典藏书目

Corydalis Rhizome (Yinchen) six liang, Gardenia Fruit (Zhizi) [broken open] fourteen pieces, Rhubarb (Dahuang) [bark removed] two liang.
The above three ingredients, with ten dou and two sheng of water, first decoct Corydalis Rhizome until the volume reduces by six sheng, then add the other two ingredients, decoct to obtain three sheng, remove the dregs, divide into three doses. After urination becomes smooth, the urine will resemble the juice of soap pods, dark red in color; after one night, abdominal distension will decrease, and jaundice will be discharged through urination.

@@@
In cold damage presenting with yellowing of the body and fever, Gardenia and Phellodendron Decoction (Zhizi Bopi Tang) is indicated.
[Note]
Regarding cold damage presenting with yellowing of the body and fever: If there is a exterior syndrome characterized by anhidrosis, Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Red Bean Decoction) for inducing sweating is appropriate. If there is an interior excess syndrome formed, Yin Chen Hao Tang (Artemisia Decoction) for purging is also appropriate. Now, since there is no exterior syndrome suitable for sweating nor an interior syndrome suitable for purging, only Qing Re (clearing heat) with Zhizi Bopi Tang is appropriate.
[Collected Notes]
Lin Lan said: Cold damage presenting with yellowing of the body involves stagnant heat in the stomach, which usually requires purging. Here, because there is fever but the heat has not yet solidified, Jie Biao (resolving the exterior) or clearing heat with Zhizi Bopi Tang is appropriate.
Wang Hu said: Yellowing of the body accompanied by fever refers to fever within the context of jaundice, not the fever associated with Ma Huang or Gui Zhi syndromes. Since heat is constrained and causes yellowing, although it involves the exterior, it is not a pure exterior syndrome. One should only clear the constrained heat to retreat the jaundice, whereupon the fever will heal itself.
Wei Litong said: Although these three clauses all describe syndromes where external cold carries dampness, stagnating into heat, one must pay special attention to whether the pathogen is in the exterior or interior, and whether dampness or heat predominates. How can one generally consider it an interior syndrome and indiscriminately use purgatives!

Gardenia Fruit (Zhizi) [broken open] fifteen pieces, Licorice Root (Gancao) [roasted] one liang, Phellodendron Bark (Huangbai) two liang.
The above three ingredients, with four sheng of water, decoct to obtain one sheng and half, remove the dregs, divide into two warm doses.
[Commentary]
The Gancao (Licorice Root) in this formula should be Yinchen (Corydalis Rhizome); it is certainly a transcription error.

@@@
In Yangming disease treated with fire therapy, if there is slight sweating on the forehead and urination is difficult, jaundice will inevitably develop.
[Note]
In Yangming disease with anhidrosis, if Ge Gen Tang (Kudzu Decoction) is not used to induce sweating, but fire therapy is employed to force sweat, leading to excessive heat and dryness of fluids, causing ingested water to stagnate, and heat steaming upward, slight sweating occurs on the forehead while the rest of the body remains without sweat. If urination is smooth, the pathology transforms towards dryness, resulting in vexation and thirst, indicating Bai Hu Tang (White Tiger Decoction). If urination is difficult, the pathology transforms towards dampness, resulting in jaundice, indicating Yin Chen Hao Tang.
[Collected Notes]
Yu Chang said: In Yangming disease, with dampness stagnating and heat constraining, vexation and thirst increase, inevitably leading to jaundice. However, if sweat occurs, heat escapes from the exterior, so jaundice can be avoided; if urination is frequent, heat drains downward, so jaundice can be avoided. If mistaken purgation is used, the heat pathogen sinks deeper, fluids are further damaged, and both sweat and urination become impossible. If mistaken fire therapy is used, the heat pathogen becomes more blazing, fluids rush upward; although there is slight sweating on the forehead, sweat over the whole body and urination become even more impossible. How can changes of jaundice be avoided?
Cheng Zhi said: Jaundice in Taiyang disease arises from cold constraining dampness, preventing its resolution; jaundice in Yangming disease arises from dampness and heat stagnating, preventing heat from dispersing. Therefore, treatment should be differentiated by meridian.

