此一卷，首论结胸与痞。盖病发于阳，下之早，即为结胸；发于阴，下之早，即
为痞。然结胸与痞相似，但以痛不痛为异耳。心下满而硬痛者为结胸，但按之满不痛者为痞
。医家不审，一有差互，立致危殆。结胸属陷胸证，痞属泻心证，其详各于逐问备论之矣。
（七十五）问心下紧满，按之石硬而痛
此名结胸也。伤寒本无结胸，应身热下之早，热气乘虚而入，痞结不散，便成结
胸。若已误转了，初未成结胸者，急频与理中汤服（正七十四），自然解了，更不
作
结胸，盖理中治中焦故也。此古人亦说不到，后人因消息得之。若大段转损，有厥证者，兼
与四逆汤（正七十五）便安。胃中虽和，伤寒未退者，即候日数足，可下，却以承气再下之，（正四十二）
盖前来下得未是故也。其证心下紧满，按之石硬而痛，项强如柔 状
（发热汗出不恶寒，名曰柔 ）。其脉寸口浮，关尺皆沉，或沉紧，名曰
结胸也。治结胸，大率当下（仲景云∶下之则和）。然脉浮与大，皆不
可下，下之则死，尚宜发汗也。仲景云∶结胸脉浮者，不可下，只可用小陷胸汤（正方四十）
。大抵脉浮，是尚有表证，兼以小柴胡汤（正二十九）等先发表，表证罢，方用
下结胸药便安。西晋崔行功云∶伤寒结胸欲绝，心膈高起，手不得近，用大陷
胸汤。（正三十八）皆不瘥者，此是下后虚逆，气已不理，而毒复上攻，
气毒相搏，结于胸中，当用枳实理中丸，（杂八十一）先理其气，次疗诸
疾。古今用之如神，应手而愈。然结胸有三种∶有大结胸（不按而痛，胸连脐
腹坚硬为大结胸，大陷胸丸主之），（正三十九）有小结胸（按之心下痛
为小结胸，小陷胸汤主之），（正四十）有水结在胸胁间，亦名结胸。头微
汗出，但结胸无大热，此水结在胸胁证，小半夏加茯苓汤、（杂八十二）小柴胡去枣加牡蛎主
之。（正二十九）又有寒热二证∶有热实结胸（胸中烦躁，心内懊 ，舌上燥渴，脉沉滑者，皆热证也，大陷胸汤主之）
（正三十八），有寒实结胸。寒实结胸，无热证者，三物白散、（正八十八）
枳实理中丸主之。（杂方八十一）。近世治结胸，多行金针丸，用硫黄、阳起石者。若
寒实结胸，行之或有瘥者；若热实结胸，行之必死也。又问∶大陷胸汤与大陷胸丸如何？大
陷胸用甘遂太峻，不可轻用，须量虚实轻重，不得已，即大陷胸丸最稳。又问∶圣饼子灸脐
中如何？此尤不可用也。又云∶脏结无阳证，不往来寒热，其人反静，舌上苔滑者，不可攻
也。二者病患胁下旧有痞，连在脐旁，痛引小腹，入阴筋者，亦名脏结，死不治。又问∶脏
结者何也？脏结者死，仲景无治法。大抵脏结，其证如结胸状，饮食如故，时时下利，阳脉
浮，关脉小细沉紧，名曰脏结。舌上白苔滑者，难治也。
（七十六）问心下满而不痛
此名痞也。伤寒本无痞，应身冷，医反下之，遂成痞，枳实理中丸（杂八十一）
最良。仲景治痞气，诸汤中有生姜泻心汤（正六十三）、半夏泻心汤，（正六十一）此二方平
和，宜常用之。仲景云∶满而不痛者为痞，柴胡不中与也，半
夏泻心汤主之（此汤药味，盖本理中人参黄芩汤方也）。审知是痞，
先用桔梗枳壳汤尤妙。（杂八十三）缘桔梗、枳壳，行气下膈，先用之，无
不
验也。结胸与痞关脉须皆沉，若关脉浮者，大黄黄连黄芩泻心汤（正方五九）主之（关
浮则结热，三黄以泻肝）。若复恶寒汗出者，附子泻
心汤（正方六十）主之。病患心下痞，与泻心汤，痞不解，发渴口燥烦
，小便不利者，五苓散（正六十六）主之。汗出表解而胃中不和，心下痞硬
，干噫食臭，胁下有水气，腹中雷鸣下利者，生姜泻心汤主之（正六十三）。
下利日数十行，谷不化，腹中雷鸣，心下痞硬而满。此以医下之也，若复下
之，其痞益甚，甘草泻心汤主之（正六十二）。
盖此非结热，以胃中虚，客气上逆，故使硬也。下利而心
下痞，服生姜泻心汤、甘草泻心汤，利不止者，当治其下焦
，
赤石脂禹余粮汤主之（正一百九）。盖生姜泻心、甘草泻心，皆治中焦，
此利在下焦，若只治中焦，则利益甚耳。服赤石脂禹余粮汤利复不止，当利其小便，五苓散
主之。凡痞服泻心汤不愈，然后可用陷胸
丸（正三十九）下之（不可用陷胸汤，盖太猛，只用陷胸丸）。大抵结胸与痞，皆应
下，然表未解者，不可攻也。仲景云∶当先解表，表解
乃可攻痞，解表宜桂枝汤，（正方一）攻痞宜大黄黄连泻心汤（正五十九）外证未解，心下妨
闷者，非痞也，谓之支结，柴胡桂枝汤主之。（正三十一）胸胁
满微结，小柴胡汤加干姜牡蛎汤主之。（正二十九）若太阳证未除而数下之，遂
协热而利，利不止，心下痞硬，表里不解者，桂枝
人参汤主之（正方十六）。十枣汤（正八十九）、大柴胡汤（正三十），皆治心下痞，此方尤难用，须是表证罢，
不恶寒，身凉，其人
汗出，发作有时，头疼，心下痞硬满引胁下疼，干呕短气
者，乃可行十枣汤；表未解者，慎不可用也。大柴胡汤，治伤寒发热，汗出不解，心下痞硬，呕吐而下利者，非大柴胡
汤不可也（正方三十）。若
人或咳逆气虚者
代赭汤，是解后心下痞硬证。
（七十七）问呕者（干呕附）
无阳则厥，无阴则呕。呕者，足阳明胃之经。足阳明之气下行，今厥而上行，故为气逆，气
逆则呕。仲景云∶呕多虽不大便，不可下，可与小柴胡汤（正二十九），上
焦得通，津液得下，胃气因和，浃然汗出而解。大抵
呕证不一，各有治法，要之小柴胡汤，
尤相主当耳。与小柴胡汤，胸胁满而呕，日晡发潮热者，可小柴胡汤加芒硝也。（正方三十四）若呕不止
，心下急，郁郁微烦者，与大柴胡汤也。（正方三十）大便秘者，方加大黄（大柴胡治呕最妙
，为内有枳实故也。枳实去
秽；压虚气，须是去大黄。仲景云∶呕多虽有阳明证，慎不可下，官局桔梗汤最良，亦用枳
实耳方具第十七卷中）。古人治呕，多用半夏、生姜。孙真人云∶生姜是呕家圣药，
仲景治呕皆用之。太阳与阳明合病，必下利，若不利，但呕者，葛根加半夏生姜
汤（正二十七）
主之。胸中有热，胃中有邪气，腹痛欲呕者，黄连汤主之（正八十三）。太阳与少
阳合病，而自利，若呕者，黄芩加半夏生姜汤主之。（正八十六）。《金匮》诸呕吐，谷
不得
下者，小半夏汤、小半夏加茯苓汤（杂八十二）、小半夏加橘皮汤，皆可
选用也；呕而发热者，小柴胡汤主之（正二十九）；呕而发渴者，猪苓汤
主之（正六十七）。先呕却渴者，此为欲解，急与之水；先渴却呕者，为
水停心下，此属饮家。仲景云∶本渴饮水而呕者，柴胡不中与也，宜治膈间，有水，赤
茯苓汤主之（杂八十四）。若少阴证而呕者，真武汤去附子加生姜也（正一百五）。若汗若
吐若下后，虚烦不得眠，若呕者，栀子生姜汤主之（正四十七）。伤寒瘥后呕者，
有余热在胃脘，竹叶汤加生姜主之。（正九十五）又问∶有干呕者何也？大凡呕者，饮
食不下；干呕者，今人所谓 也，或因汗出，或因有水，或因下利，
脾胃有热，故使干呕
，官局中桔梗汤最佳（杂方一百二十一）。仲景治法，汗自出，干呕者，桂
枝证也（正方一）；表不解，心下有水气，干呕发热者，小青龙也；（正三十六）身凉汗出
，两胁痛，或干呕者，十枣汤也；（正八十九）少阴下利脉微，与白通汤，（正方九十八）利不止，厥逆
无脉，干呕烦者，白通加猪胆汁汤也（正九十八）；少阴下利，里寒外热，脉干
欲绝，或干呕者，通脉四逆汤也（正八十一）；干呕，吐涎沫，头痛者，吴茱
萸汤也（正方一百）。《伤寒论》云∶食谷欲呕者，属阳明也，吴茱萸汤主之；得汤反剧
者属上焦也，仲景无治法。大抵吴茱萸汤治少阴证也，谷入胃而呕属阳明，宜与小柴胡汤
。若病患直患呕吐而复脚弱或疼，乃是香港脚，当作香港脚治之。（法在第七卷五十四问）
