寒。〔汪〕此条。乃少阴中寒。即成下利之证。下利便脓血。协热者多。今言少阴病下利。必脉微细但欲寐。
而复下利也。下利日久。至便脓血。乃里寒而滑脱也。〔钱〕见少阴证。而下利。为阴寒之邪在里。湿滞下焦。
大肠受伤。故皮拆血滞。变为脓血。滑利下脱。故以温中固脱之桃花汤主之。
案此条证。喻氏柯氏魏氏周氏金鉴。并为传经热邪之所致。大乖经旨。钱氏辨之详矣。见下条注。○柯氏
以症治疏略删去。
桃花汤方
赤石脂（一斤一半全用一半筛末） 干姜（一两） 粳米（一升）
上三味。以水七升。煮米令熟。去滓。温服七合。纳赤石脂末方寸匕。日三服。若一服愈。余勿服。（金
匮。千金翼。温下。无服字。千金翼。去上。有汤成二字。）
〔成〕涩可去脱。赤石脂之涩。以固肠胃。辛以散之。干姜之辛。以散里寒。粳米之甘。以补正气。〔印〕
石脂。色如桃花。故名桃花汤。或曰。即桃花石。〔吴〕服时又必加末方寸匕。留滞以沾肠胃也。
案柯氏云。名桃花者。春和之义。非徒以色言耳。王子接云。桃花汤。非名其色也。肾脏阳虚用之。一
若寒谷有阳和之致。故名。二说并凿矣。
金匮要略。下利便脓血者。桃花汤主之。
医方集解。昂案此症。成氏以为寒。而吴鹤皋王肯堂。皆以为热。窃谓便脓血者。固多属热。然岂无下
焦虚寒。肠胃不固。而亦便脓血者乎。若以此为传经热邪。仲景当用寒剂。以彻其热。而反用石脂固涩之药。
使热闭于内。而不得泄。岂非关门养盗。自贻伊芳戚也耶。观仲景之治协热利。如甘草泻心。生姜泻心。白头翁
等汤。皆用芩连黄柏。而治下焦虚寒下利者。用赤石脂禹余粮汤。比类以观。斯可见矣。此症乃因虚以见寒。
非大寒者。故不必用热药。惟用甘辛温之剂。以镇固之耳。本草言石脂性温。能益气调中固下。未闻寒能损胃
也。肘后方。疗伤寒若下脓血者。赤石脂汤方。赤石脂二两。碎。干姜二两。切。附子一两。炮破。上三味。
以水五升。煮取三升。去滓。温分三服。脐下痛者。加当归一两。芍药二两。用水六升。
千金方。桃花丸。治下冷脐下搅痛。干姜。赤石脂。各
十两。上二味。蜜丸如豌豆。服十丸。日三服。加至二十丸。和剂局方。桃花丸。治肠胃虚弱。冷气乘之。脐
腹搅痛。下利纯白。或冷热相搏。赤白相杂。肠滑不禁。日夜无度。方同上。只面和为丸为异。
千金翼。干姜丸。主胃中冷不能食。或食已不消方。干姜十两。赤石脂六两。上捣筛为末。炼蜜和丸如梧
子。服十丸。日三。
外台秘要。崔氏疗伤寒后。赤白滞下无数。阮氏桃华汤方。赤石脂八两。冷多白滞者。加四两。粳米一升。
干姜四两。冷多白滞者。加四两。切。上三味。以水一斗。煮米熟。汤成去滓。服一升。不瘥复作。热多则带
赤。冷多则带白。
少阴病。二三日至四五日。腹痛。小便不利。下利不止。便脓血者。桃花汤主之。（全书。痛。作满。止
下。玉函。有而字。）
〔成〕二三日。以至四五日。寒邪入里深也。腹痛者。里寒也。小便不利者。水谷不别也。下利不止。便
脓血者。肠胃虚弱。下焦不固也。与桃花汤。固肠止利也。〔钱〕二三日。至四五日。阴邪在里。气滞肠间。
故腹痛也。下焦无火。气化不行。故小便不利。且下利不止。则小便随大便。而频去。不得潴蓄于膀胱。而小
便不得分利也。下利不止。气虚不固。而大肠滑脱也。便脓血者。邪在下焦。气滞不流。而大肠伤损也。此属
阴寒虚利。故以涩滑固脱。温中补虚之桃花汤主之。〔汪〕少阴里寒。便脓血。所下之物。其色必黯而不鲜。
乃肾受寒湿之邪。水谷之津液。为其凝泣。酝酿于肠胃之中。而为脓血。非若火性急速。而色鲜明。盖冰伏已
久。其色黯黑。其气不臭。其人必脉微细。神气静而腹不甚痛。喜就温暖。欲得手按之。腹痛即止。斯为少阴
寒利之征。
案钱氏云。腹痛小便不利。下利不止。便脓血者。痢疾
也。自成氏以来。凡注皆为里寒。惟尚论。为少阴热邪。若果热邪填塞胃中。如何可用干姜之辛热以散之。似
属背理。恐指为寒邪者。未为大误。指为热邪者。反贻误后人不少矣。若以干姜为误。其误当责之立法之仲景
矣。但观痢证。有用大黄黄连而愈者。有用干姜肉果人参附子而愈者。皆非明证邪。此论可谓能得经旨矣。千
金诸书所用。亦皆不过治寒以热之意尔。况名医别录。赤石脂。酸辛大温。无毒。治肠 下利赤白。亦复一证矣。
少阴病。下利便脓血者。可刺。
〔钱〕邪入少阴。而下利。则下焦壅滞。而不流行。气血腐化。而为脓血。故可刺之以泄其邪。通行其脉
络。则其病可已。不曰刺何经穴者。盖刺少阴之井荣输经合也。其所以不言者。以良工必知之熟矣。故不必赘
也。〔张〕先下利日久。而后便脓血。则用桃花汤。若不先下利。而下利便脓血。则可刺经穴。若刺经穴不愈。
则当从事白头翁汤。设更咽干心烦。不得眠。则又须黄连阿胶汤。为合法也。〔汪〕补亡论。常器之云。可刺
幽门交信。
案此条证。与少阴病八九日。一身手足尽热者。以热在膀胱。必便血也。正相同。乃是热迫血分。而便脓
