白头翁（二两） 黄连 黄柏 秦皮（各三两）
上四味。以水七升。煮取二升。去滓。温服一升。不愈。更服一升。
成注引内经曰。肾欲坚。急食苦。以坚之。利则下焦虚。是以纯苦之剂坚之。
琥按成注云。肾欲坚。急食苦以坚之。以肾开窍于二阴故也。
琥又按下焦者。肾肝所主。肝主疏泄。而反下重者邪热壅瘀。气滞而不行也。条辩云。白头翁逐血以疗 。秦皮洗
肝而散热。黄连调胃而浓肠。黄柏除热而止泄。成注云。四味皆苦寒。愚以白头翁独带辛温。故泄热之中。而兼散邪之
力也。
下利欲饮水者。以有热故也。白头翁汤主之。（此条虽无下重之证。然热利。内亡津液。故欲饮水。白头翁汤。不但
坚下焦。兼能清中热。以汤中有黄连故也。热清。则津液回。饮水止而利自除矣。上二条证并汤。即从本篇之后移附于
此。）
下利脉沉而迟。其人面少赤。身有微热。下利清谷者。（云云至）其面戴阳。下虚故也。（此条系真寒证。正文与注
见中寒论中）
下利脉数而渴者。令自愈。设不瘥。必清脓血。以有热故也。（此条亦热利变脓血之证。下利而渴者。热也。脉数。
为热未解。曰自愈者。其脉必数中带虚。而其渴为未甚也。设脉数渴甚。为不瘥。必清脓血。以在里有郁热故也。按此
条论。仲景无治法。补亡论常器之云。可黄芩汤。）
下利后。脉绝。手足厥冷。 时脉还。手足温者。生脉不还者死。（此条系真阴证。然亦有热利过用凉药。而变成是
证者。医人不可以不察也。正文与注见中寒论中）
伤寒下利日十余。行脉反实者。死。（此条乃热利必死之脉证也。始由伤寒。继则下利。乃热邪传入于阴经也。然利
至一日十余行。则热邪之势宜少减。脉当虚弱而带数矣。今则脉反实者。邪气胜也。故主死。）
下利清谷。里寒外热。汗出而厥者。通脉四逆汤主之。（此条系真寒证。正文与注见中寒论中）
（重出例）热利下重者白头翁汤主之。（已见前）
下利腹胀满。身体疼痛者。先温其里。乃攻其表温里。宜四逆汤。攻表。宜桂枝汤。（此条系真寒证。正文与注见中
寒论中）
（重出例）下利欲饮水者以有热故也。白头翁汤主之（已见前）
下利谵语者有燥屎也。宜小承气汤。（已见前第六卷阳明病小承气汤方下）
下利后更烦。按之心下濡者为虚烦也。宜栀子豉汤（上条证。已见前第四卷太阳病栀子汤方下）
呕家有痈脓者。不可治呕脓尽。自愈（此条当是阳明经错简）
成注云。胃脘有痈。则呕而吐脓。不可治呕者。以治呕之药。皆辛温也。得脓尽。呕即自愈。或问胃脘痈。于何得
之。
余答云。始由风寒之邪蕴于经络。继则入于胃府。变而为热。热甚。则气瘀血积而为痈。痈者。壅也。言热毒壅聚
而成脓也。
呕而脉弱。小便复利。身有微热见厥者。难治四逆汤主之。
干呕。吐涎沫。头痛者。吴茱萸汤主之。
上二条系真阴证。（正文与注见中寒论中）
（重出例）呕而发热者小柴胡汤主之。（已见前第七卷少阳篇小柴胡汤方下。）
伤寒大吐。大下之。极虚复极汗出者。以其人外气怫郁。复与之水。以发其汗。因得哕。所以然者。胃中寒冷故也。
（此条伤寒。乃热传厥阴。误治之变证也。厥阴证。虽有吐下之方。而无大吐下之法。如瓜蒂散。承气汤。仲景不过暂
假之以吐胸中之邪。下里热之厥耳。兹则大吐下之者。医人必过用瓜蒂散。及大承气汤。故至胃气虚极也。复于吐下之
后。复极发其汗者。何也。以其人外气怫郁。怫郁者。言其人面上之气。恰如外来之邪。怫郁于表也。此系阳明胃府虚
极。浮热之气上升于面。医人认以为邪热胃燥过极。不得汗复与之水。以助其发汗因而得哕。哕者。千金方谓之哕逆。
俗云冷呃是也。所以然者。胃中虚极。又继之以冷水。虚寒相搏。故成哕也。愚按此条。本系传经热病。既服凉药。复
饮冷水。凉冷过胜。故成胃寒之证。诸家注。皆以吴茱萸汤主之者。不过暂用之以补胃虚。散寒饮也。愚以理中汤。亦
可借用之。）
伤寒哕而腹满。视其前后。知何部不利利之则愈。（此条伤寒。乃邪传厥阴。热郁于里。而成实哕之证也。厥阴之经
抵少腹。挟胃。上入颃颡。凡哕呃之气。必从少腹而起。由胃而上升于咽颡故也。哕而腹满者。必其人前后便不利。水
火之气不得通泄。气不通泄。反逆于上而作哕也。须大小便通利。而哕自愈。按此条论。仲景无治法。补亡论常器之云。
前部不利。猪苓汤。后部不利。调胃承气。汤愚以汤名调胃。而芒硝太峻。恐厥阴无大下之法。须以小承气汤微利之。）
（琥）按以上方论乃仲景治厥阴病法也。厥阴病有真寒。有热病。今止摘传经热病三十余条。一一为之解说。使后
学治厥阴一经。切毋误温。亦毋大下。其因证制宜。自有一定之良法。寓于圆机活变之中耳。
Baitouweng (2 liang), Huanglian, Huangbai, Qinpi (each 3 liang).
The above four ingredients. Use seven sheng of water. Decoct to obtain two sheng. Remove the dregs. Take one sheng warm. If not cured, take another one sheng.
