筋惕肉 ，非常有之。《经》曰∶阳气者，精则养神，柔则养筋。发汗过多，津液枯少，阳气大虚，筋肉
失养，故惕惕而跳， 而动也。《论》云∶太阳病，脉微弱，汗出恶风者，不可服大青龙汤，服之则厥逆，
筋惕肉 ，此为逆也。又云∶太阳病发汗，汗出不解，其人仍发热，头眩，身 动，振振欲擗地者，真武汤
主之。动气在左，不可发汗，发汗则头眩，汗出不止，筋惕肉 。此虽为逆，但止于发汗亡阳而表虚，治以温
经益阳可矣。有因吐、下、发汗后，表里俱虚，而有此状者，又非若但发汗后所可同也。《论》云∶伤寒吐、
下后，发汗，虚烦，脉甚微，八、九日心下痞，胁下痛，气上冲咽喉，眩冒，筋脉动惕者，久而成痿。太阳病
发汗复下之，表里俱虚，复加烧针，心烦面黄肤 者，为难治。此皆逆之甚者也。（《伤寒类证》）
协热利
表证未除，而误下之，外热未退，内利复作，故云协热下利。此热字，乃言表热，非言内热也。协者，
协同之协，非挟藏之挟也。《明理论》曰∶表邪传里，里虚协热则利，乃亦以表邪为言也。后学不明此义，止
因协热二字，每每以表作里，以寒作热，但见下利，即认为热，且有不因误下，而妄用芩、连治表热
者。表证得寒，热愈不退，乃致下利；或脾胃素弱，逢寒即泄者，既见下利，益云协热，其谬孰甚！独不观仲
景桂枝人参汤，岂治内热之剂乎？寒热倒施，杀人多矣。（《景岳全书》）
结胸痞气
心下硬满而痛者，为实，为结胸，硬满不痛者，为虚，为痞气；不满不硬，但烦闷者，为支结。《保命
集》云∶脾不能行气于四脏，结而不散则为痞。大抵诸痞皆热，故攻痞之药皆寒。其有一加附子者，是以辛热
佐寒凉，令开发痞之郁结，非攻寒也。（《证治准绳》）
伤寒结胸痞满，今医不分曾下与未下，遂皆呼为结胸，便与枳桔汤，反成真结胸矣。不知下早而胸满
硬痛者为结胸；未经下者，非结胸也。胸虽满闷而不硬痛为痞气耳，乃表邪传至胸中，未入于腑，尚为在表，
证属少阳部分，不可峻攻。（《全生集》）
大结胸，是水结在胸腹，故脉沉紧；小结胸，是痰结于心下，故脉浮滑。水结宜下，故用甘遂、葶、杏、
硝、黄等下之；痰结宜消，故用黄连、栝蒌、半夏以消之。○水结、血结，俱是膀胱病，故皆少腹硬满。小便
不利是水结，小便自利是血结。○水结胸胁，用陷胸汤，水郁折之也。热结心中，用栀豉汤，火郁发之也。（柯韵伯）
不问大、小结胸以及痞气支结，皆属于郁。郁则未有不结者，总以开郁为主，则痞结自散。又当审其兼
证，诊其脉息，气郁，顺之调之；血郁，行之破之；痰郁，化之吐之；表郁，散之和之；里郁，攻之下之；热
郁清之；寒郁温之；食郁消之；水郁利之。治痞结之能事毕矣。（刘松峰）
蓄血
蓄血证，与溺涩、燥屎证相似而不同，宜分别施治。伤寒少腹满，按之不痛，小便不利者，为溺涩也；
若绕脐硬痛，小便短涩，大便不通者，此有燥屎也；若按之少腹硬痛，小便自利，或
大便黑色者，为蓄血也。（程钟龄）
阳明有蓄血而喜忘者，证之甚也，宜抵当汤。太阳有热结膀胱如狂者，证之轻也，宜桃仁承气汤。（成无己）
蓄血，如狂在中，发狂在下。○抵当汤、丸，药味同剂，如何是二法？盖喜忘发狂，身黄屎黑者，疾之甚
也；但少腹满硬，小便自利者，疾之轻也。故有汤、丸之别，丸者取其数少而缓也。（王好古）
衄血
衄者，鼻中出血是也。杂病衄者，责热在里；伤寒衄者，责热在表。何以言之？《经》曰∶其人发烦目瞑，
剧者必衄，衄乃解。所以然者，阳气重故也。又曰∶阳盛欲衄，阴虚小便难，言衄为经中阳盛也。凡伤寒脉浮，
鼻燥口干，但漱水不欲咽者，欲衄也。《经》曰∶阳明病，口干鼻燥，能食者则衄。又不应发汗而强发之因致
衄者。《经》曰∶少阴病，但厥无汗，而强发之，必动其血，或从口鼻，或从目出，是名下厥上竭，为难治是
也。衄家虽为邪热在经，而又不可发汗。《经》曰∶衄家不可发汗，发汗则额上陷，脉紧急，直视不能 ，不
得眠。所云桂枝、麻黄治衄者，非治衄也，是发散经中邪气尔。《经》曰∶太阳病，脉浮紧，发热身无汗，自
衄者愈。是经中之邪随衄而解矣，不待桂、麻之发散也。（黄仲理）
发黄
湿热俱甚则发身黄，又邪风被火热其身必黄，又阳明病被火必发身黄者，此皆由内热火攻所致也。阳明
病无汗，小便不利，心中懊 ，必发黄者，此由阳明热甚所致也。伤寒汗已，身目为黄者，以寒湿在里不解故
也。大抵黄家属太阴，《经》云∶太阴当发身黄。或少腹硬满，小便自利，其人如狂，又为蓄血之黄也。（成无己）
仲景治太阳发黄有二法∶但头汗出，小便不利者，麻黄连翘
赤豆汤汗之；小腹硬满，小便自利者，抵当汤下之。治阳明发黄亦有二法∶但头汗，小便不利，腹满者，茵陈、
大黄以下之；身热发黄，与误治而致者，栀子、柏皮以清之。总不用渗泄之剂，要知仲景治阳明，重在存津液，
不欲利小便，惟恐胃中燥耳。○太阳、阳明，俱有发黄证，但头汗而身无汗则热不外越，小便不利则热不下泄，
故瘀热在里。然里有不同，肌肉是太阳之里，当汗而发之，故用麻黄连翘赤豆汤，为凉散法；心胸是太阳、阳明
之里，当寒以胜之，故用栀子柏皮汤，乃清火法；肠胃是阳明之里，当泻之于内，故立茵陈蒿汤，是逐秽法。
（柯韵伯）
目痛鼻干
问曰∶目痛鼻干，何以是邪在肌肉？答曰∶目鼻者，阳明所布之经络也。盖胃主肌肉，邪之侵入，必由皮
毛而传肌肉，故目痛鼻干。至于他经，各行其道，何目痛鼻干之有？（陈养晦）
唇焦漱水不欲咽
唇焦漱水不欲咽，何以是邪在肌肉？答曰∶唇者肌肉之本，唇干则思漱水以润之。然不欲咽者，知本腑无
热，表病里和也。又问曰∶表证既除，里证已见，或亦漱水而不咽者，治法从表乎？从里乎？答曰∶既无表证，
里必有热，热则能消水，漱当咽。若不咽者，是内有瘀血也。何以别之？必外无表证，小腹硬满，小便自利，
大便黑色是也。（陈养晦）
不得眠
问曰∶不得眠，何以是阳明腑证？答曰∶阴阳皆有之。其狂乱不得眠者，阳明胃热故也。《经》云∶胃
不和则卧不安。胃受热邪，故不和，不和故不眠也。若初时目痛鼻干，不得眠者，阳经病也，葛根汤主之。若
蒸热自汗，燥渴脉洪，不得眠者，阳明经、腑同病，散漫之热也，白虎加入参汤主之。若潮热自汗，便闭谵语，
不得眠者，阳明腑病，结聚之热也，调胃承气汤下之。又问曰∶有汗下后，不得眠者何也？答曰∶因汗下重亡津液，致
虚烦不得眠，宜酸枣仁汤主之。若少阴脉沉细，自利厥逆，烦躁不得眠者，为难治也。（程钟龄）
潮热
问曰∶潮热何以属阳明腑证？答曰∶潮热者，如潮之汛，不失其时，今日午后发热，明日亦午后发热，
故名潮热。若一日热发至晚者，便是发热；若寒热相间，便是往来寒热。仲景云∶其热不潮，不可与承气汤。
可见潮热合用承气汤也。又问曰∶潮热固当下，设有表证，何以治之？答曰∶潮热兼表，必先解表，然后攻里。
若里证急者，则用大柴胡法，表里并治可也。（《医学心悟》）
口渴
凡中风伤寒，结热在里，热伤气分，必烦渴饮水。治有二法∶表证已罢，而脉洪大，是热邪在阳明之半
表里，用白虎加人参汤，清火以益气；表证未罢，而脉仍浮数，是寒邪在太阳之半表里，用五苓散，利水而发
汗。○仲景治阳明渴饮有四法∶本太阳转属者，五苓散微发汗以散水气；大烦燥渴，小便自利者，白虎汤加人参
