茵陈蒿（六两） 栀子（十四枚擘） 大黄（二两去皮）
上三味。以水一斗二升。先煮茵陈减六升。内二味。煮取三升。去滓。分温三服。小盒饭利尿如皂角汁状。色正赤。
一宿腹减。黄从小便去也。
成氏明理论云。王冰曰。小热之气。凉以和之。大热之气。寒以取之。发黄者。热之极也。非大寒之剂。则不能
散其热。茵陈蒿味苦寒。酸苦涌泄为阴。酸以涌之。苦以泄之。泄甚热者。必以苦为主。故以茵陈蒿为君。心法南方火
而主热。栀子味苦寒。苦入心而寒胜热。大热之气。必以苦寒之物胜之。故以栀子为臣。大黄味苦寒。宜补必以酸。宜
下必以苦。推除邪热。必假将军攻之。故以大黄为使。苦寒相合。虽甚热。大毒必祛除分泄。前后复得利而解矣。
琥按上茵陈蒿汤。乃前后通泄之药。所以上方后云。黄从小便去。未足以尽其义。成注复云前后得利而解。斯为至
当之论。
（附例）伤寒七八日。身黄如橘子色。小便不利。腹微满者。茵陈蒿汤主之。（此条亦湿热发黄之证。伤寒七八日。
成注云。正当热甚之时。热甚于内。黄发于外。身黄如橘子色者。其黄鲜明而且润泽。乃湿热俱盛之候也。小便不利。
腹微满者。湿热之气。不能施化。阳明胃府实。故外作胀满之形也。与茵陈蒿汤。以清湿热。下胃实。此条即从本篇之
后。移附于此。）
阳明证其人喜忘者。必有蓄血。所以然者。本有久瘀血。故令喜忘屎虽硬。大便反易。其色必黑。宜抵当汤下之（此
条乃阳明胃府血分实热之证。阳明证其人喜忘者。好忘前言往事也。条辩云。志伤则好忘。心之所之谓志。心又为血之
主。血为热壅。蓄积于胃。其瘀既久。必上干于心。故令喜忘。屎虽硬非承气汤证。须验其大便易而色黑。此为瘀血欲
下之证。治宜抵当汤以下瘀血。乃通因通用之法也。或问屎既云。硬。何以大便反易。余答云。大便中所下黑物。乃败
血而非屎也。阳明本多血。故虽不至如太阳发狂之甚。亦当以抵当汤下之。又仲景法。辩太阳蓄血证。必验其小便利。
辩阳明蓄血证。必验其大便易。亦各从其府而言之。抵当汤方见前第四卷太阳中篇）
（附例）病患无表里证。发热七八日。虽脉浮数者可下之假令已下。脉数不解。合热。则消谷善饥。至六七日不大
便者。有瘀血。宜抵当汤。（此条乃阳明大肠府血分实热之证。病患者。阳明病之人也。阳明表证。当身热目疼。鼻干不
得卧。阳明里证。当痞满燥实谵语。今则两证俱无。但内发热。是里证未全具也。脉浮而数。是表证。未全具也。数为
里热。然脉浮者。犹带表。为不可下。其可下者。止因七八日之久。阳明邪热已深。故脉虽浮数。而可下之。既下之后。
则邪热去而浮数之脉。皆当解矣。假令已下。浮脉去而数脉不解。则外来风邪之热。与胃中真火之热相合。故云合热。
夫人胃中有真火。则能消化水谷今则复合邪热。故不惟消谷而且善饥。善之为言易也。谷食既能消而易饥。则后必时常
大便。今至六七日不大便者。此下焦有瘀血并绝其大便之道路也。何也。盖阳明多气多血。成注云。热客于气。则脉浮。
热客于血则脉数。数脉见于既下之后。则胃中空虚。邪热并合。迫血下行。蓄积于大肠之间。以故并大便。亦不得下。
成注云。与抵当汤以下去之。或问此条云。瘀血。与上条蓄血。有以异否余答云。蓄血者。血但蓄积而可流通。以故大
便反易。瘀血者。其血瘀积。甚至阻塞。以故大便不行。又按成注云。可下之。与大承气汤。以承气汤为清涤阳明。里
热之药。故也。尚论篇注云。可下之。如大柴胡汤之类误矣。）
