白虎。知母石膏。辛甘而寒。辛者金之味。寒者金之性。辛甘且寒。得白虎之体焉。甘草粳米。
甘平而温。甘取其缓。温取其和。缓而且和。得伏虎之用焉。饮四物之成汤。来白虎之嗥啸。阳
气者。以天地之疾风名也。汤行而虎啸者同气相求也。虎啸
而风生者。同声相应也。风生而热解者。物理必至也。抑尝以此合大小青龙真武而论之。四物者。
四方之通神也。而以命方。盖谓化裁四时。神妙万世。名义两符。实自然而然者也。方而若此可
谓至矣。然不明言其神。而神卒不容掩者。君子盛德。此其道之所以大也与。此与厥阴篇第二十
五条互看。
（十四）伤寒脉浮。发热无汗。其表不解者。不可与白虎汤。渴欲饮水无表证者。白虎加人参
汤主之。
白虎加人参汤方
用白虎汤方内加人参三两。余根据白虎汤法。
伤寒脉浮与上条同。发热无汗。风寒之表在也。故谓不解。不可与白虎者。白虎义取解秋。
啸谷风而凉收燥热。非为发表也。渴欲饮水者。里热燥甚。希救也。无表证。谓恶寒头身疼痛皆
除。非谓热也。以证大意与上条同。故主冶亦与之同。以多渴也。故加人参之润以滋之也。
（十五）伤寒无大热。口燥渴。心烦。背微恶寒者。白虎加人参汤主之。
无大热。风微也。口燥渴心烦。里热甚也。背者。太阳经脉之所适。人身至阴之地。不胜寒
而有余。恶所以微也。以上三条大意互相发明。所以治亦相仿佛而不甚殊。
（十六）伤寒脉浮。医以火迫劫之。亡阳。必惊狂起卧不安者。桂枝去芍药加蜀漆龙骨牡蛎
救逆汤主之。
桂枝去芍药加蜀漆龙骨牡蛎救逆汤方
桂枝（三两去皮） 甘草（二两炙） 生姜（三两切） 牡蛎（五两熬） 龙骨（四两）
大枣（十二枚擘）
蜀漆（三两洗去脚）
上为末。以水一斗二升。先煮蜀漆减二升。内诸药。煮取三升。去滓。温服一升。
亡阳者。阳以气言。火能助气。甚则反耗气也。惊狂起卧不安者。神者。阳之灵。阳亡则神散
乱所以动皆不安。阳主动也。桂枝甘草。和伤寒之脉浮。蜀漆辛平。散火邪之错逆。龙骨牡蛎。固
涩以收阳神之散乱。大枣生姜。醒脾以缓起卧之不安。去芍药者。嫌其主阴。则反得以胜阳也。
（十七）火逆下之。因烧针烦躁者。桂枝甘草龙骨牡蛎汤主之。
桂枝甘草龙骨牡蛎汤方
桂枝（一两去皮） 甘草（二两炙） 牡蛎（二两熬） 龙骨（二两）
上四味为末。以水五升。煮取二升半。去滓。温服八合。日三服。
火逆。承上条而言也。然虽逆而又逆。而证则未变重。故方物反差少而大意不殊。
（十八）脉浮宜以汗解。用火灸之。邪无从出。因火而盛。病从腰以下必重而痹。名火逆也。
痹。湿病也。因火逆治。火邪夹阳邪而上逆。真阳不下通。阴不用事。化不行而水不得泄。故湿
着下体而重痹也。
（十九）伤寒脉浮。自汗出。小便数。心烦。微恶寒。脚挛急。反与桂枝汤欲攻其表。此误也。
得之便厥。咽中干。烦燥吐逆者。作甘草干姜汤与之。以复其阳。若厥愈足温者。更作芍药甘草
汤与之。其脚即伸。若胃气不和谵语者。少与调胃承气汤。若重发汗复加烧针者。四逆汤主之。
甘草干姜汤方
甘草（四两炙） 干姜（二两炮）
上 咀。以水三升。煮取一升五合。去滓。分温再服。
芍药甘草汤方
白芍药（四两） 甘草（四两炙）
上二味。 咀。以水三升。煮取一升半。去滓。分。温再服之。
调胃承气汤方
大黄（四两去皮清酒浸） 芒硝（半斤） 甘草（二两炙）
上三味。 咀。以水三升。煮取一升。去滓。内芒硝。更上微火煮令沸。少少温服。
四逆汤方
甘草（二两炙） 干姜（一两半） 附子（一枚）
上三味。 咀。以水三升。煮取一升二合。去滓。分。温再服。强人可大附子一枚。干姜三两。
数。音朔。反。音板。脚挛急者。足经始终于足。寒则拘挛也。以上言风寒俱有之表里证。
故谓与桂枝汤为反。盖桂枝是中风之主治。反。不顺也。厥。谓四肢冷也。咽中干烦燥吐逆者。
误汗损阳阳虚阴独盛也。甘草益气。干姜助阳。复其阳者。充其气之谓也。厥愈足温。阳气复也。
芍药用白。酸能敛阴而主血也。甘草用炙。甘能补中而益脾也。脚即伸。阴血行也。
盖以一误治而表里俱伤。故必求阴阳如此次第而俱复。胃不和而谵语者。亡津液而胃实也。承气
而曰调胃者。以胃属阳而主里。故用甘草和阴阳而缓中也。重发汗而复加烧针。则二者皆有以大
损于阳矣。故用偏于助阳之四逆。以救其阳也。
问曰。证象阳旦。按法治之而增剧。厥逆。咽中干。两胫拘急而谵语。师曰。言夜半手足当
温。两脚当伸。后如师言。何以知此。答曰。寸口脉浮而大。浮则为风。大则为虚。风则生微热。
虚则两胫挛。病证象桂枝。因加附子参其间。增桂令汗出。附子温经。亡阳故也。厥逆。咽中干。
烦燥。阳明内结。谵语烦乱。更饮甘草干姜汤。夜半阳气还。两足当热。胫尚微拘急。重与芍药
甘草汤。尔乃胫伸。以承气汤微溏。则止其谵语。故知病可愈。
胫。音幸。此申释上文意。象。似也。阳以风言。旦。晓也。言似中风分晓。以不啻中风。
故设难详申其义。且明治不可苟。序不可紊。以致戒慎之意。末后不复言若重发汗以下一节者。
以其或然或不然故也。
（二十）伤寒腹满谵语。寸口脉浮而紧。此肝乘脾也。名曰纵。刺期门。
寸口。气口也。五脏别论。帝曰。气口何以独为五脏主。岐伯对曰。胃者水谷之海。六腑之
大源也。五味入口。藏于胃。以养五脏气。而变见于气口也。故寸口主脾胃。浮紧为弦。是肝脉
也。乘脾者。肝木自盛。脾胃之土受制也。纵见辨脉法上编。期门见太阳上编。刺之者泻木以救
土也。
（二十一）伤寒发热。啬啬恶寒。大渴欲饮水。其腹必满。自汗出。小便利。其病欲解。此
肝乘肺也。名曰横。刺期门。
伤寒发热。啬啬恶寒。风寒尚在太阳而未除也。大渴欲饮水者。肝木本自盛而邪热炽欲得润也。
腹必满者。水漫而泛滥也。自汗出。则津液得外渗矣。小便利。则水得下行矣。夫水。木之母也。
