中益气，何得用栀豉以吐之？有宿食当消食利气，何以加大黄？若腰以下有水气，当温肾利水，何得用商陆、
葶苈等峻利之剂？岂仲景法乎！且此等证候，仲景方中自有治法，如劳复，可用桂枝人参新加汤；宿食，可用
栀子浓朴汤；腰下水气，可用猪苓、五苓，与桂枝去桂加苓术等汤；虚羸少气，可用桂枝人参汤治阳虚，炙
甘草汤治阴虚。由此观之，仲景未尝无法，未尝无方，何须补续耶？后人不分此等方法是叔和插入，故曰但取
仲景法，不取仲景方。夫仲景之方不足取，则仲景之法亦非法矣。（柯韵伯）
问曰∶病有洒淅恶寒，而复发热者何？答曰∶阴脉不足，阳往从之；阳脉不足，阴往乘之。曰∶何谓阳不足？
答曰∶假令寸口脉微，名曰阳不足，阴气上入阳中，则洒淅恶寒也。曰∶何谓阴不足？答曰∶尺脉弱，名曰阴
不足；阳气下陷入阴中，则发热也。
阳为阴乘，阳脉固见其不足，而阴脉亦不见其有余。阳虽微，尚能发热，不终恶寒，犹不失阳道实、阴
道虚之定局耳。亡阳则阴不独存，治当扶阳为急，此补中益气之方为最巨也。（柯韵伯）
问曰∶病有不战不汗出而解者，何也？答曰∶其脉自微，此
以曾经发汗，若吐、若下、若亡血，以内无津液，此阴阳自和，必自愈，故不战不汗出而解也。
内无津液，安能作汗？战由汗发，无汗故不战也。复用此字，须着眼妄治之后，内无津液，阴阳岂能自和！
必当调其阴阳，不然脉微则为亡阳，将转成阴证矣。（柯韵伯）
问曰∶脉欲知病愈未愈者，何以别之？答曰∶寸口、关上、尺中三处，大小、浮沉、迟数同等，虽有寒热不
解者，此脉阴阳为和平，虽剧必愈。
阴阳和平，不是阴阳自和，不过是纯阴纯阳无驳杂之谓耳。究竟是病脉，是未愈时寒热不解之脉，虽剧当
愈，非言不治自愈。正使人知此为阴阳偏胜之病，脉阳剧者当治阳，阴剧者当治阴，必调其阴阳，使其和平，
失此不治，反加剧矣。（柯韵伯）
寸脉下不至关为阳绝，尺脉上不至关为阴绝，此皆不治，决死也。若计余命生死之期，期以月节克之也。
阴阳升降，以关为界；阳生于尺，而动于寸，阴生于寸，而动于尺，阴阳互根之义也。寸脉居上而治阳，
尺脉主下而治阴，上下分司之义也。寸脉不至关，则阳不生阴，是为孤阳，阳亦将绝矣。尺脉不至关，则阴不
生阳，是为孤阴，阴亦将绝矣。要知不至关，非脉竟不至，是将绝之兆，而非竟绝也，正示人以可续之机。此皆
不治，言皆因前此失治以至此，非言不可治也，正欲人急治之意，是先一着看法。夫上部有脉，下部无脉，
尚有吐法；上部无脉，下部有脉，尚为有根；即脉绝不至，尚有灸法。岂以不至关便为死脉哉！看余命生死句，
则知治之而有余命，不为月节所克者多耳。此又深一层看法。脉以应月，每月有节，节者，月之关也，失时
不治，则寸脉不至关者，遇月建之属阴，必克阳而死；尺脉不至关者，遇月建之阳支，则克阴而死。此是决
死期之法，若治之得宜，则阴得阳解，阳得阴解，阴阳自和而愈矣。（柯韵伯）
欲自解者，必当先烦，乃有汗而解，何以知之？脉浮，故知汗出解也。
欲自解，便寓不可妄治意。诸经皆有烦，而太阳更甚，故有发烦、反烦、更烦、复烦、内烦等证。盖烦
为阳邪内扰，汗为阳气外发，浮为阳盛之脉，脉浮则阳自内发，故可必其先烦。见其烦必当待其有汗，勿遽
妄投汤剂也。汗出则阳胜，而寒邪自解矣。若烦而不得汗，或汗而不解，则审脉定证，麻黄、桂枝、青龙随
所施而恰当矣。（柯韵伯）
太阳病，发汗后，大汗出，胃中干，烦躁不得眠，欲得饮水者，少与饮之，令胃气和则愈。
如饮水数升而不解者，又当与人参白虎汤矣。（柯韵伯）
太阳病，中风，以火劫发汗，邪风被火热，血气流溢，失其常度，两阳相熏灼，其身发黄。阳盛则欲衄，阴
虚则小便难，阴阳俱虚竭，身体则枯燥。但头汗出，剂颈而还，腹满微喘，口干咽烂，或不大便，久则谵语，
甚者至哕，手足躁扰，捻衣摸床。小便利者，其人可治。
以上诸证，莫非邪火逆乱，真阴立亡之象。推求其原，一皆血气流溢，失其常度，至于如此。邪风被
火热之害，可胜言哉！此际欲治风而火势沸腾，欲治火而风势壅遏，何从治之？唯利小便一法，如猪苓汤类，
可以导湿滋干，清热润燥，使小便得利，则丙火得泄，而太阳之邪风，亦从膀胱为去路，尚可治也。倘利之而
不利，火无从出，危矣。（《后条辨》）
太阳病，二日，反躁，反熨其背，而大汗出，火热入胃，胃中水竭，躁烦，必发谵语，十余日，振栗自下利
者，此为欲解也。故其汗从腰以下不得汗，欲小便不得，反呕，欲失溲，足下恶风；大便硬，小盒饭数，
而反不数，及多大便已，头卓然而痛，其人足心必热，谷气下流故也。
以上诸证，莫非阳强发厥，尽虚其下之象。推求其原。一皆
火热入胃，胃中水竭，至于如此。熨背之害，可胜言哉！此时欲治风而风已上解，欲治火而火无出路，何
从治之？唯通大便一法，可以彻邪去遏，润之、导之，及多大便已，然后下陷之阳邪，复上升而散，头卓然而
痛，久郁之阳气，得下彻而通，其人足心必热，以邪气随谷气而出，无复壅遏，故曰谷气下流也。合而观之，
上条病源，在血气流溢，失其常度，邪尚在经，故以利小便治之；此条病源，在火热入胃，胃中水竭，邪已入
腑，故以通大便去之。从来未经指出，必欲待小便自利，大便自多。岂有邪火炽甚之时，而能使小便自利，大
便自多也哉！（《后条辨》）
此节匀作五段看∶太阳病句，是言病证；反熨其背，至谵语，是误治后变证；十余日三句，是推原以后
不治病，势所必至，正见得一下可愈，意在言外，故其汗至反不数，是推原欲解不解，余邪未散，正气未复