血者。钱注为是。方氏则为里寒滑脱证。汪氏则亦改刺字。作灸字。并误矣。
少阴病。吐利。手足逆冷。烦躁欲死者。吴茱萸汤主之。（利下。玉函。有而字。逆。成本。作厥。诸本
同。惟志聪金鉴。作逆。）
〔钱〕吐利。阴证之本证也。或但吐。或但利者。犹可。若寒邪伤胃。上逆而吐。下攻而利。乃至手足厥
冷。盖四肢皆禀气于胃。而为诸阳之本。阴邪纵肆。胃阳衰败而不守。阴阳不相顺接而厥逆。阳受阴迫而烦。
阴盛格阳而躁。且烦躁甚。而至于欲死。故用吴茱萸之辛苦温热。以泄其厥气之
逆。而温中散寒。盖茱萸气辛味辣。性热而臭臊。气味皆浓。为厥阴之专药。然温中解寒。又为三阴并用之药。
更以甘和补气之人参。以补吐利虚损之胃气。又宣之以辛散止呕之生姜。和之以甘缓益脾之大枣。为阴经急救
之方也。〔喻〕吐利厥冷。而至于烦躁欲死。肾中之阴气上逆。将成危候。故用吴茱萸。以下其逆气。而用人
参姜枣。以浓土。则阴气不复上干矣。
案吴茱萸汤之用有三。阳明食谷欲呕用之。少阴吐利用之。厥阴干呕吐涎沫者。亦用之。要皆以呕吐逆气
为主。与四逆汤之吐利厥逆自异。
少阴病。下利咽痛。胸满心烦。猪肤汤主之。（烦下。成本。有者字。）
〔程〕下利虽是阴邪。咽痛实为急候。况兼胸满心烦。谁不曰急则治标哉。然究其由来。实是阴中阳乏。
液从下溜。而不能上蒸。故有此。只宜猪肤汤。润以滋其土。而苦寒在所禁也。虽是润剂。却加白粉。少阴经
所重者。趺阳也。
案此条证。成氏以降。诸家并以为阳经传入之热邪。特柯氏与程氏同义。若果为热邪。则宜用苦寒清热之
品。明是不过阴证治标之药耳。
猪肤汤方
猪肤（一斤）
上一味。以水一斗。煮取五升。去滓。加白蜜一升。白粉五合。熬香。和令相得。温分六服。（成本。玉
函。脱令字。）
〔周〕猪肤。王以为猪皮。吴以为 猪时刮下黑肤。二说不同。考礼运疏云。革。肤内浓皮也。肤。革
外浓皮也。由斯以言。则吴说为是。洵是浅肤之义。（案此说。出于本草纲目。引汪机会编。）〔钱〕猪肤一味。
方中向未注明。如吴绶谓 猪时刮下黑肤也。方有执谓既谓肤。当以 猪时。所起之皮外毛根之薄
肤为是。王好古以为猪皮。尚论云。若以为 猪皮外毛根薄肤。则 劣无力。且与熬香之说不符。但以外皮去
其内层之肥白为是。若果以 猪时毛根薄肤。则薄过于纸。且与垢腻同下。熬之有何香味。以意度之。必是毛
根深入之皮。尚可称肤。试观刮去毛根薄肤。毛断处。毛根尚存皮内。所谓皮之去内层。极为允当。盖以猪为
北方之水畜。肤近毛根。取其色黑。而走肾滋肾。〔吴〕猪肤。但当取浓皮。汤泡去肥白油。刮取皮上一层白
腻者。为是。〔徐〕白粉。白米粉。
舒云。取猪皮一斤。内去油。外去毛。刮净白者。
案猪肤。诸说纷纷。未知孰是。活人指掌。猪肤。诸家所论不同。庞安时云。去膜。如此论之。即猪膊膏
也。肤上安得有膜。或有用猪皮者。兼本草中。不载猪肤。但云 猪汤。解诸毒。疑可用彘猪皮上黑肤也。所
以言肤者。肌肤之义。礼内则。麋肤鱼醢。注。肤。切肉也。贾疏不太明。亦他书无所考。外台。深师贴喉膏。
集验乌扇膏。并用猪膏脂。治喉痛。则姑用皮上白腻者。于理为是。当博考。
活人指掌。英粉。白粉。即米粉也。○案钱氏以白粉。为粟米粉。非也。
张氏医通。徐君育素禀阴虚多火。且有脾约便血证。十月间患冬温。发热咽痛。俚医用麻仁杏仁半夏枳橘
之属。遂喘逆倚息。不得卧。声飒如哑。头面赤热。手足逆冷。右手寸关虚大微数。此热伤手太阴气分也。与
葳蕤甘草等药不应。为制猪肤汤一瓯。令隔汤顿热。不时挑服。三日声清。终剂而痛如失。
本经逢原。猪肤者。皮上白膏是也。取其咸寒入肾。用以调阴散热。故仲景治少阴病。下利咽痛。胸满心
烦。有猪肤汤。予尝用之。其效最捷。
少阴病。二三日。咽痛者。可与甘草汤。不瘥。与桔梗汤。（成本。玉函。瘥下。有者字。）
〔程〕若咽痛而不兼下利。则自无胸满心烦之证。虽不由于肾寒上逆。然只热客少阴之标。而无关脏本。
若寒则犯本。不可用也。只宜甘草缓之。不瘥者。经气阻而不通也。加苦梗以开之。喻嘉言曰。此在二三日。
他证未具故用之。若五六日。则少阴之下利呕逆诸证蜂起。此法并未可用矣。
甘草汤方
甘草（二两）
上一味。以水三升煮取一升半。去滓。温服七合。日二服。（二服。外台。作三服。）
桔梗汤方
桔梗（一两） 甘草（二两○外台。作三两。）
上二味。以水三升。煮取一升。去滓。温分再服。（温分。成本。玉函。千金翼。作分温。）
〔汪〕经中客热。故咽痛。用甘草汤者。甘以发其热。缓其痛也。服汤后不瘥者。与桔梗汤。即于甘草
汤内。加桔梗。以开提其邪。邪散则少阴之气自和矣。〔钱〕桔梗。乃苦桔梗。非甜桔梗也。〔徐〕甘草一味
单行。最能和阴。而清冲任之热。每见生便痈者。骤煎四两。顿服立愈。则其能清少阴客热可知。所以为咽痛
专方也。〔锡〕聂干庵曰。后人以甘桔。通治咽喉诸病。本诸于此。
