②柔痙：痙一作痓，是項背強直，角弓反張的證候名稱，有汗的叫“柔痙”，無汗的叫作“剛痙”。
鄭論：按（胸結）〔結胸〕而項亦強，有如柔痙狀者，此是邪結於胸，阻其任脈流行之氣機而言也。下之以大陷胸丸者，逐其胸中積聚，積聚亦去，任脈通而氣機複暢，故有自和之說也。但痙症則周身手足俱牽強，此獨項強，故稱為如柔痙狀，學者須知。
【闡釋】結胸的主證，本是心下鞕滿而痛，此證項強如柔痙狀，是病邪偏結於上，胸部鞕滿而不能俯，所以如同柔痙。這種項強是受胸部水熱結聚的影響，和筋脈失養的項強不同，水熱結聚一散，胸部脹滿自消，項強也就可以自愈，所以說下之則和。用大陷胸丸緩攻上部之邪，確為對證。鄭氏嫚與諸家不同：“此是邪結於胸，阻其任脈流行之氣機而言”。治之以大陷胸丸者，使藥力緩緩而行，驅邪而正不傷，乃峻藥緩攻之法也。胸中積聚去，任脈通而氣機複暢，故自和也。
大陷胸丸方（校補）
大黃半斤葶藶子半斤（熬）芒硝半升杏仁半升（去皮尖、熬黑）上四味，搗篩二味，內杏仁芒硝，合研如脂，和散，取如彈丸一枚，別搗甘遂末一錢匕，白蜜二合，水二升，煮取一升，溫頓服之，一宿乃下，如不下，更服，取下為效，禁如藥法。
【方解及其應用範圍】本方的藥物組成，為大陷胸湯更加入葶藶子杏仁白蜜而成。因其邪結在胸，胸為肺位，故加杏仁色白入肺，以利肺氣，用葶藶子佐甘遂破飲而瀉下，恐硝黃等藥下行甚速，故緩以白蜜之甘，使藥力緩行，留於胸中，熱結之水，得芒硝而解，葶藶甘遂逐水飲，隨大黃以下行，又為丸煮服，使藥力緩緩而行，驅邪而正不傷，乃峻藥緩攻之法。《醫宗金鑒》用以治水腫腸澼初起，形氣俱實者。
五十一、結胸證，其脈浮大者，不可下，下之則死。原文132
鄭論：按結胸而稱脈浮大者，明是陽邪結胸，理應清涼以解之、開之，方為合法，若攻下之，則引邪深入，結胸愈結而不解者，焉得不死。
【闡釋】此節乃結胸之虛證也。邪結於裏，脈當寸浮關沉，今脈通見浮大，是邪雖內結而未實，氣機仍有外達之象，若誤下之，則犯本論，脈浮大，而醫反下之，此為大逆之戒。亦即鄭氏所雲：“若攻下之，則引邪深入，結胸愈結而不解者，焉得不死”之謂也。
五十二、結胸證〔悉〕具，煩（燥）〔躁〕者〔亦〕死。原文133
鄭論：按證具結胸，阻其上下交通之機，故煩（燥）〔躁〕作。
蓋煩出於心，（燥）〔躁〕出於腎，病機正在坎離交會之處，不交則煩（燥）〔躁〕立作，故決之必死也。
【闡釋】結胸證悉具，邪結已深也，若更見煩躁，是正不勝邪，真氣散亂，病者必死。鄭氏以坎離立論謂：“煩出於心，躁出於腎，病機正在坎離交會之處，不交則煩躁立作，故決之必死也”。誠屬不刊之論。
五十三、太陽病，醫發汗，遂發熱惡寒，因複下之，心下痞，表裏俱虛，陰陽〔氣〕並竭①，無陽則陰獨②，複加燒針，因胸煩，面色青黃，膚瞤者，難治；今色微黃，手足溫者易愈。原文153
①陰陽氣並竭：就是表裏俱虛。發汗使表虛而陽氣竭，攻下使裏虛而陰氣竭。
②無陽則陰獨：謂表邪內陷成痞，表證罷而裏證獨具。
鄭論：按太陽證總要外邪未解，方可發汗，豈有無發熱惡寒，而反即汗之理？此言因發汗，遂見發熱惡寒，焉知非誤汗而逼陽外越乎？此症總緣汗下失宜，以致表裏俱虛，陰陽並竭，無陽則陰獨，此刻係純陰用事，痞塞之症所由生，後加燒針，因而胸煩，面色青黃，則土木相刑之機，全神畢露，故曰難治。若色微黃，而無青色，手足尚溫，是後天之根猶存，故純可治。
【闡釋】鄭氏所按：“豈有無發熱惡寒，而反即汗之理？此言因發汗，遂見發熱惡寒，焉知非誤汗而逼陽外越乎？”值得深思。總由汗下失宜，所以成痞，雖曰陰陽氣並竭，實由心下無陽，故陰獨痞塞也。複加燒針，以逼劫其陰陽，乃成此危候，自當扶陽散逆，溫中祛邪之法，可用附子理中加砂、半、吳茱萸等藥治之為當。
傷寒恒論卷二
太陽中篇
凡寒傷營之證，列於此篇，計五十八法（據舒本校增）
一、太陽病，或已發熱，或未發熱，〔必惡寒〕，體（重）〔痛〕，嘔逆，脈陰陽俱緊〔者〕①，名（曰）〔為〕傷寒②。原文3
①脈陰陽俱緊：指脈的浮沉，浮取為陽，沉取為陰。“緊脈”如切繩狀，是緊張的現象，與弦脈相似而轉索有力。這裏所說的緊脈，是浮緊的脈象，浮緊為表寒，常與發熱惡寒並見。
