胡汤
阳明病。胁下硬满。不大便而呕。舌上白苔者。可与小柴胡汤。上焦得通。津液得下。
胃
（阳明病。腹满不大便。舌上苔黄者。为邪热入腑。可下。若胁下硬满。虽不大便而呕。
舌
得
阳明中风。脉弦浮大而短气。腹部满。胁下及心痛。久按之。气不通。鼻干不得汗。嗜
卧。
脉
（浮大为阳。风在表也。弦则为阴。风在里也。短气腹满。胁下及心痛。风热壅于腹中
而不
通。
干表
循颊
如
胡
汗
阳明病。自汗出。若发汗。小便自利者。此为津液内竭。虽硬不可攻之。当须自欲大便。
宜
（津液内竭。肠胃干燥。大便因硬。此非结热。故不可攻。宜以药外治而导引之。）
蜜煎导方
蜜七合。一味。纳铜器中。微火煎之。稍凝似饴状。搅之。勿令焦着。欲可丸。并手捻
作挺
乃
猪胆汁方
大猪胆一枚。泻汁和醋少许。以灌谷道中。如一食顷。当大便出。
阳明病。脉迟。汗出多。微恶寒者。表未解也。可发汗。宜桂枝汤。
（阳明病。脉迟。汗出多。当责邪在里。以微恶寒。知表未解。与桂枝汤和表。）
阳明病。脉浮。无汗而喘者。发汗则愈。宜麻黄汤。
（阳明伤寒。表实脉浮。无汗而喘也。与麻黄汤。以发汗。）
阳明病。发热汗出。此为热越。不能发黄也。但头汗出。身无汗。剂颈而还。小便不利。
渴
（但头汗出。身无汗。剂颈而还者。热不得越也。小便不利。渴引水浆者。热甚于胃。
津液
茵陈蒿汤方
茵陈蒿（六两苦微寒） 栀子（十四枚擘苦寒） 大黄（二两去皮苦寒）
（小热之气。凉以和之。大热之气。寒以取之。茵陈、栀子之苦寒。以逐胃燥。宜下必
以苦
纳二
小便去
阳明证。其人喜忘者。必有蓄血。所以然者。本有久瘀血。故令喜忘。屎虽硬。大便反
易。
（内经曰。血并于下。乱而喜忘。此下本有久瘀血。所以喜忘也。津液少。大便硬。以
蓄血
阳明病。下之。心中懊 而烦。胃中有燥屎者。可攻。腹微满。初头硬。后必溏。不可
攻之
（下后。心中懊 而烦者。虚烦也。当与栀子豉汤。若胃中有燥屎者。非虚烦也。可与
大承
病患不大便五六日。绕脐痛。烦躁。发作有时者。此有燥屎。故使不大便也。
（不大便五六日者。则大便必结为燥屎也。胃中燥实。气不得下通。故绕脐痛。烦躁。
发作
病患烦热。汗出则解。又如疟状。日晡所发热者。属阳明也。脉实者。宜下之。脉浮虚
者。
（虽得阳明证。未可便为里实。审看脉候。以别内外。其脉实者。热已入腑。为实。可
与大
大下后。六七日不大便。烦不解。腹满痛者。此有燥屎也。所以然者。本有宿食故也。
宜大
（大下之后。则胃弱不能消谷。至六七日不大便。则宿食已结不消。故使烦热不解。而
腹满
病患小便不利。大便乍难乍易。时有微热。喘冒不能卧者。有燥屎也。宜大承气汤。
（小便利。则大便硬。此以有燥屎。故小便不利。而大便乍难乍易。胃热者。发热喘冒
无时
食谷欲呕者。属阳明也。吴茱萸汤主之。得汤反剧者。属上焦也。
（上焦主内。胃为之市。食谷欲呕者。胃不受也。与吴茱萸汤。以温胃气。得阳反剧者。
上
吴茱萸汤方
吴茱萸（一升洗辛热） 人参（三两甘温） 生姜（六两切辛温） 大枣（十二枚擘甘
温）
（内经曰。寒淫于内。治以甘热。佐以苦辛。吴茱萸、生姜之辛。以温胃。人参、大枣
之甘
太阳病。寸缓。关浮。尺弱。其人发热汗出。复恶寒。不呕。但心下痞者。此以医下之
也。
无所
（太阳病。脉阳浮。阴弱。为邪在表。今寸缓。关浮。尺弱。邪气渐传里。则发热汗出。
复
邪
汗
无
者
脉阳微。而汗出少者。为自和也。汗出多者。为太过。
（脉阳微者。邪气少。汗出少者。为适当。故自和。汗出多者。反损正气。是汗出太过
也。）
阳脉实。因发其汗。出多者。亦为太过。太过为阳绝于里。亡津液。大便因硬也。
（阳脉实者。表热甚也。因发汗。热乘虚。蒸津液外泄。致汗出太过。汗出多者。亡其
阳。
脉浮而芤。浮为阳。芤为阴。浮芤相搏。胃气生热。其阳则绝。
（浮芤相搏。阴阳不谐。胃气独治。郁而生热。消烁津液。其阳为绝。）
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。
（趺阳者。脾胃之脉。诊浮为阳。知胃气强。涩为阴。知脾为约。约者。俭约之约。又
约束
输于
四布
麻仁丸
麻子仁（二升甘平） 芍药（半斤酸平） 枳实（半斤炙苦寒） 大黄（一斤去皮苦寒）
浓朴
（一
（内经曰。脾欲缓。急食甘以缓之。麻子、杏仁之甘。缓脾而润燥。津液不足。以酸收
之。
也。
太阳病三日。发汗不解。蒸蒸发热者。属胃也。调胃承气汤主之。
（蒸蒸者。如热熏蒸。言甚热也。太阳病三日。发汗不解。则表邪已罢。蒸蒸发热。胃
热为
伤寒吐后。腹胀满者。与调胃承气汤。
（内经曰。诸胀腹大。皆属于热。热在上焦。则吐。吐后不解。复腹胀满者。邪热入胃
也
太阳病。若吐。若下。若发汗。微烦。小便数。大便因硬者。与小承气汤和之。愈。
