凡三十八条方十八
中风者。单只卫中于风而病也。伤寒者。单只荣伤于寒而病也。若风寒俱有而中伤。则荣卫
皆受而俱病。故以荣卫俱中伤风寒而病者为下编。盖寒虽专令乎冬。而风则无时不有。所以或则
单中单伤。或则俱有而中伤也。单中单伤而为病者已云难治矣。然则俱中伤而病者。其治不尤难乎。
何也。寒须发汗。风则解肌。欲并行而不悖。其为两难也。何如哉。故能发两难发之汗者名曰青
龙。能解两难解之热者名曰白虎。能救无两难。而误服大青龙之逆者则曰真武焉。夫所谓青
龙白虎真武者。言其灵应不难于其所难。妙效验于不可测度。有如此其神。神汤之谓也。神其神。
礼记曰唯圣者能之。其斯之谓乎。学人能明诸此。始可与言医也已。
（一）太阳中风。脉浮紧。发热。恶寒。身疼痛。不汗出而烦躁者。大青龙汤主之。若脉浮
弱。汗出。恶风者。不可服。服之则厥逆。筋惕肉 。此为逆也。以真武汤救之。
末后六字。旧本大青龙汤主之。黄氏正之如此。盖既曰不可服。服之为逆。则安得又复有大
青龙汤主之之文。传写之误甚明。黄氏正之甚是。当从之。后人又因其更改致疑。并六字皆删之。
删之则上编第二十五条无证书据。故存朱以备通考。然此与下条互相发明而同一治。故合二说并
见于下。
（二）伤寒脉浮缓。身不疼但重。乍有轻时。无少阴证者。大青龙汤发之。
大青龙汤方
麻黄（六两去节） 桂枝（二两去皮） 甘草（二两炙） 杏仁（四十枚去皮尖） 生姜
（三两切） 大枣（十二枚擘） 石膏如鸡子大（绵裹碎）
上七味。以水九升。先煮麻黄减二升。去上沫。内诸药。煮取三升。去滓。温服一升。取微
似汗。汗出多者温粉扑之。一服汗者。停后服。汗多亡阳。遂虚。恶风烦躁不得眠也。
上条太阳中风者。言有上编第三条之证也。病属太阳则脉浮。然浮以候风。紧以候寒。发热者。
中风热即发也。恶寒身疼痛。不汗出。皆寒也。风为烦。寒则躁。盖谓风寒俱有而中伤。风多寒少
之证。犹指言此风之中有寒之谓也。此条伤寒者。言有中篇首条之证也。缓者风之诊。身不疼亦
风也。但重。寒也。乍有轻时。亦为有风而然也。无少阴证者。言若是但欲寐。则涉于少阴之疑似矣。
今是但重。故曰无少阴证。亦谓风寒两中伤。荣卫俱受病。寒多风少之证。犹指言此寒之
中有风之谓也。盖风寒二者。大率多相因而少相离。有寒时。不皆无风。有风时。不皆无寒。所
以单中单伤者。固尝自是。相兼而中伤者。亦尝多有。此大青龙之所以作也。二条者互文而互相
发明。以为此篇之小总。太阳分病之纪。上编一。中篇二。此其三焉。三者。太阳一经吃紧太三辨也。
以下凡似此云云以为称首者。皆风寒俱有而中伤之证。其例则又皆统乎此也。夫风寒二治。大法
不外乎桂枝麻黄之二汤。然桂枝汤中忌麻黄。而麻黄汤中反用桂枝。此中有极深奥义。非言国文
字可以形容暴白者。要在人之心领神会耳。大青龙者。桂枝麻黄二汤合剂之变制也。故为并中风
寒之主治。校之桂枝麻黄各半汤。与桂枝二麻黄一汤。则少芍药而多石膏。去芍药者。不欲其收也。
以其无芍药而观之。即
麻黄汤方加石膏姜枣也。姜枣本桂枝汤中所有。其制则重在石膏。按本草。石膏辛甘大寒。辛以
散风。甘以散寒。寒以除热。故为并中风寒发热之用。然青龙以桂枝麻黄得石膏之辛甘而有青龙
之名。其白虎亦以知母粳米得石膏之辛寒而有白虎之名。一物二用。得君而成其功名于异世。神
变于时者也。夫所谓青龙白虎者。青乃木色。龙乃木神。木主春。春热而烦躁。雷雨解而致和焉。
人之汗。以天地之雨名之。龙兴云雨至。发烦躁之汗而荣卫以和。龙之所以为汤。神汤之谓也。
白乃金色。虎乃金神。金主秋。秋热而燥渴。金风解而荐凉焉。人之气以天地之疾风名之。虎啸
谷风生。解燥渴之热而表里以凉。虎之所以为汤。神汤之谓也。然均是龙也而一则曰主之。一则
曰发之。何也。主之者。以烦躁之急疾属动而言。发之者。以但重之沉默属静而言之也。上条末
节。脉微弱汗出恶风。盖指上编阳浮而阴弱中风之证而言。中风误服大青龙则为逆。其第二十五
条是也。与此参看。其义自合。夫以中风之用桂枝汤。伤寒用麻黄汤。风寒俱中伤而用大青龙汤。
