期门则动荣气，荣气出中焦故也。《脉经》曰∶无犯胃气及上二焦，必自愈，岂谓药不谓针耶。
伤寒六七日，发热微恶寒，肢节烦疼，微呕，心下支结，外证未去者，柴胡加（赵本无“加”字）桂枝汤
主之。（赵本有“柴胡桂枝汤方”详见本书卷十）
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，肢节烦疼，
为外证未去，不可攻里，与柴胡桂枝汤以和解之。
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，往来寒热心烦者，
此为未解也，柴胡桂枝干姜汤主之。
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，但头汗出，往来寒热
心烦者，即邪气犹在半表半里之间，为未解也。胸胁满，微结，寒热心烦者，邪在半
表半里之间也。小便不利而渴者，汗下后，亡津液内燥也。若热消津液，令小便不利而渴者，其人必呕，今
渴而不呕，知非里热也。伤寒汗出则和，今但头汗出而余处无汗者，津液不足而
阳虚于上也。与柴胡桂枝干姜汤，以解表里之邪，复津液而助阳也。
柴胡桂枝干姜汤方∶
柴胡（半斤。苦平） 桂枝（三两，去皮。味辛热） 干姜（三。医统本作二两。味辛热） 栝蒌根（四两。
味苦寒） 黄芩（三两。苦味寒） 牡蛎（三，赵本医统本并作二两，熬。味咸寒） 甘草（二两，炙。味甘平）
《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、甘草之辛
甘，以散在表之邪；咸以软之，牡蛎之咸，以消胸胁之满；辛以润之，干姜之辛，以
固阳虚之汗；津液不足而为渴，苦以坚之，栝蒌之苦，以生津液。
上七味，以水一斗二升，煮取六升，去滓，再煎，取三升，温服一升，日三服。初服微烦，复服汗出，便愈。
伤寒五六日，头汗出，微恶寒，手足冷，心下满，口不欲食，大便硬，脉细者，此为阳微结，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，此为半在里半在外也。脉虽沉
紧，不得为少阴病，所以然者，阴不得有汗，今头汗出，故知非少阴也，可与小柴胡汤。设不了了者，得屎而解。
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，口不欲食，大便硬，脉
细者，邪结于里也。大便硬为阳结，此邪热虽传于里，然以外带表邪，则热结犹浅，故曰阳微结。脉沉虽为在
里，若纯阴结，则更无头汗恶寒之表证。诸阴脉皆至颈胸中而还，不上循头，今头汗出，知非少阴
也。与小柴胡汤，以除半表半里之邪。服汤已，外证罢，而不了了者，为里热未除，与汤取其微利，则愈，故
云得屎而解。
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。此虽已下之，不为
逆，必蒸蒸而振，却发热汗出而解。若心下满，而硬痛者，此为结胸也，大陷胸汤主之；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。以他药下之，柴胡证不
罢者，不为逆，却与柴胡汤则愈。若下后，邪气传里者，邪在半表半里，则阴阳俱有邪。至于下后，邪气传里，
亦有阴阳之异，若下后，阳邪传里者，则结于胸中为结胸，以胸中为阳受气之分，与大陷胸
汤以下其结；阴邪传里者，则留于心下为痞，以心下为阴受气之分，与半夏泻心汤以通其痞。经曰∶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。此之谓也。
半夏泻心汤方∶
半夏（半升。赵本注∶“一方用半夏一升”，洗。味辛平） 黄芩（味苦寒） 干姜（味辛热） 人参（以
上各三两。味甘温） 黄连（一两。味苦寒） 大枣（十二枚，擘。味温甘。医统本作甘温） 甘草（三两，
炙。味甘平）
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，以泻（医统本作“泄”）痞热；
脾欲缓，急食甘以缓之，人参、甘草、大枣之甘，以缓之。
上七味，以水一斗，煮取六升，去滓，再煮，（赵本作“煎”）取三升，温服一升，日三服。
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，结于胸中为结胸，
心下硬；少阳里邪，乘虚下干肠胃，遂利不止。若邪结阴分，则饮食如故，而为
脏结；此为阳邪内结，故水浆不下而心烦。
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；浮不入里，
而紧入里者，（医统本有“为”字）阴邪入里，则作痞。
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，引胁下痛，
干呕，短气，汗出，不恶寒者，此表解里未和也，十枣汤主之。
下利，呕逆，里受邪也。邪在里者，可下，亦须待表解者，乃可攻之。其人 汗出，发作有时，不恶寒
者，表已解也；头痛，心下痞，硬满，引胁下痛，干呕，短气者，邪热内蓄而有伏
饮，是里未和也，与十枣汤，下热逐饮。
十枣汤方∶
芫花（熬。味辛苦。医统本作“温”） 甘遂（味苦寒） 大戟（味苦寒） 大枣（十枚，擘。味甘温，
赵本无大枣一药）
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；甘者，脾
之味也。大枣之甘者，益土而胜水。
右上（赵本无“上”字）三味等分，各别捣为散。以水一升半，先煮大枣肥者十枚，取八合，去滓，内
药末。强人服一钱匕，羸人服半钱，温服之，平旦服。若下少病不除者，明日更服，加半钱，得快下利后，
糜粥自养。
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，复加烧针，因胸
烦，面色青黄，肤 者，难治；今色微黄，手足温者，易愈。
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，邪内陷，传于
心下为痞。发汗表虚为竭阳，下之里虚为竭阴；表证罢为无阳，里有痞为阴独。
又加烧针，虚不胜火，火气内攻，致胸烦也。伤寒之病，以阳为主，其人面色青，肤肉 动者，阳气大虚，
故云难治；若面色微黄，手足温者，即阳气得复，故云易愈。
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，关脉沉者，实热也。心下痞，按之濡；其脉关上浮者，虚热也，大黄黄连汤，以导其虚热。
大黄黄连泻心汤方∶
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。但以麻
沸汤渍服者，取其气薄而泄虚热。
上二味，以麻沸汤二升渍之，须臾绞去滓，分温再服。
