狂是也。轻则凉血化瘀。犀角地黄汤（犀角片一钱、鲜生地一两、丹皮二钱、赤芍二钱。
）加光桃仁（三钱）、广郁金（三钱）、白薇（五钱）、归须（二钱）、青糖（一钱）
、拌炒活 虫（五只）等清消之。重则破血逐瘀。桃仁承气汤急攻之。极重用抵当汤
去虻虫。（光桃仁二十颗、酒醋炒生川军二钱、盐炒水蛭三支研细）。加夜明砂（三钱包
煎）、蜜炙延胡（钱半）、炒穿甲（一钱）、杜牛膝（四钱）、麝香（五厘冲）等峻攻之。
若夫邪实正虚。应下失下。不下必死。下之或可望生者。其证有四。（一）气虚甚
而邪实者。气短息促。四末微冷。大便至十余日不通。矢气频转腹满不舒。躁则惕而不
安。手足螈 。静则独语如见鬼。循衣摸床。舌淡红。苔前中截娇嫩而薄。后根灰腻而
腐。脉寸虽微。两尺沉部反坚。此仲景所谓微涩者里虚。最为难治。不可更与承气汤也
。法当培元养正。参草姜枣汤。别直参三钱、炙粉草一钱、鲜生姜五分、大红枣四枚、
提补之。外用蜜煎导而通之。用好蜜煎成膏子、一二时许、将皂荚麝香细辛三厘研末
、和蜜捻成条子、放入肛门中、其便即通。（二）阴亏甚而邪实者。口干舌燥。心烦不
寐。便闭已十余日。频转矢气。液枯肠燥。欲下不下。舌前半绛嫩。后根黑腻。脉细而
涩。此景岳所谓便虽不通。必不可用硝黄。而势有不得不通者。宜用通于补之剂也。法
当滋阴润肠。张氏济川煎润利之。或用吴氏六成汤。熟地五钱、淡苁蓉三钱、当归二
钱、天冬麦冬白芍各一钱、使其津液流通。自能润下。（三）气血两亏而邪实者。证本
应下。耽误失下。邪火壅闭。耗气烁血。以致循衣摸床。撮空理线。两目斜视。昏谵妄
笑。便闭已十余日。甚或有数十日不通。舌苔干黄起刺。根
带黑色。脉右弦涩。左细数。两尺细坚而搏。证虽气消血枯。而邪热独存。补之则邪
火愈甚。攻之则气血不胜。补泻不能。两无生理。然与其坐以待毙。莫若含药而亡。勉
用陶氏黄龙汤。或可回生于万一。（四）精神衰弱而邪实者。应下失下。邪热未除。静
则郑声重语。喃喃不休。躁则惊惕不安。心神昏乱。妄笑妄哭。如见神灵。大便不通。
溺赤涓滴。舌苔黄刺干涩。脉两寸陷下。关尺细坚而结。此由邪盛正虚。神明被迫。故
多瞀乱之象也。急急大补阴气以提神。幽香开窍以清心。复脉汤调下妙香丸。（辰砂三
钱巴霜一钱、冰麝西黄腻粉各三分、金箔五小张、另研极细、入黄蜡三钱、白蜜一匙、
同炼匀和药为丸、每一两作三十丸、弱者二三丸、壮者四五丸、大便通、即止服。）标本兼顾。庶可挽救于什一。
（戊）邪热传入厥阴经证。一身筋挛。寒热类疟。热重寒轻。头痛胁疼。耳聋目
赤。轻则但指头冷。重则手足乍温乍冷。胸满而痛。舌紫苔黄。脉左弦滑。此阳经热邪
。传入足厥阴经标病也。法当清泄肝热。清肝达郁汤主之。或用四逆散（川柴胡八分、
生枳壳钱半。生白芍钱半、生甘草五分）。加制香附（二钱）、小川连（八分）、霜桑
叶（二钱）、童桑枝（二尺、切寸酒炒）、广郁金（磨汁两匙冲）等疏通之。
（己）邪热传入厥阴脏证。口苦消渴。气上冲心。心中疼热。饥不欲食。食则吐
蛔。或泄利下重。虽泄不爽。或便脓血。或溺血赤淋。舌紫赤脉弦数。此阳经热邪。传
入足厥阴脏本病也。法当大泻肝火。龙胆泻肝汤去柴胡加白头翁（三钱）、胡连（一钱
）主之。若火旺生风。风助火势。头晕目眩。胸胁胀痛。四肢厥冷。烦闷躁扰。甚则手
足螈 。状如痫厥。便泄不爽。溺赤涩痛。舌焦紫起刺。脉弦而劲。此肝风上翔。邪陷
包络。厥深热亦深也。法当熄风开
窍。羚角钩藤汤加紫雪（五分或八分）急救之。若吐蛔而昏厥者。此为蛔厥。厥回则卧
起不安。脘疼烦躁。头摇手痉。面目乍赤乍白乍黑。甚则面青目瞪。口流涎沫者。此为
虫痉。舌绛而碎。生黄白点。点小如粞。或舌苔现槟榔纹。隐隐有点。脉乍数乍疏。忽
隐忽现。此胃肠灼热如沸。蛔动扰乱之危候也。小儿最多。妇人亦有。速投连梅安蛔汤
。调下妙香丸。清肝驱虫以救之。羚角钩藤汤。不可与也。
以上少阳、阳明、厥阴、三经腑脏变证。皆伤寒邪从火化之传变也。
（庚）太阳表证未罢。顺传阳明。表热里寒。肌肉烦疼。头身无汗。但手足
然汗出。下利清谷。小便不利。舌苔白滑浮涨。脉浮而迟。此仲景所谓胃中虚冷。水谷
不别故也。先以桂枝橘皮汤解其表。表解。即以香砂二陈汤温其里。里温。则水气化而
小便利。下利自止。终以白术和中汤。温脾和胃而痊。
（辛）太阳表寒虽解。而阳明中有水气。胃中寒。不能食。食谷欲呕。饮水即
哕。脘腹满。小便难。大便自利。甚则吐水肢厥。下利完谷不止。舌苔淡白。白滑而嫩
。脉沉弦而迟。此由胃阳素虚。猝为表寒所侵。触动里结之水气。累及脾阳不能健运也
。呕多者。先与吴茱萸汤。（淡吴萸一钱、米炒潞党参钱半、生姜二钱、大红枣四枚）
。止其呕。利多者。与胃苓汤。温中化水。水气化则小便利。下利自止。继以香砂理中
汤。温健脾阳。升发胃气。其病即愈。
（壬）邪传太阴经证。体痛肢懈。手足微厥。肌肉烦疼。午后寒热。头胀身重
。胸脘痞满嗌干口腻。舌苔白腻浮滑。甚则灰腻满布。脉右濡滞。此太阳经邪。越传足
太阴经标病也。法当芳淡温化。藿香正气汤主之。若湿流肌肉。发为阴黄。黄而昏暗
。如熏黄色。而无烦渴热象者。前方送下矾硫丸。燥湿除疸以退之。
（癸）邪传太阴脏证。口淡胃钝。呕吐清水。大腹痞满。满而时痛。自利不渴
。渴不喜饮。小便短少色白。甚则肢厥自汗。神倦气怯。舌苔黑滑。粘腻浮胖。或白带
黑纹而粘腻。脉沉濡无力。甚则沉微似伏。此太阳寒邪。直入足太阴脏证也。法当温健
脾阳。香砂理中汤主之。重则热壮脾肾。附子理中汤主之。
【荣斋按】何廉臣先生说∶“寒伤太阴，必其人脾阳素弱，故邪即直入阴经，对症
处方，附子理中汤固属正治，最好加姜、桂、椒、萸，善止寒吐冷痛”。
（子）太阳寒邪。内陷少阴经证。初起发热身痛。而头不痛。惟腰脊堕痛。痛
如被杖。大便不实。小便清白。恶风怕冷。神静倦卧。四肢微急。舌苔淡红而润。或白
而胖嫩。脉沉而缓。此太阳未解。少阴先溃。必其人肾阳素虚。故邪从太阳中络直入足
少阴肾经也。温调营卫为君。佐以扶阳。桂枝加附子汤治之。服药后。即啜热稀粥以微
