下痞，先与桂枝汤解表，表解，乃与大黄黄连泻心汤攻痞。《内经》曰∶从外之内而盛于内者，先治其外，而
后调其内。
伤寒，发热，汗出不解，心下痞硬，呕吐而下利者，大柴胡汤主之。
伤寒发热，寒已成热也。汗出不解，表和而里病也。吐利，心腹濡软为里虚；呕吐而下利，心下痞硬者，
是里实也，与大柴胡汤以下里热。
病如桂枝证，头不痛，项不强，寸脉微浮，胸中痞硬，气上冲咽喉，（赵本作“喉咽”）不得息者，此
为胸有寒也，当吐之，宜瓜蒂散。
病如桂枝证，为发热、汗出、恶风，言邪在表也。头痛、项强，为桂枝汤证具。若头不痛，项不强，则
邪不在表而传里也。浮为在表，沉为在里。今寸脉微浮，则邪不在表，亦不在里，而在胸中也。胸中与表相应，
故知邪在胸中者，犹如桂枝证而寸脉微浮也。以胸中痞硬，（医统本有“气”字）上冲咽喉不得息，知寒
邪客于胸中而不在表也。《千金》曰∶气浮上部，填塞心胸，（医统本作“胸心”）胸中满者，吐之则愈。与
瓜蒂散，以吐胸中之邪。
瓜蒂散方∶
瓜蒂（一分，熬黄。味苦寒） 赤小豆（一分。味酸温）
其高者越之，越以瓜蒂、豆（医统本作“香”）豉之苦；在上者涌之，以赤小豆之酸。《内经》曰∶酸
苦涌泄为阴。
上二味，各别捣筛，为散已，合治之，取一钱匕。以香豉一合，用热汤七合，煮作稀糜，去滓，取汁和
散，温顿服之。不吐者，少少加，得快吐乃止。诸亡血虚
家，不可与瓜蒂散。
病胁下素有痞，连在脐旁，痛引少腹，入阴筋者，此名脏结。死。
素有宿昔之积，结于胁下为痞。今因伤寒邪气入里，与宿积相助，（医统本作“合”）使脏之真（医统本
作“真之”）气，结而不通，致连在脐旁，痛引少腹，入阴筋而死。
伤寒病，（赵本无“病”字）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。（赵本有“白虎加人参汤方”详见卷十）
若吐若下后，七八日则当解，复不解，而热结在里。表热者，身热也；里热者，内热也。本因吐下后，
邪气乘虚内陷为结热，若无表热而纯为里热，则邪热结而为实；此以表热未罢，时时恶风。若邪气纯在表，
则恶风无时；若邪气纯在里，则更不恶风。以时时恶风，知表里俱有热也。邪热结而为实者，则无
大渴；邪热散漫则渴。今虽热结在里，表里俱热，未为结实，邪气散漫，熏蒸焦膈，故大渴，舌上干燥而烦，
欲饮水数升。与白虎加人参汤，散热生津。
伤寒无大热，口燥渴，心烦，背微恶寒者，白虎加人参汤主之。
无大热者，为身无大热也。口燥渴心烦者，当作阳明病；然以背微恶寒，为表未全罢，所以属太阳也。
背为阳，背恶寒口中和者，少阴病也，当与附子汤；今口燥而渴，背虽恶寒，此里也，则恶寒亦不至甚，故云
微恶寒。与白虎汤和表散热，加人参止渴生津。
伤寒脉浮，发热无汗，其表不解者，（赵本无“者”字）不
可与白虎汤。渴欲饮水，无表证者，白虎加人参汤主之。
伤寒脉浮，发热无汗，其表不解，不渴者，宜麻黄汤；渴者宜五苓散，非白虎所宜。大渴欲水，无表证者，
乃可与白虎加人参汤，以散里热。临病之工，大宜精别。
太阳少阳并病，心下硬，颈项强而眩者，当刺大椎、肺俞、肝俞，慎勿下之。
心下痞硬而眩者，少阳也；颈项强者，太阳也。刺大椎、肺俞，以泻太阳之邪，以太阳脉下项挟脊故尔；
肝俞以泻少阳之邪，以胆为肝之腑故尔。太阳为在表，少阳为在里，即是半表半里证。前第五（医统本作“八”）
证云∶不可发汗，发汗则谵语。是发汗攻太阳之邪，少阳之邪益甚干胃，必发谵语。此云慎勿下
之，攻少阳之邪，太阳之邪乘虚入里，必作结胸。经曰∶太阳少阳并病，而反下之，成结胸。
太阳与少阳合病，自下利者，与黄芩汤；若呕者，黄芩加半夏生姜汤主之。
太阳阳明合病，自下利为在表，当与葛根汤发汗。阳明少阳合病，自下利，为在里，可与承气汤下之。此
太阳少阳合病，自下利，为在半表半里，非汗下所宜，故与黄芩汤以和解半表半里之邪。呕者，胃气逆也，
故加半夏、生姜，以散逆气。
黄芩汤方∶
黄芩（三两。味苦寒） 甘草（二两，炙。味甘平） 芍药（二两。味酸平） 大枣（十二枚，擘。味甘温）
虚而不实者，苦以坚之，酸以收之，黄芩、芍药之苦酸，以坚敛肠胃之气。弱而不足者，甘以补之，甘草、
大枣之甘，以补固肠胃之弱。
上四味，以水一斗，煮取三升，去滓，温服一升，日再夜一服。若呕者，加半夏半升，生姜三两。（赵本无若呕
者以下十二字，有“黄芩加半夏生姜汤方”详见卷十）
伤寒胸中有热，胃中有邪气，腹中痛，欲呕吐者，黄连汤主之。
湿家下后，舌上如苔者，以丹田有热，胸中（医统本作“上”）有寒，是邪气入里，而为下热上寒也；
此伤寒邪气传里，而为下寒上热也。胃中有邪气，使阴阳不交，阴不得升，而独治于下，为
下寒腹中痛；阳不得降而独治于上，为胸中热，欲呕吐。与黄连汤，升降阴阳之气。
黄连汤方∶
黄连（味苦寒） 甘草（炙。味甘平） 干姜（味辛热） 桂枝（去皮，各三两。味辛热） 人参（二两。
味甘温） 半夏（半升，洗。味辛。医统本作甘，温） 大枣（十二枚，擘。味甘温）
上热者，泄之以苦，黄连之苦以降阳；下寒者，散之以辛，桂、姜、半夏之辛以升阴；脾欲缓，急食甘以
缓之，人参、甘草、大枣之甘以益胃。
上七味，以水一斗，煮取六升，去滓，温服一升，日三服，夜二服。
伤寒八九日，风湿相搏，身体疼烦，不能自转侧，不呕不渴，脉浮虚而涩者，桂枝附子汤主之。
伤寒与中风家，至七八日再经之时，则邪气多在里，身必不苦疼痛，今日数多，复身体疼烦，不能自转
侧者，风湿相搏也。烦者风也；身疼不能自转侧者湿也。经曰∶风则浮虚。《脉经》曰∶脉来涩者，为
