麻黃二兩半（去節）升麻一兩一分當歸一兩一分知母十八銖黃芩十八銖萎蕤十八銖（一作菖蒲）芍藥六銖天門冬六銖（去心）桂枝六銖（去皮）茯苓六銖甘草六銖（炙）白朮六銖乾薑六銖石膏六銖（碎綿裹）上十四味，以水一鬥，先煮麻黃一兩沸，去上沫，內諸藥，煮取三升，去渣，分溫三服，相去如炊三斗米頃，令盡，汗出愈。
【方解及其應用範圍】邪深入而陽內陷，故以麻黃升麻配伍可以升舉下陷之寒濕而外散之；當歸以補血；黃芩以清膽火；知母石膏以清胃熱，所以止吐膿血也；萎蕤天冬以潤肺，所以利咽喉不利也；白朮乾薑芍藥桂枝茯苓甘草，所以解水分之寒濕，增營分之熱，而通利血脈也，但令水寒去而營熱增，手足之厥冷自解矣。此方藥味較多，方組複雜，而本條是陰陽兩竭的證候，方證不符，故錄之以俟高明。
八、傷寒四五日，腹中痛，若轉氣下趨少腹者，此欲自利也。原文358
鄭論：按少陰腹痛者，寒也。其氣下趨為欲自利，此刻尚未下也，急宜溫之，庶可無害。
【闡釋】鄭氏曰：“此刻尚未下也，宜急溫之”。凡裏陽虛陰寒盛，水穀之氣不能正常運行，腹中痛，急欲作自利。筆者常用大劑四逆湯加延胡索治之，圖功於未著也。
九、傷寒本自寒下，醫複吐下之，寒（鬲）〔格〕①，更逆吐下，若食入〔口〕即吐，乾薑黃芩黃連人參湯主之。原文359
①寒格：指上熱為下寒所格，致飲食入口即吐，故稱寒格。
鄭論：按病既稱寒下，又經醫誤下吐之，寒逆更甚，食入即吐，則中宮之氣逆而又逆，寒而愈寒也明甚。此刻理應溫中、降逆、回陽。原文主以乾薑黃連黃芩人參湯，似非正論。況此證又無寒熱錯雜病情足征，何得以此方為主，恐有遺誤。
【闡釋】其人本自寒下，又誤用寒藥，條中又無熱證，純陰無陽，且又指之曰寒格。若食入口即吐，是陰寒格陽，拒食不納，如此病情，應如鄭氏所說：“溫中、降逆、回陽，原文主以乾薑黃連黃芩人參湯，似非正論”。然則如何治之，筆者認為可選用理中湯加附子、半夏，稍加黃連清胃熱可也。
乾薑黃連黃芩人參湯方（校補）
乾薑、黃連、黃芩、人參各三兩上四味，以水六升，煮取二升，去渣，分溫再服。
【方解及其應用範圍】黃連黃芩泄熱於上，則吐逆可除；乾薑溫中助陽，則下利可止；人參以補胃氣。則陰陽升降複常，而寒熱格拒自愈。藥雖四味，有溫清並用，補泄兼施之功。對上熱下寒、上下格拒，食入即吐之胃腸炎治之有效。
十、下利，脈沉而遲，其人面少赤，身有微熱，下利清穀者，必鬱冒汗出而解②，病人必微厥，所以然者，其面戴陽①，下虛故也②。
②郁冒：指眩冒昏暈，一時眼發暗黑，看不到東西。原文366
①戴陽：面部潮紅，乃寒盛於下，虛陽上浮的假熱現象。
②下虛：下焦虛寒，指微厥的原因。
鄭論：按下利清穀，脈現沉遲，其裏寒甚矣。況面戴赤，身有微熱，誠元陽外越之候也。原文以為郁冒汗出解，脈證不孚，大非確論。此證所幸者未出汗，陽尚在軀殼，可招而回，今既汗出，則陽露於外，誠死機也。既知面赤下虛，何得妄雲〔汗出而解〕？仲景當不說此。
【闡釋】鄭氏說：“原文以為鬱冒汗出而解，脈證不孚，大非確論”。蓋腎陽髮露，則面赤而為戴陽。戴陽證為裏陰盛而隔陽於上也。此時微陽僅存一線，最忌汗出，汗出而陽散矣，何得謂汗出而解也。誠不若於汗未出之際，急以通脈四逆湯挽之。
十一、下利清穀，裏寒外熱，汗出而厥者，通脈四逆湯主之。原文370
鄭論：按下利清穀，裏寒外熱，汗出而厥，此陰盛逼陽於外之候，主以通脈四逆，誠不易之法也。
【闡釋】下利清谷，是陰寒內盛；汗出而厥，是真陽外竭。此陰盛逼陽於外，虛陽欲脫的危症。與少陰前篇16條的主要證狀相同，所不同的，此為汗出，彼為面色赤，但總是虛陽欲脫的現象，所以都用通脈四逆湯。
十二、下利（而）手足厥冷，無脈者，灸之不溫，若脈不還，反微喘者，死。原文362前段
鄭論：按下利厥冷無脈，陽將盡也，灸之而溫，陽回也。灸之不溫，反見微喘者，陽將脫也，不死何待？
【闡釋】此條乃陽氣衰微欲絕，陰寒邪氣充斥內外，病情已十分危急，當此時機，用湯藥來挽救其陽，恐怕是緩不濟急，所以用灸法急救，可灸關元、氣海二穴。除用灸法以外，亦可用白通加豬膽汁以回陽救急。
十三、下利後脈絕，手足厥冷，晬時脈還③，手足溫者生，脈不還者死。原文368
③晬（zuì罪）時：一晝夜時間。
鄭論：按脈絕，手足厥冷，有時脈還，手足溫，陽尚未亡也；若脈不還，陽已盡矣，故知其必死。
【闡釋】此條乃寒中厥陰的泄瀉，非久利也。惟暴注下利，津液驟然大泄，陽氣乍脫，故手足厥冷，脈一時隱伏不見。如此危證，非大劑四逆湯不可。並可外灸關元、氣海穴，以救欲絕之陽。
十四、下利，腹脹滿，身體疼痛者，先溫其裏，乃攻其表，溫裏宜四逆湯，攻表宜桂枝湯。原文372
鄭論：按下利，腹脹滿，純是陽衰，而陰氣上逆聚於中耳。身體疼痛，乃陰邪阻滯筋脈所致，並非外感身疼可比。外感者，必有風寒病形足征，若此故知其為陰寒阻滯無疑，法宜溫裏，裏寒得溫，脹滿與身疼，亦自滅亡。原文以先溫其裏，後攻其表，溫裏以四逆湯，實屬合法，攻表以桂枝湯，殊非正論，學者宜細察之。
【闡釋】本條乃虛寒下利兼有表證的治法。鄭氏則解“身體疼痛乃陰邪阻滯筋脈所致，並非外感身疼可比，……攻表以桂枝湯，殊非正論”，是有見地的。
但服四逆湯後，如下利止，脹滿除，而身體仍然疼痛，並有頭痛、項強、脈浮等表證，則桂枝湯又為對證之方。
十五、下利清穀，不可攻表，汗出必脹滿。原文364
鄭論：按下利清穀，裏寒之極也，原文不可攻表，此是正論。
【闡釋】下利清谷是完穀不化，胃腸虛寒，裏虛之征，縱有表證，不可誤汗，嚴重者可以虛脫，故鄭氏說：“攻之豈僅汗出脹滿可患哉？”故一切腹痛嘔泄諸證，嚴戒不可發汗。
十六、傷寒下利，日十餘行，脈反實者①，死。原文369
①脈反實：實脈是長大而有力，多見於大熱大實的證候，虛證而見脈實，所以說反。
鄭論：按下利之脈，大半微細，今見脈實，是脈不合病，邪甚正虛，恐難獲效，故決其死也。
