三）（又云。发汗吐下后。虚烦不得眠。心中懊 者。栀子豉汤主之）（正四十五）（发汗若下
之。病仍未解。烦躁者茯苓四逆汤主之）（正方七十八）又有病已解而反微烦者。此由病新瘥不
胜谷。损谷则愈。（先用小柴胡汤）（正二十九）（和其营卫。以通津液。得屎而解。小柴胡不中。然后以调胃承气汤）
（正方四十三）
（九十五）问下利者
伤寒下利多种。须识别阴阳。勿令差互。（三阳下利则身热。太阴下利手足温。少阴厥阴下利。身不热。以此别之大
抵下利挟太阳脉证便不得用温药。俗医但见下利。便作阴证。用温热药。鲜不发黄生斑而死也）太阳阳明合病。必下利。
葛根汤（正二十六）主之。（下利而头疼腰痛。肌热目疼鼻干。其脉浮大而长者。是其证也）太阳少阳合病自下利。黄芩
汤主之。（正八十五）若呕者。黄芩汤加半夏生姜也。（正八六）（下利而头疼胸满。或口苦咽干。或往来寒热而呕。其脉
浮大而弦者。是其证也）阳明少阳合病。必下利。其脉不负者顺也。负者。失也。互相克贼。名为负也。（下利而身热胸
胁痛满干呕。或往来寒热。其脉长大而弦者。是其证也。盖阳明者土。其脉长大。少阳者木。其脉弦。若合病。土被木
贼。更下利为胃已困。若脉不弦者顺也。为土不负。负者死）自利不渴属太阴。（四逆汤）（正七十五）（理中汤主之）（正
七十四）自利而渴属少阴（白通汤）（正九十七）（白通加猪胆汤）（正九十八）（通脉四逆汤）（正八十二）（猪苓汤）（正
六十七）（真武汤）（正一百五）（四逆加人参汤）（正七十七）（可检证而用之）其余下利。皆因汗下后证也。大抵伤寒下
利。须看脉与外证。下利而脉大者。虚也。脉微弱者。为自止。下利日十余行。脉反实者逆。下利脉数而滑者。有宿食
也。下之愈。脉迟而滑者实也。其利未得便止。更宜下之。下利三部脉皆平。按其心下硬者急下之。协热利者。脐下必
热。大便赤黄色。及肠间津汁垢腻。（谓之肠垢）寒毒入胃。则脐下必寒。腹胀满。大便或黄白。或青黑。或下利清谷。
湿毒瓦斯盛则下利腹痛。大便如脓血。或如烂肉汁也。下利欲饮水者。以有热也。下利谵语者。有燥屎也。寒毒入胃者。
四逆汤、（正七十五）理中汤、（正七十四）白通汤加附子、（正九十七）四逆散加薤白、（正七十六）主之。协热利者。
黄芩汤、（正八十五）白头翁汤、（正一百八）三黄熟艾汤、（杂方一百）薤白汤、（杂一百一）赤石脂丸、（杂一百二）湿
毒下脓血者。桃花
汤、（正九十九）地榆散、（杂一百三）黄连阿胶散。（杂一百四）虽然。自利而渴属少阴。然三
阳下利亦有饮水者。乃有热也。三阴下利宜温之。然少阴自利清水。心下痛。口干燥者。却
宜下之。此又不可不知也。（少阴泄利下重。不可投热药。先浓煎薤白汤。）（杂一百）（内四
逆散。缘四逆散用枳实芍药之类。又寻常胃中不和腹中肠鸣下利。生姜泻心汤最妙。）（正六
十三）（此二法。不特伤寒证也。）
（九十六）问小便不利小便难
伤寒发汗后小出多亡津液。胃中极干。故小便不利。医见小便不利。往往利之误矣。类纂
云。胃中干则无小便。慎不可利。故仲景云。下之后复发汗。小便不利者。亡津液耳。若伤寒引
饮。下焦有热。小便不通。脉浮者。五苓散。（正六十六）脉沉者。猪苓汤也。（正六七）表不
解。心下有水。发热而咳。小腹满。小便不利者。小青龙汤去麻黄加茯苓也。（正三十六）伤
寒无汗。翕翕发热。头项强痛。小便不利者。桂枝汤去桂加茯苓白术也。（正方九）呕而发热
。胸胁满。心下怔忪。小便不利者。小柴胡汤去黄芩加茯苓。（正二十九）少阴病小便不利者
。四逆散加茯苓也。（正七十六）（伤寒有所不利者。行之取其渗泄也。有渴而饮停者。有躁
而烦渴者。有病气去而水气不得行者。其表里得见烦躁。口燥欲饮水。水入即吐。病名水逆。
及霍乱头痛。发热身疼痛欲饮水者。有发热汗出。复恶寒不呕。但心下痞者。并宜五苓散
。其脉浮。发热渴欲饮水。小便不利。少阴病下利六七日。咳而呕渴。心烦不得眠者。宜与猪
苓汤。其大病瘥后。从腰以下有水气者。牡蛎泽泻散。）（正九十四）（此利水道渗泄之义也。）
大抵中湿与发黄。以利小便为先。阳明汗多。以利小便为戒。○又问小便难何也。阴虚故也
。阴虚者阳必凑之。为阳所凑也。故小便黄者。中有热也。宜瞿麦滑石之类泻之。太阳病发
汗。遂漏不止。其人恶风。小便难。四肢微急。难以屈伸者。桂枝加附子汤主之。（正方六）
阳明中风。脉弦浮大。短气腹满。胁下及心痛。鼻干不得汗。嗜卧身黄。小便难。潮热而哕
者。小柴胡加茯苓主之。（正二十九）
（九十七）问小便自利小便数
太阳证。下焦有热。小腹必满。应小便不利而小便反利者。下血证也。抵当汤主之。（
正九十一）阳明证自汗出。应小便少而小便自利者。津液内竭也。屎虽硬不可攻也。当用蜜
煎导之。（正百十二）少阴证四逆而小便自利者。虚寒证也。四逆汤、（正七十五）真武汤去茯苓
主之。（正百五）○又问小便数者何也。肾与膀胱俱虚。而有客热乘之也。二经既虚。致受于
客热。虚则不能制水。故令数。小便热则水行涩。涩则小便不快。故令数起也。诊其趺阳脉
数。胃中热。即消谷引饮。大便必硬。小便即数也。太阳病自汗。四肢拘急。难以屈伸。心烦
微恶寒。脚挛急。若小便数者。慎不可行桂枝也。宜与甘草干姜汤、（正五十五）芍药甘草汤
也。（正五十七）大抵溲数则大便难。仲景云。趺阳脉浮而涩。浮则胃气强。涩即小便数。浮涩
相搏。大便则硬。其脾为约。麻子仁丸主之。（正九十二）太阳病若汗若吐若下后微烦。小便
