湿家鼻塞头疼，或头额两太阳痛，宜行此法。
苦瓜蒂不拘多少为末，令病患噙水一口，将此药一字吹入鼻中，（凡云一字者，二分半
也，
湿家头疼，是浊邪乾清阳之分也。鼻者气窍，上通于脑，下属于肺。浊邪干之，故清窍
不利
治缠喉急痹，牙关紧闭。
皂角（去皮弦炙） 白矾 雄黄 藜芦 为末搐鼻。
吐虚痰。（体弱痰干而吐不出者，此方神效，虽吐而绝不伤气血也。）
当归（五钱） 甘草头（一钱） 参芦（一钱） 逆流水煎。
（凡攻气者攻其聚，聚可散也。攻血者攻其瘀，瘀可通也。攻积者攻其坚。在脏者可破
可行
实有
所
贼
藩
盖
最
元
急
乃
其
（仲景） 治伤寒阳明腑证，阳邪入里。胃实不大便，发热谵语，自汗出，不恶寒，
痞满燥实坚全见，杂病三焦大热，脉沉实者。（阳明外证，身热汗出，不恶寒，反恶热是也
。此为在经，仍当汗散。若热邪已入胃腑，痞满燥热坚全见者，为当下。实则谵语，乱言无
次也。虚则郑声，一语频言也。阳明多血多气，法当自汗，过汗亡液，无水以制火，肠胃有
燥粪，结而不下，故妄见妄言也。经曰∶何缘行阳明病？曰∶太阳病，若汗，若下，若利小
便，此亡津液，胃中干燥，因转属阳明。胃实，大便难也。又曰∶太阳初病，发其汗，汗先
出不彻，因转属阳明。阳明证，能食为中风，风阳邪，能消谷。不能食为中寒，寒阴邪，不
能消谷，以此为辨。胸闷不食为痞，胸腹膨胀为满。大便枯少为燥，腹满痛不大便为实，按
之石硬为坚，）亦治阳明刚痉。（此太阳兼阳明证，其证腹满口噤，卧不着席，攀足 齿而无
汗，谓之刚痉，宜下之者。以阳明主润宗筋，风寒湿热，伤阳明胃，津液不行，筋失所养，
故以此汤下湿热，行津液。喻嘉言曰∶伤寒腹满可下，胸满不可下，谓热邪尚在表也。此证
入里之热，极深极重，阳热既极，阴血立至消亡。小小下之，尚不能胜。必大下之，以承领
其一线之阴，阴气不尽为阳所劫，因而得生者多矣。既有下多亡阴之大戒，复有急下救阴之
活法。学人深造，端在斯矣。经曰∶阳明居中，土也，万物所归，无所复传，以胃为水谷之
海，四旁病，皆传入胃。已入胃腑，则不复传他经矣。）
大黄（四两酒洗。王海藏曰∶邪气居高，非酒不到。若用生者，则遗高分之邪热。病愈
后，
先煎朴
大黄，
淡豉不
热淫于内，治以咸寒。气坚者以咸软之，热盛者以寒消之。故用芒硝之咸寒，以润燥软
坚。
郁夺
枳实
大
气
大
病
发汗则愈，宜麻黄汤。此断其入阳明之路，仍从外解，则不内攻也。又曰∶阳明病，应发汗
，医反下之，此为大逆，皆仲景慎于攻下之意也。喻嘉言曰∶阳明以胃实为正，则皆下证也
。阳明之邪，其来路则由太阳。凡阳明证见八九，而太阳证有一二未罢，仍从太阳而不从阳
明，可汗而不可下也。其去路则趋少阳，凡阳明证虽见八九，而少阳证略见一二，则从少阳
而不从阳明，汗下两不可用也。惟风寒之邪，已离太阳，未接少阳，恰在阳明界内，亟为攻
下，则不再传他经，津液元气，两无亏损矣。庸愚无识，必待七日，传经已尽，方敢议下，
不知太阳有十余日不解者。若不辨经，而但计日，其误下仍在太阳。至阳明二三日，即显下
证
景
古人有治恶寒战栗用大承气下燥而愈者，此阳邪入里，热结于里，表虚无阳，故恶寒战栗。
此阳盛格阴，乃热病，非寒证。误投热药，则死矣。）
加甘草等分，名三一承气汤。治大承气证，腹满实痛。调胃证，谵语下利。小承气证，
内热
承气
仲景
与仲
入
六
草
（
医
芍
大便
上
乘
入
未尝云脾弱也。喻嘉言曰∶脾弱即当补矣，何为反用大黄朴实乎？此脾土过燥，使肠胃津液
枯槁，致中消便难，使脾果弱，非溏即泻，焉能反约少胃中之谷食乎。阳明证中，凡宜攻下
者，惟恐邪未入胃，大便勿硬。又恐初硬后溏，未可妄攻，故先与小承气，试其转失气，方
可攻之，皆是虑夫脾气之弱也。若脾约证，在太阳即当下矣，何待阳明耶，朱丹溪曰∶此由
久病，大汗大下之后，阴血枯槁，内火燔灼，热伤元气，又伤于脾而成。肺金受火，气无所
摄，肾为肺子，肺耗则液亏，金耗则木寡于畏，土欲不伤，其可得乎。肺失传送，脾失转输