【闡釋】下利日十餘行，正氣甚虛，脈當沉微弱，今脈反實，是邪實，脈證不符，攻之不行，溫之則生燥，故決其死也。
十七、下利有，微熱而渴，脈弱者，（令）〔今〕自愈。下利，脈數而渴者，（令）〔今〕自愈，設不差，必圊膿血，以有熱故也。下利脈數，〔而）有微熱，汗出，（令）〔今〕自愈，設複緊為未解。原文360、367、361
鄭論：按下利一證，以脈象求之，脈弱而渴，裏有寒也，寒邪下泄，而津液不上潮，故口渴，有微熱者，是陰症而得陽也，故曰自愈。脈數而渴，裏有熱也，熱邪下行，熱傷津液，故口渴，邪脈相合，故曰自愈；設不差，而圊膿血，是餘熱未盡故也。至於下利脈數，有微熱汗出，是氣機鼓動，有上升之機，故不利可自愈；設脈緊，緊為寒邪，寒伏於內，故為未解。
【闡釋】本條在傷寒論中分列為三條。第一節從“下利有微熱而渴”至“今自愈”，指陰盛下利將愈的脈證；第二節從“下利”至“有熱故也”，指陽複自愈與陽複太過之便膿血證；第三節從“下利脈數”至“為未解”，指陰盛下利將愈的脈證及未解的脈象。鄭氏對此，詳為注釋，簡明扼要，故不贅述。
厥陰下篇
計十法
一、下利，寸脈反浮數，尺中（有）〔自〕澀者，必清膿血。原文363
鄭論：按寸為陽，尺為陰，寸見浮數，陽邪之征，尺見（浮）〔自〕澀，血虛之驗。清膿血者，邪氣太盛，逼血下行耳。
【闡釋】厥陰下利本屬虛寒，今脈反見浮數，是陰病轉陽的脈象。本條陽複太過，由於邪無出路，熱不得泄，以致內傷陰絡，血為熱蒸，腐化為膿，故大便膿血，亦即鄭氏所說：“清膿血者，邪氣太盛，逼血下行耳”。
二、下利，脈沉弦者，下重也①；脈大者，為未止；脈微弱數者，為欲自止，雖發熱，不死。原文365
①下重：指肛門有重滯之感。
鄭論：按下利一證，原有因寒、因熱、因濕、因膀胱失職、因中虛、因飲食、種種不一，總要認證分別陰陽實據，學者一見，自有定法，若只見一脈而論證，未免不恰。況脈只數十端，而病有千萬，何得只憑脈一端立法？仲景當不若此，定有遺誤。
【闡釋】下利一證，應如鄭氏所說：“總要認證分別陰陽實據”，對證用藥，無不立應。但僅憑一脈立說，玄渺難憑，不足為法。
三、熱利下重者，白頭翁湯主之。原文371
鄭論：按下利而曰熱，法宜清熱，不獨白頭翁湯可治，學者總宜圓通，認理為要。
【闡釋】下利而有各種熱性證狀的，稱為熱利，有別於寒利。下重則邪滯下焦，不獨白頭翁湯可治，應如鄭氏說“總宜圓通，認理為要。”
白頭翁湯（校補）
白頭翁二兩黃柏三兩黃連三兩秦皮三兩上四味，以水七升，煮取二升，去渣，溫服一升，不愈，更服一升。
【方解及其應用範圍】白頭翁清熱活血止腹痛；黃連、黃柏清濕熱，厚腸胃，瀉下焦之火；秦皮亦屬苦寒，有收澀之功。合之有清熱平肝止利之功。本方用於治療細菌性痢疾有特效；凡屬熱性下痢，無論腸炎痢疾療效都很高。
四、下利欲飲水者，以有熱故也，白頭翁湯主之。原文373
鄭論：按下利飲水，明是熱傷津液也，故以白頭翁湯清熱之劑主之。
【闡釋】此條與上條同，凡屬清熱之劑，可隨宜選用，不可執定白頭翁湯為是。
五、下利譫語者，（以）有燥屎也，宜小承氣湯（主之）。原文374
鄭論：按下利譫語一證，亦有虛實之不同，不得盡為有燥矢而用小承氣湯，但利有新久之分，譫語有虛實之異，務在臨時斟酌，于飲冷、飲熱、舌潤、舌幹、小便清、黃，如此求之則得矣。
【闡釋】用承氣湯之目的，是瀉陽明裏實，而不是瀉厥陰之熱，本證所以列入厥陰篇中，一方面因為下利的辨證，連類而及，一方面因為病變源于厥陰，實際上病仍屬陽明。今下利而見譫語，主有燥屎，則下利為熱結旁流，譫語為裏有實熱。裏有實熱，用小承氣湯下其實熱，則下利自止。故鄭氏：“利有新、久之別，譫語亦有虛、實之異。”則治陽虛者，急當回陽止泄，以固其脫；若陰虛者，自當急下存陰”，斯為得矣。
六、下利（後）更煩，按之心下濡者，為虛煩也，宜梔子（豆）豉湯。原文375
鄭論：按下利過甚，中氣驟傷，陰陽不交，故見虛煩，用藥宜慎，不可執一梔豉湯，為不可易，當細辨之。
【闡釋】此承上節而來，乃厥陰下利後虛煩之證也，與上節之燥屎實邪迥別。與太陽汗、吐、下後，心中懊憹，虛煩不得眠；以及陽明下早，以致虛煩的機轉是一致的。故用梔豉湯以上清包絡胸膈之餘熱，下啟腎臟寒水之陰津，則正氣複而煩自去也。
七、嘔而發熱者，小柴胡湯主之。原文379
鄭論：按嘔（而發熱，但嘔）有寒嘔、熱嘔之不同；發熱有外入、內出之各別，不得統以小柴胡湯論，當辨明為是。
【闡釋】關於嘔而發熱，鄭氏曰：“不得統以小柴胡湯論”，是正確的。如選用柴胡湯，必兼口苦、咽幹、目眩、胸脅苦滿等證，方為合法。
八、嘔而脈弱，小便複利，身有微熱，見厥者，難治，四逆湯主之。原文377
鄭論：按嘔而脈弱，虛寒上逆也；小便複利，身有微熱，真陽有外亡之機也；更加以厥，陰盛陽微也。故為難治，此際非大劑四逆不可。
【闡釋】本條敍述陰盛陽虛，嘔逆的證治，鄭氏所按甚當。筆者再為之細析，胃中虛寒，則嘔而脈弱；下焦虛寒，故小便自利；陽氣浮於外，故身有微熱；陰寒據於裏，故手足見厥。若陰盛格陽，陽氣將脫，此乃危候，故雲“難治”。“難治”並非不治，可用大劑四逆湯溫經回陽以救之。
九、幹嘔，吐涎沫①，頭痛者，吳茱萸湯主之。原文378
①吐涎沫：指味出清稀涎沫。
鄭論：按嘔吐涎沫，而巔頂痛者，則是厥陰頭痛無疑，何也？厥陰脈會頂巔故也。條內只言一頭痛，夫頭痛六經皆有，不將巔頂指出，則厥陰之證，尚屬含糊，主以吳茱萸湯，一定不易之法。
【方解及其應用範圍】邪氣深入導致陽氣內陷，因此使用麻黃與升麻配伍，可以升舉下陷的寒濕之氣並向外散發；當歸用來補血；黃芩用來清瀉膽火；知母和石膏用來清胃熱，從而止住吐膿血的症狀；萎蕤和天冬用來潤肺，以緩解咽喉不利的症狀；白朮、乾薑、芍藥、桂枝、茯苓、甘草，用來解除水飲寒濕，增加營分的熱氣，並通利血脈。只要使水寒之氣去除而營分熱氣增長，手足厥冷的症狀自然就會解除。這個方劑藥物較多，組方複雜，而本條所述是陰陽兩竭的證候，方劑與證候不符，因此錄入此方以等待高明之士評析。
