（附论）
夫伤寒四日。太阴受病。太阴者。脾之经也。为三阴之首。是故三日以后。阳受病讫。
传之
膈。
沉细
太阴
脉
又问。古人以四日太阴证。病在胸膈。可吐而愈。何也。答曰。有太阴证脉大。胸满多
痰者
在下
方
恒山散（出圣惠方）治伤寒四日。太阴初受病。宜服。吐之。
恒山（三分） 甘草（三分） 鳖甲（三分涂醋炙令黄色去裙 ） 石膏（三分） 柴
胡（三分
去苗）
不计时
和气治中汤（出圣惠方）治太阴初受病。服恒山散吐后。宜服。
人参（半两去芦头） 藿香（半两） 白术（三分） 甘草（二分炙微赤锉） 干姜（一
分炮）
白茯
姜半
分。
麻黄散（出圣惠方）治伤寒四日吐后。或壮热头痛。身体酸疼。口苦心烦。
麻黄（三分去根节） 葛根（三分） 柴胡（一两去苗） 知母（三分） 赤芍药（一
两） 栀子
仁（
散。每服
四
柴胡散（出圣惠方）治伤寒四日。头痛。背膊急痛。心腹壅滞。
柴胡（一两去苗） 川大黄（一两锉碎微炒） 恒山（一两五钱） 茵陈（一两） 知
母（一两）
赤
每服
五
半夏汤（出圣惠方）治伤寒四日。呕吐频发。烦闷头痛。大渴。此证是脾胃
疾。
半夏（三分汤浸七遍去滑） 甘草（半两炙微赤锉） 人参（一两去芦头） 浓朴（二
两去粗
皮涂
不计
大青龙汤（出圣惠方）治伤寒四日。脉浮。头痛。大发热。恶寒。身体疼痛
。无汗而烦者。
麻黄（二两去根节） 桂心（一两） 甘草（一两炙微赤色锉） 石膏（二两） 杏仁
（三十枚
汤浸
滓。
有大
小青龙汤（出圣惠方）治伤寒四日。因下后大渴。服冷药过多。喘急者。
桂心（一两） 五味子（半两） 麻黄（一两去根节） 白芍药（一两） 细辛（三分）
干姜
（三分炮裂锉） 甘草（一两炙微赤锉） 半夏（半两汤洗七遍） 杏仁（三十枚汤浸去皮
尖双仁
麸炒微
温服。
加杏
前胡散（出圣惠方）治伤寒四日。虽经发汗后。心胸不利。头目多疼。胃气
不和。少思饮食
前胡（半两去芦头） 半夏（一两汤浸七次去滑） 甘草（半两炙微赤锉） 桂心（半
两） 人
参（
归（半
两锉
两）
旋复
不计
白术散（出圣惠方）治伤寒四日。腹胁胀满。心胸不利。四肢疼痛。咳嗽喘
息。恶寒壮热。
白术（三分） 前胡（一两去芦头） 葛根（三分锉） 桑根白皮（三分锉） 川升麻
（半两）
赤芍
水一大盏。
入
朴硝散（出圣惠方）治伤寒四日。烦热不解。大小腑涩。
川朴硝（三分） 犀角屑（三分） 栀子仁（半两） 赤芍药（三分） 黄芩（三分） 陈
橘皮
（三分
以水
一中
葛根散（出圣惠方）治伤寒四日。头重身强。腰脊痛。
葛根（一两锉） 甘草（一两炙微赤锉） 桂心（一两） 大青（三分） 黄芩（半两）
石膏
（一两）
生姜半
分。枣
犀角散（出圣惠方）治伤寒四日。烦热不解。大小肠秘涩。
犀角屑（三分） 黄芩（一两） 柴胡（一两去苗） 栀子仁（半两） 地骨皮（三分）
川大黄
（一
煎至
五
茵陈散（出圣惠方）治伤寒四日。头痛。背膊急闷。骨节烦疼。心躁口干。
茵陈（一两） 柴胡（一两去苗） 甘草（半两炙微赤锉） 赤芍药（三分） 防风（三
分去芦
头）
去
滓。不
泻心汤（出圣惠方）治伤寒四日。未经吐者。
川大黄（一两锉碎微炒） 黄连（一两去须） 黄芩（一两） 附子（一两炮裂去皮） 上
为
散。每
三黄散（出圣惠方）治伤寒四日。三阴受病。其脉浮而滑。更腹满。口热舌
干而渴。大便不
黄芩（一两） 栀子仁（一两） 川大黄（一两半锉碎微炒） 上为散。每服四钱。以
水一中
盏。
未利
吐痰散（出圣惠方）治伤寒四日。毒瓦斯入胃。喉中闭闷。
瓜蒂（一分） 丁香（一分） 赤小豆（半合炒熟） 上为细散。每服以温水调下二钱。
空腹
服之
治伤寒汗出不止。已三四日。胸中恶寒。但欲吐。宜吐之方。（出圣惠方）
豉（五合） 盐（半两） 蜜（一合） 上件药。以水二大盏。煎至七分。去滓。空腹
顿热服
之。
又方（出圣惠方）
苦参（半两锉） 甘草（一分生用锉） 赤小豆（三十粒炒熟） 上以水一中盏。煮取
半盏。
去滓
二大
松萝散（出圣惠方）治伤寒四日。寒热不退。头痛。百节烦疼。毒瓦斯在胸中。
松萝（半两） 川升麻（一两） 甘草（一两生用） 恒山（半两） 上为散。每服五
钱。以水
一大
再
治伤寒四日。已呕吐。更宜吐者。（出圣惠方）
上取苦参二钱。研末。以温酒五合。调服之。得吐即瘥。
柴胡散（出圣济总录）治伤寒四日以后。烦热不解。大小肠涩。
柴胡（去苗） 黄芩（去黑心各一两） 犀角（镑） 芍药（各三分） 木通（锉二分）
山栀子
仁（
半。入
竹叶
四味承气汤（出圣济总录）治伤寒四日以后。腹胀满痛。喘粗。壮热。
大黄（细锉醋炒二两） 朴硝（二两） 甘草（三分炙锉） 枳壳（去瓤麸炒三两半） 上
粗捣
筛。
治伤寒四日。心胸中满闷。取吐。（出圣惠方）
上用猪胆一枚。取汁。以醋一小盏。纳猪胆汁相和。温过。分为二服。当以吐为度。
治伤寒四五日。头痛壮热。胸中烦痛。（出圣惠方）
上用苦参五两。乌梅十枚。细锉。以水二升。煎取一升。分服。
小柴胡汤 治伤寒四日五日。身热恶风。颈项强。胁下满。手足温而渴者。
柴胡（半斤） 瓜蒌根（四两内少黄脉者） 桂心（三两） 黄芩 牡蛎 甘草（炙） 干
姜
（各三
服
后。
治伤寒已经四五日。头痛。体痛。内热如火。病入腹胃。宜利泻之。
麦门冬（生者一升去心） 生地黄（一升切） 知母（二两） 生姜（五两半） 芒硝
