成 自利者不因攻下而自泄泻也有表邪传里里虚胁热而利者有不应攻下而下之遂利者是皆胁热也又三阳合病皆作
自利有发表攻里和解之不同(太阳阳明合病为在表故与葛根汤以汗之太阳少阳合病为在半表半里故与黄芩汤以和解之阳
明少阳合病为少阳邪气入里故与承气汤下之)且自利不渴者属太阴藏寒故也下利欲饮水者有热故也故大便溏小便自可与
夫发热后重泄色黄赤者皆为热也自利小便色白少阴病形悉具与夫恶寒脉微自利清谷者皆有寒也夫自利固多可温然肠胃
有积结与下焦客邪又非温剂所能止必也或分利之或攻泄之乃可也(经曰理中者理中焦此利在下焦宜赤石脂禹余粮汤不瘥
当利其小便是也少阴病自利清水色纯青心下必痛口干燥与夫下利三部皆平按之心下硬或脉沉而滑或不欲食而谵语或瘥
后至年月复发此数者皆肠胃有积结而须攻泄者也此则谓之通因通用)又下利虽有表证不可发汗以下利为邪气内攻走津液
而胃虚也经曰下利不可攻表汗出必胀满是也盖三阴自利居多然自利家身凉脉静为顺身热脉大为逆大抵下利脱气最为难
治盖邪盛正虚邪壅正气下脱多下利而死(经曰少阴病自利复烦躁不得卧寐者死直视谵语下利者死下利日十余行脉反实者
死下利手足厥冷无脉灸之不温脉不还者死发热下利至甚厥不止者死此数者皆邪气壅正气下脱故死)要略曰六腑气绝于外
手足寒五脏气绝于内利下不禁噫疾成而后药虽神医莫能为气已脱矣孰能为之六经俱有下利之病表里寒热治各不同学人
宜审
太阳 伤寒(汗)表不解心下有水气干呕发热而咳或渴或利或噎或小便不利少腹满或喘者小青龙汤太阳(和解)与
阳明合病必自下利葛根汤(成 伤寒有合病有并病太阳病不解并于阳明者谓之并病三经俱受邪相合病者谓之合病合病者
邪气甚也太阳阳明合病者与太阳少阳合病阳明少阳合病皆言必自下利者以邪气并于阴则阴实而阳虚邪气并于阳则阳实
而阴虚寒邪气甚客于二阳二阳方外实而不主里则里气虚故必下利与葛根汤以散经中之邪其脉必浮而长也)太阳病外证未
除而数下之遂挟热而利利不止心下痞硬表里不解者桂枝人参汤(张 或云仲景论中太阳病桂枝证医反下之利遂不止与葛
根黄连黄芩汤上条又与桂枝人参汤且二证俱系表不解而下之成利者何故用药有温凉之异夫二证俱系内虚热入协热遂利
但脉证不同故用药有殊耳经言脉促者表未解也喘而汗出者葛根黄连黄芩汤主之夫脉促为阳盛喘而汗出为里热其阳盛里
热与葛根黄连黄芩者理所宜也)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(下利而头疼胸满或口苦咽
干或往来寒热其脉或大而弦是也)
黄芩汤方
黄芩(三两) 芍药 甘草(各二两) 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(虚
而不实者苦以坚之酸以收之黄芩芍药之苦酸以坚敛肠胃之气弱而不足者甘以补之甘草大枣之甘以补固肠胃之弱)
黄芩加半夏生姜汤
黄芩汤内加半夏半升(洗)生姜三两切
太阳少阳并病而反下之结于胸中成为结胸心下硬下利不止水浆不下其人心烦(生姜泻心汤大黄黄连泻心汤小陷胸汤
张凡合病皆下利各从外证以别焉夫太阳病头项痛腰脊强阳明病目痛鼻干不得卧少阳病胸胁痛耳聋凡遇两经阳证病齐
见而下利者曰合病也虽然但见一证便是不必悉具然仲景不言脉证止言太阳与少阳合病者以前章所论包含以上之证即此
理也况各经之证所见不一难为定论)太阳病桂枝证反下之利遂不止脉促者表未解也喘而汗出者葛根黄芩黄连汤
葛根黄芩黄连汤方
葛根(半斤) 甘草(炙) 黄芩(各二两) 黄连(三两)上四味以水八升先煮葛根减二升纳诸药煮取二升去滓
分温再服(内经曰辛甘发散为阳表未解者散以葛根甘草之甘苦以坚里气弱者坚以黄芩黄连之苦)
太阳病下之脉促不结胸者为欲解脉沉滑者协热利脉浮滑者必下血黄芩汤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黄芩汤伤寒中风反下之利遂不止谷不化腹中
雷鸣心下硬满干呕心烦不安医见其痞复下之痞益甚此非结热以胃中空虚客气上逆故使硬也甘草泻心汤伤寒汗解后胃中
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
时头痛心下痞硬引胁下痛干呕短气汗出不恶寒者此表解里未和也十枣汤伤寒发热汗出不解心下痞硬呕吐而下利者大柴
胡汤伤寒十三日不解过经谵语者以有热也当以汤下之若小便利者大盒饭硬而反下利脉调和者俗医以丸药下之非其治也
若自下利者脉当微厥今反和者此为内实也调胃承气汤太阳病二日反躁反熨其背而大汗出火热入胃水竭躁烦必发谵语十
余日振栗自下利者为欲解也伤寒医下之续得下利清谷不止身痛者急当救里四逆汤身痛清便自调者急当救表桂枝汤(成
伤寒下之续得下利清谷不止身痛急当救里以里气不足必先救之急与四逆汤得清便自调知里气已和然后急与桂枝汤以救
表身疼者表邪也内经曰病发而不足标而本之先治其标后治其本此以寒为本也)
四逆汤方
甘草(炙二两) 干姜(一两半) 附子(一枚去皮破八片一用附子去皮脐先将盐水姜汁各半盏用砂罐煮七沸后入
甘草黄连各半两再加童便半盏再煮七沸住火良久捞起入瓷器盛贮受地气一昼夜取出晒干以备后用庶无毒害顶圆修正一
两一枚者佳)上三味 咀以水三升煮取一升二合去滓分温再服强壮人可用大附子一枚干姜三两
成 四肢者诸阳之本阳气不足阴寒加之阳气不相顺接是致手足不温而成四逆此汤申发阳气走散阴寒温经暖肌故以
四逆名也内经曰寒淫于内治以甘热却阴扶阳必以甘为主是以甘草为君内经曰寒淫所胜平以辛热逐寒正气必先辛热是以
干姜为臣内经曰辛以润之开发腠理致津液通气也暖肌温经必凭大热是以附子为使此奇制之大剂也四逆属少阴少阴者肾
也肾肝位远非大剂不能达内经曰远而奇偶制大其服此之谓也
伤寒服汤药下利不止心下痞硬服泻心已复以他药下之利不止治以理中利益甚理中者理中焦此利在下焦赤石脂禹余
粮汤复利不止当利小便(或用猪苓汤)
赤石脂禹余粮汤方
赤石脂(一斤碎) 禹余粮(一斤碎)以上二味以水六升煮取二升去滓分三服
伤寒十三日不解胸胁满而呕日晡潮热已而微利此本柴胡证下之不利今反利者误以丸药下之也潮热者实也先宜柴胡
以解外后以柴胡加芒硝太阳病过经十余日心下温温欲吐胸中痛大便反溏腹微满郁郁微烦先时自极吐下者调胃承气汤
阳明 病潮热大便溏小便尚可胸胁满者小柴胡汤病患无表里证发热七八日虽脉浮数者可下下之脉数不解而下利不
止必便脓血也(黄芩汤柏皮汤)阳明少阳合病必下利其脉不负者顺也负者失也互相克贼名为负也脉滑而数者有宿食也当
下之宜大承气汤(成 阳明土少阳木二经合病气不相和则必下利少阳脉不胜阳明不负是不相克为顺也若少阳脉胜阳明脉
负者是鬼贼相克为正气失也脉经曰脉滑者为病食也又曰滑数则胃气实下利者脉当微厥今脉滑数知胃有宿食与大承气汤
以下除之)脏结如结胸状饮食如故时时下利寸脉浮关脉小细沉紧舌上白苔滑者难治
太阴 太阴为病腹满而吐食不下自利益甚时腹自痛若下之必胸下结硬自利不渴者属太阴以其脏有寒故也当温之宜
