以辛润之，当归桂姜之辛以散寒；上热者，以苦泄之，知母、黄芩之苦，凉心去热；津液
少者，以甘润之，茯苓、白术之甘，缓脾生津；肺燥气热，以酸收之，以甘缓之，芍药之酸，以敛逆气，葳蕤、
（医统本有“天”字）门冬、石膏、甘草之甘，润肺除热。
上十四味，以水一斗，先煮麻黄一两沸，去上沫，内诸药，煮取三升，去滓，分温三服，相去如炊三
斗米顷，令尽，汗出愈。
伤寒四五日，腹中痛，若转气下趣少腹者，此欲自利也。
伤寒四五日，邪气传里之时。腹中痛，转气下趣少腹者，里虚遇寒，寒气下行，欲作自利也。
伤寒本自寒下，医复吐下之，寒格，更逆吐下；若食入口即吐，干姜黄连黄芩（赵本作“黄芩黄连”）人
参汤主之。
伤寒邪自传表，为本自寒下，医反吐下，损伤正气，寒气内为格拒。经曰∶格则吐逆。食入口即吐，谓
之寒格，更复吐下，则重虚而死，是更逆吐下，与干姜黄连黄芩人参汤以通寒格。
干姜黄连黄芩（赵本作“黄芩黄连”）人参汤方∶
干姜（辛热） 黄连（苦寒） 黄芩（苦寒） 人参（各三两。甘温）
辛以散之，甘以缓之，干姜、人参之甘辛，以补正气；苦以
泄之，黄连、黄芩之苦，以通寒格。
上四味，以水六升，煮取二升，去滓，分温再服。
下利，有微热而渴，脉弱者，今自愈。
下利阴寒之疾，反大热者逆。有微热而渴，里气方温也。经曰∶诸弱发热，脉弱者，阳气得复也，今必自愈。
下利，脉数，有微热汗出，今自愈；设复紧，为未解。（赵本注∶“一云∶设脉浮复紧”）
下利，阴病也。脉数，阳脉也。阴病见阳脉者生，微热汗出，阳气得通也，利必自愈。诸紧为寒，设复
脉紧，阴气犹胜，故云未解。
下利，手足厥冷无脉者，灸之不温，若脉不还，反微喘者，死。
下利，手足厥逆无脉者，阴气独胜，阳气大虚也。灸之，阳气复，手足温而脉还，为欲愈；若手足不温，
脉不还者，阳已绝也，反微喘者，阳气脱也。
少阴负趺阳者，为顺也。
少阴肾水；趺阳脾土。下利，为肾邪干脾，水不胜土，则为微邪，故为顺也。
下利，寸脉反浮数，尺中自涩者，必清脓血。
下利者，脉当沉而迟，反浮数者，里有热也。涩为无血，尺中自涩者，肠胃血散也，随利下，必便脓血。
清与圊通，《脉经》曰∶清者厕也。
下利清谷，不可攻表，汗出，必胀满。
下利者，脾胃虚也。胃为津液之主，发汗亡津液，则胃气愈虚，必胀满。
下利，脉沉弦者，下重也；脉大者，为未止；脉微弱
数者，为欲自止，虽发热不死。
沉为在里，弦为拘急，里气不足，是主下重；大则病进，此利未止；脉微弱数者，邪气微而阳气复，为
欲自止，虽发热止由阳胜，非大逆也。
下利，脉沉而迟，其人面少赤，身有微热，下利清谷者，必郁冒，汗出而解，病患必微厥。所以
然者，其面戴阳，下虚故也。
下利清谷，脉沉而迟，里有寒也。面少赤，身有微热，表未解也。病患微厥，《针经》曰∶下虚则厥。
表邪欲解，临汗之时，以里先虚，必郁冒，然后汗出而解也。
下利，脉数而渴者，今自愈；设不瘥，必清脓血，以有热故也。
经曰∶脉数不解，而下不止，必协热便脓血也。
下利后脉绝，手足厥冷， 时脉还，手足温者生，脉不还者死。
下利后，脉绝，手足厥冷者，无阳也。 时，周时也。周时厥愈，脉出，为阳气复则生；若手足
不温，脉不还者，为阳气绝则死。
伤寒下利，日十余行，脉反实者死。
下利者，里虚也。脉当微弱反实者，病胜脏也，故死。《难经》曰∶脉不应病，病不应脉，是为死病。
下利清谷，里寒外热，汗出而厥者，通脉四逆汤主之。（赵本有“通脉四逆汤方”详见卷六）
下利清谷，为里寒；身热不解为外热。汗出阳气通行于外，则未当厥；其汗出而厥者，阳气
大虚也，与通脉四逆汤，以固阳气。
热利下重者，白头翁汤主之。
利则津液少，热则伤气，气虚下（医统本作“不”）利，致后重也。与白头翁汤，散热浓肠。
