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。
风有阴阳，太阳中风汗出脉缓者，是中于鼓动之阳风。此汗不出而脉紧者，中于凛冽之阴风矣。风令脉浮，
浮紧而沉不紧，与伤寒阴阳俱紧之脉有别也。发热恶寒，与桂枝症同。身疼痛不汗出，与麻黄症同。惟烦躁是本
症所独，故制此方以治风热相搏耳。热淫于内，则心神烦扰。风淫末疾，故手足躁乱。此即如狂之状也。风盛
于表，非发汗不解。阳郁于内，非大寒不除。此本麻黄症之剧者，故于麻黄汤倍麻黄以发汗，加石膏以除烦。
凡云太阳，便具恶寒头痛。若见重者，条中必更提之。凡称中风，则必恶风。桂枝症复提恶风者，见恶寒不甚。
此恶寒甚，故不见其更恶风也。
伤寒脉浮缓、发热恶寒、无汗烦躁、身不疼但重、乍有轻时、无少阴症者，大青龙汤发之。
寒有重轻、伤之重者，脉阴阳俱紧而身疼；伤之轻者，脉浮缓而身重。亦有初时脉紧渐缓，初时身疼。继
而不疼者。诊者勿执一以拘也。本论云∶“伤寒三日，阳明脉大，少阳脉小”。脉弦细者属少阳，脉浮缓者系
太阴，可以见伤寒无定脉也。然脉浮紧者必身疼，脉浮缓者身不疼，中风伤寒皆然，又可谓之定脉定症矣。脉
浮缓下，当有发热、恶寒、无汗、烦躁等证。盖脉浮缓身不疼，见表症亦轻。但身重乍有轻时，见表症将罢，
以无汗烦躁。故合用大青龙。无少阴症，仲景正为不汗
出而烦躁之症。因少阴亦有发热、恶寒、无汗、烦躁之症，与大青龙同，法当温补。若反与麻黄之散，石膏之
寒，真阳立亡矣。必细审其所不用，然后不失其所当用也。
前条是中风之重症，此条是伤寒之轻症。仲景只为补无少阴句，与上文烦躁互相发明，意不重在伤寒。盖烦
躁是阳邪，伤寒之轻者有之，重者必呕逆矣。
若脉微弱、汗出恶风者，不可服，服之则厥逆、筋惕肉 。此为逆也。
大青龙名重剂，不特少阴伤寒不可用。即太阳中风亦不可轻用也。此条与桂枝方禁对照∶脉浮紧，汗不出，
是麻黄症，不可与桂枝汤，以中有芍药能止汗也；脉微弱，自汗出，是桂枝症，不可与大青龙，以中有麻黄、石
膏故也。夫脉微而恶风寒者，此阴阳俱虚，不可用麻黄发汗；脉微弱而自汗出，是无阳也，不可用石膏清里。
盖石膏泻胃脘之阳，服之则胃气不至于四肢，必手足厥逆；麻黄散卫外之阳，服之则血气不周于身，必筋惕肉 。
此仲景所深戒也。且脉紧身疼宜以汗解者，只尺中迟，即不可发汗，况微弱乎？
大青龙症之不明于世者，许叔微始作之俑也。其言曰∶“桂枝治中风，麻黄治伤寒，大青龙治中风见寒脉、
伤寒见风脉，三者如鼎立。”此三大纲所由来乎？愚谓先以脉论，夫中风脉浮紧，伤寒脉浮缓，是仲景互文见意
处。言中风脉多缓，然亦有脉紧者；伤寒脉当紧，然亦有脉缓者。盖中风伤寒，各有浅深，或因人之强弱而异，
或因地之高下、时之乖、和而殊。症固不可拘，脉亦不可执。如阳明中风而脉浮紧，太阴伤寒而脉浮缓，不可
谓脉紧必伤寒，脉缓必中风也。按《内经》脉滑曰风，则风脉原无定象。又盛而紧曰胀，则紧脉不专属伤寒。又
缓而滑曰热中，则缓脉又不专指中风矣。且阳明中风，有脉浮紧者，又有脉浮大者，必欲以脉浮缓为中风，则
二条将属何症耶？今人但以太阳之脉缓自汗、脉紧无汗，以分风寒、列营卫，并不知他经皆有中风，即阳明之
中风，无人谈及矣。请以太阳言之，太阳篇言中风之脉症有二∶一曰太阳中风，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。一曰太阳中风脉浮紧，发热恶寒、身
疼痛、不汗出而烦躁者，大青龙汤主之。
以二症相较∶阳浮见寒之轻，浮紧见寒之重；汗出见寒之轻，不汗出见寒之重；啬啬淅淅见风寒之轻，翕翕见发
热之轻，发热恶寒。觉寒热之俱重；鼻鸣见风之轻，身疼见风之重；自汗干呕。见烦之轻，不汗烦躁。见烦之重
