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Gui Zhi Tang (Cinnamon Twig Decoction) original formula. Add Ge Gen (Puerariae Radix, Kudzu Root) four liang. Gui Zhi (Cinnamomi Ramulus, Cinnamon Twig) and Bai Shao (Paeoniae Radix, White Peony Root) each reduced by one liang. The rest remains the same.

The above six ingredients. Use one dou (ancient unit of volume) of water. First decoct Ge Gen (Puerariae Radix) until the liquid reduces by two sheng (ancient unit of volume). Remove the foam on the surface. Add the remaining herbs. Decoct to obtain three sheng of liquid. Strain the dregs. Take one sheng warm.

Cover with blankets to induce a slight sweat. There is no need to drink hot porridge.

The classic states: In Taiyang Disease (Taiyang Disease, an early stage of exogenous disease involving the Foot-Taiyang Bladder channel), if there is stiffness and discomfort in the neck and back (Qiang Ji Ji, describing stiffness), accompanied by sweating and aversion to wind, this formula should be used. Analysis indicates that Taiyang Disease typically presents with headache and stiffness/pain in the head and neck, but here the stiffness extends to the back. "Neck and back stiffness Qiāng Jǐ Jǐ" should be read as a continuous phrase. "Ji Ji" has a unique pronunciation, resembling the sound made by a short-winged bird stretching its neck when moving. This describes the patient's inability to freely nod or look up due to stiffness.

This belongs to the pattern of Taiyang Disease combined with Yangming Disease (Yangming Disease, a mid-to-late stage often characterized by gastrointestinal excess-heat). Sweating and aversion to wind indicate that the Taiyang exterior syndrome has not yet resolved, so Gui Zhi Tang (Cinnamon Twig Decoction) remains the primary formula. Ge Gen (Puerariae Radix) is added because there is concern that the pathogenic factor may deepen further, necessitating the urgent expulsion of pathogens from the Yangming channel.

Ma Huang (Ephedrae Herba, Ephedra) three liang, remove joints; Gui Zhi (Cinnamomi Ramulus, Cinnamon Twig) two liang, remove bark; Gan Cao (Glycyrrhizae Radix et Rhizoma, Licorice Root) one liang, honey-fried; Xing Ren (Armeniacae Semen Amarum, Apricot Seed) seventy seeds, soaked in hot water, remove skin and tips.

The above four ingredients. Use nine sheng of water. First decoct Ma Huang (Ephedrae Herba) until the liquid reduces by two sheng. Remove the foam on the surface. Add the remaining herbs. Decoct to obtain two and a half sheng of liquid. Strain the dregs. Take eight he (ancient unit of volume) warm. Cover with blankets to induce a slight sweat. There is no need to drink hot porridge. Rest and care follow the method of Gui Zhi Tang (Cinnamon Twig Decoction).

This is the main formula for treating Taiyang Cold Damage (Taiyang Cold Damage, a type of Taiyang disease caused by cold pathogens, characterized by anhidrosis and tight pulse). The classic states: In Taiyang Disease (Taiyang Disease), if there is headache, fever, body pain, lower back pain, joint pain, aversion to wind, anhidrosis (absence of sweating), and wheezing, Ma Huang Tang (Ephedra Decoction, Ephedra Formula) should be used. Although both belong to Taiyang Disease presenting with floating pulse, headache, neck stiffness/pain, and aversion to cold, those with fever, sweating, aversion to wind, and a slow pulse are named Wind Strike (Wind Strike, a type of Taiyang disease caused by wind pathogens, characterized by sweating and slow pulse). Those who have already developed fever or not yet, with aversion to cold, heavy body, nausea/vomiting, and a tight pulse at all positions (cun, guan, chi) are named Cold Damage (Cold Damage). Wind Strike causes headache; Cold Damage also causes headache. Wind Strike causes fever; Cold Damage also causes fever. Wind Strike causes aversion to wind; Cold Damage also causes aversion to wind. Regarding body pain, lower back pain, and joint pain, these are signs of heaviness of the body, seemingly different from Wind Strike. However, body pain can also be suitable for treatment with Gui Zhi Tang (Cinnamon Twig Decoction) to release the exterior. So, how to distinguish whether the syndrome specifically requires Ma Huang Tang (Ephedra Decoction) and not Gui Zhi Tang (Cinnamon Twig Decoction)? The key lies entirely in the four characters "anhidrosis and wheezing". Ma Huang (Ephedrae Herba) travels through the Wei (Defensive) level to induce sweating; Xing Ren (Armeniacae Semen Amarum) descends qi to calm wheezing. These are the main agents. They are assisted by Gui Zhi (Cinnamomi Ramulus) entering the Ying (Nutritive) level to disperse cold, and Gan Cao (Glycyrrhizae Radix et Rhizoma) harmonizing the middle and preserving fluids. This differs from Gui Zhi Tang (Cinnamon Twig Decoction), which harmonizes Ying and Wei to achieve a slight sweat.

