阳明病心下硬满者不可攻之攻之利遂不止者死利止者愈
心下痞者太阴之证太阴病腹满而吐自利益甚下之必胸下结硬是也阳明之病而见太阴心下硬满之证阴盛阳弱故不可攻
之攻之脾阳陷败利遂不止者死阳回利止者则愈也
阳明中风口苦咽干腹满微喘发热恶寒脉浮而紧若下之则腹满小便难也
阳明中风而口苦咽干是有少阳证腹满是有太阴证发热恶寒脉浮而紧脉证又与伤寒太阳中风大青龙汤相似此在阳明腑
热外蒸应当汗出而脉缓乃脉紧而恶寒者是卫气外敛胃家阳虚而不能发也外有甲木之克里有太阴之侵而经腑双郁不得发越
阳明至此困惫极矣若复下之则遂成太阴之证腹满而小便难也法详下章猪苓汤一段
阳明病脉浮而紧咽燥口苦腹满而喘发热汗出不恶寒反恶热身重若发汗则躁心愦愦反谵语若加烧针必怵惕烦躁不得眠
若下之则胃中空虚客气动膈心中懊 舌上苔者栀子豉汤主之（方在太阳八十九）若渴欲饮水口干舌燥者白虎加人参汤主
之（方在太阳三十九）若脉浮发热渴欲饮水小便不利者猪苓汤主之
阳明病脉浮而紧有太阳证咽燥舌干有少阳证腹满有太阴证发热汗出不恶寒反恶热则胃热外发矣但有太阴腹满则土湿
颇旺未免身重耳湿盛阳虚汗下烧针俱属不可若发汗则阳亡躁生神败心 而反谵语若加烧针汗去阳亡必怵惕烦躁不得眠卧
若下之则阳亡土败胃中空虚不能堤防阴邪下焦客气遂逆动于膈下拒格胸中之阳心中懊 而生瘀浊心窍于舌瘀浊在心舌上
苔生者宜栀子豉汤涌瘀浊而清烦热也若下后阴亡渴欲饮水口干舌燥者宜白虎加人参汤清金而泄热益气而生津也若下后阳
旺而土湿脉浮发热渴欲饮水小便不利者宜猪苓汤二苓滑泽利水而泻湿阿胶润木而清风也土湿木遏郁生下热是以发热木气
堙塞疏泄不行故小便不利木郁风生肺津伤耗是以发渴风气发扬是以脉浮腹满身重之人下之阳败湿增故见证如此此申明上
章腹满小便难之义
阳明病出现心下硬满症状的，不可使用攻下法。如果误用攻下法，导致腹泻不止的，预后不良（主死）；如果腹泻停止的，则病情好转（主愈）。
心下痞塞胀满是太阴病的证候。太阴病表现为腹部胀满、呕吐，自发性腹泻且日益加重，若误用攻下法，必然导致胸膈下方结聚硬痛，就是这种情况。阳明病却出现了太阴病心下硬满的症状，这是因为阴气盛而阳气弱，所以不可攻下。
如果误用攻下法，脾阳下陷衰败，导致腹泻不止的，预后不良（主死）；如果阳气回复，腹泻停止的，则病情好转。
阳明中风，出现口苦、咽干、腹部胀满、轻微气喘、发热、恶寒、脉象浮而紧的症状。如果误用攻下法，会导致腹部胀满更加严重，小便困难。
阳明中风而口苦、咽干，说明兼有少阳病证；腹部胀满，说明兼有太阴病证；发热、恶寒、脉象浮而紧，这些脉证又与伤寒太阳中风证的大青龙汤证相似。但这属于阳明腑热向外蒸腾，应当汗出而脉象缓，现在却是脉紧且恶寒，这是卫气在外收敛，胃中阳气虚弱，不能发汗所致。外有甲木（胆/肝）的克制，内有太阴（脾）的侵扰，导致经络和脏腑双重郁滞，邪气不得发散。阳明病至此已经困乏疲惫到了极点。如果再误用攻下法，就会完全转化为太阴病证，出现腹部胀满和小便困难。具体治法详见下一章猪苓汤一段。
阳明病，脉象浮而紧，咽喉干燥，口苦，腹部胀满，气喘，发热，出汗，不恶寒反而恶热，身体沉重。如果误用发汗法，会导致心神烦躁、心中烦闷懊恼，反而出现胡言乱语；如果误用烧针疗法，必定会出现惊恐、烦躁、无法入睡。
如果误用攻下法，导致胃中空虚，客气（邪气）扰动膈肌，心中烦闷懊恼，舌上有苔的，主治方剂为栀子豉汤（方剂见太阳篇第八十九节）。
如果口渴想喝水，口干舌燥的，主治方剂为白虎加人参汤（方剂见太阳篇第三十九节）。
如果脉象浮、发热，口渴想喝水，小便不利的，主治方剂为猪苓汤。
阳明病脉象浮而紧，有太阳病证；咽喉干燥、舌头干燥，有少阳病证；腹部胀满，有太阴病证；发热、出汗、不恶寒反而恶热，说明胃热向外发散。但只要有太阴病的腹部胀满，就说明土湿颇旺，难免出现身体沉重的症状。湿气盛而阳气虚，发汗、攻下、烧针都属于禁忌。
