【纲】仲景曰。太阳病。发热汗出。恶风脉缓者。名为中风。欲自解者。必当先烦。乃有汗而解。何以知之。脉浮
故知汗出解也。太阳病。未解。脉阴阳俱停。必先振栗汗出而解。伤寒三日。脉浮而解。 然汗出也。
【目】朱肱曰。卫不和自汗。伤风自汗。亡阳自汗。
寇宗 曰。风阳邪。风中太阳。两阳相搏。而阴气衰弱。阳浮故热自发。阴弱故汗自出。
张云岐曰。欲自解。便寓不可妄治意。汗为阳气外发。汗出则阳胜。而寒邪自解矣。言未解。
便有当解意。停者。相等之谓。太阳病阳浮而阴弱。是阳强也。今阳脉既微。谓非阴阳之俱停者乎。
阴阳俱停。便是调和之脉。虽今犹未解。不可卜其必解乎。
楼全善曰。伤寒三日。脉浮而解。此伤寒之本轻者。故不必合太阳六七日病解之期而自解也。
曰然汗出。亦宁必再求其汗乎。
【纲】仲景曰。太阳病。头痛发热。汗出恶风者。桂枝汤主之。
【目】魏荔彤曰。太阳中风病。而发热汗出恶风。与他条同。兼患头痛。即头项强痛而专言于
头者也。风邪少盛诸阳
聚处。必多亢烈之患。正为桂枝对症之病。用之无疑矣。必指出头痛者。见无身疼体痛骨节疼痛。所以
不同于寒邪之治也。
柯琴曰。此是桂枝本症。头痛发热恶风。与麻黄症同。本方重在汗出。汗不出者。便是麻黄症。
【纲】仲景曰。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。
【目】方中行曰。脉浮为伤寒。在太阳初感。风寒未定。故本条揭示中风之脉症甚细。则阳强
阴弱。与脉之阳浮阴紧而不弱者。其异如是也。阳浮之热。为自发而快捷。阴弱之汗。为自出而直
易。热为翕翕之温热。与或已发或未发迟迟之热。鼻鸣干呕。与呕逆而喘。同为阳郁。而大分缓急。
其异又如是。辨之既详。桂枝一方。不容再疑。
柯琴曰。此太阳中风之桂枝症。阳浮因风中于卫。两阳相搏。故热自发。是卫强也。阴弱因风
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。
【纲】仲景曰。太阳病。发热汗出。此为营弱卫强。故使汗出。欲救邪风者。宜桂枝汤主之。
【目】柯琴曰。此释中风汗出之义。见桂枝为调和营卫而设。阴弱不能藏。阳强不能密。故汗出。
【纲】仲景曰。形作伤寒。其脉不弦紧而弱。弱者必渴。盖火者必谵语。弱者发热。脉浮。解之
当汗出而愈。
【目】柯琴曰。此为挟虚伤寒之症。形作。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。解之者。与桂枝汤啜热稀粥。故汗出愈也。
【纲】仲景曰。病患脏无他病。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。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耳。营
行脉中。卫行脉外。复发其汗。和营卫。则愈。宜桂枝汤。
【目】李 曰。营行脉中。在血脉。其病深。卫行脉外。在皮肤。其病浅。营血。阴也。主闭
藏。故寒喜伤营而无汗。卫气。阳也。主开泄。故风喜伤卫而有汗。然岂独太阳为营卫之会。而有
风寒之别乎。阳明善饥为伤风。不食为伤寒。少阳耳聋胸满而烦为伤风。口苦咽干目眩为伤寒。
三阴伤风。俱四肢烦疼耳。太阳为之先者。伤寒因肾水亏损。至春木无生意。故发为温病。至夏绝
生化之原。故发为热病。所以太阳少阴二经受病。最多最先也。
柯琴曰。脏无他病。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。发热汗即出。其营气不足。因阳邪下陷。阴不胜阳。
故汗自出。无热而常自汗。其营气本足。因卫气不固。不能卫外。故汗自出。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。（恶法）
以时出常出辨之。总以桂枝汤啜热粥汗之。
【纲】仲景曰。太阳病。发热无汗。反恶寒者。名曰刚痉。太阳病。发热汗出。不恶寒者。名
曰柔痉。
【目】鳌按。刚者。实也。柔者。疏也。无汗则皮毛闭而实。汗出则腠理泄而疏。
[Gang] Zhang Zhongjing said: In Taiyang disease (a syndrome caused by pathogenic factors invading the Taiyang channel), characterized by fever, sweating, aversion to wind, and a slow pulse, it is named Wind-stroke (a deficiency exterior syndrome caused by external wind pathogen). If the condition is about to resolve spontaneously, the patient will first experience restlessness (fan), followed by resolution through sweating. How do we know this? Because the pulse remains floating, indicating that resolution occurs via sweating. When Taiyang disease has not yet resolved, if the pulses at the cun, guan, and chi positions all temporarily become imperceptible (yin and yang pulses both stop), the patient will first experience chills and tremors, followed by resolution through sweating. After three days of Cold Damage, if the pulse becomes floating and the disease resolves, this is due to slight sweating.
