以姜枣易术之变制也。去术者。以寒本无汗。不似风之自汗而湿多也。用姜枣者。以寒属阴。不
如风阳之能食也。然去彼取此虽少殊。而其所以为散风除湿则均耳。
若其人大便硬。小便自利者。去桂枝加白术汤主之。（脉经末句汤名无白字。）
桂枝附子去桂枝加白术汤方
于桂枝附子汤方内。去桂枝加术三两。余根据前法。
大便硬。里实矣。故去桂枝。恶其主表而不知里也。小便自利。湿胜也。故加术。以其益土
而能燥湿也。此加减旧缺。今补。
（四十一）太阳病。项背强KT KT 。无汗恶风者。葛根汤主之。
葛根汤方
葛根（四两） 麻黄（三两去节） 桂枝（二两去皮） 芍药（二两） 甘草（二两炙）
生姜（三两切） 大枣（十二枚擘）
上七味。 咀。以水一斗。先煮麻黄葛根减二升。去沫。内诸药。煮取三升。去滓。温服一升。
覆取微似汗。不须啜粥。余如桂枝法将息。及禁忌。
太阳病项背强KT KT 与上编同者。风寒过太阳之荣卫。初交阳明之经络。经络同。所以风寒皆
然也。无汗者。以起自伤寒。故汗不出。乃上编有汗之反对。风寒之辨别也。恶风乃恶寒之互文。
风寒皆通恶。而不偏有无也。夫以太阳中风。项背强KT KT 。汗出。恶风。用桂枝加葛根而论之。
则此太阳伤寒。项背强KT KT 。无汗。恶风。当用麻黄加葛根。而用葛根汤者何哉。盖KT KT 乃加阳明
之时。喘已不作。故去杏仁。不用麻黄汤之全方。不可以麻黄加为名。而用麻黄桂枝甘草葛根
以为汤者。实则是麻黄加之规制也。用姜枣芍药者。以阳明属胃。胃为中宫。姜枣皆和中之物。
芍药有缓中之义也。不须啜粥。麻黄类例也。
（四十二）太阳与阳明合病。喘而胸满者。不可下。麻黄汤主之。
合病见上编。肺主气。气逆则喘。喘甚则肺胀。胸满者。肺胀也。胸乃阳明之部分。喘乃太
阳伤寒之本病。以喘不除。甚而至于胸满。故曰合病。然肺不属太阳阳明。而太阳阳明合病之伤寒。
病全在肺。何也。曰。肺为五脏之华盖。内受诸经百脉之朝会。其脏金。其性寒。寒邪凑于荣。
肺以寒召寒。类应故也。不可下者。喘来自太阳之初。满惟在胸。不在胃也。夫麻黄汤者。主治
太阳伤寒之初病。有阳明。何以独从太阳之主治也。曰。麻黄固善于散寒。其功尤能泻肺家之实
满。杏仁惟其利于下气。故其效则更长于定喘。桂枝虽佐。其实有纲维之妙。甘草虽使。其才有
和缓之高。是故太阳表之治行。则阳明胸之功自奏矣。
（四十三）太阳与阳明合病者。必自下利。葛根汤主之。
必。定然之词。自。谓自然而然也。盖太阳者。膀胱也。膀胱主水。阳明者。胃经也。胃主谷。
寒为阴。阴气主下降。故伤寒无他故。自然而然下利者。太阳阳明合病。经中之邪热甚。胃气弱
不化谷不厘清。杂迸而走注。所以谓之必也。以必定自然而然下利。故但用葛根汤散经中之寒邪。
而以不治治利。以不治治利者。麻黄散太阳之表。葛根解阳明之肌。桂枝主荣卫之和。姜枣健脾
之弱。甘草者。和中之国老。芍药者。缓中而佐使。夫如是而经中之邪散。则胃中之正回。不厘清
者自厘清。不显治者而治在其中矣。噫。王者不治夷狄而夷狄治。圣人无为而无不为。所谓仁之
尽义之至。吾于是乎重有感焉。彼以煦煦为仁。孑孑为义。窃圣人之王道以乱名实者。谓不自欺
以欺人。公孙龙不能为之说也。悲哉。
（四十四）二阳并病。太阳初得病时发其汗。汗先出不彻。因转属阳明。续自微汗出。不恶
寒。若太阳病证不罢者。不可下。下之为逆。如此可小发汗。设面色缘缘正赤者。阳气怫郁在表。
当解之熏之。若发汗不彻。不足言阳气怫郁不得越。当汗不汗。其人躁烦。不知痛处。乍在腹中。
乍在四肢。按之不可得。其人短气。但坐以汗出不彻故也。更发汗则愈。何以知汗出不彻。以脉
涩故知也。
转。与传同。见第五问。并病见上编。太阳初得病时至不恶寒。是原致并之因。若太阳证不
罢。至解之熏之。是言治之之次第。若发汗不彻至末。是反复申上文之详。彻。除也。去也。不彻。
言汗发不如法病不除去也。越。散也。言怫郁不散也。涩为血虚。血虚者。汗出过多也。所以转
阳明也。
（四十五）伤寒六七日。结胸热实。脉沉紧。心下痛。按之石硬者。大陷胸汤主之。
沉为里。紧为寒。结胸。故心下痛。热实。故石硬。方见上编。盖证同也。
（四十六）小结胸。病正在心下。按之则痛。脉浮滑者。小陷胸汤主之。
小陷胸汤方
黄连（一两） 半夏（半升洗） 栝蒌实（一枚大者）
