二十一、少腹坚满，小便自利，夜热昼凉，大便闭，脉沉实者，蓄血也，桃仁承气汤主之，甚则抵
当汤。
少腹坚满，法当小便不利，今反自利，则非膀胱气闭可知。夜热者，阴热也；昼凉者，邪气隐伏
阴分也。大便闭者，血分结也。故以桃仁承气通血分之闭结也。若闭结太甚，桃仁承气不得行，则
非抵当不可，然不可轻用，不得不备一法耳。
桃仁承气汤方（苦辛咸寒法）
大黄（五钱） 芒硝（二钱） 桃仁（三钱） 当归（三钱） 芍药（三钱） 丹皮（三钱）
水八杯，煮取三杯，先服一杯，得下止后服，不知再服。
抵当汤方（飞走攻络苦咸法）
大黄（五钱） 虻虫（炙干为末，二十枚） 桃仁（五钱） 水蛭（炙干为末，五分）
水八杯，煮取三杯，先服一杯，得下止后服，不知再服。
二十二、温病脉，法当数，今反不数而濡小者，热撤里虚也。里虚下利稀水，或便脓血者，桃花汤主之。
温病之脉本数，因用清热药撤其热，热撤里虚，脉见濡小，下焦空虚则寒，即不下利，亦当温
补，况又下利稀水脓血乎！故用少阴自利，关闸不藏，堵截阳明法。
桃花汤方（甘温兼涩法）
赤石脂（一两，半整用煎，半为细末调） 炮姜（五钱） 白粳米（二合）
水八杯，煮取三杯，去渣，入石脂末一钱五分，分三次服。若一服愈，余勿服。虚甚者加人参。
二十三、温病七、八日以后，脉虚数，舌绛苔少，下利日数十行，完谷不化，身虽热者，桃花粥主之。
上条以脉不数而濡小，下利稀水，定其为虚寒而用温涩。此条脉虽数而日下数十行，至于完谷
不化，其里邪已为泄泻下行殆尽。完谷不化，脾阳下陷，火灭之象；脉虽数而虚，苔化而少，身虽余热
未退，亦虚热也，纯系关闸不藏见证，补之稍缓则脱。故改桃花汤为粥，取其逗留中焦之意，此条认
定完谷不化四字要紧。
桃花粥方（甘温兼涩法）
人参（三钱） 炙甘草（三钱） 赤石脂（六钱，细末） 白粳米（二合）
水十杯，先煮参、草得六杯，去渣，再入粳米煮得三杯，纳石脂末三钱，顿服之。利不止，再服第
二杯，如上法；利止停后服。或先因过用寒凉，脉不数，身不热者，加干姜三钱。
邪热不杀谷，亦有完谷一证，不可不慎，当于脉之虚实，并兼现之证辨之。
二十四、温病少阴下利，咽痛胸满心烦者，猪肤汤主之。
此《伤寒论》原文。按温病热入少阴，逼液下走，自利咽痛，亦复不少，故采录于此。柯氏云∶少
阴下利，下焦虚矣。少阴脉循喉咙，其支者出络心，注胸中，咽痛胸满心烦者，肾火不藏，循经而上
走于阳分也；阳并于上，阴并于下，火不下交于肾，水不上承于心，此未济之象。猪为水畜而津液在
肤，用其肤以除上浮之虚火，佐白蜜、白粉之甘，泻心润肺而和脾，滋化源，培母气，水升火降，上热
自除，而下利自止矣。
猪肤汤方（甘润法）
猪肤（一斤，用白皮从内刮去肥，令如纸薄）
上一味，以水一斗，煮取五升，去渣，加白蜜一升，白米粉五合，熬香，和令相得。
二十五、温病少阴咽痛者，可与甘草汤，不瘥者，与桔梗汤。
柯氏云∶但咽痛而无下利胸满心烦等证，但甘以缓之足矣。不瘥者，配以桔梗，辛以散之也。
其热微，故用此轻剂耳。
甘草汤方（甘缓法）
甘草（二两）
上一味，以水三升，煮取一升半，去渣，分温再服。
桔梗汤方（苦辛甘升提法）
甘草（二两） 桔梗（二两）
法同前。
二十六、温病入少阴，呕而咽中伤，生疮不能语，声不出者，苦酒汤主之。
王氏晋三云∶苦酒汤治少阴水亏不能上济君火，而咽生疮声不出者。疮者，疳也。半夏之辛
滑，佐以鸡子清之甘润，有利窍通声之功，无燥津涸液之虑；然半夏之功能，全赖苦酒，摄入阴分，劫
涎敛疮，即阴火沸腾，亦可因苦酒而降矣，故以为名。
苦酒汤方（酸甘微辛法）
半夏（制，二钱） 鸡子（一枚，去黄，纳上苦酒鸡子壳中）
上二味，纳半夏着苦酒中，以鸡子壳置刀环中，安火上，令三沸，去渣，少少含咽之。不瘥，更
作三剂。
二十七、妇女温病，经水适来，脉数耳聋，干
呕烦渴，辛凉退热，兼清血分，甚至十数日不解，邪陷发痉者，竹叶玉女煎主之。
此与两感证同法。辛凉解肌，兼清血分者，所以补上中焦之未备；甚至十数日不解，邪陷发痉，
外热未除，里热又急，故以玉女煎加竹叶，两清表里之热。
竹叶玉女煎方（辛凉合甘寒微苦法）
生石膏（六钱） 干地黄（四钱） 麦冬（四钱） 知母（二钱） 牛膝（二钱） 竹叶（三钱）
水八杯，先煮石膏、地黄得五杯，再入余四味，煮成二杯，先服一杯，候六时复之，病解停后服，不
