【纲】仲景曰。太阳病。头痛发热。汗出恶风者。桂枝汤主之。太阳病。发热而渴。不恶寒者。为
温病。发汗已。身灼热者。名曰风温。
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。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。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。大青龙汤主之。
【目】朱肱曰。发热而恶寒者。属太阳也。盖太阳主气以温皮肤分肉。寒气留于外。皮肤致密。
则寒栗而发热。宜发其汗。故麻黄、大青龙主之。若温病。则发热而不恶寒。风温。亦灼热而不
恶寒也。
刘完素曰。潮热。有时而热。不失其时。寒热。寒已而热。相断而发。发热。则无时而热也。
翕翕发热。热在外也。故与桂枝汗以散之。蒸蒸发热。热在内也。故与调胃承气下以涤之。发热属
表。风寒客皮肤。阳气怫郁也。发热属里。阳气下陷阴中也。观其热所由来而汗下之。若热先自皮
肤发者。邪在外也。热先自里生而发达于表者。邪在里也。在表在里。俱有发热。邪在半表半里者。
亦发热也。或始自皮肤而渐传里热。或始自内热而外达于表。盖邪在表。表热里不热也。邪在里。
里热甚而达于表也。在半表半里。则表里俱发热也。
王肯堂曰。凡病鲜有不发热者。内伤外感。其大关键也。人迎脉大于气口为外感。气口脉大于人
迎为内伤。外感则
寒热齐作而无间。内伤则寒热间作而不齐。外感恶寒。则近烈火不能除。内伤恶寒。得就温暖而必解。
外感恶风。乃不禁一切风。内伤恶风。惟恶些小贼风。外感症显在鼻。故鼻气不利。壅盛而有声。
内伤症显在口。故口不知味。而腹中不和。外感则邪气有余。故发言壮厉。先轻而后重。内伤则元
气不足。故出言懒怯。先重而后轻。外感头痛。常常而痛。内伤头痛。时止时作。外感手背热。手
心不热。内伤手心热。手背不热。东垣辨法大要如此。或有内伤而无外感。或有外感而无内伤。以
此辨之。判然矣。若夫内伤外感兼病者。则其脉症并见而难辨。尤宜细心求之。若显内症多者。则
内伤重而外感轻。宜以补养为先。若显外症多者。则外感重而内伤轻。宜以发散解表为急。此又东
垣未言之意也。
陈士铎曰。人病发热。必先散其邪气。俟邪气速去。然后再扶其正气。则正气不为邪气所害。
方用柴胡、荆芥、半夏、黄芩、甘草各一钱煎服。则邪散而身凉。盖四时不正之气犯人。必由皮
毛而入营卫。今用柴胡、荆芥。先散皮毛之邪。邪既先散。安得入里。半夏祛痰。使邪不得挟痰作
祟。黄芩使不得挟火作殃。甘草和中。邪既先散。而正气又不相亏。人肯先服此药。何至由皮毛以
入营卫。入脏腑。至传经深入哉。一方。柴胡、当归、山栀、甘草、陈皮各一钱。花粉、白芍各二
钱。此方凡肝气郁者。一剂即快。不必专治外感也。治内伤初起者。神效。又方。当归二钱。柴胡、
白芍、茯苓、甘草、桂枝各一钱。陈皮五分。冬月。加麻黄。此方专治伤寒初起者。神效。乘其
尚未传经。可从补正之中。兼用祛邪之品而热散之也。盖初起之邪。尚不敢与正气相敌。故一补正
气。而邪气自消。及一传经。则正气遁入脏腑不敢与邪相争。愈补而愈不能出矣。故一传经。药即
不可用补。今用桂枝以散热。或加麻黄以祛寒。寒热相攻。邪难内入。又有正气之健以助之。所以
一剂而愈也。
【纲】仲景曰。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。
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。
【目】朱肱曰。此二汤。乃治发热而微恶寒者也。
张介宾曰。邪气在表发热者。表热里不热也。温散之。邪气在里发热者。里热甚而达于外也。
宜清之。
柯琴曰。热多。是指发热。不是内热。无阳。是阳已虚。而阴不虚。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。便不须合桂枝矣。
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。是在半表半里矣。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、石膏之误矣。
【纲】仲景曰。太阳病。发汗。汗出不解。其人仍发热。心下悸。头眩。身 动。振振欲擗地
者。真武汤主之。
【目】戴原礼曰。阴经不发热。惟少阴能发热。然少阴发热有二症。初得病。即见少阴症。发
热恶寒。头不疼。宜麻黄附子细辛汤。若下利清谷。身热躁扰。里寒外热。仲景谓之反发热。此乃
阴盛格阳。宜四逆汤、附子理中汤。盖阳气传阴经而下利者。乃是热利。阳陷入里。外所以无热。
阴气入阴经而下利者。乃是里寒自利。寒既在里为主。则阳气必客于外。所以反发热。要知阴症发
热。自是不同。发于阳而发热者。头必疼。发于阴而发热者。头不疼。此为验也。又有汗下后。阴
阳不相入。水火不相济。致余热未退。不可更用冷药。内外俱未可妄治。故宜小建中汤。若其人已
