典藏书目

Treat cases where, after administering Guizhi Tang (Cinnamon Twig Decoction) or following purgation therapy, symptoms such as stiffness and pain in the head and neck, mild continuous fever resembling a feather covering (Xi Xi Fa Re), absence of sweating, fullness and slight pain in the epigastrium, and dysuria persist. These should be primarily treated with Guizhi Qu Shaoyao Jia Fuling Baizhu Tang (Cinnamon Twig Decoction without Peony plus Poria and Atractylodes Macrocephala Decoction).

In the formula of Guizhi Tang, remove Shaoyao (Paeoniae Radix Alba), and add Fuling (Poria) and Baizhu (Atractylodis Macrocephalae Rhizoma), each three liang. The remaining preparation and administration follow the method of Guizhi Tang. Recovery occurs when urination becomes smooth.

[Annotation] After taking Guizhi Tang, sweating has already occurred; or after purgation, the current presentation still includes exterior signs such as stiffness and pain in the head and neck, mild continuous fever, and absence of sweating. Fullness and slight pain in the epigastrium, along with dysuria, indicate interior retention of fluid-dampness. Absence of sweating implies the exterior is not resolved, and fluid-qi in the heart region suggests Xiao Qinglong Tang (Minor Blue Dragon Decoction) should be used to resolve via sweating. However, since the patient has already undergone sweating and purgation, both the exterior and interior are deficient. Therefore, Guizhi Tang is still used to release the exterior. Shaoyao is removed for its sour and astringent properties to avoid aggravating epigastric fullness in the context of absent sweating. Fuling is added for its drying and leaching properties to address fluid retention causing dysuria. "Following the method of Guizhi Tang" refers to obtaining sweating according to Guizhi Tang protocols. "Recovery when urination becomes smooth" means the fluid disease resolves through the unblocking of water pathways. This formula is essentially Linggui Zhugan Tang (Poria, Cinnamon Twig, Licorice, and Atractylodes Macrocephala Decoction) plus Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus). Its primary intent is to release the muscle layer; promoting diuresis is secondary. Thus, Shengjiang and Dazao assist Guizhi to circulate body fluids and induce sweating. Linggui Zhugan Tang does not use Shengjiang and Dazao but increases the dosage of Fuling; its primary intent is promoting diuresis, while supporting Yang is secondary. Therefore, Fuling is doubled as the sovereign herb paired with Guizhi to support Yang during diuresis. Hence, the post-formula instructions do not say "follow the Guizhi Tang prescription."

Treat Taiyang Wind-strike (Taiyang Fengzhong) where the exterior syndrome has resolved, yet there is sweating without aversion to cold, interior fluid-qi, dysuria, vomiting and regurgitation, shortness of breath, and distending fullness, hardness, and pain from the epigastrium to the hypochondrium. This is an urgent and potent formula for treating water retention.

Dazao (broken open) ten pieces; Gansui (Kansui Radix), Daji (Euphorbiae Pekinensis Radix), Yuanhua (Genkwa Flos [roasted]) in equal parts. The above three herbs are separately pounded into powder. Take one sheng and half liang of water, first boil ten large Dazao until reduced to eight ge. Remove the dregs, then add the herbal powders. For robust individuals, administer one qian; for frail individuals, administer half a qian. Take warm on an empty stomach at dawn. If bowel movement is insufficient and the pathogen remains, administer again the next day, increasing by half a qian. After rapid purgation, nourish oneself with millet porridge.

[Collected Annotations] Ke Qin stated: Zhang Zhongjing's formulas for treating fluid-qi vary greatly; this is the most峻猛 (potent/severe) among them. Generally, when fluid-qi causes pathology, it may manifest as wheezing, coughing, palpitations, choking, vomiting, or diarrhea, stopping within one location. Here, however, evil-fluid stagnates and knots in the middle jiao, causing distending fullness, hardness, and pain in the heart and abdomen, blocking the ascending and descending qi mechanisms of the three jiao. At this time, exterior pathogens have ceased, making sweating and dispersing methods inappropriate. Interior fluid-excess is severe, exceeding the capacity of bland leaching agents. Without selecting the most potent water-draining substances to subdue it, the middle qi would collapse, leaving one helpless awaiting death. Gansui, Yuanhua, and Daji are all bitter, pungent, cold in nature, and possess extreme toxicity. Used together, their flavors complement and enhance each other, allowing them to attack the nest of evil-fluid, dredge the waterways, and purge vigorously, resolving the illness in one stroke. However, where evil gathers, qi must be deficient; using toxic drugs to attack pathogens inevitably damages the spleen and stomach. Without sweet and緩 (soothing/moderating) substances as masters, once the evil is eliminated, life itself would perish. Since these drugs are extremely toxic, Renshen (Ginseng Radix) and Baizhu cannot serve as sovereigns, and Gancao (Licorice Root) is contraindicated (Eighteen Incompatibilities). Therefore, ten large and plump Dazao are chosen as the sovereign herb: to protect the spleen and stomach, and to moderate the harsh toxicity. After rapid purgation, consuming millet porridge serves two purposes: to fill the interior with grain qi and to prevent the recurrence of pathogens. This is Zhang Zhongjing's method of using toxic drugs to attack disease—perfect in beauty and perfection. Ignorant people, confused by the theory that "sweetness causes middle-fullness," dare not use it, failing to understand the principle of mutual restraint and control.