黄连 黄芩 黄柏 黑山栀〔各二、三钱。〕 石膏〔三、四两。〕 知母〔两许。〕
甘草〔三钱。即黄连解毒汤合白虎汤，清里热以救津液。〕 薄荷〔三钱。〕 淡豉〔解肌透汗，
微汗则解，一两。〕
此方因表里俱热，故内外分消其势，兵之分击者也。若无壮热俱表症，惟大便燥结不通，及舌卷
囊缩难治者，本方去薄荷、淡豉，加大黄、芒硝，名三黄巨胜汤，权用劫之，间有可生者。
黄连解毒汤 治三焦大热，烦躁，舌苔错语，〔上焦热也。错语者，杂之谓。谵语者，数数更端
之谓，其声高。郑声者，只将一事一语，郑重谆复，其声低。乃精气夺之候也。故曰实则谵语，虚则
郑声。〕呻吟，〔下焦热也，肾在声为呻，气郁则呻吟。〕干呕不眠，〔中焦热也。〕脉数。宜用
黄连〔泻中焦之火。〕 黄芩〔泻上焦之火。〕 黄柏〔泻下焦之火。〕 栀子〔泻三焦火，屈
曲下行。各一钱至三钱。〕如狂言躁乱，〔温热之邪传入心包，乃似狂非狂，非胃实发
狂可下之比，〕或喜笑不休，〔心包本病。以心在声为笑。〕加生地、麦冬、犀角，心悸亦如之。渴
加麦冬、花粉。大渴合白虎汤。干呕合竹茹汤。烦躁加犀角、生地。脉热小便不利者，加麦冬、知母。
小便数，〔是热邪传入中焦，逼迫下行，火性急速故也，〕倍黄柏，加知母。此苦寒清热之剂，通上中
下三焦而治之。按舌苔之症，邪热在表，则不生苔；在半表半里，则生白苔；传里则生黄苔，热甚则芒刺
干燥。若见黑苔芒刺，刮去即生者难治。夏令时火邪火，内外合烧，故易生黑苔芒刺，尚有可生，冬
令见之必死。又有舌苔如黑漆之光者，舌为心苗，应南方火，譬如火之自焚，初则红，过则薪为炭而色
黑，热之极矣。亦有舌上无苔，而赤紫干光者，皆因邪热灼干肾水，不能上溉于心，火无制，自焚而死。
治舌苔之法，如见少阳症，即用小柴胡汤去人参、半夏，加知母、花粉。如自汗烦躁，大渴饮水者，用
竹叶石膏汤合本方加减，黄连泻心火，为必用之药，有下症者，用承气汤。自利者本方加减治之。一切
苔状，湿滑者吉，燥涩者凶。白苔亦有干硬如沙皮者，因津液干燥，邪虽入胃，不能变黄也。凡见舌苔，
俱用井水浸青布拭净，以薄荷末同蜜不时擦之。熬氏云∶见红色，热蓄于内也，随症清之。又有舌裂舌硬
舌短舌长舌卷，皆邪热胜，真气危，或清或下，随病制宜。热病多舌出，有病愈而不能入者，冰片
少许，涂舌即入。有舌肿满口，蒲黄为末渗上，即愈。
小陷胸汤 治误下，热邪乘虚陷入，与痰饮搏结胸间，谓之
结胸病。〔误下，心下满而硬痛者为结胸，但满而不痛者为痞。〕小结胸病心下硬满，按之则痛，
〔与大结胸之从心上至少腹硬满而痛不可近者较轻〕。脉浮滑者。〔外邪陷入原微，与大结胸之寸脉
浮关脉沉紧者，亦不同。〕
黄连〔清解热邪，一、二钱。〕 栝蒌实〔能洗涤胸膈中垢腻郁热。一，二枚捣。〕 半
夏〔善消痰饮。一、二钱。渴易花粉。〕 可加尖槟榔〔性能散结，破滞降气，下行最速。一、二钱。〕
如挟热下利，心下痞者，去半夏，调服益元散。
此方清热开结化痰，虽治误下结胸之主方，然未经误下，而外邪传入胸中，与痰相合，壅塞气道，胸
中心下满闷，或痛或不痛者，亦可借用。如有兼症，另加对症之药治之。
泻心汤 治心下痞结。
大黄〔攻痞。〕 黄连 黄芩〔清热。〕此苦寒清热攻下之剂。宜小剂微下，恐陷邪未入腹，
不可攻也，戒之戒之。
竹茹汤 食谷欲呕者属阳明，非少阳也。胸中烦热者，此方主之。
竹茹〔善疏气逆，一、二、三钱。〕 枇杷叶〔长于降气。三、五大片，姜汁炙。〕 芦根
〔独入阳明，清热下降。三、四两，或汁一大杯服更妙。〕 麦冬〔清胃止呕。三、五钱。〕 吐蛔〔
胃热如沸，蛔不自安，下既不通，必出自上。〕合白虎汤，〔清胃热则蛔安。〕去甘草，〔盖蛔得甘
则动于上也。〕或合解毒汤，〔蛔见苦则安。〕俱加乌梅。〔蛔得酸则静。此症勿认胃寒误用姜、桂。〕
此治挟热呕吐之良方也。如过用寒凉，阳明虚寒，口不渴，小便白，方可暂用吴茱萸汤，以下
逆气，人参、姜、枣以培胃气，停痰积饮而呕吐者，用芩连二陈汤，虚者用六君子汤，俱加竹茹、姜
汁。如病后虚羸少气，气逆而吐者，仲景竹叶石膏汤主之。竹叶、石膏以清余热，参、甘、粳米
以补不足，半夏以散逆气。又竹叶能除新久风邪之烦热，能止喘促气盛之上冲，合参、麦等用之，治热
而无损其真，导逆而不伤其气。若生姜可以宣偶郁之火，而不能散久凝之热，枳、朴可以下客气
有余，而不能降热伤之逆，故皆不用。石膏大寒，病后反用之者，以外感之邪，皆属阳经，阳经之邪，
非苦寒之药所能胜，其余邪上逆，何独不然，故必用之以清邪之原也。今人不忌芩连，而但畏石膏，
总不知辨症耳。
栀子豉汤 治邪在胸膈，心中结痛懊 ，〔懊者烦恼， 者郁闷，邪郁胸中，心不安。〕宜此
探吐之。
栀子〔苦以涌之。〕 淡豉〔解烦躁，除满闷。〕阳明病无汗，小便不利，心中懊 者，当
发黄，加麦冬；如已见黄，加茵陈为君。
此因邪在胸膈，用栀、豉涌吐其邪，所谓在上者因而越之也。凡用此汤，病患旧有微溏，则大腑易
动，服此不能上涌，反为下泄，故不可服。脉虚者不可吐，干呕者不可吐，素失血者不可吐，气浅者不可
吐，眩冒者不可吐，虚弱
者不可吐，故均禁用本方。
猪苓汤 治渴欲饮水，小便不利。〔阳明热邪，传入下焦，膀胱热结，气化不传。〕又治少阴
下利。〔少阴热邪，传入阳明，逼迫水谷下奔则利。〕
猪苓 泽泻〔各钱许。〕 茯苓〔二、三钱。〕 滑石〔宣导热邪，俾从膀胱而出，三、
五钱。〕 阿胶〔四味恐太渗利伤阴，故加滋阴润燥之品，一钱。生鸡子可代。〕
此滋阴润燥荡热利水之剂。渴欲饮水，小便不利，而主此方者，以饮水故知热甚，溺涩故知热结
膀胱，利其小便，则邪热消而津液回，渴自止矣。少阴下利而主此方者，即仲景所云，利不止者，当
利其小便，开支河水道，以杀奔急之势，庶水谷分，而下利自止。若阳明病汗出多而渴者，不可与猪
芩汤，以汗多胃中燥。盖胃中津液，因热已内耗，加以汗多而夺之于外，又用猪苓汤复利其小便，以夺
之于下，则津液立亡。
加减导赤散 治热结膀胱，少腹胀满，小便不利。〔若少腹硬满，小便自利，蓄血症也。〕又治
饮水过多，水结在胸，心下怔忡，但头微汗出，〔湿热蒸腾，阳气但上升而不能下达。〕无大热者。〔
邪热但结胸间，故表无大热。〕
猪苓、泽泻、茯苓、滑石、甘草、橘红。身目发黄，加茵陈。水结胸症，加木通、灯心。
此方即五苓散、天水合用，去白术、桂枝而加橘红也。五苓用桂枝者，以太阳中风，表症未罢，邪
又入里，而见烦渴，小便不利，故用桂枝解表，苓，泽荡热，白术建中，