病寒湿也。不呕不渴，里无邪也；脉得浮虚而涩，身有疼烦，知风湿但在经也，与桂枝附子汤，以散
表中风湿。
若其人大便硬，（赵本注∶“一云∶脐下心下硬”）小便自利者，去桂枝（赵本无“枝”字）加白术汤主之。
桂，发汗走津液。此小便利，大便硬为津液不足，去桂加术。
桂枝附子汤方∶
桂枝（四两，去皮。味辛热） 附子（三枚，炮，去皮，破八片，赵本无“八片”二字。辛热）
生姜（三两，切。味辛温） 甘草（二两，炙。味甘温） 大枣（十二枚，擘。味甘温）
风在表者，散以桂枝、甘草之辛甘；湿在经者，逐以附子之辛热；姜、枣辛甘行荣卫，通津液，以和表也。
上五味，以水六升，煮取二升，去滓，分温三服。赵本有去桂加白术汤方云∶
附子（三枚，炮，去皮破） 白术（四两） 生姜（三两，切） 甘草（二两，炙） 大枣（十二枚，擘）
风湿相搏，骨节烦疼，（赵本作“疼烦”）掣痛，不得屈伸，近之则痛剧，汗出短气，小便不利，恶风不
欲去衣，或身微肿者，甘草附子汤主之。
风则伤卫，湿流关节，风湿相搏，两邪乱经，故骨节疼烦，掣痛，不得屈伸，近之则痛剧也。风胜则卫气
不固，汗出，短气，恶风不欲去衣，为风在表；湿胜则水气不行，小便不利，或身微肿，为湿外薄（医统本作“
搏”）也。与甘草附子汤，散湿固卫气。
甘草附子汤方∶
甘草（二两，炙。味甘平） 附子（二枚，炮，去皮破。味辛热） 白术（二两。味甘温） 桂枝（四两，
去皮。味辛热）
桂枝、甘草之辛甘，发散风邪而固（医统本作“和”）卫；附子、白术之辛甘，解湿气而温经。
上四味，以水六升，煮取三升，去滓，温服一升，日三服。初服得微汗则解。能食，汗出（赵本作“止”）
复烦者，（赵本有“将”字）服五合，恐一升多者，宜服六七合为妙。（赵本医统本并作“始”）
伤寒脉浮滑，此（赵本有“以”字）表有热、里有寒，白虎汤主之。
浮为在表，滑为在里。表有热，外有热也；里有寒∶有邪气传里也。以邪未入腑，故止言寒，如瓜蒂散证
云∶胸上有寒者是矣。与白虎汤，以解内外之邪。
白虎汤方∶
知母（六两。味苦寒） 石膏（一斤，碎。味甘寒） 甘草（二两，赵本有“炙”字。味甘平） 粳米（
六合。味甘平）
《内经》曰∶热淫所胜，佐以苦甘。知母、石膏之苦甘以散热，热则伤气。甘以缓之，甘草、粳米之甘以益气。
上四味，以水一斗，煮米熟，汤成，去滓，温服一升，日三服。
伤寒脉结代，心动悸，炙甘草汤主之。
结代之脉，动而中止能自还者，名曰结；不能自还者，名曰代。由血气虚衰，不能相续也。心中悸动，知
真气内虚也，与炙甘草汤，益虚补血气而复脉。
炙甘草汤方∶
甘草（四两，炙。味甘平） 生姜（三两，切。味辛温） 桂枝（三两，去皮。味辛热） 人参（二两。
味甘温） 生地黄（一斤。味甘寒） 阿胶（二两。味温甘，医统本作甘温） 麦门冬（半升，去心。味甘
平） 麻子人（赵本作“仁”，半升。味甘平） 大枣（十二，赵本医统本并作三十，枚，擘。味甘温）
补可以去弱，人参、甘草、大枣之甘，以补不足之气；桂枝、生姜之辛，以益正气。《圣济经》曰∶津
耗散为枯，五脏痿弱，荣卫涸流，温剂所以润之。麻人、阿胶、麦门冬、地黄之甘，润经益血，复脉通心也。
上九味，以清酒七升，水八升，先煮八味，取三升，去滓，内胶烊消尽，温服一升，日三服，一名复脉汤。
脉按之来缓，而（赵本无“而”字）时一止复来者，名曰结。又脉来动而中止，更来小数，中有还者
反动，名曰结阴也；脉来动而中止，不能自还，因而复动，（赵本有“者”字） 名曰代阴也。得此脉者，必难治。
结代之脉，一为邪气留结，一为真气虚衰。脉来动而中止，若能自还，更来小数，止是邪气留结，名曰结
阴；若动而中止，不能自还，因其呼吸，阴阳相引复动者，是真气衰极，名曰代阴，为难治之脉。经曰∶脉结
者生，代者死，此之谓也。
治疗痞证，先用桂枝汤解除表邪，待表证解除后，再用大黄黄连泻心汤攻逐痞结。《内经》说：病邪从外部传入内部并在内部盛行的，先治疗外部，然后再调理内部。
伤寒发热，汗出后热不退，胃脘部痞塞坚硬，呕吐且伴有下利的，用大柴胡汤主治。
伤寒发热，是寒邪已经化热的表现。汗出后热仍不解，说明表气已和而里气有病。呕吐和下利，若心腹部柔软则为里虚；若呕吐且下利，心下部痞塞坚硬的，这是里实证，用大柴胡汤来攻下里的热邪。
病症类似桂枝汤证，但头不痛，项不强，寸脉微浮，胸中痞塞坚硬，气向上冲至咽喉，呼吸不畅的，这是胸中有寒邪（此处指痰饮等阴邪），应当用吐法治疗，适宜用瓜蒂散。
病症类似桂枝汤证，是指发热、汗出、恶风，说明邪气在表。头痛、项强，是桂枝汤证具备的表现。如果头不痛，项不强，那么邪气不在表而传入了里。浮脉主表，沉脉主里。现在寸脉微浮，说明邪气不在表，也不在里，而是在胸中。胸中与体表相应，所以知道邪气在胸中，就像桂枝汤证一样，但寸脉微浮。因为胸中痞塞坚硬，气上冲咽喉导致呼吸不畅，可知寒邪客居在胸中而不在表。《千金方》说：气浮于上部，填塞心胸，胸中胀满的，用吐法就能痊愈。给予瓜蒂散，以涌吐胸中的邪气。
瓜蒂散方：
瓜蒂（一分，炒至黄色。味苦寒） 赤小豆（一分。味酸温）
病位高的，用越法（吐法）祛除，用瓜蒂、豆豉的苦味来涌吐；病位在上部的，用涌法祛除，用赤小豆的酸味。《内经》说：酸味和苦味能涌泄，属于阴。
以上两味药，分别捣碎过筛，制成散剂，混合均匀，取一钱匕的药量。用香豉一合，热汤七合，煮成稀粥状，去渣，取汁液调和药散，温服一次顿下。如果不吐，逐渐增加剂量，直到快吐出来就停止。凡是失血或体质虚弱的人，不可服用瓜蒂散。
