竹叶（二把辛平） 石膏（一斤甘寒） 半夏（半升洗辛温） 人参（三两甘温）
甘草（二两甘平炙） 粳米（半升甘微寒） 麦门冬（一升甘平去心）
上七味。以水一斗。煮取六升。去滓。内粳米。煮米熟。汤成。去米。温服一升。
日三服。
辛甘发散而除热。竹叶石膏甘草之甘辛。以发散余热。甘缓脾而益气。麦门冬人参
粳米之甘。以补不足。辛者散也。气逆者欲其散。半夏之辛。以散逆气。
病患脉已解。而日暮微烦。以病新瘥。人强与谷。脾胃气尚弱。不能消谷。故令微
烦。损谷则愈。
阳明王于申酉戌。宿食在胃。故日暮微烦。当小下之。以损宿谷。
夫以为疾病至急。仓卒寻按要者难得。故重集诸可与不可方治。比之三阴三阳篇中。
此易见也。又时有不止是三阴三阳。出在诸可与不可中也。
诸不可汗。不可下。病证药方。前三阴三阳篇中。经注已具者。更不复出。其余无
者。于此以后。经注备见。
脉濡而弱。弱反在关。濡反在巅。微反在上。涩反在下。微则阳气不足。涩则无血。阳
气反微。中风汗出而反躁烦。涩则无血。厥而且寒。阳微发汗。躁不得眠。
寸关为阳脉当浮盛。弱反在关。则里气不及。濡反在巅。则表气不逮。卫行脉外。
浮为在上。以候卫。微反在上。是阳气不足。荣行脉中。沉为在下。以候荣涩。反在下。是
无血也。阳微不能固外。腠理开疏。风因客之。故令汗出而躁烦无血则阴虚。不与阳相
顺接。故厥而且寒。阳微无津液。则不能作汗。若发汗则必亡阳而躁。经曰。汗多亡阳。
遂虚。恶风。烦躁。不得眠也。
动气在右。不可发汗。发汗则衄而渴。心苦烦。饮即吐水。
动气者。筑筑然气动也。在右者。在脐之右也。难经曰。肺内证。脐右有动气。按之
牢若痛。肺气不治正气内虚。气动于脐之右也。发汗则动肺气。肺主气。开窍于鼻。气
虚则不能卫血。血溢妄行。随气出于鼻为衄。亡津液胃燥。则烦渴而心苦烦。肺恶寒。
饮冷则伤肺。故饮即吐水。
活人云。先服五苓散三服。次服竹叶汤。
动气在左。不可发汗。发汗则头眩汗不止。筋惕肉 。
难经曰。肝内证。脐左有动气。按之牢若痛。肝气不治。正气内虚。气动于脐之左
也。肝为阴之主。发汗。汗不止。则亡阳外虚。故头眩筋惕肉 。针经曰。上虚则眩。
活人云。先服防风、白术、牡蛎。汗止。次服建中汤。
动气在上。不可发汗。发汗。则气上冲。正在心端。
难经曰。心内证脐上有动气。按之牢若痛。心气不治。正气内虚。气动于脐之上也。
心为阳。发汗亡阳。则愈损心气。肾乘心虚欲上凌心。故气上冲。正在心端。
活人云。宜服李根汤。
动气在下。不可发汗。发汗。则无汗。心中大烦。骨节苦疼。目晕恶寒。食则反吐
谷不得前。
难经曰。肾内证。脐下有动气。按之牢。若痛。肾气不治。正气内虚。动气发于脐
之下也。肾者主水。发汗。则无汗者。水不足也。心中大烦者。肾虚不能制心火也。骨
节苦疼者。肾主骨也。目晕者。肾病则目KT KT 。如无所见。恶寒者。肾主寒也。食则
反吐。谷不得前者。肾水干也。王冰曰。病呕而吐。食久反出。是无水也。
活人云先服大橘皮汤。吐止。后服小建中汤。
咽中闭塞不可发汗。发汗。则吐血。气欲绝。手足厥冷。欲得蜷卧。不能自温。
咽门者。胃之系。胃经不和。则咽内不利。发汗攻阳。血随发散而上。必吐血也。胃
经不和。而反攻表。则阳虚于外。故气欲绝。手足冷。欲蜷而不能自温。
诸脉得数动微弱者。不可发汗。发汗。则大便难。腹中干。胃燥而烦。其形相像。
根本异源。
动数之脉。为热在表。微弱之脉。为热在里。发汗亡津液。则热气愈甚。胃中干燥。
故大便难。腹中干。胃燥而烦根本虽有表里之异。逆治之后。热传之则一。是以病形相
像也。
脉微而弱。弱反在关。濡反在巅。弦反在上。微反在下。弦为阳运。微为阴寒。上
实下虚。意欲得温。微弦为虚。不可发汗。发汗。则寒栗。不能自还。
弦在上。则风伤气。风胜者。阳为之运动。微在下。则寒伤血。血伤者。里为之阴寒。
