【闡釋】太陽與陽明合病下利，鄭氏以“風寒主證之不同，風為陽而上逆，寒為陰而下行”之論。則上逆而嘔，下注而為利，自是正確的，方與證合拍。
五、太陽與陽明合病，喘而胸滿者，不可下，〔宜〕麻黃湯（主之）。原文36
鄭論：按喘而胸滿，胸中之陽為寒所束，上攻於肺，呼吸錯亂，而喘證作，此條舉太陽陽明而言。若火刑於肺而喘者，下之不宜。若少陰腎氣上沖於肺而喘，不（謂）〔僅〕麻黃不可用，用之是速其亡也。原文之言不可下，是謂寒束於肺，下之恐引邪深入，必生別病，故曰不可下，下之為患不小。首用麻黃湯大開腠理，表氣一通，裏氣則暢，邪自表分出，而內境安守也。
【闡釋】陽明可下，合病則表證未解，故不可不。喘而胸滿者，因汗不得出，熱毒壅迫於肺臟故也，與麻黃湯發汗，則喘滿自除。表裏證同時出現，先解表，後攻裏，為治療原則之一，本條就是在說明這個道理。故鄭氏說：“用麻黃湯大開腠裏，表氣一通，裏氣則暢，邪自表分出”，則病解也。
六、太陽與少陽合病，自下利者，與黃芩湯，若嘔者，黃芩加半夏生薑湯主之。原文172
鄭論：按太少合病，總要兩法病情相孚，照兩經法治之，此但舉太少合病，而曰自下利者，與黃芩湯，嘔者加半夏生薑湯，其中不能無疑，疑者何？夫自下利而嘔，是屬太陰證乎？是屬太陽協熱下利乎？少陽本氣喜嘔乎？若果屬太陽協熱下利，黃芩湯乃為正治法。若嘔果係少陽本氣者，黃芩加半（下）〔夏〕生薑湯，本為對證法。如屬太陰，又當以理中湯加柴、桂，庶為合法。
【闡釋】本條雖提太陽與少陽合病，並無發熱惡寒，頭痛項強之太陽表證，亦無胸脅苦滿之少陽半表半裏證。原文僅提太少合病而至下利，故鄭氏對此條提出質疑“是屬太陽協熱下利乎？少陽本氣喜嘔乎？是屬太陰證乎”？實則太少合病，其在表之寒邪悉入而為裏熱，裏熱不實，故與黃芩湯以清裏熱，使裏熱清而在表之邪自和矣。若嘔者，乃是胃氣上逆所致，則應再加半夏生薑，以降逆止嘔。如此解釋，則明白了然，可以釋疑矣。
黃芩湯方（校補）
黃芩三兩芍藥二兩甘草二兩（炙）大棗十二枚（擘）上四味，以水一鬥，煮取三升，去渣，溫服一升，日再，夜一服。
黃芩加半夏生薑湯方（校補）
即上方加半夏半升（洗）生薑一兩半，一方三兩（切）
【方解及其應用範圍】黃芩、芍藥之苦以撤熱和陰，甘草、大棗之甘以調中，而緩其津液之下奔也，有苦甘合化清熱存陰之義。嘔為氣逆，加半夏辛降，生薑辛散，則氣逆得降，嘔亦自止。後世推廣用之以治熱痢。治痢之方劑，大都由此方化裁而來。
七、陽明少陽合病，必下利，其脈不負者，〔為〕順也。負者，失也①，互相克賊，名為負也。脈滑而數者，有宿食也，當下之，宜大承氣湯。原文256
①其脈……失也：這是根據五行生克的學說，從脈象上來解釋疾病的順逆。陽明屬土，少陽屬木，二經合病而下利，如純見少陽弦脈，則木必克土，病情較逆，是即所謂“負也”，“失也”；如果脈見滑數，則木不克土，是即所謂“順也”。證狀與脈象不符為“負”。脈象與證狀相合為“順”。
鄭論：按陽明少陽合病，察係兩經表邪，當從兩經解表法治之。但下利，裏未實也，何得下之？此以脈滑而斷為宿食者當下之。然亦當辨其果有宿食，與未有宿食，有食可下，無食斷乎不可。
【闡釋】傷寒合病章4條太陽與陽明合病自下利，是病偏重於太陽之表者，故用葛根湯；6條太陽與少陽合病自下利，是邪偏重于少陽之半表半裏者，故用黃芩湯。此節為陽明少陽合病，從脈象上來判斷順逆。脈證相符的為順，容易獲愈；脈證不符的為逆，不易治療。必下利者，脾虛裏有寒也，當用理中湯溫其裏。鄭氏曰：“有食可下，無食斷乎不可”。縱有宿食，亦宜溫下之，用附子理中湯加砂仁、雞內金、大黃，中病即止，豈有下利而反用大承氣湯下之之理？
八、三陽合病①，脈浮大，〔上〕關上②，但欲眠睡，目合則汗。原文268
①三陽合病：即太陽、少陽、陽明三經同時發病。
②上關上：脈搏長大，從關部上至寸口的意思。
鄭論：按三陽同病，陽邪盛已。關上浮大，胃邪熾也，欲眠睡者，熱甚神昏也；閉目汗出，內熱之驗也。雖然，不可不詳辨之，其中實實虛虛，千變萬化，實難窺測。有名為三陽，卻非三陽，此則專為三陽說法，若係由內出外之熱，有似此三陽者，餘亦詳而驗之，但其人舌無苔而潤，口不渴者，餘即不按三陽法治之，專主回陽，屢試屢效。
【闡釋】三陽病均屬熱證，三陽合病則邪熱尤盛，因高熱而神昏欲眠睡，不惡寒而惡熱也，與寒中少陰，但欲寐者，其人惡寒，脈必沉而微細者顯然不同；目合則汗，是由於陽熱太甚，則陰不內守。鄭氏說：“若係由內出外之熱，有似此三陽者，餘亦詳而驗之，但其人舌無苔而潤，口不渴者，餘即不按三陽法治之，專主回陽”。此鄭氏示人辨證宜細心求之，雖未列出治療方劑，總不出四逆、白通之類大劑回陽。
九、三陽合病，腹滿身重，難以轉側，口不仁③，面垢④，譫語遺尿。發汗則譫語，下之則（頞）〔額〕上生汗，手足逆冷，若自汗〔出〕者，白虎湯主之。原文219
③口不仁：言語不利，不知食味。
④面垢：面部油垢污濁。
鄭論：按三陽合病，必有三陽實據可憑，此則所現，純陰居十八，僅有腹滿譫語似陽明，餘故細辨之者，何也？陽主身輕，陰主沉重，陽主開而陰主闔；口之不仁，陰也；身重難以轉側，陰也；面垢、遺尿，腎氣不納，陰也。果係三陽表邪，汗之則解，何至腹滿譫語；果係三陽裏實，下之則解，何至（頞）〔額〕汗出，而手足逆冷？學者務于未汗下時，詳其舌之潤與不潤，舌之燥與不燥，口氣之粗與不粗，口之渴與不渴，飲之喜冷喜熱，二便之利與不利，而三陽合病之真假自得矣。原文所論之病象，大有可疑，故詳辨之。
【闡釋】鄭氏之詳辨陰證、陽證，可為後學準繩，筆者從之，無贅言也。
傷寒並病
計四法（據舒本校補）
一、二陽並病①，太陽初得病時，發其汗，汗先出不徹，因轉屬陽明，續自微汗出，不惡寒。若太陽病證不罷者，不可下，下之為逆，如此可小發汗。設面色緣緣正赤者②，陽氣（拂）〔怫〕鬱在表③，當解之熏之。若〔發〕汗（出）不徹，不足言陽氣（拂）〔怫〕鬱不得越④，當汗不汗，其人（煩燥）〔躁煩〕，不知痛外，乍在腹中，乍在四肢，按之不可得，其人短氣但坐，以汗出（而）不徹（之）故也，更發汗則愈。何以知汗出不徹，以脈澀故知也。原文48
①並病：一經之證未罷，又見到另一經證狀的，叫做並病。
②緣緣：不斷之意。
③怫鬱：此處是遏鬱之意。
④越：發、散之意。
