邪气在表。发汗则当解矣。若发汗不解。显系邪不在表。已入里而为胃实。故腹满而痛也。腹满且痛。
治之不可少缓。缓则必致伤胃。故当急下。宜大承气汤。
腹满不减。减不足言。当下之。宜大承气汤。
此承上文言下之而腹满不减。虽或稍灭而不足以言减。是胃中邪食过于坚实。不为攻下所夺也。
当下之。宜大承气汤。然有下之而脉症不为少减者。死证也。
伤寒六七日。目中不了了。睛不和。无表里证。大便难。身微热者。此为实也。急下之。宜大承气汤。
六七日。邪气在里之时也。不了了。视物不能明了也。睛。目瞳子也。睛不和。精神不能贯注。故视不明也。
外既无发热恶寒之表证。内又无谵语腹满等里邪。且非不大便。而曰大便难。又非发大热而身仅微热。势非
甚亟也。然目中不了了。是邪热伏于里而耗竭其津液也。经云。五脏六腑之精。皆上注于目。热邪内烁。
津液枯燥。则精神不得上注于
目。故目中不了了睛不和也。此终为邪热内实于里也。当急下之。以救阴液。宜大承气汤。
夫实则谵语。虚则郑声。郑声。重语也。
谵语。谵妄之语也。郑声。郑重之声也。邪热内实。则神昏颠倒。言词错乱。故语无伦次也。正气内虚。
神思虽昏。不能谵妄。但模糊作重声而已。或曰。虚则气少轻微。当语言无力矣。岂能作重语邪。曰。
正气虚。故音响深沉。邪气实。故郑声重语。虽曰虚则郑声。实正虚邪实所致也。若但虚无邪。则
亦不作郑声矣。
向以重字读平声。恐误。王肯堂云。只一语而频言之。盖神有余则能机变而乱语。神不足则无机变而
但守一声也。此说虽亦有重叠之意。然其理颇通。
直视谵语。喘满者死。下利者亦死。
谵语虽非死证。直视则心神不守而精气竭。目系不转而肝将绝。以直视谵语而加之以喘满。喘则膻中
迫促而气不接。满则传化不通而胃气绝。故死。五脏别论云。魄门亦为五脏使。脉要精微论云。仓廪不藏者。
是门户不要也。得守者生。失守者死。以直视谵语。若下利则中气不守而脾已绝。肾主二阴。下利则真气
不摄而下焦脱。乃所谓门户不要。失守者死也。
邪气在体表。通过发汗治疗应当解除。如果发汗后病证未解，明显是邪气不在体表，已经入里导致胃腑实证。所以出现腹部胀满且疼痛的症状。腹部胀满并且疼痛，
治疗不可稍有迟缓。若迟缓则必然损伤胃气。所以应当紧急攻下。适宜使用大承气汤。
腹部胀满持续不减，即使有轻微减轻也不足为道。应当采用攻下法。适宜使用大承气汤。
这句话承接上文说明攻下之后腹部胀满依然不减，虽然或许稍微缓解但不足以称为减轻，这是胃中邪热与积食过于坚实，没有被攻下药物所消除。
应当采用攻下法。适宜使用大承气汤。然而如果有经过攻下治疗后脉象和症状没有稍微减轻的，属于死证。
伤寒病程六七天，眼睛视物不清，眼球转动不灵活。没有表证也没有典型的里证，大便困难，身体只有轻微发热，这属于实证。应当紧急攻下。适宜使用大承气汤。
六七天，是邪气在体内的时期。“不了了”是指视物不能清晰明了。“睛”指瞳孔。“睛不和”指精神不能贯注于目，所以视物不明。
外部既没有发热恶寒的表证，内部又没有谵语、腹部胀满等里邪表现，而且并非完全不大便，而是说大便困难；也并非发高热，而是身体仅有微热，形势似乎并不十分急迫。然而“目中不了了”，是邪热伏藏在体内而耗竭津液所致。《内经》说：五脏六腑的精气，都上注于眼睛。热邪在内灼烧，
津液干枯，那么精神就不能上注于
眼睛，所以出现眼睛视物不清、眼球转动不灵活的情况。这终究是因为邪热内结于里。应当紧急攻下，以保存阴液。适宜使用大承气汤。
实证会出现谵语（神志不清时的胡言乱语），虚证会出现郑声（语言重复、声音低微）。郑声，是指重复的话语。
谵语，是指神志昏乱时的妄言。郑声，是指郑重其事的重复之声。邪热内结实证，会导致神志昏乱颠倒，言语错乱，所以说话没有条理。正气内部虚弱，
神思虽然昏沉，但不能胡言乱语，只是模糊地发出重复的声音罢了。有人问：虚证时气少声音微弱，应当说话无力了，怎么能发出重复沉重的声音呢？回答说：
因为正气虚，所以音响深沉；因为邪气实，所以表现为郑声重语。虽然说虚证见郑声，但这其实是正虚邪实共同导致的。如果只是单纯的虚无邪，那么
也不会出现郑声了。
以前将“郑”字读作平声，恐怕是错误的。王肯堂说：只是一句话而频繁地说。大概神气有余则能机变而乱语，神气不足则无机变而
只坚守一个声音。这种说法虽然也有重叠的意思，但其道理颇为通顺。
出现直视（两眼固定不动）、谵语，伴有气喘胸满的，预后不良（死证）。出现腹泻的，也是死证。
谵语虽然不是死证，但出现直视则心神不守而精气枯竭，目系不转而肝气将绝。在直视谵语的基础上加上气喘胸满，气喘则膻中紧迫而气息接续不上，胸满则传导化源不通而胃气断绝，所以死亡。《素问·五脏别论》说：魄门（肛门）也受五脏支配。《素问·脉要精微论》说：仓廪（脾胃）不能固藏，是因为门户失守。能够固守者生，失去固守者死。在直视谵语的情况下，如果出现下利，则中气不守而脾气已绝。肾主二阴（前后二阴），下利则真气不摄而下焦脱失，这就是所谓的门户失守，失去固守者死。
Pathogenic factors are in the exterior. Sweating should resolve them. If sweating fails to resolve the condition, it clearly indicates that the pathogen is not in the exterior but has entered the interior, resulting in Stomach excess (Stomach excess syndrome). Therefore, abdominal fullness and pain occur. With abdominal fullness and pain,
treatment cannot be delayed even slightly. Delay will inevitably damage the Stomach Qi. Therefore, urgent purgation is required. Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated.
