（十二枚擘）
上六味。以水一斗。煮取六升。去滓。再煎取三升。温服一升。日三。
伤寒中风。言伤寒与中风皆有此变证。大意与上编第六十条同。医反下之至心下痞硬而满。大略
与上编第三十五条同。此多既误而复误。不得安以上。前误成痞也。医见至益甚。言复误而痞加
重也。此非结热至末。乃原致痞之因。以出其治也。甘草大枣之甘。益反下之虚。干姜半夏之辛。
散上逆之满。黄芩黄连之苦。解邪热之烦。然证大略与上编第三十五条同。而方物有同有异者。
不用桂枝。以无表也。同用甘草干姜同为益虚而散硬也。不用参术。恶益气也。用大枣。取滋干也。
以既误复误而痞益甚。故用芩连以为干姜之反佐。协同半夏以主散。此其所以有异同之分焉。
（二十一）伤寒服汤药。下利不止。心下痞硬。服泻心汤已。复以他药下之。利不止。医以理
中与之。利益甚。理中者。理中焦。此利在下焦。赤石脂禹余粮汤主之。复利不止者。当利其小便。
赤石脂禹余粮汤方
赤石脂（一斤碎） 禹余粮（一斤碎）
以上二味。以水六升。煮取二升。去滓。分三服
服泻心汤已以上。承上条而再言之也。复以他药下之利不止。言再治之不对。医以理中与之
利益甚。言愈误也。理中者以下。乃明其误而出其治。难经曰。中焦者。在胃中脘。主腐熟水谷。
下焦者。当膀胱上口。主分别清浊。主出而不内。以传道也。灵枢曰。水谷者。常并居于胃中。
成糟粕而俱下于大小肠而成下焦。渗而俱下。济泌别汁。循下焦而渗入膀胱
焉。然则利在下焦者。膀胱不渗而大肠滑脱也。禹余粮甘。平。消痞硬而镇定其脏腑。赤石脂甘
温。固肠虚而收其滑脱。然收滑脱矣。而利仍不止者。膀胱不渗而水谷不分也。利小便者。导其
水而厘清之。使腑司各行其所有事也。腑司各
行其所有事。则利无余治。而愈可必矣。
（二十二）伤寒大下后。复发汗。心下痞恶寒者。表未解也。不可攻痞。当先解表。表解乃
可攻痞。解表。宜桂枝汤。攻痞。宜大黄黄连泻心汤。
表。非病初之表。下复发汗。言疏缓其表之表也。解。犹救也。如解渴解急之类是也。解表。
与发表不同。伤寒病初之表当发。故用麻黄汤。此以汗后之表当解。故曰宜桂枝汤。言与中风之
表同。当解肌而固卫也。桂枝汤方见上编。攻痞方说见下编。
（二十三）伤寒医下之。续得下利。清谷不止。身疼痛者。急当救里。后身疼痛。清便自调者。
急当救表。救里。宜四逆汤。救表。宜桂枝汤。
清谷不止。身疼痛者。下后胃伤。里虚寒甚。饮食不腐化。而水谷不分。亡津液而骨属不
利也。救。护也。利甚身疼痛。而急当救护其里者。下后里虚为重也。清便自调。言小便清而大
便调也。小便清大便调。里气和矣。里气和而身疼痛者。卫不外固而不与荣和也。急当救护其表
者。不令重虚之表又易得重伤也。救里宜四逆汤者复阳而收阴也。救表宜桂枝汤者。固卫以和荣
也。此救表救里之所以各有其急也。四逆汤方见下编。桂枝汤方同上。
（二十四）伤寒发汗。若吐。若下。解后。心下痞硬。噫气不除者。旋复代赭石汤主之。
旋复代赭石汤方
旋复花（三两） 人参（二两） 生姜（五两切） 代赭石（一两） 半夏（半升洗）
甘草（三两炙） 大枣（十二枚擘）
上七味。以水一斗。煮取六升。去滓。再煎取三升。温服一升。日三服。
解。谓大邪已散也。心下痞硬。噫气不除者。正气未复。胃气尚弱而伏饮为逆也。旋复半夏。
蠲饮以消痞硬。人参甘草。养正以益新虚。代赭以镇坠其噫气。姜枣以调和其脾胃。然则七物者。
养正散余邪之要用也。
（二十五）伤寒八九日。下之。胸满烦惊。小便不利。谵语。一身尽重不可转侧者。柴胡加
龙骨牡蛎汤主之。
柴胡加龙骨牡蛎汤方
柴胡（四两） 半夏（二合洗） 龙骨（一两半） 牡蛎（一两半 ） 人参（一两半）
茯苓（一两半） 铅丹（一两半） 桂枝（一两半去皮） 生姜（一两半切） 大黄（二两）
大枣（六枚擘）
上十一味。以水八升。煮取四升。内大黄。切如棋子。更煮一二沸。去滓。温服一升。
胸满者。下后里虚。外热入里挟饮而上抟于膈所以烦也。惊属心。心藏神而居膈。正虚邪胜。
所以不宁也。一身尽重不可转侧者。伤寒本一身疼痛。亡津液而血涩不利。故变沉滞而重甚也。
夫以心虚则惊也。故用人参茯苓之甘淡。入心以益其虚。龙骨牡蛎铅丹之重涩。敛心以镇其惊。
