凡五十七条方三十二
太阳统摄之荣卫。乃风寒始入之两途。寒则伤荣。故以营伤于寒而病者为中篇。夫寒。冬令也。
秋末春初以间乎冬。寒则有之。他时虽或暴变清冷。大率不外本序之令气耳。终不得入隆冬严寒
之例。以病言之。必也证候显见如经。始可谓为伤寒。不可少有分毫违错。盖经之所以条例各病。
对比而辨论者。正为与伤寒分别争差也。读者极力反复精究其旨。久久成熟。一旦贯通。则认病
自然亲切。而于凡异说之纷纭者。皆不为其所惑矣。慎哉。
（一）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。
或。未定之词。寒为阴。阴不热。以其着人而客于人之阳经。郁而与阳争。争则蒸而为热。已
发热者。时之所至。郁争而蒸也。未发热者。始初之时。郁而未争也。必。定然之词。恶寒见上
篇。然此以寒邪郁荣。故荣病而分见恶寒。曰必者。言发热早晚不一。而恶寒则必定即见也。体
痛者。寒主坚凝而伤荣。则荣实而强。卫虚而弱矣。荣强则血涩。卫弱则气滞。故痛
也。呕。吐也。逆。俗谓恶心是也。胃口畏寒而寒涌也。阴谓关后。阳谓关前。俱紧。三关
通度而急疾。寒性强劲而然也。难经曰。伤寒之脉。阴阳俱盛而紧涩。是也。伤。犹中也。彼此
两相更互发明。言太阳之为病。中风固如彼矣。若或有如此者。则又是触犯于寒而中之也。然阴
寒之袭人。从荣而入。荣。血道也。寒之所以从荣入者。荣亦阴。亦从类也。犹龙虎之于风
云。水火之于燥湿。各以其类而相从之自然也。此揭太阳分病之纪二。乃此篇之小总。下条乃申
此而互言之。详其义以出其治。余皆此条之差分耳。首尾脉络。纲领条目。大端悉类上编。乃上
篇之对待。太阳之太三辨。上编一。此其二。以下凡首称伤寒者。则又皆指有此云云之谓也。
（二）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。
麻黄汤方
麻黄（三两去节） 桂枝（二两去皮） 甘草（一两炙） 杏仁（七十个汤浸去皮尖）
上四味。以水九升。先煮麻黄减二升。去上沫。内诸药。煮取二升半。去滓。温服八合。覆取
微似汗。不须啜粥。余如桂枝法将息。
此申上条而更互言之。所以致其详而出其治也。头痛已见太阳病。而此犹出者。以其专太阳
而主始病也。上条先言或已发热。或未发热。而此先言头痛。次言发热者。则是以其已发热者言
也。身疼腰痛。骨节疼痛。即上条之体痛而详言之也。上条言必恶寒。而此言恶风者。乃更互言
之。与上编啬啬恶寒。淅淅恶风。双关互文之意同。无汗。乃对上编之有汗而言。以见彼此两相
反。所以为风寒之辨别。不然无是证者。则不言也。然所以无汗者。汗乃血之液。血为荣。荣强
则腠理闭密。虽热。汗不出也。喘。气逆也。卫主气。卫弱则气乏逆。呼吸不利而声息所以不遂也。
然上条言呕而此言喘。呕与喘。皆气逆。亦互言以明互见之意。麻黄味苦而性温。力能发汗以散
寒。然桂枝汤中忌麻黄。而麻黄汤中用桂枝。何也。曰。麻黄者。突阵擒敌之大将也。桂枝者。
运筹帷幄之参军也。故委之以麻黄。必胜之算也。监之以桂枝。节制之妙
也。甘草和中而除热。杏仁下气而定喘。惟麻黄有专功之能。故不须啜粥之助。
（三）伤寒一日。太阳受之。脉若静者为不传。颇欲吐。若燥烦脉数急者。为传也。
伤寒者。以上二条互言者而言也。下仿此。一日太阳受之。太阳主表而属外。故外者先当也。静
谓恬退而和平也。紧退恬静和平。其为不传而欲愈可诊矣。颇欲吐属上言。不甚待吐而不吐。盖
呕逆未全止也。燥。干也。数。五六至已上也。其主热。急。躁疾也。欲传而加进可知也。
（四）伤寒二三日。阳明少阳证不见者。为不传也。
见。音现。上条举太阳而以脉言。此复举阳明少阳而以证言。次第反复互相发明也。然不传
有二。一则不传而遂自愈。一则不传而犹或不解。若阳明少阳虽不见。太阳亦不解。则始终太阳
者有之。余经同推。要皆以脉证所见为准。若只蒙龙拘拘。数日以论经。则去道远矣。
（五）脉浮者。病在表。可发汗。宜麻黄汤。