母必为子。木得水则益甚而横。故挟水为邪。反侮所不胜而上乘于肺。肺金若虚。受其邪而不能
派散之。则水不得泄而肿作矣。乃金脏实。不纳其邪而转运散之。涣为自汗而外渗。潴为小便而
下行。此肝乘肺者所以不足为害。而反欲自解也。横亦见辨脉法上纵同条。然纵横不同。而同刺
期门者。纵以木贼土。横以木侮金。皆由木自盛。而以泻木为主治一也。
（二十二）脉浮而紧。而复下之。紧反入里则作痞。按之自濡。但气痞耳。
濡。与软同。古字通用。复。亦反也。紧反入里。言寒邪转内伏也。濡。言不硬不痛而柔软
也。痞。言气隔不通而痞塞也。易曰。天地不交而万物不生也。内阴而外阳也。内柔而外刚也。本
义曰。盖干往居外而坤来居内也。虽然。倾痞有先痞后喜之象。故君子不可不勉。学人不可不知所务。
（二十三）心下痞。按之濡。其脉关上浮者。大黄黄连泻心汤主之。
大黄黄连泻心汤方
大黄（二两） 黄连（一两）
上二味。以麻沸汤二升渍之。须臾绞去滓。分。温再服。
此申上条言脉以出其治。脉见关上者。以痞在心下也。以气痞而濡。所以浮也。然痞之濡。
由热聚也。故用黄连清之于上。聚虽气也。痞则固矣。故用大黄倾之于下。麻沸汤者。其取图经所谓去瘀之义欤。
（二十四）心下痞。而复恶寒汗出者。附子泻心汤主之。
附子泻心汤方
大黄（二两） 黄连（一两） 黄芩（一两） 附子（一枚炮去皮别煮取汁）
上四味。切三味。以麻沸汤二升渍之。须臾绞去滓。内附子汁。分。温再服。
痞。本阴邪内伏。而虚热上凝。复恶寒汗出。则表虚而阳不为卫护可知矣。泻心汤。固所以
为清热倾痞之用。加附子盖所以为敛其汗而固其阳也。黄芩为附子而更加。表里两解具见矣。
（二十五）病。胁下素有痞。连在脐旁。痛引少腹入阴筋者。此名脏结。死。
素。旧常也。脐旁。阴分也。脏。阴也。以阴邪结于阴经之脏。攻之不可及。所以于法为当死也。
（二十六）脏结无阳证。不往来寒热。其人反静。舌上苔滑者。不可攻也。
无阳证。言当脏结之时。表已罢除。无太阳也。不往来寒热。言痞虽属胁下。由素常有而发。
非少阳传经之邪也。反静。言无阳明之谵妄也。舌。心之苗也。苔滑。生长滑腻如胎膜也。苔滑
本由丹田有热。胸中有寒而成。然丹田。阴也。胸中。阳也。热反在阴而寒反在阳。所以为不可
攻也。
（二十七）问曰病有结胸。有脏结。其状何如。答曰。按之痛。寸脉浮。关脉沉。名曰结胸
也。何谓脏结。答曰。如结胸状。饮食如故。时时下利。寸脉浮。关脉小细沉紧。名曰脏结。舌
上白苔滑者难治。
此设问答以明结胸脏结之同异。时时下利者。阴邪结于阴脏而寒甚也。以寒甚。故脉多小细
与紧。此其所以下同。盖
结胸以阳邪结于阳。脏结以阴邪结于阴故也。末复申言脏结有难治之故者。叮咛戒谨之意也。
（二十八）伤寒表不解。心下有水气。干呕发热而咳。或渴。或利。或噎。或小便不利。少腹
满。或喘者。小青龙汤主之。
小青龙汤方
麻黄（三两去节） 芍药（三两） 五味子（半升） 干姜（二两） 甘草（三两炙） 半夏
（半升洗） 桂枝（三两去皮） 细辛（三两）
上八味。以水一斗。先煮麻黄减二升。去上沫。内诸药。煮取三升。去滓。温服一升。
水气。谓饮也。咳与喘。皆肺逆也。盖肺属金。金性寒。水者金之子。故水寒相抟则伤肺也。
或为多证者。水流行不一。无所不之也。夫风寒之表不解。桂枝麻黄甘草所以解之。水寒之相抟。
干姜半夏细辛所以散之。然水寒欲散而肺欲收。芍药五味子者。酸以收肺气之逆也。然则是汤也。
乃直易于散水寒也。其犹龙之不难于翻江倒海之谓欤。夫龙。一也。于其翻江倒海也。而小言之。
以其兴云致雨也。乃大言之。能大能小。化物而不泥于物。龙固如是夫。白虎真武虽无大小
之可言。其于主乎人身而为四体之元神则不偏殊。故在风寒之厉病。皆有感而遂通之妙应。若谓
与在天之主四时者期如此。则去道远矣。故曰道不远人。而不为索隐行怪者。圣肾无身外之道也。
老氏以降龙伏虎为造道之始。其亦知夫反求诸身之谓乎。读者。顾可忽哉。
加减法（或为诸证之治。）
若微利者。去麻黄。加荛花如鸡子大。熬令赤色（麻黄发汗。利则不宜。而或为诸证皆去
者。以汗则重亡津液也。利。水横行也。加荛花。导水也。）若渴者。去半夏。
加栝蒌根三两（渴。津液不足也。去半夏。以其燥津液也。加栝蒌根。以其彻热而生津也。）若
噎者。去麻黄。加附子一枚炮（噎与KT 咽同。水寒窒气也。附子者。利气散水寒也。）
若小便不利。少腹满。去麻黄加茯苓四两。（水停下焦而不行。则小便不利而少腹满。茯苓淡渗。
故能通窍而利水道也。）若喘者。去麻黄。加杏仁半升。去皮尖。（喘。水气射肺而声息不利也。
加杏仁。润肺以下其气也。）
（二十九）伤寒心下有水气。咳而微喘。发热不渴。服汤已渴者。此寒去欲解也。小青龙汤
主之。
发热不渴。寒胜也。故以服汤已而渴。为寒去欲解。大意与上条相仿。故治亦同。
（三十）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。邪热正炽之时也。不能卧但欲起者。邪属里而热壅甚。所以知其心下必结也。寒分。
与温病等篇第四条之寒分同。所以脉微弱也。利止作结胸。热反上逆也。四日。承上文二三日而
言也。末句此下疑有脱误。
（三十一）伤寒发热。汗出不解。心下痞硬。呕吐而下利者。大柴胡汤主之。
伤寒不汗出。得汗出则解。不解者。以有风而误于偏攻。热反入里。所以变痞硬呕吐而下利
也。大柴胡汤者。合表里而两皆解之也。方见上编。
（三十二）发汗。若下之。病仍不解。烦燥者。茯苓四逆汤主之。
茯苓四逆汤方
茯苓（六两） 人参（一两） 甘草（二两炙） 干姜（一两） 附子（一枚生用去皮破八片）
上五味。以水五升。煮取三升。去滓。温服七合。日三服。
