其后人有脉紧如转索无常者。有宿食也。脉紧头痛有风寒。腹中有宿食不化也。二条者但言宿食而不言下之者。以其兼
见外因之脉证。则当从外因例治矣。
下利瘥后至其年月日复发者。以病不尽也当下之。
此条世本。尚有宜大承气汤五字。衍文也。故去之详未尽之邪。可以留伏经年而发。必系寒邪。寒邪惟可备急丸温
下。不应大承筑寒下也。设属热邪必无经年久伏之理。
以上宿食例。
动气在右。不可发汗。发汗则衄而渴。心苦烦饮即吐水。
动气者。筑筑然气动也。在右者。气动于脐之右也发汗则动肺气。气虚则不能护卫。其血故妄行。而为衄。衄则亡
津胃燥。故渴而心中苦烦若更饮水伤其肺胃。故饮即吐水也。
动气在左。不可发汗。发汗则头眩汗不止筋惕肉 。发汗汗不止亡阳外虚故头眩筋惕肉 也。
动气在上不可发汗。发汗则气上冲正在心端。
发汗亡阳则愈损心气肾乘心虚欲上凌心。故气上冲正在心端也。
动气在下不可发汗。发汗则无汗。心中大烦。骨节苦疼。目运恶寒。食则反吐。谷不得前。
发汗则无汗者。肾水不足也。心中大烦者。肾虚不能制心火也。骨节疼目运恶寒。皆为肾病。王太仆云。食入反出
是无火也。当补肾脏真阳为主。
动气在右。不可下。下之。则津液内竭咽燥鼻干头眩心悸也。
下之伤胃动肺。咽燥鼻干者。津液内竭而喜引饮也。头眩心悸者。水饮伤肺心主不宁。而烦悸眩晕也。
动气在左。不可下。下之则腹内拘急。食不下。动气更剧虽有身热。卧则欲蜷。
腹内拘急。食不下。动气更剧下之损脾。而肝气复行于脾也。虽有身热卧则欲蜷者。表热里寒也。
动气在上不可下。下之则掌握热烦。身上浮冷。热汗自泄。欲得水自灌。
下之掌握热烦言掌中虽热而握固不伸也身上浮冷。热汗自泄。欲得水自灌表寒里热也。
动气在下。不可下。下之则腹胀满卒起头眩。食则下清谷心下痞也。
腹满头眩。下清谷心下痞以下之伤脾肾气则动。肾邪凌心也。
按动气本因脾土衰弱。不能约制肾水。水饮凝结而成虽水乘上位之微邪。而仲景汗。下俱禁者。以汗下必先动脾之
津液。故东垣每以验脾之盛衰凡按之牢若痛者。即动气也。动气本属脾疾。四脏中某脏之虚。即乘其部而见之。所以误
汗。则伤阳。阳伤则邪并于气。故吐衄呕逆。眩晕气逆上奔。误下则伤阴阴伤则虚阳无制。故虽发热。而蜷卧。当握不
伸。皆胃气虚寒困惫之候。至于病患。素有积聚连在脐旁。亦曰。动气汗下。尤不可犯。通宜理中去术加桂苓为主以茯
苓利水。桂泄奔豚故宜加用。白术滞气故去之。然久病脾气衰极而无客邪者。生术以附子制用。亦无妨碍。更须参以所
见之证为主盖不必拘活人书等方药也。
以上动气例。
问曰。病有霍乱者何。答曰。呕吐而利名霍乱。
霍乱者。三焦混乱清浊相干。阴阳乖隔寒热偏胜以致吐逆。泄利。甚则转筋厥逆。而为挥霍撩乱也。
问曰。病发热头痛身疼。恶寒吐利者。此属何病。答曰。此名霍乱。自吐已又利止复更发热也。
病发热头痛身疼。恶寒本为外感风寒。内伤生冷。故吐利霍乱。今吐已利止。又复发热。知内邪得泄而外感未除也。
即当微清。便自调后。身疼痛急当救表例治之。
霍乱头痛发热身疼痛热多欲饮水者。五苓散主之。寒多不用水者。理中丸主之。
霍乱头痛发热身疼。外感也。加以欲饮水。热邪入里。故用五苓两解表里若不用水者。知里有寒邪。故用干姜之辛。
以温中散邪参术甘草之甘以扶阳。益气甘得辛而不滞。辛得甘而不燥。辛甘合用。以理中气之虚滞。盖吐利并作当以里
证为急也。
若脐上策者。肾气动也。去术加桂四两。吐多者去术。加生姜三两。下多者还用术。悸者加茯苓二两。渴欲得水者。
加术足前成四两半。腹中痛者。加人参。足前成四两半。寒甚者加干姜足前成四两半。腹满者去术加附子一枚。服汤后
如食顷饮热粥一升许。微自温勿发揭衣被。
脐筑吐逆腹满。三者俱属气病。以术性壅滞不利于气故去之。然下多虽有筑呕不妨从权。用术以助中上约制肾邪为
要且下多气已滞甚。纵有筑呕在所不计也。而悸者但加茯苓。仍不去术以悸为停水。与气无预。况术得参。同有利水生
津之绩。故不去也。其渴欲得水之加术。寒加干姜呕加生姜脐上筑加桂悸加茯苓。皆人所易明。若夫腹满加附。腹痛加
参。非讲明有素不知也。盖人身背为阳。腹为阴。所以阳邪内陷。则结胸阴邪内结则腹满。非籍附子雄悍之力。何以破
其阴邪之固结乎。而腹中痛者。尤为阴邪无疑其在太阳本邪凌上。则用小建中汤和其阴。分之阳邪况在阴经者。不温补
其阳。和之气何以胜任其除邪之冲激耶。○霍乱为胃逆禁犯谷气。犯之则胃逆不复。此言服汤后如食顷。饮热粥一升。
许是言服理中汤大法非指霍乱为言也。
吐利止而身痛不休者。当消息和解其外宜桂枝汤小和之。
