栀子（十四枚擘） 浓朴（四两姜炙） 枳实（四枚去穣炒）
以上三味。以水三升半。煮取一升半。去滓。分二服。温进一服。得吐者。止后服。
琥按成注云。酸苦涌泄。栀子之苦以涌虚烦。浓朴枳实之苦以泄腹满。以吐中即具发泄之义故耳。
琥又按成注以腹满为里实证。盖上吐下泄。乃医家泻实满之法也。故用浓朴枳实于大黄中则其满从下而泄。用浓朴
枳实于栀子中。则其满即从上而涌也。要之上药。亦非吐剂或于服汤后。探之使吐可耳。
内台方议云。下后但腹满而不心烦。即邪气入里。若心烦而不腹满。即邪气在胸中。属栀子豉汤。今既烦而且腹满。
乃邪气在胸腹之间也。烦则不能卧。满则不能坐。故卧起皆不安。故用栀子为君。以吐其烦。浓朴为臣。枳实为佐使。
二者之苦以泻腹满也。按上议。实本成注之义。
伤寒医以丸药大下之。身热不云。微烦者。栀子干姜汤主之。（太阳伤寒。医误以丸药大下之。徒伤中气。邪热不除。
所以身热不去。邪气乘虚客于胸中。而作微烦也。与栀子干姜汤吐之。以散邪热。扶中气。）
栀子（十四枚擘） 干姜（二两切）
上二味。以水三升半。煮取一升半。去滓。分二服。温进一服得吐者。止后服。
琥按成注云。苦以涌之。栀子之苦以吐烦。辛以润之。干姜之辛以益气。夫辛味本散。其益气者乃姜气之温耳。
仲景立此汤。本吐烦之剂方中用干姜者。因医以丸药大下之后。其人必中气受伤。专赖干姜之辛温。以扶助中气。谓虽
吐而不致有妨于胃。所以外台方议云。安中正气。干姜有臣佐之力者。即此义也。
凡用栀子汤。病患旧微溏者不可与服之。（凡用栀子汤。谓凡上数汤中皆有栀子。故总上文而言之也。栀子之性太苦
而寒。若病患平素肠胃虚寒。而大便微溏者。不可与服。如误用之。恐不能上涌。反致下泄。为害甚矣。医者。可不以
此为戒。按成注引内经曰。先泄而后生他病者。治其本。必先调之。后乃治其他病。况栀子汤。仲景皆用于误下之后。
胸中烦热不解者。若病患旧微溏。又病伤寒而误下之。吾恐胸中虽烦。未必尽是郁热。故云。不可与栀子汤也。后条辩
或问云。本草不言栀子为吐剂。仲景用之攻吐。何也。答云。栀子本非吐药。兹因胸烦。为邪气在上。拒而不纳。故煮
汤投之。则自吐。邪气因得以出内经注云。此因其邪之本高。而后用药越之。为甚易耳。则是吐药。奚必尽投以瓜蒂散
邪。）
太阳病发汗。汗出不解。其人仍发热心下悸。头眩。身 动。振振欲擗地者。真武汤主之。（此条虽太阳病。强发汗
亡阳。以致里虚。实系真寒阴证。正文与注并汤俱见中寒论中）
咽喉干燥者。不可发汗（以下数条。皆言不可发汗。尚论篇序于麻黄汤之后。亦有理。兹从旧例作解。不须更易。
此承上数条发汗及吐下之误。因言不可发汗之候多端。医工不可以不知也。有如咽喉干燥者。成注云。津液不足也。以
发汗则重夺其津液。故不可也。后条辩云。凡医家欲行汗法。必当顾虑夫上焦之津液。有如此者。）
淋家不可发汗。发汗必便血。（淋者。膀胱里热。气化不行。小水淋沥而时出也。淋家。津液已虚。更发其汗。则水
府告匮。徒逼其血从小便出耳。后条辩云。凡医家欲行汗法。必当顾虑。夫下焦之津液。有如此者。）
疮家虽身疼痛不可发汗。发汗则 。（成注云。表虚聚热则生疮。疮家虽身疼如伤寒。不可发汗。发汗则表气愈。虚
热势愈甚。津液枯燥。不能荣养筋脉。因而变 。后条辩云。凡医家欲行汗法。盒饭顾虑夫周身之津液。有如此者。）
衄家。不可发汗。汗出。必额上陷。脉急紧。直视。不能 。不得眠。（汗为血液。衄血之人。血凌清道。阳经受伤。
若更发汗重亡其阳。复夺其阴。则额上必陷。乃上焦津液枯竭之应也。脉急紧者。诸脉皆属于目。目得血而能视。筋脉
无血以养。则紧急而不能牵引其目。故目直视而不 。 。瞬同。目摇动也。不得眠者。卫气夜行于阴。则眠。今者卫
无营主。仅能行于阳不能行于阴。故不得眠。即成注云。阴气虚者是也。后条辩云。凡医家欲行汗法。复不可罔顾虑。
夫阳经之营血。有如此者。）
亡血家。不可发汗。发汗则寒栗而振。（血属阴。亡血即亡阴也。阴亡。则阳无以附。更发其汗。阳从外脱。其人必
寒栗而振摇。成注所云。阴阳俱虚者。是也。后条辩云。凡医家欲行汗法。复不可罔顾虑。夫阴经之营血。有如此者。）
汗家。重发汗。必恍惚心乱。小便已。阴疼。与禹余粮丸。（阙。心主血。汗者。心之液。平素多汗之家。心虚血少
可知。重发其汗。必恍惚心乱。乃心液亡。而神气浮越也。小便已。阴疼者。小肠为心之府。心藏虚。而府中津液亦告
竭也。后条辩云。凡医家欲行汗法。更不可罔顾虑。夫表气之疏密。营室之衰旺。有如此者。仲景法。与禹余粮丸。大
都是益血镇固之剂。惜乎原方已阙不可考也。补亡论。常器之云。禹余粮一味。火 散服。亦可。郭白云云。用禹余粮。
