（疟、痢、疸、痹附）
五四、湿热上焦未清，里虚内陷，神识如蒙，舌滑脉缓，人参泻心汤加白芍主之。
湿在上焦，若中阳不虚者，必始终在上焦，断不内陷；或因中阳本虚，或因误伤于药，其势必致
内陷。湿之中人也，首如裹，目如蒙，热能令人昏，故神识如蒙，此与热邪直入包络谵语神昏有间。
里虚故用人参护里阳，白芍以护真阴；湿陷于里，
故用干姜、枳实之辛通；湿中兼热，故用黄芩、黄连之苦降。此邪已内陷，其势不能还表，法用通降，从里治也。
人参泻心汤方（苦辛寒兼甘法）
人参（二钱） 干姜（二钱） 黄连（一钱五分） 黄芩（一钱五分） 枳实（一钱） 生白芍（二钱）
水五杯，煮取二杯，分二次服，渣再煮一杯服。
五五、湿热受自口鼻，由募原直走中道，不饥不食，机窍不灵，三香汤主之。
三香汤方（微苦微辛微寒兼芳香法）
栝蒌皮（三钱） 桔梗（三钱） 黑山栀（二钱） 枳壳（二钱） 郁金（二钱） 香豉（二钱） 降香末（三钱）
水五杯，煮取二杯，分二次温服。
〔方论〕按此证由上焦而来，其机尚浅，故用蒌皮、桔梗、枳壳微苦微辛开上，山栀轻浮微苦清
热，香豉、郁金、降香化中上之秽浊而开郁。上条以下焦为邪之出路，故用重；此条以上焦为邪之出
路，故用轻；以下三焦均受者，则用分消。彼此互
参，可以知叶氏之因证制方，心灵手巧处矣！惜散见于案中而人多不察，兹特为拈出，以概其余。
五六、吸受秽湿，三焦分布，热蒸头胀，身痛呕逆，小便不通，神识昏迷，舌白，渴不多饮，先宜
芳香通神利窍，安宫牛黄丸；续用淡渗分消浊湿，茯苓皮汤。
按此证表里经络脏腑三焦，俱为湿热所困，最畏内闭外脱，故急以牛黄丸宣窍清热而护神明；
但牛黄丸不能利湿分消，故继以茯苓皮汤。
安宫牛黄丸（方法见前）
茯苓皮汤（淡渗兼微辛微凉法）
茯苓皮（五钱） 生薏仁（五钱） 猪苓（三钱） 大腹皮（三钱） 白通草（三钱） 淡竹叶（二钱）
水八杯，煮取三杯，分三次服。
五七、阳明湿温，气壅为哕者，新制桔皮竹茹汤主之。
按《金匮》桔皮竹茹汤，乃胃虚受邪之治，今治湿热壅遏胃气致哕，不宜用参甘峻补，故改用柿
蒂。按柿成于秋，得阳明燥金之主气，且其形多方，他果未之有也，故治肺胃之病有独胜（肺之脏象属
金，胃之气运属金）。柿蒂乃柿之归束处，凡花皆散，凡子皆降，凡降先收，从生而散而收而降，皆一
蒂为之也，治逆呃之能事毕矣（再按∶草木一身，芦与蒂为升降之门户，载生气上升者芦也，受阴精归
藏者蒂也，格物者不可不于此会心焉）。
新制桔皮竹茹汤（苦辛通降法）
桔皮（三钱） 竹茹（三钱） 柿蒂（七枚） 姜汁（三茶匙，冲）
水五杯，煮取二杯，分二次温服；不知，再作服。有痰火者，加竹沥、栝蒌霜。有瘀血者，加
桃仁。
五八、三焦湿郁，升降失司，脘连腹胀，大便不爽，一加减正气散主之。
再按此条与上第五十六条同为三焦受邪，彼以分消开窍为急务，此以升降中焦为定法，各因见
证之不同也。
一加减正气散方
藿香梗（二钱） 浓朴（二钱） 杏仁（二钱） 茯苓皮（二钱） 广皮（一钱） 神曲（一钱五分） 麦
芽（一钱五分） 绵茵陈（二钱） 大腹皮（一钱）
水五杯，煮二杯，再服。
〔方论〕正气散本苦辛温兼甘法，今加减之，乃苦辛微寒法也。去原方之紫苏、白芷，无须发表
也。去甘桔，此证以中焦为扼要，不必提上焦也。只以藿香化浊，浓朴、广皮、茯苓、大腹泻湿满，加
杏仁利肺与大肠之气，神曲、麦芽升降脾胃之气，茵陈宣湿郁而动生发之气，藿香但用梗，取其走中
不走外也。茯苓但用皮，以诸皮皆凉，泻湿热独胜也。
五九、湿郁三焦，脘闷，便溏，身痛，舌白，脉象模糊，二加减正气散主之。
上条中焦病重，故以升降中焦为要。此条脘闷便溏，中焦证也，身痛舌白，脉象模糊，则经络证
矣，故加防己急走经络中湿郁；以便溏不比大便不爽，故加通草、薏仁，利小便所以实大便也；大豆黄
卷从湿热蒸变而成，能化蕴酿之湿热，而蒸变脾胃之气也。
二加减正气散（苦辛淡法）
藿香梗（三钱） 广皮（二钱） 浓朴（二钱） 茯苓皮（三钱） 木防己（三钱） 大豆黄卷（二钱）
川通草（一钱五分） 薏苡仁（三钱）
水八杯，煮三杯，三次服。
六十、秽湿着里，舌黄脘闷，气机不宣，久则酿热，三加减正气散主之。
前两法，一以升降为主，一以急宣经隧为主；此则以舌黄之故，预知其内已伏热，久必化热，而
身亦热矣，故加杏仁利肺气，气化则湿热俱化，滑石辛淡而凉，清湿中之热，合藿香所以宣气机之不宣也。
三加减正气散方（苦辛寒法）
藿香（连梗叶，三钱） 茯苓皮（三钱） 浓朴（二钱） 广皮（一钱五分） 杏仁（三钱） 滑石（
五钱）
水五杯，煮二杯，再服。
六一、秽湿着里，邪阻气分，舌白滑，脉右缓，四加减正气散主之。
以右脉见缓之故，知气分之湿阻，故加草果、楂肉、神曲，急运坤阳。使足太阴之地气不上蒸手
