不伏。小承气汤症，反用大承气汤下之，则过伤正气，而腹满不能食，故有勿大泄之戒，此仲景所以分而治之，
未尝越圣人之制度。后之医者，以此三药合而为一，且云通治三药之症，及伤寒杂病内外一切所伤。若如此说，
与仲景之方甚相背戾，且失轩岐缓急之旨，由是红紫乱失，迷惑世人，一唱百和，使病者暗受其弊，将何所咎
哉。倘有公心审是者，当于《内经》、仲景方中求之，责使药症相对，以圣贤之心为心，则方之真伪，自可得而
知矣。
〔洁〕伤寒之法，先言表里，及有缓急。三阳，表当急，里当缓。三阴，表当缓，里当急。又曰∶脉浮当
汗，脉沉当下。脉浮，汗急而下缓，谓三阳表也。脉沉，下急而汗缓，谓三阴里也。麻黄汤谓之急，麻黄附子
细辛汤谓之缓。《内经》云∶有渍形以为汗，谓汗之缓，里之表也。又云∶在皮者汗而发之，谓汗之急，表之表
也。急汗者太阳，缓汗者少阴，是脏腑之输应也。假令附子麻黄细辛汤，是少阴症始得，发热脉沉，里和无汗，
故渍形为汗。今麻黄汤，是太阳症，头项痛，腰脊强，脉浮无汗，里和是也，在皮者汗而发之可也。经曰∶治
主以缓，治客以急，此之谓也。（麻黄汤方见伤寒表里上条。）假令得肝脉，其外症善洁，面青，善怒，其三
部脉俱弦而浮，恶寒里和，清便自调，麻黄汤内加羌活、防风各三钱，谓肝主风，是胆经受病也。大便秘，
或泄下赤水无数，皆里不和也。假令得心脉，其外症面赤，口干，善笑，其尺寸脉俱浮而洪，恶寒里和，清
便自调，麻黄汤内加黄芩、石膏各三钱，谓心主热，是小肠受病也。假令得脾脉，其外症面黄，善噫、善思、
善味，尺寸脉俱浮而缓，里和恶寒，麻黄汤内加白术、防风各三钱，谓脾主湿，是胃经受病也。假令得肺脉，
其外症面白，善嚏，悲愁不乐，欲哭，其尺寸脉俱浮而涩，里和恶寒，麻黄汤内加桂枝、生姜各三钱，谓肺
主燥，是大肠受病也。假令得肾脉，其外症面黑，善恐、欠，尺寸服俱沉，而里和恶寒。麻黄汤内加附子、
生姜各三钱，谓肾主寒，
是膀胱受病也。
以上五症，皆表之表也，谓在皮者急汗而发之，皆腑受病也。表之里者，下之当缓，谓随脏表症外显，
尺寸脉俱浮而复有里症，谓发热饮水，便利赤色，或泄下赤水，其脉浮，按之内实或痛，麻黄汤方去麻黄、
杏仁，随脏元加药同煎，分作五服。每下一症，初一服加大黄五分。如邪未尽，又加大黄一钱。未尽，再
加大黄一钱半。直候邪尽则止。此先缓而后急，是表之里，宜下之当缓也。
麻黄附子细辛汤（方见下少阴但欲寐条。）
假令得肝脉，其内症满闷，淋溲便难，转筋，其尺寸脉俱沉而弦，里和恶寒，肝经受病，麻黄附子细辛汤
内加羌活、防风各三钱。假令得心脉，其内症烦心，心痛，掌中热而哕，其尺寸脉俱沉洪，里和恶寒，心经受
病，于前汤内加黄芩、石膏各三钱。假令得脾脉，其内症腹满胀，食不消，怠惰嗜卧，其尺寸脉俱沉缓，里和
恶寒，脾经受病，加白术、防已各三钱。假令得肺脉，其内症喘嗽、洒淅寒热、其尺寸脉俱沉涩，里和恶寒，肺
经受病，加生姜、桂枝各三钱。假令得肾脉，其内症泄泻、下重、足胫寒而逆，其尺寸脉俱沉，里和恶寒，此
肾经受病，加姜、附各三钱。
以上五症，里之表也，宜渍形以为汗，皆脏受病也。里之里者，下之当急，谓随脏内症已显，尺寸脉俱
沉而复有里症，谓小便赤，大便秘涩，或泻下赤水，或泻或咳，不能饮食，不恶风寒，发热引饮，其脉
俱沉，按之内实而痛，此谓里实，宜速下之。麻黄附子细辛汤内去麻黄，随脏元加药同煎，分作三服。每
下一症，初一服加大黄三钱，邪尽即止。加邪未尽，第二服加大黄二钱。又未尽，第三服加大黄一钱。此
先急而后缓，是里之里也，宜速下之。
〔云〕太阳症，非头痛项强，不可发汗。非身热恶寒，不可发汗。非脉浮，不可发汗。
〔《活》〕其脉微弱，或尺脉迟者，不可表。其人当汗而衄血者，不可表。坏病者，不可表。妇人经水适来
者，不可表。风温者，不可表。湿温者，不可表。虚烦者，不可表。病患腹间左右上下有筑触动气者，不可表。
曾经发汗，若吐若下，若温病仍不解者，为坏病。脉尺寸俱浮，头痛身热，常自汗体重，其息必喘，其形
不仁，默默但欲眠者，为风温。两胫逆冷，胸腹满，头目痛苦，妄言，必多汗者，为湿温。与伤寒症相似，但
不恶寒，身不疼痛，脉不紧者，为虚烦。脐上下左右有动气，按之牢若痛者，为动气。
太阳咽干，鼻衄淋漓，小便不利，皆不当汗。已经发汗，不得重发。如无以上忌症，虽经发汗，邪气未尽，
亦当重发之。当汗不汗则生黄，其症为风寒所伤，阳气下陷入内，而与寒水上行于经络之间，本当发汗以彻其
邪，医失汗之，故生黄也，脾主肌肉，四肢寒湿，与内热相合，故生黄也。不当汗而汗，为蓄血之症，燥火也，
当益津液为上，而反汗以亡之，其毒扰阳之极则侵阴也，故燥血蓄于胸中也。当汗而发汗过多，腠理开泄，汗
漏不止，故四肢急，难以屈伸也。
〔《云》〕非阳明之本病，不可下。阳明本病，胃家实故也。非痞满燥实，不可下。非潮热发渴，不可下。非
骂詈亲疏，不可下。非脉沉数，不可下。非弃衣而走，登高而歌，如见鬼状，不可下。
〔活〕脉浮者，不可下。脉虚者，不可下。恶寒者，不可下。呕吐者，不可下。不转矢气者，不可下。
（转矢气者，下泄也。）小便清者，不可下。大便坚，小便数，不可用承气汤攻之。（乃脾约丸症也。）大便硬，
小便少者，未可攻。阳明病自汗出，若发汗小便自利者，不可下。（宜用蜜煎导之。）
〔云〕非往来寒热者，不可和。非胁肋急痛者，不可和。非胸满而呕者，不可和。
〔海〕太阳传阳明，其中或有下症，阳明症反退而无热，与不渴，却显少阳症，是知可解也。太阳症知可
解者，为头不痛，项不强，肢节不痛，则知表易解也。阳明症知可解者，为无发热恶热，则知里易解也。少阳
知可解者，寒热日不移时而作，邪未退也，若用柴胡而移其时，早移之于晏，晏移之于早，气移之于血，血移
之于气，是邪无可容之地，知可解也。可解之脉浮而虚，不可解之脉浮而实。浮而虚者只在表，浮而实者知已
在里也。汗多不解者，转属阳明也。伤寒不头痛，知邪不在经。若头痛，知邪在经也。
六经传足传手经则愈。阳中之阴，水，太阳是也。为三阳之首，能巡经传，亦能越经传。阳中之阳，土，
