谓之正阳明病。潮汗闭涩，满渴狂谵，尺脉实者，诸承气汤选用。如脉浮带呕，舌上白苔者，知邪未全入腑，
犹属半里，所谓呕家虽有阳明证，不可攻，舌上白苔未可攻者是也，宜与小柴胡汤，和其荣卫，通其津液，得
微汗而自解。然有数日不大便而烦闷甚者，虽尚有些表证，亦当与大柴胡汤，或小承气汤微润之。又阳明证汗
多，小便利而大便硬，或发汗利小便多而大便硬者，皆津液内竭，宜蜜导之。大便硬小便数者，乃为脾约，宜
麻子仁丸。大便坚小便少者，未可攻，津液未充，候其小便自如，乃可攻也。当问病患一日小便几行，若如常，
当知气已下行，大便不久自出。要知古人审用转药，若欲行大承气汤，当先一日用小承气汤，候其腹中转矢气。
转气者，腹中响而放屁，知其有燥粪，臭者有宿食，宜攻之。若不转矢气者，必先硬后溏，勿攻之。《金匮》
云∶六七日无所苦，不可攻。下之早，热气乘虚入胃，重者必死。又便闭屡下不通者，须吐以提之。阴结脉沉
迟，不渴不食，身重如石且冷，大便硬而艰难，非燥粪也，乃阴寒固结于胃，血气凝滞而闭塞也，宜四物汤、
附子汤，或金液丹、古半硫丸、五积散。如久不大便而脉反微涩者，里虚甚也，急以黄 建中汤救之。又有食
滞脾及血燥而不大便者，当于杂病伤食及燥门求之。
小便闭本下热，而亡津属阴难以渗疏。
伤寒邪在表则小便利，入里下焦有热，引饮过多，小腹胀硬，小便闭者，脉浮，五苓散；脉沉，猪苓汤。
大便乍难乍易而小便不利者，内有燥屎，大承气汤。若阳明汗多，或发汗，胃中津干不利者，切忌疏渗，待其
津液还而自通可也。汗下后，发热项强，头顶心痛，无汗，小便不利者，三白姜枣汤。半表证，小柴胡汤去芩
加茯苓。谵语身重者，柴胡龙骨牡蛎汤。少阴脉沉，小便不利者，玄武汤，或四逆汤加茯苓。少阴腹满痛，便
脓血，小便不利者，桃花散。又阴毒下利，小便不利，囊缩小腹痛欲死者，急与返阴丹暖药服之。若用寒凉之
药，阴气伏蓄小腹有至死者。或见小便不利，以炒盐熨脐下，阴气不散，被热物熨之，冷气冲心，亦有致死者。
凡小便闭而厥逆，头汗出者，阳脱关格，不治。水证、黄证、风温小便不利，见前。
水难阴虚，而阳邪凑袭；
小便难者，出不快也。经曰∶阳入阴分，则膀胱热而小便难。惟阴分虚而阳热乘之，不可强利，必小便黄
赤者，乃可万全，木通汤利之。如太阳汗不止者，桂枝汤加附子。阳明伤风，嗜卧身黄者，小柴胡汤加茯苓。
水利偏前，而后便干枯。
伤寒内热则小便闭，今反利者，膀胱主津液，而偏渗于前，宜乎后便干枯。有瘀血证，小腹硬满，其人如
狂者，抵当汤。有少阴证，厥逆脉沉者，四逆汤，或玄武汤去茯苓。有阳明证，自汗小便利而大便虽硬者，不
可攻，宜蜜导法，或猪胆汁灌之。有停水心悸者，茯苓桂甘汤。
膀胱移热，小便虽浊而不痛；
里和则小便清，里热则小便浊。膀胱移热于小肠则尿血，与赤浊相似，导赤散，或玄胡索散、朴硝二味等
分水煎服，或加川芎渗利之剂尤妙。此亦瘀血中之一证也。
肾虚协热，小便虽数而无余。
惟虚则小便频数，唯热则小便涩滞而不快。有宜温者，太阳自汗小便数者，虽有表证。不可桂枝重亡津液。
误服厥者，阳不足也，甘草干姜汤；心烦脚蜷者，血不足也，芍药甘草汤。有宜下者，谵语自汗小便数者，调
胃承气汤少与之。汗吐下后，小便数大便硬者，大柴胡汤。阳明汗多，小便数大便硬者，胃强脾约，乃约束津
液不行，宜脾约丸。余沥遗溺，见后危证。
协热自利而渴曰肠垢（肠间津汁垢腻），热甚纯下清泉；协寒自利不渴曰鸭溏（清白如鸭屎状），湿毒有
如豆汁。
阳证自利，溏泄身热，脐下亦热，作渴尿赤，后重泄下黄赤，故曰肠垢。阴证自利，太阴手足温，少阴、
厥阴手足厥冷，脐下亦冷，不渴，利下清白，故曰鸭溏。热因表邪入里，挟风则所下必暴；寒乃直中阴经。大
法热宜和解，或攻泄，或利小便；寒宜温中，或固下焦，俱不宜发汗，令胃气虚而胀满作。但自利旧分阳证、
阴证，又分协热、协寒，而治法相同。然阳证自利，亦必里气虚而表热乘之，乃能自利，虽太阳初证下利亦然，
与表邪传里协热下利无异。至于阴即协寒，其证尤显。所以云阳证下利误温，则发黄、斑出而死。此等支离去
处，每为详辨，庶不惑人。大概里气协热，下利黄赤者，黄芩汤最妙。带表口渴下利者，柴苓汤。少阴热证，
渴而下利者，白虎汤。少阴热证，咳而呕渴，心烦不得眠而下利者，猪苓汤。热甚口燥心痛，下利纯清水者，
大承气汤。潮热谵语脉滑，有宿食者，大柴胡汤，或陶氏黄龙汤。下利脉和者，内实；下利脉滑，或浮大按之
反涩，不欲食者，有宿食，并宜下之。又太阳初伤风，下利不恶寒，头痛干呕，心痞腹痛者，桂枝汤加芫花，
或十枣汤。胃不和，肠鸣下利者，生姜泻心汤。小便涩大便利者，赤石脂丸。下利频而溺如常者自止，橘皮竹
茹汤调之。合病自利及心痞下利，见各条。里气协寒，下利清白，太阴不渴者，理中汤、四逆汤。寒毒入胃者，
四逆汤加韭白。少阴自利，虚渴脉微者，白通汤。厥逆无脉者，白通加猪胆汁汤、通脉四逆汤。少阴下利，咽
痛者，甘桔汤。厥阴下利，先厥而后发热者，下利必自止，若再厥者，必复利也，小建中汤、当归四逆汤。
利不止者，赤石脂禹余粮汤。又下利身痛者，先以四逆汤救里，利止但身痛者，急服桂枝汤救表。凡下利、谵
语、直视及厥躁不得眠、汗不止、无脉及自利不禁、身热脉实者皆死。湿毒下利脓血，腹满肠内刮痛，如鱼
脑烂桃，或如黑豆汁者，除湿汤、猪苓汤、地榆散。湿挟热者，败毒散、黄芩汤、白头翁汤。如无湿但热毒，
日晡壮热，腹痛便下脓血稠粘者，黄连阿胶汤。湿挟风者，胃风汤加木香；湿挟寒者，不换金正气散加干姜、
木香。又阳证便脓血者，亦名协热肠垢，当清其肠，犀角地黄汤。阳明热入血室下血者，小柴胡汤加生地、
枳壳、山栀。少阴下利脓血者，亦谓之协寒鸭溏，当固下焦，桃花散、赤石脂丸。
壮而热，止其利，断下之生也不长；
少壮人，实热下利，不宜止涩，止之则加热闷而死，名曰壮热断下。
厥而利，反能食，除中之死也可立。
邪在表则能食，邪在里则不能食，表里之间者，欲食而不能食，今伤寒厥深下利，脉迟，当不能食而
反能食者，名曰除中。中之胃气既除，岂可再复！
风漏手足挛搐，阳亏四肢拘急。
四肢诸阳之本，腰背太阳之络。因发汗腠理空疏，盖覆不周，将息未久，以致风邪复入筋骨之间，挛搐
有妨行持，牛蒡根汤主之。如脚挛啮齿者，风热也，承气汤下之。拘急者，手足不能自如，屈伸不便，蜷卧恶
风之貌，发汗
亡阳而有此证。汗多小便难者，桂枝汤加附子。吐下后，厥逆拘急者，四逆汤；心烦足挛属血虚者，芍药甘草
汤。阴阳易病，亦有手足搐搦如风状者，古瓜竹汤。
太阳腰痛顶连尻，阳明不（可回）顾少（阳）如（针）刺；
太阳证分有汗、无汗。伤寒，人参顺气散；伤风，败毒散，或通气防风汤。粗人，刺委中血甚妙。太阳合
阳明，葛根汤；少阳，柴胡桂枝汤。与头痛参看。
少阴腰痛背及脊，太阴遗溺（腰下如横木甚则遗溺）厥（阴）张弓。
厥阴风热，故腰强急如弓。三阴通用五积散加杜仲、附子，或加于黄 建中汤、当归四逆汤中，尚当与杂
