太阳病。项背强KT KT 。无汗恶风。葛根汤主之。（无汗。外台。作反汗不出四字。风下。可发汗篇。
及玉函。外台。有者字。）
〔方〕无汗者。以起自伤寒。故汗不出。乃上编有汗之反对。风寒之辨别也。恶风。乃恶寒之互文。风寒
皆通恶。而不偏有无也。〔魏〕其辨风寒。亦重有汗无汗。亦不以畏恶风寒多少为准。畏恶风寒。不过兼言互
言。以参酌之云耳。
葛根汤方
葛根（四两） 麻黄（三两去节○外台。作四两） 桂枝（二两去皮○外台。作桂心） 生姜（三两切）
甘草（二两炙） 芍药（二两○成本。有切字） 大枣（十二枚擘）
上七味。以水一斗。先煮麻黄葛根。减二升。去白沫。纳诸药。煮取三升。去滓。温服一升。覆取微似汗。
余如桂枝法。将息及禁忌。诸汤皆仿此。（味下。玉函。成本。有 咀二字。外台。有切字。白沫。玉函。千
金翼。外台。作上沫。成本。只作去沫。似汗下。玉函。成本。千金翼。有不须啜粥四字。外台。有出不须吃
热粥助药发九字。成本。无诸汤皆仿此五字。）
〔柯〕KT KT 更甚于项强。而无汗不失为表实。脉浮不紧数。是中于鼓动之阳风。故以桂枝汤为主。而
加麻葛。以攻其表实也。葛根味甘气凉。能起阴气而生津液。滋筋脉而舒其牵引。故以为君。麻黄生姜。能开
玄府腠理之闭塞。祛风而去汗。故以为臣。寒热俱轻。故少佐桂芍。同甘枣以和里。此于麻桂二汤之间。衡其
轻重。而为调和表里之剂也。葛根与桂枝。同为解肌和里之剂。故有汗无汗。下利不下利。皆可用。与麻黄专
于治表者不同。东垣用药分经。不列于太阳。
而列于阳明。易老云。未入阳明者。不可服。岂二子未读仲景书耶。喻氏谓仲景不用于阳明。恐亡津液。与本
草生津之说左矣。桂枝汤啜粥者。因无麻黄之开。而有芍药之敛。恐邪有不尽。故假谷气以逐之。此汗生于谷
也。〔喻〕设以麻黄本汤加葛根。大发其汗。将无项背强KT KT 者。变为经脉振摇动惕乎。此仲景之所为精义
入神也。
绛雪园古方选注曰。即桂枝汤。加麻黄。倍葛根。以去营实。小变麻桂之法也。独是葛根麻黄。治营卫实。
芍药桂枝。治营卫虚。方中虚实互复者。其微妙在法先煮麻黄葛根减二升。后纳诸药。则是发营卫之汗为先。
而固表收阴袭于后。不使热邪传入阳明也。故仲景治太阳病未入阳明者。用以驱邪。断入阳明之路。若阳明正
病中。未尝有葛根之方。东垣易老谓葛根是阳明经主药。误矣。
案钱氏欲麻黄汤中加葛根。名麻黄加葛根汤。以与桂枝加葛根汤。两方并峙。遂以去方中之芍药为说。然
仍有姜枣。而无杏仁。未得为麻黄加葛根汤。其说不可从矣。
外台秘要。延年秘录。解肌汤。主天行二三日。头痛壮热。
于本方。去生姜。加黄芩二两。
太阳与阳明合病者。必自下利。葛根汤主之。（【原注】一云用后第四方。○玉函。无者字。下字。脉经。
作太阳与阳明合病。而自利不呕者。属葛根汤证。千金翼注。一云。用后葛根黄芩黄连汤。）
〔成〕伤寒。有合病。有并病。本太阳病不解。并于阳明者。谓之并病。二经俱受邪。相合病者。谓之合
病。合病者。邪气甚也。太阳阳明合病者。与太阳少阳合病。阳明少阳合病。皆言必自下利者。以邪气并于阴。
则阴实而阳虚。邪气并于阳。则阳实而阴虚。寒邪气甚。客于二阳。二阳方外实。而不主里。则里气虚。故必
下利。与葛根汤。以散经中甚邪。
〔鉴〕太阳与阳明合病者。谓太阳之发热。恶寒无汗。与阳明之烦热不得眠等证。同时均病。表里之气。升降
失常。故下利也。治法解太阳之表。表解而阳明之里自和矣。〔方〕必。定然之词。自。谓自然而然也。伤寒
无他故。自然而然下利者。太阳阳明合病。经中之邪热甚。胃气弱不化谷不厘清。杂迸而走注。所以谓之必也。
但以葛根汤。散经中之寒邪。而以不治治利也。〔程〕合病之证。凡太阳之头痛恶寒等证。与阳明之喘渴胸满
等证。同时均发。无有先后也。但见一证便是。不必悉具。并病亦如是看。仍须兼脉法断之。
明理论曰。太阳与阳明合病。必自下利。葛根汤主之。太阳与少阳合病。必自下利。黄芩汤主之。阳明与
少阳合病。必自下利。大承气汤主之。三者皆合病下利。一者发表。一者攻里。一者和解。所以不同也。下利
家。何以明其寒热邪。且自利不渴属太阴。以其脏寒故也。下利欲饮水者。以有热也。故大便溏。小便自可者。
此为有热。自利小便色白者。少阴病形悉具。此为有寒。恶寒脉微。自利清谷。此为有寒。发热后重。泄色黄
