仲景曰。大法。春夏宜发汗。庞氏作春宜汗。
又曰。凡发汗。欲令手足俱周。时出以 然一时间许。益佳。
不可令如水流漓。若病不解。当重发汗。汗多必亡阳。阳虚不得重发
汗也。
又曰。凡服汤发汗。中病便止。不必尽剂也。
又曰。凡云可发汗。无汤者丸散亦可用。要以汗出为解。然不如
汤随证良验。
又曰。太阳病。外证未解。脉浮弱者。当以汗解。宜桂枝汤。
又曰。太阳病。脉浮而数者。可发汗。属桂枝证。（一法用麻黄
汤）雍曰。麻黄桂枝二汤。分恶风恶寒有汗无汗用之。如太阳本证。
庞氏曰。恶寒者不当风而憎寒。恶风者当风而憎寒。皆属表证。
庞氏论桂枝证曰。凡桂枝汤证病有常自汗出。小便不数。手足
温和。或手足指稍露之则微冷。覆之则温。浑身热。微烦而又憎寒。
始可行桂枝汤。若病者身无汗。小便数。或手足厥冷。不恶寒反恶
热。或饮酒后。切不可桂枝汤也。此则中风自汗。用桂枝汤证。又论
麻黄证曰。伤寒之脉紧盛而按之涩是也。脉浮而紧。浮为风。紧为
寒。风伤卫。寒伤营。营卫俱病。骨节烦疼。外证必发热无汗或喘。其
人但憎寒。手足指末必微厥。厥久而复温。掌心不厥。此伤寒无汗用
麻黄证也。
又曰。脉紧必无汗。设有汗。不可误作桂枝证。
仲景曰。阳明病脉迟。汗出多。微恶寒者。表未解也。可发汗。属
桂枝汤。
又曰。病患脉浮大。问病者。言但便硬尔。设利者为逆。大便硬
为实。汗出而解。何以故。脉浮。当以汗解。
又曰。伤寒其脉不弦紧而弱。弱者必渴。被火者必谵语。弱者发
热脉浮。解之当汗出愈。常氏云。可柴胡桂枝汤。渴者。五苓散。被火
谵语者。龙骨牡蛎救逆汤。
又曰。病患烦热。汗出则解。又如疟状。日晡所发潮热者。属阳
明也。脉浮虚者。当发汗。属桂枝汤。
又曰。病常自汗出者。此为营气和。营气和者。外不谐。以卫气
不共营气和谐故尔。以营行脉中。卫行脉外。复发其汗。营卫和则
愈。属桂枝汤。脉经云。病常自汗出。此为营气和。营气和而外不解。
此外卫不和也。营行脉中。为阴主内。卫行脉外。为阳主外。复发其
汗。卫和则愈。雍曰。二者语小异。而理皆通。脉经尤明。恐本论为后
人笔削。盖营气独和而卫气未和也。故其病外不解。营卫二气本相
和。共循脉内外而行也。今寒不伤营而营气独和。风反伤卫而卫气
不和。则营卫不相通。不得谐循脉内外而并行。是以其外不解也。必
复发去卫中所中之邪风。然后营卫谐和而病解矣。所以用桂枝者。
以桂枝能和卫而不能至营也。所以不用麻黄者。以麻黄俱入营卫。
反复动已和无疾之营气。使营卫俱虚。俱出而为汗。遂令汗漏不止。
则人殆矣。此古人解表精微之意。因世人疑营气和而外不解之语。
故详明之。
又曰。病患脏无他病。时发热自汗出而不愈者。此卫气不和也。
先其时发汗则愈。属桂枝汤证。雍曰。前证言营气和而反不及卫。此
证言卫气不和而不及营。其实一证也。但前证谓常发热而汗出者。
此证谓发热汗出有时者。故论言先其时发汗则愈。其用桂枝。则二
证皆同。
又曰。脉浮而紧。浮则为风。紧则为寒。风则伤卫。寒则伤营。营
卫俱病。骨节烦疼。可发其汗。宜麻黄汤。雍曰。此营卫俱伤之证。所
以不用桂枝。
又曰。太阳病不解。热结膀胱。其人如狂。血自下。下者愈。其外
不解者。尚未可攻。当先解外。属桂枝汤。外解已。血未下。少腹急
结。乃可攻之。宜桃核承气汤。
又曰。太阳病微喘者。表未解也。宜桂枝加浓朴杏子汤。
又曰。伤寒脉浮紧。不发汗。因致衄者。属麻黄汤证。
又曰。阳明病脉浮。无汗而喘者。发汗则愈。属麻黄汤证。
又曰。太阳病。脉浮者。可发汗。属桂枝汤证。
又曰。太阳病脉浮紧。无汗。发热身疼痛。八九日不解。表证仍
在。当复发汗。服汤已。微除。其人发烦目瞑。剧者必衄。衄乃解。所
以然者。阳气重故也。属麻黄汤证。雍曰。服汤已者。谓服麻黄汤已
也。衄家不可发汗。而此用麻黄汤。盖久衄之家。既已亡血。故不可
