伤暑与伤寒俱有热，若误作伤寒治之则不可。盖寒伤形，热伤气。伤寒则外恶
寒而脉浮紧，伤暑则不恶寒而脉虚，此为异耳。经云∶脉盛身寒，得之伤寒。脉虚身热，得之伤暑。
治宜小柴胡汤，渴加知母、石膏，或人参白虎汤；天久淫雨，湿令大行，苍术白虎汤。若元气素弱
而伤之重者，清暑益气汤治之。
凡言急下，盖病热已迫，将有变也，非若他病，尚可少缓。如少阴属肾水，主口燥咽干而渴，
乃热邪内炎，肾水将绝，故当急下以救将绝之水。如腹胀不大便，土胜水也，亦当急下。阳明属土，
汗多热盛，急下以存津液。腹满痛以为土实，急当下之。热病目不明，热不已者，死。目睛不明，
肾水已竭，不能照物，则已危矣，须急下之。少阴急温有二证，内寒已甚，阳和之气欲绝，宜急温
之无疑也。
少阴病，得之二三日，口燥咽干，急下之，大承气汤。
少阴病，自利欲绝，青色，心下必痛，口燥咽干，急下之，大承气汤。
少阴病，六七日，腹胀不大便，急下之，大承气汤。
阳明病，发热汗多，胃汁干，急下之，大承气汤；汗出不解，腹满痛，急下之，大承气汤。
少阴病，脉沉微，急温之，四逆汤。
羌活冲和汤 治太阳无汗，发热头痛，恶寒脊强，脉浮紧。又治非冬时天有暴寒中人，亦
头痛，恶寒发热，通宜此汤治之。（以代麻黄汤用，太阳经之神药也。）
羌活（钱半） 防风（一钱） 苍术（钱半） 黄芩（一钱） 川芎（一钱） 白芷（一钱）
甘草（一钱） 生地黄（一钱） 细辛（五分，不可多）
上水二钟，煎至八分，热服，温被盖覆取微汗。湿土司天，加苍术一钱半；天久淫雨，亦加。
如渴，加石膏三钱，知母一钱；不渴，不加。
太阳伤风，有汗，脉浮缓。
羌活（一钱） 防风（一钱半） 白术（一钱半） 黄芩（一钱） 白芷（一钱） 甘草（一
钱） 生地黄（钱半） 川芎（五分）
上如前煎法。若一服汗还未止，加黄 一钱五分，芍药一钱。仍未止，以小柴胡加桂枝、芍药
各一钱。
葛根汤 治太阳病，项背强急，无汗恶风，脉带弦浮而发热。又治太阳与阳明合病，必自
利，此汤并主之。
葛根（一钱） 甘草（二钱） 麻黄（二钱，去节，汤泡二次）
上水二钟，姜四片，枣二枚，煎服，微覆取汗。
解肌汤 治瘟病天行，头痛壮热，春感青邪，发热而渴，不恶寒。
葛根（二钱） 桂枝（二钱） 黄芩（一钱） 芍药（一钱） 麻黄（一钱五分） 甘草（一钱）
上水二钟，枣二枚，煎服。如不解，再取汗。
独活散 治伤风、温热等病。
羌活 独活 枳壳 防风 黄芩 麻黄（汤泡二次） 人参 甘菊花 甘草（炙） 茯苓 蔓荆
子细辛（各一钱） 石膏（二钱）
上水二钟，生姜三片，薄荷五叶，同前煎法。
败毒散 治伤风，温疫，风湿，头目昏眩，四肢疼痛，憎寒壮热，项强，目睛疼，寻常风
眩拘急。
羌活 独活 前胡 柴胡 川芎 枳壳 桔梗 茯苓 人参 甘草
上各等分，水二钟，如常煎服。
六神通解散
麻黄（二两） 甘草（一两五钱） 黄芩（二两） 石膏（二两） 滑石（二两） 苍术（四两）
治时行，三日前，加葱白、香豉，煎服而汗之，立效。中病即止，不可尽剂。
小柴胡汤 治太阳病，十日已去，脉细而嗜卧，外虽已解，设胸满痛，与服之；若脉浮者，
麻黄汤。伤寒五六日，中风，来往寒热，胸胁苦痛，默默不欲食，心烦喜呕，或烦而不呕，或渴，
或腹中痛，或胁下痞硬，或心下悸，小便不利，或不渴，身有微热者，此汤主之。血气弱，腠理开，
邪气因入，与正气相搏，结于胸下，邪正分争，往来寒热，休作有时，默默不欲食，脏腑相连，其
痛必下，邪高痛下，致使呕也，此汤主之。服柴胡汤已，渴者，属阳明，以法治之。伤寒五六
日，身热恶风，头项强，胁下满，手足温而渴者，此汤主之。伤寒，阳脉涩，阴脉弦，腹中急痛，
先与小建中汤不瘥者，此汤主之。太阳病，过经十余日，发汗、吐、下后四五日，阳证仍在者，先
与小柴胡汤；呕不止，心下郁，微烦者，为未解也，与大柴胡汤下之则愈。妇人中风七八日，续得
寒热，发作有时，经水适断者，此为热入血室，其血必结，致使如疟状，此汤主之。伤寒五六日，
头汗出，微恶寒，手足冷，心下满，不欲食，大便硬，脉细者，为阳微结，必有表，复有里；脉沉，
亦里也。汗出为阳微，假令仍纯阴结，不得复有外证，悉入在里。此为半在表，半在里也。脉虽沉
紧，不得为少阴病。所以然者，阴不得有汗也，今头汗出，故知非少阴也，可与服此汤。设不了，得
尿而解。伤寒五六日，呕而发热者，柴胡汤证具而以他药下之，柴胡证在者，复与小柴胡汤。虽下
之，不为逆，必蒸蒸而振却发热，汗出而解，若心下满而腹痛者，此为结胸也，大陷胸汤主之。但
满而不痛者，此为痞气，柴胡不中与之，宜半夏泻心汤。（以上属太阳经。）阳明病，发潮热，大
便溏，小便自可，胸胁不利者，与此汤服之。阳明病，胁下硬
满，不大便而呕，舌上白苔者，可与服之，上焦得通，津液得下，胃气因和， 然汗出而解。阳明
中风，脉弦浮大而短气，腹部满，胁下及心痛，久按之，气不通，鼻干不得卧，一身及目悉黄，小
便难，有潮热，时时哕，身前后肿，刺之少瘥，外不解，病过十日，脉续浮者，此汤主之。（以上
属阳明经。）太阳病不解，转入少阳，胁下满，干呕不能食，往来寒热，尚未吐下，脉沉紧者，此
汤主之。若已吐下后，发汗温针，谵语，小柴胡汤证罢，此为坏证，知犯何逆，以法治之。（以上
属少阳经。）呕而发热，宜服此汤。伤寒已后更发热，此汤主之。若脉浮者，以汗解之。（属阳易
