仲景曰。伤寒。医下之。续得下利清谷不止。身疼痛者。急当救
里。后身疼痛。清便自调。急当救表。救里。宜四逆汤。救表。宜桂枝
汤。雍曰。此谓太阳证误下之者。
又曰。病发热头痛。脉反沉。若不瘥。身体疼痛。当救其里。宜四
逆汤。雍曰。此太阳病而得少阴脉。故急当救里。
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。和表。用小柴胡汤。复下。用调胃承气汤。雍曰。汗
出表和。则不必复下。
又曰。太阳病未解。脉阴阳俱停。（一作微）必先振 。汗出而
解。但阳脉微者。先汗出而解。千金云。宜桂枝汤。但阴脉微（一有而
尺脉实四字）者。下之而解。若欲下之。宜调胃承气汤。（一云宜大柴
胡汤）。
又曰。太阳病。发热汗出者。此为营弱卫强。故使汗出。欲救邪
风者。宜桂枝汤。雍曰。邪风。在卫之风也。
又曰。伤寒五六日。中风。往来寒热。胸胁苦满。默默不欲饮食。
心烦喜呕。或胸中烦而不呕。或渴。或腹中痛。或胁下痞硬。或心下
悸小便不利。或不渴身有微热。或咳者。与小柴胡汤主之。
又曰。血弱气尽。腠理开。邪气因入。与正气相搏。结于胁下。正
邪分争。往来寒热。休作有时。默默不欲饮食。脏腑相连。其痛必下。
邪高痛下。故使呕也。（一云脏腑相连其病必胁膈中痛）小柴胡汤主
之。服柴胡汤已。渴者。属阳明也。以法治之。常器之云。亦与小柴胡
汤。待其便坚。方可用调胃承气汤。
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。与柴胡汤。后必
下重。本渴而饮水呕者。柴胡不中与也。食谷者哕。常氏云。可五苓
散、小半夏橘皮汤。雍曰。出千金十八卷痰饮门。若证象阳旦小便难
者。属桂枝加附子汤。（见前卷）
又曰。伤寒四五日。身热恶风。颈项强。胁下满。手足温而渴者。小柴胡汤主之。
又曰。伤寒阳脉涩。阴脉弦。法当腹中急痛。先与小建中汤。不瘥者。小柴胡汤主之。
又曰。伤寒中风。有柴胡证。但见一证便是。不必悉具。凡柴胡
汤病证而下之。若柴胡证不罢者。复与柴胡汤。必蒸蒸而振。却发热
汗出而解。雍曰。柴胡汤证。误以他药下之者也。
又曰。伤寒二三日。心中悸而烦者。小建中汤主之。
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。郁郁微烦者。为未解也。与大
柴胡汤下之则愈。雍曰。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。下之而不得利。今反利者。知医以丸药下之。非其
治也。潮热者实也。先宜小柴胡汤以解外。后以柴胡加芒硝汤主之。
千金曰。柴胡加大黄芒硝桑螵蛸汤也。
又曰。伤寒十三日不解。过经谵语者。以内有热也。当以汤下
之。若小便利者。大盒饭硬。而反下利。其脉调和者。知医以丸药下
之。非其治也。若自下利者。脉当微厥。今反和者。此为内实也。调胃承气汤主之。
又曰。太阳病不解。热结膀胱。其人如狂。血自下。下者愈。其外
不解者。尚未可攻。当先解其外。外解已。但少腹急结者。乃可攻之。
宜桃核承气汤。雍曰。外不解者。未可攻。先解其外。千金用桂枝汤。
又曰。伤寒八九日。下之。胸满烦惊。小便不利。谵语。一身尽
重。不可转侧者。柴胡加龙骨牡蛎汤主之。
又曰。伤寒腹满。谵语。寸口脉浮而紧。此肝乘脾也。名曰纵。刺
期门。伤寒发热。啬啬恶寒。大渴欲饮水。其腹必满。自汗出。小便
利。其病欲解。此肝乘肺也。名曰横。刺期门。
又曰。太阳病。二日反躁。反熨其背而大汗出。火气入胃。胃中
水竭躁烦。必发谵语。十余日。振 自下利者。此为欲解也。（后不可
火证中曰振而反汗出为欲解）故其汗从腰以下不得汗。欲小便不
得。反呕。欲失溲。足下恶风。大便硬。小盒饭数。而反不数及多。大
便已。头卓然而痛。其人足心必热。谷气下流故也。常云。可与白虎
加人参汤、五苓散、调胃承气汤。雍曰。常氏之意。谓火气入胃。胃中
枯燥。故用白虎加人参汤解之。然须无表证。渴饮水者可服。有表证
者不可服。以白虎解里热故也。小便不利者。固当用五苓散。然渴饮
水者宜服。其大便硬者。用调胃承气汤。亦小便不利则可服。小便利
者反不可服。振 反汗出者。若自下利。皆不宜服。若无上诸证而大
便硬。或不通。谵语仍在者。然后可服。此一论证多。宜审之。若欲解
诸证未生时势。须先去火邪。宜救逆汤。
