[主治]
热性病后，腰以下发肿。但必须具有大小便不利、形气较实、脉象有力，喜冷性饮食等现象，方宜用之，否则即会犯虚虚之戒。慎之，慎之!
[药品]
牡蛎 泽泻 蒌根 蜀漆(暖水洗去腥) 炒葶苈子炒商陆根 海藻(洗)各等份
[制服法]
共研细末，每服一钱，米汤送下。小便利者止后服．
[用药大意]
牡蛎、蒌根滋阴清热，其余诸药逐水消肿。
[禁忌证]
病后饮食减少，大便溏泻，腰困腿酸，脉象无力，喜温恶寒，为脾肾虚寒之证，虽同样的发肿，绝不可服。不可与有甘草的药同服，因甘草与海藻相反也。
[类似方剂参考]
(1)金匮肾气丸：此治腰酸腿困、喜温恶寒、肾阳虚发肿之方。
(2)四君子汤加减：此治饮食减少、大便溏稀、脾虚发肿之方。
竹叶石膏汤第一百一十三
[方义]
此治病后热邪未尽，津液已伤，气逆欲吐，补虚降逆、清热生滓之方。
[主治]
热性病后，身热不退，欲呕。但必须具有口渴、喜冷、脉虚等症状。
按：此证之身热，与使用小柴胡汤及枳实栀子豉汤之身热完全不同。后二方之身热，都是热止后复发之证，此证之身热，系病虽减轻但身热绵绵不休。
[药品]
竹叶二至三钱 生石膏二至三钱 半夏钱半至二钱半人參一至二钱 甘草五分至一钱 粳米一至三钱 麦门冬一至二钱
[煎服法]
水三茶杯，煎至半茶杯，去滓温服。
[用约大意]
竹叶、石膏、麦冬清热生津；半夏降逆止吐；人参、粳米、炙草补中气之虚。
[禁忌]
凡没有身热、口渴、喜冷、脉虚、呕吐等任何一症者不可使用原方，应随症加减。
[类似方刑参考]
(1)小柴胡汤：此治热病后身热欲呕，偏于和解外邪之方。
(2)六君子汤：此治没有热证而虚羸少气、欲吐之方。
李翰卿语录220则
病机挈要
1．燥证，喻氏谓属热，沈氏讲属凉，其实，他们所说到的都是燥证的一个方面。故吴鞠通、俞根初都指出，燥有热燥、凉燥之分。其机理喻以蒸笼，如水火不偏，则熏蒸而无燥；如火盛水少，则无气为热燥；水多火微，蒸不起气来为凉燥。临证必须有此两种概念，则易分析，但仍凭见证为依据，方能无误。
2．四损者，气虚、血虚、阴虚、阳虚是也。杨栗山所谓气血两虚、阴阳并竭是也。大劳、大欲、大病、久病、老人、产后、先天不足、后天失调是其因。气虚者。真气不足也，其症气不足以息，言不足以听，或欲言而不能；血虚者，真血不足也，其症通身萎黄，两唇白，或素有失血之证；阴虚者，真阴不足也，其症肌肤甲错，五液干枯；阳虚者，真阳不足也，其症厥逆，下利，肢体畏寒，口鼻气冷。单虚者单治，兼虚者兼治，虚而兼寒者温而补之，虚而兼热者清而补之，虚而兼实者须审其标本、先后、缓急、多少随机而治之。
3．仲景说：太阳病欲解时从巳至未上。巳至未就是北京时间上午9时至下午3时。这个时间正是阳气最盛的时间。太阳病本来是风寒损伤了卫阳的证候，故遇阳盛之时卫阳有所帮助，故能自愈。我的看法，这不是绝对的，不可完全依靠，只可作为治疗本病的有利条件之一。
4．虚热证是虚而兼热或兼火的证候，亦称之为虚火，非单指阴液不足，阳气相对偏盛的虚性亢奋病理状态。其形成，或因虚而生热，或热久致虚，或体虚兼患热证。临证证候与火热证相同，其主症为烦热，口渴喜冷饮，但服清凉泻火药不效或反加重，只有用滋阴养血生津，引火归原，或甘温除热之法方效。如伤寒后期竹叶石膏汤证，阳明经病人参白虎汤证，口糜龈烂之甘露饮证及十味地黄汤证，咽痛之养阴清肺汤证等。
5．头不痛项不强，便知非太阳证；但头痛不项强也非太阳证，如项强痛反不恶寒，脉不沉，不可谓非太阳病。太阳病以头项强痛为提纲。
6．结胸是伤寒误用下药而成的胸腹硬痛的证候，分为大、小、寒、热、水、血、痰、食八种。其中胸腹不按自痛，按之更痛者，为大结胸；心下按之则痛，不按不痛者，为小结胸；兼不热、不渴，小便清白，为寒结胸；兼烦渴便闭，为热结胸；兼怔忡，头汗，无大熱，揉之有水声，为水结胸；兼漱水不咽，喜妄如狂，大便黑，小便利，为血结胸；兼脉滑喘嗽，为痰结胸；兼气口脉大，为食结胸。
7．人参白虎汤之“背微恶寒”、“时时恶风”，非谓之表不解，乃因内热太盛，自觉室温较低而有背微恶寒或时时恶风之感觉。
8．胸背腰痛，皆有因痰者。痰者，痰饮也，为水湿不能吸收所致，脉多带滑象。同时，痰饮在胃即呕，在上则眩，在心则悸，在背则冷，在胁则胀，在肺则咳喘，在胸膈则满闷短气，郁于经络则麻木偏枯。若忽患腰背胸胁牵引痛，走而不守者，即可考虑痰。但痰与风要加以鉴别，从体质上、脉象上和患者每感痛处有寒凉重着的感觉等，稍加留意，不难辨认。
辨证心法
9．辨证要结合整个证候群进行综合分析，不要单凭某一症状。如伤寒的证候群和温病的证候群好辨，假如单凭一“恶寒”症，究竟属风、属寒、属湿、属热，如何能认清呢?因此，辨证一定要注意四诊合参，综合分析，方不致误。
10．若表里证俱在时，症状是区别表里多少的关键；虚实证俱在时，脉色、腹诊相结合是区别虚实多少的关键；但对大实如羸状或至虚有盛候的患者必须按腹，若腹满硬痛拒按则为实，腹软喜按者为虚。
11．寒热真假之辨别关键，一在于舌苔的干燥与否，二在于口渴喜冷与否。真热假寒，必见舌苔干燥，口渴喜冷；真寒假热，则舌苔多润滑，口虽渴而不喜冷饮。当明辨之。
12．虚火上逆(炎)有两种情况，一是阴虚，须用滋阴降火；二是阳虚(虚阳外越)，须用引火归原。阴虚水不济火而致虚火上炎者，小便必黄赤，脉必兼数，兼见面赤、唇红或口鼻出血、齿痛、齿衄等症；如系虚阳外越者，为阴盛龙雷之火浮越，亦现面赤、口渴、烦躁等热象，但口虽渴而不欲饮，小便必清长，脉沉小兼迟或浮大无根(尤其须注意右迟之脉)，更有下肢发凉的见症。二者性质不同，当明辨之，不可误人。