光景；及多至下流故也，是料定正气稍复欲愈，病轻之状。学人细认此篇见病势治法，跃然目前，然此必强
壮之人，故能经此种种危候。文中不言脉理，意可想悟。倘遇素虚尺迟，安能保其生乎？（周禹载）
太阳病，以火熏之，不得汗，其人必躁；到经不解，必圊血，名为火邪。
此条名之曰为火邪，示禁也明且深矣。故喻氏治火邪，即治血之善方，洵为有得也矣。（魏荔彤）
大下之后，复发汗，小便不利者，亡津液故也。勿治之，得小便利，必自愈。○凡病若发汗、若吐、若下、若
亡血、亡津液，阴阳自和者，必自愈。
发汗后，津液既亡，小便不利者，勿治之。是禁其勿利小便，非得其自愈之谓也。然以亡津液之人，勿
生其津液，焉得小便利？欲小便利，治在益其津液也。其人亡血、亡津液，阴阳安能自和？欲其阴阳自和，
必先调其阴阳之所自；阴自亡血，阳自亡津，益血生津，阴阳自和矣。要不益津液，小便必不得利；不
益血生津，阴阳必不自和。凡看仲景书，当于无方处索方，不治处求治，才知仲景无死方，仲景无死法。（柯韵伯）
太阳病，医发汗，遂发热恶寒；因复下之，心下痞，表里俱虚，阴阳气并竭，无阳则阴独；复加烧针，因
心烦，面色青黄，肤 者，难治。今色微黄，手足温者，易愈。
曰难治，然主治者之婆心，终不恝然。言易愈，虽表里俱虚，阴阳俱竭，仍当主治于回阳，急求复其正也。
阴之竭不治而亦治，阳能生阴之义也。不出方者，当于治痞诸方升阳散阴者明其法，又何可一言以蔽之乎？（魏荔彤）
营气微者加烧针，则血留不行，更发热而躁烦也。
火为阳邪，必伤阴血，治此者当以救阴为主。（张路玉）
脉浮紧者，法当身疼痛，宜以汗解之。假令尺中脉迟者，不可发汗。何以知之？以营气不足，血少故也。
将欲攻表，先须照顾里虚。如里气不足者，或需待其自解，或人力之补助。（吴灵稚）
脉浮数者，法当汗出而愈。若下之，身重心悸者，不可发汗，当自汗出乃解。所以然者，尺中脉微，此里
虚；须表里实，津液自和，便自汗出愈。
程注谓须用表和里实之法治之，亦足匡补仲景之法。而未出方。愚谓建中、新加之属，可以酌用。要
在升阳透表，温中和里而已。方、喻俱谓此证乃阴虚，则非愚所敢宗。（魏荔彤）
咽喉干燥者，不可发汗。○淋家不可发汗，发汗则便血。○疮家虽身疼痛，不可发汗，汗出则痉。○衄家不
可发汗，汗出必额上陷，脉急紧，直视不能 ，不得眠。○亡血家不可发汗，发汗则寒栗而振。○汗家重发汗，
必恍惚心乱，小便已阴疼。○咽中闭塞不可发汗，发汗则吐血，气欲绝，手足厥冷，欲得蜷卧，不能自温。
○咳而小便利，若失小便者，不可发汗，汗出则四肢厥冷。○诸脉得数动微弱者，不可发汗，发汗则大便难，腹中干，
胃燥而烦。
咽喉干燥，不可发汗，常器之云∶当与小柴胡汤；石顽曰∶宜小建中汤。淋家不可发汗，发汗必便血，
常云∶当与猪苓汤；石顽曰∶未汗者宜黄 建中汤。疮家不可发汗，王日休云∶当用小建中汤加归、 ；常云∶
误汗成痉者，宜桂枝加葛根汤；石顽曰∶漏风发痉者，宜桂枝加附子汤。衄家不可发汗，许叔微云∶当用黄
建中汤，夺汗动血者，加犀角；吕沧洲云∶宜小建中汤加葱豉。亡血家不可发汗，常云∶当用小柴胡汤加芍
药；石顽曰∶宜黄 建中汤，误汗振栗者，宜苓桂术甘汤加当归。咽中闭塞，不可发汗，庞安常云∶当用甘草
干姜。孙兆云∶宜黄 建中汤加葱、豉；误汗吐血者，宜炙甘草汤；厥冷者，宜当归四逆汤。咳而失小便者，
不可发汗，郭白云云∶当与甘草干姜汤，或当归四逆汤；石顽曰∶未汗者，宜甘草干姜汤加葱、豉；误汗厥冷
者，宜当归四逆汤；汗后小便反数者，宜茯苓甘草汤。诸脉得数动微弱者，不可发汗，郭云∶当用小建中汤，
王云∶误汗烦燥便难者，宜炙甘草汤。汗家重发汗，小便已阴疼者，常云∶宜禹余粮丸。（《伤寒缵论》）
未持脉时，病患叉手自冒心，师因教试令咳，而不咳者，此必两耳聋无闻也。所以然者，以重发汗，虚故如此。
阳虚耳聋，与少阳传经耳聋迥别。亟宜固阳为要。叉手冒心，加之耳聋，阳虚极矣！尝见汗后阳虚耳
聋，诸医施治，不出小柴胡加减，屡服愈甚，必须大剂参、附，庶可挽回。（《伤寒缵论》）
病胁下素有痞，连在脐旁，痛引少腹入阴筋者，此名脏结，死。脏结无阳证，不往来寒热，其人反静，舌上
苔滑者，不可攻也。
脏结之所以不可攻者，从来置之不讲，以为仲景未尝明言，后人无从知之。不知仲景言之甚明，人第
不参讨耳。夫所谓不可攻者，乃垂戒之辞，正欲人详审其攻之之次第也。试思脏已结
矣，匪攻而结胡由开耶？前篇谓其外不解者尚未可攻，又谓下利呕逆不可攻，又谓表解乃可攻痞，言之已悉。于
此特出一诀，谓脏结无阳证，不往来寒热，其人反静，则证不在六经之表里，而在上下焦之两途，欲知其候，
但观舌上有苔滑与否，有之则外感之阳热，挟痞气而反在下，素痞之阴寒，挟热势而反在上，此与里证已具，
表证未除者，相去不远，但其阴阳悖逆，格拒不入，证转凶危耳。此而攻之，是速其痛引阴筋而死也！不攻则
病不除，攻之则死。所以以攻为戒。是则调其阴阳，使之相入，而苔滑既退，然后攻之，则热邪外散，寒气内
消，其脏结将自愈矣。（喻嘉言）
此条仲师不出方，惟有急以纯阳辛热之剂，开其闭结而回绝阳于一线，亦起死回生之法也。阅原文全
无一毫热气，不知方喻二注，谓热在丹田，出于何书。思胁下、脐旁、少腹、阴筋俱为阴邪固冱之所，丹田四
面受敌，何处容此热气着迹？姑存阙疑可耳。（魏荔彤）
下之后，复发汗，必振寒，脉微细。所以然者，内外俱虚故也。
