病在三阴。则有传经直中之异。在三阳则有在经在腑之分。而太阳更以伤寒营风伤卫营卫俱伤为大关钥。故篇中分
辨风寒营卫甚严。不敢漫次一条。即犯本坏证。结胸痞满。分隶各自为篇。非独不仍叔和之旧。并不若尚论之混。收温
热条例于伤寒法中。至于释义。则嘉言独开生面裁取倍于诸家读者毋以拾唾前人为诮也。
病有发热恶寒者发于阳也无热恶寒者。发于阴也。发于阳者。七日愈。发于阴者。六日愈。以阳数七。阴数六故也。
此条以有热无热证阳病阴病之大端。言阳经受病。则恶寒发热。阴经受病。则无热恶寒。尚论以风伤卫气为阳寒伤
营血为阴。亦属偏见。发于阳者七日愈阳奇数也。阳常有余。故六日周遍六经余热不能收散。至七日汗出身凉而愈。阴
偶数也。阴常不足。故六日周遍六经则阳回身暖而愈也。
上条统论阴阳受病之原。
太阳之为病脉浮头项强痛而恶寒。
脉浮者。邪气并于肌表也。头项强痛者。太阳经脉上至于头也。恶寒者虽发热而犹恶寒不止。非无热也。以始热汗
未泄。故脉但浮不缓耳。
太阳病。发热汗出恶风脉缓者。名为中风。
上条但言脉浮恶寒。而未辨其风寒营卫。此条即言脉浮缓发热自汗。而始识其为风伤卫也。风属阳从卫而入。经云
阳者。卫外而为故也。今卫疏故自汗出而脉缓。
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。即与卫强营弱同义。阳浮者。阳邪入卫脉必外浮。阳性本热。风又善行。所以发热快捷。不待郁闭自发
也。阴弱者。营无邪助。比卫不足脉必内弱。阴弱不能内守。阳疏不为外固。所以致汗直易。不待覆盖自出也。自汗既
多。则营益弱矣。啬啬恶寒。内气馁也。淅淅恶风。外体疏也。恶风未有不恶寒者。世俗相传。谓伤风恶风。伤寒恶寒。
误人多矣。翕翕发热。乃气蒸湿润之热。比伤寒之干热不同。鼻鸣者。阳气上壅也。干呕者。阳邪上逆也。若外邪不解。
势必传里。鼻鸣干呕便是传入阳明之候。是以呕。则传。不呕。则不传也。故用桂枝汤解肌表之阳邪。而与发汗驱出阴
寒之法。迥乎角立也。
太阳病。头痛发热。汗出恶风者。桂枝汤主之。
太阳病。外邪未解。脉浮弱者。当以汗解宜桂枝汤。
外邪未解。曾服过发汗药可知。
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。
卫得邪助。而强。营无邪助。故为弱也。
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。
里无宿病。而表中风邪。汗出不愈者。必是卫气不和之故。设入于营。则里已近灾。未可宴然称无病矣。时发热者。
有时发热。有时不热。故先于未发热时。用解肌之法也。
病常自汗出者。此为营气和。营气和者。外不谐以卫气。不共卫气和谐。故尔以营行脉中。卫行脉外。复发其外营
卫和则愈。宜桂枝汤。
此明中风病所以卫受邪风。营反汗出之理。见营气本和。以卫受风邪。不能内与营气和谐。汗但外泄虽是汗出。宜
复发汗。使风邪外出。则卫不强而与营和矣。
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。
服汤反烦。必服药时不如法不 热粥助药力。肌窍未开徒用引动风邪。漫无出路。势必内入而生烦也。中风未传变
者。舍桂枝解肌。别无治法。故刺后仍用桂枝汤则愈。今虽不用刺法此义不可不讲。○内编云。服桂枝汤反烦不解者为
未及其
本通其督脉则愈。即是刺风池风府之意。○内经云。有病汗出而身热者风也。汗出而烦满不解者厥也。病名风厥。言烦
满不解。必致传入阴经而发热厥也。
太阳病头痛至七日以上自愈者。以行其经尽故也。若欲厥作再经者。针足阳明。使经不传则愈。
针足阳明。言刺冲阳使邪归并阳明不犯他界也。他经则不然。盖阳明中土。万物所归。无所复传之地也。或言伤寒
多有六七日尚头痛不止者。经言七日太阳病衰头痛少愈。则知其病六日犹在太阳。至七日而始衰也。所谓七日经尽者。
言邪气虽留于一经。而人之营卫流行。六日周遍六经。至七日复行受邪之经。正气内复邪气得以外解也。若七日不罢。
则邪热势盛。必欲再经而解。非必尽如一日太阳。二日阳明。六日传尽六经之为准则也。
风家表解而不了了者。十二日愈。
风邪虽去。而阳气之扰攘未得遽宁。俟十二日再周一经。则余邪尽出。必自愈矣。当静养以需。不可喜功生事也。
太阳病。外证未解者。不可下也。下之为逆。欲解外者宜桂枝汤主之。
下之为逆。不是独指变结胸等证而言。即三阴坏病。多由误下所致也。
太阳病先发汗不解。而复下之。脉浮者不愈浮为在外。故反下之。故令不愈。今脉浮故知在外。当须解外则愈宜桂
枝汤主之。
虽已下而脉仍浮。表证未变者当急解其外也。
夫阳病。脉浮大。问病者。言但便鞭耳。设利之为大逆。鞭为实。汗出而解。何以故脉浮。当以汗解。（鞭硬同）
脉浮为邪在表。其人大便虽数日不行。不足虞也。设里实燥结。必腹胀鞭满。又不得不从证下之。以其证急也。即