病腰痛参看。
阳气虚而筋惕肉 。
阳气者，精则养神，柔则养筋。汗下后，津液耗竭，阳气大虚，肉筋失养，故惕然而跳， 然而动，
久则成痿。治宜温经养荣益胃，玄武汤是也。羸甚去芍药，热者却附子，或陶氏温经益元汤亦好。汗下后，
头眩身摇者，茯苓桂术甘草汤。心下痞满者，暂与枳梗汤加茯苓。汗下后，表里俱虚及素虚之人，微发其汗，
肤肉战，喘促汗出如油者，死。动气在左，发汗有此证者亦危。
风热极而螈短 长。
俗云搐也。螈则筋脉急而缩短， 则筋脉缓而弛长，急缓之间，筋脉牵引伸缩不定，状如风痫可畏。多因
汗下脾土受伤，木旺风热炽盛，故手足动摇搐搦。必平木降火，以柴胡、山栀涤热，防风、羌活祛风，兼佐和
血化痰之药治之，与 大同，如圣饼子、引风汤、陶氏如圣饮选用。结胸失下有此证者，大承气汤。风温被火
螈，葳蕤汤、火邪汤。经曰∶太阳终者，戴眼反折螈 ，汗出不流者死。
邪气胜则心寒而栗也，属阴；正气胜则身振而战也，属阳。
战者，身振而动；栗者，心战而惕。邪气外与正争，正气胜则战；邪气内与正争，邪气胜则栗。战则病
欲愈，栗则病欲甚。战属阳，故一战摇之间而真阳鼓动，大汗以解，不必药也。栗属阴，阴无胜阳之理，故恐
惧不战而承乎阳，于是阳反为阴所制，心寒足蜷，鼓颔厥冷，便溺妄出，不知人事，纯乎阴而阳败，遂成寒证。
宜理中、四逆，甚则养正丹，并灸关元穴。若复躁极而不得卧者，不治。若原系传经热证，口燥切牙，虽厥冷
有时温和，脉大而数，表证栗者，羌活冲和汤；里证栗者，大柴胡汤。
蛔厥却缘多饥，虫攻咽及攻胃；
即蛔也。谓之厥者，病属厥阴，又手足厥逆义也。其人素有食蛔，或因病过饥，虫逆上咽膈而出。妄
发其汗，以致胃冷，长虫上攻咽膈，胃气困乏，虽饥不能食，食即吐蛔者，虫闻食臭气而出也。外证乍静乍烦
者，虫或上或止也。又或下利脏寒，则蛔亦上入于膈。然上焦热而中下焦寒，故虽烦热消渴便硬，不可遽投凉药，
当先以乌梅丸、理中汤安蛔，然后随证调之。或烦热不退者，小柴胡汤。或热甚昏 ，腹胀便闭，或蛔不得安，
从大便而出者，大柴胡汤。
狐惑盖缘失汗，虫食脏及食肛。
此亦虫证也，如狐听冰，犹豫不决之义。初起状如伤寒，或因伤寒变成。其候四肢沉重，欲食恶闻食气，欲
眠目不能闭，舌白齿晦，面目色变无常。虫食下部为狐，下唇有疮，其咽干；虫食其喉为惑，上唇有疮，其
声哑。杀人甚急，皆因汗下失宜，邪热入腹，以致饮食少而肠胃虚，虚甚则三虫举而食人五脏。食上部者，三
黄泻心汤主之；食下部者，单苦参煎汤淹洗之；食肛门外者，用生艾汁调雄黄末，烧烟熏之，通用黄连犀角汤。
治，桃仁汤、金液丹、雄黄锐散。又湿 虫证，与狐惑证同，但专食其脏为异耳。
阴阳发斑总是火，谁知温毒时毒？
伤寒阳证发斑，谓之阳毒；春温发斑，谓之温毒；夏热发斑，谓之热毒；时行与暴温发
斑，谓之时毒。名虽不同，同归于热。或因当汗不汗，及已汗而热气不散，表虚里实而发者；
或因当下不下，热蓄于胃而发者；或因下早热邪乘虚入胃，伤血不散而发者；或因误服温
药，胃热焦烂而发者。然皆心火入肺，故见红点于皮毛之间。轻如疹子蚊迹，只在手足，先
红后黄；重如锦纹，发在胸腹，先红后赤，切忌发汗，重令开泄；甚则皮肤斑烂，阳毒具而红
润稀疏，起发五六日即愈。若阴脉见而黑斑稠密成片，身凉，六七日死。先红后黯，如果实者
亦死。阳毒舌焦鼻煤，发斑者，阳毒升麻汤、白虎加参汤；热甚者，三黄石膏汤、三黄泻心汤、
陶氏消斑青黛饮选用。有斑疮如豌豆者，黄连一物汤，水煎浓汁服，或青黛一物汤。热病发
斑与阳毒同。温毒因冬暖感温气，至春风气相搏，发为瘾疹多痒，初起升麻葛根汤加玄参，
或败毒散加紫草、赤芍。日久发渴，腹满便硬者，调胃承气汤加黄连、赤芍、生地、牡丹皮。
已经汗下而毒不解者，黑膏主之。热病发斑，时行发斑，身如火色者。大青四物汤、猪胆鸡
子汤。发斑杂证，咽痛，玄参升麻汤，或紫雪咽之；呃逆下利者，黄连橘皮汤；心烦呕吐者，葛
根橘皮汤；血热内结者，小柴胡汤、犀角地黄汤；斑盛破烂者，芒硝、猪胆汁法。凡汗下不
解，足冷耳聋，烦闷咳呕，便是发斑之候，宜化斑消斑之药以防之。诸斑药皆通用，惟温毒挟
风稍殊耳。阴证亦有发斑者，乃相火乘肺，故但出于胸背，手足稀少，脉沉，身无大热为异，
宜理中汤，或加附子、玄参。
血溺如狂有是证，争似发狂凶狂。
有阴盛发躁，欲坐井地如狂者，有火邪惊惕不安如狂者，然血溺如狂有三证与阳毒如
狂相似，故举言之。如狂属瘀血者，脉沉实，多漱水不咽，有无表证，但血蓄下焦，小便自利
如狂者；有无表里证，脉数善饥，不大便如狂者；有太阳初证，热结下焦如狂者，血自下者
即愈。如外未解者，桂枝汤、陶氏桂苓饮。外已解．但小腹急结者，桃仁承气汤；挟血传心脾
者，当归活血汤。有太阴身黄溺涩如狂者，五苓散。此皆如狂，但睡中忽欲起行，错言妄语，
犹知谏阻，尚可制御，非若发狂势凶莫能御上。发狂者，热毒在胃，并入于心，遂使神昏不
这被称为正阳明病。出现定时出汗、大便干结不通、腹部胀满、口渴、神志狂乱及胡言乱语，且尺部脉象实有力的，可选用各种承气汤治疗。如果脉象浮兼有呕吐，舌苔白，说明邪气尚未完全入腑，仍属于半里证，这就是所说的“呕吐患者即使有阳明证，也不可用攻下法”，以及“舌苔白者不可攻下”的意思，适宜用小柴胡汤，调和营卫，疏通津液，通过微微出汗而自然痊愈。然而，如果有数日不大便且烦闷严重的，虽然尚有一些表证，也应当给予大柴胡汤，或小承气汤轻微润下。另外，阳明病汗出多，小便通利而大便干硬，或者因发汗、利小便过多而导致大便干硬的，都是津液在内枯竭，适宜用蜜导法（蜂蜜栓剂）通便。大便干硬而小便频数的，这是脾约证，适宜用麻子仁丸。大便坚硬而小便少的，暂时不可攻下，因为津液未充盈，需等待小便恢复正常，才可以攻下。应当询问病人一天小便排几次，如果像平常一样，应当知道气机已下行，大便不久会自然排出。要知道古人审慎使用泻下药，如果想用大承气汤，应当先在前一天用小承气汤，观察病人腹中是否有转矢气（肠鸣排气）。转矢气，即腹中作响并放屁，说明有燥屎；气味臭秽的有宿食，适宜攻下。如果不转矢气，说明大便一定是前干后稀，不可攻下。《金匮要略》说：六七天没有痛苦症状，不可攻下。攻下过早，热气乘虚进入胃中，病情重的必死。又有便秘多次攻下仍不通的，必须用吐法来提举气机。阴结证脉象沉迟，口不渴不想吃东西，身体沉重如石头且发冷，大便硬而艰难，这不是燥屎，而是阴寒固结于胃，气血凝滞闭塞所致，适宜用四物汤、附子汤，或金液丹、古半硫丸、五积散。如果久不大便而脉象反而微涩，是里虚严重，急用黄芪建中汤救治。又有食滞脾脏及血燥导致不大便的，应当在杂病伤食及燥门中寻求治法。
小便闭阻本因下焦热盛，而亡失津液属阴虚，难以渗泄疏利。
伤寒邪气在表则小便通利，邪气入里，下焦有热，引饮过多，小腹胀硬，小便闭阻的，脉浮的用五苓散；脉沉的用猪苓汤。
