【闡釋】本節乃太陽病的脈證提綱。以後凡提“太陽病”三字，就有這些脈證的出現。太陽病是外感病的初期階段，其病在表。鄭氏提出“氣化”二字，乃傷寒書一部的真機，以及知得惡寒二字，無論一年四季為病，……毋得拘於時令，而有失經旨也，確有精卓之見。太陽經脈循行的部位，上額、交巔、入絡腦，還出別下項，連風府，故邪客其經，必令頭項強痛也。而頭痛之部位在後，與陽明頭痛之在前，少陽頭痛之在兩側，有明顯區別。本條所說惡寒，包括惡風在內，又往往與發熱並見。然惡寒與發熱雖都是表證的主要徵象，而惡寒尤為太陽表證的辨證要點。
二、病有發熱惡寒者③，發于陽也④；無熱惡寒者，發于陰也⑤。發于陽者七日愈，發于陰者六日愈，以陽數七，陰數六故也。原文7
③病：此處指太陽病。
④陽：指太陽。
⑤陰：指少陰。
鄭論：按太陽風傷衛證，發熱、惡風、自汗。（傷寒）〔寒傷〕營證，發熱、惡寒、無汗。此言病發于陽，指太陽也；太陽底面，即是少陰，病發于陰，指少陰也。若專指太陽營衛之陰陽，則與太陽風、寒兩傷病情不符。餘每臨症，常見獨惡寒身痛而不發熱者，每以桂枝湯重加附子，屢屢獲效，以此推之，則病發于陰，確有實據。至所言六日、七日者，是論陰陽之度數說法也。
【闡釋】此節鄭按與歷代注家專指太陽營衛之陰陽有所不同。病發于陽，指太陽也。太陽底面，即是少陰，病發于陰，指少陰也。若專指太陽營衛之陰陽，則與太陽風寒兩傷病情不符。隨即舉出其臨症常見獨惡寒身痛而不發熱者，以桂枝湯重加附子而獲效。筆者治惡寒身痛而出冷汗不止者，常用桂枝湯加附子、黃芪治之，數劑即愈。
三、太陽病，頭痛至七日以上自愈者①，以行其經盡故也。若欲作再經者，針足陽明，使經不傳則愈。原文8
①頭痛：下應有惡寒、發熱、項強等症狀，單舉頭痛是一種省文。七日以上自愈：這是指太陽經已經行完之故。
鄭論：按此條言邪傳七日自愈，各經皆能分消其勢也。設若未盡，又複遞傳，針足陽明，預泄其氣機，邪自無複傳也。
【闡釋】舊說傷寒日傳一經，由太陽、陽明、少陽、太陰、少陰、厥陰，但此說前人已舉出其謬誤。鄭氏在《醫理真傳》、《醫法圓通》兩書中亦指斥其非，並非一日二日挨次相傳，曰行則與傳不同，是指本經，而非他經矣。至於針足陽明，使經不傳，周禹載謂應針趺陽穴，陳修圓認為應針三裏穴，可供臨證選用。但承澹盦言趺陽穴不可用，足三裏比較切於實際，以太陽病頭痛發熱等證，其血液大多奔放於表層與上部，“三裏”一針能引血壓下降，頭部充血即趨下行，而頭痛可愈，腦係之壓迫遽減，生理機轉可為之一變而汗出熱解。承氏經驗，當取“頭維”、“足三裏”、“內庭”諸穴，可確實收效於俄頃。
四、太陽病欲解時，從巳至未上。原文9
鄭論：此言風寒之輕者也，逢太陽旺時，亦可自解也。
【闡釋】太陽為陽中之陽，而一晝夜之中，從巳時至未時，即上午十時至
下午二時，是陽氣最旺之時，所以太陽病不論自愈或服藥而解，都可以借助于陽氣旺盛之時，這是古人從臨症經驗積累而獲得的結論。
五、欲自解者，必當先煩，〔煩〕乃有汗而解，何以知之？脈浮，故知汗出（必）解（也）。原文116後段
鄭論：凡病欲解，胸中自有一段氣機鼓動，先煩二字，即是鼓動機關，此間有自汗而解，戰汗而解，狂汗而解，鼻血而解，從何得知，得知於脈浮耳。設脈不以浮應，又不得汗，其煩即為內伏之候，又不得以欲自解言也。
【闡釋】鄭氏在序中即說：“總之論其原文，發明聖意，即前後錯亂，而原文終在也，學者亦不必論長論短則得也。”（以後此種錯亂甚多，不再引鄭氏原文）本條原列在116條最末一段，鄭氏移在此處，是承接前條之意。煩是正氣抗邪氣，欲作汗的先兆，邪正相爭故煩，脈浮是邪在表的確據，故知汗出必解也。
六、太陽病，發熱、汗出、惡風、脈緩者①，名為中風②。原文2
①脈緩：王冰說：“緩者，緩縱之狀，非動而遲緩也”。即應指柔和。
②中風，即現在的傷風，與後世方書所載猝然暈倒。口眼喎（wāi歪）斜的中風不同。
鄭論：按太陽既為風邪所傷，風為陽邪，衛為陽道，兩陽相搏，拂鬱而熱生，故見發熱，風邪擾動，血液不藏，隨氣機而發洩於外，故見自汗，脈緩二字，指此刻正未大傷，尚得有此和緩之狀，是亦病之輕淺說法也。
【闡釋】本條指出太陽病中風的主證主脈。中風、傷風、感冒，名稱雖異，但都是外感風邪，卻是一致的，不過有輕重之不同。《證治要訣》說：“輕則為感，重則為傷，又重則為中，故《傷寒論》中的中風證，是傷風的重證，後世的感冒乃傷風中的輕證”。從而可以明確此條之中風，與《金匱》中風曆節篇之中風不同，與後世雜病中的猝然僕倒，口眼㖞斜的中風，其涵義則迥異，絕對不可以混為一談。
七、太陽中風，陽浮而陰弱③，陽浮者，熱自發，陰弱者，汗自出。嗇嗇惡寒④，淅淅惡風⑤翕翕發熱⑥，鼻鳴幹嘔者①，桂枝湯主之②。原文12
③陽浮而陰弱：浮脈主風，陽也、表也，表邪實而裏必虛，則陰自弱。簡言之，即脈象浮弱。
④嗇（sè瑟）音：形容怕冷畏縮之狀。
⑤淅（xī希）淅，風聲，如冷雨寒風侵入肌膚的感覺。
⑥翕（xī吸）翕，病人自覺發熱的情況，好像羽毛披複在身上一樣。
①鼻鳴：鼻中窒塞，氣息不利而發出的鳴響。嘔而無物謂之幹嘔。
②主之：《傷寒論》文中凡言某湯主之，表示為最適當的首選方劑。宜某湯，表示類方中較適當的方劑，與某湯，表示無十分適當方劑，可試與之（以後上述諸種情況仿此，不另作注釋）。
鄭論：按陽浮陰弱四字，諸家俱以寸浮尺弱為定論。餘細繹斯言，浮脈主風、陽也、表也，表邪實而裏必虛，則陰自弱。風邪已據陽分，蹂躪于中，陰不敢與之抗，俯首聽令，血淮隨氣機而外泄，故曰陽浮者熱自發，陰弱者汗自出，嗇嗇、淅淅、翕翕，是形容病有難開、難闔、難解之狀，至鼻鳴幹嘔四字，係屬陽明，當于桂枝湯內加（甘）〔幹〕葛、半夏，方為合法。
