（此少阴入腑也。六七日。少阴之邪入腑之时。阳明内热壅甚。腹满。不大便也。阳明
病。
少阴病。脉沉者。急温之。宜四逆汤。
（既吐且利。小便复利。而大汗出。下利清谷。内寒外热。脉微欲绝者。不云急温。此
少阴
有形
少阴病。饮食入口则吐。心中温温。欲吐复不能吐。始得之。手足寒。脉弦迟者。此胸
中实
（伤寒表邪传里。至于少阴。少阴之脉。从肺出络心。注胸中。邪既留于胸中。而不散
者。
是以
温而
则但
少阴病。下利脉微涩。呕而汗出。必数更衣。反少者。当温其上。灸之。
（脉微为亡阳。涩为亡血。下利呕而汗出。亡阳亡血也。津液不足。里有虚寒。必数更
衣。
厥阴之为病。消渴。气上撞心。心中疼热。饥而不欲食。食则吐蛔。下之。利不止。
（邪传厥阴。则热已深也。邪自太阳传至太阴。则腹满而嗌干。未成渴也。邪至少阴者。
口
之
时
吐
厥阴中风。脉微浮。为欲愈。不浮。为未愈。
（经曰。阴病见阳脉而生。浮者。阳也。厥阴中风。脉微浮。为邪气还表。向汗之时。
故云
厥阴病。欲解时。从丑至卯上。
（厥阴。木也。旺于卯丑寅。向旺。故为解时。）
厥阴病。渴欲饮水者。少少与之愈。
（邪至厥阴为传经尽。欲汗之时。渴欲得水者。少少与之。胃气得润。则愈。）
诸四逆厥者。不可下之。虚家亦然。
（四逆者。四肢不温也。厥者。手足冷也。皆阳气少而阴气多。故不可下。虚家亦然。
下之
伤寒先厥。后发热而利者。必自止。见厥复利。
（阴气胜则厥逆而利。阳气复则发热。利必自止。见厥。则阴气还胜而复利也。）
伤寒始发热六日。厥反九日。而利。凡厥利者。当不能食。今反能食者。恐为除中。食
以索
之旦
厥相
（始发热。邪在表也。至六日邪传厥阴。阴气胜者。作厥而利。厥反九日。阴寒气多。
当不
饮食
胃气
不能
若
疮。
伤寒脉迟。六七日而反与黄芩汤。彻其热。脉迟为寒。今与黄芩汤。复除其热。腹中应
冷。
（伤寒脉迟。六七日为寒气已深。反与黄芩汤寒药。两寒相搏。腹中当冷。冷不消谷。
则不
伤寒先厥后发热。下利必自止。而反汗出。咽中痛者。其喉为痹。发热无汗。而利必自
止。
（伤寒先厥而利。阴寒气胜也。寒极变热。后发热。下利必自止。而反汗出。咽中痛。
其喉
气下
伤寒一二日。至四五日而厥者。必发热。前热者。后必厥。厥深者。热亦深。厥微者。
热亦
（前厥后发热者。寒极生热也。前热后厥者。阳气内陷也。厥深热深。厥微热微。随阳
气陷
内发
伤寒病。厥五日。热亦五日。设六日当复厥。不厥者。自愈。厥终不过五日。以热五日。
故
（阴胜则厥。阳胜则热。先厥五日。为阴胜。至六日。阳复胜。热亦五日。后复厥者。
阴复
其病
凡厥者。阴阳气不相顺接。便为厥。厥者。手足逆冷是也。
（手之三阴三阳。相接于手十指。足之三阴三阳。相接于足十指。阳气内陷。阳不与阴
相顺
伤寒脉微而厥。至七八日肤冷。其人躁。无暂安时者。此为脏厥。非为蛔厥也。蛔厥者。
其
烦
（脏厥者。死。阳气绝也。蛔厥。虽厥而烦。吐蛔已则静。不若脏厥而躁无暂安时也。
病
乌梅丸方
乌梅（三百个味酸温） 细辛（六两辛热） 干姜（十两辛热） 黄连（一斤苦寒） 当
归（四
两辛
甘温）
黄柏（
（肺主气。肺欲收。急食酸以收之。乌梅之酸。以收阳气。脾欲缓。急食甘以缓之。人
参之
寒淫
以安
捣成
服。
伤寒热少厥微。指头寒。默默不欲食。烦躁。数日小便利色白者。此热除也。欲得食。
其病
（指头寒者。是厥微热少也。默默不欲食。烦躁者。邪热初传里也。数日之后。小便色
白。
胁烦
必致
病者。手足厥冷。言我不结胸。小腹满。按之痛者。此冷结在膀胱关元也。
（手足厥。不结胸者。无热也。小腹满。按之痛。下焦冷结也。）
伤寒发热四日。厥反三日。复热四日。厥少热多。其病当愈。四日至七日。热不除者。
其后
（先热后厥者。阳气邪传里也。发热为邪气在表。至四日后厥者。传之阴也。后三日。
复传
除者
伤寒厥四日。热反三日。复厥五日。其病为进。寒多热少。阳气退。故为进也。
