（发热者无休止时也寒热者寒已而热热已而寒相继而发也潮热者有时热有时止如潮汛之不失其期也若发热不恶寒
而渴为温病发汗已身体灼热者为风温若发热手或微厥下利清谷此为阴证也夫下血气不通四肢逆冷却发热此热深厥亦深
也头痛发热恶寒身不疼痛此伤食证也不恶寒身不痛知非伤寒头不疼脉不紧知非里实但烦热者烦虚也）
中风即发热者风伤卫也伤寒不即发热者寒伤荣也经云伤寒一二日或已发热或未发热是也凡翕翕发热而有恶风恶寒
头痛脉浮者表证也此由风寒客于皮肤阳气怫郁所致宜汗之若小便黄非在外凡蒸蒸发热而兼有谵语大便秘小便赤腹满恶
热脉滑实者里热也此由阳气下陷入阴中所致宜下之若小便清非在内也其在少阴厥阴发热者谓之反发热惟太阴无发热之
候若脉阴阳俱盛热不止者死下利发热汗后复发热脉躁疾不为汗衰狂言不能食阴阳不交者死 兰台治例曰邪在三阳太阳
证多与潮热若同而异邪在三阴少阴证多与烦躁相类而非
发热恶寒脉浮者属表即太阳证也（方论见前太阳病条）发热汗出不恶寒反恶热者属里即阳明证也（方论见自汗）发
热脉弦细头痛者属半表半里即少阳证也（论见口苦咽干）发热而呕者小柴胡汤（论见呕）发热咳嗽表不解者小青龙汤兼
胁痛喜呕者小柴胡加干姜五味子汤（方论见咳）发热而喘表不解者小青龙去麻黄加杏仁汤兼胸满者麻黄汤（方论见喘）
发热口渴有属表者有属里者治法方论甚众（并见渴门）
发热汗解半日许复烦躁脉浮数大者可更发汗宜桂枝汤（详烦）
发汗后恶风寒者虚故也不恶寒但恶热者实也当和胃气宜调胃承气汤（经曰汗出不恶寒者此表解里未和与调胃承气汤
以和胃气）
太阳病三日发汗不解蒸蒸发热者属胃也调胃承气汤主之（海 大黄泄实芒硝软坚甘草和中必燥实坚三证全者可用）
调胃承气汤方
大黄（一两 海 宜酒浸盖邪气居高非酒不到譬如物在高巅人迹所不及必射而取之故用酒浸引上若生用苦泄峻下则
遗高分之邪热所以愈后或目赤或喉闭或头肿膈上反生热证） 甘草（半两炙 海 甘以缓之） 芒硝（九钱 海 辛以
润之咸以软之）上 咀水一盏煮大黄甘草至七分去滓入芒硝更上火微煮令沸少少温服
成 内经曰热淫于内治以咸寒佐以苦甘芒硝咸寒以除热大黄苦寒以荡实甘草甘平助二物推陈而缓中发热汗出不
解
心下痞硬呕吐而利者大柴胡汤（论见痞）发汗后身灼热脉浮汗出身重多眠鼻鼾者风温（论见风温）发汗后仍发热心悸头
眩身 动振振欲擗地者宜真武汤（论见下利）汗出热不去内拘急四肢疼下利厥逆恶寒者宜四逆汤（论见下利）大汗出脉
阴阳俱盛不解者死（内经云温病汗彻复热而脉躁疾不为汗衰狂言不能食谓之阴阳交者必死也）
太阳病先发汗不解而复下之脉浮者不愈浮为在外而反下之故令不愈今脉浮故知在外当须解外则愈桂枝汤主之
汗下后仍头痛发热心下满小便不利者桂枝去桂加茯苓白术汤（论见结胸）大下后身热不去心中结痛者栀子豉汤主之（论
见心）大下后身热不去微烦者栀子干姜汤（方论见烦）阳明病下之其外有热手足温心中懊 饥不能食但头汗出者栀子豉
汤（论见烦）
太阳病当恶寒发热今自汗出不恶寒发热关上脉细数者以误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误吐之所致也此为小逆（成 恶寒发热为太阳表病自汗出不恶寒发热者阳明证本太阳表病医
反吐之伤动胃气表邪乘虚传于阳明也以关脉细数知误吐之所致病一二日为表邪尚寒而未成热吐之则表寒传于胃中胃中
虚寒故腹中饥而口不能食病三四日则表邪已传成热吐之则表热乘虚入胃胃中虚热故不喜糜粥欲食冷食朝食暮吐也朝食
暮吐者晨食入胃胃虚不能克化故停久而复吐出者知为医误吐之胃虚所致本太阳病吐不为逆以传阳明故以为逆然阳明虽
为入腑犹是阳经故不为大逆而曰小逆也）
瘥后更热者小柴胡汤脉浮者以汗解脉沉者以下解（详劳复）
伤寒脉浮滑此表有热里有寒白虎汤主之（前篇云热结在里表里俱热者白虎汤主之又云其表不解不可与白虎汤此云脉
浮滑表有热里有寒者必表里字差矣又阳明一证云脉浮迟表热里寒四逆汤主之又少阴一证云里寒外热通脉四逆汤主之以
此见差明矣又阳明篇曰脉滑而疾者小承气汤既用承气是为里热也又厥阴篇曰脉滑而厥者里有热白虎汤主之是谓滑为里
热明矣况知母石膏性皆大寒岂应以水济水成氏随文释之非也）
白虎汤方
知母（六两） 石膏（一斤） 甘草（二两） 糯米（六合）上四味以水一斗煮米熟汤成去滓温服一升日三服
成 白虎西方金神也应秋而归肺热甚于内者以寒下之热甚于外者以凉解之其有中外俱热内不得泄外不得发非是
汤
则不能解暑 之气得秋而止故曰处暑是汤以白虎名谓能止热也内经曰热淫所胜佐以苦甘又曰热淫于内以苦发之欲彻表热
必以苦为主故以知母苦寒为君热则伤气寒以胜之甘以缓之热胜其气必以甘寒为助是以石膏甘寒为臣脾苦湿急食甘以
缓之热气内余消烁津液必以甘平之物缓其中故以甘草粳米为使是太阳中 得此汤则顿除即热见白虎而尽矣立秋后不可
服白虎为大寒剂秋时服之必多为哕逆虚羸者矣
垣 身以前胃之经也胸胃肺之室也邪在阳明肺受火制故用辛寒以清肺所以号为白虎汤也
海 夫伤寒表证发热恶热而渴与下杂证同但头痛身热目痛鼻干不得卧白虎主之乃阳明经病也正阳阳明气病脉洪
大
先无形也杂病里证发热恶热而渴但目赤者病藏也手太阴气不足不能管领阳气也宜以枸杞生地黄熟地黄之类主之脉洪大
甚则呕血先有形也 气病在里误用血药无伤寒也为安血而益阴也血在里误用气药如白虎汤者非也为泻肺而损阴也
垣 辩误服白虎变证 昔西台掾葛君瑞二月中病伤寒发热以白虎汤主之病者面黑如墨本证遂不复见脉沉细小便
不
禁东垣初不知也及诊之曰此立夏以前误服白虎白虎大寒非行经之药止能寒脏腑不善用之则伤善气本病曲隐于经络之间
或投以大热之药求以去阴邪他证必起非所以救白虎也可用温药升阳行经有难者曰白虎大寒非大热何以救君之治奈何东
垣曰病隐经络间阳道不升则经不行经行而本证见矣果如其言而愈
张 活人谓白虎汤治中 并汗后一解表药耳非正伤寒药也而夏月阴气在内白虎尤宜戒之夫白虎汤俱载仲景之书
证
治昭然明白何为言非正伤寒之药也况伤寒论言无表证者可与白虎汤今云汗后一解表药耳于法既无表证何解之有又曰夏
月阴气在内白虎尤宜戒之而明理论又云立秋后不可服秋则阴气半矣而白虎大寒若不能禁服之而为哕逆不能食或虚羸者
多矣夫伤寒之法有是证则投是药安可拘于时而为治哉假如秋冬之间患伤寒身无表证而大烦渴于法合用白虎汤苟拘其时
何以措手若以白虎为大寒其承气又何行于冬令乎既以夏宜戒秋后不可行然则宜乎何时也虽然经云必先岁气无伐天和此
言常也假如贼邪变出阴阳寒热亦当舍时从证岂可以时令拘哉
伤寒脉浮发热无汗其表不解者不可与白虎汤若大渴欲饮水无表证者白虎加人参汤主之（成 伤寒脉浮发热无汗其表
不解不渴者宜麻黄汤渴者宜五苓散非白虎所宜大渴欲水无表证者乃可与白虎加人参汤以散里热临病之人大宜精别 张
经言可与某汤或言不可与者此设法御病也又云宜某汤此临证审决也言某汤主之乃对证施治也此三者方法之条目也包藏
深理非一言可以具述）
脉浮而迟表热里寒下利清谷者四逆汤（论见下利）下利厥逆汗出热不去者四逆汤
少阴病下利清谷厥逆里寒外热者通脉四逆汤（方论见下利）身热手足逆冷而脉虚当夏月发者为中暑（论见中暑）伤
寒表不解干呕发热而咳下利者小青龙去麻黄加芫花汤（论见咳）太阳与阳明合病必下利其证头痛腰疼身热鼻干脉浮大而
长者宜葛根汤（论见合病）发热下利脉微迟厥逆者通脉四逆汤 太阳与少阳合病自下利其证头寒胸满往来寒热脉浮大而
弦者宜黄芩汤（论见合病）下利清谷脉沉迟其人面赤微热而厥者必郁冒汗出自解发热下利厥逆躁不得卧者死 发热而利