上三味。以水六升。先煮栝蒌取三升。去滓。内诸药。煮取二升。去滓。分。温三服。
正在心下。言不似大结胸之高而在上也。按之则痛。言比不按亦痛则较轻也。浮则浅于沉。
滑则缓于紧。此结胸之所以有大小之分也。黄连苦寒。以泄热也。半夏辛温。以散结也。栝蒌实
苦而润。苦以益苦。则致热于易泄为可知。润以济
辛。则散结于无难开可必。所谓有兼人之勇而居上功者。惟此物为然也。
（四十七）伤寒十余日。热结在里。复往来寒热者。与大柴胡汤。但结胸无大热者。此为水
结在胸胁也。但头微汗出者。大陷胸汤主之。
水。即饮也。以不实硬。故曰水结。胸胁亦里也。以热结不高。故曰在里。此条两节。上节
以往来寒热。故用大柴胡汤。下节以水结无大热。故用大陷胸汤。然热结与水结。胸胁与里。皆
互词。大同小异。皆下法也。二方俱见上编。
（四十八）太阳与少阳合病。自下利者。与黄芩汤。若呕者。黄芩加半夏生姜汤主之。
黄芩汤方
黄芩（三两） 甘草（二两炙） 芍药（二两） 大枣（十二枚擘）
上四味。以水一斗。煮取三升。去滓。温服一升。日再。夜一服。
黄芩加半夏生姜汤方
于黄芩汤方内。加半夏半升。生姜三两。余根据黄芩汤法。
阳明间太少而中居。太少病。阳明独能逃其中乎。是故芍药利太阳膀胱而去水缓中。黄芩除
少阳寒热而主肠胃不利。大枣益胃。甘草和中。是则四物之为汤。非合三家而和调一气乎。然气
一也。下夺则利。上逆则呕。半夏逐水散逆。生姜呕家圣药。加所当加。无如二物。
（四十九）伤寒六七日。发热微恶寒。支节烦疼。微呕。心下支结。外证未去者。柴胡加桂
枝汤主之。
柴胡加桂枝汤方
柴胡（四两） 桂枝（一两半去皮） 人参（一两半） 甘草（一两炙） 半夏（二合半洗）
黄芩（一两半） 芍药（一两半） 生姜（一两半切） 大枣（六枚擘）
上九味。以水七升。煮取三升。去滓。分温三服。
支节。四肢百节也。支结言支饮抟聚而结也。发热至微呕。太阳之表也。故曰外证未去。以微
而未去也。故加桂枝以解之。支结属少阳。以结则难开也。故用柴胡为主治。然则是证也。虽无
太少之明文。而于太少之治以究之。则亦因药可以知病矣。
（五十）伤寒四五日。身热恶风。颈项强。胁下满。手足温而渴者。小柴胡汤主之。
身热恶风。太阳表也。颈项强。有阳明也。胁下满。少阳也。然则三阳俱见病矣。手足温而
渴者。邪凑半表半里而里证见也。夫以三阳俱见病而独从少阳之小柴胡以为治者。太阳阳明之邪
微。少阳近里而里证见。故从少阳一于和而三善则皆得也。
（五十一）伤寒阳脉涩。阴脉弦。法当腹中急痛者。先与小建中汤。不瘥者。与小柴胡汤主之。
阳主气。涩主痛。阴主血。弦主急。投以小建中者。求之于益阴而和阳也。不瘥。则不对可
知矣。小柴胡者。少阳之主治也。盖少阳属木。其脉弦。木盛则土受制。故涩而急痛也。然则是
治也者。伐木以救土之谓也。
（五十二）伤寒五六日。已发汗。而复下之。胸胁满。微结。小便不利。渴而不呕。但头汗
出。往来寒热心烦者。此为未解也。柴胡桂枝干姜汤主之。
柴胡桂枝干姜汤方
柴胡（半斤） 桂枝（三两去皮） 干姜（三两） 栝蒌根（四两） 黄芩（三两） 牡蛎
（三两熬） 甘草（二两炙）
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。初服微烦。
后服汗出便愈。
胸。太阳阳明也。胁。少阳也。小便不利。太阳之膀胱不清也。渴而不呕。阳明
之胃热而气不逆也。头汗出者。三阳之邪热甚于上而气不下行也。往来寒热心烦者。少阳半表半
里之邪出入不常也。柴胡黄芩。主除往来之寒热。桂枝甘草。和解未罢之表邪。牡蛎干姜。咸
以软其结。辛以散其满。栝蒌根者。苦以滋其渴。凉以散其热。是汤也。亦三阳平解之一法也。
（五十三）太阳病。十日以去。脉浮细而嗜卧者。外已解也。设胸满胁痛者。与小柴胡汤。
脉但浮者。与麻黄汤。脉浮细而嗜卧者。大邪已退。血气乍虚而肢体倦怠也。胸满胁痛。则少阳
未除。故与小柴胡以和之。脉但浮则邪还表。故与麻黄汤以发之。
（五十四）伤寒十三日。胸胁满而呕。日哺所。发潮热。已而微利。此本柴胡证。下之而不
得利。今反利者。知医以丸药下之。非其治也。潮热者实也。先宜小柴胡汤以解外。后以柴胡加
芒硝汤生之。
柴胡加芒硝汤方
于小柴胡汤方内。加芒硝六两。余根据小柴胡汤法。
十三日。过经也。不解。坏例也。非其治也以上。乃原其坏由于医之误。以下至末。救误之
