治疸病者为君，佐以大黄，使以栀子，令湿热从大小二便泻出，则身黄腹满自可除矣。
【集注】唐不岩曰∶熏黄，阴黄也；橘子黄，阳黄也。
程知曰∶此驱湿除热法也。伤寒七八日，可下之时；小便不利，腹微满，可下之证。兼
以黄色鲜明，则为三阳入里之邪无疑，故以茵陈除湿，栀子清热，用大黄以助其驱除，此
证之可下者，犹必以除湿为主；而不专取乎攻下有如此者。
茵陈蒿汤方
茵陈蒿（六两） 栀子（擘，十四枚） 大黄（去皮，二两）
上三味，以水一斗二升，先煮茵陈，减六升，纳二味，煮取三升，去滓，分三服，小
盒饭利，尿如皂荚汁状，色正赤，一宿腹减，黄从小便出也。
伤寒身黄发热，栀子柏皮汤主之。
【注】伤寒身黄发热者，设有无汗之表，宜用麻黄连轺赤小豆汗之可也；若有成实之
里，宜用茵陈蒿汤下之亦可也。今外无可汗之表证，内无可下之里证，惟宜以栀子柏皮汤清之也。
【集注】林澜曰∶伤寒身黄，胃有瘀热，须当下之，此以发热而热未实，故宜栀子柏皮汤解之。
汪琥曰∶身黄兼发热者，乃黄证中之发热，而非麻黄、桂枝证之发热也。热既郁而
发黄，虽表而非纯乎表证，但当清其郁，以退其黄，则发热自愈。
魏荔彤曰∶此三条虽皆外寒挟湿之邪，瘀而成热之证。然在表、在里，湿胜、热胜，尤
当加意也，岂可概以为里证而混下耶！
栀子柏皮汤方
栀子（擘，十五枚） 甘草（炙，一两） 黄柏（二两）
上三味，以水四升，煮取一升半，去滓，分温再服。
【按】此方之甘草，当是茵陈蒿，必传写之误也。
阳明病被火，额上微汗出，而小便不利者，必发黄。
【注】阳明病无汗，不以葛根汤发其汗，而以火劫取汗，致热盛津干，引饮水停，为
热上蒸，故额上微汗出，而周身反不得汗也。若小便利，则从燥化，必烦渴，宜白虎汤；小
便不利，则从湿化，必发黄，宜茵陈蒿汤。
【集注】喻昌曰∶阳明病，湿停热郁而烦渴有加，势必发黄，然汗出热从外越，则黄
可免；小便多，热从下泄，则黄可免。若误攻之，其热邪愈陷，津液愈伤，而汗与小便
愈不可得矣。误火之，则热邪愈炽，津液上奔，额虽微汗，而周身之汗与小便愈不可得
矣。发黄之变，安能免乎？
程知曰∶太阳发黄，由寒郁湿，湿不得解；阳明发黄，由湿瘀热，热不得越，故宜分经论治。
阳明病，无汗，小便不利，心中懊 者，身必发黄。
【注】阳明病无汗，以热无从外越也。小便不利，湿不能下泄也。心中懊 ，湿瘀热
郁于里也。故身必发黄，宜麻黄连轺赤小豆汤，外发内利可也。若经汗吐下后，或小便
利，而心中懊 者，乃热郁也，非湿瘀也。便硬者，宜调胃承气汤下之；便软者，宜栀子豉汤涌之可也。
【集注】方有执曰∶无汗小便不利，则湿停懊 ，湿停热郁，所以知必发黄也。
张璐曰∶外不得汗，下不得尿，而湿热郁于胸中不得泄，势必蒸身为黄也。
阳明病，面合色赤，不可攻之，必发热色黄，小便不利也。
【注】阳明经病，面合当色赤，是热邪犹怫郁在经，尚未入里而成实也。故虽不大便，
不可攻之。若攻之，则怫郁在经之邪不解，必令发热色黄。若其人里燥，小便利则同燥化，
当不发黄，而必大便硬矣。
【集注】方有执曰∶合，应也。赤，热色也。胃热上行，面应赤色，攻则亡津液，故
发热色黄，因小便不利也。
程知曰∶言热在阳明之经，不可攻也。热在于经，阳气怫郁在表也，攻之则经中之热，
未得表散，必发热色黄，因小便不利也。
程应旄曰∶热阻于肌肤之间，故发热而小便为之不利，郁而成黄也。
阳明病，发热汗出，此为热越，不能发黄也。但头汗出，身无汗，剂颈而还，小便
不利，渴饮水浆者，此为瘀热在里，身必发黄，茵陈蒿汤主之。
【注】阳明病发热汗出者，此为热越，小便若利，大便因硬，不能发黄也。但头汗出
身无汗，是阳明之热不得外越，而上蒸也；小便不利，湿蓄膀胱也；渴饮水浆，热灼胃腑
也。此为湿热瘀蓄在里，外薄肌肤，故身必发黄也。茵陈蒿汤主之者，通利大小二便，使
湿热从下窍而出也。
【集注】方有执曰∶越，散也。头汗瘀热发黄，注皆见太阳篇中。茵陈逐湿瘀之黄，桅
子除胃家之热，大黄推壅塞之瘀，三物者，苦以泄热，泄热则黄散矣。
程应旄曰∶头汗出，身无汗，剂颈而还，足征阳热之气，郁结于内而不得越，故但上
蒸于头，头为诸阳之首故也。气不下达，故小便不利，腑气过燥，故渴饮水浆。瘀热在
里，指无汗言，无汗而小便利者属寒，无汗而小便不利者属湿热，两邪交郁，不能宣泄，
故而发黄。解热除湿，无如茵陈、栀子
清上，大黄涤下，通身之热得泄，又何黄之不散耶？
伤寒脉浮而缓，手足自温者，是为系在太阴。太阴者，身当发黄；若小便自利者，不
能发黄。至七八日大便硬者，为阳明病也。
【注】此太阴转属阳明证也。伤寒脉浮缓，手足热者，太阳也。今手足自温，非太阳证，
是为系在太阴也。然太阴脉当沉缓，今脉浮缓，乃太阳脉也。证太阴而脉太阳，是邪由
太阳传太阴也，故曰∶系在太阴也。若小便自利者，则不从太阴湿化而发黄，至七八日
大便硬者，则是从燥化，此为阳明也。
【集注】程应旄曰∶阳明为病，本于胃家实。胃家之实，不特三阳受邪，能致其转属
阳明，即三阴受邪，亦能致转属阳明，聊举太阴一经例之∶脉浮而缓，是为表脉，然无
发热、头痛、恶寒等外证，而手足只温，是邪不在表而在里。但入里有阴阳之分，须以
小便别之，小便不利，湿蒸热瘀而发黄，以其人胃中原无燥气也；小便自利者，胃干便
硬而成实，以其胃中本有燥气也。病虽成于七八日，而其始证却脉浮而缓，手足自温，实
是太阴转属而来也。即太阴、阳明推之，少阴三大承气证，厥阴一小承气证，何非转属阳明之病哉！
魏荔彤曰∶病在太阳，热为湿郁团聚于里，必有归着。既不能发黄，小便自利，则邪何
归乎？不得不归之于万物所归之胃。至于七八日，小便自多，大便自硬，而为阳明病矣。
伤寒转系阳明者，其人 然微汗出也。
【注】凡伤寒，无论三阴、三阳，若转系阳明，其人必有 然微汗出之证，始为转属阳明也。
太阳病吐之，但太阳病当恶寒，今反不恶寒，不欲近衣，此为吐之内烦也。
【注】太阳病吐之表解者，当不恶寒，里解者，亦不恶热，今反不恶寒，不欲近衣者，
是恶热也。此由吐之后，表解里不解，内生烦热也。盖无汗烦热，热在表，大青龙证也；