数。大便因硬者。与小承气汤（正四十二）和之愈。○又云。伤寒脉浮自汗。小便数。若胃中
不和谵语者。少与调胃承气汤。（正四十三）
（九十八）问有数日不大便。有大便难。有大便硬。有燥屎。有大便溏。
伤寒数日不大便。大便硬。及有燥屎。皆知用大柴胡、（正方三十）大承气、（正四十一）
小承气（正四十二）攻之。然仲景论大便不通。亦有数种不可攻者。（在第三卷十五问中详言
之矣。）○仲景又有阳结阴结之论。不可不别也。其脉浮而数。能食不大便。此为实。名曰阳
结。宜用小柴胡汤。（正二十九）所谓和其营卫。以通津液。纵不了了。得屎而解也。其脉沉
而迟。不能食。身体重。大便反硬。名曰。阴结。宜用金液丹。所谓阳盛则促。阴盛则
结促结同也。○又问大便溏者何也。古人云。岁火不及。寒乃大行。民病骛溏。大率病患肠中有寒
。即大便鸭溏。盖溏者。胃中冷水谷不别故也。华佗云。寒即溏。热即垢。仲景说初硬后溏有二
证。小便不利。小便少。皆水谷不分耳。
（九十九）问病患默默欲眠。目不能闭。起居不安。其声嗄或咽干。（嘎，所讶切声破也）
此名狐惑伤寒也。狐惑与湿 。皆虫证。初得状如伤寒。或因伤寒变成其疾。其候默默欲眠。
目不能闭。起居不安。虫蚀其喉为惑。其声嗄。虫食下部为狐。其咽干。狐惑之病。并恶饮食。面
目乍赤、乍白、乍黑。是其证也。大抵伤寒病腹内热。入食小肠胃空虚三虫行作求食。蚀人五脏
及下部。为 病。其候齿无色。舌上尽白。甚者唇黑有疮。四肢沉重。忽忽喜眠。虫蚀其肛。烂见
五脏则死。当数看其上下唇。上唇有疮。虫食其脏也。下唇有疮。虫食其肛也。杀人甚急。多因下
利而得。治 桃仁汤、（杂一百五）黄连犀角汤（杂一百六）雄黄锐散主之。（杂一百七）
（一百）问病患欲食。复不能食。常默默欲卧。复不能卧。欲出行复不能行。饮食或有美时。或有不
饭时。如强健人而卧不能行。如有寒如无寒。如有热复无热。口苦小便赤。药入即吐利。
此名百合伤寒也。百脉一宗。悉致其病。无复经络也。其状欲食复不能食。常默默欲得卧复
不能卧。欲出行复不能行。饮食或有美时。或有不 饭时。如强健人而卧不能行。如有寒如无寒。
如有热复无热。口苦小便赤。百合之病。诸药不治。药入即吐利。如有神灵。此多因伤寒虚劳。大
病之后不平复。变成斯疾也。百
合知母汤、（杂一百八）滑石代赭汤、（杂一百九）鸡子汤、（杂一百十）百合地黄汤、（杂百十
一）百合洗方（杂百十二）栝蒌牡蛎散、（杂百十三）滑石散（杂百十四）主之。
（三）另外说：经过发汗、催吐或泻下治疗后，出现虚烦、无法入睡、心中烦闷懊恼的症状，应用栀子豉汤主治。（正四十五）若经过发汗或泻下治疗，病邪仍未解除，出现烦躁症状的，应用茯苓四逆汤主治。（正方七十八）又有病情看似已解却反而轻微心烦的，这是因为病刚痊愈时脾胃虚弱，不能承受食物的运化，减少饮食摄入即可痊愈。（先用小柴胡汤）调和营卫，以疏通津液，待大便通畅后病愈。如果小柴胡汤无效，然后使用调胃承气汤。（正方四十三）
（九十五）问关于下利（腹泻）的问题
伤寒引起的下利有多种类型，必须辨别阴阳属性，不要弄错。（三阳经下利则身体发热，太阴经下利则手足温暖，少阴和厥阴经下利则身体不发热，据此可以区分。）大抵而言，下利兼有太阳经脉证候的，便不能使用温药。世俗医生只见下利，就当作阴证处理，使用温热药物，很少有不因发黄、生斑疹而死亡的。（太阳与阳明合病，必然出现下利，用葛根汤主治。（下利伴有头痛、腰痛、肌肉发热、眼睛疼痛、鼻子干燥，脉象浮大而长的，就是这种证候。）太阳与少阳合病，自然出现下利，用黄芩汤主治。（正八十五）如果有呕吐症状的，用黄芩汤加半夏、生姜。（正八十六）（下利伴有头痛、胸满，或者口苦咽干，或者寒热往来且呕吐，脉象浮大而弦的，就是这种证候。）阳明与少阳合病，必然出现下利。脉象不负（即脉象与病机相符，如阳明土脉长大，少阳木脉弦，若土不被木克，为顺）的为顺证；负（即脉象相克，如木克土，脉反见弦急）的为逆证，互相克制贼害，称为“负”。（下利伴有身体发热、胸胁痛满、干呕，或者寒热往来，脉象长大而弦的，就是这种证候。大概阳明属土，其脉长大；少阳属木，其脉弦。若合病，土被木克制，再加上腹泻导致胃气困顿，如果脉象不弦则为顺，因为土未被克；若脉弦为负，主死。）自发性下利且不口渴的，属于太阴病。（四逆汤）（理中汤主治）（正七十四）。自发性下利且口渴的，属于少阴病（白通汤）（正九十七）（白通加猪胆汁汤）（正九十八）（通脉四逆汤）（正八十二）（猪苓汤）（正六十七）（真武汤）（正一百五）（四逆加人参汤）（正七十七）（可以根据具体证候选择使用）。其余的下利，都是由于发汗或泻下后出现的证候。大抵伤寒下利，必须看脉象和外部证候。下利而脉大的，是虚证；脉微弱的，表示病将自止。下利一天十几次，脉象反而实有力的，是逆证。下利脉数而滑的，是有宿食积滞，用泻下法可愈。脉迟而滑的，是实证，其利未止，更适宜用泻下法。下利三部脉象都平和，但按压心下部硬满的，需紧急泻下。协热利（表里俱热之下利），脐下必然发热，大便呈赤黄色，以及肠间有黏腻污浊液体。（称为肠垢）。寒毒侵入胃中，则脐下必然寒冷，腹部胀满，大便或黄白，或青黑，或下利清谷（完谷不化）。湿毒之气旺盛则下利腹痛，大便像脓血，或者像烂肉汁一样。下利想喝水的，是因为有热。下利说胡话（谵语）的，是有燥屎内结。