（七十八）问吐
吐有冷热二证。寸口脉数，手心热，烦渴而吐，以有热在胃脘，五苓散主之（正六十六）（伤寒有表证，渴欲饮水也，
水入口即吐者，名曰水逆，由心经受热而小
肠不利故也，宜服五苓散。发汗后，水药不得入口为逆，若更发汗，必吐下不止，小半夏加
茯苓汤、大半夏加橘皮汤主之）。曾经汗下，关脉迟，胃中虚冷而吐，干姜黄芩黄
连
。少阴病，饮食入口则吐，心中温温欲吐，复不能吐，始得之，手
足寒，脉弦迟者，此胸中实，不可下也，当吐之；若膈上有寒饮干呕者，不可吐也，当温之
，宜四逆汤。（正方七五）吐利，手足逆冷，烦躁甚者，吴茱萸汤主之（正方一百）。若伤寒
解后，虚羸少气，气逆欲吐，竹叶石膏汤主之（正方九十五）。
（七十九）问呕吐而利
呕吐而下利，有两证。仲景云∶伤寒发热，汗出不解，心中痞硬
，呕吐而下利者，大
柴胡汤下之。（正方三十）又有霍乱证，霍乱呕吐而利，热多而渴者，五
苓散（正方六十六）；寒多不饮水者，理中丸（正七十四）（或
有寒，腹满痛，或四肢拘急，下利，脚转筋，理中汤加附子一枚生用，并粗末作汤服之）。（正方七十四）
吐利汗出，发热恶寒，四肢拘急，手足厥冷者，四逆汤主之。
少阴病，吐利，手足逆冷，烦躁欲死，吴茱萸汤主之。（正方一百）吐利止而身体痛不休者
，当消息和解其外，宜桂枝汤（正方一）（仲
景大柴胡一证云∶伤寒发热，汗出不解，心中痞，呕吐而下利者，大柴胡主之，即非霍乱也
）。吐利已汗出而厥，四肢拘急不解，脉微欲绝者，通脉四逆加猪胆汤。（正八十二）
夏月中暑霍乱，上吐下利，心腹撮痛，大渴烦躁，四肢逆冷，冷
汗自出，两脚转筋，宜服香薷散（杂八十五）。须井中沉令极冷，顿服之
乃效（香薷散，夏月预宜合下，以备此证，其他药不能救，仍须极冷并服之）。
（八十）问咳嗽
伤寒咳嗽有两证∶有太阳证咳嗽，小青龙（正三十六）、小柴胡
也（正二十九）；有少阴证咳嗽，真武汤（正一百五）、四逆散（正七十六）、猪苓汤也（正六十七）。大抵
热在上焦，其人必饮水，水停心下，则肺为之浮，肺主于咳，水气乘之，故咳而微喘。仲
景云∶伤寒表不解，心下有水，干呕发热而咳，小青龙汤主之（小便不利，小腹
满者，去麻黄加茯苓）。往来寒热，胸胁满痛，或咳者，小柴胡汤主之（
小柴胡去人参、大枣，加五味子、干姜）。若少阴证咳嗽，四肢沉重疼痛，小便不
利，自下利而咳，真武汤主之（真武汤加五味子、干姜。大抵伤寒水气，皆因饮水
过多。古人治水气而咳者，病在阳，则小青龙汤主之；病在阴，则真武汤主之）。
四肢厥逆，腹中痛，或泄利而咳，四逆散主之（四逆散加五味子、干姜）。下利六七日，咳而呕渴，心烦不得眠，猪苓汤
主之（正六十七）。《古今录验》
（八十一）问咽喉痛
咽喉痛有阴阳二证∶脉浮数，面赤斑斑如锦文，咽喉痛，唾脓血者，此阳毒也；（在第四卷中二十一问）
脉沉迟，手足厥冷，或吐利而咽中痛，此少阴
证也。《病源》云∶此为下部脉都不至，阴阳隔绝，邪客于足少阴之络，毒瓦斯上冲，故咽喉
不利，或痛而生疮也。伤寒脉阴阳俱紧，及汗出者，亡阳也，此属少阴，法当咽痛而复吐利
，此候汗下熏熨俱不可。汗出者， 本粉敷之；咽喉痛者，甘草汤、（正五十四）桔
梗汤（正方一百二）、猪肤汤（正方一百一）、半夏散（正方一百三）、通脉四逆去芍药加桔梗汤（正方八十一）、麻黄升
麻汤（正二十五）可选而用之。又有伏气之病，谓非时有暴寒中人，伏气于少阴经，始不觉病，旬月乃发，脉微弱，法
先咽痛，似伤寒，非喉痹之病，次必下利，始用半夏桂甘草汤（杂五十三），次四逆散主之（正七十六）。此病只一二日
便瘥，古方谓之肾伤寒也。
（八十二）问口燥咽干
脾脏有热，则津液枯少，故令口燥而舌干。仲景云∶伤寒无大热，口燥渴而烦，
背微寒者，白虎汤加人参也（正六十五）。又云∶阳明病渴欲饮水，口干
舌燥者，白虎加人参汤主之。若咽干者，慎不可发汗，发汗则重亡津液。少阳证口苦咽干
者，小柴胡主之；（正二十九）少阴证，口燥咽干者，急下之。病患默默
欲眠，目不能开，起居不安，其声嘎，或咽干者，当作狐惑治之。
（八十三）问病患但漱水不欲咽
阳明证头疼，身热口燥，但漱水不欲入咽者，必衄也。若病患无表
证，不发寒热
，胸腹满，唇燥，但欲漱水不欲咽者，此为有瘀血，必发狂也，轻者犀角地黄汤，（杂八六）
甚者抵当汤。（正九十一）
（八十四）问不欲眠
This volume begins by discussing Jie Xiong (Chest Binding Syndrome) and Pi Zheng (Epigastric Fullness Syndrome). When a disease originates in the Yang aspect, premature purgation leads to Jie Xiong; when it originates in the Yin aspect, premature purgation leads to Pi Zheng. However, Jie Xiong and Pi Zheng are similar, distinguished only by the presence or absence of pain. Epigastric fullness with hardness and pain upon palpation is Jie Xiong; epigastric fullness without pain upon palpation is Pi Zheng. If physicians fail to examine carefully, even a slight error can immediately lead to critical danger. Jie Xiong belongs to the category of Xian Xiong (Sinking Chest) patterns, while Pi Zheng belongs to the category of Xie Xin (Draining Epigastrium) patterns. The details have been discussed in previous questions.
(Question 75) Inquiry regarding epigastric tightness and fullness, hardness like stone upon palpitation, and pain:
This is named Jie Xiong (Chest Binding Syndrome). Shang Han (Cold Damage) originally does not involve Jie Xiong; if one should have had fever but was purged prematurely, heat qi enters through the deficiency, becomes knotted and does not disperse, thus forming Jie Xiong. If treatment has already been mistaken but Jie Xiong has not yet fully formed, Li Zhong Tang (Regulate the Middle Decoction) should be administered frequently (see Zheng 74), and it will naturally resolve, preventing the formation of Jie Xiong, because Li Zhong Tang treats the Middle Jiao. This is a point not explicitly stated by ancient masters, but deduced by later generations through reflection. If the condition deteriorates significantly and presents with Jue (Reversal/Cold Extremities) symptoms, Si Ni Tang (Counterflow Decoction) should be added (see Zheng 75) for relief. Although the Stomach Qi may harmonize, if the Shang Han pathogen remains, one must wait for the appropriate time and then use purgation, specifically Cheng Qi Decoctions (see Zheng 42), because the previous purgation was incomplete. The symptoms include epigastric tightness and fullness, hardness like stone with pain upon palpation, and neck stiffness resembling Rou Ji (Soft Spasm) (defined as fever, sweating, and aversion to cold being absent). The pulse at Cun Kou is floating, while Guan and Chi positions are sunken, or sunken and tight; this is named Jie Xiong. Treatment for Jie Xiong generally requires purgation (as Zhang Zhongjing stated: "Purgation brings harmony"). However, if the pulse is floating or large, purgation is contraindicated; purging in such cases leads to death, and sweating methods are appropriate instead. Zhang Zhongjing stated: "If the pulse of Jie Xiong is floating, do not purge; use Xiao Xian Xiong Tang (Minor Inward-Draining Chest Decoction)" (see Zheng 40). Generally, a floating pulse indicates that exterior symptoms still exist; one should first use Xiao Chai Hu Tang (Minor Bupleurum Decoction) (see Zheng 29) etc., to release the exterior. Only after the exterior symptoms cease should one use drugs to purge Jie Xiong for safety. Cui Xinggong of the Western Jin Dynasty said: "For severe Shang Han Jie Xiong where the heart and diaphragm are elevated and cannot be touched, use Da Xian Xiong Tang (Major Inward-Draining Chest Decoction)" (see Zheng 38). If these do not work, it is due to deficiency and rebellion after purgation, Qi is disordered, and toxins attack upward again; Qi and toxin struggle and knot in the chest. One should use Zhi Shi Li Zhong Wan (Immature Bitter Orange and Regulate-Middle Pill) (see Za 81) to regulate Qi first, then treat other diseases. It works miraculously in ancient and modern times. However, there are three types of Jie Xiong: There is Da Jie Xiong (Major Chest Binding, pain without pressing, chest connected to umbilicus and abdomen hard, treated with Da Xian Xiong Wan) (see Zheng 39); there is Xiao Jie Xiong (Minor Chest Binding, pain in epigastrium upon pressing, treated with Xiao Xian Xiong Tang) (see Zheng 40); and there is Water Knotting between the chest and hypochondrium, also named Jie Xiong. Slight sweating on the head, but no high fever, indicates Water Knotting in the chest/hypochondrium, treated with Xiao Ban Xia Jia Fu Ling Tang (Minor Pinellia plus Poria Decoction) (see Za 82) or Xiao Chai Hu Tang minus