【方解及其應用範圍】桂枝湯乃仲景群方之冠，乃滋陰和陽，調和營衛之方也，加附子複陽固表，適用於汗出過多，陽氣受耗，津液暫虧的證候。蓋表陽密，則漏汗自止，惡風自罷矣；汗止津回，則小便自調，四肢自柔矣。筆者常用此方治產婦體虛，其脈浮細，舌質淡，苔薄白，漏汗不止，獲得良好效果。又治陽虛體弱之人患傷風感冒，大都面容蒼白，頭痛，倦怠乏力，惡風寒，舌質淡白，白膩苔，脈浮而細，亦取得滿意療效。近人推廣應用以治陽虛之鼻衄（nǜ女去聲）、便血、尿血或婦人帶下經漏者；陽虛而筋脈失養之證，如腰背拘急酸痛、中風半身強直、手足瘺弱者。
二十三、太陽〔病〕中風，以火劫發汗，邪風被火熱，血（液）〔氣〕〔流溢〕，失其常度，兩陽相熏灼①，其身發黃。陽盛則欲衄②，陰虛小便難③，陰陽俱虛竭④，身體則枯燥，但頭汗〔出〕，劑頸而還，腹滿（而）〔微〕喘，口乾咽爛，或不大便，（人）〔久〕則譫語，甚者至噦，手足（燥）〔躁〕擾，撚衣摸床⑤，小便利者，其人可（至）〔治〕。原文111
①兩陽：風為陽邪，火亦屬陽，中風用火劫，故稱兩陽。
②陽盛：指邪熱熾盛。
③陰虛：指陰津不足。
④陰陽俱虛竭：指氣血虧乏而言。
⑤撚衣摸床：神志昏迷時，手不自覺的摸弄衣床。
鄭論：據此條所見種種病形，都緣誤用火劫發汗，遂至亢陽為災，邪火燎原，竟有不可撲滅之勢，但視其人小便尚利，一線之元陰猶存，故曰可治。若小便全無，則元陰已盡，危亡即在轉瞬之間。
【闡釋】本條乃太陽病中風，被火誤治後的各種變證，風火相煽，真陰有欲亡之候。揭出小便利一語，從而可知津液尚未盡竭，為此證之生機。如鄭氏所說：“但視其人小便尚利，一線之元陰猶存，故曰可治。”邪盛正虛之候，以小便的有無來決定預後良否，是可靠的經驗總結。筆者認為其治法應清裏熱、滋陰液、利小便，可用白虎加人參湯或豬苓湯治療。
二十四、太陽病二日，反（煩）〔躁〕，（反）〔凡〕熨其背⑥，而大汗出，（火）〔大〕熱入胃，胃中水竭，（煩燥）〔躁煩〕，必發譫語，十餘日振栗自下利者，此為欲解也。故其汗，從腰以下不得汗，欲小便不得，反嘔欲失溲，足下惡風，大便鞕，小便當數，而反不數及〔不〕多，大便已，頭卓然而痛⑦，其人足心必熱，穀氣下流故也⑧。原文110
⑥熨：火熱療法之一。千金方有熨背散，民間有以磚燒熱，外以布包放置體外以取暖發汗的。
⑦卓然而痛：即突然頭痛得很厲害的意思。
⑧穀氣：指人飲食以後所產生的熱氣。
鄭論：按太陽二日，係陽明主氣之候，邪已入胃，應當察其邪從陽化為病，從陰化為病，隨其所化而治之，方為合法。粗工不知，反熨其背而大汗出，火熱入胃，勢必奪其胃中津液，津液被奪，則邪熱熾，熱乘於心，神無所主而譫語生，邪延十餘日，忽振栗自下者，是裏熱下行，病有從下解之意，其汗從腰以下不得，欲小便不得者，太陽氣化不宣，津液被熱奪也。反嘔者，氣機上逆也。欲失溲，而足下惡風，下元之氣不足也。迨至大便多，則裏氣暢，頭卓然而痛，是邪仍欲從三陽表分而出，足下必發熱者，陽氣複回之征，皆佳兆也。
【闡釋】本節論述誤用火治（即熨背）後的變證，陽氣上盛，陰液受損，及自愈的機轉。鄭氏注文甚詳，說理亦明透，當今用熨法治病者甚少，故從略。
二十五、太陽病，以火熏之，不得汗，其人必（燥）〔躁〕，（過）〔到〕經不解，（為）〔必〕圊血①，名為火邪。原文114
①圊（qīng青）血：即便血也。
鄭論：太陽為病，本應外解，今以火熏不汗而反（燥）〔躁〕，是邪不從外出，而從內趨也。火動於中，逼血下行，而成圊血之候，亦時勢之使然也。
【闡釋】此邪不從外出，而從內趨也。火動於中，逼血下行，而成圊血之候。此證由火誤引起，便血時但治其火，不必止血，火清邪去，其病自愈。仲景未出方治，至於救誤的方法，自不外清解血熱，大黃黃連瀉心湯加黃芩，可以採用。
二十六、微數之脈，慎不可（炙）〔灸〕，因火為邪，則為煩逆，追虛逐實②，血散脈中③，火氣雖微，內攻有力，焦骨傷筋④，血難複也。原文116上段
②追虛逐實：血本虛而更加火法，劫傷陰分，是為追虛；熱本實，而更用火法，增加裏熱，是為逐實。
③血散脈中：火毒內攻，血液流溢，失其常度。
④焦骨傷筋，形容火毒危害之烈，由於血為火灼，筋骨失去濡養，故曰焦骨傷筋。
鄭論：據脈微數，數主有熱，故不可（炙）〔灸〕，若妄（炙）〔灸〕之，則為害不淺，故見種種病形，此是為有餘之候言之，而非為不足者言之。病人苟現面白唇青，舌潤不渴，小便清利，脈現洪大、洪數、弦勁，此係元陽外越之候，回陽又慮不及，尚得以不可（炙）〔灸〕言之乎？余思原文加一慎字，此中隱已包括虛實兩法在於中也。
【闡釋】灸有隔薑而灸，隔蒜而灸之別。必其人寒濕內阻，陽氣不達，關節酸疼者，乃可灸之。微數之脈，陰虛多熱也。若用灸法，則火熱亢灼，造成諸多變證。但鄭氏舉出：“病人苟現面白唇青，舌潤不渴，小便清利，脈現洪大、洪數、弦勁，此係元陽外越之候，回陽又慮不及，尚得以不可灸言之乎？”故應脈證合參，不能單憑脈以辨證。原文加一“慎”字，不可輕易讀過。
二十七、燒針令其汗①，針處被寒，核起而赤者，必發奔豚②。氣從少腹上沖〔心〕者，灸其核上各一壯③，與桂枝加桂湯，更加桂〔二兩〕也。原文117
①燒針：就是用粗針外裹棉花，蘸油燒之，俟針紅即去棉油而刺入，是古人取汗的一種治法。
②奔豚（tún如屯）：在此處是形容悸氣自小腹上沖心胸之勢，與腎積為奔豚之義不同。
③灸其核上各一壯：在針刺部位的腫塊上，各用艾火灼燒一次（一壯就是灸一個艾丸至燼）。
鄭論：燒針者，溫經禦寒法也。針處被寒，核起而赤者，寒邪聚於皮膚，有欲從外出之勢也，何得雲必發奔豚？奔豚乃少陰之證，此刻邪在太陽，未犯少陰，即以桂枝加桂湯更加桂，其邪在太陽也明甚，果屬奔豚上沖，又非桂枝加桂倍桂所長也，學者宜細繹之。
