128．问曰∶病有结胸、有脏结，其状何如？答曰∶按之痛，寸脉浮、关脉沉，名曰结胸也。
129．何谓脏结？答曰∶如结胸状，饮食如故、时时下利，寸脉浮、关脉小细沉紧，名曰脏结。舌上白苔滑
者，难治。
130．脏结，无阳证，不往来寒热，（一云，寒而不热）其人反静，舌上苔滑者，不可攻也。
131．病发于阳，而反下之，热入因作结胸；病发于阴，而反下之，（一作汗出）因作痞也。所以成结胸者，
以下之太早故也。结胸者，项亦强，如柔 状，下之则和，宜大陷胸丸。方一。
大黄（半斤） 葶苈子（熬，半升） 芒硝（半升） 杏仁（去皮尖，熬黑，半升）
上四味，捣筛二味，内杏仁、芒硝，合研如脂，和散。取如弹丸一枚，别捣甘遂末一钱匕、白蜜二
合、水二升，煮取一升，温顿服之，一宿乃下；如不下，更服，取下为效。禁如药法。
132．结胸证，其脉浮大者，不可下，下之则死。
133．结胸证悉具，烦躁者亦死。
134．太阳病，脉浮而动数，浮则为风、数则为热、动则为痛、数则为虚；头痛、发热、微盗汗出，而反恶
寒者，表未解也。医反下之，动数变迟，膈内拒痛，（一云头痛即眩）胃中空虚，客气动膈，短气躁烦，心中
懊，阳气内陷，心下因硬，则为结胸，大陷胸汤主之。若不结胸，但头汗出，余处无汗，剂颈而还，小便不
利，身必发黄。大陷胸汤方二。
大黄（去皮，六两） 芒硝（一升） 甘遂（一钱匕）
上三味，以水六升，先煮大黄，取二升，去滓；内芒硝，煮一两沸；内甘遂末，温服一升。得快利，止后服。
135．伤寒六七日，结胸热实，脉沉而紧，心下痛，按之石硬者，大陷胸汤主之。方三。（用前第二方。）
136．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。方四。（用前第二方。）
大柴胡汤方∶
柴胡（半斤） 枳实（炙，四枚） 生姜（切，五两） 黄芩（三两） 芍药（三两） 半夏（洗，半升）
大枣（擘，十二枚）
上七味，以水一斗二升，煮取六升，去滓再煎。
温服一升，日三服。一方加大黄二两，若不加，恐不名大柴胡汤。
137．太阳病，重发汗而复下之，不大便五六日，舌上燥而渴，日晡所小有潮热，（一云日晡所发心胸大烦）
从心下至少腹硬满而痛不可近者，大陷胸汤主之。方五。（用前第二方。）
138．小结胸病，正在心下，按之则痛，脉浮滑者，小陷汤主之。方六。
黄连（一两） 半夏（洗，半升） 栝蒌实（大者一枚）
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。
139．太阳病，二三日，不能卧，但欲起，心下必结，脉微弱者，此本有寒分也。反下之，若利止，必作结
胸；未止者，四日复下之；此作协热利也。
140．太阳病，下之，其脉促，（一作纵）不结胸者，此为欲解也；脉浮者，必结胸；脉紧者，必咽痛；脉
弦者，必两胁拘急；脉细数者，头痛未止；脉沉紧者，必欲呕；脉沉滑者，协热利；脉浮滑者，必下血。
141．病在阳，应以汗解之；反以冷水 之。若灌之，其热被劫不得去，弥更益烦，肉上粟起，意欲饮水，
反不渴者，服文蛤散；若不瘥者，与五苓散；寒实结胸，无热证者，与三物小陷胸汤，（用前第六方）白散亦
可服。方七。（一云与三物小白散）
文蛤散方∶
文蛤（五两）
上一味为散，以沸汤和一方寸匕服。汤用五合。
五苓散方∶
猪苓（去黑皮，十八铢） 白术（十八铢） 泽泻（一两六铢）
茯苓（十八铢） 桂枝（去皮，半两）
上五味为散，更于臼中杵之。白饮和方寸匕服之，日三服；多饮暖水，汗出愈。
白散方∶
桔梗（三分） 巴豆（去皮心，熬黑，研如脂，一分） 贝母（三分）
上三味为散，内巴豆，更于臼中杵之，以白饮和服。强人半钱匕，羸者减之。病在膈上必吐，在
膈下必利。不利，进热粥一杯；利过不止，进冷粥一杯。身热、皮粟不解，欲引衣自覆；若以水 之
洗之，益令热劫不得出，当汗而不汗则烦。假令汗出已，腹中痛，与芍药三两如上法。
142．太阳与少阳并病，头项强痛，或眩冒，时如结胸，心下痞硬者，当刺大椎第一间、肺俞、肝俞，
慎不可发汗；发汗则谵语、脉弦，五日谵语不止，当刺期门。方八。
143．妇人中风，发热恶寒，经水适来，得之七八日，热除而脉迟、身凉、胸胁下满，如结胸状，谵语者，
此为热入血室也，当刺期门，随其实而取之。方九。
144．妇人中风，七八日续得寒热，发作有时，经水适断者，此为热入血室，其血必结，故使如疟状发作
有时，小柴胡汤主之。方十。
柴胡（半斤） 黄芩（三两） 人参（三两） 半夏（洗，半升） 甘草（三两） 生姜（切，三两） 大枣（擘，
十二枚）
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。
145．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。方十一。
146．伤寒六七日，发热、微恶寒、肢节烦痛、微呕、心下支结、外证未去者，柴胡桂枝汤主之。方十二。
桂枝（去皮） 黄芩（一两半） 人参（一两半） 甘草（炙，一两） 半夏（洗，二合半） 芍药
（一两半） 大枣（擘，六枚） 生姜（切，一两半） 柴胡（四两）
上九味，以水七升，煮取三升，去滓，温服一升。
本云人参汤，作如桂枝法，加半夏、柴胡、黄芩，复如柴胡法。今用人参作半剂。
147．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。方十三。
柴胡（半斤） 桂枝（去皮，三两） 干姜（二两） 栝蒌根（四两） 黄芩（三两） 牡蛎（熬，二两）
甘草（炙，二两）
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，复服汗出便愈。
148．伤寒五六日，头汗出、微恶寒、手足冷、心下满、口不欲食、大便硬、脉细者，此为阳微结，必有表，
复有里也。脉沉，亦在里也。汗出，为阳微；假令纯阴结，不得复有外证，悉入在里，此为半在里半在外也。
脉虽沉紧，不得为少阴病。所以然者，阴不得有汗，今头汗出，故知非少阴也，可与小柴胡汤；设不了了者，
得屎而解。方十四。（用前第十方。）
149．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。方十五。
半夏（洗，半升） 黄芩 干姜 人参 甘草（炙，各三两） 黄连（一两） 大枣（擘，十二枚）
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。须大陷胸汤者，方用前第
二法。（一方用半夏一升。）
150．太阳、少阳并病，而反下之，成结胸；心下硬，
下利不止，水浆不下，其人心烦。
151．脉浮而紧，而复下之，紧反入里，则作痞。按之自濡，但气痞耳。
152．太阳中风，下利、呕逆，表解者，乃可攻之。其人 汗出，发作有时，头痛、心下痞硬满、引胁下
痛、干呕、短气、汗出不恶寒者，此表解里未和也，十枣汤主之。方十六。
