麻黄（三两去节） 芍药（三两） 五味子（半升） 干姜（三两） 甘草（三两炙） 细辛（三两） 桂枝（三
两去皮） 半夏（半升汤洗）
上八味。以水一斗。先煮麻黄减二升。去上沫。内诸药。煮取三升。去滓。温服一升。
成氏明理论云。青龙象肝木之两岐。而主风寒两伤之疾。固已。伤寒表不解。则麻黄汤可以发。中风表不解。则
桂枝汤可以散。惟其表不解。而又加之心下有水气。则非二汤所能发散。乃须小青龙汤。始可祛除表里之邪气尔。麻黄
味甘辛温。为发散之主。表不解应发散之。则以麻黄为君。桂枝味辛热甘草味甘平。甘辛为阳。佐麻黄表散之用。二者
所以为臣。芍药味酸微寒。五味子味酸温。二者所以为佐者。寒伤肺。咳逆而喘。则肺气逆内经曰。肺欲收急食酸以收
之。故用芍药五味子为佐。以收逆气。干姜细辛味辛热。半夏味辛微温。三者所以为使者。心下有水。津液不行。则肾
气燥。内经曰。肾苦燥。急食。辛以润之。是以干姜细辛半夏为使。以散寒水而润肾燥。逆气收。寒水散。津液通行。
汗出而解矣。
琥按成氏引内经云。肾苦燥一段。殊非紧要语。条辩中因削之云。水寒之相搏。干姜细辛半夏。所以散之。反觉其
注简而易明。
琥又按内台方议云。小青龙者。以其能发越风寒。分利水气。犹龙之超越乎天地之间。是亦妙解。条辩中以小青龙
汤散水寒。犹龙之翻波逐浪而归海。不比大青龙汤之发汗。犹龙之兴云。致雨而升天。日大曰小。古人命名之义。截然
晓畅。
加减法
若微利者。去麻黄。加荛花如鸡子。熬令赤色。（成注云。下利者不可攻其表。汗出必胀满。麻黄专为表散。非下利
所宜。故去之。荛花味苦寒。下十二水。水去利则止。故加之。）若渴者。去半夏。加栝蒌根三两。（成注云半夏味辛温。
燥津液者也。去之。则津液易复。栝蒌根味苦微寒。润枯燥者也。加之。则津液通行。为渴所宜。）若噎者。去麻黄。加
附子一枚。炮（成注云。病患有寒。复发汗胃中冷。必吐蛔。噎为胃气虚冷。麻黄发汗非胃气虚冷所宜故去之。附子辛
热。热则温其气。辛则散其寒。而噎者。为当祛散冷寒之气也。）若小便不利。少腹满。去麻黄。加茯苓四两。（成注云。
凡邪客于体。在外者可汗之在下者可泄之。水蓄下焦。渗泄可也。发汗则非所当。故去麻黄而茯苓味甘淡。专行津液。
内经曰。热淫于内。以淡渗之。渗溺行水。甘淡所宜。故加茯苓。）若喘者。去麻黄。加杏人半升。去皮尖。（成注云。
喘为气逆。麻黄发阳。去之则气易顺。杏人味甘苦温。加之以泄逆气。金匮要略曰。其人形肿者。故不内。麻黄。乃内
杏子人。以麻黄发其阳故也。喘逆形肿。水气标本之疾。）
琥按上小青龙汤证云。伤寒表不解。是兼中风而言。夫干呕发热。谓非太阳中风证邪。其为咳。为渴。为噎。为
利。为小便不利少腹满。此诚水气内渍所传之证不一也。然其中冷热之候顿殊。加减药味。不可少差。恐杀人亦甚速耳。
其或为喘者。喘为太阳伤寒表不解发热之急候。何以反去麻黄。盖麻黄能发风寒外甚之喘。此则水饮上侵于肺。而气壅
作逆。故易以杏人。味苦甘而气温。能泄利肺气。兼散水饮。有专功也。内台方议云。其人脉浮者不去麻黄。但脉沉者。
宜去麻黄。以是知以上加减法亦不可执。
琥又按上条云。伤寒表不解发热。其人风寒之邪正盛。止因咳呕气逆。而汤中既用芍药之酸以收之。复用五味子半
升以敛之。今医稍知药性者。例不敢用。仲景于当日独用之者。何也。或云。五味子宜用南产黄色者。取其味辛多而酸
少也。斯言亦近乎理。
或问云。心下有水气矣。何以不直曰呕。而曰干呕。余答云。水者有形之物。其性趋下。其上升者。但气耳。故曰
干呕。曰咳。曰噎。曰喘者。皆上升之气也然其水。仍下流而或为利。或为小便不利少腹满矣。又或渴者为热水之证。
或噎者。为寒水之证。要之伤寒发噎。亦有胃中水热气逆而作者。不可但信以为寒也。仲景法。加炮附子。其论又不可
拘。
伤寒心下有水气。咳而微喘。发热不渴。服汤已。渴者。此寒去欲解也。小青龙汤主之。（小青龙汤主之句。补亡论
移在发热不渴句下。考成注中已明。但正文未校正。此条伤寒。比上条证。风寒稍轻。故但咳而不至干呕。虽喘而气亦
微也。发热不渴者。表证未罢。内虽挟水。津液未至凝塞。气不甚燥。故不渴也。与小青龙汤以发表散水。服汤已而渴
者。此水与风寒之邪俱去。而津液亡。故作渴。乃伤寒病欲解之时也。尚论篇云。仍用小青龙汤。以助其欲解之势。误
矣。愚按上条云渴。是未服汤而渴。乃津液不行而作渴也。此条云。渴。是服汤已。而渴。乃津液既亡而作渴也。渴既
不同岂可仍用上药。缵论亦云。水去而渴。与水逆而渴不同。是虽渴而不必服药。但当静俟津回。可也。）
（重出例）太阳病外证未解脉浮弱者当以汗解宜桂枝汤。
太阳病下之微喘者表未解。故也桂枝加浓朴杏人汤主之。
太阳病外证未解者。不可下也。下之为逆。欲解外者宜桂枝汤主之。
太阳病先发汗不解。而复下之脉浮者。不愈（云云至）。当须解外则愈。宜桂枝汤主之。
以上四条证（正文与注见前桂枝汤方下）
太阳病脉浮紧。无汗发热身疼痛八九日不解（云云至）。阳气重。故也麻黄汤主之。
太阳病脉浮紧发热身无汗自衄者。愈。
以上二条证（正文与注见前麻黄汤方下）
二阳并病。太阳初得病时。发其汗。汗先出不彻。因转属阳明。续自微汗出。不恶寒。若太阳病证不罢者。不可下。