鄭論：按太陽初病，漸至不惡寒獨有熱象，方為轉屬陽明，若已得汗而解，無發熱，不得為轉屬陽明。即轉屬陽明，而太陽證未罷，胃未實，即不得妄下，下之則逆，可以小發汗者，是指太陽證未罷，裏邪未即時也。若面色赤者，是內熱怫鬱之征，亦在可表可熏之例。若汗出不徹，雖面赤即不得謂之怫鬱不得越。至於當汗不汗，煩（燥）〔躁〕者，熱攻於內，而內不安也，乍腹乍四肢，總以汗未出透，裏氣不暢也。然則何以知其汗出不徹乎？以脈澀知之。余常謂澀為血少，以此澀脈而定為汗出不徹，未免牽強，夫汗之徹與不徹，實係乎正氣之旺與不旺，正氣旺則邪必盡出無遺，何致有不徹之患哉？
【闡釋】發汗不徹，為太陽與陽明並病的主要原因。雖為並病，但表證仍然存在的時候，仍當用發汗的方法，而不能使用下法。原文所舉諸種證狀，皆汗出不徹之故。何以知其汗出不徹，原文雲：以脈澀知之。鄭氏謂：“澀為血少，此以澀脈而定為汗出不徹，未免牽強。夫汗之徹與不徹，實係乎正氣之旺與不旺，正氣旺則邪必盡出無遺”。澀脈，《內經》謂參伍不調為澀，指下觸覺脈搏的波動澀滯不流利，為血行障礙的脈象，汗閉或汗出不徹，雖可能見到這種脈象，究不常見，更不可能根據脈搏的澀滯，而預知其汗不徹的情況。鄭氏之論，亦有足取。
二、二陽並病，太陽證罷，但發潮熱，手足漐漐汗出，大便艱而譫語者，下之則愈，宜大承氣湯。原文220
鄭論：按此條指太陽傳至陽明，而寒邪已化為熱，所見潮熱、譫語、大便艱、汗出，全是陽明，故稱太陽證罷，下之可愈，便是用藥的法竅處也。
【闡釋】本太陽病並于陽明，名曰並病。前條太陽證未罷，故不可下，今則表邪已解，所現全為裏實證，可用大承氣湯下之以清裏熱，此鄭氏謂“下之可愈”也。
三、太陽與少陽並病，頭頂強痛或眩冒，時如結胸，心下痞鞕者，當刺大椎第一間①、肺俞②、肝俞③，慎不可發汗，發汗則譫語，脈弦，五日譫語不止，當刺期門（穴）④。原文142
①大椎第一間：在第七頸椎和第一胸椎棘突之間（督脈經）。
②肺俞：當第三第四胸椎橫突起間，在脊外方一寸五分（膀朧經）。
③肝俞：當第九第十胸椎橫突起間，在脊椎外方一寸五分（膀朧經）。
④期門：乳直下二脅間（肝經）。
鄭論：按太少合病，如何只有太陽經證，而無少陽經證，似不可以言並病。若謂眩冒本屬少陽，加結胸，心下鞕，仍屬太陽，何也？太陽之氣，由下而上至胸腹，今結胸心下痞，多係寒水上逆而成，理應按法施治，又何必以針刺，而傷無病之經哉？
【闡釋】太陽與少陽並病，就是太陽之邪傳並少陽，而太陽之邪未罷，既有頭痛項強的太陽證，又見到頭眩昏冒胸脅痞滿的少陽證，由於邪已漸入，所以又有時如結胸的現象。汗、下治法皆非所宜，原文採取針法治之。鄭氏曰：“理應按法施治，又何必以針刺，而傷無病之經哉？”然則如何按法施治？邪入少陽而太陽證未罷，可用柴胡桂枝湯治之。桂枝湯以解太陽之邪，柴胡湯以和解少陽，則眩冒可除。若誤汗則熱邪入於肝經而譫語，當如太陽下篇16、17條例，刺期門以泄肝邪，肝之邪熱去，譫語自止。
四、太陽少陽並病，而反下之，成結胸，心下鞕，下利不止，水漿不下，其人心煩。原文150
鄭論：按此條大約當解表而不解表，誤下之，則邪正相搏，結下心下而成痞鞕，以致上之水漿不入，下之利不止，其人心煩，實危亡之首，可不（謹）〔慎〕軟？
【闡釋】此為太陽少陽並病，本不當下而反下之，三焦氣阻，水道不行，與水相結而成結胸，因而心下鞕。正虛於下則下利不止，邪逆于上則水漿不下，氣結於中則心煩，此乃誤下而成結胸之危候。鄭氏曰：“實危亡之道”。然則坐以待斃耶？筆者認為應大劑回陽收納，待正氣充實，繼用陷胸湯攻之，俟邪去而以溫補調之，斯為得矣。
傷寒壞病
計二法（據舒本校補）
一、太陽病三日，已發汗，若吐、若下、若溫針①，仍不解者，此為壞病②。桂枝不中與〔之〕也③。（現）〔觀〕其脈證，知犯何逆，隨證治之。原文16前段
①溫針：針炙的一種方法，用針針於一定穴位，以艾裹針體而蒸燒之，以冀發汗。
②壞病：因治療錯誤致病情發生惡化，證候變亂，而不能稱其名者。
③不中與：就是不中用的意思。
鄭論：按太陽證，既經汗、吐、下、溫針，治皆不愈，總其未得病之源委而誤用之也，仍究察其何逆，而隨機治之，然亦不得為之真壞證也。
【闡釋】太陽證，既經汗、吐、下、溫針的治療，病仍未解，原因是治法不當，使病情變化，成了壞病。鄭氏曰：“仍究察何逆，而隨機治之”。假如發汗、溫針亡陽，則有脈微身寒之變，宜桂枝加附子湯。吐傷中氣，氣逆脈促者，宜生薑半夏湯。下之而寒水下陷，利遂不止，脈濡滑者，宜四逆理中輩。此即原文隨證治之之義矣。
二、〔本〕太陽病不解，轉入少陽者，脅下鞕滿，幹嘔不能食，往來寒熱，尚未吐、下，脈沉緊者，與小柴胡湯。若已吐、下、發汗、溫針，譫語，柴胡證罷，此為壞病，知犯何逆，以法治之。原文266、267
鄭論：按太陽之邪不解，應當傳入陽明，何得越位而轉入少陽也？然太陽寒水之氣，亦許結於脅下鞕滿，如此而言。亦可謂轉屬少陽也。迨至幹嘔不欲食，往來寒熱，少陽之本證具也，未經吐、下，可與小柴胡湯以和解之，若已經汗、吐、下，溫針而見譫語，未見柴胡證，似從譫語法治之，亦不得盡目之為壞病也。學者又當于臨證時，細細求之可也。
【闡釋】本條前段提出太陽病不解，轉入少陽，既具少陽主證，脈雖沉緊與證不符，當舍脈從證，可與小柴胡湯治療。後段則述及少陽病誤治的變證及救誤的原則，鄭氏曰：“亦不得盡目之為壞病也，當于臨證時，細細求之可也”。
總之誤用汗、吐、下、溫針，非病胃燥，即為血熱。胃燥之證，輕則小承氣，重則調胃承氣，最重則為大承氣。血熱之證。輕則刺期門，重則桃核承氣，尤重者抵當湯，隨證施治可也。
傷寒痰病
計三法（據舒本校補）
【阐释】太阳病与阳明病同时发病（合病）出现下利症状，郑氏认为：“风邪和寒邪所致的主证不同，风为阳邪而致病趋势向上逆行，寒为阴邪而致病趋势向下流注。”因此，风邪上逆导致呕吐，寒邪下注导致下利，这种观点是正确的，符合临床证候的表现。
五、太阳病与阳明病同时发病，出现气喘且胸部胀满的症状，不可使用泻下法，应当使用麻黄汤主治。原文第36条
郑钦安论述：按此条所述，气喘且胸部胀满，是因为胸中的阳气被寒邪束缚，寒气上攻于肺，导致呼吸功能紊乱，从而引发气喘证。本条提及太阳与阳明两经同病。如果是火邪刑克肺脏而导致的气喘，则不宜使用泻下法。如果是少阴肾气上冲于肺而导致的气喘，不仅麻黄汤不可用，若误用会加速患者死亡。原文说“不可下”，是指寒邪束肺，若误用泻下法，恐怕会将邪气引入体内深处，必然产生其他病变，所以说不可下，误下后的危害不小。首先使用麻黄汤大力开通腠理（皮肤毛孔及汗腺），表气通畅后，里气也随之畅通，邪气自然从体表排出，体内环境就能安宁稳固。
