鄭論：既稱發汗已，而曰身目為黃，明言此為陰黃，而非陽黃也。陽黃有熱形可征，此無陽象實據，故曰寒濕中求之，明言陰黃無疑。法宜溫中除濕為主。
【闡釋】寒濕在裏而成的黃疸，是為陰黃，病屬太陰，與濕熱在裏的發黃，是為陽黃，病屬陽明，自屬不同。陰黃是脾胃中陽不足，寒濕內困，其黃晦暗，並有裏寒見證，至其治法，鄭氏雲：“法宜溫中除濕”。筆者常用附子理中湯加茵陳治之，屢用屢效者。
五十六、傷寒，瘀熱在裏，身必發黃，麻黃連軺赤小豆湯主之。原文262
鄭論：按瘀熱在裏，未必盡成發黃之症，是必有濕邪相湊方成。
【闡釋】本條是外有寒邪，內有濕熱，鬱蘊不解的發黃證治。原文敘證甚簡，從方劑的作用來理解，必有一系列的表證存在，如頭疼體痛，惡寒無汗等，因病勢偏重於表，故宜兼汗解以治之，清利濕熱亦不可少，此麻黃連軺赤小豆湯之所以立也。
麻黃連軺赤小豆湯方（校補）
麻黃二兩（去節）連軺二兩杏仁四十個（去皮尖）赤小豆一升大棗十二枚（擘）生梓白皮一升（切）生薑二兩（切）甘草二兩（炙）上八味，以潦水一鬥①，先煮麻黃再沸，去上沫，內諸藥，煮取三升，去渣，分溫三服，半日服盡。
①潦水：李時珍雲“潦水乃雨水所積”，取其味薄不助濕氣而利熱。
【方解及其應用範圍】方中麻黃、杏仁、甘草、生薑、大棗以發散表邪，赤小豆、連招、生梓白皮以清泄濕熱，主要使濕熱鬱蒸之邪從表而散。此表邪未解，癖熱在裏的陽黃治法。
五十七、傷寒七八日，身黃如（紫）〔橘子〕色，小便不利，腹微滿者，茵陳篙湯主之。原文260
鄭論：此明主濕熱在裏，薰蒸而成，若小便利，則必不能發黃。因小便不利，濕熱之氣不得下趨，故成此候。而曰腹微滿者，太陽蓄尿之驗也。原文以茵陳篙湯主之，妥切。但此為蓄尿發黃，而非陽明發黃，原方可加入五荃方中，庶無大謬。
【闡釋】本條是濕熱發黃，當以清熱利濕為治療準則。由於濕熱鬱蒸在裏，不得外達，又小便不利，濕熱不下行，故發黃，以茵陳篙湯主之，甚為恰切。鄭氏更進一層曰：“腹微滿者，太陽蓄尿之驗也”。此太陽腑證中之蓄尿證發黃，而非陽明發黃，故應原方加入五苓散，其效更佳，筆者從之。
五十八、傷寒身黃發熱（者），梔子柏皮湯主之。原文261
鄭論：此言身黃發熱，而在太陽，並非陽明，必是太陽之氣，拂郁於皮膚，而成此候，原文以梔子柏皮湯，是從小便以逐邪之意也。
【闡釋】本條之身黃發熱，亦濕熱鬱蒸所致，但沒有腹微滿的裏證，又沒有惡寒體疼的表證。梔子柏皮湯為清熱泄濕之劑，俾邪從小便而去，濕去熱清，黃亦自愈。
梔子柏皮湯方（校補）
肥梔子十五個（擘）甘草一兩（炙）黃柏二兩上三味，以水四升，煮取一升半，去渣，分溫再服。
【方解及其應用範圍】梔子苦寒，瀉三焦火，通利小便，治心煩懊儂，鬱熱結氣；黃柏苦寒，善於清熱除濕。甘草甘溫，和胃保脾，緩苦寒之性。三味成方，為清泄濕熱之劑，使邪從小便而去，濕去熱清，黃亦自愈。
傷寒恒論卷三太陽下篇凡風寒兩傷營衛之證，列於此篇，計二十四法（據舒本校增）一、太陽中風，脈浮緊，發熱惡寒，身疼痛，不汗出而煩躁者，大青龍湯主之。若脈微弱，汗出惡風者，不可服之，服之則厥逆①，筋惕肉膶②，此為逆也。原文38
①厥逆：指四肢厥冷。
②筋惕肉膶：就是筋肉跳動，由於亡陽脫液，筋肉得不到煦濡所致。
【闡釋】鄭書原文無此條，據舒本太陽下篇一條，《傷寒論》原書辨太陽病脈證並治上38條校補。鄭書一、二、三、四條，挨次校為二、三、四、五條，而鄭書原五條全文與三條同，應刪去。太陽中風，脈浮緊，發熱惡寒，身疼痛，無汗，此麻黃湯證也。煩躁一證，即是此節大眼目。當知此煩躁，係風邪遏閉於胸中，與少陰亡陽之煩躁，陽明熱越之煩躁不同。蓋太陽主皮毛，肺亦主皮毛，此風邪不得外泄於皮毛，所以內搏於肺也。治以大青龍湯，于辛溫發汗之中，而加以重鎮之石膏，其意在內以平風清熱，外以發表助津液也。若脈微弱，汗出惡風者，雖內有煩躁之證，亦不可用大青龍湯之峻劑，若誤服之，必亡陽，而使陰陽之氣，不相順接，而先現厥逆，以致筋惕肉膶。筋惕者，筋戰慄而如恐懼之象，肉膶者，肉跳動而有不安之形，欲救其誤，非真武湯不可。
大青龍湯方（校補）
麻黃六兩（去節）桂枝二兩（去皮）甘草二兩（炙）杏仁四十枚（去皮尖）生薑三兩（切）大棗十二枚（擘）石膏如雞子大（碎）上七味，以水九升，先煮麻黃，減二升，去上末，內諸藥，煮以三升，去渣，溫服一升，取微似汗，汗出多者，溫粉粉之③。一服汗者，停後服，若複服，汗多亡陽，遂虛，惡風煩躁，不得眠也。
③溫粉粉之：相當於用爽身粉，可以吸收汗液，《孝慈備覽》撲身止汗法，麩皮糯米粉二合，龍骨牡蠣二兩，共為極細末，以疏絹包裹，周身撲之，其汗自止。
【方解及其應用範圍】本方由麻黃湯加味而成，此麻黃證之劇者，是發汗之峻劑，倍用麻黃，佐桂枝、生薑辛溫以發散在表之風寒，加石膏辛寒以除煩熱，甘草、大棗和中以資汗源，共奏解表清裏之功。柯韻伯謂：“兩青龍俱治有表裏證，皆用兩解法，大青龍是裏熱，小青龍是裏寒，故發表之藥相同，而治裏之藥則殊也。”《金匱》用以治溢飲，現今推廣治感冒、肺炎、哮喘、胸膜炎等表裏俱實之證而裏熱較甚者，多獲滿意效果。
