满极，方敢投承气。至于口不渴，兼有一毫厥逆清谷，误投承气必危。
唇甲青 或问唇甲青，何以是寒证？曰∶盖指得血而能握，唇得血而色赤，今
寒中之血凝，不能濡润，唇甲色变，况色之赤者为热，青者为寒，急温无疑。或曰∶
阳厥亦唇甲青，别之如何？曰∶阳厥热深也，热极反厥。然唇甲似青实非青也，乃
紫黑色，唇虽紫口必渴，与之水则饮，启唇视之，咽喉如煤，指甲虽紫尚温。若直
中者，唇青而口和，甲青而厥逆，寒热之辨，相隔千里，司命者凛之毋急。
小便清长 或问小便清长，何为内有寒乎∶曰∶夫内热则便赤短少，内寒则便
清且长。或曰∶邪在皮毛，未入腑者，亦便清长，何以别之？曰∶邪在表为表病里
和，言便如常，今谓之曰清长，则异于常时耳。要知直中，小便清长，必见厥逆清
谷，外无表证为异。若有头痛发热，而小便清长如旧者，则又属表矣。
以上俱直中寒证，当救里。
少阴似太阳 有少阴直中发热。似太阳发热，何以辨之？曰∶盖太阳发热，必
有头痛，脉浮而紧，宜麻黄汤。少阴属里寒，不当发热，今发热何也？乃表里俱伤。
惟表有寒故发热，虽发热脉必沉迟，或下利清谷，当用麻黄、细辛以发表，附子以
温中，令表里寒邪两解。若有头痛发热而脉重紧，即是太阳表证，又何以为少阴热
乎？经云∶阴证少头痛，设有头痛发热，兼之下利清谷，即是两感于寒也。而非少阴热矣。
阳明经证似腑证 有阳明经证误作阳
明腑证者，如何辨？盖阳明经病，表病里和也，阳明腑病，里病表和也，经腑同见
者，表里俱病也。经则目痛鼻干，无便闭、谵语、恶热等证，此不可下。腑则恶热、自
汗、便结，无头痛、恶风、恶寒，此不可汗。然汗解者，汗阳明之经，而不汗阳明
之腑，下者下阳明之腑，而非下阳明之经也。
表证自汗似里证自汗 有表汗认为里汗，何以别之？盖表病自汗，太阳伤风也，
里病自汗，热邪传腑也。风者善行数变，性主舒畅万物，人身腠理开，故自汗必恶风、
头痛、发热，其脉浮而缓；若里证自汗，因热传腑，熏蒸鼎沸，亦腠理开而自汗，恶
热甚，外无大表证，其脉洪而有力。一恶风、脉浮而缓，一恶热、脉洪有力，须细察之。
表证身痛似直中身痛 表病身痛似直中身痛，从何分别？盖表证身痛，太阳伤
寒也；里证身痛，寒邪直中三阴也。名曰表，则头痛发热；名曰阴，又何有头痛、发
热。表证身痛者重表之，直中身痛者重温之。皆寒为病，以寒主凝滞血脉，故令人身痛。若热则无身痛证。
如狂似正狂 如狂未若正狂之甚，阳热盛极，令人发狂，其证大便闭结，小便
短赤，面红口干。经曰∶重阳者狂，此之谓与。若如狂乃蓄血下焦，小便自利，唇
焦漱水不欲咽，当用桃仁承气汤。一小便短少而狂甚，一小便自利而粪黑为别。
动阴血似衄血证 动阴血与鼻衄，何以异？盖衄从鼻孔中流出，若动阴血则不
止。在鼻乃少阴传经，里证热极而反厥逆者，是误用麻附，以热证而用热药，使内
热愈甚，迫血妄行，故从耳目、口鼻中滴流，名曰动阴血，非衄血也。
表恶寒似里恶寒 表恶寒不同里恶寒者，直中里证恶寒，外无一毫身热头痛；若
表证恶寒，必有发热头痛之异。经曰∶发热恶寒者，发于阳；无热恶寒者，发于阴。
此乃千古确论。
阴躁似阳躁 有阴极反烦燥似阳躁者，何法辨之？盖热极烦躁，必口渴饮水
能咽，或大便闭，或下利肠垢，腹中急痛；若直中阴寒反躁者，乃物极则反，口虽渴
欲饮水不上咽，大概以脉消息之耳。辨其有力无力，脉稍有力而能咽水者，即是阳躁，非阴躁也。
瘀血发黄似郁热发黄 瘀血发黄与郁热发黄，何以别之？盖当汗失汗，致热邪
传里，熏灼肌肉，热弗能升越，令人发黄，则小便不利；若膀胱热不解，瘀血蓄于下
焦而发黄，则小腹硬痛，而小便自利。二证发黄，惟视小便利与不利耳。
热厥似寒厥 寒热之厥，辨在何处？盖寒厥四肢逆冷，过乎肘膝，指甲青，脉沉
细无力，有寒证见于外；若热极而厥者，火极似水，虽厥而指甲尚温。不似寒厥过乎
肘膝，脉来沉实，大而有力，以此为别。
直中咽痛似传经咽痛 直中、传经皆有咽痛，不知传经咽痛，必口燥渴能消水，
大便闭，不闭则下利肠垢，小便短赤；若直中咽痛，则脉来无力，或下利清谷，口
不渴而咽痛者，名曰肾伤寒，急用半夏桂甘汤。即传经咽痛，宜用苦寒之剂。二者总在渴不渴，消水与不消水辨焉。
太阳无脉似阴脉 太阳无脉，（即脉不出也。）认作阳证见阴脉者，不可也。盖太阳无
脉因寒邪在肌肤，凝滞不行，血脉难以周流，故无脉乃表感寒邪深重，外必见太阳
证方是，当大发表以通血脉，岂得混作阳证见阴脉乎。
太阳脉似少阴 有太阳脉似少阴，别之奈何？在外绝是太阳表证，头痛发热，
恶寒身痛，脉当浮紧，今反沉迟无力，（此取脉不取证也。）是太阳表证得少阴脉，此里虚久
寒，正气衰弱，故脉不能浮紧而见沉细。若正气旺，脉必浮紧，何至沉迟无力，故用
四逆汤使正气旺，逼寒外出，脉遂自然浮紧，设误投麻黄发表，是重虚其虚矣。
太阳腑证似里证 太阳腑证与里证有辨。盖太阳腑者膀胱也，膀胱所以盛溺。若
溺短赤，即太阳腑病。误以溺赤为里证者，非太阳始受病，必头痛发热，甚则邪传于
本腑，遂便赤。此邪只在太阳经腑，其他脏腑平和无恙，勿作里证，治当两解太阳
经腑之邪，发散中加渗利药如五苓散，（五苓散治太阳腑，白术泽泻猪茯苓，膀胱气化添官桂，利便
消暑烦渴清，除桂名为四苓散，无寒但渴服之灵。《汤头》）即太阳腑药也。今人见病起有表证兼溺
赤，即不敢用发散，然果是里证而小便短赤，无一毫表证，清利无防。若溺赤而兼
有表证，外无胃腑证者，此是太阳经腑俱病，当即发表，又何疑焉。
津液内竭误利小便 有津液内竭，小便不利，而失错利之过矣。盖人身之汗与
溺同源。经云∶天寒衣浓则为气为溺，天热衣薄则为汗。言寒则溺多而汗少，热则
汗多而溺少，阳明腑病汗多小便不利者，皆津液内竭，妄利之重虚其虚，而便愈不利
矣。果是里证，热在下焦，及未曾大汗而小便不利者，方用渗利之品。若一见自汗，
或大汗后小便不利者，乃津液内竭，切勿轻利也。
两感须分传中 两感者，阴阳双传也，表里并行，如膀胱与肾，脾与胃，肝与胆
俱伤，若与他经同见，即为合病，或表里俱见，遂非两感矣。如《活人书》宜先救
里以四逆汤，以《六书》言不可救，以攻为主，二者偏见，非活法也。果见下利
清谷，必先救里，果见烦满口干，则先攻里。大法传经两感先治表，直中两感先救
里，或救或攻，以治其急为上。（以阴经中分寒热，于里证内别虚实，故知属于传中，不可拘传中二字，
