伤寒辨要笺记
作者：程门雪
原著：日·浅田惟常
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此著，余阅之，其议论尚中正，有可取，又分门类亦简括，故依其目而节录其可取者，附载臆义于后，以为它日之用焉。庚辰四月门雪录记。
辨六经
仲师举伤寒而括阴阳，建六经而标病位，其论至简至易，实为前古不刊之训矣。
徐洄溪曰：欲读伤寒论，必先识六经之本证，然后论中所言源流变态，形证色脉，合并疑似，用药加减异同之故，可以晓然，不致眩惑贻误矣。
物茂仰曰：三阳三阴，阳明厥阴之说，与“易”之老阳老阴有别，盖医家一家言也。
贺屋恭曰：史迁所记，既有六经之目，而与本书所设三阴三阳自别，所谓三阴三阳，因非经名也。《扁鹊传》好言脏腑，而是书不言之，其立论之意，大有径庭也。太阳少阳太阴少阴之言，始见于《子华子》，《易言》四象，而不分太少阴阳。三阴三阳，他书无所见，是必医家之所立，设以辨病体者也。
藤本廉曰：三阴三阳之目，何谓而设？凡疾病有六等之差，而地位脉证不相同也。
吉益猷曰：三阴三阳，皆因形状所名之病名，而非六经之谓也，故终篇称某病，而无称某经者可以知矣。
雉间焕曰：抑古人言称六经，动及阴阳，其志盖始于取譬，则区别其证之目耳。
浅也徽曰：伤寒所称三阴三阳者，即仲景所以标病位而分阴阳，故也单称为六部也，后人以为经络，其意不通。朱肱，王好古，陶华辈，凿凿费解，多见其违道矣。夫以六经为经络，则《素问》之义。与标病位而分阴阳者，因别也。
雪按：浅田粟原翁曰：三阴三阳，诸家皆主经络脏腑，而各有异同，毕竟穿凿拘泥，无效实用。上所录者，即其所箸六经考中征引东国诸家所论也。大旨都谓六经是借标病位，不做脏腑经络解。复有中西唯中，山田正珍二家，意也差同，其说已另录，兹不赘。其大旨均为伤寒六经与《素问》不同，《素问》是言经络，伤寒不本素问，但假此以分表里之部位，配脉证以为之统名也。山田又曰：以六经立名，犹数家者流，以甲乙为记号耳。东国诸家所言如此，几若一说，余意不然，六经病证表现与素问脏腑经络主病，合者十九，偶有一二未合耳，谓不必拘于脏腑经络之说则尚可，谓必尽指脏腑经络之说则娇枉过正矣。余以为言六经诸家说中，只程应旄《后条辨》赘余数语为最合，最得真理，盖学识经验并到之警语也。其言曰：“素问六经是一病共具之六经（谓一病传移于六经时，所各具之状态也），仲景之六经，是异病分部之六经（谓六经各自为病也），素问是因热病而原及六经，仲景是设六经以尽赅众病。”数语字字金玉，为诸家所远不及。明乎此，则素问与伤寒之同异处，（素问热论所言六经病证，与伤寒同者甚多也）可以了然无碍，一以贯之矣。
辨太阳病：
邪盛于表，谓之太阳。盖邪初犯表，正气不畅，屈而为恶寒，激而为发热，使血脉动惕逆行，是以显脉浮，头痛，项强，恶寒发热等证也。此病大端有二：一则其人腠理开疏，邪不内迫，徒泛漫肌肉，故脉浮缓汗同，是如中风，对伤寒紧缩之邪而称，其轻者耳。一则腠理紧闭，邪气怫郁，遂迫骨节，故脉浮紧，无汗，骨节烦痛，是为伤寒，对中风散漫之邪而称，其重者耳。此即表病之大纲，而桂枝麻黄之分也。
雪按：以下遍记太阳篇诸条方治，文多不录，以无精彩处也。又按：太阳正病是大青龙汤，人所未晓，以桂枝麻黄证用之，当可以一二剂解，未有变化续起也。大青龙则有麻黄之外证，而内见烦躁，即原文所谓“脉静者不传，颇欲吐，烦躁脉数急，为传也”之传证是已。一起即有传证，知其来势鸱张，方兴未艾。太阳之大小青龙，与少阳之大小柴胡，阳明之大小承气，同为三阳大邪小邪，正病副候之主要方治，人能知此意，则于原文所载，朗若观星，明如印月矣。
辨阳明病：
阳明病（外之身热，恶热，潮热，内之腹满谵语，燥屎）所谓胃家实是也。胃热散漫，未结实，脉洪大浮滑，腹满身重，谵语遗尿，为白虎汤，口干舌燥者为白虎加人参汤。
胃热结实者三治：一：胃气不和，恶热心烦，为结实，调胃承气汤。二：脉滑而疾，谵语发潮热，大便坚，腹大满不通者，小承气汤，（第二条原有未致燥屎四字，不妥，故去之）。三：脉已实大迟，燥屎转结，手足濈然汗出，身重短气，腹满而喘，谵语如见鬼状者，为大承气汤。
若不识人，循衣摸床，惕而不安，微喘直视，为胃实之热，其脉弦者，精气尚存，宜下之，若脉微涩，为精气萎缩不振之候。
此皆太阳少阳之邪渐陷于胃者，其证属缓下之治。（雪按：大承气以下重证，当移于下面正病自发之中为当。）若目中不了了，睛不和，或汗多，或腹满痛者，剧热迅传，势近危急，与少阴大承气证，同属急下之例。
雪按：上大承气证下，腹满而喘，谵语如见鬼状，循衣摸床云云，均当移在此下。
此阳明之正治也（雪按：此则正阳明病自发重证，与移传燥屎缓下之候大殊，此见与余暗合，故详录之）