汗之。仍假太阳为出路者。以少阴与太阳为表里。故发热即可发汗。微汗出。即止服。
仲景麻附细辛峻汗法。究嫌冒险。不可轻与。若脉沉紧。反发热。手足冷。是少阴合太阳之
表邪。为中见寒水实证。可与麻附甘草汤。（麻黄五分、淡附片八分、炙甘草五分）微
发其汗。即愈。若服药后。汗不出。反自下利。手足转温。脉紧去而转暴微者。为少阴
病欲解也。其寒水不从表出。反从下泄。暂虽发烦。下利必自愈。
（丑）太阳寒邪。内陷少阴脏证。上吐下利。恶寒蜷卧。但欲寐。或微烦。身重
痛。口中和。手足冷。小便白。舌苔白滑胖嫩。脉沉弱。甚则沉微欲绝。此仲景所谓下焦
虚寒。不能制水故也。先以附子理中汤。加肉挂（五分）、云苓（六钱）壮肾阳以化水气
。服药后。吐利止而手足转温。或时自烦。欲去衣被者。水去而阳气回复也。可治。若
下利虽止。反自汗大出。筋惕肉 。目眩心悸。振振欲擗地者。下多伤阴。孤阳从外而
亡也。急与真武汤回阳摄阴。若下
利既止。而头目晕眩。时时自冒。痰涌喘息。两足冰冷者。下多阴竭。孤阳从上而脱也
。急与新加八味地黄汤。镇元纳阳。此二者。皆邪传少阴。生死出入之危候也。故仲景
原论。少阴独见死证。
以上阳明。太阴。少阴。三经腑脏变证。皆伤寒邪从水化之传变也。
（寅）凡阳经表邪。传入太阴。往往脾湿与胃热相兼。其证有四（一）湿重于热。
头胀身重。寒热如疟。汗出胸痞。肢懈体痛。渴不引饮。口腻胃滞。便溏或泻。小便不
利。舌苔白滑浓腻。甚或灰腻满布。脉右弦细而缓。或沉弦而濡滞。此由其人中气素虚
。故太阴证多而阳明证少也。辛淡温化为君。佐以芳透。藿香正气汤。或大橘皮汤。二
方酌用之（二）热重于湿。始虽恶寒。后但热不寒。目黄而赤。唇焦齿燥。耳聋脘
闷。胸腹灼热。午后尤重。心烦恶热。大便热泻。溲短赤涩。舌苔黄腻带灰。中见黑点
。脉右洪数。甚或大坚而长。此由其人中气素实。故阳明证多而太阴证少也。苦降辛通
为君。佐以凉淡。增减黄连泻心汤清解之。若始虽便泻。继即便闭。舌起芒刺者。加更
衣丸（钱半至二钱）极苦泄热。其便即通。若因循而失清失下。神昏谵语。手足发痉。
甚则昏厥。舌苔黄黑糙刺。中见红点。脉右沉数。左弦数者。此由湿热化火。火旺生风
。逼乱神明之危候也。急与犀连承气汤加羚角（二钱）、紫雪（五分）开泄下夺以拯之
。服后。大便虽通。发痉虽除。而神识昏厥如尸。手足躁扰。身热不扬。脉似沉缓。甚则
沉伏。但舌仍灰黑。红点隐隐。此热陷太阴。防有伏 内发。郁于阴络之中而欲达不达也
。急与犀羚三汁饮加大青叶（五钱）凉血解毒。通络透 。果能伏 外达。自然毒透神
清。（三）湿热并重。一起即胸膈烦闷。神识瞀乱。大叫腹痛。继即昏不知人。欲
吐不吐。欲泻不泻。身发壮热。指冷甲紫。舌苔中黄尖红。甚则灰腻满布。中见红点黑
刺。脉
两寸陷下。关尺沉弦而涩。此湿遏热郁。夹痧秽。或夹食滞。阻闭中上二焦。俗称闷痧。
实即湿热夹痧食之干霍乱也。必先搠痧放血（如刺少商中冲、舌下紫筋、尺泽、委中
等穴）。继即与涌吐法。炒盐汤（食盐五钱、炒黄泡汤）。调下白矾（二钱至三钱、
生研细）。又次宣畅气机。连翘栀豉汤。调下红灵丹。（一分或二分）、终与枳实导滞
汤缓下之。此就势急者言之。若病势稍缓者。壮热口渴。饮多则呕。心烦脘闷。反复颠
倒。卧起不安。四肢倦怠。肌肉烦疼。大便溏热。溺短赤涩。甚则两目欲闭。神昏谵语
。舌苔黄腻。或灰腻兼黄点。脉右洪数。左弦滞。此湿热蒙闭中上二焦。积滞郁结下焦
也。法当三焦分消。先与连翘栀豉汤开其上。继与增减黄连泻心汤疏其中。终与枳实导
滞汤逐其下。或用大橘皮汤。去苍术官桂。加茵陈（三钱）、贯众（四钱）、利其溺。
以整肃湿热。其病自愈。（四）湿热俱轻。身热自汗。胸脘微闷。知饥不食。口腻
微渴。渴不喜饮。便溏溺热。舌苔黄白相兼。薄而粘腻。脉右滞。左微数。此湿热阻滞
上焦清阳。胃气不舒。肠热不清之轻证也。但用轻清芳淡法。苇茎汤去桃仁、活水芦根
五钱、生苡仁四钱、冬瓜子四钱、加藿香叶（二钱）、佩兰叶（钱半）、枇杷叶（
去毛筋、炒香、三钱）、淡竹叶（钱半）、青箬叶（三钱）等。宣畅气机。整肃三焦。
自然肺胃清降。湿热去而胃开矣。
（卯）邪传少阴脏证。当分手足二经。手少阴心主热气。中含君火。足少阴肾主
生阳。中藏寒水。其证有三。
（一）水为火烁。心烦不寐。肌肤枯燥。神气衰弱。咽干溺短。舌红尖绛。脉左细
数。按之搏指。右反大而虚软。此外邪挟火而动。阴虚而水液不能上济也。治宜壮水制
火。阿胶黄连汤主之。“荣斋按。少阴伤寒。有传经直中之分。直中者多从水化。浅则如
麻黄附子细辛汤症。重则如四逆汤症。传经者多从火化（即本段现证）因津枯热炽。
以黄连阿胶汤泻南补北。确是治病必求其本的方法。”若兼下利咽痛。胸满烦闷者。此
水液为虚火下迫。郁热下注而不能上升也。治宜育阴煦气。猪肤汤（净猪肤、即猪肉皮刮
净脂膏一两、净白蜜五钱、炒米粉三钱、用水三碗、煎猪肤成两碗、去渣调入蜜粉
、和匀温分四服）。加茄楠香汁（开水磨汁四匙、分四次冲）。主之。若兼神昏谵语
。溲短赤热者。此君火被相火蒸逼。水不制火而神明内乱。陶节庵所谓过经不解是也。
治宜清火利水。导赤清心汤主之。若兼筋脉拘挛。手足螈 者。此水亏火亢。液涸动风
。缪仲淳所谓内虚暗风是也。治宜滋阴熄风。阿胶鸡子黄汤主之。（二）火为水遏。四
肢厥逆。干咳心悸。便泄溺涩。腹痛下重。舌苔白而底绛。脉左沉弦而滑。右弦急。此
阳气内郁。不得外达。水气上冲而下注也。治宜达郁通阳。加味四逆散（川柴胡八分、
炒枳实一钱、生白芍一钱。清炙草八分、干姜五分拌捣北五味三分、桂枝尖五分、浙茯
苓四钱、烧酒洗捣干薤白五枚、淡附片五分、用水两碗、煎成一碗、去渣温服）。主之。
（三）水火互结。下利口渴。小便不利。咳逆干呕。心烦不得眠。舌本绛而苔白薄。脉
