【闡釋】本論中用吳茱萸湯凡三見：一為陽明中篇15條，二為少陰前篇12條，三即本條。證狀雖有不同，而其為肝胃虛寒，濁陰上逆所致則同。幹嘔，吐涎沫，是肝胃寒邪挾濁陰之氣上逆，頭痛多在巔頂部位，為陰寒上逆之征。治以吳茱萸湯散寒止嘔，溫胃降逆，則諸症自愈。筆者曾治一巔頂頭痛之患者，四肢冰涼，面容蒼白無神，食少，一身都痛，惡寒特甚，嘔吐涎沫，經中西醫治療，經年累月無效。餘綜合分析，斷為厥陰頭痛。先服麻附細辛湯加味四劑，一身痛等有所減輕；繼服四逆湯以扶陽祛陰，惡寒等又有減輕；最後治以吳茱萸湯加附片，吐涎沫、頭痛諸症悉愈，複以理中湯善其後。
十、嘔家，有癰膿〔者〕，不可治嘔，膿儘自愈。原文376
鄭論：按嘔出癰膿，大半多屬熱壅於內，在厥陰篇中，用藥多居辛燥，故教人不治吐膿，蓋慎用辛燥之意也。
【闡釋】厥陰寒盡陽回之後，陽熱太甚，傷及血分，下行則便膿血，上出則嘔癰膿。若強止其嘔，則膿不得出，反生他變。鄭氏曰：“在厥陰篇中，用藥多居辛燥，故教人不治吐膿，蓋慎用辛操之意也”。既禁辛燥之劑，其治當辛涼以開其結，苦泄以排其膿，甘寒以養其正，使膿盡而嘔自止，可用排膿湯加味治之。
過經不解
四法，附三陰經後（據舒本校補）
一、太陽病，過經十餘日②，反二三下之，後四五日，柴胡證仍在者，先與小柴胡。嘔不止，心下急③，鬱鬱微煩者④，為未解也，與大柴胡湯下之則愈。原文103
②過經：此處含有病傳他經之意。
④鬱鬱：言煩悶之狀。
鄭論：按太陽過經不解，延至十餘日，反二三下之，此際邪仍在太陽，方可雲過經不解。若是柴胡證，十餘日後，邪仍在少陽，方可言過經不解。此說一嘔不止，心下急，鬱鬱微煩病情，乃係太陰中宮不宣，陰邪上逆之象，若只據一嘔，而即雲柴胡證仍在，殊屬不當。
總要寒熱往來，口苦、耳聾、喜嘔全在，用小柴胡湯，乃為恰切，不得草草了事。
【闡釋】過經不解計四條，他書俱載在太陽中篇，舒馳遠將此四條，附在三陰經後，鄭氏從之。太陽病，過經十餘日而不解，或為桂枝湯證，或為麻黃湯證，皆無可下之理，此際邪仍在太陽，故可雲過經不解。鄭氏辨過經不解與其他注家隨文釋義不同，是有見地的。至論“嘔不止，心下急，鬱鬱微煩病情，乃係太陰中宮不宣，陰邪上逆”之征，則大柴胡湯不可用，法當溫中降逆散邪，理中湯加砂仁半夏治之。
大柴胡湯方（校補）
柴胡半斤黃芩三兩芍藥三兩半夏半升（洗）生薑五兩（切）大棗十二枚（擘）枳實四兩（炙）上七味，以水一鬥二升，煮取六升，去渣再煎，溫服一升，日三服。一方加大黃二兩①，若不加，恐不為大柴胡湯。
【方解及其應用範圍】本方有柴胡、半夏、生薑之辛以解表，黃芩、芍藥、枳實、大黃之苦以滌除裏熱，是兩解表裏之劑。若無大黃，原文何雲與大柴胡湯下之愈。
二、太陽病，過經十餘日，心下溫溫欲吐②，而胸中痛，大便反溏，腹微滿，（而）鬱鬱微煩，先此時，自極吐下者③，與調胃承氣湯。若不爾者，不可與，但欲嘔，胸，中痛，（而）微溏者，此非柴胡〔湯〕證，以嘔，故知極吐下也。原文123
②溫溫：同慍慍，言煩憒之狀。
③極吐下：大吐下的意思。
鄭論：按太陽過經十餘日，所現病情，皆正氣不足之候，何也？心下溫溫欲吐者，中宮不宣，而陰邪滯也；大便溏而微滿者，中宮有寒濕彌漫之象也；鬱鬱微煩，正氣不暢達也。此皆由吐、下失宜，方有此候。
【闡釋】諸家注解此條，紛紛聚訟，其實難從。唯鄭氏能獨抒己見雲：“太陽過經十餘日，所現病情，皆正氣不足之候”。此皆由吐、下失宜，既非柴胡證，亦非調胃承氣湯所能治。所現諸證，無非內臟虛寒，或為吐下所傷，或為中氣素弱，或為寒濕彌漫，法宜溫中散寒祛濕，理中湯加砂仁、半夏、茯苓治之。
三、傷寒十三日〔不解〕，胸脅滿而嘔，日晡所發潮熱，已而微利，此本柴胡證，下之（而）〔以〕不得利；今反利者，知醫以丸藥下之，〔此〕非其治也。潮熱者實也，先宜服小柴胡〔湯〕以解外，後以柴胡（湯）加芒硝〔湯〕主之。原文104
鄭論：按胸脅，乃肝膽地界，今見病而嘔，邪氣拂鬱也。日晡發熱而微利，本有熱也，此乃柴胡的候，下之本非其治。學者總宜相機施治為是。至原文所主之方，亦不可固執。
【闡釋】胸脅滿而嘔，日晡發潮熱等證，是少陽兼陽明內實之證，故鄭氏曰：“下之本非其治。”上證既兼裏實，大便應見秘結，今反下利，此是誤用丸藥所致，雖有微利而病不解，柴胡證仍在；潮熱為裏實。故先用小柴胡湯以解外；再用柴胡加芒硝湯兼治裏實。鄭氏又曰：“原文所主之方，亦不可固執”，示人以活法圓通之妙。
柴胡二兩十六銖黃芩一兩人參一兩甘草一兩（炙）生薑一兩（切）半夏二十銖本雲二十銖五枚（洗）大棗四枚（擘）芒硝二兩上八味，以水四升，煮取二升，去渣，內芒硝，更煮微沸，分溫再服。不解，更作。
【方解及其應用範圍】此為少陽，陽明兼治的方劑，和解清裏之方也，治小柴胡湯證兼胃有實熱者。
雖有微利，燥結仍留。加芒硝者，泄熱軟堅，胃實可除，潮熱微利自止。亦即本方證之少陽證及陽明證均較大柴胡湯證為輕者適用之。可以推廣用於小柴胡湯證，而腹有堅塊苦滿難解者；或小柴胡湯證，發潮熱，大便不通者。此用鹹寒之芒硝以潤燥軟堅之效也。