八、傷寒病四五日後，腹部疼痛，如果有腸鳴氣轉向下趨向小腹的情況，這是即將發生自發性腹瀉的徵兆。原文第358條
鄭氏評論：按少陰病腹痛，屬於寒證。氣機下趨表示即將腹瀉，此時還沒有真正腹瀉，應急用溫法治療，這樣纔不會造成危害。
【闡釋】鄭氏說：“此時還沒有腹瀉，應該急用溫法。”凡是裏陽虛弱、陰寒盛行的情況，水穀之氣不能正常運行，出現腹痛，急欲腹瀉。筆者常用大劑量的四逆湯加延胡索來治療，旨在未病先防，圖功於未然。
九、傷寒病患者本來就有虛寒腹瀉，醫生又錯誤地使用催吐或攻下的方法，導致寒格（上熱下寒相互格拒），更加重了嘔吐和下利的逆亂，如果食物吃進去就立刻吐出，應用乾薑黃連黃芩人參湯主治。原文第359條
①寒格：指上部的熱被下部的寒所格拒，導致飲食入口即吐，所以稱為寒格。
鄭氏評論：按病情既稱虛寒腹瀉，又經過醫生誤用攻下和催吐，寒逆更加嚴重，食入即吐，說明中焦脾胃之氣逆而又逆，寒上加寒是非常明顯的。此時理應溫中、降逆、回陽。原文主用乾薑黃連黃芩人參湯，似乎不是正確的論斷。況且此證也沒有寒熱錯雜病情的充分證據，怎能以此方為主治？恐怕會有遺漏誤治。
【闡釋】其人本來就是虛寒腹瀉，又誤用寒涼藥物，條文中也沒有熱證表現，純屬陰寒無陽，並且明確指出是寒格。如果食物入口即吐，這是陰寒格拒陽氣，拒絕食物納受。如此病情，應該像鄭氏所說：“溫中、降逆、回陽”。原文主用乾薑黃連黃芩人參湯，似乎不是正確的論斷。那麼如何治療呢？筆者認為可選用理中湯加附子、半夏，稍加黃連清胃熱即可。
乾薑黃連黃芩人參湯方（校補）
乾薑、黃連、黃芩、人參各三兩。以上四味藥，用水六升，煮取二升，去渣，分兩次溫服。
【方解及其應用範圍】黃連、黃芩在上部泄熱，則嘔逆可除；乾薑溫中助陽，則下利可止；人參用來補益胃氣。這樣陰陽升降恢復正常，寒熱格拒的症狀自然癒合。藥物雖只有四味，但有溫清並用、補瀉兼施的功效。對於上熱下寒、上下格拒、食入即吐的胃腸炎治療有效。
十、腹瀉，脈象沉而遲，病人面部微紅，身體有微熱，下利完穀不化的，必然會出現鬱冒（眩暈昏蒙）並出汗而解脫②，病人一定會有輕微的四肢厥冷，之所以這樣，是因為面部戴陽①，下焦虛寒的缘故②。
②郁冒：指眩暈昏蒙，一時眼前發黑，看不到東西。原文第366條
①戴陽：面部潮紅，乃下焦寒盛，虛陽上浮的假熱現象。
②下虛：下焦虛寒，指四肢微厥的原因。
鄭氏評論：按腹瀉完穀不化，脈現沉遲，裏寒非常嚴重。況且面戴紅色，身體有微熱，這確實是元陽外越的徵候。原文認為會通過鬱冒出汗而解脫，脈證不符，這不是確切的論斷。此證幸運的是還沒有出汗，陽氣還在體內，可以招引回來，現在既然已經出汗，則陽氣暴露於外，確實是死症。既然知道面赤是下虛，為何妄言“出汗而解”？仲景不應這樣說。
【闡釋】鄭氏說：“原文認為鬱冒出汗而解，脈證不符，這不是確切的論斷。”因為腎陽髮露，則面赤而為戴陽。戴陽證是裏陰盛而隔絕陽氣於上。此時微弱的陽氣僅存一線，最忌諱出汗，出汗則陽氣散失，怎麼能說出汗而解呢？誠然不如在汗未出之際，急用通脈四逆湯挽回陽氣。
十一、腹瀉完穀不化，裏寒外熱，出汗且四肢厥冷的，用通脈四逆湯主治。原文第370條
鄭氏評論：按腹瀉完穀不化，裏寒外熱，出汗且四肢厥冷，這是陰盛逼迫陽氣外越的徵候，主用通脈四逆湯，確實是不變的法則。
【闡釋】下利完谷，是陰寒內盛；出汗且厥冷，是真陽外竭。這是陰盛逼迫陽氣於外，虛陽欲脫的危重症。與少陰篇前文第16條的主要證狀相同，不同的是，此處是出汗，彼處是面色赤，但總是虛陽欲脫的現象，所以都用通脈四逆湯。
十二、腹瀉且手足厥冷，沒有脈搏的，用灸法治療後如果不溫暖，如果脈搏不恢復，反而出現微喘的，預後不良（死）。原文第362條前段
鄭氏評論：按腹瀉、厥冷、無脈，陽氣將盡。灸後如果溫暖，是陽氣回復。灸後如果不溫暖，反而見微喘，是陽氣將脫，不死還等什麼？
【闡釋】此條乃是陽氣衰微欲絕，陰寒邪氣充斥內外，病情已十分危急。在此時機，用湯藥來挽救其陽，恐怕是緩不濟急，所以用灸法急救，可灸關元、氣海兩個穴位。除了用灸法以外，也可以用白通加豬膽汁湯來回陽救急。
十三、腹瀉後脈搏消失，手足厥冷，經過一晝夜時間脈搏恢復③，手足溫暖的有生機，脈搏不恢復的預後不良（死）。原文第368條
③晬（zuì罪）時：一晝夜時間。
鄭氏評論：按脈搏消失，手足厥冷，有時脈搏恢復，手足溫暖，陽氣尚未亡失；若脈搏不恢復，陽氣已盡，所以知道必死。
【闡釋】此條乃是寒邪中於厥陰的暴注下利，不是久瀉。由於暴注下利，津液驟然大泄，陽氣乍脫，所以手足厥冷，脈搏一時隱伏不見。如此危證，非大劑量四逆湯不可。並可外用灸法灸關元、氣海穴，以救欲絕之陽氣。
十四、腹瀉，腹脹滿，身體疼痛的，先溫其裏，然後攻其表。溫裏宜用四逆湯，攻表宜用桂枝湯。原文第372條
鄭氏評論：按腹瀉、腹脹滿，純是陽氣衰微，而陰氣上逆聚於中焦。身體疼痛，是陰邪阻滯筋脈所致，並非外感引起的身疼可比。外感病，必有風寒病形的充分證據，若此證故知其為陰寒阻滯無疑，治法宜溫裏。裏寒得溫，脹滿與身疼，也會自行消除。原文主張先溫其裏，後攻其表，溫裏以四逆湯，確實合法，但攻表以桂枝湯，殊非正確論斷，學者應仔細考察。
【闡釋】本條乃是虛寒腹瀉兼有表證的治法。鄭氏則解釋“身體疼痛乃陰邪阻滯筋脈所致，並非外感身疼可比，……攻表以桂枝湯，殊非正論”，是有見地的。
但是服用四逆湯後，如果腹瀉停止，脹滿消除，而身體仍然疼痛，並有頭痛、項強、脈浮等表證，則桂枝湯又是對證的方劑。
十五、腹瀉完穀不化，不可攻表，發汗必然導致腹脹滿。原文第364條
鄭氏評論：按腹瀉完穀不化，是裏寒極度嚴重，原文說不可攻表，這是正確的論斷。