解再服（上焦用玉女煎去牛膝者，以牛膝为下焦药，不得引邪深入也。兹在下焦，故仍用之）
二十八、热入血室，医与两清气血，邪去其半，脉数，余邪不解者，护阳和阴汤主之。
此系承上条而言之也。大凡体质素虚之人，驱邪及半，必兼护养元气，仍佐清邪，故以参、甘护元
阳，而以白芍、麦冬、生地，和阴清邪也。
护阳和阴汤方（甘凉甘温复法，偏于甘凉，即复脉汤法也）
白芍（五钱） 炙甘草（二钱） 人参（二钱） 麦冬（连心炒，二钱） 干地黄（炒，三钱）
水五杯，煮取二杯，分二次温服。
二十九、热入血室，邪去八、九，右脉虚数，暮微寒热者，加减复脉汤，仍用参主之。
此热入血室之邪少虚多。亦以复脉为主法。脉右虚数，是邪不独在血分，故仍用参以补气。暮
微寒热，不可认作邪实，乃气血俱虚，营卫不和之故。
加减复脉汤仍用参方
即于前复脉汤内，加人参三钱。
三十、热病经水适至，十余日不解，舌萎饮冷，心烦热，神气忽清忽乱，脉右长左沉，瘀热在
里也，加减桃仁承气汤主之。
前条十数日不解用玉女煎者，以气分之邪尚多，故用气血两解，此条以脉左沉，不与右之长同，
而神气忽乱，定其为蓄血，故以逐血分瘀热为急务也。
加减桃仁承气汤方（苦辛走络法）
大黄（制，三钱） 桃仁（炒，三钱） 细生地（六钱） 丹皮（四钱） 泽兰（二钱） 人中白（二钱）
水八杯，煮取三杯，先服一杯，候六时，得下黑血，下后神清渴减，止后服。不知，渐进。
按邵新甫云∶考热入血室，《金匮》有五法∶第一条主小柴胡，因寒热而用，虽经水适断，急提少
阳之邪，勿令下陷为最。第二条伤寒发热，经水适来，已现昼明夜剧，谵语见鬼，恐人认阳明实证，故
有无犯胃气及上二焦之戒。第三条中风寒热，经水适来，七、八日脉迟身凉，胸胁满如结胸状，谵语
者，显无表证，全露热入血室之候，自当急刺期门，使人知针力比药力尤捷。第四条阳明病下血谵
语，但头汗出，亦为热入血室，亦刺期门，汗出而愈。第五条明其一证而有别因为害，如痰潮上脘，
昏冒不知，当先化其痰，后除其热。仲景教人当知变通，故不厌推展其义，乃今人一遇是证，不辨热
入之轻重，血室之盈亏，遽与小柴胡汤，贻害必多。要之热甚而血瘀者，与桃仁承气及山甲、归尾
之属；血舍空而热者用犀角地黄汤，加丹参、木通之属；表邪未尽而表证仍兼者，不妨借温通为使；
血结胸，有桂枝红花汤，参入海蛤、桃仁之治；昏狂甚，进牛黄膏，调入清气化结之煎。再观叶案中有
两解气血燔蒸之玉女煎法；热甚阴伤，有育阴养气之复脉法；又有护阴涤热之缓攻法。先圣后贤，其
治条分缕析，学人审证定方，慎毋拘乎柴胡一法也。
三十一、温病愈后，嗽稀痰而不咳，彻夜不寐者，半夏汤主之。
此中焦阳气素虚之人，偶感温病，医以辛凉甘寒，或苦寒清温热，不知十衰七、八之戒，用药过
剂，以致中焦反停寒饮，令胃不和，故不寐也。《素问》云∶胃不和则卧不安，饮以半夏汤，覆杯则寐。
盖阳气下交于阴则寐，胃居中焦，为阳气下交之道路，中寒饮聚，致命阳气欲下交而无路可循，故不
寐也。半夏逐痰饮而和胃，秫米秉燥金之气而成。故能补阳明燥气之不及而渗其饮，饮退则胃和，寐
可立至，故曰覆杯则寐也。
半夏汤（辛甘淡法）
半夏（制，八钱） 秫米（二两，即俗所谓高粮是也，古人谓之稷，今或名为芦稷，如南方难得，则以
薏仁代之。）
水八杯，煮取三杯，分三次温服。
三十二、饮退则寐，舌滑，食不进者，半夏桂枝汤主之。
此以胃腑虽和，营卫不和，阳未卒复，故以前半夏汤合桂枝汤，调其营卫，和其中阳，自能食也。
半夏桂枝汤方（辛温甘淡法）
半夏（六钱） 秫米（一两） 白芍（六钱） 桂枝（四钱，虽云桂枝汤，却用小建中汤法。桂枝少于
白芍者，表里异治也） 炙甘草（一钱） 生姜（三钱） 大枣（去核，二枚）
水八杯，煮取三杯，分温三服。
三十三、温病解后，脉迟，身凉如水，冷汗自出者，桂枝汤主之。
此亦阳气素虚之体质，热邪甫退，即露阳虚。故以桂枝汤复其阳也。
桂枝汤方（见上焦篇。但此处用桂枝，分量与芍药等，不必多于芍药也；亦不必啜粥再令汗出，
即仲景以桂枝汤小和之法是也）
三十四、温病愈后，面色萎黄，舌淡，不欲饮水，脉迟而弦，不食者，小建中汤主之。
此亦阳虚之质也，故以小建中，小小建其中焦之阳气，中阳复则能食，能食则诸阳皆可复也。
小建中汤方（甘温法）
白芍（酒炒，六钱） 桂枝（四钱） 甘草（炙，三钱） 生姜（三钱） 大枣（去核，二枚） 胶饴