下之为逆。如此。可小发汗。设面色缘缘正赤者。阳气怫郁在表。当解之熏之。若发汗不彻。不足言阳气怫郁。不得越。
当汗不汗。其人躁烦。不知痛处。乍在腹中。乍在四肢。按之不可得。其人短气。但坐。以汗出不彻故也。更发汗则愈。
何以知汗出不彻。以脉涩故知也。（风寒之邪。始入一经复传一经。两经相并而同病者。谓之并病。今者太阳与阳明并病。
太阳经初得病之时。发其汗。汗先出不彻。不彻者。不透也。惟不彻因转属阳明而成并病。续自微汗出。不恶寒。若似
乎太阳经证已罢。传入阳明之府。为可下矣。殊不知汗出尚微。虽不恶寒。太阳之邪犹未尽解。故云若太阳病证不罢者。
不可下。下之为逆。谓下之不以理也。如此者。可小发其汗。谓先解其表也。设其人面色缘缘正赤者。成注云。阳明之
经循面。面正赤。则阳明之邪亦在于经。二阳相并。其气怫郁。邪甚于表也。此不但小发汗。当用熏解之法。以大发之。
况此发汗不彻之证。其人阳气怫郁。不得宣越。不足言也。不足言者。犹言势所必至。不须说也。直是当汗不汗。成注
所云。邪无从出。壅甚于经。其人不但面赤。内作郁热而且躁且烦也。邪循经行。痛无常处。故乍在腹中。乍在四肢按
之不可得也。短气者。邪热壅而气促急也。但坐者不得卧也。此系太阳阳明二经之汗不彻故也。更发汗则愈者。谓太阳
初得病时。发汗之方。不宜再用。当更方以兼发阳明经汗。则愈盖此条病。始终是一汗出不彻之证。何以知之。以脉涩
故知之也。夫汗出不彻营气不得条达。则胀涩。条辩以涩脉作血虚解。大误。愚按此条。虽系二阳并病。其实太阳证居
多。始则太阳经汗先出不彻。因转属阳明。成并病。此作首一段看虽。续得微汗不恶寒。然太阳证不因微汗而罢。故仍
可小发汗此又作一段看。设其人面色缘缘正赤。此兼阳明邪热郁甚于表。当解之熏之。此又作一段看有此者。终是初得
病时。发汗不彻之误。以至因循而当汗不汗其人阳气怫郁而面赤犹不足言也。当见躁烦短气浑身上下痛无定着。此虽与
阳明并病。而太阳之邪不少衰也。故云更发汗则愈。此又作一段看。夫此等病医人遇之。大都不知其人系汗出不彻之证。
何也。盖始焉发其汗汗已先出。何以知其不彻。所以末后又云脉涩。以决其汗不彻。而当更发汗也。夫曰可小发汗。
曰当解之熏之法。则云然。实则未曾用发汗药者也。若曾用药发其汗则无面赤躁烦等变证矣。惟初得病时发其汗与末后
更发汗。此是用药以发其汗。然仲景不言汤者。其汤显而易见故不言也。庞安时云。宜麻黄汤。愚以太阳初得病时固宜
用也。但曾汗出而不彻。麻黄汤不宜用也。尚论篇于此条。更桂枝加葛根汤。甚合仲景之法。）
脉浮数者。法当汗出而愈。若下之。身重心悸者。不可发汗当自汗出乃解。所以然者。尺中脉微此里虚。须表里实。
津液自和。便自汗出愈。（成注引经曰诸脉浮数。当发热而洒淅恶寒。言邪气在表也。法当汗出而愈无疑矣。若误下之。
则身重心悸。身重者。后条辩云。下后。则津液下夺。而机关不利。故身重也。津液下夺不能上奉。则心悸而动。尚论
篇云。纵脉仍浮数。不可复发其汗但宜静调。俟其自汗出乃解耳。所以然者。以脉虽浮数而尺中则微。夫脉浮数。为表
实。尺中微为里虚。里虚者。下后津液不足而阴虚也。须待其津液回。斯里气实。为表里俱实。虽不用药以发其汗。便
当自汗出而愈矣。）
脉浮紧者。法当身疼痛。宜以汗解之。假令尺中迟者。不可发汗。何以知其然以营气不足。血少故也。（脉浮紧身疼
痛。是太阳伤寒。法当以麻黄汤汗之。设其人尺中脉迟。则知寒邪虽盛。营血自虚。便不可发汗矣。夫汗者。血之液。
而营气主之。尺迟不可发汗者。条辩云。嫌夺血也。按此条论。仲景无治法。补亡论郭白云云。宜小建中汤。次则柴胡
桂枝汤。愚以此二汤。实祖活人书之意。盖小建中者。即桂枝汤加饴糖一味。以甘能生血而先建其中也。但仲景法。无
汗者。不得服桂枝。今脉浮紧。为无汗虽尺中迟。恐不宜用此汤。又柴胡桂枝汤。即小柴胡汤加桂枝。药不对证。更属
不解。）
（重出例）脉浮者。病在表可发汗。宜麻黄汤。脉浮而数者可发汗。宜麻黄汤。
上二条证。（正文与注见前麻黄汤方下）
病常自汗出者。此为营气和（云云至）营卫和则愈。宜桂枝汤。
病患藏无他病（云云至）先其时发汗则愈。宜桂枝汤主之。
上二条证（正文与注见前桂枝汤方下。）
伤寒脉浮紧不发汗因致衄者。麻黄汤主之。
上条证（正文与注见前麻黄汤方下）
伤寒不大便六七日（云云至）。若头痛者必衄。宜桂枝汤。
伤寒发汗解半日许（云云至）。可更发汗。宜桂枝汤主之。
上二条证。（正文与注见前桂枝汤方下）
凡病若发汗。若吐。若下。若亡津液。阴阳自和者。必自愈（曰凡病者。言不仅伤寒然也。凡病若发汗。若吐之下
之太过。以致亡津液者。虽其人汗吐下证。仍在。不可复行汗吐下之法。姑慢服药。俟其阴阳自和。则气血回复。病必
自愈然此亦是当汗而汗。当吐下而吐下。故有阴阳和而自愈之日。非误用汗吐下药者。所能比也。凡病且然。而况于伤
寒乎。按此条论。因发汗而并及吐下之法。然既云。发汗必是太阳病居多。故亦附于太阳篇中。）
大下之后。复发汗小便不利者。亡津液故也。勿治之。得小便利。必自愈（先汗后下。治伤寒之正法也。今病未曾
