干姜一两 附子（去皮，生用，破八片）一枚
右二味，以水三升，煮取一升，去滓，顿服。
@@@
发汗若下之，病仍不解，烦躁者，茯苓四逆汤主之。
【注】
此又承上条言。先汗后下，于法不逆，病应解而仍不解，反烦躁者，以别其治也。盖
汗、下俱过，表里两虚，阴盛格阳，故昼夜见此扰乱之象也。当以四逆汤，壮阳胜阴
，更加茯苓以抑阴邪，佐人参以扶正气，庶阳长阴消，正回邪退，病自解而烦躁安矣
。大青龙证，不汗出之烦躁，乃未经汗下之烦躁，属实；此条病不解之烦躁，乃汗下
后之烦躁，属虚。然脉之浮紧沉微，自当别之，恐其误人，故谆谆言之也。
【集注】
汪琥曰：伤寒汗下，则烦躁止而病解矣。若阴盛之烦躁，强发其汗，则表疏亡阳；复
下之，则里虚亡阴。卫阳失护，荣阴内空，邪仍不解，更生烦躁，此亦虚烦虚躁，乃
假热之象也。只宜温补，不当散邪，故以茯苓四逆汤主之。
茯苓六两 人参一两 甘草（炙）二两 干姜一两半 附子（生用，去皮，破八片）
一枚
右五味，以水五升，煮取三升，去滓，温服七合，日三服。
【方解】
表里之病，治不如法，先过汗后复过下，或下后复汗，误而又误，变成坏病。若其人
阳盛而从热化，则转属三阳，阳衰而从寒化，则系在三阴，此二条烦躁皆坏病也。烦
躁，虽六经俱有，而多见于太阳、少阴者，太阳为真阴之标，少阴为真阳之本也。未
经汗下而烦躁，多属阳，其脉实大，其证热渴，是烦为阳盛，躁为阴虚。已经汗下而
烦躁，多属阴，其脉沉微，其证汗厥，是烦为阳虚，躁为阴盛也。夫先下后汗，于法
为逆，外无大热，内不呕渴，似乎阴阳自和，而实阳虚阴盛。所以虚阳扰乱于阳分，
故昼日烦躁不得眠；盛阴独治于阴分，故夜而安静；脉沉微，是真阳将脱而烦躁也。
用干姜附子，壮阳以配阴。姜附者，阳中阳也，先用则力更锐，不加甘草，则势更猛
，比之四逆为更峻，救其相离故当急也。先汗后下，于法为顺，病仍不解，遽增昼夜
烦躁，亦是阴盛格阳之烦躁也，用茯苓四逆，抑阴以回阳。茯苓感太和之气化，伐水
邪而不伤阳，故以为君；人参生气于乌有之乡，通血脉于欲绝之际，故以为佐；人参
得姜、附，补气兼以益火；姜、附得茯苓，补阳兼以泻阴；调以甘草，比之四逆为稍
缓和，其相格故宜缓也。一去甘草，一加参芩，而缓急自别，仲景用方之妙如此。
@@@
太阳病，先下而不愈，因复发汗，以此表里俱虚，其人因致冒，冒家汗出自愈。所以
然者，汗出表和故也，得里未和，然后复下之。
【注】
太阳表病，当汗不汗，先下之而愈，因复发其汗，以此表里俱虚，因虚其人致冒，理
必然也。冒家者，谓凡因病而昏冒者也。然冒家或有汗出自愈，其所以然者，非表里
俱虚，乃邪正皆衰，表里自和故也。得汗出而自愈者，和于表也；得下利而自愈者，
和于里也。得里未和，然后下之，宜调胃承气汤和之。由此推之，得表未和，然后汗
之，当以桂枝汤和之，自在言外矣。
【集注】
程知曰：冒者，神识不清，如有物为之冒蒙也。得汗出，表和而邪解矣。得表和而里
未和，然后下之，明不得以其冒而认为入里之邪，遂致妄下，亦不得以其冒而认为表
之未解，复妄用汗也。
汪琥曰：得里未和「里」字，诸注指二便言。窃思经文中既云然后下之，此专指大便
而言，若利小便，则不言下矣。其义可不辨而自明。
@@@
凡病若发汗、若吐、若下、若亡血、若亡津液，阴阳自和者，必自愈。
【注】
凡病，谓不论中风、伤寒一切病也，若发汗、若吐、若下、若亡血、若亡津液，施治
得宜，自然愈矣。即或治未得宜，虽不见愈，亦不至变诸坏逆，则其邪正皆衰，可不
必施治，惟当静以俟之，诊其阴阳自和，必能自愈也。
【集注】
方有执曰：阴阳以脉言，而二便在其中。两者和，则血气无相胜负，故可必自愈。
