阳明之病在胃实，当以下为正法矣。然阳明居中，诸病咸臻，故治法悉具。如多汗无汗，分麻黄桂枝；在
胸在腹，分瓜蒂栀豉；初硬燥坚，分大小承气。即用汗吐下三法，亦有轻重浅深之不同也。若大烦大渴而用白
虎，瘀血发黄而用茵陈，小便不利而用猪苓，停饮不散而用五苓，食谷欲吐而用茱萸等法，莫不各有差等。
以棋喻之，发汗是先着，涌吐是要着，清火是稳着，利水是闲着，温补是忿着，攻下是末着。病至于攻下，无
别着矣。故汗之得法，他着都不必用。其用吐法，虽是奇着，已是第二手矣。他着都非正着，惟攻下为煞着，
亦因从前之失着也。然诸法皆因清火而设，则清火是阳明之上着与？
栀子豆豉汤
栀子甘草豆豉汤
栀子生姜豆豉汤
栀子浓朴汤∶
栀子 浓朴 枳实
栀子干姜汤
栀子柏皮汤∶
栀子 柏皮 甘草
此阳明半表里涌泄之和剂也。少阳之半表是寒，半里是热。而阳明之热自内达外，有热无寒。故其外症身热
汗出，不恶寒反恶热，身重，或目痛、鼻干、不得眠；其内症咽燥、口苦、舌苔、烦躁，渴欲饮水，心中懊 ，
腹满而喘。此热半在表半在里也。脉虽浮紧，不得为
太阳病，非汗剂所宜，又病在胸腹而未入胃府，则不当下，法当涌泄以散其邪。栀子苦能泄热，寒能胜热，其
形象心，又赤色通心，故主治心中上下一切症。豆形象肾，又黑色入肾，制而为豉，轻浮上行，能使心腹之浊
邪，上出于口，一吐而心腹得舒，表里之烦热悉除矣。所以然者，二阳之病发心脾，以上诸症，是心热不是胃
家热，即本论所云有热属脏者攻之，不令发汗之谓也。若夫热伤气者少气，加甘草以益气，虚热相搏者多呕，加
生姜以散邪，此可为夹虚者立法也。若素有宿食者，加枳实以降之，地道不通者，加大黄以润之，此可为实热
者立法也。叔和用以治太阳瘥后劳复之症，误甚矣。如妄下后，而心烦腹满起卧不安者，是热已入胃，便不当
吐，故去香豉；心热未解，不宜更下，故只用栀子以除烦，佐枳、朴以泄满。此两解心腹之妙，是小承气之变
局也。或以丸药下之，心中微烦，外热不去，是知寒气留中，而上焦留热，故任栀子以除烦，用干姜逐内寒以
散表热，此甘草泻心之化方也。若因于伤寒而肌肉发黄者，是寒邪已解而热不得越，当两解表里之热。故用栀子
以除内烦，柏皮以散外热，佐甘草以和之，是又茵陈汤之轻剂矣。此皆栀豉汤加减，以御阳明表症之变幻者。
夫栀子之性，能屈曲下行，不是上涌之剂，惟豉之腐气上熏心肺，能令人吐耳。观瓜蒂散必用豉汁和服，是吐
在豉而不在栀矣。观栀子干姜汤去豉用姜，是取其横散，栀子浓朴汤以枳、朴易豉，是取其下泄，皆不欲上越
之义。旧本二方后俱云得吐止后服，岂不谬哉？观栀子柏皮汤与茵陈汤，方中俱有栀子，俱不言吐，又病患旧
微溏者不可与，则栀子之性自明矣。
瓜蒂散∶
瓜蒂 赤小豆 香豉
此阳明涌泄之峻剂，治邪结于胸中者也。胸中为清虚之府，三阳所受气，营卫所由行。寒邪凝结于此，胃
气不得上升，内热不得外达，以致痞硬。其气上冲咽喉不得息者，此寒格于上也；寸脉微浮，寒束于外也。此
寒不在营卫，非汗法所能治。因得酸苦涌泄之品，因而越之，上焦得通，中气得达，胸中之阳气复，肺气之治
节行，痞硬可得而消也。瓜蒂色青，象东方甲木之化，得春升生发之机，能提胃中阳气，以除胸中之寒热，为
吐剂中第一品。然其性走而不守，与栀子之守而不走者异，故必得谷气以和之。赤小豆形色象心，甘酸可以保
心气。黑豆形色象肾，性本沉重，霉熟而使轻浮，能令肾家之精气交于心，胃中之浊气出于口。作为稀糜，调服二味，
虽快吐而不伤神，奏功之捷，胜于汗下矣。前方以栀子配豉，此方以赤豆配豉，皆以形色取其心肾合交之义。
若夫心中温温欲吐复不吐，始得之，手足寒，脉弦迟者，以不腹满，不得为太阴病。但以欲寐而知其为少阴病，
不在上焦而在胸中，亦有可吐之理矣。夫病在少阴，当补无泻，而亦有可吐可下之法者，以其实也。实在胸中
可吐，实在胃府当下，此皆少阴阳明合并之病，是吐下二法，仍属阳明也。如病患手足厥冷，脉乍紧，心下满
而烦，饥不能食者，是厥阴阳明合病。病本发于厥阴，而实邪结于阳位，急则治其标，亦当从阳明涌吐之法矣。
余义见制方大法。
甘草干姜汤
芍药甘草汤∶
二方为阳明半表半里症，误服桂枝之变症而设也。桂枝汤本为中风自汗而设，若阳明病汗出多微恶寒而无
里症者，为表未解，故可用桂枝汤发汗。其脉迟，犹中风之缓，与脉浮而弱者同义。若但浮之脉，在太阳必无
汗，在阳明必盗汗出，则伤寒之脉浮而自汗出者，是阳明之热淫于内，而非太阳之浮为在表矣。心烦是邪中于
膺，心脉络小肠，心烦则小肠亦热，故小便数。微恶寒而脚挛急，知恶寒将自罢，趺阳脉因热甚而血虚筋急，
故脚挛也。此病在半表半里，服栀豉汤而可愈。反用桂枝攻表，汗多所以亡阳；胃脘之阳不至于四肢，故厥∶
虚阳不归其部，故咽中干呕吐逆而烦躁也。势不得不用热因热用之法，救桂枝之误以回阳，然阳亡实因于阴虚
而无所附，又不得不用益津敛血之法以滋阴，故与甘草干姜汤而厥愈，更与芍药甘草汤脚伸矣。且芍药酸寒，
可以止烦、敛自汗而利小便，甘草甘平，可以解烦和肝血而缓筋急，是又内调以解外之一法也。
仲景回阳，每用附子，此用干姜、甘草者，正以见阳明之治法。夫太阳少阴所谓亡阳者，先天之元阳也，
故必用附子之下行者回之，从阴引阳也。阳明所谓亡阳者，后天胃脘之阳也，取甘草、干姜以回之，从乎中也。
盖桂枝之性辛散，走而不守，即佐以芍药，尚能亡阳；干姜之味苦辛，守而不走，故君以甘草，便能回阳。然
先天太、少之阳不易回，回则诸症悉解。后天阳明之阳虽易回，既回而前症仍在，变症又起，故更作芍药甘草
汤继之。盖脾主四肢，胃主津液，阳盛阴虚，脾不
能为胃行津液以灌四旁，故足挛急。用甘草以生阳明之津，芍药以和太阴之液，其脚即伸，此亦用阴和阳法也。
或因姜、桂之遗热，致胃热而谵语，少与调胃承气以和之，仗硝、黄以对待姜、桂，仍不失为阳明从乎中治之
法。只以两阳合明之位，气血俱多之经，故不妨微寒之而微利之，与他经亡阳调理不同耳。甘草干姜汤，得理
中之半，取其守中，不须其补中；芍药甘草汤，减桂枝之半，用其和里，不取其攻表。是仲景加减法之隐而不宣者。
白虎加人参汤∶
石膏 知母 甘草 粳米 人参
外邪初解，结热在里，表里俱热，脉洪大，汗大出，大烦大渴，欲饮水数升者，是阳明无形之热。此方乃清
肃气分之剂也。盖胃中糟粕燥结，宜苦寒壮水以夺土；若胃口清气受伤，宜甘寒泻火而护金。要知承气之品，直
行而下泄，如胃家未实而下之，津液先亡，反从火化，故妄下之后，往往反致胃实之眚，内经所谓味过于苦，
脾气不濡，胃气反浓者是已。法当助脾家之湿土，以制胃家燥火之上炎。《经》曰“甘先入脾。”又曰∶“以甘
泻脾”。又曰∶“脾气散津，上归于肺，”是甘寒之品，乃土中泻火而生津液之上剂也。石膏大寒，寒能胜热，
味甘归脾，性沉而主降，已备秋金之体，色白通肺，质重而含津，已具生水之用。知母气寒主降，味辛能润，泄
肺火而润肾燥，滋肺金生水之源。甘草土中泻火，缓寒药之寒，用为舟楫，沉降之性，始得留连于胃。粳米稼穑
作甘，培形气而生津血，用以奠安中宫，阴寒之品，无伤脾损胃之虑矣。饮入于胃，输脾归肺，水精四布，烦渴
可除也。更加人参者，以气为水母，邪之所凑，其气必虚，阴虚则无气，此大寒剂中，必得人参之力，以大补
真阴，阴气复而津液自生也。若壮盛之人，元气未伤，津液未竭，不大渴者，只须滋阴以抑阳，不必加参而益
气。若元气已亏者，但用纯阴之剂，火去而气无由生，惟加人参，则火泻而土不伤，又使金能得气，斯立法之尽
善欤！此方重在烦渴，是热已入里，若伤寒脉浮，发热无汗恶寒表不解者，不可与。若不恶寒而渴者虽表未全解，
如背微恶寒时恶风者，亦用之。若无汗烦渴而表不解者，是麻黄杏子甘草石膏症。若小便不利，发热而渴，欲饮
水者，又五苓猪苓之症矣。若太阳阳明之疟，热多寒少，口燥舌干，脉洪大者，虽不得汗，用之反汗出而解。
陶氏以立夏后立秋前天时不热为拘，误人最甚。乌知方因症立，非为时用药也。
竹叶石膏汤∶
竹叶 石膏 人参 甘草 半夏 麦冬 粳米
此加减人参白虎汤也。三阳合病，脉浮大，在关上，但欲睡而不得眠，合目则汗出，宜此主之。若用于伤寒
解后，虚羸少气，气逆欲吐者，则谬之甚矣。三阳合病者，头项痛而胃家实，口苦、咽干、目眩者是也。夫脉
浮为阳，大为阳，是三阳合病之常脉。今在关上，病机在肝胃两部矣。凡胃不和，则卧不安，如肝火旺则上走空
窍，亦不得睡。夫肾主五液，入心为汗，血之与汗，异名同类，是汗即血也。心主血而肝藏血，人卧则血归于
肝。目合即汗出者，肝有相火，窍闭则火无从泄，血不得归肝，心不得主血，故发而为汗。此汗不由心，故名之
为盗汗耳。此为肝眚，故用竹叶为引导，以其秉东方之青色，入通于肝。大寒之气，足以泻肝家之火，用麦冬