如阳明例中。有脉浮而大。心下反鞭。有热属脏者攻之。不令发汗一条。以其燥屎逆攻脾脏。所以心下反鞭。不可泥。
心下为阳分。脉浮为表邪而行发汗也。此则病患津液素槁。大便但鞭而无所苦。亦不致于结痛攻脾。只宜小建中汤多加
饴糖以和之。表解热除而津回。大便自通矣。不得已用导法可也。设误用承气攻之。则表邪内犯。故为大逆。与寸口脉
浮大。而医反下之。此为大逆同意。是皆凭脉而不证书也。
欲自解者。必当先烦。乃有汗而解。何以知之。脉浮。故知汗出解也。
天地郁蒸而雨作。人身烦闷而汗作。气机之动也。气机一动。则其脉必与证相应。故脉浮而邪还于表才得有汗。而
外邪尽从外解。设脉不以浮应。则不能作汗。其烦即为内入之候。又在言外矣。
桂枝本为解肌。若其人脉浮紧发热汗不出者。不可与也。常须识此。勿令误也。
寒伤营之脉证不可误用桂枝汤。以中有芍药收敛寒邪。漫无出路。留连肉腠。胎患无穷。故为首禁。
凡服桂枝汤吐者。其后必唾脓血也。
桂枝辛甘。本胃所喜。服之反吐其人湿热。素盛。可知矣。湿热更服桂枝。则热愈淫溢。上焦蒸为败浊。故必唾脓
血也。
酒客病不可与桂枝汤。得汤则呕。以酒客不喜甘故也。
酒为湿热之最。酒客平素湿热搏结胸中。才挟外邪必增满逆。所以辛甘之法。不可用。则用辛凉以撒其热。辛苦以
消其满。自不待言矣。后人不察。每以葛根为酒客所宜。殊不知又犯太阳经之大禁也。○上为桂枝汤三禁。
以上风伤卫。
太阳病或已发热。或未发热。必恶寒体痛呕逆。脉阴阳俱紧者。名曰伤寒。
凡伤寒。必恶寒发热。体痛呕逆。脉阴阳俱紧。或未发热者。寒邪初入。尚未郁而为热也。仲景虑恶寒体痛呕逆又
未发热。恐误认直中阴经之证。早于辨证之先。首揭此语以明之。
病患身大热。反欲得近衣者。热在皮肤者。寒在骨髓也。身大寒。反不欲近衣者。寒在皮肤。热在骨髓也。
恶寒为寒在表。或身热恶寒。为热在皮肤。寒在骨髓者。皆误也。而活人书以此为表里言之。详仲景论。止分皮肤
骨髓。而不曰表里者。盖以皮肉脉筋骨五者主于外。而克于身者也。惟曰脏曰腑方可言里。可见皮肤即骨髓之上。外部
浮浅之分。骨髓即皮肤之下。外部深沉之分。与经络属表。脏腑属里之例不同。凡虚弱素寒之人。感邪发热。热邪浮浅
不胜沉寒。故外怯而欲得近衣。此所谓热在皮肤。寒在骨髓。药用辛温汗之。至于壮盛素热之人。或酒客辈。感邪之初。
寒未变热。阴邪闭其伏热阴凝于外。热郁于内。故内烦而不欲近衣。此所谓寒在皮肤。热在骨髓，药用辛凉必矣。一发
之后。表解正和。此仲景不言之妙。若以皮肤为表骨髓为里。则麻黄汤证。骨节疼痛。其可名为有表。复为有里之证耶。
伤寒一日太阳受之。脉若静者。为不传。颇欲吐。若躁烦脉数急者。为传也。伤寒二三日。阳明少阳证不见者。为
不传也。
此条言病欲传不传之候。以此消息。盖营起中焦。以至寒邪伤营必脉紧无汗。故欲传。则欲吐躁烦脉数急也。若风
伤卫。则自汗。脉缓。故欲传。但有干呕而无吐。亦无烦躁脉数急之例也。
太阳病。头痛发热。身疼腰痛。骨节疼痛。恶风无汗而喘者。麻黄汤主之。
人身之阳。既不得宣越于外。则必壅塞于内。故令作喘。寒气刚劲。故令脉紧耳。汗者血之液。血为营。营强则腠
理闭密。虽热汗不出。故以麻黄汤重剂发之。内经所谓因于寒。体若燔炭。汗出而散是也。麻黄发汗最猛。故以桂枝监
之。甘草和之。杏仁润下以止喘逆也。方后注云。不须啜粥者。伤寒邪迫于里。本不能食。若强与食。反增其剧也。
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。
脉浮而紧当用麻黄。若浮而不紧。虽有似乎中风。然有汗无汗迥异。故不复言病证耳。至于浮数。其邪变热已极。
并宜麻黄发汗无疑也。
伤寒发汗。解半日许。复烦脉浮数者。可更发汗。宜桂枝汤主之。
明系汗后表疏。风邪袭入所致。宜改用桂枝汤者。一以邪传卫分。一以营虚不能复任麻黄也。
伤寒不大便六七日。头痛有热者。与承气汤小便复清者。知不在里。仍在表也。当须发汗。若头痛者必衄。宜桂枝
汤。
六七日不大便。明系里热。况有热以证之。更无可疑故须头痛。必是阳明热蒸。可与承气汤。然但言可与而不明言
大小。其旨原不在下。不过借此以证明里热耳。若小便清者。为里无热。邪未入里可知。则不可下。仍当散表以头痛有
热。寒邪怫郁于经。势必致衄。然无身疼目瞑。知邪气原不为重。故不用麻黄而举桂枝。以解散营中之邪热。则寒邪亦
得解散矣。
太阳病。脉浮紧无汗。发热身疼痛。八九日不解。表证仍在。此当发其汗。麻黄汤主之服药已。微除。其人发烦目
瞑。剧则必衄。衄乃解。所以然者。阳气重故也。
世本麻黄汤主之。在阳气重故也下。今正之。○服药已微除。复发烦者。余邪未尽也。目瞑烦剧者。热盛于经。故
迫血妄行而为衄。衄则余热随血而解也。以汗后复衄。故为阳气重也。或言汗后复衄。而热邪仍未尽。重以麻黄汤。散
