桂枝汤方，桂枝三两（去皮）。
按∶桂枝汤方，原文有去皮二字。夫桂枝气味辛甘，全在于皮，若去皮是枯木矣，如何有解肌发汗之功耶？
当删此二字。后仿此。（《医宗金鉴》）
太阳病，下之后，其气上冲者，可与桂枝汤，方用前法。若不上冲者，不可与之。
用前法，是啜稀热粥法，与后文根据前法，如前法同。若谓汤中加下药，大谬！（柯韵伯）
服桂枝汤，或下之，仍头项强痛，翕翕发热，无汗，心下满微痛，小便不利者，桂枝汤去桂加茯苓白术汤主之。
按∶去桂当是去芍药。此方去桂，将何以治仍头项痛、发热、无汗之表乎？细玩其服此汤曰余根据桂枝汤
法煎服，其义自见。服桂枝汤已，温覆令一时许，通身 微似有汗，此服桂枝汤法也。若去桂则是白芍、甘
草、茯苓、白术，并无辛甘走营卫之品，而曰余根据桂枝汤法，无所谓也。且论中脉促、胸满、汗出、恶寒
者，用桂枝去芍药加附子汤主之，去芍药者为胸满也；今证虽稍异，而满则同，其为去芍药可知，当改之。
（《医宗金鉴》）
凡方中有加减法，皆佐使之药，若去其君药，则当另立方名。今去桂枝而仍以桂枝为名，义不可解。殆
以此方虽去桂枝，而意仍不离乎桂枝也。（《伤寒类方》）
太阳病，发热恶寒，热多寒少，脉微弱者，此无阳也；不可复发其汗，宜桂技二越婢一汤。
无阳乃无津液之通称，盖津为阳，血为阴也。无阳为脾胃衰，
故不可更汗；然非汗则风寒终不解，惟取桂枝之二以治风邪，越脾之一以治郁热。越脾者，石膏之辛凉，以化
胃之郁热，则热化津生，而脾气发越，得以行其胃液也。世本作"越婢"，言脾为小姑，比之女婢，若此则越
字何所取义？二字便不贯矣。今从《外台》方正之。（张路玉）
按∶本论无越婢证，亦无越婢汤，后人取《金匮》方补之，窃谓仲景言不可发汗，则必不用麻黄，言无阳
是无胃脘之阳，亦必不用石膏，古方多有名同而药不同者，安可循名而不审其实也。此等脉证最多，宜用柴胡、
桂枝为恰当。○按∶喻嘉言云∶越婢者，石膏之辛凉也。以此兼解其寒，柔缓之性，比女婢为过之。夫辛凉之
品，岂治寒之剂？而金石之坚重，岂能柔缓如女婢哉！○按∶《外台》云∶越脾汤易此一字，便合《内经》脾
气不濡、不能为胃行其津液之义。此起太阴之津，以滋阳明之液而发汗，如成氏所云发越脾气者是也。然必兼
见烦渴之证，脉不微弱者宜之。（柯韵伯）
仲景一百一十三方，循《论》中所主治者榜而名之也。然其间差讹移易，为叔和所更张者不少，如桂枝
二越婢一汤，及桂枝麻黄各半汤等类是也。今特备载之，以待考。（程郊倩）
按∶桂枝麻黄各半汤、桂枝二麻黄一汤、桂枝二越婢一汤三方，所谓一二各半之说，照方计算，并不
对准，未知何故？或云∶将本方各煎或一分或二分相和服，但方中又各药注明分两何也？存考。（徐灵胎）
桂枝去芍药加蜀漆龙骨牡蛎救逆汤。
蜀漆未详，若云常山之苗则谬！（柯韵伯）
太阳病，项背强KT KT ，而汗出恶风者，桂枝加葛根汤主之。
方内旧本有麻黄者，误。（柯韵伯）
此汤成无己本有麻黄，非；有麻黄则为葛根汤矣。（《伤寒类方》）
十枣汤方，芫花、甘遂、大戟各等分，大枣十枚。
按∶《神农本经》云∶荛花味苦寒，主伤寒温疟，下十二经水，破积聚 瘕，荡涤肠中留癖饮食寒热邪气，
利水道。仲景本方，取用此义，后人乃改芫花，何也？即曰芫花，《别录》亦云能消胸中痰水；然《本经》云∶
芫花味辛温，全与荛花不同。权移通用，殊非仲景立方本旨。（喻嘉言）
伤寒中风，医反下之，其人下利日数十行，完谷不化。腹中雷鸣，心下痞硬而满，干呕，心烦不得安。医见
心下痞，谓病不尽，复下之，其痞益甚。此非结热，但以胃中虚，客气上逆，故使硬也。甘草泻心汤主之。
相传伊芳尹汤液，原有甘草泻心汤。此汤七味，今监本无人参，脱之也。（喻嘉言）
伤寒脉结代，心动悸者，炙甘草汤主之。
一百十三方未有用地黄、麦冬者，恐亦叔和所附。然以二味已载《神农本经》，为滋阴之上品，因
《伤寒》一书故置之不用耳。此或阳亢阴竭而然，复出补阴制阳之路，以开后学滋阴一法乎？○方内旧本用麻
仁者误。当用枣仁以安神，结代可和，而悸动可止矣。（柯韵伯）
伤寒，医以丸药大下之，身热不去，微烦者，栀子干姜汤主之。○伤寒五六日，大下之后，身热不去，心
中结痛者，未欲解也，栀子豉汤主之。
按∶栀子干姜汤，当是栀子豉汤；栀子豉汤，当是栀子干姜汤。断无烦热用干姜，结痛用香豉之理，当
移之。（《医宗金鉴》）
伤寒，身热发黄者，栀子柏皮汤主之。
按∶此方之甘草，当是茵陈蒿，必传写之误也。（《医宗金鉴》）
小青龙汤方加减法内，若微利者，去麻黄加荛花如鸡子大，熬令赤色。
按∶加荛花如鸡子大，此必传写之误。考《本草》荛花攻
水，其力甚峻，五分可令人下行数十次，岂有治停饮之微利，用鸡子大之荛花乎？当改加茯苓四两。（《医宗金鉴》）
寒实结胸，无热证者，与三白小陷胸汤，为散亦可服。
太阳表热未除，而反下之，热邪与寒水相结，成热实结胸。太阴腹满时痛，而反下之，寒邪与寒药相结，
成寒实结胸。无热证者，不四肢烦疼者也。名曰三白者，三物皆白，别于小陷胸也。旧本误作三物，以黄连、
栝蒌投之，阴盛则亡矣。又误作白散，是二方矣。黄连、巴豆，寒热天渊，云亦可服，岂不误人！（柯韵伯）
寒实结胸，无热证者，与三物小陷胸汤，白散亦可服。
按∶与三物小陷胸汤，当是三物白散。小陷胸汤四字当是错简。桔梗、贝母、巴豆三物，其色皆白，
有三物白散之义，温而能攻，与寒实之理相合。小陷胸汤乃栝蒌、黄连，皆性寒之品，岂可以治寒实结胸之证
耶？亦可服三字亦衍文也，俱当删之。（《医宗金鉴》）
阳明病，自汗出。若发汗，小便自利者，此为津液内竭，大便虽硬，不可攻之；当须自欲大便，宜蜜煎导而
通之。若土瓜根及猪胆汁皆可为导。
土瓜根方（缺）
按∶土瓜即俗名赤雹也。《肘后方》治大便不通，采根捣汁，用筒吹入肛门内，此与猪胆汁方同义。
《内台》方用土瓜根削如挺，纳入谷道中，误矣！盖蜜挺入谷道，能烊化而润大便；土瓜根不能烊化，削挺用
之，恐失仲景制方之义。（《医宗金鉴》）
虚人当攻下而不可攻者，并宜导法。但须分别，津液枯者。用蜜导；热邪盛者，用胆导；湿热痰饮固
结者，用麻油浸栝蒌根导。至于阴结便秘者，宜于蜜导中加姜汁、生附子末，或用酱生姜导之。此实补仲景
之未逮也。（《伤寒缵论》）
趺阳脉浮而涩，浮则胃气强，涩则小便数，浮涩相搏，大便
则难，其脾为约，麻仁丸主之。
成无己曰∶约者，结约之约。胃强脾弱，约束津液，不得四布，但输膀胱，故小便数而大便硬，故曰脾约。
与此丸以下脾之结燥，肠润结化，津液入胃，大便利、小便少而愈矣。愚切有疑焉∶既曰约，脾弱不能运也；
脾弱则土亏矣，必脾气之散、脾血之耗也。原其所由，必久病、大汗、大下之后，阴血枯槁，内火燔灼，热
伤元气，必伤于脾，而成此证。伤元气者，肺金受火，气无所摄；伤脾者，肺为脾之子，肺耗则液竭，必窃母
气以自救，金耗则木寡于畏，土欲不伤，不可得也。脾失转输之令，肺失传送之官，宜大便秘而难下，小便数
