雍曰。伤寒阴阳二毒。最为疾势重者。张仲景有升麻甘草二汤。
今竟不见于仲景书中。惟脉经载其论证二篇。千金方中略言之。今
二汤用药加减。与仲景异同。金匮要略复合为一。曰。阴毒阳毒。升
麻鳖甲汤主之。前后诸方书。皆无是说。然二疾。冰炭也。用药正相
反。诸书之间。虽有升麻甘草二汤。方味皆同。又与要略异。以此不
能无疑。惟活人书二方。用药不同。最为当理。第不见活人书升麻汤
所出方书。想朱氏必有所据。今从活人书用二药。（士弱曰。二方载
外台秘要。云出古今录验方。）
王叔和脉经曰。阳毒为病。身重。腰背痛。烦闷不安。狂言。或
走。或见鬼。或吐血下利。其脉浮动大数。面赤斑斑如锦文。
咽喉痛。吐脓血。五日可治。至七日不可治。有伤寒一二日。便成阳毒。或服
药。吐下后。变成阳毒。升麻汤主之。庞氏云。又宜葛根龙胆汤。雍
曰。此疾常有之。不知治。多大吐下血而死。虽用助阴去热药。亦须
有解毒在其中。则可用。
活人书曰。阳毒病。阳气独盛。阴气暴绝。必发躁。狂言妄走。面
赤斑斑如锦文。咽痛。或下利赤黄。脉洪实滑促。宜用酸苦之药。令
阴气复而大汗解矣。葶苈苦酒汤、升麻汤、大黄散、栀子仁汤、黑奴
丸。可选而用之。雍曰。表里皆大热证者。宜黑奴丸。审知热在里不
在表。以朴硝大黄桃仁药下之。其物则多服升麻也。盖阳毒之作甚
暴。非阴毒比。（下原文缺）雷时强人。（下原文缺）及小儿。便宜用升
麻汤预防其毒。
又曰。近人治伤寒。脉洪大。内外结热。舌卷焦黑。鼻中如烟煤
者。则以水渍布薄之。叠布数重。新水渍之。稍挨去水。搭于胸上。须
臾蒸热。又渍令冷。如前薄之。乃换新水。日数十易。热甚者。置病患
于水中。热势才退。即已。亦良法也。
雍曰。置人水中之法。势甚不得已。虽可用。亦难用。须内热少
衰。势未解则可。不然。水迫外热。并归于内。则不可支也。大抵阳虚
狂躁。与伤寒下证不同。下证只坐卧不安。阳毒则必欲起走。且有
力。人不能制。虽见江河。亦入也。亦有偶然得解者。非常道也。雍
曰。岭南治热瘴。取蚯蚓研烂。新冷水渍取清汁饮之。此未试也。盖
说言獭肝治热不治冷。余尝苦病后潮热。以冷水调少许末服之则
止。然未尝用治大热也。漫书之以备用。
郭雍说：伤寒病中的阴毒和阳毒，是病情最为危重的两种病症。张仲景曾制定过升麻甘草二汤（由升麻、甘草等组成的方剂），但现在竟然在张仲景的著作中找不到这些方子。只有《脉经》记载了关于这两种病的辨证论述两篇，《千金方》中也略微提及。现在考察这两首汤剂的用药加减，与张仲景的原意有相同也有不同之处。《金匮要略》将阴毒和阳毒合并为一篇，说：“无论是阴毒还是阳毒，都用升麻鳖甲汤主治。”前后的各种医书都没有这种说法。然而这两种疾病，性质如同冰炭般截然相反，用药也完全相反。各书中虽然有升麻甘草二汤，方药组成都相同，却又与《金匮要略》不同。因此不能不产生怀疑。只有《活人书》中的两方，用药不同，最为合乎道理。只是没见到《活人书》中升麻汤出自哪本医书，推测朱氏（朱肱）必定有所依据。现在依照《活人书》使用这两味药。（士弱说：这两方记载于《外台秘要》，称出自《古今录验方》。）
王叔和《脉经》说：阳毒作为疾病，表现为身体沉重，腰背疼痛，烦闷不安，胡言乱语，或者奔跑，或者看见鬼怪，或者吐血、下利，脉象浮大且数，面色红赤，斑纹如锦缎般绚丽，咽喉疼痛，吐出脓血。发病五天内可以治疗，到了第七天就无法治疗了。有的伤寒病一二天就变成阳毒，或者是服药后经过催吐、泻下，变成了阳毒。用升麻汤主治。庞氏说：又适宜用葛根龙胆汤。郭雍说：这种病经常发生，如果不知道治疗，大多因大量吐血、便血而死。即使使用滋阴清热药，也必须含有解毒的药物在里面，才可以应用。
《活人书》说：阳毒病，阳气单独亢盛，阴气突然断绝，必然出现烦躁，胡言乱语，妄自奔走，面色红赤，斑纹如锦缎般绚丽，咽喉痛，或者下利赤黄色粪便，脉象洪大、实、滑、促。适宜使用酸苦性质的药物，使阴气恢复而通过大汗来解除病邪。葶苈苦酒汤、升麻汤、大黄散、栀子仁汤、黑奴丸，可以选择其中一方使用。郭雍说：表里都有大热证的，适宜用黑奴丸。确切知道热邪在里而不在表，就用朴硝、大黄、桃仁等药物攻下。这些药物中主要是多服用升麻。因为阳毒发作非常急暴，不像阴毒那样缓慢。（原文此处缺失）雷时强壮的人。（原文此处缺失）以及小儿，应当便宜地使用升麻汤预防其毒性。