（五钱）
水八杯，煮取三杯，去渣，入胶饴，上火烊化，分温三服。
三十五、温病愈后，或一月，至一年，面微赤，脉数，暮热，常思饮不欲食者，五汁饮主之，牛乳饮
亦主之。病后肌肤枯燥，小便溺管痛，或微燥咳，或不思食，皆胃阴虚也，与益胃、五汁辈。
前复脉等汤，复下焦之阴，此由中焦胃用之阴不降，胃体之阳独亢，故以甘润法救胃用，配胃体，
则自然欲食，断不可与俗套开胃健食之辛燥药，致令燥咳成痨也。
五汁饮、牛乳饮方（并见前秋燥门）
益胃汤（见中焦篇）
按吴又可云∶病后与其调理不善，莫若静以待动。是不知要领之言也。夫病后调理，较易于治
病，岂有能治病，反不能调理之理乎！但病后调理，不轻于治病，若其治病之初，未曾犯逆，处处得
法，轻者三、五日而解，重者七、八日而解，解后无余邪，病者未受大伤，原可不必以药调理，但以饮
食调理足矣，经所谓食养尽之是也。若病之始受
既重，医者又有误表、误攻、误燥，误凉之弊，遗殃于病者之气血，将见外感变而为内伤矣。全赖医
者善补其过（谓未犯他医之逆；或其人阳素虚，阴素亏；或前因邪气太盛，故剂不得不重；或本虚邪
不能张，须随清随补之类）而补人之过（谓已犯前医之治逆），退杀气（谓余邪或药伤）；迎生气（或养
胃阴，或护胃阳，或填肾阴，或兼固肾阳，以迎其先后天之生气），活人于万全，岂得听之而已哉！万
一变生不测，推委于病者之家，能不愧于心乎！至调理大要，温病后一以养阴为主。饮食之坚硬浓
浓者，不可骤进。间有阳气素虚之体质，热病一退，即露旧亏，又不可固执养阴之说，而灭其阳火。
故本论中焦篇列益胃、增液、清燥等汤，下焦篇列复脉、三甲、五汁等复阴之法，乃热病调理之常理
也；下焦篇又列建中、半夏、桂枝数法，以为阳气素虚，或误伤凉药之用，乃其变也。经所谓∶“有者求
之，无者求之，微者责之，盛者责之”，全赖司其任者，心诚求之也。
21. If the lower abdomen is hard and full, urination is normal, there is fever at night but coolness during the day, constipation, and the pulse is deep and solid, this is Blood Stasis (Blood Accumulation). It should be treated with Tao Ren Cheng Qi Tang (Peach Kernel Decoction to Order the Qi); in severe cases, Di Dang Tang (Insect Decoction) is used.
When the lower abdomen is hard and full, according to the law, urination should be difficult. Now that it is normal, it is evident that this is not due to Qi blockage of the Bladder. Fever at night indicates Heat in the Yin aspect; coolness during the day indicates that the pathogenic factor is hidden in the Yin division. Constipation indicates binding in the Blood division. Therefore, Tao Ren Cheng Qi Tang is used to unblock the binding in the Blood division. If the binding is too severe for Tao Ren Cheng Qi Tang to act, then only Di Dang Tang will suffice. However, this should not be used lightly; it is merely kept as a reserve method.