误汗则亡阳而表疏。误下则亡阴而里伤。烦燥者。风寒俱有而热甚也。茯苓人参。入心以益虚。
心安则液敛也。四逆汤者。回阳以复阴。阳倡则阴随也。
（三十三）伤寒病。若吐若下后。七八日不解。热结在里。表里俱热。时时恶风。大渴。舌
上干燥而烦。欲饮水数升者。白虎加人参汤主之。
Baihu Tang (White Tiger Decoction) consists of Zhimu (Anemarrhenae Rhizoma, 知母) and Shigao (Gypsum Fibrosum, 石膏). Its nature is pungent, sweet, and cold. Pungency is the flavor of Metal; Coldness is the property of Metal. Being pungent, sweet, and cold, it embodies the form of Baihu (the White Tiger, representing Metal in the West). Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) and Jingmi (Oryza Sativa, 粳米) are sweet, neutral, and warm. Sweetness is taken for its moderating effect; Warmth is taken for its harmonizing function. Moderation combined with harmony embodies the utility of subduing the tiger. Consuming the decoction composed of these four substances is akin to summoning the roar of the White Tiger. Yang Qi (Vital Energy) is like the swift wind between Heaven and Earth. The movement of the decoction and the roaring of the tiger occur due to the attraction of similar energies. The tiger's roar generates wind due to the resonance of similar sounds. The generation of wind leads to the resolution of heat, which is an inevitable physical law. I have previously discussed Baihu Tang in conjunction with Xiao Qinglong Tang (Minor Blue Dragon Decoction), Da Qinglong Tang (Major Blue Dragon Decoction), and Zhenwu Tang (True Warrior Decoction). The medicines of the four directions are those that communicate with the divine. Naming the formula thus implies adapting to the changes of the four seasons, being miraculous for ten thousand generations, with name and reality conforming naturally. A formula reaching such a state can be considered perfect. Although it does not explicitly speak of its divinity, the divinity cannot be concealed. Just as a gentleman possesses great virtue, this is why his Way is so profound. This clause should be read in conjunction with Clause 20 of the Jueyin Chapter.
(14) In Shaoyang disease (Cold Damage), if the pulse is floating, there is fever, no sweating, and the exterior syndrome is unresolved, Baihu Tang (White Tiger Decoction) must not be administered. If there is thirst and a desire to drink water, and there is no exterior syndrome, Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) is the primary treatment.
