厥者、逆也。手足逆冷也。其证不一。散之方书者甚多。今始撮其大概。寒热厥逆。见
诸伤门风寒证。
尸厥。即飞尸、卒厥、本门中恶证。
蛔厥。见呕吐门吐蛔证。
痰厥。饮厥。见呕吐门各证。
气厥。即中气。见本门中气证。
（附感冒 凡看病不令染用雄黄末涂鼻孔及须知避忌行从客位边入男子病秽气
出于口。女子病秽气出于阴坐立对语间宜识得向背）。
伤风。伤寒。俗呼为伤寒。传经分三阳三阴。三阳。是太阳、阳明、少阳经也。三阴。
太阴、少阴、厥阴经也。经之阴阳以脏腑言。腑为阳膀胱胃胆是也。脏为阴脾肾肝是也。病之阴
阳。乃是外邪之阴阳。阴气阳气是也。阴阳二气。皆能犯脏腑。故阳气犯太阳。则为伤风。
恶风而有汗阴气犯太阳。则为伤寒。恶寒而无汗在太阳未得解。转入阳明、少阳二经。则纯
乎阳。不如太阳易其治。若阳气未能罢。以次传入阴经。则为阴中之阳。盖缘阳经之阳气。
来入阴经。虽有自利、欲寝、唇青、手足厥冷、舌卷。囊缩等证。不可妄投热药宜泻其阳之
在阴经也。
若阳病下之太过。阳气已脱。遂变为阴。所谓害热未已。寒病复起。或初得病。便是阴
此是阴中之阴。盖缘阴气攻阴经。阴自得传。非自传诸阳经来只当以温药回其阳。故阳入阴
者。变阳以救阴。阴入阳者。用阳以救阳。二者不可不辨。
伤风伤寒。初得病时。俱见发热头疼体痛。属太阳经。但伤风恶风有汗伤寒恶寒无汗。并宜
和解散。芎芷香苏散。或养胃汤加草芎各半钱。热服温覆。若的是伤风。有前自汗恶风等证
可用桂枝汤。令其热服温覆。喘加杏仁一钱。咳加五味子一钱。渴加参半钱。外热未止者
败毒散。热而有汗者。败毒散加桂枝半钱。或阳旦汤。呕者不宜用桂枝汤。合于本方加半
夏一钱添姜煎。此非合病之呕。系伤寒杂病。即非正伤寒。故可用也。风寒二证。理当发汗
而其人虚不可汗者。宜桂枝汤加黄 半钱。若的是伤寒。有前恶寒无汗等证。可用五积散
热服。浓被覆之取汗。喘嗽者。杏子汤加麻黄半钱。欲汗而不得汗者。再进。已汗而身热不
退者。参苏饮。或败毒散加桂枝半钱。呕者。养胃汤。此非治合病之呕。若风寒俱伤。或恶
风而无汗。或恶寒而无汗。疑似之间。只宜五积散半帖和败毒散半帖。名交加散。喘嗽
者。小青龙汤。有初得病太阳证具但寒而未即为热。至一二日后方热。此伤于寒。若伤风即
有热矣。但寒未有热者。五积散发汗。有已服解表药。不恶风。不恶寒。诸表证已罢于里又
未躁未渴小便亦未赤大便如常。独身热未除者。宜香苏饮败毒散。小柴胡汤加桂枝半钱有
已服解表药。证已罢又无里证。其人体痛不减者。恐是发汗多。荣卫不和所致。宜小建中汤
用半浓半薄之桂。
若风寒二证。传经后、身热烦渴。小便赤。大便不通。言语不得。睡不宁。鼻干头目疼。日
晡增剧。不恶寒。反恶热。舌上白胎。中有断文。或黑胎方为极热。甚则昏不知人。此属阳
明经。宜大柴胡汤。小承气汤下之。若具诸证。而大便自调者。宜白虎汤少加小柴胡汤。
若胸胁俱痛头疼。耳聋。口苦。或渴或呕。大小便或利或不利。往来寒热如疟。此属少
阳证
宜小柴胡汤嗽加北五味子半钱。渴甚加栝蒌根半钱。不渴而外有热者。加桂枝半钱。自汗而
尚恶风者。以小柴胡汤半帖。加桂枝汤半帖。
如妇人病中。经水适来。或经水失断。此为热入血室其血必结。故使寒热往来如疟。昼
则明了。夜则谵语。宜小柴胡汤。或加生地黄半钱。
若胸膈不快。手足自温。或自利而渴。或腹满时痛。此属太阴经或自利不渴。宜理中汤
重
则加附子四逆汤。此阴中之阴也。腹满而痛。当得通壅。宜桂枝汤加芍药。即是小建中汤。
但易浓桂为桂枝耳。不愈。小柴胡汤。去黄芩加芍药一钱。或枳芍各半钱。腹痛甚、大便不
利者。桂枝汤加大黄一钱临熟入。或大柴胡汤。以诸实各痛当下。此阴中之阳也。
若兀兀欲吐。心烦喜寐。或自利口燥而渴。或口中和而背恶寒。此属少阴经但少阴用药
有阴
阳之分。自利而渴者宜猪苓汤。盖阳热传入肾。少阴经肾系舌本。故自利口燥而渴。以猪苓
汤利肾中之热。不愈。则当自大便去之。古法合用大承气汤若难用大承气汤。则用小承气汤
或且进白头翁汤。上项诸药。为阴中极阳者也。
泄利下重。其人四逆。先以水盏半。葱白二根。煎一盏去葱。煎四逆散至七分。咳加北
五味子、干姜各半钱。悸加桂枝一钱。小便不利加茯苓一钱。腹痛加熟附半钱。
若审是下利清谷。手足四逆。其人面带赤。或腹痛。或干呕或咽痛四逆汤倍干姜。面赤
者。加葱一根。腹痛加芍药一钱半。呕加生姜。咽病加桔梗一钱。
若口中和而背恶寒。宜正方四逆汤不必加减。四逆散四逆汤。俱治少阴下利。四肢逆冷
泄
利下重者。与下利清谷者。一凉一温。又自有阴有阳之别。（四逆散是治四逆阳证。四逆汤
是治四逆阴证。）
若初得病。便见少阴证。其人发热恶寒。身疼头不痛者。宜麻黄细辛附子汤微汗之。或
五积
散加熟附半钱。或五积散加以顺元散。若烦闷厥逆。或舌卷囊缩。或下利清谷。里寒外热。
此属厥阴经下利清谷者。阴中之阴。宜进通脉四逆汤。或当归四逆汤。加生姜茱萸。舌卷囊
缩。不特阴中之阴
有之。阳明之热。陷入厥阴亦有之。盖阳明主宗筋。宗筋为热毒风所致。故弗荣而急引舌与
卵风以舌卷囊缩。当泻阳以救阴宜大承气汤。阳传太阴而利故用小建中汤。及小柴胡汤去黄
芩
加芍药。此一药治太阴泄利。肠鸣而痛。已利而痛为虚。虚则肠鸣。盖为传阴之阳气渐微。
不敢过用冷剂。但以芍药通壅耳。
南阳谓伤寒手足必微冷。若手足自温者。系太阴也。说欠分晓。若阳明手足安得微冷。
少阳
厥阴而大冷。安得言微冷。但当言三阴经。少阴厥阴手足厥冷。惟有太阴手足自温耳。
凡渴。问其所饮。欲冷欲热。欲多欲少。若饮多而欲冷者阳渴也。更须审其有何证在经
也。
其太阳证小便不利而渴者。五苓散。其阳明证。大便不利而渴者。宜于前本经求之。已利犹
渴。宜白虎汤。其少阳证。寒热往来而渴者。小柴胡汤去半夏。加括蒌根如其数。阴亦有自
利而渴。各已见本经。但阴有渴。古人多有冷剂。以其皆挟阳气耳。经虽阴而病则阳也。然
亦有下利清谷不系热利。纯是阴证。而反见渴者。此是阴在下隔阳于上。兼因泄泻。津液既
去。枯燥而渴。其人虽引饮。所饮自少而常喜温。不可投冷剂。宜理中汤。或四逆汤加人参
一钱。渴甚连理汤。
有阳证不渴。阴证反渴者。阳明不甚渴。太阴乃大渴。不可不知。治渴一也。有坚肾水
而