【闡釋】按燒針取汗，亦是汗法之一，但針處宜當避寒，若不慎而被寒襲，則針處核起而赤者，必發奔豚。鄭氏注謂：“此寒邪聚於皮膚，有欲從外出之勢，何得雲必發奔豚？”此刻邪在太陽，未入少陰，即不得為奔豚之證。灸其核上各一壯，以散外寒，與桂枝加桂湯更加桂，是即先刺風池、風府，卻與桂枝湯之成例，蓋必疏泄高表之氣，然後可以一汗而奏功。
桂枝加桂湯方（校補）
桂枝五兩（去皮）芍藥三兩生薑三兩（切）甘草二兩（炙）大棗十二枚（擘）上五味，以水七升，煮取三升，去滓，溫服一升。本雲桂枝湯，今加桂滿五兩，所以加桂者，以能泄奔豚之氣也。
【方解及其應用範圍】本方由桂枝湯加重桂枝用量而成，為散寒降沖，和榮止痛之劑。桂枝湯調和榮衛，加重桂枝用量增加通陽降沖之力（但亦有用肉桂者）。蓋本證為心陽虛，感寒，不能制水，水寒之氣上逆，故自覺氣上沖心胸。此處奔豚氣病與《金匱》奔豚病之義不同。故凡自覺寒氣自小腹上沖之症，皆可用之。
二十八、太陽病，當惡寒發熱，今自汗出，〔反〕不惡寒發熱，關上脈細數者，以醫吐之過也。一〔二〕日吐之者，腹中饑，口不能食；三四日吐之者，不喜糜粥，欲食冷〔食〕，朝食暮吐，〔以醫吐之〕所致〔也〕，此為小逆④。原文12
④小逆：是屬誤治而引起的病變，但尚不十分嚴重的意思。
鄭論：此條既無發熱惡寒，則無外邪可知，咎在醫家誤吐之過，屢吐不止，漸至朝食暮吐，其胃陽之衰敗已極，原文稱為小逆，學者不得遽謂之小逆也。
【闡釋】此條為太陽病誤用吐法而引起胃中虛寒，關於一二日、三四日者，說明發病時間的長短，對胃的影響有輕重不同，嚴重的朝食暮吐，原文稱此為小逆。鄭注謂：“學者不得遽謂之小逆也。”有深意焉。筆者對治此證，輕者用理中湯，重者用附子理中湯，皆加半夏、吳茱萸治之，獲得滿意效果。
二十九、太陽病吐之，但太陽病當惡寒，今反不惡寒，不欲近衣，此為吐〔之〕內煩也①。原文121
①內煩：即心中煩悶之意。
鄭論：按吐治法，亦寓發散之意，但無惡寒，則不得為太陽證，不欲近衣，內定有熱，而曰吐內煩，是此病形，全是吐之過，何也？吐則氣機發外，有不可禁止之勢，故現此內煩，俟氣定神安，而能近衣，則病自愈。若氣定而仍不欲近衣，則又不得以吐內煩稱之也，學者宜細辨之。
【闡釋】本條與上條同為太陽病誤吐所致的病變，可是出現的證狀，卻不完全一樣。本條的內煩不欲近衣是胃液受傷，胃熱化燥，誤吐雖同而病變各異，其治療方法也就隨之不同。據《醫宗金鑒》：“惟宜用竹葉石膏湯，於益氣生津中清熱甯神”，于理於法皆合，可以採用。
三十、太陽病，外證未解（者）②，不可下也，下之為逆。欲解外者，宜桂枝湯。原文44
②外證：此處指表證。
鄭論：按病當外解者，原不可下，下之則引邪深入，為害不小。
病機果有向表之勢，隨機而導之，則得矣。
【闡釋】表證當解外，裏證當攻下，此一定不易之法。鄭氏雲：“病當外解者，原不可下，下之則引邪深入，為害不小。”非但外邪未解可用桂枝湯，即雖經誤下，而邪欲還表者，仍可用桂枝湯隨機而導之則愈。
三十一、太陽病，先發汗不解，而複下之，脈浮〔者〕不愈。浮為在（表）〔外〕，而反下之，故令不愈。今脈浮，故（知）在外，當須（發汗）〔解外〕則愈，宜桂枝湯。原文45
鄭論：按隨機調理，乃醫之道，如當外解而反下之，當下而反表之固之，皆醫之咎。此條既下而脈尚浮，是邪不從下趨，而仍欲從外出，故仍用桂枝湯以導之，此真用藥法竅，學者宜留心記之。
【闡釋】脈浮是邪在表的主要依據，不論汗後、下後，只要脈浮（應結合頭痛、發熱、汗出、惡風）等表證依然存在的，那就應當再汗、三汗。本條論發汗後表未解，疑其邪已入裏，而複下之，下之而不愈，脈浮等表證依然存在的，則仍當以桂枝湯解外。
三十二、太陽病，下之〔後〕，其氣上沖者①，可與桂枝湯，方用前法。若不上沖者，不（可）〔得〕與（也）〔之〕。原文15
①其氣上沖：是病人自覺胸中有逆氣上幹。
鄭論：按應外解之病，而誤下之，脈浮，邪仍在表者，俱可以桂枝湯。若因下而病現上沖，此間須宜詳察。蓋以為上沖者，病邪欲外，故仍以桂枝湯，不沖者，邪不外出，故不可與。謂上沖而脈浮，可與桂枝湯，上沖而脈不浮，不可與。然上沖之候，多因誤下傷及胸中之陽，不能鎮納下焦濁陰之氣，以致上沖者極多，法宜收納溫固，又非桂枝所能也。學者務于病情、脈息、聲音、動靜、有神、無神處求之，則得其要矣。
【闡釋】太陽病，頭項強痛而惡寒、脈浮，本應從表解，如誤用下法，病若不因下而變證，其脈浮、頭痛等之病證依然，病者自覺氣上沖者，知正氣未衰，邪猶在表，可與桂枝湯，用前之啜粥微汗法治之。若下後氣不上沖，是邪已內陷，正氣虛，桂枝湯已不適用。而鄭氏更深一層注“上沖之候”，其謂“上沖之候，多因誤下傷及胸中之陽，以致上沖者極多，法宜收納溫固，又非桂枝之所能也。”
此與過去諸名家之注不同，值得我們細心體會。
三十三、太陽病，外證未除，而數下之②，遂協〔熱〕而利③，利下不止，心下痞鞕，表裏不解者，桂枝人參湯主之。原文163
②數下：指屢用攻下的意思。
③協熱而利：就是在裏之虛寒，挾在表之熱而下利。
鄭論：按下利本非正病，因數下而致之也，痞鞕亦非本有之病，因過下傷中，陰邪得以僭居高位也。原文以桂枝人參湯治之，方中藥品，乃理中湯全方，加桂枝一味耳。不名理中，而名桂枝加人參湯者，重太陽之意，全是溫中化氣，補中祛邪之法也。
【闡釋】太陽病外證未解，仍然存在發熱惡寒、頭疼身痛等表證，本應從表解，但一再誤下，脾胃受損，遂導致外有表熱，而內則虛寒下利不止的證候，因過下傷中，故胸院之間痞塞堅硬。原文主以桂枝人參湯，故以理中湯治痞鞕與下利，僅用桂枝一味以和表，而桂枝合理中同用，亦能增強溫裏之力，故鄭氏曰：“不名理中，而名桂枝人參湯者，重太陽之意，全是溫中化氣，補中祛邪之法也”。