二、傷寒脈浮緩，身不（痛）〔疼〕，但重，乍有輕時①，無少陰證者②，大青龍湯發之。原文39
①乍：忽然也，猝也。
②無少陰證：沒有少陰陰盛陽虛的證候。
鄭論：按大青龍湯，乃風寒兩傷營衛，煩躁發熱之主方。此言脈浮緩，並無身疼發熱，而曰身重乍有輕時，論身重乃少陰之征，而曰乍有輕時，卻又非少陰的候，此為大青龍湯，實不恰切，學者宜細心求之。
【闡釋】發熱惡寒，無汗煩躁，乃大青湯之主證。此則不言主證，但言脈浮緩，身不疼，但重乍有輕時證狀，還不足以為用大青龍湯的依據。故鄭氏說：“此為大青龍湯，實不恰切”。值得學者深思。
三、太陽病，脈浮〔緊〕，〔無汗〕，發熱，身疼痛，八九日不解，表證仍在（者），此當發其汗。服藥已微除，其人發（熱）[煩]目瞑③劇者必衄④，衄乃解。所以然者，陽氣重故也，麻黃湯主之。原文46
③目瞑：目不明也，就是目合懶開的意思。
④衄：鼻腔出血曰衄。
鄭論：按此條既稱八九日不解，表證仍在者，固當發其汗，既服藥已微除，微字是發汗邪衰而未盡解之意，複見其人發熱，目瞑，劇者必衄，衄則邪必外出，故仍以麻黃湯隨機而導之之意。此條設若不衄，更見發熱目瞑劇者，又當于陽越於外求之。求之奈何？於口之飲冷飲熱判之，人之有神無神，脈之有力無力，二便之利與不利處求之，切切不可死守原文，當以不執方為要。
【闡釋】“此條設若不衄，更見發熱目瞑劇者，又當于陽越於外求之”，此又鄭氏獨特之見解。醫者則當按《醫理真傳》辨認一切陽虛證法辨之，以回陽收納為是，大劑四逆湯治之。
四、傷寒脈浮緊，不發汗，因致衄者，麻黃湯主之。原文55
鄭論：按此條乃（傷寒）〔寒傷〕營之的候，其人能大汗出而邪可立解，則不致衄，衄出，即汗出也，故以麻黃湯治之，是隨機而導之之意，俾邪盡出無遺，真上乘法也。
【闡釋】傷寒脈浮緊，用麻黃湯發汗，使外邪從汗而解。今當汗不汗，則邪無從出，壅閉陽絡，迫血妄行，因而致衄。衄出即汗出而解。但表實之傷寒不因衄出而解，仍應以麻黃湯治之，此即鄭氏“隨機而導之之意，俾邪盡出無遺。”
五、太陽病，脈浮緊，發熱，身無汗，自衄者愈。原文47
鄭論：此係與上同，毋容再論。
【闡釋】本條是太陽傷寒麻黃湯證。因熱盛而致衄，雖未服藥，亦可能邪隨衄解而病自愈。蓋血之與汗，異名同類，不從汗解，則從衄解，其義相同。又本條與三條四條俱為表實證的衄血，但本條是未經服藥的衄血，其病邪隨衄而解，故曰“自衄者愈”。四條是因失治衄血，衄後病邪仍未解，脈證如故，仍以“麻黃湯主之”。三條是已經服藥，邪熱較盛的衄血，其邪亦隨衄而解，故而“衄乃解”。
六、太陽病，得之八九日，如瘧狀①，發熱惡寒，熱多寒少，其人不嘔，清便欲自可②，一日二三度發。（而）脈微緩者③，為欲愈也；脈微而惡寒〔者〕，此陰陽俱虛④，不可更發汗、更吐、〔更〕下也；面色反有熱色者⑤，未欲解也，以其不能得小汗出，身必癢，宜桂枝麻黃各半湯。原文23
①如瘧狀：寒熱發作的情況，好象瘧疾一樣。
②清便欲自可；清同圊，清便欲自可，就是大小便尚能如常的思。
③熱色：就是紅色。
④陰陽俱虛：這裏的陰陽，指表裏言，謂表裏都虛。
⑤脈身微緩：微與洪相對，緩與緊相對，微緩就是不洪不緊而柔和的意。
鄭論：此條既稱八九日，未有不用發散祛邪之方，據所言如瘧狀，如瘧者，似瘧而非真瘧之謂也。雖現熱多㈠寒少，而其人不嘔，清便自可，以清便二字核之，與脈之微緩核之，則內無的確之風熱，明是發解太過，必是陽虛似瘧無疑，法宜扶陽溫固為是。又曰脈微而惡寒者，為陰陽俱虛，不可更發汗、吐、下也。明明此非青龍湯、麻（黃）〔桂〕各半湯的候也。若其人面皮反有赤色，赤色二字，更宜著眼，恐是（帶）〔戴〕陽，苟非（帶）〔戴〕陽，果現脈浮緊，未得小汗，而致身癢疼者，方可與麻（黃）〔桂〕各半湯，學者雖于一症之中，前後參究，方可與論傷寒，讀傷寒也。
㈠是屬陽症熱多，定現口渴飲冷，舌必有黃苔，熱時必揭去衣被，小便必赤，若似瘧則無此等病情。（頂批）
【闡釋】本條為太陽病八九日不解，可以有三種不同的轉變，但鄭氏特別指出：“明是發解太過，必是陽虛似瘧無疑，法宜扶陽溫固為是”。又“若其人面皮反有赤色，更宜著眼，恐是戴陽”。筆者認為前者可用黃芪建中湯治之，後者用白通湯。邪鬱久未得出小汗，而身癢疼者，方可與麻桂各半湯，取其微汗而解。
桂枝麻黃各半湯（校補）
桂枝一兩十六銖（去皮）芍藥、生薑（切）甘草（炙）麻黃各一兩（去節）大棗四枚（擘）杏仁二十四枚（湯浸，去皮尖及兩仁者）上七味，以水五升，先煮麻黃一二沸，去上沫，內諸藥，煮取一升八合，去滓，溫服六合。本雲桂枝湯三合，麻黃湯三合，並為六合，頓服，將息如上法。
【方解及其應用範圍】桂枝湯為協和營衛之劑，用治太陽病傷風；麻黃湯乃開表逐邪，發汗之峻劑，用治太陽病傷寒。風寒同時並傷營衛，則合二方治之，肌表兩解。因劑小量輕，如此既得小汗祛邪之功，又無過汗傷正之弊。筆者常用本方治療風寒兩感之咳嗽有很好療效。
七、太陽病，發熱惡寒，熱多寒少，脈微弱者，此無陽也，不可（更）〔發〕汗，宜（用）桂枝二越婢一湯①。原文27
