太阳标证。头痛身热。恶寒怕风。项强腰痛。骨节烦疼。无汗者寒甚于风。自汗者风重于寒。
太阳本证。渴欲饮水。水入则吐。小便不利。甚或短数淋沥。或反小便自利。蓄血如狂。
【秀按】太阳之为病。寒水之气为病也。寒为病。故宜温散。水为病。故宜利水。总以发汗为出路。利水为
去路。若非水蓄而血蓄。则又以通瘀为去路。
太阳中见证。凡见太阳标证。而大便不实。小便清白。甚则男子遗精。女子带多。腰脊坠痛。痛如被杖。甚或气促而
喘。角弓发痉。若目戴眼上视。尤为危候。
【秀按】此即张景岳所谓太阳未解。少阴先溃是也。必其人肾气先虚。则肾中之阳。不足以抵御阴寒。即从
太阳中络直入足少阴肾经。
太阳兼证。兼肺经证。鼻塞流涕。鼻鸣喷嚏。嗽痰稀白。甚则喘而胸满。兼脾经证。肢懈嗜卧。口腻腹泻。兼
胃经证。饱闷恶食。嗳腐吞酸。
【秀按】太阳经主皮毛。故《内经》云。太阳者毫毛其应。上与肺经相关。故形寒则伤肺。下与肾经相关。故汗
多则溺少。若兼脾经证。必其人素禀多湿。兼胃经证。必其人新挟食滞。
少阳标证。寒热往来。耳聋胁痛。
少阳本证。目眩咽干。口苦善呕。膈中气塞。
【秀按】少阳以寒热胁痛耳聋为半表证。口苦咽干目眩为半里证者。以少阳经外行腠理。内行两胁。不居身
之前后而居侧也。两耳寤则闻。寐则不闻。口咽目开之则见。阖之则不见。此数者。不可谓之表。亦不可谓之
里。则谓之半表里而已矣。惟寒热一证。必寒已而热。热已而汗。则为少阳之寒热往来。若发热恶寒如疟状。
一日二三发。其人不呕。仍是太阳表证。非少阳之半表证也。临证时亦要辨明。
少阳中见证。手足乍温乍冷。烦满消渴。甚则谵语发痉。四肢厥逆。
【秀按】少阳与厥阴为表里。若相火之邪。不从外达。势必内窜包络肝经。发现热深厥深。火旺风动之危
候。
【廉勘】 陆九芝曰。论经则以太阳阳明少阳为次。论病则太少之邪。俱入阳明。窃谓太阳主皮。为躯体最外
一层。少阳主腠。为躯壳上第二层。盖腠理即网膜。金匮所谓三焦通会元真之处也。故太少两阳。病在皮腠。
证多传变。两阳合明。病归中土。故不复传。由是推之。三阳传经。亦当以太阳少阳阳明为次。其三阳寒热之
分。身虽大热而仍恶寒者。太阳也。寒已而热。热已而汗。寒热往来者。少阳也。始虽恶寒。一热而不复恶寒
者。阳明也。
少阳兼证。兼胃经证。烦闷恶心。面赤便闭。身痛足冷。斑点隐隐。兼脾经证。四肢倦懈。肌肉烦疼。唇燥
口渴。膈中痞
满。斑欲出而不出。兼肾经证。耳大聋。齿焦枯。腰背酸痛如折。甚则精自遗。冲任脉动。兼肺经证。喉痛红肿。
咳则胁痛。甚则咯血。兼心经证。舌红齿燥。午后壮热。神昏不语。甚则郑声作笑。兼小肠经证。舌赤神呆。语言
颠倒。小便赤
涩。点滴如稠。兼大肠经证。胸膈硬满而呕。腹中痛。发潮热。大便秘。或反自利。
【秀按】手足少阳经。内部膈胁。外行腠理。均司相火。相火者。游行之火也。内则三焦之膜。布膻中。络
心包络。循胁里。连肝而及于胆。历络三焦。多与各脏腑相通。其相通之道路。既与三焦相关。又于膈膜相
会。如手太阴肺经脉。起于中焦。还循胃口。上膈。足太阴脾经脉。络胃。上膈。手少阴心经脉。出心系。下
膈。手厥阴心包络脉。起于胸中。下膈。足阳明胃经脉。手太阳小肠经脉。手阳明太阳经脉。均下膈。足厥阴
肝经脉。贯膈。故少阳一经。不特多中见证。抑且多各经兼证也。惟兼足少阴肾经证。则由相火炽盛。由肝及肾耳。
【廉勘】兼胃经证者。是少阳转属阳明。二阳合病。胃热已盛。就欲发斑之候。兼脾经证。由于失表。腠理
闭塞。相火被湿郁遏。斑不得透之候。兼肾经证。由少阳相火大炽。逼入少阴。阴伤热盛之候。兼肺经证。由
相火烁肺。热咳痰嗽。胸膈气痹之候。兼心经证。必其人心虚有痰。一经相火薰蒸。痰火即蒙闭清窍。每有目
睛微定。昏厥如尸之候。兼小肠经证。由相火下窜。热结小肠。小肠为火府。两火相煽。每有逆乘心包之候。
兼大肠经证。由相火炽盛。热结在里。心上痞硬。复往来寒热而呕者。热结肠痹也。由是观之。刘草窗为伤寒
传足不传手者。伪言也。
阳明标证。始虽恶寒。二日自止。身大热。汗自出。不恶寒。反恶热。目痛鼻干。不得眠。或多眠睡。
阳明本证。在上脘病尚浅。咽干口苦。气上冲喉。胸满而喘。心中懊 。在中脘病已重。大烦大渴。胃实满。手
足汗。发潮热。不大便。小便不利。在下脘。由幽门直逼小肠。且与大肠相表里。病尤深重。日晡所热。谵语发狂。目
睛不和。腹胀满。绕脐痛。喘冒不得卧。腹中转矢气。大便胶闭。或自利纯青水。昏不识人。甚则循衣摸床。撮空理线。
【秀按】上脘象天。部居胸中。清气居多。犹可宣上解肌。使里邪从表而出。下脘象地。内接小肠。浊气居
多。法可缓下。使里邪从下而出。而其能升清降浊者。全赖中脘为之运用。故中脘之气旺。则水谷之清气。上
升于肺。以灌输百脉。水谷之浊气。下达于大小肠。从便溺而泄。法虽多端。总以健运胃气。照顾胃液。或清
或下为主。俞氏细分上中下三脘现证。盖以胃虽一腑。却有浅深轻重之不同。临证者不可不详辨也。
阳明中见证。四肢烦疼。口腻而淡。脘腹痞满。便如红酱。溺短数热。甚或小便不利。便硬发黄。黄色鲜明。
或斑点隐隐。发而不透。神识模糊。躁扰异常。
【秀按】阳明之邪。失表失清。以致陷入太阴。故多中见湿证。当辨湿重而热轻者。失于汗解。或汗不得
法。湿气内留。或其人素多脾湿。湿与热合。最为浊热粘腻。热重而湿轻者。往往内郁成斑。斑不得透。毒不
得解。尤为危险。急宜提透。不使毒邪陷入少厥二阴。如大便胶闭。潮热语者。阳明证重。太阴证轻。缓缓下
之可也。《内经》所谓土郁夺之是矣。总之脾胃联膜。邪入阳明。热结燥实者固多。气结湿滞者尤多。况吾绍地居
卑湿。湿热病最占多数。治法甚繁。临证者尤宜详辨。
阳明兼证。兼肺经证。头胀心烦。脘闷嗽痰。痰色黄白相兼。喉燥渴饮。若热壮胸闷。呕恶足冷者。将发痧
疹。若胸胁
滞痛。咳嗽气喘者。肺多伏痰。兼心经证。嗌干舌燥。口糜气秽。欲寐而不得寐。或似寐而非寐。甚则郑声作笑。面色
娇红。兼肾经证。口燥咽干。心下急痛。腹胀便闭。或自利酸臭水。兼包络证。口燥消渴。气上冲心。膈上热痛。
神昏谵
语。甚或晕厥如尸。口吐粘涎。兼肝经证。脘中大痛。呕吐酸水。或吐黄绿苦水。四肢厥逆。泄利下重。或便脓血。甚则
脐间动气。 震手。
【秀按】阳明最多兼证。胃热冲肺。则咳逆痰多。冲心包络。则神昏发厥。冲心则神昏谵语。或但笑而不
语。下烁肝肾。则风动发痉。阴竭阳越。其变证由于失清失下者多。故阳明每多死证。总之勘伤寒证。阳明最
多下证。少阴最多补证。宜下失下。宜补失补。皆致殒人。虽然。用下尚易。用补最难。难在对证发药。刚刚恰好耳。
【廉勘】阳明热盛。最多蒸脑一症。病即神昏发痉。前哲不讲及此者。皆忘却《内经》胃为五脏六腑之海。其清
气上注于目。其悍气上冲于头。循咽喉。上走空窍。循眼系入络脑。数句耳。
太阴标证四肢倦怠。肌肉烦疼。或一身尽痛。四末微冷。甚则发黄。黄色晦暗。
