文蛤（五两）
上一味。为散。以沸汤和一钱匕服汤用五合。
琥按成注云。文蛤散以散表中寒水之气。夫文蛤咸寒。岂能散表寒。又注云。咸走肾。可以胜水。斯言实为定论。
夫肾与膀胱为表里。其能走肾者。即能入膀胱以胜水热也。大抵文蛤散。能解烦导水胜热。尽其用矣。
桔梗（三分） 巴豆（一分去皮心熬黑研如脂） 贝母（三分）
上件二味。为末。内巴豆。更于臼中杵之。以白饮和服。强人半钱匕。羸者减之。病在膈上。必吐在膈下。必利。
不利。进热粥一杯。利过不止。进冷粥一杯。身热。皮粟不解。欲引衣自覆者。若以水 之。洗之。益令热却。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。
琥按成注云。辛散而苦泄。桔梗贝母之苦辛。用以下气。巴豆之辛。用以散实。夫巴豆乃热毒之药。肠胃中有水
寒结积。宜用此以荡涤之。若上方后云。身热不解。引衣自覆。及以水 洗。益令热却。当汗不汗而烦者。尚宜用五苓
散。以两解之也。汗出已者。非白散能出汗。乃承上文而言。不瘥者。用五苓散。得汗后。胸中水结不散。腹中痛。故
与白散复加芍药也。
琥又按上方后云。不利进热粥。利不止进冷粥者。以热能助药力。冷能解药力也。但今人病结胸。挟食者多。不敢
进粥。每以沸汤。并凉饮代之。
（附后例）太阳与少阳并病。头项强痛。或眩冒。（云云至）当刺大椎第一间。肺俞。肝俞。慎不可发汗（云云至）
谵语不止。当刺期门。
妇人中风。发热恶寒。经水适来。（云云至）此为热入血室也。当刺期门。随其实而泻之。上二条证。（正文与注俱
见后第十四卷刺热论中）
（附后例）妇人中风。七八日。续得寒热。发作有时。（云云至）故使如疟状。发作有时。小柴胡汤主之。
妇人伤寒。发热。经水适来。（云云至）无犯胃气。及上二焦。必自愈。
伤寒六七日。发热。微恶寒。（云云至）外证未去者。柴胡加桂枝汤主之。
伤寒五六日。已发汗。而复下之。胸胁满。（云云至）此为未解也。柴胡桂枝干姜汤主之。
柴胡桂枝干姜汤方
伤寒五六日。头汗出。微恶寒。（云云至）可与小柴胡汤。设不了了者。得屎而解。
上五条证并汤方。（俱见后第七卷少阳篇中）伤寒五六日。呕而发热者。柴胡汤证具。（云云至）此虽已下之。不为
逆。（云云至）若心下满而硬痛者。此为结胸也。大陷胸汤主之。但满而不痛者。此为痞。柴胡不中与之。宜半夏泻心汤。
（此条证。乃少阳病。复兼太阴。所以柴胡证具。而以他药下之。不为逆。其成结胸者。乃少阳病误下之所致。与太阳
病实无与也。其成痞者。以病兼太阴。早下之故成痞也。正文与注并）
半夏泻心汤方（俱见后第七卷少阳篇中）
太阳少阳并病而反下之。成结胸。心下硬。下利不止。水浆不下。其人心烦（并病义。见前第四卷太阳中篇太阳病
在经者。不可下。少阳病下之。亦所当禁。故以下之为反也。下之则阳邪乘虚。上结于胸。则心下硬。下入于肠。则利
不止。中伤其胃。则水浆不入。其人心烦者。正气已虚。邪热躁极也。条辩云。心下烦。疑有脱简。大抵其候为不治之
证。仲景云。结胸证悉具。烦躁者亦死。况兼下利。水浆不下者邪。其为不治之证宜矣。愚按此条。可见少阳病。亦有
结胸证也。）
脉浮而紧。而复下之。紧反入里。则作痞。按之自濡。但气痞耳。（濡上演切音轻 同柔与。脉浮而紧。若似乎太阳
伤寒也。复。反也。复下之。紧反入里。是脉变为沉紧也。脉变沉紧。何以不成结胸而作痞。盖此条紧脉。系少阴病。
以其病自太阳经传来。故略带浮也。仲景法。少阴病未入于府者。不可下。若反下之。则少阴之邪。乘虚入里。因而作
痞。按之自濡者。言不比结胸之硬。但寒气郁而成热。遂痞塞于心下耳。此可见少阴病。亦有误下而成痞证者。或问紧
脉在少阴。未必是传经之邪。余答云。少阴受太阳寒邪之气。未入于府者。脉阴阳俱紧。既入于府而后脉沉数也。愚按
此条病。应入少阴篇。因其浮紧之脉。与太阳相似。缘从旧例以发明之。又按此条论。仲景无治法。补亡论常器之云。
可小陷胸汤。生姜泻心汤。郭白云云。宜半夏泻心汤。枳实理中丸。愚以痞证按之自濡。陷胸汤不宜用也。若理中丸。
得毋以紧脉属少阴。疑其为寒证邪。恐用之则太热而补也。惟泻心汤此本仲景治痞之药。然亦宜加减用之。）