误汗亡阳，误下亡阴，故内外俱虚。虽不出方，其用附子回阳，人参益阴，已有成法，不必赘也。
（《伤寒缵论》）
阳明病，心下硬满者，不可攻之，攻之利遂不止者死，利止者愈。
此证乃正虚邪实，杂合水湿痰饮以成其硬满。仲师不出方，在人临时审谛而已。察其寒热虚实，宜于泻
心诸方中求治法，不于承气诸方中求治法也。（魏荔彤）
食谷欲呕者，属阳明也，吴茱萸汤主之。得汤反剧者，属上焦也。
此条诸注未合。喻谓得汤转剧，属太阳，谬矣。程谓仍与吴茱萸，亦胶柱之见也。主治者见兹上热下寒
之证，则有黄连炒吴
萸、生姜易干姜一法，为温中而不僭上，或热因寒用，以猪胆为引，如用于理中汤之法，或亦有当乎？（魏荔彤）
阳明病，脉迟，食难用饱，饱则微烦，头眩，必小便难，此欲作谷疸，虽下之，腹满如故，所以然者，脉迟故也。
此迟乃兼涩之迟，非沉迟之迟。谓之虚而兼湿热则可，谓之虚寒则不可。治以除湿培土为君，清热消疸为
臣佐，斯得仲师心法也。（魏荔彤）
阳明病，法多汗，反无汗，其身如虫行皮中状者，此以久虚故也。
Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), how can Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) be used to induce vomiting? If there is retained food, one should resolve food stagnation and regulate qi; why add Da Huang (Rhubarb Rhizome)? If there is water-dampness below the waist, one should warm the Kidney Yang to promote diuresis; how can Shang Lu (Mercurialis Root) or Ting Li Zi (Lepidium Seed), which are harsh purgatives, be used? Is this the method of Zhang Zhongjing! Moreover, for such syndromes, Zhang Zhongjing’s formulas already have their own treatments. For example, for Lao Fu (relapse due to overexertion), Gui Zhi Ren Shen Xin Jia Tang (Cinnamon Twig, Ginseng, and Modified New Addition Decoction) can be used; for retained food, Zhi Zi Hou Po Tang (Gardenia and Magnolia Bark Decoction) can be used; for water-dampness below the waist, Zhu Ling Tang (Polyporus Decoction), Wu Ling San (Five-Ingredient Powder with Poria), or Gui Zhi Qu Gui Jia Fu Ling Bai Zhu Tang (Cinnamon Twig Decoction without Cinnamon Twig plus Poria and Atractylodes Macrocephala Decoction) can be used; for emaciation and shortness of breath, Gui Zhi Ren Shen Tang (Cinnamon Twig and Ginseng Decoction) can treat Yang deficiency, and Zhi Gan Cao Tang (Honey-Fried Licorice Decoction) can treat Yin deficiency. From this, we see that Zhang Zhongjing was not without methods, nor without formulas; where is the need for later generations to supplement and continue? Later scholars did not distinguish that these methods were inserted by Wang Shuhe, hence they say "take only Zhang Zhongjing's methods, not his formulas." If Zhang Zhongjing's formulas are not worth taking, then his methods are also not valid methods. (Ke Yunbo)