①越婢：“婢”與“脾”古字通用，玉函經方後煎法，二“婢”字均作“脾”可證。成無己注：發越脾氣，通行津液。
鄭論：此條言發熱惡寒者，邪犯太陽之表也，熱多寒少者，風邪之盛而寒邪之輕也，以越婢湯治之，取桂枝以伸太陽之氣，（軀）〔祛〕衛分之風，用石膏以清衛分之熱，用麻黃生薑以散寒，所為的確之方。但條中言無陽不可發汗，既曰無陽，豈有熱重寒輕之理？豈有再用石膏、桂、麻之理？定有錯誤。
【闡釋】鄭注文謂：“但條中言無陽不可發汗，既曰無陽，豈有熱重寒輕之理？豈有再用石膏、桂、麻之理？定有錯誤。”歷代很多注家都隨文順釋，牽強附會，而鄭氏認為定有錯誤，但未能指出錯在何處？惟章虛穀注曰：“此條經文，宜作兩截看，宜桂枝二越婢湯一句，是接熱多寒少句，今為煞句，是漢文兜轉法也。……”曹穎甫訂正：“按宜桂枝二越婢一湯句，當在熱多寒少下，今在節末，否則既雲不可發汗，猶用此發汗之藥，有是理乎？”章、曹二氏之注，即可解鄭氏之惑，亦嘉惠後學也。
桂枝二越婢一湯方（校補）
桂枝（去皮）芍藥、麻黃、甘草各十八銖（炙）大棗四枚〔擘）生薑一兩二銖（切）石膏二十四銖（碎、綿裹）上七味，以水五升，煮麻黃一二沸，去上沫，內諸藥，煮取二升，去渣，溫服一升。本雲當裁為越婢桂枝湯，合之飲一升，今合為一方，桂枝二分，越婢一分。
【方解及其應用範圍】本方即桂枝湯加麻黃石膏而成。桂枝二，仍以和營衛為主，輔以越婢一，取其辛涼之性，以清泄裏熱而發越郁陽。用於外有表證，裏有鬱熱，還當有裏熱口渴等現象，亦即熱多寒少。與麻桂各半湯、桂枝二麻黃一湯都是桂枝湯的變法，而其病理機轉，用藥主次都有不同之處，應細心揣摩體會，方不致誤。
八、服桂枝湯，大汗出，脈洪大者①，與桂枝湯，如前法。若形似瘧，一日再發者，汗出必解，宜桂枝二麻黃一湯。原文25
①脈洪大：脈形盛大如洪水氾濫，但來盛去衰，是其特點。
Zheng's Commentary: Since it is stated as "after sweating," yet the body and eyes turn yellow, it explicitly indicates Yin Jaundice (Yin Huang), not Yang Jaundice (Yang Huang). Yang Jaundice presents with signs of heat that can be verified; here, there is no substantial evidence of Yang syndrome. Therefore, it states to seek treatment within Cold-Dampness, clearly indicating Yin Jaundice without doubt. The method should primarily focus on warming the middle and eliminating dampness.
[Explanation] Jaundice formed by Cold-Dampness in the interior is called Yin Jaundice, belonging to the Taiyin stage. This differs from jaundice caused by Damp-Heat in the interior, which is called Yang Jaundice and belongs to the Yangming stage. Yin Jaundice results from insufficient Spleen-Stomach Yang, with Cold-Dampness confining internally; its color is dull, accompanied by interior Cold manifestations. Regarding treatment, Zheng states: "The method should primarily focus on warming the middle and eliminating dampness." I frequently treat this condition using Fuzi Lizhong Tang (Aconite Decoction for Regulating the Middle) combined with Yinchin (Artemisiae Scopariae Herba), with consistent efficacy.
56. In Shaoyang disease, stagnant heat resides in the interior, inevitably causing jaundice; Mahuang Lianqiao Chixiaodou Tang (Ephedra, Forsythia, and Red Bean Decoction) is the primary formula. Original Text 262