其未尽之邪。非也。若果邪热不尽。则衄乃解三字。从何着落。八九日不解。则热邪伤血已甚。虽急夺其汗。而营分之
热不能尽除。故必致衄。然后得以尽其余热也。将衄何以目瞑。以火邪载血而上。故知必衄乃解。内经曰阳络伤则血外
溢。血外溢则衄。又云。阳气盛则目瞑。阴气盛。则目瞑。以阳邪并于阴。故为阴盛也。
太阳病。脉浮紧。发热身无汗。自衄者愈。
衄血成流则邪热随血而散。夺血则无汗也。设不自衄。当以麻黄汤发之。发之而邪解。则不衄矣。发之而余邪未尽。
必仍衄而解。
伤寒脉浮紧。不发汗。因而衄者。麻黄汤主之。
脉浮紧当以汗解。失汗则邪郁于经。不散而致衄。衄必点滴不成流。此热邪不得大泄病必不解。急宜麻黄汤汗之。
夺汗。则无血也。○仲景云衄家不可发汗。亡血家不可发汗。以久衄亡血已多。故不可发汗。复夺其血也。此因当汗不
汗。热毒蕴结而成。衄故宜发其汗。则热泄而衄自止矣。
伤寒二三日。心中悸而烦者。小建中汤主之。呕家不用建中汤。以其甜故也。
阳气内虚而心悸。阴气内虚而心烦。将来邪与虚搏。必致危困。急用建中养正祛邪。庶免内入之患。又虑心悸。为
水饮停蓄。烦为心气不宁。故复以呕证之。盖呕为湿热在上膈。故禁甜味恋膈耳○按小建中汤本桂枝汤风伤卫药也。中
间但加饴倍芍以缓其脾。使脾胃行其津液。则营卫自和。即命之曰建中。其旨微矣。
脉浮紧者。法当身疼痛。宜以汗解之假令尺中迟者。不可发汗。何以知其然。以营气不足血少故也。
尺中脉迟。不可用麻黄发汗。当频与建中汤和之。和之而邪解。不须发汗。设不解不妨多与。俟尺中有力。乃与麻
黄汗之可也。
脉浮数者。法当汗出而愈。若下之。而身重心悸者。不可发汗。当自汗出乃解所以然者。尺中脉微。此里虚须表里
实。津液自和。便自汗出愈。
误下体重心悸。纵脉仍浮数。亦不可复发其汗。设尺脉微。为里阴素虚。尤为戒也。脉浮而数。热邪已甚。将欲作
汗也。反误下之。致汗湿内外留着。所以身重心悸。当与小建中和其津液。必自汗而愈。
伤寒头痛。翕翕发热。形象中风。常微汗出自呕者。下之益烦。心中懊 如饥。发汗则致痉身强难以屈伸。薰之则
发黄。不得小便。久则发咳唾。
阳虚多湿之人。虽感寒邪。亦必自汗发热。而呕有似中风之状。发散药中。便须清理中气。以运痰湿。则表邪方得
When the pathogen invades the Three Yin meridians, there are differences between transmission (Chuan Jing) and direct invasion (Zhi Zhong). When it invades the Three Yang meridians, there is a distinction between being in the meridian (Zai Jing) and in the fu organ (Zai Fu). For Taiyang disease, the key lies in whether cold injury damages Ying (Ying) or wind injury damages Wei (Wei), or both Ying and Wei are damaged. Therefore, this chapter distinguishes strictly between wind-cold and Ying-Wei, avoiding arbitrary arrangement. Even if complications such as Jie Xiong (Chest Binding) or Pi Man (Fullness) occur due to violation of the primary syndrome, they are classified into separate chapters. This is not only because it does not follow Wang Shuhe's old examples, but also unlike Shang Lun Pian which mixes them. Including warm-heat regulations within the Shang Han methods, regarding the interpretation of principles, Huang Yuanyu (Jiayan) has opened a new path, with references exceeding those of other schools. Readers should not ridicule this as merely picking up others' spittle.
