发热有翕翕发热，蒸蒸发热。翕翕发热者，身热无汗，恶寒拘紧，如鸟羽之合而不发舒，此
邪伤于表，郁于肌肤，表热而里未热，治宜发散表邪。蒸蒸发热者，手足遍身 多汗，热
而润泽，此表邪已散，热郁于里，蒸汗时时外出也，治宜清热。若便结腹胀，有下症者，下
之。此以表热里热分两大法也。若发热无汗，脉浮紧，此太阳伤营之表症也。冬月西北人，
用麻黄汤。余三时用羌活冲和汤、羌活败毒散。若发热有汗，脉浮缓，此太阳风伤卫之表症
也。冬月西北人，用桂枝汤。余三时用加减防风汤。若脉浮，外发热，内烦躁，作渴饮水，
小便不利者，此太阳热结膀胱之里症也，仲景以五苓散。清利膀胱。余今广推羌活木通汤，
双解太阳表里。若头痛额痛，目痛，鼻干，发汗无汗，微恶寒，脉浮而长，此阳明表症也，
治以干葛解肌汤。若发热有汗，口渴引饮，六脉洪数，不恶寒反恶热，此阳明经症也，白虎
汤加葛根。若发热烦躁，口渴唇焦，小便闭结，手足时时汗出，六脉沉数，此阳明里症也，
宜三黄巨胜汤、导赤各半汤、凉膈散。若口干舌刺，小腹硬满，欲大便而不得便，脉沉数
者，此阳明之下症，宜承气汤下之。若时寒时热，头侧作痛，两耳常聋，呕而口苦，此少阳
经症也，脉弦而紧无汗者，柴胡防风汤散表；脉弦而数有汗者，小柴胡汤和解。若身虽寒
热，大便闭结，腹痛胀满，脉见沉数，时时汗出者，此少阳里热下症也，宜大柴胡汤下之。
按三阳发热之症，要分别有汗无汗，汗多汗少。夫无汗发热，为表热，易知者也。亦有汗出
未多，而发热不减，人多误为里热矣。汗出未多而热不减，犹易知其表热也；至汗出多而发
热不减，尚是表邪，则难分别矣。例如太阳中风症，自汗出而热不愈，此表热症也。若但以
汗多妄用清里，则碍表邪矣。又如风温症，自汗出而热不退，此三阳经表热症也。若误以中
风症，用桂枝汤解肌，是犯辛温误治风温矣。若以汗多身热，阳明里热治之，是犯失散在表
之风温矣。夫太阳自汗出发热之中风，极似风温症。不知太阳中风恶风寒，风温症则不恶风
寒；太阳症口不渴，风温症口多渴；太阳症鼻不塞，风温症鼻塞多眠睡，此症之各别者也。
太阳症脉浮缓，风温症脉浮数，此脉之各别者也。夫阳明里热，自汗出热不退之症，又与太
阳中风、三时风温症亦相似。然中风风温症，必带恶寒恶风、身痛头痛之表症；若阳明里热，
自汗出热不退，则无恶寒身痛之表症，反有恶热口渴里热之症，此症之分别者也。中风、风
温之症，脉必浮数；若阳明里热之症，脉必洪大沉数。夫发热而分无汗脉浮以别表热，有汗
脉沉以别里热，此经之常、理之正也。然亦有有汗发热脉沉而见表症，但坐以汗出不彻，仍
用发汗退热者。夫无汗发热脉浮，人人知其表热，然有火闭无汗之症，其脉亦浮数，连服发
表之药，汗不出，后服清里之药，汗出热减而愈者。又如三阳经有表复有里之症，先服散表
之药，汗不出热不退，复服和解药，而汗出热退者。总之，发热无汗，表散不得外泄者，宜
发汗解表。发热有汗，里热蒸汗自出者，宜清里退热。又汗出身热，微恶风寒，脉见浮大
者，此汗出邪不出，尚宜发表。又发热无汗，时或汗出，则热暂退，少顷汗干，或停一日半
日，又复发热，仲景但坐以汗出不彻，宜再发汗。更有发热无汗，不恶风寒，脉见沉数者，
此里热火闭，不能作汗外解，清其里热，则汗出身凉。另有痰饮积热，郁结肠胃，外冒表邪
而发热，用散表之药，汗出而发热不减，用清里而里热不除，此热而有滞之症，又宜消痰化
滞，疏散肠胃郁热，则胃气宣扬敷布，里热从上而汗解。
太阳病，有发热恶寒者，发于阳也；无热恶寒者，发于阴也。
详注前章。
太阳病，头痛发热，汗出恶风，脉浮缓者，名中风，桂枝汤主之。
此条明风伤卫，汗出恶风，脉浮缓者，用桂枝汤也。
桂枝本为解肌，若人脉浮紧，发热汗不出者，不可与也。当须识此，勿令误也。
此申桂枝汤，治不得寒伤营、脉浮紧、汗不出症。
太阳病，发热汗出者，此为营弱卫强，故使汗出。欲救邪风者，宜桂枝汤主之。
此申发热汗出之症，营血无邪而弱，卫气有邪而强，故宜用桂枝汤。
病患脏无他病，时发热自汗出而不愈者，此为卫气不和也，先其时发汗则愈。宜桂枝汤主之。
按发热自汗有三症∶有太阳风伤卫之症，用桂枝汤以解肌；有阳明发热自汗之里热症，用
白虎汤以清里；有春三月发热自汗之风温症，用防风石膏汤以和解。前章无时发热之句，
此章有时发热之症，故立先其未发热之时，服桂枝汤以发其汗。推而广之，则时寒时热之
柴胡症，发作有准之似疟症，皆宜先其时而服药者。
中风发热，六七日，不解而烦，有表里症，渴欲饮水，水入即吐者，名曰水逆，五苓散主
之，多服暖水，汗出则愈。
言中风发热至六七日，有表里症，饮水不得消水，而水逆上吐，此膀胱热结，不通调水道
下行，以五苓散散太阳表邪，利膀胱结热，多服暖水，上润皮毛助汗出，下润膀胱宣水道。
