伤寒，心下有水气，咳而微喘，发热不渴；服汤已，渴者，此寒去欲解也，小青龙汤主之。
问∶既寒去欲解，不用药可矣。必用小青龙何也？答∶伤寒心下有水气，咳而微喘，此水寒相搏，而伤其
肺也。伤寒故发热，水停心下故不渴，内水与外寒相得益彰矣。今服汤已，而渴，明是表药之甘温，克胜其
外袭之寒，所以知证为欲解也。然尚未解者，外寒为内水所持，开解最难，故必更用小青龙以逐之，令其寒从
外出，水从下出，斯一举而开解无余耳。不然，纵外寒渐散，其水气之射肺中者，无由得出，异日能不为喘喝
乎？（喻嘉言）
太阳病，脉浮紧，无汗，发热，身疼痛，八九日不解，表证仍在，此当发其汗。服药已，微除，其人发烦、
目瞑，剧者必衄，衄乃解；所以然者，阳气重故也。麻黄汤主之。
问∶衄家不可发汗，衄而已解，不用麻黄可也，何复用耶？答∶衄家不可发汗者，乃不病之人，平素惯衄，
及病伤寒，则不可发汗，所谓夺血者无汗。若强发其汗，徒动其血，如下厥上竭之类也。伤寒之人，寒气深重，
其热亦重，热迫血行，因而致衄；衄乃解者，不过少解其烦瞑，未能解其深重之寒也，故必再用麻黄汤以发其
未尽之沉滞，一以尽彻其邪，一以免其再衄，此定法也。仲景复申二法，其一云∶太阳病，脉浮紧，发热，身
无汗，自衄者愈；此则不用麻黄汤也。曰身无汗，必系已用麻黄汤而未得汗，然亦足以推发其势，而致自衄也。
以其人既无发烦、目瞑之证，则一衄而邪从外解矣。何苦复用麻黄汤耶？其一云∶伤寒脉浮紧，不发汗，因致
衄者，麻黄汤主之。此因全不发其汗，因而致衄，是一衄不能尽彻其邪，仍当用麻黄汤以发之，邪始彻也。
参二条以会用法之意，了无疑惑矣。（喻嘉言）
问曰∶证象阳旦，按法治之而增剧，厥逆，咽中干，两胫拘急而谵语。师言∶夜半手足当温，两脚当伸。后
如师言，何以知此？答曰∶寸口脉浮而大，浮则为风，大则为虚。风则生微热，虚则两胫挛。病证象桂枝，因
加附子参其间，增桂令汗出，附子温经，亡阳故也。厥逆，咽中干，烦躁，阳明内结，谵语烦乱，更饮甘草干
姜汤，夜半阳气还，两足当热，胫尚微拘急；重与芍药甘草汤，尔乃胫伸，以承气汤微溏，则止其谵语，故知
病可愈。
问曰∶证象阳旦，成注谓是桂枝之别名；方注谓阳以风言，旦，晓也，似中风分晓，以不啻中风，故设难
详申其义。一主药，一主证，二家未知孰是？答曰∶主药则既名桂枝，云何别名阳旦？是必一百一十三方，方
方皆有别名然后可。主证则既似中风，复云不啻中风，果为何证？且训旦为晓，尤为牵强不通。二家如此等大
关系处，尚且昏昏，后学安得不面墙耶？夫仲景之圆机活法，妙在阳旦、阴旦二汤。阳旦者，天日晴暖以及春
夏温热之称也；阴旦者，风雨晦冥以及秋冬凉寒之称也。只一桂枝汤，遇时令温热，则加黄芩名阳旦汤；遇时
令凉寒，则加桂名阴旦汤。后世失传，纷纷谓桂枝不宜于春夏者，皆由不识此义耳。即如此证，既象阳旦，又
云按法治之，即是按用桂枝加黄芩之法也。所以病患得之便厥，明明误在黄芩助其阴寒。若单服桂枝汤，何至
是耶？故仲景即行阴旦之法，以救其失。观增桂令汗出一语，岂不昭昭耶？阴旦不足，更加附子温经，即咽中
干，阳明内结，谵语烦乱，浑不为意，且重饮甘草干姜汤，以俟夜半阳回足热，后果如其言。岂非先有所试乎？
惟黄芩入口而便厥，未几，即以桂、附、干姜尾其后，固知其厥不久，所以断云夜半手足当温，况咽干谵语，
热证相错，其非重阴冱寒可知，故才得足温，即便以和阴为务，何其审哉！（喻嘉言）
喻注谓阳旦乃桂枝汤中加黄芩，此无据之说，恐不足信。又
谓古法失传，既失传矣，何从而知之？或问∶阳旦、阴旦之说，林北海先生亦言喻说甚佳，子乃不从，何也？
答曰∶圣人曾言之矣，不征不信，不信故不从。又问∶子之说阳旦为桂枝加附子，非加黄芩，何所征信乎？答
曰∶征信于仲师之原文，一曰反与桂枝汤；又曰证象阳旦，按法治之而增剧；又曰病证象桂枝，因加附子参其
间，增桂令汗出，附子温经，亡阳故也。则知桂枝汤非别，乃阳旦之桂枝汤也。阳旦之桂枝非别，即因加附子
参其间者也。此所以从之无疑也。又问∶子言桂枝阳旦汤，为加附子。桂枝之阴旦汤，将何所加乎？答曰∶阴
旦之名，亦喻注中所有，未暇详考。别有征信，何敢言之？阙疑可耳。（魏荔彤）
服桂枝汤，大汗出后，大烦渴不解，脉洪大者，白虎加人参汤主之。
言服桂枝，即服加附子参其间增桂令汗出之阳旦桂枝也。或问∶子何以知此为加附子之阳旦汤？答曰∶于
大汗出后，大烦渴知之也。大汗出者，以附子参其间，增桂枝令汗出也；大烦渴者，即胃病津亡，谵语之轻者
也。苟非加附子，但服桂枝，乃敛汗固表之药，何以大汗出？内有芍药收阴敛液，何至大烦渴乎？故知为阳旦
之桂枝汤也。即前条仲师原文曰证象阳旦，又曰证象桂枝，可知言服桂枝即服阳旦之桂枝汤无疑也。○或问∶即
如子言，然彼条救误，用甘草干姜汤，此条何忽用白虎加人参乎？答曰∶以诊别之，彼条脉浮，此条脉洪大，
中阳强弱已不同矣。又以证别之，彼条自汗出，此条大汗出；彼条烦躁，此条大烦而渴；彼条虽咽干而不能大
饮水，此条渴欲得水以救焚；彼皆中虚阳浮，此皆中实热盛，何可同日而语乎？（魏荔彤）
伤寒，脉浮、发热、无汗，其表不解者，不可与白虎汤。渴欲饮水，无表证者，白虎加人参汤主之。○伤寒无
大热，口燥渴，心烦，背微恶寒者，白虎加人参汤主之。○伤寒病，若吐、若下后，七八日不解，热结在里，
表里俱热，时时恶风、大渴、舌上干燥
而烦、欲饮水数升者，白虎加人参汤主之。
问∶白虎汤，仲景以表不解者不可与，时时恶风，背上恶寒者，此有表也，以白虎汤主之何也？盖石膏
辛凉，解足阳明经热，为舌燥烦渴之圣药；且时时恶风者，时或恶而不常也；背上恶寒者，但觉微恶而不甚也；
