夫病阳多者热，下之则□。
【注】
阳病里热多者，宜乎下；表热多者，宜乎汗。若表里热多，当两解也。若单下之，表
不解则里虚，表热内陷，因作□也。
【集注】
张璐曰：阳热证多，即有阳明证见，亦属经证，不可下也。不当下而误下之，则阳邪
乘虚内陷，不作结胸，则为痞□也。
程应旄曰：阳病，谓表里热俱多，下之则胃中水竭。其□也，非转属阳明之□也。
@@@
无阳，阴强大，便□者，下之必清谷腹满。
【注】
亡阳阴盛，燥而无热，虽大便□者，此乃不大便无所苦之□也，下之则中寒犹盛，故
必利清谷腹满矣。
【集注】
成无己曰：无阳者，亡津液也。阴多者，寒多也。大便□，则为阴结。下之虚胃，阴
寒内甚，故清谷腹满。
方有执曰：阴，以寒言。强，犹言多也。清谷，阴不能化也。腹满阴寒，凝滞而内胀
也。
@@@
伤寒发热。头痛，微汗出，发汗则不识人，熏之则喘，不得小便，心腹满；下之则短
气，小便难，头痛背强；加温针则衄。
【注】
伤寒发热，头痛背强，微汗出，若不恶寒，非温病即邪传阳明也。若误发汗，不成风
温，外热如灼，必成阳明，热甚神昏不识人也。以火熏、温针劫之，火气入里，壅塞
于胸则喘，于腹则满也。火伤卫分津液，则不得小便，火伤荣分血脉，则必作衄也。
若下之，则中气伤，故气短；津液伤，故小便难也。
【集注】
程应旄曰：此证近于温，有热无寒，汗下温针，均在所禁也。
@@@
下利脉大者，虚也，以强下之故也。设脉浮革，因尔肠鸣者，属当归四逆汤。
【注】
下利脉大，里虚也，以其不当下而强下之故也。设脉浮革者，谓脉浮大，按之空虚，
表急里虚，因尔肠鸣，属当归四逆汤，和其表而温其里也。
【集注】
成无己曰：浮为虚，革为寒，寒虚相搏，则肠鸣，与当归四逆汤。
音切
漓林知切 嘶先齐切 萎于危切 怅丑亮切 怏于亮切 勃蒲没切 嘤于更切 囓鱼
结切 握乙角切
凡是阳热偏盛的病证，若误用攻下法，则会导致□（此处原文缺字，据注及集注推测为“痞”或类似变证）。
【注解】
如果是阳病且里热居多，适宜使用攻下法；如果是表热居多，适宜使用发汗法。如果表里热邪都多，应当表里双解。如果单独使用攻下法，表邪不解而里气已虚，表热内陷，因而形成□（此处原文缺字，据上下文推测为“痞”或“结胸”等变证）。
【集注】
张璐说：阳热证较多，即使出现了阳明病的症状，也属于经证，不可使用攻下法。不应当攻下而误用攻下，阳邪便会乘虚内陷，如果不形成结胸，就会形成痞□（此处原文缺字，推测为“痞证”）。
程应旄说：所谓阳病，是指表里热邪都多，攻下后会导致胃中津液枯竭。其形成的□（此处原文缺字），并非转属阳明的□（此处原文缺字，推测为“实”或“燥”）。
@@@
如果没有阳气，阴寒之气强盛，大便干□（此处原文缺字，推测为“硬”）的，若误用攻下法，必然导致泻下未消化的食物且腹部胀满。
【注解】
亡阳而阴寒内盛，表现为干燥而无热象，虽然大便干□（此处原文缺字，推测为“硬”），但这属于不大便但无痛苦症状的□（此处原文缺字，推测为“阴结”）。若误用攻下法，中焦寒气依然强盛，所以必然出现泻下清谷和腹部胀满的症状。
【集注】
成无己说：所谓无阳，是指津液亡失。阴气多，是指寒邪多。大便干□（此处原文缺字，推测为“硬”），就是阴结。攻下法使胃气虚弱，阴寒内盛，所以出现泻下清谷和腹部胀满。
方有执说：阴，指寒邪。强，意为多。清谷，指阴寒不能腐熟水谷。腹满是因阴寒凝滞而导致内部胀满。
@@@
伤寒发热，头痛，微汗出，若强行发汗，则会出现神志不清不认识人；用火熏法，则会出现气喘、小便不通、心腹部胀满；若误用攻下法，则会出现呼吸短促、小便困难、头痛背部僵硬；若加用温针，则会导致鼻出血。
【注解】
伤寒发热，头痛，背部僵硬，微汗出，如果不恶寒，就不是普通伤寒，而是温病或者是邪气传入阳明经。如果误用发汗法，不仅不能治愈风温，反而外热如灼烧，必然演变为阳明病，热势极盛导致神志昏迷、不认识人。如果用火熏、温针等火热疗法强迫发汗，火气入里，壅塞于胸部则气喘，壅塞于腹部则胀满。火邪损伤卫分和津液，导致小便不通；火邪损伤营分和血脉，必然导致鼻出血。
如果误用攻下法，则损伤中气，所以呼吸短促；损伤津液，所以小便困难。
【集注】
程应旄说：此证接近温病，有热无寒，发汗、攻下、温针均在禁忌之列。
@@@
腹泻而脉象大的，是虚证，是因为强行攻下所致。如果脉象浮而革，因此伴有肠鸣的，属于当归四逆汤证。
【注解】
腹泻而脉象大，是里虚的表现，是因为不应当攻下而强行攻下所致。如果说脉象浮而革，是指脉象浮大，但按之空虚，这是表急里虚，因此伴有肠鸣，这属于当归四逆汤证，该方能调和表邪并温补里虚。
【集注】
成无己说：浮脉主虚，革脉主寒，寒与虚相互搏结，导致肠鸣，给予当归四逆汤治疗。
音切（注音）
漓：林知切
嘶：先齐切
萎：于危切
怅：丑亮切
怏：于亮切
勃：蒲没切
嘤：于更切
囓：鱼结切
握：乙角切
Where the disease is characterized by an excess of Yang, there is heat; if purgation is applied, it leads to [missing character].