桂枝人參湯方（校補）
桂枝四兩（別切）甘草四兩（炙）白朮三兩人參三兩乾薑三兩上五味，以水九升，先煎四味，取五升，內桂，煮取三升，去渣，溫服一升，日再，夜一服。
【方解及其應用範圍】本方由理中湯加桂枝，不曰理中，而曰桂枝人參湯者，言桂枝與理中表裏分頭建功也。本方治下後成利，腸胃虛寒，故以人參、乾薑、白朮、甘草助陽於內以止利；表證未除，故以桂枝行陽于外以解表。桂枝應遲入藥。本方適用于理中湯證兼有表證者，以裏證為主。凡腸胃虛寒，頭痛、發熱惡寒皆宜。
[Analysis of the Formula and Its Scope of Application] Guizhi Tang (Cinnamon Twig Decoction) is the premier formula among Zhang Zhongjing's many formulas. It nourishes Yin and harmonizes Yang, and harmonizes Ying (Nutritive Qi) and Wei (Defensive Qi). When Fuzi (Prepared Aconite Root) is added, it restores Yang and consolidates the exterior. It is applicable to syndromes where excessive sweating has depleted Yang Qi and temporarily damaged Body Fluids. Because the exterior Yang Qi becomes secure, leakage sweating will naturally stop, and aversion to wind will naturally cease; once sweating stops and fluids return, urination will naturally regulate, and the limbs will naturally become supple. The author frequently uses this formula to treat postpartum women with weak constitutions, presenting with a floating and fine pulse, pale tongue body, thin white coating, and persistent leakage sweating, achieving good results. It is also used to treat individuals with Yang deficiency and weak constitutions suffering from common colds, who typically present with a pale complexion, headache, fatigue, aversion to wind and cold, pale white tongue body, white greasy coating, and a floating and fine pulse, also yielding satisfactory therapeutic effects. In recent times, its application has been expanded to treat epistaxis (nosebleed), hematochezia (blood in stool), hematuria (blood in urine), or leukorrhea and irregular uterine bleeding in women due to Yang deficiency; as well as syndromes of malnourished sinews and vessels due to Yang deficiency, such as stiffness, soreness, and pain in the lower back, hemiplegic rigidity after stroke, and flaccid weakness of the hands and feet.
23. In Taiyang disease with Wind Strike syndrome, if fire therapy is used to forcibly induce sweating, the pathogenic wind is aided by the heat of fire. Blood flows erratically, losing its normal regulation. The two Yang pathogens (wind and fire) mutually scorch each other①, causing jaundice. Excess Yang leads to a desire for epistaxis②, Yin deficiency leads to difficult urination③, and when both