经曰重阳者狂伤寒热在胃中并入于心遂使神不宁而志不定也故发狂始则少卧不饥妄语狂
笑甚则登高而歌弃衣而走逾垣上屋皆独阳亢极热甚所至非大下之不能止也亦有当汗不汗瘀热
在里下焦蓄血如狂小便不利时如狂特未至于狂耳若夫狂言直视便溺自遗与夫汗后大汗后大热
者俱危
○伤寒作喘
太阳头痛发热无汗而喘宜用 麻黄汤 有汗宜用桂枝加浓朴杏子汤
阳明病汗出不恶寒潮热腹满而喘宜用 小承气汤
水气作喘形肿而嗽宜用 小青龙汤
阴症发厥脉沉而喘宜用 五味子汤
○伤寒作渴
发热恶寒小便如常是表未解宜用 五苓散加 天花粉
不恶寒发热烦躁作渴者宜用 小柴胡汤加 天花粉 麦门冬
阳明病汗多而渴者宜用 竹叶石膏汤
○伤寒谵语
二阳并病潮热谵语大便难宜用 大承气汤
三阳合病头痛燥热自汗谵语者宜用 白虎汤
阳明病恶热狂言而渴者宜用 黄连解毒散
瘀血内结谵语烦躁大便硬宜用 桃仁承气散
○伤寒下利
太阳与阳明合病下利而呕者宜用 葛根半夏汤
阳明病协热而利便脓血者宜用 黄连解毒汤加 犀角 生地黄
少阴病下利清谷脉微而厥者宜用 通脉四逆汤 或白通汤
少阴病下利脓血协寒腹痛脉沉微者宜用 桃花汤
少阴协寒而利如鸭溏者寒也宜用 理中汤 或理中丸
○伤寒发黄
阳明病热结于内小便不利渴而发黄者宜用 茵陈汤 茵陈五苓散 栀子散
阳明病血蓄于内发黄如狂小便多大便黑宜用 桃仁承气汤
○伤寒发
赤 五死一生 黑 十死一生 因下之太早热留胃中阳毒结热在里停留不散宜用 黄连
化汤 黄连橘皮汤 玄参升麻汤 化 汤 紫雪化毒汤
温毒发 乃是冬月受寒至春发病经汗下未解者宜用 黑膏方 发 乃是表虚里实不可用
表药太过恐愈增 烂
○伤寒痞气
病患心下痞满而不痛者宜用 桔梗枳壳汤
痞满而呕发热可用 小柴胡汤 如不愈可用 半夏泻心汤
○伤寒结胸有大小寒热五症
若下之太早心胸高起不按而痛不近手者名大结胸宜用 大陷胸汤
发热胸满按之而痛者名小结胸宜用 小陷胸汤热实烦躁多谵语胸痛名热结宜用 小柴胡
汤加 枳实 黄连
寒实身冷无热胸满而痛名伤寒结胸宜用 理中汤加 枳实 半夏
饮水过多停留不散胸满结头微汗出名水结胸宜用 大陷胸丸
妇人血结胸宜用 小柴胡汤加 枳壳 生地黄 赤芍药
○伤寒呕吐有阴阳二症
阳症呕吐身热烦渴小便赤大便涩掌心热者为胃热宜用 小柴胡汤加 竹茹 竹叶石膏汤
阴症呕吐身冷不渴大便自利不发热宜用 理中汤加 藿香 橘皮半夏茯苓汤 寒甚者宜
用姜附汤加 丁香
○伤寒头汗
阳明病发热头汗出此为热越欲发黄宜用 茵陈汤
阳明病谵语头汗出大便难宜用 承气汤
少阳病五六日头汗出微恶寒心下满宜用 小柴胡汤
○伤寒可与水
伤寒大渴可与水非大渴不可强饮须少与之勿尽意也若强与之为害多矣曰水结曰喘悸曰咳
噎曰呕哕曰肿满此皆水气病也
○伤寒漱水不欲咽
阳明漱水不欲咽是热在经知里无热也必衄血也宜用 犀角地黄汤
血症发狂漱水不咽为热积血蓄于下宜用 桃仁承气汤
○伤寒背恶寒有阴阳二症
阳明背恶寒唇口干燥宜用 白虎汤
少阴背恶寒口中和宜用 附子汤
○伤寒吐血
邪热中三阳热毒留五脏当汗失汗吐血者宜用 犀角地黄汤加 炒栀子
阳症身热吐血大便硬者宜用 三黄泻心汤
○伤寒衄血
太阳病过经不得汗脉紧盛者不可复汗复汗则衄血宜用 竹叶石膏汤加 白茅根 仍用栀
子烧存性同龙骨为末吹鼻孔中
鼻衄不可用辛热药盖血得热则行先须凉血止血然后调理宜用 柏皮生地黄汤 麦门冬饮
或用苑花一把煎汤服亦可
○伤寒潮热（若潮水之潮不失时发于未申二时者是也）
阳明病日晡发潮热谵语大便实者宜用 大承气汤
阳明病便实腹满宜用 大承气汤 大柴胡汤 或小承气汤
○伤寒发热
太阳发热恶寒身痛者宜汗
阳明发热口干目痛者宜用 葛根解肌汤
大便实者宜用 大柴胡汤
少阳发热口苦干呕胁痛者宜用 小柴胡汤
○伤寒腹痛有阴阳二症
阳症腹痛大便秘涩脐下痛往来寒热烦躁作渴此肠中有燥粪宜用 大柴胡汤 或小柴胡汤
加芍药 枳壳