太阴本证。腹满而吐。食不下。时腹自痛。自利不渴。即渴亦不喜饮。胸脘痞满。嗌干口腻。热结则暴下赤
黄。小便不利。若腹痛烦闷。欲吐不吐。欲泻不泻。多挟痧秽。
【秀按】太阴以湿为主气。有阳经注入之邪。有本经自受之邪。注入之邪。多湿热证。自受之邪。多风湿寒
湿秽湿等证。
太阴中见证。腹痛痞满。呕吐不纳。大便胶秘。小溲不利。或下赤黄。或二便俱闭。发黄鲜明。
【秀按】湿与热合。脾胃同病。其人中气虚。则太阴证多。湿遏热郁。中气实。则阳明证多。热重湿轻。故
同一满闷也。脾湿满。满在脐下少腹。胃热闷。闷在心下胃口。同一腹痛也。满而时痛者属脾。满而大实痛者
属胃。同一发黄也。黄色之淤晦者属脾。黄色之鲜明者属胃。同一格吐也。朝食暮吐为脾寒格。食入即吐为胃
热格。脾胃之证。相反如是。岂可混称湿热。而以治脾者治胃。以治胃者治脾哉。总之胃为阳腑。宜通宜降。
脾为阴脏。宜健宜升。胃恶燥。宜清宜润。脾恶湿。宜温宜燥。大旨如是而已。
太阴兼证。兼心经证。神烦而悸。汗出津津。似寐非寐。或不得卧。兼肝经证。心中痛热。饥不欲食。食即呕酸
吐苦。胸胁满疼。甚则霍乱吐泻。
【秀按】兼心经多血虚证。以心生血脾统血故也。脾无血统。则脾阴将涸。势必子盗母气。阴竭阳越。故心
烦不寐。汗出津津。最为虚脱危候。兼肝经多气郁血热证。如霍乱吐泻。虽属太阴湿土为病。而致所以上吐下
泻者。实属厥阴风木乘脾而郁发也。故其眼目全在阳明。必以趺阳不负为顺。如胃家实者。既吐泻则湿郁已
发。而风木自熄。若胃家不实而阳虚。则风木必挟寒水以凌脾。吐利不止而四逆。胃家不实而阴虚。则风木必
煽相火以窜络。拘挛不伸而痉厥。至于湿竭化燥。血热生风。风动窜络之痉病。尤为太阴兼证之坏病也。
少阴标证。肌虽热而不甚恶热。反畏寒战栗。面赤目红。咽痛舌燥。胸胁烦闷而痛。痛引腰、背、肩胛、肘臂、泄利下重。甚或躁扰谵语。自汗指厥。
【秀按】此少阴实热现象。故为标证。盖少阴只有虚寒。以君火藏而不用故也。凡有热象。皆相火之所为。
非木病也。犹之厥阴经一切虚寒之证。亦少阴之所为。非厥阴本病也。
少阴本证。肢厥四逆。腹痛吐泻。下利清谷。引衣蜷卧。喜向里睡。甚则面赤戴阳。
【秀按】此少阴虚寒现象。故为本证。盖少阴虽属君火。以藏为用。其体常虚。惟赖太阳卫之于外。而表寒
不侵。阳明镇之于中。而里寒不起。若卫阳不固。而胃阳尚强。寒邪尚不能斩关直入。惟胃阳失守。寒水无
制。故厥阴之风而厥逆。挟太阴之湿而下利。则真火立见消亡。故少阴最多死证。
【廉勘】陆九芝有少阴咽痛吐利寒热辨。语最明白。特节述其说曰。少阴病脉阴阳俱紧。反汗出者。法当咽
痛而复吐利。此以热客于少阴之标。叔和平脉法。所传师说伏气之病是也。先论咽痛。少阴之脉循喉咙。在初
得病二三日。为阳邪结于会厌。但用生甘草解毒。桔梗排脓。半夏鸡子白发声利咽。足矣。若夫下利胸满。心
烦而咽痛。为阴虚液不上蒸者。治宜育阴复液。则猪肤汤加蜜粉者是。下利厥逆面赤而咽痛。为阴盛格阳于上
者。治宜驱阴复阳。则通脉四逆汤之加桔梗者是。是盖以阴虚阴盛。皆可以致咽痛。故有必从两法而解者。再
论吐利。饮食入口即吐。心下明HT HT 欲吐复不能吐者。此胸中实。不可下而可吐也。膈有寒饮而吐。且干呕者。
此有水气。不可吐而可温也。吐利交作。以手足不冷为吉。若吐且利而见厥逆。吐且利而见烦躁则凶。虽有吴
茱萸一法。亦未必及救矣。终论少阴下利。与厥阴下利不同。厥阴之利。多热少寒。少阴之利。多寒少热。故
惟厥冷而或咳或悸。腹痛下重。是阳为阴遏之利。用四逆散。咳而呕渴。心烦不眠。是水热互结之利。用猪苓
汤。小便不利。腹痛便脓血。是寒热不调之利。用桃花汤。自利清水。心下痛。二三日咽干口燥。六七日不大便。均腹满。是阳盛铄阴之利。用承气汤。凡若此者。皆为传经之邪。固属于热。若夫下利清谷。厥逆脉微。
呕而汗出。引衣自盖。欲向壁卧。不喜见明。而又面赤戴阳者。则皆合于真武、附子四逆、通脉、白通诸方。
为少阴虚寒之证。正与厥阴热利相反矣。少阴下利死证五条。吐利躁烦。四肢厥逆。恶寒身蜷。脉不至。不烦
而躁。下利止而眩冒。六七日而息高者。虽尚有吴茱萸一法。终为不治之证。苟非利止手足温。身反发热。未
易求其生也。
少阴中见证。里寒外热。手足厥冷。身反不恶寒。下利清谷。腹痛干呕。面色娇红。咽痛口燥。渴而饮。饮
而吐。吐而复渴。甚则烦躁欲死。扬手踯足。或欲坐卧水中。
【秀按】此阴盛格阳之证。内真寒。外假热。或下真寒。上假热。当以在下在内之寒为主。用热药冷服之
法。或可十救一二。
少阴兼证。兼肺经证。微见恶寒。发热不已。咳嗽不渴。咯痰稀白。身静蜷卧。似寐非寐。兼心包证。初起发热。
即神呆不语。欲寐而不得寐。心烦躁扰。口干舌燥。欲吐粘涎而不吐。身虽热。仍欲暖盖。或目睛上视。兼脾
经证。初虽头痛恶寒。继即发热不止。口燥而渴。一食瓜果。即腹痛自利。脘满而吐。兼肝经证。初起口干舌燥。心
烦恶热。即吐泻如霍乱。陡然神识昏 。虽醒似睡。手足螈 。
太阳病的标证。头痛，身体发热，怕冷畏风，颈项僵硬，腰部疼痛，骨节烦扰疼痛。无汗的，说明寒邪重于风邪；自汗出的，说明风邪重于寒邪。
太阳病本证。口渴想喝水，水喝进去就吐出来，小便不通畅，甚至短少频数、淋漓不尽，或者反而小便通利，蓄血导致神志狂乱。
【秀按】太阳病的发生，是寒水之气致病。寒邪致病，所以适宜用温散法；水邪致病，所以适宜用利水法。总以发汗作为出路，利水作为去路。如果不是水蓄积而血蓄积，那么又以通瘀作为去路。
太阳病中见证。凡是见到太阳标证，同时大便不成形，小便清亮色白，甚至男子遗精，女子白带增多，腰脊坠痛，疼痛像被棍棒打过一样，甚至气短喘息，角弓反张发生痉挛。如果眼睛向上翻视，更是危重的征候。
【秀按】这就是张景岳所说的太阳病未解，少阴经先溃败。必定是此人肾气先虚，那么肾中的阳气，不足以抵御阴寒，就会从太阳中络脉直接侵入足少阴肾经。
太阳病兼证。兼肺经证，鼻塞流鼻涕，鼻鸣喷嚏，咳嗽痰稀色白，甚至气喘且胸部胀满。兼脾经证，肢体懈怠嗜睡，口腻腹泻。兼胃经证，饱闷厌恶食物，打嗝有腐臭味，吞酸。
【秀按】太阳经主管皮毛，所以《内经》说，太阳与毫毛相应。上与肺经相关，所以受寒会伤肺；下与肾经相关，所以出汗多则尿少。如果兼见脾经证，必定是此人素体湿气重；兼见胃经证，必定是此人新近夹带食滞。
【秀按】少阳以寒热往来、胁痛耳聋为半表证，口苦咽干目眩为半里证，是因为少阳经外行腠理，内行两胁，不居于身之前后而居于侧面。两耳醒着能听见，睡着听不见；口、咽、目睁开能见，闭上看不见。这些情况，不能称为表，也不能称为里，所以称为半表里。只有寒热这一证，必须寒退之后才发热，热退之后才出汗，这才是少阳的寒热往来。如果是发热恶寒像疟疾一样，一天发作两三次，病人不呕吐，仍然是太阳表证，不是少阳的半表证。临证时也要辨别清楚。
