中风发热。六七日不解而烦有表里证。渴欲饮水。水入即吐者。名曰水逆。五苓散主之。多饮暖火汗出愈。
伤风原有汗。以其有汗也。延至日久。不行解肌之法。汗出虽多。徒伤津液表终不解。转增烦渴。邪入于腑。饮水
即吐者。名曰水逆乃热邪积挟饮上之以故外水格而不入也。服五苓散。后频溉热汤得汗则表里俱解所以一举两得之也。
膀胱为津液之府。用以通调水道。则火热自化。而津液得全矣。
发汗后水药不得入口。为逆若更发汗。必吐下不止。
水药不得入口为逆。言水逆也。若更发汗。必吐下不止者。以其原有蓄积痰饮。发汗徒伤胃中清阳之气。必致中满。
若更与发汗。则水饮土蒸。而为吐逆下渗而为泄利矣。凡发汗药皆然。不独桂枝当禁。所以太阳水逆之证。不用表药。
惟五苓散以导水。服后随溉热汤以取汗。所谓两解表里之法也。
太阳病发汗。后大汗出。胃中干烦躁不得眠。欲得饮水者。少少与饮之。令胃气和则愈。若脉浮。小便不利微热消
渴者。与五苓散主之。
不行解肌。反行发汗。致津液内耗烦燥不眠。求救于水。若水入不解。脉转单浮则无他变。而邪还于表矣。脉浮本
当用桂枝。何以变用五苓耶。盖热邪得水虽不全解势必衰其大半。所以邪既还表其热亦微。兼以小便不利证成消渴。则
腑热全其故不单解而从两解也。
发汗已脉浮数烦渴者。五苓汤主之。
脉浮数而烦渴。则津液为热所耗而内躁里证具矣津液内耗宜用四苓以滋其内而加桂以解其外。则术用苍。桂用枝。
从可推矣。○凡方中用一桂字。不分桂枝肉桂者皆然。非独此也。
病在阳应以汗解之。反以冷水 之。若灌之。其热被劫不得去。弥更益烦。肉上粟起。意欲饮水反不渴者。服文蛤
散。若不瘥者。与五苓散。
此条旧与小陷胸白散。合为一条。殊不可解。盖表邪不从表散。反灌以水。劫其邪必致内伏或入少阴之经。或犯太
阳之本。故以二汤分主。按文蛤为止渴圣药。仲景取治。意欲饮水。而反不渴者。其意何居。盖水与邪气。渗入少阴之
经。以其经脉上循喉咙。故意欲饮水。缘邪尚在经中。未入于里。故反不渴。斯时不用咸寒。收阴泻阳使邪留变热必致
大渴引饮也。所以金匮云。渴欲饮水不止者文蛤散主之。则知文蛤专治内外水饮也。服文蛤不瘥知邪不在少阴之经定犯
膀胱之本。当与五苓散无疑。
身热皮粟不解。欲引衣自覆。若以水 之洗之。益令热不得出。当汗而不汗则烦。假令汗出已腹中痛。与芍药三两。
如上法。
身热皮粟不解。欲引衣自覆者。此热在皮肤。寒在骨髓也。法当汗出而解反 之洗之致令客热内伏不出。虽烦而复
畏寒似渴而仍不渴。似乎邪客少阴之经。及与文蛤散不瘥。其邪定匿膀胱故与五苓两解之法。服后汗出。而腹中反痛者。
此又因五苓里药。引阳邪内陷之故。但阳邪内陷。曷不用小建中。而反与芍药。又云如上法何耶。盖平日阴气内虚。阳
邪内陷之腹痛。当与小建中和之。误用承气下药。致阳邪内陷之腹痛。则宜桂枝加芍药和之。因五苓利水。而引阳邪内
陷之腹痛。仍用五苓加芍药和之三法总不离乎桂枝芍药也如上法者言。即入于先前所服之药内也。
伤寒汗出而渴者。五苓散主之。不渴者。茯苓甘草汤主之。
汗出而渴者。用五苓散。以邪气犯本。必小便不利也。若汗出不渴。而小便虽不利。知邪热 欲犯膀胱。而犹未
全犯本也。故用桂枝汤中之三。五苓散中之一。少示三表一里之意。为合剂耳。
太阳病小便利者。以饮水多。必心下悸。小便少者。必苦里急也。
小便利者。以饮水过多水与邪争必心下悸也。小便少者。必苦里急明是邪热足以消水。故指为里证已急也。观上条
不渴者。茯苓甘草汤主之。治法具矣。
以上风伤卫犯本。
太阳病不解。热结膀胱。其人如狂。血自下。下者愈。其外未解者。尚未可攻。当先解外。外解已。但少腹急结者
乃可攻之。宜桃核承气汤。
邪热搏血。结于膀胱。必怫腾。而侮心火。故其人如狂见心虽未狂。有似乎狂。以血为阴类。不似阳邪内结之狂越
也。血自下者。邪热不留。故愈。若小腹急结。则膀胱之血。虽蓄而不行。须先解外乃可攻。其攻法亦自不同。必用桃
仁增入承气。以达血所。仍加桂枝分解外邪。即如五苓大柴胡两解表里同义。
太阳病。六七日表证仍在脉微而沉。反不结胸。其人发狂者。以热在下焦。少腹当鞭满。小便自利者。下血乃愈。
所以然者。以太阳随经瘀热在里故也。抵当汤主之。