四、傷寒十三日（不解），過經譫語言①，以有熱也，當以湯下之。若小便利者，大便當鞕，而反下利，脈調和者，知醫以丸藥下之，非其治也。若自下利者，〔脈〕當微厥；今反和者，此（謂）〔為〕內實也，調胃承氣湯主之。原文105
①過經：此處是病已離開太陽經的意思。
鄭論：按譫語而稱內熱，下之理也；大小便利者，裏氣通也；脈調和者，氣機順也。此以為醫以丸藥下之，非其治，殊非正論。又若自下利，當微厥者，正虛之征也；而反和者，正未大虛也。原文何得此為內實，當下之，非正論，決非仲師所語也。
【闡釋】歷代注家對本條大多只是隨文順釋，殊覺含糊。鄭氏對原文提出疑問，不同於歷代注解者。原文第一段“傷寒十三日”至“知醫以丸藥下之，非其治也”；第二段“若自下利”至“此為內實，當下之”。鄭氏均斥為非正論。最後歸結為“決非仲師所語也”。鄭論按過經不解一語，似非確論，如太陽病有十餘日，仍在太陽者；陽明病有下而再下，十餘日仍未解。總之不必專拘時日，務以認證為妥，辨明虛實為要。
【闡釋】本節鄭論，係概括前四節而言。雖曰過經，究竟仍在六經之內，辨其證在何經，即用何經之法以治之，無所往而不得之矣，又何必用此過經不解之法哉？
差後勞複
計五法（據舒本校補）
一、大病差後②，勞複者③，枳實梔子豉湯主之（若有宿食者，加大黃，如博棋子大五六枚）④。原文393
②大病：諸病源候論雲：“大病者，中風、傷寒、熱勞、溫瘧之類是也”。
③勞複：疾病新愈，因勞又發的，叫勞複。
④若有……五六枚三句：據成無己本增。其他諸書，此十六字皆在枳實梔子鼓湯後。
鄭論：按大病差後，稍有勞動，而病依然複初，此皆元氣薄弱之故，不得按前法治之。但病（果按）勞複一證，果係何髒損傷，何經為病？病差後，稍有勞動，其病依然，應按髒經施治，原文所主之方，大非確論，恐有遺誤。
【闡釋】大病新差，真元大虛，氣血未複，過勞了可能復發舊病，與前無異，自當照前用藥，此一定之理也。而鄭氏則說：“而病依然複初，此皆元氣薄弱之故，不得按前法治之”。何其自相矛盾？過勞了既可能復發舊病，亦可能新感為病，仍應以隨證施治為准。故鄭氏又謂：“原文所主之方；大非確論，恐有遺誤”。其質疑是正確的。
枳實梔子豉湯方（校補）
枳實三枚（炙）梔子十四個（擘）豉一升（綿裹）上三味，以清漿水七升①，空煮取四升，內枳實梔子，煮取二升，下豉，更煮五六沸，去渣，溫分再服，複令微似汗。若有宿食者，內大黃如博棋子大五六枚②，服之愈。
①清漿水：徐靈胎曰：漿水即淘米泔水，久貯味酸為佳。
②博棋子大：千金方：羊脂煎方後雲，棋子大小如方寸匕。
【方解及其應用範圍】體虛勞複，熱氣浮越，所以用枳實寬中下氣，梔子泄熱除煩，香豉宣洩陳腐，兼解其表，更用漿水煮藥，以開胃調中，所以具有泄熱除煩，散表和中的作用。假如兼有宿食停滯，再加大黃以蕩滌腸胃，推陳致新，所謂邪去則正自安。
二、傷寒差以後，更發熱（者），小柴胡湯主之。脈浮者，以汗解之；脈沉實者，以下解之。原文394
鄭論：按病既稱差已，何得更現發熱乎？又並未現出柴胡證，何得以小柴胡湯主之？即脈浮、沉、實，亦當審其何部何經，應表解、應下解、方可定（按）〔案〕，此以籠統言之，定非確論。
【闡釋】傷寒差已，則大邪已去，後更發熱者，表裏之氣未和也，脈當微弦，必兼有口苦、咽幹、胸脅滿等證，否則不能投以小柴胡湯。至以汗解、以下解，亦當審其何部何經，兼辨其證狀，對證下藥，始為適當。故鄭氏曰：“此以籠統言之，定非確論”。
三、大病差後，從腰以下有水氣者，牡蠣澤瀉散主之。原文395
鄭論：按大病差後，從腰下有水氣者，是病不責之太陽，而責之於腎也。太陽底面，即是少陰，太陽病已，而少陰腎氣發洩於外，故現腰以下有水氣，法當溫腎收納，若牡蠣澤瀉散，是亦利水之一法也，似非正論。
【闡釋】本條原文甚簡，必須結合其他證狀來辨別水氣之屬性，是否可用牡蠣澤瀉散治療。如下焦氣化失常，濕熱壅滯，膀胱不瀉，水性下流，故但從腰以下，水氣壅積，膝脛足跗，皆腫重也。此屬有餘之邪，脈必沉數有力，二便不利，方可用此排決逐水之劑。若脾胃氣虛，不能升清降濁；腎氣渙散，膀胱氣化不行，水邪氾濫而為腫。牡蠣澤瀉散決不可用，當如鄭氏所說：“當溫腎收納”。兼以化氣，四逆湯加肉桂、砂仁、白蔻、破故紙治之。
牡蠣澤瀉散方（校補）
牡蠣（熬）澤瀉蜀漆（暖水洗去腥）葶藶子（熬）商陸根（熬）海藻（洗去鹹）栝蔞根各等分上七味，異搗，下篩為散，更於臼中治之，白飲和服方寸匕，日三服，小便利，止後服。
【方解及其應用範圍】牡蠣軟堅行水，澤瀉滲濕利水，蜀漆祛痰逐水，葶藶子宣肺泄水，商陸、海藻專于潤下行水，共使水邪從小便排出。栝萎根止渴生津液，為本方之反佐，使水去而津液不傷。此方施之於形氣實者，其腫可隨愈也，若病後土虛不能制水，腎虛不能行水，則又當別論，慎不可服也。
四、大病差後，喜唾①，久不了了（者）②，（胃）〔胸〕上有寒，當以丸藥溫之，宜理中丸。原文396
①喜唾：即時時泛吐唾沫。
②久不了了：延綿不已的意思。