治也。然微利矣。加芒硝以更下之者。丸之为丸。大率辛热物。虽快攻下。下者药也。热以益热。
热结反实而不出。故须咸以软之也。
（五十五）伤寒五六日。呕而发热者。柴胡汤证具而以他药下之。柴胡证仍在者。复与柴胡
汤。此虽已下之不为逆。必蒸蒸而振。却发热汗出而解。若心下满而硬痛者。此为结胸也。大陷
胸汤主之。但满而不痛者。此为痞。柴胡不中与之。宜半夏泻心汤。
半夏泻心汤方
半夏（半升洗） 黄芩（三两） 干姜（三两） 人参（三两） 黄连（一两） 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。
此条上节。与上编第六十三条互相发明。盖风寒至少阳证治无差殊。故更互为文而互言之。
以见彼此皆然也。若心下满以下二节。乃复言其变以出其治。结胸乃其变之重者。以其重而结于
胸。故从大陷胸汤。痞则其变之轻者。以其轻而痞于心。故用半夏泻心汤。半夏干姜。辛以散虚
满之痞。黄芩黄连。苦以泄心膈之热。人参甘草。甘以益下后之虚。大枣甘温。润以滋脾胃于健。
曰泻心者。言满在心膈而不在胃也。
（五十六）本以下之。故心下痞。与泻心汤。痞不解。其人渴而口燥烦。小便不利者。五苓散主之。
泻心汤者。本所以治虚热之气痞也。治痞而痞不解。则非气聚之痞可知矣。渴而口燥烦小便
不利者。津液涩而不行。伏饮停而凝聚。内热甚而水结也。五苓散者。润津液而滋燥渴。导水饮
而荡结热。所以又得为消痞满之一治也。
（五十七）妇人伤寒。发热。经水适来。昼日明了。暮则谵语。如见鬼状者。此为热入血室。
无犯胃气及上二焦。必自愈。
无。与毋通。此与上编末三条文少异而证同。上编言脉与如结胸状。此言昼日明了。暮则谵语。
上编言刺期门及与小柴胡汤。此言无犯胃气及上二焦。皆互言以明互见之意。昼属阳。明了者。
阴邪退也。暮属阴。谵语者。血证得阴而剧也。毋者。禁止之词。犯胃气。以禁下言也。上二焦。
谓上焦中焦。以禁汗吐言也。盖卫气出上焦。津液蓄于中焦。汗则损卫气而亡津液。是汗则犯二焦也。
又上焦主受纳。中焦主受盛。吐则纳与盛俱为逆。是吐则上中二焦亦俱犯也。然下固
损胃。下焦犯矣。是三法皆不可用也。三法皆不可用者。邪本在血室。亦非三者攻之所可能及也。
必自愈者。言伺其经行血下。则邪热得以随血而俱出。犹之红汗而然。故决言必定自解而愈。以
警人勿妄攻取。致谬误以生变乱之意。夫以三法既皆不可用。则与其欲治。宁刺期门。及与小柴
胡汤。而法在焉。即此条之必自愈而观之。则上编之期门虽不刺。小柴胡汤虽不行。亦皆得终当
自愈。从可知矣。且上编出三条。而此篇一条。下编虽无出。要皆欲人同推也。读者通
考而参详之。则男子妇人风寒为病。证治之异同。大端可见矣。
This is a modification of the prescription by replacing Atractylodis Macrocephalae Rhizoma (Baizhu) with Zingiberis Recens Rhizoma (Shengjiang) and Jujubae Fructus (Dazao). Atractylodis Macrocephalae Rhizoma is removed because cold-pathogen-induced disease typically presents without sweating, unlike wind-pathogen-induced disease which features spontaneous sweating and heavier dampness. Ginger and Jujube are used because cold belongs to Yin, whereas wind (a Yang pathogen) tends to increase appetite. Although substituting these herbs results in minor differences, their functions of dispersing wind and eliminating dampness remain equivalent.