此条之证。较前条更重。且六七日表证仍在。曷为不先解其外耶。又曷为攻里药中。不兼加桂枝耶。以脉微而沉。
反不结胸。知邪不在上焦而在下焦也。若小肠鞭满。小便自利。则其人之发狂者。为血蓄下焦无疑。故下其血自愈。盖
邪结于胸。则用陷胸以涤余邪。结小腹。则用抵当汤以逐血。设非此法。则小腹所结之血。既不附气而行。更有何药可
破其坚垒哉。
太阳病。身黄脉沉结。少腹鞭小便不利者。为无血也。小便自利其人如狂者血证谛也。抵当汤主之。
血证为重证。抵当为重药。恐人当用而不敢用。故重申其义。言身黄脉沉结。少腹满三者。本为蓄血之证。然只见
此。尚与发黄相邻。必其人如狂。小便自利为血证无疑。设小便不利。乃热结膀胱无形之气。病为发黄之候也。其小便
自利。则膀胱之气化行。然后少腹结满者。允为有形之蓄血也。
伤寒有热少腹满应小便不利。今反利之为有血也。当下之。不可余药。宜抵当丸。
变汤为丸者。恐涤荡之不尽也。煮而连滓服之。与大陷胸丸同意。
以上伤寒营犯本。
中风发热。六七日不解而烦有表里证。渴欲饮水。水入即吐者。名曰水逆。五苓散主之。多饮暖火汗出愈。
中风（风邪袭表）导致发热，经过六七天病情未缓解，出现烦躁，且有表证和里证的表现。口渴想喝水，但水喝进去就吐出来，这种情况叫做“水逆”（因水饮内停、气化不利导致的呕吐）。主治用五苓散（利水渗湿、温阳化气方剂）。服药后多喝热水，待出汗即可痊愈。
伤风原有汗。以其有汗也。延至日久。不行解肌之法。汗出虽多。徒伤津液表终不解。转增烦渴。邪入于腑。饮水 即吐者。名曰水逆乃热邪积挟饮上之以故外水格而不入也。服五苓散。后频溉热汤得汗则表里俱解所以一举两得之也。 膀胱为津液之府。用以通调水道。则火热自化。而津液得全矣。
伤风本来就有汗出的症状。因为有汗出，拖延日久，如果不采用解肌（解除肌表邪气）的方法治疗，虽然汗出很多，却白白损伤了津液，表证始终不能解除，反而增加烦躁和口渴。邪气进入腑（此处指膀胱），喝水就吐，这叫“水逆”。这是因为热邪积聚并夹杂水饮上逆，导致外面的水被格拒而不能进入体内。服用五苓散后，频繁饮用热汤，得到汗出，这样表证和里证都能解除，所以是一举两得的办法。膀胱是津液汇聚的府库，用来通调水道，这样火热之气自然化解，津液得以保全。
发汗之后，连水和药都吃不下去，这属于逆证。如果再次发汗，必定会导致呕吐和下利不止。
水药不得入口为逆。言水逆也。若更发汗。必吐下不止者。以其原有蓄积痰饮。发汗徒伤胃中清阳之气。必致中满。 若更与发汗。则水饮土蒸。而为吐逆下渗而为泄利矣。凡发汗药皆然。不独桂枝当禁。所以太阳水逆之证。不用表药。 惟五苓散以导水。服后随溉热汤以取汗。所谓两解表里之法也。
水药不得入口称为逆，说的就是水逆证。如果再次发汗，必定导致吐泻不止，是因为患者原本就有蓄积的痰饮。发汗只会徒然损伤胃中的清阳之气，必然导致中焦胀满。如果再用发汗药，就会使水饮在体内如土中蒸腾一样，向上则为呕吐逆气，向下渗透则为泄泻。凡是发汗药都是如此，不仅仅是桂枝汤应当禁用。所以太阳病的水逆证，不使用解表的药物，只用五苓散来引导水饮排出。服药后随即饮用热汤以取汗，这就是所谓的表里双解的方法。
太阳病发汗。后大汗出。胃中干烦躁不得眠。欲得饮水者。少少与饮之。令胃气和则愈。若脉浮。小便不利微热消 渴者。与五苓散主之。
太阳病发汗后，大汗出，导致胃中干燥，烦躁无法入睡，想要喝水的，应少量多次地给予饮水，使胃气调和就能痊愈。如果脉象浮，小便不通利，轻微发热且极度口渴（消渴），主治用五苓散。
不行解肌。反行发汗。致津液内耗烦燥不眠。求救于水。若水入不解。脉转单浮则无他变。而邪还于表矣。脉浮本 当用桂枝。何以变用五苓耶。盖热邪得水虽不全解势必衰其大半。所以邪既还表其热亦微。兼以小便不利证成消渴。则 腑热全其故不单解而从两解也。
没有使用解肌法，反而使用发汗法，导致津液在内消耗，烦躁不眠，向水求救。如果喝水后症状不解，脉象转为单纯的浮脉，则没有其他变化，邪气回到了体表。脉浮本来应该用桂枝汤，为什么改用五苓散呢？因为热邪遇到水，虽然不能完全解除，但势必会衰退大半。所以邪气既然回到体表，热势也就轻微了。加上小便不利，证候形成消渴，那么腑热的情况依然存在，因此不单解表，而是采取表里双解的方法。