（吐下。发汗。皆损津液。表邪乘虚传里。大烦者。邪在表也。微烦者。邪入里也。小
便数
得病二三日。脉弱。无太阳柴胡证。烦躁。心下硬。至四五日。虽能食。以小承气汤。
少少
但初
（针经曰。脉软者。病将下。弱为阴脉。当责邪在里。得病二三日。脉弱。是日数虽浅。
而
邪
至六日。则热甚。与大承气汤一升。若不大便六七日。小便多者。为津液内竭。大便必硬。
则可下之。小便少者。则胃中水谷不别。必初硬后溏。虽不能食。为胃实。以小便少。则未
定成硬。亦不可攻。须小便利。屎定硬。乃可攻之。）
伤寒六七日。目中不了了。睛不和。无表里证。大便难。身微热者。此为实也。急下之。
宜
（内经曰。诸脉者。皆属于目。伤寒六七日。邪气入里之时。目中不了了。睛不和者。
邪热
热也
大承
阳明发热。汗多者。急下之。宜大承气汤。
（邪热入腑。外发热。汗多者。热迫津液将竭。急与大承气汤。以下其腑热。）
发汗不解。腹满痛者。急下之。宜大承气汤。
（发汗不解。邪热传入腑。而成腹满痛者。传之迅也。是须急下之。）
腹满不减。减不足言。当下之。宜大承气汤。
（腹满不减。邪气实也。经曰。大满大实。自可除下之。大承气汤。下其满实。若腹满
时减
足言
阳明少阳合病。必下利。其脉不负者。顺也。负者。失也。互相克贼。名为负也。脉滑
而数
（阳明土。少阳木。二经合病。气不相和。则必下利。少阳脉不胜。阳明不负。是不相
克。
食也
下除
病患无表里证。发热七八日。虽脉浮数者。可下之。假令已下。脉数不解。合热则消谷
饥。
（七八日。邪入腑之时。病患无表里证。但发热。虽脉浮数。亦可与大承气汤下之。浮
为热客于气。数为热客于血。下之。邪热去而浮数之脉相当解。若下后。数脉去而脉但浮。
则是营血间热。并于卫气间也。当为邪气独留心中。则饥。邪热不杀谷。潮热发渴之证。此
下之后。浮脉去而数不解。则是卫气间热。合于营血间也。热气合并。迫血下行。胃虚协热。
消
为
若脉数不解。而下不止。必协热而便脓血也。
（下后脉数不解。而不大便者。是热不得泄。蓄血于下。为瘀血也。若下后脉数不解。
而下
伤寒发汗已。身目为黄。所以然者。以寒湿在里不解故也。以为不可下也。于寒湿中求
之。
（金匮要略曰。黄家所起。从湿得之。汗出热去。则不能发黄。发汗已。身目为黄者。
风气
下。
伤寒七八日。身黄如橘子色。小便不利。腹微满者。茵陈蒿汤主之。
（当热甚之时。身黄如橘子色。是热毒发泄于外。内经曰。膀胱者。津液藏焉。气化则
能出
热。
伤寒身黄发热者。栀子柏皮汤主之。
（伤寒身黄。胃有瘀热。当须下去之。此以发热为热未实。与栀子柏皮汤。解散之。）
栀子柏皮汤方
栀子（一十五个苦寒） 甘草（一两甘平） 黄柏（二两） 上三味。以水四升。煮取
一升半。
去
伤寒瘀热在里。身必发黄。麻黄连轺赤小豆汤主之。
（湿热相交。民多病瘅。瘅。黄也。伤寒为寒湿在表。发黄为瘀热在里。与麻黄连轺赤
小豆
麻黄连轺赤小豆汤方
麻黄（二两甘温去节） 赤小豆（一升甘平） 连轺（二两连翘房也苦寒） 大枣（十
二枚甘
温）
两炙甘
平）（内经曰。湿上甚而热。治以苦温。佐以甘辛。以汗为故止。此之谓也。又煎用潦水者。
亦
药。煮取三升。分温三服。半日服尽。
胡汤（注：原文此处标题“胡汤”疑为衍文或误植，正文未载此方，故略去不译）
阳明病。胁下硬满。不大便而呕。舌上白苔者。可与小柴胡汤。上焦得通。津液得下。胃气和则愈。（阳明病。腹满不大便。舌上苔黄者。为邪热入腑。可下。若胁下硬满。虽不大便而呕。舌上白苔者。亦属少阳枢机不利。不可攻下。当和解少阳。）
阳明中风。脉弦浮大而短气。腹部满。胁下及心痛。久按之。气不通。鼻干不得汗。嗜卧。一身面目悉黄。小便难。有潮热。时时哕。耳前后肿。刺之小差。外不解。病过十日。脉续浮者。与小柴胡汤。
（浮大为阳。风在表也。弦则为阴。风在里也。短气腹满。胁下及心痛。风热壅于腹中而不通。鼻干不得汗。嗜卧。一身面目悉黄。小便难。有潮热。时时哕。耳前后肿。刺之小差。外不解。病过十日。脉续浮者。与小柴胡汤。）
阳明病。自汗出。若发汗。小便自利者。此为津液内竭。虽硬不可攻之。当须自欲大便。宜蜜煎导而通之。（津液内竭。肠胃干燥。大便因硬。此非结热。故不可攻。宜以药外治而导引之。）
蜜煎导方
蜜七合。一味。纳铜器中。微火煎之。稍凝似饴状。搅之。勿令焦着。欲可丸。并手捻作挺。头锐大。内谷道中。用力忍之。当大便出。
猪胆汁方
大猪胆一枚。泻汁和醋少许。以灌谷道中。如一食顷。当大便出。
阳明病。脉迟。汗出多。微恶寒者。表未解也。可发汗。宜桂枝汤。（阳明病。脉迟。汗出多。当责邪在里。以微恶寒。知表未解。与桂枝汤和表。）