阳明是也。阳明为中州之主，主纳而不出，如太阳传至此名曰巡经传也。阳中之阳，木，少阳是也。上传阳明，
下传太阴，如太阳传至此为越经传。阴中之阴，土，太阴是也。上传少阳为顺，下传少阴为逆，如传少阴为上
下传也，如太阳传太阴为误下传也。阴中之阳，火，少阴是也。上传太阴为顺，下传厥阴为逆。如太阳至此，
乃表传里也。阴中之阴，木，厥阴是也。上传少阴为实，再传太阴为自安。
太阳六传太阳者，巨阳也，为诸阳之首，膀胱经病。若渴者，自入于本也，名曰传本。太阳传阳明胃土者，
名曰巡经传。为发汗不尽，利小便，余邪不尽，透入于里也。太阳传少阳胆木者，名曰越经传也。为元受病，
脉浮自汗，宜用麻黄汤而不用故也。太阳传太阴脾土者，名曰误下传。为元受病，脉缓有汗，当用桂枝而反下
之所致也，当病腹痛，四肢沉重。太阳传少阴肾水，名曰表传里。为病急当下，而反不攻不发，所以传里也。
太阳传厥阴肝木者，为阴不至于首，惟厥阴与督脉上行太阳相接，名巡经得度传。
〔《本》〕有人病伤寒无汗，恶风，项既屈而且强。予曰∶项强KT KT ，葛根汤症。或问曰∶何谓KT KT ？
予曰∶KT KT 者，如KT 疾屈而强也。谢复古谓病患羸弱，须凭KT 而起误也。盖仲景论中极有难晓处，
振振欲擗地，心中懊 ，外气怫郁，郁冒不仁，膈内拒痛，如此之类甚多。（成无己云∶KT ，音殊，KT 为
短羽鸟不能飞腾，动先伸引其头项。背强者，动亦如之。非若KT 案之KT 而可偃屈也。甚得仲景之旨。）
不适宜发汗。小承气汤证，反而使用大承气汤攻下，就会过度损伤正气，导致腹部胀满不能进食，所以有不要过度泄下的告诫，这是张仲景之所以分别治疗的原因，未曾超越圣人的法度。后世的医生，将这三种药合而为一，并且说通治这三种药的病症，以及伤寒杂病内外一切所伤。如果像这样说，与张仲景的方剂非常相违背，并且失去了岐伯、黄帝关于缓急的宗旨，由此导致红紫混淆，迷惑世人，一唱百和，使病人暗中受到损害，这该怪罪谁呢？如果有公正之心审察是非的人，应当在《内经》、张仲景方剂中寻求，责成使药物与病症相对，以圣贤的心为心，那么方剂的真伪，自然可以得知了。
〔李东垣〕伤寒的方法，先讲表里，以及有缓急之分。三阳经，表证应当急治，里证应当缓治。三阴经，表证应当缓治，里证应当急治。又说：脉浮当用汗法，脉沉当用下法。脉浮，汗法急而下法缓，称为三阳表证。脉沉，下法急而汗法缓，称为三阴里证。麻黄汤（Ephedra Decoction）称为急，麻黄附子细辛汤（Ephedra, Prepared Aconite and Asarum Decoction）称为缓。《内经》说：有通过浸渍形体来取汗的，称为汗法之缓，是里的表证。又说：邪在皮者，用汗法发散，称为汗法之急，是表的表证。急汗对应太阳经，缓汗对应少阴经，这是脏腑的输注相应关系。假如遇到麻黄附子细辛汤证，是少阴病初得，发热脉沉，里和无汗，所以用浸渍形体取汗。现在的麻黄汤证，是太阳病，头项痛，腰脊强，脉浮无汗，里和，属于邪在皮者，用汗法发散即可。经上说：治主病用缓法，治客病用急法，说的就是这个道理。（麻黄汤方见伤寒表里上条。）假如诊得肝脉，其外症喜欢清洁，面色青，易怒，三部脉都弦而浮，恶寒里和，二便正常，在麻黄汤内加羌活、防风各三钱，因为肝主风，是胆经受病。大便秘结，或者泻下赤水无数，都是里不和。假如诊得心脉，其外症面赤，口干，爱笑，寸关尺脉都浮而洪，恶寒里和，二便正常，在麻黄汤内加黄芩、石膏各三钱，因为心主热，是小肠受病。假如诊得脾脉，其外症面黄，爱叹气、爱思虑、味觉敏感，寸关尺脉都浮而缓，里和恶寒，在麻黄汤内加白术、防风各三钱，因为脾主湿，是胃经受病。假如诊得肺脉，其外症面白，爱打喷嚏，悲伤忧愁不乐，想哭，寸关尺脉都浮而涩，里和恶寒，在麻黄汤内加桂枝、生姜各三钱，因为肺主燥，是大肠受病。假如诊得肾脉，其外症面黑，易恐惧、呵欠，寸关尺脉都沉，里和恶寒，在麻黄汤内加附子、生姜各三钱，因为肾主寒，是膀胱受病。
以上五种症状，都是表的表证，称为邪在皮者，急汗发散，都是腑受病。表的里证，下法应当缓，称为随着脏的病证外显，寸关尺脉都浮而又出现里证，称为发热饮水，小便赤色，或者泻下赤水，脉浮，按之内实或痛，麻黄汤方去掉麻黄、杏仁，随原脏加药同煎，分作五服。每下一症，第一服加大黄五分。如果邪气未尽，又加大黄一钱。如果还没尽，再加大黄一钱半。直到邪气尽则停止。这是先缓而后急，是表的里证，宜下法应当缓。
假如诊得肝脉，其内症闷满，小便困难，转筋，寸关尺脉都沉而弦，里和恶寒，肝经受病，在麻黄附子细辛汤内加羌活、防风各三钱。假如诊得心脉，其内症心烦，心痛，手掌热且呃逆，寸关尺脉都沉洪，里和恶寒，心经受病，在前汤内加黄芩、石膏各三钱。假如诊得脾脉，其内症腹满胀，食物不消化，怠惰嗜卧，寸关尺脉都沉缓，里和恶寒，脾经受病，加白术、防己各三钱。假如诊得肺脉，其内症喘咳、洒淅寒热，寸关尺脉都沉涩，里和恶寒，肺经受病，加生姜、桂枝各三钱。假如诊得肾脉，其内症泄泻、里急后重、足胫寒冷逆冷，寸关尺脉都沉，里和恶寒，这是肾经受病，加姜、附各三钱。
以上五种症状，是里的表证，宜浸渍形体取汗，都是脏受病。里的里证，下法应当急，称为随着脏的内症已显现，寸关尺脉都沉而又出现里证，称为小便赤，大便秘涩，或者泻下赤水，或者泻或咳，不能饮食，不恶风寒，发热引饮，脉都沉，按之内实而痛，这叫里实，宜速下之。麻黄附子细辛汤内去麻黄，随原脏加药同煎，分作三服。每下一症，第一服加大黄三钱，邪尽即止。如果邪未尽，第二服加大黄二钱。又未尽，第三服加大黄一钱。这是先急而后缓，是里的里证，宜速下之。
〔云〕太阳病，不是头痛项强，不可发汗。不是身热恶寒，不可发汗。不是脉浮，不可发汗。
〔《活人书》〕脉微弱，或者尺脉迟的，不可解表。其人应当出汗却鼻衄血的，不可解表。坏病的，不可解表。妇人月经适来的，不可解表。风温的，不可解表。湿温的，不可解表。虚烦的，不可解表。病患腹间左右上下有筑触动气的，不可解表。曾经发汗，若吐若下，若温病仍不解的，称为坏病。脉尺寸俱浮，头痛身热，常自汗体重，呼吸必喘，形体麻木不仁，默默只想睡觉的，称为风温。两小腿逆冷，胸腹满，头目痛苦，胡言乱语，必定多汗的，称为湿温。与伤寒症相似，但不恶寒，身不疼痛，脉不紧的，称为虚烦。脐上下左右有动气，按之牢若痛的，称为动气。