又曰。太阳病。中风。以火劫发汗。邪风被火热。血气流溢。失其
常度。两阳相熏灼。其身发黄。阳盛则欲衄。阴虚则小便难。阴阳俱
虚竭。身体则枯燥。但头汗出。剂颈而还。腹满微喘。口干咽烂。或不
大便。久则谵语。甚者至哕。手足躁扰。捻衣摸床。小便利者。其人可
治。常氏云。可桂枝去芍药加龙骨牡蛎救逆汤、五苓散、大承气汤。雍
曰。救逆则可。阴阳俱虚。身体枯燥。大承气不敢用。小便不利。与
五苓散。发黄者。茵陈蒿汤。
又曰。伤寒脉浮。医以火迫劫之。亡阳。必惊狂。起卧不安者。桂枝去芍药加蜀漆龙骨牡蛎救逆汤主之。
又曰。形作伤寒。其脉不弦紧而弱。弱者必渴。被火者必谵语。弱者发热脉浮。解之。当汗出愈。常氏云。可根据前
救逆汤。
又曰。太阳病。以火熏之。不得汗。其人必躁。到经不解。必圊血。名为火邪。常氏云。可根据前救逆汤、黄芩芍药
汤。
又曰。脉浮热甚。而反灸之。此为实。实以虚治。因火而动。必咽燥唾血。常氏云。可根据前救逆汤。
又曰。微数之脉。慎不可灸。因火为邪。则为烦逆。追虚逐实。血
散脉中。火气虽微。内攻有力。焦骨伤筋。血难复也。常氏云。可根据前救逆汤。欲其有汗。宜柴胡桂枝汤。
又曰。脉浮。宜以汗解。用火灸之。邪无从出。因火而盛。病从腰
以下必重而痹。名火逆也。欲自解者。必当先烦。乃有汗而解。何以
知之。脉浮。故知汗出解也。雍曰。宜少与救逆汤。（活人书第十方）
又曰。烧针令其汗。针处被寒。核起而赤者。必发奔豚。气从少
腹上冲心者。灸其核上各一壮。与桂枝加桂汤。更加桂二两。
又曰。火逆下之。因烧针烦躁者。桂枝甘草龙骨牡蛎汤主之。
又曰。太阳伤寒者。加温针。必惊也。常氏曰。可根据前救逆汤。
又曰。太阳病。当恶寒发热。今自汗出。反不恶寒发热。关上脉
细数者。以医吐之过也。一二日吐之者。腹中饥。口不能食。三四日
吐之者。不喜糜粥。欲食冷食。朝食暮吐。以医吐之所致也。此为小
逆。常氏曰。可与小半夏汤、小温中汤。亦可与半夏干姜汤。（出金匮
方）雍曰。活人书大半夏汤、小半夏加茯苓汤、半夏生姜汤。皆可选
用。
又曰。太阳病。吐之。但太阳病当恶寒。今反不恶寒。不欲近衣。
此为吐之内烦也。常氏曰。可与竹叶石膏汤。
又曰。病患脉数。数为热。当消谷引食。而反吐者。此以发汗。令
阳气微。膈气虚。脉乃数也。数为客热。不能消谷。以胃中虚冷。故吐
也。常氏云。可与小半夏汤、小温中汤。
又曰。太阳病。过经十余日。心下温温欲吐而胸中痛。大便反
溏。腹微满。郁郁微烦。先此时自极吐下者。与调胃承气汤。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。与调胃承气汤者。谓前证也。后证但欲呕以下。非柴胡
证。宜桔皮汤、大半夏加桔皮汤。
又曰。太阳病六七日。表证仍在。脉微而沉。反不结胸。其人发
狂者。以热在下焦。少腹当硬满。小便自利者。下血乃愈。所以然者。
以太阳随经。瘀热在里故也。抵当汤主之。
又曰。太阳病。身黄。脉沉结。少腹硬。小便不利者。为无血也。
小便自利。其人如狂者。血证谛也。抵当汤主之。常氏云。小便不利
无血者。与五苓散。
又曰。伤寒有热。少腹满。应小便不利。今反利者。为有血也。当
下之。不可余药。宜抵当丸。
又曰。太阳病。小便利者。以饮水多。必心下悸。小便少者。必苦
里急也。常氏曰。可茯苓桂枝甘草生姜汤、猪苓汤。雍曰。小便利。用
茯苓桂枝白术甘草汤。小便少。应用猪苓汤。
仲景问曰。病有结胸。有脏结。其状何如。答曰。按之痛。寸脉
浮。关脉沉。名曰结胸也。
又曰。何谓脏结。答曰。如结胸状。饮食如故。时时下利。寸口脉
浮。关脉小细沉紧。名曰脏结。舌上白苔滑者。难治。常氏曰。可刺关元穴。
又曰。脏结无阳证。不往来寒热。（一云寒而不热）其人反静。舌
上苔滑者。不可攻也。常氏云。可刺关元穴。雍曰。宜灸。
又曰。病发于阳而反下之。热入。因作结胸。病发于阴而反下
之。（一作汗之千金方同）因作痞。所以成结胸者。以下之太早故也。
又曰。结胸者。项亦强。如柔 状。下之则和。宜大陷胸丸。
又曰。结胸证。其脉浮大者。不可不。下之则死。常氏云。可与增
损理中丸并蜜丸服。如未效。用黄连七寸。巴豆七粒。二味捣如泥。
封脐上。灼艾灸热。渐效。
又曰。结胸证悉具。烦躁者亦死。
又曰。太阳病。脉浮而动数。浮则为风。数则为热。动则为痛。数
则为虚。头痛发热。微盗汗出。而反恶寒者。表未解也。医反下之。动
