趺阳脉浮而涩，少阴脉如经者，其病在脾，法当下利。何以知之？若脉浮大者，气实血虚也。今趺阳脉浮而
弦，故知脾气不足，胃气虚也。以少阴脉弦而浮才见。此为调脉，故称如经也。若反滑而数者，故知当屎脓也。
按∶若脉浮大者，气实血虚也二句，与上下文义不属，当删之。
少阴脉弦而浮，岂可谓如经乎？当改沉滑二字。（《医宗金鉴》）
问曰∶翕奄沉，名曰滑。何谓也？师曰∶沉为纯阴，翕为正阳，阴阳和合，故令脉滑。关尺自平，阳明脉微沉，
食饮自可，少阴脉微滑，滑者紧之浮名也，此为阴实。其人必股内汗出，阴下湿也。
按∶滑者，紧之浮名也。此为阴实二句，与上下文义不属，当是错简。（《医宗金鉴》）
太阳病，小便利者，以饮水多，必心下悸；小便少者，必苦里急也。
以饮水多，接太阳病句。小便利者，接下句。（吴灵稚）
发汗后，不可更行桂枝汤，无汗而喘，（旧本有无字）大热者，可与麻黄杏仁甘草石膏汤。
下后，不可更行桂枝汤；若无汗而喘，大热者，可与麻黄杏仁甘草石膏汤。
二条无字，旧本讹在大热上。前辈因循不改，随文衍义，为后学之迷途。仲景每于汗下后，表不解者，用
桂枝更汗，而不用麻黄。此则内外皆热，而不恶寒，必其用麻黄汤后，寒解而热反甚，与发汗解、半日许复烦、
下后而微喘者不同。发汗而不得汗，或下之而仍不汗，喘不止，其阳气重者，若与桂枝加浓朴杏仁汤，下咽即
毙矣。故于麻黄汤去桂枝之辛热，加石膏之辛寒，佐麻黄而发汗，助杏仁以定喘。一加一减，温解之方，转为
凉散之剂矣。（柯韵伯）
伤寒，吐下后，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。
按∶八九日心下痞硬、胁下痛、气上冲咽喉三句，与上下文义不属。注家皆因有此三句，不得不支离蔓
衍，牵强解释。每见此病，总因汗出过多，大伤津液而成，当用补气、补血、益筋、壮骨之药，经年始愈。三
句必是错简，当删之。（《医宗金鉴》）
伤寒发热，啬啬恶寒，大渴欲饮水，其腹必满，自汗出，小便利，其病欲愈，此肝乘肺也，名曰横，刺期门。
此肝乘肺，读当在腹必满之下；自汗出小便利，当在刺期门之下。（吴灵稚）
太阳病，寸缓、关浮、尺弱，其人发热，汗出，复恶寒，不呕，但心下痞者，此以医下之也。如其不下者，病
人不恶寒而渴者，此转属阳明也。小便数者，大便必硬，不更衣十日无所苦也。渴欲饮水，少少与饮之。但以
法救之，渴者，宜五苓散。
但以法救之一节，读当在医下之也之下。（吴灵稚）
阳明病，脉浮而紧，咽燥口苦，腹满而喘，发热汗出，不恶寒，反恶热，身重。若发汗则躁，心愦愦，反谵语。
若加烧针，必怵惕烦躁不得眠。若下之，则胃中空虚，客气动膈，心中懊 。舌上苔者，栀子豉汤主之。
心中懊 一节，读当在身重之下。（吴灵稚）
阳明病，脉浮而紧，咽燥口苦，腹满而喘，发热汗出，不恶寒，反恶热，身重，此处当接栀子豉汤主之
句。若发汗三段，因不用此方，而妄治所致。仍当栀子豉汤主之。仲景但于结句一见，是省文法也。后人竟认
栀子豉汤为汗、下救逆之剂，否则未汗、下前，仲景何法以治之乎？（柯韵伯）
病患无表里证，发热七八日，虽脉浮数者，可下之。假令已下，脉数不解，合热则消谷善饥，至六七日不大便
者，有瘀血也，宜抵当汤。若脉数不解，而下利不止，必协热而便脓血也。
若脉数已下，读当在可下之之下。（吴灵稚）
伤寒，四五日，脉沉而喘满。沉为在里，而反发其汗，津液越出，大便则难。表虚里实，久则谵语。
表虚里实一句，读当在沉为在里之下。（吴灵稚）
汗出谵语者，以有燥屎在胃中，此为风也。须下之，过经乃可下之下；之若早，语言必乱，以表虚里实故也。
下之则愈，宜
大承气汤。
以表虚里实故也句，宜安在乃可下之句下。（程郊倩）
须下之接胃中句，下之则愈接须下之句。（吴灵稚）
