（论一首证三条方十二首）
论曰。百合病者。百脉一宗。悉致其病也。意欲食。复不能食。常默默然。欲卧不能卧。
欲行不能行。饮食或有美时。或有不用。闻食臭时。如寒无寒。如热无热。口苦。小便
赤。诸药不能治。得药则剧吐利。如有神灵者。身形如和。其脉微数。每溺时头痛者。
六十日乃愈。若溺时头不痛。淅然者。四十日愈。若溺快然。但头眩者。二十日愈。其
证或未病而预见。或病四五日而出。或病二十日。或一月微见者。各随证治之。
百合病。发汗后者。百合知母汤主之。
百合知母汤方
百合（七枚擘） 知母（三钱切）
上先以水洗百合渍一宿。当白沫出。去其水。更以泉水二升。煎取一升。去滓。别
以泉水二升煎知母。取一升。去滓。后合和煎。取一升五合。分温再服。
百合病下之后者。滑石代赭汤主之。
滑石代赭汤方
百合（七枚擘） 滑石（三两碎绵裹） 代赭石（如弹丸大一枚碎绵裹）
上先以水洗百合。渍一宿。当白沫出。去其水。更以泉水二升。煎取一升。去滓。别
以泉水二升。煎滑石、代赭取一升。去滓。后合和。重煎。取一升五合。分温服。
百合病吐之后者。百合鸡子汤主之。
百合鸡子汤方
百合（七枚擘） 鸡子黄（一枚）
上先以水洗百合。渍一宿。当白沫出。去其水。更以泉水二升。煎取一升。去滓。内
鸡子黄搅匀。煎五分。温服。
百合病。不经吐下发汗。病形如初者。百合地黄汤主之。
百合地黄汤方
百合（七枚擘） 生地黄（一升）
上以水洗百合渍一宿。当白沫出。去其水。更以泉水二升。煎取一升。去滓。内地
黄汁。煎取一升五合。分温再服。中病。勿更服。大便常如漆。
百合病。一月不解。变成渴者。百合洗方主之。
百合洗方
上以百合一升。以水一斗。渍之一宿。以洗身。洗已。食煮饼。勿以盐豉也。
百合病。渴不瘥者。栝蒌牡蛎散主之。
栝蒌牡蛎散方
栝蒌根 牡蛎（熬等分）
上为细末。饮服方寸匕。日三服。
百合病。变发热者（一作发寒热）百合滑石散主之。
百合滑石散方
百合（一两炙） 滑石（三两）
上为散。饮服方寸匕。日三服。当微利者。止服。热则除。
〔衍义〕所谓百脉一宗。悉致其病者。然则经脉十二。络脉十五。此云百脉。果何脉
欤。盖脉者血之府。即是血行于脉。灌溉表里。联系俞会。遍布形体。言其百者。举
夫数之众多也。犹言百骸尔。且又脉之循行。与天地合度。应水漏百刻。是故脉
之流行者。各有定位。因之而为百脉亦宜矣。又何其一宗而悉致病耶。盖尽归
于手心主也。手心主者。主血主脉。而心又为火之主。心君也。君不用事而手心
主代之。由是手心主得专行一身阴血之生化。因号之为母气。百脉皆宗之。若
火淫则热。热蓄不散则积。积则毒生而伤其血。热毒之血流于脉。本因母气之
淫邪。是故百脉一宗。悉致其病也。考之内经。有解 证。与此百合证无少异。解
既属之热中无血。百合岂非亦是热中无血者乎。请试逐病论之。血属阴。阴
者肾水之所主。内经曰。肾虚则饥不欲食。故欲食复不能食也。阴虚者恶烦。所
以常默默也。卫气者。夜行阴则寐。今卫气因阴虚不得降。故欲卧而不得卧也。
足得血则能步。血既病。于是欲行不能行也。饮食者。由血气运化而后安。脾属
血而喜香。血时和则食美。时不和则闻食臭也。气阳而血阴。若气盛则热。气衰
则寒。今病在血。不干于气。所以虽如寒而无寒。虽如热而无热也。血气和合则
流通。不和则塞。塞则热。上热为口苦。下热为便赤也。药虽治病。然必藉胃气以
行之。若毒血在脾胃经络。而闭塞之。药虽入。亦莫行也。胃弱不安于药者。得药
则反剧吐利。有如鬼神之为祟也。病不在皮肉筋骨。则身如和。惟热在于血而
血虚。故脉微数也。脉之微数。阴之虚也。阴虚则肾虚。肾与膀胱为表里。肾虚则
膀胱不得引精于肾而亦虚。膀胱之使下入会阴。上至巅。为诸阳主气。今溺而
膀胱之脉。为气下泄。轻则不能举之于上而上虚。上虚则淅然。头眩重虚。气逆
上于巅。而为头痛。以此之轻重。则可知愈日之远近也。夫病有定所。则可言定
期。今以百脉之痛。流转无定处。故其证之发现。亦无定期。或未病而见。或数日
一月而见。用是以察其病之表里浅深。出见形状。如下文之阴阳见者。随证而
救之。故以所列方观之。日华子谓百合安心定胆。益志五脏。为能补阴也。治产
后血眩晕。为能去血中热也。除痞满。利大小便。为能导涤血之瘀塞也。而是证
用之为主。盖可见瘀积者矣。若汗之而失者。是涸其上焦津液。而上焦阳也。阳
宜体轻之药。故用知母佐以救之。知母泻火。生津液。润心肺。若下之而失者。则
损其阴。瘀血下积。而下焦阴也。阴宜镇重之剂。故用滑石、代赭佐以救之。滑石
开结利窍。代赭除脉中风痹瘀血。若吐而失者。则损上中二焦之血。用鸡子黄
补血。佐以救之。若不经吐下发汗。未有所治之失。病形得如初者。但佐之生地
黄汁。补血凉血。凉则热毒消。补则新血生。蕴积者行。而自大便出。如黑漆矣。其
一月不解。百脉壅塞。津液不化而成渴者。故用百合洗。则一身之脉。皆得通畅
而津液行。其渴自止。勿食盐豉。以味咸而凝血。且走之也。若渴不瘥。是中无津
液。则以栝蒌牡蛎主之。若变发热者。乃因脉塞郁而成热。以硝石通利。佐之滑
石性凉。又可治热血之积塞者。自微利而出。故热除矣。夫百合病。自见金匮要
略。后诸方书。皆不收。独朱奉议收之。谓伤寒变成斯疾。此乃病由之一端尔。窃
尝思之。是病多从心主。或因情欲不遂。或因离绝菀结。或忧惶煎迫。致二火郁
之所成。百脉既病。故百体皆不安。所以见不一之病状。自今观之。诸方书不收
百合病。乃有劳瘵之名。殆将以百合病与劳瘵同形状。或瘀血积于脉亦同。因
而不收。但并其方而弃之。深为可惜。于脉病救之二法遂不明于世矣。
百合病。见于阴者。以阳法救之。见于阳者。以阴法救之。见阳攻阴。复发其汗。此为
逆。见阴攻阳。乃复下之。此亦为逆。
〔衍义〕伤寒治法。有谓阳盛阴虚。汗之则死。下之则愈。阴盛阳虚。汗之则愈。下之
则死。今百合病。所云见于阴者。以阳法救之。见于阳者。以阴法救之。与伤寒之
语意。大同而小异。何则。在彼直言其盛。所以行汗下之法。此但言其见以救之。
