观加减法便知。论曰∶胸中烦者，去人参，加栝蒌实。不呕者，去半夏。渴者，去半夏，加
花粉、人参。腹中痛者，去黄芩，加芍药。胁下痞硬，去大枣，加牡蛎。心下悸、小便不利
，去黄芩，加茯苓。不渴，表有微热，去人参，加桂枝，温覆取微似汗。愈咳者，去人参、
生姜，加干姜、五味）。他如妇人经水适断，热入血室，寒热发作有时，如疟状者，亦主小
柴胡汤。又有经水适来，表邪内陷，热入血室，脉迟、身凉、胸胁下满、如结胸状、谵语者
，当刺期门，随其实而泻之（期门在乳头直下，第二肋端。以同身寸法验之，去乳头约四寸
。此厥阴、阴维之会）。其最重者，昼则明了，暮则谵语，如见鬼状，法当无犯胃气及中、
上二焦（不可汗，不可下），必自愈。又有太阳、少阳合病，发热微恶寒、支节烦疼（以上太
阳证）、微呕、心下支结（以下少阳证），主柴胡桂枝汤（小柴胡与桂枝汤并为一方），和而达
之。又有少阳与阳明腑合病，热结在里，复往来寒热者，或发热汗出不解，心下痞硬，呕吐
，复下利者，均主大柴胡汤，表里两解之（即小柴胡去人参，加芍药、枳实、大黄）。若胸胁
满而呕（少阳证），日晡潮热（胃腑邪实），已而微利（未大结实），小柴胡汤加芒硝汤软荡之。
又
（胃）、小便不利、一身尽重、不能转侧（膀胱蓄湿），柴胡加龙骨牡蛎汤主之。（小柴胡去甘
草，加龙、牡、铅丹、大黄、桂枝、茯苓）。又有误汗、误下，表邪内陷胸胁，阻遏清阳，
阳气上越，里有寒热，以致寒热往来，胸胁满，微结，心下烦（皆少阳证），小便不利，渴而
不呕，但头汗出（阳气上越），柴桂干姜汤主之（柴胡、桂枝、干姜、黄芩、牡蛎、花粉、甘
草）。二者见证错杂，故药亦错杂，真神妙无方剂也。凡此皆治胸胁、心中、少阳分野者也
。
若夫心下见证，又有不同者。论曰∶病发于阳（发热、恶寒），而反下之，热入因作结胸
；病发于阴（无热、恶寒），而反下之，热入因作痞气。所以成者，以下之太早故也。夫结胸
有热结，有寒结，总不外痰涎蓄水，搏束清阳之气，结于心胃之间（心下胃上），病属有形，
故痛而硬。痞气，寒热、虚实夹杂为病。又有湿热痰涎阻遏清阳之气，留于心胃之间。病属
有形而无形，故但满而不痛。结胸，非攻其蓄水不可；痞气，非苦辛寒热并用、消补兼施不
可。此大小陷胸、泻心诸汤之所由立也。然结胸、痞气诸剂，必表邪已解，乃可用之。若心
下痞而恶寒者，表未解也，不可攻里，先用桂枝汤解表，表解再行治里，或用五苓散两解表
里亦可。试详言之。其湿热、痰涎小结胸者，正在心下，按之则痛，脉浮滑，小陷胸汤主之
（黄连、半夏、栝蒌实）。其蓄水结胸者，头痛（清阳被阻），心下痞硬满、引胁下痛、干呕、
短气下利（皆蓄水见证），汗出不恶寒者，此表解里未和也，十枣汤主之。（芫花、甘遂、大戟
为末，共一钱匕，约今秤三分，以十枣煎汤和服，得快下利）。其蓄水与实热互结胸者，脉
沉而紧、心下痛、按之石硬，甚者，舌燥而渴，（胸有蓄饮，热不得泄，故燥而渴。前五苓散
治燥渴，亦与此同意）、日晡小有潮热（胃腑有邪）、从心上至少腹硬满、痛不可近（虽上下皆
痛，而根由心上而起）。又有结胸无大热者，此水结在胸胁也，但头汗出者，此热为水郁，
不得发泄，若小便不利，水无出路，身必发黄，故并以大陷胸汤主之（甘遂末一钱匕，大黄
、芒硝煎汤和服）。又有结胸项亦强，如柔痉状，下之则和，主大陷胸丸缓下之（大黄、芒硝
、葶苈子、杏仁，和如弹丸一枚，甘遂末一钱匕，白蜜二合，煎服。一宿乃下，不下再服，
取下为效。用丸缓下，取其不伤津液）。又寒水实结胸，无热证者，与三物白散（桔梗、贝母
、巴霜为末，服半钱匕，羸者减之。病在膈上者必吐，在膈下者必利，不利进热粥一杯，利
不止进冷粥一杯。巴豆之性，得热则行，得冷则止）。若夫痞气，有因误下而成者，有因汗
后邪未尽而成者。盖汗为水类，邪汗未尽，水湿与热停于膈下，亦能作痞。其痞有水邪较重
者，汗解后心下痞硬、干噫食臭、胁下有水气、腹中雷鸣、下利，生姜泻心汤主之，取辛以
行水之意。（生姜、半夏、黄芩、黄连、干姜、人参、甘草、大枣）。有胃虚较重者，误下，其
人下利日数十行、完谷不化、腹中雷鸣、心下痞硬而满、干呕、心烦不安，医复误下之，其
痞益甚，此胃中虚，客气挟痰热上逆，故使硬也，甘草泻心汤主之，取甘以补虚缓逆之意。（
甘草、黄芩、半夏、干姜、黄连、大枣）。又有呕而发热，柴胡汤证，医反下之，柴胡证仍
在者，仍与柴胡汤，必蒸蒸振却，发热汗出而解（即今所谓战汗是也。邪正相争而出，虚人
多有之）。若无柴胡证，但心满而不痛者，此为痞，半夏泻心汤主之，取辛以燥湿之意。（半夏
、黄芩、黄连、干姜、人参、甘草、大枣）。又有脉浮而紧，邪在表也，医误下之，紧反入
里（沉紧），则作痞，热结气分，内无水邪，故痞而按之自濡，大黄黄连泻心汤主之，取苦以
泻热之意，妙在麻沸汤（滚汤）泡汁，欲其轻扬清淡，以涤上焦之邪热。又有心下痞，复恶寒
汗出者，此阳虚也，附子泻心汤主之，取温阳止汗之意。妙在浓煎附子，轻泡大黄、黄芩、
黄连，盖扶阳欲其热而性重，开痞欲其生而性轻也。凡此皆治心下见证者也。他如胸中有热
，胃中有邪气（表邪陷入），腹痛欲呕，与黄连汤（即半夏泻心汤去黄芩，加桂枝达邪出外）。
太阳与少阳合病自下利者，与黄芩汤（黄芩、芍药、甘草、大枣），呕者黄芩加半夏生姜汤。
误下寒格吐下，食入即吐，与干姜黄连黄芩人参汤。此三者，皆寒热、湿热、虚实夹杂为病
，与泻心同一方法。又有发汗后邪气已去，腹中胀满（湿气），与浓朴生姜甘草半夏人参汤，
泄湿补虚，此又虚邪入腹中治法也。
若夫膈膜以下，病及地气，不外胃中、腹中、少腹三者而已。夫胃为中土，藏垢纳污，
