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
下之而心中懊 而烦胃中有燥屎者可再攻也平人燥屎俱在大肠阳明病热盛津枯糟粕在胃已成结燥不须至肠故曰胃中
有燥屎内无燥屎胃气未至郁遏故腹不大满也
阳明病谵语有潮热反不能食者胃中必有燥屎五六枚也宜大承气汤下之若能食者但硬耳
燥屎结塞浊气上冲则不能食
病患小便不利大便乍难乍易时有微热喘冒不得卧者有燥屎也宜大承气汤
土燥水枯则小便不利气有通塞则大便乍难乍易胃热内燔则肌表时有微热胃气郁遏则喘阻昏冒不得寝卧此有燥屎堵塞
之故也素问腹中论不得卧而息有音者是阳明之逆也足三阳者下行今逆而上行故息有音也阳明者胃脉也胃者六腑之海其脉
亦下行阳明逆不得从其道故不得卧也
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
胃气郁遏无泄之窍故绕脐作痛
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
本有宿食未消被胃火炼成燥屎阻碍肠胃之窍胃气以下行为顺下窍不通胃气壅遏不得降泄逆为上行故生烦躁而满痛也
阳明少阳合病必下利其脉不负者顺也负者失也互相克贼名为负也脉滑而数者有宿食也当下之宜大承气汤
阳明少阳合病胆经郁迫胃气壅遏失其受盛之职故必下利甲木为贼土气未败则脉不负不负为顺负则木贼土败是之为失
负者互相克贼之名宿食阻碍经气浮荡故振滑而数胃主受盛脾主消化水谷入胃以脾土之湿济胃土之燥燥湿互济阴阳交蒸是
以消烂腐化中无宿物阳明病胃强脾弱燥夺其湿未及腐化已成结硬是宿食者虽太阴之咎而实阳明之过也
阳明病经过攻下治疗后，心中烦闷懊恼且烦躁，胃中有干燥坚硬的粪便，可以使用攻下法；如果腹部只是轻微胀满，大便开头硬后面稀溏，则不可使用攻下法。如果有干燥坚硬的粪便，适宜使用大承气汤。
攻下之后，心中仍然烦闷懊恼且烦躁，胃中有干燥坚硬的粪便，可以再次攻下。普通人的燥屎都积聚在大肠中。阳明病热势亢盛，津液枯竭，糟粕在胃中已经形成结燥，不需要等到进入肠道，所以说“胃中有燥屎”。如果内部没有燥屎，胃气尚未达到郁结遏制的程度，所以腹部不会明显胀满。
阳明病出现胡言乱语（谵语），有定时发热的潮热症状，反而不能进食的，说明胃中一定有五六枚干燥坚硬的粪便，适宜使用大承气汤攻下。如果能进食的，仅仅是大便干硬罢了。
病人小便不通利，大便时而困难时而容易，身体偶尔有微热，气喘头昏目眩不能躺卧的，这是有燥屎的表现，适宜使用大承气汤。脾土燥热、肾水枯竭导致小便不利；气机有通有塞，所以大便时而困难时而容易；胃热在内焚烧，所以肌表偶尔有微热；胃气郁结遏制，导致气喘阻塞、头昏目眩不能安睡，这是因为有燥屎堵塞的缘故。《素问·腹中论》说：“不能躺卧且呼吸有声”，这是阳明经气逆乱所致。足三阳经的气本应下行，如今逆乱而上行，所以呼吸有声。阳明经是胃的经脉，胃是六腑之海，其脉气也是下行的。阳明经气逆乱，不能顺从其正常通道，所以不能躺卧。
病人不大便五六天，围绕肚脐疼痛，烦躁不安且发作有定时的，这是有燥屎，因此导致不大便。
胃气郁结遏制，没有排泄的窍道，所以围绕肚脐作痛。
剧烈攻下之后，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，是因为原本就有停滞的食物。适宜使用大承气汤。
原本有的停滞食物未消化，被胃火炼化成燥屎，阻碍了肠胃的窍道。胃气以向下运行作为顺向，下窍不通，胃气壅塞遏制，不能下降排泄，反而逆乱上行，所以产生烦躁和胀满疼痛。
阳明病与少阳病合病，必然出现腹泻。脉象没有相克现象的叫“不负”，属于顺证；出现相克现象的叫“负”，属于逆证。互相克制贼害称为“负”。脉象滑而数的，是有停滞食物的表现，应当攻下，适宜使用大承气汤。
阳明病与少阳病合病，胆经郁滞逼迫，胃气壅塞遏制，失去了受纳和盛物的职能，所以必然腹泻。甲木（胆）克制戊土（胃），如果土气未败，则脉象“不负”，“不负”为顺；如果“负”，则是木气贼害土气导致土败，这叫做“失”。“负”是互相克制贼害的名称。停滞食物阻碍经气，使脉气浮荡，所以呈现滑而数的脉象。胃主受纳和盛物，脾主消化。水谷进入胃中，依靠脾土的湿气来济助胃土的燥气，燥湿相互济助，阴阳交蒸，从而消烂腐化食物。如果中间没有停滞的食物，就不会有问题。阳明病中，胃强脾弱，燥气剥夺了湿气，来不及腐化就已经结成坚硬块状。这种停滞食物，虽然是太阴脾脏的过错，但实际上是阳明胃脏的过失。
Yangming disease, after purgation, presents with restlessness and vexation in the heart, and dry feces in the stomach; this is a case for attack (purgation). If there is only slight fullness in the abdomen, and the stool is hard at the beginning but loose later, it is not suitable for attack. If there are dry feces, Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.