佐人参以通血脉，佐白虎以回津，所以止盗汗耳。半夏禀一阴之气，能通行阴之道，其味辛，能散阳跷之满，用
以引卫气从阳入阴，阴阳通，其卧立至，其汗自止矣。其去知母者何？三阳合病而遗尿，是肺气不收，致少阴
之津不升，故藉知母以上滋手太阴，知母外皮毛而内白润，肺之润药也。此三阳合病而盗汗出，是肝火不宁，令
少阴之精妄泄，既不可复濡少阴之津，又不可再泄皮毛之泽，故用麦冬以代之欤！
茵陈蒿汤∶
茵陈 栀子 大黄
太阳阳明俱有发黄症，但头汗而身无汗，则热不外越，小便不利，则热不下泄，故瘀热在里而渴饮水浆。
然黄有不同，症在太阳之表，当汗而发之，故用麻黄连翘赤豆汤，为凉散法；症在太阳阳明之间，当以寒胜之，
用栀子柏皮汤，乃清火法；症在阳明之里，当泻之于内，故立本方，是逐秽法。茵陈秉北方之色、经冬不凋，
傲霜凌雪，历遍冬寒之气，故能除热邪留结。佐栀子以通水源，大黄以除胃热，令瘀热从小便而泄，腹满自减，
肠胃无伤。仍合“引而竭之”之义，亦阳明利水之奇法也。
仲景治阳明渴饮有四法∶本太阳转属者，五苓散微发汗以散水气；大烦燥渴，小便自利者，白虎加参，清
火而生津；脉浮发热，小便不利者，猪苓汤滋阴而利水；小便不利腹满者，茵陈汤以泄满，令黄从小
便出。病情不同，治法亦异矣。窃思仲景利小便必用化气之品，通大便必用承气之味。故小便不利者，必加茯
苓，甚者兼用猪苓，因二苓为化气之品，而小便由于气化矣。此小便不利，不用二苓者何？本论之阳明病，汗
出多而渴者，不可与猪苓汤，以汗多胃中燥，猪苓复利小便故也。斯知阳明病汗出多而渴者，不可用，则汗不
出而渴者，津液先虚，更不可用明矣。故以推陈致新之茵陈，佐以屈曲下行之栀子。不用枳、朴以承气，与芒
硝之峻利，则大黄但可以润胃燥，而大便之遽行可知。故必一宿而腹始减，黄从小便去而不由大肠。仲景立法
神奇，匪伊芳所思耳。
大承气汤∶
大黄 芒硝 枳实 浓朴
小承气汤∶
大黄 枳实 浓朴
治阳明实热，地道不通，燥屎为患。其外症身热汗出，不恶寒反恶热，日晡潮热，手足 汗出，或不了
了。其内症六七日不大便，初欲食反不能食，腹胀满绕脐痛，烦躁谵语，发作有时，喘冒不得卧，腹中转矢气，
或咽燥口干，心下痛，自利纯清水，或汗吐下后热不解，仍不大便，或下利谵语，其脉实或滑而数者，大承气
汤主之。如大便不甚坚硬者，小承气汤微和之。如大便燥硬而证未剧者，调胃承气汤和之。若汗多微发热，恶
寒未罢，腹未满，热不潮，屎未坚硬，初硬后溏，其脉弱或微满者，不可用。夫诸病皆因于气，秽物之不去，由
于气之不顺，故攻积之剂必用行气之药以主之。亢则害，承乃制，此承气之所由。又病去而元气不伤，此承气
之义也。夫方分大小，有二义焉∶浓朴倍大黄，是气药为君，名大承气；大黄倍浓朴，是气药为臣，名小承气。
味多、性猛、制大，其服欲令泄下也，因名曰大；味少、性缓、制小，其服欲微和胃气也，故名曰小。二方煎
法不同，更有妙义。大承气用水一斗，先煮枳、朴，煮取五升，内大黄，煮取三升，内硝者，以药之为性，生
者锐而先行，熟者气纯而和缓。仲景欲使芒硝先化燥屎，大黄继通地道，而后枳、朴除其痞满。缓于制剂者，
阳明病的病位在胃腑实证，应当以攻下法作为正治之法。然而阳明位居中焦，各种病证都会汇聚于此，所以治疗方法也完备齐全。比如多汗与无汗的情况，分别选用麻黄汤或桂枝汤；病邪在胸或在腹的情况，分别选用瓜蒂散或栀子豉汤；初起大便硬结干燥坚硬的，分别选用大承气汤或小承气汤。即使是使用汗、吐、下三种治法，也有轻重深浅的区别。如果患者出现严重烦躁和口渴，就用白虎汤；因瘀血导致发黄的，就用茵陈蒿汤；小便不利的，就用猪苓汤；水饮停聚不散的，就用五苓散；进食后想呕吐的，就用吴茱萸汤等治法，无不各有等级差别。
用下棋来比喻：发汗是第一步（先着），涌吐是关键的一步（要着），清热泻火是稳健的一步（稳着），利水是闲步（闲着），温补是处于劣势时的挣扎（忿着），攻下是最后的手段（末着）。病情发展到了需要攻下的地步，就已经没有其他棋路可走了。所以发汗如果得法，其他步骤都不必用。使用吐法，虽然是奇招，但也已经是第二手了。其他的步骤都不是正着，只有攻下才是绝杀之着，这也是因为之前治疗失误造成的。然而各种方法都是基于清热泻火而设立的，那么清热泻火难道是阳明的上策吗？
栀子豆豉汤
栀子甘草豆豉汤
栀子生姜豆豉汤
栀子厚朴汤：
栀子 厚朴 枳实
栀子干姜汤
栀子柏皮汤：
栀子 黄柏 甘草
这是治疗阳明半表半里证的涌泄和解剂。少阳的半表是寒，半里是热。而阳明的热是从内部达于外部，只有热没有寒。所以它的外症表现为身热、出汗、不恶寒反而恶热、身体沉重，或者目痛、鼻干、不能安睡；内症表现为咽燥、口苦、舌苔变化、烦躁、想喝水、心中懊恼不适、腹部胀满且气喘。这是热邪一半在表一半在里的表现。脉象虽然浮紧，但不能诊断为太阳病，也不适合用发汗剂；而且病邪在胸腹尚未进入胃腑，也不当下，治法应当采用涌吐泄热的方法来疏散邪气。栀子味苦能泄热，性寒能胜热，其形状像心，又因赤色通心，所以主治心中上下的一切症状。豆形状像肾，又因黑色入肾，制成豆豉后，性质轻浮上行，能使心腹中的浊邪从口中吐出，一吐之后心腹得以舒缓，表里的烦热全部消除。之所以这样，是因为“二阳之病发心脾”，上述诸症，是心热而不是胃家热，也就是本论所说的“有热属脏者攻之，不令发汗”的意思。如果热邪伤气导致少气，加甘草来益气；虚热相搏导致频繁呕吐，加生姜来散邪，这可以作为兼有虚证者的立法依据。如果素有宿食，加枳实来降气导滞；肠道不通畅的，加大黄来润燥通便，这可以作为实热证者的立法依据。王叔和用它来治疗太阳病愈后因劳累复发的病症，错误很大。如果在误用攻下后，出现心烦、腹部胀满、坐卧不安的情况，说明热邪已经入胃，就不应当再用吐法，所以去掉香豉；心热未解，不宜再攻下，所以只用栀子来除烦，配合枳实、厚朴来泄除胀满。这是两解心腹之妙的妙方，是小承气汤的变化局。如果用丸药攻下，心中轻微烦躁，体表发热不退，这说明寒气留滞于中，而上焦留有热邪，所以任用以除烦的栀子，用干姜驱逐内寒以散表热，这是甘草泻心汤的化裁方。如果是因伤寒导致肌肉发黄，说明寒邪已解而热邪不得发散，应当两解表里之热。所以用栀子来除内烦，黄柏来散外热，佐以甘草来调和，这又是茵陈蒿汤的轻剂。这些都是栀子豉汤的加减应用，用来应对阳明表证的变幻莫测。
栀子的药性，能够屈曲下行，不是上涌的药剂，只有豆豉的腐气上熏心肺，才能让人呕吐。看瓜蒂散必须用豆豉汁调服，可知吐的效果在于豆豉而不在于栀子。看栀子干姜汤去掉豆豉改用生姜，是取其横向发散；栀子厚朴汤用枳实、厚朴代替豆豉，是取其向下泄降，这都是不希望药物向上越出的含义。旧版书本在两方后面都写着“得吐止后服”，难道不荒谬吗？看栀子柏皮汤与茵陈蒿汤，方中都含有栀子，却都不说会引起呕吐，又有“病患旧微溏者不可与”的禁忌，那么栀子的药性就很明白了。
瓜蒂散：
瓜蒂 赤小豆 香豉
这是阳明涌泄的峻猛药剂，治疗邪气结聚在胸中的病症。胸中是清虚之府，是三阳经受气的地方，也是营卫运行的通道。寒邪凝结在此，胃气不得上升，内热不得外达，导致痞塞坚硬。气向上冲至咽喉导致呼吸不畅的，这是寒邪格拒于上；寸脉微浮，是寒邪束缚于外。这种寒邪不在营卫层面，不是发汗法所能治疗的。因为得到酸苦涌泄的药物，顺势使其向上涌吐，上焦得以通畅，中气得以通达，胸中的阳气恢复，肺气的治节功能运行，痞塞坚硬就可以消除。瓜蒂色青，象征东方甲木的生化，具备春升生发的机趣，能提举胃中阳气，以消除胸中的寒热，是吐剂中的上品。然而它的药性走窜而不守静，与栀子守静而不走窜的特性不同，所以必须借助谷气来调和它。赤小豆形色像心，甘酸可以保护心气。黑豆形色像肾，本性沉重，发霉成熟后变得轻浮，能使肾家的精气上交于心，胃中的浊气出于口。煮成稀粥状，调服这两味药，虽然剧烈呕吐但不伤神气，见效迅速，胜过发汗和攻下。前方用栀子配豆豉，此方用赤豆配豆豉，都是通过形色来取心肾相交的意义。
如果心中感觉恶心欲吐却又吐不出来，刚发病时，手脚发凉，脉象弦迟，因为腹部不胀满，不能诊断为太阴病。只能根据想睡觉的症状知道这是少阴病，病位不在上焦而在胸中，也有可以用吐法的道理。病在少阴，应当补益而不应泻法，但也有可用吐法和下法的情况，是因为邪气属实。邪实在胸中可以吐，邪实在胃腑应当下，这都是少阴与阳明合并的病证，吐下二法，仍属于阳明范畴。如果病人手脚冰冷，脉象突然变紧，心下部胀满而烦躁，饥饿却不能进食的，这是厥阴与阳明合病。病本发于厥阴，但实邪结聚在阳位，急则治其标，也应当遵循阳明的涌吐法了。其余义理见制方大法。
甘草干姜汤
芍药甘草汤：
