亡阳而言也。此云少阴症。亦即指脉微弱而言也。有少阴证者不可用。无少阴症者方可服。皆所以反复申明其义也。
以卫气乃真阳之发越。真阳为卫气之根源。故阳虚者不可发汗。误汗则阳气丧亡而厥逆 惕也。所以少阴条下云。
脉微不可发汗。亡阳故也。
辨误 前条冠之以中风。而所见伤寒之脉症居多。注家遂以寒多风少。此条以伤寒二字为首。而所见反中风之
脉证居多。注家又以为风多寒少。不知仲景立法垂训。唯恐不明。故前以中风立名。则多见伤寒之脉证。此以伤寒
立名。则多见中风之脉证。以见风寒两停。皆前后转换之法也。前云脉微弱汗出恶风者不可服。此云无少阴症者
可用。皆所以互相发明其义耳。非有多少之别也。观前后皆以大青龙汤发微似汗以治之。则晓然矣。若果系热多
寒少之症。则仲景必明言之。如下文桂枝麻黄各半汤。及桂枝二越婢一汤之二条可见矣。
太阳病。得之八九日。如疟状。发热恶寒。热多寒少。其人不呕。清便欲自可。一日二三度发。脉微缓者。为
欲愈也。脉微而恶寒者。此阴阳俱虚。不可更发汗。更下更吐也。面色反有热色者。未欲解也。以其不能得小汗出。
身必痒。宜桂枝麻黄各半汤。
邪入太阳。至八九日经尽而不解。发热恶寒。往来如疟状。此邪客营卫。风寒并感也。热多寒少者。风多于寒也。因先
中于风。又为寒邪所袭而不得解也。如疟状。则疑邪入少阳矣。若邪入少阳。则必呕而发热。其人不呕。则知邪气未
入少阳也。太阳表邪。虽亦有呕证。然无往来寒热之似疟。故知仍在太阳也。邪在太阳而不呕。邪气之轻者也。其小
便清。又知邪未入里。邪气轻而犹未入里。故欲自可也。一日二三度发者。在卫之风邪胜。入营之寒气轻。邪浮于表。
出入浅近。易于往来也。至真要大论云。邪正之会遇有多少。阳气多而阴气少。则其发日近。所以疟论篇中。但责重
于卫气也。若邪入少阳之经。则邪入者深。一日不能发二三度。或一日或间日作矣。邪既浮浅。脉又微缓。微者。非微
细之微。言较前略觉和缓也。以脉缓。故知邪气将解而欲愈也。何也。寒邪未解之脉当浮紧。或阴阳俱紧。风邪未解
之脉当浮缓。今不浮不紧而渐觉和缓。故为欲愈也。若以此证而脉微恶寒者。则又知其非欲愈之脉矣。前以发热恶寒。
一日二三度发。故以脉之微觉其和缓。而知其为欲愈。此所谓微者。乃轻微细小之微。非微缓之微也。脉微而但恶寒。
乃阴阳俱虚。即大青龙汤条下之脉微弱汗出恶风之义也。阴虚则津液不足。阳虚则卫气衰微。故不可更发汗。更下更
吐。自当以温经补虚为急矣。若如上文诸症。脉虽微缓而面色反有发热之赤色者。是脉虽微缓。其风寒犹在表而未欲解。
即并病条中所谓面色缘缘正赤者。阳气怫郁在表。当解之熏之之义也。未解则风寒郁于皮肤之间。不得小汗出以散其邪。
则身必作痒。故当以桂枝麻黄各半汤。约其剂而两解之也。
桂枝麻黄各半汤方
桂枝（一两十六铢） 芍药（一两） 生姜（一两切） 大枣（四枚） 甘草（一两） 麻黄（一两去节）
杏仁（二十个去皮研）
上七味。以水五升。先煮麻黄一二沸。去上沫。内诸药。煮取一升八合。去滓。温服六合。
此以风寒两伤营卫。故以桂枝麻黄之半。合而为各半汤以并解之。然邪虽浮浅。恐芍药之酸收。敛营分之寒邪。
故止留其三分之一。又欲其汗小。已有桂枝可发微汗。故麻黄杏仁亦止留其三分之一。尚恐其太泄。
又以芍药微敛之。而能适中病情也。且所煮不过一升八合。所服六合而已。为剂小而所服者少。自无过发之弊。恰可以
解散其邪已耳。无太过不及。此所以为时中之剂欤。
太阳病。发热恶寒。热多寒少。脉微弱者。此无阳也。不可更汗。宜桂枝二越婢一汤。
太阳中风。发热恶寒。热多寒少。与前证相似。但未详言其如疟不呕等证耳。前云脉微缓。则为欲愈。脉微而但恶
寒。
已为阴阳俱虚而不可汗吐下矣。此条承上文以明阴阳俱虚句。而又独申其阳虚之治也。前云脉微缓为和平而欲愈。此云
脉微弱。则细软而无力矣。故曰无阳。无阳者。命门真阳之气衰少也。真阳既衰。其升发之卫气浸弱。故云不可更汗。汗
之则阳气必败矣。即前青龙汤条内。所谓脉微弱者不可服之一义也。无阳既不可发汗。风寒又非汗不解。持其两端。不
得已而
约其制。变其法。为桂枝二越婢一汤以微解之。越婢汤者。以热多寒少。故用石膏多于麻黄也。
桂枝二越婢一汤方
桂枝（十八铢） 芍药（十八铢） 甘草（十八铢） 生姜（一两三钱切） 大枣（四枚） 麻黄（十八铢）
石膏（二十四铢研）
上七味。 咀。以水五升。煮麻黄一二沸。去上沫。内诸药。煮取二升。去滓。温服一升。本方当裁
为越婢汤。桂枝汤。合饮一升。今合为一方。桂枝二越婢一。
此亦风寒两伤营卫之剂也。名曰桂枝二越婢一汤者。煮成桂枝全汤而用其十分之二。又煮越婢全汤而用其十