发汗而先大下之。既下之后。复发其汗。是为汗下相反。津液重亡。亡者。无也。膀胱为津液之府。津液既亡。则小便
少而不利。勿治之者。谓不当用五苓散等药。以利其小便也。姑俟其津液回。则小便利。而表里之证。必皆自愈。按此
条论。必病患表里证悉具。以故汗下相反。但小便不利。无他变也。设使无里证而先下。无表证而复汗。则病患变证蜂
起。岂但小便之不利哉。勿治之。得小便利。必自愈。此即上条云。阴阳自和之义。）
下之后。复发汗。必振寒。脉微细。所以然者。以内外俱虚故也。（成注云。发汗则表虚而亡阳。下之则里虚而亡阴。
振寒者。阳气微也。脉微细者。阴血弱也。阴主内阳主外。是为内外俱虚。按此条论。仲景无治法。补亡论常器之云。
素无热人。可与芍药附子汤。有热人。可与黄 建中汤。其言尚未尽理。夫寒伤于人。则为病热。岂论其人之平素无热
与有热邪。纵其人平素无热。当其时已犯热证。理宜汗下。但今汗下相反。又且过剂。故不惟小便不利。甚至于振寒。
脉微细。而内外两虚。愚以上证。邪热虽去只宜温补。不可用大热之药。故黄 建中汤。服之为稳。芍药附子汤。用之
害人。或问下条论。亦下后复发汗所致。在仲景竟用干姜附子汤。是邪非邪。余答云。下条证。乃医人不识中寒病。因
误用汗下法。故仲景急以干姜附子汤救之。此条证。系伤寒病。故虽既下且汗。外作振寒。内无寒证。常云。芍药附子
汤。决不可用。学医者宜慎之。）
下之后。复发汗。昼日烦躁。不得眠。夜而安静。不呕不渴。无表证。脉沉微身无大热者。干姜附子汤主之。（此条
Ephedrae Herba (Mahuang, 麻黄) (3 liang, remove joints), Paeoniae Radix (Shaoyao, 芍药) (3 liang), Schisandrae Fructus (Wuweizi, 五味子) (0.5 sheng), Zingiberis Rhizoma Recens (Ganjiang, 干姜) (3 liang), Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) (3 liang, honey-fried), Asari Radix et Rhizoma (Xixin, 细辛) (3 liang), Cinnamomi Ramulus (Guizhi, 桂枝) (3 liang, remove bark), Pinelliae Tuber (Banxia, 半夏) (0.5 sheng, washed with boiling water).
The above eight ingredients. Use one dou of water. First decoct Mahuang until the volume is reduced by two sheng. Remove the foam on the surface. Add the remaining herbs. Decoct to obtain three sheng of liquid. Filter out the dregs. Take one sheng warm.
Cheng Wuji stated in his "Ming Lilun" (Theory of Clarification): The Azure Dragon symbolizes the two branches of liver wood and governs diseases caused by simultaneous injury from wind and cold, which has been clearly explained. When exterior syndrome due to Cold Injury is unresolved, Mahuang Tang can be used to induce sweating; when exterior syndrome due to Wind Strike is unresolved, Guizhi Tang can be used to dissipate it. Only when the exterior syndrome is unresolved AND there is fluid retention in the epigastrium are these two formulas insufficient for dissipation. It is necessary to use Xiao Qinglong Tang to dispel pathogenic factors from both the interior and exterior. Mahuang has a sweet, pungent, and warm flavor and serves as the sovereign herb for dispersion. Since