Question: Why does a disease present with chills like being splashed with cold water (Sa Xi E Han) followed by fever? Answer: When Yin pulses are deficient, Yang goes to attach to it; when Yang pulses are deficient, Yin takes the opportunity to invade. Question: What is meant by Yang deficiency? Answer: If the Cun Kou pulse at the wrist is faint, it is called Yang deficiency. When Yin Qi ascends into the Yang region, Sa Xi E Han occurs. Question: What is meant by Yin deficiency? Answer: If the Chi pulse is weak, it is called Yin deficiency. When Yang Qi sinks and enters the Yin region, fever occurs.
When Yang is invaded by Yin, the Yang pulse certainly shows deficiency, but the Yin pulse also does not show excess. Although Yang is faint, it can still generate fever and will not remain in chills forever; this still conforms to the fixed pattern of "Yang path is solid, Yin path is empty." In Wang Yang (loss of Yang), Yin cannot exist alone; treatment must urgently support Yang. This is the primary significance of Bu Zhong Yi Qi Tang. (Ke Yunbo)
Question: Why is there a case where a patient recovers without rigors (Zhan) and without sweating? Answer: The pulse is naturally faint. This is because the patient previously underwent sweating, vomiting, purgation, or blood loss, leading to a lack of internal Jin Ye (body fluids). This represents Yin and Yang self-harmonizing, so recovery will inevitably occur without rigors or sweating.
How can one sweat if there are no internal body fluids? Rigors are triggered by the process of sweating; since there is no sweat, there are no rigors. The re-use of the term "self-harmonizing" requires attention to the fact that after mistaken treatment, internal fluids are depleted; how can Yin and Yang self-harmonize? One must regulate Yin and Yang; otherwise, a faint pulse indicates loss of Yang, which will turn into a Yin syndrome. (Ke Yunbo)
Question: How can one know from the pulse whether a disease has healed or not? How to distinguish? Answer: At the Cun Kou, Guan, and Chi positions, if the size, floating/sinking, and slow/rapid qualities are equal and harmonious, even if there is unresolved cold or heat, this indicates that the Yin and Yang in the pulse are peaceful. Even if severe, the disease will definitely heal.