分之一也。今虽以两方合为一剂。而考其分两。如桂枝芍药之各三两。止存其十八铢。是三两而存七钱半。比之全
汤。亦止用其十之二也。越婢之麻黄六两。止用十八铢。亦七钱半也。石膏八两。止用二十四铢。乃一两也。
较之全汤。亦止用其十之一耳。其甘草生姜大枣。两方皆同。亦仿佛其分两而已。所以谓之桂枝二越婢一汤。然
越婢之名。成氏以为能发越脾气。引外台方名曰越脾汤。谬也。此为太阳治表之药。与脾脏何涉。而有此名邪。方氏
谓越。逾也。婢女子之卑也。女子。阴也。卑。少也。谓少阴之脉微弱为无阳。难于发汗。方用越婢者。寓发于
不发之中也。喻氏亦取其说。谓石膏之辛凉以兼解其寒。其柔缓之性。比之女婢。犹为过之。用之可无恐矣。愚窃
谓未必然也。想仲景当时。或以此治越人之婢而得效。遂以名方。亦未可知。但亦不必深求。况立名之义。无大关系。
当存疑而置之弗论可也。奚用强解乎。
服桂枝汤。大汗出。脉洪大者。与桂枝汤如前法。若形如疟。日再发者。汗出必解。宜桂枝二麻黄一汤。
此所以别中风。及风寒并感之疑似。恐人误用麻黄汤也。上半截。论但中风而无寒邪之证。自形如疟以下。乃风寒
均有之证也。言太阳中风。服桂枝汤。其风邪在卫而浮浅。当取微似汗。则伤卫之风邪解矣。使大汗出。则犯如水流
漓之戒而病不除矣。脉洪大者。浮而洪大。中风郁热之所致。非传入阳明之大也。若邪入阳明。当见阳明证矣。此所
谓洪大。所以别其无寒紧之脉也。然中风之脉浮缓。此何以洪大乎。观其服桂枝汤而不能解。知其为风多而郁热
之邪太重。故脉变洪大也。脉虽洪大而太阳中风之发热汗出等证仍在。当仍与桂枝汤如前法。令出微似汗可也。
若往来寒热。形状如疟而一日再发。则是风邪在表。为寒气所袭。遂成风寒并感。营卫两伤之证。即前条一日二三
度发之义也。亦以风寒所入者浮浅。故一日得再发也。如此。则不但当用桂枝汤独解卫分之邪。并当用麻黄兼发
营中之汗矣。然一日再发。当以在卫之风邪为主。入营之寒气次之。故以桂枝二麻黄一汤治之。
桂枝二麻黄一汤方
桂枝（一两十七铢） 芍药（一两六铢） 麻黄（十六铢） 杏仁（十六个去皮尖） 甘草（一两二铢）
生姜（一两六铢） 大枣（五枚擘）
上七味。以水五升。先煮麻黄一二沸。去上沫。内诸药。煮取二升。去滓。温服一升。日再服。
同前如疟之证。而前用桂枝麻黄各半汤。此用桂枝二麻黄一汤者。盖因前条八九日既如疟状。乃风寒并感。营卫
之邪。两无轻重。故以各半汤治之。此因本是中风。所以但服桂枝汤。下节又兼感寒邪。以致形状如疟。为风多于寒
之证。故以桂枝二麻黄一汤治之。然此所谓一二者。又非前桂枝二越婢一汤之法矣。前照二汤之全方而用其分两之一二。
此则以桂枝汤两倍。合麻黄汤一倍准之也。
服桂枝汤。或下之。仍头项强痛。翕翕发热无汗。心下满。微痛。小便不利者。
桂枝去桂加茯苓白术汤主
之。
头项强痛。中风伤寒均有之证也。翕翕发热。是热在皮毛。中风证也。无汗则又伤寒之本证矣。就此诸证。
为风寒兼有无疑矣。而但服桂枝汤。是治风而未治寒也。故仍头项强痛。翕翕发热无汗而不解也。又或误下之。
所以有心下满微痛之证。乃下后邪气陷入而欲结也。小便不利。太阳之热邪内犯膀胱。气化不行也。治之以桂
枝汤去桂加茯苓白术汤。未详其义。恐是后人传写之误。未可知也。即或用之。恐亦未能必效也。夫风寒并感。
以桂枝麻黄各半汤治之可也。表症未除。误下之而心满微痛。则邪气欲结未结。栀子豉汤之类吐而越之可也。
邪犯膀胱。五苓散导之可也。计不出此。而以桂枝汤去桂加茯苓白术汤主之。何也。盖桂枝汤之能解风邪。皆赖
桂枝之辛温。可以汗解其邪。用芍药者。因营阴弱而汗自出。故用之以敛阴收汗。若伤寒无汗者。必不可用。
今仍头项强痛。翕翕发热无汗。既不以麻黄桂枝并用。若曰桂枝去芍药则可。若反去桂枝而留芍药。其如无汗何。
茯苓虽能渗利小便。而白术又除湿补中之物。将置未解之表证于何地邪。余故疑其未能取效也。成注谓外证
未罢。无汗小便不利。则心下满微痛。为停饮也。与桂枝以解外。加茯苓白术以行留饮。殊不知桂枝已去。岂
能解外。加茯苓白术。即能使留饮行动耶。王肯堂云。或问头项强痛。邪气仍在表也。虽经汗下而未解。何故去桂。
加茯苓白术。是无意于表证也。曰。此非桂枝证。乃属饮家也。头项强痛。既经汗下而不解。心下满而微痛。
小便不利。此为水饮内蓄。邪不在表。故去桂枝加茯苓白术。若得小便利。水饮行。腹满减而热自除。则头项强
痛悉愈矣。如十枣汤证。头亦痛。乃邪热内蓄而有伏饮。故头痛。其水饮头痛。不须攻表。但宜逐饮。饮尽则病安