②名為傷寒：這裏的傷寒，不是指傷寒論之廣義傷寒，而是指麻黃湯證的狹義傷寒而言。
鄭論：按已發熱者，邪已拂郁於內也，未發熱者，邪入而未遏鬱也。據脈象，陰陽俱緊曰傷寒，論體（重）〔痛〕，則屬少陰，嘔逆則屬寒飲，似於此條內不切。以余細維，現有發熱、惡寒、身痛、脈浮緊者，乃為太陽傷寒之的候。若無頭痛、身痛、發熱、惡寒，而獨見身（重）〔痛〕，嘔逆，脈象見緊，乃為寒入少陰之征。蓋太陽底面，即是少陰，以此判其或已發熱，或未發熱二語，庶幾恰切。
【闡釋】本條乃太陽傷寒證之主證主脈。與太陽上篇中風條參之自別，主要不同點是脈緊無汗，此外體痛、嘔逆也是中風證所沒有的。中風因見風而惡寒，傷寒則無風而亦惡寒矣。鄭氏釋或已發熱，或未發熱，則不同於歷代注家之說，而曰“太陽底面，即是少陰，以此判其或已發熱，或未發熱，庶幾恰切”。必惡寒者，傷於寒則惡寒也。
二、太陽病，頭痛發熱，身（痛）〔疼〕腰痛，〔骨節疼痛〕，惡風，無汗而喘者，麻黃湯主之。原文35
鄭論：按此條乃寒傷太（過）〔陽〕之裏，裏寒太甚，閉束氣機，上逆而喘，此理之常，主以麻黃湯開其腠裏，俾邪外出，表裏通暢，一切證形，立即化為烏有，學者切勿以喘而即認為肺病也，須知。
【闡釋】本條為太陽傷寒的主要證狀，也是應用麻黃湯證的標準。鄭氏謂：“學者切勿以喘而即認為肺病。”蓋人身大氣，積於心中，上焦如霧也，而胸中為太陽所主，寒邪外束，榮衛閉固，氣不得泄，壅閼而為喘，于肺何有也。杏仁取其利氣，非治肺也，故麻黃湯實是治太陽傷寒之藥，而非治肺經之方也。
麻黃湯方（校補）
麻黃三兩（去節）桂枝二兩（去皮）甘草一兩（炙）杏仁七十個（去皮尖）上四味，以水九升，先煮麻黃，減二升，去上沫，內諸藥，煮取二升半，去滓，溫服八合，複取微似汗，不須啜粥，餘如桂枝法將息。
【方解及其應用範圍】麻黃辛溫，開腠理而發汗；杏仁苦溫，疏利肺氣而治喘；桂枝辛甘溫，協同麻黃，增強其發汗作用；甘草甘平，協和諸藥，藥雖四味，方義周匝。本方為開表逐邪發汗之峻劑，為太陽病表實證之主方。汪昂曰：“麻黃中空，辛溫氣薄，肺家專藥，而走太陽，能開腠散寒；桂枝辛溫，能引營分之邪達於肌表；杏仁苦甘，能散寒而降氣；甘草甘平，發散而和中。”麻黃與杏仁相配，可以解表散邪，降逆平喘。曹穎甫謂：“麻黃湯為傷寒之聖藥。獨怪近人畏忌麻黃，徒以荊芥、防風、豆豉、牛蒡等味，敷衍病家，病家亦以其平易而樂用之，卒之愈疾之功不見”。此為經驗有得之言。近代醫家惲鐵樵對用此方之標準謂：“除惡寒、發熱、頭痛、身痛等，更須注意兩點：第一是無汗，第二是口中和。如其有汗，麻黃是禁藥；如其口渴、舌幹、唇絳，桂枝也是禁藥。只要是真確無汗，口中和，此方是唯一無二的妙法，可以藥到病除。”（見惲著《傷寒論輯義按》）鄭氏在《醫法圓通》中說：“此太陽營分主方也。仲景原文治太陽病頭痛發熱，身疼腰痛，骨節疼痛，無汗惡寒而喘者。”隨即舉出其圓通應用法三條：（1）治痘初出而急隱，壯熱無汗者；（2）治肩背沉重、覺內冷者；（3）治兩腳彎發起紅塊，痛甚。
近代藥物之分析，麻黃有發汗、平咳、定喘諸作用，為辛溫發汗藥中效力最強大者。故凡一切感寒、傷寒諸疾病之無汗者，如頭痛、腰痛、身痛、關節痛等，無不可以用之。筆者多年來常用麻黃湯以治傷寒咳嗽，無不應手取效，而從未見發生副作用。近人推廣應用此方治療肺炎、上呼吸道感染屬表寒實證者，均獲良效。亦有用本方治療腎臟病的水腫，並不一定出汗，大都表現為小便增多而腫脹消。
三、傷寒一日①，太陽受之，脈若靜者為不（動）〔傳〕②，頗欲吐，若（煩燥）〔躁煩〕，脈數急者③，為傳也。傷寒二三日，陽明少陽證不見者，為不傳也。原文4、5
①傷寒：指廣義傷寒，包括中風在內，與上條名為傷寒有廣狹義之分。
②脈若靜：指脈與證符（傷寒脈緊，中風脈緩），無數急現象。傳：謂以此之所受，轉授之於彼也。
③脈數急：與脈靜相對而言。
鄭論：按傷寒本旨，以一日太陽，二日陽明，三日少陽，四日太陰，五日少陰，六日厥陰，此就六經流行之氣機而言也。至於邪入太陽，雖七八日，十徐日，只要脈靜而不動，別無他經證形足征，便不傳經。若脈見動，心煩欲吐，此為傳也。學者臨證，務要有別經證形可驗，脈象之動靜足征，則得傳與不傳之實也。
