太阳病。头痛发热。汗出恶风。桂枝汤主之。（风下。脉经。有若恶寒三字。成本。有者字。）
〔方〕此与前条。文虽差互详略。而证治则一。前条有脉无头痛。以揭病名。此有头痛无脉。以言治。互相
详略耳。无异殊也。〔柯〕此条是桂枝本证。辨证为主。合此证即用此汤。不必问其为伤寒中风杂病也。今人
凿分风寒。不知辨证。故仲景佳方。置之疑窟。四证中头痛。是太阳本证。头痛发热恶风。与麻黄证同。本方
重在汗出。汗不出者。便非桂枝证。
案金鉴。以此条为重出衍文。误。
太阳病。项背强KT KT 。反汗出恶风者。桂枝加葛根汤主之。（KT KT 。程本。作兀兀。非也。玉函
云。桂枝汤主之。论云。桂枝加葛根汤主之。千金翼同。论云。作本论云。）
〔成〕KT KT 者。伸颈之貌也。动则伸颈。摇身而行。项背强者。动则如之。〔程〕项背强兀兀五字连
读。上半身成硬直之象。〔志〕此承上文头痛。而及于项背。以见太阳循经。自
上而下之义也。太阳经脉。循于脊背之间。今风邪涉于分部。而经气不舒。故项背强而KT KT 然也。是当无
汗。反汗出者。肌腠不密也。肌腠虚。故恶风。用桂枝汤。以解太阳肌中之邪。加葛根。宣通经脉之气。而治
太阳经脉之邪。
本事方云。或问曰。何谓KT KT 。予曰。KT KT 者。如KT 足疾屈而强也。谢复古谓病患羸弱。须凭
几而起。误也。明理论云。KT 。音殊。KT 引颈之貌。KT 。短羽鸟也。短羽之鸟。不能飞腾。动则先伸引
其头尔。项背强者。动亦如之。非若几案之KT 而偃屈也。金匮直解云。案说文。KT 字无钩挑。有钩挑者。
乃KT 案之KT 字也。KT 。乃鸟之短羽。象小鸟毛羽未盛之形。飞KT KT 也。故凫字从KT 。盖形容其颈
项强急之意。
桂枝加葛根汤方
葛根（四两） 麻黄（三两去节○成本。玉函。并无。） 芍药（二两○可发汗篇。作三两。） 生姜（三
两切） 甘草（二两炙） 大枣（十二枚擘） 桂枝（二两去皮○玉函全书。志。锡。作三两。）
上七味。以水一斗。先煮麻黄葛根。减二升。去上沫。纳诸药。煮取三升。去滓。温服一升。覆取微似汗。
不须啜粥。余如桂枝法。将息及禁忌。（【原注】臣亿等谨案仲景本论。太阳中风自汗。用桂枝。伤寒无汗。用
麻黄。今证云汗出也。第三卷有葛根汤。恶风而方中有麻黄。恐非本意。证云无汗恶风。正与此方同。是合用
麻黄也。此云桂枝加葛根汤。恐是桂枝中。但加葛根耳。○玉函。无麻黄二字。一斗。作九升。无将息及禁忌
五字。成本亦无五字。方本。不载本方。但云于桂枝汤方内加葛根三两。余根据桂枝汤法。）
活人书云。伊芳尹汤液论。桂枝汤中加葛根。今监本用麻黄。误矣。
案方氏以降。以此方为太阳阳明合病之的方。只张志聪张锡驹之解。为太阳病项背强者之主剂。其说似长
矣。盖以葛根为阳明之药者。 乎张洁古。诸家未察耳。仲景用葛根
者。取之于其解表生津。痉病亦用葛根。其意可见也。本草经云。葛根。主治消渴身大热。名医别录云。疗伤
寒中风头痛。解肌发表。出汗开腠理。亦可以为佐证也。
圣济总录。桂心汤。治四时伤寒初觉。（即本方）
太阳病下之后。其气上冲者。可与桂枝汤。方用前法。若不上冲者。不得与之。（玉函。千金翼。无后字。
及方用前法四字。得。作可。成本。亦作可。）
〔成〕太阳病属表。而反下之。则虚其里。邪欲乘虚传里。若气上冲者。里不受邪。而气逆上。与邪争也。
则邪仍在表。故当复与桂枝汤解外。其气不上冲者。里虚不能与邪争。邪气已传里也。故不可更与桂枝汤攻表。
〔钱〕太阳中风。外证未解之时。而误下之。则胃气虚损。邪气乘之。当内陷而为痞为结。下陷而成协热下利矣。
以下后而其气上冲。则知外邪未陷。胸未痞结。当仍从外解。可与桂枝汤。不须加减。悉照前方服法可也。若
其气不上冲者。恐下后邪或内入。胃气已伤。将有逆变。尚未可知。桂枝汤不可与也。姑待其变。然后随证治
之可耳。〔志〕金氏曰。气上冲者。谓太阳之气。从下而上。根气盛。不因下后内陷。故上冲也。可与桂枝汤。
以解肌中之邪。若不上冲者。太阳之气下陷。邪亦从之内入。无庸桂枝以解肌。故曰不得与之。
案上冲。诸家未有明解。盖此谓太阳经气上冲。为头项强痛等证。必非谓气上冲心也。
