亡阳，然内火外火相并，热发于外则身必发黄，热搏于内则小便必难，惊狂谵语，烦躁不已，或一身尽痛，甚
则手掉足动，循衣摸床者死。如小便利者可治。通用，柴胡龙骨牡蛎汤、火邪汤。或下清血、或因燥唾血者，
犀角地黄汤。发黄瘅者，茵陈汤。若太阳证，宜汗而反用火灸者，
其邪无从而出，病当腰下重痹，麻杏薏甘汤散之。
谵语郑声虚实，全凭水道看。
谵者，妄也。或闭目言平生常事，或开目言人所未见事，或独语，或睡中呢喃，或呻吟不已，甚则狂言恶
骂，俱谓之谵语。皆因胃热乘心，故脉来洪数，二便多闭，外见阳证。有阳明汗多谵语，少阴自利谵语者，
内有燥屎也，调胃承气汤下之。半表里默默不欲语，及已得汗而身和亡阳谵语者，柴胡桂枝汤调之。已下胸
烦身重不可转侧谵语者，柴胡龙骨牡蛎汤。错语、独语、呻吟者，解毒汤、单泻心汤，或白虎汤和之。又有汗
多谵语者，风也，俟过经乃可下。瘥后谵语者，邪留心胞也，知母麻黄汤。如气逆下利，厥冷而脉又沉细者死；
身热脉大，声清气朗，目光面润者生。瘀血、亡阳、合病、湿温、热入血室、火邪谵语，见各条。郑者，重也。
言语重复不已，声音模糊，有如郑卫不正之音，皆因汗下后及风温发汗过多，以致表虚里竭，精气夺而神昏舌
短，故脉息沉微，二便多利，外见阴证，白通汤救之，或单人参汤亦可。故曰谵语实则可下，虚不可为。实者，
胃实有燥屎也；虚者，胃虚肠自利也，全凭水道断之。
咽痛有热无热，肾伏暴寒下必利；
太阴络咽，少阴络喉，热邪乘之，乃生咽痛。若汗下过多，虚而生热，亦能咽痛。有少阴身热腹痛，脉
沉咽痛或不食呕吐者，黄连龙骨汤。少阴客热咽痛者，单甘草汤。寒热相搏及亡阳咽痛者，猪肤汤、甘桔汤。
二便难者，甘桔汤加玄参、枳壳，顺导黑臭之物，续以甘草、生姜煎汤频与之，以解其毒，或陶氏芩连消毒
饮。阳毒发斑，吐血咽痛者，玄参升麻汤。阳厥宜下反发汗，则口疮赤烂，内服升麻六物汤，外用蜜渍黄柏汁
含之。咽喉闭塞者，乌扇汤。声音不出者，鸡壳苦酒汤。有少阴咽痛，无热下利，四肢厥冷者，甘桔汤；厥冷
吐利，脉沉者，猪肤汤；厥冷下利不止者，四顺汤、丸，或通脉四逆汤加桔梗，不可汗下；有汗者， 本末扑
之。又有肾伤寒一证，乃非时暴寒伏于肾经，初起头痛腰痛咽痛，次即下利，脉微弱者，先用半桂汤，次用四
逆汤主之。伤寒六七日，大下后，脉迟不至，咽痛吐脓血，厥冷利不止者死，麻黄升麻汤救之。
脏结有痞无痞，脐痛引阴生必难。
脏结与结胸相似，皆下后邪气入里。与阳相结，结在胸者为结胸；与阴相结，结在脏者为脏结。惟其阴结，
故脏结无阳证，不往来寒热，或但寒而不热，其人反静，饮食如常，时时下利，舌上白苔，胁肋脐腹引入阴筋
俱痛者，丹田有热，胸中有寒，所以难治。又病患胁下素有痞气，再加伤寒邪气与宿积相合，使真脏之气闭结
而不通，亦名脏结。不问有痞无痞，慎不可下。邪未全成，热犹在表，止宜小柴胡加生姜以和表，灸关元穴
以回阳而解阴气之结，危哉！
结胸下早而紧痛，大小寒热宜细辨；
伤寒太阳证，下之早而表邪乘虚客于上焦少阳之分，名曰结胸。当心紧痛而烦，水浆不入，但能仰而
不能俯，其表邪又不散，故项强如柔 状。有大结胸者，不按而痛，胸连脐腹痛硬，手不可近，不大便，日晡
热潮，大陷胸汤、丸。有小结胸者，按之方痛，只心下硬，小陷胸汤。有寒实结胸者，身不热，口不渴，但心中
胀硬而痛，枳实理中丸、五积散，甚者三物白散。有热实结胸者，心下满硬，懊 烦躁而渴，柴陷汤，甚者大
陷胸汤。有水结胸，血结胸，阴毒、阳毒结胸，见各条。结胸，脉浮大者，不可下，下之即死。结胸证具而烦
躁者，死。结胸见阴脉、阴证及喘急呃逆者，亦死。若未经下而胸满者，乃半表里吐证，不可误作结胸。
痞气下早而虚满，硬濡哕利更易安。
伤寒半表证，下早而邪入于中焦太阴之分，而成痞气，按之濡而不痛，比之结胸更轻。有胸满而硬，
呕吐下利者，里实有水也，大柴
胡汤。心痞引胁下痛，干呕者，十枣汤。汗出恶寒者，附子泻心汤。有胸满而濡，胁肋胀满者，虚邪气聚耳，
小柴胡汤加干姜、牡蛎各一钱。胃虚气逆者，半夏泻心汤。有心痞哕噫者，胃不和也，汗出，胁有水声雷鸣者，
生姜泻心汤。心痞哕噫不止者，旋复代赭石汤。有下利者，里虚也，谷不化腹鸣者，甘草泻心汤。或已数下，
表邪入里干于肠胃，遂成下利而心下痞硬者，谓之表里不解，桂枝人参汤。下利不止者，赤石脂禹余粮汤。又
结胸、痞气，关脉皆沉，如关浮恶热心痞者，乃肝热，非痞也，三黄泻心汤。心痞而口渴溺涩，服泻心汤不
效者，乃停水，非热痞也，五苓散。凡痞气服诸泻心汤，而热不除者，亦须大陷胸汤、丸下之。但结胸与痞虽
宜下，如脉浮恶寒有表者，须柴胡桂枝汤，或柴陷汤解表，必表证悉罢，关尺沉滑紧实者，方可下之。下后病
犹不退者，乃下虚气逆上攻，枳实理中丸和其胃气。初起未成痞结之际，虚者亦宜枳实理中丸，实者枳梗汤、
槟榔汤疏气，然后随证用药。胃冷厥逆者，俱宜理中四逆和胃，待日久邪不退而后议下。是结胸、痞气始末用