@@@
In Yangming disease, with anhidrosis, difficult urination, and internal vexation and regret (Ao Nao), the body will inevitably turn yellow.
[Note]
In Yangming disease with anhidrosis, it is because heat cannot vent outward. Difficult urination means dampness cannot drain downward. Internal vexation and regret indicate dampness and heat stagnating in the interior. Thus, the body will inevitably turn yellow; Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Red Bean Decoction) is appropriate to vent externally and drain internally. If, after sweating, vomiting, or purging, or if urination is smooth, but internal vexation and regret persist, this is heat constraining, not damp-heat stagnation. If stools are hard, Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct the Qi Decoction) for purging is appropriate; if stools are soft, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) for inducing vomiting is appropriate.
[Collected Notes]
Fang Youzhi said: Anhidrosis and difficult urination lead to dampness stagnation and internal vexation; dampness stagnation and heat constraining indicate that jaundice is inevitable.
Zhang Lu said: Unable to sweat externally, unable to urinate downward, damp-heat constrains in the chest and cannot vent, inevitably steaming the body to turn yellow.

@@@
In Yangming disease, with the face entirely red, purgation is contraindicated; otherwise, fever and yellowing will occur, along with difficult urination.
[Note]
In Yangming meridian disease, the face being entirely red indicates that heat pathogens are still constrained in the meridian and have not entered the interior to form excess. Therefore, even if there is constipation, purgation is contraindicated. If purged, the heat constrained in the meridian will not resolve, inevitably causing fever and yellowing. If the person has interior dryness and urination is smooth, it transforms towards dryness, jaundice should not occur, but stools will become hard.
[Collected Notes]
Fang Youzhi said: "He" corresponds to "should". "Chi" is the color of heat. Stomach heat rises, corresponding to facial redness. Purging loses fluids, causing fever and yellowing due to difficult urination.
Cheng Zhi said: This states that heat in the Yangming meridian cannot be purged. Heat in the meridian means yang qi is constrained at the exterior. Purging prevents the heat in the meridian from venting, inevitably causing fever and yellowing due to difficult urination.
Cheng Yingmao said: Heat obstructs between the skin and muscles, causing fever and difficult urination, constraining to form yellowing.

@@@
In Yangming disease, with fever and sweating, this is called heat venting, and jaundice cannot occur. If there is only sweating on the head, no sweating on the body, stopping at the neck, difficult urination, and thirst for drinking liquids, this is called stagnant heat in the interior, and the body will inevitably turn yellow; Yin Chen Hao Tang (Artemisia Decoction) is indicated.
[Note]
In Yangming disease with fever and sweating, this is called heat venting. If urination is smooth, stools become dry due to it, and jaundice cannot occur. Only sweating on the head and no sweating on the body indicates that Yangming heat cannot vent outward but steams upward. Difficult urination indicates dampness accumulating in the bladder; thirst for drinking liquids indicates heat scorching the stomach fu. This is damp-heat stagnating in the interior, pressing on the skin and muscles, so the body will inevitably turn yellow. Using Yin Chen Hao Tang promotes the unblocking of both large and small urination, allowing damp-heat to exit through the lower orifices.
[Collected Notes]
Fang Youzhi said: "Yue" means disperse. Notes on head sweating, stagnant heat, and jaundice appear in the Taiyang chapter. Yinchen expels damp-heat jaundice, Zhizhi clears stomach heat, Dahuang pushes away obstructive stasis. These three herbs use bitterness to drain heat; draining heat dissipates jaundice.
Cheng Yingmao said: Sweating on the head, no sweating on the body, stopping at the neck, proves yang heat qi is constrained internally and cannot vent, thus only steaming the head, as the head is the summit of all yang meridians. Qi does not descend, hence difficult urination; fu qi is overly dry, hence thirst for liquids. "Stagnant heat in the interior" refers to anhidrosis; anhidrosis with smooth urination belongs to cold, anhidrosis with difficult urination belongs to damp-heat. The two pathogens constrain each other and cannot vent, thus brewing jaundice. To resolve heat and remove dampness, nothing surpasses Yinchen and Zhizhi clearing the upper, and Dahuang cleansing the lower. With the heat of the whole body vented, how could jaundice not dissipate?