清火而生津；脉浮发热，小便不利者，猪苓汤滋阴而利水；小便不利腹满者，茵陈汤以泄满，令黄从小便出。
病情不同，治法亦异。○凡厥阴之渴，在未汗时；太阳之渴，在发汗后。（柯韵伯）
太阳无汗而渴，忌白虎；阳明有汗而渴，忌五苓。（葛逸圣）
三阴同属脏寒，少阴、厥阴有渴证，太阴独无渴证者，以其寒在中焦，总与龙雷之火无涉。少阴中有龙火，
水底寒甚则龙升，故自利而渴；厥阴中有雷火，故有消渴。（程郊倩）
即以伤寒口渴言之，邪热入于胃腑，消耗津液，故渴。恐胃汁干，急下之以存津液。其次但云∶欲饮水者，
不可不与，不可多与，别无治法；纵有治者，徒知以芩、连、栀、柏、麦、味、花粉，甚则石膏、知母治之。
此皆有形之水，以沃无形之火，安能滋肾中之真阴而止渴乎？若以六味地黄汤大剂服之，其渴立愈，何至传入
少阴而成燥、实、坚之证乎？（《赵氏医贯》）
赵氏论治伤寒口渴，独重地黄滋阴，但伤寒末后之渴为虚热，初起之渴为实热，若以地黄腻膈之味施于伤
寒初起口渴之证，则邪热凝滞，病气不消，其渴愈甚矣。且口渴属阳明气分之病，先生不分气血所属，竟云滋
阴，不知邪热未去，虽曰进滋阴，无益于病。此仲景不设滋阴之方于口燥咽干条内者，良以滋阴乃治血虚之内
伤，非治热之外感也。（《证因脉治》）
湿热则不渴，燥热则渴，此以渴、不渴分热之在湿、在燥也。热在血分则不渴，热在气分则渴，此以渴、
不渴分热之在血、在气也。胃家痰食则渴而不消水，胃家邪热则渴而消水，此以消水、不消水分痰食、邪热也。
实火口渴则脉实数，虚火口渴则脉虚数，此以脉之虚实分虚火、实火也。邪热在表则不渴，热邪在里则渴，此
以渴不渴、分热之在表在里也。凡渴，皆属阳明气分之热，故干葛、石膏乃渴证必用之药。干葛宣发阳明之表
热，石膏清解阳明之里热。有先用石膏渴不减、后用干葛而愈者，此阳明之表热也；有先用干葛渴不减、后用
石膏而愈者，此阳明之里热也。同一阳明经病，同一阳明经药，而失分表里，则不见效。杂证口渴，有肺消、
肾消；伤寒口渴，一惟阳明邪热。即有少阴口燥咽干而渴，厥阴消渴饮水，亦是阳明传入之热病也。另有三阴
下利、寒证之假渴者，然虽渴而不消水，小便清白为异耳。（《伤寒大白》）
狂乱
问曰∶狂乱何以属阳明腑病？答曰∶重阴为颠，重阳为狂。诸经之狂，皆阳盛也。又太阳病不解，热结膀
胱，其人如狂，此乃下焦蓄血，少腹当硬满，小便自利，大便黑色，虽则如狂，初不若发狂之甚也。又有以火
劫汗，遂至亡阳，发为惊狂。是知如狂者，膀胱蓄血也；惊狂者，劫汗亡阳也；发狂者，阳明胃腑实热也。又
问曰∶寒证亦有发狂者，何也？答曰∶此阴盛格阳。其人烦躁欲坐卧泥水中，是名阴躁，脉必沉迟，或见下利
清谷诸寒证，急宜温补，不可误用寒凉也。（《医学心悟》）
如狂
如狂之证，或由失志，病在心也；或由悲忧，病在肺也；或由失精，病在肾也；或由劳倦思虑，病在肝脾
也。此病伤于内，邪感于外，病随邪起，其证如狂，亦虚狂也。必外无黄赤之色、刚暴之气，内无胸腹之结、
滑实之脉。虽不时躁扰，而禁之则止；口多妄诞，而声息不壮；或眼见虚空，或惊惶不定。察其上，则口无焦
渴；察其下，则便无硬结。是皆精气受伤，神魂不守之故。与阳极为狂者，反如冰炭，妄行攻泻，必致杀人。（张景岳）
谵语郑声
谵语属阳，郑声属阴。《经》云∶实则谵语，虚则郑声。谵语者，颠倒错乱，言出无伦；郑声者，郑重
频烦，谆谆不已。此谵语、郑声虚实不同。二者本不难辨，但阳盛里实与阴盛格阳，皆能错语，须以他证别之。
如大便秘，小便赤，身热烦渴而妄言者，乃里实也；若小便如常，大便洞下，或发躁，或反发热而妄言者，乃
阴盛格阳也。里实宜下，调胃承气汤；热甚烦躁，大渴喜饮，宜白虎汤；阴盛格阳，宜白通汤、四逆汤、附子
理中汤。（戴复庵）
狂言者，开目与人语，所语未尝见之事也；谵语者，合目自言，所言日用常见之事也；郑声者，声战无
力，不相接续，造字出于喉中也。（《此事难知》）
谵语之由，又自不同，有火劫，有汗出，有下利，有下血，有燥屎在胃，有三阳合病，有过经，有亡阳。
诸如此者，脉短则死，脉自和则愈。（《证治准绳》）
循衣摸床
循衣摸床，危恶之证也。一因太阳火劫取汗，致阳盛伤阴。阴若未竭，则小便利，多生；阴若已竭，则
小便难，多死。一因阳明热极，汗、吐、下三法失宜，致成坏证，其热弥深。脉实者，堪下，则可治；脉弱者，
不堪下，则难治。此已成危恶坏证，往
往阴阳虚实，医莫能辨，无下手处，当以大剂独参、六味、干生地黄汤时时与之，每获生也。（《医宗金鉴》）
娄全善治循衣摸床，每以补益得愈。因其脉证之不足也。（程知）
手足汗
胃主四肢，为津液之主。今热聚于胃，致令手足汗出，乃津液之旁达也。《经》曰∶手足 汗出，大便
Muscle twitching is a very common occurrence. The *Classic* states: "Yang qi, in its refined aspect, nourishes the spirit; in its soft aspect, it nourishes the tendons." Excessive sweating depletes body fluids, causing severe deficiency of Yang qi. Consequently, muscles and sinews lose their nourishment, leading to palpitations and twitching. The *Treatise* says: "In Taiyang disease, if the pulse is weak and there is sweating with aversion to wind, Da Qing Long Tang (Major Blue Green Dragon Decoction) must not be administered. If taken, it will cause cold extremities and muscle twitching, which constitutes an adverse reaction due to mismanagement." It further states: "After sweating therapy for Taiyang disease, if the condition remains unresolved, the patient still has fever, dizziness, tremors, and feels as though they are about to fall to the ground, Zhen Wu Tang (True Warrior Decoction) should be used." If there is pulsation on the left side of the umbilicus, sweating