下之则愈宜大承气汤九字，当在过经乃可下之之下，不当在于章末。观前章谵语燥屎，不云大承气汤下
之，而云须下之，须字意义，欲而尚未也。至此，语言必乱。下早，表邪乘虚入胃故耳，反用大承气下之乎？（方咫园）
阳明病，谵语，有潮热，反不能食者，胃中必有燥屎五六枚也。宜大承气汤下之，若能食者，但硬耳。
按∶宜大承气汤下之句，应在必有燥屎五六枚之下始合。若但便硬，即用大承气汤下之，殊失仲景慎重
误下之旨，当移之。（《医宗金鉴》）
宜大承气汤下之，旧在但硬尔下，今正之。（《伤寒缵论》）
阳明病，下之，心中懊 而烦，胃中有燥屎者，可攻之。腹微满，初头硬，后必溏，不可攻之。若有燥屎者，
宜大承气汤。
末二句乃申上节，以决治意。（方中行）
阳明病，下之，心中懊 而烦，胃中有燥屎者，可攻之，宜大承气汤。腹微满，初头硬，后必溏，不可攻之。
下后心中懊 而烦，栀子豉证。若腹大满不通，是胃中燥屎上攻也；若微满，犹是栀子浓朴汤证。（柯韵伯）
三阳合病，腹满身重，难以转侧，口不仁而面垢，谵语遗尿。若发汗则谵语，下之则额上生汗、手足逆冷。
若自汗出者，白虎汤主之。
若自汗出一节，读当在遗尿之下。（吴灵稚）
太阴之为病，腹满而吐，食不下，自利益甚，时腹自痛。若下之，必胸下结硬。
食不下，当接有自利句；自利益甚，当在末句。（吴灵稚）
按∶吴人驹曰∶自利益甚四字，当在必胸下结硬句之下，其说
甚是。若在吐食不下句之下，则是已吐食不下，而自利益甚矣。仲景复曰若下之，无所谓也。（《医宗金鉴》）
少阴病，欲吐不吐，心烦，但欲寐，五六日自利而渴者，属少阴也，虚故饮水自救。若小便色白者，少阴病
形悉具。小便白者，以下焦虚有寒，不能制水，故令色白也。
属少阴句，当在欲寐之下。（吴灵稚）
伤寒，发热四日，厥反三日，复热四日；厥少热多，其病当愈。四日至七日热不除者，其后必便脓血。
复热四日句，语意在其病当愈下。（柯韵伯）
趺阳脉（足背动脉，候脾胃之气）浮而涩，少阴脉（尺部脉，候肾气）如同正常经脉的脉象，这是病在脾，按照法度应当出现下利。为什么这样知道？如果脉象浮大，那是气实血虚。现在趺阳脉浮而弦，所以知道是脾气不足，胃气虚弱。因为少阴脉弦而浮，刚刚显现出来。这属于调和之脉，所以称为如经（像正常的经脉一样）。如果反而出现滑而数的脉象，所以知道应当排出脓血便。
按语：若脉浮大者，气实血虚也这两句，与上下文义不连贯，应当删去。
少阴脉弦而浮，怎么能说是如经（正常）呢？应当改为“沉滑”二字。（《医宗金鉴》）
问曰：脉象忽聚忽散、忽隐忽现，名为滑脉。这是什么意思？老师说：沉脉属纯阴，翕脉（轻取即得，如羽毛触肤）属正阳，阴阳和合，所以使脉象呈现滑利之态。关脉和尺脉自然平和，阳明脉（右关脉）微沉，饮食自然正常；少阴脉（左尺脉）微滑，滑脉是紧脉的浮象表现，这属于阴实。此人必定大腿内侧出汗，外阴潮湿。
按语：滑者，紧之浮名也。此为阴实这两句，与上下文义不连贯，应当是简牍错乱所致。（《医宗金鉴》）
太阳病（外感风寒初期证候），小便通利的，是因为饮水过多，必然导致心下悸动；小便少的，必然感到小腹急迫难受。
以“饮水多”，承接“太阳病”一句。“小便利者”，接下句。（吴灵稚）
发汗后，不可再用桂枝汤（解肌发表方），若无汗且气喘，（旧版书籍中是否有“无”字存在争议）高热者，可以给予麻黄杏仁甘草石膏汤（辛凉宣泄，清肺平喘方）。
攻下后，不可再用桂枝汤；若无汗且气喘，高热者，可以给予麻黄杏仁甘草石膏汤。
两条文中缺失的“无”字，旧版书籍错误地放在“大热”之上。前辈沿袭不改，顺着文意引申解释，成为后学者的迷途。张仲景通常在发汗或攻下后，表证未解者，用桂枝汤再次发汗，而不用麻黄汤。此条则是内外皆热，且不恶寒，必定是在使用麻黄汤后，寒邪已解但热势反而加重，这与发汗后不得汗出，或半日许又烦，以及攻下后轻微气喘的情况不同。发汗却得不到汗出，或者攻下后仍然无汗，气喘不止，其阳气郁闭较重者，如果给予桂枝加浓朴杏仁汤，喝下去就会致死。所以在麻黄汤中去掉桂枝的辛热，加入石膏的辛寒，辅助麻黄发汗，帮助杏仁定喘。一加一减，温散之方，转变为凉散之剂了。（柯韵伯）