太阳病三日。已发汗。若吐。若下。若温针。仍不解者。此为坏病。桂枝不中与之也。观其脉证。知犯何
逆。随证治之。（玉函。千金翼。仍。作而。不中与之。作不复中与也。成本。无之字。）
〔方〕坏。言历遍诸治。而犹不愈。则反复杂误之余。血气已惫坏。难以正名名也。不中。犹言不当也。末
三句。言
所以治之之法也。盖既不可名以正名。则亦难以出其正治。故但示人以随机应变之微旨。斯道之一贯。斯言尽
之矣。〔程〕如汗后。亡阳动经。渴躁谵语。下后。虚烦结胸痞气。吐后。内烦腹胀满。温针后。吐衄惊狂之类。
纷纭错出者。俱是。既为前治所坏。〔王〕逆者。谓不当汗而汗。不当下而下。或汗下过甚。皆不顺于理。故云
逆也。〔志〕太阳病至三日。而已发汗。则肌表之邪已去。假使里证未除。若吐之而治其中膈。若下之而清其
肠胃。若温针而理其经脉。里证仍不解者。此为坏病。夫自败曰坏。言里气自虚。而自败也。〔柯〕坏病者。
即变证也。若误汗则有遂漏不止。心下悸。脐下悸等证。妄吐则有饥不能食。朝食暮吐。不欲近衣等证。妄下
则有结胸痞硬。协热下利。胀满清谷等证。火逆则有发黄圊血。亡阳奔豚等证。是桂枝证已罢。故不可更行桂
枝汤也。桂枝以五味成方。减一增一。便非桂枝汤。非谓桂枝竟不可用。〔钱〕论中凡属误汗吐下之变。皆坏病
也。故治之之法。即下文误汗误吐误下误烧针诸条。是也。
案坏。成氏读为古坏切。云为医所坏病也。乃似于义不稳。有太阳病为医所坏。转为少阳。为阳明者。
则不得谓之为坏病也。巢源云。或已发汗吐下。而病证不解。邪热留于腑脏。致令病候多变。故曰坏伤寒。外
台秘要引文仲云。伤寒八九日不瘥。名为败伤寒。诸药不能消。又引古今录验云。伤寒五六日以上不解。热在
胸中。口噤不能言。唯欲饮水。为败伤寒。医所不疗。千金方作坏伤寒所谓败伤寒。盖是坏败之义。即坏病耳。
当互证也。
案温针。诸注欠详。王纶明医杂着云。问。近有为温针者。乃楚人法。其法。针于穴。以香白芷作圆饼。
套针上。以艾蒸温之。多取效。答。古有针则不灸。灸则不针。未有
针而加灸者。此后人俗法也。此法行于山野贫贱之人。经络受风寒致病者。或有效。只是温经通气而已。仲景
楚人。此岂古温针之遗法耶。
案不中。方氏解为不当。是恐不尔。萧参希通录云。俚谈以不可用。为不中用。自晋时已有此语。左传成
二年。却子曰。克于先大夫。无能为役。杜预注。不中为之役使。王充耘读书管见云。中土见事之当其可者。
谓之中。其不可者。谓之不中。于物之好恶。人之贤不肖。皆以之目焉。简案不中用。见始皇本纪。韩延寿传等。
名医类案云。一人伤寒坏证垂死。手足俱冷。气息将绝。口张不能言。张致和以人参一两。去芦。加附
子一钱。于石HT 内。煎至一碗。以新汲水浸之。若冰冷。一服而尽。少顷病患汗从鼻梁上。涓涓如水。此其验
也。盖鼻梁上应脾。若鼻端有汗者可救。以土在身中周遍故也。近陆同妇。产后患疫证。二十余日。气虚脉弱。
即同坏证。亦以此汤治之。遂愈。世谓伤寒。汗吐下三法差谬。名曰坏证。孙真人云。人参汤。须得长流水煎
服。若用井水则不验。盖长流水。取其性之通达耳。○案百一选方。破证夺命散。治伤寒阴阳二证不明。或投
药错误。致患人困重垂死。即与致和方同。唯不用附子。后世所谓独参汤。卫生家宝方。名人参夺命散。有生姜。
桂枝本为解肌。若其人脉浮紧。发热汗不出者。不可与之也。常须识此勿令误也。（玉函。千金翼。桂枝
下。有汤字。汗不出。作无汗。无之字。成本亦无。）
〔成〕脉浮发热。汗出恶风者。中风也。可与桂枝汤解肌。脉浮紧发热。不汗出者。伤寒也。可与麻黄
汤。常须识此勿妄治也。〔方〕肌。肤肉也。盖风中卫。而卫不固。发热汗出。
而恶风。卫行脉外。肤肉之分也。桂枝救护之。热粥释散之。病之所以解也。识。与志同。记也。记其政事。
谓之识。言当常常用心。以记其事。勿忘勿怠。而不可使有一忽之失误。
案肌。说文。肉也。折骨分经。白为肌。赤为肉。而肌有两义。有肌肤之肌。有肌肉之肌。注证发微详
辨之。方氏因注云。肌。肤肉也。盖分肌肉之肌也。
案解肌。解散肌表之邪气也。言桂枝。虽为解肌之剂。若其人脉浮紧。发热汗不出者。不可与桂枝汤。
当以麻黄汤。解散其肌表之邪也。解肌二字。不专属于桂枝。外台秘要。有麻黄解肌汤。葛根解肌汤。名医别