脉浮数而烦渴。则津液为热所耗而内躁里证具矣津液内耗宜用四苓以滋其内而加桂以解其外。则术用苍。桂用枝。 从可推矣。○凡方中用一桂字。不分桂枝肉桂者皆然。非独此也。
脉浮数且烦躁口渴，说明津液被热邪耗损，内部躁动，里证具备。津液内耗，适宜用四苓（茯苓、猪苓、泽泻、白术）来滋养内部，加上桂枝来解除外部邪气。那么白术应用苍术，桂枝应用桂枝，由此可以推断。○凡是方剂中使用“桂”字，不分桂枝或肉桂的情况都是这样的，不仅仅在此处如此。
病在阳应以汗解之。反以冷水 之。若灌之。其热被劫不得去。弥更益烦。肉上粟起。意欲饮水反不渴者。服文蛤 散。若不瘥者。与五苓散。
病在阳分（表证），应当用发汗法解除，反而用冷水喷洒或浇灌它。热气被遏制无法散去，更加烦躁，皮肤起鸡皮疙瘩，心里想喝水但实际上并不觉得渴，服用文蛤散。如果不好转，给予五苓散。
此条旧与小陷胸白散。合为一条。殊不可解。盖表邪不从表散。反灌以水。劫其邪必致内伏或入少阴之经。或犯太 阳之本。故以二汤分主。按文蛤为止渴圣药。仲景取治。意欲饮水。而反不渴者。其意何居。盖水与邪气。渗入少阴之 经。以其经脉上循喉咙。故意欲饮水。缘邪尚在经中。未入于里。故反不渴。斯时不用咸寒。收阴泻阳使邪留变热必致 大渴引饮也。所以金匮云。渴欲饮水不止者文蛤散主之。则知文蛤专治内外水饮也。服文蛤不瘥知邪不在少阴之经定犯 膀胱之本。当与五苓散无疑。
这一条以前常与小陷胸汤和白散合并为一条，非常难以理解。大概是因为表邪不从表发散，反而用水浇灌，遏制邪气，必然导致邪气内伏，或者侵入少阴经，或者侵犯太阳的本脏（膀胱）。所以用两种汤剂分别主治。据考证，文蛤是止渴的圣药，张仲景用它来治疗。心里想喝水却反而不觉得渴，这是什么原因呢？大概是水和邪气渗入少阴经，因为少阴经脉上行沿着喉咙，所以心里想喝水。由于邪气还在经络中，没有进入脏腑内部，所以反而不觉得渴。此时如果不使用咸寒之品，收敛阴气、泻除阳热，使邪气停留变为热邪，必然导致大渴引饮。所以《金匮要略》说：“渴欲饮水不止者，文蛤散主之。”由此可知文蛤专门治疗内外的水饮。服用文蛤散后如果不痊愈，就知道邪气不在少阴经，一定侵犯了膀胱的本脏，应当给予五苓散，这是毫无疑问的。
身热皮粟不解。欲引衣自覆。若以水 之洗之。益令热不得出。当汗而不汗则烦。假令汗出已腹中痛。与芍药三两。 如上法。
身体发热，皮肤起鸡皮疙瘩症状不缓解，想要拉过衣服覆盖自己。如果用冷水喷洒或洗涤它，更加使得热气无法散发。应当出汗而没有汗出，就会烦躁。假如出汗之后腹部疼痛，给予三两芍药。按照上面的方法处理。
身热皮粟不解。欲引衣自覆者。此热在皮肤。寒在骨髓也。法当汗出而解反 之洗之致令客热内伏不出。虽烦而复 畏寒似渴而仍不渴。似乎邪客少阴之经。及与文蛤散不瘥。其邪定匿膀胱故与五苓两解之法。服后汗出。而腹中反痛者。 此又因五苓里药。引阳邪内陷之故。但阳邪内陷。曷不用小建中。而反与芍药。又云如上法何耶。盖平日阴气内虚。阳 邪内陷之腹痛。当与小建中和之。误用承气下药。致阳邪内陷之腹痛。则宜桂枝加芍药和之。因五苓利水。而引阳邪内 陷之腹痛。仍用五苓加芍药和之三法总不离乎桂枝芍药也如上法者言。即入于先前所服之药内也。
身体发热，皮肤起鸡皮疙瘩不缓解，想要拉衣覆盖，这是热在皮肤，寒在骨髓。按理应当通过出汗来解除，反而用水洗涤，导致客热内伏不能外出。虽然烦躁却又怕冷，好像口渴但仍然不渴，似乎邪气客居于少阴经。等到给予文蛤散后不痊愈，邪气一定隐匿在膀胱，所以给予五苓散进行表里双解的治疗。服药后出汗，但腹部反而疼痛，这又是由于五苓散作为治里的药物，引导阳邪内陷的缘故。但是阳邪内陷，为什么不使用小建中汤，反而给予芍药呢？又说“如上法”是什么意思呢？大概是因为平时阴气内部虚弱，阳邪内陷引起的腹痛，应当用小建中汤来调和。如果是误用承气汤等下药，导致阳邪内陷引起的腹痛，则适宜用桂枝加芍药汤来调和。因为五苓散利水，从而引起阳邪内陷的腹痛，仍然使用五苓散加芍药来调和。这三种方法总离不开桂枝和芍药。“如上法”的意思是，将芍药加入之前所服的药方中一起服用。