程知曰：脉以左、右三部匀停为无病。故汗、吐、下后，阴阳和者、必自愈，不须过
治也。
@@@
问曰：病有战而汗出，因得解者何也？答曰：脉浮而紧，按之反芤，此为本虚，故当
战而汗出也。其人本虚，是以发战，以脉浮，故当汗出而解也。若脉浮而数，按之不
芤，此人本不虚，若欲自解，但汗出耳，不发战也。问曰：病有不战而汗出解者何也
？答曰：脉大而浮数，故知不战汗出而解也。问曰：病有不战、不汗出而解者何也？
答曰：其脉自微，此以曾发汗，若吐、若下、若亡血，以内无津液，此阴阳自和，必
自愈，故不战不汗出而解也。
【注】
脉浮而紧，邪实也；按之反芤，正虚也；正虚邪实，邪与正争，故发战汗出而解也。
脉浮而数，邪未实也；按之不芤，正不虚也；正不虚，邪未实，邪不能与正争，故不
战汗出而解也。脉不芤，知不发战也；脉不浮，知不汗出也；脉自微，知曾经发汗。
若吐、若下、若亡血也，因内无津液，邪正俱衰，阴阳自和，故不发战不汗出而解也
。
@@@
问曰：伤寒三日，脉浮数而微，病人身凉和者何也？答曰：此为欲解也。解以夜半，
脉浮而解者，濈然汗出也；脉数而解者，必能食也；脉微而解者，必大汗出也。
【注】
脉浮而数，按之无力，当发战、汗出而解，以其人本虚故也。脉浮而数，按之有力，
当不发战，但汗出而解，以其人本不虚故也。脉自微，曾经发汗，若吐、若下、若亡
血不发战、不汗出而解，以其人邪正皆衰，阴阳自和故也。伤寒三日，未经汗、吐、
下，亡血也，脉浮数而微，病人热减身和，此谓欲解；解以夜半者，阳病至阴时则和
也。盖浮、数、微三脉，虽均为可解之脉，然解之征，则不无别也。如脉浮，濈然汗
出，则邪还于表而解；脉数能食，则胃和而解；脉微，必大汗出而解者，以其未经汗
、吐、下，其人未虚，故均不发战，津液未伤，故汗大出而解也。
【集注】
方有执曰：三日，言遍三阳也。浮数，不传阴也。微，邪气衰也。夜半，阴尽阳生之
时也。濈然，和而汗出貌。能食，胃气回也。
@@@
太阳病未解，脉阴阳俱停，必先振栗，汗出而解，但阳脉微者，先汗出而解，但阴脉
微者，下之而解，若欲下之，宜调胃承气汤。
【注】
太阳病未解，当见未解之脉，今不见未解之脉，而阴阳脉俱停，三部沉伏不见；既三
部沉伏不见，则当见可死之证；而又不见可死之证，是欲作解之兆也。作解之兆，必
先见振栗汗出而始解者，乃邪正交争作汗故也。但作解之脉，不能久停，脉之将出，
必有其先。先者何？先于三部上下、阴阳、沉伏不见处求之也。若从寸脉阳部微微而
见者，则知病势向外，必先汗出而解；若从尺脉阴部微微而见者，则知病势向内，必
自下利而解；如不自下利，若欲下之以和里，宜调胃承气汤主之。由此推之，则可知
如不自汗出，若欲汗之以和表，宜麻桂各半汤主之也。观若欲下之，宜调胃承气汤，
意甚轻活，无取于大下，俱在言外矣。
【集注】
程应旄曰：振栗汗解，单指脉停者言。下边两解，不必有战汗，是指其脉渐出而言也
。
@@@
伤寒，腹满谵语，寸口脉浮而紧，此肝乘脾也，名曰纵，刺期门。
【注】
伤寒脉浮紧，太阳表寒证也。腹满谵语，太阴、阳明里热也。欲从太阳而发汗，则有
太阴、阳明之里；欲从太阴、阳明而下之，又有太阳之表，主治诚为两难，故不药而
用刺法也。虽然太阴论中，太阳表不解，太阴腹满痛，而用桂枝加大黄汤，亦可法也
。此肝乘脾，名曰纵，刺期门，与上文义不属，似有遗误。
@@@
伤寒发热，啬啬恶寒，大渴欲饮水，其腹必满，自汗出，小便利，其病欲解，此肝乘
肺也，名曰横，刺期门。
【注】
伤寒发热，涩涩恶寒，无汗之表也。大渴欲饮水，其腹必满，停饮之满也。若自汗出
，表可自解，小便利满可自除，故曰：其病欲解也。若不汗出，小便闭，以小青龙汤