【阐释】阳明病通常可以使用泻下法，但既然是合病，说明表证尚未解除，所以不可使用泻下法。气喘且胸部胀满，是因为汗液无法排出，热毒壅滞逼迫肺脏所致，给予麻黄汤发汗，则气喘和胸满自然消除。表证和里证同时出现时，先解表证，后攻里证，是治疗原则之一，本条就是在阐述这个道理。所以郑氏说：“使用麻黄汤大力开通腠理，表气一通，里气则畅，邪气自然从体表分出”，这样病就好了。
六、太阳病与少阳病同时发病，出现自发性下利的，给予黄芩汤；如果伴有呕吐的，以黄芩加半夏生姜汤主治。原文第172条
郑钦安论述：按太阳与少阳合病，总要根据两经的病情相符程度，按照两经的治疗方法处理。这里只提太阳与少阳合病，并说如果是自发性下利，给予黄芩汤，如果有呕吐，加半夏生姜汤，其中不能没有疑问。疑问在哪里呢？如果是自发性下利并伴有呕吐，这属于太阴病证吗？还是属于太阳协热下利吗？或者是少阳本气导致的呕吐吗？如果确实属于太阳协热下利，黄芩汤就是正治法。如果呕吐确实是由少阳本气引起的，黄芩加半夏生姜汤本来就是对症之法。如果属于太阴病，又应当使用理中汤加入柴胡、桂枝，这才合乎法则。
【阐释】本条虽然提到太阳与少阳合病，但并没有出现发热恶寒、头痛项强等太阳表证，也没有出现胸胁苦满等少阳半表半里证。原文仅提到太少合病导致下利，所以郑氏对此条提出质疑：“这是属于太阳协热下利吗？还是少阳本气喜呕吗？或者是属于太阴病证？”实际上，太少合病，在表的寒邪全部入里化为里热，但里热并未形成实结，所以给予黄芩汤以清泄里热，使里热清除而在表的邪气自然调和。如果有呕吐，这是由于胃气上逆所致，则应再加半夏、生姜，以降逆止呕。如此解释，则明白清楚，可以消除疑惑了。
黄芩汤方（校补）
黄芩三两，芍药二两，甘草二两（炙），大枣十二枚（掰开）。以上四味药，用水一斗，煮取三升，去渣，温服一升，每日两次，夜间一次。
黄芩加半夏生姜汤方（校补）
即上方加入半夏半升（洗），生姜一两半，另一版本为三两（切）。
【方解及其应用范围】黄芩、芍药的苦味可以撤除热邪、调和阴液，甘草、大枣的甘味可以调和中焦，并减缓津液的流失，具有苦甘化合以清热存阴的意义。呕吐是气机上逆，加入半夏辛散降逆，生姜辛散，则气逆得以下降，呕吐自然停止。后世推广使用此方治疗热痢。治疗痢疾的方剂，大多由此方化裁而来。
七、阳明病与少阳病同时发病，必定出现下利，脉象不呈现相克之象的，称为顺证。所谓“负”，就是失的意思①，五行互相克制贼害，称为负。脉象滑而数的，是有宿食积滞，应当使用泻下法，适宜大承气汤。原文第256条
①其脉……失也：这是根据五行生克的学说，从脉象上来解释疾病的顺逆。阳明属土，少阳属木，两经合病而下利，如果纯见少阳弦脉，则木必克土，病情较逆，这就是所谓的“负也”、“失也”；如果脉见滑数，则木不克土，这就是所谓的“顺也”。证状与脉象不符为“负”。脉象与证状相合为“顺”。
郑钦安论述：按阳明与少阳合病，检查是否属于两经的表邪，应当从两经解表的方法治疗。但是出现下利，说明里未结实，怎么能用泻下法？此处是根据脉滑而判断为有宿食，才主张当下之。然而也应当辨别究竟是否有宿食，与没有宿食的情况，有食积才可以下，无食积绝对不可下。
【阐释】伤寒合病章中，第4条太阳与阳明合病自下利，是病偏重于太阳之表者，所以用葛根汤；第6条太阳与少阳合病自下利，是邪偏重于少阳之半表半里者，所以用黄芩汤。本节为阳明与少阳合病，从脉象上来判断顺逆。脉证相符的为顺，容易痊愈；脉证不符的为逆，不易治疗。“必下利者”，是因为脾虚里有寒，应当用理中汤温补里寒。郑氏说：“有食可下，无食断乎不可”。即使有宿食，也宜用温下法，用附子理中汤加砂仁、鸡内金、大黄，中病即止，哪有下利反而用大承气汤泻下的道理？
八、三阳合病①，脉象浮大，[上]至关上②，只想睡觉，闭眼则出汗。原文第268条
①三阳合病：即太阳、少阳、阳明三经同时发病。
②上关上：脉搏长大，从关部上至寸口的意思。
郑钦安论述：按三阳同病，阳邪已经盛极。关部脉浮大，是胃中邪热炽盛的表现；想睡觉，是因为热甚导致神志昏蒙；闭目出汗，是内热的验证。虽然如此，不可不详加辨别，其中虚实变化，千变万化，实在难以窥测。有名义上的三阳病，却并非真正的三阳病，这里只是专门针对三阳病而言，如果是由于内出外的热，有类似三阳病的表现，我也详细验证过，但如果其人舌苔无且湿润，口不渴，我就不再按三阳法治之，专门主用回阳救逆法，屡试屡效。
【阐释】三阳病均属于热证，三阳合病则邪热尤其旺盛，因高热而神昏欲睡，不恶寒而恶热，这与寒中少阴、只想睡觉且恶寒、脉必沉而微细的情况显然不同；闭眼则出汗，是由于阳热太盛，导致阴液不能内守。郑氏说：“如果是由于内出外的热，有类似三阳病的表现，我也详细验证过，但如果其人舌苔无且湿润，口不渴，我就不再按三阳法治之，专门主用回阳救逆”。这是郑氏教导人们在辨证时应细心探求，虽然未列出治疗方剂，但总不出四逆汤、白通汤之类的大剂回阳方。
九、三阳合病，腹部胀满，身体沉重，难以翻身侧卧，口不知味③，面部油垢污浊④，说胡话（谵语）且遗尿。如果发汗则会导致谵语，如果用泻下法则会导致[额]头上出汗，手足逆冷，如果自汗[出]的，以白虎汤主治。原文第219条
③口不仁：言语不利，不知食物味道。
④面垢：面部油垢污浊。
郑钦安论述：按三阳合病，必定有三阳病的实证依据可凭，此处所现症状，纯属阴证占十八分，仅有腹满、谵语似阳明，其余故需细细辨别的是什么呢？阳主身轻，阴主沉重；阳主开而阴主阖；口之不仁，属阴；身体沉重难以转侧，属阴；面垢、遗尿，是肾气不纳，属阴。果真是三阳表邪，发汗则可解，何至于腹满谵语；果真是三阳里实证，泻下则可解，何至于[额]头出汗，而手足逆冷？学者务必在未发汗、未泻下时，详细观察其舌苔润与不润，舌质燥与不燥，口气粗与不粗，口渴与不渴，饮水喜冷喜热，二便通利与否，那么三阳合病的真假自然明了。原文所论的病象，大有可疑之处，故详细辨别之。
【阐释】郑氏对阴证、阳证的详细辨别，可为后学树立准则，笔者遵从，不再赘言。
共四种治法（据舒寿山本校补）