汗。今缘失发其汗致衄。故当泄其毒瓦斯也。
又曰。脉浮者。病在表。可发汗。属麻黄汤。（一云用桂枝汤）雍
曰。亦分中风伤寒有汗无汗二证。而用桂枝麻黄二汤也。
又曰。伤寒不大便六七日。头痛有热者。与承气汤。其小便清
者。知不在里。仍在表也。当须发汗。若头痛者。必衄。属桂枝汤。常
氏云。疑其误也。设须发汗。当用麻黄汤。不然。用桂枝麻黄各半汤
取小小汗出而已。雍曰。亦当分有汗无汗二证而用汤也。其小便清
者。知不在里。故不用承气汤而用二汤也。
又曰。下利腹胀满。身体疼痛者。先温其里。乃攻其表。温里宜
四逆汤。攻表宜桂枝汤。雍曰。下利。里证。身疼痛。表证也。
又曰。下利后。身疼痛。清便自调者。急当救表。宜桂枝汤。雍
曰。可与前证相续。
又曰。太阳病。头痛发热。汗出恶风者。属桂枝汤。
又曰。太阳中风。阳浮而阴弱。阳浮者。热自发。阴弱者。汗自
出。啬啬恶寒。淅淅恶风。翕翕发热。鼻鸣干呕者。属桂枝汤证。
又曰。太阳病。发热汗出者。此为营弱卫强。故使汗出。欲救邪
风。宜桂枝汤证。雍曰。营弱者。自和也。卫强者。风邪乘之也。欲逐
风邪。须令桂枝入卫。则不动营也。
又曰。太阳病下之后。其气上冲者。属桂枝汤。脉经云。气不上
冲者。不可与服。
又曰。太阳病。初服桂枝汤。反烦不解者。先刺风池风府。却与
桂枝汤则愈。庞氏曰。风池足少阳之经。阳维之会。不针天柱而取
风池者。阳维维诸阳。巨阳为诸阳主气故也。
又曰。烧针令其汗。针处被寒。核起而赤者。必发奔豚。气从小
腹上抢心者。灸其核上各一壮。与桂枝加桂汤。
又曰。太阳病。项背强KT KT 。无汗恶风者。葛根汤主之。
又曰。太阳与阳明合病。必自下利。不呕者。属葛根汤。
又曰。太阳与阳明合病。不下利。但呕者。宜葛根加半夏汤。
又曰。太阳病桂枝证。医反下之。利遂不止。脉促者。表未解也。
喘而汗出者。宜葛根黄芩黄连汤。
又曰。太阳病。头痛发热。身疼腰痛。骨节疼痛。恶风。无汗而喘
者。属麻黄证。庞氏云。身疼痛骨节烦疼。凡脉浮数或脉浮紧。无汗。
小便不数。病虽十余日。尚宜麻黄汤也。
又曰。太阳与阳明合病。喘而胸满者。不可下也。属麻黄汤证。
又曰。太阳中风。脉浮紧。发热恶寒。身疼痛。不汗出而烦躁。或
头痛者。大青龙汤主之。若脉微弱。汗出恶风者。不可服之。服之则
厥逆。筋惕肉 。此为逆也。
又曰。伤寒脉浮缓。身不疼。但重。乍有轻时。无少阴证者。可与
大青龙汤发之。雍曰。大青龙汤惟有此二证最为难识。故世医多不能
辨。用之亦多误也。前曰太阳中风脉浮紧者。此即中风见寒脉也。后
曰太阳伤寒脉浮缓者。此则伤寒见风脉也。庞氏曰。似桂枝证。反无
汗而脉紧。似麻黄汤证。反身不疼而脉缓。此为大青龙证。其言皆不
难知。其要则在太阳中风脉浮紧。太阳伤寒脉浮缓而已。然大青龙
发汗。过于麻黄汤远甚。如中风见寒脉汗不出者。尚可用。设或中风
见寒脉自汗出者。安敢更用青龙汤发表。故仲景又曰。若脉微弱汗
出恶风者。不可服之。服之则厥逆。筋惕肉 。此为逆也。盖谓服之
则汗漏不已。至于亡阳之极。则必厥逆而生筋惕肉 之证。不可治
也。世医所以多误用者。正谓此。如是则大青龙之证。又当于中风见
寒脉之中。再分有汗无汗。作为两证。则大青龙当有三证。其两证无
汗者。可服大青龙。其一证有汗者。不可服也。有汗一证。既不可服
大青龙汤。则有证无药矣。自仲景之后。古今未尝议此一证。所以后
人多误。雍谓此一证。当用桂枝麻黄各半汤。仲景本以此汤治发热
恶寒形如疟者。且疟之发寒本因伤于寒。疟之发热本因伤于风。惟
疟具风寒二证。故与大青龙其源相似。但恐病重药轻。雍又妄意大
青龙三证。皆可代用。惟无汗者。微加麻黄。有汗者。微减麻黄。用之
则尤善。虽曰药轻。其实对证。又无误用之失。不犹愈乎。庞氏云。桂
枝石膏汤夏至后可代桂枝证用之。更加麻黄去节半两代麻黄汤青
