柴胡（半斤） 半夏（半升） 黄芩（三两） 人参（三两） 甘草（三两） 生姜（三两） 大枣（十二枚）
上七味。以水一斗二升。煮取六升。去滓。再煎取三升。温服一升。日三服。
呕因胃中虚寒者居多。故轻易无发热症。除上条虚阳格于寒而作微热之外。凡呕而发热者。是少阳之逆
气。从两胁之边旁而上冲。故呕且上冲者。必兼外浮。故发热也。小柴之降逆以止呕。解肌以退热。为正治矣
汤意见伤寒少阳。文见厥阴。意亦微别。详本注。
十八条 胃反呕吐者。大半夏汤主之。
大半夏汤方 半夏（三升洗） 人参（三两） 白蜜（一升）
上三味。以水一斗二升。和蜜扬之二百四十遍。煮药取二升半。温服一升。余分再服。
自此至二十二共五条。凡曰呕吐。及干呕吐逆。又当重吐一边。以五条俱言胃反及吐故也。此申言四条膈
虚胃寒之治例。为胃反之正病正药。盖以甘浮之蜜和水而扬乱其下流之性。是令其浮于膈中。而多停时
候。然后佐以益气之人参。君以降气之半夏。则从膈而渐渐下平矣。然本以发汗而虚其膈气。因致胃寒之
吐。故只消即补以为温也。
十九条 食已即吐者。大黄甘草汤主之。
大黄甘草汤方 大黄（四两） 甘草（一两）
上二味。以水三升。煮取一升。分温再服。
此胃热上熏之吐。为吐家之变症变治。而非胃反也。火性炎上而躁急。胃中火盛。上冲胃脘者势也。以食压
而实之。则火势受屈而迸出。故食已即吐也。以苦寒泻火之大黄为君。而佐以守中之甘草。不特浮大黄下
趋之性。使从胃脘而下。且治急冲者。惟宜以缓降胜之也。
二十条 胃反。吐而渴。欲饮水者。茯苓泽泻汤主之。
茯苓泽泻汤方 茯苓（半斤） 泽泻（四两） 白术（三两） 桂枝（二两） 甘草（二两） 生姜（四两）
上六味。以水一斗。煮取三升。内泽泻。再煮取二升半。温服八合。日三服。
胃反。本属寒因。然吐则阴伤。而虚火上动于膈。积饮内热于胸。故渴欲饮水。不知饮水多。则本病之虚寒与
水逆相济。而吐愈不可止矣。故以茯苓、泽泻之渗泄者为君。而以培土之白术佐之。则热水下渗。而虚火随
之。故渴可除。以桂枝、生姜之辛温开畅者为主。而以甘浮之甘草配之。则仍从温补膈气以暖胃之例。而胃
反可除矣。夫吐而内有水饮。极宜半夏。而独不用者。以症中病渴。而半夏性燥故也。仲景用药之细密。每如此。
二十一条 吐后。渴欲得水而贪饮者。文蛤汤主之。兼主微风。脉紧头痛。
文蛤汤方 文蛤（五两） 麻黄（三两） 石膏（五两） 杏仁（五十粒） 甘草 生姜（各三两） 大枣（十
二枚）
上七味。以水六升。煮取二升。温服一升。汗出即愈。
吐后。虽承上条胃反。其实且兼诸吐在内。但曰吐后。则吐已暂止可知。故汤意重责水饮。而不责胃反者此
也。此即上条之症。而分别尤在贪饮二字。盖贪饮是逆热上提者更甚。而积饮内热者更多也。夫逆热积饮。
停而不去。以致贪饮。不特水逆而吐将复作。且防变出饮症。而见喘满肿胀等候。故以治饮为急也。但上条
为胃反未止。又表药多致水逆。故茯苓泽泻汤。从五苓以利小便之变。此条为吐后而吐止。其渴而贪饮。为
逆热在胸。逆热者可借水以泄汗。故文蛤汤。从越婢发表之变也。至统以咸寒拒水之文蛤。副以清肺利气
之杏仁。则越婢之全汤。从文蛤杏仁之化。而发去水之汗。此所以收止渴除烦之功效矣。微风不当脉紧。紧
脉为寒为水。今其头痛。既为风而非寒。则其脉紧。不当责寒而责水矣。但既曰微风脉紧头痛。是其人平日
原有水饮。因中微风而致有表症之头痛。则其治例。似宜桂枝加术。即带渴而贪饮之上症。亦宜盖文蛤杏
仁于桂枝汤为合。而竟以此汤主之者。盖以水饮家多属无汗。而脉紧。终为水性带寒之诊。故非麻黄之疏
表散寒不可也。
二十二条 干呕吐逆。吐涎沫。半夏干姜散主之。
半夏干姜散方 半夏 干姜（等分）
上二味。杵为散。取方寸匕。浆水一升半。煎取七合。顿服之。
言干呕而因于吐逆者。又于不呕吐时。而亦尝吐涎沫。则其寒逆已甚。故主半夏以降逆。干姜以温寒也。杵
为散者。欲其并服渣质。而少停于胃。煎用浆水。取谷气之为胃所喜。且以味酸者收逆。又以性凉者为温药
之反佐耳。
二十三条 病患胸中。似喘不喘。似呕不呕。似哕不哕。彻心中。愦愦然无奈者。生姜半夏汤主之。
生姜半夏汤方 生姜汁（一升） 半夏（半升）
