文蛤（五两味咸寒）
上一味为散。以沸汤和一钱匕。服、汤用五合。
咸走肾邪。可以胜水气。
桔梗（三分味辛苦微温） 巴豆（一分去皮心熬黑研如脂平温） 贝母（三分味辛
苦平）
上件三味为末。内巴豆。更于臼中杵之。以白饮和服。强人半钱。羸者减之。病在
膈上必吐。在膈下必利。不利。进热粥一杯。利过不止。进冷粥一杯。身热。皮粟不解。
欲引衣自覆者。若以水 之洗之。益令热却不得出当汗而不汗则烦。假令汗出已。腹中
痛。与芍药三两。如上法。
辛散而苦泄。桔梗贝母之苦辛。用以下气。巴豆之辛。用以散实。
王宇泰云。右热实结胸及寒实结胸。活人不拘寒热。但用陷胸汤不瘥者。用枳实理
中丸。应手而愈。
太阳与少阳并病。头项强痛。或眩冒。时如结胸。心下痞硬者。当刺大椎第一间。肺
俞、肝俞。慎不可发汗。发汗则谵语。脉弦。五六日。谵语不止。当刺期门。
太阳之脉。络头。下项。头项强痛者。太阳表病也。少阳之脉。循胸络胁。如结胸。心
下痞硬者。少阳里病也。太阳少阳。相并为病。不纯在表。故头项不但强痛。而或
眩冒。亦未全入里。故时如结胸。心下硬痞。此邪在半表半里之间也。刺大椎第一间肺
俞。以泻太阳之邪。刺肝俞。以泻少阳之邪。邪在表。则可发汗。邪在半表半里。则不
可发汗。发汗则亡津液。损动胃气。少阳之邪。因干于胃。土为木刑。必发谵语。脉弦。
至五六日。传经尽。邪热去。而谵语当止。若复不止。为少阳邪热甚也。刺期门以泻肝
胆之气。
妇人中风。发热恶寒。经水适来。得之七八日。热除而脉迟。身凉。胸胁下满。如
结胸状。谵语者。此为热入血室也。当刺期门。随其实而泻之。
中风发热恶寒。表病也。若经水不来。表邪传里。则入腑而不入血室也。因经水适
来。血室空虚。至七八日邪气传里之时。更不入腑。乘虚而入于血室。热除。脉迟。身
凉者。邪气内陷而表证罢也。胸胁下满。如结胸状。谵语者。热入血室而里实。期门者。
肝之募。肝主血。刺期门者。泻血室之热审看何经气实。更随其实而泻之。
华学士云。妇人平居。水当养于木。血当养于肝。方未受孕。则下行以为月水。既
妊。则中蓄以养胎。及已产。则上壅以为乳。皆此血也。今邪气蓄血。并归肝经。聚
于膻中。结于乳下。故手触之则痛。非汤剂可及。故当刺期门。
妇人中风。七八日。续得寒热。发作有时。经水适断者。此为热入血室。其血必结。故
使如疟状。发作有时。小柴胡汤主之。
中风七八日。邪气传里之时。本无寒热。而续得寒热。经水适断者。此为表邪乘血
室虚。入于血室。与血相搏。而血结不行。经水所以断也。血气与邪分争。致寒热如疟。
而发作有时。与小柴胡汤。以解传经之邪。
王三阳云。经水适来。血虚甚矣。而邪气入之。热除。身凉。胸满、谵语者。则邪
尽入里。里有实邪。又难下。故刺以泻之。经水适断。则血尚未尽。为邪热相搏。而结之
不行。续得寒热发作有时。邪在半表半里。故用小柴胡汤以彻其邪也。
妇人伤寒发热经水适来。昼日明了。暮则谵语。如见鬼状者。此为热入血室。无犯
胃气及上二焦。必自愈。
伤寒发热者。寒已成热也。经水适来。则血室虚空。邪热乘虚入于血室。若昼日谵
语为邪客于腑。与阳争也。此昼日明了。暮则谵语。如见鬼状。是邪不入腑。入于血室与
阴争也。阳盛谵语则宜下。此热入血室。不可与下药犯其胃气。热入
血室。血结寒热者。与小柴胡汤。散邪发汗。此虽热入血室而不留结。不可与发汗药。
犯其上焦热入血室。胸胁满。如结胸状者可刺期门。此虽热入血室。而无满结。不可刺
期门。犯其中焦。必自愈者。以经行则热随血去。血下也已。则邪热悉除而愈矣。所为
发汗为犯上焦者。发汗则动卫气。卫气出上焦故也。刺期门为犯中焦者。刺期门则动荣
气。荣气出中焦故也。脉经曰。无犯胃气及上二焦必自愈。岂谓药不谓针耶。
王宇泰云。犯胃气。谓下之。犯上二焦。谓发汗也。
伤寒六七日。发热。微恶寒。支节烦疼。微呕。心下支结。外证未去者。柴胡加桂
枝汤主之。
伤寒六七日。邪当传里之时。支、散也。呕而心下结者。里证也。法当攻里。发热
微恶寒。支节烦疼。为外证未去。不可攻里。与柴胡桂枝汤以和解之。
王宇泰云。支节。犹云枝节。古字通也。支结。谓支撑而结。若训作散。则不能结
也。
南阳云。外证未解。心下烦闷者。非痞也。谓之支结。
Wen Ge San (Clam Shell Powder) [Formula 52]
Wen Ge (Five liang, salty and cold in nature).
