水液之余者。入胞而为尿。使胞中虚寒不能约制水液。加以邪气乘之。故使溺自遗而不
禁也
合病
亦遗
结急
歌曰遗尿风温戒利肠。腹膨身重合三阳。下焦不摄兼停血。肾绝狂言互证详。
阳明病。头疼身热。口燥。但漱水不欲入咽者必衄也。若病患无表证。不发寒热。胸腹
满。
歌曰。漱水阳明衄血时。头疼口燥热生肌。发狂瘀血无寒热。犀角桃仁类例推。
又论云。唇燥口干。血证中类有之。必欲取水而灌漱也。然漱水而不饮水何哉。盖渴者
易为
是
脉
便
丸。
华佗云。病患手循衣缝者不治。间有一二活者幸也。吐下后不解。多日不大便。日晡潮
热。
并
太阳病。用火熏之。以致发黄。阳盛则欲衄。阴虚小便难。阴阳俱虚。身体枯燥。头汗及颈
。口干咽烂。腹满微喘。或不大便。谵语。甚者呕哕。循衣摸床。此证小便利则可治。
歌曰。寻衣妄语最堪忧。下后弦阳病可瘳。脉涩为阴终不救。发黄还须小便流。
（附论）
论曰。桂枝汤本为解肌。若其人脉浮紧。发热汗不出者。不可与之。常须识此，勿令误
也。
不能发
是以
吐下
以桂
所以
辛。
温。
辛甘
津液
者请
又曰。轻可去实。麻黄、葛根之属是也。实为寒邪在表。皮腠坚实。营卫不行。津液内
涸之
之。
君也
桂枝为臣者。以风邪在表。又肤缓而理疏者。则必以桂枝解其肌。是以用桂枝为臣。寒
邪在
为臣
用以
必
则卫实而营弱。仲景所谓汗出恶风者。此谓营弱卫强者是矣。故桂枝汤佐以芍药。用和营也
麻黄汤主伤寒。寒则伤营。寒邪并于营。则营实而卫虚。内经所谓气之所并为血虚。血之
所并为气虚者是也。故麻黄佐以杏仁。用利气也。若处方之妙理。制剂之渊微。明通君子。
熟而察之乃见功焉。
又曰。青龙东方甲乙木神也。应春而主肝。专发生之令。为敷营之主。万物出甲开甲则
有两歧。肝有两叶以应木叶。所以谓之青龙者。以发散营卫两伤之邪。是应肝木之体耳。桂
枝汤主中风。麻黄汤主伤寒。二者发散之纯者也。及乎大青龙汤则不然。虽为发汗之剂。而
所
风兼寒。寒兼风。必用大青龙汤专主之也。见兹脉证。虽欲与桂枝汤解肌以祛风。而不能已
其寒则病不去。或欲与麻黄汤发汗以散寒。而不能去其风则病仍在。兹仲景所以特立大青龙
汤以两解之。麻黄味甘温。桂枝味辛热。寒则伤营。必以甘缓之。风则伤卫。必以辛散之。
此风寒两伤。营卫俱病。故以甘辛相合而为发散之剂。表虚肤缓者则以桂枝为主。先桂枝而
后麻黄。是以桂枝为君。麻黄为臣也。表实腠密者则以麻黄为主。先麻黄而后桂枝。是以麻
黄为君。桂枝为臣也。甘草味甘平。杏仁味甘苦为助。佐麻黄以发表。大枣味甘温。生姜味
辛温。相合佐桂枝以解肌。石膏味甘辛微寒。风阳邪也。寒阴邪也。风则伤阳。寒则伤阴。
营卫阴阳为风寒两伤。则非轻剂所能独散也。必须合轻重之剂以同散之。乃得阴阳之邪俱散
。营卫之气俱和。是以石膏为使。重剂而又专达肌表者也。夫大青龙汤发汗之重剂也。用之
稍过。则又有亡阳之失。经曰。若脉微弱。汗出恶风者不可服。服之则厥逆。筋惕肉 。
此为逆也。又曰。一服汗出者停后服。多服则汗多亡阳。阳虚则恶风。燥烦不得眠也。即此
观之。剂之轻重可见矣。用汤者宜详审之。
又曰。青龙象肝木两歧。而主两伤之疾。中风见寒脉。伤寒见风脉。则为营与卫两伤。
故以
且不
麻
为
。寒饮伤肺。咳逆而喘则肺气逆。内经曰。肺欲收。急食酸以收之。干姜、细辛、半夏三者
所以为使。心下有水则肾气燥。内经曰。肾若燥。急食辛以润之。是以干姜、半夏为使。以
散水寒逆气。水寒散。津液通。则汗出而解矣。心下有水气。散行所传不一。故又增损之证
。若渴者。去半夏加栝蒌根。水蓄则津液不行。气燥而渴。半夏味辛温。燥津液者也。去之
则
麻
表
之。
中冷
不利
可汗
故去
所宜
苦温
又曰。大承气汤者。承者顺也。伤寒邪气入胃者。谓之入府。腑之为言聚也。胃为水谷
之海
而为
用。
以酸
于内
治
黄
热
有燥屎乃可投之也。如非大满。则犹生寒证而病不除。况无满实者。而结胸痞气之病生矣。
是以脉经有曰。伤寒有承气之戒。古人亦特谨之。
又曰。大柴胡汤者。经云。虚者补之。实者泻之。轻重之际。临证者须消息焉。盖大满
大坚
只
大
不
胡
胡
芍
实
气者必以甘。故以半夏、生姜、大枣为之使也。一方加大黄。以大黄有将
不加大黄恐难切下。必应以大黄为使也。用方者审而行之。可得十全之
又曰。小柴胡汤者。伤寒邪气在表者。必发表以为汗。邪气在里者。必荡涤以取利。其
于不
表里
则半
芩为
为之
以散
是以
气已
以和表
以御之
则热
去之
者。
人
宜通而寒则痛。邪气入里。里气不足。寒气壅之则腹中痛。黄芩苦寒。苦性坚而寒中。故去
之
硬。去大枣加牡蛎。内经曰。甘者令人中满。大枣甘温。去之则硬寝散。酸以收之。牡蛎味
酸咸寒。加之则痞消而硬去。若心下悸。小便不利者。去黄芩加茯苓。心下悸。小便不利。
水蓄不行也。内经曰。肾欲坚。急食苦以坚之。黄芩苦寒。去之则蓄水浸行。内经曰。淡味
渗泄为阳。茯苓甘淡。加之则津液通流。若不渴。外有微热。去人参加桂。不渴则津液足。
去人参者。以人参为主内之物也。外有微热则表证多。加桂以取汗。发散邪也。若咳者。去
人
五
者
热
又曰。栀子豉汤。内经曰。其高者因而越之。其下者引而泻之。中满者泻之于其内。有
邪者
传里
邪
气乘虚留于胸中。则谓之虚烦。应以栀子豉汤吐之。栀子豉汤吐胸中虚烦者也。栀子味苦寒。
内经曰。酸苦涌泄泻为阴。涌者吐之也。涌吐虚烦。苦为主。是栀子为君。烦为热胜也。涌