虚。虚能生热。宜小建中汤加当归。或四君子汤加黄 。或十全大补汤。调其荣卫。虚者。真武汤。
审是热邪未解。虽经汗下。却不畏寒。宜竹叶石膏汤。
王肯堂曰。汗后复发热。脉躁疾。不为汗衰。狂言不能食。阴阳不交。及下利发热者。死。脉
阴阳俱盛。热不止者。死。中风即发热者。风伤卫也。伤寒不即发热者。寒伤营也。其在少阴厥阴发热者。谓之反发热。
惟太阴无发热之候。
柯琴曰。此太阳症合用桂枝。却用麻黄之类发汗者。故多亡阳而仍发热。必主以真武汤也。
鳌按。真武汤。本少阴方。阳亡则内虚寒。故必用此也。
【纲】仲景曰。太阳病。重汗。而复大下之。不大便五六日。舌上燥而渴。日晡小有潮热。从心下
至小腹硬满而痛不可近者。大陷胸汤主之。
【目】朱肱曰。太阳有潮热乎。仲景大陷胸汤一症。结胸有潮热者为大结胸。属太阳也。
楼全善曰。此妄汗下而将转属阳明。犹尚未离乎太阳者也。
日晡潮热。阳明病。然心下者。太阳之位。小腹者。膀胱之室。从心下至小腹痛。是下后热入
水结所致。非胃家实。故不得名为阳明病。
【纲】仲景曰。脉阴阳俱虚。热不止者死。
【目】朱肱曰。大抵伤寒八日以上。大发热者。难治。
【纲】仲景曰。伤寒发热。汗出不解。心中痞硬。呕吐而下利者。大柴胡汤主之。
【目】方中行曰。伤寒汗不出。得汗即解者。以有风而误于偏攻。热反入里。所以变痞硬呕吐
而下利也。故用大柴胡合表里而两解之。
魏荔彤曰。发热汗出不解。太阳已传阳明。二者阳明症也。夫太阳所感寒邪。入心中作痞硬。
而寒郁内生之热邪。作呕吐而下利。是病全离太阳而入阳明矣。其不成胃实者。惟心中素有痰饮。
故邪结于彼而成痞硬。胃中自不能复结为实。故是已传阳明而未全在阳明。未可以承气下者。故制
此方。于下之中。兼升散开破二义。阳明之邪。柴胡驱之于少阳而表解。大黄复通之于大便而里和。尚何有阳明之症足
留乎。所谓
两解之法也。是不必专言柴胡治少阳。而柴胡之用已神。不必专言胃实方可下。而大黄之用已得矣。
非仲师孰能具此手眼乎。
【纲】仲景曰。伤寒。医以丸药大下之。身热不去。微烦者。栀子干姜汤主之。
【目】喻昌曰。丸药大下。徒伤其中。而不能荡涤其邪。栀子干姜。亦温中散邪法也。
虞抟曰。攻里不远寒。用丸药大下之。寒气留中可知。心微烦而不懊 。则非吐剂所宜也。用
栀子解烦。倍干姜以逐内寒而散表热。寒因热用。热因寒用。二味成方。而三法备。
【纲】仲景曰。伤寒五六日。大下之后。身热不去。心中结痛者。未欲解也。栀子豉汤主之。
发汗。若下之。而烦热。胸中窒者。栀子豉汤主之。
【目】魏荔彤曰。大下后身热不去。犹带表症也。心烦变为心中结痛。是表症仍未解。而里症
已迫也。在表原属阴邪久未除。在里则为阳邪久成郁。栀子苦寒。治心中成郁之阳邪。香豉香辛。
治在表未散之阴邪。而此症可愈。其胸中窒者。虽未至于结痛。而窒久必痛也。亦可早为之计。而
仍主此。一法也。
柯琴曰。病发于阳而反下之。外热未除而心中结痛。虽轻于结胸。而甚于懊 矣。结胸是水结胸
胁。用陷胸汤。水郁则折之也。此乃郁结心中。用栀豉汤。火郁则发之也。
【纲】仲景曰。伤寒心下有水气。咳而微喘。发热不渴。服汤已渴者。此寒去欲解也。小青龙
汤主之。
【目】魏荔彤曰。小青龙治水气者。治在里久积之阴邪。治风寒者。治胸膈暂郁之热邪。程氏
谓下寒者类多上热。一句破的矣。学人识之。
【纲】仲景曰。太阳病。脉浮紧。发热无汗。自衄者愈。太阳病。脉浮紧。无汗。发热。身疼
痛。八九日不解。表症仍在。此当发其汗。服药已。微除。其人发烦。目瞑。剧者必衄。衄乃解。
所以然者。阳气重故也。麻黄汤主之。
【目】方中行曰。纯是寒邪伤营。故脉浮紧。发热无汗。然寒邪之着营轻微。且兼中风。阳邪
变热上冲。故自衄愈。若脉
浮紧。发热无汗。而身竟疼痛。则寒重风轻。当发汗矣。其剧者必衄。毕竟少带中风之阳邪也。
【纲】仲景曰。服桂枝汤。或下之。仍头项强痛。翕翕发热。无汗。心下满。微痛。小便不利者。桂
枝汤去桂加茯苓白术汤主之。
【目】喻昌曰。服桂枝治风而遗其寒。所以不解而症变。设更下之。邪乘虚入里。在表之风寒
未除。在里之水饮上逆。故变五苓两解之法。以茯苓、白术为主。虽因已误而去桂枝。不得不用白
芍以收阴。甘草、姜、枣以益虚和脾胃也。
魏荔彤曰。太阳伤风。头项强痛。翕翕发热而汗出。今汗不出。则中风而兼伤寒矣。但与桂枝
治风不效矣。复下。更误矣。心下满微痛。小便不利。乃下药阴寒之气。挟寒邪作痞。挟风邪作痛。
动积饮而阻闭阳气。上下不流动故耳。本方专主补土渗湿。使在里下药之阴邪先除。然后可治其
表邪耳。以表邪虽仍在而轻微。故先以误下之阴邪入里为患是急。厥阴所云。先温其里。乃攻其表。
亦此义也。参观之。
【纲】仲景曰。伤寒脉浮。发热无汗。其表不解者。不可与白虎汤。渴欲饮水。无表症者。白
虎加人参汤主之。
【目】张从正曰。白虎汤。但能解热。不能解表。必恶寒身疼头痛之表症皆除。但渴而求救于水
者。方可与之。
楼英曰。如其人渴欲饮水。与之水果能饮。是表邪已变热而入之深矣。再诊其脉。已无浮缓浮紧