上二味。以水三升。煮半夏取二升。内生姜汁。煮取一升半。小冷分四服。日三服。夜一服。呕止停后服。
此言胃寒之气。上浮心下。以及胸中之症治也。盖谓胃居中土。为熏育上焦。控制下焦之关键。胃中自寒而
阴沁。则肺气畏缩而不下引。故似喘。然而肺管未塞。故不喘。膈气飘忽而不安顿。故似呕。然而膈非本病。故
不呕也。其胃无阳光以熏育上焦之候如此。又胃中自寒而招侮。则肝气纵送而尝上胜。故似哕。然而肝非
首难。故不哕也。其胃中阴翳而吸受下焦之候。又如此。但觉从胸至心。彻上彻下。而不可指着。愦愦然无可
奈何。而不能名状者。盖因上焦之气。受之阳明之腑。今胃寒。而阳气失根株之根据辅。譬之兵凶饥馑。穷黎有
流亡无策之象也。但此条之症。为寒因特重。故似喘似呕似哕。逆气较轻。故不喘。不呕。不哕。而方意亦多用
辛温之生姜为君。减用辛降之半夏为佐。其立言立方之妙。概可知矣。门人问曰。胃寒而上沁下吸。温之
降之。固为正治。其温胃而不用甘草者何也。答曰。生姜辛温而性善走。取汁用之。则过嗓即发。是所以温上
焦之似喘似呕也。配半夏以降之。则辛温之性。渐渐下沉。是温胃之外。尤欲以辛胜肝。而并治其下焦之欲
哕。故于甘草之守中者无取焉。
二十四条 干呕哕。若手足厥者。橘皮汤主之。
橘皮汤方 橘皮（四两） 生姜（半斤）
上二味。以水七升。煮取三升。温服一升。下咽即愈。
此及下文。凡两条。言哕症之治例也。干呕哕。犹云哕而干呕之义。盖胃寒不能御下。肝气从而胜之。故哕。然
木邪上逆。必经少阳之部。故并见干呕矣。又胃阳虚而下招肝木之寒逆。则其气既不外贯。而且至阴之气。
代为行令。故手足厥也。以辛温宣发之生姜为君。辛温沉降之橘皮为佐。盖性温所以专暖胃阳。而味辛所
以兼平肝逆。则呕哕厥逆。有不立愈者乎。
二十五条 哕逆者。橘皮竹茹汤主之。
橘皮竹茹汤方 橘皮（二斤） 竹茹（二升） 人参（一两） 甘草（五钱） 生姜（半斤） 大枣（三十枚）
上六味。以水一斗。煮取三升。温服一升。日三服。
逆者。即上条手足厥之互词。且兼逆气上冲在内。以汤意按之。此与上条之症。颇同而较重者。盖上条为胃
寒而下招肝侮。是肝无倡乱之罪。特以胃寒而吸之所致。故橘皮汤。主生姜以重责胃寒。佐橘皮以轻责肝
逆也。此条之胃寒。既比上条为甚。而尤多胃虚一症。旦肝中寒逆。原有上犯之势。是肝逆为首恶。而胃中虚
寒而不能守御。罪止为从耳。故本条之橘皮竹茹汤。主橘皮而重责肝逆。佐生姜以兼责胃寒。佐人参以并
责胃虚也。竹茹具肌肉之象。而通上下之节者。用以为使。是欲其佐参姜以达阳明之气。佐橘皮以通厥阴
之逆。故加之也。然后以大枣、甘草。抬高诸药。令其从上历中。复从中至下。而渐收沉降温补之功效也。本
草载前人论橘皮。辛苦而温。谓是脾肺气药。遂以消痰下气实之。夫谓之气药固矣。至以为专走脾肺则非
也。愚按橘之物理。不特凌霜变黄。交冬成熟。其性从上降下。得敛伏之气。且瓣则酸甘。皮则辛辣。酸甘、具乙
木之阴象。而似血液。辛辣、具甲木之阳象。而主神气。况诸果之外皮。俱属包裹收藏之性者乎。则橘皮为厥
阴肝经温降之气药无疑。至于从味之辛而走肺。从气之温而走脾。不过为经历之小憩处。而非其性情之
所向也。性味温降而散。故入肺以豁痰。入脾以宣气者。不过为旁试之小效处。而非其精专之本技也。仲景
呕哕方中。君此之深意。不从可识乎。
二十六条 夫六腑气绝于外者。手足寒。上气脚缩。五脏气绝于内者。利不禁。下甚者。手足不仁。
此总言下利之死症重症。为后文二十七、三十八、两条之纲领也。腑脏两气字。俱指阳气而言。因人身以阳
气为生死之根蒂故也。六腑行五脏之气。而主充贯之用。腑气外绝。则充贯无根。手足为阳气之末。故先寒。
又腑气自绝。不但不能充贯。而且有上散下脱之势。上散、故其胸中之气。但上浮而不下纳。下脱、故其脚下
之气。有上缩而不下伸矣。五脏藏六腑之气。而主提挈之神。脏气内绝。则提挈无力。肠胃失关键之权。故利
不禁。此下利者。以手足寒。上气脚缩。及不禁者。为死候也。下甚两句。又就上文之死症。而言下犯之重症。因
下甚。有似于脏绝。手足不仁。有似于腑绝。而实有分辨故也。盖下甚者。或倾肠倒肚。而泄注有势。或连三带
五。而遍数有度之谓。若不禁。则肛门不收。宛如漏下者是也。又手足不仁。是气虚于内。而灵醒之妙用外微。
