栀子（十四枚擘味苦寒） 浓朴（四两姜炙苦温） 枳实（四两水浸去穣炒味苦寒）
以上三味。以水三升半。煮取一升半。去滓。分二服。温进一服。得吐者。止后服。
酸苦涌泄。栀子之苦。以涌虚烦。浓朴枳实之苦。以泄腹满。
伤寒。医以九药大下之。身热不去。微烦者。栀子干姜汤主之。
丸药不能除热。但损正气。邪气乘虚。留于胸中。而未入深者。则身热不去而微烦。
与栀子干姜汤。吐烦正气。
栀子（十四枚擘味苦寒） 干姜（二两味辛热）
上二味。以水三升半。煮取一升半。去滓。分二服。温进一服。得吐者。止后服。
苦以涌之。栀子之苦。以吐烦。辛以润之。干姜之辛。以益气。
凡用栀子汤。病患旧微溏者。不可与服之。
病患旧微溏者。里虚而寒在下也。虽烦。则非蕴热。故不可与栀子汤。内经曰。先
泄而后生他病者。治其本。必且调之。后乃治其他病。
太阳病发汗。汗出不解。其人仍发热。心下悸。头眩。身 。动振振欲擗地者。真
武汤主之。
发汗不解。仍发热。邪气未解也。心下悸。头眩、身 。动振振欲擗地者。汗出亡
阳也。里虚为悸。上虚为眩。经虚为身 振振摇。与真武汤主之。温经复阳。
咽喉干燥者。不可发汗。
津液不足也。
淋家不可发汗。发汗必便血。
膀胱里热则淋。反以汤药发汗。亡耗津液。增益客热。膀胱虚。必小便血。
疮家虽身疼痛。不可发汗。发汗则 。
表虚聚热则生疮。疮家身疼。如伤寒。不可发汗。发汗则表气愈虚。热势愈甚。生
风。故变 也。
衄家不可发汗。汗出。必额上陷。脉急紧。直视。不能 。不得眠。
衄者。上焦亡血也。若发汗。则上焦津液枯竭。经络干涩。故额上陷。脉急紧。诸
脉
者。皆属于目。筋脉紧急。则牵引其目。故直视。不能 。 瞬合目也。针经曰。阴气
虚。则目不瞑。亡血为阴虚。是以不得眠也。韩氏云。此人素有衄血证。非伤寒后。如
前条之衄也。故不可发汗。
亡血家不可发汗。发汗。则寒栗而振。
针经曰。夺血者无汗。夺汗者无血。亡血发汗。则阴阳俱虚。故寒栗而振摇。
汗家重发汗。必恍惚心乱。小便已阴疼。与禹余粮丸缺。
汗者心之液。汗家重发汗则心虚。恍惚心乱。夺汗则无水。故小便已。阴中疼。
王三阳云。血家汗家。俱指本人平时旧病言之也。
病患有寒。复发汗。胃中冷。必吐蛔。
病患有寒。则当温散。反发汗。损阳气。胃中冷。必吐蛔也。
王三阳云。温散者。理中汤之类是也。
活人云。先服理中丸。次服乌梅丸。
本发汗而复下之。此为逆也。若先后汗。治不为逆。本先下之。而反汗之。为逆。
若先下之。治不为逆。
病在表者。汗之为宜。下之为逆。病在里者。下之为宜。汗之为逆。经曰。阳盛阴
虚。汗之则死。下之则愈。阳虚阴盛。汗之则愈。下之则死。
娄氏云。阳盛。则阳并于阴。故宜下。阴盛。则阴并于阳。故宜汗。阳并于阴。沉
而实也。阴并于阳。浮而实也。
又云。阳盛阴虚。是病在里。阳虚阴盛。是病在表。
伤寒。医下之。续得下利。清谷不止。身疼痛者。急当救里。后身疼痛。清便自调
者。急当数表。数里。宜四逆汤。救表。宜桂枝汤。
伤寒。下之。续得下利。清谷不止。身疼痛者。急当数里者。以里气不足。必先救之。
急与四逆汤。得清便自调。知里气已和。然后急与桂枝汤。以救表。身疼者。表邪也。内
经曰。病发而不足。标而本之。先治其标。后治其本。此以寒为本也。
王三阳云。此证当照顾协热利。须审其利之色何如。与势之急缓。不可轻投四逆桂
枝也。
沈亮宸云。此大关键。不可不知。若两感者。亦可类推矣。
病、发热头痛。脉反沉。若不瘥。身体疼痛。当救其里。宜四逆汤。
阳病见阴脉。里虚甚矣。若不瘥三字紧甚。言此时当急投四逆救里不可缓也。缓则
无及矣。
发热头痛。表病也。脉反沉者。里脉也。经曰。表有病者。脉当浮大。今脉反沉迟
故知愈也。见表病而得里脉。则当瘥。若不瘥。为内虚寒甚也。与四逆汤救其里。
王宇泰云。此为阳病得阴脉。若以发热体痛。证在太阳。迟投四逆。则病生他变矣。
太阳病。先下之而不愈。因复发汗。以此表里俱虚。其人因致冒。冒家汗出自愈。所
以然者。汗出表和故也。得里未和。然后复下之。
冒者、郁也。下之则里虚而亡血。汗之则表虚而亡阳。表里俱虚。寒气怫郁。其人
因致冒。金匮要略曰。亡血复汗。寒多。故令郁冒。汗出则怫郁之邪得解。则冒愈。金
匮要略曰。冒家欲解。必大汗出。汗出表和。而里未和者。然后复下之。
太阳病未解。脉阴阳俱停。必先振栗。汗出而解。但阳脉微者。先汗出而解。但阴
脉微者。下之而解。若欲下之。宜调胃承气汤主之。
细观经文言阴阳俱利。则自然汗出而解。此振栗作汗。不必发汗明矣。但阳脉
微则先自汗而解。阴脉微尚须下之而解。先汗出与下之自有分别。
脉阴阳俱停。无偏胜者。阴阳气和也。经曰。寸口、关上、尺中。三处大小浮沉迟
数同等。此脉阴阳为和平。虽剧当愈。今阴阳既和。必先振栗。汗出而解。但阳脉微者。
阳不足而阴有余也。经曰。阳虚阴盛。汗之则愈。阴脉微者。阴不足而阳有余也。经曰。
阳盛阴虚。下之则愈。