太阴之天气也。
四加减正气散方（苦辛温法）
藿香梗（三钱） 浓朴（二钱） 茯苓（三钱） 广皮（一钱五分） 草果（一钱） 楂肉（炒，五钱
）神曲（二钱）
水五杯，煮二杯，渣再煮一杯，三次服。
六二、秽湿着里，脘闷便泄，五加减正气散主之。
秽湿而致脘闷，故用正气散之香开；便泄而知脾胃俱伤，故加大腹运脾气，谷芽升胃气也。以上
二条，应入前寒湿类中，以同为加减正气散法，欲观者知化裁古方之妙，故列于此。
五加减正气散（苦辛温法）
藿香梗（二钱） 广皮（一钱五分） 茯苓块（三钱） 浓朴（二钱） 大腹皮（一钱五分） 谷芽（
一钱） 苍术（二钱）
水五杯，煮二杯，日再服。
按今人以藿香正气散，统治四时感冒，试问四时止一气行令乎？抑各司一气，且有兼气乎？况受
病之身躯脏腑，又各有不等乎？历观前五法，均用正气散，而加法各有不同，亦可知用药非丝丝入扣，不能中病
，彼泛论四时不正之气，与统治一切诸病之方，皆未望见轩岐之堂室者也，乌可云医乎！
六三、脉缓身痛，舌淡黄而滑，渴不多饮，或竟不渴，汗出热解，继而复热，内不能运水谷之湿，
外复感时令之湿，发表攻里，两不可施，误认伤寒，必转坏证，徒清热则湿不退，徒祛湿则热愈炽，黄
芩滑石汤主之。
脉缓身痛，有似中风，但不浮，舌滑不渴饮，则非中风矣。若系中风，汗出则身痛解而热不作矣；
今继而复热者，乃湿热相蒸之汗，湿属阴邪，其气留连，不能因汗而退，故继而复热。内不能运水谷
之湿，脾胃困于湿也；外复受时令之湿，经络亦困
于湿矣。倘以伤寒发表攻里之法施之，发表则诛伐无过之表，阳伤而成痉；攻里则脾胃之阳伤，而
成洞泄寒中，故必转坏证也。湿热两伤，不可偏治，故以黄芩、滑石、茯苓皮清湿中之热，蔻仁、
猪苓宣湿邪之正，再加腹皮、通草，共成宣气利小便之功，气化则湿化，小便利则火腑通而热自
清矣。
黄芩滑石汤方（苦辛寒法）
黄芩（三钱） 滑石（三钱） 茯苓皮（三钱） 大腹皮（二钱） 白蔻仁（一钱） 通草（一钱） 猪苓（三钱）
水六杯，煮取二杯，渣再煮一杯，分温三服。
六四、阳明湿温，呕而不渴者，小半夏加茯苓汤主之；呕甚而痞者，半夏泻心汤去人参、干姜、大
枣、甘草加枳实、生姜主之。
呕而不渴者，饮多热少也，故主以小半夏加茯苓，逐其饮而呕自止。呕而兼痞，热邪内陷，与饮
相抟，有固结不通之患，故以半夏泻心，去参、姜、甘、枣之补中，加枳实、生姜之宣胃也。
小半夏加茯苓汤
半夏（六钱） 茯苓（六钱） 生姜（四钱）
水五杯，煮取二杯，分二次服。
半夏泻心汤去人参干姜甘草大枣加枳实生姜方
半夏（六钱） 黄连（二钱） 黄芩（三钱） 枳实（三钱） 生姜（三钱）
水八杯，煮取三杯，分三次服，虚者复纳人参、大枣。
六五、湿聚热蒸，蕴于经络，寒战热炽，骨骱烦疼，舌色灰滞，面目萎黄，病名湿痹，宣痹汤主之。
经谓∶风寒湿三者合而为痹。《金匮》谓∶经热则痹。盖《金匮》诚补《内经》之不足。痹之因于寒
者固多，痹之兼乎热者，亦复不少，合参二经原文，细验于临证之时，自有权衡。本论因载湿温而类及
热痹，见湿温门中，原有痹证，不及备载痹证之全，学人欲求全豹，当于《内经》、《金匮》、喻氏、叶氏以
及宋元诸名家，合而参之自得。大抵不越寒热两条，虚实异治。寒痹势重而治反易，热痹势缓而治
反难，实者单病躯壳易治，虚者兼病脏腑夹痰饮腹满等证，则难治矣，犹之伤寒两感也。此条以舌灰
目黄，知其为湿中生热，寒战热炽，知其在经络；骨骱疼痛，知其为痹证。若泛用治湿之药，而不知循
经入络，则罔效矣。故以防己急走经络之湿，杏仁开肺气之先，连翘清气分之湿热，赤豆清血分之湿
热，滑石利窍而清热中之湿，山栀肃肺而泻湿中之热，薏苡淡渗而主挛痹，半夏辛平而主寒热，蚕砂
化浊道中清气，痛甚加片子姜黄、海桐皮者，所以宣络而止痛也。
宣痹汤方（苦辛通法）
防己（五钱） 杏仁（五钱） 滑石（五钱） 连翘（三钱） 山栀（三钱） 薏苡（五钱） 半夏（醋
炒，三钱） 晚蚕砂（三钱） 赤小豆皮（三钱，赤小豆乃五谷中之赤小豆，味酸肉赤，凉水浸取皮用。非
药肆中之赤小豆，药肆中之赤豆乃广中野豆，赤皮蒂黑肉黄，不入药者也）
水八杯，煮取三杯，分温三服。痛甚加片子姜黄二钱，海桐皮三钱。
六六、湿郁经脉，身热身痛，汗多自利，胸腹白疹，内外合邪，纯辛走表，纯苦清热，皆在所忌，
辛凉淡法，薏苡竹叶散主之。
上条但痹在经脉，此则脏腑亦有邪矣，故又立一法。汗多则表阳开，身痛则表邪郁，表阳开而不
解表邪，其为风湿无疑，盖汗之解者寒邪也，风为阳邪，尚不能以汗解，况湿为重浊之阴邪，故虽有
汗不解也。学人于有汗不解之证，当识其非风则湿，或为风湿相搏也。自利者小便必短，白疹者，