Yin and Yang are exhausted④, the body becomes dry and withered. There is only sweating on the head, stopping at the neck. Abdominal fullness and slight wheezing occur, dry mouth, and throat ulceration. Or there may be constipation. If prolonged, delirium occurs. In severe cases, hiccups develop. Restlessness of the hands and feet, and unconscious picking at clothes and beds⑤ appear. If urination is free, the patient can still be treated. Original Text 111
① Two Yang: Wind is a Yang pathogen, and fire also belongs to Yang. Using fire coercion for Wind Strike is called "Two Yang."
② Yang Excess: Refers to flourishing pathogenic heat.
③ Yin Deficiency: Refers to insufficient Yin fluids.
④ Exhaustion of Both Yin and Yang: Refers to the depletion of Qi and Blood.
⑤ Picking at Clothes and Beds: Unconsciously fumbling with clothes and beds during coma.
Commentary by Zheng Qin'an: Based on the various pathological manifestations seen in this clause, they all stem from the error of using fire therapy to forcibly induce sweating, leading to hyperactive Yang causing disaster, with pathogenic fire spreading like a prairie fire, seemingly unstoppable. However, if one observes that the person's urination is still free, indicating that a thread of Primordial Yin remains, it is said that treatment is possible. If urination is completely absent, then Primordial Yin is exhausted, and danger and death are imminent.
[Interpretation] This clause discusses the various altered syndromes following the erroneous use of fire therapy for Taiyang Wind Strike syndrome. Wind and fire fan each other, and True Yin shows signs of impending loss. Highlighting the phrase "free urination" reveals that Body Fluids have not yet been completely exhausted, which is the vital sign for this syndrome. As Mr. Zheng stated: "If one observes that the person's urination is still free, indicating that a thread of Primordial Yin remains, it is said that treatment is possible." In conditions of excess pathogen and deficient healthy Qi, determining prognosis based on the presence or absence of urination is a reliable summary of experience. The author believes the treatment method should clear interior heat, nourish Yin fluids, and promote urination. Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) or Zhuling Tang (Poria Decoction) can be used.