矣。王氏此论。其或问一节。颇合于理。而后论悉遵成注。以茯苓白术
为逐饮而设。又旁引曲喻。以十枣汤之头痛。证明其说。岂理也哉。如翕翕发热无汗。明是太阳表症。虽心下满而微
痛。又未痞硬引胁。何见其必为停饮乎。若果属停饮。十枣虽或未可遽用。何半夏之辛温滑利。亦竟舍之而不用耶。
芍药茯苓白术。果能利小便。逐水饮而使诸表证悉愈耶。仲景立法。岂方不对证。而能为后世训乎。余窃疑之。大约
是历年久远。后人舛误所致。非仲景本来所系原方。近代名家。悉遵成氏之训。俱强解以合其说。谓用之而诸证悉
愈。吾不信也。
桂枝去桂加茯苓白术汤方
于桂枝汤方内。去桂枝。加茯苓白术各三两。余根据前法煎服。小便利则愈。
伤寒不大便六七日。头痛有热者。与承气汤。其小便清者。知不在里。仍在表也。当须发汗。若头痛者必
衄。宜桂枝汤。
此条以伤寒名始。而以桂枝汤终之。亦风寒并有之证也。不然。桂枝汤为伤寒之禁剂。何可用乎。盖以风寒并感故
也。上截先言伤寒热邪归里。以起下截小便清一段。以反复申明表里之辨。因上文是起下语。在所当忽。故承气汤
不言大小及调胃也。六七日。邪气入里之候也。伤寒六七日不大便。是热邪结于里也。头痛有热者。邪热在里。肠胃
不通。热壅上焦而头痛也。其热则或蒸蒸之热。或日晡潮热。非寒邪在里之头痛有热也。故当与承气汤下之。若不大便
六
七日。头痛有热而小便清者。则知邪不在里。其头痛发热之邪。仍在表也。若小便清而头痛。则里虽无热而有中风之阳
邪
盛于上也。如不解散其邪。必至衄血而后已也。故当用桂枝汤微似汗以解之。
伤寒发热。解半日许复烦。脉浮数者。可更发汗。宜桂枝汤。
伤寒而用桂枝汤。与上条同义。言风寒并有之证。但以麻黄汤发汗。则营邪去而解矣。解后半日许复烦者。
因在卫之风邪未解故也。若按其脉。但浮数而不紧者。则知寒邪已去矣。脉法云。浮则为风。数则为热。是中
风之阳邪未去。热郁而烦也。可更发其微似汗则解矣。宜桂枝汤。
伤寒二三日。心中悸而烦者。小建中汤主之。
心中。心胸之间。非必心脏之中也。悸。虚病也。烦。阳邪也。伤寒二三日。表证未解之时也。大凡中风
伤寒之心下悸者。或误汗亡阳。或饮水过多。及气血皆虚。脉见结代而然也。此条既未误汗饮水。又不言表证。
但曰心中悸而烦者。是寒邪已去。中气已虚。仅存中风之阳邪。将次入里而先烦也。中气虚馁。则膻中呼吸之
气不得伸。故筑筑然而悸动。阳邪将陷。故热邪内犯而虚烦也。若寒邪在营。则不应用桂枝汤矣。此因寒邪已去。
风邪仍在太阳。故以桂枝汤为主。以解卫分之邪。加入胶饴。倍芍药以创建中气也。
辨误 小建中汤。即桂枝汤倍芍药而加胶饴也。各注家不辨桂枝汤为伤寒之禁剂。漫因伤寒二字。遂置之
This refers to the loss of Yang Qi (a syndrome caused by the depletion of Yang energy). The mention of Shaoyin syndrome here also refers to a faint pulse. It cannot be used for those with Shaoyin syndrome, but may be taken by those without it. This is to repeatedly clarify its meaning.
Since Wei Qi (Defensive Qi) is the manifestation of True Yang, and True Yang is the root of Wei Qi, those with Yang deficiency should not undergo sweating therapy. Incorrect use of sweating will lead to the loss of Yang Qi, resulting in cold limbs and palpitations. Therefore, under the Shaoyin chapter, it states:
A faint pulse contraindicates sweating, due to the loss of Yang Qi.
