太阳病三日。已发汗。若吐若下。若温针。仍不解者。此为坏病。桂枝不中与也。观其脉证。知犯何逆。随证治之。
相传伤寒过经日久。其证不解。谓之坏病遂与过经不解之病无辨。仲景止言三日。未尝言过经日久不痊也。所谓坏
病者。言误汗吐下温针。病仍不解。表证已罢。邪气入里不可复用桂枝也。设桂枝证尚在。不得谓之坏病矣。至于过经
不解。不但七日传之不尽。即十余日。十三日。尚有传之不尽者其邪犹在三阳留恋。故仲景主以大柴胡。柴胡芒硝调胃
承气。随证虚实而解其热也。经云七日太阳病衰。头痛少愈。可见太阳一经。有行之七日。日上者。太阳既可 留多日。
则阳明少阳亦可 留。过经漫无解期矣。若谓六经传尽复传太阳。必无是理。惟病有传过三阴而脉续浮发热者。此正气
内复迫邪出外而解。必不复传也。岂有厥阴两阴交尽于里。复从皮毛再入太阳之事耶。
太阳病发汗。汗出不解。其人仍发热。心下悸。头眩身 动。振振欲擗地者。真武汤主之。
此本误用大青龙因而致变者。立法也。汗出虽多而热不退。则邪未尽而正大伤。况里虚为悸。上虚为眩。经虚为 。
身振振摇。无往而非亡阳之象。所以行真武把守关口坐镇之法也。
太阳病发汗。遂漏不止。其人恶风。小便难。四肢微急难屈伸者。桂枝加附子汤主之。
大发其汗。致阳气不能卫外。而汗漏不止。即如水流漓之互辞也。恶风者。腠理大开。为风所袭也。小便难者。津
液外泄。而不下渗。兼卫气外脱而膀胱之气化不行也。四肢微急难以屈伸者。过汗亡阳筋脉失养。兼袭虚风。而增其劲
也。故加附子于桂枝汤内。温经散寒。用桂枝汤者。和在表之营卫。加附子者。壮在表之元阳。本非阳虚。是不用四逆
也。发汗后。身疼痛脉沉迟者。桂枝加芍药生姜各一两人参三两。新加汤主之。
此本桂枝证。误用麻黄。反伤营血。阳气暴虚。故脉反沉迟而身痛也。此脉沉迟与尺迟大异。尺迟乃元气素虚。此
六部皆沉迟为发汗新虚。故仍用桂枝和营。加芍药收阴。生姜散邪。人参辅正。名曰新加汤非桂枝旧法也。
发汗后腹胀满者。生姜浓朴甘草半夏人参汤主之。
吐下腹胀为实。以邪气乘虚入里也。此本桂枝证误用麻黄发汗。津液外泄。脾胃气虚。阴气内结。壅而为满。故以
益脾和胃降气涤饮为治也。
发汗后。其人脐下悸者。欲作奔豚。茯苓桂枝甘草大枣汤主之。
汗本心之液。发汗后。脐下悸者。脾气虚而肾气发动也。明系阴邪留着。欲作奔豚之证。肾邪欲上凌心。故脐下先
悸。取用茯苓桂枝直趋肾界。预伐其邪。则中宫始得宁静矣。
发汗过多。其人叉手自冒心。心下悸。欲得按者桂枝甘草汤主之。
发汗过多。误用麻黄也。误汗伤阳。胸中阳气暴虚。故叉手冒心。虚而欲得按也。本桂枝证。故仍用桂枝甘草汤。
以芍药助阴。姜枣行津。汗后阳虚故去之。
未持脉时。病患叉手自冒心。师因教试令咳。而不咳者。此必两耳聋无闻也。所以然者以重发汗虚故如此。
此示人推测阳虚之一端也。阳虚耳聋与少阳传经耳聋迥别。亟宜固阳为要耳。叉手冒心。加之耳聋阳虚。极矣。尝
见汗后阳虚耳聋诸医施治不出小柴胡加减。屡服愈甚。必大剂参附。庶可挽回也。
太阳病多恶寒发热。今自汗出。不恶寒发热。关上脉细数者。以医吐之故也。一二日吐之者。腹中饥口不能食三四
日吐之者。不喜糜粥。欲食令食。朝食暮吐。以医吐之所致也。此为小逆。
解肌之法解散肌表风邪。全不伤动脾胃。若舍此而妄行吐法。吐中亦有发散之义。所以不恶寒发热反见胃痛也。一
二日病在太阳。吐之则腹中饥口不能食。三四日病在阳明。吐之则不喜食糜粥。欲食冷食。皆胃气受伤之故也。然朝食
暮吐脾中之真阳亦伤而不能消谷。故为小逆○关上脉细数者。明系吐伤阳气所致。尝见外感之脉。人迎细弱而气口连寸
反滑数大于人迎者。以其曾经涌吐伤胃。胃气上乘于肺故也。
太阳病吐之。但太阳病当恶寒今反不恶寒。不欲近衣。此为吐之内烦也。
此以吐而伤胃中之阴。故内烦不欲近衣。虽显虚烦之证较关上脉细。而成虚热。朝食暮吐。脾胃两伤者。稍轻虽不
致逆。医者能无过乎。
太阳病下之后。其气上冲者。可与桂枝汤。方用前法若不上冲者。不可与之。
误下而阳邪内陷。然无他变。但仍上冲阳位。则可从表里两解之法。故以桂枝汤加于前所误用之药内。则表邪外出
里邪内出。即用桂枝加大黄汤之互辞也。若不上冲。则里已受邪。不可与桂枝明矣。
太阳病下之后。脉促胸满者。桂枝去芍药汤主之。若微恶寒者。去芍药方中加附子汤主之。