不用石。石乃壳也。愚以其言。未必尽合仲景原方之义。今姑存之以备参考。按以上数条证。补亡论皆有方。治咽喉干
燥者。常器之云。可与小柴胡汤。其言于义未合。石顽云。宜小建中汤。其言犹近乎理。淋家。常云。宜猪苓汤。然用
于汗后。小便血者。亦嫌其过于渗利也。石顽云。未汗宜黄 建中汤。盖此汤。用于疮家身疼痛者。甚妙。若淋家犹未
尽善。疮家。常云。误汗成 。桂枝加葛根汤。其言虽为可取。要不若王日休云。小建中汤。加归 更妙衄家。常云。
可与犀角地黄汤。此不过治衄之常剂。许叔微云。黄 建中汤。夺汗动血。加犀角。夫衄家系阳明经热。上汤恐非阳明
药也。吕沧州云。小建中汤加葱豉。误汗直视者。不可治。大抵衄家具汗证。葱豉专豁阳明经郁热。为对证之的药亡血
家。常云。可与芍药地黄汤。夫亡血家。亦有阴虚发热者。上汤固宜用也。石顽云。黄 建中汤。误汗振栗。苓桂术甘
汤。加当归。据成注云。亡血发汗。则阴阳俱虚。愚以上二汤。皆亡血家汗后之剂。）
病患有寒。复发汗胃中冷。必吐蛔（此条系真寒证。正文与注见中寒论中）
本发汗而复下之。此为逆也。若先发汗。治不为逆。本先下之。而反汗之。为逆。若先下之。治不为逆。（成注云。
病在表者。汗之为宜。下之为逆。病在里者。下之为宜。汗之为逆。大约治伤寒之法。表证急者。即宜汗。里证急者。
即宜下。不可拘拘于先汗而后下也。汗下得宜。治不为逆。）
伤寒医下之。续得下利清谷不止。身疼痛者。急当救里。后身疼痛。清便自调者。急当救表。救里宜四逆汤。救表。
宜桂枝汤。（此条系太阳伤寒。医家误行下法。因下利清谷不止。虽身疼痛。急当温救其里。至其救表之药。仍用桂枝汤
者。以其人胃气本实。不为误下所害故也。正文与注详见中寒论中）
病发热头痛脉反沉。若不瘥。身体疼痛。当救其里宜四逆汤（此条系中寒病。其发热头痛者。以寒中少阴。必由太
阳直入。故头痛而反发热。脉沉身体疼痛。乃阴寒之气。由内而彻于外也。其为中寒病无疑。正文与注详见中寒论中）
太阳病先下之而不愈。因复发汗。以此表里俱虚。其人因致冒。冒家汗出自愈。所以然者。汗出表和故也。得里未
和然后复下之。（冒之为言覆也。谓寒邪怫郁。如以物蒙覆其头目也。太阳病先下之。复发汗是为汗下皆逆。）
徒虚其表里之气。邪终不解因而致冒。金匮要略云。冒家欲解。必大汗出。故云。自愈。其所以自愈者。非汗自出
而愈。乃用药使之汗出。斯表气得和故也。汗出表和。则不必复下。故云。必得里未和者。然后用药复下之。可见表里
两虚之人。虽其汗下之证。医人不敢轻用汗下之药。有如此者。按此条论。仲景无治法。补亡论常器之云。和表。用小
柴胡汤。然此汤。非太阳病当用之药。愚以表宜桂枝汤。或小建中汤。黄 建中汤。选而用之。常氏又云。复下。用调
胃承气汤。恐此汤。又非里虚所宜。愚以下宜桂枝加大黄汤。又按条辩注得里未和里字。指大小便言其说甚误。尚论篇
亦云。下里药无过大柴胡汤。五苓散。误之误矣。窃思正文中既云。然后复下之。此专指大便而言。若兼利小便。则不
言下矣。斯其义。可不辩而自明。
太阳病。未解。脉阴阳俱停。必先振栗。汗出而解。但阳脉微者。先汗出（脉经作之）而解。但阴脉微者。下之而
解。若欲下之。宜调胃承气汤主之。（太阳病未解。其邪所着不在于表。即入于里。表里之病。于阴阳二脉验之。脉经曰
寸为阳。关以前是也。尺为阴。关以后是也。今者。寸关尺三处脉。皆和平。是为阴阳俱停。乃正气将复邪气欲去之兆
也。然犹必先振栗。乃得汗出而后解。由其人病久。元气虚。正与邪争故也。其不为振汗。邪无从出者。但阳脉微即为
表邪盛也。法当汗之而解。但阴脉微即为里邪实也。法当下之而解。盖此为太阳病。已入于府。胃中郁热。不能自消。
故云。若欲下之宜调胃承气汤。按成注引阳虚阴盛。阳盛阴虚。为阴阳脉微。汗下作解。其义晦而不明。尚论篇注阴阳
脉微为病后之脉。与初病不同。盖初病皆邪气胜则实之脉。病后皆正气夺则虚之脉。所以最虚之处。便是容邪之处。故
阳脉微者。邪乘其阳。汗之而解。阴脉微者。邪乘其阴。下之而解。斯言实发成氏之未发。然愚以邪气既乘之后。恐其
脉未必尽出于微。若脉既微。必无用承气汤下之之理。大抵脉微二字当活看。此非微弱之微。乃邪滞而脉道细伏之义。
邪滞于经。则表气不得条达。故阳脉微邪滞于府。则里气不能通畅。故阴脉微。又按上论云。先汗出而解。仲景无方。
千金云。宜桂枝汤。谓胃承气汤方见后第六卷阳明篇中。）
（重出例）太阳病发热汗出者。此为营弱卫强。故使汗出欲救邪风者。宜桂枝汤。（正文与注见前桂枝汤方下）
（附后例）伤寒五六日。中风。往来寒热胸胁苦满。（云云至）身有微热或咳者。与小柴胡汤主之。（此条系风寒之
邪。在半表半里。乃少阳经证。不当入太阳篇。正文与注并。）