伤寒出汗并且口渴的，主治用五苓散。不出口渴的，主治用茯苓甘草汤。
汗出而渴者。用五苓散。以邪气犯本。必小便不利也。若汗出不渴。而小便虽不利。知邪热 欲犯膀胱。而犹未 全犯本也。故用桂枝汤中之三。五苓散中之一。少示三表一里之意。为合剂耳。
出汗且口渴，使用五苓散，是因为邪气侵犯了膀胱之本，必然导致小便不利。如果出汗但不口渴，虽然小便也不利，知道邪热想要侵犯膀胱，但还没有完全侵犯根本。所以使用桂枝汤中的三味药（桂枝、甘草、生姜/大枣，此处指代解表部分）配合五苓散中的一味药（可能指代某种侧重，原文意指比例或配伍思路，实为强调表里兼顾），稍微展示“三表一里”的意思，作为合剂罢了。（注：此处张璐意在解释为何有时用桂枝汤加减，有时用五苓散，强调辨证细微差别）。
太阳病，小便通畅的，因为喝水过多，必然导致心下部悸动。小便少的，必然感到内部拘急痛苦。
小便利者。以饮水过多水与邪争必心下悸也。小便少者。必苦里急明是邪热足以消水。故指为里证已急也。观上条 不渴者。茯苓甘草汤主之。治法具矣。
小便通畅，是因为饮水过多，水与邪气相争，必然导致心下悸动。小便少，必然痛苦于里急，明确是邪热足以消耗水分，所以指出这是里证已经紧急。看上一条“不渴者，茯苓甘草汤主之”，治疗方法已经完备了。
以上风伤卫犯本。
以上是关于风邪伤害卫气并侵犯本脏的内容。
太阳病不解。热结膀胱。其人如狂。血自下。下者愈。其外未解者。尚未可攻。当先解外。外解已。但少腹急结者 乃可攻之。宜桃核承气汤。
太阳病没有解除，热邪结聚在膀胱，病人神志恍惚像发狂一样。如果瘀血自行下行，下行后就会痊愈。如果体表的邪气还没有解除，还不可以攻下。应当先解除表邪。表邪解除后，如果只是少腹拘急硬结，才可以攻下。适宜用桃核承气汤。
邪热搏血。结于膀胱。必怫腾。而侮心火。故其人如狂见心虽未狂。有似乎狂。以血为阴类。不似阳邪内结之狂越 也。血自下者。邪热不留。故愈。若小腹急结。则膀胱之血。虽蓄而不行。须先解外乃可攻。其攻法亦自不同。必用桃 仁增入承气。以达血所。仍加桂枝分解外邪。即如五苓大柴胡两解表里同义。
邪热与血液搏结，积聚在膀胱，必然郁滞沸腾，进而欺侮心火，所以病人神志恍惚像发狂。虽然心脏没有真正发狂，但看起来像发狂。因为血属于阴类，不像阳邪内结那样狂乱逾越。瘀血自行下行的，邪热就不会滞留，所以痊愈。如果小腹拘急硬结，那么膀胱中的瘀血，虽然蓄积但不能运行，必须先解除表邪然后才可以攻下。它的攻下方法也自然不同，必须加入桃仁到承气汤中，以达到瘀血所在之处，仍然加入桂枝来分解外部邪气，这就如同五苓散和大柴胡汤表里双解的意义相同。
太阳病。六七日表证仍在脉微而沉。反不结胸。其人发狂者。以热在下焦。少腹当鞭满。小便自利者。下血乃愈。 所以然者。以太阳随经瘀热在里故也。抵当汤主之。
太阳病，六七天了，表证仍然存在，脉象微而沉，反而没有结胸的症状。病人发狂的，是因为热邪在下焦，少腹部应当坚硬胀满。小便通畅的，排出瘀血才能痊愈。之所以这样，是因为太阳经的邪气随着经络入里，形成瘀热在里的缘故。主治用抵当汤。
此条之证。较前条更重。且六七日表证仍在。曷为不先解其外耶。又曷为攻里药中。不兼加桂枝耶。以脉微而沉。 反不结胸。知邪不在上焦而在下焦也。若小肠鞭满。小便自利。则其人之发狂者。为血蓄下焦无疑。故下其血自愈。盖 邪结于胸。则用陷胸以涤余邪。结小腹。则用抵当汤以逐血。设非此法。则小腹所结之血。既不附气而行。更有何药可 破其坚垒哉。
这一条的证候，比前一条更严重。而且六七天表证仍然存在，为什么不先解除表邪呢？又在攻里的药物中，为什么不兼加桂枝呢？因为脉象微而沉，反而没有结胸，知道邪气不在上焦而在下焦。如果少腹坚硬胀满，小便通畅，那么病人的发狂，无疑是瘀血蓄积在下焦。所以攻下瘀血就能痊愈。大概邪气结聚在胸膈，就用陷胸汤来涤荡残余邪气；结聚在小腹，就用抵当汤来驱逐瘀血。如果不是这种方法，那么结聚在小腹的瘀血，既然不依附气机运行，还有什么药能攻破这种坚固的壁垒呢？
太阳病。身黄脉沉结。少腹鞭小便不利者。为无血也。小便自利其人如狂者血证谛也。抵当汤主之。
太阳病，身体发黄，脉象沉结，少腹坚硬，小便不利的，是没有瘀血。小便通畅，病人神志恍惚像发狂的，才是确凿的瘀血证。主治用抵当汤。