少阳病中见证。手足时而温暖时而寒冷，烦闷消渴，甚至谵语发痉，四肢厥逆。
【秀按】少阳与厥阴互为表里。如果相火之邪，不从外部发散，势必向内窜入心包络和肝经，出现热深厥深的危重征候，以及火旺风动的危象。
【廉勘】陆九芝说：论述经络则以太阳、阳明、少阳为次序；论述疾病则太阳、少阳的病邪，都传入阳明。我认为太阳主皮毛，是躯体最外面一层；少阳主腠理，是躯壳上的第二层。大概腠理就是网膜，也就是《金匮要略》所说的三焦通会元真的地方。所以太阳、少阳两阳经，病在皮腠，证候多有传变；两阳合明（阳明），病归中土，所以不再传变。由此推断，三阳经的传经，也应当以太阳、少阳、阳明为次序。其三阳寒热的区分：身体虽然大热但仍然怕冷的，是太阳病；寒退之后发热，热退之后出汗，寒热往来的，是少阳病；开始虽然怕冷，一旦发热就不再怕冷的，是阳明病。
少阳病兼证。兼胃经证，烦闷恶心，面红便秘，身体疼痛脚冷，斑点隐隐约约。兼脾经证，四肢疲倦懈怠，肌肉烦疼，嘴唇干燥口渴，膈中痞满，斑疹欲出而不出。兼肾经证，耳朵严重失聪，牙齿焦枯，腰背酸痛像折断一样，甚至精气自遗，冲任脉跳动。兼肺经证，喉咙痛红肿，咳嗽牵引胁痛，甚至咯血。兼心经证，舌头红牙齿干燥，午后高热，神志昏迷不说话，甚至说胡话发笑。兼小肠经证，舌头红赤神志呆滞，语言颠倒，小便红赤涩痛，点滴像稠液一样。兼大肠经证，胸膈硬满而且呕吐，腹中疼痛，发潮热，大便秘结，或者反而自利。
【秀按】手少阳和足少阳经，内部经过膈胁，外部行于腠理，都主管相火。相火，是游走运行的火。内部在三焦的膜原，散布在膻中，联络心包络，沿着胁肋内部，连接肝脏进而到达胆，依次联络三焦，大多与各脏腑相通。其相通的途径，既然与三焦相关，又在膈膜处相会。如手太阴肺经脉，起于中焦，回绕胃口，上膈；足太阴脾经脉，联络胃，上膈；手少阴心经脉，出心系，下膈；手厥阴心包络脉，起于胸中，下膈；足阳明胃经脉、手太阳小肠经脉、手阳明大肠经脉，均下膈；足厥阴肝经脉，贯穿膈。所以少阳一经，不仅多中见证，而且多各经兼证。只有兼足少阴肾经证，是由于相火炽盛，由肝及肾罢了。
【廉勘】兼胃经证，这是少阳转属阳明，二阳合病，胃热已盛，即将发斑的征候。兼脾经证，由于失于解表，腠理闭塞，相火被湿邪郁遏，斑疹不得透发的征候。兼肾经证，由于少阳相火大炽，逼迫进入少阴，阴伤热盛的征候。兼肺经证，由于相火灼烧肺部，热咳痰嗽，胸膈气机痹阻的征候。兼心经证，必定是此人心虚有痰，一经相火熏蒸，痰火即刻蒙闭清窍，常有眼睛微定，昏厥像尸体一样的征候。兼小肠经证，由于相火下窜，热结在小肠，小肠为火府，两火相煽，常有逆乘心包的征候。兼大肠经证，由于相火炽盛，热结在里，心上痞硬，又往来寒热而呕吐的，是热结肠痹。由此看来，刘草窗说伤寒只传足经不传手经，是伪言。
阳明病的标证。开始虽然怕冷，第二天自然停止，身体大热，汗自出，不怕冷，反而怕热，眼睛痛鼻子干，不能安睡，或者多眠睡。
阳明病本证。在上脘部位病尚浅，咽干口苦，气上冲咽喉，胸部胀满而喘，心中懊恼。在中脘部位病已重，大烦大渴，胃实满，手足出汗，发潮热，不大便，小便不利。在下脘部位，由幽门直逼小肠，且与大肠相表里，病尤其深重，日晡时分发热，谵语发狂，眼睛不和，腹部胀满，绕脐痛，气喘头昏不能卧，腹中转矢气，大便胶结闭塞，或者自利纯青色水，神志昏迷不认识人，甚至循衣摸床，撮空理线。
【秀按】上脘象征天，部位在胸中，清气居多，还可以宣上解肌，使里邪从表而出。下脘象征地，内接小肠，浊气居多，法度可缓下，使里邪从下而出。而其能升清降浊的，全赖中脘来运用。所以中脘之气旺盛，则水谷的清气，上升于肺，以灌输百脉；水谷的浊气，下达于大小肠，从便溺而泄。治法虽然多种多样，总以健运胃气，照顾胃液，或清或下为主。俞氏细分上、中、下三脘的现证，大概因为胃虽然是一个腑，却有浅深轻重的不同。临证者不可不详加辨别。
阳明病中见证。四肢烦疼，口腻而淡，脘腹痞满，大便像红酱，尿短数热，甚至小便不利，大便硬发黄，黄色鲜明，或者斑点隐隐约约，发而不透，神识模糊，躁扰异常。
【秀按】阳明的邪气，失于解表失于清热，以致陷入太阴，所以多中见湿证。应当辨别湿重而热轻的，失于汗解，或者汗不得法，湿气内留，或者此人素体脾湿重，湿与热合，最为浊热粘腻。热重而湿轻的，往往内郁成斑，斑不得透，毒不得解，尤为危险。急宜提透，不让毒邪陷入少阴、厥阴二经。如大便胶结闭塞，潮热谵语的，阳明证重，太阴证轻，缓缓攻下即可。《内经》所谓“土郁夺之”就是这个意思。总之脾胃相连膜，邪入阳明，热结燥实的固然多，气结湿滞的尤其多。况且我们绍兴地处卑湿，湿热病最占多数，治法很繁杂，临证者尤其应当详加辨别。
阳明病兼证。兼肺经证，头胀心烦，脘闷咳嗽痰多，痰色黄白相间，喉咙干燥渴饮。如果热壮胸闷，呕吐恶心脚冷的，将要发痧疹。如果胸胁滞痛，咳嗽气喘的，肺多伏痰。兼心经证，咽喉干燥舌头燥，口腔糜烂口气秽臭，想睡却睡不着，或者似睡非睡，甚至说胡话发笑，面色娇红。兼肾经证，口燥咽干，心下急痛，腹胀便秘，或者自利酸臭水。兼心包络证，口燥消渴，气上冲心，膈上热痛，神昏谵语，甚至晕厥像尸体，口吐粘涎。兼肝经证，脘中大痛，呕吐酸水，或者吐黄绿苦水，四肢厥逆，泄利下重，或者便脓血，甚至脐间动气，震手。
【秀按】阳明最多兼证。胃热冲肺，则咳逆痰多；冲心包络，则神昏发厥；冲心则神昏谵语，或者只笑而不语；下烁肝肾，则风动发痉，阴竭阳越。其变证由于失清失下的居多，所以阳明每多死证。总之诊察伤寒证，阳明最多下证，少阴最多补证。宜下而失下，宜补而失补，都会致人死亡。虽然如此，用下法还容易，用补法最难，难在对证用药，刚刚恰好而已。
【廉勘】阳明热盛，最多蒸脑一症，病即神昏发痉。前代哲人不讲及这个，都是忘记了《内经》说的“胃为五脏六腑之海，其清气上注于目，其悍气上冲于头，循咽喉，上走空窍，循眼系入络脑”这几句话罢了。
太阴病的标证。四肢倦怠，肌肉烦疼，或者一身尽痛，四末微冷，甚至发黄，黄色晦暗。
太阴病本证。腹部胀满而吐，吃不下东西，时常腹痛自利，下利不渴，即使渴也不喜欢喝水，胸脘痞满，咽喉干燥口腻。热结则暴下赤黄色，小便不利。如果腹痛烦闷，想吐吐不出来，想泻泻不出来，多挟带痧秽。
【秀按】太阴以湿为主气，有阳经注入的邪气，有本经自受的邪气。注入的邪气，多是湿热证；自受的邪气，多是风湿、寒湿、秽湿等证。
太阴病中见证。腹痛痞满，呕吐不纳，大便胶秘，小便不利，或者下赤黄色，或者二便俱闭，发黄鲜明。
【秀按】湿与热合，脾胃同病。其中气虚的，则太阴证多；湿遏热郁，中气实的，则阳明证多。热重湿轻，所以同样是满闷。脾湿满，满在脐下少腹；胃热闷，闷在心下胃口。同样是腹痛，满而时痛的属于脾，满而大实痛的属于胃。同样是发黄，黄色淤晦的属于脾，黄色鲜明的属于胃。同样是格拒呕吐，朝食暮吐为脾寒格，食入即吐为胃热格。脾胃的证候，相反如此，岂可混称湿热，而以治脾的方法治胃，以治胃的方法治脾呢？总之胃为阳腑，宜通宜降；脾为阴脏，宜健宜升。胃恶燥，宜清宜润；脾恶湿，宜温宜燥。大旨就是这样罢了。