The above single herb is ground into a powder. Mix with one qian bi (approx. 2-3 grams) using boiling water. Take with five he of liquid.
Salty flavor enters the Kidney to expel pathogenic factors and can overcome Water Qi (fluid retention).
Jie Geng Tang (Platycodon Decoction variant / Bai San) [Formula 53]
Jie Geng (Three fen, pungent, bitter, slightly warm), Ba Dou (One fen, skin and heart removed, stir-fried until black, ground into a paste-like consistency, neutral and warm), Bei Mu (Three fen, pungent, bitter, neutral).
Grind the above three herbs into fine powder. Add Ba Dou and pound thoroughly in a mortar. Mix with Bai Yin (rice water) for administration. Strong individuals take half a qian bi; frail individuals reduce the dose. If the pathology is above the diaphragm, vomiting will occur; if below the diaphragm, purgation will occur. If purgation does not occur, administer one cup of hot congee; if purgation continues excessively, administer one cup of cold congee. If body heat persists, skin shows gooseflesh, and there is a desire to cover oneself with clothes, washing or wiping with water will only trap the heat, preventing it from exiting. Since sweating should occur but does not, restlessness ensues. If sweating has already occurred and abdominal pain follows, administer San liang of Shao Yao (White Peony Root) and treat as described above.
Pungent flavors disperse, while bitter flavors drain. The pungent and bitter properties of Jie Geng and Bei Mu are used to direct Qi downward. The pungent property of Ba Dou is used to dissipate excess accumulation.
Wang Yutai stated: For both Heat-Excess Jie Xiong (Chest Binding) and Cold-Excess Jie Xiong, regardless of cold or heat patterns, if Xian Xiong Tang fails to cure, Zhi Shi Li Zhong Wan should be used, yielding immediate recovery.
Tai Yang and Shao Yang simultaneous disease presents with stiffness and pain in the head and neck, occasional dizziness or vertigo, intermittent sensations resembling Jie Xiong, and fullness/hardness in the epigastrium. Acupuncture at the first interspace of Da Zhui (GV14), Fei Shu (BL13), and Gan Shu (BL18) is indicated. Sweating must be strictly avoided. If sweating is induced, delirium and a wiry pulse will result. After five to six days, if delirium persists, Qi Men (LR14) should be acupunctured.
The Tai Yang meridian connects the head and descends to the neck. Stiffness and pain in the head and neck indicate a Tai Yang exterior syndrome. The Shao Yang meridian circulates through the chest and connects to the flanks. Sensations resembling Jie Xiong and epigastric fullness/hardness indicate a Shao Yang interior syndrome. When Tai Yang and Shao Yang pathogens combine, the condition is neither purely exterior nor fully interior. Thus, besides head/neck stiffness, dizziness occurs; since it has not fully entered the interior, intermittent Jie Xiong-like symptoms and epigastric hardness appear. This indicates pathogens in the half-exterior, half-interior region. Acupuncture at Da Zhui and Fei Shu drains Tai Yang pathogens; acupuncture at Gan Shu drains Shao Yang pathogens. Pathogens in the exterior may be treated with sweating; those in the half-exterior, half-interior must not be sweated. Sweating consumes Body Fluids and damages Stomach Qi. Shao Yang pathogens interfering with the Stomach lead to Wood overacting on Earth, causing delirium and a wiry pulse. By day five or six, if the transmission cycle completes and heat clears, delirium should cease. If it persists, Shao Yang heat is severe; acupuncture at Qi Men drains Liver and Gallbladder Qi.
In women with Wind Strike presenting fever and aversion to cold, if menstruation begins during the illness, and after seven to eight days the fever subsides, pulse becomes slow, body cools, yet hypochondriac fullness resembling Jie Xiong and delirium occur, this is Re Ru Xue Shi (Heat Entering the Blood Chamber). Acupuncture at Qi Men should be performed, applying draining methods according to excess patterns.