药俱同，但中间用药略有轻重之殊耳，不识前辈分阴阳二证谓何。陶氏又以伤风为阳，伤寒为阴；王氏又以痞
气乃阴证有表者，皆于理未协。要之皆传经阳证，但下后胃寒而用药有宜温者，若邪盛胃实，方可寒凉下之，
二证皆然。且考《伤寒论》正文云∶太阳少阳并病而反下之，成结胸，心下痞硬。入里则为痞气，初未尝分阴
阳也。设有阴证误下，不死而结胸、痞气者，亦当以阴毒结胸法治，安敢又用三黄泻心等剂耶！以此论之，谓
阴阳二证俱有结胸痞气则可，谓阳证为结胸，阴证为痞气则不可，又用寒凉药治阴证，尤不可，知者裁之。又
心下妨闷，不满不硬者，谓之支结。表未解者，柴胡桂枝汤。胸胁满而微结者，小柴胡加干姜、牡蛎各一钱。
表里俱不解者，桂枝人参汤。
客热懊 时发躁，
懊，心中不自如也，比躁更甚。表证误下，阳气内陷，心下固硬者，则为结胸。胃气空虚，客热在膈，
短气烦躁，微疼，则为懊 。将成结胸者，宜大、小陷胸汤。但懊 ，烦不得眠，饥不能食，头汗出而不结胸
者，栀豉汤。腹胀，坐卧不安者，栀子浓朴汤。渴者，白虎汤。阳明证下后懊 者，内有燥粪，犹宜承气汤下
之。懊 小便难者，必发黄，茵陈汤，
内虚动悸必生烦。
悸，动也。心膈间客邪乘之，筑筑然触动。如人将捕，即怔忡意也。有水停心下，头眩身摇，厥而悸者，
渗其水而悸厥自定。有神气素虚，心中空耗不能自持者。有汗下后内虚而悸者，比之素虚者尤甚，须先定其气，
而后治其悸。大约先烦后悸者为虚，小建中汤、玄武汤、脉代者，炙甘草汤入酒少许；汗后冒眩者，桂枝甘草
汤。先悸后烦者为热，小柴胡汤；喜呕，谵语，大便难看，小柴胡汤加大黄、或加芒硝少许；谵语，小便不利
者，柴胡龙骨牡蛎汤；小便赤者，五苓散。
胸满多带表肌证，
胸满者，未经下而胸膈气寒满闷，非心下痞气，亦非结胸也。盖外邪自皮毛传入胸中，少阳所属，半表
里证也，柴梗汤主之。谵语身痛者，柴胡龙骨牡蛎汤。有痰气逆上抢心者，栀豉汤，或加甘草、生姜。误下脉
促者，桂枝汤去芍药。喘者，麻杏甘石汤。胃虚者，半夏泻心汤。满硬便闭属脏者，方可议下。寻常胸膈不利，
多挟痰气食积者，柴陈汤、枳梗汤调之。
胁满半居表里间。
胁满，非腹中满也，乃胁肋下胀满，半表半里之间，多耳聋干呕，寒热往来，默默不欲食，少阳所主，小
柴胡汤和之。如太阳未罢，项强者，小柴胡加干葛。阳明便闭舌苔者，柴梗汤。挟痰热者，柴梗半夏汤。有水
证及脏结胁满者，见各条。
腹胀里有邪，阳闭潮而阴利厥；腹胀里未净，吐下实而汗后虚。
伤寒外邪，自表分皮肤肌肉，而入于胸膈胁肋，为半表里，直至传入胃腑，乃为入里。是腹胀虽属太阴，
而里证尚浅，未全入腑，犹宜和之。惟腹满硬不减，咽干口燥，便闭者，乃阳邪入里，方可下之。若腹满濡时
减，吐利厥冷者，乃里寒阴证，速宜温之。又汗后满者，外已解而里亦不实，乃脾胃津液不足，气涩不通，壅
而为满，宜浓朴半夏甘参汤以温散之。吐下后满者，表邪未净，乘虚入里，以致上下气不通和，宜大柴胡汤
加浓朴量下之，或栀子浓朴汤量吐之。合病胀者，身重痛，口顽麻，白虎汤加减。通用，柴梗汤、柴梗半夏汤。
凡胀满，忌用白术闭气。如腹胀，喘而不尿；脉涩者死。
腹痛热闭冷利，皆邪入里相搏；
寒热邪气入里，与正气相搏则腹痛。阳证不可按揉，大便闭者为热。表证误下，表里俱病者，桂枝加
芍药汤，甚者加大黄。半表里证者，小柴胡汤去芩加白芍。表里俱热者，大柴胡汤。绕脐腹痛满实，手不可近
而便闭者，内有燥屎也，大承气汤。经曰∶痛随利减是也。热厥泄泻者，四逆散。上热下寒欲吐者，黄连汤。
虚烦者，栀豉汤加浓朴、枳实。阴证可按与揉，痛无休息，肠鸣而大便利者为冷。太阴理中汤、黄 建中汤；
少阴四逆汤、玄武汤；厥阴正阳散、当归四逆汤。太阴连小腹痛甚，自利不止者难治。又大腹属太阴，脐腹
属少阴，脐下属厥阴，多有挟食积与痰火者。
脐满热瘀冷结，有物非气为辜。
心胸与大腹满者，皆外邪传入。惟小腹胀满者，非血瘀，便是溺涩。血结膀胱者，小便自利；热结膀胱
者，小便自涩。又有冷结膀胱，小便亦涩，但手足厥而胸不满为异。宜外灸关元穴，内服玄武汤。
妄施三法动积气，奔豚上冲尤甚；
其人先有五积在脐中，或脐上下左右，复因伤寒邪气冲动，新邪与旧积相搏而痛。或医人不识病者原有
痞积，妄施汗吐下，发动其积气，筑筑然跳动，名曰动气。动右肺气，则咽干鼻燥衄渴，饮即吐水；动左肝气，
则筋惕肉 ，身热欲蜷；动上心气，则掌热作渴，气上冲心；动下肾气，则心烦骨痛，食则呕吐，或下利清
谷。大概虚者，通用理中汤去白术加肉桂。头眩惕 ，汗多者，防术牡蛎汤、小建中汤；腹满身微热，欲蜷者，
甘草干姜汤；心烦骨痛，吐食者，大橘皮汤。热者，通用柴胡桂枝汤。烦渴者，竹叶石膏汤；衄血烦渴者，五
苓散；心痞下利清谷者，甘草泻心汤；气上冲心者，李根汤。五积惟脐下奔豚冲心最甚，多因汗下心虚而肾气