王三阳云。阴阳俱停者。三部相等。皆微脉也。既见微脉。不必更用汗下法。彼必
自汗出。自便利而愈。不必如成先生阳盛阴虚之说也。盖观经文用调胃与若字可知矣。非
必当下之下也。
太阳病。发热。汗出者。此为荣弱卫强。故使汗出。欲救邪风者。宜桂枝汤。
太阳中风。风并于卫。则卫实而荣虚。荣者、阴也。卫者、阳也。发热汗出阴弱阳
强也。内经曰。阴虚者。阳必凑之。故少气。时热而汗出。与桂枝汤。解散风邪。调和
荣卫。
伤寒。中风五六日。往来寒热。胸胁苦满。默默不欲饮食。心烦喜呕。或胸中烦而
不呕。或渴。或腹中痛。或胁下痞硬。或心下悸。小便不利。或不渴。身有微热或咳者。
与
小柴胡汤主之。
病有在表者。有在里者。有在表里之间者。此邪气在表里之间。谓之半表半里证。
五六日。邪气自表传里之时。中风者。或伤寒。至五六日也。玉函曰。中风五六日。伤
寒。往来寒热。即是。或中风。或伤寒。非是伤寒再中风。中风复伤寒也。经云。伤寒、
中风有柴胡证。但见一证便是。不必悉具者。正是谓或中风或伤寒也。邪在表则寒。邪
在里则热。今邪在半表半里之间。未有定处。是以寒热往来也。邪在表。则心腹不满。
邪在里。则心腹胀满。今止言胸胁苦满。知邪气在表里之间。未至于心腹满。言胸胁苦满。
知邪气在表里也。默默、静也。邪在表。则呻吟不安。邪在里。则烦闷乱。内经曰。阳
入之阴则静。默默者。邪方自表之里。在表里之间也。邪在表则能食。邪在里则不能食。不
欲食者。邪在表里之间。未至于必不能食也。邪在表。则不烦不呕。邪在里。则烦满而
呕烦。喜呕者。邪在表方传里也。邪初入里。未有定处。则所传不一。故有或为之证。
有柴胡证。但见一证便是。即是此或为之证。
Gardenia (Shanzhi, Zhi Zi, Fructus Gardeniae) [14 pods, broken open, bitter in flavor, cold in nature]
Thick-bark Magnolia Stem Bark (Houpo, Hou Po, Cortex Magnoliae Officinalis) [4 liang, ginger-processed, bitter in flavor, warm in nature]
Immature Bitter Orange (Zhishi, Zhi Shi, Fructus Aurantii Immaturus) [4 liang, soaked in water, pith removed, stir-fried, bitter in flavor, cold in nature]
The above three herbs. Boil with 3.5 sheng of water. Decoct to obtain 1.5 sheng. Strain the dregs. Divide into two doses. Take one dose warm. If vomiting occurs, stop subsequent doses.
Sour and bitter flavors have the effects of inducing vomiting and purging. The bitterness of Gardenia induces vomiting for deficiency-related vexation. The bitterness of Thick-bark Magnolia Stem Bark and Immature Bitter Orange purges abdominal fullness.
Shaoyang disease (Taiyang Bing). The physician used pill medicines to vigorously purge. Body heat persists, with slight vexation. Zhizi Ganjiang Tang (Gardenia and Dried Ginger Decoction) is the primary treatment.
Pill medicines cannot eliminate heat but only damage righteous Qi (Zheng Qi, 正气). Pathogenic factors take advantage of deficiency to remain in the chest without penetrating deeply. This results in persistent body heat and slight vexation.