芫花（熬） 甘遂 大戟
上三味，等分，各别捣为散。以水一升半，先煮大枣肥者十枚，取八合，去滓，内药末。强人服
一钱匕，羸人服半钱，温服之。平旦服。若下少病不除者，明日更服，加半钱；得快下利后，糜粥自养。
153．太阳病，医发汗，遂发热、恶寒；因复下之，心下痞。表里俱虚，阴阳气并竭，无阳则阴独。复加烧
针，因胸烦、面色青黄、肤 者，难治；今色微黄；手足温者，易愈。
154．心下痞，按之濡，其脉关上浮者，大黄黄连泻心汤主之。方十七。
大黄（二两） 黄连（一两）
上二味，以麻沸汤二升渍之，须臾绞去滓。
分温再服。(臣亿等看详大黄黄连泻心汤，诸本皆二味；又后附子泻心汤，用大黄、黄连、黄芩、附子，恐是
前方中亦有黄芩，后但加附子也。故后云附子泻心汤，本云加附子也。)
155．心下痞，而复恶寒、汗出者，附子泻心汤主之。方十八。
大黄（二两） 黄连（一两） 黄芩（一两） 附子（炮，去皮破，别煮取汁，一枚）
上四味，切三味，以麻沸汤二升渍之，须臾绞去滓，内附子汁，分温再服。
156．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。方十九。
一方云，忍之一日乃愈。（用前第七证方。）
157．伤寒汗出解之后，胃中不和，心下痞硬，干噫食臭，胁下有水气，腹中雷鸣下利者，生姜泻心
汤主之。方二十。
生姜（切，四两） 甘草（炙，三两） 人参（三两） 干姜（一两） 黄芩（三两） 半夏（洗，半升）
黄连（一两） 大枣（擘，十二枚）
上八味，以水一斗，煮取六升，去滓，再煎取三升。温服一升，日三服。附子泻心汤，本云加附
子，半夏泻心汤，甘草泻心汤，同体别名耳。生姜泻心汤，本云理中人参黄芩汤，去桂枝、术，加黄
连，并泻肝法。
158．伤寒中风，医反下之，其人下利，日数十行，谷不化，腹中雷鸣，心下痞硬而满，干呕心烦不得安。
医见心下痞，谓病不尽，复下之，其痞益甚。此非结热，但以胃中虚，客气上逆，故使硬也。甘草泻心汤主之。
方二十一。
甘草（炙，四两） 黄芩（三两） 干姜（三两） 半夏（洗，半升） 大枣（擘，十二枚） 黄连（一两）
上六味，以水一斗，煮取六升，去滓；再煎取三升。温服─升，日三服。(臣亿等谨按上生姜泻心汤法，
本云理中人参黄芩汤，今详泻心以疗痞。痞气因发阴而生，是半夏、生姜、甘草泻心三方，皆本于理中也，
其方必各有人参，今甘草泻心中无者，脱落之也。又按千金并外台秘要治伤寒 食，用此方，皆有人参，知
脱落无疑。)
159．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。复不止者，当利其小便。赤石脂禹余粮汤。方二十二。
赤石脂（碎，一斤） 太一禹余粮（碎，一斤）
上二味，以水六升，煮取二升，去滓，分温三
服。
160．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。
161．伤寒发汗、若吐、若下，解后，心下痞硬，噫气不除者，旋复代赭汤主之。方二十三。
旋复花（三两） 人参（二两） 生姜（五两） 代赭（一两） 甘草（炙，三两） 半夏（洗，半升）
大枣（擘，十二枚）
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。
162．下后，不可更行桂枝汤；若汗出而喘，无大热者，可与麻黄杏子甘草石膏汤。方二十四。
麻黄（四两） 杏仁（去皮尖，五十个） 甘草（炙，二两） 石膏（碎，绵裹，半斤）
上四味，以水七升，先煮麻黄，减二升，去白沫；内诸药，煮取三升。去滓，温服一升。本云黄耳 。
163．太阳病，外证未除而数下之，遂协热而利，利下不止，心下痞硬、表里不解者，桂枝人参汤主之。
方二十五。
桂枝（别切，四两） 甘草（炙，四两） 白术（三两） 人参（三两） 干姜（三两）
上五味，以水九升，先煮四味，取五升；内桂，更煮取三升，去滓。温服一升，日再夜一服。
164．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。方二十六。（泻心汤用前第十七方。）
165．伤寒发热、汗出不解，心中痞硬、呕吐而下利者，大柴胡汤主之。方二十七。（用前第四方。）
166．病如桂枝证，头不痛、项不强、寸脉微浮、胸中痞硬、气上冲喉咽不得息者，此为胸有寒也。当吐
之，宜瓜蒂散。方二十八。
瓜蒂（熬黄，一分） 赤小豆（一分）
上二味，各别捣筛，为散已，合治之。取一钱匕，以香豉一合，用热汤七合煮作稀糜，去滓，取汁
和散，温顿服之。不吐者，少少加；得快吐乃止。诸亡血虚家，不可与瓜蒂散。
167．病胁下素有痞，连在脐旁，痛引少腹，入阴筋者，此名脏结，死。方二十九。
128. Question: There are diseases of Jie Xiong (Chest Bind, a syndrome where pathogenic factors bind in the chest and diaphragm) and Zang Jie (Visceral Bind, a syndrome of visceral deficiency and cold with yin-cold coagulation). What are their manifestations? Answer: Pain upon pressure, a floating pulse at the Cun position (distal pulse position), and a deep pulse at the Guan position (middle pulse position) are named Jie Xiong.
129. What is Zang Jie? Answer: It resembles Jie Xiong in appearance, but eating and drinking remain normal, and there is frequent diarrhea. The pulse is floating at the Cun position, and small, fine, deep, and tight at the Guan position; this is named Zang Jie. If the tongue coating is white and slippery, it is difficult to treat.
130. In Zang Jie, there are no Yang heat syndromes, no alternating chills and fever (one version states only cold without heat), and the patient is instead quiet. If the tongue coating is slippery, attacking methods (purging) must not be used.
