未持脉时，病患叉手自冒心，师因教试令咳而不咳者，此必两耳聋无闻也。所以然者，以重发汗，虚，故
如此。
汗出多则心液虚，故叉手外卫，此望而知之。心寄窍于耳，心虚故耳聋，此问而知之。
病患脉数，数为热，当消谷引食。而反吐者，此以发汗令阳气微、膈气虚，脉乃数也。数为客热，不能消
谷，以胃中虚冷，故吐也。
上条因发汗而心血虚，此因发汗而胃气虚也。与服桂枝汤而吐者不同，此因症论脉，不是拘脉谈症。未汗
浮数，是卫气实；汗后浮数，是胃气虚。故切居四诊之末，当因症而消息其虚实也。
病患有寒，复发汗，胃中冷，必吐蛔。
有寒是未病时原有寒也。内寒则不能化物，饮食停滞而成蛔。以内寒之人，复感外邪，当温中以逐寒。若
复发其汗，汗生于谷，谷气外散，胃脘阳虚，无谷气以养其蛔，故蛔动而上从口出也。蛔多不止者死，吐蛔不
能食者亦死。
发汗后腹胀满者，浓朴生姜甘草半夏人参汤主之。
此条不是妄汗，以其人本虚故也。上条汗后见不足症，此条汗后反见有余症。邪气盛则实，故用浓朴姜夏
散邪以除腹满；正气虚，故用人参甘草补中而益元气。
浓朴生姜半夏甘草人参汤∶
浓朴（半斤，去皮炙） 生姜（半斤，切） 半夏（半斤，洗） 甘草（二两，炙） 人参（一两）
上五味，以水一斗，煮取三升，温服一升，日三服。
发汗后，水药不得入口为逆。若更发汗，必吐不止。
阳重之人，大发其汗，有升无降，故水药拒膈而不得入也。若认为中风之干呕、伤寒之呕逆，而更汗之，
则吐不止，胃气大伤矣。此热在胃口，须用栀子汤、瓜蒂散，因其势而吐之，亦通因通用法也。五苓散亦下剂，
不可认为水逆而妄用之。
汗家重发汗，必恍惚心乱。小便已，阴疼；与禹余粮丸。
汗家，平素多汗人也。心液大脱，故恍惚心乱，甚于心下悸矣。心虚于上，则肾衰于下，故阴疼。余粮，土
之精气所融结，用以固脱而镇怯，故为丸以治之。
上论汗后虚症。
发汗后不可更行桂枝汤。无汗而喘（旧本有无字）、大热者，可与麻黄杏子甘草石膏汤。下后不可更行桂
枝汤。若无汗而喘、大热者，可与麻黄杏子甘草石膏汤。
二条无字，旧本讹在大热上。前辈因循不改，随文衍义，为后学之迷途。仲景每于汗下后表不解者，用桂
枝更汗而不用麻黄。此则内外皆热而不恶寒，必其用麻黄汤后寒解而热反甚，与“发汗，解，半日许复烦，下后
而微喘者”不同。发汗而不得汗。或下之而仍不汗喘不止，其阳气重也。若与桂枝加浓朴杏仁汤，下咽即毙矣。
故于麻黄汤去桂枝之辛热，加石膏之甘寒，佐麻黄而发汗，助杏仁以定喘，一加一减，温解之方。转为凉散之剂
矣。未及论症，便言不可更行桂枝汤。见得汗下后表未解者，更行桂枝汤，是治风寒之常法。
麻黄杏仁甘草石膏汤∶
麻黄（四两） 杏仁（五十粒） 甘草（二两，炙） 石膏（半斤）
水七升，先煮麻黄减二升，去上沫，内诸药，煮取二升，温服一升。
病发于阳而反下之，热入因作结胸。若不结胸，但头汗出，余处无汗，至颈而还，小便不利，身必发黄也。
寒气侵人，人即发热以拒之，是为发阳。助阳散寒，一汗而寒热尽解矣。不发汗而反下之，热反内陷，寒
气随热而入，入于胸必结，瘀热在里故也。热气炎上，不能外发，故头有汗而身无汗。若小便利，则湿热下流，即
内亦解；不利则湿热内蒸于脏腑，黄色外见于皮肤矣。
伤寒瘀热在里，身必发黄，麻黄连翘赤小豆汤主之。
热反入里，不得外越，谓之瘀热。非发汗以逐其邪，湿气不散。然仍用麻黄、桂枝，是抱薪救火矣。于麻
黄汤去桂枝之辛甘，加连翘、梓皮之苦寒，以解表清火而利水，一剂而三善备。且以见太阳发热之治，与阳明
迥别也。
麻黄连翘赤小豆汤∶
麻黄 连翘 甘草 生姜（各二两） 赤小豆（一升） 生梓白皮（一斤） 杏仁（四十粒） 大枣（十二枚）
以潦水一升，先煮麻黄，再沸，去上沫，内诸药，煮取三升，分温三服，半日服尽。
此汤以赤小豆、梓白皮为君，而反冠以麻黄者，以兹汤为麻黄汤之变剂也。瘀热在中，则心肺受邪，营卫不利。
小豆赤色，心家之谷，入血分而通经络，致津液而利膀胱。梓皮色白，专走肺经，入气分而理皮肤，清胸中而
散瘀热。故以为君。更佐连翘、杏仁、大枣之苦甘，泻心火而和营；麻黄、生姜、甘草之辛甘，泻肺火而调卫。潦水
味薄，能降火而除湿，故以为使。半日服尽者，急方通剂，不可缓也。此发汗利水，又与五苓双解法径庭矣。
上论麻黄汤变症。
Before taking the pulse, the patient crossed their hands over the heart region. The physician instructed them to try coughing, but they could not cough; this indicates bilateral deafness. This occurs because excessive sweating has depleted the body's righteous qi (Zheng Qi), leading to such symptoms.
