其病在里、脉沉细者，无问风寒暑湿，或表里证俱不见，或内外诸邪所伤，有汗无汗，心腹痛满，谵语烦躁，蓄热
内盛，俱是脉沉者，并用承气合解毒下之。
或中暑自汗，以白虎汤解之。白虎解后，以五苓合天水调之，多进数服无妨。
或腹胀满脉沉者，亦当以承气合解毒微下之。
或发汗之后，热不解、脉尚浮者，白虎加苍术再解之。
或里热内盛，阳厥极深，皆因失下而成此证，以致身冷脉微，昏懵将死，切不得以寒药下之，误下即死。有一辈庸
医，妄言是阴厥，便欲投玄武、四逆温热之剂，下咽必死。殊不知此证乃阴耗阳竭，阴气极弱谓之耗，阳厥极深谓之竭。
蓄热怫郁将欲绝者。当此之际，寒剂热剂俱不可投，但进凉膈解毒，以养阴退阳，宜散蓄热，脉气渐生，得大汗而愈，
亦有无汗气和而愈者。未愈却用解毒合承气下之，次以解毒、凉膈、天水三药合而为一，调和阴阳，洗涤脏腑，则其余
别证自不生矣。有大下之后热不退，再三下之热愈盛，若下之不愈，脉微气虚，力弱不加，以法则无可生之理，若辍而
不下，则邪热极盛，阴气极衰，脉息渐绝，必不可救。似此之证，是下之亦死，不下亦死，医者到此，杀人活人一弹指
间，其不至手足失措者几希。（诀云∶伤寒汗后，汗出不解，或反不汗，脉尚浮，白虎加苍术汤再解之。又按余论云∶伤
寒下后，自汗虚热不已，白虎加苍术、人参，一服如神，汗止身凉，此通仙妙法也。如此则汗下之后热不退，不问有汗
无汗，并宜白虎加苍术解之，又加人参亦炒，仍服凉膈、解毒调之。）
经云∶三下而热不退者即死。后人有四、五次下而生，及十数次下而生者，此偶然误中耳，活者得一二，死者已千
百。后学切不可以此为法，但当根据前法用解毒合凉膈调之，使阳热除退，阴脉渐生，庶不夭人命也。
若伤饮不解散，成结胸之证，临时择用大小陷胸汤丸累下之。若脉浮者不可下，是表证未出，小柴胡合小陷胸汤投
之。脉虽浮而热大极者，承气徐徐疏利之。
或有留饮过度，湿热内生，自利不止，其热未退，解毒汤治之。阳毒生斑，凉膈散加当归。怫郁热盛在表，燥而无
汗，湿热在里，不能发于外，相搏遂成发黄，茵 汤调五苓散。甚者，茵 合承气下之。
一、心烦不得卧，栀子豉汤。
茵 蒿汤
山茵 （一两） 大黄（五钱） 栀子（十枚）
上细切，水二盏，煎一盏，温和服，以利为度。
栀子豉汤 （方见前。）
一、误下太早，遂成结胸虚痞，凉膈散加枳壳、桔梗。
一、刚柔二 ，谵语发狂，逾垣赴井，皆阳热极盛而然，承气合解毒下之。
一、汗下之后，烦渴饮水，凉膈散及减桂五苓、甘露、益元，选而用之。
甘露饮
茯苓 泽泻 甘草 石膏 寒水石（各二两） 白术 桂枝 猪苓（各五钱） 滑石（四两）
上为末，每服三钱，白汤调或新汲水调，姜汤尤妙。
一、小便不通，五苓泄之。大便闭结，承气下之。更有外证，加减防风通圣散方内随证用药处治，万无一失也。
一、妇人证治皆然，惟孕妇三、四月并七、八月不用硝黄，其余月分，用之无妨。
一、小儿减剂服之。
此中有古人治伤寒不传之妙，后之学人，宜慎宝之。
愚按∶河间以上治伤寒法，宜用于春三月及夏至前后温病及中暑热传经之证，能按法施治，无有不安。
（丹溪活套）
凡伤寒传经之证，初得太阳经病，恶寒发热，头项强，腰脊痛，无汗，急用东垣九味羌活汤表之而愈。或诸痛悉除，
亦不恶寒，但发热不解，或微汗 然出，此为挟虚证，宜用补中益气汤为主。治有汗，加桂枝、芍药。汗未透，脉尚
浮紧，加羌活、苍术、防风、葛根，倍升麻、柴胡。满闷者，去黄 、人参。仍头痛未去，加川芎、白芷、薄荷、荆芥、
细辛、葛根。如渴，加五味子、麦门东、天花粉。三、四日间，不宜前药，则以小柴胡汤验证加减。如寒热胁痛、少阳
外证悉具，只以本方服之。若兼腹满自利、已见太阴证而少阳证犹未除者，本方中加五苓散，名柴苓汤。热甚者，去桂，
倍黄芩。渴甚者，本方去半夏，加五味子、天花粉。五、六日不大便，潮热引饮，本方中去人参、甘草，加芍药、枳壳、
浓朴、大黄，甚者加芒硝，或用河间三一承气汤。七、八日过经不解，热不退，或黄连解毒汤、凉膈散选而用之，或仍
以小柴胡看证调治而愈。或愈后因劳役复热者，仍用补中益气汤，多服数帖自安。虽因食复病，切不可轻用大黄、芒硝
之类下之，盖病后气血大虚，若复下之必死，慎之慎之！
又伤寒下后谵语，初能认人，三、五日后，妄言不休，此神不守舍，慎勿复下。脉多沉细，足冷气促，面青褐色，
口干燥，宜用补中益气汤，倍人参，加竹叶二、三十片。内外本弱，得汗下后大虚，脉细数，热如火炙，气促，宜用人
参、当归、白术、黄 、甘草、五味子、知母，加竹叶数片，煎用童便，二、三帖而安。大病虚脱，本是阴虚，用艾灸
丹田补阳，阳生则阴长故也。不可用附子，止可用参 ，多服为佳。伤寒已经发汗吐下误治后，三焦生热，脉洪数，谵
语罔顾体，昼夜喘息不休，衄血热不解，身目俱黄，狂叫欲走，三黄石膏汤连进三、四服而愈。如怯弱人，因感寒湿，
发热不食，数日后不省人事，言语乱妄，神思昏迷，面青齿黑，人以为必死之证，脉沉细，先用小柴胡汤等药不愈，急
用四君子汤加附子数片煎，以碗盛放水盆中少时，杀其热性，稍温服之，脉与神思即回，然后可用别药，此谓之阴证伤