131. If a disease originates in the Yang channels (exterior syndrome) and purging is mistakenly applied, heat enters inwardly, resulting in Jie Xiong. If a disease originates in the Yin channels (interior syndrome) and purging is mistakenly applied (one version says sweating was induced), Pi (Glomus, a sensation of fullness and obstruction in the epigastrium) results. The formation of Jie Xiong is due to purging being performed too early. In Jie Xiong, the neck is also stiff, resembling Rou Jing (Soft Spasm, a condition characterized by stiffness of the neck and back with sweating). Purging will harmonize the condition; Da Xian Xiong Wan (Major Sinking Chest Pill) is appropriate.
Formula 1:
Rhei Radix et Rhizoma (Dahuang, 大黄) (half a jin)
Descurainiae Semen Lepidii Semen (Tinglizi, 葶苈子) (stir-fried, half a sheng)
Natrii Sulfas (Mangxiao, 芒硝) (half a sheng)
Armeniacae Semen Amarum (Xingren, 杏仁) (skin and tips removed, stir-fried black, half a sheng)
For the above four ingredients, crush and sieve two ingredients, add Armeniacae Semen Amarum and Natrii Sulfas, grind together until lipid-like, and mix into a powder. Take one pill the size of a bullet. Separately crush Kansui Radix (Gansui, 甘遂) powder (one qian bi), mix with Bai Mi (White Honey, 白蜜) (two ge) and water (two sheng), boil to obtain one sheng, and take warm in one dose. Bowel movement will occur after one night. If there is no bowel movement, administer again; efficacy is achieved when bowel movement occurs. Follow contraindications as per medicinal guidelines.
132. In Jie Xiong syndrome, if the pulse is floating and large, purging must not be used; purging will lead to death.
133. If all symptoms of Jie Xiong syndrome are present and restlessness/agitation occurs, it is also fatal.
134. In Tai Yang Bing (Tai Yang Disease, a syndrome caused by pathogenic invasion of the Tai Yang channel), the pulse is floating, moving, and rapid. Floating indicates Wind, rapid indicates Heat, moving indicates Pain, and rapid also indicates Deficiency. There is headache, fever, slight night sweating, and paradoxically aversion to cold, indicating that the exterior syndrome is not resolved. The physician mistakenly applies purging. The moving and rapid pulse changes to slow. There is pain upon resistance in the diaphragm (one version states headache accompanied by dizziness). The Stomach is empty and deficient, guest Qi disturbs the diaphragm, causing shortness of breath, agitation, and annoyance in the heart. Yang Qi sinks inwardly, causing hardness below the heart, thus forming Jie Xiong. Da Xian Xiong Tang (Major Sinking Chest Decoction) governs it. If Jie Xiong does not form, but there is sweating only on the head, no sweating elsewhere, stopping at the neck, and difficulty in urination, the body will inevitably develop jaundice.