向使认病亲切于克始。用汤的对于及时。则三法行之之下。风寒尚有余治乎。然则三百九十七一
百一十三者。医药注误之所致十八九。病病传变之所致无二三。由此观之。司命君子可能不惕惕
于心乎。是故。仲景氏之所以若然者。岂得已哉。惟其不得已。故谆谆然曰。知犯何逆。随证治之。
知犯何逆。以法治之。斯言也。岂非深忧天下后世而自致其不能尽其所欲言之意耶。呜呼。以仲
景氏方法之多如许。而犹自致其不能尽其所欲言之意如此。则后之以截江。杀车。活人。类证。
纂要。自谓能尽伤寒之治。而胶柱以待天下后世者。吾不知其是诚何心也。
（三）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。服药已。
微除。其人发烦目瞑。剧者必衄。衄乃解。所以然者阳气重故也。麻黄汤主之。
太阳病。脉浮紧无汗发热身疼痛。皆与首条同。而无恶寒烦躁。则是较轻于首条。亦风寒俱
有而中伤之证也。微除。言虽未全罢亦已减轻也。发烦风壅而气昏也。目瞑。寒郁而血滞也。剧。
作衄之兆也。衄。鼻出血也。鼻为肺之窍。肺为阳中之阴而主气。阳邪上盛。所以气载血上妄行
而逆出于鼻也。阳气。以风而言也。风为阳而由气道。所以得随衄散解。故曰阳气重故也。用麻
黄汤者。以寒属阴。性沉滞而难解。所以须发之也。方见中篇。下同。
（四）太阳病。脉浮紧。发热身无汗。自衄者愈。
此承上条复以其更较轻者言。以见证亦有不治自愈之变。所以晓人勿妄治以致误之意。太阳
病脉浮紧。发热身无汗与上条同。而无疼痛。既无疼痛。则比之上条又更较轻于首条可知矣。所以
不待攻治。得衄则亦自愈。得衄自愈者。汗本血之液。北人谓衄为红汗。达此义也。
（五）伤寒。脉浮紧。不发汗。因致衄者。麻黄汤主之。
以伤寒为首称而承之以脉浮紧者。寒多风少之谓也。上二条皆风多寒少。前条以服药已微除。
汗发不对而致衄。上条以较轻得自衄。此以寒多不发汗而致衄。三条之所以辨差分也。盖寒多则于
法当发汗。当发而失于不发。热郁血乱。所以衄也。衄则阳邪之风散。麻黄汤者。发其尚未散之寒也。
（六）脉浮紧者法当身疼痛。宜以汗解之。假令尺中迟者。不可发汗。何以知之。然以荣气
不足。血少故也。
令。平声。此总上三条而着其不可汗之脉。所以严致戒慎之意也。盖尺以候阴。迟为不足。
血。阴也。荣主血。汗者。血之
液。尺迟不可发汗者。嫌夺血也。
（七）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。
桂枝麻黄各半汤方
杏仁（二十四个去皮尖） 桂枝（一两十六铢去皮） 芍药（一两） 生姜（一两切） 甘草
（一两炙） 麻黄（一两去节） 大枣（四枚擘）
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。
八九日。约言久也。如疟状。谓有往来寒热而无作辍之常也。发热恶寒热多寒少者。风寒俱有而
寒少风多也。不呕不渴清便欲自可。邪之往来。出者未彻表。入亦未及里也。一日二三度发。乃
邪居浅近。则往来易及而频数。故脉亦微缓而谓为欲愈也。脉微而恶寒已下。重以不得解者言而
出其治也。阴言后。阳言前。俱虚。故禁攻也。更。再也。不可汗。已过表也。不可吐下。未见
有里也。热色。阳浮外薄也。然阳虽外薄。以阴寒持之而不能散。所以小汗亦不能得出。气郁而
痒也。桂枝麻黄各半汤者。总风寒而两解之之谓也。此与第十四篇第二十章互看。
（八）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。
桂枝二越婢一汤方
桂枝（十八铢去皮） 芍药（十八铢） 甘草（十八铢炙） 生姜（一两三钱切） 大枣
（四枚擘） 麻黄（十八铢去节） 石膏（二十四铢碎绵裹）
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。
发热恶寒。热多寒少。与上条同。上条以脉微而恶寒为阴阳俱虚。此以脉微弱为无阳。两皆
