【纲】仲景曰。太阳之为病。脉浮。头项强痛而恶寒。
【目】朱肱曰。足太阳膀胱经。从目内 上额。连于风府。分为四道。下项。并正别脉上下六
道。以行于背与身。太阳之经。为诸阳主气。或中寒邪。必发热而恶寒。缘头项腰脊。是太阳经所
过处。今头项痛、身体疼、腰脊痛。其脉尺寸俱浮者。故知太阳经受病也。
柯琴曰。太阳主表。故表脉表症。独太阳得其全。后凡言太阳病者。必据此一条脉症。如脉反
沉。头不痛。项不强。不恶寒。是太阳之变局矣。
【纲】仲景曰。太阳病。发热汗出。恶风脉缓者。名为中风。太阳病。或已发热。或未发热。
必恶寒体痛。呕逆。脉阴阳俱紧者。名曰伤寒。
【目】朱肱曰。有发热恶寒。烦躁。手足温。而脉反浮紧者。有寒多热少。不烦躁。手足微冷。
而脉反浮缓者。此名伤风见寒脉。伤寒见风脉也。皆宜服大青龙汤。盖大青龙症。脉似桂枝反无
汗。病似麻黄反烦躁是也。（脉弱有汗。为桂枝症。脉紧不烦躁。为麻黄症。）
大青龙治病。与麻黄汤症相似。但病尤重。而又加烦躁者。用大青龙。以其有烦躁一症。故可
用也。大抵感外风者为伤风。感寒冷者为伤寒。故风则伤卫。寒则伤营。
鳌按。脉阴阳俱紧者。脉浮为阳。沉为阴。言不论浮沉。俱带紧象。不专指尺寸也。其所以紧
者。寒也。
【纲】仲景曰。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。
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。
若脉微弱。汗出恶风者。不可服。服之则厥逆。筋惕肉 。此为逆也。
【目】朱肱曰。仲景言不可服青龙者。凡发汗过多。筋惕肉 。振摇动人。或虚羸之人微汗出。
便有此症。俱宜服真武汤以救之。羸甚者。芍药或量多少与之。恶热药者。去附子。余根据加减
法。仲景制真武汤。乃为合用桂枝。却用麻黄之类。发汗多。亡阳。有此症。故用真武汤。若调理
顺者。无此症也。
柯琴曰。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。风能令脉浮。浮紧而沉不紧。与伤寒俱紧之脉有别。脉浮缓而身重。是伤寒之轻者。
非若阴阳俱紧而身疼。为伤寒之最重也。脉微弱自汗出。为桂枝症。不可与大青龙。以中有麻黄、
石膏也。若脉浮紧。汗不出。是麻黄症。不可与桂枝。以中有白芍能止汗也。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。不可与石膏以清里。
【纲】仲景曰。太阳病。外症未解。脉浮弱者。当以汗解。宜桂枝汤。太阳中风。阳浮而阴弱。
阳浮者热自发。阴弱者汗自出。
【目】魏荔彤曰。太阳中风。固以桂枝汤为正治。然有久在太阳。并未传里。是不可以日久而
误为里症也。脉必仍浮。浮者。表症未解。兼弱。阴虚热发。阴何以虚。阳盛也。阳何以盛。风入于
卫助卫而盛也。故当用桂枝使汗解。
喻昌曰。阳浮者。阳邪入卫。脉外浮。阳性本热。风又善行。所以不待闭郁。而热发甚捷也。
阴弱者。营无邪助。比卫不足。脉必内弱。阴弱不能内守。阳强不为外固。所以不必覆盖而脉自易
出也。
【纲】仲景曰。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。当汗出而愈。
伤寒发汗。解半日
许。复烦。脉浮数者。可更发汗。宜桂枝汤。
【目】黄仲理曰。脉当弦紧而反浮弱。其本虚可知。此劳倦内伤症也。
鳌按。发汗解半日许。是服麻黄发之。非桂枝也。更发汗用桂枝。是服麻黄后。又与桂枝也。
【纲】仲景曰。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。
【目】柯琴曰。八九日。是当解未解之时。脉微缓。是有胃气。应不转属阳明。
【纲】仲景曰。桂枝本为解肌。若其人脉浮紧。发热汗不出者。不可与也。常须识此。勿令误
也。
【目】方中行曰。胃家湿热本甚者。复得桂枝之热。则两热相搏于中宫。搏则必伤。甘又令人
中满。壅气而上溢。所以胃不司纳。反上涌而逆出也。
魏荔彤曰。用桂枝者。以阳助阳。解卫分之风邪。浅而逐之也。用麻黄者。以阳入阴。发营分