寒毒入胃的，用四逆汤、（正七十五）理中汤、（正七十四）白通汤加附子、（正九十七）四逆散加薤白、（正七十六）主治。协热利的，用黄芩汤、（正八十五）白头翁汤、（正一百八）三黄熟艾汤、（杂方一百）薤白汤、（杂一百一）赤石脂丸、（杂一百二）。湿毒下脓血的，用桃花汤、（正九十九）地榆散、（杂一百三）黄连阿胶散。（杂一百四）虽然如此，自利而口渴属于少阴病，然而三阳经下利也有想喝水的，那是因为有热。三阴经下利宜用温法。然而少阴病自利清水，心下痛，口干燥的，却适宜用泻下法。这又是不可不知道的。（少阴病泄利伴肛门重坠感，不可投用热药，先浓煎薤白汤服用。）（杂一百）（内服四逆散，因为四逆散用了枳实、芍药之类，又常用于胃中不和、腹中肠鸣下利，生姜泻心汤最为巧妙。）（正六十三）（这两种方法，不仅适用于伤寒证。）
（九十六）问关于小便不利、小便难的问题
伤寒发汗后，出汗过多导致津液耗伤，胃中极度干燥，所以小便不利。医生见到小便不利，往往错误地使用利尿药。《类纂》说，胃中干燥则无小便，千万不要利尿。所以张仲景说，泻下后又发汗，小便不利的，是津液耗伤罢了。如果伤寒引饮，下焦有热，小便不通，脉浮的，用五苓散。（正六十六）脉沉的，用猪苓汤。（正六七）表证未解，心下有停水，发热且咳嗽，小腹满，小便不利的，用小青龙汤去掉麻黄加茯苓。（正三十六）伤寒无汗，微微发热，头项强痛，小便不利的，用桂枝汤去掉桂枝加茯苓、白术。（正方九）呕吐且发热，胸胁满闷，心下悸动不安，小便不利的，用小柴胡汤去掉黄芩加茯苓。（正二十九）少阴病小便不利的，用四逆散加茯苓。（正七十六）（伤寒中有小便不利的情况，是通过渗泄利水来治疗的。有口渴饮水停滞的，有烦躁口渴的，有病邪已去但水气运行不畅的，其表里出现烦躁，口燥想喝水，水入即吐，病名水逆。以及霍乱头痛，发热身疼痛想喝水的，有发热汗出，又恶寒不呕吐，只是心下痞满的，都适宜用五苓散。其脉浮，发热口渴想喝水，小便不利，少阴病下利六七天，咳嗽呕吐口渴，心烦失眠的，适宜给予猪苓汤。大病初愈后，腰部以下有水气的，用牡蛎泽泻散。）（正九十四）（这是利水道、渗泄的意义。）大抵中湿和发黄，以利小便为先。阳明病汗多，以利小便为禁忌。○又问为什么小便难？是因为阴虚的缘故。阴虚则阳气必凑集于内，被阳气所凑集，所以小便黄的，是因为中有热。适宜用瞿麦、滑石之类泻热。太阳病发汗，导致汗漏不止，其人恶风，小便难，四肢轻微拘急，难以屈伸的，用桂枝加附子汤主治。（正方六）阳明中风，脉弦浮大，短气腹满，胁下及心痛，鼻子干燥无汗，嗜睡身黄，小便难，潮热且呃逆的，用小柴胡汤加茯苓主治。（正二十九）
（九十七）问关于小便自利、小便数的問題
太阳证，下焦有热，小腹必然满，应该小便不利却反而小便通利的，是蓄血证。用抵当汤主治。（正九十一）阳明证自汗出，应该小便少却反而小便通利的，是津液内竭。大便虽然硬，不可攻下。应当用蜜煎导法。（正百十二）少阴证四肢厥冷而小便自利的，是虚寒证。用四逆汤、（正七十五）真武汤去掉茯苓主治。（正百五）○又问为什么小便频数？是因为肾与膀胱都虚，而有客热乘虚而入。两经既虚，导致受客热侵袭，虚则不能制约水液，所以导致尿频。小便热则水流涩滞，涩滞则小便不畅快，所以导致频频起尿。诊察其趺阳脉数，说明胃中有热，就会消谷善饥引饮，大便必然硬，小便也就频数了。太阳病自汗，四肢拘急，难以屈伸，心烦微恶寒，脚挛急，如果小便频数的，千万不可用桂枝汤。适宜用甘草干姜汤、（正五十五）芍药甘草汤。（正五十七）大抵小便频数则大便困难。仲景说，趺阳脉浮而涩，浮则胃气强，涩即小便频数，浮涩相搏，大便则硬，这叫脾约，用麻子仁丸主治。（正九十二）太阳病若发汗、催吐或泻下后轻微心烦，小便频数，大便因此变硬的，给予小承气汤（正四十二）调和即可痊愈。○又说，伤寒脉浮自汗，小便频数，如果胃中不和出现谵语的，少量给予调胃承气汤。（正四十三）
（九十八）问关于数日不大便、大便难、大便硬、燥屎、大便溏的问题。
伤寒数日不大便，大便硬，以及有燥屎，都知道用大柴胡汤、（正方三十）大承气汤、（正四十一）小承气汤（正四十二）攻下。然而张仲景论述大便不通，也有几种不可攻下的情况。（在第三卷十五问中详细说明了。）○张仲景又有阳结和阴结的理论，不可不辨别。其脉浮而数，能食不大便，这是实证，名叫阳结，适宜用小柴胡汤。（正二十九）所谓调和营卫，以通津液，即使病未完全解除，待大便排出后病愈。其脉沉而迟，不能食，身体沉重，大便反而硬，名叫阴结，适宜用金液丹。所谓阳盛则促脉，阴盛则结脉，促脉和结脉本质相同。○又问大便溏是怎么回事？古人说，岁火不及，寒气大行，百姓容易患腹泻。大概病人肠中有寒，大便就像鸭粪稀溏。大概溏便，是因为胃中冷水谷不分所致。华佗说，寒则溏，热则垢。仲景说初硬后溏有两种证候，小便不利、小便少，都是水谷不分。
（九十九）问病人沉默想睡，眼睛却无法闭合，起居不安，声音嘶哑或咽喉干燥。（嘎，所讶切，声破也）
这名叫狐惑伤寒。狐惑与湿痹，都是虫证。初得病时状如伤寒，或因伤寒变成此疾。其症状是沉默想睡，眼睛无法闭合，起居不安，虫蚀咽喉为惑，声音嘶哑；虫食下部为狐，咽喉干燥。狐惑病，都厌恶饮食，面目时而发红、时而发白、时而发黑，就是这种证候。大抵伤寒病腹内热，进食后小肠胃空虚，三虫行动求食，侵蚀人的五脏及下部，造成病变。其症状是牙齿颜色无色，舌上全白，严重的嘴唇黑且有疮，四肢沉重，恍惚喜睡，虫蚀肛门，腐烂见到五脏则死。应当经常查看上下嘴唇，上唇有疮，虫蚀内脏；下唇有疮，虫蚀肛门。杀人非常急迫，多因下利而得。治疗用桃仁汤、（杂一百五）黄连犀角汤（杂一百六）雄黄锐散主治。（杂一百七）
