言太阳中风不当如此治。故曰失其常度。着其变以致戒之意也。两阳。谓风火也。黄。脾土之色也。
脾主肌肉。邪热甚则土燥。故色显然着见于外也。阳盛。阳以气言。火能助气。故盛也。欲衄。待
衄未衄之词。阴虚。阴以血言。热则耗血。故虚也。小便。血液之类也。血耗。故难也。然火能助
气。过则反败气。所以阴阳俱虚竭。言血气俱亏乏也。身体则枯燥。承上文而言亏乏之征也。剂。
齐分也。言汗自头出至颈。自颈齐分。还而不下。灵枢曰。诸阴脉皆至颈胸中而还。独诸阳脉皆
上至头耳。然则是乃阳有汗而阴不汗也。腹满。邪内实也。微喘。热攻于肺。肺受熏蒸而气促急也。
口干。阴虚而津液不足也。咽烂。炎蒸而成腐坏也。或
不大便。言津液不足。有时或则便硬也。谵语。寐中多言妄语。盖言出于心。火盛血衰。心虚而
神乱也。哕。火炽而气逆也。手足为四肢。乃诸阳之本。阳邪盛甚。气乱神昏。所以疾动而不宁
也。小便利者。反上文阴虚小便难而言。利则阴未甚虚。阴未甚虚。则阳犹有可以回之者。所以
为可治也。
（二十九）太阳病。以火熏之。不得汗。其人必躁。到不解。必清血。名为火邪。
清与圊同。熏。亦劫汗法。盖当时庸俗用之。烧坑铺陈。洒水取气。卧病患以熏蒸之之类是也。
躁。手足疾动也。到。言犹反也。谓徒躁扰而反不得解也。清血。便血也。汗为血之液。血得热
则行。火性大热。既不得汗。则血必横溢。阴盛者。所以下圊也。
（三十）太阳病。二日。反躁。反尉其背。而大汗出。大热入胃。胃中水竭。躁烦。必发谵语。
十余日。振 自下利者。此为欲解也。故其汗从腰以下不得汗。欲小便不得。反呕。欲失溲。足下
恶风。大便 。小盒饭数。而反不数。及多大便已。头卓然而痛。其人足心必热。谷气下流故也。
尉。俗作熨。 与硬同。下利下流之下。去声。数。音朔。二日。当传之时也。反躁。欲传也。熨
其背。亦火劫汗法也。大汗出者。悖道以治。故出骤也。大热。邪热与火热相抟也。入胃。胃属土。
故火邪先之也。水竭。火盛则水涸也。躁烦谵语。皆内热也。十余日。过经同也。振。鼓战。 。
悚缩。作欲解之先兆也。下利。阴虚而津液偏于下走也。欲解。待解未解之词。故其汗从腰
以下不得汗。至大便硬一节。乃承上文说犹未解之意。言振 若是作汗。则热散而病解。今自利。
津液又偏于下泄。胃中又不足。所以待解不解。汗不到下体。干而不得小便。阳气不下通。反上逆而呕。
失。犹言不也。溲。小便也。足下恶风。无
阳以为卫护也。大便硬。无津液以为润送也。小盒饭数而反不数至末。是反上文又说要解的意。盖
言以人之津液偏渗而论之。大便既硬。则小盒饭多而频数。故以不数为反。既反不数。则津液又当
回于胃中可知也。及。言待及津液由此而回足。则大便得润而当出。出多者。以待则久久故多也。
卓。特也。头特然而痛。阴气上达也。足心必热。阳气下通也。谷气。食气也。言待解未解以来。
为津液又不足。阳不下。阴不上。是以犹不解。今阴上达而头独觉痛。阳下行而足心则
热者。以胃中津液回足。大便润而得出。食气已下行也。病虽不言解。而解之意已隐然见于不言之
表矣。读者当自悟可也。
（三十一）太阳病。当恶寒发热。今自汗出。不恶寒发热。关上脉细数者。以医吐之过也。
一二日吐之者。腹中饥。口不能食。三四日吐之者。不喜糜粥。欲食冷食。朝食暮吐。以医吐之所致。
此为小逆。
此原病变由于误治。因复推其未为大过。亦严戒警之意。关上。脾胃之部位也。细则
为虚。数则为热。所以知其误于吐也。一二日。言病之初。犹在太阳也。腹中饥。阳能化谷而吐后
胃虚也。口不能食。胃受伤也。三四日。病在阳明也。欲食冷食。阳明恶热也。朝。自寅至辰。少阳
之王时。少阳未病。故饮食如常也。暮。自申至戌。阳明之王时。阳明胃伤。故当其时则
吐也。小逆。言证未甚变。邪未乱传。但以吐伤其胃气。致使止妨于饮食。所以犹得为小逆也。
然逆虽曰小。君子必求无逆而后可。是故致戒如此。
（三十二）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。
此亦误吐之变证。不恶寒不欲近衣。言表虽不显热而热在里也。故曰内烦。内烦者。吐则津液
亡。胃中干。而热 内作也。
（三十三）太阳病。小便利者。以饮水多。必心下悸。小便少者。必苦里急也。