心下痞而复恶寒，汗出者，附子泻心汤主之。（赵本有“附子泻心汤方”详见卷十）
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。（赵本有“一
方云∶忍之，一日乃愈”九字）
本因下后成痞，当与泻心汤除之；若服之痞不解，其人渴而口燥烦，小便不利者，为水饮内蓄，津液不
行，非热痞也，与五苓散，发汗散水则愈。一方∶忍之，一日乃愈者，不饮水（医统本无“水”字）者，外
水不入，所停之水得行，而痞亦愈也。（医统本有“矣”字）
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，生姜泻心汤主之。
（赵本有“生姜泻心汤方”详见卷十）
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。《金匮要略》曰∶中焦气未和，不能消谷，故令噫。干噫、食臭者，胃虚而不杀谷
也。胁下有水气，腹中雷鸣，土弱不能胜水也。与泻心汤以攻痞，加生姜以益胃。
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。（
赵本有“甘草泻心汤方”详见卷十）
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。下利日数十行，谷不化，腹中
雷鸣者，下后里虚胃弱也。心下痞硬，干呕心烦，不得安者，胃中空虚，客气上逆也。与泻心汤以攻表，加甘
草以补虚。前以汗后胃虚，是外伤阳气，故加生姜；此以下后胃虚，是内损阴气，故加甘草。
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，利益甚。理
中者，理中焦，此利在下焦，赤石脂禹余粮汤主之。复利（赵本无“利”字）不止者，当利其小便。
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，医复以他药下之，又
虚其里，致利不止也。理中丸，脾胃虚寒下利者，服之愈。此以下焦虚，故与之，其利益甚。《圣济经》曰∶
滑则气脱，欲其收也。如开肠洞泄、便溺遗失，涩剂所以收之。此利由下焦不约，与赤石脂禹余粮汤以涩
洞泄。下焦主厘清浊，下利者，水谷不分也。若服涩剂，而利不止，当利小便，以分其气。
赤石脂禹余粮汤方∶
赤石脂（一斤，碎。味甘温） 禹（赵本禹上有“太一”二字）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（赵本作“右”）二味，以水六升，煮取二升，去滓，（赵本有“分温”二字）三服。
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。经脉动惕者，久而成痿。
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，正气当复，邪气
当罢，而心下痞，胁下痛，气上冲咽喉，眩冒者，正气内虚而不复，邪气留结而不去。经脉动惕者，经络之气虚
极，久则热气还经，必成痿弱。
伤寒发汗，若吐若下，解后，心下痞硬，噫气不除者，旋复代赭石（赵本无“石”字）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，与旋复代赭石汤降虚气而和胃。
旋复代赭石（赵本无“石”字）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） 半夏（半升，洗。味
辛温） 代赭石（赵本无“石”字，一两。味苦寒） 大枣（十二枚，擘。甘温） 甘草（三两，炙。味甘平）
硬则气坚，咸味可以软之，旋复之咸，以软痞硬。虚（医统本作“怯”）则气浮，重剂可以镇之，代赭石
之重，以镇虚逆。辛者散也，生姜、半夏之辛，以散虚痞。甘者缓也，人参、甘草、大枣之甘，以补胃弱。
上件（赵本无“件”字）七味，以水一斗，煮取六升，去滓，再煎，取三升，温服一升，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。（赵本有“麻黄杏子甘草
石膏汤方”详见卷三）
前第三卷二十六证云∶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。汗下虽殊，
既不当损正气则一，邪气所传既同，遂用一法治之。经所谓若发汗、若下、若吐后（医统本有“者”字）是矣。
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，桂枝人参汤主之。
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。若表解而下利，心下痞者
，可与泻心汤，若不下利，表不解而心下痞者，可先解表而后攻痞。以表里不解，故与桂枝人参汤和里解表。
桂枝人参汤方∶
桂枝（四两。赵本有“别切”二字，去皮。味辛热） 甘草（四两，炙。味甘平） 白术（三两。味甘平）
人参（三两。味甘温） 干姜（三两。味辛热）
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、甘草于理中汤也。
上五味，以水九升，先煮四味，取五升，内桂更煮，取三升，（赵本有“去滓”二字）温服一升，日再、
夜一服。
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。解表宜桂枝汤，
攻痞宜大黄黄连泻心汤。
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。因表不解而下之，为心
期门穴会扰动营气，因为营气产生于中焦。《脉经》说：“不要损伤胃气以及上、中二焦的功能，病必定自愈”，这难道是指药物而言，而不是指针刺吗？
伤寒病程到了六七天，出现发热、轻微怕冷，肢体关节烦扰疼痛，轻微呕吐，心下部有支撑感且结聚，表证仍未解除的，用柴胡桂枝汤主治。（赵开美本没有“加”字，“柴胡桂枝汤方”详见本书卷十）
伤寒六七天，是邪气应当传入里的时期。“支”意为散乱。呕吐且心下部结聚，属于里证，按法应当攻下治里。但发热、轻微怕冷、肢体关节烦疼，说明表证未去，不可攻里，给予柴胡桂枝汤来和解表里。
伤寒五六天，已经发汗却又用了泻下法，出现胸胁胀满、轻微结滞，小便不通利，口渴但不呕吐，只有头部出汗，寒热往来且心烦的，这是病邪未解，用柴胡桂枝干姜汤主治。
伤寒五六天，经过发汗和泻下之后，邪气应当解除。现在出现胸胁胀满、轻微结滞，小便不利，口渴但不呕吐，只有头部出汗，寒热往来且心烦，这说明邪气仍然停留在半表半里之间，属于病未解。胸胁胀满、轻微结滞、寒热往来且心烦，是邪气在半表半里之间。小便不利且口渴，是因为发汗和泻下后，津液耗损导致体内干燥。如果是因为热邪消耗津液导致小便不利而口渴，病人一定会呕吐，现在口渴却不呕吐，可知不是里热。伤寒发汗后通常周身调和，现在只有头部出汗而身体其他部位无汗，是因为津液不足且上部阳气虚弱。给予柴胡桂枝干姜汤，以解除表里之邪，恢复津液并辅助阳气。
