如阳气衰疲，寒湿凝滞，证见身体痛，手足寒，骨节痛，背恶寒，口中和，脉沉，是附子汤证，即无热恶寒之证；有阳气虚衰，水寒泛溢，证见腹痛，小便不利，四肢沉重疼痛，下利，是真武证；若大汗大下利而厥冷，或下利清谷，为纯阴无阳，是四逆汤证；有下利清谷，里寒外热，手足厥逆，脉微欲绝，身反不恶寒，证为格阳，是里真寒而外假热，为通脉四逆证；若下利，脉微，面色赤，证为戴阳，是下真寒而上假热，为白通证。前证见下利不止，厥逆无脉，干呕心烦。病机为阴寒盛于下，虚阳扰于上，当于姜附回阳救逆主药中，参入人尿、猪胆汁咸寒苦降，是为从治之法，并寓对证而治之义。然少阴病初起，阳虚不甚，见反发热，无汗，脉沉，用温阳解表两解之法，如麻附细辛、甘草汤类是也。至于少阴病，心中烦，不得眠，是肾水竭于下，心火亢于上，用黄连阿胶汤，取滋阴降火之法以治；有下利咳而呕渴，心烦不得卧，是少阴阴虚水气内结之证，宜用猪苓汤以育阴利水；若利久伤阴，证见下利咽痛，胸满心烦，用猪肤汤，取滋阴和中之法，亦即精不足者，补之以味之治法。以上三者，直是少阴阴虚热化证类矣。
肝主藏血，主疏泄。肝脉循胸胁，属肝，络胆，挟胃，贯膈，循阴器，抵少腹，上与心火相接，下与肾水为邻。故厥阴肝经受病，最易导致脾胃功能失常，而为寒热错杂上热下寒之证，如“厥阴之为病，消渴，气上撞心，心中疼热，饥而不欲食，食即吐蛔，下之利不止”（３２６条）是也。若肝失疏泄，火热内郁，下迫大肠，而为下利后重或便脓血，渴欲饮水，脉弦数，则是厥阴热利，用白头翁汤，取苦寒之品，以凉肝坚肠。若肝寒犯胃，浊阴上逆，证见干呕吐涎沫，头痛者，吴茱萸汤主之。用暖肝和胃化饮降逆之法，直是厥阴脏寒证治法。
关于腑病病机，简略言之：如膀胱为太阳之腑，太阳主寒水之化，太阳表病不解，病邪由表入腑，“若脉浮，小便不利，微热，消渴者，五苓散主之”（７１条）。病由寒水蓄于膀胱，阳气不得宣化，故上见烦渴，下而小便不利。此与“膀胱者，州都之官，津液藏焉，气化则能出矣”（《素问·灵兰秘典论》），正可互相印证。是此烦渴，当由气不化津所致，与胃热津伤之烦渴，自有本质不同，故仲景首与“胃中干，烦躁不得眠，欲得饮水者”（７１条），谆谆为辨，可以会意。胃与大肠为第三卷１９１阳明之腑，阳明主燥热之化。胃燥热盛，津液受劫，出现身大热，汗自出，不恶寒，反恶热，大烦渴不解，脉洪大滑数，宜清法；若见潮热，谵语，腹胀满痛拒按，大便不通，脉沉实，苔黄燥，属腑热结实，宜下法。然此则不仅属胃，而且有关乎肠矣。但与三焦为少阳之腑，少阳主火化。胆火上炎，故少阳病以口苦、咽干、目眩为提纲。胆气不舒，枢机不利，最易侵犯脾胃，故少阳病以往来寒热，胸胁苦满，默默不欲饮食，心烦喜呕为主证。三焦为决渎之官，主通调水道。故少阳或然证，如水气犯肺，有“或咳者”；水气结聚于胸胁，有“胁下痞硬者”；水气结于下焦，有“心下悸、小便不利者”。因水气变动不居，故见证如是也。
人体疾病受体内外各种条件的影响，病机变化复杂多端。一般来说，疾病单纯者少，合并者多。举例言之，如半夏、生姜、甘草三泻心汤，黄连汤，干姜芩连人参汤，均寓有脾胃同治之法。“伤寒二三日，心下悸而烦者，小建中汤主之”（１０２条），是心脾同治之法。“伤寒，阳脉涩，阴脉弦，法当腹中急痛，先与小建中汤，……”（１００条），是肝脾同治之法。“自利不渴者，属太阴，以其脏有寒故也；当温之，宜服四逆辈”（２７７条），治法寓有脾肾并治之义。推之太阳病外寒里饮，用小青龙汤，方中有细辛、干姜、五味子温中化饮，可以悟出脾肺同治之理。更有少阴病，水寒泛溢，“若咳者”，用真武汤加五味子、细辛、干姜，则是肾脾肺同治之法。凡此诸例，不仅限于伤寒，而杂病治法，亦可仿此类推也。
水、血、痰、食、气郁，为杂病中常见病种。水病机制，古人有其标在肺、其制在脾、其本在肾之说，实则三焦主通调水道，膀胱主调节水液，与水病关系密切。《伤寒论》中，如小青龙汤治外寒束表，水寒射肺而咳喘；五苓散治表邪入里，腑有蓄水；真武汤治少阴阳虚，寒水泛溢，此皆水病之荦荦大者。又如苓桂术甘汤治“伤寒若吐若下后，心下逆满，气上冲胸，起则头眩，脉沉紧”（６７条）。“伤寒厥而心下悸，宜先治水，当服茯苓甘草汤”（３５６条）。二者病位同在中焦，用药略同。惟前者重在脾不健运，故主白术以健脾利水；后者心阳不宣，故与生姜以宣散水气。小柴胡或然证或咳，或胁下痞硬，或心下悸、小便不利，亦与水气变动不羁有关，说已详前。此外，“大病差后，从腰下有水气，牡蛎泽泻散主之”（３９５条），是水病实证治法，亦是通利二便之法。
痰者，淡也，是水气一类，与今以清稀者为饮、稠粘者为痰之说有异。伤寒注家以大结胸病为水热结实，小结胸病则是痰热相结。又桂枝救逆汤治亡阳惊狂，中用蜀漆，亦寓辛开涤痰之义。另外，十枣汤治悬饮，可与《金匮》互参。以上三者，一主清化，一主温化，一主攻逐，一般痰饮治法，，正可从此处而得到启发。
太阳蓄血三方，桃核承气汤治“其人如狂”，“少腹急结”（１０６条）；抵当汤治“脉微而沉，其人发狂，少腹硬满”（１２４条）疼痛；抵当丸治“少腹满”（１２６条）。仲景论蓄血，血瘀之轻重宛然，治法之缓急自殊，制剂之汤丸悉备。其成因或“以太阳随经瘀热在里故也”（１２４条），或“本有久瘀血”（２３７条），此虽指蓄血而言，其它如水气痰食等在热病过程中所形成之原因，亦可由此一隅三反。
阳明承气三方，调胃承气汤治腑热燥实，为和下之剂；小承气汤为轻下之剂，治腹胀满，大便硬；大承气汤为峻下之剂，治痞满燥实坚俱备之证，取其泻下燥屎。所谓燥屎，即阳明燥热与有形宿食相结。其形成原因，仲景谓“本有宿食故也”（２４１条）。然在外感热病过程中，食物不节，亦能导致食物停滞。如“大病差后，劳复者，枳实栀子汤主之”。“若有宿食也，加大黄。
……”（３９３条）。“若下利谵语者，有燥屎者，宜小承气汤”（３７４条）。何也？因下利热结旁流，虽重在热结，但因邪热尚有出路，故不宜下，只取轻下。又“伤寒汗出解之后，胃中不和，心下痞第三卷１９２硬，干噫食臭，胁下有水气，腹中雷鸣下利者，生姜泻心汤主之”（１５７条），则是脾胃不和水食停滞之证，用辛开苦降散痞解结之法，当是虚证夹食之治法，与宿食用下法者不同。
“少阴病，四逆，……四逆散主之”（３１８条）。此条叙证不详，以方测证，当是肝郁气结，致使阴阳气不相顺接而为厥。载于少阴篇，是与阳衰阴盛之厥冷四逆，作出比较鉴别。然从气病广义言之，人体营卫流行，气血充注，环周不休，而无一息之停。若一气偶愆，即可着而为病。
