三十四、太陽病，桂枝證，醫反下之，利遂不止。脈促者①，表未解也；喘而汗出者，葛根黃芩黃連湯主之。原文34
①脈促：其義為脈勢急促，是陽氣被抑而求伸的現象
鄭論：按本應表解可了之病，而反下之，引邪深入，利遂不止，此刻邪陷於下，若惡風、自汗、身疼仍在者，可與桂枝加葛根湯救之，俾邪複還於表，不治利而利自止，此以葛根黃連黃芩湯，是為脈促、喘、汗，有邪熱上攻者言之，故用芩、連之苦寒以降之、止之，用葛根以升之、解之，俾表解熱退而利自愈，是亦正治法也。餘謂只據脈促、喘、汗，未見有熱形實據，而以芩、連之品，冀其止瀉，恐未必盡善。夫下利太過，中土業已大傷，此際之脈促者，正氣傷也；喘者，氣不歸元也；汗出者，亡陽之漸也。況喘促一證，有因火而喘者，必有火邪可征；有因外寒促者，亦有寒邪可驗；有因腎氣痰水上逆而致者，亦有陰象痰濕可證。虛實之間，大有分別，切切不可死守陳法，為方囿也。
【闡釋】鄭氏對此節所解，前半段與成無己等歷代往家大同小異，與葛根芩連湯散表邪，除裏熱，是為正治法也。而其精義則在“下利太過，中土業已大傷，此際之脈促者，正氣傷也；喘者，氣不歸元也；汗出者，亡陽之漸也。”此屬危證，回陽尚慮不及，而用葛根芩連湯散表邪，清裏熱耶？況喘促一症，有因火而喘者，可用白虎加人參湯治之；有因外寒束者，可用麻黃湯治之；有因腎氣痰水上逆而致者，可用真武湯治之。誠如鄭氏所說：虛實之間，大有分別，切切不可死守陳法，為方囿也。
葛根黃連黃芩湯方（校補）
葛根半斤甘草二兩（炙）黃芩三兩黃連三兩上四味，以水八升，先煮葛根，減兩升，內諸藥，煮取二升，去滓，分溫再服。
【方解及其應用範圍】本方以葛根為主藥，輕揚升發，芩、連苦寒清裏，甘草甘緩和中，善能清熱止利。至於應用：一、裏熱腹瀉，略兼表邪，可治痢證初起而發熱惡寒者。二、治不惡寒之溫熱病，為溫病辛涼輕劑。近代推廣應用治療所有的腸道感染疾患，有良好療效。
三十五、太陽病，下之〔後〕，脈促①，胸滿者，桂枝去芍藥湯主之；若微（惡）寒者〔桂枝〕去芍藥加附子湯主之。原文21、22
①脈促：即是脈搏很急促的形狀，診察時手指下感覺得脈搏的波動相當躁急。
鄭論：按太陽果屬可下，下之，俾邪從下解之法也，何致脈促胸滿？必是下傷胸中之陽，以致陰氣上逆而為胸滿脈促，亦氣機之常，理應扶中降逆，原文以桂枝去芍藥者，是取姜、桂之辛散，草、棗之補中，而慮芍藥陰邪之品以助邪，故去之，立法頗佳。若微惡寒，于湯中去芍加附子，亦是步步留神之意，煞費苦心。
【闡釋】太陽病誤下，脈促與胸滿並見，此陽氣被遏而欲伸，病邪仍有外出之勢。鄭注謂：“必是下傷胸中之陽，以致陰氣上逆而為胸滿脈促，亦氣機之常，理應扶中降逆”。筆者認為桂枝去芍藥湯不可用，扶中降逆可選用理中湯加半夏、砂仁為宜，若微惡寒者，是衛陽虛的確據，故宜前方加附子治之。
桂枝去芍藥湯方（校補）
桂枝三兩（去皮）甘草二兩（炙）生薑三兩（切）大棗十二枚（擘）上四味，以水七升，煮取三升，去滓，溫服一升。本雲桂枝湯，今去芍藥，將息如前法。
桂枝去芍藥加附子湯方（校補）
于上方內加附子一枚（炮、去皮、破八片）上五味，以水七升，煮取三升，去滓，溫服一升。本雲桂枝湯，今去芍藥加附子，將息如前法。
【方解及其應用範圍】桂枝去芍藥湯由桂枝湯去芍藥組成，方中桂枝、甘草溫通心胸之陽，生薑宣通衛陽，甘草、大棗補中益氣而滋榮陰，四味皆屬辛甘溫之品，組成專事辛甘化陽之方。去芍藥者，為其陰藥，恐益陰而減辛甘化陽之力也。胸陽得振，自能鼓邪外出，則脈促、胸滿除。加附子溫腎陽，合之成溫補心腎之劑，正可治陽虛較重，證見脈微，惡寒甚，胸滿者。上兩方可推廣用之治療陽虛感冒、胸痹、痰飲咳嗽、哮喘等證；亦可治療關節疼痛。筆者更用以治心臟病、高血壓等，亦獲得良好療效。
三十六、太陽病，下之微喘者，表未解〔故〕也。桂枝加厚朴杏子湯主〔之〕。喘家作①，桂（子）〔枝〕湯加〔厚樸〕杏（仁）〔子〕佳。原文43、18
①喘家：指素患喘病的人。
鄭論：按外邪蔽束肺氣，法宜解表，表解已，則氣順而喘自不作。此雲下之微喘，是喘因下而始見，非不下而即見，明明下傷中土，陽不勝陰，以致痰飲水濕，隨氣而上，干犯肺氣而喘證生，又非桂枝、厚樸、杏子所宜也，學者當詳辨之。餘思太陽表邪，發熱、惡寒、微喘，未經下者，此方實為妥切，若經下後，無發熱、惡寒、與脈未浮者，此方決不可施，當以扶陽降逆為要。
【闡釋】此條《傷寒論》原書作兩條，前段為43條：“太陽病，下之微喘者，表未解也”。是喘因下而始見，但發熱、惡風、頭痛等證依然，知其表證仍在未解故也。後段為18條：“喘家作，桂枝湯加厚樸、杏子佳”。此為素有喘病的人患外感，即有發熱、惡風、頭痛等證。兩者均可于解表藥中加厚樸、杏仁以下氣平喘。至鄭氏所雲：“下之微喘，明明下傷中土，陽不勝陰，以致痰飲水濕，隨氣而上，干犯肺氣而喘證生，又非桂枝厚樸杏子所宜也。”其說為不可從。
桂枝加厚朴杏子湯方（校補）
桂枝三兩（去皮）甘草二兩（炙）生薑三兩（切）芍藥三兩大棗十二枚（擘）厚樸二兩（炙、去皮）杏仁五十枚（去皮尖）上七味，以水七升，微火煮取三升，去滓，溫服一升，複取微似汗。
【方解及其應用範圍】本方由桂枝湯加厚樸、杏仁組成。桂枝湯以和榮衛解表邪，厚樸寬中下氣消痰，杏仁宣肺降氣平喘。適用於原有咳喘而又因感冒新邪者。但其見證，必具桂枝湯證如頭痛、發熱、惡風、脈浮等，兼有喘息者，方為適宜。
三十七、太陽病，下之，其脈促，不結胸者，此為欲解也。脈浮者，必結胸（也）；脈緊者，必咽痛；脈弦者，必兩脅拘急；脈細數者，頭痛未止；脈沉緊者，必欲嘔；脈沉滑者，（必）協熱利；脈浮滑者，必下血。原文140
鄭論：按既經下後，邪從下趨，裏氣既通，則表氣宜暢，病亦立解。原文以脈促不結胸為欲解，意者不結胸為內無邪滯，脈促為邪欲外出，亦近理之論。通條又何必舉某脈必現某病耶？夫脈之變化無窮，現證亦多不測，學者亦不必執脈以求病，總在臨時隨機應變為是。
【闡釋】太陽病，用下法治療，是屬誤治，但太陽病下之後，其脈促，又不結胸，此裏和而不受邪，則太陽表氣不因誤下而陷，反欲上沖，此邪在表，為欲解也。全條又通過脈診來斷病，而不結合望、聞、問三法以論病，是不恰當的。
故鄭氏曰：“夫脈之變化無窮，現證亦多不測，學者不必執脈以求病。總在臨時隨機應變為是。”斯為得矣。
三十八、太陽病不解，熱結膀胱，其人如狂①，血自下，下者愈。其外不解者，尚未可攻，當先解〔其〕外，外解已，但少腹（結急）〔急結〕者①，乃可攻之，宜桃核承氣湯。原文106
①如狂：是狂而不甚，較發狂為輕。
①少腹：臍以下腹部稱少腹，亦稱小腹。一說臍以下稱小腹臍兩旁稱少腹。
鄭論：按太陽蓄血，其人如狂，理應化氣從小便以逐瘀，此既已趨大腸，血自下，故斷其必自愈。但外邪未解者不可攻，恐攻而邪下陷也。外邪既已解，而獨見少腹急結者，是瘀尚未盡也，故可以逐瘀攻下之法施之，方不致誤。鄙意以桃仁承氣湯，乃陽明下血之方，而用之於太陽，似非正法，理當分別處究，血從大便則宜，血從小便則謬，學者宜細心求之，庶不誤人。
【闡釋】太陽病表病不解，邪熱與瘀血互結在下焦少腹部位，以致造成蓄血的證候。一是血結較淺，血被熱邪所迫，其所蓄之血，方能夠自下，邪熱亦可隨瘀血下趨而解除；一是病情較重，邪熱與瘀血相結不解，血不能自下，勢非用攻下藥不可。但表證沒有解除的，就不可先攻下，因為表裏同病，裏證實的當先解表，是傷寒治法的定例。解表可用桂枝湯；然後才針對裏熱證，處以桃核承氣湯。膀胱腑之衛為氣分，營為血分。熱入而犯氣分，氣化不行，熱與水結者，謂之犯衛分之裏，五苓散證也。熱入而犯血分，血蓄不行，熱與血結者，謂之犯營分之裏，桃核承氣湯證也。二方皆治犯本之劑，而一從前利，一從後攻，水與血主治，各不同也。故鄭氏說：“血從大便則宜，小便則謬。”可謂洞悉竅要。