误下脉促胸满无下利不止汗出等证。但满而不痛。未成结胸。故仍用桂枝散邪去芍药者。恐其复领阳邪下入腹中也。
脉促虽表邪未尽。然胸但满而不结。则以误下而损其胸中之阳也。加以微恶寒。则并肾中之真阳亦损。而浊阴用事矣。
故去芍药之阴。加附子以回阳也。设微见汗出恶寒。则阳虚已着。非阳邪土盛之比。是虽不言汗出。然出微汗恶寒。合
上条胸满观之。则必有汗出。暗伏亡阳之机。故于去芍药方中加附子。庶免阳脱之变。可见阳虚则恶寒矣。又可见汗不
出之恶寒。即非阳虚矣。至若桂枝证误下。遂利不止。喘而汗出。不恶寒者。则又邪并阳明之腑矣。
太阳病下之微喘者。表未解故也。桂枝加浓朴杏仁汤主之。喘家作桂枝汤加浓朴杏子仁。
表邪因误下。上逆而见微喘故仍用桂枝解表。加浓朴杏仁以下其气。若下利不止而加上气喘急者。乃是上争下夺倾
危之象非桂枝所宜也。○按寒伤营则喘。风伤卫则咳。此本风伤卫证。因误下而引风邪入犯营分。故微喘也。其寒伤营
无汗证亦有咳者。乃发热引饮水蓄之故。否则营卫俱伤之证耳。
太阳病下之。其脉促不结胸者。此为欲解也。脉浮者必结胸也。脉紧者必咽痛。脉弦者必两胁拘急。脉细数者。头
痛未止。脉沉紧者。必欲呕。脉沉滑者。协热利。脉浮滑者必下血。
脉促为阳邪上盛反不结聚于胸则阳邪未陷可勃勃从表出矣。故为欲解也。脉浮者必结胸。即指促脉而申之。见促脉
而加之以浮故必结胸也。浮字贯下四句。浮而紧必咽痛。浮而弦两胁拘急。浮而细数。必头痛未止。皆太阳之脉。故主
病亦在太阳之本位。设脉见沉紧。则阳邪已入阴分。但入而未深仍欲上冲作呕。其无结胸咽痛等证。从可知矣。只因论
中省用一个促字。三个浮字。后之读者遂眩。或谓紧者必咽痛属少阴。惑之甚矣。沉滑为阳邪入阴而主下利。浮滑则阳
邪正在营分。扰其血而主下血也。夫太阳误下之脉。主病皆在阳在表。即有沉紧沉滑亦不得以里阴名之也。○按脉促不
结胸者。为欲解。可知里不受邪矣。若脉促胸满者。桂枝去芍药。微恶寒者。加附子。及后并病例中葛根黄芩黄连汤证。
亦是太阳之邪因误下而陷于阳明所致。又厥阴例中。脉促手足厥逆。用灸一法。乃阳邪陷于阴分。则知脉促为阳。邪郁
伏不与正气和谐之。故不当与结代浑斟也。
王日休云。太阳病下之以下八证。其脉促不结胸者。为欲解。不必药。脉浮者必结胸桂枝去芍药汤。脉紧者必咽痛
甘草汤。脉弦者两胁拘急小柴胡加桂枝。脉细数者头痛未止当归四逆汤。脉沉紧者必欲呕甘草干姜汤加黄连。脉沉滑者
协热相白头翁汤。脉浮滑者必下血芍药甘草汤加秦皮。
太阳病先下之而不愈因复发汗。以此表里俱虚其人因致冒。冒家汗出自愈。所以然者汗出表和故也。得里未和。然
后复下之。
冒者神识不清。似有物蒙蔽其外。所以必须得汗。自解未尝言药也。得里未和视其二便和与否。再分解其邪。若论
用药。表无过建中。里无过大柴胡五苓矣○或云叉手自冒心曰冒。冒为发汗过多。胃中清阳气伤。故叉手自冒。必补气。
以助其作汗。宜小建中加参 。频服乃瘥。若尺中迟弱者。更加熟附子三五分。可见昏冒耳聋非大剂温补不能取效也。
太阳病未解。脉阴阳俱停。必先振栗汗出而解。但阳脉微者。先汗出而解。但阴脉微者下之而解。若欲下之。宜调
胃承气汤主之。
病久不解。不过入阴入阳之二途。脉既阴阳两传初无偏胜可以解矣。犹必先振栗。始得汗出而解虚可知也。设不振
栗。则邪不能传之于表。而无从得汗可知也。然既云阴阳两停。则在先脉浮沉俱紧盛。今则浮沉俱不紧盛也。脉既阴阳
两停。其传表传里未可预定。所以惟阳脉微者。方是邪不能传表。当从汗之而解。惟阴脉微者。方是邪不能传里。当从
下之而解。此其故甚可思也。若非邪住不传之候则阳脉微者。当补其阳。阴脉微者。当补其阴矣。岂有反汗之而伤其阳。
下之而伤其阴哉。
太阳病。二三日不能卧。但欲起心下必结。脉微弱者。此本有寒分也。反下之若利止。必作结胸未止者。四日复下
之。此作协热利也。
二三日不能卧。但欲起阳邪炽盛。逼处心胸。扰乱不宁。所以知其心下必结。然但显欲结之象。尚未至于结也。若
其人脉微弱者。此平素有寒饮积于心膈之分。适与外邪相召。外邪方炽。其不可下明矣反下之若利止。则邪热乘虚入膈。
必与寒痰上结若利未止因复下之。使阳邪不复上结。亦将差就错。因势利导之法。但邪热从表解极易。从里解极难协热
下利。热不尽其利漫无止期。亦危道也。
大下之后复发汗。小便不利者。亡津液故也勿治之。得小便利必自愈。
