并大便不通者。加甘草二两。煮取二升半。分为三服。
胃反。吐而渴。欲饮水。茯苓泽泻汤主之。
〔尤〕猪苓散。治吐后饮水者。所以崇土气胜水气也。茯苓泽泻汤。治吐未已。而渴欲饮水者。以吐
未已。知邪未去。则宜桂枝甘姜。散邪气。苓术泽泻。消水气也。
〔鉴〕李 云。吐而渴者。津液亡而胃
虚燥也。饮水则水停心下。茯苓泽泻降气行饮。白术补脾生津。此五苓散原方之义也。然胃反。因脾气虚逆。
故加生姜散逆。甘草和脾。又五苓散。治外有微热。故用桂枝。此胃反无表热。而亦用之者。桂枝非
一于攻表药也。乃彻上彻下。达表里。为通行津液。和阳治水之剂也。
茯苓泽泻汤方（〔原注〕外台治消渴脉绝。胃反吐食者。有小麦一升。○案外
台。脉上。有阴字。此本出千金。并用小麦三升。外台。引千金。出消渴门。）
茯苓（半斤） 泽泻（四两○外台作茯苓） 甘草（一两） 桂枝（二两○千金外台
作三两） 白术（三两） 生姜（四两○千金外台用三两）
上六味。以水一斗。煮取三升。内泽泻。再煮取二升半。温服八合。日三服。
〔程〕此方。乃五苓散。去猪苓。加甘草生姜。以猪苓过于利水。故去之。甘草生姜。长于和胃止吐。故
加之。茯苓白术泽泻桂枝。相须宣导。补脾而利水饮。
〔魏〕服法。后煮泽泻。取其阴性以利水。不宜煮之太过也。
兰台轨范云。此治蓄饮之吐。内泽泻再煮。似先煮五味。后煮泽泻。
外台。集验。茯苓小泽泻汤。疗胃反吐而渴者。（千金无方名。）
于本方。去白术生姜。加半夏。（千金云。一方入生姜四两。）
吐后。渴欲得水。而贪饮者。文蛤汤主之。兼主微风脉紧头痛。
〔程〕此证贪饮。与上证欲饮水。猪苓散之思水不同。夫贪饮者。饮水必多。多则淫溢上焦。必有溢饮之
患。故用此汤。以散水饮。方中皆辛甘发散之药。故亦主微风脉紧头痛。
〔尤〕用麻黄杏仁等发表之药者。必
兼有客邪。郁热于肺不解故也。观方下云。汗出即愈。可以知矣。
文蛤汤方
文蛤（五两） 麻黄 甘草 生姜（各三两） 石膏（五两） 杏仁（五十个） 大枣（十一枚）
上七味。以水六升。煮取二升。温服一升。汗出即愈。
〔程〕此大青龙汤。去桂枝。盖文蛤。水停于里。文蛤之咸寒。可以利水而消饮。水溢于外。青龙之
辛热。可以胜湿而解表。此汤与茯苓泽泻汤。猪苓散。皆预防水饮之剂。
张氏医通云。是方即大青龙汤。无桂枝。有文蛤。大青龙主发散风寒两感。今是证初不言外邪。而
用取汗。何哉。
盖因阳明经中有实热。所以贪饮。故用麻黄杏仁。开发腠理。甘草姜枣。调和营卫。石膏解利郁热。文蛤直入
少阴。散水止渴。为太阳少阴二经散邪涤饮之圣药。故又主微风脉紧头痛之疾。
干呕吐逆。吐涎沫。半夏干姜散主之。
〔魏〕干呕吐逆。吐涎沫者。亦胃中虚寒。津液变为涎沫。随逆气上冲作呕也。干呕无物。止有涎沫。
虚邪非实邪可知矣。主之以半夏干姜散方。犹之小半夏汤惟易生姜为干姜。以生姜性僭上而发越。不如干姜
之辛温为度。专功理中也。用意亦甚微也。
〔尤〕与前干呕吐涎沫头痛不同。彼为厥阴阴气上逆。此是阳明寒
涎逆气不下而已。故以半夏止逆消涎。干姜温中和胃。浆水甘酸调中引气。止呕吐也。
半夏干姜散方（千金无方名。）
半夏 干姜（各等分）
上二味。杵为散。取方寸匕。浆水一升半。煎取七合。顿服之。（千金。作上二味。 咀。以浆水一升
半。煮取七合。顿服之。日三。）
〔程〕脾寒则涎不摄。胃寒则气上逆。故干呕吐涎沫也。半夏之辛以散逆。干姜之热以温脾。煎以浆
水者。藉其酸温。以通关利膈也。此证与茱萸汤迥别。以不头痛也。
病患胸中。似喘不喘。似呕不呕。似哕不哕。彻心中愦
愦然。无奈者。生姜半夏汤主之。（无奈。外台作彻无聊赖四字。哕下无彻字。）
〔沈〕似喘不喘。似呕不呕。似哕不哕。诚不是喘。不是呕。不是哕也。彻者通也。仅是通心中。愦愦
然无奈。即泛泛恶心之义也。
〔尤〕寒邪搏饮。结于胸中。而不得出。则气之呼吸往来。出入升降者阻矣。似
喘不喘。似呕不呕。似哕不哕。皆寒饮与气相搏互击之证也。且饮水邪也。心阳脏也。
以水邪而逼处心脏。欲却不能。欲受不可。则彻心中愦愦然无奈也。生姜半夏汤。即小半夏汤。而生姜用汁。则
降逆之力少。而散结之力多。乃正治饮气相搏。欲出不出者之良法也。
生姜半夏汤方（外台伤寒呕哕门。引仲景伤寒论。作生姜汁半夏汤。云兼主天行。）
半夏（半升） 生姜汁（一升）
上二味。以水三升。煮半夏。取二升。内生姜汁。煮取一升。小冷。分四服。日三夜一服。止停后服。（
外台。作以水三升。煎半夏取一升。内姜汁取一升半。绵漉小冷。分二服。一日一夜服令尽。呕哕一服得
止者。停后服。）
〔鉴〕李 曰。生姜半夏辛温之气。足以散水饮。而舒阳气。然待小冷服者。恐寒饮固结于中。拒热药而
不纳。反致呕逆。今热药冷冻饮料。下嗌之后。冷体既消。热性便发。情且不违。而致大益。此内经之旨也。此方
与前半夏干姜汤略同。但前温中气。故用干姜。此散停饮。故用生姜。前因呕吐上逆。顿服之。则药力猛峻。
足以止逆降气。呕吐立除。此心中无奈。寒饮内结。难以猝消。故分四服。使胸中邪气。徐徐散也。
外台。必效。疗香港脚方。
大半夏（三两净削去皮） 生姜汁（三升）
上二味。水五升。煮取二升。去滓。空腹一服尽。每日一剂。三剂必好。此方梁公家出方。始有本。奇异神效。
又文仲。疗香港脚入心。闷绝欲死者。
半夏（三两洗切） 生姜汁（一升半）
上二味。内半夏。煮取一升八合。分四服。极效。
又深师。疗伤寒病 不止。半夏散。
半夏（洗焙干）
上一味。末之。生姜汤和。服一钱匕。
干呕哕。若手足厥者。橘皮汤主之。（肘后云。治卒呕 。又厥逆方。）
〔程〕干呕哕。则气逆于胸膈间。而不行于四末。故手足为之厥。橘皮能降逆气。生姜为呕家圣药。
小剂以和之也。然干呕非反胃。厥非无阳。故下咽气行即愈。
〔尤〕未可便认阳虚。而遽投温补也。
橘皮汤方（外台。引仲景伤寒论。名小橘皮汤。云兼主天行。）
橘皮（四两） 生姜（半斤○外台作去皮八两）
上二味。以水七升。煮取三升。温服一升。下咽即愈。（外台。二味下。有狭长切三字。）
外台。广济。橘皮汤。疗呕哕不止。
于本方中。加枇杷叶甘草。
又延年。人参饮。主吐。
于本方中。加人参。
又范汪半夏汤。病痰饮者。当以温药和之。疗心腹虚冷。游痰气上。胸胁满不下食。呕逆胸中冷。
于本方中。加半夏。
哕逆者。橘皮竹茹汤主之。
〔魏〕哕逆者。胃气虚寒固矣。亦有少挟虚热作哕者。将何以为治。仲景主之。橘皮竹茹汤。橘皮
竹茹。行气清胃。而毫不犯攻伐寒凉之忌。佐以补中益气。温胃之品。而胃气足胃阳生。浮热不必留意也。上
诸方于呕吐哕家。浅深缓急之治。可谓至详尽矣。
案哕。说文。气牾也。杨上善注阴阳应象大论云。气折
也。王氏准绳云。哕于月切。又乙劣切。乙劣之讹。遂为吃
逆。亦犹俗呼团为突栾。角为葛洛。其故明矣。而活人书等。
以哕为咳逆。如金鉴。仍袭其说。然楼氏纲目。王氏准绳。张氏类经。辨订其非尤详。今不繁引也。
橘皮竹茹汤方
橘皮（二斤） 竹茹（二升） 大枣（三十枚） 生姜（半斤） 甘草（五两） 人参（一两）
