【闡釋】本條從小便之利與不利，以辨別水停的部位。飲水多，小便利者，心下胃脘部築築而動，此水停中焦所致，可用茯苓甘草湯治療。飲水多，小便不利者，少腹急急迫，是水停下焦之故，可用豬苓湯治之。
四十二、大下之後，複發汗，小便不利〔者〕，亡津液故也，勿治之；〔得〕小便利，必自愈。凡病若④發汗、若吐、若下、若亡血⑤、亡津液，陰陽自和者，必自愈。原文59、58
④若：應作“或”字解。
⑤亡：應作“喪失”解。
鄭論：據所言汗、吐、下，以致亡血，亡津液，只要其人無甚大苦，可以勿藥，俟正氣來複，必自愈。明明教人不可妄用藥，誤用藥，恐生他變也。
【闡釋】此條在《傷寒論》中為兩條。“大下之後，……必自愈。”按此節乃下後複汗，俟其自愈之證也。“勿治之”三字，諸家皆謂不可用利藥。惟大下之“大”字，均未注明，所謂大下者，即用大承氣法是也。蓋大承氣直瀉君相二火，既傷津液中之陽，複發汗又傷津液中之陰，此小便所以不利也，亦必待其陰陽自和，斯小便得利，而自愈矣，“凡病若發汗，……必自愈”。按此節乃諸治後自愈之總綱也。陰陽自和者，即不能再用汗、吐、下之法，但當調其陰陽，則未盡之邪，從外解者，必自汗而解；從上解者，必自吐而解；從下解者，必自利而解。此即陰陽和，必自愈之真諦也。誠如鄭氏所言；“教人不可妄用藥、誤用藥、恐生他變也。”
四十三、太陽病，〔先〕下之而不愈，因複發汗，〔以此〕表裏俱虛，其〔人〕因致冒，冒家汗出自愈①，所以然者，汗出表和故也，（待）裏未和，然後〔複〕下之。原文93
①冒家：指頭昏目眩的病人。
鄭論：據下後複發汗，以致表裏俱虛，其傷正也太甚，虛則易於感冒，此理之常，此刻應於補正藥中，加解表之品，必自愈。推其故，汗出表和，待裏未和，然後下之，待字不可忽略，實有斟酌可否之意，學者宜細求之。
【闡釋】太陽病本不應下，先行誤下，裏氣先虛；又複發汗，表氣再虛。
則病者發生頭目昏冒，若正氣旺，必大汗出，汗出表和則自愈。否則應如鄭氏所說，於補正藥中加解表之品，如理中湯加蘇葉、防風等，則自愈。若裏未和，可酌用調胃承氣湯以下之，方為正治。
四十四、太陽病未解，脈陰陽俱停②，必先振栗汗出而解。但陽脈微者③，先汗出而解；但陰脈微者④，下之而解。（而解）若欲下之，宜調胃承氣湯。原文94
②脈陰陽俱停。陰陽作尺寸解，停是停止，脈陰陽俱停是尺寸的脈搏均隱伏而診之得。
③陽脈微：是指寸部脈，微見搏動。
④陰脈微：是指尺部脈，微見搏動。
鄭論：按太陽病，當未解之先，而有此陰陽俱停之脈，便見振栗汗出者，是邪由戰汗而解也。條中提出陽脈微者，汗之而解，陰脈微者，下之而解。余謂陽脈微者，表分之陽不足也，法宜輔正以祛之；陰脈微者，裏分之陰不足也，只當溫裏以祛之。何得雲汗之而解？下之而解？如果宜汗宜下，務要有汗下實據方可，若只憑一脈而定為可汗可下，況脈已雲微，亦非可汗可下之例，學者亦〔不〕必執原文為不可易之法也。
【闡釋】太陽病未解，其脈一定呈現浮緩或浮緊，此則謂脈陰陽俱停為不通，停應是微字之誤，觀下文陽脈微、陰脈微可知。應是營衛之氣，被邪遏阻，正邪互爭戰汗前的暫時現象，與正氣將絕的停脈，應該作出嚴格的區別。鄭氏雲：“陽脈微者，表分之陽不足也，法宜輔正以祛之；陰脈微者，裏分之陰不足也，只當溫裏以祛之”。是有見地的。況此病在太陽，不在陽明，總不宜下，其理甚明，何得雲陰脈微者下之而愈。則原文所雲若欲下之，宜調胃承氣湯為不可通。故鄭氏又雲；“學者亦不必執原文為不可易之法也”。調胃承氣湯方解，見後陽明上篇。
四十五、太陽中風，下利嘔逆，表解者，乃可攻之。其人漐漐汗出，發作有時，頭痛，心下痞鞕滿，引脅下痛，幹嘔短氣，汗出不惡寒者，此表〔解〕裏未和也，十棗湯主之。原文152
鄭論：按中風而見下利嘔逆，（夫下利嘔逆）其病似不在太陽，而在太陰也。太陰受傷，轉輸失職，不能分運水濕之氣，以致水氣泛溢，上行於皮膚，故見漐漐汗出，水停心下，故見痞鞕，水流於脅，故見脅痛，至於頭痛、幹嘔、短氣，種種病形，皆是一水氣之所致也，主以十棗湯，取大棗以培土去濕，濕去而諸症自釋。原文直指太陽，蓋太陽為一身之綱領，主皮膚，統營衛、臟腑，百脈、經絡，主寒水，司冬令，行水氣，外從皮膚毛竅而出，內自小便而出，氣化不乖，水行無滯，往來灌溉，何病之有？今為風邪所中，阻滯氣機，氣化不宣，水逆於上而為嘔，水逆於下而為利，水流于左而脅痛生，水逆於心而鞕痞作，水發於上而現頭痛，水阻於中，上下往來之氣不暢，而短氣立至，此刻水氣彌漫，表裏焉得自和，主以十棗湯，直決其水，恐水去而正不支，故取棗之甘以補正，庶不致害。前所論主在太陰者，以吐利乃太陰之提綱說法也；後所論為太陽者，本篇之大旨也。所論雖未盡當，亦可開後學之心思也，高明正之。