，故大便秘而小便数也。理宜滋养阴血，使火不炽而金化行，木有制而脾土晕，津液乃能入
胃肠，润而通矣。此方施之热盛而气实者则安，若热盛而血虚者，勿胶柱而鼓瑟也。）
当下诸证（发汗不解，腹满痛者，急下之。下利三部脉皆平，按之心下硬者，急下之。
脉滑
大，
表里证
不明，
而内燥
燥，此
邪热入
中燥者
证也。
子四逆
宗筋
承气
少阴
空者
摸床
而愈
忌下诸证（太阳病，外证未解，不可下。脉浮大为在表，不可下。恶寒为邪在表，不可
下。
不能
胃邪
热邪
可下
【背景信息】
书名：成方切用 作者：吴仪洛 朝代：清 章节：搐鼻法 / ... / 大承气汤（共5节） 类别：方剂
【待处理原文翻译】
湿家鼻塞头疼，或头额两太阳痛，宜行此法。
患有湿病的人出现鼻塞、头痛，或者前额及两侧太阳穴疼痛，适宜使用这种治疗方法。
苦瓜蒂不拘多少为末，令病患噙水一口，将此药一字吹入鼻中，（凡云一字者，二分半也，
将苦瓜蒂（Bitter Melon Stalk）不限数量研成粉末，让患者含一口水，取“一字”量的药粉吹入鼻中。（所谓“一字”，即二分半的重量。）
湿家头疼，是浊邪乾清阳之分也。鼻者气窍，上通于脑，下属于肺。浊邪干之，故清窍不利
湿病患者头痛，是因为浊邪侵扰了清阳之气分布的部位。鼻子是气息的通道，向上连通大脑，向下归属于肺脏。浊邪干扰此处，所以清窍（指头部孔窍）不通利。
治缠喉急痹，牙关紧闭。
治疗缠喉风（一种咽喉肿痛闭塞的急症）和急性痹阻，以及牙关紧闭的症状。
皂角（去皮弦炙） 白矾 雄黄 藜芦 为末搐鼻。
使用皂角（去除皮和筋膜后炒制）、白矾、雄黄、藜芦，研成粉末，通过鼻腔给药（搐鼻法）。
吐虚痰。（体弱痰干而吐不出者，此方神效，虽吐而绝不伤气血也。）
催吐虚痰。（对于身体虚弱、痰液干燥无法咳出的患者，此方效果神奇，虽然引起呕吐，但绝不会损伤气血。）
当归（五钱） 甘草头（一钱） 参芦（一钱） 逆流水煎。
使用当归（五钱）、甘草头（一钱）、人参芦（一钱），用逆流水煎煮服用。
（凡攻气者攻其聚，聚可散也。攻血者攻其瘀，瘀可通也。攻积者攻其坚。在脏者可破可行
（凡是针对气滞的治疗，要攻击其积聚之处，积聚是可以消散的。针对血瘀的治疗，要攻破其瘀血，瘀血是可以疏通的。针对积滞的治疗，要攻破其坚硬之物。病位在脏腑的，可以采用破除和通行的方法。
实有所贼藩盖最元急乃其
实证有具体的邪气侵害，如同藩篱遮盖了本源，情况最为紧急，需要针对其根本进行处理。）
（仲景） 治伤寒阳明腑证，阳邪入里。胃实不大便，发热谵语，自汗出，不恶寒，
（张仲景）治疗伤寒病的阳明腑证，阳热邪气传入体内。表现为胃部实热、大便不通、发热、说胡话（谵语）、自然出汗、不怕冷，
痞满燥实坚全见，杂病三焦大热，脉沉实者。（阳明外证，身热汗出，不恶寒，反恶热是也
痞塞、胀满、干燥、实结、坚硬等症状全部出现，或者是杂病导致的三焦大热，脉象沉实的患者。（阳明经的外证表现是身体发热、出汗、不怕冷，反而怕热。这是病在经络，仍应当用发汗法疏散。
若热邪已入胃腑，痞满燥热坚全见者，为当下。实则谵语，乱言无次也。虚则郑声，一语频言也。
如果热邪已经传入胃腑，出现痞、满、燥、热、坚全部症状的，应当采用泻下法。实证会出现谵语，即言语错乱没有次序。虚证会出现郑声，即重复说同一句话。
阳明多血多气，法当自汗，过汗亡液，无水以制火，肠胃有燥粪，结而不下，故妄见妄言也。
阳明经多血多气，按理应当自然出汗。如果发汗过度导致津液流失，没有水来制约火邪，肠胃中有干燥的粪便，凝结而不能排出，所以会出现幻觉和胡言乱语。
经曰∶何缘行阳明病？曰∶太阳病，若汗，若下，若利小便，此亡津液，胃中干燥，因转属阳明。
经典记载：为什么会发生阳明病呢？回答说：太阳病，经过发汗、攻下或利小便治疗后，导致津液流失，胃中干燥，因此转化为阳明病。
胃实，大便难也。又曰∶太阳初病，发其汗，汗先出不彻，因转属阳明。
胃实，是指大便困难。又说：太阳病初期，发汗时汗出得不彻底，因此转化为阳明病。