病人胁下素有痞块，牵连到脐旁，疼痛牵引少腹，甚至进入阴筋的，这名叫脏结。预后不良，致死。
素有宿积，结聚在胁下形成痞块。现在因伤寒邪气入里，与宿积相互结合，使脏腑的真气结滞不通，导致痞块连及脐旁，疼痛牵引少腹，进入阴筋而死。
伤寒病，如果在吐法或下法之后，七八天病情仍未解除，热邪结聚在里，表里都发热，时时感到恶风，极度口渴，舌上干燥且烦躁，想要喝几升水的，用白虎加人参汤主治。
如果在吐法或下法之后，七八天本应解除，却仍未解除，热邪结聚在里。表热是指身体发热；里热是指体内发热。原本因为吐下之后，邪气乘虚内陷成为结热，如果没有表热而纯粹是里热，那么邪热结聚就会成实；这里因为表热未完全消退，所以时时恶风。如果邪气纯粹在表，那么恶风就没有定时；如果邪气纯粹在里，那么就不会再恶风。因为时时恶风，知道表里都有热。邪热结聚成实的，就不会有大渴；邪热散漫的才会口渴。现在虽然热结在里，表里俱热，但还未结实，邪气散漫，熏蒸焦膈，所以大渴，舌上干燥且烦躁，想要喝几升水。给予白虎加人参汤，以散热生津。
伤寒没有明显高热，口燥渴，心烦，背部微微恶寒的，用白虎加人参汤主治。
没有明显高热，是指身体没有大热。口燥渴心烦，应当当作阳明病；但因为背部微微恶寒，说明表证未完全解除，所以归属于太阳病范畴。背部属阳，背部恶寒且口中平和的，是少阴病，应当用附子汤；现在口燥而渴，背部虽然恶寒，但这属于里热，所以恶寒也不至于严重，所以说微恶寒。给予白虎汤调和表邪散热，加入人参止渴生津。
伤寒脉浮，发热无汗，表证未解的，不可与白虎汤。如果口渴想喝水，且没有表证的，用白虎加人参汤主治。
伤寒脉浮，发热无汗，表证未解且不渴的，宜用麻黄汤；口渴的宜用五苓散，不适合用白虎汤。如果大渴想喝水，且没有表证的，才可以与白虎加人参汤，以发散里热。临证治疗的医生，非常需要精细辨别。
太阳少阳并病，心下硬，颈项强直且眩晕的，应当针刺大椎、肺俞、肝俞穴，千万不要用下法。
心下痞硬且眩晕的，是少阳病；颈项强直的，是太阳病。针刺大椎、肺俞，以泻除太阳之邪，因为太阳经脉下行经过颈部夹脊的缘故；针刺肝俞以泻除少阳之邪，因为胆是肝的腑的缘故。太阳病在表，少阳病在里，也就是半表半里证。前面第五证说：不可发汗，发汗则会出现谵语。这是发汗攻逐太阳之邪，会导致少阳之邪更加严重地侵犯胃腑，必然出现谵语。这里说千万不要用下法，如果用下法攻逐少阳之邪，太阳之邪会乘虚入里，必然形成结胸。经文说：太阳少阳并病，反而用下法，会形成结胸。
太阳与少阳合病，自发下利的，用黄芩汤；如果呕吐的，用黄芩加半夏生姜汤主治。
太阳阳明合病，自发下利，病位在表，应当用葛根汤发汗。阳明少阳合病，自发下利，病位在里，可以用承气汤攻下。这里是太阳少阳合病，自发下利，病位在半表半里，不适合发汗或攻下，所以用黄芩汤来和解半表半里的邪气。呕吐，是胃气上逆，所以加入半夏、生姜，以散除逆气。
黄芩汤方：
黄芩（三两。味苦寒） 甘草（二两，炙。味甘平） 芍药（二两。味酸平） 大枣（十二枚，掰开。味甘温）
正气虚弱而不充实的，用苦味来坚固它，用酸味来收敛它，黄芩、芍药的苦酸味，用来坚固收敛肠胃之气。正气微弱不足的，用甘味来补益它，甘草、大枣的甘味，用来补益巩固肠胃的虚弱。
以上四味药，用水一斗，煮取三升，去渣，温服一升，白天服两次，晚上服一次。如果呕吐，加半夏半升，生姜三两。（赵本没有“若呕者”以下的十二个字，有“黄芩加半夏生姜汤方”，详见卷十）
伤寒胸中有热，胃中有邪气，腹中疼痛，想要呕吐的，用黄连汤主治。
湿病患者经过下法治疗后，舌面上像有苔一样的，是因为丹田有热，胸中有寒，这是邪气入里，形成下热上寒的情况；这是伤寒邪气传里，形成下寒上热的情况。胃中有邪气，使阴阳之气不能交通，阴气不得上升，独自治理于下部，形成下寒腹中痛；阳气不得下降，独自治理于上部，形成胸中热，想要呕吐。给予黄连汤，以升降阴阳之气。
黄连汤方：
黄连（味苦寒） 甘草（炙。味甘平） 干姜（味辛热） 桂枝（去皮，各三两。味辛热） 人参（二两。味甘温） 半夏（半升，洗。味辛。医统本作甘温） 大枣（十二枚，掰开。味甘温）
上热的，用苦味泄降，黄连的苦味来降阳；下寒的，用辛味散寒，桂枝、干姜、半夏的辛味来升阴；脾脏喜欢缓和，急需吃甘味食物来缓和它，人参、甘草、大枣的甘味来补益胃气。
以上七味药，用水一斗，煮取六升，去渣，温服一升，白天服三次，晚上服两次。
伤寒八九日，风湿相搏，身体疼痛烦扰，不能自行翻身转侧，不呕吐不口渴，脉浮虚而涩的，用桂枝附子汤主治。
伤寒与中风患者，到了七八天再经的时候，邪气多在里，身体必定不会痛苦疼痛，现在天数多了，又身体疼痛烦扰，不能自行翻身转侧的，这是风湿相搏。烦扰是风邪所致；身体疼痛不能自行转侧是湿邪所致。经文说：风邪致病脉象浮虚。《脉经》说：脉来涩的，是患寒湿病。不呕吐不口渴，说明里没有邪气；脉象浮虚而涩，身体有疼痛烦扰，知道风湿仅在经络，用桂枝附子汤，以散发表中的风湿。
如果病人大便硬，（赵本注：“一说脐下心下硬”）小便自利的，去掉桂枝，加白术汤主治。
桂枝发汗会耗损津液。这里小便通利，大便硬，说明津液不足，所以去掉桂枝加入白术。
桂枝附子汤方：
桂枝（四两，去皮。味辛热） 附子（三枚，炮制，去皮，破成八片，赵本无“八片”二字。味辛热）
生姜（三两，切。味辛温） 甘草（二两，炙。味甘温） 大枣（十二枚，掰开。味甘温）
风邪在表的，用桂枝、甘草的辛甘味来发散；湿邪在经络的，用附子的辛热来驱逐；生姜、大枣的辛甘味运行营卫，通调津液，以调和表证。