伤寒，经过吐法、下法后，再发汗，出现虚烦，脉象非常微弱，八九天后出现心下痞硬、胁下痛、气上冲咽喉、眩晕昏冒、经脉跳动惕惧的症状，时间久了会形成痿证。
按语：“八九日心下痞硬、胁下痛、气上冲咽喉”这三句，与上下文义不连贯。注家都因为有三句存在，不得不支离破碎、蔓衍解释，牵强附会。每次见到这种病，总因出汗过多，大伤津液而成，应当使用补气、补血、益筋、壮骨的药物，经过一年才能痊愈。这三句必定是错简，应当删去。（《医宗金鉴》）
伤寒发热，啬啬恶寒（怕冷貌），大渴想喝水，腹部必然胀满，自汗出，小便通利，病情将要痊愈，这是肝木乘肺金，名叫“横”，刺期门穴（肝之募穴）。
此“肝乘肺”，读序应当在“腹必满”之下；“自汗出小便利”，应当在“刺期门”之下。（吴灵稚）
太阳病，寸脉缓、关脉浮、尺脉弱，其人发热，汗出，又恶寒，不呕吐，只是心下痞塞，这是因为医生误用下法所致。如果不曾下法，病人不恶寒而口渴的，这是转属阳明病。小便频数者，大便必然干硬，即使十天不大便也没有痛苦。想喝水，少量多次给予饮水。只要依法救治，口渴者，适宜用五苓散（化气行水方）。
“但以法救之”一节，读序应当在“医下之也”之下。（吴灵稚）
阳明病（里热实证），脉浮而紧，咽燥口苦，腹部胀满而喘，发热汗出，不恶寒，反恶热，身体沉重。如果发汗，则会出现烦躁，心中烦闷懊恼，反而谵语（胡言乱语）。如果加用烧针（温针灸），必定惊恐不安、烦躁不得眠。如果攻下，则胃中空虚，客气（邪气）扰动膈间，心中懊恼。舌上有苔者，栀子豉汤（清热除烦方）主治。
“心中懊恼”一节，读序应当在“身重”之下。（吴灵稚）
阳明病，脉浮而紧，咽燥口苦，腹部胀满而喘，发热汗出，不恶寒，反恶热，身体沉重，此处应当接“栀子豉汤主之”一句。若发汗三段文字，是因为没有使用此方，而妄治所致。仍然应当用栀子豉汤主治。张仲景只在结尾处一见，这是省文的写法。后人竟然认为栀子豉汤是发汗、攻下后的救逆之剂，否则在未发汗、攻下前，张仲景用什么方法治疗呢？（柯韵伯）
病患没有表证和里证，发热七八天，虽然脉象浮数，可以用下法。假如已经用了下法，脉数不解，合并热邪则消谷善饥（容易饥饿），到了六七天不大便的，有瘀血，适宜抵当汤（破血逐瘀方）。如果脉数不解，而下利不止，必定协热而便脓血。
“若脉数已下”，读序应当在“可下之”之下。（吴灵稚）
伤寒，四五日，脉沉而喘满。沉脉主病在里，反而发其汗，津液越出体外，大便则困难。表虚里实，时间久了会谵语。
“表虚里实”一句，读序应当在“沉为在里”之下。（吴灵稚）
汗出且谵语的，是因为胃中有燥屎，这是风邪所致。必须攻下，但需过经（度过本经病程）才可以攻下；如果过早攻下，语言必定错乱，因为表虚里实的缘故。攻下后则痊愈，宜用大承气汤（峻下热结方）。
“以表虚里实故也”句，适宜安放在“乃可下之”句之下。（程郊倩）
“须下之”接“胃中”句，“下之则愈”接“须下之”句。（吴灵稚）
“下之则愈宜大承气汤”九个字，应当在“过经乃可下之”之下，不应当在章节末尾。看前一章谵语燥屎，不说用大承气汤下之，而说“须下之”，“须”字的意义，是想下而尚未下。至此，语言错乱。下法过早，表邪乘虚入胃的缘故，反而用大承气汤攻下吗？（方咫园）
阳明病，谵语，有潮热，反而不能食的，胃中必有燥屎五六枚。宜用大承气汤攻下，如果能食的，只是大便硬罢了。
按语：“宜大承气汤下之”句，应当在“必有燥屎五六枚”之下才合理。如果只是大便硬，就用大承气汤攻下，特别违背了张仲景慎重避免误下的宗旨，应当移动位置。（《医宗金鉴》）
