有咀三物四字。本云作本方。成本不载本方。第十卷云。于桂枝汤方内。加附子一枚。炮去皮。破八片。余
根据前法。）
〔徐〕此阳气与阴津两亡。更加风气缠绵。若用四逆。则不宜干姜之刚燥。用真武。则不宜苓术之渗湿。
故用桂枝汤。加附子。以固表驱风。而复阳敛液也。〔周〕仲景何遽用附子。观本文云。遂漏不止。知其漏正未
有止期也。人身津液有几。堪漏而无已邪。故以附子入桂枝汤中。即为固表回阳上剂。〔钱〕此方。于桂枝汤
全方内。加附子者。故多一加字。伤寒八九日风湿相搏条下之桂枝附子汤。芍药已去。非桂枝全汤。乃另是一
方。故无加字。伤寒类方云。四肢。为诸阳之本。急难屈伸。乃津脱阳虚之象。但不至亡阳耳。若更甚而厥冷
恶寒。则有阳脱之虑。当用四逆汤矣。又云。桂枝同附子服。则能止汗回阳。
案成本第十卷。此方后附术附汤方。全书乃移载本条之后。盖根据太阳下编桂枝附子汤后。有术附汤。而错
出而已。
案千金方。治产后风虚。汗出不止。小便难。四肢微急。难以屈伸者。桂枝附子汤。即是此方。正见孙公
运用之妙矣。叶氏录验方。救汗汤。治阳虚自汗。即此方。出虚劳门。
本事方云。有一士人。得太阳病。因发汗汗不止。恶风小便涩。足挛曲而不伸。予诊其脉。浮而大。浮为
风。大为虚。予曰。在仲景方中。有两证。大同而小异。一则小便难。一则小便数。用药稍差。有千里之失。
仲景第七证云。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。十六证
云。伤寒脉浮。自汗出。小便数。心烦。微恶寒。脚挛。反与桂枝。欲攻其表。此误也。得之便厥。咽中干。
烦躁吐逆。一则漏风小便难。一则自汗小便数。或恶风。或恶寒。病各不同也。予用第七证。桂枝加附子汤。
三啜而汗止。佐以甘芍药汤。足便得伸。
太阳病下之后。脉促胸满者。桂枝去芍药汤主之。（【原注】促。一作纵。○后。玉函。脉经。千金翼。
作其。）
〔成〕太阳病下之。其脉促。不结胸者。此为欲解。（一百四十一条）此下后脉促。而复胸满。则不得为
欲解。由下后阳虚。表邪渐入。而客于胸中也。〔鉴〕太阳病表未解而下之。胸实邪陷。则为胸满气上冲咽喉
不得息。瓜蒂散证也。胸虚邪陷。则为气上冲。桂枝汤证也。今下之后。邪陷胸中。胸满脉促。似乎胸实。而
无冲喉不得息之证。似乎胸虚。又见胸满之证。故不用瓜蒂散以治实。亦不用桂枝汤以治虚。惟用桂枝之甘辛。
以和太阳之表。去芍药之酸收。以避胸中之满。〔张〕脉促。虽表邪未尽。然胸但满而不结。则以误下。而损
其胸中之阳也〔钱〕脉促者。非脉来数。时一止复来之促也。即急促。
亦可谓之促也。
顾宪章伤寒溯源集云。促。有短促之义。
桂枝去芍药汤方
桂枝（三两去皮） 甘草（二两炙） 生姜（三两切） 大枣（十二枚擘）
上四味。以水七升。煮取三升。去滓。温服一升。本云桂枝汤。今去芍药。将息如前法。（成本。不载
本方。第十卷云。于桂枝汤方内去芍药。余根据前法。玉函。味下。有 咀字。云。作方。）
若微恶寒者。桂枝去芍药加附子汤主之。（原本无恶字。今据成本。玉函补。成本。桂枝去芍药。作去
芍药方中。）
〔沈〕若脉促胸满。而微恶寒。乃虚而 。阳气欲脱。又非阳实之比。所以加附子固护阳气也。
案张志聪张锡驹以微恶寒。为脉微而恶寒之义。误。
桂枝去芍药加附子汤方
桂枝（三两去皮） 甘草（二两炙） 生姜（三两切） 大枣（十二枚擘） 附子（一枚。炮。去皮。
破八片。）
上五味。以水七升。煮取三升。去滓。温服一升。本云桂枝汤。今去芍药。加附子。将息如前法。（成本
不载本方 第十卷云。于桂枝汤方内去芍药。加附子一枚。炮。去皮。破八片。余根据前法。玉函。味下。有
咀字。云。作方。）
太阳病得之八九日。如疟状。发热恶寒。热多寒少。其人不呕。清便欲自可。一日二三度发。脉微缓者。
为欲愈也。脉微而恶寒者。此阴阳俱虚。不可更发汗更下更吐也。面色反有热色者。未欲解也。以其不能得小
汗出。身必痒。宜桂枝麻黄各半汤。（玉函。千金翼。发热。热多下。并有而字。欲自可。作自调。必下。有
当字。不可发汗篇。欲自可。作续自可。脉经同。此下。有为字。千金翼亦有。）
〔成〕发热恶寒。而热多寒少。为阳气进而邪气少也。里不和者。呕而利。今不呕。清便自调者。里和也。
寒热日二
三发者。邪气微也。今日数多。而脉微缓者。是邪气微缓也。故云欲愈。脉微而恶寒者。表里俱虚也。阳。表
也。阴。里也。脉微为里虚。恶寒为表虚。以表里俱虚。故不可更发汗更下更吐也。阴阳俱虚。则面色青白。
反有热色者。表未解也。热色。为赤色也。得小汗则和。不得汗。则不得邪气外散皮肤。而为痒也。与桂枝麻
黄各半汤。小发其汗。以除表邪。〔方〕八九日。约言久也。如疟状。谓有往来寒热。而无作辍之常也。更。
再也。不可汗。已过表也。不可吐下。未见有里也。〔钱〕邪既浮浅。脉又微缓。微者。非微细之微。言较前
略觉和缓也。脉微恶寒之微者。乃轻微细小之微。非微缓之微也。〔魏〕小汗出。小字亦须留意。意见正邪俱微。
大汗流漓。必在所禁也。〔张〕首节。颇似小柴胡证。故以不呕清便自调证之。次节虽脉微恶寒。止宜小建中
加黄 。以温分肉司开阖。原非温经之谓。后节面色反有热色。言表邪未尽。故宜各半。不可与面合赤色。比
类而观也。
伤寒琐言云。赵嗣真活人释疑曰。仲景之意。盖得病之八九日。如疟状发热恶寒。热多寒少。十六字。为
自初至今之证。下文乃是以后拟病防变之辞。当分作三截看。若其人不呕。清便欲自可。一日二三度发。脉浮
缓为欲愈。此一节。乃表和无病。而脉微者。邪气微缓也。阴阳同等。脉证皆向安之兆。可不待汗。而欲自愈。
若脉微而恶寒者。此阴阳俱虚。不可更汗更下更吐之。此一节宜温之。若面色反有赤色者。未欲解也。以其不
能得少汗出。其身必痒。宜桂枝麻黄各半汤。此一节。必待汗而愈也。○案程注云。作一头。下面分三脚。其
说盖原于赵氏也。
