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。此为逆也。若
先下之。治不为逆。
此泛言汗下之法。各有所宜。当随病而施治。不可或失其度也。如头痛发热恶寒者。本当发汗
而反下之。是病在表而治其里也。故曰逆。腹满便闭恶热者。本当下之。而反汗之。是病在里而治
其表也。故亦为逆。若审其当汗而汗之。或当下而下之。则亦何逆之有。外台云、表病里和。汗之
则愈。下之则死。里病表和。下之则愈。汗之则死。不可不慎也。
太阳病。先发汗不解。而复下之。脉浮者不愈。浮为在外。而反下之。故令不愈。今脉浮。故
知在外。当须解外则愈。宜桂枝汤主之。
既汗复下。邪气不从表散。而又不从里出者。以其脉浮而邪在外。故虽复下之。而病不愈也。
夫病在外者。仍须从外引而去之。今虽已汗下。而其脉仍浮。知其邪犹在外。故须桂枝汤。解散外
邪则愈。少阳篇云、柴胡汤证具。而以他药下之。柴胡证仍在者。复与柴胡汤。必蒸蒸而振。却
发热汗出而解。与此同意。所当互参。
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。
下之则伤其里。汗之则伤其表。既下复汗。表里俱虚。而邪仍不解。其人则因而为冒。冒、
昏冒也。以邪气蔽其外。阳气被郁。欲出不能。则时自昏冒。如有物蒙蔽之也。若得汗出。则邪散
阳出。而冒自愈。金匮云、冒家欲解。必大汗出也。然亦正气得复。而后汗自出耳。岂可以药强
发之哉。若汗出冒解。而里未和者。然后复下之。以和其里。所谓里病表和。下之而愈是也。
大下之后。复发汗。小便不利者。亡津液故也。勿治之。得小便利。必自愈。
既下复汗。重亡津液。大邪虽解。而小便不利。是未可以药利之。俟津液渐回。则小便自行
而愈。若强利之。是重竭其阴也。况未必即利耶。
下之后。复发汗。必振寒。脉微细。所以然者。以内外俱虚故也。
振寒、振栗而寒也。脉微为阳气虚。细为阴气少。既下复汗。身振寒而脉微细者。阴阳并伤。
而内外俱虚也。是必以甘温之剂。和之养之为当矣。
下之后。复发汗。昼日烦躁不得眠。夜而安静。不呕不渴。无表证。脉沉微。身不大热者。干
姜附子汤主之。
大法昼静夜剧。病在肾阴。夜静昼剧。病在胃阳。汗下之后。昼日烦躁不得眠。夜而安静者。
邪未尽而阳已虚。昼日阳虚欲复。而与邪争。则烦躁不得眠。夜而阴旺阳虚。不能与邪争。则反安
静也。不呕不渴。里
无热也。身无大热。表无热也。而又无头痛恶寒之表证。其脉又不浮而沉。不洪而微。其为阳气
衰少无疑。故当与干姜、附子。以助阳虚而逐残阴也。以上三条。并是汗下后。小便不利者。伤其
阴也。振寒脉微细者。阴阳并伤也。昼日烦躁不得眠。夜而安静者。伤阳而不及阴也。于此见病
变之不同。
干姜附子汤方
干姜（一两） 附子（一枚生用去皮切八片）
上二味。以水三升。煮取一升。去滓。顿服。
发汗若下之。病仍不解。烦躁者。茯苓四逆汤主之。
发汗若下。不能尽其邪。而反伤其正。于是正气欲复而不得复。邪气虽微而不即去。正邪交
争。乃生烦躁。是不可更以麻、桂之属逐其邪。及以栀、豉之类止其烦矣。是方干姜、生附之辛。
所以散邪。茯苓、人参、甘草之甘。所以养正。乃强主弱客之法也。
茯苓四逆汤方
茯苓（六两） 人参（一两） 干姜（一两半） 甘草（二两炙） 附子（一枚生用去皮破
八片）
上五味。以水五升。煮取三升。去滓。温服七合。日三服。
按汗下后烦躁一证。悉是正虚邪扰之故。而有邪多虚少。或虚多邪少之分。邪多者。宜逐邪
以安正。虚
多者。宜助正以逐邪。仲景既着栀豉汤之例。复列茯苓四逆之法。其于汗下后烦躁一证。虚实互举
。补泻不遗如此。学人所当究心也。
伤寒胸中有热。胃中有邪气。腹中痛。欲呕吐者。黄连汤主之。
此上中下三焦俱病。而其端实在胃中。邪气即寒淫之气。胃中者。冲气所居。以为上下升降
之用者也。胃受邪而失其和。则升降之机息。而上下之道塞矣。成氏所谓阴不得升而独治其下。
为下寒腹中痛。阳不得降而独治于上。为胸中热欲呕吐者是也。故以黄连之苦寒。以治上热。桂枝
之甘温。以去下寒。上下既平。升降乃复。然而中焦不治。则有升之而不得升。降之而不得降者矣。
故必以人参、半夏、干姜、甘草、大枣。以助胃气而除邪气也。此盖痞证之属。多从寒药伤中后得