服四逆辈(张 经言辈字者谓药性同类惟轻重优劣不同耳凡太阴自利不渴师言有用理中而愈者甚则理中加附子而获安者
凡言辈者盖如此夫四逆汤甘辛相合乃大热之剂苟轻用之恐有过度之失所以仲景不为定拟也莫若以理中循循而用之至为
平稳如不得已者四逆方可为用也)太阴为病脉弱其人续自便利设当行芍药大黄者宜减之以其人胃气弱易动故也(成 腹
满痛者太阴病也脉弱其人续自便利则邪虽在里未成大实欲用大黄芍药攻除满痛者宜少与之以胃气尚弱易于动利也)伤寒
脉浮而缓手足自温者系在太阴当发身黄若小便自利者不发黄至七八日虽暴烦下利日十余行必自止以脾家实腐秽当去故
也(平胃散加穿山甲)
少阴 病欲吐不吐但欲寐五六日自利而渴者属少阴也虚故引水自救若小便色白者少阴病形悉具小便白者以下焦虚
有寒不能制水故令色白也(欲吐不吐心烦者表邪传里也若腹满痛则属太阴此但欲寐则知属少阴五六日邪传少阴之时也自
利不渴者寒在中焦属太阴此自利而渴寒在下焦属少阴按寒在下焦之说不通未闻寒在下焦而渴者小便色白下焦虚寒可知
惟其虚故藉外水以自救非热而作渴也故活人云四逆汤主之若小便不白而黄赤则不在此例故厥阴篇又曰下利欲饮水者以
有热故也白头翁汤主之)少阴病下利咽痛胸满心烦者猪肤汤
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之温分六服(猪水畜也其气先入肾少阴客热
是以猪肤解之加白蜜以润躁除烦白粉以益气断利)
少阴病四逆或泄利下重者四逆散(方见前条)少阴病下利六七日咳而呕渴心烦不得眠者猪苓汤(方见渴)少阴病自
利清水色纯青心下必痛口干燥者急下之宜大承气汤
孙 窦大郎患伤寒经十余日口燥舌干而渴心中疼自利清水众医皆知守但调理耳汗下皆所不敢窦氏亲故相谓曰伤寒
邪气害人性命甚速安可以不决之疾投不明之医乎召孙至曰即日不可下明日正当下投小承气汤遂大便通得睡明日平复众
皆曰此证缘何下之而愈孙曰不深于书徒知有书耳不知书之奥也口燥舌干而渴岂非少阴证乎少阴证固不可下岂不知少阴
一证自利清水心下痛者下之而愈仲景之书明有是说也众皆钦服
少阴病下利恶寒而蜷手足温者可治四逆汤少阴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(详腹
痛)
桃花汤方
赤石脂(一斤一半全用一半节末) 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(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)
少阴病二三日至四五日腹痛小便不利四肢沉重疼痛自下利者此为有水气其人或咳或小便利或下利或呕者真武汤主
之(详腹痛)
真武汤方
茯苓(三两) 生姜(切) 芍药(各三两) 白术(二两) 附子(一枚炮去皮破八片)上五味以水八升煮取三
升去滓温服七合日三服(脾恶湿甘先入脾茯苓白术之甘以益脾逐水寒淫所胜平以辛热湿淫所胜佐以酸平附子芍药生姜之
酸辛以温经散湿)
加减法 若咳者加五味子半升细辛干姜各一两(气逆咳者五味子之酸以收逆气水寒相搏则咳细辛干姜之辛以散水
寒)若小便利者去茯苓(小便利无伏水故去茯苓)若下利去芍药加干姜二两(芍药之酸泄气干姜之辛散寒)若呕者去附
子加生姜足前成半斤(气逆则呕附子补气生姜散气千金曰呕家多服生姜此为呕家圣药)
成 真武北方水神也水气在心下外带表而属阳必应发散故治以真武汤青龙汤主太阳病真武汤主少阴病少阴肾水也
此汤可以和之脾恶湿腹有水气则脾不治脾欲缓急食甘以缓之渗水缓脾以甘为主故以茯苓甘平为君白术甘温为臣内经曰
湿淫所胜佐以酸辛除湿正气是用芍药酸寒生姜辛湿为佐也内经曰寒淫所胜平以辛热温经散湿是以附子辛热为使也水气
内渍散行不一故有加减之方焉咳者水寒射肺也肺气逆者以酸收之五味子酸而收也肺恶寒以辛润之细辛干姜辛而润也若
小便利者去茯苓茯苓专渗泄也小便不利者去芍药以酸涩也加干姜以散寒也气上逆则呕附子补气故去之生姜散气故加之
则气顺呕(止矣)少阴病下利清谷里寒外热手足厥逆脉微欲绝身反不恶寒其人面赤色或腹痛或干呕或咽痛或利止脉不出
者通脉四逆汤主之
通脉四逆汤方(此方与四逆汤同但此倍干姜耳)
甘草(二两炙) 附子(大者一枚生用去皮破八片) 干姜(三两强者可用四两)上三味以水三升煮取一升二合去
滓分温再服其脉即出者愈面色赤者加葱九茎(葱味辛以通阳气)腹中痛者去葱加芍药二两(芍药之酸通寒利腹中痛为气
不通也)呕者加生姜二两(辛以散之呕为气不散也)咽痛者去芍药加桔梗一两(咽中如结加桔梗则能散之)利止脉不出
者去桔梗加人参二两(利止脉不出者亡血也加人参以补之经曰脉微而利亡血也四逆加人参主之脉病皆与方相应者乃可服
之)
少阴病下利白通汤主之(少阴主水少阴客寒不能制水故自利也白通汤温里散寒)少阴病下利脉微者与白通汤利不止
厥逆无脉干呕烦者白通加猪胆汁汤主之服汤后脉暴出者死微续者生(少阴病下利脉微为寒极阴胜与白通汤复阳散寒服汤
利不止厥逆无脉干呕烦者寒气太甚内为格拒阳气逆乱也与白通汤加猪胆汁汤以和之内经曰逆而从之从而逆之又曰逆者
正治从者反治此之谓也服汤脉暴出者正气因会泄而脱也故死脉微续者阳气渐复也故生)
白通汤方
Cheng Wuji's Commentary: Spontaneous diarrhea (Zili) refers to diarrhea that occurs on its own without the use of purgative treatment. Some cases involve exterior pathogenic factors transmitting inward, leading to interior deficiency and heat stagnation in the hypochondriac region, resulting in diarrhea; other cases occur when purgatives are incorrectly used when they should not be, causing diarrhea. These all belong to the category of hypochondriac heat (referring here to Shaoyang Gallbladder channel heat stagnation or related pathogenesis). Additionally, combined diseases of the three Yang channels (Taiyang, Yangming, and Shaoyang channels simultaneously affected by pathogens) will