伤寒误下之。续得下利。清谷不止。身疼痛者。急当救里。宜四逆汤。此下利不止。阳
气下脱。虽有身痛表症。当以救里为急。救里之后。身疼痛。清便自调者。急当救表。
宜桂枝汤。此清谷已止。而身痛不除。仍从表治也。
邵评∶寒邪在表。而误下脏虚。内寒而下利清谷。胃阳已亡矣。身疼痛。邪在表也。
虽表里皆困。然脏气内虚。无以为散邪之地。故必先温其里。里气固而身痛未除。表
未解也。再当治表。不然。表邪内入而增患矣。
伤寒大下后。复发汗。心下痞。恶寒者。表未解也。不可攻痞。当先解表。表解乃可攻
痞。解表。宜桂枝汤。攻痞。宜大黄黄连泻心汤。
邵评∶大下复汗。正虚邪入。心下痞而恶寒。邪入里而表未罢。当先解表而后攻
痞。痞或能解。表邪必复入里为患。况痞亦未必能解耳。
太阳病下之后。脉促胸满者。桂枝去芍药汤主之。盖中气虚。而表邪仍在。故用桂
枝。而去芍药。若微兼恶寒者。阳气尤虚也。桂枝去芍药。加附子汤主之。
邵评∶此治妄下阳虚寒结之正法。
又评∶风寒在经。本无下法。误下而阳气大伤。其脉必促而无力。胸中虚满。按之
必软而不痛。乃邪客胸中而无实热。其邪仍在阳分。胃阳因下而伤。寒邪将结
而未聚。故用辛甘温药。从阳引而去之。微恶寒者。阳虚而阴气凝聚。前方恐不
胜任。故加附子。以通阳而逐阴邪也。
太阳病下之微喘者。表未解也。桂枝加浓朴杏仁汤。
邵评∶此是寒喘。误下而表气不固。故不用麻黄而用桂枝加朴杏。若热邪淫肺
作喘。当用麻杏甘石汤。误用桂枝。阳盛则毙耳。
服桂枝汤。或下之。仍头痛项强。翕翕发热。无汗。心下满。微痛。小便不利者。桂枝去
桂加茯苓白术汤主之。此心下虽满不硬。而痛尚微。乃心下有水气故也。若小便
利。邪仍在太阳之表。须发汗。今小便不利。病在太阳之府。非桂枝症未罢也。但当利其小便。
邵评∶太阳经病挟水。治以小青龙。腑病挟水。治以五苓散。临症务须细辨。
本太阳病。医反下之。因而腹满时痛。此引邪入太阴也。桂枝加芍药汤主之。大实
痛。邪气结于太阴之里。桂枝加大黄汤主之。
邵评∶因误下后。引太阳之邪入里。其邪未尽离乎太阳。自表而入。仍欲自表而
出。用桂枝以去。太阳未尽之邪。加芍药以和里虚之腹痛。加大黄下里实之痛也。
太阳病。桂枝症。医反下之。热邪下陷。利遂不止。脉促者。表未解也。喘而汗出者。葛
根黄芩黄连汤主之。因表未解。故用葛根。因喘汗而利。故用芩连之苦。以泄之坚之。
邵评∶本太阳桂枝症。法宜解表。而反下之。里虚邪入。阳重热利。表里俱热。症似
虚而脉实。勿蹈盛盛之咎。用葛根之轻清以解肌。芩连苦寒以清里。甘草和中。喘除利止。表里俱解矣。
又评∶脉促者。数而时一止也。前条胸满脉促。是阳虚寒入。用桂枝去芍药。甚则加附子辛温药
扶阳散寒。此条脉促。喘而汗出。是阳盛热入。用葛根芩连辛寒药。解肌清热。
同见促脉。辨其阳虚阳盛。寒邪热邪。全在有力无力中分出。用药
之寒温。如同冰炭。学人可不细心辨认乎。
伤寒十三日不解。胸胁满而呕。此少阳的症。医以汤药下之。不应。又以丸药下之。
因日晡潮热。已而微利潮热者。胃实也。然属少阳之邪。宜先用小柴胡以解外。后以柴胡加芒硝主之。
邵评∶此少阳经邪。因误下而成胃实之症。为少阳阳明并病。胃实者可下。而症
兼少阳。则不可下。故用小柴胡以解外。加芒硝以治里实。
太阳病过经十余日。反二三下之后。二三日。寒热而呕。柴胡症仍在者。先与小柴
胡汤。呕不止心下急。郁郁微烦者。犹有里症为未解也。与大柴胡下之则愈。
邵评∶服小柴胡后。而呕不止。心下满痞。而郁郁微烦者。此邪气郁滞于里。胸膈
气分之热。欲出不出。欲结不结。里未解也。当大柴胡下其热则愈。亦先表后里法也。
伤寒八九日。下之。胸满烦惊。小便不利。谵语。一身尽重。不能转侧者。柴胡加龙骨
牡蛎汤主之。此足太阳少阳之邪。因误下入里。以致正气虚。而扰动少阴手经。现症错杂。药亦随症施治。
邵评∶下后热邪内攻而胸满。邪痹于上也。小便不利。火盛水亏。邪痹于下也。烦
惊者。邪动于心。而神明内乱也。谵语者。邪结于胃。此病之在里者也。一身尽重。
难以转侧者。是阳内而阴反外。少阳之枢机不利。筋脉骨肉并受其邪。此病之
在表者也。夫合表里上下而为病者。必兼阴阳补泻之剂以施治。俾得表里虚
实。泛应曲当。而错杂之邪。庶可尽解耳。此是下后亡阴之症。与火逆亡阳之症不同。
又评∶此太阳病并以少阳。因下而兼入胃腑之症。与此汤。外以解热邪。内以除
水湿。兼镇浮越之气。而补其中州之虚也。
邪从太少来。故仍用柴胡、桂枝黄芩、半夏。治胸满也。龙骨、铅丹、牡蛎。治惊烦也。人
参、甘草。补正气也。小便不利。茯苓。谵语。大黄。身重不能转侧。桂枝、茯苓。
伤寒五六日。已发汗。而复下之。胸胁满。微结。小便不利。渴而不呕。但头汗出。往来
寒热。心下烦者。此为未解也。柴胡桂枝干姜汤主之。此本少阳症。而误汗下之。柴
胡症仍在。故仍用柴胡加减。心烦。不呕而渴。故去参夏。加栝蒌根。胸胁满而微结。
故去大枣。加牡蛎。小便虽不利。而心下不悸。故不去黄芩。而加茯苓。虽渴而表未
解。故不用参。而加桂枝。以干姜易生姜者。散胸中之满结也。初服烦即微者。黄芩
栝蒌之功。继服汗出便愈者。桂枝柴胡之力也。
邵评∶此亦太阳转入少阳之症。此微结。是指心下痞结。病在胸胁。与阳微结不同也。
伤寒五六日。大下之后。身热不去。心中结痛者。未欲解也。栀子豉汤主之。此病发于阳。而误下之。
外热未除。而内热又结于心中。故结痛。栀豉所以宣通热邪也。
邵评∶心中结痛。身热不去。其邪未尽入里。与结胸症之心痛而身不热者不同。
用栀子豉汤散邪撤热。轻于小陷胸汤之荡实除热。是火郁发之之法也。