之。本文虽不言及。而其为误治后证可知。故其药亦与泻心相似。而多桂枝耳。
黄连汤方
黄连 桂枝（去皮） 干姜 甘草（炙各三两） 人参（二两） 半夏（半升洗） 大枣（十
二枚擘）
上七味。以水一斗。煮取六升。去滓。温服一升。日三服。夜二服。
太阳病。当恶寒发热。今自汗出。不恶寒发热。关上脉细数者。以医吐之故也。一二日吐之者
。腹中饥。口不能食。三四日吐之者。不喜糜粥。欲食冷食。朝食暮吐。以医吐之所致也。此为
小逆。
病在表而医吐之。邪气虽去。胃气则伤。故自汗出。无寒热。而脉细数也。一二日。胃气本
和。吐之则胃空思食。故腹中饥。而胃气因吐而上逆。则又口不能食也。三四日。胃气生热。吐之
则其热上动。故不喜糜粥。欲食冷食。而胃气自虚。不能消谷。则又朝食而暮吐也。此非病邪应
尔。以医吐之所致。曰小逆者。谓邪已去而胃未和。但和其胃。则病必自愈。
伤寒吐下后。复发汗。虚烦。脉甚微。八九日。心下痞硬。胁下痛。气上冲咽喉。眩冒。经
脉动惕者。久而成痿。吐下复汗。津液叠伤。邪气陷入。则为虚烦。虚烦者。正不足而邪扰之为烦
。心不宁也。至八九日。正气复邪气退则愈。乃反心下痞硬。胁下痛。气上冲咽喉。眩冒者。邪气
抟饮内聚而上逆也。内聚者。不能四布。上逆者。无以逮下。夫经脉者。资血液以为用者也。汗吐
下后。血液之所存几何。而复抟结为饮。不能布散诸经。譬如鱼之失水。能不为之时时动惕耶。且
经脉者。所以纲维一身者也。今既失浸润于前。又不能长养于后。必将筋膜干急而挛。或枢折胫纵
而不任地。如内经所云脉痿筋痿之证也。故曰久而成痿。
太阳病吐之。但太阳病当恶寒。今反不恶寒。不欲近衣。此为吐之内烦也。
病在表而吐之。邪气虽去。胃气生热。则为内烦。内烦者。热从内动而生烦也。
太阳病。过经十余日。心下温温欲吐。而胸中痛。大便反溏。腹微满。郁郁微烦。先此时。自
极吐下者。与调胃承气汤。若不尔者。不可与。但欲呕。胸中痛。微溏者。此非柴胡证。以呕知极吐
下也。
过经者。病过一经。不复在太阳矣。详见阳明篇中。心下温温欲吐而胸中痛者。上气因吐而
逆。不得下降也。与病患欲吐者不同。大便溏而不实者。下气因下而注。不得上行也。与大便本
自溏者不同。设见腹满。郁郁微烦。知其热积在中者犹甚。则必以调胃承气以尽其邪矣。邪尽则不特
腹中之烦满释。即胸中之呕痛亦除矣。此因势利导之法也。若不因吐下而致者。则病患欲吐者。与
大便自溏者。均有不可下之戒。岂可漫与调胃承气汤哉。但欲呕。腹下痛。有似柴胡证。而系在
极吐下后。则病在中气。非柴胡所得而治者矣。所以知其为极吐大下者。以大便溏而仍复呕也。不
然。病既在下。岂得复行于上哉。
太阳病。三日。已发汗。若吐若下若温针。仍不解者。此为坏病。桂枝不中与也。观其脉证。
知犯何逆。随证治之。
若、与或同。言或汗。或吐。或下。或温针。而病仍不解。即为坏病。不必诸
法杂投也。坏病者。言为医药所坏。其病形脉证不复如初。不可以原法治也。故曰桂枝不中与也。
须审其脉证。知犯何逆。而后随证根据法治之。
原本应当发汗治疗，却反而使用了泻下法。这是治法错误。如果先使用发汗法，治疗就不算错误。原本应当使用泻下法，却反而使用了发汗法。这也是治法错误。如果先使用泻下法，治疗就不算错误。
这里泛指发汗和泻下的治疗方法，各有其适宜的情况，应当根据病情施治，不可失去分寸。比如头痛、发热、恶寒（怕冷）的症状，本应当发汗解表，却反而用了泻下法，这是病在体表却去治疗体内，所以称为错误。腹部胀满、大便闭塞、怕热的症状，本应当泻下攻里，却反而用了发汗法，这是病在体内却去治疗体表，所以也称为错误。如果能审慎判断应当发汗就发汗，或者应当泻下就泻下，那又有什么错误呢？《外台秘要》说：表证未解而里气调和，用发汗法就能痊愈，用泻下法会导致死亡；里证已现而表气调和，用泻下法就能痊愈，用发汗法会导致死亡。不可以不谨慎啊。
太阳病（太阳经受邪所致的病证），先发汗后病未愈，又再次使用泻下法，脉象仍然浮的，病不会好。脉浮说明病邪仍在体表，却反而使用泻下法，所以导致病不好。现在脉象仍浮，所以知道病邪仍在体表，应当解除表邪才能痊愈，适宜用桂枝汤（Cinnamon Twig Decoction）主治。