【闡釋】發熱、惡風、有汗、脈浮緩者為中風，今見下利、嘔逆證狀，則為並病證可知矣。並病而挾水飲，似宜以逐水之劑攻之，然必待表解而後可攻。飲為有形之邪，停結於胸脅之間，所以心下痞，鞕滿，牽引脅部疼痛，飲邪上迫於肺，氣機受阻，所以呼吸短促，飲邪外走皮膚，所以微微出汗，由於正與邪爭，所以發作有時，水邪犯胃則幹嘔，上攻則頭痛，下趨則下利。這些都是水飲內結，水氣攻竄而上下充斥，內外泛溢所致。它是屬於水飲內結的實證，故用十棗湯峻逐其水邪。原文中指出表解者乃可攻之，如表未解而攻之，則表邪內陷更增他變。
鄭氏謂：“論在太陰者，以吐利乃太陰之提綱說法也；論在太陽者，本篇之大旨也。”所論雖未盡當，亦可開後學之心思也。”此示人辨證應從各個方面來診斷，不可以偏概全。
十棗湯方（校補）
蕪花（熬）甘遂大戟上三味，等分，各別搗為散，以水一升半，先煮大棗肥者十枚，取八合，去滓，內藥末，強人服一錢匕，贏人服半錢，溫服之，平旦服。若下少，病不除者，明日更服，加半錢，得快下利後，糜粥自養。
【方解及其應用範圍】關於十棗湯，乃決堤行水之第一方也。大戟、甘遂、芫花，性味辛苦而寒，三味都是峻瀉水飲的猛藥，用之適當，其效極捷。但峻瀉之後，影響脾胃正氣，所以選用大棗為君，一以顧其脾胃，一以緩其峻毒，得快利後，糜粥自養，一以使穀氣內充，一以使邪不復作，此仲景用毒攻病之法，盡美又盡善也。《金匱·痰飲篇》飲後水流脅下，咳唾引痛的懸飲證，雖然與本條不盡相同，但病的性質是一致的，二者皆是水飲結聚於脅下，都採用攻逐水飲的十棗湯治療。筆者曾治一馮姓農民病人，腹大如鼓，能聽見水響，用峻劑十棗湯一服而解大、小便半桶，腹鼓脹頓失，繼服參附湯善其後。現今推廣用之以治水腫病、單腹脹之腹滿腸鳴、肝硬化腹水等都有療效。
四十六、太陽病二三日，不能臥，但欲起，心下必結，脈微弱者，此本有寒分也①，反下之，若利止，必作結胸，未止者，四日複下之，此作協（勢）〔熱〕利也②。原文139
①寒分：指痰飲也。以痰飲本寒，故曰寒分。
②協熱利：指表熱而下利。
鄭論：按二三日，係陽明少陽主氣之候，或經或腑，總有一定病情，此並未有二陽經腑證形足征，但雲不能臥，但欲起者，是陰陽不交，而神不安也。心下必結者，胸中之陽不宣也。所稱脈微弱，而曰本有寒分，明是正氣之不足，無熱邪之內擾，亦可概見。醫反下之，大失其旨，若利止必結胸，是由下傷中宮之陽，不能鎮下焦濁陰之氣，以致上僭而為逆，未止者複下之，是果何所見而必當下耶？又未見有裏熱足征，而斷為協熱利耶？總之，原文所論，可見醫家之咎。
【闡釋】鄭氏之按，與歷代注家不同，其諸種證狀，總由陰陽不交，胸中之陽不宣，正氣之不足，下傷中宮之陽，是有見地的。法當溫中逐飲，而不應攻下。但醫者診斷不明，見到心下痞結，以為裏有結實，妄用攻下，勢必引起下利，如正氣尚盛，則利當自止。但表熱因下而內陷，與痰水互結，則為結胸；如正氣較虛，誤下後挾表熱而下利水止，則為協熱下利。故鄭氏歸結為“原文所論，可見醫家之咎。”此證雖未出方治，但當溫中逐飲，兼解表邪，小青龍湯為對症之方，則可免結胸與協熱利之患矣。
四十七、病發于陽，而反下之，熱入（必）〔因〕作結胸；病發于陰，而反下之，因作痞〔也〕①。所以（然者）〔成結胸者〕，〔以〕下之太早故也。原文131前段
鄭論：按病發于陽，指太陽表分受病也。病發于陰，指少陰裏分受病也。二者皆非可下之證，結胸與痞，皆由誤下之過，亦非下早之過。總之，醫之過也。
①痞：證候名，主要症狀是心下痞塞，按之柔軟不痛，亦有痞鞕者，但並無痛感。
【闡釋】歷代注家對“病發于陽”、“病發于陰”的見解不一。鄭氏指出“病發于陽”是指太陽表分受病；“病發于陰”是指少陰裏分受病。無論太陽、少陰都不可下，結胸證是有形而邪實，故心下滿而痛；而痞證是無形而邪虛，所以但覺痞悶而不痛。結胸與痞，皆由誤下之過，並非早下之過。總由醫者診斷不明之過也。
四十八、太陽病，脈浮而動數，浮則為風，數則為熱，動則為痛，（散）〔數〕則為虛，頭痛發熱，微盜汗出，而反惡寒者，表未解也。醫反下之，動數變遲，（胸）〔膈〕內拒痛，胃中空虛，客氣②動膈，（氣短燥）〔短氣躁〕煩，心中懊憹③，陽氣內陷，心下因鞕，則為結胸，大陷胸湯主之。若不結胸，但頭汗出，餘〔處〕無汗，劑頸而還①，小便不利，身必發黃。原文134