伤寒。医以丸药下之。身热不去。微烦者。栀子干姜汤主之。此以丸药大下。则寒气留中可知。故用
栀子以解微烦。干姜以逐内寒。而散表热。寒因热用。热因寒用也。
邵评∶丸药妄下。热陷寒留。身热不去。内无结痛。而见微烦。知正气虚。不能与邪
相争。为外热内寒之症。故用栀子以撤胸中陷入之邪。干姜以复下药损伤之气也。
伤寒下后。心烦腹满。起卧不安者。栀子浓朴汤主之。此因误下。移邪于心胃。故用
栀子以治心烦。枳朴以泄腹满。是两解心腹之妙用也。邪虽在胃。便未燥硬。则不
可下。此为小承气之先着。
邵评∶此症邪已入胃。则不可吐。便未燥硬。则不可下。此栀子浓朴汤重于栀豉而轻于承气也。
太阳病外症未除。而数下之。遂协热而利。利下不止。心下痞硬。表里不解。桂枝人
参汤主之。此因数下之后。虽初因协热。而里必虚寒。故用温补。
邵评∶此症表里俱虚。其病根在心下。非辛热何能化痞而软硬。非甘温无以止
利解表。用理中加桂枝。双解表里之法。此条虽不言脉。其脉微弱可知。
又评∶喻嘉言曰。设利止。则其邪可从里解。乃下利不止。是里解无期。设结开。则
其邪可从表解。乃心下痞硬。是表解无期。此际欲解表里之邪。全赖中气为之
敷布。否则上下交征。中气立断。其能解耶。理中汤加桂枝一法。握枢而运。真无为之上理矣。
伤寒服汤药。下利不止。心下痞硬。服泻心汤已。复以他药下之。利不止。（一误再误）医以
理中与之。利益甚。理中者。理中焦也。此利在下焦。赤石脂禹余粮汤主之。此因下
药太过。手阳明大肠受伤。关闸不阖。二味涩以固脱也。复利不止。当利其小便。盖分其清浊。则便自坚。
邵评∶服泻心汤已。心下之痞气既除。而中焦脾胃之气亦豁然矣。复与下药。大肠滑脱。利遂不止。
以理中温补而利益甚。此利在下焦。须用涩剂以收之。复利不止者。利其小便以厘清之。则无余治。其愈
自可必也。
厥阴寒格。医复吐下之。致食入即吐。干姜黄连黄芩人参汤主之。此阴格于下。拒阳于上而为吐。故用
芩连之苦寒。以泄热。干姜之辛温。以通寒格。误吐误下。中气必虚。故用人参安胃和中。其吐自止。
邵评∶寒热相阻。则为格症。寒热相结。则为痞症。此病轻于痞。故用泻心之半。
发汗吐下后。虚烦不得眠。若剧者。必反复颠倒。心中懊 。栀子豉汤吐之。此因三法后。正气虚实。邪虽去。
而其余邪。因虚留于上焦。结于肺胃之间。非汗下所能除者。惟吐之。则余邪结气无不出矣。
邵评∶阳明之虚烦。与太阳不同。心胸居胃上。即阳明之表。凡心胸有病。皆阳明表邪。其治法亦
与太阳大异。太阳之表。当汗而不当清宣。阳明之表。当清宣而
不当汗。太阳之里。当利小便而不当下。阳明之里。当下而不当利小便。今人但知汗为解表。故于仲
景大法中。但知汗下而遗其清宣之法耳。栀豉汤本为烦躁设。又可以清宣阳明之虚烦。乃阳明之表剂也。
伤寒病误用攻下法后，继续出现腹泻，排出未消化的食物且无法停止。如果身体疼痛，应当紧急救治里证，适宜使用四逆汤。这是因为腹泻不止导致阳气下脱，虽然存在身体疼痛的表证，但应以急救里证为急务。在救治里证之后，如果身体疼痛仍在，而大小便正常，则应紧急救治表证，适宜使用桂枝汤。这是因为腹泻已止，但身体疼痛未除，治疗仍应从表证入手。
邵评：寒邪在体表，却误用攻下法导致内脏虚弱，内寒引发腹泻且排出未消化食物，胃阳已经衰亡。身体疼痛说明邪气仍在体表。虽然表里两受困厄，但由于脏气内部虚弱，没有驱散邪气的根基，所以必须先温补里证。里气稳固后若身体疼痛仍未消除，说明表证未解，再当治疗表证。否则，表邪会内传入里从而增加病患。
伤寒病经过猛烈攻下后又发汗，出现心下部痞塞感，伴有恶寒，这是表证未解的表现。不可攻治痞塞，应当先解除表证，表证解除后才能攻治痞塞。解除表证适宜用桂枝汤，攻治痞塞适宜用大黄黄连泻心汤。
邵评：猛烈攻下后又发汗，正气虚弱邪气内入，出现心下痞塞且恶寒，邪气入里但表证未罢。应当先解表而后攻痞。痞塞或许能因此缓解，但如果先攻痞，表邪必定再次入里造成病患，况且痞塞也未必能解除。
太阳病误用攻下法后，脉象急促且胸部胀满，主方为桂枝去芍药汤。这是因为中气虚弱而表邪仍在，所以用桂枝汤，但去掉芍药。如果轻微兼有恶寒，说明阳气更加虚弱，主方为桂枝去芍药加附子汤。
又评：风寒在经络，本来没有攻下法。误用攻下导致阳气大伤，脉象必然急促而无力，胸中虚满，按压时必然柔软且不痛，这是邪气客居胸中而无实热。邪气仍在阳分，胃阳因攻下而受伤，寒邪将要凝结但未聚积，所以用辛甘温药，从阳分引导邪气外出。如果轻微恶寒，是阳虚而阴气凝聚，前方恐怕不能胜任，所以加附子，以通阳而驱逐阴邪。
太阳病误用攻下法后出现轻微气喘，说明表证未解，主方为桂枝加厚朴杏子汤。
邵评：这是寒喘，误用攻下导致表气不固，所以不用麻黄而用桂枝加厚朴杏子汤。如果是热邪淫溢于肺导致的喘，应当用麻杏石甘汤。误用桂枝汤，若阳盛则会致死。
服用桂枝汤，或者被攻下后，仍然头痛项强，发热如羽毛覆盖般（翕翕发热），无汗，心下部胀满，轻微疼痛，小便不利，主方为桂枝去桂加茯苓白术汤。这是因为心下部虽然胀满但不硬，且疼痛轻微，是由于心下部有水气所致。如果小便通畅，邪气仍在太阳之表，需要发汗。现在小便不利，病在太阳之腑，并非桂枝证未罢，只是应当利小便。
邵评：太阳经病挟带水湿，用小青龙汤治疗；腑病挟带水湿，用五苓散治疗。临症务必仔细辨别。
原本太阳病，医生反而用攻下法，导致腹部胀满且有时疼痛，这是引邪进入太阴经，主方为桂枝加芍药汤。如果严重胀痛，是邪气结聚在太阴之里，主方为桂枝加大黄汤。
邵评：因为误用攻下，将太阳之邪引入里部，邪气未尽脱离太阳，自表而入，仍想自表而出。用桂枝去除太阳未尽之邪，加芍药调和里虚之腹痛，加大黄攻下里实之痛。
