(4)悸者，加茯苓。心下悸，是水气凌心，加茯苓以利水，水行则悸愈。
(5)渴欲饮水者，加白术。脾阳虚，则水不能吸收上输于肺，故渴欲饮水，加白术者，补脾阳以助其吸收也：、
(6)腹中痛者，加人参。腹中痛而喜按，是里气虚，故加人参以补之。
(7)寒者，加干姜，因干姜善治肠胃之寒。但寒甚者，桂、附也宜加入。
(8)腹满者，去白术，加附子。腹满宜宽中理气，白术甘能令中满，故去之。
整理者按：理中去术加附子，有四逆加人参汤意。
[制服法]
丸剂倍加约量。共研细末，蜜丸三钱重，早晚米汤送下；汤剂按照现拟的分量，用水二至三茶杯，煎至半茶杯，去滓温服。
[用药大意]
人参、白术、炙单补肠胃之虚，干姜去肠胃之寒。
[禁忌证]
喜冷者忌之(此系热证)；腹拒按者也忌之(此系实证)。
[类似方剂参考]
(1)小建中汤：此治肠胃虚寒，补力较少之方。
(2)附子理中丸：此治肠胃虚寒，热力较胜之方。
四逆散方第一百零二
[方义]
此宣达阳气、解除肝郁之方。
[主治]
阳气被寒邪所郁，形成热厥，四肢厥逆，兼寒热往来。但必须具有胸胁满痛，心下拒按，或肝气郁滞，脉沉等。此方治肝气郁滞、寒热、腹痛拒按、脉沉者有效．痢疾兼有寒热证者也有效。
按：仲景原文有“少阴病”三字，根据实践认为，绝不是真正阳虚的少阴病，乃貌似神非的证候。所以《医宗金鉴》云：“既无可温之寒，又无可下之热。”正说明这一点。
[药品]
炙草一至三钱 柴胡一至二钱 生杭芍二至三钱 枳实一至二钱
[加减法]
咳及下利者加五味子、干姜；悸者加桂枝；小便不利者加茯苓；腹中痛者加附子；泄利下重者加薤白。
[制服法]
将以上四味药共为细末，作为散剂，每服一钱，每日服二至三次，开水送下。或以所加之药煎水送服。
也可煎汤服：用水二茶杯，煎至半茶杯，去滓温服．
[用药大意]
柴胡升达阳气，故能治寒热往来，胸胁痛满，及由闭郁形成的厥逆证；芍药和肝，疏通血脉，故能治腹痛痢疾；枳实导滞，治心下拒按；甘草和中，以补正祛邪。
[禁忌证]
恶寒蜷卧、腹痛下利之四逆证忌之。因为这是四逆汤的症状。
[类似方剂参考]
(1)四逆汤：此治亡阳寒证、四肢厥逆之方。
(2)治痢疾的方法：这些方法对于泄利下重有互相启发之作用。
四逆汤方第一百零三
[方义]
此温中回阳之方，专治阳虚内虚之证。所谓阳虚者，即体温低落、机能沉衰是也。
[主治]
(1)太阴病，肠胃虚寒，寒邪较重，下利清谷等证。
(2)少阴病，亡阳，四肢厥逆。
按：以上二病都必须具有脉沉而微、舌无苔而润、不喜冷性饮食等表现。
．
[药品]
炙草一至二钱 干姜一至三钱 生附子一至五钱
[煎服法]
水三茶杯，煎至半茶杯。去滓温服。
[用药大意]
附子回阳，以恢复其体温；干姜温中，以疗治其厥逆；炙草补中气，兼调和诸药。
[禁忌证]
(1)外感风寒开始，手足厥冷者，不可用。此阳气被外邪所郁，不得外达之证，脉必见浮紧。
(2)麻疹初起，手足厥冷者，不可用。因阳气内郁，尚未达外。必见发热、咳嗽、喷嚏等症。
(3)热性病，神识昏迷，手足厥逆，舌苔干燥，身冷脉微的手足厥冷证，更不可用。因为这是阳极似阴、真热假寒的证候，误用之祸不旋踵。
[类似方剂参考]
(1)通脉四逆汤：此治阴盛格阳、真寒假热之方。
(2)白通汤：此温中回阳兼治头痛之方。
(3)四逆加人参汤：此治阳虚兼气虚之方。
(4)真武汤：此回阳兼镇水之方。
通脉四逆汤方第一百零四
[方义]
此回阳之方，治阴盛于内，格阳于外，或阴盛于下，格阳于上，即古人所谓“真寒假热”证，或“阴极似阳”证。
[主治]
少阴病，下利清谷，手足厥逆，或兼面赤(这是阴盛于下，格阳于上的症状)，或兼身热，不恶寒(这是阴盛于内，格阳于外的症状)。但必须具有脉微欲绝、舌润无苔、不喜冷性饮食或索冷水而不欲咽等表现。
[药品]
干姜二至三钱 炙草一至二钱 附子三至五钱
[加减法]
面赤者，加葱白一至二钱；腹痛者，去葱白加生杭芍一至三钱；干呕者，加生姜一至二钱；咽痛者，去芍药加桔梗一至二钱；利止脉不出者，去桔梗加人参三至五钱。
按：本方根据柯氏之意加葱白、人参二味，不但符合方义，实际上比原方只加重干姜有效。我的看法认为，如果不是寒邪直中证，葱白也须慎用，因为葱白或多或少总是散药，对于阴极似阳一证，千钧一发，纯粹温补尚恐不及，岂可使用散药乎!
