阳明腑实 大承气汤证案

患者,男,五十岁。伤寒六七日,表证已罢,壮热不恶寒,反恶热,日晡所潮热,手足濈然汗出,腹大满而硬,绕脐痛,大便不通已五日,谵语狂乱,目中不了了,渴欲饮冷。舌苔焦黄起刺,脉沉实有力。

A fifty-year-old male. Six or seven days into a cold-damage illness the exterior signs had resolved, leaving vigorous fever without aversion to cold — indeed aversion to heat — with tidal fever toward late afternoon, constant sweating of palms and soles, a huge hard distended abdomen with periumbilical pain, no stool for five days, delirious speech, blurred vision, and thirst for cold drinks. Tongue with charred-yellow prickly coat; pulse deep, full, and forceful.

阳明腑实,燥屎内结,热盛津伤,痞满燥实坚俱备。

Yangming bowel repletion: dry stool bound within, blazing heat injuring fluids — with the four signs of fullness, distention, dryness, and hardness all present.

急下之,一服而泻下燥屎数枚,臭秽异常,腹满顿减,谵语渐止。再进半剂以清余热,次日热退神清,粥食调养旬日而愈。

Urgent purgation was given. One dose brought down several lumps of dry foul stool; abdominal fullness at once eased and the delirium gradually stopped. Half a further dose cleared residual heat; the next day fever was gone and the spirit clear, and after ten days of gruel-based convalescence he recovered.