Gui Zhi (Cinnamomi Ramulus) and Ma Huang (Ephedrae Herba) respectively treat the two syndromes of Taiyang Disease: Wind injuring the Wei level and Cold injuring the Ying level. Gui Zhi Tang (Cinnamon Twig Decoction) does not use Ma Huang (Ephedrae Herba), so why does Ma Huang Tang (Ephedra Decoction) use Gui Zhi (Cinnamomi Ramulus)? Some say Ma Huang (Ephedrae Herba) induces sweating too violently, so Gui Zhi (Cinnamomi Ramulus) is taken to restrain it. I do not believe this. Analyzing further, Gui Zhi (Cinnamomi Ramulus) is acrid and hot, capable of entering the Ying level and assisting sweating. In Gui Zhi Tang (Cinnamon Twig Decoction), Bai Shao (Paeoniae Radix) is still used to restrain Gui Zhi (Cinnamomi Ramulus); how could Gui Zhi (Cinnamomi Ramulus) instead restrain Ma Huang (Ephedrae Herba)? Generally, diseases in the Taiyang stage must be understood through the relationship between Ying and Wei. Wind injures the Wei level; if Wei qi is loose, wind enters easily. Wei belongs to Yang, and wind is a Yang pathogen. When two Yangs combine, Wei becomes strong while Ying becomes relatively weak, resulting in a slow pulse and sweating. Pathogens in the Wei level are easy to expel; thus, using Gui Zhi (Cinnamomi Ramulus) to enter the Ying level and assist sweating is sufficient, without needing Ma Huang (Ephedrae Herba) which might excessively deplete Wei qi. Cold injures the Ying level; if Ying qi is substantial, cold adheres easily. Ying governs Yin, and cold is a Yin pathogen. When two Yins contend, cold coagulates and Wei becomes closed, resulting in a tight pulse and anhidrosis. Pathogens in the Ying level are difficult to expel; thus, Ma Huang (Ephedrae Herba) should be the main agent to travel through the Wei level and induce sweating, necessarily relying on Gui Zhi (Cinnamomi Ramulus) to disperse cold in the Ying level. This is inherently a potent diaphoretic agent, so there is even less need to drink thin porridge to assist the medicinal power. Ginger and Jujube are not used because ginger is ascending and dispersing, while jujube is cloying and stagnant, worrying that they would hinder the function of Xing Ren (Armeniacae Semen Amarum) in descending qi and calming wheezing.

A tight pulse at all positions is named Cold Damage; thus, a tight pulse is indeed the definitive pulse for cold pathogens. However, a deep and tight pulse is not suitable for sweating; differentiation relies on the character "floating". Therefore, it is also stated: If the pulse is floating, the disease is in the exterior and should be treated with sweating; Ma Huang Tang (Ephedra Decoction) is appropriate. The "tightness" of the pulse differs from "rapid". "Tight" describes the image, implying firmness and coagulation. "Rapid" describes the frequency, implying swift movement. A rapid pulse in Cold Damage indicates the disease is about to transmit. But if the pulse is floating and rapid, the disease is still in the exterior. One can strike it while it is halfway across; Ma Huang Tang (Ephedra Decoction) for sweating is also appropriate.

