治伤寒五六日呕而发热者。柴胡证具。而以他药下之。柴胡证仍在者。复与
此虽以下之。不为逆。必蒸蒸而振。却发热汗出而解。若心下满而硬痛者。此为结胸也。大
陷胸汤主之。但满而不痛者。此为痞。柴胡不中与之。宜此汤。
半夏（半升 洗。） 黄芩（三两） 干姜（三两） 甘草（三两） 人参（三两） 黄
连（
上七味。以水一斗。煮取六升。去渣再煎。取三升。温服一升。日三服。
歌曰 三两姜参炙草芩。一连痞证呕多寻。半升半夏枣十二。去滓重煎守古箴。
蔚按。师于此证。开口即云伤寒五六日呕而发热柴胡证俱在者。五六日乃厥阴主气之期。
厥
结胸。但满而不痛者为痞。痞者否也。天气不降地气不升之义也。芩、连大苦以降天气。姜、
枣、人参辛甘以升地气。所以转否而为泰也。君以半夏者。因此证起于呕。取半夏之降逆止
呕如神。亦即小柴胡汤去柴胡加黄连。以生姜易干姜是也。古人治病。不离其宗如此。
结胸为阳邪。脏结与痞为阴邪。但脏结结于下。痞结结于上也。结于下者感下焦阴寒之
气化
治太阳中风。下利呕逆表解者。乃可攻之。其人 汗出。发作有时。头痛。心下
满引胁下痛。干呕短气。汗出不恶寒者。此表解里未和。此方主之。
芫花（熬。） 甘遂 大戟
上三味等分。各别捣为散。以水一升半。先煮大枣肥者十枚。取八合。去渣。内药末。
强人服一钱匕。羸者服半钱匕。温服之。平旦服。若下少病不除者。明目更服。加半钱匕。
得快下利后。糜粥自养。
歌曰 大戟芫花甘遂平。妙将十枣煮汤行。中风表证全除尽。里气未和此法程。
蔚按。太阳为天。天连于水。太阳中风。风动水气。水气淫于上则呕逆。水气淫于下则
下利。水气聚于心下。则为痞且硬满引胁而痛也。其人 汗出。头痛。干呕短气。汗出等
证。宜辨。若恶寒为表未解。不可攻之。若不恶寒为表解而里未和。宜用此汤。第三味皆辛
苦寒毒之品。直决水邪。大伤元气。柯韵伯谓参、术所不能君。甘草又与之相反。故选十枣
以君之。一以顾其脾胃。一以缓其峻毒。得快利后糜粥自养。一以使谷气内充。一以使邪不
复作。此仲景用毒攻病之法。尽美又尽善也。
治疗伤寒五六天，出现呕吐且发热的症状。如果小柴胡汤证（少阳病证）具备，却误用其他药物进行攻下治疗。若小柴胡汤证仍然存在，再次给予小柴胡汤。虽然经过攻下治疗，但并未造成变证（逆证）。服药后必然会出现全身蒸蒸发热并伴有寒战的现象，随后发热出汗而病愈。如果心下部胀满且坚硬疼痛的，这是结胸证。应当用大陷胸汤主治。如果只是胀满而不疼痛的，这是痞证。此时不宜用小柴胡汤，适宜使用半夏泻心汤。
半夏（半升，洗净。） 黄芩（三两） 干姜（三两） 甘草（三两，炙） 人参（三两） 黄连（一两） 大枣（十二枚，擘开。）
以上七味药，用水一斗，煮取六升药液，去除药渣后再煎煮，取三升药液。每次温服一升，每日服用三次。
歌诀曰：三两生姜、人参、炙甘草、黄芩，一两黄连用于寻找治疗痞证多呕的方法。半升半夏配十二枚大枣，去滓重煎以遵守古法箴言。
蔚按（陈念祖按语）：老师在论述此证时，开篇即说“伤寒五六日，呕而发热，柴胡证俱在”。五六日是厥阴主气的时期。厥阴之气不降，则导致结胸；只有胀满而不疼痛的，称为痞。痞，就是“否”的意思，指天气不下降、地气不上升的闭塞状态。黄芩、黄连大苦之性用以降天气；干姜、大枣、人参辛甘之性用以升地气。这就是将闭塞转为通泰的方法。以半夏为君药，是因为此证起因于呕吐，取半夏降逆止呕的神奇功效。这也相当于小柴胡汤去掉柴胡加上黄连，并用干姜代替生姜。古人治病，不离其根本宗旨如此。
结胸属于阳邪，脏结与痞属于阴邪。但脏结结聚在下部，痞结结聚在上部。结聚在下部的，感受的是下焦阴寒之气化……（原文此处中断）
治疗太阳中风证，出现腹泻、呕吐逆气，表证已解除的，才可以攻里。其人汗出，发作有定时，头痛，心下部胀满牵引胁下疼痛，干呕，短气，汗出且不恶寒的，这是表证已解而里气未和，此方主治。
以上三味药等分，分别捣碎过筛成散剂。用水一升半，先煮肥大的大枣十枚，取八合药汁，去除药渣。加入药末。体质强壮的人服用一方寸匕，体弱的人服用半方寸匕。温服。清晨空腹服用。如果泻下较少，病邪未除的，次日再服，增加半方寸匕。得到快速泻下利后，喝稀粥自行调养。
歌诀曰：大戟、芫花、甘遂用量相等，妙在用十枚大枣煮汤送服。中风表证完全清除后，里气未和就用这种方法调理。