Profuse sweating depletes the Heart Yin fluid, causing the patient to cross their hands over the chest for protection; this is known through observation (Wang Zhen). The Heart opens into the ears; Heart deficiency leads to deafness, which is known through inquiry (Wen Zhen).
The patient’s pulse is rapid (Shu). A rapid pulse indicates heat, which should promote digestion and appetite. However, vomiting occurs instead. This is because sweating has weakened the Yang Qi and depleted the Qi in the Diaphragm, resulting in a rapid pulse. This rapidness represents "guest heat" (false heat) that cannot digest food, due to cold deficiency in the Stomach, hence the vomiting.
The previous clause discussed Heart Blood deficiency caused by sweating, whereas this clause discusses Stomach Qi deficiency caused by sweating. This differs from vomiting after administering Guizhi Tang (Cinnamon Twig Decoction). Here, the pulse is analyzed based on symptoms, rather than analyzing symptoms solely based on the pulse. Before sweating, a floating and rapid pulse indicates excess in the Defensive Qi (Wei Qi); after sweating, a floating and rapid pulse indicates deficiency in Stomach Qi. Therefore, palpation (Qie Zhen) is the last of the four diagnostic methods; one must discern excess and deficiency based on symptoms.
If a patient with pre-existing Cold syndrome undergoes further sweating, the Stomach becomes cold, likely leading to the expulsion of roundworms (Hui Chong).
"Pre-existing cold" refers to cold present before the current illness. Internal cold fails to transform food, leading to stagnation and the generation of roundworms. In patients with internal cold who contract external pathogens, the treatment should be to warm the Middle Jiao to dispel cold. If sweating is induced again, sweat is derived from grain Qi (Gu Qi); as Grain Qi disperses outward with sweat, the Yang Qi of the Stomach cavity becomes deficient. Lacking Grain Qi to nourish the worms, they become restless and move upward, exiting through the mouth. Death ensues if worm expulsion is unceasing or if the patient vomits worms and cannot eat.
Abdominal fullness following sweating is treated with Houpo Shengjiang Banxia Gancao Renshen Tang (Magnolia Bark, Fresh Ginger, Pinellia, Licorice, and Ginseng Decoction).