有汗烦热，热在里，白虎汤证也；吐下后心中懊 ，无汗烦热，大便虽硬，热犹在内，栀子豉汤
证也；有汗烦热，大便已硬，热悉入腑，调胃承气汤证也。今因吐后，内生烦热，是为气液已伤之虚烦，非未
经汗下之实烦也。以上之法，皆不可施，惟宜用竹叶石膏汤，于益气生津中，清热宁烦可也。
【集注】张璐曰∶此以吐而伤胃中之液，故内烦不欲近衣。虽显虚烦之证，较关上脉细数而成虚热，脾胃
两伤者稍轻，虽不致逆，亦误吐之过也。
太阳病，当恶寒发热，今自汗出，反不恶寒发热，关上脉细数者，以医吐之过也。一二日吐之者，腹中饥，
口不能食；三四日吐之者，不喜糜粥，欲食冷食；朝食暮吐。以医吐之所致也，此为小逆。
【按】欲食冷食之下，当有“五六日吐之者”六字，若无此一句，则不喜糜粥欲食冷
食，与朝食暮吐之文，不相联属。且以上文一二日、三四日之文细玩之，则可知必有
“五六日吐之”一句，由浅及深之谓也。
【注】太阳病不解，当恶寒发热，今自汗出，不恶寒发热，是表已解也。关上脉细数，
胃不和也。细者，胃气虚。数者，胃气热。证脉不和，询其故，知以医吐之过也。一二日
病在太阳，正气未衰，吐之者，伤胃未深，故腹中知饥，口不能食也；三四日病在阳明，胃
中已热，吐之者，复伤津液，故不喜糜粥，欲食冷食也；五六日病将转入阴经，正气已衰，
吐之者，胃中虚冷，故朝食暮吐也，此皆医吐之所致，尚在可治。故曰∶此为小逆也。
【集注】程知曰∶本太阳病，医吐之，则表邪乘虚传入阳明，伤动胃气，而关脉细数矣。
程应旄曰∶阳明之气，下行为顺，上行为逆，以医吐之所致，则非脾胃本来之病，此
为小逆。更勿误治，使小逆变成大逆也。
食谷欲呕，属阳明也，吴茱萸汤主之。得汤反剧者，属上焦也。
【注】食谷欲呕，属阳明者，以胃主受纳也。今胃中寒，不能纳谷，故欲呕也。以吴
茱萸汤温中降逆，而止其呕可也。若得汤反剧者，此必非中焦阳明之里寒，乃上焦太阳
之表热也。吴茱萸气味俱热，药病不合，故反剧也。法当从太阳、阳明合病，不下利但
呕之例治之，宜葛根加半夏汤。
【集注】方有执曰∶食谷欲呕，胃寒也，故曰属阳明，言与恶寒呕逆不同也。上焦，以膈言也。
病患脉数，数为热，当消谷引食，而反吐者，此以发汗令阳气微，膈气虚，脉乃数
也，数为客热，不能消谷，以胃中虚冷，故吐也。
【注】病患脉数，数为有热，则当消谷引食，今食而反吐者，盖以身热脉数，误为表
热而发其汗，因使其人阳气微，膈气虚也。不知此脉之数，乃外邪客热之数，非胃中实热
之数也，其不能消谷食而反吐者，乃胃中本虚冷故耳。
【集注】程知曰∶此言汗后脉数吐食，当责胃之阳虚也。阳受气于胸中，发汗过多，令
阳气微，膈气虚，客热外越，故脉数也。客热不能消谷而吐者，当责其胃之虚冷，若因
其数而投以清胃之药，则左矣。
程应旄曰∶见数脉而反吐者，数为热脉，无力则为虚脉，隔虚阳客于上，不能下温，故
令胃中虚冷。热为客热，寒为真寒，究其根由，只由发汗令阳气微。然则阳气之珍重何
如而可误汗乎？
阳明病，不能食，攻其热必哕。所以然者，胃中虚冷故也。以其人本虚，攻其热必哕
【注】阳明病不能食者，为中寒，即有脉数客热，上条既戒以不可汗，此又言亦不可
攻。若攻其热，则寒其胃阳，亦必作哕矣。所以然者，客热虽除，胃亦虚冷故也。以其人
本来胃虚，故攻其热必哕。哕，即干呕也。
【集注】方有执曰∶攻热皆寒药，故知必哕。胃中虚以不能食言，此亦戒谨之意。
林澜曰∶阳明谵语潮热，不能食者，可攻，由燥屎在内也。乃亦有胃中虚冷不能食
者，须详别之，未可便以不能食为实证也。若误攻之，热去哕作矣。然则安得以阳明概为宜下哉！
若胃中虚冷，不能食者，饮水则哕。
【注】此承上条不攻亦哕之义也。若其人胃中虚冷，不能食者，虽不攻其热，饮水则
哕，盖以胃既虚冷，复得水寒，故哕也，宜理中汤加丁香吴茱萸，温而降之可也。
【集注】喻昌曰∶表热里寒，法当先救其里，太阳经中亦用四逆汤，其在阳明更可知
矣。此条比前条虚寒更甚，故不但攻其热必哕，即饮水亦哕也。
汪琥曰∶若胃中虚冷不能食，饮水则水寒相抟，气逆而亦为哕矣，法当大温。
趺阳脉浮，浮则为虚，浮虚相抟，故令气KT ，言胃气虚竭也。脉滑则为哕，此为医
咎，责虚取实，守空迫血。脉浮，鼻中燥者，必衄血也。
【注】误攻饮冷，皆可致KT ，固矣。今趺阳胃脉浮而不大，无力而虚，则是胃虚与邪
相抟，即不误下饮冷，亦令KT 也。若趺阳胃脉滑则为哕者，乃热气拥郁之KT ，非胃气虚
竭之KT ，医何可取实责虚，以自取其咎耶！若趺阳胃脉浮而鼻中燥者，此热据营分，营热
迫血妄行，必作衄也。世有以哕为呃逆者，不
知哕即干呕也，以其有哕哕之声，故又名哕也。观今病呃逆之人，与饮冷水则气自脐下
冲上，退场门而作格儿格儿之声，声长时止者为实，可治；声短不已者，为虚，难治。
【集注】方有执曰∶此又出趺阳脉，而以哕与衄言，皆逼汗而不得汗之所致也。咎，过
愆也。责虚，言求病于虚。取实，言反以虚为实而攻取之也。血属阴而为内守，故曰守
空。迫血，言劫汗也。
寸口脉浮大，而医反下之，此为大逆。浮则无血，大则为寒，寒气相抟，则为肠鸣，医
乃不知，而反饮冷水，令汗大出，水得寒气，冷必相抟，其人必KT 。
【按】“令汗大出”四字，当是衍文。
【注】寸口脉浮大，指六脉皆浮大也。六脉皆浮大，则非阳明按之大脉，乃太阳不按
之大脉也。医反下之，此为大逆，则从前浮脉变而为无血之虚，大脉变而为胃冷之迟。虚
寒相抟，则为肠鸣，医乃不知。而反与饮冷水，其人得水寒之气，冷与虚相抟于胃中，故
必KT 也。KT 者，气 结有声，即今之呃逆也。
【集注】程知曰∶言邪气在表妄下之变也。寸口浮大，而无硬满脏热之证，法应发汗，若
治疗黄疸病的方剂以茵陈为君药，佐以大黃，使以梔子，让湿热从大小二便排出，那么身体发黄、腹部胀满自然就能消除了。
【集注】唐不岩说：熏黄（指颜色晦暗的阴黄）；橘子黄（指颜色鲜明的阳黄）。
程知说：这是祛湿除热的治法。伤寒病七八天，是可以用下法的时候；小便不通利，腹部微有胀满，是可以使用下法的证候。兼有黄色鲜明，就是三阳经邪气入里的病邪无疑，所以用茵陈除湿，梔子清热，用大黄来帮助驱除，这个证候虽然可以攻下，但必须以防湿为主；而不专门取效于攻下，正是如此。