大便时而难解时而易解且小便不利的，内有燥屎，用大承气汤。如果是阳明病汗出多，或发汗后胃中津液干枯导致小便不利的，切忌使用渗利药物，等待津液恢复自然会通畅。发汗攻下后，发热项强，头顶心痛，无汗，小便不利的，用三白姜枣汤。半表证，用小柴胡汤去黄芩加茯苓。胡言乱语身体沉重的，用柴胡龙骨牡蛎汤。少阴病脉沉，小便不利的，用玄武汤，或四逆汤加茯苓。少阴病腹部胀满疼痛，便脓血，小便不利的，用桃花散。又有阴毒下利，小便不利，阴囊收缩小腹剧痛欲死的，急服返阴丹等温热药。如果使用寒凉药，阴气伏蓄在小腹，有至死的危险。或者见到小便不利，用炒盐熨烫脐下，若阴气不散，被热物熨烫，冷气冲心，也有致死的。凡是小便闭阻且四肢厥逆，头汗出的，是阳气脱失的关格证，不治。水气病、黄疸病、风温病的小便不利，见前文。
水气难治因阴虚，阳邪侵袭所致；
小便困难，指排尿不畅快。经书说：阳热进入阴分，则膀胱热而小便难。只有阴分虚而阳热乘虚而入，不可强行利水，必须等到小便黄赤时，才可万全，用木通汤利水。如果是太阳病汗出不止的，用桂枝汤加附子。阳明病伤风，嗜睡身体发黄的，用小柴胡汤加茯苓。
水利偏向前阴，而后阴大便干枯。
伤寒内热则小便闭阻，现在反而通利，是因为膀胱主司津液，而津液偏渗于前阴，所以后阴大便干枯。有瘀血证，小腹硬满，其人如狂的，用抵当汤。有少阴证，四肢厥冷脉沉的，用四逆汤，或玄武汤去茯苓。有阳明证，自汗小便通利而大便虽硬的，不可攻下，适宜用蜜导法，或用猪胆汁灌肠。有水饮停聚心悸的，用茯苓桂甘汤。
膀胱移热，小便虽浑浊但不痛；
里气平和则小便清，里有热则小便浊。膀胱的热邪移于小肠则尿血，与赤浊相似，用导赤散，或玄胡索散、朴硝二味等分水煎服，或加川芎等渗利药物尤其好。这也是瘀血中的一种证候。
肾虚协热，小便虽频数但无余沥。
只有虚则小便频数，只有热则小便涩滞而不畅快。有适宜温补的，太阳病自汗小便频数的，虽然有表证，不可用桂枝汤重亡津液。误服导致四肢厥冷的，是阳气不足，用甘草干姜汤；心烦脚蜷缩的，是血不足，用芍药甘草汤。有适宜攻下的，胡言乱语自汗小便频数的，少量给予调胃承气汤。发汗、催吐、攻下后，小便频数大便硬的，用大柴胡汤。阳明病汗多，小便频数大便硬的，是胃强脾约，约束津液不行，适宜用脾约丸。余沥遗溺，见后文危证。
协热自利且口渴称为肠垢（肠间津汁垢腻），热甚纯下清水；协寒自利不渴称为鸭溏（清白如鸭屎状），湿毒有如豆汁。
阳证自利，溏泄身热，脐下亦热，作渴尿赤，后重泄下黄赤，所以叫肠垢。阴证自利，太阴病手足温，少阴、厥阴病手足厥冷，脐下亦冷，不渴，利下清白，所以叫鸭溏。热邪因表邪入里，挟风则所下必暴烈；寒邪乃直中阴经。大法热证宜和解，或攻泄，或利小便；寒证宜温中，或固涩下焦，都不宜发汗，以免令胃气虚弱而产生胀满。只是自利旧分阳证、阴证，又分协热、协寒，而治法相同。然而阳证自利，也必须是里气虚而表热乘之，才能自利，即使是太阳初证下利亦然，与表邪传里协热下利无异。至于阴证即协寒，其证候尤为明显。所以说阳证下利误用温补，则会发黄、出斑而死。这些支离偏离之处，每每详细辨析，才不会迷惑人。大概里气协热，下利黄赤的，黄芩汤最妙。带表证口渴下利的，用柴苓汤。少阴热证，渴而下利的，用白虎汤。少阴热证，咳而呕渴，心烦不得眠而下利的，用猪苓汤。热甚口燥心痛，下利纯清水的，用大承气汤。潮热谵语脉滑，有宿食的，用大柴胡汤，或陶氏黄龙汤。下利脉象平和的，为内实；下利脉滑，或浮大按之反涩，不欲食的，有宿食，都适宜攻下。又有太阳初伤风，下利不恶寒，头痛干呕，心痞腹痛的，用桂枝汤加芫花，或十枣汤。胃不和，肠鸣下利的，用生姜泻心汤。小便涩滞大便利的，用赤石脂丸。下利频繁而小便如常的会自愈，用橘皮竹茹汤调理。合病自利及心痞下利，见各条。里气协寒，下利清白，太阴病不渴的，用理中汤、四逆汤。寒毒入胃的，用四逆汤加韭白。少阴自利，虚渴脉微的，用白通汤。厥逆无脉的，用白通加猪胆汁汤、通脉四逆汤。少阴下利，咽痛的，用甘桔汤。厥阴下利，先厥冷而后发热的，下利必自愈，如果再厥冷，必复利，用小建中汤、当归四逆汤。利不止的，用赤石脂禹余粮汤。又有下利身痛的，先用四逆汤救里，利止但身痛的，急服桂枝汤救表。凡下利、谵语、直视及厥躁不得眠、汗不止、无脉及自利不禁、身热脉实的都死。湿毒下利脓血，腹满肠内刮痛，如鱼脑烂桃，或如黑豆汁的，用除湿汤、猪苓汤、地榆散。湿挟热的，用败毒散、黄芩汤、白头翁汤。如无湿但热毒，日晡壮热，腹痛便下脓血稠粘的，用黄连阿胶汤。湿挟风的，用胃风汤加木香；湿挟寒的，用不换金正气散加干姜、木香。又有阳证便脓血的，也称协热肠垢，当清其肠，用犀角地黄汤。阳明热入血室下血的，用小柴胡汤加生地、枳壳、山栀。少阴下利脓血的，也称协寒鸭溏，当固涩下焦，用桃花散、赤石脂丸。
壮年而热，止其利，断下之生也不长；
少壮人，实热下利，不宜止涩，止之则加重热闷而死，名叫壮热断下。
厥冷而利，反能食，除中之死也可立至。
邪在表则能食，邪在里则不能食，表里之间的，欲食而不能食，现在伤寒厥深下利，脉迟，应当不能食而反能食的，名叫除中。中的胃气既然已除，岂可再复！
风漏导致手足挛搐，阳亏导致四肢拘急。
四肢是诸阳之本，腰背是太阳之络。因发汗腠理空疏，覆盖不周，调养不久，以致风邪再次侵入筋骨之间，挛搐妨碍行走持物，用牛蒡根汤主治。如果脚挛咬齿的，是风热，用承气汤攻下。拘急的，手足不能自如，屈伸不便，蜷卧恶风的样子，是发汗亡阳而有此证。汗多小便难的，用桂枝汤加附子。吐下后，厥逆拘急的，用四逆汤；心烦足挛属血虚的，用芍药甘草汤。阴阳易病，也有手足搐搦如风状的，用古瓜竹汤。
太阳腰痛顶连尻，阳明不顾，少阳如针刺；
太阳证分有汗、无汗。伤寒，用人参顺气散；伤风，用败毒散，或通气防风汤。普通人，刺委中出血很妙。太阳合阳明，用葛根汤；少阳，用柴胡桂枝汤。与头痛参看。
少阴腰痛背及脊，太阴遗溺，厥阴张弓。
厥阴风热，所以腰强急如弓。三阴通用五积散加杜仲、附子，或加于黄芪建中汤、当归四逆汤中，尚当与杂病腰痛参看。
阳气虚而筋惕肉瞤。
阳气者，精微则养神，柔和则养筋。汗下后，津液耗竭，阳气大虚，肉筋失养，所以惕然而跳，瞤然而动，久则成痿。治宜温经养荣益胃，玄武汤是也。羸瘦严重的去芍药，有热的去附子，或陶氏温经益元汤也好。汗下后，头眩身摇的，用茯苓桂术甘草汤。心下痞满的，暂给枳梗汤加茯苓。汗下后，表里俱虚及素体虚弱之人，微发其汗，肤肉战栗，喘促汗出如油的，死。动气在左，发汗有此证的也危。
风热极而抽搐短缩，弛缓长大。
俗云搐也。抽搐则筋脉急而缩短，弛缓则筋脉缓而弛长，急缓之间，筋脉牵引伸缩不定，状如风痫可畏。多因汗下脾土受伤，木旺风热炽盛，故手足动摇搐搦。必平木降火，以柴胡、山栀涤热，防风、羌活祛风，兼佐和血化痰之药治之，与抽搐大同，如圣饼子、引风汤、陶氏如圣饮选用。结胸失下有此证的，用大承气汤。风温被火劫致抽搐的，用葳蕤汤、火邪汤。经书说：太阳终者，戴眼反折抽搐，汗出不流的死。
