仲景曰。脉微而涩者。此为医所病也。大发其汗。又数大下之。
其人亡血。病当恶寒。后乃发热无休止时。夏月盛暑。欲着复衣。冬
月盛寒。欲裸其身。所以然者。阳微则恶寒。阴弱则发热。此医发其
汗。使阳气微。又大下之。令阴气弱。五月之时。阴气在里。胃中虚
冷。以阳气内微。不能胜冷。故欲着复衣。十一月之时。阳气在内。胃
中烦热。以阴气内弱。不能胜热。故欲裸其身。又阴脉迟涩。故知亡
血也。庞氏曰。阳微。宜四逆汤。阴弱。宜苦酒艾之类。常氏云。宜小
建中汤。雍日。阳微阴弱之症。其候至微。亦未易言。仲景初谓亡血
之人。病当先寒。后乃发热。则一病之内。阳微阴弱之症。先后俱见
也。故言医发汗。使阳气微。又大下之。使阴气弱。则知一病是二证
也。夏月盛热。欲着复衣。冬月盛寒。欲裸其身。谓暑月犹有寒。不必
重言其热。寒月犹有热。不必重言其寒也。若如是。则暑月有寒热。
寒月亦有寒热。非五月病者独见寒。十月病者独见热也。故常氏用
小建中汤。似得其意。令阴阳两建之。虽药证相得。第恐力微。此外
亦无药矣。庞氏分寒热为两证。则阳微用四逆。阴弱用酸苦。然疾证
初不分。用药又难分也。夫然。则当见寒时用四逆。又恐后乃发热
时。热大甚不可制。若庞氏药。用之于表热里寒。表寒里热之证则相
宜。盖表热里寒。表寒里热。是自两病。非阳微阴弱同病之证也。粗
工以表热里寒。表寒里热。便为阳微阴弱者。尤非是。此证虽甚希
有。而前人论说。尚多失仲景之意。则后人用药宜审矣。
又曰。寸口脉浮大。而医反下之。此为大逆。浮则无血。大则为
寒。寒气相搏。则为腹鸣。医乃不知。而反饮冷水。令汗大出。水得寒
气。冷必相搏。其人则KT 。常氏云。宜甘草豆蔻散。
又曰。太阳病三日。已发汗。若吐。若下。若温针。仍不解者。此
为坏病。桂枝不中与也。观其脉证。知犯何逆。随证治之。
又曰。脉浮数者。法当汗出而愈。若下之。身重心悸者。不可发
汗。当自汗出而解。所以然者。尺中脉微。此里虚。须表里实。津液自
和。即自汗出愈。常氏云。疑缺。雍曰。宜柴胡桂枝汤。
又曰。凡病。若发汗。若吐。若下。若亡血。若亡津液。阴阳自和
者。必自愈。
又曰。大下后。复发汗。小便不利者。亡津液故也。勿治之。得小
便利。必自愈。
又曰。下之后。复发汗。必振寒。脉微细。所以然者。内外俱虚故
也。常氏云。可 参建中汤。
又曰。本发汗。而反下之。此为逆也。若先发汗。治不为逆。本先
下之。而反汗之。为逆。若先下之。治不为逆。雍曰。此谓病当先汗而
反先下之者。故为逆。若已汗而后下之。不为逆也。若病当先下而反
先汗之。故为逆。若已下而后汗之。不为逆也。
又曰。太阳病。先下之而不愈。因复发汗。以此表里俱虚。其人
因致冒。冒家当汗出自愈。所以然者。汗出表和故也。得里未和。然
后复下之。常氏云。可桂枝大柴胡汤。雍曰。大字误。当是两药。先用
柴胡桂枝汤和其表。复下之者。用大柴胡汤。
又曰。得病六七日。脉迟浮弱。恶风寒。手足温。医二三下之。不
能食。而胁下满痛。面目及身黄。颈项强。小便难者。与小柴胡汤。后
必下重。本渴饮水而呕者。柴胡不中与也。食谷者哕。常氏曰。可柴
胡桂枝汤、干姜汤。饮水呕者。五苓散。哕者。小半夏汤。
又曰。太阳病二三日。不能卧。但欲起。心下必结。脉微弱者。此
本有寒分也。反下之。若利止。必作结胸。未止者。四五日复下之。此
作协热利也。常氏云。可理中汤。结胸者。大陷胸汤。协热利。表不解
者。桂枝人参汤。
又曰。太阳病。下之。其脉促。（一作缓）不结胸者。此为欲解也。
脉浮者。必结胸。脉紧者。必咽痛。脉弦者。必两胁拘急。脉细数者。
头痛未止。脉沉紧者。必欲呕。脉沉滑者。必协热利。脉浮滑者。必下
血。常氏云。结胸。陷胸汤。咽痛。猪肤汤。两胁拘急。小建中汤。头痛
未止。小柴胡汤。呕者。小半夏汤。协热利者。白头翁汤。下血者。柏
皮汤。雍曰。柏皮汤用栀子柏皮汤。
又曰。太阳少阳并病。而反下之。成结胸。心下硬。下利不止。水
浆不下。其人心烦。常氏云。可陷胸汤。雍曰。太少二阳。水木无负。