阴症腹痛身不热不渴手足冷大便自利宜用 五积散 或附子理中汤
○伤寒手足厥冷有阴阳二症
阳症厥逆身热头疼小便赤大便秘狂言烦躁手足时温宜用 小柴胡汤加 山栀 大便不通
宜用 大柴胡汤
阴症厥逆身温手足常冷不烦不渴心中宁静或吐利宜用 理中汤加 附子 四逆汤 姜附
汤
○四症类伤寒（痰症 食积 虚烦 香港脚）
痰症憎寒发热恶风自汗胸痞满头不疼寸口脉浮是也宜用 参苏饮 桔梗半夏汤 温胆汤
痰饮停积呕吐恶心背痛气急宜用 二陈汤 导痰汤
食积头疼发热恶寒中脘痞闷呕吐食臭身不痛是也寒多热少者宜用 五积散 治中汤 加
消食药热多腹胀大便难宜用 大柴胡汤 桂枝加大黄汤
虚烦微恶寒发热心烦不寐气逆欲吐头身不痛此虚烦也宜用 竹叶石膏汤 温胆汤加 知
母麦门冬
香港脚憎寒发热自汗恶风腰腿沉重大便硬腿胫肿足酸挛头不痛宜用 香苏槟榔散 败毒散
加木瓜
○伤寒舌胎（舌乃心之苗也色宜红泽不宜黄黑）
伤寒四五日后舌上有胎色白而滑恶寒作呕者宜用 小柴胡汤
阳明病腹满而渴舌上胎黄者可下宜用 大柴胡汤
舌上胎白而滑者邪在表可攻下
舌上有胎干燥而涩者可下
要略曰舌黄未下者下之黄自退舌上黑者热之极也热病唇焦舌黑者死
舌上生胎不拘白黄黑用水浸青布于舌上洗净以生姜片浸时时刮之其胎自退
○伤寒后劳复
大病瘥后遗热不退宜用 小柴胡汤加减用
病后热不退脉实大便硬宜用 大柴胡汤
病后劳役仍前发热者宜用 枳壳栀子汤
瘥后食伤复热胸满者宜用 枳实栀子大黄汤
瘥后阴阳交接劳复者宜用 鼠粪汤 鼠屎豉汤
【背景信息】
书名：医方集宜 作者：丁毅 朝代：明 章节：伤寒作狂 类别：方剂
【原文翻译】
《内经》说：“重阳者狂。”伤寒热邪在胃中，并入于心，致使神志不宁、意志不定，因此出现发狂。起初表现为睡眠少、不思饮食、胡言乱语、狂笑；严重时则登高而歌、脱衣奔走、翻墙爬屋。这都是因为独阳亢极、热势极盛所致，非用峻下法不能制止。也有应当发汗而未发汗，导致瘀热在里，下焦蓄血，出现如狂之状，小便不利，有时像发狂但尚未真正发狂的情况。至于那些胡言乱语、两眼直视、大小便失禁，以及大汗之后又见大热的患者，都属于危重证候。
太阳病，头痛、发热、无汗而喘息，适宜使用麻黄汤；若有汗出，适宜使用桂枝加浓朴杏子汤。
阳明病，汗出、不恶寒、有潮热、腹部胀满而喘息，适宜使用小承气汤。
水气病引起的喘息，形体浮肿且咳嗽，适宜使用小青龙汤。
阴症发作厥逆，脉沉而喘息，适宜使用五味子汤。
发热、恶寒、小便正常，这是表证未解，适宜使用五苓散加天花粉。
不恶寒、发热、烦躁且口渴，适宜使用小柴胡汤加天花粉、麦门冬。
阳明病，汗多而口渴，适宜使用竹叶石膏汤。
二阳并病，有潮热、胡言乱语、大便困难，适宜使用大承气汤。
三阳合病，头痛、燥热、自汗、胡言乱语，适宜使用白虎汤。
阳明病，恶热、胡言乱语且口渴，适宜使用黄连解毒散。
瘀血内结，胡言乱语、烦躁、大便硬，适宜使用桃仁承气散。
太阳与阳明合病，腹泻且呕吐，适宜使用葛根半夏汤。
阳明病，协热下利，大便带脓血，适宜使用黄连解毒汤加犀角、生地黄。
少阴病，下利清谷（完谷不化），脉微细且四肢厥冷，适宜使用通脉四逆汤或白通汤。
少阴病，下利脓血，伴有寒性腹痛，脉沉微，适宜使用桃花汤。
少阴病，协寒下利，大便像鸭粪一样稀薄，这是寒证，适宜使用理中汤或理中丸。
阳明病，热结于内，小便不利，口渴且身体发黄，适宜使用茵陈汤、茵陈五苓散或栀子散。
阳明病，血蓄于内，身体发黄且如狂，小便多、大便黑，适宜使用桃仁承气汤。
赤色斑疹，十死一生；黑色斑疹，十死一生。这是因为攻下太早，热邪留在胃中，阳毒结热在里，停留不散所致。适宜使用黄连化汤、黄连橘皮汤、玄参升麻汤、化斑汤或紫雪化毒汤。
温毒发斑，乃是冬季受寒，至春季发病，经过发汗和攻下后仍未解除的，适宜使用黑膏方。
发斑是由于表虚里实，不可过度使用解表药，恐怕会加重斑烂。
患者心下痞满但不疼痛，适宜使用桔梗枳壳汤。