录。麻黄主疗云。解肌。可以见耳。
若酒客病。不可与桂枝汤。得之则呕。以酒客不喜甘故也。（玉函。千金翼。无若字。病字。以字。成本。
得之。作得汤。）
〔成〕酒客内热。喜辛而恶甘。桂枝汤甘。酒客得之。则中满而呕。〔柯〕仲景用方慎重如此。言外当知有
葛根连芩以解肌之法矣。
案程云。酒客脉浮汗自出。似风伤卫。金鉴云。酒客病。谓过饮而病也。并非是。
喘家。作桂枝汤。加浓朴杏子佳。（玉函。千金翼。杏子。作杏仁。方云。佳。一本作仁。汪云。佳。
坊本作仁。）
〔成〕太阳病。为诸阳主气。风甚气拥。则生喘也。与桂枝汤。以散风。加浓朴杏仁。以降气。〔魏〕
凡病患素有喘证。每感外邪。势必作喘。谓之喘家。亦如酒客等。有一定之治。不同泛常人一例也。〔钱〕气
逆喘急。皆邪壅上焦也。盖胃为水谷之海。肺乃呼吸之门。其气不利。则不能流通宣布。故必加入浓朴杏仁乃
佳。杏子。即杏仁也。前人有以佳字为仁字之讹者。非也。
凡服桂枝汤吐者。其后必吐脓血也。（玉函。千金翼。无凡字。也字。）
〔钱〕其后必吐脓血句。乃未至而逆料之词也。言桂枝性本甘温。设太阳中风。投之以桂枝汤。而吐者。
知其人本阳邪独盛于上。因热壅上焦。以热拒热。故吐出而不能容受也。若邪久不衰。熏灼肺胃。必作痈脓。
故曰其后必吐脓血也。此以不受桂枝而知之。非误用桂枝而致之也。乃各注家俱言胃家湿热素盛。更服桂枝。
则两热相搏。中满不行。势必上逆而吐。热愈淫溢。蒸为败浊。必吐脓血。此一大禁也。（案方。喻。并云尔。）
不知桂枝随已吐出。何曾留着于胸中。岂可云更服桂枝。两热相搏乎。前人遂以此条。列为桂枝四禁。岂不谬
乎。〔魏〕桂枝既不可用。将坐以候之乎。此处俱无一语救正。不几令主治者茫然耶。湿热家之中风。于用桂枝
之内。必佐以五苓之治法。或易桂枝为葛根。即葛根连芩汤之义也。〔汪〕此条证。仲景无治法。补亡论。常器
之云。可服类要芍药地黄汤。郭白云云。见脓血而后可服。
安舒云。酒客病。不可与桂枝。得汤则呕者。其后果必吐脓血乎。盖积饮素盛之人。误服表药。以耗其
阳。而动其饮。上逆而吐。亦常有之。若吐脓血者。从未之见也。定知叔和有错。此说似有理。
太阳病。发汗遂漏不止。其人恶风。小便难。四肢微急。难以屈伸者。桂枝加附子汤主之。（玉函。脉
经。千金翼。汗上有其字。漏下有而字。）
〔成〕太阳病。因发汗遂汗漏不止。而恶风者。为阳气不足。因发汗阳气益虚。而皮腠不固也。内经曰。
膀胱者。州都之官。津液藏焉。气化则出。小便难者。汗出亡津液。阳气虚弱。不能施化。四肢者。诸阳之本
也。四肢微急。难以
屈伸者。亡阳而脱液也。针经曰。液脱者。骨属屈伸不利。与桂枝加附子汤。以温经复阳。〔柯〕太阳固当汗。
若不取微似有汗。而发之太过。阳气无所止息。而汗出不止矣。〔方〕恶风者。太阳中风。本自汗出。腠理疏而
恶风。既漏不止。则腠理愈疏。而恶愈甚也。
徐大椿伤寒类方云。此发汗太过。如水流漓。或药不对证之故。中风本恶风。汗后当愈。今仍恶风。则表
邪未尽也。
案喻氏以恶风为外风复入所致。恐不然也。
桂枝加附子汤方
桂枝（三两去皮） 芍药（三两） 甘草（三两炙○玉函。作二两。） 生姜（三两切） 大枣（十二枚
擘） 附子（一枚炮去皮破八片○方本作三枚。云。三枚盖出于增补。非经之本文。）
上六味。以水七升。煮取三升。去滓。温服一升。本云桂枝汤。今加附子。将息如前法。（玉函。味下。
Taiyang disease (disease of the Taiyang channel). Headache, fever, sweating, aversion to wind. Guizhi Tang (Cinnamon Twig Decoction) is the primary treatment. (In the "wind" character, *Mai Jing* adds three characters "ruo e han" [as if averse to cold]. The Cheng edition has "zhe" instead of "you".)