因下伤胃。三阳俱病。轻者不成结胸。宜理中汤。或无效者。宜枳实
理中丸。
又曰。脉浮而紧。而复下之。紧反入里。则作痞。按之自濡。但气
痞耳。常氏曰。宜小陷胸汤。增损理中丸。雍曰。先枳实理中汤。不
解。用半夏泻心汤。
又曰。伤寒。吐下发汗后。虚烦。脉甚微。八九日。心下痞硬。胁
下痛。气上冲咽喉。眩冒。经脉动惕者。久而成痿。常氏云。可茯苓桂
枝五味甘草汤。成痿者。振痿汤。（甘草汤未见方。疑用茯苓桂枝白
术甘草汤。）
又曰。阳明病。不能食。若攻其热。必哕。所以然者。胃中虚冷故
也。以其人本虚。攻其热必哕。常氏云。可温中汤、小半夏汤。雍曰。
宜理中汤。
又曰。阳明病。脉迟。食难用饱。饱则微烦头眩。必小便难。此欲
作谷疸。虽下之。腹满如故。所以然者。脉迟故也。常氏云。可茵陈
汤、五苓散。雍曰。此当煎茵陈汤一物调五苓散。作茵陈蒿汤也。
又曰。夫病阳多者热。下之则硬。汗多极。发其汗亦硬。常氏云。
可小柴胡汤。
又曰。太阳病。寸缓。关浮。尺弱。其人发热汗出。复恶寒。不呕。
但心下痞者。此以医下之也。常氏云。可生姜半夏二泻心汤。
又曰。太阴之为病。腹满而吐。食不下。自利益甚。时腹自痛。若
下之。必胸下结硬。常氏云。可桂枝加芍药汤、桂枝加大黄汤。雍曰。
本太阳病。反下之。因腹满痛。转属太阴者。桂枝加芍药汤主之。大
实痛者。用桂枝加大黄汤。今证吐而食不下。自利。腹满自痛。皆无
实证。不可便用桂枝加大黄汤。有微寒者。当宜桂枝加附子汤。存芍
药而不去也。
又曰。伤寒。大吐大下之。极虚。复极出汗者。其人外气怫郁。复
与之水。以发其汗。因得哕。所以然者。胃中寒冷故也。常氏云。可小
温中汤。雍曰。胃寒甚者。理中汤。哕者。小半夏汤、五苓散。
又曰。吐利。发汗后。脉平。小烦者。以新虚不胜谷气故也。常氏
曰。可调胃承气汤。雍曰。勿服药。夺其食则愈。以脉平。不可再损
也。
又曰。太阳病。医发汗。遂发热恶寒。因复下之。心下痞。表里俱
虚。阴阳气并竭。无阳则阴独。复加烧针。因胸烦。面色青黄。肤
者。难治。今色微黄。手足温者。易愈。常氏云。可小柴胡汤、桂枝龙
骨牲蛎汤。雍曰。心下痞者。枳实理中丸。烧针胸烦。桂枝加龙骨牡
蛎汤。外证未除者。桂枝加人参汤。
又曰。太阳病。得之八九日。如疟状。发热恶寒。热多寒少。其人
不呕。清便欲自可。一日二三度发。脉微（一作浮）缓者。为欲愈也。
脉微而恶寒者。此阴阳俱虚。不可更发汗更下更吐也。面色反有热
色者。未欲解也。以其不能得小汗出。身必痒。属桂枝麻黄各半汤。
又曰。服桂枝汤。或下之。仍头项强痛。翕翕发热。无汗。心下
满。微痛。小便不利者。属桂枝去桂加茯苓白术汤。
又曰。太阳病。先发汗不解。而下之。脉浮者。为不愈。浮为在
外。而反下之。故令不愈。今脉浮。故知在外。当须解外则愈。宜桂枝
汤。雍曰。此证本当先汗。所谓若先发汗。治不为逆也。
又曰。下之后。复发汗。昼日烦躁不得眠。夜而安静。不呕不渴。
无表证。脉沉迟。身无大热者。属干姜附子汤。雍曰。此证本当先下。
所谓若先下之。治不为逆也。
又曰。伤寒。若吐若下后。心下逆满。气上冲胸。起则头眩。脉沉
紧。发汗则动经。身为振振摇者。属茯苓桂枝白术甘草汤。
又曰。发汗。若下之后。病仍不解。烦躁者。茯苓四逆汤。
又曰。发汗吐下后。虚烦不得眠。若剧者。必反复颠倒。心中懊
。属栀子豉汤。若少气者。栀子甘草豉汤。若吐者。栀子生姜豉汤。
又曰。发汗。若下之。而烦热。胸中窒者。属栀子豉汤证。
又曰。太阳证。过经十余日。心下温温欲吐。胸中痛。大便反溏。
腹微满。郁郁微烦。先此时自极吐下者。当调胃承气汤。若不尔者。
不可与。但欲呕。胸中痛。微溏者。此非柴胡证。以呕。故知极吐下
也。雍曰。庞氏云。属调胃承气汤。误也。本论原无属字。不可妄加。
此一论当分作二证。所以本论继之以承气方者。谓前证当用之方。
非后证所属也。自若不尔之下。非柴胡汤证。为后证本论门治法。宜
生姜橘皮汤、大半夏加橘皮汤。
又曰。太阳病。重发汗而复下之。不大便五六日。舌上燥而渴。