痞满且呕吐、发热，可用小柴胡汤；如果无效，可用半夏泻心汤。
○ 伤寒结胸，有大结胸、小结胸、寒实结胸、热实结胸、水结胸五种症状
如果攻下太早，心胸高起，不按也痛，手不敢靠近的，名叫大结胸，适宜使用大陷胸汤。
发热、胸部胀满，按压才痛的，名叫小结胸，适宜使用小陷胸汤。
热实、烦躁、多胡言乱语、胸痛，名叫热结胸，适宜使用小柴胡汤加枳实、黄连。
寒实、身冷无热、胸部胀满且痛，名叫伤寒结胸（寒实结胸），适宜使用理中汤加枳实、半夏。
饮水过多，停留不散，胸部胀满，头部微微出汗，名叫水结胸，适宜使用大陷胸丸。
妇人血结胸，适宜使用小柴胡汤加枳壳、生地黄、赤芍药。
阳症呕吐，身热、烦渴、小便赤、大便涩、掌心热，这是胃热，适宜使用小柴胡汤加竹茹，或竹叶石膏汤。
阴症呕吐，身冷、不渴、大便自利、不发热，适宜使用理中汤加藿香、橘皮、半夏、茯苓汤；寒邪严重的，适宜使用姜附汤加丁香。
阳明病，发热且仅头部出汗，这是热邪外越，想要发黄，适宜使用茵陈汤。
阳明病，胡言乱语、头部出汗、大便困难，适宜使用承气汤。
少阳病，五六天头部出汗，轻微恶寒，心下胀满，适宜使用小柴胡汤。
○ 伤寒可与水（关于饮水的注意事项）
伤寒大渴时可以与水，但并非大渴不可强饮，必须少量给予，不要一次性喝尽。如果强行给水，危害很多：会导致水结、喘悸、咳嗽噎膈、呕吐呃逆、肿胀胀满，这些都是水气病。
阳明病，想含水漱口但不想咽下，说明热在经络，知道里没有实热，必然会出现鼻衄（流鼻血），适宜使用犀角地黄汤。
血症发狂，想含水漱口但不咽下，是因为热积血蓄在下焦，适宜使用桃仁承气汤。
阳明病，背部恶寒，嘴唇口干燥，适宜使用白虎汤。
少阴病，背部恶寒，口中感觉平和（不苦不燥），适宜使用附子汤。
邪热侵入三阳，热毒留滞五脏，应当发汗却未发汗而导致吐血的，适宜使用犀角地黄汤加炒栀子。
阳症，身热吐血，大便硬，适宜使用三黄泻心汤。
太阳病，过了病程阶段未能发汗，脉紧盛的，不可再次发汗，若再发汗则会导致衄血。适宜使用竹叶石膏汤加白茅根；仍需用栀子烧存性，同龙骨研为末，吹入鼻孔中。
鼻衄不可用辛热药物，因为血得热则行。先须凉血止血，然后调理。适宜使用柏皮生地黄汤或麦门冬饮；或用苑花一把煎汤服用也可以。
○ 伤寒潮热（如潮水般定时发作的热，不失时机，多在未时和申时发作）
阳明病，日晡（下午3-5点）发潮热，胡言乱语，大便实，适宜使用大承气汤。
阳明病，大便实，腹部胀满，适宜使用大承气汤、大柴胡汤或小承气汤。
太阳病，发热、恶寒、身痛，适宜发汗。
阳明病，发热、口干、目痛，适宜使用葛根解肌汤；大便实者，适宜使用大柴胡汤。
少阳病，发热、口苦、干呕、胁痛，适宜使用小柴胡汤。
阳症腹痛，大便秘涩，脐下痛，往来寒热，烦躁口渴，这是肠中有燥屎，适宜使用大柴胡汤或小柴胡汤加芍药、枳壳。
阴症腹痛，身不热、不渴、手足冷、大便自利，适宜使用五积散或附子理中汤。
阳症厥逆，身热、头疼、小便赤、大便秘、胡言乱语、烦躁，手足有时温暖，适宜使用小柴胡汤加山栀；大便不通者，适宜使用大柴胡汤。
阴症厥逆，身温、手足常冷、不烦不渴、心中宁静，或有吐利，适宜使用理中汤加附子，或四逆汤、姜附汤。
痰症：憎寒发热、恶风、自汗、胸痞闷、头不疼、寸口脉浮，适宜使用参苏饮、桔梗半夏汤或温胆汤。
痰饮停积：呕吐恶心、背痛、气急，适宜使用二陈汤或导痰汤。
食积：头疼、发热、恶寒、中脘痞闷、呕吐有食臭味、身不痛。寒多热少者，适宜使用五积散、治中汤加消食药；热多腹胀、大便难，适宜使用大柴胡汤或桂枝加大黄汤。
虚烦：轻微恶寒发热、心烦不寐、气逆欲吐、头身不痛，这是虚烦，适宜使用竹叶石膏汤或温胆汤加知母、麦门冬。
香港脚（脚气）：憎寒发热、自汗、恶风、腰腿沉重、大便硬、腿胫肿、足酸挛、头不痛，适宜使用香苏槟榔散或败毒散加木瓜。
《舌乃心之苗也，色宜红泽不宜黄黑》。