外气怫郁为上实。里有阴寒为下虚。表热里寒。意欲得温。若反发汗。亡阳阴独。故寒栗不能
自还。
咳者则剧数吐涎沫咽中必干。小便不利。心中饥烦。 时而发。其形似疟。有寒无
热。虚而寒栗。咳而发汗。蜷而苦满。腹中复坚。
肺寒气逆咳者则剧。吐涎沫。亡津液。咽中必干。小便不利。膈中阳气虚。心中饥
而烦。一日一夜。气大会于肺。邪正相击。 时而发。形如寒疟。但寒无热。虚而寒栗。
发汗攻阳。则阳气愈虚。阴寒愈甚。故蜷而苦满。腹中复坚。
厥脉紧。不可发汗。发汗。则声乱咽嘶。舌萎声不得前。
厥而脉紧。则少阴伤寒也。法当温里。而反发汗。则损少阴之气。少阴之脉。入肺
中。循喉咙。挟舌本。肾为之本。肺为之标。本虚则标弱。故声乱咽嘶舌萎。声不得前。
诸逆发汗。病微者难瘥。剧者言乱目眩者死。命将难全。
不可发汗。而强发之。轻者因发汗而重。而难瘥。重者脱其阴阳之气。言乱目眩而死。
难经曰。脱阳者见鬼。是此言乱也。脱阴者目盲。是此目眩也。眩非玄而见玄。是近于
盲也。
咳而小便利。若失小便者。不可发汗。汗出则四肢厥逆冷。
肺经虚冷。上虚不能治下者。咳而小便利。或失小便。上虚发汗。则阳气外亡。四
肢者。诸阳之本。阳虚则不与阴相接。故四肢厥逆冷。
伤寒头痛。翕翕发热。形象中风。常微汗出。自呕者。下之益烦。心中懊 如饥。发汗
则致 。身强难以屈伸。熏之则发黄。不得小便。灸则发咳唾。
伤寒当无汗恶寒。今头痛发热。微汗出。自呕。则伤寒之邪。传而为热欲行于里。
若反下之。邪热乘虚。流于胸中。为虚烦心懊 如饥。若发汗。则虚表。热归经络。热
甚生风。故身强直而成 。若熏之。则火热相合。消烁津液。故小便不利而发黄。肺恶
火。灸则火热伤肺。必发咳嗽而唾脓。
永类钤方云。伤寒发汗有四难。凡发热头疼。有汗而非无汗。恶风而非恶寒。例发
其汗。汗不止为漏风。间有发而为痉者。此分外症发汗之一难也。至于发热头痛。尺脉
迟者。为荣虚血少。不可发汗。发热头痛。脉弦细。属少阳不可汗。汗则谵语。此分脉发
汗之二难也。动气在左不可汗。汗则头眩汗不止。则筋惕肉 。动气在右不可汗。汗则衄
而渴。心烦。饮则吐水。动气在上不可汗。汗则气冲心。动气在下不可汗。汗则无汗。
心烦骨节疼。此分内证发汗之三难也。春宜汗。不可大发。以阳气尚微。冬不大汗以阳
气伏藏。汗之必吐利。口烂生疮。此知时发汗之四难也。
Bamboo Leaf (Ye Zhu, two handfuls, acrid and neutral) Gypsum (Shi Gao, one jin, sweet and cold) Pinellia Tuber (Ban Xia, half sheng, washed, acrid and warm) Ginseng Root (Ren Shen, three liang, sweet and warm) Licorice Root (Gan Cao, two liang, roasted, sweet and neutral) Rice Grain (Jing Mi, half sheng, sweet and slightly cold) Ophiopogon Tuber (Mai Men Dong, one sheng, heart removed, sweet and neutral)
The above seven ingredients. Use ten dou of water. Boil to obtain six sheng of liquid. Remove the dregs. Add Jing Mi (Rice Grain). Cook until the rice is ripe. The decoction is ready. Remove the rice grains. Take one sheng warm.
