从霜降以后，至春分以前，凡有触冒霜露，体中寒即病者，谓之伤寒也。
问∶从霜降以后，至春分以前，凡有触冒者，名曰伤寒。余时则非伤寒也。其有曰立夏得洪大脉是其
本位，其人身体苦疼重者，须发其汗，非伤寒而何？答∶冬月伤时令之寒，春月伤时令之温，夏秋伤时令之暑、
湿热，此四时之正病也。然夏秋亦有伤寒，冬春亦有伤暑、伤湿，乃四时之客病，所谓异气也。此仲景特于湿
家不可发汗之外，另竖一义。盖以夏月得洪大脉，是心火之本脉，其人身体苦疼重，又似湿土之本病，恐后
学误遵湿家不可发汗之条，故以此辨析之耳。见湿病，虽夏月脉必濡弱，不能洪大，且额上有汗，非如伤寒病
腠理闭密，即在夏月亦必无汗之比也。又见洪大既为夏月本脉，断无当暑汗不出而身体疼重之理
也。两相比照，则其疼重，仍系太阳经伤寒无疑。但在夏月受邪原微，见证亦轻，令人难辨，故于脉法中析此
大疑，以昭成法。可见不但冬春正病，有汗为伤风，无汗为伤寒；即夏秋正病，有汗为伤暑、伤湿，无汗为伤
寒，参脉辨证，了然明矣。（喻嘉言）
凡阴病见阳脉者生，阳病见阴脉者死。
问∶凡阴病见阳脉者生，阳病见阴脉者死。而有曰∶病患苦发热，身体疼，其人自卧，其脉沉而迟者，
知其瘥也。曰沉、曰迟，非阴脉乎？岂亦有阳病见阴脉而愈耶？答∶凡阴病见阳脉者生，阳病见阴脉者死。此
二语乃伤寒脉法，吃紧大纲。至其比例详情，自非一端可尽。如厥阴中风，脉微浮为欲愈，不浮为未愈，是
阴病贵得阳脉也。如谵言妄语，脉沉细者死，脉短者死，脉涩者死，是阳病恶见阴脉也。又如太阳蓄血病，
六、七日表证仍在，脉微而沉，反不结胸，其人发狂者，下血乃愈。此亦阳病见阴脉，仲景复推出可生之路，
见六、七日太阳之表证仍在，自当见大、浮、数、动、滑之脉，设其人脉微而沉，自当比动数变迟之条，而证
成结胸，今乃反不结胸者，明是阳邪不结于太阳之经，而结于太阳之府也；膀胱蓄血，势必发狂而成死证，急
下其血，庶结邪解而乃可愈耳。又如厥阴下利，寸脉反浮数，此阴病得阳脉，本当愈者，设其人尺中自涩，
则是阳邪陷入阴中，其浮数之脉为血所持而不露也；然阳邪既陷入阴，寸脉不加浮数，则阳邪亦属有限；今寸
脉反浮数，其在里之热炽盛难除，更可类推，故知其必圊脓血，而成半死半生之证也。合两条论之，上条可愈
之故，全在阴脉见，脉既转阴，阳邪原有限也；下条难愈之故，全在阳脉见，阳邪既从血下出，阳邪不尽，
血必不止，万一血尽而阳邪未尽，能免脱阴而死乎？可见阴病、阳病二语，特举其大纲，至微细听人自会耳。
大纲云者，谓证属于阴，其脉反阳，必能鼓勇以却敌；证属于阳，其脉反阴，必难婴城以固守。故得涩、弱、
弦、微之脉者，其人气血精津未病先亏，小病且难
胜，况能胜传经之热病哉！尊问疑阳病见阴脉亦有愈者，兹正大彻之关，但所引病患苦发热一段，此不过验病
之法耳。谓病患苦发热身体疼，到诊脉时其人安卧，则不见有发热身疼之苦矣。加以脉沉而迟，表邪又未入里，
其从外解无疑。所以知其瘥耳。（喻嘉言）
脉双弦而迟者，必心下硬也。脉大而紧者，阳中有阴也。可下之，宜大承气汤。
问∶设遇此证，果可下否？答∶脉双弦而迟，谓左右皆然，乃阴寒内凝，所以心下必硬，其脉其证，必
因误下，邪未尽退，而反致其虚寒也。《论》云∶脉双弦者，寒也。皆大下后虚脉。所以于结胸条论脉，谓太
阳病脉浮而动数，医反下之，动数变迟，一以误下，而脉变双弦，一以误下，而脉变迟，可互证也。结胸条以
其人邪结在胸，不得已用大陷胸汤，涤去胸间之邪，则与用大承气汤峻攻肠中之结者悬矣。然且谓脉浮大者
不可下，下之则死，是并陷胸汤亦不可用也。垂戒甚明。双弦脉即欲用下，当仿用温药下之之例，今反谓宜大
承气汤下之者何耶？至于脉大而紧者，阳中有阴，明谓伤风有寒，属大青龙汤证，其不可下更明矣。两段之文，
迥不相蒙，叔和汇凑一处，指为可下之证，贻误千载，诚斯道之厄也！（喻嘉言）
脉来缓，时一止复来者，名曰结。脉来数，时一止复来者，名曰促。阳盛则促，阴盛则结。此皆病脉。
问∶此之结促，与桂枝去芍药加附子之促，炙甘草汤之结，何处分别？曰∶促结则同，而脉势之盛衰自