汗不止者死（二论俱见下利）
发热吐利心下痞硬者大柴胡汤渴者五苓散不渴者理中汤（论并见痞及吐利门）
发热经水适来适断小柴胡汤刺期门（论见谵语疟状）发热脉数消谷不大便者有瘀血宜抵当汤（论见蓄血）
戴 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 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而阳气必客于外所以外反热要知阴证发热
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也 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或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故宜小建中汤若其
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柱汤真武汤 审其是邪热
未解虽经汗下却不畏虚而养病宜竹叶石膏汤
宋元诸贤表证发热治例
洁 有汗不得服麻黄无汗不得服桂枝然春夏汗孔疏虽有汗不当服桂枝宜用黄 汤和解之秋冬汗孔闭虽无汗不当
服
麻黄宜用川芎汤和解之春夏有汗脉微而弱恶风恶寒者乃太阳证秋冬之脉也宜用黄 汤无汗亦用川芎汤秋冬有汗脉盛而
浮发热恶热者乃阳明证春夏之脉也宜用黄 汤无汗亦用川芎汤大抵有汗皆宜黄 汤无汗皆宜川芎汤主之
黄 汤 有汗则能止之
白术 黄 防风（各等分）上 咀每服五七钱至一两水煎温服汗多恶风甚者桂枝
川芎汤 无汗则能发之
川芎 苍术 羌活（各等分）上 咀每服五七钱至一两水煎热服无汗恶风甚者加麻黄一二钱
海神术汤 治内伤冷冻饮料外感寒邪无汗者
苍术（制） 防风（各二两） 甘草（一两炒）上 咀加葱白生姜同煎服如太阳证发热恶寒脉浮而紧者加羌活二钱
如太阳证脉浮紧中带弦数者是兼少阳也加柴胡二钱如太阳证脉浮紧中带洪者是兼阳明也加黄芩二钱 妇人服者加当归
或加木香汤或加 本汤各二钱如治吹奶煎调六一散三五钱神效又神术六气加减例
太阳寒水司天 加羌活桂枝余岁非时变寒亦加冬亦加
阳明燥金司天 加白芷升麻余岁非时变凉湿亦加秋亦加
少阳相火司天 加黄芩地黄余岁非时变雨湿亦加夏亦加
太阴湿土司天 加白术 本余岁非时变热湿亦加夏末秋初亦加
少阴君火司天 加细辛独活余岁非时变热亦加夏末夏初亦加
厥阴风木司天 加川芎防风余岁非时变温和亦加夏亦加
以上神术汤六气加减法非止为司天之气设也至于岁之主气与月建日时同前应见者皆当随听见根据上例加减之按海藏
此论与戴人云病如不是当年气看与何年运气同便向此中求妙法方知皆在至真中之歌相表里实发前人之所未发也盖海藏
此论所谓某气司天加某药者治常气之法也所谓随所应见加减者治变气之法也戴人所谓看与何年同气求治法者亦治变气
之法也能将二公之法扩充行之则内经运气之本义灿然矣夫同经纶运气有常气有变气常气者有定纪如某年属某气司天当
寒某年属某气司天当热是也变气者无定纪如某年属某气司天当寒反热当热反寒是也王氏注文释以经无定纪之变气作有
定纪之常气使后学人皆以年岁占运气而其应者十无一二是以人莫之信而其道湮晦久矣二公生数千百里之后复启其端而
续之与程朱续孔孟不传之绪同功也今仆谨于海藏逐年司天加药之后申明余岁变常之义同志者幸究心焉
白术汤 治内伤冷物外感风寒有汗者
白术（三两） 防风（二两） 甘草（一两炙）上 咀每服五钱水一盏姜三片煎至七分温服一日止一二服待二三日
渐渐汗少为解
又白术汤 治伤寒上解三阳下安太阴
白术（如汗之改用苍术） 防风（各二两）每服五钱水煎七分温服用后方加减 若发热引饮加黄芩甘草头疼恶风者
加羌活散三钱羌活一两半川芎七钱细辛二钱半（去芦）若身热目痛者加石膏汤四钱石膏二两知母半两白芷七钱 腹中痛
加芍药汤三钱芍药二两桂枝半两 往来寒热而呕者加柴胡散三钱柴胡一两半夏半两 心下痞加枳实一钱 若有里证加
大黄一钱次二钱又次三钱邪去止之
洁古云有汗不得服麻黄无汗不得服桂枝若未瘥则其变不可胜言故立此法使不犯三阳禁忌解表神方
九味羌活汤 （陶尚文注云不问四时但有头疼骨节痛发热恶寒无汗脉浮紧者宜用此汤以代麻黄为稳当如头痛发
热恶风自汗脉浮缓者宜用加减冲和汤即羌活汤中减苍术细辛加白术黄 是也）
（发热是指热度持续不断；寒热是指寒冷退去后发热，发热退去后寒冷，交替发作；潮热是指定时发热、定时停止，像潮汐一样有规律。如果发热不恶寒且口渴，这是温病；发汗后身体灼热，这是风温；如果发热，手脚轻微厥冷，下利清谷，这是阴证。如果便血、气机不通、四肢逆冷却发热，这是热深厥亦深。头痛、发热、恶寒但身体不疼痛，这是伤食证；不恶寒、身体不痛，知道不是伤寒；头不疼、脉不紧，知道不是里实证；只是烦热的，烦是虚证。）
中风即开始发热，是因为风邪伤了卫气；伤寒不立即发热，是因为寒邪伤了营气。经书说：“伤寒一二日，有的已经发热，有的尚未发热”，就是这种情况。凡是翕翕发热（形容发热如羽毛覆盖般温和而持续），伴有恶风、恶寒、头痛、脉浮的，属于表证。这是由于风寒客居皮肤，导致阳气怫郁所致，应当用发汗法治疗。如果小便黄，说明病不在表。凡是蒸蒸发热（形容热气由内向外蒸发），兼有谵语、大便秘结、小便赤、腹部胀满、恶热、脉滑实的，属于里热。这是由于阳气下陷入阴分所致，应当用泻下法治疗。如果小便清，说明病不在里。在少阴、厥阴经出现的发热，称为“反发热”，只有太阴经没有发热的证候。如果脉象阴阳俱盛，热势不止，预后不良；下利发热，发汗后再次发热，脉象躁疾，不因出汗而缓解，胡言乱语不能进食，这是阴阳不相交，预后不良。兰台治例说：邪气在三阳经，太阳证多与潮热相似但不同；邪气在三阴经，少阴证多与烦躁相似但不同。
发热、恶寒、脉浮的，属于表证，即太阳证。（方剂论述见前文太阳病条）发热、汗出、不恶寒反而恶热的，属于里证，即阳明证。（方剂论述见自汗条）发热、脉弦细、头痛的，属于半表半里证，即少阳证。（论述见口苦咽干条）发热而呕吐的，用小柴胡汤。（论述见呕条）发热咳嗽、表证未解的，用小青龙汤；兼有胁痛、喜欢呕吐的，用小柴胡加干姜五味子汤。（方剂论述见咳条）发热而气喘、表证未解的，用小青龙去麻黄加杏仁汤；兼有胸满的，用麻黄汤。（方剂论述见喘条）发热口渴，有的属表证，有的属里证，治疗方法及方剂论述很多。（并见渴门条）
发热通过汗液解除，半天左右又出现烦躁，脉象浮数大的，可以再次发汗，宜用桂枝汤。（详细论述见烦条）
发汗后恶风恶寒的，是因为正气虚弱；不恶寒只恶热的，是因为邪气实。应当调和胃气，宜用调胃承气汤。（经书说：“出汗后不恶寒，这是表证已解而里气未和，给予调胃承气汤以调和胃气”）
太阳病三天，发汗后病不解，蒸蒸发热的，病位在胃，用调胃承气汤主治。（海藏注：大黄泄实，芒硝软坚，甘草和中。必须燥、实、坚三证俱全者方可使用。）
调胃承气汤方
大黄（一两，海藏注：宜酒浸。盖因邪气居高位，非酒不到，如同物品在高处，人迹所不及，必用射取之法，故用酒浸以引药上行。若生用则苦泄峻下，会遗落高位的邪热，所以愈后可能出现目赤、喉闭或头肿等膈上反生热证。） 甘草（半两，炙，海藏注：甘以缓之） 芒硝（九钱，海藏注：辛以润之，咸以软之）。以上药物捣碎，用水一盏，煮大黄、甘草至七分，去渣，加入芒硝，再上火微煮令沸，少量多次温服。