之表脉。再审其症。已无头身疼痛发热无汗之表症。即可用白虎汤。但加人参止其燥渴。仍藉辛凉为
半表里之治耳。
【纲】仲景曰。伤寒病。若吐。若下后。七八日。不解。热结在里。表里俱热。时时恶风。大渴。
舌上干燥而烦。欲饮水数升者。白虎加人参汤主之。
【目】魏荔彤曰。吐下俱非。致风寒之邪久而变热。热又久而结聚在里。而在里之气血亦郁而生
热。所谓表里俱热者也。内热盛则外阳疏。时时恶风。若似表症。而大渴云云。俱是一派实热结里
之象。故不特阳虚之里当急救阳。即
阴消之里亦当急救阴也。故仍用人参白虎。兼内清外散之用。
【纲】仲景曰。伤寒瘀热在里。身必发黄。麻黄连翘赤小豆汤主之。伤寒身黄。发热者。栀子
柏皮汤主之。
【目】喻昌曰。伤寒之邪。得湿而不行。所以热瘀身中而发黄。故用外解之法。设泥里字。
岂有邪在里而反治表之理哉。热已发出于外。自与内瘀不同。正当随热势清解其黄。俾不留于肌表
间也。前条热瘀。故用麻黄。此条发热。反不用麻黄者。盖寒湿之症。难于得热。热则其热外出而
不内入矣。所谓于寒湿中求之。不尽泥伤寒定法。此其一征也。
方中行曰。热发于外。则里症较轻。故解之以栀子。而和之以甘草。以为退热之轻剂。
[Outline] Zhang Zhongjing said: In Taiyang disease, if there are headache, fever, sweating, and aversion to wind, Guizhi Tang (Cinnamon Twig Decoction) is the primary treatment. In Taiyang disease, if there is fever accompanied by thirst and no aversion to cold, it is called Wenbing (Warm Disease). After perspiration therapy, if the body feels burning hot, it is named Fengwen (Wind-Warmth).
In Taiyang disease, with headache, fever, body ache, lower back pain, joint pain, aversion to wind, absence of sweating, and wheezing, Mahuang Tang (Ephedra Decoction) is the primary treatment. In Taiyang Wind Strike syndrome, with floating-tight pulse, fever, aversion to cold, body pain, absence of sweating, and irritability, Da Qinglong Tang (Great Blue Dragon Decoction) is the primary treatment. In Shanghan (Cold Damage), with floating-slow pulse, fever, aversion to cold, absence of sweating, irritability, body heaviness without pain, which occasionally alleviates, provided there are no Shaoyin symptoms, Da Qinglong Tang (Great Blue Dragon Decoction) is the primary treatment.
[Commentary] Zhu Gong said: Fever with aversion to cold belongs to Taiyang. This is because Taiyang governs Qi to warm the skin and muscles. When cold pathogen remains on the exterior, the skin becomes dense, leading to chills and fever. Perspiration should be induced; thus, Mahuang Tang (Ephedra Decoction) and Da Qinglong Tang (Great Blue Dragon Decoction) are used. If it is a Warm Disease, there is fever but no aversion to cold; in Fengwen (Wind-Warmth), there is also burning heat without aversion to cold.
