量其有邪实病重，轻剂不行者，当再下之，以腹中和，二便通为度。〕若脉弱或不能食，〔其人本虚
勿轻议下，必不得已，用攻补兼施之法。〕或黄龙汤，〔顾其元气。即小承气汤加人参、归、地。〕或
承气养荣汤，〔顾其津液，即小承气汤加归、地、白芍、麦冬、知母。〕随宜用之。
此方节庵用代大、小承气，调胃承气，大柴胡，大陷胸等汤，凡伤寒过经，及老弱产后虚人，苟有下
症者，或有
下后不解，或有表症未除，而里症又急，不得不下者，去芒硝，小剂缓缓下之。盖大黄清血分之热，
用之而泻不止者，饮粥汤，胃得谷气则泄止，以胃之气未伤也，合芒硝，则并气分而峻寒之，且又最
伤下焦血分之真阴；必三焦俱伤，痞满燥实坚全具，热邪太甚者，方可兼用，所谓有病病当之也，若
热不至坚者，不可用。观仲景增此一味而曰大，减此一味而曰小，且诸所欲下者，必曰先与小承气汤，
则芒硝之峻可知。至调胃承气，反去枳、朴，不去芒硝，或因吐下津干，或因烦满气热，总为胃中燥热
不和，而非大实满者，此经曰热凝于内，治以咸寒之义也。去枳、朴者，恐伤上焦虚无氤氲之元气，又
加甘草，培其根本，故曰调胃承气。谓胃乃大小肠膀胱转运之本气，化则能出，有热有物以滞之，气不
承顺，则壅而不和，故取微下，以调和胃气，甚则用大承气汤，不甚则小承气也。吕晚村云∶邪既入里，故
就大便通泄其热，从其近易，非矢为害，而必欲攻之也。昧者、方中杂用消克之药误矣。仲景用承气之
法，有曰∶若不大便六、七日，恐有燥粪，欲知之法，少与小承气汤，汤入腹中，转矢气者，此有燥粪，
乃可攻之；若不转矢气，此但初头硬，后必溏，不可攻之；攻之必胀满不能食也。又阳明症，谵语发潮
热，脉滑而疾者，与小承气汤。若不转矢气，明日不大便，脉反微涩者，里虚也，为难治，不可更与承气
汤。又烦躁心下硬，若其人脉弱，虽能食，少与小承气和
之，勿令大下。以邪实不可不下，而正虚又不可大下，此汤关系安危最大。盖热邪入胃，不以寒药
治之，则胃伤，不及则药不胜邪，太过则药反伤其正气。斟酌投之，以祈无误。凡荡涤外感热邪，皆用
汤液，切禁丸药，惟脾约一症，则用麻仁丸。〔即小承气加白芍、麻仁、杏仁。〕因其人平素脾气
燥热，省约所食之物，为一、二弹丸，三、五日一大便者；所以热邪入里，益津枯血燥，大便艰涩；
故用凉血润燥，缓以通之；不比一时暂结者，可用汤药涤之耳。
再按此方，总以大便硬为主，用之固宜也，乃下利而亦用之者，因腹中有燥粪热结，则稀水从傍
流下为利，必兼谵语潮热，脐腹按之硬痛，脉滑数有力者，方可用通因通用之法。若少阴病之自利清水，
色纯青，心下必痛，口干燥，而用急下之者，因少阴邪热，挟木火乘胃，胃津肾水，将欲枯竭，不得不
因热利导，使邪热下行，而救胃肾垂绝之阴。愚谓承气养荣汤内有地冬，用治此症颇宜。尺脉若弱，
〔肾阴亏也。〕不可下；脉虚细者，〔气血衰也。〕不可下；表未解者，〔头痛发热，恶风等症未除。〕
不可下；〔恐邪气内陷也。〕诸动气者，不可下；〔恐脾气伤败也〕诸虚者，〔如劳倦阴虚，经行经断，
胎产崩漏等症。〕不可下；呕多者〔胃气大伤也。〕不可下；小便清白者，〔内无热也。〕不可下；阳明
病心下硬满者不可下；〔下之利遂不。止者死。诛伐无过，胃气下陷也。〕胁下素有痞，连在脐傍
者，〔此名脏结，必腹内拒痛，甚至不可忍。〕不可下，〔下之是速其病，小腹入阴筋而死也。〕结胸
症脉浮大者〔表邪未清也。〕不可下。〔下之是令其结而又结，则死矣。〕如误用芒、黄而下不止者，宜
大剂加味理中汤以救之。
芍药黄芩汤 〔自制〕治热邪传入太阴，腹满咽干，〔太阴脉布于胃，络于嗌。热邪壅滞经
气不通，故而腹满；热邪循经冲咽，故咽干。〕吐而食不下，〔邪迫于上也。〕自利而腹痛。〔邪迫于
下也。〕
白芍〔安脾胃而和血脉，治腹痛而止泻利。炒二、三、四钱，〕 甘草〔腹满呕吐者去
之。〕 黄芩〔以上三味即黄芩汤，本热邪入里，下利腹满方。〕 黄连〔清热邪，〕 枳壳
〔破结气。〕 橘红〔通滞气。〕 茯苓〔盖脾胃，止吐泻。各一、二、三钱。〕如便脓血加地榆，
调服滑石末。〔三、五钱。〕不止，佐以升麻、〔醋炒三、五、七分。〕葛根。〔钱许。〕若呕吐者，
〔忌用升提。〕加石莲子、〔去心炒黄。〕陈松萝茶。〔各三、五钱。〕
此方和解清热为主，佐以利气除湿之药。盖太阴本属湿土，热邪干之，湿热壅滞，故见如上诸症。
所以夏秋太阴司令之时，患此最多。今人辄云遵仲景法，遂用四逆汤，妄投姜、附，竭绝真阴而死者，
如恒河沙数。要知热邪传入太阴，协热自利必咽干口燥，小便黄赤短涩，大便黄赤或黑，形状如垢腻而
极臭，肛门如暖汤而泻出，或里急后重，
脓血错杂，其所吐之物，必糟粕酸臭。若脏寒下利，则口不燥渴，小便清白，大便泻出，或清或白，
有如骛溏，或完谷不化，而水液澄彻清冷，或吐出，亦如是，方可用温中之法。然热病中万无此症，若
过用寒凉，或亦有之。
黄连阿胶汤 治热邪传入少阴，口燥舌干而渴，〔肾属水，而邪热涸之故也。〕身凉但欲寐。〔
志气昏倦。〕脉沉细数。又治湿热下利脓血。
黄连 黄芩〔阳有余者，苦以泻之。各一、二、三钱。〕 芍药〔阴气耗者，酸以收之。二、
三钱。〕 真阿胶〔二钱。如无可用龟甲。入肾补阴、除热，兼止久痢。〕 生鸡子〔一枚，调入。
阴不足者，甘以补之。昔人谓其补阴血，与真阿胶同功。故产后虚痢，胎漏下血可用。〕可加生地〔益肾
阴。〕二冬〔除烦渴。〕知母、黄柏。〔泻肾火。〕烦躁〔水虚火旺上冲故也。〕加犀角。咽痛〔肾
脉入肺中，循喉咙，挟舌本故也。〕加玄参、甘桔。〔甘桔汤，治少阴病咽痛。〕此清火滋阴之剂，仲
景本治少阴病，心中烦不得卧之主方。盖但欲寐为少阴之本症，因热涸肾水，心相无制，神志无宁，致
烦不得卧，为自焚欲死之征。今虽身凉欲寐，而口舌干渴，总由邪热伤阴所致，故均以此治之。
四逆散 治少阴病四肢厥逆〔热邪传肾，胃关壅闭，故胃阳亦郁，不达四肢。〕又治热邪，传入厥
阴，手足逆冷，〔木郁胃阳也。〕或自利者。〔邪逼胃中，水谷下奔。〕
柴胡〔解厥阴之邪，达胃阳之郁。〕 芍药〔疏土中之水。〕 枳实〔破壅滞之气。各一、
二钱。〕 甘草〔和中。减半。〕可加黄芩。〔清木火之热。〕
此清热和解之剂。虽少阴四逆，实邪挟木乘胃所致，故但治厥阴，而少阴亦解，此母实泻子之治法
也。仲景谓∶厥应下之，而反发汗者，必口伤烂赤。谓当以寒剂降热下行，如白虎汤之清金平木解热，
以救胃中津液，亦为热厥之主方，非大承气峻下之谓也。故又戒之曰∶诸四逆厥者，不可
下之，虚家亦然。若果有下症，仍可用微下之法，须活泼泼地，不可固执。
龙胆清肝饮〔自制〕治热邪传入厥阴，烦满囊缩，〔热邪引动肝气上逆，则烦满。肝脉过
阴器，气燥灼于筋，故囊缩也。〕消渴，〔饮水多而小便少也。脾盛则母虚，故肾水消而生渴，且木火
滋盛，必乘吸胃中之津液。〕气上冲心，心中痛热，〔肝气通于心，母盛则子实，故气冲心而疼热。〕
饥不欲食，食则吐蛔者。〔木邪肆横，胃土受制也。〕
龙胆草〔专泻肝胆之热邪。〕 黄芩〔君以胆草，亦入胆矣。〕 黄连〔心痛烦满，皆南
方亢上之气，连之苦寒直泻丙丁，实则泻其子也。俱一、二钱。〕 栝蒌〔一枚〕 麦冬〔制肝者