太阳中风。下利。呕逆。表解者。乃可攻之。其人 汗出。发作有时。头痛心下痞硬。满引胁下痛。干呕。短气。
汗出不恶寒者。此表解。里未和也。十枣汤主之。（头痛二字当在发作有时之上。太阳中风者。表未解也。下利呕逆。此
肠胃中已责其有水湿之邪。必待其表解。乃可攻之。若其人 汗出。 者。汗出之貌也。头痛发作有时。言有时头
痛。有时又止。明系湿邪挟热。上升于头而作痛也。心下痞塞坚硬。又且胀满。牵引胁下亦痛。则是湿热成饮。已填塞
于胸胁间矣。干呕短气者。里未和也。汗出不恶寒者。表已解也。故与十枣汤。以下热逐饮。愚按此条。直是结胸证。
因心下痞硬。用一痞字。实非痞证比也。或问直是结胸证。何以不用大陷胸汤。余答云。结胸证热邪实而水气少。故用
陷胸汤以平之。此证热不甚而水气实。故用下汤以攻之也。又按尚论篇云。结胸证邪结于胸。其位高。此证邪在心下及
胁。其位卑。斯言亦非确论。不观最前条结胸证云。阳气内陷。心下因硬。又云。脉沉而紧。心下痛。是两言。谓非与
此条证。心下痞硬。实相合者邪。但此条证。不因误下。阳邪未曾陷入。故无躁烦等候。且其人本有水气充实乎里。故
必待表解。而后以十枣汤攻之。可无疑也。）
【文蛤散方】
文蛤（五两）
以上一味药，研成散剂。用沸水调和一钱匕大小的药量服用，汤液用量为五合。
琥按：成无己注解说：“文蛤散用来发散表部的寒水之气。”然而文蛤性味咸寒，怎么能发散表寒呢？他又注解道：“咸味入肾，可以制伏水邪。”这话确实是定论。
肾脏与膀胱互为表里，凡是能入肾的药，就能进入膀胱以胜除水热。大抵来说，文蛤散的作用在于解除烦渴、引导水湿、胜除热邪，其功效也就到此为止了。
【白散方】
桔梗（三分） 巴豆（一分，去皮心，炒黑，研如脂状） 贝母（三分）
以上三味药（原文误作“二味”，实为三味），研成细末，加入巴豆，再在臼中杵匀。用“白饮”（米汤）调服。体质强壮的人服半钱匕，体弱的人减量。病位在上膈的，服药后必然呕吐；病位在下膈的，服药后必然腹泻。
如果服药后没有腹泻，喝一杯热粥以助药力；如果腹泻不止，喝一杯冷粥以抑制药力。
身体发热，皮肤起粟粒状鸡皮疙瘩而不得缓解，想要穿衣盖被取暖的，如果用冷水浇洗它，只会让热气更加郁闭，无法散发出来。
应当发汗却未能发汗，就会心烦。假如已经出汗了，但腹中疼痛，给予芍药三两，用法同上。
琥按：成无己注解说：“辛能发散，苦能泄降。桔梗、贝母的辛苦之性，用来下气；巴豆的辛热之性，用来消散实邪。”然而巴豆是热毒之药，肠胃中有水寒凝结积聚时，适宜用它来荡涤清除。如果像前文所说，“身体发热不解，想穿衣盖被，以及用冷水浇洗，反而使热气郁闭，应当发汗却发不出而心烦”的情况，仍然适宜使用五苓散，以表里双解。所谓“汗出已者”，并非白散能发汗，而是承接上文而言。如果病不愈，应使用五苓散。得汗之后，胸中水结不散，腹中疼痛，所以给白散加芍药。
琥又按：前文后面说：“腹泻不止进热粥，利不止进冷粥”，是因为热能帮助药力，冷能解药力。但现在人患结胸证，夹杂食滞的多，不敢喝粥，常用沸水和凉饮代替。
（附后例）太阳病与少阳病并病，头项强痛，或者眩晕冒昧。（中间省略……）应当针刺大椎第一间穴、肺俞穴、肝俞穴，千万不要发汗。（中间省略……）谵语不止，应当针刺期门穴。
妇人中风，发热恶寒，月经适来。（中间省略……）这是热入血室证，应当针刺期门穴，随其实证而泻之。以上两条证候。（正文与注释均见于后第十四卷《刺热论》中）
（附后例）妇人中风，七八日，持续出现寒热，发作有时。（中间省略……）所以症状像疟疾一样，发作有时，主用小柴胡汤。
妇人伤寒，发热，月经适来。（中间省略……）不要损伤胃气及上、中二焦，必定自愈。
伤寒六七日，发热，轻微恶寒。（中间省略……）外证未去的，主用柴胡加桂枝汤。
伤寒五六日，已经发汗，而又攻下，胸胁满闷。（中间省略……）这是病未解，主用柴胡桂枝干姜汤。
柴胡桂枝干姜汤方
伤寒五六日，头汗出，轻微恶寒。（中间省略……）可予小柴胡汤。如果病情仍不清爽，大便通下即可痊愈。
