怫郁因汗失宜，便坚为实哕为虚∶
面者，阳明所主。阴盛者，面赤而黯；阳盛者，面赤而光。表证汗出未彻，以致邪热怫抑郁结，故头面
红赤，甚则蒸于肌肤，汗出未透身痒者，桂麻各半汤；恶寒热者，葛根汤；汗太过发黄者，茵陈汤；惊惕者，
火邪汤；大便硬者，里已实也，大柴胡汤。下后哕者，胃虚也，桂枝参苓汤。
戴阳浮火所冲，阴证（下痢厥逆）热微阳热甚。
《百问》云∶病患身微热，面赤，脉反沉而迟者，阴证也。身微热者，里寒也；面戴阳者，面虽赤而
不红活，乃下虚也。医者不察脉，以虚阳上膈热躁，误为实热下之，又用凉药，则气消而成大病矣。仲景理中、
四逆，陶氏益元汤主之。若阳证面赤，脉洪大，腹满潮热，大便不通者，大柴、承气主之。
目盲鼻鸣而呕衄者，热搏之重；
《难经》曰∶脱阴目盲。言精血脱而不上荣于目，故目盲不了了，或无所见也。伤寒发烦目盲，甚者必
衄。盖肝血为热气所搏，妄行于上而为衄，得衄则热随血散而解，与麻黄汤，或麻黄升麻汤、九味羌活汤。盖伤
寒衄为积热在表，用麻黄、羌活者，非治衄也，以解太阳经之邪耳。此与太阳病其人适失血及下利宜桂枝汤法
同。但衄家最忌发汗，邪轻者，犀角地黄汤。又目近鼻为内 ，属太阳；近眉尾，属少阳；当面，属阳明。赤
脉从上下者，太阳病；从下上者，阳明病；从外走内者，少阳病。热则目赤，风则目眩，寒则目疼。又狐惑目
不能闭，阴证眼睛痛，阴阳易病眼中生花。鼻者，呼吸清气之路，上窍于肺，下通膀胱。风寒壅则鼻鸣而必干呕，
太阳病，桂枝汤；太阳阳明合病，鼻干肌热者，葛根汤。
叉手冒心而聋耳者，阳脱之凶。
《难经》曰∶脱阳者见鬼。无阳气而见幽阴之鬼。伤寒汗过亡阳，其人必叉手自冒心胸而聋耳者，何也？
盖耳属肾，阳气盛则上通而聪，阳气虚则下脱而聋。仲景云∶少阴受病，胸胁满而耳聋者是也。宜芍药附甘汤、
黄建中汤救之。心悸欲得按者，桂枝甘草汤。撮空神昏者，陶氏升阳散火汤。若初证手少阳风病厥而聋者，
耳中 HT HT ，小柴胡汤，最忌吐下以致惊狂。手太阳热厥聋耳者，耳中塞满，加之热壅，出血出脓，则成
停耳。湿温厥阴耳聋见前。又有风邪入肾，耳中卒痛，外证寒热，不急治则发强如 ，俗名黄耳伤寒，不可作
正伤寒治之，内服小续命汤、败毒散，外用虎耳草捣汁滴入耳中。上证头汗如珠不流者，阳脱即死。
四肢胃末，由热而温而冷逆，知是传经之厥；
伤寒邪在三阳，则四肢热；半表半里及太阴，则邪渐入内，则四肢温；传至少阴、厥阴，则邪入深而陷伏
于内，则四肢厥冷。然先由热而后厥者，传经热厥也。轻则四逆散、白虎汤、竹叶石膏汤；重则大柴、承气下
之。若邪乍结胸中，心烦不食而厥者，瓜蒂散吐之。《百问》云∶热厥与冷厥不同。热厥者，微厥却发热；若
冷厥则不发热，四肢逆冷，脉沉细，大小便滑泄，恶寒，指甲青色。又有失下，血不通，四肢便厥，医者不识，
疑是阴厥，复进四逆汤之类，祸如反掌。大抵热厥，脉沉伏而滑，头上有汗，手掌温，指梢亦温，便宜下。
此仲景之妙旨也。
一舌心苗，由白而黄而燥黑，失其本体之红。
舌为心苗，肾主津液，无病则舌红而润。偶见红星点者，将欲发黄。如丹田邪热，则心苗枯槁，生苔如白
苔然。是以邪在表则无苔，邪初传里则苔白而滑。胃寒客热懊 者，栀豉汤吐之。阳明证，胁硬，不大便而呕，
舌苔白者，亦不可攻，小柴胡和之。如恶寒欲呕痰者，小柴胡加干姜。白苔滑而下利者，为脏结不治。热渐入
深，则苔白而涩；热深入胃，则苔黄或肥光，或尖白根黄者，表多里少也。俱白虎加参汤主之。手足腋下汗出，
谵语便闭，苔紫带黑，或生芒刺，虫碎燥裂者，承气汤下之。但舌黑亦有数种，有四边红而中灰黑成路者，失
下也；有黑圈者，过经未解也；有黑尖者，虚烦也；有舌见黄而中有黑至尖或黑乱点者，热毒深也；有弦红心
黑，或白苔中见黑点者，表未解也；有根黑尖黄，脉滑者可下，脉浮者可汗；有尖黑而有乱纹，脉滑实者急下
之，脉数无力者，必发渴而死。凡舌黑不论多少，俱系危证。惟冷而滑如淡黑然者，乃无根虚火，可以化痰降
火药治之。阴证苔白，腹痛自利者，理中汤。中湿湿痹，舌上如苔，非真苔也，丹田有热，胃中有寒，五苓散。
无寒热而唇焦者，多因血瘀；
不发寒热，胸满唇焦，漱水不入咽者，必衄血也。小腹满，小便利，大便黑者，血瘀于下也。
无色泽而唇青者，必是寒中。
阴证胸膈满，面色及唇皆无色泽，手足冷者，理中汤。若唇青有疮，则为狐惑。
口干口燥口涎岂无异？
口干者，邪热聚胃，消耗津液故也。有汗后口干者，五苓散加知母、黄柏；有阳明口干热甚口噤，背微
恶寒者，白虎加参汤；少阳证口干者，小柴胡汤；瘀血证口干，漱水不欲咽者，桃仁承气汤。口燥亦因脾胃有
热，津液涸少。阳明口燥咽干，背恶寒烦渴者，白虎加参汤；少阳口苦咽干，小柴胡汤、双解散；少阴口燥舌干
者，承气汤；口燥咽干，默默不欲言者，宜以狐惑治之。凡口干燥忌汗，汗之重亡津液。口涎有阳明热盛者则
涎热，少阴寒证则涎冷。
气逆气喘气短大相同。
气逆者，气自腹中时时上冲也。太阳无
汗、阳明胸满者，汗之。太阳下之早，表邪乘虚传里，里本虚者受邪不逆，里本实者不肯受邪，则气逆上冲，
邪仍在表，当复汗之。厥阴客热气上冲心，此热在里而气上也，下之。胸满实者，吐之。汗下后气逆眩晕者，
茯苓桂术甘草汤。有病后虚羸少气，欲吐气逆者；有动气发汗气逆者。气喘惟有太阳、阳明二证。太阳证无汗而
喘，宜汗；阳明证汗多而喘，宜下。太阳阳明合病，胸满而喘，恶寒者，亦只宜汗而不宜下也。故曰微喘缘表之