既发汗又泻下，邪气不从体表消散，也不从体内排出，是因为脉浮且邪气在体表，所以虽然用了泻下法，但病仍未愈。病在体表的，仍然需要从体表引导邪气外出。现在虽然已经经过发汗和泻下，但脉象仍然浮，知道邪气仍在体表，所以需要用桂枝汤解散表邪，病就会好。少阳篇中说：具备柴胡汤证（Bupleurum Decoction Syndrome），却用其他药物泻下，如果柴胡证仍在，再给予柴胡汤，病人一定会出现战栗发抖，随后发热出汗而痊愈。这与本条意思相同，应当互相参考。
太阳病，先用泻下法而未愈，因此又发汗，这样导致表和里都虚弱。病人因此出现头昏蒙的症状（冒）。头昏蒙的病人，如果自然出汗就会痊愈。之所以这样，是因为出汗后表气调和的缘故。如果得到里气未调和，然后再用泻下法。
泻下会损伤里气，发汗会损伤表气。既泻下又发汗，导致表和里都虚弱，而邪气仍未解除，病人因此出现头昏蒙。冒，就是头昏蒙的意思。因为邪气遮蔽体表，阳气被郁遏，想要透出但不能，所以时常感到头昏蒙，好像有东西蒙蔽一样。如果出汗，邪气散失，阳气透出，头昏蒙就会自愈。《金匮要略》说：头昏蒙的病人想要痊愈，必定是大汗出。但这也要正气恢复后，才会自然出汗，怎么能用药强行发汗呢？如果出汗后头昏蒙解除，但里气仍未调和，然后再用泻下法来调和里气。这就是所谓“里病表和，下之则愈”的道理。
大幅泻下之后，又发汗，小便不通利的，是因为津液耗损的缘故。不要治疗它，等到小便通利，病一定会自愈。
既泻下又发汗，严重耗损津液，大邪虽已解除，但小便不通利，这时不可以用药利尿。等待津液逐渐恢复，小便自然会通畅而痊愈。如果强行利尿，是再次竭尽阴液，况且未必能立即通利呢。
泻下之后，又发汗，一定出现寒战，脉象微细。之所以这样，是因为内外都虚弱的缘故。
振寒，就是战栗而寒冷。脉微是阳气虚，脉细是阴气少。既泻下又发汗，身体战栗寒冷而脉象微细，是阴阳都受伤，内外都虚弱。这必须用甘温的药物，调和滋养才是恰当的。
泻下之后，又发汗，白天烦躁不能入睡，夜间却安静，不呕吐，不口渴，没有表证，脉象沉微，身体没有大热，用干姜附子汤（Dried Ginger and Aconite Decoction）主治。
一般规律是白天静、夜间重，病在肾阴；夜间静、白天重，病在胃阳。发汗和泻下之后，白天烦躁不能入睡，夜间安静的，是邪气未尽而阳气已虚。白天阳气欲复，与邪气相争，所以烦躁不能入睡；夜间阴气旺盛而阳气虚，不能与邪气相争，所以反而安静。不呕吐不口渴，说明里没有热。身体没有大热，说明表里没有热。又没有头痛恶寒的表证，脉象不浮而沉，不洪大而微，这肯定是阳气衰少无疑。所以应当给予干姜、附子，以助阳气虚而驱逐残存的阴寒。以上三条，并是发汗和泻下后的变证：小便不利的是伤了阴液；寒战脉象微细的是阴阳都伤了；白天烦躁不能入睡、夜间安静的是伤了阳气而没有伤及阴液。从这里可以看出病变的不同。
干姜附子汤方
干姜（一两） 附子（一枚，生用，去皮，切八片）
以上两味药，用水三升，煮取一升，去渣滓，一次服完。
发汗或泻下后，病仍未解除，出现烦躁的，用茯苓四逆汤（Poria and Four-Reverse Decoction）主治。
发汗或泻下，不能尽除邪气，反而损伤正气，于是正气想恢复而不能恢复，邪气虽然微弱但不即离去，正邪交争，产生烦躁。这时不可以再用麻黄、桂枝之类的药去逐邪，也不可以用栀子、豆豉之类的药来止烦。这个方子中，干姜、生附子的辛味，是用来散邪的；茯苓、人参、甘草的甘味，是用来养正的。这是强主弱客的方法。
茯苓四逆汤方
茯苓（六两） 人参（一两） 干姜（一两半） 甘草（二两，炙） 附子（一枚，生用，去皮，破成八片）
以上五味药，用水五升，煮取三升，去渣滓，温服七合，每日三次。
按：发汗和泻下后的烦躁这一证候，都是正气虚弱、邪气干扰的缘故，但有邪多虚少，或虚多邪少的区别。邪气多的，宜逐邪以安正；正气虚的多，宜助正以逐邪。张仲景既然列出了栀子豉汤的例子，又列出茯苓四逆汤的方法，对于发汗和泻下后的烦躁这一证候，虚实并举，补泻不遗漏，如此周全。学者应当深入研究。
伤寒胸中有热，胃中有邪气，腹中痛，想呕吐的，用黄连汤（Coptis Decoction）主治。