【闡釋】本條是桂枝湯證的脈象和證狀。鄭氏釋本條謂：“浮脈主風，陽也、表也，表邪實而裏必虛，則陰自弱。至鼻鳴幹嘔，係屬陽明”。此不同于過去諸家之注，是有見地的。至嗇嗇、淅淅、翕翕，是說明惡風、惡寒、發熱同時並見的形容詞。
桂枝湯方（校補）
桂枝三兩（去皮）芍藥三兩甘草二兩（炙）生薑三兩（切）大棗十二枚（擘）上五味，口父咀三味③，以水七升，微火煮取三升④，去滓，適寒溫⑤，服一升。服已須臾，歠熱稀粥一升餘⑥，以助藥力。溫複令一時許⑦，遍身漐漐微似有汗者益佳⑧，不可令如水流離，病必不除。若一服汗出病差，停後服，不必盡劑；若不汗，更服依前法；又不汗，後服小促其間⑨，半日許令三服盡。若病重者，一日一夜服，周時觀之⑩。服一劑盡，病證猶在者，更作服。若汗不出，乃服至二、三劑。禁生冷、粘滑、肉面、五辛11、酒酪12、臭惡等物。
【方解及其應用範圍】桂枝湯乃《傷寒論》之首方，為仲景群方之冠，乃滋陰和陽，調和營衛，解肌發汗之總方也。桂枝配芍藥，是於發汗中寓斂汗之旨，和營中有調胃之功。生
③口父（fǔ甫）咀：古代煎藥，先將藥料切碎為末，好像經過咀嚼似的，稱之為口父咀。
④微火：取和緩不猛之火力，使不沸溢。
⑤適寒溫：使冷熱適當。
⑥歠：同啜，大飲也，就是大口喝之意。
⑦溫複：複蓋衣被，使周身溫暖，以助出汗。
⑧漐（zhí直）漐：形容微汗潮潤之狀。
⑨小促其間：縮短服藥間隔時間。
⑩周時：一日一夜二十四小時之意。
11五辛：《本草綱目》載：大蒜、小蒜、胡荽、韭、芸苔為五辛。
12酪：指動物乳類。
薑味辛，能助桂解肌泄邪。大棗味甘，能佐芍和營益陰。甘草甘平，調和諸藥，安內攘外，配伍最佳，故取效大。柯韻伯謂：“凡頭痛發熱，惡風惡寒，其脈浮而弱，汗自出者，不拘何經，不論中風、傷寒、雜病，鹹得用此”。近代有醫家詆毀本方者，咸謂古方不能治今病。本方之能治今病，已為臨床所證實。茲舉近代傷寒學家惲鐵樵對用本方之標準，以供參考。其謂：“太陽病發熱，形寒、頭痛、項強、口中和，汗自出，始可用桂枝湯。口中和就是舌面潤，舌質不絳，唇不幹絳，不渴。如其口渴，舌幹、唇絳，即是溫病，桂枝是禁藥。”故桂枝湯之可用不可用，在辨證之確切與否，誠所謂差之毫釐，失之千里矣。鄭氏在《醫法圓通》中說：“桂枝湯一方，乃調和陰陽，澈上澈下，能內能外之方，非僅治仲景原文所論病條而已”。隨即指出“今人不明聖意，死守陳法，不改變通，由其不識陰陽之妙，變化之機也”。接著提出“桂枝湯方，原不僅治一傷風證，凡是太陽經地面之病，皆可用得。”並將經驗病形，列出十條：（1）治胸腹痛，背亦徹痛者，（2）治通身寒冷；（3）治小兒角弓反張，手足抽掣；（4）腦後生瘡；（5）治周身皮膚作癢，時而惡風；（6）治足跟痛，痛徹腰股；（7）治小兒兩腮腫，發熱惡風；（8）治小兒發熱痘出；（9）治婦人妊娠惡阻；（10）治發熱、惡風、下痢，日數十次。筆者師法鄭氏，除用本方加減治療上述諸病外，用以治傷風咳嗽，以及長期低熱症，均獲滿意療效；合玉屏散以治流行性感冒，有立竿見影之效。
近人用本方加減治鼻炎、多種皮膚病，療效不錯，主要是協調營衛的作用；又治風寒之邪內閉而足腫痛，痛徹腰股，或關節肌肉風寒痹而有汗者，均可用本方治療。
八、桂枝本為解肌①，若其人脈浮緊，發熱汗不出者，不可與〔之〕也，（須當）〔常須〕識此，勿令誤〔也〕②。原文16後段
①解肌：就是解散肌表之邪，也屬發汗的範疇，但與開表發汗不同。
②“識”：此同“志”，記也。
鄭論：此條明言桂枝湯，乃解太陽風傷衛之證，非治脈緊寒傷營者所宜。故曰：（須當）〔常須〕識此，勿令誤。是教人辨明營衛風寒用藥界限也。原文不知何故，稱桂枝本為解肌，肌肉屬陽明，非桂枝所宜，必是後人之誤，應當削去解肌二字，而曰桂枝湯非脈浮緊者所宜，何等直切也。
【闡釋】本條是《傷寒論》16條後半段，鄭氏作為單獨一條處理，並雲應當削去“解肌”二字，似有未當。桂枝湯的作用是和營解肌，適用於汗出惡風的表虛證。如果脈浮緊，發熱而汗不出的表實證，就不能用此方，而麻黃湯則為對證之方也。
九、凡服桂枝湯吐者，其後必吐膿血也。原文19
鄭論：按桂枝湯本調和陰陽之祖方，何得雲服桂枝湯吐者，其後必吐膿血也。當其時，胸中或有火逆，或有痰逆，或有鬱熱，得桂枝辛溫助之，上湧而吐，理或有之。然亦有吐仍屬佳兆者，理應細辨。設無火、痰、鬱熱諸逆，以後服之，未定吐膿血，學者切勿執此，當以認證為要。
【闡釋】桂枝湯辛溫助陽，是太陽中風的主方。設病非風寒，或陰虛而內熱素盛，皆不能服。如誤服桂枝湯，勢將引起火熱益甚，熱盛則湧吐，甚則以後有吐膿血的可能。柯韻伯說：“桂枝湯不特酒客當禁，凡熱淫於內者，用甘溫辛熱以助其陽，不能解肌，反能湧越，熱勢所過，致傷陽絡，則吐膿血必也”。至於條文中的“吐”字和“必吐膿血”句，均當活看，主要應看誤治的程度輕重來決定。若既吐膿血，則可按《金匱·嘔吐篇》所說：“不可治嘔，膿儘自愈”。
亦可用桔梗甘草湯排膿解毒，《千金》葦莖湯去瘀生新，並可隨證加入銀花、連翹、敗醬、魚腥草等清熱解毒之品。
十、〔若〕酒客病①，不可（以）〔與〕桂枝湯，得之則（吐）〔嘔〕，以酒客不喜（甜）〔甘〕故也。原文17
①酒客：指平素喜歡飲酒之人。
鄭論：按酒客有喜甜食者，有不喜甜食者，不得執一而論。若酒客病桂枝湯證，而此方遂不可用乎？此是專為得湯則嘔者說法也。