（伤寒阴胜者先厥。至四日邪传里。重阴必阳却热三日。七日传经尽。当愈。若不愈。
而复
也。
伤寒六七日。脉微。手足厥冷。烦躁。灸厥阴。厥不还者。死。
（伤寒六七日。则正气当复。邪气当罢。脉浮身热为欲解。若反脉微而厥。则阴胜阳也。
烦
伤寒发热下利。厥逆。躁不得卧者。死。
（伤寒发热。邪在表也。下利厥逆。阳气虚也。躁不得卧者。病胜藏也。故死。）
伤寒发热。下利至甚。厥不止者。死。
（金匮要略曰。六腑气绝于外者。手足寒。五脏气绝于内者。利下不禁。伤寒发热。为
邪气
伤寒六七日不利。便发热而利。其人汗出不止者。死。有阴无阳故也。
（伤寒至七日。为邪正争之时。正胜则生。邪胜则死。始不下利。而暴忽发热下利。汗
出不
伤寒五六日。不结胸。腹濡。脉虚。复厥者。不可下。此为亡血。下之死。
（伤寒五六日。邪气当作。里热之时。若不结胸。而腹濡者。里无热也。脉虚者。亡血
也。
发热而厥。七日下利者。为难治。
（发热而厥。邪传里也。至七日传经尽。则正气胜邪。当汗出而解。反下利。则邪气胜。
里
伤寒脉促。手足厥逆者。可灸之。
（脉促。则为阳虚不相续。厥逆。则为阳虚不相接。灸之以助阳气。）
伤寒脉滑而厥者。里有热也。白虎汤主之。
（滑为阳厥。气内陷。是里热也。与白虎汤。以散里热也。）
手足厥寒。脉细欲绝者。当归四逆汤主之。
（手足厥寒者。阳气外虚。不温四末。脉细欲绝者。阴血内弱。脉行不利。与当归四逆
汤。
当归四逆汤方
当归（三两辛温） 桂枝（三两辛热） 芍药（三两酸寒） 细辛（三两辛热） 大枣
（二十五
个甘
（内经曰。脉者。血之府也。诸血者。皆属心。通脉者。必先补心益血。苦先入于心。
当归
七
若其人内有久寒者。宜当归四逆加吴茱萸生姜汤主之。
（茱萸辛温。以散久寒。生姜辛温。以行阳气。）
大汗出。热不去。内拘急。四肢疼。又下利。厥逆而恶寒者。四逆汤主之。
（大汗出。则热当去。热反不去者。亡阳也。内拘急下利者。寒甚于里。四肢疼。厥逆
而恶
大汗。若大下利而厥冷者。四逆汤主之。
（大汗。若大下利。内外虽殊。其亡津液。损阳气。则一也。阳虚阴胜。故生厥逆。与
四逆
病患手足厥冷。脉乍紧者。邪结在胸中。心中满而烦。饥不能食者。病在胸中。当须吐
之。
（手足厥冷者。邪气内陷也。脉紧牢者。为实。邪气入腑。则脉沉。今脉乍紧。知邪结
在胸
以吐
伤寒厥而心下悸者。宜先治水。当服茯苓甘草汤。却治其厥。不尔。水渍入胃。必作利
也。
（金匮要略曰。水停心下。甚者则悸。厥虽寒胜。然以心下悸。为水饮内甚。先与茯苓
甘草
伤寒六七日。大下后。寸脉沉而迟。手足厥逆。下部脉不至。咽喉不利。唾脓血。泄利
不止
（伤寒六七日。邪传厥阴之时。大下之后。下焦气虚。阳气内陷。寸脉迟。而手足厥逆。
下
咽喉不利
之。若泄
麻黄升麻汤方
麻黄（二两半去节甘温） 升麻（一两一分甘平） 当归（一两一分辛温） 知母（苦
寒） 黄
芩（
药（酸
平）
（玉函曰。大热之气。寒以取之。甚热之气。以汗发之。麻黄、升麻之甘。以发浮热。
正气
心去
芍
先
汗出愈。
伤寒四五日。腹中痛。若转气下趋少腹者。此欲自利也。
（伤寒四五日。邪气传里之时。腹中痛。转气下趋少腹者。里虚遇寒。寒气下行。欲作
自利
伤寒本自寒下。医复吐下之。寒格更逆吐下。若食入口即吐。干姜黄连黄芩人参汤主之。
（伤寒邪自传表。为本自寒下。医反吐下。损伤正气。寒气内为格拒。经曰。格则吐逆。
食
通
干姜黄连黄芩人参汤方
干姜（辛热） 黄连（苦寒） 黄芩（苦寒） 人参（甘温各三两）
（辛以散之。甘以缓之。干姜、人参之甘辛。以补正气。苦以泄之。黄连、黄芩之苦。
以通
下利有微热而渴。脉弱者。今自愈。
（下利。阴寒之疾。反大热者。逆。有微热而渴。里气方温也。经曰。诸弱发热。脉弱
者。
下利脉数。有微热汗出。今自愈。设复紧。为未解。
（下利。阴病也。脉数。阳脉也。阴病见阳脉者生。微热汗出。阳气得通也。利必自愈。
诸
下利手足厥逆。无脉者。灸之不温。若脉不还。反微喘者。死。