@@@
In cold damage, if the pulse is floating and slow, and hands and feet are naturally warm, this is related to Taiyin. Taiyin disease, the body should turn yellow; if urination is natural, jaundice cannot occur. By the seventh or eighth day, if stools become hard, it becomes Yangming disease.
[Note]
This is a Taiyin syndrome transferring to Yangming. Cold damage with floating-slow pulse and hot hands/feet is Taiyang. Now, hands and feet are naturally warm, not Taiyang, thus related to Taiyin. However, Taiyin pulse should be deep-slow; now it is floating-slow, which is a Taiyang pulse. Syndrome of Taiyin with pulse of Taiyang indicates pathogen transmitting from Taiyang to Taiyin, hence "related to Taiyin". If urination is natural, it does not transform via Taiyin dampness to cause jaundice. By the seventh or eighth day, if stools become hard, it transforms towards dryness, becoming Yangming.
[Collected Notes]
Cheng Yingmao said: Yangming disease originates from "Stomach-Fu Excess". This excess is not only caused by Three Yang meridians receiving pathogen and transferring to Yangming, but also by Three Yin meridians receiving pathogen and transferring to Yangming; let us take Taiyin as an example. Floating-slow pulse is an exterior pulse, yet without exterior symptoms like fever, headache, aversion to cold, but hands and feet are merely warm, indicating pathogen is not in exterior but in interior. Entering interior has yin-yang distinction, distinguished by urination: difficult urination, damp steaming and heat stagnating cause jaundice, because the person's stomach originally lacks dryness qi; natural urination, stomach dryness and stool hardness form excess, because the stomach originally possesses dryness qi. Although the disease forms on the seventh or eighth day, the initial syndrome of floating-slow pulse and naturally warm hands/feet is truly Taiyin transferring. Extending from Taiyin and Yangming, the Three Da Cheng Qi cases in Shaoyin and the One Xiao Cheng Qi case in Jueyin, are they not all diseases transferring to Yangming!
Wei Litong said: Disease in Taiyang, heat constrained by dampness gathers in the interior, having a destination. Since it cannot cause jaundice, and urination is natural, where does the pathogen return? It must return to the Stomach, the destination of all things. By the seventh or eighth day, urination increases, stools harden, becoming Yangming disease.

@@@
When cold damage transfers to relate to Yangming, the person exhibits slight continuous sweating (Ji Ran).
[Note]
Generally in cold damage, regardless of Three Yin or Three Yang, if it transfers to relate to Yangming, the person must exhibit slight continuous sweating, marking the transfer to Yangming.

@@@
In Taiyang disease, if vomited, but Taiyang disease should have aversion to cold, now instead there is no aversion to cold, and unwillingness to wear clothes, this is internal vexation caused by vomiting.
[Note]
In Taiyang disease, if vomited, if exterior resolves, there should be no aversion to cold; if interior resolves, there should be no aversion to heat. Now, instead of no aversion to cold and unwillingness to wear clothes, this is aversion to heat. This is because after vomiting, exterior resolves but interior does not, generating internal vexation-heat. Generally, anhidrosis with vexation-heat, heat in exterior, is Da Qing Long Tang (Major Green Dragon Decoction) syndrome; hyperhidrosis with vexation-heat, heat in interior, is Bai Hu Tang (White Tiger Decoction) syndrome. After vomiting and purging, internal vexation-regret, anhidrosis with vexation-heat, stools hard but heat still inside, is Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) syndrome; hyperhidrosis with vexation-heat, stools already hard, heat fully entered fu, is Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct the Qi Decoction) syndrome. Now, due to vomiting, generating internal vexation-heat, this is deficiency vexation with damaged qi and fluids, not excess vexation before sweating/purging. The above methods are all contraindicated; only Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) is appropriate to clear heat and calm vexation while benefiting qi and generating fluids.
[Collected Notes]
Zhang Lu said: This is vomiting damaging fluids in the stomach, hence internal vexation and unwillingness to wear clothes. Although manifesting deficiency vexation, compared to fine-rapid pulse at Guan position forming deficiency heat, it is slightly milder than dual injury of spleen and stomach. Although not leading to reversal, it is still an error of mistaken vomiting.