所以于盛热燥渴而用，则无疑矣。若夫表证恶寒，常在背上，而不燥渴者，切不可误用也。（吴绶）
伤寒，脉浮滑，此表有热，里有寒，白虎汤主之。
问∶伤寒，脉浮滑，此表有热，里有寒，白虎汤主之。寒字误耶？浮滑之脉，不应有寒也。答∶脉滑为
里热，浮滑则表亦热，所以仲景白虎汤证又云，热结在里，表里俱热，可为互证矣。寒字勿泥，即谓外感之寒
入里，而生其里热亦可。（喻嘉言）
本太阳病不解，转入少阳者，胁下硬满，干呕不能食，往来寒热，尚未吐下，脉沉紧者，与小柴胡汤。太阳中
风，下利呕逆，表解者，乃可攻之。其人 汗出，发作有时，头痛，心下痞硬满，引胁下痛，干呕短气，汗
出不恶寒，此表解里未和也，十枣汤主之。
或问∶干呕胁痛，小柴胡、十枣汤皆有之，一和解，一攻伐，何也？盖小柴胡证，邪在半表半里间，外
有寒热往来，内有干呕诸病，所以不可攻下，宜和解以散表里之邪。十枣汤证，外无寒热，其人 汗出，此
表已解也；但头痛、心下痞硬满、引胁下痛、干呕短气者，邪热内蓄，而有伏饮，是里未和也，与十枣汤以下
热逐饮。有表证而干呕胁痛者，乃柴胡汤证也；无表证而干呕胁痛者，即十枣汤证也。（张兼善）
阳明病，心下硬满者，不可攻之。○阳明病，不吐不下，心烦者，与调胃承气汤。
问∶硬满似重于心烦，何心烦可下，而硬满不可下也？答∶心下，正胸膈之间，而兼太阳。故硬满为太阳、
阳明之候，不可攻之；攻之利遂不止者，死。至于心烦一证，乃津液内耗，大率当
调其胃，然尚有重伤津液之虑，若不由吐下所致，是津液未亏，反见心烦者，其为邪热灼胃审矣。当用调胃承
气，夫复何疑！然曰与，亦是少少和胃以安津液之法，非下法也。（喻嘉言）
阳明病，若中寒，不能食，小便不利，手足 然汗出，此欲作固瘕。必大便初硬后溏。所以然者，以胃中冷，
水谷不别故也。
门人问∶ 然汗出而病解，乃手足 然汗出者，反作固瘕，何手足不宜于汗耶？答曰∶前代之业医者，
皆极大聪明学问之人，故仲景书为中人以上举一隅能以三隅反者设也。胃气虚寒之人，外邪入之，必转增其热；
胃热故膀胱亦热，气化不行，小便因之不利；小便不利，而尽注于大肠，则为洞泄，即末条之下利清谷者是也。
小便不利，乘胃热而渗于脾，则四肢先见黄色，乃至遍身发黄而成谷疸者是也。今手足 然得汗，则脾中之湿
热行，而色黄谷疸之患可免；但汗从手足而出，水热之气未得遍泄于周身，不过少分大肠奔迫之势，故不为洞
泄，而为瘕泄耳。无病之人，小便不行，尚渍为他病，况伤寒证极赤极热之小便，停蓄不行，能无此三种之变
耶？一溯其源，而轻重自分矣。（喻嘉言）
阳明病，发热汗出，此为热越，不能发黄也。但头汗出，身无汗，剂颈而还，小便不利，渴饮水浆者，此为
瘀热在里，身必发黄。茵陈蒿汤主之。
问∶白虎证亦身热烦渴引饮，小便不利，何以不发黄？答曰∶白虎证与发黄证相近，遍身汗出，此为热
越，白虎证也；头面汗出，颈以下都无汗，发黄证也。又问∶太阳病，一身尽痛，发热，身如熏黄者，何也？
答曰∶此太阳中湿也。仲景云∶伤寒发汗已，身目为黄；所以然者，以寒湿在里，不解故也。（喻嘉言）
发汗多，若重发汗者，亡其阳。谵语，脉短者，死；脉自和者，不死。
门人问∶亡阳而谵语，四逆汤可用乎？答曰∶仲景不言方，
而子欲言之，曷不详之仲景耶？盖亡阳固必急回其阳，然邪传阳明，胃热之炽否，津液之竭否，里证之实否，
俱不可知，设不辨悉，欲回其阳，先竭其阴，竟何益哉！此仲景不言方，乃其所以圣也。然得子此问，而仲景
之妙义愈彰。（《尚论篇》）
阳明病，谵语有潮热，反不能食者，胃中必有燥屎五六枚也。若能食者，但硬耳。宜大承气汤下之。
或问∶《经》言胃中有燥屎五六枚，何如？答曰∶夫胃为受纳之司，大肠为传导之府，燥屎岂有在胃中哉？
故《经》言谷消水去形亡也，以是知在大肠，而不在胃也明矣。（《此事难知》）
腹满不减，减不足言，当下之，宜大承气汤。
或谓∶减不足言，复曰当下之，何也？此古之文法如是也。言腹满不减，当下之，宜大承气汤，此满而不
减之谓也。若时满时减者，不可以当下而论，是减不足言也。然承气汤当缀腹满不减处，未可续于减不足言之
下，如《太阳篇》中云∶伤寒，不大便六七日，头痛有热者，与承气汤。其小便清者，知不在里，仍在表也，
当须发汗。若头痛者，必衄，宜桂枝汤。缘桂枝为发汗而设，非为治衄也。其减不足言之说，亦不外是。（张兼善）
趺阳脉浮而涩，浮则胃气强，涩则小便数，浮涩相搏，大便则难，其脾为约，麻仁丸主之。
门人问∶脾约一证，胃强脾弱，脾不为胃行其津液，如懦夫受悍妻之约束，岂不为家之索乎？余曰∶何以
见之？曰∶仲景云，趺阳脉浮而涩，浮则胃气强，涩则小便数，浮涩相搏，大便则难，其脾为约，麻仁丸主之。
以是知胃强脾弱也。余曰∶脾弱即当补矣，何为麻仁丸中，反用大黄、枳实、浓朴乎？子辈日聆师说，而腹笥
从前相仍之陋，甚非所望也。仲景说胃强，原未说脾弱；况其所谓胃强者，正是因脾之强而强。盖约者省约也，
脾气过强，将三、五日胃中所受之谷，省约为一、二弹丸而出，全是脾土过燥，致令肠胃中之津液日渐干枯，
所以大便则难也。
设脾弱即当便泄矣，岂有反难之理乎？相传脾弱不能约束胃中之水，何以反能约束胃中之谷耶？在阳明例中，
凡宜攻下者，惟恐邪未入胃，大便弗硬，又恐初硬后溏，不可妄攻，若欲攻之，先与小承气，试其转失气方可
攻，皆是虑夫脾气之弱，故尔踌躇也。若夫脾约之证，在太阳已即当下矣，更何待阳明耶？子辈附会前人，以
脾约为脾弱，将指吴起之杀妻者为懦夫乎？有悖圣言矣。（《尚论篇》）
汗出多，则热愈；汗出少，则便难。
问∶汗多则热愈；凡桂枝、麻黄二汤，俱取微似有汗，不令汗多。汗少则便难；汗少则津液未竭，何为