也。言伤寒脉症者二∶一曰太阳病，或未发热，或已发热，必恶寒、体痛、呕逆、脉阴阳俱紧者，名曰伤寒。
一曰伤寒脉浮，自汗出，小便数，心烦、微恶寒，脚挛急。以二症相较∶微恶寒见必恶寒之重，体痛觉挛急之轻；
自汗出、小便数、心烦，见伤寒之轻，或未发热，见发热之轻，必先呕逆，见伤寒之重；脉浮见寒之轻，阴阳俱
紧见寒之重。中风伤寒，各有轻重如此。今人必以伤寒为重，中风为轻，但知分风寒之中、伤，而不辨风寒之轻、
重，于是有伤寒见风、中风见寒之遁辞矣。合观之，则不得以脉缓自汗为中风定局，更不得以脉紧无汗为伤寒而
非中风矣。由是推之，太阳中风，以火发汗者，无汗可知，其脉紧亦可知∶太阳中风，下利呕逆，其人 汗出，
其脉缓亦可知也。要知仲景凭脉辨症，只审虚实。不论中风伤寒，脉之紧缓，但于指下有力者为实，脉弱无力者
为虚；不汗出而烦躁者为实，汗出多而烦躁者为虚；症在太阳而烦躁者为实，症在少阴而烦躁者为虚。实者可服
大青龙，虚者便不可服，此最易晓也。要知仲景立方，因症而设，不专因脉而设。大青龙汤为风寒在表而兼热中
者设，不专为无汗而设。故中风有烦躁者可用，伤寒而烦躁者亦可用。盖风寒本是一气，故汤剂可以互投。论中
有中风伤寒互称者，如青龙是也；中风伤寒并提者，如小柴胡是也。仲景细审脉症而施治，何尝拘拘于中风伤寒之
名是别乎？若仲景既拘拘于中风伤寒之别，即不得更有中风见寒、伤寒见风之浑矣。
夫风为阳邪，寒为阴邪，虽皆因于时气之寒，而各不失其阴阳之性。故伤寒轻者全似中风，独脚挛急不是，
盖腰以上为阳，而风伤于上也。中风重者全似伤寒，而烦躁不是，盖寒邪呕而不烦、逆而不躁也。然阴阳互根，
烦为阳邪，烦极致躁，躁为阴邪，躁极致烦。故中风轻者烦轻，重者烦躁；伤寒重者烦躁，轻者微烦。微烦则恶
寒亦微，阳足以胜微寒，故脉浮不紧。
盖仲景制大青龙，全为太阳烦躁而设。又恐人误用青龙，不特为脉弱汗出者禁，而在少阴尤宜禁之。盖少阴
亦有发热、恶寒、身疼、无汗而烦躁之症，此阴极似阳，寒极反见热化也。误用之，则厥逆筋惕
肉所必致矣。故必审其症之非少阴，则为太阳烦躁无疑。太阳烦躁为阳盛也。非大青龙不解。故不特脉浮紧之
中风可用，即浮缓而不微弱之伤寒亦可用也。不但身疼重者可用，即不身疼与身重而乍有轻时者，亦可用也。
盖胃脘之阳，内郁于胸中而烦，外扰于四肢而躁。若但用麻黄发汗于外，而不加石膏泄热于内，至热并阳明而
斑黄狂乱，是乃不用大青龙之故耳。
大青龙汤∶
麻黄（六两） 桂枝（二两） 甘草（二两） 杏仁（四十枚） 生姜（三两） 大枣（十枚） 石膏（打碎）
以水九升，先煮麻黄，减二升，去上沫，内诸药，煮取三升，温服一升，取微似有汗。
此即加味麻黄汤也。诸症全是麻黄，而有喘与烦躁之不同。喘者是寒郁其气，升降不得自如，故多杏仁之苦
以降气。烦躁是热伤其气，无津不能作汗，故特加石膏之甘以生津。然其质沉、其性寒，恐其内热顿除，而外之
表邪不解，变为寒中而协热下利，是引贼破家矣。故必倍麻黄以发汗，又倍甘草以和中，更用姜枣以调营卫，一
汗而表里双解、风热两除。此大青龙清内攘外之功，所以佐麻桂二方之不及也。
麻黄汤症，热全在表。桂枝症之自汗，大青龙之烦躁，皆兼里热。仲景于表剂中便用寒药以清里。盖风为阳
邪，惟烦是中风面目。自汗乃烦之兆，躁乃烦之征。汗出则烦得泄，故不躁，宜微酸微寒之味以和之；汗不出则
烦不得泄，故躁，必甘寒大寒之品以清之。夫芍药、石膏，俱是里药。今人见仲景入表剂中，疑而畏之，故不敢
用。当用不用，以至阳明实热斑黄狂乱也。夫青龙以发汗名，其方分大小，在麻黄之多寡，而不在石膏。观小青
龙之不用可知。石膏不能驱在表之风寒，独清中宫之燔灼。观白虎汤之多用可知。世不审石膏为治烦，竟以发汗
用。十剂云∶“轻可去实。”岂以至坚至重之质而能发散哉？汗多亡阳者，过在麻黄耳。用石膏以清胃火，是仲