（一百）问病人想吃东西，却又吃不下，常常沉默想躺下，却又躺不下，想出行却又走不动，饮食有时觉得美味，有时不想吃饭，像强健的人却卧倒不能行走，好像有寒又像没有寒，好像有热又像没有热，口苦小便赤，药入口即呕吐腹泻，
这名叫百合伤寒。百脉同宗，全部受到疾病影响，不再分经络。其症状是想吃又吃不下，常常沉默想躺下却又躺不下，想出行却又走不动，饮食有时觉得美味，有时不想吃饭，像强健的人却卧倒不能行走，好像有寒又像没有寒，好像有热又像没有热，口苦小便赤。百合病，各种药物都治不好，药入口即呕吐腹泻，好像有神灵作祟。这多因伤寒虚劳，大病之后未能平复，变成这种疾病。百合知母汤、（杂一百八）滑石代赭汤、（杂一百九）鸡子汤、（杂一百十）百合地黄汤、（杂百十一）百合洗方（杂百十二）栝蒌牡蛎散、（杂百十三）滑石散（杂百十四）主治。
(3) It is also said: After undergoing sweating, emesis, or purgation therapies, if deficiency-heat irritability (Xu Fan), insomnia, and a sensation of vexation and restlessness in the heart (Ao Nao) occur, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) should be administered. (Zheng 45) If after sweating or purgation the pathogenic factor remains unresolved and irritability (Fan Zao) appears, Fu Ling Si Ni Tang (Poria Decoction for Four Reversals) should be administered. (Zheng 78) In cases where the disease seems resolved but slight irritability recurs, this is due to the spleen and stomach being too weak to handle food intake shortly after recovery; reducing food intake will lead to healing. (First use Xiao Chai Hu Tang (Minor Bupleurum Decoction)) To harmonize Ying and Wei (Nutritive and Defensive levels) and unblock body fluids, allowing stool passage resolves the condition. If Xiao Chai Hu Tang is ineffective, then Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct the Qi Decoction) should be used. (Zheng 43)
(95) Inquiry regarding Li (Diarrhea/Dysentery)
There are various types of diarrhea caused by Shang Han (Cold Damage); one must distinguish between Yin and Yang patterns to avoid errors. (Involvement of the Three Yang meridians presents with fever; Tai Yin involvement presents with warm hands and feet; Shao Yin and Jue Yin involvement present without fever; these distinctions allow differentiation.) Generally, diarrhea accompanied by Tai Yang meridian symptoms contraindicates the use of warming herbs. Empirical physicians often mistake diarrhea for a Yin pattern and administer warming-hot herbs, rarely avoiding death from jaundice and macules. (Tai Yang and Yang Ming