先解其外，外解已，其满不除，十枣汤下之，亦可愈也。此肝乘肺，名曰横，刺期门
，亦与上文义不属，似有遗误。
@@@
太阳病欲解时，从巳至未上。
【注】
凡病解时，必于其经气之旺。太阳盛阳也。日中阳气盛，故从巳、午、未之旺时而病
解。
音切
惕音踢 □日轮切 擗滂吉切 栗音栗 溲所留切 □职廉切 噎一结切 荛音饶
芤苦候切 濈阻立切
干姜一两，附子（去皮，生用，破成八片）一枚。
以上两味药，用水三升，煮取一升药液，滤去药渣，一次性服用。
@@@
经过发汗或攻下治疗后，病证仍未解除，出现烦躁症状的，由茯苓四逆汤主治。
【注】
这一条是承接上一条而言的。先使用发汗法，后使用攻下法，在治法上并不违背常理，病应当解除却仍然未解，反而出现烦躁，是为了区分其治疗方法。因为发汗和攻下都过度了，导致表里两虚，阴寒内盛格拒阳气，所以昼夜都出现这种扰乱的现象。应当使用四逆汤，来壮阳胜阴，再加茯苓以抑制阴邪，佐助人参以扶持正气，这样阳气增长、阴气消退，正气恢复、邪气退却，病自然解除，烦躁也就安宁了。大青龙汤证的烦躁，是无汗出的烦躁，属于未经过发汗攻下的实证；本条病未解的烦躁，是经过发汗攻下后的虚证。然而脉象浮紧与沉微，自然应当加以辨别，恐怕误人，所以谆谆告诫地说明这一点。
【集注】
汪琥说：伤寒经过发汗或攻下，烦躁应停止而病解除。如果是阴寒内盛的烦躁，强行发汗，则表疏亡阳；再次攻下，则里虚亡阴。卫阳失去护卫，营阴内部空虚，邪气仍不解，更生烦躁，这也是虚烦虚躁，是假热的现象。只宜温补，不应当散邪，所以用茯苓四逆汤主治。
茯苓六两，人参一两，甘草（炙）二两，干姜一两半，附子（生用，去皮，破成八片）一枚。
以上五味药，用水五升，煮取三升药液，滤去药渣，每次温服七合，每日三次服用。
【方解】
表里之病，治疗不得法，先发汗过度后又攻下过度，或者攻下后又发汗，误而又误，变成了坏病。如果其人阳气盛而从热化，则转属三阳经；阳气衰而从寒化，则系在三阴经。这两条所述的烦躁都属于坏病。烦躁，虽然六经都有，但多见于太阳经和少阴经，因为太阳是真阴的标，少阴是真阳的本。未经过发汗攻下而出现的烦躁，多属阳证，其脉实大，其证见热渴，这是烦为阳盛，躁为阴虚。已经过发汗攻下而出现的烦躁，多属阴证，其脉沉微，其证见汗出厥冷，这是烦为阳虚，躁为阴盛。先攻下后发汗，在治法上为逆，外无大热，内不呕吐口渴，似乎阴阳自和，但实际上是阳虚阴盛。所以虚阳扰乱于阳分，故白天烦躁不能入睡；盛阴独治于阴分，故夜间安静；脉沉微，是真阳将脱而导致的烦躁。使用干姜、附子，壮阳以配阴。姜、附是阳中之阳，先用则药力更锐利，不加甘草，则药势更猛烈，比四逆汤更为峻烈，因为救其阴阳离决故应当急治。先发汗后攻下，在治法上为顺，病仍不解，突然增加昼夜烦躁，也是阴盛格阳的烦躁，使用茯苓四逆汤，抑阴以回阳。茯苓感受太和之气化，伐水邪而不伤阳，所以作为君药；人参生于虚无之乡，通血脉于欲绝之际，所以作为佐药；人参得到姜、附，补气兼以益火；姜、附得到茯苓，补阳兼以泻阴；调和以甘草，比四逆汤稍缓和，因为其阴阳相格故宜缓治。一去甘草，一加人参、茯苓，而缓急自然区别开来，张仲景用方的精妙之处就在于此。
@@@
太阳病，先使用攻下法而未愈，因此再次发汗，由于这样表里俱虚，其人因此导致头目昏蒙，昏冒者若汗出则自愈。之所以如此，是因为汗出则表气和故也，如果得里未和，然后再使用攻下法。
【注】
太阳表病，应当发汗而不发汗，先使用攻下法而痊愈，因此再次发汗，由于这样表里俱虚，因虚导致其人昏冒，道理当然是这样的。所谓昏冒者，是指凡是因病而导致神识昏蒙的人。然而昏冒者或有汗出而自愈，其所以如此的原因，并非表里俱虚，而是邪气与正气皆衰，表里自和的缘故。得汗出而自愈的，是与表气和；得下利而自愈的，是与里气和。得里未和，然后使用攻下法，适宜用调胃承气汤调和它。由此推论，得表未和，然后使用发汗法，应当用桂枝汤调和它，这自在言外了。
