太阳病，头痛、发热、汗出、恶风者，桂枝汤主之。
此条是桂枝本证，辨症为主，合此症即用此汤，不必问其为伤寒、中风、杂病也。今人凿分风、寒，不知
辨症，故仲景佳方置之疑窟。四症中，头痛是太阳本症。头痛、发热、恶风，与麻黄症同。本方重在汗出，汗不
出者，便非桂枝症。
太阳病，外证未解，脉浮弱者，当以汗解，宜桂枝汤。
此条是桂枝本脉，明脉为主。今人辨脉不明，故于症不合。伤寒、中风、杂病，皆有外证。太阳主表，表症
咸统于太阳。然必脉浮弱者，可用此解外。如但浮不弱，或浮而紧者，便是麻黄症。要知本方只主外症之虚者。
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。
此太阳中风之桂枝症，非谓凡中风者，盒饭主桂枝也。前条脉症，是概风寒杂病而言。此条加中风二字，
其脉其症，悉呈风象矣。上条言脉浮而弱者，是弱从浮见。此阳浮者，浮而有力，此名阳也。风为阳邪，此浮
为风脉。阳盛则阴虚，沉按之而弱。阳浮者，因风中于卫，两阳相搏，故热自发，是卫强也。阴弱者，因风中
于营，血脉不宁，故汗自出，是营弱也。两自字便见风邪之迅发。啬啬，欲闭之状；淅淅，欲开之状，翕翕，
难开难闭之状。虽风、寒、热三气交呈于皮毛，而动象是中风所由然也。风之体在动，风之用在声，风自皮毛
入肺，自肺出鼻，鼻息不和则鸣，此声之见于外者然也。风淫于内，木动土虚，胃气不和，故呕而无物，此声
之出于内者然也。干呕是风侵胃府，鼻鸣是风袭阳明，而称太阳者，以头项强痛故耳。亦以见太阳为三阳，阳
过其度矣。
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。
前条治中风之始，此条治中风之变。桂枝汤煮取三升，初服者，先服一升也，却与者，尽其二升也。热郁
于心胸者，谓之烦；发于皮肉者，谓之热。麻黄症发热无汗，热全在表；桂枝症发热汗出，便见内烦。服汤反
烦而外热不解，非桂枝汤不当用也，以外感之风邪重，内之阳气亦重耳。风邪本自项入，必刺风池、风府，
疏通来路，以出其邪，仍与桂枝汤，以和营卫。《内经》曰∶“表里刺之，服之饮汤。”此法是矣。
太阳病发热汗出者，此为营弱卫强，故使汗出。欲救邪风者，宜桂枝汤主之。
此释中风汗出之义，见桂枝汤为调和营卫而设。营者阴也，卫者阳也，阴弱不能藏，阳强不能密，故汗出。
形作伤寒，其脉不弦紧而弱。弱者必渴，被火者必谵语。弱者发热，脉浮解之，当汗出而愈。
形作伤寒，见恶寒、体痛、厥逆，脉当弦紧而反浮弱，其本虚可知。此东垣所云劳倦内伤症也。夫脉弱者，
阴不足。阳气陷于阴分必渴，渴者液虚故也。若以恶寒而用火攻，津液亡必胃实而谵语。然脉虽弱而发热，身痛
不休，宜消息和解其外，谅非麻黄所宜，必桂枝汤，啜热稀粥，汗出则愈矣。此为夹虚伤寒之症。
伤寒发汗，解半日许，复烦，脉浮数者，可更发汗，宜桂枝汤。
前条解伤寒之初，此条辑伤寒之后。前条因虚寒，此条因余热，卫解而营未解，故用桂枝更汗也。可知桂
枝汤主风伤卫，治风而不治寒之谬矣。浮弱是桂枝脉，浮数是麻黄脉。仲景见麻黄脉症，即用麻黄汤，见桂枝
脉症，便用桂枝汤。此不更进麻黄而却与桂枝者，盖发汗而解，则麻黄症已罢。脉浮数者，因内烦而然，不得
仍认麻黄汤脉矣。麻黄汤纯阳之剂，不可以治烦。桂枝汤内配芍药，奠安营气，正以治烦也。且此烦因汗后所
致，若再用麻黄发汗，汗从何来？必用啜热粥法始得汗。桂枝汤本治烦，服桂枝汤后外热不解，而内热更甚，
故曰反烦。麻黄症本不烦，服汤汗出，外热初解，而内热又发，故曰复烦。凡曰麻黄汤主之、桂枝汤主之者，
定法也。服桂枝不解，仍与桂枝，汗解后复烦，更用桂枝者，活法也。服麻黄复烦者，可更用桂枝；用桂枝复
烦者，不得更用麻黄。且麻黄脉症，但可用桂枝更汗，不可先用桂枝发汗。此又活法中定法矣。前二条论治中
风，此二条论治伤寒，后二条论治杂病，见桂枝方之大用如此。
病患藏无他病，时发热，自汗出而不愈者，此卫气不和也。先其时发汗则愈，宜桂枝汤主之。
藏无他病，知病只在形躯。发热有时，则汗出亦有时，不若外感者，发热汗出不休也。《内经》曰∶“阴