凡病若发汗。若吐若下。若亡血亡津液。阴阳自和者。必自愈。
其人已亡津液。复强责其小便。究令膀胱之气化不行。转增满硬胀喘者甚多。故宜以不治治之。
以上风伤卫坏证。
发汗后。不可更行桂枝汤。汗出而喘。无大热者。可与麻黄杏仁甘草石膏汤主之。○发汗后饮水多者。必喘。以水
灌之亦喘。
本寒伤营麻黄汤证。乃误用桂枝汤固卫。寒不得泄气逆变喘。然有大热者。恐兼里证。若无大热。为表邪实盛可知。
乃与麻黄汤除去桂枝而加石膏去桂枝者恐复助营热。已误不可再误也加石膏者。用以泄营中之热也。至于内饮水多。外
行水灌。皆足以敛邪闭汗。而成喘。不独误行桂枝汤为然也。
下后不可更行桂枝汤。若汗出而喘。无大热者可与麻黄杏仁甘草石膏汤。
易桂枝以石膏。少变麻黄之法。以治误汗而喘当矣。误下而喘亦以桂枝为戒而不越此方者何耶。盖中风伤寒。一从
桂枝。一从麻黄。分途异治。由中风之误下而喘者。用浓朴杏仁加入桂枝汤中。则伤寒之误下而喘者用石膏加入麻黄汤
中。两不移易之定法也。
伤寒五六日。大下之后。身热不去。心下结痛者。未欲解也。栀子豉汤主之。
发汗若下之而烦热。胸中窒者栀子豉汤主之。
发汗吐下后。虚烦不得眠。若剧者必反复颠倒心中懊 栀子豉汤主之。○若少气者。栀子甘草豉汤主之。○若呕者
栀子生姜豉汤主之。（ 恼同）
胸中窒塞窒比结痛则较轻也。虚烦不得眠。即下条卧起不安之互辞也。反复颠倒心中懊 。乃邪退正虚。而余邪阻
滞。不能传散。无可奈何之状也。此时将汗之乎。下之乎。和之乎。温之乎。仲景巧用栀子豉汤。涌载其余邪于上。使
一吐而尽传无余然惟无形之虚烦。用此无疑若涌吐实烦仲景别有瓜蒂散。则非栀子所能也。乃因汗吐下后。胸中阳气不
足。最虚之处便是客邪之处。若正气暴虚。余邪不尽则仲景原有炙甘草一法。宁敢妄涌以犯虚邪之戒也。
伤寒下后。心烦腹满。卧起不安者。栀子浓朴汤主之。
满而不烦。即里证已具之实满烦而不满即表证未罢之虚烦。合而有之且卧起不安明是邪奏胸表腹里之间。故取栀子
以快涌其胸中之邪而合浓朴枳实。以泄腹中之满也。
伤寒医以丸药大下之。身热不去微烦者。栀子干姜汤主之。
丸药大下之徒伤其中。而不能汤涤其邪。故栀子合干姜用之。亦温中散邪之法也。
凡用栀子豉汤。病患旧有微溏者不可与服之。
旧有微溏。则大肠易动。服此不惟不能上涌。反为下泄也。
伤寒脉结。伐心动悸者炙甘草汤主之。
或问炙甘草汤一证。但言脉结代。心动悸。并不言从前所见何证。曾服何药所致。细绎其方。不出乎滋养真阴回枯
润燥。兼和营散邪之剂。必缘其人胃气素虚。所以汗下不解。胃气转伤。真阴枯竭遂致心悸脉代。与水停心悸之脉似是
而非。水则紧而虚则代加之以结。则知正气虽亏。尚有阳邪伏结。凌烁真阴。阴阳相搏。是以动悸不宁耳。邪留不解阴
已大亏。计惟润燥养阴和营散邪。乃为合法。方中人参甘草补益胃气。桂枝甘草调和营卫。麦冬生地阿胶麻仁。润经益
血复脉通心。尚恐药力不及更须清酒。以辅助成功。盖津液枯槁之人预方二便秘涩之虞。其麦冬生地溥滋膀胱之化源。
麻仁阿胶。专主大肠之枯约。免致阴虚泉竭火燥血枯。此仲景救阴退阳之特识也。
伤寒发汗已。身目为黄所以然者。以寒湿在里不解故也。以为不可下也。于寒湿中求之。
Taiyang disease (Disease of the Taiyang/Bladder channel) for three days. Sweating has already been applied. If emesis, purgation, or warm needle therapy is used, and the condition remains unresolved, this is called a "ruined disease" (Huai Bing, a complication due to misdiagnosis or mistreatment). Guizhi Tang (Cinnamon Twig Decoction) should no longer be administered. Observe the pulse and symptoms, determine what error was committed, and treat according to the specific syndrome.
