又曰。二阳并病。太阳初得病时。发其汗。汗先出不彻。因转属
阳明。续自微汗出。不恶寒。若太阳病证不罢者。不可下。下之为逆。
如此可小发汗。设面色缘缘正赤者。阳气怫郁在表。当解之熏之。若
发汗不彻。不足言。阳气怫郁不得越。当汗不汗。其人躁烦。不知痛
处。乍在腹中。乍在四肢。按之不可得。其人短气。但坐。以汗出不彻。
故也。更发汗则愈。何以知汗不彻。以脉涩。故知之。庞氏云。宜麻黄汤。雍曰。庞氏在阳明。以古本差误。仍改本。
又曰。脉浮数者。法当汗出而愈。若下之。身重心悸者。不可发
汗。当自汗出乃解。所以然者。尺中脉微。此里虚。须表里实。津液自
和。便自汗出愈。常器之云。汗不出者。可与小柴胡汤。雍曰。若心下
悸而烦。宜小建中汤。表里俱虚。宜桂枝麻黄各半汤。设若用柴胡和
解。亦宜用柴胡桂枝和其营卫以通津液。此证是下后里虚。故仲景
待其气复。津液自和而汗出。不必更用药。此一证。非有证无治。其
不用药。便是治法也。常氏必欲和解之。疑其用药太重。故雍以柔剂
少杀其力。庶几得中。要之能少忍。待其自和。从仲景不用药法为上也。
又曰。脉浮紧者。法当身疼痛。宜以汗解之。（谓发汗也）假令尺
中迟者。不可发汗。何以知其然。以营气不足。血少故也。雍曰。此一
证与前证略相似。宜小建中汤。次则柴胡桂枝汤。又不若待其别见
证而治之。盖前证是下后证。当无别证出。故仲景不用药。此证是汗
前证。须别有证出。故不若少待之。既知血少。不可便用小柴胡汤也。
又曰。脉浮者。病在表。可发汗。宜麻黄汤。
又曰。脉浮而数者。可发汗。宜麻黄汤。
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。
又曰。病常自汗出者。此为营气和。营气和者外不谐。以卫气不
共营气和谐故耳。以营行脉中。卫行脉外。复发其汗。营卫和则愈。
宜桂枝汤。
问曰。营气既和。何为自汗出也。雍曰。平人营卫之气。常自和
也。设卫中于风。而营不中于寒。是卫有邪气。而营无邪气也。有邪
气者强。无邪气者弱。一强一弱。故营不得与卫气谐和而独和。则卫
气无所根据。以 悍无所根据之气。又以邪气济之。两气盈溢。溪谷不能
容。营深而卫浅。故卫气于皮肤间。不得内合于营。而外见隙穴。则
出为自汗也。用桂枝解其肌。则卫之邪气去。卫无邪气。则其气自
衰。自然还内与营和而汗止矣。
仲景曰。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。宜桂枝汤主之。
又曰。伤寒脉浮紧。不发汗。因致衄者。麻黄汤主之。
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。不可与之。当须发汗。若头痛者。必衄。宜
桂枝汤。常器之云。或疑其误也。设须发汗。当用麻黄汤。不然。用桂
枝麻黄各半汤。取其小小汗出而已。雍曰。仲景书。桂枝无治衄法。
麻黄有治衄法。故此一证。常氏疑其有误而改用麻黄也。设若头不
痛。则不衄。不衄则不可用麻黄。故宜桂枝麻黄各半汤。取小汗而
已。更宜以有汗无汗决之。仲景书安得无传写之误也。
又曰。伤寒发汗。解。半日许。复烦。其脉浮数者。可更发汗。宜
桂枝汤主之。雍曰。须言半日许者。以过此而复烦。即属劳复。不用
桂枝汤也。
又曰。凡病。若发汗。若吐。苦下。若亡血亡津液。阴阳自和者。
必自愈。雍曰。言凡者。不止谓伤寒也。若伤寒未和者。少待其和。或
须药。可柴胡桂枝汤少与之。不必用小柴胡也。
又曰。大下之后。复发汗。小便不利者。亡津液故也。勿治之。得
小便利者。必自愈。雍曰。不必更以药利其小便。自待其通则愈。
又曰。下之后。复发汗。必振寒。脉微细。所以然者。以内外俱虚
故也。常氏曰。素无热人。可与芍药附子汤。有热人。可与黄 建中
汤。
又曰。下之后。复发汗。昼日烦躁不得眠。夜而安静。不呕不渴。
无表证。脉沉微。身无大热者。干姜附子汤主之。
又曰。发汗后。身疼痛。脉沉迟者。桂枝加芍药生姜各一两人参
三两新加汤主之。
又曰。发汗后。不可更行桂枝汤。汗出而喘。无大热者。可与麻
黄杏子甘草石膏汤主之。
又曰。发汗后。其人脐下悸者。欲作奔豚。茯苓桂枝甘草大枣汤
主之。
又曰。发汗过多。其人叉手自冒心。心下悸。欲得按者。桂枝甘
草汤主之。
又曰。发汗后。腹胀满者。浓朴生姜半夏甘草人参汤主之。
又曰。伤寒。若吐若下后。心下逆满。气上冲胸。起则头眩。脉沉
紧。发汗则动经。身为振振摇者。茯苓桂枝白术甘草汤主之。
又曰。发汗。病不解。反恶寒者。虚故也。芍药甘草附子汤主之。
又曰。发汗。若下之。病仍不解。烦躁者。茯苓四逆汤主之。
又曰。发汗后。恶寒者。虚故也。不恶寒。但热者。实也。当和胃
气。与调胃承气汤。雍曰。虚者。芍药甘草附子汤。
又曰。太阳病。发汗后。大汗出。胃中干。烦躁不得眠。欲得饮水
者。少少与饮之。令胃气和则愈。若脉浮。小便不利。微热消渴者。五
苓散主之。
又曰。发汗已。脉浮数。烦渴者。五苓散主之。
又曰。伤寒汗出而渴者。五苓散主之。不渴者。茯苓甘草汤主之。
又曰。中风发热。六七日不解而烦。有表里证。渴欲饮水。水入
则吐者。名曰水逆。五苓散主之。
又曰。未持脉时。病患叉手自冒心。师因教试令咳。而不咳者。
此必两耳聋无闻也。所以然者。以重发汗。虚故如此。常器之云。素
无热人。可与芍药附子汤。素有热人。可与黄 建中汤。
又曰。发汗后。饮水多。必喘。以水灌之。亦喘。常云。可与麻黄
杏子甘草石膏汤。
又曰。发汗后。水药不得入口为逆。若更发汗。必吐下不止。常
云。可与半夏茯苓汤。
又曰。发汗吐下后。虚烦不得眠。若剧者。必反复颠倒。心中懊