[Annotation]
In Yang diseases where interior heat predominates, purgation is appropriate; where exterior heat predominates, diaphoresis (sweating) is appropriate. If both exterior and interior heat are excessive, a simultaneous resolution of both exterior and interior is indicated. If purgation is used exclusively, the exterior pathogen remains unresolved while the interior becomes deficient, causing exterior heat to sink inward, thereby resulting in [missing character].
[Collected Notes]
Zhang Lu stated: When Yang-heat syndromes are predominant, even if Yangming symptoms appear, they still belong to the meridian stage and should not be purged. If purgation is mistakenly applied when inappropriate, the Yang pathogen sinks inward taking advantage of the deficiency. It will either form Jie Xiong (Chest Binding) or Pi [missing character] (Fullness/Blockage).
Cheng Yingmao stated: "Yang disease" refers to conditions where both exterior and interior heat are excessive. Purgation depletes the fluids in the stomach. The resulting [missing character] is not a transformation into Yangming [missing character].
@@@
In the absence of Yang, with Yin cold being strong, and hard [missing character] stools, purgation will inevitably lead to diarrhea of undigested food and abdominal fullness.
[Annotation]
Loss of Yang and excess Yin-cold manifest as dryness without heat. Although the stool may be hard [missing character], this constitutes a type of [missing character] where constipation exists without discomfort. If purgation is applied, the middle-jiao cold remains severe, thus inevitably causing diarrhea of clear, uncooked grains and abdominal fullness.
[Collected Notes]
Cheng Wuji stated: "Absence of Yang" refers to the depletion of body fluids. "Excess Yin" refers to an abundance of cold. Hard [missing character] stools indicate Yin-Jie (Yin Constipation). Purgation weakens the Stomach Qi, allowing Yin-cold to become severe internally, leading to diarrhea of clear grains and abdominal fullness.
Fang Youzhi stated: "Yin" refers to cold. "Strong" means abundant. "Clear grains" refers to the inability of Yin-cold to transform and digest food. Abdominal fullness results from Yin-cold stagnation causing internal distension.
@@@
In Cold Damage (Shanghan), presenting with fever, headache, and slight sweating: forcing diaphoresis leads to confusion and inability to recognize people; applying moxibustion or fire therapy causes asthma/dyspnea, inability to urinate, and fullness of the heart and abdomen; purgation leads to shortness of breath, difficulty urinating, headache, and stiffness of the back; adding warm needle therapy causes epistaxis (nosebleed).
[Annotation]
Cold Damage presenting with fever, headache, and back stiffness, with slight sweating and no aversion to cold, indicates either Warm Disease (Wenbing) or transmission of pathogenic factors to the Yangming channel. Mistakenly inducing diaphoresis may result in Wind-Warmth, with external heat burning like fire, inevitably transforming into Yangming disease. Extreme heat causes mental confusion and inability to recognize persons. Using fire therapy or warm needles to force sweating allows fire qi to enter the interior, obstructing the chest causing dyspnea, and obstructing the abdomen causing fullness. Fire damage to the Wei (Defensive) level and body fluids prevents urination; fire damage to the Ying (Nutritive) level and blood vessels causes epistaxis.
If purgation is applied, the Middle Qi is injured, causing shortness of breath; body fluids are damaged, causing difficulty urinating.
[Collected Notes]
Cheng Yingmao stated: This syndrome resembles Warm Disease, having heat but no cold. Diaphoresis, purgation, and warm needle therapy are all contraindicated.
@@@
Diarrhea accompanied by a large pulse indicates deficiency, caused by forced purgation. If the pulse is floating and wiry (Ge pulse), accompanied by borborygmus (bowel sounds), it belongs to the Danggui Sini Decoction pattern.
[Annotation]
Diarrhea with a large pulse indicates interior deficiency, caused by forced purgation when it was not indicated. A floating and wiry (Ge) pulse implies a pulse that is floating and large but empty upon pressure, indicating exterior urgency and interior deficiency. Consequently, borborygmus occurs. This pattern belongs to Danggui Sini Decoction, which harmonizes the exterior and warms the interior.
[Collected Notes]
Cheng Wuji stated: Floating indicates deficiency; Ge (wiry/hollow) indicates cold. The combination of cold and deficiency leads to borborygmus. Treat with Danggui Sini Decoction.
Phonetic Notation
Li: Lin-zhi cut
Si: Xian-qi cut
Wei: Yu-wei cut
Chang: Chou-liang cut
Yang: Yu-liang cut
Bo: Pu-mo cut
Ying: Yu-geng cut
Nie: Yu-jie cut
Wo: Yi-jue cut