Diseases presenting with fever and aversion to cold originate from Yang; those without fever but with aversion to cold originate from Yin. Those originating from Yang heal in seven days; those originating from Yin heal in six days. This is because the number for Yang is seven, and for Yin is six.
This clause uses the presence or absence of heat as the major distinction between Yang diseases and Yin diseases. It states that when Yang meridians are diseased, there is aversion to cold and fever; when Yin meridians are diseased, there is no fever but aversion to cold. *Shang Lun* considers wind damaging Wei-Qi as Yang and cold damaging Ying-Blood as Yin, which is also a biased view. Healing in seven days for Yang origin is because Yang is an odd number. Yang Qi is often in excess, so after circulating through the Six Meridians in six days, residual heat cannot dissipate. By the seventh day, sweating occurs, the body becomes cool, and healing ensues. Yin is an even number. Yin Qi is often deficient, so after circulating through the Six Meridians in six days, Yang Qi returns, the body becomes warm, and healing ensues.
The previous clause generally discusses the origin of Yin and Yang contracting disease.
Taiyang disease is characterized by a floating pulse (Mai Fu), stiffness and pain in the head and neck, and aversion to cold.
A floating pulse indicates that pathogenic factors have converged on the muscular exterior. Stiffness and pain in the head and neck occur because the Taiyang meridian ascends to the head. Aversion to cold means that although there is fever, aversion to cold persists; it is not without heat. Because heat just started and sweat has not yet been released, the pulse is merely floating without being slow.
Taiyang disease presenting with fever, sweating, aversion to wind, and a slow pulse is named Wind Strike (Zhong Feng).
The previous clause only mentioned floating pulse and aversion to cold, without distinguishing wind-cold and Ying-Wei. This clause mentions floating-slow pulse, fever, and spontaneous sweating, allowing one to recognize this as wind damaging Wei. Wind belongs to Yang and enters through Wei. The Classics state: "Yang protects the exterior and maintains solidity." Now, because Wei is loose, spontaneous sweating and a slow pulse occur.
Taiyang Wind Strike presents with a floating Yang and weak Yin pulse. Floating Yang indicates heat spontaneously arises; weak Yin indicates sweat spontaneously exits. Symptoms include shivering aversion to cold (Se Se E Han), chilly aversion to wind (Xi Xi E Feng), mild fever (Xi Xi Fa Re), nasal congestion (Bi Ming), and dry retching (Gan Ou). Gui Zhi Tang (Cinnamon Twig Decoction) is the primary treatment.
Floating Yang and weak Yin is synonymous with strong Wei and weak Ying. Floating Yang indicates Yang pathogen entering Wei, causing the pulse to float externally. Yang nature is hot, and wind moves swiftly, so fever arises quickly without needing stagnation. Weak Yin indicates Ying lacks pathogenic support and is weaker than Wei, causing the pulse to be weak internally. Yin weakness fails to hold internally, while Wei looseness fails to secure externally, leading to easy sweating without covering. With excessive sweating, Ying becomes even weaker. Shivering aversion to cold reflects internal Qi deficiency. Chilly aversion to wind reflects external bodily looseness. One who fears wind invariably fears cold; the common saying that wind strike causes fear of wind while cold strike causes fear of cold misleads many. Mild fever refers to moist heat from vaporization, different from the dry heat of cold strike. Nasal congestion indicates Yang Qi obstructing upwards. Dry retching indicates Yang pathogen rebelling upwards. If external pathogens do not resolve, they will inevitably transmit inward; nasal congestion and dry retching are signs of transmission to Yangming. Thus, vomiting indicates transmission; not vomiting indicates no transmission. Therefore, Gui Zhi Tang is used to release Yang pathogens from the muscle layer, which is distinctly different from methods that induce sweating to drive out Yin cold.