风湿郁于孙络毛窍。此湿停热郁之证，故主以辛凉解肌表之热，辛淡渗在里之湿，俾表邪从气化而
散。里邪从小便而驱，双解表里之妙法也，与下条互斟自明。
薏苡竹叶散方（辛凉淡法，亦轻以去实法）
薏苡（五钱） 竹叶（三钱） 飞滑石（五钱） 白蔻仁（一钱五分） 连翘（三钱） 茯苓块（五钱）白
通草（一钱五分）
共为细末，每服五钱，日三服。
六七、风暑寒湿，杂感混淆，气不主宣，咳嗽头胀，不饥舌白，肢体若废，杏仁薏苡汤主之。
杂感混淆，病非一端，乃以气不主宣四字为扼要。故以宣气之药为君。既兼雨湿中寒邪，自当
变辛凉为辛温。此条应入寒湿类中，列于此者，以其为上条之对待也。
杏仁薏苡汤（苦辛温法）
杏仁（三钱） 薏苡（三钱） 桂枝（五分） 生姜（七分） 浓
朴（一钱） 半夏（一钱五分） 防己（一钱五分） 白蒺藜（二钱）
水五杯，煮三杯，渣再煮一杯，分温三服。
六八、暑湿痹者，加减木防己汤主之
此治痹之祖方也。风胜则引，引者（吊痛掣痛之类，或上或下，四肢游走作痛，经谓行痹是也）加
桂枝、桑叶。湿胜则肿，肿者（土曰敦阜。加滑石、萆 、苍术。寒胜则痛，痛者加防己、桂枝、姜黄、海
桐皮。面赤口涎自出者（《灵枢》谓∶胃热则廉泉开。）重加石膏、知母。绝无汗者，加羌活、苍术，汗
多者加黄 、炙甘草。兼痰饮者，加半夏、浓朴、广皮。因不能备载全文，故以祖方加减如此，聊示门
径而已。
加减木防己汤（辛温辛凉复法）
防己（六钱） 桂枝（三钱） 石膏（六钱） 杏仁（四钱） 滑石（四钱） 白通草（二钱） 薏仁（三钱）
水八杯，煮取三杯，分温三服。见小效不即退者，加重服，日三夜一。
六九、湿热不解，久酿成疸，古有成法，不及备载，聊列数则，以备规矩（下疟、痢等证仿此）。
本论之作，原补前人之未备，已有成法可循者，安能尽录。因横列四时杂感，不能不列湿温，
连类而及，又不能不列黄胆、疟、痢，不过略标法则而已。按湿温门中，其证最多，其方最伙；盖土居
中位，秽浊所归，四方皆至，悉可兼证，故错综参伍，无穷极也。即以黄胆一证而言，《金匮》有辨证
三十五条，出治一十二方，先审黄之必发不发，在于小便之利与不利；疸之易治难治，在于口之渴与
不渴；再察瘀热入胃之因，或因外并，或因内发，或因食谷，或固酣酒，或因劳色，有随经蓄血，入水黄
(Attached: Malaria, Dysentery, Jaundice, Bi Syndrome)
54. When damp-heat in the Upper Jiao is not yet cleared, and internal deficiency causes the pathogen to sink inward, resulting in a sensation of mental clouding (Shen Shi Ru Meng), slippery tongue coating, and slow pulse, Ren Shen Xie Xin Tang (Ginseng Heart-Draining Decoction) with Bai Shao (White Peony Root) is the primary treatment.
When dampness resides in the Upper Jiao, if the Middle Jiao Yang is not deficient, the pathogen will remain in the Upper Jiao throughout and certainly will not sink inward; however, if it is due to inherent deficiency of Middle Jiao Yang, or injury caused by improper medication, the condition will inevitably lead to sinking inward. When dampness invades the human body, the head feels wrapped/heavy, and the eyes feel obscured/misty. Heat can cause drowsiness and confusion, hence the sensation of mental clouding. This differs from the delirium and coma caused by heat pathogens directly entering the Pericardium (Bao Luo).