（下利手足厥逆。无脉者。阴气独胜。阳气大虚也。灸之阳气复。手足温而脉还。为欲
愈。
少阴负趺阳者。为顺也。
（少阴肾水。趺阳脾土。下利为肾邪干脾。水不胜土。则为微邪。故为顺也。）
下利寸脉反浮数。尺中自涩者。必清脓血。
（下利者。脉当沉而迟。反浮数者。里有热也。涩为无血。尺中自涩者。肠胃血散也。
随利
下利清谷。不可攻表。汗出必胀满。
（下利者。脾胃虚也。胃为津液之主。发汗亡津液。则胃气愈虚。必胀满。）
下利脉沉弦者。下重也。脉大者。为未止。脉微弱数者。为欲自止。虽发热。不死。
（沉为在里。弦为拘急。里气不足。是主下重。大则病进。此利未止。脉微弱数者。邪
气微
下利脉沉而迟。其人面少赤。身有微热。下利清谷者。必郁冒。汗出而解。病患必微厥。
所
（下利清谷。脉沉而迟。里有寒也。面少赤。身有微热。表未解也。病患微厥。针经曰。
下
下利脉数而渴者。今自愈。设不瘥。必清脓血。以有热故也。
（经曰。脉数不解。而下不止。必协热便脓血也。）
下利后。脉绝。手足厥冷。 时脉还。手足温者。生。脉不还者。死。
（下利后。脉绝。手足厥冷者。无阳也。 时。周时也。周时厥愈。脉出为阳气复。则
得生
伤寒下利。日十余行。脉反实者。死。
（下利者。里虚也。脉当微弱。反实者。病胜脏也。故死。难经曰。脉不应病。病不应
脉。
下利清谷。里寒外热。汗出而厥者。通脉四逆汤主之。
（下利清谷。为里寒。身热不解。为外热汗出阳气通行于外。则未当厥。其汗出而厥者。
属
热利下重者。白头翁汤主之。
（利则津液少。热则伤气。气虚下利。致后重也。与白头翁汤。散热浓肠。）
白头翁汤方
白头翁（二两苦寒） 黄连（苦寒） 黄柏（苦寒） 秦皮（苦寒各三两）
（内经曰。肾欲坚。急食苦以坚之。利则下焦虚。是以纯苦之剂坚之。） 上四味。以
水七
下利腹胀满。身体疼痛者。先温其里。乃攻其表。温里四逆汤。攻表桂枝汤。
（下利腹满者。里有虚寒。先与四逆汤温里。身疼痛。为表未解。利止里和。与桂枝汤
攻表
下利欲饮水者。以有热故也。白头翁汤主之。
（自利不渴。为脏寒。与四逆汤以温脏。下利饮水。为有热。与白头翁汤以凉中。）
下利谵语者。有燥屎也。宜小承气汤。
（经曰。实则谵语。有燥屎。为胃实。下利为肠虚。与小承气汤。以下燥屎。）
下利后更烦。按之心下濡者。为虚烦也。宜栀子豉汤。
（下利后不烦为欲解。若更烦而心下坚者。恐为谷烦。此烦而心下濡者。是邪热乘虚。
客于
呕家有痈脓者。不可治呕。脓尽。自愈。
（胃脘有痈。则呕而吐脓。不可治呕。得脓尽。呕亦自愈。）
呕而脉弱。小便复利。身有微热。见厥者。难治。四逆汤主之。
（呕而脉弱。为邪气传里。呕则气上逆。而小盒饭不利。小便复利者。里虚也。身有微
热。
干呕吐涎沫。头痛者。吴茱萸汤主之。
（干呕吐涎沫者。里寒也。头痛者。寒气上攻也。与吴茱萸汤。温里散寒。）
呕而发热者。小柴胡汤主之。
（经曰。呕而发热者。柴胡证具。）
伤寒大吐大下之。极虚。复极汗出者。以其人外气怫郁。复与之水。以发其汗。因得哕。
所
（大吐大下。胃气极虚。复极发汗。又亡阳气。外邪怫郁于表。则身热。医与之水。以
发其
伤寒哕而腹满。视其前后。知何部不利。利之则愈。
（哕而腹满。气上而不下也。视其前后部有不利者。即利之。以降其气。前部。小便也。
后
This is the syndrome of Shaoyin disease transmitting to the Fu organs. After six or seven days, it is the time when Shaoyin pathogenic factors transmit to the Fu organs; Yangming internal heat is severely congested, presenting with abdominal fullness and constipation.