日晡所小有潮热。（一云日晡所发心胸大烦）从心下至少腹硬满而
痛不可近者。属大陷胸汤。
又曰。伤寒五六日。已发汗而后下之。胸胁满。微结。小便不利。
渴而不呕。但头汗出。往来寒热。心烦者。此为未解也。属柴胡桂枝
干姜汤。
又曰。伤寒发汗。若吐。若下。解后。心下痞硬。噫气不除者。属
旋覆代赭石汤。
又曰。伤寒大下之后。复发汗。心下痞。恶寒者。表未解也。不可
攻痞。当先解表。表解。乃可攻痞。解表。宜桂枝汤。攻痞。宜大黄黄
连泻心汤。
又曰。伤寒。若吐下后。七八日不解。结热在里。表里俱热。时时
恶风。大渴。舌上干燥而烦。欲饮水数升者。白虎加人参汤。
又曰。伤寒。若吐若下后。不解。不大便。五六日上至十余日。其
人日晡所发潮热。不恶寒。独语如见鬼状。若剧者。发则不识人。循
衣摸床。惕而不安。（一作循衣妄撮怵惕不安）微喘直视。脉弦者生。
涩者死。微者。但发热谵语者。属大承气汤。
又曰。三阳合病。腹重身重。难以转侧。口不仁面垢。谵语遗尿。
发汗则谵语。下之。则额上生汗。手足逆冷。若自汗出者。属白虎汤。
又曰。阳明病。脉浮而紧。咽燥口苦。腹满而喘。发热汗出而不
恶寒。反恶热。身重。若发汗则躁。心愦愦而反谵语。若加温针。必怵
惕烦躁不得眠。若下之。则胃中空虚。客气动膈。心下懊 。舌上苔
者。属栀子豉汤。庞氏根据论云。凡用栀子汤得效。即止后服。病患旧
微溏者。不可与之。
又曰。阳明病。下之。心中懊 而烦。胃中有燥屎者。可攻。其人
腹微满。初头硬。后必溏者。不可攻之。若有燥屎者。宜大承气汤。
又曰。阳明病。下之。其外有热。手足温。不结胸。心中懊 。饥
不能食。但头汗出者。属栀子豉汤。
又曰。太阳病。若吐。若下。若发汗后。微烦。小便数。大便因硬
者。与小承气汤和之愈。
又曰。大汗。若大下利。而厥冷者。属四逆汤。
又曰。太阳病。下之后。其气上冲者。可与桂枝汤。若不上冲。不
得与之。雍曰。不上冲者。根据后三证。用桂枝去芍药加附子汤、桂枝
加浓朴杏子汤、葛根黄芩黄连汤。
又曰。太阳病。下之后。脉促胸满者。（促一作纵）属桂枝去芍药
汤。若微恶寒者。桂枝去芍药加附子汤。（本论二证脉经合为一）
又曰。太阳病。桂枝证。医反下之。利遂不止。脉促（一作纵）者。
表未解也。喘而汗出者。属葛根黄芩黄连汤。
又曰。太阳病。下之微喘。表未解也。属桂枝加浓朴杏子汤。
又曰。伤寒。不大便六七日。头痛有热者。与承气汤。其小便清
者。知不在里。仍在表也。当须发汗。若头痛者。必衄。宜桂枝汤。常
氏云。疑其误。当用麻黄汤及各半汤取大汗。雍曰。有汗当用桂枝。
无汗当用麻黄也。详见衄血门中。
又曰。伤寒五六日。大下之后。身热不去。心中结痛者。未欲解
也。属栀子豉汤。
又曰。伤寒下后。心烦腹满。卧起不安者。属栀子浓朴汤。
又曰。伤寒。医以丸药大下之。身热不去。微烦者。属栀子干姜
汤。
又曰。伤寒。下之。续得下利清谷不止。身疼痛者。急当救里。后
身疼痛清便自调者。急当救表。救里。宜四逆汤。救表。宜桂枝汤。
又曰。太阳病。过经十余日。反二三下之。后四五日。柴胡证仍
在者。先与小柴胡汤。呕不止。心下急。其人郁郁微烦者。为未解。可
与大柴胡汤下之愈。雍曰。与小柴胡汤。呕止小安者。勿服大柴胡
也。
又曰。伤寒十三日。不解。胸胁满而呕。日晡所发潮热。已而微
利。此本柴胡证。下之不得利。今反利者。知医以丸药下之。非其治
也。潮热者。实也。先宜服小柴胡汤以解外。后以柴胡加芒硝汤主
之。
又曰。伤寒十三日。过经谵语者。以有热也。当以汤下之。若小
便利者。大盒饭硬。而反下利。脉调和者。知医以丸药下之。非其治
Zhang Zhongjing said: A pulse that is faint (Wei, 微) and choppy (Se, 涩) indicates iatrogenic injury. This results from excessive sweating followed by repeated severe purgation.