Yin and Yang peace is not the same as Yin and Yang self-harmony; it simply means pure Yin or pure Yang without impurity. This ultimately is a disease pulse, the pulse of unresolved cold/heat before healing. Although severe, it indicates healing; it does not mean spontaneous healing without treatment. It serves to remind us that this is a disease of Yin-Yang imbalance. If the Yang aspect is extreme, treat Yang; if the Yin aspect is extreme, treat Yin. One must regulate Yin and Yang to achieve peace. If this is not done, the condition will worsen. (Ke Yunbo)
If the Cun pulse does not reach down to the Guan position, it is called Yang Jue (Yang Extinction); if the Chi pulse does not reach up to the Guan position, it is called Yin Jue (Yin Extinction). Both are untreatable and indicate death. If calculating the remaining lifespan and time of death, it is determined by the elemental overcoming relationships of the lunar months and solar terms.
The rise and fall of Yin and Yang take the Guan position as the boundary; Yang originates at the Chi position and manifests at the Cun position, while Yin originates at the Cun position and manifests at the Chi position; this is the meaning of Yin and Yang having mutual roots. The Cun pulse resides above and governs Yang; the Chi pulse dominates below and governs Yin; this is the meaning of upper and lower division of labor. If the Cun pulse does not reach the Guan, Yang cannot generate Yin, called Gu Yang (Lone Yang), and Yang will also perish. If the Chi pulse does not reach the Guan, Yin cannot generate Yang, called Gu Yin (Lone Yin), and Yin will also perish. One must understand that "not reaching the Guan" does not mean the pulse is completely absent, but rather a sign of impending extinction, not total extinction; it points out the opportunity for continuation. Saying "untreatable" here means they became so due to prior mistreatment, not that they are incurable; it urges urgent treatment. This is a perspective of foresight. If there is a pulse above but none below, emesis can still be used; if there is no pulse above but pulse below, there is still a root; even if the pulse is absent, moxibustion can still be used. How can not reaching the Guan be considered a death pulse! Reading "calculating remaining life," one knows that many survive treatment and are not overcome by the lunar cycles. This is a deeper perspective. Pulses correspond to months, each month has a Jie (solar term), which is the gate of the month. If treated late, for those whose Cun pulse does not reach the Guan, encountering a Yin month branch will overcome Yang and cause death; for those whose Chi pulse does not reach the Guan, encountering a Yang month branch will overcome Yin and cause death. This is the method for determining the date of death. If treated appropriately, Yin resolves via Yang, Yang resolves via Yin, Yin and Yang self-harmonize, and the disease heals. (Ke Yunbo)
To resolve spontaneously, one must first experience Fan (restlessness/agitation), then sweat and resolve. How do we know? Because the pulse is Floating (Fu), so we know sweat will emerge and resolve the disease.
"Spontaneous resolution" implies the principle of not treating recklessly. All meridians can have Fan, but Taiyang is more severe, hence there are Fa Fan, Fan Fan, Geng Fan, Fu Fan, Nei Fan, etc. Generally, Fan is caused by Yang pathogens disturbing internally; sweat is Yang Qi emitting externally; Floating is a pulse of Yang abundance. With a Floating pulse, Yang emits from within, so we can predict Fan will precede it. Seeing Fan, one must wait for sweat; do not hastily administer decoctions. When sweat emerges, Yang prevails, and Cold pathogens resolve. If there is Fan but no sweat, or sweat but no resolution, then examine the pulse and syndrome; Ma Huang Tang (Ephedra Decoction), Gui Zhi Tang (Cinnamon Twig Decoction), or Da Qing Long Tang (Major Green Dragon Decoction) can be applied appropriately. (Ke Yunbo)
In Taiyang disease, after sweating, profuse sweating occurs, causing dryness in the Stomach, restlessness, inability to sleep, and desire for water. Give small amounts of water frequently; when the Stomach Qi harmonizes, the patient heals.
If drinking several liters does not resolve the thirst, then Ren Shen Bai Hu Tang (Ginseng and White Tiger Decoction) should be administered. (Ke Yunbo)
In Taiyang disease with Wind Strike, using fire methods to force sweating causes the wind pathogen to be combined with fire heat. Blood and Qi flow excessively, losing their normal regulation. Two Yangs (wind and fire) scorch each other, causing jaundice. Yang excess leads to epistaxis; Yin deficiency leads to difficult urination. If both Yin and Yang are exhausted, the body becomes dry and rough. Only the head sweats, stopping at the neck. There is abdominal fullness, slight wheezing, dry mouth, and rotting throat. Possibly constipation; prolonged, delirium ensues. Severe cases involve spitting (Hui), restless hands and feet, and picking at clothes and beds. If urination is free, the patient is treatable.