白头翁汤方∶
白头翁（二两。苦寒） 黄柏（苦寒） 黄连（苦寒） 秦皮（各三两。苦寒）
《内经》曰∶肾欲坚，急食苦以坚之。利则下焦虚，是以纯苦之剂坚之。
上四味，以水七升，煮取二升，去滓，温服一升；不愈，更服一升。
下利，腹胀满，身体疼痛者，先温其里，乃攻其表。温里（赵本医统本并有“宜”字）四逆汤；攻
表（赵本医统本并有“宜”字）桂枝汤。（赵本云∶“四逆汤”用前第五方，又有“桂枝汤方”详见卷二）
下利腹满者，里有虚寒，先与四逆汤温里；身疼痛，为表未解，利止里和，与桂枝汤攻表。
下利，欲饮水者，以有热故也，白头翁汤主之。
自利不渴，为脏寒，与四逆（医统本有“汤”字）以温脏；下利饮水
为有热，与白头翁汤以凉中。
下利，谵语者，有燥屎也，宜小承气汤。（赵本有“小承气汤方”详见卷五）
经曰∶实则谵语。有燥屎为胃实，下利为肠虚，与小承气汤以下燥屎。
下利后更烦，按之心下濡者，为虚烦也，宜栀子豉汤。（赵本有“栀子豉汤方”详见卷三）
下利后不烦，为欲解；若更烦而心下坚者，恐为谷烦。此烦而心下濡者，是邪热乘虚，客于胸中，为
虚烦也，与栀子豉
汤，吐之则愈。
呕家有痈脓者，不可治，呕脓尽自愈。
胃脘有痈，则呕而吐脓，不可治呕，得脓尽，呕亦（医统本作“即”）自愈。
呕而脉弱，小便复利，身有微热见厥者难治。四逆汤主之。
呕而脉弱，为邪气传里。呕则气上逆，而小盒饭不利；小便复利者，里虚也。身有微热见厥者，阴胜
阳也，为难治。与四逆汤温里助阳。
干呕，吐涎沫，头痛者，吴茱萸汤主之。（赵本有“吴茱萸汤方”详见卷五）
干呕，吐涎沫者，里寒也；头痛者，寒气上攻也。与吴茱萸汤温里散寒。
呕而发热者，小柴胡汤主之。（赵本有“小柴胡汤方”详见卷三）
经曰∶呕而发热者，柴胡证具。
伤寒大吐大下之，极虚，复极汗出（赵本无“出”字）者，以（赵本无“以”字）其人外气怫郁，
复与之水，以发其汗，因得哕。所以然者，胃中寒冷故也。
大吐大下，胃气极虚，复极发汗，又亡阳气。外邪怫郁于表，则身热，医与之水，以发其汗，胃虚得水，
虚寒相搏成哕也。
伤寒，哕而腹满，视其前后，知何部不利，利之则（赵本作“即”）愈。
哕而腹满，气上而不下也。视其前后部，有不利者即利之，以降其气。前部，小便也；后
部，（医统本有“者”字）大便也。
用辛味药来滋润，当归、桂枝、干姜的辛味可以散寒；上焦有热者，用苦味药来泄热，知母、黄芩的苦味，能清心除热；津液不足者，用甘味药来滋润，茯苓、白术的甘味，能缓和脾气、生津液；肺燥气热，用酸味药来收敛，用甘味药来缓急，芍药的酸味，能收敛逆乱之气，葳蕤（玉竹）、天门冬、石膏、甘草的甘味，能润肺除热。
以上十四味药，用水一斗，先煮麻黄一两沸，去掉水面上的浮沫，加入其余药物，煮取三升药液，去渣，分三次温服，两次服药间隔时间约为煮熟三斗米所需的时间，让药液服完，出汗即愈。
伤寒病四五日，腹中疼痛，如果有气向下运行到少腹部的感觉，这是将要发生自利（腹泻）的表现。
伤寒病四五日，是邪气传入里的时期。腹中疼痛，气向下运行到少腹部，是因为里虚遇寒，寒气下行，想要发生自利。
伤寒本来就有寒性下利，医生反而使用吐法或下法，导致寒邪格拒，更加引起呕吐和下利；如果食物入口即吐，应当用干姜黄连黄芩人参汤主治。
伤寒邪气本应从表传变，但患者原本就有寒性下利，医生反而使用吐法和下法，损伤了正气，寒气在内部形成格拒。经书说：格拒则呕吐逆乱。食物入口即吐，称为寒格，如果再使用吐法或下法，就会使正气双重虚弱而导致死亡，这就是“更逆吐下”，此时应给予干姜黄连黄芩人参汤以通解寒格。
干姜黄连黄芩人参汤方：
干姜（辛热） 黄连（苦寒） 黄芩（苦寒） 人参（各三两，甘温）