【闡釋】鄭氏將辨太陽病脈證並治上第四條、五條合併為一條。臨床上的病變，並不是一日太陽、二日陽明……這樣機械刻板，它既可以傳入陽明，又可以傳入少陽，甚至也有轉屬太陰、少陰的。但也可以在太陽七八日、十徐日不發生傳變。可以從脈證的變化來診斷其傳與不傳，更應以證候為主。如傷寒二日，並未見到不惡寒，但惡熱，口渴欲飲等陽明證，三日並未見到口苦、咽幹、目眩等少陽證，則可知病邪仍在太陽，而沒有傳變。于此充分說明了病情已否傳變，應以證候為主，決不可以日數來決定傳與不傳。亦即鄭氏說：“務要有別經證形可驗，則得傳與不傳之實也”。
四、傷寒二三日，心中悸而煩者①，小建中湯主之（嘔家不可用建中湯②，以甜故也）。原文102
②嘔家：指素有嘔吐症狀的人。
鄭論：按太陽司寒水之令，今二三日未見別經病情，只見心悸而煩，必是太陽失氣化之令，以致水停心下，為悸而煩，今主建中湯以化太陽之氣，氣化而行，則升降不乖，而心悸與煩，則立化為烏有。但嘔家不可用建中，以甘能上湧也，須知。
【闡釋】傷寒二三日，心中悸煩是屬裏虛，雖有表證，亦不可汗之，總以救裏為急，中氣得到扶助，正氣能發揮祛邪作用，表邪亦往往能隨之而解。其所以裏虛，如鄭氏所說：“是太陽失氣化之令，以致水停心下，為悸而煩”。建中湯足以化太陽之氣，氣化而行，則升降不乖，而心悸與煩可愈矣。小建中湯方後有“嘔家不可用桂枝湯，以甜故也”。鄭氏移在原文後，未知何故。
小建中湯方（校補）
桂枝三兩（去皮）甘草二兩（炙）大棗十二枚（擘）芍藥六兩生薑三兩（切）膠飴一升上六味，以水七升，煮取三升，去滓，內膠飴，更上微火消解，溫服一升，日三服。嘔家不可用建中湯，以甜故也。
【方解及其應用範圍】桂枝湯以桂枝為君，辛甘發散，以祛邪為主；本方以膠飴為君，配芍藥酸甘相合，以補中為主。桂枝、生薑，溫中通陽；芍藥斂陰和營，桂、姜之辛，與棗、草、膠飴之甘合，則辛甘化陽；芍之苦，與甘相合，則苦甘化陰。膠飴甘溫，大補脾胃，棗、草助之，以補脾胃之虛，使中宮建立，則陽氣化而上行，陰氣化而下降，營衛調和，陰陽不偏，則心悸與煩可愈矣。又方後有“嘔家不可用建中湯，以甜故也。”不知鄭氏何故，將此段移在原文之後。本方在《傷寒論》、《金匱要略》中凡五見。治裏虛腹痛，萎黃，心中悸煩，又治虛勞裏急、手足煩熱、夢遺失精等陰陽兩虛，寒熱錯雜諸症。近代推廣用之，治療慢性胃炎、胃、十二指腸潰瘍病、更年期綜合證、心律失常、腹痛、自汗、盜汗等。筆者用治營衛不調，食減神衰，咳嗽久不愈者，以此方健胃滋脾，從陽生陰，而咳自愈。
五、太陽傷寒者，加溫針必驚也。原文117
鄭論：按寒傷太陽，在營在衛，原有區別，此言加溫針必驚，是邪在營分加溫針而驚耶？是邪在衛分加溫針而驚耶？以理揆之，當其時邪必在衛分，衛分屬陽，斷不可用溫針之法，邪在營分，方可用溫針之法。若邪在衛分而用之，如火上添膏，邪焉有不振驚內藏也，如此處斷，學者方有趨向，萬不致有用溫針之害矣。
【闡釋】歷代注家對病傷寒之人，加以溫針，一定要發生驚惕的變證。鄭氏則分別在營在衛，衛分屬陽，斷不可用溫針之法；邪在營分，可用溫針之法。如此處斷，便不致有用溫針之害矣。
六、脈浮宜以汗解，用火灸之，邪無（出路）〔從出〕因火而盛①，病從腰以下必重而痹者，名〔水）〔火〕逆也②。原文116中段
①邪無從出：誤治後，表邪不能從汗而出。因火而盛：因誤用灸法，邪熱愈加熾盛。
②火逆：凡誤用火法治療，因而形成變證的，稱為火逆。
② Rou Jing (Soft Spasm): "Jing" is also written as "Zhi". It refers to a syndrome characterized by stiffness and tension of the neck and back, and opisthotonos (arched back). When accompanied by sweating, it is called "Rou Jing"; when without sweating, it is called "Gang Jing" (Hard Spasm).
