若其邪始终在气分流连者,可冀其战汗透邪,法宜益胃,令邪与汗并,热达腠开,邪从汗出。
解后胃气空虚,当肤冷一昼夜,待气还自温暖如常矣。盖战汗而解,邪退正虚,阳从汗泄,故渐肤冷,未
必即成脱症。此时宜安舒静卧,以养阳气来复。旁人切勿惊惶,频频呼唤,扰其元气。但诊其脉若虚软和缓,
虽倦卧不语,汗出肤冷,却非脱症;若脉急疾,躁扰不卧,肤冷汗出,便为气脱之症矣。更有邪盛正虚,不能
一战而解,停一二日再战汗而愈者,不可不知。
再论气病有不传血分,而邪留三焦,犹之伤寒中少阳病也。彼则和解表里之半;此则分消上下之势。随证变
法∶如近时杏、朴、苓等类;或如温胆汤之走泄。因其仍在气分,犹有战汗之门户,转疟之机括也。
再论三焦不从外解,必致里结。里结于何?在阳明胃与肠也。亦须用下法,不可以气血之分,谓其不可下
也。惟伤寒热邪在里,劫烁津液,下之宜猛;此多湿热内抟,下之宜轻。伤寒大便溏,为邪已尽,不可再下;
湿温病大便溏为邪未尽,必大便硬,乃为无湿,始不可再攻也。
再人之体,脘在腹上,其位居中,按之痛;或自痛;或痞胀;当用苦泄,以其入腹近也。必验之于舌∶或
黄或浊,可与小陷胸汤或泻心汤,随证治之。若白不燥;或黄白相兼;或灰
白不渴;慎不可乱投苦泄。其中有外邪未解里先结者;或邪郁未伸;或素属中冷者;虽有脘中痞痛,宜从开泄,
宣通气滞以达归于肺,如近世之杏、蔻、橘、桔等,轻苦微辛,具流动之品可耳。
前云舌黄或浊,当用陷胸、泻心,须要有地之黄,若光滑者,乃无形湿热,已有中虚之象,大忌前法。其
脐以上为大腹,或满或胀或痛,此必邪已入里,表症必无,或存十之一二。亦须验之于舌∶或黄甚;或如沉香
色;或如灰黄色;或老黄色;或中有断纹。皆当下之,如小承气汤,用槟榔、青皮、枳实、元明粉、生首乌等
皆可。若未现此等舌,不宜用此等药。恐其中有湿聚太阴为满;或寒湿错杂为痛;或气壅为胀,又当以别法治之矣。
If the pathogenic factor remains lingering in the Qi level throughout, one may hope for its expulsion through *Zhan Han* (Shivering Sweat), a method suitable for benefiting the Stomach, allowing the pathogen to exit with the sweat, heat to reach the exterior and pores to open, so that the pathogen leaves via sweating.
After resolution, the Stomach Qi is temporarily empty, leading to cold skin for about one day and night; once Qi returns, warmth will normalize as usual. This is because after resolution by shivering sweat, the pathogen retreats but Zheng Qi (Upright Qi) is deficient, and Yang Qi escapes with the sweat, hence the gradual cooling of the skin; this does not necessarily constitute a Collapse Syndrome immediately. At this time, the patient should rest quietly and comfortably to nourish the recovery of Yang Qi. Bystanders must not panic or frequently call out, disturbing the Yuan Qi (Original Qi). One should only examine the pulse: if it is weak, soft, and slow, although the patient lies tiredly without speaking, sweats, and has cold skin, it is not a Collapse Syndrome; however, if the pulse is rapid and urgent, accompanied by restlessness and inability to lie down, along with cold sweat, then it is indeed a Qi Collapse Syndrome. Furthermore, when the pathogen is excess and Zheng Qi is deficient, resolution may not occur after a single episode of shivering sweat; the condition may linger for one or two days before resolving upon a subsequent episode. This point must be understood.