桃核承氣湯方（校補）
桃仁五十個（去皮尖）大黃四兩桂枝二兩（去皮）甘草二兩（炙）芒硝二兩上五味，以水七升，煮取二升半，去滓，內芒硝，更上火微沸，下火，先食溫服五合，日三服，當微利。
【方解及其應用範圍】本方為調胃承氣湯加桃仁、桂枝，為破瘀逐血之劑。大黃之苦寒，蕩實除熱為君，芒硝之鹹寒，入血軟堅為臣；桂枝之辛溫，桃仁之辛潤，擅逐血散邪之長為使；甘草之甘，緩諸藥之勢，俾去邪而不傷正為佐也。除治少腹急結，其人如狂，小便自利的下焦蓄血證外，筆者推廣以治陽虛體質的婦女月經不調，先期作痛者有良效。近代用之不僅可治瘀血，也能治出血；不僅治下部之瘀血出血，也能治上部之瘀血出血。
三十九、太陽病六七日，表證仍在，脈微而沉，反不結胸，其人發狂者，以熱在下焦，少腹當鞕滿，小便自利者，下血乃愈。所以然者，以太陽隨經，瘀熱在（表）〔裏〕故也①，抵當湯主之。原文124
①太陽隨經，瘀熱在裏：就是太陽本經邪熱，由表入裏，並未傳入他經，但蓄于下焦血分的意思。
鄭論：按此條所現，實屬瘀熱在腑，理②應以行血之品，從腑分以逐之，方於經旨不錯，此以抵當湯治之，較前頗重一格，取一派食血之品以治之，俾瘀血去而腑分清，其病自愈。此方可為女科幹血癆對症之方也。但此方施於果係腑分有瘀血則宜，蓄血則謬；幹血則宜，血枯則謬。總在醫家細心求之，否則方不可輕試也。
②“理”：原書為“裏”
【闡釋】太陽隨經瘀熱在裏，深入下焦，與血搏結而成蓄血之證，實屬瘀熱在腑，自應以行血之品，從腑分以逐之。鄭氏曰：“此方可為女科幹血癆對症之方也。”所謂幹血癆者，多見於婦女。因五勞所傷，虛火久蒸，幹血內結，瘀滯不通，久則瘀血不去，新血難生，津血不能外榮。症見經閉不行，身體羸瘦，不思飲食，骨蒸潮熱，肌膚甲錯，面目黯黑等。繼而鄭氏又言：“此方施於果係腑分有瘀血則宜，蓄血則謬，幹血則宜，血枯則謬”。確屬經驗有得之言，殊堪寶貴。
抵當湯方（校補）
水蛭三十條（熬）虻蟲三十個（去翅足熬）桃仁二十個（去皮尖）大黃三兩（酒洗）上四味，以水五升，煮取三升，去滓，溫服一升，不下更服。
代抵當湯桃仁歸尾生地肉桂大黃芒硝穿山甲
【方解及其應用範圍】本方為行瘀逐血的峻劑，藥力猛於桃核承氣湯，方中除大黃桃仁外，更有水蛭、虻蟲，水蛭即螞蝗，虻蟲是牛馬身上之蠅也。二味食血去瘀之力，可以直入血絡。惟水蛭、虻蟲二藥，人所罕用，王肯堂《證治準繩》中，訂代抵當湯（丸）：桃仁、生地、歸尾，潤以通之；肉桂熱以動之；大黃、芒硝以推蕩之；穿山甲引之以達瘀所也。代抵當湯常用於熱與瘀血結于下焦有症瘕積聚者，以及婦人經水閉滯者，對肝脾腫大等有一定療效。
四十、太陽病身黃，脈沉結，少腹鞕，小便不利者，為無血也。小便自利，其人如狂者，血證諦也①，抵當湯主之。原文125
①諦（dì帝）：審也，證據確實的意思。
鄭論：按此條只以小便之利與不利，判血之有無也。其人少腹滿而小便不利者，是蓄尿而非蓄血也；若少腹滿而小便利，其人如狂者，蓄血之驗也。苟其人不狂，小便利而腹滿，別無所苦，則又當以寒結熱結下焦處之，分別施治，庶可言活人也。
【闡釋】本條承上條辨蓄血與蓄水證。若其人少腹滿而小便不利，是太陽腑證中之蓄尿證，治以五苓倍桂。若少腹滿而小便利，其人如狂，此非膀胱蓄水，是蓄血也，所以仍用抵當湯破瘀逐血。鄭氏曰：“苟其人不狂，小便利而腹滿，別無所苦，則下焦又有寒結熱結之分。”筆者認為寒結治以苓桂朮甘湯加附片、白蔻、砂仁；熱結可用黃連解毒湯加滑石、木通。
四十一、太陽病，小便利者，以飲水多，必心下悸②；小便少者，必苦裏急也③。原文127
②心下悸：指心下胃脘部築築而動。
③苦裏急：小便欲下不能，小腹部有急迫的感覺。
鄭論：按飲水多而小便亦多，此理之常。但既稱小便多，水以下行，又何致上逆淩心而為悸乎？必是小便少而水道不暢，上逆以淩心而為悸，與理方恰。小便不暢，裏必苦急，勢所必然。原文以飲水多，致心下悸，理亦不差，仍不若小便之多少處求之，更為恰切。或曰：太陽行身之背，水氣何得淩心？余以為淩心者，誠以太陽之氣，由下而至胸腹也。
三十四、太阳病（太阳经受邪所致的病证），出现桂枝汤证（表现为发热、汗出、恶风、脉浮缓的表虚证），医生反而使用泻下法治疗，导致腹泻不止。如果脉搏急促（指脉来数而时一止，止无定数，此处指阳气被郁而欲伸之象），说明表证仍未解除；如果伴有气喘且出汗，应当用葛根黄芩黄连汤主治。原文34
①脉促：其含义为脉势急促，是阳气被抑制而寻求伸展的现象。
郑钦安论述：按此病本应通过解表而痊愈，医生反而使用泻下法，引邪气深入体内，导致腹泻不止。此时邪气陷入下部，如果仍有恶风、自汗、身体疼痛等症状，可以使用桂枝加葛根汤来救治，使邪气重新返回体表，不直接治疗腹泻而腹泻自然停止。这里使用葛根黄芩黄连汤，是针对脉促、气喘、出汗，且有邪热上攻的情况而言的，所以用黄芩、黄连的苦寒之性来降逆清热、止利，用葛根来升提透表、解肌，使表解热退而腹泻自愈，这也是正确的治疗方法。但我认为仅凭脉促、气喘、出汗，没有看到确凿的热象证据，就指望用黄芩、黄连这类药物来止泻，恐怕未必尽善尽美。如果腹泻太过严重，脾胃中气已经大伤，此时的脉促，是正气受损的表现；气喘，是气不归元（肾不纳气）的表现；出汗，是亡阳（阳气外脱）的征兆。况且气喘这一症状，有因火邪所致的气喘，必有火邪可征验；有因外寒束肺所致的气喘，也有寒邪可验证；有因肾气虚衰、痰水上逆所致的气喘，也有阴寒痰湿的迹象可证明。虚证和实证之间，区别很大，切切不可死守旧法，被方剂所局限。
【阐释】郑氏对本条的解释，前半段与成无己等历代医家大同小异，认为葛根芩连汤能散表邪、除里热，是正确的治法。但其精义在于“腹泻太过，脾胃中气已大伤，此时的脉促，是正气受伤；气喘，是气不归元；出汗，是亡阳的开端。”这属于危重证候，回阳救急尚恐不及，怎能还用葛根芩连汤来散表邪、清里热呢？况且气喘这一症状，有因火邪所致者，可用白虎加人参汤治疗；有因外寒束肺者，可用麻黄汤治疗；有因肾气痰水上逆所致者，可用真武汤治疗。正如郑氏所说：虚实之间，大有分别，切切不可死守陈法，被方剂所局限。
葛根黄芩黄连汤方（校补）
葛根半斤 甘草二两（炙） 黄芩三两 黄连三两 以上四味药，用水八升，先煮葛根，减少两升水，再加入其他药物，煮取二升药液，去渣，分两次温服。
【方解及其应用范围】本方以葛根为主药，轻扬升发，黄芩、黄连苦寒清里，甘草甘缓和中，善于清热止利。至于应用：一、适用于里热腹泻，略兼表邪，可治疗痢疾初起而伴有发热恶寒者。二、治疗不恶寒的温热病，属于温病中的辛凉轻剂。近代推广应用治疗所有的肠道感染疾患，有良好的疗效。
三十五、太阳病，使用泻下法之后，脉搏急促，胸部胀满的，用桂枝去芍药汤主治；如果伴有轻微怕冷的，用桂枝去芍药加附子汤主治。原文21、22
①脉促：即是脉搏很急促的形状，诊察时手指下感觉得脉搏的波动相当躁急。
郑钦安论述：按太阳病果真属于可下的情况，使用泻下法，使邪气从下面排出，怎么会导致脉促胸满呢？必定是泻下损伤了胸中的阳气，以致阴气上逆而出现胸满脉促，这也是气机运行的常理，理应扶助中气、降逆气。原文使用桂枝去芍药汤，是取生姜、桂枝的辛散作用，甘草、大枣的补中作用，而担心芍药作为阴邪之品会助长邪气，所以去掉它，立法颇为佳妙。如果伴有轻微怕冷，在汤剂中去掉芍药加入附子，也是步步留神的意思，煞费苦心。
【阐释】太阳病误用下法，脉促与胸满并见，这是阳气被遏制而欲伸展，病邪仍有外出之势。郑注说：“必定是下法损伤胸中之阳，以致阴气上逆而为胸满脉促，这也是气机的常理，理应扶中降逆”。笔者认为桂枝去芍药汤不可用，扶中降逆可选用理中汤加半夏、砂仁为宜，若伴有轻微怕冷者，是卫阳虚的确切依据，故宜前方加附子治疗。
