半在外也。脉虽沉紧。不得为少阴病。所以然者。阴不得有汗。今头
汗出。故知非少阴也。可与小柴胡汤。设不了了者。得屎而解。雍曰。
实者。大柴胡。虚者。蜜煎导之。
又曰。伤寒五六日。呕而发热者。柴胡汤证具。而以他药下之。
柴胡证仍在者。复与柴胡汤。此虽已下之。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。宜半夏泻心汤。
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。常氏曰。可半夏生姜二泻心汤。
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。可小陷胸汤、生姜泻心汤。雍曰。宜半夏泻心汤、枳实理中丸。
又曰。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。心下痞硬。满引胁下痛。干呕短气。汗出不恶寒者。
此表解里未和也。十枣汤主之。雍曰。十枣汤太峻。后人未易用。当以槟榔汤代之。
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。常氏曰。可生姜泻心汤、小柴
胡汤、桂枝去芍药加龙骨牡蛎救逆汤。雍曰。此难治之证。一言不可
尽。临时更详轻重。痞甚则先泻心。发热恶寒甚。则先柴胡。火逆甚。则先救逆。从所重治之。
又曰。心下痞。按之濡。其脉关上浮者。大黄黄连泻心汤主之。
又曰。心下痞。而复恶寒汗出者。附子泻心汤主之。
又曰。本以下之。故心下痞。与泻心汤。痞不解。其人渴而口燥烦。小便不利者。五苓散主之。一方云。忍之一日
乃愈。
又曰。伤寒汗出。解之后。胃中不和。心下痞硬。干噫食臭。胁下有水气。腹中雷鸣下利者。生姜泻心汤主之。
又曰。伤寒中风。医反下之。其人下利日数十行。谷不化。腹中
雷鸣。心下痞硬而满。干呕。心烦不得安。医见心下痞。谓病不尽。复
下之。其痞益甚。此非结热。但以胃中虚。客气上逆。故使硬也。甘草泻心汤主之。
又曰。伤寒服汤药。下利不止。心下痞硬。服泻心汤已。复以他
药下之。利不止。医以理中与之。利益甚。理中者。理中焦。此利在下
焦。赤石脂禹余粮汤主之。复利不止者。当利者小便。常氏云。可五
苓散。
又曰。伤寒吐下后。发汗。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
甘草白术生姜汤。成痿者。振痿汤。雍曰。当作茯苓桂枝白术甘草
汤。
又曰。伤寒发汗。若吐。若下。解后。心下痞硬。噫气不除者。旋
覆代赭汤主之。
又曰。下后。不可更行桂枝汤。若汗出而喘。无大热者。可与麻
黄杏仁甘草石膏汤。
又曰。太阳病。外证未除。而数下之。遂协热而利。利下不止。心
下痞硬。表里不解者。桂枝人参汤主之。
又曰。伤寒大下后。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。伤寒发热。汗出不解。心下痞硬。呕吐而下利者。大柴胡
汤主之。
又曰。病如桂枝证。头不痛。项不强。寸脉微浮。胸中痞硬。气上
冲咽喉不得息者。此为胸有寒也。当吐之。宜瓜蒂散。
又曰。病患胁下素有痞。连在脐旁。痛引少腹入阴筋者。此名脏
结。死。常氏云。可刺大赫。在腹部第二行。
又曰。伤寒病。若吐若下后。七八日不解。热结在里。表里俱热。
时时恶风。大渴。舌上干燥而烦。欲饮水数升者。白虎加人参汤主之。
又曰。伤寒无大热。口燥渴。心烦。背微恶寒者。白虎加人参汤主之。
又曰。伤寒脉浮。发热无汗。其表不解者。不可与白虎汤。渴欲
饮水。无表证者。白虎加人参汤主之。
又曰。太阳少阳并病。心下硬。颈项强而眩者。当刺大椎肺俞肝
俞。慎勿下之。
又曰。太阳与少阳合病。自下利者。与黄芩汤。若呕者。黄芩加
半夏生姜汤主之。
又曰。伤寒。胸中有热。胃中有邪气。腹中痛。欲呕吐者。黄连汤主之。
又曰。风湿相搏。骨节烦疼。掣痛不得屈伸。近之则痛剧。
汗出短气。小便不利。恶风不欲去衣。或身微肿者。甘草附子汤主
之。
又曰。伤寒脉浮滑。此表有热。里有寒。白虎汤主之。雍曰。此
一证传写之误。校正者谓热结在里。表里俱热。此即仲景吐下后。
欲饮水数升。白虎加人参汤之证。又非此也。仲景别条云。伤寒脉
浮。发热无汗。其表不解。不可与白虎。表不解者。尚不可服。况里
有寒者乎。详此证。当作伤寒脉浮滑。此表里有热。白虎汤主之。是
亦仲景之言。故仲景厥阴论中。脉滑而厥。亦为里有热。亦用白虎
也。
又曰。伤寒脉结代。心动悸。炙甘草汤主之。
又曰。脉。按之来缓。时一止。复来者。名曰结。又脉来动而中
止。更来小数。中有远者反动。名曰结。阴也。脉来动而中止。不能自
还。因而复动。名曰代。阴也。得此脉者。必难治。雍曰。宜炙甘草汤。
难治者。谓代阴脉也。金匮要略云。脉结心悸。炙甘草汤是也。仲景
曰。伤寒八九日。风湿相搏。身体疼烦。不能自转侧。不呕不渴。脉浮
虚而涩者。桂枝附子汤主之。若其人大便硬。小便自利者。去桂枝。
加白术汤主之。雍曰。桂枝附子汤。非桂枝加附子汤也。朱氏名曰桂
附汤者是也。所主不同。而世多误用。故朱氏少辨其名。今桂枝加附
子汤。系桂枝第六方。桂枝附子汤。系桂枝第十七方。去桂加白术
