水一盏，先煎枳、朴，减三分，下大黄煎二三沸，去渣，下芒硝煎一二沸，温服。得利即止，未利再服。
其大黄须用酒煨，若生用峻下，则必为邪热于至高之分，是以愈后多患头目等疾。《活人大全》云∶里证脉沉
宜急下者，大承气汤主之。肝之里见证者，加柴胡、黄芩；心之里见证者，加黄连、麦门冬；脾之里见证者，
加白芍、生地；肺之里见证者，加黄芩、石膏；肾之里见证者，加知母、黄柏。
小承气汤 治里证已见三四，脐腹胀满而不甚坚硬，或胸满潮热不恶寒，狂言而喘。视其病之小热小实
小满者，宜大黄五钱，浓朴、枳实各二钱，煎服同前，得利即止。《活人大全》云∶里证脉浮宜缓下者，小承
气汤主之。肝之里见证者，加柴胡、连翘；心之里见证者，加赤茯、木通；脾之里见证者，加葛根、炒山栀；
肺之里见证者，加连翘、黄芩；肾之里见证者，加滑石、黄柏。
调胃承气汤 治伤寒二三日不解，蒸蒸热而不满，腹如仰瓦，腹中转矢气，必有燥屎。及太阳邪热入于
阳明里之里，故不恶寒反恶热，大便硬，小便赤，谵语而呕，日晡潮热，狂斑烦乱，脉来洪实者，宜大黄四钱，
芒硝三钱，甘草一钱，煎服同前。如发狂走骂者，阴不足也，宜加当归。经曰∶微者逆之，顺者从之是也。方
意承者，须也。本草云∶通可去滞，泻可去壅。塞而不利，闭而不通，可以荡涤，使正气得以顺畅，是以承气
名之。经曰∶燥淫所胜，以苦下之；热淫所胜，治以咸寒。又曰∶燥淫于内，治以苦温。是以三承气汤，宜分
三焦受病而用之。若三焦伤者，痞满燥实坚俱全，是以大承气汤用大黄、枳实之苦，泄满实以涤热；浓朴之苦
温，消痞下气；芒硝之咸寒，润燥软坚。上焦伤者，有痞满实而无燥坚，是以小承气汤用枳、朴除痞满，大黄
泄实热。不用芒硝，因不甚燥，恐伤下焦血分真阴，谓下伐其根也。中焦伤者，无痞满而有燥实坚，是以调胃
承气汤，用甘草和中，芒硝润燥，大黄泄实。不用枳、朴，恐伤上焦虚无之气。
三一承气汤 治伤寒、杂病、内外所伤，一切风热、风痰、湿热、燥热入里之深，大小便闭，或产难死
胎不下，小儿斑疹黑陷等证。即大承气汤加甘草五钱，生姜三片。又能治肝经玉茎中痛。故曰肝苦急，急食甘
以缓之，故加甘草以调其中，河间得之于仲景也。
陶氏六一顺气汤 治伤寒热邪传里，大便结实，口燥咽干，怕热谵语，揭衣狂妄，扬手掷足，斑黄阳厥，
潮热自汗，胸腹满硬，绕脐疼痛等证。是以代大、小、调胃、三一承气，大柴胡、大陷胸等汤之神方也。大黄、
枳实、浓朴、芒硝、柴胡、黄芩、芍药、甘草，煎法如前，临熟入铁淬水三匙，调服立效。取铁性沉重，最能
坠热开结故也。凡大柴胡汤。脾约丸。生地芩连汤之类，皆自承气而变之也。
渗
伤寒表证忌渗，惟热近里，未可通利者宜。
猪苓汤 治阳明病，上焦热脉浮发热，中焦热渴欲饮水，下焦热小便不利，三焦俱热，宜使热邪从小便出。
兼治少阴挟热下利，咳而
呕渴，心烦不得眠，先呕后渴，头痛身痛，胃燥及秋疫发黄等证。惟溺多而渴者不可服。
猪苓 茯苓 阿胶 滑石 泽泻（各一钱）
水煎去渣，临熟入阿胶煎烊乃服。方意以茯苓之甘以行小便，泽泻之咸以泻伏水，滑石、阿胶之滑以利水
道。
五苓散 治太阳病，初无热，但狂言烦躁不安，精采与人不相当，及汗后胃中干燥不得眠，尿赤微烦作渴。
惟上焦微烦；邪犹在表；唯渴则入里，热未成实；不能消水，停蓄不散。或伤寒下早，心下痞满不痛；或太阳
少阳同病；及中 ，霍乱烦躁，中湿关节疼痛，湿痹小便不便，大便反快等证。
猪苓 茯苓 白术 泽泻（各一钱半） 肉桂（五分）
为末，每二钱，白汤调服。生津液，和表里。如无热烦躁狂言者，服后以指探吐。方意以伤寒发热而烦，
六七日不解，脉浮者，邪在表也。或汗后亡津，胃干烦躁不眠，不能食，但渴欲水者邪在里也。然上焦虚躁或
饮水不散而反吐出，为水逆证。或饮水虽多而小便不利者，皆里热未实，不能化水故耳。是以用白术、茯苓、猪
苓之甘，润虚躁而利津液∶泽泻之咸，以泻伏水；肉桂之辛甘，以和肌表。经曰∶甘甚反淡，甘缓而淡渗。
淡味渗泄为阳，咸味涌泄为阴，辛甘发散为阳，是也。加减法∶阳证，去桂热服，令汗出即愈；阴证加附子；
温热病加甘草；瘀热发黄加茵陈；头目痛加川芎、葱白；咳嗽加五味子；热吐加半夏；热泻合小柴胡汤加黄连；
狂言乱语加辰砂；小便闭加瞿麦、滑石；大便难加黄芩；劳复加桔梗；水气加葶苈；发虚热加参、 、麦门冬，以
分阴阳；腹痛加木香；气块加三棱、莪术；鼻衄加茅花；尿血加山栀；身痛加苍术；烦躁去桂加人参；心烦不
眠加阿胶。
陶氏五苓散 即五苓散用桂枝，加甘草、滑石、山栀、灯芯，临熟入盐一字调服。如中湿身目黄加茵陈；