the exterior should be dispersed, Mahuang is used as the sovereign. Guizhi has a pungent and hot flavor; Gancao has a sweet and neutral flavor. Sweet and pungent transform into Yang, assisting Mahuang in its exterior-dispersing function; these two serve as ministerial herbs. Shaoyao has a sour and slightly cold flavor; Wuweizi has a sour and warm flavor; these two serve as assistant herbs. Cold injuring the Lung leads to cough, counterflow qi, and wheezing, causing Lung qi to rebel. The Neijing states: "The Lung desires to gather; urgently feed it sour substances to gather it." Therefore, Shaoyao and Wuweizi are used as assistants to gather rebellious qi. Ganjiang, Xixin have pungent and hot flavors; Banxia has a pungent and slightly warm flavor; these three serve as envoy herbs. Fluid retention in the epigastrium impedes the movement of body fluids, leading to dryness of Kidney qi. The Neijing states: "The Kidney suffers from dryness; urgently feed it pungent substances to moisten it." Thus, Ganjiang, Xixin, and Banxia are used as envoys to disperse cold-fluid and moisten Kidney dryness. Rebellious qi is gathered, cold-fluid is dispersed, body fluids circulate freely, and the disease resolves through sweating.
Hu notes: Cheng Wuji's citation of the Neijing passage regarding "Kidney suffering from dryness" is not crucial. The "Tiaobian" commentary omitted it, stating that "Cold and water contend against each other; Ganjiang, Xixin, and Banxia are used to disperse them," which seems simpler and clearer.
Hu further notes: The "Neitai Fangyi" states: Xiao Qinglong Tang is named so because it can vent wind-cold and separate/drain fluid retention, much like a dragon soaring between heaven and earth; this is also a brilliant interpretation. The "Tiaobian" compares Xiao Qinglong Tang dispersing cold-water to a dragon turning waves and chasing waves returning to the sea, unlike Da Qinglong Tang's sweating action, which is like a dragon raising clouds and bringing rain to ascend to heaven. The distinction between "large" and "small" in the ancient naming convention is clear and distinct.