者。谓自桂枝附子汤中去桂枝加白术。非谓桂枝加附子汤中加减也。宜详之。
又曰。病欲吐者不可下。常氏云。可小半夏加橘皮汤。
又曰。太阳病。有外证未解。不可下。下之为逆。常氏云。可桂枝麻黄各半汤。雍曰。根据可汗证中。用桂枝二麻黄
一汤。
又曰。病发于阳。而反下之。热入因作结胸。病发于阴。而反下之。（官本及脉经汗之皆作下之）因作痞。脉浮而紧。
而复下之。紧反入里。则作痞。常氏云。可小陷胸汤、泻心汤。雍曰。宜用半夏泻心汤。
(Sentence-by-sentence translation follows)
The pathogen is half in the exterior and half in the interior. Although the pulse is deep and tight, it cannot be diagnosed as Shaoyin disease (Disease of the Lesser Yang). The reason for this is that Shaoyin disease should not present with sweating; since the patient now has sweat on the head, we know it is not Shaoyin disease. Xiaochaihu Tang (Minor Bupleurum Decoction) may be administered. If the condition remains unsatisfactory after medication, relief will come with the passage of stool. Guo Yong stated: For excess patterns, Dachaihu Tang (Major Bupleurum Decoction) is used; for deficiency patterns, honey suppositories are used to guide the bowels.
It is also recorded: After five or six days of Shanghan (Cold Damage), if vomiting and fever occur, the indications for Chaihu Tang (Bupleurum Decoction) are complete. If a physician mistakenly uses purgatives, but the Chaihu syndrome persists, Chaihu Tang should be re-administered. Although purgation has been performed, this is not a counter-indication (ni); the patient will inevitably experience shivering with heat rising internally, followed by fever, sweating, and resolution of the disease. If there is fullness and hardness with pain in the epigastrium, this is Jie Xiong (Chest Binding), treated with Da Xianxiong Tang (Major Draining the Chest Decoction). If there is only fullness without pain, this is Pi (Glomus/Blockage), and Chaihu Tang is contraindicated; Banxia Xiexin Tang (Pinellia Heart-Draining Decoction) is appropriate.
It is also recorded: When Taiyang (Greater Yang) and Shaoyang (Lesser Yang) diseases coexist (Bing Bing), and purgatives are mistakenly used, Jie Xiong (Chest Binding) results, characterized by hardness in the epigastrium, incessant diarrhea, inability to take even fluids, and mental restlessness. Chang Shi suggested: Banxia Shengjiang Er Xiexin Tang (Pinellia and Fresh Ginger Double Heart-Draining Decoction) can be used.