If the patient has dry stools and free urination, the primary treatment is Guizhi Fuzi Tang minus Cinnamon Twig plus Atractylodis Macrocephalae Rhizoma Decoction (Guizhi Fuzi Qu Guizhi Jia Baizhu Tang). (Note: The name of the decoction in *Mai Jing* lacks the character "Bai".)
**Decoction for Guizhi Fuzi Tang minus Cinnamon Twig plus Atractylodis Macrocephalae Rhizoma**
Based on the formula for Guizhi Fuzi Tang, remove Cinnamon Twig (Guizhi) and add three liang of Atractylodis Macrocephalae Rhizoma (Baizhu). Prepare and administer the remaining ingredients according to the previous method.
Dry stools indicate interior excess. Therefore, Cinnamon Twig is removed because it primarily treats exterior conditions and does not address the interior. Free urination indicates predominant dampness. Therefore, Atractylodis Macrocephalae Rhizoma is added because it strengthens the Spleen (Earth) and dries dampness. This supplements previously missing information regarding formula modifications.
(41) In Taiyang disease, if there is stiffness and discomfort in the nape and back, absence of sweat, and aversion to wind, Gegen Tang (Kudzu Root Decoction) is indicated.
**Gegen Tang Formula**
Puerariae Lobatae Radix (Gegen, 4 liang), Ephedrae Herba (Mahuang, 3 liang, nodes removed), Cinnamomi Ramulus (Guizhi, 2 liang, bark removed), Paeoniae Radix Alba (Shaoyao, 2 liang), Glycyrrhizae Radix et Rhizoma (Gancao, 2 liang, honey-fried), Zingiberis Recens Rhizoma (Shengjiang, 3 liang, sliced), Jujubae Fructus (Dazao, 12 pieces, split).
Chop the seven ingredients. Boil in ten sheng of water. First boil Mahuang and Gegen until reduced by two sheng, skim off the foam, then add the remaining herbs. Boil until three sheng remain, strain, and take one sheng warm. Cover the patient to induce slight sweating. Drinking hot porridge is not required. Rest and dietary precautions follow those for Guizhi Tang.
The stiffness and discomfort in the nape and back described here are consistent with the upper section, as Wind-Cold passes through the Ying and Wei of Taiyang and initially enters the meridians of Yangming. Since the meridians are the same, the manifestations of Wind and Cold are similar. Absence of sweat arises from Shanghan (Cold Damage), contrasting with the sweating seen in the upper section, serving as a key differentiator between Wind and Cold. "Aversion to wind" is synonymous with "aversion to cold"; both Wind and Cold pathogens cause aversion regardless of sweating status. If Taiyang Zhongfeng (Wind Strike) presents with neck/back stiffness, sweating, and aversion to wind, Guizhi Jia Gegen Tang is used. Conversely, this Taiyang Shanghan case presents with neck/back stiffness, no sweat, and aversion to wind. One might expect Mahuang Jia Gegen Tang, but Gegen Tang is used instead. This is because the stiffness indicates involvement of Yangming; since wheezing is absent, Xingren (Apricot Seed) is omitted, and the full Mahuang Tang is not used. The combination of Mahuang, Guizhi, Gancao, and Gegen essentially follows the structure of Mahuang Tang. Ginger, Jujube, and Shaoyao are included because Yangming corresponds to the Stomach (Central Palace); Ginger and Jujube harmonize the middle, while Shaoyao softens cramping. No porridge is needed, consistent with Mahuang-type formulas.