It is traditionally said that when Shanghan (Cold Damage) has passed through the meridians for a long time and symptoms remain unresolved, it is called a ruined disease; thus, people fail to distinguish between ruined diseases and diseases that have not resolved after passing through the meridians. Zhang Zhongjing only mentions "three days" and never states that a disease must persist for a long time after passing through the meridians to be considered a ruined disease. The so-called "ruined disease" refers to cases where, due to erroneous use of sweating, emesis, purgation, or warm needles, the illness remains unresolved, the exterior syndrome has ceased, and the pathogenic factor has entered the interior; therefore, Guizhi Tang cannot be reused. If the Guizhi Tang syndrome still exists, it cannot be called a ruined disease. As for diseases not resolving after passing through the meridians, transmission is not necessarily complete within seven days; even after ten or thirteen days, transmission may still be incomplete, with the pathogen lingering in the Three Yang channels. Therefore, Zhang Zhongjing advocates using Da Chai Hu Tang (Major Bupleurum Decoction), Xiao Chai Hu Tang (Minor Bupleurum Decoction), or Mangxiao Tiaowei Chengqi Tang (Mirabilite Regulating the Stomach and Directing Downward Decoction) to clear heat according to the deficiency or excess of the syndrome. The classic states: "On the seventh day, the Taiyang disease declines, and headache slightly improves." This shows that the Taiyang channel can last for seven days or even longer. Since Taiyang can linger for many days, Yangming and Shaoyang can also linger, meaning there is no fixed period for resolution after passing through the meridians. To claim that after all six channels are transmitted, the disease re-enters Taiyang is theoretically impossible. Only when a disease has passed through the Three Yin channels and the pulse continues to float with fever does it indicate that healthy qi is recovering internally and forcing the pathogen out from the exterior to resolve; it will certainly not transmit further. How could Jueyin (where two yins meet and end in the interior) allow the disease to re-enter Taiyang from the skin and hair?
In Taiyang disease, after sweating, if the sweat does not resolve the condition, and the patient still has fever, palpitations in the epigastrium, dizziness, tremors of the body, and a sensation of being unable to stand without falling (Zhenzhen Yu Pi Di), Zhenwu Tang (True Warrior Decoction) should be used.
This prescription was established for complications arising from the erroneous use of Da Qing Long Tang (Major Green Dragon Decoction). Although profuse sweating occurs, the fever does not subside, indicating that the pathogen is not fully expelled while the righteous qi is severely damaged. Moreover, interior deficiency causes palpitations, upper deficiency causes dizziness, and channel deficiency causes tremors. The whole-body trembling and inability to stand are all signs of Yang collapse. Therefore, Zhenwu Tang is used to guard the passes and stabilize the foundation.
In Taiyang disease, after sweating, if sweating continues unceasingly (Han Lou Bu Zhi), the patient fears wind, has difficulty urinating, and experiences slight stiffness and difficulty flexing/extending the limbs, Guizhi Jia Fuzi Tang (Guizhi Decoction with Added Aconite) should be used.
Profuse sweating damages the defensive Yang, preventing it from protecting the exterior, leading to unceasing sweating like flowing water. Fear of wind indicates that the pores are wide open and attacked by wind. Difficulty urinating results from the loss of body fluids externally and failure of bladder Qi transformation due to the escape of defensive Qi. Slight stiffness and difficulty in limb movement occur because excessive sweating leads to Yang loss, causing the sinews and vessels to lose nourishment, compounded by the invasion of deficient wind which increases stiffness. Thus, Fuzi (Aconiti Lateralis Radix Praeparata) is added to Guizhi Tang to warm the channels and dispel cold. Guizhi Tang harmonizes the Ying and Wei at the exterior, while adding Fuzi strengthens the primal Yang at the exterior. This is not simple Yang deficiency, so Si Ni Tang (Frigid Extremities Decoction) is not used.
After sweating, if the body aches and the pulse is deep and slow (Chen Chi), Xinjia Tang (Newly Added Decoction), consisting of Guizhi Tang with an additional one ren (approx. 15g) each of Shaoyao (Paeoniae Radix Alba) and Shengjiang (Zingiberis Rhizoma Recens), and three liang (approx. 45g) of Renshen (Ginseng Radix et Rhizoma), should be used.
This was originally a Guizhi Tang syndrome, but Ma Huang Tang (Ephedra Decoction) was erroneously used, damaging the Ying blood and causing sudden Yang deficiency. Hence, the pulse becomes deep and slow, and body pain occurs. This deep and slow pulse differs significantly from a slow chi pulse (at the cun-kou position); a slow chi pulse indicates constitutional deficiency of Yuan Qi, whereas a deep and slow pulse in all six positions here indicates new deficiency caused by sweating. Therefore, Guizhi is still used to harmonize Ying, Shaoyao is added to astringe Yin, Shengjiang is added to disperse pathogens, and Renshen is added to support Zheng Qi. It is named Xinjia Tang because it is not the old method of Guizhi Tang.