攻表必然導致出汗脹滿，這是教導人們不可妄用攻法。攻表豈僅導致出汗脹滿這種禍患嗎？
【闡釋】下利完谷是完穀不化，胃腸虛寒，裏虛的徵象，縱然有表證，不可誤用發汗，嚴重者可以導致虛脫，所以鄭氏說：“攻表豈僅導致出汗脹滿這種禍患？”因此一切腹痛嘔泄諸證，嚴禁發汗。
十六、傷寒腹瀉，一天十多次，脈象反而實有力的①，預後不良（死）。原文第369條
①脈反實：實脈是長大而有力，多見於大熱大實的證候，虛證而見脈實，所以說反。
鄭氏評論：按腹瀉的脈象，多半是微細的，現在見脈實，是脈不合病，邪氣甚盛正氣虛弱，恐怕難獲效，所以判斷為死證。
【闡釋】腹瀉一天十多次，正氣非常虛弱，脈應當沉微弱，現在脈反而實，是邪氣實，脈證不符，攻之不行，溫之則生燥，所以判斷為死證。
十七、腹瀉，有微熱而口渴，脈弱的，（令）〔今〕自愈。腹瀉，脈數而口渴的，（令）〔今〕自愈，設若不愈，必然排膿血，因為有熱的缘故。腹瀉脈數，〔而）有微熱，出汗，（令）〔今〕自愈，設若脈緊為未解。原文第360、367、361條
鄭氏評論：按腹瀉一證，從脈象推求，脈弱而渴，裏有寒也，寒邪下泄，而津液不上潮，所以口渴，有微熱者，是陰症而得陽氣，所以說自愈。脈數而渴，裏有熱也，熱邪下行，熱傷津液，所以口渴，邪脈相合，所以說自愈；設若不愈，而排膿血，是餘熱未盡的缘故。至於腹瀉脈數，有微熱出汗，是氣機鼓動，有上升之機，所以腹瀉可自愈；設若脈緊，緊為寒邪，寒伏於內，所以為未解。
【闡釋】本條在《傷寒論》中分列為三條。第一節從“腹瀉有微熱而渴”至“今自愈”，指陰盛腹瀉將愈的脈證；第二節從“腹瀉”至“有熱缘故也”，指陽氣回復自愈與陽氣回復太過之便膿血證；第三節從“腹瀉脈數”至“為未解”，指陰盛腹瀉將愈的脈證及未解的脈象。鄭氏對此，詳細注釋，簡明扼要，故不再贅述。
厥陰下篇
計十法
一、腹瀉，寸脈反而浮數，尺中（有）〔自〕澀的，必然排膿血。原文第363條
鄭氏評論：按寸為陽，尺為陰，寸見浮數，是陽邪的徵征，尺見（浮）〔自〕澀，是血虛的驗證。排膿血者，邪氣太盛，逼迫血液下行耳。
【闡釋】厥陰腹瀉本屬虛寒，現在脈反而見浮數，是陰病轉陽的脈象。本條陽氣回復太過，由於邪氣無出路，熱不得泄，以致內傷陰絡，血為熱蒸，腐化為膿，所以大便膿血，亦即鄭氏所說：“排膿血者，邪氣太盛，逼迫血液下行耳”。
二、腹瀉，脈沉弦的，有肛門重滯感①；脈大的，為病未止；脈微弱數的，為病欲自止，雖發熱，不致死。原文第365條
①下重：指肛門有重滯之感。
鄭氏評論：按腹瀉一證，原有因寒、因熱、因濕、因膀胱失職、因中虛、因飲食，種種不一，總要認證分別陰陽實據，學者一見，自有定法，若只見一脈而論證，未免不恰。況脈只數十端，而病有千萬，何得只憑脈一端立法？仲景不應如此，定有遺誤。
【闡釋】腹瀉一證，應如鄭氏所說：“總要認證分別陰陽實據”，對證用藥，無不立應。但僅憑一脈立說，玄渺難憑，不足為法。
三、熱利伴有肛門重滯感的，用白頭翁湯主治。原文第371條
鄭氏評論：按腹瀉而曰熱，治法宜清熱，不獨白頭翁湯可治，學者總宜圓通，認理為要。
【闡釋】腹瀉而有各種熱性證狀的，稱為熱利，有別於寒利。下重則邪滯下焦，不獨白頭翁湯可治，應如鄭氏說“總宜圓通，認理為要。”
白頭翁湯（校補）
白頭翁二兩黃柏三兩黃連三兩秦皮三兩。以上四味藥，用水七升，煮取二升，去渣，溫服一升，不愈，再服一升。
【方解及其應用範圍】白頭翁清熱活血止腹痛；黃連、黃柏清濕熱，厚腸胃，瀉下焦之火；秦皮亦屬苦寒，有收澀之功。合之有清熱平肝止利之功。本方用於治療細菌性痢疾有特效；凡屬熱性下痢，無論腸炎痢疾療效都很高。
四、腹瀉想喝水的，因為有熱的缘故，用白頭翁湯主治。原文第373條
鄭氏評論：按腹瀉飲水，明是熱傷津液也，故以白頭翁湯清熱之劑主之。
【闡釋】此條與上條同，凡屬清熱之劑，可隨宜選用，不可執定白頭翁湯為是。
五、腹瀉說胡話的，（以）有燥屎也，宜用小承氣湯（主之）。原文第374條
鄭氏評論：按腹瀉說胡話一證，亦有虛實之不同，不得盡為有燥矢而用小承氣湯，但利有新久之分，譫語有虛實之異，務在臨時斟酌，于飲冷、飲熱、舌潤、舌幹、小便清、黃，如此求之則得矣。
【闡釋】用承氣湯的目的，是瀉陽明裏實，而不是瀉厥陰之熱，本證所以列入厥陰篇中，一方面因為腹瀉的辨證，連類而及，一方面因為病變源于厥陰，實際上病仍屬陽明。今腹瀉而見說胡話，主有燥屎，則腹瀉為熱結旁流，說胡話為裏有實熱。裏有實熱，用小承氣湯下其實熱，則腹瀉自止。故鄭氏說：“利有新、久之別，譫語亦有虛、實之異。”則治陽虛者，急當回陽止泄，以固其脫；若陰虛者，自當急下存陰”，斯為得矣。
六、腹瀉（後）更煩躁，按之心下濡軟的，為虛煩也，宜用梔子（豆）豉湯。原文第375條
鄭氏評論：按腹瀉過甚，中氣驟傷，陰陽不交，故見虛煩，用藥宜慎，不可執一梔豉湯，為不可易，當細辨之。
【闡釋】此承上節而來，乃厥陰腹瀉後虛煩之證也，與上節之燥屎實邪迥別。與太陽病汗、吐、下後，心中懊憹，虛煩不得眠；以及陽明病下早，以致虛煩的機轉是一致的。故用梔豉湯以上清包絡胸膈之餘熱，下啟腎臟寒水之陰津，則正氣複而煩自去也。
七、嘔吐且發熱的，用小柴胡湯主治。原文第379條
鄭氏評論：按嘔（而發熱，但嘔）有寒嘔、熱嘔之不同；發熱有外入、內出之各別，不得統以小柴胡湯論，當辨明為是。
【闡釋】關於嘔而發熱，鄭氏曰：“不得統以小柴胡湯論”，是正確的。如選用柴胡湯，必兼口苦、咽幹、目眩、胸脅苦滿等證，方為合法。
八、嘔吐且脈弱，小便又利，身體有微熱，見四肢厥冷的，難治，用四逆湯主治。原文第377條
鄭氏評論：按嘔吐且脈弱，虛寒上逆也；小便又利，身體有微熱，真陽有外亡之機也；更加以厥，陰盛陽微也。故為難治，此際非大劑四逆不可。