以上五味药，用水六升，煮取二升，去渣，分三次温服。赵本有去桂加白术汤方说：
附子（三枚，炮制，去皮破开） 白术（四两） 生姜（三两，切） 甘草（二两，炙） 大枣（十二枚，掰开）
风湿相搏，骨节烦疼，（赵本作“疼烦”）牵掣作痛，不能屈伸，靠近就疼痛加剧，出汗短气，小便不利，恶风不想脱衣，或者身体轻微浮肿的，用甘草附子汤主治。
风邪伤害卫气，湿邪流注关节，风湿相搏，两邪扰乱经络，所以骨节疼痛烦扰，牵掣作痛，不能屈伸，靠近就疼痛加剧。风胜则卫气不固，出汗，短气，恶风不想脱衣，这是风邪在表；湿胜则水气不行，小便不利，或者身体轻微浮肿，这是湿邪外迫（医统本作“搏”）。给予甘草附子汤，以散除湿邪，固护卫气。
甘草附子汤方：
甘草（二两，炙。味甘平） 附子（二枚，炮制，去皮破开。味辛热） 白术（二两。味甘温） 桂枝（四两，去皮。味辛热）
桂枝、甘草的辛甘味，发散风邪而固护（医统本作“和”）卫气；附子、白术的辛甘味，解除湿气而温通经脉。
以上四味药，用水六升，煮取三升，去渣，温服一升，白天服三次。初服得到微微出汗则病解。如果能进食，但出汗（赵本作“止”）后又出现烦闷的，（赵本有“将”字）服用五合，恐怕一升太多的话，服用六七合为妙。（赵本医统本并作“始”）
伤寒脉浮滑，这（赵本有“以”字）表示表有热、里有寒，用白虎汤主治。
浮脉主表，滑脉主里。表有热，即外表有热；里有寒：指有邪气传入里。因为邪气尚未入腑，所以只说寒，就像瓜蒂散证说“胸上有寒”那样。给予白虎汤，以解除内外的邪气。
白虎汤方：
知母（六两。味苦寒） 石膏（一斤，打碎。味甘寒） 甘草（二两，赵本有“炙”字。味甘平） 粳米（六合。味甘平）
《内经》说：热邪淫盛，用苦甘味药物佐助。知母、石膏的苦甘味来散热，热邪会伤气。用甘味来缓急，甘草、粳米的甘味来益气。
以上四味药，用水一斗，煮米熟，汤成，去渣，温服一升，白天服三次。
结脉和代脉，跳动中止后能自己恢复的，名叫结脉；不能自己恢复的，名叫代脉。这是由于气血虚衰，不能连续接续。心中悸动，知道真气内部虚弱，给予炙甘草汤，补益虚损，补血气，恢复脉象。
炙甘草汤方：
甘草（四两，炙。味甘平） 生姜（三两，切。味辛温） 桂枝（三两，去皮。味辛热） 人参（二两。味甘温） 生地黄（一斤。味甘寒） 阿胶（二两，味温甘，医统本作甘温） 麦门冬（半升，去心。味甘平） 麻子仁（赵本作“仁”，半升。味甘平） 大枣（十二枚，赵本医统本并作三十枚，掰开。味甘温）
补法可以去除虚弱，人参、甘草、大枣的甘味，用来补益不足的气；桂枝、生姜的辛味，用来补益正气。《圣济经》说：津液耗散导致枯槁，五脏痿弱，荣卫枯竭流动，温剂是用来滋润它的。麻仁、阿胶、麦门冬、地黄的甘味，滋润经脉，补益血液，恢复脉象，通达心脏。
以上九味药，用清酒七升，水八升，先煮前八味，取三升，去渣，放入阿胶烊化消尽，温服一升，白天服三次，又名复脉汤。
脉搏按之来势缓慢，偶尔有一次停顿随后又来的，名叫结脉。又脉搏跳动中止，再次来时稍快，中间有回返的动作再次跳动，名叫结阴脉；脉搏跳动中止，不能自己回返，因而再次跳动，（赵本有“者”字）名叫代阴脉。得到这种脉象的，一定难治。
结脉和代脉，一个是邪气留结，一个是真气虚衰。脉搏跳动中止，如果能自己回返，再次来时稍快，只是邪气留结，名叫结阴脉；如果跳动中止，不能自己回返，随着呼吸，阴阳相互牵引再次跳动，这是真气衰极，名叫代阴脉，是难治的脉象。经文说：脉结的能生，脉代的会死，说的就是这个道理。
Treatment of Pi (痞, epigastric fullness/oppression) syndrome: first administer Guizhi Tang (Cinnamon Twig Decoction) to resolve the exterior; once the exterior is resolved, then administer Dahuang Huanglian Xiexin Tang (Rhubarb, Coptis, and Scutellaria Heart-Draining Decoction) to attack the Pi. The *Neijing* states: "When pathogenic factors originate from the exterior and become prevalent in the interior, treat the exterior first, and subsequently regulate the interior."
In Shanghan (Cold Damage), if there is fever, sweating does not resolve the condition, accompanied by hardness and oppression in the heart region (epigastrium), vomiting, and diarrhea, Dachaihu Tang (Minor Bupleurum Decoction) is the primary treatment.
