蜜七合。一味内。铜器中。微火煎之。稍凝似饴状搅之。勿令焦着欲可丸。并手捻作挺。令头锐。大如指。长二寸
许。当热时急作。冷则硬。以内谷道中。以手急抱。欲大便时乃去之。（内台方用蜜五合。煎。凝时。加皂角末五钱。蘸
捻作挺。以猪胆汁或油润。谷道内之。）
大猪胆一枚。泻汁和醋少许。以灌谷道中。如一食顷。当大便出。（内台方不用醋。以小竹管插入胆口。留一头。用
油润内入谷道中。以手将胆捻之。其汁自入内。此法。用之甚便。）
（琥按土瓜。即王瓜。月令。四月王瓜生。即此也。王瓜。系蔓草类。李氏纲目云。其根作土气。其实似瓜。故名
土瓜。根似栝蒌根而小。气味苦寒。肘后方。治大便不通。采根捣汁。筒吹入肛门内。取通。此与上猪胆汁方同义。内
台方用土瓜根。削如挺。内入谷道中。误矣。盖蜜挺入谷道。能烊化而润大便。土瓜根不能烊化。如削挺用之。恐失仲
景制方之义。）阳明病脉迟。汗出多微恶寒者。表未解也。可发汗宜桂枝汤（此条言阳明病。非胃家实之证。乃太阳病初
传阳明。经中有风邪也。脉迟者。太阳中风缓脉之所变。传至阳明邪将入里。故脉变迟。汗出多者。阳明热而肌腠疏也。
微恶寒者。太阳在表之风邪未尽解也。治宜桂枝汤以解肌发汗。以其病从太阳经来。故仍从太阳经例治之。愚以上条证。
虽从太阳例治。但既云。阳明病。仲景法。还宜用桂枝加葛根汤方也。）
阳明病脉浮。无汗而喘者。发汗则愈宜麻黄汤。（此条言阳明病。亦非胃家实之证。乃太阳病初传阳明经中有寒邪也。
脉浮无汗而喘者。此太阳伤寒之证仍在也。但脉浮而不紧。为其邪传入阳明。脉虽变。而麻黄汤证不变。故仍用麻黄汤。
以发其汗则愈。或问无汗而喘。但脉浮不紧何以定其为阳明证。余答云。病患必见目疼鼻干。故云阳明证也。以其病从
太阳经来。故从太阳麻黄汤例。要之既云。阳明病。仲景法。还宜用葛根汤方也。）
阳明病发热汗出。此为热越。不能发黄也。但头汗出。身无汗剂颈而还。小便不利。渴引水浆者。此为瘀热在里。
身必发黄。茵陈蒿汤主之。（此条乃阳明湿热发黄之证。阳明病发热汗出。则热气得以散越。故不发黄。今但头汗出。身
无汗剂颈而还。此为热不得越也。剂颈而还义。注已见前太阳下编。热不得越于外。庶几小便利。则热气得以下泄。亦
不至于发黄。兹者。小便又不利。则热气内郁。郁热愈深。则发渴愈盛。其所引饮必多。此为瘀热在里。里者。阳明之
府胃也。胃属土。其色黄胃实热甚。兼有水湿瘀积。则蒸其色而发出于外。其身必黄。用茵陈蒿汤者。以清湿热。下里
实也。）
蜜七合。仅用这一味药。放入铜器中。用小火慢慢煎煮。不断搅拌，直到变得稍微浓稠、像饴糖一样的状态。不要让它烧焦粘底。等到可以捏成丸子的程度时，趁热用手搓成条状。形状要一头尖细，粗细像手指一样，长度大约两寸。必须在它还热的时候赶紧制作，如果冷了就会变硬。将其塞入肛门中，用手紧紧抱住臀部，想要大便时才取出。（《内台方》使用蜜五合，煎煮，凝固时，加入皂角末五钱，蘸取后搓成条状，用猪胆汁或油润滑肛门后纳入。）
大猪胆一枚。挤出胆汁，加入少许醋。将其灌入肛门中。大约一顿饭的工夫，大便就会排出。（《内台方》不用醋，用小竹管插入胆口，留出一头，用油润滑后插入肛门中，用手挤压胆囊，胆汁自然流入体内。这种方法，使用起来非常方便。）
（王琥按：土瓜就是王瓜。《礼记·月令》记载：“四月王瓜生”，指的就是这个。王瓜属于蔓生草本植物。李时珍《本草纲目》说：它的根具有土气，果实像瓜，所以叫土瓜。根部类似栝楼根但较小，气味苦寒。《肘后备急方》治疗大便不通，采集根部捣汁，用筒吹入肛门内，以求通畅。这与上面的猪胆汁方意义相同。《内台方》使用土瓜根，削成条状，纳入肛门中，这是错误的。因为蜜条进入肛门，能够融化并润滑大便；土瓜根不能融化，如果削成条状使用，恐怕违背了张仲景制方的本意。）阳明病，脉象迟缓，出汗多，轻微怕冷的，是表证未解。可以发汗，适宜用桂枝汤。（这条条文说的是阳明病，但不是胃家实的证候，而是太阳病初传阳明，经络中有风邪。脉迟，是太阳中风缓脉的变化，邪气传入阳明即将入里，所以脉象变为迟。出汗多，是因为阳明有热导致肌腠疏松。轻微怕冷，是因为太阳在表的风邪尚未完全解除。治疗适宜用桂枝汤来解肌发汗，因为病从太阳经传来，所以仍按照太阳经的法则治疗。我认为以上条证，虽然按照太阳经法则治疗，但既然称为“阳明病”，按照张仲景的法度，还应当使用桂枝加葛根汤方。）
