【方解及其應用範圍】本方柴胡、黃芩、栝蔞根合用，和解少陽，清熱、生津、止渴之效顯著；桂枝、乾薑、甘草合用，當有健心陽、溫脾之作用；牡蠣與栝蔞根配伍，能治水飲內停之口渴。用以治少陽兼水飲病為有效。對治寒多熱少，或但寒不熱之瘧疾，療效亦佳。亦用於較小柴胡湯證為虛、貧血、呈鬱熱挾水飲上沖之證。
十二、服柴胡湯已，渴者屬陽明（也），〔以法治之〕。原文97後段
鄭論：按既服柴胡湯，而病已去。但渴者，屬陽明。試問渴飲冷乎？飲熱乎？舌幹乎？舌潤乎？大便利乎？小便利乎？飲冷、舌幹、便塞，方可指為陽明。若飲熱、舌潤、便溏，不可謂之陽明。原文雖指為陽明，學者不可執為定，當各處搜求，庶不誤人。
【闡釋】此節與陽明下篇五條相同，鄭氏更為之進一步詳細注釋，示人應靈活辨證，不可執定陽明也。
十三、凡（服）柴胡湯病證而（反）下之，若柴胡證不罷者，複與柴胡湯，必蒸蒸而振①，卻發熱汗出而解。原文101後段
①蒸蒸而振：蒸蒸，內熱貌。氣從內達，邪從外出，則發生振栗之狀，是形容戰汗的現象。
鄭論：按柴胡證既誤下，而少陽證仍在，是邪不從下而解。複以柴胡湯，樞機轉，而蒸蒸發熱汗出，是邪仍由汗而解也。總之，凡病邪有吐、下後而變逆者；有吐、下而本病尚在，無他苦者，用藥不可不知。
【闡釋】柴胡證是邪在半表半裏之間，汗、吐、下都在禁例。若誤下之，邪不從下解，而柴胡證仍在者，可複與柴胡湯，如鄭氏所說：“樞機轉，而蒸蒸發熱汗出，是邪由汗而解也”。
十四、傷寒五六日，嘔而發熱者，柴胡湯證具，而以他藥下之，柴胡證仍在者，複與柴胡湯，此雖已下之，不為逆，必蒸蒸而振，〔卻〕發熱汗出而解。若心下滿而鞕痛者，此為結胸也，（法宜）大陷胸湯主之。但滿而不痛者，此（則）為痞，柴胡不中與之，宜半夏瀉心〔湯〕。原文149
鄭論：按此條（以）〔理〕應在少陽篇，不知因何列入太陽中篇，茲不再贅。
【闡釋】柴胡證誤下後的轉歸及治法，應如鄭氏所說理應列在少陽篇，不知因何列入太陽中篇31條，前已言之，鄭氏為保留原書面貌，仍照錄，但不贅論。
十五、〔本〕發汗，而複下之，此為逆也；若先發汗，治不為逆。（未）〔本〕先下之，而反汗之（此）為逆；若先下之，治不為逆。原文90
鄭論：按少陽雖雲汗、下當禁，然亦當視其可與汗者汗之，可與下者下之，總在用之得宜，庶不為逆。
【闡釋】此條示人在臨床的時候，必須根據證情的先後緩急來處理，治有先後，先後誤施，病必不愈。亦即鄭氏所說：“總在用之得宜，庶不為逆”。
十六、傷寒五六日，頭汗出，微惡寒，手足冷，心下滿，口不欲食，大便鞕，脈細者，此為陽微結①，必有表複有裏也。脈沉，亦在裏也。汗出為陽微，假令純陰結②，不得複有外證，悉入在裏，此為半在裏半在外也。脈雖沉緊，不得為少（陽）〔陰〕病，所以然者，陰不得有汗，今頭汗出，故知非少陰也，可與小柴胡湯，（若）〔設〕不了了者，得屎而解。原文148
①陽微結：熱在裏而大便鞕，叫做陽結。外帶表邪，熱結猶淺，所以叫做陽微結。
②陰結：沒有一定表證。其症狀是身體重，不能食。大便反鞕，脈象多現沉遲。
鄭論：按頭汗出，至脈細微，陽微結等語，滿盤俱是純陰之候，何得雲必有表也？表像從何征之？又曰複有裏，以為脈沉者裏也，汗出為陽微，既稱陽微，不得以柴胡湯加之。又曰：假令純陰結，不得複有外證，此是正論。少陰、少陽，原有區分，脈沉緊而頭汗出，頭屬三陽，故知非少陰也。其為陰結者，是指外之寒邪閉束，而非謂少陰之陰寒閉結也，可與小柴胡湯，是從頭汗而得之，若不了了，得屎而解者，裏氣通，則表氣暢也。
【闡釋】本條主要在辨明少陰與少陽的疑似證。自頭汗出至脈細等症狀，都很象少陰證，但少陰病不應有表證，病人頭汗出，微惡寒，是表證尚在，所以說不是少陰證，而是“陽微結”，這種症候一定有表證也有裏證，邪在半表半裏之間，小柴胡自是對症之方。鄭氏所按，自相矛盾之處甚多，不可從。
十七、凡病若發汗、若吐、若下、若〔亡血〕①、亡津液②，陰陽自和者③，必自愈。原文58
①亡血：指一切原因的失血。
③陰陽自和：猶言氣血自和。
鄭論：按汗、吐、下三法，與亡津液，審其別無他苦，但見陰陽自和者，必能自愈。若現有別證，相機治之，便得也。
【闡釋】夫汗、吐、下都是治病的大法，如用之不當或用之太過，都能傷及正氣，皆可亡血亡津液，血與津液都是屬於陰，亡血實質上與亡津液是一個意思。如其陰陽能處於協調狀態，就可以自然痊癒。正常人的身體機能，全在陰陽平衡，亦即《內經》所說“陰平陽秘，精神乃治”的意義。
十八、婦人中風，發熱惡寒，經水適來④，得之七八日，熱除而脈遲身涼，胸脅（不）〔下〕滿，如結胸狀，譫語者，此為熱入血室也⑤，當刺期門，隨其實而（瀉）〔取〕之。原文143
④經水：即月經。