【集注】
程知说：昏冒，是指神识不清，如有物为之遮蔽。得汗出，表和而邪气解除。得表和而里未和，然后攻下，明确不能因其昏冒而认为是入里的邪气，遂致妄用攻下，也不能因其昏冒而认为是表未解，复妄用发汗。
汪琥说：得里未和中的“里”字，诸家注释指二便而言。我思考经文中既然说然后攻下，这里专指大便而言，如果是利小便，则不说攻下了。其义可以不辨而自明。
@@@
凡病，如果发汗、如果催吐、如果攻下、如果亡血、如果亡津液，阴阳自和的，必定自愈。
【注】
凡病，指不论中风、伤寒一切病证，如果发汗、如果催吐、如果攻下、如果亡血、如果亡津液，施治得当，自然痊愈。即使治疗不得当，虽然不见痊愈，也不至于变成各种坏逆证，那么其邪气与正气皆衰，可不必要再施治，只当静待，诊察其阴阳自和，必定能自愈。
【集注】
方有执说：阴阳从脉象而言，而二便包含在其中。两者和，则血气无相胜负，故可必自愈。
程知说：脉以左、右三部匀停为无病。所以汗、吐、下后，阴阳和的，必自愈，不需要过度治疗。
@@@
问曰：有病战栗而后汗出，因而得解的，是什么缘故？答曰：脉浮而紧，按之反芤，这是因为本虚，所以应当战栗而后汗出。其人本虚，所以发生战栗，因为脉浮，所以应当汗出而解。如果脉浮而数，按之不芤，此人本不虚，如果想要自解，只是汗出而已，不发生战栗。问曰：有病不战栗而汗出解的，是什么缘故？答曰：脉大而浮数，所以知道不战栗而汗出解。问曰：有病不战栗、不汗出而解的，是什么缘故？答曰：其脉自微，这是因为曾经发汗，如果催吐，如果攻下，如果亡血，因为内部没有津液，这是阴阳自和，必定自愈，所以不战栗不汗出而解。
【注】
脉浮而紧，是邪实；按之反芤，是正虚；正虚邪实，邪气与正气相争，所以发战栗汗出而解。脉浮而数，邪未实；按之不芤，正不虚；正不虚，邪未实，邪气不能与正气相争，所以不战栗而汗出解。脉不芤，知道不发战栗；脉不浮，知道不汗出；脉自微，知道曾经发汗。如果催吐，如果攻下，如果亡血，因为内部没有津液，邪正俱衰，阴阳自和，所以不发战栗不汗出而解。
@@@
问曰：伤寒三日，脉浮数而微，病人身凉和的，是什么缘故？答曰：这是将要解除的征兆。解除在夜半，脉浮而解的，是濈然汗出；脉数而解的，必定能进食；脉微而解的，必定大汗出。
【注】
脉浮而数，按之无力，应当发战栗、汗出而解，因为其人本虚的缘故。脉浮而数，按之有力，应当不发战栗，只是汗出而解，因为其人本不虚的缘故。脉自微，曾经发汗，如果催吐，如果攻下，如果亡血，不发战栗、不汗出而解，因为其人邪正皆衰，阴阳自和的缘故。伤寒三日，未经过发汗、催吐、攻下，也没有亡血，脉浮数而微，病人热减身和，这叫作将要解除；解除在夜半的，是阳病至阴时则和。盖浮、数、微三脉，虽然均为可解之脉，然而解除的征象，则不无区别。如脉浮，濈然汗出，则邪还于表而解；脉数能食，则胃和而解；脉微，必大汗出而解的，因为未经过发汗、催吐、攻下，其人未虚，所以均不发战栗，津液未伤，所以大汗出而解。
【集注】
方有执说：三日，指遍行三阳经。浮数，指不传阴经。微，指邪气衰。夜半，指阴尽阳生的时候。濈然，指和缓而汗出的样子。能食，指胃气回。
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太阳病未解，脉阴阳俱停，必先振栗，汗出而解，但阳脉微者，先汗出而解，但阴脉微者，下之而解，如果想要攻下，适宜用调胃承气汤。