成无己注：《内经》说：“热淫于内，治以咸寒，佐以苦甘。”芒硝咸寒以除热，大黄苦寒以荡涤实邪，甘草甘平助二物推陈出新并缓和药性。
发热、汗出不解，心下痞硬、呕吐而下利的，用大柴胡汤。（论述见痞条）发汗后身体灼热，脉浮、汗出、身重、多眠、鼻鼾的，是风温。（论述见风温条）发汗后仍发热，心悸、头晕、身体瞤动、振振欲倒地的，宜用真武汤。（论述见下利条）汗出热不去，内拘急，四肢疼痛，下利、厥逆、恶寒的，宜用四逆汤。（论述见下利条）大汗出，脉象阴阳俱盛而不解的，预后不良。（《内经》说：“温病汗出透彻后复热，脉象躁疾，不因汗出而缓解，胡言乱语不能进食，称为阴阳交，必死。”）
太阳病先发汗病不解，又用下法，脉仍浮的，病不愈。浮脉表示病邪在外，反而用下法，所以不愈。现在脉浮，知道病邪仍在表，应当解表则愈，主方用桂枝汤。
汗下之后，仍头痛、发热，心下满、小便不利的，用桂枝去桂加茯苓白术汤。（论述见结胸条）大下之后，身热不去，心中结痛的，用栀子豉汤主治。（论述见心条）大下之后，身热不去，微烦的，用栀子干姜汤。（方剂论述见烦条）阳明病下之，其外有热，手足温，心中懊憹，饥不能食，但头汗出的，用栀子豉汤。（论述见烦条）
太阳病本当恶寒发热，现在自汗出、不恶寒、发热，关上脉细数的，是因为误用吐法造成的过失。一二日病时吐之，腹中饥饿但口不能食；三四日病时吐之，不喜欢喝粥，想吃冷食，早晨吃晚上吐，这都是误用吐法所致。这称为小逆。（成无己注：恶寒发热为太阳表病。自汗出、不恶寒、发热者为阳明证。本是太阳表病，医生反而用吐法，损伤胃气，表邪乘虚传入阳明。从关脉细数可知是误吐所致。病在一二日时，表邪尚寒而未化热，吐之则表寒传入胃中，胃中虚寒，所以腹中饥而口不能食。病在三四日时，表邪已传化成热，吐之则表热乘虚入胃，胃中虚热，所以不喜欢喝粥，想吃冷食，早晨吃晚上吐。早晨吃晚上吐，是因为晨食入胃，胃虚不能消化，停留久而吐出，知道是医生误吐导致胃虚所致。本太阳病用吐法不为逆，但因传入阳明，所以称为逆。然而阳明虽为入腑，犹是阳经，所以不为大逆而称为小逆。）
病愈后再次发热的，用小柴胡汤。脉浮的用汗法解，脉沉的用下法解。（详细论述见劳复条）
伤寒脉浮滑，此表有热、里有寒，用白虎汤主治。（前篇云：“热结在里，表里俱热者，白虎汤主之。”又云：“其表不解，不可与白虎汤。”此处说“脉浮滑，表有热，里有寒”，必定是“表里”二字有误。又阳明一证云：“脉浮迟，表热里寒，四逆汤主之。”又少阴一证云：“里寒外热，通脉四逆汤主之。”由此可以看出错误很明显。又阳明篇曰：“脉滑而疾者，小承气汤。”既用承气汤，说明是里热。又厥阴篇曰：“脉滑而厥者，里有热，白虎汤主之。”这说明滑脉主里热是很明显的。况且知母、石膏性皆大寒，岂能用水济水？成氏随文解释是不对的。）
白虎汤方
知母（六两） 石膏（一斤） 甘草（二两） 糯米（六合）。以上四味，用水一斗，煮米熟汤成，去渣，温服一升，每日三次。
成无己注：白虎是西方金神，对应秋季，归属于肺。热甚于内的，用寒凉药攻下；热甚于外的，用清凉药解散。如果有内外俱热，内不得泄，外不得发的情况，不用此汤则不能解除暑气。暑气得秋气而止，所以说“处暑”。此汤以白虎命名，谓能止热。《内经》说：“热淫所胜，佐以苦甘。”又说：“热淫于内，以苦发之。”想要彻底解除表热，必须以苦味药为主，所以用知母苦寒为君药。热则伤气，寒以胜之，甘以缓之，热胜其气，必以甘寒为助，所以用石膏甘寒为臣药。脾苦湿，急食甘以缓之。热气内余，消烁津液，必以甘平之物缓其中，所以用甘草、粳米为使药。这是太阳中暍（中暑）得到此汤则顿除，热见到白虎而尽矣。立秋后不可服用白虎汤，因为它是大寒之剂，秋季服用必然导致多为哕逆、虚羸等症状。
李东垣注：人身前面是胃的经脉，胸部是胃、肺的居室。邪气在阳明，肺受火制，所以用辛寒药以清肺，因此号称白虎汤。
张元素注：伤寒表证发热、恶热而渴，与杂病相同。但头痛、身热、目痛、鼻干、不得卧，白虎汤主治，这是阳明经病。正阳阳明气病，脉洪大，先无形质。杂病里证发热、恶热而渴，但目赤的，病在脏。手太阴气不足，不能管领阳气，宜用枸杞、生地黄、熟地黄之类主治。脉洪大甚者则呕血，先有形质。气病在里，误用血药，无伤寒之理，是为了安血而益阴。血在里，误用气药如白虎汤者，非也，是为了泻肺而损阴。
李东垣辨析误服白虎汤的变证：昔日西台掾葛君瑞，二月中患伤寒发热，用白虎汤主治。病人面色黑如墨，本证遂不复见，脉沉细，小便不禁。李东垣起初不知道，及诊察后说：“这是在立夏以前误服白虎汤。白虎汤大寒，不是行经的药，只能寒脏腑，不善用的话则伤善气。本病曲隐于经络之间，或者投以大热之药以求去除阴邪，其他证候必然兴起，这不是救白虎汤的方法。可以用温药升阳行经。”有人问：“白虎汤大寒，不用大热药怎么救治？”李东垣说：“病隐伏在经络间，阳道不升则经不行，经行而本证见矣。”果然像他说的那样痊愈了。
张元素注：《活人书》说白虎汤治中暑，并说是汗后的一味解表药罢了，不是正伤寒药。而且夏月阴气在内，更应戒用白虎汤。夫白虎汤都记载在仲景书中，证治昭然明白，为什么说不是正伤寒药呢？况且《伤寒论》说“无表证者可与白虎汤”，现在说“汗后一味解表药罢了”，既然无法无表证，有什么可解的呢？又说“夏月阴气在内，白虎尤宜戒之”，而《明理论》又说“立秋后不可服”，秋天则阴气半矣，而白虎大寒，如果不能禁服，而为哕逆、不能食或虚羸者多了。夫伤寒之法，有是证则投是药，怎么可以拘泥于时令来治疗呢？假如秋冬之间患伤寒，身无表证而大烦渴，依法合用白虎汤，如果拘泥于时令，怎么措手？如果以白虎为大寒，那承气汤又为何行于冬令呢？既然说夏宜戒，秋后不可行，那么适宜什么时候呢？虽然经云“必先岁气，无伐天和”，这是说常理。假如贼邪变出，阴阳寒热亦当舍时从证，岂可以时令拘束呢？
伤寒脉浮发热无汗，其表不解的，不可与白虎汤。若大渴欲饮水，无表证者，白虎加人参汤主治。（成无己注：伤寒脉浮发热无汗，其表不解，不渴者，宜麻黄汤；渴者，宜五苓散，非白虎所宜。大渴欲水，无表证者，乃可与白虎加人参汤以散里热。临病之人，大宜精别。张元素注：经言“可与某汤”或言“不可与者”，此是设法御病。又云“宜某汤”，此是临证审决。言“某汤主之”，乃对证施治。此三者方法之条目也，包藏深理，非一言可以具述。）
脉浮而迟，表热里寒，下利清谷的，用四逆汤。（论述见下利条）下利、厥逆、汗出、热不去的，用四逆汤。
少阴病下利清谷，厥逆，里寒外热的，用通脉四逆汤。（方剂论述见下利条）身热、手足逆冷而脉虚，当夏月发的，为中暑。（论述见中暑条）伤寒表不解，干呕、发热而咳、下利的，用小青龙去麻黄加芫花汤。（论述见咳条）太阳与阳明合病，必下利，其证头痛、腰疼、身热、鼻干、脉浮大而长的，宜用葛根汤。（论述见合病条）发热、下利、脉微迟、厥逆的，用通脉四逆汤。太阳与少阳合病，自下利，其证头寒、胸满、往来寒热、脉浮大而弦的，宜用黄芩汤。（论述见合病条）下利清谷，脉沉迟，其人面赤、微热而厥的，必郁冒汗出自解。发热、下利、厥逆、躁不得卧的，死。发热而利，汗不止的，死。（二论俱见下利条）
发热、吐利、心下痞硬的，用大柴胡汤。渴的，用五苓散。不渴的，用理中汤。（论述并见痞及吐利门条）
发热，经水适来适断，用小柴胡汤，刺期门穴。（论述见谵语疟状条）发热、脉数、消谷、不大便的，有瘀血，宜用抵当汤。（论述见蓄血条）