therapy is contraindicated; if performed, it leads to dizziness, unremitting sweating, and muscle twitching. Although this is an adverse reaction, it stems merely from Yang depletion and exterior deficiency caused by excessive sweating, and can be treated by warming the meridians and benefiting Yang. In cases where vomiting, purging, or sweating have led to both interior and exterior deficiency resulting in these symptoms, the situation differs from that following sweating alone. The *Treatise* notes: "After vomiting and purging for Shanghan (Cold Damage), followed by sweating, if there is empty irritability, a very faint pulse, and after eight or nine days, epigastric fullness and pain, Qi rushing up to the throat, dizziness, and tendon twitching, this may eventually develop into flaccidity syndrome." "If Taiyang disease is treated with sweating followed by purging, leaving both interior and exterior deficient, and moxibustion (burning needle) is added, causing irritability, yellow complexion, and dry skin, it becomes difficult to treat." These are all examples of severe mismanagement. (From *Shanghan Leizheng*)
**Xie Re Li (Collaborative Heat Diarrhea)**
When the exterior syndrome is not yet resolved but purgatives are mistakenly used, the external heat does not recede, and internal diarrhea arises; hence it is called Xie Re Li. Here, "heat" refers to exterior heat, not interior heat. "Xie" means collaboration, not harboring. *Mingli Lun* states: "When exterior pathogens transmit inward and the interior is deficient, collaborating with heat causes diarrhea," implying the reference to exterior pathogens. Later scholars failing to understand this often mistake the exterior for the interior and cold for heat. Upon seeing diarrhea, they immediately diagnose it as heat, sometimes even using Huang Qin (Scutellaria Root) and Lian Zi (Coptis Rhizome) to treat exterior heat without prior mis-purging. This causes the heat to persist and worsen diarrhea, especially in those with weak Spleen-Stomach prone to cold-induced diarrhea. Such errors are grave. Have they not observed Zhang Zhongjing's Gui Zhi Ren Shen Tang (Cinnamon Twig and Ginseng Decoction)? Is it not a formula for interior heat? Misapplying cold and heat has killed many. (From *Jingyue Quanshu*)
**Jie Xiong Pi Qi (Chest Binding and Epigastric Fullness)**
Epigastric hardness, fullness, and pain indicate excess and Jie Xiong (Chest Binding); hardness and fullness without pain indicate deficiency and Pi Qi (Epigastric Fullness); neither full nor hard, but only irritability, indicates Zhi Jie (Branch Binding). *Baoming Ji* says: "When the Spleen cannot distribute Qi to the four Zang organs, Qi knots and fails to disperse, forming Pi." Generally, all Pi syndromes are heat-related, so formulas for Pi are mostly cold in nature. Some include Fu Zi (Aconite Lateral Root), using acrid-hot herbs to assist cold-herbs in opening the stagnation of Pi, not to attack cold. (From *Zhengzhi Zhunsheng*)