半夏辛温。以散胸膈之满。柴胡苦寒。以除郁热之烦。亡津液而小便不利。参苓足以润之。胃中
燥而谵语。姜枣有以调也。满在膈中。半夏开之。非大黄不能涤。重在一身。人参滋之。非桂枝
不能和。然是证也。虽无三阳之明文。而于是汤也。总三阳以和之之治可征也。
（二十六）下后不可更行桂枝汤。若汗出而喘无大热者。可与麻黄杏仁甘草石膏汤主之。
前第十五条发汗后不可更行桂枝汤云云。与此止差下字。余皆同。夫以汗下不同而治同者。
汗与下虽殊。其为反误而致变喘则一。惟其喘一。所以同归于一治也。然以上编第四十条误汗变
喘用桂枝浓朴杏子汤而观之。则此汗下后不可更用桂枝汤可知矣。通考则义全。
（二十七）伤寒下后。心烦腹满卧起不安者。栀子浓朴汤主之。
栀子浓朴汤方
栀子（十四枚擘） 浓朴（四两姜炙） 枳实（四两汤浸去穣炒）
以上三味。以水三升半。煮取一升半。去滓。分三服。温进一服。得吐。止后服。
凡下而致变者。皆误也。心烦者。外邪入里抟膈而郁闷也。腹满者。虚邪壅胃。彭亨而不散
也。卧属阴。腹满者。阴滞也。起属阳。心烦者。阳郁也。所以皆不安宁也。栀子苦寒。快涌心
胸之烦。浓朴枳实。主泄胃腹之满。所以三物者。能安误下后之不安也。
（二十八）伤寒医以丸药大下之。身热不去微烦者。栀子干姜汤主之。
栀子干姜汤方
栀子（十四枚擘） 干姜（二两）
上二味。以水三升半。煮取一升半。去滓。分二服。温进一服。得吐者。止后服。
丸药误用。不惟病变而且毒遗。误于大下。不独亡阴而阳亦损。所以身热不去而微烦也。栀
子酸苦。涌内热而除烦。干姜辛热。散遗毒而益气。吐能散滞。辛能复阳。此之谓也。
（二十九）伤寒五六日。大下之后。身热不去心中结痛者。未欲解也。栀子豉汤主之。
栀子豉汤方
栀子（十四枚擘） 香豉（四合绵裹）
上二味。以水四升。先煮栀子得二升半。内豉。煮取一升半。去滓。分为二服。温进一服。
得吐者止后服。
此条结痛。比上条微烦则较重。一证而争差分也。前以差轻。故散之以干姜。此以差重。故
解之以香豉。盖香豉能主伤寒寒热恶毒。烦躁满闷。然则二条者。大同小异之分也。
（三十）发汗若下之而烦热胸中窒者。栀子豉汤主之。
此条亦与上同。窒者。邪热壅滞而窒塞。未至于痛而比痛较轻也。心居胸膈。所以同为一治。
（三十一）发汗吐下后。虚烦不得眠。若剧者。必反复颠倒。心中懊 。栀子豉汤主之。
虚烦不得眠者。大邪乍退。正气暴虚。余热闷乱胃中干而不和也。剧。极也。反复颠倒心中
懊者。胸膈壅滞不得舒快也。所以用栀子豉。高者因而越之之法也。
若少气者。栀子甘草豉汤主之。若呕者。栀子生姜豉汤主之。
栀子甘草豉汤方
于栀子豉汤方内。加入甘草二两。余根据前法。得吐止后服。
栀子生姜豉汤方
于栀子豉汤方内。加生姜五两。余根据前法。得吐。止后服。
少气者。气伤也。故加甘草以益之。呕者。气逆也。故加生姜以散之。
（三十二）凡用栀子汤。病患旧微溏者。不可与服之。
栀子酸苦大寒而涌泄。病患旧微溏者。里气本虚而脏腑寒也。里气虚则易涌。脏腑寒则易泄。
故揭示禁止如此。
（三十三）下之后。复发汗。必振寒脉微细。所以然者。以内外俱虚故也。
内。谓反下则亡阴而里虚。所以脉微细也。外。谓复汗则亡阳而表虚。所以振寒也。
（三十四）下之后。复发汗。昼日烦躁不得眠。夜而安静。不呕不渴。无表证。脉沉微。身无
大热者。干姜附子汤主之。
干姜附子汤方
干姜（一两） 附子（一枚去皮生用破八片）
上二味。以水三升。煮取一升。去滓。顿服。
反下亡阴。阴既虚矣。又复发汗以亡其阳。则阳之虚。比之阴为尤甚。然阳用事于昼。热之
烦。阳之亢也。躁虽阴。阳之扰也。不得眠者。阳不能胜阴而争夺于阴也。阴用事于夜。安静者。
无阳事也。不呕不渴。无表证。脉沉微。身无大热。则阳大
虚不足以胜阴为谛矣。故用干姜附子偏于辛热以为汤者。恢复重虚之阳。而求以协和于偏胜之阴也。
（三十五）伤寒若吐。若下后。心中逆满。气上冲胸。起则头眩。脉沉紧。发汗则动经。身
为振振摇者。茯苓桂枝白术甘草汤主之。
茯苓桂枝白术甘草汤方
茯苓（四两） 桂枝（三两去皮） 白术（二两） 甘草（二两炙）
上四味。以水六升。煮取三升。去滓。分。温三服。