太阳咽干，鼻衄淋漓，小便不利，都不应当发汗。已经发汗，不得再次发汗。如果没有以上禁忌症，虽然经过发汗，邪气未尽，也应当再次发汗。应当发汗而不发汗则生黄疸，其症为风寒所伤，阳气下陷入内，而与寒水上行于经络之间，本当发汗以祛除邪气，医生失误没有发汗，所以生黄疸。脾主肌肉，四肢寒湿，与内热相合，所以生黄疸。不应当发汗而发汗，成为蓄血症，是燥火，应当补充津液为上策，反而发汗使其亡失，其毒扰乱阳气至极则侵犯阴，所以燥血蓄于胸中。应当发汗而发汗过多，腠理开泄，汗漏不止，所以四肢拘急，难以屈伸。
〔《云》〕不是阳明本病，不可下。阳明本病，是胃家实。不是痞满燥实，不可下。不是潮热发渴，不可下。不是骂詈亲疏，不可下。不是脉沉数，不可下。不是弃衣而走，登高而歌，如见鬼状，不可下。
〔《活人书》〕脉浮的，不可下。脉虚的，不可下。恶寒的，不可下。呕吐的，不可下。不转矢气的，不可下。（转矢气者，下泄也。）小便清的，不可下。大便坚，小便数，不可用承气汤攻之。（乃脾约丸症也。）大便硬，小便少的，不可攻。阳明病自汗出，若发汗小便自利的，不可下。（宜用蜜煎导之。）
〔《云》〕不是往来寒热的，不可和解。不是胁肋急痛的，不可和解。不是胸满而呕的，不可和解。
〔海〕太阳传阳明，其中或有下症，阳明症反退而无热，与不渴，却显少阳症，是知道可解。太阳症知可解的，为头不痛，项不强，肢节不痛，则知道表易解。阳明症知可解的，为无发热恶热，则知道里易解。少阳知可解的，寒热日不移时而作，邪未退也，如果用柴胡而移其时，早移之于晏，晏移之于早，气移之于血，血移之于气，是邪无可容之地，知道可解。可解之脉浮而虚，不可解之脉浮而实。浮而虚者只在表，浮而实者知已在里也。汗多不解的，转属阳明。伤寒不头痛，知道邪不在经。若头痛，知道邪在经。
六经传足传手经则愈。阳中之阴，水，太阳是也。为三阳之首，能巡经传，亦能越经传。阳中之阳，土，阳明是也。阳明为中州之主，主纳而不出，如太阳传至此名曰巡经传。阳中之阳，木，少阳是也。上传阳明，下传太阴，如太阳传至此为越经传。阴中之阴，土，太阴是也。上传少阳为顺，下传少阴为逆，如传少阴为上下传也，如太阳传太阴为误下传。阴中之阳，火，少阴是也。上传太阴为顺，下传厥阴为逆。如太阳至此，乃表传里。阴中之阴，木，厥阴是也。上传少阴为实，再传太阴为自安。
太阳六传太阳者，巨阳也，为诸阳之首，膀胱经病。若渴者，自入于本也，名曰传本。太阳传阳明胃土者，名曰巡经传。为发汗不尽，利小便，余邪不尽，透入于里。太阳传少阳胆木者，名曰越经传。为元受病，脉浮自汗，宜用麻黄汤而不用故。太阳传太阴脾土者，名曰误下传。为元受病，脉缓有汗，当用桂枝而反下之所致，当病腹痛，四肢沉重。太阳传少阴肾水，名曰表传里。为病急当下，而反不攻不发，所以传里。太阳传厥阴肝木者，为阴不至于首，惟厥阴与督脉上行太阳相接，名巡经得度传。
〔《本草》〕有人病伤寒无汗，恶风，项既屈而且强。我说：项强KT KT，葛根汤证。有人问：什么叫KT KT？我说：KT KT者，如KT疾屈而强。谢复古谓病患羸弱，须凭KT而起误。盖仲景论中极有难晓处，振振欲擗地，心中懊憹，外气怫郁，郁冒不仁，膈内拒痛，如此之类甚多。（成无己云：KT，音殊，KT为短羽鸟不能飞腾，动先伸引其头项。背强者，动亦如之。非若KT案之KT而可偃屈。甚得仲景之旨。）
Not suitable for sweating. In cases of Xiao Chengqi Tang (Minor Order the Qi Decoction) syndrome, if Da Chengqi Tang (Major Order the Qi Decoction) is used to purge, it will excessively damage the healthy Qi, leading to abdominal fullness and inability to eat; hence, there is a warning against excessive purging. This is why Zhang Zhongjing treats them separately, never exceeding the standards of the Sages. Later physicians combined these three medicines into one, claiming they treat all syndromes of these three medicines, as well as all internal and external injuries from Shanghan (Cold Damage) and miscellaneous diseases. If stated thus, it greatly contradicts Zhang Zhongjing's formulas and loses the principle of urgency and slackness from Qibo and Huangdi, thereby confusing red with purple and misleading the world. One voice is echoed by hundreds, causing patients to suffer secretly; whom should we blame? Those with a fair mind who examine right and wrong should seek answers in the *Neijing* (Classic of Internal Medicine) and Zhang Zhongjing's formulas, ensuring medicine matches the syndrome, and adopting the heart of the sages; then the authenticity of the formulas will naturally become known.