Because of internal deficiency, Ren Shen (Ginseng) is used to protect the interior Yang, and Bai Shao (White Peony Root) to protect the True Yin. Because dampness has sunk into the interior, the acrid and unblocking properties of Gan Jiang (Dried Ginger) and Zhi Shi (Immature Bitter Orange) are employed. Because dampness is combined with heat, the bitter and descending properties of Huang Qin (Scutellaria Root) and Huang Lian (Coptis Rhizome) are used. Since this pathogen has already sunk inward, its momentum cannot return to the exterior; the method employs unblocking and descending, treating from the interior.
Ren Shen Xie Xin Tang Formula (Acrid-Bitter-Cold combined with Sweet Method)
Ren Shen (2 qian) Gan Jiang (2 qian) Huang Lian (1.5 qian) Huang Qin (1.5 qian) Zhi Shi (1 qian) Sheng Bai Shao (2 qian)
Boil five cups of water until two cups remain. Divide into two doses. Boil the dregs again for one cup.
55. Damp-heat enters via the mouth and nose, moving directly from the Mu Yuan (Sea of Origin) to the Middle Dao (Pathway), presenting as lack of appetite and no hunger, with impaired sensory orifices. San Xiang Tang (Three Fragrances Decoction) is the primary treatment.
San Xiang Tang Formula (Slightly Acrid-Slightly Bitter-Slightly Cold combined with Aromatic Method)
Gua Lou Pi (Trichosanthes Peel) (3 qian) Jie Geng (Platycodon Root) (3 qian) Hei Shan Zhi (Black Gardenia Fruit) (2 qian) Zhi Ke (Aurantium Fruit) (2 qian) Yu Jin (Curcuma Tuber) (2 qian) Xiang Chi (Fermented Soybean) (2 qian) Jiang Xiang Mo (Aquilaria Wood Powder) (3 qian)
Boil five cups of water until two cups remain. Divide into two warm doses.
[Formula Commentary] According to this syndrome, originating from the Upper Jiao, the pathology is still superficial. Therefore, Gua Lou Pi, Jie Geng, and Zhi Ke are used with slight bitterness and acridity to open the Upper Jiao; Shan Zhi is light, floating, slightly bitter, and clears heat; Xiang Chi, Yu Jin, and Jiang Xiang transform turbid qi in the Middle and Upper Jiao and open depression. The previous clause uses the Lower Jiao as the exit for the pathogen, so the medication is heavy; this clause uses the Upper Jiao as the exit, so the medication is light; if all three Jiaos are affected, the method of differentiation and elimination is used. Comparing them allows one to understand Ye Tianshi’s skill in formulating prescriptions based on syndromes. Alas, these are scattered in medical cases and often overlooked; here they are specifically highlighted to generalize the rest.
56. Inhalation of foul-dampness distributes across the three Jiaos. Heat steaming causes head distension, body pain, vomiting and regurgitation, urinary obstruction, mental coma, white tongue coating, thirst but little desire to drink. Initially, use aromatic methods to unblock the spirit and benefit the orifices: An Gong Niu Huang Wan (Calculus Bovis Pill); subsequently, use bland seeping methods to differentiate and eliminate turbid dampness: Fu Ling Pi Tang (Poria Peel Decoction).
According to this syndrome, the exterior, interior, meridians, zang-fu organs, and three Jiaos are all trapped by damp-heat. The greatest fear is internal closure and external collapse. Therefore, urgently use Niu Huang Wan to open orifices, clear heat, and protect the Spirit (Shen Ming); but Niu Huang Wan cannot promote urination to differentiate dampness, so subsequently use Fu Ling Pi Tang.
An Gong Niu Huang Wan (Method seen previously)
Fu Ling Pi Tang (Bland Seeping combined with Slightly Acrid-Slightly Cool Method)
Fu Ling Pi (Poria Peel) (5 qian) Sheng Yi Yi Ren (Raw Coix Seed) (5 qian) Zhu Ling (Polyporus) (3 qian) Da Fu Pi (Areca Peel) (3 qian) Bai Tong Cao (Tetrapanax Pith) (3 qian) Dan Zhu Ye (Lophatherum Leaf) (2 qian)
Boil eight cups of water until three cups remain. Divide into three doses.
57. In Yangming damp-warmth, where Qi stagnation leads to hiccups (Yue), Xin Zhi Jie Pi Zhu Ru Tang (Newly Modified Tangerine Peel and Bamboo Shavings Decoction) is the primary treatment.
According to the Jie Pi Zhu Ru Tang in *Jin Gui Yao Lue*, it treats stomach deficiency with pathogenic invasion. Now, treating hiccups caused by damp-heat obstructing Stomach Qi, strong tonification with Ren Shen (Ginseng) and Gan Cao (Licorice) is inappropriate; thus, Shi Di (Persimmon Calyx) is substituted. Persimmons mature in autumn, receiving the dominant Qi of Yangming Dry Metal. Their shape is multifaceted, unlike other fruits, giving them unique superiority in treating Lung and Stomach diseases (Lung’s organ image belongs to Metal, Stomach’s Qi movement belongs to Metal). Shi Di is the attachment point of the persimmon. Flowers scatter, fruits descend; descent requires prior gathering. From growth to scattering to gathering to descent, all are governed by one calyx, completing the function of treating rebellious Qi and hiccups. (Further note: In plants, the root/shoot and the calyx/seed are portals of ascending and descending. The shoot carries vital Qi upward; the calyx receives Yin essence for storage. Those who investigate things must appreciate this.)