阳明病。脉浮。无汗而喘者。发汗则愈。宜麻黄汤。（阳明伤寒。表实脉浮。无汗而喘也。与麻黄汤。以发汗。）
阳明病。发热汗出。此为热越。不能发黄也。但头汗出。身无汗。剂颈而还。小便不利。渴引水浆者。必发黄。（但头汗出。身无汗。剂颈而还者。热不得越也。小便不利。渴引水浆者。热甚于胃。津液被灼。瘀热在里。身必发黄。）
茵陈蒿汤方
茵陈蒿（六两苦微寒） 栀子（十四枚擘苦寒） 大黄（二两去皮苦寒）
上三味。以水一斗。先煮茵陈。减六升。纳二味。煮取三升。分温三服。小便当利。尿如皂角汁状。色正赤。一宿腹减。黄从小便去也。
（小热之气。凉以和之。大热之气。寒以取之。茵陈、栀子之苦寒。以逐胃燥。宜下必以苦。故用大黄以下之。）
阳明证。其人喜忘者。必有蓄血。所以然者。本有久瘀血。故令喜忘。屎虽硬。大便反易。其色必黑者。宜抵当汤下之。（内经曰。血并于下。乱而喜忘。此下本有久瘀血。所以喜忘也。津液少。大便硬。以蓄血。故大便反易。其色黑。）
阳明病。下之。心中懊憹而烦。胃中有燥屎者。可攻。腹微满。初头硬。后必溏。不可攻之。（下后。心中懊憹而烦者。虚烦也。当与栀子豉汤。若胃中有燥屎者。非虚烦也。可与大承气汤。）
病患不大便五六日。绕脐痛。烦躁。发作有时者。此有燥屎。故使不大便也。（不大便五六日者。则大便必结为燥屎也。胃中燥实。气不得下通。故绕脐痛。烦躁。发作有时。）
病患烦热。汗出则解。又如疟状。日晡所发热者。属阳明也。脉实者。宜下之。脉浮虚者。宜发汗。（虽得阳明证。未可便为里实。审看脉候。以别内外。其脉实者。热已入腑。为实。可与大承气汤下之。脉浮虚者。表未解也。宜桂枝汤发汗。）
大下后。六七日不大便。烦不解。腹满痛者。此有燥屎也。所以然者。本有宿食故也。宜大承气汤。（大下之后。则胃弱不能消谷。至六七日不大便。则宿食已结不消。故使烦热不解。而腹满痛。此有燥屎。宜大承气汤。）
病患小便不利。大便乍难乍易。时有微热。喘冒不能卧者。有燥屎也。宜大承气汤。（小便利。则大便硬。此以有燥屎。故小便不利。而大便乍难乍易。胃热者。发热喘冒无时。喘冒不能卧。此有燥屎。宜大承气汤。）
食谷欲呕者。属阳明也。吴茱萸汤主之。得汤反剧者。属上焦也。（上焦主内。胃为之市。食谷欲呕者。胃不受也。与吴茱萸汤。以温胃气。得汤反剧者。属上焦也。）
吴茱萸汤方
吴茱萸（一升洗辛热） 人参（三两甘温） 生姜（六两切辛温） 大枣（十二枚擘甘温）
上四味。以水七升。煮取二升。去滓。分温再服。
（内经曰。寒淫于内。治以甘热。佐以苦辛。吴茱萸、生姜之辛。以温胃。人参、大枣之甘。以补中。）
太阳病。寸缓。关浮。尺弱。其人发热汗出。复恶寒。不呕。但心下痞者。此以医下之也。（太阳病。脉阳浮。阴弱。为邪在表。今寸缓。关浮。尺弱。邪气渐传里。则发热汗出。复恶寒。不呕。但心下痞者。此以医下之也。无所益也。）
脉阳微。而汗出少者。为自和也。汗出多者。为太过。（脉阳微者。邪气少。汗出少者。为适当。故自和。汗出多者。反损正气。是汗出太过也。）
阳脉实。因发其汗。出多者。亦为太过。太过为阳绝于里。亡津液。大便因硬也。（阳脉实者。表热甚也。因发汗。热乘虚。蒸津液外泄。致汗出太过。汗出多者。亡其阳。阳绝于里。亡津液。大便因硬也。）
脉浮而芤。浮为阳。芤为阴。浮芤相搏。胃气生热。其阳则绝。（浮芤相搏。阴阳不谐。胃气独治。郁而生热。消烁津液。其阳为绝。）
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。（趺阳者。脾胃之脉。诊浮为阳。知胃气强。涩为阴。知脾为约。约者。俭约之约。又约束之约。言脾为胃行津液。今胃强脾弱。约束津液。不得四布。但输膀胱。致小便数。大便难。麻仁丸主之。）
麻仁丸
麻子仁（二升甘平） 芍药（半斤酸平） 枳实（半斤炙苦寒） 大黄（一斤去皮苦寒） 厚朴（一尺炙甘温） 杏仁（半升去皮尖熬研甘平）
上六味。末之。炼蜜和丸梧子大。饮服十丸。日三服。渐加。以知为度。
（内经曰。脾欲缓。急食甘以缓之。麻子、杏仁之甘。缓脾而润燥。津液不足。以酸收之。芍药之酸。以收津液。枳实、大黄之苦。以下热气。厚朴之苦。以除满。共成润下之功。）
太阳病三日。发汗不解。蒸蒸发热者。属胃也。调胃承气汤主之。（蒸蒸者。如热熏蒸。言甚热也。太阳病三日。发汗不解。则表邪已罢。蒸蒸发热。胃热为实。调胃承气汤主之。）
伤寒吐后。腹胀满者。与调胃承气汤。（内经曰。诸胀腹大。皆属于热。热在上焦。则吐。吐后不解。复腹胀满者。邪热入胃也。与调胃承气汤。）
太阳病。若吐。若下。若发汗。微烦。小便数。大便因硬者。与小承气汤和之。愈。（吐下。发汗。皆损津液。表邪乘虚传里。大烦者。邪在表也。微烦者。邪入里也。小便数。大便因硬者。与小承气汤和之。）
