太阳病。发热汗出。恶风脉缓者。名为中风。
前总证中所有之脉浮头项强痛而恶寒。乃太阳经中风伤寒所均有之脉症。而犹未分其所以为中风。为伤寒也。
故此篇即于上条之脉浮头项强痛之总证。而增入发热汗出恶风脉缓。以别其为中风者如此也。中风。风伤卫也。
风者。春令阳气上腾。呼吸而为风。所以发生万物者也。其太过不及之气。乃为淫慝之邪。感之则为中风矣。然非独
春令为然也。四时皆有之。唯春时为当令耳。发热者。风邪客于卫而郁蒸也。汗出恶风者。风邪袭于毛孔。卫气不能
司其开阖之常。玄府不闭。故汗自出。腠理疏而不克任受风寒。故恶风也。风寒虽可互言。此篇则仍重于风也。缓者。
紧之对称。非迟脉之谓也。风为阳邪。非劲急之性。故其脉缓也。此一条为太阳中风之纲领。以下凡言中风发热。汗
出脉缓之太阳病。用桂枝汤者。皆同此脉证也。以风伤卫为第一层。故列为太阳上编也。
太阳中风。阳浮而阴弱。阳浮者热自发。阴弱者汗自出。啬啬恶寒。淅淅恶风。翕翕发热。鼻鸣
干呕者。桂枝汤主之。
阳浮阴弱者。即所以释前总症中脉浮之义也。热自发。汗自出。即所以申上文发热汗出也。脉法以
浮候属阳。沉候属阴。谓之阳浮者。卫行脉外。阳邪中之。则脉盛于外。故阳脉浮也。阴弱者。营行脉中。
营未受邪。则觉脉弱于内。故阴脉弱也。若总言之。浮候实。则沉候虚。唯其沉候虚。乃见其为浮脉也。
盖以阳受邪而实。阳实则阴虚也。热自发。汗自出之两自字。皆易词也。言风为阳邪。卫为阳气。二阳兼并。
邪正不容。主客相争。气郁而热自发。非若寒邪之客于腠理。至阳气不得发泄。必待郁甚而始发热也。卫为
表之表。营为表之里。卫统皮毛。风邪中之。则毛孔不闭。营中阴液。内为热邪所蒸。外为卫气固密。故
汗易出。又非若寒邪入腠。玄府紧闭。阳气不得外泄而无汗也。夫卫阳不能外固。则营阴不能自持。如妇之
无夫。失其蔽护。无以自立。唇亡则齿寒。故阳浮热自发。则阴弱汗自出也。盖卫主皮毛。犹门户之司开阖也。
风邪客卫。如有物之梗碍于门中而不得阖也。不得阖。则入者一任其入。出者一任其出矣。任其入。故恶风
寒也。任其入。则汗自出矣。啬啬。犹言飒飒。如风寒之侵逼也。淅淅。犹言淅沥。若风声之微动也。啬啬恶寒。
营阴弱于内也。淅淅恶风。卫阳疏于外也。中风而亦恶寒者。卫伤而营弱也。阳强阴弱。营卫不得和谐。故风
寒皆恶也。翕翕。热从外发。觉热气烘灼于皮肤之间也。肺主皮毛。开窍于鼻。风在皮毛。内通于肺。故气寒
热壅鼻息嘶鸣也。干呕。恶心也。胸属太阳。风邪在卫。邪气犯膈而呕也。此皆风邪伤卫之证。当解肌发汗。
宜桂枝汤主之。主者。主其治
也。凡见以上脉证。皆当以桂枝汤主其治。即有变证。亦以此方为主而损益之。如下文桂枝加桂。及桂枝
加附子汤。桂枝去芍药加附子汤之类是也。
桂枝汤方
桂枝（三两） 芍药（三两） 甘草（二两炙） 生姜（三两切） 大枣（十二枚擘）
仲景云。桂枝者。取枝上皮也。后人不知药性气味。而曰去皮。误矣。不知桂味皆在皮。若曰去皮。
则木心有何气味乎。肉桂亦大树身皮耳。岂亦舍其皮而用其木心耶。然必以气味甜辣者。方有辛温发散之功。
无气味者。非真桂也。不可入药。
上五味。以水七升。微火煮取三升。去滓。适寒温服一升。服已须臾。啜热稀粥一升余。以助药
力。温覆令一时许。遍身 微似有汗者益佳。不可令如水流漓。病必不除。若一服汗出病瘥。停后服。
不必尽剂。若不汗更服。根据前法。又不汗。后服小促役其间半日许。令三服尽。若病重者。一日一夜服。
周时观之。服一剂尽。病证犹在者。更作服。若汗不出者。乃服至二三剂。禁生冷粘滑肉面。五辛酒酪
臭恶等物。
桂。阳木也。生长于东南。盖得东南震巽发生之全气者。故能补助命门。生发中州。益下焦气化之功。
宣通百脉。而为气血之要药。其枝则得阳气而畅茂条达者也。夫木性之阳春生发。为天地发散其三冬
伏藏之郁结者也。况桂为纯阳之木。气味皆浓。且又生发新长之枝乎。故能达卫阳之分而散解其郁滞之风邪。
是以辛温发散之阳。以解阳分之阳邪也。阴阳应象论所谓辛甘发散为阳也。东垣谓桂枝汤为阴经营药。