一、二阳并病①，太阳病初得病时，发其汗，汗先出不透彻，因而转属阳明，继续出现微微出汗，不恶寒。如果太阳病证候未罢的，不可使用泻下法，误下为逆治，这种情况下可以小量发汗。假如面色持续通红者②，是阳气[怫]郁在表③，应当解表熏蒸。如果[发]汗[出]不透彻，不足以称为阳气[怫]郁不得越④，当汗而不汗，其人[烦躁]，不知道疼痛具体位置，痛处乍在腹中，乍在四肢，按压找不到，其人短气只能坐卧，这是因为汗出[而]不彻[之]故也，再次发汗则愈。怎么知道汗出不透彻呢？通过脉涩可知。原文第48条
②缘缘：不断之意。
③怫郁：此处是遏郁之意。
④越：发、散之意。
郑钦安论述：按太阳初病，逐渐变为不恶寒独有热象，才是转属阳明，如果已经得汗而解，无发热，不得称为转属阳明。即使转属阳明，而太阳证未罢，胃未结实，就不得妄用泻下，误下则为逆，可以用小量发汗，是指太阳证未罢，里邪未即时结实的时候。如果面色赤红，是内热怫郁的征象，也在可表可熏的范畴。如果汗出不透彻，虽然面赤也不得谓之怫郁不得越。至于当汗不汗，烦[躁]者，是热攻于内，而内不安也，痛处乍在腹中乍在四肢，总因汗未出透，里气不畅也。那么怎么知道汗出不透彻呢？通过脉涩得知。我常谓涩脉主血少，以此涩脉而定为汗出不透彻，未免牵强，汗之彻与不彻，实际取决于正气之旺与不旺，正气旺则邪必尽出无遗，何致有不彻之患哉？
【阐释】发汗不透彻，是太阳与阳明并病的主要原因。虽为并病，但表证仍然存在的时候，仍当用发汗的方法，而不能使用下法。原文所举诸种证状，皆因汗出不透彻之故。怎么知道汗出不透彻，原文云：通过脉涩得知。郑氏谓：“涩为血少，以此涩脉而定为汗出不透彻，未免牵强。夫汗之彻与不彻，实际取决于正气之旺与不旺，正气旺则邪必尽出无遗”。涩脉，《内经》谓参伍不调为涩，指下触觉脉搏波动涩滞不流利，为血行障碍的脉象，汗闭或汗出不透彻，虽可能见到这种脉象，究不常见，更不可能根据脉搏的涩滞，而预知其汗不透彻的情况。郑氏之论，亦有可取之处。
二、二阳并病，太阳证已罢，只出现潮热，手足微微出汗，大便困难且谵语的，泻下则愈，适宜大承气汤。原文第220条
郑钦安论述：按此条指太阳传至阳明，而寒邪已化为热，所见潮热、谵语、大便硬、汗出，全是阳明病证，故称太阳证罢，泻下可愈，这便是用药的法窍所在。
【阐释】本太阳病并于阳明，名叫并病。前条太阳证未罢，故不可下，今则表邪已解，所现全为里实证，可用大承气汤泻之以清里热，此郑氏谓“下之可愈”也。
三、太阳与少阳并病，头顶强痛或眩晕冒昧，有时像结胸，心下痞硬者，应当针刺大椎第一间①、肺俞②、肝俞③，慎不可发汗，发汗则谵语，脉弦，五日谵语不止，应当刺期门（穴）④。原文第142条
①大椎第一间：在第七颈椎和第一胸椎棘突之间（督脉经）。
②肺俞：当第三第四胸椎横突起间，在脊外方一寸五分（膀胱经）。
③肝俞：当第九第十胸椎横突起间，在脊椎外方一寸五分（膀胱经）。
郑钦安论述：按太阳与少阳合病，为何只有太阳经证，而无少阳经证，似乎不可以言并病。如果说眩晕本属少阳，加上结胸、心下硬，仍属太阳，为什么呢？太阳之气，由下而上至胸腹，现在结胸心下痞，多系寒水上逆而成，理应依法施治，又何必以针刺，而伤无病之经哉？
【阐释】太阳与少阳并病，就是太阳之邪传并少阳，而太阳之邪未罢，既有头痛项强的太阳证，又见到头眩昏冒胸胁痞满的少阳证，由于邪已渐入，所以又有有时像结胸的现象。汗、下治法皆非所宜，原文采取针法治之。郑氏曰：“理应依法施治，又何必以针刺，而伤无病之经哉？”然则如何依法施治？邪入少阳而太阳证未罢，可用柴胡桂枝汤治之。桂枝汤以解太阳之邪，柴胡汤以和解少阳，则眩晕可除。若误汗则热邪入于肝经而谵语，当如太阳下篇16、17条例，刺期门以泄肝邪，肝之邪热去，谵语自止。
四、太阳少阳并病，而反用泻下法，造成结胸，心下硬，下利不止，水浆不下，其人心中烦乱。原文第150条
郑钦安论述：按此条大约应当解表而未解表，误用下法，则邪正相搏，结于心下而成痞硬，以致上之水浆不入，下之利不止，其人心中烦乱，实为危亡之首，可不[谨]慎软？
【阐释】此为太阳少阳并病，本不应下而反用下法，三焦气阻，水道不行，与水相结而成结胸，因而心下硬。正虚于下则下利不止，邪逆于上则水浆不下，气结于中则心烦，此乃误下而成结胸之危候。郑氏曰：“实为危亡之道”。然则坐以待毙耶？笔者认为应大剂回阳收纳，待正气充实，继用陷胸汤攻之，俟邪去而以温补调之，斯为得矣。
共两种治法（据舒寿山本校补）
一、太阳病三日，已发汗，若吐、若下、若温针①，仍不解者，此为坏病②。桂枝汤不中用[之]也③。（观）察其脉证，知犯何逆，随证治之。原文第16条前段
①温针：针灸的一种方法，用针针于一定穴位，以艾裹针体而蒸烧之，以冀发汗。
②坏病：因治疗错误致病情发生恶化，证候变乱，而不能称其名者。
③不中用：就是不中用的意思。
郑钦安论述：按太阳证，既经汗、吐、下、温针，治皆不愈，总其未得病之源委而误用之也，仍究察其何逆，而随机治之，然亦不得为真坏证也。
【阐释】太阳证，既经汗、吐、下、温针的治疗，病仍未解，原因是治法不当，使病情变化，成了坏病。郑氏曰：“仍究察何逆，而随机治之”。假如发汗、温针亡阳，则有脉微身寒之变，宜桂枝加附子汤。吐伤中气，气逆脉促者，宜生姜半夏汤。下之而寒水下陷，利遂不止，脉濡滑者，宜四逆理中辈。此即原文随证治之义矣。
二、〔本〕太阳病不解，转入少阳者，胁下硬满，干呕不能食，往来寒热，尚未吐、下，脉沉紧者，与小柴胡汤。若已吐、下、发汗、温针，谵语，柴胡证罢，此为坏病，知犯何逆，以法治之。原文第266、267条
郑钦安论述：按太阳之邪不解，应当传入阳明，何得越位而转入少阳也？然太阳寒水之气，亦许结于胁下硬满，如此而言。亦可谓转属少阳也。迨至干呕不欲食，往来寒热，少阳之本证具也，未经吐、下，可与小柴胡汤以和解之，若已经汗、吐、下，温针而见谵语，未见柴胡证，似从谵语法治之，亦不得尽目之为坏病也。学者又当于临证时，细细求之可也。
【阐释】本条前段提出太阳病不解，转入少阳，既具少阳主证，脉虽沉紧与证不符，当舍脉从证，可与小柴胡汤治疗。后段则述及少阳病误治的变证及救误的原则，郑氏曰：“亦不得尽目之为坏病也，当于临证时，细细求之可也”。
总之误用汗、吐、下、温针，非病胃燥，即为血热。胃燥之证，轻则小承气，重则调胃承气，最重则为大承气。血热之证。轻则刺期门，重则桃核承气，尤重者抵当汤，随证施治可也。
共三种治法（据舒寿山本校补）