这就是狂证。病情较轻的，采用凉血化瘀的方法。用犀角地黄汤（犀角片一钱、鲜生地一两、牡丹皮二钱、赤芍药二钱）加入光桃仁（三钱）、广郁金（三钱）、白薇（五钱）、当归须（二钱）、青糖（一钱）、拌炒活地鳖虫（五只）等药物，以清热消瘀。病情较重的，采用破血逐瘀的方法。用桃仁承气汤急攻之。极重者重用抵当汤，去掉虻虫。（光桃仁二十颗、酒醋炒生大黄二钱、盐炒水蛭三支研细），加入夜明砂（三钱包煎）、蜜炙延胡索（钱半）、炒穿山甲（一钱）、杜牛膝（四钱）、麝香（五厘冲服）等峻猛药物攻逐。
如果是邪气实而正气虚，应当使用下法却延误了时机未能及时攻下，如果不攻下必然死亡，如果攻下或许还有一线生机。这种情况有四种证候：
（一）气虚严重而邪气实。表现为气短呼吸急促，四肢末端微冷，大便十余日不通，频繁转矢气，腹部胀满不适。躁动时惊恐不安，手足抽搐；安静时独自说话，如见鬼状，循衣摸床。舌质淡红，苔在前中部娇嫩而薄，后根部灰腻且腐。脉象寸部虽微弱，但两尺部沉取反而坚硬。这是张仲景所说的“微涩”属于里虚，最为难治，不可再用承气汤。治法应当培补元气，滋养正气。用参草姜枣汤提补（别直参三钱、炙甘草一钱、鲜生姜五分、大红枣四枚）。外用蜜煎导法通便。用好蜂蜜煎成膏状，约一小时左右，将皂荚、麝香、细辛三厘研末，与蜜混合捻成条状，放入肛门中，大便即可通畅。
（二）阴液亏损严重而邪气实。表现为口干舌燥，心烦失眠，便秘已十余日，频繁转矢气，津液枯竭肠道干燥，想下而不能下。舌前半部绛嫩，后根部黑腻。脉细而涩。这是张景岳所说的“虽然便秘，绝不可用硝黄（芒硝、大黄），但形势上不得不通”，适宜使用通补兼施的方剂。治法应当滋阴润肠。用张氏济川煎滋润利便。或者用吴氏六成汤（熟地黄五钱、淡苁蓉三钱、当归二钱、天冬麦冬白芍各一钱），使津液流通，自然能润下。
（三）气血两亏而邪气实。证候本应攻下，因耽误失下，邪火壅闭，耗气烁血，导致循衣摸床，撮空理线，两眼斜视，昏谵妄笑，便秘已十余日，甚至有数十日不通。舌苔干黄起刺，根部带黑色。脉右弦涩，左细数，两尺细坚而搏指。证候虽然气消血枯，但邪热独存。补益则邪火更甚，攻伐则气血不胜任，补泻两难，毫无生机。然而与其坐以待毙，不如服药而死。勉强使用陶氏黄龙汤，或许能在万分之中挽回生命。
（四）精神衰弱而邪气实。应当攻下却延误失下，邪热未除。安静时郑声重语，喃喃不休；躁动时惊惕不安，心神昏乱，妄笑妄哭，如见神灵。大便不通，小便赤涩点滴难出。舌苔黄刺干涩，脉两寸陷下，关尺细坚而结。这是由于邪盛正虚，神明被迫，所以多有昏乱之象。急急大补阴气以提神，用幽香开窍以清心。用复脉汤调服妙香丸。（辰砂三钱、巴霜一钱、冰片麝香西黄腻粉各三分、金箔五小张，另研极细，入黄蜡三钱、白蜜一匙，同炼匀和药为丸，每一两作三十丸，体弱者二三丸，壮者四五丸，大便通即停服。）标本兼顾，或许能挽救十分之一。
（戊）邪热传入厥阴经证。全身筋脉拘挛，寒热像疟疾一样，热重寒轻，头痛胁痛，耳聋目赤。轻则仅指尖冷，重则手足乍温乍冷，胸满而痛。舌紫苔黄，脉左弦滑。这是阳经热邪传入足厥阴经的标病。治法应当清泄肝热。主方用清肝达郁汤。或者用四逆散（川柴胡八分、生枳壳钱半、生白芍钱半、生甘草五分），加入制香附（二钱）、小川连（八分）、霜桑叶（二钱）、童桑枝（二尺，切寸，酒炒）、广郁金（磨汁两匙冲服）等疏通之。
（己）邪热传入厥阴脏证。口苦消渴，气上冲心，心中疼热，饥饿但不欲食，食则吐蛔，或者泄利下重，虽然腹泻但不爽快，或者便脓血，或者尿血赤淋。舌紫赤，脉弦数。这是阳经热邪传入足厥阴脏的本病。治法应当大泻肝火。主方用龙胆泻肝汤去掉柴胡，加入白头翁（三钱）、胡黄连（一钱）。如果火旺生风，风助火势，头晕目眩，胸胁胀痛，四肢厥冷，烦闷躁扰，甚至手足抽搐，状如痫厥，便泄不爽，尿赤涩痛，舌焦紫起刺，脉弦而劲。这是肝风上翔，邪陷包络，厥深热亦深。治法应当熄风开窍。主方用羚角钩藤汤加紫雪（五分或八分）急救。如果吐蛔而昏厥，这叫蛔厥。厥回则卧起不安，脘腹疼痛烦躁，头摇手痉，面目乍赤乍白乍黑，甚至面青目瞪，口流涎沫，这叫虫痉。舌绛而碎，生黄白点，点小如米，或者舌苔现槟榔纹，隐隐有点，脉乍数乍疏，忽隐忽现。这是胃肠灼热如沸，蛔虫动扰乱的危险征候。小儿最多，妇人也有。速投连梅安蛔汤，调服妙香丸，清肝驱虫以救之。此时不可用羚角钩藤汤。
以上少阳、阳明、厥阴三经腑脏变证，都是伤寒邪气从火化传变的结果。
（庚）太阳表证未罢，顺传阳明。表热里寒，肌肉烦疼，头身无汗，只有手足濈然汗出，下利清谷，小便不利。舌苔白滑浮涨，脉浮而迟。这是张仲景所说的胃中虚冷，水谷不分所致。先用桂枝橘皮汤解其表。表解后，即用香砂二陈汤温其里。里温后，水气化而小便利，下利自止。最后用白术和中汤，温脾和胃而痊愈。
（辛）太阳表寒虽解，而阳明中有水气，胃中寒，不能食，食谷欲呕，饮水即哕，脘腹满，小便难，大便自利，甚至吐水肢厥，下利完谷不止。舌苔淡白，白滑而嫩，脉沉弦而迟。这是由于胃阳素虚，猝被表寒所侵，触动里结之水气，累及脾阳不能健运。呕吐多的，先给吴茱萸汤（淡吴茱萸一钱、米炒潞党参钱半、生姜二钱、大红枣四枚），止其呕。腹泻多的，给胃苓汤，温中化水，水气化则小便利，下利自止。继以香砂理中汤，温健脾阳，升发胃气，病即愈。
（壬）邪传太阴经证。身体疼痛肢体懈怠，手足微厥，肌肉烦疼，午后寒热，头胀身重，胸脘痞满咽干口腻。舌苔白腻浮滑，甚至灰腻满布。脉右濡滞。这是太阳经邪越传足太阴经的标病。治法应当芳淡温化。主方用藿香正气汤。如果湿流肌肉，发为阴黄，黄色昏暗，如熏黄色，而无烦渴热象的，前方送下矾硫丸，燥湿除疸以退黄。
（癸）邪传太阴脏证。口淡胃钝，呕吐清水，大腹痞满，满而时痛，自利不渴，渴不喜饮，小便短少色白，甚至肢厥自汗，神倦气怯。舌苔黑滑，粘腻浮胖，或白带黑纹而粘腻，脉沉濡无力，甚至沉微似伏。这是太阳寒邪直入足太阴脏证。治法应当温健脾阳。主方用香砂理中汤。重者热壮脾肾，主方用附子理中汤。
【荣斋按】何廉臣先生说：“寒伤太阴，必其人脾阳素弱，故邪即直入阴经，对症处方，附子理中汤固属正治，最好加姜、桂、椒、萸，善止寒吐冷痛”。
