问曰。病患脉数。数为热。（脉弦者虚也以下。脉经为别条。）
病患欲吐者。不可下之。
〔朱〕此 为吐家而设大戒。非特指胃反言也。
按伤寒呕多。虽有阳明证。不可攻之。其理一也。
又按脉经所载。有出于本经之外者。宜参阅。今拈一条。曰。夫吐家。脉来形状如新卧起。哕而腹满。
按此条恐是错出。似宜在橘皮汤条上。
茱萸汤方（本草。图经引。人参一两。生姜一大两。大枣二十枚。）
半夏泻心汤方（按再煮。当作再煎。）
黄芩加半夏生姜汤方（按大枣十二个。当作十二枚。）
呕吐而病在膈上。（外台。后下。有必字。）
呕而脉弱。小便复利。
按尤氏曰。或云。呕与身热为邪实。厥利脉弱为正虚。虚实互见。故曰难治。四逆汤。舍其标。而治其本也。亦通。
此说不是。姑存之。
呕而发热者。
证治准绳曰。金匮方。（云云）洁古。用小柴胡汤。加青黛。以姜汁打糊丸。名清镇丸。治呕吐脉弦头痛。盖本诸
此。（按保命集。名青镇丸。）
大半夏汤方（本草。图经引。半夏三升。二百四十遍。大观本。作一百四十遍。政和本。作一百二十遍。二升
半。并作三升半。余分再服。作日再。下有亦治膈间支饮句。）
按魏氏曰。服后多煮白蜜。去其寒。而用其润。俾粘腻之性。流连于胃底。不速下行。而半夏人参之力。可以徐斡
旋于中。其意固微矣哉。此说颇巧。然不如李升玺之稳贴。
医心方。范汪方。治胸中乏气而呕欲死方。
人参（二两） 茯苓（二两） 生姜（三两） 白蜜（五合） 半夏（三升洗）
凡五物。入蜜。内六升水中。挠之百遍。以余药合投中。煮得三升。分四服。
禁冷食。治干呕。亦用此。本草。图经云。李绛兵部手集。疗反胃呕吐无常。粥饮入口即吐。困弱无力。垂死者。
以上党人参二大两。水一大升。煮取四合。热顿服。日再。兼以人参汁煮粥与服。
又经验后方。治大人小儿。不进乳食。和气去痰。人参四两。半夏一两。生姜汁熬一宿。曝干为末。面糊丸如绿豆
大。每服十丸。食后。生姜汤吞下。
御药院方。橘皮枳壳汤。治胸膈气痞。短气噎闷。不得升降。
枳壳（麸炒去穣） 半夏（不制各二两） 陈皮（不去白三两） 人参（一两）
上四味。用泉水五大升。入白沙蜜四两调匀。用勺扬药水。二百四十遍。
煮取一大升。去滓。分作三服。一日当服尽。食后服之。
食已即吐者。
按高世械曰。食已即吐者。非宿谷不化之胃反。乃火热。攻冲之吐逆。沈氏曰。此方。脾胃干结者宜之。当与上不
可下之条。反复互看。始得仲景前后之意。朱氏曰。胃反。病在下脘。因无阳气化谷。故食久反出。今即吐。明有实邪
壅阻中脘。不能容谷。若邪阻上脘。并不能食矣。此诸说足与金鉴相发。然先兄曰。此证胃中旧有积滞。故新谷入则不
能兼容。霎时变出也。古人属火之说。恐为强解。此说为核。且朱氏谓胃反病在下脘者误。
盖胃反。胃中无物相得激。故食下暂安。而后出也。此方用甘草。取之能缓上迫。遽引大黄令下达耳。先兄又曰。
千金。用单甘草汤。治服汤呕逆。不入腹者。正此汤用甘草之意。又按金鉴。朝食暮吐者寒也。食已而吐者火也。此寒
火二字。改为虚实。其理自通。尤氏又曰。丹溪治小便不通。用吐法。以开提肺气。使上窍通。而下窍亦通。与大黄甘
草汤之呕吐。法虽异。而理可通也。亦是。
胃反。吐而渴欲饮水。
按此条证。中焦蓄水。气液为之壅遏。不能升腾滋养。故使渴欲饮水。李氏以为津液亡者。误矣。（宜参伤寒论辑
义。五苓散条。）又此方。桂枝佐苓术等。以温散水饮。生姜以降逆气。尤氏以为散邪气者。亦误矣。
茯苓泽泻汤方
外台。集验。茯苓小泽泻汤。（按医心方。引经心方。名茯苓汤。）
圣济。治胃反吐逆。发渴饮水。茯苓饮方。
于本方。去生姜。加干姜。
又治心脾壅滞。暴渴引饮。茯苓饮方。
于本方。去生姜。加黄连。大黄。小麦。
宣明。桂苓白术丸。治消痰逆。止咳嗽。散痞满壅塞。开坚结痛闷。
于本方。加半夏。红皮。（用干生姜）为末。面糊为丸。如小豆大。生姜汤下二三十丸。日三服。吐后。渴欲得水。
而贪饮者。
按此条病轻药重。殊不相适。柯氏以此汤。移置于太阳下编文蛤散条。仍考此条。乃是文蛤散证。彼此相错
渴篇曰。渴欲饮水不止者。文蛤散主之。可以互征矣。但兼主微风脉紧头痛一句。即汤方所主也。
半夏干姜散方
按半夏散。不能散服者。水煮。此方浆水服。俱是取于不戟咽乎。后世有煮散法。其理自异。
圣惠。治冷痰饮。胸膈气满。吐逆不思饮食方。
于本方。加丁香。以生姜粥饮。调下一钱。（半夏二两。余并一两。）
又治痰逆。暖胃口。恶饮食方。
于本方。（各半两） 加白矾。（一两烧灰）为末。以生姜汁煮面糊和。圆如梧桐子大。每服不计时候。以姜枣汤下
二十丸。
生姜半夏汤方
按此汤一升分四服。殊与常例不同。伤寒蕴要曰。凡呕而不止者。服药宜徐徐呷下。不可急也。盖其义也。
干呕哕。若手足厥者。
按干呕与哕。自是二证。盖言干呕若哕也。魏氏曰。为病之浅者言之也。若夫病之深。阳气微弱之甚者。则非四逆
不足以取效也。或者先用此。以顺行其气。而后与以四逆。亦次第浅深之治也。此说失当。
橘皮汤方
十便良方。指迷。橘皮甘草汤。治若身大热。背微恶寒。心中烦闷。时时欲呕。渴不能饮。头目昏痛。恶见日光。
遇凉稍清。起居如故。此由饮食失宜。胃中空虚。热留胃口。其脉虚大而数。谓之中暑。
于本方。加甘草。
橘皮竹茹汤方
千金翼。竹茹汤。主哕方。
于本方。去人参。大枣。加半夏。紫苏。
三因。橘皮竹茹汤。治胃热多渴。呕哕不食。
于本方。去大枣。加茯苓。枇杷叶。麦门冬。半夏。
卫生家宝。人参竹茹汤。治一切呃逆。及治伤寒中暑等吐。
于本方。去大枣。加半夏。
活人事证方后集。橘皮汤。治中暑痰逆恶寒。（即本方）
伤寒蕴要。橘皮竹茹汤。治胃中壅热。而哕呕者。
于本方。去参。姜。枣。加半夏。茯苓。黄连。葛根。
伤寒大白。人参橘皮竹茹汤。治胃虚呃逆。
于本方。去大枣。加浓朴。半夏。藿香。
〔余述〕呕吐之证。其因不一。今细检经方。吴茱萸汤之呕与干呕。因阴逆。四逆汤之呕。因阳败。大黄甘草汤之
吐。因食壅。除此之外。凡十一方。虽其兼凉兼温之殊。大要皆不出于驱饮逐水。则知其系于水饮所致者为多。盖胃喜
燥而恶湿。故水饮停潴。其气易逆也。蛔之为物。最能使呕。叙在次篇。哕。啻举气逆证。然黄胆篇。
有小半夏汤之法。则亦有自停饮者。可以推知。而其更有数因。前人辨之尽矣。
夫六腑气绝于外者。
按金鉴曰。气绝。非谓脱绝。乃谓虚绝也。朱氏曰。按气绝两字。当作病气隔绝论。若真阴阳气绝。岂止手足寒与
不仁哉。二说并存考。程氏又曰。不禁则上无胀闷。中无痛楚。下无奔迫。但孔如竹筒。漫无约束。直流不休。诃子粟
壳。咸无功矣。虽有卢扁。将安施乎。此说信然。
下利。脉数而渴者。今自愈。
按邪热逼血。血渗入于肠。故清脓血。魏氏曰。热且蓄停肠脱。酿为污积。脓血随利而下。此亦理之所有也。
下利清谷。不可攻其表。（脉经。胀满下。有其脏寒者当下之七字。）
