鄭論：按脈浮之病，本應汗解，方為合法，醫家不究脈體，而妄以火灸之，大悖經旨。況表陽也，火亦陽也，二陽相合，邪不從外出而從內攻，遂致腰以下必重而痹者，是邪伏於下，阻其太陽寒水流行之氣機故也。名日火逆者，是重在未得汗解，而水滯於下也。
【闡釋】本條係116條中一節，指出浮脈誤灸後的變證。浮脈在表，宜以汗解之，醫以火灸取汗，而不得汗，邪無從出，因火而盛，雖不一定焦骨傷筋，而火阻其邪，陰氣漸竭，下焦乃營血所治，營氣竭而莫運，必重著而為痹。亦即鄭氏所說：“邪不從外出而從內攻，遂致腰以下必重而痹者，是邪伏於下。”則欲治其痹者，宜先治其火矣。
七、脈浮者，〔病在表〕，可發汗，宜麻黃湯。脈浮而數者，可發汗，宜麻黃湯。原文51、52
鄭論：按脈浮、脈數，雖雲可發汗，然有用桂枝湯者，有用麻黃湯者。在營在衛，原有區分，不得以浮、數二字，而斷為麻黃湯的證也。學者務于有汗、無汗、畏風、惡寒處追求，便得用方之實據也。
【闡釋】本條在《傷寒論》為51、52條，鄭氏合併為一條。凡表病皆見浮脈，麻黃湯證之主脈為浮緊，並有頭疼發熱，惡寒無汗等證狀，方可用麻黃湯發汗。脈浮而數者，多是風熱在表的象徵，麻黃湯是不適合的，應該與本篇一條二條互參，如證與之相合，方可用麻黃湯發其汗，則諸證自愈。觀原文不曰以麻黃湯為主之，而皆曰宜麻黃湯，則有商量斟酌之意也。
八、傷寒，發汗〔已〕解，半日許複煩，脈浮數者，可更發汗，宜（用）桂枝湯。原文57
鄭論：大約此證，既經汗解，而邪尚未盡解，故可更汗之，俾邪解盡無遺，庶無後患。
【闡釋】本條為汗解後，表邪猶未盡，因而複煩，脈浮數者，邪氣仍在表之證，故可更發汗，以祛表邪。但已汗複汗，故不宜麻黃湯之峻發，而宜桂枝湯之緩發也。
九、發汗已，脈浮數，煩渴者，五苓散主之。原文72
鄭論：按太陽傷寒，既稱發汗已，想是外邪已去。又見其脈浮數，煩渴，必是外邪已去，而內熱未解，故其脈浮數尚見。至於煩渴者，熱傷津液也，理應清解其熱，熱去則煩渴自解，脈數便平，何得即以五苓散主之？凡用五苓散，必要太陽邪已入腑，口渴而小便不利，原文只據一煩渴，脈數，學者每多不識。
煩渴二字，亦有飲冷、飲熱之分，不可不察（頂批）
【闡釋】此條鄭氏指出用五苓散之不當。凡用五苓散，必要太陽邪已入腑，口渴而小便不利，原文只據一煩渴，脈數，其不當明甚。
十、傷寒汗出而渴者①，五苓散主之；不渴者，茯苓甘草湯主之。原文73
①此處之口渴，不是陽明裏證的口渴，是水氣停在下焦，津液不能上布之口渴。
鄭論：按汗出而渴，是太陽寒水從毛竅而出，不能滋潤腸胃，故見口渴，以五苓散主之，乃使太陽寒水之氣，不從外出，而仍從內出，則汗渴便止。然有不渴者，是津液未大傷，胃中尚可支持，雖見汗出，以茯苓甘草湯主之，亦是化氣行水之妙。此條據餘所見，當時汗出而渴，小便不利者，以五苓散主之；汗出不渴，小便不利者，以茯苓甘草湯主之。加此四字，後學更易於明白了然。
再按汗出而渴，在陽明㈠有白虎之方；汗出而不渴，在少陰有亡陽之概，學者宜知。
㈠大渴飲冷（頂批）。
【闡釋】此條為茯苓甘草湯證與五苓散證之辨證要點，只在渴與不渴之間，則其他證狀，如脈浮數，小便不利，微熱等情況，亦必大致相同。鄭氏釋為加小便不利四字，更加明白了然，是正確的。兩證的主要區別是：一則水蓄於下，口渴而小便不利；一則水停於中，口不渴而小便不利。證情雖有異，但總的原因都屬停飲蓄水為患，所以都治以溫陽化水，不過一則重在溫化膀胱，以利小便，一則重在溫化胃陽而通利三焦，以蠲水飲，所以主治方劑各別。
茯苓四兩桂枝二兩（去皮）甘草一兩（炙）生薑三兩（切）上四味，以水四升，煮取二升，去滓，分溫三服。
【方解及其應用範圍】本方治汗出不渴，其蓄水比五苓散為輕，因而去掉主要的利水藥，僅用茯苓之淡滲，加重桂枝溫陽，生薑溫胃，甘草和中，四味配伍，溫胃散水之功最佳，為治水氣停中焦，不煩不渴，心下悸而四肢厥逆的有效良方。
十一、脈浮緊者，法當身疼痛，宜以汗解之。假令尺中遲者②，不可發汗，〔何以知之？然①，以營氣不足，血少故也。〕原文50
②尺中遲者：尺中的脈搏現遲而澀的現象，所謂“呼吸三至，來去極遲”。遲就是脈搏至數減少。但這裏的遲，是對緊而言。
①然：古人然字，多有作“曰”字解。
十二、〔脈浮數者，法當汗出而愈，若下之，身重心悸者，不可發汗〕，當自汗出乃解。所以然者，尺中脈微，此裏虛，須表裏實②，津液自和，便自汗出愈。原文49
②須：等待的意思。
鄭論：條內指一脈浮緊，身痛之人，法本當汗，假令尺中虛者，不可發汗，是言其陰分本虛，發之深恐亡陽，明是教人留意於發汗之間耳。即有他證，亦俟其津液自和，自汗出愈。蓋慎之深，防之密矣。
【闡釋】按此二條，鄭氏合併來加以注釋，原文錯落較多，其按亦不全面。
茲據《傷寒論》校補其錯落文字，分列兩條之釋文。脈浮緊，身疼痛，此傷寒之脈證，宜麻黃湯以汗之者也，然尺中脈遲，此營氣不足，而不可發汗之虛證也。
至12條表證誤下後，見身重、心悸、尺脈微的，不能再用發汗，可俟其自汗出而愈。但亦可以酌用小建中湯一類方劑，溫養裏氣，使表裏正氣早複，氣血充沛，則津液自和，便能汗出而愈。
十三、咽喉乾燥者，不可發汗。原文83