（子）太阳寒邪内陷少阴经证。初起发热身痛，但头不痛，只有腰脊堕痛，痛如被杖，大便不实，小便清白，恶风怕冷，神静倦卧，四肢微急。舌苔淡红而润，或白而胖嫩，脉沉而缓。这是太阳未解，少阴先溃，必其人肾阳素虚，故邪从太阳中络直入足少阴肾经。以温调营卫为主，佐以扶阳。用桂枝加附子汤治疗。服药后，即喝热稀粥以微汗之，仍借太阳为出路，因为少阴与太阳为表里，故发热即可发汗，微汗出即停服。张仲景麻黄附子细辛汤峻汗法，终究嫌冒险，不可轻用。如果脉沉紧，反发热，手足冷，是少阴合太阳之表邪，为中见寒水实证，可与麻黄附子甘草汤（麻黄五分、淡附片八分、炙甘草五分）微发其汗，即愈。如果服药后，汗不出，反自下利，手足转温，脉紧去而转暴微者，为少阴病欲解也。其寒水不从表出，反从下泄，暂虽发烦，下利必自愈。
（丑）太阳寒邪内陷少阴脏证。上吐下利，恶寒蜷卧，但欲寐，或微烦，身重痛，口中和，手足冷，小便白。舌苔白滑胖嫩，脉沉弱，甚至沉微欲绝。这是张仲景所谓下焦虚寒，不能制水所致。先用附子理中汤，加肉桂（五分）、云茯苓（六钱）壮肾阳以化水气。服药后，吐利止而手足转温，或时自烦，欲去衣被者，是水去而阳气回复也，可治。如果下利虽止，反自汗大出，筋惕肉瞤，目眩心悸，振振欲擗地者，是下多伤阴，孤阳从外而亡也。急与真武汤回阳摄阴。如果下利既止，而头目晕眩，时时自冒，痰涌喘息，两足冰冷者，是下多阴竭，孤阳从上而脱也。急与新加八味地黄汤，镇元纳阳。此二者，都是邪传少阴，生死出入的危候。所以张仲景原论，少阴独见死证。
以上阳明、太阴、少阴三经腑脏变证，都是伤寒邪气从水化传变的结果。
（寅）凡阳经表邪传入太阴，往往脾湿与胃热相兼，其证有四：
（一）湿重于热。头胀身重，寒热如疟，汗出胸痞，肢懈体痛，渴不引饮，口腻胃滞，便溏或泻，小便不利。舌苔白滑浓腻，甚或灰腻满布。脉右弦细而缓，或沉弦而濡滞。这是由其人中气素虚，故太阴证多而阳明证少。以辛淡温化为君，佐以芳透。用藿香正气汤，或大橘皮汤，二方酌用之。
（二）热重于湿。开始虽恶寒，后来但热不寒，目黄而赤，唇焦齿燥，耳聋脘闷，胸腹灼热，午后尤重，心烦恶热，大便热泻，溲短赤涩。舌苔黄腻带灰，中见黑点。脉右洪数，甚或大坚而长。这是由其人中气素实，故阳明证多而太阴证少。以苦降辛通为君，佐以凉淡。用增减黄连泻心汤清解之。如果开始虽便泻，继即便闭，舌起芒刺者，加更衣丸（钱半至二钱）极苦泄热，其便即通。如果因循而失清失下，神昏谵语，手足发痉，甚至昏厥，舌苔黄黑糙刺，中见红点，脉右沉数，左弦数者，这是由湿热化火，火旺生风，逼乱神明之危候。急与犀连承气汤加羚角（二钱）、紫雪（五分）开泄下夺以拯之。服后，大便虽通，发痉虽除，而神识昏厥如尸，手足躁扰，身热不扬，脉似沉缓，甚至沉伏，但舌仍灰黑，红点隐隐，这是热陷太阴，防有伏邪内发，郁于阴络之中而欲达不达。急与犀羚三汁饮加大青叶（五钱）凉血解毒，通络透邪。果能伏邪外达，自然毒透神清。
（三）湿热并重。一起即胸膈烦闷，神识瞀乱，大叫腹痛，继即昏不知人，欲吐不吐，欲泻不泻，身发壮热，指冷甲紫，舌苔中黄尖红，甚则灰腻满布，中见红点黑刺，脉两寸陷下，关尺沉弦而涩。这是湿遏热郁，夹痧秽，或夹食滞，阻闭中上二焦，俗称闷痧，实即湿热夹痧食之干霍乱。必先搠痧放血（如刺少商、中冲、舌下紫筋、尺泽、委中等穴），继即与涌吐法，炒盐汤（食盐五钱、炒黄泡汤），调下白矾（二钱至三钱，生研细）。又次宣畅气机，连翘栀豉汤，调下红灵丹（一分或二分），终与枳实导滞汤缓下之。此就势急者言之。如果病势稍缓者，壮热口渴，饮多则呕，心烦脘闷，反复颠倒，卧起不安，四肢倦怠，肌肉烦疼，大便溏热，溺短赤涩，甚至两目欲闭，神昏谵语，舌苔黄腻，或灰腻兼黄点，脉右洪数，左弦滞。这是湿热蒙闭中上二焦，积滞郁结下焦。治法当三焦分消。先与连翘栀豉汤开其上，继与增减黄连泻心汤疏其中，终与枳实导滞汤逐其下。或者用大橘皮汤，去苍术官桂，加茵陈（三钱）、贯众（四钱），利其溺，以整肃湿热，其病自愈。
（四）湿热俱轻。身热自汗，胸脘微闷，知饥不食，口腻微渴，渴不喜饮，便溏溺热，舌苔黄白相兼，薄而粘腻，脉右滞，左微数。这是湿热阻滞上焦清阳，胃气不舒，肠热不清之轻证。只用轻清芳淡法。苇茎汤去桃仁，加活水芦根五钱、生苡仁四钱、冬瓜子四钱、加藿香叶（二钱）、佩兰叶（钱半）、枇杷叶（去毛筋，炒香，三钱）、淡竹叶（钱半）、青箬叶（三钱）等，宣畅气机，整肃三焦，自然肺胃清降，湿热去而胃开矣。
（卯）邪传少阴脏证，当分手足二经。手少阴心主热气，中含君火；足少阴肾主生阳，中藏寒水。其证有三：
（一）水为火烁。心烦不寐，肌肤枯燥，神气衰弱，咽干溺短，舌红尖绛，脉左细数，按之搏指，右反大而虚软。这是外邪挟火而动，阴虚而水液不能上济。治宜壮水制火。主方用阿胶黄连汤。“荣斋按：少阴伤寒，有传经直中之分。直中者多从水化，浅则如麻黄附子细辛汤症，重则如四逆汤症。传经者多从火化（即本段现证），因津枯热炽，以黄连阿胶汤泻南补北，确是治病必求其本的方法。”如果兼下利咽痛，胸满烦闷者，这是水液为虚火下迫，郁热下注而不能上升。治宜育阴煦气。主方用猪肤汤（净猪肤，即猪肉皮刮净脂膏一两，净白蜜五钱，炒米粉三钱，用水三碗，煎猪肤成两碗，去渣调入蜜粉，和匀温分四服），加茄楠香汁（开水磨汁四匙，分四次冲）。如果兼神昏谵语，溲短赤热者，这是君火被相火蒸逼，水不制火而神明内乱，陶节庵所谓过经不解。治宜清火利水。主方用导赤清心汤。如果兼筋脉拘挛，手足抽搐者，这是水亏火亢，液涸动风，缪仲淳所谓内虚暗风。治宜滋阴熄风。主方用阿胶鸡子黄汤。
（二）火为水遏。四肢厥逆，干咳心悸，便泄溺涩，腹痛下重，舌苔白而底绛，脉左沉弦而滑，右弦急。这是阳气内郁，不得外达，水气上冲而下注。治宜达郁通阳。主方用加味四逆散（川柴胡八分、炒枳实一钱、生白芍一钱、清炙草八分、干姜五分拌捣北五味三分、桂枝尖五分、浙茯苓四钱、烧酒洗捣干薤白五枚、淡附片五分，用水两碗，煎成一碗，去渣温服）。