龙汤用之。然言无少阴证可用者。三阴俱不可发汗。独少阴为甚也。
又曰。伤寒表不解。心下有水气。干呕发热而咳。或渴。或利。或
噎。或小便不利少腹满。或喘者。宜小青龙汤。
又曰。伤寒。心下有水气。咳而微喘。发热不渴。服汤已渴者。此
寒去欲解也。属小青龙汤证。
又曰。阳明中风。脉弦浮大而短气。腹都满。胁下及心痛。久按
之。气不通。鼻干不得汗。嗜卧。一身及目悉黄。小便难。有潮热。时
时哕。耳前后肿。刺之小瘥。外不解。病过十日。脉续浮者。与小柴胡
汤。脉但浮。无余证者。与麻黄汤。若不溺。腹满加哕者。不治。雍曰。
发黄不溺而哕者。宜多服茵陈五苓散大通小便。若无表证。脉不浮。
则十枣汤下之。
又曰。太阳病。十日以去。脉浮细而嗜卧者。外已解也。设胸满
胁痛者。与小柴胡汤。脉但浮者。与麻黄汤。
又曰。中风。往来寒热。伤寒五六日以后。胸胁苦满。默默不欲
饮食。心烦喜呕。或胸中烦而不呕。或渴。或腹中痛。或胁下痞硬。或
心下悸小便不利。或不渴身有微热。或咳者。属小柴胡汤。
又曰。伤寒四五日。身热恶风。颈项强。胁下满。手足温而渴者。
属小柴胡汤证。
又曰。伤寒六七日。发热。微恶寒。支节烦疼。微呕。心下支结。
外证未去者。柴胡桂枝汤主之。
又曰。少阴病。得之二三日。麻黄附子甘草汤微发汗。以二三日
无里证。故微发汗也。雍曰。少阴病不可汗。惟此一证。可微发也。
又曰。脉浮。小便不利。微热消渴者。与五苓散利小便发汗。
又曰。太阳病下后。脉促胸满者。桂枝去芍药汤主之。庞氏曰。
芍药味酸。脉促胸满。成结胸。故去芍药。全用甘辛发散毒瓦斯也。
又曰。服桂枝汤或下之。仍头痛项强。翕翕发热。无汗。心下满
微痛。小便不利者。桂枝去桂加茯苓白术汤主之。
庞氏曰。伤寒三日后。与诸汤不瘥。脉势如故。阳气犹在经络。
未入脏腑。宜桂枝石膏汤。此汤可夏至后代桂枝汤证用之。若加麻
黄半两。可代麻黄青龙用之。
又曰。伤寒疗治四五日不瘥。身体毒热面赤者。葛根龙胆汤主
之。兼治阳毒风温。
又曰。凡发散以辛甘为主。复用此苦药。何也。辛甘者。折阴气
而助阳气也。今热盛于表。故加苦以发之。素问云。热淫于内。以苦
发之是也。
又曰。时行热病。六七日未得汗。脉洪大或数。面目赤。身体大
热。烦躁。狂语欲走。大渴甚。又五六日以上不解。热在胃中。口噤不
能言。为坏伤寒。医所不能治。如已死人。或精魄已竭。心下才暖。发
开其口。灌药下咽即活。兼治阳毒。麦奴丸。（活人书名黑奴丸）
又蒸法曰。伤寒连服发汗汤七八剂。汗不出者死。如中风法蒸
之。使温热之气外迎。无不得汗也。古今用效。薪火烧地良久。去火
扫地。以水洒之。取蚕沙柏桃荆叶糠及麦麸皆可用。和铺烧地上。可
侧手浓。铺席。令人卧席上。温覆之。热月只可夹被覆。其汗立出。候
周身至脚心皆 。乃用温粉扑止。移之上床即愈。如无蚕沙。则用
麦麸之类亦得。雍曰。此即千金所载陈廪邱法。已见首篇叙论之后。
不厌重出也。
又曰。伤寒瘥后。有不了了证者。谓至十日或半月二十日。终不
惺惺。常昏沉似失精神。言语错缪。或无寒热。有似鬼祟。或朝夕潮
热颊赤。或有寒热如疟状。此乃发汗不尽。余毒瓦斯在心胞络间可致
也。宜知母麻黄汤。
又曰。太阳病下之后。气上卫。其脉必浮。可根据证发汗。不与发
汗。则成结胸也。凡发汗。脉浮大。虽大便秘小便少者。可发汗而解
也。
又曰。当汗不汗。诸毛孔闭塞。闷绝而死。
Zhang Zhongjing said: The general principle is that in spring and summer, it is appropriate to use the sweating method (Fa Han). Pang Anshi expressed this as "spring is suitable for sweating."