通表里而两解之。今无太阳表邪，无取桂枝，白术性壅，故亦不用，加橘红者，以膀胱气化则出也。
犀角地黄汤 治吐血衄血。〔火邪入里，扰乱血分，血热妄行也。〕或吐衄不尽，停留于胸，
或胁，或中脘，或少腹，为蓄血满疼，手不可按。〔必小便自利，大便色黑，为蓄血症。〕
犀角尖〔三、五钱。〕 生地〔三钱至八钱。〕 芍药〔亦有用赤者。〕 丹皮〔各一、
二钱。四味皆能凉血。又犀角、丹皮，兼能消瘀。〕止血加茅根、藕汁、磨京墨调服。〔外用冷水，拊
其后额，濯其两足。〕吐衄热盛，合黄连阿胶汤，〔治病必求其本，吐衄因邪火，故以苦寒直折之。〕
加麦冬、童便。瘀痛加元胡。如破瘀，加桃仁、红花、降香、大黄。
此凉血补阴祛瘀生新之剂。虽治吐衄及蓄血之方，按热病中多有昏闷抽搐及筋跳肉动之症，此方甚
宜。经曰∶诸热瞀〔昏闷〕螈〔抽搐〕皆属于火。邪热伤神，则神昏而烦闷，亢阳伤血，则筋肉失养，
而为抽搐跳动。犀角凉心安神，解烦除闷，生地凉血补阴。神昏烦闷，重用犀角。抽搐跳动，重用生地。正
所云药不拘方，宜合用而用是也。
桃仁承气汤 外症已解，少腹硬满，痛不可按，〔血蓄下焦之故。〕小便自利，〔血病而气不病
也。〕粪硬易解，〔邪不在气，结在血也。〕其色必黑，〔瘀血积之也，皆蓄血的症。〕或喜忘，〔即昏
闷也，搏血上冲，朦昧心神之故。〕或如狂，甚则发狂，或身目发黄，〔湿热发黄必小便不利。〕脉沉
有力，宜此汤，下尽黑物则愈。
桃仁〔破瘀血。三、五钱〕 大黄〔下瘀血。二钱至五钱。〕 芒硝〔能走血，软
坚润燥。一、二钱，元明粉代之，则性缓。〕 甘草〔调胃和中。钱许。〕 桂枝〔血得热则行
也。二、三、五分。内有热则去之，观大黄 虫丸方中，用黄芩清热，以瘀久必生热也。〕若挟
虚者，加生地、归、芍。
本方加降香、穿山甲末，〔破血开气。〕名代抵当汤。
此攻下蓄血之主方也。盖伤寒蓄血，人多不识，若能识者，垂手取效。凡病神昏者，多死；此症
神昏，宜急下之，迟则杀人。
茵陈蒿汤 阳明病，但头汗出，身无汗，至颈而还，〔肌表之气，郁而不通。〕小便不利，〔邪
郁上，气不下达。〕渴饮水浆者，〔胃热津枯也。〕此为瘀热在里，身必发黄，〔湿热郁蒸，邪无出
路。〕此汤主之。
茵陈〔善去湿热。三、五钱。〕 黑山栀〔能降火，从小便中泄去。二钱。〕 大黄〔为
佐。以建驱湿除热之功，以利小便，非下之也。一钱。〕可加麦冬，〔清胃热，生津液，疗目黄。〕
花粉〔除热疗疸。〕灯心〔利水、清心火。〕此湿热发黄通利之剂。若腹满大便实者，加枳、朴，倍大黄用之。
蜜煎猪胆导法 治阳明病本自汗出，〔身热汗自出，不恶寒反恶热，为阳明外症。〕医复发汗，
〔津液重伤。〕小便自利者。〔胃中邪热逼迫津液渗前阴，则又复夺之于下。〕
此为津液内竭，虽硬不可攻之，当须自欲大便，宜导
而通之。〔白蜜煎之，作挺长如指许，纳谷道中，以手急抱，欲大便时乃去之。或用大猪胆一枚，入
醋少许，取芦管五寸许，以一头入胆扎定，一头纳入谷道中，挤汁灌入肛门内，顷当大便出〕此为
大便不行，一无所苦者设；因邪低，故用异法迎而夺之之兵也。或用生地一、二两，煎汤顿饮，大便
立通。老弱虚人，产后病后，津液不足者甚宜。
大柴胡汤 治表症未除，〔发热或往来寒热等症。〕里症又急，〔腹胀满，大便实，或心下痞
硬。〕通表里而两解之。
柴胡〔解表之邪。〕 黄芩〔清里之热。〕 大黄〔随症量用。〕 枳实〔肠胃热
结，苦以泄之。〕 芍药〔正气虚弱，收而行之。各二钱。〕 半夏〔一钱，渴易花粉。〕 姜
枣〔和荣卫。〕
大承气汤 总以大便实为主，外则验之潮热，手足出汗，转矢气，脐腹满痛，手不可按，脉沉有力。
大黄〔量人强弱，随症轻重用之。一、二钱至一两。〕
枳实 浓朴〔一、二、三钱。〕 芒硝〔一钱至五钱。〕本方去芒硝，即小承气汤。硝、黄、
甘草即调胃承气汤。
大陷胸汤 治误下因成大结胸，从心上至少腹，硬满而痛不可近，口渴舌燥，日脯潮热，大便秘
结，脉沉紧者。
大黄、芒硝、甘遂〔苦寒有毒，能直达水饮窠囊隐僻之处，峻药不可轻用。多用半分或一分，得
快利，止后服。〕
六一顺气汤 热邪传入阳明胃府，不恶寒，反恶热，欲揭衣被，扬手掷足，自汗烦
躁，〔若周身无汗，但手、腋下汗
出，非燥粪热气，不能使诸阳本之犹蒸蒸而润也，尤为胃实之的症。〕口渴饮冷，咽燥唇裂，舌苔芒
刺，谵语潮热，气短气喘，甚则发呃，发厥发狂，不大便五、六日，绕脐痛，或腹满痛，手不可按，频转
矢气，脉洪数有力，此有燥粪也，此方下之。又阳明病发热，自汗如雨，〔恐胃汁内干。〕亦宜急下。
〔以存津液。〕又热病目不明，〔肾水将绝。〕亦宜急下。〔以救肾水。〕 大黄〔苦寒泄实去热。〕
芒硝〔咸寒润燥软坚。二味走而不守，均为荡涤之剂。〕 枳实〔苦寒泄漏。〕 浓朴〔苦温去
痞。〕 芍药〔酸以收其正气，又滋津液而益营血。〕 甘草〔甘以缓其速下，又补脾胃而建中
气。〕 黄芩〔苦寒能祛诸热。〕 柴胡〔能引胃气上升，若表症未除，更宜用之。〕以解表热。加
铁锈水，〔性以沉重能坠热开结，用匙调服。〕大结胸症，去甘草换桔梗，加甘遂。〔服药后，将盐炒
麸皮，绢包于腹上熨之，药气得热则行，大便易通。若服汤则下，勿再服。〕若服汤不下，或次日方下，
或半日后吐，仍原药〔中气大虚，不能运药，大凶之兆。〕加煨姜〔和药性一、二片。〕人参〔助胃气，
Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Huangbai (Phellodendri Cortex), Heishanzhi (Gardeniae Fructus, stir-fried black, each 2-3 qian), Shigao (Gypsum Fibrosum, 3-4 liang), Zhimu (Anemarrhenae Rhizoma, approx. 1 liang), Gancao (Licorice Root, 3 qian). This formula is a combination of Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity) and Baihu Tang (White Tiger Decoction), aiming to clear interior heat to protect body fluids. Bohe (Menthae Haplocalycis Herba, 3 qian), Danshi (Fermented Soybean, 1 lian). Danshi resolves the muscle layer and induces sweating; slight sweating leads to resolution.
