麻子仁（一升味甘平） 芍药（半升味酸平） 大黄（一斤去皮味苦寒） 浓朴
（一斤炙去皮味苦寒） 枳实（半斤炙味苦寒） 杏仁（一斤去皮尖熬别作脂甘温）
上六味。为末。炼蜜为丸。桐子大。饮服十丸。日三服。渐加。以和为度。
内经曰。脾欲缓。急食甘以缓之。麻子杏仁之甘。缓脾而润燥。津液不足。以酸收
之。芍药之酸。以敛津液。肠燥胃强。以苦泄之。枳实浓朴大黄之苦。下燥结而泄胃强
也。
太阳病。三日。发汗不解。蒸蒸发热者。属胃也。谓胃承气汤汗之。
蒸蒸者。如热薰蒸。言甚热也。太阳病。三日。发汗不解。则表邪已罢。蒸蒸发热。
胃热为甚。与调胃承气汤下胃热。
伤寒吐后。腹胀满者。与调胃承气汤。
内经曰。诸胀腹大皆属于热。热在上焦则吐。吐后不解。复腹胀满者。邪热入胃也。
与调胃承气汤。下其胃热。
太阳病。若吐。若下。若发汗。微烦。小便数。大便因硬者。与小承气汤和之愈。
吐下发汗。皆损津液。表邪乘虚传里。大烦者。邪在表也。微烦者。邪入里也。小便
数。大便因硬者。其脾为约也。小承气汤和之愈。
得病二三日。脉弱。无太阳柴胡证。烦躁。心下硬。至四五日。虽能食。以小承气
汤。少
少与微和之。令小安。至六日。与承气汤一升。若不大便六七日。小便少者。虽不能食。
但初头硬。后必溏。未定成硬。攻之必溏。须小便利。屎定硬。乃可攻之。宜大承气汤。
针经曰。脉软者病将下。弱为阴脉。当责邪在里。得病二三日。脉弱。是日数虽浅
而邪气已入里也。无太阳证。为表证已罢。无柴胡证。为无半表半里之证。烦躁心下硬
者。邪气内甚也。胃实热甚。则不能食。胃虚热甚。至四五日。虽能食。亦当与小承气
汤微和之。至六日。则热甚。与大承气汤一升。若不大便六七日。小便多者。为津液内
竭。大便必硬。则可下之。小便少者。则胃中水谷不别。必初硬后溏。虽不能食。为胃
实。以小便少。则未定成硬。亦不可攻。须小便利。屎定硬。乃可攻之。
伤寒六七日。目中不了了。睛不和。无表里证。大便难。身微热者。此为实也。急
下之。宜大承气汤。
内经曰。诸脉者。皆属于目。伤寒六七日。邪气入里之时。目中不了了。睛不和者。
邪热内甚。上熏于目也。无表里证。大便难者。里实也。身大热者。表热也。身微热
者。里热也。针经曰。热病目不明。热不已者死。此目中不了了。睛不和。则证近危恶
也。须急与大承气汤下之。
阳明发热。汗多者。急下之。宜大承气汤。
邪热入腑。外发热。汗多者。热迫津液将竭。急与大承气汤。以下其腑热。
发汗不解。腹满痛者。急下之。宜大承气汤。
发汗不解。邪热传入腑。而成腹满痛者。传之迅也。是须急下之。
腹满不减。减不足言。当下之。宜大承气汤。
腹满不减。邪气实也。经曰。大满大实。自可除下之。大承气汤下其满实。若腹满
时减。非内实也。则不可下。金匮要略曰。腹满时减。复如故。此为寒。当与温药。是
减不足言也。
阳明少阳合病。必下利。其脉不负者顺也。负者失也。互相克贼。名为负也。脉滑
而数者。有宿食也。当下之。宜大承气汤。
阳明土。少阳木。二经合病。气不相和。则必下利。少阳脉不胜。阳明不负。是不
相克。为顺也。若少阳脉胜。阳明脉负者。是鬼贼相克。为正气失也。脉经曰。脉滑者。
为病食也。又曰。滑数。则胃气实。下利者。脉当微。厥冷。脉滑数。知胃有宿食。与大
承气汤。以下除之。
病患无表里证。发热七八日。虽脉浮数者。可下之。假令已下。脉数不解。合热则
消谷善饥。至六七日不大便者。有瘀血。宜抵当汤。
七八日。邪入腑之时。病患无表里证。但发热虽脉浮数。亦可与大承气汤下之。浮
为热客于气。数为热客于血。下之邪热去。而浮数之脉俱当解。若下后数脉去。而脉但浮。
则是荣血间热。并于卫气间也。当为邪气独留心中。则饥。邪热不杀谷。潮热发渴之证。
此下之后。浮脉去而数不解。则是卫气间热。合于荣血间也。热气合并迫血下行。胃虚
胁热。消谷善饥。血至下焦。若大便利者。下血乃愈。若六七日不大便。则血不得行。
蓄积于下。为瘀血。与抵当汤。以下去之。
张兼善云。攻下之法。须外无表证。里有下证。然后可攻。上言无表里证。况脉更
浮数。何故言可下之。曰。此非风寒之所病。是由内伤而致然也。若外不恶寒。里无谵语。
但七八日发热。消烁津液。乃阳盛阴虚之时。苟不攻之。其热不已而变生焉。故不待沉
实而攻之。
许叔微云。凡伤寒当下之证。皆从太阳阳明在经之邪而入于腑。故下之。今不言阳
明病。而止云病患无表里证。此非自表之里而病也。但为可下。故编入阳明篇中。
若脉数不解。而下不止。必胁热而便脓血也。
下后脉数不解而不大便者。是热不得泄。蓄血于下。为瘀血也。若下后脉数不解。而
下利不止者。为热得下泄。迫血下行。必便脓血。
伤寒发汗已。身目为黄。所以然者。以寒湿在里不解故也。以为不可下也。于寒湿
中求之。
金匮要略曰。黄家所起。从湿得之。汗出热去。则不能发黄。发汗已。身目为黄者。
风气去。湿气在也。脾恶湿。湿气内着。脾色外夺者。身目为黄。若瘀血在里发黄者。则
可下。此以寒湿在里。故不可下。当从寒湿法治之。
伤寒七八日。身黄如橘子色。小便不利。腹微满者。茵陈蒿汤主之。
当热甚之时。身黄如橘子色。是热毒发泄于外。内经曰。膀胱者。津液藏焉。气化
则能出。小便不利。小腹满者。热气甚于外。而津液不得下行也。与茵陈汤。利小
便。退黄逐热。
王海藏云。熏黄。湿病也。一身尽痛。橘子黄。黄病也。一身不痛。
唐不岩云。熏黄阴黄也。橘子黄阳黄也。
伤寒身黄发热者。栀子柏皮汤主之。
伤寒身黄。胃有瘀热。当须下去之。此以发热为热未实。与栀子柏皮汤解散之。
Hemp Seed Pill (Maziren Wan)
Hemp Seed (Cannabis Fructus, 1 sheng, sweet flavor, neutral nature)