瘥后劳复脉证。）
黄芩（一两半。若腹中痛，去芩，加芍药一两半；若心下悸，小便不利，去芩，加茯苓一两）
人参（一两半。若不渴，外有微热者，去参，加桂枝一两半，温覆得微汗，愈；若咳嗽者，去参，
加五味子一两五分） 大枣（六枚，若胁下痞硬，去枣，加牡蛎二两或一两） 半夏（一两，汤泡。
若胸烦不呕者，去半夏、人参，加栝蒌实一枚，用四分之一） 柴胡（四两，去芦） 甘草（一两
半）
上每服七八钱，生姜四片，枣三枚，水一钟，煎服。
升麻汤 治伤寒中风，头痛，憎寒壮热，肢体疼痛，发热恶寒，鼻中干不得卧。兼治
寒暄不时，人多疾疫，乍寒脱着，及暴热之顷，忽然变寒，身体疼痛，头重如石。
升麻 甘草 芍药 葛根（各等分）
上每服七八钱，煎如常法。若老人，去芍药，加柴胡、茯苓、人参各一钱。
五积散 治阴经伤冷，脾胃不和，感冒寒邪。
茯苓（四两） 肉桂 人参 川芎（各二两） 浓朴 半夏 芍药 当归 麻黄 干姜（各三两）
甘草（二两） 枳壳（五两，炒） 桔梗（十二两） 陈皮（八两） 苍术（二十四两） 白芷（四
两）
上十六味，除枳壳、肉桂、陈皮外，其余并一处，生捣为粗末，用酒拌匀，晒干，分作六分，
大锅属性武火炒，令黄色，不得焦，摊冷，入枳壳、肉桂、陈皮一处和匀，每服五钱，水二钟，姜
三片，煎一钟服。
三黄石膏汤 有伤寒发热，脉大，如滑数，表里皆实，阳盛怫郁。医者不达，已发其汗，
病势不退，又复下之，大便遂频，小便不利，五心烦热，两目如火，鼻干面赤，舌燥齿黄，大渴，
过经已成坏证。亦有错治诸温而成此证者。又八九日，已经汗下，脉洪数，身体壮热，拘急沉重，
欲治其内，由表未解；欲发其表，则
里证又急，趑趄不能措手，待毙而已。殊不知热在三焦，闭涩经络，津液枯涸，荣卫不通，遂成此
证耳。
石膏（两半） 黄芩 黄连 黄柏（各七钱） 豉（二合） 麻黄（五分） 栀子（三十个）
上每服一两，水二钟，煎服。未中病再服，其效如神。伤寒已经汗、吐、下误治后三焦生热，
脉复洪数，谵语不休，昼夜喘息，鼻加衄血，病势不解，身目俱黄，狂叫欲走，三黄石膏汤主之。
阳毒伤寒，皮肤斑烂，身如凝血，两目如火，十指皮俱脱，烦渴，躁急不宁，庸医不识，莫能措手，
命在须臾，三黄石膏汤主之。
妇人血风证，因崩漏大脱血，或前后去血，因而涸燥，其热未除，循衣摸床，撮空闭目，不省
人事，扬手掷足，摇动不宁，错语失神，脉弦浮而虚，内有燥热之极，气粗鼻干而不润，上下运燥，
此为难治。宜服∶
生地黄黄连汤 治男子去血多者有此证，其妙不可胜言也。
川芎 生地黄 川归（各七钱） 赤芍药 栀子 黄芩 黄连（各三钱） 防风（一两）
上每服五钱，水煎，清饮，徐徐呷之。脉实，可再加大黄下之。大承气汤，气药也，自外而之
内者用之。生地黄黄连汤，血药也，自内而之外者用之。气血合病，循衣摸空，治同。自气而之血，
血而复之气者，大承气汤下之。自血而之气，气而复之血者，生地黄黄连汤主之。二者俱不大便。
此是承气汤对子，又与三黄石膏汤相表里，是皆三焦胞络虚火之用也。病既危急，只得以此汤降血
中之火耳。不但妇人用之，男子去血过多而有此证者，皆宜服之，无不效。予故表而出之。
伤寒脉浮，当汗，麻黄汤。若脉在筋骨之间，半表半里，当和解，小柴胡汤；在筋骨之间，当
下，承气汤。若又在筋骨之下，谓之阴证矣，其法理中，当用附子之类。
伤寒头略痛，发热，耳聋胁痛，或往来寒热如疟，此方治之，名∶
和解散
柴胡（二钱） 黄芩（一钱） 人参（一钱） 半夏（一钱） 甘草（一钱）
上水二钟，生姜三片，枣子二枚，煎八分，不拘时服。如呕逆，加姜九片，陈皮一钱。如头痛
恶寒，加羌活、防风各一钱。寒热间作，加桂枝等药各一钱。夏
月中暑，发热头痛，加黄连一钱。春天温病时行，加生地黄、川升麻一钱。疟疾，或先寒后热，先
热后寒，加川常山、尖槟榔半钱，各要未发时煎服。伤寒，恶寒，头项强，发热，前方冲和汤内去
细辛、苍术，加白术二钱。
伤暑与伤寒都有发热症状，如果误当作伤寒来治疗就不行了。因为寒邪损伤形体，热邪损伤气机。患伤寒则体外怕冷且脉象浮紧，患伤暑则不怕冷而脉象虚软，这是两者的区别。医经说：脉象盛大而身体发冷的，是得自伤寒；脉象虚弱而身体发热的，是得自伤暑。
治疗应当使用小柴胡汤，若口渴则加入知母、石膏，或者使用人参白虎汤；如果天久阴雨，湿气盛行，则使用苍术白虎汤。如果元气素来虚弱而又严重伤暑的，用清暑益气汤治疗。
凡是说“急下”，是因为病热已经紧迫，即将发生变证，不像其他疾病还可以稍微延缓。比如少阴病属于肾水，主管口燥咽干而渴，这是热邪内炎，肾水即将枯竭，所以应当急下以挽救将绝的肾水。如出现腹胀不大便，这是土胜克水，也应当急下。阳明病属于土，汗多热盛，急下以保存津液。腹部胀满疼痛认为是土实，急下攻逐之。热病导致眼睛视物不明，热势不退的，会死亡。眼睛视物不清，说明肾水已竭，不能照见物体，这就很危险了，必须急下。少阴病急温有两种证候，内寒已经很严重，阳气温和之气将要断绝，应当急温，这是毫无疑问的。
少阴病，患病二三天，口燥咽干，应当急下，使用大承气汤。
少阴病，自利（腹泻）欲绝，大便色青，心下部必定疼痛，口燥咽干，应当急下，使用大承气汤。
少阴病，患病六七天，腹胀不大便，应当急下，使用大承气汤。
阳明病，发热汗多，胃中津液干燥，应当急下，使用大承气汤；出汗后病不解，腹部胀满疼痛，应当急下，使用大承气汤。
