干燥说明体内已经没有湿邪了。人的腹部上端称为脘，位置处于中焦，按压时疼痛，或者自发疼痛，或者感觉痞塞胀满，应当使用苦泄法（用苦寒药清热泻实），因为病位靠近腹部。然而必须通过观察舌象来验证，如果舌苔黄或浊，可以使用小陷胸汤或泻心汤，根据具体症状进行治疗。倘若舌苔白而不燥，或者黄白相间，或者灰白且不口渴，千万不可乱投苦泄之药。这种情况中可能有外邪尚未解除，但内部先已结滞；或者邪气郁结未能舒展；或者患者素体中焦虚冷，虽然也有脘部痞塞疼痛，应当采用开泄法（宣通气机阻滞），宣通气滞，使气机通达归于肺。如近代世俗常用的杏仁、豆蔻、橘皮、桔梗等，属于轻苦微辛、具有流动特性的药物即可。再之前提到的舌苔黄或浊，必须有根的黄苔（即苔质紧贴舌面，刮之不去）。如果舌面光滑，那是无形的湿热，且伴有虚象，绝对禁忌前一种苦泄方法。肚脐以上称为大腹，如果感到满闷、胀大或疼痛，这一定是病邪已经进入体内了，表证一定没有，或者十成里只剩下一二成，也要通过验舌来判断。如果舌苔黄得很厉害，或者像沉香色，或者像灰黄色，或者老黄色，或者中间有裂纹，都应当使用下法。如小承气汤，使用槟榔、青皮、枳实、元明粉、生首乌等药物，如果没有出现上述舌象，不适宜使用这些方法。恐怕其中有湿邪聚集在太阴脾经导致满闷，或者寒湿错杂导致疼痛，或者气机壅滞导致胀满，又应当用其他方法来治疗。再论黄苔不很浓而且滑润的，说明热邪尚未损伤津液，还可以使用清热透表法，如果虽然薄但是干燥的，说明邪气虽去但津液已受伤，应当禁止使用苦寒药物，适宜使用甘寒轻剂即可。
Furthermore, it is discussed that when the pathogenic factors of the Sanjiao (Triple Burner) cannot be resolved from the exterior, they inevitably lead to internal accumulation. Where does this internal accumulation occur? It occurs in the Yangming channel and the stomach and intestines. In such cases, purgation (a method using laxatives to evacuate pathogens) must also be employed; one should not refrain from purgation simply because the pathology involves the distinction between Qi and Blood. However, in Cold Damage (Shanghan), heat pathogens residing internally consume and dry up body fluids, so purgation should be applied vigorously. In contrast, damp-warmth diseases often involve internal struggle with dampness pathogens, so purgation should be applied gently. In Cold Damage, loose stools indicate that the pathogen has been exhausted, and purgation should not be repeated. In damp-warmth disease, loose stools indicate that the pathogen is not yet exhausted; one must wait until the stool becomes hard before cautiously refraining from further aggressive purgation, as dry stool signifies the absence of dampness. The upper part of the abdomen is called the "wan" (epigastrium), located in the middle jiao. If it is painful upon pressure, or spontaneously painful, or feels obstructed and distended, bitter-draining methods (using bitter-cold herbs to clear heat and drain excess) should be used because the location is close to the abdomen. However, this must be verified by inspecting the tongue. If the coating is yellow or turbid, Xiaoxianzhong Decoction (Small Trap Chest Decoction) or Xiexin Decoction (Drain the Epigastrium Decoction) may be administered according to the specific symptoms. If, however, the coating is white but not dry, or a mixture of yellow and white, or grayish-white without thirst, bitter-draining drugs must strictly not be administered indiscriminately. In such cases, there may be unresolved exterior pathogens with prior internal accumulation, or depressed pathogens failing to expand, or the patient may have a constitutionally cold middle jiao. Even if there is epigastric obstruction and pain, an opening and draining method (dispersing Qi stagnation) should be used to ventilate the Qi stagnation and restore its flow to the Lung. Herbs commonly used in modern secular practice, such as Xingren (Apricot Seed), Doukou (Black Cardamom), Jupi (Tangerine Peel), and Jiegeng (Platycodon Root), which are lightly bitter, slightly acrid, and possess mobile properties, are suitable. Regarding the previously mentioned yellow or turbid tongue coating, the yellow color must have a root (i.e., firmly attached to the tongue). If the tongue surface is smooth, it indicates formless damp-heat accompanied by deficiency signs, and the aforementioned bitter-draining method is strictly contraindicated. The area above the navel is called the "da fu" (large abdomen). If there is fullness, distension, or pain, it indicates that the pathogen has entered the interior. Exterior symptoms will certainly be absent, or only one or two out of ten may remain; the tongue must still be inspected. If the coating is deeply yellow, like the color of agarwood, grayish-yellow, old yellow, or has cracks in the center, purgation is indicated. For example, Xiao Chengqi Decoction (Minor Order the Qi Decoction) uses Binglang (Areca Seed), Qingpi (Green Tangerine Peel), Zhishi (Immature Bitter Orange), Yuanmingfen (Natrii Sulfas), and Sheng Shouwu (Raw Polygonum Multiflorum Rhizome). If these tongue signs do not appear, these methods should not be used. One must fear that the fullness might be due to dampness accumulating in the Taiyin spleen, pain due to mixed cold-dampness, or distension due to Qi congestion, in which case other methods should be employed. Furthermore, if the yellow coating is not thick but slippery, it indicates that heat has not yet damaged body fluids, and clearing heat and venting through the exterior can still be attempted. If the coating is thin but dry, it indicates that although the pathogen has departed, body fluids have been injured; bitter-cold medicines should be prohibited, and mild sweet-cold agents are appropriate.