鄭論：凡咽喉乾燥之人，津液已傷，豈可再行發汗，以重奪其液乎？餘謂咽喉乾燥之人，有因下元坎中真氣衰微，不能啟真水上升而致者，法宜扶陽；有因邪火灼其津液而致者，法宜清潤；有因寒水逆於中，阻其胃中升騰之氣而致者，法宜行水。學者留心察之，若此等證，皆非發汗所能了
【闡釋】本條為汗法禁例之一。咽喉乾燥者，上焦無津液也。鄭氏認為咽喉乾燥之人，有三種不同情況，並提出扶陽、清潤、行水三種治法。筆者認為扶陽可用四逆湯，清潤可用人參白虎湯，行水可用茯苓甘草湯或五苓散。咽喉乾燥，現今多稱為慢性咽炎、喉炎，筆者常先用炮薑甘草湯加桔梗治之，繼加補腎藥調理而愈。
③淋家：是指小便淋瀝不爽，尿時莖中疼痛的病人。
鄭論：凡患淋之人，或熱閉膀胱，或寒閉膀胱，或敗精滯於尿竅，氣化現有不宣，原無發汗之理，若強汗之，則津液外亡，中氣被奪，即不能統束血液，血液流注闌門秘清別濁之處，滲入膀胱，小便下血，於是乎作矣。
【闡釋】本條為汗法禁例之二。歷代醫家注解此條，其原因多由腎陰虛而膀胱有熱，鄭氏所指熱閉膀胱即此，法宜扶腎陰，用四苓滑石阿膠湯治之。繼指出有寒閉膀胱，或敗精滯於尿竅，氣化不宣者。寒閉膀胱者，由下焦陽微，陰寒阻截膀胱之路，陽微無力，不能化之，法宜扶下焦之陽，可用苓桂朮甘湯倍桂加砂仁、白蔻治之。至於敗精滯於尿竅，氣化不宣者，治當清熱利水中，加以化精化氣之品，可選用滋腎丸倍桂，或大劑回陽飲加味治之。淋家雖患外感，亦無強汗之理，若強汗之，陰液愈虛，膀胱之蓄熱愈熾，必致邪熱通血妄行，從小便而為尿血。
①瘡家：患瘡瘍病者，流膿已久，此皆亡失其津血。
②痙（jìng淨）：肌肉收縮，手足抽搐的現象。
鄭論：《內經》雲：諸瘡痛癢，皆屬於火。火盛則血虧，若（在）〔再〕發汗，血液被奪，筋脈失養，痙證必作。然又當察其病情輕重，可汗則汗，不可固執。
【闡釋】本條為汗法禁例之三，瘡家久失膿血，營血勢必不足，若感外邪，雖有身體疼痛等證狀，虛多實少，若以麻黃湯發其汗，則必犯虛虛之戒，故不能發汗。汗出其營血必更加虧耗，筋脈失去濡養，必然強急而為痙矣。
十六、衄③家不可發汗，汗出必（頞）〔額〕上陷，脈急緊，（目）直視不能眴④，不（能）〔得〕眠。原文86
③衄（nǜ）家：常流鼻血的病人。
④不能眴：眴同“瞬”，目轉動。不能眴，就是說目睛不能轉動。
鄭論：申言素患衄血之人，切切不可發汗，汗為血液，血液既傷，若更發汗，則陽從外亡，故現（頞）〔額〕上陷，脈緊急者，陽脫之象也。目直視不能眴者，肝開竅於目，血液已傷，不能灌溉，以致不眴不眠者，皆真陽欲絕，危亡之候也。
【闡釋】本條為汗法禁例之五。常患鼻衄的病人，由於經常失血，則血液素虧，不可任意發汗，更傷其血液，其變證多端，而嚴重的如鄭氏所說有真陽欲脫之危候。
①亡血家：平素有失血（包括吐血大便血、小便血、鼻血及婦人崩漏）疾患的病人。
鄭論：亡血二字，即亡陽之征也。若更發汗，則陽從外越，而內無陽以溫暖，故寒栗而振，此等危候非大劑回陽不可。
【闡釋】經常失血的病者，不但陰血不足，即陽氣亦不充沛，加之發汗亦能傷陽。陰血傷則無以濡養筋脈，陽氣傷則無以衛外為固，所以發生寒栗而振，此陰陽兩虛之危候。如鄭氏所言，非大劑回陽不可，誠屬經驗有得之言。
十八、汗家重發汗②，必恍惚心亂③，小便已陰疼④，與禹餘糧丸。原文88
②汗家：指平常慣會出汗的人，包括盜汗自汗在內。
③恍惚心亂：神迷意惑，慌亂不安，形容精神失常的狀態。
④小便已陰疼：小便後尿道作痛。
鄭論：按汗為心之液，素多汗之人，血液早虧，今重發其汗，汗出過多，則心陽外亡，神無所主，而恍惚生，，小便已陰疼者，血液已虧，不能澤及小便也。原文以禹餘糧丸主之，亦是收納元氣之意也。
【闡釋】本條為汗法禁例之六。平日汗多者，血液早虧，表陽即虛，若重發其汗，則陽從外亡，胸中神魂無主，故心神恍惚。而小便已陰疼者，陽氣大虛，便出則氣愈泄而化源傷，因虛而疼。禹餘糧丸方，原文闕。
發汗後惡寒者，虛故也，不惡寒（反惡）〔但〕熱者，實也，當和胃氣，與調胃承氣湯。原文68、70
鄭論：按發汗病不解，與發汗後惡寒者，皆裏陽不足，因汗而陽更傷也，故見畏寒。原文以芍藥附子甘草湯，使其收納元氣歸根，而惡寒自己。若不惡寒而反惡熱，以調胃承氣湯，是為血虧火旺說法。
餘更有說焉，當其時發汗，有素稟元陽不足，因發汗而有元陽外越者，外大熱而內寒，學者務宜細察。若果血虧，陽明胃熱，必有舌苔幹黃，大渴飲冷，方可與調胃承氣湯。若其人因發汗而元陽外越者，雖周身大熱，舌必潤滑，口必不渴，二便自利，又當以回陽為要，切切不可妄與調胃承氣湯，切記。
【闡釋】本條《傷寒論》分為兩條。“發汗病不解”至“芍藥附子甘草湯主之”為一條；以下又為一條。鄭氏所按，頗為恰當。但其中特提出元陽外越與血虧火旺，陽陰胃熱之區別，則與歷代注家不同，臨證時應特別注意。元陽外越者，可與大劑四逆或白通湯以回陽為要。
芍藥三兩甘草三兩（炙）附子一枚（炮、去皮、破八片）右三味，以水五升，煮取一升五合，去滓，分溫三服。
【方解及其應用範圍】本方芍藥以補陰斂液，附子溫經回陽，佐以甘草，從中調和，使芍、附作用，共同發揮，能夠兼顧氣陰，實屬陰陽雙補、扶正之劑。故用治汗出過多之惡寒屬於陰陽俱虛之證。筆者曾治患風濕疼痛，同時有汗出惡寒證狀，腳攣急，舌質淡，苔白膩，脈沉細，用大劑量芍藥甘草附子湯治之，芍、甘各用60克，附子80克，連服五劑而痊癒。