惟金，故以栝蒌、麦冬、润肺生津液。五钱至一两。〕 玄参〔二、三钱。〕 知母〔生肝者惟水，
故以玄参、知母，壮水滋化源。三、五钱。〕 芍药〔畏肝者惟土，故以白芍安脾泻火邪。三钱。〕
羚羊角〔独入厥阴，涤热舒筋，三、五钱。〕吐蛔加乌梅。如误下利不止者，〔徒虚阳明，木益乘
其所胜。〕去瓜、麦、玄参、知母，倍芍药。此方以清解厥阴热邪之药为君，佐以清金壮水安脾之剂。
沈氏谓∶黄芩汤一方，原治厥阴之病。愚嫌其尚少对症的药，故采加入，且更其方名，使知热邪传入厥
阴，当以清肝为首务，方书但用承气汤下法，岂非一盲引众盲，相率入火坑耳。
炒米汤 治外感六、七日间，正气来复，邪气欲出，其人本虚，邪正相争，身首皆动，是为
发战，脉必浮起。〔若正气内实，邪不能与之争，则便汗出而不发战。〕
黄米〔炒焦。一撮。〕煎汤饮之，无内热症者，方可加生姜〔驱邪外出，薄者三片。〕此不
用药，而但用米汤以助胃气，使正气胜邪，则发热汗出而解；若正气不能胜邪，虽战无汗，为难治也。
栗则但心战头摇鼓颔，乃正气虚极，不能送邪达表，扶正为急；若不止，乃为败症必死。
按伤寒家，服药后，身热发渴，烦躁冒胃瞀，两手脉忽伏而不见，恶寒战栗，此皆阴阳氤氲，正邪分
争作汗之征也，姑宜静以待之，不可因而仓惶，反至错误。
炙甘草汤 治汗下后，脉结代，〔胃脏乃津液水谷之海，内充脏腑，外灌形骸，津多脉盛，津少
脉衰。今因汗则津越，下则津空，所以脉来动而中止，不能接续。〕心动悸者。〔真阴已亡，微邪未散。〕
炙甘草〔二钱〕 人参〔补胃。一钱。〕 麦冬〔生津。〕 生地〔各三、五钱。〕 阿
胶〔养血，一钱。〕 麻仁〔润燥，炒研一钱。〕 桂枝〔二、三、五分。〕 生姜〔一、二片。〕
大枣〔调和荣卫。二枚，清酒水煎。〕
此方补胃生津，养血润燥，以为复脉之大法，少加桂枝、生姜者，为微邪未散而设也。若内有
热症者，姜，桂慎勿轻投。沈氏云∶此症脉代能食者，尚可愈，不能食者必死。故仲景谓∶得此脉者，
必难治。此方凡心中惊惕，人虚脉弱者，宜去姜、桂，加茯神、枣仁、朱砂之属治之。余于
温热病中，尝遇歇止之脉，有因火过亢，有因气血痰食停滞，阻其营运之机而致者，或清火热，
或通壅滞，脉自如常，勿执前说，不细审察，概投补剂。
加味理中汤 治误下，或过用寒凉，症变虚寒，洞泄不已，元气将脱。
人参〔二钱至二两。〕 白术〔二、三、五钱。〕 炙甘草〔补虚。一钱。〕
干姜〔温中。一、二、三钱。〕 白芍〔酸收。二、三、五钱。〕加大枣、乌梅，入炒米〔一撮〕
炒陈壁土，〔一匙，取谷气土气以助胃气。〕不止，佐以升麻、干葛〔升提。〕 赤石脂〔固
涩。一半煎，一半调末服。〕里寒甚者，酌量加桂〔五分至二钱止。〕附子〔五分至二钱止。〕
此温中救逆之剂。因用药差误，故从权以温补之，寒退泻减，即以平补之剂调之，勿过用桂、附。
〔按伤寒论中所载辛热诸方，仲景为误汗下吐，故不得已而从权暂用，原非传经伤寒正治之法，嘉言辨
之甚明。后人徒读其书，不细详审立方之旨，亦不分土地有南北之殊，天时有寒温之异，见有成法，遂
则效尤，甚至温热病中，亦恣用无忌。大概病家辄称感风寒受寒湿，见用辛温热剂，则情投意合。更于
酷暑时令，闭窗下帷，和衣复被，致病者躁扰无奈，欲饮冷水，欲求入井，反谓阴躁，禁与寒凉，因之
枉死。余所目击，已难悉数。但积习难返，时深悲悯，故着伤寒温热一卷，于六法中，惟清热方法居
其七、八，其辛热诸剂，但存温经理中吴茱等方，备救汗下吐之逆，余概不录。实非偏执，所以因
地之宜，顺天之时，庶不致遗人夭殃。但恐一齐之傅，难禁众楚之咻，若欲障百川而东之，回狂澜于既
倒，端有望于诸
高明互相倡导云耳。〕若过用桂、附及误用身目红者，乃附毒之故，急煎犀角〔二两。〕黄连 甘草
〔各三、五钱。〕萝卜捣汁，〔二大碗。〕代水煎成，〔或用澄清泥浆水亦可。〕大剂频饮，其红自
除。如解迟，血必从耳目口鼻中而出则死。
烧 散 治阴阳易症。〔感病新瘥，即行交接，无病患染着余热之毒而病。或男传女，女传
男，如换易也，〕身重少气，百节解散，〔内损真阴之故。〕热上冲心胸，头重不举，眼中生花，〔毒
气上蒸之故。〕憎寒壮热。〔热毒壅遏，卫气不行于表，故憎寒，热甚于中，故热遍于身也。〕
在男子则阴肿，少腹绞痛，在妇人则里急，连腰胯内痛。〔甚者手足厥冷挛拳，男子卵陷入腹，妇人
痛引阴中，皆难治。舌吐出者必死。〕不易自病，谓之女劳复，其症相似，〔内损真阴，外动邪热，正
虚邪盛，亦最难治。〕通用此方。
裤裆〔取阴处烧灰，女取男者用之，男取女者用之。〕 竹青皮〔能下壅热卵缩，腹痛倍
之。〕竹青煎汤和服，或入煎药服，有粘汗出为效，如无再服，以小便通利，阴头微肿则愈。
If the patient has excess pathogenic factors and severe illness, and mild agents are ineffective, purgation should be administered again, with the goal of harmonizing the abdomen and ensuring the free passage of stool and urine. If the pulse is weak or the patient cannot eat, it indicates that the patient's constitution is inherently deficient; do not lightly consider purgation. If absolutely necessary, use a method that simultaneously attacks the pathogen and tonifies deficiency. One may use Huanglong Tang (Cinnamon Twig Decoction variant protecting Yuan Qi, i.e., Xiaochengqi Tang added with Renshen [Ginseng Radix], Danggui [Angelicae Sinensis Radix], and Dihuang [Rehmanniae Radix]). Alternatively, use Chengqi Yangrong Tang (Chengqi Decoction nourishing Ying Blood, i.e., Xiaochengqi Tang added with Danggui, Dihuang, Baishao [Paeoniae Radix Alba], Maidong [Ophiopogonis Radix], and Zhimu [Anemarrhenae Rhizome]). Use them according to suitability.