Zheng's Commentary: Regarding Jie Xiong (Chest Binding) where the neck and back are also stiff, resembling the appearance of Rou Jing, this is due to pathogenic factors binding in the chest, obstructing the flow of Qi mechanism along the Ren Mai (Conception Vessel). The use of Da Xian Xiong Wan (Major Intractable Chest Pill) to purge aims to drive out the accumulation in the chest. Once the accumulation is removed, the Ren Mai becomes unobstructed and the Qi mechanism flows freely again, hence the saying that self-harmonization occurs. However, in true Jing syndromes, the entire body and limbs are pulled and stiff; here only the neck and back are stiff, thus it is described as "resembling Rou Jing." Students must be aware of this distinction.
[Elucidation]: The main manifestation of Jie Xiong (Chest Binding) is hardness, fullness, and pain in the epigastrium. In this case, the neck stiffness resembling Rou Jing indicates that the pathogenic factor is bound predominantly in the upper jiao, causing hardness and fullness in the chest that prevents bending forward, thus resembling Rou Jing. This neck stiffness is influenced by the accumulation of water-heat in the chest, differing from neck stiffness caused by malnourishment of the sinews. Once the water-heat accumulation dissipates, the chest fullness subsides naturally, and the neck stiffness heals itself; therefore, it is said that purging leads to harmony. Using Da Xian Xiong Wan to gently attack the pathogen in the upper part is indeed appropriate. Zheng's view differs from other scholars: "This is pathogenic binding in the chest, obstructing the Qi flow of the Ren Mai." Treating with Da Xian Xiong Wan allows the medicinal power to act slowly, expelling the pathogen without damaging healthy Qi, which is the method of using harsh medicines for slow purging. With the removal of chest accumulation, the Ren Mai opens and Qi flows smoothly, leading to self-harmony.
Da Xian Xiong Wan Formula (Corrected and Supplemented)
Da Huang (Rhubarb Root and Rhizome) half jin, Ting Li Zi (Descurainiae Semen / Lepidii Semen) half jin (stir-fried), Mang Xiao (Mirabilite) half sheng, Xing Ren (Apricot Seed) half sheng (skin and tips removed, stir-fried until black). The above four ingredients: crush and sift two of them, add Xing Ren and Mang Xiao, grind together until paste-like, mix with powder. Take one pill size of a bullet. Separately crush Gan Sui (Kansui Root) into fine powder, one qian bi, Bai Mi (White Honey) two he, Water two sheng. Boil to obtain one sheng. Take warm in one dose. Stool will pass after one night. If not, take another dose. Passing stool is the effect. Follow dietary restrictions as per medication rules.
[Formula Analysis and Scope of Application]: The composition of this formula is Da Xian Xiong Tang (Major Intractable Chest Decoction) plus Ting Li Zi, Xing Ren, and Bai Mi. Since the pathogen binds in the chest, and the chest is the domain of the Lung, Xing Ren (which is white and enters the Lung) is added to benefit Lung Qi. Ting Li Zi assists Gan Sui to break fluid retention and purge downwards. Fearing that Mang Xiao and Da Huang descend too rapidly, the sweetness of Bai Mi is used to slow the action of the medicine, keeping it in the chest. The heat-bound water is resolved by Mang Xiao, while Ting Li Zi and Gan Sui drive out fluid retention, descending with Da Huang. Taking it as pills boiled in water ensures the medicinal power acts slowly, expelling the pathogen without harming healthy Qi, embodying the method of harsh drugs used for slow purging. *Yi Zong Jin Jian* uses it for early-stage edema and intestinal dysentery where both form and Qi are excess.