心下逆满。伏饮上溢抟实于膈也。气上冲胸。寒邪上涌挟饮为逆也。动经。伤动经脉。振振。
奋动也。盖人之经脉。赖津液以滋养。饮之为饮。津液类也。静则为养。动则为病。病宜制胜之。
不宜发汗。既吐下后。脉又沉紧而复发汗。则重亡津液。气血衰耗。故变如此。术与茯苓。胜湿
导饮。桂枝甘草。固表和中。故发汗动经。所需者四物也。
（三十六）伤寒吐下后。发汗。虚烦。脉甚微。八九日。心下痞硬。胁下痛。气上冲咽喉。
眩冒。经脉动惕者。久而成痿。
此申上条而复言失于不治则致废之意。上条脉沉紧。以未发汗言也。此条脉甚微。以已发汗
言也。经脉动。即动经之变文。惕。即振振摇也。大抵两相更互发明之词。久。言既经八九日。
若犹不得解而更失于不治。则津液内亡。湿淫外渍。必致痹而成痿。痿者。两足痿软而不相及也。
（三十七）太阳伤寒者。加温针必惊也。
温针者。针用必先烧温以去其寒性也。惊者。心有所动而惶惧也。盖心乃神之舍。故谓心藏神。
荣气通于心。故荣与心皆主血。寒邪伤于荣。郁而蒸热矣。温针以攻寒。火之性大热。血得热则
耗。耗则虚。血虚则心虚。心虚则舍空。舍空则神无所根据而气浮越于外。故失守而惊惶也。
（三十八）伤寒二三日。心中悸而烦者。小建中汤主之。
小建中汤方
桂枝（三两去皮） 芍药（六两） 甘草（二两炙） 生姜（三两切） 胶饴（一升） 大枣
（十二枚擘）
上六味。以水七升。煮取三升。去滓。内胶饴。更上微火消解。温服一升。日三服。呕家不可
用建中汤。以甜故也。
二三日。当传之时。不传不变。但心中悸而烦者。邪虽衰微正亦虚弱。不足以退散之。所以
持也。小建中者。桂枝汤倍芍药而加胶饴也。桂枝汤扶阳而固卫。卫固则荣和。倍芍药者。酸以收
阴。阴收则阳归附也。加胶饴者。甘以润土。土润则万物生也。建。定法也。定法惟中。不偏不
党。王道荡荡。其斯之谓乎。
（三十九）伤寒脉结代。心动悸。炙甘草汤主之。
甘草（四两炙） 生姜（三两切） 桂枝（三两去皮） 麦门冬（半升） 麻子仁（半升）
大枣（十二枚擘） 人参（二两） 生地黄（一斤） 阿胶（二两）
上九味。以清酒七升。水八升。先煮八味取三升。去滓。内胶烊消尽。温服一升。日三服。
一名复脉汤。
脉结代而心动悸者。虚多实少。譬如寇欲退散。主弱不能遣发而反自 徨也。人参甘草麦冬。
益虚以复结代之脉。地黄阿胶麻仁。生血以宁动悸之心。桂枝和荣卫以救实。姜枣健脾胃以调中。
清酒为长血气之助。复脉乃核实义之名。然则是汤也。必欲使虚者加进。而驯至于实。则实者自
退散。而还复于元之意也。本条结代。下文无代而有代阴。中间疑漏代一节。
脉。按之来缓而时一止。复来者名曰结。又脉来动而中止。更来小数。中有还者反动。名曰
结阴也。脉来动而中止。不能自还。因而复动。名曰代阴也。得此脉者必难治。（结阴也下当
有代脉一股。）
此承结代。而推言结阴代阴。以各皆详辨其状。与辨脉下第四章意同。
（四十）伤寒八九日。风湿相抟。身体疼烦。不能自转侧。不呕不渴。脉浮虚而涩者。与桂枝
附子汤主之。
桂枝附子汤方
桂枝（四两去皮） 附子（三枚炮去皮破八片） 生姜（三两切） 甘草（二两炙） 大枣
（十二枚擘）
上五味。以水六升。煮取二升。去滓。分温。三服。
风湿相抟见上编。此以得之寒因。故身体疼烦不呕不渴也。不能自转侧者。湿主重着也。浮。
风也。虚则汗后之不足。涩。湿也。与上编小异而大同。桂枝附子汤者。即上编之甘草附子汤。
(Twelve pieces, split open)
The above six herbs are decocted in one dou (approx. 10 liters) of water to obtain six sheng (approx. 6 liters). The dregs are removed, and the liquid is further concentrated by boiling to three sheng (approx. 3 liters). Take one sheng (approx. 1 liter) warm at a time, three times daily.