戴元礼注：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。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，而阳气必客于外，所以外反热。要知阴证发热，自是不同。发于阳而发热者，头必疼；发于阴而发热者，头不痛，此为验也。又发汗后只恶寒的为虚，虚乃表虚；发汗后只恶热的为实，实乃里实。只恶寒的是发其汗，或汗出太过，所谓“阳微则恶寒”，宜芍药甘草附子汤。只发热的是表已解而里不消，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，故宜小建中汤。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。虚者用四柱汤、真武汤。审其是邪热未解，虽经汗下却不畏虚而养病，宜竹叶石膏汤。
洁古注：有汗不得服麻黄，无汗不得服桂枝。然春夏汗孔疏，虽有汗不当服桂枝，宜用黄芪汤和解之。秋冬汗孔闭，虽无汗不当服麻黄，宜用川芎汤和解之。春夏有汗，脉微而弱，恶风恶寒的，乃太阳证秋冬之脉也，宜用黄芪汤。无汗亦用川芎汤。秋冬有汗，脉盛而浮，发热恶热的，乃阳明证春夏之脉也，宜用黄芪汤。无汗亦用川芎汤。大抵有汗皆宜黄芪汤，无汗皆宜川芎汤主之。
黄芪汤：有汗则能止之。
白术、黄芪、防风（各等分）。以上捣碎，每服五七钱至一两，水煎温服。汗多恶风甚者，加桂枝。
川芎汤：无汗则能发之。
川芎、苍术、羌活（各等分）。以上捣碎，每服五七钱至一两，水煎热服。无汗恶风甚者，加麻黄一二钱。
海藏注神术汤：治内伤冷冻饮料，外感寒邪无汗者。
苍术（制）、防风（各二两）、甘草（一两炒）。以上捣碎，加葱白生姜同煎服。如太阳证发热恶寒、脉浮而紧者，加羌活二钱。如太阳证脉浮紧中带弦数者是兼少阳也，加柴胡二钱。如太阳证脉浮紧中带洪者是兼阳明也，加黄芩二钱。妇人服者加当归，或加木香汤，或加藁本汤各二钱。如治吹奶，煎调六一散三五钱，神效。又神术六气加减例：
太阳寒水司天，加羌活、桂枝。余岁非时变寒亦加。冬亦加。
阳明燥金司天，加白芷、升麻。余岁非时变凉湿亦加。秋亦加。
少阳相火司天，加黄芩、地黄。余岁非时变雨湿亦加。夏亦加。
太阴湿土司天，加白术、藁本。余岁非时变热湿亦加。夏末秋初亦加。
少阴君火司天，加细辛、独活。余岁非时变热亦加。夏末夏初亦加。
厥阴风木司天，加川芎、防风。余岁非时变温和亦加。夏亦加。
以上神术汤六气加减法，非止为司天之气设也。至于岁之主气与月建日时同前应见者，皆当随听见根据上例加减之。按海藏此论与戴人云：“病如不是当年气，看与何年运气同，便向此中求。”妙法方知皆在《至真要大论》中之歌相表里，实发前人之所未发也。盖海藏此论所谓“某气司天加某药”者，治常气之法也。所谓“随所应见加减”者，治变气之法也。戴人所谓“看与何年同气求治法”者，亦治变气之法也。能将二公之法扩充行之，则《内经》运气之本义灿然矣。夫同经纶运气，有常气，有变气。常气者有定纪，如某年属某气司天当寒，某年属某气司天当热，是也。变气者无定纪，如某年属某气司天当寒反热，当热反寒，是也。王氏注文释以经无定纪之变气作有定纪之常气，使后学人皆以年岁占运气，而其应者十无一二，是以人莫之信，而其道湮晦久矣。二公生数千百里之后，复启其端而续之，与程朱续孔孟不传之绪同功也。今仆谨于海藏逐年司天加药之后，申明余岁变常之义，同志者幸究心焉。
白术汤：治内伤冷物，外感风寒有汗者。
白术（三两）、防风（二两）、甘草（一两炙）。以上捣碎，每服五钱，水一盏，姜三片，煎至七分，温服，一日止一二服，待二三日渐渐汗少为解。
又白术汤：治伤寒上解三阳，下安太阴。
白术（如汗之改用苍术）、防风（各二两）。每服五钱，水煎七分，温服，用后方加减。若发热引饮，加黄芩甘草；头疼恶风者，加羌活散三钱（羌活一两半，川芎七钱，细辛二钱半，去芦）。若身热目痛者，加石膏汤四钱（石膏二两，知母半两，白芷七钱）。腹中痛，加芍药汤三钱（芍药二两，桂枝半两）。往来寒热而呕者，加柴胡散三钱（柴胡一两，半夏半两）。心下痞，加枳实一钱。若有里证，加大黄一钱，次二钱，又次三钱，邪去止之。
洁古云：有汗不得服麻黄，无汗不得服桂枝。若未瘥，则其变不可胜言，故立此法使不犯三阳禁忌，解表神方。
九味羌活汤：（陶尚文注云：不问四时，但有头疼骨节痛、发热恶寒、无汗、脉浮紧者，宜用此汤以代麻黄为稳当。如头痛发热、恶风、自汗、脉浮缓者，宜用加减冲和汤，即羌活汤中减苍术、细辛，加白术、黄芪是也。）
(Fa Re [Febrile sensation] refers to a continuous fever without cessation. Han Re [Alternating chills and fever] refers to chills subsiding followed by fever, and fever subsiding followed by chills, occurring in succession. Chao Re [Tidal fever] refers to fever that occurs at specific times and ceases at specific times, like the tide, never missing its schedule. If there is febrile sensation without aversion to cold accompanied by thirst, this is Wen Bing [Warm disease]. If body heat becomes burning after sweating, this is Feng Wen [Wind-warmth]. If there is febrile sensation, slight coldness of the hands or feet, and diarrhea with undigested food, this is Yin Zheng [Yin syndrome]. If there is hematochezia, qi stagnation, cold extremities, yet febrile sensation, this is "the deeper the heat, the deeper the coldness" (Re Shen Jue Yi Shen). Headache, febrile sensation, aversion to cold, but no body pain, indicates Shang Shi [Food injury]. No aversion to cold and no body pain indicate it is not Shang Han [Cold damage]; no headache and non-tight pulse indicate it is not Li Shi [Interior excess]; only vexatious heat indicates Vexation is due to Deficiency.]