Formula: Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng)
Add San Liang (3 liang) of Renshen (Panacis Ginseng Radix, 人参) to the formula of Baihu Tang (White Tiger Decoction). The rest follows the method of Baihu Tang (White Tiger Decoction).
The floating pulse in Shaoyang disease (Cold Damage) is the same as in the previous clause. Fever and no sweating indicate that Wind-Cold remains at the exterior, hence it is called unresolved. Baihu Tang (White Tiger Decoction) must not be used because its meaning lies in resolving Autumn dryness; by roaring the valley wind, it cools and gathers dryness-heat, rather than releasing the exterior. Thirst and a desire to drink water indicate severe interior dryness-heat requiring urgent relief. "No exterior syndrome" means symptoms such as aversion to cold, headache, and body pain have all disappeared; it does not mean there is no heat. Since the general pattern is the same as the previous clause, the treatment is also the same. However, due to greater thirst, Renshen (Panacis Ginseng Radix, 人参) is added for its moistening properties to nourish fluids.
(15) In Shaoyang disease (Cold Damage), if there is little fever, dry mouth and throat, irritability, and slight aversion to cold on the back, Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) is the primary treatment.
Little fever indicates weak wind. Dry mouth and throat with irritability indicate severe interior heat. The back is where the Taiyang Meridian (Taiyang Channel) passes and is the most Yin part of the human body. It cannot withstand cold well, so the aversion to cold is slight. The general patterns of the above three clauses elucidate each other, so their treatments are similar without significant difference.
(16) In Shaoyang disease (Cold Damage), if the pulse is floating and the physician uses fire methods to force sweating and deplete fluids, leading to Yang Collapse (Loss of Yang Qi), there will inevitably be fright, mania, and restlessness. Guizhi Qu Shaoyao Jia Shuqi Longgu Muli Jiuni Tang (Cinnamon Twig Decoction minus Peony plus Chinese Tallow Tree Bark, Dragon Bone, and Oyster Shell to Rescue from Emergency) is the primary treatment.
Formula: Guizhi Qu Shaoyao Jia Shuqi Longgu Muli Jiuni Tang (Cinnamon Twig Decoction minus Peony plus Chinese Tallow Tree Bark, Dragon Bone, and Oyster Shell to Rescue from Emergency)
Guizhi (Cinnamomi Ramulus, 桂枝) 3 Liang, peeled; Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) 2 Liang, honey-fried; Shengjiang (Zingiberis Rhizoma Recens, 生姜) 3 Liang, sliced; Muli (Concha Ostreae, 牡蛎) 5 Liang, calcined; Longgu (Os Draconis, 龙骨) 4 Liang; Dazao (Jujubae Fructus, 大枣) 12 pieces, split; Shuqi (Radix Saposhnikoviae, 蜀漆) 3 Liang, washed to remove roots.
Grind the above into powder. Use 1 Dou 2 Sheng of water. First boil Shuqi (Radix Saposhnikoviae, 蜀漆) until reduced by 2 Sheng. Add the remaining herbs. Boil to obtain 3 Sheng. Strain. Take 1 Sheng warm.
Yang Collapse (Loss of Yang Qi) refers to the Qi level. Fire can assist Qi, but excessively it consumes Qi. Fright, mania, and restlessness occur because Shen (Spirit) is the spirit of Yang. When Yang collapses, Shen scatters, causing all movements to be restless. Yang governs movement. Guizhi (Cinnamomi Ramulus, 桂枝) and Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) harmonize the floating pulse of Shaoyang disease (Cold Damage). Shuqi (Radix Saposhnikoviae, 蜀漆) is pungent and neutral, dispersing rebellious Fire Evil. Longgu (Os Draconis, 龙骨) and Muli (Concha Ostreae, 牡蛎) astringe to gather scattered Yang Shen (Spirit). Dazao (Jujubae Fructus, 大枣) and Shengjiang (Zingiberis Rhizoma Recens, 生姜) awaken the Spleen to alleviate restlessness. Shaoyao (Paeoniae Radix Alba, 芍药) is removed because it governs Yin and might counteract Yang.
(17) Due to Fire Reversal (adverse reaction to fire therapy) followed by purgation, and further aggravated by burning needles causing irritability, Guizhi Gancao Longgu Muli Tang (Cinnamon Twig and Licorice Decoction with Dragon Bone and Oyster Shell) is the primary treatment.
Formula: Guizhi Gancao Longgu Muli Tang (Cinnamon Twig and Licorice Decoction with Dragon Bone and Oyster Shell)
Guizhi (Cinnamomi Ramulus, 桂枝) 1 Liang, peeled; Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) 2 Liang, honey-fried; Muli (Concha Ostreae, 牡蛎) 2 Liang, calcined; Longgu (Os Draconis, 龙骨) 2 Liang.
Grind the above four ingredients into powder. Use 5 Sheng of water. Boil to obtain 2.5 Sheng. Strain. Take 8 Ge warm, three times a day.
Fire Reversal (adverse reaction to fire therapy) continues from the previous clause. Although it is another adverse treatment, the condition has not become too severe, so the discrepancy in herbs is small, and the general principle remains the same.
(18) A floating pulse should be treated with sweating. If moxibustion is used, the pathogen has no outlet. Due to fire, the pathogen becomes excessive. The disease will cause heaviness and numbness from the waist down, named Fire Reversal (adverse reaction to fire therapy).
Bi Syndrome (Obstruction Syndrome) is a Dampness disease. Due to Fire Reversal (adverse reaction to fire therapy), Fire Evil combines with Yang Evil and rebels upward. True Yang cannot descend and circulate. Yin fails to function. Transformation fails, and water cannot be excreted. Thus, Dampness settles in the lower body, causing heaviness and numbness.