这两方是为阳明半表半里证，误服桂枝汤后产生的变证而设的。桂枝汤原本是为中风自汗证而设的，如果阳明病出汗多、轻微恶寒而没有里证，属于表证未解，所以可以用桂枝汤发汗。其脉迟，如同中风之缓脉，与脉浮而弱意义相同。如果仅仅是浮脉，在太阳病一定无汗，在阳明病一定是盗汗出，那么伤寒脉浮而自汗出的，是阳明热邪淫溢于内，而不是太阳表证的浮脉。心烦是邪气侵入膺部，心脉络小肠，心烦则小肠也热，所以小便频数。轻微恶寒且脚部抽筋拘急，知道恶寒将会自行停止，趺阳脉因热盛而血虚筋急，所以脚部抽筋。此病在半表半里，服用栀子豉汤即可痊愈。反而使用桂枝汤攻表，出汗多所以亡阳；胃脘之阳不能到达四肢，所以手脚冰凉；虚阳不归其位，所以咽喉干燥、呕吐逆气而烦躁。形势所迫，不得不使用“热因热用”的方法，挽救桂枝汤的错误以回阳，然而阳亡实际上是因为阴虚而无依附，又不得不使用益津敛血的方法来滋阴，所以给予甘草干姜汤使手脚转暖，再给予芍药甘草汤使脚部伸展。况且芍药酸寒，可以止烦、收敛自汗并通利小便，甘草甘平，可以解烦、调和肝血并缓解筋急，这又是内调以解外的方法之一。
张仲景回阳，常用附子，这里用干姜、甘草，正是为了展示阳明病的治疗方法。太阳少阴所谓的亡阳，是先天的元阳，所以必须用下行的附子来回阳，这是从阴引阳。阳明所谓的亡阳，是后天的胃脘之阳，取甘草、干姜来回阳，这是顺从中焦之气。大概桂枝的药性辛散，走窜而不守静，即使佐以芍药，仍能导致亡阳；干姜的味道苦辛，守静而不走窜，所以以甘草为君药，便能回阳。然而先天太阴、少阴的阳气不易回复，一旦回复则诸症悉解。后天阳明之阳虽然容易回复，但回复后前症仍在，变症又起，所以更作芍药甘草汤接续治疗。大概脾主四肢，胃主津液，阳盛阴虚，脾不能为胃行津液以灌溉四旁，所以足部抽筋拘急。用甘草来生阳明之津，芍药来和太阴之液，脚部就能伸展，这也是用阴和阳的方法。
如果因为姜、桂遗留的热邪，导致胃热而出现谵语，少量给予调胃承气汤来调和它，依靠硝石、大黄来对抗姜、桂，仍然不失为阳明顺从中焦治法的原则。只因为两阳合明的部位，气血俱多的经脉，所以不妨碍用轻微的寒凉药来清泻，用轻微的泻下药来通利，与其他经亡阳后的调理不同。甘草干姜汤，具备了理中汤的一半功效，取其守中，不需要它补中；芍药甘草汤，减去桂枝汤的一半，用其调和里气，不取其攻表。这是张仲景加减法中隐晦而未宣示的奥妙。
白虎加人参汤：
石膏 知母 甘草 粳米 人参
外邪刚刚解除，热邪结聚在体内，表里俱热，脉象洪大，大汗出，严重烦躁和口渴，想要喝几升水的，这是阳明无形之热。此方是清肃气分的药剂。大概胃中糟粕燥结，宜用苦寒壮水的方法来克制土邪；如果胃口清气受伤，宜用甘寒泻火的方法来保护金气。要知道承气类的药物，直行而下泄，如果胃家未实而攻下，津液先亡，反从火化，所以在妄下之后，往往反而导致胃实的祸患，内经所说“味过于苦，脾气不濡，胃气反浓”就是这个意思。治法应当助脾家之湿土，以制约胃家燥火之上炎。《内经》说“甘先入脾”。又说“以甘泻脾”。又说“脾气散津，上归于肺”，甘寒之品，乃是土中泻火而生津液的上佳药剂。石膏大寒，寒能胜热，味甘归脾，性沉而主降，已具备秋金的形体，色白通肺，质地重而含津液，已具备生水的作用。知母气寒主降，味辛能润，泄肺火而润肾燥，滋肺金生水之源。甘草在土中泻火，缓和寒药的寒性，用作舟楫，沉降之性，才能在胃中停留。粳米稼穑作甘，培补形气而生津血，用来奠安中宫，阴寒之品，就没有损伤脾胃的顾虑了。饮入于胃，输布给脾，回归于肺，水精四布，烦渴即可消除。更加人参的原因，是因为气为水之母，邪气聚集的地方，正气必然虚弱，阴虚则无气，在这大寒剂中，必须得到人参的力量，以大补真阴，阴气恢复而津液自然生成。如果是身体强壮的人，元气未伤，津液未竭，不大渴的，只需滋阴以抑阳，不必加参而益气。如果元气已经亏损的，只用纯阴的药剂，火去而气无法生成，只有加人参，则火泻而土不伤，又使金能得到气，这才是立法的尽善尽美吧！此方重在烦渴，说明热已入里，如果伤寒脉浮，发热无汗恶寒表不解的，不可服用。如果不恶寒而渴的，虽然表证未全解，如背部轻微恶寒、时时恶风的，也使用它。如果没有汗、烦渴而表不解的，是麻黄杏子甘草石膏汤证。如果小便不利，发热而渴，想喝水的，又是五苓散、猪苓汤的适应了。如果是太阳阳明疟疾，热多寒少，口燥舌干，脉洪大的，虽然不得汗，服用它反而汗出而解。陶氏认为立夏后立秋前天时不热就拘泥不用，误导人最甚。哪里知道方剂是因症而立，不是因时令用药。
竹叶石膏汤：
竹叶 石膏 人参 甘草 半夏 麦冬 粳米
这是加减人参白虎汤。三阳合病，脉浮大，在关上，只想睡觉而不能安睡，闭眼就出汗的，适宜以此方为主治。如果用于伤寒解后，身体虚弱消瘦、少气、气逆想吐的，那就错得很厉害了。三阳合病，头项痛而胃家实，口苦、咽干、目眩的就是。脉浮为阳，大为阳，是三阳合病的常脉。现在脉在关上，病机在肝胃两部了。凡是胃不和，则卧不安，如肝火旺则上走空窍，也不能睡觉。肾主五液，入心为汗，血与汗，异名同类，所以汗即血。心主血而肝藏血，人卧则血归于肝。闭眼即出汗的，是肝有相火，窍闭则火无从发泄，血不得归肝，心不得主血，所以发而为汗。这种汗不由心发出，所以称之为盗汗。这是肝的病变，所以用竹叶为引导，因为它秉承东方的青色，入通于肝。大寒之气，足以泻肝家之火，用麦冬佐人参以通血脉，佐白虎以回津，所以能止盗汗。半夏禀一阴之气，能通行阴之道，其味辛，能散阳跷之满，用以引导卫气从阳入阴，阴阳通，睡眠立即到来，汗自然停止。为什么要去掉知母呢？三阳合病而遗尿，是肺气不收，导致少阴之津不升，所以借知母以上滋手太阴，知母外皮毛而内白润，是肺的润药。此三阳合病而盗汗出，是肝火不宁，令少阴之精妄泄，既然不能再濡养少阴之津，又不能再泄皮毛之泽，所以用麦冬来代替它吗？
茵陈蒿汤：
茵陈 栀子 大黄
太阳阳明都有发黄的病症，但只有头部出汗而身上无汗，则热邪不能向外发散，小便不利，则热邪不能向下排泄，所以瘀热在体内而口渴想喝水。然而黄色有所不同，病在太阳之表，应当发汗来解散，所以用麻黄连翘赤小豆汤，是凉散法；病在太阳阳明之间，应当以寒胜之，用栀子柏皮汤，是清火法；病在阳明之里，应当从内部泻下，所以设立本方，是逐秽法。茵陈秉承北方的颜色，经冬不凋，傲霜凌雪，经历遍冬寒之气，所以能除去热邪留结。佐以栀子来通水源，大黄来除胃热，令瘀热从小便排泄，腹部胀满自然减轻，肠胃不受伤害。仍然符合“引而竭之”的意义，也是阳明利水的奇特方法。
张仲景治疗阳明渴饮有四法：本太阳转属而来的，五苓散微发汗以散水气；大烦躁渴，小便自利的，白虎加人参汤，清火而生津；脉浮发热，小便不利的，猪苓汤滋阴而利水；小便不利腹满的，茵陈蒿汤以泄满，令黄色从小便排出。病情不同，治法也不同。我私下思考张仲景利小便必用化气之品，通大便必用承气之味。所以小便不利者，必加茯苓，严重的兼用猪苓，因为二苓是化气之品，而小便由于气化所致。此次小便不利，不用二苓是什么原因？本论的阳明病，出汗多而渴的，不可与猪苓汤，因为出汗多胃中燥，猪苓又利小便的缘故。由此可知阳明病出汗多而渴的，不可用，那么不出汗而渴的，津液先虚，更不可用也就很明白了。所以用推陈致新的茵陈，佐以屈曲下行的栀子。不用枳实、厚朴来承气，与芒硝的峻利，那么大黄只可以用来润胃燥，而大便的快速通行就可知了。所以必须过一夜腹部才减轻，黄色从小便去而不由大肠排出。张仲景立法神奇，非常人所能思议。
大承气汤：
大黄 芒硝 枳实 厚朴
小承气汤：
大黄 枳实 厚朴
治疗阳明实热，肠道不通，燥屎为患。其外症身热出汗，不恶寒反而恶热，日晡潮热，手足濈然汗出，或者不了了。其内症六七天不大便，起初想吃东西反而不能吃，腹部胀满绕脐痛，烦躁谵语，发作有时，气喘头晕不能卧床，腹部转动矢气，或者咽燥口干，心下痛，自利纯清水，或者汗吐下后热不解，仍不大便，或者下利谵语，其脉实或滑而数的，大承气汤主治。如果大便不甚坚硬的，小承气汤轻微调和它。如果大便燥硬而证候不剧烈的，调胃承气汤调和它。如果出汗多微发热，恶寒未罢，腹部不胀满，热不潮，屎未坚硬，初硬后溏，其脉弱或微满的，不可用。各种病皆因于气，秽物之不去，由于气之不顺，所以攻积之剂必用行气之药来主导。亢则害，承乃制，这就是承气名字的由来。又病去而元气不伤，这就是承气的含义。方分大小，有两层含义：厚朴倍于大黄，是气药为君，名叫大承气；大黄倍于厚朴，是气药为臣，名叫小承气。味多、性猛、制大，其服用目的是令泄下，所以名叫大；味少、性缓、制小，其服用目的是轻微调和胃气，所以名叫小。两方煎法不同，更有奥妙。大承气用水一斗，先煮枳实、厚朴，煮取五升，加入大黄，煮取三升，加入芒硝，因为药物的性质，生的锐利而先行，熟的氣纯而和缓。张仲景想让芒硝先化解燥屎，大黄继通地道，而后枳实、厚朴消除痞满。制剂缓慢者，