Zhong Feng [Wind-stroke] presenting with immediate febrile sensation is because Wind pathogen has injured Wei Qi [Defensive Qi]. Shang Han presenting with delayed febrile sensation is because Cold pathogen has injured Ying Qi [Nutritive Qi]. The Classics state: "In the first or second day of Shang Han, some have already developed fever, while others have not." This is the case. Whenever there is Xi Xi Fa Re [Mild, persistent fever resembling feathers covering the body], accompanied by aversion to wind, aversion to cold, headache, and floating pulse, it belongs to Biao Zheng [Exterior syndrome]. This is caused by Wind-Cold lodging in the skin, causing obstruction of Yang Qi. It should be treated with diaphoresis. If urine is yellow, the pathogen is not on the exterior. Whenever there is Zheng Zheng Fa Re [Evaporative fever, feeling hot from within], accompanied by delirium, constipation, dark urine, abdominal fullness, aversion to heat, and slippery-excess pulse, it belongs to Li Re [Interior Heat]. This is caused by Yang Qi sinking into the Yin aspect. It should be treated with purgation. If urine is clear, the pathogen is not on the interior. Febrile sensation appearing in Shao Yin [Lesser-Yin] and Jue Yin [Terminal-Yin] meridians is called Fan Fa Re [Counterfeit fever]. Only Tai Yin [Greater-Yin] does not present with febrile sensation. If both Yin and Yang pulses are full and vigorous, and fever persists, the prognosis is poor. Diarrhea with fever, recurrent fever after sweating, rapid and restless pulse not relieved by sweating, delirium, and inability to eat indicate failure of Yin and Yang interaction, which is fatal. Lan Tai Zhi Li [Treatment Principles of the Imperial Library] states: Pathogens in the Three Yang meridians, Tai Yin syndrome often resembles tidal fever but differs; pathogens in the Three Yin meridians, Shao Yin syndrome often resembles irritability but differs.
Febrile sensation, aversion to cold, and floating pulse belong to the Exterior, i.e., Tai Yang [Greater-Yang] syndrome. (Formula discussions see Tai Yang Disease section.) Febrile sensation, sweating, no aversion to cold but aversion to heat belong to the Interior, i.e., Yang Ming [Bright-Yang] syndrome. (Formula discussions see Spontaneous Sweating section.) Febrile sensation, wiry-thin pulse, and headache belong to Half-Exterior Half-Interior, i.e., Shao Yang [Lesser-Yang] syndrome. (Discussions see Bitter taste and dry throat section.) Febrile sensation with vomiting is treated with Xiao Chai Hu Tang [Minor Bupleurum Decoction]. (Discussions see Vomiting section.) Febrile sensation with cough and unresolved exterior is treated with Xiao Qing Long Tang [Minor Blue Dragon Decoction]; if accompanied by hypochondriac pain and frequent retching, treat with Xiao Chai Hu Tang plus Gan Jiang [Dried Ginger] and Wu Wei Zi [Schisandra Fruit]. (Formula discussions see Cough section.) Febrile sensation with wheezing and unresolved exterior is treated with Xiao Qing Long Tang minus Ma Huang [Ephedra] plus Xing Ren [Apricot Seed]; if accompanied by chest fullness, treat with Ma Huang Tang [Ephedra Decoction]. (Formula discussions see Wheezing section.) Febrile sensation with thirst may belong to the Exterior or the Interior; treatment methods and formulas are numerous. (See Thirst section.)
If fever resolves through sweating, but restlessness recurs after half a day, with floating-rapid-large pulse, another diaphoretic treatment is appropriate, using Gui Zhi Tang [Cinnamon Twig Decoction]. (Detailed discussion see Vexation section.)
After sweating, aversion to wind and cold indicates deficiency; no aversion to cold but only aversion to heat indicates excess. One should harmonize the Stomach Qi, using Tiao Wei Cheng Qi Tang [Regulate the Gut and Order the Qi Decoction]. (The Classics state: "Sweating with no aversion to cold indicates the exterior is resolved but the interior is not harmonized; give Tiao Wei Cheng Qi Tang to harmonize the Stomach.")
In Tai Yang disease, if after three days of sweating the condition remains unresolved and there is evaporative fever, the pathology is in the Stomach. Treat primarily with Tiao Wei Cheng Qi Tang. (Haizang commentary: Da Huang [Rhubarb Root and Rhizome] drains excess, Mang Xiao [Mirabilite] softens hardness, Gan Cao [Licorice Root] harmonizes the middle. It can only be used when all three signs of Dryness, Excess, and Hardness are present.)
**Tiao Wei Cheng Qi Tang Formula**
Da Huang (1 liang, Haizang commentary: Soak in wine. Since pathogens reside in high positions, they cannot be reached without wine, just as objects on high peaks require shooting to retrieve. Thus, wine soaking guides the medicine upward. If used raw, its bitter-draining action is too harsh and may leave high-level pathogenic heat, leading to post-recovery symptoms like red eyes, throat closure, or head swelling due to heat generating above the diaphragm.) Gan Cao (0.5 liang, roasted, Haizang commentary: Sweetness moderates.) Mang Xiao (9 qian, Haizang commentary: Pungency moistens, Salty softens.) Crush the herbs, add one cup of water, boil Da Huang and Gan Cao to 70%, strain, add Mang Xiao, heat briefly until boiling, and take warm in small amounts frequently.
Cheng Wuji commentary: *Nei Jing* states: "Heat rampant inside is treated with salty-cold, assisted by bitter-sweet." Mang Xiao is salty-cold to remove heat; Da Huang is bitter-cold to purge excess; Gan Cao is sweet-neutral to assist the two in pushing out the old and easing the middle.
Febrile sensation with sweating that does not resolve, epigastric fullness-hardness, vomiting, and diarrhea are treated with Da Chai Hu Tang. (Discussions see Fullness section.) After sweating, if the body feels burning hot, pulse is floating, sweating occurs, body feels heavy, drowsiness increases, and snoring appears, this is Feng Wen [Wind-warmth]. (Discussions see Wind-warmth section.) After sweating, if fever persists, palpitations occur, dizziness appears, muscles twitch, and the body trembles as if falling, use Zhen Wu Tang [True Warrior Decoction]. (Discussions see Diarrhea section.) If sweating leads to unresolving heat, internal tension, limb pain, diarrhea, cold extremities, and aversion to cold, use Si Ni Tang [Four Counterflow Decoction]. (Discussions see Diarrhea section.) Profuse sweating with full and vigorous Yin and Yang pulses that do not resolve indicates death. (*Nei Jing* says: "In Warm disease, if sweating is thorough but fever returns, pulse is rapid and restless, not relieved by sweating, with delirium and inability to eat, it is called Yin-Yang Jiao [Intersection], which is fatal.")