上六味。以水一斗。煮取三升。温服一升。日三服。（活人。有半夏。）
〔鉴〕李 曰。哕有属胃寒者。有属胃热者。此哕逆因胃
中虚热。气逆所致。故用人参甘草大枣补虚。橘皮生姜散逆。竹茹甘寒。疏逆气而清胃热。因以为君。
外台。深师大橘皮汤。疗伤寒呕哕。胸满虚烦不安。
于本方。去竹茹大枣。
又广济。麦门冬汤。疗烦热呕逆。不下食。食则吐出。
于本方。去橘皮。加麦门冬茅根。
活人大橘皮汤。动气在下。不可发汗。发汗则无汗。心
中大烦。骨节疼痛。目运恶寒。食则反吐谷不得入。先服大橘皮汤。吐止后。服小建中汤。（即本方。）
三因橘皮竹茹汤。治咳逆呕哕。胃中虚冷。每一哕。至八九声相连。收气不回。至于惊人。（即本方。）
夫六腑气绝于外者。手足寒。上气脚缩。五脏气绝于内者。利不禁。下甚者手足不仁。
〔程〕手足寒者。阳不行于四末也。上气者。宗气衰微也。平人宗气积于胸中。出于喉咙。以贯心脉。
而行呼吸。宗气衰则奔促上气也。脚缩者。寒主收引。无阳以伸也。此六腑气绝于外者如此。下利不禁者。下
焦不阖也。脾衰则四脏俱衰。故经曰。脾气孤弱。五液注下。下焦不阖。清便下重。
即不禁之谓也。下甚而至于手足不仁者。四体绝也。此五脏
气绝于内者如此。
〔徐〕下甚。手足因无阴以维阳。而脏气不相统摄。则为不仁。不仁者。伸缩皆不能也。
下利脉沉弦者下重。脉大者为未止。脉微弱数者。为欲自止。虽发热不死。
〔魏〕此滞下之病。非飧泄之病也。沉为阳陷入阴分。沉中见弦。为少阳之气。不能宣达。故气随阳
降而下重也。脉沉弦而大者。阳气陷入之深而且多。故为未止。脉微弱者。阳气陷入浅而少。更兼见数。阳气
勃勃。欲动于阴。斯易为升达也。故为欲自止。是以虽滞下而发热。亦不死也。若夫
脉沉弦而大。再身见发热。阳邪入阴而炽盛。阴分受伤而煎耗。可以有死之道也。
汪氏伤寒辨注云。此辨热利之脉也。脉沉弦者。沉主里。弦主急。故为里急后重。如滞下之证也。脉大
者邪热甚也。经云。大则病进。故为利未止也。脉微弱数者。此阳邪之热已退。真阴之气将复。故为利自止
也。下利一候。大忌发热。兹者脉微弱而带数。所存邪气有限。故虽发热不至死耳。
下利。手足厥冷无脉者。灸之不温。若脉不还。反微喘者死。少阴负趺阳者。为顺也。（少阴以下。
厥阴篇。玉函成本。分为两条。）
〔尤〕下利厥冷无脉。阴亡而阳亦绝矣。灸之所以引既绝之阳。乃厥不回脉不还。而反微喘。残阳上
奔。大气下脱。故死。下利为土负水胜之病。少阴负趺阳者。水负而土胜也。故曰顺。（详伤寒论辑义。以
下三条同。）
下利有微热而渴。脉弱者今自愈。（今。宋板伤寒论。作令。下同。）
〔尤〕微热而渴者。胃阳复也。脉弱者。邪气衰也。正复邪衰。故今自愈。
下利脉数。有微热汗出。今自愈。设脉紧为未解。（赵本。下利上。有若字。非。）
〔程〕寒则下利。脉数有微热。则里寒去。汗出则表气和。表里俱和。故今自愈。设复紧者。知寒邪
尚在。是为未解也。
下利脉数而渴者。今自愈。设不瘥。必圊脓血。以有热故也。
〔程〕脉数而渴。则寒邪去而利当止。经曰。若脉不解。
而下不止。必挟热而便脓血。此有热陷于下焦。使血流腐而为脓也。
下利。脉反弦。发热身汗者自愈。
〔程〕脉弦为寒。发热则阳气复。汗出则寒邪去。故知自愈。
〔尤〕弦脉阴阳两属。若与发热身汗并见。
则弦亦阳也。与脉数有微热汗出正同。故愈。按上数条。皆是伤寒邪气入里之候。故或热。或渴。或汗出。或
脉数。阳气既复。邪气得达则愈。若杂病湿热下利之证。则发热口渴脉数。均非美证。内经云。下利身热者
死。仲景云。下利手足不逆冷。反发热者不死。盖内经所言者。杂病湿热下利之证。仲景所言
者。伤寒阴邪内入之证。二者不可不分也。
下利气者。当利其小便。（气。脉经。作热。）
〔尤〕下利气者。气随利失。即所谓气利是也。小便得利。
则气行于阳。不行于阴而愈。故曰当利其小便。喻氏所谓急开支河者。是也。
下利。寸脉反浮数。尺中自涩者。必清脓血。
〔徐〕下利果属寒。脉应沉迟。反浮数。其阳胜可知。而
尺中自涩。涩为阳邪入阴。此亦热多。故曰必圊脓血。详伤寒论辑义厥阴篇。以下四条同。
下利清谷。不可攻其表。汗出必胀满。
〔程〕寒不杀谷。寒胜则下利清谷也。若发其表汗出。则胃中之阳益虚。其寒益胜。故作胀满。
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。（案厥。赵本。作热非。）
汪氏伤寒论辨注云。下利脉沉而迟。里寒也。所下者清谷。里寒甚也。面少赤身微热。下焦虚寒。无根失
守之火。浮于上越于表也。以少赤微热之故。其人阳气虽虚。犹能与阴寒相争。必作郁冒汗出而解。郁冒者。
头目之际。郁然昏冒。乃真阳之气。能胜寒邪。里阳回而表和顺。故能解也。病患必微厥者。此指未汗出郁冒
如果伴有便秘的，加入甘草二两。煮取药液二升半。分三次服用。
胃反病，呕吐且口渴，想要饮水，用茯苓泽泻汤主治。
〔尤在泾〕猪苓散，治疗呕吐后想喝水的情况，这是为了增强脾土之气以胜水气。茯苓泽泻汤，治疗呕吐尚未停止，而口渴想喝水的情况，因为呕吐未止，说明邪气未去，所以适宜用桂枝、干姜（原文作甘姜，据方义及下文解析应为干姜或指代温中之品，此处依原文译）来散邪气，茯苓、白术、泽泻来消水气。
〔赵良〕李中梓说，呕吐且口渴，是津液耗亡而胃虚燥热所致。饮水则水停聚在心下。茯苓泽泻能降气行饮，白术补脾生津，这符合五苓散原方的意义。然而胃反病，是因为脾气虚弱逆乱，所以加生姜散逆气，甘草调和脾胃。另外五苓散治疗外有微热的情况，所以用桂枝；此胃反病没有表热，却也使用桂枝，是因为桂枝并非单纯的解表药，而是能够通达上下、贯通表里，作为通行津液、调和阳气、治理水气的药剂。
茯苓泽泻汤方（〔原注〕《外台秘要》治疗消渴脉绝、胃反吐食者，有一升小麦。○按：《外台》中“脉”上有“阴”字。此方出自《千金方》，均用小麦三升。《外台》引用《千金》，出自消渴门。）
茯苓（半斤） 泽泻（四两○《外台》作茯苓） 甘草（一两） 桂枝（二两○《千金》《外台》作三两） 白术（三两） 生姜（四两○《千金》《外台》用三两）
以上六味药，用水一斗，煮取三升，加入泽泻，再煮取二升半。温服八合，每日三次。
〔程林〕此方，就是五苓散去掉猪苓，加上甘草和生姜。因为猪苓利水作用过于猛烈，所以去掉它。甘草和生姜善于和胃止吐，所以加上它们。茯苓、白术、泽泻、桂枝，相互辅助宣导，补益脾脏并利水饮。
〔魏荔彤〕服药方法，最后煮泽泻，是取其阴性以利水，不宜煮得太过。
《兰台轨范》说，此方治疗蓄积水饮引起的呕吐，加入泽泻再煮，似乎是先煮五味药，后煮泽泻。
《外台秘要》、《集验方》中的茯苓小泽泻汤，治疗胃反呕吐且口渴。（《千金方》无方名。）
在本方基础上，去掉白术、生姜，加入半夏。（《千金方》说：一方加入生姜四两。）
呕吐后，口渴想喝水，而且贪饮不止的，用文蛤汤主治。兼治微风脉紧头痛。
