太阳病发热而渴。不恶寒者。为温病。
周注。温病由伏邪自内发出。一达于外。表里俱热。热势既壮。郁邪耗液。故发而
即渴。其表本无邪郁。内方喜寒。故不恶寒。延至三五日间。或腹满。或下利者。即
此证也。与伤寒之先表后里者大异。然独系太阳。以未显他经之证。明自少阴发出为表里也。
若发汗已。身灼热者。名曰风温。风温为病。脉阴阳俱浮。自汗出。身重多眠睡。鼻息
必鼾。语言难出。若被下者。小便不利。直视失溲。若被火者。微发黄色。剧则如惊痫。
时螈 。若火熏之。一逆尚引日。再逆促命期。
方注。灼热。谓热转加甚也。风温。谓于温病有风也。阴阳俱浮。太阳本浮。而风温
皆阳。故上下皆见浮也。自汗出。亦卫受伤也。身重多眠睡。鼻息必鼾。语言难出
者。风拥则气昏。热甚则气郁也。小便不利者。太阳主膀胱。而风温皆阳。下则反
攻。徒亡其津液。而膀胱之气伤也。直视者。太阳之筋。支者为目上纲。故不转睛
而上窜也。失溲。言小便甚失其常度也。火。灸熨之类也。微。言攻之微。则变亦微。
发黄者。火热则土燥。故其色外夺也。剧。言攻之剧。则变亦剧。如惊痫时螈 者。
火盛热极而生风也。熏。亦火劫也。一逆。言乍误也。尚引日。言犹可俄延。再逆。言
复误也。促命期。言夭枉人之天年。其致警之意深矣。
周注。此条紧承上文云。若发汗已。身灼热者。名曰风温。是仍太阳病温。误发其
汗。与更感于风者自是不同。然亦名风温何也。既曰太阳。不即显少阴证。惟误
汗则其证本温。复以辛热之药汗之。则阴津外出。表里增热。脉必至尺寸俱浮。
正以风与温混。肾水不能独沉。其证自汗身重。肾本病也。多眠睡。鼻息鼾。语言
难。肾本病也。始先太阳。因汗使少阴之候同时荐至。危且殆矣。古律垂戒云。风
温治在少阴。不可发汗。发汗者死。岂知太阳亦不可发汗。发汗则亦同于风温
之少阴乎。缘医者误认为伤寒。而用正汗药也。若不汗而误下者。伤膀胱之气
化。小便不利。津液大伤。直视失溲。一腑一脏。同时两绝矣。至误被火劫者。微则
热伤营气。而热瘀发黄。剧则热甚风生。而惊痫螈 。盖因乱其神明。扰其筋脉
也。然则于三者之中。一逆已待毙。再犯则立危矣。喻嘉言论内经刺热论温。首
引太阳之脉色荣颧骨。荣未交。曰今且得汗。待时而已。与厥阴争见者死。期不
过三日。其热病内连肾。少阳之脉色荣颊前。荣未交。曰今且得汗。待时而已。与
少阴脉争见者死。互言得汗。非发汗也。故圣人专论谷气。肾中精胜。乃汗则生。
肾中虚甚。更热则死。其旨至矣尽矣。仲景复出不尽之脏。更视膀胱以纬之。视
小便不利。则膀胱伤甚。直视失溲。命门所藏之精不能照物。神髓涸矣。瞳子高
为太阳不足。戴眼为太阳已绝。已绝者。其足不可屈伸。是以中风暴病。多绝膀
胱。不识人者。风温扼要。首视膀胱。未有膀胱不绝。而肾水先绝者也。
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。
周注。黄芩汤。治温本药也。明言太少二阳。何不用二经药。非伤寒也。伤寒由表
入里。此则自内发外。无表何以知太少二阳。或胁满。或头痛。或口苦引饮。因不
恶寒而即热。故不得谓之表也。如伤寒合病。皆表病也。今不但无表。且有下利
里证。伤寒协热利。必自传经而入。不若此之即利也。温何以即利。外发未久。内
郁已深。其人中气本虚。岂能一时尽泄于外。势必下走作利矣。
黄芩汤
黄芩（三两） 甘草（二两炙） 芍药（二两） 大枣（十二枚擘）
上四味。以水一斗。煎取三升。去滓温服一升。日再服。夜一服。若呕者。加半夏半升。生姜三两。
黄芩加半夏生姜汤
黄芩（三两） 甘草（二两） 芍药（二两） 大枣（十二枚擘） 半夏（半升） 生姜（三两）
上六味。以水一斗。煮取三升。去滓温服一升。日再服。夜一服。
周注。黄芩涤热。故为温利主药。以能泄热也。然用芍药者。性酸寒，深入阴分。一