渴止者。有利小便而渴愈者。坚肾水则用天花粉之属。利小便则用茯苓猪苓之类。盖太阴以
利小便为先。阳明以利小便为戒少阳以胆经。半表半里未可下之。其人或大渴不止当以小柴
胡汤加天花粉之属。坚其肾水。肾水既坚。自还渗入大肠。大便微通。热去而渴解。若病在
太阳。太阳在膀胱肾经非利小便。则热无从去。渴何由愈。外有非阳一证。烦躁发渴。此乃
阴盛隔阳。不当顺其渴。惟当治其阴。
烦躁、阴阳经皆有之。阳明经胃有热屎故烦。此当下之。太阳经已得汗而烦者、五苓散
少
阳亦或有烦。宜小柴胡汤。阴烦少阴为多。由阳气传入阴经。阴得阳而烦。自利而渴。烦不
眠者、辰砂五苓散。若非是阳气传阴。阴气犯阴经。吐利手足厥冷而烦。经云。阳虚阴乘之
故烦。又云。阴盛发躁。欲坐井中。吴茱萸汤。甚者四逆汤加葱白二根。
外有虚烦一证。乃是病愈后。阴阳未复。时发烦热。竹叶石膏汤。痰多睡不宁者。温胆
汤。
呕者。橘皮汤。详见寒热门。潮热虚烦证。若误用药下之。身热不去。微烦者。栀子干姜汤
自利须辨阴阳。三阳自利。各已本经见之。太经与阳明合病。下利头痛腰疼肌热目疼鼻
干。
宜葛根汤。阳明与少阳合病。下利身热胸胁痞满而呕或往来寒热目疼鼻干。宜大柴胡汤。大
抵阳热之利。与阴热之利。与阴寒之利。自不同。阳利粪色必焦黄热臭。出作声。脐下必热
得凉药则止。得热药愈增。阴利必洞下清谷。粪色或白或淡黄。脐下多寒。宜温中止泻之
剂
此之谓阴利阳利。指阴阳二气而言。非曰阴阳二经也。缘阴中亦自有阳利。不可因下利便
以为阴也。
外有太阳证。医反下之。遂下利清谷。身体又自疼痛者。急用四逆汤救其里。后得大便
已调。身上疼痛。却用桂枝汤解其表。（先救里后解表。恐洞下阳脱变生不测。）
又有内不太满。犹生寒热。未可下而便下之。内虚热入。挟热自利。脐下必热。大便赤
黄色。及下肠间津汁垢腻。名曰利肠。宜白头翁汤。黄芩汤。
要知均自为利。身不热手足自温者。太阴身体四逆者。少阴厥阴其余身热下利。皆属阳
经。
然阴利有反发热。或初病无热。利后却热。或初得病即身热。继而自利。此阴利。非阳传阴
经之利。详见后段发热证。
又有大便秘五六日。以药利之。利遂不止。用极热剂方瘥。阳有利。阳有秘。当更以他
证别之。
外热内烦。下利上渴。或痞或痛或呕。常法多用黄芩汤。半夏泻心汤亦可。不若生姜泻
心汤之当。或温胆汤加入黄连。其中枳壳去取在人。
诸阳发热。已见前三阳经。阴不发热。惟少阴能发热。然少阴发热。有二证初得病即见
少阴
证。发热恶寒头不疼。宜麻黄细辛附子汤。（少阴病始得之反发热者。多在表。宜此汤。）
若下利清谷。身热躁扰。里寒外热。仲景谓之反发热。此乃阴盛隔阳。宜四逆汤。附子
理中
汤。盖阳气传阴经而下利者。乃是热利。阳陷入里。外所以无热。阴气入阴经而下利者。乃
是里寒自利。寒既在里为主。则阳气必客于外。所以外反热。要知阴阳二证。发热自是不同
发于阳而发热者头必疼发于阴而发热者头不痛。此为验矣。
汗下后发寒热。又发汗后只恶寒者为虚。虚乃表虚。发汗后只恶热者为实。实乃里实只
恶寒
者。是发其汗汗出太过。所谓阳微则恶寒。宜芍药甘草附子汤。只发热者。是表已解而里不
消。所谓阴微则发热宜大柴胡汤。或小承气汤。
又有汗下后。阴阳不相入。水火不相济。致余热未退。不可更用冷药内外俱未可攻。宜
小建
中汤。若其人已虚。虚能生热。宜小建中汤加当归一钱。或四君子汤加黄 半钱。或十全大
补汤调其荣卫。虚者。四桂汤真武汤。审之是邪热未解。虽经汗下。却不畏虚汤养病。宜竹
叶石膏汤。
又有潮热一证。经云。潮热者。胃家实也。属阳明经。当下。此之潮热。乃独热往来。
多于日晡时发。如潮之期长落。非若先寒后热。寒往即热来此也。
外有病瘥后。多食发热。名曰食复。作劳发热。名曰劳复。复者。愈而复作之义。食复
宜小
柴胡加大黄一钱。劳复宜枳实栀子汤。或小柴胡汤。今人有澡心浣衣沐发易床之戒。遂以幽
冥鬼神之说。盖虑患者初愈。以垢秽为嫌。作劳太过。致成劳复耳。
呕吐。有寒热二证。无物为呕。有物为吐。何以为吐有物。古语只闻有干呕。不闻干吐
太
阳与阳明合病。身热头疼项强烦热鼻干目疼而呕。宜葛根汤加半夏一钱。太阳与少阳合病。
头疼腰疼往来寒热胸胁疼痛而呕。宜黄芩汤加半夏一钱半。入生姜五片煎。若少阳证俱不系
合病。呕而热者。宜小柴胡汤。若阳明证具虽显然有可下之者。兼之呕多。犹属上焦。未可
遽下。宜小柴胡汤。若太阳不与少阳阳明合病。而独见太阳证。或吐泻者。恐病患膈间素有
痰饮停饮伤滞
且以二陈汤定之。候呕吐定。徐进解太阳经药。若先呕却渴者。宜猪苓汤。先渴却呕者。
宜治膈间有水。小半夏茯苓汤。渴欲饮水。水入即吐。吐已复渴。名曰水逆。由心经受
热。
而小肠不利也。宜五苓散。若少阴不渴而吐。或干呕者。理中汤去白术。加生姜。呕而吐涎
沫者。吴茱萸汤。太阴厥阴间有呕吐。太阴宜理中汤。厥阴宜四逆汤。并加生姜煎。以上阴
证。乃阴中之阴。宜用热剂。阳入阴者。能为利而不为呕。呕属上而近于外也。阳之所入者
深故利也。又有阳证病新瘥后见呕。别无所因。此余热在胃脘也。宜竹叶石膏汤。或橘皮竹
茹汤。
大凡得之太阳而呕者必是合病。呕乃病渐入内。非正太阳也。曾记有人。初得病。太阳
证在
呕吐不止。药投暖剂。莫能治之。知太阳已汗解。固当用冷剂。是太阳见呕。非合阳明。
则合少阳。其呕为热。用暖剂非矣。（曾见太阳证大呕。因呕吐药只解表自除。）
又记人有初病具太阳证而呕。一家少长。患状悉类。进养胃汤八服。无不立效。此时行
之气。适然如此。是为伤寒杂病。又非可以正经伤寒律之。
厥，就是逆乱的意思。指手足逆冷。其证候表现不一，散见于各医书中的内容很多。现在先概括其大要。寒热厥逆，见诸于伤门风寒证。
蛔厥，见呕吐门吐蛔证。
（附注感冒：凡看病时，不让使用雄黄末涂鼻孔，以及须知避忌从行客位边进入。男子病秽气出于口，女子病秽气出于阴。坐立对语间，宜识得向背。）
伤风、伤寒，俗呼为伤寒。传经分三阳三阴。三阳，是太阳、阳明、少阳经。三阴，是太阴、少阴、厥阴经。经的阴阳以脏腑言。腑为阳，膀胱、胃、胆是也。脏为阴，脾、肾、肝是也。病的阴阳，乃是外邪的阴阳，即阴气、阳气。阴阳二气，皆能犯脏腑。故阳气犯太阳，则为伤风，恶风而有汗；阴气犯太阳，则为伤寒，恶寒而无汗。在太阳未得解，转入阳明、少阳二经，则纯乎阳，不如太阳易治。若阳气未能罢，以次传入阴经，则为阴中之阳。盖缘阳经之阳气，来入阴经，虽有自利、欲寝、唇青、手足厥冷、舌卷、囊缩等证，不可妄投热药，宜泻其阳之在阴经也。
