缪希雍曰。太阳病。其症发热。恶寒。恶风。头痛项强。腰脊强。遍身骨痛。脉虽浮洪而不数。
多不传经。烦躁。脉数急者。是欲传经。宜先发汗以解表邪。其药以羌活汤为主。羌活三钱。前
胡、葛根各二钱。甘草八分。生姜三片。枣一枚。杏仁九粒。秋深冬月应用此方。亦可量加紫苏、
葱白。如冬月严寒。感邪即发。服此药不得汗。本方加麻黄一钱。生姜四片。共前七片。得汗。勿
再服。如病患自觉烦躁。喜就清凉。不喜就热。兼口渴。是即欲传入阳明也。若外症头疼。遍身骨
疼不解。或带口渴。鼻干目疼。不得卧。即系太阳阳明症。羌活汤中加石膏、知母、麦冬。大剂与
之。得汗即解。如自汗。烦躁。头疼。遍身骨疼不解者。羌活一钱。桂枝七分。石膏一两二钱。
麦冬六钱。知母三钱。竹叶一百二十片。白芍二钱。甘草八分。如冬月即病太阳症。恶寒畏风。头
疼。遍身骨疼。自汗不渴。宜用桂枝八分。白芍二钱。甘草一钱。枣三枚。姜一片。太阳病不解。
热结膀胱。其人如狂。血自下。下之愈。其外症不解者。不可下。当先解表。表症罢。少腹急结者。
乃可下之。桃仁承气汤。无蓄血症。大承气汤。正阳阳明病者。胃家实热是也。其症不大便。自
汗。潮热。口渴。咽干。鼻干。而呕。或干呕。目 不得眠。畏人声木声。畏火。不恶寒反恶热
或先恶寒。不久旋发热。甚则谵语狂乱。循衣摸床。脉洪大而长。宜急解其表。用竹叶石膏汤。
大剂
与之。不呕无汗。与葛根汤。亦须大剂。若表症已罢。脉缓小。小便利。是病解矣。若表症解后。
邪结于里。大便秘。小便短赤。宜用调胃承气汤。或小承气汤下之。下后。按其腹中。不作痛而和。
病即已解。如作痛。是燥屎未尽也。再用前药下之。以腹中和二便通利为度。阳明病。不能食。
若其人本虚。勿轻议下。阳明病。头眩。咳而咽痛者。用葛根、甘草、桔梗、麦冬四味浓煎。数数
与之。阳明病。无汗。小便不利。心中懊 者。当发黄。急用栀子、麦冬、淡豆豉。大剂浓煎与之。
如已见身黄。急加茵陈为君主之。阳明病。衄血。此缘失于发汗。宜用荆芥、蒲黄、侧柏叶各二
钱。葛根、生地各三钱。麦冬五钱。丹皮钱半。茅根二两。浓煎与之。兼饮童便。阳明病。心下硬
满者。此邪未入于腹中。慎勿下之。用竹叶石膏汤。加栝蒌一个捣碎。桔梗二钱。黄连一钱。阳明
病。邪结于里。汗出身重。短气腹满而喘。潮热。手足 然汗出者。此大便已硬也。六七日以来。
宜下之。用小承气不行。换大承气。勿大其剂。若大便不硬者。慎勿轻下。阳明病。发汗不解。腹
急者。亟下之。伤寒六七日。目中不了了。睛不和。无表症。大便难。承气汤下之。阳明病。下之
早。外有热。手足温。不结胸。心中懊 。不能食。但头汗出。栀子豉汤。阳明病。但潮热。大便
溏。胸满不去者。小柴胡汤去人参加黄连、栝蒌。阳明病。自汗出。或发汗后小便利。津液内渴。
大便难硬。不可攻之。须候其自欲便。或用蜜导胆导通之。大下后。六七日。不大便。烦不解。腹
满痛。本有宿食。宜再用承气汤下之。食谷欲呕。属阳明。非少阳也。胸中烦热者。竹茹汤主之。
竹茹三钱。麦冬五钱。枇杷叶三大片。芦根三两。内无热症者。小便利。口不渴。此为阳明虚也。
吴茱萸汤主之。吴萸二钱。人参三钱。生姜钱半。枣三枚。水煎。日三服。凡阳明病。多汗。津液
外出。胃中燥。大便必硬。硬则谵语。小承气汤。若一服谵语止者。勿再服。阳明病。谵语。发潮
热。脉滑而数者。小承气汤。服药后。腹中转气者。更一服。若不转气。勿更与。若服后。次日不
大便。脉反微涩者。里虚也。为难治。勿再下。阳明病。下血谵语者。此为热入血室。汗止在头。
用荆芥、葛根各三钱。黄芩、丹皮各钱半。麦冬五钱。生蒲黄二钱。浓煎。童便对饮之。阳明病。
脉浮紧。咽燥。口苦。腹满而喘。发热汗出。恶热。身重。若下之。则
胃中空虚。客气动膈。心中懊 。舌上苔者。栀子豉汤。若渴欲饮水。舌燥者。白虎加人参汤。若
脉浮。发热口渴。小便不利者。猪苓汤。阳明病。协热下利者。六一散。心下痞者。以黄连栝蒌汤
调服。脉浮迟。表热里寒。下利清谷。四逆汤。趺阳脉浮而涩。小便数。大便硬。其脾为约。麻子