。栀子豉汤主之。若少气者。栀子甘草豉汤主之。若呕者。栀子生
姜豉汤主之。
又曰。发汗。若下之。而烦热。胸中窒者。栀子豉汤主之。
又曰。伤寒五六日。大下之后。身热不去。心中结痛者。未欲解
也。栀子豉汤主之。
又曰。伤寒下后。心烦腹满。卧起不安者。栀子浓朴汤主之。
又曰。凡用栀子汤。病患旧微溏者。不可与服之。
又曰。太阳病发汗。汗出不解。其人仍发热。心下悸。头眩。身
动。振振欲擗地者。真武汤主之。
又曰。咽喉干燥者。不可发汗。常氏云。可与小柴胡汤。
又曰。疮家虽身疼痛。不可发汗。汗出则 。常氏云。可小柴胡汤。
又曰。淋家不可发汗。发汗必便血。
又曰。衄家不可发汗。汗出。必额上陷。脉急紧。直视。不能 。不得眠。常氏云。可犀角地黄汤。
又曰。亡血家不可发汗。发汗则寒 而振。常氏云。可与芍药地黄汤。
又曰。汗家重发汗。必恍惚心乱。小便已。阴疼。与禹余粮丸。方
本阙。常氏云。禹余粮石一味。火 散服亦可。雍曰。用禹余粮不用石。石乃壳也。
又曰。病患有寒。复发汗。胃中冷。必吐蛔。常氏云。可服乌梅丸。雍曰。宜服理中丸。
又曰。本发汗。而复下之。此为逆也。若先发汗。治不为逆。本先
下之。而反汗之。为逆。若先下之。治不为逆。雍曰。此为病当先汗。
而反先下之。故为逆也。若已汗而复下之者。不为逆也。或病当先
下。而反先汗之。故为逆也。若已下而后汗之者。不为逆也。如太阳
证。当汗。而反下之。少阴证。当下。而反汗之。皆为逆也。
It is also said: When two Yang meridians are involved simultaneously (Two-Yang concurrent disease), at the initial stage of the Taiyang disease, diaphoresis was applied, but the sweating was not thorough. Consequently, the pathogen transferred to the Yangming. Subsequently, there is continuous slight sweating and aversion to cold is absent. If the Taiyang syndrome has not yet resolved, purgation must not be used; using purgation in this case is a contraindicated error (Ni). In such situations, mild diaphoresis may be employed. If the patient's face is persistently red, it indicates that Yang Qi is constrained and stagnating at the exterior. It should be treated by resolving the exterior and using fumigation. If diaphoresis was not thorough, it is insufficient to cause Yang Qi to be constrained and unable to vent. If sweating should have been induced but was not, the person will become restless and irritable, unaware of the specific location of pain, which may shift between the abdomen and the four limbs, and cannot be located by palpation. The person experiences shortness of breath and can only sit upright, due to incomplete sweating. Re-inducing diaphoresis will lead to recovery. How do we know the sweating was incomplete? By observing a choppy pulse (Se Mai), we can ascertain this. Pang Anchang stated that Mahuang Tang (Ephedra Decoction) is appropriate. Guo Yong argued that Pang placed this in Yangming due to errors in ancient texts; it should be corrected to its original context.