若阳病下之太过，阳气已脱，遂变为阴。所谓害热未已，寒病复起。或初得病，便是阴，此是阴中之阴。盖缘阴气攻阴经，阴自得传，非自传诸阳经来。只当以温药回其阳。故阳入阴者，变阳以救阴；阴入阳者，用阳以救阳。二者不可不辨。
伤风、伤寒，初得病时，俱见发热、头疼、体痛，属太阳经。但伤风恶风有汗，伤寒恶寒无汗，并宜和解散、芎芷香苏散，或养胃汤加草、芎各半钱，热服温覆。若的是伤风，有前自汗、恶风等证，可用桂枝汤，令其热服温覆。喘加杏仁一钱，咳加五味子一钱，渴加参半钱。外热未止者，用败毒散。热而有汗者，败毒散加桂枝半钱，或阳旦汤。呕者不宜用桂枝汤，合于本方加半夏一钱，添姜煎。此非合病之呕，系伤寒杂病，即非正伤寒，故可用也。风寒二证，理当发汗，而其人虚不可汗者，宜桂枝汤加黄[芪]半钱。若的是伤寒，有前恶寒无汗等证，可用五积散，热服，浓被覆之取汗。喘嗽者，杏子汤加麻黄半钱。欲汗而不得汗者，再进。已汗而身热不退者，参苏饮，或败毒散加桂枝半钱。呕者，养胃汤。此非治合病之呕。若风寒俱伤，或恶风而无汗，或恶寒而无汗，疑似之间，只宜五积散半帖和败毒散半帖，名交加散。喘嗽者，小青龙汤。有初得病太阳证具，但寒而未即为热，至一二日后方热，此伤于寒。若伤风即有热矣。但寒未有热者，五积散发汗。有已服解表药，不恶风，不恶寒，诸表证已罢，于里又未躁、未渴，小便亦未赤，大便如常，独身热未除者，宜香苏饮、败毒散、小柴胡汤加桂枝半钱。有已服解表药，证已罢，又无里证，其人体痛不减者，恐是发汗多，荣卫不和所致，宜小建中汤，用半浓半薄之桂。
若风寒二证，传经后，身热烦渴，小便赤，大便不通，言语不得，睡不宁，鼻干头目疼，日晡增剧，不恶寒，反恶热，舌上白胎，中有断文，或黑胎方为极热，甚则昏不知人，此属阳明经，宜大柴胡汤、小承气汤下之。若具诸证，而大便自调者，宜白虎汤少加小柴胡汤。若胸胁俱痛、头疼、耳聋、口苦，或渴或呕，大小便或利或不利，往来寒热如疟，此属少阳证，宜小柴胡汤。嗽加北五味子半钱，渴甚加栝蒌根半钱，不渴而外有热者，加桂枝半钱。自汗而尚恶风者，以小柴胡汤半帖，加桂枝汤半帖。
如妇人病中，经水适来，或经水失断，此为热入血室，其血必结，故使寒热往来如疟，昼则明了，夜则谵语，宜小柴胡汤，或加生地黄半钱。
若胸膈不快，手足自温，或自利而渴，或腹满时痛，此属太阴经。或自利不渴，宜理中汤重[剂]，则加附子四逆汤。此阴中之阴也。腹满而痛，当得通壅，宜桂枝汤加芍药，即是小建中汤，但易浓桂为桂枝耳。不愈，小柴胡汤，去黄芩加芍药一钱，或枳芍各半钱。腹痛甚、大便不利者，桂枝汤加大黄一钱临熟入，或大柴胡汤。以诸实各痛当下，此阴中之阳也。
若兀兀欲吐，心烦喜寐，或自利口燥而渴，或口中和而背恶寒，此属少阴经。但少阴用药有阴阳之分。自利而渴者，宜猪苓汤。盖阳热传入肾，少阴经肾系舌本，故自利口燥而渴，以猪苓汤利肾中之热。不愈，则当自大便去之。古法合用大承气汤。若难用大承气汤，则用小承气汤，或且进白头翁汤。上项诸药，为阴中极阳者也。
泄利下重，其人四逆，先以水盏半，葱白二根，煎一盏去葱，煎四逆散至七分。咳加北五味子、干姜各半钱，悸加桂枝一钱，小便不利加茯苓一钱，腹痛加熟附半钱。
若审是下利清谷，手足四逆，其人面带赤，或腹痛，或干呕，或咽痛，四逆汤倍干姜。面赤者，加葱一根。腹痛加芍药一钱半，呕加生姜，咽病加桔梗一钱。
若口中和而背恶寒，宜正方四逆汤，不必加减。四逆散、四逆汤，俱治少阴下利、四肢逆冷。泄利下重者，与下利清谷者，一凉一温，又自有阴有阳之别。（四逆散是治四逆阳证，四逆汤是治四逆阴证。）
若初得病，便见少阴证，其人发热恶寒，身疼头不痛者，宜麻黄细辛附子汤微汗之。或五积散加熟附半钱，或五积散加以顺元散。若烦闷厥逆，或舌卷囊缩，或下利清谷，里寒外热，此属厥阴经。下利清谷者，阴中之阴，宜进通脉四逆汤，或当归四逆汤，加生姜茱萸。舌卷囊缩，不特阴中之阴有之，阳明之热，陷入厥阴亦有之。盖阳明主宗筋，宗筋为热毒风所致，故弗荣而急引舌与卵。风以舌卷囊缩，当泻阳以救阴，宜大承气汤。阳传太阴而利，故用小建中汤，及小柴胡汤去黄芩加芍药。此一药治太阴泄利，肠鸣而痛。已利而痛为虚，虚则肠鸣，盖为传阴之阳气渐微，不敢过用冷剂，但以芍药通壅耳。
南阳谓伤寒手足必微冷，若手足自温者，系太阴也。说欠分晓。若阳明手足安得微冷，少阳、厥阴而大冷，安得言微冷。但当言三阴经，少阴、厥阴手足厥冷，惟有太阴手足自温耳。
凡渴，问其所饮，欲冷欲热，欲多欲少。若饮多而欲冷者，阳渴也。更须审其有何证在经也。其太阳证小便不利而渴者，五苓散。其阳明证大便不利而渴者，宜于前本经求之。已利犹渴，宜白虎汤。其少阳证寒热往来而渴者，小柴胡汤去半夏，加括蒌根如其数。阴亦有自利而渴，各已见本经。但阴有渴，古人多有冷剂，以其皆挟阳气耳。经虽阴而病则阳也。然亦有下利清谷不系热利，纯是阴证，而反见渴者，此是阴在下隔阳于上，兼因泄泻，津液既去，枯燥而渴。其人虽引饮，所饮自少而常喜温，不可投冷剂，宜理中汤，或四逆汤加人参一钱。渴甚连理汤。
有阳证不渴，阴证反渴者，阳明不甚渴，太阴乃大渴，不可不知。治渴一也。有坚肾水而渴止者，有利小便而渴愈者。坚肾水则用天花粉之属，利小便则用茯苓、猪苓之类。盖太阴以利小便为先，阳明以利小便为戒。少阳以胆经，半表半里，未可下之。其人或大渴不止，当以小柴胡汤加天花粉之属，坚其肾水。肾水既坚，自还渗入大肠，大便微通，热去而渴解。若病在太阳，太阳在膀胱、肾经，非利小便，则热无从去，渴何由愈。外有非阳一证，烦躁发渴，此乃阴盛隔阳，不当顺其渴，惟当治其阴。
烦躁，阴阳经皆有之。阳明经胃有热屎故烦，此当下之。太阳经已得汗而烦者，五苓散。少阳亦或有烦，宜小柴胡汤。阴烦少阴为多，由阳气传入阴经，阴得阳而烦。自利而渴，烦不眠者，辰砂五苓散。若非是阳气传阴，阴气犯阴经，吐利手足厥冷而烦，经云：阳虚阴乘之故烦。又云：阴盛发躁，欲坐井中，吴茱萸汤。甚者四逆汤加葱白二根。