【注】
太阳病未解，应当见到未解的脉象，现在不见未解的脉象，而阴阳脉俱停，三部沉伏不见；既然三部沉伏不见，则应当见到可死之证；而又不见可死之证，这是将要作解的征兆。作解的征兆，必须先见振栗汗出而始解的，这是邪正交争作汗的缘故。但作解之脉，不能久停，脉之将出，必有其先兆。先兆是什么？先在三部上下、阴阳、沉伏不见处求之。如果从寸脉阳部微微而见者，则知病势向外，必先汗出而解；如果从尺脉阴部微微而见者，则知病势向内，必自下利而解；如果不自行下利，如果想要攻下以和里，适宜用调胃承气汤主治。由此推论，则可知如果不自行汗出，如果想要发汗以和表，适宜用麻黄桂枝各半汤主治。观其说“若欲下之，宜调胃承气汤”，意甚轻活，无取于大下，都在言外了。
【集注】
程应旄说：振栗汗解，单指脉停者而言。下边两种解法，不必有战汗，是指其脉渐出而言。
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伤寒，腹满谵语，寸口脉浮而紧，这是肝乘脾，名叫纵，刺期门穴。
【注】
伤寒脉浮紧，是太阳表寒证。腹满谵语，是太阴、阳明里热。想要从太阳而发汗，则有太阴、阳明之里；想要从太阴、阳明而攻下，又有太阳之表，主治确实为难，所以不用药而用刺法。虽然太阴篇中，太阳表不解，太阴腹满痛，而用桂枝加大黄汤，也可效法。此肝乘脾，名叫纵，刺期门，与上文义不属，似有遗误。
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伤寒发热，啬啬恶寒，大渴欲饮水，其腹必满，自汗出，小便利，其病欲解，这是肝乘肺，名叫横，刺期门。
【注】
伤寒发热，啬啬恶寒，是无汗之表证。大渴欲饮水，其腹必满，是停饮之满。如果自汗出，表可自解，小便利满可自除，所以说：其病欲解。如果不汗出，小便闭，用小青龙汤先解其外，外解已，其满不除，十枣汤下之，也可愈。此肝乘肺，名叫横，刺期门，也与上文义不属，似有遗误。
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太阳病欲解时，从巳时至未时。
【注】
凡病解时，必在其经气旺盛之时。太阳是盛阳。日中阳气盛，所以从巳、午、未之旺时而病解。
音切
惕音踢 □日轮切 擗滂吉切 栗音栗 溲所留切 □职廉切 噎一结切 荛音饶
芤苦候切 濈阻立切
Dried Ginger (Ganjiang, 干姜) one tael, Aconite Root (Fuzi, 附子) (peeled, used raw, broken into eight pieces) one piece.
These two ingredients, with three sheng of water, are boiled to obtain one sheng of decoction. The dregs are removed, and the liquid is taken in a single dose.
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If sweating or purgation has been applied but the disease remains unresolved, and irritability (Fan Zao, 烦躁) occurs, it should be treated with Poria Four-Inverse Decoction (Fuling Sini Tang, 茯苓四逆汤).
