黄连（一两苦寒） 半夏（半升洗辛温） 栝蒌实（大者一个味苦寒）
上三味。以水六升。先煮栝蒌取三升去滓。内诸药。煮取二升。去滓。分温、三服。
苦以泄之。辛以散之。黄连、栝蒌实。苦寒以泄热。半夏之辛以散结。
王海藏云。大陷胸治热实。大陷胸丸兼喘。小陷胸治痞。
太阳病。二三日不能卧。但欲起心下必结。脉微弱者。此本有寒分也。反下之。若
利止。必作结胸。未止者。四日复下之。此作协热利也。
太阳病。二三日邪在表也。不能卧。但欲起。心下必结者。以心下结满。卧则气壅
而愈甚。故不能卧。而但欲起也。心下结满。有水分。有寒分。有气分。今脉微弱。知
本有寒分医见心下结而反下之。则太阳表邪。乘虚入里。利止则邪气留结。为结胸。
利不止。至次日。复如前下利不止者。是邪热下攻肠胃。为挟热利也。
太阳病下之。其脉促。不结胸者。此为欲解也。脉浮者。必结胸也。脉紧者。必咽
痛。脉弦者。必两胁拘急。脉细数者。头痛未止。脉沉紧者。必欲呕。脉沉滑者。协热
利。脉浮滑者。必下血。
此太阳病。下之后。邪气传变。其脉促者。为阳。若下后脉促。为阳胜阴也。故不
作结胸。为欲解。下后脉浮。为上焦阳邪结而为结胸也。经曰。结胸者。寸脉浮。关脉
沉下后脉紧。则太阳之邪。传于少阴。经曰。脉紧者。属少阴。内经曰。邪客于少阴之
络。令人嗌痛。不可内食。所以脉紧者。必咽痛。脉弦。则太阳之邪。传于少阳。经曰。
尺寸俱弦者。少阳受病也。其脉循胁络于耳。所以脉弦者。必两胁俱急。下后邪气传里。
则头痛当止。脉细数。为邪未传里。而伤气也。细为气少。数为在表。故头痛未止。脉沉
紧。则太阳之邪。传于阳明。为里实也。沉为在里。紧为里实。阳明里实。故必欲呕。
脉滑则太阳之邪。传于肠胃。以滑为阴气有余。知邪气入里。干
于下焦也。沉为血胜气虚。是为协热利。浮为气胜血虚。是知必下血。经曰。不宜下而
便攻之诸变不可胜数此之谓也。
病在阳。应以汗解之。反以冷水 之。若灌之。其热被却。不得去。弥更益烦。肉
上粟起。意欲饮水。反不渴者。服文蛤散。若不瘥者。与五苓散。寒实结胸。无热证者。
与三物小陷胸汤。白散亦可服。
病在阳。为邪在表也。法当汗出而解。反以冷水 之。灌洗。热被寒水。外不得出。
则反攻其里弥更益烦。肉上粟起者水寒之气。客于皮肤也。意欲饮水者。里有热也反不
渴者。寒在表也。与文蛤散。以散表中水寒之气。若不瘥。是水热相搏。欲传于里。与
五苓散。发汗以和之。始热在表。因水寒制之。不得外泄。内攻于里。结于胸膈。心下
硬痛本是水寒伏热为实。故谓之寒实结胸。无热证者。外无热而热悉收敛于里也。与小
陷胸汤以下逐之。白散下热。故亦可攻。
Coptidis Rhizoma (1 liang, bitter and cold in nature) Pinelliae Tuber (half sheng, washed, acrid and warm in nature) Trichosanthis Fructus (one large fruit, bitter and cold in taste)
The above three herbs. Use six sheng of water. First decoct the Trichosanthis Fructus to obtain three sheng, then remove the dregs. Add the remaining herbs. Decoct further to obtain two sheng, then remove the dregs. Divide into three doses and take warm.
Bitter flavor drains downward. Acrid flavor disperses stagnation. Coptidis Rhizoma and Trichanthis Fructus, being bitter and cold, drain heat. The acridity of Pinelliae Tuber disperses nodulation.
Wang Haicang stated: Da Xianxiong Tang (Major Inward Breaking Decoction) treats Heat-Excess Jie-Xiong (chest binding). Da Xianxiong Wan (Major Inward Breaking Pill) also treats wheezing. Xiao Xianxiong Tang (Minor Inward Breaking Decoction) treats Pi (fullness/stagnation).
Taiyang Disease (disease pattern resulting from pathogenic invasion of the Taiyang channel). After two or three days, if the patient cannot lie down but desires to rise, there must be a sensation of binding in the Xin Xia (epigastrium/heart region). If the pulse is faint and weak, this indicates pre-existing Cold Fluid retention. Following a mistaken purgative treatment: if diarrhea ceases, Jie-Xiong (binding in the chest) will certainly develop; if diarrhea does not cease, and on the fourth day another purgative is administered, this constitutes Xie Re Li (diarrhea with accompanying heat).