51. In Jie Xiong syndrome, if the pulse is floating and large, purging is contraindicated; purging will lead to death. Original Text 132
Zheng's Commentary: Regarding Jie Xiong with a floating and large pulse, it clearly indicates Yang pathogen binding in the chest. It should be treated with cooling methods to resolve and open it, which is the correct approach. If purged, it draws the pathogen deeper, making the binding tighter and unresolved, how can death not ensue?
[Elucidation]: This section describes the deficiency type of Jie Xiong. Pathogen binding in the interior should present with a floating pulse at the Cun position and sunken at the Guan position. Now the pulse is generally floating and large, indicating that although the pathogen is internally bound, it is not yet solid, and the Qi mechanism still shows signs of moving outward. If mistakenly purged, it violates the principles discussed earlier: "Pulse floating and large, yet physician purges," which is a great reversal warning. This aligns with Zheng's statement: "If purged, it draws the pathogen deeper, making the binding tighter and unresolved, how can death not ensue?"
52. In Jie Xiong syndrome, if all symptoms are present, and there is restlessness (Zao), death [also] ensues. Original Text 133
Zheng's Commentary: When Jie Xiong symptoms are fully present, it obstructs the communication mechanism between the upper and lower, causing restlessness (Zao).
Restlessness (Fan) originates from the Heart, while agitation/restlessness (Zao) originates from the Kidney. The disease mechanism lies precisely at the intersection of Kan (Water/Kidney) and Li (Fire/Heart). If they do not intersect, Fan and Zao arise immediately, thus determining death is inevitable.
[Elucidation]: When all symptoms of Jie Xiong are present, the pathogen binding is deep. If restlessness (Fan-Zao) appears additionally, it means healthy Qi cannot overcome the pathogen, and True Qi is scattered; the patient will surely die. Zheng bases his argument on Kan and Li: "Fan originates from the Heart, Zao from the Kidney. The disease mechanism is at the intersection of Kan and Li. Without intersection, Fan and Zao arise immediately, thus determining death." This is indeed an irrefutable theory.
53. In Taiyang Bing, if the physician induces sweating, followed by fever and aversion to cold, and then purges, resulting in Pi (Glomus/Fullness) below the heart, both exterior and interior are deficient, Yin and Yang Qi are exhausted simultaneously, absence of Yang leads to Yin alone, adding moxibustion causes chest irritability, greenish-yellow complexion, and twitching of the skin makes it difficult to treat; if the complexion is slightly yellow and hands and feet are warm, it is easy to heal. Original Text 153
① Yin and Yang Qi exhausted simultaneously: Means both exterior and interior are deficient. Sweating causes exterior deficiency and exhaustion of Yang Qi; purging causes interior deficiency and exhaustion of Yin Qi.
② Absence of Yang leads to Yin alone: Refers to exterior pathogen sinking inward forming Pi, exterior syndrome ceases, and interior syndrome stands alone.
Zheng's Commentary: Regarding Taiyang syndrome, external pathogen must not be resolved before inducing sweating. How could one induce sweating without fever and aversion to cold? This text says sweating led to fever and aversion to cold; how do we know it wasn't mistaken sweating forcing Yang to escape outward? This syndrome arises from improper sweating and purging, leading to simultaneous deficiency of exterior and interior, and exhaustion of Yin and Yang. "Absence of Yang leads to Yin alone" means pure Yin is dominant at this moment, giving rise to Pi obstruction. Subsequent addition of burning needle causes chest irritability and greenish-yellow complexion, revealing the mechanism of Wood and Earth punishing each other, exposing the vital spirit completely; thus it is said to be difficult to treat. If the complexion is slightly yellow without green, and hands and feet remain warm, the root of Post-Heaven existence remains, thus it can be treated.
[Elucidation]: Zheng's commentary: "How could one induce sweating without fever and aversion to cold? This text says sweating led to fever and aversion to cold; how do we know it wasn't mistaken sweating forcing Yang to escape outward?" This deserves deep thought. It is generally due to improper sweating and purging that Pi forms. Although it is said Yin and Yang Qi are exhausted, it is actually because there is no Yang below the heart, so Yin alone obstructs. Adding burning needle to force and劫 (rob) Yin and Yang creates this critical state. One should employ methods to support Yang, disperse rebellion, warm the middle, and dispel pathogen. Attaching Lizhong Decoction with Sha Ren, Ban Xia, and Wu Zhu Yu would be appropriate.
Shanghan Heng Lun Volume 2
Taiyang Middle Chapter
All syndromes of Cold injuring Ying are listed in this chapter, totaling fifty-eight methods (added according to Shu edition)
1. Taiyang Bing, whether fever has already appeared or not, [must have aversion to cold], body [pain], vomiting and reversing, pulse Yin and Yang both tight [is] named [as] Shang Han. Original Text 3
① Pulse Yin and Yang both tight: Refers to the floating and sinking of the pulse. Floating taking is Yang, sinking taking is Yin. "Tight pulse" feels like cutting a rope, a tense phenomenon, similar to Wiry pulse but with stronger twisting force. The Tight pulse mentioned here is a Floating-Tight pulse image. Floating-Tight indicates Exterior Cold, often seen with fever and aversion to cold.