After sweating, if abdominal fullness occurs, Shengjiang Houpo Gancao Banxia Renshen Tang (Fresh Ginger, Magnolia Bark, Licorice, Pinellia, and Ginseng Decoction) should be used.
Abdominal fullness after vomiting or purgation is an excess pattern caused by pathogens entering the interior due to deficiency. This was originally a Guizhi Tang syndrome, but Ma Huang Tang was erroneously used for sweating, causing body fluid loss, spleen and stomach Qi deficiency, and internal stagnation of Yin Qi, leading to fullness. Therefore, the treatment principle is to tonify the spleen, harmonize the stomach, direct Qi downward, and eliminate fluid retention.
After sweating, if the patient feels palpitations below the navel and is about to develop Ben Tun (Running Piglet Syndrome), Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) should be used.
Sweat is the fluid of the Heart. After sweating, palpitations below the navel indicate spleen Qi deficiency and stirring of Kidney Qi. This is clearly Yin pathogen lingering, about to manifest as Ben Tun. The Kidney pathogen intends to assault the Heart, causing initial palpitations below the navel. Using Fuling and Guizhi targets the Kidney realm to preemptively attack the pathogen, allowing the Middle Jiao to become tranquil.
If excessive sweating causes the patient to cross their hands over the heart, experience palpitations in the epigastrium, and desire pressure, Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction) should be used.
Excessive sweating implies the erroneous use of Ma Huang. Erroneous sweating damages Yang, causing sudden deficiency of Yang Qi in the chest. Hence, the patient crosses their hands over the heart and desires pressure due to deficiency. Since this was originally a Guizhi Tang syndrome, Guizhi Gancao Tang is used. Shaoyao is removed because it aids Yin; Shengjiang and Dazao are removed because they move fluids, and Yang is deficient after sweating.
Before taking the pulse, if the patient crosses their hands over the heart, the physician instructs them to cough. If they do not cough, they are likely deaf in both ears. This happens because heavy sweating has caused severe Yang deficiency.
This illustrates one aspect of inferring Yang deficiency. Deafness due to Yang deficiency is distinctly different from deafness due to transmission to the Shaoyang channel. It is urgent to secure Yang. Crossing hands over the heart combined with deafness indicates extreme Yang deficiency. I have seen cases of post-sweating Yang deficiency deafness where physicians treated them with modifications of Xiao Chai Hu Tang (Minor Bupleurum Decoction), resulting in worsening conditions upon repeated administration. Large doses of Renshen and Fuzi are required to recover the condition.
In Taiyang disease, patients usually fear cold and have fever. Now, if they sweat spontaneously, do not fear cold, do not have fever, and the Guan (middle) pulse is fine and rapid, it is due to the physician's use of emesis. If emesis is used on days one or two, the abdomen feels hungry but the mouth cannot eat. If emesis is used on days three or four, the patient dislikes congee and desires cold food; morning food is vomited in the evening. This is caused by the physician's erroneous emesis. This is considered a minor adverse reaction.
The method of releasing the muscle layer dissipates wind pathogens from the exterior without injuring the spleen and stomach. Abandoning this for reckless emesis, which contains some dispersing properties, causes gastric pain instead of resolving fear of cold and fever. On days one or two, the disease is in Taiyang; emesis makes the abdomen feel hungry but prevents eating. On days three or four, the disease is in Yangming; emesis causes dislike of congee and desire for cold food, all due to injury of Stomach Qi. However, vomiting evening food after morning intake injures the True Yang of the spleen, preventing grain digestion, hence termed a minor adverse reaction. The fine and rapid Guan pulse clearly results from emesis injuring Yang Qi. I have observed that in external contraction pulses, if the Renying pulse is fine and weak while the Qikou pulse (cun and guan) is slippery and rapid and larger than Renying, it is because previous涌吐 (yong tu, inducing vomiting) injured the Stomach, causing Stomach Qi to ascend to the Lung.
If Taiyang disease is treated with emesis, and although Taiyang disease typically involves fear of cold, the patient now does not fear cold and does not wish to wear clothes, this is internal irritability caused by emesis.
Emesis injures the Yin of the Stomach, causing internal irritability and aversion to clothing. Although this manifests as a deficiency irritability syndrome, it is milder than the deficiency heat formed by a fine Guan pulse or the spleen-stomach dual injury causing morning food/vomiting. Although it does not lead to severe adverse reactions, the physician is still at fault.
After purgation in Taiyang disease, if Qi rushes upward, Guizhi Tang (Cinnamon Twig Decoction) may be given, following the previous method. If Qi does not rush upward, do not give it.
Erroneous purgation causes Yang pathogens to sink inward. However, if there are no other changes and Yang Qi still rushes upward to the Yang position, a method of resolving both exterior and interior can be used. Thus, Guizhi Tang is added to the previously erroneously used medicines, allowing exterior pathogens to exit outward and interior pathogens to exit inward. This is analogous to the use of Guizhi Jia Dahuang Tang (Guizhi Decoction with Added Rhubarb). If Qi does not rush upward, the interior has already been invaded by pathogens, and Guizhi Tang is clearly contraindicated.
