（明理论即名脾约丸）
麻子仁（二升） 芍药（半斤） 枳实（半斤炙） 大黄（一斤去皮） 浓朴（一尺去皮炙） 杏人（一升去皮尖
熬别作脂）
上六味。为末。炼蜜为丸。桐子大。饮服十丸。日三服。渐加。以知为度。（成氏明理论云。约者。结约之约。又约
束之约也。内经曰。饮入于胃游溢精气。上输于脾。脾气散精。上归于肺。通调水道。下输膀胱。水精四布。五经并行。
是脾主为胃行其津液者也。今胃强脾弱。约束津液。不得四布。但输膀胱。致小便数而大便硬。故曰其脾为约。麻仁味
甘平。杏仁味甘温。内经曰。脾欲缓。急食甘以缓之。麻仁杏仁润物也。本草曰润可去枯。脾胃干燥。必以甘润之物为
之主。是以麻仁为君。杏仁为臣枳实味苦寒。浓朴味苦温。润燥者。必以甘甘以润之。破结者必以苦。苦以泄之。枳实
浓朴为佐。以散脾之结约。芍药味酸微寒。大黄味苦寒。酸苦涌泄为阴。芍药大黄为使。以下脾之结燥。肠润结化。津
液还入胃中。则大便可。小便少而愈矣。）
琥按上成氏注云。酸苦涌泄为阴。芍药大黄为使。以下脾之结燥。愚以散结自有浓朴枳实。润燥自有麻子杏人。
至于下泄便难。莫如大黄之苦寒。与芍药何与焉。据伤寒论中原注云。芍药之酸以敛津液。此为正解。脾约证。津液不
足以故小便数而大便难。津液不足。以酸收之。芍药味酸而能走阴。气平而能补津液。麻仁丸虽泄胃强之药。要之泄者
自泄。补者自补道并行而不相悖耳。
（重出例）太阳病三日。发汗不解蒸蒸发热者属胃也。调胃承气汤主之
伤寒吐后腹胀满者。与调胃承气汤。
上二条证（已见前调胃承气汤方下）
太阳病若吐若下（云云）大便因硬者。与小承气汤和之愈。
得病二三日。脉弱无太阳柴胡证。（云云至）屎定硬乃可攻之。宜大承气汤
伤寒六七日。目中不了了（云云）急下之宜大承气汤。
阳明病发热汗多者。急下之宜大承气汤。
发汗不解腹满痛者。急下之宜大承气汤。
腹满不减。减不足言。当下之宜大承气汤。
阳明少阳合病必下利（云云至）有宿食也。当下之宜大承气汤。
上七条证（俱见前大小承气汤方下）
病患无表里证。发热七八日（云云至）。六七日不大便者。有瘀血宜抵当汤
若脉数不解而下不止必协热而便脓血也。
上二条证。（已见前抵当汤方下）
伤寒发汗已。身目为黄。所以然者。以寒湿在里不解故也。以为不可下也。于寒湿中求之。（伤寒寒湿在里。此内伤
生冷之寒也。内伤生冷之寒。则表之不解。徒致发黄。下之不可。以无郁热。愚意云。此海藏老人所云。阴黄者是也。
于寒湿中求之。则知非热证矣。正文与注详见中寒论中。）
（重出例）伤寒七八日身黄如橘子色（云云至）茵陈蒿汤主之。（此条证已见前茵陈蒿汤方下）
伤寒身黄发热者。栀子柏皮汤主之。（此条系阳明发黄证。阳明伤寒而病身黄者。阳明居中属土。其色黄兹者。身黄
发热。则湿热已从里而发出。非若茵陈蒿汤证之里热腹满。为可下也。王太仆云。小热之气。凉以和之。故用栀子柏皮
汤。以清解郁热。）
（明理论中称之为脾约丸）
麻子仁（二升） 芍药（半斤） 枳实（半斤，炙） 大黄（一斤，去皮） 浓朴（一尺，去皮，炙） 杏仁（一升，去皮尖，炒后单独制成脂状）
以上六味药。研成细末。用炼蜜制作成丸剂。大小如梧桐子。温水送服十丸。每日三次。逐渐增加剂量。以见效为度。（成无己在《明理论》中说：“约”字，是约束、限制的意思。《内经》说：饮食进入胃中，游溢精气，向上输送到脾。脾气散布精微物质，向上归于肺。通调水道，向下输送到膀胱。水液精微四布全身，五脏经脉并行运行。这说明脾的主要功能是为胃传输津液。如今胃气强盛而脾气虚弱，约束津液，使其不能四布全身，只能输送到膀胱，导致小便频数而大便干硬。所以称为“脾约”。麻仁味甘性平，杏仁味甘性温。《内经》说：脾喜缓急，紧急时吃甘味食物来缓和它。麻仁和杏仁都是润燥之物。本草记载：润可以去除枯槁。脾胃干燥，必须以甘润的药物为主治。因此麻仁作为君药，杏仁作为臣药。枳实味苦性寒，浓朴味苦性温。润燥必须用甘味以滋润，破结必须用苦味。苦味可以泄降。枳实和浓朴作为佐药，用来消散脾的结滞。芍药味酸微寒，大黄味苦寒。酸苦涌泄属于阴。芍药和大黄作为使药，用来下行脾的结燥。肠道润滑，结滞化解，津液回归胃中，那么大便就可以通畅，小便减少而病愈了。）
琥按：上面成无己的注释说：“酸苦涌泄为阴，芍药和大黄为使，用来下行脾的结燥。”我认为散结自有浓朴和枳实，润燥自有麻子和杏仁。至于下泄通便困难，不如大黄的苦寒之性，这与芍药有什么关系呢？根据《伤寒论》中的原注说：“芍药的酸味用来收敛津液”，这才是正确的解释。脾约证，是因为津液不足，所以小便频数而大便困难。津液不足，用酸味来收敛。芍药味酸能入阴分，气平能补充津液。麻仁丸虽然是泻胃强盛的药，但总之，泻下的自泻下，补益的自补益，两者并行而不相违背。
（重复出现的条文示例）太阳病经过三天，发汗后病不解，出现蒸蒸发热的，属于胃家实证。用调胃承气汤主治。
伤寒呕吐后出现腹胀满的，给予调胃承气汤。
以上两条证候（已经见在前文调胃承气汤方条之下）
太阳病如果经过吐法或下法（云云），大便因此变硬的，与小承气汤调和即可痊愈。
得病两三天，脉弱，没有太阳病和柴胡证的（云云直到）大便一定变硬才可以攻下。宜用大承气汤。
伤寒六七天，眼睛视物不清（云云），急需攻下的，宜用大承气汤。
阳明病发热汗多的，急需攻下的，宜用大承气汤。
发汗后病不解，腹部胀满疼痛的，急需攻下的，宜用大承气汤。
腹部胀满不减，即使减轻也不足挂齿的，当下法的，宜用大承气汤。
阳明少阳合病必然下利（云云直到）有宿食积滞的，当下法的，宜用大承气汤。
以上七条证候（都见在前文大小承气汤方条之下）
患者没有表证也没有里证，发热七八天（云云直到）。六七天不大便的，有瘀血，宜用抵当汤。
如果脉数不退而下利不止，必然会协热而便脓血。
以上两条证候（已经见在前文抵当汤方条之下）
伤寒发汗后，身体和眼睛发黄。之所以这样，是因为寒湿在体内不解的缘故。认为不可用下法。应在寒湿中寻求治疗方法。（伤寒寒湿在里，这是内伤生冷导致的寒邪。内伤生冷的寒邪，则表证不解，徒然导致发黄。下法不可用，因为没有郁热。我的意思是，这就是海藏老人所说的阴黄。在寒湿中求之，就知道这不是热证了。正文与注释详见《中寒论》中。）