Yangming disease is located in the excess syndrome of the Stomach, so purgation should be the standard treatment. However, Yangming resides in the center, and various diseases converge here; therefore, all treatment methods are complete. For instance, regarding excessive sweating versus no sweating, Ma Huang Tang (Ephedra Decoction) or Gui Zhi Tang (Cinnamon Twig Decoction) are selected respectively; for pathogenic factors in the chest or abdomen, Gua Di San (Melon Seed Powder) or Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) are chosen respectively; for initial hardness, dryness, and firmness of stool, Da Cheng Qi Tang (Major Order the Qi Decoction) or Xiao Cheng Qi Tang (Minor Order the Qi Decoction) are used respectively. Even when employing the three methods of sweating, vomiting, and purging, there are differences in severity and depth. If severe restlessness and thirst occur, Bai Hu Tang (White Tiger Decoction) is used; if jaundice results from blood stasis, Yin Chen Hao Tang (Artemisia Capillaris Decoction) is used; if urination is difficult, Zhu Ling Tang (Polyporus Decoction) is used; if fluid retention fails to dissipate, Wu Ling San (Five-Ingredient Powder with Poria) is used; if eating leads to a desire to vomit, Wu Zhu Yu Tang (Evodia Decoction) and other methods are employed. None of these lack their specific hierarchy.
Using chess as a metaphor: sweating is the opening move (first move), inducing vomiting is the critical move (key move), clearing fire is the steady move (stable move), promoting urination is the idle move (leisurely move), warming and tonifying is the desperate move (move made under pressure), and purging is the final move (last resort). When the disease reaches the stage requiring purging, there are no other moves left. Therefore, if sweating is performed correctly, other moves are unnecessary. Using the vomiting method, although it is a surprise move, is already the second move. Other moves are not orthodox moves; only purging is the decisive move, which is also due to previous errors in treatment. However, since all methods are established based on clearing fire, is clearing fire the superior move for Yangming?
Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction)
Zhi Zi Gan Cao Chi Tang (Gardenia, Licorice, and Fermented Soybean Decoction)
Zhi Zi Sheng Jiang Chi Tang (Gardenia, Ginger, and Fermented Soybean Decoction)
Zhi Zi Hou Po Tang (Gardenia and Magnolia Bark Decoction):
Zhi Zi (Gardeniae Fructus) Hou Po (Magnoliae Officinalis Cortex) Zhi Shi (Aurantii Fructus Immaturus)
Zhi Zi Gan Jiang Tang (Gardenia and Dried Ginger Decoction)
Zhi Zi Bai Pi Tang (Gardenia and Phellodendron Bark Decoction):
Zhi Zi (Gardeniae Fructus) Bai Pi (Phellodendri Cortex) Gan Cao (Glycyrrhizae Radix et Rhizoma)
This is a harmonizing decoction for inducing vomiting and draining heat in the half-exterior/half-interior syndrome of Yangming. In Shaoyang, the half-exterior is cold, and the half-interior is hot. However, in Yangming, heat radiates from the interior to the exterior, presenting heat without cold. Thus, its exterior symptoms include fever, sweating, aversion to cold being absent but aversion to heat present, heaviness of the body, or eye pain, nasal dryness, and insomnia; its interior symptoms include dry throat, bitter taste in the mouth, changes in tongue coating, restlessness, desire to drink water, mental vexation and discomfort (Ao Nao), abdominal fullness, and wheezing. This indicates that the heat is half in