阳明病，脉浮而紧，咽燥口苦，腹满而喘，发热汗出，不恶寒，反恶热，身重。若发汗则躁，心愦愦而谵
语。若加烧针，心怵惕，烦躁不得眠。若下之，则胃中空虚，客气动膈，心中懊 。舌上苔者，栀子豉汤主之。
脉证与阳明中风同。彼以恶寒，故名中风；此反恶热，故名阳明病。阳明主肌肉，热甚无津液以和之，则肉不
和，故身重，此阳明半表里证也。邪已入腹，不在营卫之间，脉虽浮。不可为在表而发汗；脉虽紧，不可以身重而
加温针；胃家初实，尚未燥硬，不可以喘满恶热而攻下。若妄汗之，则肾液虚，故躁；心液亡，故昏昧而愦愦；
胃无津液，故大便燥硬而谵语也。若谬加温针，是以火济火，故心恐惧而怵惕；土水皆因火侮，故烦躁而不得眠
也。阳明中风，病在气分，不可妄下。此既见胃实之证，下之亦不为过。但胃中以下而空虚，喘满、汗出、恶热、身
重等证或罢，而邪之客上焦者，必不因下除，故动于膈而心中懊 不安也。病在阳明，以妄汗为重、妄下为轻。舌
上苔句，顶上四段来。不恶、反恶，皆由心主，愦愦、怵惕、懊 之象，皆心病所致，故当以舌验之。舌为心之
外候，心热之微甚，与苔之浓薄、色之浅深，为可征也。栀子豉汤主之，是总结上四段症。要知本汤是胃家初受
双解表里之方，不只为误下后立法。盖阳明初病，不全在表，不全在里，诸证皆在里之半表间，汗下温针，皆在
所禁。将何以治之，惟有吐之一法，为阳明表邪之出路耳。然病在胸中，宜瓜蒂散。此已在腹中，则瓜蒂散不
中与也，栀子豉汤主之。外而自汗恶热身重可除，内而喘满咽干口苦自解矣。
阳明之有栀豉汤，犹太阳之有桂枝汤，既可以驱邪，亦可以救误，上焦得通，津液得下，胃气因和耳。
若渴欲饮水，口干舌燥者，白虎加人参汤主之。
上文是阳邪自表入里，此条则自浅入深之证也。咽燥、口苦、恶热，热虽在里，尚未犯心；愦愦、怵惕、
懊，虽入心尚不及胃；燥渴欲饮，是热已入胃。尚未燥硬。用白虎加人参汤，泻胃火而扶元气，全不涉汗吐
下三法矣。
若脉浮发热，渴欲饮水，小便不利者，猪苓汤主之。
上条根首条诸证，此条又根上文饮水来。连用五若字，见仲景说法御病之详。栀豉汤所不及者，白虎汤继之，
白虎汤不及者，猪苓汤继之，此阳明起手之三法。所以然者，总为胃家惜津液，既不肯令胃燥，亦不肯令水渍
入胃耳。余义见猪苓汤证。
发汗吐下后，虚烦不得眠。若剧者，必反复颠倒，心中懊 ，栀子豉汤主之。若少气者，栀子甘草豉汤主
之。若呕者，栀子生姜豉汤主之。
虚烦是阳明之坏病，便从栀子汤随证治之，犹太阳坏病，多用桂枝汤加减也。以吐易温针，以懊 概愦愦、
怵惕，可互文见意。栀豉汤本为治烦躁设，又可以治虚烦，以此知阳明之虚与太阳之虚不同，阳明之烦与太阳之烦
有别矣。首句虽兼汗吐下，而大意单指下后言，以阳明病多误在早下故也。反复颠倒四字，切肖不得眠之状，
为虚烦二字传神。此火性摇动，心无依着故也。心居胃上，即阳明之表。凡心病皆阳明表邪，故制栀豉汤因而越
之。盖太阳之表，当汗而不当吐；阳明之表，当吐而不当汗；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，不知吐亦为解表，故于仲景大法中，但知汗下而遗其吐法耳。若少气若呕，又从虚
烦中分出。烦必伤气，加甘草以益气；虚热相抟，必欲呕，加生姜以散邪。
发汗，若下之，而发烦热，胸中窒者，栀子豉汤主之。
窒者，痞塞之谓。烦为虚烦，则热亦虚热，窒亦虚窒矣。此热伤君主，心气不足而然。栀豉治之，是“益心
之阳，寒亦通行”之谓欤？误下后，痞不在心下而在胸中，故仍用栀豉，与太阳下后外不解者仍用桂枝同法。盖病不
变，则方不可易耳。
下后更烦，按之心下濡者，为虚烦也，宜栀子豉汤。
更烦是既解而复烦也。心下软，对胸中窒而言，与心下反硬者悬殊矣。要知阳明虚烦，对胃家实热而言，是
空虚之虚。不是虚弱之虚。
阳明病，下之，其外有热，手足温，不结胸，心中懊 ，饥不能食，但头汗出者，栀子豉汤主之。
外有热，是身热未除。手足温，尚未 然汗出，此犹未下前证，见不当早下也。不结胸，是心下无水气，知
是阳明之燥化。心中懊 ，是上焦之热不除。饥不能食，是邪热不杀谷。但头汗出而不发黄者，心火上炎，而皮
肤无水气也。此指下后变证。夫病属阳明，本有可下之理。然外证未除，下之太早，胃虽不伤，而上焦火郁不达，
仍与栀子
豉汤吐之，心清而内外自和矣。
伤寒五六日，大下后，身热不去，心中结痛者，未欲解也，栀子豉汤主之。
病发于阳而反下之，外热未除，心中结痛，虽轻于结胸，而甚于懊 矣。结胸是水结胸胁，用陷胸汤，水
郁则折之也。此乃热结心中，用栀豉汤，火郁则发之也。
栀子豉汤∶
栀子（十四枚） 香豉（四合，绵裹）
上二味，以水四升，先煮栀子，得二升半，内豉，煮取升半，去滓，分为二服，温进一服，得吐，止后服。
栀子甘草豉汤∶
本方加甘草（二两）。余同前法。
栀子生姜豉汤∶
本方加生姜（五两）。余同前法。
此阳明半表半里涌泄之剂也。少阳之半表是寒，半里是热。而阳明之热，自内达外，有热无寒。其外证身热
汗出，不恶寒反恶热，身重，或目疼鼻干不得卧。其内证咽燥口苦，舌苔、烦躁，渴欲饮水，心中懊 ，腹满而
喘。此热半在表半在里也。脉虽浮紧，不得为太阳病，非汗剂所宜。又病在胸腹，而未入胃府，则不当下。法当
涌吐以发散其邪。栀子苦能泄热，寒能胜热，其形象心；又赤色通心，故除心烦、愦愦、懊 、结痛等症。豆形象
肾，制而为豉，轻浮上行，能使心腹之邪上出于口，一吐而心腹得舒、表里之烦热悉除矣。所以然者，二阳之病
发心脾，以上诸证，是心脾热，而不是胃家热，即本论所云“有热属藏者，攻之，不令发汗”之谓也。若夫热伤
气者，少气加甘草以益气。虚热相搏者多呕，加生姜以散邪。栀豉汤以栀配豉，瓜蒂散以赤豆配豉，皆心肾交合