而能闭卫气。使阴气不泄。方有执谓桂枝固卫而善走阴。均失之矣。臣之以芍药者。收阴气而敛津液。所以
救营阴之弱而渗泄也。佐之以甘草者。甘以
缓之。佐桂枝则甘温能除大热也。使之以姜枣者。姜以助其辛散而止呕。枣以和其中气而调停之也。将佐皆得其
人。操纵各适其用。则卫不觉其强。而营不患其弱。邪解气平而自和谐矣。适寒温者。恐太热则不能骤进。
若徐饮则其势已分。太寒则热气衰而无以鼓动其阳气也。啜热稀粥以助药力者。桂枝不过解肌。原非发汗之
猛剂。恐其力绵。故以热稀粥为后劲。所以助其温散之功也。内经云。汗出皆生于谷。故以谷充其气也。 。
身热汗欲出貌。气蒸肤润之情状也。微似有汗。言汗微而似有。似有而实微也。卫在皮毛。邪气浮浅。使肌
肤暂开。仅令卫分之风邪消散。而不使过多。有伤营分之弱阴也。若强逼太过。使汗出如水流漓。是发尽营中之
汗。卫邪仍不能解。适足以愈弱其阴。故曰病必不除也。小促役者。方土之语。杨雄郭璞所谓方言也。谓暂停
半日许。如可令人催促之顷也。又小促役。宋板作小从容。禁臭恶等物者。使清谷入胃。则清浊之升降得宜。
营卫之流行无滞。庶渐得安和而无反复之虞也。
太阳病。头痛发热。汗出恶风者。桂枝汤主之。
头痛虽见之于太阳总证。而未见于中风之首条。首条虽具脉证。以正中风之名。而尚未显言其治法。此条
虽有证无脉。而前后互见。并详明其治法矣。其脉症治法。于三处互见。仲景立言。或详或略。忽现
忽隐。正神龙见首不见尾。见尾不见首之妙。开后学辨证施治之法门。其为天下后世虑也深矣。
太阳病。外证未解。脉浮弱者。当以汗解。宜桂枝汤。
脉浮弱。即前阳浮阴弱之义也。外证。即前发热汗出。头项强痛。恶寒等证也。言凡见外证未解而脉浮弱者。
无论为日多少。未经传变者。其病犹在太阳不可误以麻黄发汗。及犯下早之戒。仍当用解肌之法。以桂枝汤汗解之。此
所
以示叮咛之意也。
太阳病。发热汗出者。此为营弱卫强。故使汗出。欲救邪风者。宜桂枝汤主之。
卫以受邪而觉强。营未受邪而觉弱。太阳经之有营卫。如衣之有表里也。表以垢腻而觉浓。里无垢腻。
故反觉薄耳。以发热汗出为卫强营弱。即所以申明阳浮热自发。阴弱汗自出也。邪风即风邪。颠倒反复。皆
以明桂枝汤之用也。
病常自汗出者。此为营气和。营气和者外不谐。以卫气不共营气和谐故尔。以营行脉中。卫行脉外。复
发其汗。营卫和则愈。宜桂枝汤。
此又言营气和。以明营弱卫强。为阴弱汗自出之故。而详言其治法也。言太阳中风之所以汗常自出者。
此为营气本未受邪而自和。然营气虽和。而营外之卫气。则为风邪所中。邪气附着于卫而郁热受困。不得与
内之营气。两相和谐浃洽之所致尔。盖营为谷气之清者。其精专之气。出自中焦。化而为赤。行于脉中。故
曰脉者。血之府也。然非谓营即血也。乃血中之气也。以血非气则无以流行。气非血则无所根据附。血本属阴。
故血中之气。亦为阴气也。卫为谷气之浊者。降于下焦。为命门真火之所蒸腾。其真阳 悍之气。不循经脉。
直达皮肤而行于脉外。营则浸灌滋润。卫则温暖固密。一营一卫。两相和协。故无病也。生气通天论云。凡阴
阳之要。阳密乃固。阴平阳秘。精神乃治。阳强不能密。阴气乃绝。以此推之。即可以该卫强营弱而汗自出
之义矣。然卫气之不与营气和谐。因风中之而强也。治之之法无他。勿以汗常自出之故而疑之。仍当以桂枝
汤复发其汗。使卫分之邪解。则营卫和谐而愈矣。
病患脏无他病。时发热自汗出而不愈者。此为卫气不和也。先其时发汗则愈。宜桂枝汤主之。
上文但言营气和而外不谐。犹未宣明外不谐者。即卫气不和也。此条复补出卫不和。以反复详尽中风
用桂枝汤之义也。脏无他病。谓平日五内并无他病也。时发热者。谓其发热有时也。言病患脏无他病。
唯表中于风。以致有时发热自汗出而不愈者。此为风邪载于卫气之中。邪正不相和也。若至已发热时。
则邪气已动而汗自出。是治之失其时矣。不若乘其未发热时。则邪伏于卫。用桂枝汤先其时发汗。则
卫邪可去。营分无伤。邪随汗出而愈矣。
太阳病。初服桂枝汤。反烦不解者。先刺风池风府。却与桂枝汤则愈。