不然既两感何得又传中，既传中又何得谓之两感耶！）试以直中两感论，外证头痛发热，脊项强痛
者，太阳表证也；下利清谷，脉来沉迟无力，少阴寒证也，表急者麻黄汤为主，加
温热之品。（如麻附细辛汤是也。）里急者，以四逆汤为主，加发表药，令表里两解。表里俱
急则先治其一，若表盛于外而热盛于内，名曰传经两感，外证头痛发热太阳也，嗌干
口渴腹满少阴也，如是只以解表为主，加辛凉药。如口渴腹胀满，里证急者，方敢
攻里，必加辛凉解表，何也？凡传经不与直中同看，直中寒邪径入阴经，五脏已危，
必先救里，传经自表入里，若里证不急，有一毫表证必先解表而后攻里。《内经》所谓
逐邪必绝其源者是也。如阳明与太阳俱盛于外，头疼目痛发热，阳明也，腹胀自利
口渴，太阴也。阳明经病在者，宜解肌为主加凉药治里，阳明腑病同见者，调胃承
气汤下之。如少阳与厥阴证俱盛于外，耳聋口苦发热，少阳也，口渴囊缩，厥阴也。
少阳证急以小柴胡汤主之，加以凉药治里，厥阴消渴囊缩者，则以承气为主，加柴胡
半夏治表。噫！两感固为不救，司命者能操活法，或可冀生。总之两感之寒，宜先
救里，两感之热，宜先解表，此治两感之大法，亦治两感之活法也。
合病并病 夫合病者用也，或二阳形证俱见，或三阴形证俱见，谓之曰合。并
者归也，先二阳形证俱病，后一阳病里，一阳形证在外，方谓之曰并。其合病并病形
证，辨在何处？合病如外见脊腰疼痛及耳聋、胁痛，乃太阳与少阳合病也。外见耳
聋、胁痛，及目痛、鼻干，乃少阳与阳明合病也，如此方谓之合并病。如外先见腰
脊强及耳聋、胁痛，后耳聋、胁痛止，单腰脊项强者，此少阳并于太阳也。外先见
耳聋、胁痛，后目痛、鼻干，鼻干止而单耳聋、胁痛者，此阳明并于少阳也，外先
见目痛、鼻干及腰脊项强，已而单目痛、鼻干，此太阳并于阳明也。如此方谓并病。又
曰∶一经不彻，复过一经，亦名并病，盖阳主动，动则合，合则并，阴主静，静则
无合并之理。假如与阴经同见，或两感，或为表里俱见，则不为合病、并病矣。仲景
云∶三阳有合病，有并病，阴经既无合并，治法当从表不从里明矣。三阳合病，以解
表、发表为主，看某一经形证多者，则以某一经药为主治，加他经药在内，此治合
病之大法也。若并病看并于何经，并于太阳则发表，并于阳明经则解肌，并于腑则
下之，并于少阳则和解，此治并病之大法也。然而三阳合病，间有下者何也？盖三
阳合病宜下，外无恶寒必恶热、谵语，已合阳明之腑，方可用调胃承气汤，若有一毫恶寒，不见恶热谵语，孰敢下乎。
热人血室 伤寒有热入血室一证，昼则明了，夜则谵语如见鬼状，医误认为里，
随大下之；或昏冒终日，不知人事；又误为表，随大汗之；邪在血脉，或误攻里，或
误发表，必致不救，试思何以为血？何以为热？人身之血，譬如江河周流不息，随
气而转，在于脉中。《内经》云∶诸血皆属于脉。又曰∶脉者血之府。夫热者邪气也，
妇人伤于寒邪，必不免于病热，或病中经水适来，或已病经水忽绝，经去血空，热
邪乘虚陷入。盖血之源在心，心为血本，又主藏神，今热邪入于血室，使人昏冒、谵
语，治惟毋犯表里，毋伤胃气，只有小柴胡一汤和解，或用地黄汤。倘误用他药，令
重虚其虚，毙而后已，否则听其自愈，以经行则热随血去。倘经来适断者，证如疟
状，其血必结，结者血滞不行，用小柴胡汤加红花主之，若误认热人血室，为表为里，则死生在乎须臾，危哉！
胎前伤寒 盖胎赖血养，血去则胎不能存，孕妇设受寒邪，大汗则伤血，大下
则伤阴，皆能动胎。《内经》云∶夺汗者无血，如发汗攻里，必先安胎为主，外有表
邪，用四物汤为主，倍加黄芩、白术，佐以苏叶、干葛、羌活、柴胡，即孕妇表药
也。外有半表半里证，用小柴胡汤去半夏，倍加黄芩、白术，即孕妇和解药也。内有
里证，用四物汤加黄芩、白术，佐以大黄、浓朴、枳实，即孕妇攻里药也。假如证候
危急，非毒药不能攻，又当救母不救子，设拘执救胎，则母亦不救矣。《内经》云∶妇
人身重，毒如之何？岐伯曰∶有故无殒者，亦无殒也。大积大聚，衰其大半而止。言
有故，母有故也；上无殒者，无损母也；即救其已生，不救其未生；亦无殒者，言子
亦无损；盖言毒药只攻邪气，邪去病愈，则子亦安，故言不损也。言衰其大半而止者，
假如发表，汗一半则止，不可过汗，其大下，下一半则止，不可过下，恐多汗过下，
有伤阴血，胎气亦损，治孕妇用药之难如此。
产后久病伤寒 夫产后血气大虚，久病血气必弱，二者设感寒邪，治不与正伤
寒同，产后气血亏以致恶寒发热，脉必虚弱无力，非伤寒也，当大补气血，用小柴
胡汤加减，在里用大柴胡汤加甘草，（大柴胡汤用大黄，枳实芩夏白芍将，煎加姜枣表兼里，妙法内
攻并外攘。）若虚弱甚而里证急者，用大柴胡汤加人参固下。盖参能补肺气，肺与大肠相
为表里，用参以助药力，虽行而不伤其气血，此产后伤寒用药之法也。若久病虚疾，
亦恶寒发热与伤寒相似，慎勿作伤寒治，虚疾恶寒发作，有时鼻口息均，脉虚无力，非
正伤寒也。若脉来有力，发热恶寒，无有间时，鼻息气盛，方是外感，久病之中又
感寒邪，若表证则用参苏饮，（参苏饮内用陈皮，枳壳前胡半夏宜，干葛木香甘桔茯，内伤外感此方推。）
或人参败毒散，（羌活、独活、柴胡、前胡、川芎、枳壳、桔梗、茯苓、人参、甘草。）以表之。不可大用
燥热辛甘之剂，恐愈耗津液。若在半表半里，以小柴胡汤去半夏加减和之。盖半夏
能燥津液故去之。若邪在里用调胃承气汤去芒硝加减用之，慎勿用寒凉以伤胃气，胃
气一伤，饮食便废矣。此治久病感寒之大法也。夫久病产后，但伤其寒者，不可大
如果邪气积聚达到极点，才敢使用承气汤。至于口不渴，且伴有轻微的厥冷和完谷不化的腹泻，如果误用承气汤必定造成危险。
唇甲青 有人问：嘴唇和指甲发青，为什么是寒证？回答说：因为手指得到血液滋养才能握持，嘴唇得到血液滋养才呈现红色。现在寒气中于体内，导致血液凝滞，不能濡润肢体，所以嘴唇和指甲颜色改变。况且红色代表热，青色代表寒，必须紧急温阳散寒，这是毫无疑问的。又问：阳厥（热深厥深）也会出现嘴唇和指甲发青，如何区分呢？回答说：阳厥是因为热邪极盛，热极反而出现四肢厥冷。但是嘴唇和指甲看起来像青，实际上并不是青色，而是紫黑色；嘴唇虽然呈紫色，但口中必然口渴，给水喝能咽下，张开嘴唇看咽喉，颜色像煤炭一样黑，指甲虽然紫但摸起来还是温热的。如果是寒邪直中脏腑，则嘴唇青而口中平和（不渴），指甲青且四肢厥冷，寒证与热证的辨别，相差千里，医生必须谨慎，不可急躁。
