一、病如桂枝證，頭不痛，項不強，寸脈微浮，胸中痞鞕，氣上沖咽喉，不得息者，此為胸有寒也①，當吐之，宜瓜蒂散。（諸亡血家不可與瓜蒂散）原文166
①胸有寒：這裏的“寒”字作“邪”字解，即胸中邪氣阻滯的意思。凡痰涎宿食等都屬於邪的範圍。
鄭論：按此條頭項既不強痛，又無惡寒、惡風情狀，何得如桂枝證，此皆不經之論。應當雲寸脈微浮，胸中痞鞕，氣上沖咽喉，不得息者，胸有寒也，後人即按胸有寒結治之，何等直切，此病亦不在可吐之例，至亡血家更不在吐之例也
【闡釋】本條鄭氏持否定意見。筆者認為病如桂枝證，即有發熱汗出，但頭不痛、項不強，則非表證。寸脈微浮，主病在上，胸中痞鞕，是痰涎壅塞於膈上，阻礙氣機，痰隨氣逆，所以上沖咽喉不得息。這是正氣驅邪外出所反應的證狀，所以治療採取因勢利導的方法，用瓜蒂散湧吐，此即《經》所謂“在上者因而越之”的治則。汗、吐、下是攻病的三個大法，病在膈上就當使用吐法，吐法取效簡捷，能直接將病邪傾吐而出。但在《傷寒論》中，吐法的方證俱備者只此一條。方治後又垂戒雲：“諸亡血虛家，不可與瓜蒂散”。教人慎重之意耳。
瓜蒂散方（校補）
瓜蒂一分（熬黃）赤小豆一分上二味，各別搗篩，為散已，合治之，取一錢匕，以香豉一合，用熱湯七合，煮作稀糜，去渣，取汁和散，溫頓服之，不吐者，少少加，得快吐乃止。諸亡血虛家，不可與瓜蒂散。
【方解及其應用範圍】瓜蒂味極苦，性升而催吐；赤小豆味苦酸，功能利水消腫。兩藥配合，有酸苦湧泄之功。香豉輕清宣洩，更能加強湧吐之力。本方力猛，過吐恐傷胃氣，所以體虛或失血的人應該慎用。後世推廣用於膈上痰積、食積、以及卒中痰迷，涎痰雍盛。吐之即愈。
①複：更也，言誤也。
鄭論：按病人既有寒飲而發其汗，汗則亡陽，胃陽既亡，胃中之冷更甚，必吐蛔者，蛔不安於內也。
【闡釋】裏寒之人，雖有表證，仍當先溫其裏，否則表證雖除，裏寒轉甚，胃中冷而吐蛔矣。本條未出方治。《金鑒》說；“宜理中湯送服烏梅丸可也”。與病情頗為切合。
三、病人手足厥冷，脈乍緊者，邪結在胸中②。心（中）〔下〕滿而煩，饑〔而不〕能食者，病在胸中，當須吐之，宜瓜蒂散。原文355
鄭論：按手足逆冷，胃陽不達於四末也。但逆冷務必究其陰陽，苟陽邪甚而伏者，必有火形足征，陰邪甚而逆者，亦必有陰邪可驗；胸滿饑能食，屬陽甚者，為熱壅，胸滿而不能食，屬陰者，為寒結。或清、或溫、或吐，自有一定之法也，豈得專一吐言哉!