Shanghan (Cold Damage) and Fengzhong (Wind Strike) both present these complication patterns. The general principle is the same as Article 60 in the previous section. The physician erroneously applied purgation, resulting in epigastric fullness and hardness. This is roughly similar to Article 35 in the previous section. Here, the condition worsens due to repeated mismanagement, preventing relief from the upper aspect. The initial error led to the formation of the "Pi" (fullness/blockage) syndrome. The physician observed the worsening of the Pi syndrome, attributing it to further erroneous treatment causing increased severity. This is not merely heat accumulation at the end stage, but addresses the original cause of the Pi syndrome to propose a treatment. The sweetness of Gancao (Licorice Root) and Dazao (Jujube) tonifies the deficiency caused by purgation; the pungency of Ganjiang (Dried Ginger) and Banxia (Pinellia Tuber) disperses the rebellious fullness; the bitterness of Huangqin (Scutellaria Root) and Huanglian (Coptis Rhizome) resolves the vexation caused by pathogenic heat. Although the syndrome is roughly similar to Article 35, there are similarities and differences in the formula: Guizhi (Cinnamon Twig) is omitted because there is no exterior syndrome; Gancao and Ganjiang are used together to tonify deficiency and dissipate hardness; Renshen (Ginseng Root) and Baizhu (Atractylodes Macrocephala Rhizome) are omitted to avoid excessive Qi-tonification; Dazao is used for its ability to nourish fluids. Because the Pi syndrome has worsened due to repeated errors, Huangqin and Huanglian are used as counter-agents to Ganjiang, working with Banxia to lead the dispersion. This explains the distinction between similarity and difference.
(21) After taking herbal decoctions for Shanghan, diarrhea persists, accompanied by epigastric fullness and hardness. After taking Xiexin Tang (Heart-Draining Decoction), the physician again administered purgatives, yet diarrhea continues. The physician then prescribed Lizhong Tang (Middle-Regulating Decoction), which exacerbated the diarrhea. Lizhong Tang regulates the Middle Jiao (Middle Burner); this diarrhea originates in the Lower Jiao (Lower Burner) and should be treated with Chishizhi Yuyuliang Tang (Red Halloysite and Hematite Decoction). If diarrhea persists despite this, promoting urination is indicated.
Chishizhi Yuyuliang Tang Formula
Chishizhi (Red Halloysite, 1 jin, crushed) Yuyuliang (Hematite, 1 jin, crushed)
These two ingredients are decocted in six sheng (approx. 6 liters) of water to yield two sheng (approx. 2 liters). Strain and divide into three doses.
The phrase "After taking Xiexin Tang" continues the discussion from the previous article. "Again administering purgatives leads to persistent diarrhea" indicates incorrect secondary treatment. "Physician prescribes Lizhong Tang, worsening diarrhea" signifies further error. Regarding Lizhong Tang: *Nan Jing* states that the Middle Jiao is located at the middle epigastrium (Zhongwan) and is responsible for rotting and ripening food and drink. The Lower Jiao is located at the opening of the bladder and is responsible for separating the clear from the turbid, allowing exit without re-entry, facilitating transmission. *Ling Shu* states that food and drink reside in the stomach, transform into feces, and descend together into the small and large intestines to form the Lower Jiao. They filter and descend together, separating juices, circulating through the Lower Jiao, and seeping into the bladder. Thus, diarrhea originating in the Lower Jiao implies bladder failure to filter and intestinal slippage. Yuyuliang is sweet and neutral, eliminating fullness and stabilizing the organs; Chishizhi is sweet and warm, securing the intestines and arresting slippage. However, if diarrhea persists after arresting slippage, it is due to bladder filtration failure and inability to separate water and grain. Promoting urination guides out water and clarifies the separation, allowing each Fu organ to perform its function. When each Fu organ performs its duty, diarrhea can be cured without further intervention.
(22) After severe purgation followed by sweating in Shanghan, if epigastric fullness and aversion to cold occur, the exterior syndrome remains unresolved. One must not attack the fullness directly but should first resolve the exterior. Once the exterior is resolved, the fullness may be attacked. To resolve the exterior, Guizhi Tang (Cinnamon Twig Decoction) is appropriate. To attack the fullness, Dahuang Huanglian Xiexin Tang (Rhubarb, Scutellaria, and Coptis Heart-Draining Decoction) is appropriate.
Here, "exterior" refers not to the initial exterior syndrome. "Purgation followed by sweating" refers to gently relieving residual exterior pathogens. "Resolve" implies rescue or alleviation, such as quenching thirst or relieving urgency. Resolving the exterior differs from releasing the exterior. The initial exterior syndrome of Shanghan requires release, hence Mahuang Tang (Ephedra Decoction) is used. Here, the post-sweating exterior requires resolution, hence Guizhi Tang is indicated, similar to the exterior syndrome of Fengzhong, requiring muscle-releasing and Wei-Qi consolidation. Guizhi Tang is referenced in the previous section; the method for attacking fullness is in the following section.