二十、發汗後，身疼痛，脈沉遲者①，桂枝加芍藥生薑各一兩人參三兩新加湯主之。原文62
①脈沉遲：沉是重按才得，遲是跳動的次數緩慢。
鄭論：據稱發汗後，身疼脈遲，明是裏分有寒也。汗則表陽被奪，而內寒卒起，閉塞經絡，故見身疼。原文以桂枝加芍藥人參新加湯，取姜桂以散陰寒，參芍以養血液，亦屬妥切。
【闡釋】發汗後，身疼痛，脈沉遲，此陽氣虛損，陰液耗竭，亦即氣陰兩傷，營血不足也。鄭氏所論“汗則表陽被奪，而內寒卒起，閉塞經絡，故見身疼”。亦屬確切之論。
桂枝加芍藥生薑各一兩人參三兩新加湯（校補）
桂枝三兩（去皮）芍藥四兩甘草二兩（炙）人參三兩大棗十二枚（劈）生薑四兩上六味，以水一鬥二升，煮取三升去滓，溫服一升。本雲桂枝湯，今加芍藥、生薑、人參。
[Zheng's Commentary]: Regarding the condition with a floating pulse, sweating should originally be used to resolve it; this is the correct method. If physicians fail to investigate the nature of the pulse and recklessly apply moxibustion, they grossly violate the principles of the classics. Moreover, since the exterior represents Yang and fire also represents Yang, the combination of two Yangs causes the pathogen not to exit from the exterior but to attack inward, resulting in heaviness and bi-syndrome (obstruction syndrome) below the waist. This is because the pathogen lies latent in the lower jiao, obstructing the qi mechanism of Taiyang cold-water flow. It is named "fire reversal" (huo ni), emphasizing that without resolving via sweating, water stagnates in the lower jiao.
[Explanation]: This section corresponds to part of Article 116, pointing out the complications after misusing moxibustion for a floating pulse. A floating pulse indicates an exterior condition suitable for resolution by sweating. If a physician uses fire moxibustion to induce sweating but fails to do so, the pathogen has no outlet and becomes exacerbated by the fire. Although it may not necessarily scorch bones or injure tendons, the fire blocks the pathogen, gradually depleting Yin qi. The lower jiao is governed by Ying blood; when Ying qi is depleted and unable to circulate, heaviness and bi-syndrome inevitably occur. As Zheng stated: "The pathogen does not exit outward but attacks inward, causing heaviness and bi-syndrome below the waist, indicating the pathogen is latent in the lower jiao." Therefore, to treat this bi-syndrome, one must first address the pathology caused by fire.
Seven. When the pulse is floating [the disease is at the exterior], sweating may be induced, and Mahuang Tang (Ephedra Decoction) is appropriate. When the pulse is floating and rapid, sweating may be induced, and Mahuang Tang (Ephedra Decoction) is appropriate. Original Articles 51, 52.