伤寒四五日后，舌上有胎，色白而滑，恶寒作呕，适宜使用小柴胡汤。
阳明病，腹满而渴，舌上胎黄，可攻下，适宜使用大柴胡汤。
舌上胎白而滑，邪在表，可攻下（注：此处原文逻辑可能有误，通常白滑主寒湿在表或半表半里，但依原文翻译）。
舌上有胎，干燥而涩，可攻下。
《要略》说：舌黄未攻下的，攻下后黄苔自退；舌上黑，是热之极。热病唇焦、舌黑的，预后不良（死证）。
舌上生胎，不拘白色、黄色、黑色，用水浸湿青布擦拭舌面洗净，以生姜片浸渍，时时刮除，其胎自退。
大病痊愈后余热不退，适宜使用小柴胡汤加减。
病后热不退，脉实、大便硬，适宜使用大柴胡汤。
病后因劳役仍前发热，适宜使用枳壳栀子汤。
病后因饮食损伤复发发热，胸满，适宜使用枳实栀子大黄汤。
病后因阴阳交接（房事）劳复，适宜使用鼠粪汤或鼠屎豉汤。
[Background Information]
Book: *Yifang Jiyi* (Collection of Beneficial Medical Prescriptions)
Author: Ding Yi
Dynasty: Ming
Chapter: Shaoyang Madness Caused by Cold Damage
Category: Formulas
[Translation]
The *Neijing* states: "Excess Yang leads to madness." In cold damage, heat pathogens reside in the stomach and merge into the heart, causing the spirit (*Shen*) to be unsettled and will (*Zhi*) to be unstable, thus resulting in madness. Initially, it manifests as little sleep, loss of appetite, delirious speech, and manic laughter; severely, it presents as climbing high and singing, discarding clothes and running, or climbing over walls and roofs. This is due to extreme hyperactivity of solitary Yang and excessive heat, which cannot be stopped without drastic purgation. There are also cases where sweating should have been induced but was not, leading to blood stasis and heat in the interior, with blood accumulation in the lower *Jiao*, presenting as a state resembling madness, with difficult urination, sometimes appearing like madness but not fully reaching that state. As for those who speak deliriously, stare fixedly, and lose control of urination and defecation, or those who exhibit severe heat after profuse sweating, these are all critical conditions.