Modification Methods:
If there is mild diarrhea, remove Mahuang, add Ronghua (Adenophorae Radix or similar, traditionally Euphorbiae Humifusae Herba) the size of an egg, stir-fry until red. (Cheng's note says: For diarrhea, attacking the exterior is contraindicated; sweating will cause abdominal fullness. Mahuang is specifically for exterior dispersion and is unsuitable for diarrhea, hence removed. Ronghua is bitter and cold, draining water from twelve channels; once water is drained, diarrhea stops, hence added.) If there is thirst, remove Banxia, add Gualougen (Trichosanthis Radix) 3 liang. (Cheng's note says: Banxia is pungent and warm, drying body fluids. Removing it allows fluids to recover easily. Gualougen is bitter and slightly cold, moistening dryness. Adding it promotes fluid circulation, suitable for thirst.) If there is a sensation of choking/blockage, remove Mahuang, add one Fuzi (Aconiti Lateralis Radix Praeparata), processed. (Cheng's note says: The patient has cold, and subsequent sweating causes cold in the stomach, likely leading to vomiting of roundworms. Choking indicates deficiency-cold of Stomach qi. Mahuang's sweating action is unsuitable for deficiency-cold of Stomach qi, hence removed. Fuzi is pungent and hot; heat warms qi, pungency disperses cold, addressing the need to dispel cold-qi in choking.) If there is difficulty urinating and fullness in the lower abdomen, remove Mahuang, add Fuling (Poria) 4 liang. (Cheng's note says: Generally, pathogens in the exterior can be treated with sweating, those in the inferior with purging/drainage. Water accumulation in the Lower Jiao can be treated with seepage/drainage. Sweating is inappropriate, hence Mahuang is removed and Fuling added. Fuling is sweet and bland, specifically moving body fluids. The Neijing states: "When heat abounds internally, use bland substances to drain it." Bland-drainage promotes urination and water movement, fitting the sweet-bland nature, hence Fuling is added.) If there is wheezing/asthma, remove Mahuang, add Xingren (Prunus Armeniacae Semen) 0.5 sheng, remove skin and tips. (Cheng's note says: Wheezing is rebellious qi. Mahuang releases Yang; removing it allows qi to smooth out. Xingren is sweet, bitter, and warm; adding it drains rebellious qi. The Jingui Yaolue states: "If the person has edema, do not include Mahuang, but include Apricot Kernel, because Mahuang releases Yang." Wheezing/rebellious qi and edema are root-and-branch disorders of fluid retention.)
Hu notes: The aforementioned Xiao Qinglong Tang syndrome states: "Cold Injury exterior unresolved," implying concurrent Wind Strike. Dry heaving and fever—could this not be a Taiyang Wind Strike syndrome? The manifestations of cough, thirst, choking, diarrhea, difficulty urinating, and lower abdominal fullness are indeed various syndromes transmitted from internal fluid retention. However, the patterns of cold and heat differ drastically; modifications must not err slightly, lest they kill quickly. Regarding wheezing: Wheezing is an urgent symptom of Taiyang Cold Injury exterior unresolved with fever. Why remove Mahuang here? Mahuang can disperse wheezing caused by severe external wind-cold; here, it is water-fluid invading the Lung, causing qi congestion and rebellion, so Xingren is substituted. Xingren is bitter-sweet and warm, capable of draining Lung qi and dispersing water-fluid, possessing specific efficacy. The "Neitai Fangyi" states: If the pulse is floating, do not remove Mahuang; if the pulse is deep, it is appropriate to remove Mahuang. This shows the modification methods should not be applied rigidly.
Hu further notes: The aforementioned clause states: "Cold Injury exterior unresolved with fever," where wind-cold pathogens are vigorous. Due to dry heaving, vomiting, and rebellious qi, the decoction uses Shaoyao's sourness to gather and Wuweizi (half sheng) to astringe. Modern physicians who know herbal properties generally dare not use them. Why did Zhang Zhongjing use them alone at that time? Some say: Wuweizi should be the southern-produced yellow variety, chosen for having more pungent than sour taste. This reasoning is plausible.
Question: Since there is fluid retention in the epigastrium, why not simply say "vomiting" but instead "dry heaving"? Answer: Water is a tangible substance with a downward tendency. What rises is merely qi. Hence, it is called dry heaving, cough, choking, or wheezing—all rising qi. However, the water still flows downward, causing either diarrhea or difficulty urinating with lower abdominal fullness. Thirst may indicate a heat-fluid pattern, while choking may indicate a cold-fluid pattern. In summary, choking in Cold Injury can also result from Qi-rebellion due to water-heat in the Stomach; one cannot assume it is solely cold. Zhang Zhongjing's method adds processed Fuzi; the discussion should not be taken too literally.