太阳病，头痛发热，身疼腰痛，骨节疼痛，恶风无汗而喘，麻黄汤主之。
此条辨太阳病如此症象，乃寒伤营，宜麻黄汤者。
伤寒五六日，呕而发热者，柴胡症具，而以他药下之。柴胡症仍在者，复与柴胡汤，此虽已
下之不为逆，必蒸蒸而振，却发热汗出而解。若心下满而硬痛者，此为结胸，大陷胸汤主
之。但满而不痛者，此为痞，柴胡汤不中与之，宜泻心汤。详注结胸门。
伤寒六七日，发热微恶寒，肢节烦疼，微呕，心下支结，外症未去者，柴胡桂枝汤主之。
发热恶寒，肢节烦疼，宜麻黄桂枝汤，今因微呕，心下交结，又兼少阳症，故用柴胡桂枝汤。
伤寒身黄发热者，栀子柏皮汤。
身黄发热，有从表发散之治。今里热蒸黄，故用此方。
太阳中风，脉浮紧，发热恶寒，身疼痛，不汗出而烦躁者，大青龙汤主之。若脉微弱，汗出
恶风者，不可服，服之则厥逆，筋惕肉 ，此为逆也，以真武汤救之。
太阳中风，又恶寒身痛，汗不出而烦躁，名营卫两伤。脉浮紧，用大青龙汤。若脉微而
弱，汗出恶风寒，不可服大青龙汤。若误用，则手足厥冷，筋惕肉 ，故以真武汤救之。
太阳病，得之八九日，如疟疾状，发热恶寒，热多寒少，其人不呕，清便欲自可，一日二三
度发，脉微缓者，为欲愈也。脉微而恶寒此阴阳俱虚，不可更发汗更下更吐也。面色反有热
色者，邪未解也，以其不能得小汗出，身必痒，宜桂枝麻黄各半汤。
详注似疟。
太阳病，发热恶寒，热多寒少，脉微弱者，此无阳也，不可更汗，宜桂枝二越婢一汤。
发热恶寒，理宜发汗。然脉微者，阳津不足，故不可发汗。
太阳病，发热头痛，脉反沉，若不瘥，身体疼痛，当救其里，宜四逆汤。
此太阳症，脉似少阴之条。太阳症，故发热。正气衰微，故脉沉。今以四逆汤温里逐邪，
以代麻黄汤，非阴症温经也。
伤寒发热，啬啬恶寒，大渴饮水，其腹必满，自汗出，小便利，其病欲解，此肝乘肺也，名
曰横，刺期门。
伤寒发热，本非肺病，今洒洒恶寒，大渴饮水，此肺热不能通调水道，其腹必满。若自汗
出，小便利，则肺病得解。设汗不出，小便不利，此肝胆热邪，乘侮肺金，急刺期门。
太阳病，发热汗出，身仍灼热，脉浮汗出，身重多眠鼻鼾者，风温也。
太阳病，发热汗出，身仍灼热，脉浮汗多，绝似桂枝汤症；但无恶寒头痛，而有多眠鼻
鼾，此风温也，切不可用桂枝汤。
发热汗出，解半日许，复烦躁，脉浮大者，可更发汗。
发热汗出，止解半日许，复烦躁，脉浮大，则表邪仍在，故更发汗。
发热汗出不解，心下痞硬，呕吐而利者，大柴胡汤。
发热汗出热不解，心下痞硬，已是下症，但呕不宜下，故用大柴胡汤。
瘥后，更发热，脉浮数者，以汗解之；脉沉数者，以下解。
此示人不论初病久病，惟见症治症，凭脉用药。
发热未有汗者，不可与白虎汤。若大渴引饮无表症者，仍与白虎汤。
发热未有汗，表邪未解，故不可用白虎汤。大渴引饮无表症者，故仍与白虎汤。互相告
戒，有一定之理。
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，小青龙汤主之。
心下素有水气，又得寒邪相搏，故用小青龙汤，外散表邪，内散水饮。
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，小青龙汤主之。
此申明上文，服小青龙汤已，渴者，此水寒已去，不可再服小青龙汤。小青龙汤句，当在
发热不渴句下看。
阳明病，若汗多，微发热恶寒者，外未解也，其热不潮，未可与承气汤。若腹大满不通，可
与小承气汤，微和胃气，勿令大泄。
言阳明病，汗虽多，仍见微发热恶寒，则表邪尚在，况无潮热，故未可与承气汤。即腹大
满，大便不通，亦只用小承气汤。
阳明中风，若咽干，腹满，微喘，发热恶寒，脉浮而紧，若下之，则腹满小便难也。
阳明中风，口苦咽干，腹满，似传里矣。若发热恶寒，脉浮而紧，尚是阳明太阳表症。若
反下之，则邪从内陷而腹愈满，小便不利矣。
伤寒发热无汗，呕而不能食，而反汗出 然者，是转属阳明也。
伤寒发热无汗，本太阳表症。今呕而不能食，反汗出 然，故为转属阳明也。以其有呕
吐无下症，故不立下法。
太阳病，三日发汗不解，蒸蒸发热者，属胃也，调胃承气汤主之。
较上章多蒸蒸有汗，且无呕吐，故用调胃承气汤。
阳明病，发热汗多者，急下之，宜大承气汤。
汗多发热，津液有立尽之势，故急下之。三章次第，详注后自汗门，以为下法的诀。
伤寒脉弦细，头痛发热者，属少阳。少阳不可发汗，发汗则谵语。此属胃，胃和则愈，胃不
和则烦而悸。
头痛发热，本是太阳汗症。但脉弦而细，此是少阳也，故误用麻黄、桂枝，则谵语。此症
全赖胃气冲和可愈，若胃气不和，则烦而悸矣。
妇人中风，发热恶寒，经水适来，得之七八日，热除而脉迟，身凉，胸胁下满，如结胸状，