故仲景论气郁，并非只此一端。如麻杏石甘汤轻宣肺气，三承气汤通下腑气，大、小柴胡汤之舒胆气利枢机等等，皆可谓从气郁证治着手。以上所述，可见仲景伤寒杂病合论之旨。
２从《金匮》中探索灵活运用伤寒方之法则《伤寒论》与《金匮要略》两书，有证候相同而用同一治法与方药，如下利、呕逆、黄疸等条文，两书互见而不嫌其复。惟是《金匮要略》一书，重点在阐述杂病之机理及其治疗大法。然所用伤寒方，六经俱备。由此而推衍伤寒方能治杂病之理及治疗法则，殊有必要。例如“病溢饮者，当发其汗，大青龙汤主之，小青龙汤亦主之”（《痰饮咳嗽病脉证并治第十二》）。所谓溢饮，当如《金匮》所云，自有“饮水流行，归于四肢，当汗出而不汗出，身体疼重”之典型症状，而无头痛恶寒发热之表证。考《金匮》又治“咳逆，倚息不得卧，小青龙汤主之”。大青龙方，即麻黄汤倍麻黄加石膏、姜、枣，石膏之用，当为烦躁而设。故小青龙加石膏汤治“肺胀，咳而上气，烦躁而喘，脉浮者，心下有水”（《肺痿肺痈咳嗽上气病脉证并治第七》），其证亦有烦躁，其方加用石膏，用意可知。故小青龙以无汗而咳喘为主证，大青龙以不汗出而烦躁为主证；或属伤寒，或属溢饮，皆当有此共同症状也。
五苓散本治太阳蓄水证，《伤寒论》谓“有表里证”（７４条）。表证，是指中风恶风发热汗出脉浮；里证，当针对小便不利，少腹里急，烦渴等而言。但《金匮》“假令瘦人脐下有悸，吐涎沫而癫眩，此水也”（《痰饮咳嗽病脉证并治第十二》），亦主用五苓散，何也？盖此与苓桂术甘证“心下逆满，气上冲胸，起则头眩”（６７条）类似。但彼病位在心下，重在中焦脾虚而不能转输精微；此则病位在脐下，病由下焦蓄水，阳气不能宣化水气，故虽无太阳表证，亦用五苓散以通阳导下化气行水也。
白虎汤本治阳明气分热证，当如大论所云，自有身大热，汗自出，不恶寒，反恶热，烦渴，脉洪大等脉证，然《金匮》“太阳中热者，是也，汗出恶寒身热而渴，白虎加人参汤主之”（《痉湿病脉证治第二》）。证见恶寒，亦用白虎，此何以故？盖暑热伤气，故古人有夏暑发自阳明之喻。
气热炎炎，汗出肌疏，故身恶寒与太阳表证不同；当据汗出身热烦渴等主证，直用白虎汤清阳明气分大热，加人参以益元气，生津液。又如《金匮》“渴欲饮水，口干舌燥者，白虎加人参汤主之”（《消渴小便不利淋病脉证并治第十三》），此是三消中上消证。由于肺胃热盛，气津耗竭，虽无身热汗出，亦可用白虎加人参汤以清热益气生津。
大承气汤为枳、朴、硝、黄四味，是峻下之剂，主治阳明腑实重证，症状有潮热，谵语，手足然汗出，腹胀满疼痛，大便不通，舌苔黄，脉沉实等，多由阳明邪热与宿食搏结而成，名曰燥屎。
然《金匮》“人病有宿食者，何以别之？师曰：寸口脉浮而大，按之反涩，尺中亦微而涩，故知有宿食，大承气汤主之”（《腹满寒疝宿食病脉证治第十》），是纯属宿食，未成燥屎，当无潮热谵语汗出等证。惟仲景施用攻下之法，一般采取审慎态度，故有欲用大承气先与小承气之试法。今因宿食久结于里，自非通下之剂，莫能缓解。既用大承气，自有可攻之证存在，故又曰：“腹满不减，减不足言，当须下之，宜大承气汤”。小承气汤为枳、朴、大黄三味，是轻下之剂。主证有潮第三卷１９３热、谵语、汗出、腹胀满、大便硬等。然《金匮》“痛而闭者，厚朴三物汤主之”。此方药味与小承气同，但主证重在腹满疼痛，大便不通，而无潮热谵语，故治法以破气导滞为主，故而枳、朴药量特重，是虽同样三味药，而主次分明，用药与证候悉悉相合，可悟经方加减变化之妙。
大柴胡汤为少阳病主方之一，适用于少阳里实之证。故“伤寒十余日，热结在里，复往来寒热者，与大柴胡汤”（１３６条）及“呕不止，心下急，郁郁微烦”（１０３条），“伤寒发热汗出不解，心中痞硬，呕吐而下利者，大柴胡汤主之”（１６５条）。然而《金匮》治“按之心下满痛者，此为实也，当下之，宜大柴胡汤”（《腹满寒疝宿食病脉证治第十》）。此证当是少阳枢机不利，胆逆犯胃，故病位不在中焦而在上焦，满实不在腹部而在心下，与承气适用于腹满痛者有异。与大柴胡汤（《黄疸病脉证并治第十五》），自是胆气横逆，乘于脾为腹痛，逆于胃则为呕，胆汁不循常道，溢于周身，因而身、目、小便俱黄。治法或和解与通下并用，如大柴胡汤；或于和解中兼和营止痛之法，如小柴胡汤去黄芩加芍药。然从临床实际情况分析，此证当属阳黄，黄芩可以不去。
理中汤一名人参汤，是太阴脏寒证主方。考太阴主证为“腹满而吐，食不下，自利益甚，时腹自痛”（２７３条）。若《金匮》“胸痹，心中痞气，气结在胸，胸满，胁下逆抢心，……人参汤亦主之”（《胸痹心痛短气病脉证治第九》），当是胸中阳虚，痰饮与留气痹结于胸，而为胸痹，与胸痹实证治法，自有不同。按此证用温中法，当与大论“大病差后，喜唾，久不了了，胸上有寒，当以丸药温之，宜理中丸”（３９７条）的证治相参。
《金匮》云：“水之为病，其脉沉小，属少阴。浮者为风，无水虚胀者为气。水，发其汗即已。
脉沉者，宜麻黄附子汤”（《水气病脉证并治第十四》）。麻附甘草汤本治少阴病二三日，无下利厥逆等里证，有反发热、无汗、脉沉表证。此用以治水病，当无发热表证。然阳气衰疲，水寒不化，浸渍于表，而为肤肿。故用此温阳解表一法，温阳使浊阴痹者能通；解表则水邪自有出路，而能向外宣透而解。证候不同，病机略同，故治法可以互通。李氏治水气为病，如寒用真武方，热用猪苓汤，皆从“属少阴”一语悟出，是又不仅一麻黄附子汤可治水病而已。
如果阳气衰疲，寒湿凝滞，症状表现为身体疼痛、手足寒冷、骨节疼痛、背部怕冷、口中平和（无口干口苦）、脉象沉，这是附子汤证，即没有发热而恶寒的证候；如果有阳气虚衰，水寒之气泛溢，症状表现为腹痛、小便不利、四肢沉重疼痛、腹泻，这是真武汤证；如果出现大汗或严重腹泻导致四肢厥冷，或者排出未消化的食物残渣，属于纯阴无阳的状态，这是四逆汤证；如果有腹泻排出未消化食物、体内寒冷体外发热、手足冰冷、脉搏微弱几乎摸不到、身体反而不怕冷，证候为格阳，这是体内真寒而体表假热，属于通脉四逆汤证；如果有腹泻、脉象微弱、面色发红，证候为戴阳，这是下部真寒而上部假热，属于白通汤证。上述前一种情况出现腹泻不止、四肢厥冷、无脉、干呕、心烦。病机为阴寒盛于下焦，虚阳扰动于上焦，应当在姜、附子等回阳救逆的主药中，加入人尿、猪胆汁等咸寒苦降之品，这是从治法，同时也蕴含了对证治疗的意义。然而少阴病初起，阳虚不严重，出现反常发热、无汗、脉沉，应用温阳解表两解的方法，如麻黄附子细辛汤、甘草汤之类。至于少阴病，心中烦躁、无法入睡，是肾水枯竭于下、心火亢盛于上，使用黄连阿胶汤，采取滋阴降火的方法来治疗；有腹泻、咳嗽、呕吐、口渴、心烦无法卧睡，是少阴阴虚水气内结的证候，适宜使用猪苓汤来育阴利水；如果长期腹泻损伤阴液，症状表现为腹泻、咽痛、胸满、心烦，使用猪肤汤，采取滋阴和中的方法，也就是“精不足者，补之以味”的治疗法则。以上三种情况，直接就是少阴阴虚热化证的类别了。