Liu Wansu said: Chaore (Tidal Fever) refers to fever occurring at specific times without missing its schedule. Hanre (Alternating Chills and Fever) means fever follows chills, occurring alternately. Fare (Fever) refers to fever without a fixed time. Xixi fare (fever like feathers covering) indicates heat is on the exterior, so Guizhi Tang (Cinnamon Twig Decoction) is used to induce sweating and disperse it. Zhengzheng fare (fever steaming from within) indicates heat is in the interior, so Wei Chengqi Tang (Stomach-Regulating Purging Decoction) is used to purge and cleanse it. Fever belonging to the Exterior pattern results from Wind-Cold lodging in the skin causing Yang Qi stagnation. Fever belonging to the Interior pattern results from Yang Qi sinking into the Yin. Observe the origin of the heat to decide between inducing sweat or purging. If heat originates from the skin, the pathogen is on the exterior. If heat originates from within and reaches the exterior, the pathogen is in the interior. If both exterior and interior have fever, the pathogen is in the Half-Exterior Half-Interior region, which also causes fever. Heat may start from the skin and gradually transmit to the interior, or start as internal heat and reach the exterior. When the pathogen is on the exterior, there is exterior heat but no interior heat. When the pathogen is in the interior, interior heat is severe and reaches the exterior. In the Half-Exterior Half-Interior, both exterior and interior present with heat.
Wang Kentang said: Few diseases do not involve fever; distinguishing between Neishang (Internal Injury) and Waigan (External Contractive Disease) is key. If the Renying pulse (radial artery lateral to the styloid process) is larger than the Qikou pulse (radial artery at the wrist crease), it is an External Contractive Disease. If the Qikou pulse is larger than the Renying pulse, it is an Internal Injury. In External Contractive Disease, chills and fever occur simultaneously without interruption; in Internal Injury, they occur alternately and irregularly. In External Contractive Disease, aversion to cold cannot be relieved even by approaching fire; in Internal Injury, aversion to cold is relieved by warmth. In External Contractive Disease, aversion to wind implies intolerance to all winds; in Internal Injury, aversion to wind is only to slight drafts. External Contractive Disease manifests in the nose, causing nasal congestion and noisy breathing; Internal Injury manifests in the mouth, causing loss of taste and abdominal discomfort. In External Contractive Disease, due to excess pathogenic factors, speech is loud and strong, starting light and becoming heavy; in Internal Injury, due to deficiency of Yuan Qi (Primal Qi), speech is lazy and timid, starting heavy and becoming light. In External Contractive Disease, headache is constant; in Internal Injury, it comes and goes. In External Contractive Disease, the back of the hand is hot while the palm is cool; in Internal Injury, the palm is hot while the back of the hand is cool. These are the main points of Dongyuan’s (Li Gao’s) differentiation method. Some cases have Internal Injury without External Contractive Disease, and vice versa, making differentiation clear. If both coexist, pulses and symptoms appear together, making differentiation difficult, requiring careful investigation. If Internal Injury symptoms predominate, Internal Injury is severe and External Contractive Disease is mild; tonification should take precedence. If External Contractive Disease symptoms predominate, External Contractive Disease is severe and Internal Injury is mild; dispersing and releasing the exterior should be urgent. This is the implicit meaning of Dongyuan.