Administer Zhizi Ganjiang Tang (Gardenia and Dried Ginger Decoction). Induce vomiting of vexation to protect righteous Qi.
Gardenia (Shanzhi, Zhi Zi, Fructus Gardeniae) [14 pods, broken open, bitter in flavor, cold in nature]
Dried Ginger (Ganjiang, Gan Jiang, Radix Zingiberis Preparata) [2 liang, acrid in flavor, hot in nature]
The above two herbs. Boil with 3.5 sheng of water. Decoct to obtain 1.5 sheng. Strain the dregs. Divide into two doses. Take one dose warm. If vomiting occurs, stop subsequent doses.
Bitterness induces vomiting. The bitterness of Gardenia expels vexation. Acridity moistens and benefits Qi. The acridity of Dried Ginger benefits Qi.
When using Zhizi Tang (Gardenia Decoction), if the patient has a history of loose stools, it should not be administered.
Patients with a history of loose stools have interior deficiency and cold in the lower part. Although vexation occurs, it is not due to accumulated heat; therefore, Zhizi Tang (Gardenia Decoction) should not be used. The *Neijing* states: If diarrhea occurs first followed by other diseases, treat the root cause. One must regulate it first, then treat other diseases.
Taiyang disease (Taiyang Bing) after sweating therapy, where sweating does not resolve the condition. The person still has fever, palpitations in the epigastrium, dizziness, tremors of the body, and a sensation of being unable to stand firm, wanting to fall to the ground. Zhenwu Tang (True Warrior Decoction) is the primary treatment.
Sweating fails to resolve the condition, and fever persists, indicating pathogenic factors are not resolved. Palpitations in the epigastrium, dizziness, tremors of the body, and inability to stand firmly indicate loss of Yang Qi due to excessive sweating. Interior deficiency causes palpitations; upper deficiency causes dizziness; channel deficiency causes body tremors. Administer Zhenwu Tang (True Warrior Decoction). Warm the channels and restore Yang Qi.
Those with dry throat should not undergo sweating therapy.
This is due to insufficient Jin-Ye (Body Fluids, 津液).