⑤血室：即子宮。張景嶽雲：“子戶，即子宮也，俗名子腸，醫家以沖任之脈盛於此，則月事以時下，故名之曰血室。”
鄭論：按發熱至熱除，表已解也，脈遲身涼，如結胸、譫語，是熱不發於外，而伏於內，因其經水適來後，隨氣機收藏而入於內，故曰熱入血室，病已重也，刺期門，實以泄其邪熱也。
【闡釋】合下三節，皆言熱入血室之證也。血室在人身體上究在何處，歷代醫家注釋不一。如成無已謂：“血室者，營血停止之所，經脈留會之處，即沖脈也”。柯韻伯說：“血室者，肝也，肝為藏血之髒，故稱曰血室”。但張景嶽則謂：“血室即子宮”，筆者認為張氏之說為是，詳見注釋⑤。此條乃邪傷厥陰血分之證也。曰婦人中風，發熱惡寒，經水適來者，借婦人以明血室之所在也。
誠如鄭氏所說：“表已解也，熱伏於內，因其經水適來，隨氣機收藏而入於內，故曰熱入於血室”。邪熱入而居之，裏熱已重也，刺期門穴以瀉裏熱，則諸證盡失也。
十九、婦人中風，七八日續得寒熱，發作有時，經水適斷者，此為熱入血室，其血必結，故使如瘧狀，發作有時，小柴胡湯主之。原文144
鄭論：按此條血雖結，而表證尚在，但和解之，邪去而結自化為烏有矣，故主小柴胡湯，隨機加減，則得矣。
【闡釋】此節為經水已來，因病而適斷者，則寒熱發於外，雖與經水適來者不同，而此亦為熱入血室。如鄭氏所雲：“血雖結而表證尚在，但和解之”。小柴胡湯達經脈之結，仍借少陽之樞以轉之，俾氣行而血亦不結矣。
二十、婦人傷寒，發熱，經水適來，晝日明瞭，暮則譫語，如見鬼狀者，此為熱入血室，無犯胃氣，及上二焦，必自愈。原文145
鄭論：按晝明瞭，夜昏憒，是邪在裏而不在表，故曰熱入血室。但清其血分之熱即可了，故曰無犯胃氣，及上二焦，必自愈，是明教人不可妄用攻下之意也。
【闡釋】此節與上二節之差異處，彼是中風，此是傷寒；彼之譫語，不分晝夜，此則晝日明瞭，暮則譫語，乃邪正交爭也。此證乃經水尚行，血未曾結，為邪幹血分之輕病，原不同蓄血之如狂發狂，不分晝夜之重病也。如鄭氏所說：“但清其血分之熱即可了……不可妄用攻下之意也。”即不得用桃仁承氣、刺期門及小柴胡諸法也。蓋血海既虛，當調和膀胱之氣化，俟其正氣回復，而病自愈也。
二十一、血弱氣盡①，腠裏開，邪氣因入，與正氣相搏，結於脅下。正邪分爭，往來寒熱，休作有時，默默不欲飲食，臟腑相連，其痛必下，邪高痛下，故使嘔也，小柴胡湯主之。原文97前段
①血弱氣盡：氣血不足，正氣衰弱的意思。
鄭論：按此條指氣血虛弱而言，正虛則外邪得以乘虛而入，邪正相攻，結於脅下，往來寒熱，默默不欲食者，少陽之屬證也。臟腑相連者，指肝與膽也，肝膽氣機不舒故痛，厥陰氣上逆則嘔，主以小柴胡湯，專舒木氣，木氣一舒，樞機複運，而痛自愈矣。
【闡釋】“血弱氣盡，腠裏開，邪氣因入”，言正氣衰弱時，陽氣不能衛外為固，腠理不密，外邪因入。邪入與正氣相搏，結於脅下，……至默默不欲食等，此小柴胡湯證。又臟腑相連，邪高痛下者，少陽表熱為邪高，厥陰裏寒為痛下，厥氣上逆則作嘔。如此用小柴胡湯主之，似未盡善。既氣血不足，正氣衰弱，其身體素質之虛，可以想見。且能專用小柴胡湯舒少陽之氣以治之，而當加附子、吳萸、炮薑、肉桂以破厥陰之寒而散逆止嘔，於此病庶為合法。
傷寒合病
計九法（據舒本校補）
一、太陽病，項背強幾幾①，反汗出（而）惡風者，桂枝加葛根湯主之。原文14
①項背強幾幾：形容項背拘急，俯仰不能自如之狀。幾幾，俯仰不自如貌。
鄭論：按此條乃太陽風傷衛證。
【闡釋】太陽風傷衛證，應用桂枝湯解肌。今增項背強幾幾一證，是風邪入於經輸之故。太陽經輸在背，邪入其間，致使經氣不舒，陰滯津液不能敷布，經脈失去濡養，則項背強幾幾。故用桂枝湯解肌，加葛根以散經輸之邪。
葛根四兩桂枝三兩（去皮）芍藥三兩甘草二兩（炙）大棗十二枚（擘）生薑三兩（切）上六味，以水一鬥，先煮葛根減二升，內諸藥，煮取三升，去渣，溫服一升。覆取微似汗，不須啜粥，餘如桂枝法將息及禁忌。
【方解及其應用範圍】本方即桂枝湯加葛根，治桂枝湯證而項背強幾幾者，用桂枝湯治汗出惡風以解表；葛根味甘平，有生津液作用，則滋養筋脈，故能解除項背強直，亦即治項背強幾幾。近人推廣應用此方于營衛不和，太陽經脈不舒之證，如感冒、頭痛、抽搐等；亦有用治高血壓腦動脈供血不足之頭痛而兼項背緊痛者，效果良好。
二、太陽病，項背強幾幾，無汗惡風（者），葛根湯主之。原文31
鄭論：按此條乃寒傷營證，兩證皆未見陽明（並）〔病〕形，又從何分為合病也？總之風主太陽衛分，寒主太陽營分，以有汗無汗判之，用藥自無錯亂之。況陽明有陽明證表形，不得混而言之。
【闡釋】合病者，或合兩經，或合三經之證而為病。若兩經合病，自必並見兩經之證，此一定之法也。鄭氏謂：“兩證皆未見陽明病形，又從何分為合病也？……況陽明有陽明證表形，不得混而言之”。疑有闕文，實則本條為寒傷營病，在太陽經背部治法。