谵语者，此为热入血室也，当刺期门，随其实而泄之。
妇人伤寒发热，经水适来，昼日明了，暮则谵语，如见鬼状者，此为热入血室，无犯胃气及
上二焦，必自愈。
两条详注热入血室，皆不立方，但曰无犯胃气，此禁汗吐互词。
少阴病，始得之，反发热脉沉者，麻黄附子细辛汤。
此即少阴症似太阳也。少阴经表有寒邪，理当散表，但不同太阳方法，故以麻黄、附子温经散邪。
少阴病，吐利，手足不逆冷反发热者。不死。脉不至者，灸少阴七壮。
少阴变热，乃为回阳，故曰不死。然脉不至，尚是危兆，故灸少阴。
伤寒始发热六日，厥反九日而利，凡厥利者，本不能食，今反能食者，恐为除中。食以素饼
不发热者，知胃气尚在必愈，恐暴热来出而复去也。后三日脉之，其热续在者，期之旦日夜
半愈。所以然者，本发热六日，厥反九日，复发三日，并前六日亦为九日，与厥相应，故期
之旦日夜半愈。后三日脉之而脉数，其热不罢者，此为热气有余，必发痈脓也。
此章言阴厥回阳太过，必发痈脓。详注厥利。
伤寒先厥后发热，而利者必自止。见厥复利。
先厥后热，即阴厥回阳，故曰利必自止。若后复见厥，则必复利矣。
伤寒先厥后发热，下利必自止，而反汗出，咽中痛者，其喉为痹。
此条详注咽痛。
发热无汗，而利必自止。若自止，必便脓血。便脓血者，其喉不痹。
此条详注便脓血。
伤寒发热，四日，厥反三日，复热四日，厥少热多，其病当愈。四日至七日热不除者，必便脓血。
此章重申厥少热多，热不除，必便脓血。可见热病回阴，阴症回阳，均怕过与不及。
麻黄汤 见恶寒。
羌活冲和汤
羌活 防风 白芷 黄芩 苍术 生地 川芎 细辛 广皮 甘草
此和解太阳表里之方。燥热令，去苍术、川芎、细辛；两足冷，加独活；少阳见症，加柴
胡；夏秋加知母、天花粉、石膏、干葛；胸前饱闷，去生地，加枳壳、浓朴。汗多，加白
芍药。如湿气胜，去生地。
羌活败毒散
羌活 独活 柴胡 前胡 川芎 防风 荆芥 广皮 甘草
此方太阳经发汗解肌者。余以此代仲景麻黄汤，治四时太阳表症。口渴，去川芎；胸前饱
闷，加枳壳、浓朴；阳明见症，加干葛；里有热，加黄芩、山栀、石膏。
加减防风汤 见身痛。
冬令北方，有汗发热，用桂枝。南方三时，家秘用此方加减。详身痛。
五苓散 见小便不利。
按太阳有汗发热口渴，小便不利，此热结膀胱之症，故仲景以此方治之。加减详小便不
利、口渴门。
羌活木通汤
羌活 独活 木通 车前子
Fever presents as either "Xi Xi" fever (翕翕发热) or "Zheng Zheng" fever (蒸蒸发热). "Xi Xi" fever refers to body heat without sweating, aversion to cold, and a feeling of tightness, resembling bird feathers closing up without spreading. This indicates pathogenic factors injuring the exterior and stagnating in the skin and muscles, manifesting as exterior heat while the interior remains unheated; treatment should focus on dispersing exterior pathogens. "Zheng Zheng" fever refers to profuse sweating over the hands, feet, and whole body, with heat and moisture, indicating that exterior pathogens have dispersed but heat is stagnant in the interior, causing sweat to seep out continuously; treatment should focus on clearing heat. If accompanied by constipation and abdominal fullness, indicating a condition suitable for purgation, then purgative methods should be used. This divides the treatment of exterior and interior heat into two major approaches.