表。太阳也。伤寒脉本紧。不紧而浮。则邪见还表而欲散可知矣。发。拓而出之也。麻黄汤者。
乘其欲散而拓出之之谓也。（方见前）
（六）脉浮而数者。可发汗。宜麻黄汤。
浮与上同。而此多数。数者。伤寒之欲传也。可发汗而宜麻黄汤者。言乘寒邪有向表之浮。
当散其数。而不令其至于传也。
（七）脉浮数者。法当汗出而愈。若下之身重心悸者。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。
此承上条复以其治不如法。因而致变者言。晓人当知谨也。身重。下后阴虚而倦怠也。悸属心。
心主血。阴虚则血虚。所以心不宁也。盖不当下而反下之。故证变如此。不可汗者。禁勿重亡津
液以复损其阴也。当自汗出乃解者。言下虽反而病未甚变。须待其津液回。当得自汗而解也。所以
然者以下。乃申释上文之词。里虚。以亡津液言。须表里实。以待津液回。邪还表言也。
（八）伤寒发汗。解。半日许。复烦。脉浮数者。可更发汗。宜桂枝汤主之。（更。平声。）
伤寒发汗者。服麻黄汤以发之之谓也。解。散也。复。重复也。既解而已过半日之久矣。何事而
复哉。言发汗不如法。汗后不谨。重新又有所复中也。盖汗出过多。则腠理反开。护养不谨。邪风
又得易入。所以新又烦热而脉转浮数。故曰可更发汗。更。改也。言当改前法。故曰宜桂枝汤。
桂枝汤者。中风解肌之法。微哉旨也。庸俗不省病加小愈之义。不遵约制。自肆粗下。不喻汗法微
似之旨。骋以大汗为务。病致变矣。反谓为邪不尽。汗而又汗。辗转增剧。卒致莫救。不知悔
悟。噫。读书不喻旨。赵括鉴矣。学医废人命。伊芳谁鉴邪。伤哉。
（九）发汗已。脉浮数烦渴者。五苓散主之。
已。言发汗毕。非谓病罢也。浮数烦。与上同。而此多渴。渴者。亡津液而内燥。里证也。
以证有里而人燥渴。故用四苓以滋之。以表在而脉浮数。故凭一桂以和之。谓五苓散能两解表里
者。此也。（方见上编）
（十）伤寒汗出而渴者。五苓散主之。不渴者。茯苓甘草汤主之。
茯苓甘草汤方
茯苓（二两） 桂枝（二两去皮） 生姜（三两切） 甘草（一两）
上四味。以水四升。煮取二升。去滓。分。温三服。
伤寒不汗出。汗出者。以发之而出者言也。然则此条二节。上节乃承上条而以其不烦者再言。
下节乃承上节而以其更不渴者又出也。不烦。则热较轻可知。故治亦不殊。不渴。则内燥更减可
识。故但用四苓之一以润之。然里证既轻。则表为犹多可必。故须桂枝之三以解之。然则此汤之
四物。其桂枝五苓二方之变制与。
（十一）伤寒汗出解之后。胃中不和。心下痞硬。干噫食臭。胁下有水气。腹中雷鸣下利者。
生姜泻心汤主之。
生姜泻心汤方
生姜（四两切） 甘草（三两炙） 人参（三两） 干姜（一两） 黄芩（三两） 半夏
（半升洗） 黄连（一两） 大枣（十二枚擘）
上八味。以水一斗。煮取六升。去滓。再煎取三升。温服一升。日三服。
噫。影戒切。解。谓大邪退散也。胃为中土。温润则和。不和者。汗后亡津液。邪乍退散。正未
全复而尚弱也。痞硬。伏饮抟膈也。噫。饱食息也。食臭。 气也。平人过饱伤食。则噫食臭。
病患初瘥。脾胃尚弱。化输未强。虽无过饱。犹之过饱而然也。水气。亦谓饮也。雷鸣者。脾为阴。
胃为阳。阴阳不和。薄动之声也。下利者。惟阴阳之不和。则水谷不厘清。所以杂迸而走
注也。生姜大枣。益胃而健脾。黄芩黄连。清上而坚下。半夏干姜。蠲饮以散痞。人参甘草。益
气而和中。然则泻心者。健其脾而脾输。益其胃而胃化。斯所以为泻去其心下痞硬之谓也。
（十二）发汗病不解反恶寒者。虚故也。芍药甘草附子汤主之。
芍药甘草附子汤方
芍药（三两） 甘草（三两炙） 附子（一枚炮去皮破八片）
以上三味。以水五升。煮取一升五合。去滓。分。温三服。
未汗而恶寒。邪盛而表实。仇雠之恶也。已汗而恶寒。邪退而表虚。怯懦之恶也。盖汗出之后。
大邪退散。荣气衰微。卫气疏慢。病虽未尽解。不他变而但恶寒。故曰虚。言表气新虚而非病变
也。然荣者阴也。阴气衰微。故用芍药之酸以收之。卫者阳也。阳气疏慢。故用附子之辛以固之。
甘草甘平。合荣卫而和谐之。乃国老之所长也。