这是上、中、下三焦都生病，而其关键实在胃中。邪气即寒淫之气。胃中是冲气所在的地方，用来作为上下升降的功能。胃受邪而失去调和，那么升降的机制停止，上下通道阻塞了。成无己所说：阴气不得上升而独治于下，表现为下寒、腹中痛；阳气不得下降而独治于上，表现为胸中热、想呕吐。所以用黄连的苦寒，来治疗上部的热；用桂枝的甘温，来去除下部的寒。上下既平调，升降功能才恢复。然而中焦如果不治理，就会有升之不得升、降之不得降的情况。所以必须用人参、半夏、干姜、甘草、大枣，来助胃气而除邪气。这大概是痞证（Pi Syndrome, a sensation of fullness and obstruction in the epigastrium）的一类，多是从寒药损伤中气后得的。本文虽然没提及，但可知其为误治后的证候。所以其药物也与泻心汤类相似，只是多了桂枝罢了。
黄连汤方
黄连 桂枝（去皮） 干姜 甘草（炙，各三两） 人参（二两） 半夏（半升，洗） 大枣（十二枚，掰开）
以上七味药，用水一斗，煮取六升，去渣滓，温服一升，每日三次，夜间两次。
太阳病，应当恶寒发热，现在自汗出，不恶寒也不发热，关上脉细数的，是因为医生用了吐法的缘故。发病一二天就用吐法的，腹中饥饿，但口不能进食；发病三四天用吐法的，不喜欢喝粥，想吃冷食，早上吃晚上吐，这是因为医生用了吐法所致。这称为小逆（Minor Error）。
病在体表而医生用吐法，邪气虽去，胃气则受伤。所以自汗出，无寒热，而脉细数。发病一二天，胃气本来调和，吐后胃中空虚思食，所以腹中饥饿；但胃气因吐而上逆，所以口不能进食。发病三四天，胃气生热，吐后热气上动，所以不喜欢喝粥，想吃冷食；而胃气自虚，不能消化谷物，所以早上吃晚上吐。这不是病邪应有的表现，是因为医生用吐法所致。称为小逆，是说邪气已去而胃气未和，只要调和胃气，病必自愈。
伤寒吐下之后，又发汗，出现虚烦，脉象很微。到了第八九天，心下痞硬，胁下痛，气上冲咽喉，头昏蒙，经脉跳动不安的，时间久了会形成痿证（Wei Syndrome, flaccidity syndrome）。吐下后又发汗，津液层层受损，邪气陷入，就产生虚烦。虚烦，是正气不足而邪气干扰导致的烦闷，心神不宁。到了第八九天，正气恢复邪气退去本该痊愈，却反而出现心下痞硬、胁下痛、气上冲咽喉、头昏蒙，这是邪气搏结水饮内聚而上逆。内聚，就不能布散全身；上逆，就不能下达下肢。经脉是靠血液发挥作用的。发汗、吐、下之后，血液还剩多少？却又搏结为水饮，不能布散到各条经脉，就像鱼失去了水，能不时时跳动不安吗？而且经脉是纲维一身的作用。现在前面失去了浸润，后面又不能长养，必将导致筋膜干枯拘急而挛缩，或者关节折断、小腿松弛而不能站立，像《内经》所说的脉痿、筋痿的证候。所以说时间久了会形成痿证。
太阳病用吐法，但太阳病应当恶寒，现在反而不恶寒，不想穿衣服，这是因为吐法导致的内烦（Internal Irritation）。
病在体表而用吐法，邪气虽去，胃气生热，就产生内烦。内烦，是热从内部发动而产生的烦闷。
太阳病，过了经期十余日，心下温温想吐，而胸中痛，大便反而稀溏，腹部轻微胀满，郁郁微烦。在此之前，病人自己极力用过吐法和下法。这种情况，给予调胃承气汤（Harmonizing the Stomach and Directing Downward Decoction）。如果不是这种情况，不可以给。如果只是欲呕，胸中痛，大便微溏，这不是柴胡证，因为呕吐知道是极力用过吐下法。
过经，是指病过了一经，不再在太阳经了。详见阳明篇中。心下温温想吐而胸中痛，是上气因吐而逆，不能下降。这与病人想吐的情况不同。大便稀溏不实，是下气因下注，不能上行。这与大便本来稀溏的情况不同。假设见到腹满、郁郁微烦，知道积热在中焦还很严重，那么必须用调胃承气汤来尽除邪气。邪气尽除，则不仅腹中的烦满解除，连胸中的呕痛也消除了。这是因势利导的方法。如果不是因吐下导致的，那么病人想吐和大便自溏，都有不可下法的戒律，怎么可以随便给调胃承气汤呢？如果只是欲呕，胸中痛，有类似柴胡证的表现，但系在极力吐下之后，则病在中气，不是柴胡汤所能治疗的。所以知道其为极力吐下，是因为大便溏而仍然呕吐。不然，病既在下，怎么会又行于上呢？