[Li Dongyuan] The method for treating Shanghan first discusses exterior and interior, and distinguishes between urgency and slackness. For the Three Yang meridians, exterior syndromes should be treated urgently, while interior syndromes should be treated slackly. For the Three Yin meridians, exterior syndromes should be treated slackly, while interior syndromes should be treated urgently. It is also said: Floating pulse indicates sweating is indicated; deep pulse indicates purging is indicated. A floating pulse means urgent sweating and slack purging, referring to Three Yang exterior syndromes. A deep pulse means urgent purging and slack sweating, referring to Three Yin interior syndromes. Mahuang Tang (Ephedra Decoction) is referred to as urgent, while Mahuang Fuzi Xixin Tang (Ephedra, Prepared Aconite and Asarum Decoction) is referred to as slack. The *Neijing* states: "There is immersing the body to induce sweating," which refers to slack sweating, representing the exterior of the interior. It also states: "For pathogens in the skin, use sweating to disperse them," which refers to urgent sweating, representing the exterior of the exterior. Urgent sweating corresponds to the Taiyang (Greater Yang) meridian, and slack sweating corresponds to the Shaoyin (Lesser Yin) meridian; this reflects the correspondence of organ and meridian transmission. For example, in the Mahuang Fuzi Xixin Tang syndrome, where Shaoyin disease has just begun, with fever, deep pulse, no interior sweating, one uses immersing the body to induce sweating. Now, the Mahuang Tang syndrome is Taiyang disease, characterized by headache and stiffness of the neck and back, floating pulse, no sweating, and a harmonious interior; since the pathogen is in the skin, using urgent sweating to disperse it is appropriate. The Classics say: "Treat the primary condition with slack methods, treat the secondary condition with urgent methods." This is what is meant. (See Mahuang Tang formula in the section on Shanghan Exterior and Interior above.) Suppose the Liver pulse is obtained; its external symptoms include a preference for cleanliness, greenish complexion, and irritability. The pulses at Cun, Guan, and Chi are all wiry and floating, with aversion to cold but a