之义。
伤寒，医以丸药大下之，身热不去，微烦者，栀子干姜汤主之。
攻里不远寒，用丸药大下之，寒气留中可知。心微烦而不懊 ，则非吐剂所宜也。用栀子以解烦，倍干姜以
逐内寒而散表热。寒因热用，热因寒用，二味成方，而三法备矣。
伤寒下后，心烦腹满，起卧不安者，栀子浓朴汤主之。
心烦则难卧，腹满则难起。起卧不安，是心移热于胃，与反复颠倒之虚烦不同。栀子以治烦，枳、朴以泄满，
此两解心腹之妙剂也。热已入胃则不当吐，便未燥硬则不可下，此为小承气之先着。
栀子干姜汤∶
栀子（十四枚） 干姜（二两）
上二味，以水三升，煮取一升半，去滓，分二服，温进一服。
栀子浓朴汤∶
栀子（十四枚），浓朴（四两），枳实。余同前法。
夫栀子之性，能屈曲下行，不是上涌之剂。惟豉之腐气，上熏心肺，能令人吐耳。观瓜蒂散必用豉汁和剂服，
是吐在豉而不在栀也。此栀子干姜汤去豉用姜，是取其横散；栀子浓朴汤以枳、朴易豉，是取其下泄，皆不欲
上越之义。旧本两方后概云得吐止后服，岂不谬哉？观栀子柏皮汤与茵陈汤中俱有栀子，俱不言吐，又病患旧微
溏者不可与，则栀子之性自明。
伤寒身热发黄者，栀子柏皮汤主之。
身热汗出为阳明病。若寒邪太重，阳气怫郁在表，亦有汗不得出、热不得越而发黄者矣。黄为土色，胃火内
炽，津液枯涸，故黄见于肌肉之间。与太阳误下、寒水留在皮肤者迥别，非汗吐下三法所宜也，必须苦甘之剂以
调之。栀、柏、甘草，皆色黄而质润。栀子以治内烦，柏皮以治外热，甘草以和中气。形色之病，仍假形色以通
之也。
栀子柏皮汤∶
栀子（十五枚） 甘草（二两） 黄柏
上三味，以水四升，煮取一升半，去滓，分温再服。
阳明病无汗，小便不利，心中懊 者，身必发黄。
阳明病法多汗，反无汗，则热不得越；小便不利，则热不得降；心液不支，故虽未经汗下，而心中懊
也。无汗、小便不利，是发黄之原，心中懊 ，是发黄之兆。然口不渴，腹不满，非茵陈汤所宜，与栀子柏皮
汤，黄自解矣。
阳明病被火，额上微汗出，而小便不利者，必发黄。
阳明无表证，不当发汗，况以火劫乎？额为心部，额上微汗，心液竭矣。心虚肾亦虚，故小便不利而发黄。
非栀子柏皮汤，何以挽津液于涸竭之余耶？
阳明病面合赤色，不可下之，必发热色黄，小便不利也。
面色正赤者，阳气怫郁在表，当以汗解。而反下之，热不得越，故复发热，而赤转为黄也。上条因于火逆，
此条因于妄下。前以小便不利而发黄，此条先黄而小便不利。总因津液枯涸，不能通调水道而然。须栀子、柏皮，
滋化源而致津液，非渗泄之剂所宜矣。黄未发宜栀子豉汤，已黄宜栀子柏皮汤。
仲景治太阳发黄有二法∶但头汗出，小便不利者。麻黄连翘汤汗之；少腹硬，小便自利者，抵当汤下之。治
阳明发黄二法∶但头汗、小便不利、腹满者，茵陈、大黄以下之；身热、发黄与误治而致者，栀子、柏皮以清
之。总不用渗泄之剂。要知仲景治阳明，重在存津液，不欲利小便，惟恐胃中燥耳，所谓治病必求其本。
凡用栀子汤，病患旧微溏者，不可与服之。
向来胃气不实，即栀子亦禁用。用承气者，可不慎之欤？
阳明病，脉象浮而紧，咽喉干燥、口苦，腹部胀满且气喘，发热并出汗，不恶寒反而怕热，身体沉重。如果误用发汗法，患者会出现烦躁不安，心中昏乱并说胡话。如果误用烧针疗法，患者会惊恐害怕，烦躁无法入睡。如果误用攻下法，会导致胃中空虚，外邪乘虚扰动胸膈，心中烦闷懊恼。舌上有苔的，用栀子豉汤主治。
这些脉证与阳明中风相似。前者因为恶寒，所以称为中风；后者因为反常地怕热，所以称为阳明病。阳明经主司肌肉，热势极盛导致津液枯竭无法滋润，肌肉失和，所以身体沉重，这是阳明病的半表半里证候。邪气已经入腹，不在营卫之间，虽然脉浮，不可当作表证来发汗；虽然脉紧，不可因为身重就加用温针；胃家刚开始结实，尚未达到燥硬的程度，不可因为气喘、胀满、怕热就攻下。如果错误地发汗，肾中阴液亏虚，所以出现躁动；心之阴液耗亡，所以神志昏昧、心中烦乱；胃中没有津液，所以大便燥硬并说胡话。如果错误地加用温针，是以火助火，所以心中恐惧惊惕；脾土和肾水都因火热欺侮，所以烦躁不得安眠。阳明中风，病在气分，不可妄用攻下。这里既然出现了胃实的症状，使用攻下法也不算过分。但是胃中因为攻下而变得空虚，气喘、胀满、出汗、怕热、身重等症状或许会停止，但客居在上焦的邪气，一定不会因为攻下而消除，所以邪气动荡于胸膈，导致心中烦闷懊恼不安。病在阳明，误用发汗为重，误用攻下为轻。“舌上苔”这一句，是承接上面四段论述而来的。不恶寒、反恶热，都由心主所决定，昏乱、惊惕、懊恼的症状，都是心病所致，所以应当通过观察舌头来验证。舌是心的外在征象，心热的轻重，与舌苔的厚薄、颜色的深浅，是可以作为依据的。栀子豉汤主治，是总结上面四段症状。要知道本方是治疗胃家初受邪、双解表里的方剂，不仅仅是为了误下后的情况而设立。大概阳明初起发病，不全在表，也不全在里，各种症状都在里的半表半里之间，发汗、攻下、温针，都在禁忌之列。用什么方法治疗呢？只有涌吐这一种方法，作为排出阳明表邪的途径罢了。然而病在胸中，适宜用瓜蒂散。这里病已在腹中，那么瓜蒂散就不适用了，应用栀子豉汤主治。体表的自汗、怕热、身重可以解除，体内的气喘、胀满、咽干、口苦自然也就缓解了。
阳明病有栀子豉汤，就像太阳病有桂枝汤一样，既可以驱除邪气，也可以补救误治，使上焦通畅，津液下行，胃气因此调和。
上文讲的是阳邪从体表传入体内，这一条则是病邪由浅入深的证候。咽喉干燥、口苦、怕热，热虽然在体内，但尚未侵犯心脏；昏乱、惊惕、懊恼，虽然已入心，但还不及于胃；燥渴想饮水，说明热已入胃，但尚未燥硬。使用白虎加人参汤，泻胃火而扶助元气，完全不涉及汗、吐、下三种治法。