小柴胡汤方及加减法。（俱见后第七卷少阳篇中）
血弱气尽腠理开邪气因入。（云云至）故使呕也。小柴胡汤主之。
服柴胡汤已。渴者属阳明也。以法治之。得病六七日。脉迟浮弱。（云云至）柴胡汤不中与也。食谷者哕。
伤寒四五日。身热恶风颈项强。胁下满。手足温而渴者。小柴胡汤主之。伤寒阳脉涩阴脉弦。法当腹中急痛者。先
与小建中汤。不瘥者。与小柴胡汤主之。
上五条证。（俱见后少阳篇中）小建中汤方（见后第三条证下）
伤寒中风有柴胡证。但见一证便是。不必悉具。凡柴胡汤病证而下之。若柴胡证不罢者。复与柴胡汤。必蒸蒸而振。
却发热汗出而解。
上二条证。（俱见后少阳篇中）
伤寒二三日。心中悸而烦者。小建中汤主之。（伤寒二三日。邪当传里之时。今则别无他证。但心中悸而烦者。此外
邪已微而不传。正气骤虚。不能自持也。盖阳气内虚。则心悸。阴气内虚。则心烦。故与小建中汤。以建其里气之虚。
愚以此条病。必是太阳伤寒发汗之后所变。故建中汤。即桂枝汤小变其制也。）
栀子（十四枚，掰开） 厚朴（四两，姜汁炙） 枳实（四枚，去瓤炒）
以上三味药。用水三升半。煮取一升半。去掉药渣。分两次服用。温服一次。如果服药后出现呕吐的，停止后面的服用。
琥按：成无己注解说：“酸苦涌泄”，栀子的苦味能涌吐虚烦，厚朴、枳实的苦味能泻除腹满。因为“吐”中本身就包含了发泄的含义，所以如此。
琥又按：成无己将腹满视为里实证。大概上吐下泄，是医家泻除实满的方法。所以在大黄中使用厚朴、枳实则其满从下面排泄；在栀子中使用厚朴、枳实则其满从上面涌出。总之上面的药物，也不是专门的催吐剂，或许是在服药后，探喉使其呕吐罢了。
《内台方议》说：攻下之后只有腹满而没有心烦，就是邪气入里；如果只有心烦而没有腹满，就是邪气在胸中，属于栀子豉汤证。现在既心烦而且腹满，乃是邪气在胸腹之间。心烦则不能卧，腹满则不能坐，所以卧起都不安宁。因此用栀子为君药，以涌吐其烦；厚朴为臣药，枳实为佐使药。这两者的苦味来泻除腹满。按上述议论，实际上本于成无己注解说。
伤寒，医生用丸药猛烈攻下，身体发热不消退，微微心烦的，用栀子干姜汤主治。（太阳伤寒，医生误用丸药猛烈攻下，徒然损伤中气，邪热不除，所以身体发热不退。邪气乘虚客居胸中，而产生微烦。给予栀子干姜汤涌吐，以散邪热，扶助中气。）
栀子（十四枚，掰开） 干姜（二两，切片）
以上两味药。用水三升半。煮取一升半。去掉药渣。分两次服用。温服一次，如果服药后出现呕吐的，停止后面的服用。
琥按：成无己注解说：“苦以涌之”，栀子的苦味能涌吐烦热；“辛以润之”，干姜的辛味能益气。辛味本来主散，它之所以能益气，是因为姜气的温热所致。
仲景设立此汤，本是涌吐烦热的方剂，方中用干姜的原因，是因为医生用丸药猛烈攻下之后，病人必定中气受伤，专门依赖干姜的辛温，来扶助中气。说是虽然涌吐但不致妨碍胃气。所以《外台秘要》议论说，安定中焦正气，干姜有臣佐的力量，就是这个意思。
凡是使用栀子汤，平素大便微溏的病人不可服用。（凡是使用栀子汤，是指上面几个方剂中都有栀子，所以总括上文来说。栀子的性质太苦而寒，如果病人平素肠胃虚寒，而大便微溏的，不可服用。如果误用，恐怕不能向上涌吐，反而导致向下泄利，危害很大。医者，能不以此为戒吗？按成无己引用《内经》说：“先泄而后生他病者，治其本”，必须先调理，然后才治疗其他病。何况栀子汤，仲景都用于误下之后，胸中烦热不解的情况。如果病人平素大便微溏，又患伤寒而被误下，我担心胸中的烦未必尽是郁热，所以说，不可用栀子汤。后世条辩或问中说：“本草不说栀子是催吐药，仲景用它来攻吐，为什么呢？”回答说：“栀子本不是吐药，这里因为胸中烦，邪气在上，拒而不纳，所以煮汤投服，就会自然呕吐，邪气得以排出。《内经》注解说：‘这是因其邪之本高，而后用药越之’，非常容易。那么吐药，何必一定要用瓜蒂散呢？”）
太阳病发汗，汗出后病不解，那人仍然发热，心下悸动，头晕，身体动摇，震颤欲倒地者，用真武汤主治。（此条虽然是太阳病，强行发汗亡阳，导致里虚，实际上是真寒假阴证，正文与注释及方剂都见于《中寒论》中）
咽喉干燥的，不可发汗（以下数条，都是说不可发汗，《尚论篇》将其排在麻黄汤之后，也有道理，这里遵循旧例进行解释，不需要更改。这是承接上面几条发汗及吐下的错误，因而说不可发汗的情况有很多，医工不可以不知道。比如咽喉干燥的，成无己注解说：“津液不足”。如果发汗则会再次夺去其津液，所以不可。后世条辩说：“凡医家想要行汗法，必须顾虑上焦的津液，像这样的情况。”）
淋家（患有淋病的病人）不可发汗，发汗必然导致便血。（淋，是膀胱里有热，气化不行，小便淋沥不时排出。淋家，津液已经虚弱，再发其汗，则水府告急匮乏，只会逼迫血液从小便流出罢了。后世条辩说：“凡医家想要行汗法，必须顾虑下焦的津液，像这样的情况。”）