未解，喘满不恶寒者，当下而痊。又有汗后停水喘者，有汗下后喘者，有阴证喘息甚急者，返阴丹；脉伏者，
加味生脉散；如脉伏汗出发润者，肺绝不治，气短者，呼吸不相接续，似喘而不摇肩，似呻吟而无痛也。经曰∶
微虚相搏则为短气。短气不足以息者，实；少气不足以息者，危。有结胸者，有停水怔忡者，有风湿相搏者，
有素弱及下后脉微气虚甚者。大抵心腹胀满者，为实，为邪在里；心腹濡满者，为虚，为邪在表。气喘、气逆
亦然。
湿呕、干呕，宜察肾肝病证。
湿呕，有物有声，食已则呕；干呕，空呕无物。总属阳明气血俱病，故呕比吐为重也。热呕，口苦烦渴，
脉数，手心身热；寒呕，头痛胸满，厥冷吐沫，脉迟，吐哕噎呃皆然。湿呕，表邪传里，里气上逆，故半表里
证多呕也。三阳发热者，俱小柴胡加生姜主之。胸满日晡潮甚加芒硝；呕不止便闭者，大柴胡汤；呕多虽有阳
明证，胃薄不可下者，甘桔汤；烦渴者，先呕后渴为欲愈，猪苓汤；先渴后呕为停水，赤茯苓汤；饮水即呕者，
五苓散；虚烦渴者，竹叶石膏汤加姜汁，或栀豉汤；上热下寒呕者，黄连汤；胃寒下利，厥冷不渴者，理中汤
去术加姜汁，或正气汤加姜汁。少阴三证，膈上寒饮，呕吐涎沫，或吐利而渴者，四逆汤加生姜；脉沉，或咳
或悸，挟水气者，玄武汤去附子加姜汁；手足寒，心中温温欲吐不吐，愦愦无奈何者，生姜汁半夏汤。经汗下
虚者，干姜芩连人参汤。汗后水药及谷食不下者危，小半夏汤救之。又有温毒呕者，心闷发斑；水证呕者，先
呕怔忡；呕脓血者，腥臊气逆上冲，呕尽自愈。干呕，胃热与谷气相并上熏，心下痞塞，故呕则无所出，食则
不能纳，黄连解毒汤。有太阳无汗干呕者，风邪上壅也，桂枝汤。有太阳阳明合病，不下利而但呕或干呕者，
里实气逆，上而不下也，葛根汤。胃寒津枯干呕渴者，理中汤。少阴三证，干呕下利，脉微者，白通汤；里寒
外热，脉微欲绝者，通脉四逆汤；利不止，烦躁厥逆无脉者，白通加猪胆汁汤。厥阴头痛干呕吐痰，或自利厥
冷烦躁者，三味参萸汤。胸中似喘不喘，似呕不呕，似哕不哕，愦愦无奈何者，生姜汁半夏汤，大、小橘皮汤。
吐腥、吐酸，总因胃腑热寒。
吐，有物无声，食入即吐。丹溪以属太阳血病，然胃实主之。吐利腥臊者为寒，酸臭者为热，治与呕哕一
同。凡呕吐，脚软痛者，香港脚也。呕吐脉弱，小便自利，身微热而厥者，虚极难治。
哕噎皆因水寒相搏，
哕即干呕，声更重且长耳；噎乃胸间气塞不通。胃脉浮则为噎，滑则为哕。皆因胃气本虚，汗下太过，
或复饮冷，水寒相搏，胃虚气逆而上，理中汤加肉桂、丁香以散寒下气，茯苓、半夏以消水。哕不止者，橘皮
干姜汤、橘皮竹茹汤。间有热邪壅郁，上下之气不得通者，俱小柴胡加生姜和之。热甚便难者，小承气下之；
便软者，诸泻心汤选用。温病发渴饮冷作哕者，升麻葛根汤加茅根。凡呕、哕，必用半夏散结气也，用竹茹涩
胃解烦也，用生姜散逆气也。呕、哕、呃皆因气逆，故姜为呕家圣药，热者乌梅丸代之。
呃逆亦有阴阳两端。
旧以为咳嗽之咳，俗又以为口吃之吃。虞花溪考韵书，KT 与呃通，乃气逆上之名。又有以呃逆为哕者，
哕出声然后吸，呃逆入
声，逆尽然后呼，出入呼吸不同。兼呕、哕者，本于胃，呃逆本于肺。谷入于胃，胃气上注于肺，故寒气加新
谷，气相忤逆而复于胃，故噫噫有声。所以丹溪力辨乃相火自脐下直上冲胸，交于厥阴，水火相搏而作声也。
阳证，发热口苦胸满脉弦数，小柴胡汤加竹茹。小便闭加茯苓、或猪苓汤；大便闭者，调胃承气汤。少阴证失
下，腹满便闭，或纯下清水，呃逆者，小承气汤。阳明身热口渴，胸满烦躁，脉洪数，呃逆者，火冲肺也，甘
草泻心汤。阴证，便软胃寒，或因吐下虚极，恶寒脉细者，橘皮干姜汤。内寒厥冷者，羌活附子汤、丁香柿蒂
散，调苏合香丸。胃寒饮水相搏者，小青龙汤去麻黄加附子。手足厥冷者，小橘皮汤。胸满虚烦者，大橘皮汤。
凡呃逆，药中俱宜陈皮、竹茹、姜汁。此证有欲作正汗，阴阳升降而然者，即愈。又有食积而致者、小便闭涩
及痰水上冲者，腹满不得小便及脉见沉微散者死。以上呕、哕、呃逆大同，水气表里俱有此五证。
衄血热迫于鼻，动经则为厥竭不治；
经络中热盛逼血，从鼻出者，为衄，多属太阳，名曰阳血。点滴不成流者，表犹未解，当用辛凉之药解
表，九味羌活汤加赤芍，或升麻葛根汤加黄芩，或麻黄升麻汤、双解散；渴者，五苓散；烦者，竹叶石膏汤，
以散经中之邪。仲景云∶伤寒脉浮紧，不发汗因致衄者，麻黄汤主之是也。如无表证，衄血成流，及因汗而得
衄，或下又见血者，不治自愈。不止者，犀角地黄汤、陶氏生地芩连汤、黄芩汤、茅花汤，外用冷水浸纸贴太
阳穴，纸热又换，或用百草霜、胎发烧灰吹入鼻中。九窍出血亦效。凡衄不宜即止，恐余血入胃，着于上焦为
血结胸证。直中少阴证，热行于里，先热后厥无汗，亦阴证似阳也，医不能识，强发其汗，必动其经，外则
筋惕肉 ，内则伏热逼血从耳目而出，或从口鼻而出，名曰阴血，是为下厥上竭，不治。但厥为下厥，血出于
上为上竭。轻者黄芩汤加生地之类，或当归四逆汤、黑锡丹救之。动经与鼻衄，微有不同如此。
吐血热积于中，并牙乃是肾胃相残。
汗乃心液，热则变红而逆出上窍，阳邪失汗，以致热毒入脏，化为瘀血，从口吐出，多属阳明。凡见目红
骨热，神昏狂谵，胸腹急满，皆血证也。热浅者，犀角地黄汤加黄芩、山栀、茅根、藕节，或小柴胡汤、黄连
柏皮汤。热深者，桃仁承气汤，三黄汤，抵当汤、丸。阳毒者，升麻汤；作渴者，五苓散，恐水入复吐故也，
或竹叶石膏汤，皆加川芎调血，炒山栀降火，危哉！又有阴证吐血，脉迟腹痛，厥逆呕吐紫黑色者难治，姑以