上一条基于首条的各种症状，这一条又基于上文提到的饮水问题。连续使用五个“若”字，可见张仲景说法御病的详尽。栀子豉汤所不能解决的，由白虎汤接着解决；白虎汤所不能解决的，由猪苓汤接着解决，这是治疗阳明病的起手三法。之所以这样，总归是为了顾惜胃中的津液，既不让胃燥，也不让水湿浸渍入胃。其余含义见猪苓汤证。
经过发汗、催吐、攻下之后，出现虚烦、失眠。如果病情严重，一定翻来覆去，心中烦闷懊恼，用栀子豉汤主治。如果有短气的，用栀子甘草豉汤主治。如果有呕吐的，用栀子生姜豉汤主治。
虚烦是阳明病的变证，便从栀子汤随证治疗，就像太阳病的变证，多用桂枝汤加减一样。以吐法代替温针，用懊恼概括昏乱和惊惕，可以互文见意。栀子豉汤本来是为治疗烦躁设立的，又可以治疗虚烦，由此可知阳明的虚与太阳的虚不同，阳明的烦与太阳的烦也有区别。首句虽然兼涉汗、吐、下，但大意单指攻下之后而言，因为阳明病多误在过早攻下。翻来覆去四个字，生动描绘了不得睡眠的状态，为“虚烦”二字传神。这是因为火性摇动，心神无所依托的缘故。心位于胃之上，即阳明的表位。凡是心病都是阳明表邪，所以制作栀豉汤顺势涌吐它。大概太阳的表证，应当发汗而不应当催吐；阳明的表证，应当催吐而不应当发汗；太阳的里证，应当利小便而不应当攻下；阳明的里证，应当攻下而不应当利小便。现在的人只知道发汗是解表，不知道催吐也是解表，所以在张仲景的大法中，只知道汗法和下法而遗漏了吐法。如果有短气或呕吐，又从虚烦中分出。烦躁必伤气，加甘草以益气；虚热相搏结，必然想呕吐，加生姜以散邪。
窒，就是痞塞的意思。烦是虚烦，那么热也是虚热，窒也是虚窒。这是热邪损伤心君，心气不足而导致的。用栀豉汤治疗，这就是“益心之阳，寒亦通行”的意思吗？误下之后，痞塞不在心下而在胸中，所以仍然用栀豉汤，与太阳病误下后表证未解仍用桂枝汤的方法相同。大概病不变，方子就不可以改变。
攻下后更觉心烦，按压心下部柔软的，属于虚烦，适宜用栀子豉汤。
更烦是指病解后又复发烦。心下软，是与胸中窒相对而言，与心下反硬的情况悬殊很大。要知道阳明的虚烦，是针对胃家的实热而言的，是空虚之虚，不是虚弱之虚。
阳明病，经过攻下后，体表仍有热，手足温暖，没有形成结胸，心中烦闷懊恼，觉得饿但不能进食，只有头部出汗的，用栀子豉汤主治。
体表有热，是身热未除。手足温暖，还没有大汗出，这如同未攻下前的症状，说明不当过早攻下。没有形成结胸，说明心下没有水气，知道这是阳明燥化的表现。心中烦闷懊恼，是上焦的热邪未除。觉得饿但不能进食，是邪热不能腐熟水谷。只有头部出汗而不发黄，是心火上炎，而皮肤没有水气。这是指攻下后的变证。病属阳明，本有可下的道理。但是表证未除，攻下太早，胃虽然没受伤，但上焦火郁不能通达，仍然用栀子豉汤涌吐，心清静而内外自然调和。
伤寒五六天，经过大力攻下后，身热不退，心中结痛的，病未欲解，用栀子豉汤主治。
病发于阳却反而攻下，外热未除，心中结痛，虽然比结胸轻，但比懊恼重。结胸是水饮结聚胸胁，用陷胸汤，水郁则折之。这里是热邪结聚心中，用栀豉汤，火郁则发之。
栀子豉汤：
栀子（十四枚） 香豉（四合，绵裹）
以上两味药，用水四升，先煮栀子，取二升半，加入香豉，煮取一升半，去渣，分为两次服用，温服一次，如果得吐，停止后服。
这是治疗阳明半表半里证的涌泄剂。少阳的半表是寒，半里是热。而阳明的热，是从内达外，只有热没有寒。其外证表现为身热、出汗、不恶寒反恶热、身重，或者目痛、鼻干、不得卧。其内证表现为咽燥、口苦、舌苔、烦躁、渴欲饮水、心中懊恼、腹满而喘。这种热邪一半在表一半在里。脉虽然浮紧，不能当作太阳病，不适合用汗剂。而且病在胸腹，而未入胃腑，则不当下。治法应当涌吐以发散邪气。栀子苦能泄热，寒能胜热，其形状像心；又赤色通心，所以能除心烦、昏乱、懊恼、结痛等症状。豆形状像肾，制成豉后，性质轻浮上行，能使心腹之邪向上出于口，一吐而心腹舒畅、表里的烦热全部清除。之所以这样，是因为“二阳之病发心脾”，以上诸证，是心脾热，而不是胃家热，即本论所说的“有热属藏者，攻之，不令发汗”的意思。如果热伤气导致少气，加甘草以益气。虚热相搏结导致多呕，加生姜以散邪。栀豉汤以栀配豉，瓜蒂散以赤豆配豉，都有心肾交合的意义。
伤寒，医生用丸药大力攻下，身热不退，微烦的，用栀子干姜汤主治。
攻里不远寒，用丸药大力攻下，寒气留滞在中焦可知。心微烦而不懊恼，则不适合用吐剂。用栀子以解烦，倍用干姜以驱逐内寒而散表热。寒因热用，热因寒用，两味药成方，而汗、吐、下三法具备。
心烦则难卧，腹满则难起。坐卧不安，是心移热于胃，与翻来覆去的虚烦不同。栀子以治烦，枳实、厚朴以泄满，这是两解心腹的妙剂。热已入胃则不应当吐，大便未燥硬则不可下，这是小承气汤的先着。
栀子干姜汤：
栀子（十四枚） 干姜（二两）
以上两味药，用水三升，煮取一升半，去渣，分两次服用，温服一次。
栀子厚朴汤：
栀子（十四枚），厚朴（四两），枳实。其余同前法。
栀子的药性，能够屈曲下行，不是上涌的药剂。只有豉的发酵之气，上熏心肺，能令人呕吐。看瓜蒂散必须用豉汁调和服用，是吐在豉而不在栀。这个栀子干姜汤去掉豉用姜，是取其横向发散；栀子厚朴汤用枳实、厚朴代替豉，是取其向下泄降，都不想要向上涌越的意思。旧版本两个方子后面都写“得吐止后服”，难道不荒谬吗？看栀子柏皮汤与茵陈蒿汤中都有栀子，都不提吐，又有“病患旧微溏者不可与”的说法，那么栀子的药性就很明白了。
身热出汗是阳明病。如果寒邪太重，阳气怫郁在表，也有汗不得出、热不得越而发黄的。黄为土色，胃火内炽，津液枯涸，所以黄见于肌肉之间。这与太阳病误下、寒水留在皮肤的情况截然不同，不属于汗、吐、下三法的适宜范围，必须用苦甘的药剂来调理。栀、柏、甘草，颜色都黄而质地润泽。栀子以治内烦，柏皮以治外热，甘草以和中气。形色之病，仍假借形色来通治它。