If fever occurs without sweating and the pulse is floating and tight, this is an exterior syndrome of the Taiyang channel involving injury to Ying blood. In winter, people in the northwest region use Mahuang Tang (Ephedra Decoction). During the other three seasons, Qianghuo Chonghe Tang (Notopterygium Harmonizing Decoction) or Qianghuo Baidu San (Notopterygium Resolving Toxins Powder) are used. If fever occurs with sweating and the pulse is floating and slow, this is an exterior syndrome of the Taiyang channel involving wind injuring Wei Qi. In winter, people in the northwest region use Guizhi Tang (Cinnamon Twig Decoction). During the other three seasons, Jiajian Fangfeng Tang (Modified Saposhnikovia Decoction) is used. If the pulse is floating, there is external fever, internal restlessness, thirst with desire to drink, and difficulty urinating, this is an interior syndrome of heat binding in the Bladder of the Taiyang channel; Zhang Zhongjing uses Wuling San (Five-Ingredient Poria Pill) to clear and drain the Bladder. I now widely promote Qianghuo Mutong Tang (Notopterygium and Akebia Decoction) to simultaneously resolve both exterior and interior aspects of the Taiyang channel.
If there is headache, forehead pain, eye pain, dry nose, no sweating after inducing sweat, slight aversion to cold, and the pulse is floating and long, this is an exterior syndrome of the Yangming channel, treated with Gange Jieji Tang (Pueraria Muscle-Releasing Decoction). If there is fever with sweating, thirst with desire to drink large amounts, six pulses are surging and rapid, aversion to cold is absent but aversion to heat is present, this is an interior syndrome of the Yangming channel, treated with Baihu Tang (White Tiger Decoction) plus Gegen (Pueraria Root). If there is fever and restlessness, thirst with cracked lips, urinary obstruction, frequent sweating of the hands and feet, and six pulses are deep and rapid, this is an interior syndrome of the Yangming channel, treated with Sanhuang Jusheng Tang (Three-Yellow Giant Sesame Decoction), Daochi Banban Tang (Half-Half Guide Outward Decoction), or Liangge San (Cool Epigastrium Powder). If there is dry mouth with tongue prickling sensation, hardness and fullness in the lower abdomen, desire to defecate but inability to do so, and the pulse is deep and rapid, this is a purgable syndrome of the Yangming channel, treated with Chengqi Tang (Gut-Regulating Decoction) for purgation.
If there is alternating chills and fever, pain on the sides of the head, frequent deafness in both ears, vomiting with bitter taste, this is a syndrome of the Shaoyang channel. If the pulse is wiry and tight without sweating, Chaihu Fangfeng Tang (Bupleurum and Saposhnikovia Decoction) is used to disperse exterior pathogens; if the pulse is wiry and rapid with sweating, Xiao Chaihu Tang (Minor Bupleurum Decoction) is used for harmonization. If although there is alternating chills and fever, there is also constipation, abdominal pain and fullness, a deep and rapid pulse, and frequent sweating, this is a purgable interior heat syndrome of the Shaoyang channel, treated with Da Chaihu Tang (Major Bupleurum Decoction) for purgation.
Note: For fevers in the Three Yang channels, it is crucial to distinguish between sweating and non-sweating, and between profuse and scant sweating. Fever without sweating belongs to exterior heat, which is easy to identify. However, when sweating is not profuse but fever persists, people often mistakenly consider it interior heat. When sweating is not profuse and fever persists, it is still relatively easy to recognize as exterior heat; but when sweating is profuse and fever persists, yet it remains an exterior pathogen, it becomes difficult to distinguish. For example, in Taiyang Wind Strike syndrome, spontaneous sweating with persistent fever is an exterior heat syndrome. If one rashly uses interior-clearing methods merely because of profuse sweating, it will hinder the dispersion of exterior pathogens. Similarly, in Wind-Warmth syndrome, spontaneous sweating with persistent fever is an exterior heat syndrome of the Three Yang channels. Mistakenly treating Wind Strike syndrome as Wind-Warmth using Guizhi Tang to release the muscle layer constitutes an error of using acrid-warm treatments for Wind-Warmth. Treating profuse sweating and body heat as Yangming interior heat constitutes an error of failing to scatter Wind-Warmth located at the exterior. The Wind Strike syndrome of Taiyang with spontaneous sweating and fever closely resembles Wind-Warmth syndrome. One must know that Taiyang Wind Strike involves aversion to wind and cold, whereas Wind-Warmth does not; Taiyang syndrome involves no thirst, whereas Wind-Warmth involves much thirst; Taiyang syndrome involves no nasal congestion, whereas Wind-Warmth involves nasal congestion and excessive sleepiness—these are differences in symptoms. Taiyang syndrome has a floating and slow pulse, whereas Wind-Warmth has a floating and rapid pulse—this is a difference in pulse.