不可更汗亦同。然风为阳。病属太阳。而曰无阳。诚不可晓。阙疑可也。或曰。无阳者。谓有疾
在阴而无在阳也。审药识病。即越婢观之可知矣。越。逾也过也。婢。女子之卑者也。女子。阴也。
卑。少也。言其人本来虚弱。有宿疾在少阴。少阴之脉本微弱而有不可发汗之义。所以但责其难
发汗之过在于少阴。法则谓之无阳。方则谓之越婢。且是汤也。名虽越婢之辅桂枝。实则桂枝麻
黄之合济。乃大青龙以芍药易杏仁之变制耳。去杏仁者。恶其从阳而主气也。用芍药者。以其走
阴而酸收也。以此易彼而曰桂枝二。则主之以不发汗可知。而越婢一者。乃麻黄石膏之二物。则
是寓微发于不发之中亦可识也。寓微发者。寒少也。主之以不发者。风多而宿疾在少阴也。又况
首条末节不可服大青龙以发汗。亦由脉微弱。首条末节者。以太阳中风言也。此与上二条者。
皆以风多寒少言也。合而观之。则无阳之阳义不微矣乎。说者如此。未知是否。
（九）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。
桂枝二麻黄一汤方
桂枝（一两十七铢去皮） 芍药（一两六铢） 麻黄（十六铢去节） 生姜（一两六铢切）
杏仁（十六个去皮尖） 甘草（一两二铢炙） 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。
服桂枝汤。证转大汗出。脉转洪大者。风多寒少。风邪欲散而寒持之。两皆不得解而热反甚也。
与桂枝汤如前法者。重赜之也。形如疟日再发者。邪居浅而外向。终为微寒所持。故曰汗出必解。
言须发之也。桂枝二麻黄一汤者。重解风而轻于散寒也。
（十）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。
此与上条同而多大烦渴。盖比上条汗更出过多。亡津液而表里燥热更甚。所以用白虎两解表
里之热。加人参润其燥而消其渴也。（方见下。）
（十一）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
汤去桂加茯苓白术汤主之。
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。余根据桂枝汤法煎服。小便利则愈。
服桂枝汤病不解而证变者。不独中风而且有寒也。又或下之。益误也。仍头项强痛翕翕发热
无汗者。风寒之表皆在而未除也。心下满微痛者。误下而证入里也。小便不利。下后亡津液而水
饮停也。去桂枝用芍药甘草者。收重伤之阴而益里伤之虚也。姜枣健脾胃而和中。下后用之更宜。
故二物仍其旧也。茯苓淡渗以利窍。术能益土以胜水。本其有
停饮之故。所以加之。以为拯前治之误也。脉经术上无白字。
（十二）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。
有热则不大便为里实明矣。故虽头痛亦宜承气汤下之。小便清则里无热可知。故曰仍在表宜
发汗。然小便清而头痛。阳邪上盛也。故衄可必。而宜桂枝汤解之。承气汤有四方。此不明言。
要当随证辨用耳。桂枝汤方见上编。
（十三）伤寒脉浮滑。此表有热里有寒。白虎汤主之。
白虎汤方
知母（六两） 石膏（一斤碎绵裹） 甘草（二两炙） 粳米（六合）
上四味。以水一斗。煮米熟汤成。去滓。温服一升。日三服。
伤寒见中篇首条。其脉不浮。浮者。风也。言不独伤于寒而亦有风则然也。滑为里热。以滑
且浮。知热不独在里也。故指言此表有热。盖表里俱热之谓也。里有寒者。里字非对表而称。以
热之里言。盖伤寒之热本寒因也。故谓热里有寒。指热之所以然者言也。夫寒与风俱中伤。表与
里既皆热。欲两皆而解之。诚哉极其难也。譬如夏秋两届之间。燥热酷甚。非金风之荐凉。则暑
毒不解也。是故白虎者。西方之金神。司秋之阴兽。虎啸谷风冷。凉生酷暑消。神于解秋。莫如
There are thirty-eight clauses in total, involving eighteen formulas.