阳明证，能食为中风，风阳邪，能消谷。不能食为中寒，寒阴邪，不能消谷，以此为辨。
阳明病证候中，能进食的是中风（感受风阳邪气），风为阳邪，能够消化谷物；不能进食的是中寒（感受寒阴邪气），寒为阴邪，不能消化谷物，以此作为辨别依据。
胸闷不食为痞，胸腹膨胀为满。大便枯少为燥，腹满痛不大便为实，按之石硬为坚，）亦治阳明刚痉。
胸闷不想吃东西称为痞，胸腹部膨胀称为满。大便干枯量少称为燥，腹部胀满疼痛且不大便称为实，按压时像石头一样硬称为坚。）同时也治疗阳明刚痉。
（此太阳兼阳明证，其证腹满口噤，卧不着席，攀足 齿而无汗，谓之刚痉，宜下之者。
（这是太阳病兼有阳明病的证候，症状包括腹部胀满、牙关紧闭、睡觉时背部不能接触床席、脚向后弯曲如弓状、牙齿咬紧且无汗，这称为刚痉，适宜采用泻下法。
以阳明主润宗筋，风寒湿热，伤阳明胃，津液不行，筋失所养，故以此汤下湿热，行津液。
因为阳明经主管滋润宗筋（生殖器及周围筋肉），风寒湿热邪气伤害阳明胃，导致津液运行不畅，筋脉失去滋养，所以用这个汤剂来泻下湿热，通行津液。
喻嘉言曰∶伤寒腹满可下，胸满不可下，谓热邪尚在表也。此证入里之热，极深极重，阳热既极，阴血立至消亡。
喻嘉言说：伤寒病中，腹部胀满可以泻下，胸部胀满不可以泻下，这是因为热邪还在体表。而这个证候的热邪已经深入体内，程度极深极重，阳热达到极点，阴血立刻就会消亡。
小小下之，尚不能胜。必大下之，以承领其一线之阴，阴气不尽为阳所劫，因而得生者多矣。
轻微泻下，还不能胜任。必须大力泻下，以承接并保留那一线生机之阴气，只要阴气不被阳热完全劫夺，因此得以生存的患者就很多了。
既有下多亡阴之大戒，复有急下救阴之活法。学人深造，端在斯矣。
这里既有泻下过多导致亡阴的大禁忌，又有紧急泻下来拯救阴气的灵活法则。学者想要深入探究，关键就在这里。
经曰∶阳明居中，土也，万物所归，无所复传，以胃为水谷之海，四旁病，皆传入胃。
经典记载：阳明位居中央，属土，是万物归宿的地方，不再向其他经络传变。因为胃是水谷之海，四周的疾病，都会传入胃中。
已入胃腑，则不复传他经矣。）
一旦进入胃腑，就不再传变到其他经络了。）
大黄（四两酒洗。王海藏曰∶邪气居高，非酒不到。若用生者，则遗高分之邪热。病愈后，
大黄（四两，用酒清洗。王海藏说：邪气位置较高，不用酒引导药物到达不了。如果用生大黄，则会遗漏高位邪热。病愈后，
先煎朴硝，后纳大黄，更煎沸，内芒硝，再上火微煮令沸，温服一升，得下止后服。
先煎厚朴、枳实，后放入大黄，再次煮沸，加入芒硝，再稍微加热至沸腾，温服一升，得到通便效果后停止服用。
淡豉不
淡豆豉不参与主要药效发挥，
热淫于内，治以咸寒。气坚者以咸软之，热盛者以寒消之。故用芒硝之咸寒，以润燥软坚。
热邪肆虐于体内，用咸寒性质的药物来治疗。气机坚结的用咸味来软化它，热势旺盛的用寒性来消除它。所以使用芒硝的咸寒性质，来润燥和软化坚结。
郁夺
郁结被攻克，
大
大
气
气
大
大
病
病
发汗则愈，宜麻黄汤。此断其入阳明之路，仍从外解，则不内攻也。又曰∶阳明病，应发汗
如果通过发汗就能痊愈，适宜用麻黄汤。这是切断邪气进入阳明的道路，仍然从外部解除，就不会向内攻伐。又说：阳明病，应当发汗
医反下之，此为大逆，皆仲景慎于攻下之意也。喻嘉言曰∶阳明以胃实为正，则皆下证也。
医生反而使用泻下法，这是严重的错误，这都是张仲景对攻下疗法谨慎用意的体现。喻嘉言说：阳明病以胃实为主要特征，那么都是应当泻下的证候。
阳明之邪，其来路则由太阳。凡阳明证见八九，而太阳证有一二未罢，仍从太阳而不从阳明，可汗而不可下也。
阳明病的邪气，其来源路径是由太阳经传来的。凡是阳明证候出现八九成，而太阳证候还有二三成未消退，仍应从太阳经治疗而不从阳明经治疗，可以用发汗法而不可以用泻下法。
其去路则趋少阳，凡阳明证虽见八九，而少阳证略见一二，则从少阳而不从阳明，汗下两不可用也。
其去路则是趋向少阳经，凡是阳明证候虽然出现八九成，而少阳证候略微出现一二成，则应从少阳经治疗而不从阳明经治疗，发汗和泻下两种方法都不可用。
