问曰。病有结胸。有脏结。其状何如。答曰。按之痛。寸脉浮。关脉沉。名曰结胸也。
何谓
上白
（结胸者。邪结在胸。脏结者。邪结在脏。二者皆下后邪气乘虚入里所致。下后邪气入
里
与
心
而
结
脏结无阳证。不往来寒热。其人反静。舌上苔滑者。不可攻也。
（脏结。于法当下。无阳证。为表无热。不往来寒热。为半表半里无热。其人反静。为
里无
病发于阳。而反下之。热入因作结胸。病发于阴。而反下之。因作痞。所以成结胸者。
以下
（发热恶寒者。发于阳也。而反下之。则表中阳邪入里。结于胸中。为结胸。无热恶寒
者。
结胸者。项亦强。如柔 状。下之则和。宜大陷胸丸方。
（结胸病项强者。为邪结胸中。胸膈结满。心下紧实。但能仰而不能俯。是项强亦如柔
之
大陷胸丸方
大黄（半斤味苦寒） 葶苈（半升熬味苦寒） 芒硝（半斤味咸寒） 杏仁（半升去皮
尖熬黑味苦
（大黄、芒硝之苦咸。所以下热。葶苈、杏仁之苦甘。所以泄满。甘遂取其直达。白蜜
取其
如弹
不下
结胸证。其脉浮大者。不可下。下之则死。
（结胸。为邪结胸中。属上焦之分。得寸脉浮。关脉沉者。为在里。则可下。若脉浮大。
心
结胸证悉具。烦躁者亦死。
（结胸证悉具。邪结已深也。烦躁者。正气散乱也。邪气胜正。病者必死。）
太阳病。脉浮而动数。浮则为风。数则为热。动则为痛。数则为虚。头痛发热。微盗汗
出。
气躁
余
（动数。皆阳脉也。当责邪在表。睡而汗出者。谓之盗汗。为邪气在半表半里。则不恶
寒。
乘虚
浮脉独
于胸膈
懊。皆邪热为实。阳气内陷。气不得通于膈。壅于心下。为硬满而痛。成结胸也。与大陷
胸汤。
越。不
大陷胸汤
大黄（六两去皮苦寒） 芒硝（一升味咸寒） 甘遂（六钱匕苦寒）
（大黄谓之将军。以苦荡涤。芒硝一名硝石。以其咸能 硬。夫间有遂以通水也。甘遂
若夫
升。
伤寒六七日。结胸热实。脉沉而紧。心下痛。按之石硬者。大陷胸汤主之。
（病在表而下之。热入因作结胸。此不云下后。而云伤寒六七日。则是传里之实热也。
沉为
伤寒十余日。热结在里。复往来寒热者。与大柴胡汤。但结胸。无大热者。此为水结在
胸胁
（伤寒十余日。热结在里。是可下之证。复往来寒热。为正邪分争。未全敛结。与大柴
胡汤
水饮
以
太阳病。重发汗。而复下之。不大便五六日。舌上燥而渴。日晡所小有潮热。从心下至
少腹
（重发汗而复下之。则内外重亡津液。而邪热内结。致不大便五六日。舌上燥而渴也。
日晡
之中
小结胸病。正在心下。按之则痛。脉浮滑者。小陷胸汤主之。
（心下硬痛。手不可近者。结胸也。正在心下。按之则痛。是热气犹浅。谓之小结胸。
结胸
小陷胸汤
黄连（一两苦寒） 半夏（半升洗辛温） 栝蒌实（大者一个苦寒）
（苦以泄之。辛以散之。黄连、栝蒌实。苦寒以泄热。半夏之辛。以散结。） 上三味。
以水
太阳病二三日。不能卧。但欲起。心下必结。脉微弱者。此本有寒分也。反下之。若利
止。
（太阳病二三日。邪在表也。不能卧。但欲起。心下必结者。以心下结满。卧则气壅而
愈甚
分。
至次
太阳病。下之其脉促。不结胸者。此为欲解也。脉浮者。必结胸也。脉紧者。必咽痛。
脉弦
滑者
（此太阳病。下之后。邪气传变。其脉促者。为阳盛。下后脉促。为阳胜阴也。故不作
结胸
后脉
嗌痛
少阳
脉细
传
于
胜
病在阳。应以汗解之。反以冷水 之。若灌之。其热被劫。不得去。弥更益烦。肉上粟
起。
小
（病在阳。为邪在表也。法当汗出而解。反以冷水 之。灌洗。热被寒水。外不得出。
则反
不渴
苓散
本以
以
文蛤散
文蛤（五两味咸寒）
（咸走肾。则可以胜水气。） 上一味为散。以沸汤和一钱匕服。汤用五合。
白散方
桔梗（三分味辛苦微温） 巴豆（一分去皮心熬黑研如脂辛温） 贝母（三分味辛苦平。）
（辛散而苦泄。桔梗、贝母之苦辛。用以下气。巴豆之辛。用以散实。） 上件三味。
为
末。
利。
以
上法
太阳与少阳并病。头项强痛。或眩冒。时如结胸。心下痞硬者。当刺大椎第一间。肺俞。
肝
（太阳之脉。络头下项。头项强痛者。太阳表病也。少阳之脉。循胸络胁。如结胸心下
痞硬
全入
邪。
损
谵语当止。若复不止。为少阳邪热甚也。刺期门以泻肝胆之气。）
妇人中风。发热恶寒。经水适来。得之七八日。热除而脉迟。身凉。胸胁下满。如结胸
状。
（中风。发热恶寒。表病也。若经水不来。表邪传里。则入腑。而不入血室也。因经水
适来
凉者
之募
妇人中风。七八日。续得寒热。发作有时。经水适断者。此为热入血室。其血必结。故
使如
（中风七八日。邪气传里之时。本无寒热。而续得寒热。经水适断者。此为表邪乘血室
虚。
有时
妇人伤寒。发热。经水适来。昼日明了。暮则谵语。如见鬼状者。此为热入血室。无犯
胃气
（伤寒发热者。寒已成热也。经水适来。则血室虚空。邪热乘虚入于血室。若昼日谵语。
为
争
小
无
而
门
。）
伤寒六七日。发热微恶寒。支节烦疼。微呕。心下支结。外证未去者。柴胡加桂枝汤主
之。
（伤寒六七日。邪当传里之时。支。散也。呕而心下结者。里证也。法当攻里。发热微
恶
寒
伤寒五六日。已发汗。而复下之。胸胁满。微结。小便不利。渴而不呕。但头汗出。往
来寒
（伤寒五六日。已经汗下之后。则邪当解。今胸胁满。微结。小便不利。渴而不呕。但
头汗
心烦
令小
余处
也。
柴胡桂枝干姜汤
柴胡（半斤苦平） 桂枝（三两去皮味辛热） 干姜（二两辛热） 栝蒌根（四两苦寒）
黄芩
（三
（内经曰。热淫于内。以苦发之。柴胡、黄芩之苦。以解传里之邪。辛甘发散为阳。桂
枝、
辛。
一斗
便愈。
为阳微结
必有表。复有里也。脉沉。亦在里也。汗出为阳微。假令纯阴结。不得复有外证。悉入
在里
故
（伤寒五六日。邪当传里之时。头汗出。微恶寒者。表仍未解也。手足冷。心下满。口
不欲
则热
皆至
汤已
伤寒五六日。呕而发热者。柴胡汤证具。而以他药下之。柴胡证仍在者。复与柴胡汤。
此虽
陷胸汤主之。但满而不痛者。此为痞。柴胡不中与之。宜半夏泻心汤。
（伤寒五六日。邪在半表半里之时。呕而发热。邪在半表半里之证。是为柴胡证具。以
他
里。
中。
痞。
因
半夏泻心汤
半夏（半升洗辛温） 黄芩（苦寒） 干姜（辛热） 人参（以上各三两甘温） 黄连
（一两苦
寒）
（辛入肺而散气。半夏之辛。以散结气。苦入心而泄热。黄芩、黄连之苦以泄痞热。脾
欲缓
去滓
太阳少阳并病。而反下之。成结胸。心下硬。下利不止。水浆不下。其人心烦。