(23) In Shanghan, if the physician uses purgation, leading to subsequent persistent diarrhea with undigested food and body pain, urgent rescue of the interior is required. Later, if body pain persists but bowel movements normalize, urgent rescue of the exterior is required. For rescuing the interior, Sini Tang (Counterflow Cold Decoction) is appropriate. For rescuing the exterior, Guizhi Tang is appropriate.
Persistent diarrhea with undigested food and body pain indicates stomach injury from purgation, severe interior deficiency-cold, failure of digestion, separation of water and grain, loss of body fluids, and dysfunction of bones and joints. "Rescue" means protection. Urgent rescue of the interior is prioritized because interior deficiency is the primary concern after purgation. Normal bowel movements indicate clear urine and regular stools, signifying harmonized Li-Qi (Interior Energy). Body pain with harmonized Li-Qi indicates Wei-Qi failing to secure the exterior and disharmony with Ying-Qi (Nutritive Energy). Urgent rescue of the exterior prevents further injury to the doubly deficient exterior. Sini Tang restores Yang and consolidates Yin; Guizhi Tang secures Wei-Qi and harmonizes Ying-Qi. This explains the urgency in treating exterior versus interior. Sini Tang is in the following section; Guizhi Tang is referenced above.
(24) After Shanghan is treated with sweating, vomiting, or purgation, and the pathogen is resolved, if epigastric fullness and hardness persist along with unrelenting belching, Xuanfu Daizhe Shi Tang (Inula, Hematite, and Oyster Shell Decoction) is indicated.
Xuanfu Daizhe Shi Tang Formula
Xuanfuhua (Inula Flower, 3 liang) Renshen (Ginseng Root, 2 liang) Shengjiang (Fresh Ginger, 5 liang, sliced) Daizheshi (Hematite, 1 liang) Banxia (Pinellia Tuber, half sheng, washed)
Gancao (Licorice Root, 3 liang, honey-fried) Dazao (Jujube, 12 pieces, split)
These seven ingredients are decocted in one dou (approx. 10 liters) of water to yield six sheng (approx. 6 liters). Strain, concentrate by boiling to three sheng (approx. 3 liters). Take one sheng (approx. 1 liter) warm, three times daily.
"Resolved" means the major pathogen has dispersed. Epigastric fullness and hardness with unrelenting belching indicate unrecovered Zheng-Qi (Upright Energy), weak Stomach Qi, and rebellious retained fluid. Xuanfuhua and Banxia eliminate fluid to reduce fullness; Renshen and Gancao nourish Zheng-Qi to benefit new deficiency; Daizheshi anchors and descends belching; Shengjiang and Dazao harmonize the Spleen and Stomach. These seven herbs constitute the key strategy for nourishing Zheng-Qi and dispersing residual pathogens.
(25) After eight or nine days of Shanghan, if purgation leads to chest fullness, vexation, fright, difficulty urinating, delirium, and whole-body heaviness making turning difficult, Chaihu Jia Longgu Muli Tang (Bupleurum plus Dragon Bone and Oyster Shell Decoction) is indicated.
Chaihu Jia Longgu Muli Tang Formula
Chaihu (Bupleurum Root, 4 liang) Banxia (Pinellia Tuber, 2 he, washed) Longgu (Dragon Bone, 1.5 liang) Muli (Oyster Shell, 1.5 liang) Renshen (Ginseng Root, 1.5 liang)
Fuling (Poria, 1.5 liang) Qiandan (Lead Monoxide, 1.5 liang) Guizhi (Cinnamon Twig, 1.5 liang, peeled) Shengjiang (Fresh Ginger, 1.5 liang, sliced) Dahuang (Rhubarb Root, 2 liang)
Dazao (Jujube, 6 pieces, split)
These eleven ingredients are decocted in eight sheng (approx. 8 liters) of water to yield four sheng (approx. 4 liters). Add Dahuang, cut into chess-piece sizes, boil for one or two more boils. Strain. Take one sheng (approx. 1 liter) warm.
Chest fullness results from interior deficiency after purgation, with external heat entering the interior and combining with fluid to obstruct the diaphragm, causing vexation. Fright belongs to the Heart; the Heart houses the Spirit and resides in the diaphragm. Deficiency of Zheng-Qi and excess of pathogen cause mental unrest. Whole-body heaviness and immobility result from loss of body fluids and stagnant blood circulation after initial body pain. Due to Heart deficiency causing fright, Renshen and Fuling's sweet and bland nature tonify the Heart; Longgu, Muli, and Qiandan's heavy and astringent nature anchor the Heart to calm fright. Banxia's pungent-warm nature disperses chest fullness; Chaihu's bitter-cold nature clears depressive heat. Loss of fluids causes urinary difficulty, addressed by Renshen and Fuling; dryness in the Stomach causing delirium is regulated by Shengjiang and Dazao. Fullness in the diaphragm requires Banxia to open and Dahuang to purge; heaviness in the body requires Renshen to nourish and Guizhi to harmonize. Although this case lacks explicit mention of the Three Yang syndromes, this formula demonstrates the treatment principle of harmonizing the Three Yang syndromes.