[Cheng Wuji's Commentary] This clause and the previous one differ in textual detail and brevity, but the syndrome and treatment are identical. The previous clause mentions pulse but not headache, to highlight the disease name; this clause mentions headache but not pulse, to explain the treatment. They complement each other in detail without any difference. [Ke Qin's Commentary] This clause describes the fundamental syndrome for Guizhi Tang. It emphasizes syndrome differentiation: if the syndrome matches, use this decoction, regardless of whether it is Shanghan, Xiaofeng, or a miscellaneous disease. Modern people rigidly distinguish between wind-cold and wind-heat, failing to understand syndrome differentiation, thus placing Zhongjing's excellent prescriptions in a pit of doubt. Among these four symptoms, headache is the fundamental symptom of Taiyang. Headache, fever, and aversion to wind are the same as the Mahuang Tang syndrome. The key to this formula lies in "sweating"; if there is no sweating, it is not a Guizhi Tang syndrome.
*Yizong Jinjian* considers this clause a redundant repetition, which is incorrect.
Taiyang disease. Stiffness and tightness in the nape and back (*Jingbei Qiang Shu*), with sweating and aversion to wind. Guizhi Jia Gegen Tang (Guizhi Decoction plus Puerariae Radix) is the primary treatment. ("*Jingbei Qiang Shu*", Cheng edition writes "Wu Wu", which is incorrect. *Yuyang Jing* says: "Guizhi Tang is the primary treatment." The *Lun* says: "Guizhi Jia Gegen Tang is the primary treatment." *Qianjin Yi Fang* agrees. The *Lun* states: it should be read as stated in the main text.)
[Cheng Wuji's Commentary] "*Jingbei Qiang Shu*" refers to the appearance of stretching the neck. When moving, one stretches the neck and shakes the body while walking. Those with stiff nape and back move in the same way. [Cheng Zhi's Commentary] Reading "Jingbei Qiang Wu Wu" as five connected characters, the upper half of the body presents a stiff and straight image. [Zhang Zhicong's Commentary] This follows the previous mention of headache and extends to the nape and back, illustrating the principle that the Taiyang channel descends from top to bottom. The Taiyang channel runs between the spine and back. Now, wind pathogen invades the specific region, causing the channel qi to stagnate, resulting in stiffness and tightness in the nape and back. Normally, there should be no sweating; the presence of sweating indicates loose muscle interstices. Due to deficient muscle interstices, there is aversion to wind. Use Guizhi Tang to resolve the pathogen in the Taiyang muscle layer. Add Gegen (Puerariae Radix) to unblock the qi of the channels and treat the pathogen in the Taiyang channel.
*Benshi Fang* states: Someone asked, what is "*Jingbei Qiang Shu*"? I said: "*Jingbei Qiang Shu*" resembles the stiffness and flexion of short-winged birds' legs. Xie Fugu said patients are emaciated and need to lean on a table to rise, which is incorrect. *Mingli Lun* states: "*Shu*" sounds like "shu". "*Shu*" describes the appearance of stretching the neck. "*Shu*" is a short-winged bird. Short-winged birds cannot fly high; when they move, they first stretch their heads. Those with stiff nape and back move similarly. It is not like bending over a table. *Jingui Zhijie* states: According to *Shuowen*, the character "*Shu*" has no hook stroke. Characters with hook strokes belong to the character for table support. "*Shu*" refers to the short wings of birds, depicting the form of young birds with immature feathers. Flying "*Shu Shu*". Hence the character "Fu" (duck) contains "*Shu*". It likely describes the meaning of stiff and urgent neck and nape.
Guizhi Jia Gegen Tang Formula
Gegen (Puerariae Radix) (4 liang) Mahuang (Ephedrae Herba) (3 liang, remove joints ○ Cheng edition and *Yuyang Jing* do not list this.) Shaoyao (Paeoniae Radix Alba) (2 liang ○ In the chapter on inducing sweating, it is listed as 3 liang.) Shengjiang (Zingiberis Rhizoma Recens) (3 liang, sliced) Gancao (Glycyrrhizae Radix et Rhizoma) (2 liang, honey-fried) Dazao (Ziziphi Jujubae Fructus) (12 pieces, split) Guizhi (Cinnamomi Ramulus) (2 liang, bark removed ○ *Yuyang Jing*, Quan Shu, Zhi, Xi list it as 3 liang.)