Zheng's Commentary: Stagnant heat in the interior does not necessarily always result in jaundice; it requires the presence of Dampness to form this condition.
[Explanation] This clause addresses the treatment of jaundice characterized by exterior Cold pathogens and interior Damp-Heat stagnation. The original text describes symptoms briefly; understanding from the perspective of the formula's action, a series of exterior symptoms must exist, such as headache, body ache, aversion to cold, and anhidrosis. Since the pathological trend favors the exterior, it is appropriate to combine diaphoresis with clearing and draining Damp-Heat. This establishes the rationale for Mahuang Lianqiao Chixiaodou Tang.
Mahuang Lianqiao Chixiaodou Tang Formula (Corrected and Supplemented)
Mahuang (Ephedrae Herba) 2 liang (remove joints), Lianqiao (Forsythiae Fructus) 2 liang, Xingren (Armeniacae Semen Amarum) 40 pieces (remove skin and tips), Chixiaodou (Phaseoli Semen Rubrum) 1 sheng, Dazao (Ziziphi Jujubae Fructus) 12 pieces (split), Sheng Zibai Pi (Celtidis Cortex) 1 sheng (cut), Shengjiang (Zingiberis Rhizoma Recens) 2 liang (cut), Gancao (Glycyrrhizae Radix et Rhizoma Preparata) 2 liang (roasted). These eight ingredients are decocted in 1 dou of Liaoshui (accumulated rainwater)①. First boil Mahuang until boiling, remove the foam on top, add the remaining herbs, decoct to obtain 3 sheng, strain, and divide into three warm doses, consumed within half a day.
① Liaoshui: Li Shizhen stated, "Liaoshui is accumulated rainwater," chosen for its thin flavor that does not aid dampness but facilitates heat clearance.
[Formula Analysis and Scope of Application] Mahuang, Xingren, Gancao, Shengjiang, and Dazao disperse exterior pathogens; Chixiaodou, Lianqiao, and Sheng Zibai Pi clear and drain Damp-Heat. The main purpose is to dissipate Damp-Heat steaming from the exterior. This is the treatment for Yang Jaundice where exterior pathogens remain unresolved and stagnant heat resides in the interior.