If Yangming disease and Shaoyin disease coexist, and the pulse is deep (Chen), urgent warming is required. Si Ni Tang (Four Reversals Decoction) is indicated.
If there is simultaneous vomiting and diarrhea, urination becomes frequent, profuse sweating occurs, diarrhea passes undigested food, there is internal cold with external heat, and the pulse is faint and nearly imperceptible (Wei Yu Jue), urgent warming is not mentioned here because there are tangible pathogenic factors lingering in Shaoyin.
In Shaoyin disease, if food is vomited immediately upon entering the mouth, the person feels a sense of discomfort and oppression in the heart region, desires to vomit but cannot, and at the onset has cold hands and feet with a string-tight (Xian) and slow (Chi) pulse, this indicates excess pathogenic factors in the chest.
(Exterior pathogenic factors from Shanghan transmit inward to the Shaoyin meridian. The Shaoyin meridian originates from the Lung, connects with the Heart, and pours into the chest. Once pathogenic factors remain in the chest without dispersing...)
In Shaoyin disease, if there is diarrhea with a faint (Wei) and choppy (Se) pulse, vomiting with sweating, frequent defecation yet small volume each time, the upper part should be warmed with moxibustion.
(A faint pulse indicates loss of Yang Qi; a choppy pulse indicates loss of Blood. Diarrhea, vomiting, and sweating indicate loss of both Yang Qi and Yin Blood. Fluids are insufficient, and there is deficiency-cold in the interior, leading to frequent trips to the toilet.)
The manifestations of Jueyin disease include excessive thirst, sensation of Qi rushing up to strike the heart, pain and burning heat in the heart region, hunger without desire to eat, and vomiting roundworms if food is ingested. If purgatives are used, diarrhea will persist uncontrollably.
(When pathogenic factors transmit to Jueyin, the heat has already penetrated deeply. When transmitting from Taiyang to Taiyin, abdominal fullness and dry throat occur, but thirst has not yet formed. When reaching Shaoyin...)
In Jueyin wind-stroke, a slightly floating (Fu) pulse indicates impending recovery; absence of floating indicates non-recovery.
(The classics state: Yin diseases showing Yang pulses lead to survival. Floating is Yang. In Jueyin wind-stroke, a slightly floating pulse indicates pathogenic factors returning to the exterior, approaching the time for sweating.)
Jueyin disease tends to resolve between Chou (01:00–03:00) and Mao (05:00–07:00).
(Jueyin corresponds to Wood, which prospers in Chou, Yin, and Mao hours. Approaching prosperity, these are the times of resolution.)
In Jueyin disease, if the patient desires water, giving small amounts frequently will lead to recovery.
(When pathogenic factors reach Jueyin, the transmission of meridians is complete, approaching the time for sweating. Thirst indicates need for fluids; providing them in small amounts moistens Stomach Qi, leading to recovery.)
For all cases of Si Ni (Four Reversals/Jue), purgation is contraindicated; this also applies to patients with deficiency constitutions.
(Si Ni refers to limbs that are not warm. Jue refers to cold hands and feet. Both indicate scanty Yang Qi and abundant Yin Qi, hence purgation is forbidden. This applies equally to deficient patients. Purgation...)
In Shanghan, if initial Jue (cold extremities) is followed by fever and diarrhea, the diarrhea will stop spontaneously. If Jue returns, diarrhea recurs.
(Excess Yin leads to Jue and diarrhea; restoration of Yang leads to fever, and diarrhea stops. Appearance of Jue indicates Yin regain dominance, causing recurrence of diarrhea.)
Shanghan begins with fever for six days, but Jue lasts nine days, accompanied by diarrhea. Generally, those with Jue and diarrhea cannot eat. If they can eat now, it may be "Chu Zhong" (removal of middle Qi). Testing with food... morning... characteristics of Jue...
(Initial fever indicates pathogen in the exterior. By day six, pathogen transmits to Jueyin. Excess Yin causes Jue and diarrhea. Nine days of Jue indicates abundant Yin-cold Qi, implying inability to eat... diet... Stomach Qi... inability... if... sores.)
In Shanghan with a slow (Chi) pulse, if Huang Qin Tang is administered on days six or seven to clear heat, this is erroneous. A slow pulse indicates cold. Administering the cold-natured Huang Qin Tang again introduces double cold, likely causing abdominal coldness.