得病二三日。脉弱。无太阳柴胡证。烦躁。心下硬。至四五日。虽能食。以小承气汤。少少与饮之。初服汤。当更衣。不尔者。尽饮之。若更衣者。勿服之。（针经曰。脉软者。病将下。弱为阴脉。当责邪在里。得病二三日。脉弱。是日数虽浅。而邪已入里。烦躁。心下硬。至四五日。虽能食。以小承气汤。少少与饮之。初服汤。当更衣。不尔者。尽饮之。若更衣者。勿服之。）
至六日。则热甚。与大承气汤一升。若不大便六七日。小便多者。为津液内竭。大便必硬。则可下之。小便少者。则胃中水谷不别。必初硬后溏。虽不能食。为胃实。以小便少。则未定成硬。亦不可攻。须小便利。屎定硬。乃可攻之。（若不大便六七日。小便多者。为津液内竭。大便必硬。则可下之。小便少者。则胃中水谷不别。必初硬后溏。虽不能食。为胃实。以小便少。则未定成硬。亦不可攻。须小便利。屎定硬。乃可攻之。）
伤寒六七日。目中不了了。睛不和。无表里证。大便难。身微热者。此为实也。急下之。宜大承气汤。（内经曰。诸脉者。皆属于目。伤寒六七日。邪气入里之时。目中不了了。睛不和者。邪热炽盛。灼伤真阴。此为实也。急下之。宜大承气汤。）
阳明发热。汗多者。急下之。宜大承气汤。（邪热入腑。外发热。汗多者。热迫津液将竭。急与大承气汤。以下其腑热。）
发汗不解。腹满痛者。急下之。宜大承气汤。（发汗不解。邪热传入腑。而成腹满痛者。传之迅也。是须急下之。）
腹满不减。减不足言。当下之。宜大承气汤。（腹满不减。邪气实也。经曰。大满大实。自可除下之。大承气汤。下其满实。若腹满时减。复如故。此为寒。非实也。）
阳明少阳合病。必下利。其脉不负者。顺也。负者。失也。互相克贼。名为负也。脉滑而数者。有宿食也。当下之。宜大承气汤。（阳明土。少阳木。二经合病。气不相和。则必下利。少阳脉不胜。阳明不负。是不相克。为顺也。若少阳脉胜。阳明不负。是互相克贼。名为负也。脉滑而数者。有宿食也。当下之。宜大承气汤。）
病患无表里证。发热七八日。虽脉浮数者。可下之。假令已下。脉数不解。合热则消谷善饥。至六七日。不大便者。有瘀血也。宜抵当汤。（七八日。邪入腑之时。病患无表里证。但发热。虽脉浮数。亦可与大承气汤下之。浮为热客于气。数为热客于血。下之。邪热去而浮数之脉相当解。若下后。数脉去而脉但浮。则是营血间热。并于卫气间也。当为邪气独留心中。则饥。邪热不杀谷。潮热发渴之证。此下之后。浮脉去而数不解。则是卫气间热。合于营血间也。热气合并。迫血下行。胃虚协热。消谷善饥。至六七日。不大便者。有瘀血也。宜抵当汤。）
若脉数不解。而下不止。必协热而便脓血也。（下后脉数不解。而不大便者。是热不得泄。蓄血于下。为瘀血也。若下后脉数不解。而下不止。必协热而便脓血也。）
伤寒发汗已。身目为黄。所以然者。以寒湿在里不解故也。以为不可下也。于寒湿中求之。（金匮要略曰。黄家所起。从湿得之。汗出热去。则不能发黄。发汗已。身目为黄者。风气相击。身体重。腰中冷。如坐水中。形如水状。反不渴。小便自利。饮食如故。病属下焦。身劳汗出。衣里冷湿。久久得之。名曰水气。若汗出已。身目为黄。所以然者。以寒湿在里不解故也。以为不可下也。于寒湿中求之。）
伤寒七八日。身黄如橘子色。小便不利。腹微满者。茵陈蒿汤主之。（当热甚之时。身黄如橘子色。是热毒发泄于外。内经曰。膀胱者。津液藏焉。气化则能出矣。今湿热内蕴。气化不行。故小便不利。腹微满。茵陈蒿汤主之。）
伤寒身黄发热者。栀子柏皮汤主之。（伤寒身黄。胃有瘀热。当须下去之。此以发热为热未实。与栀子柏皮汤。解散之。）
栀子柏皮汤方
栀子（一十五个苦寒） 甘草（一两甘平） 黄柏（二两）
上三味。以水四升。煮取一升半。去滓。分温再服。
伤寒瘀热在里。身必发黄。麻黄连轺赤小豆汤主之。（湿热相交。民多病瘅。瘅。黄也。伤寒为寒湿在表。发黄为瘀热在里。与麻黄连轺赤小豆汤。以发汗散邪。清热利湿。）
麻黄连轺赤小豆汤方
麻黄（二两甘温去节） 赤小豆（一升甘平） 连轺（二两连翘房也苦寒） 大枣（十二枚甘温） 梓白皮（一升苦寒） 生姜（二两辛温） 甘草（二两甘平） 杏仁（四十个去皮尖甘平）
上八味。以潦水一斗。先煮麻黄。再沸。去上沫。纳诸药。煮取三升。分温三服。半日服尽。（内经曰。湿上甚而热。治以苦温。佐以甘辛。以汗为故止。此之谓也。又煎用潦水者。亦取其卑下之性。以利湿热。）
Hu Tang (Note: The title "Hu Tang" in the original text appears to be a transcription error or superfluous, as no formula is provided in the text. Therefore, it is omitted.)
