（一名正伤寒。张仲景先师但名曰伤寒。）
【因】立冬后。严寒为重。春夏秋暴寒为轻。触受之者。或露体用力而着寒。或脱
穿衣服而着寒。或汗出当风而着寒。或睡卧傍风而着寒。故张长沙伤寒序例云。伤寒多
从风寒得之。
【证】头痛身热。恶寒怕风。项强腰痛。骨节烦疼。无汗而喘。胸痞恶心。舌多无
苔而润。即有亦白滑而薄。甚或舌苔淡白。
【脉】左浮紧有力。右多浮滑。浮则为风。紧则为寒。有力而滑。则为表寒实象。
此太阳经表证标病也。
【治】法当辛温发表。使周身汗出至足为度。遵内经寒者温之。体如燔炭。汗出而
散之法。苏羌达表汤主之。妇女宜理气发汗。香苏葱豉汤主之。小儿宜和中发汗。葱豉
荷米煎主之。若发汗不彻。表寒虽散。而水郁在里。渴欲饮水。水入则吐。小便不利。
甚或短数淋沥。舌苔纯白而浓。脉左弦滞。右浮弦而滑。此水蓄膀胱。太阳经传里证本
病也。法当化气利水。苓术二陈煎治之。张氏五苓散。（生晒术一钱、浙茯苓四钱、猪苓
二钱、泽泻二钱、官桂五分、共研细末、每服三钱、广皮一钱、生姜二片、泡汤调下。
）亦可收效。虽然伤寒一证。传变颇多。不越乎火化、水化、水火合化、三端。从火化者
。多少阳相火证。阳明燥实证。厥阴风热证。从水化者。多阳明水结证。太阴寒湿证。
少阴虚寒证。从水火合化者。多太阴湿热证。少阴厥阴寒热错杂证。试举各经腑脏形证。
以印证化生之病。大抵吾绍患伤寒者。火化证多于水化。水火合化者亦不鲜。
（甲）邪传少阳经证。寒热往来。两头角痛。耳聋目眩。胸胁满疼。舌苔白滑
。或舌尖苔白。或单边白。或两边白。脉右弦滑。左弦而浮大。此邪郁腠理。逆于上焦
少阳经病偏于半表证也。法当和解兼表。柴胡枳桔汤主之。
（乙）邪传少阳腑证。寒轻热重。口苦膈闷。吐酸苦水。或呕黄涎而粘。甚则
干呕呃逆。胸胁胀疼。舌红苔白。间现杂色。或尖白中红。或边白中红。或尖红中白。
或尖白根灰。或根黄中带黑。脉右弦滑。左弦数。此相火上逆。少阳腑病偏于半里证也
。法当和解兼清。蒿芩清胆汤主之。如服一剂或二剂后。呕吐虽止。而寒热未除。胸胁
尚痛。膈满而闷。已成小结胸者。治以和解兼开降法。柴胡陷胸汤主之。服后、胸痛膈
闷虽除。而寒热仍发。腹满而痛。便秘溺赤。此少阳上焦之邪。渐结于中焦阳明也。当
以和解兼轻下法。大柴胡汤去姜半夏加川朴（一钱）风化硝（一钱）治之。
（丙）邪热传入胃经。身灼热、汗自出。不恶寒。反恶热。口大渴。心大烦。揭去
衣被。 点隐隐。溺短赤热。甚则谵语发狂。舌尖红。苔边白中黄。脉右浮洪而数。左
亦弦大。此外而肌腠。内而肝胆。上则心肺。下则小肠膀胱。无不受其蒸灼。但尚为散
漫无形之燥热。未曾结实。宜清透而不宜攻下之阳明外证也。辛凉泄热为君。佐以甘寒
救液。新加白虎汤主之。服后。 发虽透。谵语狂妄虽除。而身热不退。口燥渴。汗大
出。脉见虚芤者。胃汁枯涸。肺津将亡也。急宜甘凉救液为君。大生肺津。人参白虎汤
。（西洋参三钱、生石膏四钱、知母四钱、生甘草一钱、生粳米三钱、荷叶包。）加鲜石
斛（四钱）、鲜生地（六钱）、梨汁（二瓢）、鲜茅根（五钱）治之。如再不应。而虚羸少气
。气短息促。口干舌燥。汗出肤冷。心神烦躁。脉虚而急疾者。胃液将亡。肺气欲脱也
。急急益气固脱。增液宁神。孙氏生脉散参
许氏二加龙蛎汤法。（别直参钱半、原麦冬四钱、北五味五分、绵 皮二钱、青竹皮四
钱、花龙骨三钱、 牡蛎五钱、陈阿胶三钱、鸡子黄二枚、真茄楠香汁两匙冲。）力图
急救。希冀侥幸于什一。此就逆证而言。若顺证则新加白虎汤。往往一剂知。二剂即已
。
（丁）邪传阳明胃腑。其证甚多。以水谷之海。各经皆秉气于胃也。故病有太阳
阳明。有正阳阳明。有少阳阳明。有太阴阳明。有少阴阳明。有厥阴阳明。其证有热结。
痰结。水结。气结。发黄。蓄血。液枯。正虚之各异。兹将历经实验者。条述如下。
（一）太阳阳明。凡太阳病。发其汗。汗先出不彻。表邪未净。肢冷身热。微微
恶风。腹满而痛。大便不通。舌苔浅黄薄腻。黄中带白。脉右洪数。左尚浮缓。即仲景
所谓胃中干燥。因转属阳明。不更衣内实。大便难者。此为太阳转属阳明之热结也。宜
以攻里兼解表法。浓朴七物汤治之（张氏伤寒论太阳阳明、误作脾约、必是传讹。）
（二）正阳阳明。有轻重危三证。轻者。由太阳病。若发汗。若吐后。邪仍
不解。蒸蒸发热。不吐不下。心烦。腹胀满。舌苔正黄。脉右滑大。此热已结胃。胃腑
不和也。法当泻热润燥。佐以和胃。调胃承气汤微下之。重者。阳明病。潮热多汗。津
液外出。胃中燥。小便数。大便必硬。硬则谵语。腹大满。便不通。舌苔老黄。脉右滑数
而实。此胃中热结。移入小肠也。法当苦寒泻火。佐以辛通。小承气汤缓下之。（微和
胃气、勿令大泄下。）危者。阳明病。不大便五六日。至十余日。申酉时发潮热。不恶寒
。独恶热。身重短气。腹满而喘。频转矢气。手足 然汗出。
躁则头摇手痉。谵语发狂静则独语如见鬼状。循衣摸床。剧则昏厥不识人。目睛不了了。
甚则两目直视。舌苔焦黄起刺。兼有裂纹。甚或焦黑燥裂。或如沉香色苔。中后截生芒刺
黑点。脉右沉弦数实。左弦数而劲。此胃小肠热结。上蒸心脑。下移大肠也。急急峻下存
阴为君。佐以熄风开窍。大承气汤加犀角（二钱）、羚角（三钱）、紫雪（八分至一钱
）、急救之。脉弦者生。涩者死。此要诀。切记之。
（三）少阳阳明。热结膈中。膈上如焚。寒热如疟。热重寒轻。心烦懊 。口
苦而渴。大便不通。腹满而痛。舌赤苔黄。脉右弦大而数。左弦数而搏。此仲景所谓误
发汗而利小便。胃中燥烦而实。大便难是也。轻则和解兼攻下法。大柴胡汤主之。重则攻
里兼和解法。柴芩清膈煎主之。
（四）太阴阳明。其证有二。一为肺胃合病。其人素有痰火。外感伤寒。一转
阳明。肺气上逆。咯痰黄浓。或白而粘。胸膈满痛。神昏谵语。腹满胀疼。便闭溺涩。舌
苔望之黄滑。扪之糙手。脉右滑数而实。甚或两寸沉伏。此肺中痰火。与胃中热结而成
下证也。法当肺与大肠并治。开降肺气以通大便。陷胸承气汤主之。若兼鼻孔煽张。喉
间有水鸡声喘胀闷乱。胸腹坚如铁石者。速投加味凉膈煎峻逐之。又若其人素有痰饮。
适患伤寒。不先解表。或发汗不透。而反下之。阳气内陷。心下因硬。从脘至少腹。坚
痛拒按。申酉时小有潮热。但头上微汗出。不大便五六日。渴不引饮。舌燥苔白。脉右
沉弦而紧。此水与郁热。互结在胸脘胁肺胃之间也。法当急下停饮。蠲饮万灵汤主之。
若复往来寒热者。先以大柴胡汤。加煨甘遂（五分）和解以微下之。一为脾胃合病。其人
素多湿热。外感伤寒夹食。一传阳明。热结在胃。胃火炽盛。湿火转成燥火。垢浊熏蒸