（太阳、少阳并病。为邪气在半表半里也。而反下之。二经之邪。乘虚而入。太阳表邪
入里
饮食
脉浮而紧。而复下之。紧反入里。则作痞。按之自濡。但气痞耳。
（浮而紧。浮为伤阳。紧为伤阴。当发其汗。而反下之。若浮入里。为阳邪入里。则作
结胸
太阳中风。下利。呕逆。表解者。乃可攻之。其人 汗出。发作有时。头痛。心下痞
硬满
（下利呕逆。里受邪也。邪在里。可下。亦须待表解者。乃可攻之。其人 汗出。发
作有
而有
十枣汤
芫花（熬味辛苦） 甘遂（苦寒） 大戟（苦寒） 大枣（十枚擘甘温）
（辛以散之。芫花之辛。以散饮。苦以泄之。甘遂、大戟之苦。以泄水。水者。肾所主
也。
升
平
太阳病。医发汗。遂发热恶寒。因复下之。心下痞。表里俱虚。阴阳气并竭。无阳则阴
独。
（太阳病。因发汗。遂发热恶寒者。外虚阳气。邪复不除也。因复下之。又虚其里。表
中虚
为阴
肤肉
心下痞。按之濡。其脉关上浮者。大黄黄连泻心汤主之。
（心下硬。按之痛。脉关沉者。实热也。心下痞。按之濡。其脉关上浮者。虚热也。大
黄黄
大黄黄连泻心汤
大黄（二两味苦寒） 黄连（一两味苦寒）
（内经曰。火热受邪。心病生焉。苦入心。寒除热。大黄、黄连之苦寒。以导泻心下之
虚热
绞去
心下痞。而复恶寒。汗出者。附子泻心汤主之。
（心下痞者。虚热内伏也。恶寒汗出者。阳气外虚也。与泻心汤攻痞。加附子以固阳。）
本以下之。故心下痞。与泻心汤。痞不解。其人渴而口燥烦。小便不利者。五苓散主之。
（本因下后成痞。当与泻心汤除之。若服之痞不解。其人渴而口躁烦。小便不利者。为
水
者。
伤寒汗出。解之后。胃中不和。心下痞硬。干噫。食臭。胁下有水气。腹中雷鸣。下利
者。
（胃为津液之主。阳气之根。大汗出后。外亡津液。胃中空虚。客气上逆。心下痞硬。
金匮
腹中
伤寒中风。医反下之。其人下利。日数十行。谷不化。腹中雷鸣。心下痞硬而满。干呕。
心
上
（伤寒中风。是伤寒。或中风也。邪气在表。医反下之。虚其肠胃。而气内陷也。下利
日数
中空虚
生姜。此
伤寒服汤药。下利不止。心下痞硬。服泻心汤已。复以他药下之。利不止。医以理中与
之。
便。
（伤寒服汤药下后。利不止。而心下痞硬者。气虚而客气上逆也。与泻心汤攻之。则痞
已。
焦虚
所以
不分
赤石脂禹余粮汤方
赤石脂（一斤碎味甘温） 禹余粮（一斤碎味甘平）
（本草云。涩可去脱。石脂之涩。以收敛之。重可去怯。余粮之重。以镇固。） 以上
二
味。
伤寒吐下后。发汗。虚烦。脉甚微。八九日。心下痞硬。胁下痛。气上冲咽喉。眩冒。
经脉
（伤寒吐下后。发汗。则表里之气俱虚。虚烦。脉甚微。为正气内虚。邪气独在。至七
八日
邪气留结而不去。
伤寒发汗。若吐。若下。解后。心下痞硬。噫气不除者。旋复代赭石汤主之。
（大邪虽解。以曾发汗吐下。胃气弱而未和。虚气上逆。故心下痞硬。噫气不除。与旋
复代
旋复代赭石汤方
旋复花（三两味咸温） 人参（二两味甘温） 生姜（五两切味辛温） 代赭石（一两
味苦寒）
大
（硬则气坚，咸味可以 之。旋复之咸。以 痞硬。怯则气浮。重剂所以镇之。代赭之
重。
之甘。
日三服
下后。不可更行桂枝汤。若汗出而喘。无大热者。可与麻黄杏子甘草石膏汤。
（前第三卷。廿六证云。发汗后。不可更行桂枝汤。汗出而喘。无大热者。为与此证治
法同
下。若吐后
太阳病。外证未除。而数下之。遂协热而利。利下不止。心下痞硬。表里不解者。桂枝
人参
（外证未除。而数下之。为重虚其里。邪热乘虚而入。里虚协热。遂利不止。而心下痞。
若
攻
桂枝人参汤方
桂枝（四两去皮味辛热） 甘草（四两炙味甘平） 白术（三两味甘平） 干姜（三两
味辛热）
人
（表未解者。辛以散之。里不足者。甘以缓之。此以里气大虚。表里不解。故加桂枝、
甘草
升。
伤寒大下后。复发汗。心下痞。恶寒者。表未解也。不可攻痞。当先解表。表解。乃可
攻痞
（大下后。复发汗。则表里之邪当悉已。此心下痞而恶寒者。表里之邪俱不解也。因表
不解
之内
伤寒发热。汗出不解。心中痞硬。呕吐而下利者。大柴胡汤主之。
（伤寒发热。寒已成热也。汗出不解。表和而里病也。吐利。心腹濡 为里虚。呕吐而
下利
病如桂枝证。头不痛。项不强。寸脉微浮。胸中痞硬。气上冲咽喉。不得息者。此为胸
有寒
（病如桂枝证。为发热。汗出恶风。言邪在表也。头痛项强。为桂枝汤证具。若头不痛。
项
里
硬。
满
瓜蒂散方
瓜蒂（一分熬黄味苦寒） 赤小豆（一分味酸温）
（其高者越之。越以瓜蒂、香豉之苦。在上者涌之。以赤小豆之酸。内经曰。酸苦涌泄
为阴
作稀糜。
瓜蒂散。
（素有宿昔之积。结于胁下为痞。今因伤寒。邪气入里。与宿积相助使脏真之气。结而
不通
伤寒病。若吐。若下后。七八日不解。热结在里。表里俱热。时时恶风。大渴。舌上干
燥而
（若吐若下后。七八日则当解。复不解。而热结在里。表热者。身热也。里热者。内热
也。
热未
知表
未为
散热
问：疾病中有结胸证，有脏结证，它们的表现是什么样的？
答：按压胸部感到疼痛，寸脉浮，关脉沉，这叫做结胸证。
什么叫脏结证？
（结胸证，是邪气结聚在胸膈；脏结证，是邪气结聚在脏腑。这两种病都是因为误用下法后，邪气乘虚入里所致。）
脏结证没有阳证表现，不出现往来寒热，病人反而安静，舌苔滑润的，不可使用攻下法。
（脏结证，按治法应当攻下，但没有阳证，说明表无热象；不往来寒热，说明半表半里也无热象；病人反而安静，说明里没有实热病邪。）
疾病发于阳证，却反用下法，热邪内陷因而形成结胸证；疾病发于阴证，却反用下法，因而形成痞证。之所以形成结胸证，是因为误下导致……
（发热恶寒的，是发于阳证。如果反用下法，则表中的阳邪内陷，结聚于胸中，形成结胸证。无热恶寒的，是发于阴证……）
结胸证，颈部也僵硬，像柔痉病的症状一样，用下法治疗可以使病情缓解，宜用大陷胸丸方。
（结胸病出现颈项强硬的，是因为邪气结聚在胸中，胸膈间结满，心下部紧实，只能仰面而不能俯身，所以颈项强硬也像柔痉病……）
大陷胸丸方
大黄（半斤，味苦，性寒） 葶苈子（半升，炒制，味苦，性寒） 芒硝（半斤，味咸，性寒） 杏仁（半升，去皮尖，炒至变黑，味苦……）
（大黄、芒硝的苦咸之性，用来泻下热邪；葶苈子、杏仁的苦甘之性，用来泄除胀满；甘遂取其药力直达病所，白蜜取其……）
如弹丸大小……
如果不下来……
结胸证，如果脉象浮大的，不可攻下，攻下会导致死亡。