若脉数不解。而下不止。必协热而便脓血也。（此承上文脉数不解而言。下不止者。成注云。下利不止。为热得下泄。
则血不致瘀。必协热而便脓血。协合也。犹迫协也。肠胃之气。为热邪所迫协。故便脓血也。按此条论。仲景无治法。
补亡论常器之云。可白头翁汤。上二条证即从本篇之后移附于此）
（重出例）阳明病下之。心中懊 而烦（云云）。若有燥屎者。宜大承气汤。
病患不大便五六日。（云云）此有燥屎。故使不大便也。
病患烦热汗出则解。又如疟状（云云。）下之与大承气汤。发汗宜桂枝汤。
大下后六七日不大便（云云）本有宿食故也。宜大承气汤。
病患小便不利。大便乍难乍易（云云）有燥屎也。宜大承气汤。
上五条证。（俱见前大承气汤方下）
食谷欲呕者。属阳明也。吴茱萸汤主之。得汤反剧者。属上焦也。（此条系胃家虚寒证。正文与注并）
以上三味药。用水一斗二升。先煮茵陈，水量减少六升后。加入另外两味药。再煎煮取汁三升。滤去药渣。分三次温服。小便应当像皂角汁一样颜色深红且量多。
过一夜腹部胀满减轻。湿热之邪从小便排出。
成无己在《明理论》中引用王冰的话说：小热之气，用凉性药来调和它；大热之气，用寒性药来清除它。发黄证，是热邪极盛的表现。如果不是大寒性质的药剂，就不能消散其热邪。茵陈蒿味苦、寒。酸味和苦味具有涌吐和泄下的作用，属于阴的性质。酸味能涌吐，苦味能泄下。要泄除极盛的热邪，必须以苦味药为主。所以用茵陈蒿作为君药。心对应南方火，主司热邪。栀子味苦、寒。苦味入心，寒性能胜热。极盛的热邪，必须用苦寒的药物来克制。所以用栀子作为臣药。大黄味苦、寒。适宜补益时必用酸味，适宜攻下时必用苦味。推除邪热，必须借助“将军”（指大黄）来攻伐。所以用大黄作为使药。苦寒药配合使用，即使是极盛的热邪和大毒也能被祛除并分消。前后二阴得利，病邪得以解除。
琥按：上面的茵陈蒿汤，是前后二阴通泄的药物。所以上方后注说：“黄从小便去”，这不足以完全表达其含义。成无己的注释又说“前后得利而解”，这才是最确切的论述。
（附例）伤寒七八日。身体发黄如橘子色。小便不通利。腹部轻微胀满的，用茵陈蒿汤主治。（此条也是湿热发黄的证候。伤寒七八日，成无己注释说，正当热邪极盛的时候。热邪盛于体内，黄色发于体表。身体发黄如橘子色，其黄色鲜明而且润泽，这是湿热俱盛的征象。小便不利，腹部轻微胀满，是湿热之气不能施化，阳明胃腑实证，所以外表出现胀满的形状。给予茵陈蒿汤，以清利湿热，攻下胃腑实邪。此条是从本篇后面移附于此的。）
阳明证的人如果容易健忘，必定有蓄血。之所以这样，是因为原本就有久瘀的血，所以导致健忘。大便虽然硬，但排便反而容易，颜色必定黑。宜用抵当汤攻下（此条是阳明胃腑血分实热的证候。阳明证的人容易健忘，是指喜欢忘记前言往事。《条辩》说：志受伤则好忘。心之所向称为志。心又为血的主宰。血被热邪壅滞，蓄积在胃中。其瘀血既久，必定上扰于心，所以导致健忘。大便虽硬，但不是承气汤证，必须验看其大便易行且色黑，这是瘀血欲下的证候。治疗宜用抵当汤以下瘀血，这是通因通用的治法。有人问：大便既然说硬，为什么大便反而容易？我回答说：大便中所下的黑色物质，是败血而不是粪便。阳明本多血，所以即使不至于像太阳病蓄血那样严重到发狂，也应当用抵当汤攻下。另外仲景的法度，辨别太阳蓄血证，必须验看其小便通利；辨别阳明蓄血证，必须验看其大便易行。这也是各从其腑而言的。抵当汤方见前第四卷太阳中篇）