赤。此为有热。皆可理其寒热也。
太阳与阳明合病。不下利。但呕者。葛根加半夏汤主之。（玉函。无太阳以下六字。接上条。）
〔成〕邪气外甚。阳不主里。里气不和。气下而不上者。但下利而不呕。里气上逆而不下者。但呕而不下
利。与葛根汤。以散其邪。加半夏。以下逆气。
葛根加半夏汤方
葛根（四两） 麻黄（三两去节○玉函。作二两。成本。有汤泡去黄汁焙干称八字） 甘草（二两炙）
芍药（二两） 桂枝（二两去皮） 生姜（二两切○可发汗篇。成本。及诸家。并作三两。是） 半夏（半升洗）
大枣（十二枚擘）
上八味。以水一斗。先煮葛根麻黄。减二升。去白沫。
纳诸药。煮取三升。去滓。温服一升。覆取微似汗。（白。玉函。作上。）
〔汪〕愚以既云呕矣。其人胸中能免满逆之证乎。汤中半夏。固宜加矣。而甘草大枣之甘。能不相碍乎。
或云。方中止甘草二两。大枣十二枚。已有生姜三两。复加半夏半升。于呕家又何碍。斯言实合仲景用药之旨。
太阳病。桂枝证。医反下之。利遂不止。脉促者。表未解也。喘而汗出者。葛根黄芩黄连汤主之。（【原
注】促一作纵○玉函。脉经。千金翼。作遂利不止。脉上。有其字。）
〔成〕桂枝证者。邪在表也。而反下之。虚其肠胃。为热所乘。遂利不止。邪在表则见阳脉。邪在里则见
阴脉。下利脉微迟。邪在里也。促为阳盛。虽下利而脉促者。知表未解也。病有汗出而喘者。为自汗出而喘也。
即邪气外甚所致。喘而汗出者。为因喘汗出也。即里热气逆所致。与葛根黄芩黄连汤。散表邪除里热。（汪云。
成注。虚其肠胃。此非肠胃真虚证。乃胃有邪热。下通于肠。而作泄也。）〔钱〕促为阳盛。下利则脉不应促。
以阳邪炽盛。故脉加急促。是以知其邪尚在表而未解也。然未若协热下利之表里俱不解。及阳虚下陷。阴邪上
结。而心下痞硬。故但言表而不言里也。〔柯〕邪束于表。阳扰于内。故喘而汗出。利遂不止者。所谓暴注下
迫。皆属于热。与脉弱而协热下利不同。此微热在表。而大热入里。固非桂枝芍药所能和。浓朴杏仁所宜加矣。
〔鉴〕协热利二证。以脉之阴阳。分虚实主治。固当矣。然不可不辨其下利之粘秽鸭溏。小便或白或赤。脉之有
力无力也。〔锡〕案下后发喘汗出。乃天气不降。地气不升之危证。宜用人参四逆辈。仲景用葛根黄芩黄连者。
专在表未解一句。
伤寒类方曰。促有数意。邪犹在外。尚未陷入三阴。而
见沉微等证象。故不用理中等法。
葛根黄芩黄连汤方（○千金。外台。作葛根黄连汤。）
葛根（半斤○外台。作八两。） 甘草（二两炙） 黄芩（三两○成本。作二两。外台。有切字。）
黄连（三两○外台。有金色者三字。）
上四味。以水八升。先煮葛根。减二升。纳诸药。煮取二升。去滓。分温再服。（味下。玉函。有 咀
字。外台。有切字。二升下。外台。有掠去沫三字。）
〔柯〕君气轻质重之葛根。以解肌而止利。佐苦寒清肃之芩连。以止汗而除喘。用甘草以和中。先煮葛
根。后纳诸药。解肌之力优。而清中之气锐。又与补中逐邪之法迥殊矣。
古方选注曰。是方。即泻心汤之变。治表寒里热。其义重在芩连。整肃里热也。
伤寒类方曰。因表未解。故用葛根。因喘汗而利。故用芩连之苦。以泄之坚之。芩连甘草。为治痢之主药。
太阳病。头痛发热。身疼腰痛。骨节疼痛。恶风。无汗而喘者。麻黄汤主之。（玉函。脉经。千金翼。
身疼。作身体疼。千金。恶风。作恶寒。外台。作伤寒头疼腰痛。身体骨节疼。发热恶风汗不出而喘。）
〔柯〕太阳主一身之表。风寒外束。阳气不伸。故一身尽疼。太阳脉抵腰中。故腰痛。太阳主筋。所生病。
诸筋者皆属于节。故骨节疼痛。从风寒得。故恶风。风寒客于人。则皮毛闭。故无汗。太阳为诸阳主气。阳气
郁于内。故喘。太阳为开。立麻黄汤以开之。诸证悉除矣。麻黄八证。头痛发热恶风。同桂枝症。无汗身疼。
同大青龙症。本症。重在发热身疼。无汗而喘。本条不冠伤寒。又不言恶寒。而言恶风。先辈言麻黄汤主治伤
寒。不治中风。似非确论。盖麻黄汤。大青龙汤。治中风之重剂。桂枝汤。葛根汤。治中风之轻剂。伤寒可通
用之。非主治伤寒之剂也。〔钱〕恶风。虽或可与恶
寒互言。然终是营伤卫亦伤也。何则。卫病则恶风。营居卫内。寒已入营。岂有不从卫分而入者乎。故亦恶风
也。〔鉴〕无汗者。伤寒实邪。腠理闭密。虽发热而汗不出。不似中风虚邪发热。而汗自出也。