[Mu] Zhu Gong said: Spontaneous sweating caused by disharmony of Wei (Defensive) Qi, spontaneous sweating from Wind-injury, and spontaneous sweating from Yang collapse (extreme depletion of Yang Qi).
Kou Zongshi said: Wind is a Yang pathogen. When wind invades the Taiyang channel, two Yangs contend, leading to the weakening of Yin Qi. Floating Yang causes spontaneous heat; weak Yin causes spontaneous sweating.
Zhang Yunqi said: The phrase "about to resolve" implies that one should not treat recklessly. Sweat is the outward emission of Yang Qi; when sweat is produced, Yang prevails, and the cold pathogen resolves naturally. Saying "not yet resolved" implies an intention for resolution. "Stop" means equal or balanced. In Taiyang disease, floating Yang and weak Yin indicate strong Yang. Now that the Yang pulse is faint, does this not indicate that Yin and Yang pulses are balanced (both stopped)? Balanced Yin and Yang pulses signify a harmonized pulse state. Although the disease has not yet resolved, can we not infer that it will inevitably resolve?
Lou Quanshan said: In Cold Damage, resolution with a floating pulse after three days indicates a mild form of the disease. Therefore, it resolves spontaneously without waiting for the typical sixth or seventh day resolution period of Taiyang disease. Saying "slight sweating," why would one seek further diaphoresis?
[Gang] Zhang Zhongjing said: In Taiyang disease, characterized by headache, fever, sweating, and aversion to wind, Guizhi Tang (Cinnamon Twig Decoction) is the primary treatment.
[Mu] Wei Litong said: In Taiyang Wind-stroke, symptoms such as fever, sweating, and aversion to wind are consistent with other clauses. The addition of headache refers specifically to stiffness and pain in the head and neck, emphasizing the head. Since wind pathogens gather where the Yang channels converge, they often cause excessive hyperactivity. This is precisely the indication for Guizhi Tang, leaving no doubt in its use. Specifying headache serves to distinguish it from conditions involving body ache, limb pain, and joint pain, thereby differentiating the treatment from that of cold pathogens.
Ke Qin said: This is the primary syndrome for Guizhi Tang. Headache, fever, and aversion to wind are similar to Ma Huang Tang (Ephedra Decoction) syndrome. The key distinction of this formula lies in the presence of sweating; absence of sweating indicates Ma Huang Tang syndrome.
[Gang] Zhang Zhongjing said: In Taiyang Wind-stroke, the pulse is floating on superficial pressure but weak on deep pressure (Yang floating and Yin weak). Floating Yang results in spontaneous heat; weak Yin results in spontaneous sweating. With symptoms of shivering aversion to cold, chilly aversion to wind, mild fever resembling a feather covering, nasal congestion (bi ming), and dry vomiting, Guizhi Tang (Cinnamon Twig Decoction) is the primary treatment.
[Mu] Fang Zhongxing said: A floating pulse typically indicates Cold Damage. At the initial stage of Taiyang invasion, when wind-cold is undetermined, this clause details the pulse and symptoms of Wind-stroke. Thus, the difference between strong Yang/weak Yin and a pulse that is Yang-floating and Yin-tight (but not weak) is as follows. Heat from floating Yang is spontaneous and rapid; sweating from weak Yin is spontaneous and direct. The heat manifests as mild warmth (xi xi), distinct from intermittent or delayed heat. Nasal congestion and dry vomiting, versus retching and wheezing, both result from Yang stagnation but differ significantly in urgency. Once distinguished in detail, there is no room for doubt regarding Guizhi Tang.
Ke Qin said: This is the Guizhi Tang syndrome of Taiyang Wind-stroke. Yang floating occurs because wind attacks the Wei (Defensive) level, causing contention of two Yangs and spontaneous heat, indicating Wei excess. Yin weakness occurs because wind attacks the Ying (Nutritive) level, disturbing the blood vessels and causing spontaneous sweating, indicating Ying deficiency. The two instances of "spontaneous" highlight the rapid onset of the wind pathogen.