Jujube plus Oyster Shell (see Zheng 29). There are also Cold and Heat syndromes: Re-Shi Jie Xiong (Heat-Excess Chest Binding, restlessness in chest, internal vexation, dry tongue/thirst, sunken slippery pulse, all heat signs, treated with Da Xian Xiong Tang) (see Zheng 38); and Han-Shi Jie Xiong (Cold-Excess Chest Binding). For Han-Shi Jie Xiong without heat signs, San Wu Bai San (Three-Ingredient White Powder) (see Zheng 88) or Zhi Shi Li Zhong Wan (see Za 81) are used. Recent treatments often use Jin Zhen Wan containing Shu Huang (Sulfur) and Yang Qi Shi (Leucogaster), which might cure Han-Shi Jie Xiong but will certainly kill patients with Re-Shi Jie Xiong. Question: Difference between Da Xian Xiong Tang and Da Xian Xiong Wan? Da Xian Xiong Tang uses Gan Sui (Kansui Root) which is too harsh; use cautiously based on deficiency/excess severity. If unavoidable, Da Xian Xiong Wan is safest. Question: What about applying Sheng Bing Zi moxibustion to the navel? This is especially contraindicated. Also: Zang Jie (Zang Binding) has no Yang signs, no alternating chills/fever, the patient is quiet, tongue coating is slippery; do not attack. If patients have old Pi masses under the ribs connecting to the side of the umbilicus, pain radiating to lower abdomen and Yin sinews, this is also Zang Jie, a fatal untreatable condition. Question: What is Zang Jie? Zang Jie is fatal; Zhang Zhongjing provided no treatment. Generally, Zang Jie resembles Jie Xiong, food intake is normal, frequent diarrhea occurs, Yang pulse is floating, Guan pulse is small, fine, sunken, and tight; this is Zang Jie. Slippery white coating on the tongue indicates difficult treatment.
(Question 76) Inquiry regarding epigastric fullness without pain:
This is named Pi Zheng (Epigastric Fullness Syndrome). Shang Han originally does not involve Pi; if the body should have been cold (indicating Yin/Cold) but the physician purged, Pi forms. Zhi Shi Li Zhong Wan (see Za 81) is best. Zhang Zhongjing’s treatments for Pi Qi include Sheng Jiang Xie Xin Tang (Ginger Draining-Epigastrium Decoction) (see Zheng 63) and Ban Xia Xie Xin Tang (Pinellia Draining-Epigastrium Decoction) (see Zheng 61); these two formulas are mild and suitable for regular use. Zhang Zhongjing said: "Fullness without pain is Pi; Chai Hu Tang is not indicated; use Ban Xia Xie Xin Tang" (This formula is derived from Li Zhong Ren Shen Huang Qin Tang). Confirming Pi, using Jie Geng Zhi Ke Tang (Platycodon and Aurantium Decoction) first is excellent (see Za 83) because Jie Geng and Zhi Ke move Qi down through the diaphragm, ensuring efficacy. Both Jie Xiong and Pi require sunken Guan pulses; if Guan pulse is floating, Da Huang Huang Lian Huang Qin Xie Xin Tang (Rhubarb, Coptis, and Scutellaria Draining-Epigastrium Decoction) is used (see Zheng 59) (Floating Guan indicates constrained heat; the three yellows drain Liver fire). If accompanied by aversion to cold and sweating, Fu Zi Xie Xin Tang (Aconite Draining-Epigastrium Decoction) is used (see Zheng 60). If the patient has