热者必以苦。胜热者必以寒。香豉味苦寒。助栀子以吐虚烦。是以香豉为臣。内经曰。气有
高下。病有远近。证有中外。治有轻重。识其所以为治。根据而行之。斯为良矣。
又曰。半夏泻心汤。凡陷胸汤攻结也。泻心汤攻痞也。邪气结而不散。壅而不通则为结
胸。
谓
心下
是以
急食
大枣
所谓中者
气得和。上
又曰。瓜蒂散香。华佗曰。四日在胸则可吐之。此迎而夺之之法也。千金方曰。气浮上
部须
时也
矣。
为君
豉味
胸中痰热涌吐而出矣。其于亡血虚家。所以不与者。以瓜蒂散为驶剂。重亡津液之药。亡血
虚
又曰。大陷胸汤者。结胸者邪在胸中。处身之高分。邪结于是。宜若可吐。然所谓结。
若紧结之结。不能分解者也。谓阳受气于胸中。邪气与阳相结不能分解。气不通壅于心下。
为硬
之。
苦性
君。
消
为使
又曰。茵陈蒿汤。玉函曰。小热之气。凉以和之。大热之气。寒以取之。发黄者热之极
也。
者以
之气
热必
又曰。白虎汤。白虎者西方金神也。应秋而归肺。热甚于内者。以寒下之。热甚于外者。
以
气
热
欲彻里热必以甘寒为助。是以石膏为臣。甘草味甘平。经曰。热则伤气。寒以胜之。甘以缓
平之物缓其中。故以甘草、粳米为之使。是太阳中 得此汤而荡除之。即热见白虎而尽矣。
立秋后不可服。以秋则阴气半矣。白虎为大寒剂。于秋深之时。若不能禁而服之。则为哕逆
不能食。而成虚羸者多矣。
又曰。五苓散者。苓者令也。通行津液。克伐肾邪。专为号令者。苓之功也。五苓之中。
茯
泄为
君。
术为
味辛
枝为
又曰。理中丸者。心肺在膈上为阳。肾肝在膈下为阴。此上下脏也。脾胃应土。处在中
州。
甘以
温中
者以
中焦
邪气
气壅
必
姜
圣
收而不泄也。或曰。湿胜则濡泄。术专除湿。是以下多者加之。悸者加茯苓。饮聚则悸。茯
苓味甘。渗泄伏水得所宜也。渴欲得水者加术。津液不足则渴。术甘以补津液。腹中痛者加
人参。虚则痛。本草曰。人参味甘温。补可去弱。即人参羊肉之属是也。寒多者加干姜。辛
能散也。腹满者。去白术加附子。内经曰。甘者令人中满。术甘壅补。于腹满家则去之。附
子味辛热。气壅郁腹为之满。以热胜寒。以辛散满。故加附子。内经曰。热者寒之。寒者热
之。此之谓也。
又曰。四逆汤者。四肢逆而不温也。四肢者诸阳之本也。阳气不足。阴寒加之。阳气不
相顺
味甘
内
辛以润之。开发腠理使津液得通也。暖肌温经必凭大热。是以附子为使。此奇制之大剂也。
四逆属少阴。少阴者肾也。肾肝位远。非大剂则不能达。内经曰。远而奇偶。制大其服。此
之谓也。
又曰。真武汤。真武者。乃北方水神也。而属肾。用以治水焉。水气在心下。外带表而
属阳
武之
甘以
内经
曰。
故
五味子酸而收也。肺恶寒。以辛润之。细辛、干姜辛而润也。若小便利者。去茯苓。专渗泄
也。若下利者。去芍药加干姜。酸之性泄。去芍药。以酸泄也。辛之性散。加干姜以散寒也
。呕者。去附子加生姜。气上逆则呕。附子补气。生姜散而不相损。则气顺矣。增损之功。
非太和孰能贯之。
又云。建中汤。内经曰。肝生于左。肺藏于右。心位在上。肾处在下。左右上下四脏居
焉。
则
经曰
散也
桂、
焦。
合。
数多
芍药
以健
也。
又云。脾约丸者。约者约束之约也。内经曰。饮入于胃。游溢精气上输于脾。脾气散精
上归
约束
温。
以甘
以润
大黄
便利
又曰。抵当汤者。人之所有者气与血也。气为阳。气流而不行者则易散。以阳病易治故
也。
当其
必以
虻虫为臣。桃仁味苦甘平。肝者血之源。血结则肝气燥。内经曰。肝苦急。急食甘以缓之。
散血
血逐
济之
水液代谢的余剩部分，进入膀胱成为尿液。如果膀胱虚寒，不能约束控制水液，再加上邪气侵袭，就会导致小便失禁而自遗。
合病（两经或三经同时发病）也会出现遗尿。症状表现为腹部胀满、身体拘急。
歌诀说：遗尿需警惕风温证，忌用利肠药物；腹部膨隆、身体拘急属于三阳合病；下焦不固摄且伴有瘀血停滞；肾气衰竭出现狂言乱语，这些症状互相印证需详细辨析。
阳明病，头痛、身热、口燥。只是含水漱口而不愿咽下的人，必定会发生鼻衄（鼻出血）。如果病人没有表证，不发寒热，但胸腹胀满。
歌诀说：漱水不欲咽是阳明病鼻衄时的表现；头痛、口燥、热盛生肌；发狂、无寒热是瘀血所致，可参考犀角地黄汤和桃仁承气汤等方剂类推治疗。
又有论述说：嘴唇干燥、口干，在血证中也有这种情况，患者一定想要取水来含漱。然而为什么只漱口不喝水呢？大概是因为……（原文此处有缺漏，推测为渴非真渴，因瘀血内阻津液不上承）。脉象……大便……丸药。
华佗说：病人手循衣缝（手指无意识地抓摸衣被缝隙）的属于不治之症，偶尔有一两个能活的，纯属侥幸。经过吐法或下法后病情未解，多日不大便，傍晚时分出现潮热。
并（指病情复杂或兼夹）太阳病，用火熏疗法，导致发黄。阳气盛则想流鼻血，阴血虚则小便困难，阴阳俱虚则身体干枯粗糙，头颈部出汗，口干咽喉溃烂，腹满微喘，或者不大便，谵语。严重的会出现呕吐呃逆，循衣摸床。此证如果小便利则可以治疗。
歌诀说：寻衣妄语最为堪忧，下法后脉弦阳病可愈；脉涩说明阴竭终难救；发黄还需看小便是否通利。
（附论）
论述说：桂枝汤本来是用于解肌（解除肌表之邪）的。如果病人脉浮紧、发热、无汗，不可给予桂枝汤。必须时刻记住这一点，不要误用。
不能发（汗）……是以……吐下……以桂……所以……辛。温。辛甘……津液……者请……