（重复出现的条文示例）伤寒七八天，身体黄如橘子色（云云直到）茵陈蒿汤主治。（此条证候已见在前文茵陈蒿汤方条之下）
伤寒身体发黄发热的，栀子柏皮汤主治。（此条系阳明发黄证。阳明伤寒而病身体发黄的，阳明居中属土，其色黄。此时身体发黄发热，说明湿热已经从里发出，不像茵陈蒿汤证那样有里热腹满，是可以攻下的。王太仆说：小热之气，用凉性药物来调和。所以用栀子柏皮汤，来清解郁热。）
(Ming Lun Li calls it Pi Yue Wan)
Hemp Seed (2 sheng) Paeonia Root (0.5 jin) Immature Bitter Orange (0.5 jin, processed with heat) Rhubarb (1 jin, peeled) Magnolia Bark (1 chi, peeled, processed with heat) Apricot Kernel (1 sheng, peeled and de-veined, stir-fried and processed into paste separately)
The above six herbs. Grind into fine powder. Make pills with refined honey. Size of Sophora japonica seeds. Take ten pills with warm water. Three times a day. Gradually increase the dose. Stop when effective. (Cheng Wuji in Ming Lun Li says: "Yue" means constraint or restriction. Nei Jing states: Food enters the stomach, its essence floats and overflows, transported upward to the Spleen. The Spleen scatters the essence, sending it upward to the Lung. It regulates the water passages, transporting them downward to the Bladder. Water and essence distribute throughout the body, running through the five meridians simultaneously. This indicates that the Spleen's main function is to transport fluids for the Stomach. Now, the Stomach Qi is strong while the Spleen Qi is weak, constraining the fluids so they cannot distribute throughout the body but only go to the Bladder, causing frequent urination and hard stool. Hence it is called "Pi Yue" (Spleen Constraint). Hemp Seed is sweet and neutral; Apricot Kernel is sweet and warm. Nei Jing states: The Spleen desires relaxation; when urgent, eat sweet foods to relax it. Hemp Seed and Apricot Kernel are moistening substances. Ben Cao states: Moistening can remove dryness. For dryness of the Spleen and Stomach, one must use sweet and moistening substances as the primary treatment. Therefore, Hemp Seed serves as the Sovereign herb, and Apricot Kernel as the Minister. Immature Bitter Orange is bitter and cold; Magnolia Bark is bitter and warm. To moisten dryness, one must use sweet to nourish; to break stagnation, one must use bitter. Bitter can drain. Immature Bitter Orange and Magnolia Bark serve as Assistant herbs to dissipate the Spleen's constraint. Paeonia Root is sour and slightly cold; Rhubarb is bitter and cold. Sour and bitter induce vomiting and purging, belonging to Yin. Paeonia Root and Rhubarb serve as Envoy herbs to descend the Spleen's dryness and stagnation. When the intestines are lubricated and stagnation resolves, fluids return to the Stomach, allowing normal bowel movements, reducing urination, and curing the disease.)