This formula addresses conditions where both exterior and interior are hot, thus dissipating the pathogenic influence from both inside and out, akin to dividing forces to attack the enemy. If there is no high fever accompanied by exterior symptoms, but only dry and bound stools, as well as difficult-to-treat signs such as tongue retraction and scrotal contraction, remove Bohe and Danshi from this formula, add Dahuang (Rhei Radix et Rhizoma) and Mangxiao (Natrii Sulfas), naming it Sanhuang Jusheng Tang (Three Yellows Giant Victory Decoction). Use it temporarily to forcibly eliminate the pathogen; occasionally, survival is possible.
Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity): Treats severe heat in the Triple Burner, restlessness, speech confusion due to tongue coating issues (indicative of Upper Burner heat. "Speech confusion" refers to disordered speech; "delirious speech" involves frequently changing topics with a loud voice; "feeble speech" involves repeating one matter or phrase repeatedly with a low voice. These indicate depletion of essence and qi. Thus, excess manifests as delirious speech, deficiency as feeble speech), groaning (indicative of Lower Burner heat; the Kidney manifests sound as groaning, and Qi stagnation causes groaning), dry retching and insomnia (indicative of Middle Burner heat), and rapid pulse. Use Huanglian (to drain Middle Burner fire), Huangqin (to drain Upper Burner fire), Huangbai (to drain Lower Burner fire), Zhizi (Gardeniae Fructus, to drain Triple Burner fire, descending through curves, each 1-3 qian). If manic speech and agitation occur (warm-heat pathogens have entered the Pericardium, appearing as pseudo-manic rather than true manic states caused by stomach excess requiring purgation), or excessive laughter (a primary disease of the Pericardium, as the Heart manifests sound as laughter), add Shengdi (Rehmanniae Radix), Maidong (Ophiopogonis Radix), and Xijiao (Rhinocerotis Cornu). For palpitations, apply similar modifications. For thirst, add Maidong and Huafen (Trichosanthis Radix). For extreme thirst, combine with Baihu Tang (White Tiger Decoction). For dry retching, combine with Zhuru Tang (Bamboo Shavings Decoction). For restlessness, add Xijiao and Shengdi. For rapid pulse, fever, and difficulty urinating, add Maidong and Zhimu. For frequent urination (indicating heat pathogens entering the Middle Burner, forcing fluids downward due to the swift nature of fire), double the dose of Huangbai and add Zhimu. This is a bitter-cold