(19) In Shaoyang disease (Cold Damage), if the pulse is floating, there is spontaneous sweating, frequent urination, irritability, slight aversion to cold, and cramping of the feet, administering Guizhi Tang (Cinnamon Twig Decoction) to attack the exterior is an error. If this occurs, and the patient develops cold limbs, dry throat, irritability, and vomiting, administer Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) to restore Yang Qi. If the limbs warm up, administer Shaoyao Gancao Tang (Peony and Licorice Decoction) next, and the feet will extend. If there is stomach disharmony with delirium, administer a small amount of Xiaochengqi Tang (Minor Order the Qi Decoction) or Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction). If excessive sweating is repeated and burning needles are added, Sini Tang (Four Counterflow Decoction) is the primary treatment.
Formula: Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction)
Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) 4 Liang, honey-fried; Ganjiang (Zingiberis Rhizoma, 干姜) 2 Liang, roasted.
Chop the above. Use 3 Sheng of water. Boil to obtain 1.5 Sheng. Strain. Divide into two warm doses.
Formula: Shaoyao Gancao Tang (Peony and Licorice Decoction)
Baishao Yao (Paeoniae Radix Alba, 白芍药) 4 Liang; Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) 4 Liang, honey-fried.
Chop the above two. Use 3 Sheng of water. Boil to obtain 1.5 Sheng. Strain. Divide into two warm doses.
Formula: Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction)
Dahuang (Rhei Radix et Rhizoma, 大黄) 4 Liang, peeled, soaked in clear wine; Mangxiao (Natrii Sulfas, 芒硝) 0.5 Jin; Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) 2 Liang, honey-fried.
Chop the above three. Use 3 Sheng of water. Boil to obtain 1 Sheng. Strain. Add Mangxiao (Natrii Sulfas, 芒硝). Simmer gently over low heat until boiling. Take small amounts warm.
Formula: Sini Tang (Four Counterflow Decoction)
Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) 2 Liang, honey-fried; Ganjiang (Zingiberis Rhizoma, 干姜) 1.5 Liang; Fuzi (Aconiti Lateralis Radix Praeparata, 附子) 1 piece.
Chop the above three. Use 3 Sheng of water. Boil to obtain 1.2 Sheng. Strain. Divide into two warm doses. Strong individuals may use one large Fuzi (Aconiti Lateralis Radix Praeparata, 附子) and 3 Liang of Ganjiang (Zingiberis Rhizoma, 干姜).
Shuo (number/counter): Pronounced 'shuo'. Fan (reverse/opposite): Pronounced 'ban'. Cramping of the feet: The foot meridians begin at the feet; cold causes contraction. The above discusses exterior and interior syndromes of both Wind and Cold. Hence, giving Guizhi Tang (Cinnamon Twig Decoction) is inappropriate, as Guizhi Tang (Cinnamon Twig Decoction) is the main treatment for Wind Strike. Fan (reverse) means not following the proper course. Jue (cold limbs) refers to cold extremities. Dry throat, irritability, and vomiting result from mistaken sweating damaging Yang, leaving Yin dominant. Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) benefits Qi; Ganjiang (Zingiberis Rhizoma, 干姜) assists Yang. Restoring Yang means replenishing Qi. Warming of the limbs indicates Yang restoration. Baishao Yao (Paeoniae Radix Alba, 白芍药) is white; sour enters Yin and governs Blood. Honey-fried Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) is sweet; sweet tonifies the Middle and benefits the Spleen. Extension of the feet indicates Blood circulation.
One mistake damages both exterior and interior. Therefore, Yin and Yang must be restored sequentially. Stomach disharmony with delirium results from fluid loss and Stomach excess. Chengqi Tang (Order the Qi Decoction) is called Tiaowei (Regulate Stomach) because the Stomach belongs to Yang and governs the Interior; thus, Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) is used to harmonize Yin and Yang and moderate the Middle. Repeated sweating and burning needles severely damage Yang. Therefore, Sini Tang (Four Counterflow Decoction), which strongly assists Yang, is used to rescue Yang.
Question: The syndrome resembles Yangdan Tang (Yang Dawn Decoction), but treatment according to standard methods worsens it, causing cold limbs, dry throat, cramping of both calves, and delirium. The Master said, "By midnight, the hands and feet will warm, and the legs will extend." Later, it happened exactly as the Master said. How did you know this? Answer: The Cun Kou (Inch Port/Pulse at the wrist) is floating and large. Floating indicates Wind; Large indicates Deficiency. Wind generates slight heat; Deficiency causes calf cramping. The syndrome resembles Guizhi Tang (Cinnamon Twig Decoction), so Fuzi (Aconiti Lateralis Radix Praeparata, 附子) was added, and Guizhi (Cinnamomi Ramulus, 桂枝) was increased to induce sweating. Fuzi (Aconiti Lateralis Radix Praeparata, 附子) warms the channels due to Yang Collapse (Loss of Yang Qi). Cold limbs, dry throat, and irritability indicate Yangming Internal Binding, delirium, and confusion. Administer Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) again. By midnight, Yang returns, and the feet warm. The calves are still slightly cramped. Administer Shaoyao Gancao Tang (Peony and Licorice Decoction) again, then the calves extend. Use Chengqi Tang (Order the Qi Decoction) to produce mild diarrhea, stopping the delirium. Thus, we know the disease will resolve.
Jing (calf): Pronounced 'xing'. This explains the previous text. Xiang (resemble) means similar. Yang refers to Wind; Dan means dawn. It resembles Wind Strike clearly, but is more than just Wind Strike. Hence, the difficulty is posed to explain the meaning in detail, warning that treatment must not be arbitrary and sequence must not be disordered, to instill caution. The last section regarding "if excessive sweating..." is omitted because it is conditional.