②客氣：就是邪氣，因從外來，故叫客氣。
③憹：音náo（撓）。陽氣：這裏指表邪而言，不是指正氣。
①劑頸而還：劑同齊，謂汗出到頸部而止。
鄭論：按太陽既稱脈浮數動，以及惡寒表未解句，明言風熱之邪尚在，其病究竟未當下時，而醫即下之，動數浮大之脈，忽變為遲，是陽邪（便）〔變〕為陰邪也明甚。陰邪盤據中宮，故見膈內拒痛，胃中既因下而空虛，故短氣懊憹，心煩、鞕滿之症作。此刻滿腔全是純陰用事，陰氣閉塞，理應溫中化氣，則所理諸證自能潛消，茲以大陷胸湯主之。夫陷胸湯，乃硝、黃、甘遂苦寒已極之品，是為熱結於心下者宜之，若浮數變遲，中虛之候用之，實為大不恰切。又曰若不結胸，但頭汗出劑頸而還，小便不利，身必發黃。夫發黃之候，原是陽明熱邪遏鬱所致，此但以小便不利，頭汗出，而斷為必發黃，亦未必盡如斯言，學者當以病形、脈息、聲音、有神無神各處求之，便得其要也。
【闡釋】太陽病表邪未解，誤用下法，有兩種轉歸，一為結胸，一為發黃。鄭氏所釋，有特別見解：“此結胸非熱結，乃陰邪盤據中宮，滿腔全是純陰用事，陰邪閉塞，則大陷胸湯治之為不當”。而曰：“應溫中化氣，則所現諸證自能潛消。”筆者認為可選用附子理中湯加砂仁、半夏、安桂，溫中補氣，祛陰散結。若誤下未成結胸，……身必發黃，未必儘是如此，應如鄭氏所說：“當以病形、脈息、聲音、有神無神各處求之，便得其要也”。
大陷胸湯方（校補）
大黃六兩（去皮）芒硝一升甘遂一錢匕上三味，以水六升，先煮大黃，取二升，內芒硝，煮一兩沸，內甘遂末，溫服一升，得快利，止後服。
【方解及其應用範圍】本方以甘遂為君，味苦寒，既能泄熱，又能逐水破結；芒硝鹹寒軟堅，鹹味下泄為陰，熱勝者以寒消之；大黃味苦寒，蕩滌邪熱，推陳致新。本方與大承氣湯同用硝、黃，所不同者，一用甘遂，一用枳、樸，大承氣專主腸中燥糞，大陷胸並主心下水濕。燥屎在腸，必借推逐之力，故須枳、樸；水濕在胃，必兼破飲之長，故用甘遂。本方較大承氣為猛峻，非脈證俱實者不可輕用。現今推廣應用於腸梗阻亦有效。
四十九、太陽病，重發汗而複下之，不大便五六日，舌上燥而渴，日晡（時）所小有潮熱①，從心（上）〔下〕至少腹鞕滿而痛，不可近者，大陷胸湯主之。原文137
①日晡所：晡，午後三時至五時。所：不定之詞，表約數。
鄭論：按重發汗，亦是表而再表之義，再表而邪不去，故複下之，又不大便五六日，邪既不由表解，又不由裏解，固結於中，竟有負隅之勢，所現一派病情，非陷胸湯決不能拔，原文主之，深得其旨。
【闡釋】太陽病誤汗誤下後，如內無水飲，僅是燥糞內結，此為陽明腑證，可用大承氣湯下之；如內有水飲，熱與水結，則為結胸，從心下至少腹鞕滿而痛，則非大陷胸湯不能治之。徐靈胎說：“大承氣所下者燥糞，大陷胸所下者蓄水，小陷胸所下者黃涎。”乃其經驗之言。故鄭氏說：“原文主之，深得其旨”。
五十、結胸者，項亦強，如柔痙狀②，下之則和，宜大陷胸丸。原文131後段
[Explanation] This clause distinguishes the location of water retention by examining whether urination is free or obstructed. If excessive drinking is followed by free urination, and palpitations are felt in the epigastrium (stomach region), this indicates water retention in the Middle Jiao (Middle Burner), which can be treated with Fuling Gancao Tang (Poria and Licorice Decoction). If excessive drinking is followed by obstructed urination, and a sense of urgency and tightness is felt in the lower abdomen, this indicates water retention in the Lower Jiao (Lower Burner), which can be treated with Zhuling Tang (Polyporus Decoction).