Clarification of Errors: The previous clause was titled "Wind Strike," yet most observed pulse and symptoms were those of Cold Damage. Commentators thus concluded that Cold was predominant over Wind. This clause begins with "Cold Damage," yet most observed pulse and symptoms are those of Wind Strike. Commentators then argued that Wind was predominant over Cold. They fail to realize that Zhang Zhongjing established these laws for instruction, fearing ambiguity. Hence, when titled "Wind Strike," it predominantly shows Cold Damage pulses and symptoms; when titled "Cold Damage," it predominantly shows Wind Strike pulses and symptoms. This demonstrates that when Wind and Cold coexist, these are methods of transition between preceding and succeeding clauses. The former text states that those with a faint pulse, sweating, and aversion to wind should not take it; this text states that those without Shaoyin syndrome may take it. Both serve to mutually elucidate the principle, indicating no difference in predominance. Observing that both instances use Da Qing Long Tang to induce a slight sweat reveals this clearly. If it were truly a case of Heat predominating over Cold, Zhang Zhongjing would have explicitly stated so, as seen in the subsequent clauses regarding Gui Zhi Ma Huang Ge Ban Tang and Gui Zhi Er Yue Bi Yi Tang.
Taiyang disease, persisting for eight or nine days, resembling malaria, with fever and aversion to cold, where Heat is more prominent than Cold. The patient does not vomit, and bowel/bladder functions are relatively normal. The episodes occur two or three times a day. A slightly slow pulse indicates impending recovery. A faint pulse with aversion to cold indicates deficiency of both Yin and Yang; further sweating, purgation, or emesis are contraindicated. A facial complexion showing excessive heat/redness indicates the condition has not resolved. This is because the patient cannot produce a slight sweat, leading to body itching. Gui Zhi Ma Huang Ge Ban Tang is indicated.