All these symptoms are signs of chaotic evil fire and immediate destruction of True Yin. Tracing the origin, all result from blood and Qi flowing excessively and losing regulation. The harm of wind combined with fire heat is immeasurable! At this stage, wanting to treat wind, the fire blazes; wanting to treat fire, the wind is obstructed. How to treat? Only the method of promoting urination, such as Zhu Ling Tang (Polyporus Decoction), can guide dampness and nourish dryness, clear heat and moisten dryness. If urination becomes free, Bing Fire (Gallbladder/San Jiao fire) is vented, and the Taiyang wind pathogen exits via the Bladder. Treatment is still possible. If promoting urination fails, fire has no exit, and it is critical. (Post-Commentaries)
In Taiyang disease on the second day, instead of calmness, there is irritability. Instead, the back is moxa-warmed, causing profuse sweating. Fire heat enters the Stomach, depleting Stomach fluids. Irritability ensues, inevitably leading to delirium. After ten-plus days, shaking chills and spontaneous diarrhea indicate the disease is resolving. Thus, sweat does not occur from the waist down. The patient desires to urinate but cannot, vomits, feels like incontinence, and fears cold on the feet. Stool is hard, urine frequency is high, yet the pulse is not rapid. Once stool passes freely, sudden head pain occurs, and the soles of the feet become hot. This is because Gu Qi (Grain Qi) flows downward.
All these symptoms are signs of excessive Yang leading to Jue (reversal cold) and extreme deficiency below. Tracing the origin, all result from fire heat entering the Stomach and depleting fluids. The harm of warming the back is immeasurable! At this stage, wind is resolved above, fire has no exit below. How to treat? Only unblocking the bowel can thoroughly expel pathogens and remove obstruction. Moistening and guiding the bowels, once stool passes, the sunken Yang pathogen rises and disperses. Sudden head pain occurs; long-stagnant Yang Qi is freed through downward movement. Soles become hot because pathogens exit with Grain Qi, no longer obstructed. Hence, "Grain Qi flows downward." Comparing, the previous case's source was blood/Qi dysregulation with pathogen in the channels, treated by promoting urination. This case's source is fire heat in the Stomach with pathogen in the fu organs, treated by unblocking the bowels. This has never been pointed out before. One cannot wait for spontaneous urination or defecation during intense evil fire. (Post-Commentaries)
View this section in five parts: "Taiyang disease" states the syndrome; "Moxa-warming back" to "delirium" describes post-mistreatment complications; "Ten-plus days" three sentences deduce that failing to treat leads inevitably to this state, implying a single intervention could cure, meaning lies beyond words; "Sweat" to "not rapid" deduces unresolved residual pathogen and unrecovered righteous Qi; "Until much" to "Grain Qi flows" predicts slight recovery of righteous Qi and mild illness. Students should carefully recognize the disease progression and treatment methods vividly presented here. However, this applies only to robust individuals who can withstand such critical states. The text omits pulse details, but the intent can be inferred. If encountering a constitutionally deficient person with a slow Chi pulse, how can survival be guaranteed? (Zhou Yu Zai)
In Taiyang disease, using fire fumigation without inducing sweating causes irritability. If the disease cycle passes without resolution, bloody stools will occur, named Huo Xie (Fire Pathogen).
Naming this "Fire Pathogen" clearly indicates prohibition. Thus, Yu Jia Yan's treatment of Fire Pathogen using blood-resolving formulas is truly insightful. (Wei Li Tong)
After severe purgation, followed by sweating, if urination is difficult, it is due to loss of Jin Ye (body fluids). Do not treat it; when urination becomes free, it will heal itself. ○ In any disease, if sweating, vomiting, purgation, blood loss, or fluid loss has occurred, if Yin and Yang self-harmonize, it will heal.
After sweating, if Jin Ye is lost and urination is difficult, do not treat it. This prohibits diuretics, not claiming spontaneous healing. However, for one lacking fluids, how can urination become free without generating fluids? To free urination, treatment must tonify fluids. For one losing blood and fluids, how can Yin and Yang self-harmonize? To harmonize Yin and Yang, one must regulate their sources: Yin loss stems from blood loss, Yang loss from fluid loss. Tonifying blood and generating fluids allows Yin and Yang to self-harmonize. Without tonifying fluids, urination will not free; without tonifying blood and fluids, Yin and Yang will not self-harmonize. When reading Zhang Zhongjing, seek formulas where none are given, and treatment where none is prescribed, to understand that Zhang Zhongjing has no dead formulas and no dead methods. (Ke Yunbo)
In Taiyang disease, the physician induces sweating, leading to fever and aversion to cold. Then purgation is used, causing Epigastric Fullness (Xia Pi). Both exterior and interior are deficient; Yin and Yang Qi are exhausted. "No Yang means Yin stands alone." Adding moxa needles causes heart vexation, greenish-yellow complexion, and muscle twitching. This is difficult to treat. Now, if the complexion is slightly yellow and hands/feet are warm, it is easy to heal.