Yangming interior heat, presenting with spontaneous sweating and persistent fever, also resembles Taiyang Wind Strike and Wind-Warmth during the three seasons. However, Wind Strike and Wind-Warmth syndromes must carry exterior signs such as aversion to cold/wind, body pain, and headache; whereas Yangming interior heat, despite spontaneous sweating and persistent fever, lacks exterior signs like aversion to cold and body pain, instead presenting with aversion to heat and thirst indicative of interior heat—these are differences in symptoms. The pulses for Wind Strike and Wind-Warmth must be floating and rapid; whereas the pulse for Yangming interior heat must be surging, large, deep, and rapid. Distinguishing exterior heat by non-sweating and floating pulse, and interior heat by sweating and deep pulse, is the standard of this classic and the correct principle. However, there are cases of sweating with fever and a deep pulse showing exterior signs, where the cause is incomplete sweating, requiring repeated diaphoresis to reduce fever. Everyone knows that fever without sweating and a floating pulse indicates exterior heat; yet there are cases of fire-closure with no sweating where the pulse is also floating and rapid. After taking exterior-dispersing medicines without sweating, taking interior-clearing medicines results in sweating, reduced fever, and recovery. Similarly, in Three Yang channels having both exterior and interior signs, taking exterior-dispersing medicines first yields no sweat or fever reduction, but taking harmonizing medicines subsequently results in sweating and fever reduction. In summary, for fever without sweating where exterior pathogens cannot escape via sweating, diaphoresis and exterior resolution are indicated. For fever with sweating where interior heat steams sweat out spontaneously, interior clearing and fever reduction are indicated. For sweating with residual body heat, slight aversion to wind/cold, and a floating-large pulse, this indicates sweat has been produced but pathogens remain, so exterior release is still appropriate. For fever without sweating, with occasional sweating leading to temporary fever reduction, followed by drying of sweat, or cessation for a day or half-day before fever recurs, Zhang Zhongjing attributes this to incomplete sweating, recommending repeated diaphoresis. Furthermore, for fever without sweating, without aversion to wind/cold, and with a deep-rapid pulse, this indicates interior fire closure preventing sweat formation; clearing interior heat allows sweat to occur and body temperature to normalize. Additionally, for phlegm-fluids and accumulated heat stagnating in the intestines and stomach, compounded by external exposure to exterior pathogens causing fever, if exterior-dispersing medicines fail to stop fever after sweating, and interior-clearing medicines fail to remove interior heat, this is heat with stagnation; treatment should focus on resolving phlegm and transforming stagnation, dispersing stagnant heat in the intestines and stomach, allowing Stomach Qi to spread, so that interior heat resolves from above via sweating.
Taiyang disease presenting with fever and aversion to cold originates from Yang; disease presenting with no fever but aversion to cold originates from Yin. (Detailed annotation of the previous chapter.)
Taiyang disease presenting with headache, fever, sweating, aversion to wind, and a floating-slow pulse is named Wind Strike, primarily treated with Guizhi Tang (Cinnamon Twig Decoction). This clause clarifies that wind injuring Wei Qi, presenting with sweating, aversion to wind, and a floating-slow pulse, is treated with Guizhi Tang.
Guizhi Tang (Cinnamon Twig Decoction) is originally for releasing the muscle layer. If a person has a floating-tight pulse, fever, and no sweating, it must not be given. One must understand this to avoid error. This supplements that Guizhi Tang (Cinnamon Twig Decoction) is not for conditions of cold injuring Ying blood, floating-tight pulse, and absence of sweating.
In Taiyang disease, fever with sweating indicates weak Ying and strong Wei, causing sweating. To rescue from evil wind, Guizhi Tang (Cinnamon Twig Decoction) is primarily indicated. This supplements that in fever with sweating, Ying blood is weak without pathogen, while Wei Qi is strong with pathogen, hence Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
If a patient has no other internal organ diseases but experiences periodic fever and spontaneous sweating without resolution, this indicates disharmony of Wei Qi. Inducing sweat before the onset of fever leads to cure. Guizhi Tang (Cinnamon Twig Decoction) is primarily indicated. Note: There are three types of fever with spontaneous sweating: Taiyang Wind injuring Wei, treated with Guizhi Tang (Cinnamon Twig Decoction) to release the muscle layer; Yangming fever with spontaneous sweating due to interior heat, treated with Baihu Tang (White Tiger Decoction) to clear the interior; and Wind-Warmth fever with spontaneous sweating in the spring months, treated with Fangfeng Shigao Tang (Saposhnikovia and Gypsum Decoction) for harmonization. The previous chapter lacked the phrase "periodic fever," whereas this chapter features "periodic fever," thus establishing administration of Guizhi Tang (Cinnamon Twig Decoction) before fever onset to induce sweat. Extending this logic, Shaoyang syndrome with alternating chills and fever, and malaria-like syndrome with regular paroxysms, should also be treated prior to onset.
Wind Strike fever persisting for six to seven days without resolution, accompanied by vexation, presenting with both exterior and interior signs, thirst with desire to drink, and immediate vomiting upon drinking water, is named Water Reversal, primarily treated with Wuling San (Five-Ingredient Poria Pill). Drinking plenty of warm water induces sweating and cure. This explains that Wind Strike fever lasting six to seven days with exterior-interior signs, where water intake fails to transform fluids leading to upward vomiting, is due to heat binding in the Bladder obstructing water passage downward. Wuling San (Five-Ingredient Poria Pill) disperses Taiyang exterior pathogens and drains Bladder heat. Drinking warm water moistens the skin to assist sweating and moistens the Bladder to promote water passage.