all present with spontaneous diarrhea, but the treatment methods differ: releasing the exterior through sweating, purging interior excess, or harmonizing the Shaoyang. (When Taiyang and Yangming combined diseases occur, the pathogen is at the exterior, so Gegen Tang is used to induce sweating and release the exterior; when Taiyang and Shaoyang combined diseases occur, the pathogen is at the half-exterior and half-interior, so Huangqin Tang is used to harmonize the Shaoyang; when Yangming and Shaoyang combined diseases occur, it is because Shaoyang pathogenic factors have entered the interior, so Chengqi Tang is used to purge interior excess.) Furthermore, spontaneous diarrhea accompanied by no thirst belongs to Taiyin disease, due to cold in the zang organs. Diarrhea accompanied by a desire to drink water is due to heat. Therefore, loose stools with normal urination, as well as fever, tenesmus (anal heaviness), and yellow-red excrement, all indicate heat syndromes. Spontaneous diarrhea with clear-white urine, presenting the complete picture of Shaoyin disease, as well as aversion to cold, faint pulse, and diarrhea with undigested food (complete grains), all indicate cold syndromes. Although spontaneous diarrhea is mostly treated with warming methods, if there are accumulations and knots in the intestines and stomach, or external pathogens in the lower jiao, simple warming tonification cannot stop it. One must employ methods to separate and drain dampness via urination, or purge and drain heat, to be effective. (The Classic states: Lizhong Tang regulates the middle jiao; this type of diarrhea is in the lower jiao and should be treated with Chishizhi Yuyuliang Tang. If it does not improve, one should promote urination. In Shaoyin disease, spontaneous diarrhea of clear water, pure green in color, with必 pain in the epigastrium and dry mouth, as well as patients with diarrhea having normal pulses in the cun, guan, and chi positions but hardness upon pressing the epigastrium, or sinking-slippery pulses, or anorexia with delirium, or recurrence after a period of recovery—these situations all indicate intestinal and gastric accumulation requiring purgation. This is called "treating obstruction with unblocking agents" (Tong Yin Tong Yong), i.e., using unblocking methods to treat diseases presenting with unblocking symptoms.) Moreover, even if diarrhea presents with exterior signs, sweating should not be induced, because diarrhea indicates pathogenic factors attacking inward, consuming body fluids, and causing stomach qi deficiency. The Classic states: Do not attack the exterior in diarrhea; if sweating induces perspiration, abdominal fullness will inevitably result. Generally, spontaneous diarrhea occurs frequently in the three Yin channels. However, in patients with spontaneous diarrhea, a cool body