又说：近代人治疗伤寒，脉象洪大，内外结聚发热，舌头卷缩焦黑，鼻孔中像烟煤一样黑的，就用冷水浸湿布巾敷贴在上面。叠放几层布，用新水浸湿，稍微拧去水分，搭在胸部上。一会儿蒸发变热，再浸水使其冷却，像前面那样敷贴。然后换上新水，一天更换几十次。热势严重的，把病人放在水中，热势刚刚退去就停止。这也是很好的方法。
郭雍说：把人放入水中的方法，形势是非常不得已才使用的。虽然可以使用，但也很难实施。必须内热稍微衰退，病势尚未解除时才可行。否则，水迫使外热并归于体内，那就无法支撑了。大体上阳虚导致的狂躁，与伤寒里的“下证”（需要攻下的证候）不同。“下证”只是坐卧不安，阳毒则一定要起身走动，而且有力气，别人不能控制他，即使看到江河也会跳进去。也有偶然得救的，但这不是常规之道。郭雍说：岭南地区治疗热瘴，取蚯蚓研烂，用新冷水浸泡取清汁饮用。这个我没有尝试过。大概听说獭肝治疗热症而不治疗冷症。我曾经苦于病后潮热，用冷水调少许獭肝末服用就能止住。然而未曾用来治疗大热症。随意记录下来以备后用。
Guo Yong stated: Yin-toxin (Yin Du) and Yang-toxin (Yang Du) in Shanghan disease are among the most severe conditions. Zhang Zhongjing had formulated two decoctions involving Shengma and Gancao, yet they are now absent from Zhang's extant works. Only the *Mai Jing* (Pulse Classic) records two chapters on their differentiation, and the *Qianjin Fang* mentions them briefly. Examining the modifications of these two decoctions reveals similarities and differences with Zhang Zhongjing's original intent. The *Jingui Yaolue* combines Yin-toxin and Yang-toxin into one section, stating: "For both Yin-toxin and Yang-toxin, Shengma Biejia Tang (Cinnamon Twig and Turtle Shell Decoction) is the primary treatment." Previous medical texts do not support this assertion. However, these two diseases are as opposite as ice and charcoal, and their treatments are diametrically opposed. Although various texts mention the two Shengma-Gancao decoctions with identical ingredients, they differ from the *Yaolue*. Thus, doubts arise. Only the two formulas in the *Huo Ren Shu* (Book that Saves Lives), which use different medications, seem most reasonable. However, the source of the Shengma Tang in the *Huo Ren Shu* is not cited; it is presumed that Zhu Shi (Zhu Gong) must have had a basis for this. I now adopt the two herbs from the *Huo Ren Shu*. (Shi Ruo noted: These two formulas are recorded in the *Waitai Miyao*, claiming origin from the *Gujin Luyan Fang*.)