Take three times a day.
Acrid and sweet substances disperse and eliminate heat. The sweet and acrid properties of Ye Zhu (Bamboo Leaf), Shi Gao (Gypsum), and Gan Cao (Licorice) are used to disperse residual heat. Sweetness soothes the Spleen Qi and tonifies deficiency. The sweetness of Mai Men Dong (Ophiopogon Tuber), Ren Shen (Ginseng Root), and Jing Mi (Rice Grain) is used to replenish insufficiency. Acridity has a dispersing function. For rebellious Qi, dispersion is desired. The acridity of Ban Xia (Pinellia Tuber) is used to scatter rebellious Qi.
When the patient's pulse has resolved but there is slight vexation at dusk, it is because the disease has just healed, the person forces food intake, the Spleen and Stomach Qi are still weak, unable to digest food, thus causing slight vexation. Reducing food intake leads to recovery.
Yang Ming channel dominates during Shen, You, and Xu hours. If retained food remains in the Stomach, slight vexation occurs at dusk. A mild purgative method should be used to reduce the retained food.
Given that diseases arise urgently, it is difficult to find applicable prescriptions hastily. Therefore, various treatable and untreatable methods are re-collected. Compared to the Three Yin and Three Yang chapters, these are easier to see. Sometimes situations extend beyond the Three Yin and Three Yang, appearing in sections on treatable and untreatable conditions.
All conditions and prescriptions where sweating or purging are contraindicated, which are already detailed in the text and annotations of the Three Yin and Three Yang chapters, are not repeated here. Others not listed previously are fully detailed in the text and annotations from this point onwards.
A pulse that is soggy and weak, with weakness reversed at the Guan position, sogginess reversed at the Cun position (Cun refers to the distal part of the radial artery), faintness reversed at the upper position (Cun), and choppy reversed at the lower position (Chi). Faintness indicates insufficient Yang Qi; choppy indicates lack of Blood. If Yang Qi is faint, wind-stroke causes sweating with restlessness and vexation. Choppy indicates lack of Blood, leading to cold limbs and coldness. Sweating when Yang Qi is faint leads to restlessness and insomnia.
The Cun and Guan positions represent Yang pulses, which should be floating and vigorous. Weakness at the Guan position indicates interior Qi insufficiency. Sogginess at the Cun position indicates exterior Qi failure. Wei Qi circulates outside the vessels.
Floating pulse indicates presence above, reflecting Wei Qi. Faintness at the upper position indicates Yang Qi insufficiency. Ying Qi circulates inside the vessels. Deep pulse indicates presence below, reflecting Ying Qi. Choppy pulse at the lower position indicates lack of Blood. Insufficient Yang Qi fails to secure the exterior, opening the pores, allowing Wind pathogen to invade, causing sweating, restlessness, and vexation. Lack of Blood leads to Yin deficiency, failing to connect smoothly with Yang, resulting in cold limbs and coldness. Yang insufficiency lacks fluids for sweat production. Sweating would cause loss of Yang Qi and restlessness. The Classic states: "Excessive sweating causes loss of Yang Qi." This leads to emptiness, aversion to wind, restlessness, and inability to sleep.
Motional Qi (Dong Qi) on the right side is a contraindication for sweating. Sweating causes epistaxis, thirst, mental vexation, and vomiting water upon drinking.
Motional Qi refers to palpable pulsation in the abdomen. On the right means to the right of the umbilicus. The Nan Jing states: "Lung internal syndrome presents with motional Qi at the right of the umbilicus, hard and painful upon pressure." Lung Qi dysfunction and interior deficiency cause Qi movement at the right of the umbilicus. Sweating disturbs Lung Qi. Lung governs Qi and opens into the nose. Qi deficiency fails to control Blood, causing blood to溢 extravasate and flow out through the nose as epistaxis. Loss of fluids causes Stomach dryness, leading to vexation, thirst, and mental distress. Lung dislikes cold. Cold drinks injure the Lung, causing immediate vomiting of water.