and calm pulse are favorable signs, while a hot body and large pulse are unfavorable signs. Generally speaking, diarrhea leading to the collapse of vital qi is the most difficult to treat. This is because pathogenic factors are abundant while healthy qi is deficient; pathogenic stagnation causes healthy qi to collapse downward, often leading to death from diarrhea. (The Classic states: In Shaoyin disease, spontaneous diarrhea accompanied by irritability and inability to lie down or sleep results in death; staring straight ahead, delirium, and diarrhea result in death; diarrhea occurring more than ten times a day with a surprisingly solid pulse results in death; diarrhea with cold limbs and absent pulse, where moxibustion fails to warm the limbs and the pulse does not return, results in death; fever with severe diarrhea and persistent cold limbs results in death. All these cases result in death due to pathogenic stagnation and downward collapse of healthy qi.) The Synopsis of Golden Chamber states: When the qi of the six fu organs collapses externally, it manifests as cold hands and feet; when the qi of the five zang organs collapses internally, it manifests as uncontrollable diarrhea. Medication administered only after the disease has formed is futile, even for a divine physician. Once the qi has collapsed, who can save it? All six channels have diseases involving diarrhea, with different treatments for exterior/interior and cold/heat patterns. Students should examine these carefully.
Taiyang Chapter:
Cold Damage (Sweating Method): Exterior syndrome unresolved, fluid retention in the heart region, dry retching, fever with cough, or thirst, or diarrhea, or choking sensation, or dysuria with lower abdominal fullness, or wheezing. Treat with Xiao Qinglong Tang.
Combined disease of Taiyang and Yangming,必定 spontaneous diarrhea. Treat with Gegen Tang. (Cheng Wuji notes: Cold damage includes combined diseases (Hebing) and concurrent diseases (Bingbing). When Taiyang syndrome is unresolved and merges into the Yangming channel, it is called Bingbing; when all three channels are affected by pathogens and combine to cause disease, it is called Hebing. Hebing implies severe pathogenic factors. In Taiyang-Yangming combined disease, as well as Taiyang-Shaoyang and Yangming-Shaoyang combined diseases, all state "must have spontaneous diarrhea" because pathogens merging into Yin channels lead to Yin excess and Yang deficiency; pathogens merging into Yang channels lead to Yang excess and Yin deficiency. Severe cold pathogenic factors lodge in the two Yang channels. Since the two Yang channels are externally solid and do not govern the interior, interior qi becomes deficient, hence spontaneous diarrhea. Gegen Tang is used to disperse pathogens in the meridians; the pulse will likely be floating and long.)