epigastric Pi unrelieved by Xie Xin Tangs, with thirst, dry mouth, vexation, and dysuria, Wu Ling San (Five-Ingredient Powder with Poria) is used (see Zheng 66). If sweating resolves the exterior but Stomach disharmony persists, causing epigastric hardness, dry belching with food odor, water qi in hypochondrium, borborygmus, and diarrhea, Sheng Jiang Xie Xin Tang is used (see Zheng 63). If diarrhea occurs dozens of times daily with undigested food, borborygmus, and epigastric hardness/fullness caused by erroneous purgation, further purgation worsens the Pi; use Gan Cao Xie Xin Tang (Licorice Draining-Epigastrium Decoction) (see Zheng 62). This is not constrained heat but Stomach deficiency with rebellious hostile Qi causing hardness. If diarrhea and epigastric Pi persist despite Sheng Jiang/Gan Cao Xie Xin Tangs, treat the Lower Jiao with Chi Shi Zhi Yu Yi Liang Tang (Red Halloysite and Hematite Decoction) (see Zheng 109). Since Sheng Jiang/Gan Cao Xie Xin Tangs treat the Middle Jiao, and this diarrhea is in the Lower Jiao, treating only the Middle Jiao worsens diarrhea. If Chi Shi Zhi Yu Yi Liang Tang fails, promote urination with Wu Ling San. If Pi unresponsive to Xie Xin Tangs, then use Xian Xiong Wan (see Zheng 39) to purge (do not use Xian Xiong Tang as it is too fierce; use only the pill). Generally, both Jie Xiong and Pi require purgation, but not if the exterior is unresolved. Zhang Zhongjing said: "Resolve the exterior first, then attack Pi." Exterior resolution suits Gui Zhi Tang (Cinnamon Twig Decoction) (see Zheng 1); attacking Pi suits Da Huang Huang Lian Xie Xin Tang (see Zheng 59). If external symptoms remain and epigastric oppression exists, it is not Pi but Zhi Jie (Branch Binding), treated with Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) (see Zheng 31). Hypochondriac fullness with slight knotting is treated with Xiao Chai Hu Tang plus Gan Jiang and Mu Li (see Zheng 29). If Tai Yang symptoms persist and multiple purgations cause協熱利 (Collateral-Heat Diarrhea) with continuous diarrhea, epigastric hardness, and simultaneous interior/exterior disharmony, Gui Zhi Ren Shen Tang (Cinnamon Twig and Ginseng Decoction) is used (see Zheng 16). Shi Zao Tang (Ten Jujubes Decoction) (see Zheng 89) and Da Chai Hu Tang (Major Bupleurum Decoction) (see Zheng 30) treat epigastric Pi, but Shi Zao Tang is difficult to use; it is indicated only when exterior symptoms cease, no aversion to cold, body cool, sweating occurs intermittently, headache, epigastric hardness/fullness radiating to hypochondrium, dry retching, and shortness of breath are present. Contraindicated if exterior is unresolved. Da Chai Hu Tang is essential for Shang Han fever, unremitting sweating, epigastric hardness, vomiting, and diarrhea (see Zheng 30). For cough and Qi deficiency post-recovery, Dai Zhe Tang (Hematite Decoction) treats epigastric hardness.
(Question 77) Inquiry regarding Vomiting (including Dry Retching):