葛根湯方（校補）
葛根四兩麻黃三兩桂枝二兩（去皮）芍藥二兩甘草二兩（炙）生薑三兩（切）大棗十二枚（擘）上七味，以水一鬥，先煮麻黃、葛根，減二升，去上沫，內諸藥，煮取三升，去渣，溫服一升，複取微似汗，不須啜粥，余如桂枝法將息及禁忌。
【方解及其應用範圍】按葛根湯一方，乃肌、表兩解之方，亦太陽、陽明合解之方也。夫風寒之邪，一從肌腠而入，則為桂枝湯症，一從膚表而入，則為麻黃湯症，今以桂枝湯加麻黃、葛根，是從肌腠以達膚表，俾邪直出。太陽與陽明接壤，太陽之邪已在經輸，逼近陽明，此刻陽明不病亦病也。去太陽之邪，即所以救陽明也。葛根為陽明之主藥，用之以截陽明之路，而邪不敢入，又能鼓舞胃氣上騰，足以助桂、麻祛邪之力。葛根味甘氣涼，能生津液，滋養筋脈，故能解除項背強幾幾。鄭氏在《醫理真傳》中，用治太陽病，兼見項背強幾幾。自汗惡寒，以致吐血者。其在《醫法圓通》中謂係治邪在太陽之經輸，發熱、惡寒、項背強，及邪初入陽明而成的必自下利的二陽合病。更用以治發斑、嘔吐，眼皮腫痛，兩乳紅腫、發熱，小兒痘初現點四症，皆邪甚、熱鬱、津虧的陽明地界疾病，故能治之而愈。現代推廣應用于治太陽陽明合病之流行性感冒、支氣管炎、肺炎、扁桃體炎、蕁麻疹等，均可用本方施治而獲效。
三、太陽與陽明合病，（則）不下利（而）〔但〕嘔者，（用）葛根加半夏湯主之。原文33
鄭論：按此條方合，不再贅。
【闡釋】太陽與陽明合病，表邪不得外泄，不下迫於腸，故不下利，但上犯於胃，所以嘔逆，故治療應以解表為主，仍用葛根湯，但加半夏一味，降逆止嘔。
葛根四兩麻黃三兩（去節）甘草二兩（炙）芍藥二兩桂枝二兩（去皮）生薑二兩（切）半夏半升（洗）大棗十二枚（擘）上八味，以水一鬥，先煮葛根、麻黃，減二升，去白沫，內諸藥，煮取三升，去渣，溫服一升，複取微似汗。
【方解及其應用範圍】太陽與陽明合病下利，用葛根湯治療，今不下利而嘔，故加辛溫之半夏，和胃健脾，鎮逆止嘔。此亦因勢利導，宣通逆氣之方也。
鄭論：按二條下利與不下利，以見風寒主證之不同，風為陽而上逆，寒為陰而下行，此勢時自然之理，足以見用半夏之降，葛根之升，皆有妙處也。
[Explanation of the Formula and Its Scope of Application] The combination of Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), and Gualougen (Trichosanthis Radix) in this formula has a significant effect in harmonizing Shaoyang (Shaoyang channel disease), clearing heat, generating fluids, and relieving thirst; the combination of Guizhi (Cinnamomi Ramulus), Ganjiang (Zingiberis Rhizoma), and Gancao (Glycyrrhizae Radix et Rhizoma) should have the function of strengthening Heart Yang and warming Spleen; the pairing of Muli (Ostreae Concha) and Gualougen can treat thirst caused by internal retention of fluid retention. It is effective for treating Shaoyang disease complicated with fluid retention. It also yields good results in treating malaria characterized by more chills than fever, or only chills without fever. It is also applicable to conditions that are more deficient than Xiao Chaihu Tang syndrome, involving anemia and presenting with constrained heat accompanied by upward rushing of fluid retention.