Chen Shiduo said: When a patient has fever, the pathogenic factor must first be dispersed. Once the pathogen is quickly eliminated, then support the Righteous Qi (Zheng Qi) so that it is not harmed by the pathogen. Use Chaihu (Bupleuri Radix), Jingjie (Schizonepetae Herba), Banxia (Pinelliae Rhizoma), Huangqin (Scutellariae Radix), and Gancao (Glycyrrhizae Radix), each 1 qian, decocted and taken orally. The pathogen will disperse and the body will cool. Generally, the abnormal Qi of the four seasons enters the Ying and Wei (Nutritive and Defensive levels) via the skin and hair. Using Chaihu and Jingjie first disperses the pathogen from the skin and hair. Once the pathogen is dispersed externally, how can it enter the interior? Banxia resolves phlegm, preventing the pathogen from exploiting phlegm. Huangqin prevents the pathogen from exploiting Fire. Gancao harmonizes the Middle Jiao. If the pathogen is dispersed first and Righteous Qi is not depleted, why would it progress from skin/hair to Ying/Wei, then to Zang-Fu organs, and deepen through transmission? Another formula: Chaihu (Bupleuri Radix), Danggui (Angelicae Sinensis Radix), Shanzhi (Gardeniae Fructus), Gancao (Glycyrrhizae Radix), Chenpi (Citri Reticulatae Pericarpium), each 1 qian; Huafen (Trichosanthis Radix) and Baishao (Paeoniae Radix Alba), each 2 qian. For Liver Qi stagnation, one dose brings relief; this does not specifically treat External Contractive Disease. It is miraculous for early-stage Internal Injury. Another formula: Danggui (Angelicae Sinensis Radix) 2 qian; Chaihu (Bupleuri Radix), Baishao (Paeoniae Radix Alba), Fuling (Poria), Gancao (Glycyrrhizae Radix), Guizhi (Cinnamomi Ramulus), each 1 qian; Chenpi (Citri Reticulatae Pericarpium) 0.5 qian. In winter, add Mahuang (Ephedrae Herba). This formula is specifically for early-stage Shanghan (Cold Damage) and is miraculous. Taking advantage of the stage before transmission, one can use dispelling agents alongside tonifying agents to dissipate heat. Early pathogens dare not oppose Righteous Qi strongly; thus, tonifying Righteous Qi naturally eliminates the pathogen. However, once transmission occurs, Righteous Qi retreats into the Zang-Fu organs and dares not fight the pathogen; further tonification makes it harder to expel. Therefore, after transmission, tonification should not be used. Now, using Guizhi (Cinnamomi Ramulus) to dissipate heat, or adding Mahuang (Ephedrae Herba) to dispel cold, attacks the pathogen with cold and heat, preventing internal entry, aided by robust Righteous Qi, resulting in cure after one dose.
[Outline] Zhang Zhongjing said: In Taiyang disease, with fever and aversion to cold, more heat than cold, and a weak pulse, this indicates "No Yang" (Yang deficiency). Do not induce sweating; Gui Zhi Er Yue Bi Yi Tang (Guizhi Two Parts, Yuebi One Part Decoction) is appropriate.
After six or seven days of Shanghan (Cold Damage), with fever, slight aversion to cold, painful limbs and joints, slight vomiting, epigastric fullness/stuffiness, and uneliminated exterior symptoms, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) is the primary treatment.
[Commentary] Zhu Gong said: These two formulas treat fever with slight aversion to cold.
Zhang Jiabin said: When pathogen is on the exterior causing fever, there is exterior heat but no interior heat; warm and disperse it. When pathogen is in the interior causing fever, interior heat is severe and reaches the exterior; clear it.
Ke Qin said: "More heat" refers to obvious fever, not internal heat. "No Yang" means Yang is deficient while Yin is not. No Yang precludes sweating, which is Zhongjing's principle. Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) is an excellent formula by Zhongjing. If there is no stiff neck and pain, combining with Guizhi Tang (Cinnamon Twig Decoction) is unnecessary.
"Slight aversion to cold" means less cold. "Irritating pain" is only in the limb joints, lighter than body/lower back/joint pain, indicating the exterior symptom is resolving but not gone. "Slight vomiting" is a sign of frequent vomiting. "Supporting knot" is the beginning of fullness/stuffiness, located in the Half-Exterior Half-Interior. Since exterior symptoms are slight, half of Guizhi Tang (Cinnamon Twig Decoction) is taken; since interior symptoms are slight, half of Chaihu Tang (Bupleurum Decoction) is taken. Although the pulse is not mentioned, weakness is implied. Fever with irritability implies significant heat. Zhongjing created this mild formula for harmonization, showing that "No Yang" prohibits sweating; using Mahuang (Ephedrae Herba) and Shigao (Gypsum Fibrosum) would be erroneous.
[Outline] Zhang Zhongjing said: In Taiyang disease, after inducing sweating, if the illness does not resolve, and the person still has fever, palpitations in the heart region, dizziness, body tremors, and a sensation of trembling and wanting to fall to the ground, Zhenwu Tang (True Warrior Decoction) is the primary treatment.
[Commentary] Dai Yuanli said: Yin meridians generally do not cause fever; only Shaoyin can cause fever. However, Shaoyin fever has two presentations: If Shaoyin symptoms appear immediately upon onset, with fever, aversion to cold, and no headache, Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) is used. If there is diarrhea with undigested food, burning heat with restlessness, interior cold with exterior heat, Zhongjing calls this "counter fever." This is Yin excess repelling Yang; Sini Tang (Counterflow Toxin Decoction) or Fuzi Lizhong Tang (Aconite and Magnolia Bark Decoction) are used. Generally, when Yang Qi transmits to the Yin meridian causing diarrhea, it is a heat diarrhea; Yang sinks into the interior, so there is no exterior heat. When Yin Qi enters the Yin meridian causing diarrhea, it is interior cold spontaneous diarrhea. With cold dominating the interior, Yang Qi lodges on the exterior, causing counter fever. Note that Yin-pattern fever is different. Fever originating from Yang involves headache; fever originating from Yin does not involve headache; this is a verification. After sweating and purging, if Yin and Yang do not interact and Water and Fire do not harmonize, leaving residual heat, do not use cold medicines; neither interior nor exterior should be treated rashly, so Xiaojianzhong Tang (Minor Construct the Middle Decoction) is appropriate. If the person is already deficient, and deficiency generates heat, use Xiaojianzhong Tang (Minor Construct the Middle Decoction) plus Danggui (Angelicae Sinensis Radix), or Sijunzi Tang (Four Gentlemen Decoction) plus Huangqi (Astragali Radix), or Shiquan Dabu Tang (Perfect Ten Great Tonifying Decoction) to regulate Ying and Wei. For severe deficiency, use Zhenwu Tang (True Warrior Decoction). If it is confirmed that heat pathogen remains unresolved, and despite sweating/purging there is no aversion to cold, Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) is used.