桂枝去芍药汤方（校补）
桂枝三两（去皮） 甘草二两（炙） 生姜三两（切） 大枣十二枚（掰开） 以上四味药，用水七升，煮取三升药液，去渣，温服一升。原本说是桂枝汤，现在去掉芍药，调养方法如前法。
桂枝去芍药加附子汤方（校补）
于上方内加附子一枚（炮制、去皮、破成八片） 以上五味药，用水七升，煮取三升药液，去渣，温服一升。原本说是桂枝汤，现在去掉芍药加附子，调养方法如前法。
【方解及其应用范围】桂枝去芍药汤由桂枝汤去掉芍药组成，方中桂枝、甘草温通心胸之阳，生姜宣通卫阳，甘草、大枣补中益气而滋养营阴，四味皆属辛甘温之品，组成专门从事辛甘化阳的方剂。去掉芍药的原因，是因为它是阴药，恐怕益阴会减弱辛甘化阳的力量。胸阳得以振奋，自然能鼓动邪气外出，则脉促、胸满消除。加入附子温补肾阳，合之成为温补心肾的药剂，正可治疗阳虚较重，证见脉微、恶寒甚、胸满者。上述两方可推广用于治疗阳虚感冒、胸痹、痰饮咳嗽、哮喘等证；也可治疗关节疼痛。笔者更用以治疗心脏病、高血压等，也获得良好疗效。
三十六、太阳病，使用泻下法后出现轻微气喘的，说明表证仍未解除。用桂枝加厚朴杏子汤主治。素有喘病的人发作时，用桂枝汤加厚朴、杏子较好。原文43、18
①喘家：指素患喘病的人。
郑钦安论述：按外邪闭塞束缚肺气，法宜解表，表解之后，则气顺而喘自然不作。这里说下法后出现轻微气喘，是气喘因为下法才开始出现，不是不下法就立即出现，明明是下法损伤了中土（脾胃），阳气不胜阴气，以致痰饮水湿，随气而上，干犯肺气而产生喘证，这又不是桂枝、厚朴、杏子所适宜的了，学者应当详细辨别。我认为太阳表邪，伴有发热、恶寒、微喘，未经过下法治疗的，此方确实妥切，如果经过下法治疗后，没有发热、恶寒，且脉未浮的，此方决不可施用，当以扶阳降逆为主要原则。
【阐释】此条《伤寒论》原书作两条，前段为43条：“太阳病，下之微喘者，表未解也”。是气喘因为下法才开始出现，但发热、恶风、头痛等证依然，知其表证仍在未解故也。后段为18条：“喘家作，桂枝汤加厚朴、杏子佳”。此为素有喘病的人患外感，即有发热、恶风、头痛等证。两者均可于解表药中加厚朴、杏仁以下气平喘。至郑氏所说：“下之微喘，明明下伤中土，阳不胜阴，以致痰饮水湿，随气而上，干犯肺气而喘证生，又非桂枝厚朴杏子所宜也。”其说为不可从。
桂枝加厚朴杏子汤方（校补）
桂枝三两（去皮） 甘草二两（炙） 生姜三两（切） 芍药三两 大枣十二枚（掰开） 厚朴二两（炙、去皮） 杏仁五十枚（去皮尖） 以上七味药，用水七升，微火煮取三升药液，去渣，温服一升，再服后可取得微微似汗的效果。
【方解及其应用范围】本方由桂枝汤加厚朴、杏仁组成。桂枝汤以调和营卫、解表邪，厚朴宽中下气消痰，杏仁宣肺降气平喘。适用于原有咳喘而又因感冒新邪者。但其见证，必具桂枝汤证如头痛、发热、恶风、脉浮等，兼有喘息者，方为适宜。
三十七、太阳病，使用泻下法后，脉搏急促，没有形成结胸证的，这是病情将要解除的表现。脉搏浮的，必然形成结胸；脉搏紧的，必然咽喉痛；脉搏弦的，必然两胁拘急；脉搏细数的，头痛未止；脉搏沉紧的，必然想呕吐；脉搏沉滑的，必然协热利（伴随发热的腹泻）；脉搏浮滑的，必然便血。原文140
郑钦安论述：按既然经过下法治疗后，邪气从下面趋走，里气既已通畅，则表气宜畅通，病亦立即解除。原文以脉促不结胸为欲解，意思是说不结胸为内无邪滞，脉促为邪欲外出，也是近于合理的论述。整条又何必列举某脉必然现某病呢？夫脉的变化无穷无尽，现证也多不可测，学者也不必执泥于脉以求病，总要在临时随机应变才是正确的。
【阐释】太阳病，用下法治疗，是属于误治，但太阳病下之后，其脉促，又不结胸，此里和而不受邪，则太阳表气不因误下而陷，反欲上冲，此邪在表，为欲解也。全条又通过脉诊来断病，而不结合望、闻、问三法以论病，是不恰当的。
故郑氏曰：“夫脉的变化无穷无尽，现证也多不可测，学者不必执泥于脉以求病。总要在临时随机应变才是正确的。”这才是得法的。
三十八、太阳病不解，热邪结聚在膀胱，其人出现如狂（神志恍惚，似狂非狂）的状态，血液自行下行排出的，排出后病愈。如果外部表证仍未解除，还不可以攻下，应当先解除表证，表证解除后，只有少腹拘急硬结的，才可以攻下，宜用桃核承气汤。原文106
①如狂：是狂而不甚，较发狂为轻。
①少腹：脐以下腹部称少腹，亦称小腹。一说脐以下称小腹，脐两旁称少腹。
郑钦安论述：按太阳蓄血证，其人如狂，理应化气从小便以逐瘀，此既已趋向大肠，血液自行下行，所以判断其必自愈。但外邪未解者不可攻下，恐怕攻下而邪气下陷。外邪既然已解，而独见少腹急结者，是瘀血尚未尽也，故可以用逐瘀攻下的方法施治，方不致误。我的意见是以桃仁承气汤，乃是阳明经下血的方剂，而用于太阳经，似乎不是正法，理应分别探究，血从大便排出则适宜，血从小便排出则谬误，学者宜细心求之，才不会误人。
【阐释】太阳病表病不解，邪热与瘀血互结在下焦少腹部位，以致造成蓄血的证候。一是血结较浅，血被热邪所迫，其所蓄之血，方能够自下，邪热亦可随瘀血下趋而解除；一是病情较重，邪热与瘀血相结不解，血不能自下，势非用攻下药不可。但表证没有解除的，就不可先攻下，因为表里同病，里证实的当先解表，是伤寒治法的定例。解表可用桂枝汤；然后才针对里热证，处以桃核承气汤。膀胱腑之卫为气分，营为血分。热入而犯气分，气化不行，热与水结者，谓之犯卫分之里，五苓散证也。热入而犯血分，血蓄不行，热与血结者，谓之犯营分之里，桃核承气汤证也。两方皆治犯本之剂，而一从前利，一从后攻，水与血主治，各不同也。故郑氏说：“血从大便则宜，小便则谬。”可谓洞悉窍要。
桃核承气汤方（校补）
桃仁五十个（去皮尖） 大黄四两 桂枝二两（去皮） 甘草二两（炙） 芒硝二两 以上五味药，用水七升，煮取二升半药液，去渣，加入芒硝，再次上火微沸，熄火，空腹温服五合，每日三次服，应当轻微腹泻。
【方解及其应用范围】本方为调胃承气汤加桃仁、桂枝，为破瘀逐血的药剂。大黄之苦寒，荡实除热为君，芒硝之咸寒，入血软坚为臣；桂枝之辛温，桃仁之辛润，擅逐血散邪之长为使；甘草之甘，缓诸药之势，俾去邪而不伤正为佐也。除治少腹急结，其人如狂，小便自利的下焦蓄血证外，笔者推广以治阳虚体质的妇女月经不调，先期作痛者有良效。近代用之不仅可治瘀血，也能治出血；不仅治下部之瘀血出血，也能治上部之瘀血出血。
三十九、太阳病六七日，表证仍在，脉搏微而沉，反而不结胸，其人发狂的，因为热在下焦，少腹应当硬满，小便自利的，下血乃愈。之所以这样，是因为太阳随经，瘀热在里的缘故，抵当汤主治。原文124
①太阳随经，瘀热在里：就是太阳本经邪热，由表入里，并未传入他经，但蓄于下焦血分的意思。
郑钦安论述：按此条所现，实属瘀热在腑，理应行血之品，从腑分以逐之，方于经旨不错，此以抵当汤治之，较前颇重一格，取一派食血之品以治之，俾瘀血去而腑分清，其病自愈。此方可女科干血劳对症之方也。但此方施于果系腑分有瘀血则宜，蓄血则谬；干血则宜，血枯则谬。总在医家细心求之，否则方不可轻试也。
【阐释】太阳随经瘀热在里，深入下焦，与血搏结而成蓄血之证，实属瘀热在腑，自应以行血之品，从腑分以逐之。郑氏曰：“此方可女科干血劳对症之方也。”所谓干血劳者，多见于妇女。因五劳所伤，虚火久蒸，干血内结，瘀滞不通，久则瘀血不去，新血难生，津血不能外荣。症见经闭不行，身体羸瘦，不思饮食，骨蒸潮热，肌肤甲错，面目黯黑等。继而郑氏又言：“此方施于果系腑分有瘀血则宜，蓄血则谬，干血则宜，血枯则谬”。确属经验有得之言，殊堪宝贵。
抵当汤方（校补）