24. On the second day of Taiyang disease, instead of irritability, there is restlessness. Counterintuitively, the back is ironed⑥, causing profuse sweating. Fire-heat enters the Stomach, depleting Stomach fluids. Irritability and restlessness ensue, inevitably leading to delirium. After more than ten days, if the patient experiences shivering and spontaneous diarrhea, this indicates the disease is about to resolve. Therefore, sweating does not occur from the waist down. There is a desire to urinate but inability to do so, accompanied by vomiting and a sense of impending urinary incontinence. Cold sensation in the soles of the feet, hard stools, and normally frequent urination are expected, but instead, urination is infrequent and scanty. After defecation, sudden severe headache occurs⑦, and the soles of the feet must feel hot, because Grain Qi flows downward⑧. Original Text 110
⑥ Ironing: One type of heat therapy. Qianjin Fang contains an ironing powder for the back; folk practice involves heating bricks, wrapping them in cloth, and placing them outside the body to warm up and induce sweating.
⑦ Sudden Severe Pain: Means sudden, severe headache.
⑧ Grain Qi: Refers to the heat energy generated after eating.
Commentary by Zheng Qin'an: According to Taiyang disease on the second day, this is the period when Yangming governs the Qi. The pathogen has entered the Stomach. One should observe whether the pathogen transforms into disease via Yang or via Yin, and treat accordingly according to its transformation, which would be correct. Ignorant physicians do not know this; instead, they iron the back causing profuse sweating. Fire-heat enters the Stomach, inevitably seizing Stomach fluids. Once fluids are seized, pathogenic heat flourishes. Heat attacks the Heart, the Spirit has no master, and delirium arises. If the pathogen persists for over ten days and suddenly presents with shivering and spontaneous diarrhea, this indicates interior heat moving downward, suggesting the disease is resolving from below. Sweating not occurring from the waist down, and the desire to urinate without ability, indicate failure of Taiyang Qi transformation and fluid seizure by heat. Vomiting indicates upward reversal of Qi mechanism. Desire for incontinence and cold in the soles indicate insufficiency of Lower Yuan Qi. When stool increases, interior Qi becomes smooth. Sudden severe headache indicates the pathogen still desires to exit via the Three Yang exterior levels. Heat in the soles is a sign of Yang Qi returning. All are auspicious omens.
[Interpretation] This section discusses the altered syndromes after erroneous use of fire therapy (i.e., ironing the back), where Yang Qi rises excessively and Yin fluids are damaged, along with the mechanism of self-healing. Mr. Zheng's commentary is detailed and clearly reasoned. Since few people use ironing therapy today, it is omitted here.
25. In Taiyang disease, if fire moxibustion/fuming is used and no sweat is produced, the person will inevitably become restless. If the disease does not resolve after passing through a meridian cycle, bloody stool① will definitely occur, named Fire Pathogen. Original Text 114
① Qing Xue (Bloody Stool): Refers to hematochezia.
Commentary by Zheng Qin'an: Taiyang disease should originally resolve from the exterior. Now, fuming without sweating causes restlessness instead. This means the pathogen does not exit outward but moves inward. Fire stirs within, forcing blood downward, resulting in bloody stool. This is also due to the circumstances.
[Interpretation] Here, the pathogen does not exit outward but moves inward. Fire stirs within, forcing blood downward, resulting in bloody stool. This syndrome is caused by erroneous fire therapy. When treating bloody stool, one should only treat the fire, not necessarily stop the bleeding. Once the fire is cleared and the pathogen removed, the disease heals itself. Zhang Zhongjing did not provide a formula. Regarding methods to rescue errors, clearing and resolving blood heat is appropriate. Dahuang Huanglian Xiexin Tang (Rhubarb, Coptis, and Pinellia Decoction to Drain the Epigastrium) plus Huangqin (Scutellaria Root) can be adopted.
26. With a faint and rapid pulse, moxibustion must be avoided. Because fire becomes a pathogen, it causes烦逆 (distress and rebellion). Chasing deficiency and pursuing excess②, blood scatters within the vessels③. Although fire Qi is subtle, its internal attack is powerful, scorching bones and injuring sinews④. Blood is difficult to restore. Original Text 116 (Upper Paragraph)
② Chasing Deficiency and Pursuing Excess: Blood is originally deficient; adding fire therapy damages Yin further, which is "chasing deficiency." Heat is originally excess; adding fire therapy increases interior heat, which is "pursuing excess."
③ Blood Scattering in Vessels: Fire toxin attacks internally, blood flows erratically, losing normal regulation.
④ Scorched Bones and Injured Sinews: Describes the severity of fire toxin harm. Because blood is scorched by fire, sinews and bones lose nourishment, hence "scorched bones and injured sinews."