邪气胜则心寒而栗，属阴；正气胜则身振而战，属阳。
战，是身体振动而动；栗，是心中战栗而惊惕。邪气外与正争，正气胜则战；邪气内与正争，邪气胜则栗。战则病欲愈，栗则病欲甚。战属阳，故一战摇之间而真阳鼓动，大汗以解，不必用药。栗属阴，阴无胜阳之理，故恐惧不战而承乎阳，于是阳反为阴所制，心寒足蜷，鼓颔厥冷，便溺妄出，不知人事，纯乎阴而阳败，遂成寒证。适宜理中、四逆，甚则养正丹，并灸关元穴。如果复躁极而不得卧的，不治。如果原系传经热证，口燥切牙，虽厥冷有时温和，脉大而数，表证栗的，用羌活冲和汤；里证栗的，用大柴胡汤。
蛔厥却缘多饥，虫攻咽及攻胃；
即蛔虫也。谓之厥者，病属厥阴，又是手足厥逆的意思。其人素有食蛔，或因患病过饥，虫逆上咽膈而出。妄发其汗，以致胃冷，长虫上攻咽膈，胃气困乏，虽饥不能食，食即吐蛔的，是虫闻食臭气而出也。外证乍静乍烦的，是虫或上或止也。又或下利脏寒，则蛔亦上入于膈。然上焦热而中下焦寒，故虽烦热消渴便硬，不可遽投凉药，当先以乌梅丸、理中汤安蛔，然后随证调之。或烦热不退的，用小柴胡汤。或热甚昏愦，腹胀便闭，或蛔不得安，从大便而出的，用大柴胡汤。
狐惑盖缘失汗，虫食脏及食肛。
这也是虫证，如狐听冰，犹豫不决的意思。初起状如伤寒，或因伤寒变成。其候四肢沉重，欲食恶闻食气，欲眠目不能闭，舌白齿晦，面目色变无常。虫食下部为狐，下唇有疮，其咽干；虫食其喉为惑，上唇有疮，其声哑。杀人甚急，皆因汗下失宜，邪热入腹，以致饮食少而肠胃虚，虚甚则三虫举而食人五脏。食上部的，三黄泻心汤主治；食下部的，单苦参煎汤淹洗之；食肛门外者的，用生艾汁调雄黄末，烧烟熏之，通用黄连犀角汤。治，桃仁汤、金液丹、雄黄锐散。又有湿蛊虫证，与狐惑证同，但专食其脏为异耳。
阴阳发斑总是火，谁知温毒时毒？
伤寒阳证发斑，谓之阳毒；春温发斑，谓之温毒；夏热发斑，谓之热毒；时行与暴温发斑，谓之时毒。名虽不同，同归于热。或因当汗不汗，及已汗而热气不散，表虚里实而发者；或因当下不下，热蓄于胃而发者；或因下早热邪乘虚入胃，伤血不散而发者；或因误服温药，胃热焦烂而发者。然皆心火入肺，故见红点于皮毛之间。轻如疹子蚊迹，只在手足，先红后黄；重如锦纹，发在胸腹，先红后赤，切忌发汗，重令开泄；甚则皮肤斑烂，阳毒具而红润稀疏，起发五六日即愈。若阴脉见而黑斑稠密成片，身凉，六七日死。先红后黯，如果实者亦死。阳毒舌焦鼻煤，发斑的，阳毒升麻汤、白虎加参汤；热甚的，三黄石膏汤、三黄泻心汤、陶氏消斑青黛饮选用。有斑疮如豌豆的，黄连一物汤，水煎浓汁服，或青黛一物汤。热病发斑与阳毒同。温毒因冬暖感温气，至春风气相搏，发为瘾疹多痒，初起升麻葛根汤加玄参，或败毒散加紫草、赤芍。日久发渴，腹满便硬的，调胃承气汤加黄连、赤芍、生地、牡丹皮。已经汗下而毒不解的，黑膏主治。热病发斑，时行发斑，身如火色的，大青四物汤、猪胆鸡子汤。发斑杂证，咽痛的，玄参升麻汤，或紫雪咽之；呃逆下利的，黄连橘皮汤；心烦呕吐的，葛根橘皮汤；血热内结的，小柴胡汤、犀角地黄汤；斑盛破烂的，芒硝、猪胆汁法。凡汗下不解，足冷耳聋，烦闷咳呕，便是发斑之候，宜化斑消斑之药以防之。诸斑药皆通用，惟温毒挟风稍殊耳。阴证亦有发斑的，乃相火乘肺，故但出于胸背，手足稀少，脉沉，身无大热为异，适宜理中汤，或加附子、玄参。
血溺如狂有是证，争似发狂凶狂。
有阴盛发躁，欲坐井地如狂的，有火邪惊惕不安如狂的，然血溺如狂有三证与阳毒如狂相似，故举言之。如狂属瘀血的，脉沉实，多漱水不咽，有无表证，但血蓄下焦，小便自利如狂的；有无表里证，脉数善饥，不大便如狂的；有太阳初证，热结下焦如狂的，血自下的即愈。如外未解的，桂枝汤、陶氏桂苓饮。外已解．但小腹急结的，桃仁承气汤；挟血传心脾的，当归活血汤。有太阴身黄溺涩如狂的，五苓散。此皆如狂，但睡中忽欲起行，错言妄语，犹知谏阻，尚可制御，非若发狂势凶莫能御上。发狂的，热毒在胃，并入于心，遂使神昏不
This is referred to as Zheng Yangming Bing (True Yangming Disease). When there is tidal sweating, constipation, abdominal fullness, thirst, mania, and delirium, with a solid pulse at the Chi position, various Chengqi Tangs (Cathartic Decoctions) may be selected. If the pulse is floating accompanied by vomiting, and there is a white coating on the tongue, it indicates that the pathogenic factor has not fully entered the Fu organs; it still belongs to the Half-Interior stage. This corresponds to the principle that "even if a patient with vomiting presents with Yangming symptoms, purgation should not be used," and "those with a white tongue coating should not be purged." In such cases, Xiao Chaihu Tang (Minor Bupleurum Decoction) is appropriate to harmonize Ying and Wei (Nutritive and Defensive levels), unblock body fluids, and allow for spontaneous resolution through slight sweating. However, if a patient has not had a bowel movement for several days and suffers from severe restlessness and oppression, even if some exterior symptoms remain, Da Chaihu Tang (Major Bupleurum Decoction) or Xiao Chengqi Tang (Minor Cathartic