便难也？答∶太阳病，非汗不解，然汗法中，每伏亡阳、漏风种种危候，所以服桂枝、麻黄汤，但微取似汗，
虑夫阳气索薄之人，得药而汗出不止也。至于阳明胃经，为津液之府，邪热内入，津液随即外越者最多，不但
阳气素虚不可过汗，即阳气素实，亦不可过汗，所以阳明致戒云∶阳明实，因发其汗，出多者，亦为太过，太
过为阳绝于里，亡津液，大便因硬也。从前不解阳绝为何事，不知正指津液内竭而言，即无阳之互文也。所云
伤寒，心下有水气，咳嗽且轻微气喘，发热但不口渴；服用汤药后，出现口渴症状，这是寒邪已去、病势欲解的表现，主治方剂为小青龙汤。
问：既然寒邪已去、病势欲解，不用药也可以了。为什么一定要用小青龙汤呢？答：伤寒导致心下有停水，咳嗽且轻微气喘，这是水饮与寒邪相互搏结，损伤了肺脏。因为患伤寒所以发热，因为水饮停滞在心下所以不渴，体内的水饮与外来的寒邪互相助长其势。现在服药后出现口渴，明确表明是汤药中甘温的药性，战胜了外袭的寒邪，所以知道病情正在趋向解除。然而尚未完全解除的原因是，外寒被内在水饮所牵制，想要开散解除最为困难，所以必须再次使用小青龙汤来驱逐水饮，使寒邪从体表外出，水饮从下窍排出，这样一举就能彻底开散解除。否则，纵然外寒逐渐消散，但水气射入肺中的部分，没有途径排出，日后难道不会成为气喘痰鸣的病证吗？（喻嘉言）
太阳病，脉象浮紧，无汗，发热，身体疼痛，经过八九天仍未解除，表证依然存在，这应当用发汗法治疗。服药后，症状稍微减轻，病人感到心烦，眼睛闭合不想睁开，严重的必然会出现鼻出血，鼻出血后病情才会解除；之所以这样，是因为阳气郁闭太重的缘故。主治方剂为麻黄汤。
问：有鼻出血病史的人不可发汗，既然已经通过鼻出血解除了病邪，不用麻黄汤也可以了，为什么还要再用呢？答：有鼻出血病史的人不可发汗，是指那些原本没有生病、平时经常流鼻血的人，一旦患上伤寒，就不可发汗，这就是所谓的“夺血者无汗”。如果强行发汗，只会扰动血液，导致如“下厥上竭”之类的危重证候。患伤寒的人，寒气深重，热势也重，热迫血行，因而导致鼻出血；所谓“鼻出血后解除”，不过是稍微缓解了心烦和目瞑的症状，并不能解除深重的寒邪，所以必须再用麻黄汤来发散未尽的沉滞之邪，一方面彻底清除病邪，另一方面避免再次鼻出血，这是确定的治法。张仲景又补充了两种情况，其中一种说：太阳病，脉象浮紧，发热，身体无汗，自然鼻出血的就会痊愈；这种情况就不需要用麻黄汤了。说“身体无汗”，必然是已经用过麻黄汤但没有出汗，但这足以推波助澜，导致自然鼻出血。因为这个人并没有出现心烦、目瞑的症状，所以一次鼻出血后邪气就从体表解除了。何必苦于再复用麻黄汤呢？另一种情况说：伤寒脉象浮紧，没有发汗，因而导致鼻出血的，主治方剂为麻黄汤。这是因为完全没有发汗，因而导致鼻出血，这是一次鼻出血不能彻底清除病邪，仍然应当用麻黄汤来发散，邪气才能彻底清除。参考这两条来领会用药的意图，就没有疑惑了。（喻嘉言）
问：病症表现像阳旦证，按照常规法治疗反而加重，出现四肢逆冷，咽喉干燥，两小腿拘急痉挛并伴有胡言乱语。老师说：半夜时手脚应当变暖，两脚应当伸直。后来果然像老师所说的那样，怎么知道会这样呢？答：寸口脉象浮而大，浮主风邪，大主虚证。风邪侵袭则产生微热，虚证则导致两小腿拘挛。病症表现像桂枝汤证，因此加入附子，增加桂枝用量令其出汗，附子用来温经，这是因为亡阳的缘故。出现四肢逆冷，咽喉干燥，烦躁，阳明腑气内结，胡言乱语烦乱，再饮用甘草干姜汤，半夜阳气回复，两脚应当发热，小腿尚且轻微拘急；再次给予芍药甘草汤，然后小腿伸直，再用承气汤轻微通便，就能停止胡言乱语，所以知道病可以痊愈。
问：病症表现像阳旦证，成无己的注解认为是桂枝汤的别名；方有执的注解认为“阳”指风，“旦”指早晨，似乎指中风在清晨发作，因为不仅仅是普通的中风，所以设立疑难详细阐明其义。一家主张药物，一家主张证候，两家不知道谁对？答：如果主张药物，既然名叫桂枝，怎么会有别名阳旦呢？那必须是《伤寒论》一百一十三首方剂，每首方剂都有别名才行。如果主张证候，既然像中风，又说不仅仅是中风，到底是什么证候呢？况且将“旦”解释为早晨，尤为牵强不通。两家的学说在如此重大的关系处都糊涂不清，后学怎么能不面对墙壁一无所知呢？张仲景的圆机活法，妙在阳旦汤和阴旦汤。阳旦，是指天气晴朗温暖以及春夏季温热的气候特点；阴旦，是指风雨昏暗以及秋冬季凉寒的气候特点。仅仅是桂枝汤这一首方，遇到时令温热，就加入黄芩，名为阳旦汤；遇到时令凉寒，就增加桂枝用量，名为阴旦汤。后世失传，纷纷认为桂枝汤不适合用于春夏季，都是因为不认识这个义理罢了。就像这个病症，既像阳旦证，又说按照法治疗，就是按照使用桂枝加黄芩的方法治疗。所以病人服药后就出现四肢逆冷，明明错误在于黄芩助长了阴寒之气。如果单独服用桂枝汤，怎么会到这种地步呢？所以张仲景随即采用阴旦法来补救过失。看“增加桂枝令其出汗”这句话，难道不是昭然若揭吗？阴旦汤力量不足，再加上附子温经，即使出现咽喉干燥，阳明腑气内结，胡言乱语烦乱，也全然不在意，并且再次饮用甘草干姜汤，以等待半夜阳气回复、双脚发热，后果真像他所说的那样。这难道不是预先有所试探吗？只要黄芩入口就立即出现四肢逆冷，不久之后，就用桂枝、附子、干姜紧随其后，固然是知道四肢逆冷不会持续很久，所以断定半夜手脚应当变暖，况且咽喉干燥、胡言乱语是热证夹杂其中，这就可知不是重阴凝冻的寒证，所以才刚刚得到双脚温暖，就立刻以调和阴液为要务，是多么审慎啊！（喻嘉言）
