〔《活》〕发热恶寒，身体痛而脉浮者，表证也。表证者，恶寒是也。恶寒者，属太阳，宜汗之。
〔成〕恶寒一切属表，虽里症悉具，而微恶寒者，亦是表未解也，犹当先解其外，候不恶寒为外解，乃可攻里也。
不恶寒反恶热，手掌心并腋下 汗出，胃中干燥，结聚潮热，大便硬，小便如常，腹满而喘，或谵语，
脉沉而滑者，里症也。里症者，内热是也。内热者，属阳明，宜下之。伤寒始发热恶寒，今汗后不恶寒，但倍发热
而躁，始脉浮而大，今脉洪实，或沉数细，始惺静，今狂语，此为胃实阳盛，再汗即死，须下之则愈。亦有始
得病，便变阳盛之症，须便下之，不可拘以日数。更有心胸连腹脐大段疰闷，腹中痛，坐卧不安，冒闷喘急极
者，亦不问他症，便下之。若失下，则气血不通，四肢便厥，医人不知，反疑是阴厥，复进热药，祸如反掌，
不可不察也。
〔成〕邪之客于表者，为寒邪，与阳相争，则为寒矣。邪之入于里者，为热邪，与阴相争，则为热矣。邪
在半表半里，外与阳争而为寒，内与阴争而为热，是以往来寒热。邪居表多则多寒，邪居里多则多热，邪半在
表半在里，则寒热亦半矣。邪在表者，必渍形以为汗，邪在里者，必荡涤以取利，其余不外不内，半表半里，
又非发汗之所宜，亦非吐下之所对，是当和解则可矣，小柴胡为和解之剂也。
〔《活》〕伤寒表症当汗，里症当下，不易之法也。发表攻里，本自不同，甘遂、神丹，不可合饮；桂枝、
承气，安可并进。然而假令病患脉浮而大，是表症当汗，其人发热烦渴，小便赤，却当下，此是表里俱见，五
苓散主之。假令伤寒不大便六七日，头痛有热者，是里症当下，其人小便清者，知不在里，仍在表也，当须发
汗，此是两症俱见，即未可下，宜与桂枝汤。假令病患心下满，口不欲食，大便硬，脉沉细，是里症当下；其
人头汗出，微恶寒，手足冷，却当汗，此两症俱见者，仲景所谓半在表半在里也，小柴胡主之。假令太阴病，
表症未除，而医数下之，遂挟热而利不止，心下痞硬，仲景谓之表里不解，桂枝人参汤主之。
本太阳病，医反下之，因尔腹痛，是有表复有里，仲景用桂枝加芍药汤。痛甚者，桂枝加大黄。又云∶太
阳病桂枝症，医反下之，利遂不止，脉促者，表未解也，喘而汗出者，葛根黄芩汤主之。此皆仲景治伤寒有表
复有里之法也。
〔海〕大柴胡汤治表里内外俱热之症。治有表者，或脉浮，或头痛，或恶风，或恶寒，四症中或有一二尚
在者，乃十三日过经不解是也。治有里者，或谵语，或妄语，或掷手扬视，此皆里之急者也。若欲汗之，则里
症已急，欲下之，则表症尚在，通宜大柴胡汤。
伤寒四五日后，以至过经无表症，又于里症未可下者，皆可用小柴胡随证加减用之。以至十余日，亦可用。
十余日外，用小柴胡不愈者，若大便硬，看症可下，则用大柴胡下之。以过经，其人稍虚，当下者，用大柴胡
汤则稳当，恐承气太紧，病患不禁也。仲景云∶六七日目中不了了，睛不和，无表里症，大便难，身微热，此
为实也，当下之，宜大承气汤。又云∶病患无表里症，发热七八日，脉虽浮数，可用大柴胡下之，假令已下，
脉数不解，至六七日不大便者，有瘀血也，属抵当汤。
治伤寒须分表里，若表里不分，汗下差误，岂为上工？且如均是发热，身热不渴，为表有热，小柴胡加桂
枝主之；厥而脉滑，为里有热，白虎加人参主之。均是水气，干呕微利，发热而咳，为表有水，小青龙加芫花
主之；体凉表症罢，咳而胁下痛，为里有水，十枣汤主之。均是恶寒，有热而恶寒者，发于阳也，麻黄、桂枝、
小柴胡主之；无热而恶寒者，发于阴也，附子、四逆主之。均是身体痛，脉浮发热，头痛身体痛者，为表未解，
麻黄汤主之；脉沉自利，身体痛者，为里不和，四逆汤主之。以此观之，仲景表里之法甚详，学人宜深究心也。
〔海〕半表半里者有几？夫邪在荣卫之间，谓之半表半里也。太阳阳明之间，少阳居身之半表半里也。五
苓散分阴阳，膀胱经之半表半里也。理中汤治吐泄，上下之半表半里也。
〔《活》〕太阳阳明少阳，皆属阳症也。太阳者，膀胱也，发热恶寒，头疼腰痛，而脉浮也。阳明者，胃也，
不恶寒反恶热， 汗出，大便秘，潮热，而脉长也。少阳者，胆也，口苦咽干，胁下满，发热而呕，或往来
寒热，而脉弦也。麻黄汤、大青龙汤、桂枝汤，治太阳伤风寒也。大柴胡汤、调胃承气汤、小承气汤、大承气
汤，治阳明伤寒也。小柴胡汤，治少阳伤寒也。其他药，皆发汗吐下后症也。若阳气独盛，阴气暴绝，即为阳
毒，必发躁狂走，妄言，面赤咽痛，身斑斑如锦纹，或下利黄赤，脉洪实或滑促，当以酸苦之药投之，令阴气
复而大汗解矣。古人云∶酸苦涌泄为阴，谓苦参、大青、葶苈、苦酒之类，皆复其阴气也。微用苦，甚则兼用
酸苦，折热复阴。若热极发厥，阳症似阴者，学人当以脉别之。
太阴少阴厥阴，皆属阴症也。何谓太阴症？太阴脾之经，主胸膈 胀。何谓少阴症？少阴肾之经，主脉细
心烦，但欲寐，或自利而渴。何谓厥阴症？厥阴肝之经，主消渴，气上冲心，心中疼热，饥不欲食，食则吐蛔，
下之利不止也。三阴中寒，微则理中汤，稍厥，或中寒下利，即干姜甘草汤。大段重者，用四逆汤。无脉者，
用通脉四逆汤，若阴气独盛，阳气暴绝，则为阴毒，其症四肢逆冷，脐腹筑痛，身如被杖，脉沉实，病或吐或
利，当急灸脐下，服以辛热之药，令复阳气而大汗解矣。古人云∶辛甘发散为阳，谓桂枝、甘草、干姜、附子
之类，能复其阳气也。微用辛甘，甚则用辛苦。苦阴极热躁，阴症似阳者，学人亦当以脉别之。
〔罗〕阴症阳症辨静江府提刑李君长子年十九岁，四月病伤寒九日，医者作阴症治之，与附子理中丸数服，
其症增剧。别易一医，又作阳症，议论差互，不敢服药。李君邀予往视，坐间有数人，予不欲直言其症，但细
为分解，令自忖度之。凡阳症者，身大热而手足不厥卧则怛然，起则有力，不恶寒，反恶热，不呕不泻，泻
而饮水，烦躁不得眠，能食而多语，其脉浮大而数者，阳症也。凡阴症者，身不热而手足厥冷，恶寒蜷卧，恶
闻人声，或自引衣盖覆，不烦渴，不饮食，小便自利，大便反快，其脉沉细而微迟者，阴症也。今诊其脉数得
六七至。其母云，夜来叫呼不绝，全不睡。又喜饮冰水。予闻其言，知阳症悉具，且三日不见大便，宜急下之。
予遂以酒煨大黄六钱，甘草炙二钱，芒硝五钱煎服，至夕下数行，燥粪二十余块，是夜汗大出，明日又往视之，
身凉脉静矣。予思《素问》热论云∶治之各通其脏腑。故仲景述《伤寒论》云∶六经各异，传变不同。《活人》
亦云∶凡治伤寒，先须明经络。其义一也。昧者不学经络，不问病源，按寸握尺，妄意病症，不知邪气之所在，
动致颠覆，真盲医哉。昔韩子云∶医之病，病在少思。真理致之言也，学人审之。（阴症似阳，阳症似阴，并见
阴阳脏腑部发寒热反治条。）
〔《活》〕未满三日，可汗而已，满三日者，可泄而已，此大略言之耳。凡病患有虚有实，邪气传受，迟速
不同，岂可拘以日数。仲景云∶日数虽多，但有表症而脉浮者，犹宜发汗。日数虽少，若有里症而脉沉者，即
宜下之，正应随脉治之。又况六气之邪，乘虚之经，皆自背得之，则入太阳，或入少阴；自面感之，则入阳明
之类，不必皆始于太阳也。兼寒邪有首尾止在一经，或间传一二经，不可以一理推，但视脉与外症治之，此活
法也。假令有人脉浮，头项强痛，发热而恶寒，每日如此，不以日数多少，正是太阳经受之，其余经皆仿此。
大抵伤寒惟凭脉与外症以汗下之。若过日多，脉尚大浮数，按之不足者，尚责太阳也，可发汗而愈。若按之实
者，汗之必死，须下之而愈也。若始病脉沉细数，外症或腹满咽干，或口燥舌干而渴，为热，正责属里，可下
之而愈。若无此症，表热脉沉，误下者必死，须用麻黄附子甘草、麻黄细辛附子汤少发汗以治之，此皆仲景之
确论也。伤寒脉浮而紧，身体拘急，恶寒无热，寒多热少，面色惨而不舒，腰脊疼痛，手足四末微厥，此麻黄