Commentary by Zheng Qin'an: Based on the faint and rapid pulse, rapidity indicates heat, so moxibustion is contraindicated. If wrongly applied, the harm is significant, leading to various pathological forms. This statement refers to excess conditions, not deficiency conditions. If a patient presents with pale face and blue lips, moist tongue without thirst, clear and free urination, and a洪大 (surging-large), 洪數 (surging-rapid), or 弦勁 (wiry-taut) pulse, this indicates Primordial Yang floating outward. In such cases, restoring Yang might even be considered insufficient. How could one say moxibustion is contraindicated? I believe the original text adds the word "caution" (Shen), implying that both deficiency and excess methods are included within this caution.
[Interpretation] Moxibustion varies by ginger slice or garlic slice. It is only suitable for those with internal cold-damp obstruction, unattained Yang Qi, and joint soreness/pain. A faint and rapid pulse indicates Yin deficiency with much heat. If moxibustion is used, hyperactive fire-heat causes many altered syndromes. But Mr. Zheng points out: "If a patient presents with pale face and blue lips, moist tongue without thirst, clear and free urination, and a surging-large, surging-rapid, or wiry-taut pulse, this indicates Primordial Yang floating outward. In such cases, restoring Yang might even be considered insufficient. How could one say moxibustion is contraindicated?" Therefore, pulse and symptoms must be combined for differentiation; one cannot rely solely on the pulse. The addition of the word "caution" in the original text should not be read lightly.
27. Burning needles to induce sweating①. If the needle site is exposed to cold, nodules rise and turn red. Biuntun (Running Piglet)② will definitely occur. If Qi rushes from the lower abdomen to the heart, moxa one Zhu③ on each nodule, and administer Guizhi Jia Gui Tang (Cinnamon Twig Decoction plus Cinnamon), adding two Liang of Cinnamon. Original Text 117
① Burning Needles: Wrapping thick needles in cotton, dipping in oil, burning until red, removing cotton/oil, and inserting. This was an ancient method to induce sweating.
② Biuntun: Here describes the sensation of palpitations rushing from the lower abdomen to the chest/heart, differing from the meaning of Biuntun as a kidney accumulation.
③ Moxa one Zhu on each nodule: Apply moxa fire once (one Zhu equals burning one moxa cone to ash) on the swelling at the needle site.
Commentary by Zheng Qin'an: Burning needles is a method to warm meridians and ward off cold. If the needle site is exposed to cold, nodules rise and turn red. Cold pathogen gathers in the skin, showing a tendency to exit outward. How can it be said Biuntun will definitely occur? Biuntun is a Shaoyin syndrome. At this moment, the pathogen is in Taiyang and has not invaded Shaoyin. Using Guizhi Jia Gui Tang with extra Cinnamon clearly targets the pathogen in Taiyang. If it were truly Biuntun rushing upward, Guizhi Jia Gui Tang with doubled Cinnamon would not be the primary treatment. Scholars should analyze this carefully.
[Interpretation] Burning needles to induce sweating is also a sweating method. However, the needle site must avoid cold. If accidentally exposed to cold, causing nodules to rise and turn red, Biuntun will definitely occur. Mr. Zheng notes: "Cold pathogen gathers in the skin, showing a tendency to exit outward. How can it be said Biuntun will definitely occur?" At this moment, the pathogen is in Taiyang and has not entered Shaoyin, so it cannot be classified as Biuntun syndrome. Moxa one Zhu on each nodule to scatter external cold, combined with Guizhi Jia Gui Tang with extra Cinnamon, parallels the precedent of first acupuncturing Fengchi and Fengfu, then using Guizhi Tang. One must vent the Qi of the high exterior before one sweating can achieve success.
Guizhi Jia Gui Tang Formula (Corrected and Supplemented)
Guizhi (Cinnamon Twig) 5 Liang (skin removed)
Shaoyao (Peony Root) 3 Liang
Shengjiang (Fresh Ginger) 3 Liang (sliced)
Gancao (Licorice Root) 2 Liang (honey-fried)
Dazao (Jujube) 12 pieces (split)
These five ingredients, add 7 Sheng of water, boil to obtain 3 Sheng, remove dregs, take 1 Sheng warm. Originally called Guizhi Tang. Now add Cinnamon to total 5 Liang. The reason for adding Cinnamon is its ability to drain Biuntun Qi.
[Analysis of the Formula and Its Scope of Application] This formula is formed by increasing the dosage of Guizhi in Guizhi Tang. It disperses cold, directs rebellious Qi downward, harmonizes Ying, and relieves pain. Guizhi Tang harmonizes Ying and Wei; increasing Guizhi enhances the power to unblock Yang and direct rebellious Qi downward (though Rougui/Cinnamon Bark is sometimes used). This syndrome is due to Heart Yang deficiency, exposure to cold, inability to control Water, leading to counterflow of cold-water Qi upward, causing the sensation of Qi rushing to the chest and heart. The Biuntun Qi syndrome here differs from the Biuntun disease in *Jingui Yaolue*. Therefore, any symptom of feeling cold Qi rushing from the lower abdomen upward can use this formula.