脉经引四时经。清溲痢通。注云。清者。厕也。溲从水道出。而反清溲者。是谓下痢至厕也。刘熙释名云。
圊。至
秽之处。宜常修治使洁清也。颜师古急就篇注云。清言其处特异所。常当加洁清也。成氏辨脉篇注。清者圊也。
○案太阳中篇。清谷。清血。其清。皆与圊同。
案此阴阳俱虚。宜用桂枝加附子汤。附子汤之属。小建中加黄 。恐不能救之。
伤寒类方云。微邪已在皮肤中。欲自出不得。故身痒。以此汤取其小汗足矣。阳明篇云。身痒如虫行皮
中状者。此以久虚故也。
桂枝麻黄各半汤方
桂枝（一两十六铢。去皮。） 芍药 生姜（切） 甘草（炙） 大枣（四枚。擘。） 麻黄（各一两去
节○千金翼。作去节各一两。） 杏仁（二十四枚汤浸去皮尖及两仁者○千金翼。无汤浸二字。）
上七味。以水五升。先煮麻黄一二沸。去上沫。纳诸药。煮取一升八合。去滓。温服六合。本云。桂枝
汤三合。麻黄汤三合。并为六合。顿服。将息如上法。（【原注】臣亿等谨案桂枝汤方。桂枝。芍药。生姜。
各三两。甘草二两。大枣十二枚。麻黄汤方。麻黄三两。桂枝二两。甘草一两。杏仁七十二个。今以算法约之。
二汤各取三分之一。即得桂枝一两十六铢。芍药。生姜。甘草。各一两。大枣四枚。杏仁二十三个零三分枚之
一。收之得二十四个。合方。详此方。乃三分之一。非各半也。宜云合半汤。○玉函。七味下。有 咀字。云。
作方。顿服下。有今裁为一方五字。）
〔柯〕桂枝汤三合。麻黄汤三合。并为六合。后人算其分两。合作一方。大失仲景制方之意。〔徐〕是风
虽外薄。为寒所持。而不能散。所以面显怫郁之热色。必宜总风寒两解之。故桂麻合用。
伤寒类方云。案此方。分两甚轻。计共约六两。合今之秤。仅一两三四钱。分三服。只服四钱零。乃治
邪退后。至轻之剂。犹勿药也。
太阳病。初服桂枝汤。反烦不解者。先刺风池风府。却与桂枝汤则愈。（先上。玉函。千金翼。有当字。
脉经。有法当二字。）
〔柯〕此条治中风之变。桂枝汤煮取三升。初服者。先服一升也。却与者。尽其二升也。热郁于心胸者。
谓之烦。发于皮肉者。谓之热。麻黄症发热无汗。热全在表。桂枝症发热汗出。便见内烦。服汤反烦。而外热
不解。非桂枝汤不当用也。以外感之风邪重。内之阳气亦重耳。风邪本自项入。必刺风池风府。疏通来路。以
出其邪。仍与桂枝汤。以和营卫。内经曰。表里刺之。服之饮汤。此法是矣。
伤寒类方云。此非误治。因风邪凝结于太阳之要路。则药力不能流通。故刺以解其结。盖邪气太甚。不
仅在卫。而在经。刺之以泄经气。
素问骨空论云。风从外入。令人振寒。汗出头痛。身重恶寒。治在风府。大风颈项痛。刺风府。风府在上椎。
甲乙经云。风池二穴。在颞 后。发际陷中。足少阳阳维之会。风府一穴。在项发际上一寸。大筋中宛
宛中。督脉阳维之会。
案针灸资生经云。岐伯对黄帝之问曰。巨阳者。诸阳之属也。其脉连于风府。故为诸阳主气也。然则风
府者。固伤寒所自起也。北人皆以毛裹之。南人怯弱者。亦以帛护其项。俗谓三角。是也。柯氏之说。盖本于斯。
服桂枝汤。大汗出。脉洪大者。与桂枝汤。如前法。若形似疟。一日再发者。汗出必解。宜桂枝二麻黄
一汤。（成本。似。作如。玉函。脉经同。脉洪大者。作若脉但洪大者。再下。脉经有三字。）
〔志〕大汗出。脉洪大者。肌腠之气。而外合于肤表。标阳气盛。故脉洪大。而汗出也。如前啜粥之法。
以助药力。〔柯〕服桂枝汤后。而恶寒发热如疟者。是本当用麻黄发汗。
而用桂枝。则汗出不彻故也。凡太阳发汗太过。则转属阳明。不及则转属少阳。此虽寒热往来。而头项强痛未
罢。是太阳之表尚在。因风邪泊营卫。动静无常。故一日再发。或三度发耳。〔鉴〕服桂枝汤。大汗出。病不
解。脉洪大。若烦渴者。则为表邪已入阳明。是白虎汤证也。今脉虽洪大。而不烦渴。则为表邪仍在太阳也。
案玉函。有但字。可见其无他证也。
桂枝二麻黄一汤方
桂枝（一两十七铢。去皮。） 芍药（一两六铢） 麻黄（十六铢去节） 生姜（一两六铢。切。） 杏
仁（十六个去皮尖○千金翼。有两仁者三字。） 甘草（一两二铢。炙） 大枣（五枚擘）
上七味。以水五升。先煮麻黄一二沸。去上沫。纳诸药。煮取二升。去滓。温服一升。日再服。本云桂
枝汤二分。麻黄汤一分。合为二升。分再服。今合为一方。将息如前法。（【原注】臣亿等谨案桂枝汤方。桂
枝。芍药。生姜。各三两。甘草二两。大枣十二枚。麻黄汤方。麻黄三两。桂枝二两。甘草一两。杏仁七十个。
今以算法约之。桂枝汤。取十二分之五。即得桂枝。芍药。生姜。各一两六铢。甘草二十铢。大枣五枚。麻黄汤。
取九分之二。即得麻黄十六铢。桂枝十铢三分铢之二。收之得十一铢。甘草五铢三分铢之一。收之得六铢。杏
仁十五个九分枚之四。收之得十六个。二汤所取相合。即共得桂枝一两十七铢。麻黄十六铢。生姜。芍药。各
一两六铢。甘草一两二铢。大枣五枚。杏仁十六个。合方。○成本。无本云以下二十九字。玉函。云。作方。）
〔柯〕邪气稽留于皮毛肌肉之间。固非桂枝之可解。已经汗过。又不宜麻黄汤之峻攻。故取桂枝汤三分之
二。麻黄汤三分之一。合而服之。再解其肌。微开其表。审发汗于不发之中。又用桂枝后。更用麻黄法也。后
人合为一方者。是大背仲景比较二方之轻重。偶中出奇之妙理矣。〔张〕详此方与各半。药品不殊。惟铢分稍异。
而证治攸分。可见仲景于差
多差少之间。分毫不苟也。
伤寒类方云。此与桂枝麻黄各半汤。意略同。但此因大汗出之后。故桂枝略重。而麻黄略轻。
服桂枝汤。大汗出后。大烦渴不解。脉洪大者。白虎加人参汤主之。（脉上。玉函。脉经。有若字。脉经。
千金方。作白虎汤。）
〔成〕大汗出。脉洪大而不渴。邪气犹在表也。可更与桂枝汤。若大汗出。脉洪大。而烦渴不解者。表里
有热。不可更与桂枝汤。可与白虎加人参汤。生津止渴。和表散热。〔钱〕此因大汗出后。遂至胃中津液耗竭。
阳邪乘虚入里。至大烦渴而不解。上编之大汗出。脉浮而微热。消渴者。及中篇之发汗后。脉浮数烦渴之证。