It is also recorded: If the pulse is floating and tight, yet purgatives are mistakenly used, the tight pulse enters the interior, resulting in Pi (Glomus). Palpation reveals softness, indicating merely Qi Pi (Qi-type Glomus). Chang Shi suggested: Xiao Xianxiong Tang (Minor Draining the Chest Decoction) or Shengjiang Xiexin Tang (Fresh Ginger Heart-Draining Decoction). Guo Yong stated: Banxia Xiexin Tang (Pinellia Heart-Draining Decoction) or Zhishi Lizhong Wan (Immature Bitter Orange and Middle-Regulating Pill) are suitable.
It is also recorded: In Taiyang Wind Strike, accompanied by diarrhea and vomiting/reversal, one must wait until the exterior pattern is resolved before attacking the interior. If the patient has paroxysmal sweating, headache, epigastric glomus with hardness, fullness radiating to the hypochondrium causing pain, dry retching, shortness of breath, sweating without aversion to cold, this indicates the exterior is resolved but the interior is not harmonized. Shizao Tang (Ten Jujube Decoction) is indicated. Guo Yong stated: Shizao Tang is too harsh; later generations should not use it lightly. It should be replaced by Binglang Tang (Areca Seed Decoction).
It is also recorded: In Taiyang disease, if a physician mistakenly induces sweating, leading to persistent fever and aversion to cold, and then mistakenly uses purgatives, epigastric glomus results. Both exterior and interior qi are deficient, and both Yin and Yang qi are exhausted. Without Yang, Yin stands alone. If moxibustion (burning needle) is added, chest irritability ensues. If the complexion is greenish-yellow and the skin is rough/dry, it is difficult to treat. If the complexion is slightly yellow and the hands and feet are warm, recovery is easy. Chang Shi suggested: Shengjiang Xiexin Tang (Fresh Ginger Heart-Draining Decoction), Xiaochaihu Tang (Minor Bupleurum Decoction), or Guizhi Qushaoyao Jia Longgu Muli Jiuni Tang (Cinnamon Twig Decoction with Paeonia Removed plus Dragon Bone and Oyster Shell Rescue Counter-Indication Decoction). Guo Yong stated: This is a difficult syndrome that cannot be summarized in one sentence; severity must be assessed dynamically. If glomus is severe, treat the glomus first; if fever and aversion to cold are severe, treat the Chaihu pattern first; if fire counter-indication (from moxibustion) is severe, treat with Jiuni Tang first. Treat according to the primary pathology.
It is also recorded: Epigastric glomus, soft upon palpation, with a floating pulse at the Guan position, is treated with Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Heart-Draining Decoction).
It is also recorded: Epigastric glomus accompanied by aversion to cold and sweating is treated with Fuzi Xiexin Tang (Aconite Heart-Draining Decoction).
It is also recorded: Originally due to mistaken purgation causing epigastric glomus, if Xiexin Tang fails to resolve the glomus, and the patient presents with thirst, dry mouth, mental irritability, and dysuria, Wuling San (Five-Ingredient Powder with Poria) is indicated. Another version states: Enduring it for one day leads to recovery.
It is also recorded: After Shanghan resolves via sweating, if the stomach is disharmonious, presenting with epigastric glomus and hardness, belching with food odor, water accumulation in the hypochondrium, borborygmus, and diarrhea, Shengjiang Xiexin Tang (Fresh Ginger Heart-Draining Decoction) is indicated.
It is also recorded: In Shanghan or Fengzhong, if a physician mistakenly uses purgatives, the patient suffers frequent diarrhea (dozens of times daily), undigested food, borborygmus, epigastric glomus with hardness and fullness, dry retching, and mental irritability preventing peace. Seeing the glomus, the physician assumes residual pathogen and purges again, worsening the glomus. This is not heat binding, but stomach deficiency with rebellious Qi, causing hardness. Gancao Xiexin Tang (Licorice Heart-Draining Decoction) is indicated.
It is also recorded: After taking herbal medicine for Shanghan, if diarrhea persists and epigastric glomus with hardness occurs, and subsequent use of Xiexin Tang followed by other purgatives fails to stop the diarrhea, which worsens with Lizhong Tang (Middle-Regulating Decoction), note that Lizhong Tang regulates the Middle Jiao, whereas this diarrhea is in the Lower Jiao. Chishizhi Yuyuli Tang (Red Stone Lipid and Hematite Decoction) is indicated. If diarrhea persists, diuresis should be promoted. Chang Shi suggested: Wuling San (Five-Ingredient Powder with Poria).