虚者阳必凑之，故时热汗出耳。”未发热时，阳犹在卫，用桂枝汤啜稀热粥，先发其汗，使阴出之阳，谷气内
充，而卫阳不复陷，是迎而夺之，令精胜而邪却也。
病尝自汗出者，此为营气和。营气和者外不谐，以卫气不
共营气和谐故耳。营行脉中，卫行脉外，复发其汗，营卫和则愈，宜桂枝汤。
发热时汗便出者，其营气不足。因阳邪下陷，阴不胜阳，故汗自出也。此无热而常自汗者，其营气本足。
因阳气不固，不能卫外，故汗自出。当乘其汗正出时，用桂枝汤啜稀热粥。是阳不足者，温之以气，食入于阴，
气长于阳也。阳气普遍，便能卫外而为固，汗不复出矣。和者平也，谐者合也。不和见卫强，不谐见营弱，弱
则不能合，强则不能密，皆令自汗。但以有热、无热别之，以时出、常出辨之，总以桂枝汤啜热粥汗之。
上条发热汗出，便可用桂枝汤，见不必头痛、恶风俱备。此只自汗一症，即不发热者亦用之，更见桂枝方
于自汗为亲切耳。
太阳病外症未解，不可下也。下之为逆。欲解外者，宜桂枝汤。
外症初起，有麻黄、桂枝之分。如当解未解时，惟桂枝汤可用，故桂枝汤为伤寒、中风、杂病解外之总方。
凡脉浮弱、汗自出而表不解
者，咸得而主之也。即阳明病脉迟汗出多者宜之，太阴病脉浮者亦宜之。则知诸经外症之虚者，咸得同太阳未
解之治法。又可见桂枝汤不专为太阳用矣。
太阳病先发汗不解，而复下之，脉浮者不愈。浮为在外，当须解外则愈，宜桂枝汤。
误下后而脉仍浮，可知表症未解，阳邪未陷，只宜桂枝汤解外，勿以脉浮仍用麻黄汤也。下后仍可用桂枝
汤，乃见桂枝方之力量矣。
太阳病下之，其气上冲者，可与桂枝汤，用前法；若不上冲者，不得与之。
气上冲者，阳气有余也，故外虽不解，亦不内陷。仍与桂枝汤汗之，上冲者，因而外解矣。上条论下后未解
脉，此条论下后未解症，互相发明更进桂枝之义。用前法，是啜稀热粥法，与后文根据前法、如前法同。若谓汤
中加下药，大谬。
伤寒，医下之，续得下利清谷不止，身疼痛者，急当救里；后清便自调，身体痛者，急当救表。救里宜四
逆汤，救表宜桂枝汤。
寒邪在表而妄下之，移寒于脾，下利不止，继见完谷，胃阳已亡矣。身疼未除，是表里皆困，然犹幸此表邪
之未除，里邪有可救之机。凡病从外来，当先解外。此里症既急，当舍表而救里，四逆汤自不容缓。里症既瘥，
表症仍在，救表亦不容缓矣。身疼本麻黄症，而下利清谷，其腠理之疏可知，必桂枝汤和营卫，而痛自解。故不
曰攻而仍曰救，救表仍合和中也。温中之后，仍可用桂枝汤，其神乎神矣。
下利腹胀满，身体疼痛者，先温其里，乃攻其表，温里宜四逆汤，攻表宜桂枝汤。
下利而腹尚胀满，其中即伏清谷之机，先温其里，不待其急而始救也。里和而表不解，可专治其表，故不曰救
而仍曰攻。
吐利止而身痛不休者，当消息和解其外，宜桂枝汤小和之。
吐利是脏腑不和，非桂枝汤所治；止后而身痛不休，是营卫不和，非麻黄汤所宜。和解其外，惟有桂枝一法；
消息其宜，更有小与之法也。盖脉浮数，身疼痛，本麻黄之任，而在汗下后，则反属桂枝。是又桂枝之变脉、
变症，而非复麻黄之本症、本脉矣。
伤寒大下后，复发汗，心下痞、恶寒者，表未解也。不可攻痞，当先解表，表解乃可攻痞。解表宜桂枝汤，
攻痞宜大黄黄连泻心汤。
心下痞，是误下后里症；恶寒，是汗后未解症。里实表虚，内外俱病，皆因汗、下倒施所致。表里交持，
仍当遵先表后里，先汗后下正法。盖恶寒之表，甚于身疼，心下之痞，轻于清谷，与救急之法不同。
此四条是有表里症，非桂枝本病，亦非桂枝坏病。仲景治有表里症，有两解表里者，有只解表而里自和者，
有只和里而表自解者，与此先救里后救表、先解表后攻里，遂成五法。
伤寒不大便六七日，头痛有热者，与承气汤。其大便圊者，知不在里，仍在表也，当须发汗。若头痛者必
衄，宜桂枝汤。
此辨太阳阳明之法也。太阳主表，头痛为主；阳明主里，不大便为主。然阳明亦有头痛者，浊气上冲也；
太阳亦有不大便者，阳气太重也。六七日是解病之期，七日来仍不大便，病为在里，则头痛身热属阳明。外不
解由于内不通也，下之里和而表自解矣。若大便自去，则头痛身热，病为在表，仍是太阳，宜桂枝汗之。若