万物皆归焉，故邪入胃腑，即不能外达，必从下解，或邪热与胃肠渣滓搏结，或邪热与膀胱
血结，或邪热夹湿郁极走于肌肉，致身发黄。匪直此也，阳明腑实，必病及三阴∶胃脾相为
表里，太阴脾脉布胃中，络于嗌，故腹满而咽干；当脐属少阴，少阴肾脉络于肺，系舌本，
故口燥舌干而渴；少腹属厥阴，厥阴肝脉络于肝，循阴器，故烦满囊缩。三阴属脏，五脏藏
而不泻，其可泻者，惟胃肠而已，此承气诸汤所由立也。承气云者，谓承天气以平地气者也
。亦有邪由阳明经（“经”字宜着眼）传太阴经，由太阴而少阴而厥阴，成可温之证者，此寒
湿重者也，详见里寒条下，兹不具论。端以阳明腑实，必审其确实证见，如腑实则日晡（未
、申时，阳明主令）。必有潮热，或如疟状。其热未潮者，里未结也；其发热微恶寒者，表
未解也。皆不可与承气。即腹大满不通，仅可与小承气（浓朴、枳实、大黄）微和胃气，勿令
大下。若日晡潮热，或手足 然汗出，（四肢为诸阳之本，汗出则阳气已盛于土中，以此
为验大便硬一法）。多汗则津液外泄，胃中必燥，燥则大便必硬，肠有燥矢，则必谵语，或
独语如见鬼状，或腹满痛，或绕脐痛，或心以下按之硬，或烦躁发作有时，或时有微热，喘
冒不能卧，或目中不了了，睛不和，里邪结实，阳气不能外达，往往微似恶寒，甚而厥逆（
热深厥亦深），舌苔必板浓欠津，或黄或黑，皆宜大承气汤速下之（大黄、芒硝、浓朴、枳实
。大黄用酒洗先煨，以缓其性。芒硝后下，欲其先软化而后行也）。若剧者，发则不识人，
循衣摸席，惕而不安，微喘直视，此皆阳明危证，脉弦者生，涩者死。弦则以其尚能制土，
若涩则气血已枯矣（亦有邪结脉涩，气血尚未尽枯者）。又有阳明、少阳合病者，必下利，其
脉不负者顺也，负者失也（洪缓是阳明脉，为不负。弦紧是少阳脉，为负。负，木克土也）。
脉滑而数者，有宿食也；迟而滑者，内实也∶宜大承气汤。寸口脉浮而大，按之反涩，尺中
亦微而涩（邪结不通），有宿食也，宜大承气汤。少阴病得之二三日，口燥舌干者（少阴证），
急下之；少阴病自利清水，色纯青（肝邪传肾），心下必痛，口干燥者，急下之。宜大承气汤
。又有发汗后不恶寒，但蒸蒸发热者，当和胃气，与调胃承气汤（大黄、芒硝、甘草。调胃
全在甘草。恐伤中焦，故不用朴、实）。太阳病未解（未出汗），脉阴阳俱停，先振栗，汗出
乃解。但阳脉微者，先汗出乃解；但阴脉微者，下之乃解，宜调胃承气汤。其有脾约者（精
液不足，脾气约束）。大便必难，宜麻仁丸（即小承气加麻仁、杏仁、白芍），润脾泄肝，缓
化行之。其有直肠津液内竭，欲行不行者，宜蜜煎导法、猪胆汁导法（胆汁导法尤效）。又有
太阳病不解（经邪不解，势必传腑），热结膀胱，以致蓄血，其人如狂（热甚血凝，上干心包）
，血自下，下者愈（亦有血下而脱者，不可不知）！其少腹急结者，宜桃仁承气汤（桃仁、大
黄、芒硝、甘草、桂枝）；重者，少腹硬满，其人喜忘（血凝则心气结），甚则发狂，小便自
利，（蓄血在血分，不在气分），矢虽硬，大便反利（血性滑利），其色必黑（内有瘀血），或漱水
不欲咽，皆蓄血见证，抵当汤下之（水蛭、虻虫，熬一次，大黄、桃仁）。若脉数不解，而下
不止，必协热而便脓血，又别有治法。其有热而少腹满者，应小便不利，今反利者，为有血
也，当下之，宜抵当丸（即以汤药作丸）。此见证较轻，故用丸以缓下其血。若脉沉结、少腹
满、身黄、小便不利（不利知为湿热），此非血结，但湿热不行耳，茵陈汤下之（茵陈、栀子
、大黄）。阳明病，发热汗出者，此为热越，不能发黄。若但头汗出，齐颈而还，小便不利
，渴欲饮水，此为瘀热（湿与热合）在里，身必发黄，茵陈汤主之。热利下重（后重）者，白头
翁汤主之（白头翁、黄连、黄柏、秦皮）。大病瘥后，腰以下有水气者，牡蛎泽泻散主之（牡
蛎、泽泻、葶苈子、蜀漆、花粉、商陆、海藻）。凡此皆治地气为病者也，所谓六经不外三
焦者此也。
试再言经邪。少阴病得之二三日以上，（按∶循经传，一日太阳，二日阳明，三日少阳，
四日太阴，五日少阴，六日厥阴，六经传遍，七日从太阳病渐次而减。今云二三日以上，当
指五日以上之二三日言）。心中烦，不得卧，黄连阿胶汤主之（黄连、阿胶、黄芩、芍药、鸡
子黄）。此少阴传经之热邪，有热无结，故用降火养阴法。少阴病二三日，咽痛者，与甘草
汤；不瘥，与甘桔汤，此少阴虚热上烁，故用甘缓辛开苦降法。少阴病，咽伤生疮，不能言
语
少含咽之）敛火降逆。少阴病下利、咽痛、胸满而烦者，主猪肤汤（白蜜、米粉，猪肤汤和服
）。此阴虚化燥，故用甘咸润纳之法。又有病后脉结代，心动悸者，主炙甘草汤（炙甘草、干
地黄、麦冬、麻仁、阿胶、生姜、人参、桂枝、大枣）。此邪已去尽，气血两亏，经脉失养
，燥结不通，故以甘凉润养为主，尤妙在大甘缓之于上，佐辛润通其脉络，所以治脉结代
心悸有殊功。又有汗、吐、下后，病已向愈，而心胃之间尚有留邪结气，以致心下痞硬、噫
气不除，旋复代赭汤主之（旋复花、人参、生姜、炙甘草、半夏、代赭石、大枣）。此散结补
虚法也。又有少阴病始得之，反发热，脉沉者，麻黄附子细辛汤主之；无里证者，麻黄附子
甘草汤主之。此两感伤寒，一曰太阳与少阴并病。夫太阳、少阴相表里而位最近，犹可引之
外达，从汗而解，故温阳而兼达表。又有少阴病四逆，四逆散主之（甘草、枳实、芍药、
柴
阴传经之邪，非直中之邪，并无脉微、恶寒等阴证，即下利一端，并非清谷，而反下重，故
用疏邪散结，而不用温阳。若大汗、大下后，阳气大虚，则当以扶阳为急务。论曰∶伤寒脉
浮，自汗出，小便数，心烦，微恶寒，脚挛急，反与桂枝汤攻其表，此误也。得之便厥，咽
中干，烦躁（此是阴烦）。吐逆者，与甘草干姜汤，以复其阳；若厥愈足温者，更与芍药甘草