饮水多而心下悸者。心为火脏。水多则受制也。小便少则水停。所以里急也。
（三十四）太阳中风。下利呕逆。表解者。乃可攻之。其人 汗出。发作有时。头痛。心下
痞硬。满引胁下痛。干呕短气。汗出不恶寒者。此表里未和也。十枣汤主之。
十枣汤方
芫花（熬） 甘遂 大戟 大枣（十枚擘）
上上三味。等分。各别捣为散。以水一升半。先煮大枣肥者十枚。取八合。去滓。内药末。强
人服一钱匕。羸人服半钱。温服之。平旦服。若下少病不除者。明日更服加半钱。得快下利后。糜
粥自养。
下利下少之下。更。皆去声。羸。音雷。养。上声。乃可攻之以上。喻人勿妄下早之意。 汗出至
短气。言证虽有里。犹未可下。直至汗出不恶寒。方是承上起下。言当下以出其治。然下之为下。义
各不同。此盖邪热伏饮。抟满胸胁。与结胸虽涉近似。与胃实则大不相同。故但散之以芫花。达之
以甘遂。泻虽宜苦。用则大戟。胜之必甘。汤斯大枣。是皆蠲饮逐水之物。而用情自尔殊常。羸。瘦
劣也。糜粥。取糜烂过熟易化。而有能补之意。
（三十五）太阳病。外证未除。而数下之。遂协热而利。利下不止。心下痞硬。表里不解者。
桂枝人参汤主之。
桂枝人参汤方
桂枝（四两去皮） 甘草（四两炙） 白术（三两） 人参（三两） 干姜（三两）
上五味。以水九升。先煮四味取五升。内桂。更煮取三升。去滓。温服一升。日再服。夜一服。
数。读迟数有命之数。音速。数下利下之下。去声。数。言失于急遽。下之太早。所以原反。而
为反之互词也。协。互相和同之谓。言误下则致里虚。外热乘里虚而入里。里虚遂协同外热变而
为利。利即俗谓泄泻。是也。不止。里虚不守也。痞硬者。正虚邪实。中成滞碍。痞塞而不通也。
以表未除也。故用桂枝以解之。以里下虚也。故用理中以和之。干姜兼能散痞
硬之功。甘草亦有和协热之用。是故方则从理中。加桂枝而易名。义则取表里。期两解之必效。
（三十六）太阳病。桂枝证。医反下之。利遂不止。脉促者。表未解也。喘而汗出者。葛根黄
连黄芩汤主之。
葛根黄连黄芩汤方
葛根（半斤） 黄连（三两） 黄芩（二两） 甘草（二两炙）
上四味。以水八升。先煮葛根减二升。内诸药。煮取二升。去滓。分。温再服。
此与上条因同而变异。利遂不止。以上。与上条上节。两相更互发明之词。脉促以下。言变殊。
故治异也。促为阳邪上盛。阳主表故为表未解之诊。喘汗者。里虚阴弱而表阳不为之固护也。夫表
未解而利则属胃。有阳明之分也。故肌之当解者。从葛根以解之。以喘汗不独表实而有里虚也。
故但从中治而用甘草以和之。然利与上条同。而上条用理中者。
以痞硬也。此用芩连者。以喘汗属热为多也。然则四物之为用。其名虽与上条殊。其实两解表里
则一耳。
（三十七）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。
下。去声。上。上声。气上冲者。阳主气而上升。风属阳。所以乘下后里虚入里而上冲也。但
上冲而不他变。则亦有可下之机而不足为大误。然终以不先解表。致有上冲之逆。故曰。
可与桂枝汤方用前法。言以桂枝汤与前番所下之汤法合汤。再行表里两解之。如桂枝加大黄之类是
也。若不上冲。则非阳邪可知。故曰不可与之。
（三十八）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。
桂枝去芍药汤方
于桂枝汤方内。去芍药一味。余根据桂枝汤法。
桂枝去芍药加附子汤方
于桂枝汤方内去芍药。加附子一枚。
下。去声。去。上声。凡下而证变者。皆误下也。胸满者。阳邪乘虚入里而上抟于膈也。用桂
枝者。散胸满之阳邪也。去芍药者。恶其走阴而酸收也。微恶寒。阳虚也。加附子。回阳也。
（三十九）喘家作桂枝汤。加浓朴杏子。佳。（佳。一本作仁。）
此揭言阳邪作喘治法之大要。
（四十）太阳病。下之微喘者。表未解故也。桂枝加浓朴杏仁汤主之。
桂枝加浓朴杏仁汤方
于桂枝汤方内。加浓朴二两。杏仁五十个。余根据桂枝汤法。
此详上条而重出。喘者。气夺于下而上行不利。故呼吸不顺而声息不续也。盖表既未罢。下则
里虚。表邪入里而上冲。里气适虚而下夺。上争下夺。所以喘也。然微者。言气但亏乏耳。不似
大喘之气脱也。以表尚在。不解其表。则邪转内攻而喘不可定。故用桂枝。解表也。加浓朴。利