The patient has lost blood. The condition should initially present with aversion to cold, followed by fever without cessation. In the height of summer heat, the patient desires to wear thick clothing; in the depth of winter cold, the patient desires to be naked. The reason for this is that faint Yang leads to aversion to cold, while weak Yin leads to fever. This occurs because the physician's excessive sweating caused Yang Qi (Vital Energy) to become faint, and severe purgation caused Yin Essence (Substance) to become weak. In the fifth month, Yin Qi resides within, leaving the stomach empty and cold. Because internal Yang is faint and cannot overcome the cold, the patient desires thick clothing. In the eleventh month, Yang Qi resides within, causing vexatious heat in the stomach. Because internal Yin is weak and cannot overcome the heat, the patient desires to be naked. Furthermore, a slow and choppy Yin pulse indicates blood loss.
Pang Shi said: For faint Yang, Sini Tang (Frigid Four Decoction) is appropriate. For weak Yin, substances such as vinegar and mugwort are appropriate. Chang Shi said: Xiaojianzhong Tang (Minor Construct the Middle Decoction) is appropriate.
Guo Yong said: The symptoms of faint Yang and weak Yin are extremely subtle and difficult to articulate. Zhang Zhongjing initially stated that patients who have lost blood should first feel cold, then develop fever. Thus, within a single disease process, both faint Yang and weak Yin symptoms appear sequentially. Therefore, when he says the physician's sweating made Yang faint and purgation made Yin weak, it implies that one disease encompasses two syndromes. "In summer heat, desiring thick clothing; in winter cold, desiring nudity" means that even in hot months there is underlying coldness, so there is no need to reiterate heat; and in cold months there is underlying heat, so there is no need to reiterate cold. If interpreted otherwise, it would imply that both summer and winter present with alternating cold and heat, rather than May patients presenting uniquely with cold and October patients with heat. Thus, Chang Shi's use of Xiaojianzhong Tang seems to grasp the intent, establishing both Yin and Yang. Although the herbs match the syndrome, the efficacy may be weak, and few other formulas exist for this. Pang Shi divided cold and heat into two separate syndromes, using Sini Tang for faint Yang and sour/bitter agents for weak Yin. However, since the initial disease presentation does not clearly distinguish them, differentiating treatment is difficult. If one uses Sini Tang when cold signs appear, one risks uncontrolled heat when fever arises later. Pang Shi's approach is suitable for exterior-heat/interior-cold or exterior-cold/interior-heat syndromes. These represent distinct pathologies, not the simultaneous occurrence of faint Yang and weak Yin. Unskilled physicians mistake exterior-heat/interior-cold or exterior-cold/interior-heat for faint Yang/weak Yin, which is incorrect. Although this syndrome is rare, many previous commentaries deviate from Zhang Zhongjing's original meaning; thus, subsequent practitioners must exercise caution.
It is also said: If the Cun (inch) position pulse is floating (Fu, 浮) and large (Da, 大), but the physician erroneously applies purgation, this is a major contraindication. Floating indicates blood deficiency; large indicates cold. When cold qi clashes, abdominal borborygmus occurs. The physician, unaware, forces the patient to drink cold water to induce profuse sweating. The water clashes with the cold qi, causing the patient to make a dry heaving sound (Kun). Chang Shi said: Gancao Doukou San (Licorice and Cardamom Powder) is appropriate.
It is also said: In Taiyang disease (Taiyang Disease, 太阳病), after three days, if sweating, vomiting, purgation, or warm needle therapy have been applied yet the condition remains unresolved, this is termed a "ruined disease" (Huai Bing, 坏病). Guizhi Tang (Cinnamon Twig Decoction) is no longer applicable. One must observe the pulse and symptoms, identify the iatrogenic error, and treat according to the current syndrome.
It is also said: A floating and rapid (Shuo, 数) pulse indicates that sweating should lead to recovery. If purgation is used instead, resulting in heavy body sensation and palpitations, sweating is contraindicated. Recovery will occur through spontaneous sweating. This is because the Chi (cubit) position pulse is faint, indicating interior deficiency. The interior and exterior must be fortified, and fluids must harmonize spontaneously for recovery via sweating. Chang Shi suspected textual omission. Guo Yong suggested Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction).
It is also said: In any disease, whether following sweating, vomiting, purgation, blood loss, or fluid depletion, if Yin and Yang achieve self-harmony, spontaneous recovery will occur.