[煎服法]
水三茶杯，煎至多半茶杯，去滓温服。
[用药大意]
用四逆汤以回阳，加葱白、人参以通脉。面赤者，阳郁于上也，故加葱白以通之；腹痛者，寒痹于中也，故加芍药以行之；干呕者，胃寒上逆也，故加生姜以散之；咽痛者，寒痰结于上也，故加桔梗以开之；利止脉不出者，津液将绝也。故加人参以补之。
[禁忌证]
无外热现象者忌之。
[类似方剂参考]
(1)四逆汤：此治没有面赤身热等假热证之方。
(2)四逆加人参汤：此治阳虚、气虚下利之方。
(3)白通汤：此治寒邪直中下利之方。
(4)通脉四逆加猪胆汁汤：此治阴阳两虚证，寒热并用之方。
人参四逆汤方第一百零五
[方义]
此回阳固脱、生津益血补气之方。
按：此证较四逆汤证险恶。
[主治]
霍乱吐利，或利已止，而恶寒脉微、手足厥逆之症未罢，或吐利未止而身体素弱，或吐利时间较长，或吐泻次数较多。只要恶寒脉微肢厥、不喜冷性饮食等虚而兼寒之证俱见，便可使用本方。
[药品]
人参三至五钱 炙草一至三钱 干姜一至二钱 附子二至三钱
[煎服法]
水三茶杯，煎至半茶杯，去滓温服。
[用药大意]
四逆汤回阳，人参大补元气。
[禁忌证]
凡单纯阳虚气不虚，或单纯气虚阳不虚者，均不可服。因用药上不够完全吻合。
[类似方剂参考]
(1)四逆汤：此治单纯阳虚里寒下利之方。
(2)理中汤：此治肠胃虚寒下利之方。
(3)白通汤：此治寒邪直中下利之方。
(4)补中益气汤：此治单纯气虚下利之方。
茯苓四逆汤方第一百零六
[方义]
此回阳、补气、利水，治烦躁之方。
[主治]
伤寒汗下后，阳虚气虚，水邪不化形成的烦躁之证。但必须具有脉微无力、四肢厥逆及小便不利等蓄水现象。
[药品]
茯苓二至三钱 炙草一至二钱 干姜一至二钱 附子二至三钱 人参二至三钱
[煎服法]
水三茶杯，煎至半茶杯，去滓温服。
[用药大意]
四逆汤回阳，人参补气，茯苓利水。
[禁忌证]
凡未经汙下，及喜冷性饮食、小便通利之烦躁证，绝不可服。
[类似方剂参考]
(1)真武汤：此回阳利水，但补气之力不甚之方。
(2)四逆加人参汤：此治阳虚气虚但无停水之方．
(3)吴茱萸汤：此治厥阴寒证烦躁之方．
(4)大青龙汤：此治太阳病表寒兼里热烦躁之方。
(5)干姜附子汤：此阳虚烦躁之方。
通脉四逆加猪胆汁汤方第一百零七
[方义]
此治少阴病，阴胜格阳，热因寒用之方。或治阴阳俱虚，寒热并用之方。
[主治]
少阴病，吐下已止，汗出手足厥冷，四肢拘急，脉微欲绝。但必须兼有烦躁，或面赤身热，或有对热性药格拒不受等现象。
按：此证兼有烦躁现象，用本方相当有效，但在时间上多有缓不济急的情况，必须注意。
[药品]
干姜二至四钱 炙草一至三钱 附子三至五钱 猪胆汁半枚至一枚
按：本方根据实践，当加人参三至五钱更有效，不当加葱白，盖恶其散也。
[煎服法]
水三茶杯，煎至半茶杯，去滓，调胆汁，温服。
[用药大意]
四逆加人参汤回阳补气以通脉，加猪胆汁或益将绝之阴，或引阳药深入阴分，以通其拒格也。
[禁忌证]
．
单纯亡阳而见手足厥逆、脉微欲绝之症者不可用。
[类似方剂参考]
(1)通脉四逆汤：此治阴盛于内、格阳于外之方。
(2)四逆加人参汤：此治阳虚兼气虚之方。
(3)四逆汤：此治亡阳虚寒之方。
当归四逆汤方第一百零八
[方义]
此温经散寒兼理血络，保护脾胃，助正祛邪，治寒邪直中厥阴之方。
[主治]
寒邪直中厥阴，手足厥寒，脉细欲绝。但必须具有猝被寒邪侵袭厥阴的具体症状。
按：本证曾见有冬季在室外劳动，被寒邪侵袭，猝然少腹疼痛，牵引睾丸，四肢抽搐厥冷，脉微欲绝者。
[药品]
当归二至三钱 桂枝二至三钱 生杭芍二至三钱 细辛八分至一钱 大枣二至四枚 炙草一至二钱 通草一钱至钱半(陈氏主用木通)
[加减法]
内有久寒者，加吴茱萸钱半至三钱，生姜一至二钱，名当归四逆加吴茱萸生姜汤。
[煎服法]
用水三茶杯，煎至半茶杯，去滓温服。
[用药大意]
桂枝、细辛以散外寒；当归、芍药、木通以疏通血络；大枣、炙草以保护脾胃。
[禁忌证]
(1)兼内寒或久寒者不宜用。因内寒久寒宜加温里药，不宜单用温散也。
(2)单纯内寒或亡阳之手足厥逆证不可用。因此证宜温不宜散，恐阳气被散而虚脱也。
(3)阳气闭郁之四肢厥逆证不可用。因此证宜宣达阳气，不宜温经散寒。
(4)阳极似阴或热深厥深之四肢厥逆证更不可服。因此证宜寒不宜温也。
[类似方剂参考]
(1)当归四逆加吴茱萸生姜汤：此治外寒兼有内寒之方。
(2)四逆汤：此治内寒阳亡手足厥逆之方。
(3)四逆散：此治阳气闭郁四肢厥逆之方。