蔚按（陈念祖按语）：太阳对应天，天连接着水。太阳中风，风动则水气随之而动。水气淫溢于上部则呕吐逆气，水气淫溢于下部则腹泻。水气聚积于心下，就会形成痞块且硬满，牵引胁下疼痛。其人汗出、头痛、干呕、短气、汗出等症状，应当仔细辨别。如果恶寒，说明表证未解，不可攻里。如果不恶寒，说明表证已解而里气未和，适宜使用此汤。第三味药（指甘遂、大戟、芫花）都是辛苦寒毒的药物，直接决泄水邪，会大伤元气。柯韵伯认为人参、白术不能胜任君药，甘草又与之相反（十八反），所以选择十枚大枣作为君药。一是为了顾护脾胃，二是为了缓和药物的峻烈毒性。得到快速泻利后喝稀粥自养，一是为了使谷气内充，二是为了防止邪气复发。这是张仲景用毒药攻治病邪的方法，尽善尽美啊。
<Treatment of Taiyang disease (Exterior Syndrome) for five or six days, presenting with vomiting and fever. If the Shaoyang syndrome (Lesser Yang Syndrome) signs are present, but it was mistakenly treated with purgatives, and the Shaoyang syndrome signs remain, administer this formula again. Although purged, it does not constitute a complication (Ni). It will inevitably result in a feeling of heat rising from within accompanied by chills, followed by fever, sweating, and resolution. If there is fullness and hardness with pain in the epigastrium, this is Jie Xiong (Chest Binding). Da Xian Xiong Tang (Major Downward Draining Decoction) should be used. If there is only fullness without pain, this is Pi (Stagnation/Blockage). Xiao Chai Hu Tang (Minor Chest Harmony Decoction) is not appropriate; this decoction is suitable.
Ban Xia (Pinelliae Rhizoma, half sheng, washed.) Huang Qin (Scutellariae Radix, three liang) Gan Jiang (Zingiberis Rhizoma, three liang) Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata, three liang) Ren Shen (Ginseng Radix, three liang) Huang Lian (Coptidis Rhizoma, one liang) Da Zao (Jujubae Fructus, twelve pieces, split open.)
Take these seven ingredients, add ten dou of water, boil to obtain six sheng of liquid, remove the dregs, and decoct again to obtain three sheng. Take one sheng warm, three times a day.
Song says: Three liang each of Ginger, Ginseng, Prepared Licorice, and Scutellaria; One liang of Coptidis seeks to find the remedy for Pi syndrome with much vomiting. Half sheng of Pinellia and twelve Jujubes; Remove dregs and decoct again to keep the ancient wisdom.