Twelve. After taking Chaihu Tang, if thirst occurs, it belongs to Yangming (disease). [Treat according to the method]. From the latter part of Original Text 97.
Commentary by Zheng: According to the premise that Chaihu Tang has been taken and the pathogenic factor has been eliminated. If only thirst remains, it belongs to Yangming. Let us ask: Does the patient prefer cold drinks or hot drinks? Is the tongue dry or moist? Are bowel movements unobstructed? Is urination normal? Only when the patient prefers cold drinks, has a dry tongue, and constipation can it be identified as Yangming disease. If the patient prefers hot drinks, has a moist tongue, and loose stools, it cannot be called Yangming disease. Although the original text identifies it as Yangming, scholars must not rigidly adhere to this as a fixed rule. One must seek evidence from all aspects to avoid misleading others.
[Interpretation] This section is identical to the five sections in the lower part of the Yangming chapter. Zheng provides further detailed annotation to indicate that one should differentiate syndromes flexibly and not rigidly identify it as Yangming disease.
Thirteen. In cases where (taking) Chaihu Tang leads to a worsening condition due to erroneous purgation, if the Chaihu Tang syndrome persists, administering Chaihu Tang again will inevitably result in a sensation of internal heat and shivering①, followed by fever, sweating, and resolution of the disease. From the latter part of Original Text 101.
① Zhengzheng er zhen: "Zhengzheng" describes the appearance of internal heat. When Qi moves outward from the interior and pathogens exit from the exterior, trembling occurs. This describes the phenomenon of "battle sweat" (resolving pathogens through trembling followed by sweating).
Commentary by Zheng: Since the Chaihu Tang syndrome was erroneously treated with purgation, but the Shaoyang syndrome remains, it indicates that the pathogen did not resolve from the lower jiao. Re-administering Chaihu Tang turns the pivot mechanism, resulting in internal heat and sweating, indicating that the pathogen still resolves through sweating. In summary, whenever pathogens cause adverse changes after emesis or purgation; or when the primary disease remains after emesis or purgation without other distress, one must understand these principles in medication.
[Interpretation] The Chaihu Tang syndrome involves pathogens between the exterior and interior; sweating, emesis, and purgation are all contraindicated. If purgation is erroneously used and the pathogen does not resolve from below, but the Chaihu Tang syndrome persists, Chaihu Tang can be administered again. As Zheng stated: "The pivot mechanism turns, leading to internal heat and sweating, which means the pathogen resolves through sweating."
Fourteen. In cold damage diseases lasting five or six days, if there is vomiting and fever, indicating the presence of Chaihu Tang syndrome, but it was erroneously treated with purgation using other drugs, and the Chaihu Tang syndrome persists, administering Chaihu Tang again is not considered an adverse treatment despite the prior purgation. It will inevitably result in internal heat and shivering, followed by fever, sweating, and resolution. If there is fullness and hardness/pain in the epigastrium, this is Jie Xiong (Chest Binding), [the appropriate method is] Da Xianxiong Tang as the main treatment. If there is only fullness without pain, this is Pi (Stagnation/Blockage); Chaihu Tang is not suitable for it. Banxia Xiexin [Tang] is indicated. Original Text 149.
Commentary by Zheng: According to reason, this clause should belong to the Shaoyang chapter. It is unknown why it was included in the Taiyang middle chapter. I will not elaborate further here.
[Interpretation] The outcome and treatment of Chaihu Tang syndrome after erroneous purgation should, as Zheng reasoned, be listed in the Shaoyang chapter. It is unknown why it was placed in the Taiyang middle chapter (clause 31). As mentioned before, Zheng retained the original text to preserve its appearance but did not add further discussion.