寒。伤寒怫郁不解，三阳并入三阴，脏腑结燥，面赤口渴，心惊谵语，内热多而外热少，宜用二一承气汤，或以此药送
下木香槟榔丸三、五十粒，下其燥屎而安。如汗下后，热未能除，用栀子豆豉汤或东垣加减凉膈散煎服，以彻其邪而愈。
凡伤寒身体疼痛，恶风寒，遇暖则喜，脉浮而数，必得大汗而愈，不问日数，皆以六神通解散煎服。如谵语神思不宁，
盖热邪已入里，不能尽解，本方加人参、黄连即安。服前药如汗不透，更加紫苏叶、葛根、白芷等药助之，当得大汗而
病如扫。此张载仁之法，药虽轻微，不知自有神妙，不可易而忽之。伤寒发斑面赤，昏 谵语，脉洪而虚，按之无力，
或绝不见，用人参、生地黄各五钱，炮附子一钱，大黄二钱半，服之，不甚泻，夏月服亦不妨。伤寒发斑生热，用黄瓜
根杵汁（黄瓜即墙头生小瓜，黄色累累然，四月黄瓜生，即此瓜也）调伏龙肝服之，去红点甚妙。发斑似伤寒，乃痰热
之病发于外，微汗以散之，通圣散消息用之。
（医案）
东阳杜世良乃兄，三月间得伤寒证，恶寒发热，小便淋涩，大便不行。初得病时，茎中出小精血片，如枣核大。由
是众医皆谓房事所致，遂作虚证治而用补中益气等药。七、八日后热愈甚，大渴引饮，胃中满闷，语言错乱。召予诊视，
六脉俱数甚，右三部长而沉滑，左手略平，亦沉实而长。予曰∶此大实大满证，属阳明经，宜大承气汤。众皆惊愕，曰∶
先生误矣。予不听，作大剂，连进二服，大泻后热退气和。病愈十数日后，因食鸭肉太多，致复热，来问，予教用鸭肉
烧灰存性，生韭汁调下六、七钱，下黑粪一碗许而安。
东阳戚，十八岁，四月间得伤寒证，恶寒发大热而渴，舌上白胎。三日前，身脊百节俱痛。至第四日，惟胁痛而呕，
自利。六日来召予治，诊其脉左右手皆弦长而沉实，且数甚。予曰∶此本三阳合病，今太阳已罢，而少阳与阳明仍在。
与小柴胡合黄连解毒，服三服，胁痛呕逆皆除，惟热犹甚。九日后，渐加气筑痰响，声如拽锯，出大汗退后而身复热愈
甚，法当死。看其面上有红色，洁净而无贼邪之气，言语清亮，间有谵语而不甚含糊。予故不辞去而复与治，用凉膈散
倍大黄，服二服，视其所下仍如前，自利清水，其痰气亦不息。与大承气汤合黄连解毒汤，二服，其所下亦如前。予曰∶
此盖热结不开而燥屎不来耳。后以二方相间，日三、四服，每药又各服至五帖，始得结粪如肥皂子大者十数枚，痰气渐
平，热渐减，至十五日热退气和而愈。一知医者问曰∶伤寒论谓下后不可再下，连日用此峻剂而获安者，何也？曰∶燥
屎未下而脉尚实，胡为不可再下。是故为医者，不可胶柱而调瑟也。
那些病位在里、脉象沉细的，无论感受的是风寒还是暑湿，或者表证和里证都不明显，或者是被内外的各种邪气所伤，无论有汗还是无汗，出现心腹疼痛胀满、说胡话烦躁不安、体内蓄积的热邪极盛，只要是脉象沉的，都使用承气汤配合解毒汤来攻下。
如果是中暑导致自汗，用白虎汤来解热。白虎汤退热后，再用五苓散配合天水散调理，多喝几服没有关系。
如果是发汗之后，热邪没有解除、脉象仍然浮的，用白虎加苍术汤再次解表清热。
如果是里热内盛，阳气厥逆极深，这都是因为该用下法而失于攻下导致的，以致身体冰冷、脉象微弱、神志昏蒙快要死亡，千万不要用寒凉药攻下，误用攻下就会致死。有一类庸医，胡乱说是阴厥，就想投用玄武汤、四逆汤等温热药剂，喝下去必定死亡。殊不知这个证候是阴液耗竭、阳气枯竭，阴气极度虚弱叫做“耗”，阳气厥逆极深叫做“竭”。这是蓄积的热邪郁结将要断绝的情况。在这个时候，寒剂和热剂都不可投用，只宜进服凉膈散和解毒汤，以滋养阴气、消退阳热，发散蓄积的热邪，脉气逐渐恢复，通过出大汗而痊愈，也有不出汗但气机调和而痊愈的。如果还没好，再用解毒汤配合承气汤攻下，接着将解毒汤、凉膈散、天水散三药合而为一，调和阴阳，洗涤脏腑，那么其他的别证自然就不会产生了。如果有经过大泻之后热仍不退，反复多次攻下热势反而更盛的，如果攻下不能治愈，脉微气虚，体力衰弱无法支撑，按法则是没有生机的；如果停止攻下，那么邪热极盛，阴气极衰，脉息逐渐断绝，就必不可救了。像这样的证候，攻下也是死，不攻下也是死，医生到了这种地步，杀人或救人只在弹指之间，能不手足无措的很少。（歌诀说：伤寒发汗后，汗出不解，或者反而不出汗，脉象仍然浮，用白虎加苍术汤再次解表。又参考我的论述说：伤寒攻下后，自汗虚热不止，用白虎加苍术汤加人参，一服如神，汗止身凉，这是通仙妙法。这样看来，汗下之后热不退，无论有汗无汗，都适宜用白虎加苍术汤解表，再加人参（炒），并服用凉膈散、解毒汤来调理。）
经文说：三次攻下而热不退的就死。后人有的经过四次、五次攻下而活，甚至十几次攻下而活的，这只是偶然误打误撞罢了，活下来的得一二，死去的已有千百。后学者切不可以此为法，只应当根据前面的方法，用解毒汤配合凉膈散来调理，使阳热除退，阴脉渐生，或许能保全性命。
如果是伤饮邪气不散，形成结胸证，临时选择大小陷胸汤丸多次攻下。如果脉象浮的不可攻下，这是表证未解，用小柴胡汤配合小陷胸汤投用。脉象虽然浮但热势极大的，用承气汤慢慢疏利。
或者有留饮过多，湿热内生，自利不止，热邪未退，用解毒汤治疗。阳毒生斑，用凉膈散加当归。热邪郁结在表，干燥而无汗，湿热在里，不能发越于外，相互搏结遂成发黄证，用茵陈蒿汤配合五苓散调理。严重的，用茵陈蒿汤配合承气汤攻下。