Wind-stroke (Zhongfeng) refers to a disease where only the Wei Qi (Defensive Qi) is invaded by Wind pathogen. Cold damage (Shanghan) refers to a disease where only the Ying Qi (Nutritive Qi) is injured by Cold pathogen. If both Wind and Cold exist simultaneously and invade the body, both Ying and Wei will be damaged and suffer together. Therefore, cases where Ying and Wei are simultaneously injured by Wind and Cold are classified under the Lower Section. Although Cold primarily governs Winter, Wind exists at all times. Thus, sometimes one is solely affected by Wind or solely injured by Cold, and other times both coexist and jointly invade. Cases of sole Wind invasion or sole Cold injury are already difficult to treat; therefore, cases of simultaneous Wind and Cold invasion must be even more difficult to treat. Why? Because Cold requires sweating to resolve, while Wind requires releasing the muscle layer. To apply both methods without conflict is indeed a dilemma. How can this be achieved? The formula capable of inducing sweat for this dual difficulty is named Qinglong Tang (Azure Dragon Decoction); the formula capable of resolving this dual heat is named Baihu Tang (White Tiger Decoction); and the formula capable of saving those who suffered adverse reactions from mistakenly taking Da Qinglong Tang (when there was no dual difficulty) is called Zhenwu Tang (True Warrior Decoction). The terms Azure Dragon, White Tiger, and True Warrior imply that these formulas show their efficacy precisely where difficulties arise, revealing miraculous effects beyond measure. Such divinity justifies calling them "Divine Formulas" (Shen Tang). As stated in the *Book of Rites*, only sages can achieve this—this is what is meant. Only when students understand these principles can they discuss medicine.
(1) In Taiyang Wind-stroke, if the pulse is floating and tight, accompanied by fever, aversion to cold, body pain, anhidrosis (no sweat), and irritability, Da Qinglong Tang (Major Azure Dragon Decoction) is the primary treatment. However, if the pulse is floating and weak, with spontaneous sweating and aversion to wind, Da Qinglong Tang must not be administered. If mistakenly taken, it leads to cold extremities (Jue Ni), twitching of tendons, and fasciculation of muscles. This constitutes an adverse reaction (Ni). In such cases, Zhenwu Tang should be used to rescue the patient.
The last six characters ("This constitutes an adverse reaction. Use Zhenwu Tang to rescue") were originally placed after "Da Qinglong Tang is the primary treatment" in older editions. Huang corrected their position. Since it states that the formula must not be taken and mistaken use causes an adverse reaction, it makes no sense to follow it with "Da Qinglong Tang is the primary treatment." This is clearly a transcription error. Huang's correction is correct and should be followed. Later scholars, doubting his changes, deleted these six characters entirely. Deleting them removes evidence for Clause 25 in the Upper Section. Therefore, Zhu Xi's version retains them for comprehensive study. However, since this clause and the next mutually elucidate each other and share the same treatment, both views are presented together below.
(2) In Cold damage, if the pulse is floating and slow, the body feels heavy but not painful, with occasional relief, and there are no Shaoyin syndrome signs, Da Qinglong Tang should be used to disperse the pathogen.
Formula: Da Qinglong Tang (Major Azure Dragon Decoction)
Ephedrae Herba (Mahuang, 麻黄) - 6 liang, remove nodes
Cinnamomi Ramulus (Guizhi, 桂枝) - 2 liang, remove bark
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) - 2 liang, honey-fried
Prunus Armeniaca Semen (Xingren, 杏仁) - 40 seeds, remove skin and尖
Zingiberis Rhizoma Recens (Shengjiang, 生姜) - 3 liang, sliced
Jujubae Fructus (Dazao, 大枣) - 12 pieces, torn open
Receptacum Nelumbinis (Shigao, 石膏) - size of a chicken egg, wrapped in silk and crushed
Take seven ingredients. Add nine sheng of water. First boil Ephedrae Herba until reduced by two sheng, discard the foam on the surface. Add remaining herbs. Boil to obtain three sheng of decoction. Strain. Take one sheng warm. Aim for slight perspiration. If sweating is excessive, dust the body with warm powder to stop sweat. If one dose induces sweat, stop taking the remainder. Excessive sweating leads to Yang collapse, resulting in deficiency, aversion to wind, irritability, and insomnia.