疮家（患有疮疡的病人）即使身体疼痛也不可发汗，发汗则会导致痉病。（成无己注解说：“表虚聚热则生疮”。疮家即使身体疼痛像伤寒，不可发汗。发汗则表气更虚，热势更甚，津液枯燥，不能荣养筋脉，因而变成痉病。后世条辩说：“凡医家想要行汗法，必须顾虑周身津液，像这样的情况。”）
衄家（经常流鼻血的病人），不可发汗，汗出，必然导致额部凹陷，脉搏紧急拘紧，两眼直视，不能眨眼，不得睡眠。（汗是血液，衄血之人，血液污染清道，阳经受伤，如果再发汗重伤阳气，又夺取阴液，则额头必然凹陷，这是上焦津液枯竭的反应。脉搏紧急拘紧，是因为诸脉都连属于目，眼睛得到血液才能视物，筋脉没有血液滋养，则紧急而不能牵引眼球，所以眼睛直视而不能眨眼。眨眼的“瞬”字同义，指眼珠摇动。不得睡眠，是因为卫气夜间行于阴分则睡眠。现在卫气没有营血为主，仅能行于阳分不能行于阴分，所以不得睡眠。即成无己注解说：“阴气虚”就是这个意思。后世条辩说：“凡医家想要行汗法，又不可不顾虑阳经的营血，像这样的情况。”）
亡血家（失血病人），不可发汗，发汗则寒战颤抖。（血属阴，亡血即亡阴。阴亡，则阳无所依附，再发其汗，阳从外表脱失，其人必然寒战颤抖。成无己所说的“阴阳俱虚”，就是这个意思。后世条辩说：“凡医家想要行汗法，又不可不顾虑阴经的营血，像这样的情况。”）
汗家（多汗的病人），再发汗，必然导致神志恍惚、心中混乱，小便结束后，前阴疼痛，给予禹余粮丸。（原方缺失。心主血，汗是心的体液，平素多汗的人，心血亏虚可知。再发其汗，必然神志恍惚、心中混乱，这是心液亡失，神气浮越。小便结束后前阴疼痛，是因为小肠是心的腑，心藏虚，而腑中的津液也告枯竭。后世条辩说：“凡医家想要行汗法，更不可不顾虑表气的疏密，营室的衰旺，像这样的情况。”仲景的法度，给予禹余粮丸，大抵都是益血镇固的药剂，可惜原方已缺失无法考证。《补亡论》常器之说：“禹余粮一味，火煅后研末服用，也可以。”郭白云说：“用禹余粮，不用石。石是壳。”我认为他的话，未必完全符合仲景原方的意义，现在暂且保存以供参考。按以上数条证候，《补亡论》都有方子。治疗咽喉干燥的，常器之说：“可与小柴胡汤”，这话在义理上不合。石顽说：“宜用小建中汤”，这话还近乎道理。淋家，常氏说：“宜猪苓汤”，然而用在汗后小便出血的情况下，也嫌其过于渗利。石顽说：“未汗宜黄芪建中汤”，盖这个汤，用于疮家身体疼痛者，非常妙。若淋家犹未尽善。疮家，常氏说：“误汗成痉，桂枝加葛根汤”，这话虽然可取，但不如王日休说：“小建中汤，加当归更妙”。衄家，常氏说：“可与犀角地黄汤”，这不过是治衄的常规药剂。许叔微说：“黄芪建中汤，因夺汗动血，加犀角”。夫衄家系阳明经热，上方恐怕不是阳明药。吕沧州说：“小建中汤加葱豉”。误汗直视者，不可治。大抵衄家具汗证，葱豉专豁阳明经郁热，是对证的良药。亡血家，常氏说：“可与芍药地黄汤”。夫亡血家，也有阴虚发热的，上方固然适宜用。石顽说：“黄芪建中汤”。误汗振栗，苓桂术甘汤加当归。据成无己注解说：“亡血发汗，则阴阳俱虚”。我认为以上两个汤，都是亡血家汗后的药剂。）
病人有寒，再发汗，胃中冷，必然吐蛔虫（此条是真寒证，正文与注释见《中寒论》中）
本来应当发汗却反而用下法，这叫逆。如果先发汗，治疗就不算逆。本来应当先用下法，却反而发汗，这叫逆。如果先下法，治疗就不算逆。（成无己注解说：“病在表的，发汗为宜，下法为逆；病在里的，下法为宜，发汗为逆。大概治疗伤寒的方法，表证急的，就宜发汗；里证急的，就宜下法，不可拘泥于先汗而后下。汗下得当，治疗就不算逆。”）
伤寒，医生用下法，接着出现下利清谷不止，身体疼痛的，急当救里。后来身体疼痛，大小便正常的，急当救表。救里宜用四逆汤，救表宜用桂枝汤。（此条是太阳伤寒，医生误行下法，因下利清谷不止，虽然身体疼痛，急当温救其里。至于救表的药，仍用桂枝汤的，是因为这个人胃气本实，不被误下所害的缘故。正文与注释详见《中寒论》中）
病人发热头痛，脉象反而沉，如果不痊愈，身体疼痛，应当救其里，宜用四逆汤（此条是中寒病，其发热头痛的，是因为寒中少阴，必由太阳直入，所以头痛而反发热。脉沉身体疼痛，是阴寒之气，由内而彻于外。其为中寒病无疑。正文与注释详见《中寒论》中）