【闡釋】本條為痰飲食積，壅塞胸中而厥逆的治法。病人手足厥冷，陽氣不達於四末，然陽氣何以不達，則不可不辨。陽邪甚而伏者宜清，陰邪甚而逆者宜溫。胸滿饑能食為熱壅，則可吐之；胸滿饑不能食屬陰為寒結，則當溫也。故鄭氏說：“或溫、或清、或吐，自有一定之法也，豈得專一吐言哉”。
傷寒恒論卷八
太陰〔全〕篇計九法（據舒本校補）
一、太陰之為病，腹滿而吐，食不下，自利益甚，時腹自痛，若下之，必胸下結鞕①。原文273
鄭論：按腹滿而吐，有因飲食停滯而吐者，有因邪熱結聚上壅而吐者，有因寒邪閉結上逆而吐者，不可不辨。但邪之所聚，上逆則為吐，下迫則為瀉，故有腹痛之征。理應相機施治，若誤下之則正氣大傷，必有結鞕之患，不可不慎也。
【闡釋】此條為太陰病的提綱。太陰與陽明同主腸胃疾患，但兩者的性質不同，陽明為裏實熱證，而太陰為裏虛寒證。前者腹滿為腸胃中有宿食燥屎，按之鞕滿而痛，故大便利而滿亦去。後者腹滿為腸胃外鬱寒濕，按之柔軟不痛，故下利而滿仍不除。鄭氏謂：“腹滿而吐，有因飲食停滯而吐者，有因邪熱結聚上壅而吐者，有因寒邪閉結上逆而吐者”。筆者對上述三種腹滿而吐，分別以溫中行氣降逆之理中湯加半夏治之；苦寒降逆之大、小承氣湯治之；扶陽散寒降逆之吳萸四逆湯治之，均獲得滿意效果。
二、太陰中風，四肢煩疼②，陽微陰澀而長者③，為欲愈。原文274
②“煩疼”：指疼之甚，反側安置極不舒適、難於形容之狀也。
③陽微陰澀：陽微陰澀的陰陽二字，應作浮沉解，言輕取之而微，重取之而澀。
鄭論：按太陰為脾臟，既稱中風，夫中者，如矢之中人，既中脾臟，係屬絕證，何竟四肢煩疼，應是太陰受風，庶與病合。而曰四肢煩疼是風邪不勝之意。陽微、言風邪之輕，陰澀而長，言脾氣之旺，故稱曰欲愈，如此處論，庶合經旨。
【闡釋】鄭氏駁“中”字為不當。“中”字應作感受風邪解。太陰屬脾，脾主四肢，太陰經受風邪，所以四肢煩疼。風脈本浮，今而微，知風邪當去；澀是陰脈，長是陽脈，陰脈中而有陽脈，為正氣複來之征，正氣複就有力驅邪外出，故為欲愈。
三、太陰病，脈浮者，可發汗，宜桂枝湯。原文276
鄭論：按既稱太陰病，應是理中湯法也。雖見脈浮，並未見太陽惡風畏寒，不得以桂枝湯發汗，即太陰兼太陽合病，亦無非理中湯內加桂枝耳。今每見脈浮，屬飲食停滯者多，亦不可不察，學者宜知。
【闡釋】自此以下凡六節，言太陰病有表、裏、寒、熱、虛、實之不同也。鄭氏謂：“既稱太陰病，應是理中湯法也。……即太陰兼太陽合病，亦無非理中湯內加桂枝耳”。示人不能以脈定病，而必須脈證合參。若果係太陰病，當是“太陰病中風”，四肢煩疼而脈浮者，並有頭疼發熱等表證，無腹滿而嘔，食不下、自利諸症，然後可用桂枝湯。
四、自利不渴者，屬太陰，以〔其〕髒有寒故也①，當溫之，宜〔服〕四逆（湯）〔輩〕②。原文277
②四逆輩：指四逆湯一類的方劑，如四逆湯、白通湯、通脈四逆湯之類。
鄭論：按自利之人，每多口渴，以其氣機下降，津液不得上潮。此則不渴，乙太陰主濕，濕甚故自利，故不渴，稱為髒寒，法固當溫裏，應大劑溫中，而原文所主四逆（湯）〔輩〕。但四逆乃少陰之主方，而非太陰之主方，此中固屬大有關鍵，而圓通之機，即四逆亦大可用也。學者亦不可泥於法，而為法所囿也。
【闡釋】自利而渴者屬少陰，自利不渴者屬太陰。此節乃太陰自受之裏寒證也，曰自利者，非誤治後之下利也，不渴者，乃寒濕盛而無燥熱之化也。曰屬太陰，又曰以其髒有寒，蓋恐人但知太陰之濕，而不知自利不渴者，必有寒在髒也。宜服四逆輩者，當包括理中湯在內，以溫脾腎為要，斟酌用之。
五、傷寒脈浮而緩，手足自溫者，係在太陰；太陰當發身黃，若小便自利者，不能發黃；至七八日，雖暴煩下利，日十餘行，必自止，以（胃）〔脾〕家實③，腐穢當去故也④。原文278
④腐穢：指腸中宿積腐敗的物質。
鄭論：論發黃與不發黃，專視乎小便之利與不利，利者氣機不能遏鬱，故不發黃，不利者氣機遏鬱，故見發黃。此條專在小便之利與不利上分，大有卓見。至暴煩下利，日十餘行，而曰（胃）〔脾〕家實，腐穢當去，是氣機下降，非若陽明之便鞕便難，故知其屬太陰無疑也。
【闡釋】此節乃太陰表邪入裏之實證也。浮緩之脈雖類太陽中風，但無發熱汗出惡風之證，而手足自溫，所以屬於太陰。太陰為濕土之髒，寒濕滯鬱亦能發黃，但此種身黃，色黃而黯晦，為陰黃，與濕熱郁蒸之陽黃，色鮮明如橘子色者很易區別，前者治以附子理中湯加茵陳，後者用茵陳五苓散治之。若小便自利，則濕邪從下而去，濕不內鬱，故不發黃。至暴煩下利，乃脾陽回復，自動祛邪外出，可不藥而愈。
六、本太陽病，醫反下之，因（而）〔爾〕腹滿時痛者，屬太陰也，桂枝加芍藥湯主之。原文279前段
鄭論：此條原係太陽因誤下，而邪陷於脾，故見腹滿時痛，理應溫中醒脾，似非桂枝湯㈠所宜，學者細酌之。
㈠邪陷下而用桂枝湯，使邪複從于表而解，所加芍者，和脾絡之意也，亦妙（頂批）。
【闡釋】本條與下條，傷寒論原文合為一條，成無己則分為兩條，舒馳遠與鄭氏從之。太陽誤下，邪陷太陰之實證也。“腹滿時痛”是因誤下而致脾氣受傷所致，不是太陰裏虛本寒，無吐利等證，但以太陽表證未除，故于桂枝湯內加芍藥，以解表而和脾，脾氣和則滿痛自除。鄭氏謂；“理應溫中醒脾，似非桂枝湯所宜，學者細酌之”。示人不可執一，應以辨證為是。