(With a slow pulse on days six or seven, cold pathogen is deep. Administering cold herbs like Huang Qin Tang creates conflict of colds, leading to abdominal cold. Cold prevents digestion of grains, thus...)
In Shanghan, initial Jue followed by fever usually stops diarrhea. However, if sweating and sore throat occur, bi-syndrome of the throat develops. Fever without sweating and self-resolving diarrhea...
(Initial Jue with diarrhea indicates excess Yin-cold. Extreme cold transforms into heat; subsequent fever stops diarrhea. However, concurrent sweating and sore throat indicate throat bi-Qi descends...)
In Shanghan, Jue appearing from day one or two to four or five implies subsequent fever. Previous fever followed by Jue indicates deepening Jue correlates with deeper heat; mild Jue correlates with mild heat.
(Jue then fever indicates extreme cold generating heat. Fever then Jue indicates internal sinking of Yang Qi. Deep Jue means deep heat; mild Jue means mild heat, following Yang Qi sinking... internal emission...)
In Shanghan disease, if Jue lasts five days and fever lasts five days, assuming Jue returns on day six, its absence indicates spontaneous recovery. Jue does not exceed five days as fever compensates for five days, thus...
(Yin excess causes Jue; Yang excess causes fever. Five days of Jue indicates Yin excess. On day six, Yang recovers and dominates, causing five days of fever. Subsequent Jue indicates Yin recurrence... its disease...)
Generally, Jue results from failure of Yin and Yang Qi to connect smoothly. Jue manifests as inverted coldness of hands and feet.
(Hand Three Yin and Yang meridians connect at the ten fingers. Foot Three Yin and Yang meridians connect at the ten toes. Internal sinking of Yang Qi prevents smooth connection with Yin...)
In Shanghan, if the pulse is faint with Jue, progressing to cold skin by days seven or eight, and the patient is restless with no moment of peace, this is Zang Jue (Viscera Jue), not Wei Jue (Roundworm Jue). Wei Jue presents with... irritability...
(Zang Jue is fatal due to exhaustion of Yang Qi. Wei Jue involves Jue with irritability, but calmness returns after vomiting roundworms, unlike Zang Jue's constant restlessness. Disease...)
Wu Mei Wan Formula
Wu Mei (300 fruits, sour, warm) Xi Xin (6 liang, acrid, hot) Gan Jiang (10 liang, acrid, hot) Huang Lian (1 jin, bitter, cold) Dang Gui (4 liang, acrid, sweet, warm)
Huang Bo (...)
(The Lung governs Qi and prefers astringency; sour flavors astringe. Wu Mei's sourness astringes Yang Qi. The Spleen prefers relaxation; sweet flavors relax. Ren Shen's... cold invasion... to calm... pounded into... taken.)
In Shanghan with slight heat and mild Jue (cold fingertips), silence, anorexia, and irritability, if urine becomes clear and copious after several days, heat is eliminated. Desire for food indicates recovery.
(Cold fingertips indicate mild Jue and slight heat. Silence, anorexia, and irritability indicate initial transmission of pathogenic heat to the interior. Days later, clear urine... hypochondriac irritability... inevitably leads...)
Patients with cold hands and feet, stating no chest binding, lower abdominal fullness, and tenderness on pressure have cold binding at the Bladder Guanyuan point.
(Cold extremities without chest binding indicate absence of heat. Lower abdominal fullness and tenderness indicate lower Jiao cold binding.)
In Shanghan, fever for four days, Jue for three days, then fever for four days. Less Jue and more heat suggests recovery. If heat persists from day four to seven, subsequent...
(Fever then Jue indicates Yang pathogen transmitting inward. Fever indicates exterior pathogen. Jue after four days indicates transmission to Yin meridians. Subsequent three days, re-transmission... removal...)
In Shanghan, Jue for four days, fever for three days, then Jue for five days indicates disease progression. More cold than heat indicates retreat of Yang Qi, hence progression.
(Yin excess causes initial Jue. By day four, pathogen transmits inward; heavy Yin must transform to Yang, causing three days of heat. Seven days completes meridian transmission, expecting recovery. If not recovered, recurring... also.)
In Shanghan on days six or seven, with faint pulse, cold hands and feet, and irritability, moxa is applied to Jueyin. If Jue does not reverse, death ensues.
(By days six or seven, healthy Qi should recover, pathogen should cease. Floating pulse and body heat indicate resolution. Conversely, faint pulse and Jue indicate Yin excess over Yang. Irritability...)
In Shanghan with fever, diarrhea, Jue, and restlessness preventing lying down, death occurs.
(Fever indicates exterior pathogen. Diarrhea and Jue indicate Yang deficiency. Restlessness indicates disease overcoming organ Qi, hence death.)