太阳病先用下法而不愈，因而再发汗，因此表里俱虚。那人因而导致头昏蒙。头昏蒙的病人汗出自愈。之所以这样，是因为汗出则表和的缘故。得到里未和然后再用下法。（“冒”的意思是覆盖，谓寒邪怫郁，像用东西蒙覆其头目。太阳病先用下法，再发汗，这是汗下皆逆。徒然使其表里之气虚弱，邪气终不解，因而导致头昏蒙。《金匮要略》说：“冒家欲解，必大汗出”，所以说自愈。其所以自愈的，不是自己出汗而愈，而是用药使之汗出，这样表气得和的缘故。汗出表和，则不必再用下法，所以说“必须得里未和者，然后用药复下之”。可见表里两虚的人，虽然有汗下之证，医人不敢轻用汗下之药，像这样的情况。按此条论述，仲景没有治法。《补亡论》常器之说：“和表，用小柴胡汤”。然而这个汤，不是太阳病当用的药。我认为表宜用桂枝汤，或小建中汤，黄芪建中汤，选而用之。常氏又说：“复下，用调胃承气汤”，恐怕这个汤，又不是里虚所宜。我认为下宜用桂枝加大黄汤。又按条辩注解读“得里未和”的“里”字，指大小便，这种说法很错误。《尚论篇》也说：“下里药无过大柴胡汤、五苓散”，误之又误。我私下想正文中既然说“然后复下之”，这专指大便而言。如果兼利小便，则不会说“下”了。这个意义，可不辩而自明。）
太阳病，未解，脉阴阳俱停，必先振栗，汗出而解。但阳脉微的，先汗出（《脉经》作“之”）而解。但阴脉微的，下之而解。如果想用下法，宜用调胃承气汤主治。（太阳病未解，其邪所着不在于表，即入于里。表里之病，于阴阳二脉验之。《脉经》说：寸为阳，关以前是也；尺为阴，关以后是也。现在寸关尺三处脉，皆和平，是为阴阳俱停，是正气将复、邪气欲去的征兆。然而还是必须先振栗，乃得汗出而后解。由其人病久，元气虚，正与邪争的缘故。其不为振汗，邪无从出的，但阳脉微即为表邪盛也，法当汗之而解。但阴脉微即为里邪实也，法当下之而解。盖此为太阳病，已入于府，胃中郁热，不能自消，所以说：“若想下之，宜调胃承气汤”。按成无己引用“阳虚阴盛，阳盛阴虚”，为阴阳脉微，汗下作解，其义晦涩不明。《尚论篇》注阴阳脉微为病后之脉，与初病不同。盖初病皆邪气胜则实之脉，病后皆正气夺则虚之脉，所以最虚之处，便是容邪之处。故阳脉微者，邪乘其阳，汗之而解；阴脉微者，邪乘其阴，下之而解。这话实在阐发成氏未发之意。然而我认为邪气既乘之后，恐怕其脉未必尽出于微。若脉既微，必无用承气汤下之的道理。大抵“脉微”二字当活看，此非微弱之微，乃邪滞而脉道细伏之义。邪滞于经，则表气不得条达，故阳脉微；邪滞于府，则里气不能通畅，故阴脉微。又按上述论述说：“先汗出而解”，仲景无方。《千金方》说：“宜桂枝汤”。谓调胃承气汤方见后第六卷阳明篇中。）
（重出例）太阳病发热汗出的，这是营弱卫强，所以使汗出。欲救邪风的，宜用桂枝汤。（正文与注释见前桂枝汤方下）
（附后例）伤寒五六日，中风，往来寒热，胸胁苦满。（云云至）身有微热或咳的，与小柴胡汤主治。（此条是风寒之邪，在半表半里，乃少阳经证，不当入太阳篇，正文与注释并。）
小柴胡汤方及加减法。（俱见后第七卷少阳篇中）
血弱气尽，腠理开，邪气因入。（云云至）所以使呕的，小柴胡汤主治。
服柴胡汤已，渴的，属阳明也，以法治之。得病六七日，脉迟浮弱。（云云至）柴胡汤不中与也。食谷者哕。
伤寒四五日，身热恶风，颈项强，胁下满，手足温而渴的，小柴胡汤主治。伤寒阳脉涩阴脉弦，法当腹中急痛的，先与小建中汤，不愈的，与小柴胡汤主治。
上五条证。（俱见后少阳篇中）小建中汤方（见后第三条证下）
伤寒中风有柴胡证，但见一证便是，不必悉具。凡柴胡汤病证而下之，若柴胡证不罢的，复与柴胡汤，必蒸蒸而振，却发热汗出而解。
上二条证。（俱见后少阳篇中）
伤寒二三日，心中悸而烦的，小建中汤主治。（伤寒二三日，邪当传里之时，今则别无他证，但心中悸而烦的，这是外邪已微而不传，正气骤虚，不能自持。盖阳气内虚，则心悸；阴气内虚，则心烦。故与小建中汤，以建其里气之虚。我认为此条病，必是太阳伤寒发汗之后所变，故建中汤，即桂枝汤小变其制也。）
Zhi Zi (Gardeniae Fructus, 14 pods, broken open) Hou Po (Magnoliae Officinalis Cortex, 4 liang, processed with ginger juice) Zhi Shi (Immature Bitter Orange, 4 pieces, pith removed and stir-fried)
The above three herbs. Boil in 3.5 sheng of water. Decoct to obtain 1.5 sheng. Remove the dregs. Divide into two doses. Take one dose warm. If vomiting occurs after taking the medicine, stop subsequent doses.