手足寒。是火熄于中。而照耀之余温退气。于此而失辨。不致误为脏腑垂绝而弃之者。几希矣。
二十七条 下利。脉沉弦者下重。脉大者为未止。脉微弱数者为欲自止。虽发热不死。
文见厥阴并注。
二十八条 下利。手足厥冷。无脉者。灸之不温。若脉不还。反微喘者死。
经注俱见厥阴。
二十九条 少阴负趺阳者为顺也。
此少阴正文。注详其下。但人下利。当看反面。如云趺阳负少阴者为逆。以少阴负趺阳。无利下之症故也。
三十条 下利。有微热而渴。脉弱者。令自愈。
三十一条 下利。脉数。有微热。汗出。令自愈。设脉紧。为未解。
三十二条 下利。脉数而渴者。令自愈。设不瘥。必圊脓血。以有热故也。
以上三条。俱见厥阴注并见。但在厥阴。合三条作一条耳。
三十三条 下利。脉反弦。发热。身汗者。自愈。
反弦。对前二十七条沉弦而言。盖谓下利之脉。本当沉弦。以弦脉、为虚寒。为拘急之应。沉、为向里向下之应。
夫以虚寒拘急之气。向里向下。岂非泄利而下重乎。今不利而其脉弦则弦矣。但应沉反浮。故曰反弦也。脉
得反弦。则下利之邪。有上浮外散之机致。合之发热身汗。则脉症相对。邪从汗解。复何下利之不自愈哉。
门人问曰。下利而脉反弦。若不发热身汗者。将奈何。答曰。必见呕逆。又问。下利脉反弦。发热而身不汗者。又
奈何。答曰。久则为疟矣。曰。治之何如。曰。主小柴胡汤。而因症以为进退。则得矣。
三十四条 下利气者。当利其小便。
此与后文五十条之气利。不同。下利气者。水泄下利。而兼失气之谓。是下利为主病。而失气为兼症也。利小
便。则水气从小肠而渗走膀胱。故下利可止。其小肠之气。与水俱行。而随机化去。故大肠之失气。亦可止矣。
若五十条之气利。为气陷肠滑。而溏垢因气俱出。是气陷为主病。而肠滑之似利者。为兼症也。诃黎勒、温暖
固涩。温暖、则升陷以理气。固涩、则托滑以除利。粥饮和而顿服。使留恋于胃。而下提大小肠之陷滑耳。此曰
下利气。彼曰气利。其叙症先后之次。即断病重轻之案也。
三十五条 下利。寸脉反浮数。尺中自涩者。必圊脓血。
此反字。又对下利而言。盖谓下利。则气从下趋。其脉多是沉弦、沉滑、沉迟、沉紧之类。即系热利。亦宜沉数、
沉
洪者为合。乃病则下利。而其寸口之脉。反不沉而浮。且不弦滑迟紧。而于浮处又反见数。夫数为热。热从浮
而见寸口。则其上焦之邪热甚炽。而有下逼之势矣。又尺中属下部。尺中见涩。涩为血液凝聚之诊。合而断
之。谓非阳热下劫阴血之候乎。故知其必圊脓血也。
三十六条 下利清谷。不可攻其表。汗出。必胀满。
此言脾胃虚寒而下利者。不特禁下。并且禁汗也。盖下利清谷。则中寒而不能变化可知。若攻其表而汗出。
汗乃上中二焦之阳液所化。汗出则阳气更虚。而阴寒痞塞。故必胀满而不能食矣。
三十七条 下利。脉沉而迟。其人面少赤。身有微热。下利清谷者。必郁冒汗出而解。病患必微厥。
所以然者。其面戴阳。下虚故也。
迟则为虚为寒。沉为在里在下。沉处见迟。正里虚下寒之诊。故下利清谷。下寒、则逼微阳于上。故其面少赤。
里虚、则浮真气于外。故身有微热。微阳郁而不得下通内伏。故其躯壳如上眩外鼓而冒。汗出、则郁冒外透。
故面赤身热俱解矣。然中下虚寒。而表阳薄泄。则其气一时不能顺接。故必微微见厥。以戴阳者必下虚。故
知之也。文见伤寒厥阴条。宜与彼注参看。
三十八条 下利后。脉绝。手足厥冷。 时脉还。手足温者生。脉不还者死。
注见伤寒厥阴文。
Chai Hu (Bupleuri Radix, half jin), Ban Xia (Pinelliae Rhizoma, half sheng), Huang Qin (Scutellariae Radix, three liang), Ren Shen (Ginseng Radix, three liang), Gan Cao (Glycyrrhizae Radix et Rhizoma, three liang), Sheng Jiang (Zingiberis Rhizoma Recens, three liang), Da Zao (Jujubae Fructus, twelve pieces).