泄一收。热去而利止耳。取甘、枣者。和中也。膀胱与胆。二腑既病。胃无独安之理。
至有呕。明有痰饮结聚。非姜、半不除。姜、半辛燥。非伏气所宜。而去呕则有殊功
也。况以芩为君。又何畏乎。
三阳合病。脉浮大。上关上。但欲眠睡。目合则汗。
方注。太阳脉浮。阳明脉大。关上乃少阳之部位。故曰三阳合病。但欲眠睡者。热
聚于胆也。目合则汗者。少阳少血。虚则不与阳和。寐属阴。故盗汗出也。
周注。温气发出。乃至三阳皆病。其邪热溷实。不言可知。故其脉浮大也。忆邪伏
少阴时。则尺脉亦已大。今因由内发外。由下达上。而浮大见于关以上。故曰上
关上也。邪虽上见阳位。少阴之源未靖。则欲眠尚显本证。而目合则汗。即为盗
汗。又显少阳本证。何以独见少阳。因母虚子亦虚。而少阴邪火与少阳相火。同
升燔灼也。所以稍异热病者。但目合则汗。不似热病之大汗不止也。然何以不
言太阳阳明二经证。以浮为太阳经脉。大为阳明经脉也。治法当以小柴胡去人参、姜、半。加芍药为主。
师曰。伏气之病。以意候之。今月之内。欲有伏气。假令旧有伏气。当须脉之。若脉微
弱。当喉中痛似伤。非喉痹也。病患云。实咽中痛。虽尔。今复欲下利。
周注。于伏气之时。见伏气之病。而脉得微弱。则是少阴脉也。其人肾气虚者。不
及于阳。而即发于阴。以少阴脉本循喉也。故将发必咽痛。至发后则痛极似伤
矣。岂可认为痹证。而误治耶。然咽痛势已发于上。殊不知肾司开阖。阴热上升。
岂遂尽泄。故必疾趋后阴。而下利可预知也。
少阴病二三日。咽痛者。可与甘草汤。不瘥者。与桔梗汤。
周注。伏气发出少阴之经。必咽痛者。不必言矣。先与甘草汤。以缓其上升之势。
更与桔梗汤。以开其怫郁之邪。亦不必言矣。但伏气为重证。少阴为至虚。仲景
轻轻先试。不用黄芩本汤者。夫岂无故。以才发少阴。止见咽痛。无胸满心烦等
症也。无下利呕渴等症也。欲用他药。从何入手。故二三日间。姑就咽痛。连举二
汤。使服之痛止。则少阴之邪。先已去其大半。后有证见。随之投药。此圣人明示不可妄治之道也。
甘草汤
甘草（二两）
上一味。以水三升。煮取一升半。去滓温服七合。日二服。
周注。少阴之脉循喉咙。邪热客之。能无痛乎。正挟少阴之火上升也。主甘草者。
甘能治热火也。
桔梗汤
桔梗（一两） 甘草（二两）
上二味。以水三升。煮取一升半。去滓分温再服。
周注。设服前汤而不除。非药之不胜病也。正以少阴之火挟邪上攻。则并其母
亦病。故加桔梗开之。而自无不愈矣。
少阴病。得之二三日以上。心中烦不得卧。黄连阿胶汤主之。
周注。伏邪未发。津液先已暗耗。今得之二三日以上。虽阴火不升。未见咽痛等
证。而心烦不卧。已知阴血消耗。故令芩、连祛热。胶、芍滋阴。两得之矣。
黄连阿胶汤
黄连（四两） 黄芩（二两） 芍药（二两） 鸡子黄（二枚） 阿胶（三两）
上五味。以水五升。先煮三物。取二升。去滓内入胶。烊尽小冷。内鸡子黄。搅令相得。
温服七合。日三服。
周注。里热当祛之。内燥须滋之。然滋之而即得其润。祛之而适涤其热。惟圣人
合宜也。心烦故主黄连。佐以黄芩。则肺胃之邪俱清。然热甚以消少阴之水。水
源既燥。津液有不匮乏者乎。鸡子黄、阿胶。深益血分之味。以滋其阴。连、芩得此。
功莫大焉。况加芍药以敛消烁之心气。兼以入肝。遂使烦者不烦。不卧者卧矣。
周扬俊注：温病是由于伏邪从体内发出，一旦达于体表，则表里都热。热势既然强盛，郁结的邪气消耗津液，所以发病即感到口渴。其体表本来没有邪气郁结，体内反而喜凉，所以不恶寒。拖延到三、五日间，出现腹部胀满，或腹泻的，就是这种证候。这与伤寒先见表证后见里证的情况大不相同。然而唯独归属于太阳经，是因为尚未显现其他经络的证候，明确说明是从少阴发出而表现为表里同病。
如果发汗之后，身体灼热严重的，称为风温。风温这种病，脉象寸关尺三部都浮，自汗出，身体沉重，嗜睡，呼吸必然有鼾声，言语困难。如果被误用攻下法，会出现小便不利，两眼直视，大小便失禁。如果被误用火疗，轻微的发黄，严重的如同惊痫发作，时而抽搐。如果用火熏蒸，一次误治尚能拖延时日，再次误治则会缩短寿命。