(26) After purgation, Guizhi Tang should not be administered again. If sweating and wheezing occur without significant fever, Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction) is indicated.
This parallels Article 15 regarding post-sweating contraindication of Guizhi Tang, differing only by the word "purgation." Although sweating and purgation differ, both are erroneous treatments leading to wheezing. Hence, they share the same treatment. Comparing this with Article 40 (post-sweating wheezing treated with Guizhi Houpo Xingzi Tang) confirms that Guizhi Tang is contraindicated after purgation or sweating here. Comprehensive analysis ensures complete understanding.
(27) After purgation in Shanghan, if vexation, abdominal fullness, and restlessness (lying down and sitting up uncomfortably) occur, Zhizi Houpo Tang (Gardenia and Magnolia Bark Decoction) is indicated.
Zhizi Houpo Tang Formula
Zhizi (Gardenia Fruit, 14 pieces, split) Houpo (Magnolia Bark, 4 liang, ginger-fried) Zhishi (Immature Bitter Orange, 4 liang, soaked in water, pulp removed, stir-fried)
These three ingredients are decocted in three and a half sheng (approx. 3.5 liters) of water to yield one and a half sheng (approx. 1.5 liters). Strain and divide into three doses. Take one dose warm. If vomiting occurs, stop subsequent doses.
Complications from purgation are always due to error. Vexation results from external pathogen entering the interior and obstructing the diaphragm. Abdominal fullness results from deficient pathogen stagnating in the Stomach, causing distension. Lying down relates to Yin; abdominal fullness is Yin stagnation. Rising relates to Yang; vexation is Yang depression. Hence, discomfort arises. Zhizi's bitter-cold nature promotes vomiting to relieve chest vexation; Houpo and Zhishi purge gastric and abdominal fullness. These three herbs alleviate post-purgation discomfort.
(28) After Shanghan is severely purged with pill medicines, if body heat persists and mild vexation occurs, Zhizi Ganjiang Tang (Gardenia and Dried Ginger Decoction) is indicated.
Zhizi Ganjiang Tang Formula
Zhizi (Gardenia Fruit, 14 pieces, split) Ganjiang (Dried Ginger, 2 liang)
These two ingredients are decocted in three and a half sheng (approx. 3.5 liters) of water to yield one and a half sheng (approx. 1.5 liters). Strain and divide into two doses. Take one dose warm. If vomiting occurs, stop subsequent doses.
Erroneous use of pill medicines causes disease transformation and toxin retention. Severe purgation damages both Yin and Yang, leading to persistent body heat and mild vexation. Zhizi's sour-bitter nature promotes vomiting to clear internal heat and relieve vexation; Ganjiang's pungent-hot nature disperses residual toxins and benefits Qi. Vomiting disperses stagnation; pungency restores Yang. This explains the rationale.
(29) After five or six days of Shanghan, if severe purgation leads to persistent body heat and central chest binding pain, the disease is not resolving. Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is indicated.
Zhizi Chi Tang Formula
Zhizi (Gardenia Fruit, 14 pieces, split) Xiangchi (Fermented Soybean, 4 he, wrapped in cloth)
These two ingredients are decocted in four sheng (approx. 4 liters) of water. First boil Zhizi to yield two and a half sheng (approx. 2.5 liters), then add Xiangchi. Boil to yield one and a half sheng (approx. 1.5 liters). Strain and divide into two doses. Take one dose warm. If vomiting occurs, stop subsequent doses.
The binding pain in this article is heavier than the mild vexation in the previous one, representing a slight variation in the same syndrome. The previous case was lighter, so Ganjiang was used to disperse; this case is heavier, so Xiangchi is used to resolve depression. Xiangchi treats Shanghan chills, fever, toxic heat, vexation, fullness, and oppression. Thus, these two articles represent minor variations within a major similarity.
(30) After sweating or purgation, if vexation, heat, and chest obstruction occur, Zhizi Chi Tang is indicated.
This is identical to the previous article. "Obstruction" refers to pathogenic heat stagnation causing blockage, which is less severe than pain. Since the Heart resides in the chest and diaphragm, the treatment is the same.
(31) After sweating, vomiting, or purgation, if empty vexation and insomnia occur, and in severe cases, tossing and turning with deep inner embarrassment (Ao Nao), Zhizi Chi Tang is indicated.
If there is shortness of breath, Zhizi Gancao Chi Tang (Gardenia, Licorice, and Fermented Soybean Decoction) is indicated.
If there is vomiting, Zhizi Shengjiang Chi Tang (Gardenia, Fresh Ginger, and Fermented Soybean Decoction) is indicated.
Zhizi Gancao Chi Tang Formula
Add 2 liang of Gancao to the Zhizi Chi Tang formula. Follow previous methods. Stop if vomiting occurs.
Zhizi Shengjiang Chi Tang Formula
Add 5 liang of Shengjiang to the Zhizi Chi Tang formula. Follow previous methods. Stop if vomiting occurs.
Shortness of breath indicates Qi injury; thus, Gancao is added to tonify. Vomiting indicates Qi rebellion; thus, Shengjiang is added to disperse downward.