57. After seven or eight days of Shaoyang disease, if the body is yellow like an orange peel, urination is difficult, and there is slight abdominal fullness, Yinchen Hao Tang (Artemisiae Scopariae Decoction) is the primary formula. Original Text 260
Zheng's Commentary: This clarifies that Damp-Heat in the interior causes steaming and formation of jaundice. If urination were free, jaundice would not occur. Because urination is obstructed, Damp-Heat cannot descend, leading to this condition. The mention of slight abdominal fullness is evidence of Water Accumulation in the Taiyang stage. Using Yinchen Hao Tang as stated in the original text is appropriate. However, this is jaundice due to Water Accumulation, not Yangming jaundice. Adding Wuling San (Five-Ingredient Powder with Poria) to the original formula would avoid significant error.
[Explanation] This clause concerns Damp-Heat jaundice, where the treatment principle should be clearing heat and promoting urination to resolve dampness. Due to Damp-Heat stagnating in the interior without external release, and obstructed urination preventing downward flow, jaundice develops. Yinchen Hao Tang is highly suitable. Zheng further states: "Slight abdominal fullness is evidence of Taiyang Water Accumulation." This is jaundice from Water Accumulation in the Taiyang Fu organ stage, not Yangming jaundice. Therefore, adding Wuling San to the original formula yields better results, a view I follow.
58. In Shaoyang disease, if the body turns yellow and fever occurs, Zhizi Bopi Tang (Gardenia and Phellodendron Decoction) is the primary formula. Original Text 261
Zheng's Commentary: This refers to body yellowing and fever occurring in the Taiyang stage, not Yangming. It implies that Taiyang Qi is stifled and constrained in the skin, forming this condition. The use of Zhizi Bopi Tang aims to expel pathogens via urination.
[Explanation] The body yellowing and fever in this clause are also caused by Damp-Heat stagnation. However, there are no interior signs like slight abdominal fullness, nor exterior signs like aversion to cold and body ache. Zhizi Bopi Tang clears heat and drains dampness, allowing pathogens to exit via urination. Once dampness is removed and heat cleared, jaundice resolves spontaneously.
Zhizi Bopi Tang Formula (Corrected and Supplemented)
Fei Zhizi (Gardeniae Fructus) 15 pieces (split), Gancao (Glycyrrhizae Radix et Rhizoma Preparata) 1 liang (roasted), Huangbai (Phellodendri Cortex) 2 liang. These three ingredients are decocted in 4 sheng of water to obtain 1.5 sheng, strained, and divided into two warm doses.
[Formula Analysis and Scope of Application] Zhizi is bitter and cold, draining fire from the Triple Burner, promoting urination, and treating restlessness and stifling heat qi; Huangbai is bitter and cold, excelling at clearing heat and drying dampness. Gancao is sweet and warm, harmonizing the stomach and protecting the spleen, moderating the bitter-cold nature. Together, they form a formula for clearing and draining Damp-Heat, expelling pathogens via urination, resolving dampness and heat, and curing jaundice.
Shaoheng Lun, Volume 3, Lower Chapter of Taiyang: All syndromes where Wind and Cold simultaneously injure Ying and Wei are listed here, totaling twenty-four methods (supplemented according to the Shu edition).
1. In Taiyang Wind Strike, if the pulse is floating and tight, with fever, aversion to cold, body pain, anhidrosis, and restlessness, Da Qinglong Tang (Great Blue Dragon Decoction) is the primary formula. If the pulse is faint and weak, with sweating and aversion to wind, it must not be administered. Administration would lead to cold limbs① and muscle twitching②, which is a adverse reaction. Original Text 38
① Cold Limbs (Jue Ni): Refers to coldness of the four extremities.
② Muscle Twitching (Jin Ti Rou Yun): Refers to muscle twitching, caused by loss of Yang and depletion of fluids, leaving muscles without warmth and nourishment.
[Explanation] Zheng's original text lacks this clause; it is supplemented from the Shu edition's Taiyang Lower Chapter, corresponding to Clause 38 of the original Shanghan Lun. Zheng's clauses 1, 2, 3, and 4 are renumbered as 2, 3, 4, and 5 respectively. Zheng's original Clause 5 is identical to Clause 3 and should be deleted. Taiyang Wind Strike with floating-tight pulse, fever, aversion to cold, body pain, and anhidrosis is a Mahuang Tang syndrome. Restlessness is the key point of this section. One must understand that this restlessness is caused by Wind pathogen constraining the chest, differing from the restlessness of Shaoyin Yang collapse or Yangming Heat overflowing. Since Taiyang governs the skin and hair, and the Lung also governs the skin and hair, this Wind pathogen cannot escape through the skin and thus presses inward on the Lung. Treatment uses Da Qinglong Tang, combining acrid-warm diaphoresis with heavy-settling Shigao (Gypsum Fibrosum) to calm internal Wind and clear heat externally while assisting fluid production. If the pulse is faint and weak with sweating and aversion to wind, even with internal restlessness, the harsh agent Da Qinglong Tang must not be used. Misuse will cause Yang collapse, disrupting the smooth connection between Yin and Yang, leading first to cold limbs and then muscle twitching. To remedy this error, Zhenwu Tang (Aconite Decoction) is essential.