太阳病，三天，已经发汗，如果用吐、用下、或用温针，病仍不解的，这称为坏病（Complicated Disease/Damaged Disease），桂枝汤不再适用。观察病人的脉象和证候，知道犯了什么错误，随证治疗。
若，同“或”。意思是或发汗，或吐，或下，或温针，而病仍不解，就称为坏病，不必各种方法杂用。坏病，是说被医药搞坏了，其病形脉证不再像原来那样，不可以用原法治。所以说桂枝汤不再适用。必须审察其脉证，知道犯了什么错误，然后随证根据法治之。
Originally, sweating therapy should have been applied, but purgation was used instead. This is an incorrect treatment. If sweating therapy had been applied first, the treatment would not have been incorrect. Originally, purgation should have been applied, but sweating therapy was used instead. This is also an incorrect treatment. If purgation had been applied first, the treatment would not have been incorrect.
This generally refers to the methods of sweating and purging, each having its appropriate indications. Treatment should be administered according to the disease condition, without losing proper measure. For instance, if there are headache, fever, and aversion to cold, sweating therapy should originally be used; using purgation instead means treating the interior when the disease is in the exterior, hence it is called incorrect. If there is abdominal fullness, constipation, and aversion to heat, purgation should originally be used; using sweating therapy instead means treating the exterior when the disease is in the interior, hence it is also called incorrect. If one carefully determines that sweating is indicated and applies it, or that purgation is indicated and applies it, then what error could there be? The *Waitai Miyao* states: When the exterior pathogen remains while the interior is harmonious, sweating leads to cure while purgation leads to death; when the interior pathogen remains while the exterior is harmonious, purgation leads to cure while sweating leads to death. One must be cautious.