仁丸。每用十丸。日三服。阳明实则谵语。虚则郑声。郑声者。重语也。直视谵语。喘满者死。下利
者亦死。发汗多。若重发其汗。谵语。脉短者死。脉和者不死。若吐若下后不解。不大便五六日。
或至十余日。日晡发潮热。不恶寒。独语如见鬼状。若剧者。发则不识人。循衣摸床。惕而不安。
微喘直视。脉弦者生。涩者死。（涩者阳症见阴脉也）微者。但发热谵语。大承气下之。利勿再服。
阳明病发狂。弃衣而走。登高而歌。此阳明实也。以承气亟下之。如便不结。大剂白虎汤灌之。
石膏四两。麦冬二两。知母两半。加大青一两。甘草七钱。太阳阳明病。协热下利者。六一散。黄
连汤调服。太阳阳明并病。六七日表症仍在。其人发狂者。以热在下焦。小腹当硬满。小便自利。
下其血乃愈。桃仁承气汤。又二阳并病。太阳症罢。潮热。汗出。大便难。谵语者。大承气汤。少
阳病。其症口苦。咽干。目眩。往来寒热。胸胁痛。胸满或痛。耳聋。脉弦细。头痛。发热者。属
少阳。少阳不可发汗。发汗则谵语。胃和者自愈。不和则烦而悸。伤寒三日。少阳脉小者。欲已也。
凡太阳病不解。传入少阳者。胁下硬满。干呕。不能食。往来寒热。未经吐下。脉沉紧者。与小
柴胡汤。日三服。柴胡二钱四分。人参、黄芩、甘草、生姜各九分。半夏钱半。大枣二枚。加减法。
若胸中烦而不呕。去半夏、人参。加栝蒌实一枚。若心下痞满。去大枣。加牡蛎二钱半。若渴者。
去半夏。加人参、花粉。若腹中痛者。去黄芩。加白芍三钱。若心下悸。小便不利。去黄芩。加
茯苓二钱。若不渴。外有微热者。去人参。加桂一钱。夏勿用。温覆取微汗。愈。若咳者。去参、
枣。加五味一钱。少佐干姜。阳明少阳并病。必下利。脉滑而数。有宿食也。承气汤下之。若吐下
发汗温针。谵语。柴胡汤症罢。此为坏病。知犯何逆。以法治之。三阳合病。脉大。上关上。但欲
睡眠。目合则汗。药用百合一两。麦冬五钱。炙草一钱。知母、白芍、花粉各二钱。制龟甲三钱。竹
叶五十片。三阳合病。腹满
身重。谵语遗尿。白虎汤。加百合。伤寒六七日。无大热。其人烦躁者。此为阳去入阴故也。伤寒
三日。三阳为尽。三阴当受邪。其人反能食而不呕。此为三阴不受邪之故也。
缪希雍说：太阳病，其症状表现为发热、恶寒、恶风、头痛项强（后脑及颈部僵硬）、腰脊强直、全身骨节疼痛。脉象虽然浮洪但不数急。大多不传变至其他经络。如果出现烦躁、脉象数急的情况，这是病情即将传经的征兆，应当先发汗以解除表邪。用药以羌活汤为主方。羌活三钱，前胡、葛根各二钱，甘草八分，生姜三片，大枣一枚，杏仁九粒。深秋和冬季应当使用此方。也可以酌情加入紫苏、葱白。如果在严冬时节感受邪气立即发病，服用此药后未能出汗，可在本方基础上加麻黄一钱，生姜四片，共计前文提到的七片生姜。若已出汗，不要再服用。如果病人自觉烦躁，喜欢清凉环境，不喜欢温热，兼有口渴，这是病情即将传入阳明经的表现。如果外部症状如头痛、全身骨节疼痛未解，或者伴有口渴、鼻干、目痛、无法安卧，这就是太阳阳明合病。在羌活汤中加入石膏、知母、麦冬，大剂量给予患者。出汗后即可痊愈。如果是自汗、烦躁、头痛、全身骨节疼痛未解的情况，用羌活一钱，桂枝七分，石膏一两二钱，麦冬六钱，知母三钱，竹叶一百二十片，白芍二钱，甘草八分。如果在冬季即患太阳病，表现为恶寒畏风、头痛、全身骨节疼痛、自汗且不渴，宜用桂枝八分，白芍二钱，甘草一钱，大枣三枚，生姜一片。
太阳病如果不愈，热邪结聚于膀胱，病人出现如狂的症状，如果瘀血自行排出，病就好了。如果外部症状仍未解除，不可攻下，应当先解表。表证解除后，如果少腹拘急硬结，才可以攻下。使用桃仁承气汤。如果没有蓄血症状，使用大承气汤。正阳阳明病，是指胃家实热。其症状为不大便、自汗、潮热、口渴、咽干、鼻干、呕吐或干呕、眼睛不适难以入睡、害怕人声和木声、怕火、不怕冷反而怕热，或者先恶寒，不久转为发热，甚至出现谵语狂乱、循衣摸床（手无意识地抓摸衣物或床沿）。脉象洪大而长，应当紧急解除表邪，使用竹叶石膏汤，大剂量给予。如果不呕吐且无汗，给予葛根汤，也必须是大剂量。如果表证已经解除，脉象缓小，小便通畅，说明病已痊愈。如果表证解除后，邪气结聚于里，大便秘结，小便短赤，宜用调胃承气汤或小承气汤攻下。攻下后，按压腹部，如果不痛且感觉平和，病就解除了。如果疼痛，说明燥屎未尽，再用前面的药物攻下，以腹部平和、二便通利为标准。