Da Qinglong Tang Formula (Corrected and Supplemented)
Mahuang (Ephedrae Herba) 6 liang (remove joints), Guizhi (Cinnamomi Ramulus) 2 liang (remove bark), Gancao (Glycyrrhizae Radix et Rhizoma Preparata) 2 liang (roasted), Xingren (Armeniacae Semen Amarum) 40 pieces (remove skin and tips), Shengjiang (Zingiberis Rhizoma Recens) 3 liang (cut), Dazao (Ziziphi Jujubae Fructus) 12 pieces (split), Shigao (Gypsum Fibrosum) size of a chicken egg (crushed). These seven ingredients are decocted in 9 sheng of water. First boil Mahuang, reduce by 2 sheng, remove foam, add other herbs, decoct to obtain 3 sheng, strain, and take 1 sheng warm. Aim for slight sweating. If sweating is excessive, apply Wenfen (Warm Powder)③. If one dose produces sweat, stop subsequent doses. Re-administration may cause excessive sweating, Yang collapse, weakness, aversion to wind, restlessness, and insomnia.
③ Warm Powder: Equivalent to talcum powder, absorbing sweat. According to *Xiao Ci Bei Lan*, mix Bran and Glutinous Rice Flour (2 he) with Longgu (Fossilia Ossis Mastodi) and Muli (Concha Ostreae) (2 liang), grind to fine powder, wrap in loose silk, and pat over the body to stop sweating.
[Formula Analysis and Scope of Application] This formula is derived from Mahuang Tang with additions. It treats severe Mahuang patterns and is a harsh diaphoretic. Doubling Mahuang, assisted by Guizhi and Shengjiang (acrid-warm) to disperse exterior Wind-Cold, plus Shigao (acrid-cold) to relieve restlessness and heat, and Gancao and Dazao to harmonize the middle and support fluid sources, achieves both exterior resolution and interior heat clearance. Ke Yunbo stated: "Both Qinglong formulas treat exterior-interior syndromes using dual resolution. Da Qinglong treats interior Heat, Xiao Qinglong treats interior Cold. Thus, exterior-dispersing herbs are the same, but interior-treating herbs differ." In *Jingui Yaolue*, it treats Overflowing Fluid (Yi Yin). Currently, it is extended to treat colds, pneumonia, asthma, pleurisy, etc., presenting as exterior-interior excess with significant interior heat, often yielding satisfactory results.
2. In Shaoyang disease, if the pulse is floating and slow, the body does not ache but feels heavy, occasionally feeling lighter①, and there are no Shaoyin signs②, Da Qinglong Tang induces sweating. Original Text 39
① Zha: Suddenly, abruptly.
② No Shaoyin Signs: Absence of Shaoyin syndrome characterized by Yin excess and Yang deficiency.
Zheng's Commentary: Da Qinglong Tang is the principal formula for Wind-Cold injuring Ying and Wei, causing restlessness and fever. Here, the pulse is floating-slow, without body ache or fever, but with heaviness that occasionally lightens. Heaviness is a sign of Shaoyin, yet occasional lightening contradicts Shaoyin characteristics. Thus, using Da Qinglong Tang is inappropriate. Scholars should investigate carefully.
[Explanation] Fever, aversion to cold, anhidrosis, and restlessness are the main indications for Da Qinglong Tang. This clause mentions only floating-slow pulse, lack of body ache, heaviness with occasional relief—insufficient grounds for using Da Qinglong Tang. Hence Zheng says: "Using Da Qinglong Tang here is truly inappropriate." This warrants deep reflection by scholars.
3. In Taiyang disease, if the pulse is [tight], [without sweat], with fever and body pain, persisting for eight or nine days without resolution, and exterior signs remain (the patient), sweating should be induced. After medication, symptoms slightly improve, but if the patient develops fever, eye closure/lethargy③, and severe restfulness leading to epistaxis④, recovery follows upon bleeding. This occurs because Yang Qi is excessive. Mahuang Tang is the primary formula. Original Text 46
③ Mu Ming: Eyes unclear, meaning closing eyes and reluctance to open them.
④ Nu: Epistaxis (nosebleed).
Zheng's Commentary: Since this clause states eight or nine days without resolution and persistent exterior signs, sweating is indeed indicated. "Slightly improved" after medication means pathogens are weakened but not fully resolved. If fever, eye closure, and severe restlessness recur, leading to epistaxis, pathogens exit via bleeding. Thus, Mahuang Tang is used to guide pathogens out opportunistically. If epistaxis does not occur, and fever/eye closure worsen, one must seek the cause in Yang escaping outward. How? By determining preference for cold vs. hot drinks, assessing spirit (Shen), pulse strength, and bowel/bladder function. Do not rigidly adhere to the original text; flexibility in prescription is key.
[Explanation] "If epistaxis does not occur... seek the cause in Yang escaping outward" is Zheng's unique insight. Physicians should diagnose all Yang-deficiency patterns according to *Yi Li Zhen Chuan* and treat with large doses of Sini Tang (Frigid Four Decoction) to restore Yang and gather essence.