汗后热退而头痛不除，阳邪盛于阳位也。阳络受伤，故知必衄，衄乃解矣。
本条当有汗出症，故合用桂枝、承气。有热，当作身热。大便圊。从宋本订正，恰合不大便句，见他本
作小便清者谬。宜桂枝句，直接发汗来，不是用桂枝止衄，亦非用在已衄后也。读者勿以词害义可耳。
太阳病得之八九日，如疟状，发热恶寒，热多寒少，其人
不呕，圊便欲自可，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、更吐、
更下也；面色反有热色者，未欲解也。以其不得小汗出，身必痒，宜桂枝麻黄合半汤。
八九日是当解未解之时，寒热如疟，是虚实互发之症。太阳以阳为主，热多寒少，是主胜客负，有将解之
兆矣。若其人不呕，是胃无邪，圊便是胃不实；脉微缓，是有胃气，应不转属阳明。一日二三度发，是邪无可
容之地，正胜邪却，可弗药也。若其人热虽多而脉甚微，无和缓之意，是阴弱而发热；寒虽少而恶之更甚，是
阳虚而恶寒。阴阳俱虚，当调其阴阳，勿妄治，以虚其虚也。若其人热多寒少，而面色缘缘正赤者，是阳气怫
郁在表不得越。当汗不汗，其身必痒。八九日来，正气已虚，表邪未解，不可发汗，又不可不汗，故立此法。
诸本俱是各半，今根据宋本。
太阳病，发热恶寒，热多寒少，脉微弱者，此无阳也，不可发汗。宜桂枝二越婢一汤。
本论无越婢症，亦无越婢方，不知何所取义，窃谓其二字必误也。
此热多是指发热，不是内热。无阳，是阳已虚而阴不虚。不烦不躁，何得妄用石膏？观麻黄桂枝合半、桂
枝二麻黄一二方，皆当汗之症。此言不可发汗，何得妄用麻黄？凡读古人书，须传信阙疑，不可文饰，况为性
命所关者乎？且此等脉症最多。无阳不可发汗，便是仲景法旨。柴胡桂枝汤，乃是仲景佳方，若不头项强痛，
并不须合桂枝矣。读书无目，至于病患无命，愚故表而出之。
伤寒六七日，发热、微恶寒、肢节烦疼、微呕、心下支结，外症未去者，柴胡桂枝汤主之。
微恶寒，便是寒少。烦疼，只在四肢骨节间，比身疼腰痛稍轻。此外症将解而未去之时也。微呕是喜呕之
兆，支结是痞满之始，即阳微结之谓，是半在表半在里也。外症微，故取桂枝之半；内症微，故取柴胡之半。虽
不及脉，而微弱可知；发热而烦，则热多可知。仲景制此轻剂以和解，便见无阳不可发汗，用麻黄石膏之谬矣。
桂枝汤
桂枝（二两，去粗皮） 芍药（二两） 甘草（二两，炙） 生姜（二两） 大枣（十二枚）
上以水七升，微火煮取三升，去滓，适寒温，服一升。服已须臾，啜热稀粥一升，以助药力。
此为仲景群方之冠，乃滋阴和阳，调和营卫，解肌发汗之总方也。桂枝赤色通心，温能扶阳散寒，甘能益
气生血，辛能解散风邪，内辅君主，发心液而为汗。故麻、葛、青龙，凡发汗御寒咸赖之。惟桂枝汤不用麻黄，
麻黄汤不可无桂枝也。本方皆辛甘发散，惟芍药之酸苦微寒，能益阴敛血，内和营气，故能发汗而止汗。先辈
言无汗不得服桂枝汤，正以中有芍药能止汗也。芍药之功本在止烦，烦止汗亦止，故反烦、更烦与心悸而烦者
咸赖之。若倍加芍药，即建中之剂，非发汗之剂矣。是方用桂枝发汗，即用芍药止汗。生姜之辛，佐桂以解肌；
大枣之甘，助芍以和里，阴阳表里，并行而不悖，是刚柔相济，以为和也。甘草甘平，有安内攘外之能，用
以调和气血者，即以调和表里，且以调和诸药矣。而精义又在啜热稀粥，盖谷气内充，则外邪不复入，余邪不
复留。方之妙用又如此。故用之发汗，不至于亡阳；用之止汗，不至于贻患。今医凡遇发热，不论虚实，便禁
谷食，是何知仲景之心法，而有七方之精义者哉！
温覆令一时许，遍身 ，微似有汗者益佳。不可令如水流漓，病必不除。若一服汗出病瘥，停后服，
不必尽剂。
Taiyang disease (disease of the Taiyang channel), characterized by headache, fever, sweating, and aversion to wind, is primarily treated with Guizhi Tang (Cinnamon Twig Decoction).