案神农本草经。麻黄。主治中风伤寒头痛。病源候论曰。夫伤寒病者。起自风寒。入于腠理。与精气分争。
营卫痞隔。周行不通。病一日至二日。气在孔窍皮肤之间。故病者头痛恶寒。腰背强重。此邪气在表。发汗则
愈。夫麻黄发汗。而主中风。既言伤寒。而又言起自风寒。乃伤寒中风。可互为外感之称。亦不可凿凿以汗之
有无。恶之风寒。伤之营卫。为之差别也。
麻黄汤方
麻黄（三两去节） 桂枝（二两去皮○正脉本。作三两。非） 甘草（一两炙○千金翼。作二两） 杏仁
（七十第。去皮尖。○第。成本。作个。第。乃 之讹。玉函。千金翼。作枚。去上。成本。有汤字。尖下。
千金翼。有两仁者三字。外台。作去皮尖两人碎。千金云。喘不甚。用五十枚。）
上四味。以水九升。先煮麻黄减二升。去上沫。纳诸药。煮取二升半。去滓。温服八合。覆取微似汗。不
须啜粥。余如桂枝法将息。（味下。玉函。有 咀字。外台。有切字。玉函。作温覆出汗。）
〔钱〕李时珍云。津液为汗。汗即血也。在营则为血。在卫则为汗。夫寒伤营。营血内涩。不能外通于卫。
卫气闭固。津液不行。故无汗发热而憎寒。夫风伤卫。卫气受邪。不能内护于营。营气虚弱。津液不固。故有
汗发热而恶风。然风寒之邪。皆由皮毛而入。皮毛者。肺之合也。肺主卫气。包罗一身。天之象也。证虽属乎
太阳。而肺实受邪气。其证。时兼面赤怫郁。咳嗽痰喘。胸满诸证者。非肺病乎。盖皮毛外闭。则邪热内攻。
而肺气 郁。故用麻黄甘草。同桂枝引
出营分之邪。达之肌表。佐以杏仁。泄肺而利气。是则麻黄汤。虽太阳发汗重剂。实为发散肺经火郁之药也。
濒湖此论。诚千古未发之秘。唯桂枝为卫分解肌之药。而能与麻黄同发营分之汗者。以卫居营外。寒邪由卫入
营。故脉阴阳俱紧。阳脉紧。则卫分受邪。阴脉紧。则邪伤营分。所以欲发营内之寒邪。先开卫间之出路。方
能引邪由营达卫。汗出而解也。后人有用麻黄而监之以桂枝。见节制之妙。更有驭六马而执辔唯谨。恒虞其泛
轶之说。岂理也哉。〔柯〕此方。治风寒在表。头痛项强。发热身痛。腰痛骨节烦疼。恶风恶寒。无汗胸满而喘。
其脉浮紧浮数者。此为开表逐邪发汗之峻剂也。此汤入胃。行气于玄府。输精于皮毛。斯毛脉合精。而溱溱汗
出。在表之邪。其尽去而不留。痛止喘平。寒热顿解。不烦啜粥而藉汗于谷也。其不用姜枣者。以生姜之性。
横散解肌。碍麻黄之上升。大枣之性。滞泥于膈。碍杏仁之速降。此欲急于直达。稍缓则不迅。横散则不峻矣。
若脉浮弱。汗自出者。或尺脉微迟者。是桂枝所主。非此方所宜也。〔鉴〕庸工不知其制在温覆取汗。若不温覆
取汗。则不峻也。遂谓麻黄专能发表。不治他病。孰知此汤合桂枝汤。名麻桂各半汤。用以和太阳留连未尽之
寒热。去杏仁加石膏。合桂枝汤。名桂枝二越婢一汤。用以解太阳热多寒少之寒热。若阳盛于内。无汗而喘者。
又有麻黄杏仁甘草石膏汤。以解散太阴肺家之邪。若阴盛于内。而无汗者。又有麻黄附子细辛甘草汤。以温散
少阴肾家之寒。金匮要略。以此方去桂枝。千金方。以此方桂枝易桂。皆名还魂汤。用以治邪在太阴。卒中暴
厥。口噤气绝。下咽奏效。而皆不温覆取汗。因是而知麻黄汤之峻与不峻。在温覆与不温覆也。此仲景用方之
心法。岂常人之所得而窥耶。
伤寒类方曰。此痛处比桂枝症。尤多而重。因营卫俱伤故也。恶风无汗而喘者。乃肺气不舒之故。麻黄
Taiyang disease (disease of the Taiyang channel). Stiffness and tension in the nape and back. Anhidrosis (absence of sweating) and aversion to wind. Gegen Tang (Pueraria Decoction) is the primary treatment. (Anhidrosis. *Waitai Miyao* reads "contrary absence of sweat". In the "Chapter on Inducing Sweating" and *Yuhan Jing*, *Waitai Miyao*, the character "you" (having/existence) is present.)