Abdominal fullness does not decrease; any slight reduction is negligible. Purging is indicated. Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated.
This sentence continues from the previous context, explaining that after purging, abdominal fullness remains unchanged. Although there may be a slight alleviation, it is insufficient to be called a reduction. This indicates that the pathogenic heat and retained food in the Stomach are too solid and have not been eliminated by the purgative action.
Purging is indicated. Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated. However, if pulse and symptoms do not show even slight improvement after purging, it is a death syndrome.
In Taiyang Cold Damage (Cold Damage of the Taiyang channel), after six or seven days, if the eyes fail to see clearly (visual impairment) and the pupils are unresponsive (lack of coordination in eye movement), without exterior or interior syndromes, with difficult defecation and only slight fever, this is an excess condition. Urgent purging is required. Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated.
Six or seven days mark the time when pathogenic factors are in the interior. "Bulbous vision" (unclear vision) means inability to see clearly. "Jing" refers to the pupil. "Unresponsive pupils" mean that spirit cannot focus on the eyes, leading to unclear vision.
Externally, there are no exterior signs such as fever and aversion to cold. Internally, there are no interior pathogenic signs such as delirious speech or abdominal fullness. Furthermore, it is not complete constipation but rather difficulty in defecation; nor is it high fever but only slight body heat. The situation seems not extremely urgent. However, "unclear vision" indicates that pathogenic heat is hidden in the interior and consuming fluids. The Classic states: The essence of the five Zang organs and six Fu organs all ascend to nourish the eyes. When heat pathogens burn internally,
fluids become dry, so spirit cannot ascend to the
eyes, resulting in unclear vision and unresponsive pupils. This ultimately results from internal excess of pathogenic heat in the interior. Urgent purging is required to preserve Yin fluids. Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated.
Excess conditions lead to delirious speech (incoherent talking due to mental confusion); deficiency conditions lead to Zheng Sheng (repetitive speech with low voice). Zheng Sheng refers to repetitive words.
Delirious speech refers to妄言 (delusional talk). Zheng Sheng refers to the sound of earnest repetition. Internal excess of pathogenic heat causes mental confusion and disorientation, leading to chaotic speech without logic. Internal deficiency of healthy Qi,
though causing mental dullness, does not result in delirium, but rather vague, repetitive sounds. One might ask: In deficiency, Qi is scarce and voice is weak, so speech should be feeble. How can it produce repetitive heavy sounds? The answer is: Because healthy Qi is deficient, the voice sounds deep; because pathogenic factors are excess, it manifests as Zheng Sheng with heavy repetition. Although it is said that deficiency presents with Zheng Sheng, this is actually caused by both deficiency of healthy Qi and excess of pathogenic factors. If there were pure deficiency without pathogenic factors,
Zheng Sheng would not occur.
Previously, the character "Zheng" was read with a level tone, which is likely incorrect. Wang Kentang stated: It is saying one phrase repeatedly. Essentially, when Shen (Spirit) is excessive, it can change rapidly and speak chaotically; when Shen is insufficient, it lacks flexibility and
clings to a single sound. Although this explanation also implies repetition, its reasoning is quite sound.
Fixed gaze (staring fixedly), delirious speech, accompanied by asthma and chest fullness, indicate a fatal prognosis. Diarrhea also indicates a fatal prognosis.
Although delirious speech is not necessarily fatal, fixed gaze indicates that the Heart Spirit is not anchored and Jing-Essence is exhausted; unresponsive eye movements indicate that the Liver is nearing failure. When fixed gaze and delirious speech are compounded by asthma and chest fullness, asthma causes urgency in the Chest Center (Dan Zhong) and disconnects Qi flow, while fullness blocks transmission and transformation, severing Stomach Qi. Hence, death ensues. The Treatise on the Distinctions of the Five Zang Organs states: The anal sphincter (Po Men) also serves the Five Zang organs. The Essential Secrets of Pulse Diagnosis states: When the granary (Spleen and Stomach) cannot retain contents, it is because the gate is not guarded. Those who maintain control live; those who lose control die. In the context of fixed gaze and delirious speech, if diarrhea occurs, Middle Qi fails to hold and Spleen Qi is exhausted. The Kidney governs the two yin openings (anterior and posterior). Diarrhea indicates that True Qi is not secured and the Lower Jiao collapses. This is what is meant by the loss of the gate's control; losing control leads to death.