After purgation in Taiyang disease, if the pulse is hurried (Cu) and there is chest fullness, Guizhi Qu Shaoyao Tang (Guizhi Decoction without Paeonia) should be used. If there is slight fear of cold, add Fuzi to the Guizhi Qu Shaoyao formula.
Erroneous purgation causing a hurried pulse and chest fullness, without symptoms like incessant diarrhea or sweating, presents only fullness without pain, not yet forming Jie Xiong (Chest Binding). Therefore, Guizhi Tang is still used to disperse pathogens. Shaoyao is removed to prevent it from leading Yang pathogens down into the abdomen. Although a hurried pulse indicates residual exterior pathogens, the chest is merely full without binding, indicating damage to Yang Qi in the chest due to purgation. With slight fear of cold, the True Yang of the Kidney is also damaged, allowing turbid Yin to dominate. Thus, Yin-nourishing Shaoyao is removed, and Fuzi is added to restore Yang. If slight sweating and fear of cold appear, Yang deficiency is significant, unlike Yang pathogen Earth excess. Although sweating is not explicitly mentioned, combining slight sweating and fear of cold with the previous chest fullness suggests hidden mechanisms of Yang collapse. Therefore, Fuzi is added to the Guizhi Qu Shaoyao formula to prevent Yang collapse. This shows that Yang deficiency causes fear of cold, and conversely, fear of cold without sweating is not Yang deficiency. If Guizhi Tang syndrome is erroneously purged, leading to incessant diarrhea, wheezing, sweating, and no fear of cold, the pathogen has merged into the Yangming Fu organs.
After purgation in Taiyang disease, if there is slight wheezing, it is because the exterior syndrome is unresolved. Guizhi Jia Houpo Xingren Tang (Guizhi Decoction with Added Magnolia Bark and Apricot Kernel) should be used. For asthmatics presenting with Guizhi Tang syndrome, add Houpo and Xingren.
Exterior pathogens, due to erroneous purgation, rebel upward causing slight wheezing. Therefore, Guizhi is still used to resolve the exterior, and Houpo and Xingren are added to direct Qi downward. If accompanied by incessant diarrhea and severe wheezing, it indicates a critical state of fighting above and losing below, which is not suitable for Guizhi Tang. ○ Note: Cold injuring Ying causes wheezing; Wind injuring Wei causes coughing. This was originally a Wind injuring Wei syndrome, but erroneous purgation drew Wind pathogens into the Ying level, causing slight wheezing. Cold injuring Ying without sweating can also cause coughing, due to fever leading to water accumulation from drinking; otherwise, it is a syndrome of dual Ying and Wei injury.
After purgation in Taiyang disease, if the pulse is hurried but there is no Jie Xiong (Chest Binding), the disease is about to resolve. If the pulse is floating, Jie Xiong will definitely form. If tight, throat pain will occur. If wiry, bilateral hypochondriac stiffness will occur. If fine and rapid, headache will persist. If deep and tight, vomiting will occur. If deep and slippery, heat-collateral diarrhea will occur. If floating and slippery, hematochezia (blood in stool) will occur.
A hurried pulse indicates abundant Yang pathogens. If they do not bind in the chest, the Yang pathogens have not sunk and can emerge vigorously from the exterior. Hence, it is considered about to resolve. "Floating" applies to the subsequent descriptions. A hurried pulse plus floating indicates definite Jie Xiong. Floating and tight indicates throat pain; floating and wiry indicates hypochondriac stiffness; floating and fine/rapid indicates persistent headache. These are all Taiyang pulses, so the diseases are in the Taiyang domain. If the pulse is deep and tight, Yang pathogens have entered the Yin level but not deeply, intending to rush upward to cause vomiting. The absence of Jie Xiong or throat pain is evident. Readers are confused because the text omits "hurried" and "floating" characters. Some mistakenly attribute tight throat pain to Shaoyin, which is a great confusion. Deep and slippery indicates Yang pathogens entering Yin causing diarrhea; floating and slippery indicates Yang pathogens in the Ying level disturbing blood, causing hematochezia. Pulses after erroneous Taiyang purgation primarily relate to Yang and exterior; even deep/tight or deep/slippery pulses should not be classified as interior Yin. ○ Note: Hurried pulse without Jie Xiong indicates resolution, meaning the interior is unaffected. Hurried pulse with chest fullness uses Guizhi Qu Shaoyao Tang; with slight fear of cold, add Fuzi. Later cases of Gegen Qinlian Tang (Kudzu, Scutellaria, Coptis, and Licorice Decoction) also result from Taiyang pathogens sinking into Yangming due to erroneous purgation. In Jueyin examples, hurried pulse with cold extremities treated with moxibustion indicates Yang pathogens sinking into Yin. Thus, a hurried pulse indicates Yang, with pathogens stagnant and disharmonious with Zheng Qi, and should not be confused with Ji Dai (knotted and intermittent) pulses.