栀子柏皮汤：
栀子（十五枚） 甘草（二两） 黄柏
以上三味药，用水四升，煮取一升半，去渣，分两次温服。
阳明病通常多汗，反而无汗，则热不得发散；小便不利，则热不得下降；心液支撑不住，所以即使未经过汗下，心中也感到懊恼。无汗、小便不利，是发黄的根源，心中懊恼，是发黄的征兆。然而口不渴，腹不满，不适合用茵陈蒿汤，给予栀子柏皮汤，黄自然会消退。
阳明病没有表证，不应当发汗，何况用火劫呢？额头是心部，额头微汗，心液枯竭了。心虚肾也虚，所以小便不利而发黄。不用栀子柏皮汤，怎么能挽回枯竭的津液呢？
面色正红，是阳气怫郁在表，应当用汗法解表。反而攻下，热不得发散，所以再次发热，红色转为黄色。上一条是因为火逆，这一条是因为妄下。前面是因为小便不利而发黄，这一条是先黄而后小便不利。总归是因为津液枯涸，不能通调水道所致。需要用栀子、柏皮，滋生化之源而致津液，不是渗泄的药剂所适宜的。黄未发宜用栀子豉汤，已黄宜用栀子柏皮汤。
张仲景治疗太阳发黄有二法：只是头汗出，小便不利的，用麻黄连翘赤小豆汤发汗；少腹硬，小便自利的，用抵当汤攻下。治疗阳明发黄有二法：只是头汗、小便不利、腹满的，用茵陈蒿汤加大黄攻下；身热、发黄以及误治而致的，用栀子柏皮汤清解。总之不用渗泄的药剂。要知道张仲景治疗阳明，重在保存津液，不想要利小便，唯恐胃中干燥罢了，所谓治病必求其本。
Yangming disease, with a pulse that is floating and tight, dry throat, bitter taste in the mouth, abdominal fullness and wheezing, fever with sweating, aversion to cold absent but aversion to heat present, and heaviness of the body. If sweat-inducing methods are erroneously applied, restlessness ensues, accompanied by mental confusion and delirious speech. If burning needle therapy is erroneously used, palpitations, fearfulness, irritability, and insomnia occur. If purgative methods are erroneously applied, the stomach becomes empty and hollow, pathogenic factors move to disturb the diaphragm, causing deep-seated vexation and regret (Ao Nao) in the heart. In cases where there is a coating on the tongue, Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is the primary treatment.
These pulse and symptom patterns are similar to Yangming Wind-Strike. The former is named Wind-Strike due to aversion to cold; this one is named Yangming disease due to the paradoxical aversion to heat. Yangming governs the muscles. When heat is extreme and fluids are depleted, failing to moisten the tissues, the muscles lose harmony, resulting in body heaviness. This represents a half-exterior, half-interior syndrome of Yangming. The pathogen has entered the abdomen and is no longer between the Ying (Nutrient) and Wei (Defensive) levels. Although the pulse is floating, it should not be treated as an exterior syndrome requiring sweating; although the pulse is tight, warming needles should not be added simply because of body heaviness; the Stomach home has just begun to solidify but has not yet reached dryness and hardness, so purgatives should not be used merely for wheezing, fullness, and