异。彼之促者疲于奔而自憩，彼之结者不能前而代替，总非关于前途之阻也。此处之结促，曰阳盛阴盛；彼处
之结促，是阳虚阴虚。此处曰病脉，彼处曰脉病。二脉虽有盛衰之别，然渐退则吉，渐进则凶，一也。
（《伤寒分经》）
脉濡而弱，弱反在关，濡反在巅，微反在上，涩反在下，微
则阳气不足，涩则无血，阳气反微，中风汗出，而反躁烦，涩则无血，厥而且寒，阳微发汗，躁不得眠。
问∶此一节有阙文否？答∶叔和以濡、弱、微、涩之脉见，为阳气与阴血两虚，分类于《不可汗》、
《不可下》二编之首，推其所以不可汗、下之故，岂非以阳证阴脉乎？而阳证阴脉，大率归重在阳微一边。观
下文云阳微发汗，躁不得眠；又云阳微不可下，下之则心下痞硬，瘥可睹矣。其中风汗出而反躁烦一语，最
为扼要。见无汗之躁烦，用大青龙汤不对，且有亡阳之变，况于有汗之躁烦，其亡阳直在转盼间，此即用真
武汤尚恐不及，何可更汗更下乎？本非阙文，但叔和未会仲景之意，类此不一而足，反觉重复缠扰，而令读者
茫然耳。（喻嘉言）
太阳病，发汗后，大汗出、胃中干、躁烦不得眠，欲得饮水者，少少与饮之，令胃气和则愈；若脉浮、小便不
利、微热、消渴者，五苓散主之。
或问∶渴用白虎汤宜也，其用五苓散走津夜，何哉？答曰∶白虎之治渴，为燥气设也，胃火烁肺之故；
五苓之治渴，为湿气设也，阳水侮心之故。凡水津不能四布者，心火必不肯下行也，别在口虽干而舌不燥。（程郊倩）
胃中干而欲饮，此无水也，与水则愈。小便不利而欲饮，此蓄水也，利水则愈。同一渴而治法不同，
盖由渴之象及渴之余证，亦各不同也。（《伤寒类方》）
伤寒发热，汗出不解，心中痞硬，呕吐而下利者，大柴胡汤主之。○太阳证，外病未除，而数下之，遂协热
而利，利下不止，心下痞硬，表里不解者，桂枝人参汤主之。
或问∶大柴胡汤，泻也；桂枝人参汤，补也；何为皆治下利、心下痞硬？曰∶此非里热，乃下之早，
因作痞。里虚协热而利，表又不解，故与桂枝人参汤和里解表。若夫伤寒发热汗出不解，心下痞硬，呕吐而
下利者，表和而里病也；以心下痞硬，故为实，当
以大柴胡下之。二者心下痞硬虽同，而虚实之证有别，故用药有攻补之异。○又问∶大柴胡若内烦里实者，固宜
用也；其呕而下利者亦用之，何也？夫治病节目，虚实二者而已。里虚者虽便难而勿攻，里实者虽吐利而可下。
《经》曰∶汗多则便难脉迟，尚未可攻，以迟为不足，即里气未实故也。此以大柴胡主之。凡吐、利、心腹濡
软为里虚；呕吐而下利，心下痞硬，为里实也，下之当然。况太阳病过经十余日，及二三日下之，后四五日柴
胡证仍在者，先与小柴胡汤；呕不止，心下急，郁郁微烦者，为未解也，与大柴胡汤下之则愈。二节病证虽有
参差，其里实同一机也。皆与大柴胡者，宜也。（张兼善）
问∶此理中加桂枝也。设遇此证，解表用桂枝可也，协热利而用理中，人所不敢，仲景神明，必有妙义欤？
答∶太阳经表邪未解而误下，以致协热而利，心下痞硬，设腹中利止，则里邪可从里解，乃利下不止，是里邪
漫无解期也。设胸中结开，则表邪可从表解，乃心下痞硬，是表邪漫无解期也。此际欲解表里之邪，全藉中气
为敷布，夫既上下交征不已，中气且有立断之势，其能解邪开结乎？故舍桂枝人参汤无他法也。若以协热之故，
更清其热，斯殆矣。余每用此法，病者得药，腹中即响若雷奔，顷之痞硬开，下利止，捷于反掌。可见握枢而
运，真无为之上理矣。按泻心汤中治痞硬下利，用甘草干姜、人参各有其义，从未有用术之法也。此因下利不
止，恐其人五脏气绝于内，不得已而用术，故不曰桂枝理中汤，而更其名曰桂枝人参汤，岂非谓表邪未尽，不
可用术立法耶？（喻嘉言）
发汗后，身疼痛，脉沉迟者，桂枝加芍药生姜各一两人参三两新加汤主之。
问∶相传仲景全方止得一百一十二道，因有新加一汤，故名为一百一十三方，其说然欤？答曰∶此后人之
呓语也。仲景意中，明明桂枝汤不欲与人参并用，以桂枝能解肌表之邪、人参反固肌
表之邪故也。然在误汗误下以后，表里差错，正气虚微，余邪不解，则有不得不用之证。如上编太阳病外证未
除，而数下之，遂协热而利，心下痞硬，表里不解，用桂枝理中汤，乃革去理中之名，但曰桂枝人参汤者，即