Wang Kentang said: Fever recurring after sweating, with rapid/restless pulse not subsiding with sweat, delirious speech, inability to eat, non-interaction of Yin and Yang, and diarrhea with fever, indicate death. Pulse盛大 (excessively full) at all positions with unceasing fever indicates death. Wind Strike immediately causing fever indicates Wind injuring Wei (Defensive) Qi. Cold Damage not immediately causing fever indicates Cold injuring Ying (Nutritive) Blood. Fever in Shaoyin or Jueyin is called "counter fever." Only Taiyin lacks fever manifestations.
Ke Qin said: This is a Taiyang syndrome where Guizhi Tang (Cinnamon Twig Decoction) should have been used, but Mahuang (Ephedrae Herba) type herbs were mistakenly used to induce sweating, leading to Yang collapse and persistent fever. Zhenwu Tang (True Warrior Decoction) must be used. Shen Jin'ao notes: Zhenwu Tang (True Warrior Decoction) is originally a Shaoyin formula; Yang collapse leads to interior deficiency-cold, hence its necessity.
[Outline] Zhang Zhongjing said: In Taiyang disease, after excessive sweating and subsequent drastic purging, if there is constipation for five to six days, dry tongue with thirst, slight tidal fever in the late afternoon (You hour), and hardness/fullness/pain from the epigastrium to the lower abdomen that cannot be touched, Da Xiexiong Tang (Major Chest-Piercing Decoction) is the primary treatment.
[Commentary] Zhu Gong said: Does Taiyang disease have tidal fever? In Zhongjing's Da Xiexiong Tang (Major Chest-Piercing Decoction) case, Jie Xiong (Chest Binding) with tidal fever is Major Jie Xiong, belonging to Taiyang.
Lou Quanshan said: This is caused by rash sweating and purging, shifting towards Yangming but not yet fully脱离 Taiyang.
Tidal fever in the You hour is a Yangming disease characteristic. However, the epigastrium is the location of Taiyang, and the lower abdomen is the chamber of the Bladder. Pain from the epigastrium to the lower abdomen is caused by heat entering water binding after purging, not Stomach-Gut Excess (Wei Jia Shi), so it cannot be named Yangming disease.
[Outline] Zhang Zhongjing said: Pulse deficient at all positions (Yin and Yang) with unceasing fever indicates death.
[Commentary] Zhu Gong said: Generally, Shanghan (Cold Damage) lasting eight or more days with high fever is difficult to treat.
[Outline] Zhang Zhongjing said: In Shanghan (Cold Damage), fever persists despite sweating, with epigastric fullness/stuffiness, vomiting, and diarrhea, Da Chaihu Tang (Major Bupleurum Decoction) is the primary treatment.
[Commentary] Fang Zhongxing said: In Shanghan (Cold Damage), if sweating resolves the condition, it is because Wind was present but mistakenly attacked partially, causing heat to enter the interior, resulting in fullness/stuffiness, vomiting, and diarrhea. Thus, Da Chaihu Tang (Major Bupleurum Decoction) is used to resolve both exterior and interior.
Wei Litong said: Fever with sweating that does not resolve indicates transmission from Taiyang to Yangming; both are Yangming syndromes. The Cold pathogen contracted by Taiyang enters the Heart region causing fullness/stuffiness, while Cold stagnation generates internal heat causing vomiting and diarrhea. The disease has completely left Taiyang and entered Yangming. It does not become Stomach-Gut Excess because Phlegm-Fluid was previously present in the Heart region, causing pathogen binding and fullness/stuffiness, preventing the Stomach from forming excess. Thus, it is transmitted to Yangming but not entirely in Yangming, and Chengqi (Purgative) formulas should not be used. Hence, this formula is created, incorporating ascending, dispersing, opening, and breaking actions within purging. Chaihu (Bupleuri Radix) drives Yangming pathogen to Shaoyang to resolve the exterior; Dahuang (Rhei Radix et Rhizoma) clears the Large Intestine to harmonize the interior. What Yangming symptoms remain? This is the method of dual resolution. One need not say Chaihu (Bupleuri Radix) only treats Shaoyang, as its function is divine; one need not say purging is only for Stomach-Gut Excess, as Dahuang (Rhei Radix et Rhizoma) is used appropriately. Who but Master Zhongjing possesses such insight?