In Tai Yang disease, if initial sweating fails to resolve the condition and purgation is applied, yet the pulse remains floating, the disease will not heal. A floating pulse indicates the pathogen is external; applying purgation incorrectly causes failure to heal. Now that the pulse is floating, we know the pathogen is still on the exterior. We must release the exterior to achieve healing. Gui Zhi Tang [Cinnamon Twig Decoction] is the primary formula.
After sweating and purgation, if headache and fever persist, along with epigastric fullness and difficulty urinating, use Gui Zhi Qu Gui Jia Fu Ling Bai Zhu Tang [Cinnamon Twig Decoction minus Cinnamon Twig plus Poria and Atractylodes Macrocephala Decoction]. (Discussions see Chest Binding section.) After severe purgation, if body heat persists and there is painful knotting in the heart region, treat primarily with Zhi Zi Chi Tang [Gardenia and Fermented Soybean Decoction]. (Discussions see Heart section.) After severe purgation, if body heat persists with mild vexation, use Zhi Zi Gan Jiang Tang [Gardenia and Roasted Ginger Decoction]. (Formula discussions see Vexation section.) In Yang Ming disease, after purgation, if there is external heat, warm hands and feet, mental anguish (Ao Nao), hunger but inability to eat, and only sweating on the head, treat with Zhi Zi Chi Tang. (Discussions see Vexation section.)
Tai Yang disease should present with aversion to cold and fever. If now there is spontaneous sweating, no aversion to cold, fever, and a fine-rapid pulse at the Guan position, this is due to the error of emesis. Emesis performed on days 1-2 causes hunger in the abdomen but inability to eat; emesis on days 3-4 causes dislike of congee and desire for cold food, with morning intake and evening vomiting. All these result from erroneous emesis. This is called Minor Reversal. (Cheng Wuji commentary: Aversion to cold and fever are Tai Yang exterior signs. Spontaneous sweating, no aversion to cold, and fever are Yang Ming signs. Originally a Tai Yang exterior disease, the doctor erroneously used emesis, damaging Stomach Qi and allowing exterior pathogens to transmit to Yang Ming via deficiency. The fine-rapid Guan pulse confirms this. On days 1-2, exterior pathogens are cold and not yet transformed into heat; emesis transmits cold to the Stomach, causing deficiency-cold, hence hunger but inability to eat. On days 3-4, exterior pathogens have transformed into heat; emesis transmits heat to the Stomach, causing deficiency-heat, hence dislike of congee and desire for cold food, resulting in morning intake and evening vomiting. Morning intake and evening vomiting occur because the deficient Stomach cannot digest food, which stays and is vomited later. Knowing this is caused by physician-induced Stomach deficiency via emesis. Using emesis on Tai Yang disease is not reversal, but transmission to Yang Ming makes it a reversal. However, since Yang Ming is still a Yang meridian despite being an organ fu, it is not Major Reversal but Minor Reversal.)
If fever recurs after recovery, use Xiao Chai Hu Tang [Minor Bupleurum Decoction]. If the pulse is floating, use diaphoresis; if sinking, use purgation. (Detailed discussion see Labor Relapse section.)
Shang Han with floating-slippery pulse indicates Exterior Heat and Interior Cold. Treat primarily with Bai Hu Tang [White Tiger Decoction]. (Previous chapter stated: "Heat knotted inside with exterior-interior full heat is treated with Bai Hu Tang." Also: "If exterior is unresolved, do not give Bai Hu Tang." Here it says "floating-slippery pulse, exterior heat, interior cold," implying a textual error regarding "exterior-interior." Another Yang Ming case states: "Floating-slow pulse, exterior heat interior cold, treated with Si Ni Tang." Another Shao Yin case states: "Interior cold exterior heat, treated with Tong Mai Si Ni Tang." This clearly shows the error. Also, Yang Ming chapter says: "Slippery-fast pulse, treat with Xiao Cheng Qi Tang." Using Cheng Qi Tang implies Interior Heat. Jue Yin chapter says: "Slippery pulse with cold extremities indicates Interior Heat, treated with Bai Hu Tang." This proves slippery pulse indicates Interior Heat. Moreover, Zhi Mu [Anemarrhena Rhizome] and Shi Gao [Gypsum Fibrosum] are both very cold; how can water be added to water? Cheng's interpretation following the text is incorrect.)
**Bai Hu Tang Formula**
Zhi Mu (6 liang) Shi Gao (1 jin) Gan Cao (2 liang) Nu Mi [Glutinous Rice] (6 he). These four ingredients, boil in 10 dou of water until rice is cooked and decoction is ready. Strain, take 1 sheng warm, three times daily.
Cheng Wuji commentary: Bai Hu [White Tiger] is the Metal Spirit of the West, corresponding to Autumn and belonging to the Lung. Heat rampant inside is treated with cold-purgation; heat rampant outside is treated with cooling-release. If there is heat inside and outside with neither leakage nor emission, this decoction is required to resolve summer-heat. Summer-heat stops with Autumn air, hence "Chu Shu" [End of Heat]. Named Bai Hu because it stops heat. *Nei Jing* states: "Heat rampant and victorious is assisted by bitter-sweet." Also: "Heat rampant inside is released by bitterness." To thoroughly release exterior heat, bitterness is primary. Thus, Zhi Mu (bitter-cold) is the Sovereign herb. Heat injures Qi; cold overcomes heat; sweetness moderates. Since heat defeats Qi, sweet-cold assistance is needed. Thus, Shi Gao (sweet-cold) is the Minister herb. Spleen dislikes dampness; urgently eat sweet to moderate. Residual internal heat consumes fluids; sweet-neutral substances are needed to ease the middle. Thus, Gan Cao and Nu Mi are the Envoy herbs. For Tai Yang Zhong Shu [Sunstroke], this decoction removes heat instantly; heat vanishes upon seeing the White Tiger. Do not use Bai Hu Tang after Start of Autumn, as it is a major cold agent; autumn use causes hiccups, deficiency, and emaciation.
Li Dongyuan commentary: The front of the body is the meridian of the Stomach; the chest is the chamber of the Stomach and Lung. Pathogens in Yang Ming cause Fire to constrain the Lung, so pungent-cold herbs clear the Lung, hence named Bai Hu Tang.
Zhang Yuansu commentary: Exterior syndrome of Shang Han with febrile sensation, aversion to heat, and thirst is similar to miscellaneous diseases. But with headache, body heat, eye pain, nasal dryness, and insomnia, Bai Hu Tang treats Yang Ming Meridian disease. Zheng Yang Yang Ming Qi disease presents with large pulse, initially formless. Miscellaneous disease interior syndrome with febrile sensation, aversion to heat, and thirst, but with red eyes, indicates disease in the Zang organs. Hand-Taiyin Qi deficiency cannot control Yang Qi; treat with Gou Qi [Goji Berry], Sheng Di Huang [Rehmannia Root], and Shu Di Huang [Prepared Rehmannia Root]. Large pulse with vomiting blood indicates prior formation of mass. Qi disease in the interior mistakenly using blood-invigorating herbs lacks Shang Han rationale, aiming instead to calm blood and nourish Yin. Blood disease in the interior mistakenly using Qi-moving herbs like Bai Hu Tang is incorrect, aiming instead to drain Lung and damage Yin.