太阴病兼证。兼心经证，神烦而悸，汗出津津，似睡非睡，或者不能卧。兼肝经证，心中痛热，饥不欲食，食即呕酸吐苦，胸胁满疼，甚至霍乱吐泻。
【秀按】兼心经的多血虚证，因为心生血、脾统血的原因。脾没有血统，则脾阴将枯竭，势必子盗母气，阴竭阳越，所以心烦不寐，汗出津津，是最为虚脱的危候。兼肝经的多气郁血热证，如霍乱吐泻，虽然属于太阴湿土为病，而导致上吐下泻的，实属厥阴风木乘脾而郁发。所以其眼目全在阳明，必须以趺阳脉不负为顺。如胃家实者，既吐泻则湿郁已发，而风木自熄。若胃家不实而阳虚，则风木必挟寒水以凌脾，吐利不止而四肢厥逆。胃家不实而阴虚，则风木必煽相火以窜络，拘挛不伸而痉厥。至于湿竭化燥，血热生风，风动窜络的痉病，尤为太阴兼证的坏病。
少阴病的标证。肌肤虽然热但不怎么怕热，反而畏寒战栗，面赤目红，咽痛舌燥，胸胁烦闷而痛，疼痛牵引腰、背、肩胛、肘臂，泄利下重，甚至躁扰谵语，自汗手指厥冷。
【秀按】这是少阴实热现象，所以为标证。大概少阴只有虚寒，因为君火藏而不用。凡有热象，都是相火所为，不是木病。就像厥阴经一切虚寒之证，也是少阴所为，不是厥阴本病。
少阴病本证。四肢厥逆，腹痛吐泻，下利清谷，拉衣服蜷卧，喜欢向里睡，甚至面赤戴阳。
【秀按】这是少阴虚寒现象，所以为本证。大概少阴虽属君火，以藏为用，其体常虚，只依赖太阳卫护于外，而表寒不侵；阳明镇守于中，而里寒不起。如果卫阳不固，而胃阳尚强，寒邪尚不能斩关直入。只有胃阳失守，寒水无制，所以厥阴的风而厥逆，挟太阴的湿而下利，则真火立刻消亡。所以少阴最多死证。
【廉勘】陆九芝有《少阴咽痛吐利寒热辨》，话说得很明白，特别节述其说法：少阴病脉阴阳俱紧，反汗出的，法当咽痛而复吐利。这是热邪客于少阴之标，叔和《平脉法》所传的师说伏气之病。先论咽痛，少阴经脉循喉咙，在初得病二三日，为阳邪结于会厌，只用生甘草解毒，桔梗排脓，半夏、鸡子白发声利咽，就够了。如果下利胸满，心烦而咽痛，为阴虚液不上蒸的，治宜育阴复液，则是猪肤汤加蜜粉的方子。下利厥逆面赤而咽痛，为阴盛格阳于上的，治宜驱阴复阳，则是通脉四逆汤加桔梗的方子。这是因为阴虚阴盛，都可以导致咽痛，所以有必须从两法而解的。再论吐利，饮食入口即吐，心下明HT HT 想吐又吐不出来的，这是胸中实，不可下而可吐。膈有寒饮而吐，且干呕的，这是有水气，不可吐而可温。吐利交作，以手足不冷为吉，如果吐且利而见厥逆，吐且利而见烦躁则凶，虽有吴茱萸一法，也未必能救。终论少阴下利，与厥阴下利不同。厥阴之利，多热少寒；少阴之利，多寒少热。所以惟厥冷而或咳或悸，腹痛下重，是阳为阴遏之利，用四逆散；咳而呕渴，心烦不眠，是水热互结之利，用猪苓汤；小便不利，腹痛便脓血，是寒热不调之利，用桃花汤；自利清水，心下痛，二三日咽干口燥，六七日不大便，均腹满，是阳盛铄阴之利，用承气汤。凡此种种，皆为传经之邪，固属于热。如果下利清谷，厥逆脉微，呕而汗出，拉衣服自盖，想向壁卧，不喜欢见光，而又面赤戴阳的，则都合于真武、附子四逆、通脉、白通诸方，为少阴虚寒之证，正与厥阴热利相反。少阴下利死证五条：吐利躁烦，四肢厥逆，恶寒身蜷，脉不至，不烦而躁，下利止而眩冒，六七日而息高的，虽然有吴茱萸一法，终为不治之证。如果不是利止手足温，身反发热，不容易求得生机。
少阴病中见证。里寒外热，手足厥冷，身体反而不怕冷，下利清谷，腹痛干呕，面色娇红，咽痛口燥，渴而饮水，饮水则吐，吐了又渴，甚至烦躁欲死，扬手踯足，或者想坐卧水中。
【秀按】这是阴盛格阳之证，内真寒，外假热，或者下真寒，上假热。应当以下在内之寒为主，用热药冷服之法，或许可以十救一二。
少阴病兼证。兼肺经证，微见恶寒，发热不已，咳嗽不渴，咯痰稀白，身静蜷卧，似睡非睡。兼心包证，初起发热，即神呆不语，想睡却睡不着，心烦躁扰，口干舌燥，想吐粘涎而不吐，身体虽然热，仍想暖盖，或者眼睛上视。兼脾经证，初虽头痛恶寒，继即发热不止，口燥而渴，一吃瓜果，即腹痛自利，脘满而吐。兼肝经证，初起口干舌燥，心烦恶热，即吐泻如霍乱，陡然神识昏迷，虽然醒了也像睡着，手足抽搐。
Biao (Mark) Syndrome of Taiyang. Headache, feverish body, aversion to cold and fear of wind, stiffness of the neck and lower back pain, vexatious pain in the bone joints. Those without sweating indicate that Cold is heavier than Wind; those with spontaneous sweating indicate that Wind is heavier than Cold.
Ben (Root) Syndrome of Taiyang. Thirst desire to drink water, vomiting immediately after drinking, dysuria, or even oliguria with frequency and dribbling, or conversely normal urination, blood stasis accumulation leading to mania.
[Commentary by Xiu] The disease of Taiyang is caused by the pathogenic factor of Cold and Water. When Cold is the pathogen, it is suitable for warming and dispersing methods; when Water is the pathogen, it is suitable for promoting diuresis. Generally, sweating serves as the exit route, and diuresis serves as the departure route. If there is no water accumulation but blood stasis, then promoting blood circulation to remove stasis serves as the departure route.