[Annotation]
This statement follows the previous one. Applying sweating first and purgation subsequently does not violate therapeutic principles; the disease should resolve but fails to do so, instead presenting with irritability. This distinction clarifies the treatment approach. Excessive sweating and purgation have led to deficiency in both exterior and interior, with excess Yin repelling Yang. Consequently, this chaotic state manifests day and night. One should employ Four-Inverse Decoction (Sini Tang, 四逆汤) to strengthen Yang and overcome Yin, add Poria (Fuling, 茯苓) to suppress Yin pathogens, and use Ginseng (Renshen, 人参) as an assistant to support healthy Qi. Thus, Yang grows while Yin diminishes, healthy Qi returns, pathogens recede, the disease resolves, and irritability subsides. In the syndrome of Major Ephedra Decoction (Da Qinglong Tang, 大青龙汤), irritability without sweating belongs to excess, occurring before any sweating or purgation. In this case, irritability following unresolved disease after sweating and purgation belongs to deficiency. However, superficial-tight pulse versus deep-micro pulse naturally require differentiation to prevent misdiagnosis, hence the earnest explanation.
[Collected Annotations]
Wang Hu stated: In cold damage, sweating or purgation should stop irritability and resolve the disease. If irritability stems from excess Yin, forcing sweat leads to loss of Yang at the exterior; subsequent purgation leads to loss of Yin at the interior. With Wei-Yang unprotected and Ying-Yin empty inside, pathogens remain unresolved, generating new irritability. This is false heat manifesting as deficiency irritability. Only warming and tonification are suitable; dispersing pathogens is inappropriate. Hence, Poria Four-Inverse Decoction is used.
Poria (Fuling, 茯苓) six taels, Ginseng (Renshen, 人参) one tael, Licorice Root (Gancao, 甘草) (roasted) two taels, Dried Ginger (Ganjiang, 干姜) one and a half taels, Aconite Root (Fuzi, 附子) (used raw, peeled, broken into eight pieces) one piece.
These five ingredients, with five sheng of water, are boiled to obtain three sheng of decoction. The dregs are removed, and seven ge of the warm decoction are taken per dose, three times daily.
[Formula Analysis]
When diseases of the exterior and interior are treated improperly—excessive sweating followed by excessive purgation, or purgation followed by sweating—errors compound, resulting in complicated diseases (Huai Bing, 坏病). If the patient's Yang is abundant and transforms into heat, the disease shifts to the Three Yang meridians; if Yang is deficient and transforms into cold, it involves the Three Yin meridians. The irritability described in these two clauses belongs to complicated diseases. Irritability can occur in all Six Meridians but is most common in Taiyang and Shaoyin, as Taiyang is the branch of True Yin and Shaoyin is the root of True Yang. Irritability before sweating/purgation usually indicates Yang excess (pulse solid-large, symptoms of heat/thirst); here, "fan" (vexation) is Yang excess, and "zao" (restlessness) is Yin deficiency. Irritability after sweating/purgation usually indicates Yin excess (pulse deep-micro, symptoms of sweating/cold limbs); here, "fan" is Yang deficiency, and "zao" is Yin excess. Purging then sweating is therapeutically adverse. Without significant external heat or internal vomiting/thirst, it seems Yin and Yang harmonize, but actually reflects Yang deficiency and Yin excess. Deficient Yang disturbs the Yang aspect, causing daytime irritability and insomnia; Excess Yin dominates the Yin aspect, causing nighttime quietness. A deep-micro pulse indicates impending collapse of True Yang. Dried Ginger and Aconite strengthen Yang to match Yin. Ginger and Aconite are "Yang within Yang"; using them first sharpens their force, and omitting Licorice makes their action more fierce than Four-Inverse Decoction, which is necessary for urgent rescue of separated Yin and Yang. Sweating then purging is therapeutically smooth. Unresolved disease with sudden increase in day-and-night irritability also reflects Yin excess repelling Yang. Poria Four-Inverse Decoction suppresses Yin to restore Yang. Poria absorbs the Qi of Great Harmony, draining Water pathogens without damaging Yang, serving as the Sovereign herb. Ginseng generates Qi from non-existence and unblocks blood vessels at the verge of collapse, serving as an Assistant. Ginseng combined with Ginger/Aconite tonifies Qi and benefits Fire; Ginger/Aconite combined with Poria tonifies Yang and drains Yin. Harmonized with Licorice, it is milder than Four-Inverse Decoction, suitable for gradual resolution of mutual repulsion. Removing Licorice and adding Ginseng/Poria distinguishes urgency from slowness. Such is the subtlety of Zhang Zhongjing's formula usage.
@@@
In Taiyang disease, if purgation is applied first without cure, followed by sweating, the exterior and interior become deficient. The patient may experience "Mao" (dizziness/mental clouding). If the patient sweats, they will heal spontaneously. This is because sweating harmonizes the exterior. If the interior remains unharmonized, purgation may be applied subsequently.