皆以误汗亡阳。下焦无火。膀胱之气化不行。失其蒸腾之用。故气液不得上升。而渴也。然脉浮。则其邪仍在
There are four characters "Ju San Wu" (chew three substances) in the original text. It originally stated to prepare this formula, but the Song edition does not record this formula. Volume 10 states: "Add one prepared Aconitum carmichaelii radix (Fuzi, 附子), peeled and broken into eight pieces, to the Guizhi Tang (Cinnamon Twig Decoction), and follow the previous method for preparation."
[Xu] This indicates a dual loss of Yang Qi (Vital Energy) and Yin Jin (Body Fluids), compounded by lingering Wind pathogen. If Si Ni Tang (Four Reversal Decoction) were used, the acrid-hot nature of dried ginger (Ganjiang, 干姜) would be inappropriate. If Zhen Wu Tang (True Warrior Decoction) were used, the draining-dampness properties of Poria (Fuling, 茯苓) and Atractylodes macrocephala Rhizome (Baizhu, 白术) would be inappropriate. Therefore, Guizhi Tang (Cinnamon Twig Decoction) is used with added Aconitum carmichaelii radix (Fuzi, 附子) to secure the exterior, dispel wind, restore Yang Qi, and consolidate fluids. [Zhou] Why did Zhang Zhongjing urgently use Aconitum carmichaelii radix (Fuzi, 附子)? The text says "sweating continues unceasingly," indicating that the sweating has no end in sight. The body's fluids are limited; how can they be allowed to leak endlessly? Thus, adding Aconitum carmichaelii radix (Fuzi, 附子) to Guizhi Tang (Cinnamon Twig Decoction) serves as a premier formula to secure the exterior and restore Yang. [Qian] This formula adds Aconitum carmichaelii radix (Fuzi, 附子) to the complete Guizhi Tang (Cinnamon Twig Decoction), hence the character "add" (Jia, 加). In the section on Wind-Dampness entanglement on the eighth day of Shaoyang disease, the Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) has removed Peony (Shaoyao, 芍药); it is not the complete Guizhi Tang (Cinnamon Twig Decoction) but a different formula, hence no "add" character. *Shanghan Leifang* (Classification of Formulas for Cold Damage) states: The limbs are the root of all Yang Qi. Urgent inability to flex and extend is a sign of fluid depletion and Yang deficiency, though not yet Yang collapse. If it worsens to cold extremities and aversion to cold, there is a risk of Yang collapse, and Si Ni Tang (Four Reversal Decoction) should be used. It also states: When Cinnamon Twig (Guizhi, 桂枝) is taken with Aconite (Fuzi, 附子), it can stop sweating and restore Yang.