Cheng Wuji's commentary cites the *Neijing*: "The Kidney desires firmness; urgently consume bitter substances to firm it." Diarrhea implies deficiency in the Lower Jiao, therefore pure bitter agents are used to firm it.
Hu notes Cheng's commentary: "The Kidney desires firmness; urgently consume bitter substances to firm it," because the Kidney opens into the anterior and posterior orifices.
Hu further notes: The Lower Jiao is governed by the Kidney and Liver. The Liver governs Shuxie (free flow and drainage), yet heaviness in the anus occurs due to pathogenic heat stagnation and stasis, with Qi obstruction and lack of movement. Tiaobian states: Baitouweng expels blood to treat dysentery; Qinpi clears the Liver and dissipates heat; Huanglian regulates the Stomach and thickens the intestines; Huangbai eliminates heat and stops diarrhea. Cheng's commentary states: All four ingredients are bitter and cold. I believe Baitouweng alone carries acrid-warm properties, thus possessing the power to disperse pathogens while clearing heat.
Diarrhea accompanied by a desire to drink water is due to the presence of heat. Baitouweng Tang (Coptis Decoction) is the primary treatment. (Although this clause lacks the symptom of tenesmus, heat-dysentery consumes body fluids internally, hence the desire to drink. Baitouweng Tang not only firms the Lower Jiao but also clears Middle Jiao heat, due to the presence of Huanglian in the decoction. Once heat is cleared, body fluids return, thirst ceases, and diarrhea resolves spontaneously. These two clauses regarding symptoms and formulas were moved from the end of this chapter to here.)
Diarrhea with a deep and slow pulse, where the patient has slight facial redness, mild body heat, and passes undigested food (Qinggu), ... [text omitted] ... The facial redness resembling Yang floating upward (Daiyang) is due to Lower Yuan deficiency. (This clause represents a True Cold syndrome; the main text and commentary are found in *Zhonghan Lun*.)
