脉浮者病在表可发汗宜麻黄汤脉浮而数者可发汗宜麻黄汤
浮为在表表被风寒则宜汗浮数即浮紧之变文紧则必不迟缓亦可言数是伤寒之脉当以麻黄发汗也
伤寒发汗宜解半日许复烦脉浮数者可更发汗宜桂枝汤（方在太阳三）
伤寒服麻黄发汗已解乃半日许复烦脉见浮数是卫郁已泄而营郁不达可更发汗以泄其营宜桂枝汤也
伤寒不大便六七日头痛有热者与承气汤（太阳入阳明去路）其小便清者知不在里仍在表也当须发汗（此麻黄证）若
头痛者必衄宜桂枝汤（方在太阳五此麻黄证中又有用桂枝者）
阳明腑病胃燥便难伤寒不大便至六七日头痛而有热者是有阳明里证宜与承气汤以泄里热然阳明病小盒饭赤若小便清
者则病不在里犹在表也当须发汗以解表寒若头痛不已者是卫郁不得旁泄而逆冲头面故致头痛及其郁迫莫容自寻出路必将
冲突鼻窍以泄积郁卫气上泄升逼营血是为衄证此宜以桂枝泄其营郁使不闭束卫气卫气松缓则衄证免矣
太阳病脉浮紧发热身无汗自衄者愈
发热无汗而脉浮紧是宜麻黄发汗以泄卫郁若失服麻黄皮毛束闭卫郁莫泄蓄极思通势必逆冲鼻窍而为衄证自衄则卫泄
而病愈矣
伤寒脉浮紧不发汗以致衄者宜麻黄汤主之
浮紧之脉应当发汗失不发汗卫郁莫泄因而致衄是缘不早服麻黄故至此当先以麻黄发之勿俟其衄也
If the pulse is floating, the pathogen is in the exterior; sweating therapy should be applied, and Mahuang Tang (Ephedra Decoction) is indicated.
If the pulse is floating and rapid, sweating therapy should be applied, and Mahuang Tang (Ephedra Decoction) is indicated.
"Floating" indicates the pathogen is in the exterior; when the exterior is invaded by wind-cold, sweating is appropriate. "Floating and rapid" is a variant description of "floating and tight"; a "tight" pulse is necessarily not sluggish, so it can also be described as "rapid." This is the pulse pattern of Shanghan (Cold Damage); Mahuang Tang (Ephedra Decoction) should be used to induce sweating.
In cases of Shanghan (Cold Damage), after inducing sweating, if restlessness recurs after about half a day and the pulse is floating and rapid, sweating may be reapplied, and Guizhi Tang (Cinnamon Twig Decoction) is indicated (formula found in Taiyang Chapter 3).
After treating Shanghan (Cold Damage) with Mahuang Tang (Ephedra Decoction) to induce sweating, if the condition resolves but restlessness recurs after about half a day with a floating and rapid pulse, it indicates that Wei Qi (Defensive Qi) stagnation has been released, but Ying Qi (Nutritive Qi) stagnation remains unresolvable. Sweating may be reapplied to vent the Ying Qi (Nutritive Qi), and Guizhi Tang (Cinnamon Twig Decoction) is indicated.
In cases of Shanghan (Cold Damage), if there is constipation for six or seven days accompanied by headache and fever, this suggests Yangming Fu-organ syndrome (Yangming Bowel Syndrome); Chengqi Tang (Gut-Purging Decoction) should be administered (the pathway from Taiyang to Yangming). If urination is clear, it indicates the disease is not in the interior but remains in the exterior; sweating is required at this time (this belongs to the Mahuang Tang [Ephedra Decoction] syndrome category). If headache persists, epistaxis (nosebleed) will likely occur, and Guizhi Tang (Cinnamon Twig Decoction) is indicated (formula found in Taiyang Chapter 5; although this falls under the Mahuang Tang [Ephedra Decoction] syndrome category, Guizhi Tang [Cinnamon Twig Decoction] is also used here).
Yangming Fu-organ syndrome involves dryness and heat in the stomach leading to difficult defecation. In Shanghan (Cold Damage), if constipation persists for six or seven days accompanied by headache and fever, this presents signs of Yangming interior syndrome, and Chengqi Tang (Gut-Purging Decoction) should be given to purge interior heat. However, in Yangming disease, urine should typically be dark and scanty; if urine is clear, the disease is not in the interior but remains in the exterior, and sweating should be induced to resolve exterior cold. If headache persists, it is because Wei Qi (Defensive Qi) stagnation cannot dissipate laterally and instead rebels upward to the head and face, causing headache. When the stagnation becomes unbearable, the body seeks an outlet, inevitably impacting the nasal cavity to vent accumulated stagnation. As Wei Qi (Defensive Qi) vents upward, it forces Ying Qi (Nutritive Qi) blood, resulting in epistaxis (nosebleed). At this stage, Guizhi Tang (Cinnamon Twig Decoction) should be used to vent Ying Qi (Nutritive Qi) stagnation, preventing it from binding Wei Qi (Defensive Qi). Once Wei Qi (Defensive Qi) relaxes, the epistaxis (nosebleed) will cease.
In Taiyang disease, if the pulse is floating and tight, there is fever, no sweating, and spontaneous epistaxis (nosebleed) occurs, the disease will resolve.
Fever, absence of sweating, and a floating-tight pulse indicate that Mahuang Tang (Ephedra Decoction) should be used to induce sweating and vent Wei Qi (Defensive Qi) stagnation. If Mahuang Tang (Ephedra Decoction) is missed or improperly administered, the skin pores remain closed, Wei Qi (Defensive Qi) stagnation cannot vent, and upon reaching extreme accumulation, it must seek release, inevitably rebelling into the nasal cavity causing epistaxis (nosebleed). Spontaneous epistaxis (nosebleed) allows Wei Qi (Defensive Qi) to vent, thereby resolving the disease.
In cases of Shanghan (Cold Damage), if the pulse is floating and tight and epistaxis (nosebleed) occurs due to failure to induce sweating, Mahuang Tang (Ephedra Decoction) is the primary treatment.
A floating-tight pulse warrants sweating; failure to sweat early causes Wei Qi (Defensive Qi) stagnation to persist, leading to epistaxis (nosebleed). This situation arises from not administering Mahuang Tang (Ephedra Decoction) promptly. One should first use Mahuang Tang (Ephedra Decoction) to disperse the pathogen rather than waiting for spontaneous epistaxis (nosebleed).