Saying "difficult to treat" reflects the physician's compassion. Saying "easy to heal" means even with dual deficiency and exhaustion, one must still focus on restoring Yang to urgently recover Zheng Qi (Righteous Qi). Treating Yin exhaustion indirectly treats it because Yang generates Yin. No formula is given; one should look to formulas for treating Pi (fullness) that raise Yang and scatter Yin to clarify the method. (Wei Li Tong)
If Ying Qi (Nutritive Qi) is weak and moxa needles are added, blood stagnates, causing further fever and vexation.
Fire is a Yang pathogen that damages Yin Blood. Treatment must prioritize saving Yin. (Zhang Lu Yu)
A Floating-Tight pulse usually indicates body pain and should be resolved by sweating. If the Chi pulse is Slow, do not sweat. Why? Because Ying Qi is insufficient and Blood is scant.
Before attacking the exterior, one must attend to interior deficiency. If interior Qi is insufficient, either wait for spontaneous resolution or assist with human effort. (Wu Ling Zhi)
A Floating-Rapid pulse usually resolves with sweating. If purged, causing heavy body and palpitations, do not sweat; spontaneous sweating will resolve it. Why? The Chi pulse is Faint, indicating interior deficiency. Exterior and Interior must become solid, Jin Ye must self-harmonize, and spontaneous sweating will heal.
Cheng Zhi notes that treating with exterior-harmonizing and interior-firming methods supplements Zhang Zhongjing, though no formula is given. I suggest Jian Zhong Tang (Middle-Building Decoction) or Xin Jia Tang (New Addition Decoction) may be used. The key is raising Yang to penetrate the exterior and warming the middle to harmonize the interior. Fang You Zhi and Yu Jia Yan consider this Yin deficiency, which I do not follow. (Wei Li Tong)
Dry throat: Do not sweat. ○ Lin Jia (patients with strangury): Do not sweat; sweating causes hematochezia. ○ Chuang Jia (patients with sores): Even with body pain, do not sweat; sweating causes spasms. ○ Nu Jia (patients with frequent nosebleeds): Do not sweat; sweating causes depression of the forehead, tight pulse, staring gaze, insomnia. ○ Wang Xue Jia (patients with blood loss): Do not sweat; sweating causes chills and tremors. ○ Han Jia (profuse sweaters): Re-sweating causes mental confusion and post-urination genital pain. ○ Throat closure: Do not sweat; sweating causes hematemesis, near-death Qi, cold limbs, desire to curl up, inability to warm self. ○ Cough with free urination or incontinence: Do not sweat; sweating causes cold limbs. ○ Pulses that are Rapid, Agitated, and Weak: Do not sweat; sweating causes difficult stool, dry abdomen, dry Stomach, and vexation.
For dry throat, Chang Qi Zhi suggests Xiao Chai Hu Tang (Minor Bupleurum Decoction); Shi Wen suggests Xiao Jian Zhong Tang (Minor Middle-Building Decoction). For strangury, Chang suggests Zhu Ling Tang; Shi Wen suggests Huang Qi Jian Zhong Tang (Astragalus Middle-Building Decoction). For sores, Wang Ri Xiu suggests Xiao Jian Zhong Tang plus Dang Gui (Angelica Sinensis) and Di Huang (Rehmannia); Chang suggests Gui Zhi Jia Ge Gen Tang (Cinnamon Twig plus Kudzu Decoction) for spasms; Shi Wen suggests Gui Zhi Jia Fu Zi Tang (Cinnamon Twig plus Aconite Decoction) for wind leakage spasms. For nosebleeds, Xu Shu Wei suggests Huang Qi Jian Zhong Tang plus Xi Jiao (Rhinoceros Horn - now prohibited/substituted); Lv Cang Zhou suggests Xiao Jian Zhong Tang plus Cong Bai (Scallion) and Chi Xiao Dou (Fermented Soybean). For blood loss, Chang suggests Xiao Chai Hu Tang plus Shao Yao (Peony); Shi Wen suggests Huang Qi Jian Zhong Tang; for tremors, Ling Gui Zhu Gan Tang (Poria, Cinnamon, Atractylodes, and Licorice Decoction) plus Dang Gui. For throat closure, Pang An Chang suggests Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction); Sun Zhao suggests Huang Qi Jian Zhong Tang plus Cong Bai and Chi Xiao Dou; for hematemesis, Zhi Gan Cao Tang (Honey-Fried Licorice Decoction); for cold limbs, Dang Gui Si Ni Tang (Angelica Four-Coldth Decoction). For cough with incontinence, Guo Bai Yun suggests Gan Cao Gan Jiang Tang or Dang Gui Si Ni Tang; Shi Wen suggests Gan Cao Gan Jiang Tang plus Cong Bai and Chi Xiao Dou; for cold limbs, Dang Gui Si Ni Tang; for frequent urination post-sweat, Fu Ling Gan Jiang Tang (Poria and Ginger Decoction). For rapid/agitated/weak pulses, Guo suggests Xiao Jian Zhong Tang; Wang suggests Zhi Gan Cao Tang for vexation/difficult stool. For profuse sweaters with genital pain, Chang suggests Yu Yu Liang Wan (Halloysite Pill). (Commentaries on Shang Han Lun)
Before taking the pulse, the patient crosses hands over the heart. The doctor asks them to cough; if they do not cough, they are likely deaf in both ears. This is due to excessive sweating causing deficiency.