乘虚上冲，有若江豚拜浪然，桂枝汤加桂一倍。若不上冲者，不可妄与。脐下动甚，头眩身振者，茯苓桂甘大
枣汤，吐后去枣加白术。盖白术闭气，止可暂用，惟桂泻奔豚，苓伐肾邪，奔豚妙药也。
邪犯三焦成霍乱，吐利不发则殂。
三焦，水谷道路。邪在上焦，吐而不利；邪在下焦，利而不吐；邪在中焦，上吐下利。病因饮食不节，清浊
相干，阴阳乖隔。轻者止曰吐利，重者， HT 扰乱，乃曰霍乱。外证必发热恶寒，头疼身痛，本伤寒病也，因
邪入脾胃，故发为吐利。然中焦为寒热之半，邪偏高居阳分者，则多热而渴，五苓散分利之；邪偏下居阴分者，
则多寒不渴，理中汤分利之。风寒湿胜者，藿香正气散、除湿汤、五积散。穿合暑胜大渴者，二香黄连散、益
元散、柴苓汤选用。伤食甚者，平胃散、治中汤主之。转筋者，气不和也，俱加木瓜，或单用鸡屎白，略炒为末，
温汤化下方寸匕。凡霍乱多责于热，故夏秋为盛，或热伏于内，手足如冰，六脉沉伏，食即呃逆，此火气上奔
而然，不可误为阴证。必吐利，小便亦自利而大汗出，下利清谷，寒热，四肢拘急厥逆，脉微欲绝，乃为阴证，
四逆汤或加吴萸、生姜救之。少阴吐利，烦躁欲死者，三味参萸汤。吐利止，自汗厥逆不渴，脉微欲绝者，
通脉四逆汤加猪胆汁；吐利止，身痛不休者，桂枝加参汤；吐利止，发热者，随证微汗之；吐利止，亡津而渴
者，竹叶石膏汤、白虎加参汤。吐利不止者，灵砂丹，木香、干姜煎汤下。凡霍乱不可遽与米饮粥饭等食以助
邪气，必所伤物尽，然后淡食少少养之。伤寒心痞，发热吐利者，大柴胡证也，不可误为霍乱。干霍乱者，气
痞于中，欲吐不得吐，欲泄不得泄，所伤之物壅闭正气，关格阴阳，烦躁喘胀者必死，急以盐汤一盏入童便、
姜汁顿服，探吐令透，未吐再服。外用盐炒吴萸熨脐下。即以理中汤加陈皮调之，或藿香正气散加官桂倍枳壳、
茯苓、木瓜，吞苏合香丸。如发热头腹痛者，桂枝加大黄汤。
大便闭本里热，而带表属阴未可攻下；
论云∶阳结能食，不大便者，即里热证，言阳气固结于肠胃。盖病邪在表则大便如常，邪传入肠胃之里，
Yang collapse, yet internal fire and external fire combine. If heat erupts externally, the body will inevitably turn yellow; if heat combats internally, urination will inevitably become difficult. Manifestations include fright, mania, delirium, and incessant irritability. Or there may be pain throughout the entire body, and in severe cases, tremors of the hands and feet, picking at clothes or bedclothes—these are signs of death. If urination is free, the condition is treatable. The general formulae are Chaihu Longgu Muli Tang (Bupleurum, Dragon Bone, and Oyster Shell Decoction) and Huoxie Tang (Fire Evil Decoction). If clear blood (hematochezia) occurs due to premature purgation, or if expectoration of blood occurs due to dryness-heat, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) should be used. For jaundice, Yinyin Tang (Artemisia Capillaris Decoction) is indicated. If it is a Taiyang syndrome where sweating was required but moxibustion was wrongly applied, the pathogen has no outlet, and the disease manifests as heaviness and numbness below the waist; Maxing Yigan Tang (Ephedra, Apricot Kernel, Coix Seed, and Licorice Powder) should be used to disperse it.
