【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。宜桂枝麻黄合半汤。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】朱肱曰。太阳热多寒少。有此二症。其用药皆不同也。二条。以脉微弱。故不可发汗。
若脉浮。虽热多寒少。亦可发汗也。大抵伤寒。寒多易治。热多难愈。伤寒发热者。以寒极则生
热。治法。多用冷药。故令热不去。仲景热多寒少。用桂枝二越婢一汤。不渴。外有微热者。用小
柴胡加桂汤。皆温表之义也。近时多用小柴胡汤。不问阴阳表里。凡伤寒皆令服此药。往往有因服
小柴胡而成阴症者。仲景虽云伤寒中风。有小柴胡症。但见一症便是。不必悉具。此为是少阳症。
当用小柴胡。不必少阳症悉具耳。况本方又有随症加减法。古人方治。审谛如此。
赵嗣真曰。详论中热多寒少。止此二症。其一症。仲景之意盖以得病七八日如疟状。发热恶寒。
热多寒少。十六字。为自初至今之症。以下乃是以后拟议防变之辞。当分三截看。若其人不呕。
圊便欲自可。一日二三度发。脉微缓为欲愈。此一节。乃里和无病而脉微缓者。邪气微缓者。阴阳
同等。脉症皆向安之兆。可不待汗而欲自愈也。若脉微而恶寒者。此阴阳俱虚。不可发汗更吐更下
也。此一节。宜温之。若面色反有热者。未欲解也。以其不能得小汗出。其身必痒。宜各半汤。此
一节。必待汗而后愈也。活人书未详文义。却将其人不呕清便欲自可九字。本是欲愈之症。反以他
症各半汤汗之。又将不可汗吐下及各半汤症语句。并脱略而不言。反将其中欲愈之症。而用彼药汗
其所不当汗。何也。其一症。仲景云。太阳病。发热恶寒。热多寒少。脉微弱者。亡阳也。不可发
汗。宜桂枝二越婢一汤。活人书于脉微弱上添都大二字。岂以仲景论脉为未足。而故加之也乎。
刘完素曰。仲景一书。只有热多寒少之条。无寒多热少之症。
[General Principle] Zhang Zhongjing stated: In Taiyang disease (disease of the Taiyang channel caused by pathogenic invasion), after eight or nine days, the symptoms resemble malaria, with fever and aversion to cold, where heat is more prominent than cold. The patient does not vomit, and bowel movements are relatively normal. If the condition occurs two or three times a day and the pulse is slightly slow and relaxed, it indicates that recovery is imminent; Guizhi Mahuang Banhe Tang (Cinnamon Twig and Ephedra Combined Half Decoction) is appropriate. In Taiyang disease, if there is fever and aversion to cold with heat predominating over cold, and the pulse is faint and weak, this indicates a deficiency of Yang (absence of sufficient Yang energy); sweating therapy should not be used. Guizhi Er Yuebi Yi Tang (Twice Cinnamon Twig and One-Third Stone Ginger Decoction) is appropriate.
[Commentary] Zhu Gong stated: In Taiyang disease, cases where heat predominates over cold present in these two patterns, and their medication differs significantly. In these two clauses, because the pulse is faint and weak, sweating therapy is contraindicated. However, if the pulse is floating, even if heat predominates over cold, sweating therapy may still be employed. Generally speaking, in Shanghan (Cold Damage) diseases, cases with predominant cold are easier to treat, while those with predominant heat are harder to cure. Fever in Shanghan arises when cold becomes extreme and generates heat; treatment often employs cooling herbs, which can sometimes fail to resolve the heat. For cases where heat predominates over cold, Zhang Zhongjing prescribed Guizhi Er Yuebi Yi Tang. If there is no thirst and slight exterior heat, Xiaochaihu Jia Guizhi Tang (Bupleurum Decoction with Added Cinnamon Twig) is used; both represent the principle of warming and dispersing the exterior. In recent times, many physicians use Xiaochaihu Tang (Bupleurum Decoction) indiscriminately, regardless of Yin-Yang or interior-exterior differentiation, administering it for all Shanghan cases. This often leads to patients developing Yin syndrome (a pattern characterized by cold and deficiency). Although Zhang Zhongjing mentioned that Shanghan or wind-strike may present with Xiaochaihu Tang indications, only one symptom needs to be present, not necessarily all; this refers specifically to Shaoyang disease (disease of the Shaoyang channel), for which Xiaochaihu Tang is indicated, without requiring all Shaoyang symptoms to be present. Moreover, the formula itself allows for modifications based on specific symptoms. Ancient prescriptions were applied with such careful deliberation.
Zhao Sizhen stated: A detailed examination of "heat predominating over cold" in the Treatise reveals only these two patterns. Regarding the first pattern, Zhang Zhongjing's intent seems to be that the sixteen characters—"ill for seven or eight days resembling malaria, fever and aversion to cold, heat predominating over cold"—describe the symptoms from onset to the present moment. The following text consists of speculative remarks aimed at preventing future changes. It should be analyzed in three parts. If the patient does not vomit, bowel movements are normal, episodes occur two or three times daily, and the pulse is slightly slow and relaxed, indicating impending recovery: this section describes a state where the interior is harmonious and free of disease, with a slightly slow and relaxed pulse, mild pathogenic factors, balanced Yin and Yang, and signs pointing toward convalescence. Recovery may occur spontaneously without inducing sweat. If the pulse is faint accompanied by aversion to cold, this indicates a deficiency of both Yin and Yang; sweating, vomiting, or purging therapies are contraindicated. This section requires warming treatment. If the face appears flushed with heat, the disease has not yet resolved because the patient cannot produce a slight sweat, leading to pruritus; Guizhi Mahuang Banhe Tang is appropriate. This section requires sweating therapy for resolution. The *Ren Shu* (*Book of Human Life*) failed to elucidate the textual meaning accurately. It incorrectly treated the nine characters "the patient does not vomit, bowel movements are normal"—which originally indicated impending recovery—as indications for Guizhi Mahuang Banhe Tang. It omitted statements regarding contraindications for sweating, vomiting, and purging, as well as indications for Guizhi Mahuang Banhe Tang. Instead, it applied diaphoretic drugs to symptoms that did not warrant them. Why? Regarding the second pattern, Zhang Zhongjing stated: "Taiyang disease with fever, aversion to cold, heat predominating over cold, and a faint and weak pulse indicates Yang collapse/deficiency; sweating is contraindicated. Guizhi Er Yuebi Yi Tang is appropriate." The *Ren Shu* added the words "du da" (generally/majorly) before "faint and weak pulse." Did it consider Zhang Zhongjing's pulse analysis insufficient and thus arbitrarily add these words?
Liu Wansu stated: In Zhang Zhongjing's work, there are clauses describing heat predominating over cold, but no patterns described as cold predominating over heat.