Taiyang syndrome, exterior signs unresolved, yet repeatedly purged, leading to diarrhea complicated by heat, unremitting diarrhea, epigastric痞 hard/fullness, with both exterior and interior signs unresolved. Treat with Guizhi Renshen Tang. (Zhang Yuansu notes: Some say in Zhang Zhongjing's Treatise on Cold Damage, Taiyang Guizhi syndrome was incorrectly purged, causing unremitting diarrhea, which should be treated with Gegen Huanglian Huangqin Tang; the previous clause mentions Guizhi Renshen Tang. Both syndromes involve unresolved exterior and diarrhea caused by incorrect purging, yet the medications differ in temperature. Both involve interior deficiency with heat sinking and協 heat diarrhea, but the pulse and signs differ, hence the difference in medication. The Classic states: A rapid pulse indicates unresolved exterior; wheezing with sweating is treated with Gegen Huanglian Huangqin Tang. A rapid pulse indicates abundant yang; wheezing with sweating indicates interior heat. Abundant yang and interior heat warrant Gegen Huanglian Huangqin Tang.)
Combined disease of Taiyang and Shaoyang, with spontaneous diarrhea. Treat with Huangqin Tang. If vomiting occurs, treat with Huangqin Jia Banxia Shengjiang Tang. (Diarrhea with headache, chest fullness, bitter taste, dry throat, alternating chills and fever, with large or wiry pulses.)
Huangqin Tang Formula:
Huangqin (3 liang), Shaoyao, Gancao (each 2 liang), Dazao (12 pieces, split). The above four ingredients are boiled in 1 dou of water to obtain 3 sheng. Strain and take 1 sheng warm, twice daily and once at night. (For weak and deficient constitutions, bitter herbs solidify and astringents collect; the bitterness and sourness of Huangqin and Shaoyao solidify and collect the qi of the intestines and stomach. For weak and insufficient gastrointestinal function, sweet herbs tonify; the sweetness of Gancao and Dazao tonifies and consolidates gastrointestinal weakness.)
Huangqin Jia Banxia Shengjiang Tang:
Add Banxia (0.5 sheng, washed) and Shengjiang (3 liang, sliced) to Huangqin Tang.
Concurrent disease of Taiyang and Shaoyang, incorrectly purged, leading to pathogenic knotting in the chest, forming Jiechest (Chest Binding) syndrome, epigastric hardness, unremitting diarrhea, inability to swallow liquids, and mental restlessness. (Can use Shengjiang Xiexin Tang, Dahuang Huanglian Xiexin Tang, or Xiaoxianzhong Tang. Zhang Yuansu notes: All combined diseases involve diarrhea, distinguished by exterior signs. Taiyang disease presents with headache in the head and neck and stiffness in the waist and spine; Yangming disease presents with eye pain, nasal dryness, and insomnia; Shaoyang disease presents with hypochondriac pain and deafness. Whenever two Yang channel syndromes appear simultaneously with diarrhea, it is called combined disease. Although seeing one sign is sufficient for diagnosis, Zhang Zhongjing only mentions Taiyang and Shaoyang combined disease because the previous chapter encompasses these signs. Moreover, signs vary by channel, making fixed conclusions difficult.)
Taiyang syndrome, Guizhi syndrome, incorrectly purged, leading to unremitting diarrhea with a rapid pulse, indicating unresolved exterior; wheezing with sweating is treated with Gegen Huangqin Huanglian Tang.
Gegen Huangqin Huanglian Tang Formula:
Gegen (0.5 jin), Gancao (roasted), Huangqin (each 2 liang), Huanglian (3 liang). The above four ingredients are boiled in 8 sheng of water. First boil Gegen, reducing the water by 2 sheng, then add other herbs, boil to obtain 2 sheng. Strain and divide into two warm doses. (The Inner Canon states: Pungent and sweet disperse yang. For unresolved exterior, use the sweetness of Gegen and Gancao to disperse; for weak interior qi, use the bitterness of Huangqin and Huanglian to solidify.)
After purging Taiyang syndrome, a rapid pulse without Jiechest indicates the condition is resolving; a sinking-slippery pulse indicates協 heat diarrhea; a floating-slippery pulse indicates必定 hematochezia. Use Huangqin Tang.
Taiyang syndrome, persisting for two to three days, inability to lie down, desire to sit up, epigastric binding, weak pulse, indicates pre-existing cold-damp separation. Incorrect purging leads to either cessation of diarrhea (resulting in Jiechest) or continued diarrhea (leading to協 heat diarrhea on the fourth day if purged again). Use Huangqin Tang.
Cold damage wind-strike, incorrectly purged, leading to unremitting diarrhea, undigested food, borborygmus, epigastric hardness/fullness, dry retching, mental restlessness. The physician sees痞 and purges again, worsening the痞. This is not heat binding but empty stomach with rebellious guest qi causing hardness. Use Gancao Xiexin Tang.