It is also recorded: After emesis, purgation, and sweating for Shanghan, if empty irritability and a very faint pulse occur, and by the eighth or ninth day, epigastric glomus with hardness, hypochondriac pain, Qi rushing to the throat, vertigo, and twitching of meridians occur, prolonged illness leads to Wei Syndrome (Flaccidity Syndrome). Chang Shi suggested: Fuling Gancao Baizhu Shengjiang Tang (Poria, Licorice, Atractylodes, and Fresh Ginger Decoction). For established Wei Syndrome, Zhenwei Tang (Shaking Flaccidity Decoction). Guo Yong stated: It should be Fuling Guizhi Baizhu Gancao Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction).
It is also recorded: After sweating, emesis, or purgation in Shanghan, if the disease resolves but epigastric glomus with hardness and persistent belching remain, Xuanfu Daizhe Tang (Inula and Magnetite Decoction) is indicated.
It is also recorded: After purgation, Guizhi Tang (Cinnamon Twig Decoction) must not be used. If sweating and wheezing occur without significant internal heat, Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) may be given.
It is also recorded: In Taiyang disease, if external symptoms persist and multiple purgations are mistakenly used, Xiere Li (Collateral Heat Diarrhea) results with incessant diarrhea, epigastric glomus with hardness, and unresolved exterior and interior. Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction) is indicated.
It is also recorded: After heavy purgation and subsequent sweating in Shanghan, if epigastric glomus and aversion to cold occur, the exterior is not resolved. One must not attack the glomus; instead, resolve the exterior first. Once the exterior is resolved, the glomus can be attacked. Resolve the exterior with Guizhi Tang (Cinnamon Twig Decoction); attack the glomus with Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Heart-Draining Decoction).
It is also recorded: In Shanghan, if fever persists despite sweating, with epigastric glomus with hardness, vomiting, and diarrhea, Dachaihu Tang (Major Bupleurum Decoction) is indicated.
It is also recorded: If symptoms resemble Guizhi Tang syndrome but without headache or neck stiffness, with a slightly floating Cun pulse, epigastric glomus with hardness, and Qi rushing to the throat causing breathing difficulty, this is Han (Cold/Phlegm) in the Chest. Emesis is indicated; Gouti San (Melon Sepal Powder) is appropriate.
It is also recorded: If a patient has a chronic Pi mass under the hypochondrium extending to the umbilicus, with pain radiating to the lower abdomen and genital tendons, this is named Zang Jie (Zang Binding), which is fatal. Chang Shi suggested: Acupuncture at Dahe (KI12), located in the second row of the abdomen.
It is also recorded: In Shanghan, after emesis or purgation, if unresolved after seven to eight days, with heat binding in the interior, simultaneous exterior and interior heat, occasional aversion to wind, extreme thirst, dry tongue with irritability, and desire to drink several liters of water, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is indicated.
It is also recorded: In Shanghan, without significant fever, but with dry mouth/thirst, irritability, and slight aversion to cold on the back, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is indicated.
It is also recorded: In Shanghan, if the pulse is floating, with fever and no sweating, and the exterior is not resolved, Baihu Tang (White Tiger Decoction) is contraindicated. If there is thirst for water and no exterior pattern, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is indicated.
It is also recorded: In Taiyang-Shaoyang Bing Bing, with epigastric hardness, neck stiffness, and vertigo, acupuncture at Dazhui (GV14), Feishu (BL13), and Ganshu (BL18) is indicated. Purging must be strictly avoided.
It is also recorded: In Taiyang-Shaoyang He Bing (Combined Disease), if spontaneous diarrhea occurs, Huangqin Tang (Scutellaria Decoction) is given. If vomiting occurs, Huangqin Jia Banxia Shengjiang Tang (Scutellaria Plus Pinellia and Fresh Ginger Decoction) is indicated.
It is also recorded: In Shanghan, if there is heat in the chest and pathogenic Qi in the stomach, with abdominal pain and desire to vomit, Huanglian Tang (Coptis Decoction) is indicated.