This formula (referring to formulas like Chengqi Yangrong Tang) was used by Jie'an to substitute for Dachengqi Tang, Xiaochengqi Tang, Tiaowei Chengqi Tang, Daxiehu Tang, and Da Xianxiong Tang. For any case of Shanghan (Cold Damage) that has passed through its meridians, as well as for elderly, frail, or postpartum deficient individuals, if there are indications for purgation, or if purgation has been used but the disease persists, or if exterior symptoms remain while interior symptoms are urgent requiring purgation, remove Mangxiao (Natrii Sulfas), and use a small dose to gently purge. This is because Dahuang (Rhei Radix et Rhizoma) clears heat from the blood level; if diarrhea continues after its use, drinking rice soup will stop the diarrhea once the stomach receives grain qi, indicating that the stomach qi is not yet injured. However, combining it with Mangxiao causes a harsh coldness affecting both the qi and blood levels, and most severely injures the true yin of the lower jiao. It should only be used jointly when all three jiaos are damaged, and the conditions of fullness, stagnation, dryness, excess, and hardness are all present due to extreme heat pathogens—this is what is meant by "the disease bears the burden of the medicine." If the heat does not lead to such hardness, it must not be used. Observing Zhang Zhongjing, adding this one ingredient makes it "Da" (Great), and removing it makes it "Xiao" (Small); furthermore, for all cases requiring purgation, he always stated to first give Xiaochengqi Tang. Thus, the harshness of Mangxiao can be understood. As for Tiaowei Chengqi Tang, Zhi Shi (Aurantii Fructus) and Houpo (Magnoliae Officinalis Cortex) are removed, but Mangxiao is not. This may be because vomiting or purging has dried up the fluids, or due to irritability, fullness, and qi heat; generally, this represents dry-heat disharmony in the stomach, rather than a great excess of fullness. This aligns with the principle in the Classic: "Heat condensed within is treated with salty-cold." Removing Zhi Shi and Houpo avoids injuring the ethereal primordial qi of the upper jiao, and adding Gancao (Glycyrrhizae Radix et Rhizoma) cultivates the root, hence it is called Tiaowei Chengqi (Regulating the Stomach and Bearing Down). The stomach is the foundation of transport for the large intestine, small intestine, and bladder; when transformation functions normally, waste is expelled. If heat and material obstruct it, causing qi to fail to flow smoothly, congestion and disharmony result. Therefore, mild purgation is taken to harmonize stomach qi; in severe cases, Dachengqi Tang is used, and in milder cases, Xiaochengqi Tang. Lv Wancun said: Since the pathogen has entered the interior, heat is cleared via the stool, following the easier and closer route; it is not that the feces themselves are harmful and must be attacked. Ignorant practitioners who mix digestants and draining herbs into these formulas