症也。伤寒脉浮而缓，寸大而尺弱，自汗体热，头疼恶风，寒多热少，其面光而不惨，烦躁，手足不冷，此桂
枝症也。
伤寒者，脉紧而涩，伤风者，脉浮而缓。伤寒无汗，伤风有汗，伤寒畏寒不畏风，伤风畏风不畏寒。大抵
太阳病者，必脉浮发热，恶风恶寒。恶寒者不当风而自憎寒，恶风者当风而憎寒也。六经皆有伤风伤寒，其症
各异。太阳脉浮有汗为中风，脉紧无汗为伤寒。阳明善饥为中风，不食为伤寒。少阳两耳聋，目赤，胸满而烦
为中风，口苦，咽干，目眩为伤寒。苦三阴伤风，无变异形症，但四肢烦疼，余症同三阳也。伤风见寒脉者，
发热恶风，烦躁，手足温而脉反浮紧。盖发热，恶风，烦躁，手足温为中风候，脉浮紧为伤寒候也。伤寒见风
脉者，寒多热少，不烦躁，手足微厥而脉反浮缓。盖寒多热少，不烦躁，手足微厥为伤寒候，脉浮缓为中风
候也。（伤风见寒，伤寒见风，大青龙症也。）
伤寒发表，须当随病轻重而汗之，故仲景有发汗者，有和解者。发汗如麻黄汤、桂枝汤、大青龙汤是也，
和解如小青龙汤、桂枝麻黄各半汤、白虎汤、桂枝二越婢一汤、柴胡桂枝之类是也。后人不能深究寒邪浅深，
药性紧慢，一概用药，因致夭伤，其闻纵或生全，往往汗后虚乏，遂至劳复，或变成百病，淹引岁月，卒至不
救。此皆由汗下过度，阴阳并竭，血气羸损，以致此祸。如遇病轻，但当和解之，所谓调和则荣卫以通津液，
令其自解可也。
丹溪治伤寒表症，用补中益气汤发散，海藏用神术汤、白术汤、九味羌活散发散，此皆和解之意，不使真
气散失也。
伤寒连服汤剂而汗不出者，如中风法蒸之，使温热之气于外迎之，无不得汗。其法用薪火烧地，良久扫去，
以水洒之，取蚕砂、柏叶、桃叶、糠麸皆铺烧地上，可侧手浓，上铺席，令病患当上卧，温覆之，移时汗立至，
候周身至脚心 ，乃用温粉扑之，汗止上床。最得力者，蚕砂、桃、柏叶也。糠麸乃助其浓，多少随用。
〔《衍》〕治伤寒汗不出，搐脚法。用海蛤粉、乌头各二两，穿山甲三两，为末，酒糊和丸，大一寸许，捏
扁，置患人足心下，擘葱白盖药，以帛缠定，于暖室取热汤浸脚至膝下，久则水温，又添热水，候遍身汗出为
度。凡一二日一次浸脚，以和为度。
〔《活》〕伤寒里症，须看热气浅深，故仲景有直下之者，如大承气、小承气、十枣、大柴胡汤是也。有微
和其胃气者，如调胃承气汤、脾约丸，少与小承气微和之之类是也。
〔《金匮》〕虚者，十补勿一泻，强实者泻之，虚实等者，虽泻勿大泄之，故王叔和序《伤寒》，有承气之戒。
〔垣〕治大便燥结，用通幽汤、润肠汤丸，皆为血气津液不足者设也。
药用大承汤最紧，小承汤次之，调胃承气又次之，大柴胡汤又次之。
〔海〕大承气汤 治大实大满，满则胸腹胀满，状若合瓦，大实则不大便也。痞满燥实四症俱备则用之，杂病
则
进退用之。
大黄（治大实） 芒硝（治燥粪，此二味治有形血药也） 浓朴（治大满） 枳实（治痞，此二味治无形气
药也）
小承气汤 治痞实而微满，状如饥人食饱饭，腹中无转矢气。
即大承气汤，只去芒硝。心下痞，大便或通，热甚，须可下，宜此方。
调胃承气汤 治实而不满者，腹如仰瓦，腹中有转矢气，有燥粪，不大便而谵语，坚实之症宜用之。
上以上三法不可差，差则无者生之，有者遗之。假令调胃承气症，用大承气下之，则愈后元气不复，以
其气药犯之也。若大承气症，用调胃承气下之，则愈后神痴不清，以其无气药也。小承气症，若用芒硝下
之，则或利不止，变而成虚矣。
〔垣〕三一承气汤辨 实则泻之，人所共知，如缓急轻重之剂，则临时消息焉。如不恶寒反恶热，发渴谵
语，腹满而喘，手足 然汗出，急下之，宜大承气汤。如邪未深，恐有燥粪，少腹痛，小承气汤试之。腹中转
矢气者，有燥粪也，乃可攻之，不转矢气者，初硬后溏，尚未可攻，攻之则腹满不能食。若腹不通，止与小承
气汤微和胃气，勿令大泄。如发汗不恶寒，但实者，胃实也，当和胃气，调胃承气汤主之。
〔成〕大热结实者，与大承气汤。小热微结者，与小承气汤，以热不大甚，故于大承气汤中去芒硝，又以
结不至坚，故减浓朴、枳实。如不至大坚，然邪热已甚，而须攻下者，亦未可投大承气汤，必以轻缓之剂攻之，
于大承气汤中减浓朴、枳实，加甘草，乃轻缓之剂以调胃也。设若大承气汤症，反用调胃承气汤下之，则邪气
【《活人书》】发热、恶寒，身体疼痛且脉象浮的，是表证。所谓表证，主要指恶寒。恶寒属于太阳经病，适宜用发汗法治疗。
【成无己】恶寒一概归属于表证，即使具备所有的里证症状，只要仍有轻微恶寒，也是表邪未解，仍然应当先解除表邪，等到不再恶寒表示表邪已解，才可以攻治里证。
如果不恶寒反而怕热，手掌心和腋下出汗，胃中干燥，邪气结聚并出现潮热，大便干硬，小便正常，腹部胀满且气喘，或者胡言乱语，脉象沉而滑的，是里证。所谓里证，就是内热。内热属于阳明经病，适宜用泻下法治疗。伤寒起初发热恶寒，现在发汗后不恶寒，只是加倍发热且烦躁，起初脉象浮大，现在脉象洪实，或沉数细，起初神志清醒安静，现在狂言乱语，这是胃实阳盛，再发汗就会致死，必须用泻下法才能痊愈。也有刚得病就变成阳盛症状的，必须立即泻下，不可拘泥于发病天数。更有心胸连及腹部脐周严重痞闷，腹中疼痛，坐卧不安，昏闷气喘极其严重的，也不问其他症状，直接泻下。如果延误了泻下时机，则气血不通，四肢厥冷，医生不知道，反而怀疑是阴厥，又进服热药，祸患如反掌之间发生，不可不仔细考察。
【成无己】邪气客居在表的，是寒邪，与阳气相争，表现为寒。邪气进入里的，是热邪，与阴气相争，表现为热。邪气在半表半里，向外与阳争而表现为寒，向内与阴争而表现为热，所以往来寒热。邪气在表多则寒多，邪气在里多则热多，邪气一半在表一半在里，则寒热也各半。邪气在表的，必须通过浸渍形体来发汗；邪气在里的，必须荡涤肠胃以通利大便；其余既不在表也不在里，处于半表半里的，又不适合发汗，也不是吐法和下法的对症方法，此时应当和解即可，小柴胡汤是和解的方剂。
【《活人书》】伤寒表证应当发汗，里证应当泻下，是不变的法则。发表和攻里，本自不同，甘遂、神丹（此处指峻下药），不可以混合饮用；桂枝汤、承气汤，怎么可以同时进行。然而假如病人脉象浮大，这是表证应当发汗，其人发热烦渴，小便赤红，却应当泻下，这是表里证同时出现，用五苓散主治。假如伤寒不大便六七天，头痛有热的，这是里证应当泻下，其人小便清亮的，知道病不在里，仍在表，应当需要发汗，这是两种症状都出现，暂且不可泻下，宜给予桂枝汤。假如病人心下痞满，口不想吃东西，大便干硬，脉象沉细，这是里证应当泻下；其人头部出汗，轻微恶寒，手脚冰冷，却应当发汗，这是两种症状都出现的，张仲景所说的半在表半在里，用小柴胡汤主治。假如太阴病，表证未除，而医生多次泻下，于是挟带热邪而腹泻不止，心下痞硬，张仲景称之为表里不解，用桂枝人参汤主治。
原本太阳病，医生反而用泻下法，因此导致腹痛，这是既有表证又有里证，张仲景使用桂枝加芍药汤。疼痛剧烈的，用桂枝加大黄汤。又说：太阳病桂枝证，医生反而用泻下法，腹泻不停止，脉象急促的，表证未解，气喘且出汗的，用葛根黄芩黄连汤主治。这些都是张仲景治疗伤寒既有表证又有里证的方法。
【海藏】大柴胡汤治疗表里内外俱热的症状。治疗有表证的，或者脉浮，或者头痛，或者恶风，或者恶寒，这四种症状中有一两个还在的，就是过了十三天经过传变仍未解除的情况。治疗有里证的，或者胡言乱语，或者妄语，或者扔东西扬手视物，这都是里证的急症。如果想要发汗，则里证已经紧急；想要泻下，则表证还在，通通适宜用大柴胡汤。