水蛭三十条（熬） 虻虫三十个（去翅足熬） 桃仁二十个（去皮尖） 大黄三两（酒洗） 以上四味药，用水五升，煮取三升药液，去渣，温服一升，不下更服。
代抵当汤桃仁归尾生地肉桂大黄芒硝穿山甲
【方解及其应用范围】本方为行瘀逐血的峻剂，药力猛于桃核承气汤，方中除大黄桃仁外，更有水蛭、虻虫，水蛭即蚂蝗，虻虫是牛马身上之蝇也。二味食血去瘀之力，可以直入血络。惟水蛭、虻虫二药，人所罕用，王肯堂《证治准绳》中，订代抵当汤（丸）：桃仁、生地、归尾，润以通之；肉桂热以动之；大黄、芒硝以推荡之；穿山甲引之以达瘀所也。代抵当汤常用于热与瘀血结于下焦有症瘕积聚者，以及妇人经水闭滞者，对肝脾肿大等有一定疗效。
四十、太阳病身黄，脉沉结，少腹硬，小便不利的，为无血（瘀血）也。小便自利，其人如狂的，血证谛也（确凿的证据），抵当汤主治。原文125
①谛（dì帝）：审也，证据确实的意思。
郑钦安论述：按此条只以小便之利与不利，判血之有无也。其人少腹满而小便不利者，是蓄尿而非蓄血也；若少腹满而小便利，其人如狂者，蓄血之验也。苟其人不狂，小便利而腹满，别无所苦，则又当以寒结热结下焦处之，分别施治，庶可言活人也。
【阐释】本条承上条辨蓄血与蓄水证。若其人少腹满而小便不利，是太阳腑证中之蓄尿证，治以五苓倍桂。若少腹满而小便利，其人如狂，此非膀胱蓄水，是蓄血也，所以仍用抵当汤破瘀逐血。郑氏曰：“苟其人不狂，小便利而腹满，别无所得，则下焦又有寒结热结之分。”笔者认为寒结治以苓桂术甘汤加附片、白蔻、砂仁；热结可用黄连解毒汤加滑石、木通。
四十一、太阳病，小便利的，因为饮水多，必然心下悸（胃脘部跳动不安）；小便少的，必然苦里急（小腹部有急迫的感觉）。原文127
②心下悸：指心下胃脘部筑筑而动。
③苦里急：小便欲下不能，小腹部有急迫的感觉。
郑钦安论述：按饮水多而小便亦多，此理之常。但既称小便多，水以下行，又何致上逆凌心而为悸乎？必是小便少而水道不畅，上逆以凌心而为悸，与理方恰。小便不畅，里必苦急，势所必然。原文以饮水多，致心下悸，理亦不差，仍不若小便之多少处求之，更为恰切。或曰：太阳行身之背，水气何得凌心？余以为凌心者，诚以太阳之气，由下而至胸腹也。
34. In Taiyang disease (a syndrome caused by pathogenic factors invading the Taiyang meridian), if Gui Zhi Tang pattern (a exterior deficiency pattern characterized by fever, sweating, aversion to wind, and a floating, moderate pulse) is present, but the physician erroneously applies purgation, diarrhea will persist incessantly. If the pulse is Cu (rapid and occasionally irregular, indicating suppressed Yang qi seeking to extend), it signifies that the exterior syndrome has not yet resolved; if accompanied by wheezing and sweating, Ge Gen Huang Qin Huang Lian Tang (Kudzu Root, Scutellaria, and Coptis Decoction) should be administered. Original Text 34
① Pulse Cu: Its meaning refers to a rapid and urgent pulse momentum, which is a phenomenon of Yang qi being suppressed while attempting to extend.
Commentary by Zheng: According to this case, the disease should have been resolved through releasing the exterior, but the physician erroneously applied purgation, drawing the pathogen deep into the body and causing incessant diarrhea. At this moment, the pathogen has sunk to the lower jiao. If symptoms such as aversion to wind, spontaneous sweating, and body ache still persist, Gui Zhi Jia Ge Gen Tang (Cinnamon Twig Decoction with Added Kudzu Root) can be used to rescue the condition, allowing the pathogen to return to the exterior. The diarrhea will stop spontaneously without directly treating it. The use of Ge Gen Huang Qin Huang Lian Tang here is discussed in the context of pulse Cu, wheezing, and sweating due to pathogenic heat attacking upward. Therefore, the bitter-cold properties of Huang Qin (Scutellariae Radix) and Huang Lian (Coptidis Rhizoma) are used to descend and clear heat and stop diarrhea, while Ge Gen (Puerariae Lobatae Radix) is used to ascend and resolve the exterior, allowing the exterior to resolve and heat to retreat, thus healing the diarrhea. This is also a correct treatment method. However, I believe that relying solely on pulse Cu, wheezing, and sweating, without seeing concrete evidence of heat signs, and hoping to stop diarrhea with drugs like Huang Qin and Huang Lian, may not be entirely appropriate. If diarrhea is excessive, the middle Earth (Spleen and Stomach) has already been severely damaged. At this