13．伤寒是百病的基础，伤寒之方，通治百病，善治伤寒者，杂证自易，确实如此。例如，承气汤不是单纯治伤寒的，当归四逆汤也不是单纯治伤寒的。曾用承气汤治腹泻、痢疾、失眠、昏迷、咳嗽、发热、郁证、虫证、瘀证、痰证、火证、湿证等病证，均取得良效，特别是一些危急重证，用之更是得心应手，往往一剂承气，即可救危难于既倒，使病人转危为安。日人用当归四逆汤治疗冻疮，我曾用桃仁承气汤治疗宫外孕一一均说明一个道理，即伤寒为百病之基础，伤寒方通治百病，关键在于掌握伤寒每一方剂之功能、主治病证和应用规律，临证运用，才会得心应手。
14．小儿之热，如手心热盛，多为肠胃积滞，每以保赤万应散开泄之而愈；如手背热，多系(或兼)表证，宜疏风清热。发散清解之。
15．高热证要注意其兼表、兼里各个方面。兼表者，多无汗，间有恶寒；兼里者，必大便秘，腹胀痛拒按。前者宜汗，后者宜下，看证无误，才能取得效验。
16．战汗一症，多出现于外感热病病程中，为邪盛正虚之时，突然出现战栗，继而全身汗出，是正邪交争之象。有战后脉静身凉而愈者，此为正盛邪去，有战栗而不汗出者，或战而汗出不泽者，或战而汗出太过者，均属正虚之危象。若战而汗出太过，来复汤、既济汤可急用之；战而不汗者，可啜温水以助之，必要时可助以强心剂；汗不止，脉仍大者，以葡萄糖之类辅佐之。热性病过程中，若突然肢冷、脉伏，即应考虑战汗之先兆，做好救治准备。
17．湿，有寒湿、湿热，有在表、在里，有在上、在下之分，但都必须以湿为主，寒热只属兼证，居从属地位。如若热胜于湿，寒胜于湿，则不在湿证范围。必须明辨其主次，这是诊断中的一个关键之处。
18．痰证，要辨别寒热虚实。热痰黄而．口渴，溺赤，用竹沥、胆星有效。若病垂危之喉间痰鸣者，忌之。此属虚痰、寒痰之属，因三焦火衰，土崩水泛所致，《医学从众录》中风篇曾论及，可参阅之。
19.太阳头痛大部分为后头部疼痛，但根据临床，也有前头部痛者，因为太阳经脉起于目内眦，上额交巅也，但必须具有发热恶寒、项强脉浮等方能正确，因为这是感冒风寒的表证。
20．阳虚兼外感风寒者，宜用麻黄附子细辛汤治之。但要考虑夹杂的主次，是阳虚为主稍感风寒呢，还是外感为主稍兼阳虚。前者附子多用，麻黄用量宜少；后者，则按麻黄附子细辛汤原比例用之。如病情稍久，可改用麻黄附子甘草汤，必要时还须加人人参。所以临床必须细心体会分析，方能用之妥当。
21．循衣摸床，撮空理线，也属于肝风内动之范围，有实有虚，从全身证候、舌苔脉象综合分析，实者宜下，虚者大小定风珠之类可选用。
22．亡阳有二，一种为亡阳厥逆，一种为阳气飞越。亡阳惊狂，卧起不安者，属于后者。这种阳气飞越，以阴虚不能潜阳者为多见，临床见症，必须有脉数、喜冷之阴虚现象，如属下寒迫阳上越者，必须从实际证候上体验才对。
23．腹满身重，难以转侧，有属湿者，也有属热者。如阳明篇内白虎汤证，即有腹满身重难以转侧，必须综合舌苔脉象及全身症状分析，才能诊断无误。
24．吐衄为热伤阳络所致，但热须辨实热、虚热。如突然发病者，体壮实者，脉象有力者，夏季之时发者等，多为实热，症见舌苔黄、口苦、便秘等，便为确据。另一种，久病者，或热病之后期者，脉虚数者，乎素有阴虚情况者，即应以虚火沦治。
25．升阳之药，什么时候可用呢?如带证、崩漏、腹泻日久，导致清阳下陷者。又治头部之病，用升阳药的机会多，但脑充血者忌用。用药方面，都要抓住它的适应证和禁忌证，才有把握。
26．喘无善证。喘之陈发者，以虚证为多。
27．费绳甫有一治胃火郁结之案，甚佳，当细心留意体会。临床上遇到口吐冷沫之症，当然应以寒断之，可问题在于用温药而更盛，此时又不能用苦寒，所以滋胃阴以清胃火，实属良法。但我们不能因为有此案而怀疑吐冷沫之症。开始用药寒热乱投，常致影响以后用药，所以开始用药不宜太乱，用量不宜过大，即是这个道理，当注意之。
28．消化性溃疡，一般应采取芍药甘草汤加减治疗。曾治一例，因其遇冷即发，用芍药甘草附子汤好转。所以，临证用药，不能拘于常法，而应细心辨证。
29．曾治一西医认为是麻痹性肠梗阻之病人，经诊为虚寒夹实之证，融合黄龙、温脾、大承气之意，一剂即减轻。再诊，右脉稍有力，左脉沉，此为兼有郁结，再加香附，一剂则梗阻现象基本解除。
30．痢疾初起兼热者，多为表热，葛根等为必用之药。曾治一小孩，9岁，患暴发型痢疾，因兼表热，给以葛根芩连汤加银花、连翘，一剂即热退。一般如系热痢、白痢，用白虎汤，赤痢用白头翁汤(不兼表证)加减。便涩的加大黄以疏通之，亦为治痢之要则。
31．凡泻证，泻前即痛，泻后痛止者，此为有夹实的征象，治宜补中寓泻。如系胃苓汤证，亦须少加入大黄、枳实方可。
32．曾遇一例再障贫血，审其证系肝气郁结，用逍遥散治之好转。凡遇再障贫血，应从肝、脾、肾三个方面辨治。如脾的方面，血为水谷之精气，由脾胃所化生，若脾胃伤，何以生?但导致脾胃受伤不能生血的原因又是什么。需要进一步辨识，找准这个原因，即可治好。上述从肝论治用逍遥散，仅系一个方面。
33．曾治一失眠患者，多时不愈，诊之发现下腹部有压痛，考虑为瘀血，用桃仁、赤芍、枣仁、茯神等，予数剂，显著好转。此失眠之由于瘀血所致也。
34．痹证昼轻夜重者，阴邪在阴分也。遇风雨阴晦而甚者，此阴邪犯阳分之证也。得暖遇热而甚者，此湿热伤阴之火证也。体重者，为感湿之着痹证也。用散风除湿之行痹方而不效者，属寒湿之证。痛处发红，按之热者，为风化为热之证也。
35．痹证，其在皮脉者易治，在筋骨者难已。五痹日久入脏，其人中虚者，难治多死；五痹日久，不见五脏痹之症状者，为脏实不受邪，易治。
36．痹证大抵知痛知痒者易治，不痛不仁者难医。入脏者死，留连于筋骨之间者，痛久难愈，留于皮肤之间者易治。