伤寒四五天后，以至过了经传变没有表证，又在里证尚不可泻下的情况下，都可以用小柴胡汤随证加减使用。以至十几天，也可以使用。十多天外，用小柴胡汤不愈的，如果大便干硬，看症状可以泻下，则用大柴胡汤泻下。因为过了经传变，其人稍微虚弱，应当泻下的，用大柴胡汤则稳妥，恐怕承气汤药力太猛，病人承受不了。张仲景说：六七天眼睛看不清，眼球转动不灵活，没有明显的表里证，大便困难，身体微热，这是实证，应当泻下，宜用大承气汤。又说：病人没有表里证，发热七八天，脉象虽然浮数，可以用大柴胡汤泻下，假如已经泻下，脉数不解，到六七天不大便的，是有瘀血，属于抵当汤主治。
治疗伤寒必须分清表里，如果表里不分，汗法和下法出现差错失误，难道算是高明医生吗？况且同样是发热，身体热但不口渴，是表有热，用小柴胡汤加桂枝主治；四肢厥冷而脉滑，是里有热，用白虎加人参汤主治。同样是水气，干呕轻微腹泻，发热且咳嗽，是表有水，用小青龙汤加芫花主治；身体凉表证罢去，咳嗽且胁下痛，是里有水，用十枣汤主治。同样是恶寒，有热而恶寒的，是发于阳经，用麻黄汤、桂枝汤、小柴胡汤主治；无热而恶寒的，是发于阴经，用附子、四逆汤主治。同样是身体痛，脉浮发热，头痛身体痛的，是表未解，用麻黄汤主治；脉沉自利，身体痛的，是里不和，用四逆汤主治。由此看来，张仲景的表里治法非常详尽，学习的人应当深入探究用心。
【海藏】半表半里有哪些情况？邪气在荣卫之间，叫做半表半里。太阳阳明之间，少阳居于身体的半表半里。五苓散分阴阳，是膀胱经的半表半里。理中汤治疗呕吐泄泻，是上下的半表半里。
【《活人书》】太阳、阳明、少阳，都属于阳证。太阳者，是膀胱，症状为发热恶寒，头疼腰痛，且脉浮。阳明者，是胃，症状为不恶寒反怕热，出汗，大便秘结，潮热，且脉长。少阳者，是胆，症状为口苦咽干，胁下胀满，发热且呕吐，或往来寒热，且脉弦。麻黄汤、大青龙汤、桂枝汤，治疗太阳经受风寒。大柴胡汤、调胃承气汤、小承气汤、大承气汤，治疗阳明伤寒。小柴胡汤，治疗少阳伤寒。其他药物，都是发汗、吐、下后的症状。如果阳气独盛，阴气突然断绝，就成为阳毒，必定发作躁动狂走，胡言乱语，面红咽喉痛，身上斑纹像锦缎一样，或者下利黄赤色，脉象洪实或滑促，应当用酸苦的药物投喂，使阴气恢复而大汗出得以解除。古人说：酸苦涌泄为阴，指苦参、大青、葶苈、醋之类，都能恢复其阴气。轻微用苦味，严重时兼用酸苦，折损热邪恢复阴气。如果热极导致厥逆，阳证似阴的，学习的人应当通过脉象来辨别。
太阴、少阴、厥阴，都属于阴证。什么是太阴证？太阴脾经，主胸膈胀满。什么是少阴证？少阴肾经，主脉细心烦，只想睡觉，或自利且口渴。什么是厥阴证？厥阴肝经，主消渴，气向上冲心，心中疼热，饥饿不想吃东西，吃了就吐蛔虫，泻下则腹泻不止。三阴经受寒，轻微的用理中汤，稍见厥冷，或中寒下利的，就用干姜甘草汤。病情特别重的，用四逆汤。无脉的，用通脉四逆汤，如果阴气独盛，阳气突然断绝，就成为阴毒，其症状四肢逆冷，肚脐腹部剧烈疼痛，身体像被棍棒打过一样，脉象沉实，病或呕吐或腹泻，应当紧急灸脐下，服用辛热药物，使阳气恢复而大汗出得以解除。古人说：辛甘发散为阳，指桂枝、甘草、干姜、附子之类，能恢复其阳气。轻微用辛甘，严重时用辛苦。苦味极治阴热躁动，阴证似阳的，学习的人也应当通过脉象来辨别。
【罗知悌】阴证阳证辨析。静江府提刑李君的长子十九岁，四月患伤寒九天，医生按阴证治疗，给服附子理中丸几服，症状加重。另外换了一位医生，又按阳证论治，议论互相矛盾，不敢服药。李君邀请我去诊治，坐间有好几个人，我不想直言病症，只是细细分解，让他自己揣度。凡是阳证，身体大热而手脚不厥冷，躺下时惊恐不安，起来时有力量，不恶寒反恶热，不呕吐不腹泻，腹泻且想喝水，烦躁不能入睡，能吃且多话，脉象浮大而数的，是阳证。凡是阴证，身体不热而手脚厥冷，恶寒蜷缩而卧，讨厌听到人声，或者自己拉衣服盖在身上，不烦躁口渴，不吃东西，小便自利，大便反而快，脉象沉细而微迟的，是阴证。现在诊察他的脉象一息六七至。他母亲说，昨晚叫喊不停，完全没睡。又喜欢喝冰水。我听了他的话，知道阳证全部具备，而且三天没见大便，应当紧急泻下。于是我用了酒煨大黄六钱，炙甘草二钱，芒硝五钱煎服，到了傍晚下了几次，燥粪二十多块，当晚大汗出，第二天再去诊治，身体凉爽脉象平静了。我思考《素问·热论》说：治疗要分别疏通其脏腑。所以张仲景阐述《伤寒论》说：六经各异，传变不同。《活人书》也说：凡是治疗伤寒，必须先明白经络。它们的道理是一样的。愚昧的人不学经络，不问病源，按寸握尺，随意猜测病症，不知道邪气所在，动不动导致病情恶化，真是盲医啊。从前韩愈说：医生的毛病，在于缺乏思考。这是真理之言，学习的人审察它。（阴证似阳，阳证似阴，并见阴阳脏腑部发寒热反治条。）
【《活人书》】未满三天，可以发汗治愈，满三天的，可以泻下治愈，这是大概的说法。凡是病人有虚有实，邪气传受，迟速不同，怎么能拘泥于天数。张仲景说：天数虽多，只要有表证且脉浮的，仍然适宜发汗。天数虽少，如果有里证且脉沉的，就适宜泻下，正应该随脉象治疗。况且六气之邪，乘虚侵入经脉，都是从背部感受的，则进入太阳，或进入少阴；从面部感受的，则进入阳明之类，不一定都始于太阳。加上寒邪有的从头到尾只在一经，或间隔传一二经，不能用一个道理推断，只看脉象和外证治疗，这是活法。假如有人脉浮，头项强痛，发热而恶寒，每天如此，不以天数多少，正是太阳经受邪，其余各经都仿照此例。
大抵伤寒只凭脉象和外证来决定汗下。如果过了一天数多，脉象还大浮数，按之不足的，还是责求太阳经，可发汗而愈。如果按之实的，发汗必死，必须泻下而愈。如果起初病脉沉细数，外证或腹满咽干，或口燥舌干而渴，为热，正责属里，可泻下而愈。如果没有这些症状，表热脉沉，误用泻下必死，须用麻黄附子甘草汤、麻黄细辛附子汤少量发汗来治疗，这都是张仲景的确切论述。伤寒脉浮而紧，身体拘急，恶寒无热，寒多热少，面色惨淡而不舒展，腰脊疼痛，手足四末微厥，这是麻黄汤证。伤寒脉浮而缓，寸大而尺弱，自汗体热，头疼恶风，寒多热少，其面色光亮而不惨淡，烦躁，手脚不冷，这是桂枝汤证。
伤寒者，脉紧而涩；伤风者，脉浮而缓。伤寒无汗，伤风有汗；伤寒畏寒不畏风，伤风畏风不畏寒。大抵太阳病，必脉浮发热，恶风恶寒。恶寒是不当风而自然憎寒，恶风是当风而憎寒。六经都有伤风伤寒，其症状各异。太阳脉浮有汗为中风，脉紧无汗为伤寒。阳明善饥为中风，不食为伤寒。少阳两耳聋，目赤，胸满而烦为中风，口苦，咽干，目眩为伤寒。至于三阴经伤风，没有变异的症状，只是四肢烦疼，其余症状同三阳经。伤风见到寒脉的，发热恶风，烦躁，手足温而脉反浮紧。因为发热，恶风，烦躁，手足温是中风候，脉浮紧是伤寒候。伤寒见到风脉的，寒多热少，不烦躁，手足微厥而脉反浮缓。因为寒多热少，不烦躁，手足微厥是伤寒候，脉浮缓是中风候。（伤风见寒，伤寒见风，是大青龙汤证。）
伤寒发表，应当随病情轻重而发汗，所以张仲景有发汗的，有和解的。发汗如麻黄汤、桂枝汤、大青龙汤等；和解如小青龙汤、桂枝麻黄各半汤、白虎汤、桂枝二越婢一汤、柴胡桂枝汤等。后人不能深入探究寒邪浅深，药性紧慢，一概用药，因而导致夭折死亡，其中或许有的生全，往往汗后虚乏，遂至劳复，或变成百病，拖延岁月，最终至死。这都是由汗下过度，阴阳并竭，血气亏损，以致此祸。如果遇到病轻，只应当和解，所谓调和则营卫通畅津液，令其自愈即可。
丹溪治疗伤寒表证，用补中益气汤发散，海藏用神术汤、白术汤、九味羌活汤发散，这都是和解的意思，不让真气散失。