阳明病，脉象浮，无汗且气喘的，发汗则痊愈，适宜用麻黄汤。（这条条文说的阳明病，也不是胃家实的证候，而是太阳病初传阳明，经络中有寒邪。脉浮、无汗且气喘，这是太阳伤寒的证候仍然存在。只是脉浮而不紧，是因为邪气传入阳明，脉象虽有变化，但麻黄汤的证候不变，所以仍用麻黄汤，通过发汗来治愈。有人问：无汗且气喘，但脉浮不紧，如何确定它是阳明证？我回答说：病人必定会出现眼睛疼痛、鼻子干燥的症状，所以称为阳明证。因为病从太阳经传来，所以遵循太阳经麻黄汤的法则。总之，既然称为“阳明病”，按照张仲景的法度，还应当使用葛根汤方。）
阳明病，发热出汗，这叫热邪向外发散，不会发黄。如果只是头部出汗，身上无汗，汗水只到颈部就停止，小便不利，口渴想喝水浆的，这叫瘀热郁结在体内，身体一定会发黄，用茵陈蒿汤主治。（这条条文讲的是阳明湿热发黄的证候。阳明病发热出汗，热气得以散发，所以不发黄。现在只是头部出汗，身上无汗且只到颈部，这是因为热邪无法向外发散。关于“只到颈部”的含义，注释已在前面太阳篇下编中提到。热邪不能向外发散，如果小便利，那么热气就能向下排泄，也不会发黄。如今小便又不通利，热气内郁，郁热越深，口渴就越严重，所饮用的水必然很多。这叫瘀热在里。“里”指的是阳明的腑——胃。胃属土，其色黄，胃中实热很重，兼有水湿瘀积，就会蒸腾黄色并散发于体外，身体一定会发黄。使用茵陈蒿汤，是为了清利湿热，攻下里实。）
Seven he of honey. Use this single ingredient. Place it in a copper vessel. Simmer over a low fire, stirring occasionally, until it thickens slightly to a consistency resembling maltose syrup. Do not let it burn or stick to the bottom. When it reaches a state where it can be molded into pills, while still hot, quickly shape it by hand into suppositories. The tip should be sharp, with a diameter similar to a finger and a length of approximately two cun. This must be done while hot; if it cools, it will harden. Insert into the anus (rectum), hold tightly with hands, and remove only when defecation is desired. (The *Neitai Fang* uses five he of honey, simmered until solidifying, then adds five qian of powdered Gleditsia sinensis (Zaojiao) powder, shapes into suppositories, lubricates the rectum with pig bile or oil, and inserts them.)
One large pig gallbladder. Extract the juice and mix with a small amount of vinegar. Enema into the rectum. After approximately the time it takes to eat one meal, stool should be expelled. (The *Neitai Fang* does not use vinegar. Insert a small bamboo tube into the mouth of the gallbladder, leaving one end open. Lubricate with oil and insert into the rectum. Squeeze the gallbladder by hand so that its juice flows in naturally. This method is very convenient.)