少阴病，脉象沉微，应当急温，使用四逆汤。
羌活冲和汤 治疗太阳经无汗，发热头痛，恶寒脊背强直，脉象浮紧。又治疗非冬季时节突然遭受寒邪侵袭人体，也出现头痛，恶寒发热，都适宜用此汤治疗。（以此代替麻黄汤使用，是治疗太阳经的神药。）
药材及剂量：羌活（一钱半）、防风（一钱）、苍术（一钱半）、黄芩（一钱）、川芎（一钱）、白芷（一钱）、甘草（一钱）、生地黄（一钱）、细辛（五分，不可多用）。
以上药物用水两钟，煎至八分，热服，盖温被取微汗。若湿土司天，加苍术一钱半；天久阴雨，也加。如果口渴，加石膏三钱，知母一钱；不渴，不加。
太阳经伤风，有汗，脉象浮缓。
药材及剂量：羌活（一钱）、防风（一钱半）、白术（一钱半）、黄芩（一钱）、白芷（一钱）、甘草（一钱）、生地黄（一钱半）、川芎（五分）。
以上按前述方法煎服。如果服用一次后汗出仍未停止，加黄芩一钱五分，芍药一钱。如果仍未停止，用小柴胡汤加桂枝、芍药各一钱。
葛根汤 治疗太阳病，项背部强急，无汗恶风，脉带弦浮而发热。又治疗太阳与阳明合病，必然自利（腹泻），此汤一并主治。
药材及剂量：葛根（一钱）、甘草（二钱）、麻黄（二钱，去节，开水泡两次）。
以上用水两钟，生姜四片，大枣二枚，煎服，微微覆盖取汗。
解肌汤 治疗瘟疫时行疾病，头痛壮热，春季感受青邪（风邪），发热而渴，不怕冷。
药材及剂量：葛根（二钱）、桂枝（二钱）、黄芩（一钱）、芍药（一钱）、麻黄（一钱五分）、甘草（一钱）。
以上用水两钟，大枣二枚，煎服。如果病不解，再取汗。
独活散 治疗伤风、温热等病。
药材：羌活、独活、枳壳、防风、黄芩、麻黄（开水泡两次）、人参、甘菊花、甘草（炙）、茯苓、蔓荆子、细辛（各一钱）、石膏（二钱）。
以上用水两钟，生姜三片，薄荷五叶，同前法煎服。
败毒散 治疗伤风、温疫、风湿，头目昏眩，四肢疼痛，憎恶寒冷壮热，项部强直，眼睛疼痛，寻常风眩拘急。
药材：羌活、独活、前胡、柴胡、川芎、枳壳、桔梗、茯苓、人参、甘草。
以上各等分，用水两钟，按常规煎服。
六神通解散
药材及剂量：麻黄（二两）、甘草（一两五钱）、黄芩（二两）、石膏（二两）、滑石（二两）、苍术（四两）。
治疗时行疾病，发病前三日，加葱白、香豉，煎服发汗，立即见效。中病即止，不可服完全部药剂。
小柴胡汤 治疗太阳病，十日以上，脉象细而想睡觉，外表虽然已解，假如胸胁满痛，给予服用此汤；如果脉象浮者，用麻黄汤。伤寒五六日，中风，往来寒热，胸胁苦痛，默默不欲饮食，心烦喜呕，或者烦而不呕，或者口渴，或者腹中痛，或者胁下痞硬，或者心下悸动，小便不利，或者不渴，身体有微热者，此汤主治。血气虚弱，腠理开泄，邪气因而侵入，与正气相搏结，结于胸下，邪正分争，往来寒热，发作有时，默默不欲饮食，脏腑相连，其痛必在下部，邪高痛下，致使呕吐，此汤主治。服用柴胡汤后，口渴的，属于阳明病，按法治之。伤寒五六日，身热恶风，头项强直，胁下满，手足温而渴者，此汤主治。伤寒，阳脉涩，阴脉弦，腹中急痛，先与小建中汤不愈者，此汤主治。太阳病，过经十余日，发汗、吐、下后四五日，阳证仍在者，先与小柴胡汤；呕吐不止，心下郁结，微烦者，为未解也，与大柴胡汤攻下则愈。妇人中风七八日，续得寒热，发作有时，月经刚好断绝者，此为热入血室，其血必结，致使像疟疾一样，此汤主治。伤寒五六日，头汗出，微恶寒，手足冷，心下满，不欲食，大便硬，脉细者，为阳微结，必有表证，复有里证；脉沉，也是里证。汗出为阳微，假如仍是纯阴结，不得再有外证，悉入在里。此为半在表，半在里也。脉虽沉紧，不得诊断为少阴病。之所以这样，是因为阴证不得有汗，现在头汗出，所以知道不是少阴病，可以服用此汤。如果还不明白，通过排尿而解。伤寒五六日，呕而发热者，柴胡汤证具备而以他药攻下之，柴胡证仍在者，再给小柴胡汤。虽然攻下，不为逆，必然蒸蒸而振栗却发热，汗出而解，如果心下满而腹痛者，此为结胸，大陷胸汤主治。但满而不痛者，此为痞气，柴胡汤不适宜给予，宜半夏泻心汤。（以上属太阳经。）阳明病，发潮热，大便溏，小便正常，胸胁不利者，与此汤服用。阳明病，胁下硬满，不大便而呕，舌上白苔者，可以服用，上焦得通，津液得下，胃气因和，濈然汗出而解。阳明中风，脉弦浮大而短气，腹部满，胁下及心痛，久按之，气不通，鼻干不得卧，一身及目悉黄，小便难，有潮热，时时哕（呃逆），身前后肿，刺之稍好，外证未解，病过十日，脉续浮者，此汤主治。（以上属阳明经。）太阳病不解，转入少阳，胁下满，干呕不能食，往来寒热，尚未吐下，脉沉紧者，此汤主治。若已吐下后，发汗温针，谵语，小柴胡汤证罢，此为坏证，知犯何逆，以法治之。（以上属少阳经。）呕而发热，宜服此汤。伤寒已后更发热，此汤主治。如果脉浮者，以汗解之。（属阳易瘥后劳复脉证。）
药材及剂量：黄芩（一两半。若腹中痛，去黄芩，加芍药一两半；若心下悸，小便不利，去黄芩，加茯苓一两）、人参（一两半。若不渴，外有微热者，去人参，加桂枝一两半，温覆得微汗，愈；若咳嗽者，去人参，加五味子一两五分）、大枣（六枚，若胁下痞硬，去大枣，加牡蛎二两或一两）、半夏（一两，开水泡。若胸烦不呕者，去半夏、人参，加栝蒌实一枚，用四分之一）、柴胡（四两，去芦）、甘草（一两半）。
以上每服七八钱，生姜四片，大枣三枚，水一钟，煎服。