伤寒连服汤剂而不出汗的，像中风法那样蒸之，使温热之气在外面迎接它，没有不出汗的。这种方法用柴火烧地，很久后扫去，用水洒地，取蚕砂、柏叶、桃叶、糠麸都铺在烧过的地上，厚度可侧手厚，上面铺席，让病人躺在上面，温覆之，过了一会儿汗立刻出来，等到周身直到脚心出汗，然后用温粉扑身，汗止后上床。最得力的是蚕砂、桃叶、柏叶。糠麸是助其浓厚的，多少随用。
【《衍义》】治疗伤寒不出汗，浸脚法。用海蛤粉、乌头各二两，穿山甲三两，研为末，酒糊和丸，大一寸左右，捏扁，放在病人足心下，掰开葱白盖住药，用布缠定，在暖室用热汤浸脚至膝下，久了水温降低，又添热水，等到遍身出汗为止。凡是一两天一次浸脚，以舒适为度。
【《活人书》】伤寒里证，必须看热气深浅，所以张仲景有直接泻下的，如大承气汤、小承气汤、十枣汤、大柴胡汤等；有轻微调和胃气的，如调胃承气汤、脾约丸，少量给予小承气汤轻微调和等。
【《金匮要略》】虚的，十分补不要一分泻，强实的泻它，虚实相当的，虽然泻也不要大泻，所以王叔和在《伤寒序》中有承气汤的戒律。
【李东垣】治疗大便燥结，用通幽汤、润肠汤丸，都是为血气津液不足的人设立的。
药用大承气汤最猛，小承气汤次之，调胃承气汤又次之，大柴胡汤又次之。
【海藏】大承气汤治疗大实大满，满则胸腹胀满，状如合瓦，大实则不大便。痞满燥实四症俱备则用之，杂病则进退用之。
大黄（治大实） 芒硝（治燥粪，这两味是治有形血分的药） 厚朴（治大满） 枳实（治痞，这两味是治无形气分的药）
即大承气汤，只去掉芒硝。心下痞，大便或通，热甚，必须可下，宜用此方。
调胃承气汤 治疗实而不满的，腹如仰瓦，腹中有转矢气，有燥粪，不大便而谵语，坚实之症宜用之。
以上三种方法不可差错，差错则无者生之，有者遗之。假如调胃承气证，用大承气汤泻下，则愈后元气不复，因为其气药犯之。若大承气证，用调胃承气汤泻下，则愈后神痴不清，因为其无气药。小承气证，如果用芒硝泻下，则或利不止，变而成虚矣。
【李东垣】三一承气汤辨析 实则泻之，人所共知，如缓急轻重之剂，则临时斟酌。如不恶寒反恶热，发渴谵语，腹满而喘，手足濈然汗出，急下之，宜大承气汤。如邪未深，恐有燥粪，少腹痛，用小承气汤试之。腹中转矢气的，有燥粪也，才可攻之，不转矢气的，初硬后溏，尚未可攻，攻之则腹满不能食。若腹不通，只与小承气汤轻微调和胃气，勿令大泄。如发汗不恶寒，但实者，胃实也，当和胃气，调胃承气汤主治。
【成无己】大热结实者，与大承气汤。小热微结者，与小承气汤，因为热不太甚，所以在大承气汤中去掉芒硝，又因为结不至坚，所以减少厚朴、枳实。如不至大坚，然而邪热已甚，而须攻下的，也不可投大承气汤，必须用轻缓之剂攻之，在大承气汤中减少厚朴、枳实，加甘草，乃是轻缓之剂以调胃。设若大承气汤证，反用调胃承气汤泻下，则邪气
[From *Huoren Shu*] Fever, aversion to cold, body pain, and a floating pulse indicate an exterior syndrome (Biao Zheng). The exterior syndrome is characterized by aversion to cold. Aversion to cold belongs to the Taiyang (Greater Yang) channel; it is appropriate to treat it with sweating methods.
[Cheng Wuji] Aversion to cold generally belongs to the exterior. Even if all interior symptoms are present, slight aversion to cold indicates that the exterior pathogen has not yet been resolved. One should still first resolve the exterior. Only when aversion to cold ceases, indicating the exterior is resolved, can one attack the interior.
If there is no aversion to cold but rather aversion to heat, sweating in the palms and axillae, dryness in the stomach, accumulated pathogens with tidal fever, hard stools, normal urination, abdominal fullness with wheezing, or delirious speech, and a deep and slippery pulse, this is an interior syndrome (Li Zheng). The interior syndrome refers to internal heat. Internal heat belongs to the Yangming (Yang Brightness) channel; it is appropriate to treat it with purgation. In typhoid fever, initially there is fever and aversion to cold. Now, after sweating, there is no aversion to cold, but only intensified fever and restlessness. Initially the pulse was floating and large, now it is surging and solid, or deep, rapid, and fine. Initially the patient was calm, now speaking wildly. This is stomach excess with flourishing yang. Another sweat will cause death; purgation is required for recovery. There are cases where yang-excess symptoms appear immediately upon contracting the disease; purgation must be applied immediately without being constrained by the number of days. Furthermore, if there is severe oppression from the chest to the abdomen and umbilicus, abdominal pain, inability to sit or lie comfortably, and extreme suffocation and wheezing, regardless of other symptoms, purgation should be administered directly. If purgation is delayed, qi and blood flow will be blocked, leading to cold extremities. If physicians do not recognize this and mistakenly suspect yin-cold collapse, administering hot medicines again will bring disaster swiftly. This must be carefully examined.