This is the syndrome of mania. For mild cases, employ blood-cooling and stasis-resolving methods. Use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) [Rhino-cornis Cornu, *Shui Niu Jiao*] (1 qian Rhinoceros Horn slices, 1 liang fresh Shengdi Huang, 2 qian Mu Dan Pi, 2 qian Chi Shao Yao), added with Guang Tao Ren (3 qian), Guang Yu Jin (3 qian), Bai Wei (5 qian), Gui Xu (2 qian), Qing Tang (1 qian), and Ban Chao Huo Di Die Chong (5 whole insects) to clear heat and resolve stasis. For severe cases, employ blood-breaking and stasis-expelling methods. Use Tao Ren Cheng Qi Tang to attack urgently. For extreme cases, use Di Dang Tang in heavy dosage, removing Meng Chong. (20 Guang Tao Ren seeds, 2 qian raw Da Huang stir-fried with wine and vinegar, 3 dried Leeches salt-stir-fried and finely ground), added with Ye Ming Sha (wrapped in cloth, 3 qian decocted), Mi Zhi Yan Hu Suo (1.5 qian), Chao Chuan Shan Jia (1 qian), Du Niu Xi (4 qian), and She Xiang (5 li granules taken with water) for a fierce attack.
If there is excess pathogen and deficiency of healthy qi, purgation should have been used but was delayed; failure to purge leads to death, while purging may offer a chance of survival. There are four such presentations:
(1) Severe Qi deficiency with excess pathogen. Symptoms include shortness of breath and rapid respiration, slight coldness in the four extremities, constipation for over ten days, frequent passage of flatus, abdominal fullness and discomfort. When restless, there is palpitations and anxiety; when quiet, the patient speaks alone as if seeing ghosts, picks at clothes, and gropes at the bed. The tongue is pale red, with coating tender and thin in the anterior and middle parts, but grey, greasy, and rotting at the root. The pulse is faint in the Cun position, but firm upon deep pressure in both Chi positions. This corresponds to Zhang Zhongjing’s description of "faint and choppy" indicating interior deficiency, which is extremely difficult to treat. Cheng Qi Tang must not be used again. The method should be to nourish the origin and support righteous qi. Use Shen Cao Jiang Zao Tang for supplementation (3 qian Bie Zhi Ren, 1 qian Zhi Gan Cao, 0.5 fen fresh Sheng Jiang, 4 large Hong Zao). Externally, use honey suppositories to promote bowel movement. Prepare good honey into a paste; after about an hour, mix 3 li powder of Zao Jia, She Xiang, and Xi Xin with honey, roll into strips, and insert into the anus to induce defecation.