鄭論：按病後喜唾不了，中宮有寒濕未盡也。寒濕上逆而不降，故唾不止，法宜溫中降逆，是一定之理也。
【闡釋】鄭氏所論極是，法宜溫中降逆。筆者將理中丸改為湯劑，再加砂仁、半夏，增強其效，輕者一二劑，重者五六劑，即竟全功。
理中丸方（校補）
人參、乾薑、甘草（炙）、白朮各三兩上四味，搗篩，蜜和為丸，如雞子黃許大，以沸湯數合，和一丸，研碎，溫服之，日三四，夜二服，腹中未熱，益至三四丸，然不及湯。湯法：以四物依兩數切，用水八升，煮取三升，去渣，溫服一升，日三服。若臍上築者，腎氣動也，去朮，加桂四兩；吐多者，去朮加生薑三兩；下多者，還用朮；悸者，加茯苓二兩；渴欲得水者，加朮，足前成四兩半；腹中痛者，加人參，足前成四兩半；寒者，加乾薑，足前成四兩半；腹滿者，去朮，加附子一枚。服湯後如食頃，飲熱粥一升許，微自溫，勿發揭衣被。
[Explanation] In this treatise, Wuzhuyu Decoction (Wuzhuyu Tang) is used three times: once in Chapter 15 of the Yangming section, once in Chapter 12 of the Shaoyin section, and the third time is in this current clause. Although the symptoms differ, the pathogenesis is the same: deficiency-cold of the Liver and Stomach leading to the counterflow of turbid Yin Qi. "Dry retching" and "spitting saliva" indicate that cold pathogens in the Liver and Stomach are carrying turbid Yin Qi upward. "Headache" occurring mainly at the vertex is a sign of counterflow of Yin-Cold. Treatment employs Wuzhuyu Decoction to disperse cold, stop vomiting, warm the Stomach, and direct rebellious Qi downward, after which all symptoms will resolve spontaneously. The author once treated a patient with vertex headache, presenting with ice-cold limbs, pale and spiritless complexion, poor appetite, generalized body pain, severe aversion to cold, and vomiting of saliva. After years of ineffective treatment by both Chinese and Western medicine, comprehensive analysis led to a diagnosis of Jueyin Headache. Initially, Mahuang Fuzi Xixin Decoction (Mahuang Fuzi Xixin Tang) with modifications was administered for four doses, alleviating the generalized body pain. Subsequently, Sini Decoction (Sini Tang) was given to support Yang Qi and dispel Yin pathogens, further reducing aversion to cold. Finally, Wuzhuyu Decoction with added prepared Aconite root (Fupian) cured the vomiting of saliva and headache completely. Lizhong Decoction (Lizhong Tang) was then used for convalescence.
10. For patients who frequently vomit, if there is an abscess with pus within, one must not forcibly stop the vomiting; once the pus is fully discharged, the vomiting will cease spontaneously. Original Text 376