升麻汤 治疗伤寒中风，头痛，憎恶寒冷壮热，肢体疼痛，发热恶寒，鼻中干不得卧。兼治寒暄不时，人多疾疫，乍寒脱着（忽冷忽热增减衣物），及暴热之顷，忽然变寒，身体疼痛，头重如石。
药材：升麻、甘草、芍药、葛根（各等分）。
以上每服七八钱，按常规方法煎服。如果是老人，去芍药，加柴胡、茯苓、人参各一钱。
五积散 治疗阴经伤冷，脾胃不和，感冒寒邪。
药材及剂量：茯苓（四两）、肉桂、人参、川芎（各二两）、浓朴、半夏、芍药、当归、麻黄、干姜（各三两）、甘草（二两）、枳壳（五两，炒）、桔梗（十二两）、陈皮（八两）、苍术（二十四两）、白芷（四两）。
以上十六味药，除枳壳、肉桂、陈皮外，其余并一处，生捣为粗末，用酒拌匀，晒干，分作六份，大锅用武火炒，令黄色，不得焦，摊冷，入枳壳、肉桂、陈皮一处和匀，每服五钱，水两钟，生姜三片，煎一钟服。
三黄石膏汤 有伤寒发热，脉大，如滑数，表里皆实，阳盛怫郁。医生不懂，已经发其汗，病势不退，又复下之，大便遂频，小便不利，五心烦热，两目如火，鼻干面赤，舌燥齿黄，大渴，过经已成坏证。也有错治诸温而成此证者。又八九日，已经汗下，脉洪数，身体壮热，拘急沉重，欲治其内，由表未解；欲发其表，则里证又急，犹豫不能措手，等待死亡而已。殊不知热在三焦，闭涩经络，津液枯涸，营卫不通，遂成此证耳。
药材及剂量：石膏（一两半）、黄芩、黄连、黄柏（各七钱）、豉（二合）、麻黄（五分）、栀子（三十个）。
以上每服一两，水两钟，煎服。未中病再服，其效如神。伤寒已经汗、吐、下误治后三焦生热，脉复洪数，谵语不休，昼夜喘息，鼻加衄血，病势不解，身目俱黄，狂叫欲走，三黄石膏汤主治。
阳毒伤寒，皮肤斑烂，身如凝血，两目如火，十指皮俱脱，烦渴，躁急不宁，庸医不识，莫能措手，命在须臾，三黄石膏汤主治。
妇人血风证，因崩漏大脱血，或前后去血，因而涸燥，其热未除，循衣摸床，撮空闭目，不省人事，扬手掷足，摇动不宁，错语失神，脉弦浮而虚，内有燥热之极，气粗鼻干而不润，上下运燥，此为难得治。宜服：
生地黄黄连汤 治疗男子去血多者有此证，其妙不可胜言也。
药材：川芎、生地黄、川归（各七钱）、赤芍药、栀子、黄芩、黄连（各三钱）、防风（一两）。
以上每服五钱，水煎，清饮，徐徐呷之。脉实，可再加大黄下之。大承气汤，是气药，自外而之内者用之。生地黄黄连汤，是血药，自内而之外者用之。气血合病，循衣摸空，治同。自气而之血，血而复之气者，大承气汤下之。自血而之气，气而复之血者，生地黄黄连汤主治。二者俱不大便。此是承气汤对子，又与三黄石膏汤相表里，是皆三焦胞络虚火之用也。病既危急，只得以此汤降血中之火耳。不但妇人用之，男子去血过多而有此证者，皆宜服之，无不效。予故表而出之。
伤寒脉浮，当汗，用麻黄汤。如果脉在筋骨之间，半表半里，当和解，用小柴胡汤；在筋骨之间，当下，用承气汤。如果又在筋骨之下，谓之阴证矣，其法理中，当用附子之类。
伤寒头略痛，发热，耳聋胁痛，或往来寒热如疟，此方治之，名：
和解散
药材及剂量：柴胡（二钱）、黄芩（一钱）、人参（一钱）、半夏（一钱）、甘草（一钱）。
以上用水两钟，生姜三片，枣子二枚，煎八分，不拘时服。如呕逆，加姜九片，陈皮一钱。如头痛恶寒，加羌活、防风各一钱。寒热间作，加桂枝等药各一钱。夏月中暑，发热头痛，加黄连一钱。春天温病时行，加生地黄、川升麻一钱。疟疾，或先寒后热，先热后寒，加川常山、尖槟榔半钱，各要未发时煎服。伤寒，恶寒，头项强，发热，前方冲和汤内去细辛、苍术，加白术二钱。
Shangshu (Summerheat Injury) and Shanghan (Cold Damage) both present with fever. If mistakenly treated as Shanghan, it is inadvisable. This is because cold damages the form (body structure), while heat damages Qi (vital energy). In Shanghan, there is aversion to cold externally and a floating-tight pulse; in Shangshu, there is no aversion to cold but a deficient pulse. This is the distinction. The Classics state: "A surging pulse with cold body indicates Shanghan. A deficient pulse with hot body indicates Shangshu."
