本湿。得渗则盛。既盛且停。必郁而蒸热。湿热内发。色必外夺。身之肌肉。胃所主也。胃土之
色黄。所以黄发于身为可必也。发黄可必而不言其治者。以有其条也。学人。从其类以求之。则
道在矣。
（四十四）太阳病。重发汗而复下之。不大便五六日。舌上燥而渴。日晡所小有潮热。从心下
至少腹。硬满而痛不可近者。大陷胸汤主之。
晡。帮孤切。此明结胸有阳明内实疑似之辨。晡日加申时也。小有。言微觉有也。盖不大便
燥渴。日晡潮热。从心下至少腹硬满而痛。皆似阳明内实而涉疑。且变因又同。惟小有潮热。不似
阳明之甚。可以辨差分。苟非义精见切。鲜有不致误者。所以阳明必以胃家实为正。而凡有一毫
太阳证在。皆不得入阳明例者。亦以此也。诗云。战战兢兢。如临深渊。如履薄冰。司命君子。
临此任而无此心者。难以与言仁也。
（四十五）病发于阳而反下之。热入因作结胸。病发于阴而反下之。因作痞。所以成结胸者。
以下之太早故也。
反。音板。此原结胸与痞之因。发于阳发于阴见第八条。结胸。大抵以结硬高当于胸为名。痞者。
痞塞于中。而以天地不交之痞为义。病发于阴而反下之。不言热入。与末后申明上句而不及下句者。
皆欲人同推也。然发于阳而下之早
者。未尝无痞。发于阴而下之早者。亦有结胸。疾病之机。每多不期然而然。盖出于反常之变。
良由人之气禀不齐。事物之交不一。如春伤于风。夏生飧泄。夏伤于暑。秋必 疟。秋伤于湿。
冬必咳嗽。冬伤于寒。春必病温。此固圣人谕道之常经。百世不易之定论。然即今之病四病者而观
之。必各于其时而各病其病者。千百一二。不拘于时杂错而乱病者。岁岁比比然也。不言四病之
故则已。有言四病之故者。必不能外圣人之经而异其说也。是故君子道其常。而善学圣人
者。则曰。文载道之具也。六经圣人之糟粕。必求圣人之情于言国文本之外。而后圣人之道明。欲
学仲景。不可不勉。
（四十六）结胸者项亦强。如柔 状。下之则和。宜大陷胸丸。
大陷胸丸方
大黄（半斤去皮） 葶苈（半升熬） 芒硝（半升） 杏仁（半升去皮尖熬黑）
上四味。捣筛二味。内杏仁芒硝合研如脂。和散。取如弹丸一枚。别捣甘遂末一钱匕。白蜜二
合。水二升。煮取一升。温顿服之。一宿乃下。如不下。更服。取下为效。禁如药法。
王氏曰。 。当作痉。群并切。余仿此。此以结胸之剧者言。变制以出其治。大邪结硬于胸。
俯则碍而不利。势必常昂。有反张之疑似。如柔痉状之谓也。盖病已至剧。辨之不可不明。治之
不可不审。是故。大黄芒硝甘遂前有之矣。葶苈有逐饮之能。杏仁以下气为用。白蜜甘而润。导
滞最为良。名虽曰丸。犹之散耳。较之于汤。力有加焉。此诚因病制胜之良规。譬则料敌添兵之妙算。
（四十七）结胸证。其脉浮大者不可下。下之则死。
此示人冯脉不冯证之要旨。戒人勿孟浪之意。夫结胸之为阳邪内陷。法固当下。下必待实。浮为
在表。大则为虚。浮虚相搏。则表犹有未尽入。而里未全实可知。下则尚虚之里气必脱。未尽之
表邪皆陷。祸可立至。如此而命尽。谓非医咎何。是故致戒也。
（四十八）结胸证悉具。烦燥者亦死。
悉具。其候皆见。烦燥。津液竭也。津液竭者。不可下。下证具矣。不下不可。下之不可。
不死而何。
（四十九）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。然后下之。
冒。昏蒙。言邪蒙幂而外蔽也。汗出则邪散。故表和也。得。谓知则得之也。里以二便言。
盖邪无定聚。或前或后。难以定拟。故曰得。举大意而不出方。不出方者。以未得。则方无可出也。
（五十）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。
亡无通。后皆仿此。复之为言。反也。未汗而下。谓之反下。已下而汗。谓之反汗。既反下。
又反汗。谓之重亡津液。津液重亡。则小便少。应不利。非病变也。故曰勿治。言若治之以利其小
便。则小便无可利者。不惟无益而反害。害则转增变矣。亦戒慎之意。
（五十一）太阳病未解。脉阴阳俱停。必先振 。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。
先汗出。脉经作先汗之。此概举汗下之大旨。以为诀人用治之要法。夫病而至于脉阴阳
俱停。则气血转和。无相胜负可诊矣。然犹必先振 。乃得汗出而后始解者。则其人本虚可知也
。但阳脉微先汗出而解者。盖经曰。阳虚阴盛。汗出而愈是也。但阴脉微下之而解者。难经曰。
阳盛阴虚。下之而愈是也。滑氏曰。受病为虚。不受病为盛。唯其虚也。是以邪凑之。唯其盛也。