Commentary by Zheng: Vomiting pus from an abscess usually indicates heat-toxin stagnating internally. In the Jueyin chapter, medications are predominantly acrid and dry. Therefore, it is taught not to forcibly treat vomiting of pus, reflecting the intention to use acrid-dry substances cautiously.
[Explanation] After the cold in Jueyin dissipates and Yang returns, if Yang-heat becomes excessive, it damages the Blood level. Downward, this leads to pus and blood in the stool; upward, it results in vomiting abscess pus. If vomiting is forcibly stopped, the pus cannot exit, potentially causing other complications. Zheng stated: "In the Jueyin chapter, medications are mostly acrid and dry, so teaching people not to treat vomiting of pus reflects the caution against using acrid-dry agents." Since acrid-dry agents are prohibited, treatment should employ acrid-cool herbs to open stagnation, bitter-draining herbs to discharge pus, and sweet-cold herbs to nourish healthy Qi. Once the pus is cleared, vomiting stops naturally. Paiming Decoction (Paiming Tang) with modifications can be used.
Passing the Meridian Without Resolution
Four methods, appended after the Three Yin meridians (supplemented according to Shu Chongyuan's edition)
1. In Taiyang disease, if more than ten days have passed since onset, and the patient was mistakenly purged two or three times, and after another four or five days, the Chaihu Syndrome remains, administer Xiaochaihu Decoction (Xiaochaihu Tang) first. If vomiting continues incessantly, there is a sense of urgency and distress in the epigastrium, and mild irritability and depression exist, indicating the pathogen has not yet resolved. Administer Dachaihu Decoction (Dachaihu Tang) to purge, and the patient will recover. Original Text 103
② Passing the meridian: Here implies the transmission of the disease to another meridian.
③ Urgency in the epigastrium: A feeling of tightness or distress in the stomach region.
④ Depression: Describes a state of mental frustration or stifled feeling.