37．虚劳须分阳虚与阴虚，其共同点为盗汗、脉数、经闭、咳嗽等症，不同点为阳虚畏寒，不喜热饮，阴虚畏热，口千口渴，喜饮，当辨别清楚。
38．数脉有虚有热，数而无力为虚，虚劳之证脉皆数，其中数而有热象为阴虚，数而无热象为气虚。临证遇数脉，宜详辨之。
39．大脉属虚(大虚有盛候)，当结合病史及临床见症加以分析，如属热盛者，即白虎汤证的一面，当不难辨认。这种脉象，老年患者居多，或久病之后亦可见到，不论阳虚、阴虚都有，尤当细加辨之。
40．真武汤，用治喘证、咳嗽、气短、心脏病等，辨证着眼点在于有水气而属寒性者，用之即效。本方为治阳虚不能化水而设，虚者应加人参，临床如见浮肿不得卧，小便不利，畏凉喜热者，皆可用之。
[主治]
热性病后，腰以下部位发生浮肿。但必须同时具备大小便排泄不畅、形体气息较为充实、脉象有力、喜欢寒冷性质的饮食等症状，才适宜使用此方，否则就会犯下“虚其虚”（使虚弱者更虚弱）的错误。务必谨慎，务必谨慎！
[药品]
牡蛎、泽泻、天花粉（即蒌根）、蜀漆（用温水洗涤以去除腥味）、炒葶苈子、炒商陆根、海藻（洗净），以上各药等量份数。
[制服法]
将上述药物共同研磨成细末，每次服用一钱，用米汤送服。如果小便通畅了，就停止后续服药。
[用药大意]
牡蛎和天花粉具有滋阴清热的功效，其余诸药具有逐水消肿的作用。
[禁忌证]
病后饮食减少，大便溏稀泄泻，腰部困倦腿部酸软，脉象无力，喜欢温暖厌恶寒冷，这是脾肾阳虚寒盛的证候，虽然同样出现浮肿，绝对不可服用此方。此方不可与含有甘草的药物同服，因为甘草与海藻存在相反配伍禁忌。
[类似方剂参考]
(1) 金匮肾气丸：此方用于治疗腰酸腿困、喜欢温暖厌恶寒冷、因肾阳虚导致的浮肿。
(2) 四君子汤加减：此方用于治疗饮食减少、大便溏稀、因脾虚导致的浮肿。
竹叶石膏汤第一百一十三
[方义]
此方用于治疗热性病后余热未尽、津液已受损、气机上逆想要呕吐的证候，具有补益虚损、降逆止呕、清热生津的功效。
[主治]
热性病后，身体发热不退，想要呕吐。但必须同时具备口渴、喜欢冷饮、脉象虚浮等症状。
按语：此证的身体发热，与使用小柴胡汤及枳实栀子豉汤所治疗的身体发热完全不同。后两个方剂所治的身体发热，都是热邪退去后复发的情况；而此证的身体发热，是病情虽减轻但身体发热连绵不断、持续不休。
[药品]
竹叶二至三钱、生石膏二至三钱、半夏一钱半至二钱半、人参一至二钱、甘草五分至一钱、粳米一至三钱、麦门冬一至二钱。
[煎服法]
用水三茶杯，煎煮至半茶杯，滤去药渣，温服。
[用药大意]
竹叶、石膏、麦冬具有清热生津的功效；半夏具有降逆止吐的功效；人参、粳米、炙甘草具有补益中焦之气虚的功效。
[禁忌]
凡是身上没有发热、口渴、喜欢冷饮、脉象虚、呕吐等任何一项症状的患者，不可使用原方，应当根据具体症状进行加减调整。
[类似方剂参考]
(1) 小柴胡汤：此方用于治疗热病后身体发热想要呕吐，侧重于和解表邪的方剂。
(2) 六君子汤：此方用于治疗没有热证而表现为身体虚弱瘦弱、气短、想要呕吐的方剂。
1. 燥证，喻嘉言认为属于热，沈氏认为属于凉，其实，他们所说的都只是燥证的一个方面。因此吴鞠通、俞根初都指出，燥证分为热燥和凉燥两种。其机理可以用蒸笼来比喻，如果水火平衡，则熏蒸而不干燥；如果火盛水少，则无气化为热燥；如果水多火微，蒸腾不起气来则为凉燥。临证时必须具备这两种概念，才容易分析，但仍必须以临床表现为依据，才能无误。
2. 所谓“四损”，是指气虚、血虚、阴虚、阳虚。这就是杨栗山所说的气血两虚、阴阳俱竭。大劳累、大欲望、大病、久病、老人、产后、先天不足、后天失调是其成因。气虚，就是真气不足，症状是气息不足以呼吸，言语不足以听清，或者想说话却说不出；血虚，就是真血不足，症状是全身萎黄，嘴唇苍白，或者有长期失血的病史；阴虚，就是真阴不足，症状是肌肤粗糙如鳞甲交错，五液干枯；阳虚，就是真阳不足，症状是四肢厥冷，腹泻，肢体畏寒，口鼻呼出气体寒冷。单纯虚证单独治疗，兼夹虚证联合治疗，虚而兼寒的用温补法，虚而兼热的用清补法，虚而兼实的必须审察标本、先后、缓急、多少，随机应变进行治疗。
3. 张仲景说：太阳病欲解时从巳时至未时。巳时至未时就是北京时间上午9时至下午3时。这个时间正是阳气最旺盛的时间。太阳病本来是风寒损伤了卫阳的证候，所以遇到阳气旺盛的时候，卫阳得到帮助，因此能够自愈。我的看法是，这不是绝对的，不能完全依靠，只能作为治疗本病的有利条件之一。
4. 虚热证是虚而兼有热或火的证候，也称之为虚火，不仅仅指阴液不足、阳气相对偏盛的虚性亢奋病理状态。其形成，或因虚而生热，或热久导致虚，或体虚兼患热证。临证时的证候与火热证相同，主要症状为烦热、口渴喜欢冷饮，但服用清凉泻火药无效甚至反而加重，只有使用滋阴养血生津、引火归原，或甘温除热的方法才有效。例如伤寒后期的竹叶石膏汤证，阳明经病人参白虎汤证，口舌糜烂牙龈腐烂的甘露饮证及十味地黄汤证，咽痛的养阴清肺汤证等。
5. 头不痛、项不强，就知道不是太阳证；但如果头痛而不项强，也不是太阳证，比如项强痛但不恶寒，脉不沉，也不能说是太阳病。太阳病以头项强痛为提纲。
6. 结胸是伤寒误用攻下药而成的胸腹硬痛的证候，分为大结胸、小结胸、寒结胸、热结胸、水结胸、血结胸、痰结胸、食结胸八种。其中胸腹不按自痛，按压后更痛的是大结胸；心下（胃脘部）按压才痛，不按不痛的是小结胸；兼有不发热、不渴、小便清白的是寒结胸；兼有烦渴、便秘的是热结胸；兼有心悸怔忡、头汗出、无大热、揉之有水声的是水结胸；兼有漱水不欲咽、神志狂乱如狂、大便黑、小便利的是血结胸；兼有脉滑、喘咳的是痰结胸；兼有寸口脉大的是食结胸。