外有虚烦一证，乃是病愈后，阴阳未复，时发烦热，竹叶石膏汤。痰多睡不宁者，温胆汤。呕者，橘皮汤。详见寒热门潮热虚烦证。若误用药下之，身热不去，微烦者，栀子干姜汤。
自利须辨阴阳。三阳自利，各已本经见之。太阴与阳明合病，下利头痛、腰疼、肌热、目疼、鼻干，宜葛根汤。阳明与少阳合病，下利身热、胸胁痞满而呕，或往来寒热、目疼、鼻干，宜大柴胡汤。大抵阳热之利，与阴热之利，与阴寒之利，自不同。阳利粪色必焦黄热臭，出作声，脐下必热，得凉药则止，得热药愈增。阴利必洞下清谷，粪色或白或淡黄，脐下多寒，宜温中止泻之剂。此之谓阴利、阳利，指阴阳二气而言，非曰阴阳二经也。缘阴中亦自有阳利，不可因下利便以为阴也。
外有太阳证，医反下之，遂下利清谷，身体又自疼痛者，急用四逆汤救其里。后得大便已调，身上疼痛，却用桂枝汤解其表。（先救里后解表，恐洞下阳脱变生不测。）
又有内不太满，犹生寒热，未可下而便下之，内虚热入，挟热自利，脐下必热，大便赤黄色，及下肠间津汁垢腻，名曰利肠，宜白头翁汤、黄芩汤。
要知均自为利，身不热手足自温者，太阴；身体四逆者，少阴、厥阴。其余身热下利，皆属阳经。然阴利有反发热，或初病无热，利后却热，或初得病即身热，继而自利，此阴利，非阳传阴经之利，详见后段发热证。
又有大便秘五六日，以药利之，利遂不止，用极热剂方瘥。阳有利，阳有秘，当更以他证别之。
外热内烦，下利上渴，或痞或痛或呕，常法多用黄芩汤，半夏泻心汤亦可，不若生姜泻心汤之当。或温胆汤加入黄连，其中枳壳去取在人。
诸阳发热，已见前三阳经。阴不发热，惟少阴能发热。然少阴发热，有二证。初得病即见少阴证，发热恶寒头不疼，宜麻黄细辛附子汤。（少阴病始得之反发热者，多在表，宜此汤。）若下利清谷，身热躁扰，里寒外热，仲景谓之反发热，此乃阴盛隔阳，宜四逆汤、附子理中汤。盖阳气传阴经而下利者，乃是热利，阳陷入里，外所以无热。阴气入阴经而下利者，乃是里寒自利。寒既在里为主，则阳气必客于外，所以外反热。要知阴阳二证，发热自是不同。发于阳而发热者，头必疼；发于阴而发热者，头不痛。此为验矣。
汗下后发寒热，又发汗后只恶寒者为虚，虚乃表虚。发汗后只恶热者为实，实乃里实。只恶寒者，是发其汗汗出太过，所谓阳微则恶寒，宜芍药甘草附子汤。只发热者，是表已解而里不消，所谓阴微则发热，宜大柴胡汤，或小承气汤。
又有汗下后，阴阳不相入，水火不相济，致余热未退，不可更用冷药，内外俱未可攻，宜小建中汤。若其人已虚，虚能生热，宜小建中汤加当归一钱，或四君子汤加黄[芪]半钱，或十全大补汤调其荣卫。虚者，四桂汤、真武汤。审之是邪热未解，虽经汗下，却不畏虚汤养病，宜竹叶石膏汤。
又有潮热一证，经云：潮热者，胃家实也，属阳明经，当下。此之潮热，乃独热往来，多于日晡时发，如潮之期长落，非若先寒后热，寒往即热来此也。
外有病瘥后，多食发热，名曰食复。作劳发热，名曰劳复。复者，愈而复作之义。食复宜小柴胡加大黄一钱，劳复宜枳实栀子汤，或小柴胡汤。今人有澡心浣衣沐发易床之戒，遂以幽冥鬼神之说，盖虑患者初愈，以垢秽为嫌，作劳太过，致成劳复耳。
呕吐，有寒热二证。无物为呕，有物为吐。何以为吐有物？古语只闻有干呕，不闻干吐。太阳与阳明合病，身热头疼项强烦热鼻干目疼而呕，宜葛根汤加半夏一钱。太阳与少阳合病，头疼腰疼往来寒热胸胁疼痛而呕，宜黄芩汤加半夏一钱半，入生姜五片煎。若少阳证俱不系合病，呕而热者，宜小柴胡汤。若阳明证具，虽显然有可下之者，兼之呕多，犹属上焦，未可遽下，宜小柴胡汤。若太阳不与少阳阳明合病，而独见太阳证，或吐泻者，恐病患膈间素有痰饮停饮伤滞，且以二陈汤定之。候呕吐定，徐进解太阳经药。若先呕却渴者，宜猪苓汤。先渴却呕者，宜治膈间有水，小半夏茯苓汤。渴欲饮水，水入即吐，吐已复渴，名曰水逆，由心经受热，而小肠不利也，宜五苓散。若少阴不渴而吐，或干呕者，理中汤去白术，加生姜。呕而吐涎沫者，吴茱萸汤。太阴、厥阴间有呕吐，太阴宜理中汤，厥阴宜四逆汤，并加生姜煎。以上阴证，乃阴中之阴，宜用热剂。阳入阴者，能为利而不为呕。呕属上而近于外也。阳之所入者深，故利也。又有阳证病新瘥后见呕，别无所因，此余热在胃脘也，宜竹叶石膏汤，或橘皮竹茹汤。
大凡得之太阳而呕者，必是合病。呕乃病渐入内，非正太阳也。曾记有人，初得病，太阳证在，呕吐不止，药投暖剂，莫能治之。知太阳已汗解，固当用冷剂。是太阳见呕，非合阳明，则合少阳，其呕为热，用暖剂非矣。（曾见太阳证大呕，因呕吐药只解表自除。）
又记人有初病具太阳证而呕，一家少长，患状悉类，进养胃汤八服，无不立效。此时行之气，适然如此，是为伤寒杂病，又非可以正经伤寒律之。
Jue (Reversal Cold) refers to reversal and disarray, specifically manifesting as cold extremities. The clinical manifestations vary, and there are many descriptions scattered across medical texts. Here, we summarize the general principles. Cold-heat Jue reversal is discussed under the Wind-Cold syndrome in the Injury section.
Shi Jue (Corpse Jue), also known as Fei Shi (Flying Corpse), Cu Jue (Sudden Jue), or Zhong E (Smitten by Evil) in this section.
Hui Jue (Roundworm Jue) is discussed under the Vomiting of Roundworms syndrome in the Vomiting section.