惟风寒之邪，已离太阳，未接少阳，恰在阳明界内，亟为攻下，则不再传他经，津液元气，两无亏损矣。
只有风寒邪气，已经离开太阳经，尚未接触少阳经，恰好处于阳明经的范围内，急需进行攻下治疗，这样就不再传变到其他经络，津液和元气都不会受到亏损。
庸愚无识，必待七日，传经已尽，方敢议下，不知太阳有十余日不解者。若不辨经，而但计日，其误下仍在太阳。
平庸愚蠢的人，一定要等到七天过去，传经已经结束，才敢讨论泻下，他们不知道太阳病有十多天没有解除的情况。如果不辨别经络，只计算天数，其误用泻下法的情况仍然发生在太阳病阶段。
至阳明二三日，即显下证
到了阳明病二三天，就显现出应当泻下的证候
景
景象/情况
古人有治恶寒战栗用大承气下燥而愈者，此阳邪入里，热结于里，表虚无阳，故恶寒战栗。
古代有人治疗恶寒战栗的症状，使用大承气汤泻下燥结而痊愈，这是因为阳邪传入体内，热邪结聚在内部，体表空虚没有阳气，所以出现恶寒战栗。
此阳盛格阴，乃热病，非寒证。误投热药，则死矣。）
这是阳盛格阴的现象，属于热病，而不是寒证。如果误用热性药物，患者就会死亡。）
加甘草等分，名三一承气汤。治大承气证，腹满实痛。调胃证，谵语下利。小承气证，
加入等量的甘草，名为三一承气汤。治疗大承气汤证，腹部胀满实痛。调胃承气汤证，谵语伴腹泻。小承气汤证，
内热
内部热盛
承气
承气
仲景
张仲景
与仲
与张仲景
入
进入
六
六
草
甘草
（
（
医
医生
芍
芍药
大便
大便
上
上面
乘
乘袭
入
进入
未尝云脾弱也。喻嘉言曰∶脾弱即当补矣，何为反用大黄朴实乎？此脾土过燥，使肠胃津液
未曾说过脾气虚弱。喻嘉言说：如果脾气虚弱就应当补益，为什么反而使用大黄、厚朴、枳实这些攻下药呢？这是因为脾土过于干燥，导致肠胃津液
枯槁，致中消便难，使脾果弱，非溏即泻，焉能反约少胃中之谷食乎。
枯竭，导致中消症和大便困难。如果脾真的虚弱，要么是大便稀溏，要么是腹泻，怎么能反过来约束减少胃中的食物摄入呢。
阳明证中，凡宜攻下者，惟恐邪未入胃，大便勿硬。又恐初硬后溏，未可妄攻，故先与小承气，试其转失气，方可攻之，皆是虑夫脾气之弱也。
在阳明病证中，凡是适宜攻下的，只担心邪气还没有进入胃中，大便还没有变硬。又担心大便开头硬后面稀，不可以胡乱攻下，所以先给予小承气汤，测试患者是否放屁（转失气），才可以攻下，这些都是考虑到脾气可能虚弱的原因。
若脾约证，在太阳即当下矣，何待阳明耶，朱丹溪曰∶此由久病，大汗大下之后，阴血枯槁，内火燔灼，热伤元气，又伤于脾而成。
如果是脾约证，在太阳病阶段就应该泻下了，为什么要等到阳明病呢？朱丹溪说：这是由于久病，在大汗或大下之后，阴血枯竭，内火燃烧灼烧，热邪损伤元气，又损伤了脾脏而形成的。
肺金受火，气无所摄，肾为肺子，肺耗则液亏，金耗则木寡于畏，土欲不伤，其可得乎。
肺金受到火邪克制，气机无法固摄，肾是肺的子脏，肺气消耗则津液亏虚，金气消耗则木气缺乏制约，土气想要不受伤害，怎么可能呢。
肺失传送，脾失转输，故大便秘而小便数也。理宜滋养阴血，使火不炽而金化行，木有制而脾土晕，津液乃能入胃肠，润而通矣。
肺脏失去传导功能，脾脏失去转输功能，所以大便秘结而小便频数。理论上应该滋养阴血，使火不炽盛而金气生化运行，木气有制约而脾土安宁，津液才能进入胃肠，滋润而通畅。
此方施之热盛而气实者则安，若热盛而血虚者，勿胶柱而鼓瑟也。）
这个方剂用于热盛而气实的患者是安全的，如果热盛而血虚，不要拘泥固执地应用。）
当下诸证（发汗不解，腹满痛者，急下之。下利三部脉皆平，按之心下硬者，急下之。
应当立即泻下的各种证候（发汗后病不解，腹部胀满疼痛的，立即泻下。腹泻但寸关尺三部脉象都平和，按压心下部硬的，立即泻下。
脉滑
脉象滑
大
大
不明，
不明确，
而内燥
而内部干燥
燥，此
干燥，这是
邪热入
邪热进入
中燥者
中间干燥的
证也。
证候。
子四逆
四肢厥逆
承气
承气
少阴
少阴
空者
空虚的
摸床
摸索床沿