28. In Taiyang disease, there should be aversion to cold and fever. Now, there is spontaneous sweating, and counterintuitively, no aversion to cold or fever. The Guan position pulse is fine and rapid. This is due to the physician's error in using emesis. If emesis is used on day one or two, the abdomen feels hungry, but the mouth cannot eat; if used on day three or four, the patient dislikes congee, desires cold food, eats in the morning and vomits in the evening, caused by the physician's erroneous emesis. This is called Minor Deviation④. Original Text 12
④ Minor Deviation: Refers to pathological changes caused by erroneous treatment, but not yet very severe.
Commentary by Zheng Qin'an: This clause lacks fever and aversion to cold, indicating no exterior pathogen. The fault lies in the physician's erroneous emesis. Repeated emesis leads gradually to eating in the morning and vomiting in the evening. The decline of Stomach Yang is extreme. The original text calls this "Minor Deviation," but scholars should not hastily accept this term.
[Interpretation] This clause describes stomach interior cold-deficiency caused by erroneous use of emesis in Taiyang disease. Mentioning one-two days versus three-four days illustrates how the duration of onset affects the severity of impact on the Stomach. Severe cases of eating in the morning and vomiting in the evening are called "Minor Deviation" in the original text. Mr. Zheng's note: "Scholars should not hastily accept 'Minor Deviation'" carries deep meaning. The author treats this syndrome: mild cases use Lizhong Tang, severe cases use Fuzi Lizhong Tang, both added with Banxia (Pinellia Tuber) and Wuzhuyu (Evodia Fruit), achieving satisfactory results.
29. Emesis is used for Taiyang disease. But Taiyang disease should have aversion to cold. Now, counterintuitively, there is no aversion to cold, and the patient does not desire to cover themselves. This is called Internal Distress caused by emesis①. Original Text 121
① Internal Distress: Refers to mental agitation and discomfort.
Commentary by Zheng Qin'an: Emesis therapy also contains a dispersing intent. But without aversion to cold, it cannot be a Taiyang syndrome. Not desiring to cover oneself indicates internal heat. Calling it "Internal Distress from emesis" implies this pathology is entirely due to the error of emesis. Why? Emesis causes Qi mechanism to move outward with uncontrollable force, thus presenting this internal distress. Wait for Qi to settle and Spirit to calm, then the patient will desire to cover themselves, and the disease will heal spontaneously. If Qi settles but the patient still does not desire to cover themselves, it cannot be called "Internal Distress from emesis." Scholars should distinguish this carefully.
[Interpretation] This clause and the previous one both describe pathological changes from erroneous emesis in Taiyang disease, but the presented symptoms are not identical. The internal distress and desire to uncover in this clause result from damaged Stomach fluids and transformation of Stomach heat into dryness. Although the error (emesis) is the same, the pathological changes differ, so the treatment methods differ accordingly. According to *Yizong Jinjian*: "Only Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) should be used, to clear heat and calm the spirit while benefiting Qi and generating fluids." This aligns with principle and method and can be adopted.
30. If exterior signs of Taiyang disease have not resolved②, purgatives must not be used. Using purgatives is deviation. To resolve the exterior, Guizhi Tang is suitable. Original Text 44
② Exterior Signs: Refers to exterior syndrome here.
Commentary by Zheng Qin'an: Diseases that should resolve from the exterior cannot be purged. Purging draws the pathogen deeper, causing significant harm.
If the disease mechanism indeed trends toward the exterior, guide it accordingly, and success will be achieved.
[Interpretation] Exterior syndromes should be resolved externally; interior syndromes should be attacked with purgatives. This is an unchanging law. Mr. Zheng says: "Diseases that should resolve from the exterior cannot be purged. Purging draws the pathogen deeper, causing significant harm." Not only can Guizhi Tang be used when exterior pathogens are unresolved, but even after erroneous purging, if the pathogen desires to return to the exterior, Guizhi Tang can still be used to guide it accordingly for cure.
31. Taiyang disease, initially treated with sweating without resolution, followed by purging, the pulse remains floating③ and does not heal. Floating indicates location in the (exterior) [outside]. Counterintuitively purging causes non-resolution. Now the pulse is floating, therefore knowing it is outside. Resolution of the exterior is required for healing. Guizhi Tang is suitable. Original Text 45
Commentary by Zheng Qin'an: Adapting treatment to circumstances is the way of medicine. If exterior resolution is needed but purging is used, or if purging is needed but exterior-resolving and consolidating methods are used, these are medical faults. In this clause, after purging, the pulse is still floating. This means the pathogen does not trend downward but still desires to exit outward. Therefore, Guizhi Tang is still used to guide it. This is the true secret of medication. Scholars should pay attention and remember it.
[Interpretation] Floating pulse is the main basis for pathogen in the exterior. Regardless of post-sweating or post-purging states, as long as the floating pulse (combined with headache, fever, sweating, aversion to wind) and other exterior signs persist, sweating should be repeated. This clause discusses post-sweating exterior non-resolution. Suspecting pathogen entry into the interior, purging was used without resolution. Since exterior signs like floating pulse persist, Guizhi Tang should still be used to resolve the exterior.