水结胸加灯芯、木通。凡导赤、八正散之类，皆自此二方而变化之也。
和解
和其内热，解其外邪，伤寒方之王道也。
小柴胡汤 又名三禁汤，禁发汗利大小便者宜此。本治少阳半表里证，头痛项强，耳前后肿或聋，筋脉拘
急，身疼胁痛，寒热往来，或呕，或渴，或咳，或悸，胸膈痞满，烦闷硬痛，或汗下前后不解。及瘟疫两感，
太阳阳明初证，不敢汗吐与下，过经不解，热入血室等证。杂病蒸热，肌体羸瘦，为用最多。但其间有五证尤
为的当，伤寒五六日，胸满，心烦喜呕，身热心中咳逆，不欲食，或呕，或不呕者，一可服，若因渴欲饮水者，
不可服；寒热往来而心悸者，二可服；胁下满硬而痛，耳聋胸痞，小便不利，或渴或不渴者，三可服；发潮热
者，四可服；瘥后发热者，五可服。要知无热证者，不可服，为药性颇寒耳。
柴胡（三钱） 黄芩（二钱） 人参（一钱） 半夏（一钱） 甘草（四分）
姜三片，枣二枚，水煎去渣，澄清温服，则能入胆，此方内有柴胡、半夏，能利能汗，以解半表里之邪。
然本气分药也，而血病每用之者，以柴、芩专能调血故也。况伤寒日稍久不解者，热必伤血，故表恶寒发热而
里未实者，加桂以温血；表热汗里又燥渴粪硬者，加大黄以清血。胸中烦而不呕，去半夏、人参加栝蒌仁；
渴者去半夏加人参、栝蒌根；腹痛去芩加芍药；胁下痞闷去枣加牡蛎、枳实；胁痛加青皮；未经下而心中饱闷
加枳、梗；心悸，小便不利去芩加茯苓；不渴，外有微热，去参加桂；咳嗽去参、枣，加五味子、炮干姜；
呕加姜汁、竹茹；虚烦加竹叶、粳米；鼻衄加生地、茅花；痰盛或喘加桑白皮、乌梅；热盛错语不眠，加山栀、
黄连、黄柏；少阳阳明合病，口燥目疼，加芍药、干葛；坏证加鳖甲；过经不解，晡热已而微利，加芒硝；自
汗恶热，谵语烦渴，去半夏合白虎汤；自汗恶风腹痛，或寒多热少脉弱，去芩合桂枝汤；血虚发夜热，合四物
汤，去芎加麦门
冬；舌干口燥，去半夏加天花粉或贝母；齿燥无津液加石膏；脉弦虚无力，先因房劳梦遗感寒，或病后血气未
固，以致咳嗽吐痰，昼轻夜重，发热不止，合四物汤去芎，加麦门冬、知母、黄柏；脉弦虚无力，或浮散，发热
烦躁，口渴不饮水，此为虚热，去半夏、黄芩，合生脉散；热入血室，小腹痛，昼明夜昏妄见，或寒热不定似
疟，合四物汤加牡丹皮；男子热入血室加生地；妇人热入血室加当归、红花。
陶氏小柴胡汤 即小柴胡汤加陈皮、芍药、川芎，临熟入生艾汁三匙调服。治法、加减亦同。
和解散 寻常感冒，用此等分。柴胡二钱，黄芩、人参、半夏、甘草各一钱，姜三片，枣二枚，水煎服。
如呕逆倍生姜加陈皮，头痛加羌活、防风，寒热间作加桂枝，中暑发热头痛加黄连，春温时行加生地、升麻，
温疟加常山、槟榔。
火邪汤 即小柴胡汤加黑豆一撮煎服。治火邪诸证。
大柴胡汤 专治少阳病，或因发汗、利小便转属阳明，此为少阳阳明。盖少阳变证阳明，故以小柴变为大柴。
兼治里证内热，目不了了，睛不和，口渴烦躁黄斑，狂妄谵语，大便坚闭，小便赤涩，绕脐刺痛，脉洪数沉实，
身热不恶寒反恶热。及老人素虚，或过经不解热未除，或下后仍发潮热，或腹中余垢欠净，胸中胀满而潮者最
稳。若身体疼痛，是表未解，不可服之。柴胡三钱，黄芩、芍药、枳壳各一钱，半夏一钱半，大黄三钱（壮实者
倍之，怯弱者减之），姜三片，枣二枚，水煎，临熟入大黄煎二三沸，温服取通快则止，未利再服。经曰∶热
淫于内，以苦发之。柴、芩之苦以发传经之热。里不足者，以甘缓之，参、草之甘以缓中和之气。邪半入里，
则里气逆而呕，半夏之辛以散之；邪半在表，则荣卫争为寒热，姜、枣之辛甘以和之。此小柴胡治半表里证也。
经曰∶酸苦涌泄为阴，是以大柴胡汤用枳、芍之酸，大黄之苦，以泄上满除中热；去参、草之甘者，恐补中也；
仍用柴、芩、半夏、姜、枣者，邪未全入于里也。加减法∶昏乱谵语加黄连、山栀；痞满加枳、梗、浓朴；
舌苔黄赤，口燥渴饮水，加栝蒌仁；夏月热病，烦躁，脉洪大，加知母、麦门冬、石膏；发斑加生地、牡丹皮、
玄参；发黄加茵陈、黄柏；鼻衄加犀角；大便不通加芒硝。
白虎汤 白虎西方之神，应秋而归于肺，故夏近秋令，中暑烦渴妙药。主治伤寒汗后，脉洪大而渴，中外
俱热，未全入里，宜此和解。或吐下后，邪未除，热结在里，心胸烦，渴甚欲饮水，自汗，不恶寒反恶热，
大便不闭。及三阳合病，头痛面垢，谵语遗尿，身重难以转侧。一切时气瘟疫，杂病胃热咳嗽、发斑，及小
儿疮 瘾疹伏热等证。
知母（二钱） 石膏（五钱，热甚七钱） 甘草（六钱） 粳米（小半合）
水煎温服。方意以脉浮为在表，兼滑为在里。表有热，里有寒，宜知母、石膏之苦甘，以解内外之邪热；
