蜜七合。一味内铜器中。微火煎之。稍凝似饴状。搅之。勿令焦着。欲可丸。并手
捻作挺。令头锐。大如指。长二寸许。当热时急作。冷则硬。以内谷道中。以手急抱。欲
大便时。乃去之。
大猪胆一枚。泻汁。和醋少许。以灌谷道中。如一食顷。当大便出。
阳明病。脉迟。汗出多。微恶寒者。表未解也。可发汗。宜桂枝汤。
阳明病。脉迟。汗出多。当责邪在里。以微恶寒。知表未解。与桂枝汤和表。
阳明病。脉浮。无汗而喘者。发汗则愈。宜麻黄汤。
阳明伤寒。表实脉浮。无汗而喘也。与麻黄汤以发汗。
阳明病。发热。汗出。此为热越。不能发黄也。但头汗出。身无汗。剂颈而还。小
便不利。渴引水浆者。此为瘀热在里。身必发黄。茵陈汤主之。
但头汗出。身无汗。剂头而还者。热不得越也。小便不利。渴饮水浆者。热甚于胃。
津液内竭也。胃为土而色黄。胃为热蒸。则色夺于外。必发黄也。与茵陈汤。逐热退黄。
王三阳云。此与头汗出。小便不通难治条。当细辨之。
茵陈蒿（六两味苦微寒） 栀子（十四枚擘苦寒） 大黄（二两去皮苦寒）
上三味。以水一斗。先煮茵陈。减六升。内二味。煮取三升。去滓。分温三服。小
盒饭利。尿如皂角汁状。色正赤。一宿复减。黄从小便去也。
小热之气。凉以和之。大热之气。寒以取之。茵陈栀子之苦寒。以逐胃燥。宜下必
以苦。宜补必以酸。大黄之苦寒。以下瘀热。
阳明证。其人喜忘者。必有蓄血。所以然者。本有久瘀血。故令喜忘。屎虽硬。大
便反易。其色必黑。宜抵当汤下之。
内经曰。血并于下。乱而喜忘。此下本有久瘀血。所以喜忘也。津液少。大便硬。以
蓄血在内。屎虽硬。大便反易。其色黑也。与抵当汤。以下瘀血。
王海藏云。初便褐色者重。再便。深褐色者愈重。三便。黑色者为尤重。色变者。以
其火燥也。如羊血在日色中。须臾变褐色。久则渐变而为黑色。即此意也。
阳明病。下之。心中懊 而烦。胃中有燥屎者。可攻。腹微满。初头硬。后必溏。
不可攻之。若有燥屎者。宜大承气汤。
下后心中懊 而烦者。虚烦也。当与栀子豉汤。若胃中有燥屎者。非虚烦也。可与
大承气汤下之。其腹微满。初硬后溏。是无燥屎。此热不在胃而在上也。故不可攻。
病患不大便。五六日。绕脐痛。烦躁。发作有时者。此有燥屎。故使不大便也。
不大便五六日者。则大便必结为燥屎也。胃中燥实。气不得下通。故绕脐痛。烦躁。
发作有时也。
病患烦热。汗出则解。又如疟状。日晡所发热者。属阳明也。脉实者宜下之。脉浮
虚者宜发汗。下之与大承气汤。发汗宜桂枝汤。
虽得阳明证。未可便为里实。审看脉候。以别内外。其脉实者。热已入腑为实。可
与大承气汤下之。其脉浮虚者。是热未入腑。犹在表也。可与桂枝汤。发汗则愈。
大下后六七日不大便。烦不解。腹满痛者。此有燥屎也。所以然者。本有宿食故也。宜大承
气汤。
大下之后。则胃弱。不能消谷。至六七日不大便。则宿食已结不消。故使烦热不解
而腹满痛。是知有燥屎也。与大承气汤以下除之。
娄氏云。此大下之后。又下之也。反用大承气者。以津液渐竭故也。须审虚实用之。
不如栀子枳实稳当。
病患小便不利。大便乍难乍易。时有微热。喘冒不能卧者。有燥屎也。宜大承气汤。
小便利。则大便硬。此以有燥屎。故小便不利。而大便乍难乍易。胃热者。发热。喘
冒无时。及嗜卧也。此燥屎在胃。故时有微热喘冒不得卧也。与大承气汤。以下燥屎。
王三阳云。此证不宜妄动。必以手按之。大便有硬块。喘冒不能卧。方可攻之。何
也。乍难乍易故也。
食谷欲呕者。属阳明也。吴茱萸汤主之。得汤反剧者。属上焦也。
上焦主内。胃为之市。食谷欲呕者。胃不受也。与吴茱萸汤。以温胃气。得汤反剧
者。上焦不内也。以治上焦法治之。
【蜜煎导方】
取蜂蜜七合。放入铜器中。用微火慢慢煎熬。待其稍微凝固，呈现像饴糖一样的状态时，不断搅拌。不要让蜂蜜烧焦粘底。等到可以捏成丸状时，趁热用手搓捻成条状。形状要求头部尖锐，粗细如手指，长度约两寸。必须在蜂蜜还热的时候制作，凉了就会变硬。将其插入肛门中，用手紧紧抱住臀部。等有便意时，再取出。
【猪胆汁方】
取一个大猪胆，挤出胆汁。加入少许醋。灌入肛门中。大约一顿饭的工夫，大便就会排出。
阳明病，脉象迟缓，出汗多，轻微怕冷的，说明表证未解。可以采用发汗法治疗，适宜使用桂枝汤（Cinnamon Twig Decoction）。
阳明病，脉象迟缓，出汗多，应当责求病邪在里。但因为伴有轻微怕冷，可知表证仍未解除。给予桂枝汤调和表证。
阳明病，脉象浮，无汗且气喘的，通过发汗治疗即可痊愈，适宜使用麻黄汤（Ephedra Decoction）。
阳明伤寒，表现为表实、脉浮、无汗且气喘。给予麻黄汤以发汗解表。
阳明病，发热，出汗，这是热邪向外发散的表现，不会发生发黄。但如果只有头部出汗，身上无汗，汗水只到颈部就停止了，小便不通利，口渴想喝水浆的，这是瘀热郁结在体内，身体一定会发黄。应当用茵陈蒿汤（Yinchen Hao Tang）主治。
只有头部出汗，身上无汗，汗水只到颈部就停止的，说明热邪无法向外发散。小便不通利，口渴想喝水浆的，说明热邪炽盛于胃，津液在内枯竭。胃属土，其色为黄。胃被热邪熏蒸，则黄色外现，必然导致发黄。给予茵陈蒿汤，清除热邪，退去黄疸。
王三阳说：此证与“头汗出、小便不通难治”的条文，应当仔细辨别。
茵陈蒿（六两，味苦，性微寒） 栀子（十四枚，掰开，味苦，性寒） 大黄（二两，去皮，味苦，性寒）
以上三味药，用水一斗，先煮茵陈蒿，水量减少六升后，再加入另外两味药，煮取三升药液。去掉药渣，分三次温服。服药后小盒饭利，尿液像皂角汁一样颜色深赤，过一夜后尿量减少。这是因为黄色从小便排出了。