After sweating resolves cold damage, stomach disharmony, epigastric痞 hard, dry belching with food odor, fluid retention in hypochondrium, borborygmus, and diarrhea. Use Shengjiang Xiexin Tang.
Taiyang wind-strike with diarrhea and vomiting/reversal. If exterior is resolved, internal attack is permissible. Frequent sweating, intermittent headaches, epigastric痞 hard, pain radiating to hypochondrium, dry retching, shortness of breath, sweating without aversion to cold. This indicates resolved exterior and unharmonized interior. Use Shizao Tang.
Cold damage fever, sweating without resolution, epigastric痞 hard, vomiting, and diarrhea. Use Da Chaihu Tang.
Cold damage unresolved for thirteen days, passing through stages, with delirium due to heat. Should be treated with decoction for purging. If urination is free, stool should be hard; if diarrhea occurs with a harmonious pulse, it is due to vulgar physicians using pill purgatives, which is incorrect treatment. Natural diarrhea should present with faint/cold pulse; a harmonious pulse indicates internal excess. Use Tiaowei Chengqi Tang.
Taiyang disease, second day, unexpected irritability, abnormal back fanning causing profuse sweating, fire-heat entering stomach, fluid exhaustion, irritability,必定 delirium. After ten-plus days, shaking chills and spontaneous diarrhea indicate resolution.
Cold damage, physician purges, leading to unremitting diarrhea with undigested food and body pain. Urgently rescue the interior with Sini Tang. If body pain persists but bowel/bladder functions are normal, urgently rescue the exterior with Guizhi Tang. (Cheng Wuji notes: After purging, unremitting diarrhea with undigested food and body pain requires urgent interior rescue due to interior qi deficiency. Give Sini Tang urgently. Once bowel/bladder normalize, knowing interior qi is harmonized, give Guizhi Tang urgently to rescue the exterior. Body pain is exterior pathogen. The Inner Canon states: When disease begins with deficiency, treat the branch first, then the root. Here, cold is the root.)
Sini Tang Formula:
Gancao (roasted, 2 liang), Ganjiang (1.5 liang), Fuzi (1 piece, peeled, broken into 8 pieces. Alternative method: Peel Fuzi, remove navel, boil half cup salt water and ginger juice in clay pot for seven boils, add Gancao and Huanglian (0.5 liang each), add child's urine (0.5 cup), boil seven more boils, let stand, remove, store in porcelain vessel exposed to earth qi for one day, dry for later use to avoid toxicity. Best to use round, correct 1-liang pieces). The above three ingredients are crushed, boiled in 3 sheng of water to obtain 1.2 sheng. Strain and divide into two warm doses. Robust individuals may use 1 large Fuzi and 3 liang Ganjiang.
Cheng Wuji notes: The four limbs are the root of all yang. Insufficient yang qi, exacerbated by yin-cold, leads to failure of yang qi connection, causing cold limbs (Sini). This decoction promotes yang qi, disperses yin-cold, warms meridians and muscles, hence named Sini Tang. The Inner Canon states: Treat internal cold with pungent-hot herbs, dispel yin, support yang, primarily using sweet herbs. Thus, Gancao is the sovereign herb. The Inner Canon states: To counteract winning cold, use pungent-hot herbs to drive out cold; healthy qi relies on pungent-hot herbs. Thus, Ganjiang is the minister herb. The Inner Canon states: Pungent moistens, opens pores, generates fluids, circulates qi. Warming muscles and meridians requires great heat. Thus, Fuzi is the envoy herb. This is a unique large-dose formula. Sini Tang belongs to Shaoyin disease; Shaoyin is Kidney. Liver and Kidney are distant; large doses are needed to reach them. The Inner Canon states: For distant diseases, use odd/even combinations and increase dosage.
After taking decoctions for cold damage, unremitting diarrhea and epigastric痞 hard persist despite Xiexin Tang, and further purging worsens diarrhea. Lizhong Tang treats middle jiao, but this diarrhea is in the lower jiao; use Chishizhi Yuyuliang Tang. If diarrhea continues, promote urination (or use Zhuling Tang).
Chishizhi Yuyuliang Tang Formula:
Chishizhi (1 jin, crushed), Yuyuliang (1 jin, crushed). The above two ingredients are boiled in 6 sheng of water to obtain 2 sheng. Strain and divide into three doses.
Cold damage unresolved for thirteen days, chest/hypochondriac fullness with vomiting, afternoon tidal fever, followed by mild diarrhea. This was originally a Chaihu syndrome; incorrect purging caused diarrhea. Now, relapse of diarrhea is due to incorrect use of pill purgatives. Tidal fever indicates excess. First use Chaihu Tang to resolve the exterior, then Chaihu Jia Mangxiao Tang.
Taiyang disease, over ten days past the stage, epigastric warmth with urge to vomit, chest pain, loose stool, mild abdominal fullness, slight vexation. Previous aggressive vomiting/purging warrants Tiaowei Chengqi Tang.
Yangming Chapter:
Disease with tidal fever, loose stool, normal urination, hypochondriac fullness. Use Xiaochaihu Tang.
