太阳病下之。其脉促。不结胸者。此为欲解也。脉浮者。必结胸也。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
。
此因结胸。而并详太阳误下诸变。谓脉促为阳盛。而不结于胸。则必无下利痞满之变。其邪
将从外解。若脉浮者。下后邪已入里。而犹在阳分。则必作结胸矣。脉紧者。太阳之邪传入少阴
之络。故必咽痛。所为脉紧者属少阴。又邪客于足少阴之络。令人咽痛。不可内食是也。脉弦者。
太阳之邪传入少阳之经。故必两胁拘急。所为尺寸俱弦者。少阳受病。其脉循胁络于耳故也。脉细为气少。数为阳脉
。气不足而阳有余。乃邪盛于上也。故头痛未止。脉沉为在里。紧为寒脉。邪入里而正不容。则内
为格拒。故必欲呕。脉沉滑者。热胜而在下也。故协热利。脉浮滑者。阳胜而阴伤也。故必下血。
经曰、不宜下而更攻之。诸变
不可胜数。此之谓也。以下并太阳下后之证。而或胸满。或喘。或烦惊谵语。或胁痛发黄。是结
胸、痞满、烦躁、下利外。尚有种种诸变如此。
太阳病。下之后。脉促胸满者。桂枝去芍药汤主之。若微恶寒者。去芍药方中加附子汤主之。
阳邪被抑。不复浮盛于表。亦未结聚于里。故其胸满、其脉促。促者。数而时一止也。夫促为
阳脉。胸中为阳之府。脉促胸满。则虽误下。而邪气仍在阳分。故以桂、甘、姜、枣甘辛温药。从
阳引而去之。去芍药者。恐酸寒气味。足以留胸中之邪。且夺桂枝之性也。若微恶寒者。其人阳
不足。必加附子。以助阳气而逐阳邪。设徒与前法。则药不及病。虽病不增剧。亦必无济矣。
桂枝去芍药汤方
于桂枝汤内去芍药。余根据前法。
桂枝去芍药加附子汤方
于桂枝汤方内去芍药。加附子一枚。炮。去皮。破八片。余根据前法。
太阳病。下之。微喘者。表未解故也。桂枝加浓朴杏仁汤主之。喘家作桂枝汤。加浓朴、杏仁佳
。
太阳误下。无结胸下利诸变。而但微喘。知其里未受病。而其表犹未解。胸中之气。为之不利
也。故与桂枝汤解表散邪。加浓朴、杏仁下气定喘。然喘之为病。所关非细。而误下之后。其变实多
。仲景此条。盖可以互证。而难以独引。亦如太阳病。脉浮者。可发汗。宜麻黄汤之文也。学人辨诸。
太阳病。下之后。其气上冲者。可与桂枝汤。方用前法。若不上冲者。不可与之。
病在太阳。而反下之。正气遂虚。邪气则陷。乃其气反上冲者。阳邪被抑而复扬。仍欲出而
之表也。故可与桂枝汤。从阳引而去之。因其轻而扬之之意也。用前法者。即啜热稀粥。以助药力
之法。盖欲以救被伤之气。而引欲出之邪耳。若不上冲者。邪已内陷。不复外攻。当随脉证而调其
内。不可更以桂枝攻其表也。
伤寒八九日。下之。胸满烦惊。小便不利。谵语。一身尽重。不可转侧者。柴胡加龙骨牡蛎
汤主之。
伤寒下后。其邪有并归一处者。如结胸下利诸候是也。有散漫一身者。如此条所云诸证是
也。胸满者。邪痹于上。小便不利者。邪痹于下。烦惊者。邪动于心。谵语者。邪结于胃。此病之
在里者也。一身尽重。不可转侧者。筋脉骨肉。并受其邪。此病之在表者也。夫合表里上下而为病
者。必兼阴阳合散以为治。方用柴胡、桂枝。以解其外而除身重。龙、蛎、铅丹。以镇其内而止
烦惊。大黄以和胃气止谵语。茯苓以泄膀胱利小便。人参、姜、枣。益气养营卫。以为驱除邪气
之本也。如是表里虚实。泛应曲当而错杂之邪。庶几尽解耳。
柴胡加龙骨牡蛎汤方
半夏（二合洗） 柴胡（四两） 人参 龙骨 铅丹 牡蛎（熬） 茯苓 桂枝 生姜（各
一两半） 大枣（六枚）
大黄（二两）
上十一味。以水八升。煮取四升。纳大黄。切如棋子。更煮一二沸。去滓。温服一升。
得病六七日。脉迟浮弱。恶风寒。手足温。医二三下之。不能食。而胁下满痛。面目及身黄。颈
项强。小便难者。与柴胡汤。后必下重。本渴而饮水呕者。柴胡汤不中与也。食谷者哕。
病六七日。脉浮不去。恶风寒不除。其邪犹在表也。医反二三下之。胃气重伤。邪气入里。
则不能食而胁下满痛。且面目及身黄。颈项强。小便难。所以然者。其人脉迟弱而不数。手足温而
不热。为太阴本自有湿。而热又入之。相得不解。交蒸互郁。而面目身体悉黄矣。颈项强者。湿痹于
上也。胁下满痛者。湿聚于中也。小便难者。湿不下走也。皆与热相得之故也。医以其胁下满痛。
与柴胡汤以解其邪。后必下重者。邪外解而湿下行。将欲作利也。设热湿并除。则汗液俱通而愈矣
。何至下重哉。本渴而饮水呕者。金匮所谓先渴却呕者。为水停心下。此属饮家也。饮在心下。则
食谷必哕。所谓诸呕吐。谷不得下者。小半夏汤主之是也。岂小柴胡所能治哉。
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。
下后成痞。与泻心汤。于法为当矣。乃痞不解。而其人口燥烦渴。小便不利者。此非痞也。
乃热邪与水蓄而不行也。水蓄不行。则土失其润而口燥烦渴。下迷其道而小便不利。泻心汤不中
与矣。五苓散散水泄热。使小便利。则痞与烦渴俱止耳。
下后。不可更行桂枝汤。汗出而喘。无大热者。可与麻黄杏仁甘草石膏汤。
此与汗后不可更行桂枝汤条大同。虽汗下不同。其为邪入肺中则一。故其治亦同。
Taiyang disease (disease of the Taiyang/Bladder channel) treated with purgation. If the pulse is rapid and intermittent (Cui Mai, 促脉), and there is no Jie Xiong (chest binding/knotting), this indicates that the condition is about to resolve. If the pulse is floating (Fu Mai, 浮脉), Jie Xiong will definitely occur. If the pulse is tight (Jin Mai, 紧脉), throat pain will definitely occur. If the pulse is wiry (Xian Mai, 弦脉), bilateral hypochondriac stiffness