桂枝加芍藥湯方（校補）
桂枝三兩（去皮）芍藥六兩甘草二兩（炙）大棗十二枚（擘）生薑三兩（切）上五味，以水七升，煮取三升，去渣，溫分三分。本雲桂枝湯，今加芍藥。
【方解及其應用範圍】本方即桂枝湯內倍芍藥。《本草經》謂芍藥主邪氣腹痛，除血痹，破堅積，寒熱，疝瘕、止痛、利小便、益氣。本證因太陽誤下邪陷太陰，太陽表邪未解，故仍用桂枝湯解表，腹滿時痛，故加芍藥以和脾止痛。現推廣以治拘攣性疼痛、產後乳房紅腫脹痛，慢性痢疾等，主要是重用芍藥之故耳。
七、大實痛者，桂枝加大黃湯主之。原文279後段
鄭論：按大實痛而在太陰，理應大承氣湯以逐其邪，于桂枝何取乎㈠？
㈠此亦太陽之邪，陷於脾而邪實，故表裏兩解之，亦妙法也（頂批）。
【闡釋】此條緊接上條，如鄭氏所言，理應大承氣湯以逐其邪，于桂枝何取乎？但此是太陽病誤下而致，於證似可急下，此陰實而非陽實，故應從桂枝例，升舉陽邪，但加大黃以破結滯，使表裏兩解，各有去路，則寒隨濕去，不溫而自溫矣。
桂枝加大黃湯方（校補）
桂枝三兩（去皮）大黃二兩芍藥六兩生薑三兩（切）甘草二兩（炙）大棗十二枚（擘）。
上六味，以水七升，煮取三升，去渣，溫服一升，日三服。
【方解及其應用範圍】本方乃表裏兩解之劑，用桂枝湯領出陷入的陽邪，加大黃以導其滯，以治實痛，使表裏之邪，各有出路。燥尿去而陽明之內道通，則大實痛減矣。現推廣用以治腹中寒熱不調而大痛，痢疾腹痛，蕁麻診等。
八、太陰為病，脈弱，其人續自便利，設當行大黃芍藥者①，宜減之，以其人胃氣弱易動故也②。原文280
①行：此處作用字解。
②易動：指胃陽受傷，侗泄不止。
鄭論：按脈弱而又見自利，其不足甚已，焉有再行大黃之理，似近畫蛇添足，殊非確論。
【闡釋】此條緊承上條，指出臨床用藥，必須注意患者體質，體質弱的，攻伐藥應慎用，或減輕用藥量，以免正氣受損，下利不止。鄭氏所論正確，當從之。
九、太陰病，欲解時，從亥至醜上。原文275
鄭論：各經皆有旺時，病之輕者，可以當旺時而潛消，宜知。
【闡釋】鄭氏所論各經皆有旺時，涉及時間醫學，從亥至醜上，即下午九時至次日上午三時，此太陰經氣旺時也。如鄭氏所說：病之輕者，當旺時而潛消。
傷寒恒論卷九
少陰〔前〕篇
凡外邪挾水而動之證，列於此篇，計二十七法。（據舒本校增）
一、少陰之為病，脈微細①，但欲寐〔也〕②。原文281
①脈微細；微是脈的搏動輕微無力，屬於陽氣衰弱，細是脈的形態細小，屬於營血不足。
②但欲寐：是指迷迷糊糊似睡非睡的狀態。
鄭論：按此乃少陰提綱也。脈微細者，陽不足而陰有餘也。陽主開故寤，陰主闔故寐。寤則從陽，寐則從陰，故知邪入少陰也。
【闡釋】本條是少陰病的脈證提綱。少陰病，可分為直中與傳經兩種：寒邪直接侵襲少陰，一開始就是少陰證狀，為直中；由他經發病而邪傳到少陰的，為傳經。傳經則以從太陽傳來的為多，此因太陽與少陰相為表裏，二者關係密切，太陽受病時，正氣旺者，邪就在太陽而解，正氣不足者，邪即乘虛而陷入少陰；其次亦可從太陰傳入。少陰病是全身性虛寒證，較太陰病的脾胃陽虛更深一層，而為心腎陽虛，一派陰霾之氣，彌漫內外，故有四肢厥逆，惡寒踡臥，下利清穀，精神困倦等嚴重的陰盛陽微現象。但少陰之本屬陰而標屬陽，既可從陰化寒，又可從陽化熱，所以少陰是有寒化熱化的區別，也是有熱證的，後面將敍述。
二、少陰病，始得之，反發熱，脈沉者，麻黃附子細辛湯主之。原文301
鄭論：按既雲少陰病，而脈（尚浮）〔當沉〕，雖有發熱，焉知非真陽外越乎？然麻黃附子細辛，固屬少陰之法，學者總要審其發熱之原委，或有頭痛、身疼，或無頭痛、身疼，畏寒甚否，又審其色之青白，舌之黑幹潤黃，口渴之飲冷飲熱，小便之青長短赤，便得用藥之道，庶不致誤，原文反發熱三字，不可忽略，此髒係根蒂之所，不得草草讀去，務宜細心。
1. The condition resembles the Guizhi Tang (Cinnamon Twig Decoction) syndrome, but there is no headache or stiffness of the neck. The cun (inch) pulse is slightly floating. There is a sensation of fullness and hardness in the chest, Qi rushing upward to the throat causing dyspnea. This indicates the presence of pathogenic cold (here "cold" refers to pathogenic factors such as phlegm-fluids or retained food stagnating in the chest). It should be treated by inducing vomiting, and Gouti San (Melon Seed Powder) is appropriate. (Note: Gouti San should not be administered to patients who have suffered blood loss.) Original Text 166