heat-clearing agent that treats the Upper, Middle, and Lower Burners simultaneously. Regarding tongue coating: if pathogenic heat is at the exterior, no coating forms; at the half-exterior/half-interior level, a white coating forms; when transmitted inward, a yellow coating forms, becoming prickly and dry with severe heat. If a black coating with prickles appears, and regenerates after scraping, it is difficult to treat. In summer, seasonal fire pathogens burn internally and externally, easily causing black prickly coatings, yet survival is still possible; in winter, seeing this indicates death. Another sign is a tongue coating shiny like black lacquer; the tongue is the sprout of the Heart, corresponding to Southern Fire, analogous to self-immolation. Initially red, over time turning black like charcoal, indicating extreme heat. Also, a tongue without coating but red-purple, dry, and shiny indicates that pathogenic heat has scorched Kidney Water, preventing it from nourishing the Heart, leading to uncontrolled fire and self-destruction. Treatment for tongue coating: if Shaoyang syndrome is seen, use Xiao Chaihu Tang (Minor Bupleurum Decoction) removing Renshen (Ginseng Radix) and Banxia (Pinelliae Rhizoma), adding Zhimu and Huafen. If spontaneous sweating, restlessness, and extreme thirst occur, use Zhuyeshigu Tang (Leafy Lophatherum and Gypsum Decoction) combined with modified versions of this formula. Huanglian clearing Heart fire is essential. For fu-organ excess, use Chengqi Tang (Purgative Decoctions). For spontaneous diarrhea, use modified versions of this formula. Generally, wet and slippery coatings are auspicious; dry and rough ones are ominous. A white coating can also be dry and hard like sandpaper due to fluid dryness, where pathogenic heat has entered the Stomach but cannot turn yellow. Whenever tongue coating is present, wipe clean with a green cloth soaked in well water, then rub with mint powder mixed with honey. Ao Shi stated: Redness indicates internal heat accumulation; clear it according to symptoms. Other signs include cracked, stiff, short, long, or retracted tongues, all indicating victorious pathogenic heat and critical vital energy; treat with clearing or purging methods as appropriate. Heat diseases often involve the tongue protruding; if it cannot retract after recovery, apply a small amount of Bingpian (Borneolum Syntheticum) to the tongue to restore position. For swollen tongue filling the mouth, sprinkle Puhuang (Lygodii Spora) powder on top to cure.