Zhongjian (Intermediate Manifestation) Syndrome of Taiyang. Whenever Biao symptoms of Taiyang are seen, accompanied by loose stools, clear and white urine, or even seminal emission in men and excessive leukorrhea in women, heavy pain in the waist and spine feeling like being beaten by a stick, shortness of breath and asthma, opisthotonos with spasms. If the eyes roll upward, it is an especially critical condition.
[Commentary by Xiu] This is what Zhang Jingyue referred to as "Taiyang not resolved, Shaoyin collapsing first." It must be that the person's Kidney Qi was deficient beforehand, so the Yang Qi within the Kidneys was insufficient to resist Yin Cold, entering directly from the Taiyang intermediate collaterals into the Foot-Shaoyin Kidney Meridian.
Jian (Concurrent) Syndrome of Taiyang. Concurrent Lung Meridian syndrome: nasal congestion, runny nose, nasal humming, sneezing, coughing with thin white phlegm, or even asthma with chest fullness. Concurrent Spleen Meridian syndrome: limb flaccidity and drowsiness, sticky mouth and diarrhea. Concurrent Stomach Meridian syndrome: bloating and food aversion, belching with a putrid taste and acid regurgitation.
[Commentary by Xiu] The Taiyang Meridian governs the skin and hair, hence the *Neijing* states that Taiyang corresponds to the fine hairs. It connects superiorly with the Lung Meridian, so external cold injures the Lungs; it connects inferiorly with the Kidney Meridian, so excessive sweating leads to reduced urine. If concurrent Spleen Meridian syndrome is present, the person likely has constitutive dampness; if concurrent Stomach Meridian syndrome is present, the person likely has recent food stagnation.
Biao (Mark) Syndrome of Shaoyang. Alternating chills and fever, deafness, hypochondriac pain.
Ben (Root) Syndrome of Shaoyang. Vertigo, dry throat, bitter taste, propensity to vomit, qi obstruction in the epigastrium.
[Commentary by Xiu] Shaoyang presents alternating chills and fever, hypochondriac pain, and deafness as half-exterior syndromes, and bitter taste, dry throat, and vertigo as half-interior syndromes. This is because the Shaoyang Meridian runs externally through the interstices and internally along the hypochondrium, residing on the sides rather than the front or back of the body. The ears hear when awake but not when asleep; the mouth, throat, and eyes see when open but not when closed. These cannot be called exterior nor interior, thus termed half-exterior and half-interior. Only the syndrome of alternating chills and fever, where heat follows chills and sweating follows heat, constitutes the alternating chills and fever of Shaoyang. If fever and aversion to cold resemble malaria, occurring two or three times a day, without vomiting, it remains a Taiyang exterior syndrome, not a Shaoyang half-exterior syndrome. Clinical differentiation must be clear.