则是无汗下之宜施。何以知其然。所叙百合病。皆持两端。欲卧不卧。欲食不食。
如寒无寒。如热无热。为其脉行表里之病。但当救之。非如伤寒阳气之变。见于
内外。必行汗下者也。设用伤寒法。见病在表辄汗。入里辄下。虽表里不逆。然亦伤之
。是以前条用方救之是也。其后所结汗下之逆者。为反表里汗下之逆者也。
狐惑之为病。状如伤寒。默默欲眠。目不得闭。卧起不安。蚀于喉为惑。蚀于阴为狐。
不欲饮食。恶闻食臭。其面目。乍黑乍赤乍白。蚀于上部则声喝。（一作嗄）甘草泻心汤主之。
甘草泻心汤方
甘草（四两） 黄芩 人参 干姜（各三两）
黄连（一两） 大枣（十二枚） 半夏（半升）
上七味。水一斗。煮取六升。去滓再煎。温服一升。日三服。
〔衍义〕狐惑病。谓虫蚀上下也。世谓风中有虫。凡虫自风生固矣。然风阳也。独阳
不生。必有所凭而后化。盖因湿热久停。蒸腐气血而成瘀浊。于是风化所腐为
虫矣。设风不由湿热。而从寒凉者。肃杀之气。纵然腐物。虫亦不化也。由是知此
病也。虫生于湿热败气瘀血之中。其来渐矣。遇极乃发。非若伤寒一日而暴病
者也。病发默默欲眠。目不得闭。卧起欠安者。皆五脏久受湿热。伤其阴精。卫不
内入。神不内宁故也。更不欲食。恶闻食臭者。仓廪之府伤也。其面乍赤乍黑乍
白者。由五脏不足。更为衰旺。迭见其色也。其虫者。从湿热之极。所发之处而蚀
之。蚀上部者。内损心肺。外伤咽喉。肺者气之主。咽喉声音之户。由是其声嗄矣。
故用甘草泻心汤主之。治其湿热。分利其阴阳。而黄连非惟治心脾热也。而亦
治虫。后世方论谓是证。或初得。状似伤寒。或因伤寒所变也。然皆虫证也。又谓
伤寒病。腹内热。饮食少。肠胃空虚。而虫不安。故随所食上下部。而病名孤惑也。
以此二或字观之。则非独伤寒变是证。凡热病皆得生虫也。
蚀于下部则咽干苦参汤洗之。
〔衍义〕虫蚀下部则咽干者。下部肾之所在。任脉附焉。肾、水也。湿热甚于下。则虫
蚀于上。而肾水受伤。经脉乏水以资之。挟湿热逆而燥其咽嗌。故用苦参汤洗。
苦参能除热毒。疗下部 。因以洗之。虽然。此治之外者尔。若究其源。病则自内
而外出。岂独治其标而已哉。试用上部服泻心汤者观之。则下部亦必有可服
之药。自下部用洗法者观之。则上部咽喉。亦必有可治之理。此仲景特互发之
尔。不然。何后世方论有服下部药者。与内食五脏者乎。
蚀于肛者。雄黄散熏之。
雄黄一味为末。筒瓦二枚合之。烧向肛熏之。
脉经云。病患或从呼吸。上蚀其咽。或从下焦。蚀其肛阴。蚀上为惑。蚀下为狐。狐
惑病者。猪苓散主之。
〔衍义〕蚀于肛。湿热在下。二阴虽皆主于肾。然肝脉循于肛。肛又为大肠之门户。
大肠、金也。湿热伤之。则木来侮。是以虫蚀于此焉。雄黄本主 疮杀虫。又有治
风之义。故用熏之。注引脉经猪苓散主之者。亦分别湿热尔。
病者脉数。无热微烦。默默但欲卧。汗出。初得之三四日。目赤如鸠眼。七八日目四
（一本此有黄字）黑。若能食者。脓已成也。赤小豆当归散主之。
赤小豆当归散方
赤小豆（三升浸令芽出曝干） 当归（十两）
上二味。杵为散。浆水服方寸匕。日三服。
〔衍义〕凡脉数则发热而烦。此热在血。不在荣卫。故不发热。但微烦尔。汗出者。以
血病不与卫和。血病则恶烦。故欲默。卫不和则阳陷。故欲卧。腠理因开而津液
泄也。三四日目赤如鸠眼者。热血循脉炎上。注见于目也。七八日四 黑者。其
血凝蓄。则色变成黑也。若能食脓已成者。湿热之邪散漫。则毒血流。伤其中和
之气不清。故不能食。若能食。可知其毒血已结成脓。胃气无扰。故能食也。用赤
豆、当归治者。其赤小豆能消热毒。散恶血。除烦排脓。补血脉。用之为君。当归补
血生新去陈为佐。浆水味酸。解热疗烦。入血为辅使也。
阳毒之为病。面赤斑斑如锦纹。咽喉痛。吐脓血。五日可治。七日不可治。升麻鳖甲
汤主之。
阴毒之为病。面目青。身痛如被杖。咽喉痛。五日可治。七日不可治。升麻鳖甲汤去雄黄、蜀椒主之。
升麻鳖甲汤方
升麻（二两） 当归（一两） 蜀椒（炒去汗一两） 甘草（二两） 鳖甲（手指大一片炙）
雄黄（半两研）
上六味。以水四升。煮取一升。顿服之。老小再服取汗。肘后千金方。阳毒用升麻
汤无鳖甲。有桂。阴毒用甘草汤。无雄黄。
〔衍义〕按古方书谓阳毒者。阳气独盛。阴气暴衰。内外皆阳。故成阳毒。谓阴毒者。
阴气独盛。阳气暴衰。内外皆阴。故成阴毒。二者或伤寒初得。便为是证。或服药
后变而成之。阳毒尽治以寒凉。阴毒尽治以温热。药剂如冰炭之异。何乃仲景
用一方治之乎。虽曰阴毒。去雄黄、蜀椒。则是反去其温热者矣。且注曰肘后千
金方。阳毒用升麻汤。无鳖甲。有桂。阴毒用甘草汤。无雄黄。岂非皆是热毒之伤
于阴阳二经络耶。在阳经络。则面赤斑斑如锦纹。吐脓血。在阴经络。则面青身
如被杖。此皆阴阳水火动静之本象如此。岂是寒热之邪乎。尝以升麻、鳖甲之
药考之。本草谓升麻能解时气毒厉。诸毒攻咽喉痛。与热毒成脓。开壅闭。疗发
斑。当归能破恶血。养新血。补五脏肌肤。甘草和中。利血脉。缓急止痛。调药奏功。
鳖甲去恶血。雄黄破骨节积聚。避鬼邪恶气。骨蒸热极。蜀椒通血脉。调关节。逐
肌骨皮肤死肌。去留结破血。治天行时气。诸药所能者如此。即此观之。仲景于
阴阳二毒之证。总用一方。盖可见矣。病形虽由阴阳发证。论邪则一属热毒与
血病也。所以不分表里。俱以升麻解热毒为君。当归和血为臣。余者佐之而已。
但雄黄、蜀椒。理阳气药也。故病在阴者去之。如肘后千金。阳毒去鳖甲有桂枝
者。鳖、水族。乃阴中之阳。不如桂枝能调阳络之血。阴毒不去蜀椒者。蜀椒亦阴
中之阳。非若雄黄阳中之阳。故留之以治阴也。方旨如此而已。所谓五日可治。
七日不可治者。五日乃土之生数。热未极也。尚可以治。七日为火之成数。热之
极。阴阳消灭。不可治矣。其邪比之伤寒。加之以毒。故伤寒至七日犹得再经。而
此至七日。不惟灭其阴。且火极亦自灭矣。
（本篇包含一篇论述、三个证候条文和十二首方剂）