Zheng's Commentary: In this clause, since there is neither headache nor neck stiffness, nor symptoms of aversion to cold or wind, how can it be described as resembling the Guizhi Tang syndrome? This is an unfounded assertion. It should state that when the cun pulse is slightly floating, accompanied by chest fullness and hardness, Qi rushing to the throat, and dyspnea, it indicates pathogenic cold in the chest. Later physicians treated according to this understanding of chest cold-stagnation, which was direct and accurate. This disease is not indicated for emesis, and certainly not for patients with blood loss.
[Interpretation]: Zheng held a negative view of this clause. I believe that while the condition resembles the Guizhi Tang syndrome (manifesting as fever and sweating), the absence of headache and neck stiffness indicates it is not a exterior syndrome. A slightly floating cun pulse indicates the pathology is located superiorly. Chest fullness and hardness result from phlegm-fluids obstructing the diaphrag, impeding Qi mechanism; the phlegm follows the rebellious Qi upward, causing dyspnea. This reflects the body's righteous Qi driving out pathogens. Therefore, treatment employs the principle of guiding the pathogen out along its natural course, using Gouti San to induce vomiting. This aligns with the *Neijing* principle: "For pathogens located high, use the method of eversion (vomiting)." Sweating, vomiting, and purging are the three major methods for attacking pathogens. When the pathogen is above the diaphragm, vomiting is indicated. Vomiting acts swiftly, directly expelling pathogens. However, among all clauses in the *Shanghan Lun*, only this one fully presents the indications for vomiting. The text warns after the formula: "Do not give Gouti San to patients with blood loss or deficiency." This emphasizes caution.
Gouti San Formula (Corrected and Supplemented)
Gouti (Thladiantrae Fructus) 1 fen (stir-fried until yellow); Chixiaodou (Vigna angularis Semen) 1 fen.