肝主藏血，主疏泄。肝脉循行经过胸胁，归属于肝，联络胆，夹胃，贯穿膈肌，循行经过生殖器，抵达小腹，上与心火相接，下与肾水相邻。所以厥阴肝经受病，最容易导致脾胃功能失常，从而形成寒热错杂、上热下寒的证候，如“厥阴病的症状是：消渴，气向上冲撞心脏，心中疼痛且有灼热感，饥饿但不想吃东西，吃了就会吐蛔虫，如果用泻下法会导致腹泻不止”（第326条）就是这样。如果肝失疏泄，火热内郁，向下逼迫大肠，形成腹泻伴肛门重坠感或脓血便，口渴想喝水，脉象弦数，这就是厥阴热利，使用白头翁汤，采取苦寒性质的药物，以凉肝坚肠。如果肝寒侵犯胃腑，浊阴之气上逆，症状表现为干呕、吐出涎沫、头痛者，用吴茱萸汤主治。采用暖肝和胃、化饮降逆的方法，这直接就是厥阴脏寒证的治疗方法。
关于腑病的病机，简略地说：如膀胱是太阳之腑，太阳主管寒水的化生，太阳表证不解，病邪由表入腑，“如果脉浮、小便不利、微热、消渴的，用五苓散主治”（第71条）。病因为寒水蓄积在膀胱，阳气不能宣发化生，所以上面见到烦渴，下面见到小便不利。这与“膀胱者，州都之官，津液藏焉，气化则能出矣”（《素问·灵兰秘典论》），正好可以互相印证。因此这种烦渴，应当是由气不化津所致，与胃热津伤引起的烦渴，自有本质不同，所以张仲景首先与“胃中干燥，烦躁不得眠，想要喝水的人”（第71条），谆谆告诫加以辨别，可以领会其意。胃与大肠是第三卷191页阳明之腑，阳明主管燥热的化生。胃中燥热盛，津液被劫夺，出现身体大热、汗自出、不怕冷反而怕热、大烦渴不解、脉象洪大滑数，适宜用清法；如果见到潮热、谵语、腹胀满痛拒按、大便不通、脉象沉实、舌苔黄燥，属于腑热结实，适宜用下法。然而这不仅属于胃，而且关系到肠了。三焦是少阳之腑，少阳主管火化。胆火上炎，所以少阳病以口苦、咽干、目眩为提纲。胆气不舒，枢机不利，最容易侵犯脾胃，所以少阳病以往来寒热、胸胁苦满、默默不欲饮食、心烦喜呕为主证。三焦为决渎之官，主管通调水道。所以少阳病的或然证，如水气犯肺，有“或者咳嗽的”；水气结聚于胸胁，有“胁下痞硬的”；水气结于下焦，有“心下悸、小便不利的”。因为水气变动不居，所以见证如此。
人体疾病受体内外各种条件的影响，病机变化复杂多端。一般来说，单纯的疾病少，合并的疾病多。举例来说，如半夏、生姜、甘草三个泻心汤，黄连汤，干姜芩连人参汤，都寓有脾胃同治的方法。“伤寒二三日，心下悸而烦的，用小建中汤主治”（第102条），这是心脾同治的方法。“伤寒，阳脉涩，阴脉弦，法当腹中急痛，先与小建中汤，……”（第100条），这是肝脾同治的方法。“自利不渴的，属于太阴，因为其脏腑有寒的缘故；应当温之，适宜服用四逆辈”（第277条），治法寓有脾肾并治的意义。推而言之，太阳病外寒里饮，用小青龙汤，方中有细辛、干姜、五味子温中化饮，可以悟出脾肺同治的道理。更有少阴病，水寒泛溢，“如果咳嗽的”，用真武汤加五味子、细辛、干姜，则是肾脾肺同治的方法。凡此诸例，不仅限于伤寒，而杂病治法，也可以仿照此类推。
水、血、痰、食、气郁，是杂病中常见病种。水病的机制，古人有其标在肺、其制在脾、其本在肾的说法，实际上三焦主管通调水道，膀胱主管调节水液，与水病关系密切。《伤寒论》中，如小青龙汤治外寒束表，水寒射肺而咳喘；五苓散治表邪入里，腑有蓄水；真武汤治少阴阳虚，寒水泛溢，这些都是水病中显著的大证。又如苓桂术甘汤治“伤寒如果吐如果下后，心下逆满，气上冲胸，起来就头晕，脉沉紧”（第67条）。“伤寒厥而心下悸，适宜先治水，应当服茯苓甘草汤”（第356条）。二者病位同在中焦，用药大致相同。只是前者重在脾不健运，故主用白术以健脾利水；后者心阳不宣，故加生姜以宣散水气。小柴胡汤或然证或咳，或胁下痞硬，或心下悸、小便不利，也与水气变动不羁有关，前面已详细说明。此外，“大病差后，从腰下有水气，牡蛎泽泻散主治”（第395条），是水病实证治法，也是通利二便的方法。
痰者，淡也，是水气一类，与现在以清稀者为饮、稠粘者为痰的说法有所不同。伤寒注家以大结胸病为水热结实，小结胸病则是痰热相结。另外桂枝救逆汤治亡阳惊狂，其中用蜀漆，也寓有辛开涤痰的意义。另外，十枣汤治悬饮，可与《金匮要略》互参。以上三者，一主清化，一主温化，一主攻逐，一般痰饮治法，正可从此处得到启发。
太阳蓄血三方，桃核承气汤治“其人如狂”，“少腹急结”（第106条）；抵当汤治“脉微而沉，其人发狂，少腹硬满”（第124条）疼痛；抵当丸治“少腹满”（第126条）。张仲景论述蓄血，血瘀的轻重宛然可见，治法的缓急自然不同，制剂的汤丸齐全。其成因或“因为太阳随经瘀热在里故也”（第124条），或“本来就有久瘀血”（第237条），这虽然指蓄血而言，其他如水气痰食等在热病过程中所形成的原因，也可以由此举一反三。
阳明承气三方，调胃承气汤治腑热燥实，为和下之剂；小承气汤为轻下之剂，治腹胀满，大便硬；大承气汤为峻下之剂，治痞满燥实坚俱备的证候，取其泻下燥屎。所谓燥屎，即阳明燥热与有形宿食相结。其形成原因，张仲景说“本来有宿食故也”（第241条）。然而在外感热病过程中，饮食不节，也能导致食物停滞。如“大病差后，劳复的，枳实栀子汤主治”。“如果有宿食的，加大黄。……”（第393条）。“如果下利谵语的，有燥屎的，宜用小承气汤”（第374条）。为什么呢？因为下利热结旁流，虽然重在热结，但因为邪热尚有出路，所以不宜下，只取轻下。又“伤寒汗出解之后，胃中不和，心下痞硬，干噫食臭，胁下有水气，腹中雷鸣下利的，生姜泻心汤主治”（第157条），则是脾胃不和水食停滞的证候，用辛开苦降散痞解结的方法，应当是虚证夹食的治法，与宿食用下法者不同。
“少阴病，四逆，……四逆散主治”（第318条）。这条叙述症状不详，以方测证，应当是肝郁气结，致使阴阳气不相顺接而为厥。载于少阴篇，是与阳衰阴盛之厥冷四逆，作出比较鉴别。然而从气病广义言之，人体营卫流行，气血充注，环周不休，而无一息之停。若一气偶愆，即可着而为病。
所以张仲景论气郁，并非只有这一方面。如麻杏石甘汤轻宣肺气，三承气汤通下腑气，大、小柴胡汤之舒胆气利枢机等等，都可以说是从气郁证治着手。以上所述，可见张仲景伤寒杂病合论的宗旨。