(4)白虎汤或大承气汤：此治热深厥深或阳极似阴之方。
当归四逆加吴茱萸生姜汤方第一百零九
[方义]
此散寒温里，疏通血络，助正祛邪，治寒邪直中厥阴兼有久寒证之方。
[主治]
寒邪直中厥阴兼有久寒，其症手足厥寒，脉细欲绝。但必须具有猝被外寒侵袭厥阴和久寒的具体症状，如少腹猝痛，阴缩，手足抽搐(这是外寒侵袭厥阴的主要症状)，平素不敢服冷性饮食，偶服之或腹痛或吐泻，或喜温恶寒(这是久寒的主要症状)。
[药品]
当归二至三钱 桂枝二至三钱 生杭芍二至三钱 细辛八分至一钱 炙草一至二钱 通草一至二钱(陈氏主用木通) 大枣二至四枚 吴茱萸二钱至二钱半 生姜一至三钱
[煎服法]
水三茶杯，煎至半茶杯，去滓，兑白酒半杯至一小酒杯，温服。
[用药大意]
桂枝、细卒以散外寒；吴萸、生姜以温内寒；当归、芍药、木通以疏通血脉；大枣、炙草以补正祛邪。用白酒作引者，欲其通经活血，助药之力速行也。
[禁忌证]
凡单纯外寒或单纯内寒者均不宜使用本方。
[类似方剂参考]
(1)当归四逆汤：此治厥阴经单纯直中外寒之方。
(2)四逆汤：此治单纯阳虚内寒之方。
烧挥散方第一百一十
[方义]
此治阴阳易的通用方。
[主治]
热性病后，房事过早，症见头重不欲举，热上冲胸，少腹里急，或引阴中拘挛，眼中生花，膝胫拘急者。
[药品]
裈裆一块，约四五寸(近阴处的裤裆布，旧者良。男病用女裆，女病用男裆)。
[制服法]
把挥裆布烧灰存性，每服一钱，日三服，开水送服。或用青竹茹煎汤送下，或用其他适应证的药品煎汤送下。服后小便利，阴头肿则愈。
[禁忌证]
本方并无禁忌证。若无男女劳复的事实，虽有类似症状，也没有使用本方的必要。
[用药大意]
取彼之余气，祛彼之余邪。邪毒从阴部入者，复使从阴部出也。
整理者按：由刘渡舟先生主编、光明日报出版社1987年3月出版的《伤寒论讲解》第461页有这样一段记述，值得参考： “关于阴阳易之病是否存在，烧裈散是否有效，历代医家都有所探讨，至今也未成定论。据山西省中医研究所已故名医李翰卿先生1963年介绍，此病确有，用本方也确有疗效。李老以典型病例六七例，说明本病临证特点有三：一是头抬不起来，即‘头重不欲举’；二是少腹拘挛疼痛并牵引外阴拘挛；三是全身乏力，倦怠少气。治疗使用烧桿散， 皆已获效。李老的经验之谈，很值得重视。”
枳实栀子豉汤方第一百一十一
[方义]
此导滞清热，治劳复、食复之方。
[主治]
伤寒大病瘥后，因过劳或伤食致身热，心烦不眠，心下拒按。但必须根据过劳或伤食的事实，以定劳复、食复或劳而兼食之名称，根据脉象的浮、沉、虚、实决定诸药的运用轻重或取弃标准。因为单纯劳复没有心下拒按之证，即没有使用枳实的必要。
[药品]
枳实钱半至二钱半 栀子二至三钱 豆豉二至三钱
[加减法]
宿食较重者，如脐部拒按、大便不利，加大黄一至二钱。
[煎服法]
用水三茶杯。煎至半茶杯，去滓温服。
[用药大意]
栀子、豆豉清表里之虚热；枳实导肠胃之积滞；大黄推陈致新，通利大便。
[禁忌证]
身热、心烦、腹拒按三种症状缺一则不可使用本方。脉较弱者枳实、大黄宜慎用。
[类似方剂参考]
小柴胡汤：此治病后更发热之方。
牡蛎泽泻散方第一百一十二
[方义]
此滋阴清热、逐水消肿之峻剂。
(4) In cases of palpitations (Palpitation), add Poria (Poria). Palpitations below the heart are caused by water qi assaulting the heart; adding Poria promotes diuresis, and once water flows freely, the palpitations subside.
(5) In cases of thirst with a desire to drink water, add Atractylodis Macrocephalae Rhizoma (Atractylodes). When Spleen Yang is deficient, water cannot be absorbed and transported upward to the Lung, resulting in thirst and a desire to drink; adding Atractylodis Macrocephalae Rhizoma tonifies Spleen Yang to assist absorption.