Decoction) should be given to gently moisten and purge. Furthermore, in Yangming disease, excessive sweating and free urination leading to hard stools, or hard stools resulting from excessive sweating or diuresis, indicate exhaustion of internal body fluids; Honey Suppositories (Mi Dao) are suitable. Hard stools with frequent urination constitute Pi Yue (Spleen Restraint), treated with Maziren Wan (Hemp Seed Pill). Hard stools with scanty urination indicate that purgation should be withheld until body fluids are replenished and urination returns to normal. One should ask how many times the patient urinates daily; if it is normal, it indicates that Qi has descended, and the stool will pass naturally soon. It is important to know that ancient physicians carefully assessed the use of purgatives. If one intends to use Da Chengqi Tang (Major Cathartic Decoction), one should first administer Xiao Chengqi Tang the day before to observe for Zhuan Shi Qi (bowel sounds and flatus). Zhuan Shi Qi refers to abdominal rumbling and passing gas, indicating dry feces; foul-smelling gas suggests retained food, warranting purgation. If there is no Zhuan Shi Qi, the stool is likely hard at the beginning and loose at the end, and purgation should not be used. The *Jin Gui Yao Lue* states: "If there is no distress after six or seven days, do not purge." Premature purgation allows heat to enter the stomach due to deficiency, which can be fatal in severe cases. For persistent constipation unrelieved by repeated purgation, emesis should be used to lift Qi. Yin Jie (Yin Constellation) presents with a deep and slow pulse, no thirst, anorexia, heaviness like stone, coldness, and difficult hard stools; this is not dry feces but Yin-cold congealing in the stomach with stagnation of Qi and blood. Treat with Siwu Tang (Four Substance Decoction), Fuzi Tang (Aconite Decoction), Jin Ye Dan (Golden Elixir Pill), Gu Banshen Wan (Ancient Half-Sulfur Pill), or Wuji San (Five Accumulations Powder). If prolonged constipation is accompanied by a faint and choppy pulse, it indicates severe interior deficiency; urgently treat with Huangqi Jianzhong Tang (Astragalus Middle-Warming Decoction). For constipation due to food stagnation in the Spleen or dryness of Blood, refer to miscellaneous diseases regarding food stagnation and dryness.
Obstruction of Urine stems from lower Heat and Yin deficiency with fluid loss, making it difficult to promote diuresis.
In Shanghan (Cold Damage), when pathogens are in the Exterior, urination is free. When pathogens enter the Interior and Heat accumulates in the Lower Jiao, causing excessive drinking, abdominal distension and hardness, and urinary obstruction, a floating pulse indicates Wuling San (Five-Ling Powder), while a deep pulse indicates Zhuling Tang (Polyporus Decoction).
