太阳中风。脉浮紧。发热恶寒。身疼痛。不汗出而烦躁者。大青龙汤主之。若脉微弱。汗出恶
风者。不可服。服之则厥逆筋惕肉 。此为逆也。
此治中风而表实者之法。表实之人。不易得邪。设得之。则不能泄卫气。而反以实阳气。
阳气既实。表不得通。闭热于经。则脉紧身痛。不汗出而烦躁也。是当以麻黄桂姜之属。以发汗
而泄表实。加石膏以除里热而止烦躁。非桂枝汤所得而治者矣。盖其病已非中风之常病。则其法
亦不得守桂枝之常法。仲景特举此者。欲人知常知变。不使拘中风之名。而拘解肌之法也。若脉微弱
汗出恶风。则表虚不实。设与大青龙汤发越阳气。必致厥逆筋惕肉 。甚则汗多而阳亡矣。故曰此
为逆。逆者虚以实治。于理不顺。所以谓之逆也。
大青龙汤方
麻黄（六两去节） 桂枝（二两去皮） 甘草（二两炙） 大枣（十二枚擘） 石膏（如鸡子
大碎） 生姜（三两切） 杏仁（四十个去皮尖）
上七味。以水九升。先煮麻黄减二升。去上沫。纳诸药。煮取三升。去滓。温服一升。取微似
汗。汗出多者。温粉扑之。一服汗者。停后服。汗多亡阳。遂虚。恶风烦躁。不得眠也。
按伤寒分立三纲。桂枝主风伤卫。麻黄主寒伤营。大青龙主风寒两伤营卫。其说始于成氏许氏
。而成于方氏喻氏。以愚观之。桂枝主风伤卫则是。麻黄主寒伤营则非。盖有卫病而营不病者矣。未
有营病而卫不病者也。至于大青龙证其辨不在营卫两病。而在烦躁一证。其立方之旨。亦不在并用
麻、桂。而在独加石膏。王文禄谓风寒并重。闭热于经。故加石膏于发散药中是也。若不过风寒并发。
则麻黄、桂枝已足胜其任矣。何必更须石膏哉。须知中风而或表实。亦用麻黄。伤寒而或表虚。亦
用桂枝。其表不得泄。而闭热于中者。则用石膏。其无热者。但用麻、桂。此仲景心法也。炫新说
而变旧章。其于斯道。不愈趋而愈远哉。
伤寒脉浮缓。身不疼但重。乍有轻时。无少阴证者。大青龙汤发之。
伤寒脉浮缓者。脉紧去而成缓。为寒欲变热之证。经曰脉缓者多热是也。伤寒邪在表则身疼。邪
入里则身重。寒已变热而脉缓。经脉不为拘急。故身不疼而但重。而其脉犹浮。则邪气在或进或退
之时。故身体有乍重乍轻之候也。是以欲发其表。则经已有热。欲清其热。则表犹不解。而大青龙
汤兼擅发表解热之长。苟无少阴汗出厥逆等证者。则必以此法为良矣。不云主之而云发之者。谓邪
欲入里。而以药发之。使从表出也。旧注谓伤寒见风。故并用麻黄者。非。
Taiyang Wind-Strike syndrome, presenting with a floating and tight pulse, fever, aversion to cold, body pain, absence of sweating, and irritability, should be treated with Da Qing Long Tang (Major Blue Green Dragon Decoction). If the pulse is faint and weak, with sweating and aversion to wind, Da Qing Long Tang must not be administered. Ingestion would lead to cold extremities, twitching of tendons, and tremors of muscles. This constitutes a therapeutic deviation (Ni).
This method treats Wind-Strike with Excess in the Exterior. Individuals with an Excess Exterior constitution are less susceptible to pathogenic factors; if they do contract them, the Wei Qi (Defensive Qi) fails to vent, causing Yang Qi to become congested and excessive. Once Yang Qi is excessive, the exterior cannot circulate freely, trapping heat within the meridians. This results in a tight pulse, body pain, absence of sweating, and irritability. At this stage, herbs such as Ephedrae Herba (Mahuang), Cinnamomi Ramulus (Guizhi), and Zingiberis Rhizoma (Shengjiang) should be used to induce sweating and resolve the Exterior Excess, while Gypsum Fibrosum (Shigao) is added to clear interior heat and alleviate irritability. This condition is beyond the scope of treatment by Gui Zhi Tang (Cinnamon Twig Decoction). Since the pathology has deviated from the typical presentation of Wind-Strike, the treatment cannot rigidly adhere to the standard methods of Gui Zhi Tang. Zhang Zhongjing specifically highlights this case to illustrate the principles of constancy and variation, preventing practitioners from being confined by the name "Wind-Strike" and restricted solely to methods of releasing the muscle layer. Conversely, if the pulse is faint and weak, accompanied by sweating and aversion to wind, it indicates an Empty and deficient Exterior. Administering Da Qing Long Tang to disperse Yang Qi in such a case would inevitably cause cold extremities and muscle tremors, potentially leading to Yang collapse due to profuse sweating. Hence, it is termed a therapeutic deviation. A deviation refers to treating deficiency with methods for excess, which contradicts medical logic.