【闡釋】本條敍述陰盛陽虛，嘔逆的證治，鄭氏所按甚當。筆者再為之細析，胃中虛寒，則嘔吐且脈弱；下焦虛寒，故小便自利；陽氣浮於外，故身體有微熱；陰寒據於裏，故手足見厥。若陰盛格陽，陽氣將脫，此乃危候，故雲“難治”。“難治”並非不治，可用大劑四逆湯溫經回陽以救之。
九、幹嘔，吐涎沫①，頭痛的，用吳茱萸湯主治。原文第378條
①吐涎沫：指味出清稀涎沫。
鄭氏評論：按嘔吐涎沫，而巔頂痛者，則是厥陰頭痛無疑，何也？厥陰脈會頂巔故也。條內只言一頭痛，夫頭痛六經皆有，不將巔頂指出，則厥陰之證，尚屬含糊，主以吳茱萸湯，一定不易之法。
[Formula Analysis and Scope of Application] Pathogenic factors have penetrated deeply, causing Yang Qi to sink inward. Therefore, the combination of Mahuang (Ephedrae Herba) and Shengma (Cimicifugae Rhizoma) can lift the sinking cold-dampness and disperse it outward; Danggui (Angelicae Sinensis Radix) is used to nourish Blood; Huangqin (Scutellariae Radix) clears Gallbladder Fire; Zhimu (Anemarrhenae Rhizoma) and Shigao (Gypsum Fibrosum) clear Stomach Heat, thereby stopping the vomiting of pus and blood; Weiyu (Polygonati Odorati Rhizoma) and Tiantong (Asparagi Radix) moisten the Lungs to relieve throat discomfort; Baizhu (Atractylodis Macrocephalae Rhizoma), Ganjiang (Zingiberis Rhizoma), Shaoyao (Paeoniae Radix Alba), Guizhi (Cinnamomi Ramulus), Fuling (Poria), and Zhigancao (Glycyrrhizae Radix et Rhizoma Preparata) resolve water-retention and cold-dampness, increase heat in the Ying (Nutrient) level, and unblock the blood vessels. As long as the cold-dampness is removed and the heat in the Ying level increases, the cold limbs will naturally resolve. This formula contains many herbs and has a complex composition. The syndrome described in this clause represents exhaustion of both Yin and Yang, so the formula does not match the syndrome. It is recorded here for evaluation by experts.
8. After four or five days of Cold Damage, if there is abdominal pain and peristalsis moving downward toward the lower abdomen, this indicates impending spontaneous diarrhea. Original Text 358
Commentary by Zheng: Abdominal pain in Shaoyin disease is due to Cold. The downward movement of Qi indicates impending diarrhea. Since diarrhea has not yet occurred, warming treatment should be applied urgently to prevent harm.
[Interpretation] Zheng stated: "Since diarrhea has not yet occurred, urgent warming is required." In cases of deficiency of Interior Yang and excess of Yin-Cold, the Qi of food and fluids cannot circulate normally, leading to abdominal pain and imminent diarrhea. The author often treats this with a large dose of Sini Tang (Frigid Extremity Decoction) plus Yanhusuo (Corydalis Rhizoma) to act before the condition manifests fully.