It is also said: After severe purgation followed by sweating, urinary difficulty arises due to fluid depletion. Do not forcibly treat it; once urination normalizes, the condition will resolve spontaneously.
It is also said: Following purgation and then sweating, chills and fine, faint pulses occur because both interior and exterior are deficient. Chang Shi suggested Shen Jianzhong Tang (Ginseng and Minor Construct the Middle Decoction).
It is also said: If sweating was indicated but purgation was used erroneously, this is a counter-indication. If sweating is performed first, it is not an error. If purgation was indicated but sweating was used erroneously, this is a counter-indication. If purgation is performed first, it is not an error. Guo Yong clarified: This refers to treating a syndrome requiring sweating with purgation first, which is erroneous. Sweating followed by purgation is acceptable. Conversely, treating a syndrome requiring purgation with sweating first is erroneous; purgation followed by sweating is acceptable.
It is also said: In Taiyang disease, if purgation fails and sweating is subsequently applied, leading to exterior-interior deficiency, the patient may experience "Mao" (vertigo/dizziness). Spontaneous sweating will resolve this vertigo because it harmonizes the exterior. If the interior remains discordant, purgation may be applied subsequently. Chang Shi suggested Guizhi Daxiehu Tang (Cinnamon Twig and Major Bupleurum Decoction). Guo Yong noted "Da" is likely an error, implying two formulas: first Chaihu Guizhi Tang to harmonize the exterior, then Daxiehu Tang for purgation.
It is also said: On the sixth or seventh day of illness, with a slow, floating, weak pulse, aversion to wind and cold, warm hands and feet, repeated purgation by the physician leads to inability to eat, fullness/pain in the hypochondrium, jaundice of the face/body, stiff neck, and difficult urination. Give Chaihu Tang (Bupleurum Decoction). Subsequently, rectal heaviness may occur. If thirst with drinking leads to vomiting, Chaihu Tang is contraindicated. If eating triggers hiccups, Chang Shi suggested Chaihu Guizhi Tang or Ganjiang Tang (Ginger Decoction); for thirst/vomiting, Wuling San (Five Ingredient Powder); for hiccups, Xiaobanxia Tang (Minor Pinellia Decoction).
It is also said: In Taiyang disease on days two or three, inability to lie down, desire to rise, and epigastric binding indicate pre-existing cold-fluid retention. Erroneous purgation may lead to Jie Xiong (Chest Binding) if diarrhea stops, or Xie Re Li (Collaborating Heat Diarrhea) if diarrhea persists and purgation is repeated after four to five days. Chang Shi suggested Lizhong Tang (Regulate the Middle Decoction) for diarrhea; Daxiexiong Tang (Major Chest-Breaking Decoction) for Jie Xiong; Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction) for Xie Re Li with unresolved exterior.
It is also said: After purgation in Taiyang disease, a Cu (surging) pulse (or Huan, slow) without Jie Xiong indicates impending resolution. A floating pulse indicates Jie Xiong; tight pulse indicates sore throat; wiry pulse indicates bilateral hypochondriac stiffness; fine-rapid pulse indicates persistent headache; deep-tight pulse indicates nausea; deep-slippery pulse indicates Xie Re Li; floating-slippery pulse indicates bloody stool. Chang Shi suggested Xiexiong Tang for Jie Xiong; Zhufu Tang (Pig Skin Decoction) for sore throat; Xiaojianzhong Tang for hypochondriac stiffness; Xiaochaihu Tang for headache; Xiaobanxia Tang for nausea; Baitouweng Tang (Podophyllium Decoction) for Xie Re Li; Bapi Tang (Phellodendron Bark Decoction) for bloody stool. Guo Yong identified Bapi Tang as Zhi Zi Bai Pi Tang (Gardenia and Phellodendron Bark Decoction).
It is also said: In concurrent Taiyang-Shaoyang disease, erroneous purgation causes Jie Xiong, epigastric hardness, incessant diarrhea, inability to swallow liquids, and irritability. Chang Shi suggested Xiexiong Tang. Guo Yong explained that Shaoyang-Water and Taiyang-Wood do not clash; purgation damages the Stomach, affecting all three Yang channels. Mild cases do not form Jie Xiong; Lizhong Tang is appropriate. If ineffective, Zhishi Lizhong Wan (Immature Bitter Orange and Regulate the Middle Pill) is suitable.
It is also said: A floating-tight pulse treated with purgation causes the tightness to enter the interior, forming Pi (Glomus/Blockage). Palpation reveals softness, indicating only Qi Blockage. Chang Shi suggested Xiao Xiexiong Tang (Minor Chest-Breaking Decoction) and Zengsun Lizhong Wan. Guo Yong suggested Zhishi Lizhong Tang first; if unresolved, Banxia Xiexin Tang (Pinellia and Heart-Draining Decoction).