下利。脉迟而滑者。实也。
成氏曰。经曰。脉迟者。食干物得之。（按此语。未详所出。当考。）金匮要略曰。滑则谷气实。下利脉迟而滑者。
胃有宿食也。
脾胃伤食。不消水谷。是致下利者。为内实。若但以温中浓肠之药。利必不止。可与大承气汤下去宿食。利自止矣。
下利已瘥。至其年月日时复发者。
按朱氏曰。因初病利时。漫用药止住。而病根不拔。旧于此时受邪者。脏气即应时相感。而复病焉。此说不必。又
按伤寒缵论曰。此条。世本尚有宜大承气汤五字。衍文也。故去之。详未尽之邪。可以留伏经年而发。必系寒邪。寒邪
惟可备急丸温下。不应大承气寒下也。设属热邪。必无经年久伏之理。此说拘执。不可从。又按脉经下利篇所载诸条。
出于本经之外者。今录于左。曰。脉滑按之虚绝者。其人必下利。曰。下利而腹痛满者。为寒实。当下之。曰。下利腹
中坚者。当下之。曰。下利脉浮大者。虚也。以强下之故也。设脉浮革。因尔肠鸣。
当温之。（病可温证中。亦有此条。有宜当归四逆。汤字。又伤寒论不可下编。有此条。）曰。夫风寒下（疑脱利字。）
者。不可下之。下之后。心下坚痛。脉迟者。为寒。当温之。脉沉紧。下之亦然。脉大浮弦。下之当已。又病可温证曰。
下利欲食者。就温之。又曰。下利脉迟紧。为痛未欲止。当温之。得冷者。满而便肠垢。（此条。千金。载在下利中。）
千金痢门。稍与脉经同。更有一条。曰。下利大孔痛者。当温暖之。
紫参汤方（本草。图经引。甘草二两。一升半。作半升。）
气利。诃黎勒散主之。
〔赵〕治病有轻重。前言气利惟通小便。此乃通大便。盖气结处。阴阳不同。举此二者为例。六经皆得结。而为利
各有阴阳也。诃黎。勒。有通有涩。通以下涎消宿食。破结气。涩以固肠脱。佐以粥饮引肠胃。更补虚也。
圣惠方曰。夫气痢者。由表里不足。肠胃虚弱。积冷之气。客于肠间。脏腑不和。因虚则泄。故为气痢也。
诃黎勒散方
本草。图经云。诃黎勒主痢。本经不载。张仲景治气痢。以诃黎勒十枚。面裹焙。灰火中煨之。令面黄熟。去核。
细研为末。和粥饮顿服。（云云）唐刘禹锡传信方云。予曾苦赤白下。诸药服遍。久不瘥。转为白脓。令狐将军传此法。
用诃黎勒三枚上好者。两枚炮取皮。一枚生取皮。同末之。以沸浆水一两合服之。淡水亦得。若空水痢。加
而又泄气。盖其味苦涩。（按程氏所引。文不同。又程氏引杜壬方。本出本草黄连条。云。杜壬治气痢泻。里急后重。
云云用黄连甘姜二味。又引刘禹锡传信方。亦是本草所引。）
〔余述〕朱丹溪曰。仲景治痢。可温者温。可下者下。或解表。或利小便。或待其自已。区别易治难治不治之证。
至为详密。然犹与滞下衮同。立方命论。（出局方发挥。）盖肠 滞下。与濡泻滑泄。其证与治。本自不同。仲景一以下
利命之。并而为篇。然逐条寻究。判然而明矣。抑更有一义。盖濡泻滑泄。固宜温固。然有内有宿积。而治宜疏刷者。
肠滞下。固宜疏刷。然有阳虚气陷。而治宜温固者。然则学人宜审其脉证。而处其方剂。不须特以肠 泄泻为分别。
仲景之合为一篇者。意或在于此欤。（五十七难。大瘕泄者。里急后重。数至圊而不能便。茎中痛。亦即滞下。而居五
泄之一。其意与仲景一也。）
附方
千金翼。小承气汤。
〔沈〕此燥屎内结。大便不通壅逆。胃邪上行。而哕数谵语。所以亦宜轻利和中。而涤热开结也。
外台。黄芩汤。
按此黄连汤类方。亦治上热下寒。以为干呕下利也。
医心方。范汪方。治伤寒五六日。呕而利者。黄芩汤。（即本方）
疮痈肠痈浸淫病脉证并治第十八（脉经。题曰痈肿肠痈金疮浸淫脉证。似是。）
肠痈之为病。其身甲错。（本草。图经引云。张仲景治腹痈腹有脓者。薏苡仁附子败酱汤。）
按次条。其痈未至脓溃。故少腹肿痞。此条既经脓溃。故按之濡如肿状。腹无积聚。次条。血犹瘀结。营郁而卫阻。
故时时发热。复恶寒。病犹属实。故其脉迟紧。此条。营分既无所郁。故身无热。脓成则血燥。故脉数。要之此二条。
其别在脓已成与未成之分。而不拘其部位。如前注家。以大小肠为辨者。殆失之迂矣。
又按三因方。举此条云。久积阴冷所成也。故金匮用附子温之。举次条云。此以内结热所成也。故金匮用大黄利之。
亦不可从。
大黄牡丹汤方（儿琰曰。上条。宜从巢源。删去小便自调四字。而如淋上。补小便数三字。于理始顺。）
按痈肿之病。不论外内诸证。其初起也。乘其未溃。而夺之。其既成也。扶正气以外托。故葶苈大枣泻肺汤。肺痈
逐毒之治也。桔梗汤。肺痈排脓之治也。大黄牡丹汤。肠痈逐毒之治也。薏苡附子败酱散。肠痈排脓之治也。盖疡医之
方。皆莫不自此二端变化。亦即仲景之法则也。
又按方后所谓有脓者。其脓稍萌之义。与前条之全就腐溃者不同矣。
圣济。梅仁汤。治肠痈里急隐痛。大便秘涩。
于本方。以梅核仁。代桃仁。用冬瓜仁。加犀角。（按奇效梅仁散原方。）
问曰。寸口脉浮微而涩。
〔鉴〕脉微。气夺也。脉涩。血夺也。故曰。法当亡血汗出也。设无亡血汗出等病。则必身有疮。被刀斧所伤亡血
也。按不汗者一句。宜云设不亡血若汗出者。今特举不汗。而不云不亡血者。盖省文也。金鉴为是。又疮。古作创。即
问：病人的脉象数，数脉主热。（关于“脉弦者虚也”以下的条文，《脉经》将其列为另一条。）
病人想呕吐的，不可用攻下法。
〔朱〕这是为有呕吐病史的人设立的严厉戒律，不仅仅指胃反病而言。
按：《伤寒论》中说呕吐多的，即使有阳明病的证候，也不可攻下。其中的道理是一样的。
又按：《脉经》中记载的一些内容，是出自本经之外的，应当参考阅读。现在选取一条来说：凡是呕吐家，脉来形状像刚睡醒时那样（浮大无力），呃逆且腹部胀满。
按：这一条恐怕是错简，似乎应该放在橘皮汤那条上面。
吴茱萸汤方（据《本草图经》引文：人参一两，生姜一大两，大枣二十枚。）
半夏泻心汤方（按：“再煮”应作“再煎”。）
黄芩加半夏生姜汤方（按：“大枣十二个”，应作“十二枚”。）
呕吐而病位在膈上的。（《外台秘要》中，“后下”二字后有“必”字。）
呕吐而脉弱，小便清长。
按尤氏说：有人说，呕吐与身热是邪气实，四肢厥冷、下利、脉弱是正气虚，虚实夹杂，所以说难治。四逆汤，舍弃标症而治本症。这也讲得通。
这种说法不对，姑且保留它。
呕吐而发热的，
《证治准绳》说：《金匮》方……洁古用小柴胡汤，加青黛，用姜汁打糊做成丸药，名叫清镇丸，治疗呕吐、脉弦、头痛。这大概是依据……（按：《保命集》中名为青镇丸。）
大半夏汤方（据《本草图经》引文：半夏三升，洗二百四十遍。大观本作一百四十遍，政和本作一百二十遍。二升半，合起来是三升半。余分再服。“日再”下有“亦治膈间支饮”句。）
按魏氏说：服药后多煮白蜜，以去除其寒性，而利用其润性，使粘腻之性停留在胃底，不迅速下行，从而让半夏、人参的力量可以在中焦慢慢斡旋。这个意思确实很微妙。这种说法颇为巧妙，但不如李升玺的说法稳妥贴切。
《医心方》、范汪方：治疗胸中气短而呕欲死的方子。