harmonious interior and normal bowel/bladder functions. Add Qianghuo (Notopterygii Rhizoma et Radix) and Fangfeng (Saposhnikoviae Radix), each 3 qian, to Mahuang Tang. This is because the Liver governs Wind, indicating the Gallbladder meridian is diseased. Constipation or profuse discharge of red water indicates disharmony in the interior. Suppose the Heart pulse is obtained; its external symptoms include reddish complexion, dry mouth, and excessive laughter. The pulses at Cun and Chi are both floating and surging, with aversion to cold but a harmonious interior and normal bowel/bladder functions. Add Huangqin (Scutellariae Radix) and Shigao (Gypsum Fibrosum), each 3 qian, to Mahuang Tang. This is because the Heart governs Heat, indicating the Small Intestine is diseased. Suppose the Spleen pulse is obtained; its external symptoms include yellowish complexion, frequent sighing, excessive thinking, and heightened taste sensitivity. The pulses at Cun and Chi are both floating and moderate, with a harmonious interior and aversion to cold. Add Baizhu (Atractylodis Macrocephalae Rhizoma) and Fangfeng (Saposhnikoviae Radix), each 3 qian, to Mahuang Tang. This is because the Spleen governs Dampness, indicating the Stomach meridian is diseased. Suppose the Lung pulse is obtained; its external symptoms include pale complexion, frequent sneezing, sadness and melancholy, and a desire to cry. The pulses at Cun and Chi are both floating and choppy, with a harmonious interior and aversion to cold. Add Guizhi (Cinnamomi Ramulus) and Shengjiang (Zingiberis Rhizoma Recens), each 3 qian, to Mahuang Tang. This is because the Lung governs Dryness, indicating the Large Intestine is diseased. Suppose the Kidney pulse is obtained; its external symptoms include blackish complexion, fearfulness, and yawning. The pulses at Cun and Chi are all deep, with a harmonious interior and aversion to cold. Add Fuzi (Prepared Aconiti Lateralis Radix) and Shengjiang (Zingiberis Rhizoma Recens), each 3 qian, to Mahuang Tang. This is because the Kidney governs Cold, indicating the Bladder meridian is diseased.
The above five syndromes are all exterior-of-the-exterior, meaning pathogens are in the skin, requiring urgent sweating to disperse; these are all Fu organ diseases. For exterior-of-the-interior, purging should be slack, meaning that as Zang organ symptoms manifest externally, the pulses at Cun and Chi are floating yet interior symptoms appear, such as fever with thirst, dark urine, or