雪按：至太阳表证未解之桂枝，麻黄汤，胸胁满而呕之小柴胡汤，是太阳阳明并病，少阳阳明并病，先治太少之例也。栀子豉为阳明初治，介于表里之间，猪苓汤非阳明正文，实引证之例，浅田翁谓是阳明之旁证，未尽合也。惟热入血室，热结膀胱，瘀热发黄诸证，乃真阳明旁证耳。至外导诸方，当例之过汗移传燥实之下，盖即缓下之至轻者也。又阳明胃寒诸条，是另言引证，以别于胃家实之阳明病也，此阳明二字，但作胃腑解，与指胃家实热之阳明大相悬殊，勿拘泥为一解也。
记晓岚曰：乾隆癸丑间，京中疫，以景岳法治，十死八九，以又可法治，亦不甚验，桐城一医以重剂石膏治冯星寔（通是）之姬人，呼吸将绝，应手辄痊。有一剂用至八两，一人服至四斤者，踵其法者，活人无算，考喜用石膏，重过于明廖仲淳，本非中道，王懋竑（通宏字，意也通）白田集，有石膏论，力辩其非，不知何以取效如此？此也五运六气适值其年，未可执为通例也。赵藜村治袁仓山阳明经署疟，以石膏西瓜，见效亦同。（郭按：张锡纯说，石膏乃外感实热证之金丹，我于临床中也屡用得效，辨证真确，不必疑虑。）
辨少阳病：
热稍去表，而不专里，邪屯巡表里之间，邪气不借物而结，但与正气更互分争，留于胸胁而上薰，为少阳病，唯小柴胡一方正为的对，故以往来寒热，胸胁苦满，默默不欲食，心烦喜呕为本，以口苦，咽干，目眩为标，其来路必经太阳，（为柴胡加桂枝汤，柴胡干姜汤之法所出也）其去路多归阳明（大柴胡，柴胡加芒硝汤之法所由出也），其服柴胡已渴者，为属阳明，无大热而烦躁者，为陷阴位也。
刘茝（郭按：茝音chai，古书上说的一种香草,即“白芷”，山茝,藁本也。――《广雅》）庭曰：吴又可主疫邪自口鼻入，盖膜原实少阳之部，而达原三消有地方之宜，或验于今。然审其主证，犹不能出大小柴胡之例也，想当其时，邪势最厉，遽犯半表里，遂立此说耳。董氏《南塘感证》引伤寒心法称，见今世甚少太阳证，其书适与吴氏时世相近，可以证矣。世有墨守吴氏法，忌用麻桂，视柴胡为余热治法，故附识于兹。
雪按：小柴治余热甚隹，大柴则不尔，人未辨别耳。大柴实少阳主方也，《苏沈良方》小柴胡加减条曰：元佑二年，时行，无长幼皆咳，服此（去参，大枣，生姜，加五味子，干姜者）皆愈，当时上壅痰实，只依本方，食后卧时服，甚妙。赤白痢尤效，痢药中无如此妙者，盖痢多因伏署，此药极解署毒也。（雪按：治咳治痢有效可信，记以备对证之用，唯谓此药极解署毒，恐未必然耳。）
郭按：评语正确。回忆七十年代，我在风西村时，当时正搞合作医疗，那年痢疾盛行，因痢疾多有腹痛证状，我偶用痛泻要方治一人得效，当时我表哥也当赤脚医生，他把方抄去后，从亮兵大队卫生所中，一次便照方拿了几十付药，村中凡得痢疾而愿服中药者，便给予一二付煎服，几无不愈者，视为神方。当时我们二人都是初学医，只是想当然的用方就是了，并不会辨证，在后来的行医中，我也屡用之，但有效有不效，何以那年的痢疾如此有效，后来却不能尽效呢？这里有辨证准确与否的问题，有致病细菌菌株对此方药敏感与否的问题，（当然，前人也许还认识不到这些）所以不能一概而论。
辨太阴病：
感寒邪从里化，胃气屈弱，（雪按：是脾寒证也）腹满而吐，食不下，腹痛自利，故理中四逆温其脏，为的治矣。（雪按：原文明言脏有寒，脏者脾脏，证治俱符，乃东医诸公欲避去脏腑经络不言，遂硬指为胃寒，谓脏即指胃也。如直宽士粟《六经析义》即云尔，实亦太过。三阴指脏，三阳指腑，斑斑可考，证治都合，何必硬避不言耶？谓不必拘拘于脏腑经络之说可也，必谓不关脏腑经络，则大谬矣。三因方，活人书，皆疗本病用理中丸及汤（阴证略例亦然）为能得经旨矣。金鉴以厚朴生姜半夏人参为本篇治法，此大邪已去，只剩腹满一证者，与本篇胃寒腹满迥异也，
（雪按：金鉴说不诬，确是太阴病也，只稍轻耳，大邪虽去，病位不易，安可谓其非太阴耶？此段盖全本之六经析义者引其文也）至阳明中寒诸证，皆转系太阴，可见太阴阳明，殆其同局（雪按：脾胃同宫，本极有系属者）而虚实一转，互相变也。按本篇曰：下之必胸下结硬，朱肱曰：近人多不识阴证，但见胸膈不快，便投食药，非其治也。大抵阴证由冷物伤脾胃，阴经受之，主胸填满，面唇皆无色泽，手足冷，少情绪，脉沉细，投快利药，胸膈愈不快，或吐而利，一二日遂致不救，盖不知寒中太阴也，近世此证颇多，余与增损理中丸，救活甚多，因拈古人治验于右。
外台崔氏曰：时行四五日，大下后，或不下，皆患心下结满，两胁痞塞，胸中气急，厥逆欲绝，心胸高起，手不可近，不过二三日便死，用泻心，大小陷胸，并不得疗。此下后虚逆，气已不理，毒复上攻，毒气相搏，结于胸中，纵不下者毒已入胃，胃中不通，复搏于气，故致此病，当先理其气，次下诸疾，与增损理中丸。又曰：用此效的神速，下咽则折，不过六七丸，胸中豁然矣，药之速无如此者，然渴者当加栝萎，下利者当加牡蛎，不渴不下则除之，于时枳实乃为之贵，疗气理结，重过理中丸，然干姜性热，故减其分，茯苓通津，栝蒌除渴，牡蛎止利，谨审其宜，无不得矣。（以下验案数则，不录）此行功自叙也，余与此丸与枳术汤兼服，理无不验，可以征焉。（雪按：理中治痞，盖本之论中桂枝加人参汤而加减者，加栝蒌牡蛎法亦出小柴方后加减例中，盖仍由伤寒论中悟出者焉，百变不离其中，此仲师所以媲绝千古也欤。
辨少阴病：