“宜大承气汤下之”，旧版在“但硬尔”之下，现在纠正。（《伤寒缵论》）
阳明病，攻下后，心中懊恼而烦，胃中有燥屎者，可以攻之。腹部微满，初头硬，后必溏，不可攻之。如果有燥屎者，宜用大承气汤。
末两句是申述上节内容，以决定治疗意图。（方中行）
阳明病，攻下后，心中懊恼而烦，胃中有燥屎者，可以攻之，宜用大承气汤。腹部微满，初头硬，后必溏，不可攻之。
攻下后心中懊恼而烦，是栀子豉汤证。如果腹部大满不通，是胃中燥屎上攻；如果微满，还是栀子厚朴汤证。（柯韵伯）
三阳合病（太阳、阳明、少阳三经同时发病），腹部胀满，身体沉重，难以翻身，口不知味而面部污垢，谵语遗尿。如果发汗则谵语，攻下则额上生汗、手足逆冷。
如果自汗出的，白虎汤（清热生津方）主治。
“若自汗出”一节，读序应当在“遗尿”之下。（吴灵稚）
太阴病（脾虚寒湿证），腹部胀满而呕吐，饮食不下，自利（腹泻）日益严重，时常腹部自痛。如果攻下，必然胸下结硬。
“食不下”，应当接在有“自利”句之后；“自利益甚”，应当在最后一句。（吴灵稚）
按语：吴人驹说：“自利益甚”四字，应当在“必胸下结硬”句之下，这种说法很正确。如果在“吐食不下”句之下，那就是已经呕吐、食不下，而自利更加严重了。张仲景又说“若下之”，就没有意义了。（《医宗金鉴》）
少阴病（心肾虚衰证），想吐吐不出，心烦，只想睡觉，五六天后自利而口渴的，属于少阴病，因虚故饮水自救。如果小便颜色白的，少阴病的形证全部具备。小便白者，是因为下焦虚寒，不能制约水液，所以令颜色白。
“属少阴”句，应当在“欲寐”之下。（吴灵稚）
伤寒，发热四天，厥冷反而三天，又发热四天；厥冷少发热多，病情应当痊愈。从第四天到第七天热不退的，其后必定便脓血。
“复热四天”句，语意在其“其病当愈”之下。（柯韵伯）
The Fuyang pulse (radial artery at the dorsum of the foot, reflecting Spleen and Stomach Qi) is floating and choppy; the Shaoyin pulse (radial pulse at the cun position, reflecting Kidney Qi) resembles that of a normal meridian. The disease resides in the Spleen; according to the principles, diarrhea should occur. How do we know this? If the pulse were floating and large, it would indicate excess Qi and deficient Blood. Now, since the Fuyang pulse is floating and wiry, we know that Spleen Qi is insufficient and Stomach Qi is weak. Because the Shaoyin pulse is wiry and floating, appearing only slightly, this constitutes a harmonious pulse, hence it is called "like a normal meridian." If instead the pulse were slippery and rapid, we would know that pus and blood would appear in the stool.