The above seven ingredients. Use 10 dou of water. First boil Mahuang and Gegen, reduce by 2 dou, remove the foam on the surface. Add the remaining herbs. Boil until 3 sheng remain. Remove the dregs. Take 1 sheng warm. Cover to induce a slight sweat. No need to drink hot porridge. Rest and dietary restrictions follow the method of Guizhi Tang. ( [Original Note] Ministers Yi et al. carefully examined Zhongjing's original text: for Taiyang Xiaofeng with spontaneous sweating, Guizhi Tang is used; for Shanghan with no sweating, Mahuang Tang is used. Here the syndrome mentions sweating. Volume 3 has Gegen Tang, which treats aversion to wind and contains Mahuang, which seems contrary to intent. The syndrome here mentions no sweating and aversion to wind, matching this formula, suggesting Mahuang should be combined. The statement "Guizhi Jia Gegen Tang" here might imply adding only Gegen to Guizhi Tang. ○ *Yuyang Jing* omits "Mahuang". "10 dou" is written as "9 dou". The five characters "rest and dietary restrictions" are omitted. Cheng edition also omits these five characters. Fang Ben does not record this formula, stating only to add 3 liang of Gegen to Guizhi Tang, following the rest of the Guizhi Tang method.)
*Huo Ren Shu* states: Yifang Yin's *Tangye Lun* adds Gegen to Guizhi Tang. The current imperial edition uses Mahuang, which is an error.
Note: Since Fang Shi, this formula has been considered the specific prescription for the combination of Taiyang and Yangming diseases. Only the interpretations of Zhang Zhicong and Zhang Xiju, viewing it as the main agent for Taiyang disease with stiff nape and back, seem more reasonable. This likely stems from treating Gegen as a Yangming herb, influenced by Zhang Jiegou, which other families failed to notice. Zhongjing uses Gegen for its ability to release the exterior and generate fluids. The use of Gegen in Jing-spasm diseases reveals this intent. *Ben Cao Jing* states: Gegen treats thirst and high fever. *Mingyi Bie Lu* states: Treats headache from Shanghan and Xiaofeng. Releases the muscle layer and exterior, induces sweating, and opens the interstices. This serves as further evidence.
*Shengji Zonglu* Guixin Tang treats early-stage seasonal Shanghan. (This is the same formula.)
After purgation in Taiyang disease, if the qi rushes upward, Guizhi Tang may be given, using the method described previously. If the qi does not rush upward, it must not be given. (*Yuyang Jing*, *Qianjin Yi Fang* omit the character "hou" (after) and the four characters "fang yong qian fa" (formula uses previous method). "De" is written as "Ke". Cheng edition also writes "Ke".)
[Cheng Wuji's Commentary] Taiyang disease belongs to the exterior. Using purgation incorrectly empties the interior. The pathogen seeks to transmit inward due to deficiency. If the qi rushes upward, the interior rejects the pathogen, and the qi reverses upward to struggle against it. Thus, the pathogen remains in the exterior, so Guizhi Tang should be given again to resolve the exterior. If the qi does not rush upward, the interior is too weak to struggle against the pathogen, and the pathogen has already transmitted inward. Therefore, Guizhi Tang should not be given to attack the exterior.
[Qian Huang's Commentary] During Taiyang Xiaofeng, when exterior symptoms are unresolved, erroneous purgation damages stomach qi, allowing pathogen to invade. It should sink inward to form Pi (fullness) or Jie Xiong (chest binding). Sinking downward leads to Xie Re Xia Li (diarrhea with heat). However, since the qi rushes upward after purgation, we know the exterior pathogen has not sunk, and the chest is not blocked. It should still be resolved from the exterior. Guizhi Tang can be given without modification, following the previous dosage method exactly. If the qi does not rush upward, the pathogen may have entered inward after purgation, and stomach qi is damaged. An adverse transformation is possible but uncertain. Guizhi Tang should not be given. Wait for changes, then treat according to the syndrome.
[Zhang Zhicong's Commentary] Jin Shi says: Qi rushing upward refers to Taiyang qi rising from below. The root qi is strong and does not sink inward after purgation, hence it rushes upward. Guizhi Tang can be given to resolve the pathogen in the muscle layer. If it does not rush upward, Taiyang qi sinks, and the pathogen enters inward. There is no need for Guizhi to resolve the muscle layer. Hence it says "must not be given."
Note: Regarding "rushing upward," previous commentators lacked a clear explanation. This refers to the upward rush of Taiyang channel qi, manifesting as head and nape stiffness/pain. It certainly does not refer to qi rushing up to the heart.
On the third day of Taiyang disease, after sweating, vomiting, purgation, or warm needle therapy, if the condition remains unresolved, this is called Huai Bing (ruined disease). Guizhi Tang is not appropriate for it. Observe the pulse and syndrome, determine what deviation occurred, and treat according to the syndrome. (*Yuyang Jing*, *Qianjin Yi Fang*: "Reng" is written as "Er". "Bu Zhong Yu Zhi" is written as "Bu Fu Yu Zhi". Cheng edition omits "Zhi".)
[Fang Youzhi's Commentary] "Huai" means having undergone various treatments without cure, resulting in complex errors where blood and qi are exhausted and ruined, making it difficult to name properly. "Bu Zhong" means inappropriate. The last three sentences describe the treatment method. Since it cannot be named properly, standard treatment is difficult. Thus, it shows the subtle principle of adapting to circumstances. This embodies the consistency of medical practice.