（十三）发汗后恶寒者。虚故也。不恶寒但热者。实也。当和胃气。与调胃承气汤。
上节乃略上条而复言。所以起下文。而以其反者出也。不恶寒。其人表气强也。但热。亡津液
而胃中干。故曰实也。当和胃气。以干在胃而实也。故曰。与调胃承气汤。然汤以泻实。而甘草
则和中益气。何也。盖实成于虚也。所谓量凿而正枘。其斯之谓与。方见大阳下。
（十四）发汗后。身疼痛。脉沉迟者。桂枝加芍药生姜各一两。人参三两。新加汤主之。
桂枝新加汤方
桂枝（三两去皮） 芍药（四两） 甘草（二两炙） 人参（三两） 生姜（四两切）
大枣（十二枚擘）
上六味。以水一斗一升。微火煮取三升。去滓。分。温服。如桂枝法。
发汗后身疼痛脉沉迟者。邪气骤去。血气暴虚也。用桂枝者。和其荣卫。不令暴虚易得重伤也。
加人参芍药者。收复其阴阳以益其虚也。加生姜者。健其乍回之胃以安其谷也。曰新加者。得非
足一百一十三而成之之谓邪。微火皆当仿效首方。此盖后人之赘耳。
（十五）发汗后。不可更行桂枝汤。汗出而喘无大热者。可与麻黄杏仁甘草石膏汤主之。
麻黄杏仁甘草石膏汤方
麻黄（四两去节） 杏仁（五十个去皮尖） 甘草（二两炙） 石膏（半斤碎绵裹）
上四味。以水七升。先煮麻黄减二升。去上沫。内诸药。煮取二升。去滓。温服一升。
更行。犹言再用。不可再用桂枝汤。则是已经用过所以禁止也。盖伤寒当发汗。不当用桂枝
。桂枝固卫。寒不得泄。而气转上逆。所以喘益甚也。无大热者。郁伏而不显见也。以伤寒之表
犹在。故用麻黄以发之。杏仁下气定喘。甘草退热和中。本麻黄正治之佐使也。石膏有彻热之功。
尤能助下喘之用。故易桂枝以石膏。为麻黄汤之变制。而太阳伤寒。误汗转喘之主治。所以必四
物者而后可行也。
（十六）发汗后。饮水多者必喘。以水灌之亦喘。
喘属肺。肺属金。金性寒。故曰形寒饮冷则伤肺。汗后肺气新虚。易得重伤。饮水。饮冷也。水
灌则形寒。肺伤矣。其主气所以皆喘也。
（十七）发汗过多。其人叉手自冒心。心下悸欲得按者。桂枝甘草汤主之。
桂枝甘草汤方
桂枝（四两去皮） 甘草（二两炙）
上二味。以水三升。煮取一升。去滓。顿服。
汗多则血伤。血伤则心虚。心虚则动惕而悸。故叉手自冒覆而欲得人接也。桂枝走阴。敛液
宅心。能固疏慢之表。甘草缓脾。和中益气。能调不足之阳。然则二物之为方。收阴补阳之为用也。
（十八）发汗后。其人脐下悸者。欲作奔豚。茯苓桂枝甘草大枣汤主之。
茯苓桂枝甘草大枣汤方
茯苓（半斤） 桂枝（四两去皮） 甘草（二两炙） 大枣（十五枚擘）
上四味。以甘澜水一斗。先煮茯苓减二升。内诸药。煮取三升。去滓。温服一升。日三服。
作甘澜水法
取水二斗。置大盆内。以勺扬之。水上有珠子五六千颗相逐。取用之。
脐下悸者。肾乘心汗后液虚。欲上凌心而克之。故动惕于脐下也。欲作。待作未作之谓。奔
豚见上编。然水停心下则悸。茯苓淡渗胜水。能伐肾脏之淫邪。桂枝走阴降肾。能御奔豚于未至。
甘草益气。能补汗后之阳虚。大枣和土。能制为邪之肾水。甘澜水者。操之而使其性抵于纯。不令
其得以助党而长祸也。
（十九）发汗后腹胀满者。浓朴生姜甘草半夏人参汤主之。
浓朴生姜甘草半夏人参汤方
浓朴（半斤去皮炙） 生姜（半斤切） 半夏（半升洗） 人参（一两） 甘草（二两炙）
上五味。以水一斗。煮取三升。去滓。温服一升。日三服。
汗后腹胀满者。胃中干。阳虚气滞而伏饮停蓄也。人参甘草之甘。益胃而滋干。生姜半夏之
辛。蠲饮而散满。然胀非苦不泄。所以浓朴者。君四物而主治也。
（二十）伤寒中风。医反下之。其人下利日数十行。谷不化。腹中雷鸣。心下痞硬而满。干
呕心烦不得安。医见心下痞。谓病不尽。复下之。其痞益甚。此非结热。但以胃中虚。客气上逆。
故使硬也。甘草泻心汤主之。
甘草泻心汤方
甘草（四两炙） 黄芩（三两） 黄连（一两） 干姜（三两） 半夏（半升洗） 大枣
There are fifty-seven clauses in total, comprising thirty-two prescriptions.