Patient with no exterior/interior signs, fever for 7-8 days, floating-rapid pulse, can be purged. Post-purge, rapid pulse persists, unremitting diarrhea,必定 pus/blood in stool. Use Huangqin Tang, Bopi Tang.
Combined disease of Yangming and Shaoyang,必定 diarrhea. Non-defeating pulse (Shaoyang pulse does not overcome Yangming) is favorable; defeating pulse is unfavorable. Mutual overcoming is called defeating. Slippery-rapid pulse indicates retained food, should be purged with Dachengqi Tang. (Cheng Wuji notes: Yangming is Earth, Shaoyang is Wood. Combined disease, qi disharmony leads to diarrhea. Shaoyang pulse not overcoming Yangming is non-overcoming/favorable. Shaoyang overcoming Yangming is defeating/unfavorable. Pulse Classic states: Slippery pulse indicates food disease. Slippery-rapid indicates strong stomach qi. Diarrhea should have faint/cold pulse; slippery-rapid indicates retained food. Give Dachengqi Tang to purge.)
Zangjie (Organ Binding) resembles Jiechest, normal diet, frequent diarrhea, floating cun pulse, small-fine-sinking-tight guan pulse, white slippery tongue coating. Difficult to treat.
Taiyin Chapter:
Taiyin disease, abdominal fullness with vomiting, inability to eat, worsening spontaneous diarrhea, periodic abdominal pain. Incorrect purging leads to epigastric binding. Spontaneous diarrhea without thirst belongs to Taiyin due to organ cold; treat with warming, suitable for Si Ni Bei (Zhang Yuansu notes: "Bei" means similar properties, varying in strength/quality. Taiyin spontaneous diarrhea without thirst is treated with Lizhong Tang, or Lizhong Tang plus Fuzi for severe cases. Si Ni Tang is very hot; cautious use is advised. Lizhong Tang is safer. Si Ni Tang is for desperate cases.). Taiyin disease, weak pulse, continuous loose stools. If Shaoyao/Dahuang were indicated, reduce dosage due to weak stomach qi prone to moving stool. (Cheng Wuji notes: Abdominal fullness/pain is Taiyin. Weak pulse and continuous loose stools mean pathogen is interior but not severe excess. If using Dahuang/Shaoyao to purge, use small amounts as stomach qi is weak and prone to diarrhea.) Cold damage, floating-slow pulse, warm hands/feet, relates to Taiyin. Jaundice expected; if urination is free, no jaundice. By day 7-8, sudden irritability and >10 diarrheas will self-resolve as spleen qi recovers and rotting filth is expelled. (Use Pingwei San plus Chuan Shan Jia).
Shaoyin Chapter:
Desire to vomit without vomiting, drowsiness, spontaneous diarrhea with thirst after 5-6 days belongs to Shaoyin. Deficiency draws water for self-rescue. White urine indicates complete Shaoyin syndrome; white urine is due to lower jiao deficiency-cold failing to control water. (Desire to vomit/vexation is exterior transmitting inward. Abdominal pain/fullness is Taiyin. Drowsiness indicates Shaoyin. Day 5-6 is transmission time. Diarrhea without thirst is middle jiao cold/Taiyin. Diarrhea with thirst is lower jiao cold/Shaoyin. Note: "Cold in lower jiao causing thirst" is logically flawed; cold doesn't cause thirst. White urine confirms lower jiao deficiency-cold. Water is drawn externally due to deficiency, not heat. Huoren Shu says treat with Sini Tang. If urine is yellow-red, see Jueyin chapter: Diarrhea with desire to drink water is heat, treat with Baitouweng Tang.) Shaoyin disease, diarrhea, sore throat, chest fullness, vexation. Use Zhufu Tang.
Zhufu Tang Formula:
Zhufu (1 jin). Boil in 1 dou of water to obtain 5 sheng. Strain, add Baimi (1 sheng) and Baifen/Rice Flour (0.5 he), cook until fragrant, mix, divide into six warm doses. (Pig is water animal, qi enters Kidney. Shaoyin guest heat is resolved by Zhufu. Baimi moistens/dispels vexation; Baifen boosts qi/stops diarrhea.)
Shaoyin disease, cold limbs or heavy diarrhea. Use Sini San (see previous).
Shaoyin disease, diarrhea for 6-7 days, cough, vomiting, thirst, vexation, insomnia. Use Zhuling Tang (see thirst section).
Shaoyin disease, spontaneous clear green water diarrhea, epigastric pain, dry mouth. Urgently purge with Dachengqi Tang.
Sun Simiao Case: Dou Dalang had cold damage for 10+ days, dry mouth/tongue/thirst, heart pain, clear green water diarrhea. Physicians advised conservative care, fearing sweating/purging. Relatives summoned Sun Simiao. Sun said: "Cannot purge today, must purge tomorrow." Gave Xiao Chengqi Tang. Bowels opened, patient slept. Recovered next day. Asked why purging worked, Sun said: "Superficial knowledge misses the essence. Dry mouth/thirst is Shaoyin syndrome. Though Shaoyin usually forbids purging, Zhang Zhongjing explicitly states Shaoyin clear water diarrhea with heart pain is cured by purging." All admired.