○ Dyspnea Caused by Cold Damage
In *Taiyang* disease, if there is headache, fever, absence of sweating, and dyspnea, *Mahuang Tang* (Ephedra Decoction) is indicated; if sweating is present, *Guizhi Jia Houpo Zixi Tang* (Cinnamon Twig Decoction with Magnolia Bark and Apricot Seed) is indicated.
In *Yangming* disease, if there is sweating, aversion to cold is absent, tidal fever occurs, abdominal fullness is present, and dyspnea exists, *Xiao Chengqi Tang* (Minor Order the Qi Decoction) is indicated.
For dyspnea caused by water retention, accompanied by edema and cough, *Xiao Qinglong Tang* (Minor Blue Dragon Decoction) is indicated.
In *Yin* syndrome with *Jue* (cold extremities/reversal), if the pulse is deep and dyspnea is present, *Wuweizi Tang* (Schisandra Decoction) is indicated.
○ Thirst Caused by Cold Damage
If there is fever, aversion to cold, and normal urination, this indicates the exterior pattern has not resolved; *Wuling San* (Five-Ling Powder) with *Tianhuafen* (Trichosanthes Root) is indicated.
If there is no aversion to cold, fever, irritability, and thirst, *Xiao Chaihu Tang* (Minor Bupleurum Decoction) with *Tianhuafen* (Trichosanthes Root) and *Mendong* (Ophiopogon Tuber) is indicated.
In *Yangming* disease, if there is profuse sweating and thirst, *Zhuye Shigao Tang* (Bamboo Leaf and Gypsum Decoction) is indicated.
○ Delirium Caused by Cold Damage
In combined diseases of two *Yang* meridians, if there is tidal fever, delirium, and difficulty in defecation, *Da Chengqi Tang* (Major Order the Qi Decoction) is indicated.
In combined diseases of three *Yang* meridians, if there is headache, dryness and heat, spontaneous sweating, and delirium, *Baitu Tang* (White Tiger Decoction) is indicated.
In *Yangming* disease, if there is aversion to heat, delirious speech, and thirst, *Huanglian Jiedu San* (Coptis Detoxification Powder) is indicated.
If blood stasis is bound internally, causing delirium, irritability, and hard stool, *Taoren Chengqi San* (Peach Kernel Order the Qi Powder) is indicated.
○ Diarrhea Caused by Cold Damage
In combined diseases of *Taiyang* and *Yangming*, if there is diarrhea and vomiting, *Gegen Banxia Tang* (Kudzu and Pinellia Decoction) is indicated.
In *Yangming* disease, if there is diarrhea with heat, and pus and blood in the stool, *Huanglian Jiedu Tang* (Coptis Detoxification Decoction) with *Xijiao* (Rhinoceros Horn - *Note: Substitute with Buffalo Horn in modern practice*) and *Shengdihuang* (Rehmannia Root) is indicated.
In *Shaoyin* disease, if there is diarrhea with undigested food, faint pulse, and cold extremities, *Tongmai Sini Tang* (Pulse-Recovering Counterflow Cold Decoction) or *Baitong Tang* (White Through Decoction) is indicated.
In *Shaoyin* disease, if there is diarrhea with pus and blood, cold pain in the abdomen, and deep, faint pulse, *Taohua Tang* (Peach Blossom Decoction) is indicated.
In *Shaoyin* disease, if there is diarrhea with cold characteristics resembling duck droppings, indicating a cold pattern, *Lizhong Tang* (Middle-Warming Decoction) or *Lizhong Wan* (Middle-Warming Pill) is indicated.
○ Jaundice Caused by Cold Damage
In *Yangming* disease, if heat is bound internally, urination is difficult, thirst is present, and jaundice develops, *Yinchen Tang* (Artemisia Capillaris Decoction), *Yinchen Wuling San* (Artemisia Capillaris Five-Ling Powder), or *Zhizi San* (Gardenia Powder) is indicated.
In *Yangming* disease, if blood is accumulated internally, causing jaundice and a manic state, with frequent urination and black stool, *Taoren Chengqi Tang* (Peach Kernel Order the Qi Decoction) is indicated.
○ Eruption (Macules/Papules) Caused by Cold Damage
Red eruptions indicate one survivor out of ten deaths; black eruptions indicate one survivor out of ten deaths. This occurs because purgation was performed too early, leaving heat in the stomach, with Yang toxicity binding heat in the interior, lingering and not dispersing. *Huanglian Hua Tang* (Coptis Transformation Decoction), *Huanglian Jupi Tang* (Coptis and Tangerine Peel Decoction), *Xuanshen Shengma Tang* (Scrophularia and Cimicifuga Decoction), *Huaban Tang* (Eruption Resolution Decoction), or *Zixue Huadu Tang* (Purple Snow Detoxification Decoction) are indicated.