（附例）病患没有表证和里证。发热七八日。虽然脉浮数，可以用下法。假如已经用了下法，脉数不解。合热，则消谷善饥。到了六七天不大便的，有瘀血。宜用抵当汤。（此条是阳明大肠腑血分实热的证候。病患者，是患阳明病的人。阳明表证，应当身热目疼、鼻干不得卧；阳明里证，应当痞满燥实谵语。现在这两证都没有，只是内发热，说明里证未完全具备。脉浮而数，是表证未完全具备。数是里热，然而脉浮者，还带有表证，为不可下。其可下的原因，只因为经过七八日之久，阳明邪热已深，所以脉虽浮数，而可用下法。既下之后，则邪热去而浮数之脉，都应当解除。假如已经用了下法，浮脉去而数脉不解，则外来风邪之热，与胃中真火之热相合，所以说合热。人在胃中有真火，则能消化水谷。现在又复合邪热，所以不仅消谷而且善饥。“善”的意思是容易。谷食既能消而易饥，则后来必然时常大便。现在到了六七天不大便，这是下焦有瘀血并且阻绝了大便的道路。为什么呢？盖阳明多气多血。成无己注释说：热客于气，则脉浮；热客于血则脉数。数脉见于已经下法之后，则胃中空虚，邪热并合，迫血下行，蓄积在大肠之间。因此连同大便，也不能下行。成无己注释说：给予抵当汤以下去之。有人问：此条说“瘀血”，与上一条“蓄血”，有区别吗？我回答说：蓄血，是血但蓄积而可流通，所以大便反而容易；瘀血，是血瘀积，甚至阻塞，所以大便不行。另外按成无己注释说：可下之，与大承气汤。因为大承气汤是清涤阳明里热的药物。尚论篇注释说：可下之，如大柴胡汤之类，这就错了。）
如果脉数不解，而下利不止，必定协热而便脓血也。（此条承接上文脉数不解而言。下不止者，成无己注释说：下利不止，为热得下泄，则血不致瘀，必协热而便脓血。协合也，犹迫协也。肠胃之气，为热邪所迫协，故便脓血也。按此条论述，仲景无治法。补亡论常器之说：可用白头翁汤。上两条证即从本篇之后移附于此）
（重出例）阳明病下之。心中懊憹而烦（云云）。若有燥屎者，宜大承气汤。
病患不大便五六日。（云云）此有燥屎，故使不大便也。
病患烦热汗出则解。又如疟状（云云。）下之与大承气汤。发汗宜桂枝汤。
大下后六七日不大便（云云）本有宿食故也。宜大承气汤。
病患小便不利。大便乍难乍易（云云）有燥屎也。宜大承气汤。
上五条证。（俱见前大承气汤方下）
Yinchen Hao (Lai, 6 liang) Zhi Zi (14 seeds, broken), Dahuang (Rhubarb Radix et Rhizoma, 2 liang, peeled).
The above three herbs. Use one dou and two sheng of water. First decoct Yinchen until the volume is reduced by six sheng. Then add the other two herbs. Decoct to obtain three sheng of liquid. Remove the dregs. Divide into three doses and take warm. Urination should be copious like soapberry juice, with a deep red color.