。腐肠烁液。发痉撮空。谵语妄笑。按其脘腹。壮热灼手。大便不通。溺赤短涩。甚或二便俱闭。舌
苔黄刺干腻。或兼灰黑。扪之涩而戟手。脉右沉弦数实。左亦弦数搏指。此脾中湿浊。
与胃中热结而成下证也。急急开泄下夺。承接未亡之阴气于一线。小承气汤加川连
（一钱）、至宝丹（两颗）急救之。若再失下。其脾必约。盖脾与胃以膜相连。任其熏蒸
灼烁。则胃液告竭。脾阴亦枯。脾上脂膜。遂干燥而收缩。腹坚而胀。矢如羊粪。仲景
麻仁脾约丸。缓不济急。速投三仁承气汤。加硝蜜煎（风化硝三钱、净白蜜一两。）润
下之。庶可转危为安。若寻常热结液枯。病势尚缓者。只须养荣承气汤。镇润以缓下之
。
（五）少阴阳明。有轻重危三证。轻者。阳明病外证未解。不先辛凉开达。而
遽下之。则胃中空虚。客热之气。乘虚而内陷心包胃络之间。轻则虚烦不眠。重即心中
懊。反复颠倒。心窝苦闷。甚或心下结痛。卧起不安。或心愦愦。怵惕烦躁。间有谵
语。饥不能食。但头汗出。舌苔白滑微黄。或淡黄光滑。或灰白不燥。脉左寸细搏数。
或两寸陷下。右关弦滑。此外邪初陷于心胃之间。乃包络热郁之闷证也。法当微苦微辛
。轻清开透。连翘栀豉汤主之。开透后。包络血液。被邪热劫伤。往往血虚生烦。心中
不舒。愦愦无奈。间吐粘涎。呻吟错语。舌底绛而苔白薄。扪之糙手。脉右寸浮滑。左
寸搏动。急急濡液涤涎。宣畅络气。五汁一枝煎清润之。重者少阴病。口燥咽干。心下
痛。腹胀不大便。或自利清水。色纯青而气臭恶。舌深红。苔黑燥而浓。脉右沉数而实。
左细坚数搏。此少阴邪从火化。合阳明燥化而成下证也。法当急下存阴。大承气汤。加
犀角（一钱）、鲜生地（一两），峻泻之。危者少阴病。热陷神昏。似寐如醉。谵语妄笑。甚
则不语如尸。六七日至十余日。大便不通。腹热
灼手。小便赤涩涓滴。脉沉弦而涩。按之牢坚。左小数坚搏。此少阴少火悉成壮火。合
并阳明燥热而成下证也。亟亟开泄下夺。泻燎原之邪火。以救垂竭之真阴。犀连承气汤
加西黄（五分）、麝香（五厘）急拯之。
（六）厥阴阳明。有轻重危三证。轻者其人素有肝气。病伤寒六七日。热陷在里
。气上撞心。心中疼热。呕吐黄绿苦水。胸膈烦闷。气逆而喘。四肢微厥。腹满便闭。
舌边紫。苔黄浊。脉右滑。左弦数。此厥阴气结。合阳明热结而成下证。仲景所谓厥应
下之是也。法当苦辛通降。下气散结。六磨饮子去木香。加广郁金（三钱、磨汁）。主之
。重者热陷尤深。四肢虽厥。指甲紫赤。胸胁烦满。神昏谵语。消渴恶热。大汗心烦。
大便燥结。溲赤涩痛。舌苔老黄。甚则芒刺黑点。脉右滑大躁甚。左弦坚搏数。此厥阴
火亢。合阳明热结而成下证。仲景所谓脉滑而厥。厥深热亦深也。法当清燥泻火。散结
泄热。四逆散缓不济急。白虎承气汤加广郁金（三钱磨汁冲）润下之。若兼少腹攻冲作
痛。呕酸吐苦。诸药不效者。更投雪羹合更衣丸。（包煎、钱半至二钱、极重三钱。）
屡奏殊功。危者热深厥深。胸腹灼热。手足独冷。剧则如惊痫。时螈 。神迷发厥。终
日昏睡不醒。或谵语呻吟。面色青惨。摇头鼓颔。忽然坐起。吐泻不得。腹中绞痛。攒
眉切牙。疼剧难忍。二便俱闭。舌紫赤。苔灰腻带青。六脉沉细数抟。甚或伏而不见。此
由厥阴郁火。深伏于肝脏血络之中。而不发露于大经大络。直透胃肠而外发也。往往气
闭闷毙。顷刻云亡。治宜先刺要穴出血。（如少商、中冲、舌下紫筋、曲池、委中等穴
。）以开泄其血毒。再灌以紫雪（五分）、品飞龙夺命丹（二分）以开清窍而透伏
邪。果能邪透毒泄。脉起而数。若肝风未熄。神识时清时昏。二便不通。舌卷囊缩。少
腹热痛。不可暂忍者。急用犀连承气汤如羚角（钱半）、绛雪（二分）等。凉通而芳透之。或可挽回于什一。
以上太少两阳与阳明合病。仲景已有明文。三阴与阳明合病。仲景伤寒论虽未指出
。而细阅其书。亦未尝无是证。及临证实验。尤为数见不鲜。爰将病状、脉舌
疗法药方。一一标明。以补仲景原书之不逮。从岐伯中阴溜府之义。悟出三阴实而邪不
能容。邪正互争。还而并入胃腑以成下证也。
至若发黄蓄血。本阳明常见之变证。所最
难治者。阳明病应下失下。邪盛正虚之坏病耳。先述发黄。阳明病。发热汗出。热从汗越
。不能发黄。但头汗出。而身无汗。剂颈而还。小便不利。渴饮水浆。腹微满者。身必发黄
。黄而鲜明如橘子色。甚则面目金黄。间或口吐黄汁。甚则心中懊 。或热痛。溺赤黄
浊。舌苔黄腻。糙而起刺。脉右滑数。左弦滞。此为瘀热在里。热不得越而成阳黄也。
轻则清利小便为君。荡涤黄液佐之。茵陈蒿汤。（绵茵陈一两、用水五碗、煎成四碗、
分二次煎、焦栀子十四枚、酒炒生川军一钱、成一碗服。）调下矾硫丸。（绿矾一两、
倭硫黄一钱、麦粉三两、黑枣肉二两、捣匀炼丸、每服三分至五分。）使黄从小便去。
尿如皂角汁。色正赤。一宿腹减。重则荡涤黄液为君。清利小便佐之。栀子大黄汤。（
焦栀子三钱。酒炒生川军钱半、小枳实一钱、淡香豉钱半）调下矾硫丸。使黄从大便去
。叠解恶臭粪而愈。惟形色桔燥如烟熏者。阳黄死证也。不治。
次论蓄血。其人脘腹中素有宿瘀。邪传阳明与胃中燥热相搏。壅蔽神气出入之
清窍。猝然头摇目瞪。发躁欲狂。甚则血厥。手指抽掣。厥回则脘腹串痛。身重不能转
侧。屎虽硬。大便反易而色黑。小便自利。舌色紫黯。
扪之滑润。脉右沉结。左反弦紧有力。此为瘀热在里。《内经》所谓蓄血在下。其人如
【病因】立冬之后，严寒加重；春夏秋的暴寒较轻。受邪者，有的因裸露身体用力劳作而受寒，有的因脱去或穿少衣服而受寒，有的因出汗后当风而受寒，有的因睡卧时靠近风口而受寒。所以张长沙在《伤寒序例》中说：伤寒多从风寒之邪得来。
【证候】头痛身热，恶寒怕风，项背强直腰痛，骨节烦痛，无汗且喘，胸中痞闷恶心，舌苔大多无苔而湿润，即使有苔也是白滑而薄，甚至舌苔淡白。
【脉象】左手脉浮紧有力，右手脉多浮滑。浮主风，紧主寒，有力而滑，则是表寒实证的象。这是太阳经表证的标病。
【治法】应当用辛温解表的方法，使全身出汗直到脚部为度。遵循《内经》“寒者温之”以及“身体如火烧般发热，出汗后消散”的法度。以苏羌达表汤为主方。妇女适宜理气发汗，以香苏葱豉汤为主方。小儿适宜和中发汗，以葱豉荷米煎为主方。如果发汗不彻底，虽然表寒已散，但水湿郁结在体内，口渴想喝水，水喝进去就吐，小便不利，甚至短少淋漓，舌苔纯白而厚，脉象左手弦滞，右手浮弦而滑。这是水蓄积在膀胱，属于太阳经传入里的本病。治法应当化气利水，用苓术二陈煎治疗。张氏五苓散（生晒白术一钱、浙江茯苓四钱、猪苓二钱、泽泻二钱、官桂五分，共研成细末，每次服用三钱，加广陈皮一钱、生姜两片，泡汤调服）也可以收到疗效。虽然伤寒这一病症，传变很多，但不离乎火化、水化、水火合化这三端。从火化的，多是阳经相火证，阳明燥实证，厥阴风热证。从水化的，多是阳明水结证，太阴寒湿证，少阴虚寒证。从水火合化的，多是太阴湿热证，少阴厥阴寒热错杂证。试列举各经络脏腑的形证，来印证化生出的疾病。大抵我们绍兴地区患伤寒的人，火化证多于水化，水火合化的也不少见。