茵陈蒿汤
山茵陈（一两） 大黄（五钱） 栀子（十枚）
以上切碎，用水二盏，煎至一盏，温服，以大便通畅为度。
栀子豉汤 （方见前文。）
一、刚痉柔痉，说胡话发狂，爬墙跳井，都是阳热极盛所致，用承气汤配合解毒汤攻下。
一、汗下之后，烦渴饮水，选凉膈散及减桂五苓散、甘露饮、益元散使用。
甘露饮
茯苓 泽泻 甘草 石膏 寒水石（各二两） 白术 桂枝 猪苓（各五钱） 滑石（四两）
以上研为末，每服三钱，用开水调服或用新汲水调服，用姜汤送下尤其好。
一、小便不通，用五苓散泄之。大便闭结，用承气汤下之。更有外证，在加减防风通圣散方内随证用药处理，万无一失。
一、妇人证治都一样，只有孕妇在三、四月以及七、八月不用硝黄（芒硝、大黄），其余月份，使用没有问题。
一、小儿减少剂量服用。
这里面有古人治疗伤寒不传的奥妙，后世的学人，应当谨慎珍视。
我按语：河间先生以上的治疗伤寒方法，适宜用于春季三个月以及夏至前后的温病和中暑热传经的证候，能按照方法施治，没有不安稳的。
（丹溪活套）
凡是伤寒传经的证候，初得太阳经病，恶寒发热，头项强痛，腰脊痛，无汗，急用东垣九味羌活汤解表而愈。或者各种疼痛都消除了，也不恶寒了，只是发热不解，或者微微出汗，这是挟虚证，宜用补中益气汤为主。治疗有汗的，加桂枝、芍药。汗未透发，脉象尚浮紧，加羌活、苍术、防风、葛根，加倍升麻、柴胡。胸闷满闷的，去掉黄芪、人参。如果头痛仍未去，加川芎、白芷、薄荷、荆芥、细辛、葛根。如果口渴，加五味子、麦门冬、天花粉。第三、四天间，不宜用前面的药，则用小柴胡汤验证后加减。如果有寒热胁痛、少阳外证全部具备，只用本方服用。如果兼有腹满自利、已经见到太阴证而少阳证还未除的，在本方中加入五苓散，名叫柴苓汤。热势重的，去掉桂枝，加倍黄芩。口渴严重的，本方去掉半夏，加五味子、天花粉。第五、六天不大便，潮热引饮，本方中去掉人参、甘草，加芍药、枳壳、厚朴、大黄，严重的加芒硝，或者用河间三一承气汤。第七、八天过经不解，热不退，或者黄连解毒汤、凉膈散选而用之，或者仍用小柴胡汤看证调理而愈。或者痊愈后因劳累复发热的，仍用补中益气汤，多服几帖自然安适。虽然是因饮食复病，切不可轻用大黄、芒硝之类攻下，因为病后气血大虚，如果再攻下必死，慎之又慎！
另外伤寒攻下后说胡话，起初还能认人，三、五日后，妄言不休，这是神不守舍，千万不要再攻下。脉象多沉细，脚冷气息短促，面色青褐，口干燥，宜用补中益气汤，加倍人参，加竹叶二、三十片。内外原本虚弱，得汗下后大虚，脉细数，热如火烤，气促，宜用人参、当归、白术、黄芪、甘草、五味子、知母，加竹叶数片，煎煮时用童便，二、三帖而安。大病虚脱，本是阴虚，用艾灸丹田补阳，阳生则阴长所以如此。不可用附子，只可用参芪，多服为佳。伤寒已经发汗吐下误治后，三焦生热，脉洪数，说胡话不顾形体，昼夜喘息不休，鼻出血热不解，身目俱黄，狂叫欲走，连服三、四服三黄石膏汤而愈。如果怯弱的人，因感寒湿，发热不食，数日后不省人事，言语乱妄，神思昏迷，面青齿黑，人们认为必死的证候，脉沉细，先用小柴胡汤等药不愈，急用四君子汤加附子数片煎煮，用碗盛放在水盆中一会儿，杀其热性，稍温服之，脉与神思即回，然后可用别药，这叫做阴证伤寒。伤寒郁结不解，三阳并入三阴，脏腑结燥，面赤口渴，心惊谵语，内热多而外热少，宜用二一承气汤，或者以此药送下木香槟榔丸三、五十粒，下其燥屎而安。如果汗下后，热未能除，用栀子豆豉汤或东垣加减凉膈散煎服，以彻除邪气而愈。
凡是伤寒身体疼痛，恶风寒，遇暖则喜，脉浮而数，必须得大汗而愈，不问日数，都以六神通解散煎服。如果谵语神思不宁，盖因热邪已入里，不能完全解除，本方加人参、黄连即安。服用前面的药如果汗不透，更加紫苏叶、葛根、白芷等药助之，应当得大汗而病如扫。这是张载仁的方法，药虽轻微，不知自有神妙，不可轻视忽略。伤寒发斑面赤，昏愦谵语，脉洪而虚，按之无力，或者绝不见，用人参、生地黄各五钱，炮附子一钱，大黄二钱半，服用，不甚泻，夏月服亦不妨。伤寒发斑生热，用黄瓜根杵汁（黄瓜即墙头生小瓜，黄色累累然，四月黄瓜生，即此瓜也）调伏龙肝服之，去红点甚妙。发斑似伤寒，乃痰热之病发于外，微汗以散之，通圣散酌情使用。
（医案）
东阳杜世良的哥哥，三月间得伤寒证，恶寒发热，小便淋涩，大便不行。初得病时，尿道口排出小精血片，如枣核大。由此众医都认为房事所致，遂作虚证治疗而用补中益气等药。七、八日后热势更甚，大渴引饮，胃中满闷，语言错乱。召我诊视，六脉俱数甚，右三部脉长而沉滑，左手略平，也沉实而长。我说：这是大实大满证，属阳明经，宜用大承气汤。众人都惊愕，说：先生错了。我不听，开大剂，连进二服，大泻后热退气和。病愈十数日后，因吃鸭肉太多，致复发热，来询问，我教他用鸭肉烧灰存性，生韭汁调下六、七钱，下黑粪一碗许而安。