阳明病，不能进食，如果病人本身虚弱，不要轻易议定攻下。阳明病，头晕目眩，咳嗽且咽喉痛的，用葛根、甘草、桔梗、麦冬四味药浓煎，频频给予饮用。阳明病，无汗，小便不利，心中烦闷懊恼的，应当发黄，紧急使用栀子、麦冬、淡豆豉，大剂量浓煎给予。如果已经见到身黄，紧急加入茵陈作为君药。阳明病，鼻衄（流鼻血），这是因为失于发汗所致，宜用荆芥、蒲黄、侧柏叶各二钱，葛根、生地各三钱，麦冬五钱，丹皮半钱，茅根二两，浓煎给予。同时饮用童便。阳明病，心下部硬满的，这是邪气尚未进入腹中，千万不要攻下。使用竹叶石膏汤，加栝蒌一个捣碎，桔梗二钱，黄连一钱。
阳明病，邪气结聚于里，出汗后身体沉重，气短，腹部胀满而喘，潮热，手足濈然汗出（持续不断地出汗）的，这说明大便已经坚硬。从发病六七天以来，应当攻下。如果使用小承气汤无效，换用大承气汤，但不要加大剂量。如果大便不硬，千万不要轻易攻下。阳明病，发汗后病不解，腹部拘急的，必须紧急攻下。伤寒六七天，眼睛视物不清，眼球转动不灵活，没有表证，大便困难，用承气汤攻下。阳明病，攻下过早，外部有热，手足温暖，没有结胸，心中懊恼，不能进食，只有头部出汗，用栀子豉汤。阳明病，只是潮热，大便溏薄，胸部胀满不除的，用小柴胡汤去掉人参，加入黄连、栝蒌。阳明病，自汗出，或者发汗后小便通畅，津液内竭导致口渴，大便难硬，不可攻下。必须等待病人自己想排便，或者用蜜导、胆导（猪胆汁灌肠）来通便。大泻之后，过了六七天，仍然不大便，烦躁不除，腹部胀满疼痛，原本就有宿食，宜再用承气汤攻下。吃食物想呕吐，属于阳明病，不是少阳病。胸中烦热的，用竹茹汤主治。竹茹三钱，麦冬五钱，枇杷叶三大片，芦根三两。内部没有热证的，小便通畅，口不渴，这是阳明虚证。用吴茱萸汤主治。吴茱萸二钱，人参三钱，生姜半钱，大枣三枚，水煎，每日服三次。
凡是阳明病，多汗，津液外泄，胃中干燥，大便必然坚硬。硬则会出现谵语，用小承气汤。如果服一次后谵语停止，不要再服用。阳明病，谵语，发潮热，脉滑而数的，用小承气汤。服药后，腹部有转气的感觉，再服一次。如果没有转气，不要再次给予。如果服药后，第二天仍不大便，脉象反而微涩的，是里虚，属于难治，不要再攻下。阳明病，下血且谵语的，这是热入血室。汗止于头部，用荆芥、葛根各三钱，黄芩、丹皮各半钱，麦冬五钱，生蒲黄二钱，浓煎，用童便兑服。
阳明病，脉浮紧，咽燥，口苦，腹部胀满而喘，发热汗出，恶热，身体沉重。如果攻下，会导致胃中空虚，客气扰动膈部，心中懊恼。舌上有苔的，用栀子豉汤。如果口渴想喝水，舌面干燥的，用白虎加人参汤。如果脉浮，发热口渴，小便不利的，用猪苓汤。阳明病，协热下利的，用六一散。心下部痞塞的，用黄连栝蒌汤调服。脉浮迟，表热里寒，下利清谷（拉出未消化的食物）的，用四逆汤。趺阳脉浮而涩，小便频数，大便硬，这是脾约证。用麻子仁丸。每次服用十丸，每日三次。
阳明实证则谵语，虚证则郑声。郑声，是指语言重复。直视且谵语，气喘胸满的会死，下利的也会死。发汗过多，如果再重发其汗，出现谵语，脉短的会死，脉调和的不会死。如果吐法或下法之后病不解，五六天甚至十余天不大便，傍晚发潮热，不怕冷，独自说话像看见鬼怪一样。如果病情严重，发作时不认识人，循衣摸床，惊恐不安，轻微喘息，直视，脉弦的能生，脉涩的会死。（脉涩是阳证见到阴脉的缘故）。轻微的，只是发热谵语，用大承气汤攻下。如果腹泻了，不要再服用。
阳明病发狂，扔掉衣服奔跑，登上高处唱歌，这是阳明实证。用承气汤紧急攻下。如果大便不结，用大剂量的白虎汤灌服。石膏四两，麦冬二两，知母一两半，加大青一两，甘草七钱。
太阳阳明病，协热下利的，用六一散，黄连汤调服。太阳阳明并病，六七天表证仍在，病人发狂的，因为热在下焦，小腹应当硬满，小便自利，攻下瘀血才能痊愈。用桃仁承气汤。又是二阳并病，太阳症罢，潮热，汗出，大便难，谵语的，用大承气汤。