In Shanghan with fever, severe diarrhea, and unceasing Jue, death occurs.
(The Golden Cabinet states: Six Fu Qi exhaustion externally causes cold hands/feet; Five Zang Qi exhaustion internally causes uncontrolled diarrhea. Fever in Shanghan indicates pathogen...)
In Shanghan on days six or seven, without prior diarrhea, sudden fever with diarrhea and incessant sweating indicates death due to presence of Yin without Yang.
(By day seven, pathogen and healthy Qi contend. Healthy Qi victory brings life; pathogen victory brings death. Initial lack of diarrhea followed by sudden fever, diarrhea, and sweat...)
In Shanghan on days five or six, without chest binding, soft abdomen, deficient pulse, and Jue, purgation is contraindicated. This indicates blood loss; purgation causes death.
(By days five or six, pathogen acts... interior heat time. Absence of chest binding and soft abdomen indicate no interior heat. Deficient pulse indicates blood loss...)
Fever with Jue, followed by diarrhea on day seven, is difficult to treat.
(Fever with Jue indicates pathogen transmitting inward. By day seven, meridian transmission completes, healthy Qi should overcome pathogen, resolving via sweating. Recurrent diarrhea indicates pathogen victory, interior...)
In Shanghan, rapid (Cu) pulse with cold extremities can be treated with moxibustion.
(Rapid pulse indicates discontinuous Yang deficiency. Jue indicates disconnected Yang deficiency. Moxibustion assists Yang Qi.)
In Shanghan, slippery (Hua) pulse with Jue indicates interior heat; Bai Hu Tang (White Tiger Decoction) is indicated.
(Slippery pulse indicates Yang Jue, internal sinking of Qi, signifying interior heat. Bai Hu Tang disperses interior heat.)
Cold hands and feet with fine (Xi) pulse nearing imperceptibility are treated with Dang Gui Si Ni Tang (Angelica Four Reversals Decoction).
(Cold extremities indicate exterior deficiency of Yang Qi failing to warm the extremities. Fine pulse nearing imperceptibility indicates interior weakness of Yin Blood obstructing pulse flow. Dang Gui Si Ni Tang...)
Dang Gui Si Ni Tang Formula
Dang Gui (3 liang, acrid, warm) Gui Zhi (3 liang, acrid, hot) Shao Yao (3 liang, sour, cold) Xi Xin (3 liang, acrid, hot) Da Zao (25 fruits, sweet...)
(The Inner Canon states: Pulse is the mansion of Blood. All blood belongs to the Heart. To unblock pulses, one must first tonify Heart and nourish Blood. Bitter enters Heart first. Dang Gui... seven...)
If the patient has chronic cold within, Dang Gui Si Ni Tang plus Wu Zhu Yu and Sheng Jiang (Angelica Four Reversals Decoction plus Evodia and Fresh Ginger) is indicated.
(Wu Zhu Yu is acrid and warm to dispel chronic cold. Sheng Jiang is acrid and warm to circulate Yang Qi.)
Profuse sweating with persistent fever, internal tension, limb pain, diarrhea, Jue, and aversion to cold are treated with Si Ni Tang.
(Profuse sweating should reduce fever. Persistent fever indicates Yang loss. Internal tension and diarrhea indicate severe interior cold. Limb pain, Jue, and aversion to cold...)
Profuse sweating or severe diarrhea with cold extremities are treated with Si Ni Tang.
(Profuse sweating or severe diarrhea differ externally but similarly cause fluid loss and Yang damage. Yang deficiency and Yin excess cause Jue; Si Ni Tang is given...)
Patients with cold extremities and suddenly tight (Jin) pulse have pathogen binding in the chest, presenting with chest fullness, irritability, hunger without ability to eat. Pathogen is in the chest; emesis is required.
(Cold extremities indicate internal sinking of pathogen. Tight pulse indicates excess. Pathogen entering Fu organs causes deep pulse. Sudden tight pulse indicates pathogen binding in the chest... via emesis...)
In Shanghan, Jue with palpitations below the heart requires treating water retention first with Fu Ling Gan Cao Tang (Poria and Licorice Decoction), then treating Jue. Otherwise, water infiltrating the Stomach causes diarrhea.
(The Golden Cabinet states: Water stagnating below the heart causes palpitations. Although Jue is caused by cold excess, palpitations indicate severe internal fluid retention. Fu Ling Gan Cao Tang is given first...)
On days six or seven of Shanghan, after severe purgation, Cun (inch) pulse is deep and slow, extremities are cold, lower pulses are absent, throat is obstructed, expectoration of pus and blood occurs, and diarrhea is unceasing...