time, pulse Cu indicates injury to righteous Qi; wheezing indicates Qi failing to return to its root (Kidney failing to grasp Qi); sweating indicates the gradual onset of Yang collapse. Moreover, regarding the symptom of wheezing, there is wheezing caused by fire pathogen, which must have signs of fire pathogen to verify; there is wheezing caused by external cold constriction, which also has signs of cold pathogen to verify; there is wheezing caused by Kidney Qi deficiency and phlegm-fluids rushing upward, which also has signs of Yin-cold and damp-phlegm to prove. There is a significant difference between deficiency and excess patterns. One must absolutely not rigidly adhere to old methods and be confined by formulas.
[Interpretation] Zheng’s explanation of this section is largely similar to that of Cheng Wuji and other past physicians in the first half, stating that Ge Gen Huang Qin Lian Tang disperses exterior pathogens and removes interior heat, which is the correct treatment method. However, its profound significance lies in "excessive diarrhea has already severely injured the Middle Earth (Spleen/Stomach); at this moment, pulse Cu indicates injury to righteous Qi; wheezing indicates Qi failing to return to its root; sweating indicates the beginning of Yang collapse." This belongs to critical syndromes where restoring Yang is feared to be insufficient, let alone using Ge Gen Huang Qin Lian Tang to disperse exterior pathogens and clear interior heat? Furthermore, regarding the symptom of wheezing, those caused by fire pathogen can be treated with Bai Hu Jia Ren Shen Tang (White Tiger Plus Ginseng Decoction); those caused by external cold constriction can be treated with Ma Huang Tang (Ephedra Decoction); those caused by Kidney Qi and phlegm-fluids rushing upward can be treated with Zhen Wu Tang (True Warrior Decoction). As Zheng said: "There is a great difference between deficiency and excess; one must absolutely not rigidly adhere to old methods and be confined by formulas."
Ge Gen Huang Qin Huang Lian Tang Formula (Verified and Supplemented)
Ge Gen (Puerariae Lobatae Radix) - 8 liang
Gan Cao (Glycyrrhizae Radix et Rhizoma) - 2 liang (Honey-fried)
Huang Qin (Scutellariae Radix) - 3 liang
Huang Lian (Coptidis Rhizoma) - 3 liang
Take these four ingredients, add 8 sheng of water. First boil Ge Gen until the volume reduces by 2 sheng. Then add the remaining herbs. Boil to obtain 2 sheng of decoction. Remove the dregs. Divide into two warm doses.
[Formula Analysis and Scope of Application] This formula uses Ge Gen as the chief herb, which is light, ascending, and dispersing. Huang Qin and Huang Lian are bitter and cold to clear the interior. Gan Cao is sweet and neutral to harmonize the middle and is good at clearing heat and stopping diarrhea. Applications: 1. Interior heat diarrhea slightly complicated by exterior pathogen; suitable for early-stage dysentery with fever and aversion to cold. 2. Warm-heat diseases without aversion to cold; it serves as a mild acrid-cool agent for warm diseases. In modern times, it has been widely promoted for treating all kinds of intestinal infectious diseases with good efficacy.