理中汤、甘桔汤加生姜汁半夏汤救之。又牙床属胃，牙齿属肾，如阳明传入少阴，二经相并，血出于牙缝如吐
者，人多不觉其为牙血，以凉水漱血则止，少顷又来者是，外用绿袍散，内服解毒汤合犀角地黄汤，或生地芩
连汤下之。轻者，清胃降火而已。
漏汗惊狂瘅痹，总是火邪逆；
火邪者，或不当汗而用火取汗，或汗不得而用火劫夺，以致火气熏蒸，精神昏愦，肢体不宁，体虚者，漏
汗不止，真阳脱亡。凡汗不得者，谓之亡阳；汗多不止者，亦谓之亡阳，如心痞胸烦，面青肤润者难治；色黄，
手足温者可治。因太阳证者，桂枝汤加附子；或汗下后，见吐逆者亦宜。因少阴证者，四逆汤；或便清干呕者，
甘草干姜汤；咽痛者，猪肤、甘桔汤。如少阴呃逆谵语，被火，小便难者，必滋其津液，竹叶石膏汤去半夏加
生地。或时倏然而起，惕然而惊，起卧不安若狂者，救逆汤。烦躁遗精者，桂甘龙骨牡蛎汤。体实者，虽不至
Fuyu (Qi stagnation) is caused by improper sweating; dry stool indicates excess syndrome, while hiccups indicate deficiency syndrome:
The face is governed by the Yangming channel. In cases of Yin excess, the face is red and dull; in cases of Yang excess, the face is red and lustrous. If the exterior syndrome's sweating is incomplete, causing pathogenic heat to stagnate and accumulate, the head and face become red. If severe, the heat steams into the skin, resulting in incomplete sweating and body itching, use Guizhi Mahuang Gemi Tang (Cinnamon Twig and Ephedra Half-Dose Decoction). For aversion to cold and fever, use Gegen Tang (Kudzu Decoction). If excessive sweating leads to jaundice, use Yinyin Tang (Artemisia Capillaris Decoction). For palpitations and fright, use Huoxie Tang (Fire Pathogen Decoction). For hard stool, indicating interior excess, use Daxiehu Tang (Major Bupleurum Decoction). Hiccups after purgation indicate stomach deficiency, treat with Guizhi Shenling Tang (Cinnamon Twig and Ginseng-Poria Decoction).
Daiyang (floating Yang floating upward) and floating fire rushing upward occur in Yin syndromes (such as dysentery and cold limbs), where true heat is slight but Yang heat is extreme (false heat due to extreme cold).
The *Baiwen* states: If a patient has slight body heat, a red face, and a pulse that is surprisingly deep and slow, it is a Yin syndrome. Slight body heat indicates interior cold; Daiyang means the face is red but not vibrant/lively, indicating lower jiao deficiency. If the physician fails to examine the pulse correctly, mistaking the floating deficiency Yang causing upper diaphragm heat and restlessness for excess heat, and uses purgatives followed by cooling herbs, Qi will dissipate leading to serious illness. Zhang Zhongjing recommends Lizhong Tang (Regulate the Middle Decoction) and Sini Tang (Reverse the Cold Decoction); Tao Hua recommends Yiyuan Tang (Benefit Origin Decoction). If it is a Yang syndrome with a red face, surging-large pulse, abdominal fullness, tidal fever, and constipation, use Daxiehu Tang or Chengqi Tang (Gut-Draining Decoctions).