(6) In cases of abdominal pain, add Ginseng Radix et Rhizoma (Ginseng). Abdominal pain that prefers pressure indicates deficiency of interior Qi; therefore, Ginseng is added to tonify it.
(7) In cases of coldness, add Zingiberis Rhizoma (Dried Ginger), as Dried Ginger effectively treats cold in the stomach and intestines. However, if the cold is severe, Cinnamon Twig (Cassia Twig) and Aconite Lateralis Radix Preparata (Prepared Aconite Root) should also be added.
(8) In cases of abdominal fullness, remove Atractylodis Macrocephalae Rhizoma (Atractylodes) and add Aconite Lateralis Radix Preparata (Prepared Aconite Root). Abdominal fullness requires promoting middle-jiao Qi movement; since Atractylodis Macrocephalae Rhizoma is sweet and can cause middle-jiao fullness, it is removed.
Editor's Note: Removing Atractylodis Macrocephalae Rhizoma from Lizhong Tang and adding Aconite Lateralis Radix Preparata implies the formula Si Ni Jia Ren Shen Tang (Four Reversals Plus Ginseng Decoction).
[Administration Method]
For pills, double the dosage. Grind all ingredients into fine powder, mix with honey to form pills weighing three qian each, taken morning and evening with rice soup. For decoctions, use the prescribed amounts, add two to three cups of water, boil down to half a cup, strain, and take warm.
[General Principles of Medication]
Ren Shen (Ginseng), Bai Zhu (Atractylodes), and Zhi Gan Cao (Honey-fried Licorice) alone tonify deficiency in the stomach and intestines; Gan Jiang (Dried Ginger) dispels cold in the stomach and intestines.
[Contraindications]
Contraindicated for those who prefer cold drinks (this indicates Heat syndrome); contraindicated for those with abdominal rejection upon pressure (this indicates Excess syndrome).
[Reference for Similar Formulas]
(1) Xiao Jian Zhong Tang (Minor Construct the Middle Decoction): This formula treats deficiency-cold of the stomach and intestines but has weaker tonifying power.
(2) Fu Zi Li Zhong Wan (Aconite Lizhong Pill): This formula treats deficiency-cold of the stomach and intestines but has stronger warming power.
Si Ni San (Four Reversals Powder) Formula No. 102
[Formula Meaning]
This formula spreads and reaches Yang Qi and resolves Liver Qi stagnation.
[Indications]
Yang Qi constrained by Cold pathogen, forming Heat Jue (Reversal Cold), characterized by cold extremities, accompanied by alternating chills and fever. However, it must present with fullness and pain in the chest and hypochondrium, rejection at the epigastrium, or Liver Qi stagnation with a deep pulse. This formula is effective for Liver Qi stagnation, alternating chills and fever, abdominal pain with rejection, and deep pulse. It is also effective for dysentery accompanied by alternating chills and fever.
Note: Zhang Zhongjing's original text mentions "Shao Yin disease." Based on clinical practice, this is absolutely not true Shao Yin disease with Yang deficiency, but a condition that resembles it in appearance but differs in essence. Thus, *Yi Zong Jin Jian* states: "There is no cold to warm, nor heat to purge," which explains this point.
[Ingredients]
Zhi Gan Cao (Honey-fried Licorice) 1-3 qian; Chai Hu (Bupleurum Root) 1-2 qian; Sheng Bai Shao (Raw White Peony Root) 2-3 qian; Zhi Shi (Immature Bitter Orange) 1-2 qian.
[Modifications]
For cough and diarrhea, add Wu Wei Zi (Schisandra Berry) and Gan Jiang (Dried Ginger); for palpitations, add Gui Zhi (Cinnamon Twig); for difficult urination, add Fu Ling (Poria); for abdominal pain, add Fu Zi (Aconite); for tenesmus in diarrhea, add Xie Bai (Macrostemon Bulb).
[Administration Method]
Grind the four ingredients into fine powder to make a powder. Take one qian per dose, two to three times daily, with boiled water. Alternatively, decoct the added herbs and take with them.
It can also be decocted: Use two cups of water, boil down to half a cup, strain, and take warm.
[General Principles of Medication]
Chai Hu (Bupleurum Root) raises and spreads Yang Qi, thus treating alternating chills and fever, chest/hypochondriac pain/fullness, and Jue syndrome formed by constraint; Bai Shao (Peony Root) harmonizes the Liver and unblocks blood vessels, thus treating abdominal pain and dysentery; Zhi Shi (Immature Bitter Orange) guides out stagnation, treating epigastric rejection; Gan Cao (Licorice) harmonizes the middle and tonifies healthy Qi to expel pathogenic factors.
[Contraindications]
Contraindicated for Si Ni syndrome with aversion to cold, curled-up posture, abdominal pain, and diarrhea, because these are symptoms of Si Ni Tang (Four Reversals Decoction).
[Reference for Similar Formulas]
(1) Si Ni Tang (Four Reversals Decoction): This formula treats Yang collapse with Cold syndrome and cold extremities.
(2) Methods for treating dysentery: These methods offer mutual inspiration for tenesmus in diarrhea.