数变迟。膈内拒痛。（一云头痛则眩千金方同）胃中空虚。客气动膈。
短气躁烦。心中懊 。阳气内陷。心下因硬。则为结胸。大陷胸汤主
之。若不结胸。但头汗出。余处无汗。剂颈而还。小便不利。身必发黄
也。常氏云。发黄者。与茵陈蒿汤。煎茵陈浓汁调五苓散亦可。
又曰。伤寒六七日。结胸热实。脉沉而紧。心下痛。按之石硬者。大陷胸汤主之。
又曰。伤寒十余日。热结在里。复往来寒热者。与大柴胡汤。但
结胸。无大热者。此为水结在胸胁也。但头微汗出者。大陷胸汤主之。
又曰。太阳病。重发汗而复下之。不大便五六日。舌上燥而渴。
日哺所小有潮热。（一云日哺所发心胸大烦）从心下至少腹硬满而痛不可近者。大陷胸汤主之。
又曰。小结胸病。正在心下。按之则痛。脉浮滑者。小陷胸汤主之。
又曰。太阳病二三日。不能卧。但欲起。心下必结。其脉微弱者。
此本有寒分也。常云。可增损理中丸。反下之。若利止。必作结胸。常
云。可大小陷胸汤主之。利未止者。四日复下之。此作协热利也。常云。白头翁汤。
又曰。太阳病。下之。其脉促。（一作纵）不结胸者。此为欲解也。
脉浮者。必结胸。常云。可增损理中丸。脉紧者。必咽痛。常云。可桔
梗甘草汤。脉弦者。必两胁拘急。常云。小柴胡汤。脉细数者。头痛未
止。常云。可葱须汤。脉沉紧者。必欲呕。常云。可七物黄连汤。脉沉
滑者。协热利。常云。可白头翁汤。脉浮滑者。必下血。常云。可与类要柏皮汤。
又曰。病在阳。应以汗解之。反以冷水 之。若灌之。其热被劫
不得去。弥更益烦。肉上粟起。意欲饮水。反不渴者。服文蛤散。若不
瘥者。与五苓散。寒实结胸。无热证者。与三物小陷胸汤。白散亦可
服。
又曰。太阳与少阳并病。头项强痛。或眩冒。时如结胸。心下痞
硬者。当刺大椎第一间肺俞肝俞。慎不可发汗。发汗则谵语。脉弦。
五六日谵语不止。当刺期门。
又曰。妇人中风。发热恶寒。经水适来。得之七八日。热除。而脉
迟身凉。胸胁下满如结胸状。谵语者。此为热入血室也。当刺期门。
随其实而泻之。常氏云。随其实而泻。谓针家当行泻法也。亦可用小
柴胡汤。
又曰。妇人中风七八日。续得寒热。发作有时。经水适断者。此
为热入血室。其血必结。故使如疟状。发作有时。小柴胡汤主之。
又曰。妇人伤寒发热。经水适来。昼日明了。暮则谵语。如见鬼
状。此为热入血室。无犯胃气。及上二焦。必自愈。雍曰。上焦中焦。
营卫所出也。如不自愈者。服小柴胡汤。
又曰。伤寒六七日。发热微恶寒。支节烦疼。微呕。心下支结。外
证未去者。柴胡桂枝汤主之。
又曰。伤寒五六日。已发汗而复下之。胸胁满。微结。小便不利。
渴而不呕。但头汗出。往来寒热。心烦者。为未解也。柴胡桂枝干姜
汤主之。
又曰。伤寒五六日。头汗出。微恶寒。手足冷。心下满。口不欲
食。大便硬。脉细者。此为阳微结。必有表复有里也。脉沉亦在里也。
汗出为阳微。假令纯阴结。不得复有外证。悉入在里。此为半在里。
Zhang Zhongjing said: In cases of Shanghan (Cold Damage), if the physician mistakenly employs purgation, leading to persistent diarrhea with undigested food, and the patient still experiences body pain, urgent treatment of the Interior is required. If body pain persists after the diarrhea has ceased and bowel movements have normalized, urgent treatment of the Exterior is required. To treat the Interior, Sini Tang (Four Reversal Decoction) is indicated. To treat the Exterior, Guizhi Tang (Cinnamon Twig Decoction) is indicated. Guo Yong stated: This refers to cases where Taiyang syndrome was mistakenly treated with purgation.