气也。杏仁有下气之能。所以为定喘当加之要药。
（四十一）太阳病。医发汗。遂发热恶寒。因复下之。心下痞。表里俱虚。阴阳气并竭。无阳
则阴独。复加烧针。因胸烦面色青黄。肤 者难治。今色微黄。手足温者易愈。
复下之下。去声。此言病变由于误治。而明可愈不可愈之分。以见道本自然。人不可苟之意。
下原初误。痞言再误。表以误汗言。里以误下言。故曰俱虚。阴指里。阳指表。无阳。以俱虚言也。
阴独。谓痞也。青黄。脾受克贼之色。微黄。土见回生之色。手足温。阳气回于四末也。言既经
反复之误。又见克贼之色。肌肤 动而不宁。则脾家之真阴败。而为难治。今则
土见回生之色。四末得温。胃家之真阳复。故为易愈也。然则均误也。如彼变则难。如此变则易。
自然而然。所谓道也。虽有智者。岂能加毫末。是故君子慎其初以求尽道。不苟道以罔人。小人反是。
（四十二）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。
凡在太阳。皆表证也。误下则变。亦有乱生而不可以一途拘者。促为阳邪上盛。
阳盛于上而不结胸。则邪必待散而欲愈可知。浮为热在上焦。下后脉浮。则邪热上抟必结于胸可诊。
紧则寒邪客于下焦。下焦有少阴。少阴之脉。循咽挟舌
本。客邪为热。循经而上冲。所以知必作咽痛也。弦为邪抟少阳。少阳之脉循胁。所以知两胁必拘
急也。细数者。邪气因循而欲传。故知头痛未止也。沉紧。有寒气也。故气上逆而必欲呕。沉滑
邪干水分也。故必协热作利。浮滑。气伤血分也。
故知必致下血。夫以病在太阳。一误下之余。而其变乱有如此者。是故君子。不可不慎也。
（四十三）太阳病。脉浮而动数。浮则为风。数则为热。动则为痛。数则为虚。头痛发热。
微盗汗出而反恶寒者。表未解也。医反下之。动数变迟。膈内拒痛。胃中空虚。客气动膈。短气
躁烦。心中懊 。阳气内陷。心下因硬。则为结胸。大陷胸汤主之。若不结胸。但头汗出。余无汗。
剂颈而还。小便不利。身必发黄也。
大陷胸汤方
大黄（六两去皮） 芒硝（一升） 甘遂（一钱另末）
上三味。以水六升。先煮大黄取二升。去滓。内芒硝。煮一两沸。内甘遂末。温服一升。得快
利。止后服。
懊。影考切。 。音农。太阳之脉本浮。动数者。欲传也。浮则为风四句。承上文以释其义。
头痛至表未解也。言前证。然太阳本自汗。而言微盗汗。本恶寒。而言反恶寒者。稽久而然也。医
反下之。至大陷胸汤主之。言误治之变与救变之治。膈。心胸之间也。拒。格拒也。言邪气入膈。
膈气与邪气相格拒而为痛也。空虚。言真气与食气皆因下而致亏损也。客气。邪气也。短气。真气不
足以息也。懊 。悔恨之意。心为邪乱而不宁也。阳气客气之别名也。以本外邪。故曰客气。以邪本风。
故曰阳气。以里虚也。因而蹈入。故曰内陷。阳性上浮。故结于胸。以胸有凶道而势大也。故曰。大
陷胸汤。芒硝之咸。软其坚硬也。甘遂之甘。达之饮所也。然不有勇敢之才。定乱之武。不能
成二物之功用。故必大黄之将军。为建此太平之主
将。若不结胸至末。以变之亦有轻者言。盖谓邪之内陷。或不结于胸。则无有定聚。但头汗出者。
头乃诸阳之本。阳健其用。故汗出也。余处无汗者。阴脉上不过颈。阳不下通。阴不任事。故汗
不出也。小便不利者。阳不下通。阴不任事。化不行而湿停也。湿停不行。必反渗土而入胃。胃土
It is stated that the treatment for Taiyang Wind Strike (Taiyang Zhong Feng) should not be conducted in this manner. Therefore, it is said that this deviates from the standard protocol. Pointing out these variations serves as a warning. "Two Yangs" refers to Wind pathogen and Fire pathogen (Heat-Fire). "Yellow" is the color corresponding to the Spleen Earth.