② Named Shang Han: Here, Shang Han does not refer to the broad sense of Shang Han Lun, but specifically to the narrow sense Shang Han corresponding to Ma Huang Tang syndrome.
Zheng's Commentary: Those who have already developed fever, the pathogen has already been suppressed internally; those who have not yet developed fever, the pathogen has entered but not yet suppressed. According to pulse image, Yin and Yang both tight is called Shang Han. Discussing body [pain], it belongs to Shaoyin; vomiting and reversing belongs to Cold Fluid Retention, seemingly not fitting this clause well. From my careful observation, currently having fever, aversion to cold, body pain, and floating-tight pulse is the exact indication of Taiyang Shang Han. If without headache, body pain, fever, aversion to cold, but solely seeing body [pain], vomiting/reversing, and tight pulse, it is a sign of Cold entering Shaoyin. The bottom surface of Taiyang is exactly Shaoyin; using this to judge the phrases "whether fever has already appeared or not" is quite appropriate.
[Elucidation]: This clause is the main symptom and main pulse of Taiyang Shang Han syndrome. Comparing it with the Wind Strike clause in the Upper Taiyang chapter, the main difference is Tight pulse without sweating. Additionally, body pain and vomiting/reversing are also absent in Wind Strike syndrome. Wind Strike has aversion to cold due to wind; Shang Han has aversion to cold even without wind. Zheng's explanation of "whether fever has already appeared or not" differs from历代 commentators, stating "The bottom surface of Taiyang is exactly Shaoyin; using this to judge 'whether fever has already appeared or not' is quite appropriate." "Must have aversion to cold" means injury by Cold causes aversion to cold.
2. Taiyang Bing, headache, fever, body [ache], lower back pain, [bone and joint pain], aversion to wind, no sweating and wheezing, Ma Huang Tang governs it. Original Text 35
Zheng's Commentary: This clause is Cold injuring the interior of Taiyang. Interior Cold is too severe, closing and binding the Qi mechanism, reversing upward causing wheezing. This is the normal logic. Governing with Ma Huang Tang opens the Cou Li (pores/skin interstices), allowing pathogen to exit outward, making exterior and interior smooth, and all symptom forms immediately vanish. Students must not consider wheezing immediately as Lung disease; be aware.
[Elucidation]: This clause represents the main symptoms of Taiyang Shang Han and is the standard for applying Ma Huang Tang. Zheng states: "Students must not consider wheezing immediately as Lung disease." The Great Qi of the human body accumulates in the Heart; the Upper Jiao is like mist. The chest is governed by Taiyang. External Cold binds, Ying and Wei close tightly, Qi cannot vent, stagnates and causes wheezing. What does this have to do with the Lung? Xing Ren is taken for its ability to benefit Qi, not to treat the Lung. Thus, Ma Huang Tang is truly a medicine for treating Taiyang Shang Han, not a formula for treating the Lung Meridian.
Ma Huang Tang Formula (Corrected and Supplemented)
Ma Huang (Ephedrae Herba) three liang (remove joints), Gui Zhi (Cinnamomi Ramulus) two liang (remove bark), Gan Cao (Glycyrrhizae Radix et Rhizoma) one liang (honey-fried), Xing Ren (Armeniacae Semen Amarum) seventy pieces (skin and tips removed). The above four ingredients: with nine sheng of water, first boil Ma Huang, reduce by two sheng, remove foam on top, add other medicines, boil to obtain two and a half sheng, remove dregs, take warm eight ge. Induce slight sweat. No need to drink porridge. Rest follow Gui Zhi Tang care instructions.
[Formula Analysis and Scope of Application]: Ma Huang is Acrid-Warm, opens Cou Li and induces sweating; Xing Ren is Bitter-Warm, disperses and benefits Lung Qi and treats wheezing; Gui Zhi is Acrid-Sweet-Warm, cooperates with Ma Huang to enhance its sweating action; Gan Cao is Sweet-Ping, harmonizes all medicines. Although four ingredients, the formula meaning is comprehensive. This formula is a harsh agent for opening the exterior, driving out pathogen, and inducing sweating; it is the main formula for Taiyang Bing Exterior Excess Syndrome. Wang Ang said: "Ma Huang is hollow, acrid-warm, thin qi, special medicine of the Lung family, walking to Taiyang, can open Cou Li and scatter Cold; Gui Zhi is acrid-warm, can guide Ying-level pathogen to reach muscle surface; Xing Ren is bitter-sweet, can scatter Cold and descend Qi; Gan Cao is sweet-ping, disperses and harmonizes middle." Ma Huang paired with Xing Ren can release exterior and scatter pathogen, descend rebellion and calm wheezing. Cao Yingfu said: "Ma Huang Tang is the sacred medicine for Shang Han. Strange that modern people fear and avoid Ma Huang, merely using Jing Jie, Fang Feng, Dou Chi, Niu Bang etc. to敷衍 (perfunctorily treat) patients, patients also use them happily because they are mild, ultimately failing to see the merit of curing disease." These are words gained from experience. Modern physician Yun Tieqiao stated the criteria for using this formula: "Besides aversion to cold, fever, headache, body pain, etc., pay attention to two points more: First is no sweating, second is mouth and throat comfortable. If there is sweating, Ma Huang is prohibited; if thirsty, dry tongue, crimson lips, Gui Zhi is also prohibited. As long as it is truly no sweating and mouth/throat comfortable, this formula is the unique wonderful method, medicine arrives and disease removes." (See Yun's *Shanghan Lun Ji Yi An*). Zheng in *Yi Fa Yuan Tong* said: "This is the main formula of Taiyang Ying level. Zhongjing's original text treats Taiyang Bing headache, fever, body ache, lower back pain, bone/joint pain, no sweating, aversion to cold, and wheezing." Immediately listing three flexible application methods: (1) Treat acne initially erupting and suddenly hiding, high fever without sweating; (2) Treat heavy shoulders and back, feeling internal cold; (3) Treat red patches rising on the backs of both legs, very painful.