Xiao Xianxiong Tang (Small Chest-Harmonizing Decoction): Treats cases where improper purgation allowed heat pathogens to sink into deficiency, binding with phlegm-fluids in the chest, known as Jie Xiong (Knotted Chest) disease (Improper purgation leading to fullness and hardness with pain below the heart is Jie Xiong; fullness without pain is Pi [Stagnation]). Small Jie Xiong presents with hardness and fullness below the heart, painful upon pressure (milder than Large Jie Xiong which extends from heart to lower abdomen with unbearable pain), and floating-slippery pulse (external pathogens sank slightly, differing from Large Jie Xiong's floating cun and deep-tight guan pulses). Huanglian (clears heat pathogens, 1-2 qian), Gualou Shi (Trichosanthis Fructus, washes away greasy stagnant heat in chest/diaphragm, 1-2 fruits crushed), Banxia (eliminates phlegm-fluids, 1-2 qian; replace with Huafen if thirsty). Can add Jianbinglang (Arecae Semen cum Exothecio, disperses knots, breaks stagnation, directs Qi downward rapidly, 1-2 qian). If accompanied by heat-induced diarrhea and subcardiac stagnation, remove Banxia and administer Yi Yuan San (Benefit Prime Powder) mixed.
This formula clears heat, opens knots, and transforms phlegm. Although the main formula for post-purgation Jie Xiong, it can also be borrowed for external pathogens transmitting to the chest, combining with phlegm, blocking airways, causing subcardiac fullness/pain or non-pain, if not preceded by improper purgation. Add specific herbs for concurrent syndromes.
Xiexin Tang (Drain the Heart Decoction): Treats subcardiac stagnation knot. Dahuang (attacks stagnation), Huanglian, Huangqin (clears heat). This is a bitter-cold heat-clearing and purgative agent. Use small doses for mild purgation; fear that pathogens have not entered the abdomen, so do not attack fiercely. Remember this warning.
Zhuru Tang (Bamboo Shavings Decoction): Vomiting desire after eating belongs to Yangming, not Shaoyang. For heat and irritability in the chest, this formula is primary. Zhuru (Bambusa Textilis Caulis, soothes rebellious Qi, 1-3 qian), Pipaye (Loquat Leaf, descends Qi well, 3-5 large slices, processed with ginger juice), Lugen (Phragmitis Rhizoma, enters Yangming exclusively, clears heat and descends, 3-4 liang, or take 1 cup of juice for better effect), Maidong (clears Stomach and stops vomiting, 3-5 qian). For vomiting roundworms (Stomach heat boils, worms uneasy; unable to pass down, they come up), combine with Baihu Tang (clears Stomach heat to calm worms), remove Gancao (sweetness agitates worms), or combine with Jiedu Tang (bitterness calms worms), adding Wumei (Mume Fructus) (sourness quiets worms). Do not mistake this for Cold Stomach and misuse Jiang (Zingiberis Rhizoma) or Guizhi (Cinnamomi Ramulus).