No Yang leads to Jue (cold extremities); no Yin leads to vomiting. Vomiting belongs to the Foot-Yangming Stomach Meridian. Yangming Qi should descend; now it rebels upward, causing Qi rebellion and vomiting. Zhang Zhongjing said: "Even with constipation, if vomiting is frequent, do not purge; give Xiao Chai Hu Tang" (see Zheng 29). Upper Jiao opens, fluids descend, Stomach Qi harmonizes, and sweating resolves the disease. Vomiting varies; Xiao Chai Hu Tang is most appropriate. If after Xiao Chai Hu Tang, hypochondriac fullness/vomiting continues with afternoon tidal fever, add Mang Xiao (Mirabilite) to Xiao Chai Hu Tang (see Zheng 34). If vomiting persists, epigastric urgency, and mild vexation, use Da Chai Hu Tang (see Zheng 30). If constipated, add Da Huang (Rhubarb). Da Chai Hu Tang is excellent for vomiting due to Zhi Shi removing turbidity and suppressing deficient Qi; however, remove Da Huang if vomiting is prominent. Zhang Zhongjing said: "Frequent vomiting, even with Yangming signs, strictly avoid purgation." Official Bureau's Jie Geng Tang is best (also uses Zhi Shi; see Vol 17). Ancients used Ban Xia (Pinellia) and Sheng Jiang (Fresh Ginger) for vomiting. Sun Simiao said: "Sheng Jiang is the holy medicine for vomiting"; Zhang Zhongjing used it universally. Tai Yang and Yang Ming combined disease causes diarrhea; if no diarrhea but only vomiting, Ge Gen Jia Ban Xia Sheng Jiang Tang (Kudzu plus Pinellia and Fresh Ginger Decoction) is used (see Zheng 27). Heat in chest, pathogen in Stomach, abdominal pain wanting to vomit: Huang Lian Tang (Coptis Decoction) (see Zheng 83). Tai Yang and Shao Yang combined with spontaneous diarrhea and vomiting: Huang Qin Jia Ban Xia Sheng Jiang Tang (Scutellaria plus Pinellia and Fresh Ginger Decoction) (see Zheng 86). *Jin Gui* vomiting with inability to swallow grain: Xiao Ban Xia Tang, Xiao Ban Xia Jia Fu Ling Tang (see Za 82), Xiao Ban Xia Jia Ju Pi Tang are options. Vomiting with fever: Xiao Chai Hu Tang (see Zheng 29). Vomiting with thirst: Zhu Ling Tang (Polyporus Decoction) (see Zheng 67). Vomiting then thirst indicates recovery; give water freely. Thirst then vomiting indicates water retention in the epigastrium (Yin pattern). Zhang Zhongjing said: "Thirsty drinking leading to vomiting excludes Chai Hu Tang; treat inter-diaphragmatic water with Chi Fu Ling Tang" (see Za 84). Shao Yin vomiting: Zhen Wu Tang minus Fu Zi plus Sheng Jiang (see Zheng 105). Post-sweat/vomit/purge vexation-insomnia-vomiting: Zhi Zi Sheng Jiang Tang (Gardenia and Fresh Ginger Decoction) (see Zheng 47). Post-Shang Han recovery vomiting (residual heat in Stomach): Zhu Ye Tang plus Sheng Jiang (see Zheng 95). Question: Cause of Gan Ou (Dry Retching)? General vomiting involves inability to eat; Gan Ou (now called E) results from sweating, water retention, diarrhea, or Stomach/Spleen heat. Official Bureau's Jie Geng Tang is best (see Za 121). Zhang Zhongjing: Spontaneous sweating + dry retching = Gui Zhi pattern (see Zheng 1). Unresolved exterior + water in epigastrium + dry retching/fever = Xiao Qing Long Tang (see Zheng 36). Cool body/sweating + hypochondriac