the exterior and half in the interior. Although the pulse may be floating and tight, it cannot be diagnosed as Taiyang disease, nor is it suitable for diaphoretic agents. Furthermore, since the pathogen is in the chest and abdomen and has not yet entered the Stomach Fu organ, purgation is not indicated. The treatment method should employ inducing vomiting and draining heat to disperse the pathogen. Zhi Zi (Gardeniae Fructus) is bitter and can drain heat, and cold and can overcome heat. Its shape resembles the Heart, and its red color connects to the Heart; thus, it treats all symptoms above and below in the Heart region. Dou (Soybean) resembles the Kidney, and its black color enters the Kidney. After processing into Chi Shi (Fermented Soybean), it becomes light and floats upward, enabling the turbid pathogens in the Heart and abdomen to exit through the mouth. One episode of vomiting relieves the Heart and abdomen, eliminating all exterior and interior vexation and heat. This is because "diseases of the two Yang originate from the Heart and Spleen." Among the aforementioned symptoms, these are Heat of the Heart, not Heat of the Stomach house. This refers to what the Canon states: "If heat belongs to the Zang organs, attack it; do not induce sweating." If heat damages Qi leading to shortness of breath, add Gan Cao (Glycyrrhizae Radix et Rhizoma) to tonify Qi; if deficiency-heat struggles causing frequent vomiting, add Sheng Jiang (Zingiberis Rhizoma Recens) to disperse pathogens. This establishes the principle for cases complicated by deficiency. If there is pre-existing food stagnation, add Zhi Shi (Aurantii Fructus Immaturus) to descend it; if the intestinal pathway is blocked, add Da Huang (Rhei Radix et Rhizoma) to moisten and unblock. This establishes the principle for excess-heat cases. He Suhe used this to treat recurrence after labor following the resolution of Taiyang disease, which was a significant error. If after mistaken purgation, there is vexation, abdominal fullness, and restlessness in sitting and lying down, the heat has entered the Stomach, and vomiting is inappropriate; thus, remove Xiang Chi (Fermented Soybean). Since Heart heat is unresolved, further purgation is unsuitable; therefore, use only Zhi Zi (Gardeniae Fructus) to relieve vexation, assisted by Zhi Shi (Aurantii Fructus Immaturus) and Hou Po (Magnoliae Officinalis Cortex) to drain fullness. This is a subtle method of resolving both Heart and abdomen, representing a variation of Xiao Cheng Qi Tang (Minor Order the Qi Decoction). If pill-based purgatives were used, resulting in slight mental vexation and persistent external heat, it indicates cold pathogens retained in the middle while heat remains in the upper Jiao. Thus, Zhi Zi (Gardeniae Fructus) is used to relieve vexation, and Gan Jiang (Zingiberis Rhizoma) is used to drive out internal cold to disperse external heat. This is a modification of Gan Cao Xie Xin Tang (Licorice Decoction to Drain the Epigastrium). If jaundice of the muscles occurs due to Cold Damage, it means the cold pathogen has resolved but heat cannot vent; both exterior and interior heat should be resolved. Thus, Zhi Zi (Gardeniae Fructus) is used to remove internal vexation, Bai Pi (Phellodendri Cortex) to scatter external heat, and Gan Cao (Glycyrrhizae Radix et Rhizoma) to harmonize. This is a mild version of Yin Chen Hao Tang (Artemisia Capillaris Decoction). These are all modifications of Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) to manage the变幻 (changes) of Yangming exterior syndromes.