and urgency will definitely occur. If the pulse is fine and rapid (Xi Shu Mai, 细数脉), headache will not cease. If the pulse is deep and tight (Chen Jin Mai, 沉紧脉), vomiting will definitely be desired. If the pulse is deep and slippery (Chen Hua Mai, 沉滑脉), Xie Re Li (diarrhea with heat) will occur. If the pulse is floating and slippery (Fu Hua Mai, 浮滑脉), hematochezia (blood in stool) will definitely occur.
This discusses various transformations following erroneous purgation in Taiyang disease, using Jie Xiong as a reference. A Cui pulse indicates excess Yang; if it does not bind in the chest, there will be no transformation into diarrhea or Pi Man (fullness and obstruction). The pathogenic factor will likely resolve from the exterior. If the pulse is floating, it means after purgation the pathogen has entered the interior but remains in the Yang aspect, leading to Jie Xiong. A Jin (tight) pulse indicates Taiyang pathogen transmitting to the Luo vessels of Shaoyin (Kidney channel); thus, throat pain occurs. This aligns with "a tight pulse belongs to Shaoyin" and the concept that pathogen lodging in the foot-Shaoyin Luo vessels causes throat pain and inability to eat. A Xian (wiry) pulse indicates Taiyang pathogen transmitting to the Jing vessels of Shaoyang (Gallbladder channel); thus, bilateral hypochondriac stiffness occurs. This corresponds to "wiry pulses at both cun and chi indicate Shaoyang disease," as the Shaoyyang channel traverses the hypochondrium and connects to the ears. A Xi (fine) pulse indicates Qi deficiency; Shu (rapid) is a Yang pulse. Qi insufficiency with Yang excess implies pathogen excess in the upper body, causing persistent headache. A Chen (deep) pulse indicates interior location; Jin (tight) is a Cold pulse. Pathogen entering the interior while Zheng Qi (healthy Qi) resists leads to internal rejection, causing desire to vomit. A Chen Hua (deep and slippery) pulse indicates Heat excess in the lower body, causing Xie Re Li. A Fu Hua (floating and slippery) pulse indicates Yang excess injuring Yin, causing hematochezia.
The classic states: "Purgation should not be used, yet it was applied; the resulting transformations are countless." This refers to the above. The following are syndromes after erroneous purgation in Taiyang disease: some present with chest fullness, some with wheezing, some with restlessness, fright, and delirious speech, some with hypochondriac pain and jaundice. Beyond Jie Xiong, Pi Man, irritability, and diarrhea, there are numerous such variations.