Peony Root (Paeoniae Radix Alba, half sheng, sour flavor, neutral nature)
Rhubarb Rhizome (Rhei Radix et Rhizoma, 1 jin, peeled, bitter flavor, cold nature)
Phellodendron Bark (Phellodendri Cortex, 1 jin, processed with heat and peeled, bitter flavor, cold nature)
Immature Bitter Orange (Aurantii Fructus Immaturus, half jin, processed with heat, bitter flavor, cold nature)
Apricot Seed (Armeniacae Semen, 1 jin, skin and tip removed, fried until oil is released, sweet flavor, warm nature)
The above six herbs. Grind into fine powder. Form pills using refined honey. Size similar to wutong seeds. Take ten pills at a time with water. Administer three times daily. Gradually increase the dose. Stop when bowel movements are harmonized.
The *Neijing* states: The Spleen desires relaxation; urgently consume sweet substances to relax it. The sweetness of Hemp Seed and Apricot Seed relaxes the Spleen and moistens dryness. When body fluids are insufficient, use sour substances to astringe them. The sourness of Peony Root astringes body fluids. For intestinal dryness and stomach excess, use bitter substances to purge. The bitterness of Immature Bitter Orange, Phellodendron Bark, and Rhubarb purges dryness accumulation and drains stomach excess.
Taiyang Disease (Disease of the Taiyang Channel), after three days, remains unresolved after sweating. If there is "zhengzheng" fever (feeling as if heat is steaming from within, indicating intense heat), it belongs to the Stomach. One should administer Tiaowei Chengqi Decoction (Regulating the Stomach and Directing Downward Decoction) to purge the Stomach heat.
"Zhengzheng" implies heat steaming outward, indicating severe heat. In Taiyang Disease, after three days, if sweating fails to resolve the condition, the exterior pathogen has been expelled. The persistent steaming fever indicates excessive Stomach heat. Administer Tiaowei Chengqi Decoction to drain the Stomach heat.
After vomiting in Shanghan (Cold Damage), if abdominal distension and fullness occur, administer Tiaowei Chengqi Decoction.
The *Neijing* states: All cases of abdominal distension and enlargement belong to Heat. Heat in the Upper Jiao causes vomiting. If vomiting fails to resolve the condition and abdominal distension ensues, it indicates pathogenic heat entering the Stomach. Administer Tiaowei Chengqi Decoction to purge the Stomach heat.