Intermittent difficulty in defecation with obstructed urination indicates dry feces inside; use Da Chengqi Tang. If Yangming disease involves excessive sweating or post-sweating dryness of Stomach fluids leading to obstructed urination, strictly avoid diuretics; wait for fluids to recover for natural passage. After sweating and purging, if fever, neck stiffness, headache, anhidrosis, and obstructed urination occur, use Sanbai Jiangzao Tang (Three Whites Ginger Date Decoction). For half-exterior symptoms, use Xiao Chaihu Tang minus Huangqin plus Fuling. Delirium with heavy body requires Chaihu Longgu Muli Tang (Bupleurum with Dragon Bone and Oyster Shell Decoction). Shaoyin disease with a deep pulse and obstructed urination requires Xuanwu Tang (Black Tortoise Decoction) or Sini Tang (Frigid Extremities Decoction) plus Fuling. Shaoyin disease with abdominal fullness/pain, pus/blood in stool, and obstructed urination requires Taohua San (Petal Powder). For Yin Du (Yin Toxin) with diarrhea, obstructed urination, scrotal retraction, and severe lower abdominal pain, urgently administer Fanyin Dan (Return to Yin Elixir) and warm herbs. Cold herbs cause Yin Qi to accumulate in the lower abdomen, potentially leading to death. Applying hot roasted salt to the umbilicus for obstructed urination can cause cold Qi to rush to the heart if Yin Qi does not dissipate, also potentially fatal. Any case of obstructed urination with cold extremities and head sweating indicates Yang collapse and Guan Ge (Gate Obstruction), which is untreatable. Water retention, Jaundice, and Wind-Warmth with obstructed urination are discussed previously.
Water difficulty arises from Yin deficiency and attack by Yang pathogens.
Difficulty in urination means slow flow. The Classics state: "When Yang enters the Yin division, Bladder Heat causes difficulty in urination." This occurs when Yin deficiency allows Yang Heat to invade; forced diuresis is contraindicated. Only when urine becomes yellow-red can treatment proceed safely with Mutong Tang (Akebia Decoction). For Taiyang disease with non-stop sweating, use Guizhi Tang (Cinnamon Twig Decoction) plus Fuzi. Yangming wind-stroke with lethargy and jaundice requires Xiao Chaihu Tang plus Fuling.
Diuresis biased toward the anterior leads to dry posterior stool.
Shanghan internal Heat usually causes urinary obstruction; if it instead flows freely, it is because the Bladder governs fluids, which leak excessively anteriorly, leaving posterior stool dry. Blood stasis presenting with lower abdominal hardness and manic behavior requires Dandang Tang (Resolute Decoction). Shaoyin disease with cold extremities and deep pulse requires Sini Tang or Xuanwu Tang minus Fuling. Yangming disease with spontaneous sweating, free urination, and hard stool should not be purged; use honey suppositories or pig bile enemas. Palpitations due to water retention require Fuling Guigan Tang (Poria, Cinnamon, Licorice, and Jujube Decoction).
Bladder transferring Heat causes turbid but painless urination.
Interior harmony yields clear urine; interior Heat yields turbid urine. Bladder Heat transferring to the Small Intestine causes hematuria, similar to red turbidity. Use Daochi San (Guide Out Red Powder), or Xuhensuo San (Corydalis Powder), or equal parts Puxiao (Mirabilite) and water. Adding Chuanxiong and diuretics is excellent. This is also a form of blood stasis.
Kidney deficiency with協 Heat causes frequent urination without residual drops.
Deficiency causes frequency; Heat causes涩滞 (astringency/slowness). Warmth is indicated for Taiyang spontaneous sweating with frequent urination; although exterior signs exist, Guizhi Tang must be avoided to prevent further fluid loss. Misuse leading to cold extremities indicates Yang deficiency; treat with Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction). Restlessness and curled legs indicate Blood deficiency; treat with Shaoyao Gancao Tang (Peony and Licorice Decoction). Purging is indicated for delirium, spontaneous sweating, and frequent urination; give Tiaowei Chengqi Tang (Regulate Stomach Cathartic Decoction) sparingly. Post-sweat/vomit/purge frequent urination with hard stool requires Da Chaihu Tang. Yangming excessive sweating, frequent urination, and hard stool indicate strong Stomach and restrained Spleen; use Pi Yue Wan (Spleen Restraint Pill). Residual dribbling is discussed in critical conditions.
協 Heat diarrhea with thirst is called Chang Gou (Intestinal Filth); intense Heat causes pure watery diarrhea. 協 Cold diarrhea without thirst is called Yatang (Duck Droppings); damp-toxin resembles bean curd dregs.
Yang syndrome diarrhea features loose stools, fever, heat below the navel, thirst, red urine, tenesmus, and yellow-red discharge, hence "Chang Gou." Yin syndrome diarrhea features Taiyang warm extremities, Shaoyin/Jueyin cold extremities, cold below the navel, no thirst, and clear-white discharge, hence "Yatang." Heat enters the interior via exterior pathogens; with Wind, discharge is sudden. Cold strikes Yin meridians directly. Heat syndromes require harmonization, purging, or diuresis; Cold syndromes require warming the middle or securing the Lower Jiao. Sweating is contraindicated as it weakens Stomach Qi causing bloating. Diarrhea is classified into Yang/Yin and 協 Heat/協 Cold, with similar treatments. However, Yang diarrhea requires interior deficiency allowing exterior Heat to invade, similar to exterior-pathogen-transferring-interior Heat diarrhea. Yin corresponds to 協 Cold, which is more obvious. Treating Yang diarrhea with warmth causes jaundice and macules, leading to death. Detailed differentiation prevents confusion. Generally, interior Heat with yellow-red diarrhea responds best to Huangqin Tang (Scutellaria Decoction). Exterior symptoms with thirst and diarrhea require Chailing Tang (Bupleurum and Five-Ling Decoction). Shaoyin Heat with thirst and diarrhea requires Baihu Tang (White Tiger Decoction). Shaoyin Heat with cough, vomiting, thirst, restlessness, insomnia, and diarrhea requires Zhuling Tang. Intense Heat with dry mouth, heart pain, and pure watery diarrhea requires Da Chengqi Tang. Tidal fever, delirium, slippery pulse, and retained food require Da Chaihu Tang or Tao's Huanglong Tang (Yellow Dragon Decoction). Diarrhea with a harmonious pulse indicates interior excess; slippery or large/superficial yet choppy upon pressure with anorexia indicates retained food; both require purging. Early Taiyang wind-stroke with diarrhea, no aversion to cold, headache, dry retching, chest fullness, and abdominal pain requires Guizhi Tang plus Yuanhua or Shizao Tang (Ten Jujube Decoction). Stomach disharmony with borborygmus and diarrhea requires Shengjiang Xiexin Tang (Fresh Ginger Drain Heart Decoction). Astringent urination with free stool requires Chishizhi Wan (Red Stone Lipstick Pill). Frequent diarrhea with normal urination stops spontaneously; regulate with Jupi Zhuru Tang (Tangerine Peel and Bamboo Shaving Decoction). Combined disease diarrhea and chest-fullness diarrhea are detailed elsewhere. Interior Cold with clear-white diarrhea and Taiyang anorexia requires Lizhong Tang (Middle-Warming Decoction) or Sini Tang. Cold toxin entering the Stomach requires Sini Tang plus Jiubai (Garlic Sprouts). Shaoyin diarrhea with deficiency-thirst and faint pulse requires Baotong Tang (Brighten the Interior Decoction). Cold extremities with no pulse require Baotong plus Pig Bile Decoction or Tongmai Sini Tang (Pulse-Unblocking Frigid Extremities Decoction). Shaoyin diarrhea with sore throat requires Ganjie Tang (Licorice and Platycodon Decoction). Jueyin diarrhea starting with cold then fever stops spontaneously; recurrence of cold brings back diarrhea; treat with Xiaojianzhong Tang (Minor Construct the Middle Decoction) or Danggui Sini Tang (Angelica Frigid Extremities Decoction). Unstopping diarrhea requires Chishizhi Yuyuliang Tang (Red Stone and Hematite Decoction). Diarrhea with body pain requires Sini Tang first to save the Interior; once diarrhea stops but pain remains, use Guizhi Tang to save the Exterior. Death is indicated by diarrhea, delirium, fixed gaze, cold/restlessness/insomnia, non-stop sweating, no pulse, uncontrollable diarrhea, fever with a solid pulse. Damp-toxin diarrhea with pus/blood, abdominal fullness, scraping pain, fish-brain-like or black-bean-juice-like stool requires Chushi Tang (Remove Dampness Decoction), Zhuling Tang, or Diyü San (Sanguisorba Powder). Damp-Heat requires Baidu San (Resolve Toxicity Powder), Huangqin Tang, or Baitouweng Tang (Pulsatilla Decoction). Pure Heat-toxin with afternoon high fever, abdominal pain, and sticky pus/blood requires Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction). Damp-Wind requires Weifeng Tang plus Mugui; Damp-Cold requires Buhuanjin Zhengqi San plus Ganjiang and Mugui. Yang syndrome pus/blood stool is also called 協 Heat Chang Gou; clear the intestines with Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). Yangming Heat entering the Blood Chamber with bleeding requires Xiao Chaihu Tang plus Shengdi, Zhiqiao, and Shanzhi. Shaoyin pus/blood diarrhea is also called 協 Cold Yatang; secure the Lower Jiao with Taohua San or Chishizhi Wan.