之寒邪。深而夺之也。判然两途。毫厘千里。故风伤卫。如贼入其疆。顺而逐之可耳。寒伤营。如
贼近于郊。必须强而夺之。乃外在疆外把持。则贼无出路。惟有攻城掠郭而已。此喻最明。仲师所以示
人从浮紧之脉。汗不出之症。认明寒邪之伤营。与太阳中风同在一经而两分不侔。不可误也。
【纲】仲景曰。服桂枝汤。大汗出。脉洪大者。与桂枝汤如前法。若形如疟。日再发者。汗出
必解。宜桂枝二麻黄一汤。
【目】柯琴曰。大汗出后。脉洪大。不烦渴。是病犹在表。桂枝症未罢。如疟日再发。是风邪
留其处。故必倍加桂枝解肌。少与麻黄开表。此又服桂枝后少加麻黄之一法。
【纲】仲景曰。发汗后。身疼痛。脉沉迟者。桂枝去芍药生姜新加人参汤。
【目】柯琴曰。汗后身疼。是表虚。不得辛散。故去生姜。沉为在里。迟为在脏。自当远阴寒。
故去芍药。曰新加者。见表未解。无补益法。今因脉沉迟而始用之。与四逆汤治身疼脉沉之法
同义。彼在未汗前而脉反沉。是内外皆寒。故用干姜、生附大辛大热者。协甘草以逐里寒。而表寒
自解。此在发汗后而脉沉迟。是内外皆虚。故用人参之补中益气。以率领桂枝、甘枣而通血脉。则
表里自和也。
【纲】仲景曰。太阳病。二三日。不得卧。但欲起。心下必结。脉微弱者。以本有寒分也。
【目】喻昌曰。二三日不能卧。但欲起。阳邪炽盛。逼处心胸。扰乱不宁。所以知其心下必结。
然但显欲结之象。尚未至于结也。若脉微弱者。此平日素有痰饮。积于膈之分。适与外邪相召。
外邪方炽。其不可下明矣。
【纲】仲景曰。太阳病。桂枝症。医反下之。利遂不止。脉促者。表未解也。喘而汗出者。葛
根黄连黄芩汤主之。
太阳病。下之后。脉促。胸满者。桂枝去芍药汤主之。若微恶寒者。去芍药方中加附子汤主之。
【目】鳌按。邪束于外。阳不得伸。不得伸必内扰。故令脉促。夫桂枝脉本弱。促者。误下之过也。但前条脉促。
是阳重。下条脉促。又为阳虚。何则。脉虽促而不汗出。胸虽满而不喘。脉与上同。而症自各异。盖促为阳脉。胸满为
阳症固已。不知阳盛脉促胸满。阳虚亦脉促胸满。故前由阳气内扰。后由寒邪内结。将作结胸。不可混也。
【纲】仲景曰。伤寒若吐若下后。心下逆满。气上冲胸。起则头眩。脉沉紧。发汗则动经。身
为振振摇者。茯苓桂枝白术甘草汤主之。
【目】方中行曰。心下逆满。气上冲胸。寒涌于膈。所以起则头眩。脉见沉紧。明系饮中留结
外邪。若但发汗以强解其外。外虽解。而津液尽竭。反足伤动经脉。有身为振摇之患矣。盖人身经
脉。赖津液滋养。今一伤于吐下。再伤于汗。经脉失养。故身为振摇。遇此等症。必涤饮与散寒并施。
小青龙诸法。全是此意。但彼风寒两受。不得不重在表。此症外
邪已散。止存饮中之邪。故加桂枝于制饮药中。使邪尽散。津液得四布。而滋养其经脉。千百年来
孰解此微旨乎。
【纲】仲景曰。脉浮者。病在表。可发汗。麻黄汤。脉浮而数者。可发汗。宜麻黄汤。
脉浮而数。浮为风。数为虚。风为热。虚为寒。风寒相搏。则洒淅恶寒也。
诸脉浮数。当发热而洒淅恶寒。若有痛处。饮食如常者。蓄积有脓也。
疮家身虽疼。不可发汗。汗出则痉。
【目】柯琴曰。脉言浮而不言迟弱。浮而有力也。若浮而大。有热属脏者。当攻之。不令发汗。
若浮数而痛偏一处。身虽疼。不可发汗。
浮为风邪。邪之所凑。其气必虚。数本为热。而从浮见。则数为虚矣。浮为表而非风。数为实
热而非虚。故浮数之脉。而见发热恶寒之症。即痈脓亦有然者。当就痛偏一处。饮食如常辨之。庶
疮家之治。不致误作风寒。
【纲】仲景曰。脉浮数者。法当汗出而愈。若身重心悸者。不可发汗。当自汗出乃解。所以然
者。尺中脉微。此里虚。须表里实。津液自和。便汗出自愈。
【目】魏荔彤曰。下后脉尚浮数。则知其人阳气尚勃勃欲发。所以应俟其自复也。尺中脉微为
里虚。见寸脉虽浮数。阳可徐升。尺脉必微弱。阳虑内损。特标里虚二字。知在表可徐图。在里不
应误矣。程注谓须用表和里实之法治之。而未出方。愚谓建中新加之属。可斟酌而用。
【纲】仲景曰。寸口脉浮而紧。浮则为风。紧则为寒。风则伤卫。寒则伤营。营卫俱病。骨肉