如果误用发汗法，阳气亡失，躁动内生，神气败坏，心中烦闷，反而出现胡言乱语。如果误用烧针，汗出过多导致阳气亡失，必定出现惊恐、烦躁、无法卧床睡眠。
如果误用攻下法，阳气亡失，脾土败坏，胃中空虚，不能抵御阴邪，下焦的客气于是逆上扰动膈肌，格拒胸中的阳气，导致心中烦闷懊恼而生瘀浊，心窍受扰反映在舌头上，舌上生出苔垢的，适宜用栀子豉汤涌吐瘀浊并清除烦热。
如果在攻下之后，阴液亡失，口渴想喝水，口干舌燥的，适宜用白虎加人参汤清泄肺金之热以散热，益气以生津。
如果在攻下之后，阳气偏旺而土湿仍存，脉象浮、发热，口渴想喝水，小便不利的，适宜用猪苓汤。方中茯苓、猪苓、滑石、泽泻利水以泻湿，阿胶滋润肝木以清风。土湿木郁，郁而生热，所以发热；木气壅塞，疏泄功能不行，所以小便不利；木郁生风，耗伤肺津，所以发渴；风气发扬，所以脉象浮。腹部胀满、身体沉重的人，误用攻下法导致阳气败坏、湿气增加，所以出现上述见证。这是在阐明上一章“腹满、小便难”的含义。
In Yangming disease, if there is hardness and fullness in the epigastrium (heart below), purgation must not be used. If purgation is mistakenly applied and diarrhea persists without stopping, the prognosis is fatal; if the diarrhea stops, recovery occurs.
Epigastric stuffiness and fullness are signs of Taiyin disease. In Taiyin disease, abdominal fullness with vomiting and spontaneous diarrhea that worsens over time occur; if purgation is mistakenly applied, it inevitably leads to hardness and binding below the chest, which is this situation. When Yangming disease presents with the Taiyin symptom of epigastric hardness and fullness, it indicates excess Yin and deficient Yang, thus purgation is contraindicated.
If purgation is mistakenly applied, Spleen Yang sinks and fails, leading to persistent diarrhea, which is fatal; if Yang returns and diarrhea stops, recovery occurs.
Yangming Wind-Strike presents with bitter taste in the mouth, dry throat, abdominal fullness, slight panting, fever, aversion to cold, and a floating and tight pulse. If purgation is mistakenly applied, abdominal fullness will worsen, and urination will become difficult.