9. In a patient with Cold Damage who originally had cold-type diarrhea, if the physician incorrectly uses emesis or purgation, it leads to Cold-Ge (mutual rejection of upper Heat and lower Cold), exacerbating the rebellious vomiting and purging. If food is vomited immediately upon ingestion, Qiangjiang Huanglian Huangqin Renshen Tang (Dry Ginger, Coptis, Scutellaria, and Ginseng Decoction) should be administered. Original Text 359
① Cold-Ge: Refers to the mutual rejection where upper Heat is blocked by lower Cold, causing food to be vomited immediately upon entry.
Commentary by Zheng: Given that the disease is cold-type diarrhea and has been mistreated with purgation and emesis, the rebellious Cold is even more severe. Immediate vomiting after eating indicates that the Qi of the Middle Jiao is rebellious upon rebellious, becoming colder upon colder. At this stage, warming the Middle, directing rebellious Qi downward, and restoring Yang are indicated. The original text's use of Qiangjiang Huanglian Huangqin Renshen Tang seems incorrect. Moreover, there is no sufficient evidence of mixed Cold and Heat in this syndrome. Using this formula as the primary treatment may lead to errors.
[Interpretation] The patient originally suffered from cold-type diarrhea and was mistakenly treated with cold-natured drugs. There are no signs of Heat in the text; it is purely Yin-Cold without Yang, explicitly termed Cold-Ge. Immediate vomiting of ingested food indicates Yin-Cold rejecting Yang and refusing to accept food. Such a condition should be treated as Zheng suggested: "Warming the Middle, directing rebellious Qi downward, and restoring Yang." The original text's prescription of Qiangjiang Huanglian Huangqin Renshen Tang seems inappropriate. How then should it be treated? The author believes Lizhong Tang (Regulate the Middle Decoction) added with Fuzi (Aconiti Lateralis Radix Preparata) and Banxia (Pinelliae Rhizoma), with a small amount of Huanglian (Coptidis Rhizoma) to clear Stomach Heat, would be suitable.
Qiangjiang Huanglian Huangqin Renshen Tang Formula (Corrected and Supplemented)
Qiangjiang (Zingiberis Rhizoma), Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), and Renshen (Ginseng Radix et Rhizoma) each 3 liang. These four ingredients are boiled in 6 sheng of water to obtain 2 sheng. Remove the dregs and take warm in two doses.
[Formula Analysis and Scope of Application] Huanglian and Huangqin clear Heat in the Upper Jiao, resolving vomiting and rebellion; Qiangjiang warms the Middle and assists Yang, stopping diarrhea; Renshen tonifies Stomach Qi. Thus, the ascending and descending of Yin and Yang return to normal, and the mutual rejection of Cold and Heat heals spontaneously. Although only four herbs are used, the formula combines warming and clearing, tonifying and draining. It is effective for gastroenteritis characterized by upper Heat and lower Cold, mutual rejection, and immediate vomiting after eating.
10. In diarrhea with a deep and slow pulse, if the patient has a slightly red face, slight body heat, and passes undigested food, they will likely experience Yu Mao (dizziness and faintness) followed by sweating, which will lead to resolution. The patient will definitely have slight cold extremities. This is because of Dai Yang (floating Yang on the face) and deficiency in the Lower Jiao.
② Yu Mao: Dizziness and faintness, temporary blacking out of vision. Original Text 366
① Dai Yang: Facial flushing, a false heat phenomenon caused by severe Cold in the Lower Jiao forcing deficient Yang to float upward.
② Lower Deficiency: Cold-deficiency of the Lower Jiao, the cause of slight cold extremities.
Commentary by Zheng: Diarrhea with undigested food and a deep, slow pulse indicates severe Interior Cold. Furthermore, facial flushing and slight body heat are indeed signs of Yuan Yang (Primordial Yang) escaping outward. The original text's claim that resolution occurs through Yu Mao and sweating contradicts the pulse and symptoms, making it an inaccurate theory. Fortunately, the patient has not yet sweated, so Yang is still within the body and can be retrieved. Now that sweating has occurred, Yang is exposed externally, indicating a fatal prognosis. Knowing that facial redness indicates Lower Deficiency, how can one rashously claim "resolution through sweating"? Zhang Zhongjing would not say this.
[Interpretation] Zheng stated: "The original text's claim of resolution through Yu Mao and sweating contradicts the pulse and symptoms, making it an inaccurate theory." When Kidney Yang is exposed, the face becomes red, resulting in Dai Yang. Dai Yang syndrome involves excess Interior Yin blocking Yang in the Upper Jiao. At this time, only a thread of weak Yang remains; sweating is strictly contraindicated as it causes Yang to scatter. How can it be said that sweating leads to resolution? It is better to urgently use Tongmai Sini Tang (Pulse-Unblocking Frigid Extremity Decoction) before sweating occurs to salvage Yang.
11. In diarrhea with undigested food, Interior Cold with Exterior Heat, sweating, and cold extremities, Tongmai Sini Tang (Pulse-Unblocking Frigid Extremity Decoction) should be administered. Original Text 370
Commentary by Zheng: Diarrhea with undigested food, Interior Cold with Exterior Heat, sweating, and cold extremities indicate Yin Excess forcing Yang outward. Using Tongmai Sini Tang is indeed an unchangeable method.
[Interpretation] Diarrhea with undigested food indicates severe Interior Yin-Cold. Sweating and cold extremities indicate exhaustion of True Yang. This is a critical condition of Yin Excess forcing Yang outward and deficient Yang about to collapse. It shares main symptoms with Clause 16 in the previous Shaoyin chapter, differing only in that here there is sweating, whereas there was facial redness. Both represent the phenomenon of deficient Yang about to collapse, so Tongmai Sini Tang is used in both cases.
12. In diarrhea with cold extremities and absent pulse, if moxibustion fails to warm the body, and if the pulse does not return but instead slight panting occurs, the prognosis is fatal. Original Text 362 (first part)
Commentary by Zheng: Diarrhea, cold extremities, and absent pulse indicate that Yang Qi is nearly exhausted. If warming occurs after moxibustion, Yang has returned. If warming does not occur and slight panting appears, Yang is about to collapse. Death is inevitable.
[Interpretation] This clause describes a critical condition where Yang Qi is severely deficient and near extinction, with Yin-Cold pathogens filling the interior and exterior. At this juncture, herbal decoctions may be too slow to save Yang, so emergency moxibustion is used. Points such as Guanyuan (CV 4) and Qihai (CV 6) can be moxa-ed. Besides moxibustion, Baitong Jia Zhudanzhi Tang (White Cockscomb Plus Pig Bile Decoction) can also be used to restore Yang and rescue from crisis.
13. After diarrhea, if the pulse disappears and extremities are cold, but the pulse returns after one full day (Zui Shi) and extremities become warm, the patient lives; if the pulse does not return, the patient dies. Original Text 368
③ Zui Shi: One full day (24 hours).