用辛味药来发散，用甘味药来缓急，干姜、人参的甘辛之性，可以补益正气；用苦味药来泄降，黄连、黄芩的苦味，可以通解寒格。
以上四味药，用水六升，煮取二升药液，去渣，分两次温服。
下利属于阴寒疾病，如果出现大热则是逆证。出现微热且口渴，说明里气正在转温。经书说：诸弱发热，脉象弱，说明阳气得以恢复，现在必定自愈。
下利，脉数，伴有微热和汗出，现在将会自愈；如果脉象再次变得紧，说明病未解除。（赵本注：“一说：如果脉浮又紧”）
下利，属于阴病。脉数是阳脉。阴病见到阳脉者生，微热汗出，说明阳气得以通畅，下利必定自愈。凡是紧脉主寒，如果脉象再次变紧，说明阴气仍然占优势，所以说病未解除。
下利，手足厥冷且无脉，施灸后手足不温暖，如果脉搏不恢复，反而出现轻微喘息，是死证。
下利，手足厥逆且无脉，说明阴气独盛，阳气极度虚弱。施灸后，如果阳气恢复，手足变暖且脉搏恢复，是想要痊愈的迹象；如果手足不温暖，脉搏不恢复，说明阳气已绝，反而出现轻微喘息，说明阳气脱失。
少阴对应肾水，趺阳对应脾土。下利，是肾邪侵犯脾脏，如果水不胜土，则为微邪，所以是顺证。
下利病，脉象应当沉而迟，反而浮数，说明里有热。涩脉代表无血，尺脉自涩，说明肠胃血液散乱，随下利排出，必然便脓血。
“清”与“圊”相通，《脉经》说：清是指厕所。
下利，是脾胃虚弱。胃是津液的主宰，发汗亡失津液，则胃气更加虚弱，必然导致腹胀满。
下利，脉象沉弦的，是肛门重坠感；脉象大的，说明病未停止；脉象微弱数的，说明病将要自行停止，虽然发热也不会死。
沉脉主病在里，弦脉主拘急，里气不足，所以主肛门重坠；脉大则病势进展，此下利未止；脉微弱数，说明邪气微弱而阳气恢复，病将要自行停止，虽然发热只是由于阳胜，并非大逆证。
下利，脉象沉而迟，病人面部微微发红，身体有微热，下利完谷不化的，必然会出现郁冒（头晕目眩如物蒙蔽），汗出后病解，病人必然会有轻微的四肢厥冷。之所以这样，是因为病人面戴阳（虚阳上浮），下元虚故也。
下利完谷不化，脉象沉而迟，说明里有寒。面部微微发红，身体有微热，说明表邪未解。病人轻微四肢厥冷，《针经》说：下虚则厥。表邪欲解，在即将出汗的时候，因为里先虚，必然出现郁冒，然后汗出而病解。
下利，脉数且口渴的，现在将会自愈；如果不痊愈，必然排泄脓血，因为有热的缘故。
下利后脉搏消失，手足厥冷，过一周左右脉搏恢复，手足温暖的会生，脉搏不恢复的会死。
下利后，脉搏消失，手足厥冷，说明没有阳气。“时”指周时（十二小时）。经过一周时手足回暖，脉搏出现，说明阳气恢复则生；如果手足不温暖，脉搏不恢复，说明阳气绝则死。
下利，是里虚。脉象应当微弱，反而实，说明病胜于脏，所以死。《难经》说：脉不应病，病不应脉，这是死病。
下利完谷不化，里寒外热，汗出且四肢厥冷的，用通脉四逆汤主治。（赵本有“通脉四逆汤方”，详见卷六）
下利完谷不化，是里寒；身热不退是外热。汗出说明阳气通行于外，则不应当厥冷；其汗出且厥冷的，说明阳气极度虚弱，给予通脉四逆汤，以固护阳气。
热利伴有肛门重坠感的，用白头翁汤主治。
下利则津液少，热则伤气，气虚下陷导致后重。给予白头翁汤，散热坚肠。
白头翁汤方：
白头翁（二两，苦寒） 黄柏（苦寒） 黄连（苦寒） 秦皮（各三两，苦寒）
《内经》说：肾欲坚，急食苦以坚之。下利则下焦虚，所以用纯苦的药物来坚固它。
以上四味药，用水七升，煮取二升药液，去渣，温服一升；如果不愈，再服一升。
下利，腹胀满，身体疼痛的，先温其里，再攻其表。温里宜用四逆汤；攻表宜用桂枝汤。（赵本云：“四逆汤”用前第五方，又有“桂枝汤方”，详见卷二）
下利腹胀满，是里有虚寒，先用四逆汤温里；身体疼痛，是表邪未解，待下利停止、里气调和后，给予桂枝汤攻表。