Yang-deficiency deafness differs distinctly from Shaoyang transmission deafness. Urgently securing Yang is essential. Crossing hands over the heart plus deafness indicates extreme Yang deficiency. I have seen post-sweat Yang-deficiency deafness treated repeatedly with modified Xiao Chai Hu Tang, worsening each time. Large doses of Ren Shen (Ginseng) and Fu Zi (Aconite) are required to reverse it. (Commentaries on Shang Han Lun)
Chronic mass under the ribs connected to the umbilicus, pain radiating to the lower abdomen and genitals, is named Zang Jie (Organ Knotting), a death syndrome. Zang Jie has no Yang signs, no alternating chills and fever, the patient is quiet, and the tongue has a slippery coating. Do not purge.
The reason Zang Jie cannot be purged has never been discussed, assuming Zhang Zhongjing didn't explain it. But he explained it clearly; people just don't study it. "Do not purge" is a warning to carefully consider the sequence of purging. If the organ is knotted, how else to open it than purging? Previous chapters said if exterior is unresolved, do not purge; if diarrhea/vomiting, do not purge; if exterior resolved, then purge Pi. Here, the key is: Zang Jie has no Yang signs, no alternating chills/fever, patient is quiet. The syndrome is neither in the Six Meridians' exterior/interior, but in the Upper/Lower Jiao pathways. Check the tongue: if slippery, external Yang-Heat mixes with Pi-Qi sinking below, while internal Yin-Cold mixes with Heat rising above. This is close to interior-full/exterior-unresolved, but Yin-Yang rebellion and rejection make it critical. Purging here accelerates death. Not purging leaves disease; purging causes death. Hence the warning. Regulate Yin-Yang to enter each other; once slippery coating retreats, then purge. Heat scatters externally, Cold dissipates internally, and Zang Jie heals. (Yu Jia Yan)
Zhang Zhongjing gives no formula here. Only urgent use of pure Yang acrid-hot agents to open blockage and restore dying Yang is the method of reviving the dead. The original text shows no heat. Fang and Yu's notes claiming heat in the Dan Tian are baseless. Ribs, umbilicus, lower abdomen, and genitals are places of Yin-Cold accumulation. Dan Tian is surrounded by enemies; where can heat reside? Let us leave this as doubtful. (Wei Li Tong)
After purgation and sweating, chills and faint-thin pulse occur. This is due to both interior and exterior deficiency.
Mistaken sweating loses Yang; mistaken purging loses Yin. Though no formula is given, using Fu Zi to restore Yang and Ren Shen to tonify Yin is established practice. (Commentaries on Shang Han Lun)
Yangming disease with epigastric hardness/fullness: Do not purge. If purged and diarrhea persists, death; if diarrhea stops, healing.
This syndrome is righteous deficiency mixed with evil, combining dampness, phlegm, and fluid retention to form hardness. Zhang Zhongjing gives no formula, leaving it to clinical judgment. Assess cold/heat/deficiency/excess; seek treatment in Xie Xin Tang (Drain the Epigastrium Decoctions), not Cheng Qi Tang (Order the Qi Decoctions). (Wei Li Tong)
Desire to vomit after eating belongs to Yangming; treated with Wu Zhu Yu Tang (Evodia Decoction). If worse after taking it, it belongs to the Upper Jiao.
Previous annotations are incorrect. Yu claims worsening indicates Taiyang, which is wrong. Cheng insists on repeating Wu Zhu Yu Tang, which is rigid. For this Upper Heat/Lower Cold syndrome, one might use Huang Lian (Coptis) stir-fried with Wu Zhu Yu, replace Gan Jiang (Dried Ginger) with Sheng Jiang (Fresh Ginger) to warm middle without ascending too much, or use Hot-for-Cold method with Pig Gall as guide, similar to Li Zhong Tang application. (Wei Li Tong)
Yangming disease with Slow pulse, difficulty tolerating full meals, slight vexation and dizziness after eating, difficult urination,预示着 Gut Jaundice. Purging will not relieve abdominal fullness because of the Slow pulse.
This Slowness includes Choppy quality, not Deep-Slow. Calling it Deficiency with Damp-Heat is acceptable; calling it Deficiency-Cold is not. Treatment should prioritize removing dampness and strengthening Earth, with clearing heat and resolving jaundice as assistants. This follows Zhang Zhongjing's method. (Wei Li Tong)
Yangming disease typically involves sweating. If there is no sweat, and the skin feels like insects crawling, it is due to chronic deficiency.