吐利止而身痛不休外邪未解也。当消息和解。其外言当辨外邪之微甚制汤剂之大小也。盖吐下骤虚虽夏月不妨。桂
枝汤以和其营。
吐利发汗。脉平小烦者。以身虚不胜谷气实也。
霍乱吐利 时内不可便与饮食。以胃气逆反故即愈后脉平小烦者。尤当节慎饮食。以仓廪未固。不可便置米谷耳。
以上霍乱例。
大病瘥后劳复者枳实栀子豉汤主之。若有宿食者。加大黄如博棋子大五六枚。
劳复乃起居作劳复生余热之病方注作女劳。复大谬。女劳复者。自犯伤寒后御女之大戒。多死少生。岂有反用泻泄
之理太阳下编下。后身热或汗吐下。后虚烦无奈用本汤之苦。以吐撒其邪。此非用吐法也。乃加枳实于栀子豉中。以发
其微汗。而祛胸中虚热至内经火淫所胜以苦发之之义。若有宿食留结。急加大黄下夺之。不可稍延则热持不去。真阴益
困矣。观方中用清浆水七升空煮至四升。然后入药同煮全是欲其水之熟而趋下不至上涌耳。所以又云覆令微似汗。精义
入神。
伤寒瘥已后更发热者。小柴胡汤主之。脉浮者以汗解之。脉沉实者以下解之。
瘥已后更发热。乃余热在内以热召热也。然余热要当辨其何在。不可泛然施治。以虚其虚。如在半表半里则仍用小
柴胡汤和解之。法如在表则仍用汗法如在里则仍用下法。即互上条汗用枳实栀子豉微汗之下用枳实栀子豉加大黄微下之。
大病瘥后。从腰以下有水气者。牡蛎泽泻散主之。
腰以下有水气者。水渍为肿也。金匮曰。腰以下肿。当利小便。此定法矣。乃大病后脾土告困不能摄水。以致水气
泛溢。用牡蛎泽泻散峻攻。何反罔顾其虚耶。正因水分未犯。身半以上急驱其水所全甚大。设用轻剂则阴水必袭入阳界
驱之无及矣。
大病瘥后。喜唾久不了了者。胃上有寒。当以丸药温之。宜理中丸。
身中津液因胃中寒气凝结而成浊唾。久而不清其人必消瘦索。泽故不用汤药。荡涤而用丸药缓图也。理中丸乃驱分
阴阳温补脾胃之善药然仲景瘥后外邪已尽才用其方在太阳邪炽之日不得已合桂枝用之即更其名曰。桂枝人参汤。金匮于
胸痹证则名之曰人参汤。于此见其立方命名之义矣。○伤寒瘥后体虚。每有遗热。故禁温补。即问有素禀虚寒。于中气
寒者。止宜理中丸调理。未尝轻用桂附也。
伤寒解后。虚羸少气。气逆欲吐者。竹叶石膏汤主之。
身中津液。为热邪所耗。余热不清。必致虚羸。少气难于康静。若更气逆。欲吐是余热复挟津液滋扰故用竹叶石膏
汤以益气。清热散逆气也。○按此汤。即人参白虎去知母而益半夏麦冬竹叶也。病后虚烦少气为余热未尽。故加麦冬竹
叶于人参甘草之温中益气药中以清热生津。加半夏者。痰饮上逆欲呕故也。病后余热。与伏气发温不同。故不用知母以
伐少阴也。
病患脉已解而日暮微烦。以病新瘥人。强与谷脾胃气尚弱不能消谷。故令微烦损谷则愈。
病后食谷。微烦谓之食郁。减食自愈。以胃气新虚。不能胜谷也。即有余热未尽。当静养以俟津回。不治而治也即
不获已用药。须平淡处方不使药力胜气。则可即如草木凋瘁。必须时时微涧。助其生发。若恣意壅灌。则立槁矣。至于
虚而有邪者。又须峻利急攻。稍不尽邪乘虚内入不救矣。
伤寒阴阳易之为病。其人身体重少气少腹里急或引阴中拘学热上冲胸。头重不欲举。眼中生花膝胫拘急者。烧 散
主之。
阴阳易之病注家不明言。乃致后人。指为女劳复。大谬若然。则妇人病新瘥。与男子交。为男劳复乎。盖病伤寒之
人。热毒藏于气血中者渐从表里解散。惟热毒藏于精髓之中者。无由发泄。故瘥后与不病之体交接。男病传不病之女。
女病传不病之男。所以名为阴阳易。即交易之义也。其证眼中生花。身重拘急少腹痛。引阴筋。暴受阴毒。又非桂附辛
热所能驱。故烧 裆为散。以其人平昔所出之败。浊同气相求服之小便得利。阴头微肿。阴毒仍从阴窍出耳。
以上瘥后诸复阴阳易。
此后有人出现脉象紧如转索、变化无常的情况，这是有宿食。脉紧且头痛，是有风寒；腹中有宿食不消化。这两条只说了宿食而没有说用下法，是因为兼见外感的脉证，所以应当按外感病的例子来治疗。
腹泻痊愈后，到了原来的年月日又复发，是因为病邪没有除尽，应当用下法。
这一条在世俗版本中，还有“宜大承气汤”五个字，是衍文（多余的文字），所以去掉它。详细分析未尽的邪气，可以留伏经年而发作，必定是寒邪。寒邪只能用备急丸温下，不应用大承气汤寒下。如果属于热邪，必然没有经年久伏的道理。
以上列举了宿食的病例。
动气在右侧，不可发汗。发汗则会导致鼻出血且口渴，心中苦烦，喝水即吐水。
动气，是指腹部筑筑然跳动的感觉。在右侧，是指气动在肚脐的右边。发汗会扰动肺气，气虚则不能护卫体表，血液因此妄行，导致鼻衄。鼻衄则津液亡失，胃燥，所以口渴且心中苦烦。如果再饮水损伤肺胃，所以喝水即吐水。