The nature of Zhi Zi (Gardeniae Fructus) allows it to curve and descend; it is not an emetic agent. Only the fermented aroma of Chi Shi (Fermented Soybean) rises to熏 (fumigate) the Heart and Lungs, causing vomiting. Observing that Gua Di San (Melon Seed Powder) must be taken with Chi Shi juice, we see that the vomiting effect lies in the Chi Shi (Fermented Soybean), not the Zhi Zi (Gardeniae Fructus). Observing that Zhi Zi Gan Jiang Tang (Gardenia and Dried Ginger Decoction) removes Chi Shi (Fermented Soybean) and uses Jiang (Ginger), it seeks horizontal dispersion. Observing that Zhi Zi Hou Po Tang (Gardenia and Magnolia Bark Decoction) replaces Chi Shi (Fermented Soybean) with Zhi Shi (Aurantii Fructus Immaturus) and Hou Po (Magnoliae Officinalis Cortex), it seeks downward drainage. Both demonstrate the intention not to cause upward evacuation. Old editions state after these two formulas "stop taking after vomiting," which is absurd. Observing Zhi Zi Bai Pi Tang (Gardenia and Phellodendron Bark Decoction) and Yin Chen Hao Tang (Artemisia Capillaris Decoction), both contain Zhi Zi (Gardeniae Fructus) but do not mention vomiting. Additionally, it is contraindicated for patients with chronic loose stools, clarifying the nature of Zhi Zi (Gardeniae Fructus).
Gua Di San (Melon Seed Powder):
Gua Di (Momordicae Fructus) Chi Xiao Dou (Vigna umbellata Seed) Xiang Chi (Fermented Soybean)
This is a harsh emetic-draining agent for Yangming, treating pathogenic factors knotted in the chest. The chest is the clear and empty mansion, where the Three Yang receive Qi, and Ying and Wei circulate. Cold pathogens condense here, preventing Stomach Qi from ascending and internal heat from reaching the exterior, resulting in palpitations and hardness. When Qi rushes up to the throat causing breathing difficulty, this is cold blocking upwards; a slightly floating pulse at the Cun position indicates cold binding externally. This cold is not in the Ying and Wei levels, so sweating methods cannot treat it. By using sour and bitter emetic-draining substances, the pathogen is induced to vomit upwards. The Upper Jiao becomes open, Middle Qi reaches out, Chest Yang recovers, and Lung governance functions resume, allowing palpitations and hardness to dissipate. Gua Di (Momordicae Fructus) is green, symbolizing the transformation of East Wood (Jia Wood), possessing the spring-rising and generating mechanism. It can lift Stomach Yang to eliminate chest cold and heat, making it the premier emetic. However, its nature is mobile and non-staying, unlike Zhi Zi (Gardeniae Fructus) which stays and does not move. Therefore, it must be combined with Grain Qi to harmonize. Chi Xiao Dou (Vigna umbellata Seed) resembles the Heart in form and color; its sweet and sour taste protects Heart Qi. Hei Dou (Black Soybean) resembles the Kidney in form and color; its nature is heavy, but fermentation makes it light, allowing Kidney Essence to connect with the Heart and Stomach Turbidity to exit via the mouth. Cooked into a thin porridge and taken with the two ingredients, it induces rapid vomiting without damaging Shen (Spirit), achieving results faster than sweating or purging. The previous formula pairs Zhi Zi (Gardeniae Fructus) with Chi Shi (Fermented Soybean); this formula pairs Chi Xiao Dou (Vigna umbellata Seed) with Chi Shi (Fermented Soybean), both using form and color to signify the intersection of Heart and Kidney.
If one feels nauseous and wants to vomit but cannot, and upon onset has cold hands and feet and a string-tight, slow pulse, because the abdomen is not full, it cannot be diagnosed as Taiyin disease. One knows it is Shaoyin disease only by the desire to sleep. The pathology is not in the Upper Jiao but in the chest, providing a rationale for using vomiting. Disease in Shaoyin usually requires tonification, not purgation, but vomiting and purging are applicable here because the excess is real. Excess in the chest warrants vomiting; excess in the Stomach Fu warrants purging. These are combined Shaoyin-Yangming diseases, where vomiting and purging still belong to Yangming methods. If a patient has cold hands and feet, a suddenly tight pulse, epigastric fullness and vexation, hunger but inability to eat, this is a combined Jueyin-Yangming disease. Originating in Jueyin, but real pathogens knotting in Yang positions, acute treatment addresses the branch, following Yangming emetic methods. See General Principles of Formula Formulation for further meanings.
Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction)
Shao Yao Gan Cao Tang (Peony and Licorice Decoction):
These two formulas are designed for variations caused by mistakenly administering Gui Zhi Tang (Cinnamon Twig Decoction) in Yangming half-exterior/half-interior syndromes. Gui Zhi Tang (Cinnamon Twig Decoction) is originally for Wind Strike with spontaneous sweating. If Yangming disease presents with profuse sweating, slight aversion to cold, and no interior symptoms, the exterior is unresolved, so Gui Zhi Tang (Cinnamon Twig Decoction) can be used to sweat. A slow pulse is similar to the moderate pulse of Wind Strike, equivalent to a floating and weak pulse. If the pulse is merely floating, in Taiyang it implies no sweating, while in Yangming it implies night sweating. Thus, a floating pulse with spontaneous sweating in Cold Damage indicates Yangming heat flooding internally, not a Taiyang exterior floating pulse. Vexation indicates pathogen invading the Ying area; the Heart meridian connects to the Small Intestine, so Heart vexation causes Small Intestine heat and frequent urination. Slight aversion to cold and leg cramps indicate aversion to cold will cease; the Duyang pulse shows blood deficiency and tendon tension due to intense heat, causing leg cramps. This disease is in the half-exterior/half-interior; Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) would cure it. Instead, using Gui Zhi Tang (Cinnamon Twig Decoction) to attack the exterior causes excessive sweating and loss of Yang. Stomach Yang cannot reach the limbs, causing cold extremities; deficient Yang fails to return to its place, causing dry throat, vomiting, counterflow qi, and vexation. Desperate circumstances require using heat to treat heat, saving the error of Gui Zhi Tang (Cinnamon Twig Decoction) by restoring Yang. However, Yang loss is actually due to Yin deficiency lacking attachment, necessitating methods to nourish fluids and astringe blood to tonify Yin. Thus, Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction) restores warmth to the extremities, followed by Shao Yao Gan Cao Tang (Peony and Licorice Decoction) to extend the legs. Shao Yao (Paeoniae Radix Alba) is sour and cold, stopping vexation, astringing spontaneous sweating, and benefiting urination. Gan Cao (Glycyrrhizae Radix et Rhizoma) is sweet and neutral, relieving vexation, harmonizing Liver Blood, and relaxing tendon tension. This is another method of internal regulation to resolve external issues.