Taiyang disease presenting with headache, fever, sweating, and aversion to wind is treated with Gui Zhi Tang (Cinnamon Twig Decoction).
In Taiyang disease, if external pathogens are unresolved and the pulse is floating and weak, sweating should be induced using Gui Zhi Tang (Cinnamon Twig Decoction).
External pathogens are unresolved, indicating that diaphoretic medicines were previously taken.
In Taiyang disease, fever and sweating indicate weak Ying and strong Wei, causing sweating. To rescue from evil wind, Gui Zhi Tang (Cinnamon Twig Decoction) is appropriate.
Wei becomes strong with pathogenic assistance, while Ying remains weak without pathogenic assistance.
If a patient has no internal organ diseases but experiences periodic fever and spontaneous sweating that does not resolve, this is due to disharmony of Wei Qi. Inducing sweating before the onset of fever will lead to recovery; Gui Zhi Tang (Cinnamon Twig Decoction) is indicated.
With no internal chronic disease but external wind-strike causing non-resolving sweating, it must be due to Wei Qi disharmony. If the pathogen entered Ying, the interior would already be compromised, and one could not claim health. Periodic fever means fever comes and goes; thus, applying muscle-releasing methods before fever onset is necessary.
Frequent spontaneous sweating indicates harmonious Ying Qi. Harmonious Ying Qi implies external disharmony where Ying and Wei do not coordinate. Since Ying circulates within the vessels and Wei outside, inducing sweating again will harmonize Ying and Wei, leading to recovery; Gui Zhi Tang (Cinnamon Twig Decoction) is indicated.
This clarifies why in wind-strike, Wei contracts wind pathogen while Ying sweats. Ying Qi is originally harmonious, but Wei, affected by wind, cannot harmonize internally with Ying. Sweat leaks outward; although sweating occurs, inducing sweating again expels the wind pathogen, making Wei harmonious with Ying.
In Taiyang disease, if Gui Zhi Tang (Cinnamon Twig Decoction) initially causes increased irritability without resolution, first puncture Feng Chi (GB20) and Feng Fu (DU16) acupoints, then administer Gui Zhi Tang (Cinnamon Twig Decoction) for recovery.
Increased irritability after taking medicine suggests improper administration, such as failing to drink hot porridge to assist medicinal power. Without opening skin pores, merely drawing out wind pathogen leads to internal entry and irritability. For wind-strike without transmission, besides Gui Zhi releasing the muscle layer, there is no other treatment. Hence, puncturing followed by Gui Zhi Tang ensures recovery. Although puncture may not be used now, this principle must be understood. ○ Internal Compilation states: Irritability after Gui Zhi Tang indicates failure to reach the root; unblocking the Du Meridian leads to recovery, implying the intent of puncturing Feng Chi and Feng Fu. ○ *Nei Jing* states: Disease with sweating and body heat is wind; sweating with irritability and fullness unresolved is Jue. The disease name is Wind-Jue. Unresolved irritability and fullness will transmit to Yin meridians causing fever and Jue.
In Taiyang disease, headache resolving spontaneously after seven days occurs because the meridian cycle is complete. If symptoms recur requiring another meridian cycle, puncture the Foot-Yangming meridian to prevent transmission and ensure recovery.
Puncturing Foot-Yangming refers to stimulating Chongyang (ST42) to guide pathogens into Yangming, preventing invasion of other boundaries. Other meridians differ. Yangming belongs to Central Earth, the destination of all things, where no further transmission occurs. Some say cold damage often causes persistent headache beyond six or seven days. The Classic says Taiyang disease declines on the seventh day, with headache slightly improving, indicating the disease remained in Taiyang until the sixth day and declined on the seventh. "Seven days meridian completion" means although pathogen stays in one meridian, Ying-Wei circulation completes the Six Meridians in six days. On the seventh day, it re-enters the affected meridian; internal Zheng Qi recovers, allowing external expulsion of pathogens. If not resolved by seven days, heat pathogen is strong, requiring another cycle to resolve, not necessarily following the strict daily progression of Taiyang, Yangming, etc.
For wind patients, if exterior resolves but mental clarity remains poor, recovery takes twelve days.
Although wind pathogen is gone, Yang Qi agitation has not settled. Waiting for twelve days allows another meridian cycle, expelling residual pathogens for spontaneous recovery. Rest quietly; do not seek quick results and create problems.
In Taiyang disease, if exterior syndromes are unresolved, purgation is contraindicated. Purging is contrary to principles. To resolve the exterior, Gui Zhi Tang (Cinnamon Twig Decoction) is indicated.
"Purging is contrary" does not only refer to complications like Jie Xiong. Even Three Yin complicated diseases often result from erroneous purging.