[Cheng Wuji] Pathogens lodging in the exterior are cold pathogens; struggling with yang results in cold. Pathogens entering the interior are heat pathogens; struggling with yin results in heat. Pathogens in the half-exterior half-interior struggle outwardly with yang causing cold, and inwardly with yin causing heat, hence alternating chills and fever. If pathogens are mostly in the exterior, there is more cold; if mostly in the interior, there is more heat; if half in the exterior and half in the interior, chills and fever are also mixed. For pathogens in the exterior, one must soak the body to induce sweating. For pathogens in the interior, one must cleanse the bowels to promote evacuation. For those neither strictly exterior nor interior, but in the half-exterior half-interior, neither sweating nor emesis/purgation are suitable; reconciliation (He Jie) is appropriate. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is a reconciliation formula.
[From *Huoren Shu*] Exterior syndromes of typhoid fever require sweating; interior syndromes require purgation. This is an unchangeable principle. Releasing the exterior and attacking the interior are fundamentally different; Kansui (Kansui Radix) and Shen Dan (Divine Pill, a strong purgative) should not be mixed. Guizhi Tang (Cinnamon Twig Decoction) and Chengqi Tangs should not be administered simultaneously. However, suppose a patient has a floating and large pulse, indicating an exterior syndrome requiring sweating, yet presents with fever, irritability, thirst, and red urine, indicating a need for purgation. This is simultaneous exterior and interior presentation; Wuling San (Five-Ingredient Powder with Poria) should be used. Suppose typhoid fever involves constipation for six or seven days with headache and fever, indicating an interior syndrome requiring purgation, yet the urine is clear, indicating the disease is not in the interior but remains in the exterior. Sweating is required. This is simultaneous presentation; purgation should be withheld, and Guizhi Tang (Cinnamon Twig Decoction) should be given. Suppose a patient has epigastric fullness, desire not to eat, hard stools, and a deep, fine pulse, indicating an interior syndrome requiring purgation; yet the patient has head sweating, slight aversion to cold, and cold hands and feet, indicating a need for sweating. This simultaneous presentation corresponds to Zhang Zhongjing's description of "half in the exterior, half in the interior"; Xiao Chai Hu Tang (Minor Bupleurum Decoction) should be used. Suppose Taiyin (Greater Yin) disease exists with unresolved exterior symptoms, and the physician repeatedly purges, leading to persistent diarrhea with heat, and epigastric hardness. Zhang Zhongjing calls this "unresolved exterior and interior"; Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction) should be used.