〔程林〕此证贪饮，与上证欲饮水、猪苓散证的思水不同。所谓贪饮，是喝水必然很多，多了就会淫溢上焦，必有溢饮的祸患，所以用此汤，来疏散水饮。方中都是辛甘发散的药物，所以也主治微风脉紧头痛。
〔尤在泾〕使用麻黄、杏仁等发表药物的，必定兼有客邪，郁热在肺不解的缘故。看方后注说：“汗出即愈”，就可以知道了。
文蛤汤方
文蛤（五两） 麻黄 甘草 生姜（各三两） 石膏（五两） 杏仁（五十个） 大枣（十一枚）
以上七味药，用水六升，煮取二升。温服一升，汗出即愈。
〔程林〕此方是大青龙汤去掉桂枝。盖因文蛤，水停于体内，文蛤的咸寒之性，可以利水而消除水饮。水溢于体表，大青龙的辛热之性，可以胜湿而解表。此汤与茯苓泽泻汤、猪苓散，都是预防水饮的药剂。
《张氏医通》说，此方即大青龙汤，没有桂枝，有文蛤。大青龙主治发散风寒两感之邪。现在这个病症起初不说有外邪，却用取汗的方法，为什么呢？
大概是因为阳明经中有实热，所以贪饮，因此用麻黄、杏仁开发腠理，甘草、姜、枣调和营卫，石膏解除郁热，文蛤直入少阴，散水止渴，是太阳、少阴二经散邪涤饮的圣药。所以又主治微风脉紧头痛的疾病。
干呕，吐逆，吐出涎沫，用半夏干姜散主治。
〔魏荔彤〕干呕吐逆，吐出涎沫的，也是胃中虚寒，津液变为涎沫，随着逆气上冲作呕。干呕没有实物，只有涎沫，可知是虚邪而非实邪。用半夏干姜散方主治，就像小半夏汤只是将生姜换为干姜，因为生姜性僭上而发越，不如干姜的辛温适度，专门功效在于理中。用意也很微妙。
〔尤在泾〕与前文的干呕吐涎沫头痛不同，那是厥阴阴气上逆，这是阳明寒涎逆气不下而已。所以用半夏止逆消涎，干姜温中和胃，浆水甘酸调中引气，止呕吐。
半夏干姜散方（《千金方》无方名。）
半夏 干姜（各等分）
以上两味药，捣碎成散剂。取方寸匕，用浆水一升半，煎取七合，一次性服下。（《千金方》作：以上两味药，切碎，用浆水一升半，煮取七合，一次性服下。每日三次。）
〔程林〕脾寒则涎不摄，胃寒则气上逆，所以干呕吐涎沫。半夏的辛味以散逆气，干姜的热性以温脾。用浆水煎煮，是借助其酸温之性，以通关利膈。此证与吴茱萸汤截然不同，因为没有头痛。
病人胸中，似喘不喘，似呕不呕，似呃逆不呃逆，心中烦闷无奈，没有办法的，用生姜半夏汤主治。（“无奈”，《外台》作“彻无聊赖”四字，“哕”下无“彻”字。）
〔沈明宗〕似喘不喘，似呕不呕，似呃逆不呃逆，确实不是喘，不是呕，不是呃逆。彻，通也。仅仅是通于心胸，愦愦然无奈，就是泛泛恶心的意思。
〔尤在泾〕寒邪搏结水饮，结于胸中，而不能排出，那么气的呼吸往来，出入升降就受阻了。似喘不喘，似呕不呕，似呃逆不呃逆，都是寒饮与气相搏互击的证候。况且饮水是邪，心阳是脏。以水邪逼迫处于心脏，想排斥不能，想接受不可，所以心中愦愦然无奈。生姜半夏汤，就是小半夏汤，而生姜用汁，则降逆之力少，而散结之力多，正是治疗饮气相搏，欲出不出者的良法。
生姜半夏汤方（《外台伤寒呕哕门》引仲景《伤寒论》，作生姜汁半夏汤，说兼主天行病。）
半夏（半升） 生姜汁（一升）
以上两味药，用水三升，煮半夏，取二升，加入生姜汁，煮取一升。稍冷，分四次服用，白天三次，夜间一次。症状停止后停服。（《外台》作：用水三升，煎半夏取一升，加入姜汁取一升半，用绵布过滤稍冷，分两次服，一天一夜服完。呕哕一服得止者，停后服。）
〔赵良〕李中梓说，生姜半夏辛温之气，足以散水饮而舒阳气。然而待药稍冷服用，是恐怕寒饮固结于中，拒热药而不纳，反而导致呕逆。现在热药冷冻饮料，下咽之后，冷体既消，热性便发，情志不违，而获大益，这是《内经》的宗旨。此方与前半夏干姜汤略同，但前药温中气，所以用干姜；此药散停饮，所以用生姜。前药因呕吐上逆，顿服之，则药力猛峻，足以止逆降气，呕吐立除。此证心中无奈，寒饮内结，难以猝消，所以分四次服，使胸中邪气徐徐消散。
《外台秘要》、《必效方》治疗香港脚方。
大半夏（三两净削去皮） 生姜汁（三升）
以上两味药，水五升，煮取二升，去滓。空腹一次服尽，每日一剂，三剂必好。此方出自梁公家传方，始有底本，奇异神效。
又文仲治疗香港脚入心，闷绝欲死者。
半夏（三两洗切） 生姜汁（一升半）
以上两味药，放入半夏，煮取一升八合，分四次服。极有效。
又深师治疗伤寒病呃逆不止，半夏散。
半夏（洗焙干）
以上一味药，研末。用生姜汤送服，服一钱匕。
干呕呃逆，如果手足厥冷的，用橘皮汤主治。（《肘后备急方》说：治卒然呕吐呃逆，又厥逆方。）
〔程林〕干呕呃逆，则气逆于胸膈间，而不行于四肢末端，所以手足为之厥冷。橘皮能降逆气，生姜为呕家圣药。用小剂量来调和它。然而干呕非反胃，厥冷非无阳，所以下咽气行即愈。
〔尤在泾〕不可以就认为是阳虚，而急于投用温补药。
橘皮汤方（《外台》引仲景《伤寒论》，名小橘皮汤，说兼主天行病。）
橘皮（四两） 生姜（半斤○《外台》作去皮八两）
以上两味药，用水七升，煮取三升。温服一升，下咽即愈。（《外台》在二味下有“狭长切”三字。）
《外台秘要》、《广济方》橘皮汤，治疗呕哕不止。
在本方中，加枇杷叶、甘草。
又《延年方》人参饮，主治呕吐。
在本方中，加人参。
又范汪半夏汤，病痰饮者，当以温药和之。治疗心腹虚冷，游痰气上，胸胁满不下食，呕逆胸中冷。
在本方中，加半夏。
呃逆的，用橘皮竹茹汤主治。
〔魏荔彤〕呃逆，胃气虚寒是肯定的了。也有少许夹杂虚热作呃的，将如何治疗？仲景主治用橘皮竹茹汤。橘皮、竹茹，行气清胃，而毫不犯攻伐寒凉之忌。佐以补中益气、温胃之品，而胃气足胃阳生，浮热不必留意。上述诸方对于呕吐呃逆的治疗，浅深缓急之法，可谓至详尽矣。
案：哕，《说文》解释为气牾（气机逆乱）。杨上善注《阴阳应象大论》说：气折也。王肯堂《准绳》说：哕音yuě（月切），又音huì（乙劣切）。乙劣之讹，遂为吃逆，也犹如俗呼团为突栾，角为葛洛，其故明矣。而《活人书》等，以哕为咳逆，如《金鉴》，仍袭其说。然而楼全善《纲目》，王肯堂《准绳》，张景岳《类经》，辨订其非尤为详细，今不繁引。
橘皮竹茹汤方
橘皮（二斤） 竹茹（二升） 大枣（三十枚） 生姜（半斤） 甘草（五两） 人参（一两）
以上六味药，用水一斗，煮取三升。温服一升，每日三次。（《活人书》中有半夏。）
〔赵良〕李中梓说：哕有属胃寒者，有属胃热者。此哕逆因胃中虚热，气逆所致。所以用人参、甘草、大枣补虚，橘皮、生姜散逆，竹茹甘寒，疏逆气而清胃热，因此作为君药。
《外台秘要》、深师大橘皮汤，治疗伤寒呕哕，胸满虚烦不安。
在本方中，去掉竹茹、大枣。
又《广济方》麦门冬汤，治疗烦热呕逆，不下食，食则吐出。
在本方中，去掉橘皮，加麦门冬、茅根。
《活人大橘皮汤》，动气在下，不可发汗。发汗则无汗，心中大烦，骨节疼痛，目眩恶寒，食则反吐谷不得入。先服大橘皮汤，吐止后，服小建中汤。（即本方。）
《三因方》橘皮竹茹汤，治疗咳逆呕哕，胃中虚冷。每一哕，至八九声相连，收气不回，至于惊人。（即本方。）