是以邪不入。即外台所谓表病里和。里病表和之谓。学人玩味而有得焉。则于治也。思过半矣。
（五十二）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。（中。去声。）
三日。传遍三阳之时也。坏。言历遍诸治而犹不愈。则反复杂误之余。血气已惫坏。难以
正名名也。不中。犹言不当也。末三句。言所以治之之法也。盖既不可名以正名。则亦难以出其
正治。故但示人以随机应变之微旨。斯道之一贯。斯言尽之矣。盖亦圣门传心之要义。轮扁所
谓疾徐苦甘。应手厌心者。不可以言传。不犹是夫。善学人。心体而自得师焉。则
所谓三百九十七一百一十三者。可以应病变万有于无穷矣。岂惟治中风伤寒云乎哉。
（五十三）太阳病过经十余日。反二三下之。后四五日。柴胡证仍在者。先与小柴胡汤。呕
不止。心下急。郁郁微烦者。为未解也。与大柴胡汤下之。则愈。
大柴胡汤方
柴胡（半斤） 黄芩（三两） 半夏（半升） 芍药（三两） 枳实（四枚） 大黄（二两）
生姜（五两切） 大枣（十二枚擘）
上八味。以水一斗二升。煮取六升。去滓。再煎。温服一升。日三服。
过。平声。下同。过经与坏同。不知何逆而二三下之。适所以致逆耳。故曰反也。柴胡证仍
在者。言下而又下。阳明虽未见伤而邪在少阳者。亦未见除也。先与小柴胡者。赜之之意也。呕不
止。郁郁微烦者。邪扰二阳。故曰未解也。大柴胡者。
有小柴胡以为少阳之主治。用芍药易甘草者。以郁烦非甘者所宜。故以酸者收之也。加枳实
大黄者。荡阳明之郁热。非苦不可也。盖亦一举而有两解之意。
（五十四）太阳病。过经十余日。心下温温欲吐而胸中痛。大便反溏。腹微满。郁郁微烦。先
此时自极吐下者。与调胃承气汤。若不尔者。不可与。但欲呕。胸中痛微溏者。此非柴胡证。以呕
故知极吐下也。
胸中痛。邪在膈也。若曾极吐。则应有心下温温欲吐。何也。以胃口已被吐伤。邪热上抟于
膈。反欲吐而不得吐也。腹微满。郁郁微烦。邪在胃也。若曾极下。则应大便微溏。何也。以下
则胃虚。邪虽实于胃。大便反不能结硬也。故曰先此时自极吐下者。与调胃承气汤。言当荡其热
以和其胃也。不尔。言未极吐下也。但欲呕至末。申明上文。调胃承气汤方见下编。
（五十五）太阳病。项背强KT KT 。反汗出恶风者。桂枝加葛根汤主之。
桂枝加葛根汤方
于桂枝汤方内。加葛根三两。余根据桂枝汤法。
KT 音殊。KT KT 。鸟之短羽者。动则引颈KT KT 然。形容病患之颈项俱病者。俯仰不能自如之貌。
盖太阳之脉。下颈挟脊。
太阳之筋。其别者挟脊上项。阳明之脉。其支者从大迎下人迎。循喉咙。入缺盆。阳明之经。其
直者上腹而布。至缺盆而结。上颈上合于太阳。故邪凑太阳。则项背强。加阳明。则颈亦病。故
曰KT KT 也。反。转也。言太阳未罢。汗转出不已。而恶风犹在也。以太阳尚在。故用桂枝为主方。
以初有阳明。故加葛根为引用。盖葛根者。走阳明之经者也。然则桂枝加葛根之所以为汤。其
太阳阳明差多差少之兼解欤。旧本以葛根汤方为增补。谬甚。今根据经文桂枝加例补注。太阳一经。
分荣分卫。桂枝麻黄。所以同主一经。阳明。少阳。经络脏腑耳。葛根柴胡。所以各专一经矣。
（五十六）太阳与阳明合病。不下利但呕者。葛根加半夏汤主之。
葛根加半夏汤方
于葛根汤方内。加半夏半升。余根据葛根汤法。
合。见答切。合之为言。相配偶也。轻重齐。多少等。谓之合。盖阳明切近太阳。所以合也。
不下利。乃对中篇必自下利而言。两相反之词。所以为彼此互相发明。以见中风伤寒之分别也。呕
大吐也。盖太阳。膀胱也。膀胱主水。阳明胃也。胃主饮。风邪属阳。阳主气。阳邪协气。泛溢
水饮而上涌。得逆则与俱出。此呕之所以为呕。太阳阳明相合而为一家之证也。
桂枝葛根。散风而解肌。太阳阳明之的药也。半夏辛温。散气而蠲饮。主除热坚而止呕也。然所
谓葛根加者。其葛根汤。得非承上条而言。指桂枝加葛根之葛根与。以其无麻黄。殊为允当也。
用者请更参详。不浮沉于谬讹。何如。
（五十七）太阳与少阳并病。头项强痛。或眩冒。时如结胸。心下痞硬者。当刺大椎第一间
肺俞肝俞。慎不可发汗。发汗则谵语。脉弦。五六日。谵语不止。当刺期门。
椎。与槌同。俞。灵枢作 。音庶。并。犹合也。彼此相兼合而有轻重多寡之不同。谓之并。盖少
阳间阳明。去太阳远。故但兼并也。头项强痛见首条。眩。目无常主而旋转也。冒。昏蒙不明也。
二阳之脉起于目二 。风能羊角旋而善偃蔽。少阳属木。故得之则眩。太阳属水。故受之则冒。
或与时。互言也。少阳之脉络胁。而太阳内陷则为结胸。虽非内陷。然以并人。