喻嘉言的注解认为阳旦汤是在桂枝汤中加入黄芩，这种说法没有依据，恐怕不值得相信。又说古法失传，既然失传了，从哪里知道的？有人问：关于阳旦、阴旦的说法，林北海先生也说喻氏的说法很好，您却不听从，为什么呢？答：圣人曾经讲过这个道理，不征验就不相信，不相信所以不听从。又问：您所说的阳旦汤是桂枝汤加附子，而不是加黄芩，有什么证据呢？答：证据来源于张仲景的原文，第一条说“反给予桂枝汤”；第二条说“病症表现像阳旦，按法治疗反而加重”；第三条说“病症表现像桂枝，因此加入附子在其中，增加桂枝令其出汗，附子温经，这是因为亡阳的缘故”。由此可知，桂枝汤并不是别的方子，就是阳旦汤中的桂枝汤。阳旦汤中的桂枝汤并不是别的，就是因为在其中加入了附子的缘故。这就是所以我毫不犹豫地遵从它的原因。又问：您说桂枝阳旦汤是加入附子，那么桂枝的阴旦汤，将要加入什么呢？答：阴旦这个名字，也在喻嘉言的注解中出现，我没空详细考证。如果有其他确凿证据，我怎么敢妄言呢？保留疑问就可以了。（魏荔彤）
服用桂枝汤后，大汗出，随后出现严重的心烦、口渴不解，脉象洪大的，主治方剂为白虎加人参汤。
这里说的服用桂枝，实际上是指服用加入了附子、增加桂枝用量令其出汗的阳旦桂枝汤。有人问：您怎么知道这是加入附子的阳旦汤？答：从大汗出后出现严重心烦口渴就可以知道。大汗出，是因为加入了附子，增加桂枝用量令其出汗；严重心烦口渴，就是胃中津液耗伤、胡言乱语的轻症表现。如果不是加入附子，仅仅服用桂枝，那是收敛汗液、固护体表的药物，怎么会大汗出呢？方内有芍药收敛阴液，怎么会严重心烦口渴呢？所以知道这是阳旦汤中的桂枝汤。即前一条张仲景原文说“病症表现像阳旦”，又说“病症表现像桂枝”，可知说服用桂枝就是服用阳旦汤中的桂枝汤，毫无疑问。○有人问：就像您说的，但是前一条救治误治，使用的是甘草干姜汤，这一条为什么突然使用白虎加人参汤呢？答：通过脉诊来区别，前一条脉象浮，这一条脉象洪大，中焦阳气的强弱已经不同了。再通过症状来区别，前一条是自汗出，这一条是大汗出；前一条是烦躁，这一条是严重心烦且口渴；前一条虽然咽喉干燥但不能大量饮水，这一条是口渴想喝水来救焚；前一条是中虚阳气浮越，这一条是中实热盛，怎么可以相提并论呢？（魏荔彤）
伤寒，脉象浮、发热、无汗，表证未解除的，不可给予白虎汤。口渴想喝水，没有表证的，主治方剂为白虎加人参汤。○伤寒没有明显高热，口燥渴，心烦，背部微微恶寒的，主治方剂为白虎加人参汤。○伤寒病，如果在呕吐或泻下之后，七八天仍未解除，热邪结聚在体内，表里俱热，时时恶风、极度口渴、舌面干燥而烦躁、想要喝几升水的，主治方剂为白虎加人参汤。
问：白虎汤，张仲景说表证未解除的不可给予，时时恶风，背上恶寒的，这说明有表证，为什么用白虎汤主治呢？盖因石膏辛凉，能解除足阳明经的热邪，是治疗舌燥烦渴的神药；而且时时恶风，是偶尔恶风而不常有的；背上恶寒，只是觉得轻微恶寒而不严重；所以在盛热燥渴的情况下使用，就没有疑问了。如果是表证引起的恶寒，常在背上，且不燥渴的，切不可误用。（吴绶）
问：伤寒，脉象浮滑，这是表有热，里有寒，主治方剂为白虎汤。“寒”字是错字吗？浮滑的脉象，不应该有寒邪啊。答：脉滑主里热，浮滑则表也有热，所以张仲景在白虎汤证中又说，热邪结聚在体内，表里俱热，可以互为印证。“寒”字不要拘泥，即使解释为外感的寒邪入里，从而产生里热也是可以的。（喻嘉言）
原本的太阳病未解除，转入少阳的，胁下硬满，干呕不能进食，往来寒热，尚未进行吐法或下法，脉象沉紧的，给予小柴胡汤。太阳中风，出现下利、呕吐逆气，表证已解除的，才可以攻里。其人汗出，发作有时，头痛，心下痞塞硬满，牵引胁下疼痛，干呕短气，汗出不恶寒，这是表证已解除而里气未调和，主治方剂为十枣汤。
有人问：干呕胁痛，小柴胡汤和十枣汤证都有，一个是和解，一个是攻伐，为什么呢？盖因小柴胡汤证，邪气在半表半里之间，外有寒热往来，内有干呕等病，所以不可攻下，宜用和解法来疏散表里之邪。十枣汤证，外无寒热，其人汗出，这说明表证已解除；只有头痛、心下痞塞硬满、牵引胁下疼痛、干呕短气的，是邪热内蓄，且有伏留的水饮，这是里气未调和，给予十枣汤来泻下热邪、逐除水饮。有表证而出现干呕胁痛的，是柴胡汤证；无表证而出现干呕胁痛的，就是十枣汤证。（张兼善）
阳明病，心下硬满的，不可攻下。○阳明病，没有经过吐法或下法，心烦的，给予调胃承气汤。
问：硬满似乎比心烦更严重，为什么心烦可以攻下，而硬满不可以攻下呢？答：心下，正是胸膈之间，且兼涉太阳经。所以硬满是太阳、阳明合病的征候，不可攻下；如果攻下导致腹泻不止的，会死亡。至于心烦这一证候，是津液内耗，大体上应当调理胃气，然而还有重伤津液的顾虑，如果不是由吐下引起的，说明津液未亏，反而出现心烦的，这肯定是邪热灼烧胃腑无疑。应当使用调胃承气汤，还有什么可疑的呢！然而说“给予”，也是少量调和胃气以安护津液的方法，并非峻下的治法。（喻嘉言）
阳明病，如果中寒，不能进食，小便不利，手足濈然汗出，这是将要形成固瘕（一种慢性积聚病）。必定是大便初头硬而后溏。之所以这样，是因为胃中寒冷，水谷不分的原因。
门人问：濈然汗出而病解，是手足濈然汗出，反而形成固瘕，为什么手足不宜出汗呢？答：前代的医者，都是极具聪明学问的人，所以张仲景的书是为中等以上资质、能举一反三的人设立的。胃气虚寒的人，外邪侵入，必然会增添其热；胃热所以膀胱也热，气化不行，小便因此不利；小便不利，而全部流入大肠，就成为洞泄，就是最后一条的下利清谷的情况。小便不利，乘胃热而渗入脾脏，则四肢先见黄色，乃至遍身发黄而成谷疸的情况。现在手足濈然出汗，则脾中的湿热得以运行，色黄谷疸的祸患可以避免；但汗从手足而出，水热之气未能遍泄于周身，不过稍微分消大肠奔迫之势，所以不成为洞泄，而成为瘕泄罢了。没有病的人，小便不行，还会滋生其他疾病，何况伤寒证极赤极热的小便，停蓄不行，能不出现这三种变化吗？追溯其源头，轻重自然分明。（喻嘉言）