六腑之气绝于外的，手足寒冷，上气脚缩。五脏之气绝于内的，泄利不禁，下利严重者手足麻木不仁。
〔程林〕手足寒冷，是阳气不行于四肢末端。上气，是宗气衰微。平人的宗气积于胸中，出于喉咙，以贯心脉，而行呼吸。宗气衰则奔促上气。脚缩，是寒主收引，无阳以伸。六腑之气绝于外就是这样。下利不禁，是下焦不阖。脾衰则四脏俱衰，所以经上说：脾气孤弱，五液注下。下焦不阖，清便下重，即是不禁的意思。下利严重以至于手足不仁，是四体绝也。五脏之气绝于内就是这样。
〔徐灵胎〕下利严重，手足因无阴以维阳，而脏气不相统摄，则为不仁。不仁者，伸缩皆不能也。
下利脉沉弦的，下重；脉大的，为未止；脉微弱数的，为欲自止，虽发热不死。
〔魏荔彤〕这是滞下（痢疾）的病，不是飧泄（完谷不化的腹泻）的病。沉为阳陷入阴分，沉中见弦，为少阳之气，不能宣达，故气随阳降而下重。脉沉弦而大者，阳气陷入之深而且多，故为未止。脉微弱者，阳气陷入浅而少，更兼见数，阳气勃勃，欲动于阴，斯易为升达也，故为欲自止。是以虽然滞下而发热，亦不死也。如果脉沉弦而大，再身见发热，阳邪入阴而炽盛，阴分受伤而煎耗，可以有死之道也。
汪氏《伤寒辨注》说：这是辨别热利的脉象。脉沉弦者，沉主里，弦主急，故为里急后重，如滞下之证也。脉大者邪热甚也。经云：大则病进，故为利未止也。脉微弱数者，此阳邪之热已退，真阴之气将复，故为利自止也。下利一候，大忌发热，兹者脉微弱而带数，所存邪气有限，故虽发热不至死耳。
下利，手足厥冷无脉的，灸之不温，如果脉不还，反微喘的，死。少阴负趺阳的，为顺也。（少阴以下三条，厥阴篇，《玉函》本分为两条。）
〔尤在泾〕下利厥冷无脉，阴亡而阳亦绝矣。灸之所以引既绝之阳，乃厥不回脉不还，而反微喘，残阳上奔，大气下脱，故死。下利为土负水胜之病，少阴负趺阳者，水负而土胜也。故曰顺。（详见《伤寒论辑义》，以下三条同。）
下利有微热而渴，脉弱的，今自愈。（今，宋板《伤寒论》作令，下同。）
〔尤在泾〕微热而渴者，胃阳复也。脉弱者，邪气衰也。正复邪衰，故今自愈。
下利脉数，有微热汗出的，今自愈。设脉紧为未解。（赵本，下利上，有若字，非。）
〔程林〕寒则下利，脉数有微热，则里寒去，汗出则表气和，表里俱和，故今自愈。设复紧者，知寒邪尚在，是为未解也。
下利脉数而渴的，今自愈。设不瘥，必圊脓血，以有热故也。
〔程林〕脉数而渴，则寒邪去而利当止。经曰：若脉不解，而下不止，必挟热而便脓血。此有热陷于下焦，使血流腐而为脓也。
下利，脉反弦，发热身汗的，自愈。
〔程林〕脉弦为寒，发热则阳气复，汗出则寒邪去，故知自愈。
〔尤在泾〕弦脉阴阳两属，若与发热身汗并见，则弦亦阳也。与脉数有微热汗出正同，故愈。按上数条，皆是伤寒邪气入里之候，故或热，或渴，或汗出，或脉数，阳气既复，邪气得达则愈。若杂病湿热下利之证，则发热口渴脉数，均非美证。《内经》云：下利身热者死。仲景云：下利手足不逆冷，反发热者不死。盖《内经》所言者，杂病湿热下利之证，仲景所言者，伤寒阴邪内入之证，二者不可不分也。
下利气者，当利其小便。（气，《脉经》作热。）
〔尤在泾〕下利气者，气随利失，即所谓气利是也。小便得利，则气行于阳，不行于阴而愈。故曰当利其小便。喻昌所谓急开支河者，是也。
下利，寸脉反浮数，尺中自涩的，必清脓血。
〔徐灵胎〕下利果属寒，脉应沉迟，反浮数，其阳胜可知。而尺中自涩，涩为阳邪入阴，此亦热多，故曰必圊脓血。详《伤寒论辑义》厥阴篇，以下四条同。
下利清谷，不可攻其表。汗出必胀满。
〔程林〕寒不杀谷，寒胜则下利清谷也。若发其表汗出，则胃中之阳益虚，其寒益胜，故作胀满。
下利脉沉而迟，其人面少赤，身有微热，下利清谷的，必郁冒汗出而解。病患必微厥。所以然者，其面戴阳下虚故也。（案厥，赵本作热，非。）
汪氏《伤寒论辨注》说：下利脉沉而迟，里寒也。所下者清谷，里寒甚也。面少赤身微热，下焦虚寒，无根失守之火，浮于上越于表也。以少赤微热之故，其人阳气虽虚，犹能与阴寒相争，必作郁冒汗出而解。郁冒者，头目之际，郁然昏冒，乃真阳之气，能胜寒邪，里阳回而表和顺，故能解也。病患必微厥者，此指未汗出郁冒
If accompanied by constipation, add Gancao (Licorice Root) two liang. Decoct to obtain 2.5 sheng of liquid. Divide into three doses.
Wei Fan (Gastric Reversal), vomiting with thirst and desire to drink water, is primarily treated with Fuling Zexie Tang (Poria and Alisma Decoction).
[You] Zhuling San (Polyporus Powder) treats the condition of wanting to drink water after vomiting; this is to strengthen Earth Qi to overcome Water Qi. Fuling Zexie Tang treats the condition where vomiting has not yet ceased but there is thirst and desire to drink water. Since vomiting has not ceased, it indicates that pathogenic factors have not departed; thus, Guizhi (Cinnamon Twig) and Ganjiang (Dried Ginger) [Note: Text says 'Gan Jiang' likely referring to Dried Ginger in context of warming, though written as 'Gan Jiang' which can be ambiguous, context implies warming/drying] are suitable to disperse pathogenic factors, while Fuling (Poria), Baizhu (Atractylodes Macrocephala Rhizome), and Zexie (Alisma) are used to eliminate dampness/water qi.