This clause describes the fundamental syndrome for Guizhi Tang, focusing on symptom differentiation. If these symptoms are present, this decoction should be used, regardless of whether it is classified as Shanghan (Cold Damage), Zhongfeng (Wind Strike), or a miscellaneous disease. Modern practitioners rigidly distinguish between wind and cold without understanding symptom differentiation, thereby casting doubt on Jing's excellent prescriptions. Among these four symptoms, headache is the fundamental symptom of the Taiyang channel. Headache, fever, and aversion to wind are identical to those in Mahuang Tang (Ephedra Decoction) syndrome. The key point of this formula lies in the presence of sweating; if there is no sweating, it is not a Guizhi Tang syndrome.
In Taiyang disease, when exterior manifestations have not resolved and the pulse is floating and weak, treatment should aim at resolving via sweating, making Guizhi Tang suitable.
This clause addresses the fundamental pulse for Guizhi Tang, emphasizing pulse diagnosis. Modern practitioners lack clarity in pulse differentiation, leading to mismatches with symptoms. Shanghan, Zhongfeng, and miscellaneous diseases all present with exterior manifestations. Taiyang governs the exterior, and all exterior syndromes are subsumed under Taiyang. However, only when the pulse is floating and weak can this formula be used to resolve the exterior. If the pulse is merely floating without weakness, or is floating and tight, it indicates a Mahuang Tang syndrome. It must be understood that this formula is indicated only for deficient exterior syndromes.
In Taiyang Zhongfeng (Wind Strike), with a pulse that is floating at the superficial position and weak at the deep position: floating yang generates spontaneous heat, while weak yin leads to spontaneous sweating. The patient experiences chills (Sese), aversion to wind (Xixi), mild fever (Xixi), nasal congestion with rhonchi (Biming), and dry retching (Gan'ou). These are primarily treated with Guizhi Tang.
This refers to the Guizhi Tang syndrome specific to Taiyang Zhongfeng, implying that not all cases of Zhongfeng require Guizhi Tang. The previous clause's pulse and symptoms were general regarding wind-cold and miscellaneous diseases. Adding "Zhongfeng" here reveals that both pulse and symptoms fully exhibit wind characteristics. In the previous clause, "floating and weak" meant weakness emerging from floating. Here, "floating yang" is strong and forceful, termed Yang. Wind is a yang pathogen, so this floating pulse is a wind pulse. When yang is excessive, yin becomes deficient, felt as weak upon deep palpation. Floating yang occurs because wind pathogens invade the Wei (Defensive) level, causing two yangs to contend, resulting in spontaneous heat—this is Wei strength. Weak yin occurs because wind pathogens invade the Ying (Nutritive) level, disturbing the blood vessels, resulting in spontaneous sweating—this is Ying weakness. The use of the word "spontaneous" twice highlights the rapid onset of wind pathogens. "Sese" describes a desire to close up; "Xixi" describes a desire to open; "Xixi" describes a state difficult to open or close. Although wind, cold, and heat interact on the skin and hair, the dynamic nature is what characterizes Zhongfeng. The essence of wind lies in movement, and its function manifests in sound. Wind enters through the skin and hair into the Lung, exits through the nose; disharmony in nasal respiration causes rhonchi, which is sound manifesting externally. Wind excess internally causes Wood to move and Earth to weaken, leading to stomach disharmony and dry retching without vomitus; this is sound originating internally. Dry retching indicates wind invading the Stomach organ; nasal rhonchi indicates wind attacking the Yangming channel. It is called Taiyang disease due to stiffness and pain in the head and neck. This also shows that Taiyang, as the chief of the three Yang channels, has exceeded its normal degree.
In Taiyang disease, after the initial dose of Guizhi Tang, if vexation (Fan) worsens and does not resolve, first puncture Fengchi (GB20) and Fengfu (GV16) acupoints, then administer Guizhi Tang again for recovery.
The previous clause treats the onset of Zhongfeng; this clause treats its variations. Guizhi Tang is boiled to yield three sheng; the initial dose is one sheng, and the subsequent administration involves the remaining two sheng. Heat stagnating in the heart and chest is termed vexation (Fan); heat manifesting in the skin and flesh is termed fever. In Mahuang Tang syndrome, fever occurs without sweating, with heat entirely in the exterior; in Guizhi Tang syndrome, fever with sweating indicates internal vexation. If vexation increases and external heat persists after taking the decoction, it is not that Guizhi Tang is inappropriate, but rather that the external wind pathogen is heavy and the internal yang qi is also robust. Wind pathogens enter from the nape; puncturing Fengchi and Fengfu unblocks the pathway to expel the pathogen, followed by Guizhi Tang to harmonize Ying and Wei. As stated in the *Neijing*: "Puncture both interior and exterior, and administer medicinal drinks." This method is correct.