The Spleen governs the muscles. When pathogenic heat is severe, it causes Spleen Earth to become dry, thus the yellow color manifests prominently on the body surface. "Yang Excess" refers to Qi. Fire can assist Qi, leading to hyperactivity. "Desire for epistaxis" describes a state where nosebleed is impending but has not yet occurred. "Yin Deficiency" refers to Blood. Heat consumes Blood, leading to deficiency. Urine belongs to the category of Blood fluids. Since Blood is consumed, urination becomes difficult. However, while Fire assists Qi, excess Fire can damage Qi, resulting in the exhaustion of both Yin and Yang. This means both Blood and Qi are depleted. The body becomes dry and rough, which is a sign of depletion mentioned above. "Ji" refers to a boundary or level. It describes sweat emerging only from the head down to the neck, stopping at this level without flowing further down. The *Ling Shu* states: All Yin meridians reach the neck and chest and return, whereas all Yang meridians ascend to the head and ears. Thus, this indicates that Yang has sweat while Yin does not. Abdominal fullness is due to internal pathogenic excess. Mild wheezing occurs because Heat attacks the Lung; the Lung is steamed by Heat, causing rapid breathing. Dry mouth results from Yin deficiency and insufficient Body Fluids. Throat ulceration is caused by rotting due to Heat steaming. Sometimes there is constipation, meaning insufficient Body Fluids lead to hard stools. Delirious speech involves talking nonsense during sleep. Speech originates from the Heart; with excessive Fire and deficient Blood, Heart Qi deficiency leads to mental confusion. Hiccups occur due to blazing Fire causing rebellious Qi. Hands and feet belong to the four limbs, which are the roots of all Yang meridians. When Yang pathogens are extremely abundant, Qi becomes chaotic and spirit confused, causing restless movement. If urination is free, it contrasts with the previous mention of difficult urination due to Yin deficiency. Free urination indicates that Yin is not severely deficient. If Yin is not severely deficient, Yang still has the potential to recover, hence it is treatable.
(29) In Taiyang disease, if moxibustion or fumigation is used and sweating does not occur, the patient will inevitably become irritable. If the condition persists and does not resolve, bloody stool will definitely occur. This is called "Fire Pathogen."
"Qing" is synonymous with "Qing" (toilet), referring here to bloody stool. "Fumigation" is also a method of forcibly inducing sweat. It likely refers to crude practices of the time, such as digging a pit, laying bedding, sprinkling water to generate steam, and having the patient lie on it for fumigation. Irritability refers to restless movement of hands and feet. "Dao" implies reversal, meaning merely restless without resolution. "Qing blood" means bloody stool. Sweat is the fluid of Blood; when Blood encounters Heat, it moves rapidly. Fire nature is intensely hot. Since sweating cannot occur, Blood must overflow. In cases of Yin excess, bleeding occurs downward from the intestines.
(30) In Taiyang disease, on the second day, irritability appears unexpectedly. The doctor mistakenly applies hot compresses to the back, causing profuse sweating. Intense Heat enters the Stomach, exhausting Stomach fluids. Irritability and restlessness ensue, inevitably leading to delirium. After more than ten days, if tremors occur followed by spontaneous diarrhea, this indicates the disease is about to resolve. However, if sweat is absent below the waist, urination is difficult, vomiting occurs, there is a desire to lose urine control, cold sensation in the soles of the feet, hard stools, frequent but ineffective urge to urinate, and finally, upon passage of stool, sudden headache and warmth in the soles of the feet, this is because Grain Qi (nutritive energy from food) flows downward.