血证为重证。抵当为重药。恐人当用而不敢用。故重申其义。言身黄脉沉结。少腹满三者。本为蓄血之证。然只见 此。尚与发黄相邻。必其人如狂。小便自利为血证无疑。设小便不利。乃热结膀胱无形之气。病为发黄之候也。其小便 自利。则膀胱之气化行。然后少腹结满者。允为有形之蓄血也。
瘀血证是重症，抵当汤是重剂。担心人们该用而不敢用，所以重申其中的道理。说身体发黄、脉象沉结、少腹满这三者，本来是蓄血证的迹象。然而只看到这些，还与发黄证相近。必须病人神志恍惚像发狂，且小便通畅，才是确凿的瘀血证。假设小便不利，那是热邪结聚在膀胱无形的和气，病症表现为发黄的征候。如果小便通畅，那么膀胱的气化功能正常，然后少腹结满的，确实是形质的蓄血。
伤寒有热少腹满应小便不利。今反利之为有血也。当下之。不可余药。宜抵当丸。
伤寒有热，少腹满，应该小便不利。现在反而小便通畅，这是有瘀血。应当攻下它，不能用其他药物，适宜用抵当丸。
变汤为丸者。恐涤荡之不尽也。煮而连滓服之。与大陷胸丸同意。
将汤剂改为丸剂，是担心涤荡之力不够猛烈（或过于峻猛伤正，此处意为缓攻）。煮过后连同药渣一起服用，这与大陷胸丸的意义相同。
以上伤寒营犯本。
以上是关于伤寒营分受邪并侵犯本脏的内容。
Wind-stroke (Fengzhong, a pattern of exterior deficiency with sweating) causes fever. If it persists for six or seven days without resolution and is accompanied by irritability, presenting both exterior and interior signs, where the patient desires to drink water but vomits immediately after swallowing, this condition is named "Water Reversal" (Shuini, vomiting due to water retention and failed qi transformation). It is primarily treated with Wuling San (Five-Ingredient Powder with Poria). After taking the medicine, drinking plenty of warm water to induce sweating will lead to recovery.
Wind-stroke originally presents with sweating. Because sweating occurs, if left untreated for a long time without employing methods to release the muscle layer (Jieji), excessive sweating merely damages body fluids without resolving the exterior pathogen. This exacerbates irritability and thirst. When the pathogen enters the fu organs (specifically the Bladder), causing immediate vomiting upon drinking water, it is called "Water Reversal." This occurs because heat pathogens accumulate and carry fluid retention upward, causing external water to be rejected and unable to enter. Taking