动气在左侧，不可发汗。发汗则头晕，汗出不止，筋脉跳动，肌肉瞤动。发汗汗出不止，亡阳且外虚，所以头晕、筋脉跳动、肌肉瞤动。
动气在上方，不可发汗。发汗则气上冲，直冲在心尖处。
发汗亡阳，则更损心气，肾气乘心气虚弱欲上凌心，所以气上冲直在心尖处。
动气在下方，不可发汗。发汗则无汗，心中大烦，骨节痛苦疼痛，目眩恶寒，进食反而呕吐，食物无法下行。
发汗而无汗，是因为肾水不足。心中大烦，是因为肾虚不能制约心火。骨节疼、目眩、恶寒，都是肾病。王太仆说：“食入反出是无火也。”应当以补肾脏真阳为主。
动气在右侧，不可用下法。用下法，则津液内竭，咽干鼻燥，头晕心悸。
下法伤胃动肺，咽干鼻燥，是津液内竭而喜欢引饮。头晕心悸，是水饮伤肺，心主不宁，而烦悸眩晕。
动气在左侧，不可用下法。用下法则腹内拘急，饮食不下，动气更加剧烈，即使身体发热，躺下时想蜷缩。
腹内拘急，饮食不下，动气更加剧烈，是下法损伤脾脏，而肝气复行于脾。即使身体发热，躺下想蜷缩，是表热里寒。
动气在上方，不可用下法。用下法则手掌发热心烦，身上浮冷，热汗自出，想要用水浇身。
下法导致手掌发热心烦，是说掌中虽热但握拳不伸。身上浮冷，热汗自出，想要用水浇身，是表寒里热。
动气在下方，不可用下法。用下法则腹胀满，突然起身头晕，进食则排出未消化的食物，心下痞塞。
腹满、头眩、下利清谷、心下痞，是因为下法损伤脾肾之气则动气发作，肾邪凌心。
按：动气本因脾土衰弱，不能约制肾水，水饮凝结而成。虽然是水气上乘上位的微邪，但张仲景对汗法和下法都禁止，是因为汗下必先动摇脾之津液，所以李东垣常以此检验脾气的盛衰。凡是按之坚硬若痛者，就是动气。动气本属脾疾，四脏中哪一脏虚弱，就侵犯其部位而显现。所以误用汗法，则伤阳，阳伤则邪并入气，所以呕吐、鼻衄、呕逆、眩晕、气逆上奔。误用下法，则伤阴，阴伤则虚阳无制，所以虽然发热，却蜷卧，手握拳不伸，这都是胃气虚寒困惫的征候。至于病人素有积聚连在脐旁，也称为动气，汗法和下法尤其不可犯。通宜用理中汤去白术加桂枝、茯苓为主，以茯苓利水，桂枝泄奔豚，所以宜加用。白术滞气，所以去掉。然而久病脾气衰极且无客邪者，用生白术配附子制用，也没有妨碍。更须参看所见的证候为主，大概不必拘泥于《活人书》等方药。
以上列举了动气的病例。
问：什么是霍乱？答：呕吐且腹泻称为霍乱。
霍乱，是三焦混乱，清浊相干，阴阳乖隔，寒热偏胜，以致吐逆、泄利，甚至转筋厥逆，而为挥霍撩乱。
问：病发热、头痛、身疼、恶寒、吐利的，这是什么病？答：这称为霍乱。自己呕吐之后又腹泻停止，却又再次发热。
病发热、头痛、身疼、恶寒，本是外感风寒，内伤生冷，所以吐利霍乱。现在呕吐已止，腹泻停止，又再次发热，知道内邪得泄而外感未除。
此时应当轻微清热，便自调护。后来身体疼痛，急当救表，按例治疗。
霍乱头痛、发热、身疼痛，热多欲饮水的，用五苓散主治。寒多不用水的，用理中丸主治。
霍乱头痛、发热、身疼，是外感。加上欲饮水，是热邪入里，所以用五苓散两解表里。若不用水，知道里有寒邪，所以用干姜的辛味，以温中散邪；人参、白术、甘草的甘味，以扶阳益气。甘得辛而不滞，辛得甘而不燥。辛甘合用，以调理中气的虚滞。因为吐利并作，当以里证为急。
如果脐上筑动者，是肾气动，去掉白术，加桂枝四两。呕吐多的，去掉白术，加生姜三两。腹泻多的，还用白术。心悸的，加茯苓二两。渴欲饮水的，加白术足前成四两半。腹中痛的，加人参，足前成四两半。寒严重的，加干姜，足前成四两半。腹满的，去掉白术，加附子一枚。服药后如吃饭一顿饭的时间，喝热粥一升左右，微微自温，不要掀开衣被。
脐上筑动、吐逆、腹满，三者都属于气病，因为白术性壅滞不利于气，所以去掉它。然而腹泻多，虽然有筑动感、呕吐，不妨从权变，用白术以助中上约制肾邪为要。况且腹泻多气已滞甚，纵有筑动感、呕吐也在所不计。而心悸者只加茯苓，仍不去白术，因为心悸是停水，与气无关。况且白术得人参加同有利水生津的功效，所以不去。其渴欲饮水的加白术，寒重的加干姜，呕吐加生姜，脐上筑动加桂枝，心悸加茯苓，都是人们容易明白的。至于腹满加附子，腹痛加人参，不是讲明医理素来深入的人不知道。盖人身背为阳，腹为阴，所以阳邪内陷，则结胸；阴邪内结则腹满。不借助附子雄悍之力，怎么能破除阴邪的固结呢？而腹中痛者，更是阴邪无疑。其在太阳本邪凌上，则用小建中汤和其阴，分之阳邪。何况在阴经者，不温补其阳，调和之气，怎么能胜任其除邪的冲激呢？○霍乱为胃气上逆，禁犯谷气，犯了则胃逆不复。这里说服药后如吃饭一顿饭的时间，喝热粥一升许，是说服用理中汤的大法，并非指霍乱本身而言。