Forty-Two: After severe purgation, followed by sweating, if urination becomes obstructed, it is due to the depletion of body fluids; do not treat it forcibly. Wait for urination to become free naturally, and the disease will surely heal itself. In any disease, if after sweating, vomiting, purgation, blood loss, or fluid depletion, Yin and Yang achieve self-harmony, the disease will surely heal itself. Original Text 59, 58
④ Ruo: Should be interpreted as "huo" (or/sometimes).
⑤ Wang: Should be interpreted as "loss" or "depletion".
Zheng's Commentary: Based on the description that sweating, vomiting, and purgation lead to blood loss and fluid depletion, as long as the patient does not suffer greatly, medication may be withheld. Waiting for the healthy Qi to recover, the disease will surely heal itself. This clearly teaches people not to use medications recklessly or incorrectly, lest other complications arise.
[Explanation] This passage actually comprises two clauses in the *Shanghan Lun*. "After severe purgation... will surely heal itself." According to this section, it refers to a condition where sweating follows purgation, awaiting spontaneous healing. The three characters "do not treat it" are interpreted by various scholars as meaning diuretic drugs should not be used. The character "severe" in "severe purgation" is not explicitly noted; what is meant by severe purgation is the use of Dachengqi Tang (Major Order the Qi Decoction). Since Dachengqi Tang directly drains the Ministerial Fire and Sovereign Fire, it first damages the Yang within the body fluids, and subsequent sweating further damages the Yin within the body fluids; this is why urination is obstructed. It is necessary to wait for Yin and Yang to harmonize themselves before urination becomes free and healing occurs. "In any disease, if sweating... will surely heal itself." This section serves as the general principle for spontaneous healing after various treatments. "Yin and Yang achieving self-harmony" means that sweating, vomiting, and purgation methods should no longer be used; instead, one should only regulate Yin and Yang. Any remaining pathogenic factors will resolve from the exterior through sweating, from the upper jiao through vomiting, or from the lower jiao through diarrhea. This is the true essence of Yin-Yang harmony leading to spontaneous healing. As Zheng stated: "Teaching people not to use medicines recklessly or incorrectly, fearing other complications."
Forty-Three: In Taiyang disease, if purgation is performed first without resolution, and then sweating is induced again, resulting in deficiency of both the Exterior and Interior, the patient may develop dizziness (mao). Patients with dizziness will heal through sweating. The reason for this is that sweating harmonizes the Exterior. (Wait until) the Interior is harmonized, and then perform purgation again. Original Text 93
① Maojia: Refers to patients suffering from dizziness and vertigo.
Zheng's Commentary: Based on purgation followed by sweating, leading to deficiency of both Exterior and Interior, the damage to healthy Qi is too severe. Deficiency makes one susceptible to external pathogens, which is normal logic. At this moment, one should add exterior-resolving herbs to tonifying formulas, and the disease will surely heal. Analyzing the cause, sweating harmonizes the Exterior; waiting for the Interior to be unharmonized before purging, the word "wait" cannot be ignored, implying careful consideration. Scholars should investigate this carefully.
[Explanation] Taiyang disease should not be treated with purgation. Premature purgation first weakens the Interior Qi; subsequent sweating further weakens the Exterior Qi. Consequently, the patient experiences dizziness and clouding of the senses. If healthy Qi is strong, profuse sweating will occur; once sweating harmonizes the Exterior, healing ensues. Otherwise, as Zheng suggested, exterior-resolving herbs such as Ziyey (Perilla Leaf) and Fangfeng (Saposhnikovia Root) should be added to tonifying formulas like Lizhong Tang (Regulate the Middle Decoction), leading to healing. If the Interior remains unharmonized, Tiaowei Chengqi Tang (Moderate the Stomach Order the Qi Decoction) may be appropriately used for purgation, which is the correct treatment.