而无藏蓄也。理宜滋养阴血，使阳火不炽，而金行清化，木邪有制，而土健营运，津液乃能入胃，则肠润而通
矣。今以大黄为君，枳、朴为臣，虽有芍药养血，麻仁、杏仁之温润为之佐使，用之热盛而气实者，无有不安；
若内热虽盛，而气不实者，虽得暂通，保无有脾愈弱而肠愈燥者乎？后之用此方者，慎勿胶柱而调瑟。（喻嘉言）
太阳病，过经十余日，反二三下之，后四五日，柴胡证仍在者，先与小柴胡汤。呕不止，心下急，郁郁微
烦者，为未解也，与大柴胡汤下之则愈。
按∶大柴胡是半表半里气分之下药，并不言大便。其心下急与心下痞硬，是胃口之病，而不在胃中。结
热在里，非结实在胃。且下利则地道已通，仲景不用大黄之意晓然。若以下之二字妄加大黄，则十枣汤攻之二
字，加何味乎？（柯韵伯）
按∶许叔微曰∶大柴胡汤，一方无大黄，一方有大黄。盖大黄荡涤蕴热，伤寒中要药。王叔和云∶若不
用大黄，恐不名大柴胡汤，且仲景曰下之则愈，若无大黄，将何以下心下之急乎？当从叔和为是。宜补之。
（《医宗金鉴》）
少阴病，下利，咽痛，胸满，心烦者，猪肤汤主之。
肤乃是 猪刮下黑皮。《礼运疏》云∶革，肤内浓皮；肤，
革外薄皮。语云肤浅，义取诸此。（喻嘉言）
猪肤以润少阴之燥，与用黑驴皮之意同。若以为 猪皮外毛根薄肤，则签劣无力，且与熬香之说不符。但
用外皮，去其内层之肥白者为是。（《尚论篇》）
四逆散∶甘草、芍药、枳实、柴胡，上四味各十分，捣筛，白饮和服方寸匕，日三服。○咳者，加五味子、干
姜各五分。○悸者，加桂枝五分。○小便不利者，加茯苓五分。○腹中痛者，加附子一枝，炮令坼。○泄利下重者，
先以水五升，纳薤白三升，煮取三升，去滓，以散三方寸匕纳汤中，煮取一升半，分温再服。
此仿大柴胡之下法也。以少阴为阴枢，故去黄芩之大寒，姜、夏之辛散，加甘草以易大枣，良有深意。然
服方寸匕，恐不济事。少阳心下悸者加茯苓，此加桂枝；少阳腹中痛者加芍药，此加附子。其法虽有阴阳之别，
恐非泄利下重者宜加也。薤白性滑，能泄下焦阴阳气滞，然辛温太甚，荤气逼人，顿用三升，而入散三匕，
只闻薤气，而不知药味矣。且加味俱用五分，而附子一枚，薤白三升。何多寡不同若是？不能不致疑于叔和编
集之误耳！（柯韵伯）
脉浮而迟，表热里寒，下利清谷，四逆汤主之。
仲景凡治虚证以里为重，协热下利、脉微弱者，便用人参；汗后身疼、脉沉迟者，便加人参。此脉迟而
利清谷，且不烦不咳，中气大虚，元气已脱，但温不补，何以救逆乎？观茯苓四逆之烦躁，且用人参，况通
脉四逆，岂得无参？是必因本方之脱落耳。（柯韵伯）
下利清谷，里寒外热，汗出而厥者，通脉四逆汤主之。
按∶本方以阴证似阳而设。证之异于四逆者，在不恶寒而面色赤，方之异于四逆者，若无参，当与桂枝加
桂、加芍同矣。何更加以通脉之名？夫人参所以通血脉，安有脉欲绝而不用者？旧
本乃于方后云∶面赤色者加葱，利止脉不出者加参。岂非钞录者之疏失于本方，而蛇足于加法乎？且减法所
云去者，去本方之所有也，而此云去葱、芍、桔者，是后人之加减可知矣。（柯韵伯）
手足厥冷，脉细欲绝者，当归四逆汤主之。
此条证为在里，当是四逆本方加当归，如茯苓四逆之例。若反用桂枝汤攻表，误矣。既名四逆汤，岂得无
参、附？（柯韵伯）
伤寒六七日，大下后，寸脉沉而迟，手足厥逆，下部脉不至，咽喉不利，唾脓血，泄利不止者，为难治。麻
黄升麻汤主之。
伤寒六七日，大下后，寸脉沉而迟。夫寸为阳，主上焦，沉而迟，是无阳矣；沉为在里，则不当发汗，迟为
脏寒，则不当清火；且下部脉不至，手足厥冷，泄利不止，是下焦之元阳已脱。又咽喉不利，吐脓血，是上
焦之虚阳无根据而将亡，故扰乱也。如用参、附以回阳，而阳不可回，故曰难治。则仲景不立方治也明矣！此用
麻黄、升麻、桂枝以散之，汇集知母、天冬、黄芩、芍药、石膏等大寒之品以清之，以治阳实之法，治亡
阳之证，是速其毙也。安可望其汗出而愈哉！用干姜一味之温，苓、术、甘、归之补，取玉竹以代人参，是
犹攻金城高垒，而用老弱之师，且用药至十四味，犹广罗原野，冀获一兔，不论脉病之合否，而殆为妄谈欤？（柯韵伯）
阳毒之为病，面赤斑斑如锦文，咽喉痛，唾脓血，五日可治，七日不可治。升麻鳖甲汤主之。○阴毒之为病，
面目青，身痛如被杖，咽喉痛，五日可治，七日不可治。升麻鳖甲汤去雄黄、蜀椒主之。
按∶阳毒之为病，主以升麻鳖甲汤。盖升麻升透厉毒，鳖甲泄热守神，当归和血调营，甘草泻火解毒。
正《内经》热淫于内，治以碱寒，佐以苦甘之旨。而内有蜀椒、雄黄，似当加于阴毒方中，或因传写之讹耳。
一转移间，则于阳毒之义，尤为贴切，用者亦鲜疑畏矣。（《吴医汇讲》）
大病瘥后，劳复者，枳实栀子豉汤主之。若有宿食者，加大黄如博棋子大五六枚。○大病瘥后，从腰以下有水
气者，牡蛎泽泻散主之。○伤寒解后，虚羸少气，气逆欲吐者，竹叶石膏汤主之。
叔和独以伤寒立论，故称伤寒为大病。既云大病，则瘥后当用调补法矣。如云劳复，是因劳而复，当补
桂枝汤方，由桂枝三两（去皮）组成。
按语：桂枝汤方的原文中有“去皮”二字。桂枝的气味辛甘，主要存在于皮中，如果去掉皮，就只剩下枯木了，怎么还能有解肌发汗的功效呢？应当删去这两个字。后文仿照此例处理。（《医宗金鉴》）
太阳病（太阳经受邪所致的病证），经过泻下法治疗后，气机上冲的，可以给予桂枝汤，服用方法如前所述。如果不气上冲的，不可给予。
所谓“用前法”，是指喝热稀粥的方法，与后文中提到的“根据前法”意思相同。如果理解为在汤药中加入泻下药，那就大错特错了！（柯韵伯）
服用桂枝汤后，或者经过泻下治疗，仍然出现头项强痛、发热（翕翕发热）、无汗、心下满微痛、小便不利的症状，主治方剂为桂枝汤去桂加茯苓白术汤。
按语：“去桂”应当是“去芍药”。这个方子如果去掉桂枝，用什么来治疗仍然存在的头项痛、发热、无汗等表证呢？仔细研读其中提到服用此汤时说“余根据桂枝汤法煎服”，其中的含义自然显现。服用桂枝汤的方法是，服药后覆盖衣被约一顿饭的时间，全身微微似有汗出，这才是服用桂枝汤的正确方法。如果去掉桂枝，方中只剩白芍、甘草、茯苓、白术，并没有辛甘走营卫的药物，却还说“余根据桂枝汤法”，这就没有意义了。况且论中提到脉促、胸满、汗出、恶寒者，使用桂枝去芍药加附子汤主治，去掉芍药是因为胸满；现在的证候虽然稍有不同，但都有“满”的症状，因此可知是去掉芍药，应当改正。（《医宗金鉴》）
凡是方剂中有加减法的，都是佐使药的调整，如果去掉君药，就应当另立方名。现在去掉桂枝却仍以桂枝为名，道理上讲不通。大概是因为此方虽然去掉了桂枝，但用意仍不离桂枝。（《伤寒类方》）
太阳病，发热恶寒，热多寒少，脉微弱的人，这是无阳（津液不足）的表现；不可再次发汗，适宜使用桂枝二越婢一汤。