(20) In Shaoyang disease (Cold Damage), abdominal fullness and delirium with a floating and tight Cun Kou (Inch Port/Pulse at the wrist) indicate Liver attacking Spleen, named Zong (Vertical). Puncture Qimen (Liv 14).
Cun Kou (Inch Port/Pulse at the wrist) is the Qi Kou. In "Treatise on the Distinction of the Five Zang Organs," the Yellow Emperor asked: Why does the Qi Kou alone govern the Five Zang Organs? Qibo answered: The Stomach is the sea of water and grain, the great source of the Six Fu Organs. Flavors enter the mouth, store in the Stomach, and nourish the Qi of the Five Zang Organs, manifesting at the Qi Kou. Thus, Cun Kou (Inch Port/Pulse at the wrist) governs the Spleen and Stomach. Floating and tight is Xian (Wiry), the Liver pulse. Attacking Spleen means Liver Wood is excessive, controlling Spleen-Stomach Earth. Zong (Vertical) is seen in the Pulse Differentiation Method Upper Compilation. Qimen (Liv 14) is seen in the Taiyang Upper Compilation. Puncturing it drains Wood to save Earth.
(21) In Shaoyang disease (Cold Damage), if there is fever, shivering aversion to cold, extreme thirst with desire to drink, abdominal fullness, spontaneous sweating, and free urination, the disease will resolve. This is Liver attacking Lung, named Heng (Horizontal). Puncture Qimen (Liv 14).
Fever and shivering aversion to cold indicate Wind-Cold remains in Taiyang and is not resolved. Extreme thirst indicates Liver Wood is inherently excessive and pathogenic heat is intense, seeking moisture. Abdominal fullness indicates water flooding. Spontaneous sweating allows fluids to seep out externally. Free urination allows water to flow downward. Water is the Mother of Wood. The Mother serves the Child. Wood gaining Water becomes even more excessive and horizontal. Thus, carrying Water as evil, it insults the unconquerable (Metal) and attacks the Lung. If Lung Metal is deficient, it accepts the evil and cannot disperse it, leading to water retention and edema. However, if Lung Metal is solid, it rejects the evil and transports/disperses it. Dispersion becomes spontaneous sweating; accumulation becomes free urination. Thus, Liver attacking Lung is not harmful and tends to resolve itself. Heng (Horizontal) is also seen in the Pulse Differentiation Method Upper Compilation alongside Zong (Vertical). Although Vertical and Horizontal differ, both are punctured at Qimen (Liv 14). Vertical is Wood invading Earth; Horizontal is Wood insulting Metal. Both arise from Wood excess, and the main treatment is draining Wood.
(22) A floating and tight pulse, followed by repeated purgation, causes the tight pulse to enter the interior, resulting in Pi (Glomus/Fullness). Pressing it feels soft; it is merely Qi Pi (Qi Glomus).
Ru (Soft) is synonymous with Ruan (Soft); ancient characters are interchangeable. Fu (again/repeatedly) here means Fan (reverse). Tight entering the interior means Cold Pathogen turns inward and hides. Ru (Soft) means hard and painful but soft. Pi (Glomus/Fullness) means Qi obstruction and blockage. The I Ching says: When Heaven and Earth do not interact, things cannot be born. Inner Yin and Outer Yang; Inner Soft and Outer Hard. The Original Meaning states: Qian moves outward, Kun moves inward. Although, Pi has the image of first blockage then joy. Thus, the gentleman must strive, and the learner must know their duty.
(23) Pi (Glomus/Fullness) in the epigastrium, soft upon pressure, with a floating pulse at the Guan (Bar) position, is primarily treated with Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Decoction to Drain the Heart).
Formula: Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Decoction to Drain the Heart)
Dahuang (Rhei Radix et Rhizoma, 大黄) 2 Liang; Huanglian (Coptidis Rhizoma, 黄连) 1 Liang.
Soak the above two in 2 Sheng of boiling water (Mafei Tang). After a moment, strain. Divide into two warm doses.
This elaborates on the previous clause, using the pulse to determine treatment. The Guan (Bar) position corresponds to the epigastrium where Pi (Glomus/Fullness) resides. Because it is Qi Pi (Qi Glomus) and soft, the pulse floats. However, the softness of Pi is due to Heat aggregation. Thus, Huanglian (Coptidis Rhizoma, 黄连) clears Heat above. Although it is Qi, Pi is solid. Thus, Dahuang (Rhei Radix et Rhizoma, 大黄) drains it below. Mafei Tang (Boiling Water Infusion) likely takes the meaning of removing stasis from the Tu Jing.
(24) Pi (Glomus/Fullness) in the epigastrium, accompanied by aversion to cold and sweating, is primarily treated with Fuzi Xiexin Tang (Aconite Decoction to Drain the Heart).
Formula: Fuzi Xiexin Tang (Aconite Decoction to Drain the Heart)
Dahuang (Rhei Radix et Rhizoma, 大黄) 2 Liang; Huanglian (Coptidis Rhizoma, 黄连) 1 Liang; Huangqin (Scutellariae Radix, 黄芩) 1 Liang; Fuzi (Aconiti Lateralis Radix Praeparata, 附子) 1 piece, roasted, peeled, boiled separately for juice.
Cut the first three ingredients. Soak in 2 Sheng of boiling water (Mafei Tang). After a moment, strain. Add the Fuzi (Aconiti Lateralis Radix Praeparata, 附子) juice. Divide into two warm doses.