太阳病，有桂枝证，医生反而用攻下法，热邪下陷，腹泻不停，脉象急促，说明表证未解。如果有气喘且出汗，主方为葛根黄芩黄连汤。因为表证未解，所以用葛根；因为气喘、出汗且腹泻，所以用黄芩、黄连的苦味来泄热并坚阴。
邵评：原本是太阳桂枝证，法度上宜解表，却反用攻下，导致里虚邪入，阳热重且腹泻，表里俱热，症状看似虚证但脉象实证，不要犯“盛盛”的错误。用葛根的轻清来解肌，黄芩黄连的苦寒来清里，甘草和中，气喘消除腹泻停止，表里俱解。
又评：脉急促，是指脉搏快且时常有一止。前条胸满脉促，是阳虚寒入，用桂枝去芍药汤，甚至加附子等辛温药扶阳散寒。此条脉促，气喘且出汗，是阳盛热入，用葛根芩连汤等辛寒药解肌清热。
同样见到促脉，辨别是阳虚还是阳盛，寒邪还是热邪，全在于脉的有力与无力中区分。用药的寒温，如同冰炭一样截然不同，学习者能不细心辨认吗？
伤寒病程十三日未解，胸胁胀满且呕吐，这是少阳病的典型症状。医生用汤药攻下，无效，又用丸药攻下。随后出现傍晚潮热，不久又有轻微腹泻且伴潮热，这是胃实。然而属于少阳之邪，适宜先用小柴胡汤解外，后用柴胡加芒硝汤。
邵评：这是少阳经邪气，因误用攻下而成胃实症状，为少阳阳明并病。胃实可下，但症状兼有少阳，则不可单纯攻下。故用小柴胡汤解外，加芒硝治里实。
太阳病超过经期十余日，反而经过两三次攻下后，过了两三天，出现寒热往来且呕吐，柴胡证仍在的，先给予小柴胡汤。如果呕吐不止，心下部急迫，心中郁郁微烦，说明仍有里证未解，给予大柴胡汤攻下则愈。
邵评：服用小柴胡汤后，呕吐不止，心下部满闷痞塞且郁郁微烦，这是邪气郁滞于里，胸膈气分之热，欲出不出，欲结不结，里证未解。应当用大柴胡汤下其热则愈，这也是先表后里的方法。
伤寒八九日，误用攻下法，出现胸满、烦躁惊悸、小便不利、谵语、全身沉重、不能转侧，主方为柴胡加龙骨牡蛎汤。这是足太阳、少阳之邪，因误用攻下入里，导致正气虚弱，扰动少阴手经，现症错杂，药物也随症状施治。
邵评：攻下后热邪内攻导致胸满，邪气痹阻于上；小便不利，火盛水亏，邪气痹阻于下；烦躁惊悸，是邪动于心，神明内乱；谵语，是邪结于胃，这是病在里；全身沉重，难以转侧，是阳在内而阴反在外，少阳枢机不利，筋脉骨肉并受邪气，这是病在表。凡合表里上下而为病者，必须兼用阴阳补泻的药剂来施治，使得表里虚实泛应曲当，错杂之邪才能尽解。这是攻下后亡阴的症状，与火逆亡阳的症状不同。
又评：这是太阳病兼并少阳，因攻下而兼入胃腑的症状。与此汤，外以解热邪，内以除水湿，兼镇浮越之气，而补其中州之虚。
邪气从太少二经来，所以仍用柴胡、桂枝、黄芩、半夏，治疗胸满；龙骨、铅丹、牡蛎，治疗惊烦；人参、甘草，补正气；小便不利用茯苓；谵语用大黄；身重不能转侧用桂枝、茯苓。
伤寒五六日，已发汗，而又攻下，出现胸胁胀满，轻微痞结，小便不利，口渴但不呕吐，仅头部出汗，寒热往来，心下部烦闷，此为病未解，主方为柴胡桂枝干姜汤。这原本是少阳证，却误用汗法和下法，柴胡证仍在，所以仍用柴胡加减。心烦、不呕而渴，所以去人参、半夏，加栝楼根；胸胁胀满而轻微痞结，所以去大枣，加牡蛎；小便虽不利，但心下不悸，所以不去黄芩，加茯苓；虽渴但表未解，所以不用人参，加桂枝；用干姜代替生姜，是为了散胸中之满结。初服后烦闷即减轻，是黄芩、栝楼的功效；继服后出汗即痊愈，是桂枝、柴胡的力量。
邵评：这也是太阳转入少阳的症状。此处的微结，是指心下痞结，病在胸胁，与阳微结不同。
伤寒五六日，猛烈攻下后，身热不退，心中结痛，这是病未欲解，主方为栀子豉汤。此病发于阳，却误用攻下，外热未除，内热又结于心中，故致结痛。栀豉汤所以能宣通热邪。
邵评：心中结痛，身热不退，其邪气未尽入里，与结胸症之心痛而身不热的情况不同。用栀子豉汤散邪撤热，比小陷胸汤荡实除热更轻，这是火郁发之的方法。
伤寒，医生用丸药攻下，身热不退，轻微烦躁，主方为栀子干姜汤。这是因为用丸药猛烈攻下，寒气留于中焦可知。所以用栀子解轻微烦躁，用干姜驱逐内寒而散表热。寒因热用，热因寒用。
邵评：丸药妄用攻下，热陷寒留，身热不退，内无结痛而见轻微烦躁，知正气虚弱，不能与邪气相争，为外热内寒之症。故用栀子撤除胸中陷入之邪，干姜恢复下药损伤之气。
伤寒攻下后，心烦腹满，坐卧不安，主方为栀子厚朴汤。这是因为误用攻下，移邪于心胃，所以用栀子治心烦，枳实、厚朴泄腹满，这是两解心腹的妙用。邪气虽在胃，但大便未燥硬，则不可攻下，这是小承气汤的先着。
邵评：此症邪气已入胃，则不可吐；大便未燥硬，则不可下。此栀子厚朴汤重于栀豉汤而轻于承气汤。
太阳病外证未除，却多次攻下，遂协热而利，腹泻不止，心下部痞塞坚硬，表里不解，主方为桂枝人参汤。这是因为多次攻下后，虽然起初因协热，但里必虚寒，所以用温补法。
邵评：此症表里俱虚，病根在心下部，非辛热何能化痞而软硬？非甘温无以止利解表。用理中汤加桂枝，是双解表里的方法。此条虽不言脉，但其脉微弱可知。
又评：喻嘉言说：如果腹泻停止，则邪气可从里解；如今腹泻不止，说明里解无期。如果痞结打开，则邪气可从表解；如今心下部痞塞坚硬，说明表解无期。此时想要解表里之邪，全赖中气为之敷布，否则上下交征，中气立断，怎能解呢？理中汤加桂枝一法，握枢而运，真是无为的上理啊。
伤寒服用汤药后，腹泻不止，心下部痞塞坚硬，服用泻心汤后，又用其他药攻下，腹泻不止。（一误再误）医生给服理中汤，腹泻更甚。理中汤是调理中焦的，此腹泻在下焦，主方为赤石脂禹余粮汤。这是因为下药太过，手阳明大肠受伤，关闸不阖，这两味药涩以固脱。如果腹泻仍不止，应当利小便。因为分清浊，则大便自然成形。