The deficiency and excess of delirium (Zhenyu) and repetitive speech (Zhengsheng) are determined entirely by observing urinary flow.
"Zhen" implies madness. One may speak nonsense with eyes closed about past events, or with eyes open about things never seen; one may speak alone, mutter in sleep, or groan incessantly. In severe cases, one may shout wildly and curse—all are termed "delirium" (Zhenyu). These arise because stomach heat assaults the heart, resulting in a flooding and rapid pulse, blockage of both bowels and bladder, and external manifestation of Yang syndromes. There are cases of Yangming syndrome with excessive sweating leading to delirium, and Shaoyin syndrome with spontaneous diarrhea leading to delirium; these indicate dry fecal matter inside, treated with Tiaowei Chengqi Tang (Regulate the Stomach and Order Qi Decoction) to purge. For half-exterior/half-interior symptoms of silence and unwillingness to speak, or for delirium after sweating where the body feels harmonious but Yang has collapsed, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) is used to harmonize. After purgation, if there is chest irritability, body heaviness preventing turning, and delirium, Chaihu Longgu Muli Tang is indicated. For confused speech, solitary talking, or groaning, Jiedu Tang (Detoxification Decoction), Dan Xiexin Tang (Single Heart-Purging Decoction), or Baihu Tang (White Tiger Decoction) are used to harmonize. For delirium caused by excessive sweating due to wind, one must wait for the pathogen to pass through the meridians before purging. Delirium after recovery indicates pathogen lingering in the pericardium, treated with Zhimu Mahuang Tang (Anemarrhena and Ephedra Decoction). If there is rebellious qi, diarrhea, cold limbs, and a deep, fine pulse, it is fatal; if there is body heat, large pulse, clear voice, bright eyes, and moist complexion, survival is likely. Delirium caused by blood stasis, Yang collapse, combined diseases, damp-warmth, heat entering the blood chamber, or fire evil is detailed in respective sections.
"Zheng" implies repetition. Speech is repeated incessantly, voice is muffled, resembling the improper sounds of Zheng and Wei. This results from excessive sweating and purgation, or excessive sweating in wind-warmth, leading to exterior deficiency and interior exhaustion, depletion of essence and qi, mental confusion, and short tongue. The pulse is deep and faint, bowel and bladder movements are frequent, and external Yin syndromes manifest. Baotong Tang (Brighten the Interior Decoction) saves the condition, or Dan Ren Shen Tang (Single Ginseng Decoction) may also be used. Thus, it is said: Excess delirium can be purged, but deficiency cannot. Excess means stomach fullness with dry feces; deficiency means stomach weakness with spontaneous intestinal diarrhea. Judgment relies entirely on urinary flow.
Sore throat with or without heat: if kidney-hidden sudden cold causes diarrhea...
The Taiyin meridian connects to the throat, and the Shaoyin meridian connects to the larynx. Heat pathogens assaulting these areas cause sore throats. If sweating and purgation were excessive, leading to deficiency-generated heat, a sore throat can also occur. For Shaoyin syndrome with body heat, abdominal pain, deep pulse, sore throat, anorexia, or vomiting, Huanglian Longgu Tang (Coptis, Dragon Bone, and Licorice Decoction) is used. For Shaoyin exogenous heat causing sore throat, Dan Gancao Tang (Single Licorice Decoction) is used. For cold-heat combat and Yang-collapse sore throat, Zhufu Tang (Pig Skin Decoction) and Ganjie Tang (Licorice and Platycodon Decoction) are used. For difficulty in urination and defecation, Ganjie Tang is modified with Xuanshen (Scrophulariae Radix) and Zhike (Aurantii Fructus) to guide out dark, foul matter, followed by frequent administration of Gancao (Licorici Radix) and Shengjiang (Zingiberis Rhizoma Fresh) decoction to resolve toxicity, or Taoshi Qinlian Xiaodu Yin (Dr. Tao's Scutellaria, Coptis, and Detoxification Infusion). For Yang-toxin macules, hematemesis, and sore throat, Xuanshen Shengma Tang (Scrophularia and Cimicifuga Decoction) is used. For Yang-jue requiring purgation but wrongly subjected to sweating, resulting in mouth ulcers and red erosion, take Shengma Liuwu Tang (Cimicifuga Six-Ingredient Decoction) internally, and apply honey-soaked Huangbai (Phellodendri Cortex) juice externally for gargling. For throat obstruction, Wushan Tang (Iris Decoction) is used. For loss of voice, Jiqiao Kujiu Tang (Chicken Shell and Vinegar Decoction) is used. For Shaoyin sore throat without heat but with diarrhea and cold limbs, use Ganjie Tang; for cold limbs, vomiting, diarrhea, and deep pulse, use Zhufu Tang; for cold limbs and unceasing diarrhea, use Sishun Tang/pills or Tongmai Sini Tang (Unblocking the Pulse and Counter-Cold Decoction) plus Jiegeng (Platycodonis Radix); sweating and purgation are contraindicated. If sweating is present, apply Benmo Puzhi (local application method). Another condition is Kidney Cold Damage, where sudden non-seasonal cold hides in the Kidney meridian. Initially presenting with headache, lower back pain, and sore throat, followed immediately by diarrhea and a weak pulse, Ban Gui Tang (Half Cinnamon Twig Decoction) is used first, followed by Sini Tang (Counter-Cold Decoction). In Cold Damage, after six or seven days and heavy purgation, if the pulse is slow or absent, with sore throat, pus-blood expectoration, cold limbs, and unceasing diarrhea, it is fatal; however, Mahuang Shengma Tang (Ephedra and Cimicifuga Decoction) may attempt rescue.