(32) Whenever using Zhizi Tang formulas, if the patient has a history of loose stools, do not administer.
Zhizi is sour, bitter, and very cold with emetic and purgative properties. Patients with a history of loose stools have inherent interior deficiency and cold organs. Interior deficiency predisposes to vomiting; organ cold predisposes to diarrhea. Hence, this prohibition is emphasized.
(33) After purgation followed by sweating, chills and a faint, thin pulse will definitely occur. This is due to deficiency in both interior and exterior.
"Interior" refers to erroneous purgation causing Yin loss and interior deficiency, resulting in a faint, thin pulse. "Exterior" refers to subsequent sweating causing Yang loss and exterior deficiency, resulting in chills.
(34) After purgation followed by sweating, if烦躁 (restlessness) occurs during the day with inability to sleep, but quietness at night, without vomiting, thirst, or exterior syndrome, with a deep, faint pulse and no significant body heat, Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction) is indicated.
Ganjiang Fuzi Tang Formula
Ganjiang (Dried Ginger, 1 liang) Fuzi (Prepared Aconite Root, 1 piece, peeled, raw, broken into eight pieces)
These two ingredients are decocted in three sheng (approx. 3 liters) of water to yield one sheng (approx. 1 liter). Strain and take all at once.
Erroneous purgation loses Yin; subsequent sweating loses Yang. Yang deficiency becomes more severe than Yin deficiency. Yang governs daytime activity; daytime heat/vexation represents Yang hyperactivity. Restlessness (Zao), though associated with Yin, is disturbed by Yang. Inability to sleep indicates Yang failing to overcome Yin, struggling within Yin. Yin governs nighttime; quietness indicates absence of Yang activity. Absence of vomiting, thirst, exterior syndrome, deep/faint pulse, and lack of significant heat confirm severe Yang deficiency unable to overcome Yin. Thus, Ganjiang Fuzi Tang, being pungent and hot, is used to restore severely deficient Yang and harmonize with dominant Yin.
(35) After Shanghan treated with vomiting or purgation, if reverse fullness in the heart/chest, Qi rushing to the chest, dizziness upon standing, and a deep, tight pulse occur, sweating will disturb the meridians, causing tremors and shaking. Fuling Guizhi Baizhu Gancao Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) is indicated.
Fuling Guizhi Baizhu Gancao Tang Formula
Fuling (Poria, 4 liang) Guizhi (Cinnamon Twig, 3 liang, peeled) Baizhu (Atractylodes Macrocephala Rhizome, 2 liang) Gancao (Licorice Root, 2 liang, honey-fried)
These four ingredients are decocted in six sheng (approx. 6 liters) of water to yield three sheng (approx. 3 liters). Strain and divide into three warm doses.
Reverse fullness in the epigastrium results from retained fluid overflowing and accumulating in the diaphragm. Qi rushing to the chest results from cold pathogen surging upward with fluid. Disturbing the meridians means injuring the meridian channels. Trembling refers to vigorous movement. Meridians rely on body fluids for nourishment. Fluid retention is a type of fluid pathology; when static, it nourishes; when moving, it causes disease. Disease should be controlled, not induced by sweating. Post-vomiting/purgation with a deep/tight pulse followed by sweating causes further loss of fluids and depletion of Qi and Blood, leading to these symptoms. Baizhu and Fuling overcome dampness and guide out fluid; Guizhi and Gancao secure the exterior and harmonize the interior. Thus, these four herbs are needed to treat meridian disturbance caused by sweating.
(36) After Shanghan treated with vomiting and purgation, followed by sweating, if empty vexation and a very faint pulse occur, and after eight or nine days, epigastric fullness and hardness, hypochondriac pain, Qi rushing to the throat, dizziness, and meridian twitching occur, prolonged neglect will lead to flaccidity syndrome (Wei Syndrome).
This elaborates on the previous article, warning that failure to treat properly leads to disability. The previous article mentioned a deep/tight pulse before sweating; this article mentions a very faint pulse after sweating. "Meridian movement" is a variant of "disturbing meridians"; "twitching" is equivalent to trembling. These articles mutually illuminate each other. "Prolonged" means after eight or nine days, if unresolved and untreated, internal loss of fluids and external infiltration of dampness will lead to Bi Syndrome and eventually Wei Syndrome. Wei Syndrome involves flaccidity and weakness of the legs, unable to walk.
(37) In Taiyang Shanghan, applying warm needle therapy will definitely cause fright.
Warm needle therapy involves heating the needle before insertion to dispel cold. "Fright" is mental agitation and fear. The Heart houses the Spirit. Ying-Qi connects to the Heart, and both Heart and Ying-Qi govern Blood. Cold pathogen injuring Ying-Qi stagnates and generates heat. Warm needle therapy attacks cold with fire, which is intensely hot. Heat consumes Blood, leading to deficiency. Blood deficiency leads to Heart deficiency; Heart deficiency leaves the Spirit's residence empty. Without a foundation, the Spirit floats outward, losing control and causing fright.