Blindness, nasal congestion with roaring sound, vomiting, and epistaxis indicate severe binding of heat:
The *Nanjing* states: Depletion of Yin causes blindness. This means essence and blood are depleted and fail to nourish the eyes, causing blurred vision or total loss of sight. In Shanghan (Cold Damage), irritability and blindness may occur, and severely, epistaxis follows. This is because liver blood is bound by hot qi and flows recklessly upward, causing epistaxis. Once bleeding occurs, heat disperses with the blood and resolves. Use Mahuang Tang (Ephedra Decoction), or Mahuang Shengma Tang (Ephedra and Cimicifuga Decoction), or Jiuwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction). The reason for using Mahuang and Qianghuo in Shanghan epistaxis due to accumulated heat in the exterior is not to treat the bleeding itself, but to release the pathogen from the Taiyang channel. This is similar to the method of using Guizhi Tang (Cinnamon Twig Decoction) for Taiyang patients who have recently lost blood or suffered diarrhea. However, those prone to epistaxis strictly avoid sweating methods; if the pathogen is light, use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). Furthermore, the area near the nose belongs to Taiyang; near the eyebrow tail belongs to Shaoyang; facing the center of the face belongs to Yangming. Red vessels running from top to bottom indicate Taiyang disease; from bottom to top indicate Yangming disease; from outside to inside indicate Shaoyang disease. Heat causes red eyes, wind causes dizziness, cold causes eye pain. Huohuo disease prevents eye closure; Yin syndrome causes eye pain; Yin-Yang exchange disease causes visual flashes. The nose is the pathway for breathing clear Qi, connecting up to the Lung and down to the Bladder. Wind-cold obstruction causes nasal roaring and dry heaving, belonging to Taiyang disease, treated with Guizhi Tang; Taiyang-Yangming combined disease with dry nose and muscle heat is treated with Gegen Tang.