Shanghan fever indicates that cold pathogenic factors have transformed into heat. Sweating without resolution indicates that the exterior harmony is restored but the interior is diseased. Vomiting and diarrhea with a soft abdomen and epigastrium indicate interior deficiency; however, vomiting and diarrhea with hardness and oppression in the lower chest indicate interior excess. Dachaihu Tang is administered to purge the interior heat.
If symptoms resemble those of Guizhi Tang syndrome, but without headache or stiff neck, with a slightly floating pulse at the cun position, oppression and hardness in the chest, qi rushing up to the throat causing dyspnea, this is termed "cold in the chest" (referring to phlegm-fluid retention or yin pathogens). It should be treated with emesis, using Gouti San (Melon Sepal Powder).
Symptoms resembling Guizhi Tang syndrome refer to fever, sweating, and aversion to wind, indicating pathogenic factors in the exterior. Headache and stiff neck constitute the complete Guizhi Tang syndrome. If there is no headache or stiff neck, the pathogen is not in the exterior but has transmitted inward. A floating pulse indicates the exterior; a deep pulse indicates the interior. Now, with a slightly floating pulse at the cun position, the pathogen is neither in the exterior nor the interior, but in the chest. The chest corresponds to the exterior; thus, knowing the pathogen is in the chest is like Guizhi Tang syndrome but with a slightly floating cun pulse. Due to oppression and hardness in the chest, with qi rushing to the throat causing dyspnea, it is known that cold pathogens are lodged in the chest, not the exterior. The *Qianjin Fang* states: "When qi floats to the upper part, filling the chest and heart, causing chest fullness, emesis will cure it." Gouti San is given to涌 (yong, surge/emetic) the pathogens from the chest.
Gouti San Formula:
Gouti (Melon Sepalum, 1 fen, stir-fried until yellow. Bitter, Cold) Chixiaodou (Adzuki Bean, 1 fen. Sour, Warm)
For pathogens high in the body, use the method of Yue (emesis); utilize the bitterness of Gouti and Douchi (Fermented Soybean) to induce surging. For pathogens in the upper region, use the method of Yong (surge/emesis); utilize the sourness of Chixiaodou. The *Neijing* states: "Sour and bitter flavors induce surging and purging, belonging to Yin."