Li Dongyuan on misusing Bai Hu Tang: Formerly, Ge Junrui, Vice Director of the Western Terrace, suffered Shang Han fever in mid-February. Treated with Bai Hu Tang, his face turned black as ink, original symptoms disappeared, pulse became deep-fine, and urinary incontinence occurred. Li Dongyuan initially did not understand, but upon diagnosis said: "This was mistaken use of Bai Hu Tang before Start of Summer. Bai Hu Tang is very cold, not a meridian-moving drug; it only chills the Zang-Fu. Misuse damages healthy Qi. The original disease hides in the meridians. Or administer major hot drugs to remove Yin pathogens, but other syndromes will arise, which does not rescue the Bai Hu Tang error. Use warm drugs to raise Yang and move meridians." Questioner: "Bai Hu Tang is very cold; how can major hot drugs rescue?" Li Dongyuan: "Pathogen hides in meridians; if Yang Dao does not rise, meridians do not flow. When meridians flow, original symptoms appear." He healed exactly as predicted.
Zhang Yuansu commentary: *Huo Ren Shu* [Book of Life Preservers] says Bai Hu Tang treats Zhong Shu [Sunstroke] and is merely a post-sweating exterior-releasing drug, not a proper Shang Han drug. In summer, Yin Qi is inside, so Bai Hu Tang should especially be avoided. Yet Bai Hu Tang is recorded in Zhang Zhongjing's works with clear indications. Why call it not a proper Shang Han drug? *Shang Han Lun* states: "Those without exterior syndrome may receive Bai Hu Tang." Now saying "merely a post-sweating exterior-releasing drug," if there is no exterior syndrome, what is there to release? Also saying "Summer Yin Qi inside, avoid Bai Hu Tang," while *Ming Li Lun* [Theory of Clarification] says "Do not use after Start of Autumn." In Autumn, Yin Qi is half-present, and Bai Hu Tang is very cold. If not forbidden, hiccups, inability to eat, or deficiency will occur. Shang Han law dictates treating according to syndrome, not season. If in winter/autumn one has Shang Han, no exterior syndrome, but great vexation/thirst, Bai Hu Tang is indicated. If bound by season, how to proceed? If Bai Hu Tang is very cold, why is Cheng Qi Tang used in winter? If summer avoids it and autumn forbids it, when is it suitable? Although Classics say "First consider annual Qi, do not harm Heavenly Harmony," this is general rule. If treacherous pathogens vary, Yin-Yang/Cold-Heat should follow syndrome over season.
Shang Han with floating pulse, fever, no sweat, and unresolved exterior cannot receive Bai Hu Tang. If great thirst for water and no exterior syndrome exist, Bai Hu Tang Jia Ren Shen Tang [White Tiger Decoction plus Ginseng] is primary. (Cheng Wuji commentary: Floating pulse, fever, no sweat, unresolved exterior, no thirst suggests Ma Huang Tang; thirst suggests Wu Ling San [Poria Decoction], not Bai Hu Tang. Great thirst for water without exterior syndrome allows Bai Hu Tang Jia Ren Shen Tang to scatter interior heat. Clinicians must distinguish carefully. Zhang Yuansu commentary: Classics say "May give certain decoction" or "Do not give," which is setting rules to defend against disease. "Suitable for certain decoction" is clinical judgment. "Certain decoction governs" is syndrome-specific treatment. These three are method categories, containing profound principles not fully expounded in one statement.)
Floating-slow pulse, exterior heat, interior cold, diarrhea with undigested food: Si Ni Tang [Four Counterflow Decoction]. (Discussions see Diarrhea section.) Diarrhea, cold extremities, sweating, unresolving heat: Si Ni Tang.
Shao Yin disease with diarrhea of undigested food, cold extremities, interior cold exterior heat: Tong Mai Si Ni Tang [Pulse-Recovering Four Counterflow Decoction]. (Formula discussions see Diarrhea section.) Body heat, cold extremities, deficient pulse, occurring in summer: Zhong Shu [Sunstroke]. (Discussions see Sunstroke section.) Shang Han with unresolved exterior, dry retching, fever, cough, diarrhea: Xiao Qing Long Tang minus Ma Huang plus Yuan Hua [Genkwa Flower]. (Discussions see Cough section.) Tai Yang and Yang Ming combined disease with inevitable diarrhea, headache, back pain, body heat, nasal dryness, large-long-floating pulse: Ge Gen Tang [Kudzu Decoction]. (Discussions see Combined Disease section.) Fever, diarrhea, micro-slow pulse, cold extremities: Tong Mai Si Ni Tang. Tai Yang and Shao Yang combined disease with spontaneous diarrhea, cold head, chest fullness, alternating chills/fever, large-wiry-floating pulse: Huang Qin Tang [Scutellaria Decoction]. (Discussions see Combined Disease section.) Diarrhea of undigested food, deep-slow pulse, red face, slight heat, cold extremities:必郁冒汗出自解 (Must experience vertigo/sweating to self-resolve). Fever, diarrhea, cold extremities, restlessness unable to lie down: Death. Fever with diarrhea and unceasing sweating: Death. (Both discussions see Diarrhea section.)
Fever, vomiting/diarrhea, epigastric fullness-hardness: Da Chai Hu Tang [Major Bupleurum Decoction]. Thirst: Wu Ling San [Poria Decoction]. No thirst: Li Zhong Tang [Regulate the Middle Decoction]. (Discussions see Fullness and Vomiting/Diarrhea sections.)
Fever, menstruation just started or stopped: Xiao Chai Hu Tang [Minor Bupleurum Decoction], puncture Qi Men [Gate of Life] acupoint. (Discussions see Delirium/Malaria-like symptoms section.) Fever, rapid pulse, excessive digestion, constipation: Blood stasis. Use Di Dang Tang [Resolutely Attack Decoction]. (Discussions see Blood Accumulation section.)
Dai Yuanli commentary: All Yang meridians show fever as seen in the first three Yang meridians. Yin does not show fever, except Shao Yin. Shao Yin fever has two patterns: Initial onset with Shao Yin signs, fever, aversion to cold, no headache: Ma Huang Xi Xin Fu Zi Tang [Ephedra, Asarum, and Prepared Aconite Root Decoction]. If diarrhea with undigested food, body heat, restlessness, interior cold exterior heat, Zhongjing calls this Fan Fa Re [Counterfeit fever], caused by Yin excess blocking Yang. Use Si Ni Tang [Four Counterflow Decoction] or Fu Zi Li Zhong Tang [Aconite Regulate the Middle Decoction]. Generally, Yang Qi transmitting to Yin meridian causing diarrhea is Hot Diarrhea; Yang sinking inside means no external heat. Yin Qi entering Yin meridian causing diarrhea is Interior Cold spontaneous diarrhea. Cold dominates inside, so Yang guest resides outside, causing external heat. Know that Yin syndrome fever is different. Fever originating from Yang必有 headache; fever originating from Yin no headache. This is a verification. After sweating, only aversion to cold indicates deficiency (Exterior deficiency); only aversion to heat indicates excess (Interior excess). Only aversion to cold results from excessive sweating ("Yang微弱 causes aversion to cold"), use Shao Yao Gan Cao Fu Zi Tang [Peony, Licorice, and Aconite Root Decoction]. Only fever indicates exterior resolved but interior not cleared ("Yin微弱 causes fever"), use Da Chai Hu Tang or Xiao Cheng Qi Tang [Minor Order the Qi Decoction]. After sweating/purgation, if Yin/Yang do not enter each other, Water/Fire do not harmonize, leaving residual heat, do not use cold drugs. Both interior/exterior are unsettled, so use Xiao Jian Zhong Tang [Minor Construct the Middle Decoction]. If patient is already deficient, deficiency generates heat; use Xiao Jian Zhong Tang plus Dang Gui [Angelica Sinensis] 1 qian, or Si Jun Zi Tang [Four Gentlemen Decoction] plus Huang Qi [Astragalus Root] 0.5 qian, or Shi Quan Da Bu Tang [Complete Great Tonifying Decoction] to harmonize Ying/Wei. Deficient types use Si Zhu Tang [Four Pillars Decoction] or Zhen Wu Tang [True Warrior Decoction]. Determine if pathogenic heat remains unresolved; although sweating/purgation occurred, do not fear deficiency but nourish illness with Zhu Ye Shi Gao Tang [Bamboo Leaf and Gypsum Decoction].