The above seven ingredients. Use one dou and two sheng of water. Boil to obtain six sheng. Remove the dregs. Re-boil to obtain three sheng. Take one sheng warm. Administer three times daily.
Vomiting is mostly caused by deficiency-cold in the stomach. Therefore, fever symptoms are usually absent. Except for the case in the previous clause where deficient Yang is constrained by cold causing slight fever, vomiting accompanied by fever indicates rebellious Qi of the Shaoyang channel. This Qi rushes upward from the sides of the hypochondrium. Thus, vomiting with upward rushing Qi must be accompanied by a floating pulse. Hence, fever occurs. Xiao Chai Hu Tang (Minor Bupleurum Decoction) reduces rebellion to stop vomiting and releases the muscle layer to reduce fever; it is the correct treatment. Its intent is seen in the Shaoyang disease chapter of Shanghan Lun, its text in the Jueyin disease chapter, and its intent has subtle differences. See the annotation for details.
Clause 18: For patients with Wei Fan (stomach reversal) and vomiting, Da Ban Xia Tang (Major Pinellia Decoction) is the primary treatment.
Da Ban Xia Tang Formula: Ban Xia (Pinelliae Rhizoma, three sheng, washed), Ren Shen (Ginseng Radix, three liang), Bai Mi (White Honey, one sheng).
The above three ingredients. Use one dou and two sheng of water. Mix with honey and stir vigorously two hundred and forty times. Boil the medicine to obtain two sheng and half. Take one sheng warm. Divide the remainder into two doses.
From this clause to Clause 22, totaling five clauses, whenever "vomiting" or "dry heaving with regurgitation" is mentioned, emphasis should be placed on "vomiting," as all five clauses discuss Wei Fan and vomiting. This further elaborates on the treatment principle for deficiency of the diaphragm and cold in the stomach mentioned in Clause 4, which is the standard treatment for Wei Fan. Essentially, the sweet and floating nature of honey mixed with water and stirred vigorously disrupts its downward flow, causing it to float in the diaphragm and remain there for a while. Then, assisted by Ren Shen to tonify Qi and Ban Xia as the sovereign herb to direct Qi downward, the Qi gradually levels out from the diaphragm downwards. However, since the condition originated from sweating leading to weakness of the diaphragm Qi, resulting in stomach cold vomiting, immediate tonification is needed to provide warmth.
Clause 19: For those who vomit immediately after eating, Da Huang Gan Cao Tang (Rhubarb and Licorice Decoction) is the primary treatment.
Da Huang Gan Cao Tang Formula: Da Huang (Rhei Radix et Rhizoma, four liang), Gan Cao (Glycyrrhizae Radix et Rhizoma, one liang).
The above two ingredients. Use three sheng of water. Boil to obtain one sheng. Divide into two warm doses.
This is vomiting caused by stomach heat steaming upward, a variant symptom and treatment in vomiting cases, not Wei Fan. Fire nature flares upward and is impetuous. When stomach fire is excessive, rushing upward to the epigastrium is inevitable. Food presses and fills the stomach, constraining the fire, which then bursts out. Hence, vomiting occurs immediately after eating. Da Huang, bitter and cold to purge fire, is used as the sovereign herb, assisted by Gan Cao which maintains the center. This not only suppresses the downward tendency of Da Huang, guiding it from the epigastrium downward, but also treats the urgent rush by using a gentle descending method to overcome it.
Clause 20: For Wei Fan with vomiting, thirst, and desire to drink water, Fu Ling Ze Xie Tang (Poria and Alisma Decoction) is the primary treatment.
Fu Ling Ze Xie Tang Formula: Fu Ling (Poria, half jin), Ze Xie (Alismatis Rhizoma, four liang), Bai Zhu (Atractylodis Macrocephalae Rhizoma, three liang), Gui Zhi (Cinnamomi Ramulus, two liang), Gan Cao (Glycyrrhizae Radix et Rhizoma, two liang), Sheng Jiang (Zingiberis Rhizoma Recens, four liang).
The above six ingredients. Use one dou of water. Boil to obtain three sheng. Add Ze Xie. Re-boil to obtain two sheng and half. Take eight ge warm. Administer three times daily.