自利且不渴的，是脏寒，给予四逆汤以温脏；下利且饮水的，是有热，给予白头翁汤以凉中。
下利，说胡话的，是有燥屎，宜用小承气汤。（赵本有“小承气汤方”，详见卷五）
经书说：实则谵语。有燥屎为胃实，下利为肠虚，给予小承气汤以攻下燥屎。
下利后更加烦躁，按压心下部柔软的，是虚烦，宜用栀子豉汤。（赵本有“栀子豉汤方”，详见卷三）
下利后不烦躁，是病欲解；如果更加烦躁且心下部坚硬，恐怕是食积烦闷。此烦躁且心下部柔软，是邪热乘虚客于胸中，为虚烦，给予栀子豉汤，催吐则愈。
胃脘有痈，则呕吐并吐出脓液，不可治疗呕吐，得脓尽，呕吐也会随即自愈。
呕吐且脉弱，小便反而通利，身体有微热且见四肢厥冷的，难治。用四逆汤主治。
呕吐且脉弱，是邪气传入里。呕吐则气上逆，而小便应当不利；小便反而通利的，是里虚。身体有微热且见四肢厥冷的，是阴胜阳衰，为难治。给予四逆汤温里助阳。
干呕，吐涎沫，头痛的，用吴茱萸汤主治。（赵本有“吴茱萸汤方”，详见卷五）
干呕，吐涎沫的，是里寒；头痛的，是寒气上攻。给予吴茱萸汤温里散寒。
呕吐且发热的，用小柴胡汤主治。（赵本有“小柴胡汤方”，详见卷三）
经书说：呕吐且发热的，柴胡证具备。
伤寒经过大吐大下之后，极度虚弱，又极度发汗（赵本无“出”字），因为病人外表气机怫郁（赵本无“以”字），医生又给他喝水以发其汗，因此导致呃逆。之所以这样，是因为胃中寒冷的缘故。
大吐大下，胃气极度虚弱，又极度发汗，又亡失阳气。外邪怫郁于表，则身热，医生给他喝水以发其汗，胃虚得水，虚寒相搏结而成呃逆。
Use acrid (pungent) substances to moisten; the acridity of Danggui Tang (Angelica Decoction), Guizhi (Cinnamon Twig), and Ganjiang (Dried Ginger) disperses cold. For heat in the upper jiao, use bitter substances to drain it; the bitterness of Zhimu (Anemarrhena Rhizome) and Huangqin (Scutellaria Root) cools the heart and removes heat. For deficiency of body fluids, use sweet substances to moisten; the sweetness of Fuling (Poria) and Baizhu (Atractylodes Macrocephala Rhizome) moderates the spleen and generates fluids. For dryness and heat in the lungs, use sour substances to astringe and sweet substances to relax; the sourness of Shaoyao (Peony Root) astringes rebellious qi, while the sweetness of Weirui (Polygonatum Rhizome), Mendong (Ophiopogon Tuber), Shigao (Gypsum Fibrosum), and Gancao (Licorice Root) moistens the lungs and removes heat.