此意也。人参尚主半表，故曰新加。理中则全不主表，故革其名。凡此皆仲景精微之蕴也。然桂枝人参汤中
去芍药者，以误下而邪入于阴，芍药主阴，不能散阳邪也。桂枝新加汤中倍芍药者，以误汗而阳虚邪凑，恐阳
孤无偶，用芍药以和之，俾不至散乱也。故用法必识立法之意，斯用之各当矣。（喻嘉言）
此条喻注，谓在表寒邪未尽，何其谬乎？桂枝人参之固表，芍药之酸收，无一为治表之品，仲师不若是之
戆也。或谓喻意以为三者皆治其里，而表自解；然究未明此证系营血自生之寒，凝聚为害，故为含糊影响之说
而已。苟明乎姜、桂、芍药之用，为阳药入营阴，而以人参大力者负之而趋，则不必支离其语，而大白矣。通
则不痛，痛则不通，今痛则阴凝而不通也。在表为浮，在里为沉，今沉而不浮，则非在表之邪未尽也。阳为
数为浮，阴为迟为沉，今阳凝则沉迟兼见，是必不可以表言也。不明此证身疼痛、脉沉迟之义而遵用仲师之方
犹可也，苟信喻注在表寒邪未尽之言，而复发其汗，则误人多矣。（魏荔彤）
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主之。
问∶发汗后，桂枝既不可行，麻黄可行耶？无大热，石膏可行耶？义不可知也。答∶治伤寒先分营卫受邪，
桂枝、麻黄二汤，一彼一此，划然中分，果真为麻黄汤证，断无混用桂枝之理。故发汗以后，得汗而热少除，
但喘尚未除者，更与麻杏石甘汤治之则愈。此中颇有奥义，盖太阳之邪虽从汗解，其热邪袭入肺中者，无由得
解，所以热虽少止，喘仍不止，故用麻黄发肺邪，杏仁下肺气，甘草缓肺急，石膏清肺热，即以治足太阳膀胱
经药，通治
手太阴肺经，为天造地设之良法也。倘更误行桂枝，能不壅塞肺气，而吐痈脓乎？（喻嘉言）
太阳病，发热恶寒，热多寒少，脉微弱者，此无阳也，不可发汗，宜桂枝二越婢一汤。
问∶脉微弱者，此无阳也，不可发汗；方中桂枝、麻黄、石膏、生姜，能不发汗耶？答∶太阳病，风伤
卫则用桂枝汤解肌，寒伤营则用麻黄汤发汗，风寒两伤营卫，而加烦躁，则用大青龙汤峻发其汗，此定法也。
于中复有最难用法一证，如太阳病，发热恶寒，热多寒少，谓风多寒少也∶风多则麻黄汤为不可用，寒少则
桂枝汤又不能去寒，加以脉见微弱，其人胃中复无津液，是汗之固万万不可，欲不汗，其微寒终不外散，虽有
桂枝二麻黄一之法，施于此证，尚不中 。何者？桂枝二麻黄一，但可治热多寒少，而不可治脉微弱故耳。于是
更改麻黄一为越婢一，示微发于不发之中。越婢者，不过麻黄、石膏二物，形容其发散之柔缓，较女婢尤为过
之，正可胜微寒之任耳。所以然者，以石膏能解阳明之热，热解则津液复生，而不名无阳，此天然妙合之法，
仲景之精义也。（喻嘉言）
伤寒，脉浮，医以火迫劫之，亡阳，必惊狂，起卧不安者，桂枝去芍药加蜀漆龙骨牡蛎救逆汤主之。
或问∶汗液，阴也，误发而何以亡阳？方中所用诸药，俱阳品也，又何以能益阴生液？答曰∶汗液虽为
阴，然实由阳化，故汗出而阳微。诸药虽为阳，然生阳即所以安阴，阳气聚则阴敛生津，阳气散则阴扰耗津，
阴阳相济者吉，相悖者凶。○问∶龙、蛎治水邪之品，何以复能治火邪？答曰∶水邪侵扰于心下，用其涩以成
淡渗之功，火邪扰乱于心中，用其涩以奏收摄之效。盖心阳被火邪迫而出亡，患在发越，不用芍药之酸，恐
其不足以扶阳，易以龙、蛎之涩，喜其足以收阳，阳不发越于躯外作汗，则复收于心内生液矣。心液既足，神
复安矣。（魏荔彤）
此与少阴汗出之亡阳迥别。盖少阴之亡阳，乃亡其阴中之阳，故用四逆辈，回其阳于肾中。此乃以火逼汗，
亡其阳中之阳，故用安神之品，镇其阳于心中。各有至理，不可易也。（徐灵胎）
After Frost's Descent until before Spring Equinox, anyone who is exposed to frost and dew and falls ill due to cold invading the body is said to have contracted Cold Damage (Shanghan).