In Taiyang disease (disease of the Taiyang channel), if sweating is applied first but the disease does not resolve, and purgation is subsequently applied, yet the pulse remains floating, the disease will not resolve. A floating pulse indicates the pathogen is still in the exterior. Using purgation in this case causes the disease to persist. Since the pulse is currently floating, we know the pathogen remains in the exterior. To achieve cure, the exterior must be resolved. Guizhi Tang (Cinnamon Twig Decoction) is indicated.
After both sweating and purging, if the pathogen does not disperse from the exterior nor exit from the interior, it is because the pulse is floating and the pathogen remains in the exterior. Thus, even after purgation, the disease does not resolve. Diseases located in the exterior require guidance out through the exterior. Although sweating and purging have already been performed, the persistent floating pulse indicates the pathogen remains in the exterior. Therefore, Guizhi Tang is needed to dissipate the exterior pathogen for recovery. The Shaoyang chapter states: If Chaihujia Huangqin Tang (Bupleurum and Scutellaria Decoction) syndrome is present but treated with other purgatives, and the Chaihu syndrome persists, administering Chaihu Tang again will cause shivering followed by fever and sweating, leading to resolution. This aligns with the current principle and should be cross-referenced.
In Taiyang disease, if purgation is applied first without resolution, followed by sweating, this renders both the exterior and interior deficient. Consequently, the patient experiences Mao (head heaviness/vertigo). In cases of Mao, spontaneous sweating leads to recovery. This is because sweating harmonizes the exterior. If the interior remains unharmonized, purgation may be applied subsequently.
Purgation injures the interior, and sweating injures the exterior. Both procedures render the exterior and interior deficient while the pathogen remains unresolved, leading to Mao. Mao refers to head heaviness or vertigo. Due to pathogenic obstruction at the exterior and depression of Yang Qi, which desires to emerge but cannot, the patient experiences intermittent vertigo as if obscured by a covering. If sweating occurs, the pathogen disperses, Yang Qi emerges, and Mao resolves spontaneously. The *Jingui Yaolue* states: Recovery from Mao requires profuse sweating. However, this occurs only after Zheng Qi (Upright Qi) recovers; it should not be forced pharmacologically. If Mao resolves after sweating but the interior remains unharmonized, purgation may then be applied to harmonize the interior. This illustrates the principle: "When the interior is diseased but the exterior is harmonious, purgation leads to cure."
Following severe purgation and subsequent sweating, if urination is difficult, it is due to the depletion of Body Fluids (Jin Ye). Do not treat it directly; wait for urination to normalize, and the disease will self-resolve.
Both purgation and sweating severely deplete Body Fluids. Although major pathogens are resolved, difficulty in urination indicates that diuretics should not be used prematurely. Once Body Fluids gradually recover, urination will normalize naturally. Forced diuresis would further exhaust Yin fluids and may not even succeed.
After purgation and subsequent sweating, chills and tremors occur with a faint and thin pulse. This results from deficiency in both the interior and exterior.
Chills and tremors indicate shaking accompanied by cold. A faint pulse signifies Yang Qi deficiency, while a thin pulse indicates Yin Qi insufficiency. Following both purgation and sweating, chills, tremors, and a faint-thin pulse signify injury to both Yin and Yang, resulting in general deficiency. Sweet-warm herbs should be used to harmonize and nourish.
After purgation and subsequent sweating, if the patient experiences restlessness during the day but calmness at night, without vomiting, thirst, or exterior signs, and presents with a deep, faint pulse and no significant fever, Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction) is indicated.
Generally, symptoms quiet during the day and worsen at night indicate Kidney Yin pathology; symptoms quiet at night and worsen during the day indicate Stomach Yang pathology. After sweating and purging, daytime restlessness with nighttime calmness suggests residual pathogen and depleted Yang Qi. During the day, Yang Qi attempts to recover and struggles with the pathogen, causing restlessness. At night, Yin is dominant and Yang is weak, unable to struggle with the pathogen, resulting in calmness. Absence of vomiting and thirst indicates no interior heat. Lack of significant fever indicates no exterior heat. Without headache or aversion to cold, and with a deep, faint pulse rather than floating or surging, Yang Qi depletion is certain. Ganjiang and Fuzi should be administered to support Yang Qi and dispel residual Yin-cold. These three clauses illustrate post-sweating/purging variations: difficulty in urination indicates Yin injury; chills with faint-thin pulse indicate dual Yin-Yang injury; daytime restlessness with nighttime calmness indicates Yang injury without Yin involvement.