雪按：浅田宗伯少阴门无精义，惟附录尚可取耳，药就所记，参诸家而详为分析之。少阴以但欲寐，恶寒自利，脉细沉为候。
一：本证自感表邪，但素阳虚，别无里证者，麻黄附子细辛甘草汤微发汗，温经散邪，治反发热，脉沉无里证者，此是少阴经邪自病，诸家解太阳之表，少阴之里二感者，非也。（雪按：反发热虽本虚寒，尚有抵抗力也，否则但寒不热矣。）
二：深一层，无发热，背恶寒，或身体骨节痛，手足寒者，附子汤温阳逐寒，加腹痛下利等里证者，真武汤温阳利水。
三：更进一层，虚寒下利甚，手足厥逆，呕烦，里寒外热，热假寒真者，分二等：一，脉不出，或厥逆无脉。一，脉微欲绝。山田正珍分二法甚隹，今从之。
白通汤，白通加猪胆汁汤：治寒盛遏阳，厥逆无脉，脉伏不出，自利烦躁等证，是寒闭也。
四逆汤，通脉四逆汤：治虚寒之甚，脉微欲绝，手足厥逆，反不恶寒，下利清谷，里寒外热等证，是虚寒也。
又附二法：通脉四逆加猪胆汁汤：治闭脱相兼，症势更重者。吴茱萸汤：治吐利，烦躁欲死，厥冷，厥少相兼者也。（雪按：吴茱萸重在吐而烦躁欲死，是厥少二阴病也，四逆重在利而厥冷，是少阴病也，一重吐，一重利，为同中之别，此表里纯阴，少阴虚寒治法也。）至少阴热证三条，最重者一，缓证二，兹列于下：
一：大承气汤：治少阴伏气阴毒证，自利清水，色纯清，心下必痛，此少阴伏热，急下存阴之治也，浅田以为阴寒化热，非也。
二：黄连阿胶汤：治心中烦，不得卧，是少阴心阴不足，心阳有余之病，正珍引外台治大病瘥后之文，以证原文二三日之误，大有助于本证，盖人皆疑此方此证非二三日所应有，而惜无以证之，得正珍说乃豁然矣。
Jianji on the Essentials of Differentiating Cold Damage (Shanghan Bianyao Jianji)
Author: Cheng Menxue
Original Author: Asada Suzune (Japan)
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Regarding this work, after reading it, I find its discussions to be generally balanced and correct, with merits worth adopting. Furthermore, its categorization is concise and comprehensive. Therefore, I have excerpted the valuable content according to its table of contents and appended my own insights for future reference. Recorded in the fourth month of Gengchen year by Menxue.
Differentiating the Six Channels (Liu Jing)
Master Zhongjing (Zhang Zhongjing) enumerated Cold Damage to encompass Yin and Yang, established the Six Channels to mark disease locations. His discourse is extremely simple and easy to understand, truly an unalterable teaching from ancient times.
Xu Huixi stated: To read the *Treatise on Cold Damage* (*Shanghan Lun*), one must first recognize the primary manifestations of the Six Channels. Only then can one clearly understand the origins, variations, morphological symptoms, colors, pulses, combinations, similarities, and differences in prescription modifications mentioned in the text, thereby avoiding confusion and errors.
Monobu Shoyo stated: The theories of Three Yang and Three Yin, specifically regarding Yangming and Jueyin, differ from the Old Yang and Old Yin of the *I Ching*. This is likely a unique perspective within medical practice.