In Taiyang disease, fever and sweating indicate Ying weakness and Wei strength, causing sweating. To rescue from evil wind, Guizhi Tang is appropriate.
This clause explains the meaning of sweating in Zhongfeng, showing that Guizhi Tang is designed to harmonize Ying and Wei. Ying is Yin, and Wei is Yang. Yin weakness fails to contain, while Yang strength fails to secure, leading to sweating.
The presentation resembles Shanghan, but the pulse is not wiry and tight; instead, it is weak. Weakness implies thirst; fire therapy will cause delirious speech (Zhanyu). With weakness and fever, resolving via the floating pulse should result in sweating and recovery.
The presentation resembles Shanghan, with aversion to cold, body pain, and cold extremities, yet the pulse is floating and weak instead of wiry and tight, indicating underlying deficiency. This corresponds to Dong Yuan's description of fatigue-induced internal injury. A weak pulse indicates insufficient Yin. When Yang qi sinks into the Yin compartment, thirst results due to fluid deficiency. If fire therapy is applied for aversion to cold, fluid loss leads to stomach fullness and delirium. However, despite a weak pulse, if fever and persistent body pain occur, one should carefully consider resolving the exterior harmoniously; Mahuang Tang is unsuitable. Guizhi Tang, accompanied by drinking hot rice gruel, induces sweating and recovery. This is a case of Shanghan complicated by deficiency.
After treating Shanghan with sweating, if vexation recurs around half a day later and the pulse is floating and rapid, another sweating treatment may be administered using Guizhi Tang.
The previous clause discusses the beginning of Shanghan treatment; this clause covers the aftermath. The former was due to deficiency-cold; this is due to residual heat. Since Wei has resolved but Ying has not, Guizhi Tang is used for further sweating. This refutes the fallacy that Guizhi Tang only treats wind damaging Wei and does not treat cold. Floating-weak is the Guizhi pulse; floating-rapid is the Mahuang pulse. Jing used Mahuang Tang for Mahuang pulses/symptoms and Guizhi Tang for Guizhi pulses/symptoms. Here, switching from Mahuang to Guizhi is because the initial sweating resolved the Mahuang syndrome. The floating-rapid pulse arises from internal vexation and should not be mistaken for a Mahuang pulse. Mahuang Tang is a pure-yang agent and cannot treat vexation. Guizhi Tang contains Shaoyao to stabilize Ying qi, specifically treating vexation. Moreover, this vexation resulted from prior sweating; using Mahuang again would deplete fluids. Hot gruel is necessary to induce sweat. Guizhi Tang originally treats vexation; if external heat persists and internal heat intensifies after taking it, it is called "reverse vexation" (Fanfan). Mahuang syndrome typically lacks vexation; after sweating, external heat resolves but internal heat emerges, called "recurrent vexation" (Fufan). Statements like "Mahuang Tang is primary" or "Guizhi Tang is primary" represent fixed methods. Continuing Guizhi Tang if ineffective, or using it again after resolution with recurrent vexation, represents flexible methods. If Mahuang causes recurrent vexation, Guizhi may be used; if Guizhi causes recurrent vexation, Mahuang must not be used. Furthermore, for Mahuang pulses/symptoms, Guizhi may be used for secondary sweating, but Guizhi should not be used initially for sweating. This is a fixed rule within flexibility. The first two clauses discuss treating Zhongfeng; the next two discuss treating Shanghan; the following two discuss treating miscellaneous diseases, demonstrating the broad utility of Guizhi Tang.
If a patient's zang organs are otherwise healthy but experiences periodic fever and spontaneous sweating without resolution, this is due to disharmony of Wei qi. Sweating before the onset of fever will lead to recovery; Guizhi Tang is appropriate.
Healthy zang organs indicate the disease is confined to the形体 (body surface/exterior). Periodic fever implies periodic sweating, unlike continuous sweating in external contraction. The *Neijing* states: "When yin is deficient, yang converges upon it, causing periodic fever and sweating." Before fever onset, yang remains in the Wei level. Using Guizhi Tang with hot gruel induces sweating, allowing yin to emerge into yang, filling the interior with grain qi, preventing Wei yang from sinking. This is "meeting and defeating" the pathogen, ensuring essence prevails and evil retreats.
For patients with chronic spontaneous sweating, the Ying qi is harmonious. The disharmony is external, caused by Wei qi failing to harmonize with Ying qi. Ying circulates within the vessels, Wei outside. Re-inducing sweating harmonizes Ying and Wei; Guizhi Tang is appropriate.