[Explanation] When Taiyang (Taiyang disease) and Yangming (Yangming disease) diseases occur simultaneously (He Bing, combined disease) with diarrhea, Zheng Qin'an argued: "The main symptoms caused by wind pathogen and cold pathogen are different; wind is a yang pathogen and tends to move upward and reverse, while cold is a yin pathogen and tends to move downward." Therefore, wind pathogen moving upward causes vomiting, and cold pathogen moving downward causes diarrhea. This view is correct and aligns with clinical manifestations.
Five. When Taiyang and Yangming diseases occur simultaneously, presenting with wheezing and chest fullness, purgation (Xia Fa) should not be used; Mahuang Tang (Cinnamon Twig Decoction) should be administered as the primary treatment. Original Text 36
Zheng Qin'an's Commentary: In this case, wheezing and chest fullness occur because the yang qi in the chest is constrained by cold pathogen, which attacks the lungs upward, disrupting respiration and causing wheezing. This section mentions the simultaneous involvement of Taiyang and Yangming meridians. If wheezing is caused by fire pathogen damaging the lungs, purgation is inappropriate. If wheezing is caused by Kidney qi from Shaoyin (Shaoyin disease) rushing up to the lungs, not only is Mahuang Tang contraindicated, but its use would accelerate death. The original text states "do not purge" because cold constrains the lungs; purging might draw the pathogen deeper into the interior, inevitably causing other complications. Thus, it says "do not purge," as the harm from incorrect purgation is significant. First, using Mahuang Tang vigorously opens the Cou Li (pores and interstitial spaces), allowing exterior qi to flow freely. Once exterior qi is unblocked, interior qi also becomes smooth, and the pathogen naturally exits from the exterior, stabilizing the internal environment.
[Explanation] Yangming disease typically allows for purgation, but since this is a combined disease where the exterior syndrome has not resolved, purgation is contraindicated. Wheezing and chest fullness arise because sweat cannot be excreted, and heat toxin stagnates and pressures the lungs. Administering Mahuang Tang to induce sweating will resolve the wheezing and fullness. When exterior and interior syndromes appear simultaneously, resolving the exterior first and then attacking the interior is one of the treatment principles. This section illustrates this principle. Hence, Zheng Qin'an stated: "Using Mahuang Tang to vigorously open the Cou Li, once exterior qi flows, interior qi becomes smooth, and the pathogen separates from the exterior," leading to recovery.