[Annotation]
Taiyang exterior disease requires sweating. If purgation is used first and cures the disease, followed by sweating, the exterior and interior become deficient, leading to mental clouding due to deficiency. "Mao" refers to any condition causing mental cloudiness due to illness. Some cases of Mao resolve with spontaneous sweating because pathogens and healthy Qi both decline, allowing natural harmony of exterior and interior. Resolution via sweating harmonizes the exterior; resolution via diarrhea harmonizes the interior. If the interior is unharmonized, purgation is appropriate, specifically Stomach-Regulating Chengqi Decoction (Tiaowei Chengqi Tang, 调胃承气汤). By inference, if the exterior is unharmonized, sweating is appropriate, likely using Cinnamon Twig Decoction (Guizhi Tang, 桂枝汤), implied but not stated.
[Collected Annotations]
Cheng Zhi stated: Mao implies unclear consciousness, as if covered by an object. Sweating harmonizes the exterior and resolves pathogens. If the exterior is harmonized but the interior is not, purgation follows. One must not mistake Mao for interior pathogens and purge blindly, nor assume unresolved exterior and sweat blindly.
Wang Hu noted: The term "interior" in "interior unharmonized" refers to bowel movements. Since the text says "purge," it specifically refers to stool, not urine. The meaning is self-evident.
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For any disease, whether treated by sweating, vomiting, purgation, or involving blood/fluid loss, if Yin and Yang naturally harmonize, the disease will surely heal itself.
[Annotation]
"All diseases" includes wind-strike and cold damage. If treatments like sweating, vomiting, purgation, or conditions like blood/fluid loss are managed appropriately, healing occurs naturally. Even if treatment is suboptimal and no immediate cure is seen, complications are avoided as pathogens and healthy Qi decline. No further treatment is needed; one waits quietly. If diagnosis shows natural Yin-Yang harmony, self-healing is certain.
[Collected Annotations]
Fang Youzhi stated: Yin and Yang refer to pulses, including bowel/bladder function. Harmony between them ensures balanced Qi and Blood, guaranteeing self-healing.
Cheng Zhi stated: A pulse with even left/right sections indicates health. After sweating/vomiting/purgation, if Yin and Yang harmonize, self-healing occurs without over-treatment.
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Question: Why does a patient shiver then sweat, leading to resolution? Answer: A floating-tight pulse that feels hollow upon pressure indicates underlying deficiency. Therefore, shivering and sweating occur for resolution. The patient's underlying deficiency causes shivering; the floating pulse indicates sweating will lead to resolution. If the pulse is floating-numerous and not hollow upon pressure, the patient is not deficient. Resolution will occur via sweating alone, without shivering. Question: Why does a patient resolve without shivering but with sweating? Answer: A large, floating, numerous pulse indicates resolution without shivering. Question: Why does a patient resolve without shivering or sweating? Answer: A faint pulse indicates prior sweating, vomiting, purgation, or blood loss, leading to internal fluid depletion. Natural Yin-Yang harmony ensures self-resolution without shivering or sweating.
[Annotation]
Floating-tight pulse indicates pathogen excess; hollow pressure indicates healthy Qi deficiency. Deficiency of Zheng and excess of Xie cause conflict, leading to shivering and sweating for resolution. Floating-numerous pulse without hollow pressure indicates neither pathogen excess nor Zheng deficiency; thus, no conflict, resolving via sweating without shivering. Faint pulse indicates prior treatment or fluid loss. Internal fluid depletion leads to decline of both Xie and Zheng, allowing Yin-Yang harmony and resolution without shivering or sweating.
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Question: In cold damage on the third day, why does a patient with floating-numerous-faint pulse and cool body indicate impending resolution? Answer: This signifies impending resolution. Resolution occurs at midnight. Floating pulse resolution presents as continuous sweating; numerous pulse resolution indicates ability to eat; faint pulse resolution presents as heavy sweating.
[Annotation]
Floating-numerous pulse with weak pressure requires shivering/sweating due to underlying deficiency. Strong pressure indicates no shivering, only sweating, due to lack of deficiency. Faint pulse indicates prior treatment or fluid loss, resolving without shivering/sweating due to Yin-Yang harmony. On the third day of cold damage, without prior sweating/vomiting/purgation or blood loss, a floating-numerous-faint pulse with reduced heat and harmonious body indicates impending resolution. Midnight resolution occurs because Yang diseases harmonize during Yin hours. While floating, numerous, and faint pulses all suggest resolution, the signs differ. Floating pulse with continuous sweating indicates pathogens returning to the exterior. Numerous pulse with appetite indicates stomach harmony. Faint pulse with heavy sweating indicates sufficient fluids and lack of deficiency, allowing robust resolution.