Fifteen. [Originally] requiring sweating, yet followed by purgation, this is an adverse treatment; if sweating is performed first, the treatment is not adverse. (Originally) requiring purgation, yet contrary to this, sweating is performed (this) is adverse; if purgation is performed first, the treatment is not adverse. Original Text 90.
Commentary by Zheng: Although Shaoyang generally prohibits sweating and purgation, one must assess whether sweating or purgation is appropriate. If sweating is suitable, perform it; if purgation is suitable, perform it. The key lies in appropriate application so as not to cause adverse effects.
[Interpretation] This clause demonstrates that in clinical practice, one must handle situations based on the sequence and urgency of symptoms. Treatment has a specific order; if this order is mistaken, the disease will not heal. This aligns with Zheng’s statement: "The key lies in appropriate application, so as not to cause adverse effects."
Sixteen. In cold damage diseases lasting five or six days, with sweating only on the head, slight aversion to cold, cold hands and feet, epigastric fullness, lack of desire to eat, hard stools, and a fine pulse, this is called Yang Wei Jie (Yang Mild Binding)①. There must be both exterior and interior signs. A deep pulse also indicates interior involvement. Sweating indicates mild Yang binding. Suppose it were Pure Yin Binding②; there would be no exterior signs remaining, all entering the interior. This is described as half in the interior and half in the exterior. Although the pulse is deep and tight, it cannot be diagnosed as Shao (Yang) [Yin] disease. The reason is that Yin syndromes should not have sweating. Since there is now sweating on the head, we know it is not Shaoyin disease. Xiao Chaihu Tang can be given. (If) [Suppose] the patient still feels uncomfortable, resolving via bowel movement will bring relief. Original Text 148.
① Yang Wei Jie: Heat in the interior causing hard stools is called Yang Jie. With accompanying exterior pathogens and shallow heat binding, it is called Yang Wei Jie.
② Yin Jie: Lacking definite exterior signs. Symptoms include heavy body, inability to eat. Stools are conversely hard, and the pulse is often deep and slow.
Commentary by Zheng: Regarding sweating on the head, down to fine pulses and terms like Yang Wei Jie, the entire picture presents pure Yin signs. How can one say there is definitely an exterior sign? What is the basis for the exterior sign? It also states there is an interior component, considering deep pulse as interior, and sweating as mild Yang. Since it is called mild Yang, Chaihu Tang should not be applied. It also says: "Suppose it were Pure Yin Binding, there would be no exterior signs," which is a correct argument. Shaoyin and Shaoyang are originally distinct. With a deep, tight pulse and sweating on the head (the head belongs to the Three Yang channels), we know it is not Shaoyin. The Yin Jie referred to here indicates external cold pathogens closing the exterior, not the Yin-cold closure of Shaoyin. Xiao Chaihu Tang can be given, deduced from the sweating on the head. If the patient remains uncomfortable, resolving via bowel movement brings relief because interior Qi becomes unblocked, thus exterior Qi flows freely.
[Interpretation] This clause primarily differentiates between suspected Shaoyin and Shaoyang syndromes. Symptoms from sweating on the head to fine pulse resemble Shaoyin syndrome. However, Shaoyin disease should not have exterior signs. The patient has sweating on the head and slight aversion to cold, indicating the exterior sign is still present. Therefore, it is not Shaoyin syndrome, but "Yang Wei Jie." This syndrome must have both exterior and interior signs, with pathogens between the exterior and interior. Xiao Chaihu Tang is naturally the对症 (symptom-matching) formula. Zheng’s commentary contains many contradictions and should not be followed.
Seventeen. For any disease, if sweating, emesis, purgation, or [loss of blood]①, loss of body fluids② has occurred, and Yin and Yang achieve self-harmony③, the disease will necessarily heal spontaneously. Original Text 58.
① Wang Xue: Refers to blood loss from any cause.
② Wang Jin Ye: Also called "Shang Jin Ye" (Injury to Body Fluids). Excessive sweating or purgation is sufficient to damage body fluids.
③ Yin Yang Zi He: Means Qi and Blood achieve self-harmony.
Commentary by Zheng: Regarding the three methods of sweating, emesis, and purgation, as well as loss of body fluids, if one examines that there are no other distresses and only sees Yin-Yang self-harmony, spontaneous healing will occur. If other symptoms currently exist, treat them opportunistically, and success will be achieved.
[Interpretation] Sweating, emesis, and purgation are major methods of treating disease. If misused or overused, they can damage righteous Qi, leading to loss of blood and body fluids. Blood and body fluids both belong to Yin; essentially, loss of blood is equivalent to loss of body fluids. If Yin and Yang can maintain a coordinated state, natural recovery occurs. Normal bodily functions rely on Yin-Yang balance, which corresponds to the meaning in *Neijing*: "When Yin is level and Yang is secret/stable, spirit and vitality are governed."