He also said: Whenever using the sweating method, one should ensure that sweat comes out evenly throughout the hands and feet, lasting for about the time it takes to eat a meal; this is better.
One should not let sweat flow profusely like water. If the disease does not resolve, one should induce sweating again. However, excessive sweating will inevitably deplete Yang Qi (Wang Yang). Those with deficient Yang Qi must not be induced to sweat again.
He also said: Whenever taking herbal decoctions to induce sweating, stop administering the medicine once the illness is cured; there is no need to finish the entire dose.
He also said: For conditions where sweating is indicated, if a decoction is unavailable, pills or powders may also be used, provided that sweating occurs and the condition resolves. However, this is not as effective as decoctions tailored to specific patterns.
He also said: In Taiyang disease (disease of the Taiyang channel), if exterior symptoms persist and the pulse is floating and weak, the exterior should be resolved through sweating, preferably using Guizhi Tang (Cinnamon Twig Decoction).
He also said: In Taiyang disease, if the pulse is floating and rapid, sweating may be induced; this belongs to the Guizhi Tang pattern. (Another method uses Mahuang Tang Ephedra Decoction). Guo Yong stated: The distinction between Mahuang Tang and Guizhi Tang lies in differentiating wind aversion vs. cold aversion, and presence vs. absence of sweating. Regarding the primary Taiyang pattern...
Pang Anshi said: Cold aversion (E Han) refers to feeling cold even without exposure to wind; wind aversion (E Feng) refers to feeling cold only when exposed to wind. Both belong to exterior patterns.
Pang Anshi discussed the Guizhi Tang pattern: Patients with this pattern typically exhibit spontaneous sweating, normal urinary frequency, warm hands and feet, or slightly cold fingers when exposed but warming when covered, generalized fever, slight irritability, and aversion to cold. Only then should Guizhi Tang be administered. If the patient has no sweating, frequent urination, cold extremities, aversion to heat rather than cold, or has consumed alcohol, Guizhi Tang must absolutely not be used. This describes spontaneous sweating due to wind-stroke, which fits the Guizhi Tang pattern. He further discussed the Mahuang Tang pattern: In Shanghan (cold damage), a tight and full pulse that feels rough upon pressure indicates the Mahuang Tang pattern. A floating pulse indicates wind, while a tight pulse indicates cold. Wind injures the Wei (Defensive) Qi, and cold injures the Ying (Nutritive) Blood. When both Ying and Wei are affected, there is severe joint pain, and exterior symptoms necessarily include fever, absence of sweating, or wheezing. The patient feels only cold aversion, and the fingertips are slightly cold (Jue), though they warm up after a while, while the palms remain warm. This describes cold damage with no sweating, fitting the Mahuang Tang pattern.
He also said: A tight pulse invariably indicates absence of sweating. If sweating is present despite a tight pulse, it must not be mistaken for the Guizhi Tang pattern.
Zhang Zhongjing said: In Yangming disease, if the pulse is slow, there is abundant sweating, and slight cold aversion, the exterior remains unresolved. Sweating may be induced, fitting the Guizhi Tang pattern.
He also said: If a patient's pulse is floating and large, and upon inquiry, the patient reports only hard stools, this is excess. If diarrhea were present, it would be a adverse sign. Hard stools indicate excess; resolving through sweating leads to recovery. Why? Because a floating pulse indicates the need for sweating to resolve the exterior.