景于太阳经中，预保阳明之先着。加姜枣以培中气，又虑夫转属太阴也。
伤寒表不解，心下有水气，干呕发热而咳，或渴、或利、或噎、或小便不利少腹满、或喘者，小青龙汤主之。
发热是表未解，干呕而咳，是水气为患。水气者，太阳寒水之气也。太阳之化，在天为寒，在地为水。其
伤人也，浅者皮肉筋骨，重者害及五脏。心下有水气，是伤藏也。水气未入于胃，故干呕。咳者，水气射肺也。
皮毛者肺之合，表寒不解，寒水已留其合矣。心下之水气，又上至于肺则肺寒，内外合邪，故咳也。水性动，
其变多。水气下而不上，则或渴或利；上而不下，则或噎或喘；留而不行，则小便不利，而小腹因满也。制小青
龙以两解表里之邪，复立加减法，以治或然之症，此为太阳枢机之剂。水气蓄于心下，尚未固结，故有或然之
症。若误下，则硬满而成结胸矣。
小青龙汤∶
桂枝 芍药 甘草 麻黄 细辛 干姜（各三两） 半夏 五味子（各半斤）
以水一斗，先煮麻黄，减二升，去上沫，内诸药，煮取三升，温服一升。若渴，去半夏，加栝蒌根三两。若
微利，去麻黄，加芫花（如鸡子大），熬令赤色。若噎者，去麻黄，加附子一枚（炮）。若小便不利，少腹满
者，去麻黄，加茯苓四两。若喘者，去麻黄，加杏仁半升（去皮尖）。
表虽未解，寒水之气已去营卫，故于桂枝汤去姜枣，加细辛、干姜、半夏、五味。辛以散水气而除呕，酸以
收逆气而止咳，治里之剂多于发表焉。小青龙与小柴胡，俱为枢机之剂。故皆设或然症，因各立加减法。盖表症
既去其半，则病机偏于向里，故二方之症多属里。仲景多用里药，少用表药。未离于表，故为解表之小方。然小
青龙主太阳之半表里，尚用麻黄、桂枝，还重视其表；小柴胡主少阳之半表里，只用柴胡、生姜，但微解其表而已。
此缘太、少之阳气不同，故用表药之轻重亦异。小青龙设或然五症，加减法内即备五方。小柴胡设或然七症，即具
加减七方，此仲景法中之法，方外之方，何可以三百九十七、一百一十三拘之？
伤寒心下有水气，咳而微喘，发热不渴，小青龙汤主之。服汤已渴者，此寒去欲解也。
水气在心下则咳，为必然之症。喘为或然之症，亦如柴胡汤症。但见一症即是，不必悉具。咳与喘，皆水气
射肺所致。水气上升，是以不渴。服汤已而反渴，水气内散，寒邪亦外散也。此条正欲明服汤后渴者是解候。恐
人服止渴药，反滋水气，故先提不渴二字作眼，后提出渴者以明之。服汤即小青龙汤。若寒既欲解，而更服之，
不惟不能止渴，且重亡津液，转属阳明而成胃实矣。能化胸中之热气而为汗，故名大青龙，能化心下之水气而为
汗，故名小青龙。盖大青龙表症多，只烦躁是里症；小青龙里症多，只发热是表症。故有大小发汗之殊耳。发汗、
利水，是治太阳两大法门。发汗分形层之次第，利水定三焦之浅深。故发汗有五法∶麻黄汤汗在皮肤，乃外感之
寒气；桂枝汤汗在经络，乃血脉之精气；葛根汤汗在肌肤，乃津液之清气；大青龙汗在胸中，乃内扰之阳气；小
青龙汗在心下，乃内蓄之水气。其治水有三法∶干呕而咳，是水在上焦，在上者发之，小青龙是也；心下痞满，
是水在中焦，中满者泻之，十枣汤是也；小便不利，是水在下焦，在下者引而竭之，五苓散是也。其他坏症、
变症虽多，而大法不外是矣。
Taiyang wind-stroke syndrome, if presenting with a floating and tight pulse, fever, aversion to cold, body pain, anhidrosis (absence of sweating), and irritability, should be treated with Da Qing Long Tang (Major Blue Dragon Decoction).