则几于陷矣。故有时或似结胸而心下痞硬。非谓真实常如此也。然胸乃阳明之部分。太少并。阳明
不言而可知矣。肺俞。在背第三椎下两旁。肝俞。在第九椎下两旁。皆挟脊。各去同身寸之一寸
五分。刺可入同身寸之三分。肺俞留七呼。肝俞留六呼。夫肝与胆合。刺肝俞。泻少阳之太过也。
而肺与膀胱非合也。刺肺俞。其以膀胱为津液之府。气化出焉。肺主气。故刺之以通太阳膀胱之气
化与。不可发汗者。以不独太而有少。少阳无发汗法也。谵语者。心火炽而胃土燥也。
木火通明。故木盛则火炽。所以弦脉偏见也。期门。见第六十四条。
（五十八）太阳少阳并病。心下硬。颈项强而眩者。当刺大椎肺俞肝俞。慎勿下之。
此承上条而又以勿下再出。以明汗下俱不可行。通下文所以为详悉一证之意也。盖太少并病。则
五合之表里俱伤。而邪无定聚。汗则偏损表。下则偏虚里。所以两皆不可也。颈项亦头项之互词。
上条言眩冒。此有眩无冒。差互详略耳。
（五十九）太阳少阳并病。而反下之。成结胸。心下硬。下利不止。水浆不下。其人心烦。
此又承上条出其误下之变。三条一证互发。前条言慎不可发汗。发汗则谵语脉弦。则是谵语
脉弦者。误汗之变也。上言慎勿下之。未言下之之变。然则此条反下者。以上条误下之变言也。结
胸即下后阳邪内陷之结胸。下利即协热之下利。水浆不下心烦。结胸下利。两虚其胃也。末后疑有脱简。
（六十）伤寒五六日。中风。往来寒热。胸胁苦满。默默不欲饮食。心烦喜呕。或胸中烦而
不呕。或渴。或腹中痛。或胁下痞硬。或心下悸。小便不利。或不渴。身有微热。或咳者。与小
柴胡汤主之。
小柴胡汤方
柴胡（半斤） 黄芩（三两） 人参（三两） 半夏（半升洗） 甘草（三两炙） 生姜
（三两） 大枣（十二枚擘）
上七味。以水一斗二升。煮取六升。去滓。再煎取三升。温服一升。日三服。
咳。溪介切。此少阳之初证。叔和以无少阳明文。故犹类此。凡如此者。今皆从之。伤寒五
六日中风往来寒热。互文也。言伤寒与中风当五六日之时。皆有此往来寒热已下之证也。五六日。
大约言也。往来寒热者。邪入躯壳之里。脏腑之外。两夹界之隙地。所谓半表半里。少阳所主之
部位。故入而并于阴则寒。出而并于阳则热。出入无常。所以寒热间作也。胸胁苦满者。少阳之
脉循胸络胁。邪凑其经。伏饮抟聚也。默。静也。胸胁既满。谷不化消。所以静默不言。不需饮
食也。心烦喜呕者。邪热伏饮抟胸胁者涌而上溢也。或为诸证者。邪之出入不常。所以变动不一
也。柴胡少阳之君药也。半夏辛温。主柴胡而消胸胁满。黄芩苦寒。佐柴胡而主寒热往来。人参
甘枣之甘温者。调中益胃。止烦呕之不时也。此小柴胡之一汤。所以为少阳之和剂与。伤寒五六
日。中风。往来寒热。脉经作中风往来寒热。伤寒五六日之后。心烦作烦心。心下。作心中。身有。作外有。
后加减法
This is a disease caused by dampness. If diaphoresis (sweating-inducing method) is used, the dampness becomes even more abundant. Since the dampness is both abundant and stagnant, it must stagnate and generate heat. When damp-heat erupts internally, the complexion will inevitably be externally affected (turning yellow). The muscles of the body are governed by the Stomach. The color of Stomach Earth is yellow; therefore, the emergence of yellowing on the body is certain. Although the occurrence of jaundice can be determined, the treatment is not mentioned here because there are specific clauses for it. Students should seek the principle from similar conditions, and thus the Way lies therein.