It is also said: A floating and rapid pulse (Piao Shu Mai) indicates that recovery should occur through diaphoresis. If purgation is mistakenly used, resulting in heavy body sensation and palpitations (Xin Ji), further diaphoresis is contraindicated. Recovery will come when spontaneous sweating occurs. This is because a faint pulse at the Cun position of the Chi pulse (Chi Zhong Mai Wei) indicates interior deficiency. One must wait for the exterior and interior to become solid and for the Body Fluids (Jin Ye) to harmonize naturally, after which spontaneous sweating will occur and the disease will resolve. Chang Qizhi stated that if sweating does not occur, Xiao Chaihu Tang (Minor Bupleurum Decoction) may be given. Guo Yong opined that if there is epigastric palpitations accompanied by irritability, Xiaojianzhong Tang (Minor Construct the Middle Decoction) is suitable. If both exterior and interior are deficient, Guizhi Mahuang Ge Ban Tang (Guizhi and Mahuang Half-Dose Decoction) is suitable. If one were to use Chaihu Tang for harmonization, one should use Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) to harmonize Ying and Wei to unblock the Body Fluids. This syndrome results from interior deficiency following mistaken purgation. Therefore, Zhang Zhongjing waits for the Qi to recover and Body Fluids to harmonize spontaneously before sweating occurs, without using medication. This case is not "syndrome without treatment"; the absence of medication is itself the treatment. Chang insisted on harmonization, likely believing his prescription was too strong. Thus, I use a gentle formula to moderate the effect, aiming for balance. Ultimately, if one can endure slightly and wait for natural harmony, following Zhang Zhongjing’s method of no medication is superior.
It is also said: A floating and tight pulse (Piao Jin Mai) typically presents with body pain and should be treated with diaphoresis. However, if the Chi pulse is slow (Chi Zhong Chi), diaphoresis is contraindicated. Why? Because Ying Qi is insufficient and Blood is scant. Guo Yong noted this case is similar to the previous one; Xiaojianzhong Tang is suitable, followed by Chaihu Guizhi Tang. It is better to wait for other syndromes to appear before treating. The previous case was post-purgation, so no other syndromes would emerge, hence no medication. This case is pre-diaphoresis, so other syndromes must emerge; thus, waiting is better. Knowing Blood is scant, one must not immediately use Xiao Chaihu Tang.