Tan Jue (Phlegm Jue) and Yin Jue (Fluid Retention Jue) are discussed under various syndromes in the Vomiting section.
Qi Jue (Qi Stagnation Jue), also known as Zhong Qi (Strike of Qi), is discussed under the Zhong Qi syndrome in this section.
(Attachment on Common Cold: When treating patients, do not use realgar powder applied to the nostrils. One must know to avoid entering from the side where travelers sit. For male patients, foul qi emanates from the mouth; for female patients, it emanates from the yin region. When sitting, standing, or conversing face-to-face, one should be aware of the orientation.)
Wind Injury (Shang Feng) and Cold Injury (Shang Han) are commonly referred to as Shang Han. The transmission of disease through meridians is divided into Three Yang and Three Yin. The Three Yang are the Taiyang (Greater Yang), Yangming (Yang Brightness), and Shaoyang (Lesser Yang) meridians. The Three Yin are the Taiyin (Greater Yin), Shaoyin (Lesser Yin), and Jueyin (Terminal Yin) meridians. The yin-yang of meridians is defined by zang-fu organs. Fu organs are yang: Bladder, Stomach, and Gallbladder. Zang organs are yin: Spleen, Kidney, and Liver. The yin-yang of diseases refers to the yin-yang of external pathogens, namely Yin Qi and Yang Qi. Both can invade the zang-fu. If Yang Qi invades Taiyang, it results in Wind Injury, characterized by aversion to wind and sweating. If Yin Qi invades Taiyang, it results in Cold Injury, characterized by aversion to cold and absence of sweating. If the condition at Taiyang is not resolved, it may transmit to the Yangming and Shaoyang meridians, becoming purely yang, which is easier to treat than Taiyang. If yang pathogen persists and transmits sequentially to the yin meridians, it becomes "Yang within Yin." Although symptoms such as spontaneous diarrhea, desire to sleep, blue lips, cold extremities, curled tongue, and retracted scrotum may appear, hot herbs should not be recklessly administered. Instead, one should purge the yang pathogen residing in the yin meridians.
If yang disease is treated with purgatives excessively, yang qi may collapse and transform into yin. This is described as "the harm of heat has not ceased, yet cold disease arises again." Or, if yin manifests from the onset, it is "Yin within Yin," caused by yin pathogen attacking yin meridians directly, rather than transmitting from yang meridians. In such cases, warm herbs should be used to restore yang. Thus, when yang enters yin, yang is transformed to save yin; when yin enters yang, yang is used to save yang. These two scenarios must be distinguished.