aversion to heat. Erroneous sweating depletes Kidney Yin fluids, causing restlessness; exhaustion of Heart Yin fluids leads to mental dullness and confusion; lack of Stomach fluids results in dry, hard stool and delirium. Erroneous use of warming needles adds fire to fire, causing fear and palpitations; Earth (Spleen) and Water (Kidney) are oppressed by fire, leading to irritability and inability to sleep. Yangming Wind-Strike involves the Qi level and should not be blindly purged. Here, since signs of Stomach excess are present, purging is not necessarily wrong. However, purging empties the Stomach; while symptoms like wheezing, fullness, sweating, aversion to heat, and body heaviness may cease, pathogens lingering in the Upper Jiao will not be eliminated by purging, thus disturbing the diaphragm and causing deep-seated vexation and regret. In Yangming disease, erroneous sweating is considered severe, while erroneous purging is lighter. The phrase "coating on the tongue" connects to the preceding four sections. Aversion to cold and preference for heat are governed by the Heart Master; symptoms of confusion, fearfulness, and regret are caused by Heart pathology, hence the tongue should be examined. The tongue is the external manifestation of the Heart; the severity of Heart heat can be evidenced by the thickness and depth of color of the tongue coating. Zhizi Chi Tang summarizes the symptoms of the previous four sections. It must be understood that this formula is designed to simultaneously resolve both exterior and interior aspects when the Stomach home first receives pathogens, not solely for post-purging conditions. Initially, Yangming disease is neither entirely exterior nor entirely interior; all symptoms lie in the semi-exterior region within. Sweating, purging, and warming needles are all contraindicated. What method should be used? Only emesis serves as an outlet for expelling Yangming exterior pathogens. However, if the disease is in the chest, Gouti San (Melon Spike Powder) is appropriate. Since the disease here is in the abdomen, Gouti San is unsuitable, and Zhizi Chi Tang is indicated. Exterior symptoms such as spontaneous sweating, aversion to heat, and body heaviness will be resolved; interior symptoms such as wheezing, fullness, dry throat, and bitter taste will naturally subside.