Tao Ren Cheng Qi Tang Formula (Bitter, Acrid, Salty, Cold Method)
Da Huang (Rhubarb Root and Rhizome), Wu Qian; Mang Xiao (Mirabilite), Er Qian; Tao Ren (Peach Seed), San Qian; Dang Gui (Chinese Angelica Root), San Qian; Shao Yao (White Peony Root), San Qian; Dan Pi (Moutan Cortex), San Qian.
Boil eight cups of water until three cups remain. Take one cup first; if defecation occurs, stop taking the rest. If not effective, take again.
Di Dang Tang Formula (Flying and Moving, Collateral-Attacking, Bitter and Salty Method)
Da Huang (Rhubarb Root and Rhizome), Wu Qian; Meng Chong (Blister Beetle, dried and powdered), twenty pieces; Tao Ren (Peach Seed), Wu Qian; Shui Zhi (Leech, dried and powdered), Wu Fen.
Boil eight cups of water until three cups remain. Take one cup first; if defecation occurs, stop taking the rest. If not effective, take again.
22. In Warm Diseases, the pulse should normally be rapid. If it is now not rapid but rather soggy and small, it indicates that the Heat has retreated but the Interior is deficient. If Interior deficiency leads to diarrhea with watery stool, or dysentery with pus and blood, Tao Hua Tang (Peach Blossom Decoction) should be used.
The pulse in Warm Diseases is originally rapid. Because heat-clearing medicines were used to retreat the Heat, the Heat has retreated but the Interior is now deficient, resulting in a soggy and small pulse. Deficiency in the Lower Jiao generates Cold. Even without diarrhea, warming and tonification are indicated, let alone when accompanied by watery diarrhea and pus-blood stools. Therefore, the method for Shaoyin self-diarrhea, where the "gate" fails to store, and blocking the Yangming is employed.
Tao Hua Tang Formula (Sweet, Warm, and Astringent Method)
Chi Shi Zhi (Red Halloysite), Liang Yi (half boiled whole, half ground into powder for mixing); Pao Jiang (Prepared Ginger), Wu Qian; Bai Jing Mi (White Glutinous Rice), Er He.
Boil eight cups of water until three cups remain. Remove the dregs, add Chi Shi Zhi powder, Yi Qian Wu Fen, and divide into three doses. If cured after one dose, do not take the rest. For severe deficiency, add Ren Shen (Ginseng Root).
23. After seven or eight days of a Warm Disease, if the pulse is deficient and rapid, the tongue is crimson with little coating, there is diarrhea dozens of times a day with undigested food, and although the body is still hot, Tao Hua Zhou (Peach Blossom Porridge) should be used.
In the previous clause, because the pulse was not rapid but soggy and small, with watery diarrhea, it was determined to be Cold-Deficiency, hence the use of warming and astringent methods. In this clause, although the pulse is rapid, the diarrhea occurs dozens of times a day leading to undigested food, indicating that the Interior pathogens have been largely expelled downward via diarrhea. Undigested food indicates Spleen Yang sinking, resembling extinguished fire. Although the pulse is rapid yet deficient, the coating is shed and scant, and although residual Heat remains in the body, it is also Deficient Heat. This purely presents as failure of the "gate" to store. If tonification is slightly delayed, collapse may occur. Therefore, Tao Hua Tang is changed to porridge, aiming to retain it in the Middle Jiao. The four characters "undigested food" are crucial in identifying this clause.
Tao Hua Zhou Formula (Sweet, Warm, and Astringent Method)
Ren Shen (Ginseng Root), San Qian; Zhi Gan Cao (Honey-fried Licorice Root), San Qian; Chi Shi Zhi (Red Halloysite), Liu Qian, finely powdered; Bai Jing Mi (White Glutinous Rice), Er He.
Boil ten cups of water, first boiling Ren Shen and Gan Cao until six cups remain. Remove dregs, add Bai Jing Mi, and boil until three cups remain. Add Shi Zhi powder, San Qian, and take all at once. If diarrhea does not stop, take the second cup as above; stop if diarrhea ceases. If previously caused by overuse of cold-cooling medicines, resulting in a non-rapid pulse and no body heat, add Gan Jiang (Dried Ginger), San Qian.
Heat failing to digest food can also present as undigested food; caution is required. Differentiation must be made based on the deficiency or excess of the pulse and accompanying symptoms.
24. In Warm Diseases involving Shaoyin, with diarrhea, sore throat, chest fullness, and irritability, Zhu Fu Tang (Pig Skin Decoction) should be used.