（结胸证，是邪气结聚在胸中，属于上焦部位。得到寸脉浮、关脉沉的脉象，说明病在里，则可以攻下。如果脉象浮大，……）
心……
结胸证的所有症状都具备，如果出现烦躁不安的，也是死证。
（结胸证的症状全部具备，说明邪气结聚已经很深了。烦躁不安，说明正气散乱。邪气胜过正气，病人必定死亡。）
太阳病，脉象浮而动数。浮脉主风，数脉主热，动脉主痛，数脉也主虚。头痛发热，微微盗汗……
气躁……
余……
（动数和数都是阳脉，应当责求邪气在表。睡时汗出，叫做盗汗，这是邪气在半表半里的表现，则不恶寒……）
乘虚……
浮脉独……
于胸膈……
懊憹，都是邪热为实，阳气内陷，气机不能通调于膈，壅滞于心下，形成硬满而痛，成为结胸证。给予大陷胸汤。
越……
大陷胸汤
大黄（六两，去皮，苦寒） 芒硝（一升，味咸寒） 甘遂（六钱匕，苦寒）
（大黄称为将军，以苦味荡涤肠胃；芒硝又名硝石，以其咸味能软坚散结。夫……遂字以通水也。甘遂……）
若夫……
升……
伤寒病六七天，结胸热实证，脉象沉而紧，心下部疼痛，按上去像石头一样硬的，用大陷胸汤主治。
（病在表而误用下法，热邪内陷因而形成结胸证。这里不说“下后”，而说“伤寒六七日”，则是邪气传入里部的实热证。沉脉……）
伤寒病十多天，热邪结聚在里，又出现往来寒热的，用大柴胡汤。只是结胸证，没有大热表现的，这是水饮结聚在胸胁……
（伤寒病十多天，热邪结聚在里，是可以攻下的证候。又出现往来寒热，是正邪分争，尚未完全敛结，用大柴胡汤……）
水饮……
以……
太阳病，重发汗，又反复攻下，五六天不大便，舌上干燥而且口渴，傍晚时分有轻微的潮热，从心下直到……少腹……
（重发汗而又攻下，导致内外津液严重耗伤，邪热内结，导致五六天不大便，舌上干燥而口渴。日晡……）
之中……
小结胸病，病位正在心下部，按压才疼痛，脉象浮滑的，用小陷胸汤主治。
（心下部硬痛，手不能靠近的，是结胸证。病位正在心下部，按压才疼痛，说明热气尚浅，叫做小结胸。……）
结胸……
小陷胸汤
黄连（一两，苦寒） 半夏（半升，洗，辛温） 栝蒌实（大者一个，苦寒）
（苦味可以泄降，辛味可以散结。黄连、栝蒌实的苦寒之性，用来泄热；半夏的辛味，用来散结。） 以上三味。
用水……
太阳病二三天，不能卧倒，只想起来，心下部必然结聚，脉象微弱的，这是因为原本就有寒饮停聚。反用下法，如果腹泻……停止……
（太阳病二三天，邪气在表。不能卧倒，只想起来，心下部必然结聚的，是因为心下部结满，卧下则气机壅滞而……更甚……）
分……
至次……
太阳病，误用下法，脉象促的，不形成结胸证的，这是病欲解的表现。脉象浮的，一定会形成结胸证。脉象紧的，一定会咽痛。脉象弦……滑的……
（这是太阳病，下法之后，邪气传变。脉象促的，是阳盛。下后脉促，是阳胜阴退。所以不形成……结胸……）
后脉……
嗌痛……
少阳……
脉细……
传……
于……
胜……
病在阳证，应该用汗法解表，反用冷水喷洒或灌洗它，热邪被寒水遏制，不能散发，更加烦闷，皮肤上起粟粒状……
小……
（病在阳证，是邪气在表，治法应当出汗而解。反用冷水喷洒或灌洗，热邪被寒水所束，外不得出，……反而……）
不渴……
苓散……
本以……
以……
文蛤散
文蛤（五两，味咸寒）
（咸味入肾，则可以胜水气。） 以上一味研为散，用沸水调和一钱匕服用。汤用量五合。
白散方
桔梗（三分，味辛苦，微温） 巴豆（一分，去皮心，炒黑研如脂，辛温） 贝母（三分，味辛苦，平。）
（辛能发散，苦能泄降。桔梗、贝母的辛苦之性，用来下气；巴豆的辛味，用来散实邪。） 以上三味。
为……
末……
利……
以……
上法……
太阳病与少阳病并病，头项强硬疼痛，有时眩晕昏冒，有时像结胸证，心下部痞塞坚硬，应当针刺大椎第一间穴、肺俞穴、肝……
（太阳经脉，络头下项，头项强硬疼痛，是太阳表病。少阳经脉，循行胸胁，像结胸心下……痞硬……）
全入……
邪……
损……
谵语应当停止，如果再不停止，是少阳邪热太盛。针刺期门穴以泻肝胆之气。）
妇人中风，发热恶寒，月经适来，得病七八天，热退而脉迟，身体凉，胸胁下满，像结胸……状……
（中风，发热恶寒，是表病。如果月经不来，表邪传里，则入腑，而不入血室。因为月经适来……）
凉者……
之募……
妇人中风，七八天，持续出现寒热，发作有定时，月经适断，这是热入血室。其血必结，所以使……
（中风七八天，是邪气传里的时机。本来无寒热，而持续出现寒热，月经适断，这是表邪乘血室……虚……）
有时……
妇人伤寒，发热，月经适来，白天神志清楚，晚上则谵语，像看见鬼怪一样的，这是热入血室。不要侵犯胃气……
（伤寒发热，寒邪已化为热。月经适来，则血室空虚，邪热乘虚进入血室。如果白天谵语，……）
争……
小……
无……
而……
门……
伤寒六七天，发热轻微恶寒，四肢关节烦疼，轻微呕吐，心下部两侧有结聚感，外证未去的，用柴胡加桂枝汤主治。
（伤寒六七天，邪气当传里的时机。支，指散漫。呕而心下部结聚，是里证。治法应当攻里。发热轻微……恶……寒……）
伤寒五六天，已经发汗，又反复攻下，胸胁满闷，轻微结聚，小便不利，口渴但不呕吐，只有头部汗出，往来寒……
（伤寒五六天，已经经过汗下之后，邪气应当解除。现在胸胁满闷，轻微结聚，小便不利，口渴但不呕吐，只有……头汗……）
心烦……
令小……
余处……
也……
柴胡桂枝干姜汤
柴胡（半斤，苦平） 桂枝（三两，去皮，味辛热） 干姜（二两，辛热） 栝蒌根（四两，苦寒）
黄芩……
（三……）
（《内经》说：热淫于内，以苦发之。柴胡、黄芩的苦味，用来解除传入里部的邪气。辛甘发散为阳，桂枝……）
辛……
一斗……
便愈……
为阳微结……
必有表，复有里也。脉沉，也在里。汗出为阳微。假如是纯阴结，不得再有外证，悉入……在里……
故……
（伤寒五六天，邪气当传里的时机。头汗出，轻微恶寒的，表仍未解。手足冷，心下部满，口……不欲……）
则热……
皆至……
汤已……
伤寒五六天，呕吐且发热的，柴胡汤证具备，却用其他药物攻下。柴胡证仍在的，再给予柴胡汤。这虽然……
陷胸汤主治。但只满闷而不疼痛的，这叫痞证。柴胡汤不适合用它，宜用半夏泻心汤。
（伤寒五六天，邪气在半表半里的时机。呕吐且发热，是邪在半表半里的证候，这叫柴胡证具备。用……他……）
里……
中……
痞……
因……
半夏泻心汤