In Taiyang Disease, if treated with emesis, purgation, or sweating, resulting in mild irritability, frequent urination, and consequently hard stool, administer Xiaochengqi Decoction (Minor Order the Qi Decoction) to harmonize and cure.
Emesis, purgation, and sweating all damage body fluids. Exterior pathogens enter the interior due to deficiency. Severe irritability indicates the pathogen is still at the exterior; mild irritability indicates the pathogen has entered the interior. Frequent urination leads to hard stool, which is the "Spleen Constraint" syndrome where the Spleen's yin is constrained and cannot distribute fluids for the Stomach. Harmonizing with Xiaochengqi Decoction cures it.
Two to three days after contracting the disease, if the pulse is weak, without Taiyang symptoms or Shaoyang Chaihu Syndrome, but with irritability and hardness below the heart, even if eating is possible by the fourth to fifth day, administer Xiaochengqi Decoction in small amounts frequently to slightly harmonize, allowing slight relief. By the sixth day, administer one sheng of Chengqi Decoction. If no bowel movement for six to seven days, but urine output is low, even if unable to eat, the stool may be hard at the beginning but loose later. This indicates the stool is not definitively hardened; attacking it will cause diarrhea. Only when urine flows freely and stool is confirmed hard should one attack. Da Chengqi Decoction (Major Order the Qi Decoction) is suitable.
The *Zhenjing* states: A soft pulse indicates the pathogen is descending. A weak pulse is a Yin pulse, suggesting the pathogen is in the interior. Two to three days after contracting the disease, a weak pulse indicates that although the duration is short, the pathogen has entered the interior. Absence of Taiyang symptoms means the exterior pattern is resolved. Absence of Chaihu Syndrome means there is no half-exterior/half-interior pattern. Irritability and hardness below the heart indicate severe internal pathogen. Severe Stomach excess-heat prevents eating; Stomach deficiency with severe heat allows eating by the fourth-fifth day, yet requires slight harmonization with Xiaochengqi Decoction. By the sixth day, heat is severe; administer Da Chengqi Decoction. If no bowel movement for six-seven days and urine is copious, body fluids are exhausted internally, stool is hard, and purgation is permissible. Low urine output indicates failure to separate water and grain in the Stomach, leading to hard-then-loose stool. Even if unable to eat due to Stomach excess, low urine output means stool is not definitively hardened, so do not attack. Wait for free urination and confirmed hard stool before attacking.
Six to seven days into Shanghan, if vision is unclear and eyes are unresponsive, without obvious exterior or interior signs, with difficult defecation and slight body heat, this is an Excess syndrome. Urgent purgation is required. Da Chengqi Decoction is suitable.
The *Neijing* states: All vessels connect to the eyes. At six to seven days of Shanghan, when pathogens enter the interior, unclear vision and unresponsive eyes indicate severe internal pathogenic heat steaming upward to the eyes. No exterior/interior signs with difficult defecation indicates interior excess. High body heat indicates exterior heat; slight body heat indicates interior heat. The *Zhenjing* states: Heat disease causing visual impairment, if heat persists, leads to death. Unclear vision and unresponsive eyes indicate critical danger. Urgently administer Da Chengqi Decoction to purge.
Yangming Fever with profuse sweating requires urgent purgation. Da Chengqi Decoction is suitable.
Pathogenic heat enters the Fu organs, causing external fever and profuse sweating, indicating heat forcing body fluids toward exhaustion. Urgently administer Da Chengqi Decoction to purge Fu organ heat.
Unresolved condition after sweating, with abdominal distension and pain, requires urgent purgation. Da Chengqi Decoction is suitable.
Unresolved condition after sweating, with heat transmitting to the Fu organs causing abdominal distension and pain, indicates rapid transmission. Urgent purgation is necessary.
Abdominal distension that does not decrease, or decreases insignificantly, requires purgation. Da Chengqi Decoction is suitable.
Persistent abdominal distension indicates pathogenic excess. The classics state: Major fullness and excess can be purged. Da Chengqi Decoction purges fullness and excess. If abdominal distension decreases intermittently, it is not interior excess, and purgation is contraindicated. The *Jingui Yaolue* states: Abdominal distension that decreases intermittently and returns is Cold; treat with warming herbs. This is what is meant by "decrease is insignificant."
Combined Yangming and Shaoyang disease inevitably causes diarrhea. If the pulse is "not negative" (Shaoyang pulse does not overcome Yangming), it is favorable. "Negative" (Shaoyang overcomes Yangming) is unfavorable, representing mutual overcoming, termed "negative." A slippery and rapid pulse indicates retained food. Purge it. Da Chengqi Decoction is suitable.