(44) In Taiyang disease, if sweating is induced again and purgation is wrongly applied after initial treatment, resulting in no bowel movement for five or six days, dryness and thirst on the tongue, slight tidal fever at dusk (Bū shí), hardness and fullness with severe pain from the epigastrium down to the lower abdomen that cannot be touched, Da Xian Xiong Tang (Major Trapping Chest Decoction) is the primary prescription.
"Bū" refers to the hour of Shen (3 PM to 5 PM). This clarifies the differentiation between Jie Xiong (Chest Binding) and Yangming Internal Excess which may appear similar. "Slight" means feeling slightly present. Generally, constipation, dryness and thirst, tidal fever at dusk, and hardness/fullness/pain from the epigastrium to the hypogastrium all resemble Yangming Internal Excess, causing doubt. Moreover, the cause of transformation is the same. Only the slight nature of the tidal fever distinguishes it from the severity of Yangming Internal Excess, allowing for differentiation. Unless one's understanding of principles is profound and vision precise, few avoid misdiagnosis. Therefore, the correct approach for Yangming disease must be "Stomach House Excess," and any case retaining even a trace of Taiyang syndrome must not be classified under Yangming, precisely for this reason. The *Classic of Poetry* states: "Trembling and cautious, as if standing on the brink of an abyss, as if treading on thin ice." Physicians who bear the responsibility of life and death but lack this mindset find it difficult to discuss benevolence.
(45) When a disease originates in Yang (exterior) and is wrongly treated with purgation, heat enters and forms Jie Xiong (Chest Binding); when a disease originates in Yin (interior) and is wrongly treated with purgation, Pi Syndrome (Glomus/Blockage) forms. The reason Jie Xiong forms is due to premature purgation.
