瓜蒂（一分熬黄味苦寒） 赤小豆（一分味酸温）
上二味。各别捣筛为散。已合治之。取一钱匕。以香豉一合。用热汤七合。煮作稀
糜。去滓。取汁和散。温顿服之。不吐者。少少加。得快吐乃止。诸亡血虚家。不可与
瓜蒂散。
其高者越之。越以瓜蒂豆豉之苦。在上者涌之。涌以赤小豆之酸。内经曰。酸苦涌
泄为阴。
病胁下素有痞。连在脐旁。痛引少腹。入阴筋者。此名脏结。死。
素有宿昔之积。结于胁下为痞。今因伤寒。邪气入里。与宿积相助。使脏之真气。
结而不通。致连在脐旁。痛引少腹。入阴筋而死。
伤寒病。若吐。若下后。七八日不解。热结在里。表里俱热。时时恶风。大渴。舌
上干燥而烦。欲饮水数升者。白虎加人参汤主之。
若吐若下后。七八日。则当解。复不解而热结在里。表热者身热也。里热者内热
也。本因吐下后。邪气乘虚内陷。为结热。若无表热。而纯为里热。则邪热结而为实。
此以表热未罢。时时恶风。若邪气纯在表。则恶风无时。若邪气纯在里。则更不恶风。
以时时恶风。知表里俱有热也。邪热结而为实者。则无大渴。邪热散漫则渴。今虽热结
在里。表里俱热。未为结实。邪气散漫。熏蒸焦隔。故大渴。舌上干燥而烦。欲饮水数
升。与白虎加人参汤。散热生津。
伤寒无大热。口燥渴。心烦。背微恶寒者。白虎加人参汤主之。
无大热者。为身无大热也。口燥渴心烦者。当作阳明病。然以背微恶寒。为表未全
罢。所以属太阳也。背为阳。背恶寒。口中和者。少阴病也。当与附子汤。今口燥而渴。
背虽恶寒此里也。则恶寒亦不至甚。故云微恶寒。与白虎汤。和表散热。加人参。止渴
生津。
吴氏云。石膏辛寒。解足阳明经本热。蒸蒸发热。潮热。表里皆热。舌燥烦渴之圣
药也。且时时者。时或恶风而不常也。背上恶者。但觉微恶而不甚也。所有盛热燥渴而
用。则无疑矣。若夫表证恶寒。常在背上。恶寒而不燥渴者。切不可用。
伤寒脉浮。发热无汗。其表不解者。不可与白虎汤。渴欲饮水。无表证者。白虎加
人
参汤主之。
伤寒脉浮。发热无汗。其表不解。不渴者。宜麻黄汤。渴者宜五苓散。非白虎所宜。
大渴欲水。无表证者。乃可与白虎加人参汤。以散里热。临病之工。大宜精别。
太阳少阳并病。心下硬。颈项强而眩者。当刺大椎肺俞。慎勿下之。
心下硬而眩者。少阳也。颈项强者。太阳也。刺大椎肺俞。以泻太阳之邪。而以太
阳脉。下项挟脊故尔。肝俞以泻少阳之邪。以胆为肝之腑故尔。太阳为在表。少阳为在
里。明是半表半里证。前第八证云不可发汗。发汗则谵语。是发汗攻太阳之邪。少阳之
邪。益甚于胃。以发谵语。此云慎勿下之。攻少阳之邪。太阳之邪。乘虚入里。必作结
胸。经曰。太阳少阳并病。而反下之。成结胸。
太阳与少阳合病。自下利者。与黄芩汤。若呕者。黄芩加半夏生姜汤主之。
太阳阳明合病。自下利。为在表。当与葛根汤发汗。阳明少阳合病。自下利。为在
里。可与承气汤下之。此太阳少阳合病。自下利。为在半表半里。非汗下所宜。故与黄
芩汤。以和解半表半里之邪。呕者。胃气逆也。故加半夏生姜以散逆气。
Gua Di (1 fen, stir-fried until slightly yellow, bitter taste, cold nature) Chi Xiao Dou (1 fen, sour taste, warm nature)
The above two ingredients. Each is separately pounded and sifted into a powder. They are then mixed together to form the powder. Take one qian bi (a small scoop measure) of the powder. Use Xiang Chi (Fermented Soybean) 1 he, add 7 he of hot water. Boil until it becomes a thin porridge. Strain out the dregs. Take the liquid and mix it with the powder. Take warm in one dose. If vomiting does not occur, increase the dose slightly. Stop once rapid vomiting is achieved. Patients who have lost blood or are constitutionally deficient should not take Gua Di San.
Where the pathogen is high, use the method of inducing vomiting. Use the bitterness of Gua Di (Caulis Trichosanthis) and Dou Chi (Semen Sojae Praeparatum) to induce vomiting. Where the pathogen is upper, use the method of surging and draining. Use the sourness of Chi Xiao Dou (Vigna angularis) to surge and drain. The *Nei Jing* states: Sour and bitter flavors surge and drain, belonging to Yin.
If there has long been a mass in the hypochondrium, extending to beside the umbilicus, with pain radiating to the lower abdomen and entering the genital tendons, this is called Zang Jie (Organ Knotting). It is fatal.
There has long been an accumulation from past times, knotting in the hypochondrium to form a mass. Now, due to Shang Han (Cold Damage), the pathogenic factor enters the interior, assisting the old accumulation, causing the true Qi of the organs to knot and not flow freely. This leads to extension beside the umbilicus, pain radiating to the lower abdomen, entering the genital tendons, resulting in death.
In Shang Han disease, if after emesis or purgation, the condition remains unresolved for seven to eight days, heat knots in the interior, with heat present in both the exterior and interior. There is frequent aversion to wind, extreme thirst, dryness and irritability on the tongue, and a desire to drink several sheng (liters) of water. Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng) is the primary treatment.