Current physicians treating Shanghan Jie Xiong and Pi Man (Fullness) often fail to distinguish whether purgatives were previously used, labeling everything as Jie Xiong and administering Zhi Ju Tang (Citrus Aurantium and Bupleurum Decoction), thereby creating true Jie Xiong. One must know that early purgation leading to chest fullness, hardness, and pain constitutes Jie Xiong; without purgation, it is not Jie Xiong. Chest fullness without hardness/pain is Pi Qi, where exterior pathogens have reached the chest but not the Fu organs, remaining at the exterior level, belonging to the Shaoyang sector, and should not be aggressively purged. (From *Quansheng Ji*)
Da Jie Xiong (Major Chest Binding) involves water accumulation in the chest/abdomen, presenting with a deep, tight pulse. Xiao Jie Xiong (Minor Chest Binding) involves phlegm-heat knotting at the epigastrium, presenting with a floating, slippery pulse. Water accumulation requires purgation (using Gan Sui, Ting Li, Xing Ren, Mang Xiao, Da Huang); Phlegm accumulation requires resolution (using Huang Lian, Gua Lou, Ban Xia). ○ Water and Blood accumulation both affect the Bladder, causing lower abdominal hardness/fullness. Urinary difficulty indicates Water accumulation; spontaneous urination indicates Blood accumulation. ○ For water knotting in the chest/hypochondrium, use Xian Xiong Tang (Sinking Chest Decoction) to subdue water depression. For heat knotting in the heart, use Zhi Chi Tang (Gardenia and Soybean Decoction) to vent fire depression. (Ke Yunbo)
Regardless of Major/Minor Jie Xiong or Pi/Zhi Jie, all belong to Depression (Yu). Stagnation inevitably leads to knotting; thus, the primary treatment is to open the depression, allowing the knot to dissipate. One must examine accompanying symptoms and pulses: Qi depression is regulated; Blood depression is moved/broken; Phlegm depression is transformed/vomited; Exterior depression is dispersed/harmonized; Interior depression is purged; Heat depression is cleared; Cold depression is warmed; Food depression is digested; Water depression is drained. Thus, the management of Pi knotting is complete. (Liu Songfeng)
**Xu Xue (Accumulated Blood)**
Xu Xue syndrome resembles urinary retention and dry stool syndrome but differs; treatments must be distinguished. In Shanghan, lower abdominal fullness without pain upon pressure and urinary difficulty indicates urinary retention. Periumbilical hardness/pain, scanty/difficult urination, and constipation indicate dry stools. Lower abdominal hardness/pain upon pressure, spontaneous urination, or black stool indicates Xu Xue. (Cheng Zhongling)
Yangming Xu Xue with forgetfulness indicates severe pathology, requiring Di Dang Tang (Di Dang Decoction). Taiyang heat knotting in the Bladder with mania-like symptoms indicates mild pathology, requiring Tao Ren Cheng Qi Tang (Peach Kernel Purge the Qi Decoction). (Cheng Wuji)