服桂枝汤法。有一服不解而至三服者。有病重一剂不解而至二三剂者。此条乃初服桂枝汤。其邪
未得即解。亦常有之事耳。曰反烦。则不止于不解。是药后转加烦闷矣。烦则风邪郁于肌表。烦闷
不得发越。阳邪炽盛。充塞于太阳之经。服汤不能骤解。故用刺法以分泄之也。夫太阳之经脉四行。
挟督脉而行于两旁者也。风府一穴。本督脉穴也。在项上入发际上。同身寸之一寸。在大筋宛宛中。
疾言则其肉立起。言休则立下。乃督脉阳维之会。刺可入同身寸之三分而禁灸。风池二穴。本足少阳穴也。
在耳后发陷中。为足少阳阳维之会。针入七分。留七呼。三穴虽非太阳本经脉穴。而气府论云。足太阳
脉气所发者七十八穴。其浮气在皮者凡五行。而风池风府三穴。皆五行中之穴也。以其为风邪出入之门户。
故刺之以泄风邪之盛而杀其势也。正王启玄所谓浮气而通之。可以去热者也。刺之而邪气分泄。却仍
以桂枝汤汗解之。则愈矣。此又以邪气太盛。用刺法为助以两解之也。
风家表解而不了了者。十二日愈。
风家表解。是服桂枝汤而表邪已解也。了了决也。不了了言了而未了也。谓中风家表邪已解。犹有
余邪故未得遽
安。汗之则不须更汗。攻之则里内无邪。虽欲治之。无可治也。方注及喻氏。皆以为当静养以需。不可喜功生事也。十
二日愈者。言经尽两周。邪去而正自复也。此内经立法之常经。若至过经不解。则又为法外之变。又当别论矣。
凡服桂枝汤吐者。其后必吐脓血也。
其后必吐脓血句。乃未至而逆料之词也。言桂枝性本甘温。设太阳中风。投之以桂枝汤而吐者。知其人本阳邪独
盛于上。因热壅上焦。以热拒热。故吐出而不能容受也。若邪久不衰。熏灼肺胃。必作痈脓。故曰其
后必吐脓血也。此以不受桂枝而知之。非误用桂枝而致之也。乃各注家俱言胃家湿热素盛。更服桂枝。则两热相抟。
中满不行。势必上逆而吐。热愈淫溢。蒸为败浊。必吐脓血。此一大禁也。不知桂枝随已吐出。何曾留着于胸中。岂可
云
更服桂枝。两热相抟乎。前人遂以此条。列为桂枝四禁。岂不谬乎。
若酒客病。不可与桂枝汤。得汤则呕。以酒客不喜甘故也。
此条辞义明显。不须注解。其特设此义者。所以别上文服桂枝汤吐者之不同也。前以热邪上壅胸膈而吐。此以酒
客之湿热。常在胸膈而呕。前以不受温而吐。此以不喜甘而呕。如此则吐脓血与不吐脓血。亦自明矣。凡酒客中风。
风性本温。酒性湿热。此真所谓两热相合也。至真要大论云。风淫于内。治以辛凉。佐以苦。以辛散之。但不必以甘缓
之矣。其于桂枝汤。则当谨避之耳。
桂枝本为解肌。若其人脉浮紧。发热汗不出者。不可与也。当须识此。勿令误也。
此一条。真乃桂枝汤之禁例也。浮紧。伤寒之脉也。发热汗不出。伤寒之证也。具此脉证。其为寒伤营而为麻黄证
也
明矣。桂枝汤之本义。盖以桂枝辛温发散。为解肌和卫之药。芍药酸收敛液。所以救营弱而汗自出者也。唯其卫强。
故以桂枝汗解其卫分之风邪。唯其营弱。故以芍药收敛其营中之阴液。今寒既伤营。则寒邪闭于营分。郁而为热。
汗不出而头痛项强。身腰骨节皆疼。恶风而喘矣。宁可仍用桂枝。舍营分之阴邪不发。反空发卫分之阳邪乎。更不
知肃杀之寒邪在营。而反以酸寒收敛之芍药固之。岂非误治反治乎。故曰不可与也。当须识此。勿令误也。非谓桂
枝反能收汗固卫也。历代名家。如成无己。但随文顺释而不能辨。王好古谓麻黄治卫实。桂枝治卫虚。以致方氏之
辨。有风中卫而卫不固。发热汗出而恶风。桂枝救护之。热粥释散之。曾不思风中于卫。若非桂枝发汗解肌。岂一粥
之所能释散乎。遂至世俗不晓其中意义。更忘桂枝汤原文中。有复发其汗。当以汗解句。及服桂枝汤法中云。汗出
病瘥。不汗更服等语。而谓麻黄发汗。桂枝闭汗。故一遇汗出。便用桂枝。不知麻黄汗解营分之寒邪。桂枝仅解卫分
Taiyang disease (disease of the Taiyang channel). If there is fever, sweating, aversion to wind, and a slow pulse, it is named Wind Strike (Zhong Feng).