Wei Fan originally belongs to cold patterns. However, vomiting damages Yin, causing deficient fire to move upward in the diaphragm and accumulated fluid transforming into internal heat in the chest. Thus, there is thirst and desire to drink. Not knowing that drinking too much will cause the original deficiency-cold to combine with fluid rebellion, making vomiting even harder to stop. Therefore, Fu Ling and Ze Xie, which promote urination and drain dampness, are used as sovereign herbs, assisted by Bai Zhu to strengthen the Spleen and Earth. This allows hot water to seep downward, carrying the deficient fire with it, thus relieving thirst. Gui Zhi and Sheng Jiang, acrid and warm to open and unblock, are used as principal herbs, paired with sweet and floating Gan Cao. This follows the example of warming and tonifying the diaphragm Qi to warm the stomach, eliminating Wei Fan. Although Ban Xia is highly suitable for vomiting with internal fluid retention, it is not used here because the symptom includes thirst, and Ban Xia is drying. Zhang Zhongjing's meticulous use of herbs is often like this.
Clause 21: After vomiting, if there is thirst, desire to drink water, and greedily drinking, Wen Sha Tang (Clam Shell Decoction) is the primary treatment. It also treats mild wind, tight pulse, and headache.
Wen Sha Tang Formula: Wen Sha (Arcae Concha, five liang), Ma Huang (Ephedrae Herba, three liang), Shi Gao (Gypsum Fibrosum, five liang), Xing Ren (Prunus Armeniaca Seed, fifty grains), Gan Cao (Glycyrrhizae Radix et Rhizoma), Sheng Jiang (Zingiberis Rhizoma Recens) (each three liang), Da Zao (Jujubae Fructus, twelve pieces).
The above seven ingredients. Use six sheng of water. Boil to obtain two sheng. Take one sheng warm. Recovery occurs when sweat appears.
"After vomiting" implies continuity from the previous clause on Wei Fan, but actually encompasses various types of vomiting. Simply stating "after vomiting" indicates that vomiting has temporarily ceased. Thus, the decoction's intent focuses on addressing fluid retention rather than Wei Fan. This resembles the previous clause's symptoms, but the distinction lies in the words "greedily drinking." Greedy drinking indicates more severe upward rising of rebellious heat and greater accumulation of fluid-heat. Rebellious heat and accumulated fluid stagnate and do not disperse, causing greedy drinking. Not only will fluid rebellion cause vomiting to recur, but one must also prevent transformation into fluid disorders presenting with wheezing, fullness, and swelling. Therefore, treating fluid retention is urgent. The previous clause involved ongoing Wei Fan, and exterior-releasing herbs often cause fluid rebellion, so Fu Ling Ze Xie Tang is a variation of Wu Ling San to promote urination. This clause involves cessation of vomiting after vomiting, where thirst and greedy drinking indicate rebellious heat in the chest. Rebellious heat can utilize water to induce sweating, so Wen Sha Tang is a variation of Yue Bi Tang to release the exterior. Using salty and cold Wen Sha to repel water, assisted by acrid and cooling Xing Ren to clear the lungs and regulate Qi, transforms the complete Yue Bi Tang formula into one based on Wen Sha and Xing Ren, inducing sweat to remove water. This achieves the effect of stopping thirst and removing irritability. Mild wind should not present with a tight pulse; a tight pulse indicates cold and water. Now, headache is due to wind, not cold, so the tight pulse should be attributed to water, not cold. Since it states mild wind, tight pulse, and headache, the person likely had pre-existing fluid retention, and contracting mild wind caused exterior syndrome headache. The treatment seems suitable for Gui Zhi Jia Zhu Tang. Even with the upper symptoms of thirst and greedy drinking, adding Wen Sha and Xing Ren to Gui Zhi Tang would be more appropriate. The reason for using this specific decoction is that people with fluid retention often have no sweat, and a tight pulse ultimately indicates water qi with cold. Therefore, Ma Huang is necessary to vent the exterior and scatter cold.
Clause 22: For dry heaving with regurgitation and spitting out saliva/foam, Ban Xia Gan Jiang San (Pinellia and Dried Ginger Powder) is the primary treatment.
Ban Xia Gan Jiang San Formula: Ban Xia (Pinelliae Rhizoma), Gan Jiang (Zingiberis Rhizoma) (equal parts).
The above two ingredients. Pound into a powder. Take one fang cun bi (measure). Use one sheng and half of Jiang Shui (fermented grain water). Boil to obtain seven ge. Take in one dose.
Dry heaving due to regurgitation, and spitting out saliva/foam even when not vomiting, indicates severe cold rebellion. Therefore, Ban Xia is used to direct Qi downward, and Gan Jiang to warm cold. Pounding into a powder allows taking the residue, keeping the medicine slightly longer in the stomach. Using Jiang Shui for decoction utilizes the grain qi preferred by the stomach, and the sour taste helps constrain rebellion, while its cool nature acts as an antithesis to the warm herbs.