热则伤气，宜粳米、甘草之甘缓以益气。经曰∶热淫所胜，佐以苦甘是也。或问∶白虎性寒，热病里虚，误服
多成结胸，夏月阴盛体薄忌之。《百问》云∶太阳病汗后，脉洪大者宜。此云里寒者，伤寒邪未入腑言寒，
已入腑言热，非寒冷之寒，与瓜蒂散客寒上焦例同。如虚烦甚加麦门冬；里热大渴烦躁，表热微恶寒脉浮，并
加人参；尺寸俱长而疾，自汗大出，身表如冰，乃阳明传少阴，宜加桂枝；虚烦谵语，小便淋涩，起卧不安，
加山栀。
陶氏白虎汤 即白虎汤加人参、麦门冬、五味子、山栀、姜、枣、竹叶，煎服。治法同上。如心烦加竹茹；
大渴心烦背恶寒，去山栀加天花粉。凡黄芩汤、解毒汤、麦门冬汤，一切平和清解之剂，皆自此三方而变化之
也。
抑论无汗烦躁而脉浮紧者，可服青龙；无汗喜渴而脉单浮者，勿投白虎；阳明自汗引饮，则五苓散未可轻
进；太阳自汗溺数，则桂枝汤不可妄与，其故何哉？盖人身以气液为
主，在外则为正汗，以养皮毛而不燥；在内则为津液，以和胃口而不渴；在下则为小便而不涩，是以三者恒宜
相固而不相伤也。小便数则津下脱矣，岂宜桂枝重发其汗？阳明汗多津外泄矣，岂宜五苓复内渗其小便？白虎
之名义甚可畏者，性甚寒凉。无汗脉浮，表未全解，犹宜柴胡解肌之药，岂可纯以里寒药治之耶？无汗而不烦
躁者麻黄汤，有汗而烦躁者桂枝汤，惟无汗而烦躁者，而后可青龙汤。以加石膏性缓，对麻黄而言，故有是善
名。也。噫！用之当者，朝大黄，暮附子，不为悖也；用之不当，小柴虽稍平和，亦贻害也。用药者，可不
知古人立方之意乎！
Take one cup of water, first decoct Zhi Shi (Immature Bitter Orange) and Hou Po (Magnolia Bark), reduce by one-third, then add Da Huang (Rhubarb Root and Rhizome) and decoct for two or three boils, remove the dregs, add Mang Xiao (Mirabilite) and decoct for one or two boils, take warm. Stop taking if bowel movement is achieved; if not, take again.
The Da Huang must be prepared with wine roasting; if used raw for harsh purgation, it will inevitably cause pathogenic heat to remain in the highest parts of the body, so after recovery, diseases of the head and eyes often occur. *Huoren Dquan* states: For interior syndrome with a deep pulse, urgent purgation is indicated, primarily using Dachengqi Tang (Great Order the Qi Decoction). For liver channel interior syndromes, add Chai Hu (Bupleurum Root) and Huang Qin (Scutellaria Root); for heart channel interior syndromes, add Huang Lian (Coptis Rhizome) and Maidong (Ophiopogon Tuber); for spleen channel interior syndromes, add Bai Shao (White Peony Root) and Sheng Di Huang (Rehmannia Root); for lung channel interior syndromes, add Huang Qin (Scutellaria Root) and Shi Gao (Gypsum Fibrosum); for kidney channel interior syndromes, add Zhi Mu (Anemarrhenae Rhizome) and Huang Bo (Phellodendron Bark).