半夏（半升，洗，辛温） 黄芩（苦寒） 干姜（辛热） 人参（以上各三两，甘温） 黄连（一两，苦……寒）
（辛入肺而散气，半夏的辛味，用来散结气。苦入心而泄热，黄芩、黄连的苦味，用来泄痞热。脾……欲缓……）
去滓……
太阳少阳并病，反而误用下法，形成结胸，心下部硬，腹泻不止，水浆不进，其人心中烦乱。
（太阳、少阳并病，是邪气在半表半里。反而误用下法，两经之邪，乘虚而入。太阳表邪……入里……）
饮食……
脉浮而紧，又误用下法，紧脉反入里，则形成痞证。按之柔软，只是气痞而已。
（浮而紧，浮为伤阳，紧为伤阴。应当发汗，反而误用下法。如果浮脉入里，是阳邪入里，则形成……结胸……）
太阳中风，伴有腹泻，呕吐逆气，表证已解的，才可以攻下。其人……汗出，发作有定时，头痛，心下部痞……硬满……
（腹泻呕吐逆气，是里受邪。邪在里，可下，但也须等待表证解除后，才可以攻下。其人……汗出，发……作有……）
而有……
十枣汤
芫花（炒，味辛苦） 甘遂（苦寒） 大戟（苦寒） 大枣（十枚，掰开，甘温）
（辛以散之，芫花的辛味，用来散水饮。苦以泄之，甘遂、大戟的苦味，用来泄水。水，是肾所主……也……）
升……
平……
太阳病，医生发汗，于是发热恶寒，又反复攻下，心下部痞塞，表里俱虚，阴阳之气都衰竭，无阳则阴……独……
（太阳病，因发汗，于是发热恶寒，是外虚阳气，邪气未除。又反复攻下，又虚其里，表……中虚……）
为阴……
肤肉……
心下部痞塞，按之柔软，脉象关上浮的，用大黄黄连泻心汤主治。
（心下部硬，按之痛，脉关沉的，是实热。心下部痞塞，按之柔软，脉象关上浮的，是虚热。大……黄黄……）
大黄黄连泻心汤
大黄（二两，味苦寒） 黄连（一两，味苦寒）
（《内经》说：火热受邪，心病生焉。苦入心，寒除热。大黄、黄连的苦寒之性，用来导泻心下部之……虚热……）
绞去……
心下部痞塞，又恶寒、汗出的，用附子泻心汤主治。
（心下部痞塞，是虚热内伏。恶寒汗出，是阳气外虚。给予泻心汤攻痞，加附子以固护阳气。）
本因误下导致心下部痞塞，给予泻心汤，痞塞不解。其人口渴且口燥烦，小便不利的，用五苓散主治。
（本因下法后成痞，应当用泻心汤消除。如果服药后痞塞不解，其人口渴且口燥烦，小便不利的，是……水……）
者……
伤寒汗出，病解之后，胃中不和，心下部痞硬，干噫食臭，胁下有水气，腹中雷鸣，腹泻……的……
（胃为津液之主，阳气之根。大汗出后，外亡津液，胃中空虚，客气上逆，心下部痞硬。……金匮……）
腹中……
伤寒中风，医生反而误用下法，其人腹泻，一天几十次，完谷不化，腹中雷鸣，心下部痞硬而满，干呕……心……
上……
（伤寒中风，是指伤寒，或者中风。邪气在表，医生反而误用下法，虚其肠胃，而气内陷。腹泻……日数……）
中空虚……
生姜，此……
伤寒服汤药，腹泻不止，心下部痞硬，服泻心汤后，又用其他药物攻下，利不止。医生用理中汤……
便……
（伤寒服汤药下后，利不止，而心下部痞硬，是气虚而客气上逆。与泻心汤攻之，则痞……已……）
焦虚……
所以……
不分……
赤石脂禹余粮汤方
赤石脂（一斤，捣碎，味甘温） 禹余粮（一斤，捣碎，味甘平）
（《本草》说：涩可去脱，石脂之涩，用来收敛。重可去怯，余粮之重，用来镇固。） 以上……二……
味……
伤寒吐下后，发汗，虚烦，脉象非常微弱，八九天，心下部痞硬，胁下痛，气上冲咽喉，眩晕昏冒……经脉……
（伤寒吐下后，发汗，则表里之气都虚。虚烦，脉象非常微弱，是正气内虚，邪气独在。到七……八日……）
邪气留结而不去……
伤寒发汗，或者吐，或者下，病解后，心下部痞硬，嗳气不除的，用旋复代赭石汤主治。
（大邪虽解，但因为曾经过汗吐下，胃气弱而未和，虚气上逆，所以心下部痞硬，嗳气不除。给予旋……复代……）
旋复代赭石汤方
旋复花（三两，味咸温） 人参（二两，味甘温） 生姜（五两，切，味辛温） 代赭石（一两……味苦寒）
大……
（硬则气坚，咸味可以软之。旋复之咸，用来……痞硬。怯则气浮，重剂所以镇之。代赭之……重……）
之甘……
日三服……
下法后，不可再用桂枝汤。如果汗出且喘，没有大热的，可以与麻黄杏子甘草石膏汤。
（前第三卷，二十六证云：发汗后，不可再用桂枝汤。汗出而喘，无大热的，与此证治……法同……）
下。若吐后……
太阳病，外证未除，而多次攻下，遂协热而利，腹泻不止，心下部痞硬，表里不解的，用桂枝……人参……
（外证未除，而多次攻下，是重伤其里，邪热乘虚而入，里虚协热，遂腹泻不止，而心下部痞……）
若……
攻……
桂枝人参汤方
桂枝（四两，去皮，味辛热） 甘草（四两，炙，味甘平） 白术（三两，味甘平） 干姜（三两……味辛热）
人……
（表未解者，辛以散之。里不足者，甘以缓之。此因里气大虚，表里不解，故加桂枝、……甘草……）
升……
伤寒大下后，又发汗，心下部痞塞，恶寒的，表未解。不可攻痞，应当先解表。表解后，才可以……攻痞……
（大下后，又发汗，则表里之邪应当都已解除。此心下部痞而恶寒的，是表里之邪都不解。因表……不解……）
之内……
伤寒发热，汗出不解，心中痞硬，呕吐且腹泻的，用大柴胡汤主治。
（伤寒发热，寒已化为热。汗出不解，表和而里病。吐利，心腹濡……为里虚。呕吐而……下利……）
病像桂枝证，头不痛，项不强，寸脉微浮，胸中痞硬，气上冲咽喉，呼吸困难的，这是胸中……有寒……
（病像桂枝证，是发热，汗出恶风，言邪在表。头痛项强，是桂枝汤证具备。如果头不痛，……项……）
里……
硬……
满……
瓜蒂散方
瓜蒂（一分，炒黄，味苦寒） 赤小豆（一分，味酸温）
（其高者越之，越以瓜蒂、香豉之苦。在上者涌之，以赤小豆之酸。《内经》说：酸苦涌泄……为阴……）
作稀糜……
瓜蒂散……
（素有宿昔之积，结于胁下为痞。今因伤寒，邪气入里，与宿积相助，使脏真之气，结而……不通……）
伤寒病，如果吐，如果下后，七八天不解，热结在里，表里俱热，时时恶风，大渴，舌上干……燥而……
（如果吐如果下后，七八天则应当解。复不解，而热结在里，表热者，身热也。里热者，内热……也……）
热未……
知表……
未为……
散热……
Question: In disease, there is Jie Xiong (Chest Binding) and Zang Jie (Organ Binding). What are their manifestations?