论述说：百合病，是因为全身血脉同出一源，全部受到邪气侵袭而发病。患者想要进食，却又吃不下；常常沉默寡言；想要躺卧，却睡不安稳；想要行走，却无力前行。饮食有时觉得味道鲜美，有时又完全不想吃，甚至闻到食物的气味就感到不适。感觉像冷，其实并不冷；感觉像热，其实并不热。口苦，小便颜色深红。各种药物都不能治愈，服药后反而出现剧烈的呕吐和腹泻。症状好像有神灵作祟一样。身体外形看起来正常，脉象微数。每次排尿时如果头痛，六十天可以痊愈；如果排尿时头不痛，只是感到怕风发冷，四十天可以痊愈；如果排尿顺畅，只有头晕，二十天可以痊愈。这种病症，有的在没生病时就预先出现症状，有的在生病四五日后出现，有的生病二十日或一个月后才轻微显现。应当根据具体证候进行治疗。
百合病，经过发汗治疗后的，用百合知母汤主治。
百合知母汤方
百合（七枚，掰开） 知母（三钱，切片）
先将百合用水洗净，浸泡一夜，当水面出现白色泡沫时，倒掉水。再用泉水二升，煎取一升药液，去渣。另外用泉水二升煎煮知母，取一升药液，去渣。然后将两种药液混合在一起再煎，取一升五合药液，分两次温服。
百合病，经过攻下治疗后的，用滑石代赭汤主治。
滑石代赭汤方
百合（七枚，掰开） 滑石（三两，碎后用绵布包裹） 代赭石（如弹丸大小一枚，碎后用绵布包裹）
先将百合用水洗净，浸泡一夜，当水面出现白色泡沫时，倒掉水。再用泉水二升，煎取一升药液，去渣。另外用泉水二升，煎煮滑石和代赭石，取一升药液，去渣。然后将药液混合，再次煎煮，取一升五合药液，分次温服。
百合病，经过催吐治疗后的，用百合鸡子汤主治。
百合鸡子汤方
百合（七枚，掰开） 鸡蛋黄（一枚）
先将百合用水洗净，浸泡一夜，当水面出现白色泡沫时，倒掉水。再用泉水二升，煎取一升药液，去渣。加入鸡蛋黄搅匀，再煎至五分熟（约剩少量药液），温服。
百合病，没有经过催吐、攻下或发汗治疗，病情表现如初的，用百合地黄汤主治。
百合地黄汤方
百合（七枚，掰开） 生地黄（一升）
将百合用水洗净，浸泡一夜，当水面出现白色泡沫时，倒掉水。再用泉水二升，煎取一升药液，去渣。加入生地黄汁，煎取一升五合药液，分两次温服。见效后，不要继续服用。大便颜色常呈黑色如漆状。
百合病，一个月未愈，变成口渴的，用百合洗方主治。
百合洗方
用百合一升，加水一斗，浸泡一夜，用来洗浴身体。洗完之后，吃煮好的面条（煮饼），不要吃加盐豆豉的食物。
百合病，口渴没有好转的，用栝蒌牡蛎散主治。
栝蒌牡蛎散方
栝蒌根 牡蛎（煅制，等分）
将两味药研成细末，用米汤送服一方寸匕的药粉，每天服用三次。
百合病，出现发热症状的（一说为寒热往来），用百合滑石散主治。
百合滑石散方
百合（一两，炙） 滑石（三两）
将两味药研成散剂，用米汤送服一方寸匕的药粉，每天服用三次。如果出现轻微腹泻，就停止服用。热邪即可消除。
【衍义】所谓“百脉一宗，悉致其病”，那么经脉有十二条，络脉有十五条，这里说的“百脉”究竟是哪条脉呢？大概脉是血液汇聚的地方，也就是血液在脉中运行，灌溉表里，联系俞穴与会穴，遍布全身形体。说它是“百”，是列举数量众多之意，就像说“百骸”一样。况且脉的运行规律与天地相合，对应水漏计时的一百刻。因此脉的流行各有定位，称之为百脉也是适宜的。又怎么会因为同出一源而全部致病呢？大概都归属于手厥阴心包经（手心主）。手心主经，主管血液和脉道，而心又是火的主宰，是君主之官。君主如果不直接执政，由心包经代为行使职权。因此心包经得以专门主持全身阴血的生化，所以被称为“母气”。百脉都尊崇它。如果火邪过盛则产生热，热积聚不散则形成积滞，积滞久了则产生毒邪而损伤血液。含有热毒的血液流入脉中，原本是因为母气（心包/心）的淫邪所致。所以说百脉同出一源，全部受到侵害而发病。考证《内经》，其中有“解㑊”（jiě xiè，一种虚劳病证）的记载，与此处的百合病证几乎没有差异。“解㑊”属于热中无血，难道百合病也是热中无血吗？请试着逐条分析这个病证。血属阴，阴由肾水所主。《内经》说：“肾虚则饥不欲食”，所以患者想吃饭却又吃不下。阴虚的人厌恶烦扰，所以常常沉默不语。卫气夜间进入阴分则人入睡，现在因为阴虚导致卫气不能下降，所以想睡觉却睡不着。脚得到血液滋养才能行走，血液既已病变，所以想走却走不动。饮食需要依靠气血运化才能安和。脾属血且喜欢香气，血液调和时食物显得美味，血液不调和时闻到食物气味就会反感。气属阳，血属阴。如果气盛则热，气衰则寒。现在病在血分，不涉及气分，所以虽然感觉像冷但其实不冷，感觉像热但其实不热。血气和合则流通，不和则阻滞，阻滞则生热。上焦有热则口苦，下焦有热则小便赤红。药物虽然能治病，但必须依赖胃气来推动运行。如果毒血阻塞在脾胃经络，药物即使进入体内，也无法运行。胃气虚弱不安于受药，服药后反而加剧呕吐腹泻，好像鬼神作祟一样。病不在皮肉筋骨，所以身体外形看起来正常。只是因为热在血分且血虚，所以脉象微数。脉象微数，是阴虚的表现。阴虚则肾虚，肾与膀胱互为表里，肾虚则膀胱不能引精气归肾，膀胱也虚。膀胱之气下行入会阴，上行至头顶，是诸阳之主气。现在排尿时，膀胱之气随之下泄，轻则上部之气不能上升而导致上虚，上虚则感到怕风发冷（淅然）；头眩是重虚，气逆上冲至头顶，从而引起头痛。根据这些症状的轻重，就可以知道痊愈时间的远近。疾病如果有固定的部位，就可以预测固定的痊愈日期。现在因为百脉疼痛，流转没有固定位置，所以症状的出现也没有定期。或者在未病时先见症状，或者数日、一月后才见症状。用此来观察疾病的表里浅深，以及出现的形状，如下文所说的阴阳见证，随证救治。所以从所列出的方剂来看，日华子说百合能安心定胆，益志五脏，这是因为它能补阴。治疗产后血虚眩晕，是因为它能清除血中的热邪。消除痞满，通利大小便，是因为它能导涤血液的瘀塞。而这个证候以百合为主药，大概可以看出这是瘀积之证。如果误用发汗法而失误，这是耗竭了上焦的津液，而上焦属阳，阳宜用体轻的药物，所以用知母辅助来补救。知母能泻火，生津液，润心肺。