[Zheng's Commentary]: Although a floating or rapid pulse suggests that sweating may be indicated, both Guizhi Tang (Cinnamon Twig Decoction) and Mahuang Tang (Ephedra Decoction) have been used. There is a distinction between conditions affecting Ying (Nutritive) and Wei (Defensive) levels. One cannot determine the indication for Mahuang Tang (Ephedra Decoction) solely based on the characters "floating" and "rapid." Scholars must seek solid evidence for prescription usage by investigating the presence or absence of sweating, aversion to wind, and aversion to cold.
[Explanation]: These articles correspond to Articles 51 and 52 in the *Shanghan Lun*, which Zheng combined into one. Any exterior disease presents with a floating pulse. The primary pulse for Mahuang Tang (Ephedra Decoction) syndrome is floating-tight, accompanied by symptoms such as headache, fever, aversion to cold, and absence of sweating. Only under these conditions should Mahuang Tang (Ephedra Decoction) be used to induce sweating. A floating and rapid pulse often symbolizes wind-heat at the exterior, making Mahuang Tang (Ephedra Decoction) unsuitable. One should cross-reference with Articles 1 and 2 of this chapter; if the symptoms match, then Mahuang Tang (Ephedra Decoction) can be used to induce sweating, leading to the resolution of all symptoms. The text states "appropriate for Mahuang Tang (Ephedra Decoction)" rather than "Mahuang Tang (Ephedra Decoction) is the main formula," implying a degree of deliberation.
Eight. In Cold Damage, if sweating has already resolved the condition, but restlessness recurs after half a day, and the pulse is floating and rapid, sweating may be induced again, and Guizhi Tang (Cinnamon Twig Decoction) is appropriate. Original Article 57.
[Zheng's Commentary]: Generally, in this condition, although sweating has resolved the illness, the pathogen has not been completely eliminated. Therefore, sweating may be induced again to ensure the pathogen is entirely expelled, preventing future complications.