Kagaya Kyō stated: Sima Qian's records in the *Records of the Grand Historian* mention the names of the Six Channels, which are distinct from the Three Yin and Three Yin established in this book. The so-called Three Yin and Three Yang are not meridian names. The *Biography of Bian Que* frequently discusses Zang-Fu organs, whereas this book does not; their theoretical intentions differ significantly. The terms Taiyang, Shaoyang, Taiyin, and Shaoyin first appeared in *Zihua Zi*. The *Yi Yan* mentions Four Images but does not distinguish between Minor/Major or Yin/Yang. The concepts of Three Yin and Three Yang are not found in other books, indicating they were certainly established by physicians to differentiate pathological states.
Fujimoto Ren stated: Why were the names of Three Yin and Three Yang established? Diseases vary in six degrees, and their locations, pulses, and symptoms are not identical.
Yoshikawa Yū stated: Three Yin and Three Yang are disease names named based on their shapes/manifestations, not references to the Six Meridians. Thus, the end of the chapter refers to "certain diseases" rather than "certain meridians," which clarifies this point.
Shima Kan stated: When ancients spoke of the Six Channels, they often invoked Yin and Yang. Their intent likely started with analogy, merely to distinguish categories of symptoms.
Asada Hiroshi stated: The Three Yin and Three Yang mentioned in Cold Damage refer to Zhang Zhongjing marking disease locations and distinguishing Yin and Yang; hence, they are singly called the Six Parts. Later scholars interpreting them as meridians is illogical. Zhu Gong, Wang Haogu, Tao Hua, and others provided rigid explanations that are difficult to comprehend, often deviating from the Dao. If the Six Channels are equated with meridians, it aligns with the meaning of the *Suwen* (Basic Questions). However, marking disease locations to distinguish Yin and Yang is fundamentally different.