He also said: In Shanghan, if the pulse is neither wiry nor tight but weak, thirst will likely occur. If treated with fire therapy, delirium will ensue. If the pulse is weak, feverish, and floating, resolution comes through sweating. Chang Qizi suggested Chaihu Guizhi Tang. For thirst, Wuling San is indicated. For delirium caused by fire therapy, Longgu Muli Jiuni Tang is indicated.
He also said: If a patient suffers from irritability and heat, which resolve with sweating, or presents with malaria-like symptoms and tidal fever at dusk (Shen hour), this belongs to Yangming disease. If the pulse is floating and deficient, sweating should be induced, fitting the Guizhi Tang pattern.
He also said: If a patient frequently sweats spontaneously, it is because the Ying (Nutritive) Qi is harmonious. Harmonious Ying Qi implies disharmony externally, specifically that the Wei (Defensive) Qi fails to coordinate with the Ying Qi. Ying Qi circulates within the vessels, while Wei Qi circulates outside. Inducing sweating again allows Ying and Wei to harmonize, leading to recovery; this fits the Guizhi Tang pattern. The *Mai Jing* states: Frequent spontaneous sweating indicates harmonious Ying Qi. With harmonious Ying Qi but unresolved exterior symptoms, it is Wei Qi disharmony. Ying Qi is Yin, governing the interior; Wei Qi is Yang, governing the exterior. Inducing sweating again harmonizes Wei Qi, leading to recovery. Guo Yong commented: These two statements differ slightly in wording but share the same logic; the *Mai Jing* is clearer. It is likely the original text was edited by later scholars. Perhaps the Ying Qi alone is harmonized while the Wei Qi is not. Thus, the exterior remains unresolved. Originally, Ying and Wei Qi harmonize and circulate together inside and outside the vessels. Now, cold does not injure the Ying, so Ying Qi remains harmonious alone; wind injures the Wei, causing Wei Qi disharmony. Consequently, Ying and Wei do not communicate or circulate harmoniously together. Therefore, the exterior symptoms persist. One must induce sweating again to expel the pathogenic wind from the Wei Qi, allowing Ying and Wei to harmonize and the disease to resolve. Guizhi is used because it can harmonize Wei Qi but cannot reach the Ying level. Mahuang is not used because it enters both Ying and Wei, repeatedly disturbing the already harmonious Ying Qi, causing both to become deficient and exit as sweat, leading to unceasing leakage and endangering life. This reflects the subtle intent of ancient masters in resolving the exterior. Detailed explanation is provided because people doubt the phrase "Ying Qi is harmonious yet the exterior is unresolved."
He also said: If a patient has no internal organ pathology but experiences periodic fever and spontaneous sweating without resolution, this is due to Wei Qi disharmony. Inducing sweating before the onset of fever leads to recovery; this fits the Guizhi Tang pattern. Guo Yong commented: The previous statement described harmonious Ying Qi failing to extend to Wei Qi; this statement describes disharmonious Wei Qi failing to extend to Ying Qi. Essentially, it is the same pattern. The former refers to constant fever and sweating; the latter refers to fever and sweating occurring at specific times. Hence, the text advises inducing sweating before the onset. The use of Guizhi is identical for both.
He also said: A floating and tight pulse indicates wind and cold respectively. Wind injures Wei Qi, and cold injures Ying Qi. With both Ying and Wei affected and severe joint pain, sweating may be induced using Mahuang Tang. Guo Yong commented: This is a pattern of simultaneous injury to Ying and Wei, hence Guizhi Tang is not used.
He also said: If Taiyang disease persists and heat accumulates in the Bladder, the patient may appear manic. If blood passes spontaneously, the patient recovers. If exterior symptoms remain, internal attack is contraindicated; the exterior must be resolved first using Guizhi Tang. Once the exterior is resolved and blood has not passed, if there is urgency and binding in the lower abdomen, internal attack may proceed using Taohao Chengqi Tang.
He also said: In Taiyang disease with mild wheezing, the exterior is unresolved; Guizhi Jia Houpo Xingzi Tang is indicated.
He also said: In Shanghan with a floating-tight pulse, failure to induce sweating may lead to epistaxis; this fits the Mahuang Tang pattern.
He also said: In Yangming disease with a floating pulse, absence of sweating, and wheezing, inducing sweating leads to recovery; this fits the Mahuang Tang pattern.
He also said: In Taiyang disease with a floating pulse, sweating may be induced; this fits the Guizhi Tang pattern.