Six. When Taiyang and Shaoyang (Shaoyang disease) diseases occur simultaneously, presenting with spontaneous diarrhea, administer Huangqin Tang (Scutellaria Decoction); if accompanied by vomiting, Huangqin Jia Banxia Shengjiang Tang (Scutellaria Decoction plus Pinellia and Fresh Ginger Decoction) should be used. Original Text 172
Zheng Qin'an's Commentary: Regarding the combined disease of Taiyang and Shaoyang, one must generally assess the condition according to both meridians and treat them accordingly. Here, only the combined disease of Taiyang and Shaoyang is mentioned, stating that for spontaneous diarrhea, Huangqin Tang is given, and for vomiting, Banxia and Shengjiang are added. There are doubts here. What are the doubts? If there is spontaneous diarrhea with vomiting, does it belong to Taiyin (Taiyin disease) syndrome? Or is it Taiyang协同 heat diarrhea (Taiyang協熱下利)? Or is it vomiting due to the fundamental nature of Shaoyang? If it truly belongs to Taiyang协同 heat diarrhea, Huangqin Tang is the correct treatment. If the vomiting is indeed due to the fundamental nature of Shaoyang, Huangqin Jia Banxia Shengjiang Tang is the appropriate formula. If it belongs to Taiyin, Lizhong Tang (Regulate the Middle Decoction) added with Chaihu (Bupleurum) and Guizhi (Cinnamon Twig) would be more appropriate.
[Explanation] Although this section mentions the combined disease of Taiyang and Shaoyang, there are no Taiyang exterior signs such as fever, aversion to cold, headache, or stiff neck, nor are there Shaoyang half-exterior/half-interior signs like chest and hypochondriac distress. The original text only mentions diarrhea resulting from the combined disease of Taiyang and Shaoyang. Therefore, Zheng Qin'an questioned: "Is this Taiyang协同 heat diarrhea? Is it vomiting due to the fundamental nature of Shaoyang? Or is it a Taiyin syndrome?" In reality, in the combined disease of Taiyang and Shaoyang, the cold pathogen on the exterior fully enters the interior and transforms into interior heat. However, this interior heat is not solid/excess. Therefore, Huangqin Tang is given to clear the interior heat. Once the interior heat is cleared, the pathogen on the exterior harmonizes itself. If there is vomiting, it is caused by rebellious Stomach qi. In this case, Banxia (Pinellia Rhizome) and Shengjiang (Fresh Ginger) should be added to direct rebellious qi downward and stop vomiting. Such an explanation clarifies the matter and resolves doubts.
Huangqin Tang Formula (Corrected and Supplemented)
Huangqin (Scutellariae Radix) 3 liang, Shaoyao (Paeoniae Radix Alba) 2 liang, Gancao (Glycyrrhizae Radix et Rhizoma Preparata) 2 liang (roasted), Dazao (Ziziphi Jujubae Fructus) 12 pieces (split). These four ingredients are boiled in 1 dou (approx. 2 liters) of water to obtain 3 sheng (approx. 600 ml). Remove the dregs. Take 1 sheng warm, twice daily and once at night.
Huangqin Jia Banxia Shengjiang Tang Formula (Corrected and Supplemented)
Take the above formula and add Banxia (Pinelliae Rhizoma Preparata) half sheng (washed) and Shengjiang (Zingiberis Rhizoma Recens) 1.5 liang (another version uses 3 liang, sliced).
[Formula Analysis and Scope of Application] The bitterness of Huangqin and Shaoyao clears heat and harmonizes yin. The sweetness of Gancao and Dazao regulates the middle jiao and prevents the excessive loss of body fluids. This embodies the principle of bitter-sweet combination to clear heat and preserve yin. Vomiting is due to rebellious qi. Adding Banxia (pinellia) provides acridity to descend qi, and Shengjiang (fresh ginger) provides acridity to disperse, thereby directing rebellious qi downward and stopping vomiting. Later generations expanded its use to treat heat-type dysentery. Most formulas for treating dysentery are derived from modifications of this formula.
Seven. When Yangming and Shaoyang diseases occur simultaneously, diarrhea is inevitable. If the pulse does not show a controlling relationship (Fu, negative/defeat), it is considered a favorable condition (Shun, smooth). "Fu" means failure/loss①. Mutual overacting and damaging are called "Fu." A slippery and rapid pulse indicates retained food (Su Shi, accumulated food), requiring purgation; Dachengqi Tang (Major Order the Qi Decoction) is suitable. Original Text 256
① Its pulse... means failure: This interpretation is based on the theory of Five Elements generation and control, explaining disease prognosis through pulse diagnosis. Yangming belongs to Earth, and Shaoyang belongs to Wood. In their combined disease with diarrhea, if only the wiry pulse of Shaoyang is seen, Wood controls Earth, indicating a unfavorable/rebellious condition (Ni), which is the so-called "Fu" or "Loss"; if the pulse is slippery and rapid, Wood does not control Earth, which is the so-called "Shun" or favorable condition. Mismatch between symptoms and pulse is "Fu." Match between symptoms and pulse is "Shun."
Zheng Qin'an's Commentary: Regarding the combined disease of Yangming and Shaoyang, if it involves exterior pathogens of both meridians, treatment should follow the methods for releasing the exterior of both meridians. However, diarrhea indicates that the interior is not solid/excess. How can purgation be used? Here, purgation is suggested only because the slippery pulse suggests retained food. Nevertheless, one must distinguish whether there is actually retained food or not. Purgation is indicated only if food retention exists; it is absolutely contraindicated if there is no food retention.
[Explanation] In the Combined Disease chapter of Shanghan Lun, Article 4 describes Taiyang and Yangming combined disease with spontaneous diarrhea, where the pathology favors the Taiyang exterior, so Gegen Tang (Kudzu Decoction) is used. Article 6 describes Taiyang and Shaoyang combined disease with spontaneous diarrhea, where the pathogen favors the Shaoyang half-exterior/half-interior, so Huangqin Tang is used. This section discusses Yangming and Shaoyang combined disease, judging favorability/unfavorability via pulse. Pulse-symptom match is favorable and easier to cure; mismatch is unfavorable and harder to treat. "Inevitable diarrhea" implies Spleen deficiency and interior cold, warranting Lizhong Tang to warm the interior. Zheng said: "If there is food, purgation is possible; if no food, it is absolutely impossible." Even with retained food, a warming purgation method should be used, such as Fuzi Lizhong Tang added with Sharen (Amomi Fructus), Jinneijin (Galli Gigerii Endothelium Corneum), and Dahuang (Rhei Radix et Rhizoma), stopping as soon as the illness responds. How could one use the harsh purgative Dachengqi Tang for diarrhea?
Eight. San Yang (Three Yang) combined disease① presents with a floating and large pulse, [extending] to the Guan position②, somnolence (desire to sleep), and sweating upon closing the eyes. Original Text 268
① San Yang combined disease: Simultaneous onset of Taiyang, Shaoyang, and Yangming meridians.
② Extending to Guan: The pulse is long and large, extending from the Guan position to the Cun position.