In Taiyang disease, after two or three days, the pathogen is still at the exterior. The inability to lie down and desire to rise, along with binding in the Xin Xia, occur because the fullness in the epigastrium causes Qi obstruction that worsens when lying flat, hence the patient cannot lie down but wishes to rise. Binding in the Xin Xia can be due to Water Fluid, Cold Fluid, or Qi Stagnation. Since the pulse is faint and weak, it is known that Cold Fluid was present originally. When the physician sees epigastric binding and mistakenly uses purgatives, the Taiyang exterior pathogen enters the interior through the deficiency. If diarrhea stops, the pathogen remains bound, forming Jie-Xiong. If diarrhea persists, and continues as before on the following day, this is pathogenic heat attacking the intestines and stomach, forming Xie Re Li (diarrhea with accompanying heat).
After Taiyang disease is treated with purgatives: if the pulse is rapid (Cu) and Jie-Xiong does not form, this indicates the condition is about to resolve. If the pulse is floating, Jie-Xiong will certainly form. If the pulse is tight, throat pain will certainly occur. If the pulse is wiry (Xian), bilateral hypochondriac stiffness will certainly occur. If the pulse is fine and rapid (Xi Shu), headache will persist. If the pulse is deep and tight (Chen Jin), vomiting will certainly be desired. If the pulse is deep and slippery (Chen Hua), it is Xie Re Li (diarrhea with accompanying heat). If the pulse is floating and slippery (Fu Hua), hematochezia (blood in stool) will certainly occur.
This describes the transmission of pathogens after mistaken purgation in Taiyang disease. A rapid pulse indicates Yang. If the pulse becomes rapid after purgation, it signifies Yang overcoming Yin, thus Jie-Xiong does not form, indicating impending resolution. A floating pulse after purgation indicates Yang pathogen binding in the Upper Jiao, forming Jie-Xiong. The Classics state: "In Jie-Xiong, the Cun (inch) pulse is floating, and the Guan (bar) pulse is deep." A tight pulse after purgation indicates the Taiyang pathogen has transmitted to the Shaoyin channel. The Classics state: "A tight pulse belongs to Shaoyin." The Inner Canon states: "When pathogen lodges in the collaterals of Shaoyin, it causes throat pain and inability to eat." Therefore, a tight pulse leads to throat pain. A wiry pulse indicates the Taiyang pathogen has transmitted to the Shaoyang channel. The Classics state: "When both Cun and Chi pulses are wiry, Shaoyang is diseased." Its meridian traverses the hypochondrium and connects to the ear; therefore, a wiry pulse leads to bilateral hypochondriac stiffness. After purgation, if pathogens transmit inward, headache should cease. A fine and rapid pulse indicates the pathogen has not fully entered the interior but has injured Qi. Fine indicates Qi deficiency; rapid indicates presence at the exterior; thus, headache persists. A deep and tight pulse indicates the Taiyang pathogen has transmitted to the Yangming channel, forming an Interior Excess syndrome. Deep indicates interior location; tight indicates interior excess. Yangming interior excess leads to a desire to vomit. A slippery pulse indicates the Taiyang pathogen has transmitted to the intestines and stomach. Slippery indicates excess Yin Qi, showing pathogen entering the interior and disturbing the Lower Jiao. Deep indicates blood excess and Qi deficiency, constituting Xie Re Li. Floating indicates Qi excess and Blood deficiency, indicating certain hematochezia. The Classics state: "If purgation is used inappropriately, the resulting complications are countless," which refers to this situation.
Disease in the Yang aspect (exterior syndrome) should be resolved by sweating. Instead, if cold water is sprayed or poured on the body, the heat is suppressed by the cold water and cannot escape, causing increased irritability, gooseflesh on the skin, a desire to drink water but without actual thirst. Administer Wen Ge San (Clam Shell Powder). If there is no improvement, administer Wu Ling San (Five-Ingredient Powder with Poria). For Han Shi Jie-Xiong (Cold-Excess Chest Binding) without heat signs, administer San Wu Xiao Xianxiong Tang (Three-Ingredient Minor Inward Breaking Decoction). Bai San (White Powder) may also be administered.
Disease in the Yang aspect means the pathogen is at the exterior. The method should be sweating to resolve it. Instead, spraying or washing with cold water suppresses the heat with cold, preventing outward release, causing it to attack the interior and increasing irritability. Gooseflesh results from cold-water Qi lodging in the skin. Desire to drink indicates interior heat; lack of thirst indicates cold at the exterior. Wen Ge San is given to disperse the cold-water Qi at the exterior. If there is no improvement, it indicates water and heat clashing and transmitting inward; Wu Ling San is given to induce sweating and harmonize the exterior. Initially, heat was at the exterior, but suppressed by cold water, unable to vent outward, it attacked inward and bound in the chest and diaphragm. Hardness and pain in the Xin Xia result from cold water trapping heat, forming an excess syndrome, hence called Han Shi Jie-Xiong (Cold-Excess Chest Binding). "No heat signs" means no external heat, with all heat converging internally. Xiao Xianxiong Tang is given to purge the phlegm-heat downward. Bai San can also purge heat, so it may also be used for purgation.