After one night, abdominal distension decreases. The jaundice is expelled through urination.
Cheng Wuji, in his "Ming Lilun" (Theory of Clarity), quotes Wang Bing: "For mild heat pathogenic factors, use cool-natured herbs to harmonize; for severe heat pathogenic factors, use cold-natured herbs to eliminate." Jaundice represents extreme heat. Only potent cold-natured formulas can dissipate this heat. Yinchen Hao has a bitter and cold taste. Sour and bitter flavors induce vomiting and purgation, belonging to Yin nature. Sour induces vomiting, bitter purges. To purge extreme heat, bitter herbs must be primary. Therefore, Yinchen Hao is used as the Sovereign herb. The Heart corresponds to Fire in the South and governs heat. Zhi Zi has a bitter and cold taste. Bitter enters the Heart, and cold overcomes heat. Extreme heat must be overcome by bitter-cold substances. Therefore, Zhi Zi is used as the Minister herb. Dahuang has a bitter and cold taste. When tonification is needed, sour is appropriate; when purgation is needed, bitter is appropriate. To push out evil heat, one must rely on the "General" (a metaphor for Dahuang) to attack. Therefore, Dahuang is used as the Envoy herb. Combined bitter and cold properties, even extreme heat and great toxicity will be eliminated and dispersed. Through the relief of both anterior and posterior orifices, the disease resolves.
Hu notes: The above Yinchen Hao Tang is a formula that unblocks and purges both anterior and posterior orifices. Hence, the post-prescription note says, "Jaundice leaves via urination," which does not fully capture its meaning. Cheng's annotation stating "relief through benefit to both orifices" is the most accurate discussion.
(Attached Example) In Shanghan (Cold Damage) for seven to eight days, if the body turns yellow like an orange peel, with difficulty in urination and slight abdominal fullness, Yinchen Hao Tang is indicated. (This clause also describes a syndrome of damp-heat causing jaundice. In Shanghan for seven to eight days, Cheng's annotation states this is when heat is at its peak. Heat is excessive internally, manifesting externally as yellow. Body yellow like an orange peel indicates bright and lustrous yellow, a sign of both dampness and heat being abundant. Difficulty in urination and slight abdominal fullness indicate that damp-heat qi cannot transform and diffuse. Yangming Stomach Fu is excess, hence external distension. Administer Yinchen Hao Tang to clear damp-heat and purge Yangming Stomach excess. This clause was moved from the end of the original chapter to here.)
In Yangming syndrome, if the patient suffers from forgetfulness, there must be stored blood. The reason is that there was pre-existing long-standing blood stasis, leading to forgetfulness. Although stools are hard, defecation is actually easy, and the color must be black. Didang Tang is suitable for purging. (This clause describes an excess-heat syndrome in the Blood aspect of the Yangming Stomach Fu. Forgetfulness in Yangming syndrome refers to forgetting past words and deeds. "Tiaobian" states: Injury to Zhi leads to forgetfulness. What the Heart directs is called Zhi. The Heart is also the master of Blood. When Blood is congested by heat and accumulates in the Stomach, the long-standing stasis must disturb the Heart upwards, causing forgetfulness. Hard stools do not indicate Chengqi Tang syndrome; one must verify easy defecation and black color to confirm blood stasis ready to descend. Treatment requires Didang Tang to purge blood stasis, employing the method of treating obstruction with purgatives (Tong Yin Tong Yong). Question: If stools are hard, why is defecation easy? Answer: The black matter passed in stool is ruined blood, not feces. Yangming naturally has abundant blood. Thus, although it may not reach the severity of mania seen in Taiyang blood stasis, Didang Tang should still be used. Furthermore, Zhang Zhongjing's methodology distinguishes Taiyang blood stasis by verifying free urination, and Yangming blood stasis by verifying easy defecation, each according to their respective Fu organs. Didang Tang formula is found in Volume 4, Taiyang Chapter.)