The presence of Zhizi Chi Tang in Yangming disease is analogous to Guizhi Tang (Cinnamon Twig Decoction) in Taiyang disease; both can expel pathogens and rectify errors, allowing the Upper Jiao to unblock, fluids to descend, and Stomach Qi to harmonize.
If there is thirst with desire to drink water, dry mouth, and dry tongue, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is indicated.
The preceding text describes Yang pathogens entering from the exterior into the interior; this section describes a syndrome progressing from shallow to deep. Dry throat, bitter taste, and aversion to heat indicate heat in the interior but not yet affecting the Heart; confusion, fearfulness, and regret indicate entry into the Heart but not yet the Stomach; dryness, thirst, and desire to drink indicate heat has entered the Stomach but has not yet caused dryness and hardness. Baihu Jia Renshen Tang clears Stomach Fire and supports Original Qi, completely independent of sweating, emesis, or purging methods.
If the pulse is floating, there is fever, thirst with desire to drink water, and dysuria, Zhu Ling Tang (Polyporus Decoction) is indicated.
The previous section was based on the various symptoms of the first section; this section builds upon the mention of drinking water in the preceding text. The repeated use of "if" highlights Zhang Zhongjing's detailed approach to managing diseases. Where Zhizi Chi Tang is insufficient, Baihu Tang follows; where Baihu Tang is insufficient, Zhu Ling Tang follows. These are the initial three methods for treating Yangming disease. This is done to preserve Stomach fluids, preventing both Stomach dryness and water accumulation invading the Stomach. Further implications are found in the Zhu Ling Tang section.
After sweating, emesis, or purging, deficiency vexation and insomnia occur. If severe, the patient tosses and turns, experiencing deep-seated vexation and regret in the heart; Zhizi Chi Tang is indicated. If there is shortness of breath, Zhizi Gancao Chi Tang (Gardenia, Licorice, and Fermented Soybean Decoction) is indicated. If vomiting occurs, Zhizi Shengjiang Chi Tang (Gardenia, Ginger, and Fermented Soybean Decoction) is indicated.
Deficiency vexation is a transformed syndrome of Yangming, treated according to symptoms using Gardenia formulas, similar to how Taiyang transformed syndromes are often treated with modified Guizhi Tang. Replacing burning needles with emesis, and using "regret" to encompass confusion and fearfulness, allows for mutual textual interpretation. Zhizi Chi Tang was originally designed for irritability and vexation, and can also treat deficiency vexation; thus, Yangming deficiency differs from Taiyang deficiency, and Yangming vexation differs from Taiyang vexation. Although the first sentence mentions sweating, emesis, and purging, the main point refers specifically to post-purging states, as Yangming diseases are often mishandled by premature purging. "Tossing and turning" vividly depicts the state of insomnia, bringing life to the term "deficiency vexation." This is because fire nature is agitated, leaving the Heart without support. The Heart resides above the Stomach, which is the exterior of Yangming. All Heart diseases stem from Yangming exterior pathogens; thus, Zhizi Chi Tang is formulated to induce emesis顺势 (following the trend). Generally, Taiyang exterior syndromes require sweating but not emesis; Yangming exterior syndromes require emesis but not sweating; Taiyang interior syndromes require promoting urination but not purging; Yangming interior syndromes require purging but not promoting urination. People today only know sweating as resolving the exterior, unaware that emesis also resolves the exterior; thus, within Zhang Zhongjing's great principles, they recognize sweating and purging but omit emesis. Shortness of breath and vomiting are differentiated from deficiency vexation. Vexation inevitably damages Qi; add Licorice to tonify Qi. Deficiency heat binding together inevitably causes vomiting; add Ginger to disperse pathogens.
After sweating or purging, if vexation-heat and chest oppression occur, Zhizi Chi Tang is indicated.
"Oppression" refers to stagnation. If vexation is deficiency vexation, then heat is deficiency heat, and oppression is deficiency oppression. This results from heat damaging the Monarch (Heart), leading to insufficient Heart Qi. Treating with Zhizi Chi Tang exemplifies "benefiting Heart Yang, allowing even cold to circulate freely." After erroneous purging, stagnation is not in the epigastrium but in the chest; thus, Zhizi Chi Tang is still used, following the same logic as using Guizhi Tang for unresolved exterior symptoms after purging in Taiyang disease. Generally, if the disease does not change, the formula should not change.
After purging, if vexation increases and the epigastrium is soft to pressure, it is deficiency vexation, suitable for Zhizi Chi Tang.