（甲）邪气传入少阳经证。寒热往来，两侧头角疼痛，耳聋目眩，胸胁满痛，舌苔白滑，或者舌尖苔白，或者单边白，或者两边白，脉象右手弦滑，左手弦而浮大。这是邪气郁结在腠理，逆乱于上焦少阳经，病偏于半表证。治法应当和解兼解表，以柴胡枳桔汤为主方。
（乙）邪气传入少阳腑证。寒轻热重，口苦膈部闷塞，吐酸苦水，或者呕吐黄稠粘涎，甚至干呕呃逆，胸胁胀痛，舌红苔白，间现杂色，或者尖白中红，或者边白中红，或者尖红中白，或者尖白根灰，或者根黄中带黑，脉象右手弦滑，左手弦数。这是相火上逆，少阳腑病偏于半里证。治法应当和解兼清热，以蒿芩清胆汤为主方。如果服用一两剂后，呕吐虽止，但寒热未除，胸胁尚痛，膈部满闷，已成小结胸证，治以和解兼开降法，以柴胡陷胸汤为主方。服药后，胸痛膈闷虽除，但寒热仍发，腹部胀满疼痛，便秘尿赤，这是少阳上焦的邪气，逐渐结聚于中焦阳明。应当以和解兼轻下法，用大柴胡汤去掉姜半夏，加入川朴（一钱）、风化硝（一钱）治疗。
（丙）邪热传入胃经。身体灼热，汗自出，不恶寒，反恶热，口大渴，心中大烦，掀去衣被，皮肤隐约出现斑点，尿短赤热，甚至谵语发狂，舌尖红，苔边白中黄，脉象右手浮洪而数，左手也弦大。这是外至肌腠，内至肝胆，上至心肺，下至小肠膀胱，无不受其蒸灼。但尚为散漫无形之燥热，未曾结实，属于宜清透而不宜攻下的阳明外证。以辛凉泄热为君药，佐以甘寒救液，以新加白虎汤为主方。服药后，斑疹虽透，谵语狂妄虽除，但身热不退，口燥渴，大汗出，脉见虚芤，这是胃汁枯涸，肺津将亡。急宜以甘凉救液为君，大生肺津，用人参白虎汤（西洋参三钱、生石膏四钱、知母四钱、生甘草一钱、生粳米三钱，荷叶包），加鲜石斛（四钱）、鲜生地（六钱）、梨汁（两瓢）、鲜茅根（五钱）治疗。如果再无效，而身体虚弱瘦弱，气息短少，气短呼吸急促，口干舌燥，汗出皮肤冷，心神烦躁，脉虚而急疾，这是胃液将亡，肺气欲脱。急急益气固脱，增液宁神，采用孙氏生脉散配合许氏二加龙蛎汤法（别直参钱半、原麦冬四钱、北五味子五分、绵黄芪皮二钱、青竹皮四钱、花龙骨三钱、煅牡蛎五钱、陈阿胶三钱、鸡子黄二枚，真茄楠香汁两匙冲入），力图急救，希冀万分之一的侥幸。这是就逆证而言。如果是顺证，新加白虎汤往往一剂见效，二剂即愈。
（丁）邪传阳明胃腑。其证候很多，因为胃是水谷之海，各经都禀受胃气。所以病有太阳阳明，有正阳阳明，有少阳阳明，有太阴阳明，有少阴阳明，有厥阴阳明。其证有热结、痰结、水结、气结、发黄、蓄血、液枯、正虚等不同。兹将历经实验者，分条叙述如下。
（一）太阳阳明。凡是太阳病，发汗后，汗先出不透彻，表邪未净，肢冷身热，微微恶风，腹部胀满疼痛，大便不通，舌苔浅黄薄腻，黄中带白，脉象右手洪数，左手尚浮缓。这就是仲景所说的胃中干燥，因而转属阳明，不排便，内实，大便难的情况。此为太阳转属阳明的热结。宜以攻里兼解表法，用浓朴七物汤治疗（张氏《伤寒论》太阳阳明，误作脾约，必定是传讹）。
（二）正阳阳明。有轻、重、危三种证候。轻者，由太阳病，若发汗，若吐后，邪气仍不解，蒸蒸发热，不吐不下，心烦，腹胀满，舌苔正黄，脉象右手滑大。这是热已结于胃，胃腑不和。治法应当泻热润燥，佐以和胃，用调胃承气汤微下之。重者，阳明病，潮热多汗，津液外出，胃中燥，小便数，大便必硬。硬则谵语，腹部大满，便不通，舌苔老黄，脉象右手滑数而实。这是胃中热结，移入小肠。治法应当苦寒泻火，佐以辛通，用小承气汤缓下之。（微和胃气，勿令大泄下）。危者，阳明病，不大便五六日，至十余日，申酉时发潮热，不恶寒，独恶热，身重短气，腹满而喘，频繁放屁，手足濈然汗出。躁动时头摇手痉，谵语发狂；安静时独语如见鬼状，循衣摸床；剧烈时昏厥不识人，眼睛看不清，甚至两目直视，舌苔焦黄起刺，兼有裂纹，甚或焦黑燥裂，或如沉香色苔，中后截生芒刺黑点，脉象右手沉弦数实，左手弦数而劲。这是胃小肠热结，上蒸心脑，下移大肠。急急峻下存阴为君，佐以熄风开窍，用大承气汤加犀角（二钱）、羚角（三钱）、紫雪（八分至一钱）急救。脉弦者生，涩者死。这是要诀，切记。
（三）少阳阳明。热结膈中，膈上如焚，寒热如疟，热重寒轻，心烦懊恼，口苦而渴，大便不通，腹满而痛，舌赤苔黄，脉象右手弦大而数，左手弦数而搏。这是仲景所谓误发汗而利小便，胃中燥烦而实，大便难的情况。轻则和解兼攻下法，用大柴胡汤主方。重则攻里兼和解法，用柴芩清膈煎主方。
（四）太阴阳明。其证有二。一为肺胃合病。其人素有痰火，外感伤寒，一转阳明，肺气上逆，咯痰黄浓，或白而粘，胸膈满痛，神昏谵语，腹满胀疼，便闭溺涩，舌苔望之黄滑，扪之糙手，脉象右手滑数而实，甚或两寸沉伏。这是肺中痰火，与胃中热结而成下证。治法应当肺与大肠并治，开降肺气以通大便，用陷胸承气汤主方。若兼鼻孔煽张，喉间有水鸡声，喘胀闷乱，胸腹坚如铁石者，速投加味凉膈煎峻逐之。又若其人素有痰饮，适患伤寒，不先解表，或发汗不透，而反下之，阳气内陷，心下因硬，从脘至少腹，坚痛拒按，申酉时小有潮热，但头上微汗出，不大便五六日，渴不引饮，舌燥苔白，脉象右手沉弦而紧。这是水与郁热，互结在胸脘胁肺胃之间。治法应当急下停饮，用蠲饮万灵汤主方。若复往来寒热者，先以大柴胡汤，加煨甘遂（五分）和解以微下之。一为脾胃合病。其人素多湿热，外感伤寒夹食，一传阳明，热结在胃，胃火炽盛，湿火转成燥火，垢浊熏蒸，腐肠烁液，发痉撮空，谵语妄笑，按其脘腹，壮热灼手，大便不通，溺赤短涩，甚或二便俱闭，舌苔黄刺干腻，或兼灰黑，扪之涩而戟手，脉象右手沉弦数实，左手亦弦数搏指。这是脾中湿浊，与胃中热结而成下证。急急开泄下夺，承接未亡之阴气于一线，用小承气汤加川连（一钱）、至宝丹（两颗）急救。若再失下，其脾必约。盖脾与胃以膜相连，任其熏蒸灼烁，则胃液告竭，脾阴亦枯，脾上脂膜，遂干燥而收缩，腹坚而胀，矢如羊粪。仲景麻仁脾约丸，缓不济急，速投三仁承气汤，加硝蜜煎（风化硝三钱、净白蜜一两）润下之。庶可转危为安。若寻常热结液枯，病势尚缓者，只须养荣承气汤，镇润以缓下之。
