三者皆大虚之候。乃精神耗散。不能主持也。当以独参汤、左归饮、大剂与之。每
有获生者。（参西塘感症）
邵评∶循衣、摸床、撮空、三症。多相因而见。由于阴亏热盛。元神耗散。不能自主。虚
则喜实之象。用独参以补元神。左归以壮肾水救之。
阳明热极失治。致循衣摸床。微喘直视。脉弦者生。脉涩者死。此属阳明坏病。脉弦则超超而
长。胃气尚存。故可下以承气。然亦危极矣。要知生者未必尽生。而脉涩断无不死。下亦死。不
下亦死也。（述古）
邵评∶阳明热极。邪实于中。阴气几将涸竭。而见循衣摸床微喘直视之症。元神
亦耗散无主矣。故必诊其脉。如见弦象。尚有胃气。用承气下其实热。以存一线
之阴气。希冀生机。若脉涩者。阴竭血耗。必死无疑。
太阳火劫取汗。阳盛伤阴。而致循衣摸床。阴若未竭。则小便利。可生。阴若已竭。则小便不
利。多死。（参金鉴）
邵评∶火劫阴伤。阳热盛极。神被火迫而不守。致循衣摸床。以小便之利不利。验
其阴气之存亡。阴存则生。阴竭则死。
伤寒有不便而不食者。必须滋养胃阴。胃阴充溢。自然邪去便通。而思食矣。如养
未足。邪不即去。不食不妨也。
邵评∶不便不食。胃液亏而有邪滞也。阴亏故不便。胃有邪滞也。阴亏故不食。胃
有邪故不食。治须滋养胃阴。阴液恢复。则邪自退矣。
伤寒有不便而能食者。致新推陈。仓廪滋益。自能通利。不便无忧也。（二条出西塘感症）
邵评∶不便能食。阴亏而胃无邪滞也。液亏则不便。胃无邪故能食。一味滋阴养
液。阴液充足。大便自通。
这三种情况都属于极度虚弱的证候。这是由于精神耗散，无法自主主持身体所致。应当使用独参汤、左归饮等大剂量方剂给予治疗。往往有因此获救存活的案例。（参考《西塘感症》）
邵评：循衣、摸床、撮空这三种症状，多相继出现。这是由于阴液亏损、热邪炽盛，导致元神耗散，不能自主控制，呈现出虚极而喜实（即虚阳外越或假实）的征象。使用独参汤以补益元神，使用左归饮以滋壮肾水来救治。
阳明经热邪极盛且失治，导致出现循衣摸床的症状，伴有轻微喘息和直视，如果脉象弦，则预后良好可生；如果脉象涩，则预后不良主死。这属于阳明病的坏病（变证）。脉弦说明脉气超超然长，胃气尚存，因此可以使用承气汤类攻下。然而病情也非常危重。要知道，脉弦示生者未必都能存活，而脉涩者断无不死之理，无论攻下还是不攻下，最终都是死亡。（参考《述古》）
邵评：阳明热邪极盛，邪气实于中焦，阴气几乎枯竭，从而出现循衣摸床、微喘、直视等症状，元神也耗散而无主。因此必须诊察脉象，如果见到弦象，说明尚有胃气，使用承气汤攻下其实热，以保存一线阴气，希冀生机。如果脉象涩，说明阴竭血耗，必定死亡无疑。
太阳病误用火法劫汗，导致阳热亢盛损伤阴液，从而引起循衣摸床。如果阴液尚未枯竭，则小便通利，预后良好可生；如果阴液已经枯竭，则小便不利，大多死亡。（参考《医宗金鉴》）
邵评：火法劫伤阴液，阳热盛极，神志被火热逼迫而不守舍，导致循衣摸床。通过观察小便的通利与否，来验证阴气的存亡。阴气存在则生，阴气枯竭则死。
伤寒病患者有大便不通且不思饮食的情况。必须滋养胃阴。当胃阴充足充盈时，自然邪气去除，大便通畅，并且产生食欲。如果滋养不足，邪气不会立即去除，此时不进食也无妨。
邵评：大便不通且不食，是因为胃液亏虚且有邪气停滞。阴液亏虚故大便不通，胃中有邪气停滞故不思饮食。治疗需要滋养胃阴，阴液恢复后，邪气自然消退。
伤寒病患者有大便不通但能进食的情况。这是新陈代谢推陈出新的表现，脾胃功能滋益，自然能够通利，不必担忧大便不通的问题。（这两条出自《西塘感症》）
邵评：大便不通但能食，是因为阴液亏虚而胃中没有邪气停滞。津液亏虚故大便不通，胃中无邪故能进食。只需一味地滋阴养液，阴液充足后，大便自然通畅。
These three conditions all represent severe deficiency syndromes. They arise from the dispersion of spirit and essence, leading to an inability to govern the body autonomously. Treatment should involve administering large doses of Dushen Tang (Ginseng Decoction) or Zuogui Yin (Left Restoring Decoction). There are cases where patients survive due to this treatment. (Referencing *Xitang Gan Zheng*)
Shao's Commentary: The symptoms of grasping at clothes (xun yi), touching the bed (mo chuang), and picking at empty air (cuo kong) often occur sequentially. They result from yin deficiency with excessive heat, causing the depletion of the primordial spirit (yuan shen) and loss of autonomous control, presenting as a false excess pattern arising from extreme deficiency. Dushen Tang is used to tonify the primordial spirit, while Zuogui Yin is used to strengthen kidney water to rescue the condition.