而愈
而痊愈
忌下诸证（太阳病，外证未解，不可下。脉浮大为在表，不可下。恶寒为邪在表，不可
禁止泻下的各种证候（太阳病，外证未解除，不可以泻下。脉象浮大表示病在体表，不可以泻下。恶寒表示邪气在体表，不可以
不能
不能
热邪
热邪
可下
可以泻下
[Background Information]
Book: Chengfang Qieyong (Essential Use of Prescribed Formulas)
Author: Wu Yiluo
Dynasty: Qing
Chapter: Snuffing Method / ... / Dachengqi Tang (Total 5 Sections)
Category: Formula
[English Translation]
Patients with dampness disorders presenting with nasal congestion and headache, or pain in the forehead and bilateral Taiyang regions, are suitable for this method.
Take an unspecified amount of Gualadi Duan (Bitter Melon Stalk), grind it into powder. Instruct the patient to hold a mouthful of water, then blow one "yi" (approximately 1.5 fen or 0.45g) of the powder into the nose.
Headache in patients with dampness is caused by turbid pathogens interfering with the distribution of clear Yang qi. The nose is the orifice of Qi, connecting upwards to the brain and downwards to the Lung. Turbid pathogens interfere here, causing obstruction of the clear orifices.
This treats Chanhou Ji Bi (acute throat constriction and bi-syndrome) and trismus (lockjaw).
Use Zaojiao (Gleditsiae Fructus, peeled and string-removed, stir-fried), Baifan (Alumen), Xionghuang (Realgar), and Lilu (Veratrum nigrum). Grind into powder and administer via snuffing.
To induce vomiting of deficient phlegm. (For patients who are weak with dry phlegm that cannot be expectorated, this formula is miraculous; although it induces vomiting, it absolutely does not damage Qi and Blood.)
Danggui (Angelicae Sinensis Radix, 5 qian), Gancao Tou (Radix Glycyrrhizae Ulnatae, 1 qian), Shenlu (Rhizoma Ginseng, 1 qian). Decoct with reverse-flowing water.