汤，以和其阴，其脚即伸；若胃气不和谵语者，少与调胃承气汤；若重发汗，复加烧针者，
四逆汤主之（甘草、干姜、附子。此阴阳两虚之后，又复竭其阳，非此汤不能挽回阳气，然
必实有阳虚见证，方可用）。伤寒医下之，续得下利清谷不止，身疼痛者，急当救里；后身
疼痛，清便自调者，急当救表。救里宜四逆汤，救表宜桂枝汤。大汗出，热不去，内拘急，
四肢疼（以上皆外证），又下利（清谷）、厥逆、恶寒者（三者皆虚寒内证）。四逆汤主之（急当
By observing the modification methods, one can understand. The *Shanghan Lun* (Treatise on Cold Pathogenic Diseases) states: For those with vexation in the chest, remove Ren Shen (Ginseng Root), add Gua Lou Shi (Trichosanthes Fruit). For those who do not vomit, remove Ban Xia (Pinellia Tuber). For those with thirst, remove Ban Xia (Pinellia Tuber), add Hua Fen (Trichosanthes Root) and Ren Shen (Ginseng Root). For those with abdominal pain, remove Huang Qin (Scutellaria Root), add Shao Yao (Peony Root). For those with fullness and hardness under the hypochondrium, remove Da Zao (Jujube Fruit), add Mu Li (Oyster Shell). For those with palpitations of the heart and difficulty urinating, remove Huang Qin (Scutellaria Root), add Fu Ling (Poria). For those without thirst but with slight external heat, remove Ren Shen (Ginseng Root), add Gui Zhi (Cinnamon Twig), cover with blankets to induce a slight sweat. For coughs that have healed, remove Ren Shen (Ginseng Root) and Sheng Jiang (Fresh Ginger), add Gan Jiang (Dried Ginger) and Wu Wei Zi (Schisandra Berry). Furthermore, for women whose menstruation has just ceased, with heat entering the Blood Chamber (Xue Shi), presenting with alternating chills and fever occurring at intervals resembling malaria, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is also indicated. In cases where menstruation is ongoing, external pathogens sink inward, heat enters the Blood Chamber, presenting with a slow pulse, cool body, fullness under the hypochondrium resembling Jie Xiong (Chest Binding), and delirium, one should puncture Qi Men (Liv-14) and drain according to the excess condition (Qi Men is located directly below the nipple, at the end of the second rib. Measured by the "same-body inch" method, it is approximately four inches from the nipple. This is the meeting point of the Jue Yin and Yin Wei vessels). In the most severe cases, the patient is lucid during the day but delirious at dusk, seeing ghosts; the treatment principle is to avoid damaging Stomach Qi and the Middle and Upper Jiao (do not induce sweating, do not purge); the disease will