(42) When Taiyang and Yangming diseases combine, presenting with wheezing and chest fullness, purgation is contraindicated. Use Mahuang Tang.
Combined disease is defined in the upper section. The Lung governs Qi; Qi rebellion causes wheezing, and severe wheezing leads to Lung distension. Chest fullness is a manifestation of Lung distension. The chest belongs to Yangming, while wheezing is the primary symptom of Taiyang Shanghan. Because wheezing persists and worsens to cause chest fullness, it is termed "combined disease." Although the Lung does not belong exclusively to Taiyang or Yangming, why is the pathology located entirely in the Lung? The Lung is the canopy of the five Zang organs, receiving Qi from all meridians. It belongs to Metal and has a Cold nature. When Cold invades the Ying level, the Lung attracts Cold due to similarity, leading to disease. Purgation is contraindicated because the wheezing originates from the initial Taiyang exterior stage, and the fullness is limited to the chest, not the Stomach. Mahuang Tang treats early-stage Taiyang Shanghan. Why prioritize Taiyang treatment when Yangming is involved? Mahuang disperses Cold and clears Lung excess; Xingren descends Qi and stops wheezing; Guizhi coordinates the formula; Gancao harmonizes. Thus, treating the Taiyang exterior resolves the Yangming chest symptoms.
(43) In combined Taiyang and Yangming disease, spontaneous diarrhea inevitably occurs. Gegen Tang is indicated.
"Inevitably" implies a natural progression. Taiyang corresponds to the Bladder (governing Water); Yangming corresponds to the Stomach Channel (governing Grain). Cold is Yin, and Yin energy descends. Without other complications, Cold Damage naturally causes diarrhea in combined Taiyang-Yangming disease due to intense heat in the channels weakening the Stomach's ability to transform grain and separate clear from turbid, causing chaotic downward flow. Hence the term "inevitable." Since the diarrhea is natural, Gegen Tang is used to disperse Cold in the channels, treating the diarrhea indirectly by addressing the root cause. Mahuang disperses Taiyang exterior; Gegen releases Yangming muscle layer; Guizhi harmonizes Ying and Wei; Ginger and Jujube strengthen the Spleen; Gancao harmonizes the center; Shaoyao softens the middle. Once channel pathogens dissipate, Stomach Qi recovers, and separation of clear and turbid resumes. This reflects the principle that non-treatment can be treatment. As kings do not directly conquer barbarians but they submit themselves, and sages achieve all through non-action, this demonstrates the ultimate extent of Ren (Benevolence) and Yi (Righteousness). I am deeply moved by those who mistake petty kindness for Ren and isolated righteousness for Yi, confusing names and realities—a feat even Gongsun Long could not justify. Tragic indeed.
(44) In Bingbing (concurrent disease) of two Yang channels, if sweating during the initial Taiyang stage was incomplete, the condition may transfer to Yangming, presenting with slight sweating and no aversion to cold. If Taiyang symptoms persist, purgation is contraindicated as it is a reverse treatment. Mild sweating should be induced. If the face is persistently red, it indicates Yang Qi stagnation at the exterior; resolve it using fumigation or mild release methods. If sweating was insufficient, leading to Yang Qi stagnation without dispersion, and the patient was deprived of necessary sweating, they may become restless, experience migrating pain in the abdomen or limbs that cannot be pinpointed, suffer from shortness of breath, and have a choppy pulse. These symptoms result from incomplete sweating. Re-inducing sweating will cure the condition.
"Zhuan" (transfer) is synonymous with "Chuan" (transmission). "Bingbing" refers to concurrent disease. The period from initial Taiyang onset to lack of aversion to cold explains the cause of concurrency. If Taiyang signs remain, the sequence involves resolving the exterior via fumigation. Insufficient sweating fails to disperse stagnation ("Yue"). Choppy pulse indicates blood deficiency due to excessive sweating, facilitating transfer to Yangming.
(45) After six or seven days of Shanghan, if Jie Xiong (Chest Binding) presents as Heat Excess with a deep, tight pulse, pain in the epigastrium, and hardness upon palpation like stone, Da Xian Xiong Tang (Major Draining the Chest Decoction) is indicated.
Deep pulse indicates interior; tight pulse indicates Cold. Jie Xiong causes epigastric pain. Heat Excess causes hardness. The formula is identical to that in the upper section due to identical symptoms.