【闡釋】嗜酒之人，平素濕熱必重，雖患了脈緩汗出的中風證，不可用桂枝湯治療。因桂枝辛溫，能助其熱，甘草、大棗味甘，能助其濕，濕盛則中滿而嘔。如鄭氏所言：“酒客有喜甜食者，有不喜甜食者，不得執一而論”。事實上酒客亦有濕熱不甚，服用桂枝湯而不嘔吐。如濕熱素盛之人，雖不是酒客，亦要慎用。若酒客病桂枝湯證，可于桂枝湯方中加厚樸、杏仁治之。蓋厚朴苦溫以祛濕，杏仁之苦泄以清熱，濕熱去則不嘔也。
十一、發汗後，水藥不得入口為逆，若更發汗，必吐下不止。原文76前段
鄭論：病至水藥不得入口，必有寒逆、火逆、水逆之別。此則因發汗後，明係發汗過多，以致亡陽，不能鎮納濁陰，以致陰邪僭居高位，隔拒胸中，宣佈失職，氣機不得下降，故有此候，若更汗之，則中氣愈虛，而吐下更甚也，法宜扶陽、宣中、降逆為主。
[Explanation] This section serves as the outline of pulse and symptom patterns for Taiyang disease (Taiyang Disease, a syndrome caused by pathogenic factors affecting the Taiyang channel). Henceforth, whenever the term "Taiyang disease" is mentioned, these pulse and symptom patterns will appear. Taiyang disease represents the initial stage of exogenous diseases, with the pathology located at the exterior. Mr. Zheng proposed the concept of "Qi transformation" (Qi Transformation, the functional activity of Qi), which constitutes the key to understanding the entire *Shanghan Lun* (Treatise on Cold Pathogenic Diseases). Furthermore, grasping the significance of "aversion to cold" (Aversion to Cold, an aversion to cold sensation) regardless of the season in which the disease occurs... one must not be constrained by seasonal timing, thereby deviating from the principles of the classic text. This indeed reflects profound and outstanding insight. The pathway of the Taiyang channel ascends to the forehead, intersects at the vertex, enters to connect with the brain, emerges again to descend along the back of the neck, and connects with the Fengfu point (GV16). Therefore, when pathogens invade this channel, they inevitably cause stiffness and pain in the head and neck. The location of the headache is at the back, which clearly distinguishes it from Yangming headaches (located at the front) and Shaoyang headaches (located on the sides). The "aversion to cold" described in this clause includes "aversion to wind" (Aversion to Wind, sensitivity to drafts) and often appears concurrently with fever (Fever). Although both aversion to cold and fever are major signs of exterior syndromes, aversion to cold is particularly the critical diagnostic point for Taiyang exterior syndromes.
2. When a disease presents with fever and aversion to cold③, it originates from Yang④; when there is no fever but only aversion to cold, it originates from Yin⑤. Diseases originating from Yang heal in seven days, and those originating from Yin heal in six days, because the number for Yang is seven and for Yin is six. Original Text 7