Warm toxicity causing eruptions results from cold contracted in winter manifesting in spring, unresolved after sweating and purgation; *Heigao Fang* (Black Ointment Formula) is indicated.
Eruptions result from deficiency of the exterior and excess in the interior; excessive use of exterior-releasing drugs should be avoided to prevent worsening the erosion of the skin.
○ Stagnant Qi (Plugged Sensation) Caused by Cold Damage
If the patient experiences a plugged sensation in the epigastrium without pain, *Jiegeng Zhike Tang* (Platycodon and Aurantium Decoction) is indicated.
If there is plugged sensation, vomiting, and fever, *Xiao Chaihu Tang* (Minor Bupleurum Decoction) can be used; if ineffective, *Banxia Xiexin Tang* (Pinellia Heart-Draining Decoction) can be used.
○ Chest Binding (Jie Xiong) Caused by Cold Damage, with Five Types: Major, Minor, Cold-Excess, Heat-Excess, and Water Binding
If purgation was performed too early, causing the chest and heart region to bulge upward, painful even without pressure, and intolerant to touch, it is named Major Chest Binding; *Da Xianxiong Tang* (Major Trap the Chest Decoction) is indicated.
If there is fever, chest fullness, and pain upon pressure, it is named Minor Chest Binding; *Xiao Xianxiong Tang* (Minor Trap the Chest Decoction) is indicated.
If there is heat-excess, irritability, frequent delirium, and chest pain, it is named Heat-Binding; *Xiao Chaihu Tang* (Minor Bupleurum Decoction) with *Zhishi* (Aurantium Fruit) and *Huanglian* (Coptis Rhizome) is indicated.
If there is cold-excess, cold body without fever, chest fullness, and pain, it is named Cold-Binding (Cold-Excess Chest Binding); *Lizhong Tang* (Middle-Warming Decoction) with *Zhishi* (Aurantium Fruit) and *Banxia* (Pinellia Tuber) is indicated.
If excessive water intake remains stagnant, causing chest fullness and slight sweating on the head, it is named Water-Binding; *Da Xianxiong Wan* (Major Trap the Chest Pill) is indicated.
For Blood-Binding in women, *Xiao Chaihu Tang* (Minor Bupleurum Decoction) with *Zhike* (Aurantium Fruit), *Shengdihuang* (Rehmannia Root), and *Chishao* (Red Peony Root) is indicated.
○ Vomiting Caused by Cold Damage, with Yin and Yang Syndromes
In Yang syndrome vomiting, if there is fever, irritability, thirst, red urine, constipation, and hot palms, this is Stomach Heat; *Xiao Chaihu Tang* (Minor Bupleurum Decoction) with *Zhuru* (Bamboo Shavings) or *Zhuye Shigao Tang* (Bamboo Leaf and Gypsum Decoction) is indicated.
In Yin syndrome vomiting, if there is cold body, no thirst, free defecation, and no fever, *Lizhong Tang* (Middle-Warming Decoction) with *Huoxiang* (Patchouli), *Jupi* (Tangerine Peel), *Banxia* (Pinellia Tuber), and *Fuling* (Poria) is indicated; for severe cold, *Jiangfu Tang* (Ginger and Aconite Decoction) with *Dingxiang* (Clove) is indicated.
○ Head Sweating Caused by Cold Damage
In *Yangming* disease, if there is fever and only head sweating, this indicates heat venting outward, potentially leading to jaundice; *Yinchen Tang* (Artemisia Capillaris Decoction) is indicated.
In *Yangming* disease, if there is delirium, head sweating, and difficulty in defecation, *Chengqi Tang* (Order the Qi Decoction) is indicated.
In *Shaoyang* disease, on the fifth or sixth day, if there is head sweating, slight aversion to cold, and epigastric fullness, *Xiao Chaihu Tang* (Minor Bupleurum Decoction) is indicated.
○ Administration of Water in Cold Damage
When a patient with cold damage is extremely thirsty, water may be given. However, do not force drinking if not extremely thirsty; give small amounts frequently and do not allow them to drink their fill. Forcing water causes harm, leading to water-binding, palpitations with dyspnea, coughing and choking, vomiting and hiccups, and swelling/fullness. These are all Water-Qi diseases.