The previous clause regarding Taiyang Wind-stroke refers to symptoms described in Clause 3 of the Upper Section. Disease belonging to Taiyang presents with a floating pulse. Floating indicates Wind, while tight indicates Cold. Fever indicates the immediate manifestation of Wind-heat. Aversion to cold, body pain, and anhidrosis are signs of Cold. Wind causes irritability (Fan), while Cold causes restlessness (Zao). This describes a condition where both Wind and Cold are present, with Wind predominating over Cold. It implies that within the Wind invasion, there is also Cold. This clause regarding Cold damage refers to symptoms in the first clause of the Middle Section. Slow pulse is a diagnostic sign of Wind; lack of body pain also indicates Wind. Heaviness indicates Cold. Occasional relief is due to the presence of Wind. "No Shaoyin signs" means that if the patient were lethargic and desirous of sleeping, it would resemble Shaoyin disease. Here, there is only heaviness, so it is stated as no Shaoyin signs. This also refers to a condition where both Wind and Cold injure Ying and Wei, with Cold predominating over Wind. It implies that within the Cold invasion, there is also Wind. Generally, Wind and Cold accompany each other and rarely separate. Where there is Cold, there is often Wind; where there is Wind, there is often Cold. Thus, sole invasions have their specific characteristics, but combined invasions are common. This is why Da Qinglong Tang was created. These two clauses are complementary, serving as a mini-summary for this chapter and the outline of Taiyang differentiated diseases. One clause in the Upper Section, two in the Middle Section, and this is the third. These three are the critical differentiations for the Taiyang channel. All subsequent clauses starting similarly refer to simultaneous Wind and Cold invasion, following this principle. The general principles for treating Wind and Cold do not exceed Guizhi Tang (Cinnamon Twig Decoction) and Mahuang Tang (Ephedra Decoction). However, Mahuang is contraindicated in Guizhi Tang, yet Guizhi is used in Mahuang Tang. This contains profound meaning, not easily explained by words, requiring intuitive understanding. Da Qinglong Tang is a modified combination of Guizhi Tang and Mahuang Tang. Thus, it is the main treatment for simultaneous Wind and Cold. Compared to Guizhi Mahuang Ban Tang (Half-Guizhi Half-Mahuang Decoction) and Guizhi Er Mahuang Yi Tang (Two-Parts Guizhi One-Part Mahuang Decoction), it lacks Shaoyao (Paeoniae Radix Alba) and contains more Shigao (Gypsum Fibrosum). Removing Shaoyao avoids astringency. Viewed without Shaoyao, it is essentially Mahuang Tang plus Shigao, Shengjiang, and Dazao. Shengjiang and Dazao are original components of Guizhi Tang. The key ingredient here is Shigao. According to Materia Medica, Shigao is acrid, sweet, and very cold. Acrid disperses Wind, sweet disperses Cold, and cold clears Heat. Thus, it treats fever caused by simultaneous Wind and Cold. The name "Qinglong" (Azure Dragon) comes from Guizhi and Mahuang gaining the acrid-sweet properties from Shigao. Similarly, "Baihu" (White Tiger) comes from Zhimu (Anemarrhenae Rhizoma) and Jingmi (Oryza Sativa) gaining the acrid-cold properties from Shigao. One herb serves two purposes, achieving fame through its sovereign role in different eras, demonstrating divine transformation. "Qinglong" (Azure Dragon): Green is the color of Wood; Dragon is the spirit of Wood; Wood governs Spring. Spring is warm and prone to irritability; thunderstorms bring harmony. Human sweat is likened to heavenly rain. When the Dragon rises, clouds and rain arrive, inducing sweat to relieve irritability and harmonize Ying and Wei. Hence, it is called a Divine Formula. "Baihu" (White Tiger): White is the color of Metal; Tiger is the spirit of Metal; Metal governs Autumn. Autumn is dry and hot with thirst; metal winds bring coolness. Human Qi is likened to swift winds. When the Tiger roars, valley winds arise, relieving dry heat and cooling the interior and exterior. Hence, it is called a Divine Formula. However, why does one clause say "governs" (zhu zhi) and another says "disperse" (fa zhi)? "Governs" refers to the urgency of irritability, which is dynamic. "Disperse" refers to the silence of mere heaviness, which is static. The end of the previous clause mentions weak pulse, sweating, and aversion to wind, referring to the Wind-stroke syndrome of floating Yang and weak Yin from the Upper Section. Mistakenly using Da Qinglong Tang for Wind-stroke causes adverse reactions, as seen in Clause 25. Comparing this clarifies the meaning. Using Guizhi Tang for Wind-stroke, Mahuang Tang for Cold damage, and Da Qinglong Tang for simultaneous invasion: if one accurately diagnoses early and applies the correct formula promptly, are there any remaining treatments needed for Wind and Cold after these three methods? Yet, among the 397 methods and 113 formulas, 80-90% result from medical errors, and less than 20% from disease transmission. From this, physicians responsible for life must remain vigilant. Thus, Zhang Zhongjing’s approach was not out of choice but necessity. Hence he earnestly said, "Know what error occurred, and treat according to the syndrome." "Know what error occurred, and apply the appropriate method." Do these words not express deep concern for future generations and the inability to fully articulate his intent? Alas! With so many methods from Zhang Zhongjing, yet still expressing incomplete intent, how can later authors claiming to exhaustively treat Cold Damage, relying on rigid interpretations, justify their mindset?