This is the original text from Shanghan Lun. According to research, in Warm Diseases, when Heat enters Shaoyin and forces fluids downward, causing spontaneous diarrhea and sore throat, it is quite common, so it is recorded here. Ke states: Shaoyin diarrhea indicates Lower Jiao deficiency. The Shaoyin meridian runs along the throat, and its branch emerges to connect with the Heart and enter the Chest. Sore throat, chest fullness, and irritability indicate Kidney Fire failing to hide, moving upward along the meridian to the Yang aspect. Yang gathers above, Yin gathers below; Fire does not descend to communicate with the Kidney, Water does not ascend to nourish the Heart. This is the image of Water and Fire not interacting. The pig is an aquatic animal, and its fluid resides in the skin. Using its skin removes floating Deficient Fire. Assisted by the sweetness of White Honey and White Flour, it drains Heart Heat, moistens Lung Dryness, harmonizes the Spleen, nourishes the source of transformation, and cultivates maternal Qi. When Water ascends and Fire descends, Upper Heat is naturally removed, and diarrhea stops.
Zhu Fu Tang Formula (Sweet and Moistening Method)
Zhu Fu (Pig Skin), Jin Yi (one jin). Scrape off the fat from the inside until thin as paper.
Take this single ingredient, boil in ten dou of water until five sheng remain. Remove dregs, add one sheng of White Honey and five he of White Rice Flour, cook until fragrant, and mix well.
25. In Warm Diseases involving Shaoyin, if there is only a sore throat, Gan Cao Tang (Licorice Decoction) may be given. If not cured, Ge Geng Tang (Kudzu Root Decoction) is given.
Ke states: If there is only a sore throat without diarrhea, chest fullness, or irritability, using sweet herbs to relieve tension is sufficient. If not cured, combine with Ge Gen (Kudzu Root) to disperse with acridity. Since the Heat is mild, these light agents are used.
Gan Cao Tang Formula (Sweet and Relieving Method)
Gan Cao (Licorice Root), Liang Er.
Take this single ingredient, boil in three sheng of water until one and a half sheng remain. Remove dregs, divide into two warm doses.
Ge Geng Tang Formula (Bitter, Acrid, Sweet, and Ascending Method)
Gan Cao (Licorice Root), Liang Er; Ge Gen (Kudzu Root), Liang Er.
Method is the same as above.
26. In Warm Diseases entering Shaoyin, if there is vomiting, injury to the throat, sores in the throat, inability to speak, and loss of voice, Ku Jiu Tang (Vinegar Decoction) should be used.
Wang Shiyisan states: Ku Jiu Tang treats Shaoyin Water deficiency failing to assist Ministerial Fire, causing throat sores and loss of voice. Sores refer to ulcers. The acridity and slipperiness of Ban Xia (Pinellia Tuber), assisted by the sweetness and moisture of Ji Zi Qing (Egg White), have the function of opening orifices and restoring voice without drying fluids. However, the function of Ban Xia relies entirely on Ku Jiu (Vinegar) to enter the Yin division, seize phlegm, and astringe sores. Even if Yin Fire boils, it can be subdued by Vinegar, hence the name.
Ku Jiu Tang Formula (Sour, Sweet, and Slightly Acrid Method)
Ban Xia (Prepared Pinellia Tuber), Er Qian; Ji Zi (Chicken Egg, one piece, remove yolk, place vinegar and Ban Xia in the shell).
Place the two ingredients, putting Ban Xia into the vinegar. Place the eggshell in a knife ring, set over fire, boil three times. Remove dregs, hold in mouth and swallow slowly. If not cured, prepare three more doses.
27. In women with Warm Diseases, if menstruation arrives, accompanied by rapid pulse, deafness, dry retching, irritability, and thirst, and even after ten or more days the condition does not resolve, with pathogenic factors sinking inward causing spasms, Zhu Ye Yu Nu Jian (Bamboo Leaf Jade Woman Decoction) should be used.
This follows the same method as Liang Gan Syndrome (Simultaneous Taiyang and Shaoyin involvement). Using Acrid-Cool to release the muscle layer and clear the Blood division supplements the inadequacy of treating the Upper and Middle Jiao. When unresolved for ten or more days, with pathogenic factors sinking inward causing spasms, external Heat remaining and Internal Heat urgent, Zhu Ye Yu Nu Jian clears both Exterior and Interior Heat.
Zhu Ye Yu Nu Jian Formula (Acrid-Cool combined with Sweet-Cold and Slightly Bitter Method)
Sheng Shi Gao (Raw Gypsum Fibrosum), Liu Qian; Gan Di Huang (Rehmannia Root), Si Qian; Mai Dong (Ophiopogon Tuber), Si Qian; Zhi Mu (Anemarrhena Rhizome), Er Qian; Niu Xi (Achyranthes Root), Er Qian; Zhu Ye (Bamboo Leaf), San Qian.