东阳戚某，十八岁，四月间得伤寒证，恶寒发大热而渴，舌上白苔。三日前，身脊百节俱痛。至第四日，惟胁痛而呕，自利。第六日来召我治，诊其脉左右手皆弦长而沉实，且数甚。我说：这本是三阳合病，今太阳已罢，而少阳与阳明仍在。与小柴胡汤合黄连解毒汤，服三服，胁痛呕逆皆除，惟热犹甚。九日后，渐加气筑痰响，声如拽锯，出大汗退后而身复热愈甚，法当死。看其面上有红色，洁净而无贼邪之气，言语清亮，间有谵语而不甚含糊。我故不辞去而复与治，用凉膈散倍大黄，服二服，视其所下仍如前，自利清水，其痰气亦不息。与大承气汤合黄连解毒汤，二服，其所下亦如前。我说：这大概是热结不开而燥屎不来耳。后来以二方相间，日三、四服，每药又各服至五帖，始得结粪如肥皂子大者十数枚，痰气渐平，热渐减，至十五日热退气和而愈。一位知医者问我说：伤寒论谓下后不可再下，连日用此峻剂而获安者，何也？我说：燥屎未下而脉尚实，为何不可再下。因此做医生的，不可胶柱鼓瑟（拘泥固执）。
For those cases where the disease is in the interior and the pulse is deep and fine, regardless of whether it is caused by wind-cold or summer-heat-dampness, or when neither exterior nor interior symptoms are obvious, or when injured by various internal and external pathogenic factors, whether with or without sweating, presenting with heart and abdominal pain and fullness, delirium and irritability, and excessive accumulation of heat within, as long as the pulse is deep, all should be treated with Chengqi Tang (Cathartic Decoction) combined with Jiedu Tang (Detoxification Decoction) to purge.
If self-sweating occurs due to summer-heat, use Baihu Tang (White Tiger Decoction) to resolve the heat. After the heat is resolved by Baihu Tang, regulate with Wuling San (Five-Ingredient Powder with Poria) combined with Tianshui San (Heavenly Water Powder); taking several doses more is harmless.
If there is abdominal distension and fullness with a deep pulse, mild purging should also be performed using Chengqi Tang combined with Jiedu Tang.
If after inducing sweating the heat does not resolve and the pulse remains floating, use Baizhu Jia Cangzhu Tang (White Tiger Decoction with Atractylodes Rhizome) to resolve the condition again.
If interior heat is abundant and yang reversal is extremely deep, this results from failing to purge when indicated, leading to cold body, faint pulse, and stupor approaching death. Do not use cold medicines to purge; doing so will cause death. Some incompetent physicians mistakenly diagnose this as yin reversal and attempt to administer warm agents such as Xuanwu Tang or Sini Tang (Frigid Extremities Decoction); ingestion will surely lead to death. They do not realize that this syndrome involves exhaustion of yin and depletion of yang. Extreme