In Cold Injury with fluid retention in the epigastrium, coughing with slight wheezing, fever without thirst: After taking the decoction, if the patient becomes thirsty, this indicates cold has gone and resolution is impending. Xiao Qinglong Tang is indicated. (Note: The phrase "Xiao Qinglong Tang is indicated" was moved by the "Buwang Lun" to after "fever without thirst." Cheng's annotation clarifies this, though the main text remains uncorrected. Compared to the previous clause, the wind-cold here is slightly milder, resulting only in cough without dry heaving, and slight wheezing rather than severe. Fever without thirst means the exterior syndrome persists; although there is internal fluid retention, body fluids are not yet congealed/stagnated, and qi is not excessively dry, hence no thirst. Xiao Qinglong Tang is given to release the exterior and scatter water. Becoming thirsty after taking the medicine indicates both water and wind-cold pathogens have departed, but body fluids are depleted, causing thirst. This is the time when the Cold Injury is about to resolve. The "Shanglun Pian" suggests continuing Xiao Qinglong Tang to assist the resolving momentum, which is erroneous. I argue: In the previous clause, thirst occurred before taking medicine, due to impaired fluid circulation. In this clause, thirst occurs after taking medicine, due to fluid depletion. Since the nature of thirst differs, how can the same formula be used? The "Zuanlun" also states: Thirst after water removal differs from thirst due to water-rejection. Although thirsty, medication is not necessarily required; one should simply wait quietly for fluids to return.)
(Repeated Examples) Taiyang syndrome with unresolved exterior signs and a weak floating pulse should be treated with sweating; Guizhi Tang is appropriate.
Taiyang syndrome treated with purgation resulting in slight wheezing indicates the exterior is unresolved; Guizhi Houpo Xiren Tang is indicated.
Taiyang syndrome with unresolved exterior signs should not be purged; purging is contrary to principle. To resolve the exterior, Guizhi Tang is indicated.
Taiyang syndrome where initial sweating failed to resolve the condition, followed by purgation, with a floating pulse indicating non-resolution: Resolution of the exterior is required for cure; Guizhi Tang is indicated.
(The above four clauses' main text and annotations are found under the Guizhi Tang formula section previously.)
Taiyang syndrome with floating-tight pulse, no sweat, fever, body pain persisting for eight to nine days without resolution... Yang qi is heavy; Mahuang Tang is indicated.
Taiyang syndrome with floating-tight pulse, fever, no sweat, spontaneous nosebleed results in self-healing.
(The above two clauses' main text and annotations are found under the Mahuang Tang formula section previously.)
Two Yangs combined illness: When Taiyang was first contracted, sweating was induced. The sweat was initially incomplete. Consequently, it transferred to Yangming, presenting with continuous slight sweating and aversion to cold absent. If Taiyang syndrome signs have not ceased, purging is contraindicated; purging is contrary. In such cases, slight sweating may be induced. If the face is persistently bright red, Yang qi is constrained in the exterior; it should be resolved using fumigation. If sweating was incomplete, this does not fully explain Yang qi constraint and failure to vent. When sweating should occur but does not, the patient becomes restless and irritable, unaware of pain location, shifting between abdomen and limbs, unpressable. Shortness of breath, ability to sit only, is due to incomplete sweating. Further sweating will lead to recovery. How do we know sweating was incomplete? By the choppy pulse. (Combined illness refers to pathogens entering one meridian and transmitting to another, affecting both simultaneously. Here, Taiyang and Yangming are combined. Initially, sweating was incomplete—"incomplete" means not penetrating. Because it was incomplete, it transferred to Yangming, forming combined illness. Continuous slight sweating without aversion to cold might suggest Taiyang signs have ceased and pathology has entered Yangming Fu organ, suggesting purging is possible. However, sweating is still slight; despite no aversion to cold, Taiyang pathogens are not fully resolved. Thus, if Taiyang signs persist, purging is contraindicated ("contrary" means improper purging). Such cases require slight sweating to first resolve the exterior. If the face is persistently bright red, Cheng's note explains: Yangming meridian traverses the face; bright red face indicates Yangming pathogens in the meridian. Two Yangs combined, qi is constrained, pathogens are severe in the exterior. This requires not just slight sweating but fumigation to strongly disperse. Moreover, in this case of incomplete sweating, Yang qi constraint and failure to vent are inevitable ("insufficient to mention" implies inevitability). Directly, when sweating should occur but doesn't, as Cheng notes: Pathogens have no exit, stagnating severely in meridians. Patients not only have red faces but