Wind Strike with fever and aversion to cold is an exterior syndrome. If menstruation had not started, exterior pathogens would transmit to the Fu organs rather than the Blood Chamber. Because menstruation is occurring, the Blood Chamber is empty. At the seventh or eighth day, when pathogens typically transmit inward, they enter the empty Blood Chamber instead of the Fu organs. Fever subsiding, slow pulse, and cool body indicate pathogen sinking inward and resolution of exterior signs. Hypochondriac fullness resembling Jie Xiong and delirium indicate Heat entering the Blood Chamber causing interior excess. Qi Men is the Front-Mu point of the Liver; the Liver governs Blood. Acupuncture at Qi Men drains Heat from the Blood Chamber. Assess which meridian exhibits excess and drain accordingly.
Academic Hua stated: In healthy women, Water nourishes Wood, and Blood nourishes the Liver. Before pregnancy, blood flows downward as menses; during pregnancy, it accumulates centrally to nourish the fetus; postpartum, it rises upward to form milk. Now, pathogenic factors cause blood stasis returning to the Liver meridian, gathering at Dan Zhong (CV17) and knotting below the breasts, causing tenderness upon touch. This cannot be reached by decoctions, hence acupuncture at Qi Men is required.
If a woman with Wind Strike develops alternating chills and fever at regular intervals after seven to eight days, and menstruation stops, this is also Re Ru Xue Shi. The blood must be knotted, causing malaria-like symptoms with regular onset. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment.
At seven to eight days post-Wind Strike, when pathogens typically transmit inward, the absence of prior chills/fever followed by their appearance coinciding with menstrual cessation indicates exterior pathogens entering the empty Blood Chamber and contending with blood, causing blood stagnation and cessation of menses. Contention between Blood/Qi and pathogens causes malaria-like chills/fever with regular timing. Xiao Chai Hu Tang resolves transmitted pathogens.
Wang Sanyang stated: If menstruation is ongoing, blood deficiency is severe; pathogen entry leads to fever subsiding, cool body, chest fullness, and delirium, indicating full interior transmission with difficult-to-purge excess, requiring acupuncture drainage. If menstruation has just stopped, blood is not yet exhausted; contention between pathogen heat and blood causes knotting, leading to regular chills/fever and half-exterior/half-interior status, warranting Xiao Chai Hu Tang.
If a woman with Cold Damage fever experiences menstruation, and presents with clarity during the day but delirium resembling hallucinations at night, this is Re Ru Xue Shi. Do not violate Stomach Qi or the Upper and Middle Jiao; self-recovery is expected.
Cold Damage fever indicates transformation of Cold into Heat. Menstruation empties the Blood Chamber, allowing pathogenic heat to enter. Daytime delirium suggests pathogen in Fu organs contending with Yang. Here, daytime clarity and nighttime delirium indicate pathogen entering the Blood Chamber to contend with Yin. While Yang-excess delirium warrants purgation, Re Ru Xue Shi contraindicates purgatives to protect Stomach Qi. For Re Ru Xue Shi with blood-knotted chills/fever, Xiao Chai Hu Tang disperses pathogens and induces sweating. However, if there is no knotting, sweating agents should be avoided to prevent violating the Upper Jiao. For Re Ru Xue Shi with hypochondriac fullness resembling Jie Xiong, Qi Men acupuncture is suitable. If there is no fullness/knotting, Qi Men should not be acupunctured to avoid violating the Middle Jiao. Self-recovery occurs because menstruation allows heat to exit with blood; once blood flows, pathogenic heat clears. Sweating violates the Upper Jiao by disturbing Wei Qi (which originates from the Upper Jiao). Qi Men acupuncture violates the Middle Jiao by Ying Qi (which originates from the Middle Jiao). The Mai Jing states: "Do not violate Stomach Qi or the Upper and Middle Jiao, and self-recovery is expected." Does this refer only to drugs and not acupuncture?
Wang Yutai clarified: Violating Stomach Qi refers to purgation; violating the Upper and Middle Jiao refers to sweating.
For Cold Damage lasting six to seven days, presenting with fever, slight aversion to cold, limb joint discomfort, slight vomiting, epigastric support-like knotting, and unresolved exterior signs, Chai Hu Jia Gui Zhi Tang (Bupleurum plus Cinnamon Twig Decoction) is indicated.
At six to seven days of Cold Damage, pathogens are due to transmit inward. "Zhi" implies scattering; vomiting and epigastric knotting are interior signs, normally requiring interior purgation. However, fever, slight aversion to cold, and limb pain indicate unresolved exterior signs, contraindicating interior purgation. Chai Hu Gui Zhi Tang harmonizes the exterior and interior.
Wang Yutai noted: "Zhi Jie" is synonymous with "Zhi Jie" (branches/details) in ancient texts. "Zhi Jie" (epigastric support-knotting) means supporting and knotting; interpreting it as "scattering" contradicts the concept of knotting.
Nanyang stated: Unresolved exterior signs with epigastric vexation constitute "Zhi Jie," not Pi (Glomus).