小便清长 有人问：小便清澈且量多，为什么说明体内有寒？回答说：体内有热则小便赤红短少，体内有寒则小便清澈且量多。又问：如果邪气在皮毛，尚未传入腑脏，也会小便清长，如何区别呢？回答说：邪气在表属于表病里和，表现为小便如常，现在称为“清长”，则是异于平常的时候。要知道如果是寒邪直中脏腑，小便清长，必定伴随四肢厥冷和完谷不化的腹泻，且外部没有表证作为区别。如果有头痛发热，而小便清长如旧，那么又属于表证了。以上都是寒邪直中脏腑的寒证，应当急救里阳。
少阴病类似太阳病 有少阴病寒邪直中脏腑而出现发热的症状，类似于太阳病的发热，如何辨别呢？回答说：太阳病发热，必定伴有头痛，脉象浮而紧，适宜用麻黄汤。少阴病属于里寒证，不应当发热，现在为什么会发热呢？这是因为表里都受了损伤。只有因为有表寒所以发热，虽然发热，脉象必定沉迟，或者伴有下利清谷，应当用麻黄、细辛来发散表寒，用附子来温补中焦，使表里的寒邪同时解除。如果有头痛发热且脉象沉重而紧，这就是太阳表证，又怎么能说是少阴热证呢？经书说：阴证很少头痛，如果设有头痛发热，兼之下利清谷，这就是两感于寒邪。而不是少阴热证。
阳明经证类似腑证 有将阳明经证误作阳明腑证的情况，如何辨别？盖阳明经病，是表病里和；阳明腑病，是里病表和；经证和腑证同时出现的，是表里俱病。经证表现为眼睛痛、鼻子干，没有大便闭结、说胡话、怕热等症状，这种不可以用泻下法。腑证表现为怕热、自汗、大便干结，没有头痛、怕风、怕冷等症状，这种不可以用发汗法。然而，用汗法解表的，是解散阳明经的邪气，而不是解散阳明腑的邪气；用下法攻里的，是通下阳明腑的邪气，而不是通下阳明经的邪气。
表证自汗类似里证自汗 有将表证的自汗误认为里证的自汗，如何区别？回答说：表病自汗，是太阳伤风证；里病自汗，是热邪传入腑脏。风邪善于运行变化，性质主舒畅万物，人身腠理开泄，所以自汗必定伴有怕风、头痛、发热，其脉象浮而缓；如果是里证自汗，因为热邪传入腑脏，熏蒸沸腾，也是腠理开泄而自汗，极度怕热，外部没有大的表证，其脉象洪大有力。一个是怕风、脉浮而缓，一个是怕热、脉洪有力，必须仔细考察。
表证身痛类似寒邪直中脏腑的身痛 表病身痛类似寒邪直中脏腑的身痛，从何处分别？回答说：表证身痛，是太阳伤寒证；里证身痛，是寒邪直中三阴经。名为表证，则有头痛发热；名为阴证，怎么会有头痛、发热。表证身痛的，治疗要重在解表；寒邪直中脏腑身痛的，治疗要重在温里。都是因为寒邪致病，因为寒性主凝滞血脉，所以使人身体疼痛。如果是热邪，则没有身痛的症状。
如狂类似正狂 “如狂”的程度不如“正狂”严重。阳热盛极，令人发狂，其症状是大便闭结，小便短赤，面红口干。经书说：重阳者狂，说的就是这种情况。如果是“如狂”，则是瘀血蓄积在下焦，小便自利，嘴唇焦燥想漱水但不欲咽下，应当用桃仁承气汤。两者的区别在于：一个是小便短少而发狂严重，一个是小便自利而粪便色黑。
动阴血类似鼻衄证 动阴血与鼻衄有什么不同？回答说：鼻衄是从鼻孔中流出血液，如果动阴血则不止。如果在鼻部出血，那是少阴病传经，里证热极反而出现四肢厥逆，这是误用了麻黄、附子，以热证而用热药，使内热更加严重，逼迫血液妄行，所以从耳目、口鼻中滴流出来，名叫动阴血，不是鼻衄。
表证恶寒类似里证恶寒 表证的恶寒不同于里证的恶寒。寒邪直中脏腑的里证恶寒，外部没有一点身体发热和头痛；如果是表证恶寒，必定有发热头痛的不同。经书说：发热恶寒的，发于阳经；无热恶寒的，发于阴经。这是千古不变的准确理论。
阴躁类似阳躁 有阴寒极盛反而烦躁，类似阳躁的情况，用什么方法辨别？回答说：热极烦躁，必定口渴饮水能咽下，或者大便闭结，或者下利肠垢，腹中急痛；如果是寒邪直中脏腑引起的阴寒反躁，乃是物极必反，口虽渴想喝水但不能咽下，大概通过脉象来斟酌判断罢了。辨别脉象有力无力，脉稍有力且能咽水的，就是阳躁，不是阴躁。
瘀血发黄类似郁热发黄 瘀血发黄与郁热发黄，如何区别？回答说：应当发汗时失于发汗，导致热邪传入里，熏灼肌肉，热不能升越，使人发黄，则小便不利；如果是膀胱热不解，瘀血蓄积在下焦而发黄，则小腹部硬痛，而小便自利。这两种证候的发黄，只看小便通利与否而已。
热厥类似寒厥 寒厥与热厥的辨别在哪里？回答说：寒厥四肢逆冷，超过肘部和膝盖，指甲青，脉象沉细无力，外部有寒证表现；如果是热极而厥，火极似水，虽然四肢厥冷，但指甲还是温热的。不像寒厥超过肘膝，脉象沉实，大而有力，以此作为区别。
寒邪直中脏腑咽痛类似传经咽痛 寒邪直中脏腑和传经都有咽痛，不知道传经咽痛，必定口燥渴能消水，大便闭结，不闭结则下利肠垢，小便短赤；如果是寒邪直中脏腑咽痛，则脉象无力，或者下利清谷，口不渴而咽痛，名叫肾伤寒，紧急用半夏桂甘汤。即使是传经咽痛，也适宜用苦寒的药物。两者总要在是否口渴、能否消水上来辨别。
太阳病无脉类似阴脉 太阳病无脉（即脉搏不出），误认为是阳证见到阴脉，是不可以的。盖太阳病无脉是因为寒邪在肌肤，凝滞不行，血脉难以周流，所以无脉乃是感受寒邪深重，外部必定见太阳证才是，应当大力发表以通血脉，怎么能混淆当作阳证见阴脉呢。
太阳脉类似少阴脉 有太阳脉类似少阴脉，如何区别？在外完全是太阳表证，头痛发热，恶寒身痛，脉应当浮紧，现在反而沉迟无力（这是取脉象而不取症状），这是太阳表证得了少阴脉，这是里虚久寒，正气衰弱，所以脉不能浮紧而见沉细。如果正气旺盛，脉必定浮紧，怎么会沉迟无力，所以用四逆汤使正气旺盛，逼迫寒邪外出，脉遂自然浮紧，如果误投麻黄发表，是使虚弱更虚弱。
太阳腑证类似里证 太阳腑证与里证有区别。盖太阳腑即是膀胱，膀胱用来盛尿。如果尿短赤，就是太阳腑病。误以为尿赤是里证的，如果不是太阳刚开始受病，必定有头痛发热，甚至邪气传入本腑，于是小便赤。此邪气只在太阳经腑，其他脏腑平和无恙，不要当作里证，治疗应当两解太阳经腑之邪，发散中加入渗利药物如五苓散。（五苓散治太阳腑，白术泽泻猪茯苓，膀胱气化添官桂，利便消暑烦渴清，除桂名为四苓散，无寒但渴服之灵。《汤头》）这就是太阳腑药。现在的人看见病起有表证兼小便赤，就不敢用发散药，但如果果真是里证而小便短赤，无一毫表证，清利是没有妨碍的。如果小便赤而兼有表证，外部没有胃腑证，这是太阳经腑俱病，当即发表，又有什么可疑的呢。