如果误用攻下法而失误，则损伤了阴分，瘀血积聚在下焦，下焦属阴，阴宜用镇重的药剂，所以用滑石、代赭辅助来补救。滑石能开通结滞、利窍，代赭石能祛除脉中的风痹瘀血。如果误用催吐法而失误，则损伤了上、中二焦的血分，用鸡蛋黄补血，辅助来补救。如果没有经过催吐、攻下、发汗，也没有治疗上的失误，病情表现如初，只需辅以生地黄汁，补血凉血。凉则热毒消散，补则新血生成，蕴积之物得以运行，自然从大便排出，呈现黑漆状。如果一个月未愈，百脉壅塞，津液不化而成口渴，所以用百合洗浴，使一身之脉皆得通畅，津液运行，口渴自然停止。不要吃盐豉，因为咸味能凝血且走散津液。如果口渴不好转，是中焦缺乏津液，就用栝蒌牡蛎散主治。如果变成发热，是因为脉道堵塞郁结而成热，用硝石通利，配合性凉的滑石，又可治疗热血的积塞，通过轻微腹泻排出，热邪也就消除了。百合病，自从见于《金匮要略》后，后来的方书都不收录。只有朱奉议将其收录，认为这是伤寒转变而成的疾病，这只是病因的一个方面罢了。我私下思考，此病多从心主发生，或因情欲不遂，或因离别绝交郁结，或忧惶煎熬逼迫，导致二火郁结而成。百脉既然病变，所以百体都不安宁，因此出现不一的病状。从今看来，诸方书不收录百合病，却有“劳瘵”之名，大概是将百合病与劳瘵视为形状相似，或者瘀血积于脉的情况相同，因而不收录。但是连它的方剂也抛弃了，非常可惜，关于脉病救治的两种方法于是就不为人所知了。
百合病，表现为阴证特征的，用阳法来救治；表现为阳证特征的，用阴法来救治。见到阳证却攻伐阴分，又再次发汗，这是逆治。见到阴证却攻伐阳分，又再次攻下，这也是逆治。
【衍义】伤寒治法中，有说阳盛阴虚，发汗则死，攻下则愈；阴盛阳虚，发汗则愈，攻下则死。现在的百合病，所说的“见于阴者，以阳法救之；见于阳者，以阴法救之”，与伤寒的话意大同小异。为什么呢？在伤寒中直接说的是邪气盛衰，所以施行汗下之法。这里只是说根据表象来救治，这意味着不适合施用汗下法。怎么知道是这样呢？叙述的百合病症状，都是持两端的态度，想睡却不睡，想吃却不吃，像冷却不冷，像热却不热。这是因为病行于表里之间，只应当救治，不像伤寒阳气变化，见于内外，必须施行汗下法。假如使用伤寒治法，见病在表就发汗，入里就攻下，虽然表里不逆，但也会有损伤。所以前一条用方剂救治是正确的。后面总结的汗下之逆，是指反其道而行导致的逆治。
狐惑病，症状像伤寒，沉默想睡，眼睛却闭不上，坐卧不安。虫蚀咽喉称为“惑”，虫蚀前后阴称为“狐”。不想吃东西，厌恶闻到食物气味。面色一会儿发黑，一会儿发红，一会儿发白。虫蚀上部（咽喉）则声音嘶哑（一作嗄），用甘草泻心汤主治。
甘草泻心汤方
甘草（四两） 黄芩 人参 干姜（各三两）
黄连（一两） 大枣（十二枚） 半夏（半升）
以上七味药，加水一斗，煮取六升药液，去渣，再次煎煮。温服一升，每天服用三次。
【衍义】狐惑病，是说虫蚀上下部位。世人说风中有虫，凡虫自风生固然如此。然而风属阳，独阳不生，必须有所凭借而后化生。大概是因为湿热久停，蒸腐气血而成瘀浊，于是风化所腐之物化为虫。假设风不由湿热而来，而是从寒凉而来，肃杀之气纵然能使物体腐烂，虫也不会化生。由此可知此病，虫生于湿热败气瘀血之中，其来势缓慢，遇到极点才发作，不像伤寒那样一日之内暴病发作。病发时沉默想睡，眼睛闭不上，坐卧不安，这都是五脏长期受湿热伤害，损伤阴精，卫气不能内入，神气不能内宁的缘故。更不想吃东西，厌恶闻食物气味，是因为仓廪之府（脾胃）受伤。面色乍赤乍黑乍白，是因为五脏不足，盛衰交替，依次显现出不同颜色。那些虫，是从湿热极盛之处发出，侵蚀相应部位。侵蚀上部，内损心肺，外伤咽喉。肺是气的主宰，咽喉是声音的门户，因此声音嘶哑。所以用甘草泻心汤主治，治疗湿热，分利阴阳。而且黄连不仅治疗心脾热，也能杀虫。后世方论说此证，或初得时状似伤寒，或因伤寒转变而成。然而都是虫证。又说伤寒病，腹内热，饮食少，肠胃空虚，而虫不安，所以随着所食之物游走于上下部，病名孤惑。从这两个“或”字来看，则不仅仅是伤寒变为此证，凡是热病都能生虫。
虫蚀下部则咽干，用苦参汤清洗。
【衍义】虫蚀下部则咽干，下部是肾脏所在，任脉附着于此。肾属水，湿热甚于下部，则虫蚀上部，而肾水受伤，经脉缺乏水分滋润，挟带湿热逆上燥灼咽喉，所以用苦参汤清洗。苦参能除热毒，疗下部疮疡，因此用来清洗。虽然这是治其外部的办法，但如果追究根源，病则是从内向外发出的，岂止是治标而已呢？试用上部服用泻心汤的方法来看，下部也一定有可服用的药物。从下部用清洗法来看，上部咽喉也一定有可治疗的道理。这是张仲景特意互相阐发的方法。不然，为什么后世方论有服用下部药物的说法，以及与内伤五脏相关的论述呢？
虫蚀肛门者，用雄黄散熏蒸。
雄黄一味药研成末，用两片筒瓦合拢，烧向肛门熏蒸。
《脉经》说：病患有的从呼吸，上部侵蚀咽喉，有的从下焦，侵蚀肛门和外阴。侵蚀上部称为惑，侵蚀下部称为狐。狐惑病，用猪苓散主治。
【衍义】虫蚀肛门，湿热在下。二阴虽然都主于肾，但肝脉循行经过肛门，肛门又是大肠的门户。大肠属金，湿热损伤大肠，则木来侮金。因此虫在此处侵蚀。雄黄本来主治疮疡杀虫，又有治风的含义，所以用熏法。注释引用《脉经》说猪苓散主治，也是为了分别湿热。
患者脉数，无发热，轻微烦躁，沉默只想躺卧，出汗。刚得病三四天，眼睛发红像斑鸠的眼睛一样，七八天后眼四角发黑。如果能吃东西，说明脓已经形成了。用赤小豆当归散主治。
赤小豆当归散方
赤小豆（三升，浸泡令发芽，晒干） 当归（十两）
以上两味药，捣碎研成散剂，用浆水送服一方寸匕的药粉，每天服用三次。
【衍义】凡是脉数通常伴随发热和烦躁，这里的热在血分，不在营卫，所以不发热，只是轻微烦躁。出汗，是因为血病不与卫气调和，血病则恶烦，所以想沉默。卫气不和则阳气下陷，所以想躺卧。腠理因此开放，津液外泄。三四天眼睛发红像斑鸠眼睛，是热血循脉炎上，注视于目。七八天眼四角发黑，是血液凝蓄，颜色变成黑色。如果能吃东西，说明脓已成，湿热之邪散漫，毒血流散，损伤其中和气不清，所以不能吃东西。如果能吃东西，可知毒血已结成脓，胃气未被扰乱，所以能吃东西。用赤小豆、当归治疗，赤小豆能消热毒，散恶血，除烦排脓，补血脉，作为君药。当归补血生新去陈，作为佐药。浆水味酸，解热疗烦，入血为辅使药。