In Xu Xue, "mania-like" symptoms appear upper/middle, while "mania" appears lower. ○ Di Dang Tang and Wan share ingredients/dosage but differ in method. Forgetfulness, mania, yellow skin, and black stool indicate severe disease; lower abdominal fullness/hardness with spontaneous urination indicates mild disease. Hence, Tang (liquid) vs. Wan (pill): Pills act slowly with fewer doses. (Wang Haogu)
**Nu Xue (Nosebleed)**
Nu refers to nosebleed. In miscellaneous diseases, Nu is attributed to interior heat; in Shanghan, it is attributed to exterior heat. Why? The *Classic* says: "Irritability and eye dimness occur; severely, Nu happens, resolving the disease." This is due to heavy Yang Qi. Also: "Excess Yang desires Nu; Yin deficiency causes difficult urination," indicating Nu results from Yang excess in the channels. In Shanghan, floating pulse, nasal dryness, mouth thirst, rinsing water without swallowing indicates impending Nu. *Classic*: "Yangming disease, dry mouth/nose, able to eat, leads to Nu." Forced sweating when inappropriate also causes Nu. *Classic*: "Shaoyin disease, cold limbs without sweat, forced sweating moves blood, causing oral/nasal/ocular bleeding, termed Lower Jue Upper Exhaustion, difficult to treat." Even with pathogenic heat in the channel, Nu patients must not be sweated. *Classic*: "Nu patients cannot be sweated; sweating causes sunken forehead, urgent pulse, fixed gaze, inability to sleep." Guizhi/Mahuang do not treat Nu itself but disperse channel pathogens. *Classic*: "Taiyang disease, floating/tight pulse, fever, no sweat, self-Nu leads to cure," as pathogens exit via Nu. (Huang Zhongli)
**Fa Huang (Jaundice/Yellowing)**
Severe damp-heat causes yellowing. Wind-pathogen combined with fire causes yellowing. Yangming disease treated with fire causes yellowing; all result from internal heat plus fire therapy. Yangming disease with no sweat, urinary difficulty, and mental anguish (Ao Nao) leads to yellowing due to severe Yangming heat. After sweating, if yellowing occurs, it is due to unresolved cold-damp in the interior. Generally, Yellowing belongs to Taiyin (*Classic*: "Taiyin should cause yellowing"). Lower abdominal hardness/fullness, spontaneous urination, and mania-like state indicate Jaundice from Accumulated Blood. (Cheng Wuji)
Zhang Zhongjing treats Taiyang Jaundice with two methods: Head sweat only, urinary difficulty → Ma Huang Lian Qiao Chi Dou Tang (Ephedra, Forsythia, and Red Bean Decoction) to sweat; Lower abdominal hardness/fullness, spontaneous urination → Di Dang Tang to purge. Yangming Jaundice: Head sweat, urinary difficulty, abdominal fullness → Yin Chen, Da Huang to purge; Body heat/yellowing from mismanagement → Zhi Zi, Bai Pi to clear. No diuretics are used; Zhang emphasizes preserving fluids in Yangming, avoiding diuresis to prevent