邵评：服用泻心汤后，心下痞气既除，中焦脾胃之气亦豁然开朗。又给下药，大肠滑脱，腹泻遂不止。用理中汤温补而腹泻更甚，此腹泻在下焦，须用涩剂以收敛。若仍不止，利其小便以厘清之，则无其他治法，痊愈自可必得。
厥阴寒格，医生又用吐法和下法，导致食入即吐，主方为干姜黄连黄芩人参汤。这是因为阴寒格拒于下，拒绝阳气于上而致呕吐。所以用黄芩、黄连的苦寒以泄热，干姜的辛温以通寒格。误吐误下，中气必虚，所以用人参安胃和中，呕吐自止。
邵评：寒热相阻，则为格症；寒热相结，则为痞症。此病轻于痞症，故用泻心汤的一半剂量。
发汗、吐、下后，虚烦不得眠，如果严重的，必定反复颠倒，心中懊恼，主方为栀子豉汤催吐。这是因为三法之后，正气虚弱，邪气虽去，但其余邪因虚留于上焦，结于肺胃之间，非汗下所能除者。只有用吐法，则余邪结气无不出矣。
邵评：阳明之虚烦，与太阳不同。心胸位于胃之上，即阳明之表。凡心胸有病，皆属阳明表邪，其治法也与太阳大异。太阳之表，当汗而不当清宣；阳明之表，当清宣而不当汗。太阳之里，当利小便而不当下；阳明之里，当下而不当利小便。今人只知道汗法为解表，所以在仲景大法中，只知道汗下而遗忘了清宣之法。栀子豉汤本为烦躁设立，又可以清宣阳明之虚烦，乃阳明之表剂。
After the mistaken use of purgation in Taiyang disease (Taiyang Disease), diarrhea continues with undigested food and cannot be stopped. If body pain is present, urgent treatment of the interior syndrome is required, suitable for Sini Tang (Four Reversal Decoction). This is because persistent diarrhea leads to the collapse of Yang Qi downwards; although there are exterior symptoms like body pain, saving the interior takes priority. After treating the interior, if body pain persists but urination and defecation are normal, urgent treatment of the exterior syndrome is required, suitable for Guizhi Tang (Cinnamon Twig Decoction). This is because the diarrhea has stopped but body pain remains, so treatment should still focus on the exterior.
Shao's Commentary: Cold pathogen is at the exterior, but mistaken purgation causes internal organ deficiency, leading to internal cold and diarrhea with undigested food, indicating that Stomach Yang is exhausted. Body pain indicates the pathogen is still at the exterior. Although both exterior and interior are compromised, due to internal deficiency of Zang Qi, there is no foundation to disperse the pathogen, so warming the interior must come first. If body pain persists after the interior Qi is stabilized, it means the exterior is not resolved, and then one should treat the exterior. Otherwise, the exterior pathogen will enter the interior and cause further illness.
After severe purgation followed by sweating in Shanghan (Cold Damage), epigastric fullness and obstruction (Xin Xia Pi) occur with aversion to cold, indicating the exterior is not resolved. One must not attack the fullness yet; instead, resolve the exterior first. Only after the exterior is resolved can the fullness be treated. To resolve the exterior, Guizhi Tang (Cinnamon Twig Decoction) is suitable; to treat the fullness, Dahuang Huanglian Xiexin Tang (Rhubarb, Coptis, and Scutellaria Heart-Draining Decoction) is suitable.