The Taiyang (Greater Yang) channel governs Ying (Nutrient Qi) and Wei (Defensive Qi), which constitute the two pathways through which Wind-Cold pathogens initially enter the body. Cold pathogens tend to injure Ying; therefore, this chapter discusses conditions where Ying is injured by Cold, leading to disease. "Cold" refers to the climatic characteristic of Winter. Late Autumn and early Spring lie between seasons, and while Cold may be present, other times when the weather suddenly becomes clear and cold generally do not deviate from the seasonal climate order. Ultimately, such instances cannot be categorized under the severe cold of mid-winter. From a pathological perspective, only when symptoms manifest exactly as described in the classics can it be termed "Shanghan" (Cold Damage). There must be no slightest deviation. The reason the classics categorize diseases into specific clauses and compare them for differentiation is precisely to distinguish Shanghan from other conditions. Readers should strive to repeatedly investigate and thoroughly understand these principles. With long-term study and mastery, once comprehensively integrated, disease identification will become naturally accurate and intimate. Confusion arising from various conflicting theories will not mislead one. Caution is paramount.
(1) In Taiyang disease, there may be fever already present, or fever may not yet have appeared, but chills (aversion to cold) are invariably present. Accompanying symptoms include body pain, vomiting, and rebellious Qi (nausea/retching). If the pulse is tight at both Yin (post-cinnabar point) and Yang (pre-cinnabar point) positions, it is named Shanghan.
"Or" indicates uncertainty. Cold belongs to Yin, and Yin is not hot. However, because Cold adheres to the body and lodges in the Yang channels, it stagnates and contends with Yang. This contention generates heat through steaming. "Fever already present" refers to the timing being ripe, where stagnation and contention lead to steaming heat. "Fever not yet present" refers to the initial stage, where stagnation exists but contention has not yet occurred. "Invariably" indicates certainty. "Chills" were mentioned in the previous chapter. Here, however, Chills appear because Cold pathogens stagnate Ying, causing Ying pathology to manifest as chills. The term "invariably" implies that while the onset of fever varies in time, chills are certain to appear immediately. "Body pain" occurs because Cold is firm and coagulating, injuring Ying. This causes Ying to become full and strong, while Wei becomes deficient and weak. When Ying is strong, blood flow becomes stagnant; when Wei is weak, Qi stagnates, resulting in pain. "Vomiting" refers to expelling contents; "rebellious Qi" colloquially refers to nausea. This happens because the stomach cavity fears Cold, causing Cold to surge upward. "Yin" refers to the position behind the cinnabar point (radial artery), and "Yang" refers to the position before it. "Both tight" means the pulse is rapid and tense across all three positions (Cun, Guan, Chi), a manifestation of the strong and forceful nature of Cold. The *Nanjing* states: "The pulse of Shanghan is abundant and tight in both Yin and Yang," which describes this condition. "Shang" (injure) is akin to "Zhong" (strike/hit). These clauses mutually illuminate each other, explaining that while Taiyang disease presents differently in Wind Strike, if such symptoms as described above occur, it indicates injury by Cold. Yin-Cold pathogens invade the body via Ying. Ying is the pathway of Blood. Cold enters via Ying because Ying also belongs to Yin, following the principle of similarity. This is natural, like Dragons and Tigers corresponding to Wind and Clouds, or Water and Fire corresponding to Dryness and Moisture, each following its own kind. This section outlines the second major category of Taiyang differentiated diseases, serving as a brief summary of this chapter. The next clause elaborates on this with mutual textual references, detailing the rationale to derive treatment methods. The remaining clauses are subdivisions of this primary clause. The structure, guidelines, and items largely resemble the previous volume, acting as a counterpart to the first volume's discussion. This is the third differentiation of Taiyang. The previous volume was the first; this is the second. Henceforth, whenever "Shanghan" is cited at the beginning of a clause, it refers specifically to the condition possessing the aforementioned characteristics.
(2) In Taiyang disease, characterized by headache, fever, body pain, lower back pain, joint pain, aversion to wind, absence of sweating, and wheezing, Mahuang Tang (Ephedra Decoction) is the primary prescription.
Mahuang Tang Prescription
Ephedrae Herba (Mahuang, 麻黄) - 3 liang, nodes removed
Cinnamon Twig (Guizhi, 桂枝) - 2 liang, bark removed
Licorice Root (Gancao, 甘草) - 1 liang, honey-fried
Apricot Seed (Xingren, 杏仁) - 70 seeds, soaked in hot water, skin and tips removed
Take the four ingredients. Add nine sheng of water. First, decoct Ephedra until the volume reduces by two sheng. Remove the foam from the surface. Add the remaining herbs. Decoct until two and a half sheng remain. Strain. Take eight he of the warm decoction. Cover the patient to induce a slight, uniform sweat. Drinking hot porridge is not required. Rest and care instructions follow those for Guizhi Tang (Cinnamon Twig Decoction).