The above fourteen ingredients are boiled in one dou of water. First, boil Mahuang (Ephedra Herba) for two or three boils, remove the foam on the surface, then add the remaining herbs. Boil until three sheng of liquid remain, strain, and divide into three warm doses. Administer the doses at intervals equivalent to the time required to cook three dou of rice, ensuring the full amount is consumed. Recovery occurs with sweating.
In shaoyang disease after four or five days, abdominal pain accompanied by a sensation of gas moving downward toward the lower abdomen indicates impending spontaneous diarrhea.
Four or five days into shaoyang disease is the time when pathogenic factors transmit inward. Abdominal pain and gas moving downward toward the lower abdomen occur due to interior deficiency encountering cold, causing cold qi to descend, leading to spontaneous diarrhea.
If the patient originally had cold-type diarrhea, and the physician incorrectly employs vomiting or purgation methods, cold obstruction occurs, exacerbating vomiting and diarrhea. If food is vomited immediately upon entering the mouth, Ganjiang Huanglian Huangqin Renshen Tang (Dried Ginger, Coptis, Scutellaria, and Ginseng Decoction) is indicated.
Shaoyang pathogens typically transmit from the exterior, but if the patient originally suffered from cold-type diarrhea, and the physician incorrectly uses vomiting and purgation, righteous qi is damaged, and cold qi creates internal obstruction. The Classics state: "Obstruction leads to vomiting and reversal." Vomiting food immediately upon ingestion is termed "cold obstruction." Further use of vomiting or purgation would doubly weaken the righteous qi, leading to death. Therefore, Ganjiang Huanglian Huangqin Renshen Tang is administered to resolve the cold obstruction.
Formula of Ganjiang Huanglian Huangqin Renshen Tang:
Ganjiang (Acrid-Hot), Huanglian (Bitter-Cold), Huangqin (Bitter-Cold), Renshen (Each 3 liang, Sweet-Warm).
Acrid substances disperse, sweet substances moderate. The acrid-sweet nature of Ganjiang and Renshen tonifies righteous qi; the bitter nature of Huanglian and Huangqin drains and resolves cold obstruction.
The above four ingredients are boiled in six sheng of water until two sheng remain. Strain and divide into two warm doses.
In diarrhea, slight fever and thirst with a weak pulse indicate spontaneous recovery.
Diarrhea is a yin-cold disease; sudden high fever is an adverse sign. Slight fever and thirst indicate that interior warmth is returning. The Classics state: "Weak pulse with fever." A weak pulse indicates the restoration of yang qi, so spontaneous recovery is expected.
In diarrhea, if the pulse is rapid, accompanied by slight fever and sweating, spontaneous recovery is expected. If the pulse becomes tight again, the disease is not resolved. (Zhao edition note: "Alternatively: if the pulse is floating and tight.")
Diarrhea is a yin disease. A rapid pulse is a yang pulse. In yin diseases, the appearance of a yang pulse indicates life. Slight fever and sweating indicate the unblocking of yang qi, so diarrhea will spontaneously cease. Tight pulses generally indicate cold; if the pulse becomes tight again, yin qi still prevails, hence the disease is not resolved.
In diarrhea, if the hands and feet are cold and the pulse is absent, moxibustion fails to warm them, and if the pulse does not return, accompanied by slight panting, it is a fatal condition.
In diarrhea, cold hands and feet with an absent pulse indicate excessive yin qi and severe deficiency of yang qi. After moxibustion, if yang qi restores, hands and feet become warm, and the pulse returns, recovery is imminent. If hands and feet remain cold and the pulse does not return, yang qi is exhausted. Slight panting indicates the collapse of yang qi.
If the Shaoyin pulse is weaker than the Zuyang pulse, it is a favorable sign.