discharge of red water. The pulse is floating, but pressing reveals interior solidity or pain. Remove Mahuang (Ephedrae Herba) and Xingren (Armeniacae Semen Amarum) from Mahuang Tang, add herbs corresponding to the specific Zang organ, decoct together, and divide into five doses. For each syndrome, start with 5 fen of Dahuang (Rhei Radix et Rhizoma) in the first dose. If pathogens remain, increase Dahuang by 1 qian. If still remaining, increase by another 1.5 qian. Stop when pathogens are exhausted. This is first slack then urgent, applicable to exterior-of-the-interior, where purging should be slack.
Mahuang Fuzi Xixin Tang (See below under Shaoyin Desire to Sleep).
Suppose the Liver pulse is obtained; its internal symptoms include chest oppression, difficult urination, and muscle spasms. The pulses at Cun and Chi are both deep and wiry, with a harmonious interior and aversion to cold, indicating Liver meridian disease. Add Qianghuo (Notopterygii Rhizoma et Radix) and Fangfeng (Saposhnikoviae Radix), each 3 qian, to Mahuang Fuzi Xixin Tang. Suppose the Heart pulse is obtained; its internal symptoms include vexation, heart pain, hot palms, and hiccups. The pulses at Cun and Chi are both deep and surging, with a harmonious interior and aversion to cold, indicating Heart meridian disease. Add Huangqin (Scutellariae Radix) and Shigao (Gypsum Fibrosum), each 3 qian, to the previous decoction. Suppose the Spleen pulse is obtained; its internal symptoms include abdominal fullness and distension, indigestion, lethargy, and drowsiness. The pulses at Cun and Chi are both deep and moderate, with a harmonious interior and aversion to cold, indicating Spleen meridian disease. Add Baizhu (Atractylodis Macrocephalae Rhizoma) and Fangji (Stephaniae Tetrandrae Radix), each 3 qian. Suppose the Lung pulse is obtained; its internal symptoms include wheezing and coughing, chills and fever, and shivering. The pulses at Cun and Chi are both deep and choppy, with a harmonious interior and aversion to cold, indicating Lung meridian disease. Add Shengjiang (Zingiberis Rhizoma Recens) and Guizhi (Cinnamomi Ramulus), each 3 qian. Suppose the Kidney pulse is obtained; its internal symptoms include diarrhea, tenesmus, and coldness in the calves and feet. The pulses at Cun and Chi are all deep, with a harmonious interior and aversion to cold, indicating Kidney meridian disease. Add Jiang (Zingiberis Rhizoma Recens) and Fuzi (Prepared Aconiti Lateralis Radix), each 3 qian.