柴胡桂枝干姜汤方：
柴胡（半斤。性味苦平） 桂枝（三两，去皮。性味辛热） 干姜（三[两]。医统本作二两。性味辛热） 栝蒌根（四两。性味苦寒） 黄芩（三两。性味苦寒） 牡蛎（三两，赵本、医统本作二两，煅烧。性味咸寒） 甘草（二两，蜜炙。性味甘平）
《内经》说：“内热炽盛，用苦味药发散。”柴胡、黄芩的苦味，用来解除传入里的邪气；辛甘发散属阳，桂枝、甘草的辛甘，用来发散在表的邪气；咸味能软坚，牡蛎的咸味，用来消除胸胁的胀满；辛味能润燥，干姜的辛味，用来固摄因阳虚导致的汗出；津液不足而口渴，苦味能坚阴，栝蒌根的苦味，用来生津液。
以上七味药，用水一斗二升，煮取六升，去掉药渣，再次煎煮，取三升，每次温服一升，每日三次。初次服用后感觉轻微心烦，再次服用后出汗，病就好了。
伤寒五六天，头部出汗，轻微怕冷，手脚冰凉，心下部胀满，口不想吃东西，大便干硬，脉象细的，这叫“阳微结”，一定既有表证又有里证。脉沉，也主里证。出汗是阳气微弱，假如是纯阴结，就不会再有外部症状，全部邪气都在里，这叫一半在里一半在表。脉虽然沉紧，但不能诊断为少阴病，之所以这样，是因为阴证不得有汗，现在头部出汗，所以知道不是少阴病，可以给予小柴胡汤。如果服药后仍觉得不舒服，通过排便就能解除。
伤寒五六天，是邪气应当传入里的时期，头部出汗、轻微怕冷，说明表证仍未解除。手脚冰凉、心下部胀满、口不想吃东西、大便干硬、脉象细，是邪气结滞在里。大便干硬为阳结，此邪热虽然传入里，但因为外带表邪，所以热结尚浅，故称为“阳微结”。脉沉虽主在里，如果是纯阴结，就不会再有头部出汗、恶寒等表证。所有阴脉都到达颈胸部就返回，不上行循行至头部，现在头部出汗，知道不是少阴病。给予小柴胡汤，以清除半表半里的邪气。服药后，如果表证消失但仍觉不舒服，是因为里热未除，给予汤药使其轻微通利大便，病就好了，所以说“得屎而解”。
伤寒五六天，呕吐且发热的，具备柴胡汤证，却用其他药物泻下，如果柴胡证仍在，再次给予柴胡汤。这虽然已经用过泻下法，但不算误治，病人必定会出现蒸蒸然振栗，随后发热出汗而病解。如果心下部胀满且坚硬疼痛，这叫结胸，用大陷胸汤主治；只是胀满而不疼痛的，这叫痞证，不能用柴胡汤，适宜用半夏泻心汤。
伤寒五六天，邪气在半表半里的时期；呕吐且发热，是邪气在半表半里的证候，这就是柴胡证具备。用其他药物泻下后，柴胡证未罢，不算误治，再次给予柴胡汤就会痊愈。如果泻下后，邪气传入里，邪气在半表半里时，阴阳都有邪气。至于泻下后，邪气传入里，也有阴阳的区别，如果泻下后，阳邪传入里，则结聚在胸中成为结胸，因为胸中是阳气受气的部位，给予大陷胸汤以下其结聚；阴邪传入里，则留驻在心下成为痞证，因为心下是阴气受气的部位，给予半夏泻心汤以疏通痞塞。经文说：“病发于阳而反用泻下法，热邪内入因而作成结胸；病发于阴而反用泻下法，因而作成痞证。”说的就是这种情况。
半夏泻心汤方：
半夏（半升。赵本注：“一方用半夏一升”，洗净。性味辛平） 黄芩（性味苦寒） 干姜（性味辛热） 人参（以上各三两。性味甘温） 黄连（一两。性味苦寒） 大枣（十二枚，掰开。性味甘温。医统本作甘温） 甘草（三两，蜜炙。性味甘平）
辛味入肺而发散气机，半夏的辛味，用来消散结聚之气；苦味入心而泄热，黄芩、黄连的苦味，用来泻除痞证的熱邪；脾脏喜欢缓和，紧急时用甘味食物来缓和它，人参、甘草、大枣的甘味，用来缓和脾气。
以上七味药，用水一斗，煮取六升，去掉药渣，再次煎煮（赵本作“煎”），取三升，每次温服一升，每日三次。
太阳病与少阳病同时发病，反而用泻下法，造成结胸，心下部坚硬，腹泻不止，水浆不能入口，病人心中烦躁。
太阳少阳并病，是邪气在半表半里，反而用泻下法，两经的邪气乘虚而入，太阳表邪入里，结聚在胸中成为结胸，心下部坚硬；少阳里邪，乘虚下行干扰肠胃，于是腹泻不止。如果邪气结聚在阴分，则饮食如常，而为脏结；这是阳邪内结，所以水浆不能入口且心中烦躁。
脉浮而紧，却反而用泻下法，紧脉反而入里，则形成痞证。按压时柔软，这只是气痞而已。
浮脉主伤阳，紧脉主伤阴，应当发汗，却反而用泻下法。如果浮脉入里，是阳邪入里，则形成结胸；如果浮脉不入里，而紧脉入里者（医统本有“为”字），阴邪入里，则形成痞证。
太阳中风病，伴有腹泻，呕逆，表证已解的，才可以攻下。病人头汗出，发作有定时，头痛，心下部痞塞，硬满，牵引胁下疼痛，干呕，呼吸短促，汗出，不怕冷的，这是表已解而里未和，用十枣汤主治。
腹泻，呕逆，是里部受邪。邪在里，可以用下法，但也必须等待表证解除后，才可以攻下。病人头汗出，发作有定时，不怕冷，说明表已解；头痛，心下部痞塞，硬满，牵引胁下疼痛，干呕，呼吸短促，是邪热内蓄且有伏饮，这是里未和，给予十枣汤，泻热逐饮。
十枣汤方：
芫花（煅烧。性味辛苦。医统本作“温”） 甘遂（性味苦寒） 大戟（性味苦寒） 大枣（十枚，掰开。性味甘温，赵本无大枣一味药）
辛味能发散，芫花的辛味，用来发散水饮；苦味能泄降，甘遂、大戟的苦味，用来泄下水邪。水，由肾所主；甘味，是脾的味道。大枣的甘味，能补益脾胃从而克制水邪。
以上（赵本无“上”字）三味药，等分，分别捣碎成散剂。用水一升半，先煮肥大红枣十枚，取八合，去掉药渣，加入药末。体质强壮的人服一钱匕，体弱的人服半钱，温服，清晨服用。如果泻下少且病不除，第二天再服，增加半钱，得到快速腹泻后，喝稀粥自我调养。
太阳病，医生发汗，于是出现发热怕冷，接着又用泻下法，导致心下部痞塞，表里俱虚，阴阳之气都衰竭，没有阳气则阴气独存，再加上用烧针治疗，导致胸中烦躁，面色青黄，皮肤肌肉跳动，难治；如果面色微黄，手足温暖，容易治愈。
太阳病，因为发汗，于是出现发热怕冷，这是外部阳气虚弱，邪气未能去除，接着又用泻下法，又使内部虚弱，表虚，邪气内陷，传于心下成为痞证。发汗导致表虚是竭阳，泻下导致里虚是竭阴；表证消失为无阳，里有痞塞为阴独。
又加上烧针，正气虚弱不能耐受火气，火气内攻，导致胸中烦躁。伤寒病，以阳气为主，如果病人面色青，皮肤肌肉跳动，是阳气大虚，所以说难治；如果面色微黄，手足温暖，就是阳气得以恢复，所以说容易治愈。
心下部痞塞，按压时柔软，脉象关部浮的，用大黄黄连泻心汤主治。
心下部硬，按压疼痛，关脉沉的，是实热。心下部痞塞，按压柔软；脉象关部浮的，是虚热，大黄黄连汤，用来引导泻除心下的虚热。
大黄黄连泻心汤方：
大黄（二两。性味苦寒） 黄连（一两。性味苦寒）
《内经》说：“火热受邪，心病由此产生。”苦味入心，寒性能除热。大黄、黄连的苦寒，用来导泻心下的虚热。只用麻沸汤浸泡服用的原因，是取其气味轻薄以泄除虚热。
以上两味药，用麻沸汤二升浸泡它们，一会儿后绞去药渣，分两次温服。