Strong and hot, stopping diarrhea cuts off life;
Young adults with Excess-Heat diarrhea should not be treated with astringents; stopping it increases heat and stifling, leading to death, known as Zhuangre Duanxia (Strong Heat Cutting Off Downward Flow).
Cold extremities with diarrhea, yet able to eat, indicates Chuzhong (Eliminated Middle), a sign of imminent death.
Pathogens in the Exterior allow eating; in the Interior, they prevent eating. Between Exterior and Interior, one desires to eat but cannot. Now, with deep cold extremities, diarrhea, and a slow pulse, inability to eat is expected. If the patient can eat, it is called Chuzhong. Once the Stomach Qi is eliminated, it cannot return!
Wind leakage causes limb spasms; Yang deficiency causes limb constraint.
Limbs are the root of Yang; waist and back are the network vessels of Taiyang. After sweating, pores are open; inadequate covering allows Wind to re-enter sinews and bones, causing spasms hindering movement. Niu Bang Gen Tang (Arctium Root Decoction) is primary. Leg spasms with teeth-grinding indicate Wind-Heat; purge with Chengqi Tang. Constraint refers to limbs unable to move freely, bending difficulties, curling up, and aversion to wind, caused by sweating depleting Yang. Sweating with difficult urination requires Guizhi Tang plus Fuzi. Post-vomit/purge cold extremities and constraint require Sini Tang; restlessness and leg curling due to Blood deficiency require Shaoyao Gancao Tang. Yin-Yang Yi disease may present with limb spasms resembling wind; use Gu Gua Zhu Tang (Ancient Melon Bamboo Decoction).
Taiyang low back pain connects to the crown and sacrum; Yangming looks back no more; Shaoy刺痛 like needles;
Taiyang syndrome distinguishes between sweating and non-sweating. Shanghan uses Renshen Shunqi San (Ginseng Smooth Qi Powder); Wind-stroke uses Baidu San or Tongqi Fangfeng Tang (Ventilation Saposhnikovia Decoction). Acupuncture at Weizhong (BL40) to bleed is excellent. Taiyang combining with Yangming uses Gegen Tang (Kudzu Decoction); with Shaoyang, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction). Refer to Headache section.
Shaoyin low back pain extends to the spine; Taiyang involuntary urination; Jueyin bow-like tension.
Jueyin Wind-Heat causes stiff, tense waist like a bow. All Three Yin syndromes generally use Wuji San plus Duzhong and Fuzi, or add to Huangqi Jianzhong Tang or Danggui Sini Tang. Refer to miscellaneous low back pain.
Yang deficiency causes muscle twitching and tremors.
Yang Qi nourishes Spirit when refined and Sinews when soft. Post-sweat/purge fluid exhaustion and severe Yang deficiency cause loss of nourishment to muscles and sinews, resulting in twitching and trembling, eventually leading to flaccidity. Treatment requires warming meridians, nourishing Ying, and benefiting the Stomach; Xuanwu Tang is indicated. Remove Shaoyao for severe emaciation; remove Fuzu for Heat. Tao's Wenjing Yiyuan Tang (Warm Meridians Benefit Origin Decoction) is also good. Post-sweat/purge dizziness and body shaking require Fuling Gu Zhu Gancao Tang (Poria, Atractylodes, Licorice, and Gastrodia Decoction). Epigastric fullness requires temporary Zhigeng Tang plus Fuling. Post-sweat/purge interior/exterior deficiency or constitutionally weak patients with slight sweating, muscle shivering, panting, and oily sweat indicate death. Moving Qi on the left with these symptoms after sweating is critical.
Extreme Wind-Heat causes convulsions (shortening) and flaccidity (lengthening).
Commonly called convulsions. Convulsion shortens sinews; flaccidity lengthens them. Indefinite traction between tight and loose resembles wind epilepsy. Often caused by spleen damage from sweating/purging, Wood hyperactivity, and intense Wind-Heat, causing hand/foot shaking. Must pacify Wood and descend Fire using Chaihu and Zhizi to clear Heat, Fangfeng and Qianghuo to dispel Wind, combined with blood-invigorating and phlegm-resolving herbs. Similar to convulsions, use Rusheng Bingzi (Like Sage Cake), Yinfeng Tang (Attract Wind Decoction), or Tao's Rusheng Yin (Like Sage Drink). Chest binding due to missed purging with these symptoms requires Da Chengqi Tang. Wind-Warmth complicated by fire-caused convulsions requires Weihui Tang (Polygonatum Decoction) or Huoxie Tang (Fire Evil Decoction). The Classics state: Taiyang terminal stage involves upward-gazing eyes, opisthotonos, convulsions, and non-flowing sweat; this is fatal.
Excess Pathogen causes Heart cold and trembling (Li), belonging to Yin; Excess Righteous Qi causes body shaking (Zhan), belonging to Yang.
