乌梅（三百个味酸温） 细辛（六两辛热） 干姜（十两辛热） 黄连（一斤苦寒）
当归（四两辛温） 附子（六两炮辛热） 蜀椒（四两去子辛热） 桂枝（六两辛热）
人参（六两甘温） 黄柏（六两苦寒）
上十味。异捣筛。合治之。以苦酒渍乌梅一宿。去核。蒸之五升米下。饭熟。捣成
泥。和药令相得。内臼中。与蜜。杵二千下。丸如梧桐子大。先食饮服十丸。日三服。
稍加至二十丸。禁生冷滑物臭食等。
肺主气。肺欲收。急食酸以收之。乌梅之酸。以收肺气。脾欲缓。急食甘以缓之。人
参之甘。以缓脾气。寒淫于内。以辛润之。以苦坚之。当归桂椒细辛之辛。以润内寒。
寒淫所胜。平以辛热。姜附之辛热。以胜寒。蛔得甘则动。得苦则安。黄连黄柏
之苦。以安蛔。
伤寒热少厥微。指头寒。默默不欲食。烦躁数日。小便利。色白者。此热除也。欲
得食。其病为愈。若厥而呕。胸胁烦满者。其后必便血。
指头寒者。是厥微热少也。默默不欲食。烦躁者。邪热初传里也。数日之后。小便
色白。里热去。欲得食。为胃气已和。其病为愈。厥阴之脉。挟胃贯膈。布胁肋。厥而
呕。胸胁烦满者。传邪之热甚于里也。厥阴肝主血。后数日。热不去。又不得外泄。迫
血下行。故致便血。
王宇泰云。设未欲食。宜干姜甘草汤。呕而胸胁烦满者。少阳证也。少阳与厥阴为
表里。邪干其腑。故呕而胸胁烦满也。肝主血。故后必便血。
病者手足厥冷。言我不结胸。小腹满。按之痛者。此冷结在膀胱关元也。
手足厥。不结胸者。无热也。小腹满。按之痛。下焦冷结也。
吴氏云。小腹满。俱是热病。惟冷结膀胱一证为寒。有手足厥冷可辨。
又云。小腹。下焦所治。当膀胱上口。主分别清浊或用真武汤。
伤寒发热四日。厥反三日复热四日。厥少热多。其病当愈。四日至七日热不除者。
其后必便脓血。
先热后厥者。阳气邪传里也。发热为邪气在表。至四日后厥者。传之阴也。后三日
复传阳经。则复热。厥少则邪微。热多为阳胜。其病为愈。至七日传经尽。热除则愈。
热不除者。为热气有余。内搏厥阴之血。其后必大便脓血。
伤寒厥四日。热反三日。复厥五日。其病为进。寒多热少。阳气退。故为进也。
伤寒阴胜者先厥。至四日。邪传里。重阴必阳。却热三日。七日传经尽。当愈。若
不愈而复厥者。传作再经。至四日。则当复热。若不复热。至五日厥不除者。阴胜于阳。
其病进也。
伤寒六七日。脉微。手足厥冷。烦躁。灸厥阴。厥不还者死。
伤寒六七日。则正气当复。邪气当罢。脉浮身厥。为欲解。若反脉微而厥。则阴胜
阳也。烦躁者。阳虚而争也。灸厥阴以复其阳。厥不还。则阳气已绝。不能复正而死。
伤寒发热。下利厥逆。躁不得卧者。死。
伤寒发热。邪在表也。下利厥逆。阳气虚也。躁不得卧者。病胜脏也。故死。
伤寒发热。下利至甚厥不止者。死。
金匮要略曰。六腑气绝于外者。手足寒。五脏气绝于内者。利下不禁。伤寒发热。
为邪气独甚。下利至甚。厥不止。为腑脏气绝。故死。
伤寒六七日不利。便发热而利。其人汗出不止者死。有阴无阳故也。
伤寒至七日。为邪正争之时。正胜则生。邪胜则死。始不下利。而暴忽发热下利。
汗出不止者。邪气胜正。阳气脱也。故死。
伤寒五六日。不结胸。复濡脉虚。复厥者。不可下。此为亡血。下之死。
伤寒五六日。邪气当作里实之时。若不结胸而腹濡者。里无热也。脉虚者。亡血也。
复厥者。阳气少也。不可下。下之为重虚。故死。金匮玉函曰。虚者重泻。真气乃绝。
发热而厥。七日下利者。为难治。
发热而厥。邪传里也。至七日传经尽。则正气胜邪。当汗出而解。反下利。则邪气
胜。里气虚。则为难治。
伤寒脉促。手足厥逆者。可灸之。
脉促。则为阳虚不相续。厥逆。则为阳虚不相接。灸之以助阳气。
王三阳云。厥逆则为阳虚。阳虚二字。当作阴胜二字。必有差讹。
伤寒脉滑而厥者。里有热也。白虎汤主之。
滑为阳厥。气内陷。是里热也。与白虎汤以散里热也。
手足厥寒。脉细欲绝者。当归四逆汤主之。
手足厥寒者。阳气外虚。不温四末。脉细欲绝者。阴血内弱。脉行不利。与当归四
逆汤。助阳生阴也。
Wumei (300 pieces, sour flavor, warm nature) Xixin (6 liang, pungent flavor, hot nature) Ganjiang (10 liang, pungent flavor, hot nature) Huanglian (1 jin, bitter flavor, cold nature)
Danggui (4 liang, pungent flavor, warm nature) Fuzi (6 liang, processed/pao, pungent flavor, hot nature) Shujiao (4 liang, seeds removed, pungent flavor, hot nature) Guizhi (6 liang, pungent flavor, hot nature)
Renshen (6 liang, sweet flavor, warm nature) Huangbai (6 liang, bitter flavor, cold nature)
The above ten herbs. Crush each separately and sieve. Mix and process together. Soak Wumei in vinegar overnight. Remove the pits. Steam over five sheng of rice until the rice is cooked. After the rice is done, crush the Wumei into a paste. Mix evenly with the other medicines. Place in a mortar. Add honey. Pound two thousand times. Form pills the size of paulownia seeds. Take ten pills before meals with water. Three times daily. Gradually increase to twenty pills. Prohibit consumption of raw/cold foods, slippery/greasy foods, and putrid/spoiled foods, etc.