It is also said: After vomiting, purgation, or sweating in Shanghan (Cold Damage), lingering vexation with a very faint pulse, progressing over eight to nine days to epigastric hardness, hypochondriac pain, Qi rushing to the throat, vertigo, and muscle twitching, may eventually lead to Wei (Atrophy) syndrome. Chang Shi suggested Fuling Guizhi Wuwei Gancao Tang (Poria, Cinnamon Twig, Schisandra, and Licorice Decoction). For established Wei syndrome, Zhenwei Tang (Shake Atrophy Decoction) is cited (note: Gancao Tang formula missing, possibly Fuling Guizhi Baizhu Gancao Tang).
It is also said: In Yangming disease, inability to eat combined with clearing heat leads to hiccups due to Stomach deficiency-cold. Given the patient's inherent deficiency, attacking heat induces hiccups. Chang Shi suggested Wenzhong Tang (Warm the Middle Decoction) and Xiaobanxia Tang. Guo Yong suggested Lizhong Tang.
It is also said: In Yangming disease, a slow pulse with difficulty tolerating full meals (leading to mild vexation, dizziness, and difficult urination) suggests impending Gu Dan (Grass Jaundice). Purgation will not relieve abdominal fullness due to the slow pulse. Chang Shi suggested Yichen Tang (Artemisia Capillaris Decoction) and Wuling San. Guo Yong suggested combining Yichen Tang with Wuling San to create Yinchen Hao Tang (Artemisia, Mugwort, and Rhubarb Decoction).
It is also said: Diseases with excess Yang present with heat; purgation causes hardness. Excessive sweating also causes hardness. Chang Shi suggested Xiaochaihu Tang.
It is also said: In Taiyang disease, a slow Cun pulse, floating Guan pulse, and weak Chi pulse, accompanied by fever, sweating, aversion to cold, no vomiting, but epigastric blockage, results from erroneous purgation. Chang Shi suggested Shengjiang Banxia Er Xiexin Tang (Fresh Ginger, Pinellia, and Two Heart-Draining Decoctions).
It is also said: Taiyin disease presents with abdominal fullness, vomiting, inability to eat, worsening spontaneous diarrhea, and intermittent abdominal pain. Purgation causes lower chest binding. Chang Shi suggested Guizhi Ji Shaoyao Tang (Cinnamon Twig Added Peony Decoction) or Guizhi Ji Dahuang Tang (Cinnamon Twig Added Rhubarb Decoction). Guo Yong clarified: If Taiyang disease turns to Taiyin with abdominal fullness/pain, Guizhi Ji Shaoyao Tang is primary. For severe painful fullness, Guizhi Ji Dahuang Tang. However, with vomiting, food intolerance, diarrhea, and non-severe pain, there is no excess syndrome; Guizhi Ji Dahuang Tang is contraindicated. For mild cold, Guizhi Ji Fuzi Tang (Cinnamon Twig Added Aconite Decoction) is appropriate, retaining Peony.
It is also said: After severe vomiting and purgation in Shanghan, extreme deficiency ensues. Further excessive sweating causes external Qi stagnation. Giving water to induce sweating triggers hiccups due to Stomach cold. Chang Shi suggested Xiaowenzhong Tang (Minor Warm the Middle Decoction). Guo Yong suggested Lizhong Tang for severe Stomach cold; Xiaobanxia Tang or Wuling San for hiccups.
It is also said: After vomiting, diarrhea, and sweating, if the pulse is level but mild vexation persists, it is due to new deficiency failing to transform grain Qi. Chang Shi suggested Tiaoweichengqi Tang (Regulate the Stomach and Drain the Ganglion Decoction). Guo Yong advised against medication; dietary restriction resolves it, as the pulse is level and further damage is harmful.
It is also said: In Taiyang disease, excessive sweating followed by purgation causes epigastric blockage, exterior-interior deficiency, and exhaustion of Yin-Yang Qi. "No Yang means Yin stands alone." Adding fire needle therapy causes chest irritability. Cyan-yellow complexion and flaccid skin indicate difficult treatment. Yellowish complexion and warm hands/feet indicate easy recovery. Chang Shi suggested Xiaochaihu Tang or Guizhi Longgu Muli Tang (Cinnamon Twig, Dragon Bone, and Oyster Shell Decoction). Guo Yong suggested Zhishi Lizhong Wan for epigastric blockage; Guizhi Longgu Muli Tang for fire needle chest irritability; Guizhi Ji Renshen Tang (Cinnamon Twig Added Ginseng Decoction) for unresolved exterior signs.
It is also said: In Taiyang disease lasting eight to nine days, resembling malaria with more heat than cold, no vomiting, normal bowel/bladder function, occurring two to three times daily, with a faint (or floating) slow pulse indicates recovery. A faint pulse with aversion to cold indicates dual Yin-Yang deficiency; sweating, purgation, and vomiting are contraindicated. A reddish facial color indicates unresolved disease due to inability to sweat slightly, causing body itching; this belongs to Guizhi Mahuang Gemi Tang (Cinnamon Twig and Ephedra Half-Dose Decoction).
