【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。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。
【目】朱肱曰。脉浮而缓。寸大而尺弱。自汗体热。头疼恶风。热多寒少。其面光不惨。烦躁。
手足不冷。此名伤风也。伤风之候。当解肌。宜桂枝汤。轻者只与柴胡桂枝汤、败毒散、独活散
选用。又凡脉紧。必无汗。惟濡而紧。却有汗。勿误用小建中汤。是脉浮而缓者。方可用桂枝汤。
又项背强者。桂枝汤加葛根也。（本草。葛根主伤风有湿。开窍解肌。盖桂枝加葛根。谓中风有湿。
当加之。取微汗以去风湿。）里寒者。桂枝去芍药加附子汤也。（不饮水者是也）又凡发汗。汗不止。为漏风。桂枝加附
子汤。腹满者。太阴症。脉浮者。可服桂枝汤。微发汗。腹痛者。桂枝加芍药汤。痛甚者。桂枝加大黄汤。
虽然。桂枝汤自西北二方居人。四时行之皆验。江淮间。惟冬及春初可行。春末及夏至前。桂枝症
可加黄芩半两。（阳旦汤是也）至夏至后。加知母一两。石膏二两。若病患素虚。正用
古方。（大抵用温药当避春。热药当避夏。）脉浮而紧涩。头疼。身体拘急。恶寒无汗。寒多热少。
面色惨而不舒。腰脊疼痛。手足指末微厥。不燥烦。此名伤寒。宜发汗解。麻黄汤主之。轻者。
桂枝麻黄各半汤、人参顺气汤、葱豉汤、苍术散、麻黄葛根汤选用。然太阳亦有热多寒少者。须仔
细看脉症也。热多寒少。不呕。清便自可。宜桂麻各半汤。若脉浮。虽热多寒少。自可发汗。若脉
弱者。无阳也。桂枝二越婢一汤。热多寒少而尺迟者。营气本足。血少故也。先以小建中汤加黄
最良。尺尚迟。再一剂。又太阳症。宜汗。而其人适失血及下利。则频频少与桂枝汤。使体润。当
自解。假如淋家衄家。法不可汗。亦可以小柴胡之类和解之。又问。伤风与伤寒。何以别之。答曰。
伤寒者。脉紧而涩。伤风者。脉浮而缓。伤寒者。无汗脉涩。伤风者。有汗脉缓。伤寒者。畏寒
不畏风。伤风者。畏风不畏寒。大抵太阳病者。必脉浮发热。恶风恶寒也。六经皆有伤风伤寒。其症
各异。太阳脉浮有汗为中风。脉紧无汗为伤寒。阳明善饥为中风。不食为伤寒。少阳耳聋目赤。胸
满而烦。为中风。口苦咽干目眩。为伤寒。若三阴伤风。无变形异症。但四肢烦疼。余症同三阳。
风伤卫者。病在皮肤之间也。以卫行脉外。为阳。主外皮肤间卫气之道路。故其病浅。寒伤
营者。寒气中于肌肉也。以营行脉中。为阴。主内肌肉间营气之道路。故其病深。故桂枝麻黄各别。慎勿误用。
李 曰。伤风初症。惟头疼口和不恶食。与伤寒同。缘寒乃阴邪。风乃阳邪。所以伤寒郁而后
能发热。伤风即能发热。伤寒手足微厥。伤风手足背皆热。伤寒无涕。伤风流涕。声如瓮中。伤寒
面惨身痛。伤风面光声重。伤寒无汗。恶寒不恶风。伤风有汗。恶风不恶寒。甚者汗出不止。洒洒
恶风。复啬啬恶寒。冬月桂枝汤。自汗小便数。芍药甘草汤。自汗小便利。脚蜷急。桂枝加参附。轻者。
柴胡桂枝汤。自汗渴而小便难。邪渐传里。五苓散。自汗不渴。邪在表。茯苓桂甘汤。三时。防
风冲和汤、柴胡桂枝汤。或败毒散去茯苓。鼻塞。通关散。通用。柴胡半夏汤。古立六经伤风汤。
但三阴药皆辛热。似非伤寒家法。仲景治伤寒伤风表症。分有汗无汗。里症同。于和解通利。更无
分别。今详桂附八物。恐亦风邪直传
阴分。其人素虚。或房室后伤风则可。若概作表药。误人多矣。盖伤风发表。辛热不如辛温。辛温
不如辛凉也。或疑六淫。仲景特详于风寒。而略于暑湿。且不及燥火。何也。盖暑火同气。燥湿同
源。风寒传遍六经。暑湿性偏。着人五脏。壮者气行则已。怯者乃着为病故耳。先伤寒而后伤风者。
症伤寒也。而见伤风之脉。先伤风而后伤寒者。症伤风也。而见伤寒之脉。此乃营卫俱实。故无
汗而烦躁者。大青龙汤。不烦躁者。麻桂各半汤。通用。大羌活汤。九味羌活汤加人参、大枣或神术
散、香苏散。
陈氏士铎曰。凡病初起。用药原易奏功。无如人看不清。用药错乱。往往变症蜂起。苟认得清。
用得当。又何变症之生耶。如伤风。必然头痛身疼。咳嗽痰多。切其脉必浮。此伤风也。即以防
风、荆芥、柴胡、甘草、黄芩、半夏各一钱。服即止。不再剂也。伤寒初起。鼻塞目痛项强。头亦
痛。然切其脉必浮紧。此伤寒也。若以伤寒治之。即愈。方用桂枝、甘草、陈皮、葛根各一钱。不
再剂。
朱震亨曰。仲景论伤寒。而未及乎中寒。先哲治冒大寒昏中者。用附子理中汤。其议药则得之
矣。曰伤曰中。未有议其异同者。夫伤寒有即病不即病。因其旧有郁热。风寒外来。肌腠自密。郁
发为热。病邪循经而入。以渐而深。初用麻黄、桂枝辈。微而安。以病体不甚虚也。若中寒。则仓
卒感受。其病即发而暴。因其腠理疏豁。一身受邪。难分经络。无热可发。温补自解。此气大虚。不
急治。则死矣。伤风伤暑伤湿。亦如伤寒之渐入者。中风中暑中湿。亦如中寒者之卒暴而受也。