He also said: When a patient presents with fever, headache, and a pulse that is unexpectedly deep, if the condition does not improve and body pain persists, the Interior should be treated urgently with Sini Tang (Four Reversal Decoction). Guo Yong stated: This occurs when a Taiyang disease presents with Shaoyin pulses, necessitating urgent treatment of the Interior.
He further said: In Taiyang disease, if purgation is used first without resolution, followed by sweating, both the Exterior and Interior become deficient. Consequently, the patient may experience dizziness or clouding of consciousness (Mao). For such patients, spontaneous sweating leads to recovery because it harmonizes the Exterior Qi. If the Interior remains unharmonized, purgation may then be considered. Chang Shi stated: To harmonize the Exterior, Xiaochaihu Tang (Minor Bupleurum Decoction) is used; for subsequent purgation, Tiaoweichengqi Tang (Stomach-Regulating Downward-Pouring Decoction) is used. Guo Yong stated: Once sweating has harmonized the Exterior, further purgation is unnecessary.
He also said: If Taiyang disease is unresolved and the pulse at all three positions (Cun, Guan, Chi) is faint (some texts say "micro"), the patient will likely experience chills followed by sweating, leading to resolution. If only the Yang pulse (Cun position) is faint, sweating will lead to resolution. The Qianjin Fang states that Guizhi Tang (Cinnamon Twig Decoction) is indicated. If the Yin pulse (Chi position) is faint (some texts add "and the Chi pulse is solid"), resolution comes through purgation. If purgation is desired, Tiaoweichengqi Tang (Stomach-Regulating Downward-Pouring Decoction) is indicated (some texts suggest Dachaihu Tang).
He also said: In Taiyang disease, fever accompanied by sweating indicates weak Ying (Nutrient) Qi and strong Wei (Defensive) Qi, which causes sweating. To address pathogenic wind, Guizhi Tang (Cinnamon Twig Decoction) is indicated. Guo Yong stated: Pathogenic wind here refers to wind invading the Wei level.
He also said: After five or six days of Shanghan or Fengzhong (Wind Strike), presenting with alternating chills and fever, fullness and distress in the chest and hypochondrium, silence, loss of appetite, irritability, and a tendency to vomit, or alternatively, chest irritability without vomiting, thirst, abdominal pain, hypochondriac stiffness, palpitations with urination difficulty, absence of thirst with slight body heat, or cough, Xiaochaihu Tang (Minor Bupleurum Decoction) is the primary formula.
He also said: When blood and Qi are depleted and pores open, pathogenic factors enter and contend with healthy Qi, knotting in the hypochondrium. This struggle causes alternating chills and fever with regular intervals, silence, and loss of appetite. Due to the connection between organs, pain radiates downward. High pathology causing low pain induces vomiting (some texts state organ connection causes pain in the hypochondrium and diaphragm). Xiaochaihu Tang (Minor Bupleurum Decoction) is indicated. If thirst develops after taking Chaihu decoctions, the disease has shifted to Yangming and should be treated accordingly. Chang Qizi stated: One may continue with Xiaochaihu Tang until stool becomes hard, then use Tiaoweichengqi Tang (Stomach-Regulating Downward-Pouring Decoction).
He also said: On the sixth or seventh day of illness, with a slow, floating, and weak pulse, aversion to wind and cold, and warm hands and feet, repeated purgation by physicians may lead to inability to eat, hypochondriac fullness and pain, jaundice of the face and body, neck stiffness, and difficult urination. Chaihu Tang should be given, though this may later cause a sensation of heaviness in the rectum. If the patient is thirsty but vomiting upon drinking water, Chaihu Tang is contraindicated. If eating triggers hiccups, Chang Shi suggested Wuling San (Five-Ingredient Powder with Poria) or Xiao Banxia Jupi Tang (Minor Pinellia and Tangerine Peel Decoction). Guo Yong noted this appears in Volume 18 of the Qianjin Fang under Phlegm-Fluids. If symptoms resemble Yangdan Tang syndrome with difficult urination, Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite) is indicated (see previous volume).
He also said: In Shanghan on the fourth or fifth day, presenting with body heat, aversion to wind, neck stiffness, hypochondriac fullness, warm hands and feet, and thirst, Xiaochaihu Tang (Minor Bupleurum Decoction) is indicated.