③Disease: Here refers to Taiyang disease.
④Yang: Refers to Taiyang.
⑤Yin: Refers to Shaoyin.
Mr. Zheng's Commentary: Regarding the Taiyang wind-strike damaging the Defensive (Wei) aspect, symptoms include fever, aversion to wind, and spontaneous sweating. In contrast, cold damaging the Nutritive (Ying) aspect involves fever, aversion to cold, and absence of sweating. When it is said that the disease originates from Yang, it refers to Taiyang; the underlying aspect of Taiyang is Shaoyin, so when the disease originates from Yin, it refers to Shaoyin. If one were to exclusively refer to the Yin-Yang distinction between Nutritive and Defensive aspects within Taiyang, it would not align with the clinical picture of wind and cold simultaneously injuring Taiyang. In my clinical practice, I frequently encounter patients who suffer solely from aversion to cold and body pain without fever. Using Guizhi Tang (Cinnamon Twig Decoction) with a heavy addition of Fuzi (Prepared Aconite Root), I have repeatedly achieved success. This inference provides substantial evidence that "disease originating from Yin" is a valid concept. As for the mention of six or seven days, this is a theoretical discussion regarding the numerical degrees of Yin and Yang.
[Explanation] Mr. Zheng's commentary in this section differs from previous commentators who exclusively attributed Yin-Yang to the Nutritive and Defensive aspects of Taiyang. "Disease originating from Yang" refers to Taiyang. The underlying aspect of Taiyang is Shaoyin; thus, "disease originating from Yin" refers to Shaoyin. Exclusively interpreting this as the Yin-Yang of Nutritive and Defensive Taiyang does not fit the pathology of simultaneous wind and cold injury. He subsequently cites his clinical experience of treating patients with isolated aversion to cold, body pain, and no fever using Guizhi Tang (Cinnamon Twig Decoction) heavily supplemented with Fuzi (Prepared Aconite Root), achieving efficacy. I treat patients with aversion to cold, body pain, and incessant cold sweat using Guizhi Tang (Cinnamon Twig Decoction) added with Fuzi (Prepared Aconite Root) and Huangqi (Astragalus Root), often resulting in cure after a few doses.