人参（二两） 茯苓（二两） 生姜（三两） 白蜜（五合） 半夏（三升，洗）
以上五味药，加入蜂蜜，放入六升水中，搅拌一百遍，然后将其他药物一起投入，煮取三升，分四次服用。
禁止吃冷食。治疗干呕，也用此方。《本草图经》云：李绛兵部手集，治疗反胃呕吐无常，粥饮入口即吐，困倦虚弱无力，濒临死亡者。以上党人参两大两，水一大升，煮取四合，趁热一次服完，每天两次。同时用人参汁煮粥给患者服用。
又《经验后方》：治疗大人小孩，不进乳食，调和气血，祛除痰浊。人参四两，半夏一两，生姜汁熬一宿，晒干研末，面糊做成梧桐子大的丸药。每次服十丸，饭后，用生姜汤送下。
《御药院方》：橘皮枳壳汤，治疗胸膈气痞，短气噎闷，升降不利。
枳壳（麸炒去瓤） 半夏（不制，各二两） 陈皮（不去白，三两） 人参（一两）
以上四味药，用泉水五大升，加入白沙蜜四两调匀，用勺子扬药水二百四十遍。
煮取一大升，去渣，分三次服用，一天内服完。饭后服用。
吃完就呕吐的，
按高世栻说：吃完就呕吐的，不是宿食不化的胃反病，而是火热攻冲引起的吐逆。沈氏说：这个方子，适合脾胃干燥结滞的人。应当与“上不可下”的条文反复对照阅读，才能明白张仲景前后的用意。朱氏说：胃反病，病位在下脘，因为缺乏阳气化谷，所以食物久了反而吐出。现在是吃完就吐，明显有实邪壅阻中脘，不能容纳食物。如果邪气阻滞上脘，连食物都吃不下了。这些说法足以与《医宗金鉴》互相启发。但我哥哥说：这个证候，胃中原本有积滞，所以新谷进入就不能兼容，瞬间就变出呕吐了。古人归属于火的说法，恐怕是牵强附会。这种说法比较确切。而且朱氏说胃反病在下脘是错误的。
大概胃反病，是因为胃中没有东西相激，所以食物下去暂时安稳，然后才吐出来。这个方子用甘草，是取其能缓解上面的逼迫，随即引导大黄令其向下通达罢了。我哥哥又说：《千金方》用单味甘草汤，治疗服药后呕逆，药液不入腹的情况，正是这个方子用甘草的意思。又按《医宗金鉴》：朝食暮吐的是寒证，食已而吐的是火证。如果把这两个“寒”、“火”字改为“虚”、“实”，道理自然就通了。尤氏又说：丹溪治疗小便不通，用吐法，以开提肺气，使上窍通，下窍也就通了。这与大黄甘草汤治疗呕吐，方法虽然不同，但道理是可以相通的。这也是对的。
胃反病，呕吐且口渴想喝水。
按：这一条证候，是中焦蓄水，气液被壅遏，不能升腾滋养，所以导致口渴想喝水。李氏认为是津液亡失，这是错误的。（宜参考《伤寒论辑义》五苓散条。）另外这个方子，桂枝配合茯苓、白术等，以温散水饮，生姜以降逆气。尤氏认为是散邪气的，也是错误的。
茯苓泽泻汤方
《外台秘要》、《集验方》：茯苓小泽泻汤。（按：《医心方》引《经心方》，名为茯苓汤。）
《圣济总录》：治疗胃反吐逆，发渴饮水，茯苓饮方。
在本方基础上，去掉生姜，加入干姜。
又治疗心脾壅滞，突发口渴引饮，茯苓饮方。
在本方基础上，去掉生姜，加入黄连、大黄、小麦。
《宣明论方》：桂苓白术丸，治疗消痰逆，止咳嗽，散痞满壅塞，开坚结痛闷。
在本方基础上，加入半夏、红皮（用干生姜）研末，面糊做成小豆大的丸药。生姜汤送下二三十丸，每天三次。吐后，口渴想喝水，
并且贪饮的，
按：这一条病轻药重，非常不相适应。柯氏把这个汤，移置到太阳篇编入文蛤散条。仍考证这一条，乃是文蛤散证，彼此搞错了。
《渴篇》说：渴欲饮水不止的，文蛤散主治。可以互相印证。但是兼主“微风脉紧头痛”一句，就是汤方所主的。
半夏干姜散方
按：半夏散，不能散服的，用水煮。这个方子用浆水送服，都是取它不刺激咽喉的意思。后世有煮散法，其道理自然不同。
《太平惠民和剂局方》（圣惠方）：治疗冷痰饮，胸膈气满，吐逆不思饮食方。
在本方基础上，加入丁香，用生姜粥饮调下一钱。（半夏二两，其余各一两。）
又治疗痰逆，暖胃口，厌恶饮食方。
在本方基础上（各半两），加入白矾（一两，烧成灰），研末，用生姜汁煮面糊调和，做成梧桐子大的丸药。每次不服时间限制，用姜枣汤送下二十丸。
生姜半夏汤方
按：这个汤一升分四次服用，与常规例子不同。《伤寒蕴要》说：凡是呕吐不止的，服药应当慢慢呷下，不可以急。大概就是这个意思。
干呕或哕，如果手足厥冷的，
按：干呕与哕，本来是两种证候。这里说是干呕或者哕。魏氏说：这是针对病情较浅的而言。如果是病情深重，阳气微弱严重的，那么非四逆汤不足以取得疗效。或许先用这个方子，以顺行其气，然后再给予四逆汤，也是次第深浅的治疗方法。这种说法不当。
橘皮汤方
《十便良方》、《指迷方》：橘皮甘草汤，治疗如果身体大热，背部微恶寒，心中烦闷，时时想呕，口渴不能饮水，头目昏痛，厌恶见到日光，遇到凉快稍微清醒，起居如常。这是由于饮食失宜，胃中空虚，热留胃口，其脉虚大而数，称为中暑。
在本方基础上，加入甘草。
橘皮竹茹汤方
《千金翼方》：竹茹汤，主治哕方。
在本方基础上，去掉人参、大枣，加入半夏、紫苏。
《三因极一病证方论》：橘皮竹茹汤，治疗胃热多渴，呕哕不食。
在本方基础上，去掉大枣，加入茯苓、枇杷叶、麦门冬、半夏。
《卫生家宝产科备要》（卫生家宝）：人参竹茹汤，治疗一切呃逆，及治疗伤寒中暑等吐。
在本方基础上，去掉大枣，加入半夏。
《活人事证方后集》：橘皮汤，治疗中暑痰逆恶寒。（即本方）
《伤寒蕴要》：橘皮竹茹汤，治疗胃中壅热而哕呕者。
在本方基础上，去掉人参、生姜、大枣，加入半夏、茯苓、黄连、葛根。
《伤寒大白》：人参橘皮竹茹汤，治疗胃虚呃逆。
在本方基础上，去掉大枣，加入浓朴、半夏、藿香。
〔余述〕呕吐的证候，原因不一。现在仔细检查经方，吴茱萸汤的呕与干呕，原因是阴逆；四逆汤的呕，原因是阳败；大黄甘草汤的吐，原因是食壅。除此之外，凡十一方，虽然有的兼凉有的兼温，大体都不出驱除水饮，可知大多是由于水饮所致。大概胃喜燥而恶湿，所以水饮停聚，其气容易上逆。蛔虫这种东西，最能使人生呕，叙述在下一篇。哕，只举了气逆的证候。然而黄疸篇，有小半夏汤的法度，那么也有自停饮导致的，可以推知。而其更有几种原因，前人辨析得很详尽。
所谓六腑之气绝于外的，
按《医宗金鉴》说：气绝，不是说脱绝，而是说虚绝。朱氏说：按“气绝”两个字，应当当作病气隔绝来论述。如果是真正的阴阳气绝，难道只是手足寒冷和不仁吗？这两种说法并存考察。程氏又说：不禁固摄，则上无胀闷，中无痛楚，下无奔迫，只是孔穴像竹筒一样，漫无约束，直流不休，诃子、粟壳，都没有功效了。虽然有卢医、扁鹊，将如何施展呢？这种说法确实如此。
下利，脉数而口渴的，现在自愈。
按：邪热逼迫血液，血液渗入肠道，所以排出脓血。魏氏说：热邪蓄积停滞在肠脱，酿成污积，脓血随下利而下，这也是情理之中的事。
下利清谷，不可攻表。（《脉经》中，“胀满下”有“有其脏寒者当下之”七字。）
下利，脉迟而滑的，是实证。