阳明病，发热汗出，这叫热邪向外发散，不能发黄。只有头部出汗，身上无汗，仅到颈部为止，小便不利，口渴想喝水浆的，这叫瘀热结聚在体内，身体必定发黄。主治方剂为茵陈蒿汤。
问：白虎汤证也是身热烦渴引饮，小便不利，为什么不发黄？答：白虎汤证与发黄证相近，遍身汗出，这叫热邪向外发散，是白虎汤证；只有头面部出汗，颈部以下都没有汗，是发黄证。又问：太阳病，一身尽痛，发热，身体像熏黄那样的颜色，为什么呢？答：这是太阳中湿。张仲景说：伤寒发汗后，身体面目发黄；之所以这样，是因为寒湿在体内，不能解散的缘故。（喻嘉言）
发汗过多，或者重复发汗的，会导致亡阳。出现胡言乱语，脉象短的，预后不良（死）；脉象自和的，不死。
门人问：亡阳而胡言乱语，可以用四逆汤吗？答：张仲景没有提及方剂，而您想要提出方剂，为什么不详细考察张仲景的原意呢？盖因亡阳固然必须紧急回阳，然而邪气传入阳明，胃热的炽盛程度如何，津液是否枯竭，里证是否属实，都不可知，如果不辨明这些，想要回阳，反而会先竭其阴，究竟有什么好处呢！这就是张仲景不言方，正是他圣明的地方。然而得到您的这个问题，张仲景的妙义更加彰显。（《尚论篇》）
阳明病，胡言乱语且有潮热，反而不能进食的，胃中一定有燥屎五六枚。如果能进食的，只是大便硬而已。适宜用大承气汤攻下。
有人问：《内经》说胃中有燥屎五六枚，是怎么回事？答：胃是受纳食物的器官，大肠是传导糟粕的府库，燥屎哪里会在胃中呢？所以《内经》说谷物消化、水液去除、形体（糟粕）形成，由此可知在大肠，而不在胃，这是很明显的。（《此事难知》）
腹部胀满不减，即使减少也不值得一提的，当下之，适宜用大承气汤。
有人说：减少也不值得一提，又说当下之，为什么呢？这是古文的写法如此。意思是说腹部胀满不减，当下之，适宜用大承气汤，这是指满而不减的情况。如果是时满时减的，不可以说是当下之，这就是所谓的“减不足言”。然而承气汤应当接在“腹满不减”后面，不可续在“减不足言”之下，如《太阳篇》中说：伤寒，不大便六七天，头痛有热的，给予承气汤。其小便清的，知道病不在里，仍在表，应当须发汗。如果头痛的，必然鼻出血，适宜桂枝汤。因为桂枝汤是为发汗而设的，不是为了治鼻出血的。那个“减不足言”的说法，也不外乎是这个道理。（张兼善）
趺阳脉浮而涩，浮则胃气强，涩则小便频数，浮涩相搏结，大便则困难，这是脾约证，主治方剂为麻仁丸。
门人问：脾约这一证候，是胃强脾弱，脾不为胃输送津液，像懦夫受悍妻约束一样，难道不是家里的祸害吗？我说：凭什么这么说？回答说：张仲景说，趺阳脉浮而涩，浮则胃气强，涩则小便频数，浮涩相搏结，大便则困难，这是脾约证，主治方剂为麻仁丸。由此可知是胃强脾弱。我说：脾弱就应当补益了，为什么麻仁丸中，反而使用大黄、枳实、厚朴呢？你们每天聆听老师的教导，而肚子里从前依然保持着浅陋的知识，非常不符合我对你们的期望。张仲景说胃强，原本没说脾弱；况且他所说的胃强，正是由于脾的强盛而显得强盛。盖因“约”是省约的意思，脾气过强，将三、五天胃中所受的谷物，省约为一个、两个弹丸大小的粪便排出，全是脾土过燥，致使肠胃中的津液日渐干枯，所以大便困难。
假设脾弱就应该腹泻了，哪里有反而困难的道理呢？相传脾弱不能约束胃中的水液，为什么反而能约束胃中的谷物呢？在阳明病的法则中，凡是适宜攻下的，只担心邪气未入胃，大便不硬，又担心初硬后溏，不可妄攻，如果想攻下，先给予小承气汤，测试其转矢气才可以攻，这些都是顾虑脾气的虚弱，所以犹豫不决。至于脾约证，在太阳病阶段就已经应当攻下了，还等到阳明病吗？你们附和前人，把脾约说成脾弱，难道要把吴起杀妻的人说成懦夫吗？这违背了圣人的言论啊。（《尚论篇》）
汗出多，则热势更甚；汗出少，则大便困难。
问：汗多则热势更甚；凡桂枝汤、麻黄汤，都要求微似有汗，不让汗出过多。汗少则大便困难；汗少则津液未枯竭，为什么大便困难呢？答：太阳病，非发汗不能解除，然而在汗法中，常常潜伏着亡阳、漏风种种危重证候，所以服用桂枝汤、麻黄汤，只是微微取得似有汗的状态，是顾虑那些阳气素来薄弱的人，得药后汗出不止。至于阳明胃经，是津液之府，邪热内入，津液随即外越的情况最多，不但阳气素虚不可过汗，就是阳气素实，也不可过汗，所以阳明病戒律说：阳明实证，因发其汗，汗出多的，也为太过，太过导致阳气绝于里，亡失津液，大便因此变硬。从前不理解“阳绝”是什么事，不知道正是指津液内竭而言，也就是“无阳”的互文。所谓
Typhoid fever (Shanghan), with fluid retention under the heart (subcardiac fluid accumulation), accompanied by cough and slight wheezing, fever but no thirst; after taking the decoction, if thirst appears, this indicates that the cold pathogen has departed and the disease is about to resolve. Xiao Qing Long Tang (Minor Blue Dragon Decoction) is the primary formula.