Shao's Commentary: Severe purgation followed by sweating weakens Zheng Qi (Upright Qi) and allows pathogens to enter internally. Epigastric fullness with aversion to cold indicates pathogens have entered the interior while the exterior remains unresoved. One must resolve the exterior before attacking the fullness. The fullness might resolve, but if attacked first, the exterior pathogen will likely re-enter the interior causing harm, and moreover, the fullness may not resolve anyway.
After purgation in Taiyang Disease (Taiyang Disease), if the pulse is rapid and intermittent (Cu Mai, 促脉) and there is chest fullness, Guizhi Qu Shaoyao Tang (Cinnamon Twig Decoction without Paeonia) is the main formula. This is because Middle Qi is deficient while the exterior pathogen remains, so Guizhi Tang is used but Shaoyao (Paeonia Root) is removed. If there is slight aversion to cold, Yang Qi is even more deficient, and Guizhi Qu Shaoyao Fuzi Tang (Cinnamon Twig Decoction without Paeonia plus Aconite) is the main formula.
Shao's Commentary: This is the correct method for treating Yang deficiency and cold binding caused by reckless purgation.
Another Commentary: Wind-cold in the meridians originally has no indication for purgation. Mistaken purgation severely damages Yang Qi, resulting in a rapid and forceless pulse and empty fullness in the chest, which feels soft and painless upon pressure. This indicates pathogen lodging in the chest without excess heat. The pathogen remains in the Yang aspect, and Stomach Yang is injured by purgation; cold pathogen is about to bind but has not gathered. Therefore, acrid-sweet-warm herbs are used to guide the pathogen out from the Yang aspect. If there is slight aversion to cold, it is Yang deficiency with Yin Qi condensation; the previous formula may not suffice, so Fuzi (Aconite Root) is added to unblock Yang and drive out Yin pathogen.
If mild wheezing occurs after purgation in Taiyang Disease (Taiyang Disease), it indicates the exterior is not resolved. Zhige Jia Houpo Xingren Tang (Cinnamon Twig Decoction plus Magnolia Bark and Apricot Seed) is indicated.