[Fang] The absence of sweat arises from Shanghan (Cold Damage), hence no sweat is produced; this stands in contrast to the presence of sweat described in the preceding section, serving as a method to distinguish between Wind-Cold pathogens. Aversion to wind is synonymous with aversion to cold. Both Wind and Cold pathogens are associated with aversion, without bias towards the presence or absence of sweat. [Wei] The distinction between Wind and Cold also emphasizes the presence or absence of sweat, not relying on the degree of aversion to cold or wind. Aversion to cold and wind is merely supplementary language used for reference and judgment.
Gegen Tang Formula
Gegen (Radix Puerariae Lobatae, 4 liang) Mahuang (Herba Ephedrae, 3 liang, remove nodes ○ *Waitai* makes it 4 liang) Guizhi (Ramulus Cinnamomi, 2 liang, remove bark ○ *Waitai* makes it Guixin/Cinnamon Heart) Shengjiang (Rhizoma Zingiberis Recens, 3 liang, sliced)
Gancao (Radix Glycyrrhizae, 2 liang, honey-fried) Shaoyao (Radix Paeoniae Alba, 2 liang ○ Bencao edition has the character "qie"/sliced) Dazao (Fructus Jujubae, 12 pieces, split open)
The above seven ingredients. Use one dou of water. First decoct Mahuang and Gegen, reduce by two sheng, remove the white foam. Add the remaining herbs. Decoct to obtain three sheng of liquid. Remove the dregs. Take one sheng warm. Cover with blankets to induce a slight, uniform sweating.
Rest and dietary restrictions follow the method of Guizhi Tang. All other decoctions imitate this method. (Under "ingredients", *Yuhan Jing* and Bencao edition have the character "ju"/chew. *Waitai* has "qie"/slice. White foam: *Yuhan Jing*, *Qianjin Yifang*, *Waitai* read "shang mo"/upper foam. Bencao edition only reads "remove foam". Under "slight sweat", *Yuhan Jing*, Bencao edition, *Qianjin Yifang* have "no need to drink porridge" four characters. *Waitai* has "do not need to eat hot porridge to assist medicine in inducing sweat" nine characters. Bencao edition lacks the five characters "all decoctions imitate this".)
[Ke] Stiffness in the nape and back is more severe than neck stiffness alone, yet the absence of sweat still indicates exterior excess syndrome. The pulse is floating but not tight or rapid, indicating invasion by Yang-wind which stirs movement. Therefore, Guizhi Tang is used as the base, adding Mahuang and Gegen to attack the exterior excess. Gegen is sweet in taste and cool in nature; it can raise Yin Qi, generate fluids, nourish sinews and vessels, and relieve traction. Thus, it serves as the Sovereign herb. Mahuang and Shengjiang can open the closure of Xuanfu (pores) and Couli (interstices), dispel Wind, and promote sweating; thus, they serve as Ministers. Since both Cold and Heat symptoms are mild, a small amount of Guizhi and Shaoyao is added as assistants, along with Gancao and Dazao to harmonize the interior. This formula balances the severity between Mahuang Tang and Guizhi Tang, acting as a harmonizer of the exterior and interior. Gegen and Guizhi are both agents that resolve the muscle layer and harmonize the interior; therefore, they can be used whether there is sweat or not, and whether there is diarrhea or not. This differs from Mahuang, which specializes in treating the exterior. Dongyuan categorized herbs by channels and did not list Gegen under the Taiyang channel, but rather under the Yangming channel. Yilao stated that those whose pathogen has not entered the Yangming channel should not take it. Did these two scholars not read Zhang Zhongjing's book? Yu Shi claimed that Zhongjing did not use Gegen for Yangming diseases because it might deplete body fluids, which contradicts the materia medica's statement about generating fluids. The reason for drinking porridge with Guizhi Tang is that, lacking the opening action of Mahuang but possessing the astringent action of Shaoyao, there is fear that pathogens will not be fully expelled; thus, grain Qi is borrowed to drive them out. Sweat is born from grain Qi. [Yu] If one were to add Gegen to the basic Mahuang Tang and induce heavy sweating, would it not cause the person with stiff nape and back to develop trembling and palpitations of the meridians? This is the profound essence of Zhongjing's genius.
*Jiangxueyuan Gufang Xuanzhu* states: This is simply Guizhi Tang, adding Mahuang and doubling Gegen to remove excess in the Ying (Nutritive) level, slightly altering the methods of Mahuang and Guizhi. However, Gegen and Mahuang treat Ying-Wei excess, while Shaoyao and Guizhi treat Ying-Wei deficiency. The subtlety of combining deficiency and excess treatments in this formula lies in the method: first decocting Mahuang and Gegen to reduce by two sheng, then adding other herbs. This prioritizes inducing sweat from Ying and Wei, followed by securing the exterior and preserving Yin, preventing heat pathogens from transmitting into the Yangming channel. Thus, when Zhongjing treats Taiyang disease that has not yet entered Yangming, he uses this to expel pathogens and block the path to Yangming. There is no Gegen formula for primary Yangming disease. Dongyuan and Yilao claiming Gegen is the chief herb for the Yangming channel is incorrect.