[Jian] Li [Zhongzi] said: Vomiting with thirst indicates depletion of body fluids and deficiency-dryness of the Stomach. Drinking water causes water retention in the epigastrium. Fuling and Zexie descend Qi and promote fluid metabolism; Baizhu tonifies the Spleen and generates fluids. This aligns with the original principle of Wuling San (Five-Ingredient Poria Pill). However, Wei Fan is caused by deficiency and rebellion of Spleen Qi; therefore, Shengjiang (Fresh Ginger) is added to scatter rebellion, and Gancao (Licorice Root) harmonizes the Spleen. Furthermore, Wuling San uses Guizhi for exterior slight heat; although this Wei Fan case lacks exterior heat, Guizhi is still used because Guizhi is not merely an exterior-releasing herb, but a agent that penetrates upper and lower, connects interior and exterior, promotes circulation of body fluids, harmonizes Yang, and manages water.
Fuling Zexie Tang Formula ([Original Note] *Waitai* treats Xiao Ke (Wasting-Thirst) with absent pulse, and Wei Fan with vomiting food; it includes one sheng of Xiaomai (Wheat). ○ Case: In *Waitai*, "pulse" has the character "Yin" before it. This source comes from *Qianjin Fang*, using three sheng of Wheat. *Waitai* cites *Qianjin* from the Xiao Ke section.)
Fuling (Poria) (half jin) Zexie (Alisma) (four liang ○ *Waitai* lists Fuling here) Gancao (Licorice Root) (one liang) Guizhi (Cinnamon Twig) (two liang ○ *Qianjin* and *Waitai* list three liang) Baizhu (Atractylodes Macrocephala Rhizome) (three liang) Shengjiang (Fresh Ginger) (four liang ○ *Qianjin* and *Waitai* use three liang)
The above six ingredients. Use ten dou of water, decoct to obtain three sheng. Add Zexie, decoct again to obtain two and a half sheng. Take warm, eight ge per dose, three times daily.
[Cheng] This formula is Wuling San minus Zhuling (Polyporus), plus Gancao and Shengjiang. Because Zhuling's diuretic action is too strong, it is removed. Gancao and Shengjiang excel at harmonizing the Stomach and stopping vomiting, so they are added. Fuling, Baizhu, Zexie, and Guizhi assist each other in dissemination and guidance, tonifying the Spleen and promoting urination to resolve fluid retention.
[Wei] The administration method involves decocting Zexie last, to utilize its Yin nature for promoting urination; it should not be over-decocted.
*Lantai Guifan* states: This treats vomiting due to accumulated fluid retention. Adding Zexie for secondary decoction suggests decocting the five flavors first, then Zexie.
*Waitai* and *Jiyan* contain Fuling Small Zexie Tang, treating Wei Fan with vomiting and thirst. (*Qianjin* has no formula name.)
Based on this formula, remove Baizhu and Shengjiang, add Banxia (Pinellia Tuber). (*Qianjin* says: One variation adds four liang of Shengjiang.)
After vomiting, if there is thirst and desire for water, and excessive drinking (greedy drinking), Wen Ge Tang (Clam Shell Decoction) is primarily indicated. It also treats mild wind with tight pulse and headache.