志聪云。案本论汤方。甘草俱炙。炙则助脾土而守中。惟此生用。生则和经脉而流通。学人不可以其近
而忽之也。
案单味甘草汤。功用颇多。玉函经。治小儿撮口发噤。用生甘草二钱半。水一盏。煎六分。温服。令吐
痰涎。后以乳汁。点儿口中。千金方。甘草汤。治肺痿涎唾多。心中温
温液液者。又凡服汤。呕逆不入腹者。先以甘草三两。水三升。煮取二升。服之得吐。但服之不吐。益佳。消
息定。然后服余汤即流利。更不吐也。此类不遑枚举也。
金匮要略。咳而胸满。振寒脉数。咽干不渴。时出浊唾腥臭。久久吐脓。如米粥者。为肺痈。桔梗汤主之。
（即本方）肘后方。喉痹。传用神效方。桔梗。甘草。炙。各一两。上二味。切。以水一升。煮取服即消。有
脓即出。
圣惠方。治喉痹肿痛。饮食不下。宜服此方。桔梗一两。去芦头。甘草一两。生用。上件药。都锉。以水
二大盏。煎至一大盏去滓。分为二服。服后有脓出。即消。
和剂局方。如圣汤。治风热毒瓦斯。上攻咽喉。咽痛喉痹。肿塞妨闷。及肺壅咳嗽。咯唾脓血。胸满振寒。
咽干不渴。时出浊沫。气息腥臭。久久吐脓。状如米粥。又治伤寒咽痛。（即本方）
圣济总录。散毒汤。治喉痹肿塞。用桔梗甘草各二两。
又桔梗汤。治咽喉生疮疼痛。
于本方。加恶实。微炒。各一两。竹叶十斤。
小儿方诀。甘桔散。治涎热咽喉不利。甘草。炒。二两。桔梗。一两。米泔浸一宿。焙干用。上为末。每
服大二钱。水一盏。入阿胶半片。炮过。煎至五分。食后温服。
三因方。荆芥汤。治风热肺壅。咽喉肿痛。语声不出。喉中如有物哽。咽之则痛甚。
于桔梗汤内。加荆芥穗。○济生。名三神汤。
直指。保安炙甘草方。痈疽漏疮。通用神妙。粉草。以山泉溪涧长流水一小碗。徐蘸水。漫火炙。水尽为
度。秤一两。上锉粗末。用醇酒三碗。煎二碗。空心随意温服。最活血消毒。
又诸痈疽。大便秘方。甘草生一两。上锉碎。井水浓煎。入酒调服。能疏导恶物。
又乳痈初肿方。甘草生二钱。炙二钱。粗末。分两次。新水煎服。即令人吮乳。
又生姜甘桔汤。治痈疽诸发。毒瓦斯上冲。咽喉胸膈。窒塞不利。
于本方内。加生姜。
御药院方。甘桔汤。治胸中结气。咽喉不利。下一切气。
于本方。加杏仁二两。
Cold. [Wang] This clause refers to Shaoyin (Lesser Yin) contracting cold, which immediately develops into a syndrome of diarrhea. Diarrhea accompanied by pus and blood is mostly heat-collateral diarrhea. The current discussion on Shaoyin disease with diarrhea must be accompanied by a faint and thin pulse and a desire to sleep, along with recurrent diarrhea. If diarrhea persists for a long time leading to pus and blood in the stool, this indicates interior cold causing intestinal sliding and incontinence. [Qian] When Shaoyin syndrome is present alongside diarrhea, it signifies that yin-cold pathogenic factors are in the interior, with dampness stagnating in the lower jiao (lower burner), damaging the large intestine. Consequently, the intestinal lining breaks down and blood stasis transforms into pus and blood, leading to slippery downward discharge and loss of control. Therefore, Taohua Tang (Peach Blossom Decoction), which warms the middle and secures against collapse, is used as the primary treatment.