(3) In Taiyang disease, if the pulse is floating and tight, with anhidrosis, fever, and body pain, persisting for eight or nine days without resolution, and exterior signs remain, sweating should be induced. After medication, symptoms may slightly alleviate. The patient may experience irritability and closed eyes. Severe cases will likely suffer epistaxis (nosebleed), which resolves the disease. This occurs because Yang Qi is heavily constrained. Mahuang Tang is the primary treatment.
Taiyang disease with floating-tight pulse, anhidrosis, fever, and body pain matches the first clause, but lacks aversion to cold and irritability, indicating a milder case of simultaneous Wind and Cold invasion. "Slightly alleviated" means symptoms have reduced but not ceased. "Irritability" results from Wind obstruction causing Qi stagnation. "Closed eyes" results from Cold constraint causing Blood stasis. "Severe" indicates impending epistaxis. "Epistaxis" is nosebleed. The nose is the orifice of the Lung, which governs Qi and is Yin within Yang. Excess Yang pathogen forces Qi and Blood upward, causing bleeding from the nose. "Yang Qi" here refers to Wind. Wind is Yang and travels via Qi channels, thus dissipating with epistaxis. Hence, "because Yang Qi is heavy." Mahuang Tang is used because Cold is Yin, sinking and stagnant, requiring sweating to resolve. See Middle Section for formula.
(4) In Taiyang disease, if the pulse is floating and tight, with fever and anhidrosis, spontaneous epistaxis leads to recovery.
This continues the previous clause, describing an even milder variation where self-healing occurs without intervention, warning against unnecessary treatment. Taiyang disease with floating-tight pulse, fever, and anhidrosis matches the previous clause, but lacks pain. Lack of pain makes it milder than the previous clause, and thus milder than the first clause. No aggressive treatment is needed; epistaxis leads to self-healing. Sweat is the fluid of Blood; northerners call epistaxis "red sweat," reflecting this concept.
(5) In Cold damage, if the pulse is floating and tight, and failure to induce sweating leads to epistaxis, Mahuang Tang is the primary treatment.
Starting with "Cold damage" and "floating-tight pulse" indicates Cold predominates over Wind. The previous two clauses involved Wind predominating. The first resulted in epistaxis due to mismatched sweating; the second due to mildness causing spontaneous epistaxis. This one results from Cold predominance and failure to sweat. These three clauses distinguish these differences. Generally, excess Cold requires sweating. Failure to sweat when indicated causes Heat constraint and Blood chaos, leading to epistaxis. Epistaxis dissipates Yang Wind pathogen. Mahuang Tang disperses the remaining Cold.
(6) Floating-tight pulses typically indicate body pain and should be treated with sweating. However, if the Chi position pulse is slow, sweating is contraindicated. Why? Because Ying Qi is deficient and Blood is scant.
"Ling" is pronounced level tone. This summarizes the previous three clauses, highlighting pulses contraindicating sweating to emphasize caution. Chi pulse inspects Yin; slow pulse indicates deficiency. Blood is Yin. Ying governs Blood. Sweat is the fluid of Blood. Slow Chi pulse contraindicates sweating to avoid depleting Blood.
(7) In Taiyang disease, after eight or nine days, resembling malaria with fever, aversion to cold, more heat than cold, no vomiting, normal bowel movements, occurring two or three times a day, if the pulse is slightly slow and relaxed, recovery is imminent. If the pulse is faint and accompanied by aversion to cold, this indicates deficiency of both Yin and Yang; sweating, purging, and vomiting are all contraindicated. If the face shows redness, the disease has not resolved. Due to inability to produce slight sweat, the body will itch. Guizhi Mahuang Ban Tang is suitable.
Formula: Guizhi Mahuang Ban Tang (Half-Guizhi Half-Mahuang Decoction)
Prunus Armeniaca Semen (Xingren, 杏仁) - 24 seeds, remove skin and尖
Cinnamomi Ramulus (Guizhi, 桂枝) - 1 liang 16 zhu, remove bark
Paeoniae Radix Alba (Shaoyao, 芍药) - 1 liang
Zingiberis Rhizoma Recens (Shengjiang, 生姜) - 1 liang, sliced
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) - 1 liang, honey-fried
Ephedrae Herba (Mahuang, 麻黄) - 1 liang, remove nodes
Jujubae Fructus (Dazao, 大枣) - 4 pieces, torn open
Take seven ingredients. Add five sheng of water. First boil Ephedrae Herba for one or two boils, discard foam. Add remaining herbs. Boil to obtain 1.8 sheng. Strain. Take 0.6 sheng warm.