Wuling San, followed by frequent intake of hot soup to induce sweating, resolves both the exterior and interior simultaneously, achieving two goals with one action. The Bladder is the mansion of body fluids, responsible for regulating water passages; thus, fire and heat are naturally transformed, and body fluids are preserved.
After inducing sweating, if neither water nor medicine can be tolerated, it is considered a reversal syndrome (Ni). If sweating is induced again, it will inevitably lead to incessant vomiting and diarrhea.
The inability to take in water or medicine constitutes a reversal, referring to Water Reversal. If sweating is induced again, leading to incessant vomiting and diarrhea, it is because the patient already has accumulated phlegm-fluids. Inducing sweating merely damages the clear yang qi in the stomach, inevitably causing middle jiao fullness. Further use of diaphoretic drugs causes fluids and dampness to steam like earth, leading to upward vomiting and downward leakage as diarrhea. This applies to all diaphoretic drugs, not just Guizhi Tang. Therefore, for Taiyang Water Reversal, exterior-releasing drugs are not used; only Wuling San is used to guide out the water. Drinking hot soup after administration induces sweating, which is the method of simultaneous resolution of the exterior and interior.
In Taiyang disease, after inducing sweating, if profuse sweating occurs, causing dryness in the stomach, irritability, insomnia, and a desire to drink water, give small amounts of water frequently. Recovery occurs when the stomach qi harmonizes. However, if the pulse is floating, urination is difficult, there is slight fever, and extreme thirst (Xiaoke), treat primarily with Wuling San.