Answer: Tenderness upon palpation of the chest, with a floating pulse at the Cun (inch) position and a deep pulse at the Guan (middle) position, is called Jie Xiong (Chest Binding).
What is meant by Zang Jie (Organ Binding)?
(Jie Xiong (Chest Binding) refers to pathogenic factors binding in the chest; Zang Jie (Organ Binding) refers to pathogenic factors binding in the organs. Both conditions result from pathogenic factors entering the interior due to deficiency after improper purgation. The pathogenic factors enter the interior after purgation.)
Zang Jie (Organ Binding) presents without Yang syndrome signs, without alternating chills and fever, the patient appears unusually quiet, and the tongue coating is slippery. This condition must not be treated with purgation.
(Zang Jie (Organ Binding), according to treatment principles, should be purged. However, the absence of Yang syndrome indicates no heat in the exterior; the absence of alternating chills and fever indicates no heat in the half-exterior/half-interior; the patient's unusual quietness indicates no excess pathogenic factor in the interior.)
When a disease originates from a Yang syndrome but is incorrectly treated with purgation, heat enters inward and forms Jie Xiong (Chest Binding); when a disease originates from a Yin syndrome but is incorrectly treated with purgation, Pi Syndrome (Epigastric Fullness) forms. The reason Jie Xiong (Chest Binding) forms is due to...
(Fever and aversion to cold indicate origin from Yang syndrome. If purgation is incorrectly applied, Yang pathogenic factors from the exterior sink inward, binding in the chest to form Jie Xiong (Chest Binding). Absence of fever with aversion to cold indicates origin from Yin syndrome...)
Jie Xiong (Chest Binding) may present with stiffness in the neck, resembling Rou Ji (Soft Spasm). Purging can relieve the condition. Da Xian Xiong Wan (Major Draining Chest Pill) is indicated.
(Stiffness in the neck and head in Jie Xiong (Chest Binding) occurs because pathogenic factors bind in the chest, causing fullness and congestion in the chest and diaphragm, and tightness in the epigastrium. The patient can only lie supine and cannot bend forward, hence the neck stiffness resembles Rou Ji (Soft Spasm)... )
Da Xian Xiong Wan (Major Draining Chest Pill) Formula
Da Huang (Rhei Radix et Rhizoma, 8 liang, bitter, cold) Ting Li Zi (Lepidii Semen, 0.5 sheng, stir-fried, bitter, cold) Mang Xiao (Natrii Sulfas, 8 liang, salty, cold) Xing Ren (Armeniacae Semen Amarum, 0.5 sheng, skin and tip removed, stir-fried until dark, bitter...)
(The bitter and salty properties of Da Huang (Rhei Radix et Rhizoma) and Mang Xiao (Natrii Sulfas) purge heat; the bitter and sweet properties of Ting Li Zi (Lepidii Semen) and Xing Ren (Armeniacae Semen Amarum) drain fullness; Gan Sui (Kansui Radix) is used for its direct action, and Bai Mi (Honey) serves to...)
Size like a bean...
If not discharged...
In Jie Xiong (Chest Binding), if the pulse is floating and large, purgation is contraindicated; purging will lead to death.
(Jie Xiong (Chest Binding) involves pathogenic factors binding in the chest, belonging to the Upper Jiao. A floating pulse at the Cun (inch) and deep pulse at the Guan (middle) indicate the pathology is in the interior, allowing for purgation. If the pulse is floating and large...)
Heart...
If all symptoms of Jie Xiong (Chest Binding) are present and the patient becomes irritable/restless, it is a fatal sign.
(All symptoms of Jie Xiong (Chest Binding) being present indicates deep binding of pathogenic factors. Irrability/restlessness indicates dispersion of healthy Qi. When pathogenic factors overcome healthy Qi, the patient will die.)
Tai Yang Disease (Tai Yang Disorder) presenting with a floating, moving, and rapid pulse. Floating indicates Wind, Rapid indicates Heat, Moving indicates Pain, and Rapid also indicates Deficiency. Headache, fever, and slight night sweats...
Restless Qi...
Remaining...
(Moving and Rapid pulses are both Yang pulses, indicating pathogenic factors should be sought in the exterior. Sweating during sleep is called Dao Han (Night Sweat), indicating pathogenic factors in the half-exterior/half-interior, thus there is no aversion to cold...)
Taking advantage of deficiency...
Floating pulse alone...
At the chest and diaphragm...
Ao Nao (Oppressive restlessness) indicates excess of pathogenic heat, sinking of Yang Qi into the interior, obstruction of Qi flow in the diaphragm, congestion in the epigastrium, leading to hardness, fullness, and pain, forming Jie Xiong (Chest Binding). Give Da Xian Xiong Tang (Major Draining Chest Decoction).
Surpass...
Da Xian Xiong Tang (Major Draining Chest Decoction)
Da Huang (Rhei Radix et Rhizoma, 6 liang, peeled, bitter, cold) Mang Xiao (Natrii Sulfas, 1 sheng, salty, cold) Gan Sui (Kansui Radix, 6 qian bi, bitter, cold)
(Da Huang (Rhei Radix et Rhizoma) is called the General, using bitterness to cleanse; Mang Xiao (Natrii Sulfas), also known as Xiao Shi (Nitrum), uses saltiness to soften hardness. Fu Jian Sui implies unblocking water. Gan Sui (Kansui Radix)...)
If Fu...
Ascend...
After six or seven days of Shang Han (Cold Damage), presenting with Jie Xiong (Chest Binding) characterized by heat and excess, a deep and tight pulse, pain in the epigastrium, and hardness upon palpation like stone, Da Xian Xiong Tang (Major Draining Chest Decoction) is the primary treatment.
(Pathology in the exterior treated with purgation causes heat to sink inward forming Jie Xiong (Chest Binding). Here, "after purgation" is not mentioned, but "six or seven days of Shang Han (Cold Damage)" is, indicating transmitted interior excess heat. Deep pulse...)
After ten-plus days of Shang Han (Cold Damage), with heat binding in the interior and recurring alternating chills and fever, Da Chai Hu Tang (Minor Bupleurum Decoction) is given. In cases of pure Jie Xiong (Chest Binding) without significant heat, this indicates Water Binding in the chest and hypochondrium...
(Shang Han (Cold Damage) lasting ten-plus days with heat binding in the interior is an indication for purgation. Recurring alternating chills and fever indicate struggle between healthy Qi and pathogenic factors, not yet fully consolidated. Da Chai Hu Tang (Minor Bupleurum Decoction) is given...)
Water Drink...
To...
Tai Yang Disease (Tai Yang Disorder), subjected to heavy sweating and repeated purgation, resulting in constipation for five to six days, dry tongue with thirst, and slight afternoon tidal fever, extending from the epigastrium to the lower abdomen...
(Heavy sweating followed by purgation severely depletes fluids internally and externally, causing pathogenic heat to bind inward, leading to constipation for five to six days, dry tongue, and thirst. Ri Bu (Afternoon)... )
Middle...