In Taiyang disease, if initial sweating fails to resolve the condition, followed by purging, and the pulse remains floating, it is not resolved. Floating indicates exterior location; thus, purging was wrong, causing non-resolution. Current floating pulse confirms exterior location; resolving the exterior is necessary for recovery, indicated by Gui Zhi Tang (Cinnamon Twig Decoction).
Even after purging, if the pulse remains floating and exterior signs persist, immediate exterior resolution is required.
In Yang diseases, if the pulse is large and floating, and the patient reports only hard stools, purgation is a major error. Hardness indicates excess; resolution via sweating is expected. Why? Because the pulse is floating, sweating is indicated. (Hardness is synonymous with firmness).
Floating pulse indicates pathogen at the exterior. Even if bowel movements cease for several days, there is no need for concern. If interior excess and dry accumulation exist, abdominal distension and hardness will occur, necessitating purgation due to urgency. For example, in Yangming cases, a large floating pulse with epigastric hardness and heat belonging to Zang organs requires attack, not sweating. This is because dry feces attack the Spleen, causing epigastric hardness; do not rigidly apply this. Epigastrium is Yang aspect; floating pulse is exterior pathogen requiring sweating. However, if the patient has chronically dry fluids, hard stools without discomfort, and no binding pain attacking the Spleen, Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) with added maltose is suitable to harmonize. Once exterior resolves and heat clears, fluids return, and bowels open naturally. Enemas can be used if necessary. Misusing Cheng Qi Tang (Order the Qi Decoctions) allows exterior pathogen to invade interior, constituting a major error, consistent with floating-large pulse at Cun Kou where physician erroneously purges. These cases rely on pulse rather than symptoms.
Spontaneous resolution begins with irritability, followed by sweating and resolution. How do we know? Floating pulse indicates sweating leads to resolution.
Heavenly moisture condensation causes rain; human body irritability causes sweating, driven by Qi mechanism movement. When Qi moves, pulse corresponds to symptoms. Floating pulse and returning pathogen to exterior allow sweating, expelling external pathogens completely. If pulse does not respond with floating, sweating cannot occur; irritability indicates internal entry, implied beyond words.
Gui Zhi Tang is primarily for releasing the muscle layer. If the pulse is floating-tight, with fever and no sweating, it is contraindicated. Remember this always to avoid error.
Cold damaging Ying pulses and symptoms must not be treated with Gui Zhi Tang (Cinnamon Twig Decoction) because Shaoyao (Peony Root) astringes cold pathogen, leaving no exit, lingering in flesh and interstices, causing infinite harm. Thus, it is the first prohibition.
Anyone who vomits after taking Gui Zhi Tang (Cinnamon Twig Decoction) will later expectorate pus and blood.
Guizhi (Cinnamon Twig) is pungent and sweet, pleasing to the Stomach. Vomiting after ingestion indicates pre-existing damp-heat abundance. Damp-heat combined with Guizhi increases heat overflow, steaming upper Jiao into turbid败败 matter, leading to expectoration of pus and blood.
Patients habitually drinking alcohol should not receive Gui Zhi Tang (Cinnamon Twig Decoction); doing so causes vomiting because alcoholics dislike sweet flavors.
Alcohol is the most potent source of damp-heat. Alcoholics have damp-heat knotting in the chest. Contracting external pathogens increases fullness and rebellion. Therefore, pungent-sweet methods are contraindicated; instead, use pungent-cool to disperse heat and pungent-bitter to reduce fullness. Later generations mistakenly believe Gegen (Kudzu Root) suits alcoholics, unaware it violates a major Taiyang prohibition. ○ Above are the three prohibitions for Gui Zhi Tang.
Above discusses wind damaging Wei.
Taiyang disease, whether fever has appeared or not, must present with aversion to cold, body pain, retching, and tight pulses at both Cun and Chi positions. This is named Cold Damage (Shang Han).
All Cold Damage cases involve aversion to cold, fever, body pain, retching, and tight pulses. Absence of fever indicates initial cold pathogen invasion, not yet stagnant into heat. Zhang Zhongjing anticipates confusion with direct invasion of Yin meridians due to aversion to cold, body pain, and retching without fever. He highlights this early to clarify differentiation.
Patient with high body heat desiring clothing indicates heat at the skin level and cold in the bone marrow. Patient with low body heat refusing clothing indicates cold at the skin level and heat in the bone marrow.