"Eight or nine days" implies a long duration. "Resembling malaria" means alternating chills and fever without regularity. More heat than cold indicates Wind predominates over Cold. No vomiting or thirst, normal bowels, means pathogen is neither fully exterior nor interior. Occurring multiple times daily indicates shallow pathogen location, allowing easy fluctuation, hence the slightly relaxed pulse suggests recovery. Faint pulse with aversion to cold indicates Yin-Yang deficiency, prohibiting attack. "Geng" means again. Contraindication of sweating means exterior is passed. Contraindication of purging/vomiting means no interior signs. Red face indicates Yang floating outward. Although Yang floats, Yin-Cold prevents dispersion, preventing even slight sweat. Qi constraint causes itching. Guizhi Mahuang Ban Tang resolves both Wind and Cold. Compare with Chapter 14, Clause 20.
(8) In Taiyang disease, with fever, aversion to cold, more heat than cold, and faint pulse, this indicates "No Yang." Sweating is contraindicated. Guizhi Er Yuebi Yi Tang is suitable.
Formula: Guizhi Er Yuebi Yi Tang (Two-Parts Guizhi One-Part Yuebi Decoction)
Cinnamomi Ramulus (Guizhi, 桂枝) - 18 zhu, remove bark
Paeoniae Radix Alba (Shaoyao, 芍药) - 18 zhu
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) - 18 zhu, honey-fried
Zingiberis Rhizoma Recens (Shengjiang, 生姜) - 1 liang 3 qian, sliced
Jujubae Fructus (Dazao, 大枣) - 4 pieces, torn open
Ephedrae Herba (Mahuang, 麻黄) - 18 zhu, remove nodes
Receptacum Nelumbinis (Shigao, 石膏) - 24 zhu, crushed, wrapped in silk
Chop seven ingredients. Add five sheng of water. Boil Ephedrae Herba for one or two boils, discard foam. Add remaining herbs. Boil to obtain 2 sheng. Strain. Take 1 sheng warm.
Originally, this formula was calculated as one part Yuebi Tang and two parts Guizhi Tang mixed to make one sheng. Now combined into one formula named Guizhi Er Yuebi Yi.
Fever, aversion to cold, more heat than cold matches the previous clause. Previous clause diagnosed Yin-Yang deficiency due to faint pulse and aversion to cold; this diagnoses "No Yang" due to faint pulse. Both contraindicate sweating. Wind is Yang, and disease is Taiyang, yet "No Yang" is confusing. Leave as doubt. Some say "No Yang" means disease is in Yin, not Yang. Examining the formula reveals this. "Yue" means surpass/exceed. "Bi" means low-status woman. Woman is Yin. Low means little. The patient is inherently weak with chronic disease in Shaoyin. Shaoyin pulse is naturally faint, contraindicating sweating. Blame the difficulty on Shaoyin. Hence termed "No Yang" in principle and "Yuebi" in formula. This formula, though nominally Yuebi assisting Guizhi, is actually a combination of Guizhi and Mahuang, a variant of Da Qinglong Tang replacing Xingren with Shaoyao. Removing Xingren avoids its Qi-moving nature. Using Shaoyao utilizes its Yin-entering astringent property. Replacing Xingren with Shaoyao makes it "Guizhi Two," indicating non-sweating focus. "Yuebi One" consists of Mahuang and Shigao, implying slight sweating within non-sweating strategy. Slight sweating addresses minor Cold. Non-sweating addresses predominant Wind and Shaoyin chronic disease. Note Clause 1 end warns against Da Qinglong Tang due to faint pulse. That clause refers to Wind-stroke. This and previous clauses refer to Wind predominating. Combined, the meaning of "No Yang" becomes subtle. Whether this interpretation is correct remains unknown.
(9) After taking Guizhi Tang, if profuse sweating occurs and pulse becomes surging-large, administer Guizhi Tang as before. If symptoms resemble malaria occurring twice daily, sweating will resolve it. Guizhi Er Mahuang Yi Tang is suitable.
Formula: Guizhi Er Mahuang Yi Tang (Two-Parts Guizhi One-Part Mahuang Decoction)
Cinnamomi Ramulus (Guizhi, 桂枝) - 1 liang 17 zhu, remove bark
Paeoniae Radix Alba (Shaoyao, 芍药) - 1 liang 6 zhu
Ephedrae Herba (Mahuang, 麻黄) - 16 zhu, remove nodes
Zingiberis Rhizoma Recens (Shengjiang, 生姜) - 1 liang 6 zhu, sliced
Prunus Armeniaca Semen (Xingren, 杏仁) - 16 seeds, remove skin and尖
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) - 1 liang 2 zhu, honey-fried
Jujubae Fructus (Dazao, 大枣) - 5 pieces, torn open
Take seven ingredients. Add five sheng of water. First boil Ephedrae Herba for one or two boils, discard foam. Add remaining herbs. Boil to obtain 2 sheng. Strain. Take 1 sheng warm, twice daily.