Treatment should utilize Xiao Chai Hu Tang (Minor Bupleurum Decoction). If thirst is present, add Zhi Mu (Anemarrhenae Rhizoma) and Shi Gao (Gypsum Fibrosum), or use Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction). If prolonged rainy weather causes excessive dampness, use Cang Zhu Bai Hu Tang (Atractylodis Rhizoma White Tiger Decoction). If the primordial Qi is inherently weak and the injury is severe, treat with Qing Shu Yi Qi Tang (Clear Summerheat and Benefit Qi Decoction).
The term "Urgent Purging" (Ji Xia) implies that pathogenic heat has become pressing and complications are imminent, unlike other diseases where delay might be permissible. For instance, Shaoyin disease relates to Kidney Water, governing dry mouth and throat with thirst. This indicates internal flaming of pathogenic heat and impending exhaustion of Kidney Water; thus, urgent purging is required to save the dying Yin fluids. Similarly, abdominal distension with constipation indicates Earth overcoming Water, also requiring urgent purging. Yangming disease relates to Earth; excessive sweating and high heat necessitate urgent purging to preserve body fluids. Abdominal fullness and pain indicate excess in Earth, requiring urgent downward purging. In febrile diseases, if vision is impaired and heat persists, death ensues. Clouded vision indicates exhaustion of Kidney Water, unable to reflect objects, signaling critical danger; urgent purging is mandatory. There are two indications for "Urgent Warming" in Shaoyin disease: when internal cold is severe and the warming Qi of Yang is about to perish, urgent warming is undoubtedly indicated.
In Shaoyin disease, occurring within two to three days, with dry mouth and throat, urgent purging is indicated using Da Cheng Qi Tang (Major Order the Qi Decoction).
In Shaoyin disease, spontaneous diarrhea approaching collapse, green stool, pain in the epigastrium, dry mouth and throat, urgent purging is indicated using Da Cheng Qi Tang.
In Shaoyin disease, occurring on the sixth or seventh day, with abdominal distension and constipation, urgent purging is indicated using Da Cheng Qi Tang.
In Yangming disease, with fever and profuse sweating leading to dry stomach fluids, urgent purging is indicated using Da Cheng Qi Tang; if sweating does not resolve the condition and abdominal distension and pain occur, urgent purging is indicated using Da Cheng Qi Tang.