35. After Taiyang disease is treated with purgation, if the pulse is Cu and there is chest fullness, Gui Zhi Qu Shao Yao Tang (Cinnamon Twig Decoction minus Peony) should be administered; if there is slight aversion to cold, Gui Zhi Qu Shao Yao Jia Fu Zi Tang (Cinnamon Twig Decoction minus Peony plus Aconite) should be administered. Original Texts 21, 22
① Pulse Cu: It refers to the shape of a very rapid pulse, felt as quite agitated fluctuation under the fingers during examination.
Commentary by Zheng: If Taiyang disease truly required purgation, applying purgation would allow the pathogen to exit from below. Why would it lead to pulse Cu and chest fullness? It must be that purgation injured the Yang qi in the chest, causing Yin qi to rush upward, resulting in chest fullness and pulse Cu. This is also a normal state of Qi mechanism. It should be treated by supporting the middle and descending rebellion. The original text uses Gui Zhi Qu Shao Yao Tang, taking advantage of the acrid-dispersing nature of Sheng Jiang (Zingiberis Rhizoma) and Gui Zhi (Cinnamomi Ramulus), and the middle-supporting nature of Gan Cao (Glycyrrhizae Radix et Rhizoma) and Da Zao (Jujubae Fructus), while fearing that Shao Yao (Paeoniae Radix Alba), as a Yin-pathogenic substance, might assist the pathogen, so it is removed. The legislation is quite excellent. If there is slight aversion to cold, removing Shao Yao and adding Fu Zi (Aconiti Lateralis Radix Praeparata) in the decoction shows careful step-by-step consideration and painstaking effort.
[Interpretation] When Taiyang disease is erroneously purged, and pulse Cu and chest fullness appear together, this indicates that Yang qi is restrained but seeks to extend, and the pathogen still has the tendency to exit outward. Zheng’s note says: "It must be that purgation injured the Yang qi in the chest, causing Yin qi to rush upward, resulting in chest fullness and pulse Cu, which is also a normal state of Qi mechanism; it should be treated by supporting the middle and descending rebellion." The author believes that Gui Zhi Qu Shao Yao Tang should not be used. To support the middle and descend rebellion, Li Zhong Tang (Regulate the Middle Decoction) added with Ban Xia (Pinelliae Rhizoma) and Sha Ren (Amomi Fructus) is more suitable. If there is slight aversion to cold, this is definite evidence of Wei-Yang deficiency, so adding Fu Zi to the previous formula is appropriate.
Gui Zhi Qu Shao Yao Tang Formula (Verified and Supplemented)
Gui Zhi (Cinnamomi Ramulus) - 3 liang (Bark removed)
Gan Cao (Glycyrrhizae Radix et Rhizoma) - 2 liang (Honey-fried)
Sheng Jiang (Zingiberis Rhizoma) - 3 liang (Sliced)
Da Zao (Jujubae Fructus) - 12 pieces (Split open)
Take these four ingredients, add 7 sheng of water. Boil to obtain 3 sheng of decoction. Remove the dregs. Take 1 sheng warm. Originally stated as Gui Zhi Tang, now minus Shao Yao. Rest instructions as before.
Gui Zhi Qu Shao Yao Jia Fu Zi Tang Formula (Verified and Supplemented)
Add one Fu Zi (Aconiti Lateralis Radix Praeparata) (Processed, bark removed, broken into eight pieces) to the above formula.
Take these five ingredients, add 7 sheng of water. Boil to obtain 3 sheng of decoction. Remove the dregs. Take 1 sheng warm. Originally stated as Gui Zhi Tang, now minus Shao Yao and plus Fu Zi. Rest instructions as before.
[Formula Analysis and Scope of Application] Gui Zhi Qu Shao Yao Tang is composed of Gui Zhi Tang minus Shao Yao. In the formula, Gui Zhi and Gan Cao warm and unblock the Yang of the heart and chest; Sheng Jiang disseminates and unblocks Wei-Yang; Gan Cao and Da Zao tonify the middle, benefit Qi, and nourish Ying-Yin. All four ingredients are acrid, sweet, and warm, forming a formula specifically dedicated to transforming Yang through acrid-sweet synergy. Shao Yao is removed because it is a Yin medicine, fearing that nourishing Yin would reduce the power of acrid-sweet transformation of Yang. Once Chest-Yang is revitalized, it naturally drives the pathogen outward, eliminating pulse Cu and chest fullness. Adding Fu Zi warms Kidney-Yang, combining to form a formula that warms and tonifies Heart and Kidney, suitable for treating severe Yang deficiency with symptoms such as faint pulse, severe aversion to cold, and chest fullness. The above two formulas can be extended to treat Yang-deficiency common cold, chest bi (obstruction), phlegm-fluid cough, asthma, etc.; they can also treat joint pain. The author has also used them to treat heart disease and hypertension with good results.
36. In Taiyang disease, if slight wheezing occurs after purgation, it means the exterior has not yet resolved. Gui Zhi Jia Hou Po Xing Zi Tang (Cinnamon Twig Decoction with Added Magnolia Bark and Apricot Seed) should be administered. For patients who suffer from chronic wheezing, Gui Zhi Tang (Cinnamon Twig Decoction) added with Hou Po (Magnoliae Officinalis Cortex) and Xing Zi (Armeniacae Semen Amarum) is better. Original Texts 43, 18
① Chuan Jia: Refers to people who suffer from chronic wheezing/asthma.
Commentary by Zheng: External pathogens obstructing and binding Lung Qi should be treated by releasing the exterior. Once the exterior is resolved, Qi will flow smoothly, and wheezing will cease naturally. Here, slight wheezing appears after purgation, meaning the wheezing started because of purgation, not immediately without it. Clearly, purgation injured the Middle Earth (Spleen/Stomach), causing Yang to be unable to overcome Yin, leading to phlegm-fluids and dampness rising with Qi, interfering with Lung Qi and generating wheezing. This is not suitable for Gui Zhi, Hou Po, and Xing Zi. Scholars should distinguish carefully. I think for Taiyang exterior pathogens with fever, aversion to cold, and slight wheezing, without prior purgation, this formula is indeed appropriate. However, if purgation has been performed, and there is no fever or aversion to cold, and the pulse is not floating, this formula must absolutely not be applied. The priority should be supporting Yang and descending rebellion.
[Interpretation] This section in the original *Shang Han Lun* consists of two parts. The first part is Text 43: "In Taiyang disease, slight wheezing after purgation means the exterior has not yet resolved." The wheezing appeared only after purgation, but symptoms like fever, aversion to wind, and headache remain, indicating the exterior syndrome is still unresolved. The second part is Text 18: "For patients with chronic wheezing, Gui Zhi Tang added with Hou Po and Xing Zi is better." This refers to patients with chronic wheezing contracting an external pathogen, presenting with fever, aversion to wind, headache, etc. In both cases, Hou Po and Xing Zi can be added to exterior-releasing herbs to direct Qi downward and calm wheezing. Regarding Zheng’s statement: "Slight wheezing after purgation clearly indicates injury to the Middle Earth, Yang unable to overcome Yin, leading to phlegm-fluids and dampness rising with Qi, interfering with Lung Qi and generating wheezing, which is not suitable for Gui Zhi, Hou Po, and Xing Zi," this view is unacceptable.