Da Xian Xiong Tang Formula 2:
Rhei Radix et Rhizoma (Dahuang, 大黄) (skin removed, six liang)
Natrii Sulfas (Mangxiao, 芒硝) (one sheng)
Kansui Radix (Gansui, 甘遂) (one qian bi)
For the above three ingredients, use six sheng of water. First boil Rhei Radix et Rhizoma to obtain two sheng, remove dregs. Add Natrii Sulfas and boil for one or two boils. Add Kansui Radix powder. Take one sheng warm. Stop subsequent doses after rapid purgation.
135. In Shang Han (Cold Damage) for six or seven days, with Jie Xiong Heat Excess syndrome, the pulse is deep and tight, there is pain below the heart, and it feels stone-hard upon pressure. Da Xian Xiong Tang governs it. Formula 3. (Use the second formula above.)
136. In Shang Han for more than ten days, if heat binds in the interior and there is alternating chills and fever, administer Da Chai Hu Tang (Major Bupleurum Decoction). If there is only Jie Xiong without high fever, this is water binding in the chest and hypochondrium. If there is only slight sweating on the head, Da Xian Xiong Tang governs it. Formula 4. (Use the second formula above.)
Da Chai Hu Tang Formula:
Bupleuri Radix (Chaihu, 柴胡) (half a jin)
Aurantii Fructus Immaturus (Zhishi, 枳实) (honey-fried, four pieces)
Zingiberis Rhizoma Recens (Shengjiang, 生姜) (sliced, five liang)
Scutellariae Radix (Huangqin, 黄芩) (three liang)
Paeoniae Radix Alba (Shaoyao, 芍药) (three liang)
Pinelliae Rhizoma (Banxia, 半夏) (washed, half a sheng)
Jujubae Fructus (Dazao, 大枣) (broken, twelve pieces)
For the above seven ingredients, use one dou and two sheng of water. Boil to obtain six sheng, remove dregs, and decoct again. Take one sheng warm, three times a day. One version adds two liang of Rhei Radix et Rhizoma; without it, it may not be called Da Chai Hu Tang.
137. In Tai Yang Bing, if heavy sweating is induced followed by mistaken purging, and there is no bowel movement for five or six days, dryness and thirst on the tongue, slight tidal fever in the late afternoon (one version states extreme vexation in the chest and heart in the late afternoon), and hardness, fullness, and pain from below the heart to the lower abdomen that is intolerable to touch, Da Xian Xiong Tang governs it. Formula 5. (Use the second formula above.)
138. In Xiao Jie Xiong Bing (Minor Chest Bind Disease), located precisely below the heart, with pain upon pressure and a floating, slippery pulse, Xiao Xian Xiong Tang (Minor Sinking Chest Decoction) governs it. Formula 6.
Coptidis Rhizoma (Huanglian, 黄连) (one liang)
Pinelliae Rhizoma (Banxia, 半夏) (washed, half a sheng)
Trichosanthis Fructus (Gualoushi, 栝蒌实) (one large piece)
For the above three ingredients, use six sheng of water. First boil Trichosanthis Fructus to obtain three sheng, remove dregs. Add the other herbs, boil to obtain two sheng, remove dregs, and divide into three warm doses.
139. In Tai Yang Bing for two or three days, if the patient cannot lie down but wants to sit up, there must be binding below the heart. If the pulse is faint and weak, this indicates pre-existing cold fluid. If purging is mistakenly applied and diarrhea stops, Jie Xiong will inevitably form. If diarrhea does not stop, purging is applied again on the fourth day; this results in Xie Re Li (Diarrhea with concurrent heat).
140. In Tai Yang Bing, if purging is applied and the pulse is Cu (Rapid-Irregular) (one version says Zong/Relaxed), and Jie Xiong does not form, the disease is about to resolve. If the pulse is floating, Jie Xiong will inevitably form. If the pulse is tight, sore throat will inevitably occur. If the pulse is wiry, spasmodic urgency in both hypochondria will inevitably occur. If the pulse is fine and rapid, headache will not cease. If the pulse is deep and tight, vomiting will inevitably be desired. If the pulse is deep and slippery, Xie Re Li will occur. If the pulse is floating and slippery, bleeding from the lower body will inevitably occur.
141. If the disease is in the Yang, it should be resolved by sweating. Instead, cold water is sprinkled or poured. If poured, the heat is constrained and cannot escape, causing increased vexation, goosebumps on the skin, desire to drink water, but paradoxically no thirst. Administer Wen Ge San (Clam Shell Powder). If not cured, give Wu Ling San (Five-Ingredient Powder with Poria). For Han Shi Jie Xiong (Cold-Solid Chest Bind) without heat signs, give San Wu Xiao Xian Xiong Tang (Three-Ingredient Minor Sinking Chest Decoction) (use the sixth formula above); Bai San (White Powder) may also be administered. Formula 7. (One version says give San Wu Xiao Bai San.)