It is also said: After Guizhi Tang or purgation, if head/neck stiffness, low-grade fever, anhidrosis, epigastric fullness, mild pain, and urinary difficulty persist, this belongs to Guizhi Qu Gui Jia Fuling Baizhu Tang (Cinnamon Twig Decoction Without Cinnamon Plus Poria and Atractylodes Macrocephala Decoction).
It is also said: In Taiyang disease, if initial sweating fails and purgation is used, a floating pulse indicates non-recovery. Floating indicates exterior pathology; purgation is inappropriate. Since the pulse is floating, the exterior must be resolved with Guizhi Tang. Guo Yong noted this aligns with the principle that sweating first is not an error.
It is also said: After purgation and sweating, daytime restlessness with nighttime quietness, no vomiting/thirst, no exterior signs, deep-slow pulse, and lack of high fever belong to Ganjiang Fuzi Tang (Ginger and Aconite Decoction). Guo Yong noted this aligns with the principle that purgation first is not an error.
It is also said: After vomiting/purgation in Shanghan, epigastric fullness/reversal, Qi rushing to the chest, vertigo upon rising, deep-tight pulse, and body tremors after sweating belong to Fuling Guizhi Baizhu Gancao Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction).
It is also said: After sweating or purgation, if the disease persists with irritability, this belongs to Fuling Sini Tang (Poria and Frigid Four Decoction).
It is also said: After sweating/vomiting/purgation, lingering vexation and insomnia, potentially severe enough to cause restlessness and Ao Nao (regretful vexation), belong to Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction). For shortness of breath, Zhizi Gancao Chi Tang; for vomiting, Zhizi Shengjiang Chi Tang.
It is also said: After sweating or purgation, if vexatious heat and chest oppression occur, this belongs to Zhizi Chi Tang syndrome.
It is also said: In Taiyang syndrome passing the stage for over ten days, with epigastric nausea, chest pain, loose stools, mild abdominal fullness, and mild vexation, resulting from prior extreme vomiting/purgation, Tiaoweichengqi Tang is indicated. Otherwise, it is contraindicated. If merely nauseous with chest pain and loose stools, it is not a Chaihu syndrome but a result of extreme vomiting/purgation. Guo Yong criticized Pang Shi's attribution to Tiaoweichengqi Tang, noting the original text lacks "belongs to." He argued this passage describes two syndromes: the first requires Chengqi formulas; the second (post-"if not so") requires Jiangsheng Jupi Tang (Fresh Ginger and Tangerine Peel Decoction) or Banxia Jupi Tang (Pinellia and Tangerine Peel Decoction).
It is also said: In Taiyang disease, after excessive sweating and purgation, if constipation persists for five to six days, with dry tongue, thirst, late-afternoon tidal fever, and hardness/pain from epigastrium to lower abdomen, this belongs to Daxiexiong Tang (Major Chest-Breaking Decoction).
It is also said: In Shanghan on day five or six, after sweating and purgation, if hypochondriac fullness, slight binding, urinary difficulty, thirst without vomiting, head-only sweating, alternating chills/fever, and irritability persist, the disease is unresolved. This belongs to Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Ginger Decoction).
It is also said: After resolving Shanghan via sweating/vomiting/purgation, if epigastric hardness and persistent belching remain, this belongs to Xuanfu Daizheshi Tang (Inula and Hematite Decoction).
It is also said: After severe purgation and sweating in Shanghan, if epigastric blockage and aversion to cold persist, the exterior is unresolved. Do not attack the blockage; resolve the exterior first with Guizhi Tang (Cinnamon Twig Decoction). Once the exterior is resolved, attack the blockage with Dahuang Huanglian Xiexin Tang (Rhubarb, Coptis, and Heart-Draining Decoction).
It is also said: After vomiting/purgation in Shanghan, if unresolved after seven to eight days, with interior heat, exterior-interior heat, frequent aversion to wind, intense thirst, dry tongue, and desire to drink several liters of water, Baihu Ji Renshen Tang (White Tiger Added Ginseng Decoction) is indicated.
It is also said: After vomiting/purgation in Shanghan, if unresolved with constipation for five to ten+ days, presenting with late-afternoon tidal fever, no aversion to cold, delirious speech as if seeing ghosts, severe cases showing confusion, grasping at clothes, fearfulness, slight panting, and fixed gaze: wiry pulse indicates survival, choppy pulse indicates death. Mild cases with fever and delirium belong to Dachengqi Tang (Major Drain the Ganglion Decoction).
It is also said: In combined Three-Yang disease, with heavy abdomen/body, difficulty turning, impaired mouth sensation, facial grease, delirium, and enuresis: sweating worsens delirium; purgation causes forehead sweating and cold limbs. Spontaneous sweating indicates Baihu Tang (White Tiger Decoction).