(Generally, treating Qi stagnation involves attacking its accumulation, which can be dispersed. Treating Blood stasis involves breaking up the stasis, which can be unblocked. Treating accumulations involves attacking hardness. For diseases located in the Zang organs, methods of breaking down and promoting movement are used.
In excess patterns, there is a specific pathogenic factor acting as a thief, covering the origin. The situation is most urgent, requiring treatment targeting the root.)
(Zhang Zhongjing) Treats Yangming Fu syndrome of Shanghan (Cold Damage), where Yang pathogens have entered the interior. Symptoms include stomach excess, constipation, fever, delirium, spontaneous sweating, aversion to cold absent.
When Pi (stuffiness), Man (fullness), Zao (dryness), Shi (excess), and Jian (hardness) are all present, or in miscellaneous diseases presenting with severe heat in the Sanjiao and a deep, excess pulse. (The exterior syndrome of Yangming is characterized by body heat, sweating, absence of aversion to cold, and aversion to heat. This indicates the disease is in the channels, and sweating should still be used to disperse it.
If heat pathogens have entered the Stomach Fu, and Pi, Man, Zao, Re (heat), and Jian are all present, purgation is indicated. Excess patterns manifest as delirium (disordered speech without sequence). Deficient patterns manifest as Zhengsheng (repetitive speech). Yangming has abundant Qi and Blood, so spontaneous sweating is normal. Excessive sweating leads to fluid loss; without water to control fire, dry feces accumulate in the intestines and stomach, leading to hallucinations and delirium.