Commentary: Regarding this syndrome, Yu Jiayan, Ke Qin, Wei Litong, Zhou Xuehai, and *Yizong Jinjian* (Golden Mirror of Medicine) all attribute it to heat pathogens transmitted through the meridians. This seriously deviates from the original intent of the classic. Qian's analysis is detailed and can be found in the commentary for the next clause. ○ Ke Qin deleted this clause due to perceived omissions in symptoms and treatment descriptions.
Taohua Tang Formula
Chishizhi (Red Halloysite, 1 jin): half used whole, half sifted into powder. Ganjiang (Dried Ginger, 1 liang). Jingmi (Rice, 1 sheng).
Take the above three ingredients, add seven sheng of water, and boil the rice until cooked. Strain the dregs. Take seven ge of the decoction warm. Administer one fangcunbi (a square-inch measure) of Chishizhi powder with it. Take three times daily. If cured after one dose, do not take the remainder. (*Jinkui Yaolue* and *Qianjin Yifang* read "warmly administer" without the phrase "do not take the remainder"; *Qianjin Yifang* omits "Shang" and includes "Tang cheng" [when the decoction is ready].)
[Cheng] Astringent properties can resolve sliding/collapse conditions. The astringency of Chishizhi secures the stomach and intestines. Pungent properties disperse; the pungency of Ganjiang disperses interior cold. Sweet properties tonify; the sweetness of Jingmi supplements righteous qi. [Yin] Halloysite resembles peach blossoms in color, hence the name Taohua Tang. Some say it is literally "peach blossom stone." [Wu] When administering, one must add one fangcunbi of the powder to ensure retention and adherence to the gastrointestinal tract.
Commentary: Ke Qin stated that the name "Peach Blossom" implies the harmony of spring, not merely referring to color. Wang Zijie argued that Taohua Tang is not named for its color but because it is used when kidney yang deficiency exists, bringing a sense of yang warmth to a cold valley, hence the name. Both interpretations are overly speculative.
*Jinkui Yaolue* states: For diarrhea with pus and blood, Taohua Tang is indicated.