2. 从《金匮要略》中探索灵活运用伤寒方的法则《伤寒论》与《金匮要略》两书，有证候相同而用同一治法与方药，如下利、呕逆、黄疸等条文，两书互见而不嫌其重复。只是《金匮要略》一书，重点在阐述杂病的机理及其治疗大法。然而所用伤寒方，六经俱备。由此而推衍伤寒方能治杂病的理及治疗法则，非常有必要。例如“病溢饮的，应当发其汗，大青龙汤主治，小青龙汤也主治”（《痰饮咳嗽病脉证并治第十二》）。所谓溢饮，应当如《金匮要略》所说，自有“饮水流行，归于四肢，当汗出而不汗出，身体疼重”的典型症状，而无头痛恶寒发热的表证。考《金匮要略》又治“咳逆，倚息不得卧，小青龙汤主治”。大青龙方，即麻黄汤倍麻黄加石膏、姜、枣，石膏之用，应当是为烦躁而设。所以小青龙加石膏汤治“肺胀，咳而上气，烦躁而喘，脉浮的，心下有水”（《肺痿肺痈咳嗽上气病脉证并治第七》），其证也有烦躁，其方加用石膏，用意可知。所以小青龙以无汗而咳喘为主证，大青龙以不汗出而烦躁为主证；或属伤寒，或属溢饮，皆当有此共同症状也。
五苓散本治太阳蓄水证，《伤寒论》谓“有表里证”（第74条）。表证，是指中风恶风发热汗出脉浮；里证，当针对小便不利，少腹里急，烦渴等而言。但《金匮要略》“假令瘦人脐下有悸，吐涎沫而癫眩，此水也”（《痰饮咳嗽病脉证并治第十二》），也主用五苓散，为什么呢？大概这与苓桂术甘证“心下逆满，气上冲胸，起来就头晕”（第67条）类似。但彼病位在心下，重在中焦脾虚而不能转输精微；此则病位在脐下，病由下焦蓄水，阳气不能宣化水气，故虽无太阳表证，亦用五苓散以通阳导下化气行水也。
白虎汤本治阳明气分热证，应当如大论所说，自有身大热，汗自出，不恶寒，反恶热，烦渴，脉洪大等脉证，然而《金匮要略》“太阳中热者，暍是也，汗出恶寒身热而渴，白虎加人参汤主治”（《痉湿暍病脉证治第二》）。证见恶寒，也用白虎，这是什么原因呢？大概暑热伤气，所以古人有夏暑发自阳明之喻。
气热炎炎，汗出肌疏，所以身恶寒与太阳表证不同；应当据汗出身热烦渴等主证，直用白虎汤清阳明气分大热，加人参以益元气，生津液。又如《金匮要略》“渴欲饮水，口干舌燥的，白虎加人参汤主治”（《消渴小便不利淋病脉证并治第十三》），这是三消中上消证。由于肺胃热盛，气津耗竭，虽无身热汗出，也可用白虎加人参汤以清热益气生津。
大承气汤为枳、朴、硝、黄四味，是峻下之剂，主治阳明腑实重证，症状有潮热，谵语，手足濈然汗出，腹胀满疼痛，大便不通，舌苔黄，脉沉实等，多由阳明邪热与宿食搏结而成，名曰燥屎。
然而《金匮要略》“人病有宿食的，何以别之？师曰：寸口脉浮而大，按之反涩，尺中亦微而涩，故知有宿食，大承气汤主治”（《腹满寒疝宿食病脉证治第十》），是纯属宿食，未成燥屎，应当无潮热谵语汗出等证。只是张仲景施用攻下之法，一般采取审慎态度，故有欲用大承气先与小承气的试法。今因宿食久结于里，自非通下之剂，莫能缓解。既用大承气，自有可攻之证存在，故又说：“腹满不减，减不足言，当须下之，宜大承气汤”。小承气汤为枳、朴、大黄三味，是轻下之剂。主证有潮热、谵语、汗出、腹胀满、大便硬等。然而《金匮要略》“痛而闭的，厚朴三物汤主治”。此方药味与小承气同，但主证重在腹满疼痛，大便不通，而无潮热谵语，故治法以破气导滞为主，故而枳、朴药量特重，是虽同样三味药，而主次分明，用药与证候悉悉相合，可悟经方加减变化之妙。
大柴胡汤为少阳病主方之一，适用于少阳里实之证。所以“伤寒十余日，热结在里，复往来寒热的，与大柴胡汤”（第136条）及“呕不止，心下急，郁郁微烦”（第103条），“伤寒发热汗出不解，心中痞硬，呕吐而下利的，大柴胡汤主治”（第165条）。然而《金匮要略》治“按之心下满痛的，此为实也，当下之，宜大柴胡汤”（《腹满寒疝宿食病脉证治第十》）。此证应当是少阳枢机不利，胆逆犯胃，故病位不在中焦而在上焦，满实不在腹部而在心下，与承气适用于腹满痛者有异。与大柴胡汤（《黄疸病脉证并治第十五》），自是胆气横逆，乘于脾为腹痛，逆于胃则为呕，胆汁不循常道，溢于周身，因而身、目、小便俱黄。治法或和解与通下并用，如大柴胡汤；或于和解中兼和营止痛之法，如小柴胡汤去黄芩加芍药。然而从临床实际情况分析，此证当属阳黄，黄芩可以不去。
理中汤一名人参汤，是太阴脏寒证主方。考太阴主证为“腹满而吐，食不下，自利益甚，时腹自痛”（第273条）。若《金匮要略》“胸痹，心中痞气，气结在胸，胸满，胁下逆抢心，……人参汤也主治”（《胸痹心痛短气病脉证治第九》），应当是胸中阳虚，痰饮与留气痹结于胸，而为胸痹，与胸痹实证治法，自有不同。按此证用温中法，应当与大论“大病差后，喜唾，久不了了，胸上有寒，当以丸药温之，宜理中丸”（第397条）的证治相参。
《金匮要略》云：“水之为病，其脉沉小，属少阴。浮者为风，无水虚胀者为气。水，发其汗即已。
脉沉者，宜麻黄附子汤”（《水气病脉证并治第十四》）。麻附甘草汤本治少阴病二三日，无下利厥逆等里证，有反发热、无汗、脉沉表证。此用以治水病，应当无发热表证。然而阳气衰疲，水寒不化，浸渍于表，而为肤肿。故用此温阳解表一法，温阳使浊阴痹者能通；解表则水邪自有出路，而能向外宣透而解。证候不同，病机略同，故治法可以互通。李氏治水气为病，如寒用真武方，热用猪苓汤，皆从“属少阴”一语悟出，是又不仅一麻黄附子汤可治水病而已。
If Yang Qi is deficient and fatigued, with cold-dampness coagulating and stagnating, symptoms manifest as body pain, cold hands and feet, joint pain, aversion to cold in the back, a harmonious mouth (no dryness or bitter taste), and a deep pulse. This is the Fuzi Tang (Aconite Decoction) syndrome, representing a condition of aversion to cold without fever. If there is deficiency and decline of Yang Qi, with cold-water overflowing, symptoms include abdominal pain, difficulty in urination, heaviness and pain