Pathogenic factors entering the Taiyang channel, persisting beyond the eight-to-nine-day cycle without resolution, presenting with fever, aversion to cold, and alternating episodes resembling malaria. This indicates pathogenic factors lodged in Ying (Nutritive) and Wei (Defensive) levels, with simultaneous contraction of Wind and Cold. Heat predominating over Cold suggests Wind is stronger than Cold. Initially contracting Wind, followed by Cold invasion that fails to resolve, creates the malaria-like presentation, raising suspicion of Shao Yang involvement. However, Shao Yang involvement typically presents with vomiting and fever. The absence of vomiting confirms the pathogen has not entered Shao Yang. While Taiyang exterior pathogens can cause vomiting, they lack the alternating chills and fever characteristic of malaria; thus, the pathology remains in Taiyang. Absence of vomiting with Taiyang pathology indicates mild pathogenicity. Clear urine confirms the pathogen has not penetrated inward. Mild pathogenicity without interior penetration explains why bodily functions remain relatively normal. Episodes occurring two or three times daily indicate strong Wind in the Wei level and mild Cold in the Ying level. Pathogens floating on the exterior move shallowly, facilitating frequent alternation. The *Su Wen* states: "When pathogenic and healthy Qi meet, their quantities vary; if Yang Qi is abundant and Yin Qi scarce, attacks occur frequently." Thus, the *Malaria Chapter* emphasizes the role of Wei Qi. If pathogens entered Shao Yang, the depth would be greater, preventing multiple daily attacks; attacks would likely be once daily or every other day. Since the pathogen is superficial and the pulse is slightly slow ("Wei" here means slightly relaxed compared to before, not minute), recovery is imminent. Why? Unresolved Cold typically presents with a floating-tight pulse (or tight at both Cun and Chi); unresolved Wind presents with a floating-slow pulse. The current pulse is neither floating nor tight but gradually relaxing, signaling recovery. Conversely, if the pulse is faint with aversion to cold, it signifies impending deficiency rather than recovery. In the former context (fever/chills, frequent episodes), a "slightly relaxed" pulse indicates recovery. Here, "faint" refers to minute/small, distinct from "slightly slow." A faint pulse with only aversion to cold indicates Yin-Yang deficiency, aligning with the Da Qing Long Tang clause regarding faint pulse, sweating, and aversion to wind. Yin deficiency leads to fluid insufficiency; Yang deficiency leads to Wei Qi weakness. Thus, sweating, purgation, and emesis are contraindicated; warming meridians and tonifying deficiency becomes urgent. If, however, despite a slightly slow pulse, the face shows redness/heat, the Wind-Cold remains exterior and unresolved. This aligns with the Bing Bing (Combined Disease) clause describing persistent facial redness due to Yang Qi stagnation in the exterior, requiring dispersal. Unresolved Wind-Cold stagnates in the skin, preventing slight sweating to disperse pathogens, causing itching. Gui Zhi Ma Huang Ge Ban Tang is indicated to reduce dosage and resolve both aspects.
Gui Zhi Ma Huang Ge Ban Tang Formula
Gui Zhi (Cinnamon Twig) [1 liang 16 zhu], Bai Shao (White Peony Root) [1 liang], Sheng Jiang (Fresh Ginger) [1 liang, sliced], Da Zao (Jujube) [4 pieces], Gan Cao (Licorice Root) [1 liang], Ma Huang (Ephedra) [1 liang, nodes removed], Xing Ren (Apricot Seed) [20 seeds, skin removed, crushed].
Seven ingredients. Add 5 sheng of water. First boil Ma Huang for one or two boils, remove foam. Add remaining herbs. Boil to obtain 1.8 sheng. Strain. Warm dose: 0.6 sheng.
This formula addresses Wind-Cold injuring both Ying and Wei. Using half doses of Gui Zhi Tang and Ma Huang Tang resolves both. Although pathogens are superficial, Sour-astringent properties of Bai Shao might retain Cold in Ying; thus, only one-third is retained. To ensure slight sweating (already aided by Gui Zhi), Ma Huang and Xing Ren are also reduced to one-third. Fearful of excessive dispersion, Bai Shao's mild astringency balances the formula. The total volume boiled is small (1.8 sheng), and the dose is small (0.6 sheng), preventing excessive sweating while effectively dispersing pathogens. Balanced in action, it is termed a "mean" (timely/balanced) formula.
Taiyang disease, fever and aversion to cold, Heat predominating over Cold, faint pulse. This indicates "No Yang" (deficiency of Yang Qi); further sweating is contraindicated. Gui Zhi Er Yue Bi Yi Tang is indicated.