are mistaken. Zhang Zhongjing's use of Chengqi methods states: If there is no bowel movement for six or seven days and dry feces are suspected, the method to verify is to give a small amount of Xiaochengqi Tang. If, after the decoction enters the abdomen, flatus occurs, this indicates dry feces, and attack may proceed. If no flatus occurs, the head is hard but the tail is loose; do not attack, as it will cause fullness and inability to eat. In Yangming syndrome, with delirium and tidal fever, and a slippery and rapid pulse, give Xiaochengqi Tang. If no flatus occurs, and on the next day there is still no bowel movement, but the pulse becomes faint and choppy, this indicates interior deficiency; it is difficult to treat, and Chengqi Tang should not be given again. In cases of irritability and hardness below the heart, if the pulse is weak, even if the patient can eat, give a small amount of Chengqi to harmonize; do not induce severe purgation. Because the pathogen is excess and requires purgation, but the righteous qi is deficient and cannot withstand severe purgation, this decoction relates greatly to safety and danger. Heat entering the stomach must be treated with cold herbs; otherwise, the stomach is injured. If insufficient, the medicine cannot overcome the pathogen; if excessive, the medicine harms the righteous qi. Dosage must be carefully weighed to avoid error. To sweep away exogenous heat pathogens, decoctions are always used; pills are strictly prohibited. Only in the case of Pi Yue (Spleen Constriction) is Maren Wan (Hemp Seed Pill) used (i.e., Xiaochengqi Tang added with Baishao, Huomaren [Cannabis Semen], and Xingren [Armeniacae Semen Amarum]). This is because the person usually has dry-heat in the spleen qi, conserving food intake, resulting in stools the size of one or two pellets, occurring every three to five days. When heat enters the interior, fluids become depleted and blood dries, making defecation difficult. Therefore, blood-cooling and moistening-drying herbs are used to gently promote unblocking; this differs from temporary accumulation, which can be swept away by decoctions.
Furthermore, regarding this formula, it focuses primarily on hard stool, so its use is appropriate. However, it is also used for diarrhea because dry-heat accumulation in the abdomen causes thin water to flow around the blockage, presenting as diarrhea. It can only be used if accompanied by delirium, tidal fever, hardness and pain upon pressing the umbilical/abdominal area, and a slippery, rapid, and forceful pulse. In such cases, the method of "treating obstruction with unblocking agents" (Tong Yin Tong Yong) applies. In Shaoyin disease with spontaneous watery diarrhea, pure green color, pain in the epigastrium, and dry mouth/throat, urgent purgation is used because Shaoyin heat pathogens, combined with Wood-Fire attacking the stomach, deplete stomach fluids and kidney