陶华曰。风伤卫气。寒伤营血者。缘气本属阳。风亦属阳。阳则从阳。故伤卫气。阳主开泄。
皆令自汗。故用桂枝汤辛甘温之剂以实表。血本属阴。寒亦属阴。阴则从阴。故伤荣血。阴主闭
藏。皆令无汗。故用麻黄汤轻扬之剂以发表。正所谓各从其类也。
[Outline] Zhang Zhongjing said: In Taiyang disease (a syndrome caused by pathogenic factors affecting the Taiyang meridian), if there is fever, sweating, aversion to wind, and a slow pulse, it is named Wind-stroke (an external contraction of wind pathogen). In Taiyang disease, whether fever has already appeared or not, there will definitely be aversion to cold, body pain, and vomiting. If the pulses at the cun, guan, and chi positions are all tight, it is named Cold-strike (an external contraction of cold pathogen).
The pulse at the cunkou position is floating and tight. A floating pulse indicates wind, and a tight pulse indicates cold. Wind damages the Wei Qi (defensive qi circulating outside the vessels), and cold damages the Ying Blood (nutritive blood circulating inside the vessels). When both Ying and Wei are diseased, it causes restlessness and pain in the bones and muscles; one should employ diaphoresis (sweating method) for treatment.
[Commentary] Zhu Gong said: If the pulse is floating and slow, with a large cun pulse and weak chi pulse, accompanied by spontaneous sweating, body heat, headache, aversion to wind, more heat than cold, a bright but not sallow complexion, irritability, and warm hands and feet, this is called Wind-injury (equivalent to Wind-stroke). The pattern of Wind-injury requires releasing the muscle layer (resolving exterior pathogens from the muscle level); Guizhi Tang (Cinnamon Twig Decoction) is appropriate. For mild cases, choose one of Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction), Baidu San (Poison-Resolving Powder), or Duhuo San (Angelica Pubescens Powder). Furthermore, a tight pulse always indicates absence of sweat; only when the pulse is soggy yet tight is there sweat. Do not mistakenly use Xiaojianzhong Tang (Minor Construct the Middle Decoction). Only when the pulse is floating and slow can Guizhi Tang be used.