Wang Rixiu stated: Regarding eight syndromes after Taiyang purgation: Hurried pulse without Jie Xiong means resolution, no medicine needed. Floating pulse indicates Jie Xiong, use Guizhi Qu Shaoyao Tang. Tight pulse indicates throat pain, use Gancao Tang (Licorice Decoction). Wiry pulse indicates hypochondriac stiffness, use Xiao Chai Hu Tang plus Guizhi. Fine and rapid pulse indicates persistent headache, use Danggui Sini Tang (Angelica Decoction for Cold Extremities). Deep and tight pulse indicates vomiting, use Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) plus Huanglian. Deep and slippery pulse indicates heat-collateral diarrhea, use Baitouweng Tang (Pulsatilla Decoction). Floating and slippery pulse indicates hematochezia, use Shaoyao Gancao Tang plus Qinpi.
If Taiyang disease is first treated with purgation without success, followed by sweating, the exterior and interior become deficient, causing the patient to experience Mao (dizziness/confusion). Mao resolves spontaneously with sweating because the exterior harmony is restored. If the interior is not harmonized, purgation may be reapplied.
Mao refers to unclear consciousness, as if obscured externally. It requires spontaneous sweating to resolve; medication is not mentioned. Assess interior harmony by checking bowel movements and urination before resolving pathogens. Regarding medication, for exterior issues, Jianzhong Tang (Middle-Joint Building Decoction) is paramount; for interior issues, Dachaihu Tang or Wuling San (Five-Ling Powder) are paramount. ○ Some say crossing hands over the heart is Mao, caused by excessive sweating injuring clear Yang Qi in the Stomach, requiring Qi tonification to assist sweating, using Xiaojianzhong Tang plus Renshen, taken frequently until recovery. If the Chi pulse is slow and weak, add cooked Fuzi. This shows that confusion and deafness require large doses of warming and tonifying herbs to be effective.
If Taiyang disease is unresolved and the pulse appears suspended/stopped (Yin Yang Ju Ting), the patient must first shiver and then sweat to resolve. If only the Yang pulse is faint, sweating resolves it. If only the Yin pulse is faint, purgation resolves it. If purgation is desired, Tiaowei Chengqi Tang (Regulating the Stomach and Directing Downward Decoction) should be used.
Prolonged unresolved disease follows either Yin or Yang pathways. If the pulse transmits to both Yin and Yang without bias, resolution is possible. However, shivering is required for sweating and resolution, indicating deficiency. Without shivering, pathogens cannot transmit to the exterior, and sweating is impossible. "Yin Yang suspension" means the previously tight and vigorous floating and deep pulses are now neither. Since transmission direction is uncertain, a faint Yang pulse indicates pathogens cannot transmit to the exterior, requiring sweating. A faint Yin pulse indicates pathogens cannot transmit to the interior, requiring purgation. This logic is profound. If this were not a sign of pathogens staying without transmitting, a faint Yang pulse would require tonifying Yang, and a faint Yin pulse would require tonifying Yin. Why would sweating injure Yang and purgation injure Yin?
In Taiyang disease, if for two or three days the patient cannot lie down but wants to sit up, indicating cardiac constraint, and the pulse is weak, this is due to pre-existing cold-fluid retention. Erroneous purgation: if diarrhea stops, Jie Xiong will form; if diarrhea continues and purgation is repeated on the fourth day, Xiere Li (Heat-Collateral Diarrhea) will form.
Inability to lie down for two or three days indicates blazing Yang pathogens pressing on the heart and chest, causing restlessness, implying cardiac constraint. However, it is only a tendency to bind, not yet bound. If the pulse is weak, it indicates constitutional cold-fluid retention in the chest-diaphragm area, coinciding with external pathogens. With intense external pathogens, purgation is clearly contraindicated. Erroneous purgation: if diarrhea stops, heat pathogens enter the diaphragm due to deficiency and bind with cold-phlegm. If diarrhea continues and purgation is repeated, preventing upward binding, it attempts to guide the pathogen along its course. Resolving heat pathogens from the exterior is easy; resolving from the interior is difficult. Xiere Li, where heat is not exhausted and diarrhea is endless, is a dangerous path.
After massive purgation followed by sweating, if urination is difficult, it is due to loss of body fluids. Do not treat it directly; once urination normalizes, the patient will heal spontaneously.
For any disease, whether treated with sweating, emesis, purgation, or involving blood/fluid loss, if Yin and Yang self-harmonize, the patient will heal spontaneously.
If body fluids are already lost, forcibly demanding urination will ultimately impair bladder Qi transformation, leading to fullness, hardness, distension, and wheezing. Therefore, non-treatment is appropriate.
Above are Ruined Syndromes caused by Wind injuring Wei.
After sweating, Guizhi Tang should not be used again. If there is sweating and wheezing without high fever, Mahuang Xinggan Caishi Gao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) may be used. ○ Drinking too much water after sweating causes wheezing; bathing with cold water also causes wheezing.
Originally a Cold injuring Ying Mahuang Tang syndrome, Guizhi Tang was erroneously used to secure Wei, preventing Cold expulsion and causing Qi reversal and wheezing. If there is high fever, interior involvement is suspected. Without high fever, exterior pathogen excess is certain. Mahuang Tang is modified by removing Guizhi and adding Shigao (Gypsum). Guizhi is removed to avoid assisting Ying heat, as errors should not be repeated. Shigao is added to clear heat in the Ying level. Excessive internal water intake or external cold water application can trap pathogens and close pores, causing wheezing, not just erroneous Guizhi Tang use.