Ganjiang Fuzi Tang Formula
Ganjiang (Dried Ginger, 1 liang) Fuzi (Aconite Root, raw, peeled, cut into 8 slices, 1 piece)
These two ingredients are boiled in 3 sheng of water to obtain 1 sheng. Strain and administer in one dose.
If the disease persists with irritability after sweating or purging, Fuling Sini Tang (Poria and Four-Reverse Decoction) is indicated.
Sweating or purging fails to eliminate pathogens completely and damages Zheng Qi. Zheng Qi attempts to recover but cannot, while residual pathogens linger. The struggle between Zheng Qi and pathogens generates irritability. At this stage, Mahuang and Guizhi should not be used to expel pathogens, nor Zhizi and Chishao to suppress irritability. In this formula, the acridity of Ganjiang and Sheng Fuzi disperses pathogens, while the sweetness of Fuling, Renshen, and Gancao nourishes Zheng Qi. This is a method of strengthening the host to overcome the guest.
Fuling Sini Tang Formula
Fuling (Poria, 6 liang) Renshen (Ginseng Root, 1 liang) Ganjiang (Dried Ginger, 1.5 liang) Gancao (Licorice Root, honey-fried, 2 liang) Fuzi (Aconite Root, raw, peeled, broken into 8 pieces, 1 piece)
These five ingredients are boiled in 5 sheng of water to obtain 3 sheng. Strain, warm, and administer 7 ge per dose, three times daily.
Note: Irritability following sweating and purging is caused by Zheng Qi deficiency and pathogenic disturbance, varying between excess pathogen with slight deficiency, or slight pathogen with marked deficiency. When pathogens are excessive, expelling them stabilizes Zheng Qi; when deficiency is predominant, supporting Zheng Qi expels pathogens. Zhang Zhongjing provided Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) for excess cases and Fuling Sini Tang for deficiency cases, demonstrating comprehensive management of excess and deficiency. Scholars should study this thoroughly.
In Shanghan (Cold Damage) with heat in the chest and pathogenic qi in the stomach, presenting with abdominal pain and desire to vomit, Huanglian Tang (Coptis Decoction) is indicated.
This involves all three Jiao (Upper, Middle, Lower Burners), with the root in the Stomach. The pathogen is cold-dampness. The Stomach houses Chong Qi, facilitating ascending and descending functions. Pathogenic invasion disrupts Stomach harmony, halting the mechanism of ascent and descent and blocking upper-lower pathways. As Cheng Wuji stated: Yin Qi failing to ascend dominates the lower, causing lower cold and abdominal pain; Yang Qi failing to descend dominates the upper, causing chest heat and nausea. Huanglian's bitter-cold clears upper heat; Guizhi's sweet-warm dispels lower cold. Once upper and lower are balanced, ascent and descent resume. However, without regulating the Middle Jiao, ascent and descent remain impaired. Therefore, Renshen, Banxia, Ganjiang, Gancao, and Dazao are used to boost Stomach Qi and eliminate pathogens. This belongs to Pi Syndrome (epigastric fullness/obstruction), often arising after damage from cold herbs. Though not explicitly stated, it is evident as a post-mistreatment condition. Its composition resembles Xiexin Tang formulas but includes Guizhi.
Huanglian Tang Formula
Huanglian (Coptis Rhizome) Guizhi (Cinnamon Twig, peeled) Ganjiang (Dried Ginger) Gancao (Licorice Root, honey-fried, 3 liang each) Renshen (Ginseng Root, 2 liang) Banxia (Pinellia Tuber, half sheng, washed) Dazao (Jujube Fruit, 12 pieces, split)
These seven ingredients are boiled in 1 dou of water to obtain 6 sheng. Strain, warm, and administer 1 sheng per dose, three times daily and twice at night.
Taiyang disease typically presents with aversion to cold and fever. Currently, however, there is spontaneous sweating, no aversion to cold or fever, and a fine, rapid pulse at the Guan position. This results from the physician inducing vomiting. If vomiting was induced on days 1-2, the patient feels hungry in the abdomen but cannot eat. If induced on days 3-4, the patient dislikes congee and craves cold food, vomiting what was eaten in the morning by evening. This is caused by the physician's vomiting and is termed a Minor Error.