Question: From Frost's Descent until before Spring Equinox, anyone who is exposed is named as having Cold Damage. What about other times? It is not Cold Damage then? Someone says: "When Summer begins, a surging and large pulse appears, which is the native pulse of the Heart. If this person suffers from painful and heavy body sensations, sweating must be induced. Is this not Cold Damage?" Answer: In winter, injury by the seasonal cold; in spring, injury by the seasonal warmth; in summer and autumn, injury by the seasonal heat, dampness, and dryness—these are the proper diseases of the four seasons. However, there is also Cold Damage in summer and autumn, and injury by heat and dampness in winter and spring; these are guest diseases of the four seasons, also known as "abnormal qi." Zhang Zhongjing specifically established another principle besides stating that those with dampness patterns should not induce sweating. This is likely because a surging and large pulse in summer is the native pulse of Heart Fire; and painful, heavy body sensations resemble the native disease of Earth Dampness. He feared later students might mistakenly follow the rule that "those with dampness should not induce sweating," so he analyzed this to clarify. Thus, in dampness patterns, even in summer, the pulse must be soggy and weak, never surging and large, and there will be sweat on the forehead, unlike Cold Damage where pores are closed and there is no sweat even in summer. Furthermore, since a surging and large pulse is the native pulse of summer, it is impossible to have heatstroke without sweat accompanied by painful and heavy body sensations. Comparing the two, this pain and heaviness still undoubtedly belongs to Cold Damage affecting the Taiyang Channel. However, the pathogen acquired in summer is originally slight, and the manifestations are mild, making it difficult to distinguish. Therefore, this major doubt is analyzed in the pulse methods to clarify established rules. It can be seen that not only in winter and spring proper diseases, where sweating indicates Wind Injury and no sweating indicates Cold Damage; but also in summer and autumn proper diseases, where sweating indicates Heatstroke or Dampness Injury, and no sweating indicates Cold Damage. By combining pulse analysis with syndrome differentiation, it becomes clear. (Yu Jiayan)
Generally, if Yin patterns present with Yang pulses, there is survival; if Yang patterns present with Yin pulses, there is death.