4. In Shaoyang disease, if the pulse is floating-tight and sweating is not induced, resulting in epistaxis, Mahuang Tang is the primary formula. Original Text 55
Zheng's Commentary: This clause describes the definitive pattern of Cold injuring Ying. Profuse sweating would resolve pathogens immediately, preventing epistaxis. Epistaxis is equivalent to sweating. Thus, Mahuang Tang is used to guide pathogens out opportunistically, ensuring complete expulsion—a superior method.
[Explanation] In Shaoyang disease with floating-tight pulse, Mahuang Tang induces sweating to resolve exterior pathogens. Failure to sweat when indicated causes pathogens to have no exit, blocking Yang collaterals and forcing blood recklessly, leading to epistaxis. Epistaxis acts as sweating, resolving the condition. However, if exterior excess Shaoyang disease does not resolve via epistaxis, Mahuang Tang remains indicated, reflecting Zheng's idea of "guiding pathogens out opportunistically to ensure complete expulsion."
5. In Taiyang disease, if the pulse is floating-tight, with fever and no body sweat, spontaneous epistaxis leads to recovery. Original Text 47
Zheng's Commentary: Identical to the previous clause; no further discussion needed.
[Explanation] This clause describes the Taiyang Shaoyang Mahuang Tang pattern. Heat excess causes epistaxis. Even without medication, pathogens may resolve via bleeding, leading to spontaneous recovery. Blood and sweat are different names for similar substances; if not resolved via sweat, they resolve via bleeding. Unlike Clauses 3 and 4 which involve treated exterior excess cases, this clause involves untreated epistaxis where pathogens resolve spontaneously, hence "spontaneous epistaxis leads to recovery." Clause 4 involves neglected treatment where pathogens persist despite epistaxis, requiring Mahuang Tang. Clause 3 involves post-medication high heat where pathogens resolve via epistaxis, hence "epistaxis leads to resolution."
6. In Taiyang disease, after eight or nine days, resembling malaria① with fever and aversion to cold, more heat than cold, no vomiting, normal bowel/bladder function②, occurring two or three times a day. If the pulse is faint and slow③, recovery is imminent. If the pulse is faint with aversion to cold④, this indicates simultaneous Yin and Yang deficiency⑤; do not induce sweating, vomiting, or purgation again. If the face shows a red hue⑥, resolution is not yet achieved because small sweating is impossible, causing body itching; Guizhi Mahuang Ge Ban Tang (Guizhi and Mahuang Half-Dose Decoction) is appropriate. Original Text 23
① Like Malaria: Paroxysmal chills and fever resembling malaria.
② Normal Bowel/Bladder Function: "Qing" refers to toilet. Normal function means regular bowel and bladder movements.
③ Red Hue: Red color.
④ Simultaneous Yin and Yang Deficiency: Here, Yin and Yang refer to Interior and Exterior, indicating both are deficient.
⑤ Pulse and Body Slightly Slow: "Wei" contrasts with "Hong" (Surging); "Huan" contrasts with "Jin" (Tight). "Wei Huan" means neither surging nor tight, but soft.
Zheng's Commentary: After eight or nine days, dispersing formulas are typically used. "Like malaria" means resembling but not true malaria. Although heat exceeds cold, with no vomiting and normal digestion, combined with a faint-slow pulse, there is no definite interior Wind-Heat. Clearly, excessive dispersion has occurred, leading to Yang deficiency mimicking malaria. The method should be supporting Yang and warming consolidation. "Faint pulse with aversion to cold" indicates simultaneous Yin-Yang deficiency, prohibiting further sweating, vomiting, or purgation. This is clearly not a Qinglong Tang or Mahuang/Guizhi Half-Dose pattern. If the face is red, attention must be paid to "Dai Yang" (Floating Yang). Unless it is Dai Yang, and if floating-tight pulse exists without small sweating causing body itch/pain, Guizhi Mahuang Ge Ban Tang may be given. Scholars must analyze前後 (front and back) within the symptom complex to discuss and study Shaoyang disease properly.
㈠ Yang syndromes with excess heat present thirst for cold drinks, yellow tongue coating, removing covers during fever, and dark urine. Malaria-like symptoms lack these features. (Top Annotation)
[Explanation] This clause describes Taiyang disease persisting for eight or nine days with three possible transformations. Zheng specifically points out: "Clearly, excessive dispersion has led to Yang deficiency mimicking malaria; the method should be supporting Yang and warming consolidation." And "If the face is red, watch for Dai Yang." I believe the former can be treated with Huangqi Jianzhong Tang (Astragalus Decoction for Building the Middle), and the latter with Baitong Tang (White Through Decoction). For pathogens lingering without small sweating causing body itch/pain, Guizhi Mahuang Ge Ban Tang is appropriate to achieve mild sweating and resolution.
