治胃实热。呕吐长虫。
黄连（姜汁炒三钱） 黄柏（酒炒钱半） 枳实（麸炒二钱） 乌梅（三个） 川椒（去目炒去汗三十粒）
上五味。共剂。水二钟。加生姜三大片。煎八分。细口服。
（琥）于上方。用黄连生姜者。以清中而止呕也。复加黄柏乌梅川椒者。蛔得苦则安。得酸则止。得辛则头伏也。
用枳实者。泄胃实也。如病患胃中虚热而呕者。去枳实。加人参一钱五分。
（琥）总按以上方论。乃治厥阴热病通变之活法也。厥阴所难治者。惟发厥一证。据仲景论中。真寒之厥。十居其
七。郁热之厥。十止二三。以故今医治厥。每以热证作寒治者。其误良多。殊不知寒厥证。仲景治法虽多。而病者十不
得一。热厥证。仲景治法虽少。而病者十居其九。愚因集昔贤续论。附于仲景原论之后。学人诚能通变观之。则庶乎其
不瘥矣。
此系仲景原文琥按仲景论。叔和所增入者。王安道云。乃第一卷辩脉平脉法。又第七八九卷汗吐下诸篇而已。至
若六经篇以前。则有痉湿 三证。六经篇以后。则有霍乱一证。此亦仲景原文。非叔和所能赞辞。愚今不为辩注者。盖
以上四证。本非伤寒。仲景当日偶比类言之也。然其实。则各有不同。有如痉证。当见头摇。口噤。背反张。湿证。则
皆小便不利。大便反快。 证。大都口开。前板齿燥霍乱。亦必挥霍撩乱。呕利齐作。此其与伤寒不同处。所以喻嘉言
着尚论篇以四证为杂病。而不列之伤寒中也。其他如阴阳易。瘥后等证。此即伤寒病之未愈者。故特辩注之如下。
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。烧 散主之。（此言瘥后诸病。而先以阴阳易冠其首也。阴阳易之为病。成注言之已明。易者。以无病患清正之气。
与病后人交合。换得浊邪之气。故曰易也。身体重少气者。我之正气脱也。少腹里急云云者。我受彼之邪气上逆也。后
条辩云。三焦相混。一皆秽浊之邪。布塞于经络之中。故见以上诸证。用烧 散者。以导引其浊邪之气。男女各由溺而
出也。）
治疗胃中实热。呕吐蛔虫。
黄连（用姜汁炒三钱） 黄柏（用酒炒一钱半） 枳实（用麦麸炒二钱） 乌梅（三个） 川椒（去掉目，炒去汗液三十粒）
以上五味药。一起煎煮。加水两钟。加入生姜三大片。煎至八分满。细细服用。
（王琥）对于上方。使用黄连和生姜的原因。是为了清泄中焦热邪并停止呕吐。又加入黄柏、乌梅、川椒的原因。是蛔虫得到苦味则安宁。得到酸味则停止扰动。得到辛味则头部伏下不动。
使用枳实的原因。是泻除胃中的实邪。如果病患胃中是虚热并且呕吐的。去掉枳实。加入人参一钱五分。
（王琥）总括以上方论。这是治疗厥阴热病灵活变通的活法。厥阴病难以治疗的。只有发厥这一证候。根据仲景的论述。真寒导致的厥逆。占十分之七。郁热导致的厥逆。仅占十分之二三。因此现在医生治疗厥逆。常常把热证当作寒证来治。错误很多。殊不知寒厥证。虽然仲景的治疗方法多。但患此病的十人中不到一个。热厥证。虽然仲景的治疗方法少。但患此病的十人中有九人。我因此收集前代贤人的续论。附在仲景原论之后。学习者如果能通晓变通地观察它。那么大概就不会出错了。
以上是仲景原文。王琥按：仲景的论述。是由叔和增入的。王安道说。是第一卷辩脉平脉法。以及第七、八、九卷汗吐下诸篇而已。至于六经篇以前。则有痉、湿、暍三证。六经篇以后。则有霍乱一证。这些也是仲景的原文。不是叔和所能随意添加的文辞。我现在不为它们做辩注的原因。是因为以上四证。本来不属于伤寒。是仲景当时偶然用来类比说明的。然而实际上。它们各有不同。比如痉证。应当见到头摇。口噤。背反张。湿证。则都是小便不利。大便反而快。暍证。大都是口开。前板齿干燥。霍乱。也必定是挥霍撩乱。呕吐和下利同时发作。这就是它们与伤寒不同的地方。所以喻嘉言著《尚论篇》将这四证列为杂病。而不列入伤寒中。其他如阴阳易、瘥后等证。这即是伤寒病尚未痊愈的情况。所以特别进行辩注如下。
伤寒阴阳易这种病。患者身体沉重。气短。少腹内部急迫。或者牵引阴中拘挛。热气上冲胸部。头重不想抬起。眼中生花。膝胫拘急的。用烧裈散主治。（这里说的是瘥后各种病症。而先用阴阳易冠于首位。阴阳易这种病。成无己的注解已经讲得很明白。易。是指健康人清正之气。与病愈后人交合。换得了浊邪之气。所以叫易。身体沉重气短。是我的正气脱失。少腹里急等等。是我受了彼方的邪气上逆。后来的条辩说。三焦混杂。全都是秽浊之邪。布塞在经络之中。所以出现以上诸证。用烧裈散。是为了引导其浊邪之气。男女都通过尿道排出。）
Treats stomach excess heat. Vomiting of roundworms (Ascaris lumbricoides).
