此一卷。首论咳逆。伤寒咳逆。此证极恶。仲景经中不载。孙真人云。咳逆遍寻方论。无此
名称。深穷其状。咳逆者。哕逆之名。盖古人以咳逆为哕耳。大抵咳逆者。古人所谓哕是也。 者
。今人所谓干呕是也。
（八十七）问咳逆
咳逆者。仲景所谓哕者是也（乙芮切。逆气）哕、胃寒所生。伤寒本虚。攻其热必哕。又云。
伤寒大吐下之极虚。复发汗者。其人外怫郁。复与之水。以发其汗。因得哕。所以然者。胃中寒故
也。橘皮干姜汤、（杂方九十）羌活附子散、（杂九一）半夏生姜汤、（杂九十二）退阴散主之。（
杂方十四）若服药不瘥者。灸之必愈。其法妇人屈乳头向下尽处。骨间灸三壮。丈夫及乳小
者。以一指为率。正以男左女右。艾炷如小豆许。与乳相直间。陷中动脉处是。然亦有阳证咳逆者
小柴胡汤（正二十九）橘皮竹茹汤。（杂方五）仲景又云。伤寒哕而腹满。视其前后。知何部不利
。利之即愈。（仲景无方。前部宜猪苓汤）（正六十七）（后部宜调胃承气汤）（正四十三）
○扁鹊中藏经。治伤寒咳逆。丁香散、丁香柿蒂各一分。甘草良姜各半钱。沸汤点。作一服。乘热
猛吃极效。○三因第十一卷。又有竹茹汤等方亦丁香散方竹茹汤治阳证也。○本事方第八卷。治
伤寒候咳逆。豆蔻汤。治阴证咳逆。丁香茴香肉豆蔻等药。若阳证不可用。○凡咳逆多有先热而吃
生冷。或凉药多相激而成。盖阴阳二气相搏。林人之仆。本发大热。以凉药下之。想太甚咳逆四五
日竟至于服丁香柿蒂而后却。再以小柴胡之属解其余热。遂愈。下后盖有身热不解。○治伤寒咳逆
后二方。出抚州华盖山周
先生。唯一备急方。救急方。香附子、橘核各半两细锉。用酒半盏。先将药在石银器内炒。渐渐
滴酒炒药焦黄色。研细末。每二钱。水一小盏。煎至八分。细细旋呷服。○一方单用香附子末
。○又方。大蒜头二个煨动研爆。入白姜末。（丸得为度）研和。如梧桐子大。捣薤菜自然汁。
吞下二十丸。病退再服一十五丸。
（八十八）问发黄
病患寒湿在里不散。热蓄于脾胃。腠理不开。瘀热与宿谷相搏。郁蒸不消化。故发黄。（
汉赞南方暑湿。近夏瘅热。盖瘅者。黄也。古人以黄为瘅。湿热相搏。民多病瘅。甚为跗肿也）
然发黄与瘀血。外证及脉俱相似。但小便不利为黄。小便自利为瘀血。要之发黄之人。心脾蕴积
。发热引饮。脉必浮。滑而紧数。若瘀血证。即如狂。大便必黑。此为异耳。凡病患身体发热头
面汗出。身无汗剂颈而止。渴引水浆。小便不利。如此必发黄。茵陈蒿汤（正九十三）加五苓散（
正六十六）也。茵陈蒿汤十分。五苓散五分。二件拌和。每服一钱。温水调下。日三服。病患
服汤得小便利如皂荚汁赤。一宿腹减。则黄从小便中出也。古人云。治湿不利小便。非其治也。
大抵发黄者。瘀热在里。由小便不利而致之也。栀子柏皮汤、（正方五十）麻黄连翘赤小豆汤
。（正二十四）可选而用之。又方。伤寒欲发黄者。急用瓜蒂末。口含水。搐一字许入鼻中。出
黄水甚验。即用茵陈蒿汤调五苓散服之最良。○又问白虎证。亦身热烦渴引饮。小便不利。何以
不发黄。答曰。白虎与发黄证相近。遍身汗出。此为热越。白虎证也。头面汗出。颈以下都无汗。
发黄证也。○又问太阳病一身尽痛。发热。身如熏黄者何。太阳中湿也。仲景云。伤寒发汗已。
身目为黄。所以然者。以寒湿在里不解故也。以为不可下也。于寒湿中求之。（第九卷六十九问。
）○又问病患脉弦浮大而短气。腹都满。胁下及心痛。久按之气不通。鼻干。不
得汗。嗜卧。一身及目悉黄。小便难。有潮热。时时咳嗽者何也。少阳中风也。小柴胡汤主
之。（正方二十九）
（八十九）问发狂
发狂有二证。阳毒发狂。蓄血如狂。其外证与脉皆不同。病患烦躁。狂走妄言。面赤咽痛。脉
实潮热独语。如见鬼状。此阳毒也。（治药方在二十一问）病患无表证。不发寒热。唇燥但欲
漱水。不欲入咽。其脉微而沉。小腹硬满。小便反利。大便必黑。身黄发狂。此血证谛也。病患
如热状。烦满口燥。其脉反无热。此为阴伏。其血证审矣。仲景云。太阳病不解。热结膀胱。其人
如狂。其血自下者愈。若外不解者。尚未可攻。当先解其表。且桂枝汤。（正方一）外已解。但小
腹急结者。乃可攻之。属桃仁承气汤主之。（正四十四）大抵伤寒当汗不汗。热蓄在里。热化为
血。其人喜忘而如狂。血上逆则喜忘。血下蓄则内争。甚者抵当汤、（正九十一）抵当丸、（正
方九十）轻者桃仁承气汤、（正四十四）犀角地黄汤。（杂八十六）须取尽黑物为效。（夫血热蓄
在膀胱经。若用抵当汤。更须仔细审其有无表证。若有蓄血证而外不解。亦未可便用抵当汤。先用桂枝汤。以解
其外。缘热在膀胱太阳经故也）○又有火邪发惊狂者。医以火于卧床下。或周身用火。迫劫汗
出。或熨而成火邪。其人亡阳烦躁惊狂。卧起不安。桂枝去芍药加蜀漆牡蛎龙骨救逆汤、（正方
十）桂枝甘草龙骨牡蛎汤（正方十四）主之。（凡灸及烧针后证似火劫者。并用劫法治之。金匮风
引汤尤良。柴胡加龙骨牡蛎汤更捷）。（正三十三）
（九十）问发斑
发斑有两证。（温病发斑。热病发斑）温毒发斑者。冬月触冒寒毒。至春始发。或已汗下。
表证未除。毒瓦斯未解。故发斑黑膏主之。（杂九十三）或冬月温暖。人感乖戾之气。至春初为积
寒所折。毒瓦斯未得泄。迨天气暄暖。温毒始发。肌肉斑烂。瘾疹如锦文而咳。心闷呕清汁。葛根橘
皮汤。（杂九十四）屡用之验。黄连橘皮汤亦佳。（杂一
百二十五）（广州褚 子斑如坏梨靥）热病发斑者。与时气发斑同。或未汗下。或已汗下。热毒不
散。表虚里实。热毒乘虚出于皮肤。遂发斑疮。瘾疹如锦纹。俗呼疮麸。素问谓之疹。（发斑者
。下之太早。热气乘虚故也。下之太迟。热留胃中。亦发斑。服热药过多。亦发斑。微者赤
斑出。五死一生。剧者黑斑出。十死一生）大抵发斑不可用表药。表虚里实。若发汗开泄。更增
斑烂也。皆当用化斑汤、（杂百二十）玄参升麻汤、（杂九十五）阿胶大青汤、（杂九十六）猪
胆栀子汤。（杂四十四）或与紫雪大妙。可下者。与调胃承气汤。（正四十三）（暑月阳气重者
。常宜体候。才有赤点如蚊蚤咬。却急治之）○又有阳毒发斑。见十九问。二十一问。宜参酌
之。
（九十一）问谵语
病患有谵语。有郑声二证。郑声为虚。当用温药。白通汤主之。（正九十七）谵语为实。当须
调胃承气汤主之。（正四十三）服调胃承气而谵语止。或更衣者。停后服。不尔再与之。仲景云。
实则谵语。虚则郑声。郑重也。重语也。世多不别。然谵语郑声。亦相似难辨。须更用外证与脉别之
。若大小便利。手足冷。脉微细者。必郑声也。大便秘。小便赤。手足温。脉洪数者。必谵语也。
以此相参。然后用药万全矣。大抵伤寒不应发汗。即谵语。（仲景云。伤寒四五日脉沉而喘满。沉
为在里。反发其汗。津液越出。大便为难。表虚里实。实则谵语）谵语属胃。和中则愈。不和则
烦而躁。宜调胃承气汤。然亦有三阳合病谵语者。三阳合病。腹满身重。难以转侧。口中不仁。
面垢谵语遗溺。其脉必滑实。不可汗下。宜白虎汤。（正六十四）有胃实谵语者。病患身热汗出。
大便硬为胃实。宜调胃承气汤。（正四十三）大承气。（正四十一）外台承气汤。无芒硝尤
稳或发汗多。亡阳谵语者。（仲景云。发汗多亡阳谵语者。不可下。此为津液不和。与柴胡桂
枝汤）（正三十一）（和其营卫。以通津液后自愈。恐人作燥屎攻之。慎不可攻也）有下利
谵语者。（下利谵语。有燥屎也。调胃承气汤）（正方四十三）（小承气汤主之）（正四十二）
有下后谵语者。（伤寒八九日下之。胸满烦惊。小便不利。谵语身重不可转侧者。柴胡加龙骨牡蛎
汤）（正三十三）有妇人热入血室谵语者。（妇人伤寒发热。经水适来。昼日明了。暮则谵语。
如见鬼状者。此为热入血室。无犯胃气。及上二
焦。速用小柴胡汤主之）（正二十九）（若行汤迟热入胃。令津燥。中焦上焦不荣。成血结胸
状。须当针期门也。妇人中风。发热恶寒。经水适来。入血室也。当刺期门。随其实而取之，已
上二焦。热结在期门也。若犯胃气。昼夜谵语喜忘。小腹满。小便利。属抵当汤证中）（正九十
一）○又问。仲景云。无犯胃气何也。答曰。热因经水适来。乘虚入室。故血室有热。遂令谵语
。当以小柴胡解之。（正二十九）却与胃实谵语不同。胃实有燥粪。故宜调胃承气汤下之。（正
四十三）若血实有热谵语。非胃家实。仲景恐人作胃实攻之。故曰无犯胃气也。大抵谵语是热。属
阳而反见阴证者逆。
（九十二）问吐血
伤寒吐血。由诸阳受邪。热初在表。应发汗而不发汗。热毒入深。结于五脏。内有瘀积。故
吐血也。瘀血甚者。抵当丸（正方九十）轻者桃仁承气汤（正四十四）兼服犀角地黄汤（杂八十
六）三黄丸（杂九十八）
（九十三）问腹痛（腹胀满附）
本太阳病。医反下之。因尔腹满时痛。是有表。复有里。仲景所以用桂枝加芍药汤主之。（
正方十二）痛甚者。加大黄。（正方十三）（桂枝加芍药。即是小建中也。太阴脉弱自利。设当行
大黄芍药者宜减之。其人胃虚。阳气易动故也。下利者。先煎芍药十余沸）难经云。痛为实
。大抵痛宜下。（仲景云。发汗不解。腹满痛者急下之。宜大承气汤）（正四十一）（又曰
腹中满痛。此为实。当下之。属大柴胡汤）（正方三十）腹痛有二证。有热痛、有冷痛、尺脉弦、肠鸣泄利而痛者冷痛也。
小建中汤主之。（正三十七）仲景云。阳脉涩。阴脉弦。法当腹中急痛。先与小建中汤。不瘥者。与小柴胡汤。（小柴
胡去黄芩加芍药）（正方二十九）阴证腹痛。即四逆散、（正七十六）通脉四逆加芍药汤。（正
八十一）腹痛小便不利者。真武汤（正一百五）关脉实。腹满大便秘。按之而痛者。实痛也。桂枝
加大黄汤。（正方十三）
黄连汤、（正八十三）大承气汤主之。（正四十一）○又问腹胀满者何也。阴阳不和也。桔梗半夏汤最良。（杂九十九）仲
景论太阳证发汗后。腹胀满也。浓朴生姜半夏甘草人参汤。
（正五十八）下后心烦腹满。卧起不安者。栀子浓朴汤。（正四十八）吐后腹胀满者。与调胃承气
汤。（正四十三）少阴病六七日腹胀不大便者。急下之。宜承气汤。（正四十三）
（九十四）问烦躁
伤寒烦躁。太阳与少阴经为多。（盖太阳与少阴为表里）阳明经或因不大便。中有燥屎。故
烦躁耳。（仲景云。病患不大便五六日绕脐痛。烦躁。发作有时者。此有燥屎也。宜承气汤。大抵
得病二三日。脉弱无太阳柴胡证。烦躁。心下硬。小便利。屎定硬。以小承气汤）（正四十二）（
少少与。微利之。然有病已瘥。尚微烦。必大便硬。当问其小便日几行。若小便少。津液当还入胃
。不须攻也）大抵阴气少。阳气胜。则热而烦。故太阳经伤风。多烦而躁也。（仲景云。太
阳伤风。服桂枝汤）（正一）烦不解。先刺风池风府。却与桂枝汤。又云。太阳伤风。脉浮紧。
发热恶寒。身疼痛无汗而烦躁者。大青龙汤主之。（正三十五）又云。伤寒二三日心中悸而烦者。
小建中汤主之（正三十七）（又云。伤风发热。六七日不解而烦。有表里证。渴欲饮水。水
入则吐。五苓散主之）（正六十六）（又云。伤寒得病无热。但狂言。烦躁不安。精气不与人
相当。但与五苓散。二大钱服之。常与新汲井水饮一升许。即以指刺喉去之。随手愈。然而太阳
证自汗心烦。若小便数者。又不可用桂枝表也）阳虚阴盛。亦发烦躁。阳气弱为阴所乘而躁。故
少阴病亦烦躁。（少阴病二三日以上。心烦不得卧。黄连阿胶汤主之）（正八十四）（少阴病吐
利手足逆冷。烦躁欲死者。吴茱萸汤主之）（正方一百）（少阴病下利咽痛。胸痛心烦者。猪
肤汤主之）（正一百一）少阴下利。六七日咳而呕。渴烦不得眠。猪苓汤主之。（正六十七）
少阴病恶寒而蜷。时时自烦。欲去衣被。大柴胡汤下之。（正方三十）学人当以外证与脉别之。（
寸关浮数。身热而烦者。属太阳也。尺寸俱沉。手足厥逆。自利而烦者。属少阴也）然有汗之而
烦者。（仲景云。太阳病发汗后。大汗出。胃中干。烦躁不得眠。欲得饮水者。少少与之。令胃中
和则愈。若脉浮小便不利。微热稍渴。五苓散主之）（正方六十六）有下之而烦者（仲景云。下之后
发汗。昼日烦躁不得眠。夜而安静。不呕不渴。无表证。脉沉微者。干姜附子汤主之）（正七十
这一卷首先论述咳逆。伤寒引起的咳逆，这个证候非常凶险。张仲景的经书中没有记载。孙思邈说，咳逆遍寻方论，没有这个名称。深入探究其症状，咳逆就是哕逆的名称。大概古人把咳逆称为哕。哕，是今人所说的干呕。
（八十七）问咳逆
咳逆，就是张仲景所说的哕（乙芮切，指气逆）。哕，是由胃寒产生的。伤寒本来正气虚弱，如果攻伐其热邪，必然导致哕。又说，伤寒经过大吐、大下之后极度虚弱，又再次发汗，病人出现外部的郁闭，再给水以发汗，因此导致哕。之所以这样，是因为胃中寒冷。橘皮干姜汤、羌活附子散、半夏生姜汤、退阴散主治。如果服药后不痊愈，艾灸必定能治愈。方法是：妇女在乳头弯曲向下尽头处的骨间灸三壮；男子及乳房较小者，以一指宽度为标准。正对男左女右，艾炷如小豆大小，与乳头相对直线的凹陷处动脉位置。然而也有阳证引起的咳逆，用小柴胡汤、橘皮竹茹汤治疗。张仲景又说，伤寒哕且腹部胀满，观察前后二便，知道哪一部分不通利，通利它就能痊愈。（张仲景原书无方，前部不利宜用猪苓汤，后部不利宜用调胃承气汤）。
扁鹊《中藏经》治疗伤寒咳逆，用丁香散：丁香、柿蒂各一分，甘草、良姜各半钱，用沸水冲泡，一次服完，趁热猛喝，效果极佳。
《三因方》第十一卷，又有竹茹汤等方，也是丁香散的变方。竹茹汤治疗阳证。
《本事方》第八卷，治疗伤寒候见咳逆，用豆蔻汤治疗阴证咳逆，药物包括丁香、茴香、肉豆蔻等。如果是阳证不可使用。
凡是咳逆多是因为先发热而吃生冷，或者凉药过多相互激荡而成。大概是阴阳二气相搏。林某人的仆人，原本发大热，用凉药攻下，想得太厉害导致咳逆四五天后才服用丁香柿蒂汤才得以缓解，再用小柴胡汤之类解除剩余的热邪，于是痊愈。攻下后身体发热不解。
治疗伤寒咳逆的后两个方子，出自抚州华盖山周先生。一个是备急方、救急方：香附子、橘核各半两，细锉，用酒半盏，先将药在石银器内炒，渐渐滴酒炒至焦黄色，研成细末。每服二钱，水一小盏，煎至八分，细细慢慢呷服。一方单用香附子末。又一法：大蒜头二个煨熟研烂，加入白姜末（丸剂成型为度），研和，如梧桐子大，捣薤菜自然汁吞服二十丸，病退后再服十五丸。
（八十八）问发黄
病人寒湿在体内不散，热蓄积于脾胃，腠理不开，瘀热与宿食相搏，郁蒸不消化，所以发黄。（汉代赞语说南方暑湿，近夏瘅热。大概瘅就是黄。古人以黄为瘅，湿热相搏，百姓多病瘅，甚至浮肿。）然而发黄与瘀血，外在证候及脉象都相似，只是小便不利的是发黄，小便自利的是瘀血。总之，发黄的人，心脾蕴积，发热引饮，脉必浮、滑、紧、数。如果是瘀血证，就会像发狂一样，大便必黑，这是不同之处。凡是病人身体发热，头面出汗，身上无汗仅到颈部为止，口渴想喝水浆，小便不利，如此必定发黄，用茵陈蒿汤加五苓散。茵陈蒿汤十分，五苓散五分，两方拌和，每服一钱，温水调下，日服三次。病人服汤后得小便利，尿色如皂荚汁般赤红，一夜之间腹部减轻，则黄从小便中排出。古人说，治湿不利小便，不是正确的治法。大概发黄，是瘀热在里，由小便不利导致的。栀子柏皮汤、麻黄连翘赤小豆汤可选用。又一法，伤寒想要发黄时，急用瓜蒂末，口含水，搐一字许入鼻中，流出黄水很有效。随即用茵陈蒿汤调五苓散服用最好。
又问白虎汤证，也是身热烦渴引饮，小便不利，为什么不发黄？回答说，白虎汤证与发黄证相近，但遍身汗出，这是热邪向外发散，属于白虎汤证。头面汗出，颈以下都无汗，属于发黄证。
又问太阳病一身尽痛，发热，身如熏黄的是什么？这是太阳中湿。张仲景说，伤寒发汗后，身目发黄，之所以这样，是因为寒湿在体内不解的缘故。认为不可用下法，应在寒湿中求治。（第九卷六十九问）。
又问病人脉弦浮大而短气，腹部都胀满，胁下及心痛，久按之气不通，鼻干，不得汗，嗜卧，一身及目悉黄，小便难，有潮热，时时咳嗽的是什么？这是少阳中风。用小柴胡汤主治。
（八十九）问发狂
发狂有两种证候。阳毒发狂，蓄血如狂。其外在证候与脉象都不同。病人烦躁，狂跑乱走，胡言乱语，面赤咽痛，脉实潮热，独语，像看见鬼怪一样，这是阳毒。（治疗药方在二十一问）。病人没有表证，不发寒热，唇燥只想漱水，不想咽下，脉微而沉，小腹硬满，小便反而通利，大便必黑，身黄发狂，这是血证的确凿证据。病人像有热的样子，烦满口燥，脉反而没有热象，这是阴伏。血证可以确定了。张仲景说，太阳病不解，热结膀胱，其人如狂，血自行下的就痊愈。如果外部表证未解，还不可以攻下，应当先解表，用桂枝汤。外部已解，只有小腹急结的，才可以攻下，属桃仁承气汤主治。大概伤寒应当发汗而不发汗，热蓄积在里，热化为血，其人喜忘而且像发狂。血上逆则喜忘，血下蓄则内部争斗。严重的用抵当汤、抵当丸，轻的用桃仁承气汤、犀角地黄汤。必须排出黑色物质才算有效。（夫血热蓄积在膀胱经，如果用抵当汤，更须仔细审查是否有表证。如果有蓄血证而外部表证未解，也不可立即用抵当汤，先用桂枝汤解其外，因为热在膀胱太阳经的缘故）。
又有火邪导致惊狂的。医生在卧床下用火，或周身用火，逼迫劫夺汗出，或熨烫而成火邪。其人亡阳烦躁惊狂，卧起不安。用桂枝去芍药加蜀漆牡蛎龙骨救逆汤、桂枝甘草龙骨牡蛎汤主治。（凡灸及烧针后证候似火劫的，都用劫法治之。金匮风引汤尤其好，柴胡加龙骨牡蛎汤更快捷）。
（九十）问发斑
发斑有两种证候。（温病发斑，热病发斑）。温毒发斑，冬天触犯寒毒，到春天才发作。或者已经汗下，表证未除，毒瓦斯未解，所以发斑，用黑膏主治。或者冬天温暖，人感乖戾之气，到春初被积寒所折，毒瓦斯未得泄，等到天气暄暖，温毒始发，肌肉斑烂，瘾疹如锦纹而咳，心闷呕清汁，用葛根橘皮汤，屡用有效。黄连橘皮汤也很好。（广州褚子斑如坏梨靥）。热病发斑，与时气发斑相同。或者未汗下，或者已汗下，热毒不散，表虚里实，热毒乘虚出于皮肤，遂发斑疮，瘾疹如锦纹，俗呼疮麸，素问谓之疹。（发斑者，下之太早，热气乘虚故也。下之太迟，热留胃中，亦发斑。服热药过多，亦发斑。微者赤斑出，五死一生，剧者黑斑出，十死一生）。大概发斑不可用表药，表虚里实，若发汗开泄，更增加斑烂。都应当用化斑汤、玄参升麻汤、阿胶大青汤、猪胆栀子汤。或者配合紫雪大妙。可下的，用调胃承气汤。（暑月阳气重者，常宜体候，才有赤点如蚊蚤咬，却急治之）。
又有阳毒发斑，见十九问、二十一问，宜参酌之。
（九十一）问谵语
病人有谵语，有郑声两种证候。郑声为虚，当用温药，白通汤主治。谵语为实，应当用调胃承气汤主治。服调胃承气汤而谵语止，或者排便的，停后服，不然再给。张仲景说，实则谵语，虚则郑声。郑重也，重语也。世人多不辨别。然而谵语郑声，也相似难辨，须结合外在证候与脉象来辨别。如果大小便利，手足冷，脉微细的，一定是郑声。大便秘，小便赤，手足温，脉洪数的，一定是谵语。以此参合，然后用药万全。大概伤寒不应发汗，即谵语。（张仲景说，伤寒四五日脉沉而喘满，沉为在里，反发其汗，津液越出，大便为难，表虚里实，实则谵语）。谵语属胃，和中则愈，不和则烦而躁，宜调胃承气汤。然而也有三阳合病谵语的，三阳合病，腹满身重，难以转侧，口中不仁，面垢谵语遗溺，其脉必滑实，不可汗下，宜白虎汤。有胃实谵语的，病人身热汗出，大便硬为胃实，宜调胃承气汤、大承气汤、外台承气汤，无芒硝尤稳。或者发汗多，亡阳谵语的。（张仲景说，发汗多亡阳谵语的，不可下，此为津液不和，与柴胡桂枝汤）（和其营卫，以通津液后自愈，恐人作燥屎攻之，慎不可攻也）。有下利谵语的。（下利谵语，有燥屎也，调胃承气汤，小承气汤主之）。有下后谵语的。（伤寒八九日下之，胸满烦惊，小便不利，谵语身重不可转侧者，柴胡加龙骨牡蛎汤）。有妇人热入血室谵语的。（妇人伤寒发热，经水适来，昼日明了，暮则谵语，如见鬼状者，此为热入血室，无犯胃气，及上二焦，速用小柴胡汤主之）（若行汤迟热入胃，令津燥，中焦上焦不荣，成血结胸状，须当针期门也。妇人中风，发热恶寒，经水适来，入血室也。当刺期门，随其实而取之，已上二焦，热结在期门也。若犯胃气，昼夜谵语喜忘，小腹满，小便利，属抵当汤证中）。
又问，张仲景说无犯胃气是什么意思？回答说，热因经水适来，乘虚入室，故血室有热，遂令谵语，当以小柴胡解之。却与胃实谵语不同。胃实有燥粪，故宜调胃承气汤下之。若血实有热谵语，非胃家实，张仲景恐人作胃实攻之，故曰无犯胃气也。大概谵语是热，属阳而反见阴证者逆。
（九十二）问吐血
伤寒吐血，由诸阳受邪，热初在表，应发汗而不发汗，热毒入深，结于五脏，内有瘀积，故吐血也。瘀血甚的用抵当丸，轻的用桃仁承气汤，兼服犀角地黄汤、三黄丸。
（九十三）问腹痛（腹胀满附）
本太阳病，医生反而下之，因此腹满时痛，是有表证，复有里证。张仲景所以用桂枝加芍药汤主治。痛甚的，加大黄。（桂枝加芍药，即是小建中也。太阴脉弱自利，设当行大黄芍药者宜减之，其人胃虚，阳气易动故也。下利者，先煎芍药十余沸）。《难经》说，痛为实。大概痛宜下。（张仲景说，发汗不解，腹满痛者急下之，宜大承气汤）。又说腹中满痛，此为实，当下之，属大柴胡汤。腹痛有二种证候，有热痛、有冷痛。尺脉弦、肠鸣泄利而痛的是冷痛。用小建中汤主治。张仲景说，阳脉涩，阴脉弦，法当腹中急痛，先与小建中汤，不愈的，与小柴胡汤（小柴胡去黄芩加芍药）。阴证腹痛，即四逆散、通脉四逆加芍药汤。腹痛小便不利的，真武汤。关脉实，腹满大便秘，按之而痛的，实痛。桂枝加大黄汤、黄连汤、大承气汤主治。
又问腹胀满是什么？是阴阳不和。桔梗半夏汤最好。张仲景论太阳证发汗后，腹胀满，用浓朴生姜半夏甘草人参汤。下后心烦腹满，卧起不安的，栀子浓朴汤。吐后腹胀满的，与调胃承气汤。少阴病六七日腹胀不大便的，急下之，宜承气汤。
（九十四）问烦躁
伤寒烦躁，太阳与少阴经为多。（盖太阳与少阴为表里）。阳明经或因不大便，中有燥屎，故烦躁耳。（张仲景说，病人不大便五六日绕脐痛，烦躁，发作有时的，此有燥屎也，宜承气汤。大概得病二三日，脉弱无太阳柴胡证，烦躁，心下硬，小便利，屎定硬，以小承气汤）（少少与，微利之。然有病已瘥，尚微烦，必大便硬，当问其小便日几行，若小便少，津液当还入胃，不须攻也）。大概阴气少，阳气胜，则热而烦。故太阳经伤风，多烦而躁也。（张仲景说，太阳伤风，服桂枝汤）烦不解，先刺风池风府，却与桂枝汤。又说，太阳伤风，脉浮紧，发热恶寒，身疼痛无汗而烦躁的，大青龙汤主治。又说，伤寒二三日心中悸而烦的，小建中汤主治。又说，伤风发热，六七日不解而烦，有表里证，渴欲饮水，水入则吐，五苓散主治。又说，伤寒得病无热，但狂言，烦躁不安，精气不与人相当，但与五苓散，二大钱服之，常与新汲井水饮一升许，即以指刺喉去之，随手愈。然而太阳证自汗心烦，若小便数者，又不可用桂枝表也。阳虚阴盛，亦发烦躁。阳气弱为阴所乘而躁，故少阴病亦烦躁。（少阴病二三日以上，心烦不得卧，黄连阿胶汤主治）。（少阴病吐利手足逆冷，烦躁欲死的，吴茱萸汤主治）。（少阴病下利咽痛，胸痛心烦的，猪肤汤主治）。少阴下利，六七日咳而呕，渴烦不得眠，猪苓汤主治。少阴病恶寒而蜷，时时自烦，欲去衣被，大柴胡汤下之。学人应当以外证与脉象来辨别。（寸关浮数，身热而烦的，属太阳也。尺寸俱沉，手足厥逆，自利而烦的，属少阴也）。然而有汗之而烦的。（张仲景说，太阳病发汗后，大汗出，胃中干，烦躁不得眠，欲得饮水的，少少与之，令胃中和则愈。若脉浮小便不利，微热稍渴，五苓散主治）。有下之而烦的（张仲景说，下之后发汗，昼日烦躁不得眠，夜而安静，不呕不渴，无表证，脉沉微的，干姜附子汤主治）。
This volume begins by discussing ke ni (coughing with upward rushing qi, often referring to hiccups or dry heaving). Ke ni caused by Shang Han (Cold Damage) is a very ominous syndrome. It is not recorded in Zhang Zhongjing's classic texts. Sun Simiao stated that searching through various medical treatises, there is no mention of this specific name. Upon deep investigation of its symptoms, ke ni is the same as yue ni (hiccups/dry heaving). Generally speaking, what the ancients called ke ni is what they referred to as yue. Yue corresponds to what modern people call gan ou (dry heaving).
(87) Inquiry into Ke Ni
Ke ni is what Zhang Zhongjing refers to as yue (pronounced 'yi ruie', meaning rebellious qi). Yue is generated by stomach cold. In Shang Han, if the body is originally deficient and one attacks the heat pathogen, yue will inevitably occur. It is also stated: After severe vomiting and purging in Shang Han leading to extreme deficiency, if sweating is induced again, the patient experiences external constraint; giving water to induce sweating further results in yue. The reason for this is cold in the stomach. Ju Pi Gan Jiang Tang (Tangerine Peel and Dried Ginger Decoction), Qiang Huo Fu Zi San (Notopterygium and Aconite Powder), Ban Xia Sheng Jiang Tang (Pinellia and Fresh Ginger Decoction), and Tui Yin San (Yin-Removing Powder) are indicated. If medication fails to cure, moxibustion will certainly heal it. The method is: For women, apply three moxa cones at the bone depression where the nipple curves downward to its end; for men and those with smaller breasts, use a finger's width as the standard. Treat the left side for men and the right side for women. Use moxa cones the size of a small bean, aligned directly with the nipple, at the depressed area over the artery. However, there are cases of ke ni due to yang syndromes, treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction) and Ju Pi Zhu Ru Tang (Tangerine Peel and Bamboo Shavings Decoction). Zhang Zhongjing also said: In Shang Han, if yue is accompanied by abdominal fullness, observe the anterior and posterior orifices to determine which is obstructed; unblocking it leads to recovery. (Zhang Zhongjing provided no formula; for anterior obstruction, Zhu Ling Tang is suitable; for posterior obstruction, Tiao Wei Cheng Qi Tang is suitable).
Bian Que's *Zhong Zang Jing* treats Shang Han ke ni with Ding Xiang San (Clove Powder): Clove and Persimmon Calyx each 1 fen, Licorice and Galangal each half qian. Steep in boiling water and take in one dose. Drink it hot and forcefully for excellent effect.
The *San Yin Fang*, Volume 11, mentions Zhu Ru Tang and other formulas, which are variations of Ding Xiang San. Zhu Ru Tang treats yang syndromes.
The *Ben Shi Fang*, Volume 8, treats Shang Han presenting with ke ni using Dou Kou Tang (Cardamom Decoction) for yin syndrome ke ni, containing herbs such as Clove, Fennel, and Nutmeg. These should not be used for yang syndromes.
Generally, ke ni often arises from consuming raw/cold food after initial fever, or from excessive use of cooling medicines, causing mutual agitation of yin and yang qi. For example, a servant of Lin suffered high fever and was treated with cooling purgatives excessively, leading to ke ni for four to five days. Only after taking Ding Xiang Shi Di Tang was it alleviated, followed by Xiao Chai Hu Tang to resolve residual heat, resulting in recovery. Post-purging fever may persist.
Two additional formulas for treating Shang Han ke ni come from Mr. Zhou of Huagai Mountain, Fuzhou. One is the Bei Ji Fang (Emergency Formula) or Jiu Ji Fang: Cyperi Rhizome and Tangerine Seed each half liang, finely chopped. Stir-fry in a stone or silver vessel with half a cup of wine, adding wine gradually until scorched yellow. Grind into fine powder. Take 2 qian, decoct with one small cup of water until reduced to 0.8 cup, and sip slowly. Another formula uses only Cyperi Rhizome powder. Yet another method: Roast two garlic bulbs, mash them, add powdered white ginger (enough to form pills), mix well, and shape like paulownia seeds. Swallow 20 pills with fresh juice of Scallion Bulb; take 15 more pills as the condition recedes.
(88) Inquiry into Jaundice (Huang)
When cold-dampness remains unresolved internally, heat accumulates in the spleen and stomach. With closed pores, stasis-heat clashes with retained food, causing stagnation and steaming, leading to jaundice. (Ancient texts note that southern regions suffer from summer dampness and early summer 'dan' heat; 'dan' means yellow. When damp-heat combines, people often contract 'dan', sometimes leading to edema.) However, jaundice and blood stasis present similar external signs and pulses. The distinction lies in urination: difficulty urinating indicates jaundice, while free urination indicates blood stasis. In jaundice, heart and spleen harbor accumulation, fever drives thirst, and the pulse is floating, slippery, tight, and rapid. In blood stasis, the patient acts like someone manic, and stools are invariably black. Generally, if a patient has body fever, sweating on the head and face but no sweat below the neck, thirst for fluids, and difficulty urinating, jaundice is certain. Yin Chen Hao Tang (Artemisia Scoparia Decoction) combined with Wu Ling San (Five-Ingredient Powder with Poria) is indicated. Mix ten parts Yin Chen Hao Tang with five parts Wu Ling San. Take one qian mixed with warm water, three times daily. After taking the decoction, if urine becomes clear and red like soap pod juice, and abdominal distension subsides overnight, the jaundice exits via urination. Ancients said: Treating dampness without promoting urination is incorrect. Generally, jaundice results from stasis-heat in the interior due to urinary obstruction. Zhi Zi Bai Pi Tang (Gardenia and Phellodendron Bark Decoction) and Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Adzuki Bean Decoction) are also options. Another method: If Shang Han is about to develop jaundice, urgently insert a character's worth of Gou Ti (Melon Spine) powder into the nose with water in the mouth to discharge yellow fluid, which is very effective. Immediately follow with Yin Chen Hao Tang adjusted with Wu Ling San.
Question: Bai Hu Tang syndrome also presents with body fever, irritability, thirst, and difficulty urinating. Why does it not cause jaundice? Answer: Bai Hu Tang syndrome is similar to jaundice, but involves sweating all over the body, indicating heat venting outward. This is Bai Hu Tang syndrome. Head and face sweating with no sweat below the neck indicates jaundice.
Question: What causes whole-body pain, fever, and a smoky-yellow complexion in Tai Yang disease? Answer: This is Tai Yang dampness. Zhang Zhongjing said: After inducing sweating in Shang Han, if the body and eyes turn yellow, it is because cold-dampness remains unresolved internally. It should not be treated with purgation; seek resolution within the context of cold-dampness.
Question: What causes a string-taut, floating, large pulse with shortness of breath, general abdominal fullness, hypochondriac and heart pain, blocked qi upon pressure, dry nose, inability to sweat, drowsiness, generalized and ocular jaundice, difficult urination, tidal fever, and occasional coughing? Answer: This is Shaoyang wind-strike. Xiao Chai Hu Tang is indicated.
(89) Inquiry into Manic Behavior (Kuang)
There are two types of manic behavior: Yang toxicity causing mania, and blood stasis causing manic-like behavior. Their external signs and pulses differ. Irritability, running wildly, delirious speech, red face, sore throat, solid pulse, tidal fever, talking to oneself, and seeing ghosts indicate Yang toxicity. (Treatment formulas are in Question 21). Absence of exterior signs, no chills/fever, dry lips desiring to rinse mouth but not swallow, faint and sinking pulse, hard and full lower abdomen, free urination, and black stools with jaundice and mania confirm blood stasis. Symptoms resembling heat, irritability, and dry mouth with a pulse lacking heat signs indicate hidden yin pathology, confirming blood stasis. Zhang Zhongjing said: If Tai Yang disease is unresolved and heat binds to the Bladder, the patient may act manic; if blood passes spontaneously, it heals. If exterior signs remain, do not attack yet; first resolve the exterior with Gui Zhi Tang. Once the exterior is resolved and only lower abdominal urgency remains, attack with Tao Ren Cheng Qi Tang. Generally, if Shang Han requires sweating but fails to do so, heat accumulates internally and transforms into blood, causing forgetfulness and manic behavior. Upward rebellion of blood causes forgetfulness; downward accumulation causes internal conflict. Severe cases require Di Dang Tang or Di Dang Wan; mild cases use Tao Ren Cheng Qi Tang or Xi Jiao Di Huang Tang. Effectiveness is confirmed by the passage of black material. (Note: Blood heat stasis in the Bladder meridian requires careful assessment of exterior signs before using Di Dang Tang. If exterior signs exist, resolve them first with Gui Zhi Tang because the heat is in the Tai Yang/Bladder meridian).
Another type is fright-manic behavior caused by fire pathogens. If doctors use fire under the bed or on the body to force sweating, or use hot compresses creating fire pathogens, the patient suffers yang depletion, irritability, fright, and mania, unable to rest. Gui Zhi Qu Shao Yao Jia Chu Jin Mu Li Long Gu Jiu Ni Tang (Cinnamon Twig Decoction Removing Peony plus Cockscomb, Oyster Shell, and Dragon Bone to Save from Crisis) or Gui Zhi Gan Cao Long Gu Mu Li Tang (Cinnamon Twig and Licorice with Dragon Bone and Oyster Shell Decoction) are indicated. (For post-moxibustion or acupuncture complications resembling fire coercion, use coercive methods. Feng Yin Tang from *Jin Gui* is excellent; Chai Hu Jia Long Gu Mu Li Tang is faster).
Another type is macules/rash (Ban). There are two types: Warm disease rash and Heat disease rash. Wen Du (Warm Toxicity) rash occurs when winter cold toxins manifest in spring, or after improper sweating/purging where exterior signs persist and toxins remain. Hei Gao (Black Plaster) is indicated. Or, if winter warmth allows abnormal qi invasion, suppressed by spring cold, and released when weather warms, muscle maceration and rashes like brocade patterns with cough, chest oppression, and vomiting clear fluid occur. Ge Gen Ju Pi Tang (Pueraria and Tangerine Peel Decoction) is frequently effective; Huang Lian Ju Pi Tang is also good. Heat disease rash is similar to seasonal epidemic rash. Whether prior sweating/purging occurred or not, if heat toxins remain unresolved, exterior deficiency and interior excess allow heat toxins to emerge through skin, causing rashes like brocade patterns,俗称 "chuang fu" (crusts), known in *Su Wen* as zhen. (Rashes can result from premature purging allowing heat to invade deficiency, delayed purging leaving heat in stomach, or excessive hot medicines. Mild red rashes have 5 deaths to 1 life; severe black rashes have 10 deaths to 1 life). Generally, do not use exterior-releasing drugs for rashes as exterior deficiency and interior excess mean sweating worsens maceration. Use Hua Ban Tang (Macule-Transforming Decoction), Xuan Shen Sheng Ma Tang (Scrophularia and Cimicifuga Decoction), E Da Qing Tang (Donkey-Hide Gelatin and Indigo Decoction), or Zhu Dan Zhi Zi Tang (Pig Gallbladder and Gardenia Decoction). Zi Xue (Purple Snow) is also excellent. If purgation is suitable, use Tiao Wei Cheng Qi Tang. (In summer months with heavy yang qi, monitor closely; treat urgently at the first sign of red spots like mosquito bites). Yang toxicity rash is discussed in Questions 19 and 21.
(91) Inquiry into Delirium (Shan Yu)
Patients exhibit either Shan Yu (delirious speech) or Zheng Sheng (whispering/repetitive speech). Zheng Sheng indicates deficiency, treated with warming medicines like Bai Tong Tang. Shan Yu indicates excess, treated with Tiao Wei Cheng Qi Tang. If Shan Yu stops or bowel movement occurs after Tiao Wei Cheng Qi Tang, stop subsequent doses; otherwise, continue. Zhang Zhongjing said: Excess causes Shan Yu, deficiency causes Zheng Sheng (repetitive speech). People often confuse them. Differentiate using external signs and pulses. Free urination/stool, cold extremities, and faint/thin pulse indicate Zheng Sheng. Constipation, red urine, warm extremities, and surging/rapid pulse indicate Shan Yu. Combine these for safe treatment. Generally, inappropriate sweating in Shang Han leads to Shan Yu. (Zhang Zhongjing: If pulse is deep and wheezing/fullness exists on day 4-5, it is interior; forcing sweating loses fluids, causing constipation, exterior deficiency, interior excess, and Shan Yu). Shan Yu belongs to the Stomach; harmonizing the middle cures it, while disharmony causes irritability. Tiao Wei Cheng Qi Tang is indicated. However, Shan Yu can also occur in Three-Yang combined diseases: abdominal fullness, heaviness, difficulty turning, oral numbness, facial grease, delirium, and incontinence, with slippery/solid pulse. Do not sweat or purge; use Bai Hu Tang. Stomach-excess Shan Yu presents with fever, sweating, and hard stools; use Tiao Wei Cheng Qi Tang, Da Cheng Qi Tang, or Wai Tai Cheng Qi Tang (without Mang Xiao for stability). Excessive sweating causing yang depletion and Shan Yu should not be purged; use Chai Hu Gui Zhi Tang to harmonize Ying and Wei and restore fluids. Diarrhea with Shan Yu indicates dry feces; use Tiao Wei Cheng Qi Tang or Xiao Cheng Qi Tang. Post-purging Shan Yu with chest fullness, fright, urinary difficulty, body heaviness, and immobility requires Chai Hu Jia Long Gu Mu Li Tang. Women with Re entering the Blood Chamber presenting with fever, menstruation onset, clarity during day and delirium/seeing ghosts at night, should receive Xiao Chai Hu Tang quickly without harming Stomach Qi or Upper/Middle Jiao. Delay allows heat to dry fluids, forming Blood Binding Chest syndrome, requiring acupuncture at Qi Men. (If Stomach Qi is harmed, day-and-night delirium, forgetfulness, lower abdominal fullness with free urination indicates Di Dang Tang syndrome). Question: Why did Zhang Zhongjing say "do not harm Stomach Qi"? Answer: Heat enters the Blood Chamber via menstrual deficiency, causing heat-induced delirium. Resolve with Xiao Chai Hu Tang, distinct from Stomach-excess Shan Yu which has dry feces requiring Tiao Wei Cheng Qi Tang. Blood-excess heat delirium is not Stomach excess; Zhang Zhongjing warned against attacking the Stomach unnecessarily. Generally, Shan Yu is heat/yang; presenting with yin signs is adverse.