in the four limbs, and diarrhea. This is the Zhenwu Tang (True Warrior Decoction) syndrome. If massive sweating or severe diarrhea leads to cold extremities, or if undigested food is passed in the stool, it belongs to a state of pure Yin and absence of Yang, which is the Sini Tang (Frigid Extremities Decoction) syndrome. If there is diarrhea passing undigested food, internal cold with external heat, cold extremities, a faint pulse nearly imperceptible, and the body actually feels no aversion to cold, the syndrome is Ge Yang (Gridlock Yang), indicating true internal cold and false external heat, which is the Tongmai Sini Tang (Pulse-Reviving Frigid Extremities Decoction) syndrome. If there is diarrhea, a faint pulse, and red facial complexion, the syndrome is Dai Yang (Floating Yang), indicating true lower cold and false upper heat, which is the Baitong Tang (White Pass Decoction) syndrome. In the aforementioned former case, if diarrhea persists, extremities are cold, there is no pulse, dry retching occurs, and irritability is present, the pathogenesis is excessive Yin-cold in the lower Jiao disturbing the deficient Yang in the upper Jiao. One should add human urine and pig bile, which are salty, cold, and bitter-descending, to the main herbs for restoring Yang and rescuing from collapse, such as Shengjiang (Dried Ginger) and Fuzi (Prepared Aconite Root). This is the method of following treatment (Cong Zhi), also implying targeted treatment. However, in the early stage of Shaoyin disease, if Yang deficiency is not severe, but atypical fever, anhidrosis, and a deep pulse appear, a method of simultaneously warming Yang and releasing the exterior should be used, such as Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) or Gancao Tang (Licorice Decoction). Regarding Shaoyin disease, if there is irritability in the heart and inability to sleep, it indicates exhaustion of Kidney Water below and hyperactivity of Heart Fire above. Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) should be used to nourish Yin and descend fire. If there is diarrhea, cough, vomiting, thirst, irritability, and inability to lie down, it is a syndrome of Shaoyin Yin deficiency with internal accumulation of water-Qi. Zhuling Tang (Polyporus Decoction) is suitable to nourish Yin and promote urination. If prolonged diarrhea damages Yin, manifesting as diarrhea, sore throat, chest fullness, and irritability, Zhufu Tang (Pig Skin Decoction) should be used to nourish Yin and harmonize the middle, which is also the treatment principle of "nourishing essence with flavor." The above three cases directly belong to the category of Shaoyin Yin deficiency with heat transformation.