(Days six or seven of Shanghan mark transmission to Jueyin. Severe purgation depletes lower Jiao Qi and sinks Yang Qi. Slow Cun pulse and cold extremities. Lower... throat obstruction... of. If diarrhea...)
Ma Huang Sheng Ma Tang Formula
Ma Huang (2.5 liang, removed nodes, sweet, warm) Sheng Ma (1.1 liang, sweet, flat) Dang Gui (1.1 liang, acrid, warm) Zhi Mu (bitter, cold) Huang Qin (...)
Wei Yu (... herb, sour, flat)
(The Yu Han states: Great heat is taken by cold. Intense heat is released by sweating. Sweetness of Ma Huang and Sheng Ma disperses floating heat. Healthy Qi... heart departure... Shao... first... sweating resolves.)
On days four or five of Shanghan, abdominal pain with gas moving downward to the lower abdomen indicates impending spontaneous diarrhea.
(Days four or five mark pathogen transmission to the interior. Abdominal pain and gas moving downward indicate interior deficiency meeting cold, cold Qi descending, impending diarrhea...)
If Shanghan originally involved cold-type diarrhea, and the physician erroneously used vomiting or purgation, cold rejection worsens vomiting and diarrhea. If food is vomited immediately upon ingestion, Gan Jiang Huang Lian Huang Qin Ren Shen Tang (Dry Ginger, Coptis, Scutellaria, and Ginseng Decoction) is indicated.
(Shanghan pathogen transmits from exterior; originally cold diarrhea. Physician's erroneous vomiting/purgation damages healthy Qi. Cold rejects internally. Classics state: Rejection causes vomiting and reversal. Food... through...)
Gan Jiang Huang Lian Huang Qin Ren Shen Tang Formula
Gan Jiang (acrid, hot) Huang Lian (bitter, cold) Huang Qin (bitter, cold) Ren Shen (sweet, warm, 3 liang each)
(Acrid disperses, sweet moderates. Sweet-acrid nature of Gan Jiang and Ren Shen tonifies healthy Qi. Bitter drains. Bitter nature of Huang Lian and Huang Qin promotes...)
Diarrhea with slight fever and thirst, weak pulse, indicates spontaneous recovery.
(Diarrhea is a Yin-cold disease. Excessive heat is adverse. Slight fever and thirst indicate warming of interior Qi. Classics state: Weak pulse with fever indicates...)
Diarrhea with rapid (Shuo) pulse, slight fever, and sweating indicates spontaneous recovery. If pulse becomes tight again, unresolved.
(Diarrhea is Yin disease. Rapid pulse is Yang pulse. Yin disease showing Yang pulse indicates survival. Slight fever and sweating indicate通畅 of Yang Qi. Diarrhea self-resolves. All...)
Diarrhea with cold extremities and absent pulse, unresponsive to moxibustion, with slight wheezing, indicates death.
(Diarrhea with cold extremities and absent pulse indicates sole dominance of Yin and severe Yang deficiency. Moxibustion restores Yang, warming limbs and returning pulse indicates recovery. ...)
Shaoyin pulse weaker than Fuyang pulse is favorable.
(Shaoyin represents Kidney Water; Fuyang represents Spleen Earth. Diarrhea indicates Kidney pathogen interfering with Spleen. Water failing to control Earth is minor evil, hence favorable.)
Diarrhea with floating-rapid Cun pulse and choppy Chi pulse indicates passage of pus and blood.
(Diarrhea pulse should be deep-slow. Floating-rapid indicates interior heat. Choppy indicates lack of blood. Choppy Chi pulse indicates scattering of intestinal blood. Following diarrhea...)
Diarrhea passing undigested food contraindicates exterior attack. Sweating causes abdominal fullness.
(Diarrhea indicates Spleen-Stomach deficiency. Stomach is master of fluids. Sweating loses fluids, worsening Stomach Qi deficiency, causing fullness.)
Diarrhea with deep-stringy pulse indicates heaviness in defecation (tenesmus). Large pulse indicates unceasing disease. Weak-rapid pulse indicates impending cessation. Even with fever, death is avoided.
(Deep indicates interior; stringy indicates tension. Interior Qi deficiency causes tenesmus. Large indicates disease progression, unceasing diarrhea. Weak-rapid indicates minor pathogen...)
Diarrhea with deep-slow pulse, flushed face, slight body heat, and passing undigested food indicates dizziness (Yu Mao), resolving with sweating. Patient has slight Jue. The Needle Classic states...
(Passing undigested food with deep-slow pulse indicates interior cold. Flushed face and slight heat indicate unresolved exterior. Slight Jue, Needle Classic states...)
Diarrhea with rapid pulse and thirst indicates spontaneous recovery. If unresolved, pus and blood passage occurs due to heat.
(Classics state: Unresolved rapid pulse with persistent diarrhea leads to heat-collateral pus and blood stool.)