Commentary by Zheng: Absent pulse and cold extremities, with subsequent pulse return and warm extremities, indicate Yang has not yet perished. If the pulse does not return, Yang is exhausted, indicating certain death.
[Interpretation] This clause refers to acute watery diarrhea due to Cold invading Jueyin, not chronic diarrhea. Acute profuse diarrhea causes sudden loss of body fluids and transient collapse of Yang, leading to cold extremities and temporarily imperceptible pulse. For such a critical condition, a large dose of Sini Tang is essential. External moxibustion on Guanyuan (CV 4) and Qihai (CV 6) can also be used to rescue the dying Yang.
14. In diarrhea with abdominal fullness and body pain, first warm the Interior, then attack the Exterior. Warming the Interior requires Sini Tang (Frigid Extremity Decoction); attacking the Exterior requires Guizhi Tang (Cinnamon Twig Decoction). Original Text 372
Commentary by Zheng: Diarrhea and abdominal fullness are purely due to Yang deficiency and counterflow of Yin Qi gathering in the Middle. Body pain is caused by Yin pathogens obstructing the sinews and vessels, distinct from external contraction body pain. External contraction must have clear signs of Wind-Cold. This case is undoubtedly Yin-Cold obstruction. The method should be warming the Interior. Once Interior Cold is warmed, fullness and body pain will subside. The original text's sequence of warming Interior then attacking Exterior, using Sini Tang for Interior and Guizhi Tang for Exterior, is legally correct for the former but questionable for the latter. Scholars should examine this carefully.
[Interpretation] This clause outlines the treatment for deficiency-cold diarrhea accompanied by Exterior syndrome. Zheng's interpretation that "body pain is caused by Yin pathogens obstructing sinews, not comparable to external contraction... using Guizhi Tang for Exterior is questionable" is insightful.
However, after taking Sini Tang, if diarrhea stops and fullness resolves but body pain persists, accompanied by headache, neck stiffness, and floating pulse (Exterior signs), then Guizhi Tang is the appropriate formula.
15. In diarrhea with undigested food, do not attack the Exterior. Sweating will inevitably cause abdominal fullness. Original Text 364
Commentary by Zheng: Diarrhea with undigested food indicates extreme Interior Cold. The original text's warning against attacking the Exterior is correct.
Attacking the Exterior will cause sweating and fullness, teaching people not to rashously purge. Does attacking the Exterior only cause sweating and fullness?
[Interpretation] Diarrhea with undigested food indicates incomplete digestion, Stomach and Intestine deficiency-cold, and Interior deficiency. Even if Exterior signs exist, mistaken sweating can lead to severe collapse. Hence Zheng stated: "Does attacking the Exterior only cause sweating and fullness?" Therefore, all conditions involving abdominal pain, vomiting, and diarrhea strictly prohibit sweating.
16. In Cold Damage with diarrhea occurring more than ten times a day, if the pulse is unexpectedly strong and forceful, the prognosis is fatal. Original Text 369
① Unexpectedly Strong Pulse: A strong, large, and forceful pulse, usually seen in excessive Heat and Excess syndromes. Seeing a strong pulse in a deficiency syndrome is termed "unexpectedly."
Commentary by Zheng: The pulse in diarrhea is mostly fine and weak. Seeing a strong pulse now means the pulse does not match the disease; pathogenic factors are severe while healthy Qi is deficient. Recovery is unlikely, hence the fatal prognosis.
[Interpretation] Diarrhea occurring more than ten times a day indicates severe deficiency of Healthy Qi; the pulse should be deep, fine, and weak. An unexpectedly strong pulse indicates Excess Pathogen. Pulse and syndrome do not match. Purging is ineffective, and warming creates dryness. Hence, the prognosis is fatal.
17. In diarrhea with slight Heat and thirst, if the pulse is weak, the patient will heal spontaneously. In diarrhea with a rapid pulse and thirst, the patient will heal spontaneously. If it does not heal, pus and blood will appear in the stool due to Heat. In diarrhea with a rapid pulse, slight Heat, and sweating, the patient will heal spontaneously. If the pulse becomes tight, the condition is unresolved. Original Texts 360, 367, 361
Commentary by Zheng: Regarding diarrhea, analyzing by pulse: weak pulse with thirst indicates Interior Cold. Cold pathogen evacuating downward prevents fluids from rising, causing thirst. Slight Heat indicates Yin syndrome acquiring Yang, hence spontaneous healing. Rapid pulse with thirst indicates Interior Heat. Heat pathogen moving downward injures fluids, causing thirst. Pathogen and pulse align, hence spontaneous healing. If it does not heal and pus/blood appear, residual Heat remains. Regarding diarrhea with rapid pulse, slight Heat, and sweating, this indicates Qi mechanism stirring with upward potential, so diarrhea heals spontaneously. If the pulse is tight, tightness indicates Cold pathogen hiding internally, so the condition is unresolved.
[Interpretation] This content is divided into three clauses in the Shanghan Lun. The first section ("diarrhea with slight Heat and thirst" to "heals spontaneously") refers to the pulse and syndrome of resolving Yin-excess diarrhea. The second section ("diarrhea" to "due to Heat") refers to spontaneous healing via Yang recovery and diarrhea with pus/blood due to excessive Yang recovery. The third section ("diarrhea with rapid pulse" to "unresolved") refers to the pulse signs of resolving Yin-excess diarrhea and unresolved pulses. Zheng's annotations are detailed and concise, so further elaboration is omitted.
Jueyin Lower Chapter
Ten Methods
1. In diarrhea, if the Cun (Inch) pulse is unexpectedly floating and rapid, and the Chi (Cubit) pulse is self-choppy, pus and blood will appear in the stool. Original Text 363
Commentary by Zheng: Cun represents Yang, Chi represents Yin. Floating and rapid at Cun indicates Yang pathogen. Choppy at Chi indicates Blood deficiency. Pus and blood in stool result from excessive pathogen forcing Blood downward.
[Interpretation] Jueyin diarrhea is inherently deficiency-cold. An unexpectedly floating and rapid pulse indicates Yin disease transforming into Yang. In this clause, Yang recovery is excessive. With no exit for the pathogen, Heat cannot vent, injuring the Yin collaterals internally. Blood steamed by Heat decomposes into pus, resulting in bloody stools. This aligns with Zheng's statement: "Pus and blood in stool result from excessive pathogen forcing Blood downward."
2. In diarrhea, if the pulse is deep and wiry, there is a sensation of heaviness in the anus; if the pulse is large, the disease has not stopped; if the pulse is weak, fine, and rapid, the disease is about to stop spontaneously. Even with fever, death will not occur. Original Text 365
① Heaviness in Anus: Sensation of weight and stagnation in the anus.