Question: Since the cold pathogen has departed and the disease is resolving, medication is unnecessary. Why must Xiao Qing Long Tang be used? Answer: Typhoid fever causing fluid retention under the heart, with cough and slight wheezing, results from water-cold binding together and injuring the Lung. The presence of typhoid causes fever; fluid stagnation under the heart causes lack of thirst; internal water and external cold mutually enhance each other's effects. Now, after taking the medicine, thirst appears, clearly indicating that the sweet-warm nature of the table-releasing medicine has overcome the externally invading cold, thus knowing the condition is resolving. However, it has not yet fully resolved because the external cold is held back by internal water, making release difficult. Therefore, Xiao Qing Long Tang must be used again to expel the water, allowing cold to exit from the exterior and water to exit from below, achieving complete resolution in one move. Otherwise, even if external cold gradually dissipates, the water qi shooting into the lungs will have no way out, potentially leading to wheezing and phlegm-rattling in the future. (Yu Jiayan)
Taiyang disease (Disease of the Taiyang Channel), with a floating-tight pulse, anhidrosis (absence of sweating), fever, and body pain, persisting for eight or nine days without resolution, where the exterior syndrome remains, requires diaphoresis (sweating therapy). After taking medicine, symptoms slightly subside, but the patient becomes irritable and desires to keep eyes closed; in severe cases, epistaxis (nosebleed) occurs, and the disease resolves upon bleeding; this happens because Yang Qi is heavily constrained. Ma Huang Tang (Ephedra Decoction) is the primary formula.
Question: Patients with a history of nosebleeds should not undergo diaphoresis. If the disease has already resolved via nosebleed, why use Ma Huang Tang again? Answer: The prohibition against diaphoresis for those with a history of nosebleeds applies to individuals who are otherwise healthy but prone to spontaneous nosebleeds. When they contract typhoid, diaphoresis is contraindicated, as stated in "those who lose blood do not sweat." Forcing diaphoresis would only disturb the blood, leading to conditions like "lower coldness and upper depletion." In typhoid patients, cold pathogens are deep and heavy, and heat is also intense; heat forces blood flow, causing nosebleeds. The statement "resolves upon bleeding" merely refers to slight relief of irritability and eye closure, not the resolution of deep cold. Thus, Ma Huang Tang must be used again to disperse remaining stagnant pathogens, ensuring thorough elimination and preventing recurrence. This is a fixed method. Zhang Zhongjing further clarified two scenarios: 1) Taiyang disease with floating-tight pulse, fever, anhidrosis, resolving spontaneously via nosebleed—no Ma Huang Tang needed. "Anhidrosis" implies previous administration of Ma Huang Tang failed to induce sweat, yet was sufficient to provoke spontaneous bleeding. Without irritability or eye closure, one episode of bleeding resolves the pathogen externally. 2) Typhoid with floating-tight pulse, no prior diaphoresis, resulting in nosebleed—Ma Huang Tang is indicated. Here, lack of sweating led to bleeding, which was insufficient to clear pathogens completely; Ma Huang Tang is required for thorough expulsion. Understanding these two clauses clarifies the application. (Yu Jiayan)
Question: Symptoms resemble Yang Dan Syndrome (Yang Dawn Syndrome), but treatment according to standard methods worsens the condition, leading to cold extremities, dry throat, bilateral calf cramping, and delirium. The Master said: "By midnight, hands and feet will warm, and legs will extend." Later, this proved true. How could this be predicted? Answer: The Cun Kou (radial artery at the wrist) pulse is floating and large. Floating indicates wind; large indicates deficiency. Wind generates mild heat; deficiency causes calf cramping. The symptoms resemble Gui Zhi Tang (Cinnamon Twig Decoction) syndrome, so Fu Zi (Aconite Lateral Root) was added, and Gui Zhi dosage increased to induce sweating. Fu Zi warms the meridians due to Yang collapse. Cold extremities, dry throat, irritability, Yangming internal constraint, and delirious confusion require Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction). By midnight, Yang Qi returns, feet warm, though calves remain slightly cramped. Re-administering Shao Yao Gan Cao Tang (Peony and Licorice Decoction) extends the legs. Finally, Cheng Qi Tang (Order the Qi Decoction) mildly induces bowel movement to stop delirium, predicting recovery.