少阳病，其症状为口苦、咽干、目眩、往来寒热（忽冷忽热）、胸胁痛、胸满或痛、耳聋、脉弦细、头痛、发热，这属于少阳病。少阳病不可发汗，发汗则会出现谵语。胃气和顺的会自愈，不和顺则会心烦心悸。伤寒三日，少阳脉小的，是病欲愈的表现。
凡是太阳病不愈，传入少阳的，胁下硬满，干呕，不能进食，往来寒热，未经过吐下法，脉沉紧的，给予小柴胡汤。每日服三次。柴胡二钱四分，人参、黄芩、甘草、生姜各九分，半夏半钱，大枣二枚。加减法：如果胸中烦闷但不呕吐，去掉半夏、人参，加栝蒌实一枚。如果心下部痞满，去掉大枣，加牡蛎二钱半。如果口渴，去掉半夏，加人参、花粉。如果腹中痛，去掉黄芩，加白芍三钱。如果心下悸动，小便不利，去掉黄芩，加茯苓二钱。如果不渴，外部有轻微发热的，去掉人参，加桂枝一钱，夏季不要用。温覆取微汗，痊愈。如果咳嗽，去掉人参、大枣，加五味子一钱，少量佐以干姜。
阳明少阳并病，必然下利，脉滑而数，有宿食的，用承气汤攻下。如果经过吐、下、发汗、温针等治疗，出现谵语，柴胡汤证已罢，这叫坏病。要知道犯了什么错误，根据情况依法治疗。
三阳合病，脉大，关脉以上明显，只想睡觉，闭眼则出汗。药用百合一两，麦冬五钱，炙甘草一钱，知母、白芍、花粉各二钱，制龟甲三钱，竹叶五十片。三阳合病，腹部胀满，身体沉重，谵语，遗尿的，用白虎汤加百合。
伤寒六七天，没有大热，病人烦躁的，这是阳气离去转入阴经的缘故。伤寒三日，三阳经的病期已过，三阴经应当受邪，但病人反而能进食且不呕吐，这是三阴经不受邪的缘故。
Miao Xiyong said: In Taiyang disease (Disease of the Taiyang channel), the symptoms include fever, aversion to cold, aversion to wind, headache with stiffness in the nape and neck, stiffness in the waist and spine, and generalized bone pain. The pulse is floating and surging but not rapid. It mostly does not transmit to other channels. If irritability and a rapid pulse appear, this indicates that the disease is about to transmit; it is appropriate to induce sweating first to resolve the exterior pathogenic factor. The primary prescription is Qianghuo Tang (Notopterygium Decoction). Notopterygii Rhizoma et Radix (Qianghuo) 3 qian, Peucedani Radix (Qianhu) and Puerariae Radix (Gegen) each 2 qian, Glycyrrhizae Radix et Rhizoma (Gancao) 8 fen, Zingiberis Rhizoma Recens (Shengjiang) 3 slices, Jujubae Fructus (Zao) 1 piece, Armeniacae Semen Amarum (Xingren) 9 grains. This formula should be used in late autumn and winter. Zi Su Ye (Perilla Leaf) and Cong Bai (Scallion White) may