For stiffness in the neck and back, add Gegen (Puerariae Radix) to Guizhi Tang. (According to Materia Medica, Gegen treats Wind-injury with dampness, opens orifices, and releases the muscle layer. Adding Gegen to Guizhi Tang implies treating Wind-injury with dampness, taking slight sweat to dispel wind and dampness.) For interior cold, use Guizhi Qushaoyao Fuzi Tang (Cinnamon Twig Decoction without Paeonia plus Aconite). (This applies to those who do not desire water.) Additionally, after diaphoresis, if sweating does not stop, it is called Lou Feng (Leaking Wind); use Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction). For abdominal fullness, which belongs to Taiyin disease (a syndrome of Spleen Yang deficiency), if the pulse is floating, one may take Guizhi Tang to induce slight sweating. For abdominal pain, use Guizhi Ji Shaoyao Tang (Cinnamon Twig Decoction augmented with Paeonia). For severe pain, use Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction augmented with Rhubarb).
Nevertheless, Guizhi Tang is effective in all seasons for people in the northwest regions. However, in the Jianghuai region, it is only suitable for winter and early spring. Before late spring and the Summer Solstice, for Guizhi Tang patterns, add Banliang Huangqin (half tael of Scutellaria Root)—this is Yangdan Tang (Yang Dawn Decoction). After the Summer Solstice, add Yiliang Zhimu (one tael of Anemarrhena Rhizome) and Erliang Shigao (two taels of Gypsum Fibrosum). If the patient is constitutionally deficient, the ancient formulas are precisely applicable. (Generally, warm herbs should be avoided in spring, and hot herbs in summer.)
If the pulse is floating, tight, and choppy, with headache, bodily rigidity, aversion to cold, absence of sweat, more cold than heat, a sallow and uncomfortable complexion, lower back and spine pain, slight coldness in the fingertips and toes, and no irritability, this is named Cold-strike. It is suitable for diaphoresis to resolve the exterior; Mahuang Tang (Ephedra Decoction) is the primary formula. For mild cases, choose one of Guizhi Mahuang Ge Ban Tang (Equal Parts of Cinnamon Twig and Ephedra Decoction), Renshen Shunqi Tang (Ginseng Smooth Qi Decoction), Congchi Tang (Scallion and Soybean Decoction), Cangzhu San (Atractylodes Macrocephala Powder), or Mahuang Gegen Tang (Ephedra and Pueraria Decoction). However, Taiyang disease can also present with more heat than cold; one must carefully examine the pulse and symptoms. With more heat than cold, no vomiting, and normal bowel/bladder function, Guizhi Mahuang Ge Ban Tang is appropriate. If the pulse is floating, even with more heat than cold, diaphoresis can be used. If the pulse is weak, it indicates a lack of Yang; use Guizhi Er Yuebi Yi Tang (Cinnamon Twig Decoction twice and Breathing-Opening Decoction once). With more heat than cold and a slow chi pulse, it means Ying Qi is sufficient but Blood is deficient; first use Xiaojianzhong Tang with modifications for best results. If the chi pulse remains slow, administer another dose.