Originally Taiyang disease, if treated incorrectly with purgation, resulting in abdominal pain, indicates both exterior and interior involvement. Zhang Zhongjing uses Guizhi Ji Shaoyao Tang (Cinnamon Twig Decoction Augmented with Peony Root). For severe pain, Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction Augmented with Rhubarb) is used. It is also stated: In Taiyang disease with Guizhi syndrome, if treated incorrectly with purgation leading to persistent diarrhea, a rapid pulse indicates the exterior is unresolved; wheezing and sweating indicate Ge Gen Huang Qin Huang Lian Tang (Kudzu, Scutellaria, and Coptis Decoction) should be used. These are all Zhang Zhongjing's methods for treating typhoid fever with simultaneous exterior and interior symptoms.
[Hai Zang] Da Chai Hu Tang (Major Bupleurum Decoction) treats conditions with heat in both the exterior and interior. To treat exterior involvement, manifested as floating pulse, headache, aversion to wind, or aversion to cold, if one or two of these four symptoms persist after thirteen days beyond the usual transmission period, it indicates unresolved disease. To treat interior involvement, manifested as delirium,妄语 (wild speech), or throwing hands and staring upward, these are urgent interior conditions. If one attempts sweating, the interior condition is already urgent; if one attempts purgation, the exterior condition persists. In such cases, Da Chai Hu Tang (Major Bupleurum Decoction) is universally appropriate.
After four or five days of typhoid fever, or beyond the transmission period without exterior symptoms, yet where purgation is not yet indicated for interior symptoms, Xiao Chai Hu Tang (Minor Bupleurum Decoction) can be used with modifications. It can even be used after ten days. If Xiao Chai Hu Tang fails after ten days, and stools are hard, allowing for purgation based on symptoms, Da Chai Hu Tang (Major Bupleurum Decoction) should be used for purgation. Because the disease has passed through the meridians, the patient is slightly deficient; using Da Chai Hu Tang is safer, as Chengqi Tangs may be too harsh for the patient to tolerate. Zhang Zhongjing said: After six or seven days, if vision is unclear and eyes are unresponsive, without obvious exterior or interior symptoms, difficulty in defecation, and slight body heat, this is excess; purgation is required, and Da Chengqi Tang (Major Order the Qi Decoction) is appropriate. He also said: If a patient has no exterior or interior symptoms, fever for seven or eight days, and although the pulse is floating and rapid, Da Chai Hu Tang (Major Bupleurum Decoction) can be used for purgation. If purgation has been performed, the rapid pulse persists, and after six or seven days there is no defecation, this indicates blood stasis; Didang Tang (Hit-and-Kill Decoction) is indicated.
Treating typhoid fever requires distinguishing between exterior and interior. If exterior and interior are not distinguished, errors in sweating and purgation occur, which is not the way of a skilled physician. Consider fever: body heat without thirst indicates heat in the exterior; Xiao Chai Hu Tang (Minor Bupleurum Decoction) augmented with Guizhi (Cinnamon Twig) is used. Cold extremities with a slippery pulse indicate heat in the interior; Baihu Jia Renshen Tang (White Tiger Decoction with Ginseng) is used. Consider water retention: retching, mild diarrhea, fever, and cough indicate water in the exterior; Xiao Qinglong Tang (Minor Green Dragon Decoction) augmented with Yuanhua (Genkwa Flos) is used. Cool body with resolved exterior symptoms, cough, and hypochondriac pain indicate water in the interior; Shizao Tang (Ten Jujube Decoction) is used. Consider aversion to cold: aversion to cold with heat indicates onset in the Yang channels; Mahuang Tang (Ephedra Decoction), Guizhi Tang (Cinnamon Twig Decoction), and Xiao Chai Hu Tang (Minor Bupleurum Decoction) are used. Aversion to cold without heat indicates onset in the Yin channels; Fuzi (Aconite Root) and Sini Tang (Recover the Yielding Decoction) are used. Consider body pain: floating pulse, fever, headache, and body pain indicate unresolved exterior; Mahuang Tang (Ephedra Decoction) is used. Deep pulse with spontaneous diarrhea and body pain indicate interior disharmony; Sini Tang (Recover the Yielding Decoction) is used. From this, we see Zhang Zhongjing's methods for exterior and interior are very detailed; students should investigate them deeply.
[Hai Zang] What constitutes the half-exterior half-interior? Pathogens between Ying (Nutrient) and Wei (Defensive) levels are called half-exterior half-interior. Between Taiyang and Yangming, Shaoyang (Lesser Yang) resides in the half-exterior half-interior of the body. Wuling San (Five-Ingredient Powder with Poria) distinguishes yin and yang, representing the half-exterior half-interior of the Bladder channel. Lizhong Tang (Regulate the Middle Decoction) treats vomiting and diarrhea, representing the upper and lower half-exterior half-interior.
[From *Huoren Shu*] Taiyang, Yangming, and Shaoyang all belong to Yang syndromes. Taiyang is the Bladder; symptoms include fever, aversion to cold, headache, lower back pain, and a floating pulse. Yangming is the Stomach; symptoms include no aversion to cold but aversion to heat, sweating, constipation, tidal fever, and a long pulse. Shaoyang is the Gallbladder; symptoms include bitter taste, dry throat, hypochondriac fullness, fever with vomiting, or alternating chills and fever, and a wiry pulse. Mahuang Tang (Ephedra Decoction), Da Qinglong Tang (Major Green Dragon Decoction), and Guizhi Tang (Cinnamon Twig Decoction) treat Taiyang wind-cold. Da Chai Hu Tang (Major Bupleurum Decoction), Tiaowei Chengqi Tang (Regulate the Stomach Order the Qi Decoction), Xiaochengqi Tang (Minor Order the Qi Decoction), and Dachengqi Tang (Major Order the Qi Decoction) treat Yangming typhoid. Xiao Chai Hu Tang (Minor Bupleurum Decoction) treats Shaoyang typhoid. Other medicines treat symptoms after sweating, emesis, or purgation. If yang qi flourishes exclusively and yin qi suddenly perishes, it becomes Yang Du (Yang Poison); symptoms include agitation, manic running, delirium, red face, sore throat, skin spots like brocade, or yellow-red diarrhea, with a surging, solid, slippery, or rapid pulse. Sour and bitter medicines should be administered to restore yin qi, leading to resolution via heavy sweating. Ancients said: "Sour and bitter induce vomiting and purgation, belonging to Yin." Examples include Kushen (Sophora Root), Daqingye (Isatis Leaf), Tingli (Descurainia Seed), and vinegar, all restoring yin qi. Mildly use bitter; severely, combine sour and bitter to reduce heat and restore yin. If extreme heat causes cold limbs (Yang syndrome resembling Yin), students must distinguish by pulse.