烦疼。当发其汗也。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。
麻黄汤主之。
伤寒脉浮紧者。麻黄汤主之。不发汗。因致衄。
太阳病。脉浮紧。发热身无汗。自衄者愈。衄家不可出汗。汗出必额上陷。脉浮紧。目直视。
不能 。不得眠。脉浮紧者。法当身疼痛。宜以汗解之。假令尺中迟者。不可发汗。以营气不足。
血少故也。脉浮而紧。而复下之。紧反入里。则作痞。按之自濡。但气痞耳。
【目】危亦林曰。风先开腠理。寒得入经络。脉亦应其象。而变见于寸口。紧为寒而从浮。故
汗之则愈。
黄仲理曰。脉则浮紧。症则无汗。身疼痛。与大青龙症同而异。脉紧无汗。阳气内扰。阳络伤
而衄血夺血者。无汗故也。
喻昌曰。脉浮紧发热无汗。纯是阴邪伤营矣。然寒邪轻微着营而不致涸冱其
血。且兼中风阳邪。掺入易散。此所以不致身疼腰痛骨节疼也。如是则寒邪本轻。而风入之阳邪。
变热上冲。其势迅速。血自鼻出者。则中风阳邪既越而上出矣。而伤寒之阴邪。本在血分。亦随血
而去。必愈。何以知其愈。脉不浮紧。身不发热。而 然汗出。即是愈也。
魏荔彤曰。衄家血常上溢。由阴不足。血中素有热以鼓荡之。使不循其经而常在颡过山也。若
复发汗。以伤阴而动其热。于是邪热上干诸阳之首。阳随汗而外亡。额上气遂陷入。脉紧急。无阳
以制阴也。直视不能 。无血以荣筋脉也。不得眠。无阴而阳亢也。此俱应救其阴以维亡而未尽之
阳。所谓诸症宜救阳。而伤寒独宜救阴。此其一也。（鳌按。额上陷、乃气虚陷入脑内。非如小儿
之囟陷下也。）尺中迟。血短而阴不足矣。然迟则为寒。非气微而阳不足乎。故必先理阴阳。然
后可发汗治表也。但仲师言血少。今言阳不足何哉。以血少而尺迟。正以少阴肾家之真阴不足。非
止如肝脾血短之症也。夫肾阴不足。非阳不足气不足乎。此而误汗。当与误发少阴汗同忌。则治之
之法。建中而外。少阴温经散寒之方。尤不可不加意也。
喻昌曰。紧反入里。寒邪转入转深矣。故作痞。按之自濡。则其所挟者止气耳。不同于挟饮之
满硬也。
鳌按。上七条。乃详叙脉同浮紧。而治各不同之故。
【纲】仲景曰。太阳病。十日已去。脉浮细而嗜卧者。外已解也。胸满胁痛者。与小柴胡汤。
脉但浮者。与麻黄汤。
【目】柯琴曰。脉微细欲寐。少阴症也。脉浮细嗜卧。无少阴症。虽十日后尚属太阳。此表解
而不了了之谓。兼胁痛。是
太阳少阳合病。以少阳脉弦细也。但浮不细。是浮而有力。无胸胁痛。则不属少阳。但浮而不大。
又不属阳明。故仍在太阳也。
【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。
【目】柯琴曰。本论无越婢方症。金匮有之。世本取合者即是也。仲景言不可发汗。则不用麻
黄可知。无阳。则不用石膏可知。若非方有不同。必抄录者误耳。宁阙其方。勿留之以滋惑也。
鳌按。此是风寒两伤症。但无身疼腰痛骨节痛。是寒之伤营也轻。脉微弱。即阳浮阴弱之脉。
是风之伤卫也重。故虽未见有寒。而发热。热多寒少。又不汗出。其亦有寒在于营分明矣。但脉已
见微弱。其无阳可知。故曰。不可发汗。故不用大青龙之辛散。而去其杏仁。加以芍药。以桂枝主
风多之治。麻黄主寒少之治。芍药固摄虚阳之根。主脉微弱之治。名之曰桂枝二越婢一汤。则此方
能固真阴。足以维阳之根蒂。虽发汗驱邪。而正阳不致上浮。故本方既有芍药。虽麻黄亦无害也。
乃柯氏据不可发汗。以麻黄为不可用。据无阳。以石膏为不可用。其麻黄之无害。已详言之。至石
膏乃治上中焦邪热。与下焦肾虚之症无碍也。又以本论无越婢方症。惟金匮有之。亦思仲景本合伤
寒杂病为一书。叔和分而为二。则仲景当时。金匮中所有之方。即如本论中所有。其合桂枝越婢成
方。奚不可。不必阙之也。特此症原非易认。此方又难轻用。医者固当详审而斟酌之。与其蹈误用
[Outline] Zhang Zhongjing said: The main characteristics of Taiyang disease are a floating pulse, stiffness and pain in the head and neck, and aversion to cold.