Si Ni Tang (Four Reversals Decoction) Formula No. 103
[Formula Meaning]
This formula warms the middle and restores Yang, specifically treating syndromes of Yang deficiency and interior deficiency. "Yang deficiency" refers to low body temperature and depressed physiological functions.
[Indications]
(1) Tai Yin disease: Deficiency-cold of the stomach and intestines, heavier Cold pathogen, such as diarrhea with undigested food.
(2) Shao Yin disease: Yang collapse, cold extremities.
Note: Both diseases must present with a deep and faint pulse, tongue without coating but moist, and aversion to cold foods/drinks.
[Ingredients]
Zhi Gan Cao (Honey-fried Licorice) 1-2 qian; Gan Jiang (Dried Ginger) 1-3 qian; Sheng Fu Zi (Raw Aconite Lateralis Radix) 1-5 qian.
[Decoction and Administration]
Use three cups of water, boil down to half a cup. Strain and take warm.
[General Principles of Medication]
Fu Zi (Aconite) restores Yang to recover body temperature; Gan Jiang (Dried Ginger) warms the middle to treat reversal cold; Zhi Gan Cao (Honey-fried Licorice) tonifies middle Qi and harmonizes the various herbs.
[Contraindications]
(1) Not for initial stages of external contraction of Wind-Cold with cold extremities. This is a syndrome where Yang Qi is constrained by external pathogens and cannot reach the exterior; the pulse will be floating and tight.
(2) Not for early stage of measles with cold extremities. This is due to internal constraint of Yang Qi not yet reaching the exterior. Symptoms must include fever, cough, sneezing, etc.
(3) More contraindicated for extremity cold syndrome in febrile diseases with coma, cold extremities, dry tongue coating, cold body, and faint pulse. This is a syndrome of extreme Yang resembling Yin, true Heat with false Cold; misuse leads to immediate disaster.
[Reference for Similar Formulas]
(1) Tong Mai Si Ni Tang (Pulse-Returning Four Reversals Decoction): This formula treats Yin excess repelling Yang outward, true Cold with false Heat.
(2) Bai Tong Tang (White Connection Decoction): This formula warms the middle, restores Yang, and treats headache.
(3) Si Ni Jia Ren Shen Tang (Four Reversals Plus Ginseng Decoction): This formula treats Yang deficiency combined with Qi deficiency.
(4) Zhen Wu Tang (True Warrior Decoction): This formula restores Yang and calms water.
Tong Mai Si Ni Tang (Pulse-Returning Four Reversals Decoction) Formula No. 104
[Formula Meaning]
This formula restores Yang, treating Yin excess internally repelling Yang outward, or Yin excess below repelling Yang above. This is what ancients called "true Cold with false Heat" or "extreme Yin resembling Yang."
[Indications]
Shao Yin disease with diarrhea of undigested food, cold extremities, possibly accompanied by red face (symptom of Yin excess below repelling Yang above), or body heat and aversion to cold (symptom of Yin excess inside repelling Yang outside). However, it must present with a pulse faint to the point of disappearance, moist tongue without coating, aversion to cold foods/drinks, or craving cold water but not wanting to swallow.
[Ingredients]
Gan Jiang (Dried Ginger) 2-3 qian; Zhi Gan Cao (Honey-fried Licorice) 1-2 qian; Fu Zi (Aconite) 3-5 qian.
[Modifications]
For red face, add Cong Bai (Scallion White) 1-2 qian; for abdominal pain, remove Cong Bai and add Sheng Bai Shao (Raw White Peony Root) 1-3 qian; for dry retching, add Sheng Jiang (Fresh Ginger) 1-2 qian; for sore throat, remove Bai Shao and add Jie Geng (Platycodon Root) 1-2 qian; for cessation of diarrhea with non-palpable pulse, remove Jie Geng and add Ren Shen (Ginseng) 3-5 qian.
Note: Following Ke's intention, adding Cong Bai and Ren Shen not only fits the formula meaning but is actually more effective than just increasing Gan Jiang in the original formula. My view is that unless it is direct invasion by Cold pathogen, Cong Bai should be used cautiously. Cong Bai is largely a dispersing herb. In the critical moment of extreme Yin resembling Yang, pure warming and tonification may barely suffice; how can dispersing herbs be used?
[Decoction and Administration]
Use three cups of water, boil down to slightly more than half a cup. Strain and take warm.
[General Principles of Medication]
Si Ni Tang restores Yang; adding Cong Bai and Ren Shen unblocks the pulse. Red face indicates Yang constrained above, so Cong Bai is added to unblock it; abdominal pain indicates Cold obstruction in the middle, so Bai Shao is added to move it; dry retching indicates Stomach Cold reversing upward, so Sheng Jiang is added to disperse it; sore throat indicates Cold-phlegm knotting above, so Jie Geng is added to open it; cessation of diarrhea with non-palpable pulse indicates impending exhaustion of Body Fluids, so Ren Shen is added to tonify it.
[Contraindications]
Contraindicated if there are no signs of external heat.
[Reference for Similar Formulas]
(1) Si Ni Tang (Four Reversals Decoction): This formula treats cases without false Heat signs like red face or body heat.
(2) Si Ni Jia Ren Shen Tang (Four Reversals Plus Ginseng Decoction): This formula treats Yang and Qi deficiency with diarrhea.
(3) Bai Tong Tang (White Connection Decoction): This formula treats diarrhea from direct Cold pathogen invasion.