方有执注：灼热，是说热势更加严重。风温，是说在温病基础上又感受了风邪。阴阳俱浮，太阳脉本应浮，而风温皆属阳证，所以上下脉象都见浮。自汗出，也是卫气受伤的表现。身体沉重、多眠睡、鼻息必鼾、言语难出的原因，是风邪壅滞导致气机昏蒙，热盛导致气机郁结。小便不利，是因为太阳主司膀胱，而风温皆属阳证，误下反而攻伐正气，徒然耗亡津液，损伤膀胱的气化功能。直视，是因为太阳经的筋脉，分支者为目上纲（眼睑），所以眼球不转动而上窜。失溲，是说小便完全失去常态。火，指灸熨之类疗法。微，是说攻伐轻微，则变证也轻微。发黄，是因为火热导致脾土燥热，所以面色外现黄色。剧，是说攻伐剧烈，则变证也剧烈。如惊痫、时发抽搐，是因为火盛热极而生风。熏，也是火劫疗法。一逆，是说初次误治。尚引日，是说还可以暂时拖延。再逆，是说再次误治。促命期，是说夭折人的自然寿命。其中的警示之意非常深远。
周扬俊注：这一条紧承上文说，如果发汗之后，身体灼热的，称为风温。这是仍然属于太阳病中的温病，因误发其汗所致，与再次感受风邪者自然是不同的。但也称为风温，为什么呢？既然说是太阳病，没有立即显现少阴证，只是误汗导致原本的温病证候，又用了辛热药物发汗，使得阴津外出，表里热势增加，脉象必定达到寸尺俱浮。正是因为风与温混杂，肾水不能独沉，所以出现自汗、身重等证，这是肾的本脏病变。多眠睡、鼻息鼾、言语难，也是肾的本脏病变。起初是太阳病，因误汗使得少阴的证候同时呈现，危险极了。古医律告诫说：风温治在少阴，不可发汗，发汗者死。难道不知道太阳也不可以发汗吗？发汗就会同样导致风温那样累及少阴的后果。这是因为医生误认为是伤寒，而使用了正确的发汗药。如果不发汗而误用下法，会损伤膀胱的气化功能，导致小便不利，津液大伤，出现直视、失溲，这是一腑一脏同时衰竭。至于误用火劫的，轻微的热伤营气，导致热瘀发黄；严重的热甚生风，导致惊痫抽搐。这是因为扰乱了神明，扰动筋脉。那么在三种误治中，一次误治已等待死亡，再次犯错则立刻危及生命。喻嘉言论述《内经·刺热论》关于温病，首先引用太阳脉色荣颧骨，若荣未交，曰现在可得汗，待时而已。与厥阴争见的，死期不超过三日，因为热病内连肾脏。少阳脉色荣颊前，若荣未交，曰现在可得汗，待时而已。与少阴脉争见的，死。互相论述得汗，不是发汗。所以圣人专门论述谷气，肾中精气胜，才能通过汗出而生存；肾中虚甚，更受热则死。其旨意非常精妙完备。张仲景补充了未尽的脏腑理论，更结合膀胱来阐述。看小便不利，则膀胱损伤严重；直视失溲，则是命门所藏之精不能照物，神髓枯竭。瞳子高为太阳不足，戴眼为太阳已绝。已绝的，其足不可屈伸。所以中风暴病，多绝膀胱。不识人者，是风温的要害，首先观察膀胱。没有膀胱不绝而肾水先绝的情况。
太阳与少阳合病，出现自发性腹泻的，给予黄芩汤。如果有呕吐的，用黄芩加半夏生姜汤主治。
周扬俊注：黄芩汤，是治疗温病的本方。明明说是太阳和少阳两经合病，为什么不用这两经的药？这不是伤寒。伤寒是由表入里，此病则是从内发外，没有表证怎么知道是太少二阳？或者胁肋胀满，或者头痛，或者口苦想喝水，因为不恶寒而即发热，所以不能称之为表证。如伤寒合病，都是表病。现在不但没有表证，而且有下利的里证。伤寒协热利，必然是经过传经而入，不像此病即刻下利。温病为何即刻下利？因为外发不久，内郁已深，患者中气本虚，岂能一时全部发泄于外？势必向下走泄成为下利。
黄芩汤
黄芩（三两） 甘草（炙，二两） 芍药（二两） 大枣（十二枚，掰开）
以上四味，用水一斗，煎取三升，去渣，温服一升，每日两次，夜间一次。若有呕吐，加半夏半升，生姜三两。
黄芩加半夏生姜汤