Furthermore, Taiyang disease is suitable for diaphoresis, but if the person has recently lost blood or suffered diarrhea, give Guizhi Tang frequently in small amounts to moisten the body, and it should resolve spontaneously. For example, patients with Lin disease (dysuria) or those prone to epistaxis should not be treated with diaphoresis according to the law; instead, harmonize using formulas similar to Xiaochaihu Tang (Minor Bupleurum Decoction). Question: How to distinguish Wind-injury from Cold-strike? Answer: Cold-strike presents with a tight and choppy pulse, while Wind-injury presents with a floating and slow pulse. Cold-strike has no sweat and a choppy pulse; Wind-injury has sweat and a slow pulse. Cold-strike involves aversion to cold but not wind; Wind-injury involves aversion to wind but not cold. Generally, Taiyang disease features a floating pulse, fever, and aversion to wind and cold. All six meridians can suffer from Wind-injury and Cold-strike, with different symptoms. Taiyang with a floating pulse and sweat is Wind-stroke; with a tight pulse and no sweat is Cold-strike. Yangming with hunger is Wind-stroke; anorexia is Cold-strike. Shaoyang with deafness, red eyes, chest fullness, and irritability is Wind-stroke; bitter taste, dry throat, and vertigo is Cold-strike. If the Three Yin meridians suffer Wind-injury, there are no abnormal symptoms other than limb restlessness and pain, with other symptoms identical to the Three Yang.
Wind damaging Wei Qi locates in the skin layer. Since Wei Qi circulates outside the vessels and belongs to Yang, governing the pathway of defensive Qi in the skin, the disease is shallow. Cold damaging Ying Blood enters the muscles. Since Ying Blood circulates inside the vessels and belongs to Yin, governing the pathway of nutritive Qi in the muscles, the disease is deep. Therefore, Guizhi Tang and Mahuang Tang are distinct; do not misuse them.
Li said: Initial symptoms of Wind-injury include only headache, a neutral mouth sensation, and no food aversion, which are the same as Cold-strike. This is because cold is a Yin pathogen and wind is a Yang pathogen. Thus, Cold-strike develops fever only after stagnation, whereas Wind-injury develops fever immediately. Cold-strike presents with slightly cold hands and feet; Wind-injury presents with hot hands and backs of feet. Cold-strike has no nasal discharge; Wind-injury has runny nose with a muffled voice. Cold-strike presents with a sallow complexion and body pain; Wind-injury presents with a bright complexion and heavy voice. Cold-strike has no sweat and is averse to cold but not wind; Wind-injury has sweat and is averse to wind but not cold. Severe Wind-injury presents with continuous sweating, shivering aversion to wind, and chilly aversion to cold. In winter, for Guizhi Tang patterns with spontaneous sweating and frequent urination, use Shaoyao Gancao Tang (Peony and Licorice Decoction); for spontaneous sweating, free urination, and curled legs/cramps, use Guizhi Tang plus Renshen (Ginseng) and Fuzi (Aconite). For mild cases, use Chaihu Guizhi Tang. For spontaneous sweating, thirst, and difficult urination, indicating pathogen transmitting inward, use Wuling San (Five-Ingredient Powder with Poria). For spontaneous sweating without thirst, indicating pathogen still in the exterior, use Fuling Guigan Tang (Poria, Cinnamon Twig, Licorice, and Ginger Decoction). For the other three seasons, use Fangfeng Chonghe Tang (Saposhnikovia Harmonizing Decoction), Chaihu Guizhi Tang, or Baidu San minus Fuling (Poria). For nasal congestion, use Tongguan San (Pass Through Orifices Powder). General formula: Chaihu Banxia Tang (Bupleurum and Pinellia Decoction). Ancient texts establish Liu Jing Shang Feng Tang (Six Meridians Wind-Injury Decoction), but the herbs for Three Yin are acrid and hot, seemingly contrary to Shanghan methodology. Zhang Zhongjing treats exterior patterns of Cold-strike and Wind-injury by distinguishing sweat/no sweat; interior patterns are the same, with no distinction in harmonizing or purging methods. Examining Guizhi, Fuzi, and Bayue Tang closely, these might apply if wind pathogen directly transmits to the Yin aspect, especially if the person is constitutionally weak or injured by wind after sexual activity. Using them generally as exterior-resolving agents would cause much harm. Generally, for resolving Wind-injury via the exterior, acrid-hot is inferior to acrid-warm, and acrid-warm is inferior to acrid-cool. Some doubt why Zhang Zhongjing details Wind and Cold regarding the Six Excesses (pathogenic factors) but omits Summerheat, Dampness, Dryness, and Fire. This is because Summerheat and Fire share the same nature, and Dryness and Dampness share the same source. Wind and Cold transmit through all six meridians, while Summerheat and Dampness tend to attach to the Five Zang organs. Robust individuals recover as Qi moves freely; frail individuals develop disease due to attachment.