be added according to circumstances. If in severe winter, upon contracting the pathogen immediately, taking this medicine fails to produce sweat, add Ephedrae Herba (Mahuang) 1 qian and Zingiberis Rhizoma Recens (Shengjiang) 4 slices to the original formula (totaling 7 slices of ginger). Once sweat is produced, do not take more. If the patient feels irritable, prefers cool environments, dislikes heat, and has thirst, this indicates the disease is about to transmit to the Yangming channel. If external symptoms such as headache and generalized bone pain persist, or if accompanied by thirst, dry nose, eye pain, and inability to sleep, this is a combined Taiyang-Yangming syndrome. Add Gypsum Fibrosum (Shigao), Anemarrhenae Rhizoma (Zhimu), and Ophiopogonis Radix (Maidong) to Qianghuo Tang, and administer in large doses. The disease resolves once sweat is produced.
If there is spontaneous sweating, irritability, headache, and persistent generalized bone pain, use Notopterygii Rhizoma et Radix (Qianghuo) 1 qian, Cinnamomi Ramulus (Guizhi) 7 fen, Gypsum Fibrosum (Shigao) 1 liang 2 qian, Ophiopogonis Radix (Maidong) 6 qian, Anemarrhenae Rhizoma (Zhimu) 3 qian, Phyllostachydis Folium (Zhuye) 120 leaves, Paeoniae Radix Alba (Baishao) 2 qian, and Glycyrrhizae Radix et Rhizoma (Gancao) 8 fen. If one contracts Taiyang disease in winter, presenting with aversion to cold and wind, headache, generalized bone pain, spontaneous sweating, and no thirst, use Cinnamomi Ramulus (Guizhi) 8 fen, Paeoniae Radix Alba (Baishao) 2 qian, Glycyrrhizae Radix et Rhizoma (Gancao) 1 qian, Jujubae Fructus (Zao) 3 pieces, and Zingiberis Rhizoma Recens (Shengjiang) 1 slice.