Patients with Lin syndrome (Lin Zheng, 淋证) should not undergo sweating therapy. If sweating is induced, hematuria will inevitably occur.
Heat in the Bladder causes Lin syndrome (Lin Zheng, 淋证). Using decoctions to induce sweating consumes fluids and increases exogenous heat. The Bladder becomes deficient, inevitably leading to hematuria.
Patients with sores/ulcers (Chuang Jia, 疮家), even if they have body pain, should not undergo sweating therapy. If sweating is induced, spasms and convulsions will occur.
Deficiency of the exterior with accumulated heat generates sores. Patients with sores have body pain resembling Shaoyang disease (Taiyang Bing), but sweating should not be induced. Sweating further weakens exterior Qi and intensifies heat, generating wind. Thus, the condition changes to spasms and convulsions.
Patients prone to nosebleeds (Xu Jia, 衄家) should not undergo sweating therapy. If sweating is induced, the arteries on the forehead will sink, the pulse will become tight and urgent, eyes will stare straight ahead without blinking, and sleep will be impossible.
Nosebleed indicates blood loss in the Upper Jiao (Upper Burner, 上焦). If sweating is induced, fluids in the Upper Jiao will be depleted, and meridians will become dry. Thus, forehead arteries sink, and the pulse becomes tight and urgent. All vessels connect to the eyes. Tight tendons and vessels pull the eyes, causing them to stare straight ahead without blinking. Blinking closes the eyes. The *Zhenjing* states: When Yin Qi is deficient, the eyes cannot close. Blood loss leads to Yin deficiency, hence insomnia. Han Shi says: This person has a chronic history of nosebleeds, not post-Shaoyang disease (Taiyang Bing) epistaxis as in previous clauses. Therefore, sweating should not be induced.
Patients with blood loss (Wang Xue Jia, 亡血家) should not undergo sweating therapy. If sweating is induced, chills and trembling will occur.
The *Zhenjing* states: Those who lose blood have no sweat; those who lose sweat have no blood. Sweating a patient with blood loss leads to dual deficiency of Yin and Yang. Thus, chills and trembling occur.
Profuse sweaters (Han Jia, 汗家) who undergo repeated sweating will inevitably suffer from mental confusion and restlessness. Pain in the genitals after urination. Yu Yuliang Wan (Hematite Pill) is indicated (formula missing).
Sweat is the fluid of the Heart. Profuse sweaters undergoing repeated sweating lead to Heart deficiency. Mental confusion and restlessness result. Excessive loss of sweat depletes water, causing pain in the genitals after urination.
Wang Sanyang states: "Blood patients" and "profuse sweaters" refer to the patient's chronic conditions.
If a patient with cold symptoms undergoes sweating again, the Stomach becomes cold, likely leading to vomiting of roundworms.
Patients with cold should be treated with warming dispersion. Sweating damages Yang Qi, causing Stomach cold and vomiting of roundworms.
Wang Sanyang states: Warming dispersion methods include formulas like Lizhong Wan (Regulate the Middle Pill).
The *Huoren Shu* states: First administer Lizhong Wan (Regulate the Middle Pill), then Wu Mei Wan (Mume Pill).
Originally indicated for sweating but instead purged is called counter-treatment (Ni, 逆). If sweating and purging are applied in the correct sequence, treatment is not counter-treatment. Originally indicated for purging but instead sweated is counter-treatment. If purging is done first, treatment is not counter-treatment.
For exterior diseases, sweating is appropriate; purging is counter-treatment. For interior diseases, purging is appropriate; sweating is counter-treatment. The *Classic* states: In excess Yang and deficient Yin, sweating leads to death, purging leads to recovery. In deficient Yang and excess Yin, sweating leads to recovery, purging leads to death.
Lou Shi states: Excess Yang implies Yang merging into Yin, so purging is suitable. Excess Yin implies Yin merging into Yang, so sweating is suitable. Yang merging into Yin presents as deep and solid pulse. Yin merging into Yang presents as floating and solid pulse.