Clause 23: The patient feels in the chest as if panting but not panting, as if vomiting but not vomiting, as if hiccoughing but not hiccoughing, with a pervasive sense of distress and helplessness in the heart, extending from top to bottom. Sheng Jiang Ban Xia Tang (Fresh Ginger and Pinellia Decoction) is the primary treatment.
Sheng Jiang Ban Xia Tang Formula: Sheng Jiang Zhi (Fresh Ginger Juice, one sheng), Ban Xia (Pinelliae Rhizoma, half sheng).
The above two ingredients. Use three sheng of water. Boil Ban Xia to obtain two sheng. Add Sheng Jiang Zhi. Boil to obtain one sheng and half. Take cool, divided into four doses. Administer three times during the day and once at night. Stop subsequent doses if vomiting ceases.
This describes symptoms and treatment of stomach cold Qi floating upward to the lower heart and chest. The stomach resides in the central earth, key to nourishing the Upper Jiao and controlling the Lower Jiao. Stomach cold causes Yin to infiltrate, causing Lung Qi to shrink and fail to descend, hence feeling like panting. However, the airways are not blocked, so actual panting does not occur. Diaphragm Qi is unsettled, hence feeling like vomiting. However, the diaphragm is not the primary site, so actual vomiting does not occur. Such is the state of the stomach lacking Yang warmth to nourish the Upper Jiao. Additionally, stomach cold attracts Liver Qi rebellion, causing Liver Qi to surge upward, hence feeling like hiccoughing. However, the Liver is not the primary offender, so actual hiccoughing does not occur. Such is the state of stomach Yin shadow absorbing Lower Jiao Qi. One feels pervasive distress from chest to heart, indescribable and helpless. This is because Upper Jiao Qi is affected by the Yangming organ. Now, stomach cold means Yang Qi lacks root support, resembling refugees in war and famine with no strategy. In this clause, the cold pathogen is particularly heavy, so the rebellious Qi causing the sensations of panting, vomiting, and hiccoughing is relatively light, hence no actual panting, vomiting, or hiccoughing. The formula intent uses acrid-warm Sheng Jiang as sovereign and reduces acrid-descending Ban Xia to assistant. The subtlety of its formulation is evident. A student asked: Warming and descending for stomach cold infiltration and absorption is correct treatment. Why is Gan Cao not used to warm the stomach? The answer: Sheng Jiang is acrid-warm and moves freely. Taking juice makes it act quickly upon passing the throat, warming the Upper Jiao sensations of panting and vomiting. Paired with Ban Xia to descend, its acrid-warm nature sinks gradually. Besides warming the stomach, it aims to use acridity to subdue the Liver and treat Lower Jiao hiccough tendencies. Thus, Gan Cao, which stays in the center, is not selected.
Clause 24: For dry heaving and hiccough with cold extremities, Ju Pi Tang (Tangerine Peel Decoction) is the primary treatment.
Ju Pi Tang Formula: Ju Pi (Citri Reticulatae Pericarpium, four liang), Sheng Jiang (Zingiberis Rhizoma Recens, half jin).
The above two ingredients. Use seven sheng of water. Boil to obtain three sheng. Take one sheng warm. Recovery occurs upon swallowing.
These two clauses describe treatment principles for hiccough. "Dry heaving and hiccough" implies hiccough accompanied by dry heaving. Stomach cold fails to control the lower aspect, allowing Liver Qi to dominate, causing hiccough. Wood evil rebelling upward passes through the Shaoyang region, hence accompanying dry heaving. Furthermore, Stomach Yang deficiency attracts Liver Wood cold rebellion. Qi cannot circulate outward, and extreme Yin Qi takes command, causing cold extremities. Acrid-warm and dispersing Sheng Jiang is used as sovereign, acrid-warm and descending Ju Pi as assistant. Warmth specifically warms Stomach Yang, and acridity pacifies Liver rebellion. Will not dry heaving, hiccough, and cold extremities resolve immediately?
Clause 25: For hiccough and rebellion, Ju Pi Zhu Ru Tang (Tangerine Peel and Bamboo Shavings Decoction) is the primary treatment.
Ju Pi Zhu Ru Tang Formula: Ju Pi (Citri Reticulatae Pericarpium, two jin), Zhu Ru (Bambusa Textilis Caulis Interior Paramenta, two sheng), Ren Shen (Ginseng Radix, one liang), Gan Cao (Glycyrrhizae Radix et Rhizoma, five qian), Sheng Jiang (Zingiberis Rhizoma Recens, half jin), Da Zao (Jujubae Fructus, thirty pieces).
The above six ingredients. Use one dou of water. Boil to obtain three sheng. Take one sheng warm. Administer three times daily.