Xin Zhi Jie Pi Zhu Ru Tang (Acrid-Bitter Unblocking and Descending Method)
Jie Pi (Tangerine Peel) (3 qian) Zhu Ru (Bamboo Shavings) (3 qian) Shi Di (Persimmon Calyx) (7 pieces) Jiang Zhi (Ginger Juice) (3 tea spoons, mixed in)
Boil five cups of water until two cups remain. Divide into two warm doses. If ineffective, prepare another dose. Add Zhu Li (Bamboo Sap) and Gua Lou Shuang (Trichosanthes Powder) for phlegm-fire. Add Tao Ren (Peach Kernel) for blood stasis.
58. Dampness stagnating in the three Jiaos, with loss of ascending and descending functions, causing epigastric distension extending to the abdomen and unsatisfactory bowel movements, Yi Jia Jian Zheng Qi San (Modified Upright Qi Powder No. 1) is the primary treatment.
Note: This clause and Clause 56 above both involve pathogen affecting the three Jiaos. The former prioritizes differentiation and opening orifices; this one prioritizes regulating the Middle Jiao. Each depends on the different manifestations.
Yi Jia Jian Zheng Qi San Formula
Huo Xiang Geng (Agastache Stem) (2 qian) Hou Po (Magnolia Bark) (2 qian) Xing Ren (Apricot Kernel) (2 qian) Fu Ling Pi (Poria Peel) (2 qian) Guang Pi (Tangerine Peel) (1 qian) Shen Qu (Medicated Leaven) (1.5 qian) Mai Ya (Malt) (1.5 qian) Mian Yin Chen (Artemisia Capillaris) (2 qian) Da Fu Pi (Areca Peel) (1 qian)
Boil five cups of water until two cups remain. Take again.
[Formula Commentary] Zheng Qi San is originally an Acrid-Bitter-Warm combined with Sweet method. The modification makes it Acrid-Bitter-Slightly Cold. Zi Su (Perilla Leaf) and Bai Zhi (Angelica Dahurica) are removed because releasing the exterior is unnecessary. Gan Cao (Licorice) and Jie Geng (Platycodon) are removed because this syndrome focuses on the Middle Jiao, making the Upper Jiao irrelevant. Huo Xiang transforms turbidity; Hou Po, Guang Pi, Fu Ling, and Da Fu Pi drain dampness and fullness; Xing Ren benefits Lung and Large Intestine Qi; Shen Qu and Mai Ya regulate Spleen and Stomach Qi; Yin Chen promotes dampness stagnation and stimulates rising Qi. Only Huo Xiang stem is used because it travels inward rather than outward. Only Poria peel is used because all peels are cool, excelling at draining damp-heat.
59. Dampness stagnating in the three Jiaos, epigastric stuffiness, loose stools, body pain, white tongue coating, and vague pulse, Er Jia Jian Zheng Qi San (Modified Upright Qi Powder No. 2) is the primary treatment.
The previous clause had severe Middle Jiao pathology, focusing on regulating the Middle Jiao. This clause has epigastric stuffiness and loose stools (Middle Jiao signs), plus body pain, white tongue coating, and vague pulse (Meridian signs). Therefore, Fang Ji (Stephania Root) is added to rapidly move dampness stagnation in the meridians. Because loose stools differ from unsatisfactory bowel movements, Tong Cao (Tetrapanax Pith) and Yi Yi Ren (Coix Seed) are added; promoting urination solidifies the stool. Da Dou Huang Juan (Soybean Sprout) is formed from damp-heat steaming and transformation, capable of resolving accumulated damp-heat and transforming Spleen-Stomach Qi.
Er Jia Jian Zheng Qi San (Acrid-Bitter-Bland Method)
Huo Xiang Geng (Agastache Stem) (3 qian) Guang Pi (Tangerine Peel) (2 qian) Hou Po (Magnolia Bark) (2 qian) Fu Ling Pi (Poria Peel) (3 qian) Mu Fang Ji (Stephania Tetrandra) (3 qian) Da Dou Huang Juan (Soybean Sprout) (2 qian) Chuan Tong Cao (Tetrapanax Pith) (1.5 qian) Yi Yi Ren (Coix Seed) (3 qian)
Boil eight cups of water until three cups remain. Divide into three doses.
60. Foul-dampness settling in the interior, yellow tongue coating, epigastric stuffiness, unventilated Qi mechanism, which over time brews heat, San Jia Jian Zheng Qi San (Modified Upright Qi Powder No. 3) is the primary treatment.
The first two methods focus on ascending/descending and rapidly venting meridians, respectively. This clause, due to the yellow tongue coating, anticipates latent heat inside, which will eventually transform into heat and cause fever. Therefore, Xing Ren (Apricot Kernel) is added to benefit Lung Qi; when Qi moves, damp-heat transforms together. Hua Shi (Talcum) is acrid, bland, and cool, clearing heat within dampness. Combined with Huo Xiang, it ventilates the stagnant Qi mechanism.
San Jia Jian Zheng Qi San Formula (Acrid-Bitter-Cold Method)
Huo Xiang (Agastache, including stem and leaf) (3 qian) Fu Ling Pi (Poria Peel) (3 qian) Hou Po (Magnolia Bark) (2 qian) Guang Pi (Tangerine Peel) (1.5 qian) Xing Ren (Apricot Kernel) (3 qian) Hua Shi (Talcum) (5 qian)
Boil five cups of water until two cups remain. Take again.