Xiao Jie Xiong Bing (Minor Chest Binding Disease) is located precisely in the epigastrium, painful only upon pressure, with a floating and slippery pulse. Xiao Xian Xiong Tang (Minor Draining Chest Decoction) is the primary treatment.
(Hardness and pain in the epigastrium, intolerable to touch, is Jie Xiong (Chest Binding). Location precisely in the epigastrium, painful only upon pressure, indicates shallow heat, termed Xiao Jie Xiong Bing (Minor Chest Binding Disease)... )
Chest Binding...
Xiao Xian Xiong Tang (Minor Draining Chest Decoction)
Huang Lian (Coptidis Rhizoma, 1 liang, bitter, cold) Ban Xia (Pinelliae Rhizoma, 0.5 sheng, washed, acrid, warm) Gua Lou Shi (Trichosanthis Fructus, one large fruit, bitter, cold)
(Bitterness drains, Acridity disperses. Huang Lian (Coptidis Rhizoma) and Gua Lou Shi (Trichosanthis Fructus) use bitterness and cold to drain heat; Ban Xia (Pinelliae Rhizoma) uses acridity to disperse binding.) Three ingredients above.
With water...
Two to three days into Tai Yang Disease (Tai Yang Disorder), inability to lie down, desire to rise, inevitable binding in the epigastrium, with a weak pulse, indicates pre-existing Cold Fluid retention. Incorrect purgation, if diarrhea... stops...
(Tai Yang Disease (Tai Yang Disorder) for two to three days means pathogens are in the exterior. Inability to lie down, desire to rise, and inevitable binding in the epigastrium occur because epigastric fullness worsens lying down due to Qi stagnation... more severe...)
Fluid...
Next...
In Tai Yang Disease (Tai Yang Disorder), after incorrect purgation, if the pulse is Cu (Crescendo/Intermittent) and Jie Xiong (Chest Binding) does not form, the disease is resolving. If the pulse is floating, Jie Xiong (Chest Binding) will definitely form. If the pulse is tight, throat pain will definitely occur. If the pulse is Xuan (Wiry)... Slippery...
(This is Tai Yang Disease (Tai Yang Disorder) after purgation, with pathogenic transmission. A Cu (Crescendo/Intermittent) pulse indicates Excess Yang. Post-purgation Cu pulse indicates Yang overcoming Yin. Thus, no... Jie Xiong (Chest Binding)... )
Post-pulse...
Ai Tong (Throat Pain)...
Shao Yang (Lesser Yang)...
Fine Pulse...
Transmission...
At...
Overcome...
Pathology in Yang syndrome should be resolved via sweating. Incorrectly spraying or washing with cold water traps the heat, preventing release, causing increased irritability and gooseflesh on the skin...
Small...
(Pathology in Yang syndrome means pathogens are in the exterior; the method should be sweating to resolve. Incorrectly spraying or washing with cold water binds the heat externally, preventing release, ... conversely...)
No thirst...
Ling San...
Originally...
To...
Wen Sha San (Clam Shell Powder)
Wen Sha (Mercurii Carbonas, 5 liang, salty, cold)
(Salty enters the Kidney, thereby overcoming Water Qi.) One ingredient above, ground into powder. Mix one qian bi with boiling water (5 he).
Bai San (White Powder) Formula
Jie Geng (Platycodonis Radix, 3 fen, acrid-bitter, slightly warm) Ba Dou (Crotonis Fructus, 1 fen, skin and heart removed, stir-fried black, ground to paste, acrid, warm) Bei Mu (Fritillariae Bulbus, 3 fen, acrid-bitter, neutral.)
(Acrid disperses, Bitter drains. The acrid-bitter nature of Jie Geng (Platycodonis Radix) and Bei Mu (Fritillariae Bulbus) directs Qi downward; the acrid nature of Ba Dou (Crotonis Fructus) disperses excess.) Three ingredients above.
As...
Powder...
Diarrhea...
By...
Above methods...
Tai Yang Disease (Tai Yang Disorder) combined with Shao Yang Disease (Shaoyang Disorder) presents with stiffness and pain in the head and neck, occasional dizziness or vertigo, occasional sensation of chest binding, and epigastric fullness/hardness. Acupuncture at Dayui (DU-14), Feishu (BL-13), and Ganshu (BL-18) is indicated.
(The Tai Yang meridian connects the head and neck; stiffness and pain indicate Tai Yang exterior pathology. The Shao Yang meridian courses through the chest and flanks; sensation of chest binding and epigastric... fullness/hardness...)
Complete entry...
Pathogen...
Damage...
Delirium should cease. If it continues, Shao Yang pathogenic heat is excessive. Qimen (LR-14) is needled to drain Liver and Gallbladder Qi.)
A woman with Feng Zhong (Wind Strike) presents with fever and aversion to cold. Her menses arrive. After seven to eight days, the fever subsides, pulse becomes slow, body cools, hypochondriac fullness occurs, resembling Jie Xiong (Chest Binding)... shape...
(Feng Zhong (Wind Strike) with fever and aversion to cold is exterior pathology. If menses had not arrived, exterior pathogens would transmit inward to the Fu organs, not entering the Blood Chamber. Because menses arrived...)
Cool...
Mu (Acupoint)...
A woman with Feng Zhong (Wind Strike), after seven to eight days, develops recurring chills and fever at specific times, and her menses stop. This is Re Ru Xue Shi (Heat Entering the Blood Chamber). The blood must be bound, thus causing...
(Feng Zhong (Wind Strike) for seven to eight days is the time for pathogenic transmission. Originally no chills or fever, but recurring chills and fever with stopped menses indicate exterior pathogens taking advantage of Blood Chamber... deficiency...)
Specific times...
A woman with Shang Han (Cold Damage) has fever and her menses arrive. She is clear-headed during the day but delirious at night, seeing ghosts. This is Re Ru Xue Shi (Heat Entering the Blood Chamber). Do not violate Stomach Qi...
(Shang Han (Cold Damage) with fever indicates Cold has transformed to Heat. Menses arrival means the Blood Chamber is empty; pathogenic heat enters vacantly. If delirious during the day...)
Struggle...
Small...
No...
And...
Men (Gate)...
Six to seven days into Shang Han (Cold Damage), slight fever and aversion to cold, vexing pain in limbs and joints, slight vomiting, partial binding in the epigastrium, with exterior signs unresolved, Chai Hu Jia Gui Zhi Tang (Bupleurum plus Cinnamon Twig Decoction) is indicated.
(Six to seven days into Shang Han (Cold Damage) is when pathogens transmit inward. Zhi (Branch/Partial) indicates scattering. Vomiting and epigastric binding are interior signs. Treatment should attack the interior. Slight fever... aversion... cold...)
Five to six days into Shang Han (Cold Damage), after sweating and repeated purgation, chest and hypochondriac fullness, slight binding, difficulty urinating, thirst without vomiting, only head sweating, recurring chills...
(Five to six days into Shang Han (Cold Damage), after sweating and purgation, pathogens should resolve. Now chest/hypochondriac fullness, slight binding, difficulty urinating, thirst without vomiting, only... head sweat...)
Vexation...
Make small...
Other places...
Yes...
Chai Hu Gui Zhi Gan Jiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction)
Chai Hu (Bupleuri Radix, 8 liang, bitter, neutral) Gui Zhi (Cinnamomi Ramulus, 3 liang, peeled, acrid, hot) Gan Jiang (Zingiberis Rhizoma, 2 liang, acrid, hot) Gua Lou Gen (Trichosanthis Radix, 4 liang, bitter, cold)
Huang Qin (Scutellariae Radix...)
(Three...)