Zheng Qin'an's Commentary: In simultaneous disease of the Three Yang, yang pathogens are abundant. A floating and large pulse at the Guan position indicates blazing stomach pathogen heat. Somnolence results from severe heat causing mental confusion. Sweating upon closing the eyes is a sign of interior heat. However, detailed differentiation is essential, as虚实 (deficiency and excess) changes are complex and hard to predict. Some cases named "Three Yang" are not true Three Yang diseases. This discussion applies specifically to true Three Yang diseases. If the heat originates internally and moves outward, resembling Three Yang symptoms, I have verified this carefully. But if the patient has a tongue without coating and moist, and no thirst, I do not treat it according to Three Yang methods but focus solely on restoring yang (Hui Yang). This approach has proven effective repeatedly.
[Explanation] Diseases of the Three Yang are all heat syndromes. In San Yang combined disease, pathogenic heat is particularly intense. High fever causes mental confusion and desire to sleep, with aversion to heat rather than cold. This is clearly distinct from Shaoyin cold injury, where patients desire sleep, feel cold, and have a deep, fine, and weak pulse. Sweating upon closing the eyes occurs because extreme yang heat fails to allow yin to remain within. Zheng stated: "If heat originates internally and moves outward, resembling Three Yang symptoms... but the tongue is coating-less and moist, and there is no thirst, I do not treat it according to Three Yang methods but focus solely on restoring yang." Zheng teaches careful differentiation. Although no specific formula is listed, the treatment generally involves large doses of Hui Yang formulas like Sini Tang (Frigid Extremities Decoction) or Baitong Tang (White Pass Decoction).
Nine. San Yang combined disease presents with abdominal fullness, heavy body, difficulty turning over, insensitivity of the mouth③, greasy facial appearance④, delirium (Chan Yu), and urinary incontinence. If sweating is induced, delirium worsens; if purgation is used, sweat appears on the forehead, and extremities become cold. If there is spontaneous sweating, Baihu Tang (White Tiger Decoction) should be administered. Original Text 219
③ Insensitivity of the mouth: Difficulty speaking, loss of taste sensation.
④ Greasy facial appearance: Oily and dirty complexion.
Zheng Qin'an's Commentary: True San Yang combined disease must have substantial evidence of the Three Yang. The symptoms described here are predominantly yin (eighteen parts yin). Only abdominal fullness and delirium resemble Yangming. Why differentiate carefully? Yang governs lightness of body; Yin governs heaviness. Yang governs opening; Yin governs closing. Insensitivity of the mouth is yin. Heavy body and difficulty turning are yin. Greasy face and urinary incontinence indicate Kidney qi failing to grasp, which is yin. If it were truly Taiyang exterior pathogen, sweating would resolve it, leading to abdominal fullness and delirium? If it were truly Yangming interior excess, purgation would resolve it, leading to forehead sweat and cold extremities? Scholars must carefully examine tongue moisture/dryness, breath roughness, thirst preference (cold/hot drinks), and bowel/bladder function before inducing sweat or purging. Then the truth/falsehood of San Yang combined disease will become clear. The pathological phenomena described in the original text are highly questionable, hence the detailed differentiation.
[Explanation] Zheng’s detailed differentiation of yin and yang syndromes serves as a standard for students. I follow his lead without adding redundant comments.
Shanghan Bingbing (Consecutive Disease)
Four Methods (Based on Shu Ben edition supplements)
One. Er Yang (Two Yang) consecutive disease①: When Taiyang disease is first contracted, sweating is induced. If the sweat is initially incomplete, the condition may transform to Yangming, continuing with slight sweating and no aversion to cold. If Taiyang symptoms persist, purgation is contraindicated; doing so is incorrect. In such cases, mild sweating may be induced. If the face is persistently red②, it indicates yang qi [stagnant/depressed] in the exterior③, requiring resolution via sweating or fumigation. If [induced] sweat is incomplete, it is insufficient to claim yang qi [stagnant/depressed] cannot escape④. When sweating should occur but does not, the patient becomes [restless/agitated], unaware of pain location, with pain shifting between abdomen and limbs, unpressable. The patient suffers from shortness of breath and can only sit, due to incomplete sweating [cause]. Re-inducing sweating leads to recovery. How to know sweat was incomplete? Through a choppy (Se) pulse. Original Text 48
① Bingbing (Consecutive Disease): When symptoms of one meridian persist while symptoms of another meridian appear.
② Yuan Yuan: Continuous/uninterrupted.
③ Fu Yu: Depressed/stagnant here.
④ Yue: Emerge/disperse.
Zheng Qin'an's Commentary: Initially, Taiyang disease gradually loses aversion to cold and shows only heat signs when transforming to Yangming. If sweat resolves the disease without fever, it is not transformation to Yangming. Even if transformed to Yangming, if Taiyang symptoms persist and the Stomach is not solid, blind purgation is forbidden; purging is incorrect. "Mild sweating" refers to cases where Taiyang symptoms persist and interior pathogens have not yet solidified. Facial redness indicates internal heat stagnation, falling under the category of exterior-releasing or fumigation treatments. If sweat is incomplete, facial redness alone does not constitute "stagnant yang qi unable to escape." When sweating is indicated but withheld, agitation results from heat attacking the interior. Pain shifting locations is due to incomplete sweating and unsmooth interior qi. How to know sweat is incomplete? Via choppy pulse. I often say choppy pulse indicates blood deficiency. Using choppy pulse to define incomplete sweating is somewhat forced. Whether sweat is complete depends on the strength of righteous qi (Zheng Qi). Strong righteous qi expels pathogens completely, preventing incomplete sweating.
[Explanation] Incomplete sweating is the main cause of Taiyang-Yangming consecutive disease. Even in consecutive disease, if exterior symptoms persist, sweating methods should be used, not purgation. All symptoms cited in the original text result from incomplete sweating. How to know? Choppy pulse. Zheng argues: "Choppy pulse indicates blood deficiency; defining incomplete sweating solely by choppy pulse is forced. Completeness of sweating depends on righteous qi strength." Choppy pulse, defined in Neijing as irregular and non-smooth, reflects impaired blood circulation. While seen in sweat retention or incomplete sweating, it is uncommon. Predicting incomplete sweating solely from pulse sluggishness is unreliable. Zheng’s critique has merit.
Two. Er Yang consecutive disease: When Taiyang symptoms cease, presenting only with tidal fever, continuous slight sweating on hands and feet, difficult defecation, and delirium, purgation leads to recovery; Dachengqi Tang is suitable. Original Text 220
Zheng Qin'an's Commentary: This section describes transmission from Taiyang to Yangming, where cold pathogen has transformed into heat. Tidal fever, delirium, hard stool, and sweating are all Yangming symptoms. Thus, Taiyang symptoms have ceased. Purging can cure this, revealing the key to medication application.
[Explanation] This is Taiyang disease consecutively involving Yangming, called Bingbing. In the previous article, Taiyang symptoms persisted, so purgation was contraindicated. Now, exterior pathogens have resolved, presenting purely as interior excess. Dachengqi Tang can be used to purge and clear interior heat. Zheng states "purging cures this."