weakness of yin is called "hao" (exhaustion), and extreme depth of yang reversal is called "jie" (depletion). This is a state where accumulated heat is stifled and about to cease. At this juncture, neither cold nor hot agents should be administered. One should only advance Liangge San (Cooling the Chest Powder) and Jiedu Tang to nourish yin and retreat yang, dissipate the accumulated heat, allow the pulse qi to gradually regenerate, and achieve recovery through profuse sweating; some recover without sweating but with harmonious qi. If not recovered, use Jiedu Tang combined with Chengqi Tang to purge. Subsequently, combine Jiedu Tang, Liangge San, and Tianshui San into one formula to harmonize yin and yang, cleanse the zang-fu organs, so that other residual syndromes will naturally not arise. In cases where heat persists after severe purging, and repeated purging increases the heat, if purging fails to cure and the pulse is faint with qi deficiency and physical weakness, there is no principle for survival according to standard methods. If purging is stopped, the pathogenic heat becomes extremely abundant while yin qi becomes extremely deficient, the pulse gradually ceases, and rescue is impossible. Such cases result in death whether purged or not. Physicians facing this situation determine life or death in an instant; few can remain composed. (The rhyme states: After sweating in shaoyang disease, if sweating does not resolve or fails to occur and the pulse remains floating, use Baizhu Jia Cangzhu Tang to resolve again. Also referring to my discussion: After purging in shaoyang disease, if spontaneous sweating and deficiency-heat persist, use Baizhu Jia Cangzhu Tang with Ren Shen (Ginseng Radix et Rhizoma), which works miraculously after one dose, stopping sweating and cooling the body; this is a transcendent wonderful method. Thus, for heat persisting after sweating or purging, regardless of sweating presence, Baizhu Jia Cangzhu Tang is suitable for resolution, adding Chao Ren Shen (Stir-fried Ginseng Radix et Rhizoma), along with Liangge San and Jiedu Tang for regulation.)