The above two ingredients are separately pounded and sifted into powder, mixed together. Take one qianbi (approx. 2-3g). Use Xiangchi (Fragrant Fermented Soybean, 1 he) and hot water (7 he), boil into a thin porridge, strain, and mix the juice with the powder. Take warm in one dose. If no emesis occurs, increase the dose slightly until imminent emesis is achieved, then stop. Patients with blood loss or deficiency constitution must not take Gouti San.
If a patient has a pre-existing Pi mass under the hypochondrium, extending to the side of the navel, with pain radiating to the lower abdomen and entering the genital tendons, this is named Zangjie (Organ Knotting). This is fatal.
Pre-existing accumulated masses form Pi under the hypochondrium. Now, due to Shanghan pathogenic factors transmitting inward and combining with the accumulated mass, the true qi of the zang organs becomes knotted and blocked. This causes the mass to extend to the side of the navel, pain radiating to the lower abdomen and genital tendons, leading to death.
In Shanghan disease, if after emesis or purgation, the condition remains unresolved for seven to eight days, with heat knotting in the interior, fever in both exterior and interior, occasional aversion to wind, extreme thirst, dry tongue with irritability, and desire to drink several liters of water, Baizhu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is the primary treatment.
After emesis or purgation, by seven to eight days, resolution should occur. If unresolved, heat knots in the interior. Exterior heat refers to body fever; interior heat refers to internal heat. Originally, due to emesis/purgation, pathogenic factors sank inward due to deficiency, forming knotted heat. If there were no exterior heat and only pure interior heat, the pathogenic heat would knot into excess. Here, because exterior heat has not completely ceased, there is occasional aversion to wind. If pathogens were purely in the exterior, aversion to wind would be constant; if purely in the interior, there would be no aversion to wind. Occasional aversion to wind indicates heat in both exterior and interior. When pathogenic heat knots into excess, there is no extreme thirst; when pathogenic heat is diffuse, there is thirst. Although heat knots in the interior and both exterior and interior are hot, it is not yet fully knotted/excess. The diffuse pathogenic heat steams and scorches the diaphragm, causing extreme thirst, dry tongue, irritability, and desire to drink several liters of water. Baizhu Jia Renshen Tang is given to dissipate heat and generate fluids.
In Shanghan, if there is no significant high fever, but dry mouth/thirst, irritability, and slight aversion to cold on the back, Baizhu Jia Renshen Tang is the primary treatment.
"No significant high fever" means the body lacks major heat. Dry mouth/thirst and irritability suggest Yangming disease; however, slight aversion to cold on the back indicates the exterior is not fully resolved, so it belongs to the Taiyang category. The back is Yang. Back aversion to cold with a normal mouth/taste indicates Shaoyin disease, treated with Fuzi Tang. Here, dry mouth/thirst indicates interior heat; although there is back aversion to cold, it is mild ("slight") because it is interior-related. Baizhu Tang harmonizes the exterior and dissipates heat; adding Renshen stops thirst and generates fluids.
In Shanghan, if the pulse is floating, with fever and no sweating, and the exterior is unresolved, Baizhu Tang must not be given. If there is thirst for water and no exterior syndrome, Baizhu Jia Renshen Tang is the primary treatment.
In Shanghan, with floating pulse, fever, no sweating, unresolved exterior, and no thirst, Mahuang Tang is suitable; with thirst, Wuling San is suitable, not Baizhu Tang. Only with extreme thirst for water and no exterior syndrome can Baizhu Jia Renshen Tang be given to dissipate interior heat. Physicians must exercise great precision in differentiation.
When Taiyang and Shaoyang diseases occur simultaneously, with hardness in the epigastrium, stiff neck, and dizziness, acupuncture at Dazhui (GV14), Feishu (BL13), and Ganshu (BL18) is indicated. Strictly avoid purgation.
Epigastric hardness with dizziness indicates Shaoyang; stiff neck indicates Taiyang. Acupuncture at Dazhui and Feishu drains Taiyang pathogens, as the Taiyang meridian descends along the neck and spine. Ganshu drains Shaoyang pathogens, as Gallbladder is the paired organ of Liver. Taiyang is exterior; Shaoyang is interior (half-exterior/half-interior). As stated in previous Case 5: "Do not induce sweating; doing so leads to delirium." Inducing sweat attacks Taiyang pathogens, causing Shaoyang pathogens to worsen and invade the Stomach, leading to delirium. Here, avoiding purgation prevents Shaoyang pathogens from being attacked while Taiyang pathogens sink inward due to deficiency, which would cause Jiechest (Knotted Chest). The classic states: "Taiyang-Shaoyang simultaneous disease, if wrongly purged, results in Jiechest."
When Taiyang and Shaoyang diseases combine with spontaneous diarrhea, Huangqi Tang (Scutellaria Decoction) is given. If vomiting occurs, Huangqi Jia Banxia Shengjiang Tang (Scutellaria Plus Pinellia and Fresh Ginger Decoction) is the primary treatment.
Taiyang-Yangming combination with spontaneous diarrhea is exterior-level, treated with Gegen Tang (Kudzu Decoction) to induce sweating. Yangming-Shaoyang combination with spontaneous diarrhea is interior-level, treated with Chengqi Decoctions to purge. This Taiyang-Shaoyang combination with spontaneous diarrhea is half-exterior/half-interior, unsuitable for sweating or purging. Huangqi Tang harmonizes the half-exterior/half-interior pathogens. Vomiting indicates rebellious Stomach Qi; Banxia and Shengjiang are added to disperse rebellious Qi.