3. In Taiyang disease, if headache persists for more than seven days and resolves spontaneously①, it is because the pathogen has exhausted its course within the channel. If there is a tendency for the disease to transmit to the next channel (secondary transmission), needling points on the Foot-Yangming channel can prevent transmission and lead to recovery. Original Text 8
①Headache: Symptoms such as aversion to cold, fever, and neck stiffness should follow; mentioning only headache is a concise literary device. Healing after seven days or more: This indicates that the pathogen has completed its course in the Taiyang channel.
Mr. Zheng's Commentary: This clause states that if pathogens transmit over seven days, they resolve spontaneously as each channel dissipates their momentum. If the pathogen is not fully exhausted and continues to transmit sequentially, needling the Foot-Yangming channel pre-emptively drains its Qi mechanism, preventing further transmission of the pathogen.
[Explanation] Old theories claimed that cold damage transmits one channel per day, moving from Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, to Jueyin. However, predecessors have already pointed out the fallacy of this view. Mr. Zheng also refuted this in his books *Yili Zhuan* (True Transmission of Medical Principles) and *Yifa Yuantong* (Comprehensive Understanding of Medical Methods). It is not a sequential daily transmission. "Xing" (moving/traveling) differs from "Chuan" (transmitting); here, "Xing" refers to the process within the current channel, not transmission to another channel. Regarding needling the Foot-Yangming channel to prevent transmission, Zhou Yuzai suggested the Duyang point (ST42), while Chen Xiuyuan advocated for Zusanli (ST36), both offering options for clinical use. However, Cheng Dan'an argued that Duyang (ST42) should not be used, and Zusanli (ST36) is more practical. In Taiyang disease presenting with headache and fever, blood tends to surge to the superficial and upper layers. Needling Zusanli (ST36) can lower blood pressure, redirect congestion from the head downwards, alleviate headache, reduce cranial pressure, and alter physiological mechanisms to induce sweating and resolve fever. Based on Cheng's experience, selecting Touwei (ST8), Zusanli (ST36), and Neiting (ST44) can yield immediate results.
4. The time when Taiyang disease is likely to resolve is from Si hour to Wei hour. Original Text 9
Mr. Zheng's Commentary: This refers to mild wind-cold pathogens. During the peak time of Taiyang, the disease can also resolve spontaneously.
[Explanation] Taiyang is the Yang within Yang. Within a twenty-four-hour cycle, the period from Si hour to Wei hour (10:00 AM to 2:00 PM) is when Yang Qi is most vigorous. Therefore, whether Taiyang disease resolves spontaneously or through medication, it can leverage this time of abundant Yang Qi. This conclusion was derived from the accumulation of ancient clinical experiences.
5. For a patient wishing to resolve the condition spontaneously, there must first be irritability (Fan). [Irritability] indicates resolution through sweating. How do we know this? Because the pulse is floating, we know that sweating will lead to resolution. Second half of Original Text 116
Mr. Zheng's Commentary: Whenever a disease is about to resolve, there is a natural stirring of Qi mechanism in the chest. The character "Fan" (irritability/restlessness) signifies this stirring mechanism. Resolution may occur through spontaneous sweating, battle-sweating, manic sweating, or epistaxis. How do we distinguish these? By observing the floating pulse. If the pulse does not respond with a floating quality and sweating does not occur, the irritability indicates internal stagnation, and it cannot be described as a spontaneous resolution.
[Explanation] In his preface, Mr. Zheng stated: "In discussing the original text, we elucidate the sage's intent. Even if the order is disordered, the original text remains. Scholars need not argue over length or brevity." (There are many such disorders later, so Mr. Zheng's original text is no longer quoted). This clause was originally at the end of Text 116; Mr. Zheng moved it here to follow the previous clause. Irritability (Fan) is the body's righteous Qi resisting the pathogen, a precursor to sweating. The struggle between pathogen and righteous Qi causes irritability. A floating pulse is definitive evidence that the pathogen is at the exterior; thus, we know that sweating will lead to resolution.
6. In Taiyang disease, if there is fever, sweating, aversion to wind, and a slow pulse①, it is named Wind-Strike②. Original Text 2
①Slow Pulse: Wang Bing stated, "Slow refers to a relaxed and loose state, not necessarily slow in rate." It implies a soft and gentle feeling upon palpation.
②Wind-Strike: Equivalent to modern common cold (Shangfeng). It differs from the sudden collapse and facial paralysis (stroke) described in later medical formularies.
Mr. Zheng's Commentary: Since Taiyang is injured by wind pathogen, and wind is a Yang pathogen while Defensive Qi (Wei Qi) follows the Yang pathway, the collision of two Yangs causes friction and heat generation, resulting in fever. Wind pathogen disturbs the blood, preventing it from being contained, causing it to leak outward with the Qi mechanism, resulting in spontaneous sweating. The term "slow pulse" indicates that the righteous Qi is not yet severely damaged and retains a harmonious and moderate quality, suggesting a mild and superficial disease.