茵陈蒿汤方
茵陈蒿（六两） 梔子（掰开，十四枚） 大黄（去皮，二两）
以上三味药，用水一斗二升，先煮茵陈，水量减少六升后，加入另外两味药，煮取三升药液，去掉药渣，分三次服用。如果小便利，尿液像皂荚汁一样，颜色正红，过一夜腹部就会减轻，黄色从小便排出。
【注】伤寒病身体发黄发热的，如果有无汗的表证，应该用麻黄连轺赤小豆汤发汗即可；如果有已成实证的里证，用茵陈蒿汤攻下也可以。现在外面没有可发汗的表证，里面没有可攻下的里证，只适宜用梔子柏皮汤清解热邪。
【集注】林澜说：伤寒病身体发黄，胃中有瘀积的热邪，应当用下法，这里因为发热而热邪尚未结实，所以适宜用梔子柏皮汤来解之。
汪琥说：身体发黄兼有发热，是黄疸证中的发热，而不是麻黄、桂枝证那种发热。热邪既已郁结而发黄，虽然有表证但不是纯粹的表证，只应当清解其郁热，以退去黄疸，那么发热自然痊愈。
魏荔彤说：这三条虽然都是外寒挟带湿邪，瘀积而成热邪的证候。但在表、在里，湿胜、热胜，尤其应当注意区分，怎么能一概认为是里证而混用下法呢！
梔子柏皮汤方
梔子（掰开，十五枚） 甘草（炙，一两） 黄柏（二两）
以上三味药，用水四升，煮取一升半药液，去掉药渣，分两次温服。
【按语】这个方子里的甘草，应该是茵陈，一定是传抄书写时的错误。
阳明病被火疗，额头微微出汗，而小便不通利的，一定会发黄。
【注】阳明病无汗，不用葛根汤发汗，而是用火劫迫取汗，导致热盛津液干枯，饮水后水饮停聚，热气上蒸，所以额头微微出汗，而周身反而不能出汗。如果小便利，则从燥化，必定烦渴，宜用白虎汤；小便不利，则从湿化，必定发黄，宜用茵陈蒿汤。
【集注】喻昌说：阳明病，湿停热郁而烦渴加重，势必发黄，然而汗出热邪从体表发散，就可以避免发黄；小便多，热邪从下排泄，就可以避免发黄。如果误用攻下，热邪更加陷入，津液更加受伤，那么汗和小便就更得不到了。误用火疗，热邪更加炽盛，津液向上奔涌，额头虽然微汗，而周身的汗与小便就更得不到了。发黄的变证，怎么能避免呢？
程知说：太阳病发黄，是由寒郁湿，湿不得解；阳明病发黄，是由湿瘀热，热不得越，所以应当分经论治。
【注】阳明病无汗，是因为热邪无法从体表发散。小便不利，是因为湿邪不能向下排泄。心中懊恼，是湿邪瘀积热邪郁结在里。所以身体必定发黄，适宜用麻黄连轺赤小豆汤，外发内利即可。如果经过汗、吐、下治疗后，或者小便利，而心中懊恼的，那是热邪郁结，不是湿邪瘀积。大便硬的，适宜用调胃承气汤攻下；大便软的，适宜用梔子豉汤涌吐即可。
【集注】方有执说：无汗小便不利，则湿停心中懊恼，湿停热郁，所以知道必定发黄。
张璐说：外不能出汗，下不能排尿，而湿热郁结在胸中不得宣泄，势必蒸腾身体发黄。
【注】阳明经病，面色应当发红，这是热邪仍然怫郁在经脉，尚未入里形成实证。所以即使不大便，也不可以攻下。如果攻下，那么怫郁在经脉的邪气不解，必定导致发热色黄。如果其人里燥，小便利则同于燥化，应当不发黄，而必定是大便硬了。
【集注】方有执说：合，对应。赤，热色。胃热上行，面部对应红色，攻下则亡失津液，所以发热色黄，因小便不利。
程知说：说的是热在阳明经脉，不可攻下。热在于经脉，阳气怫郁在表，攻下则经脉中的热邪，未能从表散，必定发热色黄，因小便不利。
程应旄说：热阻于肌肤之间，所以发热而小便为之不利，郁结而成黄。
阳明病，发热汗出，这叫热邪向外发散，不能发黄。只有头部出汗，身上无汗，汗止于颈部，小便不利，口渴想喝水浆的，这叫瘀热在里，身体必定发黄，用茵陈蒿汤主治。
【注】阳明病发热汗出的，这叫热邪向外发散，如果小便利，大便因此变硬，不能发黄。只有头部出汗身上无汗，是阳明之热不能向外发散，而上蒸；小便不利，是湿蓄积在膀胱；口渴喝水浆，是热灼伤胃腑。这叫湿热瘀积在里，外迫肌肤，所以身体必定发黄。用茵陈蒿汤主治，是通利大小二便，让湿热从下窍排出。
【集注】方有执说：越，散也。头汗瘀热发黄，注释都见于太阳篇中。茵陈驱逐湿瘀之黄，梔子清除胃家之热，大黄推荡壅塞之瘀，这三味药，苦味以泄热，泄热则黄散。
程应旄说：头汗出，身上无汗，止于颈部，足以证明阳热之气，郁结在内而不能发散，所以只上蒸于头，头是诸阳之首的缘故。气不下达，所以小便不利，腑气过燥，所以渴饮水浆。瘀热在里，指无汗而言，无汗而小便利者属寒，无汗而小便不利者属湿热，两邪交结郁滞，不能宣泄，故而发黄。解热除湿，没有比茵陈、梔子清上焦，大黄涤荡下焦更好的了，通身之热得以宣泄，又有什么黄不散的呢？
伤寒脉浮而缓，手足自温的，这是病系在太阴。太阴病，身体应当发黄；如果小便自利的，不能发黄。到了七八天大便硬的，是转为阳明病。
【注】这是太阴病转属阳明的证候。伤寒脉浮缓，手足热，是太阳病。现在手足自温，不是太阳病证，这是病系在太阴。然而太阴脉应当沉缓，现在脉浮缓，乃是太阳脉。证候属太阴而脉象属太阳，是邪气由太阳传入太阴，所以说：系在太阴。如果小便自利，就不从太阴湿化而发黄，到了七八天大便硬的，则是从燥化，这是阳明病。
【集注】程应旄说：阳明为病，本于胃家实。胃家的实证，不仅是三阳经受邪，能导致转属阳明，即使是三阴经受邪，也能导致转属阳明，姑且举太阴一经为例：脉浮而缓，这是表脉，然而没有发热、头痛、恶寒等外证，而手足只是温，是邪气不在表而在里。但入里有阴阳之分，须以小便来辨别，小便不利，湿蒸热瘀而发黄，是因为其人胃中原无燥气；小便自利者，胃干便硬而成实证，是因为胃中本有燥气。病虽然成于七八天，而其始证却是脉浮而缓，手足自温，实在是太阴转属而来的。即从太阴、阳明推之，少阴三大承气证，厥阴一小承气证，何尝不是转属阳明的病呢！
魏荔彤说：病在太阳，热为湿郁团聚于里，必有归着。既然不能发黄，小便自利，那么邪气归于何处呢？不得不归于万物所归的胃。至于七八天，小便自多，大便自硬，就成为阳明病了。
【注】凡是伤寒，无论三阴、三阳，如果转系阳明，其人必定有濈然微汗出的证候，这才算是转属阳明。
太阳病误用吐法，本来太阳病应当恶寒，现在反而不恶寒，不想穿衣服，这是吐法导致的内烦。