以上五条证候及汤方。（均见于后第七卷少阳篇中）
伤寒五六日，呕吐且发热的，具备柴胡汤证。（中间省略……）这虽然已经攻下，但不为逆证。（中间省略……）如果心下胀满而且硬痛，这是结胸证，主用大陷胸汤。只是胀满而不痛的，这是痞证，柴胡汤不适用，宜用半夏泻心汤。
（此条证候，乃是少阳病，又兼太阴病，所以柴胡证具备，但因为用其他药物攻下，不为逆证。形成结胸的，是少阳病误下所致，与太阳病实在无关。形成痞证的，是因为病兼太阴，过早攻下故而成痞。正文与注释并列。）
半夏泻心汤方（均见于后第七卷少阳篇中）
太阳病与少阳病并病，反而攻下，形成结胸，心下硬，下利不止，水浆不能入口，其人烦躁。（并病的含义，见前第四卷太阳中篇。太阳病在经者，不可下；少阳病下之，亦在所禁，所以说攻下是“反”。攻下则阳邪乘虚上结于胸，则心下硬；下入于肠，则利不止；中伤其胃，则水浆不入。其人烦躁，是因为正气已虚，邪热躁动至极。条辩云：“心下烦”，怀疑有脱简。大抵这种证候属于不治之证。仲景云：“结胸证悉具，烦躁者亦死”，何况兼有下利、水浆不下呢？其为不治之证是显然的。愚按：此条可见少阳病也有结胸证。）
脉浮而紧，反而攻下，紧脉反入里，则形成痞证，按之自软，只是气痞罢了。（濡，上演切，音轻，同柔与。脉浮而紧，似乎像是太阳伤寒。复，即反也。复下之，紧脉反入里，是脉变为沉紧。脉变沉紧，为什么不成结胸而作痞？因为此条的紧脉，属于少阴病。因其病从太阳经传来，所以略带浮象。仲景法度：少阴病未入于腑者，不可下。若反下之，则少阴之邪乘虚入里，因而作痞。按之自软，是说不同于结胸之硬，只是寒气郁结而成热，遂痞塞于心下耳。由此可见少阴病也有误下而成痞证的。有人问：紧脉在少阴，未必是传经之邪。我回答：少阴受太阳寒邪之气，未入于腑者，脉阴阳俱紧；既入于腑而后脉沉数。愚按：此条病证，本应入少阴篇，因其浮紧之脉与太阳相似，缘于沿袭旧例以发明之。又按：此条论述，仲景无治法，《补亡论》常器之说：可用小陷胸汤、生姜泻心汤。郭白云说：宜用半夏泻心汤、枳实理中丸。我认为痞证按之自软，不宜用陷胸汤。至于理中丸，难道是因为紧脉属少阴，疑其为寒证吗？恐怕用了会太热而补益过度。只有泻心汤本是仲景治痞的药物，但也宜加减使用。）
太阳中风，下利，呕逆，表证已解者，才可以攻下。其人濈然汗出，发作有时，头痛，心下痞硬，胀满牵引胁下痛，干呕，短气，汗出不恶寒者，这是表已解，里未和，主用十枣汤。（“头痛”二字应当在“发作有时”之上。太阳中风者，表未解也。下利呕逆，这是肠胃中已有水湿之邪。必须等待其表解，才可以攻下。如果其人濈然汗出，“濈者”，是汗出的样子。头痛发作有时，是说有时头痛，有时又止，明系湿邪挟热，上升于头而作痛。心下痞塞坚硬，又且胀满，牵引胁下亦痛，则是湿热成饮，已填塞于胸胁间矣。干呕短气，是里未和。汗出不恶寒，是表已解。故给予十枣汤，以下热逐饮。愚按：此条直是结胸证，因心下痞硬，用一个“痞”字，实在不是痞证可比。或问：直是结胸证，为何不用大陷胸汤？我回答：结胸证热邪实而水气少，故用陷胸汤以平之。此证热不甚而水气实，故用十枣汤以攻之。又按：《尚论篇》云：结胸证邪结于胸，其位高；此证邪在心下及胁，其位卑。这话也不是确论。不看最前面的结胸证云：“阳气内陷，心下因硬”，又说：“脉沉而紧，心下痛”，这两句话，谓非与此条证“心下痞硬”实相符合吗？只是此条证，不因误下，阳邪未曾陷入，故无躁烦等候。且其人本有水气充实乎里，故必待表解，而后以十枣汤攻之，可无疑也。）
[Wenli San Formula]
Wenli (Five Liang)
Take the above single herb, grind into a powder. Mix with boiling water to administer one Qianbi-sized dose, using five He of liquid.