Note: Qian Shi wanted to add Gegen to Mahuang Tang, naming it Mahuang Jia Gegen Tang, to stand alongside Guizhi Jia Gegen Tang, arguing for removing Shaoyao from the formula. However, since it still contains Jiang and Zao but lacks Xingren, it cannot be called Mahuang Jia Gegen Tang. His theory is untenable.
*Waitai Miyao* and *Yannian Milu* Jiemi Tang treats Tianxing (epidemic) disease for two to three days, with headache and high fever.
In this formula, remove Shengjiang, add Huangqin (Radix Scutellariae, 2 liang).
When Taiyang and Yangming channels are simultaneously affected (Hebing), spontaneous diarrhea will occur. Gegen Tang is the primary treatment. ([Original Note] One version says use the fourth formula below. ○ *Yuhan Jing* lacks the character "zhe". The character "xia" (diarrhea): *Maijing* reads "Taiyang and Yangming Hebing, with spontaneous diarrhea but no vomiting, belongs to Gegen Tang syndrome." *Qianjin Yifang* note: One version says use Gegen Huangqin Huanglian Tang below.)
[Cheng] Shanghan includes Hebing (simultaneous involvement) and Bingbing (sequential involvement). When Taiyang disease does not resolve and transmits to Yangming, it is called Bingbing. When both channels are affected by pathogens simultaneously, it is called Hebing. Hebing indicates severe pathogenic factors. In Taiyang-Yangming Hebing, as well as Taiyang-Shaoyang Hebing and Yangming-Shaoyang Hebing, all mention spontaneous diarrhea because when pathogens congregate in Yin, Yin becomes full and Yang deficient; when pathogens congregate in Yang, Yang becomes full and Yin deficient. Severe Cold pathogens lodge in the two Yang channels. These channels are externally solid and do not govern the interior, leading to interior deficiency, hence spontaneous diarrhea. Gegen Tang is given to disperse the severe pathogens in the channels.
[Jian] Taiyang and Yangming Hebing means that symptoms of Taiyang (fever, aversion to cold, anhidrosis) and Yangming (restlessness, heat, insomnia) occur simultaneously. The ascending and descending of Exterior and Interior Qi become disordered, resulting in diarrhea. The treatment principle is to release the Taiyang exterior; once the exterior is resolved, the Yangming interior naturally harmonizes. [Fang] "Bi" (must) implies certainty. "Zi" (spontaneously) means naturally. In Shanghan, without other causes, spontaneous diarrhea occurs because in Taiyang-Yangming Hebing, the pathogenic heat in the channels is severe, stomach Qi is weak, failing to transform grain and separate clear from turbid, causing chaotic discharge. Hence it is called "must". Simply use Gegen Tang to disperse Cold pathogens in the channels, treating the diarrhea indirectly without directly targeting it. [Cheng] Symptoms of Hebing involve Taiyang symptoms (headache, aversion to cold) and Yangming symptoms (wheezing, thirst, chest fullness) occurring simultaneously, without sequence. Seeing one symptom is sufficient; not all need to be present. Bingbing is viewed similarly. Pulse diagnosis must also be considered.
*Ming Lilun* states: Taiyang and Yangming Hebing leads to spontaneous diarrhea, treated with Gegen Tang. Taiyang and Shaoyang Hebing leads to spontaneous diarrhea, treated with Huangqin Tang. Yangming and Shaoyang Hebing leads to spontaneous diarrhea, treated with Dachengqi Tang. All three involve diarrhea due to Hebing, but differ in that one releases the exterior, one purges the interior, and one harmonizes. How to distinguish Cold and Heat in diarrhea? Spontaneous diarrhea without thirst belongs to Taiyin due to organ Cold. Diarrhea with desire to drink water indicates Heat. Loose stool with normal urination indicates Heat. Spontaneous diarrhea with white urine indicates complete Shaoyin Cold syndrome. Aversion to cold, faint pulse, spontaneous diarrhea with undigested food indicates Cold. Fever with tenesmus and yellow-red stool indicates Heat. These allow differentiation of Cold and Heat.
When Taiyang and Yangming channels are simultaneously affected, without diarrhea but only with vomiting, Gegen Jia Banxia Tang (Gegen plus Pinellia Decoction) is the primary treatment. (*Yuhan Jing* lacks the six characters "Taiyang..." following Taiyang, connecting to the previous clause.)
[Cheng] When external pathogens are severe, Yang fails to govern the interior, and interior Qi is disharmonious. If Qi descends but does not ascend, there is only diarrhea without vomiting. If interior Qi rebels upward but does not descend, there is only vomiting without diarrhea. Gegen Tang is given to disperse the pathogen, adding Banxia to direct rebellious Qi downward.