Modern drug analysis shows Ma Huang has effects of inducing sweating, calming cough, and stopping wheezing, being the most powerful among Acrid-Warm sweating medicines. Therefore, for all diseases contracting Cold or Shang Han without sweating, such as headache, lower back pain, body pain, joint pain, etc., none cannot be treated with it. I have commonly used Ma Huang Tang to treat Shang Han cough for many years, always effective, never seeing side effects. Modern people promoted using this formula to treat pneumonia and upper respiratory tract infections belonging to Exterior Cold Excess Syndrome, all achieving good results. Some also used this formula to treat edema in kidney disease, not necessarily sweating, mostly manifesting as increased urination and reduction of swelling.
3. Shang Han one day①, Taiyang receives it, if pulse is quiet, it is not (moving) [transmitting]②, greatly wanting to vomit, or (restlessness) [agitation], pulse rapid and urgent③, is transmitting. Shang Han two or three days, Yangming and Shaoyang symptoms not seen, is not transmitting. Original Text 4, 5
① Shang Han: Refers to broad sense Shang Han, including Wind Strike, differing in broad/narrow sense from the previous clause named Shang Han.
② Pulse if quiet: Means pulse matches syndrome (Shang Han pulse tight, Wind Strike pulse slow), no rapid/urgent phenomena. Transmitting: Means transferring what was received here to there.
③ Pulse rapid and urgent: Opposite to pulse quiet.
Zheng's Commentary: According to the original intent of Shang Han, one day Taiyang, two days Yangming, three days Shaoyang, four days Taiyin, five days Shaoyin, six days Jueyin, this speaks of the Qi mechanism flowing through the Six Meridians. As for pathogen entering Taiyang, even after seven or eight days, ten or more days, as long as pulse is quiet and unmoving, with no other meridian symptoms sufficient evidence, it does not transmit meridians. If pulse moves, heart vexation wanting to vomit, this is transmitting. Students in clinical practice must have other meridian symptoms to verify, and pulse movement/stillness sufficient evidence, then obtaining the reality of transmitting or not transmitting.
[Elucidation]: Zheng merged Articles 4 and 5 of "Distinguishing Taiyang Bing Pulse and Symptoms" into one article. Clinical pathological changes are not mechanically rigid like "one day Taiyang, two days Yangming..." It can transmit to Yangming, can transmit to Shaoyang, and even transfer to Taiyin or Shaoyin. But it also may not undergo transmission after seven or eight days, ten or more days in Taiyang. One can diagnose transmission or non-transmission from pulse and symptom changes, but should prioritize symptoms more. For example, Shang Han on the second day, did not see no aversion to cold but aversion to heat, thirst wanting to drink, etc., Yangming symptoms; on the third day did not see bitter taste, dry throat, dizzy eyes, etc., Shaoyang symptoms, then one knows pathogen is still in Taiyang, without transmission. This fully illustrates whether condition has transmitted should be based on symptoms, absolutely cannot decide transmission by days. Also as Zheng said: "Must have other meridian symptoms to verify, then obtaining the reality of transmitting or not transmitting."
4. Shang Han two or three days, heart palpitations and vexation①, Xiao Jian Zhong Tang governs it (Vomit-prone persons cannot use Jian Zhong Tang②, due to sweetness). Original Text 102
① Heart palpitations and vexation: Palpitating sensation in heart and restless/vexed state.
② Vomit-prone person: Refers to person with chronic vomiting symptoms.
Zheng's Commentary: Taiyang governs the command of Cold Water. Now two or three days, no other meridian condition seen, only seeing heart palpitations and vexation, must be Taiyang losing its Qi transformation command, causing Water stopping below heart, leading to palpitations and vexation. Now governing with Jian Zhong Tang to transform Taiyang Qi, Qi transforms and moves, then ascending/descending not abnormal, and heart palpitations and vexation immediately vanish. But vomit-prone persons cannot use Jian Zhong, because Sweet can surge upward, be aware.