In the previous general syndrome section, all mentioned floating pulse, stiffness and pain in the head and neck, and aversion to cold are pulse and symptom complexes common to both Wind Strike and Cold Damage affecting the Taiyang channel. However, it has not yet distinguished between Wind Strike and Cold Damage.
Therefore, this chapter adds fever, sweating, aversion to wind, and a slow pulse to the general syndrome of floating pulse and stiffness/pain in the head and neck from the previous article, thereby distinguishing it as Wind Strike. "Wind Strike" refers to wind pathogen injuring the Wei Qi (Defensive Qi).
Wind is the qi rising in spring, formed by respiration, which generates all things. Its excessive or deficient qi becomes pernicious evil pathogens; contracting them leads to Wind Strike. However, this is not limited to spring; it occurs in all four seasons, though spring is its governing season.
Fever results from wind pathogen lodging in the Wei level causing stagnation and steaming. Sweating and aversion to wind occur because wind pathogen attacks the pores, and Wei Qi fails to regulate opening and closing normally. The Xuan Fu (sweat pores) do not close, so sweat flows out spontaneously. The Cou Li (interstices) are loose and unable to resist wind-cold, hence aversion to wind. Although wind and cold can be discussed interchangeably, this chapter emphasizes wind. "Slow" is the opposite of "tight"; it does not refer to a slow rate pulse. Wind is a Yang pathogen and lacks the forceful/urgent nature, thus the pulse is slow. This article serves as the guideline for Taiyang Wind Strike. All subsequent mentions of Taiyang disease with Wind Strike characteristics—fever, sweating, and slow pulse—treated with Guizhi Tang (Cinnamon Twig Decoction) share this pulse-syndrome complex. Since wind injuring Wei is the primary layer, it is listed under the Upper Section of Taiyang.
Taiyang Wind Strike. The Yang position floats and the Yin position is weak. Floating Yang indicates spontaneous heat generation. Weak Yin indicates spontaneous sweating. With a sensation of shivering aversion to cold, a sensation of dripping aversion to wind, a feeling of warmth-like fever, nasal congestion with roaring sounds, and dry retching, Guizhi Tang (Cinnamon Twig Decoction) should govern the treatment.
"Yang floats and Yin is weak" explains the meaning of the floating pulse in the previous general syndrome. "Spontaneous heat" and "spontaneous sweating" elaborate on the fever and sweating mentioned earlier. In pulse diagnosis, the superficial (Fu) position belongs to Yang, and the deep (Chen) position belongs to Yin. It is called "Yang floats" because Wei Qi circulates outside the vessels; when Yang pathogen attacks it, the pulse becomes vigorous externally, hence the Yang pulse floats. "Yin is weak" because Ying Qi (Nutritive Qi) circulates within the vessels; since Ying has not been attacked by pathogen, the pulse feels weak internally, hence the Yin pulse is weak. Generally speaking, if the superficial position is solid, the deep position is empty. Precisely because the deep position is empty, the floating pulse is manifested. This is because Yang is attacked and becomes solid; Yang solidity implies Yin deficiency. The word "spontaneous" in "spontaneous heat" and "spontaneous sweating" indicates natural occurrence. It means wind is a Yang pathogen and Wei is Yang Qi; the combination of two Yangs creates conflict between pathogen and healthy Qi. Stagnation of Qi causes spontaneous heat generation. This differs from cold pathogen lodging in the interstices, where Yang Qi cannot vent until severe stagnation causes fever. Wei is the exterior of the exterior, Ying is the interior of the exterior. Wei controls the skin and hair. When wind pathogen attacks, pores do not close. The Yin fluids in Ying are steamed internally by heat and constrained externally by Wei Qi, making sweating easy. This differs from cold pathogen entering the interstices, where Xuan Fu closes tightly, Yang Qi cannot vent externally, and there is no sweating. If Wei Yang cannot