[Explanation]: This article describes a situation where, after sweating, the exterior pathogen remains incomplete, causing recurrent restlessness and a floating-rapid pulse, indicating the pathogen is still at the exterior. Thus, sweating may be induced again to dispel the exterior pathogen. However, since sweating has already occurred, harsh sweating agents like Mahuang Tang (Ephedra Decoction) are inappropriate; instead, the mild sweating action of Guizhi Tang (Cinnamon Twig Decoction) is suitable.
Nine. After sweating, if the pulse is floating and rapid, accompanied by irritability and thirst, Wuling San (Five-Ingredient Powder with Poria) should govern the treatment. Original Article 72.
[Zheng's Commentary]: Regarding Taiyang Cold Damage, if it is stated that sweating has been performed, it implies the exterior pathogen has likely been removed. Seeing a floating-rapid pulse, irritability, and thirst indicates that while the exterior pathogen is gone, internal heat remains unresolved, hence the persistent floating-rapid pulse. Irritability and thirst result from heat damaging body fluids. Logically, one should clear and resolve the heat; once the heat is gone, irritability and thirst will resolve, and the rapid pulse will normalize. Why use Wuling San (Five-Ingredient Powder with Poria) directly? Wuling San (Five-Ingredient Powder with Poria) is indicated only when the Taiyang pathogen has entered the Fu organs, presenting with thirst and difficult urination. Relying solely on irritability and a rapid pulse, scholars often fail to recognize the proper indication.
Note: The term "irritability and thirst" distinguishes between preference for cold drinks and hot drinks; this must be carefully observed.
[Explanation]: Zheng points out the inappropriateness of using Wuling San (Five-Ingredient Powder with Poria) here. Wuling San (Five-Ingredient Powder with Poria) is indicated only when the Taiyang pathogen enters the Fu organs, presenting with thirst and difficult urination. Relying solely on irritability and a rapid pulse makes its inappropriateness obvious.
Ten. In Cold Damage, if sweating occurs with thirst, Wuling San (Five-Ingredient Powder with Poria) should govern the treatment; if there is no thirst, Fuling Gancao Tang (Poria and Licorice Decoction) should govern the treatment. Original Article 73.
①Thirst here does not refer to the thirst of Yangming interior syndrome, but to thirst caused by water-qiang stagnating in the lower jiao, preventing body fluids from ascending.
[Zheng's Commentary]: Sweating with thirst indicates that Taiyang cold-water vapor is exiting through the pores and failing to moisten the intestines and stomach, causing thirst. Using Wuling San (Five-Ingredient Powder with Poria) directs the Taiyang cold-water vapor to exit internally rather than externally, stopping both sweating and thirst. However, in cases without thirst, body fluids are not significantly damaged, and the Stomach can still sustain itself. Even with sweating, Fuling Gancao Tang (Poria and Licorice Decoction) is appropriate, demonstrating the efficacy of transforming Qi and moving water. Based on my observations, adding "difficult urination" clarifies the indication: use Wuling San (Five-Ingredient Powder with Poria) for sweating with thirst and difficult urination; use Fuling Gancao Tang (Poria and Licorice Decoction) for sweating without thirst and difficult urination. Adding these four words makes it easier for later learners to understand clearly.
Furthermore, sweating with thirst relates to Baihu Tang (White Tiger Decoction) in Yangming syndrome; sweating without thirst relates to collapse of Yang in Shaoyin syndrome. Scholars should be aware of this.
①Great thirst with preference for cold drinks.
[Explanation]: This article highlights the differential diagnosis between Fuling Gancao Tang (Poria and Licorice Decoction) syndrome and Wuling San (Five-Ingredient Powder with Poria) syndrome, centered on the presence or absence of thirst. Other symptoms such as floating-rapid pulse, difficult urination, and slight fever are likely similar. Zheng’s addition of "difficult urination" clarifies the distinction and is correct. The main difference is: one involves water accumulation in the lower jiao with thirst and difficult urination; the other involves water retention in the middle jiao without thirst but with difficult urination. Although the conditions differ, the root cause is retained fluid and water accumulation, treated by warming Yang and transforming water. One focuses on warming the Bladder to promote urination; the other focuses on warming Stomach Yang and unblocking the Triple Burner to eliminate fluid retention, hence different main formulas.
Fuling Gancao Tang (Poria and Licorice Decoction) Formula (Corrected):
Poria 4 liang, Cinnamon Twig 2 liang (peeled), Licorice 1 liang (honey-fried), Fresh Ginger 3 liang (sliced). Boil the above four ingredients in 4 sheng of water to obtain 2 sheng. Remove dregs and divide into three warm doses.