Forty-Four: In Taiyang disease that has not resolved, if the pulse at the Yin and Yang positions (Cun and Chi) both disappear (ting), the patient will first experience chills and tremors, followed by sweating, and then resolve. If only the Yang pulse (Cun position) is faint, resolution comes through sweating; if only the Yin pulse (Chi position) is faint, resolution comes through purgation. (To resolve) if purgation is desired, Tiaowei Chengqi Tang (Moderate the Stomach Order the Qi Decoction) is appropriate. Original Text 94
② Mai Yin Yang Ju Ting: Yin and Yang refer to Cun and Chi positions. Ting means stopping/disappearing. "Mai Yin Yang Ju Ting" means the pulses at Cun and Chi are hidden and difficult to palpate.
③ Yang Mai Wei: Refers to the Cun pulse, showing faint movement.
④ Yin Mai Wei: Refers to the Chi pulse, showing faint movement.
Zheng's Commentary: In Taiyang disease, prior to resolution, the presence of Yin and Yang pulses disappearing, accompanied by chills and sweating, indicates resolution via battle-sweat (zhan han). The text mentions that faint Yang pulse resolves with sweating, and faint Yin pulse resolves with purgation. I believe that a faint Yang pulse indicates insufficiency of Yang in the Exterior branch, so the method should be to support healthy Qi to expel pathogens. A faint Yin pulse indicates insufficiency of Yin in the Interior branch, so one should only warm the Interior to expel pathogens. How can it be said that sweating resolves it? Or purgation resolves it? If sweating or purgation is indicated, there must be solid evidence. Relying solely on a pulse, especially a faint one, to determine suitability for sweating or purgation is incorrect. Scholars should not rigidly adhere to the original text as an immutable law.
[Explanation] In unresolved Taiyang disease, the pulse should typically present as Floating-Slow or Floating-Tight. Saying the Yin and Yang pulses disappear is inconsistent; "Ting" is likely a typo for "Wei" (faint), as seen in the subsequent text regarding faint Yang and Yin pulses. This likely represents a temporary phenomenon before battle-sweat, where Ying and Wei Qi are blocked by pathogens, causing struggle between healthy Qi and pathogens. This must be strictly distinguished from the "stopping pulse" indicating impending collapse of healthy Qi. Zheng stated: "Faint Yang pulse indicates insufficiency of Yang in the Exterior branch, suitable for supporting healthy Qi to expel pathogens; faint Yin pulse indicates insufficiency of Yin in the Interior branch, suitable for warming the Interior to expel pathogens." This is insightful. Moreover, since the disease is in Taiyang, not Yangming, purgation is generally inappropriate, which is obvious. How can it be said that faint Yin pulse resolves with purgation? Therefore, the original text's statement that "if purgation is desired, Tiaowei Chengqi Tang is appropriate" is untenable. Hence Zheng said: "Scholars should not rigidly adhere to the original text as an immutable law." For the formula explanation of Tiaowei Chengqi Tang, see the Yangming Upper Chapter later.
Forty-Five: In Taiyang Wind Strike, accompanied by diarrhea and vomiting/reversal, if the Exterior is resolved, interior attack may proceed. The patient sweats slightly, attacks occur at specific times, has headache, epigastric fullness and hardness, pain radiating to the hypochondrium, dry retching, shortness of breath, sweating without aversion to cold. This indicates the Exterior is resolved but the Interior is unharmonized; Shizao Tang (Ten Dates Decoction) is the primary treatment. Original Text 152
Zheng's Commentary: Regarding Wind Strike presenting with diarrhea and vomiting, the pathology seems to lie not in Taiyang, but in Taiyin. Taiyin injury leads to failure of transportation and transformation, inability to distribute water-dampness, causing water qi to overflow upward into the skin, hence slight sweating. Water retention in the epigastrium causes fullness and hardness; water flowing to the hypochondrium causes pain. Headache, dry retching, and shortness of breath are all caused by this single water qi. Shizao Tang is used, taking large dates to strengthen Earth and remove dampness; once dampness is removed, symptoms resolve. The original text points directly to Taiyang. Taiyang is the guideline for the whole body, governing the skin, integrating Ying and Wei, Zang-Fu, vessels, and meridians, governing Cold-Water, presiding over Winter, moving water qi. Externally, it exits through skin pores; internally, through urine. If Qi transformation is normal, water flows without stagnation, irrigating everywhere, what disease would exist? Now, struck by Wind Pathogen, Qi mechanism is blocked, Qi transformation fails. Water reverses upward causing vomiting, downward causing diarrhea, leftward causing hypochondriac pain, central causing epigastric hardness/fullness, upward manifesting as headache, middle blocking causing shortness of breath. At this moment, water qi permeates everywhere, how can Exterior and Interior harmonize? Shizao Tang directly drains the water. Fearing that draining water might overwhelm healthy Qi, sweet dates are taken to tonify healthy Qi, preventing harm. The previous discussion focusing on Taiyin is because vomiting and diarrhea are the guiding principles of Taiyin; the latter discussion focusing on Taiyang is the main theme of this chapter. Although the discussion may not be entirely accurate, it opens the minds of future students. Experts please correct.