Xiao Chengqi Tang (Minor Order the Qi Decoction) treats interior syndromes that have manifested to about thirty or forty percent, with abdominal distension and fullness around the navel but not very hard, or chest fullness, tidal fever without aversion to cold, delirious speech, and wheezing. Observing conditions of slight heat, slight excess, and slight fullness, use Da Huang (Rhubarb Root and Rhizome) 5 qian, Hou Po (Magnolia Bark) and Zhi Shi (Immature Bitter Orange) each 2 qian, decoct and take as before; stop when beneficial effect is achieved. *Huoren Dquan* states: For interior syndrome with a floating pulse, slow purgation is indicated, primarily using Xiao Chengqi Tang (Minor Order the Qi Decoction). For liver channel interior syndromes, add Chai Hu (Bupleurum Root) and Lian Qiao (Forsythia Fruit); for heart channel interior syndromes, add Chi Fu Ling (Red Poria) and Mu Tong (Akebia Stem); for spleen channel interior syndromes, add Ge Gen (Kudzu Root) and Chao Shan Zhi (Stir-fried Gardenia Fruit); for lung channel interior syndromes, add Lian Qiao (Forsythia Fruit) and Huang Qin (Scutellaria Root); for kidney channel interior syndromes, add Hua Shi (Talcum) and Huang Bo (Phellodendron Bark).
Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction) treats Shanghan (Cold Damage) unresolved after two or three days, with steaming heat but no fullness, abdomen flat like an inverted tile, passing flatus, indicating dry fecal matter. It also treats Taiyang pathogenic heat entering the interior of Yangming, resulting in aversion to heat rather than cold, hard stool, red urine, delirium, vomiting, tidal fever at dusk, manic rashes, irritability, and a surging, solid pulse. Use Da Huang (Rhubarb Root and Rhizome) 4 qian, Mang Xiao (Mirabilite) 3 qian, Gan Cao (Licorice Root) 1 qian, decoct and take as before. If manic running and cursing occur, indicating yin deficiency, add Dang Gui (Angelica Sinensis). The classics state: Treat mild conditions by opposing them, and severe conditions by following them. "Cheng" means to succeed or inherit. Materia Medica states: Unblocking agents remove stagnation, purgatives remove obstruction. When blocked and unyielding, purgation can cleanse, allowing righteous qi to flow smoothly, hence the name "Chengqi". Classics state: When dryness prevails, use bitter purgatives; when heat prevails, treat with salty-cold agents. Also: When dryness is internal, treat with bitter-warm agents. Thus, the three Chengqi Decoctions should be used according to which Jiao (Triple Burner) is affected. If all three Jiaos are injured, with pi (glomus), man (fullness), zao (dryness), shi (excess), and jian (hardness) all present, Dachengqi Tang uses the bitterness of Da Huang and Zhi Shi to drain excess and cleanse heat; the bitter-warmness of Hou Po to eliminate glomus and direct qi downward; the salty-coldness of Mang Xiao to moisten dryness and soften hardness. If only the Upper Jiao is injured, with pi, man, and shi but no zao or jian, Xiao Chengqi Tang uses Zhi Shi and Hou Po to remove glomus and fullness, and Da Huang to drain excess heat. Mang Xiao is omitted because dryness is not severe, avoiding injury to the Lower Jiao blood aspect and true yin, termed "attacking the root from below." If only the Middle Jiao is injured, with zao, shi, and jian but no pi or man, Tiaowei Chengqi Tang uses Gan Cao to harmonize the middle, Mang Xiao to moisten dryness, and Da Huang to drain excess. Zhi Shi and Hou Po are omitted to avoid injuring the empty qi of the Upper Jiao.
Sanyi Chengqi Tang (Three-One Order the Qi Decoction) treats Shanghan, miscellaneous diseases, and internal/external injuries where wind-heat, wind-phlegm, damp-heat, or dry-heat penetrate deeply, causing constipation and urinary retention, or difficult labor with retained dead fetus, or blackening and sinking of infantile maculopapular eruptions. It is Dachengqi Tang (Great Order the Qi Decoction) plus Gan Cao (Licorice Root) 5 qian and Sheng Jiang (Fresh Ginger) 3 slices. It also treats pain in the liver channel's jade stem (penis). Thus, "the liver suffers from urgency, urgently eat sweet to relax it," so Gan Cao is added to harmonize the middle; Liu Hejian derived this from Zhang Zhongjing.
Tao's Liuyi Shunqi Tang (Six-One Smooth Qi Decoction by Tao) treats Shanghan heat pathogen transmitting to the interior, hard stool, dry mouth and throat, aversion to heat, delirium, throwing off clothes wildly, waving hands and kicking feet, yellow rashes, yang jue (heat-depth leading to cold extremities), tidal fever with spontaneous sweating, chest and abdominal fullness and hardness, periumbilical pain, etc. It serves as a divine formula replacing Dachengqi, Xiao Chengqi, Tiaowei Chengqi, Sanyi Chengqi, Da Chaihu Tang (Greater Bupleurum Decoction), and Daxiexiong Tang (Major Chest Trap Decoction). Da Huang (Rhubarb Root and Rhizome), Zhi Shi (Immature Bitter Orange), Hou Po (Magnolia Bark), Mang Xiao (Mirabilite), Chai Hu (Bupleurum Root), Huang Qin (Scutellaria Root), Shao Yao (Peony Root), Gan Cao (Licorice Root) are decocted as before; near completion, add 3 spoons of iron-quenching water, mix and take for immediate effect. This utilizes the heavy nature of iron to descend heat and resolve knots. Formulas such as Da Chaihu Tang (Greater Bupleurum Decoction), Pi Yue Wan (Spleen Restriction Pill), and Shengdi Qinlian Tang (Rehmannia and Coptis Decoction) are all variations from Chengqi Tang.