water. One must guide the heat down through the diarrhea to save the nearly exhausted yin of the stomach and kidneys. I believe Chengqi Yangrong Tang, containing Dihuang and Maidong, is quite suitable for this condition. If the Chi (Cun-Kou) pulse is weak (kidney yin deficiency), do not purge. If the pulse is empty and fine (qi and blood decline), do not purge. If the exterior is not resolved (headache, fever, aversion to wind, etc., not yet gone), do not purge (fear of pathogen sinking inward). In cases of frequent Qi movements (fear of spleen qi damage), do not purge. In all deficiency cases (such as fatigue-induced yin deficiency, menstrual irregularities, postpartum bleeding, etc.), do not purge. In cases of frequent vomiting (stomach qi severely damaged), do not purge. If urine is clear and white (no interior heat), do not purge. In Yangming disease with hardness/fullness below the heart, do not purge (purging leads to unstoppable diarrhea and death; this is punishing the innocent and causing stomach qi to sink). If there is a pre-existing mass under the ribs connected to the navel (called Zang Jie, organ knot, characterized by abdominal tenderness and rebound pain, unbearable), do not purge (purging accelerates the disease, leading to contraction of the genitals and death). In Jie Xiong (Chest Binding) syndrome with a floating and large pulse (exterior pathogen not cleared), do not purge (purbing causes binding upon binding, leading to death). If Mangxiao and Dahuang are mistakenly used and purging does not stop, use a large dose of Jiawei Lizhong Tang (Modified Lizhong Decoction) to rescue.
Shaoyao Huangqin Tang (Self-made): Treats heat pathogens transmitting to Taiyin, causing abdominal fullness and dry throat (Taiyin meridian spreads over the stomach and connects to the pharynx; heat stagnation blocks meridian qi, causing fullness; heat follows the meridian to the throat, causing dryness), vomiting with inability to eat (pathogen forcing upward), spontaneous diarrhea with abdominal pain (pathogen forcing downward).
Baishao (Harmonizes spleen/stomach and blood vessels, treats abdominal pain and stops diarrhea. Stir-fry 2-4 qian), Gancao (Remove if abdominal fullness or vomiting is present), Huangqin (These three constitute Huangqin Tang, originally for heat entering interior with diarrhea and fullness), Huanglian (Clears heat pathogens), Zhike (Breaks stagnant qi), Juhong (Unblocks stagnant qi), Fuling (Benefits spleen/stomach, stops vomiting/diarrhea. Each 1-3 qian). If pus and blood in stool, add Diyü (Sanguisorbae Radix), mixed with Huashi (Talcum) powder (3-5 qian). If it does not stop, assist with Shengma (Cimicifugae Rhizoma, vinegar-fried 3-5 fen) and Gegen (Puerariae Radix, approx. 1 qian). If vomiting occurs (avoid lifting herbs), add Shilianzi (Nelumbinis Plumula, heart removed, stir-fried yellow) and Chensongluocha (Old Song Luocha Tea, each 3-5 qian).