"Fan" (wrongly/reversely) is pronounced like "Ban". This traces the causes of Jie Xiong and Pi. "Originating in Yang/Yin" is explained in Clause 8. Jie Xiong is generally named for the knotting and hardness located high in the chest. Pi refers to blockage in the middle, symbolizing the non-interaction of Heaven and Earth. In the case of disease originating in Yin and wrongly purged, "heat entering" is not stated, nor is the latter clause fully elaborated at the end; these omissions invite readers to infer by analogy. However, premature purgation in diseases originating in Yang does not preclude Pi, and premature purgation in diseases originating in Yin can still result in Jie Xiong. The mechanisms of disease often occur unexpectedly, arising from abnormal variations. This is largely due to differences in individual constitution and varying interactions of factors. For instance, wind injury in spring leads to undigested diarrhea in summer; summer heat injury in summer leads to malaria in autumn; dampness injury in autumn leads to cough in winter; cold injury in winter leads to Warm Disease in spring. These are indeed the constant principles elucidated by sages, unchanging doctrines for generations. Yet, observing those suffering from these four diseases today, only one or two in a thousand contract the disease strictly according to the season; most suffer from mixed disorders unrelated to seasons, year after year. If one does not discuss the causes of these four diseases, fine; but if one does, one cannot deviate from the Sage's classics. Thus, the gentleman follows the constant way, and those who learn well from the Sages say: Texts are vessels for the Way; the Six Classics are the dregs of the Sages. One must seek the Sages' intent beyond the text to clarify the Way. To learn from Zhang Zhongjing, one must strive diligently.
(46) In Jie Xiong (Chest Binding), the neck is also stiff, resembling the condition of Rou Jing (Soft Spasm). Purging harmonizes the condition; Da Xian Xiong Wan (Major Trapping Chest Pill) is appropriate.
Da Xian Xiong Wan Formula
Dahuang (Rhubarb Root, half jin, peeled) Tingli (Descurainia Seed, half sheng, fried) Mangxiao (Mirabilite, half sheng) Xingren (Apricot Seed, half sheng, peeled, tipped, fried until black)
The above four ingredients: crush and sieve two of them. Mix the Xingren and Mangxiao and grind into a paste. Combine with the powder. Take a pill size equivalent to a bullet. Separately crush Gansui root to make one qianbi of powder. Add Ermi (White Honey) two he and water two sheng. Boil to obtain one sheng. Take warm in one dose. Bowel movement occurs after one night. If no movement, take another dose. Passage of stool indicates efficacy. Observe dietary restrictions as per general medication rules.
Wang Shi says: The character should be "Jing" (Spasm), pronounced like "Qun". This describes severe Jie Xiong. The formula variation offers a specific treatment. Major evil knots and hardens in the chest; bending forward obstructs flow, so the head tends to tilt back, resembling the opisthotonos of Rou Jing. The disease is severe, so differentiation must be clear and treatment prudent. Dahuang, Mangxiao, and Gansui were previously mentioned. Tingli has the ability to drain fluid retention; Xingren functions to descend Qi; Ermi is sweet and moistening, excellent for guiding stagnation. Though called a pill, it acts like a powder. Compared to decoctions, its action is sustained. This is indeed a good rule for overcoming disease with specific measures, akin to adding troops when analyzing the enemy.
(47) In Jie Xiong syndrome, if the pulse is floating and large, do not purge. Purging leads to death.
This illustrates the principle of relying on the pulse rather than symptoms alone, warning against rashness. Jie Xiong involves the internal collapse of Yang pathogenic factors; purging is indicated. However, purging requires confirmed excess. Floating indicates exterior presence; Large indicates deficiency. Floating and deficiency combined suggest residual exterior pathogen and incomplete interior excess. Purging now would cause the deficient interior Qi to collapse and the residual exterior pathogen to fully penetrate, leading to immediate disaster. Such death is undoubtedly the physician's fault. Hence the warning.
(48) If all signs of Jie Xiong syndrome are present and restlessness (Fan Zao) occurs, it is a death sign.
"Xi Ju" means all symptoms are manifest. "Fan Zao" indicates exhaustion of Body Fluids. Exhaustion of fluids contraindicates purging. Although purging indications are present, neither purging nor not purging works; why would the patient not die?