[Explanation] Fever, aversion to wind, sweating, and Floating-Slow pulse characterize Wind Strike. Now presenting with diarrhea and vomiting, it is evident that this is a concurrent disease (Bing Bing) involving water-fluid retention. Concurrent disease with water-fluid retention seems suitable for water-draining agents, but one must wait for the Exterior to resolve before attacking. Fluid retention is a tangible pathogen, accumulating between the chest and hypochondrium, causing epigastric fullness/hardness and radiating pain. Fluid pressing on the Lung blocks Qi mechanism, causing shortness of breath. Fluid moving to the skin causes slight sweating. Due to struggle between healthy Qi and pathogens, attacks occur at specific times. Water invading the Stomach causes dry retching; attacking upward causes headache; moving downward causes diarrhea. These are all caused by internal accumulation of water-fluid, with water qi attacking upwards/downwards and overflowing internally/externally. This belongs to excess syndrome of internal water-fluid accumulation, hence Shizao Tang is used to severely drain the water pathogen. The original text states that interior attack is permissible only after Exterior resolution; if attacked while Exterior is unresolved, Exterior pathogens sink inward, causing more complications.
Zheng stated: "Discussion on Taiyin is based on vomiting/diarrhea being Taiyin's guiding principle; discussion on Taiyang is the main theme of this chapter." Although not entirely accurate, it stimulates future students. This shows that differentiation should be diagnosed from various aspects, not generalized from partial signs.
Shizao Tang Formula (Corrected/Supplemented)
Yuanhua (roasted), Gansui, Daji. These three ingredients, equal parts, each separately pounded into powder. With 1.5 sheng of water, first decoct ten plump large dates (Dazao), obtain 0.8 sheng, remove dregs, add medicine powder. Strong persons take one qianbi; weak persons take half qianbi. Take warm, on an empty stomach in the morning. If bowel movement is insufficient and disease persists, take again tomorrow, increase by half qianbi. After obtaining rapid loose stool, nourish with millet porridge.
[Formula Explanation and Scope of Application] Regarding Shizao Tang, it is the premier formula for draining water like breaking a dam. Daji, Gansui, and Yuanhua have pungent, bitter, and cold properties; all three are fierce drugs for severely draining water-fluid. When used appropriately, their effect is extremely rapid. However, after severe drainage, Spleen-Stomach healthy Qi is affected; therefore, Dazao (Large Date) is chosen as the Monarch herb, to protect the Spleen-Stomach and to moderate the fierce toxicity. After rapid loose stool, nourishing with millet porridge replenishes Gu Qi internally and prevents recurrence. This is Zhang Zhongjing's method of using toxic substances to attack disease, perfect in beauty and goodness. In *Jingui Yaolue · Tan Yin Chapter*, Xuan Yin syndrome (suspended fluid) characterized by water flowing under the hypochondrium after drinking, coughing/sputum causing pulling pain, although not identical to this clause, shares the same pathological nature. Both involve water-fluid accumulation under the hypochondrium, both treated with Shizao Tang to attack and drain water-fluid. I once treated a farmer surnamed Feng, whose abdomen was distended like a drum, with audible water sounds. One dose of the fierce agent Shizao Tang resulted in excretion of half a bucket of stool and urine; abdominal distension disappeared instantly. Subsequently, Shenfu Tang (Ginseng and Aconite Decoction) was used for recovery. Currently, it is widely promoted for treating edema, monolithic abdominal distension with borborygmus, liver cirrhosis ascites, etc., with curative effects.
Forty-Six: In Taiyang disease, two to three days later, inability to lie down, desire only to rise, epigastric binding is certain. If the pulse is faint and weak, this originally indicates Cold Branch (Phlegm-Fluid). Reversely applying purgation: if diarrhea stops, Jie Xiong (Chest Binding) will certainly form; if diarrhea does not stop, after four days, purging again will result in Xie Re Li (Collaborating Heat Diarrhea). Original Text 139
① Han Fen: Refers to Phlegm-Fluid. Since Phlegm-Fluid is inherently cold, it is called Cold Branch.
② Xie Re Li: Refers to diarrhea accompanying Exterior Heat.
Zheng's Commentary: Two to three days corresponds to the ruling Qi of Yangming and Shaoyang. Whether Meridian or Fu organ, there is always a certain pathology. Here, there is no sufficient evidence of Yangming-Shaoyang Meridian/Fu syndromes. Only saying inability to lie down and desire to rise indicates Yin-Yang non-interaction and restless Shen. Epigastric binding indicates lack of circulation of Yang in the chest. The mentioned faint-weak pulse, coupled with "originally Cold Branch," clearly indicates insufficiency of healthy Qi and absence of internal disturbing Heat Pathogen. The physician reversely applies purgation, greatly missing the point. If diarrhea stops, Chest Binding forms because purgation damages Yang of the Central Palace (Spleen/Stomach), failing to suppress turbid Yin Qi of the Lower Jiao, leading to rebellious upward movement. If diarrhea continues and purgation is applied again, what is the basis for insisting on purgation? Furthermore, lacking sufficient evidence of Interior Heat, how can Collaborating Heat Diarrhea be diagnosed? In summary, the original text reveals the fault of the physician.