This formula primarily harmonizes and clears heat, assisted by herbs that promote qi movement and drain dampness. Taiyin belongs to wet earth; when invaded by heat, damp-heat stagnates, causing the aforementioned symptoms. Thus, during summer and autumn when Taiyin governs, this disease is most common. Modern practitioners often claim to follow Zhang Zhongjing's methods but use Sixini Tang (Four Reversal Decoction), recklessly administering Jiang (Zingiberis Rhizoma) and Fu Zi (Aconiti Lateralis Radix Praeparata), exhausting true yin and causing death, numbering as many grains of sand in the Ganges River. One must know that when heat transmits to Taiyin, heat-collateralized diarrhea presents with dry throat/mouth, yellow/red/scanty urine, yellow/red/black stool resembling grime and extremely foul-smelling, anus feeling warm upon expulsion, tenesmus, and mixed pus/blood. Vomit consists of sour/foul undigested food. In contrast, cold-deficiency diarrhea presents with no thirst, clear/white urine, stool resembling duck manure or undigested food, clear/cold fluid, or similar vomit; only then can warming methods be used. However, such symptoms never occur in heat diseases unless cold herbs are overused.
Huanglian Ejiao Tang: Treats heat transmitting to Shaoyin, causing dry mouth/tongue and thirst (Kidney belongs to Water, depleted by heat), cool body but desire to sleep (spiritual fatigue), deep, fine, rapid pulse. Also treats damp-heat diarrhea with pus and blood.
Huanglian, Huangqin (For excess yang, use bitter to drain. Each 1-3 qian), Shaoyao (For consumed yin, use sour to astringe. 2-3 qian), Zhen Ejiao (Donkey-hide Gelatin, 2 qian. If unavailable, use Guijia [Testudinis Carapax et Plastrum]. Enters kidney to tonify yin, clear heat, and stop chronic dysentery), Raw Chicken Egg (One egg, stirred in. For yin insufficiency, use sweet to tonify. Ancients said it tonifies yin-blood, working similarly to Ejiao. Suitable for postpartum dysentery and uterine bleeding). Can add Shengdi (Rehmanniae Radix Recens, benefits kidney yin), Er Dong (Ophiopogonis and Asparagi rhizomes, relieves irritability/thirst), Zhi Mu, Huangbai (Drains kidney fire). For irritability (water deficiency with fire hyperactivity rushing upward), add Xijiao (Rhinocerotis Cornu). For sore throat (Kidney meridian enters lung, follows throat, grasps tongue base), add Xuanshen (Scrophulariae Radix) and Ganjie (Licorice and Platycodon Decoction, treats Shaoyin sore throat). This is a fire-clearing and yin-nourishing formula. Zhang Zhongjing originally used it as the main formula for Shaoyin disease with vexation and inability to sleep. Desire to sleep is the fundamental symptom of Shaoyin; due to heat depleting kidney water, Heart Fire is uncontrolled, spirit is restless, causing vexation and insomnia—a sign of self-burning. Although the current presentation includes cool body and desire to sleep, the dry mouth/tongue and thirst are caused by heat damaging yin; thus, this formula is used for both.
Sixini San (Four Reversal Powder): Treats Shaoyin disease with cold extremities (Heat transmits to Kidney, stomach gate is blocked, so Stomach Yang is also constrained and fails to reach limbs). Also treats heat transmitting to Jueyin, with cold hands/feet (Wood constraining Stomach Yang), or spontaneous diarrhea (Pathogen forces water/grain downward).
Chaihu (Resolves Jueyin pathogen, releases Stomach Yang constraint), Shaoyao (Drains water in Earth), Zhishi (Breaks stagnant qi. Each 1-2 qian), Gancao (Harmonizes middle. Halve dose). Can add Huangqin (Clears Wood-Fire heat).
This is a heat-clearing and harmonizing agent. Although it treats Shaoyin reversal, it is actually caused by pathogen combining with Wood attacking the Stomach. Thus, treating Jueyin resolves Shaoyin; this is the method of draining the mother when she is excess. Zhang Zhongjing stated: Reversal should be purged, but if sweating is induced instead, the mouth will be injured and red. This means cold agents should be used to descend heat, such as Baihu Tang (White Tiger Decoction) clearing Metal to calm Wood and resolve heat, saving stomach fluids; this is the main formula for heat-reversal, not referring to the harsh purgation of Dachengqi Tang. He warned: All cases of reversal/cold extremities should not be purged, nor should deficient persons. If there are truly purgative indications, mild purgation may still be used, but one must be flexible and not rigid.