Boil eight cups of water, first boiling Shi Gao and Di Huang until five cups remain. Add the remaining four ingredients, boil until two cups remain. Take one cup first, wait six hours, then take again. Stop if the disease resolves; continue if not. (Note: In Upper Jiao applications of Yu Nu Jian, Niu Xi is omitted because it is a Lower Jiao herb and should not guide pathogens deeper. Here, since it is in the Lower Jiao, it is retained.)
28. When Heat enters the Blood Chamber, and the physician uses simultaneous clearing of Qi and Blood, removing half the pathogen, but the pulse remains rapid and residual pathogens persist, Hu Yang He Yin Tang (Protect Yang and Harmonize Yin Decoction) should be used.
This continues from the previous clause. Generally, for individuals with constitutionally weak bodies, when expelling pathogens halfway, one must simultaneously protect Yuan Qi while assisting in clearing pathogens. Thus, Ren Shen and Gan Cao protect Yuan Yang, while Bai Shao, Mai Dong, and Di Huang harmonize Yin and clear pathogens.
Hu Yang He Yin Tang Formula (Sweet-Cold and Sweet-Warm Combined Method, leaning towards Sweet-Cold, i.e., Fu Mai Tang Method)
Bai Shao (White Peony Root), Wu Qian; Zhi Gan Cao (Honey-fried Licorice Root), Er Qian; Ren Shen (Ginseng Root), Er Qian; Mai Dong (Ophiopogon Tuber, heart-mind removed and stir-fried), Er Qian; Gan Di Huang (Rehmannia Root, stir-fried), San Qian.
Boil five cups of water until two cups remain. Divide into two warm doses.
29. When Heat enters the Blood Chamber, and eight or nine parts of the pathogen are gone, with a deficient and rapid right pulse, and slight chills and fever in the evening, Jia Jian Fu Mai Tang (Modified Pulse-Recovering Decoction) with Ren Shen as the main ingredient should be used.
This indicates that in Heat entering the Blood Chamber, the pathogen is less and deficiency is greater. Fu Mai Tang is still the primary method. A deficient and rapid right pulse indicates the pathogen is not solely in the Blood division, so Ren Shen is still used to tonify Qi. Slight chills and fever in the evening should not be mistaken for Excess Pathogen; it is due to deficiency of both Qi and Blood, and disharmony of Ying and Wei.
Jia Jian Fu Mai Tang with Ren Shen Formula
Add Ren Shen, San Qian, to the previous Fu Mai Tang.
30. In Heat Diseases where menstruation arrives, unresolved for ten or more days, with a shriveled tongue, desire for cold drinks, irritability and heat, sudden clarity and confusion of spirit, and a long right pulse and deep left pulse, this is Stagnant Heat in the Interior. Jia Jian Tao Ren Cheng Qi Tang (Modified Peach Kernel Decoction to Order the Qi) should be used.
In the previous clause, unresolved for ten or more days was treated with Yu Nu Jian because there was still much Qi-level pathogen, thus using simultaneous Qi and Blood resolution. In this clause, because the left pulse is deep, differing from the long right pulse, and the spirit is suddenly confused, it is determined as Blood Stasis. Therefore, urgently expelling Stagnant Heat from the Blood division is the priority.
Jia Jian Tao Ren Cheng Qi Tang Formula (Bitter, Acrid, and Collateral-Traversing Method)
Da Huang (Rhubarb Root and Rhizome, prepared), San Qian; Tao Ren (Peach Seed, fried), San Qian; Xi Di Huang (Fine Rehmannia Root), Liu Qian; Dan Pi (Moutan Cortex), Si Qian; Ze Lan (Lycopus Herb), Er Qian; Ren Zhong Bai (Human Ash), Er Qian.
Boil eight cups of water until three cups remain. Take one cup first, wait six hours. If black blood is passed, and spirit clears and thirst reduces after passing, stop taking the rest. If not effective, increase dosage gradually.