Sweating accompanying fever indicates insufficient Ying qi. Due to yang pathogen sinking, yin cannot overcome yang, causing spontaneous sweating. In cases without fever but with chronic spontaneous sweating, Ying qi is originally sufficient. However, insecure yang fails to guard the exterior, causing sweating. One should apply Guizhi Tang with hot gruel during active sweating. For yang deficiency, tonify with qi; food entering yin generates yang qi. Universal yang secures the exterior, stopping sweating. "Harmonious" means balanced; "concordant" means united. Disharmony shows Wei strength; discordance shows Ying weakness. Weakness prevents union; strength prevents securing. Both cause spontaneous sweating. Differentiate by presence/absence of heat and periodicity/continuity of sweating. Ultimately, Guizhi Tang with hot gruel induces sweating.
The previous clause showed that Guizhi Tang works for fever and sweating without requiring headache or aversion to wind. This clause shows it works for spontaneous sweating alone, even without fever, highlighting its precision for sweating disorders.
In Taiyang disease, when exterior symptoms persist, purgation is contraindicated. Purging is adverse. To resolve the exterior, Guizhi Tang is appropriate.
At the onset of exterior symptoms, there is a distinction between Mahuang and Guizhi indications. When resolution is needed but not achieved, only Guizhi Tang is applicable. Thus, Guizhi Tang is the general formula for resolving the exterior in Shanghan, Zhongfeng, and miscellaneous diseases.
It is suitable for any case with floating-weak pulse, spontaneous sweating, and unresolved exterior. It is also suitable for Yangming disease with slow pulse and profuse sweating, and for Taiyin disease with floating pulse. Thus, deficient exterior syndromes in all channels share the same treatment principle as unresolved Taiyang. This shows Guizhi Tang is not exclusive to Taiyang.
In Taiyang disease, if initial sweating fails to resolve the condition and purgation is subsequently applied, persistence of a floating pulse indicates non-resolution. Floating indicates the pathogen remains exterior; resolving the exterior is required for recovery, making Guizhi Tang appropriate.
A floating pulse after erroneous purgation confirms unresolved exterior syndrome and non-sinking of yang pathogen. Only Guizhi Tang should be used to resolve the exterior; do not use Mahuang Tang simply because the pulse is floating. The ability to use Guizhi Tang post-purgation demonstrates its potency.
In Taiyang disease, if purgation is applied and qi rushes upward, Guizhi Tang may be given using the previous method; if qi does not rush upward, it must not be given.
Upward rushing qi indicates abundant yang qi; thus, although the exterior is unresolved, the pathogen does not sink inward. Administering Guizhi Tang to induce sweating allows the upward-rushing qi to facilitate exterior resolution. The previous clause discussed the pulse after purgation; this clause discusses the symptoms, mutually illuminating the advanced application of Guizhi Tang. "Using the previous method" refers to drinking hot gruel, consistent with later references to "following the previous method." Interpreting this as adding purgatives to the decoction is a major error.
In Shanghan, if a physician erroneously applies purgation, leading to continuous diarrhea with undigested food and body pain, urgent rescue of the interior is required. Once stool normalizes and body pain persists, urgent rescue of the exterior is required. Rescue of the interior requires Sini Tang (Frigid Extremities Decoction); rescue of the exterior requires Guizhi Tang.
Erroneous purgation of exterior cold transfers cold to the Spleen, causing continuous diarrhea and eventually undigested food, indicating exhaustion of Stomach yang. Persistent body pain indicates both interior and exterior are distressed. Fortunately, the exterior pathogen remains, offering hope for rescue. Diseases originating externally should first be resolved externally. Here, the interior urgency necessitates abandoning the exterior to rescue the interior; Sini Tang cannot be delayed. Once the interior improves but exterior symptoms remain, rescuing the exterior is equally urgent. Body pain is typically a Mahuang syndrome, but with diarrhea and undigested food, the pores are loose. Guizhi Tang harmonizes Ying and Wei, resolving pain. Hence, it is termed "rescue" rather than "attack," aligning with harmonizing the middle. After warming the middle, Guizhi Tang can still be used, demonstrating its miraculous efficacy.
For diarrhea with abdominal fullness and body pain, warm the interior first, then attack the exterior. Warming the interior requires Sini Tang; attacking the exterior requires Guizhi Tang.
Diarrhea with abdominal fullness suggests impending diarrhea with undigested food. Warm the interior preemptively rather than waiting for urgency. Once the interior is harmonized but the exterior remains unresolved, focus solely on the exterior. Hence, it is termed "attack" rather than "rescue."
If vomiting and diarrhea cease but body pain persists, carefully resolve the exterior harmoniously; Guizhi Tang should be used gently.