Inducing vomiting in an exterior disease removes pathogens but damages Stomach Qi, causing spontaneous sweating, absence of cold/fever, and a fine-rapid pulse. On days 1-2, Stomach Qi is initially harmonious; vomiting empties the Stomach, causing hunger. However, upward reversal of Stomach Qi prevents eating. By days 3-4, Stomach heat generates; vomiting exacerbates upward heat, causing dislike of congee and craving for cold food. Deficient Stomach Qi fails to digest grain, leading to morning intake and evening vomiting. This is not natural disease progression but iatrogenic. It is called a Minor Error because pathogens are gone but Stomach Qi is unharmonized; harmonizing the Stomach ensures recovery.
Following vomiting and purging in Shanghan, then sweating, virtual irritability and a very faint pulse occur. By day 8-9, epigastric hardness, hypochondriac pain, Qi rushing to the throat, vertigo, and twitching of meridians appear. Prolonged, this becomes Wei Syndrome (flaccidity syndrome). Repeated vomiting, purging, and sweating layer upon layer deplete Body Fluids, allowing pathogens to sink, causing virtual irritability. Virtual irritability arises from insufficient Zheng Qi disturbed by pathogens, leading to mental unrest. By day 8-9, Zheng Qi recovery should bring cure. Instead, epigastric hardness, hypochondriac pain, Qi rushing to the throat, and vertigo indicate pathogenic fluid accumulation and upward rebellion. Accumulated fluid cannot circulate; rebellious Qi cannot descend. Meridians rely on Blood. After sweating, vomiting, and purging, little Blood remains. Pathogens bind into fluid, preventing meridian distribution, like fish out of water trembling. Meridians sustain the body. Lacking prior immersion and future nourishment, tendons become dry and contracted, or joints break and legs relax, unable to bear weight, resembling Mai Wei and Jin Wei syndromes described in the *Neijing*. Hence, prolonged cases develop Wei Syndrome.
In Taiyang disease, vomiting induces internal irritation. Taiyang disease typically involves aversion to cold; now, aversion is absent, and the patient dislikes clothing. This results from vomiting causing internal heat.
Vomiting in an exterior disease removes pathogens but generates Stomach heat, causing internal irritation. Internal irritation is heat arising internally, generating vexation.
In Taiyang disease, after passing the initial stage for over ten days, if there is epigastric discomfort with desire to vomit, chest pain, loose stools, mild abdominal fullness, and mild vexation, and the patient previously underwent extreme vomiting and purging, Tiaowei Chengqi Tang (Harmonizing the Stomach and Directing Downward Decoction) is indicated. Otherwise, do not use it. If there is merely desire to vomit, chest pain, and loose stools, this is not Chaihu Syndrome, as vomiting indicates prior extreme vomiting/purging.
"Passing the stage" means the disease has moved beyond the Taiyang channel (see Yangming chapter). Epigastric discomfort and chest pain result from Qi reversing upward due to vomiting, unable to descend. This differs from normal nausea. Loose stools result from Qi sinking downward due to purging, unable to ascend. This differs from chronic loose stools. If abdominal fullness and vexation are present, indicating significant heat accumulation in the middle, Tiaowei Chengqi Tang is necessary to clear pathogens. Clearing pathogens resolves abdominal fullness/vexation and chest pain/nausea. This utilizes the momentum of the disease. If not caused by vomiting/purging, nausea and loose stools contraindicate purgation; Tiaowei Chengqi Tang should not be given indiscriminately. Mere nausea and chest pain resembling Chaihu Syndrome, occurring after extreme vomiting/purging, indicate Middle Qi pathology, not treatable by Chaihu formulas. The indication for extreme vomiting/purging is loose stools combined with persistent vomiting. Otherwise, if pathology were solely lower, it would not rebound upward.
In Taiyang disease, after three days of sweating, if vomiting, purging, or warm needle therapy fails to resolve the condition, it is termed Huai Bing (Complicated Disease). Guizhi Tang is no longer applicable. Observe the pulse and symptoms, identify the error, and treat according to the presentation.
"If" here implies "or": whether sweating, vomiting, purging, or warm needles were used, persistence of disease constitutes Huai Bing. Huai Bing refers to disease altered by medical intervention, where signs and pulses no longer match the original state, rendering original treatments ineffective. Thus, Guizhi Tang is unsuitable. One must examine pulse and symptoms, identify the specific error, and apply treatment accordingly.