黄芩（三两） 甘草（二两） 芍药（二两） 大枣（十二枚，掰开） 半夏（半升） 生姜（三两）
以上六味，用水一斗，煮取三升，去渣，温服一升，每日两次，夜间一次。
周扬俊注：黄芩涤除热邪，所以作为温病下利的主药，因为它能泄热。然而使用芍药，是因为其性酸寒，深入阴分，一泄一收，热去则利止。取用甘、枣，是为了和中。膀胱与胆，这两个腑既已生病，胃不可能单独安宁。至于有呕吐，明确是有痰饮结聚，非姜、半不能去除。姜、半辛燥，不适合伏气病，但去除呕吐则有特殊功效。况且以黄芩为君药，又有什么可畏惧的呢？
三阳合病，脉象浮大，出现在关上部位，只想睡觉，闭眼则出汗。
方有执注：太阳脉浮，阳明脉大，关上是少阳的部位，所以叫三阳合病。只想睡觉，是因为热聚于胆。闭眼则出汗，是因为少阳血少，虚则不与阳和。寐属阴，所以盗汗出。
周扬俊注：温气发出，以至于三阳都生病，其邪热混实，不言可知。所以其脉浮大。回忆邪气伏于少阴时，尺脉也已大，现在因为由内发外，由下达上，而浮大见于关以上，所以说上关上。邪气虽然上见于阳位，但少阴之源未靖，所以欲眠仍显本证，而目合则汗，即为盗汗，又显少阳本证。为什么独见少阳？因为母虚子亦虚，少阴邪火与少阳相火，同升燔灼。所以稍异于热病的是，仅目合则汗，不像热病的大汗不止。然而为什么不提太阳、阳明二经证？因为浮为太阳经脉，大为阳明经脉。治法应当用小柴胡汤去人参、生姜、半夏，加芍药为主。
老师说：伏气之病，凭意候之。在这个月之内，想要有伏气，假如旧有伏气，应当诊察脉象。如果脉微弱，应当喉中痛似伤，但不是喉痹。病人说，确实咽中痛，即使如此，现在又想下利。
周扬俊注：在伏气之时，见到伏气之病，而脉得微弱，则是少阴脉。其人肾气虚者，不及于阳，而即发于阴，因为少阴脉本循喉咙。所以将发必咽痛，至发后则痛极似伤。岂可认为痹证，而误治呢？然而咽痛势已发于上，殊不知肾司开阖，阴热上升，岂遂尽泄？所以必疾趋后阴，而下利可预知也。
周扬俊注：伏气发出少阴之经，必咽痛者，不必说了。先与甘草汤，以缓其上升之势。更与桔梗汤，以开其怫郁之邪，也不必说了。但伏气为重证，少阴为至虚，张仲景轻轻先试，不用黄芩本汤者，夫岂无故？因为才发少阴，只见咽痛，无胸满心烦等症，无下利呕渴等症。欲用他药，从何入手？所以在二三日间，姑就咽痛，连举二汤，使服之痛止，则少阴之邪，先已去其大半，后有证见，随之投药，这是圣人明示不可妄治之道。
甘草汤
甘草（二两）
上一味，用水三升，煮取一升半，去渣，温服七合，每日两次。
周扬俊注：少阴之脉循喉咙，邪热客之，能无痛乎？正是挟少阴之火上升。主用甘草者，甘能治热火也。
桔梗汤
桔梗（一两） 甘草（二两）
上二味，用水三升，煮取一升半，去渣，分温再服。
周扬俊注：设服前汤而不除，非药之不胜病也。正以少阴之火挟邪上攻，则并其母亦病，故加桔梗开之，而自无不愈矣。
周扬俊注：伏邪未发，津液先已暗耗。今得之二三日以上，虽阴火不升，未见咽痛等证，而心烦不卧，已知阴血消耗，故令芩、连祛热，胶、芍滋阴，两得之矣。
黄连阿胶汤
黄连（四两） 黄芩（二两） 芍药（二两） 鸡子黄（二枚） 阿胶（三两）
上五味，用水五升，先煮前三物，取二升，去渣，内入胶，烊尽小冷，内鸡子黄，搅令相得，温服七合，每日三次。
周扬俊注：里热当祛之，内燥须滋之。然滋之而即得其润，祛之而适涤其热，惟圣人合宜也。心烦故主黄连，佐以黄芩，则肺胃之邪俱清。然热甚以消少阴之水，水源既燥，津液有不匮乏者乎？鸡子黄、阿胶，深益血分之味，以滋其阴。连、芩得此，功莫大焉。况加芍药以敛消烁之心气，兼以入肝，遂使烦者不烦，不卧者卧矣。
Taiyang disease (disease of the Taiyang channel) presenting with fever and thirst, without aversion to cold, is termed Warm Disease (Wen Bing).