Cheng Menxue's Note: Mr. Asada Suigenshi stated: Regarding Three Yin and Three Yang, various schools emphasize meridians and Zang-Fu organs, each with differences, ultimately resulting in forced interpretations lacking practical utility. The above excerpts are cited from his *Six Channels Examination*, referencing Japanese scholars' discussions. The general consensus is that the Six Channels borrow the concept to mark disease locations, not to be interpreted as Zang-Fu or meridians. Scholars like Nakanishi Ijū and Yamada Masazane share similar views, recorded separately. Their main argument is that the Six Channels of Cold Damage differ from the *Suwen*; the *Suwen* discusses meridians, while Cold Damage uses these terms merely to divide exterior-interior regions and combine them with pulses and symptoms as collective names. Yamada further stated: Naming the Six Channels is akin to numerologists using Heavenly Stems and Earthly Branches as markers. While Japanese scholars seem unanimous, I disagree. Ninety percent of Six Channel manifestations align with the *Suwen*'s Zang-Fu and meridian pathologies; only occasionally do they mismatch. It is acceptable to say one need not strictly adhere to Zang-Fu/meridian theories, but insisting they must exclusively refer to them is overcorrection. Among various theories, only Cheng Yingmao's *Post-Commentaries* contains a few sentences that best capture the truth, reflecting profound knowledge and experience. He said: "The Six Channels in the *Suwen* are the six stages possessed by a single disease (states when one disease transmits through the Six Channels); Zhang Zhongjing's Six Channels are the six divisions for different diseases (each channel suffers independently). The *Suwen* extends to the Six Channels due to heat diseases; Zhang Zhongjing established the Six Channels to encompass all diseases." These words are precious and unsurpassed. Understanding this clarifies the similarities and differences between the *Suwen* and Cold Damage (many Six Channel symptoms in *Suwen·Re Lun* match Cold Damage), allowing for a unified understanding.
Differentiating Taiyang Disease:
When pathogenic factors are abundant at the exterior, it is called Taiyang. Initially, pathogens invade the exterior, causing healthy Qi to stagnate. Oppression leads to aversion to cold, agitation leads to fever, and blood vessels become restless and reverse flow, manifesting as floating pulse, headache, stiff neck, aversion to cold, and fever. This disease has two main types: First, if the person's couli (pores/skin texture) are loose, pathogens do not penetrate inward but spread superficially in muscles, resulting in a floating-slow pulse and sweating. This is Wind Strike (Zhongfeng), considered lighter compared to the contracting pathogen of Cold Damage. Second, if couli are tightly closed, pathogens stagnate and oppress bone joints, resulting in a floating-tight pulse, no sweating, and severe joint pain. This is Cold Damage (Shanghan), considered heavier compared to the dissipating pathogen of Wind Strike. This outlines the major principles of exterior diseases and the distinction between Guizhi Tang (Cinnamon Twig Decoction) and Mahuang Tang (Ephedra Decoction).
Cheng Menxue's Note: The following details prescriptions for Taiyang chapter items are omitted due to lack of novelty. Also, the primary treatment for Taiyang is Da Qinglong Tang (Major Green Dragon Decoction), which is unknown to many. Using it for Guizhi or Mahuang patterns should resolve the condition in one or two doses without complications. Da Qinglong Tang presents Mahuang Tang exterior signs but internally shows irritability, corresponding to the original text's transmission signs: "If the pulse is quiet, it does not transmit; if there is much desire to vomit, irritability, rapid pulse, it transmits." Immediate transmission indicates aggressive pathology. The Major/Minor Qinglong Decoctions for Taiyang, Major/Minor Chaihu Decoctions for Shaoyang, and Major/Minor Chengqi Decoctions for Yangming are the primary treatments for major/minor pathogens in the Three Yang channels. Understanding this makes the original text clear as stars and bright as the moon.
Differentiating Yangming Disease:
Yangming Disease (external body heat, aversion to heat, tidal fever; internal abdominal fullness, delirium, dry stool) refers to "Stomach House Excess" (Wei Jia Shi). If Stomach heat is diffuse and not yet consolidated, with a surging-large-floating-slippery pulse, abdominal fullness, heaviness, delirium, and urinary incontinence, use Baihu Tang (White Tiger Decoction). For dry mouth and tongue, use Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng).
For consolidated Stomach heat, there are three treatments: 1. Disharmony of Stomach Qi, aversion to heat, heart vexation, indicating consolidation: Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction). 2. Slippery-rapid pulse, delirium, tidal fever, hard stool, significant abdominal fullness and obstruction: Xiao Chengqi Tang (Minor Direct Downward Decoction). (Note: Original text item 2 had "not yet dry stool," which was inappropriate and removed.) 3. Solid-large-slow pulse, dry stool formation, continuous sweating on hands and feet, body heaviness, shortness of breath, abdominal fullness with panting, delirium seeing ghosts: Da Chengqi Tang (Major Direct Downward Decoction).