又说：轻清的药物可以祛除实邪，麻黄、葛根这类药物就是如此。实邪是指寒邪在体表，皮肤腠理坚实，营卫之气运行不畅，津液在内枯竭。
君药……桂枝作为臣药，是因为风邪在表，且肌肤松弛、腠理疏泄的人，必须用桂枝来解肌。所以用桂枝为臣。寒邪在……为臣……用以……必……则卫气实而营气弱，张仲景所说的“汗出恶风”，指的就是营弱卫强的情况。所以桂枝汤中佐以芍药，用来调和营气。
麻黄汤主治伤寒。寒邪伤营，寒邪并入营分，则营实而卫虚。《内经》所说的气并则为血虚，血并则为气虚，就是这个道理。所以麻黄汤中佐以杏仁，用来利气。处方的妙理、制剂的精微之处，明达的君子熟察之后才能见到功效。
又说：青龙对应东方甲乙木神，应春季而主肝，专司发生之令，是敷布营气的主体。万物破甲而出，甲有两歧，肝有两叶以应木叶，所以称为青龙，是因为它能发散营卫两伤的邪气，这符合肝木的特性。桂枝汤主治中风，麻黄汤主治伤寒，这两者是纯发散之剂。至于大青龙汤则不然，虽然也是发汗剂，但所治……风兼寒，寒兼风，必须用大青龙汤专门主治。见到这种脉证，虽然想用桂枝汤解肌祛风，但不能去除寒邪则病不去；或者想用麻黄汤发汗散寒，但不能去除风邪则病仍在。这就是张仲景特别设立大青龙汤来两解风寒的原因。麻黄味甘温，桂枝味辛热。寒邪伤营，必须用甘味药缓之；风邪伤卫，必须用辛味药散之。这是风寒两伤，营卫俱病，所以用甘辛相合成为发散之剂。表虚肤缓的人以桂枝为主，先桂枝后麻黄，所以桂枝为君，麻黄为臣。表实腠理致密的人以麻黄为主，先麻黄后桂枝，所以麻黄为君，桂枝为臣。甘草味甘平，杏仁味甘苦作为辅助，佐助麻黄发表；大枣味甘温，生姜味辛温，相合佐助桂枝解肌。石膏味甘辛微寒，风为阳邪，寒为阴邪。风伤阳，寒伤阴。营卫阴阳被风寒两伤，则不是轻剂所能单独解散的。必须结合轻重不同的药物共同解散，才能使阴阳之邪俱散，营卫之气俱和，所以用石膏为使药，它是重剂又能直达肌表的药物。大青龙汤是发汗的重剂。使用稍有过量，就会有亡阳的过失。《内经》说：如果脉微弱、汗出恶风，不可服用。服了就会出现四肢厥冷、筋惕肉瞤（肌肉跳动）。这是逆证。又说：一服药后汗出的，停服后面的药。多服则汗多亡阳，阳虚则恶风、烦躁不得眠。由此看来，药剂的轻重可见一斑。使用汤剂应当详审。
又说：青龙象征肝木的两歧，主治两伤的疾病。中风见寒脉，伤寒见风脉，就是营与卫两伤。故以……且不……麻……为……。寒饮伤肺，咳嗽气逆而喘，肺气上逆。《内经》说：肺欲收，急食酸味以收敛它。干姜、细辛、半夏三者作为使药。心下有停水则肾气燥。《内经》说：肾若燥，急食辛味以润之。所以用干姜、半夏为使药，以散水寒逆气。水寒散去，津液通畅，则汗出而解。心下有 water qi（水气），散布流传不一，所以又增减证候。如果口渴，去半夏加栝蒌根。水蓄积则津液不行，气燥而渴。半夏味辛温，会燥伤津液。去之……麻……表……之。中冷……不利……可汗……故去……所宜……苦温。
又说：大承气汤，“承”的意思是顺。伤寒邪气入胃，叫做入腑。腑的意思就是聚。胃是水谷之海……而为……用。以酸……于内……治……黄……热……有燥屎才可以投用。如果不是大满，则仍会有寒证而病不除。何况没有满实的，就会产生结胸、痞气等疾病。所以《脉经》说：伤寒有使用承气汤的禁忌，古人也特别谨慎。
又说：大柴胡汤，《内经》说：虚者补之，实者泻之。轻重之际，临证者须斟酌。盖大满大坚……只……大……不……胡……胡……芍……实……气者必以甘味。所以用半夏、生姜、大枣作为使药。一方加大黄，因为大黄有将……不加大黄恐怕难以切中病机，必须以大黄为使药。用方者审慎而行，可得十全之功。
又说：小柴胡汤，伤寒邪气在表的，必须发表取汗；邪气在里的，必须荡涤取利。其于不……表里……则半……芩为……为之……以散……是以……气已……以和表……以御之……则热……去之……者。人……宜通而寒则痛。邪气入里，里气不足，寒气壅滞则腹中痛。黄芩苦寒，苦性坚而寒中，故去之……硬。去大枣加牡蛎。《内经》说：甘者令人中满。大枣甘温，去之则硬块消散。酸以收之，牡蛎味酸咸寒，加之则痞消而硬去。如果心下悸、小便不利，去黄芩加茯苓。心下悸、小便不利，是水蓄不行。《内经》说：肾欲坚，急食苦以坚之。黄芩苦寒，去之则蓄水浸行。《内经》说：淡味渗泄为阳。茯苓甘淡，加之则津液通流。如果不渴，外有微热，去人参加桂枝。不渴则津液足，去人参是因为人参主内。外有微热则表证多，加桂枝以取汗，发散邪气。如果咳嗽，去……五……者……热。
又说：栀子豉汤。《内经》说：其高者因而越之，其下者引而泻之，中满者泻之于其内。有邪者……传里……邪……气乘虚留于胸中，则谓之虚烦，应用栀子豉汤吐之。栀子豉汤是吐胸中虚烦的方剂。栀子味苦寒。《内经》说：酸苦涌泄泻为阴。涌就是吐的意思。涌吐虚烦，以苦为主，所以栀子为君药。烦是热胜所致。涌吐热邪必以苦味，胜热必以寒味。香豉味苦寒，助栀子以吐虚烦，所以香豉为臣药。《内经》说：气有高下，病有远近，证有中外，治有轻重。懂得治疗的原理，据此而行，这才是良医。
又说：半夏泻心汤。凡陷胸汤攻结胸，泻心汤攻痞证。邪气结而不散，壅塞不通则为结胸……谓……心下……是以……急食……大枣……所谓中者……气得和，上……
又说：瓜蒂散香。华佗说：病邪在胸中四天，可以吐之。这是迎而夺之的方法。《千金方》说：气浮上部须……时也……矣。为君……豉味……胸中痰热涌吐而出。对于亡血虚家，所以不给用，是因为瓜蒂散是峻剂，是重伤津液的药。亡血……