Da Qing Long Tang Formula:
Ephedrae Herba (Mahuang, 麻黄) - 6 liang, nodes removed
Cinnamomi Ramulus (Guizhi, 桂枝) - 2 liang, bark removed
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) - 2 liang, honey-fried
Ziziphi Jujubae Fructus (Dazao, 大枣) - 12 pieces, split open
Gypsum Fibrosum (Shigao, 石膏) - size of a chicken egg, crushed
Zingiberis Rhizoma Recens (Shengjiang, 生姜) - 3 liang, sliced
Prunus Armeniaca Semen (Xingren, 杏仁) - 40 seeds, skin and tips removed
Take the above seven ingredients. Add nine sheng of water. First boil Mahuang, reducing the volume by two sheng, and skim off the foam on the surface. Then add the remaining herbs. Boil until three sheng of liquid remain. Strain the dregs. Take one sheng warm. The goal is to achieve a slight, uniform sweating. If sweating is excessive, apply warm powder to the body to stop it. If sweating occurs after the first dose, discontinue subsequent doses. Profuse sweating may lead to Yang collapse and debility, resulting in aversion to wind, irritability, and insomnia.
Commentary: In the Shanghan Lun, three main categories are established: Gui Zhi Tang is said to treat Wind injuring the Wei level; Ma Huang Tang is said to treat Cold injuring the Ying level; and Da Qing Long Tang is said to treat both Wind and Cold injuring both Ying and Wei levels. This theory originated with Cheng Wuji and Xu Shuwei, and was further developed by Fang Youzhi and Yu Jiayuan. In my view, stating that Gui Zhi Tang treats Wind injuring the Wei level is correct, but stating that Ma Huang Tang treats Cold injuring the Ying level is incorrect. There are cases where the Wei level is diseased while the Ying level remains unaffected, but there are no cases where the Ying level is diseased while the Wei level is unaffected. Regarding the differentiation of Da Qing Long Tang syndrome, the key lies not in the simultaneous disease of Ying and Wei, but in the symptom of irritability (Fan Zao). The principle of its formulation does not lie in the combined use of Mahuang and Guizhi, but rather in the specific addition of Shigao. Wang Wenlu stated that when Wind and Cold are heavy and trap heat in the meridians, Shigao is added to dispersing herbs; this is accurate. If it were merely a concurrent occurrence of Wind and Cold, Mahuang and Guizhi alone would suffice; why is Shigao necessary? It must be understood that in Wind-Strike, if the Exterior is Excess, Mahuang is used; in Cold Damage, if the Exterior is Deficient, Guizhi is used. When the Exterior cannot vent and heat is trapped internally, Shigao is used. If there is no internal heat, only Mahuang and Guizhi are employed. This is the core methodology of Zhang Zhongjing. To flaunt novel theories and alter established principles distances one further from the true Dao of medicine.
In Cold Damage, if the pulse is floating and slow, the body is not painful but feels heavy, occasionally feeling lighter at times, and there are no Shaoyin syndrome signs, Da Qing Long Tang should be used to disperse the pathogen.
A floating and slow pulse in Cold Damage indicates that the tightness of the pulse has dissipated into slowness, signifying a transformation of Cold into Heat. As the classics state, "a slow pulse often indicates Heat." When pathogens are in the Exterior during Cold Damage, the body aches; when they enter the Interior, the body feels heavy. With Cold transforming into Heat and the pulse becoming slow, the meridians are no longer contracted or spasmodic, hence the body is not painful but feels heavy. The pulse remains floating, indicating that the pathogen is in a phase of advancing or retreating, causing the body sensation to fluctuate between heaviness and lightness. Therefore, to disperse the Exterior, one finds heat already present in the meridians; to clear the Heat, one finds the Exterior unresolved. Da Qing Long Tang excels in both releasing the Exterior and clearing Heat. Provided there are no Shaoyin signs such as sweating and cold extremities, this method is optimal. The text uses the term "fa zhi" (disperse it) rather than "zhu zhi" (mainly treat it) to indicate that since the pathogen desires to enter the Interior, medication is used to disperse it, forcing it to exit via the Exterior. Old annotations claiming that Mahuang is used because Cold Damage presents with Wind features are incorrect.