The Liver stores Blood and governs free flow. The Liver meridian circulates through the chest and hypochondrium, belongs to the Liver, connects with the Gallbladder, flanks the Stomach, penetrates the diaphragm, circulates along the genitalia, reaches the lower abdomen, connects with Heart Fire above, and is adjacent to Kidney Water below. Therefore, when the Jueyin Liver meridian is affected, it easily leads to dysfunction of the Spleen and Stomach, resulting in a syndrome of mixed cold and heat, upper heat and lower cold. For example, "The Jueyin disease manifests as excessive thirst, Qi rushing up to strike the heart, pain and heat in the heart, hunger without desire to eat, vomiting roundworms upon eating, and persistent diarrhea if purged" (Clause 326). If the Liver fails to maintain free flow, with internal depression of fire pressing downward on the Large Intestine, it results in diarrhea with tenesmus or pus and blood in the stool, thirst with desire to drink, and a wiry-rapid pulse. This is Jueyin Heat Diarrhea, treated with Baitouweng Tang (Pulsatilla Decoction) using bitter-cold herbs to cool the Liver and strengthen the intestines. If Liver Cold invades the Stomach, with turbid Yin rising upward, manifesting as dry retching, vomiting of saliva and froth, and headache, Wuzhuyu Tang (Evodia Decoction) is the primary formula. This employs the method of warming the Liver, harmonizing the Stomach, resolving fluid retention, and descending rebellion, directly addressing the Jueyin Organ Cold syndrome.
Regarding the pathogenesis of Fu-organ diseases, briefly stated: The Bladder is the Fu organ of Taiyang. Taiyang governs the transformation of cold water. If the Taiyang exterior syndrome is unresolved, pathogens enter the Fu organ from the exterior: "If the pulse is floating, there is difficulty in urination, slight fever, and excessive thirst, Wuling San (Five-Ingredient Powder with Poria) should be used" (Clause 71). The pathology is cold-water accumulating in the Bladder, preventing the diffusion and transformation of Yang Qi, thus causing thirst and irritability above and difficulty in urination below. This corroborates "The Bladder is the official of the capital, storing fluids; only through Qi transformation can they be excreted" (Suwen, Linglan Midian Lun). Thus, this thirst is caused by failure of Qi to transform fluids, fundamentally different from thirst due to Stomach heat damaging fluids. Zhang Zhongjing carefully distinguishes this from "dryness in the Stomach, irritability, insomnia, and desire to drink" (Clause 71). The Stomach and Large Intestine are the Fu organs of Yangming. Yangming governs dry-heat transformation. Excessive dry-heat in the Stomach robs fluids, causing high fever, spontaneous sweating, aversion to heat rather than cold, severe irritability and thirst unrelieved, and a flooding-slippery-rapid pulse. Clearing methods are appropriate. If tidal fever, delirium, abdominal fullness and pain with refusal to press, constipation, deep-solid pulse, and yellow-dry coating appear, it belongs to Fu-organ heat accumulation, requiring purging methods. This involves both the Stomach and the Intestines. The Sanjiao is the Fu organ of Shaoyang, governing Fire transformation. Gallbladder Fire flares upward, so the outline of Shaoyang disease includes bitter taste, dry throat, and vertigo. When Gallbladder Qi is stagnant and the pivot mechanism is unfavorable, it easily invades the Spleen and Stomach. Thus, the main symptoms of Shaoyang disease are alternating chills and fever, hypochondriac distress, silent lack of appetite, irritability, and frequent vomiting. The Sanjiao is the official of drainage, governing the smooth passage of water passages. Therefore, in Shaoyang optional symptoms, if Water-Qi attacks the Lung, there may be "cough"; if Water-Qi accumulates in the chest and hypochondrium, there may be "subcostal hardness"; if Water-Qi accumulates in the Lower Jiao, there may be "palpitations under the heart and difficulty in urination." Since Water-Qi moves unpredictably, the manifestations vary accordingly.
Human diseases are influenced by various internal and external conditions, making pathogenesis complex. Generally, simple diseases are rare, while combined diseases are common. For instance, Banxia, Shengjiang, and Gancao Xie Xin Tang (Three Variants of Bitter Drainage Heart-Dissolving Decoctions), Huanglian Tang (Coptis Decoction), and Ganjiang Qinlian Renshen Tang (Dried Ginger, Coptis, and Ginseng Decoction) all embody the method of treating the Spleen and Stomach together. "After two or three days of Shanghan, if there is palpitation and irritability in the epigastrium, Xiaojianzhong Tang (Minor Construct the Middle Decoction) should be used" (Clause 102), which is the method of treating the Heart and Spleen together. "In Shanghan, if the Yang pulse is choppy and the Yin pulse is wiry, cramping pain in the abdomen is expected; first give Xiaojianzhong Tang..." (Clause 100), which is the method of treating the Liver and Spleen together. "Spontaneous diarrhea without thirst belongs to Taiyin, due to cold in the organs; it should be warmed, preferably with Sini Tang variants" (Clause 277), implying the method of treating the Spleen and Kidney together. By extension, for Taiyang disease with exterior cold and interior fluid retention, Xiao Qinglong Tang (Minor Green Dragon Decoction) is used. With Xixin (Asarum), Ganjiang (Dried Ginger), and Wuweizi (Schisandra) to warm the middle and resolve fluid retention, one can understand the principle of treating the Spleen and Lungs together. Furthermore, in Shaoyin disease with cold-water overflow, if there is "cough," adding Wuweizi, Xixin, and Ganjiang to Zhenwu Tang constitutes a method of treating the Kidney, Spleen, and Lungs together. These examples apply not only to Shanghan but also to the treatment of miscellaneous diseases.