成氏说：经文说：脉迟的，是吃了干物导致的。（按：这句话，不详出处，应当考证。）《金匮要略》说：滑则谷气实。下利脉迟而滑的，是胃中有宿食。
脾胃伤食，不消化水谷，导致下利的，属于内实。如果只用温中厚肠的药物，下利必定不止。可以给予大承气汤下去宿食，下利自然停止。
下利已经痊愈，到了原来的年月日时复发的，
按朱氏说：因为初病下利时，随意用药止住，而病根未拔，旧时在此时受邪的，脏气就会应时而感，再次发病。这种说法不必采纳。又按《伤寒缵论》说：这一条，世传本还有“宜大承气汤”五字，是衍文。所以去掉。详细的未尽之邪，可以留伏经年而发作，必定是寒邪。寒邪只能用备急丸温下，不应用大承气汤寒下。如果属热邪，必定没有经年久伏的道理。这种说法拘执，不可听从。又按《脉经·下利篇》所载诸条，是出自本经之外的，现在记录在下面。说：脉滑按之虚绝的，其人必定下利。说：下利而腹痛满的，为寒实，当下之。说：下利腹中坚的，当下之。说：下利脉浮大的，虚也，是因为强行攻下造成的。如果脉浮革，因此肠鸣。
应当温之。（在“病可温证”中，也有这一条，有“宜当归四逆汤”字样。又在《伤寒论》不可下编中，有这一条。）说：风寒下（疑脱“利”字）。
不可下之。下之后，心下坚痛，脉迟的，为寒，当温之。脉沉紧，下之亦然。脉大浮弦，下之当已。又在“病可温证”说：下利欲食的，就温之。又说：下利脉迟紧，为痛未欲止，当温之。得冷的，满而便肠垢。（这一条，《千金方》载在下利中。）
《千金方·痢门》，稍与《脉经》相同，多有一条，说：下利大孔痛的，当温暖之。
紫参汤方（据《本草图经》引文：甘草二两，一升半，作半升。）
气利，诃黎勒散主治。
〔赵〕治病有轻重。前文说气利只通小便，这里是通大便。大概气结之处，阴阳不同。举这两者为例，六经皆可得结，而为利各有阴阳。诃黎勒，有通有涩。通以下涎消宿食，破结气；涩以固肠脱。佐以粥饮引导肠胃，更补虚。
《太平惠民和剂局方》（圣惠方）说：所谓气痢，是由表里不足，肠胃虚弱，积冷之气，客于肠间，脏腑不和，因虚则泄，所以成为气痢。
诃黎勒散方
《本草图经》云：诃黎勒主治痢疾，本经不载。张仲景治疗气痢，用诃黎勒十枚，面裹焙，在灰火中煨，令面黄熟，去核，细研为末，和粥饮顿服。（云云）唐刘禹锡《传信方》云：我曾苦于赤白痢，各种药都服遍了，长久不愈，转为白脓。令狐将军传授这个方法，用好诃黎勒三枚，两枚炮取皮，一枚生取皮，同研为末，用沸浆水一两合服之，淡水也可以。如果是空水痢，加……而又泄气，大概因为其味苦涩。（按：程氏所引，文字不同。又程氏引杜壬方，本出《本草》黄连条，云：杜壬治疗气痢泻，里急后重，云云用黄连、甘姜二味。又引刘禹锡《传信方》，也是《本草》所引。）
〔余述〕朱丹溪说：仲景治疗痢疾，可温的温，可下的下，或者解表，或者利小便，或者等待其自愈，区别易治、难治、不治的证候，极为详密。然而仍然与滞下混同，立方命名议论。（出自《局方发挥》）。大概肠滞下，与濡泻滑泄，其证与治疗，本来不同。仲景一概以下利命名，并为一篇。然而逐条寻究，判然分明。抑且还有一层含义，大概濡泻滑泄，固然适宜温固，然而有内有宿积，而治疗适宜疏刷的。肠滞下，固然适宜疏刷，然而有阳虚气陷，而治疗适宜温固的。那么学人应当审察其脉证，而处方剂，不需要特意以肠泄泻作为分别。仲景合为一篇的意思，或许在于此吧。（《难经·五十七难》：大瘕泄者，里急后重，数至圊而不能便，茎中痛，也就是滞下，而居五泄之一，其意与仲景一致。）
附方
《千金翼方》：小承气汤。
〔沈〕这是燥屎内结，大便不通壅逆，胃邪上行，而哕数谵语，所以也适宜轻利和中，而涤热开结。
《外台秘要》：黄芩汤。
按：这是黄连汤类方，也治疗上热下寒，以为干呕下利。
《医心方》、范汪方：治疗伤寒五六日，呕而利的，黄芩汤。（即本方）
疮痈肠痈浸淫病脉证并治第十八（《脉经》题曰：痈肿肠痈金疮浸淫脉证，似是。）
肠痈这个病，其身甲错。（据《本草图经》引文：张仲景治疗腹痈腹有脓者，薏苡仁附子败酱汤。）
按：次条，其痈未至脓溃，所以少腹肿痞。这一条既然已经脓溃，所以按之濡软如肿状，腹无积聚。次条，血犹瘀结，营郁而卫阻，所以时时发热，又恶寒。病犹属实，所以其脉迟紧。这一条，营分既无所郁，所以身无热。脓成则血燥，所以脉数。总之这两条，其区别在于脓已成与未成的分别，而不拘泥于部位，如前注家，以大小肠为辨别的，大概失之迂腐了。
又按《三因方》，举这一条说：是久积阴冷所成的。所以《金匮》用附子温之。举次条说：这是以内结热所成的。所以《金匮》用大黄利之。也不可听从。
大黄牡丹汤方（儿琰说：上条，宜从《巢源》，删去“小便自调”四字，而如淋上，补“小便数”三字，于理始顺。）
按：痈肿的病，不论外内诸证，其初起时，乘其未溃，而夺之。其既成时，扶正气以外托。所以葶苈大枣泻肺汤，是肺痈逐毒的治疗。桔梗汤，是肺痈排脓的治疗。大黄牡丹汤，是肠痈逐毒的治疗。薏苡附子败酱散，是肠痈排脓的治疗。大概疡医的方子，皆莫不从此两端变化，也就是仲景的法则。
又按方后所谓“有脓者”，是其脓稍萌生的意思，与前条之全就腐溃的不同。
《圣济总录》：梅仁汤，治疗肠痈里急隐痛，大便秘涩。
在本方基础上，以梅核仁，代桃仁，用冬瓜仁，加犀角。（按：《奇效梅仁散》原方。）
问：寸口脉浮微而涩。
〔鉴〕脉微，是气夺。脉涩，是血夺。所以说：法当亡血汗出。如果没有亡血汗出等疾病，那么必定身上有疮，被刀斧所伤亡血。按“不汗者”一句，宜说“设不亡血若汗出者”，现在特举不汗，而不说不亡血，是省文的写法。《医宗金鉴》是对的。又“疮”，古作“创”，即
Question: The patient's pulse is rapid (Shu, indicating heat). A rapid pulse indicates heat. (Regarding the following text "If the pulse is wiry, it indicates deficiency," *Mai Jing* lists it as a separate clause.)
When a patient desires to vomit, purgation should not be used.
[Zhu] This is a strict prohibition established for those with a history of vomiting, not specifically referring only to stomach reversal (Wei Fan).