The Classic states: Those whose heat does not resolve after three purgations will die. Later practitioners have survived after four or five purgations, or even ten or twenty times; these were accidental errors. For every one saved, hundreds or thousands died. Students must not take this as a method. Instead, follow the previous method using Jiedu Tang combined with Liangge San to regulate, allowing yang-heat to recede and yin pulse to gradually emerge, thereby preserving life.
If injury from fluid retention fails to disperse, forming Jie Xiong (Chest Binding) syndrome, select Da Xianxiong Tang/Wan (Major Cathartic Pill for Chest Binding) or Xiao Xianxiong Tang/Wan (Minor Cathartic Pill for Chest Binding) for repeated purging. If the pulse is floating, do not purge, as the exterior syndrome has not exited; use Xiao Chaihu Tang (Minor Bupleurum Decoction) combined with Xiao Xianxiong Tang. If the pulse is floating but heat is extremely intense, slowly unblock and drain using Chengqi Tang.
If there is excessive retained fluid generating internal damp-heat, causing continuous spontaneous diarrhea with unresolved heat, treat with Jiedu Tang. For Yang Du (Yang Toxin) with macules, use Liangge San with Dang Gui (Angelicae Sinensis Radix). For stifled heat abundant at the exterior, dry without sweat, and damp-heat trapped inside unable to vent externally, struggling together to cause jaundice, use Yinchen Hao Tang (Artemisiae Scopariae and Sophorae Flavescens Decoction) regulated with Wuling San. Severe cases use Yinchen Hao Tang combined with Chengqi Tang to purge.
1. For mental restlessness and inability to lie down, use Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction).
Yinchen Hao Tang
Shan Yin Chen (Artemisiae Scopariae Herba, 1 liang)
Da Huang (Rhei Radix et Rhizoma, 5 qian)
Zhi Zi (Gardeniae Fructus, 10 pieces)
Finely cut, decoct in 2 zhan of water until 1 zhan remains, take warm; stop when bowel movement is achieved.
Zhizi Chi Tang (Formula seen previously.)
1. For premature purging leading to chest binding and deficiency bloating, use Liangge San with Zhi Ke (Aurantii Fructus) and Jie Geng (Platycodonis Radix).
1. For Gang Jing (Yang Spasm) and Rou Jing (Yin Spasm), presenting with delirium and mania, climbing walls, or jumping into wells, all caused by extreme abundance of yang-heat, use Chengqi Tang combined with Jiedu Tang to purge.
1. For thirst and desire for water after sweating and purging, select Liangge San, Jian Gui Wuling San (Wuling San without Cinnamon Twig), Ganlu Yin (Sweet Dew Drink), or Yiyuan San (Primordial Element Powder) as appropriate.
Ganlu Yin
Fu Ling (Poria, 2 liang)
Ze Xie (Alismatis Rhizoma, 2 liang)
Gan Cao (Glycyrrhizae Radix et Rhizoma, 2 liang)
Shi Gao (Gypsum Fibrosum, 2 liang)
Han Shui Shi (Halloysit Rubrum, 2 liang)
Bai Zhu (Atractylodis Macrocephalae Rhizoma, 5 qian)
Gui Zhi (Cinnamomi Ramulus, 5 qian)
Zhu Ling (Polyporus, 5 qian)
Hua Shi (Talcum, 4 liang)
Grind into powder; take 3 qian per dose, mixed with boiling water or fresh well water; taking with ginger soup is especially excellent.
1. For urinary obstruction, use Wuling San to drain. For fecal impaction, use Chengqi Tang to purge. For additional exterior symptoms, adjust medications within the Fangfeng Tongsheng San (Saposhnikovia Universal Relief Powder) formula according to the syndrome; this ensures success.
1. Women's treatments are the same, except pregnant women in the third/fourth months and seventh/eighth months should avoid Xiao Yao (Mangxiao/Metastone) and Da Huang (Rhubarb); usage is safe in other months.
1. Children should take reduced doses.
This contains the secret wonders of ancient treatments for shaoyang disease; later students should carefully treasure them.