Eighteen. In women with wind strike, presenting with fever and aversion to cold, whose menstruation happens to begin④, after seven or eight days of illness, when the fever subsides and the pulse becomes slow with a cool body, if there is fullness under the chest/hypochondrium (not) [lower], resembling Jie Xiong (Chest Binding), and delirium, this is Re Ru Xue Shi (Heat Entering the Blood Chamber)⑤. One should puncture Qimen (LR-14) and drain according to excess. Original Text 143.
④ Jing Shui: Menstruation.
⑤ Xue Shi: Uterus. Zhang Jingyue said: "Zi Hu is the uterus, commonly known as Zi Chang. Physicians name it Xue Shi because the Chong and Ren meridians flourish here, causing menstruation to descend on time."
Commentary by Zheng: From fever to fever subsiding, the exterior is resolved. Slow pulse and cool body, along with Jie Xiong-like symptoms and delirium, indicate heat is not manifesting externally but lying latent internally. Because menstruation happened to begin, following the Qi mechanism's storage function, the pathogen enters inward. Thus, it is called Heat Entering the Blood Chamber, indicating severe disease. Puncturing Qimen actually drains the pathogenic heat.
[Interpretation] The following three sections all discuss Heat Entering the Blood Chamber. Where exactly the Blood Chamber is located in the human body has been interpreted differently by physicians throughout history. Cheng Wuji stated: "The Blood Chamber is where Ying Blood stops and meridians converge, i.e., the Chong Mai." Ke Yunbo said: "The Blood Chamber is the Liver; the Liver stores blood, hence called Blood Chamber." But Zhang Jingyue stated: "The Blood Chamber is the uterus." I believe Zhang’s view is correct, see Annotation ⑤. This clause represents pathogenic invasion of the Jueyin Blood aspect. Saying "women with wind strike, fever and aversion to cold, menstruation happening to begin" uses women to clarify the location of the Blood Chamber.
As Zheng said: "The exterior is resolved, heat lies latent inside. Because menstruation began, following the Qi mechanism's storage function, it enters inward. Thus, it is called Heat Entering the Blood Chamber." Pathogenic heat resides within, making interior heat severe. Puncturing Qimen drains interior heat, causing all symptoms to disappear.
Nineteen. In women with wind strike, developing alternating chills and fever at intervals over seven or eight days, whose menstruation happens to end, this is Heat Entering the Blood Chamber. The blood must be bound, causing symptoms resembling malaria with periodic发作 (attacks). Xiao Chaihu Tang is the main treatment. Original Text 144.
Commentary by Zheng: In this clause, although the blood is bound, the exterior sign remains. Harmonization alone will eliminate the pathogen, and the binding will dissolve into nothingness. Therefore, Xiao Chaihu Tang is the main treatment. Adjusting randomly according to circumstances will yield success.
[Interpretation] This section describes menstruation having started but stopping abruptly due to illness. Chills and fever manifest externally. Although different from menstruation just beginning, this is also Heat Entering the Blood Chamber. As Zheng said: "Although the blood is bound, the exterior sign remains; only harmonize it." Xiao Chaihu Tang reaches the binding in the meridians, borrowing the Shaoyang pivot to turn it, allowing Qi to move so blood does not bind.
Twenty. In women with cold damage, presenting with fever, whose menstruation happens to begin, if they are lucid during the day but experience delirium at night, seeing ghosts, this is Heat Entering the Blood Chamber. Do not violate Stomach Qi or the Upper Two Jiaos; it will necessarily heal spontaneously. Original Text 145.
Commentary by Zheng: Lucidity by day and confusion by night indicate the pathogen is in the interior, not the exterior, hence Heat Entering the Blood Chamber. Clearing heat from the Blood aspect is sufficient. Hence, "Do not violate Stomach Qi or the Upper Two Jiaos, and it will heal," clearly teaching people not to recklessly use purgation.
[Interpretation] The difference between this section and the previous two is: the former is Wind Strike, this is Cold Damage; the former's delirium occurs day and night, while this is lucid by day and delirious by night, representing the struggle between pathogen and righteous Qi. This condition involves menstruation still flowing, blood not yet bound, representing a mild disease of pathogen interfering with the Blood aspect. It is originally different from the severe disease of Blood Accumulation causing mania day and night. As Zheng said: "Clearing heat from the Blood aspect is sufficient... do not recklessly use purgation." That is, one must not use Taoren Chengqi Tang, puncturing Qimen, or Xiao Chaihu Tang. Since the Sea of Blood is already deficient, one should harmonize Bladder Qi transformation, waiting for righteous Qi to recover, and the disease will heal.
Twenty-one. Blood is weak and Qi is exhausted①, pores open, pathogens enter accordingly, struggling with righteous Qi, binding under the hypochondrium. Righteous and pathogenic factors contend, causing alternating chills and fever, occurring at times, silence, and lack of desire to eat. Zang and Fu are connected; pain must descend. Pathogens are high, pain is low, thus causing vomiting. Xiao Chaihu Tang is the main treatment. From the first part of Original Text 97.
① Xue Ruo Qi Jin: Meaning insufficient Qi and Blood, and weakened righteous Qi.