心下部痞塞而又怕冷、出汗的，用附子泻心汤主治。（赵本有“附子泻心汤方”详见卷十）
心下部痞塞，是虚热内伏；怕冷出汗，是阳气外虚。给予泻心汤攻痞，加附子以固护阳气。
本来因为泻下导致心下部痞塞，给予泻心汤；痞塞不解，病人口渴且口燥心烦，小便不利的，用五苓散主治。（赵本有“一方云：忍之，一日乃愈”九个字）
本来因泻下后形成痞证，应当用泻心汤清除；如果服药后痞塞不解，病人口渴且口燥心烦，小便不利，这是水饮内蓄，津液不行，不是热痞，给予五苓散，发汗散水则痊愈。一方说：忍住口渴，一天就会痊愈，是不饮水（医统本无“水”字），外部水液不入，所停之水得以运行，痞塞也就痊愈了。（医统本有“矣”字）
伤寒发汗后，病解了，但胃中不和，心下部痞塞坚硬，干噫气，食物腐败的气味，胁下有水气，腹中雷鸣般作响且腹泻的，用生姜泻心汤主治。（赵本有“生姜泻心汤方”详见卷十）
胃是津液的主宰，阳气的根本。大汗出后，外部津液亡失，胃中空虚，客气上逆，导致心下部痞塞坚硬。《金匮要略》说：“中焦气机未和，不能消化谷物，所以令人嗳气。”干噫气、有食物臭味，是胃虚而不能消化谷物。胁下有水气，腹中雷鸣，是土弱不能胜水。给予泻心汤以攻痞，加生姜以益胃。
伤寒或中风，医生反而用泻下法，病人腹泻，每天几十次，完谷不化；腹中雷鸣，心下部痞塞坚硬且胀满，干呕，心烦不得安宁。医生见心下部痞塞，认为病邪未尽，再次用泻下法，痞塞更加严重，这不是结热，只是因为胃中虚，客气上逆，所以使心下部变硬，用甘草泻心汤主治。（赵本有“甘草泻心汤方”详见卷十）
伤寒中风，是指伤寒或者中风。邪气在表，医生反而用泻下法，使肠胃虚弱而气机内陷。腹泻每天几十次，完谷不化，腹中雷鸣，是泻下后里虚胃弱。心下部痞塞坚硬，干呕心烦，不得安宁，是胃中空虚，客气上逆。给予泻心汤以攻邪，加甘草以补虚。之前因发汗后胃虚，是外伤阳气，所以加生姜；这里因泻下后胃虚，是内损阴气，所以加甘草。
伤寒服用汤药后，腹泻不止，心下部痞塞坚硬。服用泻心汤后，又用其他药物泻下，腹泻不止，医生用理中丸给予治疗，腹泻更严重。理中丸是调理中焦的，此腹泻在下焦，用赤石脂禹余粮汤主治。如果腹泻仍不止，应当通利小便。
伤寒服用汤药泻下后，腹泻不止，且心下部痞塞坚硬，是气虚而客气上逆，给予泻心汤攻痞则痞塞可愈，医生又用其他药物泻下，又使里虚，导致腹泻不止。理中丸，适用于脾胃虚寒引起的腹泻，服用后会痊愈。此处因下焦虚，所以给予理中丸，腹泻反而更严重。《圣济经》说：“滑脱则气散，需要收敛。如肠洞泄、大小便失禁，涩剂用来收敛它。”此腹泻由于下焦约束无力，给予赤石脂禹余粮汤以涩止洞泄。下焦主管分清泌浊，下利是水谷不分。如果服用涩剂后，腹泻仍不止，应当通利小便，以分别气机。
赤石脂禹余粮汤方：
赤石脂（一斤，捣碎。性味甘温） 禹（赵本禹上有“太一”二字）余粮（一斤，捣碎。性味甘平）
《本草》说：“涩可去脱，石脂的涩味用来收敛它；重可去怯，余粮的重味用来镇固。”
以上（赵本作“右”）两味药，用水六升，煮取二升，去掉药渣（赵本有“分温”二字），分三次服用。
伤寒经过吐、下后又发汗，出现虚烦，脉象非常微弱。到了八九天，心下部痞塞坚硬，胁下疼痛，气上冲咽喉，眩晕冒昧。经脉跳动不安，时间久了会形成痿证。
伤寒经过吐、下后又发汗，则表里之气都虚弱，虚烦，脉象非常微弱，是正气内虚，邪气独存。到了七八天，正气应当恢复，邪气应当罢退，但出现心下部痞塞，胁下疼痛，气上冲咽喉，眩晕冒昧，是正气内虚而不能恢复，邪气留结不去。经脉跳动不安，是经络之气极度虚弱，久了热气返还经络，必然形成痿弱。
伤寒发汗，或者吐、或者下，病解后，心下部痞塞坚硬，嗳气不止的，用旋复代赭石汤（赵本无“石”字）主治。
大邪虽然已解，但因为曾经发汗、吐、下，胃气虚弱而未调和，虚气上逆，所以心下部痞塞坚硬，嗳气不止，给予旋复代赭石汤以降虚气和胃。
旋复代赭石汤（赵本无“石”字）方：
旋复花（三两。性味咸温） 人参（二两。性味甘温） 生姜（五两，切。性味辛温） 半夏（半升，洗净。性味辛温） 代赭石（赵本无“石”字，一两。性味苦寒） 大枣（十二枚，掰开。甘温） 甘草（三两，蜜炙。性味甘平）
硬则气坚，咸味可以软坚，旋复花的咸味，用来软化痞硬。虚（医统本作“怯”）则气浮，重剂可以镇潜，代赭石的重量，用来镇潜虚逆之气。辛味能散，生姜、半夏的辛味，用来消散虚痞。甘味能缓，人参、甘草、大枣的甘味，用来补益胃弱。
以上（赵本无“件”字）七味药，用水一斗，煮取六升，去掉药渣，再次煎煮，取三升，每次温服一升，每日三次。
泻下后，不可再用桂枝汤。如果出汗且喘，没有大热的，可以给予麻黄杏子甘草石膏汤。（赵本有“麻黄杏子甘草石膏汤方”详见卷三）
前第三卷第二十六证说：发汗后，不可再用桂枝汤。出汗且喘，没有大热的，与此证治法相同。汗法和下法虽然不同，既然都不应当损伤正气是一样的，邪气所传也是一样的，于是用同一法治之。经文所说的“若发汗、若下、若吐后”就是这样。
太阳病，外部症状未除却多次用泻下法，于是协热而利。腹泻不止，心下部痞塞坚硬，表里同病的，用桂枝人参汤主治。
外部症状未除却多次用泻下法，是双重损伤内部，邪热乘虚而入，里虚协热，于是腹泻不止且心下部痞塞。如果表解而下利，心下部痞塞的，可与泻心汤；如果不下利，表不解而心下部痞塞的，可先解表而后攻痞。因为表里同病，所以给予桂枝人参汤以和里解表。
桂枝人参汤方：
桂枝（四两。赵本有“别切”二字，去皮。性味辛热） 甘草（四两，蜜炙。性味甘平） 白术（三两。性味甘平） 人参（三两。性味甘温） 干姜（三两。性味辛热）
表未解，用辛味发散；里不足，用甘味缓和。这是因为里气大虚，表里同病，所以在理中汤中加入桂枝、甘草。
以上五味药，用水九升，先煮前四味，取五升，加入桂枝再煮，取三升（赵本有“去滓”二字），温服一升，白天两次，晚上一次服用。
伤寒大泻下后，又发汗，心下部痞塞，怕冷的，是表证未解，不可攻痞，应当先解表，表解了才可以攻痞。解表适宜用桂枝汤，攻痞适宜用大黄黄连泻心汤。
大泻下后，又发汗，表里之邪应当都已解除。现在心下部痞塞且怕冷，是表里之邪都不解。因为表不解而用泻下法，导致心下部痞塞……
The Qimen acupoint disturbs Ying (Nutrient) Qi, because Ying Qi originates from the Middle Jiao. The *Mai Jing* (Pulse Classic) states: "Do not damage the Stomach Qi and the functions of the Upper and Middle Jiaos; the illness will surely resolve on its own." Does this refer to medication rather than acupuncture?