This clause elaborates on the previous one through mutual reference, providing detail and deriving treatment. Headache was already mentioned in Taiyang disease; listing it again emphasizes that this clause focuses on the initial onset of Taiyang disease. The previous clause stated "fever may or may not be present," whereas this clause lists headache first, then fever, addressing cases where fever is already present. Body pain, lower back pain, and joint pain are detailed descriptions of the "body pain" mentioned previously. The previous clause stated "invariably chills," while this states "aversion to wind," employing mutual textual variation, similar to the dual meaning of "shivering chills" and "chilly wind" in the previous volume. "Absence of sweating" contrasts with the "presence of sweating" in the previous volume, highlighting their opposition to differentiate Wind from Cold. Otherwise, such symptoms would not be noted. The reason for absence of sweating is that sweat is the fluid of Blood, and Blood belongs to Ying. When Ying is strong, the interstices (couli) close tightly; thus, even with fever, sweat cannot escape. "Wheezing" indicates rebellious Qi. Wei governs Qi; when Wei is weak, Qi becomes deficient and rebellious, leading to difficult breathing and abnormal respiratory sounds. The previous clause mentioned "vomiting," while this mentions "wheezing." Both involve rebellious Qi, illustrating mutual visibility through textual variation. Mahuang is bitter and warm in nature, capable of inducing sweating to disperse Cold. However, Mahuang is contraindicated in Guizhi Tang, yet Guizhi is used in Mahuang Tang. Why? Mahuang is like a general charging into battle to capture the enemy, while Guizhi is like an advisor strategizing in the command tent. Entrusting Mahuang ensures victory; supervising with Guizhi provides strategic control. Licorice harmonizes the middle and clears heat. Apricot seed directs Qi downward and calms wheezing. Only Mahuang possesses this specialized efficacy, hence the need for porridge assistance is absent.
(3) On the first day of Shanghan, the Taiyang channel is affected. If the pulse remains calm/stable, the disease has not transmitted. If the patient desires to vomit significantly, or experiences restlessness/agitation with a rapid and urgent pulse, transmission is occurring.
"Shanghan" here refers to the context established by the previous two clauses, applied similarly thereafter. On the first day, Taiyang is affected. Taiyang governs the exterior and belongs to the outside, so external factors affect it first. "Stable" implies tranquility and harmony. A pulse transitioning from tight to tranquil and harmonious indicates non-transmission and impending recovery. "Desires to vomit significantly" relates to the earlier mention; the patient does not strongly desire to vomit nor actually vomits, suggesting that rebellious Qi/vomiting has not fully ceased. "Restless" refers to dryness/agitation. "Rapid" indicates five or six beats per breath cycle or more, signifying Heat. "Urgent" denotes impatience or speed. This indicates impending transmission and progression.
(4) On the second or third day of Shanghan, if Yangming and Shaoyang syndromes are not observed, transmission has not occurred.
"Observe" (xian) is pronounced as "appear." The previous clause cited Taiyang based on pulse; this clause cites Yangming and Shaoyang based on symptoms, repeating and mutually illuminating the sequence. Non-transmission has two outcomes: either spontaneous resolution or persistent unresolved status. If Yangming and Shaoyang symptoms are absent but Taiyang symptoms persist without resolving, the disease remains in Taiyang. This logic applies to other channels. Ultimately, diagnosis relies on observed pulse and symptoms. Mere speculation over days regarding channels misses the mark entirely.
(5) If the pulse is floating, the disease is at the exterior. Sweating therapy is indicated; Mahuang Tang is appropriate.
"Exterior" refers to Taiyang. The pulse in Shanghan is typically tight. If it is not tight but floating, it indicates the pathogen is returning to the exterior and attempting to dissipate. "Release" (fa) means to push out. Mahuang Tang is used to exploit this tendency to dissipate by pushing the pathogen out. (Prescription seen above).
(6) If the pulse is floating and rapid, sweating therapy is indicated; Mahuang Tang is appropriate.
"Floating" is as described above. "Rapid" indicates the potential for transmission in Shanghan. Indicating sweating and Mahuang Tang here means exploiting the floating pulse (indicating outward movement of Cold) to disperse the rapidity and prevent transmission.
(7) If the pulse is floating and rapid, the law dictates recovery through sweating. If purgation is incorrectly applied, resulting in heavy body sensation and palpitations, sweating is contraindicated. Recovery will occur through spontaneous sweating. The reason is that the Chi (cun) pulse is faint, indicating interior deficiency. Table and interior must be strengthened; when fluids harmonize spontaneously, sweating will occur, leading to recovery.
This follows the previous clause, discussing complications arising from improper treatment, warning caution. Heavy body sensation results from Yin deficiency after purgation, causing fatigue. Palpitations relate to the Heart, which governs Blood. Yin deficiency leads to Blood deficiency, causing heart unrest. Incorrect purgation caused this change. Sweating is forbidden to prevent further loss of fluids and damage to Yin. Spontaneous sweating indicates recovery because, although purged incorrectly, the condition hasn't severely deteriorated; waiting for fluid restoration allows spontaneous sweating to resolve the issue. The explanation below clarifies this. "Interior deficiency" refers to fluid loss. "Strengthen table and interior" awaits fluid restoration and pathogen return to the exterior.
(8) After Shanghan sweating therapy resolves, about half a day later, if vexation recurs and the pulse is floating and rapid, sweating may be repeated; Guizhi Tang is appropriate. ("Geng" is read as a level tone.)