secure the exterior, Ying Yin cannot maintain itself, like a woman without a husband losing protection and unable to stand alone; just as lips gone make teeth cold, Yang floating and spontaneous heat lead to Yin weakness and spontaneous sweating. Wei governs the skin and hair, acting like a door controlling opening and closing. Wind pathogen lodging in Wei is like an object blocking the door preventing closure. If it cannot close, entry is allowed freely, and exit is allowed freely. Allowing entry causes aversion to wind and cold. Allowing exit leads to spontaneous sweating. "Sese" (shivering) resembles the rustling sound of wind and cold invading. "Xixi" (dripping) resembles the sound of light rain or wind. Sese aversion to cold indicates Ying Yin weakness internally. Xixi aversion to wind indicates Wei Yang looseness externally. Wind Strike also involves aversion to cold because Wei is injured and Ying is weak. Yang excess and Yin deficiency prevent harmony between Ying and Wei, hence aversion to both wind and cold. "Xixi" (warmth-like) describes heat radiating from outside, feeling like hot air baking the skin. The Lung governs skin and hair and opens into the nose. Wind in the skin and hair connects internally to the Lung, causing nasal congestion and roaring breath due to Qi obstruction and heat/cold. Dry retching is nausea. The chest belongs to Taiyang; wind pathogen in Wei attacks the diaphragm causing vomiting. These are all syndromes of wind pathogen injuring Wei. Treatment should resolve the muscle layer and induce sweating; Guizhi Tang (Cinnamon Twig Decoction) is appropriate. "Govern" means to primarily treat. For any pulse-syndrome complex seen above, Guizhi Tang (Cinnamon Twig Decoction) should primarily treat. Even if complications arise, modifications of this formula serve as the basis, such as Guizhi Jia Gui Tang (Guizhi Decoction Plus Cinnamon Twig), Guizhi Jia Fuzi Tang (Guizhi Decoction Plus Prepared Aconite Root), Guizhi Qu Shaoyao Jia Fuzi Tang (Guizhi Decoction Removing Peony Plus Prepared Aconite Root), etc.
Formula: Guizhi Tang (Cinnamon Twig Decoction)
Guizhi (Cinnamomi Ramulus, 3 liang), Shaoyao (Paeoniae Radix Alba, 3 liang), Gancao (Glycyrrhizae Radix et Rhizoma Preparata, 2 liang, honey-fried), Shengjiang (Zingiberis Rhizoma Recens, 3 liang, sliced), Dazao (Jujubae Fructus, 12 pieces, split).
Zhongjing stated that Guizhi refers to taking the bark of the twig. Later generations, unaware of the medicinal properties and flavors, said to remove the bark, which is erroneous. The flavor of cinnamon lies entirely in the bark; if removed, what flavor would remain in the heartwood? Rougui (Cinnamomi Cortex) is also merely the bark of the large tree trunk; why discard the bark and use the heartwood? Only cinnamon with sweet and pungent flavors possesses the efficacy of acrid-warm dispersion. Cinnamon lacking flavor is not true cinnamon and should not be used medicinally.
Take the above five ingredients, add seven sheng of water, simmer over low heat to obtain three sheng, remove dregs. Take one sheng at a temperature suitable for consumption. Shortly after ingestion, drink more than one sheng of hot thin porridge to assist the medicinal power. Cover warmly for about one hour until the whole body has a slight perspiration, which is ideal. Do not allow profuse sweating like flowing water, otherwise the disease will not be resolved. If after one dose sweating occurs and the disease resolves, stop subsequent doses; there is no need to finish the entire decoction. If no sweating occurs, administer another dose following the previous method. If still no sweating, shorten the interval slightly over half a day, ensuring three doses are completed. If the disease is severe, administer over one day and night, observing for a full cycle (12 hours). If one prescription is finished and symptoms persist, prepare another dose. If no sweating occurs, continue up to two or three prescriptions. Avoid raw, cold, sticky, slippery foods, meat, flour, five pungent spices, alcohol, dairy products, and foul-smelling substances.