Song-Yuan Experts' Treatment Examples for Exterior Syndrome Fever
Jiegu commentary: With sweat, do not use Ma Huang; without sweat, do not use Gui Zhi. However, Spring/Summer pores are open; even with sweat, do not use Gui Zhi; use Huang Qi Tang [Astragalus Decoction] to harmonize. Autumn/Winter pores are closed; even without sweat, do not use Ma Huang; use Chuan Xiong Tang [Ligusticum Decoction] to harmonize. Spring/Summer with sweat, weak-micro pulse, aversion to wind/cold (Tai Yang pulse in Autumn/Winter): Use Huang Qi Tang. Without sweat, also use Chuan Xiong Tang. Autumn/Winter with sweat, strong-floating pulse, fever/aversion to heat (Yang Ming pulse in Spring/Summer): Use Huang Qi Tang. Without sweat, also use Chuan Xiong Tang. Generally, with sweat use Huang Qi Tang; without sweat use Chuan Xiong Tang.
**Huang Qi Tang**: Stops sweat.
Bai Zhu [Atractylodes Macrocephala Rhizome], Huang Qi, Fang Feng [Saposhnikovia Root] (equal parts). Crush, take 5-7 qian to 1 liang, decoct in water, drink warm. If profuse sweat/severe aversion to wind, add Gui Zhi.
**Chuan Xiong Tang**: Releases sweat.
Chuan Xiong [Ligusticum Chuanxiong Rhizome], Cang Zhu [Atractylodes Lancea Rhizome], Qiang Huo [Notopterygium Rhizome] (equal parts). Crush, take 5-7 qian to 1 liang, decoct in water, drink hot. If no sweat/severe aversion to wind, add Ma Huang 1-2 qian.
Haizang commentary Shen Shu Tang: Treats internal injury from cold drinks, external Cold pathogen, no sweat.
Cang Zhu (processed), Fang Feng (2 liang each), Gan Cao (1 liang, roasted). Crush, decoct with Cong Bai [Green Onion White] and Sheng Jiang [Fresh Ginger]. If Tai Yang syndrome fever/aversion to cold, floating-tight pulse, add Qiang Huo 2 qian. If floating-tight pulse with wiry-rapid quality indicating Shao Yang involvement, add Chai Hu [Bupleurum Root] 2 qian. If floating-tight pulse with surging quality indicating Yang Ming involvement, add Huang Qin [Scutellaria Root] 2 qian. For women, add Dang Gui, or Mu Xiang [Aucklandia Root], or Gao Ben [Ligusticum Wallichii Rhizome] 2 qian each. For breast abscess, mix with Liu Yi San [Six-to-One Powder] 3-5 qian, miraculous. Six Qi Additions/Subtractions for Shen Shu Tang:
Tai Yang Han Shui Si Tian [Solar Cold-Water Ruling Heaven]: Add Qiang Huo, Gui Zhi. Other years non-seasonal cold changes also add. Winter also add.
Yang Ming Zao Jin Si Tian [Solar Dry-Metal Ruling Heaven]: Add Bai Zhi [Angelica Dahurica Root], Sheng Ma [Cimicifuga Rhizome]. Other years non-seasonal cool-damp changes also add. Autumn also add.
Shao Yang Xiang Huo Si Tian [Solar Minister-Fire Ruling Heaven]: Add Huang Qin, Di Huang [Rehmannia Root]. Other years non-seasonal rainy-damp changes also add. Summer also add.
Tai Yin Shi Tu Si Tian [Solar Damp-Earth Ruling Heaven]: Add Bai Zhu, Gao Ben. Other years non-seasonal hot-damp changes also add. Late Summer/Early Autumn also add.
Shao Yin Jun Huo Si Tian [Solar Sovereign-Fire Ruling Heaven]: Add Xi Xin [Asarum], Du Huo [Angelica Pubescens Root]. Other years non-seasonal heat changes also add. Late Summer/Early Summer also add.
Jue Yin Feng Mu Si Tian [Solar Wind-Wood Ruling Heaven]: Add Chuan Xiong, Fang Feng. Other years non-seasonal mild-warm changes also add. Summer also add.
These Shen Shu Tang Six Qi additions/subtractions are not only for Si Tian Qi [Ruling Heaven Qi]. Regarding Annual Principal Qi and Month/Day/Hour correspondences, all should be adjusted according to the above examples. Haizang's theory aligns with Dai Ren's saying: "If disease does not match current year's Qi, look to which year's Qi matches, then seek treatment here." This wonderful method reveals connections in *Zhi Zhen Yao Da Lun* [Essential Requirements of the Most Truthful], truly uncovering predecessors' insights. Haizang's "Add certain herb for certain Si Tian Qi" treats Constant Qi. "Adjust according to appearances" treats Variable Qi. Dai Ren's "Match with any year's Qi" also treats Variable Qi. Expanding these two masters' methods clarifies *Nei Jing*运气 [Yunqi/Five Movements and Six Qi] principles. Yunqi has Constant Qi and Variable Qi. Constant Qi has fixed records (e.g., Year X ruled by Cold is cold; Year Y ruled by Heat is heat). Variable Qi has no fixed record (e.g., Year X ruled by Cold turns hot; Year Y ruled by Heat turns cold). Wang's commentary interpreted Variable Qi (no fixed record) as Constant Qi (fixed record), leading students to predict Yunqi by year, with few accurate predictions, causing disbelief and obscuring the doctrine. Two masters, born thousands of miles apart, revived and continued this, akin to Cheng-Zhu continuing Confucius-Mencius' lineage. I respectfully clarify the meaning of Variable/Constant Qi after Haizang's annual additions for colleagues to study.
**Bai Zhu Tang**: Treats internal injury from cold food, external Wind-Cold with sweat.
Bai Zhu (3 liang), Fang Feng (2 liang), Gan Cao (1 liang, roasted). Crush, take 5 qian, 1 cup water, 3 slices ginger, boil to 70%, drink warm. Once or twice daily. Wait 2-3 days for gradual sweat reduction as resolution.
**Another Bai Zhu Tang**: Treats Shang Han, releases Three Yang above, calms Tai Yin below.
Bai Zhu (use Cang Zhu if sweating), Fang Feng (2 liang each). Take 5 qian, decoct in water to 70%, drink warm. Adjust with following formulas:
If fever with drinking urge, add Huang Qin Gan Cao [Scutellaria-Licorice]; headache/aversion to wind, add Qiang Huo San 3 qian (Qiang Huo 1.5 liang, Chuan Xiong 7 qian, Xi Xin 2.5 qian, remove roots).
If body heat/eye pain, add Shi Gao Tang 4 qian (Shi Gao 2 liang, Zhi Mu 0.5 liang, Bai Zhi 7 qian).
Abdominal pain, add Shao Yao Tang 3 qian (Shao Yao 2 liang, Gui Zhi 0.5 liang).
Alternating chills/fever with vomiting, add Chai Hu San 3 qian (Chai Hu 1 liang, Ban Xia [Pinellia Tuber] 0.5 liang).
Epigastric fullness, add Zhi Shi [Immature Bitter Orange] 1 qian.
If interior syndrome exists, add Da Huang 1 qian, then 2 qian, then 3 qian. Stop when pathogen is gone.
Jiegu said: With sweat, do not use Ma Huang; without sweat, do not use Gui Zhi. If not cured, variations are countless. Thus, this method prevents violating Three Yang taboos, a divine formula for releasing exterior.
**Jiu Wei Qiang Huo Tang** [Nine-Ingredient Notopterygium Decoction]: (Tao Shangwen commentary: Regardless of season, if headache, bone/joint pain, fever, aversion to cold, no sweat, floating-tight pulse exist, use this to replace Ma Huang safely. If headache/fever/aversion to wind/spontaneous sweat/floating-slow pulse exist, use Jia Jian Chong He Tang [Modified Harmonizing Decoction], which is Qiang Huo Tang minus Cang Zhu/Xi Xin plus Bai Zhu/Huang Qi.)