"Sweating therapy for Shanghan" refers to administering Mahuang Tang. "Resolve" means dispersal. "Recurs" means repetition. Although resolved, half a day has passed. Why recurrence? It indicates improper sweating technique or poor post-sweat care, allowing new pathogenic invasion. Excessive sweating opens the interstices; careless protection allows wind pathogens to re-enter, causing new vexation and a floating-rapid pulse. Thus, sweating may be repeated. "Geng" means change. The method should be changed; hence, Guizhi Tang is appropriate. Guizhi Tang is the method for releasing the muscle layer in Wind Strike, with profound significance. Vulgar practitioners fail to understand the meaning of slight improvement, ignore protocols, use crude purgatives arbitrarily, and misunderstand the principle of slight sweating, aiming for profuse sweating. This causes complications, mistakenly attributed to residual pathogens, leading to repeated sweating, worsening condition, and untreatable states. They fail to repent. Alas, failing to grasp principles in study, Zhao Kuo serves as a warning. Neglecting human life in medicine, who serves as a warning? Tragic.
(9) After sweating is completed, if the pulse is floating and rapid, accompanied by vexation and thirst, Wuling San (Five-Ingredient Powder with Poria) is appropriate.
"Completed" means sweating is finished, not that the disease is cured. "Floating, rapid, vexation" are same as above, but here accompanied by "thirst." Thirst indicates fluid loss and internal dryness, a interior syndrome. Because there is an interior syndrome with dryness and thirst, Si Ling (Four-Ingredient component) is used to moisten. Because exterior signs persist with floating-rapid pulse, Gui Zhi (Cinnamon Twig) is used to harmonize. This explains why Wuling San resolves both exterior and interior. (Prescription seen in previous volume).
(10) In Shanghan, if sweating occurs with thirst, Wuling San is appropriate. If there is no thirst, Fuling Gancao Jiangtang (Poria, Licorice, and Ginger Decoction) is appropriate.
Fuling Gancao Jiangtang Prescription
Poria (Fuling, 茯苓) - 2 liang
Cinnamon Twig (Guizhi, 桂枝) - 2 liang, bark removed
Fresh Ginger (Shengjiang, 生姜) - 3 liang, sliced
Licorice Root (Gancao, 甘草) - 1 liang
Take the four ingredients. Add four sheng of water. Decoct to two sheng. Strain. Divide into three warm doses.
Saying Shanghan does not sweat, but sweats, refers to induced sweating. The two parts of this clause: the upper part reiterates the previous clause focusing on the absence of vexation; the lower part adds the absence of thirst. Absence of vexation implies milder heat, so treatment is similar. Absence of thirst implies less internal dryness, so only one ingredient from Si Ling is used to moisten. Since interior syndrome is mild, exterior syndrome likely predominates, requiring triple dosage of Gui Zhi to resolve exterior. Thus, this prescription appears to be a modification of Guizhi Tang and Wuling San.
(11) After Shanghan sweating resolves, if the stomach is disharmonious, presenting with epigastric fullness and hardness, belching with food odor, water qi under the flanks, borborygmus, and diarrhea, Shengjiang Xiexin Tang (Fresh Ginger Heart-Draining Decoction) is appropriate.
Shengjiang Xiexin Tang Prescription
Fresh Ginger (Shengjiang, 生姜) - 4 liang, sliced
Licorice Root (Gancao, 甘草) - 3 liang, honey-fried
Ginseng Root (Renshen, 人参) - 3 liang
Dried Ginger (Ganjiang, 干姜) - 1 liang
Scutellaria Root (Huangqin, 黄芩) - 3 liang
Pinellia Tuber (Banxia, 半夏) - 0.5 sheng, washed
Coptis Rhizome (Huanglian, 黄连) - 1 liang
Jujube Fruit (Dazao, 大枣) - 12 pieces, split
Take the eight ingredients. Add ten dou of water. Decoct to six sheng. Strain. Re-decoct to three sheng. Take one sheng warm, three times daily.
"Belching" (yi). "Resolve" means major pathogens have dispersed. The Stomach belongs to Central Earth; warmth and moisture bring harmony. Disharmony arises from fluid loss after sweating, with pathogens just dispersing and righteous Qi not fully restored and still weak. "Fullness and hardness" refers to retained fluid accumulating in the diaphragm. "Belching" is sighing after full meals. "Food odor" is the smell of food. Overeating damages food digestion, causing belching with food odor. After initial recovery, Spleen and Stomach are weak, transformation and transportation are not strong. Even without overeating, it resembles overeating effects. "Water qi" refers to fluid retention. "Borborygmus" is the sound of Yin (Spleen) and Yang (Stomach) clashing due to disharmony. "Diarrhea" occurs because Yin-Yang disharmony prevents proper separation of clear and turbid water and grain, causing mixed discharge. Fresh Ginger and Jujube benefit the Stomach and strengthen Spleen. Scutellaria and Coptis clear the upper and secure the lower. Pinellia and Dried Ginger eliminate fluid and dissipate fullness. Ginseng and Licorice boost Qi and harmonize the middle. Thus, "Heart-Draining" means strengthening Spleen transport and benefiting Stomach digestion, thereby draining the epigastric fullness and hardness.