Yangming Wind-Strike with bitter taste and dry throat indicates concurrent Shaoyang syndrome; abdominal fullness indicates concurrent Taiyin syndrome; fever, aversion to cold, and a floating and tight pulse resemble the Da Qing Long Tang syndrome of Taiyang Wind-Strike in Cold Damage. However, this involves Yangming Fu-heat steaming outward, where sweating should occur and the pulse should be slow. The current tight pulse and aversion to cold indicate that Wei Qi (Defensive Qi) is constrained externally, and Stomach Yang is deficient, unable to induce sweating. Externally, there is constraint from Jia Wood (Gallbladder/Liver); internally, there is invasion by Taiyin (Spleen). This results in dual stagnation of the channels and Fu organs, preventing the release of pathogens. Yangming disease has reached a state of extreme exhaustion at this point. If purgation is further mistakenly applied, it will fully transform into a Taiyin syndrome, characterized by abdominal fullness and difficult urination. The specific treatment method is detailed in the section on Zhu Ling Tang in the next chapter.
In Yangming disease, with a floating and tight pulse, dry throat, bitter taste, abdominal fullness, panting, fever, sweating, absence of aversion to cold but presence of aversion to heat, and heaviness of the body: if diaphoresis (sweating-inducing therapy) is mistakenly applied, restlessness, mental confusion, and delirium may occur; if burning needle therapy is mistakenly applied, fright, irritability, and insomnia will definitely ensue.
If purgation is mistakenly applied, resulting in an empty stomach, disturbance of pathogenic Qi moving to the diaphragm, and mental vexation and oppression (Xin Zhong Ao Nao) with coating on the tongue, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is the primary formula.
If there is thirst desire to drink water, dry mouth, and dry tongue, Bai Hu Jia Ren Shen Tang (White Tiger Plus Ginseng Decoction) is the primary formula.
If the pulse is floating, there is fever, thirst desire to drink water, and difficult urination, Zhu Ling Tang (Polyporus Decoction) is the primary formula.
Yangming disease with a floating and tight pulse presents Taiyang symptoms; dry throat and tongue present Shaoyang symptoms; abdominal fullness presents Taiyin symptoms; fever, sweating, absence of aversion to cold but presence of aversion to heat indicate Stomach heat radiating outward. However, the presence of Taiyin abdominal fullness suggests abundant Earth dampness, inevitably causing body heaviness. With excessive dampness and deficient Yang, diaphoresis, purgation, and burning needle therapies are all contraindicated.
If diaphoresis is mistakenly applied, Yang collapses, restlessness arises, spirit deteriorates, mental confusion occurs, and delirium follows. If burning needles are mistakenly applied, excessive sweating leads to Yang collapse, causing fright, irritability, and inability to lie down and sleep.
If purgation is mistakenly applied, Yang collapses, Earth (Spleen) fails, the stomach becomes empty, failing to defend against Yin pathogens. Pathogenic Qi from the Lower Jiao reverses upward to disturb the diaphragm, repelling Yang in the Chest, causing mental vexation and oppression, generating turbid stasis. Heart orifices are affected, manifesting as tongue coating. Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is suitable to purge turbid stasis and clear vexatious heat.
If after purgation, Yin fluids are depleted, causing thirst, dry mouth, and dry tongue, Bai Hu Jia Ren Shen Tang (White Tiger Plus Ginseng Decoction) is suitable to clear Metal (Lung) heat, dissipate heat, tonify Qi, and generate fluids.
If after purgation, Yang is exuberant while Earth dampness remains, with a floating pulse, fever, thirst, and difficult urination, Zhu Ling Tang (Polyporus Decoction) is suitable. Fu Ling (Poria) and Zhu Ling (Polyporus), Hua Shi (Talcum), and Ze Xie (Alisma) promote urination to drain dampness; E Jiao (Donkey-hide Gelatin) nourishes Wood (Liver) to clear wind. Earth dampness constrains Wood, stagnation generates heat, causing fever; Wood Qi is blocked, failure of dispersion and descent causes difficult urination; Wood stagnation generates Wind, consuming Lung fluids, causing thirst; Wind Qi rises, causing a floating pulse. In cases of abdominal fullness and body heaviness, mistaken purgation damages Yang and increases dampness, leading to these manifestations. This clarifies the meaning of "abdominal fullness and difficult urination" from the previous chapter.