太阳与阳明合病,必自下利,葛根汤主之。不下利但呕者,葛根加半夏汤主之。
太阳与少阳合病,自下利者,与黄芩汤。若呕者,黄芩加半夏生姜汤主之。
阳明与少阳合病,必下利,脉滑而数者,有宿食也,当下之,宜大承气汤。(论见下利。)
二阳并病,太阳出汗不彻,因转属阳明,自汗不恶寒,太阳症不罢,面赤躁烦短气者,更发汗则愈。
二阳并病,太阳症罢,潮热谵语者,下之则愈。(论见谵语。)
太阳与少阳并病,项强眩冒,心下硬如结胸者,刺胸 肝 。(论见项强。)
太阳与阳明合病,喘而胸满者,不可下,麻黄汤主之。
〔许〕有人病伤寒,脉浮而长,喘而胸满,身热头痛,腰脊强,鼻干不得卧。予曰∶太阳阳明合病。
仲景云∶中有三证,下利,葛根汤;不下利呕逆者,加半夏;喘而胸满者,麻黄汤也。治以麻黄汤得解。
太阳病,头疼发热,身疼恶风,无汗而喘者,麻黄汤。(论见发热。)阳明病,脉浮无汗而喘者,
麻黄汤。(论见不大便。)喘家有汗,桂枝汤加浓朴杏仁佳。
桂枝加浓朴杏仁汤
桂枝(去皮) 芍药(各一两) 甘草(炙) 浓朴(各六钱) 杏仁(去皮尖,二十一个)
上 咀,每服五钱,水一盏半,生姜五片,肥枣三枚,劈破同煎至八分,温服,覆取微汗。
表不解,干呕发热咳喘者,小青龙去麻黄加杏仁汤。(论见咳。)阳明病,潮热汗出,不恶寒,短气
腹满而喘者,大承气汤。(论见不大便。注云∶在里而喘者腹满,在表而喘者腹不满。)
小便不利,大便乍难乍易,微热喘冒不能卧者,大承气汤。脉沉喘满,反发汗,大便难者,里实。(论见谵语。)
发汗后不可更行桂枝汤,汗出而喘,无大热者,可与麻黄杏仁甘草石膏汤。
麻黄(四两) 杏仁(五十个) 甘草(二两) 石膏(半斤)
上四味,以水七升,先煮麻黄减二升,去上沫,纳诸药,煮取二升,去渣,温服一升。
发汗后,饮水多,必喘,以水灌之,亦喘。汗后脉沉,喘满,大便难,谵语者,里实。(论见谵语。)
下后不可更行桂枝汤,若汗出而喘,无大热者,可与麻黄杏仁甘草石膏汤。下后利不止,脉促而喘汗者,
葛根黄芩黄连汤。(论见下利。)太阳病下之微喘者,表未解故也,桂枝加浓朴杏仁汤主之。
〔许〕有武臣为寇执,置舟中 板下,数日得脱,乘饥恣食,良久,解衣扪虱,次日遂伤寒自汗,而膈不
利。一医作伤食而下之,一医作解衣中邪而汗之,杂治数日,渐觉昏困,上喘息高。予诊之曰∶太阳下之,表
未解,微喘者,桂枝加浓朴杏仁汤,此仲景之法也。命令医者急治药,一啜喘定,再啜 汗出,至晚
身凉,脉已和矣。医曰∶某平生不曾用仲景方,不知其神捷如此。
伤寒吐下后,不大便,潮热,若剧则不识人,循衣摸床,微喘直视,脉弦者生,涩者死。(论见循衣摸床。)
湿家下后,额汗微喘,大小便利者死。(论见体痛。)少阴病息高者死。(详见厥利,论见欲寐。)厥冷无脉,
灸之不还,反微喘者死。(详见厥利。)直视谵语,喘满者死。(论见谵语。)脉浮洪,汗出如油,发润,
喘不休者,为命绝。(论见大法。)
When Taiyang (Greater Yang) and Yangming (Yang Brightness) diseases occur simultaneously, spontaneous diarrhea will inevitably ensue; Gegen Tang (Kudzu Decoction) is the primary treatment. If there is no diarrhea but vomiting occurs, Gegen Jia Banxia Tang (Gegen plus Pinellia Decoction) is indicated.