Taiyin, Shaoyin, and Jueyin all belong to Yin syndromes. What is Taiyin syndrome? Taiyin Spleen channel governs chest and diaphragm distension. What is Shaoyin syndrome? Shaoyin Kidney channel governs fine pulse, heart vexation, desire to sleep, or spontaneous diarrhea with thirst. What is Jueyin syndrome? Juevin Liver channel governs excessive thirst, qi rushing up to the heart, heart pain and heat, hunger without desire to eat, vomiting worms after eating, and persistent diarrhea if purged. For cold in the Three Yin channels: mild cases use Lizhong Tang (Regulate the Middle Decoction); slight cold limbs or cold-induced diarrhea use Ganjiang Gancao Tang (Ginger and Licorice Decoction). Severe cases use Sini Tang (Recover the Yielding Decoction). Absent pulse uses Tongmai Sini Tang (Restore Pulse Recover the Yielding Decoction). If yin qi flourishes exclusively and yang qi suddenly perishes, it becomes Yin Du (Yin Poison); symptoms include cold extremities, severe abdominal pain, body feeling like being beaten, deep solid pulse, vomiting or diarrhea. Emergency moxibustion below the umbilicus and administration of acrid-hot medicines are required to restore yang qi, leading to resolution via heavy sweating. Ancients said: "Acrid and sweet disperse and ascend, belonging to Yang." Examples include Guizhi (Cinnamon Twig), Gancao (Licorice Root), Ganjiang (Dried Ginger), and Fuzi (Aconite Root), all restoring yang qi. Mildly use acrid-sweet; severely, use acrid-bitter. Bitter cures extreme yin heat and restlessness; Yin syndrome resembling Yang must also be distinguished by pulse.
[Luo Zhi Di] Differentiation of Yin and Yang Syndromes. The eldest son of Li Jun, Judicial Intendant of Jingjiang Prefecture, aged nineteen, contracted typhoid fever for nine days in April. Physicians treated him as a Yin syndrome, administering Fuzi Lizhong Wan (Aconite Regulate the Middle Pills) several times, worsening his condition. Another physician treated him as a Yang syndrome, leading to conflicting opinions and hesitation to take medicine. Li Jun invited me to examine him. Not wishing to speak plainly in front of others, I analyzed the details for him to consider. Generally, Yang syndromes feature high body heat without cold extremities, restlessness when lying down but strength when rising, no aversion to cold but aversion to heat, no vomiting or diarrhea (or diarrhea with desire to drink water), irritability and insomnia, ability to eat and talkativeness, and a floating, large, rapid pulse. Yin syndromes feature no body heat but cold extremities, aversion to cold with curling up, aversion to human voices, pulling clothes over oneself, no irritability or thirst, no desire to eat, spontaneous urination, loose stools, and a deep, fine, weak, slow pulse. His pulse was six or seven beats per breath. His mother said he cried out all night without sleeping and liked drinking ice water. Hearing this, I knew all Yang syndrome symptoms were present, and with three days of no defecation, urgent purgation was needed. I prescribed wine-wrapped Dahuang (Rhubarb Root) 6 qian, roasted Gancao (Licorice Root) 2 qian, and Mangxiao (Mirabilite) 5 qian, decocted and taken. By evening, he defecated several times, passing over twenty pieces of dry stool. That night, he sweated heavily. The next day, his body was cool and pulse calm. Reflecting on *Suwen*, "Treatment must unblock the zang-fu organs," Zhang Zhongjing stated in *Shanghan Lun*: "The Six Channels differ, transmission varies." *Huoren Shu* also says: "In treating typhoid fever, one must first understand the meridians." The principle is the same. Ignorant people who do not study meridians, ignore disease origins, and guess symptoms by palpating pulses without knowing the pathogen's location often cause disaster. They are blind physicians. As Han Yu said: "The doctor's disease is lack of thought." This is true wisdom; students should reflect on it. (See sections on Yin resembling Yang, Yang resembling Yin, and reverse treatment of cold/heat in Yin/Yang Zang-Fu sections.)
[From *Huoren Shu*] Less than three days: sweating suffices. More than three days: purgation suffices. This is a generalization. Patients vary in deficiency and excess; pathogen transmission speed varies. How can one be constrained by days? Zhang Zhongjing said: Even if many days have passed, if exterior symptoms and a floating pulse exist, sweating is still appropriate. Even if few days have passed, if interior symptoms and a deep pulse exist, purgation is appropriate. Treatment must follow the pulse. Moreover, Six Qi pathogens enter via deficiency points, usually from the back into Taiyang or Shaoyin, or from the face into Yangming, etc., not always starting in Taiyang. Pathogens may stay in one channel or transmit to one or two others; they cannot be deduced by a single rule. One must treat based on pulse and external symptoms—this is flexible practice. For example, floating pulse, stiff neck/headache, fever, and aversion to cold daily indicate Taiyang channel involvement, regardless of days. Other channels follow this analogy.
Generally, typhoid fever treatment relies on pulse and external symptoms for sweating or purgation. If many days pass but the pulse remains large, floating, and rapid, yet empty upon pressure, the issue remains in Taiyang; sweating will cure it. If firm upon pressure, sweating will cause death; purgation is required. If initially the pulse is deep, fine, and rapid, with external symptoms like abdominal fullness, dry throat, or dry mouth/tongue/thirst indicating heat, the issue is interior; purgation will cure it. Without these symptoms, if there is exterior heat with a deep pulse, mistaken purgation will cause death. Instead, use Mahuang Fuzi Gancao Tang (Ephedra, Aconite, and Licorice Decoction) or Mahuang Xixin Fuzi Tang (Ephedra, Asarum, and Aconite Decoction) for mild sweating. These are Zhang Zhongjing's definitive theories. Typhoid fever with floating, tight pulse, body stiffness, aversion to cold without fever, more cold than heat, pale/uncomfortable complexion, back/spine pain, and slightly cold extremities is a Mahuang Tang (Ephedra Decoction) pattern. Typhoid fever with floating, moderate pulse, large cun and weak chi pulses, spontaneous sweating, body heat, headache, aversion to wind, more cold than heat, bright/comfy complexion, irritability, and warm extremities is a Guizhi Tang (Cinnamon Twig Decoction) pattern.