Coptidis Rhizoma (Huanglian) (stir-fried with ginger juice, 3 qian), Phellodendri Cortex (Huangbai) (stir-fried with wine, 1.5 qian), Immature Bitter Orange (Zhishi) (stir-fried with bran, 2 qian), Mume Fructus (Wumei) (3 pieces), Zanthoxyli Pericarpium (Chuanjiao) (remove eyes, stir-fry to remove sweat/oil, 30 grains).
The above five herbs. Decoct together. Add water two zhong. Add three large slices of fresh ginger root (Shengjiang). Decoct until eight parts remain. Take slowly in small sips.
(Wang Hu) Regarding the above formula. The use of Coptidis Rhizoma and fresh ginger root is to clear the middle jiao and stop vomiting. The addition of Phellodendri Cortex, Mume Fructus, and Zanthoxyli Pericarpium is because roundworms are pacified by bitter taste, restrained by sour taste, and their heads subside due to pungent taste.
The use of Immature Bitter Orange is to drain stomach excess. If the patient has stomach deficiency-heat with vomiting, remove Immature Bitter Orange and add Ginseng Radix et Rhizoma (Renshen) 1.5 qian.
(Wang Hu) Summarizing the above formula discussion, this is a flexible method for treating Jueyin heat diseases. The difficult-to-treat aspect of Jueyin disease is only the syndrome of jue (cold extremities/convulsions). According to Zhang Zhongjing's treatise, true cold jue accounts for seven-tenths, while stagnant heat jue accounts for only two or three-tenths. Therefore, current physicians often treat heat jue as cold jue, leading to many errors. Little do they know that although Zhang Zhongjing has many treatments for cold jue, patients suffer from it less than one in ten. Conversely, although Zhang Zhongjing has fewer treatments for heat jue, nine out of ten patients suffer from it. I have therefore collected previous sages' supplementary discussions and appended them after Zhang Zhongjing's original text. Students who can understand and apply these principles flexibly will likely avoid mistakes.
This is Zhang Zhongjing's original text. Wang Hu notes: The content added by He Huang (Shuhe) includes the first volume on Pulse Differentiation and Equilibrium, and volumes seven, eight, and nine on sweating, vomiting, and purging methods. Prior to the Six Channels chapters, there are syndromes of spasm (Jing), dampness (Shi), and heat-stroke (Ye). After the Six Channels chapters, there is the syndrome of cholera-like disorder (Huoluan). These are also Zhang Zhongjing's original texts, not additions by Shuhe. I do not provide commentary on them now because these four syndromes originally did not belong to Cold Damage (Shanghan); Zhang Zhongjing merely used them for analogy at the time. However, they differ essentially. For instance, spasm syndrome presents with head shaking, locked jaw, and opisthotonos; dampness syndrome presents with difficulty in urination and loose stools; heat-stroke syndrome presents with open mouth and dry anterior teeth; cholera-like disorder presents with sudden turmoil, simultaneous vomiting and diarrhea. These are differences from Cold Damage. Thus, Yu Jiayan, in his *Shanglun Pian*, classified these four syndromes as miscellaneous diseases rather than Cold Damage. Other syndromes such as Yin-Yang Exchange (Yinyangyi) and post-recovery relapse (Chaihou) refer to conditions where the Cold Damage disease has not yet fully resolved. Therefore, specific commentary follows below.
In Cold Damage Yin-Yang Exchange disease, the patient experiences heavy body, shortness of breath, urgency and discomfort in the lower abdomen, possibly extending to spasms in the genitalia, rising heat rushing to the chest, heaviness of the head making lifting difficult, visual disturbances (seeing spots), and stiffness/spasms in the knees and shins. This is treated with Burnt Underwear Powder (Shao Kun San). (This section discusses various post-recovery illnesses, starting with Yin-Yang Exchange. Cheng Wuji's annotation explains Yin-Yang Exchange clearly: "Exchange" refers to a healthy person's pure qi interacting sexually with a convalescent person, thereby acquiring turbid pathogenic qi. Heavy body and shortness of breath indicate depletion of one's own righteous qi. Lower abdominal urgency etc. indicates receiving rebellious pathogenic qi from the other party. Later commentaries state that the Triple Burner becomes mixed, filled with foul turbid pathogens obstructing the meridians, causing the aforementioned symptoms. Burnt Underwear Powder is used to guide out the turbid qi, which exits through the urethra in both men and women.)