（五）少阴阳明。有轻、重、危三种证候。轻者，阳明病外证未解，不先辛凉开达，而遽下之，则胃中空虚，客热之气，乘虚而内陷心包胃络之间。轻则虚烦不眠，重即心中懊恼，反复颠倒，心窝苦闷，甚或心下结痛，卧起不安，或心愦愦，怵惕烦躁，间有谵语，饥不能食，但头汗出，舌苔白滑微黄，或淡黄光滑，或灰白不燥，脉象左寸细搏数，或两寸陷下，右关弦滑。这是外邪初陷于心胃之间，乃包络热郁之闷证。治法应当微苦微辛，轻清开透，用连翘栀豉汤主方。开透后，包络血液，被邪热劫伤，往往血虚生烦，心中不舒，愦愦无奈，间吐粘涎，呻吟错语，舌底绛而苔白薄，扪之糙手，脉象右寸浮滑，左寸搏动。急急濡液涤涎，宣畅络气，用五汁一枝煎清润之。重者少阴病，口燥咽干，心下痛，腹胀不大便，或自利清水，色纯青而气臭恶，舌深红，苔黑燥而浓，脉象右手沉数而实，左手细坚数搏。这是少阴邪从火化，合阳明燥化而成下证。治法应当急下存阴，用大承气汤，加犀角（一钱）、鲜生地（一两），峻泻之。危者少阴病，热陷神昏，似寐如醉，谵语妄笑，甚则不语如尸，六七日至十余日，大便不通，腹热灼手，小便赤涩涓滴，脉沉弦而涩，按之牢坚，左小数坚搏。这是少阴少火悉成壮火，合并阳明燥热而成下证。亟亟开泄下夺，泻燎原之邪火，以救垂竭之真阴，用犀连承气汤加西黄（五分）、麝香（五厘）急拯之。
（六）厥阴阳明。有轻、重、危三种证候。轻者其人素有肝气，病伤寒六七日，热陷在里，气上撞心，心中疼热，呕吐黄绿苦水，胸膈烦闷，气逆而喘，四肢微厥，腹满便闭，舌边紫，苔黄浊，脉象右手滑，左手弦数。这是厥阴气结，合阳明热结而成下证。仲景所谓厥应下之是也。治法应当苦辛通降，下气散结，用六磨饮子去木香，加广郁金（三钱、磨汁）主之。重者热陷尤深，四肢虽厥，指甲紫赤，胸胁烦满，神昏谵语，消渴恶热，大汗心烦，大便燥结，溲赤涩痛，舌苔老黄，甚则芒刺黑点，脉象右手滑大躁甚，左手弦坚搏数。这是厥阴火亢，合阳明热结而成下证。仲景所谓脉滑而厥，厥深热亦深也。治法应当清燥泻火，散结泄热，四逆散缓不济急，用白虎承气汤加广郁金（三钱磨汁冲）润下之。若兼少腹攻冲作痛，呕酸吐苦，诸药不效者，更投雪羹合更衣丸（包煎，钱半至二钱，极重三钱），屡奏殊功。危者热深厥深，胸腹灼热，手足独冷，剧则如惊痫，时抽搐，神迷发厥，终日昏睡不醒，或谵语呻吟，面色青惨，摇头鼓颔，忽然坐起，吐泻不得，腹中绞痛，攒眉切牙，疼剧难忍，二便俱闭，舌紫赤，苔灰腻带青，六脉沉细数抟，甚或伏而不见。这是由厥阴郁火，深伏于肝脏血络之中，而不发露于大经大络，直透胃肠而外发也。往往气闭闷毙，顷刻云亡。治宜先刺要穴出血（如少商、中冲、舌下紫筋、曲池、委中等穴），以开泄其血毒，再灌以紫雪（五分）、品飞龙夺命丹（二分）以开清窍而透伏邪。果能邪透毒泄，脉起而数，若肝风未熄，神识时清时昏，二便不通，舌卷囊缩，少腹热痛，不可暂忍者，急用犀连承气汤如羚角（钱半）、绛雪（二分）等，凉通而芳透之。或可挽回于什一。
以上太少两阳与阳明合病，仲景已有明文。三阴与阳明合病，仲景《伤寒论》虽未指出，而细阅其书，亦未尝无是证。及临证实验，尤为数见不鲜。爰将病状、脉舌疗法药方，一一标明，以补仲景原书之不逮。从岐伯中阴溜府之义，悟出三阴实而邪不能容，邪正互争，还而并入胃腑以成下证也。
至若发黄蓄血，本阳明常见之变证。所最难治者，阳明病应下失下，邪盛正虚之坏病耳。先述发黄。阳明病，发热汗出，热从汗越，不能发黄。但头汗出，而身无汗，剂颈而还，小便不利，渴饮水浆，腹微满者，身必发黄。黄而鲜明如橘子色，甚则面目金黄，间或口吐黄汁，甚则心中懊恼，或热痛，溺赤黄浊，舌苔黄腻，糙而起刺，脉象右手滑数，左手弦滞。此为瘀热在里，热不得越而成阳黄也。轻则清利小便为君，荡涤黄液佐之，用茵陈蒿汤（绵茵陈一两，用水五碗，煎成四碗，分二次煎，焦栀子十四枚，酒炒生川军一钱，成一碗服），调下矾硫丸（绿矾一两，倭硫黄一钱，麦粉三两，黑枣肉二两，捣匀炼丸，每服三分至五分），使黄从小便去。尿如皂角汁，色正赤，一宿腹减。重则荡涤黄液为君，清利小便佐之，用栀子大黄汤（焦栀子三钱，酒炒生川军钱半，小枳实一钱，淡香豉钱半），调下矾硫丸，使黄从大便去。叠解恶臭粪而愈。惟形色桔燥如烟熏者，阳黄死证也。不治。
次论蓄血。其人脘腹中素有宿瘀，邪传阳明与胃中燥热相搏，壅蔽神气出入之清窍，猝然头摇目瞪，发躁欲狂，甚则血厥，手指抽掣，厥回则脘腹串痛，身重不能转侧，屎虽硬，大便反易而色黑，小便自利，舌色紫黯，扪之滑润，脉象右手沉结，左反弦紧有力。此为瘀热在里，《内经》所谓蓄血在下，其人如……
(Also known as True Cold Damage. Master Zhang Zhongjing simply called it Cold Damage.)
[Etiology] After the Start of Winter, severe cold is heavy; sudden cold in spring, summer, and autumn is light. Those affected may contract cold by exposing their bodies while exerting themselves, by removing clothes or wearing too few, by being exposed to wind after sweating, or by sleeping near a draft. Thus, Zhang Changsha stated in the "Precedents of Cold Damage": Cold damage mostly arises from wind-cold pathogens.
[Symptoms] Headache and fever, aversion to cold and fear of wind, stiffness and pain in the nape and lower back, vexatious pain in bone joints, absence of sweat with panting, chest oppression with nausea. The tongue usually has no coating and is moist; if there is a coating, it is white, slippery, and thin, or even pale white.