It is also said: A floating pulse indicates the disease is at the exterior; diaphoresis is permissible, and Mahuang Tang is suitable.
It is also said: A floating and rapid pulse permits diaphoresis; Mahuang Tang is suitable.
It is also said: A floating and tight pulse: Floating indicates Wind, Tight indicates Cold. Wind injures Wei Qi, Cold injures Ying Qi. Both Ying and Wei are diseased, causing bone and joint discomfort. Diaphoresis is indicated; Mahuang Tang is suitable.
It is also said: Patients who frequently sweat spontaneously have harmonious Ying Qi. However, the exterior is disharmonious because Wei Qi does not harmonize with Ying Qi. Ying Qi moves within the vessels, while Wei Qi moves outside. Inducing diaphoresis again will harmonize Ying and Wei, leading to recovery; Guizhi Tang is suitable.
Question: If Ying Qi is harmonious, why is there spontaneous sweating? Guo Yong answered: In healthy individuals, Ying and Wei Qi are constantly harmonious. If Wei Qi is attacked by Wind but Ying Qi is not attacked by Cold, then Wei Qi has pathogenic factors while Ying Qi does not. The presence of pathogens makes it strong; the absence makes it weak. Due to this strength disparity, Ying Qi cannot harmonize with Wei Qi, leaving Wei Qi without support. Relying on this unrestrained, vigorous Qi, aided by pathogens, the excess overflows the muscle spaces (Xi Gu). Since Ying is deep and Wei is superficial, Wei Qi in the skin cannot merge internally with Ying and instead leaks out through pores, causing spontaneous sweating. Using Guizhi to resolve the muscle-level exterior allows the pathogenic factor in Wei Qi to depart. Without pathogens, the excessive Qi subsides, naturally returning internally to harmonize with Ying, stopping the sweating.
Zhang Zhongjing said: If a patient has no internal organ diseases but suffers from periodic fever and spontaneous sweating that does not resolve, this is disharmony of Wei Qi. Inducing diaphoresis prior to the onset of symptoms will lead to recovery; Guizhi Tang is the primary treatment.
It is also said: In Shanghan with a floating and tight pulse, if diaphoresis is not performed and nasal bleeding (Nu) ensues, Mahuang Tang is the primary treatment.
It is also said: In Shanghan, if there is constipation for six or seven days, headache, and fever, Chengqi Tang may be given. If urination is clear, the disease is not in the interior but remains in the exterior; Chengqi Tang should not be given. Diaphoresis is required. If there is headache, nasal bleeding will likely occur; Guizhi Tang is suitable. Chang Qizhi suggested this might be an error. If diaphoresis is needed, Mahuang Tang should be used. Otherwise, Guizhi Mahuang Ge Ban Tang can be used to induce slight sweating. Guo Yong stated that in Zhang Zhongjing’s texts, Guizhi Tang has no protocol for treating nasal bleeding, whereas Mahuang Tang does. Thus, Chang suspected an error and switched to Mahuang. However, if there is no headache, there will be no nasal bleeding; if no bleeding, Mahuang Tang is contraindicated. Therefore, Guizhi Mahuang Ge Ban Tang is suitable to induce slight sweating. One must decide based on the presence or absence of sweating. How could there be transcription errors in Zhang Zhongjing’s book?
It is also said: After Shanghan diaphoresis resolves, if restlessness returns after half a day and the pulse is floating and rapid, diaphoresis may be repeated; Guizhi Tang is the primary treatment. Guo Yong noted the phrase "half a day" is crucial; if restlessness returns after this period, it constitutes relapse due to exertion (Lao Fu), and Guizhi Tang is not used.
It is also said: For any disease, whether treated with diaphoresis, emesis, or severe purgation, or resulting in loss of Blood or Body Fluids, if Yin and Yang can self-harmonize, the disease will surely resolve spontaneously. Guo Yong clarified that "any disease" includes non-Shanghan conditions. If Shanghan has not harmonized, wait for harmony or use Chaihu Guizhi Tang in small doses; Xiao Chaihu Tang is not necessary.
