凡汗出于阴。阳气和则热解。此出于相格。故热不去而阳气反虚。不能布于手
足。而厥不止者死。发热汗不止者亦死。此二证兼之。犹可治者。为其厥未至阳
绝。汗未至阴脱也。方见解明理论矣。然尚有可言者。附子之热。走而不止。通行
经脉。自里达表。以至手足。汗止治厥也。干姜之热。止而不走。内守腑脏。消谷养
正。温补中气。以和阴阳。解其拒格。更调二药之走止。合适其用也。
下利肺痛。紫参汤主之。
紫参汤方
紫参（半斤） 甘草（三两）
上二味。以水五升。先煮紫参取二升。内甘草。煮取一升半。分温三服。
〔衍义〕下利。肠胃病也。乃云肺病何哉。此大肠与肺合故也。大抵肠中积聚。则肺
气不行。肺有所积。大肠亦不固。二害互为病。大肠病。而气塞于肺者痛。肺有积
者亦痛。痛必通用。紫参。本草谓主心腹积聚。疗肠胃中热积。九窍可通。大小肠可利。逐其陈。
开其道。佐以甘草。和其中外。气通则愈。积去则利止。注云非仲景方。以紫参非仲景常用也。
气利。诃黎勒散主之。
诃黎勒方
诃黎勒（十枚煨）
上一味为散。粥饮和，顿服。
〔衍义〕治病有轻重。前言气利。惟通小便。此乃通大便。盖气结处。阴阳不同。举此
二者为例。六经皆得结而为利。各有阴阳也。诃黎勒有通有涩。通以下涎。消宿
食。破结气。涩以固肠脱。佐以粥饮引肠胃。更补虚也。
凡是汗出源于阴分，若阳气调和则热邪自解；此处的汗出是由于阴阳格拒所致，因此热邪不去而阳气反而虚弱，不能布达于手足，导致四肢厥冷不止的，预后不良（死证）。发热且汗出不止的，也是死证。这两种证候如果同时出现，尚且还有可治的机会，是因为此时厥逆尚未发展到阳气绝灭的程度，汗出也未达到阴液脱失的地步。其机理已在《解明理论》中解释清楚了。然而还有可以进一步说明的地方：附子的热性，走窜而不留止，能通行经脉，从体内达于体表，直至手足，用于止汗并治疗厥逆；干姜的热性，守内而不走窜，能固守脏腑，消食化谷以养护正气，温补中焦之气，从而调和阴阳，解除阴阳格拒。更需斟酌这两味药“走”与“止”的特性，使其应用得当。
下利伴有肺部疼痛的，用紫参汤主治。
紫参汤方
紫参（半斤） 甘草（三两）
以上两味药，用水五升，先煮紫参取二升药汁，加入甘草，再煮取一升半药汁，分三次温服。
〔衍义〕下利是肠胃的疾病，却说涉及肺病，为什么呢？这是因为大肠与肺相表里（相合）。大抵肠中有积聚，则肺气运行不畅；肺中有积滞，大肠也不能固摄。两种病变互为因果。大肠有病，气机壅塞于肺则痛；肺有积滞也会痛。疼痛的治疗原则通用，紫参，本草记载它能主治心腹积聚，治疗肠胃中的热积，使九窍通畅，大小肠得利，祛除陈旧的积滞，开通其道，佐以甘草来调和内外。气机通畅则痊愈，积滞去除则下利停止。注释说这不是张仲景的原方，因为紫参不是张仲景常用的药物。
气利（指大便随矢气而出），用诃黎勒散主治。
诃黎勒方
诃黎勒（十枚，煨制）
以上一味药研为散剂，用米粥汤送服，一次性服完。
〔衍义〕治病有轻重的区别。前面所说的气利，主要是通利小便；这里的气利，则是通利大便。大概气机郁结之处，阴阳属性不同。举这两个例子为例，六经都可能出现气结而导致下利，各有不同的阴阳属性。诃黎勒既有通利作用又有收敛作用，通利方面可以降下痰涎，消化宿食，破除结聚之气；收敛方面可以固涩防止肠滑脱肛。佐以米粥汤，既能引导药力入肠胃，又能补益虚损。
Whenever sweating originates from the Yin aspect, if the Yang Qi harmonizes, the heat resolves. However, when sweating arises due to mutual rejection (Ge Ju) between Yin and Yang, the heat persists while Yang Qi becomes deficient, failing to distribute to the hands and feet, resulting in persistent cold extremities (Jue); this indicates a fatal prognosis. Similarly, fever accompanied by incessant sweating is also fatal. If these two conditions occur simultaneously, there may still be a chance for treatment, as the cold extremities have not yet reached the stage of Yang exhaustion, and the sweating has not yet led to Yin collapse. The theoretical explanation for this can be found in *Jie Ming Li Lun* (Theory Explained). Nevertheless, further clarification is warranted: The heat of Fuzi (Aconiti Lateralis Radix Praeparata) is mobile and unceasing, circulating through the meridians from the interior to the exterior, reaching the hands and feet; it is used to stop sweating and treat cold extremities. The heat of Ganjiang (Zingiberis Rhizoma) is stationary and non-mobile, guarding the interior organs, aiding digestion, nourishing righteous Qi, warming and tonifying Middle Jiao Qi, thereby harmonizing Yin and Yang and resolving mutual rejection. One must carefully balance the "mobile" nature of Fuzi and the "stationary" nature of Ganjiang to apply them appropriately.
For diarrhea accompanied by lung pain, Zishen Tang (Purple Ginseng Decoction) is the primary formula.
**Zishen Tang Formula**
Zishen (Radix Periplocae or similar, 8 liang)
Gancao (Licorice Root, 3 liang)
Take the above two ingredients, add five sheng of water, first decoct Zishen until two sheng remain, then add Gancao, and decoct until one and a half sheng remains. Divide into three warm doses.
*Yanyi Commentary*: Diarrhea is a disease of the intestines and stomach; why is it said to involve the Lung? This is because the Large Intestine and Lung are internally-externally related. Generally, accumulation in the intestines impedes Lung Qi circulation; accumulation in the lungs causes the Large Intestine to lose its firmness. These two pathologies affect each other. When the Large Intestine is diseased, Qi stagnation obstructs the Lung causing pain; accumulation in the lungs also causes pain. The treatment principle for pain is general. Zishen is recorded in Materia Medica as treating abdominal accumulations and clearing heat accumulation in the intestines and stomach, opening the nine orifices, and promoting bowel movement. It removes old stagnation and opens the pathways. Gancao is added to harmonize the interior and exterior. When Qi flows freely, recovery occurs; when stagnation is removed, diarrhea stops. The annotation notes that this is not originally from Zhang Zhongjing's formulas, as Zishen was not commonly used by him.
For Qi-type diarrhea (stool passing with flatus), Helile San (Areca Nut Shell Powder) is the primary formula.
**Helile Formula**
Helile (Pericarpium Arecae, ten pieces, roasted)
Grind the single ingredient into a powder. Mix with rice broth and take in one dose.
*Yanyi Commentary*: Treatment varies in severity. The previously mentioned Qi-type diarrhea primarily involved regulating urination; this Qi-type diarrhea involves regulating defecation. Wherever Qi is knotted, the Yin and Yang differ. These two cases serve as examples: all six channels can experience Qi knotting leading to diarrhea, each having distinct Yin-Yang characteristics. Helile possesses both purgative and astringent properties. Its purgative action descends phlegm, digests retained food, and breaks Qi knots; its astringent action secures the intestine against prolapse. Rice broth is added to guide the medicine into the intestines and stomach and to tonify deficiency.