呕吐腹泻停止而身体疼痛不休的，应当斟酌和解其外，宜用桂枝汤小和之。
呕吐腹泻停止而身体疼痛不休，是外邪未解。应当斟酌和解其外，是说应当辨别外邪的微甚，制定汤剂的大小。因为吐下骤虚，即使是夏天也不妨用桂枝汤以和其营卫。
呕吐腹泻后，脉平，轻微心烦的，是因为身体虚弱不胜谷气实。
霍乱呕吐腹泻时，内部不可便给饮食，因为胃气逆反。所以即使痊愈后脉平轻微心烦，尤当节制谨慎饮食，因为仓廪未固，不可便置米谷耳。
以上列举了霍乱的病例。
大病瘥后劳复的，用枳实栀子豉汤主治。如果有宿食的，加大黄如博棋子大五六枚。
劳复乃起居作劳复生余热之病。“方注”作“女劳复”，大谬。女劳复者，是自犯伤寒后御女的极大禁忌，多死少生，岂有反而用泻泄的道理？太阳下编下篇后身热，或汗、吐、下后虚烦无奈，用本汤之苦以吐撒其邪，此非用吐法也。乃是加枳实于栀子豉中，以发其微汗，而祛胸中虚热，至《内经》“火淫所胜，以苦发之”之义。如果有宿食留结，急加大黄下夺之，不可稍延，则热持不去，真阴益困矣。观方中用清浆水七升空煮至四升，然后入药同煮，全是欲其水之熟而趋下不至上涌耳。所以又说“覆令微似汗”，精义入神。
伤寒瘥已后更发热者，用小柴胡汤主治。脉浮的用汗法解之，脉沉实的用下法解之。
瘥已后更发热，是余热在内，以热召热。然而余热要当辨其何在，不可泛然施治，以虚其虚。如在半表半里则仍用小柴胡汤和解之法。如在表则仍用汗法，如在里则仍用下法。即互用上条，汗用枳实栀子豉微汗之下，用枳实栀子豉加大黄微下之。
大病瘥后，从腰以下有水气的，用牡蛎泽泻散主治。
腰以下有水气，是水渍为肿。《金匮》说：“腰以下肿，当利小便。”这是定法。乃是大病后脾土告困，不能摄水，以致水气泛溢。用牡蛎泽泻散峻攻，何反罔顾其虚耶？正因水分未犯，身半以上急驱其水，所全甚大。设用轻剂则阴水必袭入阳界，驱之无及矣。
大病瘥后，喜唾久不了了者，是胃上有寒，当以丸药温之，宜理中丸。
身中津液因胃中寒气凝结而成浊唾，久而不清，其人必消瘦索泽，故不用汤药荡涤，而用丸药缓图。理中丸乃驱分阴阳、温补脾胃之善药。然张仲景在瘥后外邪已尽才用其方，在太阳邪炽之日，不得已合桂枝用之，即更其名曰桂枝人参汤。《金匮》于胸痹证则名之曰人参汤。于此见其立方命名之义矣。○伤寒瘥后体虚，每有遗热，故禁温补。即问有素禀虚寒，于中气寒者，止宜理中丸调理，未尝轻用桂附也。
伤寒解后，虚羸少气，气逆欲吐者，用竹叶石膏汤主治。
身中津液，为热邪所耗，余热不清，必致虚羸，少气难于康静。若更气逆欲吐，是余热复挟津液滋扰，故用竹叶石膏汤以益气、清热、散逆气。○按此汤，即人参白虎汤去知母而益半夏、麦冬、竹叶。病后虚烦少气为余热未尽，故加麦冬、竹叶于人参、甘草之温中益气药中以清热生津。加半夏者，痰饮上逆欲呕故也。病后余热，与伏气发温不同，故不用知母以伐少阴也。
病患脉已解而日暮微烦，是因为病新瘥人，强与谷，脾胃气尚弱，不能消谷，故令微烦，损谷则愈。
病后食谷，微烦谓之食郁，减食自愈，因为胃气新虚，不能胜谷。即有余热未尽，当静养以俟津回，不治而治也。即不获已用药，须平淡处方，不使药力胜气，则可。即如草木凋瘁，必须时时微涧，助其生发。若恣意壅灌，则立槁矣。至于虚而有邪者，又须峻利急攻，稍不尽邪乘虚内入不救矣。
伤寒阴阳易之为病，其人身体重，少气，少腹里急，或引阴中拘挛，热上冲胸，头重不欲举，眼中生花，膝胫拘急者，用烧裈散主治。
阴阳易之病，注家不明言，乃致后人指为女劳复，大谬。若然，则妇人病新瘥，与男子交，为男劳复乎？盖病伤寒之人，热毒藏于气血中者，渐从表里解散，惟热毒藏于精髓之中者，无由发泄。故瘥后与不病之体交接，男病传不病之女，女病传不病之男，所以名为阴阳易，即交易之义也。其证眼中生花，身重拘急，少腹痛，引阴筋，暴受阴毒，又非桂附辛热所能驱，故烧裈裆为散，以其人平昔所出之败浊，同气相求，服之小便得利，阴头微肿，阴毒仍从阴窍出耳。
以上列举了瘥后诸复及阴阳易。
Subsequently, there are cases where the pulse is tight like a turning rope and variable; this indicates retained food (retained food). A tight pulse with headache indicates wind-cold; retained food in the abdomen that fails to digest. These two clauses only mention retained food without prescribing purgation, because external pathogenic factors' pulses and symptoms are also present; therefore, treatment should follow the principles for external pathogens.