It is also recorded: When Wind-Dampness combats, causing severe joint pain, pulling pain preventing flexion/extension, exacerbated by touch, sweating, shortness of breath, dysuria, aversion to wind with reluctance to remove clothing, or mild body swelling, Gancao Fuzi Tang (Licorice and Aconite Decoction) is indicated.
It is also recorded: In Shanghan, if the pulse is floating and slippery, indicating exterior heat and interior cold, Baihu Tang (White Tiger Decoction) is indicated. Guo Yong stated: This is a transcription error. Correctors argue it should read "Heat binding in the interior, simultaneous exterior and interior heat," which corresponds to the Baihu Jia Renshen Tang syndrome described by Zhang Zhongjing after emesis/purgation with intense thirst. Furthermore, Zhang Zhongjing states elsewhere: In Shanghan with floating pulse, fever, no sweating, and unresolved exterior, Baihu Tang is contraindicated. If unresolved exterior precludes its use, how much more so for interior cold? Detailed analysis suggests the text should read: "Shanghan with floating and slippery pulse, indicating heat in both exterior and interior, treated with Baihu Tang." This aligns with Zhang Zhongjing's principle in the Jueyin chapter where slippery pulse with cold extremities indicates interior heat, also treated with Baihu Tang.
It is also recorded: In Shanghan, if the pulse is Jie Dai (Knotted and Intermitting) and the heart palpitates, Zhigancao Tang (Roasted Licorice Decoction) is indicated.
It is also recorded: A pulse that is slow upon palpation with occasional pauses before resuming is called Jie Mai (Knotted Pulse). A pulse that stops mid-beat and resumes with a slightly faster rhythm, with long intervals, is also called Jie Mai, a Yin pulse. A pulse that stops mid-beat and cannot resume spontaneously, requiring a rebound movement, is called Dai Mai (Intermitting Pulse), also a Yin pulse. Obtaining these pulses indicates a difficult-to-treat condition. Guo Yong stated: Zhigancao Tang (Roasted Licorice Decoction) is suitable. "Difficult to treat" refers to the Dai Yin pulse. *Jingui Yaolue* states: Knotted pulse with palpitations, treated with Zhigancao Tang. Zhang Zhongjing stated: In Shanghan after eight or nine days, with Wind-Dampness combat causing body pain and irritability, inability to turn over, no vomiting or thirst, and floating, deficient, and choppy pulse, Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) is indicated. If the patient has hard stool and normal urination, remove Cinnamon Twig and add Atractylodes (Qu Gui Jia Baizhu Tang). Guo Yong stated: Guizhi Fuzi Tang is not Guizhi Jia Fuzi Tang (Cinnamon Twig Plus Aconite Decoction). Zhu Shi named the former Guifu Tang. Their indications differ, yet they are often confused. Zhu Shi clarified the names. Guizhi Jia Fuzi Tang is the sixth formula in the Guizhi Tang category; Guizhi Fuzi Tang is the seventeenth. "Remove Cinnamon, Add Atractylodes" refers to modifying Guizhi Fuzi Tang, not Guizhi Jia Fuzi Tang. Careful distinction is required.
It is also recorded: Patients desiring to vomit should not be purged. Chang Shi suggested: Xiaobanxia Jia Jupi Tang (Minor Pinellia Plus Tangerine Peel Decoction).
It is also recorded: In Taiyang disease, if external symptoms are unresolved, purging is contraindicated; doing so is a counter-indication. Chang Shi suggested: Guizhi Mahuang Ge Ban Tang (Half Guizhi Half Ephedra Decoction). Guo Yong stated: According to the principles for sweating-inducing patterns, Guizhi Er Mahuang Yi Tang (Two Parts Guizhi One Part Ephedra Decoction) should be used.
It is also recorded: Diseases originating from Yang, if mistakenly purged, lead to heat entering and forming Jie Xiong (Chest Binding). Diseases originating from Yin, if mistakenly purged (Gu Ben and *Mai Jing* read "sweated" as "purged"), lead to Pi (Glomus). If the pulse is floating and tight, yet purged, the tight pulse enters the interior, forming Pi. Chang Shi suggested: Xiao Xianxiong Tang (Minor Draining the Chest Decoction) or Xiexin Tang (Heart-Draining Decoction). Guo Yong stated: Banxia Xiexin Tang (Pinellia Heart-Draining Decoction) is suitable.