The Classics state: Why does Yangming disease occur? Answer: After Taiyang disease, if sweating, purgation, or diuresis were used excessively, fluids are lost, the Stomach becomes dry, and it transforms into Yangming disease. "Stomach excess" refers to difficulty in defecation. It also states: In early Taiyang disease, if sweating was induced but was incomplete, it transforms into Yangming disease.
In Yangming syndromes, the ability to eat indicates Windstroke (Wind-Yang pathogen, which digests grain); inability to eat indicates Coldstroke (Cold-Yin pathogen, which fails to digest grain). This is the basis for differentiation. Chest stuffiness with anorexia is Pi; chest and abdominal distension is Man. Dry and scant stools is Zao; abdominal fullness, pain, and constipation is Shi; hardness upon palpation like stone is Jian. This also treats Yangming Gangjing (Yangming rigid spasm).
(This is a Taiyang-Yangming combined syndrome. Symptoms include abdominal fullness, trismus, inability to lie flat on the back, opisthotonos [arching back], teeth grinding, and anhidrosis. This is called Gangjing, and purgation is indicated. Because Yangming moistens the Zongjin (major sinews), when Wind-Cold-Damp-Heat damages the Yangming Stomach, Jin-Ye (body fluids) fail to circulate, and sinews lose nourishment. Thus, this decoction is used to purge damp-heat and promote fluid circulation.
Yu Jiayan said: In Shanghan, abdominal fullness can be purged, but chest fullness cannot, because the heat pathogen is still at the exterior. In this syndrome, the interior heat is extremely deep and severe. When Yang heat reaches its peak, Yin blood is immediately threatened with depletion. Mild purgation is insufficient. Strong purgation is necessary to preserve the last thread of Yin. If Yin is not completely robbed by Yang, many patients will survive. There is both a major prohibition against excessive purgation leading to Yin collapse, and a vital method of urgent purgation to save Yin. For students seeking deep understanding, this is key.
The Classics state: Yangming resides in the center, belongs to Earth, and is the destination of all things, with no further transmission. Since the Stomach is the Sea of Water and Grain, diseases from the four directions all transmit to the Stomach. Once entering the Stomach Fu, it no longer transmits to other channels.)
Dahuang (Rhei Radix et Rhizoma, 4 liang, washed with wine). Wang Haicang said: Pathogens located high require wine to reach them. If raw Dahuang is used, high-level heat pathogens may be missed. After the illness resolves...
First decoct Puxiao (Natrii Sulfas), then add Dahuang. Boil again, add Mangxiao (Natrii Sulfas), boil slightly over low heat until boiling. Take warm, one sheng. Stop taking after defecation occurs.
Danshi (Sojae Semen Preparatum) plays a minor role.
When heat invades the interior, treat with salty-cold substances. To soften firm Qi, use salty flavors. To eliminate intense heat, use cold properties. Therefore, Mangxiao's salty-cold nature is used to moisten dryness and soften hardness.
Accumulation is overcome.
Zhishi (Aurantii Fructus Immaturus)
Da (Great/Large)
Qi (Energy/Qi)
Da (Great/Large)
Bing (Disease)
If sweating leads to recovery, Mahuang Tang (Ephedra Decoction) is appropriate. This cuts off the path of the pathogen entering Yangming, resolving it from the exterior, preventing internal attack. It also states: In Yangming disease, sweating is indicated. If the physician incorrectly uses purgation, this is a major error. This reflects Zhang Zhongjing's caution regarding purgation. Yu Jiayan said: Yangming disease centers on Stomach excess, making purgation the standard treatment.
The pathogen in Yangming comes from Taiyang. If Yangming symptoms are 80-90% present but Taiyang symptoms remain 10-20%, treat from Taiyang, not Yangming; sweating is allowed, purgation is forbidden.
Its exit route trends toward Shaoyang. If Yangming symptoms are 80-90% present but Shaoyang symptoms appear slightly (10-20%), treat from Shaoyang, not Yangming; neither sweating nor purgation is applicable.