If Taiyang disease does not resolve, heat accumulates in the Bladder, and the patient exhibits manic-like behavior. If blood discharges spontaneously, the disease heals. If external symptoms remain unresolved, purgation is contraindicated; one must first resolve the exterior. After the exterior syndrome subsides, if there is urgency and binding in the lower abdomen, purgation may be performed using Tao Ren Cheng Qi Tang (Peach Kernel Downward-Flowing Decoction). If there is no blood retention syndrome, Da Cheng Qi Tang (Major Downward-Flowing Decoction) is used. Zhengyang Yangming disease refers to excess heat in the Stomach and Intestines. Symptoms include constipation, spontaneous sweating, tidal fever, thirst, dry throat, dry nose, vomiting or dry heaving, ocular discomfort preventing sleep, fear of human voices and wooden sounds, fear of fire, aversion to heat rather than cold, or initial aversion to cold followed quickly by fever. Severe cases may involve delirium, mania, picking at clothes and bedrails. The pulse is surging, large, and long. The exterior should be urgently resolved using Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction), administered in large doses. If there is no vomiting and no sweat, Gegen Tang (Kudzu Decoction) is given, also in large doses. If the exterior syndrome has resolved, the pulse is slow and small, and urination is free, the disease is healed. If after resolving the exterior, pathogens bind internally causing constipation and scanty dark urine, Tiao Wei Cheng Qi Tang (Regulate the Stomach Downward-Flowing Decoction) or Xiao Cheng Qi Tang (Minor Downward-Flowing Decoction) should be used for purgation. After purgation, palpating the abdomen: if there is no pain and the area feels peaceful, the disease is resolved. If there is pain, dry feces remain; repeat the previous purgative method until the abdomen is peaceful and bowel/bladder movements are unobstructed.
In Yangming disease, inability to eat suggests underlying deficiency; do not lightly recommend purgation. For Yangming disease with dizziness, cough, and sore throat, decoct Ge Gen (Puerariae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Jie Geng (Platycodonis Radix), and Mai Dong (Ophiopogonis Radix) thickly, and administer frequently. For Yangming disease with no sweat, difficult urination, and internal restlessness (Ao Nan), jaundice will likely develop; urgently use Zhi Zi (Gardeniae Fructus), Mai Dong (Ophiopogonis Radix), and Dan Dou Chi (Prepared Soybean) in a large, thick decoction. If yellow skin is already visible, urgently add Yin Chen (Artemisiae Scopariae Herba) as the sovereign herb. For Yangming disease with epistaxis due to missed sweating therapy, use Jing Jie (Schizonepetae Spica), Pu Huang (Typhae Pollen), and Ce Bai Ye (Biota Top Leaf) each 2 qian, Ge Gen (Puerariae Radix) and Di Huang (Rehmanniae Radix) each 3 qian, Mai Dong (Ophiopogonis Radix) 5 qian, Mu Dan Pi (Moutan Cortex) half qian, and Mao Gen (Imperatae Rhizoma) 2 liang, decocted thickly. Drink with child's urine. For Yangming disease with hardness and fullness in the epigastrium, the pathogen has not entered the abdomen; do not purge. Use Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) with Gua Lou (Trichosanthis Fructus) crushed, Jie Geng (Platycodonis Radix) 2 qian, and Huang Lian (Coptidis Rhizoma) 1 qian.
For Yangming disease with internal pathogen binding, sweating followed by heaviness, shortness of breath, abdominal fullness and wheezing, tidal fever, and continuous sweating on hands and feet, the stool is hard. From the sixth or seventh day, purgation is indicated. If Xiao Cheng Qi Tang (Minor Downward-Flowing Decoction) fails, switch to Da Cheng Qi Tang (Major Downward-Flowing Decoction) without increasing the dose. If the stool is not hard, do not purge lightly. If Yangming disease persists after sweating with abdominal urgency, urgent purgation is needed. In Cold Damage lasting six to seven days, with unclear vision and unsteady eyes, no exterior syndrome, and difficulty defecating, use Cheng Qi Tang (Downward-Flowing Decoction). If Yangming purgation was premature, resulting in external heat, warm hands/feet, no chest binding, internal restlessness, anorexia, and only head sweating, use Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction). For Yangming disease with only tidal fever, loose stools, and persistent chest fullness, use Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Renshen (Ginseng) removed and Huang Lian (Coptidis Rhizoma) and Gua Lou (Trichosanthis Fructus) added. For Yangming disease with spontaneous sweating or post-sweating free urination leading to internal fluid depletion, thirst, and hard difficult stool, do not attack with purgatives. Wait for the natural urge to defecate, or use honey suppositories or pig bile enemas. After severe purgation, if six to seven days pass without defecation, unresolved irritability, and abdominal fullness/pain due to retained food, use Cheng Qi Tang again. Vomiting after eating indicates Yangming, not Shaoyang. For internal chest烦热 (heat and vexation), Zhu Ru Tang (Bamboo Shavings Decoction) is used: Zhu Ru (Bamboo Shavings) 3 qian, Mai Dong (Ophiopogonis Radix) 5 qian, Pi Pa Ye (Loquat Leaf) 3 large slices, Lu Gen (Imperatae Rhizoma) 3 liang. For internal deficiency without heat signs (free urination, no thirst), Wu Zhu Yu Tang (Evodia Decoction) is used: Wu Zhu Yu (Evodiae Fructus) 2 qian, Renshen (Ginseng) 3 qian, Sheng Jiang (Fresh Ginger) half qian, Zao (Jujube) 3 pieces, decocted in water, taken three times daily.