Commentary by Zheng: Regarding Taiyang disease passing the meridian without resolution, extending to over ten days, if mistakenly purged two or three times, only when the pathogen remains in the Taiyang meridian can it be called "passing the meridian without resolution." If it is a Chaihu syndrome, and after ten days the pathogen remains in the Shaoyang meridian, only then can it be described as passing the meridian without resolution. The condition described here—"incessant vomiting, urgency in the epigastrium, mild irritability and depression"—is actually a manifestation of failure of the Taiyin Spleen to transport and transform, with Yin pathogens rebelling upward. To claim that Chaihu syndrome persists solely based on vomiting is inappropriate.
Only when chills and fever alternate, bitter taste, deafness, and preference for vomiting are all present should Xiaochaihu Decoction be used appropriately, rather than acting hastily.
[Explanation] There are four clauses regarding "passing the meridian without resolution," recorded in the Taiyang section in other texts. Shu Chongyuan appended these four clauses after the Three Yin meridians, which Zheng followed. In Taiyang disease, if unresolved after ten days, it may be a Guizhi Tang syndrome or a Mahuang Tang syndrome; neither warrants purgation. Since the pathogen remains in Taiyang, it is termed "passing the meridian without resolution." Zheng’s differentiation of this concept differs from other commentators’ literal interpretations and shows insight. However, regarding the claim that "incessant vomiting, urgency in the epigastrium, and mild irritability" are signs of Taiyin Spleen failure and Yin rebellion, Dachaihu Decoction should not be used. The method should be warming the middle, directing rebellious Qi downward, and dispersing pathogens, using Lizhong Decoction (Lizhong Tang) with Amomum fruit (Sharen) and Pinellia tuber (Banxia).
Dachaihu Decoction Formula (Supplemented)
Bupleurum root (Chaihu) half jin, Scutellaria root (Huangqin) three liang, White peony root (Shaoyao) three liang, Pinellia tuber (Banxia) half sheng (washed), Fresh ginger (Shengjiang) five liang (sliced), Jujube (Dazao) twelve pieces (broken), Immature bitter orange (Zhishi) four liang (roasted). These seven ingredients are boiled in 12 sheng of water to obtain 6 sheng. Strain and decoct again. Take 1 sheng warm, three times daily. Another version adds Rhubarb (Dahuang) two liang. Without Rhubarb, it might not be considered true Dachaihu Decoction.
① Rhubarb: Ge Hong’s *Zhouhou Beiji Fang* records that Dachaihu Decoction always includes two liang of Rhubarb; this should be followed.
[Formula Analysis and Scope of Application] This formula uses the acrid nature of Bupleurum, Pinellia, and Fresh Ginger to release the exterior, and the bitter nature of Scutellaria, White Peony, Immature Bitter Orange, and Rhubarb to clear interior heat. It is a formula that resolves both exterior and interior. Without Rhubarb, how could the original text state that purging with Dachaihu Decoction leads to recovery?
2. In Taiyang disease, if more than ten days have passed, the patient feels nauseous and wants to vomit, has chest pain, loose stools, slight abdominal fullness, and mild irritability. Prior to this, the patient had undergone extreme vomiting or purging. Administer Tiaowei Chengqi Decoction (Tiaowei Chengqi Tang). If this is not the case, do not administer it. If there is only desire to vomit, chest pain, and slightly loose stools, this is not a Chaihu Tang syndrome; due to vomiting, we know it resulted from prior extreme vomiting or purging. Original Text 123
② Nausea (Wenwen): Same as "Yunyun," describing a state of inner discomfort or nausea.
③ Extreme vomiting/purging: Refers to drastic emetic or cathartic treatments.
Commentary by Zheng: In Taiyang disease passing the meridian for over ten days, the presented conditions are signs of deficient healthy Qi. Why? Nausea indicates failure of the Middle Jiao to transport and Yin pathogen stagnation. Loose stools with slight fullness indicate cold-dampness permeating the Middle Jiao. Mild irritability indicates blocked flow of healthy Qi. All these result from improper use of vomiting or purging methods.
[Explanation] Various commentaries on this clause are contentious and difficult to follow. Only Zheng offered an independent view: "The conditions appearing after Taiyang disease passes the meridian for over ten days are signs of deficient healthy Qi." These arise from improper vomiting or purging. Neither is a Chaihu syndrome nor treatable by Tiaowei Chengqi Decoction. The symptoms reflect internal organ deficiency-cold, injury from vomiting/purging, inherent weakness of Middle Qi, or pervasive cold-dampness. The method should be warming the middle, dispelling cold, and removing dampness, using Lizhong Decoction (Lizhong Tang) with Amomum fruit (Sharen), Pinellia tuber (Banxia), and Poria (Fuling).