Zhongjian (Intermediate Manifestation) Syndrome of Shaoyang. Hands and feet alternately warm and cold, vexation and fullness, wasting-thirst, or even delirium and spasms, cold extremities.
[Commentary by Xiu] Shaoyang and Jueyin are exterior-interior pairs. If the pathogenic factor of Ministerial Fire does not dissipate outward, it will inevitably invade inward to the Pericardium and Liver Meridians, presenting critical conditions of deep heat with deep cold extremities and wind stirring due to hyperactive fire.
[Annotation by Lian] Lu Jiuzhi stated: In discussing meridians, the order is Taiyang, Yangming, Shaoyang; in discussing diseases, pathogens of Taiyang and Shaoyang both enter Yangming. I believe Taiyang governs the skin, the outermost layer of the body; Shaoyang governs the interstices, the second layer. Essentially, the interstices are the omentum, which Jin Gui refers to as the place where the Sanjiao connects and unites primordial true qi. Thus, the two Yang meridians (Taiyang and Shaoyang), with disease in the skin and interstices, have syndromes prone to transmission; Yangming, where the two Yangs combine and brighten, has disease returning to the central earth, thus no longer transmitting. From this, we deduce that the transmission among the Three Yang meridians should also follow the order of Taiyang, Shaoyang, Yangming. Regarding the differentiation of cold and heat among the Three Yang: body very hot but still aversive to cold is Taiyang; chills followed by heat, heat followed by sweating, alternating chills and fever is Shaoyang; initially aversive to cold, but once feverish, no longer aversive to cold is Yangming.
Jian (Concurrent) Syndrome of Shaoyang. Concurrent Stomach Meridian syndrome: vexation and oppression, nausea, red face, constipation, body pain with cold feet, faint macules. Concurrent Spleen Meridian syndrome: four limbs fatigue and flaccidity, vexatious muscle pain, dry lips and thirst, epigastric distension and fullness, macules wanting to erupt but failing to do so. Concurrent Kidney Meridian syndrome: severe deafness, scorched and withered teeth, sore and painful waist and back feeling like breaking, or even spontaneous seminal emission, pulsation of the Chong and Ren vessels. Concurrent Lung Meridian syndrome: sore and swollen throat, coughing with hypochondriac pain, or even hemoptysis. Concurrent Heart Meridian syndrome: red tongue and dry teeth, high fever in the afternoon, unconsciousness and muteness, or even speaking incoherently and laughing. Concurrent Small Intestine Meridian syndrome: red tongue and dull spirit, inverted speech, red and scanty urine, drops like thick fluid. Concurrent Large Intestine Meridian syndrome: hard and full chest and diaphragm with vomiting, abdominal pain, tidal fever, constipation, or conversely spontaneous diarrhea.
[Commentary by Xiu] The Hand and Foot Shaoyang meridians pass internally through the diaphragm and hypochondrium, and externally through the interstices, all governing Ministerial Fire. Ministerial Fire is a wandering fire. Internally, it is in the membranes of the Sanjiao, spreads in the Danzhong, connects with the Pericardium, follows the inside of the hypochondrium, connects to the Liver and reaches the Gallbladder, sequentially connecting the Sanjiao, and mostly communicates with various Zang-Fu organs. The pathways of communication relate to the Sanjiao and converge at the diaphragm. For example, the Hand-Taiyin Lung Meridian starts in the middle jiao, circles the stomach opening, goes up through the diaphragm; the Foot-Taiyin Spleen Meridian connects to the stomach, goes up through the diaphragm; the Hand-Shaoyin Heart Meridian exits the heart system, goes down through the diaphragm; the Hand-Jueyin Pericardium Meridian starts in the chest, goes down through the diaphragm; the Foot-Yangming Stomach Meridian, Hand-Taiyang Small Intestine Meridian, and Hand-Yangming Large Intestine Meridian all go down through the diaphragm; the Foot-Jueyin Liver Meridian penetrates the diaphragm. Therefore, the Shaoyang meridian not only has many Zhongjian manifestations but also many concurrent syndromes of other meridians. Only the concurrent Foot-Shaoyin Kidney Meridian syndrome occurs because Ministerial Fire is blazing, moving from the Liver to the Kidney.
[Annotation by Lian] Concurrent Stomach Meridian syndrome indicates Shaoyang transferring to Yangming, a combined disease of Two Yangs, with excess stomach heat, a sign that macules are about to erupt. Concurrent Spleen Meridian syndrome results from failure to release the exterior, closing the interstices, trapping Ministerial Fire with dampness, preventing macule eruption. Concurrent Kidney Meridian syndrome is due to blazing Shaoyang Ministerial Fire forcing entry into Shaoyin, a sign of yin injury and heat excess. Concurrent Lung Meridian syndrome is due to Ministerial Fire scorching the lungs, causing hot cough and phlegm, and qi obstruction in the chest and diaphragm. Concurrent Heart Meridian syndrome implies the person has heart deficiency with phlegm; once steamed by Ministerial Fire, phlegm-fire immediately clouds the clear orifices, often presenting with fixed eyes and coma resembling death. Concurrent Small Intestine Meridian syndrome is due to Ministerial Fire rushing downward, heat binding in the small intestine; since the small intestine is the fire organ, two fires fanning each other often lead to counter-attack on the Pericardium. Concurrent Large Intestine Meridian syndrome is due to blazing Ministerial Fire, heat binding internally, epigastric hardness, alternating chills and fever with vomiting, indicating heat binding in the large intestine bowels. Thus, Liu Caochuang's claim that Shanghan transmits only to foot meridians and not hand meridians is false.
Biao (Mark) Syndrome of Yangming. Initially aversive to cold, stops spontaneously on the second day, high fever, spontaneous sweating, no aversion to cold, but aversion to heat, eye pain and dry nose, insomnia, or hypersomnia.
Ben (Root) Syndrome of Yangming. In the upper wan (epigastrium), the disease is shallow: dry throat, bitter taste, qi rushing to the throat, chest fullness and asthma, mental restlessness. In the middle wan, the disease is severe: great vexation and thirst, stomach excess fullness, sweating on hands and feet, tidal fever, constipation, dysuria. In the lower wan, pressing directly from Youmen to the small intestine, and related internally and externally to the large intestine, the disease is particularly deep and severe: fever at dusk, delirium and madness, disordered eyes, abdominal fullness, periumbilical pain, asthma and dizziness unable to lie down, passing gas in the abdomen, fecal impaction, or spontaneous passage of pure green water, unconsciousness, even grasping at empty air and picking at clothes.
[Commentary by Xiu] Upper wan symbolizes Heaven, located in the chest, rich in clear qi, allowing for releasing the exterior and resolving the muscle layer, letting interior pathogens exit via the exterior. Lower wan symbolizes Earth, internally connecting to the small intestine, rich in turbid qi, allowing for gentle purgation, letting interior pathogens exit via the lower orifices. Its ability to ascend clear and descend turbid relies entirely on the middle wan. Thus, when middle wan qi is vigorous, clear qi from food and drink ascends to the Lungs to nourish the hundred vessels; turbid qi descends to the large and small intestines to be excreted via stool and urine. Although methods vary, the main principle is strengthening and transporting stomach qi, caring for stomach fluids, using either clearing or purging. Yu's detailed division of upper, middle, and lower wan syndromes reflects that although the stomach is one fu organ, it has differences in depth and severity. Clinicians must differentiate carefully.