likely resolve spontaneously. There are also cases of Tai Yang and Shao Yang combined diseases, presenting with fever, slight aversion to cold, and painful limbs (Tai Yang signs above), slight vomiting, and a sensation of support/constraint in the epigastrium (Shao Yang signs below); Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) is indicated (combining Xiao Chai Hu Tang and Gui Zhi Tang into one formula) to harmonize and release. There are also cases of Shao Yang and Yang Ming Fu organ combined diseases, with heat binding internally and alternating chills and fever, or fever and sweating that does not resolve, epigastric fullness and hardness, vomiting, and diarrhea; Da Chai Hu Tang (Major Bupleurum Decoction) is indicated to resolve both exterior and interior (i.e., Xiao Chai Hu Tang minus Ren Shen, plus Shao Yao, Zhi Shi, and Da Huang). If there is fullness in the chest and hypochondrium with vomiting (Shao Yang sign), tidal fever in the late afternoon (Stomach Fu organ excess pathogen), followed by slight diarrhea (not fully bound), Xiao Chai Hu Tang plus Mang Xiao (Mirabilite) Decoction is used to soften and purge. Additionally, for cases involving (Stomach) difficulty urinating, heaviness throughout the body, and inability to turn over (Bladder accumulation of dampness), Chai Hu Jia Long Gu Mu Li Tang (Bupleurum Plus Dragon Bone and Oyster Shell Decoction) is indicated (Xiao Chai Hu Tang minus Gan Cao, plus Long Gu, Mu Li, Qian Dan, Da Huang, Gui Zhi, and Fu Ling). There are also cases of erroneous sweating or purging, where external pathogens sink into the chest and hypochondrium, obstructing Clear Yang, causing Yang Qi to float upward, with internal cold and heat leading to alternating chills and fever, chest and hypochondriac fullness, slight binding, epigastric vexation (all Shao Yang signs), difficulty urinating, thirst without vomiting, and only sweating on the head (Yang Qi floating upward); Chai Hu Gui Zhi Gan Jiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction) is indicated (Chai Hu, Gui Zhi, Gan Jiang, Huang Qin, Mu Li, Hua Fen, Gan Cao). These two types present mixed symptoms, so the herbs are also mixed; truly miraculous and unbound by fixed formulas. All these treat conditions in the chest, hypochondrium, heart/mind, and the Shao Yang domain.