Note: In *Shanghan Lun*, it is stated that if there is much vomiting, even if there are Yangming syndrome signs, one must not attack with purgatives. The principle is the same.
Furthermore, some contents recorded in *Mai Jing* are outside the scope of this classic and should be consulted. Here is one example: For patients prone to vomiting, the pulse comes in a shape like someone who has just woken up (floating and large but weak), accompanied by hiccups and abdominal fullness.
Note: This clause seems to be misplaced and likely belongs above the clause for Jupi Tang (Tangerine Peel Decoction).
Wuzhuyu Tang (Evodia Decoction) [Recipe cited from *Bencao Tujing*: Ren Shen (Ginseng Root) 1 liang, Sheng Jiang (Fresh Ginger Rhizome) 1 da liang, Da Zao (Jujube Fruit) 20 pieces.]
Banxia Xiexin Tang (Pinellia Decoction to Drain the Epigastrium) [Note: "Boil again" should read "Simmer again".]
Huangqin Jie Banxia Shengjiang Tang (Scutellaria Decoction plus Pinellia and Fresh Ginger) [Note: "Twelve pieces of Da Zao" should read "Twelve pieces".]
Vomiting where the pathology is located above the diaphragm. (*Waitai Mi Yao* adds the character "bi" [must] after "hou xia" [add later].)
Vomiting with a weak pulse, and urination is clear and frequent.
You Shi says: Some say that vomiting and fever indicate pathogenic excess, while cold limbs, diarrhea, and a weak pulse indicate righteous deficiency. With both excess and deficiency present, it is said to be difficult to treat. Sini Tang (Frigid Extremities Decoction) abandons the branch symptoms to treat the root. This explanation is also acceptable.
This view is incorrect; it is retained here tentatively.
Vomiting accompanied by fever,
*Zhengzhi Zhunsheng* states: The formula from *Jinkui*... Jiegu used Xiaochaihu Tang (Minor Bupleurum Decoction) added with Qingdai (Indigo Naturalis), made into pills using ginger juice and flour paste, named Qingzhen Wan (Clearing and Settling Pill), treating vomiting, wiry pulse, and headache. This is likely based on... (Note: In *Baoming Ji*, it is named Qingzhen Wan.)
Dabanxia Tang (Major Pinellia Decoction) [Cited from *Bencao Tujing*: Banxia (Pinellia Tuber) 3 sheng, washed 240 times. Daguan edition says 140 times, Zhenghe edition says 120 times. Two sheng and half, combined makes three sheng and half. Divide into two doses. Below "two times a day" is the phrase "also treats fluid retention between the diaphragm and stomach".]
Wei Shi says: After taking the medicine, boil more white honey to remove its cold nature and utilize its moistening property, so that its sticky nature lingers at the bottom of the stomach, preventing rapid downward movement, allowing the power of Banxia and Renshen to slowly rotate in the middle. The intent is indeed subtle. This explanation is quite clever, but not as steady and appropriate as Li Shengxi's view.