Wen Ge San Formula:
Meretricis Concha (Wenge, 文蛤) (five liang)
Grind the above single ingredient into powder. Mix with one fang cun bi of boiling water and take. Use five ge of water.
Wu Ling San Formula:
Polypori Umbellati Sclerotium (Zhuling, 猪苓) (black skin removed, eighteen zhu)
Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) (eighteen zhu)
Alismatis Rhizoma (Zexie, 泽泻) (one liang six zhu)
Poria (Fuling, 茯苓) (eighteen zhu)
Cinnamomi Ramulus (Guizhi, 桂枝) (skin removed, half a liang)
Grind the above five ingredients into powder, then pound further in a mortar. Mix with one fang cun bi of rice water and take, three times a day. Drink plenty of warm water; sweating leads to recovery.
Bai San Formula:
Platycodonis Radix (Jiegeng, 桔梗) (three fen)
Crotonis Fructus (Badou, 巴豆) (skin and core removed, stir-fried black, ground to lipid consistency, one fen)
Fritillariae Bulbus (Beimu, 贝母) (three fen)
Grind the above three ingredients into powder, add Crotonis Fructus, and pound further in a mortar. Mix with rice water and take. Strong individuals take half a qian bi; weak individuals reduce the dose. If the disease is above the diaphragm, vomiting will occur; if below the diaphragm, diarrhea will occur. If no diarrhea, drink one cup of hot porridge. If diarrhea is excessive and does not stop, drink one cup of cold porridge. If body heat and goosebumps do not resolve, and the patient desires to cover themselves with clothes, spraying or washing with water will further constrain the heat, preventing its exit. Failure to sweat when sweating is indicated causes vexation. If sweating has occurred but there is abdominal pain, administer three liang of Paeoniae Radix Alba as described above.
142. In concurrent Tai Yang and Shao Yang disease, with stiff pain in the head and neck, or dizziness, occasionally resembling Jie Xiong, and glomus and hardness below the heart, needle Da Zhui (GV14) first interspace, Fei Shu (BL13), and Gan Shu (BL18). Sweating must be strictly avoided. Sweating will cause delirium and a wiry pulse. If delirium persists for five days, needle Qi Men (LR14). Formula 8.
143. In a woman with Zhong Feng (Wind Strike), featuring fever and aversion to cold, if menstruation just begins and after seven or eight days the fever subsides, the pulse becomes slow, the body cools, there is fullness below the chest and hypochondrium resembling Jie Xiong, and delirium, this is Re Ru Xue Shi (Heat Entering the Blood Chamber). Needle Qi Men (LR14) to drain the excess. Formula 9.
144. In a woman with Zhong Feng, if chills and fever continue for seven or eight days, occurring at regular intervals, and menstruation just stops, this is Re Ru Xue Shi. The blood will inevitably coagulate, causing malaria-like episodes at regular intervals. Xiao Chai Hu Tang (Minor Bupleurum Decoction) governs it. Formula 10.
Bupleuri Radix (Chaihu, 柴胡) (half a jin)
Scutellariae Radix (Huangqin, 黄芩) (three liang)
Ginseng Radix et Rhizoma (Renshen, 人参) (three liang)
Pinelliae Rhizoma (Banxia, 半夏) (washed, half a sheng)
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) (three liang)
Zingiberis Rhizoma Recens (Shengjiang, 生姜) (sliced, three liang)
Jujubae Fructus (Dazao, 大枣) (broken, twelve pieces)
For the above seven ingredients, use one dou and two sheng of water. Boil to obtain six sheng, remove dregs, and decoct again to obtain three sheng. Take one sheng warm, three times a day.
145. In a woman with Shang Han, featuring fever, if menstruation just begins, she is clear-headed during the day but delirious at night, as if seeing ghosts, this is Re Ru Xue Shi. Do not damage Stomach Qi or the Upper and Middle Jiao; it will inevitably heal spontaneously. Formula 11.
146. In Shang Han for six or seven days, with fever, slight aversion to cold, vexing pain in the limbs and joints, slight vomiting, supporting binding below the heart, and unresolved exterior signs, Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) governs it. Formula 12.
Cinnamomi Ramulus (Guizhi, 桂枝) (skin removed)
Scutellariae Radix (Huangqin, 黄芩) (one and a half liang)
Ginseng Radix et Rhizoma (Renshen, 人参) (one and a half liang)
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) (honey-fried, one liang)
Pinelliae Rhizoma (Banxia, 半夏) (washed, two and a half ge)
Paeoniae Radix Alba (Shaoyao, 芍药) (one and a half liang)
Jujubae Fructus (Dazao, 大枣) (broken, six pieces)
Zingiberis Rhizoma Recens (Shengjiang, 生姜) (sliced, one and a half liang)
Bupleuri Radix (Chaihu, 柴胡) (four liang)
For the above nine ingredients, use seven sheng of water. Boil to obtain three sheng, remove dregs, and take one sheng warm.
Originally called Ren Shen Tang, prepared like Gui Zhi Tang, adding Pinelliae Rhizoma, Bupleuri Radix, and Scutellariae Radix, then following Chai Hu Tang method. Now Ginseng Radix et Rhizoma is used as a half dose.