“无阳”是津液不足的通称，因为津属阳，血属阴。“无阳”意味着脾胃衰弱，所以不能再发汗；然而不发汗则风寒终不能解除，只取桂枝的二分以治风邪，越婢的一分以治郁热。越婢指的是石膏的辛凉性质，用以化解胃中的郁热，这样热化津生，脾气得以发越，从而能够运行胃中的津液。世传版本作“越婢”，意思是脾是小姑，比作女婢，如果是这样，“越”字就没有取义了，两个字就不连贯了。现在依据《外台秘要》的版本改为正字。（张路玉）
按语：本论中没有越婢证，也没有越婢汤，后人从《金匮要略》中取方补入，我认为仲景说不可发汗，就一定不用麻黄；说无阳是无胃脘之阳，也一定不用石膏。古方中有很多同名而药物不同的情况，怎么能只循名而不审其实呢？这种脉证很多，适宜使用柴胡、桂枝较为恰当。○按语：喻嘉言说：越婢，指的是石膏的辛凉性质。用它兼解其寒，柔缓的性质，比女婢还要好。但是辛凉的药，难道是治寒的药剂吗？金石类的坚重之物，难道能柔缓得像女婢一样吗！○按语：《外台秘要》说：将“脾”字改为“婢”字，便符合《内经》中“脾气不濡、不能为胃行其津液”的含义。这是提起太阴的津液，以滋润阳明之液而发汗，就像成无己所说的“发越脾气”那样。然而必须兼见烦渴的症状，且脉不微弱者才适宜使用。（柯韵伯）
张仲景的一百一十三首方剂，都是遵循《伤寒论》中所主治的病证来命名的。然而其中有差错讹误和移易，被王叔和修改的不少，如桂枝二越婢一汤，以及桂枝麻黄各半汤等就是这类。现在特别详细记载它们，以供考证。（程郊倩）
按语：桂枝麻黄各半汤、桂枝二麻黄一汤、桂枝二越婢一汤这三方，所谓的“一二各半”的说法，按照方剂计算，并不吻合，不知道是什么原因？有人说：是将原方分别煎煮，取一分或二分混合服用，但方中又对各药注明分量，这是为什么呢？暂且存疑供考证。（徐灵胎）
桂枝去芍药加蜀漆龙骨牡蛎救逆汤。
蜀漆不详，如果说它是常山的嫩芽，那是错误的！（柯韵伯）
太阳病，项背强几几（KT KT 指项背拘急不舒的样子），且汗出恶风的，主治方剂为桂枝加葛根汤。
方剂旧本中有麻黄的，是错误的。（柯韵伯）
此汤在成无己的版本中有麻黄，是不对的；如果有麻黄，那就是葛根汤了。（《伤寒类方》）
十枣汤方，由芫花、甘遂、大戟各等分，大枣十枚组成。
按语：《神农本草经》说：荛花味苦寒，主治伤寒温疟，下十二经水，破积聚瘕瘕，荡涤肠中留癖饮食寒热邪气，利水道。张仲景的本方，取用此意，后人却改为芫花，为什么呢？即使说是芫花，《名医别录》也说它能消胸中痰水；然而《神农本草经》说：芫花味辛温，完全与荛花不同。权且通用，殊非张仲景创立方剂的初衷。（喻嘉言）
伤寒中风，医生反而使用泻下法，病人腹泻每天几十次，完谷不化。腹中雷鸣，心下痞硬而满，干呕，心烦不得安宁。医生见心下痞，认为病邪未尽，再次使用泻下法，痞满更加严重。这不是结热，只是因为胃中虚，客气上逆，所以导致硬满。主治方剂为甘草泻心汤。
相传伊尹的汤液，原有甘草泻心汤。此方七味药，现在监本（官方刻本）中没有人参，是脱漏了。（喻嘉言）
伤寒脉结代（脉搏跳动不规则，时有间歇），心动悸（心跳不安）的，主治方剂为炙甘草汤。
一百一十三方中从未有用过地黄、麦冬的，恐怕也是王叔和附加的。然而这两味药已载于《神农本草经》，是滋阴的上品，只因《伤寒论》一书的原因而被弃置不用。这或许是阳亢阴竭所致，又开辟了补阴制阳的途径，以开启后世滋阴的一法吗？○方剂旧本中使用麻仁的是错误的。应当使用枣仁以安神，结代可调和，悸动可停止。（柯韵伯）
伤寒，医生用丸药猛烈泻下，身热不退，轻微烦躁的，主治方剂为栀子干姜汤。○伤寒五六天，经过猛烈泻下后，身热不退，心中结痛的，病未解除，主治方剂为栀子豉汤。
按语：栀子干姜汤，应当是栀子豉汤；栀子豉汤，应当是栀子干姜汤。断没有烦热用干姜，结痛用香豉的道理，应当互换位置。（《医宗金鉴》）
伤寒，身体发热发黄的，主治方剂为栀子柏皮汤。
按语：此方中的甘草，应当是茵陈蒿，一定是传写时的错误。（《医宗金鉴》）
小青龙汤方加减法内，如果轻微腹泻的，去掉麻黄，加入荛花如鸡蛋大小，炒至赤色。
按语：加入荛花如鸡蛋大小，这一定是传写时的错误。考查《本草》，荛花攻逐水饮，其力甚峻，五分即可使人下行数十次，哪有治疗停饮引起的轻微腹泻，使用鸡蛋大小的荛花的道理？应当改为加入茯苓四两。（《医宗金鉴》）
寒实结胸（寒邪与痰水互结于胸膈），无热证的，给予三物小陷胸汤，制成散剂也可以服用。
太阳表热未除，反而使用泻下法，热邪与寒水相结，形成热实结胸。太阴腹满时痛，反而使用泻下法，寒邪与寒药相结，形成寒实结胸。无热证，是指没有四肢烦疼的症状。名为“三白”的，是因为三味药皆白色，区别于小陷胸汤。旧本错误地写作“三物”，如果用黄连、栝蒌投予，阴盛则亡矣。又错误地写作“白散”，就成了两个方子了。黄连、巴豆，寒热天地之别，说“亦可服”，岂不是误导人！（柯韵伯）
寒实结胸，无热证的，给予三物小陷胸汤，白散亦可服用。
按语：给予三物小陷胸汤，应当是三物白散。“小陷胸汤”四字当是错简。桔梗、贝母、巴豆三味药，颜色皆白，有三物白散的含义，性温而能攻，与寒实的病机相合。小陷胸汤乃栝蒌、黄连，皆是性寒之品，岂可以用来治疗寒实结胸的证候呢？“亦可服”三字也是衍文，都应当删去。（《医宗金鉴》）
阳明病，自汗出。如果发汗，小便自利的，这是津液内竭，大便虽然硬，不可攻下；应当等到病人自己想大便时，适宜用蜜煎导法通便。土瓜根及猪胆汁都可以作为导法。
土瓜根方（缺）
按语：土瓜即俗名赤雹。《肘后方》治疗大便不通，采集根捣汁，用筒吹入肛门内，这与猪胆汁方的意思相同。《外台秘要》方用土瓜根削成挺状，纳入谷道中，这是错误的！因为蜜挺入谷道，能融化而润大便；土瓜根不能融化，削成挺状使用，恐怕失去了张仲景制方的本义。（《医宗金鉴》）
体虚之人应当攻下而不可攻下的，都适宜用导法。但须分辨，津液枯干的，用蜜导；热邪盛的，用胆导；湿热痰饮固结的，用麻油浸栝蒌根导。至于阴结便秘的，适宜在蜜导中加入姜汁、生附子末，或用酱生姜导。这实际上是补充张仲景的不足之处。（《伤寒缵论》）
趺阳脉浮而涩，浮则胃气强，涩则小便数，浮涩相搏，大便则难，这是脾约（脾的功能受限，约束津液），主治方剂为麻仁丸。
成无己说：约者，结约之约。胃强脾弱，约束津液，不得四布，只输注膀胱，所以小便数而大便硬，所以叫脾约。给予此丸以下脾之结燥，肠润结化，津液入胃，大便利、小便少而痊愈了。我私下有疑问：既然叫“约”，说明脾弱不能运化；脾弱则土亏，必定是脾气散、脾血耗。推究其来源，必定是久病、大汗、大下之后，阴血枯槁，内火燔灼，热伤元气，必伤于脾，而成此证。伤元气者，肺金受火，气无所摄；伤脾者，肺为脾之子，肺耗则液竭，必窃取母气以自救，金耗则木寡于畏，土欲不伤，是不可能的。脾失转输之令，肺失传送之官，宜大便秘而难下，小便数而无藏蓄也。理宜滋养阴血，使阳火不炽，而金行清化，木邪有制，而土健营运，津液乃能入胃，则肠润而通矣。今以大黄为君，枳、朴为臣，虽有芍药养血，麻仁、杏仁之温润为之佐使，用之热盛而气实者，无有不安；若内热虽盛，而气不实者，虽得暂通，保无有脾愈弱而肠愈燥者乎？后之用此方者，慎勿胶柱而调瑟。（喻嘉言）