Yangming corresponds to Earth, Shaoyang to Wood. Combined disease with disharmonious Qi causes diarrhea. If Shaoyang pulse is defeated and Yangming is not overcome, there is no mutual overcoming, which is favorable. If Shaoyang pulse overcomes Yangming, it is pathological overcoming, representing loss of righteous Qi. The *Maijing* states: Slippery pulse indicates food retention. Slippery-rapid pulse indicates Stomach Qi excess. Diarrhea usually presents with a faint pulse. Here, slippery-rapid pulse with diarrhea indicates retained food in the Stomach. Administer Da Chengqi Decoction to purge and remove it.
Patient with no exterior or interior signs, fever for seven to eight days, even with floating and rapid pulse, can be purged. If already purged and rapid pulse persists, combined heat causes efficient digestion and hunger. By six to seven days without bowel movement, blood stasis exists. Didang Decoction is suitable.
Seven to eight days is when pathogens enter the Fu organs. With no exterior/interior signs, only fever and floating-rapid pulse, Da Chengqi Decoction can be used. Floating indicates heat in the Qi level; rapid indicates heat in the Blood level. After purging, pathogenic heat leaves, and both pulses should resolve. If the rapid pulse disappears but floating remains, heat between Ying and Wei levels persists. Pathogen stays in the Heart, causing hunger, but heat cannot digest food, leading to tidal fever and thirst. If after purging, floating pulse disappears but rapid persists, heat between Wei and Ying levels merges. Merged heat forces blood downward. Stomach deficiency and flank heat cause efficient digestion and hunger. Blood reaches the Lower Jiao; if stool passes freely, bleeding heals it. If no bowel movement for six-seven days, blood stagnates in the Lower Jiao, forming blood stasis. Administer Didang Decoction to purge it.
Zhang Jianshan said: Purgation methods require no exterior signs and presence of interior purgation indications before proceeding. The text mentions no exterior/interior signs and even floating-rapid pulse, yet suggests purgation. Answer: This is not caused by Wind-Cold but by internal injury. Without external aversion to cold or internal delirium, but with seven-eight days of fever consuming fluids, it is a time of Yang excess and Yin deficiency. Without purgation, heat persists and complications arise. Thus, purgation is performed without waiting for deep-solid pulse.
Xu Shuwei said: All Shanghan conditions requiring purgation involve pathogens from Taiyang/Yangming channels entering the Fu organs. Here, Yangming disease is not mentioned, only "no exterior/interior signs," indicating this is not a progression from exterior to interior. It is included in the Yangming chapter because purgation is applicable.
If rapid pulse persists and diarrhea continues, flank heat and pus-blood in stool will occur.
If rapid pulse persists and constipation follows purgation, heat cannot vent, blood stasis forms in the lower part. If rapid pulse persists and diarrhea continues after purgation, heat vents downward, forcing blood down, resulting in pus-blood in stool.
After sweating in Shanghan, if the body and eyes turn yellow, it is because Cold-Dampness remains unresolved in the interior. Purgation is contraindicated. Seek treatment within the Cold-Damp framework.
The *Jingui Yaolue* states: Jaundice originates from Dampness. Sweating removes heat, preventing jaundice. After sweating, if body and eyes turn yellow, Wind pathogen is gone, but Dampness remains. The Spleen dislikes Dampness; internal Dampness causes Spleen color to manifest externally, turning body and eyes yellow. If jaundice is due to blood stasis in the interior, purgation is allowed. Here, Cold-Dampness is in the interior, so purgation is contraindicated. Treat according to Cold-Dampness methods.
Shanghan for seven to eight days, body yellow like orange peel, difficulty in urination, slight abdominal fullness: Yinchen Hao Tang (Artemisiae Scopariae Decoction) governs.
When heat is severe, body yellow like orange peel indicates heat toxin venting outward. The *Neijing* states: The Bladder stores body fluids; Qi transformation allows excretion. Difficulty in urination and lower abdominal fullness indicate heat exceeding externally and body fluids failing to descend. Administer Yinchen Tang to promote urination, reduce jaundice, and drain heat.
Wang Haicang said: Xunhuang (smoke-yellow) is Dampness disease, with whole-body pain. Juzihuang (orange-yellow) is Jaundice disease, without whole-body pain.
Tang Buyan said: Xunhuang is Yin Jaundice. Juzihuang is Yang Jaundice.
Shanghan with body yellow and fever: Zhizi Baipi Tang (Gardeniae and Phellodendri Bark Decoction) governs.
Shanghan with body yellow indicates Stomach blood-heat, requiring purgation. Since fever indicates heat is not fully consolidated, administer Zhizi Baipi Tang to dissipate heat.