Wind pathogens have yin and yang distinctions. In Taiyang wind-stroke syndrome, sweating with a slow pulse indicates contracting the dynamic, ascending yang wind. Here, the absence of sweating and a tight pulse indicate contracting the chilling,肃杀 yin wind. Wind causes the pulse to float. A floating and tight pulse that is not tight upon deep pressure differs from the condition in Shanghan (cold damage) where both superficial and deep pulses are tight. Fever and aversion to cold are similar to Guizhi Tang (Cinnamon Twig Decoction) syndrome. Body pain with anhidrosis is similar to Mahuang Tang (Ephedra Decoction) syndrome. Only irritability is unique to this syndrome; thus, this formula was created to treat the interplay of wind and heat. When heat overflows internally, it disturbs the heart spirit causing irritability. When wind invades the extremities causing disease, restlessness of the hands and feet occurs. This resembles a state of mania. When wind is abundant at the exterior, only diaphoresis can resolve it. When yang is depressed internally, only major cold herbs can eliminate it. This is essentially a severe form of Mahuang Tang syndrome; therefore, Mahuang (Ephedrae Herba) is doubled to enhance diaphoresis, and Shigao (Gypsum Fibrosum) is added to clear irritability. Whenever "Taiyang" is mentioned, aversion to cold and headache are inherent. If symptoms are particularly severe, they will be reiterated in the text. Whenever "wind-stroke" is called for, aversion to wind must be present. The re-emphasis on aversion to wind in Guizhi Tang syndrome indicates that aversion to cold is not severe. Here, aversion to cold is severe, so aversion to wind is not separately mentioned.
In Shanghan syndrome, if presenting with a floating and slow pulse, fever, aversion to cold, anhidrosis, irritability, body heaviness without pain, occasional relief, and no Shaoyin syndrome, Da Qing Long Tang (Major Blue Dragon Decoction) should be used to disperse.
Cold pathogens have severity levels. Severe injury presents with tight pulses at both cun and chi positions and body pain; mild injury presents with a floating and slow pulse and body heaviness. There are also cases where the pulse starts tight and gradually becomes slow, or body pain starts and later ceases. Practitioners should not be rigid. The Treatise states: "On the third day of Shanghan, the Yangming pulse is large, and the Shaoyang pulse is small." A wiry and fine pulse belongs to Shaoyang; a floating and slow pulse relates to Taiyin; thus, Shanghan has no fixed pulse. However, a floating and tight pulse necessarily involves body pain, while a floating and slow pulse does not; this applies to both wind-stroke and Shanghan, suggesting a fixed pulse-symptom correspondence. Below "floating and slow pulse," symptoms such as fever, aversion to cold, anhidrosis, and irritability should be implied. Because a floating and slow pulse with no body pain indicates milder exterior syndrome, but body heaviness with occasional relief suggests the exterior syndrome is subsiding. Due to anhidrosis and irritability, Da Qing Long Tang (Major Blue Dragon Decoction) is combined. The phrase "no Shaoyin syndrome" is specifically by Zhang Zhongjing regarding anhidrosis and irritability, because Shaoyin syndrome also presents with fever, aversion to cold, anhidrosis, and irritability, identical to Da Qing Long Tang syndrome, but its treatment should be warming and tonifying. If one instead uses the dispersing nature of Mahuang (Ephedrae Herba) and the cold nature of Shigao (Gypsum Fibrosum), true yang will perish instantly. One must carefully examine what is contraindicated to avoid misusing what is indicated.
The previous clause describes a severe wind-stroke case; this clause describes a mild Shanghan case. Zhang Zhongjing adds "no Shaoyin syndrome" to clarify with the preceding irritability, implying the focus is not strictly on distinguishing Shanghan. Irritability is caused by yang pathogenic factors; mild Shanghan may have this, but severe cases will definitely have vomiting and counterflow qi.
If the pulse is faint and weak, with sweating and aversion to wind, Da Qing Long Tang (Major Blue Dragon Decoction) must not be taken. Taking it will lead to cold limbs (Jue Ni) and muscle twitching (Jin Ti Rou Tiao). This is an adverse reaction due to misprescription.
Da Qing Long Tang (Major Blue Dragon Decoction) is named a heavy agent. It is not only contraindicated in Shaoyin Shanghan but also should not be lightly used in Taiyang wind-stroke. Comparing this clause with the contraindications for Guizhi Tang (Cinnamon Twig Decoction): A floating and tight pulse with anhidrosis is a Mahuang Tang (Ephedra Decoction) syndrome; Guizhi Tang (Cinnamon Twig Decoction) should not be given because it contains Shaoyao (Paeoniae Radix Alba) which stops sweating. A faint and weak pulse with spontaneous sweating is a Guizhi Tang (Cinnamon Twig Decoction) syndrome; Da Qing Long Tang (Major Blue Dragon Decoction) should not be given because it contains Mahuang (Ephedrae Herba) and Shigao (Gypsum Fibrosum). A faint pulse with aversion to cold and wind indicates deficiency of both yin and yang; Mahuang (Ephedrae Herba) for diaphoresis should not be used. A faint and weak pulse with spontaneous sweating indicates absence of yang; Shigao (Gypsum Fibrosum) for clearing interior heat should not be used. Shigao (Gypsum Fibrosum) drains the yang of the stomach region; taking it prevents stomach qi from reaching the four limbs, inevitably causing cold limbs. Mahuang (Ephedrae Herba) scatters the defensive yang; taking it prevents blood and qi from circulating through the body, inevitably causing muscle twitching. This is deeply cautioned by Zhang Zhongjing. Furthermore, for tight pulse and body pain suitable for diaphoresis, if the chi pulse is slow, diaphoresis is forbidden; how much more so if the pulse is faint and weak?