（二两半）
上
(Attached Discussion)
On the fourth day of Cold Damage (Shanghan), the Taiyin meridian is affected. The Taiyin meridian belongs to the Spleen and is the head of the Three Yin meridians. Therefore, after the third day, when the Yang meridians have completed their transmission of pathogenic factors,
the pathogen transmits to the Diaphragm.
The pulse presents as deep and fine, characteristic of the Taiyin pulse.
Another question: Ancient texts state that on the fourth day, Taiyin syndrome involves the chest and diaphragm, and can be cured by inducing vomiting. Why? Answer: If a patient presents with Taiyin syndrome characterized by a large pulse, chest fullness, and excessive phlegm,
the following formula may be used.
Hengshan San (from *Shenghui Fang*), indicated for Cold Damage on the fourth day when the Taiyin meridian is initially affected. It induces vomiting.
*Hengshan* (3 fen) *Gancao* (3 fen) *Biejia* (3 fen, coated with vinegar and roasted until yellow, remove skirt) *Shigao* (3 fen) *Chaihu* (3 fen, remove seedlings)
Take without time restriction. Heqi Zhizhong Tang (from *Shenghui Fang*), indicated for initial Taiyin disease. It should be taken after inducing vomiting with Hengshan San.
*Renshen* (0.5 liang, remove rhizome) *Huoxiang* (0.5 liang) *Baizhu* (3 fen) *Gancao* (2 fen, roasted slightly red, chopped) *Ganjiang* (1 fen, processed)
*Bailingfu* (0.5 liang, sliced).
Mahuang San (from *Shenghui Fang*), indicated for post-vomiting symptoms on the fourth day of Cold Damage, such as high fever, headache, body ache, bitter taste in the mouth, and irritability.
*Mahuang* (3 fen, remove root and joints) *Gegen* (3 fen) *Chaihu* (1 liang, remove seedlings) *Zhimu* (3 fen) *Chishao* (1 liang) *Zhizi Ren* (appropriate amount)
Grind into powder. Take 4 qian per dose.
Chaihu San (from *Shenghui Fang*), indicated for Cold Damage on the fourth day, presenting with headache, stiffness and pain in the back and shoulders, and stagnation in the heart and abdomen.
*Chaihu* (1 liang, remove seedlings) *Chuan Dahuang* (1 liang, chopped, lightly fried) *Hengshan* (1.5 liang) *Yinchen* (1 liang) *Zhimu* (1 liang)
*Chishao* (appropriate amount)
Take 5 qian per dose.