津液内竭误用利小便 有津液内竭，小便不利，而错误地使用了利小便的方法，这就错了。盖人体的汗与尿同源。经书说：天冷衣厚则为气为尿，天热衣薄则为汗。说寒冷则尿多而汗少，热则汗多而尿少，阳明腑病汗多小便不利的，都是津液内竭，妄用利小便药会重伤其虚，而使小便更加不利。果真是里证，热在下焦，以及未曾大汗而小便不利的，才用渗利之品。如果一见自汗，或大汗后小便不利的，乃是津液内竭，切勿轻率使用利小便药。
两感病须分传中与直中 两感病，是阴阳双传，表里并行，如膀胱与肾，脾与胃，肝与胆都受伤，如果与其他经同时出现，即为合病，或表里俱见，遂非两感病了。如《活人书》说宜先救里用四逆汤，《六书》说不可救，以攻为主，二者都是偏见，不是灵活的方法。果见下利清谷，必先救里，果见烦满口干，则先攻里。大法是传经两感先治表，直中两感先救里，或者救或者攻，以治其急为上。（以阴经中分寒热，于里证内别虚实，故知属于传中，不可拘泥于“传中”二字，不然既然两感何得又传中，既传中又何得谓之两感耶！）试以直中两感论，外证头痛发热，脊项强痛的是太阳表证；下利清谷，脉来沉迟无力，是少阴寒证，表急的用麻黄汤为主，加温热之品。（如麻黄附子细辛汤是也。）里急的，以四逆汤为主，加发表药，令表里两解。表里俱急则先治其一，如果表盛于外而热盛于内，名叫传经两感，外证头痛发热是太阳，嗌干口渴腹满是少阴，如是只以解表为主，加辛凉药。如果口渴腹胀满，里证急，才敢攻里，必须加辛凉解表，为什么呢？凡是传经不与直中同看，直中寒邪径入阴经，五脏已危，必须先救里，传经自表入里，如果里证不急，有一毫表证必须先解表而后攻里。《内经》所谓逐邪必绝其源者是也。如阳明与太阳俱盛于外，头疼目痛发热，是阳明，腹胀自利口渴，是太阴。阳明经病在的，宜解肌为主加凉药治里，阳明腑病同见的，调胃承气汤下之。如少阳与厥阴证俱盛于外，耳聋口苦发热，是少阳，口渴囊缩，是厥阴。少阳证急以小柴胡汤主之，加以凉药治里，厥阴消渴囊缩的，则以承气为主，加柴胡半夏治表。噫！两感固为不救，医生如果能操持活法，或许可以希望生还。总之两感的寒证，宜先救里，两感的热证，宜先解表，这是治两感的大法，也是治两感的活法。
合病并病 夫合病者是用也，或二阳形证俱见，或三阴形证俱见，叫做合。并者归也，先二阳形证俱病，后一阳病里，一阳形证在外，才叫做并。其合病并病的形证，辨别在哪里？合病如外部见脊腰疼痛及耳聋、胁痛，乃太阳与少阳合病。外部见耳聋、胁痛，及目痛、鼻干，乃少阳与阳明合病，如此才叫合并病。如外部先见腰脊强及耳聋、胁痛，后耳聋、胁痛止，单腰脊项强的，此少阳并于太阳。外部先见耳聋、胁痛，后目痛、鼻干，鼻干止而单耳聋、胁痛的，此阳明并于少阳，外部先见目痛、鼻干及腰脊项强，已而单目痛、鼻干，此太阳并于阳明。如此才叫并病。又说：一经不彻，复过一经，也叫并病，盖阳主动，动则合，合则并，阴主静，静则无合并的道理。假如与阴经同见，或两感，或为表里俱见，则不为合病、并病。仲景说：三阳有合病，有并病，阴经既无合并，治法当从表不从里明矣。三阳合病，以解表、发表为主，看哪一经形证多的，就以哪一经药为主治，加他经药在内，这是治合病的大法。若并病看并于何经，并于太阳则发表，并于阳明经则解肌，并于腑则下之，并于少阳则和解，这是治并病的大法。然而三阳合病，间或有下的情况为什么呢？盖三阳合病宜下，外部无恶寒必恶热、谵语，已合阳明之腑，方可用调胃承气汤，如果有一毫恶寒，不见恶热谵语，谁敢下呢。
热入血室 伤寒有热入血室一证，白天则神志清楚，晚上则说胡话如见鬼状，医生误认为是里证，随即用大下法；或者昏冒终日，不知人事；又误认为是表证，随即用大汗法；邪在血脉，或误攻里，或误发表，必定导致不治，试思考什么为血？什么为热？人身之血，譬如江河周流不息，随气而转，在于脉中。《内经》说：诸血皆属于脉。又说：脉者血之府。夫热者邪气也，妇人伤于寒邪，必不免于病热，或病中经水适来，或已病经水忽绝，经去血空，热邪乘虚陷入。盖血的源头在心，心为血之本，又主藏神，现在热邪入于血室，使人昏冒、谵语，治疗只要不犯表里，不伤胃气，只有小柴胡一汤和解，或者用地黄汤。倘若误用他药，令重伤其虚，毙而后已，否则听其自愈，以经行则热随血去。倘若经来适断的，证如疟状，其血必结，结者血滞不行，用小柴胡汤加红花主之，如果误认热入血室，为表为里，则死生在乎须臾，危险啊！
胎前伤寒 盖胎儿赖血养，血去则胎不能存，孕妇如果受寒邪，大汗则伤血，大下则伤阴，都能动胎。《内经》说：夺汗者无血，如发汗攻里，必先安胎为主，外部有表邪，用四物汤为主，倍加黄芩、白术，佐以苏叶、干葛、羌活、柴胡，即孕妇表药。外部有半表半里证，用小柴胡汤去半夏，倍加黄芩、白术，即孕妇和解药。内部有里证，用四物汤加黄芩、白术，佐以大黄、浓朴、枳实，即孕妇攻里药。假如证候危急，非毒药不能攻，又当救母不救子，如果拘执救胎，则母也不救了。《内经》说：妇人身重，毒如之何？岐伯说：有故无殒者，亦无殒也。大积大聚，衰其大半而止。言有故，母有故也；上无殒者，无损母也；即救其已生，不救其未生；亦无殒者，言子亦无损；盖言毒药只攻邪气，邪去病愈，则子亦安，故言不损也。言衰其大半而止者，假如发表，汗一半则止，不可过汗，其大下，下一半则止，不可过下，恐多汗过下，有伤阴血，胎气亦损，治孕妇用药之难如此。
产后久病伤寒 夫产后血气大虚，久病血气必弱，二者如果感受寒邪，治疗不与正伤寒同，产后气血亏以致恶寒发热，脉必虚弱无力，不是伤寒，应当大补气血，用小柴胡汤加减，在里用大柴胡汤加甘草，（大柴胡汤用大黄，枳实芩夏白芍将，煎加姜枣表兼里，妙法内攻并外攘。）如果虚弱甚而里证急的，用大柴胡汤加人参固下。盖参能补肺气，肺与大肠相为表里，用参以助药力，虽行而不伤其气血，这是产后伤寒用药之法。如果久病虚疾，也恶寒发热与伤寒相似，慎勿作伤寒治，虚疾恶寒发作，有时鼻口息均，脉虚无力，不是正伤寒。如果脉来有力，发热恶寒，无有间断，鼻息气盛，方是外感，久病之中又感寒邪，如果表证则用参苏饮，（参苏饮内用陈皮，枳壳前胡半夏宜，干葛木香甘桔茯，内伤外感此方推。）或人参败毒散，（羌活、独活、柴胡、前胡、川芎、枳壳、桔梗、茯苓、人参、甘草。）以表之。不可大用燥热辛甘之剂，恐愈耗津液。若在半表半里，以小柴胡汤去半夏加减和之。盖半夏能燥津液故去之。若邪在里用调胃承气汤去芒硝加减用之，慎勿用寒凉以伤胃气，胃气一伤，饮食便废矣。这是治久病感寒的大法。夫久病产后，但伤其寒者，不可大