Penetrating (Shen)
Shanghan exterior syndromes contraindicate penetrating/diuretic methods, except when heat approaches the interior and cannot yet be freely drained.
Zhuling Tang (Polyporus Decoction) treats Yangming disease: Upper Jiao heat with floating pulse and fever, Middle Jiao heat with thirst for water, Lower Jiao heat with difficult urination, and heat in all three Jiaos, facilitating the exit of heat pathogen via urine. It also treats Shaoyin syndrome with heat-complicated diarrhea, cough with vomiting and thirst, irritability and insomnia, vomiting followed by thirst, headache and body ache, stomach dryness, and autumn epidemic jaundice. It is contraindicated for those with frequent urination and thirst.
Zhuling (Polyporus), Fuling (Poria), Ejiao (Donkey-Hide Gelatin), Huashi (Talcum), Zexie (Alisma Rhizome) (each 1 qian).
Decoct in water, remove dregs, add Ejiao near completion until melted, then take. The formula intent uses the sweetness of Fuling to promote urination, the saltiness of Zexie to drain hidden water, and the slipperiness of Huashi and Ejiao to lubricate the water pathways.
Wuling San (Five-Ling Powder) treats Taiyang disease: initially no heat, but delirious speech, irritability, and mismatched spirit; or post-sweat stomach dryness causing insomnia, red urine, slight irritability, and thirst. Only slight Upper Jiao irritability indicates pathogen still in the exterior; thirst indicates entry into the interior, heat not yet forming excess, inability to transform water leading to accumulation. Or premature purgation in Shanghan causing epigastric glomus without pain; or concurrent Taiyang and Shaoyang disease; or dampness-induced Huoluan (vomiting and diarrhea) with irritability, dampness-induced joint pain, damp-bi with difficult urination and loose stools.
Zhuling (Polyporus), Fuling (Poria), Baizhu (Atractylodes Macrocephala Rhizome), Zexie (Alisma Rhizome) (each 1.5 qian), Rougui (Cinnamon Bark) (0.5 qian).
Grind to powder, take 2 qian mixed with warm water. Generates fluids, harmonizes interior and exterior. If there is no heat, irritability, or delirium, induce vomiting with a finger after ingestion. The rationale: Shanghan fever with irritability unresolved for 6-7 days with a floating pulse indicates pathogen in the exterior. Post-sweat fluid loss, stomach dryness, irritability, insomnia, anorexia, and thirst indicate pathogen in the interior. However, Upper Jiao deficiency-irritability or drinking water that isn't transformed and is vomited is called Water Reversal Syndrome. Drinking much water with difficult urination indicates interior heat not yet excess, unable to transform water. Thus, the sweetness of Baizhu, Fuling, and Zhuling moistens deficiency-irritability and promotes fluid metabolism; the saltiness of Zexie drains hidden water; the pungent-sweetness of Rougui harmonizes the muscle layer. Classics state: Sweetness turns to blandness, sweet relaxes and bland penetrates. Bland draining is Yang, salty涌泄 (surging/draining) is Yin, pungent-sweet dispersing is Yang. Modification: Yang syndrome, remove Rougui, take hot to induce sweat and cure; Yin syndrome, add Fuzi (Aconite Lateral Root); Warm-heat disease, add Gan Cao (Licorice Root); Blood-stasis heat jaundice, add Yichen (Artemisia Capillaris); Head/eye pain, add Chuanxiong (Ligusticum Rhizome) and Congbai (Green Onion White); Cough, add Wuweizi (Schisandra Berry); Heat-vomiting, add Banxia (Pinellia Tuber); Heat-diarrhea, combine with Xiaochaihu Tang (Minor Bupleurum Decoction) and add Huang Lian (Coptis Rhizome); Delirium, add Chen Sha (Cinnabar); Urinary retention, add Qumai (Dianthus Herb) and Huashi (Talcum); Difficult defecation, add Huang Qin (Scutellaria Root); Labor relapse, add Jiegeng (Platycodon Root); Water qi, add Tingli (Periploca Seed); Deficiency-heat, add Renshen (Ginseng Root), Maidong (Ophiopogon Tuber), and Men Dong (Ophiopogon Tuber) to differentiate Yin/Yang; Abdominal pain, add Muxiang (Vladimiria Root); Qi mass, add Sanleng (Sparganium Rhizome) and Ezhu (Curcuma Rhizome); Epistaxis, add Maohua (Miscanthus Flower); Hematuria, add Shanzhi (Gardenia Fruit); Body ache, add Cangzhu (Atractylodes Lancea Rhizome); Irritability, remove Rougui and add Renshen (Ginseng Root); Heart irritability and insomnia, add Ejiao (Donkey-Hide Gelatin).
Tao's Wuling San (Five-Ling Powder by Tao) uses Guizhi (Cinnamon Twig) instead of Rougui in Wuling San, adding Gan Cao (Licorice Root), Huashi (Talcum), Shanzhi (Gardenia Fruit), Dengxincao (Juncus Effusus Pith), and a pinch of salt near completion. Add Yichen (Artemisia Capillaris) for dampness jaundice; add Dengxincao (Juncus Effusus Pith) and Mutong (Akebia Stem) for Water Glomus in the Chest. Daochi San (Guide Out Red Powder) and Bazheng San (Eight-Righteous Powder) are variations from these two formulas.