Zang-Jie (Organ Knotting) presents with or without epigastric fullness; umbilical pain radiating to the genitals indicates difficulty.
Zang-Jie resembles Jie-Xiong (Chest Binding), both occurring after erroneous purgation allowing pathogens to enter the interior. Binding with Yang in the chest is Jie-Xiong; binding with Yin in the organs is Zang-Jie. Because it is a Yin binding, Zang-Jie lacks Yang symptoms: no alternating chills and fever, or only chills without fever; the patient is quiet, eats normally, has occasional diarrhea, white tongue coating, and pain radiating from hypochondrium, umbilicus, and abdomen to the genital tendons. With heat in the Dantian and cold in the chest, it is difficult to treat. Additionally, if a patient has chronic epigastric masses (Pi-Qi) and contracts Cold Damage, the new pathogen combines with old accumulation, closing off the true organ Qi, also named Zang-Jie. Regardless of presence of mass, purgation is strictly forbidden. If the pathogen is not fully formed and heat remains in the exterior, Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Shengjiang should be used to harmonize the exterior. Moxibustion on Guanyuan (CV-4) acupoint should be applied to restore Yang and resolve Yin binding. How dangerous!
Jie-Xiong results from premature purgation causing tight pain; minor and major, cold and heat must be carefully distinguished.
In Taiyang Cold Damage, premature purgation allows exterior pathogens to invade the upper Jiao and Shaoyin division, named Jie-Xiong. There is tight pain in the heart region with irritability, inability to swallow fluids, ability to lie supine but not prone, and persistent exterior pathogen causing neck stiffness similar to Rou-Jing (Soft Spasm). Major Jie-Xiong involves pain without pressure, hardness extending from chest to umbilicus and abdomen, intolerance to touch, constipation, and afternoon tidal fever; Da Xianxiong Tang/Pills (Major Chest-Binding Decoction/Pills) are used. Minor Jie-Xiong involves pain only upon pressure, hardness only in the epigastrium; Xiao Xianxiong Tang (Minor Chest-Binding Decoction) is used. Cold-excess Jie-Xiong involves no body heat, no thirst, but distension, hardness, and pain in the heart region; Zhishi Lizhong Wan (Immature Bitter Orange and Polemonium Pill) or Wuji San (Five Accumulations Powder) are used, or Sanwu Baisan (Three-Ingredient White Powder) for severe cases. Heat-excess Jie-Xiong involves epigastric fullness and hardness, vexation, irritability, and thirst; Chai Xian Tang (Bupleurum and Chest-Binding Decoction) is used, or Da Xianxiong Tang for severe cases. Water-binding, blood-binding, Yin-toxin, and Yang-toxin Jie-Xiong are detailed in respective sections. For Jie-Xiong with floating, large pulse, purgation is contraindicated; purging leads to death. If Jie-Xiong symptoms are complete with irritability, it is fatal. If Jie-Xiong presents with Yin pulse, Yin symptoms, panting, or hiccups, it is also fatal. If there is chest fullness without prior purgation, it is a half-exterior/half-interior vomiting syndrome, not Jie-Xiong.
Pi-Qi (Stagnant Qi) results from premature purgation causing empty fullness; hardness, softness, hiccups, and diarrhea require careful management.