Commentary: In Volume 10 of the Song edition, the Shu Fu Tang (Atractylodes and Aconite Decoction) is attached after this formula. In the whole book, it is transferred after this clause. This is likely due to a misplaced slip, based on the fact that Shu Fu Tang (Atractylodes and Aconite Decoction) follows Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) in the lower section of Taiyang disease.
Commentary: *Qianjin Fang* (Essential Prescriptions Worth a Thousand Gold) treats postpartum wind-deficiency with unceasing sweating, difficult urination, slight stiffness of the four limbs making them hard to flex and extend, using Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction). This perfectly demonstrates the ingenuity of Sun Simiao. Ye Shi's *Luyuan Fang* (Recorded Verified Prescriptions) contains Jiuhans Tang (Sweat-Saving Decoction) for treating spontaneous sweating due to Yang deficiency, which is this very formula, appearing in the chapter on Consumption.
*Benshi Fang* (Prescriptions from My Cabinet) records: A scholar contracted Taiyang disease. Due to sweating therapy, his sweating did not stop; he had aversion to wind, astringent urine, and his legs were cramped and bent, unable to straighten. I palpated his pulse: floating and large. Floating indicates Wind; large indicates Deficiency. I said: In Zhang Zhongjing's formulas, there are two syndromes that are largely similar but slightly different. One involves difficult urination; the other involves frequent urination. A slight error in medication leads to a thousand-li deviation. Clause 7 of Zhang Zhongjing states: "Taiyang disease, after sweating, sweating continues unceasingly, the person has aversion to wind, difficult urination, slight stiffness of the four limbs making them hard to flex and extend; use Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction with Added Aconite)." Clause 16 states: "Cold damage, pulse floating, spontaneous sweating, frequent urination, vexation, slight aversion to cold, cramping of the feet; giving Guizhi Tang to attack the exterior is an error. Upon contracting it, cold extremities occur, dryness in the throat, restlessness, vomiting, and counterflow." One has leaking sweat and difficult urination; the other has spontaneous sweating and frequent urination. Some have aversion to wind, some aversion to cold; the diseases are different. I used Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction with Added Aconite) from Clause 7. After three doses, sweating stopped. Assisted by Gan Shaoyao Tang (Sweet and Peony Decoction), the legs could straighten.
After purgation in Taiyang disease, if the pulse is rapid/urgent and there is chest fullness, Guizhi Qu Shaoyao Tang (Cinnamon Twig Decoction without Peony) governs. ([Original Note] "Rapid/urgent" (Cu, 促), alternatively written as "longitudinal" (Zong, 纵). ○ "After" (Hou, 后), Yuhan, Maijing, Qianjin Yi write as "its" (Qi, 其).)
[Cheng] In Taiyang disease, after purgation, if the pulse is rapid/urgent and there is no Jie Xiong (Chest Binding), this indicates the syndrome is about to resolve. (Clause 141) Here, after purgation, the pulse is rapid/urgent and there is chest fullness, so it cannot be considered about to resolve. This is because purgation damages Yang Qi, allowing the exterior pathogen to gradually enter and lodge in the chest. [Jian] In Taiyang disease, if the exterior is unresolved and purgation is used, if excess pathogen sinks into the chest, it causes chest fullness and Qi rushing up to the throat preventing breathing, which is a Gua Di San (Melon Spittle Powder) syndrome. If deficient pathogen sinks into the chest, it causes Qi rushing up, which is a Guizhi Tang (Cinnamon Twig Decoction) syndrome. Now, after purgation, the pathogen sinks into the chest, causing chest fullness and a rapid/urgent pulse. It seems like chest excess, yet lacks the symptom of Qi rushing to the throat preventing breathing; it seems like chest deficiency, yet exhibits chest fullness. Therefore, do not use Gua Di San (Melon Spittle Powder) to treat excess, nor Guizhi Tang (Cinnamon Twig Decoction) to treat deficiency. Only use the sweet-acrid nature of Cinnamon Twig (Guizhi, 桂枝) to harmonize the Taiyang exterior, and remove the sour-astringent Peony (Shaoyao, 芍药) to avoid aggravating the chest fullness. [Zhang] A rapid/urgent pulse indicates that although the exterior pathogen is not fully resolved, the chest is only full without binding, because erroneous purgation damaged the Yang Qi in the chest. [Qian] A rapid/urgent pulse (Cu, 促) does not refer to a pulse that is rapid with occasional pauses. It simply refers to urgency/swiftness, which can also be called Cu (促).
Gu Xianzhang's *Shanghan Suyuan Ji* (Source Tracing Collection for Cold Damage) states: Cu (促) implies shortness and urgency.
Guizhi Qu Shaoyao Tang (Cinnamon Twig Decoction without Peony) Formula
Guizhi (Cinnamomi Ramulus, 桂枝) (3 liang, peeled)
Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) (2 liang, honey-fried)
Shengjiang (Zingiberis Rhizoma Recens, 生姜) (3 liang, sliced)
Dazao (Ziziphi Jujubae Fructus, 大枣) (12 pieces, split open)
These four ingredients, use 7 sheng of water, boil to obtain 3 sheng, remove dregs, take 1 sheng warm. Originally said to be Guizhi Tang (Cinnamon Twig Decoction), now remove Peony (Shaoyao, 芍药). Adjust care as per previous methods. (Song edition does not record this formula. Volume 10 says: "Remove Peony (Shaoyao, 芍药) from the Guizhi Tang (Cinnamon Twig Decoction) formula, and follow the previous method for the rest." Yuhan has the character "Ju" (chew) under the ingredients, saying "prepare as a formula".)