Question: Generally, if Yin patterns present with Yang pulses, there is survival; if Yang patterns present with Yin pulses, there is death. But it is also said: "If a patient suffers from fever and body pain, lies quietly, and has a deep and slow pulse, one knows the illness is improving." Are 'deep' and 'slow' not Yin pulses? Can Yang patterns presenting with Yin pulses also recover? Answer: "Generally, if Yin patterns present with Yang pulses, there is survival; if Yang patterns present with Yin pulses, there is death." These two sentences are the crucial outline of Cold Damage pulse methods. The specific details and ratios cannot be fully explained in one aspect. For example, in Jueyin wind strike, a faint and floating pulse indicates impending recovery, while non-floating indicates no recovery; this shows Yin patterns benefit from obtaining Yang pulses. For instance, delirious speech with a deep and fine pulse leads to death, a short pulse leads to death, and a choppy pulse leads to death; this shows Yang patterns abhor seeing Yin pulses. Again, in Taiyang blood stasis pattern, after six or seven days, if exterior symptoms remain, the pulse is faint and deep, but there is no chest binding, and the patient goes mad, bleeding out leads to recovery. This is also a case of Yang patterns presenting with Yin pulses, where Zhang Zhongjing deduces a path to survival. It means that if Taiyang exterior symptoms remain after six or seven days, one should expect large, floating, rapid, moving, or slippery pulses. If the pulse is faint and deep, it should correspond to the rule where moving/rapid changes to slow, leading to chest binding. Since there is no chest binding now, it clearly indicates the Yang pathogen does not bind in the Taiyang Channel but in the Taiyang Fu organ. Bladder blood stasis will inevitably lead to madness and death; urgently purging the blood may resolve the binding pathogen and lead to recovery. Again, in Jueyin diarrhea, if the cun position pulse is surprisingly floating and rapid, this is a Yin pattern obtaining a Yang pulse, which should naturally recover. If the chi position is naturally choppy, it means the Yang pathogen has sunk into the Yin, and the floating/rapid pulse is held back by blood and not revealed. Since the Yang pathogen has sunk into Yin, if the cun pulse were not floating and rapid, the Yang pathogen would be limited. Now that the cun pulse is surprisingly floating and rapid, the internal heat is intense and hard to remove, which can be inferred further, so one knows pus and blood will be excreted, resulting in a half-dead, half-alive condition. Combining the two lines: the reason for recovery in the first line lies entirely in the appearance of Yin pulses; once the pulse turns Yin, the Yang pathogen is inherently limited. The reason for difficulty in recovery in the second line lies entirely in the appearance of Yang pulses; since the Yang pathogen exits via blood, if the Yang pathogen is not exhausted, bleeding will not stop. If blood is exhausted but Yang pathogen remains, can one avoid death from Yin collapse? Thus, the terms Yin pattern and Yang pattern specifically highlight the outline, while subtleties are left for individual understanding. The term 'outline' means if the syndrome belongs to Yin but the pulse is Yang, the Qi will surely rally to defeat the enemy; if the syndrome belongs to Yang but the pulse is Yin, it will be difficult to defend the city. Therefore, those with choppy, weak, wiry, or faint pulses have pre-existing deficiency in Qi, Blood, Essence, and Fluids; they struggle with minor illnesses, let alone transmitting heat diseases. Your question doubts whether Yang patterns presenting with Yin pulses can also recover. This is the key to thorough understanding. However, the cited passage about a patient suffering from fever is merely a method to verify the disease. It states that although the patient suffers from fever and body pain, when examined, the person lies peacefully, indicating the suffering of fever and pain has ceased. Added to the deep and slow pulse, and knowing the exterior pathogen has not entered the interior, recovery from the exterior is certain. Hence, one knows it is healing. (Yu Jiayan)
A double-string-like and slow pulse indicates hardness below the heart. A large and tight pulse indicates Yang containing Yin. Purging may be used; Da Cheng Qi Tang is suitable.
Question: If encountering this syndrome, can purging truly be used? Answer: A double-string-like and slow pulse refers to both hands showing this, indicating internal congealing of Yin-Cold, hence hardness below the heart. The pulse and syndrome result from mistaken purging, where the pathogen has not fully retreated, causing deficiency-cold. The Treatise says: "Double-string-like pulse indicates Cold. All are deficiency pulses after severe purging." Thus, in the chest-binding section discussing pulse: "Taiyang disease with floating, moving, and rapid pulse, doctor mistakenly purges, moving/rapid changes to slow." One instance of mistaken purging changes pulse to double-string-like; another changes it to slow; they corroborate each other. In the chest-binding section, because the pathogen binds in the chest, Da Xian Xiong Tang is used to cleanse the chest pathogen, which differs significantly from using Da Cheng Qi Tang to aggressively attack intestinal binding. Yet it states that floating/large pulses cannot be purged; purging leads to death, implying even Xian Xiong Tang is unusable. The warning is clear. For double-string-like pulse, even if purging is desired, one should imitate the example of using warm medicines to purge. Why now say Da Cheng Qi Tang is suitable? As for large and tight pulse, Yang containing Yin, it clearly indicates wind-strike with cold, belonging to Da Qing Long Tang syndrome, making it clear that purging is contraindicated. The two passages are unrelated; Wang Shuhe compiled them together, pointing to them as purgable syndromes, misleading for millennia, truly a disaster for this art! (Yu Jiayan)
Pulse coming slowly, occasionally stopping and resuming, is named Jie (Knotted) pulse. Pulse coming rapidly, occasionally stopping and resuming, is named Cu (Surging) pulse. Yang excess leads to Cu; Yin excess leads to Jie. These are all pathological pulses.