In Shaoyin disease, with a deep and faint pulse, urgent warming is indicated using Si Ni Tang (Frigid Extremities Decoction).
Qiang Huo Chong He Tang (Notopterygii and Ligustici Decoction) treats Taiyang disease without sweat, fever, headache, aversion to cold, stiff spine, and floating-tight pulse. It also treats sudden cold invasion outside of winter, presenting with headache, aversion to cold, and fever; this decoction is universally suitable. (It serves as a substitute for Ma Huang Tang, being a divine medicine for the Taiyang channel.)
Ingredients: Qiang Huo (Notopterygii Rhizoma et Radix, 1.5 qian), Fang Feng (Saposhnikoviae Radix, 1 qian), Cang Zhu (Atractylodis Rhizoma, 1.5 qian), Huang Qin (Scutellariae Radix, 1 qian), Chuan Xiong (Ligustici Chuanxiong Rhizoma, 1 qian), Bai Zhi (Angelicae Dahuricae Radix, 1 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma, 1 qian), Sheng Di Huang (Rehmanniae Radix, 1 qian), Xi Xin (Asari Radix et Rhizoma, 0.5 qian, do not exceed).
Decoct two zhong of water to eight fen, take warm, cover with warm blankets to induce slight sweating. If Damp Earth governs the year, add Cang Zhu 1.5 qian; also add during prolonged rain. If thirsty, add Shi Gao 3 qian and Zhi Mu 1 qian; if not thirsty, do not add.
Taiyang Wind Strike with sweating presents with a floating-slow pulse.
Ingredients: Qiang Huo (1 qian), Fang Feng (1.5 qian), Bai Zhu (Atractylodis Macrocephalae Rhizoma, 1.5 qian), Huang Qin (1 qian), Bai Zhi (1 qian), Gan Cao (1 qian), Sheng Di Huang (1.5 qian), Chuan Xiong (0.5 qian).
Decoct as previously described. If sweating persists after one dose, add Huang Qin 1.5 qian and Shao Yao (Paeoniae Radix Alba, 1 qian). If still uncontrolled, use Xiao Chai Hu Tang with Gui Zhi (Cinnamomi Ramulus) and Shao Yao each 1 qian.
Ge Gen Tang (Puerariae Decoction) treats Taiyang disease with stiffness in the neck and back, absence of sweat, aversion to wind, string-taut floating pulse, and fever. It also treats concurrent Taiyang and Yangming diseases presenting with spontaneous diarrhea.
Ingredients: Ge Gen (Puerariae Lobatae Radix, 1 qian), Gan Cao (2 qian), Ma Huang (Ephedrae Herba, 2 qian, remove joints, soak in boiling water twice).
Decoct two zhong of water with four slices of fresh ginger and two jujubes, take warm, cover slightly to induce sweating.
Jie Ji Tang (Release the Muscle Decoction) treats epidemic febrile diseases, headache, high fever, spring wind-pathogen infection, fever with thirst, and no aversion to cold.
Ingredients: Ge Gen (2 qian), Gui Zhi (2 qian), Huang Qin (1 qian), Shao Yao (1 qian), Ma Huang (1.5 qian), Gan Cao (1 qian).
Decoct two zhong of water with two jujubes, take warm. If unresolved, induce sweating again.
Du Huo San (Angelicae Pubescentis Powder) treats wind strike, warm-heat diseases, etc.
Ingredients: Qiang Huo, Du Huo (Angelicae Pubescentis Radix), Zhi Ke (Aurantii Fructus Immaturus), Fang Feng, Huang Qin, Ma Huang (soaked twice), Ren Shen (Ginseng Radix), Gan Ju Hua (Chrysanthemi Indici Flos), Gan Cao (roasted), Fu Ling (Poria), Man Jing Zi (Viticis Fructus), Xi Xin (each 1 qian), Shi Gao (2 qian).
Decoct two zhong of water with three slices of fresh ginger and five leaves of Bo He (Menthae Haplocalycis Herba) using the previous method.
Bai Du San (Eliminate Toxicity Powder) treats wind strike, warm epidemics, wind-dampness, dizziness, limb pain, aversion to cold with high fever, stiff neck, eye pain, and common wind-induced dizziness and spasms.
Ingredients: Qiang Huo, Du Huo, Qian Hu (Peucedani Radix), Chai Hu (Bupleuri Radix), Chuan Xiong, Zhi Ke, Jie Geng (Platycodonis Radix), Fu Ling, Ren Shen, Gan Cao.
Equal parts, decoct two zhong of water, take as usual.
Liu Shen Tong Jie San (Six Miracles Freeing and Releasing Powder)
Ingredients: Ma Huang (2 liang), Gan Cao (1.5 liang), Huang Qin (2 liang), Shi Gao (2 liang), Hua Shi (Talcum, 2 liang), Cang Zhu (4 liang).
Treats seasonal epidemics. In the first three days, add Cong Bai (Allii Fistulosi Bulbus) and Xiang Chi (Fermented Soybean), decoct and induce sweating for immediate effect. Stop upon symptom resolution; do not consume the entire dose.
