（三十七）伤寒下利。日十余行。脉反实者。死。
实。言邪胜也。
（三十八）下利有微热而渴。脉弱者。令自愈。
微热。阳渐回也。渴内燥未复也。弱。邪退也。令自愈。言不须治也。
（三十九）下利。脉数而渴者。令自愈。设不瘥。必清脓血。以有热故也。
清。与圊通。脉数。与上文微热互相发明。清。犹言便脓血也。
（四十）下利。脉数有微热。汗出。令自愈。设复紧。为未解。
此与上二条互相发明。汗出。亦阳回气彻也。紧。寒未除也。
（四十一）下利。脉沉而迟。其人面少赤。身有微热。下利清谷者。必郁冒汗出而解。病患
必微厥。所以然者。其面戴阳。下虚故也。
诸阳聚于面。少赤。亦阳回也。故曰戴阳。郁冒。作汗也。微厥。邪正争也。下虚指利而言也。
（四十二）下利。手足厥冷。无脉者。灸之不温。若脉不还。反微喘者。死。
喘。言息短而声不续。阳气衰绝也。
（四十三）下利后。脉绝。手足厥冷。 时脉还。手足温者。生。脉不还者。死。
。音碎。 时。周时也。此与上条互相发明。
（四十四）下利。寸脉反浮数。尺中自涩者。必清脓血。
清。与圊同。寸反浮数者。热转上逆也。尺中自涩者。热壅而血瘀也。
（四十五）下利。脉沉弦者。下重也。脉大者。为未止。脉微弱数者。为欲自止。虽发热。
不死。
下重。谓滞下也。大则病进。微弱者邪气衰也。
（四十六）热利下重者。白头翁汤主之。
白头翁汤方
白头翁（三两） 黄连（三两去须） 黄柏（三两去皮） 秦皮（三两）
上四味。以水七升。煮取二升。去滓。温服一升。不愈。更服一升。
此申上条而出其治。白头翁。逐血以疗癖。秦皮。洗肝而散热。黄连。调胃而浓肠。黄柏者。
除热而止泄也。
（四十七）下利。欲饮水者。以有热故也。白头翁汤主之。
有热。谓亡津液而内燥。所以欲饮水也。方同上。
（四十八）干呕吐涎沫头痛者。吴茱萸汤主之。
厥阴之脉。挟胃。属肝。上贯膈。布胁肋。循喉咙之后。上入颃颡。连目系。上出额。与督
脉会于巅。其支者。复从肝。别贯膈。上注肺。故灵枢曰。是肝所生病者。腹满呕逆。然则厥阴
之邪。循经而上逆。故其证见如此。方见阳明篇。
（四十九）呕而发热者。小柴胡汤主之。
小柴胡或为有呕。故通其治。
（五十）呕而脉弱。小便复利。身有微热。见厥者难治。四逆汤主之。
脉弱。虽似邪衰。而小便复利。则是里属虚寒也。故曰见厥者难治。以身有微热也。故虽厥。
可以四逆汤得救其阳之复。
（五十一）呕家有痈脓者。不可治呕。脓尽自愈。
肝脉。其支者上注肺。肝主血。善呕。血热瘀。与肺痿者。皆为痈而呕脓。不可治者。谓脓
当呕。与邪逆而呕者不同也。
（五十二）伤寒本自寒下。医复吐下之。寒格更逆吐下。若食入口即吐。干姜黄连黄芩人参
汤主之。
干姜黄连黄芩人参汤方
干姜（三两去皮） 黄连（三两去须） 黄芩（三两） 人参（三两）
上四味。以水六升。煮取二升。去滓。分温再服。
寒格。谓药寒致成格拒也。干姜人参。正治以遏其吐。黄连黄芩。反佐以通其格。
（五十三）伤寒大吐大下之。极虚。复极汗出者。以其人外气怫郁。复与之水。以发其汗。
因得哕。所以然者。胃中寒冷故也。
上条以药吐下言。此以水发汗言。亦互明之意。
（五十四）伤寒哕而腹满。视其前后。知何部不利。利之则愈。
哕。承上条而言。腹满。即寒生 胀也。前后。谓二便也。三条疑太阳中篇错简。
(37) In a Shanghan (Cold Damage) condition presenting with diarrhea, if the patient defecates more than ten times a day and the pulse is unexpectedly excess-strong (Shi), it indicates a fatal prognosis.