61. Foul-dampness settling in the interior, pathogen obstructing the Qi Division, white slippery tongue coating, right-side slow pulse, Si Jia Jian Zheng Qi San (Modified Upright Qi Powder No. 4) is the primary treatment.
Due to the slow pulse on the right side, dampness obstruction in the Qi Division is known. Therefore, Cao Guo (Tsaoko Fruit) and Zha Rou (Hawthorn Flesh) and Shen Qu (Medicated Leaven) are added to urgently transport Kun Yang (Spleen Earth Yang). This prevents the Earth Qi of Foot Taiyin (Spleen) from steaming up to the Heaven Qi of Hand Taiyin (Lung).
Si Jia Jian Zheng Qi San Formula (Acrid-Bitter-Warm Method)
Huo Xiang Geng (Agastache Stem) (3 qian) Hou Po (Magnolia Bark) (2 qian) Fu Ling (Poria) (3 qian) Guang Pi (Tangerine Peel) (1.5 qian) Cao Guo (Tsaoko Fruit) (1 qian) Zha Rou (Hawthorn Flesh, fried) (5 qian) Shen Qu (Medicated Leaven) (2 qian)
Boil five cups of water until two cups remain. Boil dregs again for one cup. Divide into three doses.
62. Foul-dampness settling in the interior, epigastric stuffiness, diarrhea, Wu Jia Jian Zheng Qi San (Modified Upright Qi Powder No. 5) is the primary treatment.
Foul-dampness causing epigastric stuffiness requires the aromatic opening of Zheng Qi San. Diarrhea indicates damage to both Spleen and Stomach. Therefore, Da Fu Pi (Areca Peel) is added to move Spleen Qi, and Gu Ya (Barley Sprout) to raise Stomach Qi. The above two clauses should belong to the Cold-Damp category, as they use the Modified Upright Qi Powder method. They are listed here to show readers the ingenuity of modifying ancient formulas.
Wu Jia Jian Zheng Qi San (Acrid-Bitter-Warm Method)
Huo Xiang Geng (Agastache Stem) (2 qian) Guang Pi (Tangerine Peel) (1.5 qian) Fu Ling Kuai (Poria Cubes) (3 qian) Hou Po (Magnolia Bark) (2 qian) Da Fu Pi (Areca Peel) (1.5 qian) Gu Ya (Barley Sprout) (1 qian) Cang Zhu (Atractylodes Rhizome) (2 qian)
Boil five cups of water until two cups remain. Take twice daily.
Note: Modern people use Huo Xiang Zheng Qi San to treat colds in all four seasons. I ask: Do the four seasons operate under a single Qi command? Or do they each govern their own Qi, with combinations? Moreover, the constitutions and organ states of patients vary. Observing the first five methods, all use Zheng Qi San, but the additions differ. This shows that medication must be precise to hit the target. Those who discuss irregular Qi of four seasons generally, or formulas claiming to rule all diseases, have not even glimpsed the hall of Xuanyuan and Qibo. How can they be called doctors!
63. Slow pulse, body pain, pale yellow slippery tongue coating, thirst but little desire to drink, or no thirst at all. Heat resolves after sweating but returns subsequently. Internally unable to transport dampness from food and water; externally re-infected by seasonal dampness. Neither releasing the exterior nor purging the interior is applicable. Mistaking this for Shang Han (Cold Damage) will surely lead to deteriorated syndromes. Merely clearing heat will not remove dampness; merely dispelling dampness will intensify heat. Huang Qin Hua Shi Tang (Scutellaria and Talcum Decoction) is the primary treatment.
Slow pulse and body pain resemble Feng Zhong (Wind Strike), but the pulse is not floating. Slippery tongue and no desire to drink indicate it is not Wind Strike. If it were Wind Strike, sweating would relieve body pain and prevent fever. The subsequent return of fever is sweat from damp-heat steaming. Dampness is a Yin pathogen with lingering nature, not resolved by sweat, hence fever returns. Internal inability to transport dampness means Spleen-Stomach is trapped by dampness; external seasonal dampness traps the meridians. Applying Shang Han methods of releasing exterior and purging interior would injure Wei Yang (causing spasms) or Spleen-Stomach Yang (causing severe diarrhea and cold center), leading to deteriorated syndromes. With both damp and heat injuring the body, neither can be treated exclusively. Huang Qin, Hua Shi, and Fu Ling Pi clear heat within dampness; Kou Ren (Cardamom Seed) and Zhu Ling (Polyporus) promote the proper flow of dampness. Added Da Fu Pi and Tong Cao complete the function of venting Qi and promoting urination. When Qi moves, dampness transforms; when urine flows, the Fire Fu (Small Intestine) opens and heat clears naturally.
Huang Qin Hua Shi Tang Formula (Acrid-Bitter-Cold Method)
Huang Qin (Scutellaria Root) (3 qian) Hua Shi (Talcum) (3 qian) Fu Ling Pi (Poria Peel) (3 qian) Da Fu Pi (Areca Peel) (2 qian) Bai Kou Ren (White Cardamom Seed) (1 qian) Tong Cao (Tetrapanax Pith) (1 qian) Zhu Ling (Polyporus) (3 qian)
Boil six cups of water until two cups remain. Boil dregs again for one cup. Divide into three warm doses.