The confusion surrounding Da Qing Long Tang (Major Blue Dragon Decoction) syndrome began with Xu Shuwei. He stated: "Guizhi Tang (Cinnamon Twig Decoction) treats wind-stroke, Mahuang Tang (Ephedra Decoction) treats Shanghan, and Da Qing Long Tang (Major Blue Dragon Decoction) treats wind-stroke with cold pulse or Shanghan with wind pulse; these three stand like a tripod." Is this the origin of these three main categories? I argue we must first discuss pulses. Wind-stroke pulse is floating and tight, Shanghan pulse is floating and slow; this is Zhang Zhongjing's use of mutual textual meaning. It means wind-stroke pulses are mostly slow, but can be tight; Shanghan pulses should be tight, but can be slow. Wind-stroke and Shanghan have varying depths, differing by individual strength, geographical altitude, or climatic harmony/disorder. Symptoms cannot be rigidly defined, nor can pulses. For example, Yangming wind-stroke can have a floating and tight pulse, and Taiyin Shanghan can have a floating and slow pulse. One cannot say tight pulse is always Shanghan and slow pulse is always wind-stroke. According to *Neijing*, a slippery pulse indicates wind, so wind pulse has no fixed image. A full and tight pulse indicates distension, so tight pulse is not exclusive to Shanghan. A slow and slippery pulse indicates internal heat, so slow pulse does not exclusively refer to wind-stroke. Moreover, Yangming wind-stroke has floating and tight pulses, and floating and large pulses. If one insists floating and slow pulse defines wind-stroke, what do these two clauses belong to? Modern practitioners only distinguish wind and cold based on Taiyang slow pulse with sweating versus tight pulse without sweating, listing Ying and Wei, ignoring that other meridians also have wind-stroke, let alone Yangming wind-stroke. Let us take Taiyang as an example. The Taiyang chapter mentions two wind-stroke pulse-symptom patterns: First, Taiyang wind-stroke with floating yang and weak yin, where floating yang means spontaneous heat and weak yin means spontaneous sweating, accompanied by shivering aversion to cold, chilly aversion to wind, mild fever, nasal congestion, and dry vomiting, treated with Guizhi Tang (Cinnamon Twig Decoction). Second, Taiyang wind-stroke with floating and tight pulse, fever, aversion to cold, body pain, anhidrosis, and irritability, treated with Da Qing Long Tang (Major Blue Dragon Decoction).
Comparing these two syndromes: Floating yang indicates mild cold, floating and tight indicates severe cold; sweating indicates mild cold, anhidrosis indicates severe cold; shivering/chilly indicates mild wind-cold, mild fever indicates mild heat, fever with aversion to cold indicates severe sensation of heat; nasal congestion indicates mild wind, body pain indicates severe wind; spontaneous sweating and dry vomiting indicate mild irritability, anhidrosis and irritability indicate severe irritability. Two Shanghan pulse-symptom patterns are mentioned: First, Taiyang disease, whether fever has appeared or not, must have aversion to cold, body pain, vomiting, counterflow qi, and tight pulses at both cun and chi, named Shanghan. Second, Shanghan with floating pulse, spontaneous sweating, frequent urination, irritability, slight aversion to cold, and foot cramping. Comparing these: Slight aversion to cold indicates the severity of mandatory aversion to cold; body pain feels less severe than cramping; spontaneous sweating, frequent urination, and irritability indicate mild Shanghan, or no fever indicates mild heat, mandatory vomiting and counterflow qi indicate severe Shanghan; floating pulse indicates mild cold, tight pulses at both cun and chi indicate severe cold. Thus, wind-stroke and Shanghan have varying degrees of severity. Modern practitioners insist Shanghan is severe and wind-stroke is mild, knowing only to distinguish 'wind-strike' vs 'wind-injure', but failing to distinguish mild vs severe wind/cold, leading to excuses like "Shanghan showing wind pulse, wind-stroke showing cold pulse." Synthesizing this, one cannot take slow pulse with sweating as the definitive pattern for wind-stroke, nor tight pulse without sweating as definitively Shanghan and not wind-stroke. By deduction, Taiyang wind-stroke treated with fire-induced diaphoresis implies anhidrosis and tight pulse; Taiyang wind-stroke with diarrhea, vomiting, counterflow qi, and continuous sweating implies slow pulse. One must know Zhang Zhongjing diagnoses based on pulse and symptoms, examining only excess and deficiency. Regardless of wind-stroke or Shanghan, if the pulse is forceful under the fingers, it is excess; if weak and powerless, it is deficiency. Anhidrosis with irritability is excess; profuse sweating with irritability is deficiency. Irritability in Taiyang is excess; irritability in Shaoyin is deficiency. Excess cases can take Da Qing Long Tang (Major Blue Dragon Decoction); deficiency cases cannot. This is easy to understand. One must know Zhang Zhongjing creates formulas based on symptoms, not solely on pulses. Da Qing Long Tang (Major Blue Dragon Decoction) is designed for wind-cold at the exterior with concurrent internal heat, not solely for anhidrosis. Therefore, wind-stroke with irritability can use it, and Shanghan with irritability can also use it. Since wind and cold are originally one qi, the decoctions can be interchangeable. The Treatise mentions wind-stroke and Shanghan interchangeably, such as with Qing Long; and together, such as with Xiao Chai Hu Tang (Minor Bupleurum Decoction). Did Zhang Zhongjing ever rigidly distinguish between wind-stroke and Shanghan names when carefully examining pulses and symptoms? If he were rigid about the distinction, there would be no mixing of "wind-stroke showing cold" or "Shanghan showing wind."