*Yixin Fang* and Fan Wang's Formula: Treats chest qi deficiency with severe desire to vomit.
Renshen (Ginseng Root) 2 liang, Fuling (Poria) 2 liang, Sheng Jiang (Fresh Ginger Rhizome) 3 liang, Baimi (White Honey) 5 he, Banxia (Pinellia Tuber) 3 sheng (washed).
These five substances, add honey, put into six sheng of water, stir one hundred times, then add the remaining herbs together, boil to obtain three sheng, divide into four doses.
Prohibit cold food. Also used for dry heaves. *Bencao Tujing* states: Li Jiang's Military Department Manual Collection treats irregular regurgitation and vomiting, where porridge or drink is vomited immediately upon entering the mouth, with exhaustion, weakness, and impending death. Use two large liang of Shangdang Renshen, one da sheng of water, boil to obtain four he, take hot in one dose, twice a day. Also cook porridge with Renshen juice and administer.
Also *Jingyan Houfang*: Treats adults and children who cannot take milk or food, harmonizes qi, removes phlegm. Renshen 4 liang, Banxia 1 liang, Shengjiang juice boiled overnight, dried and powdered, made into pills the size of mung beans with flour paste. Take ten pills per dose, after meals, swallowed with ginger soup.
*Yuyao Yuan Fang*: Jupi Zhike Tang (Tangerine Peel and Aurantium Decoction), treats chest and diaphragm qi stagnation, shortness of breath, choking sensation, inability to ascend and descend properly.
Zhike (Aurantium Fruit, bran-fried, pith removed) 2 liang, Banxia (unprocessed) 2 liang, Chenpi (Tangerine Peel, white pith not removed) 3 liang, Renshen (Ginseng Root) 1 liang.
These four ingredients, use five da sheng of spring water, add four liang of Baisha honey, mix evenly, stir/yang the medicinal liquid two hundred and forty times with a ladle.
Boil to obtain one da sheng, remove dregs, divide into three doses. Finish within one day. Take after meals.
Vomiting immediately after eating,
Gao Shixi says: Vomiting immediately after eating is not the stomach reversal of undigested food, but vomiting caused by fire-heat attacking upward. Shen Shi says: This formula is suitable for those with dry and constricted spleen and stomach. It should be read repeatedly with the clause "upper part cannot be purged" to understand Zhang Zhongjing's intent before and after. Zhu Shi says: Stomach reversal disease is in the lower wan (stomach outlet), due to lack of yang qi to transform grain, so food stays long and then comes out. Now it vomits immediately, clearly indicating real pathogen blocking the middle wan, unable to hold grain. If the pathogen blocked the upper wan, one wouldn't even be able to eat. These explanations complement each other with *Yizong Jinjian*. However, my elder brother says: This condition involves old accumulation in the stomach, so when new grain enters, it cannot coexist, leading to immediate vomiting. The ancients' attribution to fire is likely forced interpretation. This view is more accurate. Also, Zhu Shi's statement that stomach reversal is in the lower wan is wrong.
Generally, in stomach reversal, because there is nothing in the stomach to stimulate, food settles temporarily and then comes out. This formula uses Gancao (Licorice Root) to relieve the upward pressure and guide Dahuang (Rhubarb Root) downward. My elder brother also said: *Qianjin Fang* uses single Gancao Tang to treat vomiting/reflux after taking medicine, preventing entry into the abdomen; this is exactly the intent of using Gancao in this formula. Also according to *Yizong Jinjian*: Vomiting in the evening what was eaten in the morning is cold; vomiting immediately after eating is fire. If these characters "cold" and "fire" are changed to "deficiency" and "excess", the logic becomes clear. You Shi also said: Danxi treated urinary obstruction using emesis to lift lung qi, opening the upper orifice so the lower orifice opens too. Although the method differs from Dahuang Gancao Tang's treatment of vomiting, the principle is相通 (interconnected). This is also correct.
Stomach reversal, vomiting and thirst desiring to drink water.
Note: This syndrome involves water accumulation in the middle jiao, obstructing qi and fluids, preventing them from ascending and nourishing, thus causing thirst. Li Shi considered it loss of body fluids, which is mistaken. (Refer to *Shanghan Lun Jiyi* on Wuling San clause.) Furthermore, in this formula, Guizhi (Cinnamon Twig) assists Ling (Poria) and Zhu (Atractylodes Macrocephala Rhizome) to warm and dissipate fluid retention, and Sheng Jiang (Fresh Ginger Rhizome) descends rebellious qi. You Shi considered it dispersing pathogenic qi, which is also mistaken.
Fuling Zexie Tang (Poria and Alisma Decoction)
*Waitai Mi Yao* and *Jiyan Fang*: Fuling Xiao Zexie Tang. (Note: *Yixin Fang* citing *Jingxin Fang* names it Fuling Tang.)
*Shengji Zonglu*: Treats stomach reversal vomiting and thirst desiring water, Fuling Yin.
On this base formula, remove Sheng Jiang, add Gan Jiang (Dried Ginger Rhizome).
Also treats sudden heart-spleen stagnation and extreme thirst desiring water, Fuling Yin.
On this base formula, remove Sheng Jiang, add Huanglian (Coptis Rhizome), Dahuang (Rhubarb Root), Xiaomai (Wheat Grain).
*Xuanming Lun*: Guiling Baizhu Wan (Bupleurum, Poria, and Atractylodes Pill), treats eliminating phlegm and rebellious qi, stopping cough, dissipating fullness and blockage, opening hard knots and painful oppression.
On this base formula, add Banxia (Pinellia Tuber), Hongpi (Red Peel, using Gan Jiang/Dried Ginger), powder them, make pills the size of small beans with flour paste. Take 20-30 pills with ginger soup, three times a day. After vomiting, thirst desiring water,
and greedy for drinking,
Note: This case has mild disease but heavy medication, which is highly inappropriate. Ke Shi moved this decoction to the Taiyang chapter under the Wenli San (Clam Shell Powder) clause. Still, examining this clause, it is actually the Wenli San syndrome; they are confused.
The Thirst Chapter states: Thirst desiring water without relief is primarily treated with Wenli San. They can corroborate each other. But the phrase "accompanied by slight wind, tight pulse, and headache" refers to what the decoction treats.
Banxia Ganjiang San (Pinellia and Dried Ginger Powder)
Note: Banxia San, if it cannot be taken as a powder, is boiled in water. This formula is taken with Jiangshui (Sour Rice Water). Both aim to avoid irritating the throat. Later generations had the method of boiling powders (Zhusan), the principle is naturally different.
*Taiping Huimin Heji Jufang* (Shenghui Fang): Treats cold-phlegm-fluid retention, chest-diaphragm qi fullness, vomiting and refusal to eat.
On this base formula, add Dingxiang (Clove), take one qian mixed with ginger porridge drink. (Banxia 2 liang, others 1 liang each.)
Also treats phlegm rebellion, warming the stomach appetite, aversion to food.
On this base formula (each half liang), add Baifan (Alum, 1 liang, calcined to ash), powder them, mix with ginger juice and flour paste to make pills the size of paulownia seeds. Take twenty pills at any time, swallowed with ginger-jujube soup.