combined diseases inevitably involve diarrhea, treated with Ge Gen Tang (Kudzu Decoction). (Diarrhea accompanied by headache, lower back pain, muscle heat, eye pain, nasal dryness, and a floating, large, long pulse indicates this syndrome.) Tai Yang and Shao Yang combined diseases naturally involve diarrhea, treated with Huang Qin Tang (Scutellaria Decoction). (Zheng 85) If vomiting occurs, Ban Xia and Sheng Jiang (Pinellia and Fresh Ginger) are added to Huang Qin Tang. (Zheng 86) (Diarrhea with headache, chest fullness, bitter taste, dry throat, alternating chills and fever, vomiting, and a floating, large, wiry pulse indicates this syndrome.) Yang Ming and Shao Yang combined diseases inevitably involve diarrhea. A pulse that does not show "Fu" (defeat/overcoming) indicates a favorable prognosis; "Fu" indicates defeat. Mutual overcoming is termed "Fu". (Diarrhea with fever, chest/hypochondriac pain/fullness, dry heaving, or alternating chills and fever, and a large-long, wiry pulse indicates this syndrome. Yang Ming corresponds to Earth with a large-long pulse; Shao Yang corresponds to Wood with a wiry pulse. In combined disease, if Wood overcomes Earth, plus diarrhea exhausting Stomach Qi, a non-wiry pulse is favorable as Earth is not overcome; a wiry pulse indicates defeat and death.) Spontaneous diarrhea without thirst belongs to Tai Yin. (Si Ni Tang (Four Reversals Decoction)) (Li Zhong Tang (Regulate the Middle Decoction) treats it. (Zheng 74)). Spontaneous diarrhea with thirst belongs to Shao Yin (Bai Tong Tang (White Pass Decoction)) (Zheng 97) (Bai Tong Jia Zhu Dan Tang (White Pass with Pig Bile Decoction)) (Zheng 98) (Tong Mai Si Ni Tang (Unblock Vessels Four Reversals Decoction)) (Zheng 82) (Zhu Ling Tang (Polyporus Decoction)) (Zheng 67) (Zhen Wu Tang (True Warrior Decoction)) (Zheng 105) (Si Ni Jia Ren Shen Tang (Four Reversals with Ginseng Decoction)) (Zheng 77) (Select based on syndrome verification). Other diarrheas result from post-sweating or post-purgation conditions. Generally, for Shang Han diarrhea, examine the pulse and external signs. Diarrhea with a large pulse indicates deficiency; a faint pulse suggests spontaneous cessation. Diarrhea