If there is slight aversion to cold, Guizhi Qu Shaoyao Jia Fuzi Tang (Cinnamon Twig Decoction without Peony with Added Aconite) governs. (Originally missing the character "aversion" (E, 恶), now supplemented according to Song edition and Yuhan. In Song edition, "Guizhi Qu Shaoyao" is written as "Qu Shaoyao Fang Zhong" (In the formula removing Peony).)
[Shen] If the pulse is rapid/urgent and there is chest fullness, accompanied by slight aversion to cold, this indicates deficiency with Yang Qi about to collapse, which is not comparable to Yang excess. Therefore, add Aconite (Fuzi, 附子) to secure and protect Yang Qi.
Commentary: Zhang Zhicong and Zhang Xiju interpreted "slight aversion to cold" as meaning "pulse is faint and aversion to cold," which is incorrect.
Guizhi Qu Shaoyao Jia Fuzi Tang (Cinnamon Twig Decoction without Peony with Added Aconite) Formula
Guizhi (Cinnamomi Ramulus, 桂枝) (3 liang, peeled)
Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) (2 liang, honey-fried)
Shengjiang (Zingiberis Rhizoma Recens, 生姜) (3 liang, sliced)
Dazao (Ziziphi Jujubae Fructus, 大枣) (12 pieces, split open)
Fuzi (Aconiti Lateralis Radix Praeparata, 附子) (1 piece, prepared, peeled, broken into 8 pieces)
These five ingredients, use 7 sheng of water, boil to obtain 3 sheng, remove dregs, take 1 sheng warm. Originally said to be Guizhi Tang (Cinnamon Twig Decoction), now remove Peony (Shaoyao, 芍药) and add Aconite (Fuzi, 附子). Adjust care as per previous methods. (Song edition does not record this formula. Volume 10 says: "Remove Peony (Shaoyao, 芍药) from the Guizhi Tang (Cinnamon Twig Decoction) formula, add one piece of Aconite (Fuzi, 附子), prepared, peeled, broken into 8 pieces, and follow the previous method for the rest." Yuhan has the character "Ju" (chew) under the ingredients, saying "prepare as a formula".)
Contracting Taiyang disease for eight or nine days, presenting like malaria, with fever and aversion to cold, more heat than cold. The patient does not vomit, and bowel/bladder functions are relatively normal. It occurs two or three times a day. If the pulse is faint and slow, it indicates recovery is near. If the pulse is faint and there is aversion to cold, this indicates dual deficiency of Yin and Yang; do not administer sweating, purgation, or emesis again. If the face shows a contrary red color, the disease is not resolving, because he cannot produce a slight sweat, and the body will likely itch. Gui Zhi Ma Huang Ge Ban Tang (Half-Guizhi Half-Mahuang Decoction) is appropriate. (Yuhan and Qianjin Yi have the character "er" (and) after "fever" and "more heat". "Yu zi ke" is written as "zi tiao". Under "bi", there is the character "dang". In the chapter on "Cannot Sweat", "yu zi ke" is written as "xu zi ke", same as Maijing. Under this sentence, there is the character "wei". Qianjin Yi also has it.)
[Cheng] Fever and aversion to cold, with more heat than cold, indicate that Yang Qi is advancing and the pathogen is diminishing. If the interior is disharmonious, there is vomiting and diarrhea. Now, there is no vomiting, and bowel/bladder functions are self-regulated, indicating interior harmony. Occurring twice or three times a day indicates the pathogen is minor. Although the frequency is high today, the pulse is faint and slow, indicating the pathogen is faint and slow. Hence, it is said to be recovering. A faint pulse and aversion to cold indicate both exterior and interior deficiency. Yang represents the exterior, Yin represents the interior. A faint pulse indicates interior deficiency; aversion to cold indicates exterior deficiency. Because both exterior and interior are deficient, do not administer sweating, purgation, or emesis again. Dual deficiency of Yin and Yang results in a blue-white complexion. A contrary red color indicates the exterior is unresolved. Red color refers to crimson. Obtaining a slight sweat brings harmony; failing to sweat prevents the pathogen from dispersing through the skin, resulting in itching. Administer Gui Zhi Ma Huang Ge Ban Tang (Half-Guizhi Half-Mahuang Decoction) to slightly induce sweating and eliminate the exterior pathogen. [Fang] Eight or nine days refers to a long duration. Like malaria means having alternating chills and fever, but without a fixed pattern. "Geng" (more/again) means again. Cannot sweat because the exterior stage has passed. Cannot use emesis/purgation because there is no interior syndrome. [Qian] The pathogen is superficial, and the pulse is faint and slow. "Faint" here does not mean minute/thin, but rather slightly slower/more relaxed compared to before. The "faint" in faint pulse and aversion to cold refers to minute/thin, not the "faint/slow" mentioned earlier. [Wei] The character "small" in "small sweat" must be noted. The opinion is that both righteous Qi and pathogen are minor; profuse sweating is strictly prohibited. [Zhang] The first section resembles Xiao Chai Hu Tang (Minor Bupleurum Decoction) syndrome, verified by no vomiting and normal bowel/bladder function. The second section, despite faint pulse and aversion to cold, should only use Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) plus Astragalus (Huangqi, 黄芪) to warm the muscle spaces and regulate opening/closing, not for warming meridians. The third section, face showing red color, indicates the exterior pathogen is not fully resolved, hence suitable for Ge Ban Tang (Half-Half Decoction); do not compare it with "face combined with red color".