Shaoyin corresponds to Kidney Water; Zuyang corresponds to Spleen Earth. Diarrhea involves kidney pathogenic factors affecting the spleen. If water cannot overcome earth, it is considered a minor pathogen, thus a favorable sign.
In diarrhea, if the cun pulse is unexpectedly floating and rapid, while the chi pulse is choppy, pus and blood will inevitably appear in the stool.
In diarrhea, the pulse should be deep and slow. An unexpected floating and rapid pulse indicates interior heat. A choppy pulse indicates blood deficiency. A choppy chi pulse indicates scattered blood in the intestines and stomach, which will pass with the diarrhea as pus and blood.
"Qing" (clear) is interchangeable with "Qing" (to defecate). The Mai Jing states: "Qing refers to the toilet."
In diarrhea with undigested food, exterior-attacking methods (sweating) are contraindicated. Sweating will inevitably lead to abdominal distension.
Diarrhea indicates spleen-stomach deficiency. The Stomach is the master of body fluids. Sweating depletes fluids, further weakening stomach qi, inevitably causing abdominal distension.
In diarrhea, a deep-chord pulse indicates tenesmus (heavy sensation in the rectum); a large pulse indicates the disease has not ceased; a weak-rapid pulse indicates the disease is about to stop spontaneously. Even with fever, death will not occur.
Deep pulse indicates interior location; chord pulse indicates tension. Interior qi deficiency causes tenesmus. A large pulse indicates disease progression, meaning diarrhea has not stopped. A weak-rapid pulse indicates minimal pathogenic qi and restored yang qi, suggesting spontaneous cessation. Fever here results from yang excess, not a major adverse condition.
In diarrhea, if the pulse is deep and slow, the patient's face shows slight redness, there is slight body heat, and undigested food passes in stool, the patient will likely experience vertigo and dizziness (Yu Mao). Recovery occurs with sweating. The patient will likely have mild cold extremities. This occurs because the face shows "floating yang" due to lower deficiency.
Undigested food in diarrhea with a deep-slow pulse indicates interior cold. Slight facial redness and body heat indicate unresolved exterior pathogens. Mild cold extremities, as stated in the Zhen Jing: "Lower deficiency leads to cold limbs." As exterior pathogens resolve, just before sweating, the pre-existing interior deficiency causes vertigo, followed by sweating and resolution.
In diarrhea, if the pulse is rapid and there is thirst, spontaneous recovery is expected. If it does not improve, pus and blood will appear due to heat.
The Classics state: "If rapid pulse persists and diarrhea continues, heat-collateral diarrhea with pus and blood will occur."
After diarrhea, if the pulse is absent and hands/feet are cold, but the pulse returns and hands/feet become warm after a cycle (12 hours), life is preserved. If the pulse does not return, death ensues.
After diarrhea, absent pulse and cold extremities indicate lack of yang. "Cycle" refers to twelve hours. If extremities warm and pulse appears after a cycle, yang qi has restored, indicating survival. If extremities remain cold and pulse does not return, yang qi is exhausted, indicating death.
In shaoyang diarrhea occurring more than ten times a day, if the pulse is unexpectedly strong/excess, it is a fatal condition.
Diarrhea indicates interior deficiency. The pulse should be weak; an unexpectedly strong pulse indicates the disease overcomes the viscera, hence death. The Nan Jing states: "When the pulse does not match the disease, and the disease does not match the pulse, it is a fatal illness."
In diarrhea with undigested food, interior cold with exterior heat, sweating, and cold extremities, Tongmai Sini Tang (Pulse-Restoring Four Reversal Decoction) is indicated. (Zhao edition contains the formula details in Volume 6).
Undigested food in diarrhea indicates interior cold; persistent body heat indicates exterior heat. Sweating usually indicates yang qi circulating outward, preventing cold limbs. However, sweating with cold limbs indicates severe yang deficiency. Tongmai Sini Tang is given to secure yang qi.
In hot diarrhea with tenesmus, Baitouweng Tang (Pulsatilla Decoction) is indicated.
Diarrhea depletes fluids; heat damages qi. Qi deficiency sinking downward causes tenesmus. Baitouweng Tang clears heat and firms the intestines.
Formula of Baitouweng Tang:
Baitouweng (2 liang, Bitter-Cold), Huangbai (Bitter-Cold), Huanglian (Bitter-Cold), Qinpi (Each 3 liang, Bitter-Cold).