The Huo Ren Shu states: First administer Wu Ling San (Five-Ingredient Powder with Poria) three doses, then follow with Zhu Ye Tang (Bamboo Leaf Decoction).
Motional Qi on the left side is a contraindication for sweating. Sweating causes dizziness, continuous sweating, and muscle twitching.
The Nan Jing states: "Liver internal syndrome presents with motional Qi at the left of the umbilicus, hard and painful upon pressure." Liver Qi dysfunction and interior deficiency cause Qi movement at the left of the umbilicus. The Liver is the master of Yin. Sweating causes continuous loss of Yang Qi and exterior deficiency, leading to dizziness and muscle twitching. The Zhen Jing states: "Deficiency above causes dizziness."
The Huo Ren Shu states: First administer Fang Feng (Saposhnikovia Root), Bai Zhu (Atractylodes Macrocephala Rhizome), and Mu Li (Oyster Shell). Once sweating stops, follow with Jian Zhong Tang (Middle-Building Decoction).
Motional Qi above is a contraindication for sweating. Sweating causes Qi rushing upward, directly striking the heart region.
The Nan Jing states: "Heart internal syndrome presents with motional Qi above the umbilicus, hard and painful upon pressure." Heart Qi dysfunction and interior deficiency cause Qi movement above the umbilicus. The Heart is Yang. Sweating causes loss of Yang Qi, further damaging Heart Qi. Kidney Water exploits Heart deficiency to ascend and oppress the Heart, causing Qi rushing upward to the heart region.
The Huo Ren Shu states: Li Gen Tang (Li Root Decoction) is appropriate.
Motional Qi below is a contraindication for sweating. Sweating causes anhidrosis, severe mental vexation, bone and joint pain, blurred vision, aversion to cold, vomiting after eating, and food stagnation.
The Nan Jing states: "Kidney internal syndrome presents with motional Qi below the umbilicus, hard and painful upon pressure." Kidney Qi dysfunction and interior deficiency cause Qi movement below the umbilicus. The Kidney governs Water. Sweating results in anhidrosis due to fluid insufficiency. Severe mental vexation arises because Kidney deficiency fails to control Heart Fire. Bone and joint pain occur because the Kidney governs bones. Blurred vision occurs because Kidney disease causes visual impairment ("KTKT" implies unclear vision). Aversion to cold occurs because the Kidney governs cold. Vomiting after eating and food stagnation occur because Kidney Water is exhausted. Wang Bing states: "Vomiting and regurgitation of old food indicate lack of Water."
The Huo Ren Shu states: First administer Da Ju Pi Tang (Large Tangerine Peel Decoction). Once vomiting stops, follow with Xiao Jian Zhong Tang (Small Middle-Building Decoction).
Throat obstruction is a contraindication for sweating. Sweating causes hematemesis, impending death of Qi, cold hands and feet, desire to curl up, and inability to self-warm.
The throat is the connection of the Stomach. Stomach Channel disharmony causes throat discomfort. Sweating attacks Yang, causing Blood to rise with dispersal, inevitably leading to hematemesis. Stomach Channel disharmony attacking the exterior causes Yang deficiency externally, leading to impending Qi loss, cold hands and feet, and curling inability to self-warm.
Pulses showing rapid, moving, or faint characteristics are contraindications for sweating. Sweating causes difficult defecation, abdominal dryness, Stomach dryness, and vexation. The symptoms appear similar, but the root origins differ.
Rapid and moving pulses indicate Heat in the exterior. Faint pulses indicate Heat in the interior. Sweating causes loss of fluids, intensifying Heat. Stomach dryness leads to difficult defecation, abdominal dryness, and Stomach dryness with vexation. Although roots differ by exterior/interior, mis-treatment leads to similar Heat transmission, hence similar symptoms.
Faint and weak pulses, with weakness at Guan, sogginess at Cun, wiriness at upper, and faintness at lower. Wiry represents Yang movement; faint represents Yin Cold. Upper excess and lower deficiency indicate a desire for warmth. Faint and wiry pulses indicate deficiency; sweating is contraindicated. Sweating causes chills and inability to recover.