If the pathogenic factor accumulation reaches its extreme, only then dare one administer Chengqi Tang (Cathartic Decoction). As for cases with no thirst, accompanied by slight cold extremities and diarrhea with undigested food, misusing Chengqi Tang will surely lead to danger.
Cyanosis of Lips and Nails Someone asked: Why is cyanosis of the lips and nails a sign of Cold syndrome? The answer is: Fingers can grasp when nourished by blood, and lips appear red when nourished by blood. Now, Cold stagnating in the interior causes blood coagulation, failing to moisten the body, thus changing the color of the lips and nails. Moreover, red indicates Heat, while cyanosis indicates Cold; urgent warming is undoubtedly required. Another asked: Yang Jue (extreme heat causing cold extremities) also presents with cyanosis of lips and nails; how to distinguish it? The answer is: Yang Jue results from extreme Heat, where extreme heat paradoxically causes cold extremities. However, the lips and nails may look cyanotic but are actually not truly cyanotic; they are purple-black. Although the lips are purple, there must be thirst in the mouth; water given can be swallowed. Opening the lips reveals the throat is black like coal; although the nails are purple, they remain warm. In contrast, direct invasion by Cold presents with cyanotic lips and a calm mouth (no thirst), cyanotic nails, and cold extremities. The distinction between Cold and Heat syndromes is vast; physicians must be cautious and not rash.
Clear and Profuse Urine Someone asked: Why does clear and profuse urine indicate interior Cold? The answer is: Interior Heat leads to dark and scanty urine, whereas interior Cold leads to clear and profuse urine. Another asked: If the pathogen is in the skin and hair (Wei level) and has not entered the Fu organs, urine is also clear and profuse; how to differentiate? The answer is: Pathogen at the exterior constitutes an Exterior syndrome with harmonious Interior, presenting with normal urine. Calling it "clear and profuse" implies it differs from the usual state. One must know that in direct invasion by Cold, clear and profuse urine must be accompanied by cold extremities and diarrhea with undigested food, without any Exterior syndrome signs as a differentiator. If there is headache and fever, yet urine remains clear and profuse as before, it belongs to an Exterior syndrome. All the above are Cold syndromes due to direct invasion by Cold; one should rescue the Interior.