He also said: In Shanghan, if the Yang pulse is choppy and the Yin pulse is string-taut, abdominal cramping pain is expected according to principles. First, give Xiaojianzhong Tang (Minor Construct the Middle Decoction). If ineffective, Xiaochaihu Tang (Minor Bupleurum Decoction) is indicated.
He also said: In Shanghan or Fengzhong, if Chaihu syndrome signs are present, observing one sign is sufficient; all signs need not be present. If Chaihu syndrome is mistakenly purged but the syndrome persists, administering Chaihu Tang again will likely cause shivering followed by fever and sweating, leading to resolution. Guo Yong stated: This refers to Chaihu syndrome mistakenly treated with purgatives.
He also said: In Shanghan on the second or third day, if there is palpitation and irritability, Xiaojianzhong Tang (Minor Construct the Middle Decoction) is indicated.
He also said: In Taiyang disease lasting over ten days, if mistakenly purged two or three times, and after four or five days Chaihu signs persist, administer Xiaochaihu Tang (Minor Bupleurum Decoction) first. If vomiting continues, epigastric urgency, and mild vexation occur, indicating unresolved disease, Dachaihu Tang (Major Bupleurum Decoction) should be used to purge. Guo Yong stated: If vomiting ceases and the patient feels slightly better, do not administer Dachaihu Tang.
He also said: In unresolved Shanghan on the thirteenth day, with chest-hypochondriac fullness and vomiting, evening tidal fever, and subsequent mild diarrhea, this was originally a Chaihu syndrome. Purging should not have caused diarrhea; its presence indicates the physician incorrectly used pill-based purgatives. Tidal fever indicates excess heat. First, use Xiaochaihu Tang (Minor Bupleurum Decoction) to resolve the exterior, then use Chaihu Jia Mangxiao Tang (Bupleurum Decoction plus Niter) as the main treatment. The Qianjin Fang describes this as Chaihu Jia Dahuang Mangxiao Sangpiaoxiao Tang (Bupleurum Decoction plus Rhubarb, Niter, and Mantis Egg Case).
He also said: In unresolved Shanghan on the thirteenth day, passing into another stage with delirium indicates internal heat requiring decoction-based purgation. If urine is clear, stool should be hard; if diarrhea occurs instead with a harmonious pulse, it indicates incorrect pill-purgative use. Natural diarrhea would present with a faint or knotted pulse; a harmonious pulse indicates internal excess, treated with Tiaoweichengqi Tang (Stomach-Regulating Downward-Pouring Decoction).
He also said: If Taiyang disease is unresolved and heat knots in the Bladder, causing manic behavior, spontaneous bleeding resolves the condition. If the exterior remains unresolved, attack is premature; resolve the exterior first. Once the exterior is resolved, if only lower abdominal urgency and binding remain, attack with Taohexie Chengqi Tang (Peach Kernel Downward-Pouring Decoction). Guo Yong stated: Do not attack while the exterior is unresolved; resolve the exterior first. The Qianjin Fang uses Guizhi Tang.
He also said: In Shanghan on the eighth or ninth day, following mistaken purgation, presenting with chest fullness, fright, palpitations, urination difficulty, delirium, whole-body heaviness, and inability to turn, Chaihu Jia Longgu Muli Tang (Bupleurum Decoction plus Dragon Bone and Oyster Shell) is indicated.
He also said: In Shanghan with abdominal fullness and delirium, and a floating-tight pulse at Cun, this is Liver Wood overacting on Spleen Earth, termed "Zong" (Vertical). Acupuncture at Qimen (LR14) is indicated. In Shanghan with fever, shivering aversion to cold, extreme thirst, abdominal fullness, spontaneous sweating, and free urination, the disease is resolving; this is Liver Wood overacting on Lung Metal, termed "Heng" (Horizontal). Acupuncture at Qimen (LR14) is indicated.
He also said: In Taiyang disease on the second day, restlessness appearing contrary to expectation, followed by back moxibustion causing profuse sweating, allows fire qi to enter the Stomach, depleting fluids, causing restlessness, vexation, and likely delirium. After ten-plus days, if chills and spontaneous diarrhea occur, the disease is resolving (as noted in the Fire Syndrome section: chills with sweating indicate resolution). However, if sweat is absent from the waist down, urination is difficult, vomiting occurs, incontinence is feared, feet fear cold, stool is hard, and urination frequency is paradoxically low despite thirst, these are complex signs. After stool passage, sudden head pain and warm soles indicate descending Grain Qi. Chang Shi suggested Baihu Jiaren Tang (White Tiger Decoction plus Ginseng), Wuling San (Five-Ingredient Powder with Poria), or Tiaoweichengqi Tang (Stomach-Regulating Downward-Pouring Decoction). Guo Yong clarified: Chang Shi intended Baihu Jiaren Tang for dryness from fire entering the Stomach, but only if no exterior syndrome exists and thirst is present. With an exterior syndrome, it is contraindicated as it clears interior heat. Wuling San is suitable for difficult urination with thirst. Tiaoweichengqi Tang is for hard stool with difficult urination, but contraindicated if urination is free. Chills with sweating and natural diarrhea are contraindications for these formulas. If none of these apply but stool is hard/unblocked with persistent delirium, they may be used. Careful differentiation is required. To prevent these complications, eliminate fire pathogens early using Niujin Tang (Rescue the Perished Decoction).