64. Yangming damp-warmth, vomiting without thirst: Xiao Ban Xia Jia Fu Ling Tang (Minor Pinellia with Poria Decoction) is the primary treatment. Vomiting severely with palpable fullness (Pi): Ban Xia Xie Xin Tang (Pinellia Heart-Draining Decoction) with Ren Shen, Gan Jiang, Da Zao, and Gan Cao removed, and Zhi Shi and Sheng Jiang added, is the primary treatment.
Vomiting without thirst indicates more fluid retention and less heat. Thus, Xiao Ban Xia Jia Fu Ling Tang is used to expel fluid retention, stopping vomiting. Vomiting with palpable fullness indicates heat sinking inward, binding with fluid retention, causing blockage. Ban Xia Xie Xin Tang is used, removing the tonifying properties of Ren Shen, Gan Jiang, Gan Cao, and Da Zao, and adding Zhi Shi and Sheng Jiang to vent the Stomach.
Xiao Ban Xia Jia Fu Ling Tang
Ban Xia (Pinellia Tuber) (6 qian) Fu Ling (Poria) (6 qian) Sheng Jiang (Fresh Ginger) (4 qian)
Boil five cups of water until two cups remain. Divide into two doses.
Ban Xia Xie Xin Tang Modified (Remove Ren Shen, Gan Jiang, Gan Cao, Da Zao; Add Zhi Shi, Sheng Jiang)
Ban Xia (Pinellia Tuber) (6 qian) Huang Lian (Coptis Rhizome) (2 qian) Huang Qin (Scutellaria Root) (3 qian) Zhi Shi (Immature Bitter Orange) (3 qian) Sheng Jiang (Fresh Ginger) (3 qian)
Boil eight cups of water until three cups remain. Divide into three doses. For deficiency, add Ren Shen and Da Zao.
65. Dampness gathers, heat steams, accumulating in meridians. Chills and high fever, bone joint irritation and pain, grayish-stagnant tongue color, sallow complexion. Disease name: Shi Bi (Damp Bi). Xuan Bi Tang (Vent Bi Decoction) is the primary treatment.
The Classics state: Wind, Cold, and Dampness combine to form Bi. *Jin Gui* states: Heat in meridians causes Bi. *Jin Gui* indeed supplements *Nei Jing*. While many Bis are due to Cold, many also involve Heat. Comparing both classics and verifying clinically provides balance. This treatise mentions Re Bi (Heat Bi) alongside Shi Wen (Damp-Warmth). The Shi Wen section contains Bi syndromes but does not exhaustively list all Bis. Scholars seeking completeness should consult *Nei Jing*, *Jin Gui*, Yu Shi, Ye Shi, and Song-Yuan masters. Generally, it does not exceed Cold and Heat lines, treated differently by Deficiency and Excess. Cold Bi is severe but easier to treat; Heat Bi is mild but harder to treat. Excess cases involving only the body shell are easy; Deficiency cases involving organs, phlegm-fluid, and abdominal fullness are difficult, akin to Shang Han Liang Gan (Double Exposure). This clause: Gray tongue and yellow eyes indicate Heat born from Dampness; Chills and high fever indicate location in meridians; Bone joint pain indicates Bi syndrome. Using general damp-resolving drugs without following meridians and collaterals is ineffective. Therefore, Fang Ji rapidly moves dampness in meridians; Xing Ren opens Lung Qi first; Lian Qiao (Forsythia) clears Qi-level damp-heat; Chi Dou (Adzuki Bean) clears Blood-level damp-heat; Hua Shi benefits orifices and clears heat-damp; Shan Zhi (Gardenia)肃 (subdues) Lung and drains heat-damp; Yi Yi Ren (Coix Seed) is bland and seeping, treating spasmodic Bi; Ban Xia is acrid-ping and treats chills/fever; Can Sha (Silkworm Frass) transforms turbidity and clarifies Qi in the pathway. For severe pain, Pian Zi Jiang Huang (Turmeric) and Hai Tong Pi (Sapindus Bark) are added to vent collaterals and stop pain.
Xuan Bi Tang Formula (Acrid-Bitter Unblocking Method)
Fang Ji (Stephania Root) (5 qian) Xing Ren (Apricot Kernel) (5 qian) Hua Shi (Talcum) (5 qian) Lian Qiao (Forsythia) (3 qian) Shan Zhi (Gardenia) (3 qian) Yi Yi Ren (Coix Seed) (5 qian) Ban Xia (Pinellia, vinegar-fried) (3 qian) Wan Can Sha (Silkworm Frass) (3 qian) Chi Xiao Dou Pi (Adzuki Bean Skin) (3 qian, Adzuki bean is sour and red inside, soaked in cold water to take skin. Not the common red bean sold in pharmacies, which is wild bean from Guangdong, with black hilum and yellow flesh, not medicinal.)
Boil eight cups of water until three cups remain. Divide into three warm doses. For severe pain, add Pian Zi Jiang Huang (2 qian) and Hai Tong Pi (3 qian).
66. Dampness stagnating in meridians, body heat and pain, profuse sweating, spontaneous diarrhea, white rashes on chest and abdomen. Exterior and interior pathogens combine. Pure Acrid moving to exterior, Pure Bitter clearing heat, are both contraindicated. Use Acrid-Cool-Bland method. Yi Yi Zhu Ye San (Coix and Lophatherum Powder) is the primary treatment.