It is also said: After severe purgation followed by diaphoresis, if urination is difficult, it is due to loss of Body Fluids. Do not treat it directly; once urination becomes normal, the condition will resolve spontaneously. Guo Yong added that one should not use drugs to promote urination; waiting for natural patency leads to recovery.
It is also said: Following purgation and subsequent diaphoresis, chills and a faint, thin pulse may occur. This is due to deficiency in both interior and exterior. Chang stated that for patients without heat signs, Shaoyao Fuzi Tang (Peony and Aconite Decoction) may be given. For those with heat signs, Huangqi Jianzhong Tang (Astragalus Construct the Middle Decoction) may be given.
It is also said: After purgation and diaphoresis, if the patient is irritable and cannot sleep during the day but is quiet at night, without vomiting, thirst, or exterior signs, and with a sinking, faint pulse and no significant fever, Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction) is the primary treatment.
It is also said: After diaphoresis, if body pain persists with a sinking, slow pulse, Guizhi Jia Shaoyao Shengjiang Ge Yi Ren Shen San Liang Xinjia Tang (Newly Added Decoction with Added Peony and Fresh Ginger and Three Taels of Ginseng to Guizhi Decoction) is the primary treatment.
It is also said: After diaphoresis, Guizhi Tang must not be used again. If there is sweating, wheezing, and no high fever, Mahuang Xingzhi Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) is the primary treatment.
It is also said: After diaphoresis, if palpitations occur below the umbilicus, indicating impending Ben Tun (Rushing Pig) syndrome, Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) is the primary treatment.
It is also said: If excessive diaphoresis causes the patient to cross hands over the heart region, experiencing palpitations and a desire for pressure, Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction) is the primary treatment.
It is also said: After diaphoresis, if abdominal fullness occurs, Nongpo Shengjiang Banxia Gancao Renshen Tang (Magnolia Bark, Fresh Ginger, Pinellia, Licorice, and Ginseng Decoction) is the primary treatment.
It is also said: In Shanghan, after emesis or purgation, if there is epigastric fullness and rebellious Qi rushing to the chest, dizziness upon standing, and a sinking, tight pulse, further diaphoresis will disturb the collaterals, causing tremors and swaying. Fuling Guizhi Baizhu Gancao Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction) is the primary treatment.
It is also said: If after diaphoresis the disease does not resolve and aversion to cold appears, it indicates deficiency; Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction) is the primary treatment.
It is also said: If after diaphoresis or purgation the disease persists with irritability, Fuling Sini Tang (Poria and Four Reversal Decoction) is the primary treatment.
It is also said: After diaphoresis, aversion to cold indicates deficiency. Absence of aversion to cold with only fever indicates excess. One should harmonize Stomach Qi by giving Tiaowei Chengqi Tang (Regulate the Intestines and Order the Bowels Chengqi Decoction). Guo Yong noted that for deficiency, Shaoyao Gancao Fuzi Tang is used.
It is also said: In Taiyang disease, after diaphoresis with excessive sweating, if the Stomach becomes dry, causing irritability and insomnia, and the patient desires water, give small sips of water until Stomach Qi harmonizes and recovery occurs. If the pulse is floating, urination is difficult, and there is slight fever with polydipsia, Wuling San (Five-Ingredient Powder with Poria) is the primary treatment.
It is also said: After diaphoresis, if the pulse is floating and rapid with irritability and thirst, Wuling San is the primary treatment.
It is also said: In Shanghan with sweating and thirst, Wuling San is the primary treatment. If there is no thirst, Fuling Gancao Tang (Poria and Licorice Decoction) is the primary treatment.
It is also said: In Fengzhong (Wind Strike) with fever persisting for six or seven days without resolution, accompanied by irritability, exterior and interior signs, thirst for water, and vomiting after drinking (Shui Ni/Water Revulsion), Wuling San is the primary treatment.