He also said: In Taiyang Fengzhong, using fire to force sweating damages blood and Qi flow. Dual Yang (wind and fire) scorching causes jaundice. Excess Yang leads to nasal bleeding; Yin deficiency leads to difficult urination. Total depletion causes dryness. Only head sweats up to the neck. Abdominal fullness, slight wheezing, dry mouth, throat erosion, constipation, delirium, hiccups, restless limbs, and picking at clothes may occur. Free urination indicates treatability. Chang Shi suggested Guizhi Qu Shaoyao Jia Longgu Muli Jiujie Tang (Cinnamon Twig Decoction minus Peony plus Dragon Bone and Oyster Shell Rescue Decoction), Wuling San, or Dachengqi Tang. Guo Yong stated: Rescue is appropriate, but Dachengqi Tang is too harsh for total deficiency and dryness. Use Wuling San for difficult urination; Yinchen Hao Tang (Artemisia Capillaris Decoction) for jaundice.
He also said: In Shanghan with a floating pulse, forcing sweat via fire causes Yang collapse, leading to fright, mania, and restlessness. Guizhi Qu Shaoyao Jia Shuqi Longgu Muli Jiujie Tang (Cinnamon Twig Decoction minus Peony plus Coelia, Dragon Bone, and Oyster Shell Rescue Decoction) is indicated.
He also said: If the presentation resembles Shanghan but the pulse is weak rather than string-taut, weakness implies thirst. Fire therapy causes delirium. If weakness, fever, and floating pulse coexist, resolving via sweating brings cure. Chang Shi suggested referring to the previous Rescue Decoction.
He also said: In Taiyang disease, fire fumigation without sweating causes restlessness. If unresolved by the time the meridian cycle completes, bloody stools ("fire evil") occur. Chang Shi suggested referring to the previous Rescue Decoction or Huangqin Shaoyao Tang (Scutellaria and Peony Decoction).
He also said: With a floating and intense heat pulse, moxibustion is erroneous as it treats excess as deficiency. Fire agitation causes dry throat and hemoptysis. Chang Shi suggested referring to the previous Rescue Decoction.
He also said: With a faint and rapid pulse, moxibustion is strictly forbidden. Fire becomes pathogenic, causing vexation and rebellion, chasing deficiency and pursuing excess, scattering blood. Though fire's effect seems minor, its internal attack is powerful, potentially burning bones and injuring sinews, making blood restoration difficult. Chang Shi suggested referring to the previous Rescue Decoction. To induce sweating, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) is indicated.
He also said: With a floating pulse, sweating is indicated. Moxibustion traps pathogens, exacerbating the condition, leading to heaviness and numbness below the waist ("Fire Reversal"). Spontaneous resolution requires initial vexation followed by sweating. This is known because the floating pulse indicates resolution via sweating. Guo Yong suggested small doses of Niujin Tang (Rescue the Perished Decoction) (from Huoren Shu, Formula 10).
He also said: If needle-cauterization induces sweating, and cold enters the puncture site causing red nodules, Ben Tun (Running Piglet) qi rising from the lower abdomen to the heart may occur. Moxa one cone on each nodule, then administer Guizhi Jia Gui Tang (Cinnamon Twig Decoction plus Cinnamon), adding two liang of Cinnamon Twig.
He also said: Following fire reversal and purgation, with烦躁 (restlessness/agitation) due to cauterization, Guizhi Gancao Longgu Muli Tang (Cinnamon Twig and Licorice Decoction plus Dragon Bone and Oyster Shell) is indicated.
He also said: In Taiyang Shanghan, adding warm needles causes fright. Chang Shi suggested referring to the previous Rescue Decoction.
He also said: Taiyang disease should present with aversion to cold and fever. If spontaneous sweating occurs with absence of these signs, and the Guan pulse is fine and rapid, it results from physician-induced emesis. Emesis on days 1-2 causes hunger but inability to eat. Emesis on days 3-4 causes dislike of congee, desire for cold food, and morning-eating/evening-vomiting. This is a "Minor Reversal." Chang Shi suggested Xiao Banxia Tang (Minor Pinellia Decoction), Xiao Wenzhong Tang (Minor Warm the Middle Decoction), or Banxia Ganjiang Tang (Pinellia and Dried Ginger Decoction) from Jingui Yaolue. Guo Yong added that Dahongxia Tang, Xiao Banxia Jia Fuling Tang, and Banxia Shengjiang Tang from Huoren Shu are also options.