@@@
Taiyang disease should have aversion to cold and fever; now there is spontaneous sweating, instead no aversion to cold or fever, and fine-rapid pulse at Guan position, due to medical error of vomiting. Vomiting on day one or two: abdominal hunger, inability to eat; vomiting on day three or four: dislike congee, desire cold food, morning eating evening vomiting, caused by medical error of vomiting, this is called minor reversal (Xiao Ni).
[Commentary]
After "desire cold food", the six characters "vomiting on day five or six" should exist. Without this sentence, "dislike congee, desire cold food" and "morning eating evening vomiting" are not connected. Carefully studying the text regarding days one-two and three-four reveals that "vomiting on day five-six" must exist, representing progression from shallow to deep.
[Note]
Taiyang disease unresolved should have aversion to cold and fever; now spontaneous sweating, no aversion to cold or fever, indicates exterior resolved. Fine-rapid pulse at Guan indicates stomach disharmony. Fine indicates stomach qi deficiency. Rapid indicates stomach qi heat. Syndrome and pulse discordance, upon inquiry, is known to be medical error of vomiting. On days one-two, disease in Taiyang, righteous qi not depleted, vomiting injures stomach superficially, hence abdominal hunger but inability to eat. On days three-four, disease in Yangming, stomach already hot, vomiting further damages fluids, hence dislike congee, desire cold food. On days five-six, disease about to transfer to Yin meridians, righteous qi depleted, vomiting makes stomach cold, hence morning eating evening vomiting. All caused by medical vomiting, yet treatable. Hence called "minor reversal".
[Collected Notes]
Cheng Zhi said: Originally Taiyang disease, medical vomiting causes exterior pathogen to enter Yangming via deficiency, injuring stomach qi, resulting in fine-rapid Guan pulse.
Cheng Yingmao said: Yangming qi descends smoothly, ascends reversely. Caused by medical vomiting, this is not the original disease of spleen and stomach, hence "minor reversal". Do not mistreat, lest minor reversal becomes major reversal.

@@@
Desiring to vomit after eating grain belongs to Yangming, treated with Wu Zhu Yu Tang (Evodia Decoction). If symptoms worsen after taking the decoction, it belongs to Upper Jiao.
[Note]
Desiring to vomit after eating grain, belonging to Yangming, is because Stomach governs reception. Now Stomach is cold, unable to receive grain, hence desiring to vomit. Wu Zhu Yu Tang warms middle and directs rebellion downward to stop vomiting. If worsening after taking the decoction, this is certainly not Middle Jiao Yangming interior cold, but Upper Jiao Taiyang exterior heat. Wu Zhu Yu is hot in nature and flavor, mismatching the disease, hence worsening. Method should follow Taiyang-Yangming combined disease, non-diarrhea but vomiting precedent, treating with Ge Gen Jia Ban Xia Tang (Kudzu plus Pinellia Decoction).
[Collected Notes]
Fang Youzhi said: Desiring to vomit after eating is stomach cold, hence "belongs to Yangming", distinguishing it from aversion-to-cold vomiting/reversal. Upper Jiao refers to Diaphragm.

@@@
Patient has rapid pulse. Rapid indicates heat, should digest grain and stimulate appetite, but instead vomits. This is because sweating made yang qi weak, diaphragm qi deficient, hence rapid pulse. Rapid here is guest heat, unable to digest grain, because stomach is deficient and cold, hence vomiting.
[Note]
Patient has rapid pulse, rapid indicates heat, should digest grain and stimulate appetite. Now eating but vomiting, likely because body heat and rapid pulse were mistaken for exterior heat and sweated, thereby making yang qi weak and diaphragm qi deficient. Not knowing this rapid pulse is external guest heat, not stomach excess heat, the inability to digest grain and vomiting is due to original stomach deficiency-cold.
[Collected Notes]
Cheng Zhi said: This discusses post-sweating rapid pulse and vomiting of food, attributing it to stomach yang deficiency. Yang receives qi in chest; excessive sweating makes yang qi weak, diaphragm qi deficient, guest heat vents outward, hence rapid pulse. Guest heat unable to digest grain and causing vomiting attributes to stomach deficiency-cold. If one prescribes stomach-clearing drugs based on rapid pulse, it is wrong.
Cheng Yingmao said: Seeing rapid pulse but vomiting: rapid is heat pulse, powerless is deficiency pulse. Diaphragm deficiency, yang guests above, cannot warm below, causing stomach deficiency-cold. Heat is guest heat, cold is true cold. Investigating root cause, it is solely due to sweating making yang qi weak. How precious is yang qi, how can one mistake sweat!

@@@
Yangming disease, inability to eat. Attacking its heat will surely cause hiccups (Yue). The reason is stomach deficiency-cold. Because the person is originally deficient, attacking heat will surely cause hiccups.
[Note]
Yangming disease inability to eat is middle cold. Even if there is rapid pulse and guest heat, the previous clause warned against sweating, this says attacking is also contraindicated. If attacking heat, it chills stomach yang, surely causing hiccups. The reason is, although guest heat is removed, stomach is also deficiency-cold. Because the person originally has stomach deficiency, attacking heat surely causes hiccups. Yue is dry heaving.
[Collected Notes]
Fang Youzhi said: Attacking heat uses cold drugs, hence knowing it will cause hiccups. Stomach deficiency refers to inability to eat, this is also a warning of caution.
Lin Lan said: Yangming delirium and tidal fever, inability to eat, can be purged, due to dry feces inside. But there are also cases of stomach deficiency-cold inability to eat, requiring detailed differentiation, one cannot simply treat inability to eat as excess. If mistakenly purged, heat goes, hiccups arise. How can one generally assume Yangming is suitable for purgation!