[Pulse] The left pulse is floating, tight, and forceful; the right pulse is mostly floating and slippery. Floating indicates wind, tight indicates cold. Forceful and slippery indicates an exterior cold-excess pattern. This is the branch disease of the Taiyang channel exterior syndrome.
[Treatment] The method should be acrid-warm release of the exterior, inducing sweating throughout the body down to the feet as the goal. Following the *Neijing* principle of "warming what is cold" and the method of "body burning like charcoal, dispersing after sweating," Su Qiang Da Biao Tang (Perilla and Notopterygium Exterior-Release Decoction) is the primary formula. For women, regulating Qi and releasing the exterior is suitable, using Xiang Su Cong Chi Tang (Elsholtzia and Fermented Soybean Decoction). For children, harmonizing the middle and releasing the exterior is suitable, using Cong Chi He Mi Jian (Scallion, Fermented Soybean, Lotus Leaf, and Rice Decoction). If sweating is incomplete, although the exterior cold is dispersed, water-dampness remains郁 (stagnant) inside. There is thirst with desire to drink, vomiting immediately after drinking, dysuria, or even scanty, dribbling urination. The tongue coating is pure white and thick. The left pulse is wiry and stagnant, the right is floating, wiry, and slippery. This is water accumulation in the Bladder, representing the root disease of the Taiyang channel transmitting inward. The method should be transforming Qi and promoting urination, treated with Ling Zhu Er Chen Jian (Poria, Atractylodes, and Two-Chen Decoction). Zhang's Wu Ling San (Five-Ingredient Powder with Poria: Raw-dried Bai Zhu 1 qian, Zhe Fu Ling 4 qian, Zhu Ling 2 qian, Ze Xie 2 qian, Guan Gui 0.5 qian, ground into fine powder; take 3 qian per dose, mixed with Guang Pi 1 qian and Sheng Jiang 2 slices soaked in water) can also be effective. Although Cold damage has many transmission patterns, they do not exceed Fire Transformation, Water Transformation, and Water-Fire Combined Transformation. From Fire Transformation: mostly Yang meridian Minister Fire syndromes, Yangming Dryness-Excess syndromes, Jueyin Wind-Heat syndromes. From Water Transformation: mostly Yangming Water-Binding syndromes, Taiyin Cold-Damp syndromes, Shaoyin Deficiency-Cold syndromes. From Water-Fire Combined Transformation: mostly Taiyin Damp-Heat syndromes, Shaoyin-Jueyin Cold-Heat Complex syndromes. Listing the manifestations of each meridian and organ to verify the diseases generated by transformation: Generally, in our Shaoxing area, Fire Transformation syndromes are more common than Water Transformation, and Water-Fire Combined Transformation cases are also frequent.