Pi (Glomus/Fullness) is originally Yin Pathogen hiding inside, with Deficient Heat condensing above. Aversion to cold and sweating indicate Exterior Deficiency and Yang failing to protect. Xiexin Tang (Drain the Heart Decoction) clears Heat and drains Pi (Glomus/Fullness). Adding Fuzi (Aconiti Lateralis Radix Praeparata, 附子) stops sweating and secures Yang. Huangqin (Scutellariae Radix, 黄芩) is added for Fuzi (Aconiti Lateralis Radix Praeparata, 附子). Both Exterior and Interior are resolved.
(25) Disease: There has long been a Pi (Glomus/Fullness) under the hypochondrium, connected to beside the navel, pain radiating to the lower abdomen and Yin sinews. This is named Zang Jie (Zang Knot), fatal.
Su (originally) means old or habitual. Beside the navel is the Yin division. Zang (Organ) is Yin. Yin Pathogen knotting in the Yin meridians and Zang Organs cannot be attacked. Thus, according to the method, it is fatal.
(26) Zang Jie (Zang Knot) has no Yang syndromes, no alternating chills and fever, the person is quiet, and the tongue has slippery coating. It must not be attacked with purgatives.
No Yang syndromes means at the time of Zang Jie (Zang Knot), the exterior is resolved, with no Taiyang syndrome. No alternating chills and fever means although Pi (Glomus/Fullness) is under the hypochondrium, it arises from pre-existing conditions, not Shaoyang transmitted pathogen. Quiet means no Yangming delirium. Tongue is the sprout of the Heart. Slippery coating grows smooth and greasy like a membrane. Slippery coating originates from Heat in the Dantian and Cold in the Chest. Dantian is Yin; Chest is Yang. Heat is in Yin and Cold in Yang, so it must not be attacked.
(27) Question: There are Jie Xiong (Knot Chest) and Zang Jie (Zang Knot). What are their appearances? Answer: Pain upon pressure, floating Cun pulse, sinking Guan pulse, is named Jie Xiong (Knot Chest). What is Zang Jie (Zang Knot)? Answer: Similar to Jie Xiong (Knot Chest), eating and drinking are normal, frequent loose stools, floating Cun pulse, small, fine, sinking, and tight Guan pulse, is named Zang Jie (Zang Knot). Slippery white coating on the tongue indicates difficult treatment.
This Q&A clarifies the similarities and differences between Jie Xiong (Knot Chest) and Zang Jie (Zang Knot). Frequent loose stools indicate Yin Pathogen knotting in Yin Zang Organs with severe Cold. Due to severe Cold, the pulse is often small, fine, and tight. This is why the lower aspects are similar. Jie Xiong (Knot Chest) is Yang Pathogen knotting in Yang; Zang Jie (Zang Knot) is Yin Pathogen knotting in Yin. The final statement reiterates the difficulty of treating Zang Jie (Zang Knot) with caution.
(28) Shaoyang disease (Cold Damage) with unresolved exterior, Water-Qi (Fluid Retention) in the epigastrium, dry retching, fever, and cough, or thirst, or diarrhea, or choking, or dysuria with lower abdominal fullness, or wheezing, is primarily treated with Xiao Qinglong Tang (Minor Blue Dragon Decoction).
Formula: Xiao Qinglong Tang (Minor Blue Dragon Decoction)
Mahuang (Ephedrae Herba, 麻黄) 3 Liang, nodes removed; Shaoyao (Paeoniae Radix Alba, 芍药) 3 Liang; Wuweizi (Schisandrae Fructus, 五味子) 0.5 Sheng; Ganjiang (Zingiberis Rhizoma, 干姜) 2 Liang; Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) 3 Liang, honey-fried; Banxia (Pinelliae Rhizoma, 半夏) 0.5 Sheng, washed; Guizhi (Cinnamomi Ramulus, 桂枝) 3 Liang, peeled; Xixin (Asari Radix et Rhizoma, 细辛) 3 Liang.
Boil the above eight ingredients in 1 Dou of water. First boil Mahuang (Ephedrae Herba, 麻黄) until reduced by 2 Sheng, remove foam. Add other herbs. Boil to obtain 3 Sheng. Strain. Take 1 Sheng warm.
Water-Qi (Fluid Retention) refers to Fluids. Cough and wheezing are Lung rebellion. Lung belongs to Metal; Metal is cold. Water is the Child of Metal. Thus, Cold Water combining harms the Lung. Various symptoms occur because Water flows differently everywhere. Unresolved Wind-Cold exterior is resolved by Guizhi (Cinnamomi Ramulus, 桂枝), Mahuang (Ephedrae Herba, 麻黄), and Gancao (Glycyrrhizae Radix et Rhizoma, 甘草). Combining Cold Water is dispersed by Ganjiang (Zingiberis Rhizoma, 干姜), Banxia (Pinelliae Rhizoma, 半夏), and Xixin (Asari Radix et Rhizoma, 细辛). However, while Cold Water wants to disperse, Lung wants to collect. Shaoyao (Paeoniae Radix Alba, 芍药) and Wuweizi (Schisandrae Fructus, 五味子) are sour to collect rebellious Lung Qi. Thus, this decoction easily disperses Cold Water. Is it not like the Dragon finding it easy to overturn rivers and seas? The Dragon is one. Regarding overturning rivers and seas, speaking small, it brings clouds and rain. Speaking large, it can be big or small, transforming things without being stuck. The Dragon is indeed like this. Although Baihu Tang (White Tiger Decoction) and Zhenwu Tang (True Warrior Decoction) have no size distinction, they govern the human body as the primordial spirit of the four limbs without bias. Thus, in severe Wind-Cold diseases, they respond miraculously. If one expects them to act like the Heaven governing the four seasons, it is far off. Thus, the Way is not far from humans. Those who do not seek hidden mysteries or act strangely, the Sage has no Way outside the self. Laozi regarded subduing the Dragon and taming the Tiger as the beginning of the Dao. Does he not know the meaning of seeking within oneself? Readers, how can they ignore this?