The above five syndromes are interior-of-the-exterior, suitable for immersing the body to induce sweating; these are all Zang organ diseases. For interior-of-the-interior, purging should be urgent, meaning that as internal Zang symptoms have manifested, the pulses at Cun and Chi are deep yet interior symptoms appear, such as dark urine, constipation, or discharge of red water, or diarrhea/cough, inability to eat, aversion to wind and cold absent, fever with thirst. The pulses are all deep, and pressing reveals interior solidity and pain. This is called interior excess, and rapid purging is indicated. Remove Mahuang (Ephedrae Herba) from Mahuang Fuzi Xixin Tang, add herbs corresponding to the specific Zang organ, decoct together, and divide into three doses. For each syndrome, start with 3 qian of Dahuang (Rhei Radix et Rhizoma) in the first dose; stop when pathogens are exhausted. If pathogens remain, increase Dahuang by 2 qian in the second dose. If still remaining, increase by 1 qian in the third dose. This is first urgent then slack, applicable to interior-of-the-interior, where rapid purging is indicated.
[Yun] For Taiyang syndrome, without headache and stiffness of the neck, sweating is not indicated. Without fever and aversion to cold, sweating is not indicated. Without a floating pulse, sweating is not indicated.
[Huoxuan] If the pulse is faint and weak, or the Chi pulse is slow, exterior resolution is contraindicated. If the patient should sweat but experiences epistaxis, exterior resolution is contraindicated. For Huai Bing (Broken Disease), exterior resolution is contraindicated. For women whose menstruation has just begun, exterior resolution is contraindicated. For Fengwen (Wind-Warmth), exterior resolution is contraindicated. For Shiwen (Damp-Warmth), exterior resolution is contraindicated. For Xu Fan (Deficiency Vexation), exterior resolution is contraindicated. If the patient has pulsating Qi moving up and down in the abdomen, exterior resolution is contraindicated. If sweating, vomiting, or purging have been performed previously, or if Wenbing (Warm Disease) remains unresolved, it is called Huai Bing (Broken Disease). If pulses at Cun and Chi are both floating, with headache, fever, spontaneous sweating, heaviness of the body,必 panting, numbness of the form, and silence with a desire to sleep, it is Fengwen (Wind-Warmth). If both calves are reversely cold, with chest and abdominal fullness, headache and eye pain, delirium, and profuse sweating, it is Shiwen (Damp-Warmth). Similar to Shanghan syndrome but without aversion to cold, body pain, or tight pulse, it is Xu Fan (Deficiency Vexation). Pulsating Qi at the upper, lower, left, and right of the navel, firm and painful upon pressure, is called Dong Qi (Moving Qi).
For Taiyang with dry throat, profuse epistaxis, and difficulty urinating, sweating is inappropriate. If sweating has already been performed, do not repeat it. Unless the above contraindications exist, even if sweating has been performed, if pathogens remain, repeated sweating is necessary. Failure to sweat when indicated leads to Jaundice. This syndrome results from Wind-Cold injury, where Yang Qi sinks inward and combines with Cold Water rising through the meridians. Sweating should have been used to expel pathogens; the physician's failure to sweat causes Jaundice. The Spleen governs muscles; cold-dampness in the four limbs combining with interior heat causes Jaundice. Sweating when inappropriate leads to Xu Xue (Accumulated Blood), a condition of Dry Fire. Nourishing fluids is superior, but sweating depletes them. The toxicity disturbs Yang to the extreme, invading Yin, causing Dry Blood to accumulate in the chest. Excessive sweating when indicated opens the pores, causing continuous leakage of sweat, leading to stiffness of the four limbs and difficulty in flexion and extension.
[Yun] Without Yangming proper disease, purging is not indicated. Yangming proper disease is Wei Jia Shi (Stomach House Excess). Without Pi Man Zao Shi (Epigastric Oppression, Fullness, Dryness, and Solidity), purging is not indicated. Without Chao Re Fa Ke (Tidal Fever and Thirst), purging is not indicated. Without cursing relatives and strangers, purging is not indicated. Without a deep and rapid pulse, purging is not indicated. Without discarding clothes, running, climbing high, singing, and seeing ghosts, purging is not indicated.
[Huoxuan] If the pulse is floating, purging is not indicated. If the pulse is deficient, purging is not indicated. If there is aversion to cold, purging is not indicated. If there is vomiting, purging is not indicated. If there is no passing of gas (Zhuan Shi Qi), purging is not indicated. (Zhuan Shi Qi refers to downward expulsion of gas.) If urine is clear, purging is not indicated. If stool is hard and urination is frequent, Chengqi Tang is not used for attack. (This is Pi Yue Wan Syndrome.) If stool is hard and urination is scant, attack is premature. For Yangming disease with spontaneous sweating, if sweating is induced and urination becomes free, purging is not indicated. (Use Honey Suppository instead.)