"Wei" is commonly written as "Yun" (hot compress). "Ying" is identical to "Hard". "Xia li" (diarrhea) pronunciation note: "Li" is pronounced with the departing tone. "Shuo" is pronounced "shuo". On the second day, transmission should occur. Unexpected irritability suggests impending transmission. Hot compressing the back is also a fire-forced sweating method. Profuse sweating results from treating against the proper principle, hence sudden onset. Intense Heat is the struggle between pathogenic heat and fire heat. Entering the Stomach: since the Stomach belongs to Earth, Fire pathogens attack it first. Exhaustion of Water (fluids) occurs because Fire prosperity dries up Water. Irritability, restlessness, and delirium are all manifestations of internal Heat. More than ten days indicates passing the meridian cycle. Tremors refer to shivering. "Ying" refers to shrinking in fear, serving as a precursor to resolution. Diarrhea occurs because Yin is deficient and fluids drain downward. "Yu jie" (desire to resolve) is a phrase indicating waiting for resolution. Thus, lack of sweat below the waist, up to the point of hard stool, continues the theme of unresolved condition. If tremors were like sweating, Heat would dissipate and the disease would resolve. Now, however, spontaneous diarrhea drains fluids downward, further depleting the Stomach, preventing resolution. Lack of sweat in the lower body causes dryness and inability to urinate; Yang Qi fails to descend smoothly, rebelling upward causing vomiting. "Shi" means not. "Sou" means urine. Cold sensation in soles indicates lack of Yang protection. Hard stool indicates lack of fluids for lubrication. From frequent ineffective urination to the end, it reiterates the hope for resolution. Considering fluid distribution, if stool is hard, urine should be frequent. Thus, infrequency is abnormal. If abnormal, fluids should return to the Stomach. When fluids return sufficiently, stool becomes moist and passes. Large volume indicates accumulation over time. "Zhuo" means distinct/sudden. Sudden headache indicates Yin Qi ascending. Warm soles indicate Yang Qi descending. Grain Qi refers to food energy. During the waiting period, insufficient fluids prevent Yang descent and Yin ascent, keeping the disease unresolved. Now, Yin ascends causing headache, Yang descends causing warm soles, because Stomach fluids have returned, stool is moist and passed, and food energy has moved downward. Although resolution is not explicitly stated, the intent is implicit. Readers should comprehend this themselves.
(31) In Taiyang disease, chills and fever are expected. Now, there is spontaneous sweating, no chills, and no fever. The pulse at the Guan position is fine and rapid. This is an error caused by the physician's use of emesis.
If emesis is used on day one or two, the patient feels hungry in the abdomen but cannot eat. If used on day three or four, the patient dislikes congee and desires cold food, vomiting what was eaten in the morning by evening. These are consequences of erroneous emesis. This is termed a "Minor Reversal" (Xiao Ni).
This explains that the pathology stems from mis-treatment, deducing that major damage has not yet occurred, serving as a strict warning. The Guan position corresponds to the Spleen and Stomach. Fine pulse indicates deficiency; rapid pulse indicates Heat. Hence, emesis error is identified. Days one and two represent the early stage, still in Taiyang. Hunger indicates Yang can transform grain, but post-emesis Stomach Qi is weak. Inability to eat indicates Stomach injury. Days three and four indicate the disease is in Yangming. Desire for cold food reflects Yangming's aversion to Heat. "Zhao" (morning) spans Yin to Chen hours, the peak time of Shaoyang. Since Shaoyang is unaffected, diet remains normal. "Mu" (evening) spans Shen to Xu hours, the peak time of Yangming. Since Yangming/Stomach is injured, vomiting occurs during this time. "Minor Reversal" means symptoms have not changed drastically, pathogens have not spread chaotically, but emesis damaged Stomach Qi, merely hindering diet. Thus, it remains a minor reversal. However, even minor reversals should be avoided by the superior person. Hence, this caution.
(32) In Taiyang disease, after erroneous emesis, the patient no longer feels chills and dislikes wearing clothes. This is called "Internal Restlessness" (Nei Fan) caused by emesis.
This is another variation of erroneous emesis. No chills and dislike for clothing indicate that although exterior Heat is not obvious, Heat resides internally. Hence, "Internal Restlessness." Internal Restlessness arises because emesis causes loss of Body Fluids, drying the Stomach, allowing Heat to arise within.
(33) In Taiyang disease, if urination is free, it is due to excessive drinking, which必然 causes palpitations in the epigastrium. If urination is scanty, it必然 causes internal urgency and discomfort.
Excessive drinking leading to epigastric palpitations occurs because the Heart is a Fire organ; excess Water suppresses Heart Fire. Scanty urination leads to water retention, causing internal urgency.
(34) In Taiyang Wind Strike, accompanied by diarrhea and vomiting/retching. If the exterior syndrome is resolved, interior attacking methods may be used. If the patient has continuous sweating occurring at intervals, headache, hardness and fullness in the epigastrium radiating to the hypochondrium, dry retching, shortness of breath, sweating without chills, this indicates disharmony between exterior and interior. Shi Zao Tang (Ten Date Decoction) is indicated.
Shi Zao Tang Formula
Yuan Hua (Processed Spurge Flower) Gan Sui (Kansui Root) Da Ji (Euphorbia Lathyris Root) Da Zao (Ten Jujube Dates, split open)
Process the first three ingredients equally, grinding each separately into powder. Boil ten large Jujube Dates in 1.5 liters of water to obtain 800 ml. Strain, add the powders. Strong adults take one qian bi (coin-sized measure); frail individuals take half. Take warm on an empty stomach in the morning. If bowel movement is insufficient and disease persists, increase dose by half a qian bi the next day. After achieving brisk purgation, nourish with millet porridge.