Process the two herbs separately by pounding and sieving. Mix them well to make a powder. Take one qianbi (a measure approx. 1-2g) of the powder. Use Xiangchi (Fermented Soybean) 1 he, boiled in 7 he of hot water until a thin porridge forms. Strain the residue and mix the liquid with the powder. Take warm in one dose. If vomiting does not occur, gradually increase the dose until vomiting occurs, then stop. Do not administer Gouti San to patients with blood loss or deficiency.
[Formula Analysis and Scope of Application]: Gouti is extremely bitter and ascending, inducing vomiting. Chixiaodou is bitter and sour, promoting urination and reducing edema. Together, they possess the property of sour-bitter eversion and drainage. Xiangchi is light and clear, dispersing and draining, further enhancing the emetic power. This formula is potent; excessive vomiting may damage Stomach Qi, so it should be used cautiously in patients with weak constitution or blood loss. Later generations extended its use to phlegm-food stagnation above the diaphragm, stroke with phlegm-misting the mind, and excessive salivation. Vomiting leads to cure.
2. If a patient has internal cold and is mistakenly given sweating therapy again①, the Stomach becomes cold, inevitably leading to vomiting of roundworms. Original Text 89
① Fu (Again/Repeatedly): Means "again," here implying error/mistreatment.
Zheng's Commentary: Since the patient already has cold-fluids, sweating causes Yang Qi to escape. With the loss of Stomach Yang, the cold in the Stomach intensifies, inevitably causing vomiting of roundworms due to their restlessness inside.
[Interpretation]: For patients with interior cold, even if exterior symptoms exist, the interior must be warmed first. Otherwise, although exterior symptoms may resolve, interior cold worsens, leading to a cold Stomach and vomiting of roundworms. No formula is provided in this clause. *Yizong Jjian* suggests: "It is suitable to use Lizhong Tang taken with Wu Mei Wan." This fits the condition well.
3. If a patient has cold extremities and the pulse suddenly becomes tight, the pathogen is knotted in the chest②. There is chest fullness and irritability, hunger but inability to eat. The disease is in the chest and requires vomiting; Gouti San is appropriate. Original Text 355
② Pathogen: Refers to pathogenic factors like retained phlegm or food stagnation. Chest: Generally refers to the chest and stomach area.
Zheng's Commentary: Cold extremities indicate Stomach Yang failing to reach the four limbs. However, one must distinguish between Yin and Yang syndromes. If Yang pathogen is severe and latent, there will be signs of heat. If Yin pathogen is severe causing cold, there will be signs of Yin excess. Chest fullness with ability to eat belongs to severe Yang/Heat obstruction; chest fullness with inability to eat belongs to Yin/Cold knotting. Treatment may involve clearing heat, warming, or vomiting, each having its specific method. How can one speak only of vomiting?
[Interpretation]: This clause addresses the treatment for cold extremities caused by phlegm-food stagnation obstructing the chest. Cold extremities indicate Yang Qi failing to reach the limbs. One must determine why Yang fails to reach them. Severe latent Yang pathogens require clearing heat; severe Yin pathogens causing cold require warming. Chest fullness with hunger and ability to eat indicates Heat obstruction, suitable for vomiting. Chest fullness with hunger but inability to eat indicates Yin-Cold knotting, requiring warming. Thus, Zheng states: "Warming, clearing, or vomiting each have their laws; why speak only of vomiting?"
Shanghan Henglun Volume 8
Taiyin Chapter: Total Nine Methods (Based on Shu's edition)
1. Taiyin disease manifests as abdominal fullness and vomiting, inability to eat, spontaneous diarrhea worsening over time, and spontaneous abdominal pain. If purged incorrectly, it will definitely lead to epigastric binding and hardness①. Original Text 273
① Epigastric binding and hardness: Refers to the sensation of blockage and hardness in the epigastrium.
Zheng's Commentary: Abdominal fullness and vomiting can be caused by food stagnation, heat accumulation obstructing upward, or cold closure reversing upward. These must be distinguished. Pathogens accumulating reverse upward causing vomiting, or press downward causing diarrhea, hence abdominal pain. Treatment should be adaptive. Incorrect purging severely damages Righteous Qi, leading to binding and hardness. Caution is required.