Regarding symptoms in the epigastrium, there are differences. The *Shanghan Lun* states: When a disease originates from Yang (fever, aversion to cold) but is erroneously purged, heat enters and forms Jie Xiong (Chest Binding); when a disease originates from Yin (no fever, aversion to cold) but is erroneously purged, heat enters and forms Pi Qi (Epigastric Fullness/Blockage). This occurs because purging was done too early. Jie Xiong involves heat binding or cold binding, generally due to phlegm-fluid retention constraining Clear Yang Qi, binding between the Heart and Stomach (the epigastrium); the pathology is tangible, hence pain and hardness. Pi Qi is a disease of mixed cold/heat and deficiency/excess. It may also involve damp-heat and phlegm-fluid obstructing Clear Yang Qi, remaining between the Heart and Stomach. The pathology is tangible yet intangible, hence fullness without pain. Jie Xiong requires attacking the fluid retention; Pi Qi requires using bitter, acrid, cold, and hot herbs together, combining draining and tonifying. This is why Da/Xiao Xian Xiong Tang (Major/Minor Chest Binding Decoctions) and Xie Xin Tang (Drain the Epigastrium Decoctions) were established. However, formulas for Jie Xiong and Pi Qi can only be used after the external pathogen has resolved. If there is epigastric fullness with aversion to cold, the exterior is unresolved; do not attack the interior. First use Gui Zhi Tang (Cinnamon Twig Decoction) to resolve the exterior, then treat the interior, or use Wu Ling San (Five Ingredient Powder with Poria) to resolve both. Let us discuss in detail. For mild Jie Xiong due to damp-heat and phlegm-fluid, located exactly in the epigastrium, painful upon pressure, with a floating and slippery pulse, Xiao Xian Xiong Tang (Minor Chest Binding Decoction) is indicated (Huang Lian, Ban Xia, Gua Lou Shi). For Jie Xiong due to fluid retention, with headache (Clear Yang obstructed), epigastric fullness and hardness radiating to the hypochondrium, dry heaving, shortness of breath, and diarrhea (all fluid retention signs), if there is sweating without aversion to cold, this indicates the exterior is resolved but the interior is not harmonized; Shi Zao Tang (Ten Date Decoction) is indicated (Yuan Hua, Gan Sui, Da Ji powdered, one qian bi total, approx. 3 fen modern weight, taken with decoction of ten dates, until profuse loose stools occur). For Jie Xiong due to fluid retention and excess heat binding, with a deep and tight pulse, epigastric pain, hardness like stone upon pressure, severe cases having dry tongue and thirst (fluid retention in chest prevents heat dissipation, causing dryness/thirst; similar to the logic of treating thirst with Wu Ling San earlier), slight tidal fever in the late afternoon (pathogen in Stomach Fu), hard and full pain from epigastrium to lower abdomen intolerable to touch (pain originates from epigastrium), Da Xian Xiong Tang (Major Chest Binding Decoction) is indicated. For Jie Xiong without significant heat, this is water binding in the chest and hypochondrium; only head sweating indicates heat constrained by water, unable to vent. If urination is difficult, water has no outlet, jaundice will ensue; thus Da Xian Xiong Tang is used (Gan Sui powder one qian bi, Da Huang and Mang Xiao decocted and taken together). For Jie Xiong with neck stiffness resembling Rou Jing (Soft Spasm), purging brings harmony; Da Xian Xiong Wan (Major Chest Binding Pill) is used for gentle purging (Da Huang, Mang Xiao, Ting Li Zi, Xing Ren formed into a pill size of an egg, Gan Sui powder one qian bi, Bai Mi (white honey) two he, decocted and taken. Stools pass overnight; if not, take again. Passing stool is the goal. Pills are used for gentle purging to preserve fluids). For Han Shui (Cold Water) excess Jie Xiong without heat signs, San Wu Bai San (Three Item White Powder) is given (Jie Geng, Bei Mu, Ba Dou Shuang (Croton