Question: Symptoms resemble Yang Dan Syndrome. Cheng Wuji's commentary calls it an alias for Gui Zhi Tang; Fang Youzhi's commentary interprets "Yang" as wind and "Dan" as dawn, suggesting morning-onset wind-strike, distinct from typical wind-strike. One focuses on herbs, the other on syndromes—who is correct? Answer: If focusing on herbs, why call Gui Zhi Tang by another name unless all 113 formulas had aliases? If focusing on syndrome, if it resembles wind-strike but is more than that, what exactly is it? Interpreting "Dan" as dawn is forced. Both scholars are confused on such critical points, leaving students bewildered. Zhang Zhongjing’s flexibility lies in Yang Dan Tang and Yin Dan Tang. Yang Dan refers to sunny, warm spring/summer weather; Yin Dan refers to rainy, dark autumn/winter cold. Simply adding Huang Qin (Scutellaria Root) to Gui Zhi Tang creates Yang Dan Tang for warm seasons; increasing Gui Zhi creates Yin Dan Tang for cold seasons. Later generations lost this knowledge, wrongly claiming Gui Zhi Tang is unsuitable for spring/summer. In this case, resembling Yang Dan, treatment followed Gui Zhi plus Huang Qin, causing cold extremities due to Huang Qin aggravating Yin-cold. Had pure Gui Zhi Tang been used, this wouldn't happen. Zhang Zhongjing then applied Yin Dan method to correct the error. Increasing Gui Zhi to induce sweat confirms this. With insufficient Yin Dan power, Fu Zi was added to warm meridians. Despite dry throat and delirium, Gan Cao Gan Jiang Tang was given to await Yang return by midnight. Once feet warmed, focus shifted to harmonizing Yin. This demonstrates extreme prudence. (Yu Jiayan)
Yu Jiayan’s note that Yang Dan Tang is Gui Zhi Tang plus Huang Qin lacks evidence and is unreliable. He claims ancient methods were lost, so how could he know? Someone asked: Mr. Lin Beihai praised Yu’s view, why do you reject it? Answer: The Sages spoke of it; without verification, I cannot accept it. Asked: You claim Yang Dan Tang is Gui Zhi plus Fu Zi, not Huang Qin. What is your evidence? Answer: From Zhang Zhongjing’s original text: "Given Gui Zhi Tang"; "Symptoms resemble Yang Dan, worsening with standard treatment"; "Symptoms resemble Gui Zhi, so Fu Zi was added...". Thus, Gui Zhi Tang is the base of Yang Dan Tang, modified by adding Fu Zi. This is why I follow it unquestioningly. Asked: If Yang Dan is Gui Zhi plus Fu Zi, what is Yin Dan? Answer: "Yin Dan" appears in Yu’s notes, but I lack sufficient evidence to elaborate. I leave it as a doubt. (Wei Litong)
After taking Gui Zhi Tang, profuse sweating occurs, followed by severe irritability, unquenchable thirst, and a flooding pulse. Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng) is indicated.
Here, "taking Gui Zhi Tang" refers to the Yang Dan variant containing Fu Zi and increased Gui Zhi to induce sweat. Question: How do you know it is the Fu Zi-containing Yang Dan Tang? Answer: Profuse sweating indicates the addition of Fu Zi and increased Gui Zhi. Severe irritability and thirst indicate stomach fluid depletion and mild delirium. Without Fu Zi, Gui Zhi alone (which consolidates the exterior) would not cause profuse sweating. With Shao Yao (Peony Root) conserving Yin fluids, severe thirst would not occur. Thus, it is the Yang Dan variant. Previous texts state "symptoms resemble Yang Dan" and "symptoms resemble Gui Zhi," confirming this interpretation. ○ Question: In the previous error-correction case, Gan Cao Gan Jiang Tang was used. Why Bai Hu Jia Ren Shen Tang here? Answer: Pulse differentiation: previous case had floating pulse; this has flooding pulse, indicating different middle-Jiao Yang strength. Symptom differentiation: previous had spontaneous sweating; this has profuse sweating. Previous had irritability; this has severe irritability and thirst. Previous had dry throat but inability to drink much; this has intense thirst requiring water to quench fire. Previous was middle-deficiency with floating Yang; this is middle-excess with intense heat. They are incomparable. (Wei Litong)
In typhoid, with floating pulse, fever, and anhidrosis, if the exterior is unresolved, Bai Hu Tang (White Tiger Decoction) is contraindicated. If there is thirst for water and no exterior syndrome, Bai Hu Jia Ren Shen Tang is indicated. ○ In typhoid with no high fever, dry mouth/thirst, irritability, and slight aversion to cold on the back, Bai Hu Jia Ren Shen Tang is indicated. ○ After vomiting or purging in typhoid, if unresolved after 7-8 days, with heat constrained internally, simultaneous exterior-interior heat, occasional aversion to wind, extreme thirst, dry tongue with irritability, and desire to drink several liters of water, Bai Hu Jia Ren Shen Tang is indicated.
Question: Zhang Zhongjing states Bai Hu Tang is contraindicated if exterior is unresolved. Occasional aversion to wind and slight back coldness suggest exterior presence. Why use Bai Hu Tang? Answer: Shi Gao (Gypsum) is acrid-cool, clearing Foot-Yangming channel heat, and is a holy medicine for dry tongue and thirst. "Occasional" aversion to wind means intermittent, not constant. Slight back coldness is mild, not severe. Thus, in cases of intense heat and thirst, its use is justified. However, if aversion to cold is constant on the back without thirst/dryness, Bai Hu Tang must never be used. (Wu Shou)
Typhoid with floating-slippery pulse indicates exterior heat and interior cold; Bai Hu Tang is indicated.
Question: Floating-slippery pulse suggests heat, not cold. Is "cold" a typo? Answer: Slippery pulse indicates interior heat; floating-slippery indicates both exterior and interior heat. Zhang Zhongjing also states "heat constrained internally, simultaneous exterior-interior heat" in Bai Hu Tang cases, corroborating this. Do not rigidly interpret "cold"; it may refer to external cold transforming into interior heat. (Yu Jiayan)
If unresolved Taiyang disease transfers to Shaoyang, presenting with fullness/hardness in the hypochondrium, dry retching, inability to eat, alternating chills and fever, and without prior vomiting/purging, with a deep-tight pulse, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is given. In Taiyang wind-strike with diarrhea and vomiting, if the exterior is resolved, internal attack is permissible. If the patient sweats intermittently, has headache, subcardiac stiffness/fullness radiating to the hypochondrium, dry retching, shortness of breath, sweating without aversion to cold, this indicates resolved exterior and unharmonized interior. Shi Zao Tang (Ten Date Decoction) is indicated.
Question: Dry retching and hypochondriac pain appear in both Xiao Chai Hu Tang and Shi Zao Tang indications—one uses harmonization, the other purgation. Why? Answer: Xiao Chai Hu Tang addresses pathogens between exterior and interior, with alternating chills/fever and internal dry retching; purgation is contraindicated, requiring harmonization. Shi Zao Tang addresses cases with no exterior signs (no chills/fever, intermittent sweating), but with headache, subcardiac stiffness, hypochondriac pain, dry retching, and shortness of breath. This indicates internal heat constraint and retained fluid, requiring Shi Zao Tang to purge heat and fluid. Hypochondriac pain with exterior signs points to Chai Hu Tang; without exterior signs, it points to Shi Zao Tang. (Zhang Jianshan)
In Yangming disease, subcardiac hardness/fullness is a contraindication for purgation. ○ In Yangming disease, without prior vomiting/purging, if irritability is present, Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction) is given.
Question: Hardness/fullness seems more severe than irritability. Why can irritability be purged but not hardness/fullness? Answer: Subcardiac region corresponds to the chest/diaphragm and involves Taiyang. Hardness/fullness here is a Taiyang-Yangming sign; purgation leads to intractable diarrhea and death. Irritability indicates internal fluid consumption, usually requiring stomach regulation. However, caution is needed regarding fluid injury. If not caused by vomiting/purging, irritability suggests pathogenic heat scorching the stomach, warranting Tiao Wei Cheng Qi Tang. The term "give" implies gentle regulation to protect fluids, not aggressive purgation. (Yu Jiayan)
In Yangming disease, if complicated by cold, leading to inability to eat, urinary difficulty, and continuous sweating of hands/feet, this indicates impending Gu Jia (chronic accumulation). Stool will likely be hard initially then loose. This occurs because of cold in the stomach and failure to separate food and water.