Wang Shuhe's *Mai Jing* states: Yang-toxin manifests as heaviness of the body, pain in the lower back and back, restlessness and discomfort, delirious speech, running about, hallucinations of seeing ghosts, hematemesis, or diarrhea. The pulse is floating, large, and rapid. The face is red with mottled patterns like brocade. There is sore throat and expectoration of pus and blood. It is treatable within five days but incurable after seven days. Some cases of Shanghan transform into Yang-toxin within one or two days, or following emetic or purgative treatments. Shengma Tang is indicated. Pang Shi added that Gegen Longdan Tang (Pueraria Root and Gentiana Decoction) is also suitable. Guo Yong remarked: This disease occurs frequently; without proper treatment, patients often die from massive hematemesis and hematochezia. Even when using yin-nourishing and heat-clearing herbs, detoxifying agents must be included for the prescription to be effective.
The *Huo Ren Shu* states: In Yang-toxin disease, yang qi alone is hyperactive while yin qi suddenly fails. This inevitably leads to agitation, delirium, and aimless running. The face is red with brocade-like mottling, there is sore throat, or passage of yellow-red stool. The pulse is surging, full, slippery, and hurried. Sour and bitter herbs should be used to restore yin qi and resolve the condition through profuse sweating. Options include Tingli Kujiu Tang (Descurainia Seed and Vinegar Decoction), Shengma Tang, Dahuang San (Rhubarb Powder), Zhizi Ren Tang (Gardenia Seed Decoction), and Heinu Wan (Black Slave Pill). One may select an appropriate formula. Guo Yong commented: For simultaneous exterior and interior excess-heat syndromes, Heinu Wan is suitable. If it is confirmed that the heat resides in the interior rather than the exterior, purge using Poxiao (Mirabilite), Dahuang (Rhubarb), and Taoren (Peach Kernel). Among these, Shengma should be administered in larger doses. Yang-toxin arises violently, unlike Yin-toxin. (Original text missing here) Lei Shi Qiangren. (Original text missing here) And for children, it is advisable to use Shengma Tang prophylactically to prevent toxicity.
Furthermore, it is said: In recent times, treating Shanghan with a surging pulse, internal and external knotted heat, curled and scorched-black tongue, and nostrils resembling soot involves wetting a cloth with water, layering several cloths, soaking them in fresh water, wringing out slightly, and applying to the chest. When the cloth warms up from evaporation, re-soak it in cold water and apply again. Change to fresh water dozens of times a day. For severe heat, immerse the patient in water until the heat subsides. This is also a good method.
Guo Yong stated: Immersing a person in water is a measure of last resort. Although usable, it is difficult to implement. It is only feasible if internal heat has slightly abated but the condition persists. Otherwise, the water may force external heat inward, leading to collapse. Generally, mania due to yang deficiency differs from the "xia zheng" (syndromes requiring purgation) in Shanghan. The latter presents merely with restlessness in sitting or lying down; Yang-toxin involves an urge to rise and run, accompanied by strength that others cannot restrain, even jumping into rivers. Occasionally, such patients may survive, but this is not a standard approach. Guo Yong added: In Lingnan, heat zhang (malaria-like fever) is treated by crushing earthworms and drinking the clear juice obtained by soaking them in fresh cold water. I have not tried this. It is said that Otter Liver (Tagan) treats heat but not cold. I once suffered from post-illness tidal fever and found that taking a small amount of Otter Liver powder mixed with cold water stopped it. However, I have never used it for high fever. I record this casually for future reference.