(49) In Taiyang disease, if purgation fails initially and sweating is subsequently induced, both exterior and interior become deficient. The patient develops Mao (dizziness/clouded consciousness). Patients with Mao recover through sweating.
This happens because sweating harmonizes the exterior. Once the interior is harmonized, then purgation may be considered.
"Mao" refers to clouded consciousness, where pathogens obscure the exterior. Sweating disperses pathogens, harmonizing the exterior. "De" implies knowing the timing. Interior refers to bowel and bladder function. Pathogens gather unpredictably; thus, one must wait to discern the specific interior pattern before prescribing. No specific formula is given because the exact interior pattern is not yet determined.
(50) After severe purgation followed by sweating, if urination is difficult, it is due to the loss of Body Fluids. Do not treat this directly. When urination returns to normal, the patient will heal spontaneously.
"Wang" is synonymous with "Wu" (no/lack). "Fu" means reversal. Purgation before sweating is "reverse purgation"; sweating after purgation is "reverse sweating". Double reverse actions lead to double loss of Body Fluids. Severe loss of fluids results in oliguria, which is expected, not a pathological change. Hence, "do not treat." Using diuretics would further deplete fluids, causing harm and exacerbating the condition. This serves as a warning of caution.
(51) In Taiyang disease unresolved, if the pulses at Yin and Yang positions are both hidden/still, the patient must first experience chills/shivering, then sweat, and the disease resolves. If only the Yang pulse (Cun) is slightly active, sweating resolves it. If only the Yin pulse (Chi) is slightly active, purging resolves it. If purging is desired, Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct Downward Decoction) is the primary prescription.
"First sweat" appears as "induce sweating first" in *Mai Jing*. This summarizes the major principles of sweating and purging methods. When pulses at Yin and Yang are still, Qi and Blood have harmonized without dominance. However, the necessity of shivering before sweating indicates underlying deficiency. Resolution via slight Yang pulse activity aligns with the saying: "Yang deficiency and Yin abundance, resolve by sweating." Resolution via slight Yin pulse activity aligns with *Nan Jing*: "Yang abundance and Yin deficiency, resolve by purging." Mr. Hua Shou said: The affected part is deficient; the unaffected part is abundant. Deficiency attracts pathogens; abundance repels them. This corresponds to "Exterior disease, Interior harmony" or "Interior disease, Exterior harmony." Studying this deeply yields significant insight into treatment.
(52) In Taiyang disease, after three days, if sweating, emesis, purgation, or warm needle therapy have been applied but the disease remains unresolved, this is called Huai Bing (Ruined/Damaged Disease). Guizhi Tang (Cinnamon Twig Decoction) is no longer applicable. Observe the pulse and symptoms, identify the error committed, and treat according to the current syndrome.
"Zhong" is pronounced with the departing tone. "Three days" marks the transmission through the Three Yang stages. "Huai" implies that despite various treatments, the disease persists, indicating that Qi and Blood are exhausted and damaged, making standard classification difficult. "Bu Zhong" means inappropriate. The final three sentences describe the treatment principle: since standard naming and treatment fail, one must adapt flexibly. This embodies the continuous Dao of medicine. It is a core teaching of the Confucian school, comparable to Lun Bian's assertion that skill cannot be fully transmitted verbally. A good learner internalizes this and becomes their own teacher, capable of applying the 397 methods and 113 formulas to infinite variations, far beyond just treating Wind Strike or Cold Damage.
(53) In Taiyang disease, after passing the meridian cycle for over ten days, if purgation was wrongly applied two or three times, and after another four or five days, Chai Hu (Bupleurum) syndrome persists, first administer Xiao Chai Hu Tang (Minor Bupleurum Decoction). If vomiting continues, epigastric urgency, and mild depression/restlessness persist, the disease is unresolved; administer Da Chai Hu Tang (Major Bupleurum Decoction) to purge, and the patient will heal.