Vomiting and diarrhea indicate zang-fu disharmony, not treated by Guizhi Tang. Post-ceasement of vomiting/diarrhea with persistent body pain indicates Ying-Wei disharmony, not suitable for Mahuang Tang. Harmonizing the exterior relies solely on Guizhi; careful dosing ("small harmony") is advised. Typically, floating-rapid pulse and body pain indicate Mahuang indications, but post-sweating/purging, they shift to Guizhi indications. This represents variable pulses and symptoms for Guizhi, distinct from original Mahuang presentations.
After severe purgation and subsequent sweating in Shanghan, if epigastric stuffiness (Pi) and aversion to cold persist, the exterior is unresolved. Do not attack Pi; resolve the exterior first. Once the exterior is resolved, attack Pi. Resolve the exterior with Guizhi Tang; attack Pi with Dahuang Huanglian Xiexin Tang (Rhubarb, Coptis, and Scutellaria Heart-Purging Decoction).
Epigastric stuffiness is an interior syndrome from erroneous purgation; aversion to cold is an unresolved exterior syndrome from sweating. Interior excess and exterior deficiency, affecting both interior and exterior, result from inverted sweating and purging. With exterior-interior conflict, adhere to the standard sequence: exterior first, then interior. Aversion to cold is more severe than body pain; epigastric stuffiness is less critical than diarrhea with undigested food, differing from emergency protocols.
These four clauses address simultaneous exterior-interior syndromes, neither fundamental nor deteriorated Guizhi cases. Jing's treatments for simultaneous exterior-interior syndromes include: dual resolution, exterior-only resolution (interior self-harmonizes), interior-only harmonization (exterior self-resolves), interior-first rescue followed by exterior, and exterior-first resolution followed by interior attack, forming five methods.
In Shanghan, if constipation persists for six to seven days with headache and fever, administer Chengqi Tang. If stool is normal, the pathogen is not in the interior but remains in the exterior; sweating is required. If headache persists, hemorrhinia (Nü) is likely; Guizhi Tang is appropriate.
This distinguishes Taiyang from Yangming. Taiyang governs the exterior, with headache as primary; Yangming governs the interior, with constipation as primary. Yangming may have headache due to turbid qi ascending; Taiyang may have constipation due to excessive yang qi. Six to seven days is the period for resolution. Persistent constipation after seven days indicates interior pathology; headache and fever belong to Yangming. Exterior non-resolution stems from interior blockage; purging harmonizes the interior and resolves the exterior spontaneously. If stool passes naturally, headache and fever indicate exterior pathology, remaining Taiyang; Guizhi Tang induces sweating. If fever subsides post-sweating but headache persists, yang pathogen dominates yang positions. Injury to yang collaterals predicts hemorrhinia, which brings resolution.
This clause implies sweating symptoms, justifying combined consideration of Guizhi and Chengqi. "Heat" refers to body heat. "Stool normal" aligns with "constipation" in Song editions, correcting other versions claiming "clear urine." "Appropriate for Guizhi" directly follows "sweating," indicating use for inducing sweat, not stopping hemorrhinia or treating post-hemorrhinia. Readers should not let wording obscure meaning.
In Taiyang disease lasting eight to nine days, presenting like malaria with fever and aversion to cold, more heat than cold, no vomiting, normal bowel movements, occurring two or three times daily: if the pulse is slightly slow and smooth, recovery is imminent; if the pulse is slight with aversion to cold, both yin and yang are deficient, precluding further sweating, vomiting, or purging; if the face appears flushed with heat, resolution is not imminent. Due to inability to produce slight sweating, the body itches; Guizhi Mahuang Banxia Tang (Half-Guizhi Half-Mahuang Decoction) is appropriate.
Eight to nine days is the time of pending resolution. Malaria-like chills and fever indicate alternating deficiency and excess. Taiyang is yang-dominant; more heat than cold suggests victor over vanquished, a sign of impending resolution. No vomiting indicates no stomach pathogen; normal bowels indicate no stomach excess; slight-smooth pulse indicates Stomach qi presence, suggesting no transition to Yangming. Occurring two or three times daily implies no room for pathogen; righteous qi defeats evil, potentially requiring no medicine. If heat is abundant but pulse is very slight without smoothness, yin is weak with fever; if cold is minimal but aversion is severe, yang is deficient with aversion. Dual deficiency requires harmonizing yin and yang, avoiding reckless treatment that exacerbates deficiency. If heat exceeds cold with persistent facial redness, yang qi is constrained in the exterior without venting. Lack of sweating causes itching. After eight to nine days, righteous qi is depleted, exterior pathogen unresolved. Sweating is contraindicated yet necessary; hence this method is established.
All editions state "Banxia" (Half); now corrected according to Song edition.
In Taiyang disease, with fever, aversion to cold, more heat than cold, and a faint pulse, this indicates absence of yang; sweating is contraindicated. Guizhi Er Yuespi Yi Tang (Two-Parts Guizhi One-Part Yuespi Decoction) is appropriate.