太阳病，过了病程十余日，反而多次使用泻下法，后四五日，柴胡证仍在的，先给予小柴胡汤。呕吐不止，心下急迫，郁郁微烦的，为病未解除，给予大柴胡汤攻下则痊愈。
按语：大柴胡汤是半表半里气分的下药，并不提及大便。其心下急与心下痞硬，是胃口之病，而不在胃中。结热在里，非结实在胃。且下利则地道已通，张仲景不用大黄的意思显而易见。如果将“下之”二字妄加在大黄上，那么十枣汤攻下的“下之”二字，加什么味道呢？（柯韵伯）
按语：许叔微说：大柴胡汤，一方无大黄，一方有大黄。大黄荡涤蕴热，是伤寒中的重要药物。王叔和说：如果不用大黄，恐怕不叫大柴胡汤，而且仲景说下之则愈，如果没有大黄，将何以解心下之急呢？应当遵从王叔和的说法是正确的。应当补入。（《医宗金鉴》）
少阴病，下利，咽痛，胸满，心烦的，主治方剂为猪肤汤。
肤乃是猪刮下的黑皮。《礼运疏》说：革，是内层的厚皮；肤，是外层的薄皮。俗语说肤浅，义取于此。（喻嘉言）
猪肤用来滋润少阴之燥，与用黑驴皮的意思相同。如果认为是猪皮外毛根的薄肤，则签劣无力，且与熬香的说不符。只用外皮，去掉内层之肥白者为是。（《尚论篇》）
四逆散：甘草、芍药、枳实、柴胡，以上四味各十分，捣筛，用白饮（米汤）和服方寸匕，每日三次。○咳嗽者，加五味子、干姜各五分。○心悸者，加桂枝五分。○小便不利者，加茯苓五分。○腹中痛者，加附子一枚，炮令坼（裂开）。○泄利下重者，先以水五升，纳薤白三升，煮取三升，去滓，以散三方寸匕纳汤中，煮取一升半，分温再服。
这是仿效大柴胡汤的下法。因为少阴为阴枢，所以去掉黄芩之大寒，姜、夏之辛散，加甘草以易大枣，良有深意。然而服方寸匕，恐怕不起作用。少阳心下悸者加茯苓，这里加桂枝；少阳腹中痛者加芍药，这里加附子。其法虽有阴阳之别，恐怕不适合泄利下重者加用。薤白性滑，能泄下焦阴阳气滞，然辛温太甚，荤气逼人，顿用三升，而入散三匕，只闻薤气，而不知药味矣。且加味俱用五分，而附子一枚，薤白三升。何多寡不同若是？不能不致疑于王叔和编集之误耳！（柯韵伯）
脉浮而迟，表热里寒，下利清谷（腹泻排出未消化的食物），主治方剂为四逆汤。
张仲景凡是治疗虚证以里为重，协热下利、脉微弱者，便用人参；汗后身疼、脉沉迟者，便加人参。此脉迟而利清谷，且不烦不咳，中气大虚，元气已脱，只温不补，何以救逆乎？观茯苓四逆之烦躁，且用人参，况通脉四逆，岂得无参？这必定是因为本方脱落了。（柯韵伯）
下利清谷，里寒外热，汗出而厥的，主治方剂为通脉四逆汤。
按语：本方是针对阴证似阳而设。证候不同于四逆汤证的地方，在于不恶寒而面色赤；方剂不同于四逆汤的地方，如果无参，应当与桂枝加桂、加芍药同了。为何更加以通脉之名？夫人参所以通血脉，安有脉欲绝而不用者的道理？旧本却在方后说：面赤色者加葱，利止脉不出者加参。这岂不是抄录者的疏忽，而在加法中画蛇添足吗？且减法所说去者，是去本方之所有，而此云去葱、芍、桔者，是后人的加减可知矣。（柯韵伯）
手足厥冷，脉细欲绝的，主治方剂为当归四逆汤。
此条证候为在里，应当是四逆本方加当归，如茯苓四逆之例。如果反用桂枝汤攻表，就错了。既名四逆汤，岂得无人参、附子？（柯韵伯）
伤寒六七日，大下后，寸脉沉而迟，手足厥逆，下部脉不至，咽喉不利，唾脓血，泄利不止的，为难治。主治方剂为麻黄升麻汤。
伤寒六七日，大下后，寸脉沉而迟。寸为阳，主上焦，沉而迟，是无阳了；沉为在里，则不当发汗，迟为脏寒，则不当清火；且下部脉不至，手足厥冷，泄利不止，是下焦之元阳已脱。又咽喉不利，吐脓血，是上焦之虚阳无根据而将亡，故扰乱也。如用参、附以回阳，而阳不可回，故曰难治。则仲景不立方治也明矣！此用麻黄、升麻、桂枝以散之，汇集知母、天冬、黄芩、芍药、石膏等大寒之品以清之，以治阳实之法，治亡阳之证，是速其毙也。安可望其汗出而愈哉！用干姜一味之温，苓、术、甘、归之补，取玉竹以代人参，是犹攻金城高垒，而用老弱之师，且用药至十四味，犹广罗原野，冀获一兔，不论脉病之合否，而殆为妄谈欤？（柯韵伯）
阳毒之为病，面赤斑斑如锦文，咽喉痛，唾脓血，五日可治，七日不可治。主治方剂为升麻鳖甲汤。○阴毒之为病，面目青，身痛如被杖，咽喉痛，五日可治，七日不可治。主治方剂为升麻鳖甲汤去雄黄、蜀椒。
按语：阳毒之为病，主以升麻鳖甲汤。盖升麻升透厉毒，鳖甲泄热守神，当归和血调营，甘草泻火解毒。正《内经》热淫于内，治以咸寒，佐以苦甘之旨。而内有蜀椒、雄黄，似当加于阴毒方中，或因传写之讹耳。一转移间，则于阳毒之义，尤为贴切，用者亦鲜疑畏矣。（《吴医汇讲》）
大病瘥后（大病初愈），劳复（因劳累复发）的，主治方剂为枳实栀子豉汤。若有宿食的，加大黄如博棋子大五六枚。○大病瘥后，从腰以下有水气的，主治方剂为牡蛎泽泻散。○伤寒解后，虚羸少气，气逆欲吐的，主治方剂为竹叶石膏汤。
王叔和独以伤寒立论，故称伤寒为大病。既云大病，则瘥后当用调补法矣。如云劳复，是因劳而复，当补……
Decoction of Ramulus Cinnamomi (Guizhi Tang) consists of Ramulus Cinnamomi (Guizhi) three liang (with the bark removed).
Note: The original text of the Decoction of Ramulus Cinnamomi includes the phrase "with the bark removed." The aroma and flavor of Ramulus Cinnamomi are entirely contained in the bark; if the bark is removed, only dead wood remains, how can it exert the effect of resolving the muscle layer and inducing sweating? These two characters should be deleted. Subsequent cases follow this example. (*Zongjin Yijian*)
In Taiyang disease (disease of the Taiyang channel), after purgation, if there is an upward rush of Qi, the Decoction of Ramulus Cinnamomi may be administered, using the method described previously. If there is no upward rush of Qi, it should not be given.