Gegen Jia Banxia Tang Formula
Gegen (Radix Puerariae Lobatae, 4 liang) Mahuang (Herba Ephedrae, 3 liang, remove nodes ○ *Yuhan* makes it 2 liang. Bencao edition has "soak in boiling water, remove yellow juice, bake dry and weigh" eight characters) Gancao (Radix Glycyrrhizae, 2 liang, honey-fried)
Shaoyao (Radix Paeoniae Alba, 2 liang) Guizhi (Ramulus Cinnamomi, 2 liang, remove bark) Shengjiang (Rhizoma Zingiberis Recens, 2 liang, sliced ○ Chapter on Inducing Sweating, Bencao edition, and various families make it 3 liang, correct) Banxia (Rhizoma Pinelliae Ternatae, half sheng, washed)
Dazao (Fructus Jujubae, 12 pieces, split open)
The above eight ingredients. Use one dou of water. First decoct Gegen and Mahuang, reduce by two sheng, remove white foam.
Add remaining herbs. Decoct to obtain three sheng. Remove dregs. Take one sheng warm. Cover to induce slight sweating. ("Bai"/white: *Yuhan* reads "Shang"/upper.)
[Wang] I believe that if vomiting is present, how could the chest be free of fullness and rebellion? Banxia in the decoction should certainly be added. But would the sweetness of Gancao and Dazao not interfere?
Some say: The formula contains only 2 liang of Gancao and 12 pieces of Dazao, already has 3 liang of Shengjiang, and adds half a sheng of Banxia. What harm does this pose to those who vomit? This statement truly aligns with Zhongjing's principles of herbal usage.
Taiyang disease, presenting with Guizhi syndrome, the physician incorrectly applied purgation. Diarrhea ensued and did not stop. The pulse is Cu (rapid and intermittent), indicating the exterior is not yet resolved. Wheezing with sweating: Gegen Huangqin Huanglian Tang (Gegen, Scutellaria, and Coptis Decoction) is the primary treatment. ([Original Note] Cu is alternatively read as Zong. ○ *Yuhan Jing*, *Maijing*, *Qianjin Yifang* read "sui li bu zhi" / diarrhea continued unceasingly. Above "mai" (pulse), the character "qi" (its) is present.)
[Cheng] Guizhi syndrome indicates the pathogen is at the exterior. Incorrect purgation damages the stomach and intestines, allowing Heat to invade, leading to incessant diarrhea. Pathogens at the exterior manifest Yang pulses; pathogens at the interior manifest Yin pulses. Diarrhea with faint and slow pulses indicates interior pathogens. Cu pulse indicates Yang excess. Even with diarrhea, a Cu pulse indicates the exterior is not yet resolved. Illness with sweating and wheezing can be spontaneous sweating causing wheezing (due to severe external pathogens) or wheezing causing sweating (due to interior Heat rebelling upward). Gegen Huangqin Huanglian Tang is given to disperse exterior pathogens and clear interior Heat. (Wang comments on Cheng's note: "Damaging stomach and intestines" is not true deficiency of stomach and intestines, but rather evil Heat in the stomach transmitting to the intestines, causing diarrhea.) [Qian] Cu pulse indicates Yang excess. Diarrhea should not present with a Cu pulse. Because Yang pathogens are blazing, the pulse becomes rapid and urgent, indicating the pathogen remains at the exterior and is unresolved. However, this is not as severe as Xiere Li (Collateral Heat Diarrhea) where both exterior and interior are unresolved, or Yang deficiency with sinking and Yin pathogens knotting upward causing epigastric hardness. Thus, only the exterior is mentioned, not the interior. [Ke] Pathogens bind the exterior, disturbing Yang internally, causing wheezing and sweating. Diarrhea continuing unceasingly is what is meant by "acute watery diarrhea and urgency belong to Heat." This differs from weakness pulse with collateral heat diarrhea. Here, slight Heat is at the exterior, while major Heat enters the interior. It is certainly beyond the capacity of Guizhi and Shaoyao to harmonize, nor is Houpo and Xingren appropriate to add. [Jian] For the two types of Xiere Li, distinguishing deficiency and excess based on Yin/Yang pulses is correct. However, one must differentiate sticky/foul vs. duck-like loose stools, white vs. red urine, and forceful vs. weak pulses. [Xi] Note: Post-purgation wheezing and sweating is a critical condition where Heaven Qi does not descend and Earth Qi does not ascend. Ren Shen Si Ni Tang type formulas should be used. Zhongjing uses Gegen Huangqin Huanglian Tang specifically focusing on the phrase "exterior not yet resolved."
*Shanghan Leifang* states: Cu implies rapidity. Pathogens remain outside, not yet having sunk into the Three Yin channels, so symptoms like deep and faint pulses do not appear. Therefore, Lizhong Tang methods are not used.
Gegen Huangqin Huanglian Tang Formula (○ *Qianjin Fang*, *Waitai* read Gegen Huanglian Tang.)
Gegen (Radix Puerariae Lobatae, half jin ○ *Waitai* makes it 8 liang) Gancao (Radix Glycyrrhizae, 2 liang, honey-fried) Huangqin (Radix Scutellariae, 3 liang ○ Bencao edition makes it 2 liang. *Waitai* has "qie"/slice character.)
Huanglian (Rhizoma Coptidis, 3 liang ○ *Waitai* has "golden colored" three characters.)