Huangqi Tang Formula:
Huangqin (Scutellaria Root, 3 liang. Bitter, Cold) Gancao (Licorice Root, 2 liang, honey-fried. Sweet, Neutral) Shaoyao (Peony Root, 2 liang. Sour, Neutral) Dazao (Jujube, 12 pieces, torn. Sweet, Warm)
For deficiency without excess, use bitter to firm and sour to astringe. The bitterness and sourness of Huangqin and Shaoyao firm and constrain the Qi of the intestines and stomach. For weakness and insufficiency, use sweet to tonify. The sweetness of Gancao and Dazao tonifies and secures the weakness of the intestines and stomach.
The above four ingredients are boiled in 1 dou (approx. 10L) of water to obtain 3 sheng (approx. 3L). Strain and take 1 sheng warm, twice daily and once at night. If vomiting, add Banxia (Pinellia Tuber, 0.5 sheng) and Shengjiang (Fresh Ginger, 3 liang). (Zhao edition omits the last 12 characters regarding vomiting and Huangqi Jia Banxia Shengjiang Tang formula details, see Volume 10).
In Shanghan, if there is heat in the chest, pathogenic factors in the Stomach, abdominal pain, and desire to vomit, Huanglian Tang (Coptis Decoction) is the primary treatment.
In dampness patients, after purgation, a tongue coating resembling moss indicates heat in the Dantian (lower abdomen) and cold in the chest. This is pathogenic factors entering the interior, creating lower-heat/upper-cold. In this Shanghan case, transmission to the interior creates lower-cold/upper-heat. Pathogenic factors in the Stomach prevent interaction between Yin and Yang. Yin fails to ascend, governing only the lower, causing lower-cold and abdominal pain. Yang fails to descend, governing only the upper, causing upper-heat and desire to vomit. Huanglian Tang regulates the ascending and descending of Yin and Yang Qi.
Huanglian Tang Formula:
Huanglian (Coptis Rhizome. Bitter, Cold) Gancao (Licorice Root, honey-fried. Sweet, Neutral) Ganjiang (Dried Ginger. Pungent, Hot) Guizhi (Cinnamon Twig, peeled, 3 liang each. Pungent, Hot) Renshen (Ginseng Root, 2 liang. Sweet, Warm) Banxia (Pinellia Tuber, 0.5 sheng, washed. Pungent. Yitong edition: Sweet, Warm) Dazao (Jujube, 12 pieces, torn. Sweet, Warm)
For upper heat, drain with bitter; Huanglian's bitterness descends Yang. For lower cold, disperse with pungent; the pungency of Guizhi, Ganjiang, and Banxia ascends Yin. The Spleen desires relaxation; urgently eat sweet to relax it. The sweetness of Renshen, Gancao, and Dazao benefits the Stomach.
The above seven ingredients are boiled in 1 dou of water to obtain 6 sheng. Strain and take 1 sheng warm, three times during the day and twice at night.
In Shanghan, after eight or nine days, if Wind-Dampness interlocks, causing severe body pain, inability to turn over, no vomiting, no thirst, and a floating, deficient, and choppy pulse, Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) is the primary treatment.
In Shanghan or Zhongfeng (Wind Strike) cases, by seven to eight days (second cycle), pathogens are mostly in the interior, and the body typically does not suffer pain. Now, with many days passed, severe body pain and inability to turn over indicate Wind-Dampness interlocking. Irritability is Wind; body pain and inability to turn is Dampness. The classic states: "Wind [causes] floating and deficient [pulse]." The *Maijing* states: "A choppy pulse indicates Cold-Dampness disease." No vomiting/thirst indicates no interior pathogens. Floating, deficient, choppy pulse with body pain indicates Wind-Dampness is only in the meridians. Guizhi Fuzi Tang disperses Wind-Dampness in the exterior.
If the patient has hard stool and free urination, remove Guizhi and add Baizhu Tang (Atractylodes Macrocephala Decoction) as the primary treatment.
Guizhi induces sweating and depletes fluids. Free urination and hard stool indicate fluid insufficiency; thus, remove Guizhi and add Baizhu.
Guizhi Fuzi Tang Formula:
Guizhi (Cinnamon Twig, peeled, 4 liang. Pungent, Hot) Fuzi (Prepared Aconite Root, 3 pieces, prepared, peeled, broken into 8 slices. Zhao ed.: no "8 slices". Pungent, Hot) Shengjiang (Fresh Ginger, 3 liang, sliced. Pungent, Warm) Gancao (Licorice Root, 2 liang, honey-fried. Sweet, Warm) Dazao (Jujube, 12 pieces, torn. Sweet, Warm)
For Wind in the exterior, disperse with the pungent-sweet of Guizhi and Gancao. For Dampness in the meridians, drive out with the pungent-hot of Fuzi. Jiang (Ginger) and Zao (Jujube) move Ying and Wei, unblock fluids, and harmonize the exterior.
The above five ingredients are boiled in 6 sheng of water to obtain 2 sheng. Strain and divide into three warm doses. Zhao edition includes the Qu Gui Jia Baizhu Tang (Remove Cinnamon Add Atractylodes) formula:
Fuzi (Prepared Aconite Root, 3 pieces, prepared, peeled, broken) Baizhu (Atractylodes Macrocephala Rhizome, 4 liang) Shengjiang (Fresh Ginger, 3 liang, sliced) Gancao (Licorice Root, 2 liang, honey-fried) Dazao (Jujube, 12 pieces, torn)
When Wind-Dampness interlocks, causing severe joint pain, pulling pain, inability to flex/extend, severe pain upon touch, sweating, shortness of breath, difficult urination, aversion to wind with reluctance to remove clothing, or slight body swelling, Gancao Fuzi Tang (Licorice and Aconite Decoction) is the primary treatment.