In half-exterior Cold Damage, premature purgation allows pathogens to enter the middle Jiao and Taiyin division, forming Pi-Qi. It is soft upon pressure and painless, lighter than Jie-Xiong. For chest fullness with hardness, vomiting, and diarrhea, indicating water retention in the interior, Da Chaihu Tang (Major Bupleurum Decoction) is used. For epigastric binding radiating to hypochondriac pain and dry retching, Shizao Tang (Ten Jujube Decoction) is used. For sweating and aversion to cold, Fuzi Xiexin Tang (Aconite and Heart-Purging Decoction) is used. For chest fullness with softness and hypochondriac distension, it is empty pathogenic Qi aggregation; Xiao Chaihu Tang plus Ganjiang (Dried Ginger) and Muli (Ostreae Concha) is used. For stomach weakness and rebellious Qi, Banxia Xiexin Tang (Pinellia and Heart-Purging Decoction) is used. For epigastric binding with hiccups and belching due to stomach disharmony, with sweating and thunderous fluid sound in hypochondrium, Shengjiang Xiexin Tang (Fresh Ginger and Heart-Purging Decoction) is used. For unceasing epigastric binding with hiccups and belching, Xuansu Daizhe Shi Tang (Perilla Stem, Hematitum, and Magnetite Decoction) is used. For diarrhea indicating interior deficiency, undigested food and borborygmus, Gancao Xiexin Tang (Licorice and Heart-Purging Decoction) is used. If multiple purgations have occurred and exterior pathogens enter the interior affecting intestines/stomach, causing diarrhea and epigastric hardness, it is called exterior-interior unresolved; Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction) is used. For unceasing diarrhea, Chishizhi Yuyuliang Tang (Red Halloysite and Pyrite Decoction) is used. Both Jie-Xiong and Pi-Qi have deep Guan pulses; if Guan pulse is floating with aversion to heat and epigastric binding, it is Liver heat, not Pi-Qi, treated with Sanhuang Xiexin Tang (Three-Yellow Heart-Purging Decoction). For epigastric binding with thirst and difficult urination unresponsive to Xiexin Tang, it is water retention, not heat-binding, treated with Wuling San (Five-Ingredient Powder). If Pi-Qi persists despite various Xiexin Tangs, Da Xianxiong Tang/Pills may be needed to purge. However, for Jie-Xiong and Pi-Qi requiring purgation, if pulse is floating with aversion to cold and exterior signs exist, Chaihu Guizhi Tang or Chai Xian Tang should resolve the exterior first. Only when exterior signs cease and Guan/Cun pulses are deep, slippery, tight, and solid can purgation proceed. If illness persists after purgation due to interior deficiency and rebellious Qi attacking upward, Zhishi Lizhong Wan harmonizes stomach Qi. At onset before Pi-Qie forms, deficiency cases suit Zhishi Lizhong Wan, while excess cases suit Zhigeng Tang or Binglang Tang to diffuse Qi, followed by syndrome-specific medication. For cold stomach with Jue-Ni (Cold Limbs), Lizhong and Sini Tangs harmonize the stomach; purgation is considered only if pathogens persist long-term. Thus, treatment for Jie-Xiong and Pi-Qie is fundamentally similar, differing only in severity. The前辈 (ancestors') division into Yin/Yang syndromes is questioned. Tao氏 regarded wind-injury as Yang and cold-damage as Yin; Wang氏 regarded Pi-Qi as Yin syndrome with exterior signs; both are logically inconsistent. Essentially, these are transmitted Yang syndromes, but post-purgation stomach cold requires warming herbs. Only with strong pathogens and stomach excess can cold-purgatives be used. Examining Shanghan Lun text: "Taiyang-Shaoyang combined disease wrongly purged becomes Jie-Xiong and epigastric hardness." Entering interior becomes Pi-Qi. No initial Yin/Yang distinction exists. If Yin syndrome is wrongly purged and results in Jie-Xiong/Pi-Qi, it should be treated as Yin-toxin Jie-Xiong, not with Sanhuang Xiexin Tang. Therefore, stating both Yin/Yang syndromes can have Jie-Xiong/Pi-Qi is acceptable, but equating Yang with Jie-Xiong and Yin with Pi-Qi is incorrect, as is using cold-purgatives for Yin syndromes. Wise practitioners will judge. For epigastric oppression without fullness or hardness, called Zhi-Jie (Supporting Knot): if exterior is unresolved, use Chaihu Guizhi Tang; if hypochondriac fullness with slight knotting, Xiao Chaihu Tang plus Ganjiang and Muli; if exterior-interior unresolved, Guizhi Renshen Tang.
Exogenous heat causing Ao-Nao (Vexation) triggers periodic irritability.
Ao-Nao is a state of inner discomfort, more severe than irritability. Erroneous purgation of exterior syndrome causes Yang Qi to sink inward. If the epigastrium is hard, it becomes Jie-Xiong. If stomach Qi is empty and exogenous heat resides in the diaphragm, causing shortness of breath, irritability, and mild pain, it is Ao-Nao. Approaching Jie-Xiong warrants Da/Xiao Xianxiong Tang. Pure Ao-Nao with insomnia, hunger without appetite, and head sweating without Jie-Xiong is treated with Zhichi Tang (Gardenia and Fermented Soybean Decoction). For abdominal distension and restlessness, Zhizi Houpo Tang (Gardenia and Magnolia Bark Decoction) is used. For thirst, Baihu Tang. For Yangming syndrome post-purgation Ao-Nao with dry feces, Chengqi Tang is still appropriate. For Ao-Nao with difficult urination, jaundice will follow; Yinyin Tang is used.
Interior deficiency causing palpitations inevitably generates vexation.
Palpitation refers to trembling. Pathogens assaulting the heart-diaphragm area cause a thumping sensation, like being hunted, akin to Zheng-Chong (Palpitations). With water retention under the heart, dizziness, body shaking, cold limbs, and palpitations, draining the water resolves the condition. For those with inherent spirit/Qi deficiency and internal emptiness unable to sustain themselves, or for palpitations after sweating/purgation due to interior deficiency (worse than inherent deficiency), Qi must be stabilized first, then palpitations treated. Generally, vexation preceding palpitation indicates deficiency, treated with Xiaojianzhong Tang (Minor Construct the Middle Decoction), Xuanwu Tang, or Zaoganzcao Tang (Baked Licorice Decoction) with wine for intermittent pulse. Post-sweating dizziness/blindness is treated with Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction). Palpitation preceding vexation indicates heat, treated with Xiao Chaihu Tang; for nausea, delirium, and difficult stool, Xiao Chaihu Tang plus Dahuang (Rhei Radix) or Mangxiao (Natrii Sulfas) is used. For delirium with difficult urination, Chaihu Longgu Muli Tang; for red urine, Wuling San.
Chest fullness often accompanies exterior/muscle syndromes.