(4) Tong Mai Si Ni Jia Zhu Dan Jiang Tang (Pulse-Returning Four Reversals Plus Pig Gallbladder Juice Decoction): This formula treats dual deficiency of Yin and Yang, using both Cold and Heat herbs.
Ren Shen Si Ni Tang (Ginseng Four Reversals Decoction) Formula No. 105
[Formula Meaning]
This formula restores Yang, secures collapse, generates fluids, benefits blood, and tonifies Qi.
Note: This syndrome is more dangerous than Si Ni Tang syndrome.
[Indications]
Huoluan (Colic disorder) with vomiting and diarrhea, or after diarrhea stops but aversion to cold, faint pulse, and cold extremities persist; or while vomiting/diarrhea continue but the constitution is weak; or prolonged duration of vomiting/diarrhea; or frequent episodes. As long as deficiency-cold signs such as aversion to cold, faint pulse, cold extremities, and aversion to cold foods/drinks are present, this formula can be used.
[Ingredients]
Ren Shen (Ginseng) 3-5 qian; Zhi Gan Cao (Honey-fried Licorice) 1-3 qian; Gan Jiang (Dried Ginger) 1-2 qian; Fu Zi (Aconite) 2-3 qian.
[Decoction and Administration]
Use three cups of water, boil down to half a cup. Strain and take warm.
[General Principles of Medication]
Si Ni Tang restores Yang; Ren Shen greatly tonifies Yuan Qi (Original Qi).
[Contraindications]
Not for pure Yang deficiency without Qi deficiency, or pure Qi deficiency without Yang deficiency, because the medication does not fully match the syndrome.
[Reference for Similar Formulas]
(1) Si Ni Tang (Four Reversals Decoction): This formula treats pure Yang deficiency with interior Cold diarrhea.
(2) Li Zhong Tang (Regulate the Middle Decoction): This formula treats deficiency-cold of stomach/intestines with diarrhea.
(3) Bai Tong Tang (White Connection Decoction): This formula treats diarrhea from direct Cold pathogen invasion.
(4) Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction): This formula treats pure Qi deficiency with diarrhea.
Fu Ling Si Ni Tang (Poria Four Reversals Decoction) Formula No. 106
[Formula Meaning]
This formula restores Yang, tonifies Qi, promotes diuresis, and treats irritability.
[Indications]
Irritability formed by Yang and Qi deficiency after sweating/purging in Shanghan (Cold Damage), leading to failure of Water Pathogen transformation. However, it must present with signs of water retention such as faint/weak pulse, cold extremities, and difficult urination.
[Ingredients]
Fu Ling (Poria) 2-3 qian; Zhi Gan Cao (Honey-fried Licorice) 1-2 qian; Gan Jiang (Dried Ginger) 1-2 qian; Fu Zi (Aconite) 2-3 qian; Ren Shen (Ginseng) 2-3 qian.
[Decoction and Administration]
Use three cups of water, boil down to half a cup. Strain and take warm.
[General Principles of Medication]
Si Ni Tang restores Yang; Ren Shen tonifies Qi; Fu Ling promotes diuresis.
[Contraindications]
Absolutely contraindicated for irritability without prior sweating/purging, or with preference for cold drinks, or with free urination.
[Reference for Similar Formulas]
(1) Zhen Wu Tang (True Warrior Decoction): This formula restores Yang and promotes diuresis but has less Qi-tonifying power.
(2) Si Ni Jia Ren Shen Tang (Four Reversals Plus Ginseng Decoction): This formula treats Yang and Qi deficiency without water retention.
(3) Wu Zhu Yu Tang (Evodia Decoction): This formula treats irritability in Jue Yin Cold syndrome.
(4) Da Qing Long Tang (Major Green Dragon Decoction): This formula treats irritability in Tai Yang disease with exterior Cold and interior Heat.
(5) Gan Jiang Fu Zi Tang (Dried Ginger and Aconite Decoction): This formula treats Yang deficiency with irritability.
Tong Mai Si Ni Jia Zhu Dan Jiang Tang (Pulse-Returning Four Reversals Plus Pig Gallbladder Juice Decoction) Formula No. 107
[Formula Meaning]
This formula treats Shao Yin disease with Yin excess repelling Yang, using Heat for Cold. Or it treats dual deficiency of Yin and Yang, using both Cold and Heat herbs.
[Indications]
Shao Yin disease where vomiting/diarrhea have stopped, but sweating, cold extremities, limb cramping, and pulse faint to disappearance persist. However, it must be accompanied by irritability, or red face/body heat, or rejection of hot herbs.
Note: This formula is quite effective for this syndrome with irritability, but often acts too slowly for urgent situations; attention must be paid.
[Ingredients]
Gan Jiang (Dried Ginger) 2-4 qian; Zhi Gan Cao (Honey-fried Licorice) 1-3 qian; Fu Zi (Aconite) 3-5 qian; Zhu Dan Jiang (Pig Gallbladder Juice) half to one gallbladder.
Note: Based on practice, adding Ren Shen (Ginseng) 3-5 qian is more effective; Cong Bai (Scallion White) should not be added because its dispersing nature is undesirable.
[Decoction and Administration]
Use three cups of water, boil down to half a cup. Strain, mix in the gallbladder juice, and take warm.