After emesis or purgation, by seven to eight days, resolution should have occurred. If it remains unresolved and heat knots in the interior: Exterior heat refers to body heat; Interior heat refers to internal heat. Originally, because of emesis and purgation, the pathogen sank inward taking advantage of deficiency, forming knotted heat. If there is no exterior heat, but purely interior heat, the pathogenic heat knots to become excess. Here, because exterior heat has not completely ceased, there is frequent aversion to wind. If the pathogen were purely in the exterior, aversion to wind would be constant. If the pathogen were purely in the interior, there would be no aversion to wind. From the frequent aversion to wind, we know there is heat in both the exterior and interior. When pathogenic heat knots to become excess, there is no extreme thirst; thirst occurs when pathogenic heat is diffuse. Although heat now knots in the interior with heat in both exterior and interior, it has not yet formed a solid excess. The pathogen is diffuse, steaming and scorching the diaphragm, hence extreme thirst, dryness and irritability on the tongue, and a desire to drink several sheng of water. Administer Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng) to dissipate heat and generate fluids.
In Shang Han disease, with no significant fever, dry mouth and thirst, irritability, and slight aversion to cold on the back, Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng) is the primary treatment.
"No significant fever" means the body lacks significant heat. Dry mouth, thirst, and irritability suggest Yang Ming disease. However, due to slight aversion to cold on the back, the exterior has not fully resolved, so it belongs to Tai Yang disease. The back is Yang. Aversion to cold on the back with a harmonious mouth indicates Shao Yin disease, treated with Fu Zi Tang (Aconite Decoction). Now, with dry mouth and thirst, although there is aversion to cold on the back, this is interior heat, so the aversion to cold is not severe, hence "slight aversion to cold." Administer Bai Hu Tang (White Tiger Decoction) to harmonize the exterior and dissipate heat. Add Ren Shen (Ginseng) to stop thirst and generate fluids.
Wu Shi stated: Shi Gao (Gypsum Fibrosum) is pungent and cold; it is the sacred medicine for resolving the intrinsic heat of the Foot Yang Ming channel. It is effective for steaming fever, tidal fever, heat in both exterior and interior, dry tongue, and irritability/thirst. "Frequent" means occasional aversion to wind, not constant. "Aversion on the back" means only feeling slight aversion, not severe. For cases of intense heat, dryness, and thirst, its use is unquestionable. However, if there is exterior syndrome with aversion to cold, typically on the back, without dryness and thirst, it must absolutely not be used.
In Shang Han disease, with floating pulse, fever, no sweat, and unresolved exterior syndrome, Bai Hu Tang (White Tiger Decoction) must not be given. With thirst desiring water and no exterior syndrome, Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng) is the primary treatment.
In Shang Han disease, with floating pulse, fever, no sweat, unresolved exterior syndrome, and no thirst, Ma Huang Tang (Ephedra Decoction) is appropriate. With thirst, Wu Ling San (Five-Ingredient Powder with Poria) is appropriate. This is not suitable for Bai Hu Tang. With extreme thirst desiring water and no exterior syndrome, Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng) may be given to dissipate interior heat. Practitioners facing illness must be extremely precise in differentiation.
When Tai Yang and Shao Yang diseases occur simultaneously, with hardness below the heart, stiffness and tension in the neck, and vertigo, Da Zhui (GV14) and Fei Shu (BL13) should be needled. Do not use purgation.
Hardness below the heart with vertigo indicates Shao Yang disease. Stiffness and tension in the neck indicates Tai Yang disease. Needling Da Zhui (GV14) and Fei Shu (BL13) drains the pathogen of Tai Yang. Because the Tai Yang channel descends along the neck and flanks the spine, this is done. Gan Shu (BL18) drains the pathogen of Shao Yang. Because Gallbladder is the paired organ of Liver, this is done. Tai Yang disease is in the exterior; Shao Yang disease is in the interior. Clearly, this is a half-exterior, half-interior syndrome. The previous eighth case stated that sweating is contraindicated; if sweating is induced, delirium ensues. This is because sweating attacks the Tai Yang pathogen, causing the Shao Yang pathogen to worsen in the stomach, leading to delirium. Here, it is stated that purgation must absolutely not be used. If purgation attacks the Shao Yang pathogen, the Tai Yang pathogen will enter the interior taking advantage of deficiency, inevitably forming Jie Xiong (Chest Binding). The classic states: When Tai Yang and Shao Yang diseases occur simultaneously, and purgation is wrongly applied, Jie Xiong (Chest Binding) results.
When Tai Yang and Shao Yang diseases combine, with spontaneous diarrhea, Huang Qin Tang (Scutellaria Decoction) is given. If there is vomiting, Huang Qin Jia Ban Xia Sheng Jiang Tang (Scutellaria Decoction plus Pinellia and Fresh Ginger) is the primary treatment.
When Tai Yang and Yang Ming diseases combine, with spontaneous diarrhea, the pathology is in the exterior; Ge Gen Tang (Kudzu Decoction) should be used to induce sweating. When Yang Ming and Shao Yang diseases combine, with spontaneous diarrhea, the pathology is in the interior; Cheng Qi Tang (Ordering the Qi Decoction) may be used to purge. Here, Tai Yang and Shao Yang diseases combine, with spontaneous diarrhea; the pathology is in the half-exterior, half-interior region, making sweating and purgation inappropriate. Therefore, Huang Qin Tang (Scutellaria Decoction) is given to harmonize the half-exterior, half-interior pathogen. Vomiting indicates rebellious Stomach Qi; therefore, Ban Xia (Pinellia Rhizome) and Sheng Jiang (Fresh Ginger) are added to disperse the rebellious Qi.