This is an excellent formula for heat-complicated vomiting. If excessive cold/herb use leads to Yangming deficiency-cold (no thirst, clear urine), temporarily use Wuzhuyu Tang (Evodia Decoction) to direct rebellious Qi downward, using Renshen, Jiang, and Zao to support Stomach Qi. For phlegm-fluid retention causing vomiting, use Qinlian Erchen Tang (Scutellaria-Coptis Two-Chen Decoction); for deficiency, use Liujunzi Tang (Six-Gentlemen Decoction), both adding Zhuru and Jiangzhi (Ginger Juice). For post-illness emaciation and shortness of breath with rebellious Qi vomiting, Zhang Zhongjing's Zhuyeshigu Tang is primary. Zhuye and Shigao clear residual heat; Renshen, Gancao, and Jingmi (Glumi Semen) tonify insufficiency; Banxia disperses rebellious Qi. Zhuye also removes new/old wind-pathogen heat and stops wheezing/Qi rushing upward. Combined with Renshen, Maidong, etc., it treats heat without damaging True Qi, guides rebellion without injuring Qi. Shengjiang (Fresh Ginger) disperses occasional stagnant fire but not long-standing凝 heat; Zhishi (Aurantii Fructus Immaturus) and Houpo (Magnoliae Officinalis Cortex) descend excess guest Qi but cannot descend heat-injured rebellion, hence unused. Shigao is very cold; used post-illness because external pathogens belong to Yang meridians, which bitter-cold herbs alone cannot overcome. Residual rebellious Qi requires clearing the source, hence Shigao is necessary. People today fear Shigao but not Huangqin/Huanglian, showing ignorance of syndrome differentiation.
Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction): Treats pathogens in chest/diaphragm, knotted pain and anguish in the heart (Anguish implies vexation; "Nao" implies depression; pathogens stagnate in chest, disturbing heart). Use this formula to induce vomiting. Zhizi (bitter induces vomiting), Danshi (resolves restlessness, removes fullness). For Yangming disease with no sweat, difficult urination, and heart anguish, jaundice will develop; add Maidong. If jaundice is already present, add Yinchen (Artemisiae Scopariae Herba) as chief herb.
Since pathogens are in chest/diaphragm, Zhizi and Danshi induce vomiting to expel them, following the principle "those above should be evacuated upwards." When using this decoction, if the patient has chronic loose stools, the large intestine moves easily; taking this will cause downward discharge instead of upward vomiting, so it is contraindicated. Contraindications for vomiting: weak pulse, dry retching, history of blood loss, shallow Qi, dizziness/fainting, and weakness. All these forbid this formula.
Zhuling Tang (Polyporus Decoction): Treats thirst with desire to drink and difficult urination (Yangming heat pathogens transmit to Lower Jiao, bladder heat knot, Qi transformation fails). Also treats Shaoyin diarrhea (Shaoyin heat transmits to Yangming, forcing grain/water downward causing diarrhea). Zhuling (Polyporus), Zexie (Alismatis Rhizoma, each approx. 1 qian), Fuling (Poria), Huashi (Talcum, 3-5 qian, disseminates heat pathogens allowing exit via bladder), Ejiao (Asini Corii Colla, 1 qian, prevents the four draining herbs from damaging Yin by adding yin-nourishing/moistening properties; raw egg yolk can substitute).
This is a yin-nourishing, moistening, heat-scouring, and diuretic agent. Thirst and difficult urination justify this formula: drinking indicates severe heat; urinary涩 indicates heat knot in bladder. Promoting urination eliminates heat pathogens and restores fluids, stopping thirst. For Shaoyin diarrhea, this follows Zhang Zhongjing's saying: for persistent diarrhea, promote urination to open water pathways, reducing urgent flow, separating water/grain, stopping diarrhea. However, for Yangming disease with profuse sweating and thirst, Zhuling Tang is forbidden because sweating dries the Stomach. Stomach fluids are internally consumed by heat; sweating depletes them externally; using Zhuling Tang further depletes them via urination, causing immediate fluid loss.
Jiajian Daochi San (Modified Guiding Out Red Powder): Treats heat knot in bladder, lower abdominal fullness, difficult urination (If lower abdomen is hard/full with free urination, it is Blood Stasis syndrome). Also treats excessive water intake causing water knot in chest, palpitations, slight head sweating (Damp-heat steaming, Yang Qi rises but doesn't descend), and absence of significant exterior heat (Heat knots in chest, so no major exterior heat). Ingredients: Zhuling, Zexie, Fuling, Huashi, Gancao, Juhong (Citri Reticulatae Pericarpium Rubrum). For jaundiced body/eyes, add Yinchen. For water knot in chest, add Mutong (Akebiae Caulis) and Dengxincao (Junci Medulla).