Modification Methods (for various symptoms):
If slight diarrhea, remove Mahuang (Ephedrae Herba, 麻黄), add Raohua (Radix Euphorbiae Humifusae, 荛花) the size of a chicken egg, roasted until red (Mahuang (Ephedrae Herba, 麻黄) induces sweating, unsuitable for diarrhea. Removing it prevents further fluid loss. Diarrhea is Water flowing horizontally. Raohua (Radix Euphorbiae Humifusae, 荛花) guides Water.) If thirsty, remove Banxia (Pinelliae Rhizoma, 半夏), add Gualougen (Trichosanthis Radix, 栝蒌根) 3 Liang (Thirst indicates insufficient fluids. Remove Banxia (Pinelliae Rhizoma, 半夏) as it dries fluids. Add Gualougen (Trichosanthis Radix, 栝蒌根) to clear Heat and generate fluids.) If choking, remove Mahuang (Ephedrae Herba, 麻黄), add one roasted Fuzi (Aconiti Lateralis Radix Praeparata, 附子) (Choking is same as Yan (swallowing); Cold Water obstructs Qi. Fuzi (Aconiti Lateralis Radix Praeparata, 附子) promotes Qi and disperses Cold Water.) If dysuria and lower abdominal fullness, remove Mahuang (Ephedrae Herba, 麻黄), add Fuling (Poria, 茯苓) 4 Liang (Water stagnating in Lower Jiao fails to move, causing dysuria and fullness. Fuling (Poria, 茯苓) is bland and渗 (permeating), opening orifices and promoting water passages.) If wheezing, remove Mahuang (Ephedrae Herba, 麻黄), add Xingren (Armeniacae Semen Amarum, 杏仁) 0.5 Sheng, skin and tips removed (Wheezing is Water-Qi shooting into Lung, causing breathing difficulty. Add Xingren (Armeniacae Semen Amarum, 杏仁) to moisten Lung and descend Qi.)
(29) Shaoyang disease (Cold Damage) with Water-Qi (Fluid Retention) in the epigastrium, cough with slight wheezing, fever without thirst. If after taking the decoction there is thirst, this indicates Cold is going and the disease is about to resolve. Xiao Qinglong Tang (Minor Blue Dragon Decoction) is the primary treatment.
Fever without thirst indicates Cold dominance. Thus, thirst after taking the decoction indicates Cold is gone and the disease is resolving. The general idea is similar to the previous clause, so the treatment is the same.
(30) Taiyang disease (Sunshine Disease), on the second or third day, inability to lie down but desire to rise, epigastric binding, and weak pulse indicates pre-existing Cold Division. Mistaken purgation leads to Jie Xiong (Knot Chest) if diarrhea stops. If diarrhea continues and purgation is repeated on the fourth day, it becomes Xie Re Li (Collaborative Heat Diarrhea).
Second or third day is when pathogenic heat is intense. Inability to lie down but desire to rise indicates pathogen is in the Interior with severe heat obstruction, hence epigastric binding. Cold Division is the same as in the Warm Disease chapter, Clause 4, explaining the weak pulse. Stopping diarrhea leads to Jie Xiong (Knot Chest) as Heat rebels upward. Fourth day continues from the second or third day. The last sentence likely has missing text.
(31) Shaoyang disease (Cold Damage) with fever, sweating but unresolved, epigastric hardness, vomiting, and diarrhea is primarily treated with Da Chaihu Tang (Major Bupleurum Decoction).
Shaoyang disease (Cold Damage) without sweating resolves with sweating. Unresolved sweating indicates mistaken partial attack due to Wind, causing Heat to enter the Interior, resulting in epigastric hardness, vomiting, and diarrhea. Da Chaihu Tang (Major Bupleurum Decoction) resolves both Exterior and Interior. Formula seen in Upper Compilation.
(32) After sweating or purgation, if the disease remains unresolved with irritability, Fuling Sini Tang (Poria and Four Counterflow Decoction) is the primary treatment.
Formula: Fuling Sini Tang (Poria and Four Counterflow Decoction)
Fuling (Poria, 茯苓) 6 Liang; Renshen (Panacis Ginseng Radix, 人参) 1 Liang; Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) 2 Liang, honey-fried; Ganjiang (Zingiberis Rhizoma, 干姜) 1 Liang; Fuzi (Aconiti Radix Preparata, 附子) 1 piece, raw, peeled, broken into eight pieces.
Boil the above five ingredients in 5 Sheng of water. Obtain 3 Sheng. Strain. Take 7 Ge warm, three times a day.
Mistaken sweating causes Yang Collapse (Loss of Yang Qi) and Exterior looseness. Mistaken purgation causes Yin Collapse (Loss of Yin) and Interior injury. Irrability indicates both Wind and Cold with severe Heat. Fuling (Poria, 茯苓) and Renshen (Panacis Ginseng Radix, 人参) enter the Heart to benefit Deficiency; calming the Heart collects fluids. Sini Tang (Four Counterflow Decoction) restores Yang to recover Yin; when Yang leads, Yin follows.
(33) Shaoyang disease (Cold Damage), after vomiting or purgation, unresolved after seven or eight days, Heat binding in the Interior, Exterior and Interior both hot, occasional aversion to wind, extreme thirst, dry and irritable tongue, desiring to drink several liters of water, is primarily treated with Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng).