【纲】仲景曰。伤寒脉迟。六七日。而反与黄芩汤彻其热。脉迟为寒。今与黄芩汤复除其热。
腹中应冷。当不能食。今反能食。此名除中。必死。
【目】刘完素曰。除者。除去也。与除夕之除同义。夫脉迟为寒。胃中真阳已薄。不可更与凉
药。盖胃暖乃能纳食。今胃冷而反能食。则是胃之真气发露无余。而胃阳亦必渐去而不能久存。故
必死。腹中。即胃中也。
魏荔彤曰。此为阳虚阴寒家立法。见厥阴一症。原寒热杂合。其盈虚消息之机。全在临时斟酌。
为阳气盛。热有余。则越之散之。甚且凉之下之。为阴气盛。热不足。则升之举之。甚且温之补之。
俱难一以为治也。此固为厥阴传经之邪言之。而不止此也。伤寒中何经不然。杂病中何症不然。故
此条俱未尝专指厥阴也。学人可不察乎。
【纲】仲景曰。眼睛不慧。语言不出。而设食反多者。此为除中。口虽欲言。舌不能言。
伤寒始发热六日。厥反九日而利。凡厥利者。当不能食。今反能食者。恐为除中。食以索饼。
不发热者。知胃气尚在。必愈。恐暴热来出而复去也。后三日脉之。其热续在者。期之旦日夜半愈。
【目】杨士瀛曰。除中者。脏寒应不能食。今反能食是也。有三症。悉属厥阴。其一由误服黄
芩汤而致。期以必死。其一则热少厥多。胃气在者愈。暴来出而复者死。其热续在者生。此不因药
故也。其一至眼不慧。舌不能言。则为坏症。必死
[Outline] Zhang Zhongjing stated: In Taiyang disease (Sun Yang Disease), if the pulse is slow, and after six or seven days, one mistakenly administers Huangqin Tang (Scutellaria Decoction) to clear heat. A slow pulse indicates cold. By administering Huangqin Tang to further remove heat, the abdomen should become cold, and logically, the patient should be unable to eat. However, if the patient can eat contrary to expectation, this is termed "Chu Zhong" (Elimination of the Middle). This condition is fatal.
[Commentary] Liu Wansu explained: "Chu" means to remove, identical in meaning to "Chu Xi" (New Year's Eve). A slow pulse indicates cold; the true Yang energy in the stomach is already thin. One must not administer cooling medicines. Since a warm stomach is required to accept food, if the stomach is cold yet the patient can eat, it signifies that the true Qi of the stomach is exposed without reserve, and Stomach Yang will inevitably gradually depart and cannot persist long. Therefore, it is fatal. "Abdomen" here refers to the stomach.
Wei Litong stated: This establishes a principle for patients with Yang deficiency and Yin-cold constitution. Observing the symptom of Jueyin disease (Jueyin Disorder), which is originally a mixture of cold and heat, the mechanism of waxing and waning depends entirely on temporary deliberation. If Yang Qi is excessive and heat is surplus, disperse and scatter it; even use cooling or purging methods. If Yin Qi is excessive and heat is insufficient, lift and raise it; even use warming and tonifying methods. It is difficult to treat these with a single method. This certainly discusses pathogens transmitted through the Jueyin channel, but not limited to this. Which meridian in Shanghan (Cold Damage) is not like this? Which symptom in miscellaneous diseases is not like this? Thus, this clause does not specifically refer only to Jueyin. Students must examine this carefully.
[Outline] Zhang Zhongjing stated: When the eyes are dim and vision unclear, and speech cannot be produced, yet the patient eats more when offered food, this is called "Chu Zhong". Although the mouth desires to speak, the tongue cannot articulate.
In Shanghan disease, fever began for six days, but cold extremities (Jue) lasted for nine days accompanied by diarrhea. Generally, those with cold extremities and diarrhea should be unable to eat. If they can eat now, one should fear "Chu Zhong". Feed the patient Suobing (noodle cakes). If there is no fever, it indicates that Stomach Qi remains, and recovery is certain. The concern is whether sudden heat will appear and then disappear. Three days later, upon palpating the pulse, if the heat continues, recovery is expected at midnight of the next day.
[Commentary] Yang Shiying stated: "Chu Zhong" refers to the condition where internal cold should prevent eating, yet the patient can eat. There are three presentations, all belonging to Jueyin. The first results from the mistaken administration of Huangqin Tang (Scutellaria Decoction), leading to certain death. The second involves less heat and more cold extremities; if Stomach Qi remains, the patient recovers; if sudden heat appears and then disappears, the patient dies; if heat continues, the patient lives. This case is not due to medication error. The third presentation involves dim eyes and an inability of the tongue to speak, constituting a "Huai Bing" (ruined disease/complication), which is fatal.