Longdan Qinggan Yin (Dragon Gallbladder Liver-Clearing Drink, Self-made): Treats heat transmitting to Jueyin, causing irritability/fullness and scrotal retraction (Heat moves Liver Qi upward, causing irritability/fullness; Liver meridian passes through genitalia, dry-heat scorches sinews, causing retraction), Xiao Ke (Wasting-thirst: drinking much but urinating little. Spleen excess leads to Mother deficiency, so Kidney Water diminishes causing thirst; Wood-Fire flourishing sucks Stomach fluids), Qi rushing to heart with painful/hot sensation in chest (Liver Qi connects to Heart; Mother excess leads to Son excess, so Qi rushes to heart causing pain/heat), hunger without desire to eat, and vomiting roundworms after eating (Wood pathogen runs rampant, Stomach Earth is controlled).
Longdancao (Gentianae Radix, specifically drains Liver/Gallbladder heat), Huangqin (As the sovereign with Gentian, it also enters Gallbladder), Huanglian (Painful/hot chest and irritability are Southern excessive rising Qi; Licorice's bitter-cold directly drains Bing-Ding [Fire]; excess drains the son. Each 1-2 qian), Gualou (Trichosanthis Fructus, one fruit), Maidong (To control Liver, only Metal works; thus Gualou and Maidong moisten lung and generate fluids. 5 qian to 1 liang), Xuanshen (2-3 qian), Zhi Mu (To generate Liver, only Water works; thus Xuanshen and Zhi Mu strengthen water to nourish source. 3-5 qian), Shaoyao (To fear Liver, only Earth works; thus Baishao calms Spleen and drains fire. 3 qian), Lingyangjiao (Antelope Horn, enters Jueyin exclusively, clears heat and relaxes sinews. 3-5 qian). For vomiting worms, add Wu Mei (Mume Fructus). If mistakenly purged leading to continuous diarrhea (Only empties Yangming, allowing Wood to further conquer its conquered element), remove Gualou, Maidong, Xuanshen, Zhi Mu, and double Shaoyao. This formula uses Jueyin heat-clearing herbs as sovereign, assisted by Lung-nourishing, Kidney-strengthening, and Spleen-calming agents. Shen Shi said: Huangqin Tang originally treats Jueyin disease. I find it lacks specific symptomatic herbs, so I added them and renamed the formula, to indicate that when heat transmits to Jueyin, clearing Liver is the priority. Formulas books only using Chengqi purgation are like blind leading the blind into a pit.
Chao Mi Tang (Fried Rice Soup): Treats exogenous disease at 6-7 days, when righteous qi recovers and pathogen desires to exit. The patient is inherently deficient; pathogen and righteous qi struggle, causing shaking of body and head, known as Fa Zhan (shivering/chills), with a floating pulse (If righteous qi is internally solid, pathogen cannot struggle, so sweat occurs without shivering).
Huangmi (Yellow Millet, fried until charred. A pinch), decocted and drunk. If no internal heat symptoms, Ginger (Shengjiang) can be added (to drive pathogen out, 3 thin slices). This uses no medicine, only rice soup to boost stomach qi, allowing righteous qi to overcome pathogen, resulting in fever, sweat, and resolution. If righteous qi cannot overcome pathogen, shivering occurs without sweat; this is difficult to treat. Li Ze (a variation?) presents only with heart shivering, head shaking, and jaw trembling, indicating extreme righteous qi deficiency unable to send pathogen to surface; supporting righteousness is urgent. If it does not stop, it is a failing syndrome and death is certain.
According to Shanghan experts, after taking medicine, if fever/thirst, irritability, gastric confusion, sudden disappearance of pulses, aversion to cold, and chills occur, these are signs of Yin-Yang mingling, righteous-pathogen struggle, and impending sweat. One should wait quietly; do not panic, lest errors occur.
Zhigancao Tang (Baked Licorice Decoction): Treats knotted/intermittent pulse and palpitations after sweating/purging (Stomach is the sea of fluids and grain, filling organs and nourishing body; abundant fluids mean strong pulse, scarce fluids mean weak pulse. Sweating causes fluid loss, purging empties fluids, so pulse stops intermittently and cannot connect). True yin is lost, slight pathogen remains.
Zhigancao (2 qian), Renshen (Tonifies stomach. 1 qian), Maidong (Generates fluids), Shengdi (Each 3-5 qian), Ejiao (Nourishes blood. 1 qian), Huomaren (Moistens dryness, fried and ground. 1 qian), Guizhi (Cinnamon Twig. 2-3-5 fen), Shengjiang (Ginger. 1-2 slices), Dazao (Jujube. Harmonizes Ying/Wei. 2 fruits, decocted with clear wine and water).