The above four ingredients. Use eight sheng of water. First decoct Gegen, reduce by two sheng. Add remaining herbs. Decoct to obtain two sheng. Remove dregs. Divide into two warm doses. (Under "ingredients", *Yuhan Jing* has "ju"/chew character. *Waitai* has "qie"/slice character. Under "two sheng", *Waitai* has "lue qu mo"/skim off foam three characters.)
[Ke] Using Gegen, light in aroma but heavy in substance, as Sovereign to resolve the muscle layer and stop diarrhea. Assisting with bitter-cold, clearing, and肃 (solemn/clearing) Huangqin and Huanglian to stop sweating and relieve wheezing. Using Gancao to harmonize the middle. Decocting Gegen first, then adding other herbs, optimizes the muscle-resolving power and sharpens the interior-clearing energy. This is distinctly different from tonifying the middle while expelling pathogens.
*Gufang Xuanzhu* states: This formula is a variation of Xiexin Tang, treating Exterior Cold and Interior Heat. Its significance lies in Huangqin and Huanglian, rectifying interior Heat.
*Shanghan Leifang* states: Because the exterior is unresolved, Gegen is used. Because wheezing, sweating, and diarrhea occur, the bitterness of Huangqin and Huanglian is used to drain and consolidate. Huangqin, Huanglian, and Gancao are the main drugs for treating dysentery.
Taiyang disease. Headache, fever, body ache, lower back pain, joint pain, aversion to wind, anhidrosis, and wheezing: Mahuang Tang (Ephedra Decoction) is the primary treatment. (*Yuhan Jing*, *Maijing*, *Qianjin Yifang*: "body ache" reads "body ache". *Qianjin Fang*: "aversion to wind" reads "aversion to cold". *Waitai*: reads "Shanghan headache and lower back pain, body and joint ache, fever, aversion to wind, anhidrosis, and wheezing".)
[Ke] Taiyang governs the exterior of the whole body. External binding by Wind-Cold prevents Yang Qi from extending, causing whole-body pain. Taiyang meridians reach the waist, hence lower back pain. Taiyang governs sinews; diseases it produces involve sinews belonging to joints, hence joint pain. Acquired from Wind-Cold, hence aversion to wind. When Wind-Cold lodges in humans, pores close, hence anhidrosis. Taiyang is the master Qi of all Yangs; Yang Qi stagnates internally, hence wheezing. Taiyang is the "opening"; Mahuang Tang is established to open it, and all symptoms are eliminated. The Eight Signs of Mahuang: Headache, fever, aversion to wind are same as Guizhi syndrome. Anhidrosis and body ache are same as Da Qinglong Tang syndrome. This syndrome focuses on fever, body ache, anhidrosis, and wheezing. This clause does not prefix "Shanghan" nor mention "aversion to cold," but mentions "aversion to wind." Predecessors stated Mahuang Tang treats Shanghan but not Zhongfeng, which seems inaccurate. Mahuang Tang and Da Qinglong Tang are heavy agents for treating Zhongfeng; Guizhi Tang and Gegen Tang are light agents for treating Zhongfeng. Shanghan can generally use them; they are not exclusively for treating Shanghan. [Qian] Aversion to wind, although sometimes interchangeable with aversion to cold, ultimately indicates damage to both Ying and Wei. Why? When Wei is diseased, there is aversion to wind. Ying resides within Wei. If Cold has entered Ying, how could it not enter via Wei? Hence, there is also aversion to wind. [Jian] Anhidrosis indicates Shanghan Excess pathogen; Couli are closed and dense. Although there is fever, sweat does not come out, unlike Zhongfeng Deficiency pathogen fever where sweat comes out spontaneously.
Note: *Shennong Bencao Jing* states Mahuang treats Zhongfeng, Shanghan, and headache. *Bingyuan Holun* states: Shanghan disease originates from Wind-Cold, entering Couli, contending with Essence-Qi, causing blockage between Ying and Wei, obstructing circulation. On the first to second day, Qi is in orifices and skin. Hence patients have headache, aversion to cold, and heavy/stiff back. This pathogen is at the exterior; inducing sweat cures it. Mahuang induces sweat and primarily treats Zhongfeng. Since it mentions Shanghan and originates from Wind-Cold, Shanghan and Zhongfeng can be mutually used as terms for external contraction. One should not rigidly differentiate based on presence/absence of sweat, aversion to Wind/Cold, or damage to Ying/Wei.
Mahuang Tang Formula
Mahuang (Herba Ephedrae, 3 liang, remove nodes) Guizhi (Ramulus Cinnamomi, 2 liang, remove bark ○ Zhengmai edition makes it 3 liang, incorrect) Gancao (Radix Glycyrrhizae, 1 liang, honey-fried ○ *Qianjin Yifang* makes it 2 liang) Xingren (Semen Pruni Armeniacae, 70 pieces, remove skins and tips ○ Piece/Bu: Bencao edition reads "ge"/piece. "Bu" is a corruption of "ge". *Yuhan Jing*, *Qianjin Yifang* read "mei"/unit. Remove "Shang". Bencao edition has "Tang"/boiling water character. Under "tip", *Qianjin Yifang* has "two kernels" three characters. *Waitai* reads "remove skin and tip, two kernels crushed". *Qianjin* says: If wheezing is not severe, use 50 pieces.)