[Cheng Zhi's Commentary] For example, after sweating, Yang loss with channel agitation, thirst, irritability, and delirium; after purgation, empty irritability, Jie Xiong, Pi Qi; after vomiting, internal irritability, abdominal fullness; after warm needles, hematemesis, epistaxis, fright, and mania. These chaotic manifestations are all examples. Having been ruined by prior treatment...
[Wang Kentang's Commentary] "Ni" (deviation/adversity) refers to sweating when one should not, purging when one should not, or excessive sweating/purging, all contrary to reason, hence called "Ni".
[Zhang Zhicong's Commentary] By the third day of Taiyang disease, if sweating has been performed, the exterior pathogen is gone. If interior symptoms persist, vomiting treats the middle diaphragm, purging clears the intestines/stomach, warm needles regulate the channels. If interior symptoms remain unresolved, this is Huai Bing. Self-destruction is called Huai, meaning interior qi is self-deficient and self-ruined.
[Ke Qin's Commentary] Huai Bing is synonymous with Bian Zheng (transformed syndrome). Erroneous sweating leads to continuous leakage, palpitations in the heart or umbilical region. Erroneous vomiting leads to hunger without desire to eat, morning food vomited at night, aversion to clothing. Erroneous purgation leads to Jie Xiong, hard Pi, Xie Re Xia Li, abdominal fullness, and undigested food. Fire adversity leads to jaundice, bloody stool, Yang loss, and Ben Tun (fleeing tumor). The Guizhi syndrome has ceased, so Guizhi Tang cannot be used. Guizhi Tang consists of five flavors; changing even one ingredient makes it not Guizhi Tang. This does not mean Guizhi itself is unusable.
[Qian Huang's Commentary] All variations caused by erroneous sweating, vomiting, or purgation in the *Lun* are Huai Bing. Thus, the treatment methods are found in the subsequent clauses regarding erroneous sweating, vomiting, purgation, and burning needles.
Note: Cheng Wuji reads "Huai" as "gu huai qie", saying it is a disease ruined by doctors. This seems semantically unstable. Some Taiyang diseases ruined by doctors transform into Shaoyang or Yangming; these cannot be called Huai Bing. Chao Yuanfang states: After sweating, vomiting, or purgation, if symptoms do not resolve, pathogenic heat remains in the fu-zang organs, causing variable symptoms, hence called Huai Shanghan. *Waitai Miyao* cites Wenzhong: Shanghan lasting eight to nine days without resolution is called Bai Shanghan (defeated Shanghan), resistant to all medicines. It also cites *Gujin Luyan*: Shanghan unresolved after five to six days, heat in the chest, jaw stiffness preventing speech, only desiring water, is Bai Shanghan, untreatable by doctors. *Qianjin Fang* writes Huai Shanghan. "Bai" implies ruin/defeat, i.e., Huai Bing. These should be cross-referenced.
Note: Explanations of "warm needle" are insufficient. Wang Lun's *Mingyi Zazhu* asks: Recently, some use warm needles, a Chu method. Needles are inserted, white angelica cake is placed on the needle, and moxa is steamed over it. Often effective. Answer: Anciently, needles were not combined with moxibustion, and moxibustion was not combined with needles. Combining them is a later folk practice. Used among poor mountain dwellers for wind-cold affecting channels, it may work by warming channels and promoting qi flow. Zhongjing was from Chu; is this a remnant of ancient warm needle technique?
Note: Regarding "Bu Zhong" (not suitable/inappropriate), Fang Shi interprets it as "inappropriate," which may be incorrect. Xiao Shen's *Xitong Lu* states: Colloquially, "bu zhong yong" means unusable. This phrase existed since the Jin dynasty. *Zuo Zhuan* (Duke Cheng, Year 2): Xi Zi said, "I am unable to serve your senior ministers." Du Yu commented: "Bu Zhong" means unable to serve. Wang Chongyun's *Dushu Guan Jian* states: In central lands, matters fitting appropriateness are called "Zhong"; those unfit are called "Bu Zhong". This applies to objects' likes/dislikes and people's worthiness. Brief note: "Bu Zhong Yong" appears in *Records of the First Emperor* and *Han Yanshou Biography*.
* Mingyi Leian* records: A patient with severe Shanghan Huai Zheng was dying, limbs cold, breath nearly stopped, mouth open unable to speak. Zhang Zhihe used 1 liang of Renshen (Ginseng Radix et Rhizoma), removing rhizome, added 1 qian of Fuzi (Aconiti Lateralis Radix Praeparata), boiled in a stone vessel to 1 bowl. Cooled in fresh well water until ice cold. Patient drank it all at once. Soon, sweat dripped from the bridge of the nose like water. This was effective. The nose bridge corresponds to the Spleen. Sweat at the nasal tip indicates salvageability because Earth permeates the body. Recently, Mrs. Lu, postpartum with epidemic disease for 20+ days, had deficient qi and weak pulse, similar to Huai Zheng. Treated with this decoction and recovered. People say errors in sweating, vomiting, or purging in Shanghan are called Huai Zheng. Sun Simiao said: Renshen Tang must be boiled with long-flowing water. Well water is ineffective. Long-flowing water is used for its penetrating nature. ○ Note: *Baiyi Xuanfang* Po Zheng Duo Ming San treats unclear Yin/Yang Shanghan or medication errors leading to critical condition. It is the same as Zhihe's formula but without Fuzi. Later known as Du Shen Tang. *Weisheng Jiabao Fang* renames it Ren Shen Duo Ming San, adding Shengjiang.
