桂枝 甘草 白术 人参 干姜
太阳病。外症未除。而数下之。遂协热而利不止。心下痞硬。表里不解。 仲景论太阳
病桂枝症。医反下之。利遂不止。与葛根黄连黄芩汤。此又与桂枝人参汤。二症俱系表不解。而
下之成利者。何故用药有温凉之异乎。二症虽同是内虚热入。协热遂利。但脉症不同，故用
药有别耳。前言脉促者。表未解。喘而汗出者。主葛根黄连黄芩汤。夫脉促为阳盛喘汗为里
热。用葛根芩连。理所宜也。且前症但曰下之。此曰数下之。前症但曰利下。此曰利不止。
两论细味之。即有虚实之分矣。
瓜蒂 赤小豆 香豉
病如桂枝症。头不痛。项不强。寸脉微浮。痞硬。气上冲咽喉。不得息。此胸有寒也。当
以瓜蒂散吐之。 病在上者。因而越之。邪客胸中。至气冲不得息。非吐之不可也。寒气在胸。瓜
蒂之苦寒。从其
。然此为快剂。重亡津液。与栀子豉汤。大不相侔也。故亡血虚家。特为申禁。
黄连 甘草 干姜 桂枝 人参 半夏 大枣
胸中有热。胃中有邪气。腹痛欲呕吐。此方主之。 邪气传里。下寒上热。夫胃中有邪
。则阴阳不交。阴不得升。而独治于下。为下寒而腹痛。阳不得降。而独治于上。为上热而呕吐
。上热者泄之以苦。黄连之职也。下寒者。散之以辛。姜桂半夏之任也。脾欲缓急食甘以缓
之。人参甘枣之用。其在斯乎。
Cinnamon Twig (Guizhi), Licorice Root (Gancao), Atractylodes Macrocephala Rhizome (Baizhu), Ginseng Radix (Renshen), Dried Ginger (Ganjiang)
Taiyang disease (disease of the Taiyang channel), where exterior symptoms persist, yet multiple purgative treatments have been applied. This results in diarrhea that continues incessantly, accompanied by fever (xie re). There is fullness and hardness in the epigastrium (xin xia pi ying), with both exterior and interior pathogens unresolved. In his treatise on Taiyang disease, Zhang Zhongjing discusses cases where a Guizhi Tang pattern (exterior deficiency pattern characterized by sweating, aversion to wind, and floating-slow pulse) is present, but the physician erroneously applies purgatives, leading to persistent diarrhea. In such cases, Gegen Huangqin Huanglian Tang (Kudzu, Scutellaria, Coptis, and Licorice Decoction) is indicated. Here, however, Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction, essentially Lizhong Tang plus Cinnamon Twig) is prescribed. Both conditions involve an unresolved exterior pathogen leading to diarrhea due to erroneous purgation. Why is there a difference between using warming versus cooling formulas? Although both conditions share internal deficiency and heat entering internally, causing diarrhea with fever, the pulse and symptoms differ, necessitating different prescriptions. The former case mentions a rapid pulse (cu mai), indicating the exterior is not resolved; panting and sweating indicate interior heat, for which Gegen Huangqin Huanglian Tang is the primary treatment. A rapid pulse signifies excess Yang, while panting and sweating signify interior heat; thus, using Gegen, Huangqin, and Huanglian is appropriate. Furthermore, the former case merely states "purgation was applied," whereas this case states "multiple purgations were applied." The former mentions "diarrhea," while this one specifies "incessant diarrhea." Careful comparison reveals the distinction between deficiency and excess.
Melon Seed (Gua Di), Red Bean (Chi Xiaodou), Fermented Soybean (Xiang Chi)
The condition resembles a Guizhi Tang pattern, yet there is no headache or neck stiffness. The cun (inch) pulse is slightly floating. There is epigastric fullness and hardness, with qi rushing upward to the throat, causing difficulty in breathing. This indicates the presence of cold-fluid retention (han) in the chest. One should induce vomiting using Gua Di San (Melon Seed Powder). For pathogens located in the upper jiao, the method of expulsion via vomiting ("yin er yue zhi") should be employed. When pathogens lodge in the chest, causing qi rebellion and respiratory distress, vomiting is the only effective remedy. Cold fluids stagnating in the chest are expelled by the bitter-cold nature of Gua Di, following its natural tendency. However, this is a harsh emetic that severely depletes body fluids (jin ye). It is vastly different from Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction), which clears and disperses constrained heat. Therefore, it is strictly contraindicated for patients with blood loss or those who are constitutionally deficient.
Coptis Rhizome (Huanglian), Licorice Root (Gancao), Dried Ginger (Ganjiang), Cinnamon Twig (Guizhi), Ginseng Radix (Renshen), Pinellia Tuber (Banxia), Jujube Fruit (Dazao)
There is heat in the chest and pathogenic factors (specifically cold) in the stomach, accompanied by abdominal pain and nausea/vomiting. This formula is indicated. When pathogens transmit inward, they create a pattern of lower cold and upper heat. Pathogens in the stomach disrupt the interaction between Yin and Yang. Yin fails to ascend and remains isolated in the lower jiao, resulting in lower cold and abdominal pain. Yang fails to descend and remains isolated in the upper jiao, resulting in upper heat and vomiting. To drain upper heat, bitter herbs are used; this is the function of Huanglian. To disperse lower cold, acrid herbs are used; this is the role of Ganjiang, Guizhi, and Banxia. The Spleen desires relaxation to relieve tension; sweet flavors soothe this condition. Hence, the use of Renshen and Dazao serves this purpose.