Zhongjian (Intermediate Manifestation) Syndrome of Yangming. Vexatious pain in four limbs, sticky and bland taste in mouth, epigastric and abdominal fullness, stool like red sauce, short and frequent hot urination, or even dysuria, hard stool turning yellow with bright color, or faint macules erupting incompletely, blurred consciousness, extreme restlessness.
[Commentary by Xiu] Yangming pathogens, failing to be released via sweating or cleared, sink into Taiyin, thus often presenting with damp manifestations. One must distinguish damp-heavy and heat-light cases: failing sweat resolution or improper sweating leaves dampness internally; or constitutive spleen dampness combines with heat, becoming turbid, hot, and sticky. Heat-heavy and damp-light cases often develop internal郁 (depression) into macules that fail to erupt, toxins failing to resolve, which is especially dangerous. Urgent lifting and penetrating is needed to prevent toxin pathogens sinking into Shaoyin and Jueyin. If fecal impaction and tidal fever with delirium occur, Yangming syndrome is heavy, Taiyin is light, slow purgation is acceptable. As the *Neijing* says, "Earth depression requires seizing [purging]." In summary, the Spleen and Stomach share membranes; pathogens entering Yangming are often heat-binding and dry-excess, but qi-binding and damp-stagnation are even more common. Moreover, our Shaoxing region is low and damp, making damp-heat diseases predominant, with complex treatments. Clinicians must differentiate meticulously.
Jian (Concurrent) Syndrome of Yangming. Concurrent Lung Meridian syndrome: head distension and vexation, epigastric oppression, coughing with phlegm, yellow-white mixed sputum, dry throat and thirst. If high fever, chest oppression, vomiting, nausea, and cold feet occur, sand-rash is impending. If chest and hypochondriac stagnation and pain, coughing and asthma occur, the Lungs have latent phlegm. Concurrent Heart Meridian syndrome: dry throat and tongue, oral ulceration and foul breath, desire to sleep but inability, or semi-sleep state, even delirium and laughing, delicate red complexion. Concurrent Kidney Meridian syndrome: dry mouth and throat, urgent pain below the heart, abdominal fullness and constipation, or spontaneous passage of sour-smelling water. Concurrent Pericardium Meridian syndrome: dry mouth and wasting-thirst, qi rushing to the heart, hot pain above the diaphragm, unconsciousness and delirium, or even fainting resembling death, spitting sticky saliva. Concurrent Liver Meridian syndrome: severe pain in the epigastrium, vomiting sour water or yellow-green bitter water, cold extremities, heavy sensation during diarrhea, or bloody pus in stool, even pulsation at the umbilicus shaking the hand.
[Commentary by Xiu] Yangming has the most concurrent syndromes. Stomach heat rushing to the Lungs causes cough and copious phlegm; rushing to the Pericardium causes unconsciousness and fainting; rushing to the Heart causes unconsciousness and delirium, or only laughing without speaking; scorching the Liver and Kidneys downward causes wind stirring and spasms, yin exhaustion and yang floating. Most variations result from failure to clear or purge, hence Yangming often has fatal cases. In summary, diagnosing Shanghan, Yangming has the most purgative indications, Shaoyin has the most tonifying indications. Failing to purge when indicated, or failing to tonify when indicated, both cause death. Although purging is relatively easy, tonifying is hardest, difficult in matching the prescription precisely to the syndrome.
[Annotation by Lian] Yangming heat excess most commonly presents with brain steaming, causing unconsciousness and spasms. Ancients did not discuss this because they forgot the *Neijing*: "The Stomach is the sea of the five zang and six fu organs; its clear qi ascends to the eyes; its fierce qi rushes to the head, follows the throat, ascends to the orifices, follows the eye system, and enters the brain to connect."
Biao (Mark) Syndrome of Taiyin. Four limbs fatigue, vexatious muscle pain, or whole-body pain, slight coldness in the four extremities, or even jaundice with dark yellow color.
Ben (Root) Syndrome of Taiyin. Abdominal fullness with vomiting, inability to eat, intermittent spontaneous abdominal pain, spontaneous diarrhea without thirst, or if thirsty, no desire to drink, epigastric distension, dry throat and sticky mouth. Heat binding causes sudden passage of red-yellow stool, dysuria. If abdominal pain, vexation, desire to vomit but cannot, desire to defecate but cannot, it often involves sha-toxin and filth.
[Commentary by Xiu] Taiyin takes dampness as its dominant qi. There are pathogens injected from Yang meridians, and pathogens self-received by the meridian itself. Injected pathogens are mostly damp-heat syndromes; self-received pathogens are mostly wind-damp, cold-damp, and filth-damp syndromes.
Zhongjian (Intermediate Manifestation) Syndrome of Taiyin. Abdominal pain and distension, vomiting and refusal to eat, fecal impaction, dysuria, or passage of red-yellow stool, or closure of both stool and urine, bright yellow jaundice.
[Commentary by Xiu] Dampness combining with heat affects both Spleen and Stomach. If middle qi is deficient, Taiyin syndromes predominate; if damp suppresses heat and middle qi is solid, Yangming syndromes predominate. Heat-heavy and damp-light cause similar fullness and oppression. Spleen damp-fullness is full below the navel in the lower abdomen; Stomach heat-oppression is oppressed in the epigastrium and stomach opening. Same abdominal pain: fullness with intermittent pain belongs to Spleen; fullness with severe constant pain belongs to Stomach. Same jaundice: dark and turbid yellow belongs to Spleen; bright yellow belongs to Stomach. Same regurgitant vomiting: morning food evening vomiting is Spleen cold rejection; immediate vomiting after eating is Stomach heat rejection. Spleen and Stomach syndromes are so opposite, how can one confuse them as damp-heat and treat Stomach with Spleen methods, or vice versa? In summary, Stomach is a Yang fu organ, suitable for unblocking and descending; Spleen is a Yin zang organ, suitable for strengthening and ascending. Stomach dislikes dryness, suitable for clearing and moistening; Spleen dislikes dampness, suitable for warming and drying. This is the general principle.
Jian (Concurrent) Syndrome of Taiyin. Concurrent Heart Meridian syndrome: mental vexation and palpitations, profuse sweating, semi-sleep state, or inability to lie down. Concurrent Liver Meridian syndrome: painful heat in the heart, hunger without desire to eat, vomiting sour and bitter fluid upon eating, hypochondriac fullness and pain, or even cholera-like vomiting and diarrhea.