Shao's Commentary: This is cold-induced wheezing. Mistaken purgation fails to secure the Exterior Qi, so Mahuang Tang (Ephedra Decoction) is not used; instead, Zhige Jia Houpo Xingren Tang is used. If wheezing is caused by heat pathogen flooding the Lung, Maxing Shigan Tang (Ephedra, Apricot Seed, Gypsum, and Licorice Decoction) should be used. Mistakenly using Guizhi Tang when Yang is excessive can lead to death.
After taking Guizhi Tang (Cinnamon Twig Decoction) or being purged, if headache, neck stiffness, feverish sensation (Xi Xi Fa Re, 翕翕发热), anhidrosis, epigastric fullness, slight pain, and dysuria persist, Zhige Qu Gui Jia Fuling Baizhu Tang (Cinnamon Twig Decoction without Cinnamon Twig plus Poria and Atractylodes Macrocephala Decoction) is the main formula. This is because although there is epigastric fullness, it is not hard, and pain is slight, indicating water-Qi retention in the epigastrium. If urination is free, the pathogen is still at the Taiyang Exterior, requiring sweating. Now, with dysuria, the disease is in the Taiyang Fu Organ; it is not that the Guizhi pattern has not ceased, but rather that promoting diuresis is needed.
Shao's Commentary: Taiyang Jing Disease (Taiyang Meridian Disease) complicated with water uses Xiao Qinglong Tang (Minor Blue Dragon Decoction); Fu Organ disease complicated with water uses Wuling San (Five-Ling Powder). Clinical differentiation must be meticulous.
Originally Taiyang Disease (Taiyang Disease), if the doctor mistakenly uses purgation, leading to abdominal fullness and occasional pain, this draws the pathogen into Taiyin Disease (Taiyin Disease). Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction plus Paeonia) is the main formula. For severe distending pain, where pathogen binds in the Taiyin Interior, Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction plus Rhubarb) is the main formula.
Shao's Commentary: Due to mistaken purgation, Taiyang pathogen is drawn inward. The pathogen has not completely left Taiyang; entering from the exterior, it still seeks to exit via the exterior. Guizhi removes residual Taiyang pathogen; Shaoyao harmonizes interior deficiency causing abdominal pain; Dahuang purges interior excess causing pain.
In Taiyang Disease (Taiyang Disease) with Guizhi Pattern (Guizhi Syndrome), if the doctor mistakenly uses purgation, heat pathogen sinks downward, causing persistent diarrhea. If the pulse is rapid and intermittent (Cu Mai, 促脉), it indicates the exterior is not resolved. If there is wheezing and sweating, Gegen Qinlian Tang (Kudzu, Coptis, and Scutellaria Decoction) is the main formula. Because the exterior is unresolved, Gegen (Kudzu Root) is used; because of wheezing, sweating, and diarrhea, the bitter properties of Qinlian (Coptis and Scutellaria) are used to drain heat and firm the intestines.
Shao's Commentary: Originally a Taiyang Guizhi Pattern, the method should be to resolve the exterior, but purgation was wrongly used, causing interior deficiency and pathogen entry. Yang heat is heavy with diarrhea; both exterior and interior are hot. Symptoms appear deficient but the pulse is excess; do not commit the error of "reinforcing excess." Use light-clearing Gegen to release the muscle layer; bitter-cool Qinlian to clear the interior; Gancao (Licorice) to harmonize the middle. Wheezing stops, diarrhea ceases, and both exterior and interior are resolved.
Another Commentary: Cu Mai (rapid and intermittent pulse) refers to a fast pulse with occasional pauses. In the previous case of chest fullness and Cu Mai, it was Yang deficiency with cold entry, treated with Guizhi Qu Shaoyao Tang, adding Fuzi (Aconite) if severe to support Yang and scatter cold. In this case, Cu Mai with wheezing and sweating indicates Yang excess with heat entry, treated with Gegen Qinlian Tang to release the muscle layer and clear heat.
Seeing the same Cu Mai, distinguishing between Yang deficiency/excess and cold/heat pathogen depends entirely on whether the pulse is forceful or forceless. The choice of cold/warm herbs is as different as ice and charcoal; learners must distinguish carefully.
Shanghan (Cold Damage) unresolved for thirteen days, with chest-hypochondriac fullness and vomiting, is a definitive Shaoyang Disease (Shaoyang Disease) symptom. The doctor used herbal decoction to purge, which failed, then used pill laxatives to purge. Subsequently, afternoon tidal fever occurred, followed by slight diarrhea with tidal fever, indicating Stomach Excess. However, since it belongs to Shaoyang pathogen, initially use Xiaochaihu Tang (Minor Bupleurum Decoction) to resolve the exterior, then Chaihu Jia Mangxiao Tang (Bupleurum plus Mirabilite Decoction).
Shao's Commentary: This is Shaoyang Jing pathogen becoming Stomach Excess due to mistaken purgation, constituting Shaoyang-Yangming concurrent disease. Stomach Excess can be purged, but since Shaoyang symptoms are present, simple purgation is contraindicated. Thus, Xiaochaihu Tang resolves the exterior, and Mangxiao (Mirabilite) treats interior excess.
Taiyang Disease (Taiyang Disease) lasting over ten days past the meridian cycle, subjected to two or three purgations, then after two or three days presenting with alternating chills and fever, vomiting, and remaining Shaohu Pattern (Chaihu Syndrome), first give Xiaochaihu Tang (Minor Bupleurum Decoction). If vomiting persists, epigastric urgency, and郁郁微烦 (depressed slight vexation) occur, indicating interior symptoms remain unresolved, give Daxie Tang (Major Bupleurum Decoction) to purge for cure.