Harmonizing (Hejie)
Harmonizing internal heat and resolving external pathogens is the royal way of Shanghan formulas.
Xiaochaihu Tang (Minor Bupleurum Decoction) also known as Sanjin Tang (Three-Prohibitions Decoction), suitable when sweating, diuresis, and emesis/purgation are prohibited. It primarily treats Shaoyang half-exterior/half-interior syndromes: headache and stiff neck, swelling or deafness around ears, tendon tension, body ache, hypochondriac pain, alternating chills and fever, vomiting, thirst, cough, palpitations, chest/diaphragm glomus/fullness, irritability, hard pain, or unresolved symptoms despite sweating/purgation. It also treats plague dual-infection, early Taiyang/Yangming stages where sweating/emesis/purgation are unsafe, prolonged illness, heat entering the blood chamber, etc. It is widely used for miscellaneous diseases with steaming heat and emaciation. Five specific indications are particularly accurate:
1. Shanghan day 5-6, chest fullness, heart irritability, desire to vomit, body heat, central cough/reversal, anorexia, vomiting or not. Acceptable unless thirst drives water intake.
2. Alternating chills/fever with palpitations. Acceptable.
3. Hypochondriac fullness/hardness/pain, deafness, chest glomus, difficult urination, with or without thirst. Acceptable.
4. Tidal fever. Acceptable.
5. Fever after recovery. Acceptable.
Contraindicated if no heat signs exist due to its cold nature.
Chai Hu (Bupleurum Root) 3 qian, Huang Qin (Scutellaria Root) 2 qian, Ren Shen (Ginseng Root) 1 qian, Ban Xia (Pinellia Tuber) 1 qian, Gan Cao (Licorice Root) 0.4 qian.
Sheng Jiang (Fresh Ginger) 3 slices, Da Zao (Jujube) 2 pieces. Decoct, remove dregs, clarify and take warm to enter the Gallbladder. Chai Hu and Ban Xia promote drainage and sweating to resolve half-exterior/half-interior pathogens. Although primarily a Qi-level formula, it is used for Blood disorders because Chai Hu and Huang Qin specifically regulate Blood. In prolonged Shanghan, heat injures Blood. If exterior has chills/fever but interior is not excess, add Guizhi (Cinnamon Twig) to warm Blood; if exterior heat/sweat with interior dryness/thirst/hard stool, add Da Huang (Rhubarb Root and Rhizome) to clear Blood.
Modifications: Chest irritability without vomiting, remove Ban Xia and Ren Shen, add Gualou Ren (Trichosanthes Seed); Thirst, remove Ban Xia, add Ren Shen and Gualou Gen (Trichosanthes Root); Abdominal pain, remove Huang Qin, add Shao Yao (Peony Root); Hypochondriac glomus, remove Da Zao, add Muli (Oyster Shell) and Zhi Shi (Immature Bitter Orange); Hypochondriac pain, add Qingpi (Citrus Peel); Fullness without prior purgation, add Zhi Shi (Immature Bitter Orange) and Jie Geng (Platycodon Root); Palpitations with difficult urination, remove Huang Qin, add Fu Ling (Poria); No thirst, slight exterior heat, add Guizhi (Cinnamon Twig); Cough, remove Ren Shen and Da Zao, add Wu Wei Zi (Schisandra Berry) and Pao Gan Jiang (Prepared Dried Ginger); Vomiting, add Sheng Jiang Zhi (Fresh Ginger Juice) and Zhu Ru (Bamboo Shavings); Deficiency-irritability, add Zhu Ye (Bamboo Leaf) and Jing Mi (Rice); Epistaxis, add Sheng Di Huang (Rehmannia Root) and Mao Hua (Miscanthus Flower); Phlegm/strength, add Sang Bai Pi (Mulberry Root Bark) and Wu Mei (Mume Fruit); Severe heat, confused speech, insomnia, add Shan Zhi (Gardenia Fruit), Huang Lian (Coptis Rhizome), Huang Bo (Phellodendron Bark); Shaoyang-Yangming combined disease, dry mouth/eye pain, add Shao Yao (Peony Root) and Gan Ge (Kudzu Root); Complicated syndrome, add Biejia (Turtle Shell); Prolonged illness, dusk fever with slight diarrhea, add Mang Xiao (Mirabilite); Spontaneous sweating, aversion to heat, delirium, thirst, remove Ban Xia, combine with Baihu Tang (White Tiger Decoction); Spontaneous sweating, aversion to wind, abdominal pain, or more chills than fever with weak pulse, remove Huang Qin, combine with Guizhi Tang (Cinnamon Twig Decoction); Blood deficiency night fever, combine with Siwu Tang (Four Substance Decoction), remove Xiong (Chuanxiong), add Mai Dong (Ophiopogon Tuber); Dry tongue/mouth, remove Ban Xia, add Tian Hua Fen (Trichosanthes Root) or Bei Mu (Fritillaria Bulb); Dry teeth/no fluids, add Shi Gao (Gypsum Fibrosum); String-taut weak pulse due to sexual exhaustion/dream emission/cold or post-illness instability causing cough/phlegm, worse at night, continuous fever, combine with Siwu Tang (Four Substance Decoction) minus Xiong, add Mai Dong (Ophiopogon Tuber), Zhi Mu (Anemarrhenae Rhizome), Huang Bo (Phellodendron Bark); String-taut weak or floating-scattered pulse, fever, irritability, thirst without desire to drink (deficiency heat), remove Ban Xia and Huang Qin, combine with Shengmai San (Generate the Pulse Powder); Heat entering blood chamber, lower abdominal pain, clarity by day/darkness by day/delusions, or irregular chills/fever resembling malaria, combine with Siwu Tang (Four Substance Decoction) plus Mudan Pi (Tree Peony Bark); Male heat entering blood chamber, add Sheng Di Huang (Rehmannia Root); Female heat entering blood chamber, add Dang Gui (Angelica Sinensis) and Hong Hua (Carthamus Flower).