Water, Blood, Phlegm, Food, and Qi stagnation are common in miscellaneous diseases. Ancient theories state that the root of Water disease lies in the Kidney, its control in the Spleen, and its manifestation in the Lung. In reality, the Sanjiao governs water passage regulation, and the Bladder regulates fluid metabolism, both closely related to Water disease. In Shanghan Lun, Xiao Qinglong Tang treats exterior cold binding the surface with cold-water attacking the Lung causing cough and wheezing; Wuling San treats exterior pathogens entering the interior with water accumulation in the Fu organ; Zhenwu Tang treats Shaoyin Yang deficiency with cold-water overflow. These are prominent Water diseases. Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) treats "after Shanghan vomiting or purging, epigastric reverse fullness, Qi rushing to the chest, dizziness upon standing, and deep-tight pulse" (Clause 67). "Shanghan with cold extremities and epigastric palpitation should first treat water with Fuling Jiangtang Tang (Poria and Dried Ginger Decoction)" (Clause 356). Both have pathology in the Middle Jiao and similar medications. The former focuses on Spleen failing to transport, using Baizhu (Atractylodes Macrocephala Rhizome) to strengthen the Spleen and promote urination; the latter addresses unexpressed Heart Yang, using Shengjiang (Dried Ginger) to disperse Water-Qi. Optional symptoms of Xiaochaihu Tang (Minor Bupleurum Decoction) such as cough, subcostal hardness, or epigastric palpitation with difficulty in urination are also related to unpredictable Water-Qi movement. Additionally, "After a major illness resolves, if there is Water-Qi from the waist down, Mushe Zaixie San (Oyster Shell and Thunberg Fritillary Decoction) should be used" (Clause 395), a treatment for excess Water disease involving promoting urination and defecation.
Phlegm (Tan) is synonymous with 'dan' (bland/light), a type of Water-Qi, differing from the modern distinction where thin fluid is Yin and thick sticky fluid is Tan. Shanghan commentators regard Da Jie Xiong Bing (Major Chest Binding Disease) as water-heat accumulation, while Xiao Jie Xiong Bing (Minor Chest Binding Disease) is phlegm-heat accumulation. Guizhi Jiuxu Tang (Cinnamon Twig Rescue Collapse Decoction) treats collapse of Yang with fright and mania, using Shuqi (Japanese Tussilago Herba) to open with acridity and wash away phlegm. Shizao Tang (Ten Jujubes Decoction) treats suspended drinking, comparable to Jin Gui Yao Lue. These three represent clearing-transforming, warming-transforming, and attacking-purging methods, inspiring general treatments for Phlegm-Drinking.
The three formulas for Taiyang Blood Accumulation: Taoheng Chengqi Tang (Peach Kernel and Rhubarb Decoction) treats "the person appears manic" and "lower abdomen urgent and knotted" (Clause 106); Didang Tang (Hit and Capture Decoction) treats "pulse faint and deep, the person is manic, lower abdomen hard and full" (Clause 124) with pain; Didang Wan (Hit and Capture Pill) treats "lower abdomen fullness" (Clause 126). Zhang Zhongjing's discussion on blood accumulation shows clear differences in severity of blood stasis and urgency of treatment, with both decoctions and pills prepared. Causes include "Sun-Jing residual heat and blood stasis in the interior" (Clause 124) or "pre-existing long-term blood stasis" (Clause 237). Although referring to blood accumulation, this logic applies to other factors like water, phlegm, and food formed during febrile diseases.
The three Yangming Chengqi formulas: Wei Chengqi Tang (Stomach-Nourishing Rhegma-Decreasing Decoction) treats Fu-organ heat and dryness-solidity, a mild purgative; Xiao Chengqi Tang (Minor Rhegma-Decreasing Decoction) is a light purgative for abdominal fullness and hard stool; Da Chengqi Tang (Major Rhegma-Decreasing Decoction) is a strong purgative for syndromes with fullness, obstruction, dryness, solidity, and hardness, aiming to purge dry feces. Dry feces result from Yangming dry-heat combining with retained food. Zhang Zhongjing states the cause is "pre-existing retained food" (Clause 241). However, irregular diet during febrile diseases can also cause food stagnation. "After a major illness, relapse due to overwork is treated with Zhishi Zhizi Tang (Immature Bitter Orange and Gardenia Decoction). If there is retained food, add Dahuang (Rhubarb Root and Rhizome)..." (Clause 393). "If diarrhea with delirium indicates dry feces, Xiao Chengqi Tang is appropriate" (Clause 374). Why? Because diarrhea with heat-binding bypass flow prioritizes heat-binding, but since pathogens have an exit, strong purging is avoided, opting for light purging. "After Shanghan sweating resolves, if the Stomach is disharmonious, epigastric hardness, belching with food odor, Water-Qi in the hypochondrium, borborygmus, and diarrhea occur, Shengjiang Xiexin Tang (Dried Ginger Bitter Drainage Heart-Dissolving Decoction) should be used" (Clause 157), treating Spleen-Stomach disharmony with food-fluid stagnation using acrid-opening and bitter-descending methods to dissipate fullness and resolve knots, suitable for deficiency with food retention, distinct from purging retained food.
"Shaoyin disease, cold extremities... Sini San (Frigid Extremities Powder) should be used" (Clause 318). Symptoms are not detailed; inferring from the formula, it is Liver Qi stagnation causing failure of Yin and Yang Qi to connect, leading to cold extremities. Listed in the Shaoyin chapter to differentiate from Yang-deficiency Yin-excess cold extremities. Broadly speaking, Ying and Wei circulate, and Qi and Blood fill the body continuously. If one Qi deviates, disease arises. Thus, Zhang Zhongjing's discussion on Qi stagnation is not limited to this. Maxing Shigan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) lightly diffuses Lung Qi; the three Chengqi formulas purge Fu-organ Qi; Chaihu formulas soothe Gallbladder Qi and benefit the pivot. All start from Qi stagnation syndromes, reflecting Zhang Zhongjing's integration of Shanghan and miscellaneous diseases.
2. Exploring flexible application of Shanghan formulas from Jin Gui Yao Lue: Both books share identical symptoms and treatments, such as diarrhea, vomiting, and jaundice. Jin Gui Yao Lue focuses on miscellaneous disease mechanisms and general treatment principles, yet uses formulas from all six meridians. Deriving the rationale for using Shanghan formulas for miscellaneous diseases is necessary. For example, "For Yi Yin (Overflowing Drinking), sweating should be induced; Da Qinglong Tang (Major Green Dragon Decoction) or Xiao Qinglong Tang should be used" (Jin Gui, Phlegm-Fluids Chapter). Yi Yin features "drinking water flowing to limbs, intended sweating does not occur, body pain and heaviness" without exterior signs like headache and aversion to cold. Jin Gui also treats "coughing backward, unable to lie flat" with Xiao Qinglong Tang. Da Qinglong Tang is Mahuang Tang doubled Ephedra plus Gypsum, Ginger, and Jujube; Gypsum addresses irritability. Thus, Xiao Qinglong Tang plus Gypsum treats "Lung distension, cough with Qi reversal, irritability and wheezing, floating pulse, water under the heart" (Jin Gui, Lung Abscess Chapter). The presence of irritability justifies adding Gypsum. Xiao Qinglong targets anhidrosis with cough/wheeze; Da Qinglong targets anhidrosis with irritability. Both syndromes share these symptoms whether Shanghan or Yi Yin.