It is also said: In Yangming disease, with floating-tight pulse, dry throat, bitter taste, abdominal fullness, wheezing, fever, sweating, no aversion to cold but aversion to heat, and body heaviness: sweating causes irritability and delirium; warming needles cause fearfulness and insomnia; purgation empties the Stomach, allowing hostile Qi to disturb the Diaphragm, causing Ao Nao and tongue coating. This belongs to Zhizi Chi Tang. Pang Shi noted: Stop Zhizi Tang once effective; contraindicated in patients with chronic loose stools.
It is also said: In Yangming disease, after purgation, if Ao Nao and irritability occur with dry feces in the Stomach, purgation is permissible. If abdominal fullness is mild with hard head but loose tail, purgation is contraindicated. If dry feces are confirmed, Dachengqi Tang is appropriate.
It is also said: In Yangming disease, after purgation, if exterior heat and warm hands/feet persist without Jie Xiong, but Ao Nao, hunger without ability to eat, and head-only sweating occur, this belongs to Zhizi Chi Tang.
It is also said: In Taiyang disease, after vomiting/purgation/sweating, if mild vexation, frequent urination, and hard stools occur, give Xiaochengqi Tang (Minor Drain the Ganglion Decoction) to harmonize and cure.
It is also said: Profuse sweating or severe diarrhea leading to cold extremities belongs to Sini Tang (Frigid Four Decoction).
It is also said: In Taiyang disease, after purgation, if Qi rushes upward, Guizhi Tang may be given. If not, it is contraindicated. Guo Yong added: If Qi does not rush, consider Guizhi Qu Shaoyao Jia Fuzi Tang (Cinnamon Twig Decoction Without Peony Added Aconite), Guizhi Ji Houpo Zixi Tang (Cinnamon Twig Added Magnolia Bark and Apricot Kernel), or Gegen Huangqin Huanglian Tang (Kudzu, Scutellaria, and Coptis Decoction) based on subsequent syndromes.
It is also said: In Taiyang disease, after purgation, if pulse is Cu (surging) with chest fullness, this belongs to Guizhi Qu Shaoyao Tang (Cinnamon Twig Decoction Without Peony). If mild aversion to cold occurs, use Guizhi Qu Shaoyao Jia Fuzi Tang. (Note: Pulse Jing combines these two syndromes).
It is also said: In Taiyang disease with Guizhi syndrome, if purgation is erroneously used causing incessant diarrhea with a Cu pulse, the exterior remains unresolved. Wheezing with sweating belongs to Gegen Huangqin Huanglian Tang.
It is also said: In Taiyang disease, if purgation causes mild wheezing with unresolved exterior, this belongs to Guizhi Ji Houpo Zixi Tang.
It is also said: In Shanghan, if constipation persists for six to seven days with headache and fever, Chengqi Tang may be given. If urine is clear, the pathogen is in the exterior, not interior; sweating is required. If headache persists, nasal bleeding may occur; Guizhi Tang is appropriate. Chang Shi doubted this, suggesting Mahuang Tang (Ephedra Decoction) or Gemi Tang for heavy sweating. Guo Yong clarified: Use Guizhi Tang if sweating; Mahuang Tang if anhidrotic. See Nosebleed section.
It is also said: In Shanghan on day five or six, after severe purgation, if body heat persists and heart-region pain occurs, the disease is unresolved. This belongs to Zhizi Chi Tang.
It is also said: After purgation in Shanghan, if irritability, abdominal fullness, and restlessness occur, this belongs to Zhizi Houpo Tang (Gardenia and Magnolia Bark Decoction).
It is also said: In Shanghan, if harsh pill-based purgation leaves body heat and mild vexation, this belongs to Zhizi Ganjiang Tang (Gardenia and Ginger Decoction).
It is also said: In Shanghan, after purgation, if continuous diarrhea with undigested food and body pain occur, urgently rescue the interior with Sini Tang. Once bowels normalize and pain persists, urgently rescue the exterior with Guizhi Tang.
It is also said: In Taiyang disease passing the stage for ten+ days, if erroneous purgation is repeated and Chaihu syndrome persists after four to five days, first give Xiaochaihu Tang. If vomiting persists, epigastric urgency, and mild vexation remain, the disease is unresolved; give Daxiehu Tang to purge and cure. Guo Yong noted: If vomiting stops and peace returns after Xiaochaihu Tang, do not administer Daxiehu Tang.
It is also said: In Shanghan lasting thirteen days, unresolved with hypochondriac fullness, vomiting, and late-afternoon tidal fever, followed by mild diarrhea: this was originally a Chaihu syndrome. Purging should not cause diarrhea; the presence of diarrhea indicates the physician used inappropriate pill-based purgation. Tidal fever indicates excess. First give Xiaochaihu Tang to resolve the exterior, then Chaihu Jia Mangxiao Tang (Bupleurum Added Mirabilite Decoction).
It is also said: In Shanghan lasting thirteen days, passing the stage with delirium indicates heat; purgation with decoction is indicated. If urination is free, stool should be hard; paradoxical diarrhea with a harmonious pulse indicates inappropriate pill-based purgation by the physician.