[Interpretation]: This is the outline of Taiyin disease. Both Taiyin and Yangming govern gastrointestinal disorders, but their nature differs. Yangming is Interior Excess-Heat; Taiyin is Interior Deficiency-Cold. In Yangming, abdominal fullness is due to retained food/dry stool in the intestines; pressing reveals hardness and pain, relieved by bowel movement. In Taiyin, abdominal fullness is due to external depression of cold-dampness; pressing reveals softness without pain, and fullness persists despite diarrhea. Zheng notes three types of fullness/vomiting: food stagnation, heat accumulation, and cold closure. I treated these respectively with Lizhong Tang plus Banxia (warming/moving/reversing), Da/Xiao Chengqi Tang (bitter-cold descending), and Wuzhuyu Sini Tang (supporting Yang/scattering cold/reversing), achieving satisfactory results.
2. Taiyin Wind Strike causes vexatious pain in the four limbs②. If the pulse is slightly floating (Yang micro) and choppy yet long (Yin se er chang)③, recovery is imminent. Original Text 274
② Vexatious pain: Severe pain causing extreme discomfort and restlessness.
③ Yang Micro Yin Choppy: "Yang/Yin" here refers to superficial/deep palpation. Superficial pulse is faint; deep pulse is choppy.
Zheng's Commentary: Taiyin corresponds to the Spleen. "Wind Strike" implies sudden invasion. If the Spleen were truly struck, it would be a critical condition. "Vexatious pain" suggests Taiyin is affected by wind, indicating mild wind pathogen. "Yang micro" indicates mild wind; "Yin choppy yet long" indicates robust Spleen Qi. Hence, "imminent recovery." This interpretation aligns with the classics.
[Interpretation]: Zheng disputes the term "Strike," interpreting it as "contracting wind." Taiyin corresponds to the Spleen, which governs the limbs. Wind invading Taiyin causes limb pain. Wind pulses are typically floating; a faint pulse indicates wind is departing. Choppy is a Yin pulse; long is a Yang pulse. A Yin pulse containing Yang characteristics indicates the return of Righteous Qi, which drives out pathogens, signifying recovery.
3. In Taiyin disease, if the pulse is floating, sweating is permissible; Guizhi Tang is appropriate. Original Text 276
Zheng's Commentary: If it is Taiyin disease, Lizhong Tang method should apply. Although the pulse is floating, there are no Taiyang symptoms of aversion to wind/cold. Guizhi Tang should not be used for sweating. Even if Taiyin combines with Taiyang, it would merely be Lizhong Tang plus Guizhi. Often, floating pulses relate to food stagnation; scholars must observe carefully.
[Interpretation]: The following six clauses discuss the variations of Taiyin disease (exterior/interior, cold/heat, deficiency/excess). Zheng argues that Taiyin disease generally requires Lizhong Tang. He suggests that even combined cases are just Lizhong Tang plus Guizhi. This teaches that diagnosis cannot rely solely on pulse; pulse and symptoms must be integrated. If it is truly Taiyin Wind Strike (limb pain, floating pulse, headache, fever, etc., without abdominal fullness/vomiting/diarrhea), then Guizhi Tang is applicable.
4. Spontaneous diarrhea without thirst belongs to Taiyin, due to cold in the Zang organs①. It should be warmed; Sini Tang category② is appropriate. Original Text 277
① Cold in Zang: Refers to deficiency-cold of the Stomach and Intestines.
② Sini Tang Category: Refers to formulas similar to Sini Tang, such as Sini Tang, Baitong Tang, Tongmai Sini Tang.
Zheng's Commentary: Patients with spontaneous diarrhea are often thirsty due to Qi sinking and fluids failing to ascend. Here, lack of thirst indicates dampness predominance (Taiyin governs dampness), causing diarrhea without thirst, termed "Zang Cold." While warming the interior is correct, Sini Tang is primarily for Shaoyin, not Taiyin. However, flexible application allows its use. Scholars should not be rigidly bound by rules.
[Interpretation]: Diarrhea with thirst belongs to Shaoyin; diarrhea without thirst belongs to Taiyin. This clause describes Taiyin's intrinsic interior cold. "Spontaneous diarrhea" distinguishes it from iatrogenic purgative-induced diarrhea. "No thirst" indicates cold-dampness without dry-heat transformation. "Zang Cold" warns against focusing only on dampness; one must recognize the cold. "Sini Tang category" includes Lizhong Tang, emphasizing warming Spleen and Kidney, used judiciously.