If the patient cannot recognize others, grasps at clothing and bedrails, is terrified and uneasy, has slight panting and fixed gaze, this is heat from Stomach excess. If the pulse is wiry, essence and Qi remain; purgation is suitable. If the pulse is faint and choppy, essence and Qi are depleted and weak.
These cases involve pathogens from Taiyang and Shaoyang gradually sinking into the Stomach, requiring mild purgation. (Cheng Menxue's Note: Heavy conditions treated by Da Chengqi Tang should be moved to the section on spontaneous severe Yangming disease.) If eyes appear unclear and pupils are unresponsive, or there is excessive sweating or severe abdominal pain, intense heat transmits rapidly, approaching crisis. This belongs to emergency purgation, similar to Shaoyin Da Chengqi Tang indications.
Cheng Menxue's Note: Descriptions under Da Chengqi Tang (abdominal fullness, panting, delirium, grasping behavior) should be moved here.
This is the standard treatment for Yangming. (Cheng Menxue's Note: This refers to severe spontaneous Yangming disease, vastly different from transmitted dry stool requiring mild purgation. This aligns with my views, so recorded in detail.)
Cheng Menxue's Note: Guizhi Tang and Mahuang Tang for unresolved Taiyang exterior, and Xiaochaihu Tang for chest-hypochondriac fullness with vomiting, treat Taiyang-Yangming and Shaoyang-Yangming combined diseases, prioritizing Shaoyang/Taiyang first. Zhizi Chi Tang is initial Yangming treatment, intermediate between exterior and interior. Zhuling Tang is not core Yangming text but illustrative; Asada called it a collateral symptom, which is incomplete. True Yangming collateral symptoms include Heat Entering Blood Chamber, Heat Knotting Bladder, and Stasis-Heat Jaundice. External guiding prescriptions belong to post-excessive sweating transmitted dry-stuff conditions, being the mildest purgatives. Yangming Stomach Cold items are separate illustrations to distinguish from Wei Jia Shi (Stomach House Excess). Here, "Yangming" refers only to the Stomach organ, differing greatly from Yangming referring to Stomach House Excess Heat; do not interpret uniformly.
Ji Xiaolan stated: During Qianlong Gui Chou year, an epidemic occurred in Beijing. Treatment using Zhang Jingyue's methods resulted in 80-90% mortality. Wu Keyi's methods were also ineffective. A physician from Tongcheng used heavy doses of Shigao (Gypsum) to treat Feng Xingshi's concubine, who was near death, and she recovered immediately. One dose used eight taels; one patient consumed four jin. Following this method saved countless lives. Xi favored heavy Shigao more than Ming dynasty Liao Zhongchun, which was extreme. Wang Maohong refuted this in *Baitian Ji*, yet efficacy was high. This may be due to favorable Five Movements and Six Qi for that year, not a universal rule. Zhao Licun treated Yuan Cangshan's Yangming meridian malaria with Shigao and watermelon, with similar success. (Guo's Note: Zhang Xichun said Shigao is the golden pill for external contraction excess heat. I have used it effectively clinically with accurate differentiation.)
Differentiating Shaoyang Disease:
Heat slightly leaves the exterior but does not specialize in the interior. Pathogens linger between exterior and interior, not condensing with matter but competing with healthy Qi, lingering in chest and hypochondrium ascending upward, called Shaoyang Disease. Only Xiaochaihu Tang (Minor Bupleurum Decoction) is the precise remedy. Its root symptoms are alternating chills and fever, chest-hypochondriac distress, silent desire not to eat, heart vexation, and frequent vomiting. Its branch symptoms are bitter taste, dry throat, and vertigo. Its origin passes through Taiyang (basis for Chaihu Jia Guizhi Tang and Chaihu Ganjiang Tang); its destination often returns to Yangming (basis for Dachaihu Tang and Chaihu Jia Mangxiao Tang). If thirst occurs after taking Chaihu Tang, it belongs to Yangming. If no great heat but irritability occurs, it has sunk to Yin positions.
Liu Chi Ting stated: Wu Keyi claimed epidemic pathogens enter via mouth and nose, suggesting Membrane Origin is actually Shaoyang territory. Dahuang Yuan Yin (Origin Reaching Decoction) has local suitability and may be effective today. However, analyzing main symptoms still falls within Major/Minor Chaihu frameworks. Perhaps当时邪势最厉 (pathogen force was most severe then), suddenly attacking half-exterior/half-interior, leading to this theory. Dong's *Nantang Gan Zheng* cites Shanghan Xin Fa stating Shaoyang symptoms are rare now, matching Wu's era, proving this. Some blindly follow Wu's methods, avoiding Mahuang/Guizhi, viewing Chaihu as residual heat treatment. Recorded here.