Generally, Yangming disease involves much sweat and outward loss of fluids, leading to dry stomach and hard stool, which causes delirium; treat with Xiao Cheng Qi Tang. If delirium stops after one dose, do not continue. For Yangming disease with delirium, tidal fever, and slippery-rapid pulse, use Xiao Cheng Qi Tang. If abdominal gas turns after medication, give another dose; if not, do not give more. If the next day there is still no defecation and the pulse becomes faint and choppy, it indicates interior deficiency and is difficult to treat; do not purge further. Yangming disease with bloody discharge and delirium indicates heat entering the Blood Chamber; sweat stops at the head. Use Jing Jie (Schizonepetae Spica) and Ge Gen (Puerariae Radix) each 3 qian, Huang Qin (Scutellariae Radix) and Mu Dan Pi (Moutan Cortex) each half qian, Mai Dong (Ophiopogonis Radix) 5 qian, Sheng Pu Huang (Raw Typhae Pollen) 2 qian, decocted thickly and drunk with child's urine.
For Yangming disease with floating-tight pulse, dry throat, bitter taste, abdominal fullness with wheezing, fever with sweating, aversion to heat, and body heaviness: if purged, the Stomach becomes empty, rebellious qi disturbs the diaphragm, causing internal restlessness. With tongue coating, use Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction). With thirst and dry tongue, use Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng). With floating pulse, fever, thirst, and difficult urination, use Zhu Ling Tang (Polyporus Decoction). For Yangming disease with diarrhea accompanying heat, use Liu Yi San (Six-to-One Powder). For epigastric stuffiness, use Huang Lian Gua Lou Tang (Coptis and Trichosanthis Decoction) mixed in. For floating-slow pulse, exterior heat with interior cold, and diarrhea with undigested food, use Si Ni Tang (Frigid Extremities Decoction). For Fuyang pulse floating and choppy with frequent urination and hard stool, this is Spleen Constriction (Pi Yue); use Ma Zi Ren Wan (Hemp Seed Pill), 10 pills three times daily.
Yangming excess causes delirium; deficiency causes Zheng Sheng (repetitive speech). Zheng Sheng means repeating words. Fixed gaze with delirium, wheezing/fullness, or diarrhea indicates death. Excessive sweating or re-sweating leading to delirium with a short pulse indicates death; a harmonious pulse indicates survival. If vomiting or purgation fails to resolve the condition, with no defecation for five to ten days, evening tidal fever, no aversion to cold, and solitary speech resembling seeing ghosts: if severe, the patient does not recognize others, picks at clothes/bedrails, is terrified and restless, with slight wheezing and fixed gaze. A wiry pulse indicates life; a choppy pulse indicates death (choppy pulse in Yang syndrome shows Yin signs). Mild cases with only fever and delirium are treated with Da Cheng Qi Tang; if diarrhea occurs, stop administration. Yangming disease with mania, discarding clothes, running, and climbing high singing is Yangming excess; urgently purge with Cheng Qi Tang. If stool is not bound, administer large-dose Bai Hu Tang (White Tiger Decoction): Shi Gao (Gypsum) 4 liang, Mai Dong (Ophiopogonis Radix) 2 liang, Zhi Mu (Anemarrhenae Rhizoma) 1.5 liang, Da Qing Ye (Isatidis Folium) 1 liang, Gan Cao (Glycyrrhizae Radix et Rhizoma) 7 qian.