Increased vexation means vexation recurring after resolution. Softness of the epigastrium contrasts with chest oppression and differs significantly from hardness of the epigastrium. It must be known that Yangming deficiency vexation contrasts with Stomach excess heat; it is "empty" deficiency, not "weak" deficiency.
In Yangming disease, after purging, if there is residual heat on the exterior, warm hands and feet, no formation of Chest Binding, deep-seated vexation and regret in the heart, hunger but inability to eat, and sweating only on the head, Zhizi Chi Tang is indicated.
Residual heat on the exterior means body heat has not subsided. Warm hands and feet indicate no profuse sweating yet, resembling pre-purging symptoms, showing that premature purging was inappropriate. Absence of Chest Binding indicates no fluid retention in the epigastrium, confirming Yangming dry transformation. Deep-seated vexation and regret indicate persistent heat in the Upper Jiao. Hunger but inability to eat indicates pathogenic heat failing to digest food. Sweating only on the head without jaundice indicates Heart Fire flaring upward and absence of fluid retention in the skin. This refers to post-purging transformations. Yangming disease inherently has indications for purging. However, if exterior signs persist and purging is too early, although the Stomach may not be damaged, Upper Jiao Fire depression fails to communicate. Zhizi Chi Tang should still be used to induce emesis; once the Heart is clear, interior and exterior naturally harmonize.
In Shanghan (Cold Damage) at five to six days, after vigorous purging, if body heat persists and there is knotted pain in the heart, the disease is not resolving; Zhizi Chi Tang is indicated.
Disease originating in Yang but treated with purging leaves exterior heat unresolved and causes knotted pain in the heart. Although milder than Chest Binding, it is more severe than regret. Chest Binding involves water accumulation in the chest and hypochondrium, treated with Xianxiong Tang (Major Pinellia Decoction); water depression is broken. Here, heat accumulates in the heart, treated with Zhizi Chi Tang; fire depression is vented.
Zhizi Chi Tang:
Zhizi (Gardeniae Fructus) (14 pieces) Xiangchi (Prepared Fermented Soybeans) (4 he, wrapped in silk)
Take these two ingredients, boil in 4 sheng of water. First decoct Zhizi until 2.5 sheng remains, then add Xiangchi. Boil until 1.5 sheng remains, remove dregs, divide into two doses. Take warm. If vomiting occurs, stop subsequent doses.
Zhizi Gancao Chi Tang:
Add Gancao (Licoriae Radix) (2 liang) to the base formula. Remainder of preparation is the same as above.
Zhizi Shengjiang Chi Tang:
Add Shengjiang (Zingiberis Rhizoma Recens) (5 liang) to the base formula. Remainder of preparation is the same as above.
This is an emetic and draining agent for Yangming half-exterior, half-interior syndromes. Shaoyang half-exterior is cold, half-interior is hot. Yangming heat moves from interior to exterior, presenting heat without cold. Exterior signs include body heat, sweating, absence of aversion to cold but presence of aversion to heat, body heaviness, or eye pain, nasal dryness, and inability to sleep. Interior signs include dry throat, bitter taste, tongue coating, irritability, thirst, deep-seated vexation and regret, abdominal fullness, and wheezing. This heat is half-exterior, half-interior. Although the pulse is floating and tight, it cannot be diagnosed as Taiyang disease and is not suitable for sweating agents. Moreover, the disease is in the chest and abdomen but has not entered the Stomach Fu organ, so purging is inappropriate. The method should be emesis to disperse pathogens. Zhizi is bitter and can drain heat, cold and can overcome heat; its shape resembles the Heart; its red color corresponds to the Heart, thus removing Heart vexation, confusion, regret, and knotted pain. Beans resemble the Kidney; processed into Chi, they become light and float upward, enabling pathogens in the Heart and abdomen to exit via the mouth. One emesis relieves the Heart and abdomen, clearing all interior and exterior vexation-heat. This is because "diseases of the Two Yangs originate in the Heart and Spleen"; the aforementioned symptoms represent Heart-Spleen heat, not Stomach heat, aligning with the principle "where heat belongs to the Zang organs, attack it, do not induce sweating." If heat damages Qi causing shortness of breath, add Licorice to tonify Qi. If deficiency heat binds causing vomiting, add Ginger to disperse pathogens. Zhizi paired with Chi in Zhizi Chi Tang, and Red Bean paired with Chi in Gouti San, both embody the interaction of Heart and Kidney.
In Shanghan, if a physician uses pill-based purgatives vigorously, and body heat persists with slight vexation, Zhizi Ganjiang Tang (Gardenia and Dried Ginger Decoction) is indicated.
Attacking the interior does not avoid cold; using pill purgatives vigorously implies cold pathogens remaining in the middle. Slight Heart vexation without regret indicates emesis is unsuitable. Use Zhizi to relieve vexation and double the amount of Ganjiang (Zingiberis Rhizoma) to drive out internal cold and disperse exterior heat. Cold utilized through heat, heat utilized through cold; two ingredients form the prescription, completing the three methods.
After Shanghan purging, if there is Heart vexation, abdominal fullness, and restlessness, Zhizi Houpo Tang (Gardenia and Magnolia Bark Decoction) is indicated.