Zhou Yangjun's Commentary: Warm Disease arises from latent pathogenic factors emerging from within. Once they reach the exterior, both interior and exterior become hot. Since the heat intensity is vigorous, the stagnant pathogen consumes body fluids, hence thirst occurs immediately upon onset. The exterior originally has no pathogenic stagnation, and the interior actually prefers coolness, hence there is no aversion to cold. If delayed for three to five days, abdominal fullness or diarrhea may occur; this is such a syndrome. It differs greatly from Cold Damage (Shang Han), where exterior symptoms appear first followed by interior symptoms. However, it is solely attributed to the Taiyang channel because other channel syndromes have not yet manifested, clearly indicating that it originates from Shaoyin and presents as simultaneous interior-exterior involvement.
If after inducing sweating, the body becomes scorching hot, it is named Wind-Warmth (Feng Wen). In Wind-Warmth disease, the pulse is floating at all positions (Yin and Yang); there is spontaneous sweating; the body feels heavy; there is excessive sleepiness; nasal breathing is necessarily snoring; and speech is difficult to produce. If purgatives are mistakenly used, urinary difficulty, fixed staring, and incontinence will occur. If fire therapy is mistakenly applied, slight jaundice may appear; in severe cases, it resembles convulsive epilepsy with occasional spasms. If fumigated with fire, one error may prolong the illness, but a second error will hasten death.