Zhong Jing often uses Fu Zi (Aconiti Lateralis Radix Praeparata) to restore Yang; here, Gan Jiang (Zingiberis Rhizoma) and Gan Cao (Glycyrrhizae Radix et Rhizoma) are used to demonstrate Yangming treatment principles. The "loss of Yang" in Taiyang-Shaoyin refers to Primordial Yang, requiring descending Fu Zi (Aconiti Lateralis Radix Praeparata) to restore it, drawing Yang from Yin. The "loss of Yang" in Yangming refers to Postnatal Stomach Yang, restored by Gan Cao (Glycyrrhizae Radix et Rhizoma) and Gan Jiang (Zingiberis Rhizoma), following the Middle Jiao. Gui Zhi (Cinnamomi Ramulus) is acrid and dispersing, mobile and non-staying; even with Shao Yao (Paeoniae Radix Alba), it can cause Yang loss. Gan Jiang (Zingiberis Rhizoma) is bitter and acrid, staying and non-mobile; with Gan Cao (Glycyrrhizae Radix et Rhizoma) as sovereign, it restores Yang. Primordial Taiyang-Shaoyin Yang is hard to restore; once restored, all symptoms resolve. Postnatal Yangming Yang is easier to restore, but if prior symptoms persist and new ones arise, Shao Yao Gan Cao Tang (Peony and Licorice Decoction) follows. The Spleen governs the four limbs, the Stomach governs fluids. Yang excess and Yin deficiency mean the Spleen cannot transport fluids for the Stomach to irrigate the periphery, causing leg cramps. Gan Cao (Glycyrrhizae Radix et Rhizoma) generates Yangming fluids; Shao Yao (Paeoniae Radix Alba) harmonizes Taiyin fluids, extending the legs. This is using Yin to harmonize Yang.
If residual heat from Jiang (Ginger) and Gui (Cinnamon) causes Stomach heat and delirious speech, a small amount of Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction) harmonizes it. Relying on Xiao Ming (Natrii Sulfas) and Da Huang (Rhei Radix et Rhizoma) to counteract Jiang and Gui, it remains a Yangming treatment following the Middle. Because this is the location of Two Yang combining, a meridian with abundant Qi and Blood, mild cold and mild purgation are acceptable, differing from regulating loss of Yang in other meridians. Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction) takes half of Li Zhong Tang (Regulate the Middle Decoction), focusing on stabilizing the middle without tonifying it. Shao Yao Gan Cao Tang (Peony and Licorice Decoction) reduces Gui Zhi Tang (Cinnamon Twig Decoction) by half, using it to harmonize the interior rather than attack the exterior. These are the hidden, unspoken reduction and addition methods of Zhong Jing.
Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng):
Shi Gao (Gypsum Fibrosum) Zhi Mu (Anemarrhenae Rhizoma) Gan Cao (Glycyrrhizae Radix et Rhizoma) Geng Mi (Oryza Sativa Grain) Ren Shen (Panacis Ginseng Radix)
After initial resolution of external pathogens, heat knots internally, causing simultaneous exterior and interior heat, a洪大 (surging-large) pulse, profuse sweating, severe vexation and thirst, desiring to drink several liters of water. This is formless heat of Yangming. This formula clears and purifies the Qi level. Generally, if dry feces knot in the Stomach, bitter-cold substances strengthening Water to control Earth are needed. If Clear Qi of the Stomach mouth is damaged, sweet-cold substances clearing Fire protecting Metal are needed. Note that Cheng Qi (Order the Qi) agents act directly downward. If purged before the Stomach House is solid, fluids perish first, transforming into fire. Thus, after mistaken purgation, Stomach excess often results, as stated in the Classic: "Excessive bitterness renders Spleen Qi damp-less and Stomach Qi thick." The method should assist Spleen Wet Earth to control Stomach Dry Fire rising. The Classic says: "Sweet first enters the Spleen." Also: "Use Sweet to drain the Spleen." Also: "Spleen Qi scatters fluids, returning them to the Lung." Sweet-cold substances are the superior agents for draining fire in Earth and generating fluids. Shi Gao (Gypsum Fibrosum) is greatly cold, overcoming heat; sweet, entering the Spleen; heavy and descending, possessing the form of Autumn Metal; white color connecting to the Lung; heavy texture containing fluids, possessing the function of generating Water. Zhi Mu (Anemarrhenae Rhizoma) is cold and descending; acrid and moistening; drains Lung Fire and moistens Kidney Dryness; nourishes Lung Metal, the source of generating Water. Gan Cao (Glycyrrhizae Radix et Rhizoma) drains fire in Earth, moderates the cold of cold herbs, acting as a boat and oar, allowing its sinking nature to linger in the Stomach. Geng Mi (Oryza Sativa Grain) is sweet from cultivation, nurturing form and Qi, generating fluids and blood, anchoring the Central Palace, ensuring cold herbs do not damage the Spleen and Stomach. Drinking enters the Stomach, transmits to the Spleen, returns to the Lung, fluids distribute everywhere, and vexation/thirst are removed. Ren Shen (Panacis Ginseng Radix) is added because Qi is the mother of Water; where pathogens gather, Qi is deficient; Yin deficiency leads to Qi deficiency. In this great cold formula, Ren Shen (Panacis Ginseng Radix) is essential to greatly tonify True Yin; as Yin recovers, fluids generate naturally. For robust individuals with undamaged Yuan Qi and fluids, who are not very thirsty, only Yin-nourishing to suppress Yang is needed, without adding Ren Shen (Panacis Ginseng Radix) to tonify Qi. For those with depleted Yuan Qi, using pure Yin agents removes fire but leaves no way for Qi to generate; adding Ren Shen (Panacis Ginseng Radix) ensures fire is drained without injuring Earth, and Metal receives Qi, perfecting the formulation. This formula focuses on vexation and thirst, indicating heat has entered the interior. If Cold Damage presents with floating pulse, fever, no sweating, aversion to cold, and unresolved exterior, it is contraindicated. If there is no aversion to cold but thirst, even if the exterior is not fully resolved, such as slight back aversion to cold or occasional wind aversion, it is used. If there is no sweating, vexation, thirst, and unresolved exterior, it is Ma Huang Xing Zi Gan Cao Shi Gao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction). If urination is difficult, fever, thirst, and desire to drink, it is Wu Ling San (Five-Ingredient Powder with Poria) or Zhu Ling Tang (Polyporus Decoction). For Taiyang-Yangming malaria with more heat than cold, dry mouth/tongue, and surging-large pulse, even without sweating, it induces sweating and resolution. Tao's restriction against using it when weather is not hot between Start of Summer and Start of Autumn is misleading. Formulas are established based on symptoms, not seasons.
Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction):
Zhu Ye (Bambusae Folium) Shi Gao (Gypsum Fibrosum) Ren Shen (Panacis Ginseng Radix) Gan Cao (Glycyrrhizae Radix et Rhizoma) Ban Xia (Pinelliae Rhizoma) Mai Dong (Ophiopogonis Radix) Geng Mi (Oryza Sativa Grain)
This is a modified Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction). In combined Three Yang disease, with a floating-large pulse at the Guan position, drowsiness without ability to sleep, and sweating upon closing eyes, this formula is indicated. Using it for post-Cold Damage weakness, thinness, shortness of breath, and counterflow qi wanting to vomit is a major error. Combined Three Yang disease involves head/neck pain, Stomach excess, bitter taste, dry throat, and vertigo. Floating pulse is Yang, large pulse is Yang; these are common pulses for combined Three Yang disease. Now at the Guan position, the pathology is in the Liver and Stomach. Whenever Stomach is disharmonious, sleep is disturbed; if Liver Fire flares upwards to orifices, sleep is impossible. The Kidney governs five fluids; entering the Heart, they become sweat. Blood and sweat are different names for the same substance; thus, sweat is blood. The Heart governs blood, the Liver stores blood; when sleeping, blood returns to the Liver. Sweating upon closing eyes indicates Liver Ministerial Fire; orifices closed prevent fire venting, blood cannot return to Liver, Heart cannot govern blood, resulting in sweat. This sweat does not originate from the Heart, hence called "stealing sweat" (Dao Han). This is a Liver pathology, so Zhu Ye (Bamboo Leaf) guides, possessing Eastern Green color connecting to the Liver. Great cold energy drains Liver Fire. Mai Dong (Ophiopogonis Radix) assists Ren Shen (Panacis Ginseng Radix) to unblock vessels and Bai Hu Tang to restore fluids, stopping stealing sweat. Ban Xia (Pinelliae Rhizoma) inherits Yin Qi, unblocking Yin pathways; its acrid taste disperses Yang Qiao fullness, guiding Wei Qi from Yang to Yin. When Yin and Yang connect, sleep comes immediately, and sweat stops. Why remove Zhi Mu (Anemarrhenae Rhizoma)? In combined Three Yang disease with enuresis, Lung Qi fails to收 (gather), preventing Shaoyin fluids from ascending; Zhi Mu (Anemarrhenae Rhizoma) nourishes Hand Taiyin. Zhi Mu (Anemarrhenae Rhizoma) moistens skin/hair externally and is white/moist internally, a Lung moistener. In this combined Three Yang disease with stealing sweat, Liver Fire unsettles, causing Shaoyin essence to leak wantonly. Since Shaoyin fluids cannot be re-moistened, and skin moisture cannot be further leaked, Mai Dong (Ophiopogonis Radix) replaces it.