[Formula Analysis and Application Scope]: This formula treats sweating without thirst. The water accumulation is lighter than in Wuling San (Five-Ingredient Powder with Poria), so the primary diuretic is omitted. Instead, the mild leaching effect of Poria is used, while increasing Cinnamon Twig to warm Yang, Fresh Ginger to warm the Stomach, and Licorice to harmonize the middle. This combination best warms the Stomach and disperses water. It is an effective formula for water-qiang stagnating in the middle jiao, characterized by no irritability or thirst, palpitations in the epigastrium, and cold limbs.
Eleven. When the pulse is floating-tight, body pain is expected, and sweating should be used to resolve it. If the Chi position pulse is slow, sweating is contraindicated. [How do we know this? It is said that Ying Qi is insufficient due to blood deficiency.] Original Article 50.
②Chi slow pulse: The pulse at the Chi position appears slow and choppy, described as "three beats per respiration, extremely slow." Slow refers to reduced pulse frequency. Here, "slow" is contrasted with "tight."
①Ran: In ancient texts, "ran" is often interpreted as "said."
Twelve. [When the pulse is floating and rapid, sweating should normally lead to recovery. If purgatives are incorrectly used, resulting in heavy body and palpitations, sweating is contraindicated.] Recovery occurs when spontaneous sweating happens naturally. This is because the Chi pulse is faint, indicating interior deficiency. One must wait for the exterior and interior to become solid, for body fluids to harmonize naturally, and for spontaneous sweating to occur for recovery. Original Article 49.
②Xu: Means to wait.
[Zheng's Commentary]: The article refers to a person with a floating-tight pulse and body pain, who should normally be treated with sweating. However, if the Chi pulse is deficient, sweating is contraindicated, indicating inherent Yin deficiency. Inducing sweating could severely deplete Yang. This teaches caution regarding sweating therapies. Even if other symptoms exist, one must wait for body fluids to harmonize naturally and for spontaneous sweating to bring recovery. This demonstrates extreme prudence and careful prevention.
[Explanation]: Zheng combines these two articles for commentary, noting the original text is disordered and his commentary is incomplete. Correcting the text according to the *Shanghan Lun*: Floating-tight pulse and body pain indicate Cold Damage, suitable for Mahuang Tang (Ephedra Decoction) to induce sweating. However, a slow Chi pulse indicates Ying Qi deficiency, a deficiency condition where sweating is contraindicated.
Regarding Article 12, after incorrect purgation of an exterior condition, presenting with heavy body, palpitations, and a faint Chi pulse, sweating is contraindicated. Recovery may occur through spontaneous sweating. Alternatively, Xiao Jianzhong Tang (Minor Construct the Middle Decoction) or similar formulas may be used to warm and nourish the interior, restoring exterior and interior Zheng Qi, enriching Qi and Blood, harmonizing body fluids, and inducing spontaneous sweating for recovery.
Thirteen. Throat dryness is a contraindication for sweating. Original Article 83.
[Zheng's Commentary]: In cases of throat dryness, body fluids are already damaged; how can sweating be used to further deprive fluids? I believe throat dryness arises from three situations: 1) Decline of True Qi in the lower Yuan (Kan center), failing to ascend True Water; treatment requires supporting Yang. 2) Pathogenic fire scorching body fluids; treatment requires clearing and moistening. 3) Cold water counterflow in the middle, obstructing the ascending Qi of the Stomach; treatment requires moving water. Scholars must observe carefully, as these conditions cannot be resolved by sweating.
[Explanation]: This is one of the contraindications for sweating therapy. Throat dryness indicates lack of fluids in the Upper Jiao. Zheng identifies three scenarios and proposes supporting Yang, clearing/moistening, and moving water. Supporting Yang may use Sini Tang (Four Reversal Decoction); clearing/moistening may use Renshen Baihu Tang (Ginseng White Tiger Decoction); moving water may use Fuling Gancao Tang (Poria and Licorice Decoction) or Wuling San (Five-Ingredient Powder with Poria). Modern chronic pharyngitis/laryngitis is often treated initially with Paogani Gancao Tang (Roasted Ginger and Licorice Decoction) plus Jiegeng (Platycodon), followed by kidney-tonifying herbs.
Fourteen. Patients with Lin syndrome (strangury) must not undergo sweating; if sweating occurs, hematuria will inevitably follow. Original Article 84.
③Lin patients: Those with dribbling, painful urination.
[Zheng's Commentary]: Patients with Lin syndrome suffer from heat closing the Bladder, cold closing the Bladder, or stagnant seminal essence blocking the urethra, leading to impaired Qi transformation. There is no rationale for sweating. Forcing sweating causes external loss of fluids and depletion of Middle Qi, leading to failure to control blood. Blood flows to the Lanmen (gate separating clear and turbid), infiltrates the Bladder, and causes hematuria.