[General Principles of Medication]
Si Ni Jia Ren Shen Tang restores Yang and tonifies Qi to unblock the pulse. Adding Pig Gallbladder Juice either nourishes the nearly exhausted Yin or guides the Yang-warming herbs deeply into the Yin level to overcome rejection.
[Contraindications]
Not for pure Yang collapse presenting with cold extremities and faint-to-disappearance pulse.
[Reference for Similar Formulas]
(1) Tong Mai Si Ni Tang (Pulse-Returning Four Reversals Decoction): This formula treats Yin excess internally repelling Yang externally.
(2) Si Ni Jia Ren Shen Tang (Four Reversals Plus Ginseng Decoction): This formula treats Yang deficiency combined with Qi deficiency.
(3) Si Ni Tang (Four Reversals Decoction): This formula treats Yang collapse with interior Cold.
Dang Gui Si Ni Tang (Angelica Four Reversals Decoction) Formula No. 108
[Formula Meaning]
This formula warms the meridians, dispels Cold, regulates blood collaterals, protects the Spleen and Stomach, assists Healthy Qi to expel pathogens, and treats Cold pathogen directly invading Jue Yin.
[Indications]
Cold pathogen directly invading Jue Yin, causing cold extremities and fine pulse nearing disappearance. However, it must present with specific symptoms of sudden Cold pathogen invasion into Jue Yin.
Note: This syndrome has been seen in winter laborers exposed to Cold, suddenly experiencing lower abdominal pain radiating to the testicles, limb spasms and cold, and faint pulse.
[Ingredients]
Dang Gui (Angelica Sinensis Root) 2-3 qian; Gui Zhi (Cinnamon Twig) 2-3 qian; Sheng Bai Shao (Raw White Peony Root) 2-3 qian; Xi Xin (Asarum) 0.8-1 qian; Da Zao (Jujube) 2-4 pieces; Zhi Gan Cao (Honey-fried Licorice) 1-2 qian; Tong Cao (Tetrapanax Pith) 1-1.5 qian (Chen prefers Mu Tong).
[Modifications]
For chronic internal Cold, add Wu Zhu Yu (Evodia Fruit) 1.5-3 qian and Sheng Jiang (Fresh Ginger) 1-2 qian, named Dang Gui Si Ni Jia Wu Zhu Yu Sheng Jiang Tang (Angelica Four Reversals Plus Evodia and Fresh Ginger Decoction).
[Decoction and Administration]
Use three cups of water, boil down to half a cup. Strain and take warm.
[General Principles of Medication]
Gui Zhi (Cinnamon Twig) and Xi Xin (Asarum) dispel external Cold; Dang Gui (Angelica), Bai Shao (Peony), and Mu Tong (Akebia Stem) unblock blood collaterals; Da Zao (Jujube) and Zhi Gan Cao (Licorice) protect the Spleen and Stomach.
[Contraindications]
(1) Not suitable for cases with concurrent internal or chronic Cold. Internal/chronic Cold requires warming interior herbs, not just warming and dispersing.
(2) Not for pure internal Cold or Yang collapse with cold extremities. This syndrome requires warming, not dispersing, lest Yang Qi scatter and collapse.
(3) Not for extremity cold due to Yang Qi constraint. This syndrome requires spreading Yang Qi, not warming meridians and dispersing Cold.
(4) More contraindicated for extremity cold due to extreme Yang resembling Yin or deep Heat causing deep Cold. This syndrome requires Cold, not Warmth.
[Reference for Similar Formulas]
(1) Dang Gui Si Ni Jia Wu Zhu Yu Sheng Jiang Tang: This formula treats external Cold with internal Cold.
(2) Si Ni Tang (Four Reversals Decoction): This formula treats internal Cold with Yang collapse and cold extremities.
(3) Si Ni San (Four Reversals Powder): This formula treats extremity cold due to Yang Qi constraint.
(4) Bai Hu Tang (White Tiger Decoction) or Da Cheng Qi Tang (Major Order the Qi Decoction): This formula treats deep Heat with deep Cold or extreme Yang resembling Yin.
Dang Gui Si Ni Jia Wu Zhu Yu Sheng Jiang Tang (Angelica Four Reversals Plus Evodia and Fresh Ginger Decoction) Formula No. 109
[Formula Meaning]
This formula dispels Cold, warms the interior, unblocks blood collaterals, assists Healthy Qi to expel pathogens, and treats Cold pathogen directly invading Jue Yin with chronic Cold.
[Indications]
Cold pathogen directly invading Jue Yin with chronic Cold, presenting with cold extremities and fine pulse nearing disappearance. Must present with specific symptoms of sudden external Cold invasion into Jue Yin and chronic Cold, such as sudden lower abdominal pain, retraction of genitals, limb spasms (main symptoms of external Cold invading Jue Yin), aversion to cold foods, occasional abdominal pain/vomiting/diarrhea after consuming cold foods, or preference for warmth and aversion to cold (main symptoms of chronic Cold).
[Ingredients]
Dang Gui (Angelica Sinensis Root) 2-3 qian; Gui Zhi (Cinnamon Twig) 2-3 qian; Sheng Bai Shao (Raw White Peony Root) 2-3 qian; Xi Xin (Asarum) 0.8-1 qian; Zhi Gan Cao (Honey-fried Licorice) 1-2 qian; Tong Cao (Tetrapanax Pith) 1-2 qian (Chen prefers Mu Tong); Da Zao (Jujube) 2-4 pieces; Wu Zhu Yu (Evodia Fruit) 2-2.5 qian; Sheng Jiang (Fresh Ginger) 1-3 qian.