[Gang] Zhang Zhongjing said: In Taiyang disease, fever and sweating occur because Ying is weak and Wei is strong, leading to sweating. To rescue from the pathogenic wind, Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
[Mu] Ke Qin said: This explains the mechanism of sweating in Wind-stroke, demonstrating that Guizhi Tang is designed to harmonize Ying and Wei. Weak Ying cannot contain, and strong Wei cannot secure, resulting in sweating.
[Gang] Zhang Zhongjing said: The presentation resembles Cold Damage, but the pulse is not wiry and tight; instead, it is weak. Weakness implies thirst. Fire pathogens typically cause delirious speech. Weakness with fever and a floating pulse indicates that resolution should be achieved through diaphoresis.
[Mu] Ke Qin said: This describes Cold Damage complicated by deficiency. "Resembling" refers to symptoms like aversion to cold, body pain, and cold extremities. The pulse should be wiry and tight but is instead floating and weak, revealing underlying deficiency. This corresponds to Li Dongyuan's description of internal injury due to fatigue and overwork. "Resolution" here involves administering Guizhi Tang (Cinnamon Twig Decoction) accompanied by hot rice gruel, leading to resolution through sweating.
[Gang] Zhang Zhongjing said: If a patient has no internal organ pathology but experiences periodic fever and spontaneous sweating without recovery, this is due to disharmony of Wei (Defensive) Qi. Administering diaphoresis prior to the onset of fever and sweating leads to recovery; Guizhi Tang (Cinnamon Twig Decoction) is indicated. For patients who frequently experience spontaneous sweating, this indicates that Ying (Nutritive) Qi is harmonious, but external harmony is lacking because Wei Qi does not coordinate with Ying Qi. Ying Qi circulates within the vessels, while Wei Qi circulates outside. Re-inducing sweating harmonizes Ying and Wei, leading to recovery; Guizhi Tang (Cinnamon Twig Decoction) is indicated.
[Mu] Li [Name Missing] said: Ying Qi circulates within the vessels, making its pathology deep; Wei Qi circulates outside the skin, making its pathology superficial. Ying Blood is Yin, governing closure and storage, so cold pathogens tend to injure Ying, causing absence of sweating. Wei Qi is Yang, governing opening and dispersal, so wind pathogens tend to injure Wei, causing sweating. However, is it only the Taiyang channel where Ying and Wei intersect that distinguishes wind from cold? Yangming channel hunger indicates wind injury, while anorexia indicates cold damage; Shaoyang channel deafness, chest fullness, and irritability indicate wind injury, while bitter taste, dry throat, and vertigo indicate cold damage; Wind injury in the Three Yin channels presents with vexatious pain in the four limbs. Taiyang is affected first because Cold Damage stems from Kidney Water deficiency; in spring, Wood lacks vitality, leading to Warm Disease; in summer, the source of transformation and generation is exhausted, leading to Heat Disease. Thus, Taiyang and Shaoyin channels are affected most frequently and earliest.
Ke Qin said: No internal organ pathology indicates the disease is confined to the exterior. Periodic fever implies periodic sweating, unlike continuous fever and sweating in external contraction. The *Neijing* states: "When Yin is deficient, Yang rushes to invade it," causing periodic fever and sweating. Fever accompanied immediately by sweating indicates insufficient Ying Qi due to sinking of Yang pathogens, where Yin cannot overcome Yang, leading to spontaneous sweating. Absence of fever with constant spontaneous sweating indicates sufficient Ying Qi but insecure Wei Qi that fails to protect the exterior, leading to spontaneous sweating. "Disharmony" reflects strong Wei; "lack of coordination" reflects weak Ying. Weakness prevents integration; strength prevents securing. Both lead to spontaneous sweating, distinguished by the presence or absence of fever. Distinguished by periodic versus constant occurrence. Ultimately, Guizhi Tang (Cinnamon Twig Decoction) with hot gruel induces sweating.
[Gang] Zhang Zhongjing said: In Taiyang disease, fever with absence of sweating and aversion to cold is named Gang Jing (Rigid Spasm). In Taiyang disease, fever with sweating and absence of aversion to cold is named Rou Jing (Soft Spasm).
[Mu] Shen Jin'ao notes: "Gang" (Hard/Rigid) means solid/excess. "Rou" (Soft) means loose/dispersed. Absence of sweating closes the pores, creating solidity; sweating opens the cou li (interstices), creating looseness.