The previous clause had Bi only in meridians; this clause has pathogen in Zang-Fu as well, hence a new method. Profuse sweating opens Wei Yang; body pain indicates exterior pathogen stagnation. Wei Yang opens but exterior pathogen remains unresolved, undoubtedly Wind-Damp. Sweating resolves Cold pathogens; Wind is Yang pathogen and cannot be resolved by sweat alone; how much less Damp, a heavy-turbid Yin pathogen? Hence, sweat does not resolve it. Scholars should recognize that unresolved cases with sweat are either Wind or Damp, or Wind-Damp combining. Spontaneous diarrhea implies short urine. White rashes indicate Wind-Damp stagnating in Sun Luo (branch collaterals) and hair follicles. This is a case of Damp stagnation and Heat depression. Acrid-Cool resolves muscle-surface heat; Acrid-Bland seeps interior dampness. Exterior pathogen disperses through Qi transformation; interior pathogen drives out through urine. This is a wonderful method of dual resolution of exterior and interior, clarified by comparing with the next clause.
Yi Yi Zhu Ye San Formula (Acrid-Cool-Bland Method, also Light-to-Remove-Excess Method)
Yi Yi Ren (Coix Seed) (5 qian) Zhu Ye (Lophatherum Leaf) (3 qian) Fei Hua Shi (Flying Talcum) (5 qian) Bai Kou Ren (White Cardamom Seed) (1.5 qian) Lian Qiao (Forsythia) (3 qian) Fu Ling Kuai (Poria Cubes) (5 qian) Bai Tong Cao (Tetrapanax Pith) (1.5 qian)
Grind into fine powder. Take 5 qian per dose, three times daily.
67. Wind, Summer-heat, Cold, Dampness mixed and confused, Qi fails to vent. Cough, head distension, no appetite, white tongue coating, limbs seem useless. Xing Yi Tang (Apricot and Coix Decoction) is the primary treatment.
Mixed confusion presents various diseases, but "Qi fails to vent" is the key. Therefore, Qi-venting herbs are the sovereign. Since it combines rain-damp and Cold, Acrid-Cool should change to Acrid-Warm. This clause should belong to Cold-Damp, listed here as the counterpart to the previous clause.
Xing Yi Tang (Acrid-Bitter-Warm Method)
Xing Ren (Apricot Kernel) (3 qian) Yi Yi Ren (Coix Seed) (3 qian) Gui Zhi (Cinnamon Twig) (0.5 qian) Sheng Jiang (Fresh Ginger) (0.7 qian) Hou Po (Magnolia Bark) (1 qian) Ban Xia (Pinellia) (1.5 qian) Fang Ji (Stephania Root) (1.5 qian) Bai Ji Li (Tribulus Fruit) (2 qian)
Boil five cups of water until three cups remain. Boil dregs again for one cup. Divide into three warm doses.
68. Summer-heat Damp Bi: Jia Jian Mu Fang Ji Tang (Modified Stephania Decoction) is the primary treatment.
This is the ancestral formula for treating Bi. If Wind dominates causing pulling/pain (moving pain in limbs, Xing Bi), add Gui Zhi (Cinnamon Twig) and Sang Ye (Mulberry Leaf). If Damp dominates causing swelling (Earth called Dun Fu), add Hua Shi (Talcum), Bi Xie (Dioscorea Hypoglauca), and Cang Zhu (Atractylodes). If Cold dominates causing pain, add Fang Ji, Gui Zhi, Jiang Huang (Turmeric), and Hai Tong Pi. If face is red and saliva flows freely (Stomach Heat opens Lian Quan), heavily add Shi Gao (Gypsum) and Zhi Mu (Anemarrhena). If absolutely no sweat, add Qiang Huo (Notopterygium) and Cang Zhu; if profuse sweat, add Huang Qi (Astragalus) and Zhi Gan Cao (Honey-fried Licorice). If combined with Phlegm-Fluid, add Ban Xia, Hou Po, and Guang Pi. Due to space, only the ancestral formula modifications are shown to indicate the path.
Jia Jian Mu Fang Ji Tang (Acrid-Warm and Acrid-Cold Complex Method)
Fang Ji (Stephania Root) (6 qian) Gui Zhi (Cinnamon Twig) (3 qian) Shi Gao (Gypsum) (6 qian) Xing Ren (Apricot Kernel) (4 qian) Hua Shi (Talcum) (4 qian) Bai Tong Cao (Tetrapanax Pith) (2 qian) Yi Ren (Coix Seed) (3 qian)
Boil eight cups of water until three cups remain. Divide into three warm doses. If slight effect but not resolved, increase dose to three times daily and once at night.
69. Damp-heat unresolved, brewing into Jaundice over time. Ancient established methods exist, too numerous to record fully. Briefly listing several as rules (Subsequent Malaria, Dysentery, etc., follow this pattern).
This treatise aims to supplement predecessors' omissions. Where established methods exist, they cannot all be recorded. Because it lists miscellaneous infections of four seasons, Shi Wen must be included; by association, Huang Dan (Jaundice), Malaria, and Dysentery must be mentioned, merely marking principles. In the Shi Wen section, syndromes are most numerous and formulas most abundant. Earth occupies the central position, gathering turbidity; paths from all directions converge, allowing complex combinations, infinite in variety. Taking Jaundice as an example, *Jin Gui* has 35 diagnostic clauses and 12 formulas. First examine whether Jaundice will develop based on urination advantage/disadvantage; ease/difficulty of treatment depends on thirst/no thirst. Then observe causes of Stasis-Heat entering Stomach: external combination, internal generation, dietary intake, alcohol indulgence, labor/exhaustion, sexual excess, meridian-stored blood, or Water Jaundice...