(46) For Xiao Jie Xiong (Minor Chest Binding), where pathology is localized to the epigastrium, tenderness upon pressure, and a floating, slippery pulse, Xiao Xian Xiong Tang (Minor Draining the Chest Decoction) is indicated.
**Xiao Xian Xiong Tang Formula**
Coptidis Rhizoma (Huanglian, 1 liang), Pinelliae Tuber (Banxia, half sheng, washed), Trichosanthis Fructus (Gualou Shi, one large fruit).
Boil the three ingredients in six sheng of water. First boil Gualou Shi to obtain three sheng, strain, add remaining herbs, boil to two sheng, strain, and divide into three warm doses.
Pathology in the epigastrium indicates it is lower than Major Jie Xiong. Tenderness only upon pressure indicates milder severity compared to spontaneous pain. Floating pulse is shallower than deep; slippery pulse is slower/softer than tight. These distinctions define the size difference between Major and Minor Jie Xiong. Huanglian is bitter and cold to drain Heat; Banxia is acrid and warm to dissipate nodules; Gualou Shi is bitter and moistening. Bitterness enhances heat drainage; moisture aids acridity in opening nodules. It possesses unique efficacy.
(47) After more than ten days of Shanghan, if Heat is bound internally accompanied by alternating chills and fever, Da Chai Hu Tang (Major Bupleurum Decoction) is given. If Jie Xiong presents without significant heat, it indicates Water Binding in the chest and hypochondrium. If only slight head sweating occurs, Da Xian Xiong Tang is indicated.
"Water" refers to Fluid retention. Lack of hardness distinguishes it as Water Binding rather than Heat Binding. Chest and hypochondrium are interior locations. Low heat binding is termed "interior." The first clause uses Da Chai Hu Tang for alternating chills and fever. The second uses Da Xian Xiong Tang for Water Binding without significant heat. "Heat binding" and "Water binding," "chest/hypochondrium" and "interior" are mutually explanatory terms with minor differences, both employing purgation. Both formulas are in the upper section.
(48) In combined Taiyang and Shaoyang disease, spontaneous diarrhea warrants Huang Qin Tang (Scutellaria Decoction). If vomiting occurs, Huang Qin Jia Ban Xia Sheng Jiang Tang (Scutellaria Decoction plus Pinellia and Fresh Ginger) is indicated.
**Huang Qin Tang Formula**
Scutellariae Radix (Huangqin, 3 liang), Glycyrrhizae Radix et Rhizoma (Gancao, 2 liang, honey-fried), Paeoniae Radix Alba (Shaoyao, 2 liang), Jujubae Fructus (Dazao, 12 pieces, split).
Boil four ingredients in ten sheng of water to obtain three sheng. Strain and take one sheng warm, twice daily and once at night.
**Huang Qin Jia Ban Xia Sheng Jiang Tang Formula**
Add Pinelliae Tuber (Banxia, half sheng) and Zingiberis Recens Rhizoma (Shengjiang, 3 liang) to Huang Qin Tang. Follow Huang Qin Tang preparation methods.
Yangming lies between Taiyin and Shaoyang. Can Yangming escape the influence of Taiyin and Shaoyang diseases? Shaoyao benefits Taiyang Bladder by draining water and soothing the middle; Huangqin clears Shaoyang chills/fever and treats intestinal-external disharmony; Dazao tonifies Stomach; Gancao harmonizes. This four-herb formula harmonizes Qi across three channels. Qi is unified: downward depletion causes diarrhea; upward rebellion causes vomiting. Banxia drains water and counters rebellion; Shengjiang is the sage herb for vomiting. Adding these two is essential.
(49) After six or seven days of Shanghan, with slight fever and aversion to cold, limb joint pain, slight vomiting, subcostal support/fullness, and unresolved exterior signs, Chai Hu Jia Gui Zhi Tang (Bupleurum plus Cinnamon Twig Decoction) is indicated.
**Chai Hu Jia Gui Zhi Tang Formula**
Bupleuri Radix (Chaihu, 4 liang), Cinnamomi Ramulus (Guizhi, 1.5 liang, bark removed), Ginseng Radix et Rhizoma (Renshen, 1.5 liang), Glycyrrhizae Radix et Rhizoma (Gancao, 1 liang, honey-fried), Pinelliae Tuber (Banxia, 2.5 he, washed), Scutellariae Radix (Huangqin, 1.5 liang), Paeoniae Radix Alba (Shaoyao, 1.5 liang), Zingiberis Recens Rhizoma (Shengjiang, 1.5 liang, sliced), Jujubae Fructus (Dazao, 6 pieces, split).
Boil nine ingredients in seven sheng of water to obtain three sheng. Strain and divide into three warm doses.