Chest fullness, without prior purgation, involves cold Qi stagnation in the chest/diaphragm, distinct from epigastric Pi-Qi or Jie-Xiong. Exterior pathogens entering from skin/hair into the chest belong to Shaoyang, a half-exterior/half-interior syndrome, treated with Chai Geng Tang (Bupleurum and Platycodon Decoction). For delirium and body pain, Chaihu Longgu Muli Tang. For phlegm-Qi rebelling upward assaulting the heart, Zhichi Tang plus Gancao/Shengjiang. For premature pulse after erroneous purgation, Guizhi Tang minus Shaoyao. For wheezing, Maxing Gan Shi Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction). For stomach weakness, Banxia Xiexin Tang. For fullness, hardness, and constipation belonging to the Zang, purgation may be considered. For common chest/diaphragm discomfort with phlegm/Qi/food accumulation, Chaichen Tang or Zhigeng Tang harmonizes.
Hypochondriac fullness lies between exterior and interior.
Hypochondriac fullness is not abdominal fullness but distension in the hypochondrium, situated between exterior and interior. Symptoms often include deafness, dry retching, alternating chills/fever, silence, and anorexia, governed by Shaoyang, treated with Xiao Chaihu Tang. If Taiyang is unresolved with neck stiffness, Xiao Chaihu Tang plus Ge Gen (Puerariae Radix). For Yangming constipation with tongue coating, Chai Geng Tang. For phlegm-heat, Chai Geng Banxia Tang. For water syndromes and Zang-Jie hypochondriac fullness, see respective sections.
Abdominal distension indicates interior pathogens: Yang closure with tidal fever, Yin diarrhea with cold limbs. Abdominal distension with incomplete interior clearance: post-vomit/purge excess, post-sweat deficiency.
Exterior Cold Damage pathogens enter from skin/muscle to chest/diaphragm/hypochondrium (half-exterior), eventually reaching the stomach (interior). Abdominal distension belongs to Taiyin, but if interior syndrome is shallow and not fully in the Fu organs, harmonization is preferred. Only if abdominal fullness is hard and unrelenting, with dry throat/mouth and constipation (Yang pathogen entering interior), can purgation proceed. If abdominal fullness is soft and intermittently relieved, with vomiting, diarrhea, and cold limbs, it is interior cold/Yin syndrome, requiring rapid warming. Post-sweat fullness indicates exterior resolved but interior not excess; spleen/stomach fluid deficiency causes Qi stagnation and distension, treated with Houpo Banxia Gan Shen Tang (Magnolia, Pinellia, Licorice, and Ginseng Decoction) to warm and disperse. Post-vomit/purge fullness indicates residual exterior pathogens invading interior due to deficiency, disrupting Qi harmony; Da Chaihu Tang plus Houpo may purge, or Zhizi Houpo Tang may induce vomiting. Combined disease with distension, heavy body, pain, and numb mouth uses modified Baihu Tang. General formulas: Chai Geng Tang, Chai Geng Banxia Tang. Avoid Baizhu (Atractylodis Macrocephalae Rhizoma) for distension as it closes Qi. Abdominal distension with wheezing, anuria, and choppy pulse is fatal.
Abdominal pain: heat closure vs. cold diarrhea, both result from interior pathogen combat.
Cold/heat pathogens entering interior combat righteous Qi causing abdominal pain. Yang syndromes are intolerant to pressure; constipation indicates heat. Erroneous purgation of exterior causing exterior-interior disease uses Guizhi Ji Shaoyao Tang (Cinnamon Twig plus Peony Decoction), or plus Dahuang for severe cases. Half-exterior/half-interior syndrome uses Xiao Chaihu Tang minus Huangqin (Scutellariae Radix) plus Shaoyao. Exterior-interior heat uses Da Chaihu Tang. Periumbilical pain, fullness, hardness, intolerance to touch, and constipation indicate dry feces; Dachengqi Tang (Major Order the Qi Decoction) is used, as stated: "Pain decreases with relief." Heat-Jue diarrhea uses Sini San (Counter-Cold Powder). Upper heat/lower cold with urge to vomit uses Huanglian Tang (Coptis Decoction). Empty vexation uses Zhichi Tang plus Houpo/Zhishi. Yin syndromes allow pressure/rubbing; unceasing pain, borborygmus, and loose stools indicate cold. Taiyin: Lizhong Tang, Huangqi Jianzhong Tang; Shaoyin: Sini Tang, Xuanwu Tang; Jueyin: Zhengyang San, Danggui Sini Tang. Taiyin extending to lower abdomen with severe pain and unceasing diarrhea is difficult to treat. Large abdomen belongs to Taiyin, periumbilical to Shaoyin, sub-umbilical to Jueyin; often complicated by food accumulation and phlegm-fire.
Umbilical fullness: heat-blood stasis vs. cold-binding, substance rather than Qi is culpable.
Fullness in heart/chest and large abdomen results from exterior pathogen transmission. Sub-umbilical fullness is either blood stasis or urinary retention. Blood binding in Bladder: urination is free. Heat binding in Bladder: urination is difficult. Cold binding in Bladder: urination is difficult, but differs by cold limbs and lack of chest fullness. External moxibustion on Guanyuan (CV-4) and internal Xuanwu Tang are indicated.
Erroneous application of three methods agitates accumulated Qi; Ben-Tun (Running Piglet) rising upward is especially severe.