According to Shao Xinpu: Examining Heat entering the Blood Chamber, Jingui Yaolue has five methods: The first primarily uses Xiao Chai Hu Tang (Minor Bupleurum Decoction) for chills and fever; although menstruation has just stopped, urgently extracting Shaoyang pathogen prevents sinking inward, which is best. The second is Shaoyin fever with menstruation arriving, presenting with clarity by day and worsening by night, delirium seeing ghosts; fearing misdiagnosis as Yangming Excess, there is a warning against violating Stomach Qi and the Upper Two Jiaos. The third is Wind-Cold with fever, menstruation arriving, pulse slow and body cool after seven-eight days, chest and hypochondriac fullness like Jie Xiong syndrome, delirious; clearly no Exterior syndrome, fully revealing Heat entering Blood Chamber signs, requiring urgent puncture of Qi Men (LR14) to show acupuncture is faster than medicine. The fourth is Yangming disease with bleeding and delirium, only head sweating; also Heat entering Blood Chamber, also puncturing Qi Men, curing with sweat. The fifth clarifies one syndrome with other causes, such as Phlegm flooding the Upper Jiao causing coma; one must first resolve Phlegm, then clear Heat. Zhang Zhongjing taught people to know flexibility, endlessly expanding meanings. Yet modern practitioners, upon encountering this syndrome, do not distinguish the severity of Heat entry or the fullness/emptiness of the Blood Chamber, rashly using Xiao Chai Hu Tang, causing much harm. In summary, for severe Heat and Blood Stasis, use Tao Ren Cheng Qi Tang plus Shan Jia (Pig Spicule) and Gui Wei (Angelica Tail); for empty Blood chamber with Heat, use Xi Jiao Di Huang Tang (Rhino Horn and Rehmannia Decoction) plus Dan Shen (Salvia Root) and Mu Tong (Akebia Stem); for incomplete Exterior pathogens with Exterior signs, borrowing Warm-Moving agents is acceptable; for Blood Jie Xiong, Gui Zhi Hong Hua Tang (Cinnamon Twig and Safflower Decoction) plus Hai Ge (Clam Shell) and Tao Ren; for severe coma and mania, advance Niu Huang Gao (Calculus Bovis Paste) mixed with Qing Qi Hua Jie decoction. Observing Ye Tianshi's cases, there is Yu Nu Jian for simultaneous clearing of Qi and Blood blazing; for severe Heat injuring Yin, Fu Mai Tang for nourishing Yin and tonifying Qi; and for protecting Yin and washing out Heat, a mild purgative method. Ancient sages and later worthies analyzed treatments meticulously. Students determining formulas based on syndromes must not stick to the Chai Hu method alone.
31. After recovery from a Warm Disease, if there is coughing of thin phlegm without actual coughing, and insomnia throughout the night, Ban Xia Tang (Pinellia Decoction) should be used.
This applies to individuals with constitutionally deficient Middle Jiao Yang who accidentally contract a Warm Disease. Physicians used Acrid-Cool Sweet-Cold or Bitter-Cold to clear Warm-Heat, ignoring the warning of "ten deficiencies, seven or eight remaining," leading to excessive medication. This causes Cold-Fluid retention in the Middle Jiao, disturbing the Stomach, hence insomnia. Suwen states: "If the Stomach is disturbed, sleep is uneasy." Drinking Ban Xia Tang allows sleep immediately after placing the cup down.
When Yang Qi descends to interact with Yin, sleep occurs. The Stomach is in the Middle Jiao, the pathway for Yang Qi to descend. Accumulation of Cold-Fluid in the Middle blocks this path, preventing Yang from descending, hence insomnia. Ban Xia expels Phlegm-Fluid and harmonizes the Stomach. Shu Mi (Sorghum) is formed bearing the Qi of Dry Metal, thus supplementing the insufficiency of Yangming Dry Qi and渗 (seeping/drainage) its Fluid. When Fluid recedes, the Stomach harmonizes, and sleep arrives immediately, hence "sleep upon placing the cup."
Ban Xia Tang Formula (Acrid, Sweet, and Pale Method)
Ban Xia (Prepared Pinellia Tuber), Ba Qian; Shu Mi (Sorghum), Liang Er (commonly known as Sorghum, anciently called Ji, now sometimes Lu Ji; if rare in the South, replace with Yi Ren (Coix Seed)).
Boil eight cups of water until three cups remain. Divide into three warm doses.
32. When Fluid recedes allowing sleep, but the tongue is slippery and appetite is poor, Ban Xia Gui Zhi Tang (Pinellia and Cinnamon Twig Decoction) should be used.
Although the Stomach腑 is harmonized, Ying and Wei are disharmonious, and Yang has not fully recovered. Therefore, combining the previous Ban Xia Tang with Gui Zhi Tang harmonizes Ying and Wei and warms Middle Yang, restoring appetite.
Ban Xia Gui Zhi Tang Formula (Acrid-Warm, Sweet, and Pale Method)
Ban Xia (Pinellia Tuber), Liu Qian; Shu Mi (Sorghum), Yi Liang; Bai Shao (White Peony Root), Liu Qian; Gui Zhi (Cinnamon Twig), Si Qian (Although named Gui Zhi Tang, it uses the method of Xiao Jian Zhong Tang. Gui Zhi is less than Bai Shao because Exterior and Interior treatments differ); Zhi Gan Cao (Honey-fried Licorice Root), Yi Qian; Sheng Jiang (Fresh Ginger), San Qian; Da Zao (Jujube, pitted), Er Mei.
Boil eight cups of water until three cups remain. Divide into three warm doses.