Wind is a yang pathogen, cold is a yin pathogen. Although both arise from seasonal cold, each retains its yin-yang nature. Thus, mild Shanghan resembles wind-stroke completely, except for foot cramping, because the upper body is yang, and wind injures the upper part. Severe wind-stroke resembles Shanghan completely, except for irritability, because cold pathogens cause vomiting without irritability and counterflow without restlessness. However, yin and yang are mutually rooted. Irritability is a yang pathogen; extreme irritability leads to restlessness. Restlessness is a yin pathogen; extreme restlessness leads to irritability. Thus, mild wind-stroke has mild irritability, severe has irritability and restlessness; severe Shanghan has irritability and restlessness, mild has slight irritability. Slight irritability means slight aversion to cold, as yang is sufficient to overcome slight cold, so the pulse floats but is not tight.
Generally, Zhang Zhongjing formulated Da Qing Long Tang (Major Blue Dragon Decoction) entirely for Taiyang irritability. He feared people might misuse it, prohibiting it not only for faint pulse and sweating but especially for Shaoyin syndrome. Shaoyin syndrome also presents with fever, aversion to cold, body pain, anhidrosis, and irritability; this is extreme yin resembling yang, extreme cold manifesting as heat transformation. Misuse leads to cold limbs and muscle twitching. Therefore, one must verify the syndrome is not Shaoyin, confirming it as Taiyang irritability. Taiyang irritability is excessive yang. Only Da Qing Long Tang (Major Blue Dragon Decoction) can resolve it. Thus, it can be used not only for wind-stroke with floating and tight pulse, but also for Shanghan with floating and slow pulse that is not faint and weak. It can be used not only for body pain and heaviness, but also for no body pain or body heaviness with occasional relief. The yang of the stomach region, depressed internally in the chest causing irritability, and disturbing the four limbs externally causing restlessness. If only Mahuang (Ephedrae Herba) is used to induce diaphoresis externally, without Shigao (Gypsum Fibrosum) to drain heat internally, the heat will merge with Yangming causing macules, jaundice, and mania. This is the consequence of not using Da Qing Long Tang (Major Blue Dragon Decoction).
Da Qing Long Tang (Major Blue Dragon Decoction):
Mahuang (Ephedrae Herba) (6 liang), Guizhi (Cinnamomi Ramulus) (2 liang), Gancao (Glycyrrhizae Radix et Rhizoma) (2 liang), Xingren (Armeniacae Semen Amarum) (40 pieces), Shengjiang (Zingiberis Rhizoma Recens) (3 liang), Dazao (Ziziphi Jujubae Fructus) (10 pieces), Shigao (Gypsum Fibrosum) (crushed).
Boil in 9 sheng of water. First boil Mahuang (Ephedrae Herba), reduce by 2 sheng, remove the foam on top. Add remaining herbs. Boil to obtain 3 sheng. Take 1 sheng warm. Aim for slight sweating.
This is essentially a modified Mahuang Tang (Ephedra Decoction). All symptoms are based on Mahuang Tang (Ephedra Decoction), differing in wheezing and irritability. Wheezing is due to cold depressing qi, obstructing free ascent and descent, hence bitter Xingren (Armeniacae Semen Amarum) is added to direct qi downward. Irritability is due to heat damaging qi and lack of fluids to produce sweat, hence sweet Shigao (Gypsum Fibrosum) is specially added to generate fluids. However, Shigao (Gypsum Fibrosum) is heavy and cold. We fear that if internal heat is suddenly cleared, exterior pathogens remain unresolved, transforming into cold-middle with協熱下利 (diarrhea with heat), which is like inviting thieves to destroy the house. Therefore, Mahuang (Ephedrae Herba) must be doubled to induce diaphoresis, Gancao (Glycyrrhizae Radix et Rhizoma) doubled to harmonize the middle, and Jiang Zao (Shengjiang and Dazao) used to regulate Ying and Wei. One diaphoresis resolves both exterior and interior, eliminating both wind and heat. This is the merit of Da Qing Long Tang (Major Blue Dragon Decoction) in clearing interior and repelling exterior, supplementing the inadequacies of Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction).