Commentary by Zheng: This clause refers to deficiency of Qi and Blood. When righteous Qi is deficient, external pathogens take advantage to enter. Pathogen and righteous Qi attack each other, binding under the hypochondrium. Alternating chills and fever, silence, and lack of desire to eat are Shaoyang sub-syndromes. "Zang and Fu connected" refers to Liver and Gallbladder. Unsmooth Liver-Gallbladder Qi mechanism causes pain; Jueyin Qi reversing upward causes vomiting. Using Xiao Chaihu Tang specifically soothes Wood Qi. Once Wood Qi is soothed, the pivot mechanism operates again, and pain heals itself.
[Interpretation] "Blood is weak and Qi is exhausted, pores open, pathogens enter accordingly" means when righteous Qi is weak, Yang Qi cannot defend the exterior, pores are not dense, and external pathogens enter. Pathogens enter and struggle with righteous Qi, binding under the hypochondrium... down to silence and lack of desire to eat, this is Xiao Chaihu Tang syndrome. "Zang and Fu connected, pathogens high, pain low": Shaoyang exterior heat is "pathogens high," Jueyin interior cold is "pain low." Jueyin Qi reversing upward causes vomiting. Using Xiao Chaihu Tang as the main treatment here seems imperfect. Given insufficient Qi and Blood and weakened righteous Qi, the physical deficiency can be imagined. Moreover, using only Xiao Chaihu Tang to soothe Shaoyang Qi to treat this, one should add Fuzi, Wuyu, Paojiang, and Rougui to break Jueyin cold, scatter reversal, stop vomiting, which would be more appropriate for this disease.
Cold Damage Combined Diseases
Total Nine Methods (Supplemented according to Shu edition)
One. Taiyang disease, with stiffness and tension in the neck and back①, paradoxically with sweating and aversion to wind, Guizhi Jia Gegen Tang is the main treatment. Original Text 14.
① Xiang Bei Jiang Ji Ji: Describes stiffness and tension in the neck and back, unable to bend or extend freely. "Ji Ji" describes the inability to move freely up and down.
Commentary by Zheng: This clause is a Taiyang Wind injuring Wei syndrome.
[Interpretation] Taiyang Wind injuring Wei syndrome should be treated with Guizhi Tang to release the muscle layer. Now adding the symptom of neck and back stiffness, this is due to Wind pathogens entering the meridians and collaterals. Taiyang meridians are located on the back. Pathogens entering here cause meridian Qi stagnation, Yin obstruction prevents fluid distribution, and meridians lose nourishment, resulting in neck and back stiffness. Therefore, use Guizhi Tang to release the muscle layer, adding Gegen to dispel pathogens in the meridians.
Guizhi Jia Gegen Tang Formula (Supplemented)
Gegen (Puerariae Lobatae Radix) 4 liang, Guizhi (Cinnamomi Ramulus) 3 liang (remove bark), Shaoyao (Paeoniae Radix) 3 liang, Gancao (Glycyrrhizae Radix et Rhizoma) 2 liang (honey-fried), Dazao (Ziziphi Jujubae Fructus) 12 pieces (split), Shengjiang (Zingiberis Rhizoma Recens) 3 liang (sliced). Six ingredients. Use 1 dou of water. First decoct Gegen, reducing by 2 sheng. Add other herbs. Decoct to obtain 3 sheng. Remove dregs. Warm drink 1 sheng. Cover to induce slight sweating. No need to drink porridge. Rest follows Guizhi Tang instructions and taboos.
[Explanation of the Formula and Its Scope of Application] This formula is Guizhi Tang plus Gegen. It treats Guizhi Tang syndrome with neck and back stiffness. Guizhi Tang treats sweating and aversion to wind to release the exterior; Gegen is sweet and neutral, generates fluids, nourishes sinews and vessels, thus relieving neck and back stiffness, i.e., treating neck and back stiffness. Modern practitioners have expanded its application to syndromes of disharmony of Ying and Wei, and unsmooth Taiyang meridians, such as common cold, headache, convulsions, etc.; it is also used to treat headaches combined with neck/back tightness due to hypertension and insufficient cerebral artery blood supply, with good effects.
Two. Taiyang disease, with stiffness and tension in the neck and back, no sweating, and aversion to wind (patients), Gegen Tang is the main treatment. Original Text 31.
Commentary by Zheng: This clause is Cold injuring Ying syndrome. Neither syndrome shows Yangming (combined) [disease] forms. How then can they be classified as combined diseases? In short, Wind governs Taiyang Wei aspect, Cold governs Taiyang Ying aspect. Judging by sweating or no sweating, medication will naturally not be confused. Moreover, Yangming has its own exterior signs; they cannot be mixed together.
[Interpretation] Combined disease refers to syndromes combining two or three meridians becoming ill. If two meridians combine, their respective syndromes must appear simultaneously; this is a fixed rule. Zheng said: "Neither syndrome shows Yangming disease forms, how then can they be classified as combined diseases? ... Moreover, Yangming has its own exterior signs; they cannot be mixed together." Suspecting missing text, in reality, this clause is Cold injuring Ying syndrome, a treatment method for the back of the Taiyang meridian.