Yin Chen Hao Tang (Artemisia Capillaris Decoction):
Yin Chen (Artemisiae Scopariae Herba) Zhi Zi (Gardeniae Fructus) Da Huang (Rhei Radix et Rhizoma)
Both Taiyang and Yangming have jaundice syndromes. If only the head sweats and the body does not, heat cannot vent outward; if urination is difficult, heat cannot drain downward. Thus, stagnant heat remains inside, causing thirst for drinks. Jaundice varies: if in Taiyang exterior, sweat to release; use Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Adzuki Bean Decoction), a cool-dispersing method. If between Taiyang and Yangming, overcome with cold; use Zhi Zi Bai Pi Tang (Gardenia and Phellodendron Bark Decoction), a fire-clearing method. If in Yangming interior, purge internally; establish this formula, a filth-removing method. Yin Chen (Artemisiae Scopariae Herba) inherits Northern color, does not wither in winter, braves frost and snow, experiencing winter cold, thus removing lingering heat pathogens. Assisted by Zhi Zi (Gardeniae Fructus) to open water sources, Da Huang (Rhei Radix et Rhizoma) to remove Stomach heat, letting stagnant heat drain via urine, reducing abdominal fullness without harming intestines/stomach. It aligns with "guide and exhaust," a unique Yangming diuretic method.
Zhong Jing has four methods for Yangming thirst/desire to drink: Transferred from Taiyang, Wu Ling San (Five-Ingredient Powder with Poria) mildly sweats to disperse water; Severe vexation/thirst with normal urination, Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng) clears fire and generates fluids; Floating pulse, fever, difficult urination, Zhu Ling Tang (Polyporus Decoction) nourishes Yin and promotes urination; Difficult urination with abdominal fullness, Yin Chen Hao Tang (Artemisia Capillaris Decoction) drains fullness, expelling yellow via urine. Different conditions require different treatments. I ponder that Zhong Jing always uses Qi-transforming substances for diuresis and Cheng Qi (Order the Qi) flavors for bowel movement. Thus, for difficult urination, Fu Ling (Poria) is added; severely, Zhu Ling (Polyporus) is combined, as these transform Qi, and urination depends on Qi transformation. Why not use these two Ling here? The Canon states Yangming disease with profuse sweating and thirst cannot take Zhu Ling Tang (Polyporus Decoction) because profuse sweating causes Stomach dryness, and Zhu Ling (Polyporus) further promotes urination. Thus, Yangming with profuse sweating and thirst is contraindicated; therefore, Yangming without sweating but with thirst, where fluids are initially deficient, is definitely contraindicated. Hence, Tu Chen Zhi Xin (Pushing out the old, bringing forth the new) Yin Chen (Artemisiae Scopariae Herba) is assisted by Qu Qu Xia Xing (Curving and descending) Zhi Zi (Gardeniae Fructus). Without Zhi Shi (Aurantii Fructus Immaturus) and Hou Po (Magnoliae Officinalis Cortex) to order Qi, or Mang Xiao (Natrii Sulfas) for harsh purgation, Da Huang (Rhei Radix et Rhizoma) only moistens Stomach dryness, and rapid bowel movement is known. Thus, abdominal fullness reduces only after a night, and yellow exits via urine, not the Large Intestine. Zhong Jing's legislation is miraculous, beyond ordinary thought.
Da Cheng Qi Tang (Major Order the Qi Decoction):
Da Huang (Rhei Radix et Rhizoma) Mang Xiao (Natrii Sulfas) Zhi Shi (Aurantii Fructus Immaturus) Hou Po (Magnoliae Officinalis Cortex)
Xiao Cheng Qi Tang (Minor Order the Qi Decoction):
Da Huang (Rhei Radix et Rhizoma) Zhi Shi (Aurantii Fructus Immaturus) Hou Po (Magnoliae Officinalis Cortex)
Treats Yangming excess-heat, unblocked intestinal pathway, and dry feces pathology. Exterior symptoms: fever, sweating, absence of aversion to cold but presence of aversion to heat, afternoon tidal fever, continuous sweating on hands and feet, or vague sensations. Interior symptoms: no bowel movement for 6-7 days, initial desire to eat turning to inability to eat, abdominal fullness and periumbilical pain, vexation, delirious speech, occurring at times, wheezing and dizziness preventing lying down, passing gas in abdomen, or dry throat/mouth, epigastric pain, spontaneous diarrhea of pure clear water, or persistent heat after sweating/vomiting/purging with continued constipation, or diarrhea with delirium. Pulse is excess, slippery, or rapid. Da Cheng Qi Tang (Major Order the Qi Decoction) is primary. If stool is not very hard, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) mildly harmonizes. If stool is dry/hard but syndrome is not severe, Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction) harmonizes. If profuse sweating, slight fever, unresolved aversion to cold, non-full abdomen, non-tidal heat, soft stool (hard then loose), weak or slightly full pulse, it is contraindicated. All diseases stem from Qi; waste removal depends on smooth Qi flow. Thus, accumulation-purgative agents must use Qi-moving drugs as sovereign. "Hyperactivity brings disaster, succession brings restraint"; this is the origin of "Cheng Qi" (Order the Qi). Also, disease resolves without damaging Yuan Qi; this is the meaning of "Cheng Qi". The distinction between Major and Minor has two meanings: Hou Po (Magnoliae Officinalis Cortex) double Da Huang (Rhei Radix et Rhizoma) makes Qi drug sovereign, named Major Cheng Qi; Da Huang (Rhei Radix et Rhizoma) double Hou Po (Magnoliae Officinalis Cortex) makes Qi drug minister, named Minor Cheng Qi. Many flavors, fierce nature, large dosage aim for purgation, hence Major; few flavors, mild nature, small dosage aim to mildly harmonize Stomach Qi, hence Minor. Decoction methods differ significantly. Da Cheng Qi Tang (Major Order the Qi Decoction) uses one dou of water, first decocting Zhi Shi (Aurantii Fructus Immaturus) and Hou Po (Magnoliae Officinalis Cortex) to five sheng, adding Da Huang (Rhei Radix et Rhizoma) to three sheng, then adding Mang Xiao (Natrii Sulfas). Drug nature: raw is sharp and acts first, cooked is pure in aroma and acts gently. Zhong Jing intends Mang Xiao (Natrii Sulfas) to first dissolve dry feces, Da Huang (Rhei Radix et Rhizoma) to subsequently unblock the pathway, then Zhi Shi (Aurantii Fructus Immaturus) and Hou Po (Magnoliae Officinalis Cortex) to remove palpitations/fullness. For slowly prepared agents,