[Outline] Zhang Zhongjing said: In Shanghan (Cold Damage), if a physician uses pill-based drastic purgatives, and fever persists with slight irritability, Zhizi Ganjiang Tang (Gardenia and Dried Ginger Decoction) is the primary treatment.
[Commentary] Yu Chang said: Drastic purging with pills only injures the Middle Jiao and fails to eliminate the pathogen. Zhizi (Gardeniae Fructus) and Ganjiang (Zingiberis Rhizoma) represent warming the middle and dispersing pathogen.
Yu Tun said: Purging the interior does not avoid cold; using pill-based drastic purgatives leaves Cold in the Middle. Slight irritability without profound anxiety suggests emetics are inappropriate. Zhizi (Gardeniae Fructus) resolves irritability; doubled Ganjiang (Zingiberis Rhizoma) expels internal cold and disperses exterior heat. Cold is used with heat, heat is used with cold. Two ingredients form the formula, completing three methods.
[Outline] Zhang Zhongjing said: In Shanghan (Cold Damage), after five to six days and drastic purging, if fever persists and there is knotted pain in the Heart region, the disease is not resolving. Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is the primary treatment. After sweating or purging, if there is irritability and chest stuffiness, Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is the primary treatment.
[Commentary] Wei Litong said: Fever persisting after drastic purging still carries exterior symptoms. Irritability changing to knotted pain in the Heart region indicates the exterior is unresolved while the interior is pressured. The exterior originally harbored Yin pathogen lingering long; the interior has Yang pathogen stagnating long. Zhizi (Gardeniae Fructus) is bitter and cold, treating Yang pathogen stagnated in the Heart; Xiangchi (Sojae Preparatum) is fragrant and acrid, treating Yin pathogen lingering on the exterior, curing this syndrome. Chest stuffiness, though not yet knotted pain, will hurt if prolonged; plan early and use this same formula.
Ke Qin said: Disease originating from Yang but mistakenly purged results in unremoved exterior heat and knotted pain in the Heart. Though milder than Jie Xiong (Chest Binding), it is worse than Ao Nao (Profound Anxiety). Jie Xiong is Water binding in the chest/hypochondrium, treated with Xiexiong Tang (Chest-Piercing Decoction); Water stagnation is broken. Here, stagnation is in the Heart, treated with Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction); Fire stagnation is dispersed.
[Outline] Zhang Zhongjing said: In Shanghan (Cold Damage), with Fluid retention in the epigastrium, cough with slight wheezing, fever without thirst. If thirst occurs after taking the medicine, it indicates Cold is departing and the disease is resolving. Xiao Qinglong Tang (Minor Blue Dragon Decoction) is the primary treatment.
[Commentary] Wei Litong said: Xiao Qinglong Tang (Minor Blue Dragon Decoction) treats Fluid retention by addressing long-standing Yin pathogen in the interior; it treats Wind-Cold by addressing temporary Heat stagnation in the chest/diaphragm. Master Cheng stated, "Lower Cold often presents with Upper Heat," piercing the truth. Students must recognize this.
[Outline] Zhang Zhongjing said: In Taiyang disease, with floating-tight pulse, fever, absence of sweating, spontaneous nosebleed indicates recovery. In Taiyang disease, with floating-tight pulse, absence of sweating, fever, body pain, unresolved after eight to nine days, with exterior symptoms remaining, sweating should be induced. After taking medicine, symptoms slightly alleviate, but the person becomes irritable and wants to close their eyes; in severe cases, nosebleed occurs, and the disease resolves upon bleeding. This is because Yang Qi is heavy. Mahuang Tang (Ephedra Decoction) is the primary treatment.
[Commentary] Fang Zhongxing said: Pure Cold pathogen injuring Ying (Nutritive) Blood causes floating-tight pulse, fever, and absence of sweating. However, if Cold invading Ying is mild and combined with Wind Strike, Yang pathogen transforming into Heat rushes upward, causing spontaneous nosebleed and recovery. If floating-tight pulse, fever, absence of sweating, and body pain persist, Cold is heavy and Wind is light; sweating should be induced. Severe cases will nosebleed, carrying some Wind Strike Yang pathogen.
[Outline] Zhang Zhongjing said: After taking Guizhi Tang (Cinnamon Twig Decoction) or purging, if there is still stiff neck and pain, feather-like fever, absence of sweating, epigastric fullness, slight pain, and urination difficulty, Guizhi Tang Qu Gui Jia Fuling Baizhu Tang (Guizhi Tang minus Cinnamon Twig plus Poria and Atractylodes Macrocephala Decoction) is the primary treatment.