Banxia Tang (from *Shenghui Fang*), indicated for frequent vomiting, irritability, headache, and extreme thirst on the fourth day of Cold Damage. This syndrome is a disorder of the Spleen and Stomach.
*Banxia* (3 fen, soaked in water seven times to remove slipperiness) *Gancao* (0.5 liang, roasted slightly red, chopped) *Renshen* (1 liang, remove rhizome) *Houpo* (2 liang, remove rough bark, coated with ginger juice and roasted)
Do not restrict the timing.
Da Qinglong Tang (from *Shenghui Fang*), indicated for Cold Damage on the fourth day, presenting with floating pulse, headache, high fever, aversion to cold, body pain, absence of sweating, and irritability.
*Mahuang* (2 liang, remove root and joints) *Guixin* (1 liang) *Gancao* (1 liang, roasted slightly red, chopped) *Shigao* (2 liang) *Xingren* (30 seeds, soaked in water, remove skin and tips)
Decoct and remove dregs.
Xiao Qinglong Tang (from *Shenghui Fang*), indicated for Cold Damage on the fourth day, where excessive thirst follows incorrect purgation, or due to excessive intake of cold medicines, leading to rapid breathing.
*Guixin* (1 liang) *Wuweizi* (0.5 liang) *Mahuang* (1 liang, remove root and joints) *Baishao* (1 liang) *Xixin* (3 fen) *Ganjiang* (3 fen, processed until cracked, chopped) *Gancao* (1 liang, roasted slightly red, chopped) *Banxia* (0.5 liang, washed in water seven times) *Xingren* (30 seeds, soaked in water, remove skin and tips, use double-kernel ones, bran-roasted until slightly yellow)
Take warm. Xingren may be added.
Qianhu San (from *Shenghui Fang*), indicated for Cold Damage on the fourth day, where despite prior sweating, there is chest discomfort, frequent headaches and eye pain, disharmony of Stomach Qi, and poor appetite.
*Qianhu* (0.5 liang, remove rhizome) *Banxia* (1 liang, soaked in water seven times to remove slipperiness) *Gancao* (0.5 liang, roasted slightly red, chopped) *Guixin* (0.5 liang) *Renshen* (appropriate amount) *Danggui* (0.5 liang, chopped)
*Xuanfuhua* (appropriate amount)
Do not restrict the timing.
Baizhu San (from *Shenghui Fang*), indicated for Cold Damage on the fourth day, presenting with abdominal and hypochondriac distension, chest discomfort, limb pain, cough and wheezing, aversion to cold, and high fever.
*Baizhu* (3 fen) *Qianhu* (1 liang, remove rhizome) *Gegen* (3 fen, chopped) *Sangbaipí* (3 fen, chopped) *Chuan Shengma* (0.5 liang) *Chishao* (appropriate amount)
Decoct with one large cup of water.
Puxiao San (from *Shenghui Fang*), indicated for unresolved irritability and heat on the fourth day of Cold Damage, with constipation and difficult urination/defecation.
*Chuan Puxiao* (3 fen) *Xijiao Xie* (3 fen) *Zhizi Ren* (0.5 liang) *Chishao* (3 fen) *Huangqin* (3 fen) *Chenpi* (3 fen)
Decoct with one medium cup of water.
Gegen San (from *Shenghui Fang*), indicated for Cold Damage on the fourth day, presenting with heavy head, stiff body, and lower back/spine pain.
*Gegen* (1 liang, chopped) *Gancao* (1 liang, roasted slightly red, chopped) *Guixin* (1 liang) *Daqing* (3 fen) *Huangqin* (0.5 liang) *Shigao* (1 liang) *Shengjiang* (0.5 liang) *Dazao* (appropriate amount)
Xijiao San (from *Shenghui Fang*), indicated for unresolved irritability and heat on the fourth day of Cold Damage, with constipation and difficult urination/defecation.
*Xijiao Xie* (3 fen) *Huangqin* (1 liang) *Chaihu* (1 liang, remove seedlings) *Zhizi Ren* (0.5 liang) *Digupi* (3 fen) *Chuan Dahuang* (appropriate amount)
Decoct to a specific volume.
Yinchen San (from *Shenghui Fang*), indicated for Cold Damage on the fourth day, presenting with headache, stiffness and oppression in the back and shoulders, painful joints, mental restlessness, and dry mouth.
*Yinchen* (1 liang) *Chaihu* (1 liang, remove seedlings) *Gancao* (0.5 liang, roasted slightly red, chopped) *Chishao* (3 fen) *Fangfeng* (3 fen, remove rhizome)
Remove dregs. Do not restrict the timing.