Taiyang disease presenting with headache, fever, body ache, waist pain, joint pain, aversion to wind, no sweating, and wheezing is primarily treated with Mahuang Tang (Ephedra Decoction). This clause differentiates Taiyang disease with these symptoms as cold injuring Ying blood, suitable for Mahuang Tang (Ephedra Decoction).
In Cold Damage five to six days later, vomiting and fever indicate Chaihu syndrome is present, but if treated with other purgatives, and Chaihu syndrome persists, administering Xiao Chaihu Tang (Minor Bupleurum Decoction) again is not contraindicated despite prior purgation. The patient will likely experience shivering and shaking, followed by fever, sweating, and resolution. If the epigastrium is full, hard, and painful, this is Jie Xiong (Chest Binding), treated with Da Xianxiong Tang (Major Ganoderma Decoction). If only full without pain, this is Pi (Glomus), and Xiao Chaihu Tang (Minor Bupleurum Decoction) is inappropriate; Xixin Tang (Heart-Draining Decoction) is indicated. (See detailed annotation in Chest Binding section.)
Cold Damage six to seven days later, with slight fever and aversion to cold, irritability in limbs and joints, slight vomiting, subcostal support and binding, and unresolved exterior signs, is primarily treated with Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction). While fever, aversion to cold, and limb irritability suggest Mahuang Guizhi Tang (Ephedra and Cinnamon Twig Decoction), the presence of slight vomiting and subcostal binding alongside Shaoyang signs necessitates Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction).
Cold Damage presenting with yellowing of the body and fever is treated with Zhizi Bopi Tang (Gardenia and Phellodendron Bark Decoction). Yellowing with fever can be treated by dispersing from the exterior. Since this case involves interior heat steaming yellowing, this formula is used.
Taiyang Wind Strike presenting with floating-tight pulse, fever, aversion to cold, body pain, no sweating, and restlessness is primarily treated with Da Qinglong Tang (Major Blue-Green Dragon Decoction). If the pulse is faint and weak, with sweating and aversion to wind, it must not be taken; ingestion causes cold extremities and twitching of tendons and flesh, constituting a mismanagement, which should be rescued with Zhenwu Tang (True Warrior Decoction). Taiyang Wind Strike with aversion to cold, body pain, no sweating, and restlessness is named Ying-Wei Dual Injury. Floating-tight pulse warrants Da Qinglong Tang (Major Blue-Green Dragon Decoction). Faint and weak pulse with sweating and aversion to wind/cold contraindicates Da Qinglong Tang (Major Blue-Green Dragon Decoction). Misuse causes cold extremities and twitching, hence Zhenwu Tang (True Warrior Decoction) is used for rescue.
Taiyang disease persisting for eight to nine days, resembling malaria with fever and aversion to cold, more heat than cold, no vomiting, normal bowel and bladder function, occurring two to three times a day, with a slightly slow pulse, indicates impending recovery. A faint pulse with aversion to cold indicates dual deficiency of Yin and Yang; further sweating, purgation, or emesis are contraindicated. If the face shows redness, pathogens remain unresolved due to inability to produce slight sweat, causing body itching; Guizhi Mahuang Ge Ban Tang (Half-Half Combination of Cinnamon Twig and Ephedra Decoction) is indicated. (See detailed annotation in Malaria-Like section.)
Taiyang disease with fever, aversion to cold, more heat than cold, and a faint pulse indicates "No Yang"; further sweating is contraindicated. Guizhi Er Yuebi Yi Tang (Two Parts Cinnamon Twig and One Part Yuebi Decoction) is indicated. Although fever and aversion to cold theoretically warrant sweating, a faint pulse indicates insufficient Yang fluids, prohibiting sweating.
Taiyang disease with fever, headache, and a contrary deep pulse, if unresponsive, and with body pain, requires interior rescue with Sini Tang (Reverse-Turning Decoction). This Taiyang symptom with a pulse resembling Shaoyin indicates Taiyang fever due to deficient righteous Qi causing a deep pulse. Sini Tang (Reverse-Turning Decoction) warms the interior and expels pathogens, substituting for Mahuang Tang (Ephedra Decoction), rather than warming meridians for Yin syndrome.
Cold Damage with fever, shivering aversion to cold, intense thirst with drinking, and inevitable abdominal fullness, resolving with spontaneous sweating and free urination, indicates Liver attacking Lung, named Heng (Horizontal), treated by puncturing Qimen (LR14). Cold Damage fever is not originally a Lung disease. Shivering aversion to cold and intense thirst indicate Lung heat failing to regulate water passages, causing abdominal fullness. Spontaneous sweating and free urination resolve Lung disease. If no sweating and urinary difficulty, Liver-Gallbladder heat attacks Metal; urgently puncture Qimen (LR14).
Taiyang disease with fever, sweating, persistent burning heat, floating pulse with sweating, heaviness, excessive sleepiness, and snoring is Wind-Warmth. Although resembling Guizhi Tang (Cinnamon Twig Decoction) syndrome with floating pulse and heavy sweating, the absence of aversion to cold/headache and presence of sleepiness/snoring identifies it as Wind-Warmth; Guizhi Tang (Cinnamon Twig Decoction) must strictly be avoided.