Crossing hands over the heart and deafness indicates catastrophic Yang depletion:
The *Nanjing* states: Depletion of Yang leads to seeing ghosts. Without Yang Qi, one sees dark, yin ghosts. After excessive sweating in Shanghan leading to Yang collapse, the patient crosses hands over the chest/heart and becomes deaf. Why? The ears belong to the Kidney; abundant Yang Qi connects upward for hearing, while deficient Yang Qi collapses downward causing deafness. Zhang Zhongjing says: When Shaoyin is affected, there is chest/hypochondriac fullness and deafness. Treat with Shaoyao Fuzi Gancao Tang (Peony, Aconite, and Licorice Decoction) or Huangqi Jianzhong Tang (Astragalus Building the Middle Decoction). Palpitations relieved by pressure are treated with Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction). Grasping at empty air and confusion are treated with Tao Hua's Shengyang Sanhuo Tang (Raise Yang and Scatter Fire Decoction). If early-stage Shaoyang wind-pathogen causes厥 (Jue/cold limbs) and deafness with ear ringing, use Xiaochaihu Tang (Minor Bupleurum Decoction); emetics and purgatives are strictly forbidden to avoid惊狂 (frightened mania). Hand-Taiyang heat-Jue deafness involves ear blockage, heat obstruction, bleeding, or pus, leading to chronic otitis media. Wet-warmth Shaoyin deafness is described earlier. Wind-pathogen entering the Kidney causes sudden ear pain with external chills/fever; if untreated, it becomes "Yellow Ear Shanghan" (acute mastoiditis/otitis), not to be treated as ordinary Shanghan. Internal treatment: Xiao Xuming Tang (Small Continuation of Life Decoction) or Baidu San (Defeat Poison Powder); External: Tiger Ear Grass juice dropped into the ear. If head sweat beads up without flowing, it is Yang collapse and death ensues.
Limbs are the extremities of Stomach Qi; progression from heat to warmth to cold reversal indicates transmitting Jue syndrome:
When Shanghan pathogens are in the Three Yang channels, limbs are hot; in half-exterior/half-interior and Taiyin, pathogens enter inward, limbs are warm; when transmitting to Shaoyin and Jueyin, pathogens sink deep internally, limbs become cold. Heat turning into Jue is "Transmitting Heat Jue". Mild cases: Sini San (Reverse the Cold Powder), Baihu Tang (White Tiger Decoction), Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction). Severe cases: Daxiehu Tang or Chengqi Tang to purge. If pathogen suddenly binds in the chest, causing irritability, anorexia, and Jue, use Goudi San (Melon Seed Powder) to vomit. The *Baiwen* states: Heat Jue differs from Cold Jue. Heat Jue involves slight coldness but subsequent fever; Cold Jue involves no fever, cold limbs, deep-thready pulse, incontinence, aversion to cold, and cyanotic nails. Failure to purge can cause blood stasis and limb Jue; misdiagnosing this as Yin Jue and administering Sini Tang is disastrous. Generally, Heat Jue presents with deep-slipping pulse, head sweat, warm palms/fingers, requiring purgation. This is Zhang Zhongjing's profound principle.
The tongue is the sprout of the Heart; color changes from white to yellow to dry black indicate loss of its original red hue.
The tongue is the Heart's sprout; Kidneys govern fluids. Healthy tongues are red and moist. Red star spots suggest impending jaundice. Dantian pathogenic heat withers the Heart sprout, creating white coating-like moss. Exterior pathogens have no coating; initial interior transmission has white slippery coating. Stomach cold with guest heat causing internal restlessness is treated with Zhizi Chihui Tang (Gardenia and Soybean Fermented Decoction) to induce vomiting. Yangming syndrome with stiff hypochondrium, constipation, vomiting, and white tongue coating should not be purged; use Xiaochaihu Tang to harmonize. With aversion to cold and phlegm vomiting, add Ginger to Xiaochaihu Tang. White slippery coating with diarrhea indicates Zang Jie (Organ Binding), which is untreatable. As heat deepens, coating becomes white and rough; deep stomach heat turns coating yellow, thick/glossy, or white-tip/yellow-root (exterior > interior), treated with Baihu Jiaren Tang (White Tiger plus Ginseng Decoction). Sweating in hands/feet/armpits, delirium, constipation, purple-black coating, prickles, or cracked coating require Chengqi Tang purgation. Black tongue has variations: red edges/gray-black center indicates missed purgation; black ring indicates prolonged pathogen; black tip indicates deficiency irritability; yellow with black center/tip indicates deep heat toxin; red frame/black center or white coating with black dots indicates unresolved exterior; root black/tip yellow with slipping pulse allows purgation, floating pulse allows sweating; black tip with chaotic pattern and slippery-solid pulse requires urgent purgation; rapid-weak pulse indicates fatal thirst. All black tongues are critical. Only cold/slippe/light-black indicates rootless deficiency fire, treatable with phlegm-resolving/fire-descending herbs. Yin syndrome with white coating, abdominal pain, spontaneous diarrhea: Lizhong Tang. Damp-bi with false coating indicates Dantian heat/Stomach cold, treat with Wuling San (Five-Ingredient Poria Powder).