[Explanation] This clause identifies the main symptoms and pulse of Wind-Strike in Taiyang disease. Although terms like Wind-Strike, Shangfeng (common cold), and Ganmao (cold) differ, they all refer to exogenous wind pathogen invasion, differing only in severity. *Zhengzhi Yaojue* states: "Mild is called Gan, severe is called Shang, and very severe is called Zhong." Thus, the Wind-Strike in *Shanghan Lun* is a severe form of Shangfeng, while modern Ganmao is a mild form. Clearly, the Wind-Strike in this clause differs from that in the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) chapter on Wind-Strike and Bi-Syndrome, and is entirely distinct from the sudden collapse and facial deviation seen in later miscellaneous diseases. They must not be confused.
7. In Taiyang Wind-Strike, the pulse is floating externally and weak internally③. Floating externally means fever arises spontaneously; weak internally means sweating occurs spontaneously. Chilly aversion to cold④, shivering aversion to wind⑤, feather-like fever⑥, nasal congestion with dry retching①, Guizhi Tang (Cinnamon Twig Decoction) is indicated②. Original Text 12
③Floating externally and weak internally: Floating pulse indicates wind, Yang, and exterior. If exterior pathogens are excess, interior deficiency must exist, making the interior weak. Simply put, the pulse appearance is floating and weak.
④Se-se sound: Describes a shriveled, fearful state due to cold.
⑤Xi-xi: Sound of wind, describing the sensation of cold rain and wind penetrating the skin.
⑥Xi-xi: Describes the patient's subjective feeling of fever, as if feathers are covering the body.
①Nasal congestion: Nasal obstruction causing noisy breathing. Dry retching is vomiting without substance.
②Indicated: In *Shanghan Lun*, "indicated" means it is the most appropriate primary formula. "Suitable" implies a relatively appropriate alternative. "With" suggests no perfect formula exists, but it can be tried. (These conventions apply henceforth without further note).
Mr. Zheng's Commentary: Regarding the four characters "floating externally and weak internally," most scholars define them as floating at the Cun position and weak at the Chi position. Upon careful analysis, floating pulse indicates wind, Yang, and exterior. If exterior pathogens are excess, interior deficiency must exist, making the interior weak. Once wind pathogen occupies the Yang aspect and ravages the center, Yin dares not resist and submits. Blood leaks outward with the Qi mechanism. Thus, "floating externally means fever arises spontaneously, weak internally means sweating occurs spontaneously." Se-se, Xi-xi, and Xi-xi describe the difficulty of opening, closing, and resolving the disease. The four characters "nasal congestion and dry retching" belong to Yangming. Therefore, adding Ge Gen (Kudzu Root) and Ban Xia (Pinellia Tuber) to Guizhi Tang (Cinnamon Twig Decoction) would be legally correct.
[Explanation] This clause describes the pulse and symptoms of Guizhi Tang (Cinnamon Twig Decoction) syndrome. Mr. Zheng interpreted this clause: "Floating pulse indicates wind, Yang, and exterior. If exterior pathogens are excess, interior deficiency must exist, making the interior weak. Nasal congestion and dry retching belong to Yangming." This differs from previous commentaries and shows insight. Se-se, Xi-xi, and Xi-xi are adjectives describing the simultaneous presence of aversion to wind, aversion to cold, and fever.
Guizhi Tang Formula (Corrected and Supplemented)
Guizhi (Cinnamon Twig) 3 liang (peeled), Shaoyao (White Peony Root) 3 liang, Gancao (Licorice Root) 2 liang (roasted), Shengjiang (Fresh Ginger) 3 liang (sliced), Dazao (Jujube) 12 pieces (torn). The above five ingredients, chewed/crushed③, boiled in 7 sheng of water with low heat④ to extract 3 sheng④, strain, adjust to warm temperature⑤, drink 1 sheng. Shortly after drinking, consume more than 1 sheng of hot thin porridge⑥ to assist medicinal power. Cover with warm clothing for about an hour⑦. Whole-body slight perspiration is best⑧; do not allow profuse sweating like flowing water, or the disease will not be eliminated. If sweating occurs after one dose and the illness improves, stop subsequent doses; no need to finish the decoction. If no sweating, administer again according to previous method. If still no sweating, shorten the interval for subsequent doses⑨, ensuring three doses are taken within half a day. For severe cases, administer day and night, observing for 24 hours⑩. If one dose is finished and symptoms persist, prepare another dose. If no sweating occurs, continue up to two or three doses. Avoid raw, cold, sticky, slippery, meat, dough, five pungents11, dairy12, and foul-smelling foods.