Student asks: Sweating usually resolves disease, why does hand/foot sweating lead to Gu Jia? Answer: Ancient physicians were wise; Zhang Zhongjing’s text is for those capable of inference. In patients with deficient-cold stomach, external pathogens increase heat. Stomach heat affects the Bladder, impairing Qi transformation and causing urinary difficulty. If urine flows entirely to the Large Intestine, it causes watery diarrhea (Xia Li Qing Gu). If urine渗es into the Spleen due to stomach heat, jaundice (Gu Dan) develops. Here, hand/foot sweating allows spleen damp-heat to vent, preventing jaundice. However, since sweat is limited to limbs, heat-water vapor isn't fully expelled, only partially relieving intestinal pressure, resulting in "Jia Xie" (accumulation-type diarrhea) rather than watery diarrhea. Even in healthy people, urinary retention causes disease; in typhoid with intense heat/red urine, retention inevitably leads to these variations. Tracing the source clarifies severity. (Yu Jiayan)
In Yangming disease, fever and sweating indicate heat venting outward, preventing jaundice. If only head sweats, body has no sweat up to the neck, urinary difficulty, and thirst for fluids, this indicates stasis-heat constrained internally, leading to jaundice. Yin Chen Hao Tang (Artemisiae Scopariae Decoction) is indicated.
Question: Bai Hu Tang syndrome also presents with fever, thirst, and urinary difficulty, yet no jaundice. Why? Answer: Bai Hu Tang syndrome features whole-body sweating (heat venting); jaundice syndrome features only head sweating (heat constrained). Question: In Taiyang disease, body ache, fever, and yellowish skin color—why? Answer: This is Taiyang dampness. Zhang Zhongjing states: "After sweating in typhoid, body and eyes turn yellow" due to unresolved cold-dampness internally. (Yu Jiayan)
Excessive sweating or repeated sweating leads to Yang collapse. Delirium with a short pulse indicates death; pulse self-harmonizing indicates survival.
Student asks: Can Si Ni Tang (Four Reverse Decoction) be used for delirium due to Yang collapse? Answer: Zhang Zhongjing did not specify a formula. Why propose one? Yang collapse requires urgent restoration, but if pathogen transferred to Yangming, we must assess stomach heat intensity, fluid depletion, and interior excess. Without distinguishing these, restoring Yang might deplete Yin first, yielding no benefit. Zhang Zhongjing’s omission of a formula reflects his sagacity. Your question highlights his profound wisdom. (Shang Lun Pian)
In Yangming disease, delirium with tidal fever and inability to eat indicates 5-6 pieces of dry stool in the stomach. If able to eat, stool is merely hard. Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated for purgation.
Question: The Classic mentions "dry stool in the stomach." How? Answer: The Stomach receives food; the Large Intestine conducts waste. Dry stool belongs in the Large Intestine, not the Stomach. The Classic’s mention of "grain digested, water gone, form formed" confirms stool resides in the Large Intestine. (Ci Shi Nan Zhi)
Abdominal fullness that does not decrease, or decreases insignificantly, requires purgation. Da Cheng Qi Tang is indicated.
Question: "Decreases insignificantly" yet "requires purgation"? Answer: This is classical phrasing. It means "fullness does not decrease"—purgation is indicated. If fullness fluctuates, purgation is not indicated; this is "decrease insignificant." Da Cheng Qi Tang follows "fullness does not decrease," not "decrease insignificant." As in Taiyang chapter: Typhoid, constipation 6-7 days, headache with fever, give Cheng Qi Tang. If urine is clear, pathology is still exterior; induce sweating. If headache persists, expect nosebleed; Gui Zhi Tang is indicated. Gui Zhi Tang is for sweating, not nosebleed. The "insignificant decrease" logic aligns with this. (Zhang Jianshan)
Fu Yang pulse floating and choppy: floating indicates strong Stomach Qi; choppy indicates frequent urination. Floating-choppy interaction causes difficult defecation. This is Pi Yue (Spleen Constraint) syndrome. Ma Ren Wan (Hemp Seed Pill) is indicated.
Student asks: Pi Yue implies strong Stomach and weak Spleen, where Spleen fails to transport fluids to Stomach, like a weak husband controlled by a fierce wife—isn't this a family disaster? Answer: Evidence? Zhang Zhongjing states: "Fu Yang pulse floating/choppy... difficult defecation... Pi Yue... Ma Ren Wan." Thus, strong Stomach/weak Spleen. Answer: If Spleen were weak, tonification would be needed. Why use Da Huang (Rhubarb Root), Zhi Shi (Immature Bitter Orange), and Hou Po (Magnolia Bark) in Ma Ren Wan? You repeat old errors. Zhang Zhongjing says "Strong Stomach," not "Weak Spleen." His "Strong Stomach" actually stems from Spleen excess. "Yue" means restraint. Excessive Spleen Qi condenses 3-5 days’ worth of grain into 1-2 small pellets. This is excessive Spleen dryness drying out intestinal fluids, causing constipation. If Spleen were weak, diarrhea would occur, not constipation. Tradition says weak Spleen can’t control Stomach water, but here it controls grain? In Yangming purgation protocols, caution is exercised due to potential Spleen weakness. If Spleen Constraint existed in Taiyang, purgation would be immediate. You blindly follow predecessors, equating Pi Yue with Spleen Weakness, akin to calling Wu Qi (who killed his wife) a coward. This contradicts Sage teachings. (Shang Lun Pian)
Profuse sweating increases heat; scant sweating leads to difficult defecation.
Question: Profuse sweating increases heat; Gui Zhi/Ma Huang Tangs require slight sweating, not profuse. Scant sweating leads to difficult defecation; if fluids aren't depleted, why constipation? Answer: Taiyang disease requires sweating to resolve, but sweating therapy risks Yang collapse and wind leakage. Hence, slight sweating is prescribed to prevent endless sweating in Yang-deficient patients. Yangming Stomach channel is the repository of fluids. Internal pathogenic heat causes fluid loss via sweating. Neither Yang-deficient nor Yang-excess patients should sweat excessively. Yangming warning states: "Yangming excess, induced sweating, profuse output is excessive; excess leads to Yang extinction internally, fluid loss, and hard stool." Previously misunderstood "Yang extinction" as literal Yang loss, but it actually refers to internal fluid exhaustion, synonymous with "No Yang." The statement...