Xiao Chai Hu Tang (Minor Bupleurum Decoction) treats Taiyang disease lasting over ten days, with fine pulse and desire to sleep. Although exterior symptoms have resolved, if chest and hypochondriac fullness/pain exist, administer this. If the pulse is floating, use Ma Huang Tang. In Shanghan or wind strike after five to six days, with alternating chills and fever, bitter taste in chest/hypochondrium, silent desire not to eat, irritability, and vomiting, or variations thereof (thirst, abdominal pain, hypochondriac hardness, palpitations, dysuria, no thirst, slight fever), this decoction is primary. When blood and Qi are weak and pores open, pathogens enter and struggle with righteous Qi, knotting below the chest, causing alternating chills/fever, loss of appetite, and vomiting due to organ connection and pathogen location. This decoction is primary. After taking Chai Hu Tang, if thirst develops, it belongs to Yangming; treat accordingly. In Shanghan after five to six days, with fever, aversion to wind, stiff head/neck, full hypochondrium, warm hands/feet, and thirst, this decoction is primary. In Shanghan with choppy yang pulse and string-taut yin pulse, with acute abdominal pain, if Xiao Jian Zhong Tang fails, use this decoction. In Taiyang disease persisting over ten days, after sweating, vomiting, or purging, if yang signs remain, first give Xiao Chai Hu Tang; if vomiting persists with epigastric oppression and slight irritability, give Da Chai Hu Tang (Greater Bupleurum Decoction) to purge. In women with wind strike after seven to eight days, recurring chills/fever coinciding with menstruation cessation, this is Heat Entering the Blood Chamber with blood coagulation resembling malaria; this decoction is primary. In Shanghan after five to six days, with head sweating, slight aversion to cold, cold extremities, epigastric fullness, anorexia, hard stool, and fine pulse, this is Minor Yang Knotting with both exterior and interior signs. Deep pulse indicates interior. Sweating indicates minor yang; pure yin knotting would lack exterior signs. Thus, it is half-exterior, half-interior. Despite deep-tight pulse, it is not Shaoyin because yin patterns do not sweat; head sweating confirms non-Shaoyin. Administer this decoction. Resolution may occur via urination. In Shanghan after five to six days, with vomiting and fever, if Chai Hu syndrome exists despite prior incorrect purging, re-administer Xiao Chai Hu Tang. Though purged, it is not adverse; shaking and subsequent fever/sweating will resolve the condition. If epigastric fullness and pain occur, it is Jie Xiong (Chest Binding); treat with Da Xian Xiong Tang (Major Draining the Chest Decoction). If fullness without pain, it is Pi Qi (Stagnant Qi); Chai Hu Tang is contraindicated; use Ban Xia Xie Xin Tang (Pinellia Drain the Epigastrium Decoction). (Above pertains to Taiyang.) In Yangming disease, with tidal fever, loose stool, normal urination, and chest/hypochondriac discomfort, administer this decoction. In Yangming disease, with hard/full hypochondrium, constipation, vomiting, and white tongue coating, administration allows upper jiao to open, fluids to descend, stomach qi to harmonize, and sweating to resolve. In Yangming wind strike, with string-taut-floating-large pulse, shortness of breath, abdominal fullness, hypochondriac/heart pain, blocked qi upon pressure, dry nose, insomnia, generalized jaundice, difficult urination, tidal fever, occasional hiccups, swelling, and persistent floating pulse after ten days, this decoction is primary. (Above pertains to Yangming.) When Taiyang unresolved transfers to Shaoyang, with full hypochondrium, dry retching, anorexia, alternating chills/fever, before vomiting/purging, with deep-tight pulse, this decoction is primary. If already vomited/purged/sweated/warmed-needled, resulting in delirium and cessation of Chai Hu signs, it is a damaged pattern; treat according to the deviation. (Above pertains to Shaoyang.) Vomiting with fever indicates this decoction. Post-Shanghan fever is treated with this; if floating pulse, resolve via sweating. (Pertains to post-recovery labor recurrence.)
Ingredients: Huang Qin (1.5 liang; if abdominal pain, remove Huang Qin, add Shao Yao 1.5 liang; if palpitations/dysuria, remove Huang Qin, add Fu Ling 1 liang), Ren Shen (1.5 liang; if no thirst/exterior slight fever, remove Ren Shen, add Gui Zhi 1.5 liang; if cough, remove Ren Shen, add Wu Wei Zi (Schisandrae Fructus) 1.5 qian), Da Zao (Ziziphus Jujuba Fruit, 6 pieces; if hypochondriac hardness, remove Da Zao, add Mu Li (Ostreae Concha) 2 or 1 liang), Ban Xia (Pinelliae Rhizoma, 1 liang, soaked; if chest irritability without vomiting, remove Ban Xia/Ren Shen, add Gua Lou Shi (Trichosanthis Fructus) 1 piece, use 1/4), Chai Hu (4 liang, remove rhizome), Gan Cao (1.5 liang).
Take 7-8 qian per dose with four slices of ginger and three jujubes in one zhong of water, decoct and take.
Sheng Ma Tang (Cimicifugae Decoction) treats Shanghan/Wind Strike with headache, aversion to cold with high fever, limb pain, fever/aversion to cold, dry nose, and insomnia. Also treats irregular climate, epidemics, fluctuating clothing needs, sudden heat turning to cold, body pain, and heavy head.
Ingredients: Sheng Ma (Cimicifugae Rhizoma), Gan Cao, Shao Yao, Ge Gen (equal parts).
Take 7-8 qian per dose, decoct normally. For elderly, remove Shao Yao, add Chai Hu, Fu Ling, Ren Shen each 1 qian.
Wu Ji San (Five Accumulations Powder) treats Cold Injury to Yin Channels, Spleen/Stomach disharmony, and Cold Pathogen invasion.