[Formula Analysis and Scope of Application] Guizhi Tang (Cinnamon Twig Decoction) is the premier formula of *Shanghan Lun* and the crown of Zhang Zhongjing's formulas. It is the general formula for nourishing Yin, harmonizing Yang, regulating Ying and Wei, and releasing the muscle layer to induce sweating. The combination of Guizhi (Cinnamon Twig) and Shaoyao (White Peony Root) contains the principle of restraining sweating within the action of inducing it, and harmonizing Ying while regulating the Stomach. Shengjiang (Fresh Ginger) is acrid and assists Guizhi in releasing the muscle layer and expelling pathogens. Dazao (Jujube) is sweet and assists Shaoyao in harmonizing Ying and benefiting Yin. Gancao (Licorice Root) is sweet and neutral, harmonizing all herbs, stabilizing the interior and repelling the exterior, forming an optimal combination for great efficacy. Ke Yunbo stated: "For any headache and fever, with aversion to wind and cold, floating and weak pulse, and spontaneous sweating, regardless of the channel, whether Wind-Strike, Cold Damage, or miscellaneous disease, this formula can be used." Some modern physicians disparage this formula, claiming ancient formulas cannot treat modern diseases. Clinical practice has proven its efficacy for modern conditions. We cite the standards of modern Shanghan scholar Yun Tieqiao for reference: "For Taiyang disease with fever, chills, headache, neck stiffness, normal mouth/tongue, and spontaneous sweating, Guizhi Tang (Cinnamon Twig Decoction) can be used. 'Normal mouth' means moist tongue coating, non-crimson tongue body, non-dry crimson lips, and no thirst. If there is thirst, dry tongue, and crimson lips, it is Warm Disease, and Guizhi (Cinnamon Twig) is contraindicated." Thus, the applicability of Guizhi Tang (Cinnamon Twig Decoction) depends on accurate differentiation; a slight error leads to significant failure. Mr. Zheng in *Yifa Yuantong* stated: "Guizhi Tang (Cinnamon Twig Decoction) is a formula that harmonizes Yin and Yang throughout the body, capable of acting internally and externally, not merely for the disease clauses discussed in Zhang Zhongjing's original text." He immediately pointed out, "Modern people do not understand the sage's intent, rigidly adhering to old methods without adaptation, due to ignorance of the subtleties of Yin-Yang and the mechanisms of change." He then proposed that "Guizhi Tang (Cinnamon Twig Decoction) is not only for treating common cold; it can be used for any disease on the surface of the Taiyang channel." He listed ten clinical applications based on experience: (1) Chest and abdominal pain extending to the back; (2) Generalized coldness; (3) Opisthotonos and limb spasms in children; (4) Sores at the back of the head; (5) Generalized pruritus with intermittent aversion to wind; (6) Heel pain radiating to waist and thigh; (7) Swollen cheeks with fever and aversion to wind in children; (8) Fever with eruptive diseases in children; (9) Morning sickness in pregnant women; (10) Fever, aversion to wind, and frequent diarrhea. Following Mr. Zheng's methods, I have used this formula with modifications to treat the above diseases, as well as common cold cough and chronic low-grade fever, with satisfactory results. Combined with Yupingfeng San (Jade Windscreen Powder) for influenza, it yields immediate effects.
Recent practitioners have used modified Guizhi Tang (Cinnamon Twig Decoction) for rhinitis and various skin diseases with good results, primarily due to its role in coordinating Ying and Wei. It is also effective for foot swelling and pain caused by internal closure of wind-cold pathogens, pain radiating to the waist and thigh, or wind-cold Bi-syndrome in joints and muscles with sweating.
8. Guizhi (Cinnamon Twig) is essentially for releasing the muscle layer①. If a person has a floating-tight pulse, fever, and no sweating, it must not be given (must always recognize this, do not make mistakes)②. Second half of Original Text 16
①Releasing the muscle layer: Dispersing pathogens in the muscle layer, belonging to the category of sweating, but different from opening the exterior to induce sweating.
②"Recognize": Here synonymous with "Zhi" (to remember/record).
Mr. Zheng's Commentary: This clause explicitly states that Guizhi Tang (Cinnamon Twig Decoction) treats Taiyang wind-strike damaging the Defensive aspect, and is not suitable for tight-pulse cold damaging the Nutritive aspect. Thus, it says: "Must always recognize this, do not make mistakes." It teaches distinguishing the boundaries of medication for Nutritive/Defensive and Wind/Cold. For unknown reasons, the original text calls Guizhi "essentially for releasing the muscle layer." Muscles belong to Yangming, where Guizhi is not ideally suited. This must be a later error; the words "releasing the muscle layer" should be deleted, stating instead that Guizhi Tang (Cinnamon Twig Decoction) is unsuitable for floating-tight pulses, which is much more direct and precise.
[Explanation] This clause is the second half of *Shanghan Lun* Text 16. Mr. Zheng treated it as a separate clause and suggested deleting "releasing the muscle layer," which seems inappropriate. Guizhi Tang (Cinnamon Twig Decoction) harmonizes Ying and releases the muscle layer, suitable for exterior deficiency syndromes with sweating and aversion to wind. For exterior excess syndromes with floating-tight pulse, fever, and no sweating, this formula should not be used; Mahuang Tang (Ephedra Decoction) is the appropriate formula.