Yangming Disease. Hardness and fullness below the hypochondrium. Constipation accompanied by vomiting. White coating on the tongue. Xiao Chai Hu Tang (Minor Bupleurum Decoction) may be administered. When the Upper Jiao (Upper Burner) becomes unobstructed, body fluids descend, and the Stomach Qi harmonizes, recovery ensues. (In Yangming Disease, abdominal fullness with constipation and yellow coating on the tongue indicates pathogenic heat entering the Fu organs; purgation is indicated. However, if there is hardness and fullness below the hypochondrium, constipation with vomiting, and a white coating on the tongue, this belongs to the Shaoyang pivot mechanism being obstructed. Purging is contraindicated; instead, the Shaoyang should be harmonized.)
Yangming Wind Strike. The pulse is wiry, floating, large, and shortness of breath occurs. Abdominal fullness. Pain in the hypochondrium and heart region. Long pressure reveals obstruction of Qi flow. Dry nose, inability to sweat, drowsiness. (The text continues describing symptoms such as jaundice of the face and eyes, difficulty urinating, tidal fever, occasional hiccups, swelling around the ears. Acupuncture provides slight relief. If exterior symptoms persist beyond ten days and the pulse remains floating, Xiao Chai Hu Tang is indicated.)
(Floating and large indicate Yang; wind is at the exterior. Wiry indicates Yin; wind is at the interior. Shortness of breath and abdominal fullness, pain in the hypochondrium and heart region, indicate wind-heat congesting the abdomen and blocking Qi flow. Dry nose, inability to sweat, drowsiness, jaundice, difficulty urinating, tidal fever, hiccups, ear swelling... if these persist, acupuncture is used, and if exterior symptoms remain after ten days with a continuing floating pulse, Xiao Chai Hu Tang is given.)
Yangming Disease. Spontaneous sweating. If sweating is induced additionally, and urination is frequent, this indicates depletion of body fluids internally. Although the stool is hard, it cannot be attacked with harsh purgatives. One must wait for the patient's natural desire to defecate, and then use Mi Jian Dao (Honey Suppository) to guide the passage of stool. (Depletion of internal body fluids leads to dry intestines and hard stool. This is not excess heat accumulation; thus, harsh purging is contraindicated. External medication to guide the stool is appropriate.)
Mi Jian Dao Formula
Seven he of honey. Single ingredient. Place in a copper vessel. Simmer over low fire until slightly thickened like malt syrup. Stir constantly to prevent burning. When it can be formed into pills, shape by hand into a cone-like suppository with a pointed head. Insert into the rectum. Hold firmly. Stool will be expelled.
Zhu Dan Zhi Fang (Pig Gallbladder Juice Formula)
One large pig gallbladder. Extract the juice and mix with a small amount of vinegar. Instill into the rectum. After the duration of one meal, stool will be expelled.
Yangming Disease. Pulse is slow. Profuse sweating. Slight aversion to cold. The exterior is unresolved. Sweating may be induced. Gui Zhi Tang (Cinnamon Twig Decoction) is suitable. (In Yangming Disease, slow pulse and profuse sweating usually suggest interior pathology. However, slight aversion to cold indicates the exterior is still unresolved. Gui Zui Tang is used to harmonize the exterior.)
Yangming Disease. Pulse is floating. No sweating and wheezing. Inducing sweating will lead to recovery. Ma Huang Tang (Ephedra Decoction) is suitable. (Yangming Cold Damage with exterior excess, floating pulse, no sweating, and wheezing. Ma Huang Tang is given to induce sweating.)
Yangming Disease. Fever and sweating indicate that heat is venting outward, so jaundice will not occur. However, if only the head sweats, the body has no sweat, and the sweat stops at the neck, accompanied by difficulty urinating and thirst prompting intake of fluids, jaundice will definitely develop. (Sweat only on the head, no body sweat stopping at the neck, indicates heat cannot vent. Difficulty urinating and thirst for fluids indicate intense heat in the Stomach. Body fluids are scorched, and stagnant heat resides in the interior, leading to jaundice.)