(a) Pathogen transmitting to Shaoyang Channel Syndrome. Alternating chills and fever, pain at both temples, deafness and vertigo, chest and hypochondriac fullness and pain. Tongue coating white and slippery, or white on the tip, or unilateral white, or bilateral white. Pulse right wiry and slippery, left wiry and floating-large. This is pathogen stagnating in the interstices, rebelling in the Upper Jiao Shaoyang channel, biased towards the Half-Exterior syndrome. The method should be harmonizing combined with exterior-release, using Chai Hu Zhi Jie Tang (Bupleurum and Aurantium Decoction).
(b) Pathogen transmitting to Shaoyang Organ Syndrome. Light chills, heavy fever, bitter taste in mouth, diaphragmatic oppression, vomiting sour-bitter fluid, or yellow sticky phlegm, even dry retching and hiccups, chest-hypochondriac distending pain. Tongue red with white coating, showing mixed colors: tip white center red, edges white center red, tip red center white, tip white root grey, or root yellow with black. Pulse right wiry and slippery, left wiry and rapid. This is Minister Fire rebelling upward, Shaoyang Organ syndrome biased towards the Half-Interior syndrome. The method should be harmonizing combined with clearing heat, using Hao Qin Qing Dan Tang (Artemisiae Scopariae and Scutellariae Gallbladder-Clearing Decoction). If after one or two doses vomiting stops but chills/fever persist, chest-hypochondriac pain remains, diaphragm is full and oppressed, forming a Small Knot-Breast syndrome, treat with harmonizing combined with opening-descending method, using Chai Hu Xian Xiong Tang (Bupleurum and Thorax-Sinking Decoction). After taking it, chest pain and diaphragmatic oppression resolve, but chills/fever recur, abdomen is full and painful, constipation and dark urine occur. This is Shaoyang Upper Jiao pathogen gradually binding in the Middle Jiao Yangming. Use harmonizing combined with mild purging method, Da Chai Hu Tang (Major Bupleurum Decoction) removing Jiang Ban Xia, adding Chuan Po (1 qian) and Feng Hua Xiao (1 qian).
(c) Pathogenic heat transmitting to Stomach Channel. Body scorching hot, spontaneous sweating, no aversion to cold, but aversion to heat, great thirst, great mental restlessness, throwing off clothes/quilts, faint macules appearing, short dark-hot urine, even delirium and mania. Tongue tip red, coating white on edges and yellow in center. Pulse right floating-hyperactive and rapid, left also wiry-large. This affects muscles/interstices externally, Liver/Gallbladder internally, Heart/Lungs superiorly, Small Intestine/Bladder inferiorly, all steamed and scorched. However, it is still scattered formless dry-heat, not yet solidified. It belongs to Yangming Exterior Syndrome, suitable for clearing/penetrating rather than purging. Acrid-cool clearing heat is the Sovereign herb, assisted by sweet-cool saving fluids, using Xin Jia Bai Hu Tang (Newly Added White Tiger Decoction). After taking it, if macules emerge, delirium/manic behavior ceases, but fever persists, mouth/dryness/thirst, profuse sweating, pulse becomes deficient and hollow, this is exhaustion of Stomach juices and impending loss of Lung fluids. Urgently use sweet-cool saving fluids as Sovereign, greatly generating Lung fluids, using Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction: Xi Yang Shen 3 qian, Sheng Shi Gao 4 qian, Zhi Mu 4 qian, Sheng Gan Cao 1 qian, Sheng Jing Mi 3 qian wrapped in Lotus Leaf), add Xian Shi Hu (4 qian), Xian Sheng Di (6 qian), Li Zhi (two ladles), Xian Mao Gen (5 qian). If still ineffective, and weakness/few qi, shortness of breath, dry mouth/tongue, sweating with cold skin, mental restlessness, pulse deficient and rapid, this is impending loss of Stomach fluids and Lung Qi collapse. Urgently tonify Qi and secure collapse, increase fluids and calm spirit, using Sun's Sheng Mai San (Life-Preserving Pulse Powder) combined with Xu's Er Jia Long Li Tang Method (Bie Zhi Shen 1.5 qian, Yuan Mai Dong 4 qian, Bei Wu Wei 0.5 fen, Mian Huang Qi Pi 2 qian, Qing Zhu Pi 4 qian, Hua Long Gu 3 qian, Zhen Mu Li 5 qian, Chen E Jiao 3 qian, Ji Zi Huang 2 eggs, Zhen Qie Nan Xiang juice 2 spoons mixed in). Strive for emergency rescue, hoping for a one-in-ten chance. This refers to adverse syndromes. If favorable syndromes, Xin Jia Bai Hu Tang often works in one dose, cures in two.
(d) Pathogen transmitting to Yangming Stomach Organ. Syndromes are numerous because the Stomach is the Sea of Food and Fluids, and all meridians derive Qi from it. Thus, there are Taiyang-Yangming, Zheng Yang-Yangming, Shaoyang-Yangming, Taiyin-Yangming, Shaoyin-Yangming, Jueyin-Yangming. Syndromes include Heat Binding, Phlegm Binding, Water Binding, Qi Binding, Jaundice, Blood Stasis, Fluid Exhaustion, Righteous Deficiency, etc. Listed below are those verified through experience.
(1) Taiyang-Yangming. In Taiyang disease, if sweating is induced but incomplete, exterior pathogen not cleared, limbs cold, body hot, slight aversion to wind, abdominal fullness/pain, constipation. Tongue coating shallow yellow, thin greasy, yellow with white. Pulse right hyperactive-rapid, left still floating-slow. This is what Zhongjing calls "dryness in the Stomach, transferring to Yangming, not defecating, internal excess, difficult stool." This is Heat Binding from Taiyang transferring to Yangming. Use attacking interior combined with releasing exterior method, Nong Po Qi Wu Tang.