轻微的邪气，用凉性药物来调和它。严重的邪气，用寒性药物来攻逐它。茵陈蒿和栀子的苦寒之性，用来清除胃中的燥热。适宜攻下的病症必须用苦味药。适宜补益的病症必须用酸味药。大黄的苦寒之性，用来攻下瘀热。
阳明证，如果病人容易健忘，必定有蓄血。之所以这样，是因为原本就有久存的瘀血，所以导致健忘。大便虽然干硬，但排便反而容易，大便的颜色一定是黑色的。适宜使用抵当汤（Didang Decoction）攻下。
《内经》说：血气并聚于下部，神志混乱而容易健忘。这是因为下部原本就有久存的瘀血，所以导致健忘。津液少，大便硬，但因为蓄血在体内，所以大便虽然硬，排便反而容易，颜色发黑。给予抵当汤，攻下瘀血。
王海藏说：初次排便呈褐色的病情较重；再次排便呈深褐色的病情更重；第三次排便呈黑色的病情尤为严重。颜色的变化，是因为火热燥烈所致。就像羊血在阳光下，一会儿变成褐色，久了逐渐变为黑色，就是这个意思。
阳明病，经过泻下治疗后，心中烦闷懊恼，胃中有燥屎的，可以攻下。如果腹部轻微胀满，大便开头硬，后面稀溏的，不可攻下。如果有燥屎的，适宜使用大承气汤（Da Chengqi Tang）。
泻下后心中烦闷懊恼的，是虚烦。应当给予栀子豉汤（Zhizi Chi Tang）。如果胃中有燥屎的，就不是虚烦了，可以给予大承气汤攻下。如果腹部轻微胀满，大便开头硬后面稀溏的，是没有燥屎。这说明热邪不在胃而在上焦。所以不可攻下。
病人不大便，过了五六天，围绕脐部疼痛，烦躁，发作有定时的，这是有燥屎。所以导致不大便。
不大便五六天的，大便必然结成燥屎。胃中干燥实热，气机不能下行通畅，所以出现绕脐痛、烦躁、发作有定时。
病人烦热，出汗后症状缓解，但又像疟疾一样发作，每天下午申时左右发热的，属于阳明病。脉象实的适宜攻下；脉象浮虚的适宜发汗。攻下给予大承气汤，发汗适宜桂枝汤。
即使得了阳明病，也不能立即断定就是里实证。要仔细诊察脉象，以区分病邪在表还是在里。脉象实的，说明热邪已入腑成为实证，可以给予大承气汤攻下。脉象浮虚的，说明热邪未入腑，仍在表，可以给予桂枝汤，发汗后即可痊愈。
大力泻下之后，过了六七天又不大便，烦躁不解除，腹部胀满疼痛的，这是有燥屎。之所以这样，是因为原本就有留积的食物。适宜使用大承气汤。
大力泻下之后，胃气虚弱，不能消化食物。到了六七天不大便，留积的食物已经凝结无法消化，所以导致烦热不解且腹部胀满疼痛。由此可知是有燥屎。给予大承气汤攻下消除燥屎。
娄氏说：这是在大力泻下之后，再次使用泻下法。反而使用大承气汤，是因为津液逐渐枯竭的缘故。必须审察虚实情况来使用。不如使用栀子枳实散稳妥。
病人小便不利，大便时而困难时而容易，偶尔有轻微发热，气喘头晕不能躺卧的，是有燥屎。适宜使用大承气汤。
小便通利，大便就会干硬。这里因为存在燥屎，所以小便不利，而大便时而困难时而容易。如果是胃热，会持续发热、气喘头晕、嗜睡。这里是燥屎在胃中，所以偶尔有轻微发热、气喘头晕、不能躺卧。给予大承气汤，攻下燥屎。
王三阳说：此证不宜妄动手术或用药，必须用手按压腹部，确认大便有硬块，且伴有气喘头晕不能躺卧，才可以攻下。为什么呢？因为大便乍难乍易的缘故。
进食后想要呕吐的，属于阳明病。用吴茱萸汤（Wuzhuyu Tang）主治。如果服用汤药后症状反而加重的，属于上焦病变。
上焦主管受纳，胃如同集市。进食后想要呕吐，是胃不接受食物。给予吴茱萸汤，以温养胃气。如果服用汤药后症状反而加重，说明上焦不能受纳。应当按照治疗上焦的方法来处理。
[Melted Honey Suppository Formula]
Take seven he of honey. Place it in a copper vessel. Simmer over low heat until it slightly thickens and resembles maltose syrup, stirring constantly to prevent burning or sticking. When it can be molded into pills, while still hot, roll it by hand into suppositories. The shape should have a pointed head, be as thick as a finger, and about two cun long. It must be shaped while hot; otherwise, it will harden. Insert into the anus and hold tightly with the hand. Remove only when there is an urge to defecate.
[Pig Bile Formula]
Take one large pig gallbladder, extract the bile. Mix with a small amount of vinegar. Enema into the anus. After approximately the time it takes to eat one meal, stool should be expelled.