Heart vexation makes lying down difficult; abdominal fullness makes standing up difficult. Restlessness indicates Heart heat transferring to the Stomach, differing from the tossing-and-turning deficiency vexation. Zhizi treats vexation; Zhishi (Immature Bitter Orange) and Houpo (Magnolia Bark) drain fullness. This is a subtle agent resolving both Heart and abdomen. Heat has entered the Stomach, so emesis is contraindicated; stool is not yet dry and hard, so purging is contraindicated. This is a preliminary step toward Xiao Chengqi Tang (Minor Order the Qi Decoction).
Zhizi Ganjiang Tang:
Zhizi (14 pieces) Ganjiang (Dried Ginger) (2 liang)
Take these two ingredients, boil in 3 sheng of water until 1.5 sheng remains, remove dregs, divide into two doses. Take warm.
Zhizi Houpo Tang:
Zhizi (14 pieces), Houpo (4 liang), Zhishi (Immature Bitter Orange). Remainder of preparation is the same as above.
The nature of Zhizi allows it to descend curvingly; it is not an emetic agent. Only the fermented aroma of Chi rises to熏 (fumigate) the Heart and Lungs, inducing vomiting. Observing that Gouti San must be taken with Chi juice confirms that the emetic effect lies in Chi, not Zhizi. Zhizi Ganjiang Tang removes Chi and adds Ginger to achieve horizontal dispersion; Zhizi Houpo Tang replaces Chi with Zhishi and Houpo to achieve downward drainage, avoiding upward projection. Old editions stating "stop subsequent doses if vomiting occurs" for both formulas are erroneous. Observing Zhizi Baipi Tang and Yinchen Hao Tang, which contain Zhizi but do not mention vomiting, and the contraindication for patients with chronic loose stools, clarifies Zhizi's nature.
For Shanghan with body heat and jaundice, Zhizi Baipi Tang (Gardenia and Phellodendron Bark Decoction) is indicated.
Body heat and sweating characterize Yangming disease. If cold pathogens are too heavy, Yang Qi is constrained in the exterior, preventing sweating and heat release, leading to jaundice. Yellow is the color of Earth; intense Stomach Fire and depleted fluids cause yellowing in the muscles. This differs distinctly from Taiyang erroneous purging where cold water remains in the skin; it is not suitable for sweating, emesis, or purging. Bitter-sweet agents are required for regulation. Zhizi, Baipi (Phellodendri Cortex), and Gancao are all yellow in color and moist in texture. Zhizi treats internal vexation; Baipi treats exterior heat; Gancao harmonizes Qi. Diseases of form and color are treated using corresponding forms and colors.
Zhizi Baipi Tang:
Zhizi (15 pieces) Gancao (2 liang) Huangbai (Phellodendri Cortex)
Take these three ingredients, boil in 4 sheng of water until 1.5 sheng remains, remove dregs, divide into two warm doses.
In Yangming disease, absence of sweating, dysuria, and deep-seated vexation and regret in the heart indicate impending jaundice.
Yangming disease typically presents with sweating; absence of sweating prevents heat release. Dysuria prevents heat descent. Heart fluids fail to sustain, causing deep-seated vexation and regret even without prior sweating or purging. Absence of sweating and dysuria are the origins of jaundice; deep-seated vexation and regret are the precursors. However, absence of thirst and abdominal fullness makes Yinchen Hao Tang unsuitable; Zhizi Baipi Tang will resolve the jaundice.
If Yangming disease is subjected to fire therapy, with slight sweating on the forehead and dysuria, jaundice will definitely develop.
Yangming disease lacks exterior signs and should not be sweated, let alone subjected to fire coercion. The forehead is the area of the Heart; slight sweating here indicates exhaustion of Heart fluids. Heart deficiency leads to Kidney deficiency, causing dysuria and jaundice. How else can Zhizi Baipi Tang restore fluids amidst depletion?
In Yangming disease, if the face is fully red, purging is contraindicated; otherwise, fever and yellowing will occur, along with dysuria.
Full redness of the face indicates Yang Qi constrained in the exterior, requiring sweating for resolution. Erroneous purging prevents heat release, causing recurrent fever and transformation of redness into yellow. The previous section resulted from fire reversal; this section from erroneous purging. The former had dysuria before jaundice; this section has jaundice before dysuria. Both result from fluid depletion failing to regulate water passages. Zhizi and Baipi are needed to nourish the source and generate fluids; diuretic agents are unsuitable. For jaundice not yet developed, Zhizi Chi Tang is appropriate; for developed jaundice, Zhizi Baipi Tang is appropriate.
Zhang Zhongjing has two methods for treating Taiyang jaundice: Head sweating only with dysuria requires Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Small Soybean Decoction) to sweat; lower abdominal hardness with normal urination requires Di Dang Tang (Di Dang Decoction) to purge. He has two methods for treating Yangming jaundice: Head sweating, dysuria, and abdominal fullness require Yinchen Hao Tang plus Da Huang (Rhei Radix et Rhizoma) to purge; body heat, jaundice, and iatrogenic cases require Zhizi Baipi Tang to clear. Diuretic agents are never used. It must be known that Zhang Zhongjing's treatment of Yangming focuses on preserving fluids, avoiding promoting urination, fearing Stomach dryness above all, adhering to the principle "treat diseases by seeking their root."
When using any Zhizi Tang, if the patient has a history of chronic loose stools, it must not be administered.
Since ancient times, if Stomach Qi is not firm, even Zhizi is contraindicated. One must be cautious when using Chengqi Tang formulas.