(12) After sweating, if the disease does not resolve but aversion to cold increases, it is a deficiency syndrome. Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction) is appropriate.
Shaoyao Gancao Fuzi Tang Prescription
White Peony Root (Shaoyao, 芍药) - 3 liang
Licorice Root (Gancao, 甘草) - 3 liang, honey-fried
Prepared Aconite Root (Fuzi, 附子) - 1 piece, processed, bark removed, broken into eight pieces
Take the three ingredients. Add five sheng of water. Decoct to one and a half sheng. Strain. Divide into three warm doses.
Aversion to cold before sweating indicates excess pathogens and solid exterior, like hostility. Aversion to cold after sweating indicates resolved pathogens and deficient exterior, like timidity. After sweating, major pathogens disperse, Ying Qi declines, and Wei Qi becomes lax. Although the disease isn't fully resolved, no other changes occur except aversion to cold, hence termed "deficiency." This refers to new exterior Qi deficiency, not pathological change. Ying belongs to Yin; declining Yin requires Sour Peony to astringe. Wei belongs to Yang; lax Yang requires Pungent Aconite to consolidate. Licorice is sweet and neutral, harmonizing Ying and Wei, excelling in this role (like the "Old Statesman").
(13) After sweating, aversion to cold indicates deficiency. Absence of aversion to cold with only heat indicates excess. Harmonize Stomach Qi with Tiaowei Chengqi Tang (Harmonizing the Stomach and Directing Downward Decoction).
The upper part briefly repeats the previous clause to introduce the text below, highlighting the "contrary" aspect. No aversion to cold indicates strong exterior Qi. Only heat indicates fluid loss and dry Stomach, hence "excess." Harmonize Stomach Qi because dryness and excess reside in the Stomach. Thus, administer Tiaowei Chengqi Tang. Although the decoction drains excess, Licorice harmonizes the middle and boosts Qi. Why? Excess forms upon deficiency. As the saying goes, "fit the tenon to the mortise," referring to this principle. (Prescription seen in Taiyang Lower Volume).
(14) After sweating, if body pain persists and the pulse is deep and slow, Guizhi Jia Shaoyao Shengjiang Ge Yi Liang Renshen San Liang Xinjia Tang (Guizhi Decoction with Added Peony and Ginger, One Liang Each, and Ginseng, Three Liangs, New Addition Decoction) is appropriate.
Guizhi Xinjia Tang Prescription
Cinnamon Twig (Guizhi, 桂枝) - 3 liang, bark removed
White Peony Root (Shaoyao, 芍药) - 4 liang
Licorice Root (Gancao, 甘草) - 2 liang, honey-fried
Ginseng Root (Renshen, 人参) - 3 liang
Fresh Ginger (Shengjiang, 生姜) - 4 liang, sliced
Jujube Fruit (Dazao, 大枣) - 12 pieces, split
Take the six ingredients. Add eleven sheng of water. Simmer gently to obtain three sheng. Strain. Divide and take warm, following Guizhi Tang methods.
After sweating, body pain with deep-slow pulse indicates sudden removal of pathogens and abrupt deficiency of Blood and Qi. Guizhi harmonizes Ying and Wei, preventing severe injury from abrupt deficiency. Adding Ginseng and Peony recovers Yin and Yang to supplement deficiency. Adding Fresh Ginger strengthens the newly recovered Stomach Qi to settle food grains. "New Addition" implies completing the set of 113 formulas. Gentle simmering should follow the first formula. This note is likely a later addition.
(15) After sweating, Guizhi Tang must not be used again. If sweating occurs with wheezing and no significant heat, Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction) is appropriate.
Mahuang Xingren Gancao Shigao Tang Prescription
Ephedrae Herba (Mahuang, 麻黄) - 4 liang, nodes removed
Apricot Seed (Xingren, 杏仁) - 50 seeds, skin and tips removed
Licorice Root (Gancao, 甘草) - 2 liang, honey-fried
Gypsum (Shigao, 石膏) - 0.5 jin, crushed, wrapped in muslin
Take the four ingredients. Add seven sheng of water. First, decoct Ephedra until volume reduces by two sheng. Remove foam. Add other herbs. Decoct to two sheng. Strain. Take one sheng warm.
"Geng xing" means using again. Guizhi Tang is prohibited because it has already been used. Shanghan requires sweating, but Guizhi Tang is inappropriate. Guizhi consolidates Wei, preventing Cold release and causing Qi rebellion, worsening wheezing. "No significant heat" means latent heat not visibly apparent. Since Shanghan exterior pathogen remains, Ephedra is used to release it. Apricot seed directs Qi down and calms wheezing. Licorice clears heat and harmonizes the middle, serving as assistant to Ephedra. Gypsum has the power to penetrate heat and aids in directing Qi down to calm wheezing. Thus, Guizhi is replaced by Gypsum, creating a variation of Mahuang Tang, the main treatment for Taiyang Shanghan complicated by wheezing after mistaken sweating. All four ingredients are necessary for efficacy.