Wind injures Wei (Defensive) Qi; Dampness flows into joints. Wind-Dampness interlock disrupts meridians, causing severe joint pain, pulling pain, inability to flex/extend, and severe pain upon touch. Wind excess leads to insecure Wei Qi, sweating, shortness of breath, aversion to wind, reluctance to remove clothing (Wind in exterior). Damp excess leads to stagnant Water Qi, difficult urination, slight swelling (Dampness pressing externally). Gancao Fuzi Tang disperses Dampness and secures Wei Qi.
Gancao Fuzi Tang Formula:
Gancao (Licorice Root, 2 liang, honey-fried. Sweet, Neutral) Fuzi (Prepared Aconite Root, 2 pieces, prepared, peeled, broken. Pungent, Hot) Baizhu (Atractylodes Macrocephala Rhizome, 2 liang. Sweet, Warm) Guizhi (Cinnamon Twig, peeled, 4 liang. Pungent, Hot)
The pungent-sweet of Guizhi and Gancao disperses Wind pathogens and secures (Yitong ed.: harmonizes) Wei. The pungent-sweet of Fuzi and Baizhu resolves Dampness and warms the meridians.
The above four ingredients are boiled in 6 sheng of water to obtain 3 sheng. Strain and take 1 sheng warm, three times daily. Initial dose resulting in slight sweating resolves the condition. If appetite returns but sweating (Zhao ed.: cessation) recurs with irritability, take 5 he. If 1 sheng is considered too much, taking 6-7 he is optimal. (Zhao/Yitong eds.: "shi" instead of "mi").
In Shanghan, if the pulse is floating and slippery, indicating exterior heat and interior cold (Zhao ed.: "yi"), Baizhu Tang (White Tiger Decoction) is the primary treatment.
Floating indicates exterior; slippery indicates interior. Exterior heat means external heat. Interior cold: pathogenic factors have transmitted to the interior. Since pathogens have not entered the Fu organs, it is called "cold," similar to Gouti San stating "cold in the chest." Baizhu Tang resolves exterior and interior pathogens.
Baizhu Tang Formula:
Zhimu (Anemarrhena Rhizome, 6 liang. Bitter, Cold) Shigao (Gypsum Fibrosum, 1 jin, crushed. Sweet, Cold) Gancao (Licorice Root, 2 liang. Zhao ed.: honey-fried. Sweet, Neutral) Jingmi (Glutinous Rice, 6 he. Sweet, Neutral)
The *Neijing* states: "When Heat is excessive, assist with Bitter-Sweet." The bitterness and sweetness of Zhimu and Shigao dissipate heat. Heat damages Qi. Sweetness moderates; the sweetness of Gancao and Jingmi tonifies Qi.
The above four ingredients are boiled in 1 dou of water until rice is cooked. Strain and take 1 sheng warm, three times daily.
In Shanghan, if the pulse is Jie (knotted) or Dai (intermittent), with palpitations, Zhigancao Tang (Honey-Fried Licorice Decoction) is the primary treatment.
Jie and Dai pulses stop beating and return. If they return spontaneously, it is Jie; if they do not, it is Dai. This is due to deficiency of Blood and Qi, unable to continue. Palpitations indicate deficiency of True Qi internally. Zhigancao Tang tonifies deficiency, nourishes Blood and Qi, and restores the pulse.
Zhigancao Tang Formula:
Gancao (Licorice Root, 4 liang, honey-fried. Sweet, Neutral) Shengjiang (Fresh Ginger, 3 liang, sliced. Pungent, Warm) Guizhi (Cinnamon Twig, peeled, 3 liang. Pungent, Hot) Renshen (Ginseng Root, 2 liang. Sweet, Warm) Shengdihuang (Rehmannia Root, fresh, 1 jin. Sweet, Cold) Ejiao (Donkey-Hide Gelatin, 2 liang. Warm, Sweet. Yitong ed.: Sweet, Warm) Maimendong (Ophiopogon Tuber, 0.5 sheng, core removed. Sweet, Neutral) Maziren (Hemp Seed, Zhao ed.: Ren, 0.5 sheng. Sweet, Neutral) Dazao (Jujube, 12 pieces. Zhao/Yitong eds.: 30 pieces, torn. Sweet, Warm)
Tonification removes weakness. The sweetness of Renshen, Gancao, and Dazao tonifies insufficient Qi. The pungency of Guizhi and Shengjiang benefits Righteous Qi. The *Shengji Jing* states: "Fluid consumption leads to withering; Five Zang organs become weak; Ying and Wei flow cease. Warm agents moisten them." The sweetness of Maziren, Ejiao, Maimendong, and Dihuang moistens meridians, benefits Blood, restores the pulse, and connects to the Heart.
The above nine ingredients are boiled in 7 sheng of Qingjiu (Clear Wine) and 8 sheng of water. First boil the eight ingredients to obtain 3 sheng. Strain, add Ejiao, melt completely, and take 1 sheng warm, three times daily. Also known as Fumai Tang (Pulse-Restoring Decoction).
If the pulse feels slow upon pressure, occasionally stopping and returning, it is named Jie (Knotted). If the pulse stops, returns quickly with a slight acceleration, and has a rebound movement, it is named Jieyin (Knotted Yin). If the pulse stops, cannot return spontaneously, and moves again due to respiratory influence of Yin and Yang, it is named Daiyin (Intermittent Yin). Obtaining these pulses indicates difficult treatment.
Jie and Dai pulses: one is due to pathogenic retention/knotting, the other to True Qi deficiency. Pulse stops but returns spontaneously with quickening is pathogenic knotting, named Jieyin. Pulse stops, cannot return, and resumes due to Yin-Yang attraction via respiration is extreme True Qi deficiency, named Daiyin, a difficult-to-treat pulse. The classic states: "Jie pulse lives, Dai pulse dies," referring to this.