*Shanghan Suoyan* quotes Zhao Sizhen's *Huoren Shiyi*: Zhang Zhongjing's intent is that contracting disease for eight or nine days, presenting like malaria with fever and aversion to cold, more heat than cold, these sixteen characters describe the syndrome from the beginning to now. The following text describes future potential changes to prevent progression. It should be read in three sections. If the patient does not vomit, bowel/bladder functions are normal, occurring two or three times a day, with floating-slow pulse, it indicates recovery. This section indicates exterior harmony and no disease, while the pulse is faint, meaning the pathogen is faint and slow. Yin and Yang are equal; pulse and symptoms show signs of peace. Recovery may occur without sweating. If the pulse is faint and there is aversion to cold, this indicates dual deficiency of Yin and Yang; do not sweat, purge, or emese again. This section requires warming. If the face shows red color, it is not resolving, because he cannot produce a little sweat, and his body will itch. Use Gui Zhi Ma Huang Ge Ban Tang (Half-Guizhi Half-Mahuang Decoction). This section requires sweating to heal. ○ Commentary by Cheng: Treat as one head branching into three legs. His theory originates from Zhao.
*Maijing* quotes *Six Seasons Classic*: Qing Sou Li Tong. Annotation: Qing refers to the toilet. Sou exits via the water pathway, but referring to it as Qing Sou means defecating at the toilet. Liu Xi's *Shiming* says: Qing is a place of extreme filth, should be kept clean. Yan Shigu's annotation on *Jijiu Pian* says: Qing denotes a special place, always keep it clean. Cheng's annotation on *Bian Mai Pian*: Qing is Qing (toilet). ○ Commentary: In the Taiyang Middle Chapter, Qing Gu (clear grains) and Qing Xue (clear blood), their "Qing" is identical to Qing (toilet).
Commentary: For this dual deficiency of Yin and Yang, Gui Jia Fuzi Tang (Guizhi Tang with Added Aconite) or Fu Zi Tang (Aconite Decoction) should be used. Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) plus Huangqi (Astragalus) is likely insufficient.
*Shanghan Leifang* states: Minor pathogens are already in the skin, wanting to exit but unable, hence body itching. This decoction obtains slight sweating, which is sufficient. Yangming Chapter states: Body itching like insects crawling under the skin is due to long-term deficiency.
Gui Zhi Ma Huang Ge Ban Tang (Half-Guizhi Half-Mahuang Decoction) Formula
Guizhi (Cinnamomi Ramulus, 桂枝) (1 liang 16 zhu, peeled)
Shaoyao (Paeoniae Radix Alba, 芍药)
Shengjiang (Zingiberis Rhizoma Recens, 生姜) (sliced)
Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) (fried)
Dazao (Ziziphi Jujubae Fructus, 大枣) (4 pieces, split open)
Mahuang (Ephedrae Herba, 麻黄) (each 1 liang, nodes removed ○ Qianjin Yi writes nodes removed each 1 liang)
Xingren (Armeniacae Semen Amarum, 杏仁) (24 pieces, soaked in water, peel tips and twin kernels ○ Qianjin Yi omits "soaked in water")
These seven ingredients, use 5 sheng of water, first boil Mahuang (Ephedrae Herba, 麻黄) for 1-2 boils, remove foam on top, add other herbs, boil to obtain 1 sheng 8 he. Remove dregs, take 6 he warm. Originally said: Take 3 he of Guizhi Tang (Cinnamon Twig Decoction) and 3 he of Mahuang Tang (Ephedra Decoction), combine to make 6 he, take once. Adjust care as above. ([Note] Ministers Yi et al. carefully note: Guizhi Tang (Cinnamon Twig Decoction) formula: Guizhi (Cinnamomi Ramulus, 桂枝), Shaoyao (Paeoniae Radix Alba, 芍药), Shengjiang (Zingiberis Rhizoma Recens, 生姜) each 3 liang, Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) 2 liang, Dazao (Ziziphi Jujubae Fructus, 大枣) 12 pieces. Mahuang Tang (Ephedra Decoction) formula: Mahuang (Ephedrae Herba, 麻黄) 3 liang, Guizhi (Cinnamomi Ramulus, 桂枝) 2 liang, Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) 1 liang, Xingren (Armeniacae Semen Amarum, 杏仁) 72 pieces. Now calculating by algorithm, taking one-third of each decoction yields: Guizhi (Cinnamomi Ramulus, 桂枝) 1 liang 16 zhu, Shaoyao (Paeoniae Radix Alba, 芍药), Shengjiang (Zingiberis Rhizoma Recens, 生姜), Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) each 1 liang, Dazao (Ziziphi Jujubae Fructus, 大枣) 4 pieces, Xingren (Armeniacae Semen Amarum, 杏仁) 23 and 1/3 pieces, rounded to 24. Combining formulas, detailed analysis shows this is one-third, not half-half. It should be called He Ban Tang (Combined Half Decoction). ○ Yuhan has "Ju" (chew) under the seven ingredients, saying "prepare as a formula". Under "take once", there are five characters "now cut into one formula".)
[Ke] Taking 3 he of Guizhi Tang (Cinnamon Twig Decoction) and 3 he of Mahuang Tang (Ephedra Decoction) combines to 6 he. Later generations calculated the weights and combined them into one formula, greatly losing Zhang Zhongjing's intention in formulating. [Xu] The Wind pathogen is thin on the exterior but held by Cold, unable to disperse, hence the face shows suppressed heat color. It is necessary to resolve both Wind and Cold together, hence combining Guizhi (Cinnamon Twig) and Mahuang (Ephedra).