In Shaoyang disease, after six or seven days, if there is fever, slight aversion to cold, irritative pain in the limbs and joints, slight vomiting, a sensation of support and knotting in the epigastrium, and the exterior syndrome has not yet resolved, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) is the primary treatment. (The Zhao edition omits the character "Jia" [Add]; the formula for Chaihu Guizhi Tang is detailed in Volume 10 of this book.)
Six or seven days into Shaoyang disease is the time when pathogenic factors should transmit inward. "Zhi" [Support] means scattered. Vomiting with knotting in the epigastrium constitutes an interior syndrome, which by law requires purgation. However, fever, slight aversion to cold, and irritative pain in the limbs and joints indicate that the exterior syndrome remains; therefore, interior purgation is contraindicated. One should administer Chaihu Guizhi Tang to harmonize the condition.
Five or six days into Shaoyang disease, if sweating has already been induced followed by purgation, and symptoms include fullness in the chest and hypochondrium, slight knotting, difficulty in urination, thirst without vomiting, only sweating on the head, alternating chills and fever, and irritability, this indicates the pathogen has not yet resolved. Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction) is the primary treatment.
Five or six days into Shaoyang disease, after sweating and purgation have been performed, the pathogen should theoretically be resolved. The presence of fullness in the chest and hypochondrium, slight knotting, difficulty in urination, thirst without vomiting, only sweating on the head, alternating chills and fever, and irritability indicates that the pathogen remains between the half-exterior and half-interior, signifying unresolved illness. Fullness in the chest and hypochondrium, slight knotting, alternating chills and fever, and irritability signify pathogenic factors between the half-exterior and half-interior. Difficulty in urination accompanied by thirst results from the depletion of body fluids and internal dryness following sweating and purgation. If heat consumes body fluids causing difficulty in urination and thirst, vomiting would necessarily occur. Since there is thirst but no vomiting, it is known not to be interior heat. In Shaoyang disease, sweating usually leads to systemic harmony; however, sweating only on the head while the rest of the body is dry indicates insufficient body fluids and deficiency of Yang Qi in the upper portion. Chaihu Guizhi Ganjiang Tang is administered to resolve pathogens in both the exterior and interior, restore body fluids, and assist Yang Qi.
**Chaihu Guizhi Ganjiang Tang Formula:**
Chai Hu (Radix Bupleuri), half jin. Nature and flavor: Bitter, neutral.
Gui Zhi (Caulis Cinnamomi), three liang, bark removed. Nature and flavor: Pungent, hot.
Gan Jiang (Rhizoma Zingiberis Preparatum), three [liang]. The Yitong edition makes it two liang. Nature and flavor: Pungent, hot.
Gua Lou Gen (Radix Trichosanthis), four liang. Nature and flavor: Bitter, cold.
Huang Qin (Radix Scutellariae), three liang. Nature and flavor: Bitter, cold.
Mu Li (Concha Ostreae), three liang. The Zhao and Yitong editions make it two liang, calcined. Nature and flavor: Salty, cold.
Gan Cao (Radix Glycyrrhizae Preparata), two liang, honey-fried. Nature and flavor: Sweet, neutral.
The *Nei Jing* (Inner Canon) states: "When heat dominates internally, use bitter flavors to disperse." The bitterness of Chai Hu and Huang Qin resolves pathogens that have transmitted inward. Pungent and sweet flavors promote dispersal and belong to Yang; the pungency and sweetness of Gui Zhi and Gan Cao disperse pathogens remaining in the exterior. Salty flavors soften hardness; the salinity of Mu Li eliminates fullness in the chest and hypochondrium. Pungent flavors moisten; the pungency of Gan Jiang secures sweat caused by Yang deficiency. Thirst due to insufficient body fluids is addressed by bitter flavors that firm Yin; the bitterness of Gua Lou Sheng (Radix Trichosanthis) generates body fluids.
Take the above seven ingredients, add twelve sheng of water, decoct to obtain six sheng, remove the dregs, decoct again to obtain three sheng. Take one sheng warm, three times daily. After the first dose, slight irritability may occur; after subsequent doses, sweating ensues, and the patient recovers.
Five or six days into Shaoyang disease, if there is sweating on the head, slight aversion to cold, cold hands and feet, fullness in the epigastrium, desire not to eat, hard stools, and a fine pulse, this is called "slight Yang knotting." There must be both exterior and interior involvement. A deep pulse also indicates an interior condition. Sweating indicates slight Yang deficiency. If it were pure Yin knotting, there would be no exterior symptoms, as all pathogenic factors would be interior. This is described as being half interior and half exterior. Although the pulse is deep and tight, it cannot be diagnosed as Shaoyin disease. The reason is that Yin syndromes do not present with sweating; since there is sweating on the head, it is known not to be Shaoyin. Xiao Chai Hu Tang (Minor Bupleurum Decoction) may be given. If the patient still feels unwell after taking the medicine, resolution occurs through defecation.
Five or six days into Shaoyang disease is the time when pathogens should transmit inward. Sweating on the head and slight aversion to cold indicate the exterior has not yet resolved. Cold hands and feet, fullness in the epigastrium, desire not to eat, hard stools, and a fine pulse indicate pathogenic factors knotted in the interior. Hard stools constitute Yang knotting. Although the pathogenic heat has transmitted inward, because it is accompanied by exterior pathogenic factors, the heat knot is still shallow, hence termed "slight Yang knotting." Although a deep pulse indicates interior location, in pure Yin knotting, there would be no exterior symptoms such as sweating on the head or aversion to cold. All Yin meridians return at the neck and chest and do not ascend to the head. Since there is sweating on the head, it is known not to be Shaoyin. Xiao Chai Hu Tang is given to eliminate pathogens between the half-exterior and half-interior. After taking the decoction, if the exterior symptoms cease but the patient remains uncomfortable, it is because interior heat has not been cleared. Administering the decoction to induce mild purgation resolves the condition, hence it is said "resolution occurs with stool."