stomach dryness. ○ Taiyang/Yangming Jaundice: Head sweat/no body sweat prevents heat release; urinary difficulty prevents heat drainage → Heat knots in interior. Muscle is Taiyang interior → Sweat (Ma Huang Lian Qiao Chi Dou Tang, Cool Dispersal). Heart/Chest is Taiyang/Yangming interior → Cold overcomes heat (Zhi Zi Bai Pi Tang, Clear Fire). Intestines/Stomach are Yangming interior → Purge internally (Yin Chen Hao Tang, Remove Filth). (Ke Yunbo)
**Mu Tong Bi Gan (Eye Pain and Nasal Dryness)**
Q: Why is Eye Pain/Nasal Dryness considered pathogen in the Muscle layer? A: Eyes and nose are pathways of the Yangming meridian. Stomach governs muscles; pathogens enter via skin/hair to muscles, causing these symptoms. Other meridians follow their own paths. (Chen Yanghui)
**Chun Jiao Shu Shui Bu Yu Yan (Lip Chapping, Rinsing Water, Not Swallowing)**
Q: Why is this pathogen in the Muscle layer? A: Lips are the root of muscles; dry lips prompt rinsing. Not swallowing indicates no interior heat, only exterior pathology with harmonious interior. Q: If exterior resolves and interior signs appear, or rinsing without swallowing occurs, treat exterior or interior? A: Without exterior signs, interior heat exists. Heat consumes water, so one should swallow. Not swallowing indicates interior Blood stasis. Distinguish by: No exterior signs, lower abdominal hardness/fullness, spontaneous urination, black stool. (Chen Yanghui)
**Bu De Mian (Insomnia)**
Q: Why is Insomnia a Yangming Fu syndrome? A: It occurs in both Yin and Yang. Manic insomnia is Yangming Stomach heat. *Classic*: "Stomach disharmony leads to restless sleep." Heat disrupts harmony. Initial eye pain/nasal dryness insomnia is Yang channel disease → Ge Gen Tang. Steaming fever/sweat/thirst/huge pulse insomnia is Yangming Channel/Fu simultaneous heat → Bai Hu Jia Ren Shen Tang. Tidal fever/sweat/constipation/confusion insomnia is Yangming Fu knotting heat → Tiao Wei Cheng Qi Tang. Post-sweating/purging insomnia is fluid depletion causing empty irritability → Suan Zao Ren Tang. Shaoyin pulse deep/fine, diarrhea/cold limbs/restlessness is difficult to treat. (Cheng Zhongling)
**Chao Re (Tidal Fever)**
Q: Why is Tidal Fever Yangming Fu? A: Like tides, it occurs regularly (e.g., afternoon). All-day fever is just fever; alternating chills/fever is Shaoyang. Zhang Zhongjing: "If fever is not tidal, do not give Cheng Qi Tang." Thus, tidal fever suits Cheng Qi Tang. Q: If exterior signs exist with tidal fever? A: Resolve exterior first, then purge interior. If interior urgency exists, use Da Chai Hu Tang for simultaneous treatment. (*Yixue Xinwu*)