Taiyang-Yangming disease with diarrhea accompanying heat uses Liu Yi San (Six-to-One Powder) mixed with Huang Lian Tang (Coptis Decoction). Taiyang-Yangming concurrent disease with exterior symptoms persisting for six-seven days and mania indicates heat in the Lower Jiao; the lower abdomen should be hard and full with free urination; purge the blood with Tao Ren Cheng Qi Tang (Peach Kernel Downward-Flowing Decoction). In concurrent diseases of two Yang channels, after Taiyang symptoms cease, with tidal fever, sweating, difficult defecation, and delirium, use Da Cheng Qi Tang (Major Downward-Flowing Decoction).
Shaoyang disease symptoms include bitter taste, dry throat, vertigo/dizziness, alternating chills and fever, hypochondriac pain, chest fullness or pain, deafness, wiry-thin pulse, headache, and fever; this belongs to Shaoyang. Shaoyang disease must not be treated with sweating; sweating leads to delirium. If the Stomach harmonizes, it self-heals; if not, irritability and palpitations occur. On the third day of Cold Damage, a small Shaoyang pulse indicates the disease is about to end.
When Taiyang disease transmits to Shaoyang without resolving, presenting with hypochondriac hardness/fullness, dry retching, anorexia, alternating chills and fever, and a deep-tight pulse without prior vomiting or purgation, administer Xiao Chai Hu Tang (Minor Bupleurum Decoction) three times daily: Chai Hu (Bupleuri Radix) 2.4 qian, Renshen (Ginseng), Huang Qin (Scutellariae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Sheng Jiang (Fresh Ginger) each 9 fen, Ban Xia (Pinelliae Rhizoma) half qian, Da Zao (Jujube) 2 pieces. Modifications: If chest vexation without vomiting, remove Ban Xia and Renshen, add Gua Lou Shi (Trichosanthis Fructus) one piece. If epigastric fullness, remove Da Zao, add Mu Li (Ostrea Shell) 2.5 qian. If thirsty, remove Ban Xia, add Renshen and Hua Fen (Trichosanthis Radix). If abdominal pain, remove Huang Qin, add Baishao (Paeoniae Radix Alba) 3 qian. If palpitations with difficult urination, remove Huang Qin, add Fu Ling (Poria) 2 qian. If not thirsty with slight external heat, remove Renshen, add Guizhi (Cinnamomi Ramulus) 1 qian (avoid in summer). Cover warmly to induce slight sweat for cure. If coughing, remove Renshen and Zao, add Wu Wei Zi (Schisandrae Fructus) 1 qian with a little Gan Jiang (Dried Ginger).
Concurrent Yangming-Shaoyang disease必然 (inevitably) presents with diarrhea; slippery-rapid pulse indicates retained food; purge with Cheng Qi Tang. If vomiting, purgation, sweating, or warm needle therapy cause delirium and Chai Hu syndrome ceases, this is a "ruined disease" (Huai Bing); determine the error and treat accordingly.
Combined disease of the Three Yangs presents with a large pulse, prominent Guan position, somnolence, and sweating upon closing eyes. Formula: Bai He (Lilii Bulbus) 1 liang, Mai Dong (Ophiopogonis Radix) 5 qian, Zhi Gan Cao (Honey-fried Licorice) 1 qian, Zhi Mu (Anemarrhenae Rhizoma), Baishao (Paeoniae Radix Alba), Hua Fen (Trichosanthis Radix) each 2 qian, Zhi Gui Jia (Prepared Tortoise Shell) 3 qian, Zhuye (Bamboo Leaf) 50 leaves. For Combined Three Yangs with abdominal fullness, body heaviness, delirium, and urinary incontinence, use Bai Hu Tang (White Tiger Decoction) plus Bai He (Lilii Bulbus).
In Cold Damage lasting six-seven days, without significant fever but with irritability, this indicates Yang leaving and entering Yin. On the third day of Cold Damage, the Three Yang periods end, and the Three Yin should receive pathogens; however, if the patient can eat and does not vomit, it indicates the Three Yin are not receiving pathogens.