Profuse sweating and surging-large pulse after Guizhi Tang indicate Wind predominating, Wind pathogen attempting to scatter but held by Cold, causing intensified heat. Re-administering Guizhi Tang emphasizes caution. Resembling malaria twice daily indicates shallow pathogen facing outward but held by slight Cold, requiring sweating for resolution. Guizhi Er Mahuang Yi Tang focuses on resolving Wind rather than dispersing Cold.
(10) After taking Guizhi Tang, if profuse sweating leads to severe irritability and unquenchable thirst with surging-large pulse, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is the primary treatment.
Similar to the previous clause but with severe irritability and thirst. Likely due to excessive sweating damaging fluids, intensifying interior-exterior dry-heat. Baihu Tang clears interior-exterior heat; Ginseng moistens dryness and quenches thirst. (See formula below.)
(11) After taking Guizhi Tang, or after purging, if head/neck stiffness, mild fever, anhidrosis, fullness in epigastrium, slight pain, and dysuria persist, Guizhi Qu Guijia Fuling Baizhu Tang (Guizhi Tang minus Cinnamon Twig plus Poria and Atractylodes Macrocephala Decoction) is the primary treatment.
Formula: Guizhi Qu Guijia Fuling Baizhu Tang
In Guizhi Tang formula, remove Cinnamomi Ramulus (Guizhi), add Poria (Fuling) and Atractylodes Macrocephala Rhizome (Baizhu), each 3 liang. Prepare and administer according to Guizhi Tang method. Recovery occurs when urination improves.
Failure to resolve after Guizhi Tang indicates not only Wind-stroke but also Cold. Purging was an additional error. Persistent head/neck stiffness, mild fever, anhidrosis indicate lingering exterior Wind-Cold. Epigastric fullness and slight pain indicate interior shift due to purging. Dysuria indicates fluid retention due to fluid loss from purging. Removing Guizhi and using Shaoyao/Gancao conserves injured Yin and tonifies interior deficiency. Shengjiang/Dazao strengthen Spleen/Stomach and harmonize middle, suitable post-purging. Fuling promotes diuresis; Baizhu strengthens Earth to control Water. Added to address fluid retention and correct previous errors. Note: *Mai Jing* omits "Bai" before Baizhu.
(12) In Cold damage, if constipation persists for six-seven days with headache and fever, administer Chengqi Tang. If urine is clear, the disease is not in the interior but remains in the exterior; sweating is required. If headache occurs, epistaxis is likely; Guizhi Tang is suitable.
Fever with constipation indicates interior excess. Thus, even with headache, Chengqi Tang is appropriate for purging. Clear urine indicates no interior heat, confirming exterior location requiring sweating. Clear urine with headache indicates excess Yang pathogen ascending, making epistaxis certain. Guizhi Tang resolves this. There are four Chengqi Tang formulas; choose based on syndrome. Guizhi Tang see Upper Section.
(13) In Cold damage, if pulse is floating and slippery, this indicates Heat in Exterior and Cold in Interior. Baihu Tang is the primary treatment.
Formula: Baihu Tang (White Tiger Decoction)
Anemarrhenae Rhizoma (Zhimu, 知母) - 6 liang
Receptacum Nelumbinis (Shigao, 石膏) - 1 jin, crushed, wrapped in silk
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) - 2 liang, honey-fried
Oryza Sativa (Jingmi, 粳米) - 6 he
Take four ingredients. Add ten dou of water. Cook until rice is ripe and soup is ready. Strain. Take 1 sheng warm, three times daily.
Cold damage in Middle Section first clause has non-floating pulse. Floating indicates Wind. This implies injury is not solely by Cold but involves Wind. Slippery indicates interior Heat. Floating and slippery indicate Heat is not solely interior. Thus, "Heat in Exterior" means interior-exterior Heat. "Cold in Interior": "Interior" here does not contrast with Exterior, but refers to the origin of Heat. Cold-damage Heat originates from Cold. Thus, "Heat in Interior [has] Cold" refers to the cause of Heat. Simultaneous Wind-Cold invasion causing interior-exterior Heat is extremely difficult to resolve. Like late Summer/early Autumn, intense dry-heat requires autumn winds to cool. Thus, Baihu (Western Metal Spirit, Autumn Beast) brings coolness when roaring, dispelling summer heat. Regarding resolving Autumn heat, nothing is more...