*Yifang Jijie* Commentary: Cheng Wuji considered this a cold syndrome, whereas Wu Hegao and Wang Kentang considered it heat. I privately believe that while pus and blood in stool often belong to heat syndromes, could there not be cases of lower jiao deficiency-cold and insecure stomach/intestines resulting in pus and blood? If this were attributed to transmitted heat pathogens, Zhang Zhongjing would have used cold-natured herbs to clear the heat. Instead, he used astringents like Chishizhi, which would trap heat inside and prevent its exit. Would this not be like locking the door to nurture thieves, bringing disaster upon oneself? Observing how Zhongjing treats heat-collateral diarrhea, such as in Gancao Xiexin Tang, Shengjiang Xiexin Tang, and Baitouweng Tang, he uses Huangqin, Huanglian, and Huangbai. Conversely, for lower jiao deficiency-cold diarrhea, he uses Chishizhi Yuyuliang Tang. By comparing these, the distinction becomes clear. This syndrome presents cold due to deficiency, not extreme cold, so strong hot herbs are unnecessary; rather, sweet, pungent, and warm agents should be used to stabilize and secure. Materia Medica records that Chishizhi is warm in nature, benefiting qi, regulating the middle, and securing the lower. It is unheard of that cold damages the stomach. *Zhouhou Beiji Fang* treats typhoid with pus and blood using Chishizhi Tang: Chishizhi 2 liang (crushed), Ganjiang 2 liang (sliced), Fuzi 1 liang (processed and broken). Boil these three in five sheng of water to obtain three sheng, strain, and divide into three warm doses. If pain below the umbilicus occurs, add Danggui 1 liang and Shaoyao 2 liang, boiling in six sheng of water.
*Qianjin Fang*: Taohua Wan (Peach Blossom Pill) treats cold diarrhea with abdominal twisting pain. Ganjiang and Chishizhi, each 10 liang. Make pills the size of pea seeds using honey. Take 10 pills, three times daily, increasing to 20 if necessary. *Heji Jufang* Taohua Wan treats weak stomach/intestines invaded by cold qi, causing abdominal twisting pain, pure white diarrhea, or mixed red and white due to cold-heat interaction, with uncontrollable intestinal sliding day and night. The formula is the same, differing only in using flour paste for pill formation.
*Qianjin Yifang*: Ganjiang Wan treats cold stomach inability to eat or indigestion. Ganjiang 10 liang, Chishizhi 6 liang. Powder them, mix with refined honey, and make pills the size of wutong seeds. Take 10 pills, three times daily.
*Waitai Miyao*: Cui Shi’s treatment for post-typhoid dysentery with excessive red and white discharge, Ruan Shi Taohua Tang Formula: Chishizhi 8 liang (add 4 liang if cold predominates with white discharge); Jingmi 1 sheng; Ganjiang 4 liang (add 4 liang if cold predominates with white discharge, sliced). Boil these three in ten dou of water until rice is cooked, strain, and take one sheng. Repeat preparation if ineffective. Heat predominance leads to red discharge; cold predominance leads to white discharge.
Shaoyin disease, progressing from two to three days to four to five days, presenting with abdominal pain, difficult urination, unceasing diarrhea, and pus/blood in stool, is treated with Taohua Tang. (The complete text reads "fullness" instead of "pain," and "down" instead of "stop"; *Yuhan Jing* includes the character "er" [and].)
[Cheng] From two to three days up to four to five days indicates deep penetration of cold pathogens into the interior. Abdominal pain indicates interior cold. Difficult urination indicates failure to separate fluids and food residue. Unceasing diarrhea with pus/blood indicates weakness of the stomach/intestines and insecurity of the lower jiao. Taohua Tang is given to secure the intestines and stop diarrhea. [Qian] From two to three days to four to five days indicates yin pathogens in the interior causing qi stagnation in the intestines, hence abdominal pain. Lack of fire in the lower jiao prevents qi transformation, causing difficult urination. Furthermore, unceasing diarrhea causes urine to pass frequently with stool, preventing accumulation in the bladder and thus hindering separate fluid metabolism. Unceasing diarrhea results from qi deficiency failing to secure, leading to large intestine sliding. Pus/blood in stool results from pathogens in the lower jiao causing qi stagnation and damage to the large intestine. This belongs to yin-cold deficiency diarrhea; therefore, Taohua Tang, which astringes sliding, secures collapse, warms the middle, and tonifies deficiency, is indicated. [Wang] In Shaoyin interior cold with pus/blood in stool, the discharged material is necessarily dark and dull, not bright. This is because the kidney has contracted cold-damp pathogens, coagulating the fluids of food and drink, which ferment in the stomach/intestines to form pus/blood. Unlike fire pathology which is rapid and bright-colored, ice trapped for a long time becomes dark/black and odorless. The patient will have a faint/thin pulse, quiet spirit, minimal abdominal pain, preference for warmth, and desire for pressure, with pain ceasing upon pressing. These are signs of Shaoyin cold diarrhea.
Commentary: Qian stated that abdominal pain, difficult urination, unceasing diarrhea, and pus/blood constitute dysentery. Since Cheng Wuji, commentators have generally interpreted this as interior cold. Only *Shanglun* attributes it to Shaoyin heat pathogens. If heat truly filled the stomach, how could pungent-hot Ganjiang be used to disperse it? This seems illogical. Attributing it to cold pathogens is likely not a major error, whereas attributing it to heat pathogens has misled many later practitioners. If Ganjiang were an error, the fault would lie with the legislator, Zhang Zhongjing. However, observing that dysentery can be cured with Dahuang/Huanglian or with Ganjiang/Rouguo/Renshen/Fuzi, neither interpretation is absolute. This argument captures the essence of the classic well. The formulas in Qianjin books also reflect the principle of treating cold with heat. Moreover, *Mingyi Bielu* records Chishizhi as sour, pungent, and greatly warm, non-toxic, treating intestinal dysentery with red/white discharge, providing further evidence.