In Taiyang disease, after purgation, if the pulse is Cui and there is chest fullness, Gui Zhi Qu Shao Yao Tang (Cinnamon Twig Decoction without Paeonia) is the primary treatment. If there is slight aversion to cold, Gui Zhi Qu Shao Yao Jia Fu Zi Tang (Cinnamon Twig Decoction without Paeonia plus Aconite) is used.
Yang pathogen is suppressed, neither floating excessively on the exterior nor binding in the interior, hence chest fullness and Cui pulse. Cui pulse is rapid with occasional pauses. It is a Yang pulse; the chest is the mansion of Yang. With Cui pulse and chest fullness, despite erroneous purgation, the pathogen remains in the Yang aspect. Therefore, Gan Xin Wen (sweet, acrid, warm) herbs like Gui Zhi (Ramulus Cinnamomi), Gan Cao (Radix Glycyrrhizae), Sheng Jiang (Rhizoma Zingiberis Recens), and Da Zao (Fructus Jujubae) are used to guide the pathogen out from the Yang aspect. Shao Yao (Radix Paeoniae Alba) is removed because its sour-cold nature may retain pathogen in the chest and counteract Gui Zhi. Slight aversion to cold indicates Yang insufficiency; Fu Zi (Radix Aconiti Lateralis Preparata) must be added to assist Yang Qi and expel Yang pathogen. Using only the previous method would result in insufficient medicinal strength; although the disease might not worsen, it would certainly not benefit.
Gui Zhi Qu Shao Yao Tang Formula
Remove Shao Yao from Gui Zhi Tang. Prepare according to previous methods.
Gui Zhi Qu Shao Yao Jia Fu Zi Tang Formula
Remove Shao Yao from Gui Zhi Tang formula, add one Fu Zi (processed, peeled, broken into eight pieces). Prepare according to previous methods.
In Taiyang disease, after purgation, if there is slight wheezing, it is because the exterior syndrome has not resolved. Gui Zhi Jia Hou Po Xing Ren Tang (Cinnamon Twig Decoction plus Magnolia Bark and Apricot Kernel) is the primary treatment. For patients with chronic asthma, adding Hou Po (Cortex Magnoliae Officinalis) and Xing Ren (Semen Pruni Armeniacae) to Gui Zhi Tang is effective.
Erroneous purgation in Taiyang disease results in no Jie Xiong or diarrhea, only slight wheezing. This indicates the interior is unaffected, but the exterior remains unresolved, causing stagnation of Qi in the chest. Thus, Gui Zhi Tang is given to release the exterior and disperse pathogen, plus Hou Po and Xing Ren to direct Qi downward and calm wheezing. Asthma is a serious condition, and transformations after purgation are numerous. Zhang Zhongjing's clause here serves for mutual verification but cannot be cited alone, similar to the text stating "Taiyang disease with floating pulse can be treated with sweating,适宜 Ma Huang Tang." Scholars must distinguish carefully.
In Taiyang disease, after purgation, if Qi rushes upward, Gui Zhi Tang can be administered, using the previous method. If Qi does not rush upward, do not administer it.
When disease is in Taiyang, purgation was wrongly applied, causing Zheng Qi to become deficient and pathogen to sink. If Qi rushes upward, it means the Yang pathogen, though suppressed, rises again, attempting to return to the exterior. Thus, Gui Zhi Tang is given to guide the pathogen out from the Yang aspect, following the principle of "using light substances to scatter." "Using the previous method" refers to drinking hot rice gruel to aid medicinal power, aiming to rescue damaged Qi and guide the pathogen seeking exit. If Qi does not rush upward, the pathogen has sunk internally and no longer attacks outward. One should regulate the interior based on pulse and symptoms, not use Gui Zhi Tang to attack the exterior.
After eight or nine days of Shang Han (cold damage), erroneous purgation leads to chest fullness, restlessness, fright, difficulty urinating, delirious speech, whole-body heaviness, and inability to turn over. Chai Hu Jia Long Gu Mu Li Tang (Bupleurum Decoction plus Dragon Bone and Oyster Shell) is the primary treatment.