Fang Youzhi's Commentary: "Scorching hot" means the heat intensifies significantly. "Wind-Warmth" means wind pathogen complicating Warm Disease. "Floating at Yin and Yang" refers to the Taiyang pulse naturally being floating, and since Wind-Warmth is entirely Yang, floating pulses are seen above and below. Spontaneous sweating indicates injury to the Defensive Qi (Wei Qi). Heavy body, excessive sleepiness, snoring, and difficulty speaking result from wind obstruction causing mental clouding and severe heat causing Qi stagnation. Urinary difficulty occurs because Taiyang governs the Bladder, and Wind-Warmth is Yang; purgation attacks downward, vainly depleting body fluids and injuring the Bladder's Qi transformation. Fixed staring occurs because Taiyang sinews branch to the upper eyelid; thus, the eyes do not rotate but stare upward. Incontinence means urine completely loses its normal regulation. "Fire" refers to moxibustion or warming therapies. "Slight" means mild intervention leads to mild complications. Jaundice appears because fire-heat dries the Earth element (Spleen/Stomach), causing yellow color to manifest externally. "Severe" means intense intervention leads to severe complications. Convulsions and spasms resemble epilepsy due to extreme heat generating wind. "Fumigation" is also a fire coercion method. "One error" refers to an initial mistake; "still prolongs days" means it can still linger temporarily. "Second error" refers to repeated mistakes; "hastens life period" means shortening natural lifespan. The warning intent here is profound.
Zhou Yangjun's Commentary: This clause follows the previous text closely: if after sweating, the body becomes scorching hot, it is named Wind-Warmth. This remains a Taiyang Warm Disease caused by mistaken sweating, which is distinct from contracting wind subsequently. Yet why is it called Wind-Warmth? Since it is Taiyang, it does not immediately show Shaoyin signs. Only through mistaken sweating does the original Warm Disease syndrome, combined with acrid-warm herbs for sweating, cause Yin fluids to escape outward, increasing heat in both interior and exterior. The pulse must become floating at both Cun and Chi positions. Precisely because wind and warmth mix, Kidney Water cannot sink alone, leading to spontaneous sweating and heavy body—these are root diseases of the Kidney. Excessive sleepiness, snoring, and difficulty speaking are also root diseases of the Kidney. Initially Taiyang, mistaken sweating causes Shaoyin manifestations to appear simultaneously, which is critical and dangerous. Ancient medical laws warn: "Wind-Warmth is treated in Shaoyin; do not induce sweating; those who sweat die." Does one not know that Taiyang should also not be sweated? Sweating Taiyang leads to the same Shaoyin involvement as Wind-Warmth. This happens because physicians mistakenly identify it as Cold Damage and use appropriate sweating drugs. If purged without sweating, Bladder Qi transformation is injured, causing urinary difficulty, massive fluid loss, fixed staring, and incontinence—one Fu organ and one Zang organ fail simultaneously. Regarding mistaken fire coercion: slight cases injure Ying and Wei Qi with heat, causing heat stasis and jaundice; severe cases generate wind from extreme heat, causing convulsions and spasms. This disrupts the Spirit (Shen) and disturbs sinews and vessels. Thus, among these three errors, one error awaits death; repeating the offense brings immediate peril. Yu Jiayan discusses the *Neijing* chapter on Acupuncture for Heat Diseases regarding Warm Disease, citing Taiyang pulse/color shining on cheekbones. If the luster has not crossed, it says "now sweat can be obtained, wait for the time." Those competing with Jueyin die within three days because heat disease connects internally to the Kidney. Shaoyang pulse/color shines on the front of cheeks. If luster has not crossed, "now sweat can be obtained, wait for the time." Those competing with Shaoyin die. These discuss obtaining sweat, not inducing sweat. Thus, the Sages specifically discuss Grain Qi; if Kidney essence prevails, sweating leads to survival; if Kidney deficiency is severe, further heat leads to death. The meaning is extremely thorough. Zhang Zhongjing complements the incomplete Zang theory, integrating the Bladder. Observing urinary difficulty indicates severe Bladder injury; fixed staring and incontinence indicate the Essence stored in the Gate of Vitality cannot illuminate objects, and Spirit/Marrow is exhausted. High pupils indicate Taiyang insufficiency; rolling back of eyes indicates Taiyang exhaustion. Exhausted limbs cannot flex or extend. Therefore, in stroke-like diseases, Bladder often fails. Failure to recognize people is the key point of Wind-Warmth: first observe the Bladder. There is no case where Bladder does not fail while Kidney Water fails first.
Simultaneous disease of Taiyang and Shaoyang with spontaneous diarrhea is treated with Huangqin Decoction. If vomiting occurs, Huangqin Jia Banxia Shengjiang Tang (Huangqin Decoction plus Pinellia and Fresh Ginger Decoction) is the primary treatment.