Commentary by Zheng: Diarrhea can arise from Cold, Heat, Dampness, Bladder dysfunction, Middle Jiao deficiency, or diet. One must distinguish Yin and Yang based on solid evidence. Scholars should have their own methods upon seeing the case. Judging syndrome solely by one pulse is inappropriate. There are dozens of pulse types but thousands of diseases; relying on a single pulse type for legislation is flawed. Zhang Zhongjing would not be so limited; there must be omissions or errors.
[Interpretation] For diarrhea, as Zheng said, "One must distinguish Yin and Yang based on solid evidence," prescribing according to syndrome yields immediate results. However, basing theory solely on one pulse is obscure and unreliable, insufficient as a standard.
3. In hot diarrhea with heaviness in the anus, Beitouweng Tang (Podopterum Decoction) should be administered. Original Text 371
Commentary by Zheng: Diarrhea termed "hot" requires clearing Heat. Beitouweng Tang is not the only option. Scholars should be flexible, prioritizing understanding of principles.
[Interpretation] Diarrhea presenting with various Heat signs is called Hot Diarrhea, distinct from Cold Diarrhea. Heaviness in the anus indicates pathogen stagnation in the Lower Jiao. Beitouweng Tang is not the only cure; as Zheng said, "Flexibility and understanding principles are key."
Beitouweng Tang (Corrected and Supplemented)
Beitouweng (Bertouwen Radix) 2 liang, Huangbai (Phellodendri Cortex) 3 liang, Huanglian (Coptidis Rhizoma) 3 liang, Qinpi (Fraxini Cortex) 3 liang. These four ingredients are boiled in 7 sheng of water to obtain 2 sheng. Remove dregs and take 1 sheng warm. If not healed, take another 1 sheng.
[Formula Analysis and Scope of Application] Beitouweng clears Heat, invigorates Blood, and stops abdominal pain; Huanglian and Huangbai clear Damp-Heat, strengthen intestines and stomach, and drain Lower Jiao Fire; Qinpi is also bitter-cold with astringent properties. Together, they clear Heat, calm Liver, and stop diarrhea. This formula is highly effective for bacillary dysentery and generally effective for all types of hot dysentery, including enteritis and dysentery.
4. In diarrhea with desire to drink water, due to Heat, Beitouweng Tang (Podopterum Decoction) should be administered. Original Text 373
Commentary by Zheng: Desire to drink water in diarrhea clearly indicates Heat injuring body fluids. Therefore, Beitouweng Tang, a Heat-clearing formula, is appropriate.
[Interpretation] This clause is similar to the previous one. Any Heat-clearing formula can be selected appropriately; one should not rigidly adhere to Beitouweng Tang.
5. In diarrhea with delirium, due to dry feces, Xiao Chengqi Tang (Minor Order the Qi Decoction) should be administered. Original Text 374
Commentary by Zheng: Diarrhea with delirium can be Excess or Deficiency. One cannot assume dry feces and automatically use Xiao Chengqi Tang. Diarrhea varies in newness and duration; delirium varies in Excess and Deficiency. Careful consideration is needed based on preference for cold/hot drinks, tongue moisture/dryness, and urine clarity/yellowness.
[Interpretation] The purpose of using Chengqi formulas is to drain Yangming Interior Excess, not Jueyin Heat. This syndrome is included in the Jueyin chapter partly because diarrhea differentiation is related, and partly because the pathology originates in Jueyin, though clinically it belongs to Yangming. Diarrhea with delirium suggests dry feces; thus, diarrhea is "Hot Binding with Flowing Around" (Re Jie Pang Liu), and delirium indicates Interior Excess Heat. Using Xiao Chengqi Tang to drain Interior Excess Heat will stop diarrhea. Zheng stated: "Diarrhea has new/old distinctions; delirium has Excess/Deficiency distinctions." Treating Yang deficiency requires urgent restoration of Yang to stop leakage and secure collapse; treating Yin deficiency requires urgent purging to preserve Yin. This is the correct approach.
6. In diarrhea followed by increased irritability, if pressing the epigastrium feels soft, it is Empty Irritability. Zhizi Chitang (Gardenia and Fermented Soybean Decoction) should be administered. Original Text 375
Commentary by Zheng: Severe diarrhea suddenly injures Middle Qi, disrupting Yin-Yang interaction, leading to Empty Irritability. Medication should be cautious. Do not rigidly stick to Zhizi Chitang; differentiate carefully.
[Interpretation] Following the previous section, this describes Empty Irritability after Jueyin diarrhea, distinct from the Dry Feces Excess in the previous section. It shares the same mechanism as post-sweating/vomiting/purging agitation in Taiyang or premature purging in Yangming causing Empty Irritability. Zhizi Chitang clears residual Heat from the Pericardium and Chest/Diaphragm above and启 (opens) Kidney Cold-Water Yin fluids below. Thus, Healthy Qi recovers, and irritability resolves.
7. In vomiting with fever, Xiaochaihu Tang (Minor Bupleurum Decoction) should be administered. Original Text 379
Commentary by Zheng: Vomiting can be Cold or Heat; fever can be external or internal. One cannot uniformly treat with Xiaochaihu Tang; differentiation is necessary.
[Interpretation] Regarding vomiting with fever, Zheng's statement "cannot uniformly treat with Xiaochaihu Tang" is correct. If choosing a Chaihu formula, it must be accompanied by bitter taste, dry throat, vertigo, and chest/hypochondriac fullness to be legally appropriate.
8. In vomiting with weak pulse, frequent urination, slight body heat, and cold extremities, the condition is difficult to treat. Sini Tang (Frigid Extremity Decoction) should be administered. Original Text 377
Commentary by Zheng: Vomiting with weak pulse indicates deficiency-cold counterflow. Frequent urination and slight body heat indicate risk of True Yang escaping. Combined with cold extremities, it indicates Yin Excess and Yang deficiency. Hence, it is difficult to treat, requiring a large dose of Sini Tang.
[Interpretation] This clause describes the syndrome and treatment of Yin Excess and Yang deficiency with vomiting. Zheng's analysis is accurate. To elaborate: Stomach deficiency-cold causes vomiting and weak pulse; Lower Jiao deficiency-cold causes spontaneous urination; Yang floating externally causes slight body heat; Yin-Cold residing internally causes cold extremities. If Yin Excess rejects Yang and Yang is about to collapse, it is a critical sign, hence "difficult to treat." "Difficult to treat" does not mean untreatable; a large dose of Sini Tang can warm meridians, restore Yang, and rescue the patient.
9. In dry retching, vomiting of saliva/phlegm, and headache, Wuzhuyu Tang (Evodia Decoction) should be administered. Original Text 378
① Vomiting Saliva/Phlegm: Expelling clear, thin saliva.
Commentary by Zheng: Vomiting saliva/phlegm with vertex headache is undoubtedly Jueyin headache. Why? Because the Jueyin meridian connects to the vertex. The text only mentions "headache"; headaches occur in all six meridians. Without specifying the vertex, the Jueyin syndrome remains vague. Prescribing Wuzhuyu Tang is a fixed and unchangeable method.