At the onset of Wind Injury or Cold Injury, fever, headache, and body pain are common, belonging to the Taiyang meridian. However, Wind Injury presents with aversion to wind and sweating, while Cold Injury presents with aversion to cold and no sweating. Both may initially be treated with Hejie San, Xiong Zhi Xiang Su San, or Yangwei Tang added with Ban Qian of Chuanxiong and Fangfeng, taken hot with warm covering to induce sweat. If it is indeed Wind Injury with spontaneous sweating and aversion to wind, Guizhi Tang (Cinnamon Twig Decoction) should be used, taken hot with warm covering. For wheezing, add 1 qian of Xingren (Apricot Seed); for cough, add 1 qian of Wuweizi (Schisandra Berry); for thirst, add 0.5 qian of Renshen (Ginseng). If external heat persists, Baidu San (Detoxification Powder) is indicated. If there is heat with sweating, Baidu San added with 0.5 qian of Guizhi (Cinnamon Twig) or Yangdan Tang is suitable. For vomiting, Guizhi Tang is contraindicated; instead, add 1 qian of Banxia (Pinellia Tuber) and ginger to the base formula. This vomiting is not due to combined disease but is a mixed condition of cold injury, so it is permissible. For Wind-Cold conditions, sweating therapy is appropriate, but if the patient is deficient and cannot tolerate sweating, Guizhi Tang added with 0.5 qian of Huangqi (Astragalus Root) is recommended. If it is indeed Cold Injury with aversion to cold and no sweating, Wuji San (Five Accumulations Powder) should be taken hot with thick blankets to induce sweating. For wheezing and cough, Xingzi Tang added with 0.5 qian of Mahuang (Ephedra Herb) is used. If sweating is desired but not achieved, administer again. If fever persists after sweating, Shensu Yin or Baidu San added with 0.5 qian of Guizhi is indicated. For vomiting, Yangwei Tang is used. This is not for combined disease vomiting. If both wind and cold injure, or if there is aversion to wind without sweating or aversion to cold without sweating, creating diagnostic uncertainty, half a dose of Wuji San mixed with half a dose of Baidu San, named Jiaojia San (Intersecting Addition Powder), is appropriate. For wheezing and cough, Xiao Qinglong Tang (Minor Green Dragon Decoction) is used. If Taiyang symptoms are present at onset but only cold without immediate heat, developing heat after one or two days, it is Cold Injury. Wind Injury would have heat immediately. If only cold without heat, Wuji San is used to induce sweating. If exterior-releasing drugs have been taken, and there is no aversion to wind or cold, and all exterior symptoms have resolved, yet internal signs show no restlessness or thirst, urine is normal, stool is normal, but fever persists, Xiangsu Yin, Baidu San, or Xiao Chaihu Tang (Minor Bupleurum Decoction) added with 0.5 qian of Guizhi is indicated. If exterior symptoms have resolved after taking exterior-releasing drugs, and there are no interior symptoms, but body pain persists, it may be due to excessive sweating causing disharmony of Ying and Wei nutrients. Xiaojianzhong Tang (Minor Construct the Middle Decoction) using cinnamon bark of medium strength is suitable.
If Wind-Cold conditions transmit through meridians, presenting with fever, irritability, thirst, red urine, constipation, inability to speak, restless sleep, dry nose, head and eye pain, worsening in the afternoon (Dibang), aversion to heat rather than cold, white coating on the tongue with cracks, or black coating indicating extreme heat, even coma, this belongs to the Yangming meridian. Daxiehu Tang (Major Bupleurum Decoction) or Xiaochengqi Tang (Minor Cabbage Decoction) should be used to purge. If these symptoms are present but bowel movements are normal, Baihu Tang (White Tiger Decoction) with a small amount of Xiao Chaihu Tang is indicated. If chest and hypochondrium are painful, headache, deafness, bitter taste in mouth, thirst or vomiting, irregular bowel movements, and alternating chills and fever resembling malaria occur, this belongs to Shaoyang syndrome. Xiao Chaihu Tang is indicated. Add 0.5 qian of Bei Wuweizi (North Schisandra) for cough, 0.5 qian of Gualougen (Trichosanthes Root) for severe thirst, 0.5 qian of Guizhi for external heat without thirst. For spontaneous sweating with lingering aversion to wind, mix half a dose of Xiao Chaihu Tang with half a dose of Guizhi Tang.
In women's diseases, if menstruation occurs suddenly or stops abruptly during illness, this is Heat Entering the Blood Chamber. The blood will clot, causing alternating chills and fever like malaria, clarity during the day, and delirium at night. Xiao Chaihu Tang is indicated, or add 0.5 qian of Sheng Dihuang (Fresh Rehmannia Root).
If chest and diaphragm feel uncomfortable, hands and feet are naturally warm, or there is spontaneous diarrhea with thirst, or abdominal fullness and occasional pain, this belongs to the Taiyin meridian. If spontaneous diarrhea without thirst, Lizhong Tang (Regulate the Middle Decoction) in heavy dosage is used, or Fuzi Si Ni Tang (Aconite Reversal Cold Decoction) if severe. This is Yin within Yin. For abdominal fullness and pain requiring unblocking, Guizhi Tang added with Shaoyao (Peony Root), which is Xiaojianzhong Tang, but using Guizhi (Cinnamon Twig) instead of thick cinnamon bark. If ineffective, Xiao Chaihu Tang without Huangqin (Scutellaria Root) plus 1 qian of Shaoyao, or 0.5 qian each of Zhishi (Immature Bitter Orange) and Shaoyao. For severe abdominal pain with constipation, Guizhi Tang added with 1 qian of Dahuang (Rhubarb Root) added near the end of decoction, or Daxiehu Tang. Purge based on excess pain; this is Yang within Yin.
If there is persistent nausea, heart vexation, preference for sleep, or spontaneous diarrhea with dry mouth and thirst, or neutral mouth temperature with aversion to cold on the back, this belongs to the Shaoyin meridian. Medication for Shaoyin differs by yin-yang. For spontaneous diarrhea with thirst, Zhu Ling Tang (Polyporus Decoction) is indicated because heat transmitted to the Kidney affects the tongue root. Zhu Ling Tang drains heat from the Kidney. If ineffective, purge via stool. Ancient methods combine Dachengqi Tang (Major Cabbage Decoction). If Dachengqi Tang is difficult to use, Xiaochengqi Tang or Baitouweng Tang (Pulsatilla Decoction) may be advanced. These drugs represent extreme Yang within Yin.
For dysentery with heaviness and cold extremities, first decoct Ban Ban Shui (half cup water) with two roots of Congbai (Green Onion White) to one cup, remove onions, then decoct Sini San (Reversal Cold Powder) to 70%. Add 0.5 qian each of Bei Wuweizi and Ganjiang (Dried Ginger) for cough, 1 qian of Guizhi for palpitations, 1 qian of Fuling (Poria) for difficult urination, 0.5 qian of Shu Fuzi (Prepared Aconite) for abdominal pain.
If confirmed as diarrhea with undigested food, cold extremities, flushed face, or abdominal pain, dry retching, or sore throat, Si Ni Tang with doubled Ganjiang is used. For flushed face, add one root of Congbai. For abdominal pain, add 1.5 qian of Shaoyao. For vomiting, add Shengjiang (Fresh Ginger). For throat issues, add Jiegeng (Platycodon Root) 1 qian.
If the mouth feels neutral with aversion to cold on the back, Zhengfang Si Ni Tang (Standard Formula Si Ni Decoction) without modifications is used. Both Sini San and Si Ni Tang treat Shaoyin diarrhea and cold extremities. Dysentery with heaviness versus diarrhea with undigested food represents one cool and one warm, distinguishing yin and yang. (Sini San treats Yang syndrome of reversal cold; Si Ni Tang treats Yin syndrome of reversal cold.)
If Shaoyin symptoms appear at onset with fever, aversion to cold, body pain but no headache, Mahuang Xixin Fuzi Tang (Ephedra, Asarum, and Aconite Decoction) is used to induce slight sweating. Alternatively, Wuji San added with 0.5 qian of Shu Fuzi, or Wuji San combined with Yishun Yuan San. For irritability, reversal cold, curled tongue, retracted scrotum, or diarrhea with undigested food, interior cold with exterior heat, this belongs to Jueyin meridian. Diarrhea with undigested food is Yin within Yin; Tongmai Si Ni Tang (Pulse-Recovering Si Ni Decoction) or Danggui Sini Tang (Angelica Reversal Cold Decoction) added with Shengjiang and Zhuyu (Cornus Fruit) is indicated. Curled tongue and retracted scrotum are not only seen in Yin within Yin but also when Yangming heat sinks into Jueyin. Yangming governs the sinews, which are affected by heat toxin and wind, leading to contraction pulling the tongue and genitals. Purge yang to save yin with Dachengqi Tang. When Yang transmits to Taiyin causing diarrhea, Xiaojianzhong Tang and Xiao Chaihu Tang without Huangqin plus Shaoyao are used. This treats Taiyin diarrhea with intestinal murmurs and pain. Pain after diarrhea indicates deficiency causing murmurs due to declining yang qi transmitting to yin. Avoid excessive cold agents; use Shaoyao to unblock.
Nanyang stated that Shang Han always causes slightly cold extremities, and naturally warm extremities indicate Taiyin. This explanation is unclear. How could Yangming extremities be slightly cold? Shaoyang and Jueyin are very cold, not slightly cold. It should be said that among the Three Yin meridians, Shaoyin and Jueyin have cold extremities, while only Taiyin has naturally warm extremities.
For thirst, ask about drinking preferences: cold or hot, much or little. Drinking much and desiring cold indicates Yang thirst. Further examine which meridian syndrome is present. For Taiyang syndrome with difficult urination and thirst, Wuling San (Five-Ling Powder) is used. For Yangming syndrome with constipation and thirst, seek treatment in the respective meridian. If diarrhea persists with thirst, Baihu Tang is indicated. For Shaoyang syndrome with alternating chills/fever and thirst, Xiao Chaihu Tang without Banxia plus equal amount of Gualougen is used. Yin syndromes may also have spontaneous diarrhea with thirst, as seen in their respective meridions. Ancient practitioners often used cold agents for yin thirst because they involve residual yang qi. Although the meridian is yin, the pathology is yang. However, some cases of diarrhea with undigested food are pure yin syndromes yet present with thirst. This is yin below blocking yang above, compounded by fluid loss from diarrhea causing dryness. Patients drink little and prefer warmth; do not use cold agents. Lizhong Tang or Si Ni Tang added with 1 qian of Renshen is suitable. For severe thirst, Lianli Tang is used.
There are yang syndromes without thirst and yin syndromes with reverse thirst. Yangming thirst is mild; Taiyin thirst is severe. Treatment for thirst varies. Strengthening kidney water stops thirst (using Tianhuafen/Fritillaria Thunbergii Rhizome); promoting urination cures thirst (using Fuling/Poria and Zhuling/Menodora Root). For Taiyin, promoting urination is priority; for Yangming, it is cautioned against. Shaoyang involves the Gallbladder meridian, half-exterior/half-interior, not suitable for purging. For severe unrelenting thirst, Xiao Chaihu Tang added with Tianhuafen strengthens kidney water. Once kidney water is strengthened, it渗 into the Large Intestine, slightly moistening stool, clearing heat and resolving thirst. For Taiyang disease involving Bladder/Kidney meridians, unless urination is promoted, heat cannot leave, and thirst cannot resolve. Additionally, non-yang syndromes with vexation and thirst are caused by yin excess blocking yang; do not follow thirst, treat yin instead.
Vexation occurs in both yin and yang meridians. Yangming stomach heat/feces causes vexation, requiring purging. Taiyang vexation after sweating uses Wuling San. Shaoyang may also have vexation, treated with Xiao Chaihu Tang. Yin vexation is mostly Shaoyin, caused by yang qi transmitting to yin, where yin receives yang and becomes vexed. Spontaneous diarrhea with thirst, vexation, and insomnia use Chen Sha Wuling San (Cinnabar Five-Ling Powder). If not yang transmitting to yin, but yin attacking yin meridians with vomiting, diarrhea, cold extremities, and vexation, classics state: "Yang deficiency allows yin invasion causing vexation" and "Yin excess causes agitation, wanting to sit in a well." Use Wuzhuyu Tang. Severe cases use Si Ni Tang added with two roots of Congbai.
Additionally, deficiency vexation occurs after recovery when yin-yang are not restored, causing intermittent heat/vexation. Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) is used. For phlegm with restless sleep, Wendan Tang (Warm Gallbladder Decoction) is used. For vomiting, Jupi Tang (Tangerine Peel Decoction). See Cold-Heat Section for tidal fever and deficiency vexation. If mistakenly purged, leading to persistent fever and mild vexation, Zhizi Jiangye Tang (Gardenia and Ginger Decoction) is used.
Diarrhea must distinguish yin/yang. Three Yang diarrheas are seen in their respective meridians. Taiyin-Yangming combined disease with diarrhea, headache, back pain, muscle heat, eye pain, dry nose uses Gegen Tang (Kudzu Decoction). Yangming-Shaoyang combined disease with diarrhea, fever, chest/hypochondriac fullness, vomiting, alternating chills/fever, eye pain, dry nose uses Daxiehu Tang. Generally, yang-heat diarrhea differs from yin-heat and yin-cold diarrhea. Yang diarrhea features dark yellow, hot, foul-smelling stool, sound emission, warm umbilicus, stopping with cold meds, worsening with hot meds. Yin diarrhea features clear undigested food, white/pale yellow stool, cold umbilicus, treated with warming/astringent agents. This refers to yin/yang qi, not meridians. Yin may contain yang diarrhea; do not assume all diarrhea is yin.
If Taiyang syndrome is mistakenly purged, leading to diarrhea with undigested food and body pain, urgently use Si Ni Tang to rescue the interior. After stool normalizes, if body pain persists, use Guizhi Tang to release the exterior. (Rescue interior first to prevent collapse from severe diarrhea.)
If interior is not fully full but chills/fever persist, and purging is premature, interior deficiency allows heat entry, causing heat-associated diarrhea with warm umbilicus, reddish-yellow stool, and greasy intestinal fluid, named Li Chang (Intestinal Diarrhea). Use Baitouweng Tang or Huangqin Tang.
Note that all are diarrhea: naturally warm extremities without fever indicate Taiyin; cold extremities indicate Shaoyin/Jueyin. Remaining fever with diarrhea belong to yang meridians. However, yin diarrhea may have reverse fever, or no fever initially followed by fever after diarrhea, or initial fever followed by diarrhea. This is yin diarrhea, not yang transmitting to yin. See Fever Section.
Constipation for 5-6 days treated with laxatives leading to unceasing diarrhea requires extremely hot agents to cure. Yang has diarrhea and constipation; distinguish by other symptoms.
Exterior heat, interior vexation, diarrhea, upper thirst, or bloating/pain/vomiting usually use Huangqin Tang or Banxia Xiexin Tang, but Shengjiang Xiexin Tang (Fresh Ginger Pinellia Heart-Middle Dissipating Decoction) is more appropriate. Or Wendan Tang added with Huanglian (Coptis Rhizome); usage of Zhike (Bitter Orange) depends on judgment.
All yang fevers are seen in the first three yang meridians. Yin does not typically fever, except Shaoyin. Shaoyin fever has two types: onset with Shaoyin symptoms, fever, aversion to cold, no headache uses Mahuang Xixin Fuzi Tang. (Shaoyin disease starting with reverse fever is mostly exterior; use this decoction.) If diarrhea with undigested food, fever, restlessness, interior cold/exterior heat, Zhang Zhongjing calls it "reverse fever," caused by yin excess blocking yang. Use Si Ni Tang or Fuzi Lizhong Tang. Yang transmitting to yin causes heat diarrhea (yang sinking inside, no exterior heat). Yin entering yin causes interior cold diarrhea (cold dominant inside, yang guest outside, hence exterior heat). Differentiate: yang fever has headache; yin fever has no headache.
After sweating/purging, chills/fever recur. Only aversion to cold after sweating indicates deficiency (exterior deficiency). Only heat after sweating indicates excess (interior excess). Only aversion to cold implies excessive sweating depleting yang ("Yang micro leads to aversion to cold"); use Shaoyao Gancao Fuzi Tang. Only fever implies exterior resolved but interior unresolved ("Yin micro leads to fever"); use Daxiehu Tang or Xiaochengqi Tang.
After sweating/purging, if yin-yang do not interact, water-fire do not harmonize, leaving residual heat, do not use cold meds. Neither interior nor exterior can be attacked; use Xiaojianzhong Tang. If already deficient generating heat, use Xiaojianzhong Tang added with 1 qian of Danggui (Angelica Sinensis Root), or Sijunzi Tang (Four Gentlemen Decoction) added with 0.5 qian of Huangqi, or Shiquan Dabu Tang (Ten Complete Tonifying Decoction) to regulate Ying/Wei. For deficiency, Sigui Tang or Zhenwu Tang. If evil heat remains despite sweating/purging, do not fear tonics; use Zhuye Shigao Tang.
Tidal fever: Classics state "Tidal fever is Stomach excess," belonging to Yangming, requiring purging. This tidal fever is isolated heat occurring mostly at Dibang (afternoon), like tides, not alternating chills/fever.
After recovery, overeating causing fever is Food Recurrence (Shi Fu). Overexertion causing fever is Labor Recurrence (Lao Fu). Recurrence means healing then relapsing. Food recurrence uses Xiao Chaihu Tang added with 1 qian of Dahuang. Labor recurrence uses Zhishi Zhizi Tang (Immature Bitter Orange and Gardenia Decoction) or Xiao Chaihu Tang. Modern warnings about bathing/cleaning clothes/hair/bed to avoid ghosts are actually concerns about impurity and excessive labor causing recurrence.
Vomiting has cold/heat types. No substance vomited is Ou (retching); with substance is Tu (vomiting). Ancients spoke of Gan Ou (dry retching) but not Gan Tu. Taiyang-Yangming combined disease with fever, headache, stiff neck, vexation, dry nose, eye pain, vomiting uses Gegen Tang added with 1 qian of Banxia. Taiyang-Shaoyang combined disease with headache, back pain, alternating chills/fever, chest/hypochondriac pain, vomiting uses Huangqin Tang added with 1.5 qian of Banxia and five slices of Shengjiang. If Shaoyang symptoms are not combined disease, vomiting with heat uses Xiao Chaihu Tang. If Yangming symptoms are clear with purging indication, but frequent vomiting suggests upper jiao involvement, do not purge quickly; use Xiao Chaihu Tang. If Taiyang is not combined with Shaoyang/Yangming, but shows Taiyang symptoms with vomiting/diarrhea, suspect phlegm-fluid retention in diaphragm; stabilize with Erchen Tang (Two-Aged Decoction). After vomiting settles, slowly administer Taiyang releasing meds. If vomiting precedes thirst, use Zhu Ling Tang. If thirst precedes vomiting, treat diaphragmatic water with Xiaobanxia Fuling Tang (Minor Pinellia and Poria Decoction). Thirst wanting water, water immediately vomited, vomiting then thirst again is Shui Ni (Water Counterflow), caused by Heart meridian heat affecting Small Intestine; use Wuling San. If Shaoyin vomiting without thirst or dry retching, use Lizhong Tang without Baizhu (Atractodes Macrocephala Rhizome) added with Shengjiang. Vomiting with saliva/foam uses Wuzhuyu Tang. Taiyin/Jueyin may have vomiting; Taiyin uses Lizhong Tang, Jueyin uses Si Ni Tang added with Shengjiang. Above yin syndromes are Yin within Yin, using hot agents. Yang entering yin causes diarrhea not vomiting. Vomiting is upper/exterior; deep yang entry causes diarrhea. Post-recovery yang syndrome vomiting with no other cause is residual heat in Stomach; use Zhuye Shigao Tang or Jupi Zhuru Tang (Tangerine Peel and Bamboo Shavings Decoction).
Generally, Taiyang vomiting implies combined disease. Vomiting indicates disease moving inward, not pure Taiyang. Recall a case: Taiyang symptoms with incessant vomiting, warm agents failed. Knowing Taiyang was released by sweating, cold agents were needed. Taiyang vomiting, if not Yangming combined, is Shaoyang combined, heat-induced vomiting; warm agents were wrong. (Saw Taiyang great vomiting cured by exterior-releasing meds alone.)
Another case: Initial Taiyang symptoms with vomiting, family members similar, eight doses of Yangwei Tang effective. This was epidemic qi, a mixed condition, not standard Shang Han.