Hu notes: Cheng Wuji commented: "Wenli San is used to disperse cold and dampness in the exterior." However, Wenli is salty and cold; how can it disperse exterior cold? He further commented: "Salty flavor enters the Kidney and can overcome water." This statement is indeed definitive.
The Kidney and Bladder are interior-exteriorly related. Any substance that enters the Kidney can also enter the Bladder to overcome water-heat. Generally speaking, the function of Wenli San lies in relieving vexation, guiding out water-dampness, and overcoming heat; its efficacy ends there.
[Baisan Formula]
Jiegeng (Three Fen) Badou (One Fen, skin and heart removed, roasted black, ground into a paste-like consistency) Beimu (Three Fen)
Grind the above three herbs (the text erroneously says "two") into a fine powder. Add Badou and pound thoroughly in a mortar. Administer with "Baiyin" (rice soup). For robust individuals, administer half a Qianbi; for frail individuals, reduce the dose. If the pathology is located above the diaphragm, vomiting will inevitably occur after administration; if below the diaphragm, diarrhea will inevitably occur.
If diarrhea does not occur after administration, drink one cup of hot porridge to assist the medicinal power; if diarrhea persists uncontrollably, drink one cup of cold porridge to inhibit the medicinal power.
If the body is feverish, skin presents with gooseflesh that does not resolve, and the patient desires to cover themselves with clothes, pouring or washing with cold water will only cause the heat to become more constrained and unable to escape.
When sweating should occur but does not, vexation arises. If sweating has already occurred but abdominal pain follows, administer Sanliang of Shaoyao, using the same method as above.