Wiry pulse above indicates Wind injuring Qi. Excess Wind causes Yang movement. Faint pulse below indicates Cold injuring Blood. Injured Blood causes interior Yin Cold. Exterior Qi stagnation creates upper excess; interior Yin Cold creates lower deficiency. Exterior Heat and interior Cold indicate a desire for warmth. Reversed sweating causes Yang loss and Yin dominance, leading to chills and inability to recover.
Severe coughing with frequent salivation, dry throat, difficult urination, hungry vexation, paroxysmal episodes resembling malaria (cold without heat), and deficiency chills. Coughing with sweating causes curling, fullness, and abdominal hardness.
Lung Cold with rebellious Qi causes severe coughing. Salivation causes fluid loss and dry throat. Difficult urination and hungry vexation indicate Diaphragm Yang deficiency. Qi gathers in the Lung daily; pathogen and righteous Qi clash, causing paroxysmal episodes resembling cold malaria. Sweating attacks Yang, increasing Yang deficiency and Yin Cold, leading to curling, fullness, and abdominal hardness.
Jue syndrome with tight pulse is a contraindication for sweating. Sweating causes hoarseness, tongue flaccidity, and inability to speak.
Jue with tight pulse indicates Shaoyin Cold Damage. Treatment should warm the interior; reversed sweating damages Shaoyin Qi. The Shaoyin channel enters the Lung, follows the throat, and binds the tongue base. Kidney is root, Lung is branch. Root deficiency leads to branch weakness, causing hoarseness, tongue flaccidity, and speech difficulty.
Reversal syndromes treated with sweating: mild cases are hard to cure; severe cases with confused speech and dizziness die, life cannot be saved.
Forced sweating in contraindicated cases worsens mild cases and cures them poorly. Severe cases lose Yin and Yang Qi, dying with confused speech and dizziness. The Nan Jing states: "Loss of Yang causes hallucinations (confused speech); loss of Yin causes blindness (dizziness)." Dizziness approaches blindness.
Cough with free urination or urinary incontinence is a contraindication for sweating. Sweating causes cold reversal of the four limbs.
Lung Channel deficiency-cold with upper deficiency failing to control lower causes cough with free urination or incontinence. Sweating in upper deficiency causes external loss of Yang Qi. The four limbs are the root of all Yang. Yang deficiency fails to connect with Yin, causing cold reversal of the four limbs.
Cold Damage headache,翕翕 (warm) fever, resembling wind-stroke, with slight spontaneous sweating and vomiting. Purging increases vexation and mental depression like hunger. Sweating causes stiffness and difficulty bending. Moxibustion causes jaundice and urinary retention. Cauterization causes cough and pus expectoration.
Cold Damage should present with anhidrosis and aversion to cold. Now headache, fever, slight sweating, and vomiting indicate Cold Damage pathogen transforming into Heat entering the interior. Reversed purging allows Heat to enter the chest, causing empty vexation and depression. Sweating makes the deficient exterior vulnerable; Heat enters meridians, generating Wind, causing stiffness and spasms. Moxibustion combines fire, consuming fluids, causing jaundice and urinary retention. Lung dislikes fire; cauterization injures Lung, causing cough and pus expectoration.
Yong Lei Qian Fang states: Four difficulties in sweating for Cold Damage. Fever and headache with sweating (not anhidrosis), aversion to wind (not cold), if sweated generally, causes leakage wind (continuous sweating). Occasionally causes spasms. This is the first difficulty of exterior syndrome sweating. Fever and headache with slow Chi pulse indicate Ying deficiency and Blood scarcity; sweating is contraindicated. Fever and headache with wiry-thin pulse indicate Shaoyang; sweating is contraindicated (causes delirium). This is the second difficulty of pulse-based sweating. Motional Qi on left: sweating causes dizziness, continuous sweating, muscle twitching. Motional Qi on right: sweating causes epistaxis, thirst, vexation, vomiting water. Motional Qi above: sweating causes Qi rushing to heart. Motional Qi below: sweating causes anhidrosis, vexation, bone/joint pain. This is the third difficulty of internal syndrome sweating. Spring favors sweating but not excessive, as Yang Qi is slight. Winter avoids heavy sweating as Yang Qi is hidden; sweating causes vomiting, diarrhea, mouth ulcers. This is the fourth difficulty of seasonal sweating.