Shaoyin Syndrome Mimicking Taiyang Syndrome There are cases of Shaoyin syndrome with direct Cold invasion presenting with fever, resembling Taiyang syndrome fever. How to distinguish? The answer is: Taiyang fever is always accompanied by headache, with a floating and tight pulse, suitable for Mahuang Tang (Ephedra Decoction). Shaoyin belongs to Interior Cold and should not present with fever. Why is there fever now? It is because both Exterior and Interior are injured. Because there is Cold at the Exterior, fever occurs; although there is fever, the pulse must be deep and slow, or accompanied by diarrhea with undigested food. One should use Mahuang (Ephedrae Herba) and Xixin (Asari Radix et Rhizoma) to release the Exterior, and Fuzi (Aconiti Lateralis Radix Praeparata) to warm the Middle, resolving both Exterior and Interior Cold pathogens. If there is headache and fever with a heavy and tight pulse, it is a Taiyang Exterior syndrome, so how can it be called Shaoyin Heat? The Classics state: Yin syndromes rarely have headaches. If there is headache and fever, accompanied by diarrhea with undigested food, it is a simultaneous contraction of Cold on two meridians (Lianggan), not a Shaoyin Heat syndrome.
Yangming Meridian Syndrome Mimicking Fu Organ Syndrome There are cases where Yangming Meridian syndrome is mistaken for Yangming Fu organ syndrome. How to distinguish? Yangming Meridian disease is an Exterior syndrome with a harmonious Interior; Yangming Fu organ disease is an Interior syndrome with a harmonious Exterior; when both meridian and Fu organ are involved, both Exterior and Interior are diseased. Meridian syndrome presents with eye pain and dry nose, without constipation, delirium, or aversion to heat; this cannot be treated with purgation. Fu organ syndrome presents with aversion to heat, spontaneous sweating, and constipation, without headache, aversion to wind, or aversion to cold; this cannot be treated with diaphoresis. However, treatment with sweating resolves the Yangming Meridian pathogen, not the Yangming Fu organ pathogen; treatment with purgation evacuates the Yangming Fu organ pathogen, not the Yangming Meridian pathogen.
Exterior Spontaneous Sweating Mimicking Interior Spontaneous Sweating Some mistake Exterior spontaneous sweating for Interior spontaneous sweating. How to distinguish? The answer is: Exterior spontaneous sweating is Taiyang Wind-strike syndrome; Interior spontaneous sweating is Heat pathogen transmitting to the Fu organs. Wind moves swiftly and changes easily, promoting the smooth growth of all things; human pores open, leading to spontaneous sweating accompanied by aversion to wind, headache, and fever, with a floating and moderate pulse. If it is Interior syndrome spontaneous sweating, caused by Heat transmitting to the Fu organs, steaming and boiling, pores also open leading to spontaneous sweating, with severe aversion to heat, no significant Exterior syndrome signs externally, and a surging and forceful pulse. One involves aversion to wind and a floating/moderate pulse; the other involves aversion to heat and a surging/forceful pulse. Careful observation is required.
Exterior Body Pain Mimicking Direct Invasion Body Pain Exterior body pain resembles body pain from direct invasion. How to differentiate? The answer is: Exterior body pain is Taiyang Cold damage; Interior body pain is Cold pathogen directly invading the Three Yin meridians. Named as Exterior, there must be headache and fever; named as Yin, how could there be headache and fever? For Exterior body pain, treatment focuses on the Exterior; for direct invasion body pain, treatment focuses on warming the Interior. Both are caused by Cold, as Cold causes stagnation of blood vessels, leading to body pain. Heat does not cause body pain.
Restlessness Resembling Mania "Ru Kuang" (restlessness resembling mania) is less severe than "Zheng Kuang" (true mania). Extreme Yang Heat causes mania, with symptoms of constipation, scanty dark urine, red face, and dry mouth. The Classics say: Excess Yang leads to mania, referring to this. If it is "Ru Kuang," it is due to Blood stasis accumulating in the Lower Jiao, with free urination, dry lips, desire to rinse mouth but no desire to swallow, requiring Taoren Chengqi Tang (Peach Kernel Cathartic Decoction). The distinction lies in: one has scanty urine and severe mania; the other has free urination and black stool.
Yin Blood Disturbance Mimicking Epistaxis How does Yin Blood disturbance differ from epistaxis? The answer is: Epistaxis flows from the nostrils. If Yin Blood is disturbed, bleeding does not stop. If bleeding occurs from the nose, it is Shaoyin transmission syndrome, where extreme Interior Heat paradoxically causes cold extremities. This is due to the misuse of Mahuang and Fuzi, using Hot herbs for a Heat syndrome, exacerbating internal Heat and forcing blood to flow recklessly, dripping from ears, eyes, mouth, and nose. This is called Yin Blood disturbance, not epistaxis.
Exterior Aversion to Cold Mimicking Interior Aversion to Cold Exterior aversion to cold differs from Interior aversion to cold. Direct invasion Interior syndrome aversion to cold has no external body heat or headache. If it is Exterior syndrome aversion to cold, there must be distinct fever and headache. The Classics state: Fever with aversion to cold originates in Yang; absence of fever with aversion to cold originates in Yin. This is an eternal truth.
Yin Restlessness Mimicking Yang Restlessness There are cases of extreme Yin Cold causing restlessness, resembling Yang restlessness. How to distinguish? The answer is: Extreme Heat restlessness involves thirst, ability to swallow water, or constipation, or diarrhea with intestinal mucus, and acute abdominal pain. If direct invasion by Yin Cold causes restlessness, it is due to reversal at the extreme; although thirsty and desiring water, one cannot swallow. Generally, judge by the pulse. Distinguish by strength: if the pulse is slightly forceful and water can be swallowed, it is Yang restlessness, not Yin restlessness.
Blood Stasis Jaundice Mimicking Depressed Heat Jaundice How to distinguish blood stasis jaundice from depressed heat jaundice? The answer is: Failure to sweat when indicated allows Heat pathogen to transmit inward, scorching muscles, preventing Heat from ascending, causing jaundice with difficult urination. If Bladder Heat is unresolved and Blood stasis accumulates in the Lower Jiao causing jaundice, there is hardness and pain in the lower abdomen, with free urination. For these two types of jaundice, the distinction lies solely in whether urination is difficult or free.
Heat Jue Mimicking Cold Jue Where is the distinction between Cold and Heat Jue? The answer is: Cold Jue presents with cold extremities extending beyond elbows and knees, cyanotic nails, deep, thin, and weak pulse, with external Cold signs. If extreme Heat causes Jue, Fire extreme resembles Water; although there is Jue, nails remain warm. Unlike Cold Jue extending beyond elbows/knees, the pulse here is deep, solid, large, and forceful. This is the distinction.
Direct Invasion Sore Throat Mimicking Transmission Sore Throat Both direct invasion and transmission involve sore throat. Transmission sore throat always involves dry mouth/thirst with ability to consume water, constipation, or if not constipated, diarrhea with intestinal mucus, and scanty dark urine. Direct invasion sore throat presents with a weak pulse, or diarrhea with undigested food, no thirst but sore throat, named Kidney Cold Damage, requiring Banxia Guigan Tang (Pinellia and Licorice Decoction) urgently. Even for transmission sore throat, bitter-cold agents are appropriate. The distinction lies in thirst and ability to consume water.
Taiyang Pulseless Condition Mimicking Yin Pulse Taiyang pulseless condition (pulse not palpable) mistaken for Yang syndrome showing Yin pulse is incorrect. Taiyang pulselessness is due to Cold pathogen in skin and muscle, stagnating and blocking circulation, making pulse hard to feel. Thus, pulselessness indicates severe external Cold invasion; external Taiyang signs must be present. Treatment requires strong diaphoresis to unblock blood vessels; it cannot be confused with Yang syndrome showing Yin pulse.