Ma Huang Tang (Ephedra Decoction) is a heavy diaphoretic agent. If administered improperly, adverse reactions are significant. Even for agents suitable for sweating, one must assess the patient's body fluids. If the Chi pulse (reflecting Kidney essence and yin) is slow, sweating is contraindicated. If there is heavy body sensation and palpitations, sweating is contraindicated. If the throat is dry, sweating is contraindicated. Patients with Lin Syndrome (Lin Syndrome, disorders characterized by frequent, painful, and scanty urination) cannot sweat. Patients with sores/ulcers cannot sweat. Patients prone to epistaxis (nosebleeds) cannot sweat. Patients with blood loss cannot sweat. Patients prone to spontaneous sweating should not be heavily sweated again. All these are contraindications for Ma Huang (Ephedrae Herba). However, when sweating is indicated, some may hesitate and fail to sweat, causing pathogens to fail to resolve from the exterior and sink inward, leading to significant adverse reactions. Ultimately, one must verify that the patient has robust Ying and Wei, anhidrosis, and wheezing, before confidently using it without doubt. This relies entirely on the skill of pulse taking and syndrome differentiation.

In Cold Damage, resolution can occur via epistaxis (nosebleed). The classic states: Taiyang Disease, floating-tight pulse, anhidrosis, fever, body pain, unresolved after eight or nine days, with exterior symptoms still present. This should be treated with sweating. After taking medicine, symptoms slightly alleviate, but the patient develops irritability, heat, and closes their eyes. In severe cases, epistaxis will occur, and the disease resolves upon bleeding. This happens because Yang qi is overly congested. Ma Huang Tang (Ephedra Decoction) is the main formula. It also states: Cold Damage with floating-tight pulse, if not treated with sweating, leading to epistaxis, Ma Huang Tang (Ephedra Decoction) is the main formula. Commentators expand on the text, suggesting that after epistaxis, Ma Huang Tang (Ephedra Decoction) should be used again to disperse residual pathogens. However, there is a prohibition against sweating in patients prone to epistaxis in Cold Damage, and the classic also says that Taiyang Disease with floating-tight pulse, fever, and anhidrosis resolves spontaneously upon epistaxis. If the disease resolves after epistaxis, why use the harsh attack of Ma Huang Tang (Ephedra Decoction) again? Ke Yunbo stated that the five characters "Ma Huang Tang Zhu Zhi" (Ma Huang Tang is the main formula) likely belong to the period before epistaxis occurs, suggesting previous authors inverted the syntax. This statement is close to the truth.

Furthermore, regarding the main formula for Taiyang Disease, Ma Huang Tang (Ephedra Decoction), it is always indicated for floating pulse, anhidrosis, and wheezing. In cases of combined Taiyang and Yangming Disease, with wheezing and chest fullness, the pathogen is结 (knotted) in the Upper Jiao (Upper Burner). Do not rashly use purgatives. Treatment follows Taiyang rather than Yangming; Ma Huang Tang (Ephedra Decoction) is still appropriate. If Taiyang Disease lasts more than ten days, with a floating-thin pulse and lethargy, if there is chest and hypochondriac fullness/pain, it belongs to Chai Hu Syndrome (Chai Shao Syndrome, the main syndrome of Shaoyang disease). If the pulse is merely floating, the pathogen still lingers in Taiyang. Treatment follows Taiyang rather than Shaoyang; Ma Huang Tang (Ephedra Decoction) is still appropriate.

Regarding Ke Yunbo's view that Gui Zhi (Cinnamomi Ramulus) and Ma Huang (Ephedrae Herba) are general remedies for Wind and Cold in Taiyang Disease: Severe Wind Strike is Cold Damage; mild Cold Damage is Wind Strike. Gui Zhi (Cinnamomi Ramulus) is a light diaphoretic; Ma Huang (Ephedrae Herba) is a heavy diaphoretic. There is no need to finely distinguish between Wind and Cold, only focusing on the presence or absence of sweating. This opens the door for later confusion and should not be set as a standard. In summary, Ma Huang (Ephedrae Herba) induces sweating, Xing Ren (Armeniacae Semen Amarum) calms wheezing. Anhidrosis and wheezing are the definitive syndromes of Cold Damage, and Ma Huang Tang (Ephedra Decoction) is the definitive formula for Cold Damage. Users must examine carefully.