If Cold-strike occurs first followed by Wind-injury, the symptoms manifest as Cold-strike but the pulse shows Wind-injury. If Wind-injury occurs first followed by Cold-strike, the symptoms manifest as Wind-injury but the pulse shows Cold-strike. This occurs when Ying and Wei are both substantial. For those with no sweat and irritability, use Da Qinglong Tang (Major Blue-Green Dragon Decoction); for those without irritability, use Guizhi Mahuang Ge Ban Tang. General formulas: Da Qianghuo Tang (Major Notopterygium Decoction), Jiwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction) plus Renshen (Ginseng) and Dazao (Jujube), or Shenzhu San (Divine Efficacy Powder) or Xiangsu San (Fragrant Perilla Powder).
Chen Shiduo said: At the onset of illness, medication is originally easy to achieve efficacy. Unfortunately, people fail to see clearly and use medications chaotically, often causing numerous variable syndromes arise. If recognized clearly and applied correctly, how could variable syndromes arise? For Wind-injury, there is inevitably headache and body pain, cough with profuse phlegm; the pulse must be floating. This is Wind-injury. Use Fangfeng (Saposhnikovia Root), Jingjie (Schizonepeta Spike), Chaihu (Bupleurum Root), Gancao (Licorice Root), Huangqin (Scutellaria Root), and Banxia (Pinellia Tuber), each one qian. Stop after one dose; do not administer a second dose. For initial Cold-strike, there is nasal congestion, eye pain, neck stiffness, and headache; the pulse must be floating and tight. This is Cold-strike. Treating it as Cold-strike leads to cure. Use Guizhi (Cinnamon Twig), Gancao (Licorice Root), Chenpi (Tangerine Peel), and Gegen (Puerariae Radix), each one qian. Stop after one dose.
Zhu Zhenheng said: Zhang Zhongjing discussed Cold-strike but did not address Middle-Cold (Zhong Han). Ancients treated Middle-Cold with coma caused by severe cold using Fuzi Lizhong Tang (Aconite and Gastrodia Decoction); their discussion on medication was correct. Regarding "Shang" (Injury) and "Zhong" (Strike/Middle), no one discussed their differences. Cold-strike has immediate onset (Ji Bing) and delayed onset (Bu Ji Bing). Due to existing internal stagnant heat, external Wind-Cold causes dense pores, leading to stagnant heat eruption. Pathogens enter via meridians and deepen gradually. Initially, use Mahuang and Guizhi types; it is mild and safe because the body is not very deficient. If Middle-Cold, it is contracted suddenly, manifests immediately and violently. Because pores are open, the whole body receives pathogens, making it hard to distinguish meridians. There is no heat to erupt; warming and tonifying resolve it. This is due to extreme Qi deficiency; without urgent treatment, death ensues. Wind-injury, Summerheat-injury, and Dampness-injury, like Cold-strike, enter gradually. Wind-strike, Summerheat-strike, and Dampness-strike, like Middle-Cold, are contracted suddenly and violently.
Tao Hua said: Wind damages Wei Qi, and Cold damages Ying Blood. This is because Qi belongs to Yang, and Wind also belongs to Yang; Yang follows Yang, thus damaging Wei Qi. Yang governs opening and leakage, causing spontaneous sweating; therefore, use Guizhi Tang, an acrid-sweet-warm agent, to secure the exterior. Blood belongs to Yin, and Cold also belongs to Yin; Yin follows Yin, thus damaging Ying Blood. Yin governs closing and storing, causing absence of sweat; therefore, use Mahuang Tang, a light and ascending agent, to release the exterior. This is precisely what is meant by "each following its kind."