Five or six days into Shaoyang disease, vomiting and fever indicate that the Chai Hu syndrome is fully present. If other medications are used for purgation, and the Chai Hu syndrome persists, Chai Hu Tang should be readministered. Although purgation has been performed, this is not a counter-indication (error). The patient will likely experience trembling and shaking, followed by fever and sweating, leading to resolution. If the epigastrium is full, hard, and painful, this is Jie Xiong (Chest Binding), treated with Da Xian Xiong Tang (Major Expel the Chest Decoction). If it is merely full without pain, this is Pi (Glomus/Blockage); Chai Hu Tang is not appropriate, and Ban Xia Xie Xin Tang (Pinellia Heart-Draining Decoction) is suitable.
Five or six days into Shaoyang disease is the period when pathogens are between the half-exterior and half-interior. Vomiting and fever are signs of pathogens in the half-exterior and half-interior, constituting the Chai Hu syndrome. If purgation is used and the Chai Hu syndrome does not cease, it is not an error; readministering Chai Hu Tang leads to recovery. If, after purgation, pathogens transmit inward, while pathogens in the half-exterior and half-interior involve both Yin and Yang, transmission inward after purgation differs by Yin and Yang. If Yang pathogens transmit inward, they knot in the chest forming Jie Xiong (Chest Binding); because the chest is the region where Yang Qi receives energy, Da Xian Xiong Tang is used to purge the knot. If Yin pathogens transmit inward, they remain in the epigastrium forming Pi (Glomus); because the epigastrium is the region where Yin Qi receives energy, Ban Xia Xie Xin Tang is used to unblock the glomus. The Classics state: "Illness originating in Yang, if wrongly purged, heat enters and forms Chest Binding; illness originating in Yin, if wrongly purged, forms Glomus." This refers to the aforementioned scenario.
**Ban Xia Xie Xin Tang Formula:**
Ban Xia (Rhizoma Pinelliae Preparata), half sheng. The Zhao edition notes: "Another prescription uses one sheng of Ban Xia," washed. Nature and flavor: Pungent, neutral.
Huang Qin (Radix Scutellariae). Nature and flavor: Bitter, cold.
Gan Jiang (Rhizoma Zingiberis Preparatum). Nature and flavor: Pungent, hot.
Ren Shen (Radix Ginseng), three liang each of the above. Nature and flavor: Sweet, warm.
Huang Lian (Rhizoma Coptidis), one liang. Nature and flavor: Bitter, cold.
Da Zao (Fructus Jujubae), twelve pieces, broken open. Nature and flavor: Sweet, warm. The Yitong edition describes it as sweet and warm.
Gan Cao (Radix Glycyrrhizae Preparata), three liang, honey-fried. Nature and flavor: Sweet, neutral.
Pungent flavors enter the Lung and disperse Qi; the pungency of Ban Xia disperses knotted Qi. Bitter flavors enter the Heart and drain Heat; the bitterness of Huang Qin and Huang Lian drains the heat of the glomus. The Spleen desires relaxation; urgently, sweet foods are eaten to relax it. The sweetness of Ren Shen, Gan Cao, and Da Zao provides this relaxation.
Take the above seven ingredients, add one dou of water, decoct to obtain six sheng, remove the dregs, decoct again (the Zhao edition says "decoct") to obtain three sheng. Take one sheng warm, three times daily.
In Bing Bing (simultaneous) disease of Taiyang and Shaoyang, if purgation is wrongly applied, Jie Xiong (Chest Binding) forms, characterized by hardness in the epigastrium, incessant diarrhea, inability to take food or drink, and mental restlessness.
Bing Bing disease of Taiyang and Shaoyang involves pathogens in the half-exterior and half-interior. Wrongly applying purgation allows pathogens from both meridians to enter via deficiency. Taiyang exterior pathogens enter the interior and knot in the chest forming Jie Xiong, resulting in epigastric hardness. Shaoyang interior pathogens descend via deficiency to interfere with the intestines and stomach, causing incessant diarrhea. If pathogens knot in the Yin aspect, diet remains normal, resulting in Zang Jie (Visceral Binding); here, Yang pathogens knot internally, so food and drink cannot be taken, and mental restlessness occurs.
A floating and tight pulse, if wrongly purged, causes the tightness to enter the interior, forming Pi (Glomus). Upon palpation, it is soft, indicating it is merely Qi Pi (Qi Glomus).
Floating indicates injury to Yang; tight indicates injury to Yin. Sweating should be induced, but purgation was wrongly applied. If the floating pulse enters the interior, Yang pathogens enter the interior, forming Jie Xiong. If the floating pulse does not enter the interior, but the tight pulse enters the interior (the Yitong edition includes the character "wei" [is]), Yin pathogens enter the interior, forming Pi.
In Taiyang Wind Strike, if accompanied by diarrhea and vomiting/regurgitation, and the exterior is resolved, purgation may be applied. If the patient sweats on the head at specific times, has headache, epigastric glomus, hardness and fullness radiating to the hypochondrium, dry retching, shortness of breath, sweating, and no aversion to cold, this indicates the exterior is resolved but the interior is not harmonized. Shi Zao Tang (Ten Date Decoction) is the primary treatment.
Diarrhea and vomiting indicate interior pathogenic invasion. Pathogens in the interior can be purged, but one must wait for the exterior to resolve before attacking. Sweating on the head at specific times and lack of aversion to cold indicate the exterior is resolved. Headache, epigastric glomus, hardness and fullness radiating to the hypochondrium, dry retching, and shortness of breath indicate internal accumulation of pathogenic heat and latent fluid retention, meaning the interior is not harmonized. Shi Zao Tang is administered to purge heat and drive out fluid retention.
**Shi Zao Tang Formula:**
Yuan Hua (Flos Spatholobi), calcined. Nature and flavor: Pungent, bitter. The Yitong edition describes it as "warm."
Gan Sui (Radix Euphorbiae Kansui). Nature and flavor: Bitter, cold.
Da Ji (Radix Euphorbiae Pekinensis). Nature and flavor: Bitter, cold.
Da Zao (Fructus Jujubae), ten pieces, broken open. Nature and flavor: Sweet, warm. The Zhao edition omits Da Zao as an ingredient.
Pungent flavors disperse; the pungency of Yuan Hua disperses fluid retention. Bitter flavors drain; the bitterness of Gan Sui and Da Ji drains water. Water is governed by the Kidney; sweet is the flavor of the Spleen. The sweetness of Da Zao benefits Earth (Spleen) to overcome Water.
Take the above (the Zhao edition omits "Shang" [Above]) three ingredients in equal parts, each separately pounded into powder. Add one and a half sheng of water, first decoct ten large Da Zao, obtain eight ge, remove dregs, and add the medicinal powder. Strong individuals take one qian bi; weak individuals take half a qian bi. Take warm in the morning. If the purgation is insufficient and the illness persists, administer again the next day, increasing by half a qian bi. After rapid loose stools, nourish oneself with millet porridge.
In Taiyang disease, if the physician induces sweating, leading to fever and aversion to cold, and then applies purgation, epigastric glomus forms. Both exterior and interior are deficient; Yin and Yang Qi are exhausted. Without Yang, Yin stands alone. If moxibustion with burning needles is added, chest irritability ensues. If the complexion is greenish-yellow and skin/muscles twitch, the prognosis is difficult; if the complexion is slightly yellow and hands and feet are warm, recovery is easy.