After purgation, if restlessness and vexation in the heart persist, and dry feces remain in the stomach, a second attack may be performed. In healthy individuals, dry feces accumulate in the large intestine. In Yangming disease, heat is excessive and body fluids are depleted; residues in the stomach have already formed hardened knots and do not need to reach the intestines. Hence, it is said that "dry feces are in the stomach." If there are no dry feces internally, the Stomach Qi has not yet reached a state of stagnation and constraint, so the abdomen is not significantly full.
In Yangming disease, if delirium (speaking nonsense), tidal fever (fever that rises at a specific time), and an inability to eat are present, it indicates that there must be five or six pieces of dry feces in the stomach. Da Cheng Qi Tang (Major Order the Qi Decoction) should be used to purge. If the patient can eat, it merely indicates hard stool.
Dry feces causing blockage lead to turbid Qi rushing upward, resulting in an inability to eat.
If a patient has difficulty urinating, bowel movements that are alternatively difficult and easy, occasional slight fever, wheezing, dizziness, and an inability to lie down, this indicates the presence of dry feces. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate. Dry earth and depleted water cause difficulty urinating. The flow of Qi being obstructed or patent causes bowel movements to be alternatively difficult and easy. Internal Stomach heat blazing causes occasional slight fever on the body surface. Stagnant and constrained Stomach Qi leads to wheezing obstruction, dizziness, and insomnia. This is due to the blockage by dry feces. *Su Wen: Fu Zhong Lun* states: "Inability to lie down with audible breathing" is caused by the rebellion of Yangming. The Qi of the three Foot-Yang meridians normally descends; now it rebels and ascends, hence the audible breathing. Yangming is the meridian of the Stomach; the Stomach is the sea of the six fu organs, and its meridian Qi also descends. When Yangming Qi rebels and cannot follow its proper pathway, one cannot lie down.
If a patient has not had a bowel movement for five or six days, experiences pain around the umbilicus, restlessness, and irritability that occurs at specific times, this indicates the presence of dry feces, which causes the constipation.
Stagnant and constrained Stomach Qi, lacking an outlet for excretion, causes pain around the umbilicus.
After severe purgation, if seven or more days pass without a bowel movement, accompanied by persistent restlessness, abdominal fullness, and pain, this indicates the presence of dry feces. The reason is that there was originally retained food. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.
Originally retained food, undigested, is refined into dry feces by Stomach fire, blocking the orifices of the intestines and stomach. Stomach Qi follows the downward direction as normal; when the lower orifice is blocked, Stomach Qi becomes congested and constrained, unable to descend and excrete, instead rebelling and ascending, thus generating restlessness, fullness, and pain.
When Yangming disease combines with Shaoyang disease, diarrhea inevitably occurs. A pulse that does not show mutual overcoming is called "not losing" (bu fu) and is a favorable sign (shun); showing mutual overcoming is called "losing" (fu) and is an unfavorable sign (shi). Mutual overcoming and harming is named "losing." A slippery and rapid pulse indicates retained food, which requires purgation; Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.
In the combination of Yangming and Shaoyang diseases, Gallbladder Qi stagnation forces Stomach Qi to become congested and constrained, causing it to lose its function of receiving and containing, thus inevitably leading to diarrhea. Jia Wood (Gallbladder) overacting on Wu Earth (Stomach): if Earth Qi is not defeated, the pulse shows "not losing," which is favorable; if "losing," it means Wood overacts on Earth, causing Earth to fail, which is termed "loss." "Losing" refers to the name of mutual overacting and harming. Retained food obstructs meridian Qi, causing it to fluctuate, resulting in a slippery and rapid pulse. The Stomach governs receiving and containing; the Spleen governs digestion. When food and drink enter the Stomach, Spleen Earth dampness moistens Stomach Earth dryness. The interaction of dryness and dampness, and the steaming of Yin and Yang, allows for the decomposition and transformation of food. If there is no retained food in the center, there is no issue. In Yangming disease, Stomach strength is high while Spleen weakness prevails; dryness deprives dampness before decomposition can occur, forming hardened knots. Although this retained food is technically a fault of Taiyin (Spleen), it is essentially the fault of Yangming (Stomach).