7. 人参白虎汤证中的“背微恶寒”、“时时恶风”，不是说表证未解，而是因为内热太盛，自觉室温较低从而产生背部轻微恶寒或时时恶风的感觉。
8. 胸背腰痛，都有因痰引起的。痰，即痰饮，是由于水湿不能被吸收所致，脉象多带滑象。同时，痰饮在胃则呕吐，在上则眩晕，在心则心悸，在背则发冷，在胁肋则胀满，在肺则咳嗽气喘，在胸膈则满闷短气，郁于经络则麻木偏枯。如果突然患上腰背胸胁牵引痛，游走不定，就可以考虑是痰。但痰与风需要加以鉴别，从体质、脉象以及患者每感到疼痛处有寒凉重着的感觉等方面稍加留意，不难辨认。
9. 辨证要结合整个证候群进行综合分析，不要单凭某一症状。比如伤寒的证候群和温病的证候群好辨别，假如单凭一个“恶寒”症状，究竟属风、属寒、属湿、属热，怎么能认清呢？因此，辨证一定要注意四诊合参，综合分析，才不会出错。
10. 如果表里证同时存在，症状是区别表里多少的关键；虚实证同时存在，脉色、腹诊相结合是区别虚实多少的关键；但对于大实像羸弱状或至虚有盛势表现的患者必须按腹，如果腹部胀满硬痛拒按则为实，腹部柔软喜按者为虚。
11. 寒热真假辨别的关键，一在于舌苔的干燥与否，二在于口渴是否喜欢冷饮。真热假寒，必然见到舌苔干燥，口渴喜欢冷饮；真寒假热，则舌苔多润滑，口虽渴但不喜欢冷饮。应当明辨清楚。
12. 虚火上逆（炎）有两种情况，一是阴虚，须用滋阴降火；二是阳虚（虚阳外越），须用引火归原。阴虚水不济火而导致虚火上炎者，小便必黄赤，脉必兼数，兼见面赤、唇红或口鼻出血、齿痛、齿衄等症状；如果是虚阳外越者，是因为阴盛导致龙雷之火浮越，也现出面赤、口渴、烦躁等热象，但口虽渴而不想喝水，小便必清长，脉沉小兼迟或浮大无根（尤其须注意右脉迟），更有下肢发凉的症状。二者性质不同，应当明辨清楚，不可误人。
13. 伤寒是百病的基础，伤寒的方剂，通治百病，善于治疗伤寒的人，治疗杂证自然容易，确实如此。例如，承气汤不是单纯治伤寒的，当归四逆汤也不是单纯治伤寒的。曾用承气汤治疗腹泻、痢疾、失眠、昏迷、咳嗽、发热、郁证、虫证、瘀证、痰证、火证、湿证等疾病，均取得良效，特别是一些危急重症，用它更是得心应手，往往一剂承气汤，即可救危难于既倒，使病人转危为安。日本人用当归四逆汤治疗冻疮，我曾用桃仁承气汤治疗宫外孕——这都说明一个道理，即伤寒为百病之基础，伤寒方通治百病，关键在于掌握伤寒每一方剂的功能、主治病证和应用规律，临证运用，才会得心应手。
14. 小儿的热，如果手心热盛，多为肠胃积滞，常用保赤万应散开泄治疗而痊愈；如果手背热，多系（或兼）表证，宜疏风清热，发散清解。
15. 高热证要注意其兼表、兼里各个方面。兼表者，多无汗，间有恶寒；兼里者，必大便秘结，腹胀痛拒按。前者宜发汗，后者宜攻下，看证无误，才能取得疗效。
16. 战汗一症，多出现于外感热病病程中，为邪盛正虚之时，突然出现战栗，继而全身汗出，是正邪交争的现象。有战后脉静身凉而愈者，这是正气盛邪气去；有战栗而不汗出者，或战而汗出不润泽者，或战而汗出太过者，均属正气虚的危象。若战而汗出太过，来复汤、既济汤可急用之；战而不汗者，可喝温水以助之，必要时可辅助以强心剂；汗不止，脉仍大者，以葡萄糖之类辅佐之。热性病过程中，若突然肢冷、脉伏，即应考虑战汗的先兆，做好救治准备。
17. 湿，有寒湿、湿热，有在表、在里，有在上、在下之分，但都必须以湿为主，寒热只属兼证，居从属地位。如若热胜于湿，寒胜于湿，则不在湿证范围。必须明辨其主次，这是诊断中的一个关键之处。
18. 痰证，要辨别寒热虚实。热痰黄稠而口渴，尿赤，用竹沥、胆南星有效。如果病垂危之喉间痰鸣者，忌用。此属虚痰、寒痰之属，因三焦火衰，土崩水泛所致，《医学从众录》中风篇曾论及，可参阅之。
19. 太阳头痛大部分为后头部疼痛，但根据临床，也有前头部痛者，因为太阳经脉起于目内眦，上额交巅也，但必须具有发热恶寒、项强脉浮等方能正确诊断，因为这是感冒风寒的表证。
20. 阳虚兼外感风寒者，宜用麻黄附子细辛汤治之。但要考虑夹杂的主次，是阳虚为主稍感风寒呢，还是外感为主稍兼阳虚。前者附子多用，麻黄用量宜少；后者，则按麻黄附子细辛汤原比例用之。如病情稍久，可改用麻黄附子甘草汤，必要时还须加入人参。所以临床必须细心体会分析，方能用之妥当。
21. 循衣摸床，撮空理线，也属于肝风内动之范围，有实有虚，从全身证候、舌苔脉象综合分析，实者宜下，虚者大小定风珠之类可选用。
22. 亡阳有二，一种为亡阳厥逆，一种为阳气飞越。亡阳惊狂，卧起不安者，属于后者。这种阳气飞越，以阴虚不能潜阳者为多见，临床见症，必须有脉数、喜冷之阴虚现象，如属下寒迫阳上越者，必须从实际证候上体验才对。
23. 腹满身重，难以转侧，有属湿者，也有属热者。如阳明篇内白虎汤证，即有腹满身重难以转侧，必须综合舌苔脉象及全身症状分析，才能诊断无误。
24. 吐衄（吐血、鼻出血）为热伤阳络所致，但热须辨实热、虚热。如突然发病者，体壮实者，脉象有力者，夏季之时发者等，多为实热，症见舌苔黄、口苦、便秘等，便为确据。另一种，久病者，或热病之后期者，脉虚数者，平素有阴虚情况者，即应以虚火论治。
25. 升阳之药，什么时候可用呢？如带下证、崩漏、腹泻日久，导致清阳下陷者。又治头部之病，用升阳药的机会多，但脑充血者忌用。用药方面，都要抓住它的适应证和禁忌证，才有把握。
27. 费绳甫有一治胃火郁结之案，甚佳，当细心留意体会。临床上遇到口吐冷沫之症，当然应以寒断之，可问题在于用温药而更盛，此时又不能用苦寒，所以滋胃阴以清胃火，实属良法。但我们不能因为有此案而怀疑吐冷沫之症。开始用药寒热乱投，常致影响以后用药，所以开始用药不宜太乱，用量不宜过大，即是这个道理，当注意之。