Da Chai Hu Tang Formula
Chaihu (Bupleurum Root, half jin) Huangqin (Scutellaria Root, three liang) Banxia (Pinellia Tuber, half sheng) Shaoyao (Peony Root, three liang) Zhishi (Immature Bitter Orange, four pieces) Dahuang (Rhubarb Root, two liang)
Shengjiang (Fresh Ginger, five liang, sliced) Dazao (Jujube, twelve pieces, split)
The above eight ingredients: Boil in water one dou two sheng to obtain six sheng. Remove dregs. Re-boil to obtain three sheng. Take one sheng warm, three times daily.
"Guo" is pronounced with the level tone. Passing the meridian is similar to Ruined Disease. Wrongful purgation causes deviation, hence "fan" (reversely). Persistence of Chai Hu syndrome indicates that despite repeated purgation, the Shaoyang pathogen remains. First giving Xiao Chai Hu Tang explores the pathology. Persistent vomiting and depression indicate pathogen disturbing both Yangming and Shaoyang, hence unresolved. Da Chai Hu Tang uses Shaoyao instead of Gancao because sour flavors restrain depression better than sweet ones. Adding Zhishi and Dahuang clears Yangming郁热 (stagnant heat). This achieves a dual resolution.
(54) In Taiyang disease, after passing the meridian cycle for over ten days, if there is nausea with epigastric discomfort, chest pain, loose stools, mild abdominal fullness, and mild depression/restlessness: if the patient had previously undergone extreme emesis or purgation, administer Tiao Wei Cheng Qi Tang. Otherwise, do not administer it. If there is merely desire to vomit, chest pain, and loose stools, this is not Chai Hu syndrome; the vomiting indicates prior extreme emesis/purgation.
Chest pain indicates pathogen in the Diaphragm. Extreme emesis damages the stomach opening, causing heat to rush upward, creating nausea without actual vomiting. Mild abdominal fullness and depression indicate pathogen in the Stomach. Extreme purgation weakens the Stomach, preventing stool hardening despite pathogenic excess. Thus, Tiao Wei Cheng Qi Tang is used to clear heat and harmonize the Stomach in cases of prior extreme treatment. "Bu Er" means no prior extreme treatment. The final section reiterates the diagnosis based on vomiting. See Lower Section for Tiao Wei Cheng Qi Tang formula.
(55) In Taiyang disease, if the neck and back are stiff and rigid, accompanied by sweating and aversion to wind, Guizhi Jia Gegen Tang (Cinnamon Twig Decoction plus Kudzu Root) is the primary prescription.
Guizhi Jia Gegen Tang Formula
Add Gegen (Kudzu Root, three liang) to the Guizhi Tang formula. Follow Guizhi Tang preparation methods otherwise.
"Gǔn gǔn" (onomatopoeia for stiffness) resembles a bird stretching its neck with short wings. It describes the inability to freely move the neck and back. The Taiyang meridian runs down the neck and along the spine. The Yangming meridian branches to the neck. Pathogen affecting Taiyang causes neck/back stiffness; involvement of Yangming adds neck stiffness. "Fan" indicates reversal: Taiyang syndrome persists, but sweating occurs excessively with persistent aversion to wind. Since Taiyang is predominant, Guizhi Tang is base; since Yangming is involved, Gegen is added as a guiding herb. This formula treats both Taiyang and Yangming. Old editions incorrectly added Gegen Tang; this correction follows the text. Ge Gen targets Yangming; Chai Hu targets Shaoyang.
(56) In concurrent Taiyang and Yangming disease, if there is no diarrhea but only vomiting, Gegen Jia Banxia Tang (Kudzu Root Decoction plus Pinellia) is the primary prescription.
Gegen Jia Banxia Tang Formula
Add Banxia (Pinellia Tuber, half sheng) to the Gegen Tang formula. Follow Gegen Tang preparation methods otherwise.
"He" means combination/equilibrium. Yangming is close to Taiyang, hence they combine. "No diarrhea" contrasts with the typical "spontaneous diarrhea" in mid-section texts, distinguishing Wind Strike from Cold Damage. Vomiting is forceful expulsion. Taiyang (Bladder) governs water; Yangming (Stomach) governs fluids. Wind (Yang) combines with Qi, flooding fluids upward. This combined syndrome involves both meridians. Guizhi and Gegen release wind and muscle layer; Banxia disperses Qi and resolves phlegm-fluid, stopping vomiting. Note: "Gegen Jia" likely refers to Guizhi Jia Gegen Tang (without Mahuang) rather than pure Gegen Tang, for accuracy. Users should verify.