Question: How do these Jie and Cu pulses differ from the Cu pulse in Gui Zhi Qu Shao Yao Jia Fu Zi Tang and the Jie pulse in Zhi Gan Cao Tang? Answer: The Jie and Cu forms are the same, but the momentum of the pulse differs. The Cu there is like running until exhaustion and resting; the Jie there is unable to advance and relies on replacement; neither concerns obstruction ahead. Here, Jie and Cu refer to Yang/Yin excess; there, they refer to Yang/Yin deficiency. Here they are called pathological pulses; there, they are called pulse-disease. Although there is a difference in strength, gradual decline is auspicious, and gradual progression is ominous; this is consistent. (Shang Han Fen Jing)
Pulse soggy and weak; weak pulse unexpectedly at Guan; soggy pulse unexpectedly at Dian (Cun); faint pulse unexpectedly at Upper; choppy pulse unexpectedly at Lower. Faint indicates insufficient Yang Qi; choppy indicates lack of Blood. Yang Qi becoming faint, wind-strike with sweating, yet restlessness and vexation; choppy indicates lack of Blood, cold limbs and coldness. Faint Yang inducing sweating, restlessness and inability to sleep.
Question: Is there missing text in this paragraph? Answer: Wang Shuhe categorized the appearance of soggy, weak, faint, and choppy pulses as dual deficiency of Yang Qi and Yin Blood, placing them at the beginning of the 'Cannot Sweat' and 'Cannot Purge' sections. Deduced reasons for not sweating or purging are likely due to Yang syndrome presenting with Yin pulse. And Yang syndrome presenting with Yin pulse generally focuses on faint Yang. Looking at the following text: "Faint Yang inducing sweating, restlessness and inability to sleep"; also "Faint Yang cannot be purged, purging leads to epigastric fullness and hardness," recovery is visible. The phrase "wind-strike with sweating yet restlessness and vexation" is most crucial. It shows that for no-sweat restlessness/vexation, Da Qing Long Tang is incorrect and risks Yang collapse; how much more so for sweat-with-restlessness/vexation, where Yang collapse happens instantly. Even using Zhen Wu Tang might be too late, how can one sweat or purge again? There is no missing text; Wang Shuhe simply failed to understand Zhang Zhongjing's intent, similar cases abound, causing repetition and confusion for readers. (Yu Jiayan)
Taiyang disease, after sweating, profuse sweating, dryness in Stomach, restlessness and inability to sleep, desire for water: give small amounts of water frequently; when Stomach Qi harmonizes, it heals. If pulse is floating, urination is difficult, slight fever, and excessive thirst: Wu Ling San governs.
Someone asks: Using Bai Hu Tang for thirst is appropriate; why use Wu Ling San which moves fluids? Answer: Bai Hu Tang treats thirst for dryness, caused by Stomach Fire scorching Lung; Wu Ling San treats thirst for dampness, caused by Yang Water insulting Heart. Whenever water fluids cannot distribute to four directions, Heart Fire refuses to descend. The distinction is dry mouth but non-dry tongue. (Cheng Jiaoqian)
Dryness in Stomach with desire to drink: this is lack of water, giving water heals. Difficulty urinating with desire to drink: this is water retention, draining water heals. Same thirst, different treatments, because the manifestation of thirst and accompanying symptoms differ. (Shang Han Lei Fang)
Cold damage with fever, sweating not resolving, epigastric fullness and hardness, vomiting and diarrhea: Da Chai Hu Tang governs. ○ Taiyang syndrome, exterior disease not removed, and repeatedly purged, leading to heat-collaborating diarrhea, diarrhea unceasing, epigastric fullness and hardness, exterior and interior unresolved: Gui Zhi Ren Shen Tang governs.
Someone asks: Da Chai Hu Tang is purging; Gui Zhi Ren Shen Tang is tonifying; why both treat diarrhea and epigastric fullness/hardness? Answer: This is not interior heat, but premature purging causing fullness. Interior deficiency with heat-collaborating diarrhea, exterior unresolved, thus Gui Zhi Ren Shen Tang harmonizes interior and releases exterior. Regarding cold damage fever, sweating not resolving, epigastric fullness/hardness, vomiting and diarrhea: exterior is harmonized but interior is diseased; because of epigastric fullness/hardness, it is excess, thus Da Chai Hu Tang should purge. Both have epigastric fullness/hardness, but deficiency/excess syndromes differ, so medication differs in attacking/tonifying. ○ Also asked: Da Chai Hu Tang is suitable for internal vexation and interior excess; why use it for vomiting and diarrhea? Treating disease involves only deficiency and excess. Interior deficiency, even with difficult stool, should not be attacked; interior excess, even with vomiting/diarrhea, can be purged. The Classic says: "Profuse sweating leads to difficult stool and slow pulse, still cannot attack, because slow indicates insufficiency, i.e., interior Qi not yet excess." Here Da Chai Hu Tang governs. Vomiting/diarrhea, soft abdomen/chest indicates interior deficiency; vomiting/diarrhea, epigastric fullness/hardness indicates interior excess, purging is natural. Moreover, Taiyang disease passing beyond stage for ten+ days, or purged after 2-3 days, then 4-5 days later Chai Hu symptoms remain: first give Xiao Chai Hu Tang; if vomiting unceasing, epigastric urgency, slight vexation, unresolved: give Da Chai Hu Tang to purge and heal. Though symptoms vary slightly, the interior excess mechanism is the same. Giving Da Chai Hu Tang is appropriate. (Zhang Jianshan)