Shaoyin disease with diarrhea and pus/blood in stool may be treated with acupuncture.
[Qian] When pathogens enter Shaoyin causing diarrhea, the lower jiao becomes obstructed and stagnant, failing to circulate. Qi and blood decompose, transforming into pus/blood. Acupuncture can be used to drain the pathogen and unblock the meridians, resolving the disease. The specific meridian/acupoint is not specified because skilled physicians are familiar with needling the Jing-River-Shu-Well-He points of Shaoyin. Thus, no elaboration is needed. [Zhang] If diarrhea precedes pus/blood, use Taohua Tang. If pus/blood appears without prior prolonged diarrhea, needle the meridian points. If needling fails, proceed to Baitouweng Tang. If dry throat, irritability, and insomnia occur, then Huanglian Ejiao Tang is appropriate. [Wang] *Buwang Lun* notes Chang Qizhi stating that Hunyuan and Jiaoxin acupoints may be needled.
Commentary: This syndrome is identical to Shaoyin disease on the eighth/ninth day where heat pervades the body and limbs due to heat in the Bladder, inevitably causing blood in stool. This is heat forcing blood into the vessels, causing pus/blood. Qian’s annotation is correct. Fang Youzhi incorrectly identified it as interior cold sliding collapse. Wang changed "needle" to "moxibustion," both being errors.
Shaoyin disease with vomiting, diarrhea, cold extremities, and severe irritability bordering on death, is treated with Wuzhuyu Tang. ("Li xia" in *Yuhan Jing* has "er"; "Ni" in Cheng Ben is "Jue"; most editions agree, except Zhi Cong and *Jinjian* use "Ni".)
[Qian] Vomiting and diarrhea are root symptoms of yin syndromes. Isolated vomiting or diarrhea may be manageable. However, if cold pathogens injure the stomach, causing upward rebellion (vomiting) and downward attack (diarrhea), leading to cold extremities, it is because the four limbs derive qi from the Stomach and serve as the root of all yang. Unrestrained yin pathogens cause stomach yang to fail and lose control. Yin and yang fail to connect smoothly, resulting in reversal/cold extremities. Yang is oppressed by yin, causing irritability; yin excess repels yang, causing restlessness. Severe irritability approaching death necessitates Wuzhuyu Tang. Its pungent-bitter-warm-hot nature drains rebellious jue qi, warms the middle, and dispels cold. Wuzhuyu is pungent, spicy, hot, and musky, with strong aroma/flavor, serving as a specific herb for Jueyin. Yet, warming the middle and resolving cold makes it applicable to all three yin meridians. Combined with Ren Shen (sweet, harmonizing, tonifying qi) to repair stomach qi damaged by vomiting/diarrhea, Shengjiang (pungent, dispersing, anti-emetic) to promote dispersion, and Dazao (sweet,緩ing, spleen-benefiting) to harmonize, this forms an emergency formula for yin meridians. [Yu] Vomiting, diarrhea, cold extremities, and severe irritability indicate kidney yin qi rebelling upward, threatening critical condition. Wuzhuyu descends rebellious qi, while Ren Shen, Jiang, and Zao thicken earth (strengthen spleen/stomach), preventing yin qi from harassing upward.
Commentary: Wuzhuyu Tang has three applications: Yangming disease with desire to vomit after eating; Shaoyin disease with vomiting/diarrhea; Jueyin disease with dry vomiting and spitting saliva/froth. All focus on vomiting and rebellious qi, distinct from Sini Tang’s treatment of vomiting/diarrhea/cold extremities.
Shaoyin disease with diarrhea, sore throat, chest fullness, and irritability is treated with Zhufu Tang. ("Fan" in Cheng Ben has "zhe" below it.)
[Cheng] Although diarrhea is a yin pathogen, sore throat is an urgent condition. Coupled with chest fullness and irritability, one might say "treat the branch in urgency." However, investigating the origin, it is actually a lack of yang within yin, with fluids leaking downward and failing to steam upward. Zhufu Tang moistens and nourishes earth (spleen). Bitter-cold herbs are prohibited. Although a moistening formula, it adds Baifen (rice flour). What Shaoyin meridian values most is the Fuyang pulse.
Commentary: Post-Cheng commentators generally viewed this as heat pathogens transmitted from yang meridians. Only Ke Qin and Cheng Shi agreed. If it were truly heat, bitter-cold clearing herbs would be appropriate. Clearly, these are merely branch-treating herbs for yin syndromes.