○ Rinsing Mouth Without Swallowing in Cold Damage
In *Yangming* disease, rinsing the mouth without swallowing indicates heat in the channels and no heat in the interior; epistaxis (nosebleed) is likely; *Xijiao Dihuang Tang* (Rhinoceros Horn and Rehmannia Decoction) is indicated.
In blood disorders with mania, rinsing the mouth without swallowing indicates heat accumulation and blood stasis in the lower burner; *Taoren Chengqi Tang* (Peach Kernel Order the Qi Decoction) is indicated.
○ Aversion to Cold on the Back Caused by Cold Damage, with Yin and Yang Syndromes
In *Yangming* disease, if there is aversion to cold on the back and dry lips/mouth, *Baitu Tang* (White Tiger Decoction) is indicated.
In *Shaoyin* disease, if there is aversion to cold on the back and a neutral sensation in the mouth, *Fuzi Tang* (Aconite Decoction) is indicated.
○ Hematemesis (Vomiting Blood) Caused by Cold Damage
If evil heat enters the three *Yang* meridians and heat toxin lodges in the five Zang organs, and hematemesis occurs due to missed sweating, *Xijiao Dihuang Tang* (Rhinoceros Horn and Rehmannia Decoction) with fried *Zhizi* (Gardenia Fruit) is indicated.
In Yang syndrome, if there is fever, hematemesis, and hard stool, *Sanhuang Xiexin Tang* (Three-Yellow Heart-Draining Decoction) is indicated.
○ Epistaxis (Nosebleed) Caused by Cold Damage
In *Taiyang* disease, if the course has passed without sweating and the pulse is tight and full, do not induce sweating again; doing so will cause epistaxis. *Zhuye Shigao Tang* (Bamboo Leaf and Gypsum Decoction) with *Baimaogen* (Imperata Rhizome) is indicated; additionally, charred *Zhizi* (Gardenia Fruit) mixed with *Longgu* (Fossilized Bone) as powder can be insufflated into the nostrils.
For epistaxis, acrid-warm herbs must not be used, as blood flows when heated. First, cool the blood and stop bleeding, then regulate. *Baipi Shengdihuang Tang* (Phellodendron and Rehmannia Decoction) or *Mendong Yin* (Ophiopogon Drink) is indicated; alternatively, decocting *Yuanhua* (Genkwa Flower) in water for oral administration is also effective.
○ Tidal Fever Caused by Cold Damage (Fever occurring at regular times, like the tide, typically in Wei and Shen hours [1 PM - 7 PM])
In *Yangming* disease, if tidal fever occurs at dusk (You hour, 5-7 PM), accompanied by delirium and solid stool, *Da Chengqi Tang* (Major Order the Qi Decoction) is indicated.
In *Yangming* disease, if there is solid stool and abdominal fullness, *Da Chengqi Tang* (Major Order the Qi Decoction), *Da Chaihu Tang* (Major Bupleurum Decoction), or *Xiao Chengqi Tang* (Minor Order the Qi Decoction) is indicated.
○ Fever Caused by Cold Damage
In *Taiyang* fever with aversion to cold and body pain, sweating (diaphoresis) is indicated.
In *Yangming* fever with dry mouth and eye pain, *Gegen Jiemo Tang* (Kudzu Muscle-Relieving Decoction) is indicated; if stool is solid, *Da Chaihu Tang* (Major Bupleurum Decoction) is indicated.
In *Shaoyang* fever with bitter taste, dry throat, retching, and hypochondriac pain, *Xiao Chaihu Tang* (Minor Bupleurum Decoction) is indicated.
○ Abdominal Pain Caused by Cold Damage, with Yin and Yang Syndromes
In Yang syndrome abdominal pain, if there is constipation, pain below the umbilicus, alternating chills and fever, irritability, and thirst, this indicates dry feces in the intestines; *Da Chaihu Tang* (Major Bupleurum Decoction) or *Xiao Chaihu Tang* (Minor Bupleurum Decoction) with *Shaoyao* (Peony Root) and *Zhike* (Aurantium Fruit) is indicated.
In Yin syndrome abdominal pain, if there is no fever, no thirst, cold extremities, and free defecation, *Wuji San* (Five-Accumulations Powder) or *Fuzi Lizhong Tang* (Aconite Middle-Warming Decoction) is indicated.
○ Cold Extremities Caused by Cold Damage, with Yin and Yang Syndromes
In Yang syndrome *Jue* (reversal/cold extremities), if there is fever, headache, red urine, constipation, delirium, irritability, and hands/feet that are occasionally warm, *Xiao Chaihu Tang* (Minor Bupleurum Decoction) with *Shanzhi* (Gardenia Fruit) is indicated; if stool is blocked, *Da Chaihu Tang* (Major Bupleurum Decoction) is indicated.