(57) In concurrent Taiyang and Shaoyang disease, with headache, stiff neck, vertigo, dizziness, occasional sensation of chest binding, and epigastric hardness, puncture Dazhui (GV1), Feishu (BL13), and Ganshu (BL18). Strictly avoid sweating. Sweating causes delirium and wiry pulse. After five to six days, if delirium persists, puncture Qimen (LR14).
"Bing" means combination with unequal severity. Shaoyang is distant from Taiyang, hence "combination" rather than "concurrent". Vertigo (Xuan) is spinning vision; Dizziness (Mao) is clouded consciousness. Wind affects Shaoyang (Wood) causing vertigo; Water affects Taiyang causing dizziness. Occasional chest-binding sensation mimics Jie Xiong due to pathogen merging. Feishu and Ganshu are punctured to regulate Lung/Bladder Qi and drain Shaoyang excess. Sweating is forbidden because Shaoyang lacks a sweating method. Delirium and wiry pulse indicate Heart Fire and Stomach Dryness exacerbated by Wood-Fire interaction. Qimen is referenced in Clause 64.
(58) In concurrent Taiyang and Shaoyang disease, with epigastric hardness, stiff neck, and vertigo, puncture Dazhui, Feishu, and Ganshu. Strictly avoid purgation.
This reiterates the prohibition of purgation from the previous clause, emphasizing that both sweating and purging are contraindicated in concurrent Taiyang-Shaoyang disease to avoid damaging both exterior and interior. "Neck" is interchangeable with "Head and Neck". The absence of "Mao" (dizziness) here compared to "Xuan Mao" in the previous clause reflects textual variation/detail.
(59) In concurrent Taiyang and Shaoyang disease, if wrongly purged, resulting in Jie Xiong, epigastric hardness, incessant diarrhea, inability to swallow liquids, and irritability.
This describes the consequences of erroneous purgation. Previous clauses warned against sweating (causing delirium) and purging. Here, purgation leads to Jie Xiong (internal collapse of Yang pathogen) and Xie Re Xia Li (diarrhea with fever). Inability to eat/drink and irritability indicate severe Stomach deficiency from both Jie Xiong and diarrhea. There may be missing text at the end.
(60) In Cold Damage or Wind Strike after five to six days, presenting with alternating chills and fever, oppression/fullness in chest and hypochondrium, silent desire not to eat, irritability, and frequent vomiting; or optionally: chest irritation without vomiting, thirst, abdominal pain, hardness under ribs, palpitations, difficulty urinating, no thirst, slight body heat, or cough: Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary prescription.
Xiao Chai Hu Tang Formula
Chaihu (Bupleurum Root, half jin) Huangqin (Scutellaria Root, three liang) Renshen (Ginseng Root, three liang) Banxia (Pinellia Tuber, half sheng, washed) Gancao (Licorice Root, three liang, honey-fried) Shengjiang (Fresh Ginger, three liang) Dazao (Jujube, twelve pieces, split)
The above seven ingredients: Boil in water one dou two sheng to obtain six sheng. Remove dregs. Re-boil to obtain three sheng. Take one sheng warm, three times daily.
"Cough" pronunciation noted. This is the initial presentation of Shaoyang disease. Wang Shuhe grouped it here due to lack of explicit Shaoyang headings. Alternating chills and fever indicate pathogen in the Half-Exterior/Half-Interior region governed by Shaoyang. Entering Yin causes chills; emerging to Yang causes fever. Chest/hypochondriac fullness results from pathogen blocking the Shaoyang meridian and fluid accumulation. Silence and anorexia reflect digestive stagnation. Irritability and vomiting result from heat/fluid surging upward. Variations ("Or...") show the unpredictable nature of pathogen movement. Chaihu is the sovereign herb for Shaoyang. Banxia resolves fullness; Huangqin clears heat. Renshen and Dazao harmonize the Middle Jiao and stop vomiting. This formula is the harmonizer for Shaoyang. Note textual variants in *Mai Jing* regarding word order. Subsequent modifications follow.