Tao's Xiaochaihu Tang (Minor Bupleurum Decoction by Tao) adds Chen Pi (Citrus Peel), Shao Yao (Peony Root), and Chuan Xiong (Ligusticum Rhizome) to Xiaochaihu Tang, mixing with 3 spoons of raw Ai Ye Zhi (Mugwort Juice) near completion. Indications and modifications are the same.
Hejie San (Harmonizing Powder) for common colds, equal parts: Chai Hu (Bupleurum Root) 2 qian, Huang Qin (Scutellaria Root), Ren Shen (Ginseng Root), Ban Xia (Pinellia Tuber), Gan Cao (Licorice Root) each 1 qian, Sheng Jiang (Fresh Ginger) 3 slices, Da Zao (Jujube) 2 pieces. Decoct and take.
Modifications: Vomiting/reversal, double Sheng Jiang and add Chen Pi; Headache, add Qiang Huo (Notopterygium Rhizome) and Fang Feng (Saposhnikovia Root); Alternating chills/fever, add Guizhi (Cinnamon Twig); Summerheat fever/headache, add Huang Lian (Coptis Rhizome); Spring warmth epidemic, add Sheng Di Huang (Rehmannia Root) and Sheng Ma (Cimicifuga Rhizome); Warm malaria, add Chang Shan (Dichroa Root) and Bing Lang (Areca Seed).
Huoxie Tang (Fire Pathogen Decoction) is Xiaochaihu Tang (Minor Bupleurum Decoction) plus a handful of Hei Dou (Black Soybean), decocted and taken. Treats various Fire Pathogen syndromes.
Da Chaihu Tang (Greater Bupleurum Decoction) specializes in Shaoyang disease, or cases transferred to Yangming due to sweating/diuresis, constituting Shaoyang-Yangming. Since Shaoyang transforms into Yangming, it modifies Xiaochaihu Tang. It also treats interior heat: unclear vision, eye discomfort, thirst, irritability, yellow rashes, manic delirium, hard constipation, red/scanty urine, periumbilical stabbing pain, surging-rapid/deep-solid pulse, body heat without aversion to cold but with aversion to heat. It is most stable for elderly with inherent deficiency, prolonged illness with residual heat, tidal fever post-purgation, residual gut waste, or chest fullness with tidal sensations. Contraindicated if body pain indicates unresolved exterior.
Chai Hu (Bupleurum Root) 3 qian, Huang Qin (Scutellaria Root), Shao Yao (Peony Root), Zhi Ke (Bitter Orange) each 1 qian, Ban Xia (Pinellia Tuber) 1.5 qian, Da Huang (Rhubarb Root and Rhizome) 3 qian (double for robust, reduce for weak), Sheng Jiang (Fresh Ginger) 3 slices, Da Zao (Jujube) 2 pieces. Decoct, add Da Huang near completion for 2-3 boils, take warm. Stop when bowel movement is smooth; take again if not. Classics state: Heat prevalent internally, disperse with bitter agents. The bitterness of Chai Hu and Huang Qin disperses transmitted heat. Interior insufficiency, soothe with sweet agents. The sweetness of Ren Shen and Gan Cao moderates the middle Qi. Pathogen half-entering interior causes rebellious Qi and vomiting; Ban Xia's pungency disperses it. Pathogen half-in exterior causes Ying-Wei conflict and chills/fever; Sheng Jiang and Da Zao's pungent-sweetness harmonizes it. This is how Xiaochaihu Tang treats half-exterior/half-interior syndromes. Classics state: Sour-bitter surging-draining is Yin. Thus, Da Chaihu Tang uses the sourness of Zhi Shi and Shao Yao, and bitterness of Da Huang to drain upper fullness and remove middle heat; removing Ren Shen and Gan Cao's sweetness avoids tonifying the middle; retaining Chai Hu, Huang Qin, Ban Xia, Sheng Jiang, Da Zao indicates pathogen not fully in interior.
Modifications: Confusion/delirium, add Huang Lian (Coptis Rhizome) and Shan Zhi (Gardenia Fruit); Glomus/fullness, add Zhi Shi (Immature Bitter Orange), Jie Geng (Platycodon Root), Hou Po (Magnolia Bark); Yellow-red tongue coating, dry mouth/thirst, add Gualou Ren (Trichosanthes Seed); Summer heat disease, irritability, surging-large pulse, add Zhi Mu (Anemarrhenae Rhizome), Mai Dong (Ophiopogon Tuber), Shi Gao (Gypsum Fibrosum); Rashes, add Sheng Di Huang (Rehmannia Root), Mudan Pi (Tree Peony Bark), Xuan Shen (Scrophularia Root); Jaundice, add Yichen (Artemisia Capillaris) and Huang Bo (Phellodendron Bark); Epistaxis, add Xijiao (Rhinoceros Horn - *Note: Substitute with Niuxi or other safe alternatives in modern practice, though text specifies Xijiao*); Constipation, add Mang Xiao (Mirabilite).