Taiyang Pulse Resembling Shaoyin Pulse How to distinguish Taiyang pulse resembling Shaoyin pulse? Externally, it is purely a Taiyang Exterior syndrome: headache, fever, aversion to cold, body pain. The pulse should be floating and tight, but now is deep, slow, and weak (this relies on pulse rather than symptoms). This is Taiyang Exterior syndrome presenting with Shaoyin pulse, indicating long-standing Interior deficiency and Cold, with weakened Zheng Qi, so the pulse cannot be floating/tight but appears deep/thin. If Zheng Qi were robust, the pulse would be floating/tight. Therefore, use Sini Tang (Frigid Extremities Decoction) to strengthen Zheng Qi, forcing Cold outward, allowing the pulse to naturally become floating/tight. Misusing Mahuang to release the Exterior would further weaken the deficiency.
Taiyang Fu Organ Syndrome Mimicking Interior Syndrome There is a distinction between Taiyang Fu organ syndrome and Interior syndrome. The Taiyang Fu organ is the Bladder, which stores urine. Scanty dark urine indicates Taiyang Fu disease. Mistaking dark urine for Interior syndrome is wrong unless it is the initial stage of Taiyang disease, which must have headache and fever, eventually transmitting to the primary Fu organ, causing dark urine. The pathogen is only in the Taiyang Meridian and Fu organ; other Zang-Fu are harmonious. Do not treat as Interior syndrome. Treatment should resolve both Taiyang Meridian and Fu organ pathogens, adding diuretic herbs like Wuling San (Five-Ingredient Powder with Poria) to the diaphoretic formula. (Wuling San treats Taiyang Fu organ... [formula description]). This is a Taiyang Fu organ formula. Nowadays, people see exterior signs with dark urine and dare not use diaphoretics. But if it is truly an Interior syndrome with scanty dark urine and no exterior signs, clearing and draining is safe. If dark urine accompanies exterior signs, without Stomach/Fu organ signs, it is Taiyang Meridian and Fu organ disease simultaneously; one should immediately release the Exterior.
Internal Exhaustion of Fluids Mistakenly Treated with Diuretics There are cases of internal exhaustion of fluids causing difficult urination, mistakenly treated with diuretics. Sweat and urine share the same source. The Classics state: Cold weather and thick clothes produce Qi and urine; hot weather and thin clothes produce sweat. Cold leads to more urine and less sweat; heat leads to more sweat and less urine. In Yangming Fu disease, excessive sweat and difficult urination are due to internal exhaustion of fluids. Recklessly using diuretics severely damages deficiency, worsening urination. Only if it is truly an Interior syndrome with Heat in the Lower Jiao, and without prior massive sweating, should diuretics be used. If spontaneous sweating or post-massive sweating leads to difficult urination, it is internal exhaustion of fluids; do not lightly use diuretics.
Simultaneous Contraction (Lianggan) Requires Differentiating Transmission vs. Direct Invasion Lianggan (simultaneous contraction) is the simultaneous transmission of Yin and Yang, affecting Exterior and Interior together, e.g., Bladder and Kidney, Spleen and Stomach, Liver and Gallbladder. If appearing with other meridians, it is He Bing (combined disease), or simultaneous Exterior-Interior involvement, thus not Lianggan. Huo Ren Shu suggests rescuing Interior first with Sini Tang; Liu Shu says rescue is impossible, focusing on attack. Both are biased views, not flexible methods. If diarrhea with undigested food appears, rescue Interior first. If irritability, fullness, and dry mouth appear, attack Interior first. The general rule is: for transmission-type Lianggan, treat Exterior first; for direct-invasion-type Lianggan, rescue Interior first. Rescue or attack depends on urgency. (Differentiate Cold/Heat in Yin meridians, Deficiency/Excess in Interior syndromes, thus knowing it belongs to transmission/direct invasion; do not rigidly stick to the terms 'transmission' or 'direct invasion', otherwise simultaneous contraction cannot coexist with transmission, nor vice versa!). Taking direct-invasion Lianggan as an example: External signs of headache, fever, and stiff neck/back are Taiyang Exterior syndrome; diarrhea with undigested food, deep/slow/weak pulse are Shaoyin Cold syndrome. If Exterior is urgent, use Mahuang Tang as main formula, adding warm herbs (e.g., Mahuang Fuzi Xixin Tang). If Interior is urgent, use Sini Tang as main formula, adding exterior-releasing herbs to resolve both. If both are urgent, treat one first. If Exterior excess is outside and Heat excess is inside, it is called transmission-type Lianggan: External headache/fever is Taiyang; throat dryness/thirst/abdominal fullness is Shaoyin. In this case, focus on releasing the Exterior with acrid-cool herbs. If thirst and abdominal fullness make Interior urgent, only then dare one attack the Interior, but must add acrid-cool exterior-releasing herbs. Why? Transmission is not viewed like direct invasion. Direct invasion Cold enters Yin meridians directly, endangering the Five Zang; rescue Interior first. Transmission enters from Exterior to Interior; if Interior is not urgent, even a slight Exterior sign requires releasing Exterior before attacking Interior. This aligns with the Neijing principle: eliminating pathogens must cut off their source. If Yangming and Taiyang are both盛 (excessive) externally: headache, eye pain, fever are Yangming; abdominal fullness, spontaneous diarrhea, thirst are Taiyin. For Yangming Meridian disease, focus on releasing muscle layer with cool herbs treating Interior; for Yangming Fu organ disease appearing together, use Tiaowei Chengqi Tang to purge. If Shaoyang and Jueyin are both盛 externally: deafness, bitter taste, fever are Shaoyang; thirst, testicular retraction are Jueyin. For urgent Shaoyang, use Xiaochaihu Tang as main formula, adding cool herbs for Interior; for Jueyin with thirst and testicular retraction, use Chengqi Tang as main formula, adding Chaihu and Banxia for Exterior. Alas! Lianggan is generally considered incurable, but a physician mastering flexible methods may hope for survival. In summary, for Cold-type Lianggan, rescue Interior first; for Heat-type Lianggan, release Exterior first. This is the general and flexible method for treating Lianggan.