Hu notes: Cheng Wuji commented: "Pungent flavors disperse, bitter flavors drain. The pungent-bitter nature of Jiegeng and Beimu is used to direct Qi downward; the pungent nature of Badou is used to dissipate excess accumulation." However, Badou is a hot-toxic herb. When there is cold-water accumulation in the intestines and stomach, it is appropriate to use this herb to purge and cleanse. Regarding the scenario described earlier: "body heat unresolved, desire to cover oneself, washing with cold water causing heat to constrain, inability to sweat leading to vexation," Wuling San is still appropriate to resolve both exterior and interior. The phrase "after sweating occurs" does not imply Baisan induces sweating, but rather continues from the previous context. If the condition does not improve, Wuling San should be used. After sweating, if water accumulation in the chest remains unresolved and abdominal pain occurs, Shaoyao is added to Baisan.
Hu further notes: The text later states: "For persistent diarrhea, advance hot porridge; for uncontrolled diarrhea, advance cold porridge," because heat assists medicinal power while cold resolves it. Currently, patients with Jie Xiong (chest binding) often have food retention and dare not consume porridge, substituting instead with boiling water and cool drinks.
[Attached Examples]
Taiyang and Shaoyang Bing (combined disease): Stiffness and pain in the head and neck, or dizziness and vertigo. (Omitted...) Acupuncture should be applied to Dazhui (First Intercostal Space), Feishu, and Ganshu. Sweating must strictly be avoided. (Omitted...) Incessant delirium requires acupuncture at Qimen.
In women with Fengzhong (wind strike), fever and aversion to cold, occurring simultaneously with menstruation: (Omitted...) This is Re Ru Xue Shi (Heat entering the Blood Chamber). Acupuncture at Qimen is indicated, draining according to excess patterns. The above two conditions (both main text and commentary are found in Volume 14, Chapter on Acupuncture for Heat).
[Attached Example]
In women with Fengzhong, after seven or eight days, continuous alternating chills and fever occurring at specific times: (Omitted...) Symptoms resemble malaria, occurring at specific times. Xiao Chai Hu Tang is the primary formula.
In women with Shanghan (cold damage), fever, occurring simultaneously with menstruation: (Omitted...) Do not damage the Stomach Qi or the Upper and Middle Jiao; the condition will likely resolve spontaneously.
Shanghan for six or seven days, fever, slight aversion to cold: (Omitted...) If exterior symptoms persist, Chai Hu Jia Gui Zhi Tang is the primary formula.
Shanghan for five or six days, after sweating therapy followed by purgation, fullness in the chest and hypochondrium: (Omitted...) This indicates the disease is unresolved. Chai Hu Gui Zhi Gan Jiang Tang is the primary formula.
Chai Hu Gui Zhi Gan Jiang Tang Formula
Shanghan for five or six days, sweating on the head, slight aversion to cold: (Omitted...) Xiao Chai Hu Tang may be given. If the condition remains unsatisfactory, resolution occurs upon defecation.
The above five conditions and formulas (all found in Volume 7, Chapter on Shaoyang).
Shanghan for five or six days, vomiting and fever presenting Chai Hu Tang syndrome: (Omitted...) Although purgation has been performed, it is not a counter-indication. (Omitted...) If there is fullness and hardness with pain in the epigastrium, this is Jie Xiong (Chest Binding), treated primarily with Da Xian Xiong Tang. If there is fullness without pain, this is Pi (Glomus), Chai Hu Tang is contraindicated; Ban Xia Xie Xin Tang is suitable.
(This condition involves Shaoyang disease combined with Taiyin disease. Thus, Chai Hu syndrome is present, but because other drugs were used for purgation, it is not counter-indicative. Formation of Jie Xiong results from erroneous purgation of Shaoyang disease, unrelated to Taiyang disease. Formation of Pi results from premature purgation in a disease involving Taiyin. Main text and commentary are listed.)
Ban Xia Xie Xin Tang Formula (found in Volume 7, Chapter on Shaoyang).