@@@
If stomach is deficiency-cold and unable to eat, drinking water causes hiccups.
[Note]
This continues the meaning of the previous clause that even without attacking, hiccups occur. If the person has stomach deficiency-cold and inability to eat, even without attacking heat, drinking water causes hiccups, because stomach is deficiency-cold, receiving cold water, hence hiccups. Li Zhong Tang (Regulate the Middle Decoction) plus Ding Xiang (Clove) and Wu Zhu Yu (Evodia) to warm and direct downward is appropriate.
[Collected Notes]
Yu Chang said: Exterior heat, interior cold, method dictates saving interior first. Si Ni Tang (Frigid Extremities Decoction) is used in Taiyang meridian, how much more so in Yangming. This clause is more severe deficiency-cold than the previous, hence not only attacking heat causes hiccups, but drinking water also causes hiccups.
Wang Hu said: If stomach deficiency-cold inability to eat, drinking water causes water-cold conflict, qi rebels causing hiccups, method requires strong warming.

@@@
Fu Yang pulse floating. Floating indicates deficiency. Floating and deficiency interacting causes belching (Ai), stating stomach qi deficiency and exhaustion. Pulse slippery indicates hiccups (Yue), this is medical fault, blaming deficiency for excess, guarding emptiness and forcing blood. Pulse floating, nose dry, surely nasal bleeding (Xu).
[Note]
Mistaken purging and drinking cold can both cause belching, undoubtedly. Now Fu Yang stomach pulse is floating but not large, powerless and deficient, indicating stomach deficiency interacting with pathogen. Even without mistaken purging or drinking cold, it causes belching. If Fu Yang stomach pulse is slippery causing hiccups, this is heat qi congestion belching, not stomach qi deficiency belching. How can doctors blame deficiency for excess, bringing fault upon themselves! If Fu Yang stomach pulse is floating and nose is dry, heat occupies Ying level, Ying heat forces blood to move recklessly, surely causing nasal bleeding. Some people today confuse Yue (hiccups/dry heave) with E Ni (hiccup). They do not know Yue is dry heaving, named so for its sound. Observing modern hiccup patients, drinking cold water causes qi rushing up from navel, exiting mouth with "ge-er ge-er" sound. Long sound with pauses is excess, treatable; short sound without pause is deficiency, difficult to treat.
[Collected Notes]
Fang Youzhi said: This again presents Fu Yang pulse, discussing Yue and Xu, both caused by forced sweating without actual sweat. Jiu means fault/blame. Ze Xu means seeking disease in deficiency. Qu Shi means treating deficiency as excess and attacking. Blood belongs to yin and guards inward, hence "guarding emptiness". Po Xue means coercing sweat.

@@@
Cun Kou pulse floating and large, but doctor mistakenly purges, this is major reversal. Floating indicates lack of blood, Large indicates cold. Cold qi interacting causes bowel sounds. Doctor does not know, and instead gives cold water, causing profuse sweating. Water meets cold qi, cold conflicts, the person surely belches (Ai).
[Commentary]
The four characters "causing profuse sweating" are likely interpolations.
[Note]
Cun Kou pulse floating and large refers to all six pulses being floating and large. All six pulses floating and large is not the large pulse pressed in Yangming, but the large pulse unpressed in Taiyang. Doctor mistakenly purges, this is major reversal. Previous floating pulse changes to deficiency lacking blood, large pulse changes to stomach cold slow pulse. Deficiency-cold interact, causing bowel sounds. Doctor does not know, gives cold water. Person receives cold-water qi, cold and deficiency conflict in stomach, hence surely belches. Ai is qi stagnation with sound, i.e., modern hiccup.
[Collected Notes]
Cheng Zhi said: Discusses changes of mistaken purging when pathogen is in exterior. Cun Kou floating-large, without fullness/heat signs, method should be sweating. If mistakenly purged, this is major reversal. After mistaken purging, what was floating becomes internally empty lacking blood; what was large becomes interior deficiency.