5. In Shanghan, if the pulse is floating and slow, and extremities are self-warm, it relates to Taiyin. Taiyin disease usually causes jaundice; however, if urination is free, jaundice will not develop. After 7-8 days, even if sudden irritability and diarrhea occur (more than ten times daily), it will stop spontaneously because the Spleen is real/full③, and foul matter is being expelled④. Original Text 278
③ Spleen Real/Full: Refers to the restoration of gastrointestinal function.
④ Foul Matter: Refers to accumulated rotting material in the intestines.
Zheng's Commentary: Jaundice development depends on urination. Free urination prevents Qi stagnation and jaundice; blocked urination causes stagnation and jaundice. This distinction is insightful. Sudden irritability and frequent diarrhea indicate Qi descending, unlike Yangming constipation. Thus, it undoubtedly belongs to Taiyin.
[Interpretation]: This clause describes Taiyin exterior pathogen entering the interior as an excess pattern. Floating-slow pulse resembles Taiyang Wind Strike, but lacks fever/sweating/aversion to wind. Self-warm extremities confirm Taiyin. Taiyin is Earth/Dampness; cold-damp stagnation can cause jaundice (Yin Jaundice: dull yellow), distinct from Yangming Damp-Heat Jaundice (Yang Jaundice: bright orange-yellow). Yin Jaundice is treated with Fuzi Lizhong Tang plus Yinyin; Yang Jaundice with Yinchen Wuling San. Free urination drains dampness, preventing jaundice. Sudden irritability/diarrhea indicates Spleen Yang recovery expelling pathogens; it resolves spontaneously.
6. Originally a Taiyang disease, mistaken purging led to abdominal fullness and intermittent pain, belonging to Taiyin. Guizhi Jia Shaoyao Tang (Guizhi Tang plus Peony) is the main treatment. Original Text 279 (First part)
Zheng's Commentary: This clause involves Taiyang pathogen sinking into the Spleen due to incorrect purging, causing abdominal fullness/pain. Warming the middle and awakening the Spleen is appropriate; Guizhi Tang alone seems unsuitable. Scholars should deliberate carefully.
[Interpretation]: Combined with the next clause, this describes Taiyang mistaken purging leading to Taiyin excess. "Abdominal fullness and intermittent pain" results from Spleen Qi injury, not intrinsic Taiyin deficiency-cold (no vomiting/diarrhea). Since Taiyang exterior remains, Guizhi Tang is used plus Shaoyao to harmonize the Spleen and relieve pain. Zheng advises warming the middle, suggesting careful differentiation rather than rigid adherence.
Guizhi Jia Shaoyao Tang Formula (Corrected and Supplemented)
Guizhi (Cinnamomi Ramulus) 3 liang (peeled); Shaoyao (Paeoniae Radix Rubra/Alba) 6 liang; Gancao (Glycyrrhizae Radix) 2 liang (roasted); Dazao (Zizyphi Fructus) 12 pieces (split); Shengjiang (Zingiberis Rhizoma Recens) 3 liang (sliced).
Boil five ingredients in 7 sheng of water to obtain 3 sheng. Strain. Take warm, divided into three doses. Originally Guizhi Tang, now with added Shaoyao.
[Formula Analysis and Scope of Application]: This is Guizhi Tang with doubled Shaoyao. *Bencao Jing* states Shaoyao treats abdominal pain, blood stasis, masses, and calms pain. Here, Taiyang exterior pathogen sank into Taiyin. Guizhi Tang releases the exterior; added Shaoyao harmonizes the Spleen and relieves pain. Extended use includes spasmodic pain, postpartum breast swelling, and chronic dysentery, primarily due to heavy Shaoyao dosage.
7. For severe abdominal pain, Guizhi Da Huang Tang (Guizhi Tang plus Rhubarb) is the main treatment. Original Text 279 (Second part)
Zheng's Commentary: Severe pain in Taiyin should be treated with Dachengqi Tang to purge pathogens. Why use Guizhi?
[Interpretation]: Following the previous clause, while Dachengqi Tang might seem appropriate for severe pain, this case stems from Taiyang mistaken purging. It is Yin-excess, not Yang-excess. Therefore, follow the Guizhi principle to lift Yang pathogens, adding Da Huang to break stagnation. This achieves simultaneous resolution of exterior and interior, allowing pathogens separate exit routes. Cold leaves with dampness, warming occurs naturally.
Guizhi Da Huang Tang Formula (Corrected and Supplemented)
Guizhi (Cinnamomi Ramulus) 3 liang (peeled); Da Huang (Rhei Radix et Rhizoma) 2 liang; Shaoyao (Paeoniae Radix) 6 liang; Shengjiang (Zingiberis Rhizoma Recens) 3 liang (sliced); Gancao (Glycyrrhizae Radix) 2 liang (roasted); Dazao (Zizyphi Fructus) 12 pieces (split).