Hu notes: Cheng Wuji's commentary states: "Sour and bitter induce vomiting and purging." The bitterness of Zhi Zi induces vomiting for deficiency vexation, while the bitterness of Hou Po and Zhi Shi purges abdominal fullness. This is because the act of vomiting inherently contains the meaning of venting and releasing.
Hu further notes: Cheng Wuji regards abdominal fullness as a interior excess syndrome. Generally, upper vomiting and lower purging are methods used by physicians to drain excess fullness. Therefore, when Hou Po and Zhi Shi are used with Da Huang, the fullness is drained from below; when used with Zhi Zi, the fullness is induced to vomit from above. In short, the aforementioned medicines are not specific emetics; perhaps vomiting can be induced by probing the throat after taking the decoction.
*Nei Tai Fang Yi* states: After purgation, if there is only abdominal fullness without mental vexation, the pathogenic factor has entered the interior. If there is only mental vexation without abdominal fullness, the pathogenic factor is in the chest, belonging to the Zhi Zi Chi Tang syndrome. Now, since there is both vexation and abdominal fullness, the pathogenic factor is between the chest and abdomen. Vexation prevents lying down, and fullness prevents sitting, so both lying and sitting are uncomfortable. Therefore, Zhi Zi is used as the sovereign herb to induce vomiting for vexation; Hou Po as the minister herb, and Zhi Shi as the assistant envoy herb. The bitterness of these two herbs purges abdominal fullness. According to the above discussion, this actually originates from Cheng Wuji's commentary.
In Shanghan (Cold Damage), if a physician mistakenly uses pill-based purgatives vigorously, resulting in persistent body heat and slight mental vexation, Zhi Zi Gan Jiang Tang (Gardenia and Dried Ginger Decoction) should be administered. (In Taiyang Cold Damage, the physician mistakenly used vigorous pill purgatives, merely injuring the Middle Qi, leaving the pathogenic heat unremoved, hence the persistent body heat. The pathogenic factor takes advantage of the deficiency to lodge in the chest, causing slight vexation. Administer Zhi Zi Gan Jiang Tang to induce vomiting, thereby dispersing the pathogenic heat and supporting the Middle Qi.)
Zhi Zi (Gardeniae Fructus, 14 pods, broken open) Gan Jiang (Zingiberis Rhizoma, 2 liang, sliced)
The above two herbs. Boil in 3.5 sheng of water. Decoct to obtain 1.5 sheng. Remove the dregs. Divide into two doses. Take one dose warm. If vomiting occurs after taking the medicine, stop subsequent doses.
Hu notes: Cheng Wuji's commentary states: "Bitterness induces vomiting." The bitterness of Zhi Zi induces vomiting for vexation; "Pungency moistens." The pungency of Gan Jiang benefits Qi. Pungency naturally disperses; its ability to benefit Qi stems from the warming nature of ginger's Qi.
Zhong Jing established this decoction primarily as an agent to induce vomiting for vexation. The reason for including Gan Jiang is that after the physician's vigorous purgation with pills, the patient's Middle Qi must have been injured. It relies specifically on the pungent-warming nature of Gan Jiang to support the Middle Qi, stating that although vomiting occurs, it will not harm the Stomach. Thus, *Wai Tai Mi Yao* commentary says that Gan Jiang has the power of a minister or assistant in stabilizing the upright Qi of the Middle Jiao, which is the meaning here.
Whenever using Zhi Zi Tang, patients who habitually have loose stools should not take it. (This refers generally to the previous formulas containing Zhi Zi. Zhi Zi is too bitter and cold. If a patient has habitual deficiency-cold of the intestines and stomach with slightly loose stools, it should not be taken. Misuse may fail to induce vomiting and instead cause downward purging, causing great harm. Physicians, how can they not take this as a warning? Cheng Wuji cites the *Neijing*: "If diarrhea precedes other diseases, treat the root first," implying regulation before treating other conditions. Moreover, Zhong Jing uses Zhi Zi Tang mainly after mistaken purgation for unresolved heat-vexation in the chest. If a patient has habitual loose stools and suffers mistaken purgation for Shanghan, I fear the chest vexation may not solely be due to constrained heat, hence the instruction not to use Zhi Zi Tang. Later commentaries ask: "Bencao does not list Zhi Zi as an emetic; why does Zhong Jing use it for purging/vomiting?" The answer is: "Zhi Zi is not inherently an emetic. Here, due to chest vexation with pathogenic factors high in the upper jiao refusing to accept intake, boiling the decoction and administering it causes natural vomiting, allowing the pathogen to exit. The *Neijing* commentary states: 'Because the pathogen is originally high, using medication to elevate it is very easy.' Thus, must all emetics be Gua Di San (Melon Seed Powder)?)"
In Taiyang disease, if sweating fails to resolve the condition, and the patient still has fever, palpitations in the epigastrium, dizziness, body tremors, and a sensation of shaking as if about to fall to the ground, Zhen Wu Tang (True Warrior Decoction) should be administered. (Although this clause involves Taiyang disease, forced sweating leading to Yang depletion results in interior deficiency, constituting a true cold-Yin syndrome. The main text, commentary, and formula are found in the *Zhong Han Lun* [Treatise on Cold Injury].)
Those with dry throat should not be sweated. (The following clauses all state contraindications for sweating. *Shang Lun Pian* places them after Ma Huang Tang, which has merit, but here we follow the old example for explanation without alteration. This follows up on the errors of previous sweating, vomiting, and purging, explaining that there are many situations where sweating is contraindicated, which physicians must know. For instance, those with dry throat: Cheng Wuji notes, "Deficiency of body fluids." Sweating would severely deplete fluids further, hence it is contraindicated. Later commentaries state: "Physicians intending to use sweating methods must consider the fluids of the Upper Jiao.")