He also said: In Taiyang disease with a floating-tight pulse, absence of sweating, fever, and body pain persisting for eight to nine days without resolution, if exterior signs remain, sweating should be induced again. After taking the decoction, symptoms may slightly subside. The patient may feel irritable and wish to close their eyes; severe cases will experience epistaxis, after which the disease resolves. This occurs because Yang Qi is heavily constrained. This fits the Mahuang Tang pattern. Guo Yong commented: "After taking the decoction" refers to taking Mahuang Tang. Patients prone to epistaxis should not be induced to sweat, yet Mahuang Tang is used here because the epistaxis resulted from delayed sweating, so the toxic vapors must be vented.
He also said: A floating pulse indicates an exterior disease; sweating may be induced, fitting the Mahuang Tang pattern. (Some say Guizhi Tang). Guo Yong commented: This also distinguishes between wind-stroke and cold damage, and presence vs. absence of sweating, guiding the choice between Guizhi Tang and Mahuang Tang.
He also said: In Shanghan with constipation for six to seven days, headache, and fever, administer Chengqi Tang. If urine is clear, the disease is not in the interior but remains in the exterior, requiring sweating. If headache is present, epistaxis will likely occur; this fits the Guizhi Tang pattern. Chang Qizi suspected an error, suggesting Mahuang Tang if sweating is needed, or Guizhi Mahuang Ban Tang for mild sweating. Guo Yong commented: One must distinguish between sweating and non-sweating patterns. Clear urine indicates the disease is not in the interior, hence Chengqi Tang is avoided in favor of the other two formulas.
He also said: In cases of diarrhea with abdominal fullness and body pain, first warm the interior, then attack the exterior. Si Ni Tang warms the interior; Guizhi Tang attacks the exterior. Guo Yong commented: Diarrhea is an interior sign; body pain is an exterior sign.
He also said: After diarrhea, if body pain persists but bowel movements and urination are normal, urgently rescue the exterior using Guizhi Tang. Guo Yong commented: This follows the previous case.
He also said: In Taiyang disease with headache, fever, sweating, and wind aversion, this fits the Guizhi Tang pattern.
He also said: In Taiyang wind-stroke, the pulse is floating on the surface and weak on the interior. Floating indicates spontaneous fever; weak indicates spontaneous sweating. With chills, wind aversion, mild fever, nasal congestion, and dry vomiting, this fits the Guizhi Tang pattern.
He also said: In Taiyang disease with fever and sweating, this is due to weak Ying Qi and strong Wei Qi, causing sweating. To rescue against pathogenic wind, Guizhi Tang is indicated. Guo Yong commented: Weak Ying Qi means it is self-harmonious; strong Wei Qi means wind pathogens have invaded. To expel wind, Guizhi must enter the Wei level without disturbing the Ying Qi.
He also said: After purgation in Taiyang disease, if Qi rushes upward, this fits the Guizhi Tang pattern. The *Mai Jing* states: If Qi does not rush upward, do not administer it.
He also said: In Taiyang disease, if initial administration of Guizhi Tang causes increased irritability without resolution, first needle Fengchi and Fengfu points, then administer Guizhi Tang for recovery. Pang Anshi commented: Fengchi is a point on the Foot-Shaoyang Gallbladder channel and a meeting point of the Yang Linking Vessel. We needle Fengchi instead of Tianzhu because the Yang Linking Vessel connects all Yang channels, and the Taiyang channel governs all Yang Qi.
He also said: If moxibustion needles induce sweating, but the puncture sites become cold and develop red nodules, Ben Tun (fleeing pig) disease will occur, with Qi rushing from the lower abdomen to the heart. Apply one moxa cone to each nodule and administer Guizhi Jia Gui Tang.
He also said: In Taiyang disease with stiffness in the neck and back, absence of sweating, and wind aversion, Gegen Tang is the primary treatment.
He also said: In combined Taiyang and Yangming disease with spontaneous diarrhea and no vomiting, this fits the Gegen Tang pattern.
He also said: In combined Taiyang and Yangming disease without diarrhea but with vomiting, Gegen Jia Banxia Tang is indicated.
He also said: In Taiyang disease with a Guizhi pattern, if the physician incorrectly uses purgation, leading to persistent diarrhea and a rapid pulse indicating unresolved exterior, with wheezing and sweating, Gegen Huangqin Huanglian Tang is indicated.
He also said: In Taiyang disease with headache, fever, body and waist pain, joint pain, wind aversion, absence of sweating, and wheezing, this fits the Mahuang Tang pattern. Pang Anshi added: For body/joint pain with floating-rapid or floating-tight pulses, absence of sweating, and normal urination, even after ten days, Mahuang Tang is still appropriate.