Seed Frost) powdered, half qian bi for adults, less for weak. Pathogen above diaphragm causes vomiting; below causes diarrhea. If no diarrhea, give hot porridge cup; if diarrhea persists, give cold porridge cup. Ba Dou moves with heat, stops with cold). Regarding Pi Qi, it arises from erroneous purging or residual pathogens after sweating. Sweat is akin to water; if pathogens remain after sweating, water-dampness and heat stop below the diaphragm, forming Pi. For cases with heavy water pathogen, after resolving sweating, epigastric hardness, belching with food odor, water qi under hypochondrium, borborygmus, and diarrhea, Sheng Jiang Xie Xin Tang (Fresh Ginger Drain the Epigastrium Decoction) is indicated, using acrid herbs to move water (Sheng Jiang, Ban Xia, Huang Qin, Huang Lian, Gan Jiang, Ren Shen, Gan Cao, Da Zao). For cases with severe Stomach deficiency, after erroneous purging, frequent diarrhea with undigested food, borborygmus, epigastric fullness/hardness, dry heaving, and restlessness, compounded by further erroneous purging worsening the Pi, this is Stomach deficiency with rebellious Qi carrying phlegm-heat upward causing hardness; Gan Cao Xie Xin Tang (Licorice Drain the Epigastrium Decoction) is indicated, using sweet herbs to tonify deficiency and calm rebellion (Gan Cao, Huang Qin, Ban Xia, Gan Jiang, Huang Lian, Da Zao). For vomiting with fever, if Chai Hu Tang syndrome exists but was erroneously purged, and Chai Hu signs persist, give Chai Hu Tang again; the patient will likely experience Zheng Zheng Zhen Que (shivering then fever/sweat resolution), known as Zhan Han (Battle Sweat), where pathogen and righteous Qi struggle. If no Chai Hu signs, only epigastric fullness without pain is Pi; Ban Xia Xie Xin Tang (Pinellia Drain the Epigastrium Decoction) is indicated, using acrid herbs to dry dampness (Ban Xia, Huang Qin, Huang Lian, Gan Jiang, Ren Shen, Gan Cao, Da Zao). For floating and tight pulse indicating exterior pathogen, erroneous purging causes the tight pulse to enter the interior (becoming deep/tight), forming Pi; heat binds in Qi division without water pathogen, so Pi is soft upon pressure; Da Huang Huang Lian Xie Xin Tang (Rhubarb and Scutellaria Drain the Epigastrium Decoction) is indicated, using bitter herbs to drain heat. The skill lies in steeping in Ma Fei Tang (boiling water) to keep it light and clear to cleanse Upper Jiao heat. For epigastric Pi with aversion to cold and sweating, this is Yang deficiency; Fu Zi Xie Xin Tang (Aconite Drain the Epigastrium Decoction) is indicated, warming Yang and stopping sweat. The skill lies in decocting Fu Zi strongly and steeping Da Huang, Huang Qin, Huang Lian lightly; supporting Yang requires heat and heavy nature, opening Pi requires raw/light nature. All these treat epigastric symptoms. Others include heat in chest, pathogen in Stomach (exterior pathogen sinking), abdominal pain and desire to vomit; Huang Lian Tang (Coptis Decoction) is given (Ban Xia Xie Xin Tang minus Huang Qin, plus Gui Zhi to guide pathogen out). Tai Yang and Shao Yang combined disease with spontaneous diarrhea; Huang Qin Tang (Scutellaria Decoction) is given (Huang Qin, Shao Yao, Gan Cao, Da Zao); if vomiting, Huang Qin Jia Ban Xia Sheng Jiang Tang (Scutellaria Plus Pinellia and Fresh Ginger Decoction). Erroneous purging causing cold obstruction with vomiting/diarrhea, eating immediately vomited; Gan Jiang Huang Lian Huang Qin Ren Shen Tang (Dried Ginger, Coptis, Scutellaria, Ginseng Decoction) is given. These three are mixed cold/heat, damp-heat, deficiency/excess diseases, treated similarly to Xie Xin Tang. After sweating, pathogen gone, abdominal fullness (dampness); Nong Po Sheng Jiang Gan Cao Ban Xia Ren Shen Tang (Magnolia Bark, Fresh Ginger, Licorice, Pinellia, Ginseng Decoction) is given to drain dampness and tonify deficiency, treating deficiency pathogens entering the abdomen.