[Explanation] Zheng's commentary differs from历代注家 (past commentators). His various symptoms are attributed to Yin-Yang non-interaction, lack of Yang circulation in the chest, insufficiency of healthy Qi, and damage to Central Palace Yang by purgation, which is insightful. The method should be warming the Middle and draining fluid, not attacking with purgation. However, due to unclear diagnosis, seeing epigastric binding and assuming interior solidity, reckless purgation inevitably causes diarrhea. If healthy Qi is still strong, diarrhea should stop spontaneously. But if Exterior Heat sinks inward due to purgation and binds with phlegm-water, it forms Chest Binding (Jie Xiong); if healthy Qi is relatively weak, and after mistaken purgation, Exterior Heat accompanies diarrhea stopping, it forms Collaborating Heat Diarrhea. Thus Zheng concludes: "The original text reveals the fault of the physician." Although no formula is given for this syndrome, warming the Middle, draining fluid, and resolving Exterior pathogens with Xiao Qinglong Tang (Minor Green Dragon Decoction) would be symptomatic, avoiding Chest Binding and Collaborating Heat Diarrhea.
Forty-Seven: Disease originating in Yang, reversedly purged, heat enters and certainly forms Chest Binding (Jie Xiong); disease originating in Yin, reversedly purged, consequently forms Pi (Stagnation/Fullness). The reason for forming Chest Binding is that purgation was done too early. Original Text 131 First Part
Zheng's Commentary: Disease originating in Yang refers to Taiyang Exterior branch receiving pathogen. Disease originating in Yin refers to Shaoyin Interior branch receiving pathogen. Neither is suitable for purgation. Chest Binding and Pi are both faults of mistaken purgation, not faults of purging too early. In summary, it is the physician's fault.
① Pi: Syndrome name, main symptom is epigastric obstruction/fullness, soft upon pressure without pain. There are also hard Pi cases, but still without pain sensation.
[Explanation] Past commentators have differing views on "Disease originating in Yang" and "Disease originating in Yin." Zheng pointed out that "Disease originating in Yang" refers to Taiyang Exterior branch receiving pathogen; "Disease originating in Yin" refers to Shaoyin Interior branch receiving pathogen. Neither Taiyang nor Shaoyin should be purged. Chest Binding syndrome involves tangible pathogens and excess, hence epigastric fullness and pain. Pi syndrome involves intangible pathogens and deficiency, hence only feeling obstructed/full without pain. Chest Binding and Pi are both faults of mistaken purgation, not faults of premature purgation. Ultimately, it is the fault of the physician's unclear diagnosis.
Forty-Eight: Taiyang disease, pulse Floating, Moving, and Rapid. Floating indicates Wind, Rapid indicates Heat, Moving indicates Pain, Rapid indicates Deficiency. Headache, fever, slight night sweating, yet conversely aversion to cold, indicates Exterior is not resolved. Physician reversely applies purgation. Moving-Rapid pulse changes to Slow. Internal rejection pain in the Diaphragm. Stomach becomes empty and deficient. Guest Qi disturbs the Diaphragm. Shortness of breath, irritability, mental restlessness (Ao Nao). Yang Qi sinks inward. Epigastrium becomes hard, forming Chest Binding (Jie Xiong), treated with Da Xianxiong Tang (Major Infiltrate the Chest Decoction). If not Chest Binding, but only head sweating, no sweat elsewhere, stopping at the neck, obstructed urination, the body will certainly develop Jaundice. Original Text 134
② Ke Qi: Is Pathogen Qi, called Guest Qi because it comes from outside.
③ Nao: Pronounced náo (scratch). Yang Qi: Here refers to Exterior Pathogen, not Healthy Qi.
① Ji Jing Er Huan: Ji is same as Qi (equal). Means sweating stops at the neck level.