[Cheng] This condition of greedy drinking differs from the previous desire to drink water and the Zhuling San syndrome of craving water. Greedy drinking implies consuming large amounts of water, which may overflow into the Upper Jiao, causing Yi Yin (Overflowing Fluid Retention). Therefore, this decoction is used to dissipate fluid retention. The ingredients are all acrid-sweet dispersing herbs, hence it also treats mild wind with tight pulse and headache.
[You] Using Bofa (releasing exterior) herbs like Mahuang (Ephedra Herb) and Xingren (Apricot Seed) implies the presence of external pathogens and stagnant heat in the Lung that has not resolved. As noted in the post-formula instructions: "Sweating leads to recovery," this can be understood.
Wen Ge Tang Formula
Wenge (Clam Shell) (five liang) Mahuang (Ephedra Herb) Gancao (Licorice Root) Shengjiang (Fresh Ginger) (each three liang) Shigao (Gypsum Fibrosum) (five liang) Xingren (Apricot Seed) (fifty pieces) Dazao (Jujube) (eleven pieces)
The above seven ingredients. Use six sheng of water, decoct to obtain two sheng. Take one sheng warm. Recovery occurs with sweating.
[Cheng] This is Da Qing Long Tang (Major Green Dragon Decoction) minus Guizhi. Wenge, dealing with internal water stagnation, uses its salty-cold nature to promote urination and resolve fluid retention. Qing Long, dealing with water overflowing externally, uses its acrid-hot nature to overcome dampness and release the exterior. This decoction, along with Fuling Zexie Tang and Zhuling San, are all preventive agents against fluid retention.
*Zhangshi Yitong* states: This formula is essentially Da Qing Long Tang without Guizhi, but with Wenge. Da Qing Long primarily disperses Wind-Cold affecting both Taiyang and Yangming. Why use sweating when the initial presentation does not mention external pathogens?
It is because there is excess heat in the Yangming Meridian, causing greedy drinking. Thus, Mahuang and Xingren open the couli (pores); Gancao, Shengjiang, and Dazao harmonize Ying and Wei; Shigao resolves stagnant heat; Wenge enters directly into the Shaoyin, dissipating water and quenching thirst. It is a sacred herb for dispelling pathogens and cleansing fluid retention in the Taiyang and Shaoyin meridians. Hence, it also treats mild wind with tight pulse and headache.
Dry vomiting, regurgitation, and spitting of saliva/foam are primarily treated with Banxia Ganjiang San (Pinellia and Dried Ginger Powder).
[Wei] Dry vomiting, regurgitation, and spitting of saliva/foam indicate deficiency-cold in the Stomach, where body fluids transform into saliva/foam and rise with rebellious Qi to cause vomiting. Dry vomiting without solid matter, only saliva/foam, indicates deficiency pathogen rather than excess. Banxia Ganjiang San is used, similar to Xiaobanxia Tang but replacing Shengjiang with Ganjiang (Dried Ginger). Shengjiang is acrid and ascending/expansive, whereas Ganjiang's acrid-warm nature is moderate and specifically functions to regulate the Middle. The intention is subtle.
[You] This differs from the previous dry vomiting with saliva/foam and headache, which was due to Jueyin Yin Qi rebelling upward. Here, it is merely Yangming cold saliva and rebellious Qi failing to descend. Thus, Banxia stops rebellion and eliminates saliva; Ganjiang warms and harmonizes the Middle; Jiangshui (Acidic Fermented Rice Water) is sweet-sour, regulating the Middle and guiding Qi to stop vomiting.
Banxia Ganjiang San Formula (*Qianjin* has no formula name.)
Banxia (Pinellia Tuber) Ganjiang (Dried Ginger) (equal parts)
The above two ingredients. Pound into powder. Take one fangcun bi (measure), decoct in one and a half sheng of Jiangshui (Acidic Fermented Rice Water) to obtain seven ge. Take in one dose. (*Qianjin*: Chop the two ingredients, decoct in one and a half sheng of Jiangshui to obtain seven ge, take in one dose. Three times daily.)
[Cheng] Spleen cold fails to control saliva; Stomach cold causes Qi to rebel upward, resulting in dry vomiting and spitting of saliva/foam. Banxia's acridity disperses rebellion; Ganjiang's heat warms the Spleen. Decocting with Jiangshui utilizes its sour-warm nature to unblock orifices and benefit the diaphragm. This condition is distinct from Zhuyu Tang because there is no headache.
The patient feels in the chest as if panting but not panting, as if vomiting but not vomiting, as if hiccoughing but not hiccoughing, with a pervasive sense of mental confusion and helplessness in the heart/chest, unable to bear it. This is primarily treated with Shengjiang Banxia Tang (Fresh Ginger and Pinellia Decoction). ("Unable to bear it," *Waitai* reads "che wu liaolai"; no "che" character after "yue".)
[Shen] As if panting but not panting, etc., truly means it is not panting, not vomiting, not hiccoughing. "Che" means through/pervasive. It is merely a pervasive feeling of confusion and helplessness in the chest, synonymous with general nausea.
[You] Cold pathogen combats fluid retention, knotting in the chest and unable to exit. Thus, the movement of Qi during respiration, entering/exiting and ascending/descending is obstructed. These sensations are syndromes of cold-fluid retention combusting and striking against Qi. Drinking water introduces evil; Heart Yang is the organ. With water evil pressing upon the Heart, rejection is impossible, acceptance is impossible, leading to pervasive confusion and helplessness in the heart. Shengjiang Banxia Tang is essentially Xiaobanxia Tang, but using Shengjiang juice reduces the power to descend rebellion and increases the power to dissipate knots. It is an excellent method for treating fluid-Qi combat where expulsion is desired but hindered.
Shengjiang Banxia Tang Formula (*Waitai Taishang Yonglei Leishi Shuyi Shanghan E Yue Men* cites Zhang Zhongjing's *Shanghan Lun*, calling it Shengjiang Zhi Banxia Tang, stating it also treats epidemic febrile diseases.)
Banxia (Pinellia Tuber) (half sheng) Shengjiang Zhi (Fresh Ginger Juice) (one sheng)
The above two ingredients. Use three sheng of water, decoct Banxia to obtain two sheng. Add Shengjiang Zhi, decoct to obtain one sheng. Take slightly cool, divide into four doses. Three times during the day, once at night. Stop subsequent doses if symptoms cease. (*Waitai*: Use three sheng of water, decoct Banxia to obtain one sheng. Add ginger juice to obtain one and a half sheng. Strain through silk, take slightly cool. Divide into two doses. Consume within one day and night. If vomiting/hiccough stops after one dose, stop subsequent doses.)
[Jian] Li [Zhongzi] said: The acrid-warm Qi of Shengjiang and Banxia is sufficient to dissipate fluid retention and soothe Yang Qi. However, taking it slightly cool prevents the cold-fluid retention from rejecting the hot medicine, which would otherwise cause vomiting. By taking hot medicine cold, once swallowed, the cold nature dissipates and the hot nature activates. This complies with emotional/physiological acceptance and yields great benefit, following the principle of *Neijing*. This formula is slightly similar to Banxia Ganjiang Tang; the former warms Middle Qi using Ganjiang; this one dissipates retained fluid using Shengjiang. The former addresses vomiting/rebellion with a single large dose for potent effect to quickly stop rebellion. This case involves chest helplessness and internal cold-fluid retention, difficult to resolve suddenly, so it is divided into four doses to slowly dissipate chest pathogens.