[Yun] Without alternating chills and fever, harmonizing is not indicated. Without hypochondriac urgency and pain, harmonizing is not indicated. Without chest fullness and vomiting, harmonizing is not indicated.
[Hai] When Taiyang transmits to Yangming, if there are purging indications, but Yangming symptoms retreat without fever and thirst, revealing Shaoyang symptoms, it indicates resolution is possible. For Taiyang syndrome indicating resolution: no headache, no neck stiffness, no joint pain, indicating the exterior is easily resolved. For Yangming syndrome indicating resolution: no fever or aversion to heat, indicating the interior is easily resolved. For Shaoyang indicating resolution: chills and fever occur daily without shifting time, pathogens have not retreated. Using Chaihu (Bupleuri Radix) shifts the timing; early shifts to late, late shifts to early, Qi shifts to Blood, Blood shifts to Qi. Where pathogens have no place to reside, resolution is possible. Pulses indicating resolution are floating and deficient; pulses indicating non-resolution are floating and excess. Floating and deficient indicates only the exterior; floating and excess indicates the interior. Profuse sweating without resolution indicates transmission to Yangming. Shanghan without headache indicates pathogens are not in the meridians. Headache indicates pathogens are in the meridians.
Transmission of the Six Meridians to Foot or Hand meridians leads to recovery. Yin within Yang is Water, Taiyang. It is the head of the Three Yangs, capable of following the meridian transmission (Xun Jing Chuan) and skipping meridian transmission (Yue Jing Chuan). Yang within Yang is Earth, Yangming. Yangming is the master of the Central Region, governing intake without output. Transmission from Taiyang here is called Xun Jing Chuan. Yang within Yang is Wood, Shaoyang. Upward transmission to Yangming, downward transmission to Taiyin. Transmission from Taiyang here is called Yue Jing Chuan. Yin within Yin is Earth, Taiyin. Upward transmission to Shaoyang is smooth; downward transmission to Shaoyin is adverse. Transmission to Shaoyin is vertical transmission. Transmission from Taiyang to Taiyin is erroneous purging transmission. Yang within Yin is Fire, Shaoyin. Upward transmission to Taiyin is smooth; downward transmission to Jueyin is adverse. Transmission from Taiyang here is exterior-to-interior transmission. Yin within Yin is Wood, Jueyin. Upward transmission to Shaoyin is solid; further transmission to Taiyin is self-recovery.
Taiyang transmitting to Taiyang: Ju Yang (Great Yang), head of all Yangs, Bladder meridian disease. If thirsty, it transmits to its own root, called Chuan Ben (Transmission to Root). Taiyang transmitting to Yangming Stomach Earth is called Xun Jing Chuan (Following Meridian Transmission). Due to incomplete sweating, promoting urination, residual pathogens penetrate inward. Taiyang transmitting to Shaoyang Gallbladder Wood is called Yue Jing Chuan (Skipping Meridian Transmission). Due to original illness, floating pulse and spontaneous sweating, Mahuang Tang should have been used but was not. Taiyang transmitting to Taiyin Spleen Earth is called Wu Xia Chuan (Erroneous Purging Transmission). Due to original illness, moderate pulse and sweating, Guizhi Tang should have been used but purging was applied instead, causing abdominal pain and heavy limbs. Taiyang transmitting to Shaoyin Kidney Water is called Biao Chuan Li (Exterior to Interior Transmission). Because the disease was urgent and required purging, but neither attack nor sweating was applied, it transmitted inward. Taiyang transmitting to Jueyin Liver Wood: Yin does not reach the head; only Jueyin connects upward with Du Mai to Taiyang, called Xun Jing De Du Chuan (Following Meridian Degree Transmission).
[Bencao] Someone suffered from Shanghan with no sweating, aversion to wind, and neck stiffness and rigidity. I said: Neck stiffness [Kui Kui], Gegen Tang syndrome. Asked: What is [Kui Kui]? I said: [Kui Kui] means stiff and rigid like a bird with short wings unable to fly, stretching its neck when moving. Xie Fugu said patients are weak and must rely on [Kui Kui] to rise, which is an error. Zhang Zhongjing's discussions have many obscure points, such as trembling wanting to fall to the ground, internal vexation, external Qi stagnation, depression and numbness, rejection pain in the diaphragm, etc. (Cheng Wuji says: [Kui], pronounced Shu. [Kui] refers to a short-winged bird unable to fly, stretching its neck when moving. Back stiffness moves similarly. It is not like [Kui] lying down and bending. This deeply understands Zhang Zhongjing's intent.)