Patients with Lin syndrome (strangury) should not be sweated; sweating will inevitably lead to hematuria. (Lin syndrome involves heat in the Bladder with failed Qi transformation, causing dribbling urination. Patients with Lin have depleted fluids; further sweating exhausts the Water House, forcing blood out through the urine. Later commentaries state: "Physicians intending to use sweating methods must consider the fluids of the Lower Jiao.")
Patients with sores/ulcers (Chuang Jia) should not be sweated even if they have body pain; sweating will lead to spasms (Jing). (Cheng Wuji notes: "Exterior deficiency with accumulated heat generates sores." Even if Chuang Jia presents with body pain resembling Shanghan, sweating is contraindicated. Sweating worsens exterior deficiency and heat, drying fluids and failing to nourish sinews, leading to spasms. Later commentaries state: "Physicians intending to use sweating methods must consider the fluids of the whole body.")
Patients with frequent nosebleeds (Xu Jia) should not be sweated; sweating will cause depression of the forehead, tight and rapid pulse, fixed gaze unable to blink, and insomnia. (Sweat is blood. Those with nosebleeds have damaged clear pathways and Yang meridians. Further sweating severely damages Yang and Yin, causing forehead depression (sign of Upper Jiao fluid exhaustion). Tight pulse relates to eyes, as vessels connect to the eyes; without blood nourishment, sinews tighten, preventing eye movement (blinking). Insomnia occurs because Wei Qi cannot enter Yin at night without Ying Blood as its host, remaining stuck in Yang. Cheng Wuji attributes this to Yin deficiency. Later commentaries state: "Physicians intending to use sweating methods must consider the Ying Blood of Yang meridians.")
Patients with blood loss (Wang Xue Jia) should not be sweated; sweating will cause chills and trembling. (Blood belongs to Yin; blood loss is Yin loss. Without Yin, Yang has no attachment. Sweating causes Yang to escape externally, leading to chills and trembling. Cheng Wuji describes this as simultaneous deficiency of Yin and Yang. Later commentaries state: "Physicians intending to use sweating methods must consider the Ying Blood of Yin meridians.")
Patients prone to sweating (Han Jia) should not be sweated again; doing so causes mental confusion and post-urination genital pain. Treat with Yu Yu Liang Wan. (Formula missing. Heart governs blood; sweat is the fluid of the Heart. Habitual sweaters have Heart-blood deficiency. Re-sweating causes Heart-fluid loss and floating Spirit, leading to confusion. Post-urination genital pain occurs because the Small Intestine is the Fu organ of the Heart; Heart deficiency leads to depletion of Fu fluids. Later commentaries state: "Physicians intending to use sweating methods must consider the density of exterior Qi and the strength of Ying chambers." Zhong Jing's method uses Yu Yu Liang Wan, generally a formula for nourishing blood and stabilizing. The original formula is lost. *Bu Wang Lun* Chang Qizi suggests single herb Yu Yu Liang powder. Guo Baiyun suggests using Yu Yu Liang stone, not shell. I doubt this fully matches Zhong Jing's intent. Regarding treatments for previous clauses in *Bu Wang Lun*: For dry throat, Chang Qizi suggests Xiao Chai Hu Tang (disputed); Shi Wan suggests Xiao Jian Zhong Tang (plausible). For Lin, Chang suggests Zhu Ling Tang (too draining for post-sweat hematuria); Shi Wan suggests Huang Qi Jian Zhong Tang (better for sores). For sores, Chang suggests Gui Zhi Jia Ge Gen Tang for spasms; Wang Ri Xiu suggests Xiao Jian Zhong Tang plus Dang Gui (superior). For Xu Jia, Chang suggests Xi Jiao Di Huang Tang (standard); Xu Shu Wei suggests Huang Qi Jian Zhong Tang plus Xi Jiao (for Yangming heat); Lu Cang Zhou suggests Xiao Jian Zhong Tang plus Cong Chi. For Wang Xue Jia, Chang suggests Shao Yao Di Huang Tang (suitable for Yin-deficiency heat); Shi Wan suggests Ling Gui Zhu Gan Tang plus Dang Gui for trembling. Cheng Wuji notes simultaneous Yin-Yang deficiency; I consider both formulas suitable for post-sweat Wang Xue Jia.)
Patients with cold who are sweated again develop cold Stomach and regurgitate roundworms. (This is a true cold syndrome; text and commentary are in *Zhong Han Lun*.)
Originally indicated for sweating but treated with purging is contrary. If sweating is done first, treatment is not contrary. Originally indicated for purging but treated with sweating is contrary. If purging is done first, treatment is not contrary. (Cheng Wuji notes: Exterior diseases suit sweating, not purging; interior diseases suit purging, not sweating. Generally, urgent exterior cases require sweating; urgent interior cases require purging. One should not rigidly adhere to sweating before purging. Proper application of sweating and purging is not contrary.)
In Shanghan, if a physician purges and diarrhea with undigested food persists, accompanied by body pain, urgently rescue the interior. Later, if body pain persists but bowel/bladder function normalizes, urgently rescue the exterior. Rescue interior with Si Ni Tang; rescue exterior with Gui Zhi Tang. (This clause involves Taiyang Shanghan mistakenly purged, causing persistent diarrhea with undigested food. Despite body pain, interior warmth is urgent. Gui Zhi Tang is used for exterior rescue because the patient's Stomach Qi was originally strong and unaffected by the mistaken purgation. Text and commentary are in *Zhong Han Lun*.)