*Waitai* and *Bixiao Fang* treat Hongjiaojiao (Tropical Swelling/Gout-like condition) formula.
Dabanxia (Large Pinellia Tuber) (three liang, cleaned and peeled) Shengjiang Zhi (Fresh Ginger Juice) (three sheng)
The above two ingredients. Use five sheng of water, decoct to obtain two sheng. Remove dregs. Take on an empty stomach in one dose. One dose daily. Three doses will surely cure. This formula originated from Lord Liang's family secret recipe, proven miraculous.
Also, Wen Zhong treats Hongjiaojiao entering the Heart, causing suffocation and near-death state.
Banxia (Pinellia Tuber) (three liang, washed and sliced) Shengjiang Zhi (Fresh Ginger Juice) (one and a half sheng)
The above two ingredients. Add Banxia, decoct to obtain one and eight ge. Divide into four doses. Extremely effective.
Also, Shenshi treats Shanghan disease with persistent hiccough, Banxia San.
Banxia (Pinellia Tuber) (washed, baked, dried)
One ingredient. Powder it. Mix with Shengjiang Tang and take one qianbi.
Dry vomiting and hiccough, if accompanied by cold extremities, are primarily treated with Ju Pi Tang (Tangerine Peel Decoction). (*Zhouhou* says: Treats sudden vomiting/hiccough and cold extremities.)
[Cheng] Dry vomiting and hiccough indicate Qi rebelling in the chest/diaphragm and failing to reach the four extremities, causing cold hands and feet. Ju Pi descends rebellious Qi; Shengjiang is the sage herb for vomiting. A small dose is used to harmonize. However, dry vomiting is not gastric reversal, and cold extremities do not mean absence of Yang; thus, Qi flows and recovers upon swallowing.
[You] Do not hastily diagnose Yang Deficiency and administer warming-tonifying herbs immediately.
Ju Pi Tang Formula (*Waitai* cites *Shanghan Lun*, naming it Xiao Ju Pi Tang, stating it also treats epidemic febrile diseases.)
Ju Pi (Tangerine Peel) (four liang) Shengjiang (Fresh Ginger) (half jin ○ *Waitai* lists peeled eight liang)
The above two ingredients. Use seven sheng of water, decoct to obtain three sheng. Take one sheng warm. Recovery occurs upon swallowing. (*Waitai*: Adds "cut into long strips" after the two ingredients.)
*Waitai* and *Guangji* Ju Pi Tang treats persistent vomiting and hiccough.
Add Pipaye (Loquat Leaf) and Gancao (Licorice Root) to this formula.
Also, Yannian Ren Shen Yin (Ginseng Drink) primarily treats vomiting.
Add Renshen (Ginseng Root) to this formula.
Also, Fan Wang Banxia Tang: For phlegm-fluid retention diseases, warm herbs should be used to harmonize. Treats deficiency-cold of Heart/Abdomen, wandering phlegm Qi rising, chest/hypochondriac fullness, inability to eat, vomiting/rebellion with cold in chest.
Add Banxia (Pinellia Tuber) to this formula.
Hiccough is primarily treated with Ju Pi Zhu Ru Tang (Tangerine Peel and Bamboo Shavings Decoction).
[Wei] Hiccough confirms deficiency-cold of Stomach Qi. There are cases with slight deficiency-heat causing hiccough. How to treat? Zhongjing prescribes Ju Pi Zhu Ru Tang. Ju Pi and Zhu Ru move Qi and clear the Stomach without violating the taboo of attacking/cold-cooling. Assisted by herbs that tonify Middle, boost Qi, and warm the Stomach, Stomach Qi becomes sufficient and Stomach Yang arises; floating heat need not be concerned. The aforementioned formulas cover the shallow/deep and slow/urgent treatments for vomiting/hiccough exhaustively.
Case: *Shuowen* defines Yue (hiccough) as Qi obstruction. Yang Shangshan's commentary on *Yinyang Yingxiang Dalun* says: Qi fracture. Wang Ken-tang's *Zhunsheng* says: Yue pronounced yue (moon cut), or huai (evil inferior cut). The error of huai led to chi ni (stuttering hiccough), just as colloquially tuan is called tuluan, jiao is geluo. The reason is clear. However, *Huanren Shu* etc. equate Yue with ke ni (cough-hiccough). *Jinjian* follows this. But Lou Quan-shan's *Gangmu*, Wang Ken-tang's *Zhunsheng*, Zhang Jing-yue's *Leijing* detail the refutation. I will not cite them extensively here.
Ju Pi Zhu Ru Tang Formula
Ju Pi (Tangerine Peel) (two jin) Zhu Ru (Bamboo Shavings) (two sheng) Dazao (Jujube) (thirty pieces) Shengjiang (Fresh Ginger) (half jin) Gancao (Licorice Root) (five liang) Renshen (Ginseng Root) (one liang)
The above six ingredients. Use one dou of water, decoct to obtain three sheng. Take one sheng warm, three times daily. (*Huanren* contains Banxia.)
[Jian] Li [Zhongzi] said: Hiccough can belong to Stomach Cold or Stomach Heat. This hiccough is caused by deficiency-heat in the Stomach and rebellious Qi. Thus, Renshen, Gancao, and Dazao tonify deficiency; Ju Pi and Shengjiang scatter rebellion; Zhu Ru is sweet-cold, dispersing rebellious Qi and clearing Stomach Heat, serving as the Sovereign herb.
*Waitai* and Shenshi Da Ju Pi Tang treats Shanghan vomiting/hiccough with chest fullness, deficiency-heat, restlessness.
Remove Zhu Ru and Dazao from this formula.
Also, Guangji Maidong Tang treats irritability-heat, vomiting/rebellion, inability to eat, vomiting upon eating.
Remove Ju Pi, add Maidong (Ophiopogon Tuber) and Maogen (Imperata Rhizome) to this formula.
Huoren Da Ju Pi Tang: When Dong Qi (moving Qi) is in the Lower Jiao, sweating is contraindicated. Sweating causes no sweat, extreme heart vexation, bone/joint pain, vertigo, aversion to cold, vomiting grain upon eating. First take Da Ju Pi Tang; after vomiting stops, take Xiao Jianzhong Tang (which is this formula).
*Sanyuan* Ju Pi Zhu Ru Tang treats cough-hiccough and vomiting, Stomach deficiency-cold. Each hiccough lasts 8-9 sounds continuously, with failure to inhale, startling observers. (This is this formula.)
When Qi of the Six Fu organs fails externally, hands and feet are cold, upper Qi rises, legs curl up. When Qi of the Five Zang organs fails internally, diarrhea is uncontrollable; severe cases lead to numbness of hands and feet.
[Cheng] Cold hands and feet indicate Yang failing to circulate to the four extremities. Upper Qi indicates decline of Zong Qi (Gathering Qi). Normal Zong Qi accumulates in the chest, exits the throat, penetrates the Heart vessels, and governs respiration. Decline of Zong Qi causes rushing upper Qi. Leg curling is due to Cold causing contraction and lack of Yang to extend. This is how Qi of Six Fu fails externally. Uncontrollable diarrhea indicates failure of the Lower Jiao to close. Spleen decline leads to decline of the Four Zang; thus the Classic says: Spleen Qi is isolated and weak, five fluids pour downward. Failure of Lower Jiao closure, heavy sensation in clear/turbid stools, is what is meant by uncontrollable. Severe diarrhea leading to numbness indicates severance of the four limbs. This is how Qi of Five Zang fails internally.