Cheng Menxue's Note: Xiaochaihu Tang treats residual heat well; Dachaihu Tang does not. People fail to distinguish. Dachaihu Tang is actually the primary Shaoyang formula. *Su Shen Liang Fang* notes on Xiaochaihu modifications: In Yuanyou Year 2, during an epidemic, everyone coughed. Taking this modified formula (removing Renshen, Dazao, Shengjiang; adding Wuweizi, Ganjiang) cured all. At that time, phlegm obstructed upper jiao; taken after meals and before bed, it was excellent. Especially effective for dysentery; no dysentery medicine compares. Dysentery often stems from latent summerheat; this drug resolves summerheat toxin well. (Cheng Menxue's Note: Effective for cough/dysentery, recorded for reference. Claiming it strongly resolves summerheat toxin may be doubtful.)
Guo's Note: Commentary is correct. Recalling the 1970s in Fengxi Village, during cooperative medical services, dysentery was prevalent. Due to abdominal pain symptoms, I accidentally used Tongxie Yaofang (Painful Diarrhea Essential Formula) on one patient with success. My cousin, a barefoot doctor, copied the formula, obtained dozens of doses from Liangbing Brigade Health Station, and distributed one or two decoctions to villagers willing to take Chinese medicine for dysentery. Almost all recovered, viewing it as a divine formula. We were beginners, using formulas intuitively without differentiation. Later, I used it frequently with variable results. Why was it so effective that year but not always later? Issues include accuracy of differentiation and bacterial strain sensitivity to the herbs (though ancients might not have known this). Thus, generalizations are invalid.
Differentiating Taiyin Disease:
Cold pathogens transform internally, weakening Stomach Qi. (Cheng Menxue's Note: This is Spleen Cold syndrome.) Abdominal fullness with vomiting, inability to eat, abdominal pain with spontaneous diarrhea. Therefore, Lizhong Tang (Regulate the Middle Decoction) and Sini Tang (Reverse the Extremities Decoction) warm the Zang organs, providing targeted treatment. (Cheng Menxue's Note: Original text explicitly states "cold in the Zang." Zang refers to Spleen. Symptoms and treatment match. Japanese doctors avoid mentioning Zang-Fu/Meridians, forcing interpretation as Stomach Cold, claiming Zang means Stomach. E.g., *Six Channels Analysis* says this, which is excessive. Three Yin refers to Zang, Three Yang to Fu, verifiable and consistent. Why avoid mentioning them? Saying one need not strictly adhere to Zang-Fu/Meridian theories is fine; denying any relation is a major error. *San Yin Fang* and *Huoren Shu* both treat this disease with Lizhong Wan/Tang (and *Yin Zheng Lue Li*), capturing the channel essence. *Yizong Jinjian* uses Houpo Shengjiang Banxia Renshen Tang as the treatment for this chapter. This applies when major pathogens are gone, leaving only abdominal fullness, distinct from Stomach Cold abdominal fullness in this chapter.
(Cheng Menxue's Note: *Jinjian* is correct; it is indeed Taiyin disease, just milder. Although major pathogens are gone, the disease location remains unchanged. How can it not be Taiyin? This paragraph seems derived from *Six Channels Analysis*.) Yangming Middle Cold conditions all relate to Taiyin, showing Taiyin and Yangming share the same framework (Cheng Menxue's Note: Spleen and Stomach share the palace, inherently connected), transforming between deficiency and excess. According to this chapter: Purging causes lower chest knotting and hardness. Zhu Gong stated: Modern people rarely recognize Yin syndromes. Seeing chest discomfort, they administer laxatives, which is incorrect treatment. Generally, Yin syndromes result from cold foods injuring Spleen/Stomach, affecting Yin channels. Main symptoms: chest fullness, pale face/lips, cold hands/feet, low spirit, deep-thin pulse. Administering harsh purgatives worsens chest discomfort or causes vomiting/diarrhea, leading to death within days due to ignorance of Cold invading Taiyin. This syndrome is common recently. I used Modified Lizhong Wan to save many, citing ancient cases here.