Gui (Cinnamon) is a Yang wood. It grows in the southeast, obtaining the complete generating Qi of Zhen and Xun (East and Southeast trigrams). Thus, it can supplement the Mingmen (Gate of Life), generate Qi in the Middle Jiao, enhance Qi transformation in the Lower Jiao, unblock all vessels, and serve as a crucial herb for Qi and Blood. Its twigs obtain Yang Qi and grow lush and spreading. The spring-like generating nature of Wood disperses the stagnation accumulated during the three winter months of storage. Moreover, Gui is pure Yang wood with strong flavors and consists of newly growing twigs. Therefore, it can reach the Wei Yang division to disperse stagnant wind pathogen. It uses acrid-warm dispersing Yang to resolve Yang pathogen in the Yang division. As stated in the Huangdi Neijing's Yin Yang Ying Xiang Lun: "Acrid and sweet substances disperse and are Yang." Dong Yuan considered Guizhi Tang (Cinnamon Twig Decoction) a medicine for nourishing Ying and regulating Qi, capable of closing Wei Qi to prevent Yin leakage. Fang Youzhi believed Guizhi secures Wei and travels well into Yin; both views are incorrect. Shaoyao (Peony) acts as the minister herb, gathering Yin Qi and astringing Body Fluids, thereby rescuing the weakness and leakage of Ying Yin. Gancao (Licorice) acts as the assistant herb, using sweetness to moderate; combined with Guizhi, sweet-warmness can eliminate significant heat. Shengjiang (Fresh Ginger) and Dazao (Jujube) act as envoys; ginger assists acrid dispersion and stops vomiting, while jujube harmonizes Middle Qi and mediates. With proper ministers and assistants utilizing their functions appropriately, Wei will not feel excessively strong, and Ying will not suffer weakness. Pathogen resolves, Qi calms, and harmony is restored naturally. Taking the medicine at a suitable temperature prevents sudden intake of overly hot liquid or gradual loss of potency from lukewarm liquid, or insufficient heat to stimulate Yang Qi from cold liquid. Drinking hot thin porridge assists the medicinal power because Guizhi Tang (Cinnamon Twig Decoction) mainly resolves the muscle layer and is not a potent diaphoretic. To compensate for its mild strength, hot porridge serves as reinforcement to aid warm dispersion. The Neijing states: "Sweat is generated from grain," thus grain replenishes Qi. "Shi" describes the appearance of body heat and desire to sweat, and the state of steaming Qi moistening skin. "Slight perspiration" means sweat is minimal and seemingly present but actually very slight. Wei resides in the skin and hair; pathogen is superficial. Temporarily opening the skin allows only the wind pathogen in the Wei division to dissipate without excessive sweating that might injure the weak Yin of the Ying division. Forcing too much sweating like flowing water exhausts Ying sweat, fails to resolve Wei pathogen, and further weakens Yin, hence "the disease will not be resolved." "Xiao Cu Yi" is a regional term, noted by Yang Xiong and Guo Pu as dialect, meaning pausing for about half an hour, as if urging someone. Song editions read "Xiao Cong Rong." Prohibiting foul-smelling foods ensures clear grain enters the stomach, allowing proper ascent and descent of clear and turbid Qi, smooth circulation of Ying and Wei, gradually achieving harmony without recurrence.
Taiyang disease. Headache, fever, sweating, and aversion to wind. Guizhi Tang (Cinnamon Twig Decoction) should govern the treatment.
Headache appears in the general Taiyang syndrome but was not in the first article of Wind Strike. The first article established the pulse-syndrome to define Wind Strike but did not explicitly state the treatment. This article presents symptoms without pulse, but together they clarify the treatment method across sections. Zhang Zhongjing's writing varies in detail and brevity, appearing and disappearing like a divine dragon showing its head but not tail, or tail but not head. This brilliance opens methods for differentiation and treatment for future students, showing profound consideration for the world.
Taiyang disease. Exterior syndrome unresolved. Pulse floating and weak. Should be resolved through sweating. Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
Floating and weak pulse corresponds to the previous meaning of Yang floating and Yin weak. Exterior syndrome refers to previous symptoms: fever, sweating, stiffness/pain in head and neck, aversion to cold. It states that whenever exterior syndrome is unresolved with a floating-weak pulse, regardless of duration or lack of transmission, the disease remains in Taiyang. Do not mistakenly use Mahuang Tang (Ephedra Decoction) to induce sweating, nor violate prohibitions against premature purgation. Still, use the method of resolving the muscle layer with Guizhi Tang (Cinnamon Twig Decoction) to induce sweating. This expresses earnest admonition.
Taiyang disease. Fever and sweating. This is Ying weakness and Wei strength. Hence sweating occurs. To rescue from pathogenic wind, Guizhi Tang (Cinnamon Twig Decoction) should govern the treatment.
Wei feels strong due to pathogen invasion; Ying feels weak because it is uninvaded. Ying and Wei in the Taiyang channel are like the lining and outer fabric of clothing. The outer layer feels thick due to dirt/grease; the inner layer feels thin due to lack thereof. Fever and sweating indicate Wei strength and Ying weakness, reiterating Yang floating/spontaneous heat and Yin weakness/spontaneous sweating. "Pathogenic wind" is wind pathogen; phrasing variations emphasize the utility of Guizhi Tang (Cinnamon Twig Decoction).