32. After Taiyang disease is treated with purging①, if Qi rushes upward, Guizhi Tang may be given, using the previous method. If Qi does not rush upward, it must not be given. Original Text 15
① Qi Rushing Upward: The patient feels rebellious Qi rising in the chest.
Commentary by Zheng Qin'an: For diseases requiring exterior resolution, if erroneously purged, and the pulse is floating with pathogen still in the exterior, Guizhi Tang can be used. If purging causes upward rushing of Qi, careful observation is needed. Assuming upward rushing means pathogen desires to exit, Guizhi Tang is still used. No rushing means pathogen does not exit outward, so it cannot be given. It is said: Upward rushing with floating pulse allows Guizhi Tang; upward rushing without floating pulse prohibits it. However, upward rushing often results from erroneous purging damaging Chest Yang, failing to suppress turbid Yin Qi from the Lower Jiao, causing much upward rushing. The method should involve gathering and warming consolidation, which Guizhi cannot achieve. Scholars must seek the essence in disease condition, pulse/respiration, voice, movement/stillness, presence/absence of Spirit.
[Interpretation] Taiyang disease presents with stiffness/pain in head and neck, aversion to cold, and floating pulse. It should resolve from the exterior. If erroneously purged, and the disease does not change due to purging, with floating pulse and headache persisting, and the patient feeling Qi rushing upward, this indicates healthy Qi is not depleted and pathogen is still in the exterior. Guizhi Tang can be given, using the previous method of sipping warm porridge to induce slight sweating. If after purging Qi does not rush upward, the pathogen has sunk inward, healthy Qi is deficient, and Guizhi Tang is no longer applicable. Mr. Zheng provides a deeper commentary on "upward rushing": "Upward rushing often results from erroneous purging damaging Chest Yang, causing much upward rushing. The method should involve gathering and warming consolidation, which Guizhi cannot achieve."
This differs from previous famous commentators' notes and deserves careful appreciation.
33. Taiyang disease, exterior signs remain, but multiple purgations② are used. Consequently, diarrhea accompanies heat③. Diarrhea continues incessantly. Epigastric fullness and hardness occur. Exterior and interior are both unresolved. Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction) is the principal treatment. Original Text 163
② Multiple Purgations: Refers to repeated use of purgatives.
③ Diarrhea Accompanying Heat: Interior cold-deficiency carrying exterior heat downward causing diarrhea.
Commentary by Zheng Qin'an: Diarrhea is not the primary disease but caused by multiple purgations. Epigastric fullness/hardness is not inherent but caused by excessive purging damaging the Middle, allowing Yin pathogen to usurp high positions. The original text uses Guizhi Renshen Tang. The ingredients are Lizhong Tang plus Guizhi. Not named Lizhong, but Guizhi Jia Renshen Tang, emphasizes Taiyang intent. It is entirely a method of warming the middle, transforming Qi, tonifying the middle, and expelling pathogen.
[Interpretation] Taiyang disease exterior signs remain, with persistent fever, aversion to cold, headache, and body ache. It should resolve from the exterior. But repeated erroneous purging damages Spleen and Stomach, leading to exterior heat and interior cold-deficiency diarrhea. Due to excessive purging damaging the Middle, epigastric blockage and hardness occur. The original text prescribes Guizhi Renshen Tang. Thus, Lizhong Tang treats epigastric fullness/hardness and diarrhea, using only Guizhi to harmonize the exterior. Combined with Lizhong, Guizhi also enhances interior-warming power. Hence Mr. Zheng says: "Not named Lizhong, but Guizhi Renshen Tang, emphasizes Taiyang intent. It is entirely a method of warming the middle, transforming Qi, tonifying the middle, and expelling pathogen."
Guizhi Renshen Tang Formula (Corrected and Supplemented)
Guizhi (Cinnamon Twig) 4 Liang (separately sliced)
Gancao (Licorice Root) 4 Liang (honey-fried)
Baizhu (Atractylodes Macrocephala Rhizome) 3 Liang
Renshen (Ginseng Root) 3 Liang
Ganjiang (Dried Ginger) 3 Liang
These five ingredients, add 9 Sheng of water. First decoct four ingredients, obtain 5 Sheng. Add Guizhi, boil to obtain 3 Sheng. Remove residue. Take 1 Sheng warm. Twice daily, once at night.
[Analysis of the Formula and Its Scope of Application] This formula is Lizhong Tang plus Guizhi. Not called Lizhong, but Guizhi Renshen Tang, indicates Guizhi and Lizhong achieve results separately in exterior and interior. This formula treats diarrhea after purging, with intestinal-stomach cold-deficiency. Thus, Renshen, Ganjiang, Baizhu, and Gancao assist Yang internally to stop diarrhea. Exterior signs remain, so Guizhi moves Yang externally to resolve the exterior. Guizhi should be added later. This formula is suitable for Lizhong Tang syndrome combined with exterior syndrome, focusing on the interior syndrome. It is appropriate for intestinal-stomach cold-deficiency with headache, fever, and aversion to cold.