[Elucidation]: Shang Han two or three days, heart palpitations and vexation belong to Interior Deficiency. Even if there are exterior symptoms, sweating is contraindicated; total priority is saving the interior. Middle Qi supported, Healthy Qi can exert anti-pathogen effect, exterior pathogen often resolves with it. The reason for interior deficiency, as Zheng said: "Is Taiyang losing Qi transformation command, causing Water stopping below heart, leading to palpitations and vexation." Jian Zhong Tang is sufficient to transform Taiyang Qi, Qi transforms and moves, ascending/descending not abnormal, heart palpitations and vexation can heal. Xiao Jian Zhong Tang formula notes say "Vomit-prone persons cannot use Gui Zhi Tang, due to sweetness." Zheng moved it after the original text, unknown why.
Xiao Jian Zhong Tang Formula (Corrected and Supplemented)
Gui Zhi (Cinnamomi Ramulus) three liang (remove bark), Gan Cao (Glycyrrhizae Radix et Rhizoma) two liang (honey-fried), Da Zao (Jujubae Fructus) twelve pieces (split), Shao Yao (Paeoniae Radix Alba) six liang, Sheng Jiang (Zingiberis Rhizoma Recens) three liang (sliced), Jiao Yi (Malt Sugar) one sheng. The above six ingredients: with seven sheng of water, boil to obtain three sheng, remove dregs, add Jiao Yi, further place on slight fire to dissolve, take warm one sheng, three times daily. Vomit-prone persons cannot use Jian Zhong Tang, due to sweetness.
[Formula Analysis and Scope of Application]: Gui Zhi Tang takes Gui Zhi as Sovereign, Acrid-Sweet dispersing, mainly expelling pathogen; this formula takes Jiao Yi as Sovereign, paired with Shao Yao Sour-Sweet combining, mainly tonifying Middle. Gui Zhi, Sheng Jiang, warm middle and unblock Yang; Shao Yao gathers Yin and harmonizes Ying. Acridity of Gui/Zheng combined with Sweetness of Zao/Cao/Jiao Yi, then Acrid-Sweet transforms Yang; Bitterness of Shao combined with Sweetness, then Bitter-Sweet transforms Yin. Jiao Yi is Sweet-Warm, greatly tonifies Spleen and Stomach, Zao/Cao assist it, to tonify Spleen/Stomach deficiency, making Middle Palace established, then Yang Qi transforms and ascends, Yin Qi transforms and descends, Ying and Wei harmonized, Yin and Yang not biased, then heart palpitations and vexation can heal. Again formula notes say "Vomit-prone persons cannot use Jian Zhong Tang, due to sweetness." Don't know why Zheng moved this paragraph after original text. This formula appears five times in *Shanghan Lun* and *Jinkui Yaolue*. Treats Interior Deficiency abdominal pain, sallow complexion, heart palpitations/vexation, also treats Deficiency Labor interior urgency, hot palms/soles, nocturnal emission, spermatorrhea, etc., Yin-Yang dual deficiency, Cold-Heat complex various syndromes. Modern promotion uses it to treat chronic gastritis, gastric/duodenal ulcer disease, menopause syndrome, arrhythmia, abdominal pain, spontaneous sweating, night sweats, etc. I used it to treat Ying-Wei disharmony, reduced appetite, mental fatigue, chronic cough not healing, using this formula to strengthen stomach and nourish spleen, generating Yin from Yang, and cough heals itself.
5. Taiyang Shang Han, adding warm needle must cause fright. Original Text 117
Zheng's Commentary: Cold injuring Taiyang, in Ying or in Wei, originally has distinction. This says adding warm needle must cause fright, is pathogen in Ying level adding warm needle causing fright? Or pathogen in Wei level adding warm needle causing fright? Reasoning logically, at that time pathogen must be in Wei level. Wei level belongs to Yang, absolutely cannot use warm needle method. Pathogen in Ying level, can use warm needle method. If pathogen in Wei level uses it, like adding fat to fire, how can pathogen not cause fright disturbing internal organs? Judging thus, students have direction, never causing harm from using warm needle.
[Elucidation]:历代 commentators believe that adding warm needle to someone sick with Shang Han must cause frightful change. Zheng distinguishes between Ying and Wei. Wei level belongs to Yang, absolutely cannot use warm needle method; pathogen in Ying level, can use warm needle method. Judging thus, one avoids harm from using warm needle.
6. Pulse floating suitable to resolve with sweating, using fire moxa, pathogen has no (exit) [from exiting] thus fire becomes excessive①, disease from waist downward must be heavy and numb, named [Water) [Fire] Ni (Reversal) also②. Original Text 116 middle segment
① Pathogen has no exit: After mistaken treatment, exterior pathogen cannot exit via sweat. Due to fire becoming excessive: Due to mistaken use of moxibustion, pathogen heat becomes more intense.
② Fire Ni (Reversal): Any mistaken use of Fire method treatment, thereby forming changed syndrome, is called Fire Ni.