Taiyang and Shaoyang Bing treated erroneously with purgation leads to Jie Xiong: Hardness in the epigastrium, incessant diarrhea, inability to take fluids, and irritability. (Definition of Bing is in Volume 4, Taiyang Middle Chapter. Taiyang disease in the meridians cannot be purged; Shaoyang disease purgation is also prohibited, hence termed 'counter'. Purgation allows Yang pathogenic factors to enter deficiency and bind upward in the chest, causing epigastric hardness; descending into the intestines causes incessant diarrhea; damaging the Stomach prevents fluid intake. Irritability indicates deficient righteous Qi and extreme pathogenic heat agitation. Tiao Bian states: 'Irritation in the epigastrium,' suspecting missing text. Generally, this is an untreatable condition. Zhongjing stated: 'If all Jie Xiong symptoms are present and irritability ensues, death occurs.' How much more so with diarrhea and inability to take fluids? It is clearly untreatable. I observe: This shows Shaoyang disease can also present Jie Xiong syndrome.)
Floating and tight pulse, treated erroneously with purgation, the tight pulse moves inward, forming Pi. Palpation reveals softness, indicating merely Qi Pi. (Ru implies light/soft. Floating-tight pulse resembles Taiyang Shanghan. 'Fu' means 'fan' (contrary). Erroneous purgation causes the tight pulse to move inward, changing to sinking-tight. Why does sinking-tight not form Jie Xiong but Pi? Because this tight pulse belongs to Shaoyin disease. Transmitted from Taiyang, it retains a slight floating quality. Zhongjing's method: Shaoyin disease not yet entered the Fu organs cannot be purged. Erroneous purgation allows Shaoyin pathogens to enter inward due to deficiency, forming Pi. Softness upon palpation distinguishes it from Jie Xiong hardness; it is merely cold Qi stagnation transforming into heat, obstructing the epigastrium. This shows Shaoyin disease can also form Pi via erroneous purgation. Question: Tight pulse in Shaoyin may not be transmitted pathogen. Answer: Shaoyin receiving Taiyang cold pathogens, before entering Fu organs, presents Yin-Yang俱 tight pulse; after entering Fu, pulse becomes sinking-numerous. I note: This case belongs in Shaoyin chapter, but due to similarity with Taiyang floating-tight pulse, retained for illustration. Note: Zhongjing provides no treatment here. Bu Wang Lun Chang Qizhi suggests Xiao Xian Xiong Tang or Sheng Jiang Xie Xin Tang. Guo Baiyun suggests Ban Xia Xie Xin Tang or Zhi Shi Li Zhong Wan. I argue Pi with softness on palpation contraindicates Xian Xiong Tang. As for Li Zhong Wan, is it because tight pulse in Shaoyin suggests cold pattern? Fear of excessive heat and tonification. Only Xie Xin Tang is originally Zhongjing's remedy for Pi, though modifications are advisable.)
Taiyang Fengzhong with diarrhea and retching: If exterior is resolved, purgation may proceed. Patient presents with continuous sweating, occurring at intervals, headache, epigastric hardness and fullness radiating to hypochondriac pain, dry retching, shortness of breath, sweating without aversion to cold. This indicates exterior resolved, interior unharmonized. Shi Zao Tang is the primary formula. ('Headache' should precede 'occurring at intervals'. Taiyang Fengzhong implies exterior unresolved. Diarrhea and retching indicate water-dampness pathogens in intestines/stomach. Exterior must resolve before purgation. Continuous sweating indicates moisture. Headache occurring intermittently suggests damp-heat rising to head. Epigastric hardness/fullness radiating to hypochondrium indicates damp-heat transforming into fluid filling chest/hypochondrium. Dry retching/shortness of breath indicate interior disharmony. Sweating without aversion to cold indicates exterior resolved. Hence Shi Zao Tang is given to purge heat and drive out fluid. I note: This is essentially Jie Xiong syndrome. Using 'Pi' is misleading compared to true Pi. Question: Why not Da Xian Xiong Tang? Answer: Jie Xiong has solid heat and less fluid, suited for Xian Xiong Tang. This case has mild heat but substantial fluid, suited for Shi Zao Tang. Also, Shang Lun Pian argues Jie Xiong binds high in chest, while this binds lower in epigastrium/hypochondrium. This is inaccurate. Previous Jie Xiong texts mention 'Yang Qi sinking inward, epigastric hardness' and 'sinking-tight pulse, epigastric pain,' matching this 'epigastric Pi-hardness.' However, this case did not result from erroneous purgation, nor did Yang pathogen sink deeply, lacking agitation. Since internal fluid was already abundant, waiting for exterior resolution before using Shi Zao Tang is unquestionable.)