Yin Chen Hao Tang (Artemisia Capillaris Decoction) Formula
Yin Chen Hao (Herba Artemisiae Scopariae, six liang, bitter, slightly cold)
Zhi Zi (Fructus Gardeniae, fourteen seeds, broken, bitter, cold)
Da Huang (Radix et Rhizoma Rhei, two liang, peeled, bitter, cold)
Boil the three ingredients in ten sheng of water. First boil Yin Chen Hao until reduced by six sheng. Add the other two ingredients. Boil to obtain three sheng. Divide into three warm doses. Urination should become profuse, resembling soapberry juice, dark red in color. After one night, abdominal fullness decreases, and jaundice exits via the urine.
(Slight heat is harmonized with coolness. Intense heat is treated with coldness. The bitterness and coldness of Yin Chen and Zhi Zi clear stomach dryness. Purging requires bitter agents, hence Da Huang is used to purge downward.)
Yangming Syndrome. The patient suffers from forgetfulness. There must be accumulated blood. The reason is pre-existing long-standing blood stasis, causing forgetfulness. Although the stool is hard, defecation is surprisingly easy, and the color is black. Di Dang Tang (Di Dang Decoction) should be used to purge. (The Nei Jing states: "When blood congregates below, confusion and forgetfulness arise." Pre-existing blood stasis causes forgetfulness. Low body fluids make stool hard, but due to blood stasis, defecation is easy and black.)
Yangming Disease. After purgation, the patient experiences mental restlessness and irritability (Ao Nao). If there is dry stool in the Stomach, purging is indicated. If the abdomen is only slightly full, with hard stool at the beginning and loose stool later, purging is contraindicated. (After purgation, mental restlessness and irritability indicate empty irritability; Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is appropriate. If dry stool exists in the Stomach, it is not empty irritability; Da Cheng Qi Tang (Major Order the Golden Elixir Decoction) may be given.)
The patient has not had a bowel movement for five to six days. Pain around the umbilicus. Irritability. Symptoms occurring intermittently. This indicates dry stool, causing constipation. (Not having a bowel movement for five to six days implies stool has hardened into dry feces. Dryness and excess in the Stomach block Qi descent, causing periumbilical pain, irritability, and intermittent symptoms.)
The patient suffers from vexing heat. Sweating brings relief, but symptoms resemble malaria. Fever occurs in the late afternoon (Shi hour, 3-5 PM), indicating involvement of the Yangming channel. If the pulse is excess, purging is indicated. If the pulse is floating and deficient, inducing sweating is indicated. (Even with Yangming syndrome, interior excess cannot be assumed immediately. Examine the pulse to distinguish interior from exterior. An excess pulse indicates heat has entered the Fu organs and is excess; Da Cheng Qi Tang may be used to purge. A floating/deficient pulse indicates the exterior is unresolved; Gui Zhi Tang should induce sweating.)
After severe purgation, if the patient does not have a bowel movement for six to seven days, and irritability persists with abdominal fullness and pain, this indicates dry stool. The reason is pre-existing retained food. Da Cheng Qi Tang is suitable. (Severe purgation weakens the Stomach, impairing digestion. By the sixth or seventh day, retained food consolidates and fails to digest, causing persistent irritability and abdominal fullness/pain. This is dry stool; Da Cheng Qi Tang is indicated.)
The patient has difficulty urinating. Stool is alternately difficult and easy to pass. Occasional mild fever. Wheezing, vertigo, and inability to lie down. This indicates dry stool. Da Cheng Qi Tang is suitable. (Profuse urination leads to hard stool. Here, difficulty urinating and alternating stool consistency indicate dry stool. Stomach heat causes fever, wheezing, and vertigo without cessation. Inability to lie down confirms dry stool; Da Cheng Qi Tang is indicated.)
Desire to vomit after eating food indicates involvement of the Yangming channel. Wu Zhu Yu Tang (Evodia Decoction) governs this. If symptoms worsen after taking the decoction, the pathology belongs to the Upper Jiao. (The Upper Jiao governs reception; the Stomach is the market. Desire to vomit after eating indicates the Stomach rejects food. Wu Zhu Yu Tang warms Stomach Qi. Worsening after ingestion suggests Upper Jiao pathology.)
Wu Zhu Yu Tang Formula
Wu Zhu Yu (Fructus Evodiae, one sheng, washed, acrid, hot)
Ren Shen (Radix Ginseng, three liang, sweet, warm)
Sheng Jiang (Rhizoma Zingiberis Recens, six liang, sliced, acrid, warm)
Da Zao (Fructus Jujubae, twelve seeds, broken, sweet, warm)
Boil the four ingredients in seven sheng of water to obtain two sheng. Remove dregs. Divide into two warm doses.
(The Nei Jing states: "For cold invading internally, treat with sweet-hot, assisting with bitter-acrid." The acridity of Wu Zhu Yu and Sheng Jiang warms the Stomach. The sweetness of Ren Shen and Da Zao tonifies the Middle.)
Taiyang Disease. Cun position slow, Guan position floating, Chi position weak. The patient has fever and sweating, yet also aversion to cold. No vomiting, but only epigastric stuffiness (Pi). This results from the physician using purgation incorrectly. (Taiyang Disease with floating Yang pulse and weak Yin pulse indicates pathogen at the exterior. Now, slow Cun, floating Guan, and weak Chi indicate the pathogen gradually transmitting inward, causing fever, sweating, aversion to cold, and epigastric stuffiness due to incorrect purgation.)
If the Yang pulse is subtle and sweating is scant, this indicates self-harmonization. Profuse sweating indicates excess. (A subtle Yang pulse means little pathogen. Scant sweating is appropriate, leading to self-harmonization. Profuse sweating damages righteous Qi, indicating excessive sweating.)