This formula combines Wuling San (Five-Ling Powder) and Tianshui San (Heavenly Water Powder), removing Baizhu (Atractylodis Macrocephalae Rhizoma) and Guizhi, adding Juhong. Wuling San uses Guizhi because Taiyang Wind Strike has unresolved exterior symptoms, pathogens enter interior causing thirst and difficult urination; Guizhi releases exterior, Ling/Zexie scour heat, Baizhu strengthens middle, resolving both exterior and interior. Here, no Taiyang exterior pathogen exists, so Guizhi is unnecessary; Baizhu is cloying, so removed; Juhong is added to facilitate Bladder Qi transformation and output.
Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction): Treats hematemesis and epistaxis (Fire pathogens enter interior, disturbing Blood level, causing reckless bleeding due to blood heat). Or incomplete bleeding remaining in chest, hypochondrium, epigastrium, or lower abdomen, causing blood stasis fullness/pain, untouchable (Must have free urination and black stool to confirm Blood Stasis). Xijiao tip (3-5 qian), Shengdi (3-8 qian), Shaoyao (Paeoniae Radix, sometimes Chishao), Mudanpi (Moutan Cortex, each 1-2 qian). All four cool blood; Xijiao and Mudanpi also resolve stasis. To stop bleeding, add Maogen (Imperatae Rhizoma), Ouji (Nymphaeae Fructus), and Jingmo (Ink Stick) ground and taken with medicine. External application: cold water on back of forehead and soaking feet. For severe heat in bleeding, combine with Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) (treat root cause; bleeding due to evil fire, so use bitter-cold to directly suppress), add Maidong and Tongbian (Child's Urine). For stasis pain, add Yuanhu (Corydalis Rhizoma). For breaking stasis, add Taoren (Persicae Semen), Honghua (Carthami Flos), Jiangxiang (Dalbergiae Odoriferae Lignum), Dahuang.
This is a blood-cooling, yin-tonifying, stasis-resolving, and new-blood-generating agent. Though treating bleeding and blood stasis, it is suitable for heat diseases with coma, convulsions, and muscle twitching. Classic says: All heat-related coma (mao) and convulsions (yuan) belong to Fire. Pathogenic heat damages Spirit, causing coma/restlessness; hyperactive Yang damages Blood, causing muscle twitching. Xijiao cools Heart, calms Spirit, relieves restlessness; Shengdi cools blood, tonifies Yin. For coma/restlessness, heavily use Xijiao; for convulsions/twitching, heavily use Shengdi. As stated, formulas are not rigid; use combinations appropriately.
Taoren Chengqi Tang (Peach Kernel Purgative Decoction): Exterior symptoms resolved, lower abdomen hard/full, painful to touch (Blood stasis in Lower Jiao), free urination (Blood diseased, Qi healthy), hard stool easy to pass (Pathogen in Blood, not Qi), stool color black (Accumulated blood stasis, signs of stored blood), forgetfulness (Coma/confusion, blood rushing up obscuring Heart Spirit), mania or madness, or jaundice (Damp-heat jaundice must have difficult urination), deep-strong pulse. Use this decoction; recover after passing black material. Taoren (breaks blood stasis, 3-5 qian), Dahuang (purges blood stasis, 2-5 qian), Mangxiao (enters Blood, softens hardness/moistens dryness, 1-2 qian; Yuanmingfen substitutes, milder action), Gancao (harmonizes Stomach/Middle, approx. 1 qian), Guizhi (Blood moves with heat, 2-5 fen; remove if internal heat exists, see Dahuang Zhechong Wan using Huangqin to clear heat as old stasis generates heat). If accompanied by deficiency, add Shengdi, Danggui (Angelicae Sinensis Radix), Shaoyao.
Adding Jiangxiang and Chuanshanjia (Manis Squama) powder to this formula creates Dai Didang Tang (Substitute Strong Attack Decoction).
This is the main formula for attacking stored blood. Many fail to recognize Typhoid stored blood; those who recognize it achieve quick results. Coma in general illness often leads to death; but in this condition, coma requires urgent purgation; delay kills.
Yinchen Hao Tang (Artemisia and Yellow Poppy Seed Decoction): Yangming disease, only head sweats, body no sweat, stopping at neck (Muscle/surface Qi stagnant/unblocked), difficult urination (Pathogen stagnant above, Qi doesn't reach below), thirst for drinks (Stomach heat, fluid exhaustion). This is damp-heat trapped inside, leading to jaundice (Damp-heat steaming, no exit for pathogen). This formula treats it. Yinchen (removes damp-heat, 3-5 qian), Heishanzhi (descends fire, excretes via urine, 2 qian), Dahuang (assistant, drives damp/heat, promotes urination, not purgation, 1 qian). Can add Maidong (clears Stomach heat, generates fluids, treats eye jaundice), Huafen (clears heat, treats jaundice), Dengxincao (promotes urination, clears Heart fire). This is a damp-heat jaundice-promoting agent. If abdominal fullness and solid stool exist, add Zhishi and Houpo, doubling Dahuang.