Zhou Yangjun's Commentary: Huangqin Decoction is the fundamental medicine for treating Warm Disease. Why mention Taiyang and Shaoyang two channels but not use medicines for these two channels? This is not Cold Damage. Cold Damage moves from exterior to interior; this disease emerges from interior to exterior. Without exterior signs, how do we know it involves Taiyang and Shaoyang? Symptoms may include hypochondriac fullness, headache, or bitter taste with desire to drink. Because there is no aversion to cold but immediate heat, it cannot be called an exterior syndrome. In Cold Damage simultaneous disease, all are exterior diseases. Now there is not only no exterior syndrome but also interior diarrhea. Cold Damage concurrent heat diarrhea must result from transmission through channels, unlike this immediate diarrhea. Why does Warm Disease cause immediate diarrhea? Because external emergence is recent, internal stagnation is deep. The patient's Middle Qi is originally deficient; how can it all be discharged outward at once? It must flow downward causing diarrhea.
Huangqin Decoction
Huangqin (3 liang), Gancao (2 liang, honey-fried), Shaoyao (2 liang), Dazao (12 pieces, split).
These four ingredients are boiled in 10 sheng of water to yield 3 sheng. Strain and take 1 sheng warm, twice daily and once at night. If vomiting occurs, add Banxia (0.5 sheng) and Shengjiang (3 liang).
Huangqin Jia Banxia Shengjiang Tang
Huangqin (3 liang), Gancao (2 liang), Shaoyao (2 liang), Dazao (12 pieces, split), Banxia (0.5 sheng), Shengjiang (3 liang).
These six ingredients are boiled in 10 sheng of water to yield 3 sheng. Strain and take 1 sheng warm, twice daily and once at night.
Zhou Yangjun's Commentary: Huangqin clears heat, making it the main drug for Warm Disease diarrhea because it drains heat. However, Shaoyao is used because its sour-cold nature penetrates deeply into the Yin level. One drains, one astringes; when heat leaves, diarrhea stops. Gancao and Dazao are taken to harmonize the Middle. Since the Bladder and Gallbladder (two Fu organs) are diseased, the Stomach cannot remain safe alone. Vomiting indicates phlegm-fluid retention; only Ginger and Pinellia can remove it. Although Ginger and Pinellia are acrid-dry and unsuitable for latent Qi, they excel at stopping vomiting. Moreover, with Huangqin as the sovereign herb, what is there to fear?
Simultaneous disease of the Three Yang channels: pulse is floating and large, located above the Guan position; the patient desires sleep; sweating occurs when closing the eyes.
Fang Youzhi's Commentary: Taiyang pulse is floating, Yangming pulse is large. The Guan position belongs to Shaoyang, hence "Three Yang simultaneous disease." Desire to sleep results from heat gathering in the Gallbladder. Sweating upon closing eyes occurs because Shaoyang has little blood; deficiency prevents harmony with Yang. Sleep belongs to Yin, hence nocturnal sweating occurs.
Zhou Yangjun's Commentary: Warm Qi emerging affects all Three Yang channels; the pathogenic heat is mixed and solid, evident without saying. Hence the pulse is floating and large. Recalling when pathogen was latent in Shaoyin, the Chi pulse was already large. Now, emerging from interior to exterior and rising from lower to upper, floating and large pulses appear above Guan, hence "above Guan." Although pathogen appears in Yang positions, the source in Shaoyin is unsettled, so desire to sleep shows the root syndrome, and sweating upon eye closure shows nocturnal sweating, revealing Shaoyang root syndrome. Why only Shaoyang? Because Mother (Water/Kidney) deficiency causes Son (Wood/Liver/Gallbladder) deficiency; Shaoyin pathogenic fire and Shaoyang ministerial fire rise together burning fiercely. The difference from general heat disease is that only sweating upon eye closure occurs, unlike the continuous profuse sweating of heat disease. Why not mention Taiyang and Yangming channel signs? Because floating represents Taiyang channel pulse, and large represents Yangming channel pulse. Treatment should focus on Xiaochaihu Tang (Minor Bupleurum Decoction) minus Renshen, Shengjiang, and Banxia, plus Shaoyao.