Zhan is body vibration; Li is Heart trembling and fear. External struggle with Pathogen where Righteous Qi wins causes Zhan; Internal struggle where Pathogen wins causes Li. Zhan indicates recovery; Li indicates worsening. Zhan is Yang; true Yang stirs during the shake, resolving with profuse sweating without medicine. Li is Yin; Yin cannot overcome Yang. Fear prevents shaking, allowing Yang to be controlled by Yin, resulting in cold Heart, curled legs, chattering teeth, cold extremities, incontinence, unconsciousness, pure Yin failure, and Cold syndrome. Treat with Lizhong, Sini, or Yangzheng Dan, and moxa Guanyuan (CV4). Restlessness preventing sleep is untreatable. Original transmitted Heat syndrome with dry mouth, teeth-grinding, intermittent warmth despite cold extremities, large/fast pulse, and exterior Li requires Qianghuo Chonghe Tang (Notopterygium Harmonizing Decoction); interior Li requires Da Chaihu Tang.
Hui Jue (Roundworm Cold Extremities) stems from hunger; worms attack the throat and Stomach.
Refers to roundworms. "Jue" indicates Jueyin disease or cold extremities. Patients with existing roundworms or those who fast too much experience worms rising to the throat/diaphragm. Erroneous sweating causes Cold Stomach, prompting long worms to attack the throat/diaphragm. Stomach Qi is exhausted; though hungry, one cannot eat. Eating triggers vomiting of worms due to smell. Exterior symptoms of alternating calmness and irritability indicate worms moving up or stopping. Visceral Cold from diarrhea also prompts worms to rise. Upper Jiao Heat with Middle/Lower Jiao Cold means despite irritability, thirst, and hard stool, cool herbs should not be given immediately. First soothe worms with Wumei Wan (Mume Pill) or Lizhong Tang, then treat symptoms. Persistent irritability requires Xiao Chaihu Tang. Intense Heat with stupor, abdominal fullness, constipation, or worms exiting via stool requires Da Chaihu Tang.
Hu Huo (Fox-Manifestation) stems from missed sweating; worms eat viscera and anus.
This is a worm syndrome, named for hesitation like a fox listening to ice. Initially resembles Shanghan or transforms from it. Symptoms: heavy limbs, desire to eat but aversion to food odor, desire to sleep but eyes won't close, white tongue, dull teeth, changing facial colors. Worms eating the lower part cause Hu (Fox) with ulcers on the lower lip and dry throat; eating the throat cause Huo (Manifestation) with ulcers on the upper lip and hoarseness. Highly lethal. Caused by improper sweating/purging, allowing Heat to enter the abdomen, weakening intestines/stomach, allowing three worms to eat viscera. Upper part eaten: Sanhuang Xiexin Tang (Three Yellows Drain Heart Decoction). Lower part eaten: soak/wash with Kanshen (Sophora) decoction. Anus eaten: smoke with mugwort juice and realgar powder. General use: Huanglian Xijiao Tang (Coptis and Rhinoceros Horn Decoction). Treatment: Taoren Tang (Peach Kernel Decoction), Jin Ye Dan, Xionghuang Ruisan (Realgar Sharp Powder). Wet Gu worm syndrome is same as Hu Huo but eats viscera exclusively.
Yin-Yang Macules are always Fire; who knows Warm-Toxin and Time-Toxin?
Shanghan Yang syndrome macules are Yang Du (Yang Toxin); Spring Warmth macules are Wen Du (Warm Toxin); Summer Heat macules are Re Du (Heat Toxin); Epidemic/Sudden Warmth macules are Shi Du (Time Toxin). Though named differently, all belong to Heat. Causes: missed sweating, lingering Heat after sweating (exterior deficiency, interior excess), missed purging (Heat accumulating in Stomach), premature purging (Heat entering deficient Stomach damaging Blood), or misusing warm herbs (Stomach Heat scorching). Heart Fire enters Lung, causing red spots on skin/hair. Mild: like rash/mosquito bites, only on hands/feet, red then yellow. Severe: like brocade patterns, on chest/abdomen, red then crimson. Strictly avoid sweating/opening pores. Severe: skin maceration. Yang Du with red/sparse macules resolves in 5-6 days. Yin pulse with dense black macules, cool body, dies in 6-7 days. Red turning dark, like fruit, also dies. Yang Du with scorched tongue and sooty nose/macules: Yang Du Shengma Tang (Poplar Bark Decoction) or Baihu Jia Shen Tang (White Tiger plus Ginseng Decoction). Intense Heat: Sanhuang Shigao Tang (Three Yellows Gypsum Decoction), Sanhuang Xiexin Tang, or Tao's Xiaoban Qingdai Yin (Reduce Macules Cyan Blue Drink). Pea-like macules: Huanglian Yiwu Tang (Coptis Single Herb Decoction) or Qingdai Yiwu Tang (Indigo Decoction). Heat disease macules are same as Yang Du. Warm Toxin from Winter Warmth meeting Spring Wind causes itchy rashes; initially Shengma Gegen Tang plus Xuanshen, or Baidu San plus Zicao and Chishao. Thirst, abdominal fullness, hard stool after long duration: Tiaowei Chengqi Tang plus Huanglian, Chishao, Shengdi, and Mudanpi. Heat/toxin unresolved after sweat/purge: Hei Gao (Black Plaster). Heat/Epidemic macules with fiery body: Daqing Siwu Tang (Isatis Four Substances Decoction) or Zhudan Jizi Tang (Pig Gall Chicken Egg Decoction). Macule miscellaneous: sore throat Xuan Shen Shengma Tang or Zixue (Purple Snow); hiccups/diarrhea Huanglian Jupi Tang (Coptis Tangerine Peel Decoction); restlessness/vomiting Gegen Jupi Tang (Kudzu Tangerine Peel Decoction); Blood Heat interior knot Xiao Chaihu Tang or Xijiao Dihuang Tang; severe/ulcerated macules Mangxiao and Pig Bile method. Sweat/purge unresolved with cold feet/deafness/restlessness/cough/vomiting indicates impending macules; use Hua Ban/Xiao Ban (Resolve/Reduce Macule) herbs to prevent. Most macule herbs are general; Warm Toxin with Wind is slightly different. Yin syndrome macules occur when Ministerial Fire attacks Lung, appearing only on chest/back, scarce on limbs, with deep pulse and no high heat; treat with Lizhong Tang or plus Fuzi/Xuanshen.
Blood in urine with manic appearance has these signs; how does it compare to fierce Mania?
Yin excess causing agitation, wanting to sit in wells like mania; Fire Evil causing fright/insecurity like mania. Blood-in-urine mania has three signs similar to Yang Du mania. Mania due to Blood Stasis: deep-solid pulse, frequent rinsing mouth without swallowing, regardless of exterior signs, Blood stasis in Lower Jiao, free urination, mania. Regardless of interior/exterior signs, rapid pulse, hunger, constipation, mania. Taiyang initial stage, Heat knot in Lower Jiao, mania; self-passing of Blood cures. If Exterior unresolved: Guizhi Tang or Tao's Guiling Yin. Exterior resolved, lower abdominal urgency: Taoren Chengqi Tang (Peach Kernel Cathartic Decoction). Blood transmitting to Heart/Spleen: Danggui Huoxue Tang (Angelica Invigorate Blood Decoction). Taiyang jaundice, astringent urination, mania: Wuling San. All are "Ru Kuang" (Like Mania): suddenly wanting to get up in sleep, talking nonsense, yet knowing admonition, controllable. Unlike "Fa Kuang" (Mania), which is fierce and uncontrollable. Fa Kuang: Heat-Toxin in Stomach entering Heart, causing spirit confusion...