Gui Zhi Jia Hou Po Xing Zi Tang Formula (Verified and Supplemented)
Gui Zhi (Cinnamomi Ramulus) - 3 liang (Bark removed)
Gan Cao (Glycyrrhizae Radix et Rhizoma) - 2 liang (Honey-fried)
Sheng Jiang (Zingiberis Rhizoma) - 3 liang (Sliced)
Shao Yao (Paeoniae Radix Alba) - 3 liang
Da Zao (Jujubae Fructus) - 12 pieces (Split open)
Hou Po (Magnoliae Officinalis Cortex) - 2 liang (Honey-fried, bark removed)
Xing Zi (Armeniacae Semen Amarum) - 50 pieces (Skin and tip removed)
Take these seven ingredients, add 7 sheng of water. Boil over low heat to obtain 3 sheng of decoction. Remove the dregs. Take 1 sheng warm. Repeat dosage to induce slight sweating.
[Formula Analysis and Scope of Application] This formula is composed of Gui Zhi Tang added with Hou Po and Xing Zi. Gui Zhi Tang harmonizes Ying and Wei and releases exterior pathogens; Hou Po broadens the middle, directs Qi downward, and eliminates phlegm; Xing Zi disseminates Lung Qi, directs Qi downward, and calms wheezing. It is suitable for patients with existing cough/wheezing who contract a new external pathogen. However, the presentation must include Gui Zhi Tang symptoms such as headache, fever, aversion to wind, and floating pulse, combined with wheezing, for it to be appropriate.
37. In Taiyang disease, after purgation, if the pulse is Cu and there is no Jie Xiong (Chest Binding), this indicates the disease is about to resolve. If the pulse is Floating, Jie Xiong will definitely occur; if the pulse is Tight, throat pain will definitely occur; if the pulse is Wiry, bilateral hypochondriac stiffness will definitely occur; if the pulse is Fine and Rapid, headache will not stop; if the pulse is Deep and Tight, vomiting will definitely occur; if the pulse is Deep and Slippery, Xie Re Li (Diarrhea with accompanying heat) will definitely occur; if the pulse is Floating and Slippery, hematochezia (blood in stool) will definitely occur. Original Text 140
Commentary by Zheng: After purgation, the pathogen tends downward, and since the interior Qi is now unblocked, the exterior Qi should be smooth, and the disease should resolve immediately. The original text considers pulse Cu without Jie Xiong as a sign of impending resolution, implying that absence of Jie Xiong means no interior pathogenic stagnation, and pulse Cu means the pathogen desires to exit outward. This is a near-reasonable argument. Why does the entire text list specific pulses corresponding to specific diseases? The changes in pulse are infinite, and current symptoms are often unpredictable. Scholars need not rigidly seek disease based on pulse alone; rather, one should adapt flexibly according to circumstances at the time.
[Interpretation] Taiyang disease treated with purgation is a mis-treatment. However, after purgation in Taiyang disease, if the pulse is Cu and there is no Jie Xiong, the interior is harmonious and not invaded by pathogen. Thus, the Taiyang exterior Qi does not sink due to erroneous purgation but instead tends to rush upward. With the pathogen still in the exterior, this indicates the disease is about to resolve. The entire section diagnoses disease solely through pulse diagnosis without integrating Observation, Auscultation/Olfaction, and Inquiry, which is inappropriate.
Therefore, Zheng said: "The changes in pulse are infinite, and current symptoms are often unpredictable. Scholars need not rigidly seek disease based on pulse alone. Adapting flexibly according to circumstances at the time is correct." This is indeed the right approach.
38. If Taiyang disease is unresolved, and heat binds in the Bladder, the patient appears delirious (Ru Kuang - resembling madness but less severe than true mania). If blood exits spontaneously, the patient heals. If the exterior is not yet resolved, attack (purge) is not yet permissible; one must first resolve the exterior. Once the exterior is resolved, if only the lower abdomen is tight and knotted, then attack is permissible, using Tao He Cheng Qi Tang (Peach Kernel Decoction to Direct the Qi). Original Text 106
① Ru Kuang: Resembling madness but not severe, milder than true mania.
① Shao Fu: The abdomen below the navel is called Shao Fu, also known as Xiao Fu. Some say the area below the navel is Xiao Fu, and the areas beside the navel are Shao Fu.
Commentary by Zheng: In Taiyang Blood Accumulation, the patient appears delirious. Theoretically, Qi transformation should occur to expel stasis via urination. Since the blood has now tended toward the Large Intestine and exits spontaneously, it is judged that the patient will heal naturally. However, if external pathogens are unresolved, attack is forbidden to prevent the pathogen from sinking deeper. Once external pathogens are resolved, and only lower abdominal tightness/knotting remains, the stasis is not yet exhausted, so blood-expelling and purging methods can be applied without error. My opinion is that Tao Ren Cheng Qi Tang is a formula for Yangming blood discharge, and using it for Taiyang seems incorrect. It should be distinguished: if blood exits via stool, it is appropriate; if via urine, it is erroneous. Scholars should investigate carefully to avoid harming patients.
[Interpretation] When Taiyang exterior disease is unresolved, pathogenic heat and blood stasis interlock in the lower Jiao (lower abdomen), causing Blood Accumulation syndrome. One scenario is shallow blood accumulation, where heat forces the accumulated blood to exit spontaneously, allowing pathogenic heat to resolve along with the stasis. Another scenario is severe illness, where heat and stasis bind tightly and cannot exit spontaneously, requiring purgatives. However, if the exterior syndrome is unresolved, purgation must not be performed first. When exterior and interior are simultaneously affected, and the interior is excess, resolving the exterior first is the fixed principle of Shang Han treatment. Exterior can be resolved with Gui Zhi Tang; then, target the interior heat with Tao He Cheng Qi Tang. The Wei (Defensive) aspect of the Bladder organ corresponds to Qi level, and Ying (Nutritive) corresponds to Blood level. Heat entering and affecting Qi level, causing failure of Qi transformation and binding of heat with water, is termed invasion of the interior of the Wei level, corresponding to Wu Ling San (Five Ingredient Powder with Poria) syndrome. Heat entering and affecting Blood level, causing blood stasis and binding of heat with blood, is termed invasion of the interior of the Ying level, corresponding to Tao He Cheng Qi Tang syndrome. Both formulas treat invasion of the organ level, but one promotes urination from the front, and the other purges from the back; their management of water and blood differs. Thus, Zheng said: "Blood exiting via stool is appropriate; via urine is erroneous." This insightfully grasps the key point.
Tao He Cheng Qi Tang Formula (Verified and Supplemented)
Tao Ren (Persicae Semen) - 50 pieces (Skin and tip removed)
Da Huang (Rhei Radix et Rhizoma) - 4 liang
Gui Zhi (Cinnamomi Ramulus) - 2 liang (Bark removed)
Gan Cao (Glycyrrhizae Radix et Rhizoma) - 2 liang (Honey-fried)
Mang Xiao (Natrii Sulfas) - 2 liang
Take these five ingredients, add 7 sheng of water. Boil to obtain 2.5 sheng of decoction. Remove the dregs. Add Mang Xiao. Boil again briefly over fire. Remove from fire. Take 5 he of warm decoction before meals. Three times daily. Mild purgation is expected.