"Using the previous method" refers to the method of drinking hot thin porridge, which is consistent with the later mention of "following the previous method." To interpret it as adding purgative herbs to the decoction is a major error! (Ke Yunbo)
After taking the Decoction of Ramulus Cinnamomi, or after purgation, if there is still stiffness and pain in the head and neck, slight fever (Xi Xi Fa Re), absence of sweat, fullness and slight pain in the epigastrium, and difficulty in urination, the Decoction of Ramulus Cinnamomi minus Ramulus Cinnamomi plus Rhizoma Alismatis (Ze Xie) and Atractylodis Macrocephalae Rhizoma (Bai Zhu) is the primary treatment.
Note: "Minus Ramulus Cinnamomi" should likely be "minus Radix Paeoniae Alba (Baishao)." If Ramulus Cinnamomi is removed from this formula, what would treat the persistent headache, fever, and absence of sweat characteristic of the exterior syndrome? Careful study reveals that the text states to prepare and take this decoction "according to the method of the Decoction of Ramulus Cinnamomi," which clarifies the meaning. The correct method for taking the Decoction of Ramulus Cinnamomi involves covering the patient with blankets for about the time it takes to cook a meal, resulting in a slight, generalized sweat. If Ramulus Cinnamomi is removed, the remaining herbs—Radix Paeoniae Alba, Radix Glycyrrhizae, Rhizoma Alismatis, and Atractylodis Macrocephalae Rhizoma—lack the acrid-sweet herbs that navigate Ying and Wei. Claiming to follow the "method of the Decoction of Ramulus Cinnamomi" becomes meaningless. Furthermore, in the discussion regarding pulse compression, chest fullness, sweating, and aversion to cold, the Decoction of Ramulus Cinnamomi minus Radix Paeoniae Alba plus Radix Aconiti Lateralis Preparata (Fuzi) is used, where Radix Paeoniae Alba is removed due to chest fullness. Although the current presentation differs slightly, the presence of "fullness" indicates that Radix Paeoniae Alba should be removed. This should be corrected. (*Zongjin Yijian*)
Whenever a formula contains instructions for additions and subtractions, these adjustments apply to assistant and courier herbs. If the sovereign herb is removed, a new formula name should be established. It is inexplicable why this formula retains the name of the Decoction of Ramulus Cinnamomi despite the removal of Ramulus Cinnamomi. Perhaps the intent remains closely related to Ramulus Cinnamomi even after its removal. (*Shanghan Leifang*)
In Taiyang disease, presenting with fever and aversion to cold, where heat predominates over cold, and the pulse is faint and weak, this indicates a lack of Yang (fluid deficiency). Re-inducing sweating is contraindicated; instead, the Two-Parts Decoction of Ramulus Cinnamomi and One-Part Yuebi Decoction (Guizhi Er Yuebi Yi Tang) is appropriate.