After diarrhea, if pulse vanishes and extremities are cold, but pulse returns and extremities warm after one cycle (Zhou Shi), survival is expected. If pulse does not return, death occurs.
(Post-diarrhea pulse absence and cold extremities indicate Yang absence. Zhou Shi means one cycle. Resolution of Jue and emergence of pulse after one cycle indicates Yang recovery, ensuring survival...)
Shanghan diarrhea occurring ten-plus times daily with strong (Shi) pulse indicates death.
(Diarrhea indicates interior deficiency. Pulse should be weak. Strong pulse indicates disease overcoming organ Qi, hence death. Nan Jing states: Pulse mismatching disease, disease mismatching pulse...)
Diarrhea passing undigested food, interior cold with exterior heat, sweating, and Jue are treated with Tong Mai Si Ni Tang (Unblocking Pulse Four Reversals Decoction).
(Passing undigested food indicates interior cold. Unresolved body heat indicates exterior heat. Sweating allows Yang Qi to circulate outward, preventing Jue. Sweating with Jue indicates belonging...)
Heat-type diarrhea with tenesmus is treated with Bai Tou Weng Tang (Pulsatilla Decoction).
(Diarrhea reduces fluids; heat damages Qi. Qi deficiency in diarrhea causes tenesmus. Bai Tou Weng Tang clears heat and consolidates intestines.)
Bai Tou Weng Tang Formula
Bai Tou Weng (2 liang, bitter, cold) Huang Lian (bitter, cold) Huang Bo (bitter, cold) Qin Pi (bitter, cold, 3 liang each)
(The Inner Canon states: Kidney prefers firmness; bitter flavors firm it. Diarrhea causes lower Jiao deficiency, hence pure bitter agents firm it. Upper four ingredients, boiled in seven parts water...)
Diarrhea with abdominal fullness and body pain requires warming the interior first, then attacking the exterior. Warm interior with Si Ni Tang; attack exterior with Gui Zhi Tang (Cinnamon Twig Decoction).
(Abdominal fullness in diarrhea indicates interior deficiency-cold. Si Ni Tang warms interior first. Body pain indicates unresolved exterior. After diarrhea stops and interior harmonizes, Gui Zhi Tang attacks exterior...)
Diarrhea with desire to drink water indicates heat; Bai Tou Weng Tang is indicated.
(Self-diarrhea without thirst indicates Zang cold; Si Ni Tang warms Zang. Diarrhea with thirst indicates heat; Bai Tou Weng Tang cools middle.)
Diarrhea with delirium indicates dry feces; Xiao Cheng Qi Tang (Minor Order the Qi Decoction) is appropriate.
(Classics state: Excess causes delirium. Dry feces indicate Stomach excess. Diarrhea indicates intestine deficiency. Xiao Cheng Qi Tang purges dry feces.)
Increased irritability after diarrhea, with soft epigastrium on palpation, indicates empty irritability; Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is appropriate.
(Lack of irritability post-diarrhea indicates resolution. Increased irritability with hard epigastrium suggests food stagnation. Irritability with soft epigastrium indicates pathogenic heat exploiting deficiency, lodging in...)
Vomiting with abscess pus requires no anti-emetic treatment; vomiting ceases spontaneously when pus is exhausted.
(Gastric abscess causes vomiting of pus. No anti-emetic needed. Vomiting ceases when pus is exhausted.)
Vomiting with weak pulse, frequent urination, slight body heat, and Jue is difficult to treat; Si Ni Tang is indicated.
(Vomiting with weak pulse indicates pathogen transmitting inward. Vomiting reverses Qi upward, normally reducing urination. Frequent urination indicates interior deficiency. Slight body heat...)
Dry heaving with salivary foam and headache is treated with Wu Zhu Yu Tang (Evodia Decoction).
(Dry heaving with saliva indicates interior cold. Headache indicates ascending cold Qi. Wu Zhu Yu Tang warms interior and dispels cold.)
Vomiting with fever is treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction).
(Classics state: Vomiting with fever indicates complete Chai Hu syndrome.)
Severe vomiting and purgation in Shanghan cause extreme deficiency. Profuse sweating follows. Due to exterior Qi stagnation, administering water to induce sweating causes hiccups (Yue). So...
(Severe vomiting/purgation exhausts Stomach Qi. Profuse sweating further depletes Yang Qi. Exterior pathogen stagnates in exterior, causing fever. Physician administers water to induce sweating, causing...)
Shanghan hiccups with abdominal fullness require observing anterior (urination) and posterior (defecation) obstructions. Unblocking the obstruction cures the condition.
(Hiccups and fullness indicate ascending Qi failing to descend. Observing anterior/posterior obstructions and unblocking them descends Qi. Anterior refers to urination. Posterior...)