After purgation in Shang Han, pathogens may converge in one area (e.g., Jie Xiong, diarrhea) or scatter throughout the body (as in this case). Chest fullness indicates pathogen blocking the upper body; difficulty urinating indicates pathogen blocking the lower body. Restlessness and fright indicate pathogen disturbing the Heart; delirium indicates pathogen binding in the Stomach. These are interior manifestations. Whole-body heaviness and inability to turn over indicate sinews, vessels, flesh, and bones all affected by pathogen; these are exterior manifestations. Diseases involving both exterior and interior, upper and lower, require treating Yin and Yang together. The formula uses Chai Hu (Radix Bupleuri) and Gui Zhi to resolve the exterior and remove heaviness; Long Gu (Os Draconis), Mu Li (Concha Ostreae), and Qian Dan (Lithargyrum) to settle the interior and stop fright; Da Huang (Radix et Rhizoma Rhei) to harmonize Stomach Qi and stop delirium; Fu Ling (Poria) to drain Bladder water and promote urination; Ren Shen (Radix Ginseng), Sheng Jiang, and Da Zao to tonify Qi and nourish Ying and Wei (Nutritive and Defensive Qi) as the root for expelling pathogen. In this way, complex pathogens affecting exterior, interior, deficiency, and excess can be comprehensively resolved.
Chai Hu Jia Long Gu Mu Li Tang Formula
Ban Xia (2 he, washed), Chai Hu (4 liang), Ren Shen, Long Gu, Qian Dan, Mu Li (calcined), Fu Ling, Gui Zhi, Sheng Jiang (each 1.5 liang), Da Zao (6 pieces), Da Huang (2 liang).
These eleven ingredients are boiled in 8 sheng of water to obtain 4 sheng. Add Da Huang, cut into chess-piece sizes, boil for one or two more boils. Strain. Warm dose: 1 sheng.
After six or seven days of illness, with slow, floating, weak pulse, aversion to wind and cold, and warm hands and feet, if the physician purges two or three times, leading to inability to eat, hypochondriac fullness and pain, yellow complexion and body, stiff neck, and difficult urination, administering Chai Hu Tang will later cause a sensation of heaviness in the rectum. If originally thirsty but vomiting after drinking water, Chai Hu Tang is contraindicated; eating grain will cause hiccups.
Illness persists for six or seven days, floating pulse remains, aversion to wind and cold persists, indicating pathogen still in the exterior. The physician erroneously purges two or three times, severely damaging Stomach Qi and allowing pathogen to enter the interior. This causes inability to eat and hypochondriac fullness/pain. Yellow complexion/body, stiff neck, and difficult urination occur because the pulse is slow/weak (not rapid), and hands/feet are warm (not hot). This indicates inherent Dampness in Taiyin (Spleen) combined with invading Heat. Heat and Dampness fail to resolve, steaming and郁 (stagnating), causing total yellowing of face and body. Stiff neck indicates Damp-Bi blocking the upper; hypochondriac fullness indicates Damp gathering in the middle; difficult urination indicates Damp failing to flow downward. All result from interaction with Heat. If the physician treats hypochondriac fullness with Chai Hu Tang to resolve pathogen, subsequent rectal heaviness occurs because pathogen resolves externally while Damp flows downward, impending diarrhea. If Heat and Damp were fully cleared, sweat would flow freely and recovery would ensue, without rectal heaviness. Original thirst with vomiting after drinking matches the Golden Cabinet statement: "Thirst followed by vomiting indicates Water retention below the Heart," belonging to Yin (Fluid retention) disorders. Fluid retention in the lower Heart causes hiccups upon eating. This matches "vomiting preventing food intake," treated by Xiao Ban Xia Tang (Minor Magnolia and Ginger Decoction), not Xiao Chai Hu Tang (Minor Bupleurum Decoction).
Originally due to purgation, Pi (fullness/obstruction) developed in the epigastrium. Xie Xin Tang (Drain the Epigastrium Decoction) was given. Pi did not resolve; patient is thirsty, dry-mouthed, irritable, with difficult urination. Wu Ling San (Five-Ingredient Powder with Poria) is the primary treatment.
Pi formed after purgation, treated with Xie Xin Tang, is legally appropriate. However, if Pi persists with dry mouth/thirst and difficult urination, this is not simple Pi, but Heat and Water accumulation obstructing flow. Water accumulation fails to move, causing Earth (Spleen) to lose moisture (dry mouth/thirst) and Lower Jiao to lose direction (difficult urination). Xie Xin Tang is unsuitable. Wu Ling San disperses Water and drains Heat, promoting urination; then Pi and thirst/irritability cease.
After purgation, Gui Zhi Tang must not be used again. If there is sweating and wheezing without high fever, Ma Huang Xing Ren Gan Cao Shi Gao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) can be given.
This parallels the clause regarding post-sweating prohibition of Gui Zhi Tang. Although sweating and purgation differ, pathogen entering the Lung is the same; thus, treatment is identical.