"Lack of Yang" is a general term for fluid deficiency, as fluids belong to Yang and blood belongs to Yin. Lack of Yang implies spleen-stomach weakness, thus precluding further sweating; however, without sweating, wind-cold cannot be resolved. Taking two parts of Ramulus Cinnamomi treats the wind pathogen, while one part of Yuebi treats the stagnant heat. "Yuebi" refers to the acrid-cool nature of Gypsum Fibrosum (Shigao), which transforms stomach stagnation heat, thereby generating fluids and allowing the Spleen Qi to ascend and transport stomach fluids. The common version reads "Yuebi" (Little Maid), implying the Spleen is like a young maid; if so, the character "Yue" loses its meaning, making the term incoherent. Now, following the *Waitai Miyao*, the correct term is restored. (Zhang Luyu)
Note: The main text does not describe a Yuebi syndrome or formula; later authors supplemented it from the *Jingui Yaolue*. I believe that since Zhongjing stated sweating is contraindicated, Ephedrae Herba (Mahuang) would certainly not be used. Stating "lack of Yang" refers to a lack of Stomach Yang, so Gypsum Fibrosum would also not be used. Ancient formulas often share names but differ in ingredients; one must examine the reality, not just the name. Such pulse and symptom presentations are common, and Bupleuri Radix (Chaihu) combined with Ramulus Cinnamomi is more appropriate. ○ Note: Yu Jiayan stated: "Yuebi" refers to the acrid-cool nature of Gypsum Fibrosum. Using it to simultaneously resolve cold, its soft and slow nature surpasses that of a female maid. However, are acrid-cool herbs agents for treating cold? Can heavy mineral substances be as soft and slow as a maid? ○ Note: The *Waitai Miyao* suggests changing "Pi" (Spleen) to "Bi" (Maid), aligning with the *Neijing* principle that "when Spleen Qi is not moistened, it cannot transport fluids for the Stomach." This raises Taiyin fluids to nourish Yangming fluids and induce sweating, similar to Cheng Wuji's concept of "ascending Spleen Qi." However, it is suitable only when accompanied by irritability and thirst, and when the pulse is not faint and weak. (Ke Yunbo)
The 113 formulas of Zhang Zhongjing were named according to their indicated treatments in the *Lun*. However, many errors, alterations, and changes were made by Wang Shuhe, such as the Two-Parts Decoction of Ramulus Cinnamomi and One-Part Yuebi Decoction, and the Half-Half Decoction of Ramulus Cinnamomi and Ephedrae Herba (Guizhi Mahuang Ge Ban Tang), among others. These are recorded here specifically for examination. (Cheng Jiaoqian)
Note: Regarding the Half-Half Decoction of Ramulus Cinnamomi and Ephedrae Herba, the Two-Parts Decoction of Ramulus Cinnamomi and One-Part Ephedrae Herba, and the Two-Parts Decoction of Ramulus Cinnamomi and One-Part Yuebi Decoction, the so-called "one-two half-half" theory does not match the calculated dosages in the formulas. The reason is unknown. Some claim that the original formulas are decocted separately, and one part or two parts are mixed for administration. But why are specific weights noted for each herb in the formula? This remains for further study. (Xu Lingtai)
Decoction of Ramulus Cinnamomi minus Radix Paeoniae Alba plus Rhizoma Trichosanthis (Shuqi), Longgu, and Molluscum Concha (Muli) for Saving from Deviation (Jiuni Tang).
Rhizoma Trichosanthis (Shuqi) is unclear; claiming it is the sprout of Dichroa Febrifuga Radix (Changshan) is erroneous! (Ke Yunbo)
In Taiyang disease, presenting with stiffness and tension in the nape and back (Jin Jin), sweating, and aversion to wind, the Decoction of Ramulus Cinnamomi plus Rhizoma Puerariae (Gegen) is the primary treatment.
Old versions of the formula containing Ephedrae Herba (Mahuang) are incorrect. (Ke Yunbo)
This decoction in Cheng Wuji's version contains Ephedrae Herba, which is wrong; if it contained Ephedrae Herba, it would be the Decoction of Rhizoma Puerariae (Gegen Tang). (*Shanghan Leifang*)
Ten-Jujube Decoction (Shizao Tang) consists of Radix Daphnes (Yuanhua), Radix Kansui (Gansui), and Radix Euphorbiae (Daji) in equal parts, and ten large jujubes (Dazao).
Note: The *Shennong Bencao Jing* states: Radix Daphnes (Raohua) has a bitter and cold taste, treating shānghán and warm malaria, draining water from the twelve channels, breaking accumulations and masses, cleansing retained food and pathogens in the intestines, and promoting urination. Zhang Zhongjing’s original formula utilizes this property. Why did later authors change it to Radix Daphnes (Yuanhua)? Even if it is Radix Daphnes, the *Bielu* states it eliminates phlegm-fluid in the chest; however, the *Bencao Jing* states Radix Daphnes (Yuanhua) is acrid and warm, completely different from Raohua. Treating them as interchangeable deviates from Zhang Zhongjing’s original intent. (Yu Jiayan)
In shānghán or wind-stroke, if the physician erroneously uses purgation, the patient suffers diarrhea dozens of times daily with undigested food. There is borborygmus in the abdomen, hardness and fullness in the epigastrium, dry retching, irritability, and inability to find peace. Seeing epigastric fullness, the physician assumes the pathogen remains and purges again, worsening the fullness. This is not heat binding, but rather deficiency in the Stomach with rebellious Qi ascending, causing hardness. The Licorice Decoction for Resolving Epigastric Fullness (Ganxie Xixin Tang) is the primary treatment.
It is passed down that Yi Yin’s decoctions originally included the Licorice Decoction for Resolving Epigastric Fullness. This formula has seven ingredients, but the official edition lacks Codonopsis Radix (Renshen), indicating an omission. (Yu Jiayan)
In shānghán, with a knotted and intermittent pulse (Jiedai Mai) and palpitations (Xindong Ji), the Roasted Licorice Decoction (Zhigancao Tang) is the primary treatment.
None of the 113 formulas use Rehmanniae Radix (Dihuang) or Ophiopogonis Radix (Ma Dong), likely added by Wang Shuhe. However, these two are recorded in the *Shennong Bencao Jing* as premier yin-nourishing herbs, perhaps omitted from the *Shanghan Lun* due to context. This might address hyperactive Yang and exhausted Yin, opening a path for subsequent generations to use yin-nourishing methods. ○ Old versions of the formula use Semen Persicae (Maren), which is incorrect. Semen Ziziphi Spinosae (Suanzaoren) should be used to calm the spirit; this can harmonize the knotted pulse and stop palpitations. (Ke Yunbo)
In shānghán, if the physician uses pill-based strong purgatives, and fever persists with slight irritability, the Gardenia and Ginger Decoction (Zhizi Ganjiang Tang) is the primary treatment. ○ In shānghán, after five or six days, following strong purgation, if fever persists and there is painful knotting in the heart region, the condition is unresolved; the Gardenia and Fermented Soybean Decoction (Zhichi Chi Tang) is the primary treatment.
Note: The Gardenia and Ginger Decoction should be the Gardenia and Fermented Soybean Decoction; the Gardenia and Fermented Soybean Decoction should be the Gardenia and Ginger Decoction. It is illogical to use dried ginger for irritability-heat or fermented soybeans for painful knotting. They should be swapped. (*Zongjin Yijian*)
In shānghán, presenting with fever and jaundice, the Gardenia, Phellodendri Cortex (Huangbai), and Licorice Decoction (Zhizi Bopi Tang) is the primary treatment.
Note: The Licorice (Gancao) in this formula should be Coicis Semen (Yiyiren) or Artemisiae Scopariae Herba (Yinchen Hao); this is likely a transcription error. (*Zongjin Yijian*)
In the modification instructions for the Minor Green Dragon Decoction (Xiao Qinglong Tang), if there is slight diarrhea, remove Ephedrae Herba (Mahuang) and add Radix Daphnes (Raohua) the size of a chicken egg, roasted until red.
Note: Adding Radix Daphnes (Raohua) the size of a chicken egg is certainly a transcription error. According to materia medica, Raohua aggressively drains water and is very potent; a dose of five fen can cause dozens of bowel movements. How could one use a chicken-egg-sized dose of Raohua for mild diarrhea caused by retained fluid? It should be changed to adding four liang of Poria (Fuling). (*Zongjin Yijian*)
For Cold-Excess Chest Binding (Han Shi Jie Xiong) without heat signs, administer the Three-White Minor Intra-Chest Binding Decoction (San Bai Xiao Jianxiong Tang); it can also be taken as a powder.