Commentary by Wei: The Master begins this discussion by stating "Taiyang disease for five or six days, vomiting and fever, Shaoyang signs are all present." Five or six days is the period governed by Jueyin (Greater Yin). When Jueyin qi fails to descend, it leads to Jie Xiong (Chest Binding); when there is only fullness without pain, it is called Pi (Stagnation). Pi implies "Pi" (Obstruction), meaning heaven's qi does not descend and earth's qi does not ascend. Scutellaria and Coptidis, being greatly bitter, descend heaven's qi; Dried Ginger, Jujube, and Ginseng, being acrid and sweet, ascend earth's qi. Thus, obstruction is transformed into harmony. Pinellia is used as the sovereign herb because this syndrome originates from vomiting, utilizing Pinellia's miraculous ability to direct rebellious qi downward and stop vomiting. This is essentially Xiao Chai Hu Tang (Minor Chest Harmony Decoction) with Chai Hu removed, Huang Lian added, and Sheng Jiang replaced by Gan Jiang. Ancient physicians treated diseases without departing from their fundamental principles.
Jie Xiong (Chest Binding) belongs to Yang pathogenic factors; Zang Jie (Visceral Binding) and Pi (Stagnation) belong to Yin pathogenic factors. However, Zang Jie binds in the lower part, while Pi binds in the upper part. Those binding in the lower part are affected by the yin-cold qi transformation of the Lower Jiao... [Text cuts off]
For Taiyang Zhong Feng (Wind Strike), if diarrhea and vomiting/reversal occur, and the exterior syndrome has resolved, then internal purging may be performed. If the patient has sweating that occurs at specific times, headache, fullness in the epigastrium radiating to the hypochondrium, dry retching, shortness of breath, sweating without aversion to cold, this indicates the exterior is resolved but the interior is not harmonized. This formula governs.
Yuan Hua (Genkwa Flos, processed.) Gan Sui (Kansui Radix) Da Ji (Euphorbiae Pekinensis Radix)
These three ingredients in equal parts, each separately pounded into powder. Add one sheng and half of water, first boil ten large Jujubes until eight ge remains, remove dregs, and add the medicinal powder. Strong persons take one cun bi (one square-inch spoonful); weak persons take half a cun bi. Take warm. Administer on an empty stomach at dawn. If the purgation is insufficient and the disease persists, take again the next day, increasing by half a cun bi. After rapid purgation, nourish oneself with millet porridge.
Song says: Euphorbia, Genkwa, and Kansui are equal; The wonder lies in boiling ten Jujubes to administer. When Wind Strike exterior signs are completely cleared, this method harmonizes the interior qi.
Commentary by Wei: Taiyang corresponds to Heaven, and Heaven connects to Water. In Taiyang Zhong Feng, wind moves the water qi. If water qi overflows upward, it causes vomiting and reversal; if it overflows downward, it causes diarrhea. If water qi gathers in the epigastrium, it forms Pi and hardness, radiating pain to the hypochondrium. Symptoms such as sweating, headache, dry retching, shortness of breath, and sweating must be differentiated. If there is aversion to cold, the exterior is not resolved, and purging is contraindicated. If there is no aversion to cold, the exterior is resolved but the interior is unharmonized, making this decoction suitable. The third category of herbs (Gan Sui, Da Ji, Yuan Hua) are acrid, bitter, cold, and toxic substances that directly drain water pathogens but severely damage primordial qi. Ke Yunbo stated that Ren Shen (Ginseng) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) cannot serve as sovereigns, and Gan Cao (Licorice) is incompatible (Eighteen Incompatibilities). Therefore, ten Jujubes are chosen as the sovereign. One purpose is to protect the Spleen and Stomach; another is to moderate the harsh toxicity. Nourishing with porridge after rapid purgation serves two purposes: to fill the interior with grain qi and to prevent the recurrence of pathogens. This is Zhang Zhongjing's method of using toxic substances to attack disease, perfect in both beauty and goodness.