又说：大陷胸汤。结胸者邪在胸中，处于身体高位。邪结于此，似乎可以吐。然而所谓的结，如果是紧结之结，不能分解的。谓阳受气于胸中，邪气与阳相结不能分解，气不通壅于心下，为硬……之。苦性……君。……为使。
又说：茵陈蒿汤。《玉函经》说：小热之气，凉以和之；大热之气，寒以取之。发黄是热之极也……者以……之气……热必……
又说：白虎汤。白虎是西方金神，应秋季而归肺。热甚于内的，用寒下法；热甚于外的，用……气……热……欲彻里热必以甘寒为助，所以石膏为臣药。甘草味甘平。《内经》说：热则伤气，寒以胜之，甘以缓之。用平和之物缓其中，所以用甘草、粳米为使药。这是太阳中……得此汤而荡除之，即热见白虎而尽矣。立秋后不可服，因为秋时阴气已半。白虎是大寒剂，在深秋之时，如果不能禁受而服用，就会变成哕逆、不能食，而成虚羸的多。
又说：五苓散，“苓”是令的意思，通行津液，克伐肾邪，专门作为号令，这是茯苓的功效。五苓之中……茯……泄为……君。术为……味辛……枝为……
又说：理中丸。心肺在膈上为阳，肾肝在膈下为阴，这是上下脏。脾胃应土，处于中州……甘以……温中……者以……中焦……邪气……气壅……必……姜……圣……收而不泄也。有人说：湿胜则濡泄，术专除湿，所以下利多者加术。心悸者加茯苓，饮聚则悸，茯苓味甘，渗泄伏水得其宜。渴欲得水者加术，津液不足则渴，术甘以补津液。腹中痛者加人参，虚则痛。《本草》说：人参味甘温，补可去弱，即人参羊肉之类。寒多者加干姜，辛能散。腹满者，去白术加附子。《内经》说：甘者令人中满。术甘壅补，对于腹满者则去之。附子味辛热，气壅郁腹为之满，以热胜寒，以辛散满，所以加附子。《内经》说：热者寒之，寒者热之，说的就是这个道理。
又说：四逆汤，四肢逆冷不温。四肢是诸阳之本。阳气不足，阴寒加之，阳气不相顺……味甘……内……辛以润之，开发腠理使津液得通。暖肌温经必凭大热，所以附子为使。这是奇制的大剂。四逆属少阴，少阴就是肾。肾肝位置深远，非大剂则不能到达。《内经》说：远而奇偶，制大其服，说的就是这个道理。
又说：真武汤。真武是北方水神，属肾，用来治水。水气在心下，外带表而属阳……武之……甘以……内经……曰。……故……五味子酸而收。肺恶寒，以辛润之，细辛、干姜辛而润。如果小便利，去茯苓，专事渗泄。如果下利，去芍药加干姜。酸之性泄，去芍药是因为酸泄。辛之性散，加干姜以散寒。呕者，去附子加生姜。气上逆则呕，附子补气，生姜散而不相损，则气顺。增损之功，非太和谁能贯通。
又说：建中汤。《内经》说：肝生于左，肺藏于右，心位在上，肾处在下。左右上下四脏居焉……则……经曰……散也……桂、……焦。……合。……数多……芍药……以健……也。
又说：脾约丸。“约”是约束的意思。《内经》说：饮入于胃，游溢精气上输于脾，脾气散精……约束……温。……以甘……以润……大黄……便利。
又说：抵当汤。人之所有者是气与血。气为阳，气流而不行则易散，因为阳病易治……当其……必以……虻虫为臣。桃仁味苦甘平。肝是血的源头，血结则肝气燥。《内经》说：肝苦急，急食甘以缓之。散血……血逐……济之。
The residual part of fluid metabolism enters the bladder to become urine. If the bladder is deficient and cold, failing to constrain and control the fluids, and is further invaded by pathogenic factors, it leads to involuntary urination (enuresis).
He Bing (simultaneous involvement of two or three meridians) can also present with enuresis. Symptoms include abdominal distension and body stiffness/tightness.
The verse states: Enuresis requires caution regarding Wind-Warmth syndromes; purgatives for the intestines are contraindicated. Abdominal distension and body stiffness belong to the simultaneous involvement of the Yang meridians. Failure of the Lower Jiao to secure and retention of blood stasis are involved. Maniacal speech indicates Kidney Qi exhaustion; these symptoms must be differentiated in detail through mutual corroboration.