(The Nei Jing states: For heat rampant within, use bitter to vent. The bitterness of Chai Hu (Bupleuri Radix) and Huang Qin (Scutellariae Radix) resolves transmitted interior pathogens. Acrid and Sweet disperse for Yang. Gui Zhi (Cinnamomi Ramulus)...)
Acrid...
One dou...
Then cured...
As Yang Minor Binding...
There must be exterior, and also interior. Pulse deep, also in the interior. Sweating indicates minor Yang. If it were pure Yin Binding, there would be no exterior signs, all entering... in the interior...
Therefore...
(Five to six days into Shang Han (Cold Damage) is when pathogens transmit inward. Head sweating and slight aversion to cold mean the exterior is unresolved. Cold hands and feet, epigastric fullness, mouth... not desiring...)
Then heat...
All arrive...
Decoction taken...
Five to six days into Shang Han (Cold Damage), vomiting and fever indicate Chai Hu Tang (Bupleurum Decoction) syndrome is present, but other drugs were used for purgation. If Chai Hu syndrome persists, give Chai Hu Tang again. Although this...
Xian Xiong Tang (Draining Chest Decoction) is indicated. But if there is fullness without pain, it is Pi Syndrome (Epigastric Fullness). Chai Hu Tang is not appropriate; Ban Xia Xie Xin Tang (Pinellia Decoct to Drain the Epigastrium) is suitable.
(Five to six days into Shang Han (Cold Damage) is when pathogens are in the half-exterior/half-interior. Vomiting and fever are signs of pathogens in the half-exterior/half-interior, constituting Chai Hu syndrome. Using... other...)
Interior...
Middle...
Pi (Fullness)...
Because...
Ban Xia Xie Xin Tang (Pinellia Decoct to Drain the Epigastrium)
Ban Xia (Pinelliae Rhizoma, 0.5 sheng, washed, acrid, warm) Huang Qin (Scutellariae Radix, bitter, cold) Gan Jiang (Zingiberis Rhizoma, acrid, hot) Ren Shen (Ginseng Radix, 3 liang each above, sweet, warm) Huang Lian (Coptidis Rhizoma, 1 liang, bitter... cold)
(Acrid enters Lung and disperses Qi; Ban Xia's acridity disperses binding Qi. Bitter enters Heart and drains heat; Huang Qin and Huang Lian's bitterness drains Pi heat. Spleen... desires relaxation...)
Remove dregs...
Tai Yang Disease (Tai Yang Disorder) combined with Shao Yang Disease (Shaoyang Disorder), incorrectly treated with purgation, results in Jie Xiong (Chest Binding), epigastric hardness, continuous diarrhea, inability to take food/fluids, and mental restlessness.
(Tai Yang and Shao Yang combined pathology means pathogens are in the half-exterior/half-interior. Incorrect purgation allows pathogens from both meridians to enter vacantly. Tai Yang exterior pathogens... enter interior...)
Diet...
Pulse floating and tight, followed by purgation, the tight pulse enters the interior, forming Pi Syndrome (Epigastric Fullness). Palpation reveals softness, indicating merely Qi Pi (Qi Fullness).
(Floating and tight: floating injures Yang, tight injures Yin. Sweating should be induced, but purgation was incorrectly used. If floating pulse enters interior, Yang pathogen enters interior, forming... Jie Xiong (Chest Binding)... )
Tai Yang Feng Zhong (Wind Strike) with diarrhea and vomiting/reversal. If exterior signs are resolved, purgation can proceed. The patient... sweats, attacks occur at specific times, headache, epigastric Pi... hardness/fullness...
(Diarrhea and vomiting/reversal indicate interior pathogen. Pathogen in interior can be purged, but must wait for exterior resolution before attacking. The patient... sweats, at... tacks have...)
And have...
Shi Zao Tang (Ten Jujubes Decoction)
Yuan Hua (Genkwa Flos, stir-fried, acrid-bitter) Gan Sui (Kansui Radix, bitter, cold) Da Ji (Euphorbiae Pekinensis Radix, bitter, cold) Da Zao (Ziziphi Jujubae Fructus, 10 fruits, split, sweet, warm)
(Acrid disperses; Yuan Hua's acridity disperses fluid retention. Bitter drains; Gan Sui and Da Ji's bitterness drains water. Water is governed by the Kidney... yes...)
Ascend...
Peaceful...
Tai Yang Disease (Tai Yang Disorder), doctor induces sweating, resulting in fever and aversion to cold, then repeatedly purges, causing epigastric Pi (Fullness). Exterior and interior are both deficient, Yin and Yang Qi are exhausted. No Yang means Yin stands alone.
(Tai Yang Disease (Tai Yang Disorder), due to sweating, resulting in fever and aversion to cold, indicates external deficiency of Yang Qi, pathogens remain. Repeated purgation further deficiences the interior, exterior... middle deficiency...)
As Yin...
Skin flesh...
Epigastric Pi (Fullness), soft upon palpation, with floating pulse at the Guan (middle) position, is treated with Da Huang Huang Lian Xie Xin Tang (Rhubarb and Coptis Decoct to Drain the Epigastrium).
(Epigastriac hardness and pain with deep Guan pulse indicate Excess Heat. Epigastric Pi (Fullness), soft upon palpation, with floating Guan pulse, indicates Deficient Heat. Da... Huang Huang...)
Da Huang Huang Lian Xie Xin Tang (Rhubarb and Coptis Decoct to Drain the Epigastrium)
Da Huang (Rhei Radix et Rhizoma, 2 liang, bitter, cold) Huang Lian (Coptidis Rhizoma, 1 liang, bitter, cold)
(The Nei Jing states: Fire-heat receives pathogen, Heart disease arises. Bitter enters Heart, Cold removes heat. The bitter-cold nature of Da Huang (Rhei Radix et Rhizoma) and Huang Lian (Coptidis Rhizoma) guides out Deficient Heat in the epigastrium...)
Squeeze and remove...
Epigastric Pi (Fullness) accompanied by aversion to cold and sweating is treated with Fu Zi Xie Xin Tang (Aconite Decoct to Drain the Epigastrium).
(Epigastriac Pi (Fullness) indicates internal latent Deficient Heat. Aversion to cold and sweating indicate external deficiency of Yang Qi. Use Xie Xin Tang to drain Pi (Fullness), add Fu Zi (Aconiti Lateralis Radix Praeparata) to secure Yang.)
Originally caused by purgation, leading to epigastric Pi (Fullness). Given Xie Xin Tang (Draining Epigastrium Decoction), but Pi (Fullness) does not resolve. Patient has thirst, dry mouth, restlessness, and difficulty urinating. Wu Ling San (Five-Ingredient Powder with Poria) is indicated.
(Originally Pi (Fullness) formed after purgation, should be treated with Xie Xin Tang to eliminate. If Pi (Fullness) does not resolve after taking it, and patient has thirst, dry mouth/restlessness, difficulty urinating, it is... Water...)
Person...
After Shang Han (Cold Damage) sweating resolves, stomach harmony is disrupted, epigastric Pi (Fullness) and hardness, dry belching with food odor, Water Qi under the flanks, borborygmus in the abdomen, diarrhea... of...
(Stomach is master of Jin Ye (Body Fluids), root of Yang Qi. After heavy sweating, external loss of fluids leaves Stomach empty, rebellious Qi ascends, causing epigastric Pi (Fullness) and hardness. ... Jin Kui...)
Abdomen...
Shang Han (Cold Damage) or Feng Zhong (Wind Strike), doctor incorrectly purges. Patient has diarrhea dozens of times daily, undigested food, borborygmus, epigastric Pi (Fullness) and fullness, dry vomiting... Heart...
Up...
(Shang Han (Cold Damage) or Feng Zhong (Wind Strike) refers to Cold Damage or Wind Strike. Pathogens in exterior, doctor incorrectly purges, damaging Spleen/Stomach, Qi sinks inward. Diarrhea... daily number...)