"Rebellion" is synonymous with the cold extremities in the previous clause and includes upward rushing rebellious Qi. Analyzing the formula intent, this clause presents similar but more severe symptoms than the previous one. The previous clause was stomach cold attracting Liver rebellion without Liver initiating chaos, caused by stomach cold sucking it in. Thus, Ju Pi Tang uses Sheng Jiang to heavily address stomach cold and Ju Pi lightly to address Liver rebellion. This clause's stomach cold is more severe than the previous, with added Stomach deficiency. Moreover, Liver cold rebellion has a tendency to invade upward, making Liver rebellion the primary evil, while Stomach deficiency-cold failing to defend is secondary. Thus, Ju Pi Zhu Ru Tang uses Ju Pi to heavily address Liver rebellion, Sheng Jiang to address stomach cold, and Ren Shen to address Stomach deficiency. Zhu Ru, having the image of muscle and connecting upper and lower joints, serves as envoy. It assists Ren Shen and Sheng Jiang to reach Yangming Qi and Ju Pi to connect Jueyin rebellion. Da Zao and Gan Cao elevate the other herbs, guiding them from top to middle, then middle to bottom, gradually achieving sinking, warming, and tonifying effects. Materia Medica records predecessors describing Ju Pi as acrid, bitter, and warm, a Qi herb for Spleen and Lung, used to resolve phlegm and direct Qi downward. While calling it a Qi herb is correct, claiming it exclusively travels to Spleen and Lung is incorrect. Observing the physical nature of orange, it turns yellow in frost and matures in winter, its nature descending from top to bottom, acquiring敛伏 (gathering and hiding) Qi. The pulp is sour and sweet, the peel is acrid and spicy. Sour and sweet possess Yi Wood (Liver) Yin imagery, resembling blood; acrid and spicy possess Jia Wood (Gallbladder) Yang imagery, governing Spirit Qi. Furthermore, outer peels of fruits generally have wrapping and storing properties. Thus, Ju Pi is undoubtedly a warming and descending Qi herb for the Jueyin Liver meridian. Traveling to Lung via acrid taste and to Spleen via warm Qi are merely brief stops, not its true destination. Its warm, descending, and dispersing nature allows it to enter Lung to resolve phlegm and Spleen to disseminate Qi, but these are side effects, not its specialized function. Zhang Zhongjing's deep intention in using Ju Pi as sovereign in vomiting and hiccough formulas is discernible.
Clause 26: When Qi of the Six Fu organs perishes externally, there is cold in hands and feet, upward rushing Qi, and retracted legs. When Qi of the Five Zang organs perishes internally, there is uncontrollable diarrhea. If diarrhea is severe, there is numbness in hands and feet.
This generally describes fatal and severe conditions of diarrhea, serving as a guideline for Clauses 27 and 38. The term "Qi" in both Fu and Zang refers to Yang Qi, as Yang Qi is the root of life and death in the human body. The Six Fu organs transmit Zang Qi and govern permeation. External perishing of Fu Qi means permeation lacks a root. Hands and feet are the extremities of Yang Qi, so they become cold first. Internal perishing of Fu Qi not only fails to permeate but also leads to upward dispersion and downward collapse. Upward dispersion causes Chest Qi to float up without descending; downward collapse causes Leg Qi to retract upward without extending. The Five Zang organs store Fu Qi and govern lifting and supporting. Internal perishing of Zang Qi means lifting support is weak. Intestines and stomach lose their key authority, causing uncontrollable diarrhea. Such diarrhea, characterized by cold extremities, upward Qi/retracted legs, and uncontrollability, is a death omen. The last two sentences discuss severe conditions arising from below within the context of death omens. Severe diarrhea resembles Zang perishing; numbness resembles Fu perishing, yet there is a distinction. Severe diarrhea may involve emptying intestines with forceful discharge or frequent bowel movements. Uncontrollability means the anus cannot close, like leaking. Numbness in hands and feet indicates Qi deficiency internally with diminished spiritual function externally. Cold extremities indicate fire extinguished internally with fading residual warmth. Failing to distinguish here risks mistakenly abandoning patients thought to be in terminal organ failure, which is rare.
Clause 27: In diarrhea, a deep and string-taut pulse indicates heaviness in the rectum (tenesmus); a large pulse indicates the condition has not stopped; a weak, thin, and rapid pulse indicates the condition is about to stop spontaneously. Even with fever, death is not imminent.
Text appears in the Jueyin disease chapter with annotations.
Clause 28: In diarrhea, with cold extremities and no pulse, moxibustion fails to warm. If the pulse does not return and slight wheezing occurs, death ensues.
Scripture and annotations appear in the Jueyin disease chapter.
Clause 29: When the Shaoyin pulse is weaker than the Foot-Yang (Dazu) pulse, it is a favorable sign.
This is the main text for Shaoyin. Annotations are detailed below. In diarrhea, one should look at the reverse: if Dazu is weaker than Shaoyin, it is unfavorable, because Shaoyin being weaker than Dazu implies no diarrhea symptoms.
Clause 30: In diarrhea, with slight fever, thirst, and a weak pulse, spontaneous recovery is expected.
Clause 31: In diarrhea, with a rapid pulse, slight fever, and sweating, spontaneous recovery is expected. If the pulse is tight, the condition is unresolved.