In Taiyang disease, sweating leads to fever and aversion to cold, indicating external deficiency of Yang Qi and persistence of pathogens. Subsequent purgation further depletes the interior. Exterior deficiency allows pathogens to sink inward, transmitting to the epigastrium forming glomus. Sweating causing exterior deficiency exhausts Yang; purgation causing interior deficiency exhausts Yin. Resolution of exterior symptoms is "no Yang"; interior glomus is "Yin alone."
Adding burning needles, the deficient constitution cannot withstand fire; fire qi attacks inward, causing chest irritability. Shaoyang disease prioritizes Yang Qi. If the complexion is green and skin/muscles twitch, Yang Qi is greatly deficient, hence "difficult to treat." If the complexion is slightly yellow and hands and feet are warm, Yang Qi is restored, hence "easy to recover."
Epigastric glomus, soft upon palpation, with a floating pulse at the Guan position, is treated with Da Huang Huang Lian Xie Xin Tang (Rhubarb and Coptis Heart-Draining Decoction).
Hardness in the epigastrium with pain upon palpation and a deep Guan pulse indicates Excess Heat. Epigastric glomus, soft upon palpation, with a floating Guan pulse, indicates Deficient Heat. Da Huang Huang Lian Tang guides and drains the deficient heat in the epigastrium.
**Da Huang Huang Lian Xie Xin Tang Formula:**
Da Huang (Radix et Rhizoma Rhei), two liang. Nature and flavor: Bitter, cold.
Huang Lian (Rhizoma Coptidis), one liang. Nature and flavor: Bitter, cold.
The *Nei Jing* states: "When Fire-Heat receives pathogenic influence, Heart disease arises." Bitter flavors enter the Heart; Cold removes Heat. The bitter-cold nature of Da Huang and Huang Lian drains the deficient heat in the epigastrium. They are soaked in boiling water rather than decocted to utilize their thin qi to drain deficient heat.
Take the above two ingredients, soak in two sheng of boiling water for a moment, strain, and divide into two warm doses.
Epigastric glomus accompanied by aversion to cold and sweating is treated with Fu Zi Xie Xin Tang (Aconite Heart-Draining Decoction). (The Zhao edition contains the formula for Fu Zi Xie Xin Tang, detailed in Volume 10.)
Epigastric glomus indicates internal潜伏 (latent) deficient heat; aversion to cold and sweating indicate external deficiency of Yang Qi. Xie Xin Tang is used to attack the glomus, and Fu Zi is added to secure Yang.
Originally, glomus formed due to purgation; Xie Xin Tang was given. If the glomus does not resolve, and the patient experiences thirst, dry mouth, irritability, and difficulty urinating, Wu Ling San (Five-Ingredient Powder with Poria) is the primary treatment. (The Zhao edition adds nine characters: "One prescription says: Endure it, and it will resolve in one day.")
Originally, glomus formed after purgation and should be cleared with Xie Xin Tang. If the glomus does not resolve after administration, and the patient has thirst, dry mouth, irritability, and difficulty urinating, this indicates internal accumulation of fluid retention and non-circulation of body fluids, not Heat Glomus. Wu Ling San is administered to induce sweating and dissipate water, leading to recovery. One prescription states: "Endure [thirst], and it will resolve in one day." This applies to those who do not drink water; if external water does not enter, the retained water moves, and the glomus resolves. (The Yitong edition adds the character "yi" [particle]).
After Shaoyang disease sweating resolves, if the Stomach is disharmonious, presenting with hard epigastric glomus, dry belching, odor of food, fluid retention in the hypochondrium, borborygmus, and diarrhea, Sheng Jiang Xie Xin Tang (Fresh Ginger Heart-Draining Decoction) is the primary treatment. (The Zhao edition contains the formula for Sheng Jiang Xie Xin Tang, detailed in Volume 10.)
The Stomach is the master of body fluids and the root of Yang Qi. After heavy sweating, external loss of body fluids leaves the Stomach empty, allowing hostile Qi to rebel upward, causing hard epigastric glomus. The *Jin Gui Yao Lue* states: "If Middle Jiao Qi is not harmonious and cannot digest grain, belching occurs." Dry belching with food odor indicates Stomach deficiency and inability to digest grain. Fluid retention in the hypochondrium and borborygmus indicate Spleen weakness failing to control Water. Xie Xin Tang is used to attack the glomus, and Sheng Jiang is added to benefit the Stomach.
In Shaoyang or Wind Strike, if the physician wrongly applies purgation, the patient suffers diarrhea dozens of times daily with undigested food, borborygmus, hard and full epigastric glomus, dry retching, and irritability preventing peace. Seeing the epigastric glomus, the physician assumes incomplete pathology and purges again, worsening the glomus. This is not Heat Knotting, but Stomach deficiency with hostile Qi rebelling upward, causing hardness. Gan Cao Xie Xin Tang (Licorice Heart-Draining Decoction) is the primary treatment. (The Zhao edition contains the formula for Gan Cao Xie Xin Tang, detailed in Volume 10.)
Shaoyang or Wind Strike refers to either condition. Pathogens are in the exterior; wrong purgation weakens the intestines and stomach, causing Qi to sink inward. Diarrhea dozens of times daily with undigested food and borborygmus indicates interior deficiency and Stomach weakness post-purgation. Hard epigastric glomus, dry retching, and irritability indicate Stomach emptiness and hostile Qi rebellion. Xie Xin Tang attacks the pathogen, and Gan Cao tonifies deficiency. Previously, Stomach deficiency after sweating involved external injury to Yang Qi, so Sheng Jiang was added. Here, Stomach deficiency after purgation involves internal damage to Yin Qi, so Gan Cao is added.
After taking herbal medicine for Shaoyang disease, if diarrhea persists and the epigastrium is hard, and after taking Xie Xin Tang, further purgation with other drugs causes persistent diarrhea, and the physician administers Li Zhong Wan (Regulate the Middle Pill), the diarrhea worsens. Li Zhong regulates the Middle Jiao, but this diarrhea is in the Lower Jiao. Chi Shi Zhi Yu Yi Liang Tang (Red Halloysite and Hematite Decoction) is the primary treatment. If diarrhea persists, promoting diuresis is indicated.
After purgation for Shaoyang disease, persistent diarrhea and hard epigastric glomus indicate Qi deficiency and hostile Qi rebellion. Xie Xin Tang clears the glomus. Further purgation by the physician further weakens the interior, causing persistent diarrhea. Li Zhong Wan treats diarrhea due to Spleen-Stomach deficiency-cold. Here, Lower Jiao deficiency makes Li Zhong inappropriate, worsening diarrhea. The *Sheng Ji Jing* states: "Slippage indicates Qi escape, requiring astringency. For intestinal洞泄 (hole-like diarrhea) and incontinence, astringents are used to consolidate." This diarrhea results from Lower Jiao failure to constrain; Chi Shi Zhi Yu Yi Liang Tang astringes洞泄. The Lower Jiao governs separating clear from turbid; diarrhea indicates failure to distinguish water and grain. If astringents fail to stop diarrhea, promoting diuresis separates the Qi.