3. Cold damage for thirteen days unresolved, with chest and hypochondriac fullness and vomiting, tidal fever in the late afternoon, followed by slight diarrhea. This was originally a Chaihu syndrome. The physician mistakenly purged without achieving bowel movement. Now, diarrhea occurs instead, indicating the physician used pill-based purgatives, which was incorrect treatment. Tidal fever indicates interior excess. First, administer Xiaochaihu Decoction (Xiaochaihu Tang) to resolve the exterior; subsequently, treat with Chaihu Jia Mangxiao Decoction (Chaihu Jia Mangxiao Tang). Original Text 104
Commentary by Zheng: The chest and hypochondrium are the domain of the Liver and Gallbladder. Vomiting indicates pathogenic stagnation. Tidal fever with slight diarrhea indicates existing heat; this is a typical Chaihu syndrome. Purging was inherently incorrect. Scholars should adapt treatment to the situation. One should not rigidly adhere to the formulas in the original text.
[Explanation] Chest/hypochondriac fullness, vomiting, and tidal fever indicate a Shaoyang syndrome combined with Yangming interior excess. Thus, Zheng stated: "Purging was inherently incorrect." Since interior excess is present, stools should be constipated; the occurrence of diarrhea is due to erroneous use of pill-purgatives. Despite slight diarrhea, the Chaihu syndrome persists. Tidal fever signifies interior excess. Therefore, Xiaochaihu Decoction is used first to resolve the exterior, followed by Chaihu Jia Mangxiao Decoction to address the interior excess simultaneously. Zheng also noted: "One should not rigidly adhere to the original formulas," demonstrating the flexibility of clinical application.
Chaihu Jia Mangxiao Decoction Formula (Supplemented)
Bupleurum root (Chaihu) 2 liang 16 zhu, Scutellaria root (Huangqin) 1 liang, Ginseng (Renshen) 1 liang, Licorice root (Gancao) 1 liang (roasted), Fresh ginger (Shengjiang) 1 liang (sliced), Pinellia tuber (Banxia) 20 zhu (originally said 20 zhu 5 pieces, washed), Jujube (Dazao) 4 pieces (broken), Mirabilite (Mangxiao) 2 liang. These eight ingredients are boiled in 4 sheng of water to obtain 2 sheng. Strain, add Mirabilite, boil until slightly bubbling. Divide into two warm doses. If unresolved, prepare another dose.
[Formula Analysis and Scope of Application] This is a formula treating both Shaoyang and Yangming, harmonizing and clearing the interior. It treats Xiaochaihu Tang syndrome complicated by Stomach excess-heat.
Although there is slight diarrhea, dry impaction remains. Adding Mirabilite drains heat and softens hardness, resolving Stomach excess and stopping tidal fever and slight diarrhea. This formula is suitable for cases where Shaoyang and Yangming syndromes are milder than those in Dachaihu Decoction indications. It can be extended to Xiaochaihu Tang syndrome with hard abdominal masses and distension, or with tidal fever and constipation. This utilizes the salty-cold property of Mirabilite to moisten dryness and soften hardness.
4. Cold damage for thirteen days unresolved, passing the meridian, with delirium (Zhanyu) due to heat. One should use decoctions to purge. If urination is free, stools should be hard, but diarrhea occurs instead, and the pulse is harmonious. This indicates the physician used pill-purgatives, which was incorrect. If the patient self-induced diarrhea, the pulse should be faint or accompanied by cold extremities. Now, the pulse is harmonious, indicating interior excess. Treat with Tiaowei Chengqi Decoction (Tiaowei Chengqi Tang). Original Text 105
① Passing the meridian: Here means the disease has left the Taiyang meridian.
Commentary by Zheng: Delirium attributed to interior heat justifies purging. Free urination and defecation indicate unobstructed interior Qi. Harmonious pulse indicates smooth Qi mechanism. Claiming that pill-purgatives were incorrect is not a sound argument. Furthermore, self-induced diarrhea should present with faint pulse and cold extremities, signs of deficiency. A harmonious pulse indicates healthy Qi is not severely deficient. How can the original text conclude interior excess requiring purging? This is not a sound argument and certainly not words of Zhang Zhongjing.
[Explanation] Most past commentators merely explained the text literally, finding it vague. Zheng questioned the original text, differing from previous annotators. He rejected both the first part ("Cold damage for thirteen days... physician used pill-purgatives incorrectly") and the second part ("If self-induced diarrhea... interior excess, should purge") as unsound arguments, concluding they were not spoken by Zhang Zhongjing. Zheng argued that "passing the meridian without resolution" is not necessarily accurate; Taiyang disease can persist for ten days in Taiyang, and Yangming disease can remain unresolved for ten days despite purging. One should not be bound by timeframes but must focus on accurate syndrome differentiation and distinguishing deficiency from excess.