Zhufu Tang Formula
Zhufu (Pig Skin, 1 jin)
Take this single ingredient, add ten dou of water, boil to obtain five sheng, strain dregs. Add Baimi (White Honey, 1 sheng) and Baifen (Rice Flour, 5 he), roast until fragrant, and mix thoroughly. Divide into six warm doses. (Cheng Ben and *Yuhan Jing* omit "ling" [make/let].)
[Zhou] Zhufu: Wang Haogu considered it pig skin; Wu Shou considered it the black skin scraped off during slaughtering. Two different views. Examining *Liyun Shu*: "Ge is the inner thick skin; Fu is the outer thick skin." Thus, Wu’s view is correct, referring to superficial skin. (Commentary: This view comes from *Bencao Gangmu*, citing Wang Huiji.) [Qian] Zhufu is rarely specified in formulas. Wu Shou said it is black skin scraped during slaughter. Fang Youzhi said since it is called "Fu," it should be the thin skin at the hair roots on the exterior. Wang Haogu said it is pig skin. *Shanglun* argued that if it were thin skin at hair roots, efficacy would be weak and inconsistent with "roast until fragrant." It is better to take the outer skin removing the inner fatty white layer. If it were truly thin skin at hair roots, it would be thinner than paper and mixed with dirt/grease, yielding no fragrance. Presumably, it is skin with deep hair roots, still worthy of the name "Fu." Observe that after scraping thin skin, hair roots remain in the skin. Removing the inner layer is very appropriate. Since pigs are northern water animals, and skin near hair roots is black, entering the Kidney to nourish it. [Wu] For Zhufu, take thick skin, soak in decoction to remove fatty oil, scrape the top white greasy layer. [Xu] Baifen is white rice flour.
Shu Yun says: Take one jin of pig skin, remove internal oil, external hair, scrape clean white parts.
Commentary: Opinions on Zhufu vary widely. *Huo Ren Zhi Zhang* notes diverse views. Pang Anshi said "remove membrane." If so, it would be pig arm fat. How can skin have a membrane? Perhaps pig skin is used. Materia Medica does not record Zhufu, only Zhi Zhu Tang for detoxification. Suspect black skin on pig skin is usable. "Fu" means skin/flesh. *Li Nei Ze*: "Mi Fu Yu Hai," commentary says "Fu means cut meat." Jia Gongyan’s commentary is unclear, lacking other sources. *Waitai*’s Shen Shi Hou Gao and *Ji Yan* Wu Shan Gao both use pig lard for sore throat. Thus, tentatively using the white greasy part of the skin is reasonable. Further research is needed.
*Huo Ren Zhi Zhang*: Ying Fen/Baifen is rice flour. ○ Commentary: Qian considered Baifen millet flour, which is incorrect.
*Zhang Shi Yi Tong*: Xu Junyu had inherent yin deficiency with hyperactive fire and splein constraint with blood in stool. In October, he contracted Winter-Warmth, with fever and sore throat. Quacks used Mahren, Xingren, Banxia, Zhike, Ju Pi, etc., leading to wheezing, orthopnea, aphonia, red/hot head/face, and cold extremities. Right Cun/Guan pulses were deficient, large, slightly rapid. This was heat injuring Hand Taiyang qi. Weiyu and Gancao failed. Prepared Zhufu Tang, heated over water, taken occasionally. Voice cleared in three days; pain vanished after finishing.
*Benjing Fengyuan*: Zhufu is the white grease on the skin. Its salty-cold nature enters the Kidney to regulate yin and dissipate heat. Hence Zhongjing used Zhufu Tang for Shaoyin disease with diarrhea, sore throat, chest fullness, and irritability. I have used it with swift effect.
Shaoyin disease, two to three days, with sore throat, may be given Gancao Tang. If not cured, give Jiegeng Tang. (Cheng Ben and *Yuhan Jing* have "zhe" after "chai" [cured].)
[Cheng] If sore throat lacks accompanying diarrhea, there is no chest fullness/irritability. Though not due to kidney cold rebelling, it is merely heat lodging in the Shaoyin branch, unrelated to the zang root. Cold would affect the root and be contraindicated. Use Gancao to soothe. If uncured, it is meridian qi obstruction; add Jiegeng to open. Yu Jiayan said: Used here because other symptoms are absent in 2-3 days. By 5-6 days, Shaoyin diarrhea/vomiting arise, making this method unusable.
Gancao Tang Formula
Gancao (Licorice Root, 2 liang)
Boil this single ingredient in three sheng of water to obtain one and a half sheng, strain, take seven ge warm, twice daily. ("Er fu" in *Waitai* is "San fu".)
Jiegeng Tang Formula
Jiegeng (Platycodon Root, 1 liang) Gancao (Licorice Root, 2 liang ○ *Waitai* says 3 liang.)