He also said: In Taiyang disease, emesis should cause aversion to cold. Absence of aversion and discomfort with clothing indicates internal vexation from emesis. Chang Shi suggested Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction).
He also said: A rapid pulse indicates heat and normal digestion. Vomiting instead suggests sweat-induced Yang deficiency and Diaphragm Qi deficiency, causing the rapid pulse. This is "guest heat" unable to digest food due to Cold Stomach. Chang Shi suggested Xiao Banxia Tang (Minor Pinellia Decoction) or Xiao Wenzhong Tang (Minor Warm the Middle Decoction).
He also said: In Taiyang disease after ten-plus days, epigastric nausea, chest pain, loose stool, mild abdominal fullness, and vexation, following extreme prior emesis/purgation, Tiaoweichengqi Tang (Stomach-Regulating Downward-Pouring Decoction) is indicated. Otherwise, it is contraindicated. If only nausea, chest pain, and loose stool exist without other Chaihu signs, it is not Chaihu syndrome but result of extreme emesis/purgation. Guo Yong stated: Tiaoweichengqi Tang applies to the former case. The latter (nausea etc.) is not Chaihu syndrome; use Jupi Tang or Banxia Jia Jupi Tang (Pinellia Decoction plus Tangerine Peel).
He also said: In Taiyang disease on days 6-7, with persistent exterior signs, faint-deep pulse, no Jie Xiong (Chest Knotting), but manic behavior due to heat in the Lower Jiao, hard/full lower abdomen, and free urination, blood letting cures the condition due to Taiyang transmitting heat and stasis internally. Didang Tang (Throne-Occupying Decoction) is indicated.
He also said: In Taiyang disease, jaundice, deep-knotted pulse, hard lower abdomen, and difficult urination indicate no blood stasis. Free urination with manic behavior confirms blood stasis. Didang Tang (Throne-Occupying Decoction) is indicated. Chang Shi stated: For difficult urination without stasis, use Wuling San.
He also said: In Shanghan with heat and full lower abdomen, urination should be difficult. Free urination indicates blood stasis requiring purgation with Didang Wan (Throne-Occupying Pill).
He also said: In Taiyang disease, free urination with high fluid intake causes epigastric palpitations. Low urination causes internal urgency. Chang Shi suggested Fuling Guizhi Gancao Shengjiang Tang or Zhu Ling Tang. Guo Yong specified: Free urination uses Fuling Guizhi Baizhu Gancao Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction); low urination uses Zhu Ling Tang (Polyporus Decoction).
Zhang Zhongjing asked: What are the differences between Jie Xiong (Chest Knotting) and Zang Jie (Organ Knotting)? Answer: Pain on pressure, floating Cun pulse, and sinking Guan pulse define Jie Xiong.
He also said: Zang Jie resembles Jie Xiong but with normal diet and frequent diarrhea. Floating Cun pulse and fine-sink-tight Guan pulse define Zang Jie. Slippery white tongue coating indicates difficult treatment. Chang Shi suggested acupuncture at Guanyuan (CV4).
He also said: Zang Jie lacks Yang signs, has no alternating chills/fever, patient is quiet, and tongue has slippery coating; attack is contraindicated. Chang Shi suggested acupuncture at Guanyuan (CV4). Guo Yong suggested moxibustion.
He also said: Disease originating in Yang mistakenly purged allows heat entry, causing Jie Xiong. Disease originating in Yin mistakenly purged causes Pi (Glomus/Stagnation). Jie Xiong results from premature purgation.
He also said: Jie Xiong with neck stiffness resembling Rou Jing (Soft Spasm) resolves with purgation using Da Xianxiong Wan (Major Chest-Sinking Pill).
He also said: Jie Xiong with floating-large pulse cannot be attacked; purgation leads to death. Chang Shi suggested Zengsun Lizhong Wan (Modified Licorice and Ginger Pill) or honey pills. If ineffective, apply黄连 (Coptis) and Badou (Croton seed) paste to the umbilicus with moxa.
He also said: Complete Jie Xiong with烦躁 (restlessness) indicates death.
He also said: In Taiyang disease, floating-moving-rapid pulse indicates Wind, Heat, Pain, and Deficiency. Headache, fever, slight night sweating, and aversion to cold mean the exterior is unresolved. Mistaken purgation changes the pulse to slow, causing膈内拒痛 (rejection pain in the diaphragm). Empty Stomach allows hostile Qi to disturb the Diaphragm, causing shortness of breath,烦躁, and懊憹 (deep vexation). Yang Qi sinks inward, hardening the Epigastrium, forming Jie Xiong treated with Da Xianxiong Tang (Major Chest-Sinking Decoction). If no Jie Xiong, but only head sweating up to the neck, difficult urination, and jaundice occur, Yinyin Hao Tang (Artemisia Capillaris Decoction) or Wuling San mixed with Yinchen decoction is suggested by Chang Shi.