Aversion to cold signifies cold at the exterior. Body heat with aversion to cold signifies heat at skin and cold in bone marrow—both are errors. *Huo Ren Shu* interprets this as exterior-interior. Detailed study of Zhang Zhongjing’s treatise shows distinction between skin and bone marrow, not exterior-interior. Skin, flesh, vessels, sinews, and bones govern the exterior. Only Zang and Fu organs constitute interior. Skin is superficial exterior above bone marrow; bone marrow is deep exterior below skin. This differs from meridians being exterior and organs being interior. In frail, chronically cold individuals contracting pathogens, shallow heat cannot overcome deep cold, causing external timidity and desire for clothing. This is "heat at skin, cold in bone marrow," treated with pungent-warm diaphoretics. In robust, chronically hot individuals or alcoholics, upon initial contraction, cold has not transformed to heat; Yin pathogen closes latent heat, Yin congeals externally, heat stagnates internally, causing internal irritability and refusal of clothing. This is "cold at skin, heat in bone marrow," treated with pungent-cool methods. After one release, exterior resolves and Zheng Qi harmonizes; this is Zhang Zhongjing’s subtle wisdom. Confusing skin with exterior and bone marrow with interior makes Ma Huang Tang (Ephedra Decoction) syndrome of bone joint pain seem both exterior and interior, which is illogical.
On the first day of Cold Damage, Taiyang receives the pathogen. If the pulse is quiet, transmission has not occurred. Desire to vomit, irritability, and rapid-urgent pulse indicate transmission. On the second or third day, absence of Yangming and Shaoyang symptoms indicates no transmission.
This clause discusses signs of impending transmission. Ying originates in Middle Jiao. Cold damaging Ying causes tight pulse and no sweating. Transmission involves desire to vomit, irritability, and rapid-urgent pulse. Wind damaging Wei causes spontaneous sweating and slow pulse. Transmission involves dry retching without vomiting, and lacks irritability and rapid-urgent pulse.
Taiyang disease presenting with headache, fever, body ache, lower back pain, joint pain, aversion to wind, no sweating, and wheezing is treated with Ma Huang Tang (Ephedra Decoction).
Human Yang Qi, unable to diffuse externally, stagnates internally, causing wheezing. Cold Qi is rigid, causing tight pulse. Sweat is fluid of blood; blood is Ying. Strong Ying closes pores; despite heat, no sweat occurs. Thus, heavy dose of Ma Huang Tang induces sweating. *Nei Jing* states: Caused by cold, body like burning charcoal, resolved by sweating. Ma Huang induces strongest sweating; Guizhi (Cinnamon Twig) monitors it; Gancao (Licorice Root) harmonizes it; Xingren (Apricot Seed) moistens downward to stop wheezing. Post-formula note: Porridge is unnecessary. Cold pathogen presses inward, appetite is lost. Forcing food worsens condition.
Floating pulse indicates disease at exterior; sweating is indicated, Ma Huang Tang (Ephedra Decoction) is appropriate. Floating and rapid pulse indicates sweating is appropriate, Ma Huang Tang (Ephedra Decoction) is appropriate.
Floating-tight pulse requires Ma Huang. If floating but not tight, resembling Wind Strike, the difference in sweating/non-sweating is distinct, so syndrome description is omitted. Regarding floating-rapid, pathogen has transformed to extreme heat; Ma Huang sweating is undoubtedly appropriate.
After Cold Damage sweating, if irritability recurs half a day later with floating-rapid pulse, sweating may be induced again, indicated by Gui Zhi Tang (Cinnamon Twig Decoction).
This clearly results from post-sweat exterior looseness and wind pathogen invasion. Switching to Gui Zhi Tang (Cinnamon Twig Decoction) is due to pathogen transmitting to Wei division and Ying deficiency unable to tolerate Ma Huang.
In Cold Damage, constipation for six to seven days with headache and heat suggests Cheng Qi Tang (Order the Qi Decoction). If urine is clear, pathogen is not in interior but remains at exterior. Sweating is required. If headache occurs, epistaxis (Nv) is likely; Gui Zhi Tang (Cinnamon Twig Decoction) is indicated.
Constipation for six to seven days indicates interior heat, confirmed by fever. Headache suggests Yangming heat steaming; Cheng Qi Tang (Order the Qi Decoction) may be given. However, "may be given" without specifying size implies the goal is not purgation but proving interior heat. Clear urine indicates no interior heat; pathogen has not entered interior. Purgation is contraindicated; exterior dispersion is needed. Headache and heat suggest cold pathogen constrained in meridians, likely causing epistaxis. Lack of body pain and eye closing indicates pathogen is not severe; thus, Ma Huang is avoided, and Gui Zhi is chosen to disperse Ying heat, allowing cold pathogen to resolve.
Taiyang disease, floating-tight pulse, no sweating, fever, body pain, unresolved for eight to nine days, exterior signs persist. Sweating is indicated, Ma Huang Tang (Ephedra Decoction) is primary. After medication, slight relief occurs, but patient becomes irritable and eyes close. Severe cases result in epistaxis, which brings resolution. This is because Yang Qi is heavy.