Below the diaphragm, diseases affecting Earth Qi involve the Stomach, Abdomen, and Lower Abdomen. Stomach is Central Earth, storing filth, receiving all things; pathogens entering Stomach Fu cannot exit externally and must resolve downward. Pathogen heat may bind with intestinal waste, bind with Bladder blood, or combine with dampness郁极 (extreme constraint) moving to muscles, causing jaundice. Moreover, Yang Ming Fu excess affects the Three Yin: Stomach and Spleen are exterior-interior; Tai Yang Spleen meridian distributes in Stomach, connects to throat, causing abdominal fullness and dry throat; umbilicus belongs to Shao Yin; Shao Yin Kidney meridian connects to Lung, ties to tongue base, causing dry mouth/tongue and thirst; lower abdomen belongs to Jue Yin; Jue Yin Liver meridian connects to Liver, follows genitalia, causing irritability, fullness, and retracted testicles. Three Yin belong to Zang organs, which store but do not drain; only Stomach and Intestines can be drained; this is why Cheng Qi Tang (Order the Qi Decoctions) were established. "Cheng Qi" means receiving Heaven Qi to level Earth Qi. Pathogens may transmit from Yang Ming Jing (Meridian) to Tai Yang, then Shao Yin, then Jue Yin, forming conditions suitable for warming; this is heavy cold-dampness, detailed in Interior Cold section, not discussed here. Focus on Yang Ming Fu excess: verify true signs. Fu excess presents with tidal fever in late afternoon (Wei/Shen hours, Yang Ming ruling), resembling malaria. If heat is not tidal, interior is not bound; if fever with slight aversion to cold, exterior is unresolved. Do not give Cheng Qi. Even with large abdominal fullness and blockage, only Xiao Cheng Qi Tang (Minor Order the Qi Decoction) (Nong Po, Zhi Shi, Da Huang) may be given to mildly harmonize Stomach Qi, avoiding drastic purging. If tidal fever in late afternoon, or continuous sweating on hands/feet (limbs are root of Yang Qi; sweating indicates Yang Qi abundant in Earth, verifying hard stool), excessive sweating drains fluids, Stomach becomes dry, stool becomes hard, dry feces in intestines cause delirium, talking alone seeing ghosts, abdominal pain, periumbilical pain, hardness pressing epigastrium, intermittent irritability, slight fever, asthma/fullness preventing lying down, unclear vision/uncoordinated eyes, interior pathogen bound, Yang Qi cannot reach exterior, often slight aversion to cold, even厥逆 (cold extremities) (deep heat causes deep cold), tongue coating thick/lack of moisture, yellow or black; Da Cheng Qi Tang (Major Order the Qi Decoction) should be used to purge quickly (Da Huang, Mang Xiao, Nong Po, Zhi Shi. Da Huang wine-washed and pre-cooked to moderate nature; Mang Xiao added later to soften first). If severe, unconsciousness, grasping clothes/bed, fear/restlessness, slight asthma, staring straight ahead; these are Yang Ming critical signs. Pulse Xian (Wiry) indicates survival (can control Earth); Se (Choppy) indicates death (Qi/Blood exhausted) (some cases of pathogen binding with choppy pulse still have Qi/Blood). Yang Ming and Shao Yang combined disease causes diarrhea; non-negative pulse is favorable, negative pulse is adverse (Hong/Huan is Yang Ming, non-negative; Xian/Jin is Shao Yang, negative; Negative implies Wood overcoming Earth). Slippery/rapid pulse indicates retained food; Slow/Slippery pulse indicates interior excess; Da Cheng Qi Tang is appropriate. Cun Kou pulse floating/large, pressing choppy, Chi choppy (pathogen binding), retained food; Da Cheng Qi Tang. Shao Yin disease days 2-3, dry mouth/tongue; Ji Xia (urgent purge); Shao Yin spontaneous diarrhea clear water, pure green color (Liver pathogen transmitting to Kidney), epigastric pain, dry mouth; Ji Xia; Da Cheng Qi Tang. After sweating, no aversion to cold, only steaming fever; harmonize Stomach Qi; Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction) (Da Huang, Mang Xiao, Gan Cao. Regulation relies on Gan Cao to protect Middle Jiao, hence no Nong Po/Zhi Shi). Tai Yang unresolved (no sweat), Yin/Yang pulses stop, shivering then sweating resolves. Only Yang pulse micro: sweat resolves; only Yin pulse micro: purging resolves; Tiao Wei Cheng Qi Tang. Pi Yue (Spleen Constriction) due to insufficient fluids, Spleen constrains; difficult stool; Ma Ren Wan (Hemp Seed Pill) (Xiao Cheng Qi plus Ma Ren, Xing Ren, Bai Shao), moistens Spleen, drains Liver, gently transforms. Rectal fluid exhaustion, stool stuck; Mi Jian Dao (Honey Suppository) or Zhu Dan Zhi Dao (Pig Bile Suppository) (Bile method effective). Tai Yang unresolved, heat binds Bladder, causing Xu Xue (Blood Accumulation), patient manic (heat/stasis harassing Pericardium); blood self-discharge heals (watch for depletion). Lower abdomen urgent binding; Tao Ren Cheng Qi Tang (Peach Kernel Order the Qi Decoction) (Tao Ren, Da Huang, Mang Xiao, Gan Cao, Gui Zhi). Severe cases: lower abdomen hard/full, forgetfulness (stasis binds Heart Qi), mania, free urination (blood level, not Qi level), stool hard but loose passage (blood is slippery), black color (stasis), rinsing water without swallowing; Di Dang Tang (Mustard Wasp Decoction) purges (Shui Zhi, Meng Chong, Da Huang, Tao Ren). If rapid pulse persists with diarrhea, heat-blood pus stool; different treatment. Heat with lower abdomen fullness, should be difficulty urinating, but is free; indicates blood; purge; Di Dang Wan (Mustard Wasp Pill). Milder signs, use pill for gentle purging. Deep/choppy pulse, lower abdomen full, jaundice, difficulty urinating (damp-heat); not blood stasis, just damp-heat stagnation; Yin Chen Tang (Artemisia Decoction) purges (Yin Chen, Zhi Zi, Da Huang). Yang Ming fever/sweating, heat vents, no jaundice. Only head sweating to neck, difficulty urinating, thirst drinking water; Yu Re (Stagnant Heat/Damp-Heat) inside, jaundice ensues; Yin Chen Tang. Hot diarrhea with heaviness (tenesmus); Bai Tou Weng Tang (Pulsatilla Decoction) (Bai Tou Weng, Huang Lian, Huang Bo, Qin Pi). Post-major illness, edema below waist; Mu Li Ze Xie San (Oyster Shell and Alisma Powder) (Mu Li, Ze Xie, Ting Li Zi, Shu Qi, Hua Fen, Shang Lu, Hai Zao). All these treat Earth Qi diseases; Six Channels are not outside Three Jiao.