Taiyang Wind Strike, fever and aversion to cold, Heat predominating over Cold, resembles previous cases but lacks detailed description of malaria-like symptoms or absence of vomiting. Previous text stated slightly slow pulse indicates recovery; faint pulse with only aversion to cold indicates Yin-Yang deficiency precluding sweating/purgation/emesis. This clause continues explaining Yin-Yang deficiency, specifically focusing on Yang deficiency treatment. Previously, slightly slow pulse meant peace/recovery; now, faint pulse means fine, soft, and powerless. Hence, "No Yang." "No Yang" refers to decline of Ming Men True Yang Qi. With True Yang decline, ascending Wei Qi weakens, contraindicating sweating. Sweating would destroy Yang Qi, consistent with the Da Qing Long Tang warning against faint pulses. Since sweating is contraindicated for "No Yang," yet Wind-Cold requires sweating for resolution, a compromise is made. Modifying the method, Gui Zhi Er Yue Bi Yi Tang is used for mild resolution. Yue Bi Tang uses Gypsum (Shi Gao) exceeding Ephedra (Ma Huang) due to Heat predominating over Cold.
Gui Zhi Er Yue Bi Yi Tang Formula
Gui Zhi (Cinnamon Twig) [18 zhu], Bai Shao (White Peony Root) [18 zhu], Gan Cao (Licorice Root) [18 zhu], Sheng Jiang (Fresh Ginger) [1 liang 3 qian, sliced], Da Zao (Jujube) [4 pieces], Ma Huang (Ephedra) [18 zhu], Shi Gao (Gypsum) [24 zhu, crushed].
Seven ingredients. Crush. Add 5 sheng of water. Boil Ma Huang for one or two boils, remove foam. Add remaining herbs. Boil to obtain 2 sheng. Strain. Warm dose: 1 sheng. Originally, this formula was calculated as two parts Gui Zhi Tang and one part Yue Bi Tang, combined to drink 1 sheng. Now combined into one prescription named Gui Zhi Er Yue Bi Yi Tang.
This is also a formula for Wind-Cold injuring Ying and Wei. Named Gui Zhi Er Yue Bi Yi Tang because it uses 2/10 of a full Gui Zhi Tang decoction and 1/10 of a full Yue Bi Tang decoction. Examining weights: Gui Zhi and Bai Shao, originally 3 liang each, are reduced to 18 zhu (approx. 7.5 qian), which is 2/10 of the full dose. Yue Bi's Ma Huang, originally 6 liang, uses 18 zhu (7.5 qian). Gypsum, originally 8 liang, uses 24 zhu (1 liang). Compared to full formulas, these are 1/10 doses. Gan Cao, Sheng Jiang, and Da Zao are identical in both source formulas, maintaining proportional weights. Hence the name. Regarding the name "Yue Bi," Cheng Wuji interpreted it as "stimulating Spleen Qi," citing *Wai Tai Mi Yao*'s "Yue Pi Tang" as erroneous. This is a Taiyang exterior-dispersing formula, unrelated to the Spleen. Fang Youzhi explained: "Yue" means surpass; "Bi" means humble servant (female). Female represents Yin; humble means little. Since Shao Yang pulse is faint (No Yang), difficult to sweat, using "Yue Bi" implies inducing sweating within non-sweating principles. Yu Jiayan adopted this, suggesting Gypsum's acrid-cool nature resolves Cold, its mild nature likened to a servant, ensuring safety. I doubt this. Perhaps Zhang Zhongjing named it after curing a servant of a famous physician (Yue Ren), but such origins need not be deeply sought. Naming conventions are secondary; skepticism is preferable to forced interpretation.
After taking Gui Zhi Tang, profuse sweating occurs, pulse becomes flooding (Hong Da). Administer Gui Zhi Tang as before. If symptoms resemble malaria, occurring twice daily, sweating will resolve them. Gui Zhi Er Ma Huang Yi Tang is indicated.
This distinguishes Wind Strike from suspected Wind-Cold combination, preventing misuse of Ma Huang Tang. The first part discusses Wind Strike without Cold. From "resembling malaria" onward, it discusses cases with both Wind and Cold. Sun Wind Strike treated with Gui Zhi Tang: Wind pathogen in Wei is superficial; slight sweating resolves it. Profuse sweating violates the prohibition against drenching sweat, failing to cure. Flooding pulse (floating and large) results from Wind-stagnant Heat, not Yangming transmission. Yangming transmission would show Yangming signs. "Flooding" here distinguishes from Cold-tight pulses. Wind Strike pulse is typically floating-slow; why flooding? Failure of Gui Zhi Tang to resolve indicates heavy Wind and stagnant Heat, altering the pulse to flooding. Despite flooding pulse, Taiyang Wind Strike signs (fever, sweating) persist. Continue Gui Zhi Tang per previous method to induce slight sweating. If chills and fever alternate like malaria, occurring twice daily, Wind in exterior is constrained by Cold, forming Wind-Cold combination and Ying-Wei injury (similar to previous clause's 2-3 daily episodes). Superficial entry allows twice-daily occurrence. Treatment should not only use Gui Zhi Tang to resolve Wei-level Wind but also Ma Huang to induce Ying-level sweating. However, since episodes are only twice daily, Wei-level Wind is primary, Ying-level Cold secondary. Gui Zhi Er Ma Huang Yi Tang is used.