Boil six ingredients in 7 sheng of water to obtain 3 sheng. Strain. Take 1 sheng warm, three times daily.
[Formula Analysis and Scope of Application]: This is a simultaneous exterior-interior resolving formula. Guizhi Tang extracts sunk Yang pathogens; Da Huang guides stagnation out to treat excess pain. Dry stool removal opens Yangming pathways, relieving severe pain. Extended use includes abdominal pain from cold-heat disharmony, dysentery abdominal pain, and urticaria.
8. In Taiyin disease, if the pulse is weak and the patient has continuous spontaneous diarrhea, if Da Huang or Shaoyao should be used①, the dose should be reduced because the person's Stomach Qi is weak and prone to diarrhea②. Original Text 280
① Xing (Use/Administer): Used here as a verb meaning "to use."
② Yi Dong (Easily Moved): Refers to damaged Stomach Yang leading to persistent diarrhea.
Zheng's Commentary: Weak pulse with spontaneous diarrhea indicates severe deficiency. Using Da Huang again seems superfluous and inaccurate.
[Interpretation]: Continuing from the previous clause, this emphasizes considering patient constitution. Weak constitutions require caution with purgatives or reduced doses to avoid damaging Righteous Qi and causing persistent diarrhea. Zheng's view is correct and should be followed.
9. Taiyin disease tends to resolve from Hai hour to Chou hour (9 PM to 3 AM). Original Text 275
Zheng's Commentary: Each meridian has a prosperous time. Mild diseases may subside during their respective prosperous times. Scholars should know this.
[Interpretation]: Zheng's discussion involves Chronomedicine. Hai to Chou hours (9 PM - 3 AM) are when Taiyin Qi is prosperous. As Zheng states, mild diseases may subside during this peak time.
Shanghan Henglun Volume 9
Shaoyin Chapter (Front)
Clauses involving external pathogens combining with water/fluids are listed here, totaling twenty-seven methods. (Added based on Shu's edition)
1. Shaoyin disease manifests as a micro-fine pulse① and a desire only to sleep②. Original Text 281
① Micro-Fine Pulse: "Micro" indicates faint, weak beating, reflecting deficient Yang Qi. "Fine" indicates slender shape, reflecting deficient Ying-Blood.
② Dan Yu Mei (Desire Only to Sleep): A drowsy state, half-asleep, half-awake.
Zheng's Commentary: This is the outline of Shaoyin disease. Micro-fine pulse indicates insufficient Yang and excess Yin. Yang governs opening (wakefulness); Yin governs closing (sleep). Awakening follows Yang; sleeping follows Yin. Thus, we know the pathogen has entered Shaoyin.
[Interpretation]: This is the pulse-symptom outline of Shaoyin disease. Shaoyin disease divides into Direct Invasion and Transmission. Direct invasion: Cold attacks Shaoyin directly, presenting Shaoyin symptoms immediately. Transmission: Pathogen moves from other meridians to Shaoyin, mostly from Taiyang due to their interior-exterior relationship. Strong Righteous Qi resolves pathogen at Taiyang; weak Righteous Qi allows pathogen to sink into Shaoyin. It can also transmit from Taiyin. Shaoyin disease is systemic deficiency-cold, deeper than Taiyin's Spleen-Stomach Yang deficiency, involving Heart-Kidney Yang deficiency. Yin mist pervades interior/exterior, causing cold extremities, aversion to cold/curling up, clear watery diarrhea, and mental fatigue. However, Shaoyin's root is Yin, branch is Yang. It can transform into Cold or Heat. Thus, Shaoyin has both cold and heat patterns, discussed later.
2. In Shaoyin disease, initially contracting it, if there is contrary fever and a sunken pulse, Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) is the main treatment. Original Text 301
Zheng's Commentary: If it is Shaoyin disease, the pulse should be sunken. Despite fever, how do we know it is not True Yang floating outward? However, Mahuang Fuzi Xixin is indeed a Shaoyin method. Scholars must examine the origin of fever: presence/absence of headache/body ache, severity of aversion to cold, complexion (blue/white), tongue coating (black/dry/wet/yellow), thirst preference (cold/hot drinks), urine color/volume. Careful observation prevents error. The phrase "contrary fever" must not be overlooked; this organ is the root of life, requiring meticulous study.