Guizhi Mahuang Ge Ban Tang (Corrected and Supplemented)
Guizhi (Cinnamomi Ramulus) 1 liang 16 zhu (remove bark), Shaoyao (Paeoniae Radix Alba), Shengjiang (Zingiberis Rhizoma Recens, cut), Gancao (Glycyrrhizae Radix et Rhizoma Preparata, roasted), Mahuang (Ephedrae Herba) each 1 liang (remove joints), Dazao (Ziziphi Jujubae Fructus) 4 pieces (split), Xingren (Armeniacae Semen Amarum) 24 pieces (soaked in water, remove skin, tips, and double kernels). These seven ingredients are decocted in 5 sheng of water. First boil Mahuang for 1-2 boils, remove foam, add other herbs, decoct to obtain 1.8 sheng, strain, and take 6 he warm. Originally, it was said to mix 3 he of Guizhi Tang and 3 he of Mahuang Tang to make 6 he, taken at once, with care as above.
[Formula Analysis and Scope of Application] Guizhi Tang harmonizes Ying and Wei, treating Taiyang Wind Strike; Mahuang Tang opens the exterior and expels pathogens via harsh sweating, treating Taiyang Cold Damage. When Wind and Cold simultaneously injure Ying and Wei, combining both formulas resolves the muscle and exterior. Due to small dosage, it achieves mild sweating to expel pathogens without damaging healthy Qi via excessive sweating. I frequently use this formula for coughs caused by simultaneous Wind-Cold invasion with good results.
7. In Taiyang disease, with fever, aversion to cold, more heat than cold, and faint pulse, this is "No Yang"; do not induce sweating①. Gui Zhi Er Yue Bi Yi Tang (Two Parts Guizhi, One Part Yuebi Decoction) is appropriate. Original Text 27
① Yuebi: "Bi" and "Pi" are ancient variants. In *Yu Han Jing*, both are written as "Pi". Cheng Wuji noted: "To stimulate Spleen Qi and circulate fluids."
Zheng's Commentary: Fever and aversion to cold indicate exterior Taiyang invasion. More heat than cold indicates strong Wind and weak Cold. Using Yuebi Tang, Guizhi extends Taiyang Qi and dispels Wei-level Wind, Shigao clears Wei-level Heat, and Mahuang/Shengjiang disperses Cold. This is an accurate formula. However, the clause states "No Yang, do not induce sweating." If there is "No Yang," how can heat exceed cold? How can Shigao, Guizhi, and Mahuang be used? There must be an error.
[Explanation] Zheng notes: "Since it says 'No Yang, do not induce sweating,' how can heat exceed cold? How can Shigao, Guizhi, and Mahuang be used? There must be an error." Many past commentators forced interpretations, but Zheng insisted on error without specifying where. Zhang Xugu noted: "Read this clause in two parts. 'Use Guizhi Er Yue Bi Yi Tang' connects to 'more heat than cold.' Placing it at the end is a rhetorical turn. ..." Cao Yingfu corrected: "'Use Guizhi Er Yue Bi Yi Tang' should follow 'more heat than cold.' Placed at the end, it contradicts 'do not induce sweating' while using diaphoretic herbs." These annotations resolve Zheng's confusion and benefit future students.
Gui Zhi Er Yue Bi Yi Tang Formula (Corrected and Supplemented)
Guizhi (Cinnamomi Ramulus, remove bark), Shaoyao (Paeoniae Radix Alba), Mahuang (Ephedrae Herba), Gancao (Glycyrrhizae Radix et Rhizoma Preparata) each 18 zhu (roasted), Dazao (Ziziphi Jujubae Fructus) 4 pieces (split), Shengjiang (Zingiberis Rhizoma Recens) 1 liang 2 zhu (cut), Shigao (Gypsum Fibrosum) 24 zhu (crushed, wrapped in cloth). These seven ingredients are decocted in 5 sheng of water. First boil Mahuang for 1-2 boils, remove foam, add other herbs, decoct to obtain 2 sheng, strain, and take 1 sheng warm. Originally, it was said to divide into Yuebi Guizhi Tang, mixing 1 sheng. Now combined into one formula: Guizhi part 2, Yuebi part 1.
[Formula Analysis and Scope of Application] This formula is Guizhi Tang added with Mahuang and Shigao. The "Guizhi 2" portion primarily harmonizes Ying and Wei; the "Yuebi 1" portion uses acrid-cool properties to clear interior heat and vent constrained Yang. It applies to exterior signs with interior constrained heat, accompanied by thirst, i.e., more heat than cold. Like Mahuang-Guizhi Half-Dose and Guizhi-Er-Mahuang-Yi Tang, it is a variation of Guizhi Tang, but pathological mechanisms and herb priorities differ. Careful contemplation is required to avoid error.
8. After taking Guizhi Tang, if profuse sweating occurs and the pulse becomes surging-large①, give Guizhi Tang as before. If the condition resembles malaria, occurring twice a day, sweating will resolve it; Guizhi Er Mahuang Yi Tang (Two Parts Guizhi, One Part Mahuang Decoction) is appropriate. Original Text 25
① Surging-Large Pulse: Pulse shape vast like flooding, but strong on arrival and weak on departure, its characteristic feature.