9. Anyone who vomits after taking Guizhi Tang (Cinnamon Twig Decoction) will subsequently vomit pus and blood. Original Text 19
Mr. Zheng's Commentary: Guizhi Tang (Cinnamon Twig Decoction) is the ancestral formula for harmonizing Yin and Yang. How can it be said that vomiting after taking it leads to vomiting pus and blood? At that time, there may be fire rebellion, phlegm rebellion, or stagnant heat in the chest. The acrid-warm nature of Guizhi (Cinnamon Twig) aids this, causing upward surging and vomiting, which is theoretically possible. However, vomiting can also be a favorable sign, requiring careful differentiation. If there is no fire, phlegm, or stagnant heat rebellion, subsequent administration does not necessarily lead to vomiting pus and blood. Scholars must not adhere rigidly to this; confirming the diagnosis is paramount.
[Explanation] Guizhi Tang (Cinnamon Twig Decoction) is acrid-warm and assists Yang, serving as the main formula for Taiyang Wind-Strike. If the disease is not wind-cold, or if there is Yin deficiency with inherent excessive internal heat, it cannot be taken. Misadministration will intensify fire and heat, leading to violent vomiting, and potentially vomiting pus and blood. Ke Yunbo stated: "Guizhi Tang (Cinnamon Twig Decoction) is contraindicated not only for wine drinkers but for anyone with excessive internal heat. Using sweet-warm and acrid-hot herbs to assist Yang cannot release the muscle layer but rather causes surging. Wherever the heat passes, it damages the Yang collaterals, inevitably leading to vomiting pus and blood." The word "vomits" and the phrase "will subsequently vomit pus and blood" in the text should be interpreted flexibly, depending on the severity of the misdiagnosis. If pus and blood are already vomited, following *Jingui* Chapter on Vomiting, "do not treat the vomiting; once the pus is exhausted, it will self-heal."
One can also use Jiegeng Gancao Tang (Platycodon and Licorice Decoction) to drain pus and detoxify, or Qianjin Weijing Tang (Thousand Gold Reed Rhizome Decoction) to remove stasis and generate new tissue, adding herbs like Jinyinhua (Honeysuckle Flower), Lianqiao (Forsythia Fruit), Baijiangcao (Patrinia Herb), and Yuxingcao (Houttuynia Herb) for clearing heat and detoxifying based on symptoms.
10. [If] the patient is a wine drinker①, Guizhi Tang (Cinnamon Twig Decoction) must not be given; doing so will cause vomiting, because wine drinkers do not like sweetness①. Original Text 17
①Wine drinker: Refers to someone who habitually drinks alcohol.
Mr. Zheng's Commentary: Wine drinkers vary; some like sweet foods, others do not. One cannot generalize. If a wine drinker has Guizhi Tang (Cinnamon Twig Decoction) syndrome, is the formula absolutely contraindicated? This statement specifically addresses those who vomit after taking the soup.
[Explanation] People addicted to alcohol typically have heavy damp-heat internally. Even if they present with Wind-Strike syndrome characterized by slow pulse and sweating, Guizhi Tang (Cinnamon Twig Decoction) should not be used. Guizhi (Cinnamon Twig) is acrid-warm and can aggravate heat; Gancao (Licorice Root) and Dazao (Jujube) are sweet and can aggravate dampness. Excessive dampness causes fullness in the middle jiao and vomiting. As Mr. Zheng stated: "Wine drinkers vary in preference for sweets; one cannot generalize." In fact, some wine drinkers with mild damp-heat can take Guizhi Tang (Cinnamon Twig Decoction) without vomiting. Those with inherent severe damp-heat, even if not wine drinkers, must use caution. If a wine drinker has Guizhi Tang (Cinnamon Twig Decoction) syndrome, Houpo (Magnolia Bark) and Xingren (Apricot Seed) can be added. Houpo is bitter-warm to dispel dampness, and Xingren is bitter-draining to clear heat. Once damp-heat is removed, vomiting ceases.
11. After inducing sweating, if water and medicine cannot enter the mouth, it is adverse. If sweating is induced again, vomiting and diarrhea will ceaselessly continue. First half of Original Text 76
Mr. Zheng's Commentary: When a disease progresses to the point where water and medicine cannot enter the mouth, there must be distinctions between cold rebellion, fire rebellion, and water rebellion. In this case, due to excessive sweating, Yang is depleted, unable to anchor and assimilate turbid Yin, allowing Yin pathogens to usurp high positions, obstructing the chest, failing to distribute properly, and preventing Qi mechanism from descending, causing this condition. If sweating is induced again, Middle Qi becomes more deficient, and vomiting and diarrhea worsen. The treatment principle should focus on supporting Yang, promoting the Middle, and directing rebellious Qi downward.