Furthermore: Excess Yang and deficient Yin indicate interior disease. Deficient Yang and excess Yin indicate exterior disease.
In Shaoyang disease (Taiyang Bing), after physician-induced purging, diarrhea with undigested food persists. With body pain, urgently rescue the interior. Later, if body pain persists but bowel movements normalize, urgently release the exterior. To rescue the interior, use Sini Tang (Frigid Extremities Decoction). To rescue the exterior, use Guizhi Tang (Cinnamon Twig Decoction).
In Shaoyang disease (Taiyang Bing), after purging, diarrhea with undigested food persists. With body pain, urgently rescue the interior because interior Qi is insufficient and must be treated first.
Urgently administer Sini Tang (Frigid Extremities Decoction). Once bowel movements normalize, knowing interior Qi is harmonized, then urgently administer Guizhi Tang (Cinnamon Twig Decoction) to release the exterior. Body pain indicates exterior pathogenic factors. The *Neijing* states: When disease onset involves insufficiency, treat the manifest symptom first, then the root. Here, cold is the root.
Wang Sanyang states: This condition requires attention to heat-collateral diarrhea. One must examine the color of the stool and the urgency of the condition; do not lightly administer Sini Tang (Frigid Extremities Decoction) or Guizhi Tang (Cinnamon Twig Decoction).
Shen Liangchen states: This is a critical point that must not be ignored. Two-interaction diseases can be inferred similarly.
Patient has fever and headache, but the pulse is unexpectedly deep. If the condition does not improve, and body pain persists, rescue the interior with Sini Tang (Frigid Extremities Decoction).
Yang disease presenting with Yin pulse indicates severe interior deficiency. The phrase "if not improving" emphasizes urgency: immediately administer Sini Tang (Frigid Extremities Decoction) to rescue the interior; delay is fatal.
Fever and headache are exterior diseases. An unexpectedly deep pulse is an interior pulse. The *Classic* states: Exterior disease should present with floating and large pulses. An unexpectedly deep and slow pulse suggests improvement. Seeing exterior signs with an interior pulse usually indicates resolution. If it does not resolve, it is due to severe interior deficiency and cold. Administer Sini Tang (Frigid Extremities Decoction) to rescue the interior.
Wang Yutai states: This is Yang disease obtaining Yin pulse. Relying only on fever and body pain to diagnose Taiyang disease (Taiyang Bing) and delaying Sini Tang (Frigid Extremities Decoction) will cause complications.
In Shaoyang disease (Taiyang Bing), initial purging failed, followed by sweating. This leads to dual deficiency of exterior and interior. The patient experiences Mao (dizziness/heaviness like being covered). Mao resolves spontaneously with sweating because the exterior becomes harmonious. If the interior is not yet harmonized, purging may be reapplied.
"Mao" refers to stagnation. Purging causes interior deficiency and blood loss. Sweating causes exterior deficiency and Yang loss. Dual deficiency of exterior and interior with cold Qi stagnation causes Mao. The *Jingui Yaolue* states: Blood loss followed by sweating with significant cold causes stagnation and Mao. Sweating resolves stagnation, curing Mao. The *Jingui Yaolue* states: Resolution of Mao requires profuse sweating. Sweating harmonizes the exterior; if the interior remains unharmonized, purging may follow.
In Shaoyang disease (Taiyang Bing) unresolved, pulses at Cun, Guan, and Chi positions are all hidden/stopped. There will be chills and trembling, followed by sweating and resolution. If only the Yang pulse is slightly weak, spontaneous sweating resolves it. If only the Yin pulse is slightly weak, purging resolves it. If purging is desired, Tiaowei Chengqi Tang (Harmonize the Stomach and Direct Downward Dragon’s Gate Decoction) is the primary treatment.
Careful reading of the text implies natural resolution via sweating when Yin and Yang are balanced. Chills and trembling leading to sweat do not require induced sweating. Weak Yang pulse indicates spontaneous sweating resolves it. Weak Yin pulse requires purging. Spontaneous sweating and purging are distinct.