internal郁 heat, restlessness, and irritability. Pathogens follow meridians, pain has no fixed location, shifting between abdomen and limbs, unpressable. Shortness of breath is due to heat-stagnation causing急促 qi. Ability to sit only means inability to lie down. This is due to incomplete sweating in Taiyang and Yangming meridians. Further sweating cures it, meaning the initial Taiyang sweating formula should not be reused; a new formula should be used to jointly sweat the Yangming meridian. This illness is fundamentally one of incomplete sweating. How do we know? Choppy pulse. Incomplete sweating prevents Ying qi from flowing smoothly, causing distension and choppiness. The "Tiaobian" interprets choppy pulse as blood deficiency, which is a major error. I argue: Although this is a Two Yangs combined illness, Taiyang signs predominate. Initially, Taiyang sweating was incomplete, transferring to Yangming to form combined illness. This constitutes the first segment. Although subsequent slight sweating occurs without aversion to cold, Taiyang signs do not cease due to slight sweating, allowing for slight sweating again; this is the second segment. If the face is persistently bright red, this involves severe Yangming heat-pathogen constrained in the exterior, requiring resolution via fumigation; this is the third segment. These outcomes ultimately stem from the error of incomplete sweating at onset, leading to delay and missed opportunity to sweat, causing Yang qi constraint and facial redness (which is secondary). Symptoms include restlessness, shortness of breath, and migrating pain throughout the body. Although combined with Yangming, Taiyang pathogens have not diminished. Hence, "further sweating cures"; this is the fourth segment. Physicians encountering such cases often fail to recognize incomplete sweating. Why? Initial sweating produced sweat, but how to know it was incomplete? Hence, the choppy pulse is mentioned at the end to confirm incomplete sweating and the need for further sweating. Saying "slight sweating" or "fumigation" aligns with theory. In reality, no sweating drugs were used previously. If they had been, symptoms like facial redness and irritability would not have appeared. Only the initial sweating and final further sweating involve actual medication. Zhang Zhongjing omits the formula name because it is obvious. Pang Anshi suggests Mahuang Tang. I agree it was suitable initially, but since sweating was already attempted incompletely, Mahuang Tang is now inappropriate. The "Shanglun Pian" suggests Guizhi Ge Gen Tang for this clause, which aligns well with Zhang Zhongjing's principles.)
Floating and rapid pulse indicates sweating should lead to recovery. If purged, heaviness of body and palpitations occur; sweating is contraindicated. Spontaneous sweating will lead to resolution. Why? Because the pulse at the Chi position is faint, indicating interior deficiency. Exterior and interior must become solid/full; body fluids must harmonize spontaneously, leading to spontaneous sweating and recovery. (Cheng's note cites the Neijing: Floating-rapid pulses indicate fever and aversion to cold/chills, signifying pathogens in the exterior. Recovery via sweating is certain. If mistakenly purged, body heaviness and palpitations result. Body heaviness: Post-purgation, body fluids are depleted downwards, impairing joint/muscle function, causing heaviness. Depleted fluids cannot nourish upwards, causing palpitations. "Shanglun Pian" states: Even if pulse remains floating-rapid, re-sweating is contraindicated; quiet adjustment is needed, waiting for spontaneous sweating. Reason: Although pulse is floating-rapid (exterior excess), Chi position is faint (interior deficiency). Interior deficiency means post-purgation fluid insufficiency and Yin deficiency. Wait for fluids to return, then Qi becomes solid, achieving exterior-interior fullness. Without medication, spontaneous sweating will occur and cure.)
Floating-tight pulse typically presents with body pain; sweating is indicated. If the Chi pulse is slow, sweating is contraindicated. Why? Due to insufficient Ying qi and blood deficiency. (Floating-tight pulse with body pain is Taiyang Cold Injury, normally treated with Mahuang Tang to sweat. If Chi pulse is slow, although Cold pathogens are strong, Ying blood is deficient internally, making sweating contraindicated. Sweat is the fluid of blood, governed by Ying qi. Slow Chi pulse contraindicates sweating to avoid depleting blood. The "Tiaobian" warns against blood depletion. Zhang Zhongjing provides no treatment method for this clause. "Buwang Lun" by Guo Baiyun suggests Xiao Jianzhong Tang, then Chaihu Guizhi Tang. I argue these derive from the "Liu Ren Shu". Xiao Jianzhong Tang is Guizhi Tang plus Yitang (maltose); sweetness generates blood and strengthens the Middle. However, Zhang Zhongjing's rule states those without sweat should not take Guizhi. Current floating-tight pulse indicates no sweat; even with slow Chi, this formula is likely unsuitable. Chaihu Guizhi Tang is Xiaochaihu Tang plus Guizhi; the herbs do not match the syndrome, which is confusing.)