[Decoction and Administration]
Use three cups of water, boil down to half a cup. Strain, add half a cup to one small glass of white wine, and take warm.
[General Principles of Medication]
Gui Zhi (Cinnamon Twig) and Xi Xin (Asarum) dispel external Cold; Wu Zhu Yu (Evodia) and Sheng Jiang (Fresh Ginger) warm internal Cold; Dang Gui (Angelica), Bai Shao (Peony), and Mu Tong (Akebia Stem) unblock blood vessels; Da Zao (Jujube) and Zhi Gan Cao (Licorice) tonify Healthy Qi to expel pathogens. White wine is used as a guide to promote meridian circulation and blood activation, helping the medicinal power act quickly.
[Contraindications]
Not suitable for pure external Cold or pure internal Cold.
[Reference for Similar Formulas]
(1) Dang Gui Si Ni Tang (Angelica Four Reversals Decoction): This formula treats simple direct external Cold invasion of Jue Yin Meridian.
(2) Si Ni Tang (Four Reversals Decoction): This formula treats pure Yang deficiency with internal Cold.
Shao Kun San (Burnt Underwear Powder) Formula No. 110
[Formula Meaning]
This is a general formula for treating Yin-Yang Exchange (Yin Yang Yi).
[Indications]
After febrile disease, premature sexual activity, presenting with heavy head unwilling to lift, heat rushing to the chest, urgency/tightness in lower abdomen, or drawing cramps in the yin organs, visual disturbances ("seeing flowers"), and stiffness/cramping in knees and calves.
[Ingredients]
One piece of kun dang (underwear crotch cloth), approx. 4-5 cun (cloth near the genitals, old is better. Men use women's underwear, women use men's underwear).
[Administration Method]
Burn the underwear cloth to ash, preserving its nature. Take one qian per dose, three times daily, with boiled water. Alternatively, take with decoction of Qing Zhu Ru (Bamboo Shavings) or other appropriate herbs. Recovery occurs when urination becomes free and swelling of the glans penis/vulva appears.
[Contraindications]
No contraindications for this formula. If there is no fact of post-illness relapse due to sexual activity, even with similar symptoms, there is no need to use this formula.
[General Principles of Medication]
Take the residual Qi of the other to expel the residual pathogen of the other. If pathogenic toxins entered via the yin organs, they are expelled via the yin organs.
Editor's Note: The book *Explanation of Shanghan Lun*, edited by Liu Duzhou, published by Guangming Daily Press in March 1987, page 461, contains a reference worth noting: "Whether Yin-Yang Exchange exists and whether Shao Kun San is effective has been discussed by physicians through generations without a definitive conclusion. According to the late famous physician Mr. Li Hanqing of Shanxi Institute of Traditional Chinese Medicine in 1963, this disease indeed exists, and this formula is indeed effective. Mr. Li used six or seven typical cases to illustrate three clinical characteristics of this disease: first, inability to lift the head ('heavy head unwilling to lift'); second, lower abdominal cramping pain radiating to external genital cramps; third, whole-body fatigue and lassitude. Treatment with Shao Kun San was successful in all cases. Mr. Li's experience is highly valuable."
Zhi Shi Zhi Zi Chi Tang (Immature Bitter Orange, Gardenia, and Fermented Soybean Decoction) Formula No. 111
[Formula Meaning]
This formula guides out stagnation, clears Heat, and treats relapse due to overexertion (Lao Fu) or dietary indiscretion (Shi Fu).
[Indications]
After recovery from severe Shanghan, fever, restlessness, insomnia, and epigastric rejection occur due to overexertion or dietary injury. Diagnosis of Lao Fu, Shi Fu, or combined must be based on the history. The weight/importance of herbs should be determined by pulse (floating, deep, deficient, excess). Pure Lao Fu lacks epigastric rejection, so Zhi Shi is unnecessary.
[Ingredients]
Zhi Shi (Immature Bitter Orange) 1.5-2.5 qian; Zhi Zi (Gardenia Fruit) 2-3 qian; Chi Xiao Dou (Fermented Soybean) 2-3 qian.
[Modifications]
For heavier retained food, such as umbilical rejection and difficult defecation, add Da Huang (Rhubarb) 1-2 qian.
[Decoction and Administration]
Use three cups of water, boil down to half a cup. Strain and take warm.
[General Principles of Medication]
Zhi Zi (Gardenia) and Chi Xiao Dou (Fermented Soybean) clear deficient Heat in exterior and interior; Zhi Shi (Immature Bitter Orange) guides intestinal/stomach stagnation; Da Huang (Rhubarb) eliminates old to generate new and unblocks bowels.
[Contraindications]
Cannot be used if any of the three symptoms—fever, restlessness, abdominal rejection—is missing. Use Zhi Shi and Da Huang with caution in patients with weaker pulses.
[Reference for Similar Formulas]
Xiao Chai Hu Tang (Minor Bupleurum Decoction): This formula treats recurrence of fever after illness.
Mu Li Ze Xie San (Oyster Shell and Alisma Powder) Formula No. 112
[Formula Meaning]
This is a potent agent for nourishing Yin, clearing Heat, draining water, and reducing edema.