Diarrhea with a rapid pulse and thirst indicates spontaneous recovery. If it does not improve, pus and blood will inevitably appear, due to the presence of heat. (This clause also describes a heat-dysentery transforming into a pus-and-blood syndrome. Diarrhea with thirst indicates heat. A rapid pulse means heat is unresolved. The statement "spontaneous recovery" implies the pulse must be rapid yet deficient, and the thirst not severe. If the pulse is rapid and thirst is severe, indicating non-recovery, pus and blood will appear due to stagnant heat inside. According to this discussion, Zhang Zhongjing provides no treatment method. *Buwang Lun* by Chang Qizhi states: Huangqin Tang may be used.)
After diarrhea, if the pulse vanishes and the hands and feet are cold, but the pulse returns later and the hands and feet become warm, life is preserved; if the pulse does not return, death ensues. (This clause represents a True Yin syndrome. However, there are cases where excessive use of cooling medicines for heat-dysentery transforms it into this syndrome; physicians must examine this carefully. The main text and commentary are found in *Zhonghan Lun*.)
In Shanghan, diarrhea occurring more than ten times a day with a surprisingly excess pulse indicates death. (This clause represents the fatal pulse and symptom pattern for heat-dysentery. Initially caused by Shanghan, followed by diarrhea, indicating pathogenic heat transmitted to the Yin meridians. However, after diarrhea occurring more than ten times a day, the pathogenic heat should have diminished somewhat, and the pulse should be weak and rapid. Now that the pulse is surprisingly excess, the pathogenic factor prevails over the healthy Qi, hence death is indicated.)
Diarrhea passing undigested food, interior cold with exterior heat, sweating, and cold extremities are treated with Tongmai Sini Tang (Pulse-Reviving Four-Ingredient Decoction). (This clause represents a True Cold syndrome; the main text and commentary are found in *Zhonghan Lun*.)
(Repeated Example) Heat-dysentery with tenesmus is treated with Baitouweng Tang. (Already seen previously.)
Diarrhea with abdominal fullness and body pain requires first warming the interior, then attacking the exterior. To warm the interior, Sini Tang (Frigid Extremities Decoction) is appropriate. To attack the exterior, Guizhi Tang (Cinnamon Twig Decoction) is appropriate. (This clause represents a True Cold syndrome; the main text and commentary are found in *Zhonghan Lun*.)
(Repeated Example) Diarrhea with a desire to drink water is due to heat. Baitouweng Tang is the primary treatment. (Already seen previously.)
Diarrhea accompanied by delirium indicates dry fecal matter. Xiao Chengqi Tang (Minor Order the Qi Decoction) is appropriate. (Already seen in Volume 6, Yangming Disease, under the formula for Xiao Chengqi Tang.)
After diarrhea, increased irritability with a soft epigastrium upon palpation indicates empty irritability (Xufan). Zhizi Chitang (Gardenia and Fermented Soybean Decoction) is appropriate. (The previous clause's symptoms were already seen in Volume 4, Taiyang Disease, under the formula for Zhizi Tang.)
For a vomiting patient with abscess pus, do not treat the vomiting directly; once the pus is exhausted, it will heal spontaneously. (This clause likely belongs to a misplaced section in the Yangming Meridian chapter.)
Cheng's commentary states: An abscess in the stomach region causes vomiting and expulsion of pus. One should not treat the vomiting directly, as anti-emetic drugs are all acrid and warm. Once the pus is exhausted, vomiting heals spontaneously. Someone asked: How is a stomach abscess acquired?
I answered: Initially, wind-cold pathogens accumulate in the collaterals, then enter the Stomach organ, transforming into heat. Severe heat causes Qi stagnation and blood accumulation, forming an abscess. "Abscess" (Yong) means blockage, referring to the accumulation of heat toxins forming pus.