(Wang Hu notes: Tugua is the same as Wanggua. The *Liji · Yueling* states: "In the fourth month, Wanggua grows," referring to this plant. Wanggua belongs to the creeping herb category. Li Shizhen's *Bencao Gangmu* states: Its root possesses the qi of earth, and its fruit resembles a melon, hence the name Tugua. The root resembles Trichosanthes kirilowii root but is smaller, with a bitter and cold flavor. The *Zhouhou Beifang* treats constipation by harvesting the root, crushing it to extract juice, blowing it into the anus using a tube to achieve patency. This shares the same principle as the above Pig Bile Formula. The *Neitai Fang* uses Tugua root, carved into a suppository shape and inserted into the rectum, which is incorrect. Because honey suppositories enter the rectum and melt to lubricate the stool, whereas Tugua root cannot melt. If used carved into a suppository, it may violate the intent of Zhang Zhongjing's formula creation.) Yangming disease, with a slow pulse, profuse sweating, and slight aversion to cold, indicates the exterior syndrome is unresolved. Sweating may be induced; Guizhi Tang (Cinnamon Twig Decoction) is appropriate. (This clause refers to Yangming disease, but not the syndrome of excess in the stomach-intestines. Rather, it is the initial transmission from Taiyang to Yangming, with wind pathogen in the meridians. A slow pulse is a variation of the slow pulse seen in Taiyang wind-strike syndrome; as the pathogen transmits to Yangming and is about to enter the interior, the pulse becomes slow. Profuse sweating occurs because Yangming heat causes the muscle pores to loosen. Slight aversion to cold indicates that the wind pathogen on the exterior of Taiyang has not yet fully resolved. Treatment should employ Guizhi Tang to release the muscles and induce sweating. Since the disease originated from the Taiyang meridian, it is still treated according to Taiyang protocols. I believe that although the above case is treated according to Taiyang protocols, since it is termed "Yangming disease," following Zhang Zhongjing's methods, Guizhi Jia Gegen Tang (Cinnamon Twig Decoction plus Kudzu Root Decoction) should ideally be used.)
Yangming disease, with a floating pulse, absence of sweating, and wheezing, resolves upon inducing sweating; Mahuang Tang (Ephedra Decoction) is appropriate. (This clause refers to Yangming disease, also not a syndrome of excess in the stomach-intestines, but rather the initial transmission from Taiyang to Yangming, with cold pathogen in the meridians. Floating pulse, absence of sweating, and wheezing indicate that the Taiyang cold-strike syndrome persists. However, the pulse is floating but not tight, indicating the pathogen has transmitted to Yangming. Although the pulse changes, the indications for Mahuang Tang remain unchanged; thus, Mahuang Tang is still used to induce sweating for cure. One might ask: With absence of sweating and wheezing, but a floating and non-tight pulse, how is it determined to be a Yangming syndrome? My answer is: The patient must exhibit eye pain and nasal dryness, hence it is called a Yangming syndrome. Since the disease originates from the Taiyang meridian, it follows the Taiyang Mahuang Tang protocol. In summary, since it is termed "Yangming disease," following Zhang Zhongjing's methods, Gegen Tang (Kudzu Root Decoction) should ideally be used.)
Yangming disease with fever and sweating indicates that the heat is venting outward, and jaundice will not develop. If there is sweating only on the head, no sweating on the body, stopping at the neck, combined with dysuria and thirst prompting intake of fluids, this indicates stagnant heat trapped in the interior, and jaundice will inevitably develop. Yinchen Hao Tang (Artemisia Capillaris and Yellow Barley Decoction) is the primary treatment. (This clause describes the syndrome of damp-heat jaundice in Yangming disease. Fever and sweating in Yangming disease allow heat to dissipate, preventing jaundice. Currently, sweating is limited to the head and stops at the neck, meaning heat cannot vent outward. Regarding the meaning of "stops at the neck," the annotation was previously mentioned in the lower section of the Taiyang chapter. If heat cannot vent outward, and urination is free, heat can drain downward, avoiding jaundice. Now, urination is obstructed, causing internal retention of heat. The deeper the retained heat, the more severe the thirst, leading to excessive fluid intake. This is described as stagnant heat in the interior. "Interior" refers to the fu-organ of Yangming, the Stomach. The Stomach belongs to Earth, whose color is yellow. Severe excess heat in the Stomach, combined with water-dampness stagnation, steams the yellow color and manifests externally, resulting in jaundice. Yinchen Hao Tang is used to clear damp-heat and purge interior excess.)