He also said: In combined Taiyang and Yangming disease with wheezing and chest fullness, purgation is contraindicated; this fits the Mahuang Tang pattern.
He also said: In Taiyang wind-stroke with a floating-tight pulse, fever, cold aversion, body pain, absence of sweating, and irritability, or headache, Da Qinglong Tang is the primary treatment. If the pulse is weak, with sweating and wind aversion, it is contraindicated. Administration would cause cold limbs and muscle twitching, which is an adverse reaction.
He also said: In Shanghan with a floating-slow pulse, body heaviness without pain (which occasionally lightens), and no Shaoyin signs, Da Qinglong Tang may be used to induce sweating. Guo Yong commented: Da Qinglong Tang is most difficult to identify in these two patterns, leading to frequent misdiagnosis by physicians. The earlier mention of wind-stroke with a floating-tight pulse represents wind-stroke presenting with cold signs. The later mention of cold damage with a floating-slow pulse represents cold damage presenting with wind signs. Pang Anshi noted: It resembles Guizhi Tang pattern but lacks sweating and has a tight pulse; it resembles Mahuang Tang pattern but lacks body pain and has a slow pulse. This is the Da Qinglong Tang pattern. The key lies in recognizing wind-stroke with floating-tight pulse and cold damage with floating-slow pulse. However, Da Qinglong Tang induces sweating much more vigorously than Mahuang Tang. If wind-stroke presents with cold signs and no sweating, it may be used. But if wind-stroke presents with cold signs and spontaneous sweating, Da Qinglong Tang must absolutely not be used. Zhang Zhongjing therefore warned: If the pulse is weak, with sweating and wind aversion, do not administer it. Doing so causes cold limbs and muscle twitching due to extreme Yang depletion from unceasing sweating, which is untreatable. Physicians err because of this. Thus, the Da Qinglong Tang pattern should be subdivided within "wind-stroke with cold signs" into sweating and non-sweating categories, creating three total patterns. The two non-sweating patterns may take Da Qinglong Tang; the one sweating pattern must not. Since there is no formula for the sweating pattern in the original text, Guo Yong suggests using Guizhi Mahuang Ban Tang. Zhang Zhongjing originally used this for fever/chills resembling malaria. Malaria involves both wind and cold, similar to Da Qinglong Tang's origin. Guo Yong speculates that all three Da Qinglong patterns could be treated with modified versions: adding slight amounts of Mahuang for non-sweating cases, and reducing Mahuang for sweating cases. Pang Anshi mentioned Guizhi Shigao Tang could replace Guizhi Tang after the Summer Solstice, and adding half a liang of Mahuang could replace Mahuang Tang or Qinglong Tang, provided there are no Shaoyin signs, as Shaoyin is the most critical channel to avoid sweating.
He also said: In Shanghan with unresolved exterior and fluid retention in the Heart, accompanied by dry heaving, fever, and cough, or thirst, diarrhea, dysphagia, difficulty urinating with lower abdominal fullness, or wheezing, Xiao Qinglong Tang is indicated.
He also said: In Shanghan with fluid retention in the Heart, cough, mild wheezing, fever, and no thirst, if thirst develops after taking the decoction, it indicates the cold is departing and the disease is resolving; this fits the Xiao Qinglong Tang pattern.
He also said: In Yangming wind-stroke with wiry-floating-large pulse, shortness of breath, abdominal fullness, hypochondriac and heart pain, obstruction upon pressure, dry nose with no sweating, lethargy, jaundice of the whole body and eyes, difficulty urinating, tidal fever, occasional hiccups, and swelling around the ears, acupuncture provides slight relief. If exterior symptoms persist beyond ten days and the pulse remains floating, administer Xiao Chaihu Tang. If the pulse is merely floating without other symptoms, administer Mahuang Tang. If there is no urination, abdominal fullness, and hiccups, the condition is untreatable. Guo Yong commented: For jaundice with no urination and hiccups, administer Yinchen Wuling San to promote urination. Without exterior signs and with a non-floating pulse, Shizao Tang may be used to purge.
He also said: In Taiyang disease after ten days, if the pulse is floating-thin and the patient desires sleep, the exterior has resolved. If there is chest fullness and hypochondriac pain, administer Xiao Chaihu Tang. If the pulse is merely floating, administer Mahuang Tang.
He also said: In wind-stroke with alternating chills and fever, or in Shanghan after five to six days, with chest/hypochondriac fullness, silent desire not to eat, irritability, and frequent vomiting, or chest irritability without vomiting, thirst, abdominal pain, hypochondriac hardness, palpitations with difficulty urinating, no thirst with slight fever, or cough, this fits the Xiao Chaihu Tang pattern.