If diarrhea resolves but recurs at the same time of year or month, it is because the pathogen was not completely eliminated; purgation should be used.
This clause in secular editions contains the five characters "suitable for Da Cheng Qi Tang" as an interpolation (superfluous text), so they are removed. Detailed analysis shows that residual pathogens can lie dormant for years before manifesting; this must be cold pathogen. Cold pathogens can only be treated with warm purgation using Bei Ji Wan, not cold purgation with Da Cheng Qi Tang. If it were a heat pathogen, there would be no logic for lying dormant for years.
The above lists examples of retained food.
If there is pulsating qi on the right side, sweating methods are contraindicated. Sweating will cause epistaxis and thirst, bitter vexation in the heart, and vomiting water immediately after drinking.
"Pulsating qi" refers to a throbbing sensation of qi movement. "On the right" means the qi moves on the right side of the umbilicus. Sweating disturbs Lung qi; when qi is deficient, it cannot protect the exterior, causing blood to move recklessly, resulting in epistaxis. Epistaxis leads to loss of body fluids and stomach dryness, hence thirst and bitter vexation in the heart. If one drinks water, damaging the Lung and Stomach, water is vomited immediately.
If there is pulsating qi on the left side, sweating methods are contraindicated. Sweating will cause dizziness, continuous sweating, twitching of sinews, and tremors of muscles. Continuous sweating from sweating methods leads to Yang collapse and exterior deficiency, hence dizziness, twitching of sinews, and muscle tremors.