[Commentary] Zhu Gong said: The Foot-Taiyang Bladder Meridian starts from the inner canthus, goes upward to the forehead, connects with the Fengfu (GV16) acupoint, and divides into four pathways. It descends through the neck, along with the principal and divergent meridians, forming six pathways in total, running along the back and lateral body. The Taiyang meridian is the master of Qi for all Yang meridians. If invaded by cold pathogenic factors, fever and aversion to cold must occur. This is because the head, neck, waist, and spine are areas traversed by the Taiyang meridian. Now, with headache, body pain, and spinal pain, and a floating pulse at all three positions (Cun, Guan, Chi), we know that the Taiyang meridian has been affected.
Ke Qin said: Taiyang governs the exterior. Therefore, the pulses and symptoms of the exterior syndrome are most comprehensively manifested in Taiyang disease. Whenever subsequent texts mention Taiyang disease, they must refer to this set of pulse and symptom criteria. If the pulse is instead deep, the head does not hurt, the neck is not stiff, and there is no aversion to cold, this constitutes a variant pattern of Taiyang disease.
[Outline] Zhang Zhongjing said: In Taiyang disease, if there is fever, sweating, aversion to wind, and a moderate (slow/relaxed) pulse, it is named Wind Strike (Zhongfeng). In Taiyang disease, whether fever has already appeared or not, there will definitely be aversion to cold, body pain, and reverse flow of stomach Qi (nausea/vomiting); if the pulses at both Yin and Yang positions are tight, it is named Cold Damage (Shanghan).
[Commentary] Zhu Gong said: Some patients present with fever, aversion to cold, irritability, and warm hands and feet, yet the pulse is surprisingly tight and floating; others have more cold than heat, no irritability, and slightly cold hands and feet, yet the pulse is surprisingly loose and floating. These are respectively called "Wind Strike presenting with Cold Damage pulse" and "Cold Damage presenting with Wind Strike pulse." Both conditions are suitable for treatment with Gaoqinglong Decoction. This is because the Gaoqinglong pattern features a pulse resembling that of Guizhi Tang but without sweating, and a condition resembling Mahuang Tang but with irritability. (A weak pulse with sweating belongs to the Guizhi Tang pattern; a tight pulse without irritability belongs to the Mahuang Tang pattern.)
The condition treated by Gaoqinglong Decoction is similar to the Mahuang Tang pattern, but the condition is more severe and includes irritability. Therefore, Gaoqinglong Decoction is used because of the presence of irritability. Generally speaking, contracting external wind leads to Wind Strike, while contracting cold leads to Cold Damage. Thus, wind injures the Defensive Qi (Wei), and cold injures the Nutritive Qi (Ying).
Shen Jin'ao's Note: When it says "the pulses at both Yin and Yang positions are tight," it means that regardless of whether the pulse is superficial (floating) or deep, it exhibits a tight quality. It does not specifically refer only to the Cun and Chi positions. The reason for the tightness is the presence of cold.
[Outline] Zhang Zhongjing said: In Taiyang Wind Strike, if the pulse is floating and tight, accompanied by fever, aversion to cold, body pain, anhidrosis (no sweating), and irritability, Gaoqinglong Decoction is the primary treatment.
In Cold Damage, if the pulse is floating and loose, accompanied by fever, aversion to cold, anhidrosis, irritability, absence of body pain but feeling of heaviness, which occasionally alleviates, and in the absence of Shaoyin disease signs, Gaoqinglong Decoction should be used to induce sweating and resolve the exterior.
If the pulse is faint and weak, with sweating and aversion to wind, it must not be administered. Administration would lead to cold limbs (Jue Ni) and twitching of muscles and fasciae. This is a contraindication resulting in adverse effects.
[Commentary] Zhu Gong said: Zhang Zhongjing stated that Qinglong Decoction should not be taken usually due to excessive sweating, leading to twitching of muscles and fasciae, tremors, and agitation. Or, in frail individuals with slight sweating, these symptoms may appear. All such cases are suitable for Zhenwu Tang to rescue them. For those extremely emaciated, the dosage of Shaoyao (Paeonia lactiflora) should be adjusted. For those who dislike hot herbs, remove Fuzi (Aconitum carmichaelii). Follow other modification rules. Zhang Zhongjing formulated Zhenwu Tang to address symptoms arising after excessive sweating from using herbs like Guizhi or Mahuang, which caused loss of Yang Qi. If recovery proceeds smoothly, such symptoms do not occur.
Ke Qin said: Wind has Yin and Yang aspects. Taiyang Wind Strike with sweating and a loose pulse indicates invasion by the dynamic Yang wind. Here, anhidrosis and a tight pulse indicate invasion by the biting Yin wind. Wind causes the pulse to float; a floating-tight pulse that is not tight upon deep pressing differs from the uniformly tight pulse of Cold Damage. A floating-loose pulse with body heaviness represents a milder form of Cold Damage, unlike the uniformly tight pulse with body pain, which represents the most severe form. A faint-weak pulse with spontaneous sweating belongs to the Guizhi Tang pattern and should not be given Gaoqinglong Decoction, as it contains Mahuang and Shigao (Gypsum fibrosum). A floating-tight pulse with anhidrosis belongs to the Mahuang Tang pattern and should not be given Guizhi Tang, as it contains Baishao (White Peony Root) which stops sweating. A faint pulse with aversion to wind and cold indicates deficiency of both Yin and Yang; Mahuang should not be used for sweating. A faint-weak pulse with spontaneous sweating indicates lack of Yang; Shigao should not be used to clear interior heat.