Yang Ming disease presents with headache, fever, and dry mouth. Patients who only rinse their mouths with water but do not wish to swallow will likely experience epistaxis (nosebleed). If the patient has no exterior syndrome, no chills or fever, but experiences chest and abdominal fullness.
The verse states: Rinsing the mouth without swallowing is a sign of Yang Ming epistaxis; headache, dry mouth, and heat generating muscle issues. Mania without chills or fever indicates blood stasis; treatments like Xi Jiao Di Huang Tang (Rhino Horn and Rehmannia Decoction) or Tao Ren Cheng Qi Tang (Peach Kernel and Rhubarb Decoction) can be inferred by analogy.
Another discussion states: Dry lips and mouth also occur in blood syndromes, where patients desire water for rinsing. However, why rinse without swallowing? Generally... [text missing, likely implying thirst is not due to true fluid deficiency but obstruction]. Pulse... stool... pill.
Hua Tuo stated: Patients who unconsciously grasp at the seams of their clothing (Xun Yi Mo Chuang) have an untreatable condition; occasional survival is mere luck. After emesis or purgation, if the condition does not resolve, with multiple days of constipation and tidal fever in the late afternoon...
Combined with Tai Yang disease, using moxibustion/fumigation can lead to jaundice. Excess Yang desires epistaxis; Yin deficiency leads to difficult urination. Deficiency of both Yin and Yang leads to dry and rough skin, sweating on the head and neck, dry mouth and rotting throat, abdominal fullness with slight panting, or constipation, and delirium. Severe cases may present with vomiting and hiccups, grasping at clothing and bedrails. This syndrome is treatable if urination is free.
The verse states: Grasping at clothing and delirium is most worrying; after purgation, if the pulse is wiry and Yang, the disease can heal. A choppy pulse indicates Yin exhaustion and ultimate non-recovery; for jaundice, one must observe if urine flows freely.
(Attached Discussion)
It is stated: Gui Zhi Tang (Cinnamon Twig Decoction) is originally intended to release the muscle layer (Jie Ji). If the patient has a floating-tight pulse, fever, and no sweat, Gui Zhi Tang must not be given. One must always remember this to avoid error.