If there is pulsating qi on the upper side, sweating methods are contraindicated. Sweating will cause qi to rush upward, striking directly at the tip of the heart.
Sweating leading to Yang collapse further damages Heart qi; Kidney qi takes advantage of Heart deficiency to ascend and oppress the Heart, hence qi rushes upward directly at the heart tip.
If there is pulsating qi on the lower side, sweating methods are contraindicated. Sweating will result in anhidrosis, severe mental restlessness, painful bone joints, aversion to cold with vertigo, vomiting after eating, and food failing to descend.
Anhidrosis after sweating indicates insufficient Kidney Water. Severe mental restlessness indicates Kidney deficiency failing to control Heart Fire. Painful bones/joints, vertigo, and aversion to cold are all Kidney diseases. Wang Taipu stated: "Food entering and then coming out indicates lack of fire." Treatment should primarily tonify the true Yang of the Kidneys.
If there is pulsating qi on the right side, purgation is contraindicated. Purgation will lead to internal exhaustion of body fluids, dry throat and nose, dizziness, and palpitations.
Purgation injures the Stomach and disturbs the Lung. Dry throat and nose indicate internal fluid exhaustion and desire to drink. Dizziness and palpitations indicate water retention injuring the Lung, Heart Master being unsettled, leading to vexation, palpitations, and vertigo.
If there is pulsating qi on the left side, purgation is contraindicated. Purgation will cause abdominal tension, inability to eat, worsening of pulsating qi, and even if there is body heat, a desire to curl up when lying down.
Abdominal tension, inability to eat, and worsening pulsating qi indicate Spleen damage from purgation, allowing Liver qi to overact on the Spleen. Desire to curl up despite body heat indicates exterior heat and interior cold.
If there is pulsating qi on the upper side, purgation is contraindicated. Purgation will cause hot palms with vexation, floating coldness on the body, spontaneous hot sweating, and a desire to pour water on oneself.
Purgation causing hot palms with vexation means although palms are hot, the grip remains clenched. Floating coldness on the body, spontaneous hot sweating, and desire to pour water on oneself indicate exterior cold and interior heat.
If there is pulsating qi on the lower side, purgation is contraindicated. Purgation will cause abdominal fullness, dizziness upon sudden rising, passing undigested food after eating, and epigastric stuffiness.
Abdominal fullness, dizziness, passing undigested food, and epigastric stuffiness occur because purgation injures Spleen and Kidney qi, triggering pulsating qi and Kidney pathogen oppressing the Heart.
Note: Pulsating qi originates from Spleen Earth weakness, failing to control Kidney Water, leading to condensation of water retention. Although it is a minor pathogen of Water attacking the upper positions, Zhang Zhongjing prohibits both sweating and purgation because these methods first disturb Spleen fluids. Therefore, Li Dongyuan often uses this to test Spleen Qi strength/weakness. Where pressing feels firm and painful, it is pulsating qi. Pulsating qi fundamentally belongs to Spleen disease; whichever of the four Zang organs is deficient, the pathogen attacks its corresponding region. Thus, erroneous sweating injures Yang; Yang injury causes pathogen to merge with qi, leading to vomiting, epistaxis, retching, vertigo, and qi rushing upward. Erroneous purgation injures Yin; Yin injury leaves deficient Yang uncontrolled, leading to curling up despite fever and clenched hands. These are signs of Stomach Qi deficiency, cold, and exhaustion. For patients with existing accumulations connected to the umbilicus, also called pulsating qi, sweating and purgation are especially forbidden. Generally, Li Zhong Tang removing Bai Zhu and adding Gui Zhi and Fu Ling is suitable, using Fu Ling to drain water and Gui Zhi to subdue running piglet. Bai Zhu is removed because it stagnates qi. However, for chronic illness with extreme Spleen Qi deficiency and no exogenous pathogen, using raw Bai Zhu with prepared Fu Zhi is acceptable. One must prioritize observed symptoms rather than rigidly adhering to formulas in books like *Huo Ren Shu*.
The above lists examples of pulsating qi.
Question: What is Huo Luan? Answer: Vomiting and diarrhea constitute Huo Luan.
Huo Luan involves chaos in the San Jiao, mixing of clear and turbid, separation of Yin and Yang, and dominance of cold or heat, leading to retching, vomiting, diarrhea, and potentially tendon spasms and cold extremities, causing chaotic turmoil.
Question: What disease is characterized by fever, headache, body pain, aversion to cold, vomiting, and diarrhea? Answer: This is named Huo Luan. After self-induced vomiting stops and diarrhea ceases, fever returns.
Fever, headache, body pain, and aversion to cold are due to exogenous wind-cold and endogenous injury from cold/raw food, causing Huo Luan. Now that vomiting has stopped and diarrhea has ceased, yet fever returns, it indicates internal pathogens have been expelled but external contraction remains.
At this point, mild clearing is appropriate, followed by self-regulation. Later, if body pain persists, urgent rescue of the exterior is required, treating according to standard protocols.