The Nei Jing states: "The Kidney desires firmness; urgently consume bitter substances to firm it." Diarrhea causes lower jiao deficiency, so purely bitter agents are used to firm it.
The above four ingredients are boiled in seven sheng of water until two sheng remain. Strain, take one sheng warm. If ineffective, take another sheng.
In diarrhea with abdominal fullness and body pain, first warm the interior, then attack the exterior. Warm the interior with Sini Tang (Four Reversal Decoction); attack the exterior with Guizhi Tang (Cinnamon Twig Decoction). (Zhao edition notes Sini Tang uses the fifth formula from earlier, and Guizhi Tang details are in Volume 2).
Abdominal fullness in diarrhea indicates interior deficiency-cold; treat first with Sini Tang to warm the interior. Body pain indicates unresolved exterior pathogens. Once diarrhea stops and interior harmony is achieved, use Guizhi Tang to attack the exterior.
In diarrhea, if the patient desires to drink water, it is due to heat; Baitouweng Tang is indicated.
Spontaneous diarrhea without thirst indicates cold in the zang organs; treat with Sini Tang to warm the viscera. Diarrhea with desire to drink water indicates heat; treat with Baitouweng Tang to cool the middle.
In diarrhea, if delirium occurs, it indicates dry feces; Xiao Chengqi Tang (Minor Order the Qi Decoction) is appropriate. (Zhao edition contains the formula details in Volume 5).
The Classics state: "Excess conditions cause delirium." Dry feces indicate stomach excess; diarrhea indicates intestinal deficiency. Xiao Chengqi Tang is given to purge the dry feces.
After diarrhea, if irritability increases and the epigastrium is soft upon palpation, it is empty irritability (Xu Fan); Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is appropriate. (Zhao edition contains the formula details in Volume 3).
Absence of irritability after diarrhea suggests resolution. Increased irritability with a hard epigastrium suggests food stagnation. Here, irritability with a soft epigastrium indicates pathogenic heat invading the chest due to deficiency, constituting empty irritability. Zhizi Chi Tang is given; inducing vomiting leads to cure.
In patients with vomiting due to abscess pus, do not treat the vomiting directly. When the pus is exhausted, vomiting will cease spontaneously.
An abscess in the stomach region causes vomiting of pus. Do not treat the vomiting; once the pus is expelled, vomiting ceases.
In vomiting with a weak pulse, free urination, slight body heat, and cold extremities, the prognosis is difficult. Sini Tang is indicated.
Vomiting with a weak pulse indicates pathogenic transmission to the interior. Vomiting involves rebellious qi, so urination should be difficult. Free urination indicates interior deficiency. Slight heat with cold extremities indicates yin prevailing over yang, making it difficult to treat. Sini Tang warms the interior and assists yang.
In dry heaving, spitting saliva, and headache, Wuzhuyu Tang (Evodia Decoction) is indicated. (Zhao edition contains the formula details in Volume 5).
Dry heaving and spitting saliva indicate interior cold; headache indicates cold qi attacking upward. Wuzhuyu Tang warms the interior and disperses cold.
In vomiting with fever, Xiaochaihu Tang (Minor Bupleurum Decoction) is indicated. (Zhao edition contains the formula details in Volume 3).
The Classics state: "Vomiting with fever indicates the Chai Hu syndrome is complete."
In shaoyang disease, after severe vomiting and purgation, the patient is extremely deficient. If extreme sweating occurs, and due to external qi stagnation (Fu Yu), the physician gives water to induce sweating, hiccups result. This occurs because of cold in the stomach.
Severe vomiting and purgation severely damage stomach qi. Extreme sweating further depletes yang qi. External pathogens stagnate at the exterior, causing fever. Giving water to induce sweating in a deficient stomach leads to a struggle between deficiency and cold, resulting in hiccups.
In shaoyang disease, if hiccups are accompanied by abdominal fullness, examine the anterior (urinary) and posterior (anal) orifices to determine which is obstructed. Relieving the obstruction cures the condition.
Hiccups with abdominal fullness indicate rebellious qi ascending without descending. Examine the anterior and posterior orifices; relieve any obstruction to descend the qi. The anterior orifice refers to urine; the posterior orifice refers to stool.