Typhoid fever: tight and choppy pulse. Wind injury: floating and moderate pulse. Typhoid fever: no sweat. Wind injury: sweat. Typhoid fever: fears cold, not wind. Wind injury: fears wind, not cold. Generally, Taiyang disease features floating pulse, fever, aversion to wind and cold. Aversion to cold occurs without wind; aversion to wind occurs with wind. All Six Channels can have wind injury or typhoid fever, with distinct symptoms. Taiyang: floating pulse with sweat is Wind Strike (Zhong Feng); tight pulse without sweat is Typhoid Fever (Shang Han). Yangming: hunger is Wind Strike; anorexia is Typhoid Fever. Shaoyang: bilateral deafness, red eyes, chest fullness/vexation is Wind Strike; bitter taste, dry throat, dizziness is Typhoid Fever. For Three Yin wind injuries, there are no major symptom variations, only limb vexation/pain, similar to Three Yang. Wind injury presenting with cold pulse: fever, aversion to wind, irritability, warm extremities, but floating-tight pulse. Fever, aversion to wind, irritability, warm extremities are Wind Strike signs; floating-tight pulse is Typhoid Fever sign. Typhoid fever presenting with wind pulse: more cold than heat, no irritability, slightly cold extremities, but floating-moderate pulse. More cold than heat, no irritability, slightly cold extremities are Typhoid Fever signs; floating-moderate pulse is Wind Strike sign. (Wind injury with cold pulse, or typhoid fever with wind pulse, indicates Da Qinglong Tang (Major Green Dragon Decoction) pattern.)
Releasing the exterior in typhoid fever requires matching sweating to severity. Thus, Zhang Zhongjing used sweating methods (Mahuang Tang, Guizhi Tang, Da Qinglong Tang) and reconciliation methods (Xiao Qinglong Tang, Guizhi Mahuang Ban Tang, Baihu Tang, Guizhi Er Yuebi Yi Tang, Chaihu Guizhi Tang). Later generations failed to probe pathogen depth and drug potency, applying uniform treatments, causing death or post-sweat deficiency leading to relapse or myriad diseases, dragging on until death. This results from excessive sweating/purgation, exhausting yin/yang and qi/blood. For mild illness, reconciliation is sufficient: harmonizing allows Ying/Wei to flow and fluids to generate, enabling self-resolution.
Danxi treated exterior typhoid fever with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) for dispersion. Haizang used Shenzhu Tang (Spiritual Efficacy Decoction), Baizhu Tang (Atractylodes Macrocephala Decoction), and Jiwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction) for dispersion. These embody reconciliation, preventing loss of vital qi.
For typhoid fever where oral decoctions fail to induce sweat, apply steaming like Wind Strike treatment, welcoming warmth externally. Method: Burn firewood on the floor, sweep after heating, sprinkle water. Spread Can Sha (Silkworm Frass), Bai Ye (Cypress Leaves), Tao Ye (Peach Leaves), and Bran on the heated floor, thickness of a hand side. Place a mat on top, have the patient lie on it, cover warmly. Sweat will arrive shortly. When sweat reaches soles, apply warm powder to stop sweating, then get into bed. Most effective agents: Silkworm Frass, Peach Leaves, Cypress Leaves. Bran aids thickness; amount varies.
[From *Yanyi*] Treating typhoid fever non-sweating with foot soaking: Hai Ge Fen (Clam Shell Powder) and Wu Tou (Aconite Root) 2 liang each, Chuan Shan Jia (Pangolin Scale) 3 liang, powdered, mixed with rice paste into pills size of a thumb joint, flattened, placed under soles. Cover with scallion white, bind with cloth. Soak feet in hot water to knees in a warm room. Add hot water as it cools. Stop when whole-body sweat appears. Soak once every one or two days, stopping at comfort.
[From *Huoren Shu*] Interior typhoid fever requires assessing heat depth. Zhang Zhongjing used direct purgation (Da Chengqi Tang, Xiao Chengqi Tang, Shizao Tang, Da Chai Hu Tang) and mild stomach harmonization (Tiaowei Chengqi Tang, Pi Yao Wan, small doses of Xiao Chengqi Tang).
[From *Jingui Yaolue*] For deficiency, tonify ten parts, purge none. For excess, purge. For equal deficiency/excess, purge moderately. Hence Wang Shuhe warned against Chengqi Tang in his preface.
[Li Dongyuan] For dry fecal impaction, use Tongyou Tang (Unblock the Lower Decoction) and Runchang Tang/Wan (Moisten Intestines Decoction/Pills), designed for blood/qi/fluid deficiency.
Drug potency ranking: Da Chengqi Tang (Major Order the Qi Decoction) is strongest; Xiao Chengqi Tang (Minor Order the Qi Decoction) second; Tiaowei Chengqi Tang (Regulate the Stomach Order the Qi Decoction) third; Da Chai Hu Tang (Major Bupleurum Decoction) fourth.
[Hai Zang] Da Chengqi Tang (Major Order the Qi Decoction) treats major excess and fullness. Fullness means chest/abdominal distension like joined tiles; major excess means constipation. Use when Pi (Stagnation), Man (Fullness), Zao (Dryness), and Shi (Excess) are all present. For miscellaneous diseases, adjust dosage.
Dahuang (Rhubarb Root): Treats major excess.
Mangxiao (Mirabilite): Treats dry feces. (These two treat tangible blood/stasis).
Houpo (Magnolia Bark): Treats major fullness.
Zhishi (Immature Bitter Orange): Treats stagnation. (These two treat intangible qi).
Xiao Chengqi Tang (Minor Order the Qi Decoction): Treats stagnation and excess with slight fullness, like a hungry person feeling overly full, without flatus.
It is Da Chengqi Tang minus Mangxiao. Use for epigastric stagnation, open or closed bowels, severe heat requiring purgation.
Tiaowei Chengqi Tang (Regulate the Stomach Order the Qi Decoction): Treats excess without fullness, abdomen like an inverted tile, with flatus, dry feces, constipation, and delirium. Suitable for solid excess patterns.
These three methods must not be confused. Error leads to creating deficiency where none existed, or missing excess where it exists. Using Da Chengqi Tang for Tiaowei Chengqi pattern damages post-recovery vitality due to qi-moving herbs. Using Tiaowei Chengqi Tang for Da Chengqi pattern causes mental cloudiness post-recovery due to lack of qi-moving herbs. Using Mangxiao for Xiao Chengqi pattern may cause persistent diarrhea, turning into deficiency.
[Li Dongyuan] Differentiation of Sanyi Chengqi Tang. Purge excess is common knowledge; adjust dose based on urgency/severity.
- No aversion to cold, aversion to heat, thirst, delirium, abdominal fullness/wheezing, continuous hand/foot sweating: Urgent purgation, Da Chengqi Tang.
- Pathogen not deep, suspected dry feces, lower abdominal pain: Test with Xiao Chengqi Tang. Flatus indicates dry feces; proceed to attack. No flatus indicates hard start/loose end; do not attack, or abdominal fullness/anorexia results. If bowels don't open, give small Xiao Chengqi Tang to mildly harmonize stomach, avoid massive purgation.
- Post-sweating, no aversion to cold, only excess/stomach excess: Harmonize stomach, Tiaowei Chengqi Tang.
[Cheng Wuji] Major heat with solid accumulation: Da Chengqi Tang. Minor heat with slight accumulation: Xiao Chengqi Tang. Heat is not severe, so remove Mangxiao from Da Chengqi Tang. Accumulation is not hard, so reduce Houpo and Zhishi. If not extremely hard but heat is severe requiring purgation, do not use Da Chengqi Tang. Use a mild agent: reduce Houpo and Zhishi in Da Chengqi Tang, add Gancao, to create a mild stomach-harmonizing purgative. If Da Chengqi Tang pattern is treated with Tiaowei Chengqi Tang, the pathogen...