28. 消化性溃疡，一般应采取芍药甘草汤加减治疗。曾治一例，因其遇冷即发，用芍药甘草附子汤好转。所以，临证用药，不能拘于常法，而应细心辨证。
29. 曾治一西医认为是麻痹性肠梗阻之病人，经诊为虚寒夹实之证，融合黄龙、温脾、大承气之意，一剂即减轻。再诊，右脉稍有力，左脉沉，此为兼有郁结，再加香附，一剂则梗阻现象基本解除。
30. 痢疾初起兼热者，多为表热，葛根等为必用之药。曾治一小孩，9岁，患暴发型痢疾，因兼表热，给以葛根芩连汤加银花、连翘，一剂即热退。一般如系热痢、白痢，用白虎汤，赤痢用白头翁汤（不兼表证）加减。便涩的加大黄以疏通之，亦为治痢之要则。
31. 凡泻证，泻前即痛，泻后痛止者，此为有夹实的征象，治宜补中寓泻。如系胃苓汤证，亦须少加入大黄、枳实方可。
32. 曾遇一例再障贫血，审其证系肝气郁结，用逍遥散治之好转。凡遇再障贫血，应从肝、脾、肾三个方面辨治。如脾的方面，血为水谷之精气，由脾胃所化生，若脾胃伤，何以生？但导致脾胃受伤不能生血的原因又是什么。需要进一步辨识，找准这个原因，即可治好。上述从肝论治用逍遥散，仅系一个方面。
33. 曾治一失眠患者，多时不愈，诊之发现下腹部有压痛，考虑为瘀血，用桃仁、赤芍、枣仁、茯神等，予数剂，显著好转。此失眠之由于瘀血所致也。
34. 痹证昼轻夜重者，阴邪在阴分也。遇风雨阴晦而甚者，此阴邪犯阳分之证也。得暖遇热而甚者，此湿热伤阴之火证也。体重者，为感湿之着痹证也。用散风除湿之行痹方而不效者，属寒湿之证。痛处发红，按之热者，为风化为热之证也。
35. 痹证，其在皮脉者易治，在筋骨者难已。五痹日久入脏，其人中虚者，难治多死；五痹日久，不见五脏痹之症状者，为脏实不受邪，易治。
36. 痹证大抵知痛知痒者易治，不痛不仁者难医。入脏者死，留连于筋骨之间者，痛久难愈，留于皮肤之间者易治。
37. 虚劳须分阳虚与阴虚，其共同点为盗汗、脉数、经闭、咳嗽等症，不同点为阳虚畏寒，不喜热饮，阴虚畏热，口干口渴，喜饮，当辨别清楚。
38. 数脉有虚有热，数而无力为虚，虚劳之证脉皆数，其中数而有热象为阴虚，数而无热象为气虚。临证遇数脉，宜详辨之。
39. 大脉属虚（大虚有盛候），当结合病史及临床见症加以分析，如属热盛者，即白虎汤证的一面，当不难辨认。这种脉象，老年患者居多，或久病之后亦可见到，不论阳虚、阴虚都有，尤当细加辨之。
40. 真武汤，用治喘证、咳嗽、气短、心脏病等，辨证着眼点在于有水气而属寒性者，用之即效。本方为治阳虚不能化水而设，虚者应加人参，临床如见浮肿不得卧，小便不利，畏凉喜热者，皆可用之。
[Indications]
After a febrile disease, edema occurs below the waist. However, it is essential to have symptoms such as difficulty in urination and defecation, substantial physical constitution and qi, forceful pulse, and preference for cold food and drink before using this formula; otherwise, one will commit the error of "depleting the depleted" (making the deficient more deficient). Exercise extreme caution!
[Ingredients]
Ostreae Concha (Muli), Alisma Rhizoma (Zexie), Puerariae Radix (Gegen/Lougen - *Note: Text says Lougen which usually refers to Trichosanthes Root/Gualougen, but context implies cooling fluids*), Lycopodium Herba (Shujing - washed with warm water to remove fishy smell), Semen Lepidii et Descurainiae (Tinglizi - stir-fried), Radix Phytolaccae (Shanglu - stir-fried), Sargassum (Haizao - washed), all in equal parts.
[Preparation and Administration]
Grind all ingredients into a fine powder. Take one qian per dose, swallowed with rice soup. Stop subsequent doses if urination becomes smooth.
[Principles of Medication]
Ostreae Concha and Puerariae Radix (Trichosanthes Root) nourish yin and clear heat; the remaining herbs promote water metabolism and reduce edema.