No chills/fever but scorched lips often indicates blood stasis:
Absence of chills/fever, chest fullness, scorched lips, rinsing mouth without swallowing indicates impending epistaxis. Lower abdominal fullness, free urination, black stool indicates blood stasis in the lower jiao.
Lack of luster and blue lips indicate cold invasion:
Yin syndrome with chest/diaphragm fullness, lack of luster on face/lips, cold limbs: Lizhong Tang. Blue lips with sores indicate Huohuo disease.
Are dry mouth, parched mouth, and saliva different?
Dry mouth is caused by pathogenic heat gathering in the Stomach consuming fluids. Post-sweat dry mouth: Wuling San plus Zimu, Huangbai. Yangming dry mouth with intense heat, lockjaw, slight back aversion to cold: Baihu Jiaren Tang. Shaoyang dry mouth: Xiaochaihu Tang. Blood stasis dry mouth, rinsing without swallowing: Taoren Chengqi Tang. Parched mouth is also due to Stomach/Spleen heat drying fluids. Yangming parched mouth/throat with back aversion to cold/thirst: Baihu Jiaren Tang. Shaoyang bitter taste/parched throat: Xiaochaihu Tang or Shuangjie San. Shaoyin dry mouth/tongue: Chengqi Tang. Dry mouth/throat with silence/unwillingness to speak: Treat as Huohuo. Dry mouth forbids sweating. Saliva: Yangming heat makes saliva hot; Shaoyin cold makes saliva cold.
Qi rebellion, asthma, and shortness of breath are largely similar.
Qi rebellion is Qi rushing up from the abdomen. Taiyang without sweat/Yangming chest fullness: Sweat. Premature purgation in Taiyang allows exterior pathogen to enter deficient interior (no rebellion) or excess interior (rebellion); if pathogen remains exterior, re-sweat. Jueyin guest heat rushing to heart (interior heat, ascending Qi): Purge. Chest fullness/excess: Vomit. Post-sweat/purgation rebellion/dizziness: Fuling Guizhi Baizhu Gancao Tang. Post-illness weakness/short Qi/rebellious Qi/vomiting: Treat accordingly. Dongqi (Moving Qi) post-sweat rebellion: Treat accordingly. Asthma exists only in Taiyang and Yangming. Taiyang no-sweat asthma: Sweat. Yangming sweat-heavy asthma: Purge. Taiyang-Yangming combined chest fullness/asthma/aversion to cold: Sweat only, do not purge. Mild asthma due to unresolved exterior; asthma/fullness without aversion to cold: Purge. Post-sweat water retention asthma: Treat water. Post-sweat/purgation asthma: Treat accordingly. Yin syndrome severe asthma: Fanyin Dan. Deep pulse: Jiawei Shengmai San. Deep pulse + sweat + wet hair: Lung Qi exhaustion (fatal). Shortness of breath is discontinuous respiration, like asthma but without shoulder movement, like groaning but without pain. Classics: Mild deficiency binding causes shortness of breath. Insufficient breath is excess; insufficient Qi is critical. Causes include Jie Xiong (Binding Chest), water retention, wind-damp binding, constitutional weakness, or post-purgation weak pulse/Qi. Abdominal fullness is excess/interior; flaccid fullness is deficiency/exterior. Asthma/rebellion follow this logic.
Wet vomiting and dry vomiting require examining Liver/Kidney signs.