Failure to use muscle-releasing methods and instead using diaphoresis consumes internal body fluids, causing irritability and insomnia, leading the patient to seek relief from water. If drinking water does not resolve symptoms, and the pulse becomes purely floating, there are no other changes, and the pathogen returns to the exterior. A floating pulse typically indicates the use of Guizhi Tang; why change to Wuling San? Heat pathogens interacting with water may not fully resolve but will significantly diminish. Since the pathogen returns to the exterior, the heat is mild. Combined with difficulty in urination and symptoms of extreme thirst, the interior heat remains. Thus, rather than treating the exterior alone, a simultaneous exterior-interior resolution is employed.
After inducing sweating, if the pulse is floating and rapid with irritability and thirst, treat primarily with Wuling Tang (Wuling San).
A floating, rapid pulse with irritability and thirst indicates that body fluids are consumed by heat, causing internal agitation and establishing interior signs. For consumed body fluids, Si Ling (Four-Poria Powder) nourishes the interior, while adding Guizhi releases the exterior. Consequently, Baizhu should be Cangzhu, and Gui should be Guizhi, which can be deduced. ○ Whenever "Gui" appears in formulas, distinguishing between Guizhi (Cinnamon Twig) and Rougui (Cinnamon Bark) is generally unnecessary; this applies here as well.
When the disease is in the Yang (exterior), it should be resolved by sweating. Instead, if cold water is sprayed or poured on the patient, the heat is constrained and cannot escape, increasing irritability. Gooseflesh appears on the skin. The patient feels the desire to drink water but actually lacks thirst. Treat with Wen Ge San (Clam Shell Powder). If there is no improvement, administer Wuling San.
This clause was historically combined with Xiao Xian Xiong Bai San, which is hard to understand. Since the exterior pathogen did not disperse from the exterior but was suppressed by water, the pathogen must have become internalized, either entering the Shaoyin meridian or attacking the root of Taiyang. Hence, two decoctions are used respectively. Wen Ge (Clam Shell) is a supreme remedy for thirst. Zhang Zhongjing uses it for cases where there is a desire to drink but no actual thirst. Why? Water and pathogenic factors infiltrate the Shaoyin meridian, whose channel runs up along the throat, hence the desire to drink. Since the pathogen is still in the channel and has not entered the interior, there is no actual thirst. At this time, if salty-cold herbs are not used to collect yin and drain yang, allowing the pathogen to linger and transform into heat, it will result in extreme thirst requiring large volumes of water. Thus, the *Jingui Yaolue* states: "For those who desire to drink water incessantly, Wen Ge San is primary." This indicates Wen Ge specifically treats internal and external fluid retention. If Wen Ge San fails, it indicates the pathogen is not in the Shaoyin meridian but has attacked the root of the Bladder, so Wuling San is undoubtedly indicated.
If body heat and gooseflesh persist without resolution, and the patient desires to cover themselves with clothes, spraying or washing with water further prevents heat dissipation. If sweating should occur but does not, irritability arises. If sweating occurs and is followed by abdominal pain, administer three liang of Shaoyao (Peony Root). Follow the method above.
Persistent body heat and gooseflesh with a desire to cover oneself indicate heat in the skin and cold in the bone marrow. The proper method is resolution through sweating. Washing with water causes external heat to become internalized and trapped. Although irritable and fearing cold, resembling thirst but not actually thirsty, it seems the pathogen is in the Shaoyin meridian. If Wen Ge San fails, the pathogen is definitely hidden in the Bladder, so the dual-resolution method of Wuling San is used. After taking it, if sweating occurs but abdominal pain arises, this is due to the interior-acting nature of Wuling San drawing the yang pathogen inward. However, for inwardly fallen yang pathogen causing abdominal pain, why not use Xiao Jian Zhong Tang but instead Shaoyao? And what does "follow the method above" mean? Generally, if internal yin qi is deficient and yang pathogen falls inward causing abdominal pain, Xiao Jian Zhong Tang should harmonize it. If mistaken use of Chengqi purgatives caused inward fall of yang pathogen and abdominal pain, Guizhi Jia Shaoyao Tang should harmonize it. Since Wuling San promotes urination and draws the yang pathogen inward, causing abdominal pain, Wuling San plus Shaoyao should still be used to harmonize. These three methods all revolve around Guizhi and Shaoyao. "Follow the method above" means adding the herb to the previously administered formula.