Yangming disease, with a slow pulse, profuse sweating, and slight aversion to cold, indicates that the exterior syndrome has not yet resolved. Sweating therapy may be employed; Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
In Yangming disease, with a slow pulse and profuse sweating, pathology should be sought in the interior. However, due to the presence of slight aversion to cold, it is known that the exterior syndrome remains unresolved. Administer Guizhi Tang to harmonize the exterior.
In Yangming disease, with a floating pulse, absence of sweating, and wheezing, recovery follows sweating therapy; Mahuang Tang (Ephedra Decoction) is appropriate.
Yangming cold damage, presenting as exterior excess with a floating pulse, no sweating, and wheezing. Administer Mahuang Tang to induce sweating and release the exterior.
In Yangming disease, fever and sweating indicate that heat is venting outward, so jaundice will not occur. However, if there is sweating only on the head, no sweating on the body, limited to the neck, accompanied by dysuria and thirst for fluids, this indicates stagnant heat trapped in the interior, leading to jaundice. Yinchen Hao Tang (Artemisiae Scopariae Decoction) is the primary treatment.
Sweating only on the head, no sweating on the body, limited to the neck, indicates that heat cannot vent. Dysuria and thirst for fluids indicate excessive heat in the Stomach and depletion of body fluids internally. The Stomach belongs to Earth and its color is yellow. When steamed by heat, the yellow color manifests externally, resulting in jaundice. Administer Yinchen Hao Tang to purge heat and resolve jaundice.
Wang Sanyang stated: This condition must be carefully distinguished from the clause regarding "head sweating with difficult urination."
Yin Chen Hao (Six liang, bitter, slightly cold) Zhi Zi (Fourteen seeds, broken open, bitter, cold) Da Huang (Two liang, peeled, bitter, cold)
These three ingredients are boiled in ten dou of water. First, boil Yin Chen Hao until the volume reduces by six sheng. Then add the other two ingredients and boil to obtain three sheng of decoction. Strain and divide into three warm doses. Urine will become copious and dark red like soapberry juice. After one night, urine volume decreases. The yellow pigment is eliminated via urination.