阳毒之为病，面部红赤，斑纹如锦缎花纹，咽喉痛，吐脓血。五天可以治疗，七天不可治疗。用升麻鳖甲汤主治。
阴毒之为病，面目青暗，身体痛如被棍棒打过，咽喉痛。五天可以治疗，七天不可治疗。用升麻鳖甲汤去掉雄黄、蜀椒主治。
升麻鳖甲汤方
升麻（二两） 当归（一两） 蜀椒（炒去汗，一两） 甘草（二两） 鳖甲（手指大一片，炙）
雄黄（半两，研）
以上六味药，加水四升，煮取一升，一次性服用。老人小孩再服一次，以出汗为度。《肘后方》《千金方》中，阳毒用升麻汤，无鳖甲，有桂枝。阴毒用甘草汤，无雄黄。
【衍义】按古方书记载，所谓阳毒，是阳气独盛，阴气暴衰，内外皆阳，所以成为阳毒。所谓阴毒，是阴气独盛，阳气暴衰，内外皆阴，所以成为阴毒。这两种情况，有的是伤寒初得时就出现此证，有的是服药后转变而成。阳毒完全用寒凉药物治疗，阴毒完全用温热药物治疗，药剂性质如同冰炭般不同。为什么张仲景用同一个方剂治疗呢？虽然说阴毒，去掉雄黄、蜀椒，那就是反而去掉了温热药。而且注释说《肘后方》《千金方》中，阳毒用升麻汤，无鳖甲，有桂枝；阴毒用甘草汤，无雄黄。这难道不是热毒伤害阴阳二经络吗？在阳经络，则面赤斑斑如锦纹，吐脓血；在阴经络，则面青身如被杖打。这都是阴阳水火动静的基本象如此，难道是寒热之邪吗？我曾考察升麻、鳖甲等药的药性。本草说升麻能解时气毒厉，诸毒攻咽喉痛，与热毒成脓，开壅闭，疗发斑。当归能破恶血，养新血，补五脏肌肤。甘草和中，利血脉，缓急止痛，调药奏功。鳖甲去恶血，雄黄破骨节积聚，避鬼邪恶气，治骨蒸热极。蜀椒通血脉，调关节，逐肌骨皮肤死肌，去留结破血，治天行时气。诸药所能达到的效果如此。由此观之，张仲景对于阴阳二毒之证，总用一方，大概可见一斑。病形虽然由阴阳发证，论邪则都属于热毒与血病。所以不分表里，都以升麻解热毒为君药，当归和血为臣药，其余药物作为佐使。但雄黄、蜀椒是调理阳气的药物，所以病在阴者去掉它们。如《肘后方》《千金方》中，阳毒去鳖甲而有桂枝，鳖甲是水族，乃阴中之阳，不如桂枝能调阳络之血。阴毒不去蜀椒，是因为蜀椒也是阴中之阳，不像雄黄是阳中之阳，所以保留它以治疗阴证。方旨就是这样。所谓五天可治，七天不可治，是因为五日是土的生成数，热尚未至极，还可以治疗。七日是火的成数，热之极，阴阳消灭，不可治疗了。其邪比之伤寒，加上毒性，所以伤寒到七天还可以再传一经，而此病到七天，不仅灭其阴，而且火极也会自灭。
(One treatise, three syndrome patterns, and twelve prescriptions)
The treatise states: Baihe disease (Lily Disease) occurs because all the vessels share a common origin, and thus all are affected by the pathogenic factor. The patient desires to eat but cannot; often remains silent; desires to lie down but cannot sleep peacefully; desires to walk but lacks the strength. Sometimes food tastes delicious, sometimes there is no desire to eat at all, or even an aversion to the smell of food. There is a sensation of cold without actual coldness, and a sensation of heat without actual heatiness. The mouth is bitter, and urination is dark red. Various medications fail to cure it; taking medicine results in severe vomiting and diarrhea. The symptoms seem as if possessed by spirits. The physical appearance looks normal, yet the pulse is slightly rapid. If headache occurs during urination, recovery takes sixty days. If there is no headache during urination but rather a shivering sensation (feeling chilly), recovery takes forty days. If urination is smooth but accompanied only by dizziness, recovery takes twenty days. This syndrome may appear before illness onset, or emerge four to five days after illness begins, or manifest mildly after twenty days or a month. Treatment should be tailored to the specific presentation.