*Shanghan Leifang* states: This formula has very light dosages, totaling about 6 liang, equivalent to only 1 liang 3-4 qian in modern weights. Divided into three doses, only about 4 qian is taken per dose. It is a very mild formula for after the pathogen recedes, almost like no medicine.
In Taiyang disease, after initially taking Guizhi Tang (Cinnamon Twig Decoction), if vexation occurs and the condition does not resolve, first puncture Fengchi (GB20) and Fengfu (GV16) acupoints, then give Guizhi Tang (Cinnamon Twig Decoction) for recovery. ("First" has "dang" (should) in Yuhan and Qianjin Yi. Maijing has "fa dang" (method should).)
[Ke] This clause treats variations of Wind Strike. Guizhi Tang (Cinnamon Twig Decoction) boils to 3 sheng. Initial taking means taking 1 sheng first. "Que yu" (then give) means finishing the remaining 2 sheng. Heat stagnating in the heart/chest is called Vexation (Fan, 烦). Heat manifesting in skin/flesh is called Fever (Re, 热). Mahuang Tang (Ephedra Decoction) syndrome has fever without sweat, heat entirely on the exterior. Guizhi Tang (Cinnamon Twig Decoction) syndrome has fever with sweat, revealing internal vexation. Taking the decoction causes vexation, and external heat does not resolve; this does not mean Guizhi Tang (Cinnamon Twig Decoction) is inappropriate. It is because the external Wind pathogen is heavy, and internal Yang Qi is also heavy. Wind pathogen enters from the neck; one must puncture Fengchi (GB20) and Fengfu (GV16) to clear the pathway and expel the pathogen. Then give Guizhi Tang (Cinnamon Twig Decoction) to harmonize Ying and Wei. *Neijing* states: Puncture exterior and interior, take medicines and soups; this method is correct.
*Shanghan Leifang* states: This is not erroneous treatment. Because Wind pathogen condenses on the main route of Taiyang, medicinal power cannot circulate, hence puncture to resolve the knot. The pathogen is too severe, not only in Wei (Defensive) level but in Jing (Meridian) level; puncture to drain Jing Qi.
*Suwenn · Gugong Lun* states: Wind entering from outside causes shaking chills, sweating, headache, heaviness of body, and aversion to cold. Treat at Fengfu (GV16). Severe wind causing neck/head pain, puncture Fengfu (GV16). Fengfu (GV16) is at the upper vertebra.
*Jiayi Jing* states: Fengchi (GB20) acupoint, two points, behind the temples, in the depression at the hairline, intersection of Foot-Shaoyang and Yangwei vessels. Fengfu (GV16) acupoint, one point, one cun above the nape hairline, in the depression between the large tendons, intersection of Du and Yangwei vessels.
Commentary: *Zhenjiu Zisheng Jing* states: When Qibo answered Huangdi's question: Juyang (Greater Yang) belongs to all Yang Qi. Its meridian connects to Fengfu (GV16), thus governing all Yang Qi. Therefore, Fengfu (GV16) is indeed where Cold Damage originates. Northerners wrap it with fur; southerners who are weak protect their necks with cloth, commonly called "triangle". Ke's theory is based on this.
After taking Guizhi Tang (Cinnamon Twig Decoction), if profuse sweating occurs and the pulse is洪大 (Hongda, Large and Surging), give Guizhi Tang (Cinnamon Twig Decoction) as before. If the body resembles malaria, occurring twice a day, sweating will resolve it; Gui Zhi Er Ma Huang Yi Tang (Two-Parts Guizhi One-Part Mahuang Decoction) is appropriate. (Song edition, "si" (resemble) is written as "ru" (like). Yuhan and Maijing are the same. "Mai hong da zhe" is written as "ruo mai dan hong da zhe". Under "zai", Maijing has three characters.)
[Zhi] Profuse sweating and Hongda (Large and Surging) pulse indicate Qi of muscle pores combining externally with the skin surface, marking Yang Qi abundance, hence Hongda (Large and Surging) pulse and sweating. Follow the previous method of drinking porridge to assist medicinal power. [Ke] After taking Guizhi Tang (Cinnamon Twig Decoction), if chills and fever resemble malaria, originally Mahuang Tang (Ephedra Decoction) should be used for sweating, but using Guizhi Tang (Cinnamon Twig Decoction) results in incomplete sweating. Generally, excessive sweating in Taiyang transfers to Yangming; insufficient sweating transfers to Shaoyang. Although there is alternating chills and fever, head and neck stiffness has not ceased, indicating Taiyang exterior remains. Because Wind pathogen lingers in Ying and Wei, moving unpredictably, it occurs twice a day, or three times. [Jian] After taking Guizhi Tang (Cinnamon Twig Decoction), profuse sweating, disease unresolved, Hongda (Large and Surging) pulse, if there is vexation and thirst, the exterior pathogen has entered Yangming, which is Bai Hu Tang (White Tiger Decoction) syndrome. Now, although the pulse is Hongda (Large and Surging), there is no vexation or thirst, so the exterior pathogen remains in Taiyang. Yuhan has the character "dan" (only), confirming no other syndromes.