Combined Disease (He Bing) and Sequential Disease (Bing Bing) Combined disease (He Bing) refers to simultaneous presentation of symptoms of two Yang meridians or three Yin meridients. Sequential disease (Bing Bing) refers to one meridian's pathology merging into another; initially two Yang meridians are affected, then one Yang meridian's pathology moves to the Interior while the other remains in the Exterior. How to distinguish the signs of He Bing and Bing Bing? He Bing: External back/waist pain, deafness, hypochondriac pain indicates Taiyang-Shaoyang combined disease. External deafness, hypochondriac pain, eye pain, dry nose indicates Shaoyang-Yangming combined disease. This is called combined disease. Bing Bing: Initially external back stiffness, deafness, hypochondriac pain; later deafness/hypochondriac pain cease, leaving only back/stiffness indicates Shaoyang merging into Taiyang. Initially deafness/hypochondriac pain; later eye pain/dry nose appear, then dry nose ceases leaving only deafness/hypochondriac pain indicates Yangming merging into Shaoyang. Initially eye pain/dry nose and back stiffness; later only eye pain/dry nose remain indicates Taiyang merging into Yangming. This is called sequential disease. Also, if one meridian's pathogen is not fully resolved and passes to another, it is also called Bing Bing. Yang is active; activity leads to combination, combination leads to sequence. Yin is static; stillness has no logic of combination/sequence. If appearing with Yin meridians, or Lianggan, or simultaneous Exterior-Interior, it is not He Bing or Bing Bing. Zhang Zhongjing stated: Three Yang meridians have He Bing and Bing Bing; since Yin meridians have no combination, treatment should follow Exterior over Interior. For Three Yang He Bing, focus on releasing Exterior. Whichever meridian has more symptoms dictates the main formula, adding herbs for other meridians. This is the general method for He Bing. For Bing Bing, depend on which meridian it merges into: merging into Taiyang releases Exterior; merging into Yangming Meridian releases muscle layer; merging into Fu organ purges; merging into Shaoyang harmonizes. This is the general method for Bing Bing. However, sometimes purgation is used for Three Yang He Bing. Why? Purging is suitable for He Bing only if there is no aversion to cold, but aversion to heat and delirium, indicating merger with Yangming Fu organ, allowing use of Tiaowei Chengqi Tang. If there is any aversion to cold, or no aversion to heat/delirium, who dares to purge?
Heat Entering Blood Chamber (Xue Shi) In Shanghan, Heat entering Blood Chamber presents with clarity during the day and delirium resembling seeing ghosts at night. Doctors mistakenly treat as Interior syndrome and use massive purgation; or the patient becomes comatose all day, unaware. Mistaking it for Exterior syndrome and using massive sweating also occurs. Pathogen is in blood vessels; mistreating Interior or Exterior leads to death. Consider: what is Blood? What is Heat? Blood in the body flows endlessly like rivers, moving with Qi, residing in vessels. Neijing states: All blood belongs to vessels. Vessels are the house of blood. Heat is pathogenic factor. Women injured by Cold inevitably develop Heat. During illness, menstruation may start or suddenly stop. After menstruation, blood is empty, and Heat pathogen sinks in due to deficiency. Blood originates in the Heart; Heart is the root of blood and houses the Spirit. Heat entering Blood Chamber causes coma and delirium. Treatment must avoid violating Exterior/Interior and damaging Stomach Qi. Only Xiaochaihu Tang (Minor Bupleurum Decoction) for harmonizing, or Dihuang Tang (Rehmannia Decoction) should be used. Misusing other drugs causes severe deficiency and death. Otherwise, let it heal spontaneously, as menstruation carries Heat away. If menstruation stops abruptly, symptoms resemble malaria, blood clots, stagnation prevents flow; use Xiaochaihu Tang plus Honghua (Carthami Flos). Mistaking Heat entering Blood Chamber for Exterior or Interior determines life or death instantly; it is critical!
Pre-natal Shanghan Fetus relies on Blood for nourishment; loss of Blood means fetus cannot survive. If pregnant women contract Cold, massive sweating damages Blood, massive purgation damages Yin, both disturbing the fetus. Neijing states: Depriving sweat deprives blood. When using diaphoresis or purgation, securing the fetus is primary. For external Exterior pathogen, use Siwu Tang (Four Substances Decoction) as main formula, doubling Huangqin (Scutellariae Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma), assisted by Ziye (Perillae Folium), Genge (Puerariae Radix), Qianghuo (Notopterygii Rhizoma et Radix), Chaihu (Bupleuri Radix); this is the prenatal exterior formula. For semi-Exterior/Semi-Interior syndrome, use Xiaochaihu Tang minus Banxia, doubling Huangqin and Baizhu; this is the prenatal harmonizing formula. For internal Interior syndrome, use Siwu Tang plus Huangqin and Baizhu, assisted by Dahuang (Rhei Radix et Rhizoma), Houpo (Magnoliae Officinalis Cortex), Zhishi (Aurantii Fructus); this is the prenatal purgative formula. If symptoms are critical and require toxic drugs for attack, save the mother, not the fetus. Insisting on saving the fetus may lose the mother. Neijing asks: Woman with heavy pregnancy, how to handle toxins? Qibo answers: If there is a cause/pathogen, no injury occurs; neither does the toxin injure. For large accumulations, reduce by more than half then stop. "Cause" means the mother has pathology; "No injury" means no harm to the mother; "Save the born, not the unborn"; "No injury to child" means the child is also unharmed. Toxins attack pathogens; when pathogens leave and disease heals, the child is safe, hence "no injury." "Reduce by half then stop" means if releasing Exterior, stop after half-sweat, do not over-sweat; if purging, stop after half-purge, do not over-purge. Fear that excessive sweating/purging damages Yin-Blood and fetal Qi. Thus, prescribing for pregnant women is difficult.
Post-partum Long-term Illness and Shanghan Post-partum Blood-Qi is greatly deficient; long-term illness makes Blood-Qi weak. If either contracts Cold, treatment differs from standard Shanghan. Post-partum Blood-Qi deficiency causing aversion to cold and fever presents with weak, powerless pulse; this is not Shanghan. One should tonify Blood-Qi massively, using modified Xiaochaihu Tang. For Interior, use modified Dahuang Tang with Gancao (Glycyrrhizae Radix). (Dahuang Tang uses Dahuang, Zhishi, Qin, Xia, Baishao... [formula description]). If very weak and Interior is urgent, use Dahuang Tang plus Renshen (Ginseng Radix) to secure the Lower. Renshen tonifies Lung Qi; Lung and Large Intestine are Exterior-Interior pairs. Using Renshen aids drug power without damaging Blood-Qi. This is the method for post-partum Shanghan. If long-term deficiency illness mimics Shanghan with aversion to cold/fever, do not treat as Shanghan. Deficiency illness aversion to cold occurs intermittently, breath is equal, pulse is weak/powerless; not true Shanghan. If pulse is forceful, fever/aversion to cold continuous, breath is vigorous, it is external contraction. If contracting Cold during long-term illness: for Exterior syndrome, use Shen Su Yin (Ginseng and Perilla Drink) or Renshen Baidu San (Ginseng and Detoxification Powder) to release Exterior. Do not use large amounts of drying-hot-acrid-sweet agents, fearing further fluid depletion. For Semi-Exterior/Semi-Interior, use modified Xiaochaihu Tang minus Banxia to harmonize. Banxia is removed because it dries fluids. For Interior pathogen, use modified Tiaowei Chengqi Tang minus Mangxiao (Natrii Sulfas). Do not use cold-cool agents damaging Stomach Qi; once Stomach Qi is damaged, diet fails. This is the general method for long-term illness contracting Cold. For long-term illness or post-partum, if only Cold is injured, do not use large...