猪苓（去皮味甘平） 茯苓（味甘平） 阿胶（味甘平） 滑石（碎味甘寒） 泽
泻（味甘咸寒各一两）
上五味。以水四升。先煮四味。取二升。去滓。内下阿胶。烊消。温服七合。日三
服。
甘甚而反淡。淡味渗泄为阳。猪苓茯苓之甘。以行小便。咸味涌泄为阴。泽泻之咸。
以泄伏水。滑利窍。阿胶滑石之滑。以利水道。
阳明病。汗出多而渴者。不可与猪苓汤。以汗多。胃中燥。猪苓汤复利其小便故也。
针经曰。水谷入于口。输于肠胃。其液别为五。天寒衣薄则为溺。天热衣浓则为汗。
是汗溺一液也。汗多为津液外泄。胃中干燥。故不可与猪苓汤利小便也。
脉浮而迟。表
热里寒。下利清谷者。四逆汤主之。
浮为表热。迟为里寒。下利清谷者。里寒甚也。与四逆汤。温里散寒。
若胃中虚冷。不能食者。饮水则哕。
哕者、咳逆是也。千金曰。咳逆者。哕逆之名。胃中虚冷。得水。则水寒相搏。胃
气逆而哕。
脉浮发热。口干鼻燥。能食者。则衄。
脉浮发热。口干鼻燥者。热在经也。能食者。里和也。热甚于经。迫血为衄。胃中
虚冷。阴胜也。水入于经其血乃成。饮水者。助阴气。逆为哕。发热口干。阳胜也。食
入于阴。长气于阳。能食者。助阳。血妄为衄。三者。偏阴偏阳之疾也。
王三阳云。上二条。另是中阴腑之疾。此条以下。又是阳经传来之疾也。
阳明病。下之。其外有热。手足温。不结胸。心中懊 。饥不能食。但头汗出者。
栀子豉汤主之。
表未罢而下者。应邪热内陷也。热内陷者。则外热而无手足温。今外有热而手足温
者。热虽内陷。然而不深。故不作结胸也。心中懊 。饥不能食者。热客胸中。为虚烦
也。热自胸中薰蒸于上。故但头汗出而身无汗。与栀子豉汤。以吐胸中之虚烦。
阳明病。发潮热。大便溏。小便自可。胸胁满不去者。小柴胡汤主之。
阳明病。潮热。为胃实。大便硬而小便数。今大便溏。小便自可。则胃热未实而水
谷不别也。大便溏者。应气降而胸胁满去。今反不去者。邪气犹在半表半里之间。与小
柴胡汤。以去表里之邪。
吴氏云。邪在半表半里。虽潮热。不得为里大实。故仍以半表半里治之。何也。便
溏胁满故也。
阳明病。胁下硬满。不大便而呕。舌上白苔者。可与小柴胡汤。上焦得通。津液得
下。
胃气因和。身 然而汗出解也。
阳明病。腹满。不大便。舌上苔黄者。为邪热入腑。可下。若胁下硬满。虽不大便
而呕。舌上白苔者。为邪未入腑。在表里之间。与小柴胡汤。以和解之。上焦得通。则
呕止。津液得下。则胃气因和。汗出而解。
吴氏云。且有胁下硬满在。柴胡证犹未除也。
阳明中风。脉弦、浮、大、而短气。腹都满。胁下及心痛。又按之气不通。鼻干、不得
汗。嗜卧。一身及面目悉黄。小便难。有潮热。时时哕。耳前后肿。刺之小瘥。外不解。
病过十日。脉续浮者。与小柴胡汤。脉但浮无余证者。与麻黄汤。若不尿。腹满加哕者。
不治。
浮大为阳。风在表也。弦则为阴。风在里也。短气腹满。胁下及心痛。风热壅于腹
中而不通也。若寒客于内而痛者。按之则寒气散而痛止。此以风热内壅。故虽久按而气亦
不通。阳明病。鼻干。不得卧。自汗出者。邪在表也。此鼻干。不得汗。而嗜卧者。风
热内攻不干表也。一身面目悉黄。小便难。有潮热。时时哕者。风热攻于胃也。阳明之脉。
出大迎。循颊车。上耳前过客主人。热胜则肿。此风热在经。故耳前后肿。刺之经气通肿则
小瘥。如此者。外证罢。则可攻。若外证不解。虽过十
日。脉续浮者。邪气犹在半表半里。与小柴胡汤。以和解之。若其脉但浮而不弦大。无
诸里证者。是邪但在表也。可与麻黄汤。以发其汗。若不尿。腹满。加哕者。关格之疾
也。故云不治。难经曰。关格者。不得尽其命而死。
阳明病。自汗出。若发汗。小便自利者。此为津液内竭。虽硬。不可攻之。当须自
欲大便。宜蜜煎导而通之。若土瓜根。及与大猪胆汁。皆可为导。
津液内竭。肠胃干燥。大便因硬。此非结热。故不可攻。宜以药外治而导引之。
[Formula 75: Zhu Ling Tang (Polyporus Decoction)]
Zhu Ling (Polyporus, *Poria cocos* sclerotium, skin removed, sweet flavor, neutral nature) Fu Ling (Poria, *Poria cocos* sclerotium, sweet flavor, neutral nature) E Jiao (Donkey-hide Gelatin, *Colla Corii Asini*, sweet flavor, neutral nature) Hua Shi (Talcum, *Talcum*, crushed, sweet flavor, cold nature) Ze Xie (Alisma Rhizome, *Alismatis Rhizoma*, sweet and salty flavor, cold nature, each one tael).