Shengjiang Banxia Tang (Fresh Ginger and Pinellia Decoction)
Note: This decoction, one sheng divided into four doses, differs from the usual example. *Shanghan Yunyao* states: For continuous vomiting, medicine should be sipped slowly, not taken hastily. This is likely the meaning.
Dry heaves or hiccup, if accompanied by cold extremities,
Note: Dry heaves and hiccups are two distinct syndromes. It means dry heaves OR hiccups. Wei Shi says: This speaks of shallow disease. If the disease is deep, with severe weakness of yang qi, then Sini Tang is insufficient to achieve efficacy. Perhaps use this first to smooth the qi flow, then give Sini Tang; this is a treatment of gradual depth. This view is inappropriate.
Jupi Tang (Tangerine Peel Decoction)
*Shibian Liangfang* and *Zhimi Fang*: Jupi Gancao Tang, treats high fever, slight aversion to cold on the back, mental restlessness, frequent desire to vomit, thirst unable to swallow, dizzy head and painful eyes, aversion to sunlight, slightly clears when cool, daily life unchanged. This is due to improper diet, empty stomach, heat lingering in the stomach gate, pulse is deficient, large, and rapid, termed Summerheat.
On this base formula, add Gancao (Licorice Root).
Jupi Zhuru Tang (Tangerine Peel and Bamboo Shavings Decoction)
*Qianjin Yifang*: Zhuru Tang, primarily treats hiccups.
On this base formula, remove Renshen and Dazao, add Banxia and Zisu (Perilla Leaf).
*Sanyin Fang*: Jupi Zhuru Tang, treats stomach heat with much thirst, vomiting/hiccups and anorexia.
On this base formula, remove Dazao, add Fuling (Poria), Pipaye (Loquat Leaf), Maidong (Ophiopogon Tuber), Banxia.
*Weisheng Jiabao*: Renshen Zhuru Tang, treats all types of hiccups, and vomiting from typhoid or summerheat.
On this base formula, remove Dazao, add Banxia.
*Huoren Shizheng Fang Houji*: Jupi Tang, treats summerheat with phlegm rebellion and aversion to cold. (i.e., this formula)
*Shanghan Yunyao*: Jupi Zhuru Tang, treats stomach congestion-heat with hiccups/vomiting.
On this base formula, remove Renshen, Shengjiang, Dazao, add Banxia, Fuling, Huanglian, Gegen (Kudzu Root).
*Shanghan Dabai*: Renshen Jupi Zhuru Tang, treats stomach deficiency with hiccups.
On this base formula, remove Dazao, add Houpo (Magnolia Bark), Banxia, Huoxiang (Patchouli).
[Additional Remarks] The causes of vomiting are various. Carefully examining the classic formulas: Wuzhuyu Tang's vomiting and dry heaves are due to yin rebellion; Sini Tang's vomiting is due to yang failure; Dahuang Gancao Tang's vomiting is due to food obstruction. Apart from these, the eleven other formulas, although varying in cooling and warming properties, generally do not go beyond expelling fluid retention. Thus, we know most are caused by fluid retention. The stomach prefers dryness and dislikes dampness; therefore, when fluid retention stagnates, its qi easily rebels. Roundworms are the object that most causes vomiting, discussed in the next chapter. Hiccups only mention qi rebellion. However, in the Jaundice chapter, there is the method of Xiaobanxia Tang, implying some are caused by stagnant fluids, which can be inferred. There are several other causes, thoroughly distinguished by predecessors.
When the qi of the six fu organs fails externally,
*Yizong Jinjian* says: Qi failure does not mean absolute depletion, but deficiency failure. Zhu Shi says: The term "qi failure" should be interpreted as pathological qi being isolated. If true yin-yang qi failed, would it only manifest as cold and insensitivity of the hands and feet? Keep both theories for study. Cheng Shi also said: Without retention, there is no upper distension, middle pain, or lower urgency. The orifices are like bamboo tubes, unconstrained, flowing continuously. Hezi (Chebula Fruit) and Suske (Persimmon Calyx) are useless. Even with Lu and Bian, how could they act? This view is credible.
Diarrhea with a rapid pulse and thirst will heal spontaneously.
Note: Pathogenic heat forces blood to渗 (seep) into the intestines, hence pus and blood are passed. Wei Shi says: Heat accumulates and stagnates in the intestinal lining, brewing into foul accumulation, pus and blood follow the diarrhea downward. This is also logical.
Diarrhea with undigested food, do not attack the exterior. (*Mai Jing* has seven characters under "fullness": "there is cold in the zang organs, should be purged".)
Diarrhea with a slow and slippery pulse indicates excess.
Cheng Shi says: The classic states: A slow pulse results from eating dry food. (Note: The source of this quote is unclear and should be verified.) *Jinkui Yaolue* states: Slippery indicates abundant grain qi. Diarrhea with slow and slippery pulse indicates retained food in the stomach.
Spleen and stomach damaged by food, failing to digest water and grain, resulting in diarrhea, is internal excess. If only using medicines to warm the middle and thicken the intestines, diarrhea will certainly not stop. One may give Dachengqi Tang (Major Order the Qi Decoction) to purge the retained food, and the diarrhea will stop naturally.
After diarrhea has healed, if it recurs at the same month, day, and hour,
Zhu Shi says: Because during the initial illness of diarrhea, arbitrary medication stopped it, but the root cause was not removed. The zang qi responds to the time when the pathogen was originally contracted, causing recurrence. This view is unnecessary. Also, *Shanghan Zuanchun* states: This clause in world editions still has the five characters "should use Dachengqi Tang", which are interpolations. Hence removed. Detailed unresolved pathogens can lie dormant for years and erupt; it must be cold pathogen. Cold pathogen can only be warmed and purged with Beiji Wan, not coldly purged with Dachengqi Tang. If it were heat pathogen, there would be no reason for year-long dormancy. This view is rigid and should not be followed. Also, various clauses in *Mai Jing·Diarrhea Chapter* are outside this classic, recorded below: A slippery pulse that feels void upon pressing indicates the person must have diarrhea. Diarrhea with abdominal pain and fullness is cold-excess, should be purged. Diarrhea with firm abdomen should be purged. Diarrhea with floating-large pulse is deficiency, caused by forceful purging. If the pulse is floating and革 (leather-like), with intestinal rumbling,
one should warm it. (In "Diseases Suitable for Warming", this clause also exists, with "should use Danggui Sini Tang"). Also in *Shanghan Lun* "Cannot Purge" section, this clause exists. It states: Wind-cold descending (likely missing "diarrhea") should not be purged. After purging, epigastric hardness and pain with slow pulse indicates cold, should be warmed. Pulse sinking-tight, purging similarly. Pulse large-floating-wiry, purging should resolve it. In "Diseases Suitable for Warming": Diarrhea desiring food should be warmed. Also: Diarrhea with slow-tight pulse indicates pain has not ceased, should be warmed. Getting cold leads to fullness and passing intestinal mucus. (This clause is recorded in *Qianjin Fang* under Diarrhea.)
*Qianjin Fang·Dysentery Section* is slightly similar to *Mai Jing*, with one additional clause: Diarrhea with painful anus should be warmed.
Zican Tang (Purple Ginseng Decoction) [Cited from *Bencao Tujing*: Gancao (Licorice Root) 2 liang, one sheng and half, made into half sheng.]