[Formula Analysis and Scope of Application] This formula is Tiao Wei Cheng Qi Tang (Regulate the Stomach Direct Qi Decoction) added with Tao Ren and Gui Zhi, a formula for breaking stasis and expelling blood. Da Huang’s bitter-cold nature sweeps out excess and clears heat as Chief; Mang Xiao’s salty-cold nature enters blood to soften hardness as Minister; Gui Zhi’s acrid-warm and Tao Ren’s acrid-moist nature excel at expelling blood and dispersing pathogen as Assistant; Gan Cao’s sweet nature moderates the action of other herbs, ensuring pathogen removal without injuring righteousness as Envoy. Besides treating lower Jiao blood accumulation with lower abdominal tightness, delirium, and free urination, the author has extended its use to treat menstrual irregularities with early onset and pain in women with Yang-deficient constitutions, with good effects. Modern usage treats not only stasis but also bleeding; not only lower body stasis/bleeding but also upper body stasis/bleeding.
39. In Taiyang disease, after six or seven days, if exterior symptoms persist, the pulse is faint and deep, and contrary to expectation, there is no Jie Xiong, but the patient is manic (Fa Kuang), it is because heat is in the lower Jiao. The lower abdomen should be hard and full, and urination is free. Hematochezia leads to recovery. The reason is that Taiyang pathogen followed the channels, and stasis-heat resides in the interior. Di Dang Tang (Resist the Horse Decoction) should be administered. Original Text 124
① Taiyang sui jing, Yu Re Zai Li: Pathogenic heat from the Taiyang channel itself moves from exterior to interior, not transmitting to other channels, but accumulating in the Blood level of the lower Jiao.
Commentary by Zheng: The manifestations in this text actually belong to stasis-heat in the Fu organs. Theoretically, blood-moving substances should be used to expel it from the Fu level. Using Di Dang Tang here is heavier than the previous method, employing a set of blood-consuming substances to treat it, allowing stasis to be removed and Fu clarity to be restored, leading to natural recovery. This formula can be considered a symptomatic prescription for Female Medicine Dry Blood Lao (Consumption due to Dry Blood). However, this formula is appropriate if there is indeed stasis in the Fu level, but erroneous for Blood Accumulation; appropriate for Dry Blood, but erroneous for Blood Deficiency. It depends on the physician’s careful investigation; otherwise, the formula should not be tried lightly.
[Interpretation] Taiyang pathogen following the channels with stasis-heat in the interior sinks deeply into the lower Jiao, combing with blood to form Blood Accumulation syndrome. It truly belongs to stasis-heat in the Fu organs, so blood-moving substances should naturally be used to expel it from the Fu level. Zheng said: "This formula can be considered a symptomatic prescription for Female Medicine Dry Blood Lao." Dry Blood Lao is mostly seen in women. Caused by damage from the Five Exertions, long-standing deficiency fire steaming dry blood internally, stasis blocking flow, eventually preventing new blood generation and failing to nourish the exterior. Symptoms include amenorrhea, emaciation, loss of appetite, bone-steaming tidal fever, rough skin like fish scales, and dark complexion. Zheng further stated: "This formula is appropriate if there is indeed stasis in the Fu level, but erroneous for Blood Accumulation; appropriate for Dry Blood, but erroneous for Blood Deficiency." These are valuable words gained from experience.
Di Dang Tang Formula (Verified and Supplemented)
Shui Zhi (Hirudo) - 30 pieces (Roasted)
Meng Chong (Tabanus) - 30 pieces (Wings and legs removed, roasted)
Tao Ren (Persicae Semen) - 20 pieces (Skin and tip removed)
Da Huang (Rhei Radix et Rhizoma) - 3 liang (Washed with wine)
Take these four ingredients, add 5 sheng of water. Boil to obtain 3 sheng of decoction. Remove the dregs. Take 1 sheng warm. If no effect, administer again.
Dai Di Dang Tang (Substitute Resist the Horse Decoction): Tao Ren, Gui Wei (Angelicae Sinensis Caudex), Sheng Di (Rehmanniae Radix), Rou Gui (Cinnamomi Cortex), Da Huang, Mang Xiao, Chuan Shan Jia (Manis Squama).
[Formula Analysis and Scope of Application] This formula is a harsh agent for moving stasis and expelling blood, stronger than Tao He Cheng Qi Tang. Besides Da Huang and Tao Ren, it contains Shui Zhi and Meng Chong. Shui Zhi is leech, Meng Chong is horse-fly. These two possess strong blood-consuming and stasis-resolving powers, penetrating directly into blood collaterals. However, Shui Zhi and Meng Chong are rarely used by people. Wang Kentang in *Zheng Zhi Zhun Sheng* established Dai Di Dang Tang (Pill): Tao Ren, Sheng Di, Gui Wei moisten to unblock; Rou Gui warms to activate; Da Huang and Mang Xiao push and sweep; Chuan Shan Jia guides to the site of stasis. Dai Di Dang Tang is commonly used for heat and blood stasis binding in the lower Jiao with masses/growths, and for women with closed/stagnant menstruation, having certain effects on hepatosplenomegaly.
40. In Taiyang disease, if the body is yellow, pulse is Deep and Knotted, lower abdomen is hard, and urination is difficult, there is no blood stasis. If urination is free and the patient appears delirious, the diagnosis of blood syndrome is confirmed. Di Dang Tang should be administered. Original Text 125
① Di: To examine; means evidence is solid.
Commentary by Zheng: This section judges the presence or absence of blood stasis solely by whether urination is free or difficult. If the patient has lower abdominal fullness and difficult urination, it is Urine Accumulation, not Blood Accumulation. If lower abdominal fullness exists with free urination and the patient appears delirious, it is verification of Blood Accumulation. If the patient is not delirious, urination is free, abdomen is full, and there is no other discomfort, then one should differentiate between Cold Binding and Heat Binding in the lower Jiao and treat accordingly, so as to save lives.
[Interpretation] This section continues the differentiation between Blood Accumulation and Water Accumulation from the previous section. If the patient has lower abdominal fullness and difficult urination, it is Urine Accumulation in Taiyang Fu syndrome, treated with Wu Ling San increasing Gui Zhi. If lower abdominal fullness exists with free urination and the patient appears delirious, this is not Bladder Water Accumulation, but Blood Accumulation, so Di Dang Tang is still used to break stasis and expel blood. Zheng said: "If the patient is not delirious, urination is free, abdomen is full, and there is no other discomfort, then there is a division between Cold Binding and Heat Binding in the lower Jiao." The author believes Cold Binding is treated with Ling Gui Zhu Gan Tang (Poria, Cinnamon, Atractylodes, and Licorice Decoction) added with Fu Pian (Prepared Aconite), Bai Kou (Cardamom), and Sha Ren (Amomi Fructus); Heat Binding can be treated with Huang Lian Jie Du Tang (Coptis Decoction to Resolve Toxicity) added with Hua Shi (Talcum) and Mu Tong (Akebiae Caulis).
41. In Taiyang disease, if urination is free, due to excessive water intake, there will definitely be palpitations in the Xin Xia (epigastrium/sub-xiphoid region); if urination is scanty, there will definitely be distressing internal urgency. Original Text 127
② Xin Xia Ji: Refers to the throbbing sensation in the epigastrium/sub-xiphoid region.
③ Ku Li Ji: Difficulty urinating, with a sense of urgency in the lower abdomen.
Commentary by Zheng: Drinking much water and urinating much is the normal logic. But if urination is much, water flows downward, how could it reverse upward to harass the Heart and cause palpitations? It must be that urination is scanty and water pathways are blocked, causing water to reverse upward and harass the Heart, which fits the logic. If urination is blocked, internal distress is inevitable. The original text attributes palpitations to excessive water intake, which is also reasonable, but still not as appropriate as seeking the cause in the amount of urination. Someone might ask: Taiyang runs along the back, how can water Qi harass the Heart? I believe harassing the Heart is indeed because Taiyang Qi travels from below to the chest and abdomen.