Note: The two sentences "If the pulse were floating and large, it would indicate excess Qi and deficient Blood" do not align with the context and should be deleted.
How can a Shaoyin pulse that is wiry and floating be considered "normal"? It should be amended to "deep and slippery." (*Yi Zong Jin Jian*)
Question: A pulse that gathers and disperses suddenly, appearing and disappearing intermittently, is named Slippery Pulse. What does this mean? The Master said: Deep pulse belongs to pure Yin; Xi pulse (light touch yields sensation like a feather touching skin) belongs to correct Yang. When Yin and Yang harmonize, the pulse becomes slippery. The Guan and Chi pulses are naturally balanced; the Yangming pulse (right Guan pulse) is slightly deep, indicating normal appetite and digestion; the Shaoyin pulse (left Chi pulse) is slightly slippery. Slippery pulse is the floating manifestation of a Wiry pulse; this indicates Yin Excess. Such a person will surely have sweating on the inner thighs and dampness in the external genitalia.
Note: The two sentences "Slippery pulse is the floating manifestation of a Wiry pulse. This indicates Yin Excess" do not align with the context and are likely due to bamboo slip dislocation. (*Yi Zong Jin Jian*)
In Taiyang disease (early stage of exterior cold-heat disorder), if urination is free, it is because excessive water intake has occurred, inevitably leading to palpitations in the epigastrium; if urination is scanty, there will surely be distressing urgency in the lower abdomen.
"Excessive water intake" connects to the sentence "Taiyang disease." "Free urination" connects to the following sentence. (Wu Lingzhi)
After inducing sweating, Guizhi Tang (Cinnamon Twig Decoction) must not be used again. If there is no sweat accompanied by wheezing, (there is textual debate regarding the presence of the character "no" in old editions) and high fever, Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) may be administered.
After purgation, Guizhi Tang must not be used again; if there is no sweat accompanied by wheezing and high fever, Mahuang Xingren Gancao Shigao Tang may be administered.
The missing character "no" in these two passages was erroneously placed before "high fever" in old editions. Predecessors followed suit without correction, extending the meaning along with the text, leading later learners astray. Zhang Zhongjing usually employs Guizhi Tang for further sweating when the exterior syndrome remains unresolved after sweating or purgation, rather than using Mahuang Tang. In this case, however, there is heat both inside and outside, without aversion to cold. This必定 follows the use of Mahuang Tang, where the cold pathogen has resolved but heat intensifies. This differs from cases where sweating fails to produce sweat, or restlessness returns after half a day, or slight wheezing occurs after purgation. If sweating fails to produce sweat, or purgation still results in no sweat, with persistent wheezing and heavy stagnation of Yang Qi, administering Guizhi Jia Houpo Xingren Tang (Guizhi Tang plus Magnolia Bark and Apricot Kernel) would be fatal upon ingestion. Therefore, in Mahuang Tang, the acrid-hot Guizhi is removed, and the acrid-cool Shigao (Gypsum) is added to assist Mahuang in inducing sweating and help Xingren calm wheezing. One addition and one subtraction transform a warm-releasing formula into a cool-releasing agent. (Ke Yunbo)
In Shanghan (Cold Damage), after emesis and purgation, followed by sweating, deficiency vexation occurs, and the pulse is extremely faint. After eight or nine days, epigastric fullness and hardness, hypochondriac pain, Qi rushing up to the throat, dizziness, vertigo, and twitching of the meridians occur; over time, this develops into Wei syndrome (flaccidity syndrome).