For Huo Luan with headache, fever, body pain, abundant heat, and desire to drink water, Wu Ling San is indicated. For abundant cold and no desire to drink, Li Zhong Wan is indicated.
Headache, fever, and body pain in Huo Luan indicate exogenous contraction. Desire to drink indicates heat pathogen entering the interior; thus, Wu Ling San is used to resolve both exterior and interior. No desire to drink indicates interior cold; thus, dried Ginger's pungency warms the middle and disperses pathogens, while Ginseng, Atractylodes, and Licorice's sweetness supports Yang and boosts Qi. Sweetness combined with pungency prevents stagnation; pungency combined with sweetness prevents dryness. Together, they regulate middle Qi deficiency and stagnation. Since vomiting and diarrhea occur simultaneously, interior symptoms take priority.
If there is throbbing above the umbilicus, indicating Kidney qi movement, remove Bai Zhu and add Gui Zhi 4 liang. For excessive vomiting, remove Bai Zhu and add fresh Ginger 3 liang. For excessive diarrhea, retain Bai Zhu. For palpitations, add Fu Ling 2 liang. For thirst and desire to drink, increase Bai Zhu to total 4.5 liang. For abdominal pain, add Ren Shen to total 4.5 liang. For severe cold, add dried Gan Jiang to total 4.5 liang. For abdominal fullness, remove Bai Zhu and add one Fu Zi. After taking the decoction, wait about the time it takes to eat a meal, then drink about one sheng of hot porridge to maintain slight warmth; do not uncover clothes or blankets.
Throbbing above the umbilicus, vomiting, and abdominal fullness all relate to qi disorders. Bai Zhu is removed because its cloying nature hinders qi flow. However, for excessive diarrhea, even with throbbing and vomiting, Bai Zhu may be used temporarily to assist the middle and upper jiao in controlling Kidney pathogens, as qi is already stagnant and such symptoms are secondary. For palpitations, only Fu Ling is added, retaining Bai Zhu, because palpitations stem from water retention, unrelated to qi issues. Moreover, Bai Zhu paired with Ren Shen benefits water metabolism and generates fluids, so it is retained. Adding Bai Zhu for thirst, Gan Jiang for cold, fresh Ginger for vomiting, Gui Zhi for umbilical throbbing, and Fu Ling for palpitations are common knowledge. Adding Fu Zi for abdominal fullness and Ren Shen for abdominal pain requires profound understanding. The back is Yang, the abdomen is Yin. Exogenous Yang pathogens sinking inward cause chest binding; endogenous Yin pathogens knotting inward cause abdominal fullness. Only the potent force of Fu Zi can break the solid knotting of Yin pathogens. Abdominal pain is undoubtedly Yin pathogen. In Taiyang, if original pathogen oppresses the upper, Xiao Jian Zhong Tang harmonizes Yin and separates Yang. In Yin meridians, warming and tonifying Yang is necessary to harmonize Qi and withstand pathogen expulsion. ○ Huo Luan involves rebellious Stomach Qi; consuming grain aggravates it, making rebellion irreversible. The instruction to drink hot porridge after taking the decoction refers to the general method for Li Zhong Tang, not specifically for Huo Luan itself.
If vomiting and diarrhea cease but body pain persists, one should assess and harmonize the exterior; Gui Zhi Tang is suitable for mild harmonization.
Cessation of vomiting/diarrhea with persistent body pain indicates unresolved exterior pathogen. Assessment and harmonization mean judging the severity of the exterior pathogen to adjust the dosage. Despite sudden deficiency from vomiting/purging, Gui Zhi Tang can be used even in summer to harmonize Ying and Wei.
After vomiting and diarrhea, if the pulse is calm and there is slight vexation, it is because the body is too weak to handle the qi of grain.
During Huo Luan vomiting/diarrhea, diet should be avoided because Stomach Qi is rebellious. Even after recovery, if the pulse is calm but slight vexation occurs, dietary restraint is crucial because the digestive capacity is not yet solid.
The above lists examples of Huo Luan.
For relapse due to overexertion after a major illness resolves, Zhi Shi Zhi Zi Chi Tang is indicated. If there is retained food, add Da Huang, sized like a chess piece, 5-6 pieces.
Relapse due to overexertion refers to residual heat arising from physical labor. Annotations claiming "female sexual relapse" are gross errors. Female sexual relapse is a strict taboo after typhoid, often fatal, never treated with purgatives. For residual heat after Taiyang purgation or post-sweating/vomiting/purging with empty vexation, this formula's bitterness induces slight emesis to expel pathogens; this is not an emetic method. Adding Zhi Shi to Zhi Zi Chi induces slight sweating to dispel empty heat in the chest, aligning with the *Neijing* principle: "For excess fire, use bitterness to induce release." If retained food knots internally, urgently add Da Huang to purge; delay allows heat to persist and deplete True Yin. Using seven sheng of sour rice water, boiled down to four sheng before adding herbs, ensures the liquid sinks downward rather than rising. Hence, covering the patient to induce slight sweating is key.