[Commentary] Yu Chang said: Taking Guizhi Tang (Cinnamon Twig Decoction) to treat Wind but neglecting Cold causes unresolved symptoms and changes. Further purging allows pathogen to enter the interior due to deficiency. Exterior Wind-Cold is unremoved, and interior Fluid retention rebels upward. Thus, the dual-resolution method of Wuling San (Five-Ingredient Powder with Poria) is varied, focusing on Fuling (Poria) and Baizhu (Atractylodis Macrocephalae Rhizoma). Although Guizhi (Cinnamomi Ramulus) is removed due to error, Baishao (Paeoniae Radix Alba) is necessary to astringe Yin; Gancao (Glycyrrhizae Radix), Shengjiang (Zingiberis Rhizoma Recens), and Dazao (Jujubae Fructus) tonify deficiency and harmonize the Spleen and Stomach.
Wei Litong said: Taiyang Wind Strike presents with stiff neck/pain, feather-like fever, and sweating. Now, absence of sweating indicates Wind Strike combined with Cold Damage. Treating only Wind with Guizhi Tang (Cinnamon Twig Decoction) is ineffective. Subsequent purging is another error. Epigastric fullness, slight pain, and urination difficulty result from the Yin-Cold nature of purgatives combining with Cold pathogen to cause fullness/stuffiness, and with Wind pathogen to cause pain, disturbing accumulated Fluid and blocking Yang Qi, preventing circulation. This formula primarily tonifies Earth and leaches dampness, removing the Yin pathogen from erroneous purging in the interior first, before treating the exterior pathogen. Although the exterior pathogen remains, it is mild; thus, the urgent issue is the interior harm from erroneous purging. As stated in the Jueyin chapter, "First warm the interior, then attack the exterior," applies here. Study this.
[Outline] Zhang Zhongjing said: In Shanghan (Cold Damage), with floating pulse, fever, absence of sweating, and unresolved exterior, Baihu Tang (White Tiger Decoction) must not be given. If there is thirst desiring water, and no exterior symptoms, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is the primary treatment.
[Commentary] Zhang Congzheng said: Baihu Tang (White Tiger Decoction) only clears heat, does not resolve the exterior. It can only be given when exterior symptoms like aversion to cold, body pain, and headache are absent, and only thirst seeking water remains.
Lou Ying said: If the patient desires water and drinks fruit/water freely, it indicates exterior pathogen has transformed into heat and penetrated deeply. Re-checking the pulse shows absence of floating-slow or floating-tight exterior pulses. Re-checking symptoms shows absence of head/body pain, fever, and absence of sweating. Then Baihu Tang (White Tiger Decoction) can be used, adding Renshen (Ginseng Radix) to stop dryness/thirst, utilizing acrid-cool properties for the Half-Exterior Half-Interior level.
[Outline] Zhang Zhongjing said: In Shanghan (Cold Damage), after vomiting or purging, if unresolved after seven to eight days, heat binds in the interior, presenting with simultaneous exterior and interior heat, occasional aversion to wind, extreme thirst, dry tongue with irritability, and desire to drink several liters of water, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is the primary treatment.
[Commentary] Wei Litong said: Vomiting and purging were incorrect, causing Wind-Cold pathogen to transform into heat over time. Prolonged heat binds in the interior, and Qi/Blood in the interior stagnate generating heat, termed simultaneous exterior and interior heat. Excessive internal heat causes external Yang to loosen, leading to occasional aversion to wind, resembling exterior symptoms. Extreme thirst etc. are all signs of solid heat binding in the interior. Thus, not only should Yang deficiency in the interior urgently rescue Yang, but Yin consumption in the interior should urgently rescue Yin. Hence, Renshen (Ginseng Radix) and Baihu Tang (White Tiger Decoction) are used again, combining internal clearing and external dispersing functions.
[Outline] Zhang Zhongjing said: In Shanghan (Cold Damage), with stagnant heat in the interior, jaundice will likely develop. Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Adzuki Bean Decoction) is the primary treatment. In Shanghan (Cold Damage) with jaundice and fever, Zhizi Bopi Tang (Gardenia and Phellodendron Bark Decoction) is the primary treatment.
[Commentary] Yu Chang said: Shanghan (Cold Damage) pathogen, combined with dampness, fails to move, causing heat stagnation in the body and jaundice. Thus, external resolution methods are used. Clinging to the word "interior," one might ask how pathogen in the interior is treated externally. Heat emerging externally differs from internal stagnation; one should clear and resolve jaundice following the heat trend, preventing retention on the muscle surface. In the previous clause, heat stagnation required Mahuang (Ephedrae Herba); in this clause, fever does not require Mahuang (Ephedrae Herba) because Cold-Damp conditions rarely generate heat; heat allows heat to exit externally rather than enter internally. This illustrates seeking solution within Cold-Damp, not rigidly adhering to fixed Shanghan (Cold Damage) laws, as seen here.
Fang Zhongxing said: Heat emerging externally means interior symptoms are lighter; thus, it is resolved with Zhizi (Gardeniae Fructus) and harmonized with Gancao (Glycyrrhizae Radix) as a mild heat-clearing agent.