Xiexin Tang (from *Shenghui Fang*), indicated for Cold Damage on the fourth day in patients who have not undergone emesis.
*Chuan Dahuang* (1 liang, chopped, lightly fried) *Huanglian* (1 liang, remove stamens) *Huangqin* (1 liang) *Fuzi* (1 liang, processed, remove skin) Grind all into powder. Take 3 qian per dose.
Sanhuang San (from *Shenghui Fang*), indicated for Cold Damage on the fourth day affecting the Three Yin meridians, with floating and slippery pulse, abdominal fullness, hot mouth, dry tongue, thirst, and constipation.
*Huangqin* (1 liang) *Zhizi Ren* (1 liang) *Chuan Dahuang* (1.5 liang, chopped, lightly fried) Grind all into powder. Take 4 qian per dose, decocted with one medium cup of water. If no relief, take again.
Tutan San (from *Shenghui Fang*), indicated for Cold Damage on the fourth day where toxic heat enters the Stomach, causing throat obstruction and oppression.
*Gua Di* (1 fen) *Dingxiang* (1 fen) *Chixiaodou* (0.5 he, roasted) Grind all into fine powder. Take 2 qian per dose mixed with warm water, on an empty stomach.
Formula for treating persistent sweating in Cold Damage for three to four days, with cold sensation in the chest and desire to vomit, suitable for inducing vomiting. (From *Shenghui Fang*)
*Douchi* (5 he) *Yan* (0.5 liang) *Mi* (1 he) Decoct these ingredients in two large cups of water until reduced to 70%. Remove dregs and drink hot on an empty stomach in one go.
Another formula (from *Shenghui Fang*)
*Kushen* (0.5 liang, chopped) *Gancao* (1 fen, raw, chopped) *Chixiaodou* (30 grains, roasted) Decoct these in one medium cup of water until half remains. Remove dregs and divide into two doses.
Songluo San (from *Shenghui Fang*), indicated for Cold Damage on the fourth day with unrelenting chills and fever, headache, joint pain, and toxic heat in the chest.
*Songluo* (0.5 liang) *Chuan Shengma* (1 liang) *Gancao* (1 liang, raw) *Hengshan* (0.5 liang) Grind all into powder. Take 5 qian per dose, decocted in one large cup of water.
Formula for inducing vomiting in Cold Damage on the fourth day after previous vomiting. (From *Shenghui Fang*)
Take 2 qian of *Kushen*, grind into powder, mix with 5 he of warm wine, and take. Recovery occurs upon vomiting.
Chaihu San (from *Shengji Zonglu*), indicated for unresolved irritability and heat after the fourth day of Cold Damage, with sluggish bowel and bladder movements.
*Chaihu* (remove seedlings) *Huangqin* (remove black heart, each 1 liang) *Xijiao* (sliced) *Shaoyao* (each 3 fen) *Mutong* (chopped, 2 fen) *Shanzhizi Ren* (appropriate amount) *Zhuye* (appropriate amount)
Take half a cup, add water, and decoct.
Siwei Chengqi Tang (from *Shengji Zonglu*), indicated for abdominal distension and pain, coarse breathing, and high fever after the fourth day of Cold Damage.
*Dahuang* (finely chopped, vinegar-fried, 2 liang) *Puxiao* (2 liang) *Gancao* (3 fen, roasted, chopped) *Zhiqiao* (remove pith, bran-roasted, 3.5 liang) Coarsely crush and sieve all ingredients.
Emetic method for Chest and Heart oppression on the fourth day of Cold Damage. (From *Shenghui Fang*)
Use one pig gallbladder, extract the juice, mix with one small cup of vinegar, warm it, and divide into two doses. Stop when vomiting occurs.
Treatment for headache, high fever, and chest distress/pain on the fourth or fifth day of Cold Damage. (From *Shenghui Fang*)
Use 5 liang of *Kushen* and 10 *Wumei*, finely chopped. Decoct in two sheng of water until one sheng remains. Divide and take.
Xiao Chaihu Tang, indicated for Cold Damage on the fourth or fifth day, presenting with fever, aversion to wind, stiff neck, hypochondriac fullness, warm hands and feet, and thirst.
*Chaihu* (0.5 jin) *Gualou Gen* (4 liang, those with slight yellow veins are preferred) *Guixin* (3 liang) *Huangqin* *Muli* *Gancao* (roasted) *Ganjiang* (each 3 liang)
After taking...
For Cold Damage lasting four to five days, with headache, body pain, internal heat like fire, and pathogen entering the abdomen and Stomach, purgation is appropriate.
*Maimendong* (raw, 1 sheng, remove heart) *Shengdihuang* (1 sheng, sliced) *Zhimu* (2 liang) *Shengjiang* (5.5 liang) *Mangxiao* (2.5 liang)
These ingredients...