For fever recurring after Typhoid resolves, Xiao Chai Hu Tang is indicated. If the pulse is floating, resolve via sweating; if deep and solid, resolve via purgation.
Recurrent fever after resolution indicates residual heat within, attracting more heat. Residual heat must be localized; generic treatment worsens deficiency. If in half-exterior/half-interior, use Xiao Chai Hu Tang to harmonize. If in the exterior, use sweating; if in the interior, use purgation. This parallels previous clauses: sweating with Zhi Shi Zhi Zi Tang for slight sweating, purging with Zhi Shi Zhi Zi Tang plus Da Huang for slight purging.
For edema below the waist after a major illness resolves, Mu Li Ze Xie San is indicated.
Edema below the waist results from water accumulation. *Jin Gui* states: "Edema below the waist should be treated by promoting urination." This is a fixed rule. After major illness, Spleen Earth is exhausted and cannot control water, causing overflow. Using Mu Li Ze Xie San for aggressive attack seems to ignore deficiency. However, since water hasn't invaded the upper body, urgently driving water from below preserves much health. Mild agents would allow Yin water to invade Yang regions, becoming untreatable.
For frequent spitting lasting long after a major illness resolves, indicating cold in the Stomach, warm with pills; Li Zhong Wan is suitable.
Body fluids congeal into turbid saliva due to Stomach cold. Long-standing unclear saliva leads to emaciation; thus, decoctions for scouring are unsuitable, and slow-acting pills are preferred. Li Zhong Wan is excellent for separating Yin/Yang and warming/tonifying Spleen/Stomach. Zhang Zhongjing uses it only after external pathogens are gone. In Taiyang with intense pathogen, he combines it with Gui Zhi, renaming it Gui Zhi Ren Shen Tang. In *Jin Gui* for Chest Bi, it is named Ren Shen Tang. This reveals his naming logic. ○ Post-Typhoid deficiency often leaves residual heat, prohibiting warm tonics. Even for constitutional cold/deficiency, only Li Zhong Wan is suitable for regulation; Gui Zhi and Fu Zi are rarely used lightly.
After Typhoid resolves, if there is emaciation, shortness of breath, and rebellious Qi with urge to vomit, Zhu Ye Shi Gao Tang is indicated.
Body fluids consumed by heat pathogens leave residual heat, causing emaciation and shortness of breath. Rebellious Qi with urge to vomit indicates residual heat disturbing fluids with phlegm. Zhu Ye Shi Gao Tang tonifies Qi, clears heat, and directs rebellious Qi downward. Note: This formula is Ren Shen Bai Hu Tang removing Zhi Mu and adding Ban Xia, Mai Dong, and Zhu Ye. For post-illness empty vexation and shortness of breath due to residual heat, Mai Dong and Zhu Ye are added to Ren Shen and Gan Cao to clear heat and generate fluids. Ban Xia is added for phlegm-fluid rebellion causing vomiting. Post-illness residual heat differs from latent Qi inducing warmth; thus, Zhi Mu is omitted to avoid damaging Sha Yin.
If the pulse has resolved but there is slight evening vexation, it is because the patient recently recovered and forced food intake. Spleen/Stomach Qi is still weak and cannot digest food, causing slight vexation. Reducing food intake leads to recovery.
Post-illness food intake causing slight vexation is called food stagnation; reducing intake heals it naturally due to new Stomach Qi deficiency. If residual heat remains, quiet rest awaits fluid return; this is treating without treating. If medication is unavoidable, use bland prescriptions so drug power doesn't overwhelm Qi. Like wilting plants needing gentle watering to revive, excessive irrigation causes death. For deficiency with pathogens, urgent strong purging is needed; incomplete pathogen removal allows invasion and death.
Typhoid Yin-Yang Exchange disease presents with heavy body, shortness of breath, lower abdominal urgency, possibly drawing into the genitalia, heat rushing to the chest, heavy head unwilling to lift, visual disturbances, and knee/calf stiffness. Shao Kun San is indicated.
Annotations fail to clarify Yin-Yang Exchange, leading later generations to mistakenly call it female sexual relapse. If so, would intercourse between a recovering woman and healthy man be male sexual relapse? Heat toxins in Typhoid reside in Blood/Qi and gradually disperse via exterior/interior. Toxins hidden in essence/marrow cannot exit. Thus, contact between recovered and healthy individuals transmits toxin: male to female, female to male. Hence "Yin-Yang Exchange" (trading). Symptoms include visual disturbances, heaviness/stiffness, lower abdominal pain drawing to genitals, sudden exposure to Yin toxin. This cannot be driven by Gui Zhi/Fu Zi pungent heat. Burning the inner garment (kun) into powder works because it shares the same qi as the patient's past waste. Taking it promotes urination, slight penile swelling, and expels Yin toxin through the yin orifice.
The above lists post-recovery relapses and Yin-Yang Exchange.