Gui Zhi Er Ma Huang Yi Tang Formula
Gui Zhi (Cinnamon Twig) [1 liang 17 zhu], Bai Shao (White Peony Root) [1 liang 6 zhu], Ma Huang (Ephedra) [16 zhu], Xing Ren (Apricot Seed) [16 seeds, skin and tips removed], Gan Cao (Licorice Root) [1 liang 2 zhu], Sheng Jiang (Fresh Ginger) [1 liang 6 zhu], Da Zao (Jujube) [5 pieces, split].
Seven ingredients. Add 5 sheng of water. Boil Ma Huang first for one or two boils, remove foam. Add remaining herbs. Boil to obtain 2 sheng. Strain. Warm dose: 1 sheng. Take twice daily.
Regarding similar malaria-like symptoms: Previous clause used Gui Zhi Ma Huang Ge Ban Tang because after 8-9 days, Wind-Cold combination injured Ying and Wei equally, with no predominance. This case originated as Wind Strike, treated initially with Gui Zhi Tang. Subsequent Cold contraction caused malaria-like shape, indicating Wind predominating over Cold. Hence Gui Zhi Er Ma Huang Yi Tang. Note: "Er" and "Yi" here differ from Gui Zhi Er Yue Bi Yi Tang. The latter used fractions of full formulas; this one uses double Gui Zhi Tang combined with single Ma Huang Tang proportions.
Taking Gui Zhi Tang, or incorrect purgation, still presents with stiff/painful head and neck,翕翕 (mild) fever, anhidrosis, fullness below heart, slight pain, and dysuria.
Gui Zhi Qu Gui Jia Fu Ling Zhu Shu Tang (Gui Zhi Tang minus Cinnamon Twig plus Poria and Atractylodes Macrocephala) is the principal formula.
Stiff/painful head and neck occur in both Wind and Cold. Mild fever indicates heat in skin/hair, typical of Wind. Anhidrosis is typical of Cold. These signs confirm Wind-Cold combination. Taking only Gui Zhi Tang treats Wind but not Cold, hence persistence of symptoms. Incorrect purgation causes fullness below heart and slight pain, indicating pathogen sinking and attempting to knot. Dysuria indicates Taiyang Heat invading Bladder, impairing Qi transformation. Treating with Gui Zhi Tang minus Cinnamon plus Poria/Atractylodes is unclear; likely a transcription error by later generations. Even if used, efficacy is doubtful. For Wind-Cold combination, Gui Zhi Ma Huang Ge Ban Tang is appropriate. For unremoved exterior signs post-purgation with fullness/pain (pathogen knotting but not formed), Zhi Zi Chi Tang (Emetic/Dispersing) is suitable. For Bladder invasion, Wu Ling San (Five Ingredient Powder with Poria) guides out fluids. Choosing Gui Zhi Tang minus Cinnamon plus Poria/Atractylodes is questionable. Gui Zhi Tang resolves Wind via Gui Zhi's acrid-warm diaphoresis. Bai Shao is used for Ying deficiency with spontaneous sweating to astringe Yin. For Cold with anhidrosis, it is contraindicated. Persisting stiff neck, mild fever, anhidrosis—without combining Ma Huang and Gui Zhi—if Gui Zhi is removed but Bai Shao kept, what about anhidrosis? Poria promotes urination, but Atractylodes moistens/dries dampness and tonifies middle. Where does the unresolved exterior go? I suspect inefficacy. Cheng Wuji noted: Exterior signs unremoved, anhidrosis, dysuria, fullness/pain below heart indicates fluid retention. Gui Zhi resolves exterior; Poria/Atractylodes move retained fluid. But Gui Zhi is removed; how can it resolve exterior? Can Poria/Atractylodes alone move fluid? Wang Kentang questioned: Head/neck stiffness indicates exterior pathogen. Post-sweat/purgation unresolved, why remove Gui Zhi and add Poria/Atractylodes? Ignoring exterior? Answer: Not a Gui Zhi pattern, but a Fluid pattern. Head/neck stiffness unresolved post-treatment, fullness/pain, dysuria indicate internal fluid accumulation, not exterior. Remove Gui Zhi, add Poria/Atractylodes. If urination improves, fluid moves, abdominal fullness decreases, heat clears, head/neck pain resolves. Like Shi Zao Tang syndrome, headache exists due to internal heat and latent fluid. Water-induced headache requires draining fluid, not attacking exterior. Once fluid is gone, health returns. Wang's question is reasonable, but his conclusion follows Cheng, attributing Poria/Atractylodes to fluid drainage, citing Shi Zao Tang headache as proof. Is this logical? Mild fever with anhidrosis clearly indicates Taiyang exterior. Fullness/pain below heart, without rigidity or costal pulling, why assume fluid retention? If fluid retention, even if Shi Zao Tang is too harsh, why exclude Ban Xia (Pinellia), acrid-warm and slippery? Can Bai Shao, Poria, and Atractylodes promote urination, drain water, and resolve all exterior signs? Does Zhang Zhongjing prescribe mismatched formulas as models for posterity? I suspect ancient texts were corrupted by later errors, not Zhang's original. Modern masters follow Cheng, forcing interpretations claiming universal efficacy. I do not believe this.