(38) In Shanghan, on the second or third day, if palpitations and vexation occur, Xiao Jianzhong Tang (Minor Construct the Middle Decoction) is indicated.
Xiao Jianzhong Tang Formula
Guizhi (Cinnamon Twig, 3 liang, peeled) Shaoyao (White Peony Root, 6 liang) Gancao (Licorice Root, 2 liang, honey-fried) Shengjiang (Fresh Ginger, 3 liang, sliced) Jiaoyi (Maltose, 1 sheng) Dazao (Jujube, 12 pieces, split)
These six ingredients are decocted in seven sheng (approx. 7 liters) of water to yield three sheng (approx. 3 liters). Strain, add Jiaoyi, and melt over low heat. Take one sheng (approx. 1 liter) warm, three times daily. Patients prone to vomiting should not use Jianzhong Tang due to its sweetness.
On the second or third day, transmission should occur. If no transmission/change happens, but palpitations and vexation persist, it indicates that although the pathogen is weakening, Zheng-Qi is also too weak to expel it, leading to stagnation. Xiao Jianzhong Tang is Guizhi Tang with doubled Shaoyao and added Jiaoyi. Guizhi Tang supports Yang and secures Wei-Qi; secured Wei-Qi harmonizes Ying-Qi. Doubling Shaoyao uses sourness to consolidate Yin; consolidated Yin allows Yang to return. Adding Jiaoyi uses sweetness to moisten Earth (Spleen); moistened Earth generates all things. "Jian" means establishing a standard. The standard is centrality, unbiased and impartial, like the broad royal way. This describes such a principle.
(39) In Shanghan, if the pulse is Knotted (Jie) or Intermittent (Dai), with palpitations, Zhi Gancao Tang (Honey-Fried Licorice Decoction) is indicated.
Zhi Gancao Tang Formula
Gancao (Licorice Root, 4 liang, honey-fried) Shengjiang (Fresh Ginger, 3 liang, sliced) Guizhi (Cinnamon Twig, 3 liang, peeled) Maidong (Ophiopogon Tuber, half sheng) Maziren (Hemp Seed, half sheng)
Dazao (Jujube, 12 pieces, split) Renshen (Ginseng Root, 2 liang) Sheng Dihuang (Rehmannia Root, 1 jin) Ejiao (Donkey-Hide Gelatin, 2 liang)
These nine ingredients are decocted in seven sheng of Qingjiu (clear wine) and eight sheng of water. First boil the eight ingredients to yield three sheng. Strain, add Ejiao, and melt completely. Take one sheng (approx. 1 liter) warm, three times daily.
Also known as Fumai Tang (Pulse-Recovering Decoction).
Knotted/Intermittent pulse with palpitations indicates deficiency exceeding excess. It is like bandits wanting to retreat, but the host is too weak to direct them, leading to hesitation. Renshen, Gancao, and Maidong tonify deficiency to recover the Knotted/Intermittent pulse; Dihuang, Ejiao, and Maziren generate Blood to calm palpitations; Guizhi harmonizes Ying and Wei to address excess; Shengjiang and Dazao strengthen the Spleen and Stomach to regulate the center; Qingjiu assists in generating Qi and Blood. "Fumai" (Pulse-Recovering) reflects its true meaning. This formula aims to gradually tonify the deficient until sufficient, causing the excess to recede and return to the original state. There may be a missing section regarding Dai pulse between the text mentioning Jie/Dai and Dai Yin.
The pulse that is slow with occasional pauses is called Jie (Knotted) pulse. If the pulse stops and returns slightly faster, it is called Jie Yin (Knotted Yin) pulse. If the pulse stops and cannot return immediately, resuming later, it is called Dai Yin (Intermittent Yin) pulse. Patients with these pulses are difficult to treat. (There should be a paragraph on Dai pulse after Jie Yin.)
This follows the discussion of Jie and Dai pulses, elaborating on Jie Yin and Dai Yin, detailing their characteristics, consistent with Chapter 4 of the Pulse Diagnosis section.
(40) After eight or nine days of Shanghan, if Wind and Dampness combine, causing painful body aches, inability to turn oneself, without vomiting or thirst, and with a floating, deficient, and choppy pulse, Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) is indicated.
Guizhi Fuzi Tang Formula
Guizhi (Cinnamon Twig, 4 liang, peeled) Fuzi (Prepared Aconite Root, 3 pieces, processed, peeled, broken into eight pieces) Shengjiang (Fresh Ginger, 3 liang, sliced) Gancao (Licorice Root, 2 liang, honey-fried) Dazao (Jujube, 12 pieces, split)
These five ingredients are decocted in six sheng (approx. 6 liters) of water to yield two sheng (approx. 2 liters). Strain and divide into three warm doses.
"Wind and Dampness combining" is described in the previous section. Here, it arises from cold, causing painful body aches, no vomiting, and no thirst. Inability to turn indicates the heavy nature of Dampness. Floating indicates Wind; deficient indicates insufficiency after sweating; choppy indicates Dampness. This is slightly different but largely similar to the previous section. Guizhi Fuzi Tang is essentially the same as Gancao Fuzi Tang from the previous section.