(92) Inquiry into Hematemesis (Tu Xue)
Shang Han hematemesis results from pathogens affecting Yang meridians. Heat initially at the exterior should be released by sweating; failure allows heat toxins to penetrate deeply, binding in the Five Zang organs with internal stasis, causing bleeding. Severe blood stasis requires Di Dang Wan; mild cases use Tao Ren Cheng Qi Tang combined with Xi Jiao Di Huang Tang and San Huang Wan.
(93) Inquiry into Abdominal Pain (with Distension)
Original Tai Yang disease treated incorrectly with purgation leads to abdominal fullness and intermittent pain, indicating both exterior and interior involvement. Zhang Zhongjing uses Gui Zhi Jia Shao Yao Tang (Cinnamon Twig Decoction Augmented with Peony). For severe pain, add Da Huang. (Gui Zhi Jia Shao Yao is essentially Xiao Jian Zhong Tang. For Tai Yin with weak pulse and diarrhea, reduce Da Huang and Shao Yao due to stomach deficiency and easy yang movement; boil Shao Yao longer for diarrhea). *Nan Jing* states pain indicates excess; generally, pain warrants purgation. (Zhang Zhongjing: Unresolved sweating with abdominal fullness/pain requires urgent purgation with Da Cheng Qi Tang. Also: Abdominal fullness/pain indicates excess requiring purgation, belonging to Da Chai Hu Tang). Two types of abdominal pain: Heat pain and Cold pain. String-tight chi pulse, borborygmus, diarrhea, and pain indicate cold pain, treated with Xiao Jian Zhong Tang. Zhang Zhongjing: Rough yang pulse and string-tight yin pulse suggest acute abdominal pain; start with Xiao Jian Zhong Tang, then Xiao Chai Hu Tang (remove Huang Qin, add Shao Yao) if ineffective. Yin syndrome abdominal pain uses Si Ni San or Tong Mai Si Ni Jia Shao Yao Tang. Abdominal pain with urinary difficulty uses Zhen Wu Tang. Solid guan pulse, abdominal fullness, constipation, and tenderness indicate excess pain, treated with Gui Zhi Jia Da Huang Tang, Huang Lian Tang, or Da Cheng Qi Tang.
Abdominal distension results from yin-yang disharmony. Jie Geng Ban Xia Tang is best. Zhang Zhongjing discusses post-sweating abdominal distension in Tai Yang, treated with Hou Po Sheng Jiang Ban Xia Gan Ren Tang. Post-purging irritability and abdominal distension with restlessness uses Zhi Zi Hou Po Tang. Post-vomiting distension uses Tiao Wei Cheng Qi Tang. Shaoyin disease with six-seven days of distension and constipation requires urgent purgation with Cheng Qi Tang.
(94) Inquiry into Irritability (Fan Zao)
Shang Han irritability commonly affects Tai Yang and Shao Yin meridians (interior-exterior pair). Yang Ming irritability often stems from constipation and dry feces. (Zhang Zhongjing: Five-six days of constipation, periumbilical pain, irritability, and periodic发作 indicate dry feces; use Cheng Qi Tang. Generally, days 2-3 with weak pulse, no Tai Yang/Shaoyang signs, irritability, epigastric hardness, free urination, and hard stool warrant Xiao Cheng Qi Tang given sparingly for slight loosening. If illness resolves but slight irritability persists with hard stool, check urine frequency; low urine suggests fluids returning to stomach, no purgation needed). Generally, less yin and more yang cause heat and irritability. Tai Yang wind-strike often causes irritability. (Zhang Zhongjing: Wind-strike taking Gui Zhi Tang without resolving irritability requires needling Feng Chi and Feng Fu first, then Gui Zhi Tang. Also: Floating-tight pulse, fever, aversion to cold, body pain, anhidrosis, and irritability in Shang Han require Da Qing Long Tang. Also: Palpitations and irritability on days 2-3 of Shang Han require Xiao Jian Zhong Tang. Also: Fever unresolved after 6-7 days with exterior-interior signs, thirst, and vomiting water requires Wu Ling San. Also: Afebrile Shang Han with delirium, irritability, and mismatched spirit requires Wu Ling San with cool well water and inducing vomiting). Tai Yang self-sweating with irritability and frequent urination contraindicates Gui Zhi exterior release. Yang deficiency with yin excess causes irritability. Weak yang overwhelmed by yin causes restlessness; thus Shao Yin disease presents with irritability. (Shao Yin >3 days with irritability and insomnia requires Huang Lian E Jiao Tang. Shao Yin with vomiting/diarrhea, cold extremities, and severe irritability requires Wu Zhu Yu Tang. Shao Yin with diarrhea, sore throat, chest pain, and irritability requires Zhu Fu Tang. Shao Yin diarrhea with cough, vomiting, thirst, and insomnia after 6-7 days requires Zhu Ling Tang. Shao Yin with aversion to cold, curling up, and spontaneous irritability desiring to remove covers requires Da Chai Hu Tang purgation). Students must differentiate by external signs and pulses. Floating-rapid cun/guan with fever and irritability indicates Tai Yang. Sinking chi/cun with cold extremities, diarrhea, and irritability indicates Shao Yin. Irritability after sweating (excessive sweating drying stomach, causing thirst/insomnia; give small amounts of water; if floating pulse, urinary difficulty, mild fever/thirst, use Wu Ling San). Irritability after purgation and sweating (daytime irritability/insomnia, nighttime quietness, no vomiting/thirst, no exterior signs, faint/deep pulse) requires Gan Jiang Fu Zi Tang.