Qi diarrhea is primarily treated with Helile San (Terminalia Powder).
Zhao Shi says: Treating diseases has degrees of severity. Previously, qi diarrhea only involved promoting urination; here it promotes defecation. Where qi binds, yin and yang differ. Taking these two as examples, the six meridians can all bind, and diarrhea has its own yin and yang. Helile has both draining and astringent properties. Draining to descend saliva and eliminate retained food, break qi knots; astringing to secure the intestinal lining. Assisted by porridge drink to guide the intestines and stomach, further tonifying deficiency.
*Shenghui Fang* states: Qi dysentery is caused by insufficiency of interior and exterior, weakness of intestines and stomach, accumulation of cold qi lodging between intestines, disharmony of zang-fu, leading to leakage due to deficiency, thus becoming qi dysentery.
Helile San (Terminalia Powder)
*Bencao Tujing* states: Helile treats dysentery, not recorded in Benjing. Zhang Zhongjing treats qi dysentery using ten Helile fruits, wrapped in flour, baked, roasted in ash fire until flour turns yellow and ripe, remove core, grind finely, mix with porridge drink and take in one dose. (Etc.) Liu Yuxi of Tang Dynasty *Chuanxin Fang* states: I once suffered from red-white dysentery, tried all medicines, long unhealed, turned into white pus. General Lingfu transmitted this method: Use three good Helile fruits, two roasted for peel, one raw for peel, grind together, take with one liang of boiling rice water, plain water is also fine. If empty water dysentery, add... and it leaks qi, probably because its taste is bitter and astringent. (Note: Cheng Shi's citation differs. Cheng Shi also cites Du Ren's formula from *Bencao* Huanglian clause: Du Ren treats qi dysentery with urgency and tenesmus, using Huanglian and Ganjiang. Also cites Liu Yuxi *Chuanxin Fang*, also cited in *Bencao*.)
[Additional Remarks] Zhu Danxi said: Zhongjing treats dysentery; if suitable for warming, warm it; if suitable for purging, purge it; or release the exterior, or promote urination, or wait for self-healing. Distinguishing easy-to-treat, difficult-to-treat, and untreatable syndromes is very detailed. Yet it still conflates it with Lizhi (dysentery with pus/blood), naming formulas and discussing principles. (From *Jufang Fahui*). Generally, Chang Lizhi (intestinal dysentery) and Ruxia Huaxie (soft diarrhea and slippery discharge) have different syndromes and treatments. Zhongjing named them all "Diarrhea" and combined them into one chapter. However, investigating clause by clause, they are clearly distinct. Moreover, there is another meaning: Soft diarrhea and slippery discharge are indeed suitable for warming and securing, yet some have internal retained accumulation requiring clearing/scouring. Intestinal dysentery is indeed suitable for scouring, yet some have yang deficiency with qi sinking requiring warming and securing. Therefore, students should examine pulses and syndromes to prescribe formulas, without specifically distinguishing intestinal diarrhea. Zhongjing's combining them into one chapter might intend this. (*Nanjing* Clause 57: Dajia Xie is characterized by tenesmus, frequent visits to toilet unable to pass stool, pain in urethra, which is also Lizhi, and is one of the Five Diarrheas; its intent is consistent with Zhongjing.)
Attached Formulas
*Qianjin Yifang*: Xiao Chengqi Tang (Minor Order the Qi Decoction).
[Shen] This is dry feces internally bound, bowel obstruction and rebellion, stomach pathogen moving upward, causing frequent hiccups and delirious speech. Therefore, it is also suitable for mild purging to harmonize the middle, and cleansing heat to open knots.
*Waitai Mi Yao*: Huangqin Tang (Scutellaria Decoction).
Note: This is a variant of Huanglian Tang, also treating upper heat and lower cold, manifested as dry heaves and diarrhea.
*Yixin Fang*, Fan Wang's Formula: Treats typhoid after five or six days, vomiting and diarrhea, Huangqin Tang. (i.e., this formula)
Chapter 18: Pulse, Syndrome, and Treatment of Sores, Abscesses, Intestinal Abscesses, and Excoriations (*Mai Jing* titles it: Pulse Signs of Swelling, Intestinal Abscess, Metal Wounds, and Excoriations, which seems plausible.)
Intestinal abscess presents with rough, scaly skin on the body. (Cited from *Bencao Tujing*: Zhang Zhongjing treats abdominal abscess with pus, Yiyi Ren Fuzi Baijiang Tang.)
Note: In the next clause, the abscess has not yet ruptured into pus, hence the lower abdomen is swollen and firm. In this clause, since pus has already formed, palpation feels soft like swelling, with no masses in the abdomen. In the next clause, blood is still stasis, Ying qi is constrained and Wei qi blocked, hence occasional fever and aversion to cold. The disease is still excess, hence the pulse is slow and tight. In this clause, Ying qi is no longer constrained, hence no fever. When pus forms, blood dries, hence the pulse is rapid. In summary, the distinction between these two clauses lies in whether pus has formed or not, regardless of location. As previous commentators distinguished by large and small intestines, this is likely pedantic.
Also, *Sanyin Fang* cites this clause saying: It is formed by long-term accumulation of yin-cold. Hence *Jinkui* uses Fuzi to warm it. Citing the next clause saying: It is formed by internal binding of heat. Hence *Jinkui* uses Dahuang to drain it. This is also unacceptable.
Dahuang Mudan Tang (Rhubarb and Moutan Decoction) [Er Yan says: For the previous clause, one should follow *Chaoyuan*, delete "urination is normal" and add "frequent urination" under Lin syndrome, for logic to be smooth.]
Note: For abscess diseases, whether external or internal, in the early stage, while unruptured, attack it. Once formed, support righteous qi to push toxins outward. Hence Tingli Dazao Xiefei Tang is the treatment for lung abscess to purge toxins. Jiegeng Tang is the treatment for lung abscess to drain pus. Dahuang Mudan Tang is the treatment for intestinal abscess to purge toxins. Yiyi Fuzi Baijiang San is the treatment for intestinal abscess to drain pus. Generally, surgical formulas vary from these two ends, which are also Zhongjing's principles.
Also, the post-formula note "has pus" implies pus is just beginning to form, different from the previous clause where it is fully rotted and溃 (ruptured).
*Shengji Zonglu*: Meiren Tang, treats intestinal abscess with urgency and hidden pain, constipation.
On this base formula, replace Taoren (Peach Kernel) with Meiheren (Plum Kernel), use Dongguaren (Winter Melon Seed), add Xijiao (Rhinoceros Horn - *Note: Substitute with Niuhuang or other legal alternatives in modern practice, though text says Xijiao*). (According to original formula of *Qixiao Meiren San*.)
Question: The cunkou pulse is floating, faint, and choppy.
[Jian] Faint pulse indicates qi depletion. Choppy pulse indicates blood depletion. Hence it is said: Legally, this should involve blood loss or sweating. If there are no such diseases as blood loss or sweating, then there must be a sore/wound, blood loss from knife/axe injury. Note: The phrase "not sweating" should read "if there is no blood loss or sweating". Now it specifically mentions not sweating but omits not losing blood, which is an ellipsis. *Yizong Jinjian* is correct. Also, "chuang" (sore) anciently written as "chuang" (create/injure), i.e.,