(2) Severe Yin fluid depletion with excess pathogen. Symptoms include dry mouth and tongue, irritability and insomnia, constipation for over ten days, frequent passage of flatus, dry intestines due to fluid exhaustion, desire to purge but inability to do so. The anterior half of the tongue is crimson and tender, the root is black and greasy. The pulse is fine and choppy. This aligns with Zhang Jingyue’s statement that although constipation exists, Xiao and Huang (Mang Xiao and Da Huang) must absolutely not be used, yet the situation necessitates unblocking; thus, tonifying purgatives are suitable. The method is to nourish Yin and moisten the intestines. Use Zhang Shi Ji Chuan Jian to moisten and promote flow, or Wu Shi Liu Cheng Tang (5 qian Shu Di Huang, 3 qian Dan Cong Rong, 2 qian Dang Gui, 1 qian each of Tian Dong, Mai Dong, and Bai Shao) to facilitate fluid circulation, allowing natural lubrication and downward movement.
(3) Deficiency of both Qi and Blood with excess pathogen. The condition originally required purgation, but delay led to stagnation of pathogenic fire, consuming Qi and scorching Blood, resulting in picking at clothes, grasping at empty air, squinting eyes, delirious laughter, constipation for over ten days, or even decades. The tongue coating is dry yellow with prickles, black at the root. The pulse is wiry-choppy on the right, fine-rapid on the left, and fine-firm-beating in both Chi positions. Although Qi is exhausted and Blood is dried, pathogenic heat remains. Tonification exacerbates fire, while purgation overwhelms the deficient Qi and Blood, leaving no room for either approach, rendering the prognosis hopeless. However, rather than waiting passively for death, it is better to take medicine before dying. Tentatively use Tao Shi Huang Long Tang, which might save one in ten thousand.
(4) Mental-spiritual weakness with excess pathogen. Purgation was delayed, leaving pathogenic heat unresolved. When quiet, the patient murmurs repeatedly (Zheng Sheng); when restless, they are startled and uneasy, with chaotic spirit, delirious laughter and crying, as if seeing spirits. Constipation and scanty dark urine. Tongue coating is yellow-prickly and dry; pulse is sunken in both Cun, fine-firm-knotted in Guan and Chi. This results from excess pathogen and deficiency of righteous qi forcing the spirit, causing confusion. Urgently tonify Yin to refresh the spirit and use aromatic orifices-opening herbs to clear the heart. Administer Fu Mai Tang to guide Miao Xiang Wan. (Miao Xiang Wan ingredients: 3 qian Chen Sha, 1 qian Ba Shuang, 3 fen each Bing Pian, She Xiang, Xi Huang, Ni Fen, 5 small sheets of Jin Bo, all finely ground separately, mixed with 3 qian Huang La and 1 spoon of Bai Mi, refined together into pills; 30 pills per liang; weak patients take 2-3 pills, strong patients 4-5 pills; stop when stool passes.) Addressing both root and branch may salvage one in ten.
(Wu) Pathogenic heat transmitting to the Jueyin Meridian syndrome. Generalized tendon spasms, alternating chills and fever resembling malaria, heat heavier than chills, headache and hypochondriac pain, deafness, red eyes. Mild cases show only cold fingertips; severe cases show intermittent warmth and coldness in hands and feet, chest fullness and pain. Tongue is purple with yellow coating; pulse is wiry-slipping on the left. This is Yang meridian heat pathogen transmitting to the exterior aspect of the Foot Jueyin Liver Meridian. The method is to clear and drain Liver heat. Main formula: Qing Gan Da Yu Tang. Alternatively, Si Ni San (0.8 fen Chai Hu, 1.5 qian Sheng Zhi Ke, 1.5 qian Sheng Bai Shao, 0.5 fen Sheng Gan Cao), added with Zhi Xiang Fu (2 qian), Xiao Chuan Lian (0.8 fen), Shuang Sang Ye (2 qian), Tong Sang Zhi (2 chi, cut into inches, wine-stir-fried), and Guang Yu Jin (2 spoons juice, taken with water) to unblock and dredge.
(Ji) Pathogenic heat transmitting to the Jueyin Organ syndrome. Bitter taste, excessive thirst, Qi rushing up to the heart, painful heat in the epigastrium, hunger without desire to eat, vomiting roundworms upon eating, or dysentery with heaviness in the rectum despite incomplete evacuation, or bloody stools, or hematuria with dark dysuria. Tongue is purple-crimson, pulse is wiry-rapid. This is Yang meridian heat pathogen transmitting to the interior aspect of the Foot Jueyin Liver Organ. The method is to severely drain Liver fire. Main formula: Long Dan Xie Gan Tang, remove Chai Hu, add Bai Tou Weng (3 qian) and Hu Lian (1 qian). If fire generates wind, aiding the fire, symptoms include dizziness, vertigo, chest and hypochondriac distending pain, cold limbs, irritability and restlessness, even limb convulsions resembling epilepsy, incomplete evacuation, dark painful urination, scorched purple tongue with prickles, wiry-taut pulse. This is Liver wind rising, pathogen trapping the Pericardium, deep Jueyin with deep heat. The method is to extinguish wind and open the orifices. Main formula: Ling Jiao Gou Teng Tang added with Zi Xue (0.5 or 0.8 fen) for emergency rescue. If vomiting worms with syncope occurs, this is Hui Jue (Roundworm Syncope). After syncope resolves, restlessness in lying and sitting, epigastric pain and irritability, head shaking and hand spasms, alternating red-white-black face, cyanotic face, fixed eyes, and drooling indicate Chong Jing (Worm Spasm). Tongue is crimson and cracked with yellow-white spots like rice grains, or betel-nut patterned coating with hidden spots. Pulse is intermittently rapid-thready, hidden-visible. This indicates boiling heat in stomach and intestines with disturbing roundworms, a critical sign. Most common in children, also seen in women. Quickly administer Lian Mei An Hui Tang guided by Miao Xiang Wan to clear Liver, expel parasites, and rescue. Ling Jiao Gou Teng Tang is contraindicated here.
The above variations of Shaoyang, Yangming, and Jueyin meridians/organs are all transmissions where Shaoyang pathogens transform via Fire.
(Geng) Taiyang exterior syndrome not yet resolved, smoothly transmitting to Yangming. Exterior heat with interior cold, vexing pain in muscles, head and body without sweat, but sweating on hands and feet, diarrhea with undigested food, difficulty urinating. Tongue coating is white-slippery and swollen; pulse is floating and slow. This is Zhang Zhongjing’s description of cold deficiency in the Stomach causing indistinct separation of water and grain. First use Gui Zhi Ju Pi Tang to release the exterior. Once released, use Xiang Sha Er Chen Tang to warm the interior. Once warmed, water transforms, urination improves, and diarrhea stops. Finally, use Bai Zhu He Zhong Tang to warm Spleen and harmonize Stomach for recovery.
(Xin) Taiyang exterior cold has resolved, but water qi remains in Yangming. Cold in Stomach prevents eating; eating induces retching; drinking water causes hiccups. Epigastric/abdominal fullness, difficulty urinating, spontaneous loose stools, even vomiting water and cold limbs, continuous diarrhea with undigested food. Tongue coating is pale white, slippery and tender; pulse is deep-wiry-slow. This is due to inherent Stomach Yang deficiency invaded by sudden exterior cold, stirring internal water accumulation affecting Spleen Yang transport. For frequent vomiting, first give Wu Zhu Yu Tang (1 qian Dan Wu Zhu Yu, 1.5 qian Mi Chao Lu Dang Shen, 2 qian Sheng Jiang, 4 Hong Zao) to stop vomiting. For frequent diarrhea, give Wei Ling Tang to warm middle and transform water; once water transforms, urination improves, diarrhea stops. Follow with Xiang Sha Li Zhong Tang to warm and strengthen Spleen Yang and ascend Stomach Qi for cure.