Guizhi Tang is originally for releasing the muscle layer. If the pulse is floating and tight, with fever and no sweating, it must not be given. Always remember this to avoid errors. (*Yuyang Jing*, *Qianjin Yi Fang*: "Tang" follows "Guizhi". "Han Bu Chu" is written as "Wu Han". "Zhi" is omitted. Cheng edition also omits it.)
[Cheng Wuji's Commentary] Floating pulse, fever, sweating, aversion to wind is Xiaofeng. Guizhi Tang can be given to release the muscle layer. Floating-tight pulse, fever, no sweating is Shanghan. Mahuang Tang can be given. Always remember this to avoid reckless treatment.
[Fang Youzhi's Commentary] "Ji" refers to skin and flesh. Wind injures Wei (Defensive Qi), which becomes insecure, causing fever, sweating, and aversion to wind. Wei circulates outside the vessels, in the space of skin and flesh. Guizhi protects it; hot porridge disperses the pathogen, resolving the disease. "Shi" (remember) is the same as "Zhi" (record). Recording political affairs is called "Shi". One must constantly keep this in mind, not forgetting or neglecting, avoiding any slip-up.
Note: *Shuowen* defines "Ji" as flesh. *Zhe Gu Fen Jing* states: White is Ji, Red is Rou (meat). "Ji" has two meanings: skin/flesh Ji and muscle Rou. *Zhu Zheng Fa Wei* distinguishes them in detail. Fang Shi notes: "Ji" is skin and flesh, distinguishing muscle Ji.
Note: "Jie Ji" means releasing pathogen from the muscle layer. Although Guizhi is a formula for releasing the muscle layer, if the pulse is floating-tight, with fever and no sweating, Guizhi Tang must not be given. Mahuang Tang should be used to release the pathogen from the muscle layer. "Jie Ji" does not exclusively belong to Guizhi. *Waitai Miyao* lists Mahuang Jie Ji Tang and Gegen Jie Ji Tang. *Mingyi Bie Lu* states Mahuang treats "Jie Ji". This confirms it.
If a wine-drinker (Jiu Ke) has illness, Guizhi Tang must not be given. Taking it will cause vomiting, because wine-drinkers dislike sweet flavors. (*Yuyang Jing*, *Qianjin Yi Fang* omit "Ruo", "Bing", "Yi". Cheng edition: "De Zhi" is written as "De Tang".)
[Cheng Wuji's Commentary] Wine-drinkers have internal heat, preferring pungent and disliking sweet. Guizhi Tang is sweet. If wine-drinkers take it, they will experience fullness in the middle and vomiting.
[Ke Qin's Commentary] Zhongjing is so cautious with formulas. Implicitly, one should know the method of Gegen Huangqin Tang to release the muscle layer.
Note: Cheng states: Wine-drinkers have floating pulse and spontaneous sweating, resembling wind injuring Wei. *Jinjian* states: "Jiu Ke Bing" means illness from excessive drinking. This is not correct.
For those with chronic asthma (Chuan Jia), taking Guizhi Tang with Houpo (Magnoliae Officinalis Cortex) and Xingzi (Prunus Armeniacae Semen) is beneficial. (*Yuyang Jing*, *Qianjin Yi Fang*: "Xingzi" is written as "Xingren". Fang says: "Jia" (beneficial). One version writes "Ren". Wang says: "Jia". Market editions write "Ren".)
[Cheng Wuji's Commentary] Taiyang disease governs the Qi of all Yang channels. Severe wind causes Qi congestion, leading to asthma. Give Guizhi Tang to scatter wind. Add Houpo and Xingren to direct Qi downward.
[Wei Litong's Commentary] Patients with chronic asthma who contract external pathogens will inevitably develop asthma. This is called Chuan Jia. Like wine-drinkers, they have a fixed treatment approach, different from ordinary people.
[Qian Huang's Commentary] Qi reversal and rapid breathing are due to pathogen congesting the Upper Jiao. The Stomach is the sea of water and grain; the Lung is the gate of respiration. If Qi is obstructed, it cannot circulate and distribute. Therefore, adding Houpo and Xingren is beneficial. Xingzi is Xingren. Previous scholars who thought "Jia" was a typo for "Ren" were incorrect.
Anyone who vomits after taking Guizhi Tang will subsequently vomit pus and blood. (*Yuyang Jing*, *Qianjin Yi Fang* omit "Fan" and "Ye".)