occurring ten-plus times daily with a surprisingly strong pulse is adverse. Diarrhea with a rapid and slippery pulse indicates retained food; purgation cures it. A slow and slippery pulse indicates excess; if diarrhea persists, purgation is appropriate. If all three positions of the pulse are level but epigastric hardness upon palpation exists, urgent purgation is required. Xie Re Li (Heat-Collaborating Diarrhea) features heat below the umbilicus, reddish-yellow stool, and sticky intestinal discharge (called Chang Gou/Intestinal Mucus). Cold toxin entering the stomach causes cold below the umbilicus, abdominal fullness, and yellow-white, green-black, or undigested stool. Damp-toxin abundance causes painful diarrhea with pus/blood-like or rotten meat juice-like stool. Thirst during diarrhea indicates Heat. Delirium during diarrhea indicates Dry Feces (Zao Shi). For Cold toxin in the stomach, use Si Ni Tang, (Zheng 75) Li Zhong Tang, (Zheng 74) Bai Tong Tang with Fu Zi (Aconite), (Zheng 97) Si Ni San (Four Reversals Powder) with Xie Bai (Allium Macrostemon), (Zheng 76). For Xie Re Li, use Huang Qin Tang, (Zheng 85) Bai Tou Weng Tang (Pulsatilla Decoction), (Zheng 108) San Huang Shu Ai Tang (Three Yellows with Cooked Mugwort Decoction), (Misc 100) Xie Bai Tang, (Misc 101) Chi Shi Zhi Wan (Red Halloysite Pill), (Misc 102). For damp-toxin pus/blood diarrhea, use Tao Hua Tang (Peach Blossom Decoction), (Zheng 99) Di Yu San (Sanguisorba Powder), (Misc 103) Huang Lian E Jiao San (Coptis and Donkey-Hide Gelatin Powder). (Misc 104) Although thirst in spontaneous diarrhea indicates Shao Yin, Three Yang diarrhea may also involve thirst due to Heat. Three Yin diarrhea requires warming. However, Shao Yin spontaneous clear water diarrhea with epigastric pain and dry mouth/throat requires purgation. This must be known. (Shao Yin diarrhea with heaviness/restriction in the anus contraindicates hot herbs; first brew thick Xie Bai Tang.) (Misc 100) (Internal Si Ni San uses Zhi Shi and Shao Yao; for general Stomach disharmony, borborygmus, and diarrhea, Sheng Jiang Xie Xin Tang (Fresh Ginger Drain the Epigastrium Decoction) is best.) (Zheng 63) (These two methods apply beyond Shang Han.)