(Ren) Pathogen transmitting to Taiyin Meridian syndrome. Body ache, limb flaccidity, slight coldness in hands/feet, vexing muscle pain, afternoon chills/fever, head distension, heavy body, chest/epigastric stuffiness, dry throat, greasy mouth. Tongue coating is white-greasy-slippery, even grey-greasy covering entire surface. Pulse is right Ru-zhi. This is Taiyang pathogen transmitting to the exterior aspect of Foot Taiyin Spleen Meridian. Method: Aromatic-light warm transformation. Main formula: Huo Xiang Zheng Qi Tang. If dampness flows into muscles causing Yin Jaundice (dark yellow like smoked color, without vexation/thirst/heat signs), send down Fan Liu Wan with the previous formula to dry dampness and remove jaundice.
(Gui) Pathogen transmitting to Taiyin Organ syndrome. Pale taste, dull Stomach, vomiting clear fluid, large abdomen fullness/pain, spontaneous diarrhea without thirst, or thirst without desire to drink, scanty white urine, even cold limbs and spontaneous sweating, mental fatigue and Qi timidity. Tongue coating is black-slippery, sticky-swollen, or white with black veins sticky. Pulse is deep-Ru-weak, even deep-micro-like-hidden. This is Taiyang cold pathogen directly entering Foot Taiyin Spleen Organ. Method: Warm and strengthen Spleen Yang. Main formula: Xiang Sha Li Zhong Tang. For severe cases involving Heat blazing Spleen/Kidney, main formula: Fu Zi Li Zhong Tang.
[Rongzhai Note]: Mr. He Lianchen said: "Cold injuring Taiyin requires inherent Spleen Yang weakness, so pathogen enters Yin meridians directly. Prescribing according to syndrome, Fu Zi Li Zhong Tang is correct treatment, best added with Sheng Jiang, Gui Zhi, Hua Jiao, Wu Zhu Yu to effectively stop cold vomiting and pain."
(Zi) Taiyang cold pathogen sinking into Shaoyin Meridian syndrome. Initial fever and body pain, but no headache, only low back/spine soreness feeling like being beaten, loose stools, clear/white urine, aversion to wind/cold, quiet lethargy, slight stiffness in limbs. Tongue coating is pale-red moist, or white-swollen-tender. Pulse is deep-slow. This is Taiyang unresolved, Shaoyin collapsing first, due to inherent Kidney Yang deficiency, pathogen entering Foot Shaoyin Kidney Meridian directly from Taiyang collaterals. Main strategy: Warm and regulate Ying-Wei, assisted by supporting Yang. Treat with Gui Zhi Jia Fu Zi Tang. After taking medicine, drink hot thin porridge to induce slight sweating, still using Taiyang as exit since Shaoyin and Taiyang are exterior-interior. Fever allows sweating; stop medication after slight sweat. Zhang Zhongjing’s Ma Huang Fu Zi Xi Xin Tang harsh sweating method is risky and should not be used lightly. If pulse is deep-tight, with fever and cold limbs, this is Shaoyin combining Taiyang exterior pathogen, presenting as Cold-Water Excess. Give Ma Huang Fu Zi Gan Cao Tang (0.5 fen Ma Huang, 0.8 fen Dan Fu Pian, 0.5 fen Zhi Gan Cao) to slightly sweat for cure. If after medicine, no sweat but spontaneous diarrhea, warming limbs, pulse tightness disappearing turning suddenly micro, this is Shaoyin disease resolving. Cold-water exiting downwards instead of exterior; temporary irritability will resolve with diarrhea.
(Chou) Taiyang cold pathogen sinking into Shaoyin Organ syndrome. Vomiting and diarrhea, aversion to cold, curling up, desire to sleep, or slight irritability, heavy body pain, neutral mouth, cold limbs, white urine. Tongue coating is white-slippery-swollen-tender. Pulse is deep-weak, even deep-micro-desperate. This is Zhang Zhongjing’s lower Jiao deficiency-cold failing to control water. First use Fu Zi Li Zhong Tang added with Rou Gui (0.5 fen) and Fu Ling (6 qian) to strengthen Kidney Yang and transform water qi. After medicine, vomiting/diarrhea stop, limbs warm, or occasional irritability wanting to remove covers, indicating water gone and Yang recovering; treatable. If diarrhea stops but spontaneous profuse sweating occurs, muscle twitching, vertigo, palpitations, trembling wanting to fall to ground, this is excessive diarrhea injuring Yin, solitary Yang escaping externally. Urgently give Zhen Wu Tang to return Yang and secure Yin. If diarrhea stops but vertigo/dizziness, frequent faintness, phlegm surging, panting, cold feet occur, this is excessive diarrhea exhausting Yin, solitary Yang escaping upwards. Urgently give Xin Jia Ba Wei Di Huang Tang to anchor Yuan and absorb Yang. These two are critical Shaoyin transmission signs of life/death. Hence Zhang Zhongjing’s original text shows Shaoyin having unique death syndromes.
The above Yangming, Taiyin, Shaoyin meridian/organ variations are all transmissions where Shaoyang pathogens transform via Water.
(Yin) Generally, Yang meridian exterior pathogens transmitting to Taiyin often combine Spleen Dampness and Stomach Heat. Four presentations:
(1) Dampness heavier than Heat. Head distension, heavy body, malaria-like chills/fever, sweating with chest stuffiness, limb flaccidity/body ache, thirst without desire to drink, greasy mouth/stomach stagnation, loose stools or diarrhea, difficulty urinating. Tongue coating is white-slippy-thick-greasy, even grey-greasy covering surface. Pulse is right-wiry-fine-slow, or deep-wiry-Ru-zhi. This is due to inherent Middle Qi deficiency, hence more Taiyin than Yangming signs. Strategy: Acrid-light warm transformation as main, assisted by aromatic penetrating. Use Huo Xiang Zheng Qi Tang or Da Ju Pi Tang, choosing between them.
(2) Heat heavier than Dampness. Initially aversion to cold, later only heat without cold, yellow/red eyes, dry lips/teeth, deafness/epigastric stuffiness, burning chest/abdomen, worse in afternoon, irritability/aversion to heat, hot diarrhea, short-dark-acrid urine. Tongue coating is yellow-greasy-grey with black dots. Pulse is right-Hong-shu, even large-firm-long. This is due to inherent robust Middle Qi, hence more Yangming than Taiyin signs. Strategy: Bitter-descending acrid-unblocking as main, assisted by cool-light. Use Zeng Jian Huang Lian Xie Xin Tang to clear and resolve. If initially loose stools then constipation with tongue prickles, add Geng Yi Wan (1.5-2 qian) bitter heat-draining to通便. If neglecting clearing/purging leads to coma/delirium, limb spasms, even syncope, yellow-black rough-spiky tongue coating with red dots, right-deep-numerous/left-wiry-numerous pulse, this is Damp-Heat transforming to Fire, Fire generating Wind, disturbing Spirit critically. Urgently give Xi Lian Cheng Qi Tang added with Ling Jiao (2 qian) and Zi Xue (0.5 fen) to open/draining/purging for rescue. After taking, if stool passes and spasms cease but consciousness remains corpse-like, restless limbs, latent fever, pulse seemingly slow-deep-even hidden, but tongue remains grey-black with hidden red dots, this is Heat sinking into Taiyin, preventing latent pathogen emergence, stagnating in Yin collaterals desiring to emerge but unable. Urgently give Xi Ling San Zhi Yin added with Da Qing Ye (5 qian) to cool-blood detoxify, unblock collaterals, and vent pathogen. If latent pathogen emerges externally, naturally toxin clears and spirit refreshes.