"Excess-strong" refers to the predominance of pathogenic factors.
(38) In diarrhea accompanied by slight fever and thirst, if the pulse is weak, the disease will resolve spontaneously.
Slight fever indicates the gradual return of Yang Qi; thirst indicates that internal dryness has not yet recovered due to fluid deficiency; a weak pulse indicates the retreat of pathogens. "Spontaneous resolution" means no treatment is required for recovery.
(39) In diarrhea, if the pulse is rapid and there is thirst, the disease will resolve spontaneously. If it does not improve, pus and blood will inevitably appear in the stool, due to the presence of Heat.
"Qing" is interchangeable with "Qing" (to visit the latrine). The rapid pulse corroborates the "slight fever" mentioned in the previous clause. Here, "Qing" refers to the passage of pus and blood in the stool.
(40) In diarrhea, if the pulse is rapid, there is slight fever, and sweating occurs, the disease will resolve spontaneously. If the pulse becomes tight again, the pathogen has not been resolved.
This clause corroborates the preceding two. Sweating also indicates the return of Yang Qi and the thorough circulation of Qi. A tight pulse indicates that Cold has not yet been eliminated.
(41) In diarrhea, if the pulse is deep and slow, the patient's face shows slight redness, the body has slight fever, and the stool contains undigested food (Wan Gu Bu Hua), the patient will inevitably experience Yu Mao (dizziness and confusion as if covered), followed by sweating and resolution. The patient will likely have slight cold limbs (Jue). This is because the facial redness is Dai Yang (Floating Yang), caused by deficiency and Cold in the lower Jiao.
All Yang meridians converge on the face; slight redness here also indicates the return of Yang, hence termed "Dai Yang". Yu Mao is a precursor to sweating. Slight Jue represents the struggle between Healthy Qi and Pathogens. "Lower deficiency" refers to the deficiency resulting from diarrhea.
(42) In diarrhea, if the hands and feet are cold and the pulse is absent, and after moxibustion the limbs remain cold and the pulse does not return, but instead slight panting occurs, it indicates a fatal prognosis.
"Panting" refers to shortness of breath with discontinuous sounds, indicating the exhaustion and extinction of Yang Qi.
(43) After diarrhea, if the pulse vanishes and the hands and feet are cold, but the pulse occasionally returns and the hands and feet become warm, the prognosis is good (Life); if the pulse does not return, it indicates death.
"Sui" sounds like "Cu", meaning sudden or intermittent. "Shi" means periodically or occasionally. This clause corroborates the previous one.
(44) In diarrhea, if the Cun (inch) pulse is unexpectedly floating and rapid, while the Chi (cubit) pulse is naturally choppy (Se), pus and blood will inevitably appear in the stool.
"Qing" is interchangeable with "Qing". An unexpectedly floating and rapid Cun pulse indicates that Heat is turning upward and reversing; a naturally choppy Chi pulse indicates that Heat stagnation leads to Blood stasis.
(45) In diarrhea, if the pulse is deep and wiry (Xian), there is a sensation of heaviness and urgency in the lower rectum (Li Ji Hou Zhong); if the pulse is large, the disease has not stopped; if the pulse is weak, minute, and rapid, the disease is about to stop spontaneously. Even if there is fever, it will not be fatal.
"Heaviness in the lower part" refers to the feeling of tenesmus seen in dysentery. A large pulse indicates disease progression; a weak and minute pulse indicates the decline of pathogenic factors.
(46) For heat-type diarrhea accompanied by tenesmus, Bai Tou Weng Tang (Pulsatilla Decoction) is the primary treatment.
Bai Tou Weng Tang Formula
Bai Tou Weng (Pulsatillae Radix) (3 liang) Huang Lian (Coptidis Rhizoma) (3 liang, remove musts) Huang Bo (Phellodendri Cortex) (3 liang, remove bark) Qin Pi (Fraxini Cortex) (3 liang)
The above four ingredients are boiled in seven sheng of water until two sheng remain. Strain the dregs. Take one sheng warm. If not cured, take another sheng.