Three. Taiyang and Shaoyang consecutive disease: Occipital stiffness/pain or dizziness/vertigo, sometimes resembling Jie Xiong (Chest Binding), epigastric stuffiness and hardness. Acupoints Dazhui (First Intervertebral Space)①, Feishu②, and Ganshu③ should be needled. Sweating is strictly contraindicated. Sweating causes delirium and wiry pulse. If delirium persists for five days, Qimen (Acupoint)④ should be needled. Original Text 142
① Dazhui First Intervertebral Space: Between spinous processes of C7 and T1 (Du Meridian).
② Feishu: Between transverse processes of T3 and T4, 1.5 cun lateral to spine (Bladder Meridian).
③ Ganshu: Between transverse processes of T9 and T10, 1.5 cun lateral to spine (Bladder Meridian).
④ Qimen: Below nipple, between costal margins (Liver Meridian).
Zheng Qin'an's Commentary: In Taiyang-Shaoyang combined disease, why are there only Taiyang symptoms and no Shaoyang symptoms? It seems inappropriate to call this consecutive disease. If dizziness belongs to Shaoyang, and Chest Binding/epigastric hardness belongs to Taiyang, why needle? Taiyang qi moves upward from lower to upper chest/abdomen. Chest Binding and epigastric stuffiness are often caused by cold-water rebellion. Standard treatment should apply; why needle and injure healthy meridians?
[Explanation] Taiyang-Shaoyang consecutive disease means Taiyang pathogen transmits to Shaoyang while Taiyang symptoms persist. There are Taiyang signs (headache, stiff neck) and Shaoyang signs (dizziness, hypochondriac fullness). As pathogen enters deeper, symptoms may resemble Jie Xiong. Neither sweating nor purging is appropriate; the original text uses acupuncture. Zheng asks: "Why needle?" How to treat properly? With Shaoyang pathogen invasion and persistent Taiyang symptoms, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) can be used. Guizhi Tang releases Taiyang pathogen; Chaihu Tang harmonizes Shaoyang, resolving dizziness. Incorrect sweating drives heat into Liver meridian, causing delirium. Following Articles 16-17 of Taiyang chapter, needling Qimen drains Liver pathogen. Removing Liver heat stops delirium.
Four. Taiyang-Shaoyang consecutive disease, incorrectly treated with purgation, resulting in Jie Xiong, epigastric hardness, incessant diarrhea, inability to take food/fluids, and mental restlessness. Original Text 150
Zheng Qin'an's Commentary: This case likely failed to release the exterior, leading to incorrect purgation. Pathogen and righteous qi struggle, binding in the epigastrium causing stuffiness/hardness. Upper obstruction prevents intake; lower weakness causes incessant diarrhea. Mental restlessness ensues. This is a critical danger. Must one not be [cautious]?
[Explanation] This is Taiyang-Shaoyang consecutive disease, incorrectly purged. Sanjiao qi obstruction blocks water passages, binding with water to form Jie Xiong, causing epigastric hardness. Righteous deficiency below causes diarrhea; pathogen rebellion above prevents fluid intake; qi binding in middle causes restlessness. This is a critical state of Jie Xiong from incorrect purgation. Zheng says: "This is the path to danger and death." Should one wait passively? I believe large-dose Hui Yang (restore yang) and grasping qi methods should be used first. Once righteous qi is sufficient, Xianxiong Tang (Depress the Chest Decoction) can attack the pathogen. After pathogen removal, tonify and regulate with warmth. This is the proper approach.
Shanghan Huaibing (Ruined Disease)
Two Methods (Based on Shu Ben edition supplements)
One. After three days of Taiyang disease, if sweating, emesis, purgation, or warm needle① therapy still fails to resolve the condition, this is Huaibing (Ruined Disease)②. Guizhi Tang is ineffective [for it]③. Observe the pulse and symptoms, determine what error occurred, and treat according to the syndrome. Original Text 16 (first part)
① Warm Needle: An acupuncture method where needles are inserted into specific points and heated with moxa to induce sweating.
② Huaibing: Disease deterioration and symptom chaos due to incorrect treatment, making standard naming impossible.
③ Not useful: Means ineffective/useless.
Zheng Qin'an's Commentary: For Taiyang syndrome, if sweating, emesis, purgation, and warm needle fail, it is due to misunderstanding the disease origin and misapplying treatments. One must investigate the specific deviation and treat flexibly. However, this is not necessarily a true "ruined" state.
[Explanation] Taiyang syndrome remains unresolved after sweating, emesis, purgation, or warm needle therapy due to improper treatment methods, leading to changed conditions known as Huaibing. Zheng said: "Investigate the deviation and treat flexibly." If sweating/warm needle caused yang collapse, presenting with faint pulse and cold body, Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite) is suitable. Emesis damaging middle qi with rebellious qi and surging pulse warrants Shengjiang Banxia Tang (Fresh Ginger and Pinellia Decoction). Purgation causing cold water sinking and incessant diarrhea with soggy/slippery pulse requires Sini and Lizhong categories. This embodies the meaning of "treat according to syndrome."
Two. [Originally] Taiyang disease unresolved, transmitting to Shaoyang: Hardness/fullness in hypochondrium, dry retching, inability to eat, alternating chills and fever. If not yet vomited or purged, and pulse is deep and tight, administer Xiao Chaihu Tang (Minor Bupleurum Decoction). If already vomited, purged, sweated, or warmed with needle, presenting with delirium, and Chaihu symptoms have ceased, this is Huaibing. Determine the error and treat accordingly. Original Text 266, 267
Zheng Qin'an's Commentary: Unresolved Taiyang pathogen should transmit to Yangming. How can it skip to Shaoyang? However, Taiyang cold-water qi may bind in hypochondriac hardness. In this sense, it can be called transmission to Shaoyang. When dry retching, anorexia, and alternating chills/fever appear, Shaoyang fundamental symptoms are complete. Without prior emesis/purgation, Xiao Chaihu Tang can harmonize. If already subjected to sweating, emesis, purgation, or warm needle, presenting with delirium without Chaihu symptoms, one might treat delirium. However, it should not be entirely labeled as Huaibing. Scholars must seek details carefully during clinical practice.
[Explanation] The first part states Taiyang unresolved transmitting to Shaoyang, possessing Shaoyang main symptoms. Although pulse is deep/tight (mismatching symptoms), prioritize symptoms over pulse. Xiao Chaihu Tang is suitable. The second part describes Shaoyang disease complications from incorrect treatment and rescue principles. Zheng said: "Do not label entirely as Huaibing; seek details carefully in clinical practice."
In summary, incorrect use of sweating, emesis, purgation, or warm needle either causes Stomach dryness or Blood heat. Stomach dryness: mild cases use Xiaochengqi Tang, moderate Tiaoweichengqi Tang, severe Dachengqi Tang. Blood heat: mild cases needle Qimen, moderate Taohé Chengqi Tang, severe Didang Tang. Treat according to syndrome.
Shanghan Tanbing (Phlegm Disease)
Three Methods (Based on Shu Ben edition supplements)