147. In Shang Han for five or six days, if sweating has been induced followed by mistaken purging, resulting in fullness and slight binding in the chest and hypochondrium, difficulty in urination, thirst without vomiting, sweating only on the head, alternating chills and fever, and vexation in the heart, the disease is not resolved. Chai Hu Gui Zhi Gan Jiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction) governs it. Formula 13.
Bupleuri Radix (Chaihu, 柴胡) (half a jin)
Cinnamomi Ramulus (Guizhi, 桂枝) (skin removed, three liang)
Zingiberis Rhizoma (Ganjiang, 干姜) (two liang)
Trichosanthis Radix (Gualougen, 栝蒌根) (four liang)
Scutellariae Radix (Huangqin, 黄芩) (three liang)
Ostreae Concha (Muli, 牡蛎) (stir-fried, two liang)
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) (honey-fried, two liang)
For the above seven ingredients, use one dou and two sheng of water. Boil to obtain six sheng, remove dregs, and decoct again to obtain three sheng. Take one sheng warm. Three times a day. Initial administration may cause slight vexation; subsequent administration leads to sweating and recovery.
148. In Shang Han for five or six days, with sweating on the head, slight aversion to cold, cold hands and feet, fullness below the heart, lack of appetite, hard stool, and a fine pulse, this is Yang Wei Jie (Yang Micro-Binding). There must be both exterior and interior signs. A deep pulse also indicates interior involvement. Sweating indicates Yang deficiency. If it were pure Yin Binding, there would be no exterior signs, with all pathology in the interior. This is half in the interior and half in the exterior. Although the pulse is deep and tight, it should not be considered Shao Yin Disease. The reason is that Yin syndromes do not present with sweating. Since there is sweating on the head, it is known not to be Shao Yin. Xiao Chai Hu Tang may be given. If discomfort persists, resolution occurs with bowel movement. Formula 14. (Use the tenth formula above.)
149. In Shang Han for five or six days, with vomiting and fever, if Chai Hu Tang syndrome is fully present but other medicines are used for purging, and Chai Hu syndrome remains, administer Chai Hu Tang again. Although purging has been performed, it is not contrary to treatment. There will inevitably be steaming and shivering, followed by fever and sweating, leading to resolution. If there is fullness and hard pain below the heart, this is Jie Xiong; Da Xian Xiong Tang governs it. If there is only fullness without pain, this is Pi; Chai Hu Tang is not suitable. Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Epigastrium) is appropriate. Formula 15.
Pinelliae Rhizoma (Banxia, 半夏) (washed, half a sheng)
Scutellariae Radix (Huangqin, 黄芩)
Zingiberis Rhizoma (Ganjiang, 干姜)
Ginseng Radix et Rhizoma (Renshen, 人参)
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) (honey-fried, each three liang)
Coptidis Rhizoma (Huanglian, 黄连) (one liang)
Jujubae Fructus (Dazao, 大枣) (broken, twelve pieces)
For the above seven ingredients, use one dou of water. Boil to obtain six sheng, remove dregs, and decoct again to obtain three sheng. Take one sheng warm, three times a day. If Da Xian Xiong Tang is needed, use the second method above. (One version uses one sheng of Pinelliae Rhizoma.)
150. In concurrent Tai Yang and Shao Yang disease, if purging is mistakenly applied, Jie Xiong forms. There is hardness below the heart, incessant diarrhea, inability to swallow fluids, and vexation in the heart.
151. If the pulse is floating and tight, and purging is applied again, the tight pulse enters the interior, resulting in Pi. Upon pressure, it is naturally soft; this is merely Qi Pi (Qi Glomus).
152. In Tai Yang Zhong Feng (Tai Yang Wind Strike), with diarrhea and rebellious vomiting, attacking methods may be used only after the exterior syndrome is resolved. If the patient has paroxysmal sweating occurring at regular intervals, headache, glomus, hardness, and fullness below the heart, pain radiating to the hypochondrium, dry vomiting, shortness of breath, and sweating without aversion to cold, this indicates the exterior is resolved but the interior is not harmonized. Shi Zao Tang (Ten Jujube Decoction) governs it. Formula 16.
Genkwa Flos (Yuanhua, 芫花) (stir-fried)
Kansui Radix (Gansui, 甘遂)
Knoxiae Radix (Daji, 大戟)
For the above three ingredients, in equal parts, crush separately into powder. Use one and a half sheng of water. First boil ten large Jujubae Fructus to obtain eight ge, remove dregs, and add the powder. Strong individuals take one qian bi; weak individuals take half a qian. Take warm. Administer at dawn. If purgation is scant and the disease is not eliminated, administer again the next day, adding half a qian. After rapid purgation, nourish with thin porridge.
153. In Tai Yang Bing, if the physician induces sweating, resulting in fever and aversion to cold, and then applies purging, glomus below the heart occurs. Both exterior and interior are deficient; Yin and Yang Qi are both exhausted. Without Yang, Yin exists alone. If burning needles are additionally applied, causing chest vexation, greenish-yellow complexion, and skin crawling, it is difficult to treat. If the complexion is slightly yellow and hands and feet are warm, recovery is easy.
154. For glomus below the heart, soft upon pressure, with a floating pulse at the Guan position, Da Huang Huang Lian Xie Xin Tang (Rhubarb and Coptis Decoction to Drain the Epigastrium) governs it. Formula 17.