In Mahuang Tang (Ephedra Decoction) syndrome, heat is entirely at the exterior. Spontaneous sweating in Guizhi Tang (Cinnamon Twig Decoction) syndrome and irritability in Da Qing Long Tang (Major Blue Dragon Decoction) syndrome both involve interior heat. Zhang Zhongjing uses cold herbs within exterior-resolving agents to clear interior heat. Wind is a yang pathogen; only irritability is the hallmark of wind-stroke. Spontaneous sweating is a precursor to irritability; restlessness is a sign of irritability. Sweating allows irritability to vent, so there is no restlessness; mild sour and mild cold flavors are suitable to harmonize it. Anhidrosis prevents irritability from venting, so restlessness occurs; sweet, cold, and major cold substances are necessary to clear it. Shaoyao (Paeoniae Radix Alba) and Shigao (Gypsum Fibrosum) are interior herbs. Modern practitioners see them in exterior formulas, doubt and fear them, and dare not use them. Failure to use them appropriately leads to Yangming excess heat, macules, jaundice, and mania. Da Qing Long Tang (Major Blue Dragon Decoction) is named for diaphoresis. Its size variation (Major/Minor) depends on the quantity of Mahuang (Ephedrae Herba), not Shigao (Gypsum Fibrosum). Observe that Xiao Qing Long Tang (Minor Blue Dragon Decoction) does not use Shigao (Gypsum Fibrosum). Shigao (Gypsum Fibrosum) cannot drive out wind-cold at the exterior; it only clears the blazing heat in the central palace. Observe the extensive use of Shigao (Gypsum Fibrosum) in Bai Hu Tang (White Tiger Decoction). People fail to recognize Shigao (Gypsum Fibrosum) as a treatment for irritability/thirst, mistakenly using it for diaphoresis. The *Ten Categories* states: "Lightness can remove excess." How can a substance of utmost hardness and weight cause dispersion? Excessive sweating leading to loss of yang is the fault of excessive Mahuang (Ephedrae Herba). Using Shigao (Gypsum Fibrosum) to clear stomach fire is Zhang Zhongjing's preemptive move to protect Yangming within the Taiyang channel. Adding Jiang Zao (Shengjiang and Dazao) to cultivate middle qi anticipates potential transmission to Taiyin.
When Shanghan exterior is unresolved, and there is fluid retention in the epigastrium, presenting with dry vomiting, fever, and cough, or thirst, or diarrhea, or choking, or dysuria with hypogastric fullness, or wheezing, Xiao Qing Long Tang (Minor Blue Dragon Decoction) is indicated.
Fever indicates the exterior is unresolved. Dry vomiting and cough indicate fluid retention pathology. Fluid retention refers to Taiyang cold-water qi. Taiyang transformation is cold in heaven and water on earth. When injuring humans, shallow injury affects skin, flesh, sinews, and bones; severe injury harms the five zang organs. Fluid retention in the epigastrium indicates zang organ injury. Fluid retention has not entered the stomach, hence dry vomiting. Cough is fluid retention attacking the lungs. The skin and hair are the exterior of the lungs. Unresolved exterior cold means cold water has remained in the lung's exterior association. Fluid retention in the epigastrium ascends to the lungs, cooling them. Internal and external pathogens combine, causing cough. Water nature is mobile, with many variations. If fluid retention goes down but not up, there is thirst or diarrhea; if up but not down, there is choking or wheezing; if stagnant and not moving, there is dysuria and hypogastric fullness. Xiao Qing Long Tang (Minor Blue Dragon Decoction) is formulated to resolve both exterior and interior pathogens. Additional modification methods are established to treat optional symptoms. This is the pivot agent of Taiyang. Fluid retention is stored in the epigastrium, not yet firmly knotted, hence optional symptoms exist. If mistaken for purgation, hard fullness and Jie Xiong (chest binding) will form.
Xiao Qing Long Tang (Minor Blue Dragon Decoction):
Guizhi (Cinnamomi Ramulus), Shaoyao (Paeoniae Radix Alba), Gancao (Glycyrrhizae Radix et Rhizoma), Mahuang (Ephedrae Herba), Xixin (Asari Radix et Rhizoma), Ganjiang (Zingiberis Rhizoma) (each 3 liang), Banxia (Pinelliae Rhizoma), Wubeizi (Schisandrae Fructus) (each half jin).
Boil in 1 dou of water. First boil Mahuang (Ephedrae Herba), reduce by 2 sheng, remove foam. Add remaining herbs. Boil to obtain 3 sheng. Take 1 sheng warm. If thirsty, remove Banxia (Pinelliae Rhizoma), add Gualougen (Trichosanthis Radix) 3 liang. If slight diarrhea, remove Mahuang (Ephedrae Herba), add Yuanhua (Kadsurae Flos) the size of a chicken egg, roasted until red. If choking, remove Mahuang (Ephedrae Herba), add Fuzi (Aconiti Lateralis Radix Praeparata) 1 piece (prepared). If dysuria with hypogastric fullness, remove Mahuang (Ephedrae Herba), add Fuling (Poria) 4 liang. If wheezing, remove Mahuang (Ephedrae Herba), add Xingren (Armeniacae Semen Amarum) half sheng (skin and tips removed).