He also said: Shanghan on days 6-7 with heat-excess Jie Xiong, deep-tight pulse, epigastric pain, and stone-hard palpation is treated with Da Xianxiong Tang (Major Chest-Sinking Decoction).
He also said: Shanghan after ten days with internal heat and alternating chills/fever uses Dachaihu Tang (Major Bupleurum Decoction). Pure Jie Xiong without significant heat indicates Water Knotting in the Chest/Hypochondrium, treated with Da Xianxiong Tang (Major Chest-Sinking Decoction) if only slight head sweating occurs.
He also said: Taiyang disease with excessive sweating and purgation, leading to five-six days of constipation, dry tongue/thirst, evening tidal fever, and hardness/pain from Epigastrium to Lower Abdomen, is treated with Da Xianxiong Tang (Major Chest-Sinking Decoction).
He also said: Minor Jie Xiong located at the Epigastrium, painful on pressure, with floating-slippery pulse, is treated with Xiao Xianxiong Tang (Minor Chest-Sinking Decoction).
He also said: Taiyang disease on days 2-3 with inability to lie down, desire to rise, and Epigastric binding with weak pulse indicates pre-existing Cold Fluids. Mistaken purgation stopping diarrhea leads to Jie Xiong, treated with Da/Xiao Xianxiong Tang. Unstopping diarrhea treated with purgation on day 4 leads to Xie Re Li (Collateral Heat Diarrhea), treated with Baitouweng Tang (Pulsatilla Decoction).
He also said: In Taiyang disease, purgation leading to a Cu (Crowing/Rooster-crow) pulse without Jie Xiong indicates resolution. Floating pulse indicates Jie Xiong (treat with modified Lizhong Pill per Chang Shi). Tight pulse indicates sore throat (Jiegeng Gancao Tang). String-taut pulse indicates hypochondriac tension (Xiaochaihu Tang). Fine-rapid pulse indicates persistent headache (Congxu Tang). Deep-tight pulse indicates urge to vomit (Qi Wu Huanglian Tang). Deep-slippery pulse indicates Collateral Heat Diarrhea (Baitouweng Tang). Floating-slippery pulse indicates bloody stool (Leiyao Bai Pi Tang).
He also said: Exterior disease should be treated with sweating. Cold water application traps heat, increasing vexation and gooseflesh. Thirst without desire to drink is treated with Wenli San (Clam Shell Powder). If ineffective, use Wuling San. Cold-excess Jie Xiong without heat signs is treated with Sanwu Xiao Xianxiong Tang or Baisan (White Powder).
He also said: Taiyang-Shaoyang combined disease with neck stiffness, dizziness, occasional Jie Xiong-like symptoms, and Epigastric hardness requires acupuncture at Dazhui (GV14), Feishu (BL13), and Ganshu (BL18). Sweating is forbidden as it causes delirium and string-taut pulse. Persistent delirium after five-six days requires acupuncture at Qimen (LR14).
He also said: In women with Fengzhong, fever/aversion to cold, and menstruation starting, resolution of fever with slow pulse, cool body, hypochondriac fullness like Jie Xiong, and delirium indicates Re Ru Xue Shi (Heat Entering Blood Chamber). Acupuncture at Qimen (LR14) to drain excess is indicated, or Xiaochaihu Tang (Minor Bupleurum Decoction).
He also said: In women with Fengzhong after seven-eight days, recurring chills/fever at intervals, and menstruation stopping, this is Heat Entering Blood Chamber with blood knotting, resembling malaria. Xiaochaihu Tang (Minor Bupleurum Decoction) is indicated.
He also said: In women with Shanghan fever and menstruation, clarity by day and delirium/hallucinations by night indicates Heat Entering Blood Chamber. Do not harm Stomach Qi or Upper/Middle Jiao; self-resolution is expected. Guo Yong noted Upper/Middle Jiao generate Ying/Wei Qi; if unresolved, use Xiaochaihu Tang.
He also said: Shanghan on days 6-7 with slight fever/aversion to cold, limb joint pain, slight vomiting, Epigastric branch-binding, and unresolved exterior signs is treated with Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction).
He also said: Shanghan on days 5-6, post-sweat and purgation, with chest-hypochondriac fullness, slight binding, difficult urination, thirst without vomiting, head sweating, alternating chills/fever, and vexation indicates unresolved disease. Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction) is indicated.
He also said: Shanghan on days 5-6 with head sweating, slight aversion to cold, cold hands/feet, Epigastric fullness, lack of appetite, hard stool, and fine pulse indicates Yang Micro-Knot. There is both exterior and interior involvement. Deep pulse indicates interior. Sweating indicates Yang micro-deficiency. Pure Yin Knot would lack exterior signs. This is half-exterior, half-interior.