"Zhi jie" refers to limbs and joints. "Zhi jie" (supporting knot) refers to Fluid accumulation forming knots. Fever to slight vomiting indicates Taiyang exterior; thus, exterior signs remain. Due to mild persistence, Guizhi is added to resolve the exterior. Subcostal knot belongs to Shaoyang; since knots are hard to open, Chaihu is the primary agent. Although explicit Taiyin/Shaoyang text is absent, treatment principles allow inferring pathology from herbs.
(50) After four or five days of Shanghan, with body heat, aversion to wind, stiff neck, hypochondriac fullness, warm hands/feet, and thirst, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is indicated.
Body heat and aversion to wind indicate Taiyang exterior. Stiff neck involves Yangming. Hypochondriac fullness indicates Shaoyang. All three Yang channels are affected. Warm hands/feet and thirst suggest pathogen gathering at the half-exterior/half-interior level with interior signs emerging. Despite involvement of all three Yang channels, treatment focuses on Shaoyang via Xiao Chai Hu Tang because Taiyang/Yangming pathogens are mild, and Shaoyang is closer to the interior with emerging interior signs. Harmonizing Shaoyang achieves balance for all three.
(51) In Shanghan, if the Yang pulse is choppy and the Yin pulse is string-taut, abdominal acute pain is expected per theory. First administer Xiao Jian Zhong Tang (Minor Construct the Middle Decoction). If ineffective, use Xiao Chai Hu Tang.
Yang governs Qi; choppy indicates pain. Yin governs Blood; string-taut indicates urgency. Xiao Jian Zhong Tang nourishes Yin and harmonizes Yang. Ineffectiveness indicates mismatch. Xiao Chai Hu Tang treats Shaoyang. Shaoyang corresponds to Wood with string-taut pulse. Excessive Wood controls Earth (Spleen/Stomach), causing choppy pulse and acute pain. This treatment suppresses Wood to rescue Earth.
(52) After five or six days of Shanghan, following sweating and purgation, if chest/hypochondriac fullness, slight knotting, dysuria, thirst without vomiting, head-only sweating, alternating chills/fever, and irritability occur, the disease is unresolved. Use Chai Hu Gui Zhi Gan Jiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction).
**Chai Hu Gui Zhi Gan Jiang Tang Formula**
Bupleuri Radix (Chaihu, half jin), Cinnamomi Ramulus (Guizhi, 3 liang, bark removed), Zingiberis Rhizoma (Ganjiang, 3 liang), Trichosanthis Radix (Gualou Gen, 4 liang), Scutellariae Radix (Huangqin, 3 liang), Ostreae Concha (Muli, 3 liang, calcined), Glycyrrhizae Radix et Rhizoma (Gancao, 2 liang, honey-fried).
Boil seven ingredients in twelve sheng of water to obtain six sheng. Strain, re-boil to three sheng. Take one sheng warm, three times daily. Initial dose may cause slight irritability; subsequent doses induce sweating and cure.
Chest relates to Taiyang/Yangming; hypochondrium to Shaoyang. Dysuria indicates unclear Taiyang Bladder function. Thirst without vomiting indicates Yangming Stomach Heat without Qi rebellion. Head sweating indicates intense Heat above with descending Qi failure. Alternating chills/fever and irritability reflect Shaoyang half-exterior/half-interior pathogen fluctuation. Chaihu/Huangqin clear alternating chills/fever; Guizhi/Gancao harmonize residual exterior pathogens; Muli/Ganjiang soften knots and dissipate fullness; Gualou Gen moistens thirst and clears Heat. This formula harmonizes all three Yang channels.
(53) In Taiyang disease, after ten days, if the pulse is floating and fine, and the patient desires to lie down, the exterior has resolved. If chest fullness and hypochondriac pain persist, give Xiao Chai Hu Tang. If the pulse is merely floating, give Mahuang Tang.
Floating/fine pulse and lethargy indicate pathogen retreat and temporary Qi/Blood deficiency. Chest/hypochondriac pain indicates lingering Shaoyang pathogen; Xiao Chai Hu Tang harmonizes. Mere floating pulse indicates pathogen returning to exterior; Mahuang Tang induces sweating.
(54) On the thirteenth day of Shanghan, with chest/hypochondriac fullness, vomiting, afternoon tidal fever, followed by slight diarrhea, this was originally a Chai Hu syndrome. Purging failed to stop diarrhea. The current diarrhea indicates the physician incorrectly used pill-based purgatives. Tidal fever indicates interior excess. First treat with Xiao Chai Hu Tang to resolve the exterior, then use Chai Hu Jia Mang Xiao Tang (Bupleurum plus Niter Decoction) to clear residual heat.