[Explanation] Zheng’s commentary summarizes the preceding four sections. Although termed "passing the meridian," the disease remains within the Six Meridians. Differentiate which meridian is affected and apply the corresponding treatment method accordingly. There is no need for a specific "passing the meridian" method.
Post-Illness Labor Relapse
Five methods (supplemented according to Shu Chongyuan's edition)
1. After a major illness resolves, if relapse occurs due to labor/overexertion, treat with Zhishi Zhizi Chi Decoction (Zhishi Zhizi Chi Tang). (If there is retained food, add Rhubarb, size of five or six chess pieces). Original Text 393
② Major illness: *Zhubing Yuanhou Lun* states: "Major illnesses include wind-stroke, cold damage, heat-labor, and warm malaria."
③ Labor relapse: Relapse of disease after recent recovery due to exertion.
④ "If retained food... five or six pieces": Added according to Cheng Wuji’s edition. Other texts place these sixteen characters after the Zhishi Zhizi Chi Tang formula.
Commentary by Zheng: After a major illness, slight exertion causes relapse to the initial state due to weak Yuan Qi. Treatment should not follow previous methods. If this is truly a labor relapse, which organ is damaged and which meridian is involved? Post-recovery relapse upon slight exertion requires treatment based on the affected organ and meridian. The formula in the original text is likely inaccurate and may cause oversight.
[Explanation] Immediately after a major illness, True Yuan is greatly depleted, and Qi and Blood have not recovered. Overexertion may cause the old disease to recur identically to before, warranting the previous medication; this is a fixed principle. Zheng stated: "Relapse to the initial state is due to weak Yuan Qi; do not treat as before." This is contradictory. Overexertion may cause recurrence of the old disease or new external contraction; treatment must follow symptom differentiation. Thus, Zheng’s skepticism about the original formula is correct.
Zhishi Zhizi Chi Decoction Formula (Supplemented)
Immature bitter orange (Zhishi) 3 pieces (roasted), Gardenia (Zhizi) 14 pieces (broken), Fermented soybean (Chi) 1 sheng (wrapped in silk). These three ingredients are boiled in 7 sheng of Qingjiangshui (clear fermented rice water)① alone until reduced to 4 sheng. Add Zhishi and Zhizi, boil to 2 sheng. Add Chi, boil for 5-6 boils. Strain. Take warm, divided into two doses, inducing slight sweating. If retained food exists, add Rhubarb size of 5-6 chess pieces②. Cure follows.
① Qingjiangshui: Xu Lingtai said: Jiangshui is rice-washing water, best when stored long and sour.
② Size of chess pieces: *Qianjin Fang* states chess piece size is like a square-inch spoon.
[Formula Analysis and Scope of Application] For post-illness labor relapse with floating heat, Zhishi regulates Qi and directs it downward; Zhizi drains heat and relieves irritability; Chi releases stale heat and resolves the exterior. Boiling with Jiangshui opens the Stomach and harmonizes the Middle. The formula drains heat, relieves irritability, and harmonizes the exterior and interior. If complicated by retained food, adding Rhubarb purges the intestines and stomach, eliminating pathogens so healthy Qi can settle.
2. After cold damage resolves, if fever recurs, treat with Xiaochaihu Decoction (Xiaochaihu Tang). If the pulse is floating, resolve with sweating; if deep and excess, resolve with purging. Original Text 394
Commentary by Zheng: If the illness is declared resolved, why does fever recur? Without Chaihu syndrome signs, how can Xiaochaihu Tang be indicated? Even with floating, deep, or excess pulses, one must determine the location and meridian to decide between releasing the exterior or purging. General statements are not accurate conclusions.
[Explanation] After cold damage resolves, major pathogens are gone. Recurrent fever indicates disharmony between exterior and interior. The pulse should be slightly wiry, accompanied by bitter taste, dry throat, and chest/hypochondriac fullness. Otherwise, Xiaochaihu Tang is inappropriate. Sweating or purging must also be determined by specific location, meridian, and symptoms. Zheng correctly stated: "General statements are not accurate conclusions."