【注】太阳病误用吐法，表解者，应当不恶寒，里解者，也不恶热，现在反而不恶寒，不想穿衣服，这是恶热。这是由于吐之后，表解里不解，内生烦热。盖无汗烦热，热在表，是大青龙汤证；有汗烦热，热在里，是白虎汤证；吐下后心中懊恼，无汗烦热，大便虽硬，热犹在内，是梔子豉汤证；有汗烦热，大便已硬，热悉入腑，是调胃承气汤证。现在因吐后，内生烦热，这是气液已伤的虚烦，不是未经汗下的实烦。以上的方法，都不可以施用，只适宜用竹叶石膏汤，在益气生津中，清热宁烦即可。
【集注】张璐说：这是因为吐而伤胃中之液，所以内烦不欲近衣。虽然显现虚烦的证候，较之关上脉细数而成虚热，脾胃两伤者稍轻，虽然不至于逆乱，也是误用吐法的过错。
太阳病，应当恶寒发热，现在自汗出，反而不恶寒发热，关上脉细数的，是医生误用吐法的过错。一二日病时用吐法，腹中饥，口不能食；三四日用吐法，不喜欢喝粥，想吃冷食；早晨吃晚上吐。是医生误用吐法所致，这称为小逆。
【按语】“想吃冷食”之下，应当有“五六日用吐法者”六个字，如果没有这一句，则“不喜欢喝粥想吃冷食”与“早晨吃晚上吐”的文字，不相联属。且以上文一二日、三四日的文字仔细玩味，则可知必定有“五六日用吐法”一句，这是由浅入深的说法。
【注】太阳病不解，应当恶寒发热，现在自汗出，不恶寒发热，是表已解。关上脉细数，是胃不和。细，是胃气虚。数，是胃气热。证脉不和，询问其原因，知道是医生误用吐法的过错。一二日病在太阳，正气未衰，用吐法，伤胃未深，所以腹中知饥，口不能食；三四日病在阳明，胃中已热，用吐法，又伤津液，所以不喜欢喝粥，想吃冷食；五六日病将转入阴经，正气已衰，用吐法，胃中虚冷，所以早晨吃晚上吐，这都是医生误用吐法所致，尚在可治范围。所以说：这是小逆。
【集注】程知说：本是太阳病，医生误用吐法，则表邪乘虚传入阳明，伤动胃气，而关脉细数。
程应旄说：阳明之气，下行顺，上行逆，因医生误用吐法所致，则不是脾胃本来之病，这称为小逆。更勿误治，使小逆变成大逆。
进食就想呕吐，属于阳明病，用吴茱萸汤主治。服药后反而加重的，属于上焦病。
【注】进食就想呕吐，属于阳明病，是因为胃主受纳。现在胃中寒，不能纳谷，所以想呕吐。用吴茱萸汤温中降逆，而止其呕吐即可。如果服药后反而加重，这必定不是中焦阳明的里寒，而是上焦太阳的表热。吴茱萸气味俱热，药不对病，所以反而加重。法当从太阳、阳明合病，不下利但呕的例证治疗，适宜用葛根加半夏汤。
【集注】方有执说：进食就想呕吐，是胃寒，所以说属阳明，意思是与恶寒呕逆不同。上焦，以膈膜言。
病患脉数，数是热，应当消谷引食，而反而呕吐的，这是因为发汗令阳气微弱，膈气虚，脉才数。数是客热，不能消谷，因为胃中虚冷，所以呕吐。
【注】病患脉数，数是有热，则应当消谷引食，现在吃饭反而呕吐，大概是因为身热脉数，误认为表热而发其汗，因而使其人阳气微弱，膈气虚。不知道此脉之数，是外邪客热之数，不是胃中实热之数，其不能消谷食而反呕吐的，是胃中本虚冷的缘故。
【集注】程知说：这说的是汗后脉数吐食，应当责之于胃之阳虚。阳受气于胸中，发汗过多，令阳气微弱，膈气虚，客热外越，所以脉数。客热不能消谷而吐的，应当责其胃之虚冷，如果因其数而投以清胃的药，那就错了。
程应旄说：见数脉而反呕吐的，数是热脉，无力则为虚脉，隔虚阳客于上，不能下温，所以令胃中虚冷。热为客热，寒为真寒，究其根由，只由发汗令阳气微弱。然而阳气之珍重何如，岂可误汗呢？
阳明病，不能食，攻其热必哕（呃逆）。之所以这样，是因为胃中虚冷。因为其人本来虚，攻其热必哕。
【注】阳明病不能食的，是中寒，即使有脉数客热，上条既告诫不可汗，这里又说也不可攻。如果攻其热，则寒其胃阳，也必定作哕。之所以这样，是客热虽除，胃亦虚冷的缘故。因为其人本来胃虚，所以攻其热必哕。哕，即干呕。
【集注】方有执说：攻热皆用寒药，所以知道必哕。胃中虚以不能食言，这也是戒慎的意思。
林澜说：阳明谵语潮热，不能食的，可攻，由燥屎在内。乃亦有胃中虚冷不能食的，须详细辨别，不可便将不能食当作实证。如果误攻，热去哕作。然而怎能一概认为阳明适宜下法呢！
【注】这是承接上条不攻亦哕的意思。如果其人胃中虚冷，不能食的，虽然不攻其热，喝水则哕，盖因胃既虚冷，又得水寒，所以哕，适宜理中汤加丁香吴茱萸，温而降之即可。
【集注】喻昌说：表热里寒，法当先救其里，太阳经中也用四逆汤，其在阳明更可知矣。此条比前条虚寒更甚，所以不但攻其热必哕，即饮水亦哕。
汪琥说：如果胃中虚冷不能食，饮水则水寒相搏，气逆而亦为哕，法当大温。
趺阳脉浮，浮则为虚，浮虚相搏，故令气噫（嗳气），言胃气虚竭也。脉滑则为哕，这是医生的过错，责虚取实，守空迫血。脉浮，鼻中燥的，必衄血。
【注】误攻饮冷，皆可致噫，固然是这样。现在趺阳胃脉浮而不大，无力而虚，则是胃虚与邪相搏，即不误下饮冷，也令噫。如果趺阳胃脉滑则为哕的，是热气拥郁之噫，非胃气虚竭之噫，医生何可取实责虚，以自取其咎耶！如果趺阳胃脉浮而鼻中燥的，此热据营分，营热迫血妄行，必作衄血。世上有人把哕当作呃逆，不知道哕即干呕，以其有哕哕之声，故又名哕。看今病呃逆之人，与饮冷水则气自脐下冲上，退场门而作格儿格儿之声，声长时止者为实，可治；声短不已者，为虚，难治。
【集注】方有执说：这又提出趺阳脉，而以哕与衄言，都是逼汗而不得汗所致。咎，过失。责虚，言求病于虚。取实，言反以虚为实而攻取之。血属阴而为内守，故曰守空。迫血，言劫汗。
寸口脉浮大，而医生反用下法，这是大逆。浮则无血，大则为寒，寒气相搏，则为肠鸣，医生却不知道，反而饮冷水，令汗大出，水得寒气，冷必相搏，其人必噫。
【按语】“令汗大出”四字，应当是衍文。
【注】寸口脉浮大，指六脉皆浮大。六脉皆浮大，则非阳明按之大脉，乃太阳不按之大脉。医生反用下法，这是大逆，则从前浮脉变而为无血之虚，大脉变而为胃冷之迟。虚寒相搏，则为肠鸣，医生却不知道。反而给饮冷水，其人得水寒之气，冷与虚相搏于胃中，所以必噫。噫者，气结有声，即今之呃逆。