Gui Zhi Qu Gui Jia Fu Ling Zhu Shu Tang Formula
From Gui Zhi Tang formula, remove Gui Zhi, add Fu Ling (Poria) and Bai Zhu (Atractylodes Macrocephala), each 3 liang. Decoct and administer according to previous methods. Recovery occurs when urination improves.
Cold Damage with constipation for 6-7 days, headache with fever. Administer Cheng Qi Tang. If urine is clear, know pathogen is not interior, but still exterior. Must induce sweating. If headache persists, epistaxis (nosebleed) is likely. Gui Zhi Tang is indicated.
This clause starts with "Cold Damage" and ends with Gui Zhi Tang, indicating Wind-Cold combination. Otherwise, Gui Zhi Tang is contraindicated in Cold Damage. Due to Wind-Cold combination, the first part discusses Cold Heat returning to interior to introduce the "clear urine" section, reiterating Interior-Exterior differentiation. Since this is introductory, specific Cheng Qi variations (Da, Xiao, Tiao Wei) are omitted. 6-7 days indicates pathogen entering interior. Constipation for 6-7 days in Cold Damage indicates Heat knotting in interior. Headache with fever indicates interior Heat blocking Upper Jiao. Heat may be steaming or tidal (afternoon). This differs from Cold-Damage interior headache/fever. Cheng Qi Tang is used for purgation. If constipation for 6-7 days, headache/fever, but clear urine, pathogen is not interior; headache/fever pathogen remains exterior. Clear urine with headache indicates interior lacks Heat, but Wind-Yang pathogen is abundant above. If not dispersed, epistaxis will occur. Gui Zhi Tang induces slight sweating to resolve.
Cold Damage fever, resolving after half a day, then recurring irritability. Floating-rapid pulse. Further sweating is permissible. Gui Zhi Tang is indicated.
Using Gui Zhi Tang in Cold Damage shares meaning with previous clause: Wind-Cold combination. Ma Huang Tang resolves Ying pathogen. Recurring irritability after half-day resolution indicates Wei-level Wind pathogen unresolved. Pulse floating-rapid but not tight indicates Cold pathogen gone. Pulse theory: Floating indicates Wind, Rapid indicates Heat. Wind-Yang pathogen remains, Heat stagnates causing irritability. Induce slight sweating to resolve. Gui Zhi Tang is indicated.
Cold Damage 2-3 days, palpitations and irritability in the heart region. Xiao Jian Zhong Tang is indicated.
"Heart region" refers to chest/epigastrium, not necessarily the Heart organ. Palpitations indicate deficiency; irritability indicates Yang pathogen. 2-7 days into Cold Damage, exterior signs unresolved. Generally, palpitations in Wind/Cold result from mistaken sweating causing Yang loss, excessive water intake, or Qi/Blood deficiency with knotted/intermittent pulse. This clause lacks mistaken sweating/water intake mentions, nor explicit exterior signs. "Palpitations and irritability" indicates Cold pathogen gone, Middle Qi deficient, remaining Wind-Yang pathogen about to enter interior, causing irritability. Middle Qi deficiency prevents Shen Mai (Conception Vessel) Qi extension, causing palpitations. Yang pathogen sinking allows Heat to invade internally, causing empty irritability. If Cold were in Ying, Gui Zhi Tang would be inappropriate. Since Cold is gone, Wind remains in Taiyang, Gui Zhi Tang resolves Wei-level Wind. Added Yi Tang (Maltose) and doubled Bai Shao to establish Middle Qi.
Clarification of Errors: Xiao Jian Zhong Tang is Gui Zhi Tang with doubled Bai Shao and added Yi Tang. Commentators fail to distinguish that Gui Zhi Tang is contraindicated in Cold Damage, blindly applying it due to the term "Cold Damage," thereby placing...