Cannot induce sweat... therefore... emesis/purgation... use Gui... therefore... Acrid. Warm. Acrid-Sweet... Body Fluids... please...
It is also said: Light and clear herbs can dispel excess; Ephedrae Herba (Mahuang) and Puerariae Radix (Gegen) are examples. "Excess" refers to Cold pathogens on the exterior, where the skin and pores are firm, Ying and Wei Qi circulation is blocked, and body fluids are depleted internally.
Monarch herb... Gui Zhi serves as Minister because Wind pathogens are on the exterior, and in those with loose skin and open pores, Gui Zhi is needed to release the muscle layer. Thus, Gui Zhi is used as Minister. When Cold pathogens are... as Minister... used to... must... then Wei Qi becomes solid and Ying Qi becomes weak. Zhang Zhongjing's statement about "sweating and aversion to wind" refers to this state of weak Ying and strong Wei. Therefore, Shaoyao (Paeonia Lactiflora) is added to Gui Zhi Tang to harmonize Ying Qi.
Ma Huang Tang treats Shang Han (Cold Damage). Cold injures Ying Qi; when Cold pathogens merge into Ying, Ying becomes solid and Wei becomes weak. As stated in the *Nei Jing*: Qi aggregation leads to Blood deficiency, and Blood aggregation leads to Qi deficiency. Thus, Xingren (Apricot Seed) is added to Ma Huang Tang to promote Qi movement. The subtle principles of prescription formulation require wise scholars to study carefully to see their efficacy.
It is also said: Qing Long (Azure Dragon) corresponds to the East, Wood Deity, Spring, and Liver, governing growth and distribution of Ying. Just as sprouts split, the liver has two lobes corresponding to wood leaves. Hence "Qing Long" because it disperses pathogens injuring both Ying and Wei, aligning with the nature of Liver Wood. Gui Zhi Tang treats Zhong Feng (Wind Strike); Ma Huang Tang treats Shang Han. These are pure dispersing formulas. Da Qing Long Tang (Major Azure Dragon Decoction) is different. Although it induces sweat, it treats... Wind combined with Cold, Cold combined with Wind. It must be treated specifically with Da Qing Long Tang. Seeing such pulse and signs, although one might want to use Gui Zhi Tang to release the muscle and dispel Wind, if Cold is not removed, the disease remains; or if one wants to use Ma Huang Tang to induce sweat and disperse Cold, if Wind is not removed, the disease remains. This is why Zhang Zhongjing established Da Qing Long Tang to resolve both Wind and Cold. Mahuang is sweet and warm; Guizhi is acrid and hot. Cold injures Ying, requiring Sweet herbs to moderate; Wind injures Wei, requiring Acrid herbs to disperse. This is Wind and Cold injuring both Ying and Wei. Thus, Sweet and Acrid are combined to form a dispersing agent. For exterior deficiency with loose skin, Guizhi is primary; Guizhi first, then Mahuang, so Guizhi is Monarch, Mahuang is Minister. For exterior excess with tight pores, Mahuang is primary; Mahuang first, then Guizhi, so Mahuang is Monarch, Guizhi is Minister. Gancao (Licorice Root) is sweet and neutral; Xingren is sweet and bitter, assisting Mahuang to release the exterior; Dazao (Jujube) is sweet and warm; Shengjiang (Fresh Ginger) is acrid and warm, combining to assist Guizhi in releasing the muscle layer. Shigao (Gypsum Fibrosum) is sweet, acrid, and slightly cold. Wind is Yang pathogen, Cold is Yin pathogen. Wind injures Yang, Cold injures Yin. When Ying, Wei, Yin, and Yang are injured by Wind and Cold, light agents alone cannot disperse them. Heavy and light agents must be combined to disperse both Yin and Yang pathogens and harmonize Ying and Wei Qi. Thus, Shigao is used as Envoy, a heavy agent reaching the muscle layer. Da Qing Long Tang is a heavy sweating agent. Overuse leads to loss of Yang. The *Jing* says: If the pulse is faint, with sweating and aversion to wind, do not administer. Administration causes cold limbs and muscle twitching (Jin Ti Rou Tiao). This is a counter-indication. It also says: Stop subsequent doses if sweating occurs after the first dose. Overuse causes excessive sweating and loss of Yang; Yang deficiency leads to aversion to wind, irritability, and insomnia. Thus, the weight of the dosage is evident. Physicians should examine carefully.
It is also said: Qing Long symbolizes the bifurcation of Liver Wood, treating dual injuries. Wind strike showing Cold pulse, or Shang Han showing Wind pulse, indicates dual injury of Ying and Wei. Therefore... and not... Ma... as... Cold-fluid injuring Lung causes cough, wheezing, and rebellious Lung Qi. The *Nei Jing* says: Lung desires consolidation; urgently eat Sour to consolidate. Ganjiang (Dried Ginger), Xixin (Asarum), and Banxia (Pinellia) serve as Envoys. Water retention in the Heart causes Kidney dryness. The *Nei Jing* says: If Kidney is dry, urgently eat Acrid to moisten. Thus, Ganjiang and Banxia are used as Envoys to disperse Cold-fluid rebellious Qi. Once Cold-fluid disperses and fluids flow, sweating resolves the condition. Water-Qi in the Heart spreads differently, so symptoms are modified. If thirsty, remove Banxia and add Gualougen (Trichosanthes Root). Water retention blocks fluids, causing Qi dryness and thirst. Banxia is acrid and warm, drying fluids. Remove it... Ma... Exterior... . Middle Cold... unfavorable... can sweat... therefore remove... suitable... Bitter-Warm.