[Explanation]: This is the second contraindication for sweating. Historically, this is attributed to Kidney Yin deficiency with Bladder heat. Zheng’s "heat closing the Bladder" aligns with this; treatment supports Kidney Yin using Siling Huashi Ejiao Tang (Four Substances, Talcum, and Donkey-Hide Gelatin Decoction). He also notes cold closing the Bladder or stagnant essence impairing Qi transformation. Cold closing the Bladder results from lower Jiao Yang deficiency and Yin-cold obstruction; treatment supports lower Jiao Yang using Linggui Zhugan Tang (Poria, Cinnamon, Atractylodes, and Licorice Decoction) with increased Cinnamon and added Amomum and White Cardamom. For stagnant essence, clear heat and promote urination while adding herbs to transform essence and Qi, such as Zishen Wan (Kidney Nourishing Pill) with increased Cinnamon, or large doses of Huiyang Yin (Return Yang Decoction). Even with exterior pathogens, forcing sweating in Lin patients is wrong; it worsens Yin deficiency and Bladder heat, causing pathogenic heat to force blood to wander, resulting in hematuria.
Fifteen. Patients with sores/chancres, even if experiencing body pain, must not undergo sweating; if sweating occurs, spasms (Jing) will develop. Original Article 85.
①Sore patients: Those with chronic suppurative sores, having lost significant fluids and blood.
②Jing: Muscle contraction, convulsions of hands and feet.
[Zheng's Commentary]: The *Neijing* states: "All sores and itching belong to Fire." Excessive Fire leads to Blood deficiency. If sweating is induced again, Blood is further depleted, tendons and vessels lose nourishment, and spasms will occur. However, severity must be assessed; if sweating is appropriate, it may be done, but rigid adherence is discouraged.
[Explanation]: This is the third contraindication for sweating. Chronic sores lead to Ying Blood deficiency. If exposed to exterior pathogens, despite body pain, deficiency outweighs excess. Using Mahuang Tang (Ephedra Decoction) would commit the error of treating deficiency as excess. Sweating would further deplete Ying Blood, causing tendons to lose nourishment and resulting in spasms.
Sixteen. Patients prone to nosebleeds (Nu) must not undergo sweating; if sweating occurs, depression above the forehead, tight/urgent pulse, fixed gaze inability to blink, and insomnia will result. Original Article 86.
③Nu patients: Those prone to frequent nosebleeds.
④Unable to blink: Blinking refers to eye movement. Inability to blink means eyes cannot move.
[Zheng's Commentary]: Emphasizing that those with chronic nosebleeds must absolutely avoid sweating. Sweat is derived from Blood; if Blood is injured and sweating continues, Yang escapes externally. Depression above the forehead and urgent pulse indicate Yang collapse. Fixed gaze and inability to blink occur because the Liver opens into the eyes; injured Blood cannot irrigate them. Insomnia follows. These are signs of impending True Yang exhaustion and critical danger.
[Explanation]: This is the fifth contraindication for sweating. Frequent nosebleeds imply chronic Blood deficiency. Arbitrary sweating further injures Blood, leading to various complications, including the critical state of True Yang collapse described by Zheng.
Seventeen. Patients with history of blood loss (Wangxue) must not undergo sweating; if sweating occurs, chills and tremors will result. Original Article 87.
①Wangxue patients: Those with chronic bleeding disorders (hematemesis, melena, hematuria, epistaxis, uterine bleeding).
[Zheng's Commentary]: "Blood loss" is a sign of Yang collapse. Further sweating causes Yang to escape externally, leaving the interior without Yang warmth, resulting in chills and tremors. Such critical conditions require large doses of Yang-restoring formulas.
[Explanation]: Chronic blood loss patients suffer not only from Yin Blood deficiency but also insufficient Yang. Sweating further damages Yang. Damaged Yin fails to nourish tendons; damaged Yang fails to defend the exterior. This results in chills and tremors, a critical state of dual Yin-Yang deficiency. Zheng’s assertion that large doses of Yang-restoring formulas are necessary reflects valuable clinical experience.
Eighteen. Patients prone to sweating who undergo heavy sweating will experience mental confusion and anxiety, and pain in the genitals after urination. Yu Yuliang Wan (Hematite Pill) should be given. Original Article 88.
②Sweating-prone patients: Those habitually prone to sweating, including night sweats and spontaneous sweating.
③Mental confusion: Disoriented, panicked, describing mental instability.
④Genital pain after urination: Pain in the urethra after voiding.
[Zheng's Commentary]: Sweat is the fluid of the Heart. Those prone to sweating already have Blood deficiency. Heavy sweating causes excessive loss, leading to external escape of Heart Yang and loss of Shen mastery, resulting in confusion. Genital pain after urination occurs because Blood deficiency fails to moisten the urinary tract. Yu Yuliang Wan (Hematite Pill) is prescribed to gather and secure Yuan Qi.