He also said: In Shanghan after four to five days, with body heat, wind aversion, neck stiffness, hypochondriac fullness, warm hands/feet, and thirst, this fits the Xiao Chaihu Tang pattern.
He also said: In Shanghan after six to seven days, with fever, slight cold aversion, limb/joint pain, mild vomiting, and partial constriction in the epigastrium, with unresolved exterior symptoms, Chaihu Guizhi Tang is the primary treatment.
He also said: In Shaoyin disease acquired two to three days prior, Mahuang Fuzi Gancao Tang induces mild sweating because there are no interior signs after two to three days. Guo Yong commented: Shaoyin disease generally prohibits sweating, but this single pattern allows mild sweating.
He also said: With a floating pulse, difficulty urinating, slight fever, and polydipsia, Wuling San is administered to promote urination and induce sweating.
He also said: After purgation in Taiyang disease with a rapid pulse and chest fullness, Guizhi Qu Shaoyao Tang is the primary treatment. Pang Anshi commented: Shaoyao is sour; a rapid pulse and chest fullness risk forming Jie Xiong (chest binding), so Shaoyao is removed to rely entirely on sweet and acrid herbs to disperse toxicity.
He also said: After taking Guizhi Tang or purgatives, if headache, neck stiffness, mild fever, absence of sweating, epigastric fullness with slight pain, and difficulty urinating persist, Guizhi Qu Gui Jia Fuling Baizhu Tang is the primary treatment.
Pang Anshi commented: After three days of Shanghan, if various decoctions fail and the pulse remains unchanged, with Yang Qi still in the meridians and not entering the organs, Guizhi Shigao Tang is indicated. This can replace Guizhi Tang after the Summer Solstice. Adding half a liang of Mahuang allows it to replace Mahuang Tang or Qinglong Tang.
He also said: If Shanghan persists after four to five days of treatment, with toxic heat in the body and red face, Gegen Longdan Tang is the primary treatment. It also treats Yang Du (Yang Toxicity) and Feng Wen (Wind Warmth).
He also said: Dispersing agents primarily use acrid and sweet herbs. Why add bitter herbs? Acrid and sweet reduce Yin Qi and assist Yang Qi. Since heat is abundant in the exterior, bitter herbs are added to disperse it. The *Su Wen* states: "When heat invades internally, disperse it with bitter herbs."
He also said: In epidemic febrile diseases, if after six to seven days there is no sweating, with a洪大 (surging-large) or rapid pulse, red face/eyes, high body heat, irritability, delirium, restlessness, severe thirst, and unresolved heat in the stomach causing locked jaw and inability to speak, this is "Bad Shanghan" (complicated cold damage), untreatable by doctors, resembling death. If the spirit is exhausted but the epigastrium is still warm, pry open the mouth, administer medicine, and the patient may revive. This also treats Yang Du using Maidu Wan (Black Slave Pill in *Huo Ren Shu*).
He also described steaming therapy: If Shanghan patients take sweating decoctions for seven to eight doses without sweating, they die. Steaming them like wind-stroke patients, inviting warm qi from outside, ensures sweating. Ancient methods involve heating earth with firewood, sweeping it clean, sprinkling water, and spreading mulberry leaves, peach leaves, thorn branches, bran, and wheat chaff on the hot ground to a thickness of a hand. The patient lies on a mat covered warmly. In hot months, a quilt suffices. Sweat appears immediately. Once sweat reaches the soles of the feet, apply warm powder to stop sweating. Move the patient to bed for recovery. If mulberry leaves are unavailable, wheat chaff works. Guo Yong commented: This is the Chen Linqiu method recorded in *Qian Jin Fang*, already cited in the introduction; repetition is unnecessary.
He also said: After Shanghan recovery, lingering symptoms ("Bu Liao Liao") may persist for ten days to twenty days, with confusion, loss of spirit, erratic speech, or symptoms resembling ghost possession, tidal fever, flushed cheeks, or malaria-like chills/fever. This results from incomplete sweating leaving residual toxic vapors in the Pericardium collaterals. Zhimu Mahuang Tang is indicated.
He also said: After purgation in Taiyang disease, if Qi rises to the Wei level and the pulse becomes floating, sweating may be induced according to the pattern. Failure to sweat leads to Jie Xiong (chest binding). Generally, if the pulse is floating-large, even with constipation and low urine output, sweating resolves the condition.
He also said: If sweating is indicated but withheld, pore closure leads to suffocation and death.