Clause 32: In diarrhea, with a rapid pulse and thirst, spontaneous recovery is expected. If it does not improve, pus and blood will appear in stool due to heat.
The above three clauses appear in the Jueyin annotations. In the Jueyin chapter, these three are combined into one.
Clause 33: In diarrhea, if the pulse is reversely string-taut, with fever and sweating, spontaneous recovery occurs.
"Reverse string-taut" contrasts with the deep-string-taut pulse in Clause 27. Diarrhea pulses are typically deep and string-taut, as string-taut indicates deficiency-cold and tension, and deep indicates inward/downward direction. Deficiency-cold and tension moving inward/downward causes diarrhea with tenesmus. Here, although the pulse is string-taut, it should be deep but is instead floating, hence "reverse string-taut." A reverse string-taut pulse suggests the pathogenic factor of diarrhea has a mechanism to float upward and disperse outward. Combined with fever and sweating, the pulse and symptoms correspond, indicating the pathogen resolves through sweat. How could diarrhea not heal? A student asked: If diarrhea has a reverse string-taut pulse but no fever or sweating, what happens? Answer: Vomiting and regurgitation will likely occur. Asked: If diarrhea has reverse string-taut pulse and fever but no sweating? Answer: It will eventually become malaria. Asked: How to treat? Answer: Use Xiao Chai Hu Tang (Minor Bupleurum Decoction) and adjust based on symptoms.
Clause 34: For diarrhea with excessive gas, promote urination.
This differs from Clause 50's "Qi Li" (Gas Diarrhea). "Xia Li Qi" refers to watery diarrhea accompanied by flatulence. Diarrhea is the primary disease, flatulence is the accompanying symptom. Promoting urination allows water Qi to seep from Small Intestine to Bladder, stopping diarrhea. Small Intestine Qi travels with water and dissipates randomly, stopping Large Intestine flatulence. In contrast, Clause 50's "Qi Li" involves Qi sinking and intestinal sliding, where loose stool exits with Qi. Qi sinking is primary, intestinal sliding mimicking diarrhea is secondary. He Li Le (Terminalia Chebula Fruit) warms and astrings. Warming lifts sinking to regulate Qi; astringing supports sliding to stop diarrhea. Mixed with porridge drink and taken in one dose, it lingers in the stomach to lift sinking/sliding of Large and Small Intestines. The order of mentioning symptoms ("Diarrhea with Gas" vs "Gas Diarrhea") determines severity.
Clause 35: In diarrhea, if the Cun (inch) pulse is reversely floating and rapid, and Chi (cubit) pulse is naturally choppy, pus and blood will definitely appear in stool.
"Reverse" contrasts with diarrhea. Diarrhea Qi moves downward, so pulses are usually deep-string-taut, deep-slippery, deep-choppy, or deep-tight. Even in heat diarrhea, deep-rapid or deep-full pulses are appropriate. Here, despite diarrhea, the Cun pulse is not deep but floating, and not string-taut/slippery/choppy/tight, but rapidly appearing in the floating position. Rapid indicates heat. Heat appearing at Cun floating suggests intense Upper Jiao pathogenic heat with downward pressure. Chi represents the lower part; choppy at Chi indicates blood coagulation. Combining these, it indicates Yang heat robbing Yin blood downward. Thus, pus and blood in stool are certain.
Clause 36: In diarrhea with undigested food, do not attack the exterior. Sweating will cause abdominal fullness.
This states that for spleen-stomach deficiency-cold diarrhea, purging is forbidden, and sweating is also forbidden. Undigested food diarrhea indicates middle cold unable to transform. Attacking the exterior causes sweating. Sweat is formed from Yang fluids of Upper and Middle Jiao. Sweating further depletes Yang Qi, causing Yin-cold stagnation, leading to inevitable fullness and inability to eat.
Clause 37: In diarrhea, with deep-choppy pulse, slight redness on face, slight body heat, and diarrhea with undigested food, there will be depression/dizziness followed by sweating and resolution. The patient will have slight cold extremities.
The reason is facial flushing (Dai Yang) due to lower deficiency. Choppy indicates deficiency and cold; deep indicates interior and lower. Deep-choppy confirms interior deficiency and lower cold. Lower cold forces slight Yang upward, causing slight facial redness. Interior deficiency causes floating True Qi outward, causing slight body heat. Slight Yang depressed and unable to descend/internalize causes dizziness and external distension. Sweating allows depression/dizziness to penetrate outward, resolving facial redness and body heat. However, middle-lower deficiency-cold with superficial Yang leakage means Qi cannot connect smoothly at once, causing slight cold extremities. Dai Yang implies lower deficiency. Text appears in Shanghan Lun Jueyin clause; refer to its annotation.
Clause 38: After diarrhea, if pulse vanishes and extremities are cold, but pulse returns intermittently and extremities become warm, life is preserved. If pulse does not return, death ensues.
Annotation appears in Shanghan Lun Jueyin text.