Vomiting with a weak pulse, frequent urination, mild body heat, and cold extremities indicate a difficult-to-treat condition. Sini Tang is the primary treatment.
Dry heaving, spitting saliva and foam, and headache are treated with Wuzhuyu Tang (Evodia Decoction).
The above two clauses represent True Yin syndromes. (The main text and commentary are found in *Zhonghan Lun*.)
(Repeated Example) Vomiting with fever is treated with Xiaochaihu Tang (Minor Bupleurum Decoction). (Already seen in Volume 7, Shaoyang Chapter, under the formula for Xiaochaihu Tang.)
In Shanghan, after excessive purging and emesis leading to extreme deficiency and profuse sweating, if the physician observes external Qi stagnation (Fuyu) and administers water to induce sweating, hiccups (Yue) result. This occurs because the Stomach is cold. (This Shanghan case involves heat transmitting to the Jueyin meridian, resulting from mismanagement. Although Jueyin diseases have formulas for emesis and purging, there is no method for excessive emesis or purging. Formulas like Genti San and Chengqi Tang are merely temporarily borrowed by Zhang Zhongjing to vomit pathogenic factors from the chest or purge interior heat in Jueyin. Here, however, excessive emesis and purging occurred, likely due to the physician's overuse of Genti San and Da Chengqi Tang, exhausting Stomach Qi. Subsequently, after emesis and purging, profuse sweating was induced again. Why? Because the patient exhibited external Qi stagnation. "Fuyu" refers to Qi on the face appearing as if pathogenic factors are stagnating at the exterior. This is extreme deficiency of the Yangming Stomach organ, with floating heat rising to the face. The physician mistook this for extreme Stomach dryness due to pathogenic heat, unable to sweat, and gave water to aid sweating, causing hiccups. Hiccups, called "Yue Ni" in *Qianjin Fang*, are commonly known as cold eructation. The reason is that the Stomach was extremely deficient, and cold water was subsequently administered; deficiency and cold interacted, forming hiccups. I note: This clause originally involved a transmitted heat disease. After taking cooling medicines and drinking cold water, the excessive cold resulted in a Stomach cold syndrome. Most commentators prescribe Wuzhuyu Tang, merely using it temporarily to tonify Stomach deficiency and dispel cold fluid. I believe Lizhong Tang could also be borrowed.)
In Shanghan, hiccups accompanied by abdominal fullness require observing the anterior and posterior orifices to determine which is obstructed; unblocking it leads to recovery. (This Shanghan case involves pathogenic transmission to Jueyin, with heat stagnating internally, forming a solid-type hiccup syndrome. The Jueyin meridian reaches the lower abdomen, flanks the Stomach, and enters the pharynx. All hiccup Qi originates from the lower abdomen, rising through the Stomach to the pharynx. Hiccups with abdominal fullness necessarily imply obstruction in both anterior and posterior orifices, preventing the free flow and excretion of Water and Fire Qi. This blocked Qi reverses upward, causing hiccups. Recovery requires the free flow of both urine and stool. According to this discussion, Zhang Zhongjing provides no treatment method. *Buwang Lun* by Chang Qizhi states: For anterior obstruction, Zhu Ling Tang; for posterior obstruction, Tiaowei Chengqi Tang. I believe that although named "Regulating the Stomach," Mangxiao (Mirabilite) is too harsh; given that Jueyin has no major purging method, Xiao Chengqi Tang should be used for mild purgation.)
(Hu) Note: The above formulas and discussions constitute Zhang Zhongjing's methods for treating Jueyin diseases. Jueyin diseases include True Cold and Heat diseases. Here, only over thirty clauses of transmitted heat diseases are excerpted and explained one by one, so that future students treating the Jueyin meridian will not mistakenly use warming methods nor excessive purging. Adapting treatment to specific conditions inherently possesses sound methods, embedded within flexible and adaptive clinical reasoning.