Rhei Radix et Rhizoma (Dahuang, 大黄) (two liang)
Coptidis Rhizoma (Huanglian, 黄连) (one liang)
For the above two ingredients, steep in two sheng of Ma Fei Tang (boiling water) for a moment, then squeeze out the dregs. Divide into two warm doses. (Ministers Yi and others examined Da Huang Huang Lian Xie Xin Tang; all versions contain two ingredients. Later, Fu Zi Xie Xin Tang uses Rhei Radix et Rhizoma, Coptidis Rhizoma, Scutellariae Radix, and Aconiti Lateralis Radix Praeparata. It is feared that the former formula also contained Scutellariae Radix, with Aconiti Lateralis Radix Praeparata added later. Thus, it is stated later that Fu Zi Xie Xin Tang originally involved adding Fu Zi.)
155. For glomus below the heart, with additional aversion to cold and sweating, Fu Zi Xie Xin Tang (Aconite Decoction to Drain the Epigastrium) governs it. Formula 18.
Rhei Radix et Rhizoma (Dahuang, 大黄) (two liang)
Coptidis Rhizoma (Huanglian, 黄连) (one liang)
Scutellariae Radix (Huangqin, 黄芩) (one liang)
Aconiti Lateralis Radix Praeparata (Fuzi, 附子) (processed, skin removed and broken, decocted separately to obtain juice, one piece)
For the above four ingredients, cut three ingredients and steep in two sheng of Ma Fei Tang for a moment, then squeeze out the dregs. Add the juice of Aconiti Lateralis Radix Praeparata. Divide into two warm doses.
156. Originally, purging caused glomus below the heart. Xie Xin Tang was given, but the glomus did not resolve. If the patient is thirsty, has dry mouth and vexation, and difficulty in urination, Wu Ling San governs it. Formula 19.
One version states: Endure for one day to heal. (Use the seventh formula above.)
157. After Shang Han is resolved by sweating, if the Stomach is disharmonious, with glomus and hardness below the heart, dry belching with food odor, fluid retention in the hypochondrium, borborygmus, and diarrhea, Sheng Jiang Xie Xin Tang (Fresh Ginger Decoction to Drain the Epigastrium) governs it. Formula 20.
Zingiberis Rhizoma Recens (Shengjiang, 生姜) (sliced, four liang)
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) (honey-fried, three liang)
Ginseng Radix et Rhizoma (Renshen, 人参) (three liang)
Zingiberis Rhizoma (Ganjiang, 干姜) (one liang)
Scutellariae Radix (Huangqin, 黄芩) (three liang)
Pinelliae Rhizoma (Banxia, 半夏) (washed, half a sheng)
Coptidis Rhizoma (Huanglian, 黄连) (one liang)
Jujubae Fructus (Dazao, 大枣) (broken, twelve pieces)
For the above eight ingredients, use one dou of water. Boil to obtain six sheng, remove dregs, and decoct again to obtain three sheng. Take one sheng warm, three times a day. Fu Zi Xie Xin Tang was originally said to add Fu Zi. Ban Xia Xie Xin Tang and Gan Cao Xie Xin Tang are different names for the same body. Sheng Jiang Xie Xin Tang was originally called Li Zhong Ren Shen Huang Qin Tang, with Gui Zhi and Bai Zhu removed, and Huang Lian added, also following the method of draining the Liver.
158. In Shang Han Zhong Feng, if the physician mistakenly applies purging, the patient experiences diarrhea dozens of times a day, undigested food, borborygmus, glomus, hardness, and fullness below the heart, dry vomiting, vexation, and restlessness. Seeing the glomus below the heart, the physician assumes the disease is not exhausted and applies purging again, worsening the glomus. This is not accumulated heat, but rather Stomach deficiency with guest Qi rebelling upward, causing hardness. Gan Cao Xie Xin Tang (Licorice Decoction to Drain the Epigastrium) governs it. Formula 21.
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) (honey-fried, four liang)
Scutellariae Radix (Huangqin, 黄芩) (three liang)
Zingiberis Rhizoma (Ganjiang, 干姜) (three liang)
Pinelliae Rhizoma (Banxia, 半夏) (washed, half a sheng)
Jujubae Fructus (Dazao, 大枣) (broken, twelve pieces)
Coptidis Rhizoma (Huanglian, 黄连) (one liang)
For the above six ingredients, use one dou of water. Boil to obtain six sheng, remove dregs, and decoct again to obtain three sheng. Take one sheng warm, three times a day. (Ministers Yi and others carefully note that the above Sheng Jiang Xie Xin Tang method was originally called Li Zhong Ren Shen Huang Qin Tang. Examining Xie Xin Tang for treating Pi, Pi Qi arises from Yin development. Thus, Ban Xia, Sheng Jiang, and Gan Cao Xie Xin Tangs are all based on Li Zhong Tang. Each formula must contain Ginseng Radix et Rhizoma. Its absence in Gan Cao Xie Xin Tang is an omission. Furthermore, according to Qian Jin Fang and Wai Tai Mi Yao for treating Shang Han with food stagnation, this formula always contains Ginseng Radix et Rhizoma, confirming the omission beyond doubt.)