If Taiyang exterior heat is not resolved and purgation is used, heat pathogens bind with cold water, forming Heat-Excess Chest Binding. If Taiyin abdominal fullness and pain occur and purgation is used, cold pathogens bind with cold medicines, forming Cold-Excess Chest Binding. "Without heat signs" means absence of limb restlessness. Named "Three White" because all three ingredients are white, distinguishing it from the Minor Intra-Chest Binding Decoction. Old versions mistakenly wrote "Three Items"; administering Coptidis Rhizoma (Huanglian) and Trichosanthis Fructus (Gualou) would lead to death from excess Yin. Another mistake writes "White Powder," creating two different formulas. Huanglian and Arecae Semen Preparatum (Badou) are as different as heaven and earth in temperature; saying "can also be taken" misleads people! (Ke Yunbo)
For Cold-Excess Chest Binding without heat signs, administer the Three-Items Minor Intra-Chest Binding Decoction; the White Powder may also be taken.
Note: "Administer the Three-Items Minor Intra-Chest Binding Decoction" should be "Three-Item White Powder." The characters "Minor Intra-Chest Binding Decoction" are likely misplaced text. Scutellariae Radix (Huangqin), Trichosanthis Fructus (Gualou), and Coptidis Rhizoma (Huanglian) are the components of the Minor Intra-Chest Binding Decoction, all cold-natured, unsuitable for Cold-Excess Chest Binding. The "Three-Item White Powder" consists of Platycodonis Radix (Jiegeng), Fritillariae Bulbus (Beimu), and Arecae Semen Preparatum (Badou), all white, warming and attacking, matching the cold-excess pathology. The phrase "may also be taken" is superfluous and should be deleted. (*Zongjin Yijian*)
In Yangming disease, with spontaneous sweating, if sweating is induced and urination is free, this indicates internal exhaustion of body fluids. Although the stool is hard, purgation is contraindicated; one must wait for the patient's urge to defecate and use honey suppositories (Mi Jian Dao) to facilitate passage. Radix Trichosanthis (Tugua Gen) and Porcine Bile (Zhudanshi) can also be used as suppositories.
Formula for Radix Trichosanthis (missing)
Note: Tugua is commonly known as Chibao. The *Zhouhou Fang* treats constipation by crushing the root, extracting juice, and blowing it into the anus via a tube, which shares the same principle as the Porcine Bile formula. The *Waitai* formula suggests carving the root into a suppository shape and inserting it, which is incorrect. Honey suppositories melt and lubricate the stool internally; Radix Trichosanthis does not melt. Carving it into a suppository likely deviates from Zhang Zhongjing’s original intent. (*Zongjin Yijian*)
For deficient patients requiring purgation but unable to tolerate it, suppository methods are appropriate. Differentiate accordingly: for fluid exhaustion, use honey suppositories; for excess heat pathogens, use bile suppositories; for solidified damp-heat, phlegm-fluid, use radish seed oil-soaked Trichosanthis Radix (Gualou Gen) suppositories. For Yin-binding constipation, add ginger juice and powdered Raw Aconite (Sheng Fuzi) to honey suppositories, or use sauce-ginger suppositories. This effectively supplements Zhang Zhongjing’s omissions. (*Shanghan Zuankan*)
At the foot pulse (Zuyang Mai), floating and choppy: floating indicates strong Stomach Qi, choppy indicates frequent urination. The interaction of floating and choppy pulses leads to difficult defecation; this is Spleen Constraint (Pi Yue), treated with the Hemp Seed Pill (Maren Wan).
Cheng Wuji said: "Yue" means constrained. Strong Stomach and weak Spleen constrain fluids, preventing distribution, directing them only to the Bladder, hence frequent urination and hard stool, called Spleen Constraint. This pill resolves Spleen dryness, moistens the intestines, allows fluids to enter the Stomach, restores normal bowel movements, reduces urination, and cures the condition. I have doubts: If it is "constrained," the Spleen is weak and cannot transform; Spleen weakness implies Earth deficiency, involving dispersion of Spleen Qi and consumption of Spleen Blood. The origin is likely prolonged illness, excessive sweating, or severe purgation, leading to枯竭 Yin-blood, blazing internal fire, damaging Yuan Qi and the Spleen. Damaging Yuan Qi affects Lung Metal, losing Qi control; damaging the Spleen, since Lung is the child of Spleen, Lung consumption depletes fluids, stealing mother Qi for self-rescue. Metal depletion leaves Wood unchecked, making Earth injury inevitable. Spleen loses transport, Lung loses transmission, leading to constipation and frequent urination without storage. Ideally, nourish Yin-blood to curb Yang fire, clear Metal, restrain Wood, strengthen Earth, allow fluids to enter the Stomach, moisten intestines, and restore flow. Using Cortex Magnoliae Officinalis (Zhi) and Pericarpium Citri Reticulatae (Ke) as ministers, with Radix Paeoniae Alba for blood, and Hemp Seed (Huoren) and Apricot Kernel (Xingren) as assistants, works for excess heat and Qi. But for excess heat with deficient Qi, although temporary relief occurs, will it not weaken the Spleen further and dry the intestines? Users of this formula must avoid rigid application. (Yu Jiayan)
In Taiyang disease, after passing the stage for over ten days, if purgation was wrongly applied two or three times, and after four or five days, Shaoyang symptoms persist, first administer the Minor Bupleurum Decoction (Xiao Chaihu Tang). If vomiting continues, epigastric urgency arises, and there is slight depression and irritability, the condition is unresolved; administer the Major Bupleurum Decoction (Da Chaihu Tang) to purge, and it will heal.
Note: Major Bupleurum Decoction is a purgative for the half-exterior/half-interior Qi level, not specifically for the bowels. Epigastric urgency and hardness are disorders of the stomach gate, not the Stomach organ itself. Heat binding in the interior is not solid accumulation in the Stomach. Moreover, if diarrhea occurs, the intestinal pathway is open; Zhongjing’s reason for omitting Radix Rhei Preparata (Dahuang) is clear. If "purge" implies adding Dahuang, what flavor would be added to the Ten-Jujube Decoction’s "purge"? (Ke Yunbo)
Note: Xu Shuwu stated: Major Bupleurum Decoction exists in versions with and without Radix Rhei Preparata (Dahuang). Dahuang clears accumulated heat, a crucial herb in shānghán. Wang Shuhe said: Without Dahuang, it cannot be called Major Bupleurum Decoction. Also, Zhongjing said "purge to heal"; without Dahuang, how would epigastric urgency be resolved? Following Wang Shuhe is correct. It should be supplemented. (*Zongjin Yijian*)
In Shaoyin disease, with diarrhea, sore throat, chest fullness, and irritability, the Pig Skin Decoction (Zhufu Tang) is the primary treatment.
"Fu" refers to the black skin scraped off a pig. The *Li Yun Shu* states: "Ge" is the thick inner hide; "Fu" is the thin outer skin. The idiom "superficial" derives from this meaning. (Yu Jiayan)
Pig skin moistens Shaoyin dryness, similar to the intent of using Black Donkey-hide Gelatin (Ejiao). Interpreting it as the thin skin at the hair roots makes it inferior and ineffective, contradicting the instruction to roast until fragrant. Using only the outer skin, removing the inner fatty white layer, is correct. (*Shanglun Pian*)
Four-Reversal Powder (Sini San): Radix Glycyrrhizae (Gancao), Radix Paeoniae Alba (Shaoyao), Aurantii Fructus Immaturus (Zhishi), and Bupleuri Radix (Chaihu), four ingredients, each ten parts, pounded and sifted, taken with rice water as a square-inch spoonful, three times daily. ○ For cough, add Schisandrae Fructus (Wuweizi) and Rhizoma Zingiberis Recens (Ganjiang), five parts each. ○ For palpitations, add Ramulus Cinnamomi (Guizhi), five parts. ○ For difficulty in urination, add Poria (Fuling), five parts. ○ For abdominal pain, add one Radix Aconiti Lateralis Preparata (Fuzi), roasted until cracked. ○ For heaviness in defecation, first decoct three sheng of Allii Macrostemonis Bulbus (Xiebai) in five sheng of water to obtain three sheng, strain, then add three square-inch spoonfuls of the powder to the decoction, boil to obtain one and a half sheng, divide into two warm doses.