It is also said: Da Cheng Qi Tang (Major Order the Qi Decoction): "Cheng" means to follow/obey. When Shang Han pathogens enter the Stomach, it is called entering the Fu organs. "Fu" implies gathering. The Stomach is the sea of water and grain... and for... use. With Sour... inside... treat... Jaundice... Heat... Only administer if there is dry feces. If not major fullness, Cold syndromes may persist and the disease not be cured. How much more so if there is no fullness/excess, leading to Jie Xiong (Chest Binding) and Pi Qi (Glomus)? Thus, the *Mai Jing* states: There are warnings against using Cheng Qi Tang in Shang Han; ancients were particularly cautious.
It is also said: Da Chai Hu Tang (Major Bupleurum Decoction): The *Jing* says: Tonify deficiency, drain excess. Physicians must weigh the severity. Major fullness and hardness... only... large... not... Hu... Hu... Shaoyao... Excess... Qi must be Sweet. Thus, Banxia, Shengjiang, and Dazao are used as Envoys. One formula adds Dahuang (Rhubarb Root) because Dahuang has the function of... Without adding Dahuang, it may fail to hit the pathology; thus Dahuang must be used as Envoy. Practitioners should exercise judgment to achieve perfection.
It is also said: Xiao Chai Hu Tang (Minor Bupleurum Decoction): For Shang Han pathogens on the exterior, release via sweating; for pathogens in the interior, purge via bowel movements. Its... Exterior-Interior... then Ban... Qin as... for it... to disperse... therefore... Qi already... to harmonize Exterior... to defend against it... then Heat... remove it... person. Should be unobstructed; Cold causes pain. Pathogens entering the interior, with insufficient Interior Qi, cause abdominal pain due to Cold stagnation. Huangqin (Scutellaria Root) is bitter and cold; its bitterness is hardening and cold damages middle. Thus remove it... Hard. Remove Dazao, add Muli (Oyster Shell). The *Nei Jing* says: Sweet causes abdominal fullness. Dazao is sweet and warm; removing it dissipates hardness. Sour consolidates; Muli is sour, salty, and cold; adding it resolves glomus and hardness. If palpitations in the Heart and difficult urination, remove Huangqin, add Fuling (Poria). Palpitations and difficult urination indicate water retention. The *Nei Jing* says: Kidney desires firmness; urgently eat Bitter to firm it. Huangqin is bitter and cold; removing it allows retained water to flow. The *Nei Jing* says: Bland taste promotes leaching and draining (Yang). Fuling is sweet and bland; adding it promotes fluid flow. If not thirsty, with slight external heat, remove Renshen (Ginseng Root), add Guizhi (Cinnamon Twig). No thirst means sufficient fluids; remove Renshen as it acts internally. Slight external heat means many exterior signs; add Guizhi to induce sweating and disperse pathogens. If coughing, remove... Five... person... Heat.
It is also said: Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction). The *Nei Jing* says: For high pathogens, induce vomiting (Yue); for low pathogens, guide downward and purge; for central fullness, purge from within. Pathogens... transmitting to interior... Pathogen... Qi remaining in the Chest due to deficiency is called Empty Irritation (Xu Fan). Zhi Zi Chi Tang should be used to vomit. Zhi Zi Chi Tang treats empty irritation in the Chest. Zhi Zi is bitter and cold. The *Nei Jing* says: Sour and Bitter induce vomiting and purging (Yin). "Yong" means vomiting. To vomit empty irritation, Bitter is primary; thus Zhi Zi is Monarch. Irritation is caused by Heat excess. To vomit Heat, Bitter is required; to overcome Heat, Cold is required. Xiang Chi (Fermented Soybean) is bitter and cold, assisting Zhi Zi to vomit empty irritation; thus Xiang Chi is Minister. The *Nei Jing* says: Qi has height and depth; diseases have distance and proximity; signs have interior and exterior; treatments have lightness and heaviness. Understanding the principle of treatment and acting accordingly makes a good physician.
It is also said: Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Epigastrium). Jian Xiong Tang attacks binding; Xie Xin Tang attacks glomus. Pathogens binding and not dispersing, obstructing and not flowing, become Jie Xiong... referred to... Epigastric region... therefore... urgently eat... Dazao... referred to as Central... Qi harmonizes, Upper...
It is also said: Gua Di San (Melon Spittle Powder) is fragrant. Hua Tuo said: If pathogens are in the Chest for four days, they can be vomited. This is the method of meeting and seizing. *Qian Jin Fang* said: Qi floating to the upper part requires... time... . Monarch... Chi flavor... Phlegm-Heat in the Chest is vomited out. For those with blood loss or deficiency, it is not given because Gua Di San is a harsh agent that severely depletes fluids. Blood loss...
It is also said: Da Xian Xiong Tang (Major Trap the Chest Decoction). In Jie Xiong, pathogens are in the Chest, a high position. Pathogens bind here, seemingly suitable for vomiting. However, the "binding" refers to tight binding that cannot separate. Yang receives Qi in the Chest; pathogens bind with Yang and cannot separate, blocking Qi in the Epigastrium, causing hardness... . Bitter nature... Monarch. ... as Envoy.
It is also said: Yin Chen Hao Tang (Artemisiae Scopariae Spica Decoction). *Yu Han Jing* says: For mild heat, cool to harmonize; for severe heat, use Cold to resolve. Jaundice is extreme heat... person with... Qi... Heat must...