Shao's Commentary: After taking Xiaochaihu Tang, if vomiting persists, epigastric fullness/oppression occurs with depressed slight vexation, this indicates pathogen stagnation in the interior, heat in the chest-diaphragm Qi aspect wanting to exit but unable, wanting to bind but unable, meaning interior is unresolved. Daxie Tang should be used to purge heat for cure. This is also the method of treating exterior first, then interior.
Shanghan (Cold Damage) for eight or nine days, subjected to purgation, presenting with chest fullness, irritability, fright, dysuria, delirium, whole-body heaviness, and inability to turn over, is treated with Chaihu Jia Longgu Muli Tang (Bupleurum plus Dragon Bone and Oyster Shell Decoction). This is Foot Taiyang-Shaoyang pathogen entering the interior due to mistaken purgation, causing Zheng Qi deficiency and disturbing the Hand Shaoyin meridian. Symptoms are complex, and medication is administered according to symptoms.
Shao's Commentary: After purgation, heat pathogen attacks internally causing chest fullness, pathogen obstructs above; dysuria indicates fire excess and water deficiency, pathogen obstructs below; irritability and fright indicate pathogen moving in the Heart, disturbing Shen Ming (Spirit); delirium indicates pathogen binding in the Stomach, this is disease in the interior; whole-body heaviness and difficulty turning indicate Yang inside and Yin outside, Shaoyang pivot mechanism unfavorable, sinews, vessels, bones, and muscles all affected by pathogen, this is disease in the exterior. Diseases combining exterior-interior and upper-lower require formulas combining Yin-Yang tonification and purgation to address exterior-interior deficiency-excess appropriately, so complex pathogens can be fully resolved. This is a post-purgation Yin depletion syndrome, different from Fire Adverse Yang depletion syndrome.
Another Commentary: This is Taiyang disease combined with Shaoyang, entering the Stomach Fu Organ due to purgation. This formula externally resolves heat pathogen, internally removes water-dampness, calms floating Qi, and tonifies the deficiency of the Central Region.
Pathogen comes from Shaoyang and Taiyang, so Chaihu (Bupleurum), Guizhi (Cinnamon Twig), Huangqin (Scutellaria), and Banxia (Pinellia) are used to treat chest fullness; Longgu (Dragon Bone), Qiandan (Lead Monoxide), and Muli (Oyster Shell) treat fright and vexation; Renshen (Ginseng) and Gancao (Licorice) tonify Zheng Qi; Fuling (Poria) for dysuria; Dahuang (Rhubarb) for delirium; Guizhi and Fuling for whole-body heaviness and inability to turn over.
Shanghan (Cold Damage) for five or six days, after sweating and subsequent purgation, presenting with chest-hypochondriac fullness, slight binding, dysuria, thirst without vomiting, only head sweating, alternating chills and fever, and epigastric vexation, indicates disease unresolved. Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Ginger Decoction) is the main formula. This was originally a Shaoyang pattern, but mistaken sweating and purgation were applied. Chaihu pattern remains, so Chaihu modifications are used. Vexation, no vomiting but thirst, so Renshen and Banxia are removed, adding Gualougen (Trichosanthes Root). Chest-hypochondriac fullness with slight binding, so Dazao (Jujube) is removed, adding Muli (Oyster Shell). Although dysuria exists, no epigastric palpitation, so Huangqin (Scutellaria) is not removed, adding Fuling (Poria). Although thirsty, exterior is unresolved, so Renshen is not used, adding Guizhi (Cinnamon Twig); replacing Shengjiang (Fresh Ginger) with Ganjiang (Dried Ginger) to dissipate epigastric fullness-binding. Initial dose reduces vexation due to Huangqin and Gualou; subsequent doses induce sweating and cure due to Guizhi and Chaihu.
Shao's Commentary: This is also Taiyang transitioning to Shaoyang. This "slight binding" refers to epigastric oppression-binding, disease in chest-hypochondriac region, different from Yang Wei Jie (Yang Minor Binding).
Shanghan (Cold Damage) for five or six days, after severe purgation, body heat persists, heart-knotting pain occurs, indicating disease not resolving. Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is the main formula. This disease originated in Yang, but mistaken purgation was used. External heat is not removed, and internal heat binds in the heart, causing knotting pain. Zhizi Chi Tang disseminates and unblocks heat pathogen.
Shao's Commentary: Heart-knotting pain with persistent body heat indicates pathogen has not fully entered the interior, different from Jie Xiong (Chest Binding) syndrome where heart pain occurs without body heat. Zhizi Chi Tang disperses pathogen and withdraws heat, lighter than Xiao Xian Xiong Tang (Minor Chest-Sinking Decoction) which purges excess and removes heat; this is the method of "releasing fire depression."
Shanghan (Cold Damage), doctor used pill laxatives to purge, body heat persists, slight vexation occurs. Zhizi Ganjiang Tang (Gardenia and Ginger Decoction) is the main formula. Pill purgation causes severe downward movement, indicating cold qi retained in the middle. Zhizi resolves slight vexation; Ganjiang drives out internal cold and dissipates external heat. Cold used for heat, heat used for cold.