Regarding Qi-level diseases that do not transmit to the Blood level but remain lingering in the San Jiao (Triple Burner), this is analogous to Shaoyang disease in Cold Damage disorders. In Shaoyang disease, the method is to harmonize the half-exterior and half-interior; here, the method is to distribute and eliminate the pathogenic factors from the upper, middle, and lower aspects. Treatment methods vary according to the syndrome: such as using modern common herbs like Xing Ren (Apricot Seed), Hou Po (Magnolia Bark), Ling Zhu (Poria), etc.; or formulas like Wendan Tang (Warm Gallbladder Decoction) which have a draining and dispersing action. Since the pathogen remains in the Qi level, there is still a pathway for expulsion via shivering sweat and a mechanism for transformation into malaria-like paroxysms.
Furthermore, if the San Jiao pathogen does not resolve from the exterior, it will inevitably lead to internal binding. Where does this internal binding occur? It occurs in the Yangming Stomach and Intestines. The purgative method (Xia Fa) must also be employed; one cannot claim it is inadvisable simply because the pathogen is in the Qi level rather than the Blood level. However, in Cold Damage, heat pathogens in the interior consume body fluids, so purgatives should be used vigorously; whereas in Damp-Warmth diseases, damp-heat usually clumps internally, so purgatives should be used mildly. In Cold Damage, loose stools indicate the pathogen has been exhausted, and purgatives should not be used again; in Damp-Warmth, loose stools indicate the pathogen is not yet exhausted, and purgation should only cease when the stool becomes hard, indicating the absence of dampness.
Regarding the human body, the Wan (Epigastrium) is located above the abdomen, in the central position. If pressing causes pain, or spontaneous pain, or a sensation of fullness and distension, bitter-draining methods (Ku Xie) should be used because the location is close to the abdomen. Tongue diagnosis is essential: if the coating is yellow or turbid, Xiaoxianxiong Tang (Small Trap Chest Decoction) or Xiexin Tang (Drain Heart Decoction) can be administered according to the syndrome. If the coating is white but not dry; or a mixture of yellow and white; or gray-white without thirst, bitter-draining drugs must absolutely not be given indiscriminately. Among these cases, some involve external pathogens unresolved while internal binding has already occurred; some involve stagnant pathogens unable to extend; some involve patients with inherent Spleen-Stomach cold; even if there is epigastric stuffiness and pain, an opening and draining method should be used to circulate Qi stagnation and guide it back to the Lung, using light, slightly bitter, and slightly acrid herbs with mobile properties, such as Xing Ren (Apricot Seed), Dou Kou (Cardamom), Ju Pi (Tangerine Peel), Jie Geng (Platycodon Root), etc., commonly used in recent times.
As mentioned earlier, if the tongue coating is yellow or turbid, Xianxiong Tang or Xiexin Tang should be used, provided the yellow color is rooted (firmly attached). If the tongue surface is smooth, it indicates formless damp-heat and signs of Middle Jiao deficiency; the aforementioned methods are strictly contraindicated. The area above the navel is the Greater Abdomen. If there is fullness, distension, or pain, the pathogen has definitely entered the interior, and exterior syndromes are likely absent or present in only 10-20%. Tongue diagnosis is also required here: if the coating is deeply yellow; like沉香 (Agarwood) color; like gray-yellow; old yellow; or has cracks in the center, purgatives should be used, such as Xiao Chengqi Tang (Minor Order the Qi Decoction), containing Bing Lang (Areca Seed), Qing Pi (Aged Tangerine Peel), Zhi Shi (Immature Bitter Orange), Yuan Ming Fen (Mirabilite), Sheng Shou Wu (Raw Polygonum Multiflorum), etc. If these tongue signs are not present, these drugs should not be used. There may be cases where dampness gathers in the Taiyin causing fullness; or cold-dampness complex causing pain; or Qi obstruction causing distension, which require different treatments.