[Contraindications]
If after illness there is reduced appetite, loose stools, soreness and weakness of the lower back and legs, forceless pulse, and preference for warmth while fearing cold, this indicates Spleen and Kidney Yang deficiency with cold. Even if edema is present, this formula must absolutely not be used. It cannot be taken with medicines containing Glycyrrhizae Radix et Rhizoma (Gancao) because Gancao and Sargassum are incompatible.
[Reference for Similar Formulas]
(1) Jin Gui Shen Qi Wan: This formula treats soreness and weakness of the lower back and legs, preference for warmth and fear of cold, and edema caused by Kidney Yang deficiency.
(2) Si Jun Zi Tang modified: This formula treats reduced appetite, loose stools, and edema caused by Spleen deficiency.
Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) No. 113
[Formula Rationale]
This formula treats conditions where residual pathogenic heat remains and body fluids are damaged after a febrile disease, accompanied by rebellious qi and nausea. It tonifies deficiency, directs rebellious qi downward, clears heat, and generates fluids.
[Indications]
After a febrile disease, persistent fever and nausea. However, it is essential to have symptoms such as thirst, preference for cold drinks, and a deficient pulse.
Note: The persistent fever in this condition is completely different from the fever treated with Xiao Chai Hu Tang and Zhi Shi Zhi Zi Chi Tang. The fever in the latter two formulas recurs after the heat has subsided; whereas in this condition, the fever persists continuously even though the illness has alleviated.
[Ingredients]
Zhu Ye (Bamboo Leaves) 2-3 qian, Sheng Shi Gao (Raw Gypsum) 2-3 qian, Ban Xia (Pinellia Tuber) 1.5-2.5 qian, Ren Shen (Ginseng Root) 1-2 qian, Gan Cao (Licorice Root) 0.5-1 qian, Jing Mi (Rice Grain) 1-3 qian, Mai Men Dong (Ophiopogon Tuber) 1-2 qian.
[Decoction and Administration]
Add three cups of water, decoct until half a cup remains, strain, and take warm.
[Principles of Medication]
Zhu Ye, Shi Gao, and Mai Men Dong clear heat and generate fluids; Ban Xia directs rebellious qi downward and stops vomiting; Ren Shen, Jing Mi, and Zhi Gan Cao (Honey-fried Licorice) tonify deficiency of Middle Jiao qi.
[Contraindications]
Patients who do not exhibit any of the following symptoms—fever, thirst, preference for cold drinks, deficient pulse, or vomiting—should not use the original formula; modifications should be made based on specific symptoms.
[Reference for Similar Formulas]
(1) Xiao Chai Hu Tang (Minor Bupleurum Decoction): This formula treats fever and nausea after a febrile disease, focusing on harmonizing and resolving exterior pathogens.
(2) Liu Jun Zi Tang (Six Gentlemen Decoction): This formula treats cases without heat signs, characterized by emaciation, shortness of breath, and nausea.
Li Hanqing's 220 Aphorisms
Essentials of Pathogenesis
1. Regarding dryness syndromes, Yu Jiayan considered them heat-related, while Shen considered them cool-related. In reality, they each described only one aspect of dryness syndromes. Therefore, Wu Jutong and Yu Genchu pointed out that dryness is divided into hot dryness and cool dryness. The mechanism can be likened to a steamer: if fire and water are balanced, steaming occurs without dryness; if fire is excessive and water scarce, lack of vaporization leads to hot dryness; if water is abundant and fire weak, inability to steam leads to cool dryness. Clinically, one must possess these two concepts for easier analysis, but diagnosis must still rely on clinical manifestations to avoid errors.
2. The "Four Damages" refer to Qi deficiency, Blood deficiency, Yin deficiency, and Yang deficiency. This is what Yang Lisshan meant by dual deficiency of Qi and Blood, and exhaustion of Yin and Yang. Causes include severe fatigue, excessive desire, serious illness, chronic illness, old age, postpartum state, congenital insufficiency, and acquired imbalance. Qi deficiency means insufficiency of true Qi; symptoms include insufficient breath, inability to speak clearly, or wanting to speak but being unable to. Blood deficiency means insufficiency of true Blood; symptoms include sallow complexion, white lips, or a history of blood loss. Yin deficiency means insufficiency of true Yin; symptoms include rough, scaly skin, and dryness of the five fluids. Yang deficiency means insufficiency of true Yang; symptoms include cold extremities, diarrhea, aversion to cold in limbs, and cold breath from mouth and nose. Pure deficiencies are treated singly; combined deficiencies are treated jointly. Deficiency with cold is treated with warming and tonifying; deficiency with heat is treated with clearing and tonifying; deficiency with excess requires examining root and branch, priority, urgency, and quantity for flexible treatment.
3. Zhang Zhongjing stated: The time when Taiyang disease resolves is from Si hour to Wei hour (9 AM to 3 PM Beijing time). This is the time when Yang qi is most vigorous. Taiyang disease is originally a syndrome where wind-cold damages defensive Yang; thus, encountering vigorous Yang helps defensive Yang, allowing self-healing. My view is that this is not absolute and cannot be fully relied upon; it serves only as one favorable condition for treating the disease.
4. Deficient heat syndrome is a syndrome of deficiency combined with heat or fire, also called deficient fire. It does not solely refer to the pathological state of hyperexcitability due to insufficient Yin fluids and relatively excessive Yang qi. Its formation may result from deficiency generating heat, prolonged heat causing deficiency, or deficiency combined with heat syndrome. Clinical manifestations are similar to excess heat/fire syndromes, with main symptoms of vexatious heat, thirst, and preference for cold drinks. However, cooling and purging fire herbs are ineffective or worsen the condition. Only methods like nourishing Yin, tonifying Blood, generating fluids, guiding fire back to its source, or sweet-warm removing heat are effective. Examples include Zhu Ye Shi Gao Tang syndrome in late-stage Shanghan, Ren Shen Bai Hu Tang syndrome in Yangming channel disease, Gan Lu Yin and Shi Wei Di Huang Tang syndromes for oral ulcers and gum rot, and Yang Yin Qing Fei Tang syndrome for sore throat.
5. If the head does not hurt and the neck is not stiff, it is known not to be a Taiyang syndrome; however, headache without neck stiffness is also not Taiyang syndrome. For instance, if neck stiffness and pain occur without aversion to cold, and the pulse is not deep, it cannot be called Taiyang disease. Taiyang disease takes headache and neck stiffness as its guiding symptom.