pain/dry retching = Shi Zao Tang (see Zheng 89). Shao Yin diarrhea/micro-pulse + Bai Tong Tang, then non-stop diarrhea/Jue/no pulse/vexation = Bai Tong Jia Zhu Dan Jiang Tang (see Zheng 98). Shao Yin diarrhea/cold interior/heat exterior/micro-pulse/dry retching = Tong Mai Si Ni Tang (see Zheng 81). Dry retching, salivation, headache = Wu Zhu Yu Tang (see Zheng 100). *Shang Lun*: "Wanting to vomit after eating belongs to Yangming, Wu Zhu Yu Tang." If worse after taking it, it belongs to Upper Jiao; Zhang Zhongjing gave no method. Generally, Wu Zhu Yu Tang treats Shao Yin; grain-induced vomiting is Yangming, suit Xiao Chai Hu Tang. If vomiting accompanies weak/painful legs, it is Hong Kong Foot (Beriberi), treat accordingly (see Vol 7, Q54).
(Question 78) Inquiry regarding Spitting/Vomiting Up:
Vomiting has Cold and Heat types. Cun pulse rapid, palm heat, vexation/thirst/vomiting indicates heat in Stomach; use Wu Ling San (see Zheng 66) (Shang Han exterior signs, thirst/water rejection named Shui Ni [Water Rebellion] due to Heart heat affecting Small Intestine; use Wu Ling San. Post-sweat inability to keep water down is adverse; re-sweating causes endless vomiting/diarrhea; use Xiao Ban Xia Jia Fu Ling Tang or Da Ban Xia Jia Ju Pi Tang). Post-sweat/purge, Chi Guan pulse, cold deficient Stomach vomiting: Gan Jiang Huang Qin Huang Lian Ren Shen Tang. Shao Yin disease: Food enters then vomits, warm desire to vomit but cannot, initial cold hands/feet, string-tight slow pulse indicates excess in chest, do not purge, induce vomiting. Cold fluid in diaphragm with dry retching: Do not vomit, warm with Si Ni Tang (see Zheng 75). Vomiting/diarrhea/cold extremities/severe vexation: Wu Zhu Yu Tang (see Zheng 100). Post-Shang Han recovery emaciation/shortness of breath/rebellious Qi wanting to vomit: Zhu Ye Shi Gao Tang (see Zheng 95).
(Question 79) Inquiry regarding Vomiting/Diarrhea:
Vomiting and diarrhea have two types. Zhang Zhongjing: Shang Han fever, unremitting sweat, epigastric hardness, vomiting/diarrhea: Da Chai Hu Tang purges (see Zheng 30). Huo Luan (Stomach-Gut Turmoil) vomiting/diarrhea: Heat/thirst -> Wu Ling San (see Zheng 66); Cold/no thirst -> Li Zhong Wan (see Zheng 74) (Add raw Fu Zi if cold/pain/spasms/diarrhea/tendon twitching; make decoction) (see Zheng 74). Vomiting/diarrhea/sweating/fever/aversion to cold/spasms/cold extremities: Si Ni Tang. Shao Yin vomiting/diarrhea/cold extremities/vexation wanting to die: Wu Zhu Yu Tang (see Zheng 100). Vomiting/diarrhea stop but body pain continues: Harmonize exterior with Gui Zhi Tang (see Zheng 1) (Note: Zhang Zhongjing's Da Chai Hu Tang case is not Huo Luan). Vomiting/diarrhea/post-sweat/Jue/spasms/micro-pulse: Tong Mai Si Ni Jia Zhu Dan Tang (see Zheng 82). Summer heat Huo Luan vomiting/diarrhea/abdominal cramping/thirst/vexation/cold extremities/sweating/tendon twitching: Xiang Ru San (Elsholtzia Powder) (see Za 85). Soak in well water until extremely cold, drink at once (Prepare Xiang Ru San in summer; other medicines fail; must be cold).
