太阳病三日。发汗不解。蒸蒸发热者。属胃也。调胃承气汤主之。
发汗不解。邪不外散。而欲内传。为太阳而之阳明之候也。蒸蒸发热者。热聚于内。而气蒸于
外。与太阳邪郁于外。而热盛于表者不同。故彼宜外解。此宜清里也。然无燥实等证。则所以治之
者。宜缓而不宜急矣。调胃者。调其胃气。返于中和。不使热盛气实。而劫夺津气也。
调胃承气汤 方见太阳权变法。
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。知医以丸药下之。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
气汤主之。
此亦邪气去太阳而之阳明之证。过经者。邪气去此而之彼之谓。非必十三日不解。而后
谓之过经也。观少阳篇第二十条云、太阳病。过经十余日。又本篇第六十一条云、此为风也。须下
之。过经乃可下之。则是太阳病罢而入阳明。或传少阳者。即谓之过经。其未罢者。即谓之并病耳
。谵语。胃有热也。则热当以汤下之。若小便利者。津液偏渗。其大便必硬。而反下利。脉调和者
。医知宜下。而不达宜汤之旨。故以丸药下之。非其治也。脉微厥。脉乍不至也。言自下利者。里
气不守。脉当微厥。今反和者。以其内实。虽下利而胃有燥屎。本属可下之候也。故当以调胃承气
汤下其内热。此条太阳篇移入。
阳明病。不吐不下。心烦者。可与调胃承气汤。
病在阳明。既不上涌。又不下泄。而心烦者。邪气在中土。郁而成热也。经曰、土郁则夺之。
调胃承气盖以通土气。非以下燥屎也。
伤寒吐后。腹胀满者。与调胃承气汤。
吐后腹胀满者。邪气不从吐而外散。反因吐而内陷也。然胀形已具。自必攻之使去。而吐后气
伤。又不可以大下。故亦宜大黄、甘草、芒硝调之。俾反于利而已。设遇庸工。见其胀满。必以枳
、朴为急矣。
Taiyang disease (disease of the Taiyang/Bladder and Small Intestine channels) has persisted for three days. After inducing sweating, the condition remains unresolved. The patient exhibits a sensation of heat steaming from within (Zhengzheng Refa), indicating that the pathogen has entered the Stomach. Tiaowei Chengqi Tang (Regulate the Stomach Decoction to Bear Weight) should be primarily administered.
After inducing sweating, if the condition remains unresolved, it signifies that the pathogenic factor has not dispersed from the exterior but is attempting to transmit inward. This represents a transition from the Taiyang channel to the Yangming channel. "Steaming heat" indicates that heat is concentrated internally and steams outward, which differs from Taiyang diseases where pathogens are constrained externally and heat is excessive at the surface. Therefore, while the former requires external release, this case requires clearing internal heat. However, in the absence of severe excess syndromes such as dry stool accumulation, the treatment should be gentle rather than drastic. "Regulating the Stomach" refers to harmonizing Stomach Qi, restoring it to a state of neutrality, preventing excessive heat and Qi stagnation, and avoiding the depletion of body fluids and vital energy.
Tiaowei Chengqi Tang (Regulate the Stomach Decoction to Bear Weight): See the section on "Modified Methods for Taiyang Disease."
In cold damage disease, if after thirteen days the condition remains unresolved and the patient passes beyond the original meridian stage (Guojing) exhibiting delirious speech (Shanyu), it is due to internal heat. It should be treated with a decoction to purge downward. If urination is free, the feces must be hard; yet if diarrhea occurs instead, and the pulse is harmonious, it indicates that the physician used pill-form purgatives, which was inappropriate. If the patient had spontaneous diarrhea, the pulse should be faint or cold (Jue). Since the pulse is now harmonious, this indicates internal excess (Neishi). Tiaowei Chengqi Tang (Regulate the Stomach Decoction to Bear Weight) should be primarily administered.
This is also a syndrome where the pathogen leaves the Taiyang channel and enters the Yangming channel. "Passing beyond the meridian" means the pathogen leaves one channel and enters another; it does not necessarily require thirteen days of unresolved disease to be termed "passing beyond the meridian." Observing Article 20 of the Shaoyang chapter: "Taiyang disease, passing beyond the meridian for more than ten days." And Article 61 of this chapter: "This is wind pathogen, purging is indicated; purging can only be performed after passing beyond the meridian." Thus, when Taiyang disease resolves and enters Yangming, or transmits to Shaoyang, it is called "passing beyond the meridian"; if it has not resolved, it is called "combined disease" (Bingbing). Delirious speech indicates heat in the Stomach; thus, heat should be purged with a decoction. If urination is free, body fluids are diverted to the bladder, making the feces hard; yet if diarrhea occurs and the pulse is harmonious, the physician knew purging was indicated but failed to understand the principle of using a decoction rather than pills, hence using pills was inappropriate. A faint or absent pulse (Mai Wei Jue) implies that spontaneous diarrhea results from unstable interior Qi, leading to a faint or cold pulse. Since the pulse is now harmonious, it is due to internal excess; although there is diarrhea, there is dry stool in the Stomach, which is an indication for purging. Therefore, Tiaowei Chengqi Tang (Regulate the Stomach Decoction to Bear Weight) should be used to purge internal heat. This clause originally belonged to the Taiyang chapter and has been moved here.
In Yangming disease, without prior emesis or catharsis, if the patient experiences mental restlessness (Xinfan), Tiaowei Chengqi Tang (Regulate the Stomach Decoction to Bear Weight) may be given.
When the disease is in Yangming, neither vomiting nor purging has occurred, yet mental restlessness arises, it is because the pathogen is in the Middle Jiao (Spleen/Stomach), constrained and transforming into heat. The Classic states: "When Earth is constrained, it must be plundered/purged." Tiaowei Chengqi Tang (Regulate the Stomach Decoction to Bear Weight) serves to unblock the Qi of the Earth element, not merely to purge dry stool.
After cold damage induces vomiting, if abdominal distension and fullness occur, administer Tiaowei Chengqi Tang (Regulate the Stomach Decoction to Bear Weight).
Abdominal distension and fullness after vomiting indicate that the pathogen did not disperse outward via emesis but sank inward due to the disruption of Qi dynamics. Although the distension is established and requires removal, Qi is damaged after vomiting, so drastic purging is contraindicated. Therefore, Da Huang (Rhubarb Radix et Rhizoma), Gancao (Licorice Root), and Mangxiao (Mirabilite) should be used to regulate the condition, restoring smooth flow. An incompetent physician seeing distension and fullness would hastily use Zhishi (Aurantii Fructus Immaturus) and Houpo (Magnolia Bark), which is incorrect.