Wet vomiting has substance and sound, occurring after eating; dry vomiting is empty retching. Both involve Yangming Qi/Blood pathology, making vomiting heavier than spitting. Heat vomiting: bitter taste, thirst, rapid pulse, hot palms/body. Cold vomiting: headache, chest fullness, cold limbs, frothy spit, slow pulse. Wet vomiting results from exterior pathogen entering interior, causing rebellious Qi, common in half-exterior/half-interior syndromes. Three Yang fevers: Xiaochaihu Tang plus Ginger. Chest fullness worsening at dusk + Mangxiao: Add Mangxiao. Unstoppable vomiting + constipation: Daxiehu Tang. Frequent vomiting despite Yangming signs with weak Stomach (cannot purge): Ganjie Tang. Thirst: Vomiting then thirst indicates recovery, use Zhu Ling Tang; Thirst then vomiting indicates water retention, use Chi Fuling Tang. Vomiting immediately after drinking: Wuling San. Deficiency irritability/thirst: Zhuye Shigao Tang plus Ginger juice, or Zhizi Chihui Tang. Upper heat/Lower cold vomiting: Huanglian Tang. Stomach cold diarrhea/cold limbs/no thirst: Lizhong Tang minus Baizhu plus Ginger juice, or Zhengqi Tang plus Ginger juice. Shaoyin three syndromes: Cold fluid above diaphragm, vomiting saliva, or vomiting/diarrhea with thirst: Sini Tang plus Ginger. Deep pulse, cough/palpitations with water-Qi: Xuanwu Tang minus Fuzi plus Ginger juice. Cold limbs, warm feeling wanting to vomit but unable, helpless: Shengjiang Banxia Tang (Ginger Rhizome and Pinellia Decoction). Post-sweat/purgation deficiency: Ganjiang Qinlian Renshen Tang. Post-sweat inability to keep food/water: Critical, use Xiao Banxia Tang. Warm-toxin vomiting with chest stuffiness/rash: Treat rash. Water-syndrome vomiting with palpitations: Treat water. Vomiting pus/blood with foul smell rising: Self-resolves after vomiting. Dry vomiting due to Stomach heat combining with grain Qi steaming upward, causing epigastric oppression, preventing egress/ingestion: Huanglian Jiedu Tang. Taiyang no-sweat dry vomiting due to wind-pathogen obstruction: Guizhi Tang. Taiyang-Yangming combined no-diarrhea but vomiting/dry vomiting due to interior excess/rebellious Qi: Gegen Tang. Stomach cold/fluid-depletion dry vomiting/thirst: Lizhong Tang. Shaoyin three syndromes: Dry vomiting/diarrhea with faint pulse: Baitong Tang. Interior cold/external heat, faint/nearly absent pulse: Tongmai Sini Tang. Unstoppable diarrhea, irritability, cold limbs, absent pulse: Baitong Jia Zhuyedan Tang (Baitong plus Pig Gallbladder Bile Decoction). Jueyin headache/dry vomiting/phlegm, or spontaneous diarrhea/cold limbs/irritability: Sanwei Shanyu Tang. Chest sensation like asthma/vomit/hiccup but none fully present, helpless: Shengjiang Banxia Tang, Dajupi Tang, Xiaojupi Tang.
Vomiting fishy or sour tastes generally stems from Stomach heat/cold.
Vomiting has substance but no sound, immediate expulsion after eating. Danxi attributes this to Taiyang blood pathology, but Stomach excess dominates. Fishy-smelling vomit/diarrhea is cold; sour/stinky is heat. Treatment aligns with vomiting/hiccups. Vomiting with soft/painful legs indicates Hong Kong Foot (Beriberi). Weak pulse, free urination, slight fever/cold limbs during vomiting indicates extreme deficiency (hard to treat).
Hiccups and choking result from water-cold binding.
Hiccups are dry heaves with heavier/longer sounds; choking is Qi blockage in the chest. Floating Stomach pulse indicates choking; slippery indicates hiccups. Caused by deficient Stomach Qi, excessive sweating/purgation, or cold drinks binding water-cold, causing rebellious Qi. Lizhong Tang plus Rougui, Dingxiang to disperse cold/downbear Qi; Fuling, Banxia to resolve water. Persistent hiccups: Ju Pi Ganjiang Tang, Ju Pi Zhuru Tang. Heat obstruction blocking upper/lower Qi: Xiaochaihu Tang plus Ginger. Severe heat/constipation: Xiao Chengqi Tang. Soft stool: Select Xiexin Decoctions. Warm disease thirst/cold drink-induced hiccups: Shengma Gegen Tang plus Maogen. Banxia resolves Qi knots in vomiting/hiccups; Zhuru astringes Stomach/resolves irritability; Ginger disperses rebellious Qi. Since all stem from Qi rebellion, Ginger is the sage herb; for heat, use Wu Mei Wan.
Hiccups also have Yin and Yang aspects.
Historically confused with cough or stuttering. Yu Huaxi notes "E" connects to "Kai", meaning ascending rebellious Qi. Some confuse hiccup with hiccups; hiccups exhale then inhale, hiccups inhale sound then exhale. Vomiting/hiccups originate in Stomach; hiccups originate in Lungs. Grain enters Stomach, Stomach Qi ascends to Lungs; cold attacking new grain causes Qi conflict returning to Stomach, creating belching sounds. Danxi argues it is Minister Fire rising from below, interacting with Jueyin, water-fire binding creating sound. Yang syndrome: Fever, bitter taste, chest fullness, string-taut-rapid pulse: Xiaochaihu Tang plus Zhuru. Urinary obstruction: Add Fuling or Zhu Ling Tang. Constipation: Tiaowei Chengqi Tang. Shaoyin missed purgation, abdominal fullness/constipation or pure clear water diarrhea with hiccups: Xiao Chengqi Tang. Yangming fever/thirst, chest fullness/irritability, surging-rapid pulse with hiccups: Fire rushing to Lung, Gancao Xiexin Tang. Yin syndrome: Soft stool/Stomach cold, or extreme deficiency from vomiting/purgation, aversion to cold/fine pulse: Ju Pi Ganjiang Tang. Internal cold/cold limbs: Qianghuo Fuzi Tang, Dingxiang Shidi San, adjusted Suhexiang Wan. Stomach cold/water binding: Xiao Qinglong Tang minus Mahuang plus Fuzi. Cold limbs: Xiaojupi Tang. Chest fullness/deficiency irritability: Dajupi Tang. Hiccups generally benefit from Chenpi, Zhuru, Ginger juice. Recovery via proper sweating/Yin-Yang regulation heals. Food stagnation, urinary obstruction, phlegm-water rushing upward, abdominal fullness/inability to urinate, sinking-micro-scattered pulse indicate death. Vomiting, hiccups, and hiccups share similarities; water-Qi affects both exterior/interior presenting these five syndromes.