Fever with sweating resolving for about half a day, followed by restlessness and a floating-large pulse, permits re-induction of sweating. Persistent restlessness and floating-large pulse after brief resolution indicate remaining exterior pathogens, warranting further sweating.
Fever with sweating failing to resolve, epigastric stiffness, vomiting, and diarrhea are treated with Da Chaihu Tang (Major Bupleurum Decoction). Unresolved fever with sweating and epigastric stiffness indicates a purgable condition, but vomiting precludes simple purgation; thus Da Chaihu Tang (Major Bupleurum Decoction) is used.
Post-recovery fever with floating-rapid pulse is treated by sweating; with deep-rapid pulse, by purgation. This illustrates treating symptoms based on presentation and pulse, regardless of initial or chronic disease.
Fever without sweating contraindicates Baihu Tang (White Tiger Decoction). If intense thirst with drinking exists without exterior signs, Baihu Tang (White Tiger Decoction) may still be given. Absence of sweating indicates unresolved exterior pathogens, prohibiting Baihu Tang (White Tiger Decoction); intense thirst without exterior signs permits its use. This mutual warning adheres to fixed principles.
Cold Damage with unresolved exterior, fluid retention in the epigastrium, dry heaving, fever, cough, optionally thirst, diarrhea, choking, urinary difficulty, hypogastric fullness, or wheezing, is primarily treated with Xiao Qinglong Tang (Minor Green-Dragon Decoction). Pre-existing fluid retention combined with cold pathogen interaction necessitates Xiao Qinglong Tang (Minor Green-Dragon Decoction) to disperse exterior pathogens and internal fluid-drink.
Cold Damage with fluid retention in the epigastrium, cough with slight wheezing, fever without thirst; if thirst develops after medication, this indicates cold departure and impending resolution. Xiao Qinglong Tang (Minor Green-Dragon Decoction) is indicated. This clarifies that thirst after taking Xiao Qinglong Tang (Minor Green-Dragon Decoction) signals resolved cold-fluid; do not re-administer. The phrase "Xiao Qinglong Tang (Minor Green-Dragon Decoction)" should be read under "fever without thirst."
Yangming disease with profuse sweating, slight fever, and aversion to cold indicates unresolved exterior. Without tidal fever, Chengqi Tang (Gut-Regulating Decoction) is contraindicated. If severe abdominal fullness and obstruction exist, Xiao Chengqi Tang (Minor Gut-Regulating Decoction) may be given to mildly harmonize Stomach Qi, avoiding severe purgation. Profuse sweating with slight fever/cold indicates remaining exterior pathogens; absence of tidal fever prohibits Chengqi Tang (Gut-Regulating Decoction). Even with severe fullness and constipation, only Xiao Chengqi Tang (Minor Gut-Regulating Decoction) is used.
Yangming Wind Strike with dry throat, abdominal fullness, slight wheezing, fever, aversion to cold, and floating-tight pulse: if purged, abdominal fullness and urinary difficulty result. Symptoms like bitter taste, dry throat, and abdominal fullness suggest transmission inward. However, fever, aversion to cold, and floating-tight pulse indicate Taiyang-Yangming exterior syndrome. Purging causes pathogen sinking, worsening fullness and urinary difficulty.
Cold Damage with fever, no sweating, vomiting, inability to eat, and sudden profuse sweating indicates transformation into Yangming. Originally Taiyang exterior syndrome, vomiting/inability to eat plus profuse sweating signifies transformation into Yangming. No specific purgative method is established due to vomiting without purgative indications.
Taiyang disease persisting after three days of sweating, with "Zheng Zheng" fever, belongs to the Stomach, treated with Tiaowei Chengqi Tang (Stomach-Harmonizing Gut-Regulating Decoction). Compared to the previous chapter, this presents with "Zheng Zheng" sweating and no vomiting, warranting Tiaowei Chengqi Tang (Stomach-Harmonizing Gut-Regulating Decoction).
Yangming disease with fever and profuse sweating requires urgent purgation with Da Chengqi Tang (Major Gut-Regulating Decoction). Profuse sweating and fever threaten immediate exhaustion of body fluids, necessitating urgent purgation. See detailed annotations in the Spontaneous Sweating section for sequence and decision-making.
Cold Damage with wiry-thin pulse, headache, and fever belongs to Shaoyang. Shaoyang contraindicates sweating; sweating causes delirium. This relates to the Stomach; harmony brings cure, disharmony causes vexation and palpitations. Headache and fever are typically Taiyang sweating signs, but wiry-thin pulse indicates Shaoyang. Misuse of Mahuang/Guizhi causes delirium. Recovery relies on Stomach Qi harmony; disharmony causes vexation and palpitations.
Women with Wind Strike, fever, aversion to cold, menstruation arriving, developing after seven to eight days, with fever subsiding, slow pulse, cool body, hypochondriac fullness resembling Chest Binding, and delirium, is Heat Entering Blood Chamber, treated by puncturing Qimen (LR14) to drain excess. Women with Cold Damage fever, menstruation arriving, lucid by day but delirious/hallucinating by night, is Heat Entering Blood Chamber. Do not injure Stomach Qi or Upper/Middle Jiao; self-resolution is expected. Both clauses annotate Heat Entering Blood Chamber without prescribing formulas, stating "do not injure Stomach Qi," implying prohibition of sweating/vomiting.