My commentary: The shaoyang treatment methods from Hejian and earlier are suitable for spring months and warm diseases/summer-heat transmitting meridians around Summer Solstice. Following these methods ensures safety.
(Danxi Flexible Methods)
For any shaoyang disease transmitting meridians, initially acquiring Taiyang meridian disease with aversion to cold, fever, stiff neck and back, lumbar and spinal pain, and anhidrosis, urgently use Dongyuan Jiwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction) to release the exterior and achieve cure. If all pains disappear and aversion to cold ceases, but fever persists or slight sweating occurs, this indicates accompanying deficiency; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) as the main formula. For sweating cases, add Guizhi (Cinnamomi Ramulus) and Shaoyao (Paeoniae Radix Alba). If sweat is not penetrating and pulse is still floating and tight, add Qianghuo (Notopterygii Rhizoma et Radix), Cangzhu (Atractylodis Rhizoma), Fangfeng (Saposhnikoviae Radix), Gegen (Puerariae Lobatae Radix), and double Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix). For chest oppression, remove Huang Qi (Astragali Radix) and Ren Shen (Ginseng Radix et Rhizoma). If headache persists, add Chuanxiong (Ligustici Chuanxiong Rhizoma), Baizhi (Angelicae Dahuricae Radix), Bohe (Menthae Haplocalycis Herba), Jingjie (Schizonepetae Spica), Xixin (Asari Radix et Rhizoma), Gegen. For thirst, add Wuweizi (Schisandrae Chinensis Fructus), Maidong (Ophiopogonis Radix), Tianhuafen (Trichosanthis Radix). On days 3-4, do not use previous herbs; instead verify and adjust with Xiao Chaihu Tang. If chills and fever, hypochondriac pain, and all Shaoyang exterior symptoms are present, use the base formula alone. If accompanied by abdominal fullness and spontaneous diarrhea, indicating Taiyang syndrome while Shaoyang symptoms remain, add Wuling San to the base formula, named Chai Ling Tang (Bupleurum and Poria Decoction). For intense heat, remove Guizhi and double Huang Qin (Scutellariae Radix). For severe thirst, remove Banxia (Pinelliae Rhizoma) from the base formula and add Wuweizi and Tianhuafen. On days 5-6 with constipation, tidal fever, and desire for drinks, remove Ren Shen and Gan Cao from the base formula, add Shaoyao, Zhi Ke, Houpo (Magnoliae Officinalis Cortex), and Da Huang; for severe cases, add Mangxiao (Natrii Sulfas), or use Hejian Sanyi Chengqi Tang (Three-One Cathartic Decoction). On days 7-8, if past the meridian stage and heat persists, select Huanglian Jiedu Tang (Coptis Detoxification Decoction) or Liangge San, or continue regulating with Xiao Chaihu Tang based on symptoms. If fever recurs due to overwork after recovery, use Buzhong Yiqi Tang again; multiple doses will bring peace. Even if recurrence is due to dietary indiscretion, never lightly use Da Huang or Mangxiao to purge, as qi and blood are greatly deficient post-illness; further purging will cause death. Be extremely cautious!
Additionally, for delirium after purging in shaoyang disease, initially able to recognize people, but after 3-5 days speaking incessantly and irrationally, this is spirit failing to reside in its house; do not purge again. Pulse is often deep and fine, with cold feet and shortness of breath, cyanotic-brown complexion, and dry mouth; use Buzhong Yiqi Tang with doubled Ren Shen and 20-30 leaves of Zhuye (Bambusae Folium). For internal and external weakness becoming severely deficient after sweating/purging, with fine-rapid pulse, burning heat, and shortness of breath, use Ren Shen, Dang Gui, Bai Zhu, Huang Qi, Gan Cao, Wuweizi, and Zhi Mu (Anemarrhenae Rhizoma), plus a few leaves of Zhuye, decocted with Tongbian (Boy's Urine); 2-3 doses bring peace. For critical illness collapse due to yin deficiency, moxa Dantian (CV-8) to tonify yang, as yang generation promotes yin growth. Do not use Fuzi (Aconiti Lateralis Radix Praeparata); only use Renshen and Huangqi, taken in large amounts is best. After mistaken sweating/vomiting/purging in shaoyang disease, with sanjiao heat, surging-rapid pulse, delirium ignoring bodily form, day-night panting, epistaxis with unresolved heat, yellow eyes and body, screaming and running, continue Sanhuang Shigao Tang (Three-Yellow and Gypsum Decoction) for 3-4 doses to cure. For frail individuals infected with cold-dampness, presenting with fever, anorexia, unconsciousness, erratic speech, coma, cyanotic face, black teeth after several days—considered fatal—with deep fine pulse, if Xiao Chaihu Tang fails, urgently use Sijunzi Tang (Four-Gentlemen Decoction) with a few slices of Fuzi. Decoct, place the bowl in a basin of water briefly to reduce heat properties, then take slightly warm; pulse and consciousness return, then use other medicines. This is called Yin Syndrome Shaoyang Disease. For shaoyang disease with stifled stagnation unresolved, where Three Yang merge into Three Yin, causing organ dryness, red face, thirst, palpitations, delirium, more internal than external heat, use Er Yi Chengqi Tang (Two-One Cathartic Decoction), or send down 30-50 Muxiang Binglang Wan (Costus and Areca Seed Pills) with this medicine to purge dry stool and achieve peace. If heat persists after sweating/purging, use Zhizi Douchi Tang (Gardenia and Fermented Soybean Decoction) or Dongyuan Modified Liangge San to decoct and drink, eliminating pathogens to cure.