Note: The three sentences "After eight or nine days, epigastric fullness and hardness, hypochondriac pain, Qi rushing up to the throat" do not align with the context. Commentators, forced by the presence of these sentences, offer fragmented and forced explanations. Whenever I encounter this condition, it is always caused by excessive sweating severely damaging body fluids. It should be treated with herbs that tonify Qi, nourish Blood, benefit tendons, and strengthen bones, taking a year to recover. These three sentences are certainly misplaced slips and should be deleted. (*Yi Zong Jin Jian*)
In Shanghan, with fever,啬啬 aversion to cold (shivering/chilling), intense thirst wanting to drink, abdominal fullness, spontaneous sweating, and free urination, the disease is about to resolve. This is Liver Wood overacting on Lung Metal, named "Heng" (Horizontal), and Qimen (LR14) should be punctured.
The phrase "Liver Wood overacting on Lung Metal" should be read after "abdominal fullness"; "spontaneous sweating and free urination" should be read after "puncture Qimen." (Wu Lingzhi)
In Taiyang disease, the Cun pulse is slow, the Guan pulse is floating, and the Chi pulse is weak. The patient has fever, sweating, and renewed aversion to cold, no vomiting, but only epigastric stuffiness. This is due to the physician's erroneous use of purgation. If purgation had not been used, and the patient is not averse to cold but is thirsty, this has transferred to the Yangming disease. If urination is frequent, the stool will surely be hard; even if no bowel movement occurs for ten days, there is no discomfort. If there is a desire to drink water, give small amounts frequently. As long as treatment follows the appropriate method, for thirst, Wuling San (Five-Ingredient Powder with Poria) is suitable.
The section "But save it according to the method" should be read after "the physician used purgation." (Wu Lingzhi)
In Yangming disease, the pulse is floating and tight, with dry throat, bitter taste, abdominal fullness and wheezing, fever and sweating, no aversion to cold, but aversion to heat, and heavy body. If sweating is induced, restlessness, mental confusion, and delirium will occur. If moxibustion with burning needles is applied, fright, irritability, and insomnia will result. If purgation is used, the Stomach becomes empty, pathogenic Qi disturbs the Diaphragm, causing mental depression and vexation. If there is coating on the tongue, Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) governs.
The section "Mental depression and vexation" should be read after "heavy body." (Wu Lingzhi)
In Yangming disease, with floating and tight pulse, dry throat, bitter taste, abdominal fullness and wheezing, fever and sweating, no aversion to cold, aversion to heat, and heavy body, the sentence "Zhizi Chi Tang governs" should follow here. The three paragraphs regarding sweating imply that because this formula was not used, wrongful treatment ensued. Zhizi Chi Tang should still be the primary treatment. Zhang Zhongjing mentions it only at the conclusion, employing a省略 (elliptical) writing style. Later generations mistakenly regarded Zhizi Chi Tang as a rescue formula for post-sweating or post-purgation complications. Otherwise, before sweating or purgation, what method did Zhang Zhongjing use? (Ke Yunbo)
A patient presents with neither exterior nor interior syndromes, with fever for seven or eight days. Although the pulse is floating and rapid, purgation may be used. If purgation has already been applied and the rapid pulse persists, combined heat causes efficient digestion and hunger. By the sixth or seventh day, if there is no bowel movement, blood stasis exists, and Didang Tang (Di Dang Decoction) is suitable. If the rapid pulse persists and diarrhea continues incessantly, heat combines with pathogens leading to pus and blood in the stool.
"If the pulse is rapid after purgation" should be read after "purge may be used." (Wu Lingzhi)
In Shanghan, on the fourth or fifth day, the pulse is deep with wheezing and fullness. Deep pulse indicates interior pathology. Inducing sweating in error causes body fluids to escape, making defecation difficult. Exterior deficiency and interior excess, persisting over time, lead to delirium.
"The sentence 'Exterior deficiency and interior excess'" should be read after "Deep pulse indicates interior pathology." (Wu Lingzhi)
Sweating accompanied by delirium indicates dry fecal matter in the Stomach, caused by Wind. Purging is required, but only after passing the meridian cycle (exiting the current disease stage) can purging be performed; if done too early, speech will become chaotic due to exterior deficiency and interior excess. Purging will then cure the condition; Dachengqi Tang (Major Order the Qi Decoction) is suitable.