When Taiyang and Shaoyang (Lesser Yang) diseases occur simultaneously, with spontaneous diarrhea, Huangqin Tang (Scutellaria Decoction) should be administered. If vomiting is present, Huangqin Jia Banxia Shengjiang Tang (Huangqin plus Pinellia and Fresh Ginger Decoction) is the main treatment.
When Yangming and Shaoyang diseases occur simultaneously, diarrhea will inevitably occur. If the pulse is slippery and rapid, it indicates retained food in the stomach; purgation should be employed, and Dachengqi Tang (Major Order the Qi Decoction) is suitable. (See discussion under "Diarrhea".)
In Bingbing (concurrent disease) of two Yang meridians, if sweating from the Taiyang stage was incomplete, causing the pathogen to transfer to Yangming, presenting with spontaneous sweating, aversion to cold absent, yet Taiyang symptoms persisting, accompanied by a red face, restlessness, and shortness of breath, further inducing sweating will lead to recovery.
In Bingbing of two Yang meridians, once Taiyang symptoms have ceased, if tidal fever and delirium occur, purgation will lead to recovery. (See discussion under "Delirium".)
In concurrent disease of Taiyang and Shaoyang, presenting with stiffness of the neck, dizziness, and hardness below the heart resembling Jie Xiong (Chest Binding), needle the Liver Shu point on the chest. (See discussion under "Neck Stiffness".)
When Taiyang and Yangming diseases occur simultaneously, with wheezing and chest fullness, purgation is contraindicated; Mahuang Tang (Ephedra Decoction) is the primary treatment.
[Xu Shumi] Once treated a patient with Shanghan (Cold Damage), whose pulse was floating and long, with wheezing and chest fullness, body heat, headache, stiff waist and spine, dry nose, and inability to lie down. I said: This is concurrent Taiyang-Yangming disease.
Zhongjing stated: There are three syndromes here: for diarrhea, use Gegen Tang; for non-diarrhea with vomiting and rebellious qi, add Banxia (Pinellia); for wheezing and chest fullness, use Mahuang Tang. The condition was resolved after treatment with Mahuang Tang.
For Taiyang disease, with headache, fever, body ache, aversion to wind, absence of sweat, and wheezing, use Mahuang Tang. (See discussion under "Fever".) For Yangming disease, with a floating pulse, absence of sweat, and wheezing, use Mahuang Tang. (See discussion under "Constipation".) For patients with a chronic history of asthma who have sweating, Guizhi Tang (Cinnamon Twig Decoction) added with Houpo (Magnolia Bark) and Xingren (Apricot Seed) is excellent.
Guizhi Jia Houpo Xingren Tang (Guizhi Tang plus Magnolia Bark and Apricot Seed Decoction)
Guizhi (Cortex Cinnamomi, peeled) and Shaoyao (Radix Paeoniae Alba, each one liang); Gancao (Radix Glycyrrhizae, honey-fried); Houpo (Cortex Magnoliae Officinalis, each six qian); Xingren (Semen Pruni Armeniacae, peeled and removed of kernels, twenty-one).
Chop the above ingredients. Take five qian per dose, add one and a half cups of water, five slices of Shengjiang (Fresh Ginger), and three Feizao (Large Dates, split). Simmer together until eight-tenths remain. Take warm, then cover to induce slight sweating.