Zheng's Commentary: Since Taiyang is described with Floating-Rapid-Moving pulse, and aversion to cold indicating Exterior not resolved, it clearly states Wind-Heat Pathogen remains. The disease definitely was not suitable for purgation, yet the physician purged. The Moving-Rapid-Floating-Large pulse suddenly changed to Slow, clearly indicating Yang Pathogen transformed into Yin Pathogen. Yin Pathogen occupies the Central Palace, hence internal rejection pain in the diaphragm. Since the stomach became empty due to purgation, shortness of breath, mental restlessness, irritability, and fullness/hardness symptoms arise. At this moment, the entire cavity is dominated by pure Yin, Yin Qi is blocked. One should warm the Middle and transform Qi, then these symptoms will subside. Using Da Xianxiong Tang here is inappropriate. Da Xianxiong Tang consists of Xiaoshi (Niter), Huanglian (Coptis - *Note: Text says Huang, usually Rhubarb/Dahuang in context of Xianxiong, but Zheng critiques its extreme bitterness/cold*), Gansui, extremely bitter and cold. It is suitable for Heat Binding in the epigastrium. If Floating-Rapid changes to Slow, indicating Middle Deficiency, using it is highly inappropriate. Also, if not Chest Binding, but only head sweating stopping at the neck, obstructed urination, leading to jaundice. Jaundice is originally caused by Yangming Heat Pathogen suppression/stagnation. Judging jaundice solely by obstructed urination and head sweating is not necessarily accurate. Scholars should seek the essence by observing disease manifestations, pulse/breath, voice, and presence/absence of Shen (Spirit) from various aspects.
[Explanation] In Taiyang disease, if Exterior Pathogen is unresolved and purgation is mistakenly used, there are two outcomes: Chest Binding or Jaundice. Zheng's interpretation offers special insight: "This Chest Binding is not Heat Binding, but Yin Pathogen occupying the Central Palace, pure Yin dominating, Yin Pathogen blocking; thus treating with Da Xianxiong Tang is inappropriate." He said: "Should warm the Middle and transform Qi, then presented symptoms will subside." I believe Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction) plus Sharen (Amomum), Banxia (Pinellia), Angui (Cinnamon Bark) could be selected to warm the Middle, tonify Qi, dispel Yin, and dissipate nodules. If mistaken purgation does not form Chest Binding... and body develops jaundice, it may not be entirely as stated. One should follow Zheng: "Seek the essence by observing disease manifestations, pulse/breath, voice, and presence/absence of Shen from various aspects."
Da Xianxiong Tang Formula (Corrected/Supplemented)
Dahuang (Rhubarb) 6 liang (peeled), Mangxiao (Niter) 1 sheng, Gansui 1 qianbi. These three ingredients, with 6 sheng of water, first decoct Dahuang, obtain 2 sheng, add Mangxiao, boil for one or two boils, add Gansui powder, take 1 sheng warm. Obtain rapid loose stool, then stop subsequent doses.
[Formula Explanation and Scope of Application] This formula takes Gansui as the Monarch herb, bitter and cold, capable of draining Heat and driving out water to break nodules. Mangxiao is salty and cold, softening hardness; salty flavor descends as Yin, Heat excess is eliminated by Cold. Dahuang is bitter and cold, sweeping away Evil Heat, eliminating old and generating new. This formula uses Xiaoshi and Dahuang like Dachengqi Tang. The difference is one uses Gansui, the other uses Zhishi and Zhiqiao. Dachengqi Tang specifically targets dry feces in the intestines; Da Xianxiong Tang targets water-dampness in the heart/epigastrium. Dry feces in the intestine require pushing force, hence Zhishi and Zhiqiao are needed. Water-dampness in the stomach requires breaking fluid capability, hence Gansui is used. This formula is fiercer than Dachengqi Tang and should not be used lightly unless both pulse and syndrome indicate excess. Currently, it is effectively promoted for intestinal obstruction.
Forty-Nine: Taiyang disease, heavy sweating followed by purgation. No bowel movement for five to six days. Tongue is dry and thirsty. Slight tidal fever at dusk (rib hour). From epigastrium to lower abdomen, hardness, fullness, and pain, intolerable to touch. Da Xianxiong Tang (Major Infiltrate the Chest Decoction) is the primary treatment. Original Text 137
① Ribushuo: Bu is 3 PM to 5 PM. Suo is an indefinite term, indicating approximation.
Zheng's Commentary: Heavy sweating implies repeating exterior treatment. Repeating exterior treatment fails to expel the pathogen, hence purgation is applied. No bowel movement for five to six days. The pathogen neither resolves from the Exterior nor the Interior, firmly bound in the Middle, showing a posture of entrenched resistance. The presented syndrome cannot be拔 (extracted/resolved) without Xianxiong Tang. The original text's prescription deeply grasps the essence.
[Explanation] After mistaken sweating and purgation in Taiyang disease, if there is no internal water-fluid, only dry feces accumulation, this is Yangming Fu Organ syndrome, treatable with Dachengqi Tang. If there is internal water-fluid, Heat binds with Water, forming Chest Binding. From epigastrium to lower abdomen, hardness, fullness, and pain cannot be treated without Da Xianxiong Tang. Xu Lingtai said: "What Dachengqi Tang purges is dry feces; what Da Xianxiong Tang purges is accumulated water; what Xiao Xianxiong Tang purges is yellow phlegm." This is his experiential words. Thus Zheng said: "The original text's prescription deeply grasps the essence."
Fifty: In Chest Binding (Jie Xiong), the neck is also stiff, resembling Rou Jing (Soft Spasm) syndrome. Purging brings harmony; Da Xianxiong Wan (Major Infiltrate the Chest Pill) is appropriate. Original Text 131 Second Part