It is also said: Before taking the pulse, if the patient crosses hands over the heart, and upon instruction to cough does not cough, this indicates bilateral deafness. This results from heavy diaphoresis causing deficiency. Chang stated that for patients without heat signs, Shaoyao Fuzi Tang may be given. For those with heat signs, Huangqi Jianzhong Tang may be given.
It is also said: After diaphoresis, excessive drinking may cause wheezing. Washing the body with cold water may also cause wheezing. It is commonly stated that Mahuang Xingzhi Gancao Shigao Tang may be given.
It is also said: After diaphoresis, if water and medicine cannot be retained, it is a adverse reaction. Further diaphoresis will cause incessant vomiting and diarrhea. It is commonly stated that Banxia Fuling Tang (Pinellia and Poria Decoction) may be given.
It is also said: After diaphoresis, emesis, or purgation, if there is empty irritability and insomnia, or severe cases with tossing and turning and mental anguish (Ao Nan), Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is the primary treatment. If Qi is deficient, Zhizi Gancao Chi Tang is used. If vomiting occurs, Zhizi Shengjiang Chi Tang is used.
It is also said: After diaphoresis or purgation, if there is irritability, heat, and chest oppression, Zhizi Chi Tang is the primary treatment.
It is also said: In Shanghan on the fifth or sixth day, after severe purgation, if fever persists and there is painful knotting in the heart, the disease has not resolved. Zhizi Chi Tang is the primary treatment.
It is also said: After purgation in Shanghan, if there is irritability, abdominal fullness, and restlessness day and night, Zhizi Houpo Tang (Gardenia and Magnolia Bark Decoction) is the primary treatment.
It is also said: When using Zhizi Tang formulas, if the patient has a history of loose stools, they must not be administered.
It is also said: After Taiyang diaphoresis, if the disease does not resolve, fever persists, palpitations occur, dizziness is present, and the body trembles violently as if falling, Zhenwu Tang (True Warrior Decoction) is the primary treatment.
It is also said: If the throat is dry, diaphoresis is contraindicated. Chang stated that Xiao Chaihu Tang may be given.
It is also said: For patients with sores (Chuang Jia), even if there is body pain, diaphoresis is contraindicated. Sweating will cause spasms. Chang stated that Xiao Chaihu Tang may be given.
It is also said: For patients with strangury (Lin Jia), diaphoresis is contraindicated. Sweating will cause hematuria.
It is also said: For patients with frequent nasal bleeding (Nu Jia), diaphoresis is contraindicated. Sweating will cause depression of the temporal arteries, tight and rapid pulse, fixed gaze, inability to blink, and insomnia. Chang stated that Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) may be given.
It is also said: For patients with blood loss (Wang Xue Jia), diaphoresis is contraindicated. Sweating will cause chills and trembling. Chang stated that Shaoyao Dihuang Tang may be given.
It is also said: For persons who sweat excessively, re-inducing diaphoresis will cause mental confusion and palpitations, along with pain in the genitalia after urination. Yuyuli Wan (Hematit Pill) is given. The formula is missing. Chang stated that Hematit alone, calcined and powdered, may be taken. Guo Yong clarified that Hematit refers to the mineral, not the shell.
It is also said: If a patient with cold signs undergoes diaphoresis, the Stomach becomes cold, leading to expulsion of roundworms. Chang stated that Wu Mei Wan (Mume Pill) may be taken. Guo Yong opined that Lizhong Wan (Regulate the Middle Pill) is suitable.
It is also said: If diaphoresis should have been performed first but purgation was used instead, this is an error. If diaphoresis is performed first, the treatment is not erroneous. If purgation should have been performed first but diaphoresis was used instead, this is an error. If purgation is performed first, the treatment is not erroneous. Guo Yong explained: This is an error because the disease required diaphoresis first, but purgation was used. If diaphoresis was already done and then purgation, it is not an error. Or if purgation was required first but diaphoresis was used, it is an error. If purgation was already done and then diaphoresis, it is not an error. For example, in Taiyang syndrome, diaphoresis is indicated; using purgation is an error. In Shaoyin syndrome, purgation is indicated; using diaphoresis is an error. Both are erroneous treatments.