Mi Jian Zhu Dan Dao Fa (Honey-Suppository and Pig Gallbladder Method): Treats Yangming disease with spontaneous sweating (Body heat, spontaneous sweat, no aversion to cold but aversion to heat = Yangming exterior symptoms), doctor reapplied sweating method (Severe fluid injury), free urination (Stomach heat forces fluids to anterior yin, depleting them downward). This indicates internal fluid exhaustion; even if stool is hard, do not purge. Wait for natural urge to defecate, then guide/open passage (Melt white honey into suppositories finger-length, insert into anus, hold tightly, remove when urge arises. Or use large pig gallbladder, add vinegar, insert 5-inch reed tube into gallbladder, other end into anus, squeeze juice in, bowel movement follows soon). Designed for constipation without discomfort; due to low pathogen, use alternative method to intercept. Alternatively, boil 1-2 liang Shengdi, drink instantly for immediate bowel movement. Suitable for elderly, weak, postpartum, post-illness patients with insufficient fluids.
Da Chaihu Tang (Major Bupleurum Decoction): Treats unresolved exterior symptoms (Fever or alternating chills/fever) and urgent interior symptoms (Abdominal fullness, solid stool, or subcardiac stiffness), resolving both exterior and interior. Chaihu (Bupleuri Radix, releases exterior pathogens), Huangqin (clears interior heat), Dahuang (dose according to symptoms), Zhishi (bitter drains intestinal/stomach heat knots), Shaoyao (tonifies/restrains weak righteous Qi, each 2 qian), Banxia (1 qian; replace with Huafen if thirsty), Jiang and Zao (harmonize Ying/Wei).
Da Chengqi Tang (Major Purgative Decoction): Primarily indicated by solid stool. Exterior signs: tidal fever, sweaty hands/feet, passing gas, umbilical/abdominal fullness/pain, untouchable, deep-strong pulse. Dahuang (dose based on strength/symptom severity, 1-2 qian to 1 liang), Zhishi, Houpo (1-3 qian), Mangxiao (1-5 qian). Remove Mangxiao to make Xiao Chengqi Tang (Minor Purgative Decoction). Mangxiao, Dahuang, Gancao make Tiaowei Chengqi Tang (Harmonize Stomach Purgative Decoction).
Da Xianxiong Tang (Major Chest-Harmonizing Decoction): Treats Large Jie Xiong caused by improper purgation: hardness/fullness/pain from heart to lower abdomen, unbearable, thirst, dry tongue, afternoon tidal fever, constipation, deep-tight pulse. Dahuang, Mangxiao, Gansui (Kansui Radix, bitter-cold toxic, reaches hidden phlegm-fluid nests; harsh drug, use lightly. 0.5-1 fen max; stop after effective loose stool).
Liuyi Shunqi Tang (Six-One Harmonizing Qi Decoction): Heat pathogens transmit to Yangming Stomach Fu organ: no aversion to cold, aversion to heat, desire to remove clothes, waving hands/kicking, spontaneous sweating, restlessness (If no body sweat except hands/armpits, not due to dry feces/heat making Yang Qi steam/moisten, especially indicative of Stomach excess), thirst for cold drinks, dry throat/cracked lips, prickly tongue coating, delirium, tidal fever, shortness of breath, hiccups, syncope, madness, no bowel movement for 5-6 days, periumbilical pain, or abdominal fullness/pain, untouchable, frequent gas, surging-rapid-strong pulse. Indicates dry feces; use this formula to purge. Also, Yangming fever with profuse sweating (fear Stomach juice drying) requires urgent purgation (to preserve fluids). Also, heat disease with unclear vision (Kidney Water about to perish) requires urgent purgation (to save Kidney Water). Dahuang (bitter-cold drains excess/removes heat), Mangxiao (salty-cold moistens dryness/softens hardness. Both move freely, scouring agents), Zhishi (bitter-cold leaks/drains), Houpo (bitter-warm removes stagnation), Shaoyao (sour gathers righteous Qi, nourishes fluids/nourishes Ying-Blood), Gancao (sweet slows rapid purgation, tonifies Spleen/Stomach/builds Middle Qi), Huangqin (bitter-cold removes various heats), Chaihu (guides Stomach Qi upward; if exterior unresolved, use to release exterior heat). Add Tie Xiu Shui (Iron Rust Water, heavy nature sinks heat/opens knots, mix with spoon). For Large Jie Xiong, remove Gancao, replace with Jiegeng (Platycodonis Radix), add Gansui (After taking medicine, wrap salt-fried bran in silk, iron on abdomen; heat helps medicine act, easier bowel movement. If stool passes, do not take more). If medicine doesn't work, or works next day, or vomits after half day, keep original formula (Middle Qi severely deficient, cannot transport medicine, ominous sign), add Wei Jiang (Roasted Ginger, harmonize medicine, 1-2 slices), Renshen (Tonify Stomach Qi,