[Explanation]: This is the sixth contraindication for sweating. Habitual sweaters have Blood deficiency and weak Exterior Yang. Heavy sweating causes Yang escape, leaving the chest/Shen without mastery, resulting in mental confusion. Genital pain after urination occurs because severe Yang deficiency leads to further Qi leakage during voiding, injuring the source of transformation, causing pain due to deficiency. The formula for Yu Yuliang Wan (Hematite Pill) is missing in the original text.
Nineteen. If sweating fails to resolve the illness, and aversion to cold反而 (instead) appears, it is due to deficiency; Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction) should govern the treatment.
After sweating, if aversion to cold appears, it is due to deficiency; if there is no aversion to cold but heat appears, it is due to excess; one should harmonize Stomach Qi with Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction). Original Articles 68, 70.
[Zheng's Commentary]: Failure to resolve illness after sweating, or aversion to cold afterward, indicates insufficient Interior Yang, further damaged by sweating, causing aversion to cold. Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction) helps gather Yuan Qi and return it to its root, resolving aversion to cold. If there is no aversion to cold but aversion to heat, Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction) addresses Blood deficiency and Fire hyperactivity.
I add further insight: During sweating, some patients with inherent Yuan Yang insufficiency may experience Yuan Yang escaping externally, presenting with external heat and internal cold. Scholars must examine carefully. If truly Blood deficiency with Yangming Stomach Heat, expect dry yellow tongue coating, great thirst with preference for cold drinks, before using Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction). If Yuan Yang escapes externally due to sweating, despite generalized heat, the tongue will be slippery, mouth non-thirsty, and urination/bowel movements normal. In such cases, restoring Yang is paramount; never rashly use Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction). Remember this well.
[Explanation]: The *Shanghan Lun* splits this into two articles. Zheng’s commentary is appropriate. However, his distinction between Yuan Yang escaping externally versus Blood deficiency/Fire hyperactivity and Yangming Stomach Heat differs from traditional commentators and requires special attention in practice. For Yuan Yang escaping externally, large doses of Sini Tang (Four Reversal Decoction) or Baitong Tang (White Through Decoction) should be used to restore Yang.
Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction) Formula (Corrected):
Peony 3 liang, Licorice 3 liang (honey-fried), Aconite 1 piece (roasted, peeled, broken into eight pieces). Boil the above three ingredients in 5 sheng of water to obtain 1.5 sheng. Remove dregs and divide into three warm doses.
[Formula Analysis and Application Scope]: Peony nourishes Yin and astringes fluids; Aconite warms channels and restores Yang; Licorice harmonizes the middle. Together, they balance Qi and Yin, serving as a dual Yin-Yang tonic and upright-supporting agent. It treats aversion to cold after excessive sweating, indicative of dual Yin-Yang deficiency. I once treated a patient with rheumatic pain, sweating, aversion to cold, leg cramps, pale tongue, white greasy coating, and deep-thin pulse using a large dose of Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction): Peony and Licorice 60g each, Aconite 80g, taken for five doses, resulting in cure.
Twenty. After sweating, if body pain persists and the pulse is deep and slow, Xinjia Tang (Newly Added Decoction) with Guizhi, increased Peony and Ginger, and Ginseng should govern the treatment. Original Article 62.
①Deep-slow pulse: Deep requires heavy pressure; slow indicates reduced beat frequency.
[Zheng's Commentary]: Post-sweating body pain and slow pulse clearly indicate interior cold. Sweating depletes Exterior Yang, causing sudden interior cold to block collaterals, resulting in body pain. The formula Guizhi Jiashyaoshengjiang Renshen Xinjia Tang (Guizhi Decoction with Added Peony, Ginger, and Ginseng) uses Ginger and Cinnamon to disperse Yin cold, and Ginseng and Peony to nourish Blood, which is appropriate.
[Explanation]: Post-sweating body pain and deep-slow pulse indicate Yang Qi damage and Yin fluid exhaustion, i.e., Qi-Yin dual injury and Ying Blood deficiency. Zheng’s statement that "sweating depletes Exterior Yang, causing sudden interior cold to block collaterals, resulting in body pain" is accurate.
Guizhi Jiashyaoshengjiang Renshen Xinjia Tang (Guizhi Decoction with Added Peony, Ginger, and Ginseng) Formula (Corrected):
Cinnamon Twig 3 liang (peeled), Peony 4 liang, Licorice 2 liang (honey-fried), Ginseng 3 liang, Jujube 12 pieces (split), Fresh Ginger 4 liang. Boil the above six ingredients in 12 sheng of water to obtain 3 sheng. Remove dregs and take 1 sheng warm. Originally Guizhi Tang (Cinnamon Twig Decoction), now with added Peony, Ginger, and Ginseng.