Hidden pulses at all three positions without bias indicate harmony of Yin and Yang. The *Classic* states: Equal size, floating/sinking, slow/rapid pulses at Cun, Guan, and Chi indicate peaceful Yin-Yang pulse; even severe illness will recover. With harmony, chills and trembling precede sweating and resolution. Weak Yang pulse indicates Yang insufficiency and Yin excess. The *Classic* states: Deficient Yang and excess Yin recover with sweating. Weak Yin pulse indicates Yin insufficiency and Yang excess. The *Classic* states: Excess Yang and deficient Yin recover with purging.
Wang Sanyang states: "Yin and Yang stopped" means equal pulses at all three positions, all weak. Seeing weak pulses, no sweating or purging is needed. Spontaneous sweating and bowel movement will lead to recovery. It is not necessarily as described by Mr. Cheng regarding excess Yang and deficient Yin. The use of "Tiaowei" and "Ruo" (if) in the text indicates purging is not mandatory.
Shaoyang disease (Taiyang Bing) with fever and sweating indicates Ying weakness and Wei strength. This causes sweating. To resolve pathogenic wind, Guizhi Tang (Cinnamon Twig Decoction) is indicated.
Taiyang Wind Strike (Zhong Feng, 中风): Wind merges with Wei, making Wei excess and Ying deficiency. Ying is Yin; Wei is Yang. Fever and sweating indicate Yin weakness and Yang strength. The *Neijing* states: When Yin is deficient, Yang converges upon it. This causes shortness of breath, intermittent fever, and sweating. Administer Guizhi Tang (Cinnamon Twig Decoction) to dissipate wind and harmonize Ying and Wei.
After five to six days of Shaoyang disease (Taiyang Bing) or Wind Strike, alternating chills and fever, bitter fullness in the chest and hypochondrium, silent desire not to eat, heart vexation, and frequent vomiting. Or chest vexation without vomiting, thirst, abdominal pain, hypochondriac stiffness, epigastric palpitations, difficult urination, no thirst, slight body heat, or cough. Xiao Chaihu Tang (Minor Bupleurum Decoction) is the primary treatment.
Diseases can be in the exterior, interior, or between exterior and interior. This is pathogenic factors between exterior and interior, termed Half-Exterior Half-Interior Syndrome (Ban Biao Ban Li Zheng, 半表半里证).
Five to six days is the time for pathogenic factors to transmit from exterior to interior. Wind Strike or Shaoyang disease (Taiyang Bing) reaching five to six days. The *Yukan Jing* states: Wind Strike five to six days, Shaoyang disease (Taiyang Bing) with alternating chills and fever is this case. It refers to either Wind Strike or Shaoyang disease (Taiyang Bing), not Shaoyang disease (Taiyang Bing) followed by Wind Strike. The *Classic* says: In Shaoyang disease (Taiyang Bing) and Wind Strike, if Chai Hu patterns exist, seeing one symptom suffices, not all need be present. This refers to either Wind Strike or Shaoyang disease (Taiyang Bing). Pathogens in exterior cause chills; pathogens in interior cause heat. Now pathogens are between half-exterior and half-interior, without fixed location, causing alternating chills and fever. Pathogens in exterior cause no abdominal fullness; pathogens in interior cause abdominal fullness. Only chest/hypochondriac fullness is mentioned, indicating pathogens are between exterior and interior, not yet causing abdominal fullness. Silent means quiet. Pathogens in exterior cause groaning and unrest; pathogens in interior cause vexation and chaos. The *Neijing* states: Yang entering Yin brings quietness. "Silent" means pathogens are moving from exterior to interior, residing between them. Pathogens in exterior allow eating; pathogens in interior prevent eating. Lack of appetite indicates pathogens are between exterior and interior, not preventing eating entirely. Pathogens in exterior cause no vexation/vomiting; pathogens in interior cause vexation/fullness/vomiting. Frequent vomiting indicates pathogens transmitting from exterior to interior. Newly entered interior without fixed location causes varied transmission, hence "or" symptoms. Chai Hu patterns, seeing one symptom suffices, refers to these "or" symptoms.