[Commentary by Xiu] Concurrent Heart Meridian often involves blood deficiency, because the Heart generates blood and the Spleen controls blood. Without Spleen control of blood, Spleen yin will dry up, inevitably stealing mother qi from daughter, leading to yin exhaustion and yang floating, hence mental vexation and insomnia, profuse sweating, which is a critical sign of collapse. Concurrent Liver Meridian often involves qi stagnation and blood heat. Cholera-like vomiting and diarrhea, although belonging to Taiyin damp-earth disease, the cause of vomiting and diarrhea is actually Jueyin wind-wood attacking the Spleen and郁 (depressing) then erupting. Thus, the key lies in Yangming; Fu Yang pulse must not be negative to be auspicious. If Stomach home is solid, vomiting and diarrhea mean damp depression has erupted, and wind-wood extinguishes itself. If Stomach home is not solid and yang is deficient, wind-wood will carry cold-water to bully the Spleen, continuous vomiting and diarrhea with cold extremities. If Stomach home is not solid and yin is deficient, wind-wood will fan ministerial fire to invade collaterals, spasms and inability to extend limbs, leading to convulsions and fainting. When damp exhausts and transforms into dryness, blood heat generates wind, and wind stirring invading collaterals causes spasms, which is a worsened disease of Taiyin concurrent syndromes.
Biao (Mark) Syndrome of Shaoyin. Skin is hot but not greatly averse to heat, instead fearful of cold and shivering, red face and red eyes, sore throat and dry tongue, chest and hypochondriac vexation and pain, pain radiating to waist, back, shoulder blades, elbows, and arms, heavy sensation during diarrhea, or even restlessness and delirium, spontaneous sweating with cold fingers.
[Commentary by Xiu] This is a Shaoyin excess-heat phenomenon, hence termed Biao syndrome. Basically, Shaoyin only has deficiency-cold, because Lord Fire is stored and unused. Any heat signs are the work of Ministerial Fire, not Wood pathology. Similarly, all deficiency-cold syndromes of Jueyin are also the work of Shaoyin, not Jueyin's root disease.
Ben (Root) Syndrome of Shaoyin. Cold extremities and four reversals, abdominal pain, vomiting and diarrhea, passage of undigested food, pulling clothes and curling up, preferring to sleep facing inward, or even red face with floating yang (Dai Yang).
[Commentary by Xiu] This is a Shaoyin deficiency-cold phenomenon, hence termed Ben syndrome. Although Shaoyin belongs to Lord Fire, it uses storage as function, its body is constantly deficient, relying only on Taiyang guarding outside so exterior cold does not invade, and Yangming anchoring inside so interior cold does not rise. If defensive yang is not secure but stomach yang is still strong, cold pathogens cannot break through directly. Only when stomach yang is lost and cold water is unchecked, does Jueyin wind cause cold reversals, carrying Taiyin dampness to cause diarrhea, then true fire immediately vanishes. Hence Shaoyin has the most fatal cases.
[Annotation by Lian] Lu Jiuzhi has "Differentiation of Shaoyin Sore Throat, Vomiting, Diarrhea, Cold and Heat," which is very clear. Excerpting his view: Shaoyin disease, pulses tight on both cun and chi, yet sweating occurs; legally, this should present with sore throat and subsequent vomiting and diarrhea. This is heat lodging in the Biao of Shaoyin, as transmitted by Shuhe in Ping Mai Fa regarding latent qi disease. First discussing sore throat: the Shaoyin meridian follows the throat. In the first two or three days of illness, it is yang pathogen knotting at the uvula; using raw licorice to detoxify, platycodon to drain pus, pinellia and egg white to promote voice and benefit the throat is sufficient. If diarrhea, chest fullness, mental vexation, and sore throat occur, it is yin deficiency with fluids failing to steam upward; treatment should nourish yin and restore fluids, such as Pig Skin Decoction plus honey powder. If diarrhea, cold extremities, red face, and sore throat occur, it is yin excess repelling yang upward; treatment should drive out yin and restore yang, such as Tongmai Sini Decoction plus platycodon. This is because both yin deficiency and yin excess can cause sore throat, requiring resolution via two methods. Next discussing vomiting and diarrhea: food vomited immediately upon entering mouth, Ming HT HT below heart, desire to vomit but cannot, this is excess in the chest, not suitable for purging but suitable for inducing vomiting. Cold-fluid in the diaphragm causing vomiting and dry heaving, this is water qi, not suitable for vomiting but suitable for warming. Simultaneous vomiting and diarrhea: hand and foot warmth is auspicious; if vomiting and diarrhea accompanied by cold reversals, or vomiting and diarrhea accompanied by restlessness, it is ominous. Even with Wuzhuyu Decoction, rescue may not be possible. Finally discussing Shaoyin diarrhea: different from Jueyin diarrhea. Jueyin diarrhea is mostly heat, little cold; Shaoyin diarrhea is mostly cold, little heat. Thus, cold extremities with cough or palpitations, abdominal pain and heavy sensation, is yang suppressed by yin diarrhea, use Six Reversal Powder (Sini San); cough with vomiting, thirst, mental vexation and insomnia, is water-heat interbinding diarrhea, use Polyporus Decoction (Zhu Ling Tang); dysuria, abdominal pain, bloody pus in stool, is cold-heat disharmony diarrhea, use Peach Blossom Decoction (Taohua Tang); spontaneous passage of clear water, pain below heart, dry mouth and throat in two to three days, constipation in six to seven days, all abdominal fullness, is yang excess scorching yin diarrhea, use Chengqi Decoction. All these are transmitted pathogens, inherently heat. If passage of undigested food, cold reversals, faint pulse, vomiting with sweating, pulling clothes to cover, desire to lie facing the wall, dislike light, yet red face with floating yang, these all correspond to Zhenwu, Fuzi Sini, Tongmai, and Baotong formulas, representing Shaoyin deficiency-cold syndromes, exactly opposite to Jueyin heat diarrhea. Five fatal Shaoyin diarrhea syndromes: vomiting, diarrhea, restlessness, cold reversals, aversion to cold, curled body, absent pulse, restlessness without vexation, cessation of diarrhea with dizziness, respiration rising after six to seven days. Even with Wuzhuyu Decoction, ultimately incurable. Unless diarrhea stops, hands and feet warm, body returns to fever, survival is unlikely.
Zhongjian (Intermediate Manifestation) Syndrome of Shaoyin. Interior cold with exterior heat, cold extremities, body seemingly not averse to cold, passage of undigested food, abdominal pain and dry heaving, delicate red face, sore throat and dry mouth, thirst with drinking, drinking leads to vomiting, vomiting leads to renewed thirst, or even extreme restlessness, waving hands and kicking feet, or desire to sit/lie in water.
[Commentary by Xiu] This is yin excess repelling yang syndrome, true interior cold with false exterior heat, or true lower cold with false upper heat. Treatment should focus on the cold in the lower and interior, using the method of taking hot medicine cold, perhaps saving one or two out of ten.
Jian (Concurrent) Syndrome of Shaoyin. Concurrent Lung Meridian syndrome: slight aversion to cold, unremitting fever, cough without thirst, expectoration of thin white phlegm, quiet curled lying, semi-sleep state. Concurrent Pericardium Meridian syndrome: initial fever, immediately dull spirit and muteness, desire to sleep but inability, mental vexation and restlessness, dry mouth and tongue, desire to spit sticky saliva but cannot, body hot yet desiring warm covers, or eyes rolling upward. Concurrent Spleen Meridian syndrome: initially headache and aversion to cold, subsequently unremitting fever, dry mouth and thirst, eating fruits or melons immediately causes abdominal pain and spontaneous diarrhea, epigastric fullness and vomiting. Concurrent Liver Meridian syndrome: initial dry mouth and tongue, mental vexation and aversion to heat, immediately vomiting and diarrhea like cholera, sudden unconsciousness, waking appears sleeping, convulsions of limbs.