The above five herbs. Use four sheng of water. First decoct the first four herbs. Obtain two sheng of liquid. Remove the dregs. Add E Jiao. Melt it completely. Take seven ge warm per dose. Three times a day.
When the sweet flavor is extreme, it appears bland. The bland flavor has a seeping and draining action, which belongs to Yang. The sweet flavor of Zhu Ling and Fu Ling promotes urination. The salty flavor has a surging and draining action, which belongs to Yin. The salty flavor of Ze Xie drains latent water. The slippery nature of Hua Shi and E Jiao facilitates the flow of the water passages.
In Yangming disease, if there is excessive sweating and thirst, Zhu Ling Tang should not be administered. This is because excessive sweating causes dryness in the stomach, and Zhu Ling Tang further promotes urination.
The *Zhen Jing* (Needle Classic) states: Food and drink enter the mouth, are transported by the stomach and intestines, and their fluids are transformed into five types. When it is cold and clothing is thin, they transform into urine; when it is hot and clothing is thick, they transform into sweat. Thus, sweat and urine are derived from the same fluid. Excessive sweating leads to the external leakage of body fluids and dryness in the stomach. Therefore, Zhu Ling Tang should not be used to promote urination.
If the pulse is floating and slow, indicating exterior heat and interior cold, with diarrhea containing undigested food, Si Ni Tang (Frigid Four Decoction) is indicated.
Floating indicates exterior heat; slow indicates interior cold. Diarrhea with undigested food signifies severe interior cold. Si Ni Tang is given to warm the interior and dispel cold.
If the stomach is deficient and cold, unable to accept food, drinking water will induce hiccups (yue). Hiccups refer to coughing against the reverse flow. The *Qian Jin Fang* states that "coughing against the reverse flow" is another name for hiccups. With a deficient and cold stomach, water interacts with cold, causing stomach qi to rebel and inducing hiccups.
If the pulse is floating, accompanied by fever, dry mouth, dry nose, and the ability to eat, epistaxis (nosebleed) will occur.
Floating pulse and fever indicate heat in the meridians. The ability to eat indicates harmony in the stomach. Heat prevailing in the meridians forces blood to bleed, causing epistaxis. A deficient and cold stomach represents excess yin. Water entering the meridians forms blood; drinking water aids yin qi, leading to rebellion and hiccups. Fever and dry mouth represent excess yang. Food enters the yin and nourishes the yang. The ability to eat aids yang, causing blood to move recklessly and resulting in epistaxis. These three conditions are diseases of yin or yang bias.
Wang Sanyang said: The previous two clauses describe diseases of the middle yin fu organs. The following clauses describe diseases transmitted from the yang meridians.
In Yangming disease, after purgation, if there is exterior heat, warm hands and feet, no chest binding, mental restlessness (ao nu), hunger but inability to eat, and only sweating on the head, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is indicated.
Exterior syndrome unresolving followed by purgation suggests internal collapse of pathogenic heat. If heat collapses internally, there would be exterior heat but cold hands and feet. Since there is exterior heat and warm hands and feet, although heat has collapsed internally, it is not deep, so chest binding does not form. Mental restlessness, hunger, and inability to eat indicate heat lodging in the chest, causing deficiency vexation. Heat steaming upward from the chest causes sweating only on the head and no sweat on the body. Zhi Zi Chi Tang is given to induce vomiting of the deficiency vexation in the chest.