The Lung governs Qi. The Lung desires contraction/astringency. It urgently requires sour substances to contract it. The sourness of Wumei contracts Lung Qi. The Spleen desires relaxation/soothing. It urgently requires sweet substances to soothe it. The sweetness of Renshen soothes Spleen Qi. When Cold dominates internally, use Pungent to moisten and Bitter to firm/strengthen. The pungency of Danggui, Guizhi, Shujiao, and Xixin moistens internal Cold. When Cold dominates and prevails, use Pungent-Hot to level it. The pungent-hot nature of Ganjiang and Fuzi defeats Cold. Roundworms move when encountering Sweet; they settle when encountering Bitter. The bitterness of Huanglian and Huangbai settles the roundworms.
In Shanghan (Cold Damage), if fever is slight and Jue (cold extremities) is mild, only the fingertips are cold. The patient is silent, has no desire to eat, and experiences irritability for several days. If urination is smooth and the color is clear/white, this indicates the Heat has been eliminated. If the patient desires food, the disease will heal. However, if there are Jue accompanied by vomiting, and fullness/distress in the chest and hypochondrium, hematochezia (blood in stool) will likely follow later.
Fingertip cold indicates mild Jue and slight Heat. Silence, lack of appetite, and irritability indicate that pathogenic Heat has just transmitted to the interior. Several days later, if urine becomes white, it means interior Heat has gone; desiring food indicates Stomach Qi has harmonized, and the disease will heal. The Jueyin meridian clamps the Stomomach, pierces the diaphragm, and spreads along the hypochondrium. Jue with vomiting and chest/hypochondrial distress indicates that transmitted pathogenic Heat is severe in the interior. Jueyin Liver governs Blood. After several days, if Heat persists and cannot vent outward, it forces blood downward, causing hematochezia.
Wang Yutai stated: If the patient still does not desire food, Ganjiang Gancao Tang (Dry Ginger and Licorice Decoction) is suitable. Vomiting with chest/hypochondrial distress belongs to Shaoyang syndrome. Shaoyang and Jueyin are exterior-interior pairs. Pathogen invading its fu organ causes vomiting and chest/hypochondrial distress. Since Liver governs Blood, hematochezia will likely follow later.
If the patient has cold hands and feet, states that there is no Jie Xiong (chest binding/fullness), but has abdominal distension in the lower abdomen which is painful upon pressure, this is Cold binding at the Bladder Guan Yuan point.
Cold hands and feet without Jie Xiong indicate absence of Heat. Lower abdominal distension painful on pressure indicates Cold binding in the Lower Jiao.
Wu Shi said: Lower abdominal distension is generally due to Heat diseases; only Cold binding in the Bladder is a Cold pattern. It can be distinguished by cold hands and feet.
He also said: The lower abdomen is governed by the Lower Jiao, located at the upper opening of the Bladder, primarily responsible for separating the clear from the turbid. Zhenwu Tang may be used.
In Shanghan, fever lasts four days, then Jue lasts three days, followed by fever for another four days. Less Jue and more Heat indicates the disease should heal. If from day four to seven the Heat does not subside, hematochezia/pus-blood stool will likely follow later.