[Outline] Zhang Zhongjing said: In Taiyang disease, if the exterior syndrome has not resolved and the pulse is floating and weak, it should be resolved by inducing sweating, preferably using Guizhi Tang. In Taiyang Wind Strike, the Yang pulse floats and the Yin pulse is weak. Floating Yang pulse indicates spontaneous generation of heat; weak Yin pulse indicates spontaneous sweating.
[Commentary] Wei Litong said: Taiyang Wind Strike is indeed correctly treated with Guizhi Tang. However, some patients remain in the Taiyang stage for a long time without transmitting to the interior. One must not mistake this prolonged duration for an interior syndrome. The pulse will likely still be floating; floating indicates the exterior syndrome has not resolved. Combined with weakness, it indicates Yin deficiency with heat emergence. Why is Yin deficient? Because Yang is exuberant. Why is Yang exuberant? Because wind pathogen enters the Wei level and assists Wei Qi, causing it to become exuberant. Therefore, Guizhi Tang should be used to resolve via sweating.
Yu Chang said: "Floating Yang" refers to Yang pathogen entering the Wei level, causing the pulse to float on the exterior. Yang nature is inherently hot, and wind moves swiftly, so heat emerges rapidly without needing stagnation. "Weak Yin" means the Ying level lacks pathogenic assistance and is weaker than the Wei level, causing the pulse to feel weak internally. Weak Yin cannot hold inward, and strong Yang cannot secure outwardly, so the pulse reveals itself easily even without covering.
[Outline] Zhang Zhongjing said: The appearance resembles Cold Damage, but the pulse is not wiry and tight but weak. A weak pulse necessarily implies thirst. If fire therapy is applied, delirium will certainly occur. If there is fever with a weak, floating pulse, sweating should induce recovery.
After treating Cold Damage with sweating, if restlessness recurs after about half a day and the pulse is floating and rapid, sweating may be induced again, preferably using Guizhi Tang.
[Commentary] Huang Zhongli said: The pulse should be wiry and tight but is instead floating and weak, indicating inherent deficiency. This is a syndrome of internal injury due to fatigue and overwork.
Shen Jin'ao's Note: "Sweating resolves the condition after about half a day" refers to taking Mahuang Tang to induce sweating, not Guizhi Tang. Using Guizhi Tang for subsequent sweating means administering it after Mahuang Tang.
[Outline] Zhang Zhongjing said: In Taiyang disease, after eight or nine days, the patient presents like malaria, with fever and aversion to cold, more heat than cold. The patient does not vomit, and bowel/bladder functions are relatively normal. The episodes occur two or three times a day. If the pulse is slightly slow and harmonious, it indicates impending recovery.
[Commentary] Ke Qin said: Eight or nine days is the time when resolution should have occurred but hasn't. A slightly slow and harmonious pulse indicates the presence of Stomach Qi, suggesting transmission to Yangming is unlikely.
[Outline] Zhang Zhongjing said: Guizhi Tang is originally intended to release the muscle layer. If the patient has a floating-tight pulse, fever, and anhidrosis, it must not be given. Keep this in mind always to avoid error.
[Commentary] Fang Zhongxing said: If the Stomach has severe damp-heat, adding the heat of Guizhi Tang causes the two heats to clash in the middle Jiao. Clashing causes damage. Sweet flavors cause fullness in the center, obstructing Qi and causing it to overflow upward. Thus, the Stomach fails to receive food, leading to regurgitation and vomiting.
Wei Litong said: Using Guizhi Tang uses Yang to assist Yang, releasing wind pathogen from the Wei level, driving it out superficially. Using Mahuang Tang uses Yang to enter Yin, releasing cold pathogen from the Ying level, capturing it deeply. These are two distinct paths; a hair's breadth difference leads to miles of deviation. Wind injuring Wei is like a thief entering the border; one should drive him out following the trend. Cold injuring Ying is like a thief near the suburbs; one must forcefully capture him. If one blocks exits externally, the thief has no way out and will attack the city walls. This analogy is very clear. Master Zhongjing uses this to show people that from the floating-tight pulse and anhidrosis, one must clearly recognize cold injuring Ying. Although Taiyang Wind Strike and this condition belong to the same meridian, they are vastly different and must not be confused.
[Outline] Zhang Zhongjing said: After taking Guizhi Tang, if profuse sweating occurs and the pulse becomes surging and large, continue giving Guizhi Tang as before. If the condition resembles malaria, occurring twice a day, sweating will resolve it; Guizhi Er Mahuang Yi Tang is appropriate.