Question: This is Li Zhong Tang adding Gui Zhi. If encountering this syndrome, using Gui Zhi to release exterior is acceptable; using Li Zhong Tang for heat-collaborating diarrhea is something people dare not do. Zhang Zhongjing is divine, must have profound meaning? Answer: Taiyang exterior pathogen unresolved and mistakenly purged, leading to heat-collaborating diarrhea and epigastric fullness/hardness. If abdominal diarrhea stops, interior pathogen can resolve from interior; but diarrhea unceasing means interior pathogen has no resolution date. If chest binding opens, exterior pathogen can resolve from exterior; but epigastric fullness/hardness means exterior pathogen has no resolution date. At this time, to resolve exterior/interior pathogens, reliance is entirely on Middle Qi for distribution. Since upper and lower are constantly attacked, Middle Qi faces imminent rupture, how can it resolve pathogens and open binding? Thus, apart from Gui Zhi Ren Shen Tang, there is no other method. If due to heat-collaborating, clearing heat further, that would be disastrous. I often use this method; patients hear rumbling in abdomen like thunder rushing, soon fullness/hardness opens, diarrhea stops, faster than turning a palm. Seeing grasp pivot and operate, truly the supreme principle of non-action. Note: In Xie Xin Tang treating fullness/diarrhea, Gan Cao, Gan Jiang, Ren Shen have their meanings; never using Zhu Yu. Because diarrhea unceasing, fearing five Zang Qi perishes internally, reluctantly using Zhu Yu. Hence not called Gui Zhi Li Zhong Tang, but renamed Gui Zhi Ren Shen Tang, isn't it saying exterior pathogen not finished, cannot use Zhu Yu as principle? (Yu Jiayan)
After sweating, body pain, pulse deep and slow: Gui Zhi Jia Shao Yao Sheng Jiang Ge Yi Ren Can San Liang Xin Jia Tang governs.
Question: Traditionally, Zhang Zhongjing's complete formulas total 112; because of this Xin Jia formula, it is named 113 formulas. Is this true? Answer: This is nonsense of later generations. Zhang Zhongjing's intent clearly did not want Gui Zhi Tang used with Ren Shen, because Gui Zhi releases muscle-surface pathogen, while Ren Shen固 (consolidates/stagnates) muscle-surface pathogen. However, after mistaken sweating/purging, exterior-interior disorder, righteous Qi deficient, residual pathogen unresolved, there are situations requiring its use. As above, Taiyang exterior symptoms not removed, repeatedly purged, heat-collaborating diarrhea, epigastric fullness/hardness, exterior-interior unresolved, using Gui Zhi Li Zhong Tang, removing Li Zhong name, calling it Gui Zhi Ren Shen Tang, is this intent. Ren Shen still governs semi-exterior, hence named Xin Jia. Li Zhong completely does not govern exterior, hence name changed. All these are Zhang Zhongjing's subtle essence. However, removing Shao Yao in Gui Zhi Ren Shen Tang is because mistaken purging sends pathogen into Yin; Shao Yao governs Yin, cannot scatter Yang pathogen. Doubling Shao Yao in Gui Zhi Xin Jia Tang is because mistaken sweating causes Yang deficiency and pathogen gathering; fearing Yang solitary without companion, using Shao Yao to harmonize, preventing scattering. Thus, usage must recognize legislative intent, then application is appropriate. (Yu Jiayan)
This commentary by Yu states exterior cold pathogen not finished, how absurd! Gui Zhi Ren Shen Tang consolidates exterior, Shao Yao astringes; none treat exterior. Zhang Zhongshi is not that foolish. Some say Yu intends all three treat interior, and exterior resolves itself; however, ultimately failing to understand this syndrome is cold generated from Ying-Blood self, condensing to cause harm, thus vague and impressionistic. If one understands usage of Ginger, Cinnamon, Shao Yao: Yang herbs entering Ying-Yin, carried forward by Ren Shen's great power, then language need not be disjointed, and truth is revealed. Unobstructed means no pain; pain means obstruction. Now pain is Yin condensation and obstruction. Exterior is floating, interior is deep. Now deep not floating, then not exterior pathogen unfinished. Yang is number/floating, Yin is slow/deep. Now Yang condensed, slow/deep seen together, definitely cannot speak of exterior. Not understanding meaning of body pain and deep/slow pulse in this syndrome, yet following Zhang Shi's formula is okay; believing Yu's note on unfinished exterior cold pathogen, and inducing sweating again, misleads many. (Wei Litong)
After sweating, Gui Zhi Tang cannot be used again. Sweating and wheezing, no significant heat: Ma Huang Xing Ren Gan Cao Shi Gao Tang may be given.