(2) Zheng Yang-Yangming. Has mild, severe, critical syndromes. Mild: From Taiyang disease, after sweating or vomiting, pathogen unresolved, steaming fever, no vomiting/defecation, mental restlessness, abdominal fullness. Tongue coating truly yellow, pulse right slippery-large. Heat has bound in Stomach, Stomach organ disharmony. Method: purge heat, moisten dryness, assist harmonizing Stomach, Tiao Wei Cheng Qi Tang (Regulate the Stomach Chengqi Decoction) mildly purge. Severe: Yangming disease, tidal fever, profuse sweat, fluids exiting, Stomach dry, frequent urination, stool must be hard. Hardness causes delirium, large abdominal fullness, constipation. Tongue coating old yellow, pulse right slippery-rapid-solid. Heat binding in Stomach transfers to Small Intestine. Method: bitter-cold purge fire, assist acrid-unblocking, Xiao Cheng Qi Tang (Minor Chengqi Decoction) gently purge. Critical: Yangming disease, no stool for 5-6 days to over 10 days, tidal fever at Shen-You hours, no aversion to cold, only aversion to heat, heavy body, shortness of breath, abdominal fullness with panting, frequent passing of gas, hands/feet continuously sweaty. Restless: head shaking, hand spasms, delirium/manic. Quiet: talking alone as if seeing ghosts, grasping at bedclothes/seams. Severe: coma, unrecognizing people, eyes unclear, even staring straight ahead. Tongue coating scorched yellow with prickles, cracks, or scorched black/dry, or like agarwood color with black points/prickles in middle/rear. Pulse right deep-wiry-rapid-solid, left wiry-rapid-tough. Heat binding in Stomach/Small Intestine steams Heart/Brain, transfers to Large Intestine. Urgently purge severely to preserve Yin as Sovereign, assist extinguishing wind/opening orifices, Da Cheng Qi Tang (Major Chengqi Decoction) plus Xi Jiao (2 qian), Ling Jiao (3 qian), Zi Xue (0.8-1 qian) for emergency. Wiry pulse lives, choppy pulse dies. Remember this key point.
(3) Shaoyang-Yangming. Heat binding in Diaphragm, Diaphragm burning, chills/fever like malaria, heavy heat/light chills, mental restlessness/sighing, bitter taste/thirst, constipation, abdominal fullness/pain. Tongue red, yellow coating. Pulse right wiry-large-rapid, left wiry-rapid-pulsing. This is Zhongjing's description of mistaken sweating and promoting urination causing Stomach dryness/restlessness/excess, difficult stool. Mild: harmonize combined with attacking purge, Da Chai Hu Tang. Severe: attack interior combined with harmonizing, Chai Qin Qing Ge Jian.
(4) Taiyin-Yangming. Two syndromes. First: Lung-Stomach combined disease. Person has chronic phlegm-fire, contracts Cold Damage, transforms to Yangming, Lung Qi rebels, coughs thick yellow or white sticky sputum, chest-diaphragm fullness/pain, confusion/delirium, abdominal fullness/pain, constipation/scanty urination. Tongue looks yellow-slippery, feels rough. Pulse right slippery-rapid-solid, even both Cun pulses deep-hidden. This is Lung phlegm-fire combining with Stomach heat-binding to form Lower Excess. Method: treat Lung and Large Intestine together, open-descend Lung Qi to unblock stool, Xian Xiong Cheng Qi Tang. If accompanied by nostril flaring, frog-like sound in throat, panting/oppression/confusion, chest/abdomen hard as iron, urgently administer Jia Wei Liang Ge Jian to violently expel. Second: If person has chronic phlegm-fluid, contracts Cold Damage, fails to release exterior first, or sweating incomplete, then mistakenly purges, Yang Qi sinks inward, epigastrium becomes hard, hardness/pain from epigastrium to lower abdomen, refusing pressure, slight tidal fever at Shen-You hours, only slight sweat on head, no stool for 5-6 days, thirst without desire to drink, dry tongue white coating, pulse right deep-wiry-tight. This is water and constrained heat binding between Chest-Epigastrium-Hypochondrium/Lung/Stomach. Method: urgently purge retained fluid, Juan Yin Wan Ling Tang. If alternating chills/fever return, first use Da Chai Hu Tang plus Wei Gan Sui (0.5 fen) to harmonize and mildly purge. Second type: Spleen-Stomach combined disease. Person has chronic damp-heat, contracts Cold Damage with food retention, transforms to Yangming, heat binds in Stomach, Stomach fire blazing, damp-fire turns to dry-fire, turbid steaming, rotting intestines/scorching fluids, convulsions/grasping air, delirium/laughing wildly. Palpating epigastrium/abdomen, high fever burns hand, constipation, dark/scanty urination, even both bowels/bladder closed. Tongue coating yellow-prickly dry-greasy, or grey-black, feels rough/stinging. Pulse right deep-wiry-rapid-solid, left wiry-rapid-pulsing. This is Spleen damp-turbidity combining with Stomach heat-binding to form Lower Excess. Urgently open-drain and purge, catching remaining Yin, Xiao Cheng Qi Tang plus Chuan Lian (1 qian), Zhi Bao Dan (2 pills) for emergency. If purging is delayed further, Spleen will be constricted. Spleen and Stomach connected by membrane, allowing steaming/scorching leads to Stomach fluid exhaustion, Spleen Yin withering, Spleen fat-membrane drying/shrinking, abdomen hard/distended, stool like sheep dung. Zhongjing's Ma Ren Pi Yue Wan is too slow, urgently use San Ren Cheng Qi Tang plus Xiao Mi Jian (Feng Hua Xiao 3 qian, Jing Bai Mi 1 liang) to moisten-purge. May turn danger to safety. For ordinary heat-binding/fluid-exhaustion with slow progression, just use Yang Rong Cheng Qi Tang to nourish/moisten and gently purge.
(5) Shaoyin-Yangming. Mild, severe, critical. Mild: Yangming exterior syndrome unresolved, not first using acrid-cool opening, but hastily purging, leaving Stomach empty, guest-heat sinking into Pericardium/Stomach collaterals. Mild: deficiency-restlessness-insomnia. Severe: mental restlessness/sighing, tossing turning, epigastric bitterness/oppression, even epigastric knotting pain, restless lying/sitting, or mental confusion/fear/restlessness, occasional delirium, hunger but cannot eat, only head sweating. Tongue coating white-slippery-light yellow, or pale yellow-smooth, or grey-white-not dry. Pulse left Cun fine-pulsing-rapid, or both Cuns sunken, right Guan wiry-slippery. This is exterior pathogen initially sinking between Heart/Stomach, Pericardium heat-constraint oppression syndrome. Method: slightly bitter-slightly acrid, light-clear opening-penetrating, Lian Qiao Zhi Chi Tang. After opening, Pericardium blood damaged by heat, often blood-deficiency generating restlessness, discomfort, confusion, spitting sticky saliva, groaning/wrong speech. Tongue bottom crimson, thin white coating, rough to touch. Pulse right Cun floating-slippery, left Cun pulsing. Urgently moisten fluids/clear saliva, promote collateral Qi, Wu Zhi Yi Zhi Jian clear-moisten. Severe: Shaoyin disease, dry mouth/throat, epigastric pain, abdominal fullness/constipation, or spontaneous diarrhea clear-water, pure green color foul smell. Tongue deep red, black-dry-thick coating. Pulse right deep-rapid-solid, left fine-tough-rapid-pulsing. This is Shaoyin pathogen transforming via Fire, combining with Yangming Dryness to form Lower Excess. Method: urgently purge to preserve Yin, Da Cheng Qi Tang plus Xi Jiao (1 qian), Xian Sheng Di (1 liang) to violently purge. Critical: Shaoyin disease, heat sinking causing confusion, sleeping/drunk-like, delirium/laughing, even mute like corpse, 6-7 to 10+ days, no stool, abdomen hot/burning, urine dark-scanty/dropping, pulse deep-wiry-choppy, firm-hard on pressure, left small-rapid-tough-pulsing. This is Shaoyin Minor Fire becoming Major Fire, merging with Yangming Dry-Heat to form Lower Excess. Urgently open-drain and purge,泻 blazing evil-fire to save nearly exhausted True Yin, Xi Lian Cheng Qi Tang plus Xi Huang (0.5 fen), She Xiang (0.05 fen) for emergency rescue.