When yangming heat reaches its extreme and is left untreated, it leads to grasping at clothes and touching the bed, accompanied by slight panting and fixed staring. If the pulse is wiry (xian), survival is possible; if the pulse is choppy (se), death is certain. This belongs to the "bad disease" (huai bing) of Yangming. A wiry pulse indicates that the qi extends long and superabundant, suggesting that stomach qi remains, so purgatives like Chengqi Tang may be used. However, the condition is extremely critical. It must be understood that those showing signs of life may not necessarily survive, whereas those with a choppy pulse will certainly die, regardless of whether purgation is administered or not. (Referencing *Shu Gu*)
Shao's Commentary: In extreme Yangming heat, pathogenic factors are solid in the middle jiao, and yin qi is nearly exhausted, manifesting as grasping at clothes, touching the bed, slight panting, and fixed staring, with the primordial spirit depleted and uncontrolled. Therefore, pulse diagnosis is essential. If a wiry image is seen, it indicates remaining stomach qi; Chengqi Tang should be used to purge the excess heat to preserve a thread of yin qi, hoping for a chance of survival. If the pulse is choppy, it indicates exhaustion of yin and depletion of blood, making death inevitable.
In Taiyang disease, improper use of fire therapy to induce sweating causes excessive yang heat to injure yin, leading to grasping at clothes and touching the bed. If yin has not yet been exhausted, urination will be free, indicating potential survival; if yin has already been exhausted, urination will be difficult or absent, usually resulting in death. (Referencing *Yi Zong Jin Jian*)
Shao's Commentary: Fire therapy injures yin, causing extreme yang heat. The spirit is forced away by the fire and loses its residence, leading to grasping at clothes and touching the bed. The presence or absence of free urination is used to verify the existence or exhaustion of yin qi. If yin exists, there is life; if yin is exhausted, there is death.
In typhoid diseases, some patients present with constipation and anorexia. It is necessary to nourish stomach yin. When stomach yin is sufficiently replenished, pathogens will naturally be expelled, bowel movements will become smooth, and appetite will return. If nourishment is insufficient, pathogens will not immediately dissipate, and lack of appetite is acceptable.
Shao's Commentary: Constipation and anorexia indicate deficient stomach fluids with pathogenic stagnation. Yin deficiency causes constipation; pathogenic stagnation in the stomach causes anorexia. Treatment requires nourishing stomach yin. Once yin fluids recover, pathogens will recede naturally.
In typhoid diseases, some patients present with constipation but retain the ability to eat. This reflects the process of eliminating the old and generating the new, with the spleen and stomach functions benefiting, allowing for natural patency. There is no need to worry about constipation. (These two items are from *Xitang Gan Zheng*)
Shao's Commentary: Constipation with preserved appetite indicates yin deficiency without pathogenic stagnation in the stomach. Fluid deficiency causes constipation; the absence of pathogenic factors in the stomach allows for eating. The treatment consists solely of nourishing yin and fluids. Once yin fluids are sufficient, bowel movements will naturally become smooth.