For Baihe disease following improper sweating therapy, Baihe Zhi Mu Tang (Lily and Anemone Decoction) is indicated.
Baihe Zhi Mu Tang Prescription
He Tian Ma (Baihe, Lily Bulb) [7 bulbs, split] Zhi Mu (Anemone Radix) [3 qian, sliced]
First, wash the He Tian Ma and soak it overnight until white foam appears on the surface; discard this water. Then add two sheng of spring water, decoct to obtain one sheng of liquid, and strain. Separately, decoct the Zhi Mu in two sheng of spring water to obtain one sheng of liquid, and strain. Mix the two filtrates and decoct together to obtain one sheng and five he of liquid. Divide into two warm doses.
For Baihe disease following improper purgative therapy, Hua Shi Dai Zhe Tang (Talcum and Hematite Decoction) is indicated.
Hua Shi Dai Zhe Tang Prescription
He Tian Ma (Baihe, Lily Bulb) [7 bulbs, split] Hua Shi (Talcum) [3 liang, crushed and wrapped in cotton] Dai Zhe Shi (Hematite) [1 piece the size of a bullet, crushed and wrapped in cotton]
First, wash the He Tian Ma and soak it overnight until white foam appears; discard this water. Add two sheng of spring water, decoct to obtain one sheng of liquid, and strain. Separately, decoct the Hua Shi and Dai Zhe Shi in two sheng of spring water to obtain one sheng of liquid, and strain. Mix the liquids and decoct again to obtain one sheng and five he of liquid. Take in divided warm doses.
For Baihe disease following improper emetic therapy, Baihe Ji Zi Tang (Lily and Egg Yolk Decoction) is indicated.
Baihe Ji Zi Tang Prescription
He Tian Ma (Baihe, Lily Bulb) [7 bulbs, split] Ji Zi Huang (Egg Yolk) [1 unit]
First, wash the He Tian Ma and soak it overnight until white foam appears; discard this water. Add two sheng of spring water, decoct to obtain one sheng of liquid, and strain. Add the Ji Zi Huang, stir well, and decoct until reduced by five fen. Take warm.
For Baihe disease not treated with emetics, purgatives, or sweating methods, where the condition remains unchanged, Baihe Di Huang Tang (Lily and Rehmannia Decoction) is indicated.
Baihe Di Huang Tang Prescription
He Tian Ma (Baihe, Lily Bulb) [7 bulbs, split] Sheng Di Huang (Fresh Rehmannia Root) [1 sheng]
Wash the He Tian Ma and soak it overnight until white foam appears; discard this water. Add two sheng of spring water, decoct to obtain one sheng of liquid, and strain. Add the juice of Sheng Di Huang, decoct to obtain one sheng and five he of liquid. Divide into two warm doses. Once effective, do not continue administration. Stool will often appear black like lacquer.
For Baihe disease persisting for a month and developing into thirst, Baihe Xi Fang (Lily Wash Formula) is indicated.
Baihe Xi Fang Prescription
Use one sheng of He Tian Ma, soak in ten dou of water overnight, and use the water to wash the body. After washing, consume boiled noodles (Zhu Bing). Do not consume salted fermented soybeans (Yan Chi).
For Baihe disease with persistent thirst unrelieved by the above, Gua Lou Mu Li San (Trichosanthes Root and Oyster Shell Powder) is indicated.
Gua Lou Mu Li San Prescription
Gua Lou Gen (Trichosanthes Root) Mu Li (Oyster Shell) [calcined, equal parts]
Grind both ingredients into a fine powder. Administer one fang cun bi (square-inch measure) with drinkable liquid, three times daily.
For Baihe disease presenting with fever (alternatively stated as chills and fever), Baihe Hua Shi San (Lily and Talcum Powder) is indicated.
Baihe Hua Shi San Prescription
He Tian Ma (Baihe, Lily Bulb) [1 liang, processed with heat] Hua Shi (Talcum) [3 liang]
Grind into powder. Administer one fang cun bi with drinkable liquid, three times daily. Stop administration if mild diarrhea occurs. The heat will then be eliminated.
[Commentary]: The phrase "all vessels share a common origin, and thus all are affected" implies that while there are twelve main meridians and fifteen collaterals, what does "hundred vessels" refer to? Vessels are the reservoirs of blood; blood flows within them, nourishing the interior and exterior, connecting acupoints and intersections, and permeating the entire body. "Hundred" denotes multitude, similar to saying "hundred bones." Moreover, vessel circulation aligns with heaven and earth, corresponding to the hundred marks of a clepsydra. Thus, vessels have specific locations, justifying the term "hundred vessels." Why would they all become diseased from one source? It is attributed to the Pericardium Meridian of Hand-Jueyin (Shou Xin Zhu). The Pericardium governs blood and vessels. The Heart is the master of fire and the Sovereign Lord. When the Sovereign does not act directly, the Pericardium acts on its behalf. Thus, the Pericardium exclusively manages the transformation and generation of yin blood throughout the body, earning the title "Mother Qi," which all vessels revere. If fire becomes excessive, heat arises; if heat accumulates without dispersing, stagnation forms; prolonged stagnation generates toxicity that damages blood. Blood containing heat-toxin flows into the vessels, originally due to the excess pathogen of the Mother Qi. Hence, "all vessels share a common origin, and thus all are affected." Examining the *Neijing*, there is a condition called "Jie Xie" (a type of consumptive disease), which is nearly identical to Baihe disease. Since Jie Xie belongs to "heat in the middle without blood," is Baihe also "heat in the middle without blood"? Let us analyze this syndrome. Blood belongs to yin, governed by Kidney Water. The *Neijing* states: "Kidney deficiency leads to hunger without desire to eat," explaining the desire to eat but inability to do so. Yin deficiency causes aversion to vexation, hence the silence. Wei Qi enters yin at night to induce sleep; now, due to yin deficiency, Wei Qi cannot descend, causing the desire to sleep but inability to do so. Feet require blood to walk; since blood is diseased, walking is impossible. Food requires qi and blood transformation for digestion. Spleen relates to blood and prefers fragrance; when blood is harmonious, food tastes good; when disharmonious, the smell of food is repulsive. Qi is yang, blood is yin. Excess qi brings heat, deficiency brings cold. Here, the disease is in the blood, not affecting qi, so although there is a sensation of cold, there is no actual cold, and vice versa for heat. Harmonious blood flows smoothly; disharmony causes obstruction, leading to heat. Upper heat causes bitter taste; lower heat causes dark urine. Medicines treat disease but rely on Stomach Qi for transport. If toxic blood blocks the Stomach and Spleen meridians, medicine cannot circulate. A weak Stomach reacting poorly to medicine causes