The above four ingredients. Use nine sheng of water. First decoct Mahuang, reduce by two sheng, remove upper foam. Add remaining herbs. Decoct to obtain two and a half sheng. Remove dregs. Take eight ge warm. Cover to induce slight sweating. No need to drink porridge. Rest and care follow Guizhi Tang method. (Under "ingredients", *Yuhan Jing* has "ju"/chew character. *Waitai* has "qie"/slice character. *Yuhan Jing* reads "wen fu chu han"/warm cover induce sweat.)
[Qian] Li Shizhen said: Body fluids become sweat; sweat is blood. Within Ying, it is blood; within Wei, it is sweat. Cold damages Ying; Ying blood becomes sluggish internally, unable to communicate externally with Wei. Wei Qi closes and secures, body fluids do not move, hence anhidrosis, fever, and aversion to cold. Wind damages Wei; Wei Qi receives pathogen, unable to protect Ying internally. Ying Qi is weak, body fluids are not secured, hence sweating, fever, and aversion to wind. However, Wind-Cold pathogens all enter via skin and hair. Skin and hair are the exterior of the Lung. Lung governs Wei Qi, enveloping the whole body, representing Heaven. Although symptoms belong to Taiyang, the Lung actually receives the pathogen. Symptoms often include flushed face, depression, cough, phlegm, wheezing, chest fullness. Is this not a Lung disease? When skin and hair close externally, evil Heat attacks internally, and Lung Qi becomes stagnant. Thus, Mahuang and Gancao, together with Guizhi, draw out Ying-level pathogens and deliver them to the muscle surface. Assisted by Xingren to vent the Lung and benefit Qi. Thus, although Mahuang Tang is a heavy sweating agent for Taiyang, it is actually a drug to dissipate Fire stagnation in the Lung channel.
Binhu's (Li Shizhen's) discussion reveals a secret unmentioned for millennia. Only Guizhi is a drug to resolve Wei and harmonize the muscle layer, yet it can induce sweat from Ying together with Mahuang because Wei resides outside Ying. Cold pathogens enter Ying via Wei, hence both Yin and Yang pulses are tight. Tight Yang pulse indicates Wei pathogen; tight Yin pulse indicates Ying pathogen. To induce Cold pathogens from within Ying, one must first open the exit in Wei, allowing pathogens to travel from Ying to Wei, resulting in sweat and resolution. Later generations used Mahuang monitored by Guizhi, seeing the wonder of restraint. Some compared it to driving six horses holding the reins tightly, fearing deviation. Is this logical? [Ke] This formula treats Wind-Cold at the exterior: headache, neck stiffness, fever, body pain, lower back pain, joint pain, aversion to wind/cold, anhidrosis, chest fullness, and wheezing. With floating-tight or floating-rapid pulses, this is a harsh agent to open the exterior, expel pathogens, and induce sweat. Upon entering the stomach, this decoction moves Qi in Xuanfu and transports essence to skin and hair. When hair and pulse essence combine, sweat pours forth. Exterior pathogens are completely expelled and leave no trace. Pain stops, wheezing calms, cold and heat instantly resolve. No need to drink porridge to borrow sweat from grain. The reason for not using Jiang and Zao is that Shengjiang's nature disperses horizontally to resolve the muscle layer, hindering Mahuang's upward movement. Dazao's nature is sticky in the diaphragm, hindering Xingren's rapid descent. This formula aims for rapid direct action; slight delay reduces speed, horizontal dispersion reduces harshness. If pulse is floating-weak with spontaneous sweating, or Chi pulse is faint-slow, this is governed by Guizhi Tang, not suitable for this formula. [Jian] Unskilled physicians do not know its control lies in warming and covering to induce sweat. Without warming and covering, it is not harsh. They claim Mahuang only releases the exterior and treats no other diseases. Who knows that combining this decoction with Guizhi Tang forms Magui Ge Ban Tang (Half-Mahuang Half-Guizhi Decoction) to harmonize lingering Cold-Heat in Taiyang? Removing Xingren and adding Shigao (Gypsum) combined with Guizhi Tang forms Guizhi Er Yuebi Yi Tang (Guizhi Two Parts, Yuebi One Part Decoction) to resolve Taiyang Heat-dominant Cold-minor Cold-Heat. If Yang is excessive internally with anhidrosis and wheezing, there is Mahuang Xingren Gancao Shigao Tang to dissipate pathogens in the Taiyin Lung. If Yin is excessive internally with anhidrosis, there is Mahuang Fuzi Xixin Gancao Tang to warm and dissipate Cold in the Shaoyin Kidney. *Jingui Yaolue* removes Guizhi from this formula; *Qianjin Fang* replaces Guizhi with Gui (Cinnamon Bark); both are named Huanhun Tang (Return Soul Decoction) to treat pathogens in Taiyang, sudden stroke/coma, locked jaw, and absent breath, effective upon swallowing, yet none require warming and covering. From this, we know the harshness of Mahuang Tang depends on warming and covering. This is the heart method of Zhongjing's formula usage, inaccessible to ordinary people.
*Shanghan Leifang* states: These pain sites are more numerous and severe than in Guizhi syndrome because both Ying and Wei are damaged. Aversion to wind, anhidrosis, and wheezing are due to Lung Qi not舒展 (smooth/unobstructed). Mahuang