Gegen Tang Formula (Supplemented)
Gegen (Puerariae Lobatae Radix) 4 liang, Mahuang (Ephedrae Herba) 3 liang, Guizhi (Cinnamomi Ramulus) 2 liang (remove bark), Shaoyao (Paeoniae Radix) 2 liang, Gancao (Glycyrrhizae Radix et Rhizoma) 2 liang (honey-fried), Shengjiang (Zingiberis Rhizoma Recens) 3 liang (sliced), Dazao (Ziziphi Jujubae Fructus) 12 pieces (split). Seven ingredients. Use 1 dou of water. First decoct Mahuang and Gegen, reducing by 2 sheng. Remove foam on top. Add other herbs. Decoct to obtain 3 sheng. Remove dregs. Warm drink 1 sheng. Cover to induce slight sweating. No need to drink porridge. Rest follows Guizhi Tang instructions and taboos.
[Explanation of the Formula and Its Scope of Application] Gegen Tang is a formula releasing both muscle and exterior, and also jointly releasing Taiyang and Yangming. Wind-Cold pathogens enter either through muscle clefts, becoming Guizhi Tang syndrome, or through skin surface, becoming Mahuang Tang syndrome. Now, adding Mahuang and Gegen to Guizhi Tang allows reaching the skin surface from the muscle clefts, enabling pathogens to exit directly. Taiyang and Yangming are adjacent. Taiyang pathogens are already in the meridians, approaching Yangming. At this moment, even if Yangming is not diseased, it becomes diseased. Removing Taiyang pathogens is thus saving Yangming. Gegen is the chief herb for Yangming. Using it blocks the path to Yangming so pathogens dare not enter. It also stimulates Stomach Qi to rise, assisting Guizhi and Mahuang in expelling pathogens. Gegen is sweet and cool in nature, generates fluids, and nourishes sinews and vessels, thus relieving neck and back stiffness. Zheng used it in *Yili Zhuan* to treat Taiyang disease with neck/back stiffness, spontaneous sweating, aversion to cold, leading to hematemesis. In *Yifa Yuantong*, he stated it treats pathogens in Taiyang meridians with fever, aversion to cold, neck/back stiffness, and combined Er Yang disease formed by pathogens initially entering Yangming causing inevitable diarrhea. He further used it to treat macules, vomiting, eyelid swelling/pain, bilateral breast redness/swelling/fever, and four initial stages of childhood smallpox, all Yangming region diseases with severe pathogens, constrained heat, and fluid deficiency, thus curing them. Modern applications expand to influenza, bronchitis, pneumonia, tonsillitis, urticaria, etc., associated with Taiyang-Yangming combined diseases, all of which can be treated effectively with this formula.
Three. Taiyang and Yangming combined disease, (then) no diarrhea (but) [only] vomiting, Gegen Jia Banxia Tang is the main treatment. Original Text 33.
Commentary by Zheng: The formula for this clause fits; no further elaboration needed.
[Interpretation] In Taiyang and Yangming combined disease, exterior pathogens cannot vent outward. They do not press downward into the intestines, hence no diarrhea, but instead attack upward into the Stomach, causing retching/vomiting. Therefore, treatment should focus on releasing the exterior, still using Gegen Tang, but adding Banxia to direct rebellious Qi downward and stop vomiting.
Gegen Jia Banxia Tang Formula (Supplemented)
Gegen (Puerariae Lobatae Radix) 4 liang, Mahuang (Ephedrae Herba) 3 liang (remove joints), Gancao (Glycyrrhizae Radix et Rhizoma) 2 liang (honey-fried), Shaoyao (Paeoniae Radix) 2 liang, Guizhi (Cinnamomi Ramulus) 2 liang (remove bark), Shengjiang (Zingiberis Rhizoma Recens) 2 liang (sliced), Banxia (Pinelliae Rhizoma) half sheng (washed), Dazao (Ziziphi Jujubae Fructus) 12 pieces (split). Eight ingredients. Use 1 dou of water. First decoct Gegen and Mahuang, reducing by 2 sheng. Remove white foam. Add other herbs. Decoct to obtain 3 sheng. Remove dregs. Warm drink 1 sheng. Cover to induce slight sweating.
[Explanation of the Formula and Its Scope of Application] For Taiyang and Yangming combined disease with diarrhea, Gegen Tang is used. Now, with no diarrhea but vomiting, add pungent-warm Banxia to harmonize Stomach, strengthen Spleen, calm rebellion, and stop vomiting. This is also a formula guiding according to momentum and promoting unblocking of rebellious Qi.
Four. Taiyang and Yangming combined disease, inevitably with spontaneous diarrhea, Gegen Tang is the main treatment. Original Text 32.
Commentary by Zheng: Comparing diarrhea and no diarrhea in the two clauses reveals the difference in main symptoms of Wind and Cold. Wind is Yang and rebels upward; Cold is Yin and descends. This is the natural law of trends, sufficiently showing the subtlety of using Banxia to descend and Gegen to ascend.