Note: "Xia li" and "xia shao" - "li/shao" pronounced departing tone. "Geng" pronounced departing tone. "Lei" pronounced lei. "Yang" pronounced rising tone. "Nai ke gong zhi" above advises against premature purging. "Se se han chu" to "duan qi" describes interior symptoms that are not yet ready for purgation. Only when sweating occurs without chills is it appropriate to proceed with purging. The term "xia" (purge/down) has various meanings. Here, it addresses latent Heat and retained fluid clumping in the chest and hypochondrium. Similar to Jie Xiong (Chest Binding) but different from Wei Shi (Stomach Excess). Yuan Hua disperses, Gan Sui reaches, Da Ji purges (bitter), and Da Zao wins over (sweet). These are phlegm-fluid resolving agents, but their application is unique. "Lei" means thin/frail. "Mi zhou" (millet porridge) is easily digested and nourishing.
(35) In Taiyang disease, if exterior signs persist and multiple purgations are performed,協熱利 (collaborative heat diarrhea) ensues, with unremitting diarrhea and epigastric hardness. If both exterior and interior remain unresolved, Gui Zhi Ren Shen Tang (Cinnamon Twig and Ginseng Decoction) is indicated.
Gui Zhi Ren Shen Tang Formula
Gui Zhi (Cinnamon Twig, 4 liang, bark removed) Zhi Gan Cao (Honey-fried Licorice Root, 4 liang) Bai Zhu (Atractylodes Macrocephala Rhizome, 3 liang) Ren Shen (Ginseng Root, 3 liang) Gan Jiang (Dried Ginger, 3 liang)
Boil the five ingredients in 9 liters of water. First boil the first four to reduce to 5 liters. Add Gui Zhi, boil further to reduce to 3 liters. Strain. Take 1 liter warm. Twice daily, once at night.
Note: "Shu" (frequent) pronounced "su". "Xia" in "shu xia" and "xia li" pronounced departing tone. "Shu" implies haste/rashness. "Xia zhi tai zao" (purgation too early) leads to counter-intuitive results. "Xie" means mutual harmony. Erroneous purgation causes interior deficiency, allowing exterior Heat to enter. Interior deficiency collaborates with exterior Heat to cause diarrhea. "Bu zhi" (unremitting) indicates interior deficiency failing to hold. "Pi ying" (hard fullness) results from righteous deficiency and pathogenic excess creating obstruction. Since exterior is unresoved, Gui Zhi resolves the exterior. Since interior is deficient, Li Zhong Tang harmonizes the interior. Gan Jiang disperses Pi Ying; Gan Cao harmonizes collaborative Heat. The formula is based on Li Zhong Tang with added Gui Zhi. The principle aims to resolve both exterior and interior simultaneously.
(36) In Taiyang disease with Gui Zhi pattern, if the physician erroneously purges, diarrhea persists. If the pulse is Cui (surging/interrupted), the exterior is unresolved. If wheezing and sweating occur, Ge Gen Huang Lian Huang Qin Tang (Kudzu, Coptis, and Scutellaria Decoction) is indicated.
Ge Gen Huang Lian Huang Qin Tang Formula
Ge Gen (Kudzu Root, 8 liang) Huang Lian (Coptis Rhizome, 3 liang) Huang Qin (Scutellaria Root, 2 liang) Zhi Gan Cao (Honey-fried Licorice Root, 2 liang)
Boil the four ingredients in 8 liters of water. First boil Ge Gen to reduce by 2 liters. Add remaining herbs, boil to obtain 2 liters. Strain. Divide into two warm doses.
This case shares the same cause as the previous article but presents different variations. "Diarrhea persists" mirrors the previous section's discussion. "Pulse Cui" onwards highlights the difference, justifying different treatment. Cui pulse indicates Yang pathogen excess upward. Yang governs the exterior, so this signals unresolved exterior. Wheezing and sweating result from interior deficiency and Yin weakness, failing to secure exterior Yang. Unresolved exterior with diarrhea involves the Stomach/Yangming. Ge Gen resolves the muscle layer/exterior. Since wheezing/sweating involve interior deficiency alongside exterior excess, Gan Cao is used to harmonize the middle. Although diarrhea is similar to the previous case, Li Zhong Tang was used there due to epigastric hardness. Here, Huang Lian/Huang Qin are used because wheezing/sweating are predominantly Heat-related. Thus, while names differ, the goal of resolving both exterior and interior remains the same.
(37) After purgation in Taiyang disease, if Qi rushes upward, Gui Zhi Tang (Cinnamon Twig Decoction) may be given using the previous method. If Qi does not rush upward, do not give it.