6. Jie Xiong (Chest Binding) is a syndrome of chest and abdominal hardness and pain resulting from erroneous use of purgatives in Shanghan. It is divided into eight types: Large, Small, Cold, Heat, Water, Blood, Phlegm, and Food. Among them, spontaneous pain in chest/abdomen worsening on pressure is Large Jie Xiong; pain only upon pressing the epigastrium is Small Jie Xiong; accompanied by no fever, no thirst, clear urine is Cold Jie Xiong; accompanied by vexation, thirst, constipation is Heat Jie Xiong; accompanied by palpitations, head sweat, no high fever, fluid sound on rubbing is Water Jie Xiong; accompanied by rinsing mouth without swallowing, manic delirium, black stool, free urination is Blood Jie Xiong; accompanied by slippery pulse, wheezing cough is Phlegm Jie Xiong; accompanied by large pulse at the Cun position is Food Jie Xiong.
7. "Slight aversion to cold on the back" and "occasional aversion to wind" in Ren Shen Bai Hu Tang syndrome do not indicate unresolved exterior syndrome. Rather, it is because internal heat is too severe, causing the patient to feel the room temperature is low, leading to sensations of slight back chill or occasional wind aversion.
8. Chest, back, and waist pain can all be caused by Phlegm. Phlegm, i.e., Phlegm-fluids, results from failure to absorb water-dampness, and the pulse often carries a slippery quality. Simultaneously, Phlegm-fluids in the Stomach cause vomiting; above, they cause dizziness; in the Heart, palpitations; in the Back, coldness; in the Hypochondrium, distension; in the Lung, cough and wheezing; in the Chest/Diaphragm, fullness and shortness of breath; stagnating in collaterals, numbness and hemiplegia. If sudden traction pain occurs in the waist, back, chest, or hypochondrium, moving without staying in one place, consider Phlegm. However, Phlegm must be differentiated from Wind. By paying attention to constitution, pulse, and the patient's sensation of cold/heaviness at painful sites, recognition is not difficult.
Essentials of Syndrome Differentiation
9. Syndrome differentiation must involve comprehensive analysis of the entire syndrome cluster, not relying on a single symptom. For example, Shanghan and Warm Disease syndrome clusters are easy to distinguish. But if relying solely on "aversion to cold," how can one determine if it belongs to Wind, Cold, Dampness, or Heat? Therefore, differentiation must emphasize combining four diagnostic methods for comprehensive analysis to avoid errors.
10. When exterior and interior syndromes coexist, symptoms are key to distinguishing the degree of exterior vs. interior. When deficiency and excess syndromes coexist, pulse, color, and abdominal palpation combined are key to distinguishing deficiency vs. excess. However, for patients presenting with "great excess resembling debility" or "extreme deficiency resembling excess," abdominal palpation is mandatory. Abdominal fullness, hardness, pain, and rejection of pressure indicate excess; soft abdomen favoring pressure indicates deficiency.
11. The key to distinguishing true/false cold and heat lies in whether the tongue coating is dry and whether thirst involves preference for cold drinks. True heat with false cold must show dry tongue coating and thirst preferring cold drinks; true cold with false heat shows moist tongue coating, and although thirsty, no preference for cold drinks. These must be clearly distinguished.
12. Deficient fire rebelling upward (flaring) has two situations: one is Yin deficiency, requiring nourishing Yin and descending fire; the other is Yang deficiency (deficient Yang floating outward), requiring guiding fire back to its source. In Yin deficiency where water fails to control fire leading to flaring, urine must be yellow-red, pulse rapid, accompanied by red face, red lips, or bleeding from mouth/nose, toothache, gingival bleeding. If it is deficient Yang floating outward, due to Yin excess causing Dragon-Lei fire to float, it also presents with red face, thirst, irritability, etc., but although thirsty, there is no desire to drink, urine is clear and profuse, pulse is deep-small-slow or floating-large-rootless (especially note right slow pulse), and lower limbs are cold. The natures differ; they must be clearly distinguished to avoid misleading others.
13. Shanghan is the foundation of hundred diseases; Shanghan formulas treat hundred diseases universally. Those skilled in Shanghan find treating miscellaneous diseases easy; this is indeed true. For example, Cheng Qi Tang is not solely for Shanghan, nor is Dang Gui Si Ni Tang. I have used Cheng Qi Tang to treat diarrhea, dysentery, insomnia, coma, cough, fever, depression, parasitic disorders, blood stasis, phlegm, fire, dampness, etc., achieving good effects, especially in critical cases where one dose could save life from danger. Japanese doctors use Dang Gui Si Ni Tang for frostbite; I used Tao Ren Cheng Qi Tang for ectopic pregnancy—all illustrate that Shanghan is the foundation of hundred diseases, and Shanghan formulas treat them universally. The key lies in mastering the function, indications, and application rules of each Shanghan formula for flexible clinical use.
14. Children's fever: if palm heat is severe, it is mostly gastrointestinal stagnation, often cured by Bao Chi Wan Ying San to open and purge; if back-of-hand heat, it is mostly (or combined with) exterior syndrome, suitable for dispersing wind and clearing heat.
15. High fever syndromes require attention to exterior and interior aspects. Exterior-combined cases mostly have no sweat, sometimes with aversion to cold; Interior-combined cases must have constipation, abdominal fullness/pain rejecting pressure. Former suit sweating, latter suit purging. Accurate diagnosis ensures efficacy.
16. Zhan Han (Shivering Sweat) often appears during the course of exogenous febrile diseases, occurring when pathogen is strong and healthy qi is weak. Sudden shivering followed by whole-body sweating is a sign of struggle between healthy qi and pathogen. Recovery with quiet pulse and cool body after shivering indicates strong qi expelling pathogen. Shivering without sweating, or non-glistening sweat, or excessive sweat, all indicate critical healthy qi deficiency. If sweat is excessive, Lai Fu Tang or Ji Ji Tang should be used urgently; if shivering without sweat, warm water can help; if necessary, cardiac stimulants; if sweat continues with large pulse, glucose support. Sudden cold limbs and hidden pulse during febrile disease suggest impending Zhan Han; prepare rescue measures.
17. Dampness is divided into cold-damp and heat-damp, exterior-interior, upper-lower. However, dampness must be primary; cold/heat are secondary. If heat exceeds damp or cold exceeds damp, it falls outside damp syndrome scope. Distinguishing primary from secondary is key to diagnosis.
18. Phlegm syndromes require distinguishing cold, heat, deficiency, excess. Heat-phlegm is yellow, with thirst and red urine; Zhu Li (Bamboo Sap) and Dan Xing (Arisaema with Bile) are effective. Contraindicated in terminal cases with rattling phlegm in throat, belonging to deficiency-cold phlegm caused by declining Fire of San Jiao and flooding waters. Refer to "Wind Stroke" chapter in Yi Cong Zhong Lu.