The Master said: Latent Qi disease is diagnosed by intuition. Within this month, latent Qi is anticipated. If latent Qi exists previously, the pulse must be examined. If the pulse is faint and weak, throat pain resembling injury should occur, but it is not Hou Bi (throat bi). The patient reports actual throat pain. Even so, diarrhea is expected now.
Zhou Yangjun's Commentary: During latent Qi, observing latent Qi disease with a faint and weak pulse indicates Shaoyin pulse. In persons with Kidney Qi deficiency, Yang does not reach, and Yin manifests immediately. Since Shaoyin pulse traverses the throat, throat pain must precede eruption. After eruption, pain becomes extreme, resembling injury. How can it be mistaken for Bi syndrome and mistreated? Although throat pain erupts upward, one must realize the Kidney controls opening and closing. Yin-heat rises; how can it all discharge downward? Thus, diarrhea rushing to the posterior orifice is predictable.
Shaoyin disease lasting two to three days with throat pain may be treated with Gancao Tang (Licorice Decoction). If ineffective, Jiegeng Tang (Platycodon Decoction) is given.
Zhou Yangjun's Commentary: When latent Qi emerges from Shaoyin channel, throat pain is inevitable. First giving Gancao Tang slows its upward momentum. Then giving Jiegeng Tang opens the stagnant pathogen. This needs no explanation. However, latent Qi is a severe syndrome, and Shaoyin is extremely deficient. Zhang Zhongjing gently tests first, not using Huangqin Ben Tang, for good reason. Since Shaoyin just emerged, only throat pain is seen, without chest fullness, irritability, etc., nor diarrhea, vomiting, or thirst. To use other drugs, where to start? Thus, in two to three days, focusing on throat pain, two decoctions are presented. If pain stops after taking them, more than half of Shaoyin pathogen is removed. Subsequent symptoms guide further medication. This is the Sage's clear instruction against reckless treatment.
Gancao Tang
Gancao (2 liang).
This single ingredient is boiled in 3 sheng of water to yield 1.5 sheng. Strain and take 0.7 sheng warm, twice daily.
Zhou Yangjun's Commentary: Shaoyin pulse traverses the throat; how can pathogenic heat lodging there not cause pain? It precisely carries Shaoyin fire upward. Gancao is used because sweet flavor treats hot-fire.
Jiegeng Tang
Jiegeng (1 liang), Gancao (2 liang).
These two ingredients are boiled in 3 sheng of water to yield 1.5 sheng. Strain, divide into two warm doses.
Zhou Yangjun's Commentary: If the previous decoction fails to resolve symptoms, it is not because the medicine is insufficient for the disease. Precisely because Shaoyin fire carries pathogen attacking upward, affecting its mother (Earth/Spleen-Stomach), adding Jiegeng opens the blockage, ensuring recovery.
Shaoyin disease persisting for two to three days or more, with vexation in the heart and inability to lie down, is primarily treated with Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction).
Zhou Yangjun's Commentary: Before latent pathogen emerges, body fluids are secretly consumed. Now, after two to three days, although Yin fire does not rise and throat pain etc. are absent, heart vexation and insomnia indicate Yin-blood consumption. Thus, Huangqin and Huanglian dispel heat, while Ejiao and Shaoyao nourish Yin, achieving both goals.
Huanglian Ejiao Tang
Huanglian (4 liang), Huangqin (2 liang), Shaoyao (2 liang), Ji Zi Huang (2 yolks), Ejiao (3 liang).
These five ingredients are boiled in 5 sheng of water. First boil the three herbs to yield 2 sheng, strain, add Ejiao until melted, cool slightly, add chicken egg yolks, stir well. Take 0.7 sheng warm, three times daily.
Zhou Yangjun's Commentary: Interior heat must be dispelled; internal dryness must be moistened. Moistening provides lubrication; dispelling cleanses heat. Only the Sage achieves this appropriateness. Heart vexation makes Huanglian the sovereign, assisted by Huangqin, clearing Lung and Stomach pathogens. However, severe heat consumes Shaoyin Water; once the water source is dry, how can fluids not be scarce? Chicken egg yolk and Ejiao deeply benefit Blood-level substances to nourish Yin. With this support, Huanglian and Huangqin achieve great merit. Furthermore, adding Shaoyao astringes the consuming Heart Qi and enters the Liver, making the vexed calm and the insomniac sleep.