Hu notes: Cheng Wuji's annotation above states: "Sour and bitter induce purging, belonging to Yin; Paeonia Root and Rhubarb are Envoys to descend the Spleen's dryness." I believe that dispersing stagnation relies on Magnolia Bark and Immature Bitter Orange, while moistening dryness relies on Hemp Seed and Apricot Kernel. As for purging difficult stools, nothing beats the bitter-cold nature of Rhubarb; what does this have to do with Paeonia Root? According to the original annotation in Shang Han Lun: "The sour taste of Paeonia Root is used to astringe fluids," which is the correct interpretation. In Pi Yue syndrome, due to insufficient fluids, there is frequent urination and difficult defecation. Insufficient fluids should be treated with sour astringents. Paeonia Root is sour and enters the Yin aspect; its neutral qi can replenish fluids. Although Ma Ren Wan is a formula that drains excess Stomach heat, essentially, draining acts by draining, and tonifying acts by tonifying; they proceed together without contradiction.
(Repeated Clause Example) Taiyang disease for three days, after sweating therapy, the disease persists with steaming fever, indicating involvement of the Stomach. Treat with Tiao Wei Cheng Qi Tang.
After vomiting in Shang Han, abdominal fullness occurs. Administer Tiao Wei Cheng Qi Tang.
The above two conditions (already seen under the Tiao Wei Cheng Qi Tang formula section previously)
Taiyang disease if subjected to vomiting or purging (etc.), resulting in hard stool. Administer Xiao Cheng Qi Tang to harmonize and cure.
Two or three days after contracting the disease, pulse is weak, lacking Taiyang or Chai Hu signs (etc. until) stool is definitely hard, then attack is permissible. Da Cheng Qi Tang is appropriate.
Shang Han for six or seven days, eyes appear unclear (etc.), urgently attack with Da Cheng Qi Tang.
Yangming disease with fever and profuse sweating, urgently attack with Da Cheng Qi Tang.
After sweating, disease persists with abdominal fullness and pain, urgently attack with Da Cheng Qi Tang.
Abdominal fullness does not decrease, even if slight reduction is insufficient to mention, must purge with Da Cheng Qi Tang.
Yangming and Shaoyang combined disease inevitably causes diarrhea (etc. until) presence of retained food, must purge with Da Cheng Qi Tang.
The above seven conditions (all seen under the Da/Xiao Cheng Qi Tang formula sections previously)
Patient has neither exterior nor interior signs, fever for seven or eight days (etc. until). No bowel movement for six or seven days, indicating blood stasis. Di Dang Tang is appropriate.
If pulse remains rapid with persistent diarrhea, it will likely involve heat leading to pus and blood in stool.
The above two conditions (already seen under the Di Dang Tang formula section previously)
After sweating in Shang Han, body and eyes turn yellow. The reason is unresolved cold-dampness in the interior. Purging is contraindicated. Seek treatment within the context of cold-dampness. (Cold-dampness in Shang Han refers to internal injury from raw/cold food. Internal cold from raw/cold food prevents exterior resolution, merely causing jaundice. Purging is inadvisable due to lack of constrained heat. My view is that this refers to the Yin Jaundice mentioned by Hai Zang Lao Ren. Seeking within cold-dampness reveals it is not a heat syndrome. Main text and annotations are detailed in Zhong Han Lun.)
(Repeated Clause Example) Shang Han for seven or eight days, body yellow like orange peel (etc. until) Yin Chen Hao Tang is the main treatment. (This condition is already seen under the Yin Chen Hao Tang formula section)
Shang Han with body yellow and fever is treated with Zhi Zi Bai Pi Tang. (This clause belongs to Yangming Jaundice. Yangming Shang Han causing body yellow: Yangming resides in the center, associated with Earth, whose color is yellow. Here, body yellow with fever indicates damp-heat emerging from the interior, unlike Yin Chen Hao Tang syndrome which features interior heat and abdominal fullness amenable to purging. Wang Tai Pu stated: Minor heat requires cooling to harmonize. Thus, Zhi Zi Bai Pi Tang is used to clear and resolve constrained heat.)