19. Taiyang headaches are mostly occipital, but clinically anterior headaches occur because Taiyang meridian starts at inner eye corner, crosses forehead to vertex. Correct diagnosis requires fever, aversion to cold, neck stiffness, floating pulse, indicating exterior syndrome of wind-cold invasion.
20. Yang deficiency combined with exterior wind-cold is treated with Ma Huang Fu Zi Xi Xin Tang. Consider主次 (primary/secondary): is Yang deficiency primary with slight wind-cold, or exterior primary with slight Yang deficiency? Former uses more Fu Zi, less Ma Huang; latter uses original ratio. If prolonged, switch to Ma Huang Fu Zi Gan Cao Tang, adding Ren Shen if necessary. Careful analysis is required for appropriate use.
21. Grasping clothes, picking at empty air belong to internal stirring of Liver Wind, having excess and deficiency. Comprehensive analysis of whole syndrome, tongue, pulse determines treatment: excess suits purging, deficiency suits Da/Xiao Ding Feng Zhu.
22. Wang Yang (Loss of Yang) has two types: Wang Yang Jue Ni (Cold Extremities) and Yang Qi Fei Yue (Flying Away Yang). Wang Yang with panic/manic restlessness belongs to the latter. Flying Away Yang is mostly due to Yin deficiency failing to anchor Yang. Clinical signs must include rapid pulse, preference for cold (Yin deficiency signs). If caused by lower cold forcing Yang upward, actual syndrome experience is needed.
23. Abdominal fullness, heavy body, difficulty turning sides can be Damp or Heat. Bai Hu Tang syndrome in Yangming chapter includes these; comprehensive analysis of tongue, pulse, whole symptoms is needed for accurate diagnosis.
24. Hematemesis and epistaxis are caused by heat damaging Yang collaterals. Heat must be distinguished as excess or deficiency. Sudden onset, robust constitution, forceful pulse, summer occurrence suggest excess heat (yellow coating, bitter taste, constipation). Chronic illness, late febrile stage, deficient-rapid pulse, chronic Yin deficiency suggest deficient fire treatment.
25. When to use ascending Yang herbs? For leukorrhea, metrorrhagia, chronic diarrhea causing sinking of clear Yang. Also for head diseases, but contraindicated in cerebral congestion. Grasping indications and contraindications ensures safety.
26. Asthma has no benign prognosis. Chronic asthma is mostly deficiency syndrome.
27. Fe Shengfu's case of treating stagnant Stomach Fire is excellent. Clinically, cold foam spitting suggests cold, but if warming herbs worsen it, and bitter-cold cannot be used, nourishing Stomach Yin to clear Stomach Fire is a good method. Do not doubt cold foam spitting due to this case. Random initial medication affects future treatment; start cautiously with small doses.
28. Peptic ulcers generally treated with Shao Yao Gan Cao Tang modified. One case improved with Shao Yao Gan Cao Fu Zi Tang due to cold aggravation. Clinical medication should not stick to routine methods but requires careful differentiation.
29. Treated a patient diagnosed by Western medicine as paralytic intestinal obstruction as deficiency-cold with excess. Combined Huang Long, Wen Pi, Da Cheng Qi intentions; one dose relieved. Second visit: right pulse slightly forceful, left deep, indicating stagnation; added Xiang Fu, one dose basically resolved obstruction.
30. Dysentery early stage with heat is mostly exterior heat; Ge Gen is essential. Treated a 9-year-old with fulminant dysentery and exterior heat using Ge Gen Qin Lian Tang plus Yin Hua, Lian Qiao; heat subsided after one dose. Generally, heat/white dysentery uses Bai Hu Tang, red dysentery uses Bai Tou Weng Tang (if no exterior). Constipation adds Da Huang. Key principles for dysentery treatment.
31. Diarrhea with pain before and relief after indicates combined excess; treatment should tonify while purging. For Wei Ling Tang syndrome, add small amounts of Da Huang, Zhi Shi.
32. Treated aplastic anemia diagnosed as Liver Qi stagnation, improved with Xiao Yao San. Aplastic anemia should be treated from Liver, Spleen, Kidney perspectives. Spleen transforms grain essence into blood; if Spleen damaged, blood cannot generate. Identify cause of Spleen damage to cure. Treating from Liver with Xiao Yao San is just one aspect.
33. Treated chronic insomnia; found lower abdominal tenderness, considered blood stasis. Used Tao Ren, Chi Shao, Suan Zao Ren, Fu Shen; several doses significantly improved. Insomnia caused by blood stasis.
34. Bi syndrome lighter by day, heavier by night: Yin pathogen in Yin division. Worse in wind/rain/cloudy weather: Yin pathogen attacking Yang division. Worse with warmth/heat: Heat-Damp injuring Yin fire syndrome. Heavy body: Dampness Bi (Zhuo Bi). Failure of wind-dispersing/damp-resolving Bi formula: Cold-Damp syndrome. Red, hot painful site: Wind transforming into Heat syndrome.
35. Bi in skin/channels easy to treat; in sinews/bones hard to cure. Five Bis entering Zang organs over long time: difficult/deadly if person is deficient. If no Zang Bi symptoms after long time: Zang is solid, resists pathogen, easy to treat.
36. Bi knowing pain/itch easy to treat; insensate hard to cure. Entering Zang dies; lingering in sinews/bones hard to cure; in skin easy to treat.
37. Xu Lao (Deficiency Consumption) must distinguish Yang/Yin deficiency. Common: night sweats, rapid pulse, amenorrhea, cough. Different: Yang deficiency fears cold, dislikes hot drinks; Yin deficiency fears heat, dry mouth/thirst, likes drinking. Distinguish clearly.
38. Rapid pulse can be deficiency or heat. Rapid-forceless is deficiency. Xu Lao pulses are all rapid; rapid-with-heat signs is Yin deficiency; rapid-without-heat signs is Qi deficiency. Examine rapid pulse carefully.
39. Large pulse belongs to deficiency (Great deficiency mimics excess). Analyze with history/symptoms. If heat-excess, resembles Bai Hu Tang syndrome, easy to recognize. Common in elderly or post-chronic illness, seen in both Yang/Yin deficiency. Distinguish carefully.
40. Zhen Wu Tang treats asthma, cough, shortness of breath, heart disease. Differentiation focus: water-fluids with cold nature. Effective for Yang deficiency failing to transform water. Add Ren Shen for deficiency. Clinical signs: edema preventing lying down, difficult urination, fear of cold, preference for heat—all suitable.