The treatment for jaundice uses Yinchen (Artemisiae Scopariae Herba) as the sovereign drug, assisted by Dahuang (Rhei Radix et Rhizoma), and guided by Zhizi (Gardeniae Fructus), allowing damp-heat to be discharged through the large and small intestines. Consequently, the yellowing of the body and abdominal fullness will naturally resolve.
[Collected Annotations] Tang Buyan stated: Xunhuang refers to Yin Jaundice (dark-yellow jaundice); Juzihuang refers to Yang Jaundice (bright-yellow jaundice).
Cheng Zhi stated: This is a method to expel dampness and remove heat. In Shanghan (Cold Damage) disease after seven or eight days, it is the time when purgation may be used; difficulty in urination and slight abdominal fullness are indications that purgation is appropriate. With the addition of bright yellow coloration, it is undoubtedly pathogenic factors from the Three Yang channels entering the interior. Therefore, Yinchen is used to dispel dampness, Zhizi to clear heat, and Dahuang to assist in expulsion. Although this condition allows for purgation, the primary focus must be on dispelling dampness; it does not rely solely on aggressive purgation, which is precisely the point.
Yinchen Hao Tang Formula
Yinchen Hao (Six liang) Zhizi (Broken open, fourteen pieces) Dahuang (Bark removed, two liang)
Take these three ingredients, add one dou and two sheng of water, first decoct Yinchen until the volume reduces by six sheng, then add the other two ingredients. Decoct until three sheng remain, strain off the dregs, and divide into three doses. If urination becomes free, with urine resembling the juice of soap pods and appearing reddish, the abdomen will reduce after one night, and the yellow color will exit via the urine.
In Shanghan disease presenting with yellowing of the body and fever, Zhizi Bopi Tang should be administered.
[Annotation] In Shanghan disease with yellowing of the body and fever, if there is a exterior syndrome of anhidrosis (absence of sweating), Mahlian Lianqiao Chixiaodou Tang should be used to induce sweating; if there is an interior excess syndrome, Yinchenshao Tang can be used to purge. Currently, since there is no exterior syndrome suitable for sweating nor an interior syndrome suitable for purging, only Zhizi Bopi Tang should be used to clear the heat.
[Collected Annotations] Lin Lan stated: In Shanghan disease with yellowing of the body, there is stagnant heat in the Stomach requiring purgation. Here, because there is fever but the heat has not yet solidified, Zhizi Bopi Tang is appropriate to resolve it.