Shaoyin disease presenting initially with contrary fever and deep pulse is treated with Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction). This is Shaoyin syndrome resembling Taiyang. Cold pathogen on the exterior of Shaoyin meridian requires exterior dispersal, but differs from Taiyang methods; Mahuang and Fuzi warm meridians and expel pathogens.
Shaoyin disease with vomiting, diarrhea, cold-free extremities, and contrary fever is not fatal. If pulse is absent, moxa Shaoyin points seven moxa cones. Shaoyin transforming to heat indicates return of Yang, hence survival. Absent pulse remains critical, warranting moxibustion.
Cold Damage starting with fever for six days, reversing to cold extremities for nine days with diarrhea: patients with cold extremities/diarrhea normally cannot eat. Sudden ability to eat suggests Chu Zhong (Elimination of Middle). Feeding plain cake without subsequent fever indicates remaining Stomach Qi and impending recovery, fearing sudden heat flare-up and disappearance. Pulse check after three days: if heat persists, recovery is expected at dawn/midnight. Reason: Six days fever + Nine days cold + Three days recurrence = Nine days, matching cold duration, predicting recovery at dawn/midnight. If pulse is rapid and heat persists after three days, excess heat will cause abscess/pus. This chapter discusses excessive return of Yang from Yin cold extremities causing abscesses. (See detailed annotation in Cold Extremities/Diarrhea section.)
Cold Damage with initial cold extremities followed by fever sees diarrhea cease spontaneously. Return of cold extremities causes recurrence of diarrhea. Initial cold extremities followed by heat indicates Yin cold returning to Yang, so diarrhea stops. Recurrence of cold extremities causes diarrhea recurrence.
Cold Damage with initial cold extremities followed by fever, where diarrhea ceases but sweating occurs with throat pain, results in Bi syndrome of the throat. (See detailed annotation in Throat Pain section.)
Fever without sweating ensures diarrhea ceases. If it ceases, pus/blood in stool occurs. Pus/blood in stool prevents throat Bi. (See detailed annotation in Pus/Blood in Stool section.)
Cold Damage with four days fever, three days cold extremities, then four days fever: less cold, more heat indicates impending recovery. If heat persists from day four to seven, pus/blood in stool occurs. This reiterates that less cold/more heat predicts recovery, but persistent heat causes pus/blood in stool. Heat diseases returning to Yin, and Yin diseases returning to Yang, both fear excess and insufficiency.
Mahuang Tang (Ephedra Decoction) - See Aversion to Cold.
Qianghuo Chonghe Tang (Notopterygium Harmonizing Decoction)
Ingredients: Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Baizhi (Angelicae Dahuricae Radix), Huangqin (Scutellariae Radix), Cangzhu (Atractylodis Rhizoma), Shengdi (Rehmanniae Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Xixin (Asari Radix et Rhizoma), Guangpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma).
This formula harmonizes Taiyang exterior and interior. In dry-heat season, remove Cangzhu, Chuanxiong, Xixin. For cold feet, add Duhuo (Angelicae Pubescentis Radix). For Shaoyang signs, add Chaihu (Bupleuri Radix). In summer/autumn, add Zhimu (Anemarrhenae Rhizoma), Tianhuafen (Trichosanthis Radix), Shigao (Gypsum Fibrosum), Genge (Puerariae Radix). For chest fullness, remove Shengdi, add Zhike (Aurantii Fructus), Houpo (Magnoliae Officinalis Cortex). For profuse sweating, add Baishao (Paeoniae Radix Alba). For dampness dominance, remove Shengdi.
Qianghuo Baidu San (Notopterygium Resolving Toxins Powder)
Ingredients: Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Chaihu (Bupleuri Radix), Qianhu (Peucedani Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Fangfeng (Saposhnikoviae Radix), Jingjie (Schizonepetae Spica), Guangpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma).
This formula induces sweating and releases the muscle layer for Taiyang channel. I use it to substitute Zhang Zhongjing's Mahuang Tang (Ephedra Decoction) for Taiyang exterior syndromes in all seasons. For thirst, remove Chuanxiong. For chest fullness, add Zhike (Aurantii Fructus), Houpo (Magnoliae Officinalis Cortex). For Yangming signs, add Genge (Puerariae Radix). For interior heat, add Huangqin (Scutellariae Radix), Shanzhi (Gardeniae Fructus), Shigao (Gypsum Fibrosum).
Jiajian Fangfeng Tang (Modified Saposhnikovia Decoction) - See Body Pain.
In winter North, fever with sweating uses Guizhi Tang (Cinnamon Twig Decoction). In South during three seasons, family secret uses this modified formula. See Body Pain.
Wuling San (Five-Ingredient Poria Pill) - See Urinary Difficulty.
Note: Taiyang fever with sweating, thirst, and urinary difficulty indicates heat binding in Bladder; Zhang Zhongjing uses this formula. Modifications see Urinary Difficulty/Thirst section.
Qianghuo Mutong Tang (Notopterygium and Akebia Decoction)
Ingredients: Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Mutong (Akebiae Caulis), Cheqianzi (Plantaginis Semen)