[Commentary] Ke Qin said: After profuse sweating, a surging-large pulse without irritability or thirst indicates the pathogen remains in the exterior, and the Guizhi Tang pattern persists. Resembling malaria occurring twice daily indicates wind pathogen lingering at the surface. Therefore, double the amount of Guizhi to release the muscle layer and add a small amount of Mahuang to open the exterior. This is another method of adding a little Mahuang after taking Guizhi Tang.
[Outline] Zhang Zhongjing said: After sweating, if body pain persists and the pulse is deep and slow, use Guizhi Decoction minus Shaoyao, Shengjiang, plus new-added Renshen (Guizhi Qu Shaoyao Shengjiang Xinjia Renshen Tang).
[Commentary] Ke Qin said: Body pain after sweating indicates exterior deficiency; pungent-dispersing herbs should not be used, hence Shengjiang is removed. Deep pulse indicates interior involvement; slow pulse indicates organ involvement. One should naturally avoid Yin-cold, hence Shaoyao is removed. The term "new-added" implies that although the exterior is unresolved, tonification was not previously indicated. Now, due to the deep-slow pulse, tonification is used. This shares the same principle as using Sini Tang for body pain with a deep pulse. In Sini Tang, before sweating, a deep pulse indicates cold in both interior and exterior, so Ganjiang (Dried Ginger) and Sheng Fuzi (Raw Aconite), being greatly pungent and hot, coordinate with Gancao to drive out interior cold, resolving exterior cold automatically. Here, after sweating, a deep-slow pulse indicates deficiency in both interior and exterior. Therefore, Renshen (Ginseng) is used to tonify Middle Qi, leading Guizhi, Gancao, and Dazao to unblock blood vessels, harmonizing interior and exterior.
[Outline] Zhang Zhongjing said: In Taiyang disease, on the second or third day, if the patient cannot lie down, only wants to rise, there must be palpitations/fullness in the epigastrium. If the pulse is faint and weak, it is because there was pre-existing cold-fluid retention.
[Commentary] Yu Chang said: Inability to lie down and desire to rise on the second or third day indicates exuberant Yang pathogen forcing its way into the heart and chest, causing disturbance and restlessness. Thus, we know there is epigastric fullness. However, it only shows the tendency to knot, not actual knotting. If the pulse is faint and weak, this indicates chronic phlegm-fluid retention accumulated in the diaphragm region, coinciding with the external pathogen. Since the external pathogen is currently exuberant, purgation is clearly contraindicated.
[Outline] Zhang Zhongjing said: In Taiyang disease, if the Guizhi Tang pattern is present and the physician incorrectly uses purgation, diarrhea continues incessantly. If the pulse is hurried (Cu), the exterior is unresolved. If there is wheezing and sweating, Gegen Huanglian Huangqin Tang is the primary treatment.
In Taiyang disease, after purgation, if the pulse is hurried and there is chest fullness, Guizhi Qu Shaoyao Tang is the primary treatment. If there is slight aversion to cold, add Fuzi to the Guizhi Qu Shaoyao formula (Guizhi Qu Shaoyao Fuzi Tang).
[Commentary] Shen Jin'ao's Note: Pathogen binding externally prevents Yang Qi from extending. Lack of extension causes internal disturbance, leading to a hurried pulse. The Guizhi pattern typically has a weak pulse; hurrying is the fault of incorrect purgation. However, in the previous clause, a hurried pulse indicates excess Yang; in the next clause, it indicates deficient Yang. Why? Although the pulse is hurried, there is no sweating; although the chest is full, there is no wheezing. The pulse is the same as above, but symptoms differ. Hurried pulse is a Yang pulse, and chest fullness is a Yang symptom, which is understood. But one must not forget that excess Yang causes hurried pulse and chest fullness, while deficient Yang also causes hurried pulse and chest fullness. The former is caused by internal disturbance of Yang Qi; the latter by internal knotting of cold pathogen, potentially developing into Jie Xiong (Knot Chest). They must not be confused.
[Outline] Zhang Zhongjing said: After Cold Damage is treated with emesis or purgation, if there is rebellious fullness in the epigastrium, Qi rushing up to the chest, dizziness upon standing, and a deep-tight pulse, inducing sweating will disturb the meridians, causing the body to tremble and shake. Fuling Guizhi Baizhu Gancao Tang is the primary treatment.
[Commentary] Fang Zhongxing said: Rebellious fullness in the epigastrium and Qi rushing to the chest result from cold fluid surging in the diaphragm, causing dizziness upon standing. A deep-tight pulse clearly indicates water-fluid retention combined with external pathogen. If one merely induces sweating to forcibly resolve the exterior, although the exterior resolves, body fluids are exhausted, damaging the meridians and causing trembling and shaking. Meridians rely on body fluids for nourishment. Having been injured once by emesis/purgation and again by sweating, the meridians lose nourishment, causing trembling. For such cases, eliminating fluid retention and dispersing cold must be done simultaneously. Xiao Qinglong Tang methods embody this idea. However, in those cases, both wind and cold are affected, emphasizing the exterior. Here, the external pathogen has dispersed, leaving only fluid-retention pathogen. Therefore, Guizhi is added to fluid-regulating herbs to scatter the pathogen completely, allowing fluids to distribute evenly and nourish the meridians. Who among thousands of years has understood this subtle principle?