Fever first, then Jue, indicates Yang Qi transmitting to the interior due to pathogen. Fever means pathogen is in the exterior. By day four, Jue appears, meaning transmission to Yin meridians. After three days, transmission returns to Yang meridians, hence fever again. Less Jue means weak pathogen; more Heat means Yang predominance, so the disease heals. By day seven, transmission cycles complete; if Heat subsides, healing occurs. If Heat persists, it is due to excess Heat pressing into Jueyin Blood, leading to pus-blood stool later.
In Shanghan, Jue lasts four days, Heat lasts three days, then Jue lasts five days. The disease progresses. More Cold and less Heat indicates declining Yang Qi, hence progression.
In Shanghan, Yin predominance presents initially as Jue. By day four, pathogen transmits to interior. Extreme Yin transforms to Yang, resulting in three days of Heat. By day seven, transmission completes, and healing should occur. If not healed and Jue recurs, it is transmission to the next cycle. By day four, Heat should return. If Heat does not return, and by day five Jue persists, Yin predominates over Yang, indicating disease progression.
In Shanghan, six or seven days in, pulse is faint, hands and feet are cold, and there is irritability. Moxibustion on Jueyin is indicated. If Jue does not resolve, death ensues.
By six or seven days in Shanghan, Zheng Qi (Upright Qi) should recover, and pathogen should cease. Floating pulse with body Jue suggests resolution. Conversely, faint pulse with Jue indicates Yin predominating over Yang. Irritability indicates deficient Yang struggling. Moxibustion on Jueyin restores Yang. If Jue does not resolve, Yang Qi is exhausted, unable to restore Zheng Qi, leading to death.
Shanghan with fever, diarrhea, Jue Ni (severe cold extremities), and restlessness preventing lying down indicates death.
Fever in Shanghan indicates pathogen in exterior. Diarrhea and Jue Ni indicate deficient Yang Qi. Restlessness preventing lying down indicates pathogen overcoming Zang-Fu function. Hence, death.
Shanghan with fever, severe diarrhea, and unceasing Jue indicates death.
Jin Gui Yao Lue states: When Qi of the Six Fu organs fails externally, hands and feet are cold; when Qi of the Five Zang organs fails internally, diarrhea is incontinent. In Shanghan, fever indicates pathogen alone is excessive; severe diarrhea and unceasing Jue indicate exhaustion of Zang-Fu Qi. Hence, death.
In Shanghan, six or seven days in, initially no diarrhea, but sudden fever and diarrhea with unceasing sweating indicates death. This is due to having Yin but no Yang.
By the seventh day in Shanghan, it is the time of struggle between pathogen and Zheng Qi. Zheng Qi victory brings life; pathogen victory brings death. Initially no diarrhea, but sudden violent fever, diarrhea, and unceasing sweating indicates pathogen overcoming Zheng Qi and Yang Qi collapse. Hence, death.
In Shanghan, five or six days in, no Jie Xiong, pulse is soft/deficient, and Jue recurs. Purging is contraindicated. This is due to loss of Blood. Purging leads to death.
At five or six days in Shanghan, when pathogen should form interior excess, if there is no Jie Xiong and the abdomen is soft, there is no interior Heat. A deficient pulse indicates loss of Blood. Recurrent Jue indicates insufficient Yang Qi. Purging is contraindicated. Purging causes double deficiency, leading to death. Jin Gui Yu Han states: Heavy purgation in deficiency exhausts True Qi.
Fever with Jue, progressing to diarrhea by the seventh day, is difficult to treat.
Fever with Jue indicates pathogen transmitting to interior. By day seven, transmission completes; Zheng Qi should overcome pathogen, resolving via sweating. Recurrent diarrhea indicates pathogen prevailing and interior Qi deficiency, making it difficult to treat.
In Shanghan, rapid pulse with Jue Ni can be treated with moxibustion.
A rapid pulse indicates deficient Yang Qi lacking continuity. Jue Ni indicates deficient Yang Qi lacking connection. Moxibustion assists Yang Qi.
Wang Sanyang stated: Jue Ni implies Yang deficiency. The phrase "Yang deficiency" should read "Yin predominance." There must be an error.
In Shanghan, slippery pulse with Jue indicates interior Heat. Baihu Tang is the primary treatment.
Slippery pulse indicates Yang Jue, Qi sinking inward, signifying interior Heat. Baihu Tang is given to disperse interior Heat.
Cold hands and feet with a fine pulse nearly imperceptible are treated with Danggui Sini Tang.
Cold hands and feet indicate deficient Yang Qi externally, failing to warm the four extremities. A fine, nearly imperceptible pulse indicates deficient Yin-Blood internally, with poor vessel flow. Danggui Sini Tang is given to assist Yang and generate Yin.