Note: "Xia" pronounced departing tone. "Shang" pronounced rising tone. Qi rushing upward occurs because Yang governs ascending Qi. Wind is Yang. After purgation, interior deficiency allows pathogen to enter and rush upward. If only upward rushing occurs without other changes, there may be a chance for purgation, but it is not a major error. Ultimately, failure to resolve the exterior first caused this upward rebellion. Thus, "Give Gui Zhi Tang using previous method." This implies combining Gui Zhi Tang with prior purgative methods to resolve both exterior and interior again, similar to Gui Zhi Jia Da Huang Tang. If no upward rushing, it is not a Yang pathogen, so do not give it.
(38) After purgation in Taiyang disease, if pulse is Cui and chest is full, Gui Zhi Qu Shao Yao Tang (Cinnamon Twig Decoction without Paeonia) is indicated. If slightly aversive to cold, Gui Zhi Qu Shao Yao Jia Fu Zi Tang (Cinnamon Twig Decoction without Paeonia plus Aconite) is indicated.
Gui Zhi Qu Shao Yao Tang Formula
From Gui Zhi Tang formula, remove Shao Yao (Paeonia Root). Follow Gui Zhi Tang preparation method otherwise.
Gui Zhi Qu Shao Yao Jia Fu Zi Tang Formula
From Gui Zhi Tang formula, remove Shao Yao, add one Fu Zi (Prepared Aconite Root).
Note: "Xia" pronounced departing tone. "Qu" pronounced rising tone. Any symptom change after purgation indicates erroneous purgation. Chest fullness results from Yang pathogen entering interior due to deficiency and clumping in the diaphragm. Gui Zhi disperses Yang pathogen causing chest fullness. Removing Shao Yao avoids its Yin-moving and sour-astringent properties. Slight aversion to cold indicates Yang deficiency. Adding Fu Zi restores Yang.
(39) For patients with chronic asthma suffering from Gui Zhi pattern, adding Hou Po (Magnolia Bark) and Xing Ren (Apricot Seed) to Gui Zhi Tang is beneficial. (Benign/Ren variant exists).
This outlines the general principle for treating asthma caused by Yang pathogens.
(40) In Taiyang disease, if mild wheezing occurs after purgation, it is because the exterior is unresolved. Gui Zhi Jia Hou Po Xing Ren Tang (Cinnamon Twig Decoction plus Magnolia Bark and Apricot Seed) is indicated.
Gui Zhi Jia Hou Po Xing Ren Tang Formula
To Gui Zhi Tang, add Hou Po (2 liang) and Xing Ren (50 seeds). Follow Gui Zhi Tang method otherwise.
This elaborates on the previous article. Wheezing occurs because Qi is depleted downward, obstructing upward flow, causing irregular breathing. Since exterior is unresoved, purgation causes interior deficiency. Exterior pathogen enters interior and rushes upward; interior Qi is deficient and sinks downward. Upward contention and downward depletion cause wheezing. Mild wheezing indicates Qi deficiency, unlike severe wheezing involving Qi collapse. Since exterior remains, failing to resolve it allows pathogen to attack interior, making wheezing incurable. Gui Zhi resolves exterior. Hou Po promotes Qi flow. Xing Ren directs Qi downward, making it essential for calming wheezing.
(41) In Taiyang disease, if the physician induces sweating, leading to fever and chills, and then purges, causing epigastric fullness, both exterior and interior become deficient, exhausting Yin and Yang Qi. "No Yang means Yin stands alone." If moxibustion needles are added, causing chest irritability, greenish-yellow complexion, and twitching skin, it is difficult to treat. If the complexion is slightly yellow and hands/feet are warm, recovery is easy.
Note: "Fu xia" - "xia" pronounced departing tone. This explains pathology from mis-treatment and distinguishes recoverable from non-recoverable cases, showing the Dao follows nature and humans should not act rashly. Initial error was sweating; subsequent error was purgation. Exterior refers to sweating error; interior to purgation error. Hence "both deficient." Yin refers to interior; Yang to exterior. "No Yang" refers to overall deficiency. "Yin stands alone" refers to epigastric fullness. Green-yellow is the color of Spleen being overcome. Slightly yellow is the color of Earth recovering. Warm hands/feet indicate Yang returning to extremities. After repeated errors, seeing overcoming colors and twitching skin indicates Spleen True Yin destruction, making it difficult to treat. Seeing recovering Earth color and warm extremities indicates Stomach True Yang restoration, making it easy to treat. Both are errors, but outcomes differ naturally. Even wise men cannot add to this natural order. Thus, gentlemen guard the beginning to fulfill the Dao, not acting rashly to deceive others. Villains do the opposite.