**Kou Ke (Thirst)**
Wind-stroke/Shanghan with interior heat damaging Qi causes irritability/thirst. Two methods: Exterior resolved, huge pulse (Yangming half-exterior/half-interior heat) → Bai Hu Jia Ren Shen Tang (Clear fire, benefit Qi). Exterior unresolved, floating/rapid pulse (Taiyang half-exterior/half-interior cold) → Wu Ling San (Drain water, induce sweat). ○ Zhang Zhongjing’s four Yangming thirst methods: Taiyang transferring to Yangming → Wu Ling San (micro-sweat, scatter water); Great irritability/thirst, spontaneous urination → Bai Hu Tang + Ren Shen (clear fire, generate fluids); Floating pulse/fever, urinary difficulty → Zhu Ling Tang (nourish Yin, drain water); Urinary difficulty/abdominal fullness → Yin Chen Tang (drain fullness, excrete yellow via urine). ○ Jueyin thirst occurs pre-sweating; Taiyang thirst post-sweating. (Ke Yunbo)
Taiyang no-sweat thirst forbids Bai Hu; Yangming sweat thirst forbids Wu Ling. (Ge Yisheng)
Three Yin are cold-Zang. Shaoyin/Jueyin have thirst; Taiyin does not, as cold is in Middle Jiao, unrelated to Dragon/Thunder fire. Shaoyin Dragon fire rises with extreme cold-water, causing diarrhea/thirst. Jueyin Thunder fire causes Xiao Ke (Consumption Thirst). (Cheng Jiaoqian)
Regarding Shanghan thirst: Pathogenic heat in Stomach consumes fluids. Urgent purging preserves fluids. Alternatively, allow drinking but limit quantity. Using cold herbs (Huang Qin, Lian Zi, etc.) or Yin-nourishing herbs (Shi Gao, Zhi Mu) fails to nourish Kidney True Yin. Large doses of Liu Wei Di Huang Tang cure thirst instantly, preventing progression to Shaoyin dryness/excess. (*Zhao Shi Yi Guan*)
Zhao emphasizes Di Huang for Yin-nourishing. However, late-stage Shanghan thirst is deficiency-heat; early-stage is excess-heat. Using cloying Di Huang in early excess-heat traps pathogens, worsening thirst. Thirst belongs to Yangming Qi level; Zhao ignores Qi/Blood distinction. Zhang Zhongjing omitted Yin-nourishing formulas for dry mouth/throat because Yin-nourishing treats Blood-deficiency internal injury, not external heat. (*Zhengyin Maizhi*)
Damp-heat: no thirst; Dry-heat: thirst. Differentiates Damp vs. Dry. Heat in Blood: no thirst; Heat in Qi: thirst. Differentiates Blood vs. Qi. Phlegm/Food in Stomach: thirst but no water consumption; Pathogenic heat: thirst with water consumption. Real Fire: real/rapid pulse; Deficient Fire: deficient/rapid pulse. Exterior heat: no thirst; Interior heat: thirst. All thirst belongs to Yangming Qi heat; Ge Gen (Pueraria) and Shi Gao (Gypsum) are essential. Ge Gen disperses Yangming exterior heat; Shi Gao clears Yangming interior heat. Response to Ge Gen/Shi Gao determines location. Miscellaneous thirst includes Lung/Kidney Consumption; Shanghan thirst is exclusively Yangming heat. Shaoyin/Jueyin thirst is transmitted Yangming heat. False thirst in Three Yin cold/diarrhea presents with non-consumption of water and clear urine. (*Shanghan Da Bai*)