(3) Dampness and Heat equal. Immediately chest-diaphragm vexation, confused spirit, loud screaming abdominal pain, then unconsciousness, desire to vomit but cannot, desire to defecate but cannot, high fever, cold fingers/purple nails, tongue center yellow tip crimson, even grey-greasy covering with red/black prickles, pulse Cun sunken, Guan-Chi deep-wiry-choppy. This is Damp suppressing Heat, complicated by Sha/Toxins or Food Stagnation, blocking Upper/Middle Jiao, commonly called Men Sha, actually Dry Huoluan complicated by Damp-Heat/Sha/Food. First perform Sha puncture bleeding (e.g., Shao Shang, Zhong Chong, sublingual purple veins, Chi Ze, Wei Zhong points). Then use emetic method: Fried Salt Soup (5 qian Salt, fried yellow, soaked), guiding Bai Fan (2-3 qian raw-ground) to vomit. Next, smooth Qi mechanism: Lian Qiao Zhi Chi Tang guiding Hong Ling Dan (0.1-0.2 fen). Finally, Zhi Shi Dao Zhi Tang gentle purgation. This addresses urgent cases. For slower progression: high fever/thirst, vomiting after drinking much, irritability/epigastric stuffiness, tossing/restlessness, limb fatigue, vexing muscle pain, hot loose stools, short-dark-acrid urine, even closing eyes, coma/delirium, yellow-greasy or grey-greasy-yellow-dotted tongue, right-Hong-shu/left-wiry-zhi pulse. This is Damp-Heat misting Upper/Middle Jiao, accumulation stagnating Lower Jiao. Strategy: Three-Jiao separate elimination. First Lian Qiao Zhi Chi Tang opening upper, then Zeng Jian Huang Lian Xie Xin Tang smoothing middle, finally Zhi Shi Dao Zhi Tang purging lower. Or Da Ju Pi Tang removing Cang Zhu/Gui Zhi, adding Yin Chen (3 qian) and Guan Zhong (4 qian) to promote urination, regulating Damp-Heat for self-healing.
(4) Dampness and Heat both light. Fever with spontaneous sweating, slight chest/epigastric stuffiness, knowing hunger but not eating, greasy mouth/mild thirst, thirst without desire to drink, loose stools/hot urine, yellow-white mixed thin-sticky tongue coating, right-zhi/left-micro-numerous pulse. This is Damp-Heat blocking Upper Jiao Clear Yang, Stomach Qi not舒展, Intestine Heat not clear, a mild case. Use only light-clear aromatic-light method. Wei Jing Tang remove Tao Ren, add Huo Shui Lu Gen (5 qian), Sheng Yi Ren (4 qian), Dong Gua Zi (4 qian), Huo Xiang Ye (2 qian), Pei Lan Ye (1.5 qian), Pi Pa Ye (de-husk/vein, fried-aromatic, 3 qian), Dan Zhu Ye (1.5 qian), Qing Ruo Ye (3 qian) etc. to smooth Qi, regulate Three Jiao, naturally Lung/Stomach descend, Damp-Heat leaves, Stomach opens.
(Mao) Pathogen transmitting to Shaoyin Organ syndrome, distinguishing Hand/Foot meridians. Hand Shaoyin Heart Master governs Heat Qi containing Jun Fire; Foot Shaoyin Kidney governs Sheng Yang storing Han Water. Three presentations:
(1) Water scorched by Fire. Vexation/insomnia, dry skin, weak spirit, dry throat/scant urine, red tongue tip crimson, left pulse fine-rapid beating finger, right pulse large-void-soft. This is external pathogen carrying fire moving, Yin deficiency failing to send fluids upward. Strategy: Strengthen Water to control Fire. Main formula: E Jiao Huang Lian Tang. [Rongzhai Note: Shaoyin Shanghan has transmitted vs direct invasion. Direct invasion mostly transforms via Water, shallow like Ma Huang Fu Zi Xi Xin Tang, severe like Si Ni Tang. Transmitted mostly transforms via Fire (current syndrome). Due to fluid exhaustion/intense heat, Huang Lian E Jiao Tang draining South supplementing North is indeed treating the root.] If accompanied by diarrhea/sore throat, chest fullness/vexation, this is fluids forced downward by deficiency fire, stagnant heat pouring down unable to rise. Strategy: Nourish Yin warm Qi. Main formula: Zhu Fu Tang (clean pig skin scraping fat 1 liang, clean Bai Mi 5 qian, fried rice flour 3 qian, 3 bowls water, boil skin to 2 bowls, strain, mix honey/flour, warm divide 4 doses), added with Qie Nan Xiang juice (4 spoons water-grind, divide 4 doses). If accompanied by coma/delirium, short-dark-hot urine, this is Jun Fire steamed by Xiang Fire, Water failing to control Fire, Spirit internally chaotic, Tao Jie’an’s "passing meridians unresolved". Strategy: Clear fire promote water. Main formula: Dao Qi Qing Xin Tang. If accompanied by tendon spasms/limb convulsions, this is Water deficiency Fire hyperactivity, fluid exhaustion generating wind, Miao Zhongchun’s "internal deficiency dark wind". Strategy: Nourish Yin extinguish wind. Main formula: E Jiao Ji Zi Huang Tang.
(2) Fire suppressed by Water. Cold limbs, dry cough/palpitations, loose stools/acrid urine, abdominal pain/heaviness, white tongue coating with crimson base, left pulse deep-wiry-slipping, right pulse wiry-urgent. This is Yang Qi internally depressed unable to reach exterior, Water Qi rushing up and pouring down. Strategy: Unblock depression conduct Yang. Main formula: Jia Wei Si Ni San (0.8 fen Chai Hu, 1 qian Chao Zhi Shi, 1 qian Sheng Bai Shao, 0.8 fen Qing Zhi Gan Cao, 0.5 fen Gan Jiang stir-pounded with 0.3 fen Bei Wu Wei Zi, 0.5 fen Gui Zhi Jian, 4 qian Zhe Fu Ling, 5 dried Xie Bai washed in wine/pounded, 0.5 fen Dan Fu Pian, 2 bowls water, boil to 1 bowl, strain warm drink).
(3) Water and Fire mutually binding. Diarrhea/thirst, difficulty urinating, cough/reverse dry heaving, vexation/insomnia, crimson tongue base with thin white coating, pulse