exacerbated vomiting and diarrhea, resembling demonic possession. Since the disease is not in skin, flesh, sinews, or bones, the body appears normal. Only heat in the blood and blood deficiency cause the slightly rapid pulse. A slightly rapid pulse indicates yin deficiency. Yin deficiency leads to Kidney deficiency. The Kidney and Bladder are exterior-interior pairs; Kidney deficiency impairs the Bladder's ability to guide essence back to the Kidney, leading to Bladder deficiency. Bladder qi descends to Huiyin and ascends to the vertex, governing yang qi. During urination, Bladder qi leaks downward. Mildly, upper qi fails to rise, causing upper deficiency and a shivering sensation (Xi Ran); dizziness indicates severe deficiency, with rebellious qi rising to the vertex causing headache. Based on severity, the time to recovery can be predicted. Diseases with fixed locations have fixed recovery periods. Here, pain flows through the hundred vessels without fixed location, so symptom onset varies—sometimes before illness, sometimes after days or months. This helps assess the depth and level of the disease. As seen below regarding yin-yang manifestations, treatment follows the syndrome. From the listed formulas, Ri Huazi noted that Baihe calms the heart, stabilizes the gallbladder, benefits the five zang organs, and tonifies yin. It treats postpartum blood-deficiency vertigo by clearing blood-heat. It removes fullness and promotes urination/defecation by draining blood stasis. Using Baihe as the main herb for this syndrome reveals underlying stasis accumulation. If sweating was used improperly, depleting upper jiao fluids (yang), Zhi Mu is added to rescue. Zhi Mu clears fire, generates fluids, and moistens lungs/heart. If purgatives were used improperly, damaging yin and accumulating blood stasis in the lower jiao (yin), Hua Shi and Dai Zhe Shi are added. Hua Shi opens knots and benefits orifices; Dai Zhe Shi removes wind-bi and blood stasis from vessels. If emetics were used improperly, damaging upper/middle jiao blood, Ji Zi Huang is used to tonify blood. If no improper treatments occurred and the condition remains initial, Sheng Di Huang juice is added to tonify and cool blood. Cooling eliminates heat-toxin; tonifying generates new blood. Accumulations move and exit via stool as black lacquer. If unresolved for a month, hundred vessels are blocked, fluids fail to transform causing thirst, so Baihe is used for bathing to unblock vessels and promote fluid movement, stopping thirst. Salt is avoided as saltiness coagulates blood and scatters fluids. If thirst persists, indicating lack of fluids in the middle, Gua Lou Mu Li San is used. If fever develops due to vessel blockage and stagnation, Shi Xiao (Niter) promotes urination, combined with cooling Hua Shi to resolve blood-heat stasis, exiting via mild diarrhea, eliminating heat. Baihe disease appeared in *Jingui Yaolue*; later texts omitted it, except Zhu Fengyi, who attributed it to transformed Shanghan. I believe this disease often originates from the Heart Master, due to unfulfilled desires, separation/stagnation, or anxiety/oppression, causing郁结 of the two fires. With hundred vessels diseased, the whole body is uneasy, producing varied symptoms. Later texts omitted Baihe disease, listing "Lao Zhai" (consumption) instead, likely due to similar appearances or blood stasis in vessels. Discarding the formulas is regrettable, obscuring the treatment principles.
For Baihe disease manifesting yin characteristics, treat with yang methods; for yang characteristics, treat with yin methods. Treating yang manifestations by attacking yin and inducing sweat again is contrary. Treating yin manifestations by attacking yang and purging again is also contrary.
[Commentary]: Shanghan treatment states: Yang excess/yin deficiency, sweating kills, purging heals; Yin excess/yang deficiency, sweating heals, purging kills. Baihe disease's "treat yin manifestations with yang methods, yang manifestations with yin methods" differs slightly. In Shanghan, excess dictates sweating/purging. Here, it refers to treating based on manifestation, implying sweating/purging are not appropriate. Baihe symptoms are ambivalent (want to sleep but don't, want to eat but don't, feel cold/hot but aren't), indicating pathology moving between exterior/interior, requiring gentle rescue rather than drastic measures like Shanghan. Using Shanghan methods blindly could cause damage. Thus, the previous formulas are correct. The warning against contrary sweating/purging refers to reversing the proper approach to exterior/interior dynamics.
Hu Huo disease resembles Shanghan: silent, sleepy, eyes unable to close, restlessness. Erosion of the throat is "Huo"; erosion of the genitals is "Hu". Anorexia, aversion to food smells. Complexion alternates between black, red, and white. Erosion of the upper part causes hoarseness, treated with Gan Cao Xie Xin Tang (Licorice Decoction for Draining the Epigastrium).
Gan Cao Xie Xin Tang Prescription
Gan Cao (Licorice Root) [4 liang] Huang Qin (Scutellaria Root) Ren Shen (Ginseng Root) Gan Jiang (Dried Ginger) [each 3 liang]
Huang Lian (Coptis Rhizome) [1 liang] Da Zao (Jujube) [12 units] Ban Xia (Pinellia Tuber) [0.5 sheng]
Boil seven ingredients in ten dou of water to obtain six sheng. Strain and decoct again. Take one sheng warm, three times daily.
[Commentary]: Hu Huo disease involves worm erosion of upper and lower orifices. Folklore says worms arise from wind. However, wind is yang; yang alone cannot generate life. It requires a medium. Prolonged damp-heat steams and rots qi and blood, forming turbid stasis, which wind transforms into worms. Without damp-heat, cold air might rot matter but not generate worms. Thus, worms arise slowly from damp-heat and stagnant blood, erupting at their peak, unlike sudden Shanghan. Symptoms of silence, sleepiness, eye closure issues, and restlessness stem from long-term damp-heat damaging five zang yin essence, preventing Wei Qi entry and Spirit tranquility. Anorexia and aversion to smells indicate Spleen/Stomach injury. Fluctuating complexion reflects five zang deficiency and alternating prosperity. Worms emerge from extreme damp-heat, eroding sites. Upper erosion damages Heart/Lungs and throat; Lung governs qi, throat governs voice, causing hoarseness. Gan Cao Xie Xin Tang treats damp-heat and balances yin/yang. Huang Lian clears Heart/Spleen heat and kills worms. Later texts suggest Hu Huo arises from Shanghan or other febrile diseases where internal heat, poor diet, and empty intestines allow worms to wander. Thus, any febrile disease can produce worms.