World editions place "Ma Huang Tang is primary" after "because Yang Qi is heavy." Corrected here. ○ Slight relief after medication with recurring irritability indicates residual pathogen. Eye closing and severe irritability indicate heat盛 in meridians forcing blood recklessly, causing epistaxis. Epistaxis allows residual heat to resolve with blood. Post-sweat epistaxis indicates heavy Yang Qi. Some argue that post-sweat epistaxis with unresolved heat requires heavy Ma Huang Tang to scatter remaining pathogen. This is incorrect. If heat were unresolved, "epistaxis brings resolution" would be meaningless. Eight to nine days unresolved means heat has severely injured blood. Even urgent sweating cannot fully remove Ying heat, necessitating epistaxis to exhaust residual heat. Why eye closing before epistaxis? Fire pathogen carries blood upward. *Nei Jing* states: Injury to Yang collaterals causes external blood overflow, i.e., epistaxis. Also: Excess Yang causes eye closing; excess Yin causes eye closing. Yang pathogen merging into Yin creates apparent Yin excess.
Taiyang disease, floating-tight pulse, fever, no body sweating, spontaneous epistaxis leads to recovery.
Epistaxis flowing freely disperses heat pathogen with blood; loss of blood means no sweat. If spontaneous epistaxis does not occur, Ma Huang Tang (Ephedra Decoction) should induce sweating. If pathogen resolves, no epistaxis occurs. If residual pathogen remains, epistaxis will still bring resolution.
Cold Damage, floating-tight pulse, failure to sweat resulting in epistaxis, Ma Huang Tang (Ephedra Decoction) is primary.
Floating-tight pulse requires sweating. Failure to sweat causes pathogen constraint in meridians, leading to epistaxis. Epistaxis is scanty, not flowing, meaning heat pathogen cannot vent greatly, and disease will not resolve. Urgently induce sweating with Ma Huang Tang (Ephedra Decoction). Loss of sweat leads to blood loss. ○ Zhang Zhongjing states: Patients prone to epistaxis or blood loss should not be sweated, as prolonged epistaxis causes significant blood loss. Here, failure to sweat when indicated causes heat-toxin accumulation leading to epistaxis. Sweating vents heat, stopping epistaxis.
Cold Damage, second or third day, palpitations and irritability are treated with Xiao Jian Zhong Tang (Minor Construct the Middle Decoction). Patients with vomiting should not use Xiao Jian Zhong Tang due to its sweetness.
Internal deficiency of Yang Qi causes palpitations; internal deficiency of Yin Qi causes irritability. Future struggle between pathogen and deficiency leads to danger. Urgently use Jian Zhong to nourish Zheng Qi and expel pathogen, preventing internal invasion. Palpitations may indicate water-fluid retention; irritability indicates Heart Qi unrest. Vomiting is used to confirm diagnosis. Vomiting indicates damp-heat in Upper Jiao; thus, sweet taste adhering to diaphragm is prohibited. ○ Note: Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) is originally a Gui Zhi Tang (Cinnamon Twig Decoction) formula for wind damaging Wei. Adding maltose and doubling Shaoyao (Peony Root) soothes the Spleen, allowing Spleen and Stomach to transport fluids, harmonizing Ying and Wei naturally. Named "Construct Middle," its meaning is profound.
Floating-tight pulse typically causes body pain, requiring sweating. If Chi pulse is slow, sweating is contraindicated. Why? Because Ying Qi is insufficient and Blood is scarce.
Slow Chi pulse contraindicates Ma Huang sweating. Frequent administration of Jian Zhong Tang (Construct the Middle Decoction) to harmonize is appropriate. If harmony resolves pathogen, sweating is unnecessary. If unresolved, continue administration until Chi pulse strengthens, then Ma Huang sweating is permissible.
Floating-rapid pulse typically resolves with sweating. If purged, causing heaviness and palpitations, sweating is contraindicated. Spontaneous sweating will bring resolution. Why? Micro Chi pulse indicates interior deficiency. Exterior and Interior must become solid; fluids self-harmonize, leading to spontaneous sweating and recovery.
Erroneous purging causing heaviness and palpitations, even if pulse remains floating-rapid, prohibits further sweating. Micro Chi pulse indicates inherent Yin deficiency, a serious warning. Floating-rapid pulse indicates severe heat, about to sweat. Erroneous purging retains sweat-dampness internally and externally, causing heaviness and palpitations. Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) harmonizes fluids, leading to spontaneous sweating and recovery.
Cold Damage headache, mild fever, resembling Wind Strike, frequent slight sweating and spontaneous vomiting. Purging increases irritability and epigastric distress like hunger. Sweating causes spasms, body stiffness with difficulty bending/extending. Fumigation causes jaundice, inability to urinate, long-term cough and sputum.
Individuals with Yang deficiency and dampness, even contracting cold, experience spontaneous sweating, fever, and vomiting resembling Wind Strike. Diaphoretic medicines must clear Middle Qi to transform phlegm-dampness, allowing exterior pathogen to resolve.