In Yangming disease, with tidal fever, loose stools, normal urination, and persistent fullness in the chest and hypochondrium, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is indicated.
Tidal fever in Yangming disease usually indicates stomach excess, hard stools, and frequent urination. Here, loose stools and normal urination indicate that stomach heat is not yet solidified and water and grain are not separated. Loose stools should allow qi to descend and relieve chest and hypochondriac fullness. Since fullness persists, pathogenic factors remain between the exterior and interior. Xiao Chai Hu Tang is given to eliminate pathogenic factors between the exterior and interior.
Wu said: Pathogenic factors between the exterior and interior, even with tidal fever, cannot be considered major interior excess. Therefore, it is still treated as a half-exterior, half-interior condition. Why? Because of loose stools and hypochondriac fullness.
In Yangming disease, with hardness and fullness below the hypochondrium, constipation, vomiting, and a white coating on the tongue, Xiao Chai Hu Tang may be given. Once the upper jiao becomes unobstructed, body fluids can descend, stomach qi harmonizes, and the patient sweats slightly and recovers.
In Yangming disease, abdominal fullness, constipation, and a yellow coating on the tongue indicate pathogenic heat entering the fu organs; purgation is applicable. If there is hardness and fullness below the hypochondrium, constipation, vomiting, and a white coating on the tongue, pathogenic factors have not entered the fu organs but remain between the exterior and interior. Xiao Chai Hu Tang is given to harmonize. Unobstruction of the upper jiao stops vomiting; descent of body fluids harmonizes stomach qi; sweating leads to recovery.
Wu said: Moreover, since hardness and fullness below the hypochondrium persist, the Chai Hu syndrome remains unresolved.
Yangming wind-strike presents with wiry, floating, and large pulses, shortness of breath, generalized abdominal fullness, pain in the hypochondrium and heart region, obstruction of qi upon palpation, dry nose, inability to sweat, lethargy, jaundice of the whole body and face, difficulty in urination, tidal fever, occasional hiccups, and swelling around the ears. Acupuncture provides slight relief. If the exterior syndrome remains unresolved and the disease lasts over ten days, if the pulse continues to float, give Xiao Chai Hu Tang. If the pulse is merely floating without other symptoms, give Ma Huang Tang (Ephedra Decoction). If there is no urination, increased abdominal fullness, and added hiccups, it is incurable.
Floating and large pulses indicate yang; wind is at the exterior. Wiry pulse indicates yin; wind is at the interior. Shortness of breath, abdominal fullness, and pain in the hypochondrium and heart region indicate wind-heat congesting the abdomen and obstructing qi flow. If pain were caused by cold invading internally, pressing would disperse the cold and stop the pain. Here, due to internal congestion of wind-heat, pressing does not relieve the obstruction. In Yangming disease, dry nose, inability to lie down, and spontaneous sweating indicate pathogenic factors at the exterior. Here, dry nose, inability to sweat, and lethargy indicate internal attack by wind-heat rather than involvement of the exterior. Generalized jaundice, difficulty in urination, tidal fever, and occasional hiccups indicate wind-heat attacking the stomach. The Yangming meridian emerges at Daying, follows Jiache, and ascends to Erqianzhong passing through Guest Master. Excess heat causes swelling. This is wind-heat in the meridian, causing swelling around the ears. Acupuncture unblocks meridian qi, reducing swelling. If such cases resolve externally, purgation may proceed. If the exterior syndrome remains unresolved, even after ten days, if the pulse continues to float, pathogenic factors remain between the exterior and interior; give Xiao Chai Hu Tang to harmonize. If the pulse is merely floating, not wiry or large, without interior symptoms, pathogenic factors are solely at the exterior; give Ma Huang Tang to induce sweating. If there is no urination, abdominal fullness, and added hiccups, this is Guan Ge (Gate and Grid) disease, hence incurable. The *Nan Jing* states: Guan Ge disease leads to death before the natural lifespan is exhausted.
In Yangming disease, with spontaneous sweating, if sweating is induced again and urination is free, this indicates internal exhaustion of body fluids. Although stools are hard, purgation is contraindicated. One must wait for the natural desire to defecate. Honey suppositories are suitable to guide passage. Radix Trichosanthis (Tu Gua Gen) or large pig bile can also be used as guiding agents.
Internal exhaustion of body fluids leads to dryness of the intestines and stomach, causing hard stools. This is not accumulated heat; therefore, purgation is contraindicated. External medication and guiding methods are appropriate.