Shaoyin disease, diarrhea, aversion to cold, curling up, warm hands/feet. Treatable with Sini Tang.
Shaoyin disease, days 2-4, abdominal pain, dysuria, unremitting bloody/pus diarrhea. Treat with Taohua Tang (see abdominal pain).
Taohua Tang Formula:
Chishizhi (1 jin, half whole, half powder), Ganjiang (1 liang), Jingmi (1 sheng). Boil in 7 sheng water until rice is cooked. Strain, take 0.7 sheng warm, add 1 cubic inch of Chishizhi powder, three times daily. Stop if cured. (Astringency removes collapse; Chishizhi secures intestines. Pungency disperses; Ganjiang disperses interior cold. Sweetness tonifies; Jingmi supports healthy qi.)
Shaoyin disease, days 2-4, abdominal pain, dysuria, heavy limbs, diarrhea, indicates water qi. Cough, free urination, diarrhea, or vomiting variants. Treat with Zhenwu Tang (see abdominal pain).
Zhenwu Tang Formula:
Fuling (3 liang), Shengjiang (sliced), Shaoyao (each 3 liang), Baizhu (2 liang), Fuzi (1 piece, roasted, peeled, broken). Boil in 8 sheng water to obtain 3 sheng. Strain, take 0.7 sheng warm, three times daily. (Spleen dislikes dampness; sweet enters spleen. Fuling/Baizhu tonify spleen/drive water. Cold/wind dampness treated with pungent-hot/sour-flat. Fuzo/Shao Yao/Sheng Jiang warm meridians/disperse damp.)
Modifications: If cough, add Wuweizi (0.5 sheng), Xixin, Ganjiang (each 1 liang) to astringe lung qi and disperse cold-water. If urination free, remove Fuling (no retained water). If diarrhea, remove Shaoyao, add Ganjiang (2 liang) as Shaoyao drains qi and Ganjiang disperses cold. If vomiting, remove Fuzi, add Shengjiang (to 0.5 jin) as Fuzi tonifies qi (bad for rebellion) and Shengjiang disperses qi (stops vomiting).
Cheng Wuji notes: Zhenwu is Northern Water God. Water qi in heart region/exterior yang requires dispersion, hence Zhenwu Tang for Shaoyin (Kidney Water). Spleen dislikes dampness; water in abdomen impairs spleen. Spleen desires relaxation, sweet foods relax. Sweet herbs (Fuling/Baizhu) drain water/relax spleen. Sour-flat (Shaoyao/Sheng Jiang) assist in draining damp. Pungent-hot (Fuzi) warms meridians. Variations exist due to water qi distribution. Cough is cold-water attacking lung; astringe with Wuweizi. Lung dislikes cold; moisten with Xixin/Ganjiang. Free urination removes Fuling. Dysuria removes Shaoyao (astringent) adds Ganjiang (disperses cold). Vomiting removes Fuzi (tonifies) adds Shengjiang (disperses).
Shaoyin disease, diarrhea with undigested food, interior cold/exterior heat, cold limbs, faint/almost absent pulse, no aversion to cold, red face, abdominal pain, dry retching, sore throat, or cessation of diarrhea with absent pulse. Treat with Tongmai Sini Tang.
Tongmai Sini Tang Formula (Same as Sini Tang but double Ganjiang):
Gancao (roasted, 2 liang), Fuzi (1 large, raw, peeled, broken), Ganjiang (3 liang, 4 liang for robust). Boil in 3 sheng water to obtain 1.2 sheng. Strain, divide into two warm doses. Pulse returning indicates cure. Red face: add Congbai (9 stems) to unblock yang. Abdominal pain: remove Congbai, add Shaoyao (2 liang) to unblock qi. Vomiting: add Shengjiang (2 liang) to disperse qi. Sore throat: remove Shaoyao, add Jiegeng (1 liang) to scatter knot. Cessation of diarrhea/absent pulse: remove Jiegeng, add Renshen (2 liang) to tonify blood/qi. (Classic: Faint pulse with diarrhea indicates blood loss; Sini Jia Renshen Tang treats this. Match pulse/symptoms to formula.)
Shaoyin disease, diarrhea. Baitong Tang treats (Shaoyin governs water; guest cold fails to control water, causing diarrhea. Baitong Tang warms interior/disperses cold).
Shaoyin disease, diarrhea, faint pulse, given Baitong Tang. If diarrhea continues, cold limbs, absent pulse, dry retching, vexation. Baotong Jia Zhu Danji Tang treats. Post-medication, sudden pulse emergence indicates death; gradual pulse return indicates life. (Faint pulse indicates extreme cold/yin excess. Baitong Tang restores yang. Continued symptoms indicate severe cold rejection/rebellion. Baotong Jia Zhu Danji Tang harmonizes. Inner Canon: Reverse treatment vs. Follow treatment. Sudden pulse is healthy qi collapsing; death. Gradual pulse is yang recovering; life.)
Baitong Tang Formula