Erosion of the lower part causes dry throat, treated with Ku Shen Tang (Sophora Root Decoction) for washing.
[Commentary]: Lower erosion causes dry throat because the lower part houses the Kidney and Ren Mai. Kidney is water. Severe lower damp-heat causes worms to erode upward, injuring Kidney water. Meridians lack moisture, and damp-heat rebels upward, drying the throat. Ku Shen Tang washes externally. Ku Shen clears heat-toxin and treats lower orifice sores. However, this is symptomatic treatment. Tracing the root, disease moves from inside out. Just as upper parts use oral formulas, lower parts should have oral remedies. Just as lower parts use washing, upper parts should have topical logic. Zhang Zhongjing intentionally cross-references these methods. Otherwise, why do later texts mention oral medicines for lower parts or internal organ damage?
Erosion of the anus is treated with Xiong Huang San (Realgar Powder) fumigation.
Grind Xiong Huang (Realgar) into powder. Place in two tube-shaped tiles, join them, and burn towards the anus for fumigation.
*Mai Jing* states: Patients may have erosion of the throat from respiration (upper) or anus/genitals from the lower jiao (lower). Upper erosion is "Huo"; lower is "Hu". Hu Huo disease is treated with Zhu Ling San (Polyporus Powder).
[Commentary]: Anal erosion indicates lower damp-heat. Although both orifices belong to the Kidney, the Liver meridian passes through the anus, which is the gate of the Large Intestine. Large Intestine is Metal; damp-heat injures Metal, allowing Wood (Liver) to insult it. Thus, worms erode here. Xiong Huang treats sores, kills worms, and dispels wind, hence fumigation. Citing *Mai Jing*'s Zhu Ling San distinguishes damp-heat.
Patient has rapid pulse, no fever, slight vexation, silence, desire to lie down, sweating. On days 3-4, eyes turn red like a turtledove's. By days 7-8, corners of eyes turn black. If the patient can eat, pus has formed. Chi Xiao Dou Dang Gui San (Adzuki Bean and Angelica Decoction) is indicated.
Chi Xiao Dou Dang Gui San Prescription
Chi Xiao Dou (Adzuki Bean) [3 sheng, soaked until sprouted, dried] Dang Gui (Angelica Sinensis Root) [10 liang]
Pound into powder. Administer one fang cun bi with Jiang Shui (fermented grain water), three times daily.
[Commentary]: Rapid pulse usually means fever/vexation, but here heat is in blood, not Ying/Wei, so no fever, only slight vexation. Sweating occurs because blood disease disrupts Wei harmony; blood disease causes aversion to vexation (silence). Wei disharmony causes yang sinking (desire to lie down). Pores open, leaking fluids. Red eyes on day 3-4 show hot blood rising through vessels to the eyes. Black corners on day 7-8 indicate congealed blood changing color. Ability to eat indicates pus formation; damp-heat toxins scatter, damaging middle harmony, preventing eating. If eating is possible, toxin-blood has formed pus, leaving Stomach Qi undisturbed. Chi Xiao Dou clears heat-toxin, resolves bad blood, relieves vexation, drains pus, and tonifies blood vessels (Monarch). Dang Gui tonifies blood, generates new, removes old (Minister). Jiang Shui is sour, clears heat, relieves vexation, assists blood (Assistant/Envoy).
Yang Du disease presents with red face, mottled rash like brocade, sore throat, vomiting of pus/blood. Treatable within five days; untreatable after seven. Sheng Ma Bie Jia Tang ( Cimicifuga and Turtle Shell Decoction) is indicated.
Yin Du disease presents with blue/green face and body, body pain as if beaten by sticks, sore throat. Treatable within five days; untreatable after seven. Sheng Ma Bie Jia Tang minus Xiong Huang and Shu Jiao is indicated.
Sheng Ma Bie Jia Tang Prescription
Sheng Ma (Cimicifuga Rhizome) [2 liang] Dang Gui (Angelica Sinensis Root) [1 liang] Shu Jiao (Sichuan Pepper) [stir-fried to remove oil, 1 liang] Gan Cao (Licorice Root) [2 liang] Bie Jia (Turtle Shell) [size of a finger, roasted]
Xiong Huang (Realgar) [0.5 liang, ground]
Boil six ingredients in four sheng of water to obtain one sheng. Take in one dose. Elderly and children take a second dose to induce sweating. *Zhou Hou Bei Ji Fang* and *Qian Jin Fang* state: For Yang Du, use Sheng Ma Tang without Bie Jia, adding Gui Zhi. For Yin Du, use Gan Cao Tang without Xiong Huang.
[Commentary]: Ancient texts define Yang Du as exclusive yang excess and sudden yin decline (pure yang). Yin Du is exclusive yin excess and sudden yang decline (pure yin). These may occur initially in Shanghan or after medication. Yang Du is treated with cold/cool herbs; Yin Du with warm/hot herbs. Why does Zhang Zhongjing use one formula? Removing Xiong Huang/Shu Jiao (warm) for Yin Du seems contradictory. *Zhou Hou* adds Gui Zhi (warm) for Yang Du and removes Bie Jia (yin-nourishing). This suggests heat-toxin affects both yin and yang meridians. Yang meridian involvement causes red rash and pus/blood; Yin meridian involvement causes blue face and body pain. These reflect fundamental yin-yang/water-fire dynamics, not simple cold/heat pathogens. Analyzing herbs: Sheng Ma clears seasonal toxins, throat pain, pus, and rashes. Dang Gui breaks bad blood, nourishes new blood, tonifies five zang. Gan Cao harmonizes middle, benefits vessels, relieves pain. Bie Jia removes bad blood. Xiong Huang breaks accumulations, dispels evil qi, treats bone-steaming heat. Shu Jiao unblocks vessels, joints, removes dead tissue and blood stasis, treats epidemic qi. Thus, Zhang uses one formula for both. Although arising from yin/yang signs, the pathogen is heat-toxin and blood disease. No distinction between exterior/interior; Sheng Ma clears heat-toxin (Monarch), Dang Gui harmonizes blood (Minister), others assist. Xiong Huang/Shu Jiao regulate yang, so removed for Yin Du. *Zhou Hou* removes Bie Jia (yin-within-yang) for Yang Du, adding Gui Zhi to regulate yang vessels. Yin Du keeps Shu Jiao (yin-within-yang) to treat yin. The principle is clear. "Five days treatable, seven days not" relates to numerology: Five is Earth's generating number, heat not extreme, treatable. Seven is Fire's completing number, heat extreme, yin/yin exhausted, untreatable. Compared to Shanghan, this has added toxicity. Shanghan allows transmission after seven days; here, extreme fire destroys itself.