(16) After sweating, drinking large amounts of water inevitably causes wheezing. Washing the body with water also causes wheezing.
Wheezing relates to the Lung, which belongs to Metal. Metal is cold; thus, "cold form and cold drinks injure the Lung." After sweating, Lung Qi is newly deficient and easily injured. Drinking water implies cold drinks. Washing with water causes external cold. Lung injury leads to wheezing as they govern Qi.
(17) After excessive sweating, if the person crosses hands over the heart region, feels palpitations in the epigastrium, and desires pressure, Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction) is appropriate.
Guizhi Gancao Tang Prescription
Cinnamon Twig (Guizhi, 桂枝) - 4 liang, bark removed
Licorice Root (Gancao, 甘草) - 2 liang, honey-fried
Take the two ingredients. Add three sheng of water. Decoct to one sheng. Strain. Take in one dose.
Excessive sweating injures Blood; Blood injury leads to Heart deficiency. Heart deficiency causes trembling and palpitations. Hence, crossing hands over the heart and desiring pressure. Guizhi moves inward, astringes fluids, and anchors the Heart, consolidating lax exterior. Licorice soothes the Spleen, harmonizes the middle, and boosts Qi, regulating deficient Yang. This two-ingredient formula functions to collect Yin and tonify Yang.
(18) After sweating, if palpitations occur below the umbilicus, indicating impending Ben Tun (Running Piglet) syndrome, Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) is appropriate.
Fuling Guizhi Gancao Dazao Tang Prescription
Poria (Fuling, 茯苓) - 0.5 jin
Cinnamon Twig (Guizhi, 桂枝) - 4 liang, bark removed
Licorice Root (Gancao, 甘草) - 2 liang, honey-fried
Jujube Fruit (Dazao, 大枣) - 15 pieces, split
Take the four ingredients. Add one dou of Ganlan Water (Agitated Water). First, decoct Poria until volume reduces by two sheng. Add other herbs. Decoct to three sheng. Strain. Take one sheng warm, three times daily.
Method for preparing Ganlan Water:
Take two dou of water, place in a large basin. Agitate with a ladle until 5,000-6,000 pearl-like bubbles chase each other on the surface. Use this water.
Palpitations below the umbilicus indicate Kidney Qi attacking the Heart due to fluid deficiency after sweating, with Kidney Water threatening to ascend and overcome Heart Fire, causing trembling below the umbilicus. "Impending" means awaiting onset. "Ben Tun" is seen in the previous volume. Fluid retention in the Heart region causes palpitations. Poria is bland and leaching, overcoming water and suppressing Kidney excess. Guizhi moves inward, directs Kidney Qi downward, and prevents Ben Tun before it arrives. Licorice boosts Qi, compensating for Yang deficiency post-sweating. Jujube harmonizes Earth, restraining pathogenic Kidney Water. Ganlan Water, through agitation, achieves pure nature, preventing it from aiding evil and causing disaster.
(19) After sweating, if abdominal fullness occurs, Houpo Shengjiang Gancao Banxia Renshen Tang (Magnolia Bark, Fresh Ginger, Licorice, Pinellia, and Ginseng Decoction) is appropriate.
Houpo Shengjiang Gancao Banxia Renshen Tang Prescription
Magnolia Bark (Houpo, 厚朴) - 0.5 jin, bark removed, honey-fried
Fresh Ginger (Shengjiang, 生姜) - 0.5 jin, sliced
Pinellia Tuber (Banxia, 半夏) - 0.5 sheng, washed
Ginseng Root (Renshen, 人参) - 1 liang
Licorice Root (Gancao, 甘草) - 2 liang, honey-fried
Take the five ingredients. Add one dou of water. Decoct to three sheng. Strain. Take one sheng warm, three times daily.
Abdominal fullness after sweating indicates Stomach dryness, Yang deficiency with Qi stagnation, and retained fluid. Sweetness of Ginseng and Licorice benefits the Stomach and moistens dryness. Pungency of Fresh Ginger and Pinellia eliminates fluid and dissipates fullness. However, fullness requires Bitterness to drain; thus, Magnolia Bark acts as the sovereign herb among the four to treat the condition.
(20) In Shanghan or Fengzhong (Wind Strike), if the physician incorrectly uses purgation, the patient suffers diarrhea dozens of times daily, undigested food, borborygmus, epigastric fullness and hardness, dry retching, vexation, and inability to rest. Seeing epigastric fullness, the physician assumes incomplete pathogen elimination and purges again, worsening the fullness. This is not accumulated Heat, but rather Stomach deficiency with rebellious hostile Qi ascending, causing hardness. Gancao Xiexin Tang (Licorice Heart-Draining Decoction) is appropriate.
Gancao Xiexin Tang Prescription
Licorice Root (Gancao, 甘草) - 4 liang, honey-fried
Scutellaria Root (Huangqin, 黄芩) - 3 liang
Coptis Rhizome (Huanglian, 黄连) - 1 liang
Dried Ginger (Ganjiang, 干姜) - 3 liang
Pinellia Tuber (Banxia, 半夏) - 0.5 sheng, washed
Jujube Fruit (Dazao, 大枣)