This formula tonifies stomach, generates fluids, nourishes blood, and moistens dryness, serving as the major method for restoring pulse. The small addition of Guizhi and Shengjiang is for the remaining slight pathogen. If there are internal heat symptoms, ginger and cinnamon must be used cautiously. Shen Shi said: If the pulse is intermittent but the patient can eat, recovery is possible; if unable to eat, death is certain. Thus, Zhang Zhongjing said: Those with this pulse are difficult to treat. For those with heart palpitations, deficiency, and weak pulse, remove ginger/cinnamon and add Fushen (Poria with Hostwood), Zaoren (Ziziphus Seed), and Zhusha (Cinnabar). In warm-heat diseases, I have encountered intermittent pulses caused by excessive fire or stagnation of qi/blood/phlegm/food blocking circulation. Clearing heat or unblocking stagnation restores the pulse naturally. Do not rigidly apply previous theories or indiscriminately administer tonics without careful examination.
Jiawei Lizhong Tang (Modified Lizhong Decoction): Treats mistaken purgation or overuse of cold herbs, leading to deficiency-cold syndrome, relentless diarrhea, and impending collapse of Yuan Qi.
Renshen (2 qian to 2 liang), Baizhu (Atractylodis Macrocephalae Rhizoma. 2-3-5 qian), Zhigancao (Tonifies deficiency. 1 qian), Ganjiang (Dried Ginger. Warms middle. 1-2-3 qian), Baishao (Astringes sour. 2-3-5 qian). Add Dazao, Wumei, Chao Mi (A pinch), Chao Chenbitu (Fried old wall earth. One spoon, to take grain/earth qi to assist stomach qi). If not stopping, assist with Shengma, Gan Ge (Kudzu Root, lifting), Chishizhi (Halloysit Rubra. Half decocted, half taken as powder). For severe interior cold,酌情 add Rougui (Cinnamon Bark, 5 fen to 2 qian) and Fuzi (Prepared Aconite Root, 5 fen to 2 qian).
This is a warming-middle and rescuing-reversal agent. Due to medication error, it is used temporarily to warm and tonify. Once cold retreats and diarrhea decreases, switch to mild tonifying agents; do not overuse Gui/Fu. (Note: The pungent-hot formulas in Shanghan Lun were used by Zhang Zhongjing for mistaken sweating/purgation/vomiting, as a temporary measure, not the standard treatment for transmitted cold damage. Jiayan clarified this clearly. Later readers merely copied prescriptions without examining their intent, ignoring regional north/south differences and seasonal cold/warm variations. Seeing established methods, they imitated them, even recklessly using them in warm-heat diseases. Patients often claim cold-damp invasion; seeing pungent-hot agents, they feel satisfied. In hot summers, closing windows and bundling up causes patients to be restless, craving cold water or jumping into wells, yet this is misdiagnosed as "Yin Restlessness," prohibiting cold herbs, leading to wrongful death. I have witnessed too many such cases. Habits are hard to break, and I deeply pity this. Thus, in my volume on Cold Damage and Warm Diseases, among the six methods, heat-clearing accounts for 70-80%. Pungent-hot agents are limited to Wenli, Lizhong, and Wuzhuyu formulas to rescue sweating/purgation/vomiting reversals; others are excluded. This is not bias, but adapting to location and timing to prevent premature death. However, fearing that one consistent teaching cannot withstand widespread contrary influences, hoping for experts to advocate together.) If Gui/Fu are overused or mistakenly used causing redness of body/eyes, it is due to Fu Zi toxicity. Immediately decoct Xijiao (2 liang), Huanglian, Gancao (each 3-5 qian), and Radish juice (2 large bowls), decocting in water (or clarified mud water). Drink large doses frequently; redness will disappear. If treatment is delayed, bleeding from eyes/ears/mouth/nose will occur, leading to death.
Shao San (Burnt Powder): Treats Yin-Yang Yi Syndrome (After recovering from illness, sexual intercourse occurs; the healthy partner contracts residual heat toxin. Transmission between male/female is like exchanging). Heavy body, shortness of breath, joints feel loose (Internal damage to true yin). Heat rushing to chest/heart, heavy head unable to lift, flowers before eyes (Toxic qi steaming upward). Aversion to cold with high fever (Heat-toxin stagnation prevents Wei Qi from circulating on surface, causing aversion to cold; intense heat inside causes fever throughout body).
In men: Scrotal swelling, severe lower abdominal colic. In women: Urgency in lower jiao, pain radiating to waist/hips. (Severe cases: cold/clenched hands/feet, testicles retracting into abdomen, pain drawing into vagina—all difficult to treat. Protruding tongue indicates death). This is not self-inflicted but called Nu Lao Fu (Female Labor Relapse); symptoms are similar (Internal yin damage, external heat activation, righteous deficiency/pathogen excess—also very difficult to treat). This formula is universally used.
Kudang (Underwear crotch, burned to ash. Women use men's, men use women's), Zhuqingpi (Bamboo Green Skin. Descends stagnant heat, treats scrotal retraction/abdominal pain; double dose for pain). Decoct bamboo green skin and take with powder, or add to decoction. Effect indicated by sticky sweat. If none, repeat until urine flows freely and glans swells slightly, indicating cure.