Diseases with constant spontaneous sweating. This is Ying Qi harmony. Ying Qi harmony implies external disharmony. Because Wei Qi does not harmonize with Ying Qi. Ying circulates within vessels; Wei circulates outside vessels. Re-induce sweating. When Ying and Wei harmonize, the disease resolves. Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
This again discusses Ying Qi harmony to explain that Ying weakness and Wei strength cause Yin weakness and spontaneous sweating, detailing the treatment. It states that constant spontaneous sweating in Taiyang Wind Strike occurs because Ying Qi is originally uninvaded and harmonious. However, although Ying Qi is harmonious, the Wei Qi outside Ying is attacked by wind pathogen. Pathogen attaches to Wei, causing stagnation and heat confinement, preventing harmony with internal Ying Qi. Ying is the clear part of Grain Qi, its refined essence originates in the Middle Jiao, transforms into red (blood), and circulates in vessels. Thus, "vessels are the house of blood." However, Ying is not blood itself, but Qi within blood. Blood cannot circulate without Qi; Qi has no foundation without blood. Blood belongs to Yin, so Qi within blood is also Yin Qi. Wei is the turbid part of Grain Qi, descending to the Lower Jiao, steamed by the True Fire of Mingmen. Its vigorous Yang Qi does not follow vessels but reaches skin directly, circulating outside vessels. Ying irrigates and moistens; Wei warms and secures. One Ying, one Wei, mutually harmonizing, hence health. Sheng Qi Tong Tian Lun states: "The key to Yin and Yang is that Yang must be dense to secure; when Yin is peaceful and Yang is secreted, Spirit thrives. Yang excess cannot be dense, leading to Yin exhaustion." Inferring from this explains the meaning of Wei strength, Ying weakness, and spontaneous sweating. Wei Qi fails to harmonize with Ying Qi because wind makes it feel strong. The treatment is simple: do not doubt due to constant sweating. Still use Guizhi Tang (Cinnamon Twig Decoction) to re-induce sweating. Once Wei pathogen resolves, Ying and Wei harmonize, and the disease resolves.
Patients with no internal organ diseases, experiencing intermittent fever and spontaneous sweating without resolution. This is Wei Qi disharmony. Induce sweating before the onset time, then resolve. Guizhi Tang (Cinnamon Twig Decoction) should govern the treatment.
The previous text mentioned Ying harmony but external disharmony, without clarifying that external disharmony is Wei Qi disharmony. This article supplements Wei disharmony to thoroughly explain the rationale for using Guizhi Tang (Cinnamon Twig Decoction) in Wind Strike. "No internal organ diseases" means no other illnesses in the five viscera usually. "Intermittent fever" means fever occurring at specific times. It states that patients with no internal diseases, only wind attacking the exterior, causing intermittent fever and spontaneous sweating without resolution, have wind pathogen carried within Wei Qi, with pathogen and healthy Qi not harmonizing. If waiting until fever starts, pathogen moves and sweat flows out, missing the optimal treatment time. Better to act before fever starts, when pathogen lies hidden in Wei. Use Guizhi Tang (Cinnamon Twig Decoction) to induce sweating beforehand. Then Wei pathogen is removed, Ying division is uninjured, pathogen exits with sweat, and the disease resolves.
Taiyang disease. After initially taking Guizhi Tang (Cinnamon Twig Decoction), instead of relief,烦躁 (irritability/agitation) occurs and symptoms are unresolved. First puncture Fengchi (GB20) and Fengfu (GV16). Then administer Guizhi Tang (Cinnamon Twig Decoction), and the patient will recover.
Methods for taking Guizhi Tang (Cinnamon Twig Decoction) include cases where one dose is unresolved leading to three doses, or severe disease requiring one prescription unresolved leading to two or three. This article describes initial administration where pathogen does not immediately resolve, which is common. "Instead of irritability" means not just unresolved, but worsening agitation after medication. Irritability indicates wind pathogen stagnating in the muscle layer, agitation unable to vent, Yang pathogen flourishing, filling the Taiyang channel. Medication cannot quickly resolve it, so acupuncture is used to drain it. The Taiyang channel runs alongside the Du Mai (Governing Vessel). Fengfu (GV16) is a Du Mai point, located one cun above the hairline at the nape, in the depression of the large tendon. Speaking quickly raises the flesh; resting lowers it. It is the meeting of Du Mai and Yang Wei Mai. Puncture depth is three cun; moxibustion is prohibited. Fengchi (GB20) is a Foot-Shaoyang Gallbladder channel point, located in the depression behind the ear, meeting of Foot-Shaoyang and Yang Wei Mai. Needle depth seven fen, retain seven breaths. Although these three points are not original Taiyang channel points, the Qifu Lun states seventy-eight points emit Taiyang Qi, with floating Qi in the skin forming five rows. Fengchi and Fengfu are among these points. As gates for wind pathogen entry/exit, puncturing drains excessive wind pathogen and reduces its momentum. As Wang Bing noted, connecting floating Qi can remove heat. After puncturing to divide and drain pathogen, administering Guizhi Tang (Cinnamon Twig Decoction) to induce sweating resolves the disease. This uses acupuncture to assist in dual resolution when pathogen is too strong.
Wind patients whose exterior syndrome resolves but who feel unsettled/uncomfortable. They will recover in twelve days.