This clause elaborates on the treatment for the previous condition. Bai Tou Weng expels blood stasis to treat accumulations; Qin Pi clears the Liver and dissipates Heat; Huang Lian regulates the Stomach and thickens the intestines; Huang Bo eliminates Heat and stops diarrhea.
(47) In diarrhea, if the patient desires to drink water, it is due to Heat. Bai Tou Weng Tang (Pulsatilla Decoction) is the primary treatment.
"Having Heat" refers to the depletion of Jin Ye (Body Fluids) causing internal dryness, hence the desire to drink. The formula is the same as above.
(48) For dry heaving, vomiting of saliva/froth, and headache, Wu Zhu Yu Tang (Evodia Decoction) is the primary treatment.
The Jueyin Liver meridian clamps the Stomach, belongs to the Liver, passes through the diaphragm, distributes along the costal region, follows the posterior aspect of the throat, enters the nasopharynx (Hang Sang), connects to the eye system, emerges above the forehead, and meets the Du Meridian at the vertex. Its branch diverges from the Liver, pierces the diaphragm, and ascends to inject into the Lung. Thus, the Ling Shu states: Diseases generated by the Liver include abdominal fullness and vomiting/reversal of Qi. Therefore, when Jueyin pathogens reverse upward along the meridian, these symptoms manifest. The formula is found in the Yangming chapter.
(49) For vomiting accompanied by fever, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment.
Since Xiao Chai Hu Tang syndrome sometimes presents with vomiting, this formula is generally applicable for its treatment.
(50) For vomiting with a weak pulse, free urination, slight fever in the body, and the appearance of cold limbs (Jue), the condition is difficult to treat. Si Ni Tang (Frigid Extremities Decoction) is the primary treatment.
Although a weak pulse may seem to indicate declining pathogens, free urination indicates interior deficiency-Cold. Hence, the appearance of Jue makes it difficult to treat. However, due to the slight fever, Si Ni Tang can be used to rescue and restore Yang Qi despite the Jue.
(51) For patients vomiting due to abscesses and pus, do not treat the vomiting directly; once the pus is exhausted, it will heal spontaneously.
The branch of the Liver meridian ascends to inject into the Lung. The Liver governs Blood. Frequent vomiting may result from Blood Heat and stasis. Similar to patients with Fei Wei (Lung Atrophy), they may vomit pus due to abscesses. "Do not treat" means this vomiting is the expulsion of pus, which differs from vomiting caused by the reversal of pathogens.
(52) In Shanghan, if the patient originally had Cold-type diarrhea, and the physician erroneously applied emesis or purgation, leading to Cold rejection (Ge Ju) and further exacerbating vomiting and diarrhea, such that food is vomited immediately upon ingestion, Gan Jiang Huang Lian Huang Qin Ren Shen Tang (Ginger, Coptis, Scutellaria, and Ginseng Decoction) is the primary treatment.
Gan Jiang Huang Lian Huang Qin Ren Shen Tang Formula
Gan Jiang (Zingiberis Rhizoma) (3 liang, remove skin) Huang Lian (Coptidis Rhizoma) (3 liang, remove musts) Huang Qin (Scutellariae Radix) (3 liang) Ren Shen (Ginseng Radix) (3 liang)
The above four ingredients are boiled in six sheng of water until two sheng remain. Strain the dregs. Divide into two doses and take warm.
"Cold Ge" refers to rejection caused by the cold nature of the medicine/pathogen. Gan Jiang and Ren Shen act orthodoxy to suppress vomiting; Huang Lian and Huang Qin act as counter-agents (Fan Zuo) to overcome the rejection.
(53) In Shanghan, after severe emesis and purgation, the patient is extremely deficient. If extreme sweating then occurs, and because the exterior Qi was already constrained (Fu Yu), the physician gave water to induce sweating, resulting in hiccup (Yue). This is due to Cold in the Stomach.
The previous clause discussed drug-induced emesis/purgation; this clause discusses water-induced sweating. They mutually illuminate each other.
(54) In Shanghan, if there is hiccup (Yue) and abdominal fullness, observe the anterior and posterior orifices to determine which part is obstructed; unblocking it will lead to cure.
"Yue" continues from the previous clause. "Abdominal fullness" refers to distension caused by Cold. "Anterior and posterior" refer to urination and defecation. These three clauses are suspected to be misplaced text (Cuo Jian) from the Taiyang chapter.