Baihu Tang (White Tiger Decoction) Baihu is the Western Deity, corresponding to Autumn and the Lung. Thus, near Autumn in Summer, it is a miraculous medicine for summerheat, irritability, and thirst. It primarily treats post-sweat Shanghan with surging-large pulse and thirst, heat throughout interior/exterior, not fully entered interior, suitable for harmonization. Or post-emesis/purgation with unresolved pathogen, heat knot in interior, chest/heart irritability, severe thirst for water, spontaneous sweating, aversion to heat rather than cold, non-obstipated stool. Also treats Three-Yang combined disease: headache, greasy face, delirium, enuresis, heavy body difficult to turn. All seasonal epidemics, miscellaneous diseases with stomach heat/cough/rashes, and infantile eruption/maculopapular rash latent heat.
Zhi Mu (Anemarrhenae Rhizome) 2 qian, Shi Gao (Gypsum Fibrosum) 5 qian (7 qian if heat severe), Gan Cao (Licorice Root) 6 qian, Jing Mi (Rice) small half-he.
Decoct and take warm. Rationale: Floating pulse indicates exterior, combined slippery indicates interior. Exterior heat, interior cold (referring to pathogenic cold vs heat status), use bitter-sweet of Zhi Mu and Shi Gao to resolve exterior/interior pathogenic heat; heat injures Qi, use sweet-moderating of Jing Mi and Gan Cao to tonify Qi. Classics state: Heat prevailing, assist with bitter-sweet. Question: Baihu Tang is cold; internal deficiency in heat disease, mistaken use often leads to Jie Xiong (Chest Knot); contraindicated in Summer when Yin is abundant and constitution thin. *Baiwen* states: Taiyang disease post-sweat with surging-large pulse is suitable. Here "interior cold" refers to Shanghan pathogen not yet entering Fu organs (cold stage), whereas entering Fu organs implies heat stage, not literal cold, similar to Genti San (Melon Dispersant) treating external cold in Upper Jiao. Modifications: Severe deficiency-irritability, add Mai Dong (Ophiopogon Tuber); Interior heat, severe thirst/irritability, slight exterior cold/floating pulse, add Ren Shen (Ginseng Root); Long-rapid pulse at Cun-Chi positions, profuse sweating, cold skin, Yangming transmitting to Shaoyin, add Guizhi (Cinnamon Twig); Deficiency-irritability/delirium, dysuria, restlessness, add Shan Zhi (Gardenia Fruit).
Tao's Baihu Tang (White Tiger Decoction by Tao) adds Ren Shen (Ginseng Root), Mai Dong (Ophiopogon Tuber), Wu Wei Zi (Schisandra Berry), Shan Zhi (Gardenia Fruit), Sheng Jiang (Fresh Ginger), Da Zao (Jujube), Zhu Ye (Bamboo Leaf) to Baihu Tang. Indications same. Heart irritability, add Zhu Ru (Bamboo Shavings); Severe thirst/heart irritability/back cold, remove Shan Zhi, add Tian Hua Fen (Trichosanthes Root). Huangqin Tang (Scutellaria Decoction), Jiedu Tang (Detoxification Decoction), and Maidong Tang (Ophiopogon Decoction), all mild clearing agents, are variations from these three formulas.
Discussion: No sweat, irritability, floating-tight pulse: Qinglong Tang (Azure Dragon Decoction) is suitable. No sweat, thirst, single floating pulse: Do not use Baihu Tang (White Tiger Decoction). Yangming spontaneous sweating with desire to drink: Wuling San (Five-Ling Powder) should not be lightly advanced. Taiyang spontaneous sweating with frequent urination: Guizhi Tang (Cinnamon Twig Decoction) should not be given blindly. Why? The body relies on Qi and Fluids. Externally, proper sweat nourishes skin/hair without drying; internally, Jin Ye (Body Fluids) harmonize the stomach without thirst; below, urine flows without obstruction. These three should mutually support without injury. Frequent urination depletes fluids downwards; why use Guizhi Tang to heavily induce sweat? Yangming profuse sweat depletes fluids externally; why use Wuling San to further penetrate internally to urine? The name "Baihu" is formidable due to its cold nature. No sweat, floating pulse, exterior not fully resolved: Chai Hu (Bupleurum Root) muscle-releasing agents are still appropriate; how can pure interior-cold agents be used? No sweat without irritability: Mahuang Tang (Ephedra Decoction). Sweat with irritability: Guizhi Tang (Cinnamon Twig Decoction). Only no sweat WITH irritability: Qinglong Tang (Azure Dragon Decoction). Adding Shi Gao (Gypsum Fibrosum) moderates the harshness relative to Mahuang, hence the good name. Alas! Proper use allows morning Da Huang and evening Fuzi without violating principles; improper use causes harm even with the relatively mild Xiaochaihu Tang. Prescribers must understand the intent behind ancient formulas!