Gui Zhi Er Ma Huang Yi Tang (Two-Parts Guizhi One-Part Mahuang Decoction) Formula
Guizhi (Cinnamomi Ramulus, 桂枝) (1 liang 17 zhu, peeled)
Shaoyao (Paeoniae Radix Alba, 芍药) (1 liang 6 zhu)
Mahuang (Ephedrae Herba, 麻黄) (16 zhu, nodes removed)
Shengjiang (Zingiberis Rhizoma Recens, 生姜) (1 liang 6 zhu, sliced)
Xingren (Armeniacae Semen Amarum, 杏仁) (16 pieces, peel tips ○ Qianjin Yi has "twin kernels")
Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) (1 liang 2 zhu, fried)
Dazao (Ziziphi Jujubae Fructus, 大枣) (5 pieces, split open)
These seven ingredients, use 5 sheng of water, first boil Mahuang (Ephedrae Herba, 麻黄) for 1-2 boils, remove foam on top, add other herbs, boil to obtain 2 sheng, remove dregs, take 1 sheng warm, twice daily. Originally said: Two parts Guizhi Tang (Cinnamon Twig Decoction), one part Mahuang Tang (Ephedra Decoction), combine to make 2 sheng, divide into two doses. Now combine into one formula, adjust care as before. ([Note] Ministers Yi et al. carefully note: Guizhi Tang (Cinnamon Twig Decoction) formula: Guizhi (Cinnamomi Ramulus, 桂枝), Shaoyao (Paeoniae Radix Alba, 芍药), Shengjiang (Zingiberis Rhizoma Recens, 生姜) each 3 liang, Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) 2 liang, Dazao (Ziziphi Jujubae Fructus, 大枣) 12 pieces. Mahuang Tang (Ephedra Decoction) formula: Mahuang (Ephedrae Herba, 麻黄) 3 liang, Guizhi (Cinnamomi Ramulus, 桂枝) 2 liang, Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) 1 liang, Xingren (Armeniacae Semen Amarum, 杏仁) 70 pieces. Now calculating by algorithm, taking 5/12 of Guizhi Tang (Cinnamon Twig Decoction) yields: Guizhi (Cinnamomi Ramulus, 桂枝), Shaoyao (Paeoniae Radix Alba, 芍药), Shengjiang (Zingiberis Rhizoma Recens, 生姜) each 1 liang 6 zhu, Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) 20 zhu, Dazao (Ziziphi Jujubae Fructus, 大枣) 5 pieces. Taking 2/9 of Mahuang Tang (Ephedra Decoction) yields: Mahuang (Ephedrae Herba, 麻黄) 16 zhu, Guizhi (Cinnamomi Ramulus, 桂枝) 10 zhu and 2/3 zhu, rounded to 11 zhu, Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) 5 zhu and 1/3 zhu, rounded to 6 zhu, Xingren (Armeniacae Semen Amarum, 杏仁) 15 and 4/9 pieces, rounded to 16 pieces. Combining the taken amounts from both decoctions yields: Guizhi (Cinnamomi Ramulus, 桂枝) 1 liang 17 zhu, Mahuang (Ephedrae Herba, 麻黄) 16 zhu, Shengjiang (Zingiberis Rhizoma Recens, 生姜), Shaoyao (Paeoniae Radix Alba, 芍药) each 1 liang 6 zhu, Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) 1 liang 2 zhu, Dazao (Ziziphi Jujubae Fructus, 大枣) 5 pieces, Xingren (Armeniacae Semen Amarum, 杏仁) 16 pieces. Combine formula. ○ Song edition lacks the 29 characters from "Ben Yun" onwards. Yuhan says "prepare as a formula".)
[Ke] Pathogen lingering between skin and muscles cannot be resolved by Guizhi Tang (Cinnamon Twig Decoction) alone. Having already sweated, Mahuang Tang (Ephedra Decoction) is too harsh. Hence, take 2/3 of Guizhi Tang (Cinnamon Twig Decoction) and 1/3 of Mahuang Tang (Ephedra Decoction), combine and take, to resolve the muscle layer again, slightly open the exterior. Carefully induce sweating within non-sweating, employing the method of using Mahuang (Ephedra) after Guizhi (Cinnamon Twig). Later generations combining them into one formula greatly背离 (deviate from) Zhang Zhongjing's comparison of the weight of the two formulas, accidentally hitting the profound principle. [Zhang] Detailed examination shows this formula differs from Ge Ban Tang (Half-Half Decoction) only slightly in dosage units, yet the syndrome and treatment are distinct. This shows Zhang Zhongjing was meticulous even in small differences.
*Shanghan Leifang* states: This is similar in intent to Gui Zhi Ma Huang Ge Ban Tang (Half-Guizhi Half-Mahuang Decoction), but because this follows profuse sweating, Guizhi (Cinnamon Twig) is slightly heavier and Mahuang (Ephedra) slightly lighter.
After taking Guizhi Tang (Cinnamon Twig Decoction), following profuse sweating, if severe vexation and thirst persist and are not resolved, and the pulse is Hongda (Large and Surging), Bai Hu Jia Ren Shen Tang (White Tiger Decoction with Added Ginseng) governs. ("Mai" (pulse) has "ruo" (if) in Yuhan and Maijing. Maijing and Qianjin Fang write "Bai Hu Tang" (White Tiger Decoction).)
[Cheng] Profuse sweating, Hongda (Large and Surging) pulse without thirst, pathogen still on the exterior; can give Guizhi Tang (Cinnamon Twig Decoction) again. If profuse sweating, Hongda (Large and Surging) pulse, with unresolved severe vexation and thirst, interior and exterior have heat; do not give Guizhi Tang (Cinnamon Twig Decoction) again. Can give Bai Hu Jia Ren Shen Tang (White Tiger Decoction with Added Ginseng) to generate fluids, stop thirst, harmonize exterior, and dissipate heat. [Qian] This is because after profuse sweating, stomach fluids are exhausted, Yang pathogen enters the interior through deficiency, causing severe unresolved vexation and thirst. In the upper section, profuse sweating, floating pulse with slight heat, and thirst, and in the middle section, after sweating, floating-rapid pulse with vexation and thirst, all are due to erroneous sweating causing Yang collapse, lack of fire in the Lower Jiao, failure of Bladder Qi transformation, loss of steaming function, hence Qi and fluids cannot rise, causing thirst. However, since the pulse is floating, the pathogen remains...