Mild pathogenic factors are harmonized with cool-natured herbs. Severe pathogenic factors are purged with cold-natured herbs. The bitter-cold nature of Yin Chen Hao and Zhi Zi clears stomach dryness. Purging requires bitter flavors. Tonifying requires sour flavors. The bitter-cold nature of Da Huang purges stagnant heat.
In Yangming syndrome, if the patient suffers from forgetfulness, blood stasis is present. This is because pre-existing old blood stasis causes forgetfulness. Although stool is hard, defecation is surprisingly easy, and the stool color is necessarily black. Didang Tang (Didang Decoction) is appropriate to purge.
The *Neijing* states: "Blood pooling below causes confusion and forgetfulness." This is due to pre-existing old blood stasis below. With depleted fluids and hard stool, but with internal blood stasis, defecation is easy despite hardness, and the color is black. Administer Didang Tang to purge blood stasis.
Wang Haizang stated: Initial brown stool indicates severe condition; deep brown stool upon second passage indicates greater severity; black stool upon third passage indicates extreme severity. Color changes result from fire-dryness. Like sheep blood exposed to sunlight, turning brown quickly and then black over time, this illustrates the principle.
Following purgation in Yangming disease, if there is mental restlessness and epigastric dry feces, purgation is indicated. If there is mild abdominal fullness with hard initial stool followed by loose stool, purgation is contraindicated. If dry feces are present, Da Chengqi Tang (Major Order the Qi Decoction) is appropriate.
Post-purgation mental restlessness indicates empty irritability (*Xu Fan*), treated with Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction). If dry feces exist in the Stomach, it is not empty irritability; Da Chengqi Tang may be used to purge. Mild abdominal fullness with hard initial and loose final stool indicates no dry feces; heat is above, not in the Stomach, so purgation is contraindicated.
If a patient has constipation for five to six days, periumbilical pain, irritability, and periodic exacerbations, dry feces are present, causing constipation. Constipation for five to six days leads to hardened dry feces. Dry-heat excess in the Stomach obstructs qi descent, causing periumbilical pain, irritability, and periodic symptoms.
If a patient has irritability and heat, relief follows sweating. If symptoms resemble malaria with afternoon fever (around Shen hour), it belongs to Yangming. A solid pulse indicates suitability for purgation; a floating-deficient pulse indicates suitability for sweating. Use Da Chengqi Tang for purgation; use Guizhi Tang for sweating.
Even with Yangming signs, interior excess cannot be assumed immediately. Examine the pulse to distinguish between exterior and interior. A solid pulse indicates heat has entered the Fu organs becoming excess; Da Chengqi Tang may be used to purge. A floating-deficient pulse indicates heat remains in the exterior; Guizhi Tang may be used to sweat, leading to recovery.
After strong purgation, if constipation persists for six to seven days with unresolved irritability and abdominal fullness/pain, dry feces are present. This is due to retained food. Da Chengqi Tang is appropriate.
After strong purgation, Stomach qi is weak and unable to digest food. By day six or seven, retained food congeals, causing unresolved irritability and abdominal fullness/pain, indicating dry feces. Da Chengqi Tang is used to purge and eliminate them.
Lou Shi stated: This involves purging again after strong purgation. Da Chengqi Tang is used because fluids are gradually depleted. One must assess deficiency and excess. Zhizi and Zhi Shi San is safer.
If a patient has dysuria, alternating difficulty and ease in defecation, occasional slight fever, wheezing, dizziness, and inability to lie down, dry feces are present. Da Chengqi Tang is appropriate.
Normally, free urination leads to hard stool. Here, due to dry feces, urination is restricted, and defecation alternates. Stomach heat causes continuous fever, wheezing, dizziness, and somnolence. Here, dry feces in the Stomach cause intermittent slight fever, wheezing, dizziness, and inability to lie down. Da Chengqi Tang is used to purge dry feces.
Wang Sanyang stated: This condition should not be treated recklessly. Palpate the abdomen; if hard fecal masses are felt, along with wheezing, dizziness, and inability to lie down, purgation is justified. This is due to the alternating nature of defecation.
Food intake triggering vomiting belongs to Yangming. Wuzhuyu Tang (Evodia Decoction) is the primary treatment. If symptoms worsen after taking the decoction, the pathology lies in the Upper Jiao.
The Upper Jiao governs reception; the Stomach is like a market. Vomiting after eating indicates the Stomach rejects food. Wuzhuyu Tang warms Stomach qi. If symptoms worsen after administration, the Upper Jiao fails to receive; treat according to Upper Jiao protocols.