**Chai Hu Jia Mang Xiao Tang Formula**
Add Natrii Sulfas (Mangxiao, 6 liang) to Xiao Chai Hu Tang. Follow Xiao Chai Hu Tang preparation.
Thirteen days exceeds the meridian cycle. Failure to resolve constitutes a complication. The preceding text analyzes the error; the latter describes correction. Although slight diarrhea exists, Mangxiao is added because pill purgatives are often acrid-hot. While fast-acting, heat exacerbates heat binding, making it stubborn. Salty Mangxiao softens hardness.
(55) After five or six days of Shanghan, with vomiting and fever indicating Chai Hu syndrome, if purgatives were wrongly administered but Chai Hu signs persist, re-administer Chai Hu Tang. Though purged, this is not adverse; the patient will likely shiver and sweat, resolving the disease. If epigastric fullness and painful hardness occur, it is Jie Xiong; treat with Da Xian Xiong Tang. If fullness without pain occurs, it is Pi (Glomus); Chai Hu Tang is inappropriate; use Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Epigastrium).
**Ban Xia Xie Xin Tang Formula**
Pinelliae Tuber (Banxia, half sheng, washed), Scutellariae Radix (Huangqin, 3 liang), Zingiberis Rhizoma (Ganjiang, 3 liang), Ginseng Radix et Rhizoma (Renshen, 3 liang), Coptidis Rhizoma (Huanglian, 1 liang), Glycyrrhizae Radix et Rhizoma (Gancao, 3 liang, honey-fried), Jujubae Fructus (Dazao, 12 pieces, split).
Boil seven ingredients in ten sheng of water to obtain six sheng. Strain, re-boil to three sheng. Take one sheng warm, three times daily.
The first part mirrors Article 63 in the upper section, showing consistency in treating Wind-Cold at the Shaoyang stage. The latter parts describe variations: Jie Xiong is severe binding in the chest (Da Xian Xiong Tang); Pi is mild glomus in the epigastrium (Ban Xia Xie Xin Tang). Banxia/Ganjiang disperse empty fullness; Huangqin/Huanglian drain Heart/Diaphragm Heat; Renshen/Gancao tonify post-purge deficiency; Dazao nourishes Spleen/Stomach. "Xie Xin" (Drain Heart) refers to fullness in the Heart/Diaphragm region, not the anatomical Heart.
(56) Originally caused by purgation leading to epigastric Pi, if Xi Xin Tang fails to resolve it, and the patient presents with thirst, dry mouth, irritability, and dysuria, Wu Ling San (Five-Ingredient Powder with Poria) is indicated.
Xi Xin Tang treats Qi-related Pi. Failure to resolve suggests it is not mere Qi stagnation. Thirst, dry mouth, irritability, and dysuria indicate stagnant fluids, retained drinking-fluids, intense internal Heat, and Water binding. Wu Ling San moistens fluids, quenches thirst, guides out fluid retention, and clears Heat binding, offering another method to resolve Pi.
(57) In women with Shanghan, fever, and menstruation beginning, if consciousness is clear during the day but delirious at night (seeing ghosts), this is Re Ru Xue Shi (Heat Entering the Blood Chamber). Do not invade Stomach Qi or the Upper/Middle Jiao; it will self-resolve.
"Wu" means "Do not." This parallels the last three articles of the upper section. Upper section mentions pulse and Jie Xiong-like symptoms; this mentions diurnal clarity/nocturnal delirium. Upper section suggests puncturing Qimen and using Xiao Chai Hu Tang; this prohibits invading Stomach Qi and Upper/Middle Jiao. Day is Yang; clarity indicates Yin pathogen retreat. Night is Yin; delirium indicates Blood pathology worsening with Yin. "Invading Stomach Qi" prohibits purgation. "Upper/Middle Jiao" prohibits sweating and emesis. Sweating damages Wei Qi and fluids (Upper/Middle Jiao); emesis disrupts reception and transformation (Upper/Middle Jiao). Purgation damages Stomach (Lower Jiao). All three are contraindicated because the pathogen is in the Blood Chamber, inaccessible to these methods. Self-resolution occurs as menstrual blood expels Heat, akin to "Red Sweat." This warns against reckless purgation. Given contraindications, puncturing Qimen or using Xiao Chai Hu Tang remains valid. Even without these, self-resolution is assured. Comparing upper and lower sections reveals similarities/differences in Wind-Cold treatment for men and women. Readers should analyze comprehensively.