"Wind patients' exterior resolves" means taking Guizhi Tang (Cinnamon Twig Decoction) and resolving exterior pathogen. "Liao liao" means clear/resolved. "Bu liao liao" means partially resolved/unsettled. It means Wind Strike patients have resolved exterior pathogen but residual pathogen remains, preventing immediate peace. Sweating is unnecessary; purging is contraindicated as there is no interior pathogen. Though wanting to treat, there is nothing to treat. Fang Zhu and Yu Shi believe rest is needed; forcing recovery causes trouble. "Recover in twelve days" means completing two menstrual cycles (or channel cycles); pathogen leaves, healthy Qi recovers naturally. This is the standard law of the Neijing. If exceeding the cycle without resolution, it is an extra-legal variation, requiring separate discussion.
Anyone taking Guizhi Tang (Cinnamon Twig Decoction) who vomits will subsequently vomit pus and blood.
The phrase "subsequently vomit pus and blood" is a prediction before occurrence. It states Guizhi is inherently sweet-warm. If Taiyang Wind Strike patient takes Guizhi Tang (Cinnamon Twig Decoction) and vomits, it indicates pre-existing Yang pathogen excess in the upper burner. Heat obstructs the upper burner; heat rejects heat, causing vomiting and inability to tolerate. If pathogen persists, scorching Lung and Stomach, abscesses/pus will form, hence "subsequently vomit pus and blood." This infers intolerance to Guizhi, not injury from misuse. Commentators claim patients with pre-existing damp-heat in Stomach taking Guizhi causes two heats clashing, middle fullness, upward reversal vomiting, heat overflowing turning to turbid pus/blood, calling it a major prohibition. But Guizhi is vomited out; how can it remain in the chest? How can one say "taking Guizhi again causes clashing"? Predecessors listed this as one of the Four Prohibitions of Guizhi, which is absurd.
If a wine-drinker falls ill, do not give Guizhi Tang (Cinnamon Twig Decoction). Taking it causes vomiting because wine-drinkers dislike sweet substances.
The meaning of this article is obvious, requiring no annotation. Its purpose distinguishes it from the previous article on vomiting after Guizhi Tang (Cinnamon Twig Decoction). Previously, vomiting was due to heat pathogen obstructing chest/diaphragm; here, it is damp-heat in wine-drinkers often residing in chest/diaphragm causing vomiting. Previously, vomiting due to rejecting warmth; here, vomiting due to disliking sweetness. Thus, vomiting pus/blood versus not vomiting is clear. For wine-drinkers with Wind Strike, wind nature is warm, wine nature is damp-heat; truly "two heats combining." Su Wen: Zhi Zhen Yao Da Lun states: "Wind invading internally, treat with acrid-cool, assist with bitter, disperse with acrid, but do not necessarily use sweet to moderate." Regarding Guizhi Tang (Cinnamon Twig Decoction), one must strictly avoid it.
Guizhi is originally for resolving the muscle layer. If the pulse is floating-tight, with fever and no sweating, do not give it. Must recognize this, do not err.
This article is truly a prohibition example for Guizhi Tang (Cinnamon Twig Decoction). Floating-tight is the pulse of Cold Damage. Fever with no sweating is the syndrome of Cold Damage. Possessing these pulse-symptoms clearly indicates Cold injuring Ying, constituting Mahuang Tang (Ephedra Decoction) syndrome. The original intent of Guizhi Tang (Cinnamon Twig Decoction) is Guizhi's acrid-warm dispersion to resolve muscle and harmonize Wei; Shaoyao's sour-astringency to collect fluids, rescuing Ying weakness and spontaneous sweating. Because Wei is strong, Guizhi induces sweating to resolve wind pathogen in Wei division. Because Ying is weak, Shaoyao astringes Yin fluids in Ying. Now, Cold has injured Ying; Cold pathogen closes Ying division, stagnates into heat, causing no sweating, headache, neck stiffness, body/waist/bone/joint pain, aversion to wind, and wheezing. How can one still use Guizhi, abandoning Ying Yin pathogen without releasing it, while falsely attacking Wei Yang pathogen? Furthermore, ignoring that austere Cold pathogen is in Ying, and instead using sour-cold astringent Shaoyao to secure it, is this not mistaken and contrary treatment? Hence, "do not give it." Must recognize this, do not err. It does not mean Guizhi can collect sweat and secure Wei. Past masters like Cheng Wuji merely followed the text without辨析. Wang Haogu stated Mahuang treats Wei excess, Guizhi treats Wei deficiency, leading to Fang's debate: Wind strikes Wei, Wei is insecure, fever/sweating/aversion to wind, Guizhi protects it, hot porridge disperses it. Did they not consider that if wind strikes Wei, without Guizhi inducing sweating and resolving muscle, could one porridge disperse it? Thus, laypeople misunderstand, forgetting the original text of Guizhi Tang (Cinnamon Twig Decoction) stating "re-induce sweating, should resolve via sweating," and dosage instructions saying "if sweating resolves disease, stop; if no sweating, take again." They wrongly claim Mahuang induces sweating, Guizhi closes sweat. Thus, encountering sweating, they use Guizhi, unaware Mahuang resolves Cold pathogen in Ying division, while Guizhi only resolves...