Wang Hu stated: Yellowing of the body accompanied by fever is the fever associated with jaundice syndromes, not the fever seen in Mahuang or Guizhi syndromes. Since heat is constrained and causes yellowing, although there is an exterior component, it is not a pure exterior syndrome. One should only clear the constrained heat to retreat the jaundice, at which point the fever will heal itself.
Wei Litong stated: Although these three clauses all describe conditions where exterior cold combines with dampness, stagnating into heat, one must pay special attention to whether the pathogen is in the exterior or interior, and whether dampness or heat predominates. How can one generally consider them interior syndromes and indiscriminately use purgation?
Zhizi Bopi Tang Formula
Zhizi (Broken open, fifteen pieces) Gancao (Honey-fried, one liang) Huangbai (Phellodendri Cortex, two liang)
Take these three ingredients, add four sheng of water, decoct until one and a half sheng remain, strain off the dregs, and divide into two warm doses.
[Note] The Gancao (Licorice Root) in this formula should likely be Yinchenshao (Artemisiae Scopariae Herba); this is certainly a transcription error.
In Yangming disease treated with fire therapy, if there is slight sweating on the forehead and difficulty in urination, yellowing of the body will inevitably occur.
[Annotation] In Yangming disease with anhidrosis, instead of using Gegen Tang to induce sweating, fire therapy was used to force sweat. This resulted in excessive heat and dryness of fluids. Drinking water led to fluid retention, and heat steamed upward, causing slight sweating on the forehead while the rest of the body remained without sweat. If urination were free, the condition would transform towards dryness, resulting in vexation and thirst, treated with Baihu Tang. Since urination is difficult, it transforms towards dampness, resulting in yellowing, treated with Yinchenshao Tang.
[Collected Annotations] Yu Chang stated: In Yangming disease, with dampness stagnating and heat constrained, vexation and thirst worsen, inevitably leading to yellowing. However, if sweating occurs, heat escapes outward, avoiding yellowing; if urination is frequent, heat drains downward, avoiding yellowing. If mistakenly purged, the heat sinks deeper, fluids are further damaged, and both sweat and urination become impossible. If mistakenly treated with fire, heat becomes more intense, fluids rush upward; although there is slight sweating on the forehead, sweat and urination elsewhere become impossible. How can one avoid the transformation of yellowing?
Cheng Zhi stated: Jaundice in Taiyang disease arises from cold constraining dampness, preventing its resolution. Jaundice in Yangming disease arises from dampness constraining heat, preventing its release. Therefore, treatment must distinguish between meridians.
In Yangming disease, with anhidrosis, difficulty in urination, and inner restlessness (Xinzhong Aonao), yellowing of the body will inevitably occur.
[Annotation] Anhidrosis in Yangming disease means heat cannot escape outward. Difficulty in urination means dampness cannot drain downward. Inner restlessness indicates dampness and heat constrained within the interior. Thus, yellowing is inevitable. Malign Lianqiao Chixiaodou Tang should be used to release externally and drain internally. If, after sweating, vomiting, or purging, or if urination is free but inner restlessness persists, it is due to heat constraint, not dampness constraint. If stools are hard, Tiaowei Chengqi Tang should be used to purge; if stools are soft, Zhizi Chi Tang should be used to induce emesis.
[Collected Annotations] Fang Youzhi stated: Anhidrosis and difficulty in urination lead to dampness stagnation and inner restlessness. With dampness stagnating and heat constrained, yellowing is certain.
Zhang Lu stated: Unable to sweat externally or urinate downward, damp-heat is constrained in the chest and cannot vent, inevitably steaming the body to become yellow.
In Yangming disease, if the entire face appears red, purgation must not be used. It will inevitably result in fever, yellowing, and difficulty in urination.
[Annotation] In Yangming meridian disease, facial redness indicates heat still constrained in the meridian, not yet entering the interior to form excess. Therefore, even if there is constipation, purgation is contraindicated. If purged, the heat constrained in the meridian will not resolve, inevitably causing fever and yellowing. If the patient has interior dryness and free urination, it transforms towards dryness, so yellowing will not occur, but stools will become hard.
[Collected Annotations] Fang Youzhi stated: "He" means corresponding. "Chi" means red, the color of heat. Stomach heat rises, causing facial redness. Purging destroys fluids, leading to fever and yellowing due to difficulty in urination.
Cheng Zhi stated: This states that heat in the Yangming meridian cannot be purged. Heat in the meridian means Yang Qi is constrained at the exterior. Purging prevents the heat in the meridian from being released, inevitably causing fever and yellowing due to difficulty in urination.
Cheng Yingmao stated: Heat obstructs between the skin and muscles, causing fever and difficulty in urination, constraining into yellowing.
In Yangming disease, fever and sweating indicate heat venting outward, so yellowing cannot occur. If there is only sweating on the head, no sweating on the body, stopping at the neck, difficulty in urination, and thirst for liquids, this indicates stagnant heat in the interior, inevitably causing yellowing. Yinchenshao Tang should be administered.
[Annotation] Fever and sweating in Yangming disease indicate heat venting outward. If urination is free and stools become hard due to dryness, yellowing cannot occur. Only head sweating with no body sweating indicates Yangming heat cannot vent outward but steams upward. Difficulty in urination indicates dampness accumulating in the Bladder. Thirst for liquids indicates heat scorching the Stomach. This is damp-heat stagnant in the interior, pressing on the skin and muscles, inevitably causing yellowing. Yinchenshao Tang is used to unblock the large and small bowels, allowing damp-heat to exit via the lower orifices.
[Collected Annotations] Fang Youzhi stated: "Yue" means dispersing. Head sweating, stagnant heat, and yellowing are noted in the Taiyang chapter. Yinchen drives out damp-stagnant yellow, Zhizi removes Stomach heat, and Dahuang pushes away obstructive stasis. These three herbs use bitterness to drain heat; draining heat disperses the yellow.
Cheng Yingmao stated: Head sweating, no body sweating, stopping at the neck, proves Yang heat qi is constrained internally and cannot vent, thus only steaming the head, as the head is the summit of all Yang meridians. Qi fails to descend, causing difficulty in urination; Fu organ qi is overly dry, causing thirst for liquids. "Stagnant heat in the interior" refers to anhidrosis. Anhidrosis with free urination belongs to cold; anhidrosis with difficulty in urination belongs to damp-heat. Two pathogens intertwine and cannot vent, hence yellowing. To resolve heat and dispel dampness, nothing surpasses Yinchen and Zhizi clearing the upper, and Dahuang cleansing the lower. Once the heat of the whole body is vented, how can the yellow not disperse?
In Shanghan disease, if the pulse is floating and slow, and the hands and feet are naturally warm, this indicates the disease is related to Taiyin. In Taiyin disease, the body should yellow; however, if urination is naturally free, yellowing cannot occur. By the seventh or eighth day, if stools become hard, it has become Yangming disease.