Epistaxis is heat forcing blood from the nose; damaging channels leads to Jue exhaustion (untreatable):
Excessive heat in channels forcing blood from nose is Epistaxis, mostly Taiyang, called Yang Blood. Dripping/not flowing indicates unresolved exterior; use acrid-cool herbs to release exterior, Jiawei Qianghuo Tang plus Chishao, or Shengma Gegen Tang plus Huangqin, or Mahuang Shengma Tang, Shuangjie San. Thirst: Wuling San. Irritability: Zhuye Shigao Tang to scatter channel heat. Zhang Zhongjing: Shanghan floating-tight pulse, failure to sweat causing epistaxis, treated with Mahuang Tang. No exterior signs, flowing epistaxis, or post-sweat/post-purgation bleeding: Self-resolves. Unstopping: Xijiao Dihuang Tang, Tao Hua Shengdi Qinlian Tang, Huangqin Tang, Maohua Tang. External: Cold wet paper on Taiyang acupoint (replace when warm), or Baicaoshuang/Fetal bone ash blown into nose. Effective for nine orifices bleeding. Do not stop epistaxis immediately to prevent residual blood entering Stomach causing Blood Binding Chest. Direct Shaoyin invasion, heat in interior, initial heat then cold/no sweat, Yin syndrome mimicking Yang: Misidentified as Yang, forced sweating damages channels, causing external muscle twitching/internal latent heat forcing blood from eyes/ears/mouth/nose, called Yin Blood, Lower Jue Upper Exhaustion (untreatable). Jue is Lower Jue; blood from above is Upper Exhaustion. Mild: Huangqin Tang plus Shengdi, or Danggui Sini Tang, Heixi Dan. Channel damage vs. nasal epistaxis differs slightly.
Hematemesis is heat accumulating in the middle; gum bleeding is Kidney-Stomach mutual destruction.
Sweat is Heart fluid; heat turns it red and forces it out upper orifices. Yang pathogen failing to sweat allows heat-toxin to enter Zang, transforming into blood stasis vomited from mouth, mostly Yangming. Red eyes, bone heat, confusion/manic delirium, acute chest/abdominal fullness indicate blood syndromes. Shallow heat: Xijiao Dihuang Tang plus Huangqin, Shanzhi, Maogen, Ou jie, or Xiaochaihu Tang, Huanglian Bopi Tang. Deep heat: Taoren Chengqi Tang, Sanhuang Tang, Didang Tang/Wan. Yang Du (Toxic Heat): Shengma Tang. Thirst: Wuling San (fear of water rejection) or Zhuye Shigao Tang, all plus Chuanxiong to regulate blood, fried Shanzhi to descend fire. Dangerous! Yin syndrome hematemesis: Slow pulse, abdominal pain, cold limbs, vomiting purple-black blood is hard to treat; temporarily use Lizhong Tang, Ganjie Tang plus Shengjiang Banxia Tang. Gums belong to Stomach, teeth to Kidney. Yangming transmitting to Shaoyin, two channels merging, blood from gums like vomiting: Often mistaken for other bleeding; stops with cool water rinse but returns. External: Lv Pao San; Internal: Jiedu Tang combined with Xijiao Dihuang Tang, or Shengdi Qinlian Tang. Mild: Clear Stomach, descend fire.
Leaking sweat, fright/mania, damp-heat bi always stem from Fire Pathogen rebellion:
Fire Pathogen arises from inappropriate fire-induced sweating or fire-forced sweating when sweat cannot occur, causing fire vaporization, mental confusion, restlessness. In the weak, leaking sweat continues, True Yang collapses. Inability to sweat is Wang Yang (Yang Collapse); excessive sweating is also Wang Yang. Chest palpitations/irritability, blue face/moist skin: Hard to treat. Yellow face/warm limbs: Treatable. Taiyang origin: Guizhi Tang plus Fuzi; or post-sweat/purgation vomiting: Also suitable. Shaoyin origin: Sini Tang; or clear stool/dry heaving: Gancao Ganjiang Tang; sore throat: Zhufu Tang, Ganjie Tang. Shaoyin hiccups/delirium post-fire, difficult urination: Nourish fluids, Zhuye Shigao Tang minus Banxia plus Shengdi. Sudden rising, startled fear, restless like mania: Jiuni Tang. Irritability/enuresis: Guigan Longgu Muli Tang. Strong constitution...