Only when Wind-Cold pathogens have left Taiyang but not yet reached Shaoyang, residing precisely within Yangming, is urgent purgation required. This prevents transmission to other channels, preserving both Jin-Ye and Yuan-Qi.
Mediocre and ignorant practitioners wait seven days for transmission to complete before daring to discuss purgation. They do not know that Taiyang disease can persist for over ten days without resolution. If meridians are not differentiated and only days are counted, misapplied purgation may still target Taiyang. By the second or third day of Yangming, purgative signs often appear.
Ancient practitioners cured chills and tremors using Dachengqi Tang to purge dryness. This occurred when Yang pathogens entered the interior, heat knotted inside, and the exterior was empty of Yang, causing chills and tremors.
This is Yang excess repelling Yin, a heat disease, not a cold pattern. Administering hot medicines would be fatal.)
Add Gancao (Licorice Root) in equal parts, named Sanyi Chengqi Tang (Three-One Resolving Decoction). Treats Dachengqi Tang syndrome (abdominal fullness and solid pain), Tiaowei Chengqi Tang syndrome (delirium with diarrhea), and Xiaochengqi Tang syndrome (internal heat).
Chengqi (Resolving Decoction)
Zhang Zhongjing
With Zhang
Enter
Six
Cao (Grass/Licorice)
(
Doctor
Shao (Peony)
Stool
Up
Ride/Attack
Enter
It was never stated that Spleen Qi is weak. Yu Jiayan said: If Spleen Qi were weak, tonification would be indicated. Why use Dahuang, Houpo, and Zhishi? This is due to excessive dryness of Spleen Earth, causing dehydration of the intestines and stomach, leading to middle-xiao (middle burning consumption) and difficult defecation. If the Spleen were truly weak, stools would be loose or diarrheal; how could it restrict food intake in the Stomach?
In Yangming syndromes suitable for purgation, one fears the pathogen has not yet entered the Stomach and stools are not hard. One also fears initial hardness followed by looseness, prohibiting reckless purgation. Thus, Xiaochengqi Tang is given first to test for flatus (turning loss of gas). Only then is purgation applied. This considers the potential weakness of Spleen Qi.
If this is Pi Yue Syndrome (Spleen Restriction), it should have been purged during Taiyang stage. Why wait for Yangming? Zhu Danxi said: This results from prolonged illness, following massive sweating or purgation, leading to exhaustion of Yin and Blood, blazing internal fire, damaging Yuan-Qi, and injuring the Spleen.
Lung Metal is controlled by Fire, losing its ability to govern Qi. Kidney is the child of Lung; Lung consumption leads to fluid deficiency. Metal consumption means Wood lacks restraint. Can Earth remain uninjured? Impossible.
Lung loses its transport function, Spleen loses its transformation and transportation function. Hence, constipation and frequent urination. Theoretically, one should nourish Yin and Blood, extinguish fire, allow Metal to transform, restrain Wood, and calm Spleen Earth. Then Jin-Ye can enter the intestines and stomach, moistening and unblocking them.
This formula is safe for patients with excess heat and robust Qi. For those with excess heat and deficient Blood, do not apply it rigidly.)
Indications for Immediate Purgation (Patterns):
(Sweating fails to resolve the condition, accompanied by abdominal fullness and pain: immediate purgation. Diarrhea with smooth pulses in all three positions, hardness upon pressing the epigastrium: immediate purgation.
Pulse slippery
Large
Exterior-Interior syndromes
Unclear,
Internal dryness
Dryness, this
Heat pathogens enter
Middle dryness
Syndrome.
Si Ni (Four Reversals)
Zongjin
Chengqi
Shaoyin
Empty
Touching bed
And recovered
Contraindications for Purgation:
Taiyang disease, exterior syndrome unresolved: do not purge. Pulse floating and large indicates exterior location: do not purge. Aversion to cold indicates pathogen at exterior: do not purge.
Cannot
Stomach pathogen
Heat pathogen
Can purge