"The sentence 'due to exterior deficiency and interior excess'" should be placed under "then purging may be performed." (Cheng Jiaoqian)
"Sufficient to purge" connects to "in the Stomach"; "Purging then cures" connects to "Sufficient to purge." (Wu Lingzhi)
The nine characters "Purging then cures, suitable for Dachengqi Tang" should be placed after "after passing the meridian cycle, then purging may be performed," not at the end of the chapter. Observing the previous chapter on delirium and dry feces, it says "sufficient to purge" rather than "use Dachengqi Tang to purge." The word "sufficient" implies intent but not yet action. Here, speech is chaotic. Premature purging allows exterior pathogens to enter the Stomach via deficiency; should Dachengqi Tang be used for purging? (Fang Zhiyuan)
In Yangming disease, delirium with tidal fever, yet inability to eat, indicates five or six pieces of dry fecal matter in the Stomach. Dachengqi Tang should be used to purge. If able to eat, the stool is merely hard.
Note: The sentence "Dachengqi Tang should be used to purge" should follow "five or six pieces of dry fecal matter in the Stomut" to be logical. Using Dachengqi Tang merely for hard stool violates Zhang Zhongjing's principle of caution against erroneous purging; it should be moved. (*Yi Zong Jin Jian*)
"Dachengqi Tang should be used to purge" was previously under "merely hard," now corrected. (*Shanghan Zuanyu*)
In Yangming disease, after purgation, mental depression and vexation occur. If there is dry fecal matter in the Stomach, it may be attacked. If the abdomen is slightly full, with hard stool at the beginning and loose stool later, it must not be attacked. If there is dry fecal matter, Dachengqi Tang is suitable.
The last two sentences elaborate on the previous section to determine the treatment intent. (Fang Zhongxing)
In Yangming disease, after purgation, mental depression and vexation occur. If there is dry fecal matter in the Stomach, it may be attacked, and Dachengqi Tang is suitable. If the abdomen is slightly full, with hard stool at the beginning and loose stool later, it must not be attacked.
Post-purgation mental depression and vexation is a Zhizi Chi Tang syndrome. If abdominal fullness is severe and obstructed, it is dry fecal matter attacking from the Stomach; if slightly full, it remains a Zhizi Houpo Tang syndrome. (Ke Yunbo)
In San Yang He Bing (Combined Disorder of the Three Yang Meridians), there is abdominal fullness, body heaviness, difficulty turning over, insensitivity of the mouth, facial grease, delirium, and urinary incontinence. If sweating is induced, delirium occurs; if purged, sweating appears on the forehead with cold extremities.
If there is spontaneous sweating, Baihu Tang (White Tiger Decoction) governs.
The section "If there is spontaneous sweating" should be read after "urinary incontinence." (Wu Lingzhi)
Taiyin disease manifests as abdominal fullness and vomiting, inability to eat, worsening spontaneous diarrhea, and occasional spontaneous abdominal pain. If purged, chest and hypochondriac knotting and hardness will definitely occur.
"Inability to eat" should connect to the sentence with "spontaneous diarrhea"; "worsening spontaneous diarrhea" should be at the end. (Wu Lingzhi)
Note: Wu Renju stated: The four characters "worsening spontaneous diarrhea" should be placed after the sentence "chest and hypochondriac knotting and hardness will definitely occur," which is very correct. If placed after "vomiting and inability to eat," it implies that after vomiting and inability to eat, diarrhea worsens. Then Zhang Zhongjing says "if purged," which loses its meaning. (*Yi Zong Jin Jian*)
Shaoyin disease presents with desire to vomit but inability to do so, heart vexation, and desire to sleep. After five or six days, spontaneous diarrhea with thirst belongs to Shaoyin; due to deficiency, drinking water is an attempt at self-rescue. If urine color is white, the manifestations of Shaoyin disease are complete. White urine is due to lower Jiao deficiency-cold, unable to control water, thus causing white color.
"The sentence 'belongs to Shaoyin'" should be under "desire to sleep." (Wu Lingzhi)
In Shanghan, fever for four days, reversal (cold limbs) for three days, then fever for four days again; less reversal and more fever indicates the disease should resolve. If fever persists from the fourth to the seventh day without abating, pus and blood will subsequently appear in the stool.
The sentence "fever for four days again" has its semantic meaning under "the disease should resolve." (Ke Yunbo)