After purgation, Guizhi Tang should not be used again. If there is sweating and wheezing without high fever, Mahuang Xinggan Caishi Gao Tang may be used.
Replacing Guizhi with Shigao slightly modifies the Mahuang method to treat post-sweating wheezing appropriately. Why is Guizhi avoided for post-purgation wheezing as well? Wind strike and Cold damage are treated differently via Guizhi and Mahuang respectively. For wind strike with post-purgation wheezing, Houpo and Xingren are added to Guizhi Tang. For cold damage with post-purgation wheezing, Shigao is added to Mahuang Tang. These are immutable rules.
In Shanghan for five or six days, after massive purgation, if body heat persists and there is cardiac constraint and pain, the disease is not resolving. Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) should be used.
After sweating or purgation, if there is irritability and heat with chest oppression, Zhizi Chi Tang should be used.
After sweating, emesis, or purgation, if there is deficiency irritability and insomnia, or severe restlessness and mental anguish (Ao Nao), Zhizi Chi Tang should be used. ○ If there is shortness of breath, Zhizi Gancao Chi Tang (Gardenia, Licorice, and Fermented Soybean Decoction) should be used. ○ If there is vomiting, Zhizi Shengjiang Chi Tang (Gardenia, Fresh Ginger, and Fermented Soybean Decoction) should be used.
Chest oppression is lighter than cardiac constraint. Deficiency irritability and insomnia are synonymous with restlessness described later. Severe restlessness and mental anguish indicate that pathogens have retreated, righteous Qi is deficient, and residual pathogens are stagnant, unable to disperse, creating a helpless state. Should one sweat, purge, harmonize, or warm? Zhang Zhongjing cleverly uses Zhizi Chi Tang to induce vomiting, expelling residual pathogens upward. This is suitable only for formless deficiency irritability. For substantial irritability requiring vomiting, Zhongjing uses Geng Ti San (Melon Seed Powder), which Zhizi cannot handle. After sweating/emesis/purgation, Yang Qi in the chest is insufficient; the most deficient area is where pathogens lodge. If righteous Qi is suddenly deficient and residual pathogens remain, Zhongjing’s original method is Zhi Gancao Tang (Honey-Fried Licorice Decoction). One dare not recklessly induce vomiting to violate the warning against attacking deficiency with pathogens.
After Shanghan purgation, if there is心烦 (heart irritability), abdominal fullness, and restlessness, Zhizi Houpo Tang (Gardenia and Magnolia Bark Decoction) should be used.
Fullness without irritability indicates interior excess; irritability without fullness indicates unresoved exterior deficiency irritability. Combined with restlessness, it indicates pathogens gathering between the chest exterior and abdomen interior. Zhizi is used to rapidly vent chest pathogens, combined with Houpo and Zhishi to drain abdominal fullness.
If a Shanghan physician uses pill-based purgatives causing massive purgation, and body heat persists with slight irritability, Zhizi Ganjiang Tang (Gardenia and Dried Ginger Decoction) should be used.
Massive purgation with pills only injures the Middle Jiao and fails to wash away pathogens. Zhizi combined with Ganjiang (Dried Ginger) warms the middle and disperses pathogens.
When using Zhizi Chi Tang, if the patient has a history of mild diarrhea, it should not be administered.
Pre-existing mild diarrhea makes the Large Intestine prone to movement; administering this decoction will not induce vomiting but rather cause downward discharge.
In Shanghan, if the pulse is knotted (Jie) and there is palpitation (Xin Dong Ji), Zhi Gancao Tang (Honey-Fried Licorice Decoction) should be used.
Regarding Zhi Gancao Tang, it mentions only knotted/intermittent pulse and palpitation, without specifying prior symptoms or medications. Analyzing the formula, it nourishes True Yin, restores dryness, and harmonizes Ying while dispersing pathogens. It implies the patient had constitutional weak Stomach Qi, so sweating/purgation failed, further injuring Stomach Qi and depleting True Yin, leading to palpitation and intermittent pulse. This differs from palpitation due to water retention (tight vs. intermittent/knotted). Knotted pulse indicates righteous Qi deficiency with latent Yang pathogens harassing True Yin, causing Yin-Yang conflict and restless palpitation. With pathogens lingering and Yin severely depleted, moistening dryness, nourishing Yin, harmonizing Ying, and dispersing pathogens is correct. The formula uses Renshen and Gancao to tonify Stomach Qi; Guizhi and Gancao to harmonize Ying and Wei; Maidong, Shengdi, Ejiao, and Hema to moisten channels, benefit blood, restore pulse, and connect to the Heart. Qingjiu (Clear Wine) is added to assist efficacy. For those with dry fluids, constipation is anticipated. Maidong and Shengdi nourish the Bladder’s source; Hema and Ejiao address Large Intestine dryness, preventing Yin deficiency, fluid exhaustion, fire dryness, and blood depletion. This demonstrates Zhongjing’s special insight in saving Yin and retreating Yang.
After Shanghan sweating, if the body and eyes turn yellow, it is because Cold-Dampness in the interior is unresolved. Purging is contraindicated; seek resolution within the context of Cold-Dampness.