3. After a major illness resolves, if edema/water accumulation occurs below the waist, treat with Muli Zexie San (Muli Zexie Powder). Original Text 395
Commentary by Zheng: Post-major illness edema below the waist implicates the Kidney rather than the Taiyang. The root of Taiyang is Shaoyin. When Taiyang disease ends, Shaoyin Kidney Qi leaks outward, causing lower body edema. The method should be warming the Kidney and securing essence. Muli Zexie San is merely a diuretic method and seems unsound.
[Explanation] The original text is brief; other symptoms must be combined to determine the nature of water accumulation and suitability for Muli Zexie San. If Lower Jiao Qi transformation fails, damp-heat stagnates, and the Bladder does not drain, water flows downward, accumulating below the waist, causing swelling of knees, shins, and feet. This is an excess pathogen; the pulse must be deep, rapid, and forceful, with difficulty in urination and defecation. Only then can this draining formula be used. If Spleen-Stomach Qi is deficient, failing to raise clear and descend turbid, or Kidney Qi is scattered with failed Bladder transformation, causing flooding edema, Muli Zexie San is absolutely contraindicated. As Zheng said: "Warm the Kidney and secure essence." Combine with Qi-transforming herbs, using Sini Decoction (Sini Tang) with Cinnamon bark (Rougui), Amomum fruit (Sharen), White cardamom (Baiko), and Psoralea seed (Poguzhi).
Muli Zexie San Formula (Supplemented)
Oyster shell (Muli) (roasted), Alisma root (Zexie), Patrinia root (Shuqi) (washed with warm water to remove fishy smell), Lepidium seed (Tinglizi) (roasted), Phytolacca root (Shanglu) (roasted), Seaweed (Haizao) (washed to remove saltiness), Trichosanthes root (Gualougen) in equal parts. Seven ingredients. Process separately, grind into powder, sieve, and mix thoroughly in a mortar. Take one fangcunbi with white rice water, three times daily. Stop when urination increases.
[Formula Analysis and Scope of Application] Oyster shell softens hardness and moves water; Alisma promotes dampness drainage; Patrinia removes phlegm and drives out water; Lepidium diffuses Lung Qi to drain water; Phytolacca and Seaweed specifically moisten and guide water downward. Together, they expel water via urine. Trichosanthes root stops thirst and generates fluids, acting as an antagonist to prevent fluid depletion during water expulsion. This formula is for patients with strong constitution; edema resolves quickly. For post-illness Earth deficiency failing to control water, or Kidney deficiency failing to move water, it is contraindicated.
4. After a major illness resolves, if the patient frequently spits saliva①, lingering indefinitely②, due to cold above the chest (Stomach), treat with pills to warm, preferably Lizhong Wan (Lizhong Pill). Original Text 396
① Frequent spitting: Constant production of saliva.
② Lingering indefinitely: Continuing without end.
Commentary by Zheng: Post-illness frequent spitting indicates residual cold-dampness in the Middle Jiao. Cold-damp rebelling upward prevents descent, causing continuous spitting. The method must be warming the middle and directing rebellious Qi downward.
[Explanation] Zheng’s analysis is correct; the method is warming the middle and directing rebellious Qi downward. The author modified Lizhong Wan into a decoction, adding Amomum fruit (Sharen) and Pinellia tuber (Banxia) to enhance efficacy. Mild cases resolved in 1-2 doses; severe cases in 5-6 doses.
Lizhong Wan Formula (Supplemented)
Ginseng (Renshen), Dried ginger (Ganjiang), Licorice root (Gancao) (roasted), Atractylodes macrocephala (Baizhu) each 3 liang. Four ingredients. Grind, sieve, mix with honey to form pills the size of chicken egg yolks. Dissolve one pill in a few ounces of boiling water, crush, and take warm. Take 3-4 times daily, 2 times at night. If abdomen does not feel warm, increase to 3-4 pills. However, decoction is superior. Decoction method: Cut four ingredients according to dosage, boil in 8 sheng of water to obtain 3 sheng. Strain, take 1 sheng warm, three times daily. If pulsation above the umbilicus (Kidney Qi moving), remove Baizhu, add Cinnamon (Guizhi) 4 liang. If vomiting is frequent, remove Baizhu, add Fresh Ginger (Shengjiang) 3 liang. If diarrhea is frequent, retain Baizhu. If palpitations occur, add Poria (Fuling) 2 liang. If thirsty for water, increase Baizhu to total 4.5 liang. If abdominal pain, increase Renshen to total 4.5 liang. If cold, increase Ganjiang to total 4.5 liang. If abdominal fullness, remove Baizhu, add Aconite (Fuzi) 1 piece. After taking decoction, drink about 1 sheng of hot porridge, keep warm, and avoid uncovering clothes/blankets.