[Outline] Zhang Zhongjing said: If the pulse is floating, the disease is in the exterior; sweating may be induced using Mahuang Tang. If the pulse is floating and rapid, sweating may be induced, preferably using Mahuang Tang.
A floating and rapid pulse: floating indicates wind, rapid indicates deficiency. Wind indicates heat, deficiency indicates cold. Wind and cold clashing cause shivering and aversion to cold.
For all floating-rapid pulses, one should expect fever and shivering aversion to cold. If there is a painful area but diet remains normal, it indicates accumulation of pus.
Patients with sores/ulcers, even if their bodies ache, must not be induced to sweat. Sweating will lead to spasms.
[Commentary] Ke Qin said: The pulse is described as floating and not slow/weak, meaning it is floating and forceful. If floating and large with heat belonging to the Zang organs, purgation is needed, not sweating.
If floating-rapid with pain localized to one area, even if the body aches, sweating is contraindicated.
Floating indicates wind pathogen; where pathogen gathers, Qi is necessarily deficient. Rapid normally indicates heat, but appearing with floating, it indicates deficiency. Floating indicates exterior rather than wind; rapid indicates excess heat rather than deficiency. Thus, with a floating-rapid pulse and fever/aversion to cold symptoms, even abscesses/pus can present similarly. One must differentiate based on localized pain and normal diet. This prevents mistreating sores as wind-cold.
[Outline] Zhang Zhongjing said: With a floating-rapid pulse, recovery via sweating is expected. However, if the body feels heavy and the heart palpitates, sweating is contraindicated. Recovery comes through spontaneous sweating. The reason is that the Chi position pulse is faint, indicating interior deficiency. Interior and exterior must become solid; when body fluids harmonize, spontaneous sweating occurs and healing follows.
[Commentary] Wei Litong said: If the pulse remains floating and rapid after purgation, it indicates the person's Yang Qi is still vigorous and ready to emerge. Therefore, one should wait for self-recovery. Faint Chi pulse indicates interior deficiency. Although the Cun pulse is floating and rapid, allowing Yang to rise slowly, the Chi pulse must be weak/faint, fearing internal damage to Yang. The term "interior deficiency" is highlighted to warn that while the exterior can be treated gradually, the interior must not be mistaken. Cheng's commentary suggests using methods to harmonize the exterior and solidify the interior but provides no formula. I believe formulas like Jianzhong (Build the Middle) or Xinjia (New Addition) types can be considered.
[Outline] Zhang Zhongjing said: At the Cunkou position, a pulse that is floating and tight: floating indicates wind, tight indicates cold. Wind injures Wei, cold injures Ying. When Ying and Wei are both diseased, bones and muscles feel restless and painful. Sweating should be induced.
In Taiyang disease, with a floating-tight pulse, anhidrosis, fever, and body pain persisting for eight or nine days without resolution, if the exterior syndrome remains, sweating should be induced. Mahuang Tang is the primary treatment.
In Cold Damage with a floating-tight pulse, Mahuang Tang is the primary treatment. If not induced to sweat, nasal bleeding (Nu) may occur.
In Taiyang disease, with a floating-tight pulse, fever, body pain, and anhidrosis, spontaneous nasal bleeding leads to recovery. Patients prone to nasal bleeding must not be induced to sweat; sweating will cause depression of the supraorbital ridge, a floating-tight pulse, staring eyes unable to move, inability to sleep. For a floating-tight pulse, body pain is expected, and sweating is appropriate. However, if the Chi pulse is slow, sweating is contraindicated due to insufficient Ying Qi and blood deficiency. If the pulse is floating and tight, and purgation is reapplied, the tight pulse enters the interior, forming Pi (Glomus/Fullness). Palpation reveals softness, indicating it is merely Qi obstruction.
[Commentary] Wei Yilin said: Wind first opens the pores; cold enters the meridians. The pulse reflects this image, changing at the Cunkou. Tightness indicates cold accompanying floating; thus, sweating leads to recovery.
Huang Zhongli said: The pulse is floating-tight, symptoms include anhidrosis and body pain, similar to but distinct from Gaoqinglong patterns. Tight pulse with anhidrosis causes internal disturbance of Yang; injury to Yang collaterals leads to nasal bleeding/blood loss due to anhidrosis.
Yu Chang said: Floating-tight pulse, fever, and anhidrosis indicate pure Yin pathogen injuring Ying. However, if the cold pathogen is mild and affects Ying without freezing the blood, and is mixed with Yang pathogen from Wind Strike, it disperses easily. This explains why there is no body, waist, or joint pain. In such cases, the cold pathogen is light, and the Yang pathogen from wind turns to heat and rushes upward rapidly. Blood exiting the nose indicates the Yang pathogen has exited upward, and the Yin pathogen of cold, residing in the blood level, leaves with the blood. Recovery is certain. How do we know? When the pulse is no longer floating-tight, fever subsides, and gentle sweating occurs, recovery is confirmed.