(Attached Example) A patient presents without exterior or interior syndromes, with fever for seven to eight days. Although the pulse is floating and rapid, purgation may be applied. Suppose purgation has already been performed, but the rapid pulse remains unresolved. Combined heat causes digestion of food and frequent hunger. By the sixth or seventh day, if there is no bowel movement, there is blood stasis. Didang Tang is indicated. (This clause describes an excess-heat syndrome in the Blood aspect of the Yangming Large Intestine Fu. The patient is suffering from Yangming disease. Yangming exterior syndrome involves fever, eye pain, nasal dryness, and inability to sleep. Yangming interior syndrome involves stuffiness, fullness, dryness, excess, and delirium. Currently, neither set of symptoms is fully present, only internal fever, indicating incomplete interior syndrome. Floating and rapid pulse suggests incomplete exterior syndrome. Rapid indicates interior heat, but floating implies lingering exterior, making purgation generally contraindicated. However, after seven to eight days, Yangming evil heat has penetrated deeply, so despite floating and rapid pulse, purgation is permissible. After purgation, evil heat should leave, and the floating and rapid pulse should resolve. Suppose purgation was done, floating pulse disappears but rapid pulse persists. This means external wind-heat combines with true fire in the Stomach, termed "combined heat." True fire in the Stomach digests grain; combined with evil heat, it causes not only digestion but also frequent hunger ("Shan" means easy/eager). Since grain is digested easily and hunger is frequent, bowel movements should follow. But by the sixth or seventh day, no bowel movement occurs because lower Jiao blood stasis blocks the pathway. Why? Yangming is abundant in Qi and Blood. Cheng's annotation: Heat in Qi causes floating pulse; heat in Blood causes rapid pulse. Rapid pulse after purgation indicates empty Stomach, allowing evil heat to combine and force Blood downward, accumulating in the Large Intestine, thus blocking stool passage. Cheng's annotation: Administer Didang Tang to purge it. Question: Does "blood stasis" here differ from "stored blood" in the previous clause? Answer: Stored blood accumulates but flows freely, hence easy defecation. Blood stasis is obstructive, hence no defecation. Also, Cheng's annotation suggests Da Chengqi Tang, as it clears Yangming interior heat. Shanglun Pian annotation warns against using Xiaochaihu Tang, which would be erroneous.)
If the rapid pulse remains unresolved and diarrhea persists, dysentery with pus and blood due to combined heat will occur. (This clause follows the previous discussion on unresolved rapid pulse. Persistent diarrhea means Cheng's annotation: Diarrhea allows heat to escape, preventing blood stasis, but combined heat forces pus and blood into stool. "Xie" means combining or forcing. Intestinal and stomach Qi are forced by evil heat, resulting in pus and blood. Note: Zhang Zhongjing provides no treatment for this clause. Buwang Lun by Chang Qizi suggests Baitouweng Tang. These two clauses were moved from the end of the original chapter to here.)
(Repeated Examples)
Yangming disease treated with purgation results in vexation and restlessness in the chest (etc.). If dry feces are present, Da Chengqi Tang is indicated.
Patient has not had a bowel movement for five to six days (etc.). This indicates dry feces, causing the lack of bowel movement.
Patient experiences vexation, heat, and sweating leading to resolution, then resembles malaria (etc.). Purge with Da Chengqi Tang. For sweating, Guizhi Tang is indicated.
After severe purgation, no bowel movement for six to seven days (etc.). This is due to retained food. Da Chengqi Tang is indicated.
Patient has difficulty urinating, and bowel movements alternate between difficult and easy (etc.). This indicates dry feces. Da Chengqi Tang is indicated.
The above five conditions (all found under the Da Chengqi Tang formula previously).
Food intake followed by desire to vomit belongs to Yangming. Wuzhuyu Tang is indicated. If symptoms worsen after taking the decoction, it belongs to the Upper Jiao. (This clause relates to deficiency-cold of the Stomach family. Both main text and annotation apply.)