This case does not result from erroneous sweating, but from the patient's inherent deficiency. The previous clause showed deficiency symptoms after sweating, while this one shows excess symptoms. Since pathogenic factors are abundant (excess), Magnolia Bark, Ginger, and Pinellia are used to disperse pathogens and relieve abdominal fullness. Since righteous Qi is deficient, Ginseng and Licorice are used to tonify the Middle and boost Yuan Qi.
**Houpo Shengjiang Banxia Gancao Renshen Tang:**
Houpo (Magnoliae Officinalis Cortex, 8 liang, bark removed and stir-fried)
Shengjiang (Fresh Zingiberis Rhizoma, 8 liang, sliced)
Banxia (Pinelliae Rhizoma Preparatum, 8 liang, washed)
Gancao (Glycyrrhizae Radix et Rhizoma, 2 liang, stir-fried)
Renshen (Panacis Ginseng Radix, 1 liang)
Decoct these five herbs in 10 sheng of water to obtain 3 sheng. Take 1 sheng warm, three times daily.
If, after sweating, the patient cannot keep fluids or medicine down, it is considered a adverse reaction (Ni). Further sweating will inevitably lead to incessant vomiting.
In individuals with strong Yang, excessive sweating causes Qi to ascend without descending, rejecting fluids and medicine at the Diaphragm. If mistaken for dry heaving due to Wind-Strike or retching due to Cold Damage, and sweating is induced again, vomiting will ceaselessly continue, severely damaging Stomach Qi. Heat resides at the Stomach opening; thus, Zhizi Tang (Gardenia Decoction) or Gouti San (Melon Spicule Powder) should be used to induce vomiting according to the pathogen's trend, employing the method of "treating obstruction with draining agents" (Tong Yin Yong Tong). Wuling San (Five-Ingredient Powder with Poria) is also a downward-draining formula and should not be mistakenly used for Water-Reversal.
A person habitually prone to sweating (Han Jia), if subjected to further sweating, will suffer from mental confusion and restlessness. After urination, pain in the genitalia may occur; treat with Yuyuliang Wan (Hematitum Pill).
"Han Jia" refers to those who sweat easily. Severe depletion of Heart Yin leads to mental confusion and restlessness, worse than palpitations. Heart deficiency above leads to Kidney decline below, causing genital pain. Yuliang (Hematitum) is a concretion of Earth's essence, used to secure leakage and calm fright; thus, it is made into pills for treatment.
The above discusses deficiency syndromes following sweating.
After sweating, Guizhi Tang (Cinnamon Twig Decoction) must not be administered again. If there is no sweat, wheezing, and high fever, Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) may be given. After purgation, Guizhi Tang must not be administered again. If there is no sweat, wheezing, and high fever, Mahuang Xingren Gancao Shigao Tang may be given.
The character "wu" (no/without) in these two clauses was erroneously placed before "da re" (high fever) in old editions. Predecessors followed suit without correction, misleading students. Zhang Zhongjing typically uses Guizhi Tang to induce sweating again when the exterior remains unresolved after sweating or purgation, avoiding Mahuang Tang. However, in this case, both interior and exterior are hot without aversion to cold. This implies that after using Mahuang Tang, the cold resolved but heat intensified, differing from cases where "after sweating, the disease resolves, but half a day later irritability returns, or mild wheezing follows purgation." Failure to sweat after sweating, or persistent wheezing without sweat after purgation, indicates heavy accumulation of Yang Qi. Administering Guizhi Jia Houpo Xingren Tang (Guizhi Tang plus Magnolia Bark and Apricot Kernel) would be fatal. Thus, in Mahuang Tang, the acrid-warm Guizhi is removed, and sweet-cold Shigao (Gypsum) is added. Assisting Mahuang to induce sweating and Xingren to calm wheezing, this modification transforms a warming-dispersing formula into a cooling-dispersing agent. The warning against using Guizhi Tang immediately highlights that for exterior unresolved cases after sweating/purgation, using Guizhi Tang is the standard method for Wind-Cold.