*Waitai Miyao* Cui Shi stated: During epidemic days 4-5, after strong purging or failure to purge, patients suffer epigastric knotting/fullness, hypochondriac blockage, chest urgency, extremity reversal nearing death, elevated chest intolerable to touch. Death occurs within 2-3 days. Xie Xin Tang, Da/Xiao Xian Xiong Tang fail. This is post-purge deficiency/reversal, Qi disordered, toxins attacking upward, clashing in chest. Even if not purged, toxins enter Stomach, blocking Qi, causing this. Must first regulate Qi, then address other ailments, using Modified Lizhong Wan. Also: Effect is swift. Swallowing 6-7 pills clears the chest instantly. No medicine acts faster. Thirsty add Gualou; diarrhea add Muli. If no thirst/diarrhea, remove them. At that time, Zhishi was valued for regulating Qi and resolving knots, heavier than Lizhong Wan. Ganjiang is hot, so reduce dosage. Fuling promotes fluids, Gualou relieves thirst, Muli stops diarrhea. Carefully judge appropriateness, and nothing will fail. (Several case studies omitted.) This is the author's narrative. I combined this pill with Zhizhu Tang, and logic dictates efficacy. Verifiable. (Cheng Menxue's Note: Lizhong treating palpitations originates from modifying Guizhi Jia Renshen Tang in *Shanghan Lun*. Adding Gualou/Muli follows Xiaochaihu modification examples, deduced from *Shanghan Lun*.万变不离其中 (Ten thousand changes do not leave the center). This is why Master Zhongjing surpasses antiquity.)
Differentiating Shaoyin Disease:
Cheng Menxue's Note: Asada Suzane's Shaoyin section lacks depth; appendices are valuable. Based on records and consulting various schools, analyzed in detail. Shaoyin manifests as desire to sleep, aversion to cold, spontaneous diarrhea, thin-deep pulse.
1. Primary syndrome contracting exterior pathogens, but constitutionally Yang deficient, no interior symptoms: Mahuang Fuzi Xixin Gancao Tang (Ephedra, Aconite, Asarum, Licorice Decoction) mildly induces sweating, warms meridians, disperses pathogens. Treats counter-flushing fever, deep pulse without interior symptoms. This is Shaoyin channel self-disease. Scholars interpreting it as simultaneous Taiyang exterior and Shaoyin interior infection are incorrect. (Cheng Menxue's Note: Counter-flushing fever indicates residual resistance despite deficiency-cold; otherwise, only cold without fever.)
2. Deeper level, no fever, back aversion to cold, or body/joint pain, cold hands/feet: Fuzi Tang (Aconite Decoction) warms Yang, expels cold. Adding interior symptoms like abdominal pain/diarrhea: Zhenwu Tang (True Warrior Decoction) warms Yang, promotes urination.
3. Further progression, severe deficiency-cold diarrhea, extremity reversal, vomiting/vexation, interior cold/exterior heat (false heat, true cold): Divided into two grades: 1. Pulse absent or extremity reversal without pulse. 2. Pulse faint, nearly vanished. Yamada Masazane divided methods excellently; I follow him.
Baitong Tang, Baitong Jia Zhuyedan Tang: Treats cold abundance suppressing Yang, extremity reversal without pulse, hidden pulse, spontaneous diarrhea, irritability. This is Cold Closure.
Sini Tang, Tongmai Sini Tang: Treats severe deficiency-cold, faint/nearly vanished pulse, extremity reversal, counter-aversion to cold, diarrhea with undigested food, interior cold/exterior heat. This is Deficiency-Cold.
Two additional methods: Tongmai Sini Jia Zhuyedan Tang: Treats closure and collapse combined, more severe condition. Wuzhuyu Tang: Treats vomiting/diarrhea, severe irritability, cold extremities, combining Jueyin and Shaoyin. (Cheng Menxue's Note: Wuzhuyu focuses on vomiting/severe irritability, involving Jueyin/Shao Yin. Sini focuses on diarrhea/cold extremities, Shaoyin disease. One emphasizes vomiting, one diarrhea, a distinction within similarity. This is pure Yin interior/exterior, Shaoyin deficiency-cold treatment.) Regarding three Shaoyin Heat syndromes, one is heaviest, two are mild, listed below:
1. Da Chengqi Tang: Treats Shaoyin latent Qi Yin-Du syndrome, spontaneous diarrhea of clear water, pure color,必心痛 (must have epigastric pain). This is Shaoyin latent heat, urgent purgation to preserve Yin. Asada considered it Yin-cold transforming to heat, which is incorrect.
2. Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction): Treats heart vexation, inability to sleep. This is Shaoyin Heart Yin deficiency with Heart Yang excess. Masazane cited *Waitai* texts on post-major illness recovery to prove the original text's "two to three days" error, greatly aiding this syndrome. People doubted this formula/syndrome shouldn't occur in 2-3 days, lacking proof. Masazane's explanation clarified it.