In Shanghan (Cold Damage), if sweating is accompanied by thirst, treat primarily with Wuling San. If there is no thirst, treat primarily with Fuling Gancao Tang.
Sweating with thirst indicates Wuling San is used because the pathogen has attacked the root (Bladder), inevitably causing difficulty in urination. If sweating occurs without thirst, although urination is difficult, it indicates the pathogenic heat intends to attack the Bladder but has not fully attacked the root. Thus, using three parts from Guizhi Tang and one part from Wuling San subtly indicates a ratio of three exterior to one interior, serving as a combined preparation.
In Taiyang disease, if urination is free, due to excessive water intake, there will likely be palpitations in the epigastrium. If urination is scanty, there will likely be distressing urgency in the interior.
Free urination with excessive water intake leads to water fighting with the pathogen, causing epigastric palpitations. Scanty urination with distressing interior urgency clearly indicates pathogenic heat consuming water, marking an urgent interior syndrome. Observing the previous clause, "no thirst, treat with Fuling Gancao Tang," the treatment method is complete.
Above: Wind damaging Wei and attacking the root.
If Taiyang disease does not resolve, heat knots in the Bladder. The patient appears manic. If blood passes spontaneously, the patient recovers. If the exterior is not yet resolved, attack is not yet permissible. One must first resolve the exterior. Once the exterior is resolved, if only the lower abdomen is tense and knotted, then attack is permissible. Taohe Chengqi Tang is appropriate.
Pathogenic heat combats blood, knotting in the Bladder, causing stagnation and harassing Heart Fire, so the patient appears manic. Although the Heart is not truly manic, it resembles mania. Blood belongs to Yin, unlike the wild excess of internal Yang pathogen. If blood passes spontaneously, pathogenic heat does not remain, so recovery occurs. If the lower abdomen is tense and knotted, blood in the Bladder is stored but not moving. Exterior must be resolved first before attacking. The method of attack differs; one must add Taoren (Peach Kernel) to Chengqi to reach the blood location, still adding Guizhi to resolve external pathogen. This is similar in meaning to the dual resolution of exterior and interior in Wuling San and Da Chaihu Tang.
In Taiyang disease, after six or seven days, if exterior signs remain, the pulse is faint and deep, and contrary to expectation, there is no chest binding. If the patient is manic, it is because heat is in the Lower Jiao. The lower abdomen should be hard and full. If urination is free, passing blood leads to recovery. The reason is that Taiyang pathogen follows the meridian, creating stasis-heat in the interior. Dishuidang Tang is primary.
The syndrome in this clause is more severe than the previous one. With exterior signs remaining after six or seven days, why not resolve the exterior first? Why not add Guizhi to the interior-attacking medicine? The faint, deep pulse and absence of chest binding indicate the pathogen is not in the Upper Jiao but in the Lower Jiao. If the lower abdomen is hard and full, and urination is free, the mania is undoubtedly due to blood stasis in the Lower Jiao. Thus, evacuating blood leads to recovery. Pathogen knotting in the chest uses Xianxiong Tang to cleanse residual pathogen; knotting in the lower abdomen uses Dishuidang Tang to purge blood. Without this method, the blood knotted in the lower abdomen, not moving with qi, would be impregnable.
In Taiyang disease, if the body is yellow, the pulse is deep and knotted, the lower abdomen is hard, and urination is difficult, there is no blood stasis. If urination is free and the patient appears manic, it is definitively a blood stasis syndrome. Dishuidang Tang is primary.
Blood stasis syndromes are severe; Dishuidang is a heavy medicine. To prevent hesitation in its use, the principle is reiterated. Body yellow, deep knotted pulse, and lower abdominal fullness are signs of blood storage. However, seeing only these is close to jaundice. Only with mania and free urination is it undeniably blood stasis. If urination is difficult, it is heat knotting in the Bladder's formless qi, presenting as jaundice. If urination is free, Bladder qi transformation functions, making the lower abdominal fullness definitively formed blood stasis.
In Shanghan, with heat and lower abdominal fullness, urination should be difficult. If it is now free, it indicates blood stasis. It must be purged. Do not use other medicines; Dishuidang Wan (Pill) is appropriate.
Changing from decoction to pill is to avoid overly vigorous scouring. Boiling and taking with the dregs aligns with the intent of Daxiexiong Wan.
Above: Shanghan Ying damaging the root.