(42) After purgation in Taiyang disease, if pulse is Cui and there is no Chest Binding, the disease is about to resolve. If pulse is Floating, Chest Binding will definitely occur. If pulse is Tight, throat pain will definitely occur. If pulse is Wiry, bilateral hypochondriac stiffness will definitely occur. If pulse is Fine and Rapid, headache will persist. If pulse is Deep and Tight, vomiting will definitely occur. If pulse is Deep and Slippery, collaborative heat diarrhea will occur. If pulse is Floating and Slippery, bloody stool will definitely occur.
All Taiyang conditions are exterior syndromes. Erroneous purgation causes variations that cannot be confined to one pattern. Cui pulse indicates Yang pathogen excess upward. If Yang excess upward does not form Chest Binding, pathogen will dissipate and resolve. Floating pulse indicates Heat in upper Jiao. Post-purgation floating pulse suggests pathogenic Heat clumping in the chest. Tight pulse indicates Cold pathogen in lower Jiao. Lower Jiao contains Shaoyin; Shaoyin meridian runs through throat. Cold transforming to Heat rushes upward along the meridian, causing throat pain. Wiry pulse indicates pathogen clumping in Shaoyang. Shaoyang meridian runs through hypochondrium, causing stiffness. Fine and Rapid pulse indicates pathogen transmitting, so headache persists. Deep and Tight indicates Cold Qi, causing rebellious Qi and vomiting. Deep and Slippery indicates pathogen affecting Water Division, causing collaborative heat diarrhea. Floating and Slippery indicates Qi damaging Blood division, leading to bloody stool. Given Taiyang disease, one erroneous purgation causes such chaos; thus, gentlemen must be cautious.
(43) In Taiyang disease, if pulse is Floating, Active, and Rapid. Floating indicates Wind, Rapid indicates Heat, Active indicates Pain, Rapid indicates Deficiency. Headache, fever, slight nocturnal sweating, and paradoxical chills indicate unresolved exterior. If physician erroneously purges, Active/Rapid pulse becomes Slow. Rejection pain in the diaphragm, empty Stomach, Guest Qi disturbing the diaphragm, shortness of breath, irritability, and mental restlessness (Ao Nao) occur. Yang Qi sinks inward, causing epigastric hardness, forming Chest Binding. Da Xian Xiong Tang (Major Decoction to Sink the Chest) is indicated. If no Chest Binding, but only head sweating with no sweat elsewhere, stopping at the neck, and difficulty urinating, jaundice will definitely develop.
Da Xian Xiong Tang Formula
Da Huang (Rhubarb Root, 6 liang, bark removed) Mang Xiao (Mirabilite, 1 sheng) Gan Sui (Kansui Root, 1 qian, ground separately)
Boil the three ingredients in 6 liters of water. First boil Da Huang to obtain 2 liters. Strain, add Mang Xiao, boil briefly. Add Gan Sui powder. Take 1 liter warm. Achieve brisk purgation, then stop taking.
Note: "Ao" pronounced ao kao qie. "Nao" pronounced nong. Taiyang pulse is naturally Floating. Active/Rapid indicates impending transmission. "Floating is Wind..." explains the previous text. Headache to unresolved exterior describes prior symptoms. Taiyang normally sweats spontaneously; mentioning slight nocturnal sweating, and normally chills but mentioning paradoxical chills, indicates prolonged stagnation. Erroneous purgation leads to Da Xian Xiong Tang, describing mis-treatment variation and rescue. Diaphragm is between heart and chest. Ju means rejection. Pathogen enters diaphragm, diaphragmatic Qi rejects pathogen, causing pain. Kong Xu (empty) means True Qi and Food Qi are depleted by purgation. Ke Qi (Guest Qi) is pathogen. Shortness of breath means insufficient True Qi for respiration. Ao Nao means regret/distress, Heart disturbed by pathogen. Yang Qi is another name for Guest Qi. Called Guest Qi because it is external; called Yang Qi because pathogen is Wind. Because interior is deficient, pathogen invades, hence "sinking inward." Yang nature floats upward, clumping in chest. Chest is a dangerous pathway with great force, hence "Major" Decoction. Mang Xiao's saltiness softens hardness. Gan Sui's sweetness reaches fluid retention. Without brave talent and martial stability, these two cannot function. Thus, Da Huang, the General, acts as the main general establishing peace. If no Chest Binding, it describes milder variations. Pathogen sinking inward may not clump in chest, lacking fixed location. Head sweating occurs because head is root of all Yangs; Yang functions vigorously, causing sweat. No sweat elsewhere because Yin meridians don't pass neck, Yang doesn't descend, Yin cannot perform, hence no sweat. Difficulty urinating occurs because Yang doesn't descend, Yin cannot perform, transformation fails, dampness stagnates. Dampness stagnation infiltrates Earth into Stomach, Stomach Earth...