Empty center...
Sheng Jiang (Zingiberis Rhizoma Recens), this...
Shang Han (Cold Damage) patient takes herbal medicine, diarrhea continues, epigastric Pi (Fullness) and hardness. After taking Xie Xin Tang (Draining Epigastrium Decoction), other purgatives are used, diarrhea continues. Doctor uses Li Zhong Tang (Regulate the Middle Decoction)...
Stool...
(Shang Han (Cold Damage) post-medication purgation, continuous diarrhea and epigastric Pi (Fullness) and hardness indicate Qi deficiency and rebellious Qi. Xie Xin Tang (Draining Epigastrium Decoction) attacks, then Pi... resolved...)
Burnt deficiency...
Therefore...
Not divided...
Chi Shi Zhi Yu Yi Liang Tang (Red Halloysite and Metalaugite Decoction) Formula
Chi Shi Zhi (Halloysitum Rubrum, 1 jin, crushed, sweet, warm) Yu Yi Liang (Metalaugites Sum, 1 jin, crushed, sweet, neutral)
(The Ben Cao states: Astringency removes slipping; Chi Shi Zhi's astringency consolidates. Heaviness calms fright; Yu Yi Liang's heaviness stabilizes.) Above... two...
Ingredients...
After Shang Han (Cold Damage) vomiting and purgation, followed by sweating, causing Xu Fan (Deficient Vexation), very faint pulse. After eight to nine days, epigastric Pi (Fullness) and hardness, hypochondriac pain, Qi rushing to throat, dizziness... Meridians...
(Shang Han (Cold Damage) post-vomit/purge/sweating means exterior and interior Qi are both deficient. Xu Fan (Deficient Vexation) and very faint pulse indicate internal deficiency of healthy Qi, pathogen remains alone. By seven... eight days...)
Pathogen stays bound and does not leave...
After Shang Han (Cold Damage) sweating, vomiting, or purgation, resolution occurs, but epigastric Pi (Fullness) and hardness persist, with incessant belching. Xuan Fu Dai Zhe Shi Tang (Inula and Hematite Decoction) is indicated.
(Major pathogens resolved, but due to prior sweating/vomit/purge, Stomach Qi is weak and unharmonized, deficient Qi rebels upward, causing epigastric Pi (Fullness) and hardness, incessant belching. Give Xuan... Fu Dai...)
Xuan Fu Dai Zhe Shi Tang (Inula and Hematite Decoction) Formula
Xuan Fu Hua (Inulae Flos, 3 liang, salty, warm) Ren Shen (Ginseng Radix, 2 liang, sweet, warm) Sheng Jiang (Zingiberis Rhizoma Recens, 5 liang, sliced, acrid, warm) Dai Zhe Shi (Hematitum, 1 liang... bitter, cold)
Large...
(Hardness makes Qi firm; Salty flavor can soften it. Xuan Fu's salinity softens... Pi (Fullness) hardness. Fright makes Qi float; Heavy agents calm it. Dai Zhe's... heaviness...)
Its sweetness...
Three doses daily...
After purgation, Gui Zhi Tang (Cinnamon Twig Decoction) should not be used. If sweating and wheezing occur without significant heat, Ma Huang Xing Zi Gan Cao Shi Gao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) can be given.
(Volume 3, 26 syndromes states: After sweating, Gui Zhi Tang (Cinnamon Twig Decoction) should not be used. Sweating with wheezing and no significant heat shares this treatment... same as...)
Down. If after vomiting...
Tai Yang Disease (Tai Yang Disorder), exterior signs unresolved, repeatedly purged, resulting in Xie Re Er Li (Collaborating Heat Diarrhea), continuous diarrhea, epigastric Pi (Fullness) and hardness, exterior and interior unresolved. Gui Zhi... Ren Shen...
(Exterior signs unresolved, repeatedly purged, severely deficiencies the interior, pathogenic heat enters vacantly, interior deficiency collaborates with heat, causing continuous diarrhea and epigastric Pi (Fullness)... )
If...
Attack...
Gui Zhi Ren Shen Tang (Cinnamon Twig and Ginseng Decoction) Formula
Gui Zhi (Cinnamomi Ramulus, 4 liang, peeled, acrid, hot) Gan Cao (Glycyrrhizae Radix et Rhizoma, 4 liang, honey-fried, sweet, neutral) Bai Zhu (Atractylodis Macrocephalae Rhizoma, 3 liang, sweet, neutral) Gan Jiang (Zingiberis Rhizoma, 3 liang... acrid, hot)
Ren...
(Exterior unresolved: Acrid disperses. Interior insufficient: Sweet relaxes. Due to severe interior deficiency and unresolved exterior, Gui Zhi (Cinnamomi Ramulus) and... Gan Cao (Glycyrrhizae Radix et Rhizoma) are added...)
Ascend...
After severe purgation and subsequent sweating in Shang Han (Cold Damage), epigastric Pi (Fullness) and aversion to cold indicate unresolved exterior. Do not attack Pi (Fullness); first resolve the exterior. Once exterior is resolved, then attack Pi (Fullness)...
(Severe purgation then sweating should resolve exterior and interior pathogens. Epigastric Pi (Fullness) with aversion to cold indicates both exterior and interior pathogens remain. Because exterior... unresolved...)
Inside...
Shang Han (Cold Damage) with fever, sweating without resolution, epigastric Pi (Fullness) and hardness, vomiting and diarrhea. Da Chai Hu Tang (Minor Bupleurum Decoction) is indicated.
(Shang Han (Cold Damage) fever indicates Cold has transformed to Heat. Sweating without resolution means exterior is harmonized but interior is diseased. Vomiting/diarrhea, epigastric/flank softness... indicates interior deficiency. Vomiting and... diarrhea...)
Symptoms resemble Gui Zhi Tang (Cinnamon Twig Decoction) syndrome, but no headache, no neck stiffness, Cun (inch) pulse slightly floating, epigastric Pi (Fullness) and hardness, Qi rushing to throat, difficulty breathing. This is Xiongyou Han (Cold in the Chest)...
(Symptoms resembling Gui Zhi Tang (Cinnamon Twig Decoction) syndrome mean fever, sweating, aversion to wind, indicating pathogen in exterior. Headache and neck stiffness constitute Gui Zhi Tang (Cinnamon Twig Decoction) syndrome. If no headache... neck...)
Interior...
Hardness...
Fullness...
Gua Di San (Melon Seed Powder) Formula
Gua Di (Momordicae Fructus, 1 fen, stir-fried yellow, bitter, cold) Chi Xiao Dou (Vigna Semen Rubrum, 1 fen, sour, warm)
(Where high, vent it. Vent with bitterness of Gua Di (Momordicae Fructus) and Xiang Chi (Sojae Semen Preparatum). Where upper,涌 (induce vomiting) with sourness of Chi Xiao Dou (Vigna Semen Rubrum). Nei Jing states: Sour and bitter induce vomiting and draining... as Yin...)
Make thin porridge...
Gua Di San (Melon Seed Powder)...
(Prior accumulation binds in hypochondrium as Pi (Fullness). Now due to Shang Han (Cold Damage), pathogen enters interior, assisting old accumulation, causing Zhen Qi (True Qi) to bind and... not flow...)
Shang Han (Cold Damage), after vomiting or purgation, unresolved for seven to eight days, heat binds in interior, exterior and interior both hot, occasional aversion to wind, extreme thirst, dry tongue... and...
(After vomiting/purgation, seven to eight days should bring resolution. Unresolved, heat binds in interior. Exterior heat is body heat. Interior heat is internal heat... yes...)
Heat not...
Know exterior...
Not yet...
Disperse heat...