For any shaoyang disease with body pain, aversion to wind and cold, preference for warmth, floating-rapid pulse, requiring profuse sweating for cure regardless of days, use Liutong Shenjie San (Six-Penetration Divine Release Powder) decocted. For delirium and restless spirit, indicating heat entering the interior incompletely resolved, add Ren Shen and Huang Qin to the base formula for peace. If previous medicine does not induce sufficient sweat, add Zi Su Ye (Perillae Folium), Gegen, Baizhi, etc., to assist; profuse sweating will sweep away the disease. This is Zhang Zairen's method; though mild, it possesses divine efficacy, do not neglect it. For shaoyang disease with macules, red face, stupor, delirium, surging-empty pulse, weak on pressure, or absent, use 5 qian each of Ren Shen and Sheng Di Huang (Rehmanniae Radix), 1 qian Pao Fuzi (Prepared Aconite Lateralis Radix), and 2.5 qian Da Huang; taking it causes mild diarrhea, acceptable in summer. For shaoyang disease with macules and heat, use cucumber root juice (Cucumber refers to small melons growing on walls, yellow clusters, appearing in April) mixed with Fulonggan (Vitreum) to take; removing red spots is excellent. Macules resembling shaoyang disease are actually phlegm-heat manifesting externally; induce slight sweating to disperse, use Tongsheng San cautiously.
(Medical Cases)
Dongyang Du Shiliang's elder brother contracted shaoyang disease in March, with aversion to cold, fever, dysuria, and constipation. Initially, small blood clots like dates emerged from the urethra. Physicians attributed this to sexual activity, treating it as deficiency with Buzhong Yiqi Tang. After 7-8 days, heat intensified, with extreme thirst, gastric fullness, and confused speech. Upon examination, all six pulses were rapid and strong; right three positions were long, deep, and slippery; left hand was slightly level but also deep, solid, and long. I stated: This is a major excess and fullness syndrome belonging to Yangming Meridian; use Da Chengqi Tang (Major Cathartic Decoction). Everyone was shocked, saying: Sir is mistaken. I did not listen, prepared a large dose, administered two doses consecutively; after severe diarrhea, heat subsided and qi harmonized. Ten days after recovery, due to excessive duck consumption, fever recurred. I advised burning duck meat to ash, mixing with raw leek juice, taking 6-7 qian; passage of one bowl of black stool brought peace.
Dongyang Qi, aged 18, contracted shaoyang disease in April, with aversion to cold, high fever, thirst, and white tongue coating. Three days prior, whole body and spine joints ached. By the fourth day, only hypochondriac pain, vomiting, and spontaneous diarrhea remained. Summoned on the sixth day, pulse was string-long, deep, solid, and very rapid in both hands. I stated: Originally a combination of Three Yang syndromes; Taiyang has ceased, but Shaoyang and Yangming remain. Administered Xiao Chaihu Tang combined with Huanglian Jiedu Tang; after three doses, hypochondriac pain and vomiting ceased, but heat persisted. By the ninth day, breathing became noisy with phlegm, sounding like sawing wood; after profuse sweating, body heat increased further, indicating fatal prognosis. However, his face had a clean red hue without evil qi, speech was clear with occasional unclear delirium. I continued treatment, using Liangge San with doubled Da Huang; two doses resulted in similar output as before, clearing watery stool, phlegm noise continued. Administered Da Chengqi Tang combined with Huanglian Jiedu Tang; two doses yielded similar results. I stated: This is likely heat knotting without dry stool expulsion. Subsequently alternating the two formulas, 3-4 times daily, each medicine taken for five doses, finally expelled over ten hard stools like soap pods; phlegm noise gradually calmed, heat decreased, recovering on the fifteenth day with heat subsided and qi harmonized. A knowledgeable physician asked: Shanghan Lun states purging should not be repeated after initial purging; why did daily harsh purging succeed? I replied: As long as dry stool remains and pulse is solid, why not purge again? Therefore, physicians must not be rigid.