Wei Litong said: Patients prone to nasal bleeding often have upper溢 (overflow) of blood due to Yin deficiency and latent heat stirring within the blood, preventing it from following its channels. Further sweating damages Yin and stirs heat, causing pathogenic heat to assault the head (summit of all Yang). Yang escapes with sweat, causing Qi to sink into the supraorbital ridge. The pulse becomes urgent due to lack of Yang to control Yin. Staring eyes unable to move result from lack of blood nourishing sinews and vessels. Insomnia results from Yang hyperactivity due to Yin deficiency. These cases require saving Yin to sustain the remaining Yang. While most syndromes prioritize saving Yang, Cold Damage uniquely prioritizes saving Yin, which is one instance. (Shen Jin'ao Note: Depression of the supraorbital ridge is due to Qi deficiency sinking into the brain, unlike infant fontanelle depression.) Slow Chi pulse indicates shortness of blood and Yin deficiency. However, slow indicates cold, implying Qi/Yang deficiency. Thus, Yin and Yang must be regulated before sweating the exterior. Why does Zhongjing speak of blood deficiency while I speak of Yang deficiency? Because blood deficiency with slow Chi points to true Yin deficiency of the Kidney (Shaoyin), not just liver/spleen blood shortage. Kidney Yin deficiency implies Qi/Yang deficiency. Incorrect sweating here is as taboo as incorrectly sweating Shaoyin. Treatment methods, besides Jianzhong, must pay special attention to Shaoyin warming meridians and dispersing cold formulas.
Yu Chang said: Tight pulse entering the interior means the cold pathogen penetrates deeper, forming Pi. Softness upon palpation indicates it involves only Qi, unlike fullness/hardness caused by fluid retention.
Shen Jin'ao's Note: The above seven clauses detail why treatments differ despite identical floating-tight pulses.
[Outline] Zhang Zhongjing said: In Taiyang disease, after ten days, if the pulse is floating and fine and the patient desires to lie down/sleep, the exterior has resolved. If there is chest fullness and hypochondriac pain, Xiaochaihu Tang is given. If the pulse is only floating, Mahuang Tang is given.
[Commentary] Ke Qin said: Fine pulse with desire to sleep is Shaoyin disease. Floating-fine pulse with desire to lie down, without Shaoyin symptoms, indicates Taiyang even after ten days. This is "lingering illness" after exterior resolution. With hypochondriac pain, it is a Taiyang-Shaoyin combined disease (due to Shaoyang's wiry-fine pulse). Only floating without fineness indicates forceful floating; without chest/hypochondriac pain, it does not belong to Shaoyang. Only floating without largeness does not belong to Yangming. Thus, it remains in Taiyang.
[Outline] Zhang Zhongjing said: In Taiyang disease, with fever and aversion to cold, more heat than cold, and a faint-weak pulse, this indicates "No Yang." Sweating is contraindicated. Guizhi Er Yuebi Yi Tang is appropriate.
[Commentary] Ke Qin said: The Treatise on Cold Damage does not list the Yuebi formula pattern; it appears in the Golden Cabinet. Editions combining them are correct. Zhongjing said sweating is contraindicated, implying Mahuang is unused. "No Yang" implies Shigao is unused. Unless the formula differs, it must be a copying error. Better to omit the formula than leave it to cause confusion.
Shen Jin'ao's Note: This is a syndrome of dual wind-cold injury. Absence of body/waist/joint pain indicates mild cold injuring Ying. Faint-weak pulse corresponds to floating-Yang/weak-Yin pulse, indicating severe wind injuring Wei. Thus, although cold signs are absent, fever, more heat than cold, and anhidrosis clearly show cold in Ying. However, the faint-weak pulse confirms "No Yang." Hence, sweating is contraindicated. Therefore, the pungent-dispersing power of Gaoqinglong is avoided; Xingren (Apricot Seed) is removed, and Shaoyao is added. Guizhi treats predominant wind; Mahuang treats minor cold; Shaoyao secures the root of deficient Yang and addresses the faint-weak pulse. Named Guizhi Er Yuebi Yi Tang, this formula consolidates True Yin and sustains the root of Yang. Although it induces sweating to驱邪 (expel pathogens), Zheng Yang does not float upward. Thus, with Shaoyao present, Mahuang is harmless. Ke Qin argued Mahuang is unusable due to "contraindication to sweating" and Shigao unusable due to "No Yang." He detailed Mahuang's harmlessness. Shigao treats heat in Upper/Middle Jiao and does not affect Lower Jiao Kidney deficiency. He also noted the formula is only in the Golden Cabinet, forgetting Zhongjing originally combined Cold Damage and miscellaneous diseases. Shu He separated them. Thus, Zhongjing's time, formulas in the Golden Cabinet were part of the main text. Combining Guizhi and Yuebi is permissible; omission is unnecessary. However, this syndrome is hard to recognize, and the formula is difficult to use lightly. Physicians must examine carefully. Rather than falling into misuse...