[Qian Huang's Commentary] The sentence "subsequently will vomit pus and blood" is a prediction before the event occurs. It means Guizhi is naturally sweet and warm. Assuming Taiyang Xiaofeng, if Guizhi Tang is administered and vomiting occurs, it indicates the person inherently has excess Yang pathogen in the upper jiao. Heat congests the upper jiao; heat rejects heat, causing vomiting and inability to tolerate the medicine. If the pathogen persists, scorching the Lung and Stomach, abscesses and pus will form. Hence, "subsequently will vomit pus and blood." This is deduced from the rejection of Guizhi, not caused by its misuse. However, most commentators state that patients with inherent damp-heat in the Stomach, upon taking Guizhi, cause two heats to clash, leading to middle fullness and upward rebellion/vomiting. As heat overflows, it steams into turbid decay, causing vomiting of pus and blood. This is a major contraindication. (Fang and Yu agree.) But Guizhi is vomited out; how could it remain in the chest? How can one say taking Guizhi again causes two heats to clash? Predecessors listed this clause as one of the Four Prohibitions of Guizhi. Is this not absurd?
[Wei Litong's Commentary] If Guizhi cannot be used, should we just wait? There is no corrective advice here, leaving the practitioner confused. For wind-stroke in patients with damp-heat, within the use of Guizhi, one must assist with the treatment method of Wuling San, or replace Guizhi with Gegen, implying the meaning of Gegen Huangqin Tang.
[Wang Ang's Commentary] Zhongjing provides no treatment method for this syndrome. *Bu Wang Lun* states Chang Qizhi said: Keel Si Lei Yao Shaoyao Dihuang Tang. Guo Baiyun said: Administer only after pus and blood appear.
An Shu comments: For wine-drinkers, Guizhi is prohibited. If vomiting occurs after taking the decoction, will they subsequently vomit pus and blood? Generally, people with accumulated fluid retention, mistakenly taking exterior-releasing drugs, deplete Yang and disturb fluid, causing upward rebellion and vomiting, which is common. Vomiting pus and blood has never been seen. Surely Shuhe made an error. This explanation seems reasonable.
In Taiyang disease, if sweating leads to continuous leakage (profuse sweating), with aversion to wind, difficulty urinating, slight stiffness in the four limbs, and difficulty flexing/extending them, Guizhi Jia Fuzi Tang (Guizhi Decoction plus Prepared Aconite Root) is the primary treatment. (*Yuyang Jing*, *Mai Jing*, *Qianjin Yi Fang*: "Qi" precedes "Han". "Er" follows "Lou".)
[Cheng Wuji's Commentary] Taiyang disease, due to sweating, leads to continuous leakage and aversion to wind. This indicates insufficient Yang Qi. Sweating further depletes Yang Qi, making skin and pores insecure. *Nei Jing* states: The Bladder is the official of the capital, storing fluids. Through Qi transformation, they exit. Difficulty urinating results from fluid loss through sweating; deficient Yang Qi cannot perform transformation. The four limbs are the root of all Yang channels. Slight stiffness and difficulty flexing/extending the limbs indicate loss of Yang and depletion of fluids. *Zhen Jing* states: Fluid depletion leads to inability to flex and extend bone attachments. Give Guizhi Jia Fuzi Tang to warm the channels and restore Yang.
[Ke Qin's Commentary] Taiyang disease should indeed be treated with sweating. But if one does not aim for a slight sweat and sweats excessively, Yang Qi has no resting place, leading to continuous sweating.
[Fang Youzhi's Commentary] Aversion to wind: Taiyang Xiaofeng naturally involves sweating, loose pores, and aversion to wind. With continuous leakage, pores become looser, and aversion worsens.
Xu Dachun's *Shanghan Leifang* states: This is excessive sweating, like a flowing stream, possibly due to mismatched medication. Xiaofeng naturally involves aversion to wind; after sweating, it should resolve. Continued aversion to wind indicates the exterior pathogen is not fully resolved.
Note: Yu Shi attributes aversion to wind to re-entry of external wind, which is likely incorrect.
Guizhi Jia Fuzi Tang Formula
Guizhi (Cinnamomi Ramulus) (3 liang, bark removed) Shaoyao (Paeoniae Radix Alba) (3 liang) Gancao (Glycyrrhizae Radix et Rhizoma) (3 liang, honey-fried ○ *Yuyang Jing*: 2 liang.) Shengjiang (Zingiberis Rhizoma Recens) (3 liang, sliced) Dazao (Ziziphi Jujubae Fructus) (12 pieces, split) Fuzi (Aconiti Lateralis Radix Praeparata) (1 piece, processed, bark removed, broken into 8 slices ○ Fang Ben lists 3 pieces. States: 3 pieces likely from additions, not the original text.)
The above six ingredients. Use 7 sheng of water. Boil until 3 sheng remain. Remove dregs. Take 1 sheng warm. Originally this is Guizhi Tang. Now add Fuzi. Rest and care follow the previous method. (*Yuyang Jing*, under "wei"...)