Although the exterior is unresolved, the cold-water qi has affected Ying and Wei. Therefore, in Guizhi Tang (Cinnamon Twig Decoction), Jiang Zao (Shengjiang and Dazao) are removed, and Xixin (Asari Radix et Rhizoma), Ganjiang (Zingiberis Rhizoma), Banxia (Pinelliae Rhizoma), and Wubeizi (Schisandrae Fructus) are added. Pungent herbs scatter fluid retention and stop vomiting; sour herbs collect counterflow qi and stop coughing. Interior-treating herbs outnumber exterior-releasing ones. Xiao Qing Long Tang (Minor Blue Dragon Decoction) and Xiao Chai Hu Tang (Minor Bupleurum Decoction) are both pivot agents. Hence, both establish optional symptoms and respective modification methods. Since half the exterior syndrome is resolved, the disease mechanism shifts inward; thus, symptoms of these two formulas largely belong to the interior. Zhang Zhongjing uses more interior herbs and fewer exterior herbs. Since the disease has not left the exterior, it is called a small exterior-resolving formula. However, Xiao Qing Long Tang (Minor Blue Dragon Decoction) governs the semi-exterior/semi-interior of Taiyang, still using Mahuang (Ephedrae Herba) and Guizhi (Cinnamomi Ramulus), valuing the exterior. Xiao Chai Hu Tang (Minor Bupleurum Decoction) governs the semi-exterior/semi-interior of Shaoyang, using only Chaihu (Bupleuri Radix) and Shengjiang (Zingiberis Rhizoma Recens), merely slightly resolving the exterior. This is because the yang qi of Taiyang and Shaoyang differ, so the weight of exterior herbs varies. Xiao Qing Long Tang (Minor Blue Dragon Decoction) establishes five optional symptoms, containing five formulas in modifications. Xiao Chai Hu Tang (Minor Bupleurum Decoction) establishes seven optional symptoms, containing seven formulas in modifications. This is the method within methods, the formula beyond formulas of Zhang Zhongjing. How can it be confined to 397 methods and 113 formulas?
When Shanghan involves fluid retention in the epigastrium, with cough and slight wheezing, fever but no thirst, Xiao Qing Long Tang (Minor Blue Dragon Decoction) is indicated. Thirst after taking the decoction indicates cold is departing and the disease is resolving.
Fluid retention in the epigastrium causes cough, a necessary symptom. Wheezing is an optional symptom, similar to Chai Hu Tang syndrome. Seeing one symptom suffices; all need not be present. Cough and wheezing are both caused by fluid retention attacking the lungs. Fluid retention ascends, hence no thirst. After taking the decoction, if thirst appears, it means fluid retention is dispersing internally and cold pathogen is dispersing externally. This clause aims to clarify that thirst after medication is a sign of resolution. It fears people might take thirst-quenching medicines, thereby nourishing fluid retention. Thus, "no thirst" is highlighted first as the key, and "thirst" is raised later to explain. "Taking the decoction" refers to Xiao Qing Long Tang (Minor Blue Dragon Decoction). If cold is already resolving, taking it again will not quench thirst but will severely deplete body fluids, transmitting to Yangming and forming stomach excess. Da Qing Long Tang (Major Blue Dragon Decoction) is named so because it transforms heat in the chest into sweat. Xiao Qing Long Tang (Minor Blue Dragon Decoction) is named so because it transforms fluid retention in the epigastrium into sweat. Generally, Da Qing Long Tang (Major Blue Dragon Decoction) has more exterior symptoms, with only irritability being an interior symptom. Xiao Qing Long Tang (Minor Blue Dragon Decoction) has more interior symptoms, with only fever being an exterior symptom. Hence, the difference in major and minor diaphoresis. Diaphoresis and promoting urination are the two major gates for treating Taiyang. Diaphoresis distinguishes layers of形体 (body structure); promoting urination determines depth of Sanjiao. Thus, there are five methods of diaphoresis: Mahuang Tang (Ephedra Decoction) induces sweat in the skin, dealing with external cold qi; Guizhi Tang (Cinnamon Twig Decoction) induces sweat in the collaterals, dealing with essence and qi of blood vessels; Gegen Tang (Puerariae Decoction) induces sweat in the muscles and skin, dealing with clear qi of body fluids; Da Qing Long Tang (Major Blue Dragon Decoction) induces sweat in the chest, dealing with internally disturbing yang qi; Xiao Qing Long Tang (Minor Blue Dragon Decoction) induces sweat in the epigastrium, dealing with internally stored fluid qi. There are three methods for treating water: Dry vomiting and cough indicate water in the Upper Jiao; what is above should be dispersed, which is Xiao Qing Long Tang (Minor Blue Dragon Decoction); Epigastric stuffiness and fullness indicate water in the Middle Jiao; what is full in the middle should be drained, which is Shi Zao Tang (Ten Jujube Decoction); Dysuria indicates water in the Lower Jiao; what is below should be drawn and exhausted, which is Wu Ling San (Five-Ingredient Powder with Poria). Although there are many damaged and transformed syndromes, the major principles do not exceed these.