In Yin syndrome *Jue*, if the body is warm, hands/feet are constantly cold, there is no irritability or thirst, the mind is calm, or there is vomiting/diarrhea, *Lizhong Tang* (Middle-Warming Decoction) with *Fuzi* (Aconite Root), or *Sini Tang* (Counterflow Cold Decoction) or *Jiangfu Tang* (Ginger and Aconite Decoction) is indicated.
○ Four Conditions Resembling Cold Damage (Phlegm Disorder, Food Retention, Deficiency Irritability, Hong Kong Foot/Jiaqi)
Phlegm Disorder: Characterized by aversion to cold with fever, aversion to wind, spontaneous sweating, epigastric plugged sensation, no headache, and floating pulse at the Cun position. *Shensu Yin* (Ginseng and Perilla Drink), *Jiegeng Banxia Tang* (Platycodon and Pinellia Decoction), or *Wendan Tang* (Gallbladder-Warming Decoction) are indicated.
Phlegm-Fluid Accumulation: Characterized by vomiting, nausea, back pain, and shortness of breath. *Erchen Tang* (Two-Aged Decoction) or *Daotan Tang* (Great Phlegm Decoction) is indicated.
Food Retention: Characterized by headache, fever, aversion to cold, epigastric plugged sensation, vomiting with food odor, and no body pain. If cold exceeds heat, *Wuji San* (Five-Accumulations Powder) or *Zhizhong Tang* (Middle-Sustaining Decoction) with digestive herbs is indicated; if heat exceeds cold, with abdominal distension and difficult defecation, *Da Chaihu Tang* (Major Bupleurum Decoction) or *Guizhi Jia Dahuang Tang* (Cinnamon Twig with Rhubarb Decoction) is indicated.
Deficiency Irritability: Characterized by slight aversion to cold and fever, irritability, insomnia, rebellious Qi with urge to vomit, and no headache/body pain. This is deficiency irritability; *Zhuye Shigao Tang* (Bamboo Leaf and Gypsum Decoction) or *Wendan Tang* (Gallbladder-Warming Decoction) with *Zhimu* (Anemarrhena Rhizome) and *Mendong* (Ophiopogon Tuber) is indicated.
Hong Kong Foot (Jiaqi): Characterized by aversion to cold with fever, spontaneous sweating, aversion to wind, heavy waist/legs, hard stool, swollen calves, sore/spasmodic feet, and no headache. *Xiangsu Binglang San* (Perilla and Areca Nut Powder) or *Baidu San* (Detoxify Hundred Powders) with *Mugua* (Chaenomeles Fruit) is indicated.
○ Tongue Coating in Cold Damage
"The tongue is the sprout of the heart; its color should be red and lustrous, not yellow or black."
After four or five days of cold damage, if there is a white, slippery coating, aversion to cold, and vomiting, *Xiao Chaihu Tang* (Minor Bupleurum Decoction) is indicated.
In *Yangming* disease, if there is abdominal fullness, thirst, and a yellow coating, purgation is appropriate; *Da Chaihu Tang* (Major Bupleurum Decoction) is indicated.
If the coating is white and slippery, the pathogen is in the exterior, and purgation may be considered (Note: Context implies resolving exterior via specific methods).
If the coating is dry and rough, purgation is appropriate.
The *Jingyao* states: If the tongue is yellow and purgation has not been used, purgation will make the yellow coating recede. A black coating indicates extreme heat. In heat diseases, cracked lips and black tongue indicate death.
For any tongue coating (white, yellow, or black), rinse the tongue with water using a wet blue cloth, then scrape gently with soaked ginger slices until the coating recedes.
○ Recurrence Due to Overexertion After Cold Damage
If residual heat persists after recovery from a major illness, modify and use *Xiao Chaihu Tang* (Minor Bupleurum Decoction).
If fever persists after illness, with a solid pulse and hard stool, *Da Chaihu Tang* (Major Bupleurum Decoction) is indicated.
If fever recurs due to labor/exertion after illness, *Zhike Zhizi Tang* (Aurantium and Gardenia Decoction) is indicated.
If fever recurs due to dietary injury after illness, with epigastric fullness, *Zhishi Zhizi Dahuang Tang* (Aurantium, Gardenia, and Rhubarb Decoction) is indicated.
If recurrence occurs due to sexual intercourse (Yin-Yang connection) after illness, *Shufen Tang* (Mouse Feces Decoction) or *Shushi Chi Tang* (Mouse Feces and Fermented Soybean Decoction) is indicated.