[Collected Annotations]
Fang Youzhi stated: "Three days" covers the Three Yang meridians. Floating-numerous indicates no transmission to Yin. Faint indicates declining pathogens. Midnight is when Yin ends and Yang begins. "Continuous sweating" describes harmonious perspiration. "Ability to eat" indicates return of Stomach Qi.
@@@
In unresolved Taiyang disease, if both Yin and Yang pulses cease (stop), the patient will first tremble and shake, then sweat to resolve. If only the Yang pulse is faint, sweating resolves it. If only the Yin pulse is faint, purgation resolves it. For purgation, Stomach-Regulating Chengqi Decoction (Tiaowei Chengqi Tang, 调胃承气汤) is appropriate.
[Annotation]
Unresolved Taiyang disease should show specific pulses. Absence of these, with Yin/Yang pulses ceasing (deep/faint/unfelt), suggests a critical state. However, absence of death signs indicates impending resolution. Resolution requires trembling/shaking followed by sweating, caused by Xie-Zheng conflict. The resolving pulse cannot stay ceased; its emergence has precursors. If the Yang pulse (Cun position) emerges faintly, the pathogen moves outward, resolving via sweating. If the Yin pulse (Chi position) emerges faintly, the pathogen moves inward, resolving via diarrhea. If diarrhea does not occur spontaneously, purgation with Tiaowei Chengqi Tang harmonizes the interior. By inference, if sweating does not occur spontaneously, sweating with Mahuang Guizhi Half-Decoction (Mahuang Guizhi Ban Tang, 麻黄桂枝半汤) harmonizes the exterior. The phrasing "if purgation is desired" implies mild intervention, not drastic purgation.
[Collected Annotations]
Cheng Yingmao stated: Trembling/sweating resolution applies only to ceased pulses. The subsequent resolutions apply to gradually emerging pulses, not necessarily involving shivering.
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In cold damage, abdominal fullness and delirium with a floating-tight Cun Kou pulse indicate Liver attacking Spleen, named "Zong" (Vertical). Acupuncture Qimen (LR14).
[Annotation]
Floating-tight pulse in cold damage is Taiyang exterior cold. Abdominal fullness and delirium are Taiyin/Yangming interior heat. Sweating (for Taiyang) conflicts with interior presence; purging (for Taiyin/Yangming) conflicts with exterior presence. Treatment is difficult, hence acupuncture is used instead of herbs. Although Guizhi Plus Rhubarb Decoction (Guizhi Jia Dahuang Tang, 桂枝加大黄汤) treats Taiyang exterior with Taiyin abdominal pain, this case of Liver attacking Spleen ("Zong") at Qimen seems disconnected from the preceding context, possibly a textual error.
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In cold damage, fever, aversion to cold, extreme thirst with desire to drink, abdominal fullness, spontaneous sweating, and free urination indicate impending resolution. This is Liver attacking Lung, named "Heng" (Horizontal). Acupuncture Qimen (LR14).
[Annotation]
Fever and aversion to cold without sweating is exterior. Extreme thirst and abdominal fullness indicate retained fluid. Spontaneous sweating resolves the exterior; free urination removes fullness. Thus, the disease resolves. If no sweating and closed urination, Xiao Qinglong Decoction (Xiao Qinglong Tang, 小青龙汤) resolves the exterior first; if fullness persists, Shizao Decoction (Shizao Tang, 十枣汤) purges. This Liver attacking Lung ("Heng") at Qimen also seems disconnected, possibly a textual error.
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Taiyang disease tends to resolve from Si hour to Wei hour.
[Annotation]
Diseases resolve when their meridian Qi is prosperous. Taiyang is盛 Yang. Yang Qi is abundant at noon; thus, resolution occurs during the prosperous hours of Si, Wu, and Wei.
Phonetics
Ti sounds like Ti □ Ri Lun Qie Pi Pang Ji Qie Li sounds like Li Sou Suo Liu Qie □ Zhi Lian Qie Ye Yi Jie Qie Rao Yin Rao
Kou Ku Hou Qie Ji Zu Li Qie