Fever, headache, with reverse deep pulse: if unrelieved and body pain persists, rescue the interior with Si Ni Tang. (This is a Zhong Han (Cold Strike) case. Fever and headache result from Cold striking Shaoyin, entering directly from Taiyang. Deep pulse and body pain indicate Yin-Cold penetrating from interior to exterior. Definitely Zhong Han. Text and commentary are in *Zhong Han Lun*.)
Taiyang disease, initially purged without resolution, then sweated, resulting in simultaneous exterior-interior deficiency. The patient experiences Mao (vertigo/dizziness). Mao resolves spontaneously with sweating. This is because sweating harmonizes the exterior. Only after interior harmony is achieved should purging be reconsidered. ("Mao" means covered, like something covering the head/eyes due to constrained Cold. Initial purging followed by sweating is contradictory, weakening exterior-interior Qi and trapping pathogens. *Jin Gui Yao Lue* states: "Mao resolves with heavy sweating," implying spontaneous recovery via medication-induced sweating harmonizing exterior Qi. Once exterior is harmonized, purging is unnecessary. Thus, for dual deficiency, physicians hesitate to use sweating/purging. Zhong Jing provides no formula here. *Bu Wang Lun* Chang Qizi suggests Xiao Chai Hu Tang for harmonizing exterior (disputed as inappropriate for Taiyang); I suggest Gui Zhi Tang or Xiao/Jian Zhong Tang. For purging, Chang suggests Tiao Wei Cheng Qi Tang (unsuitable for interior deficiency); I suggest Gui Zhi Jia Da Huang Tang. Commentators interpreting "interior" as bowel/bladder movements are incorrect. *Shang Lun Pian* suggests Da Chai Hu Tang or Wu Ling San for purging interior, which is erroneous. "Purging" here specifically refers to bowels, not diuresis.)
Taiyang disease unresolved, pulse Yin and Yang both pause/still: first chills and tremors, then sweating resolves it. If only Yang pulse is micro, sweating resolves it. If only Yin pulse is micro, purging resolves it. If purging is desired, Tiao Wei Cheng Qi Tang should be administered. (Unresolved Taiyang implies pathogen moves from exterior to interior. Pulse diagnosis distinguishes location. *Mai Jing*: Cun is Yang (above Guan), Chi is Yin (below Guan). Peaceful pulses at all three positions indicate "Yin Yang Ju Ting," signifying returning upright Qi and departing pathogen. However, chills/tremors precede sweating due to prolonged illness and Qi deficiency fighting pathogens. Micro Yang pulse indicates exterior pathogen excess, requiring sweating. Micro Yin pulse indicates interior pathogen excess, requiring purging. Since pathogen entered the Fu organ with constrained Stomach heat, Tiao Wei Cheng Qi Tang is suggested. Cheng Wuji's interpretation of "Yang deficiency/Yin excess" is obscure. *Shang Lun Pian* interprets micro pulse as post-illness deficiency vs. initial excess. "Most deficient place harbors pathogen." Micro Yang allows pathogen to attack Yang (sweat resolves); Micro Yin allows pathogen to attack Yin (purge resolves). This clarifies Cheng's view. However, if pulse is truly micro, purging with Cheng Qi Tang is illogical. "Micro" here likely means constrained/narrow vessel due to pathogen stagnation, not weakness. Pathogen in channels constrains exterior Qi (Yang micro); pathogen in Fu organs obstructs interior Qi (Yin micro). *Qian Jin* suggests Gui Zhi Tang for sweating. Formula reference: Vol 6 Yangming chapter.)
(Repeated Clause) Taiyang disease with fever and sweating indicates weak Ying and strong Wei, causing sweating. To rescue from pathogenic wind, Gui Zhi Tang is appropriate. (Text and commentary see Gui Zhi Tang section above.)
(Attached Clause) Shanghan five to six days, Windstroke, alternating chills and heat, bitter fullness in chest/hypochondrium... slight body heat or cough: Xiao Chai Hu Tang is appropriate. (This clause involves Wind-Cold at half-exterior half-interior, a Shaoyang syndrome, incorrectly placed in Taiyang chapter. Text and commentary included.)
Xiao Chai Hu Tang formula and modifications (See Vol 7 Shaoyang chapter).
Weak blood and exhausted Qi, interstices open, pathogen enters... causes vomiting. Xiao Chai Hu Tang is appropriate.
After taking Chai Hu Tang, thirst indicates Yangming syndrome; treat accordingly. Disease for six to seven days, slow floating weak pulse... Chai Hu Tang is not suitable. Vomiting upon eating.
Shanghan four to five days, body heat, aversion to wind, stiff neck, hypochondriac fullness, warm hands/feet, thirst: Xiao Chai Hu Tang is appropriate. Shanghan, Yang pulse choppy, Yin pulse string-taut, law dictates acute abdominal pain: First give Xiao Jian Zhong Tang. If unrelieved, give Xiao Chai Hu Tang.
(The above five clauses are in the Shaoyang chapter. Xiao Jian Zhong Tang formula is under Clause 3 below.)
In Shanghan or Windstroke, if Chai Hu syndrome exists, seeing one symptom suffices; complete presentation is not required. If Chai Hu syndrome is treated with purging, and Chai Hu symptoms persist, re-administer Chai Hu Tang. There will be steaming chills and tremors, followed by fever, sweating, and resolution.
(The above two clauses are in the Shaoyang chapter.)
Shanghan two to three days, palpitations and vexation in the heart: Xiao Jian Zhong Tang is appropriate. (At two to three days, pathogen should transmit to interior. With no other symptoms, only heart palpitations and vexation, external pathogen is mild/non-transmitting, while upright Qi suddenly defies self-support. Interior Yang deficiency causes palpitations; interior Yin deficiency causes vexation. Xiao Jian Zhong Tang builds interior Qi. I believe this condition arises post-sweating in Taiyang Shanghan; thus Jian Zhong Tang is a slight modification of Gui Zhi Tang.)