33. After resolution of a Warm Disease, if the pulse is slow, the body is cool as water, and cold sweat flows spontaneously, Gui Zhi Tang (Cinnamon Twig Decoction) should be used.
This also applies to constitutionally Yang-deficient individuals. As soon as Heat pathogens retreat, Yang deficiency is revealed. Thus, Gui Zhi Tang is used to restore Yang.
Gui Zhi Tang Formula (See Upper Jiao Chapter. But here, Gui Zhi is used in equal amount to Shao Yao, not necessarily more; nor is it necessary to drink porridge to induce sweat. This is Zhang Zhongjing's method of "smallly harmonizing" with Gui Zhi Tang.)
34. After recovery from a Warm Disease, if the complexion is sallow, the tongue is pale, there is no desire to drink, the pulse is slow and wiry, and there is no appetite, Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) should be used.
This is also a Yang-deficient constitution. Thus, Xiao Jian Zhong Tang is used to slightly construct Middle Jiao Yang. Once Middle Yang recovers, appetite returns; with appetite, all Yang can recover.
Xiao Jian Zhong Tang Formula (Sweet and Warm Method)
Bai Shao (White Peony Root, wine-fried), Liu Qian; Gui Zhi (Cinnamon Twig), Si Qian; Gan Cao (Licorice Root, honey-fried), San Qian; Sheng Jiang (Fresh Ginger), San Qian; Da Zao (Jujube, pitted), Er Mei; Jiao Yi (Maltose), Wu Qian.
Boil eight cups of water until three cups remain. Remove dregs, add Jiao Yi, melt over fire, divide into three warm doses.
35. After recovery from a Warm Disease, whether one month or up to a year later, if the face is slightly red, the pulse is rapid, there is evening fever, frequent desire to drink but no desire to eat, Wu Zhi Yin (Five Juice Drink) should be used; Niu Nai Yin (Cow Milk Drink) is also used. Post-illness dry skin, pain in the urethra during urination, slight dry cough, or lack of appetite are all due to Stomach Yin Deficiency. Provide Yi Wei Tang (Benefit the Stomach Decoction) or Wu Zhi Yin.
Previous Fu Mai Tang etc. restored Lower Jiao Yin. This case involves Middle Jiao Stomach Use Yin failing to descend, while Stomach Body Yang stands alone in hyperactivity. Thus, Sweet-Moistening method saves Stomach Use and pairs with Stomach Body, naturally restoring appetite. One must absolutely avoid vulgar Acrid-Dry stomach-opening and appetite-stimulating drugs, which cause dry cough progressing to consumption (Lao).
Wu Zhi Yin and Niu Nai Yin Formulas (See Autumn Dryness Chapter).
Yi Wei Tang (See Middle Jiao Chapter).
According to Wu Youke: Regarding post-illness care, rather than poor regulation, it is better to wait quietly for movement. This is ignorant talk. Post-illness regulation is easier than treating illness; how can one treat illness but not regulate? However, post-illness regulation is not lighter than treatment. If the initial treatment had no errors, every step appropriate, mild cases resolve in 3-5 days, severe in 7-8 days. With no residual pathogens and no major damage to the patient, medication for regulation is unnecessary; dietary regulation suffices, as stated in the Classics: "Nourish with food to complete the cure." If the initial illness was severe, and the physician committed errors in exterior-releasing, purging, drying, or cooling, damaging the patient's Qi and Blood, external contraction becomes internal injury. It relies entirely on the physician to make up for their own mistakes (not violating other doctors' treatments; or the person's inherent Yang/Yin deficiency; or previous heavy dosing due to strong pathogens; or tonifying while clearing for root deficiency) and the patient's mistakes (violating previous doctors' treatments), reduce killing Qi (residual pathogens or drug injury), and welcome generating Qi (nourishing Stomach Yin, protecting Stomach Yang, filling Kidney Yin, or securing Kidney Yang to welcome congenital and acquired generating Qi), saving lives completely. How can one just let it be? If unpredictable changes occur and blame is shifted to the family, can one not feel ashamed? The general principle of regulation is that post-Warm Disease focuses mainly on nourishing Yin. Hard and rich foods should not be introduced abruptly. In rare cases of constitutionally Yang-deficient bodies, where old deficiencies appear as soon as Heat retreats, one must not rigidly adhere to nourishing Yin and extinguish Yang Fire. Thus, in the Middle Jiao Chapter, Yi Wei, Zeng Ye, Qing Zao etc. are listed; in the Lower Jiao Chapter, Fu Mai, San Jia, Wu Zhi etc. are listed for Yin recovery—this is the constant principle. The Lower Jiao Chapter also lists Jian Zhong, Ban Xia, Gui Zhi methods for those with inherent Yang deficiency or injury from cooling drugs—this is the variation. The Classics say: "Seek what exists, seek what does not exist; blame the minor, blame the severe." It all depends on the practitioner sincerely seeking it.