(96) Inquiry regarding Bu Li (Difficulty Urinating) and Nan (Hardship in Urination)
After sweating in Shang Han, excessive sweating depletes body fluids, causing extreme dryness in the Stomach, leading to difficulty urinating. Physicians often mistakenly prescribe diuretics for this. *Lei Zuan* states that Stomach dryness results in no urine; do not diurese. Thus Zhang Zhongjing says: After purgation and subsequent sweating, difficulty urinating is due to fluid depletion. If Shang Han involves drinking, Lower Jiao Heat, urinary obstruction, and a floating pulse, use Wu Ling San (Five-Ling Powder). (Zheng 66) If the pulse is deep, use Zhu Ling Tang (Polyporus Decoction). (Zheng 67) If the exterior is unresolved, there is fluid retention in the epigastrium, fever with cough, lower abdominal fullness, and difficulty urinating, use Xiao Qing Long Tang (Minor Green Dragon Decoction) removing Ma Huang (Ephedra) and adding Fu Ling (Poria). (Zheng 36) For Shang Han with no sweat, mild fever, stiff neck/head, and difficulty urinating, use Gui Zhi Tang (Cinnamon Twig Decoction) removing Gui Zhi (Cinnamon Twig) and adding Fu Ling (Poria) and Bai Zhu (Atractylodes). (Zheng 9) For vomiting with fever, hypochondriac fullness, epigastric palpitations, and difficulty urinating, use Xiao Chai Hu Tang (Minor Bupleurum Decoction) removing Huang Qin (Scutellaria) and adding Fu Ling (Poria). (Zheng 29) For Shao Yin disease with difficulty urinating, use Si Ni San (Four Reversals Powder) adding Fu Ling (Poria). (Zheng 76) (For Shang Han difficulties involving urination, promote permeation/drainage. Cases include thirst with fluid stagnation, restlessness with thirst, pathogen gone but water qi stuck, interior/exterior irritability, dry mouth wanting water but vomiting immediately upon drinking (Water Reverse/Shui Ni), Hu Luan (Cholera-like) headache/fever/body ache wanting water, fever/sweating/chills/no vomiting/epigastric stuffiness—all suit Wu Ling San. Floating pulse, fever/thirst/wanting water/difficulty urinating, Shao Yin diarrhea for 6-7 days with cough/vomit/thirst/irritability/insomnia—suit Zhu Ling Tang. Post-major illness edema below the waist suits Mu Li Ze Xie San (Oyster and Alisma Powder).) (Zheng 94) (This illustrates the principle of promoting water pathways and permeation.) Generally, for Dampness and Jaundice, promoting urination is primary. For Yang Ming with excessive sweating, promoting urination is contraindicated. ○ Why is urination difficult? Due to Yin Deficiency. Yin Deficiency allows Yang to gather within; Yang accumulation causes yellow urine indicating internal Heat. Use Qu Mai (Dianthus) and Hua Shi (Talc) to drain. For Tai Yang disease where sweating leads to continuous leakage, aversion to wind, difficulty urinating, and slight stiffness/tension in limbs preventing flexion/extension, Gui Zhi Jia Fu Zi Tang (Cinnamon Twig Decoction with Aconite) treats it. (Zheng 6) For Yang Ming Wind Strike with wiry-floating-large pulse, shortness of breath, abdominal fullness, hypochondriac/epigastric pain, nasal dryness/no sweat, lethargy, jaundice, difficulty urinating, tidal fever, and hiccups, use Xiao Chai Hu Tang adding Fu Ling (Poria). (Zheng 29)
(97) Inquiry regarding Zi Li (Spontaneous Free Urination) and Shu (Frequency of Urination)
In Tai Yang syndrome, Lower Jiao Heat causes lower abdominal fullness. If urination should be difficult but is actually free, it indicates Blood Accumulation (Xue Zheng). Di Dang Tang (Resist Water Decoction) treats it. (Zheng 91) In Yang Ming syndrome with spontaneous sweating, if urination should be scant but is actually free, it indicates internal exhaustion of fluids. Even if stool is hard, do not purge. Use Mi Jian Dao (Honey Suppository). (Zheng 112) In Shao Yin syndrome with cold extremities and spontaneous free urination, it is a Deficient-Cold pattern. Si Ni Tang (Four Reversals Decoction), (Zheng 75) or Zhen Wu Tang (True Warrior Decoction) removing Fu Ling (Poria) treat it. (Zheng 105) ○ Why frequency of urination? Kidney and Bladder deficiency with Guest Heat invading. Both meridians deficient, they receive Guest Heat. Deficiency fails to control water, causing frequency. Heat in urine causes sluggish flow, leading to frequent urges. Palpating the Du Yang pulse as rapid indicates Stomach Heat, which consumes grain and induces drinking, leading to hard stool and frequent urination. For Tai Yang disease with spontaneous sweating, limb stiffness, irritability, mild aversion to cold, foot cramps, if urination is frequent, strictly avoid Gui Zhi Tang. Use Gan Cao Gan Jiang Tang (Licorice and Ginger Decoction), (Zheng 55) or Shao Yao Gan Cao Tang (Peony and Licorice Decoction). (Zheng 57) Generally, frequent urination leads to hard stool. Zhongjing says: Du Yang pulse floating and choppy; floating indicates strong Stomach Qi, choppy indicates frequent urination. Floating and choppy interacting leads to hard stool, called Pi Yue (Spleen Constraint), treated with Ma Zi Ren Wan (Hemp Seed Pill). (Zheng 92) For Tai Yang disease post-sweating/vomiting/purgation with slight irritability, frequent urination, and resulting hard stool, give Xiao Cheng Qi Tang (Minor Order the Qi Decoction) (Zheng 42) to harmonize and cure. ○ Also: Shang Han with floating pulse, spontaneous sweating, frequent urination, if Stomach disharmony causes delirium, give small doses of Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct the Qi Decoction). (Zheng 43)
(98) Inquiry regarding several days without stool, difficulty passing stool, hard stool, dry feces, and loose stool.