This imitates the purging method of Major Bupleurum Decoction. Since Shaoyin is the Yin pivot, removing the great cold of Scutellariae Radix (Huangqin) and the acrid-dispersing properties of Rhizoma Zingiberis Recens (Sheng Jiang) and Rhizoma Pinelliae (Banxia), and replacing Jujubae Fructus (Dazao) with Radix Glycyrrhizae (Gancao) has deep significance. However, a square-inch spoonful may be insufficient. For Shaoyang palpitations, Poria is added; here, Ramulus Cinnamomi is added. For Shaoyang abdominal pain, Radix Paeoniae Alba is added; here, Radix Aconiti Lateralis Preparata is added. Although the methods differ in Yin-Yang, they may not suit heaviness in defecation. Allii Macrostemonis Bulbus is slippery, clearing lower Jiao Qi stagnation, but is too acrid-warm and pungent. Using three sheng at once with three spoonfuls of powder results in tasting only the bulb, not the medicine. Also, additions use five parts, while Fuzi uses one piece and Xiebai uses three sheng. Why such disparity? One cannot help suspecting editorial errors by Wang Shuhe! (Ke Yunbo)
Floating and slow pulse, exterior heat and interior cold, diarrhea with undigested food: Four-Reversal Decoction (Sini Tang) is the primary treatment.
When treating deficiency, Zhongjing prioritizes the interior. For shānghán with diarrhea and faint pulse, he uses Codonopsis Radix (Renshen); for body ache after sweating with a deep-slow pulse, he adds Renshen. Here, with a slow pulse, diarrhea of undigested food, no irritability or cough, Middle Qi is greatly deficient, and Yuan Qi is escaping. Warming without tonifying cannot save deviation. Observing that in Poria and Four-Reversal Decoction for irritability, Renshen is used, how much more so in Pulse-Rescuing Four-Reversal Decoction? This must be an omission in the original formula. (Ke Yunbo)
Diarrhea with undigested food, interior cold and exterior heat, sweating and cold extremities: Pulse-Rescuing Four-Reversal Decoction (Tongmai Sini Tang) is the primary treatment.
Note: This formula is designed for Yin conditions resembling Yang. The difference from Four-Reversal Decoction is the absence of aversion to cold and presence of flushed face. The difference in the formula, if lacking Renshen, would be identical to Ramulus Cinnamomi Decoction plus extra Ramulus Cinnamomi or Radix Paeoniae Alba. Why the name "Pulse-Rescuing"? Renshen promotes blood vessels; why omit it when the pulse is near extinction? Old editions state at the end: "For flushed face, add Scallion White (Congbai); for stopped diarrhea and absent pulse, add Renshen." Is this not a scribe’s negligence, adding supplementary instructions to the main formula? And "subtract" instructions refer to removing existing ingredients, whereas removing Congbai, Shaoyao, and Jiegeng implies later modifications. (Ke Yunbo)
Cold extremities, fine pulse nearly imperceptible: Return-to-Extremities Decoction with Angelica (Danggui Sini Tang) is the primary treatment.
This syndrome is interior; it should be Four-Reversal Base Formula plus Angelicae Sinensis Radix (Danggui), similar to Poria and Four-Reversal Decoction. Using Ramulus Cinnamomi Decoction to attack the exterior is an error. Named Four-Reversal Decoction, how can it lack Renshen and Fuzi? (Ke Yunbo)
Shānghán for six or seven days, after strong purgation, if the Cun pulse is deep and slow, extremities are cold, lower pulses are absent, throat is obstructed, spitting of pus and blood occurs, and diarrhea is unceasing, it is difficult to treat. Ephedrae Herba and Asari Rhizome et Radix (Mahuang Shengma Tang) is the primary treatment.
Shānghán for six or seven days, after strong purgation, Cun pulse is deep and slow. Cun is Yang, governing the Upper Jiao; deep and slow indicates lack of Yang. Deep indicates interior, so sweating is inappropriate; slow indicates Cold in the Zang organs, so clearing fire is inappropriate. Absent lower pulses, cold extremities, and unceasing diarrhea indicate exhaustion of Lower Jiao Yuan Yang. Obstructed throat and spitting of pus/blood indicate Upper Jiao deficient Yang has no root and is perishing, causing chaos. Using Renshen and Fuzi to restore Yang fails, hence "difficult to treat." Thus, Zhongjing provides no formula, clearly! Using Ephedrae Herba, Asari Rhizome et Radix, and Ramulus Cinnamomi to disperse, combined with Anemarrhenae Rhizoma (Zhimu), Asparagi Radix (Tian Dong), Scutellariae Radix (Huangqin), Radix Paeoniae Alba, and Gypsum Fibrosum to clear, applies a method for Yang-excess to a Yang-perishing condition, hastening death. How can sweating and healing be expected? Using only Zingiberis Rhizoma (Ganjiang) for warmth, and Poria, Atractylodis Macrocephalae Rhizoma, Radix Glycyrrhizae, and Angelicae Sinensis Radix for tonification, substituting Polygonati Rhizoma (Yuzhu) for Renshen, is like attacking a fortified city with a weak army. Using fourteen herbs is like casting a wide net hoping to catch one rabbit, regardless of pulse-disease correspondence. This is likely reckless talk! (Ke Yunbo)
Yang-Toxin disease: red face with mottled patterns like brocade, sore throat, spitting pus and blood. Treatable within five days, untreatable after seven. Corydalis and Turtle Shell Decoction (Shengma Biejia Tang) is the primary treatment. ○ Yin-Toxin disease: blue-green face and body, body pain as if beaten, sore throat. Treatable within five days, untreatable after seven. Corydalis and Turtle Shell Decoction minus Realgar (Xionghuang) and Sichuan Pepper (Shuzao) is the primary treatment.
Note: Yang-Toxin is primarily treated with Corydalis and Turtle Shell Decoction. Corydalis Radix (Shengma) lifts and penetrates toxic pathogens; Testudinis Carapax et Plastrum (Biejia) clears heat and anchors Spirit; Angelicae Sinensis Radix harmonizes blood and regulates Ying; Radix Glycyrrhizae clears fire and detoxifies. This aligns with the *Neijing* principle: "When heat floods the interior, treat with salty-cold, assist with acrid-sweet." The inclusion of Sichuan Pepper and Realgar seems intended for the Yin-Toxin formula, possibly due to transcription error. A slight shift makes the meaning for Yang-Toxin more precise, reducing user hesitation. (*Wu Yi Huijiang*)
After recovery from serious illness, relapse due to overexertion: Aurantii Fructus Immaturus, Gardeniae Fructus, and Fermented Soybean Decoction (Zhishi Zhichi Tang) is the primary treatment. If there is retained food, add Radix Rhei Preparata (Dahuang) the size of five or six chess pieces. ○ After recovery from serious illness, with fluid retention below the waist: Oyster Shell and Smilacis Glabrae Rhizoma (Muli Ze Xie) Powder is the primary treatment. ○ After resolution of shānghán, with emaciation, shortness of breath, and rebellious Qi causing nausea: Bamboo Leaf and Gypsum Decoction (Zhuye Shigao Tang) is the primary treatment.
Wang Shuhe focused solely on shānghán, calling it "serious illness." Since it is serious illness, post-recovery treatment should involve regulation and tonification. Relapse due to overexertion implies recurrence from labor; tonification is required...