If the exterior is not resolved, presenting with dry heaves, fever, cough, and wheezing, use Xiao Qinglong Tang (Minor Green Dragon Decoction) with Mahuang removed and Xingren added. (See discussion under "Cough".) In Yangming disease, with tidal fever, sweating, aversion to cold absent, shortness of breath, abdominal fullness, and wheezing, use Dachengqi Tang. (See discussion under "Constipation". Note: Wheezing due to interior pathology presents with abdominal fullness; wheezing due to exterior pathology presents without abdominal fullness.)
With difficulty in urination, stool that is sometimes difficult and sometimes easy, slight fever, wheezing, vertigo, and inability to lie down, use Dachengqi Tang. With a deep pulse, wheezing, and fullness, if sweating was incorrectly induced leading to difficult defecation, this constitutes Interior Excess. (See discussion under "Delirium".)
After inducing sweating, do not administer Guizhi Tang again. If there is sweating with wheezing and no significant heat, Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction) may be given.
Mahuang (Ephedrae Herba, four liang); Xingren (Semen Pruni Armeniacae, fifty seeds); Gancao (Radix Glycyrrhizae, two liang); Shigao (Gypsum Fibrosum, half jin).
Take the four ingredients, add seven sheng of water. First boil Mahuang until reduced by two sheng, remove the foam on top. Add the remaining herbs, boil to obtain two sheng, strain, and take one sheng warm.
After inducing sweating, if excessive water intake occurs, wheezing will inevitably result; bathing with cold water also causes wheezing. After sweating, if the pulse is deep, with wheezing, fullness, difficult defecation, and delirium, this is Interior Excess. (See discussion under "Delirium".)
After purgation, do not administer Guizhi Tang again. If there is sweating with wheezing and no significant heat, Mahuang Xingren Gancao Shigao Tang may be given. If purgation leads to persistent diarrhea, with a rapid pulse, wheezing, and sweating, Ge Gen Huang Qin Huang Lian Tang (Kudzu, Scutellaria, and Coptis Decoction) is indicated. (See discussion under "Diarrhea".) In Taiyang disease, if mild wheezing occurs after incorrect purgation, it is because the exterior is unresolved; Guizhi Jia Houpo Xingren Tang is the primary treatment.
[Xu Shumi] A military officer was captured by bandits and confined under a boat plank. After escaping days later, he ate voraciously out of hunger. Later, while undressing to catch lice, he contracted Shanghan with spontaneous sweating and stagnation in the diaphragm. One physician treated him as food retention with purgatives; another treated him as pathogenic invasion from exposure with diaphoretics. After several days of mixed treatments, he became increasingly lethargic with high-pitched breathing. Upon diagnosis, I said: Following incorrect purgation in Taiyang disease, with unresolved exterior and mild wheezing, Guizhi Jia Houpo Xingren Tang is the method of Zhongjing. The physician was ordered to prepare the medicine urgently. After one sip, the wheezing stopped; after a second sip, sweating occurred. By evening, the body cooled, and the pulse harmonized. The physician said: "I have never used Zhongjing's formulas in my life; I did not know they were so miraculous and swift."
After emesis or purgation in Shanghan, if there is constipation and tidal fever, and in severe cases, loss of recognition, grasping at clothes and bedrails, mild wheezing, and fixed gaze, a string-like pulse indicates survival, while a choppy pulse indicates death. (See discussion under "Grasping at Clothes and Bedrails".)
In patients with Dampness, if purgation is incorrectly applied, resulting in sweating on the forehead, mild wheezing, and free passage of urine and stool, the prognosis is fatal. (See discussion under "Body Pain".) In Shaoyin (Lesser Yin) disease, if respiration is elevated/shallow, the prognosis is fatal. (See details under "Jue Li", discussion under "Desire to Sleep".) In cold limbs with no pulse, if moxibustion fails to restore the pulse and mild wheezing ensues, the prognosis is fatal. (See details under "Jue Li".) Fixed gaze, delirium, wheezing, and chest fullness indicate death. (See discussion under "Delirium".) A floating and surging pulse, sweating like oil, moist hair, and ceaseless wheezing indicate the end of life. (See discussion under "General Principles".)