Ingredients: Fu Ling (4 liang), Rou Gui (Cinnamomi Cortex), Ren Shen, Chuan Xiong (each 2 liang), Hou Po (Magnoliae Officinalis Cortex), Ban Xia, Shao Yao, Dang Gui (Angelicae Sinensis Radix), Ma Huang, Gan Jiang (Zingiberis Rhizoma) (each 3 liang), Gan Cao (2 liang), Zhi Ke (stir-fried, 5 liang), Jie Geng (12 liang), Chen Pi (Citri Reticulatae Pericarpium, 8 liang), Cang Zhu (24 liang), Bai Zhi (4 liang).
Of the sixteen ingredients, except Zhi Ke, Rou Gui, and Chen Pi, grind the rest into coarse powder, mix with wine, dry, divide into six portions. Stir-fry in a large pot over strong fire until yellow (do not burn), cool, then mix with Zhi Ke, Rou Gui, and Chen Pi. Take 5 qian per dose with two zhong of water and three slices of ginger, decoct to one zhong and take.
San Huang Shi Gao Tang (Three Yellows and Gypsum Decoction) treats Shanghan fever, large/slipping-rapid pulse, excess in both exterior and interior, and Yang excess with depression. If physicians fail to understand, having already induced sweating without relief, then purged, leading to frequent stools, dysuria, five-palm heat, fiery eyes, dry nose/red face, dry tongue/yellow teeth, and extreme thirst, becoming a damaged pattern. Or caused by incorrect warm treatments. After eight to nine days, post-sweat/purge, with flooding-rapid pulse, high fever, stiffness/heaviness, internal treatment is hindered by unresolved exterior, and exterior treatment is hindered by urgent interior signs, leading to hesitation. Actually, heat in the Three Jiao blocks collaterals, drying fluids and disrupting Ying/Wei circulation.
Ingredients: Shi Gao (1.5 liang), Huang Qin, Huang Lian (Coptidis Rhizoma), Huang Bai (Phellodendri Cortex) (each 7 qian), Chi (Fermented Soybean, 2 he), Ma Huang (0.5 qian), Zhi Zi (Gardeniae Fructus, 30 pieces).
Take 1 liang per dose with two zhong of water, decoct and take. Repeat if ineffective; efficacy is miraculous. For Shanghan post-mistreatment with Three Jiao heat, flooding-rapid pulse, delirium, panting, epistaxis, unresolved condition, jaundice, mania, use San Huang Shi Gao Tang.
For Yang Du Shanghan (Yang Toxin Cold Damage) with skin eruptions, congealed-blood appearance, fiery eyes, peeling fingers, irritability, and restlessness, life is at stake; use San Huang Shi Gao Tang.
For Women's Blood Wind Syndrome due to metrorrhagia/hemorrhage causing fluid depletion and residual heat, with behaviors like grasping clothes, picking at empty air, unconsciousness, flailing limbs, delirium, wiry-floating-deficient pulse, extreme internal dry-heat, rough breathing, dry nose, use:
Sheng Di Huang Huang Lian Tang (Rehmannia and Coptis Decoction) treats men with excessive blood loss exhibiting these signs; its efficacy is beyond words.
Ingredients: Chuan Xiong, Sheng Di Huang, Chuan Gui (Angelicae Sinensis Radix) (each 7 qian), Chi Shao Yao (Red Paeonia Root), Zhi Zi, Huang Qin, Huang Lian (each 3 qian), Fang Feng (1 liang).
Take 5 qian per dose, decoct in water, drink clear liquid slowly. If pulse is excess, add Da Huang (Rhei Radix et Rhizoma) to purge. Da Cheng Qi Tang is a Qi-moving drug for external-to-internal progression. Sheng Di Huang Huang Lian Tang is a Blood-moving drug for internal-to-external progression. For combined Qi/Blood disease with grasbing/picking, treatment is similar. For Qi moving to Blood, purge with Da Cheng Qi Tang. For Blood moving to Qi, use Sheng Di Huang Huang Lian Tang. Both present with constipation. These are counterparts to Cheng Qi Tang and relate to San Huang Shi Gao Tang, addressing deficient fire in Three Jiao/Bao Luo. In critical illness, use this to descend fire in blood. Effective for men with excessive blood loss as well. I highlight this here.
In Shanghan, floating pulse requires sweating with Ma Huang Tang. Pulse between sinews/bones (half-exterior/half-interior) requires harmonizing with Xiao Chai Hu Tang. Pulse between sinews/bones (interior) requires purging with Cheng Qi Tang. Pulse below sinews/bones indicates Yin Pattern; treat with Li Zhong principles using Fu Zi (Aconiti Lateralis Radix Praeparata) type herbs.
For Shanghan with slight headache, fever, deafness, hypochondriac pain, or alternating chills/fever like malaria, use this formula named:
He Jie San (Harmonizing and Resolving Powder)
Ingredients: Chai Hu (2 qian), Huang Qin (1 qian), Ren Shen (1 qian), Ban Xia (1 qian), Gan Cao (1 qian).
Decoct two zhong of water with three slices of ginger and two jujubes to eight fen, take anytime. For vomiting, add nine slices of ginger and 1 qian Chen Pi. For headache/aversion to cold, add Qiang Huo and Fang Feng each 1 qian. For alternating chills/fever, add Gui Zhi etc. each 1 qian. For summer heatstroke with fever/headache, add Huang Lian 1 qian. For spring warm epidemics, add Sheng Di Huang and Chuan Sheng Ma ( Cimicifugae Rhizoma) each 1 qian. For malaria (chills then fever or vice versa), add Chuan Chang Shan (Dichroae Radix) and Jian Bing Lang (Arecae Semen) 0.5 qian, decoct before onset. For Shanghan with aversion to cold, stiff head/neck, fever, remove Xi Xin and Cang Zhu from previous Chong He Tang, add Bai Zhu 2 qian.