[Annotation] This is a Taiyin condition transferring to Yangming. Shanghan with floating-slow pulse and hot hands/feet is Taiyang. Now, with naturally warm hands/feet, it is not a Taiyang syndrome, but related to Taiyin. However, Taiyin pulse should be sinking-slow; the current floating-slow pulse is Taiyang. A Taiyin syndrome with a Taiyang pulse indicates pathogenic factors transmitting from Taiyang to Taiyin, hence "related to Taiyin." If urination is free, it does not transform via Taiyin dampness to cause yellowing. By the seventh or eighth day, hard stools indicate transformation via dryness, becoming Yangming disease.
[Collected Annotations] Cheng Yingmao stated: Yangming disease originates from Stomach Excess. Stomach excess is caused not only by pathogenic factors in the Three Yang channels transferring to Yangming, but also by factors in the Three Yin channels transferring to Yangming. Taking Taiyin as an example: Floating-slow pulse is a surface pulse, but without exterior symptoms like fever, headache, or aversion to cold, and with only warm hands/feet, the pathogen is in the interior, not the exterior. Interior transmission has Yin-Yang distinctions, distinguished by urination. Difficulty in urination leads to steaming dampness and stagnant heat causing yellowing, because the person lacks dryness in the Stomach originally. Free urination leads to dry Stomach and hard stools forming excess, because the person possesses dryness in the Stomach originally. Although the disease manifests after seven or eight days, the initial signs of floating-slow pulse and warm hands/feet truly represent a transfer from Taiyin. Extending this logic from Taiyin and Yangming, the Three Da Chengqi cases in Shaoyin and the Xiao Chengqi case in Jueyin are all diseases transferring to Yangming!
Wei Litong stated: When disease is in Taiyang, heat constrained by dampness gathers in the interior and must have a destination. If it cannot cause yellowing and urination is free, where does the pathogen go? It must return to the Stomach, the destination of all things. By the seventh or eighth day, increased urination and hard stools constitute Yangming disease.
When Shanghan transfers to involve Yangming, the patient exhibits continuous mild sweating (Jieran Han Chu).
[Annotation] In all Shanghan diseases, regardless of Three Yin or Three Yang channels, if they transfer to involve Yangming, the patient must exhibit continuous mild sweating to confirm the transfer to Yangming.
If Taiyang disease is treated with emesis, and although Taiyang disease should present with aversion to cold, now there is no aversion to cold and a desire to remove clothing, this is internal vexation caused by emesis.
[Annotation] If Taiyang disease is treated with emesis and the exterior resolves, there should be no aversion to cold; if the interior resolves, there should be no aversion to heat. Now, the absence of aversion to cold and the desire to remove clothing indicate aversion to heat. This is due to the exterior resolving but the interior remaining unresolved after emesis, generating internal vexation and heat. Vexation and heat without sweating, with heat in the exterior, is Da Qinglong Tang syndrome. Vexation and heat with sweating, with heat in the interior, is Baihu Tang syndrome. After emesis and purging, with inner restlessness, no sweating, and vexation/heat, even if stools are hard, heat remains in the interior, indicating Zhizi Chi Tang syndrome. Vexation and heat with sweating and hard stools, with heat fully entering the Fu organs, indicates Tiaowei Chengqi Tang syndrome. Now, following emesis, internal vexation arises, representing deficiency vexation due to damage of Qi and fluids, not excess vexation before sweating/purging. None of the above methods apply; only Zhuye Shigao Tang should be used to benefit Qi, generate fluids, clear heat, and calm vexation.
[Collected Annotations] Zhang Lu stated: Emesis damages fluids in the Stomach, causing internal vexation and desire to remove clothing. Although manifesting deficiency vexation, it is slightly milder than deficiency heat with fine-rapid Guan pulse damaging Spleen and Stomach. It does not lead to reversal, but is still the fault of mistaken emesis.
Taiyang disease should present with aversion to cold and fever. Now, spontaneous sweating occurs, with no aversion to cold or fever, and the Guan pulse is fine and rapid. This is the fault of the physician's emesis. If emesis is used on the first or second day, the patient feels hungry in the abdomen but cannot eat. If used on the third or fourth day, the patient dislikes congee and desires cold food. If used on the fifth or sixth day, morning food is vomited in the evening. This is caused by the physician's emesis and is considered a minor deviation (Xiao Ni).
[Note] Under "desires cold food," the phrase "if emesis is used on the fifth or sixth day" should exist. Without this sentence, the text regarding disliking congee/desiring cold food and morning food/evening vomiting is disjointed. Careful examination of the first-second and third-fourth day texts reveals the necessity of the "fifth-sixth day" clause, representing progression from shallow to deep.
[Annotation] Unresolved Taiyang disease should have aversion to cold and fever. Now, spontaneous sweating with no aversion to cold or fever indicates the exterior has resolved. Fine-rapid Guan pulse indicates Stomach disharmony. Fine indicates deficient Stomach Qi; rapid indicates hot Stomach Qi. The mismatch between syndrome and pulse, upon inquiry, reveals the fault of physician-emesis. On days one or two, disease is in Taiyang, Zheng Qi is not depleted; emesis causes shallow Stomach injury, so the patient feels hungry but cannot eat. On days three or four, disease is in Yangming, Stomach is already hot; emesis further damages fluids, so the patient dislikes congee and desires cold food. On days five or six, disease is about to enter Yin channels, Zheng Qi is depleted; emesis causes cold deficiency in the Stomach, so morning food is vomited in the evening. All are caused by physician-emesis but remain treatable. Hence, "minor deviation."
[Collected Annotations] Cheng Zhi stated: Original Taiyang disease treated with emesis allows exterior pathogens to enter Yangming via deficiency, disturbing Stomach Qi, resulting in fine-rapid Guan pulse.
Cheng Yingmao stated: Yangming Qi descends smoothly; ascending is reversal. Caused by physician-emesis, this is not the original pathology of Spleen and Stomach, hence "minor deviation." Do not mistreat it, lest minor deviation becomes major reversal.
Food intake triggering desire to vomit belongs to Yangming; Wuzhuyu Tang should be administered. If symptoms worsen after taking the decoction, it belongs to the Upper Jiao.
[Annotation] Desire to vomit upon eating belongs to Yangming because the Stomach governs reception. Current cold in the Stomach prevents grain reception, causing desire to vomit. Wuzhuyu Tang warms the middle and directs rebellious Qi downward to stop vomiting. If symptoms worsen after ingestion, this is not Middle Jiao Yangming interior cold, but Upper Jiao Taiyang exterior heat. Wuzhuyu is hot in nature and flavor, mismatching the pathology, hence worsening. Treatment should follow the principle of Taiyang-Yangming combined disease with vomiting but no diarrhea, using Gegen Banxia Tang.