Several days without stool, hard stool, and dry feces in Shang Han are known to be treated with Da Chai Hu Tang (Major Bupleurum Decoction), (Zheng 30) Da Cheng Qi Tang (Major Order the Qi Decoction), (Zheng 41) Xiao Cheng Qi Tang (Minor Order the Qi Decoction) (Zheng 42) for purgation. However, Zhongjing notes several types of constipation unsuitable for purgation. (Detailed in Volume 3, Question 15.) ○ Zhongjing also discusses Yang Jie (Yang Knotting) and Yin Jie (Yin Knotting), which must be distinguished. Pulse floating and rapid, able to eat but no stool, is Excess, named Yang Jie, suited for Xiao Chai Hu Tang (Minor Bupleurum Decoction). (Zheng 29) Harmonizing Ying/Wei and unblocking fluids; even if not fully resolved, passage of stool brings cure. Pulse deep and slow, unable to eat, heavy body, stool paradoxically hard, named Yin Jie, suited for Jin Ye Dan (Golden Liquid Pill). Yang excess causes Cu (rapid) pulse, Yin excess causes Jie (knotted) pulse; Cu and Jie are essentially similar. ○ Why loose stool? Ancients say: Insufficient Fire of the year, Great Cold prevails, people suffer from watery diarrhea. Generally, intestinal Cold causes duck-like loose stool. Loose stool occurs because Stomach Cold fails to separate water and grain. Hua Tuo said: Cold causes loose stool, Heat causes mucus/foulness. Zhongjing describes initial hard then loose stool in two syndromes: difficulty urinating and scant urination both indicate failure to separate water and grain.
(99) Inquiry regarding patients who are silent and want to sleep but cannot close their eyes, restless, hoarse voice, or dry throat. (Ga, sound of broken voice)
This is named Hu He Shang Han (Fox-Sorrow Cold Damage). Hu He and Shi Bi (Damp Bi) are both worm syndromes. Initially resembling Shang Han, or transforming from Shang Han. Symptoms: silence, desire to sleep but inability to close eyes, restlessness. Worms eroding the throat cause "He" (Sorrow/Hoarseness); worms eroding the lower part cause "Hu" (Fox); dry throat. Hu He disease involves aversion to food/drink, fluctuating facial color (red/white/black). Generally, Shang Han internal heat, empty intestines/stomach after eating, Three Worms move seeking food, eroding five Zang organs and lower parts. Symptoms: colorless teeth, white tongue, severe cases black lips with sores, heavy limbs, sudden drowsiness, worm erosion of anus, rotting to reveal five Zang organs leads to death. Frequently check upper/lower lips: upper lip sore indicates visceral erosion; lower lip sore indicates anal erosion. Kills quickly, often arising from diarrhea. Treat with Tao Ren Tang (Peach Kernel Decoction), (Misc 105) Huang Lian Xi Jiao Tang (Coptis and Rhinoceros Horn Decoction), (Misc 106) Xiong Huang Rui San (Realgar Sharp Powder). (Misc 107)
(100) Inquiry regarding patients who want to eat but cannot, silently want to lie down but cannot, want to walk but cannot, appetite fluctuates, like a strong person unable to walk when lying, feeling neither clearly cold nor hot, bitter taste, red urine, medicine causes immediate vomiting/diarrhea.
This is named Bai He Shang Han (Lily Cold Damage). All vessels share one source, all affected, no distinction of meridians. Symptoms: want to eat/cannot, silently want to lie/cannot, want to walk/cannot, appetite fluctuates, like strong person unable to walk, ambiguous temperature sensations, bitter taste, red urine. Bai He Bing (Lily Disease) resists all treatments; medicine causes vomiting/diarrhea, seeming spirit-possession. Often arises from Shang Han deficiency-lao (consumption), failing to recover after major illness. Bai He Zhi Mu Tang (Lily and Anemarrhena Decoction), (Misc 108) Hua Shi Dai Zhe Tang (Talc and Hematite Decoction), (Misc 109) Ji Zi Tang (Chicken Egg Decoction), (Misc 110) Bai He Di Huang Tang (Lily and Rehmannia Decoction), (Misc 111) Bai He Xi Fang (Lily Wash Formula), (Misc 112) Gua Lou Mu Li San (Trichosanthes and Oyster Powder), (Misc 113) Hua Shi San (Talc Powder). (Misc 114) Treat with these.