The Treatise lacks Yuespi syndrome descriptions or formulas, leaving its origin unclear. I suspect the character "Er" (two) is erroneous.
"More heat" refers to fever, not internal heat. "Absence of yang" means yang is deficient while yin is not. Without vexation or restlessness, how could Shigao (Gypsum) be used recklessly? Observing Guizhi Mahuang Banxia Tang and Guizhi Er Mahuang Yi Tang, both are indications for sweating. Here, sweating is contraindicated; how could Mahuang be used recklessly? When reading ancient texts, preserve faith and acknowledge doubts; do not embellish, especially when lives are at stake. Such pulse-symptom combinations are common. "Absence of yin precludes sweating" is Jing's principle. Chaihu Guizhi Tang is an excellent formula; without head/neck stiffness, combining with Guizhi is unnecessary. Blind reading risks patients' lives; thus, I highlight this error.
In Shanghan lasting six to seven days, with fever, slight aversion to cold, painful limbs and joints, slight vomiting, and subcostal binding, with exterior symptoms unresolved, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) is primary.
Slight aversion to cold indicates minimal cold. Painful discomfort limited to limb joints is milder than whole-body/lower back pain. This represents exterior symptoms nearing resolution but persisting. Slight vomiting signals impending frequent vomiting; subcostal binding marks early stuffiness/fullness, known as Yangwei Jie (Yang Minor Binding), located half-exterior, half-interior. Mild exterior symptoms warrant half the Guizhi dose; mild interior symptoms warrant half the Chaihu dose. Though pulse details are omitted, slightness is implied; fever with vexation implies abundant heat. Jing formulated this light agent for harmonization, demonstrating that absence of yang precludes sweating and refuting the reckless use of Mahuang and Shigao.
Guizhi Tang (Cinnamon Twig Decoction)
Guizhi (Cinnamomi Ramulus, 2 liang, remove coarse bark)
Shaoyao (Paeoniae Radix Alba, 2 liang)
Ganzhi (Glycyrrhizae Radix et Rhizoma Preparata, 2 liang, honey-fried)
Shengjiang (Zingiberis Rhizoma Recens, 2 liang)
Dazao (Jujubae Fructus, 12 pieces)
Boil the above five ingredients in 7 sheng of water, simmer gently to obtain 3 sheng. Strain. Take 1 sheng at a comfortable temperature. Shortly after ingestion, drink 1 sheng of hot thin rice gruel to assist medicinal power.
This is the premier formula among Jing's prescriptions, serving as the general formula for nourishing yin, harmonizing yang, regulating Ying and Wei, releasing the muscle layer, and inducing sweating. Guizhi, red in color, connects to the Heart; its warmth supports yang and disperses cold; its sweetness benefits qi and generates blood; its pungency dissipates wind pathogens. Internally assisting the Sovereign, it stimulates heart fluids to produce sweat. Thus, Mahuang, Gegen (Kudzu Root), and Qinglong (Green Dragon) decoctions, all used for sweating and resisting cold, rely on it. Guizhi Tang uniquely excludes Mahuang, whereas Mahuang Tang requires Guizhi. The formula consists mainly of pungent-sweet dispersants, except for Shaoyao's sour-bitter-mild cold nature, which nourishes yin, consolidates blood, and harmonizes Ying internally, enabling both sweating and stopping sweating. Ancients stated that Guizhi Tang is forbidden for non-sweating cases precisely because Shaoyao stops sweating. Shaoyao's primary function is stopping vexation; once vexation ceases, sweating stops. Thus, reverse vexation, recurrent vexation, and palpitations with vexation all depend on it. Doubling Shaoyao transforms it into Jianzhong (Establish the Middle) formula, not a sweating agent. This formula uses Guizhi to sweat and Shaoyao to stop sweating. Pungent Shengjiang assists Guizhi in releasing the muscle layer; sweet Dazao aids Shaoyao in harmonizing the interior. Yin and yang, interior and exterior proceed in parallel without contradiction, achieving harmony through complementarity of firm and soft. Sweet and neutral Ganzhi possesses abilities to pacify the interior and repel the exterior; used to harmonize qi and blood, it simultaneously harmonizes interior/exterior and moderates the other herbs. The essential brilliance lies in drinking hot rice gruel: when grain qi fills the interior, external pathogens cannot re-enter, and residual pathogens do not linger. Such is the subtle utility of the formula. Used for sweating, it prevents yang collapse; used for stopping sweating, it avoids lingering complications. Modern physicians, encountering fever regardless of deficiency or excess, forbid grain consumption. How can they understand Jing's heart-method and the profound principles of the Seven Formulas!
Cover with warm blankets for about one hour until a slight, uniform perspiration appears throughout the body. This is optimal. Do not allow profuse sweating like flowing water, as the disease will not be eliminated. If sweating occurs after the first dose and the illness resolves, stop subsequent doses; there is no need to consume the entire decoction.