If a person has five accumulations in/around the umbilicus, Cold Damage pathogens agitate them, combining new and old pathogens causing pain. If physicians fail to recognize existing masses and erroneously apply sweating/vomiting/purgation, they agitate accumulated Qi, causing thumping跳动, named Dong-Qi (Agitated Qi). Agitating Right Lung Qi: dry throat, nasal dryness/bleeding, thirst, vomiting water upon drinking. Agitating Left Liver Qi: muscle twitching, body heat, desire to curl up. Agitating Upper Heart Qi: hot palms, thirst, Qi rushing to heart. Agitating Lower Kidney Qi: heart vexation, bone pain, vomiting upon eating, or diarrhea with undigested food. Generally, deficiency cases use Lizhong Tang minus Baizhu plus Rougui (Cinnamon Bark). For dizziness, twitching, and sweating, Fangzhu Muli Tang or Xiaojianzhong Tang; for abdominal fullness, mild heat, desire to curl, Gancao Ganjiang Tang; for heart vexation, bone pain, vomiting, Dajupi Tang. Heat cases generally use Chaihu Guizhi Tang. For vexation/thirst, Zhuye Shigao Tang; for epistaxis/vexation/thirst, Wuling San; for epigastric binding with diarrhea of undigested food, Gancao Xiexin Tang; for Qi rushing to heart, Ligen Tang (Li Root Decoction). Among five accumulations, sub-umbilical Ben-Tun rushing to heart is most severe, often due to heart deficiency post-sweating allowing Kidney Qi to rush upward like a porpoise. Guizhi Tang plus double Cinnamon Twig is used. If no upward rushing, do not administer blindly. Severe sub-umbilical agitation with dizziness/body tremors uses Fuling Guigan Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction); remove Jujube and add Baizhu after vomiting. Baizhu closes Qi, use temporarily only; Cinnamon expels Ben-Tun, Poria attacks Kidney pathogen—miracle drugs for Ben-Tun.
Pathogen invading Three Jiao causes Huoluan (Colic and Diarrhea); death ensues if vomiting/diarrhea do not occur.
Three Jiao are pathways for food/water. Pathogen in Upper Jiao: vomiting without diarrhea. Pathogen in Lower Jiao: diarrhea without vomiting. Pathogen in Middle Jiao: both vomiting and diarrhea. Etiology: irregular diet, turbid/clear Qi conflict, Yin/Yang separation. Mild cases: vomiting/diarrhea only. Severe cases: chaotic disturbance, named Huoluan. Exterior signs: fever, aversion to cold, headache, body pain—originally Cold Damage, but pathogen enters Spleen/Stomach causing vomiting/diarrhea. Middle Jiao is half-cold/half-heat. Pathogen higher in Yang division: more heat and thirst, treated with Wuling San to separate/drain. Pathogen lower in Yin division: more cold without thirst, treated with Lizhong Tang to separate/drain. Wind-cold-damp excess: Huoxiang Zhengqi San, Chushi Tang, Wuji San. Summerheat excess with great thirst: Erxiang Huanglian San, Yi Yuan San, Chai Ling Tang. Severe food injury: Pingwei San, Zhizhong Tang. Muscle cramps indicate Qi disharmony; add Mugua (Chaenomelis Fructus) to all, or use single Jishibai (Chicken Droppings White) lightly roasted to powder, dissolved in warm water. Huoluan is mostly heat-related, prevalent in summer/autumn. If heat hides internally, limbs are ice-cold, six pulses are deep/faint, hiccupping after eating—this is Fire Qi rushing upward, not to be mistaken for Yin syndrome. True Yin syndrome: vomiting/diarrhea, free urination, profuse sweating, diarrhea of undigested food, chills/fever, limb rigidity/cold, pulse faint/almost gone. Treat with Sini Tang or plus Wuyu (Tso-Wu Fruit) and Shengjiang. Shaoyin vomiting/diarrhea with extreme irritability: Sanwei Shanyu Tang. If vomiting/diarrhea stop, spontaneous sweating, cold limbs, no thirst, pulse faint: Tongmai Sini Tang plus Zhu Danzhi (Pig Gallbladder Bile). If vomiting/diarrhea stop, body pain persists: Guizhi Jiaren Tang (Cinnamon Twig plus Ginseng Decoction). If vomiting/diarrhea stop, fever appears: induce slight sweat according to syndrome. If vomiting/diarrhea stop, fluid depletion with thirst: Zhuye Shigao Tang or Baihu Jiaren Tang. If vomiting/diarrhea continue: Lingsha Dan, administered with Muxiang (Aucklandiae Radix) and Ganjiang decoction. Do not give rice/gruel immediately to Huoluan patients to avoid aiding pathogens; wait until injured matter is cleared, then nourish with bland food in small amounts. Cold Damage with epigastric binding, fever, vomiting/diarrhea is Da Chaihu syndrome, not Huoluan. Dry Huoluan: Qi stagnates in middle, unable to vomit or purge, injured matter blocks righteous Qi, Yin/Yang blocked, irritability, panting, distension—fatal. Emergency: salt soup with child's urine and ginger juice, induce thorough vomiting, repeat if necessary. External: salt-fried Wuyu applied to umbilicus. Then regulate with Lizhong Tang plus Chenpi, or Huoxiang Zhengqi San plus Guigui (Cassiae Cortex), doubled Zhike, Fuling, Mugua, swallowed with Suhexiang Wan. If fever, headache, abdominal pain: Guizhi Jiadahuang Tang (Cinnamon Twig plus Rhubarb Decoction).
Constipation is essentially interior heat, but if accompanied by exterior signs belonging to Yin, purgation is not yet appropriate.
Discussion states: Yang-Jie (Binding) with ability to eat but no bowel movement is interior heat, meaning Yang Qi is firmly bound in intestines/stomach. When pathogen is in exterior, stool is normal; when pathogen enters interior of intestines/stomach...