Shao's Commentary: Reckless pill purgation causes heat sinking and cold retention. Persistent body heat, no internal knotting pain but slight vexation, indicates Zheng Qi deficiency unable to contend with pathogen, an external-heat internal-cold syndrome. Zhizi withdraws pathogen sunk in the chest; Ganjiang restores Qi damaged by purgation.
After Shanghan (Cold Damage) purgation, heart vexation, abdominal fullness, restlessness day and night occur. Zhizi Houpo Tang (Gardenia and Magnolia Bark Decoction) is the main formula. Mistaken purgation shifts pathogen to Heart and Stomach. Zhizi treats heart vexation; Zhishi (Immature Bitter Orange) and Houpo (Magnolia Bark) drain abdominal fullness. This is the subtle application of simultaneously resolving Heart and Abdomen. Pathogen is in Stomach, but stool is not dry/hard, so purgation is contraindicated. This is a preliminary step before Xiao Chengqi Tang (Minor Order the Qi Decoction).
Shao's Commentary: Pathogen has entered Stomach, so emesis is contraindicated; stool not dry/hard, so purgation is contraindicated. Zhizi Houpo Tang is heavier than Zhizi Chi Tang but lighter than Chengqi Tangs.
Taiyang Disease exterior symptoms persist, but multiple purgations are applied, leading to協熱利 (Collaborating Heat Diarrhea), persistent diarrhea, epigastric hardness/fullness, unresolved exterior and interior. Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction, i.e., Lizhong Tang plus Cinnamon Twig) is the main formula. Multiple purgations cause initial collaborating heat but ultimately interior deficiency-cold, so warm-tonification is used.
Shao's Commentary: Exterior and interior are both deficient; root pathology is in the epigastrium. Only acrid-hot can transform phlegm-fullness and hardness/softness; only sweet-warm can stop diarrhea and resolve exterior. Lizhong Tang plus Guizhi is a method of dual resolution of exterior and interior. Though pulse is not mentioned, it is known to be faint and weak.
Another Commentary: Yu Jiayan said: If diarrhea stops, pathogen can resolve from interior; now diarrhea persists, interior resolution is indefinite. If fullness opens, pathogen can resolve from exterior; now epigastric hardness/fullness exists, exterior resolution is indefinite. At this moment, resolving exterior-interior pathogen relies entirely on Middle Qi distribution. Otherwise, upper and lower conflict, Middle Qi collapses instantly, how can it resolve? Lizhong Tang plus Guizhi grasps the pivot and operates; truly the supreme principle of non-action.
Shanghan patient takes herbal medicine, diarrhea persists, epigastric hardness/fullness occurs. After taking Xiexin Tang (Heart-Draining Decoction), other drugs are used to purge, diarrhea persists (one mistake repeated). Doctor gives Lizhong Tang (Regulate Middle Decoction), diarrhea worsens. Lizhong Tang regulates Middle Jiao; this diarrhea is in Lower Jiao. Shizhi Yiyu Liang Tang (Red Stone Lipstick and Hematite Decoction) is the main formula. Excessive purgation injures Hand Yangming Large Intestine, failing to close gates; these two herbs astringe to secure collapse. If diarrhea persists, promote diuresis. Separating clear and turbid makes stool firm.
Shao's Commentary: After Xiexin Tang, epigastric fullness is removed, Middle Jiao Spleen-Stomach Qi is open. Further purgation causes Large Intestine sliding/collapse, diarrhea persists. Warm-tonification with Lizhong worsens diarrhea; this diarrhea is in Lower Jiao, requiring astringents to consolidate. If still persistent, promote diuresis to clarify clear/turbid, leaving no other treatment; cure is certain.
Jueyin Cold Ge (Rejection), doctor applies emesis and purgation again, causing immediate vomiting after eating. Ganjiang Huanglian Huangqin Renshen Tang (Ginger, Coptis, Scutellaria, and Ginseng Decoction) is the main formula. Yin cold rejects below, refusing Yang above, causing vomiting. Bitter-cold Huanglian/Huangqin drains heat; acrid-warm Ganjiang unblocks cold rejection. Mistaken emesis/purgation causes Middle Qi deficiency, so Renshen stabilizes Stomach and harmonizes middle; vomiting stops.
Shao's Commentary: Cold-heat obstruction is Ge (Rejection) syndrome; cold-heat binding is Pi (Fullness) syndrome. This disease is milder than Pi, so half dose of Xiexin Tang is used.
After sweating, emesis, and purgation, deficiency-vexation prevents sleep. If severe, tossing and turning occurs, heart feels agonized (Ao Nao, 懊憹). Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) induces emesis. After these three methods, Zheng Qi is deficient. Although pathogen is gone, residual pathogen remains in Upper Jiao due to deficiency, binding between Lung and Stomach, not removable by sweating/purgation. Only emesis expels residual pathogen and binding Qi.
Shao's Commentary: Yangming deficiency-vexation differs from Taiyang. Heart-chest is above Stomach, i.e., Yangming Exterior. Any disease in heart-chest belongs to Yangming exterior pathogen. Treatment differs greatly from Taiyang. Taiyang Exterior requires sweating, not clearing/disseminating; Yangming Exterior requires clearing/disseminating, not sweating. Taiyang Interior requires promoting diuresis, not purging; Yangming Interior requires purging, not promoting diuresis. People today only know sweating resolves exterior, so within Zhang Zhongjing's great methods, they only know sweating/purging and forget clearing/disseminating. Zhizi Chi Tang was set for vexation; it can also clear/disseminate Yangming deficiency-vexation, serving as Yangming Exterior formula.