Wuling San originally treats Taiyang Water Accumulation, having "exterior and interior symptoms" (Clause 74). Exterior means Wind-stroke with aversion to wind, fever, sweating, floating pulse; Interior refers to difficulty in urination, lower abdominal urgency, and thirst. However, Jin Gui states "if a thin person has palpitations below the umbilicus, vomiting saliva/froth, and epilepsy/vertigo, this is Water," also treated with Wuling San. This resembles Linggui Zhugan Tang's "epigastric reverse fullness, Qi rushing to chest, dizziness upon standing" (Clause 67). The latter's pathology is in the epigastrium (Middle Jiao Spleen deficiency failing to transport essences); the former's is below the umbilicus (Lower Jiao water accumulation preventing Yang Qi from transforming water). Thus, even without Taiyang exterior signs, Wuling San is used to unblock Yang, guide downward, transform Qi, and move water.
Baitang Tang (White Tiger Decoction) originally treats Yangming Qi-level heat, featuring high fever, sweating, aversion to heat, irritability/thirst, and flooding pulse. However, Jin Gui states "Taiyang Zhong Re (Summerheat), characterized by sweating, aversion to cold, fever, and thirst, is treated with Baitang Tang plus Renshen (Ginseng)" (Jin Gui, Spasm-Dampness-Summerheat Chapter). Aversion to cold here differs from Taiyang exterior due to Summerheat damaging Qi and opening pores. Based on main symptoms of sweating, fever, and thirst, Baitang Tang clears Yangming Qi-level heat, adding Renshen to boost Yuan Qi and generate fluids. Similarly, "thirst with desire to drink, dry mouth and tongue" (Jin Gui, Polydipsia Chapter) represents Upper Jiao Sanxiao, treated with Baitang Tang plus Renshen due to Lung-Stomach heat consuming Qi and fluids, even without fever/sweating.
Da Chengqi Tang (Atractylodes, Magnolia Bark, Mirabilite, Rhubarb) is a strong purgative for severe Yangming Fu-organ excess, with symptoms like tidal fever, delirium, sweaty hands/feet, abdominal fullness/pain, constipation, yellow coating, and deep-solid pulse, caused by Yangming pathogenic heat binding with retained food into dry feces. Jin Gui states "how to identify retained food? Pulse floating-large at Cun, choppy on pressure; Chi pulse faint-choppy. This indicates retained food, treated with Da Chengqi Tang" (Jin Gui, Abdominal Fullness Chapter). Pure retained food without dry feces lacks tidal fever/delirium. Zhang Zhongjing cautiously uses purging, sometimes testing with Xiao Chengqi before Da Chengqi. Long-standing retained food requires purging. "If abdominal fullness does not decrease, purging with Da Chengqi Tang is indicated." Xiao Chengqi Tang (Magnolia Bark, Rhubarb, Atractylodes-like Zhi Shi) is a light purgative for tidal fever, delirium, sweating, fullness, and hard stool. Jin Gui states "pain with constipation is treated Houpo Sanwu Tang (Magnolia Bark Three-Ingredient Decoction)." Though ingredients match Xiao Chengqi, the focus is on abdominal fullness/pain without tidal fever/delirium, prioritizing breaking Qi stagnation with heavier doses of Zhi Shi and Houpo, demonstrating the subtlety of classical formula modifications.
Da Chaihu Tang (Major Bupleurum Decoction) is a primary formula for Shaoyang interior excess. "Shanghan for ten+ days, heat binding in interior with alternating chills/fever, use Da Chaihu Tang" (Clause 136); "persistent vomiting, epigastric urgency, mild irritability" (Clause 103); "Shanghan fever/sweating unresolved, epigastric hardness, vomiting with diarrhea, use Da Chaihu Tang" (Clause 165). Jin Gui treats "tenderness and fullness below the heart as excess, requiring purging with Da Chaihu Tang" (Jin Gui, Abdominal Fullness Chapter). This syndrome involves Shaoyang pivot dysfunction and Gallbladder rebellion invading the Stomach. Pathology is in the Upper Jiao (epigastrium), not Middle Jiao abdomen, differing from Chengqi indications for abdominal pain. In Jaundice Chapter, Da Chaihu Tang treats Gallbladder Qi rebellion affecting Spleen (abdominal pain) and Stomach (vomiting), with bile overflowing causing jaundice. Treatment combines harmonizing and purging (Da Chaihu Tang) or harmonizing with nourishing Blood/relieving pain (Xiao Chaihu Tang minus Huangqin plus Shaoyao). Clinically, this is Yang Jaundice, so Huangqin should not be removed.
Lizhong Tang (also Renshen Tang) is the primary formula for Taiyin Organ Cold. Main symptoms: "abdominal fullness, vomiting, inability to eat, worsening spontaneous diarrhea, intermittent abdominal pain" (Clause 273). Jin Gui states "Xiong Bi (Chest Bi) with epigastric stuffiness, Qi knot in chest, chest fullness, Qi rushing from hypochondrium to heart... Renshen Tang also treats" (Jin Gui, Chest Bi Chapter). This indicates Chest Yang deficiency with Phlegm-Fluid and stagnant Qi binding in the chest, distinct from excess Chest Bi. Using warming-middle method aligns with "after major illness, frequent spitting due to cold above the chest, treat with Lizhong Wan" (Clause 397).
Jin Gui states: "Water disease with deep-small pulse belongs to Shaoyin. Floating indicates Wind. Empty distension without water indicates Qi. Sweating cures Water disease. For deep pulse, Mahuang Fuzi Tang is appropriate" (Jin Gui, Water-Qi Chapter). Mahuang Fuzi Gancao Tang originally treats Shaoyin disease day 2-3 with exterior signs (fever, anhidrosis, deep pulse) but no interior signs (diarrhea/cold extremities). Used for Water disease without exterior fever, it addresses Yang deficiency and cold-water failure to transform, soaking the exterior causing edema. This method warms Yang to unblock turbid Yin and releases exterior to allow water expulsion. Different symptoms, similar pathogenesis, hence interchangeable methods. Li Peisheng learned from "belongs to Shaoyin" to treat Water-Qi disease: Zhenwu Tang for cold, Zhuling Tang for heat, showing Mahuang Fuzi Tang is not the only option.