[Collected Annotations] Fang Youzhi stated: Desire to vomit upon eating indicates Stomach cold, hence belonging to Yangming, distinguishing it from aversion-to-cold vomiting. Upper Jiao refers to the diaphragm.
If a patient has a rapid pulse, rapid indicates heat, and digestion should be efficient with good appetite, yet vomiting occurs instead, this is because sweating made Yang Qi weak and Diaphragm Qi deficient, causing the rapid pulse. Rapid here indicates guest heat, which cannot digest food; vomiting occurs due to cold deficiency in the Stomach.
[Annotation] Patient has rapid pulse, indicating heat, so digestion should be efficient. Yet vomiting occurs after eating. This is because fever and rapid pulse were mistaken for exterior heat, leading to sweating, which weakened Yang Qi and Diaphragm Qi. The rapid pulse is due to external guest heat, not interior Stomach excess heat. Inability to digest food and vomiting result from original Stomach cold deficiency.
[Collected Annotations] Cheng Zhi stated: This describes post-sweating rapid pulse and vomiting of food, attributing it to Stomach Yang deficiency. Yang receives Qi from the Chest; excessive sweating weakens Yang Qi and Diaphragm Qi, causing guest heat to escape outward, resulting in rapid pulse. Guest heat cannot digest food, causing vomiting; this must be attributed to Stomach cold deficiency. Using Stomach-clearing herbs based on the rapid pulse would be erroneous.
Cheng Yingmao stated: Seeing rapid pulse but vomiting: rapid is a heat pulse, but if forceless, it is a deficiency pulse. Deficient Yang guests in the upper region cannot warm downward, causing Stomach cold deficiency. Heat is guest heat; cold is true cold. Ultimately, the root is sweating weakening Yang Qi. How precious is Yang Qi, and how can one rashly sweat?
In Yangming disease, inability to eat, attacking the heat will inevitably cause hiccups (Yue). The reason is cold deficiency in the Stomach. Because the person is originally deficient, attacking the heat will inevitably cause hiccups.
[Annotation] Inability to eat in Yangming disease indicates Middle Cold. Even if there is a rapid pulse with guest heat, the previous clause warned against sweating; this adds that purging is also contraindicated. Attacking heat will chill Stomach Yang, inevitably causing hiccups. The reason is that although guest heat is removed, the Stomach remains cold-deficient. Because the person is originally Stomach deficient, attacking heat causes hiccups. Yue refers to dry heaving.
[Collected Annotations] Fang Youzhi stated: Heat-purging herbs are cold, hence hiccups are inevitable. Stomach deficiency described as inability to eat serves as a warning.
Lin Lan stated: Yangming delirium and tidal fever with inability to eat can be purged due to dry stool in the interior. However, some cases involve Stomach cold deficiency causing inability to eat; these must be carefully distinguished. One cannot simply assume inability to eat indicates excess. Mistaken purging removes heat but triggers hiccups. Thus, one cannot generalize that Yangming always requires purgation!
If Stomach cold deficiency causes inability to eat, drinking water will trigger hiccups.
[Annotation] This continues the meaning of the previous clause that hiccups occur even without purging. If Stomach cold deficiency causes inability to eat, drinking water will trigger hiccups because the cold-deficient Stomach encounters cold water. Lizhong Tang plus Dingxiang (Caryophylli Flos) and Wuzhuyu (Evodiae Fructus) should be used to warm and direct downward.
[Collected Annotations] Yu Chang stated: Exterior heat with interior cold requires saving the interior first. SiNi Tang is used in Taiyang; how much more so in Yangming? This clause presents more severe cold deficiency than the previous one; thus, not only does attacking heat cause hiccups, but drinking water also causes them.
Wang Hu stated: If Stomach cold deficiency causes inability to eat, drinking water causes water and cold to clash, rebellious Qi rises, causing hiccups. Treatment requires strong warming.
Fuyang pulse is floating; floating indicates deficiency. Floating and deficiency interacting causes belching (Qi Yi), indicating exhaustion of Stomach Qi. Pulse slippery indicates hiccups; this is the physician's fault, treating deficiency as excess, guarding emptiness while forcing blood. If pulse is floating and nose is dry, epistaxis (Nu) will occur.
[Annotation] Mistaken purging or drinking cold water can cause belching, certainly. Now, Fuyang Stomach pulse is floating but not large, forceless and deficient, indicating Stomach deficiency interacting with pathogen. Even without mistaken purging or cold drinks, belching occurs. If Fuyang Stomach pulse is slippery, hiccups occur; this is belching due to heat congestion, not Stomach Qi exhaustion. How can the physician treat excess as deficiency, taking blame upon themselves? If Fuyang Stomach pulse is floating and nose is dry, heat occupies the Ying level, Ying heat forces blood to move recklessly, causing epistaxis. Some confuse Yue (dry heave) with hiccup (E Ni). Yue is dry heave, named for its sound. Modern hiccups (E Ni) involve air rushing from below the navel upwards after drinking cold water, making grunting sounds. Long pauses indicate excess, treatable; short, incessant sounds indicate deficiency, difficult to treat.
[Collected Annotations] Fang Youzhi stated: This introduces Fuyang pulse, discussing hiccups and epistaxis, both caused by forced sweating failing to produce sweat. Jiu means fault. Ze Xu means seeking disease in deficiency. Qu Shi means wrongly treating deficiency as excess. Blood belongs to Yin and guards inwardly, hence "guarding emptiness." Po Xue means coercing sweat.
Cunkou pulse is floating and large, yet the physician mistakenly uses purgation; this is a major reversal. Floating indicates lack of blood; large indicates cold. Cold qi interacting causes borborygmus. The physician fails to recognize this and instead gives cold water to induce heavy sweating. Water meeting cold qi causes cold interaction, inevitably causing belching in the patient.
[Note] The four characters "ling han da chu" (causing heavy sweating) are likely interpolations.
[Annotation] Cunkou floating-large pulse refers to all six pulses being floating and large. Six pulses floating-large are not the large pulse of Yangming palpable under pressure, but the large pulse of Taiyang not palpable under pressure. Mistaken purgation is a major reversal. The former floating pulse transforms into deficiency lacking blood; the large pulse transforms into slow pulse of Stomach cold. Deficiency and cold interact, causing borborygmus. The physician fails to recognize this and gives cold water. The patient receives cold-water qi; cold and deficiency interact in the Stomach, inevitably causing belching. Yi refers to qi knotting with sound, i.e., modern hiccup.
[Collected Annotations] Cheng Zhi stated: This describes the transformation of mistaken purgation when pathogen is in the exterior. Cunkou floating-large without hardness/fullness or interior heat syndromes should be treated with sweating. If