Discussing Meridian Pathogens. Shao Yin disease days 2-3+, (Note: Sequential transmission: Day 1 Tai Yang, 2 Yang Ming, 3 Shao Yang, 4 Tai Yin, 5 Shao Yin, 6 Jue Yin. Seven days reduces from Tai Yang. "Days 2-3+" refers to days 5+). Vexation in heart, insomnia; Huang Lian E Jiao Tang (Coptis and Donkey-Hide Gelatin Decoction) (Huang Lian, E Jiao, Huang Qin, Shao Yao, Ji Zi Huang). This is Shao Yin transmitted heat pathogen, heat without binding; use Fire-draining and Yin-nourishing method. Shao Yin days 2-3, sore throat; Gan Cao Tang (Licorice Decoction); if not better, Gan Jie Tang (Licorice and Marshmallow Decoction); Shao Yin deficient heat scorching upward; use Sweet-calming, Acrid-opening, Bitter-draining method. Shao Yin throat injury/ulcer, inability to speak; swallow slowly to calm fire and direct rebellion. Shao Yin diarrhea, sore throat, chest fullness/vexation; Zhu Fu Tang (Pig Skin Decoction) (Bai Mi, Mi Fen, Zhu Fu Tang mixed); Yin deficiency drying out; use Sweet/Salty moistening/nourishing method. Post-illness Knotted/Intermittent pulse, palpitations; Zhi Gan Cao Tang (Honey-Fried Licorice Decoction) (Zhi Gan Cao, Gan Di Huang, Mai Dong, Ma Ren, E Jiao, Sheng Jiang, Ren Shen, Gui Zhi, Da Zao). Pathogen gone, Qi/Blood dual deficiency, meridians malnourished, dry binding; primarily Sweet/Cool/Moist/Nourish; skill lies in heavy Sweet calming above, assisting Acrid/Moist to open meridians; excellent for Knotted pulse/palpitations. After sweating/vomiting/purging, illness improving, but residual pathogen/qi binding in Heart/Stomach causing epigastric hardness/belching; Xuan Fu Dai Zhe Tang (Inula and Hematite Decoction) (Xuan Fu Hua, Ren Shen, Sheng Jiang, Zhi Gan Cao, Ban Xia, Dai Zhe Shi, Da Zao). Dissolving binding and tonifying deficiency. Shao Yin onset, fever, deep pulse; Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction); no interior signs; Ma Huang Fu Zi Gan Cao Tang. Two-gan Cold Damage, Tai Yang and Shao Yin concurrent. Tai Yang/Shao Yin exterior-interior, closest position, can guide outward via sweat; warm Yang and release exterior. Shao Yin Si Ni (Four Extremities Cold); Si Ni San (Four Extremities Powder) (Gan Cao, Zhi Shi, Shao Yao, Chai Hu). Shao Yin transmitted pathogen, not direct invasion; no micro pulse/aversion to cold; diarrhea is not clear undigested food but tenesmus; use dispersing pathogen/resolving binding, not warming Yang. After massive sweating/purging, Yang Qi severely deficient; prioritize supporting Yang. *Shanghan Lun*: Cold damage floating pulse, spontaneous sweating, frequent urination, vexation, slight aversion to cold, leg cramps; erroneously giving Gui Zhi Tang to attack exterior is error. Results in cold extremities, dry throat, vexation (Yin vexation). Vomiting/reversal; Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction) to restore Yang; if extremities warm, Shao Yao Gan Cao Tang (Peony and Licorice Decoction) to harmonize Yin, legs extend; if Stomach Qi disharmony delirium, small dose Tiao Wei Cheng Qi Tang; if re-sweating + burning needle; Si Ni Tang (Licorice, Dried Ginger, Aconite). After Yin/Yang dual deficiency and further Yang depletion, only this formula restores Yang; must have true Yang deficiency signs. Cold damage purged, continuous diarrhea clear undigested food, body pain; urgently save Interior; later body pain, normal stool; urgently save Exterior. Save Interior with Si Ni Tang, Exterior with Gui Zhi Tang. Massive sweating, heat remains, internal cramping, limb pain (exterior signs), diarrhea (clear undigested), cold extremities, aversion to cold (interior deficiency-cold signs); Si Ni Tang (urgently