159. In Shang Han, after taking decoctions, if diarrhea is incessant and there is glomus and hardness below the heart, and after taking Xie Xin Tang, other purgatives are used, and diarrhea continues, and the physician gives Li Zhong Tang, worsening the diarrhea: Li Zhong Tang regulates the Middle Jiao, but this diarrhea is in the Lower Jiao. Chi Shi Zhi Yu Yu Liang Tang (Halloysitum Rubrum and Limonitum Decoction) governs it. If it still does not stop, promote urination. Chi Shi Zhi Yu Yu Liang Tang. Formula 22.
Halloysitum Rubrum (Chishizhi, 赤石脂) (crushed, one jin)
Limonitum (Taiyi Yuyuliang, 太一禹余粮) (crushed, one jin)
For the above two ingredients, use six sheng of water. Boil to obtain two sheng, remove dregs, and divide into three warm doses.
160. After vomiting and purging in Shang Han, if sweating is induced, resulting in deficiency vexation and a very faint pulse, and after eight or nine days there is glomus and hardness below the heart, pain in the hypochondrium, Qi rushing to the throat, dizziness, and throbbing in the channels, prolonged condition leads to Wei (Flaccidity Syndrome).
161. After Shang Han is resolved by sweating, vomiting, or purging, if there is glomus and hardness below the heart and belching is not eliminated, Xuan Fu Dai Zhe Tang (Inula and Hematite Decoction) governs it. Formula 23.
Inulae Flos (Xuanfuhua, 旋复花) (three liang)
Ginseng Radix et Rhizoma (Renshen, 人参) (two liang)
Zingiberis Rhizoma Recens (Shengjiang, 生姜) (five liang)
Haematitum (Daizhe, 代赭) (one liang)
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) (honey-fried, three liang)
Pinelliae Rhizoma (Banxia, 半夏) (washed, half a sheng)
Jujubae Fructus (Dazao, 大枣) (broken, twelve pieces)
For the above seven ingredients, use one dou of water. Boil to obtain six sheng, remove dregs, and decoct again to obtain three sheng. Take one sheng warm, three times a day.
162. After purging, Gui Zhi Tang must not be used again. If there is sweating and panting without high fever, Ma Huang Xing Zi Gan Cao Shi Gao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) may be given. Formula 24.
Ephedrae Herba (Mahuang, 麻黄) (four liang)
Armeniacae Semen Amarum (Xingren, 杏仁) (skin and tips removed, fifty pieces)
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) (honey-fried, two liang)
Gypsum Fibrosum (Shigao, 石膏) (crushed, wrapped in cotton, half a jin)
For the above four ingredients, use seven sheng of water. First boil Ephedrae Herba, reducing by two sheng, and remove white foam. Add the other herbs and boil to obtain three sheng. Remove dregs and take one sheng warm. Originally called Huang Er Bei.
163. In Tai Yang Bing, if the exterior syndrome is not eliminated and purging is frequently applied, resulting in Xie Re Li, incessant diarrhea, glomus and hardness below the heart, and unresolved exterior and interior, Gui Zhi Ren Shen Tang (Cinnamon Twig and Ginseng Decoction) governs it. Formula 25.
Cinnamomi Ramulus (Guizhi, 桂枝) (separately sliced, four liang)
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) (honey-fried, four liang)
Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) (three liang)
Ginseng Radix et Rhizoma (Renshen, 人参) (three liang)
Zingiberis Rhizoma (Ganjiang, 干姜) (three liang)
For the above five ingredients, use nine sheng of water. First boil four ingredients to obtain five sheng. Add Cinnamomi Ramulus and boil again to obtain three sheng. Remove dregs. Take one sheng warm, twice during the day and once at night.
164. After major purging in Shang Han, if sweating is induced again, resulting in glomus below the heart and aversion to cold, the exterior is not resolved. Attacking the glomus is prohibited. First resolve the exterior; only after the exterior is resolved can the glomus be attacked. To resolve the exterior, Gui Zhi Tang is suitable. To attack the glomus, Da Huang Huang Lian Xie Xin Tang is suitable. Formula 26. (Use the seventeenth formula above for Xie Xin Tang.)
165. In Shang Han with fever and sweating that does not resolve, with glomus and hardness in the heart, vomiting, and diarrhea, Da Chai Hu Tang governs it. Formula 27. (Use the fourth formula above.)
166. If the disease resembles Gui Zhi syndrome, but there is no headache, no neck stiffness, a slightly floating pulse at the Cun position, glomus and hardness in the chest, and Qi rushing to the throat preventing breathing, this is Cold in the Chest. Induce vomiting; Gua Di San (Melon Pedicle Powder) is suitable. Formula 28.
Cucumis Pediculus (Guadi, 瓜蒂) (stir-fried yellow, one fen)
Vignae Semen (Chixiaodou, 赤小豆) (one fen)
For the above two ingredients, crush and sieve separately. After forming powder, combine. Take one qian bi. Use one ge of Xiang Chi (Fermented Soybean) and seven ge of hot water to cook into thin gruel. Remove dregs, mix the juice with the powder, and take warm in one dose. If no vomiting occurs, increase the dose slightly. Stop after rapid vomiting. Patients with blood loss or deficiency must not be given Gua Di San.
167. If there is a longstanding glomus below the hypochondrium, connecting to the side of the umbilicus, with pain radiating to the lower abdomen and entering the genitalia, this is named Zang Jie. It is fatal. Formula 29.