Question: After sweating, if Gui Zhi cannot be used, can Ma Huang be used? No significant heat, can Shi Gao be used? Meaning unknown. Answer: Treating Cold Damage first distinguishes Ying-Wei pathogen invasion. Gui Zhi and Ma Huang two formulas, one here, one there, distinctly divided. If truly Ma Huang Tang syndrome, absolutely no mixing with Gui Zhi. Thus after sweating, if sweat obtained and heat slightly reduced, but wheezing not resolved, giving Ma Xing Shi Gan Tang heals. This contains profound meaning. Although Taiyang pathogen resolves via sweat, heat pathogen invading Lung has no way to resolve, so heat slightly stops, wheezing continues. Thus Ma Huang releases Lung pathogen, Xing Ren descends Lung Qi, Gan Cao缓 (relaxes) Lung urgency, Shi Gao clears Lung heat. Using foot-Taiyang Bladder channel herbs to treat hand-Taiyin Lung channel, a heaven-made earth-set good method. If mistakenly using Gui Zhi again, can it not obstruct Lung Qi and cause vomiting of abscess pus? (Yu Jiayan)
Taiyang disease, fever and aversion to cold, more heat less cold, pulse faint and weak: this is no Yang, cannot induce sweating, Gui Zhi Er Yue Bi Yi Tang is suitable.
Question: Pulse faint and weak, this is no Yang, cannot induce sweating; formula contains Gui Zhi, Ma Huang, Shi Gao, Sheng Jiang, can they not induce sweating? Answer: Taiyang disease, wind injuring Wei uses Gui Zhi Tang to release muscle; cold injuring Ying uses Ma Huang Tang to induce sweating; wind-cold injuring both Ying-Wei with irritability uses Da Qing Long Tang to vigorously induce sweating; this is fixed method. Among them, there is a hardest-to-use syndrome: Taiyang disease, fever/aversion to cold, more heat less cold, meaning more wind less cold: more wind makes Ma Huang Tang unusable; less cold makes Gui Zhi Tang unable to remove cold; added with faint/weak pulse, stomach lacks fluids, sweating is absolutely impossible; wanting not to sweat, slight cold eventually won't disperse externally. Although Gui Zhi Er Ma Huang Yi method exists, applying it here is ineffective. Why? Gui Zhi Er Ma Huang Yi only treats more heat less cold, not faint/weak pulse. Thus change Ma Huang Yi to Yue Bi Yi, showing slight induction within non-induction. Yue Bi consists of only Ma Huang and Shi Gao, describing gentle dispersion, even softer than a maid, just capable of handling slight cold. Why? Because Shi Gao resolves Yangming heat; heat resolved, fluids regenerate, no longer called no Yang. This is natural perfect combination, Zhang Zhongjing's essence. (Yu Jiayan)
Cold damage, pulse floating, doctor uses fire coercion, Yang collapses, inevitably panic/madness, restless lying/sitting: Gui Zhi Qu Shao Yao Jia Shu Ku Long Gu Mu Li Jiu Ni Tang governs.
Or ask: Sweat fluid is Yin, why does mistaken sweating cause Yang collapse? Herbs in formula are all Yang items, how can they benefit Yin generate fluid? Answer: Sweat fluid though Yin, actually transforms from Yang, thus sweating leads to Yang deficiency. Herbs though Yang, generating Yang is to calm Yin; Yang Qi gathers then Yin condenses to generate fluid, Yang Qi scatters then Yin disturbs to consume fluid. Yin-Yang assisting is auspicious, opposing is inauspicious. ○ Ask: Long Gu, Mu Li treat water pathogen, why treat fire pathogen? Answer: Water pathogen harassing below Heart, use astringency to achieve leaching effect; Fire pathogen disturbing inside Heart, use astringency to achieve collection effect. Since Heart Yang forced out by fire pathogen, problem is hyperactivity; not using Sour Shao Yao fears insufficient supporting Yang, replace with Astringent Long/Mu, pleased it sufficiently collects Yang. Yang not hyperactive outside body as sweat, then returns to Heart to generate fluid. Heart fluid sufficient, Spirit returns to peace. (Wei Litong)
This is distinct from Shaoyin sweating Yang collapse. Shaoyin Yang collapse is collapsing Yang within Yin, thus using Si Ni category, returning Yang to Kidney. This is fire forcing sweat, collapsing Yang within Yang, thus using calming substances, anchoring Yang in Heart. Each has ultimate principle, cannot change. (Xu Lingtai)