If the Yang pulse is excess, and inducing sweating leads to profuse output, this is also excessive. Excessiveness leads to Yang exhaustion in the interior, loss of body fluids, and consequently hard stool. (An excess Yang pulse indicates intense exterior heat. Inducing sweating allows heat to vaporize body fluids outward, causing excessive sweating. Loss of Yang fluids leads to interior Yang exhaustion and fluid depletion, resulting in hard stool.)
The pulse is floating and hollow (Kou). Floating indicates Yang; hollow indicates Yin. The interaction of floating and hollow pulses generates heat in the Stomach Qi, leading to Yang exhaustion. (The interplay of floating and hollow pulses indicates disharmony of Yin and Yang. Stomach Qi acts independently, stagnating and generating heat, consuming fluids, leading to Yang exhaustion.)
The Fuyang pulse (pulse at the dorsum pedis, reflecting Spleen/Stomach) is floating and choppy. Floating indicates strong Stomach Qi. Choppy indicates frequent urination. The interaction of floating and choppy pulses makes defecation difficult. This is Spleen Constriction (Pi Yue). Ma Ren Wan (Hemp Seed Pill) governs this. (Fuyang reflects Spleen and Stomach. Floating indicates strong Stomach Qi. Choppy indicates Spleen Constriction. "Constriction" means restriction. The Spleen transports fluids for the Stomach. Here, Stomach is strong, Spleen is weak, restricting fluids from distributing widely, sending them only to the Bladder, causing frequent urination and difficult stool. Ma Ren Wan is indicated.)
Ma Ren Wan Formula
Ma Zi Ren (Semen Cannabis, two sheng, sweet, neutral)
Shao Yao (Radix Paeoniae Alba, half jin, sour, neutral)
Zhi Shi (Fructus Aurantii Immaturus, half jin, roasted, bitter, cold)
Da Huang (Radix et Rhizoma Rhei, one jin, peeled, bitter, cold)
Hou Po (Cortex Magnoliae Officinalis, one chi, roasted, sweet, warm)
Xing Ren (Semen Armeniacae Amarum, half sheng, skin and tip removed, roasted, sweet, neutral)
Grind the six ingredients into powder. Mix with refined honey to form pills the size of bird seeds. Take ten pills with water, three times daily. Gradually increase dosage until effective.
(The Nei Jing states: "The Spleen desires relaxation; urgently feed sweet to relax it." The sweetness of Hemp Seed and Apricot Kernel relaxes the Spleen and moistens dryness. Fluid deficiency is addressed with sour astringents; Shao Yao's sourness collects fluids. The bitterness of Zhi Shi and Da Huang descends heat. Hou Po's bitterness removes fullness. Together, they achieve moist purgation.)
Taiyang Disease for three days. Inducing sweating failed to resolve the condition. Steaming fever indicates involvement of the Stomach. Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Golden Elixir Decoction) governs this. ("Steaming" describes intense heat radiating outward. After three days of Taiyang disease, if sweating fails to resolve it, the exterior pathogen has ceased. Steaming fever indicates Stomach heat excess; Tiao Wei Cheng Qi Tang is indicated.)
Cold Damage. After vomiting, abdominal distension and fullness occur. Administer Tiao Wei Cheng Qi Tang. (The Nei Jing states: "All distensions and abdominal enlargements belong to heat." Heat in the Upper Jiao causes vomiting. If vomiting fails to resolve the condition and abdominal fullness recurs, pathogenic heat has entered the Stomach. Tiao Wei Cheng Qi Tang is given.)
Taiyang Disease. Whether caused by vomiting, purgation, or inducing sweating, if there is mild irritability, frequent urination, and consequently hard stool, Xiao Cheng Qi Tang (Minor Order the Golden Elixir Decoction) harmonizes the condition, leading to recovery. (Vomiting, purging, and sweating all damage body fluids. Exterior pathogen transmits inward due to deficiency. Severe irritability indicates pathogen at the exterior; mild irritability indicates pathogen at the interior. Frequent urination and hard stool are treated with Xiao Cheng Qi Tang to harmonize.)
On the second or third day of illness, with a weak pulse, no Taiyang or Shaoyang symptoms, irritability, and hardness below the heart. By the fourth or fifth day, even if the patient can eat, administer a small amount of Xiao Cheng Qi Tang. (The Zhen Jing states: "Soft pulse indicates disease moving downward." Weak is a Yin pulse, suggesting interior pathology. On day two or three, weak pulse indicates interior transmission despite few days. Irritability and epigastric hardness warrant a small dose of Xiao Cheng Qi Tang. Initial dose should cause bowel movement. If not, complete the dose. If bowel movement occurs, stop administration.)
By the sixth day, heat is intense. Administer one sheng of Da Cheng Qi Tang. If no bowel movement for six to seven days: if urination is profuse, body fluids are depleted internally, stool is hard, and purging is indicated. If urination is scant, Stomach and Intestines fail to separate clear and turbid; stool will be hard initially and loose later. Even if unable to eat, if urination is scant, stool hardness is undetermined, and purging is contraindicated. Wait for normal urination and confirmed hard stool before purging.
Cold Damage for six or seven days. Eyes appear unclear and pupils are unresponsive. No exterior or interior signs. Difficulty defecating. Mild body heat. This is excess. Urgent purging is required. Da Cheng Qi Tang is suitable. (The Nei Jing states: "All meridians connect to the eyes." During Cold Damage days six to seven, when pathogen enters the interior, unclear vision and unresponsive pupils indicate blazing pathogenic heat scorching true Yin. This is excess; urgent purging with Da Cheng Qi Tang is required.)
Yangming fever with profuse sweating requires urgent purging. Da Cheng Qi Tang is suitable. (Pathogenic heat enters the Fu organs. Exterior fever and profuse sweating indicate heat forcing body fluids toward depletion. Urgently administer Da Cheng Qi Tang to purge Fu heat.)