(Question 80) Inquiry regarding Cough:
Shang Han cough has two types: Tai Yang cough -> Xiao Qing Long Tang (see Zheng 36), Xiao Chai Hu Tang (see Zheng 29); Shao Yin cough -> Zhen Wu Tang (see Zheng 105), Si Ni San (see Zheng 76), Zhu Ling Tang (see Zheng 67). Heat in Upper Jiao causes thirst; water retention in epigastrium floats the Lung; Lung governs cough, water attacks it -> cough/mild wheezing. Zhang Zhongjing: Unresolved exterior + water in epigastrium + dry retching/fever/cough -> Xiao Qing Long Tang (Remove Ma Huang add Fu Ling if dysuria/lower abdominal fullness). Alternating chills/fever/hypochondriac pain/cough -> Xiao Chai Hu Tang (Remove Ren Shen/Da Zao add Wu Wei Zi/Gan Jiang). Shao Yin cough/heavy limbs/pain/dysuria/diarrhea/cough -> Zhen Wu Tang (Add Wu Wei Zi/Gan Jiang). Generally, Shang Han water cough stems from excessive drinking. Yang disease -> Xiao Qing Long Tang; Yin disease -> Zhen Wu Tang. Limb Jue/abdominal pain/diarrhea/cough -> Si Ni San (Add Wu Wei Zi/Gan Jiang). Diarrhea 6-7 days/cough/vomit/thirst/vexation-insomnia -> Zhu Ling Tang (see Zheng 67). *Gu Jin Lu Yan*.
(Question 81) Inquiry regarding Sore Throat:
Sore throat has Yin/Yang types. Floating-rapid pulse/red mottled face/throat pain/pus-blood sputum = Yang Du (Yang Toxin) (see Vol 4, Q21). Sunken-slow pulse/cold extremities/vomiting/diarrhea/throat pain = Shao Yin pattern. *Bing Yuan*: Lower pulses absent, Yin/Yang separated, pathogen in Foot-Shaoin collateral, toxic qi rushes up -> throat obstruction/pain/ulcers. Shang Han Yin-Yang tight pulse + sweating = Yang exhaustion, Shao Yin pattern, law dictates throat pain + vomiting/diarrhea. Sweating/purging/fumigation/moxibustion all contraindicated. Sweating: Apply Fen Jing (Rice Flour). Throat pain: Gan Cao Tang (Licorice Decoction) (see Zheng 54), Jie Geng Tang (see Zheng 102), Zhu Fu Tang (Pig Skin Decoction) (see Zheng 101), Ban Xia San (Pinellia Powder) (see Zheng 103), Tong Mai Si Ni Qu Shao Yao Jia Jie Geng Tang (see Zheng 81), Ma Huang Sheng Ma Tang (Ephedra and Ligusticum Decoction) (see Zheng 25) are options. Fu Qi (Hidden Qi) disease: Non-seasonal cold hides in Shaoin, manifests after a month, micro-weak pulse, starts with throat pain (like Shang Han but not Hou Bi), then diarrhea. Start with Ban Xia Gui Gan Cao Tang (see Za 53), then Si Ni San (see Zheng 76). Cures in 1-2 days, ancient name Kidney Shang Han.
(Question 82) Inquiry regarding Dry Mouth/Throat:
Spleen heat dries fluids -> dry mouth/tongue. Zhang Zhongjing: No high fever, dry mouth/thirst/vexation, slight back chill -> Bai Hu Jia Ren Shen Tang (White Tiger plus Ginseng Decoction) (see Zheng 65). Yang Ming thirst/dry mouth/tongue -> Bai Hu Jia Ren Shen Tang. Dry throat: Strictly avoid sweating (renews fluid loss). Shao Yang bitter taste/dry throat -> Xiao Chai Hu Tang (see Zheng 29). Shao Yin dry mouth/throat: Urgent purgation. Patient silent/wants sleep/cannot open eyes/restless/hoarse/dry throat -> Treat as Hu Huo (Fox-Sore) disease.
(Question 83) Inquiry regarding Rinsing Mouth Without Swallowing:
Yang Ming headache/fever/dry mouth, rinsing without swallowing -> Bi Xu (Nosebleed). No exterior signs, no chills/fever, chest/abdominal fullness, dry lips, rinsing without swallowing -> Blood Stasis, likely madness. Mild: Xi Jiao Di Huang Tang (Rhino Horn and Rehmannia Decoction) (see Za 86); Severe: Di Dang Tang (Residence-Destroying Decoction) (see Zheng 91).
(Question 84) Inquiry regarding Insomnia