It is also said: Bai Hu Tang (White Tiger Decoction). Bai Hu is the Western Metal Deity, corresponding to Autumn and returning to the Lung. For heat severe internally, use Cold to purge; for heat severe externally, use... Qi... Heat... To thoroughly clear internal heat, Sweet-Cold is needed as assistance; thus Shigao is Minister. Gancao is sweet and neutral. The *Jing* says: Heat injures Qi; Cold overcomes it; Sweet moderates it. Use neutral substances to moderate the center; thus Gancao and Jingmi (Rice Grain) are Envoys. This clears Tai Yang... obtaining this decoction sweeps it away; heat meets White Tiger and vanishes. Do not use after Start of Autumn, as Yin Qi is half-present. Bai Hu is a Great Cold agent; in deep Autumn, if taken without tolerance, it causes hiccups, inability to eat, and many cases of deficiency and emaciation.
It is also said: Wu Ling San (Five Ingredient Powder with Poria). "Ling" means order/command, promoting fluid flow, overcoming Kidney pathogens, serving as a command; this is the merit of Fuling. Among Wu Ling... Fuling... Leaching as... Monarch. Zhu (Atractylodes Macrocephala Rhizome) as... Acrid flavor... Zhi (Cinnamon Twig) as...
It is also said: Li Zhong Wan (Regulate the Middle Pill). Heart and Lung above the Diaphragm are Yang; Kidney and Liver below are Yin; these are Upper and Lower Zang. Spleen and Stomach correspond to Earth, located in the Central Region... Sweet to... Warm Middle... person with... Middle Jiao... Pathogen... Qi stagnation... must... Ginger... Sage... Retain without leaking. Some say: Dampness excess causes loose stools; Zhu specializes in removing dampness, thus added for frequent diarrhea. Palpitations add Fuling; fluid accumulation causes palpitations; Fuling is sweet, leaching hidden water is appropriate. Thirst desiring water adds Zhu; fluid insufficiency causes thirst; Zhu is sweet to replenish fluids. Abdominal pain adds Renshen; deficiency causes pain. *Ben Cao* says: Renshen is sweet and warm; tonification removes weakness, similar to Renshen and mutton. More Cold adds Ganjiang; Acrid disperses. Abdominal fullness removes Zhu, adds Fuzi (Aconite Lateralis Radix Praeparata). The *Nei Jing* says: Sweet causes abdominal fullness. Zhu is sweet and cloying; remove for abdominal fullness. Fuzi is acrid and hot; Qi stagnation causes abdominal fullness; Heat overcomes Cold, Acrid disperses fullness, thus add Fuzi. The *Nei Jing* says: Heat with Cold, Cold with Heat; this is what is meant.
It is also said: Si Ni Tang (Four Reversals Decoction): Limbs are reversed and cold. Limbs are the root of all Yang. Yang Qi is insufficient, compounded by Yin Cold, Yang Qi does not flow smoothly... Sweet flavor... Internal... Acrid to moisten, opening pores to allow fluid flow. Warming muscles and meridians relies on Great Heat; thus Fuzi is Envoy. This is a unique large-dose formula. Si Ni belongs to Shao Yin; Shao Yin is Kidney. Kidney and Liver are distant; only large doses can reach them. The *Nei Jing* says: Distant and odd/even, make the dose large; this is what is meant.
It is also said: Zhen Wu Tang (True Warrior Decoction). Zhen Wu is the Northern Water Deity, belonging to Kidney, used to treat Water. Water-Qi is in the Heart, extending to the exterior and belonging to Yang... Wu Zhi... Sweet to... Nei Jing... Says... Therefore... Wu Wei Zi (Schisandra Fruit) is Sour and consolidating. Lung dislikes Cold; moisten with Acrid; Xixin and Ganjiang are Acrid and moistening. If urination is free, remove Fuling, focusing on leaching. If diarrhea, remove Shaoyao, add Ganjiang. Sour nature leaks; remove Shaoyao because Sour leaks. Acrid nature disperses; add Ganjiang to disperse Cold. Vomiting: remove Fuzi, add Shengjiang. Rebellious Qi causes vomiting; Fuzi tonifies Qi, Shengjiang disperses without damaging, so Qi becomes smooth. The merit of modification is understood only by Great Harmony.
It is also said: Jian Zhong Tang (Establish the Middle Decoction). The *Nei Jing* says: Liver grows on the left, Lung stores on the right, Heart is above, Kidney is below. The four Zang occupy left, right, above, and below... then... Jing says... Disperse... Gui... Scorched... Combine... Many times... Shaoyao... to strengthen... .
It is also said: Pi Yue Wan (Spleen Constraint Pill). "Yue" means constraint. The *Nei Jing* says: Drink enters Stomach, essence floats up to Spleen, Spleen Qi scatters essence... Constraint... Warm... With Sweet... With Moistening... Dahuang... Convenient stool.
It is also said: Di Dang Tang (Break Through Accumulation Decoction). What humans possess is Qi and Blood. Qi is Yang; Qi flows but if stagnant it easily scatters, because Yang diseases are easy to treat... When it... Must... Meng Chong (Blister Beetle) as Minister. Tao Ren (Peach Kernel) is bitter, sweet, and neutral. Liver is the source of Blood; Blood binding causes Liver Qi dryness. The *Nei Jing* says: Liver suffers from urgency; urgently eat Sweet to moderate it. Disperse Blood... Blood drives out... Assist it.