发汗后不可更行桂枝汤若汗出而喘无大热者可与麻黄杏仁甘草石膏汤主之
汗后表寒未解郁其肺气热蒸皮毛窍开而不能透泄故汗出而喘表得汗泄故外无大热麻黄发表杏仁降逆石膏清金甘草培
土则表里俱解矣此亦大青龙证之轻者以在汗后故不用青龙汗后不可行桂枝亦大概言之他如发汗已解半日许复烦可更发汗
宜桂枝汤未尝必禁桂枝也
麻黄(四两) 杏仁(三十枚) 甘草(二两炙) 石膏(半斤碎绵裹)
上四味以水七升先煮麻黄减二升去上沫内诸药煮取二升去滓温服一升
发汗后饮水多者必喘以水灌之亦喘
推原上章喘字之义汗出亡津液燥渴饮水饮水太多而汗后阳虚不能消散水停则肺气壅遏故必喘以水灌之皮毛外闭肺气
郁阻故亦喘也
下后不可更行桂枝汤若汗出而喘无大热者可与麻黄杏仁甘草石膏主之
下后表寒未解郁其肺气肺郁生热蒸发皮毛而不能透泄故汗出而喘表寒里热宜麻杏甘石双解之可也
下后不可行桂枝亦大概言之他如伤寒医下之续得下利清谷章救表宜桂枝汤又伤寒大下后复汗心下痞章解表宜桂枝汤
太阳病先发汗不解而复下之脉浮者不愈章当须解外则愈桂枝汤主之未尝必禁桂枝也
服桂枝汤大汗出后大烦渴不解脉洪大者白虎加人参汤主之(方在太阳三十九)
服桂枝汤后汗出表解而津液亡泄里热则增是宜白虎清里而大汗之后大作烦渴而脉又洪大是亡津而气亦泄也津由气化
灵枢决气上焦开发宣五谷味薰肤充身泽毛若雾露之溉是为气此当益气以生津故加人参素问谈热论脉燥疾不为汗衰者死以
精气消亡无以渗灌其枯燥也白虎而加人参使清气降洒化而为露滋润枯涸涤洗烦躁莫善于此矣
After inducing sweating, the Guizhi Tang (Cinnamon Twig Decoction) should not be administered again. If the patient presents with sweating accompanied by wheezing and no significant high fever on the exterior, the Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction) may be used as the primary treatment.
After sweating, the pathogenic cold at the exterior has not yet resolved, leading to stagnation of Lung Qi; heat steams the skin and hair follicles, causing the pores to open, but the pathogen cannot penetrate and dissipate. Consequently, sweating and wheezing occur. Since the exterior is vented through sweating, there is no significant high fever externally. Mahuang (Ephedrae Herba) disperses exterior pathogens, Xingren (Armeniacae Semen Amarum) directs rebellious Qi downward and calms wheezing, Shigao (Gypsum Fibrosum) clears heat from the Metal (Lung), and Gancao (Glycyrrhizae Radix et Rhizoma) fortifies Earth (Spleen). Thus, both interior and exterior pathogens are resolved. This is also a milder form of the Da Qinglong Tang (Major Green Dragon Decoction) syndrome; however, because it occurs after sweating, Da Qinglong Tang is not used. The statement that Guizhi Tang should not be used after sweating is a generalization. For instance, if symptoms resolve after sweating but restlessness recurs after half a day, another diaphoretic treatment is appropriate, and Guizhi Tang is suitable. There is no absolute prohibition against using Guizhi Tang.
Mahuang (Ephedrae Herba) (4 liang), Xingren (Armeniacae Semen Amarum) (30 seeds), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (2 liang, honey-fried), Shigao (Gypsum Fibrosum) (0.5 jin, crushed, wrapped in cotton cloth).
Take the above four herbs, add 7 sheng of water, first decoct Mahuang until the volume reduces by 2 sheng, remove the foam on the surface, then add the remaining herbs. Decoct until 2 sheng remains, strain, and take 1 sheng warm.
If a patient drinks too much water after sweating, wheezing will inevitably occur; even washing the body with cold water can cause wheezing.
To understand the meaning of "wheezing" mentioned in the previous chapter: Sweating leads to fluid loss, causing dryness and thirst, prompting drinking. If too much water is consumed, and Yang Qi is deficient after sweating, failing to transform and dissipate the fluids, water retention occurs, obstructing Lung Qi, thus inevitably causing wheezing. Washing with cold water closes the pores externally, causing stagnation and obstruction of Lung Qi, which also results in wheezing.
After purgation, the Guizhi Tang should not be administered again. If the patient presents with sweating accompanied by wheezing and no significant high fever on the exterior, the Mahuang Xingren Gancao Shigao Tang may be used as the primary treatment.
After purgation, the pathogenic cold at the exterior has not yet resolved, leading to stagnation of Lung Qi; lung stagnation generates heat, which steams the skin and hair follicles but cannot penetrate and dissipate. Consequently, sweating and wheezing occur. This is a syndrome with exterior cold and interior heat, suitable for dual resolution of interior and exterior using Mahuang Xingren Gancao Shigao Tang. The statement that Guizhi Tang should not be used after purgation is a generalization. For instance, in the chapter regarding Taiyang disease where a physician incorrectly uses purgation, followed by diarrhea with undigested food, treating the exterior requires Guizhi Tang. Similarly, in the chapter where severe purgation followed by sweating leads to epigastric fullness, resolving the exterior requires Guizhi Tang. In the chapter where Taiyang disease fails to resolve after initial sweating and subsequent purgation, with a floating pulse, resolving the exterior is necessary, primarily using Guizhi Tang. These cases demonstrate that there is no absolute prohibition against using Guizhi Tang.
After taking Guizhi Tang, if profuse sweating occurs, followed by severe restlessness and unquenchable thirst, with a flooding pulse, the Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) should be used as the primary treatment (see Taiyang Chapter 39).
After taking Guizhi Tang, sweating resolves the exterior syndrome, but fluids are lost, increasing interior heat. At this point, Baihu Tang (White Tiger Decoction) is suitable to clear interior heat. However, after profuse sweating, severe restlessness and thirst appear, and the pulse becomes flooding, indicating loss of fluids and leakage of Qi. Fluid generation relies on Qi transformation. As stated in the *Ling Shu: Jue Qi* chapter: "The Upper Jiao opens and develops, distributing the essence of grains, warming the skin, filling the body, moistening hair, like mist and dew irrigation; this is called Qi." In such cases, Qi should be tonified to generate fluids, hence Renshen (Ginseng Radix et Rhizoma) is added to Baihu Tang. The *Su Wen: Re Lun* states that if the pulse is rapid and restless and does not slow down after sweating, the prognosis is poor, due to the depletion of Essence and Qi, unable to nourish the dryness. Adding Renshen to Baihu Tang allows Clear Qi to descend and scatter, transforming into dew to nourish dryness and wash away restlessness; nothing is better than this.