**Mahuang Xingren Gancao Shigao Tang:**
Mahuang (Ephedrae Herba, 4 liang)
Xingren (Armeniacae Semen Amarum, 50 grains)
Gancao (Glycyrrhizae Radix et Rhizoma, 2 liang, stir-fried)
Shigao (Gypsum Fibrosum, 8 liang)
Decoct in 7 sheng of water. First boil Mahuang, reduce by 2 sheng, skim off foam, then add other herbs. Boil to obtain 2 sheng. Take 1 sheng warm.
When a disease begins in the Yang (Exterior) and is incorrectly treated with purgation, heat enters and forms Jie Xiong (Chest Binding). If Jie Xiong does not form, but only the head sweats, with no sweat elsewhere up to the neck, and urination is difficult, jaundice will likely develop.
When Cold Qi invades, the body generates heat to resist it, termed "Fa Yang" (Manifesting Yang). Assisting Yang to scatter Cold, a single sweating episode resolves both cold and heat. If sweating is not induced but purgation is used instead, heat sinks inward, and Cold Qi follows the heat into the Chest, binding there due to stagnant heat in the interior. Heat flares upward and cannot vent externally, causing head sweat but no body sweat. If urination is free, damp-heat flows downward and resolves internally; if obstructed, damp-heat steams within the Zang-Fu organs, manifesting as yellow skin color.
In Cold Damage, stagnant heat in the interior causes jaundice; treat with Mahlianqiao Chixiaodou Tang (Ephedra, Forsythia, and Red Bean Decoction).
Heat sinking inward without external venting is called "Yu Re" (Stagnant Heat). Without sweating to expel the pathogen, dampness will not dissipate. Using Mahuang and Guizhi here would be like adding fuel to fire. In Mahuang Tang, remove acrid-sweet Guizhi and add bitter-cold Lianqiao (Forsythiae Fructus) and Zibi (Catalpae Cortex) to release the exterior, clear fire, and promote urination. One dose achieves three benefits. This demonstrates that treating Taiyang heat differs significantly from Yangming treatments.
**Mahlianqiao Chixiaodou Tang:**
Mahuang (Ephedrae Herba)
Lianqiao (Forsythiae Fructus)
Gancao (Glycyrrhizae Radix et Rhizoma)
Shengjiang (Fresh Zingiberis Rhizoma) [Each: 2 liang]
Chixiaodou (Phaseoli Hongti Semen, 1 sheng)
Sheng Zibai Pi (Catalpae Cortex, 1 jin)
Xingren (Armeniacae Semen Amarum, 40 grains)
Dazao (Zizyphi Fructus, 12 pieces)
Decoct in 1 sheng of rainwater (Liao Shui). First boil Mahuang until boiling twice, skim foam, add other herbs. Boil to obtain 3 sheng. Divide into three warm doses, finish within half a day.
This decoction uses Chixiaodou and Zibai Pi as Sovereign herbs, yet is named after Mahuang because it is a modification of Mahuang Tang. Stagnant heat in the Middle affects the Heart and Lung, disrupting Ying and Wei circulation. Chixiaodou is red (Heart grain), enters the Blood level to unblock collaterals, generates fluids, and promotes bladder function. Zibai Pi is white (Lung color), enters the Qi level to regulate skin, clears the Chest, and dissipates stagnant heat. Hence, they are Sovereign. Lianqiao, Xingren, and Dazao (bitter-sweet) assist by clearing Heart Fire and harmonizing Ying; Mahuang, Shengjiang, and Gancao (acrid-sweet) assist by clearing Lung Fire and regulating Wei. Liao Shui (rainwater) is thin in flavor, descending fire and drying dampness, serving as Envoy. Finishing within half a day indicates this is an urgent, penetrating formula requiring speed. This method of inducing sweat and promoting urination differs fundamentally from the dual-resolving method of Wuling San.
The above discusses variations of Mahuang Tang.