(6) Jueyin-Yangming. Mild, severe, critical. Mild: Person has chronic Liver Qi, Cold Damage for 6-7 days, heat sinks inward, Qi hits Heart, heart pain/heat, vomiting yellow-green-bitter fluid, chest-diaphragm oppression, Qi rebellion/panting, slight limb cold, abdominal fullness/constipation. Tongue edge purple, yellow-turbid coating. Pulse right slippery, left wiry-rapid. This is Jueyin Qi-binding combining with Yangming Heat-binding to form Lower Excess. Zhongjing says "Jueyin should be purged." Method: bitter-acrid unblocking-descending, descending Qi/dispersing knots, Liu Mo Yin Zi removing Mu Xiang, adding Guang Yu Jin (3 qian, ground juice). Severe: Heat sinks deeper, limbs cold, nails purple-red, chest-hypochondriac oppression/fullness, confusion/delirium, excessive thirst/aversion to heat, profuse sweat/mental restlessness, dry-stool constipation, dark-scanty-painful urination. Tongue coating old yellow, even black points/prickles. Pulse right slippery-large-restless, left wiry-tough-rapid-pulsing. This is Jueyin Fire-hyperactivity combining with Yangming Heat-binding to form Lower Excess. Zhongjing says "Wiry pulse with cold limbs means deep heat." Method: clear-dryness/purge-fire, disperse-knots/release-heat, Si Ni San is too slow, Bai Hu Cheng Qi Tang plus Guang Yu Jin (3 qian, ground juice mixed) to moisten-purge. If accompanied by lower abdomen attacking pain, vomiting acid/bitter, drugs ineffective, use Xue Geng combined with Geng Yi Wan (wrapped decoction, 1.5-2 qian, very severe 3 qian), achieving remarkable results. Critical: Deep heat/deep cold, chest/abdomen burning, hands/feet only cold. Severe: like epilepsy, intermittent spasms, confused/coma, daily sleepiness, or delirium/groaning, cyanotic face, head shaking/jaw trembling, suddenly sitting up, unable to vomit/diarrhea, severe abdominal colic, furrowed brows/grinding teeth, unbearable pain, both bowels/bladder closed. Tongue purple-crimson, grey-greasy-blue coating. Six pulses deep-fine-rapid-pulsing, even hidden. This is Jueyin constrained fire deeply hiding in Liver blood collaterals, not revealing in major channels, penetrating directly to intestines/stomach to erupt externally. Often dies from Qi closure/choking instantly. Treatment: first puncture key acupoints to bleed (Shao Shang, Zhong Chong, sublingual purple veins, Qu Chi, Wei Zhong, etc.) to open-drain blood toxicity, then pour Zi Xue (0.5 fen), Pin Fei Long Duo Ming Dan (0.02 fen) to open clear-orifices and penetrate latent pathogen. If pathogen penetrates/toxin drains, pulse rises and quickens, but Liver Wind not extinguished, consciousness fluctuates, bowels/bladder blocked, tongue curled/testicle retracted, lower abdomen hot/pain intolerable, urgently use Xi Lian Cheng Qi Tang with Ling Jiao (1.5 qian), Jiang Xue (0.02 fen) etc., cool-unblocking and aromatic-penetrating. May save one in ten.
Above, Tai/Shao and Yangming combined diseases are explicit in Zhongjing. Three Yin and Yangming combined diseases are not explicitly pointed out in Zhongjing's *Shanghan Lun*, but careful reading shows such syndromes exist. Clinical verification shows they are common. I have marked symptoms, pulse/tongue, treatment methods, and formulas to supplement Zhongjing's original text. From Qibo's meaning of "Middle Yin flowing into Fu organs," I realized that when Three Yin are full, pathogen cannot reside; pathogen-righteous struggle returns and merges into Stomach organ to form Lower Excess.
Regarding Jaundice and Blood Stasis, these are common variations of Yangming. The most difficult to treat are Bad Diseases where Yangming required purging but failed, leading to strong pathogen and weak righteousness. First discussing Jaundice. Yangming disease, fever/sweating, heat escapes via sweat, cannot cause jaundice. Only head sweating, body no sweat, stopping at neck, dysuria, thirst for drinks, slight abdominal fullness, body must become jaundiced. Bright yellow like orange peel, even golden face/eyes, occasionally vomiting yellow juice, even mental restlessness or heat-pain, dark-yellow turbid urine. Tongue coating yellow-greasy, rough with prickles. Pulse right slippery-rapid, left wiry-stagnant. This is stasis-heat inside, heat unable to escape, forming Yang Jaundice. Mild: clear-promote urination as Sovereign, sweep yellow fluid as Assistant, Yin Chen Hao Tang (Yin Chen 1 liang, water 5 bowls, boil to 4 bowls, divide twice, Jiao Zhi Zi 14 pieces, Jiu Chao Sheng Chuan Jun 1 qian, make 1 bowl to drink), mix with Fan Liu Wan (Lv Fan 1 liang, Wo Liu Huang 1 qian, Mai Fen 3 liang, Hei Zao Rou 2 liang, pound/mix/pill, take 0.3-0.5 fen per dose), let yellow go via urine. Urine like soapberry juice, true red color, abdomen reduces overnight. Severe: sweep yellow fluid as Sovereign, clear-promote urination as Assistant, Zhi Zi Da Huang Tang (Jiao Zhi Zi 3 qian, Jiu Chao Sheng Chuan Jun 1.5 qian, Xiao Zhi Shi 1 qian, Dan Xiang Chi 1.5 qian), mix with Fan Liu Wan, let yellow go via stool. Resolve foul stool and cure. Only if color/form is orange-dry like smoke-burnt, it is Yang Jaundice death syndrome. Untreatable.
Next discussing Blood Stasis. Person has chronic blood stasis in epigastrium/abdomen, pathogen transmits to Yangming, combats Stomach dry-heat, blocks clear orifices of Spirit/Qi entry/exit, suddenly head shaking/eye staring, agitation wanting to go mad, even Blood Syncope, finger twitching. After cold resolves, epigastrium/abdomen string-pain, body heavy cannot turn, stool hard but bowel movement easy and black, urination normal. Tongue purple-dark, smooth-moist to touch. Pulse right deep-knotted, left wiry-tight-forceful. This is stasis-heat inside, *Neijing* says "Blood Stasis below, person like..."