Boil these two in three sheng of water to obtain one sheng, strain, divide into two warm doses. ("Wen fen" in Cheng Ben, *Yuhan Jing*, *Qianjin Yifang* is "Fen Wen".)
[Wang] Guest heat in the meridian causes sore throat. Gancao Tang uses sweetness to disperse heat and soothe pain. If uncured, Jiegeng Tang adds Jiegeng to lift and scatter pathogen. Once pathogen scatters, Shaoyin qi harmonizes. [Qian] Jiegeng is bitter Jiegeng, not sweet. [Xu] Single Gancao harmonizes yin and clears Chong/Ren heat. Seen in sudden abscesses cured by decocting 4 liang and taking at once, proving its ability to clear Shaoyin guest heat. Hence it is a specific formula for sore throat. [Xi] Nie Gan’an said: Later generations use Gan-Jie for all throat diseases based on this.
Zhi Cong commented: In *Benlun* formulas, Gancao is always roasted. Roasting aids spleen earth and stabilizes the center. Here it is raw. Raw harmonizes meridians and promotes circulation. Do not neglect it due to its simplicity.
Commentary: Single-herb Gancao Tang has many functions. *Yuhan Jing* treats infant mouth-closing/jerking with 2.5 qian raw Gancao in one cup water, boiled to 0.6 cup, taken warm to induce phlegm vomiting, followed by breast milk drops. *Qianjin Fang* Gancao Tang treats Lung萎 (Flaccidity) with excessive saliva and warm liquid sensation in heart. Also, before taking any decoction, if vomiting prevents ingestion, take 3 liang Gancao in 3 sheng water, boil to 2 sheng. If it induces vomiting, good; if not, better. Once qi settles, subsequent medicines flow smoothly without vomiting. Examples are too numerous to list.
*Jinkui Yaolue*: Cough with chest fullness, chills, rapid pulse, dry throat, no thirst, occasional foul-smelling turbid sputum, long-term expectoration of pus like rice porridge constitutes Lung Abscess. Jiegeng Tang is indicated (Same formula). *Zhouhou Fang*: Pharyngitis, Divine Efficacy Formula: Jiegeng, Gancao (roasted), each 1 liang. Slice, boil in one sheng water. Drink to resolve. If pus exists, it will discharge.
*Shenghui Fang*: Treats pharyngitis swelling/pain, difficulty swallowing. Jiegeng 1 liang (remove rhizome), Gancao 1 liang (raw). Chop, boil in two large cups water to one cup, strain, divide into two doses. Discharge of pus indicates resolution.
*Heji Jufang*: Rusheng Tang treats wind-heat toxins attacking throat, sore throat/pharyngitis, swelling/blockage, lung congestion cough, bloody sputum, chest fullness/chills, dry throat/no thirst, foul sputum, long-term pus like rice porridge. Also treats typhoid sore throat (Same formula).
*Shengji Zonglu*: Sandu Tang treats pharyngitis swelling/blockage using Jiegeng/Gancao, each 2 liang.
Also Jiegeng Tang treats throat ulcers/pain.
Add Niuxibang (Burdock Fruit), lightly roasted, each 1 liang; Zhuye (Bamboo Leaf), 10 jin.
*Xiao Er Fang Jue*: Gan-Jie San treats salivary-heat throat obstruction. Gancao (roasted) 2 liang; Jiegeng 1 liang. Soak in rice wash overnight, dry, powder. Take 2 qian with one cup water + half piece processed Ejiao, boil to 0.5 cup, take warm after meal.
*Sanyin Fang*: Jingjie Tang treats wind-heat lung congestion, throat swelling/pain, voice loss, foreign body sensation, severe pain on swallowing.
Add Jingjie Sui (Schizonepeta Spike) to Jiegeng Tang. ○ *Jisheng* names this Sanshen Tang.
*Zhizhi*: Bao’an Zhi Gancao Fang treats carbuncles/fistulas universally. Licorice: dip slowly in mountain stream water, roast over slow fire until water evaporates, weigh 1 liang. Chop coarse, boil in three bowls strong wine to two bowls, take warm on empty stomach. Best for invigorating blood and detoxifying.
Also for constipation in carbuncles: Raw Gancao 1 liang, chop, decoct strongly in well water, mix with wine. Guides out evil matter.
Also for early breast abscess: Raw Gancao 2 qian, Roasted Gancao 2 qian, coarse powder, divide into two doses, decoct in new water, drink, then have infant suckle.
Also Shengjiang Gan-Jie Tang treats carbuncles/all eruptions where toxins rush upward, blocking throat/chest.
Add Shengjiang to base formula.
*Yuyao Yuan Fang*: Gan-Jie Tang treats knotting qi in chest, throat obstruction, descending all qi.
Add Xingren (Apricot Seed) 2 liang to base formula.