Inducing sweating fails to resolve the condition; abdominal fullness and pain occur. Urgent purging is required. Da Cheng Qi Tang is suitable. (Failure to resolve after sweating indicates rapid transmission of pathogenic heat into the Fu organs, causing abdominal fullness and pain. Urgent purging is necessary.)
Abdominal fullness that does not decrease, or decreases insignificantly, requires purging. Da Cheng Qi Tang is suitable. (Persistent abdominal fullness indicates pathogenic excess. The Classic states: "Great fullness and excess can be removed by purging." Da Cheng Qi Tang purges fullness and excess. If fullness decreases intermittently, it indicates cold, not excess.)
Combined Yangming and Shaoyang disease必然 involves diarrhea. If the pulse is "not defeated" (Fu), it is favorable. If "defeated" (Fu), it is unfavorable. Mutual overcoming is called defeat. Slippery and rapid pulse indicates retained food. Purge with Da Cheng Qi Tang. (Yangming Earth and Shaoyang Wood combined disease. Disharmony causes diarrhea. If Shaoyang pulse is weaker than Yangming, it is not defeated (favorable). If Shaoyang overcomes Yangming, it is defeated (unfavorable). Slippery and rapid pulse indicates retained food; purge with Da Cheng Qi Tang.)
The patient has no exterior or interior signs. Fever for seven to eight days. Even if the pulse is floating and rapid, purging may be used. If purging has been performed and the rapid pulse persists, combined heat causes efficient digestion and hunger. By the sixth or seventh day, if no bowel movement occurs, blood stasis exists. Di Dang Tang is suitable. (Seven to eight days marks pathogen entry into Fu organs. Without exterior/interior signs, only fever, purging with Da Cheng Qi Tang is possible even with floating/rapid pulse. Floating indicates heat in Qi, rapid indicates heat in Blood. After purging, if rapid pulse persists, combined heat causes hunger. By day six/seven, no bowel movement indicates blood stasis; Di Dang Tang is indicated.)
If the rapid pulse persists and diarrhea continues, heat will combine with dampness causing pus and blood in stool. (After purging, if rapid pulse persists without constipation, heat cannot vent. Accumulated blood in the lower jiao becomes stasis. If rapid pulse persists with diarrhea, heat combines with dampness causing bloody/purulent stool.)
Cold Damage. After inducing sweating, the body and eyes turn yellow. The reason is unresolved cold-dampness in the interior. Purging is contraindicated; seek treatment within the context of cold-dampness. (Jin Gui Yao Lue states: Jaundice arises from dampness. If sweating resolves heat, jaundice does not occur. If body/eyes turn yellow after sweating, it is due to wind-damp interaction. Cold-damp in the interior prevents resolution. Do not purge; treat cold-dampness.)
Cold Damage for seven to eight days. Body yellow like orange peel. Difficulty urinating. Mild abdominal fullness. Yin Chen Hao Tang governs this. (Intense heat causes orange-yellow jaundice, indicating heat toxin venting outward. The Nei Jing states: The Bladder stores fluids; Qi transformation allows excretion. Here, internal damp-heat blocks Qi transformation, causing difficulty urinating and mild abdominal fullness. Yin Chen Hao Tang is indicated.)
Cold Damage with jaundice and fever. Zhi Zi Bai Pi Tang (Gardenia and Phellodendron Bark Decoction) governs this. (Jaundice with Stomach stagnant heat requires purging. Since fever indicates heat is not yet fully consolidated, Zhi Zi Bai Pi Tang disperses and resolves it.)
Zhi Zi Bai Pi Tang Formula
Zhi Zi (Fructus Gardeniae, fifteen seeds, bitter, cold)
Gan Cao (Radix Glycyrrhizae, one liang, sweet, neutral)
Huang Bo (Cortex Phellodendri, two liang)
Boil the three ingredients in four sheng of water to obtain one and a half sheng. Remove dregs. Divide into two warm doses.
Cold Damage with stagnant heat in the interior必然 leads to jaundice. Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Red Bean Decoction) governs this. (Damp-heat interaction causes many cases of jaundice. Cold Damage with cold-damp at the exterior differs from stagnant heat at the interior causing jaundice. Ma Huang Lian Qiao Chi Xiao Dou Tang induces sweating to scatter pathogen and clears heat/dampness.)
Ma Huang Lian Qiao Chi Xiao Dou Tang Formula
Ma Huang (Herba Ephedrae, two liang, sweet, warm, tips removed)
Chi Xiao Dou (Semen Phaseoli Angularis, one sheng, sweet, neutral)
Lian Qiao (Fructus Forsythiae, two liang, bitter, cold)
Da Zao (Fructus Jujubae, twelve seeds, sweet, warm)
Zi Bai Pi (Cortex Mori Radicis, one sheng, bitter, cold)
Sheng Jiang (Rhizoma Zingiberis Recens, two liang, acrid, warm)
Gan Cao (Radix Glycyrrhizae, two liang, sweet, neutral)
Xing Ren (Semen Armeniacae Amarum, forty seeds, skin/tip removed, sweet, neutral)
Boil the eight ingredients in ten sheng of rainwater (liao shui). First boil Ma Huang, remove foam upon boiling. Add remaining herbs. Boil to obtain three sheng. Divide into three warm doses. Finish within half a day. (The Nei Jing states: "For dampness rising with heat, treat with bitter-warm, assist with sweet-acrid. Stop when sweating occurs." Rainwater is used for its heavy, descending nature to benefit damp-heat clearance.)