**Chi Shi Zhi Yu Yi Liang Tang Formula:**
Chi Shi Zhi (Halloysitum Rubrum), one jin, crushed. Nature and flavor: Sweet, warm.
Yu Yi Liang (Hematites), one jin, crushed. The Zhao edition places "Tai Yi" before "Yu". Nature and flavor: Sweet, neutral.
The *Ben Cao* states: "Astringents remove slippage; the astringency of Shi Zhi consolidates it. Heavy agents remove timidity; the heaviness of Yu Yi Liang stabilizes it."
Take the above (the Zhao edition uses "You" [Right]) two ingredients, add six sheng of water, decoct to obtain two sheng, remove dregs (the Zhao edition adds "fen wen" [divide warm]), and take in three doses.
After emesis, purgation, and sweating for Shaoyang disease, if vexation is deficient and the pulse is very faint, and after eight or nine days, hard epigastric glomus, hypochondriac pain, Qi rushing to the throat, dizziness, and tremors of the meridians occur, prolonged duration leads to Wei Syndrome (flaccidity).
Emesis, purgation, and sweating deplete both exterior and interior Qi, causing deficient vexation and a very faint pulse, indicating internal deficiency of righteous Qi and isolation of pathogenic factors. By the seventh or eighth day, righteous Qi should recover and pathogens subside. However, hard epigastric glomus, hypochondriac pain, Qi rushing to the throat, and dizziness indicate internal deficiency of righteous Qi failing to recover and lingering pathogenic knots. Tremors of the meridians indicate extreme deficiency of Qi in the channels; over time, returning heat in the channels leads to flaccidity.
After sweating, emesis, or purgation in Shaoyang disease, if the exterior resolves but hard epigastric glomus and persistent belching remain, Xuan Fu Dai Zhe Shi Tang (Inula and Magnetite Decoction) is the primary treatment. (The Zhao edition omits the character "Shi").
Although major pathogens are resolved, previous sweating, emesis, or purgation has weakened Stomach Qi and disrupted harmony. Deficient Qi rebels upward, causing hard epigastric glomus and persistent belching. Xuan Fu Dai Zhe Shi Tang descends deficient Qi and harmonizes the Stomach.
**Xuan Fu Dai Zhe Shi Tang Formula:**
Xuan Fu Hua (Flos Inulae), three liang. Nature and flavor: Salty, warm.
Ren Shen (Radix Ginseng), two liang. Nature and flavor: Sweet, warm.
Sheng Jiang (Rhizoma Zingiberis Recens), five liang, sliced. Nature and flavor: Pungent, warm.
Ban Xia (Rhizoma Pinelliae Preparata), half sheng, washed. Nature and flavor: Pungent, warm.
Dai Zhe Shi (Magnetitum), one liang. The Zhao edition omits "Shi". Nature and flavor: Bitter, cold.
Da Zao (Fructus Jujubae), twelve pieces, broken open. Sweet, warm.
Gan Cao (Radix Glycyrrhizae Preparata), three liang, honey-fried. Nature and flavor: Sweet, neutral.
Hardness implies firm Qi; salty flavors soften it. The salinity of Xuan Fu softens hard glomus. Deficiency implies floating Qi; heavy agents anchor it. The weight of Dai Zhe Shi anchors rebellious deficient Qi. Pungent flavors disperse; the pungency of Sheng Jiang and Ban Xia disperses deficient glomus. Sweet flavors moderate; the sweetness of Ren Shen, Gan Cao, and Da Zuo tonifies Stomach weakness.
Take the above (the Zhao edition omits "Jian" [Items]) seven ingredients, add one dou of water, decoct to obtain six sheng, remove dregs, decoct again to obtain three sheng. Take one sheng warm, three times daily.
After purgation, Guizhi Tang should not be administered again. If there is sweating and wheezing without significant heat, Ma Huang Xing Zi Gan Cao Shi Gao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) may be given. (The Zhao edition contains the formula for Ma Huang Xing Zi Gan Cao Shi Gao Tang, detailed in Volume 3.)
As stated in Case 26 of Volume 3: After sweating, Guizhi Tang should not be used again. Sweating with wheezing and absence of significant heat share the same treatment principle as this case. Although sweating and purgation differ, neither should damage righteous Qi, and the transmission of pathogens is identical; thus, the same treatment is applied. This aligns with the Classic statement: "After sweating, purging, or emesis..."
In Taiyang disease, if exterior symptoms persist and multiple purgations are applied,協熱利 (diarrhea accompanying heat) occurs. Persistent diarrhea, hard epigastric glomus, and simultaneous exterior-interior involvement are treated with Gui Zhi Ren Shen Tang (Cinnamon Twig and Ginseng Decoction).
Multiple purgations while exterior symptoms persist doubly damages the interior. Pathogenic heat enters via deficiency, causing interior deficiency with協熱 (accompanied heat), leading to persistent diarrhea and epigastric glomus. If the exterior resolves with diarrhea and glomus, Xie Xin Tang may be used. If there is no diarrhea but the exterior is unresolved with glomus, resolve the exterior first, then attack the glomus. Due to simultaneous exterior-interior involvement, Gui Zhi Ren Shen Tang harmonizes the interior and resolves the exterior.
**Gui Zhi Ren Shen Tang Formula:**
Gui Zhi (Caulis Cinnamomi), four liang. The Zhao edition notes "separately sliced," bark removed. Nature and flavor: Pungent, hot.
Gan Cao (Radix Glycyrrhizae Preparata), four liang, honey-fried. Nature and flavor: Sweet, neutral.
Bai Zhu (Rhizoma Atractylodis Macrocephalae), three liang. Nature and flavor: Sweet, neutral.
Ren Shen (Radix Ginseng), three liang. Nature and flavor: Sweet, warm.
Gan Jiang (Rhizoma Zingiberis Preparatum), three liang. Nature and flavor: Pungent, hot.
For unresolved exterior, pungent flavors disperse; for interior insufficiency, sweet flavors moderate. Due to severe interior deficiency and simultaneous exterior-interior involvement, Gui Zhi and Gan Cao are added to Li Zhong Tang.
Take the above five ingredients, add nine sheng of water, first decoct the four ingredients to obtain five sheng, add Gui Zhi, decoct to obtain three sheng (the Zhao edition adds "remove dregs"). Take one sheng warm, twice during the day and once at night.
After severe purgation and subsequent sweating in Shaoyang disease, if epigastric glomus and aversion to cold occur, the exterior is unresolved. Do not attack the glomus; resolve the exterior first. Once the exterior is resolved, attack the glomus. Guizhi Tang is suitable for resolving the exterior; Da Huang Huang Lian Xie Xin Tang is suitable for attacking the glomus.
Severe purgation followed by sweating should theoretically resolve both exterior and interior pathogens. However, epigastric glomus with aversion to cold indicates that both exterior and interior pathogens remain unresolved. Applying purgation due to unresolved exterior leads to epigastric glomus...