(Repeated Examples) Floating pulse indicates exterior disease; sweating is appropriate, Mahuang Tang is indicated. Floating-rapid pulse allows sweating; Mahuang Tang is indicated.
(The above two clauses' main text and annotations are found under the Mahuang Tang formula section previously.)
Disease with constant spontaneous sweating indicates Ying qi harmony... (text omitted) Harmony of Ying and Wei leads to recovery; Guizhi Tang is indicated.
Patient with no internal organ pathology... (text omitted) Sweating at the appropriate time leads to recovery; Guizhi Tang is indicated.
(The above two clauses' main text and annotations are found under the Guizhi Tang formula section previously.)
Cold Injury with floating-tight pulse, failure to sweat leading to nosebleed: Mahuang Tang is indicated.
(This clause's main text and annotation are found under the Mahuang Tang formula section previously.)
Cold Injury with constipation for six to seven days... (text omitted). If headache occurs, nosebleed is certain; Guizhi Tang is indicated.
Cold Injury resolving after sweating for half a day... (text omitted). Further sweating may be induced; Guizhi Tang is indicated.
(The above two clauses' main text and annotations are found under the Guizhi Tang formula section previously.)
Generally, if a disease undergoes sweating, vomiting, or purgation, leading to loss of body fluids, if Yin and Yang self-harmonize, it will surely self-heal. (Saying "generally" implies this applies beyond just Cold Injury. If excessive sweating, vomiting, or purgation causes fluid loss, even if symptoms persist, repeating these methods is contraindicated. Delay medication; wait for Yin-Yang self-harmony, then Qi and Blood recover, and the disease heals. This applies when sweating/vomiting/purging were correctly indicated, not when misused. If true for general diseases, how much more so for Cold Injury? This clause mentions vomiting/purging alongside sweating, but since sweating is primary, it mostly concerns Taiyang disease, hence attached to the Taiyang chapter.)
After severe purgation followed by sweating, if urination is difficult, it is due to fluid loss. Do not treat it; when urination normalizes, it will self-heal. (Sweating then purging is the correct method for Cold Injury. Here, severe purgation was done before sweating, followed by sweating, creating contradictory treatments and double fluid loss. "Loss" means absence. Bladder is the mansion of fluids; fluid loss leads to scanty/difficult urination. "Do not treat" means do not use Wuling San etc. to promote urination. Wait for fluids to return, then urination normalizes, and exterior-interior syndromes heal. This clause assumes both exterior and interior signs are present, leading to contradictory treatment, with only difficult urination as a change. If purging was done without interior signs, or sweating without exterior signs, numerous complications would arise, not just difficult urination. "Do not treat... self-heals" reflects the principle of Yin-Yang self-harmony mentioned earlier.)
After purgation followed by sweating, chills and tremors occur, with faint-thin pulse. Reason: Interior and exterior are both deficient. (Cheng's note: Sweating causes exterior deficiency and Yang loss; purging causes interior deficiency and Yin loss. Chills/tremors indicate weak Yang; faint-thin pulse indicates weak Yin blood. Yin governs interior, Yang governs exterior; thus, interior-exterior dual deficiency. Zhang Zhongjing provides no treatment. "Buwang Lun" by Chang Qizhi suggests Shaoyao Fuzi Tang for those without prior heat, and Huangqi Jianzhong Tang for those with heat. This reasoning is incomplete. Cold injuring the body causes heat disease; whether the person was naturally cool or hot is irrelevant. Even if naturally cool, heat syndrome arises at onset, warranting sweating/purging. However, contradictory and excessive treatment here causes not just difficult urination but chills, faint-thin pulse, and dual deficiency. I argue: Although heat pathogens are gone, only warming tonification is suitable; strong heat drugs should be avoided. Huangqi Jianzhong Tang is stable; Shaoyao Fuzi Tang is harmful. Question: The next clause also results from post-purgation sweating. Zhang Zhongjing uses Ganjiang Fuzi Tang. Is this wrong? Answer: The next clause involves a physician failing to recognize Central Cold disease, mistakenly using sweating/purging, prompting Zhang Zhongjing to urgently use Ganjiang Fuzi Tang to rescue. This clause involves Cold Injury; although purged and sweated, presenting externally with chills but internally lacking cold signs, Shaoyao Fuzi Tang is absolutely contraindicated. Students should be cautious.)
After purgation followed by sweating, daytime restlessness and insomnia, nighttime quietness, no vomiting/thirst, no exterior signs, deep-faint pulse, no significant fever: Ganjiang Fuzi Tang is indicated. (This clause...)