[Xu] Severe diarrhea, hands and feet lack Yin to sustain Yang, and Zang Qi fails to control each other, resulting in numbness. Numbness means inability to extend or flex.
In diarrhea, if the pulse is Chen (Deep) and Xian (Wiry), there is heaviness in the rectum; if Da (Large), the condition has not stopped; if Wei Ruo (Weak/Faint) and Shuo (Rapid), it is about to stop spontaneously; even with fever, death is not imminent.
[Wei] This is a case of Lizhong (Dysentery/Stagnant Downward Flow), not Xunxie (Undigested Food Diarrhea). Deep indicates Yang sinking into Yin. Deep with Wiry indicates Shaoyang Qi cannot disseminate, so Qi sinks with Yang causing rectal heaviness. Deep, Wiry, and Large indicates Yang has sunk deeply and significantly, hence not stopped. Weak indicates Yang has sunk shallowly and slightly; combined with Rapid, Yang is vigorous and desires to move within Yin, facilitating ascent, hence about to stop. Thus, even with dysentery and fever, death is not imminent. If Deep, Wiry, Large, plus body fever, Yang pathogen enters Yin and becomes fierce, Yin injury and consumption occur, leading to death.
Wang's *Shanghan Bianzhu* states: This distinguishes pulses of Heat Diarrhea. Deep/Wiry indicates Interior and Urgency, hence tenesmus like dysentery. Large indicates intense pathogenic heat. Classic says: Large means disease progresses, hence diarrhea not stopped. Weak/Rapid indicates pathogenic heat has retreated and True Yin Qi is recovering, hence diarrhea self-stopping. Fever is taboo in diarrhea; here, pulse is Weak/Rapid, remaining pathogen is limited, so despite fever, death does not ensue.
In diarrhea, if hands and feet are cold and pulse is absent, moxibustion fails to warm, pulse does not return, and slight panting occurs: Death. If Shaoyin is subordinate to Fuyang, it is favorable. (From Shaoyin onwards, Jueyin chapter, *Yuhan* edition splits into two entries.)
[You] Diarrhea with cold extremities and absent pulse indicates Yin exhaustion and Yang extinction. Moxibustion aims to draw back extinct Yang. If cold extremities do not recover and pulse does not return, but slight panting occurs, residual Yang rushes upward and Grand Qi collapses downward: Death. Diarrhea is a disease of Earth losing to Water. If Shaoyin is subordinate to Fuyang, Water loses and Earth wins. Hence, favorable. (See *Shanghan Lun Jiyi*, same for following three entries.)
In diarrhea, if there is slight fever and thirst, and pulse is Weak: Spontaneous recovery. (Now, Song edition *Shanghan Lun* reads Ling, same below.)
[You] Slight fever and thirst indicate recovery of Stomach Yang. Weak pulse indicates decline of pathogen. Righteous Qi recovers, pathogen declines, hence spontaneous recovery.
In diarrhea, if pulse is Rapid, with slight fever and sweating: Spontaneous recovery. If pulse is Tight, not resolved. (Zhao edition adds "Ruo" before Diarrhea, incorrect.)
[Cheng] Cold causes diarrhea. Rapid pulse with slight fever indicates interior cold departing. Sweating indicates exterior Qi harmonizing. Interior and exterior harmonized, hence spontaneous recovery. If pulse becomes tight again, pathogenic cold remains, hence not resolved.
In diarrhea, if pulse is Rapid and thirsty: Spontaneous recovery. If not healed, must pass pus and blood, due to Heat.
[Cheng] Rapid pulse and thirst indicate pathogenic cold has departed and diarrhea should stop. Classic says: If pulse does not resolve and diarrhea continues, it must involve Heat causing pus/blood in stool. This is Heat sinking into Lower Jiao, causing blood flow to rot into pus.
In diarrhea, if pulse is contrary Xian (Wiry), with fever and sweating: Spontaneous recovery.
[Cheng] Wiry pulse indicates Cold. Fever indicates Yang recovery. Sweating indicates Cold pathogen departure. Hence, spontaneous recovery.
[You] Wiry pulse belongs to both Yin and Yang. If seen with fever and sweating, Wiry becomes Yang. Same as Rapid pulse with slight fever/sweating, hence recovery. Note: The above entries describe Shanghan pathogens entering the interior. Thus, either fever, thirst, sweating, or rapid pulse indicates Yang recovery and pathogen emergence leads to recovery. For mixed disease Damp-Heat diarrhea, fever/thirst/rapid pulse are unfavorable signs. *Neijing* says: Diarrhea with body heat is fatal. Zhongjing says: Diarrhea with non-cold extremities and contrary fever is not fatal. *Neijing* refers to mixed disease Damp-Heat diarrhea; Zhongjing refers to Shanghan Yin pathogen entering interior. The two must be distinguished.
In diarrhea with Qi loss (Qi Li), one should promote urination. (Qi, *Maijing* reads Re/Heat.)
[You] Diarrhea with Qi loss means Qi is lost with the diarrhea, known as Qi Li. If urination promotes, Qi moves to Yang and not Yin, leading to recovery. Hence, "should promote urination." Yu Chang's concept of "opening branch rivers urgently" applies here.
In diarrhea, if Cun (Inch) pulse is contrary Fu Shuo (Floating-Rapid), and Chi (Cubit) pulse is Zi Se (Self-Choppy): Must pass pus and blood.
[Xu] If diarrhea is Cold, pulse should be Chen Chi (Deep-Slow). Contrary Fu Shuo indicates Yang victory. Chi pulse being Choppy indicates Yang pathogen entering Yin. This is also Heat-dominant, hence must pass pus/blood. See *Shanghan Lun Jiyi* Jueyin chapter, same for following four entries.
In diarrhea with undigested food (Qing Gu), do not attack the exterior. Sweating will cause abdominal fullness.
[Cheng] Cold fails to digest grain; Cold dominance causes diarrhea with undigested food. If exterior is released via sweating, Stomach Yang becomes more deficient, Cold becomes stronger, causing fullness.
In diarrhea, if pulse is Chen (Deep) and Chi (Slow), face is slightly red, body has slight fever, diarrhea with undigested food: Must experience Yu Mao (Depression/Dizziness) and sweating to resolve. Patient must have slight cold extremities. Reason: Face Dai Yang (Facing Yang/Red face) due to Lower Deficiency. (Case: Jue, Zhao edition reads Re/Heat, incorrect.)
Wang's *Shanghan Lun Bianzhu* states: Deep/Slow pulse in diarrhea indicates Interior Cold. Undigested food indicates severe Interior Cold. Slightly red face and slight fever indicate Lower Jiao deficiency-cold, rootless fire floating upward and outward. Due to slight redness/fever, although Yang is deficient, it can still contend with Yin-Cold. Must experience depression/dizziness and sweating to resolve. Depression/dizziness refers to dizziness in head/eyes, where True Yang Qi defeats Cold pathogen, Interior Yang returns and Exterior harmonizes, hence resolution. Slight cold extremities refer to the state before sweating/depression.