**Kuang Luan (Mania/Delirium)**
Q: Why is Mania Yangming Fu? A: Heavy Yin is Dian (Depression); Heavy Yang is Kuang (Mania). All Meridian Mania is Yang excess. Taiyang unresolved, heat knotting Bladder, mania-like state indicates Lower Jiao Blood stasis (lower abdominal fullness, spontaneous urination, black stool). Fire-induced sweating causing Yang depletion leads to Jing Kuang (Frightened Mania). Thus: Ru Kuang = Bladder Blood stasis; Jing Kuang = Sweating Yang depletion; Fa Kuang = Yangming Stomach excess heat. Q: Can Cold cause Mania? A: Yin excess repelling Yang. Irritability wanting to sit in mud is Yin Zao (Yrestlessness), pulse deep/slow, with cold signs. Warm and tonify urgently; do not use cold. (*Yixue Xinwu*)
**Ru Kuang (Mania-like State)**
Ru Kuang may stem from emotional loss (Heart), grief (Lung), essence loss (Kidney), or fatigue/overthinking (Liver/Spleen). Internal injury with external pathogen causes "like-manic" deficiency mania. Absence of red/yellow complexion, aggression, chest/knotting, or slippery/real pulse. Restlessness stops when restrained; delirious speech lacks strength; visual hallucinations or fear. No dry mouth/thirst; no hard stool. Caused by Essence/Qi damage and unsettled Spirit. Opposite to Extreme Yang Mania; aggressive purging kills. (Zhang Jingyue)
**Chan Yu Zheng Sheng (Delirium and Weak Repetitive Speech)**
Chan Yu (Delirium) is Yang; Zheng Sheng (Weak Repetition) is Yin. *Classic*: "Excess Chan Yu, Deficiency Zheng Sheng." Chan Yu: confused, illogical speech. Zheng Sheng: repetitive, earnest speech. Differentiate Excess vs. Deficiency. Yang excess/Interior excess and Yin excess/Repelling Yang both cause confusion. Constipation/red urine/fever/thirst/delirium = Interior Excess → Tiao Wei Cheng Qi Tang. Normal urine/diarrhea/restlessness/fever/delirium = Yin Excess Repelling Yang → Bai Tong Tang, Si Ni Tang, Fu Zi Li Zhong Tang. (Dai Fuan)
Kuang Yan (Mad Speech): Open eyes, speak of unseen things. Chan Yu (Delirium): Closed eyes, speak of daily things. Zheng Sheng (Weak Speech): Trembling voice, disjointed, guttural. (*Ci Shi Nan Zhi*)
Causes of Chan Yu vary: Fire therapy, sweating, diarrhea, bleeding, dry stool, Three Yang combination, passing stages, Yang depletion. Short pulse = death; Harmonious pulse = recovery. (*Zhengzhi Zhunsheng*)
**Xun Yi Mo Chuang (Groping Bedclothes)**
Xun Yi Mo Chuang is critical. Cause 1: Taiyang fire therapy damages Yin. If Yin not exhausted, urine flows, survival likely; if exhausted, urine difficult, death likely. Cause 2: Yangming extreme heat, improper sweating/vomiting/purging creates bad syndrome, deepening heat. Real pulse = purgable, treatable; Weak pulse = not purgable, difficult. When Yin/Yang/Excess/Deficiency are indistinguishable, use large doses of Du Shen Tang, Liu Wei Tang, or Gan Sheng Di Huang Tang frequently for survival. (*Yizong Jinjian*)
Lou Quanshan cured this with tonification due to deficiency pulse/symptoms. (Cheng Zhi)
**Shou Zu Han (Hand/Foot Sweat)**
Stomach governs limbs and is master of fluids. Heat gathering in Stomach causes hand/foot sweat, representing fluid dispersion. *Classic*: Hand/foot sweat...