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In ancient times, when heaven and earth were first opened, the Qi transformation was dense and thick, so people received strong Qi, possessed simple and honest natures, retained their innate innocence, and lived to be over a hundred years old before passing away. As time passed, Qi transformation gradually became thinner, so people's received Qi was often weak; moreover, due to depletion and damage that were hard to restrain or resolve, their lifespan and spirit gradually diminished, causing their blood, Qi, and zang-fu organs to decline accordingly. Therefore, the adjustment of medication should also change gradually. Furthermore, regarding cold damage (Shanghan), since people in ancient times were strong and robust, only severe pathogens could infect them, and only potent medicines could expel them. Additionally, ancient sages had clear insight like a mirror reflecting the gallbladder, so they used few medicinal ingredients but with large dosages, allowing the pathogen to be rapidly defeated without harming the healthy Qi. Today, people's constitution is weak, and even slight cold can cause injury; small doses of mild draining and regulating herbs are sufficient to disperse it. If the illness is minor but the medicine is heavy, if the person is weak but the medicine is fierce, the primordial Qi will be severely damaged, worsening their condition, and there have even been cases resulting in death. Moreover, miscellaneous diseases in all four seasons present symptoms such as fever, headache, and thirst; how can one simply diagnose them as Taiyang disease (Disease of the Bladder and Small Intestine channels) or Yangming disease (Disease of the Stomach and Large Intestine channels)? Even if one contracts cold damage in winter, where Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction) might be tolerated, how could these be applied to conditions resembling Xianxiong Tang (Pectoral Depression Decoction) or Chengqi Tang (Descending the Qi Decoction) presentations in other seasons? Thus, the theory of "transmission of lines" (Chuanjing) is considered by many sages as fragmented and disjointed; the harsh sweating and purging formulas have long been set aside by later generations. I believe that while the laws established by ancient sages should not be discarded, they may still be applicable for those with strong constitutions and heavy pathogens. It is crucial for later practitioners to accurately differentiate syndromes and decide whether to sweat, purge, attack, or tonify, appropriately applying ancient methods to current illnesses with flexibility. This aligns with Jiegu's saying: "The influence of the six Qi varies; the paths of ancient and modern times differ; old formulas cannot easily fit new diseases." Scholar Xu stated: "I read Zhang Zhongjing's books and follow his principles, yet I do not use his formulas; this is truly grasping the essence of Zhang Zhongjing."

Zhang Zhongjing said: In Taiyang disease, presenting with headache, fever, body pain, lower back pain, joint pain, aversion to wind, anhidrosis (absence of sweating), and wheezing; it can also treat Taiyang-Yangming combined disease presenting with wheezing and chest fullness, with a floating and tight pulse; Mahuang Tang (Ephedra Decoction) is the primary treatment; it also treats asthma syndrome.
Mahuang (Ephedrae Herba, 3 liang, remove joints) Guizhi (Cinnamomi Ramulus, 2 liang) Gancao (Glycyrrhizae Radix et Rhizoma, 1 liang, honey-fried) Xingren (Armeniacae Semen Amarum, 70 seeds, remove skin and tips) Boil in 9 sheng of water. First boil Mahuang, reduce by 2 sheng, skim off the foam, then add the remaining herbs. Boil until 2.5 sheng remains. Take warm, 8 ge at a time. Cover to induce slight sweating. Stop when the illness is cured; do not necessarily finish the entire dose. If no sweat occurs, take again.

Li Shizhen said: Zhang Zhongjing used Mahuang for anhidrotic cold damage and Guizhi for diaphoretic cases, but few explored the subtleties. Body fluids transform into sweat; sweat is essentially blood. Within the Ying (Nutritive) level, it is blood; within the Wei (Defensive) level, it is sweat. Cold injuring the Ying causes internal stagnation of Ying blood, preventing external communication with the Wei, leading to closed Wei Qi and stagnant body fluids, resulting in anhidrosis. Fever with aversion to cold indicates Wind injuring the Wei; Wei Qi leaks externally and fails to protect the Ying internally, causing Ying Qi deficiency and insecure body fluids, resulting in sweating, fever, and aversion to wind. However, Wind-Cold enters via the skin and hair, which connect to the Lung. Although the syndrome belongs to Taiyang, symptoms like facial redness, depression, cough with phlegm, wheezing, and chest fullness indicate Lung pathology. Generally, when the exterior is closed, pathogenic heat attacks inward. Therefore, Mahuang and Gancao, assisted by Guizhi, draw out Ying-level pathogens to the muscle surface, aided by Xingren to vent the Lung and promote Qi flow, ensuring pathogens exit from the exterior. Shanghan typically occurs in winter cold; Cold pathogens remain on the exterior, closing the Couli (pores); only acrid-warm herbs can disperse them, hence the necessity of Mahuang and Guizhi. Wenbing (Warm Diseases) and Rebing (Heat Diseases) occur in warmth and heat;郁热 (stagnant heat) reaches outward from within, with no Cold on the exterior; thus, only acrid-cool, bitter-cold, or bitter-sour herbs can resolve them, making Guizhi and Mahuang unsuitable. Previous sages stated "Do not use Mahuang in winter, do not use Guizhi in summer" because winter governs storage and should not be dispersed, while summer is hot and should not be treated with acrid-warm herbs. The Classic says: "First observe the seasonal Qi, do not violate the Harmony of Heaven." It also states: "Mahuang must be used only when Cold pathogens are on the exterior in winter, with closed Couli and anhidrosis." Does this contradict previous statements? Those warning against use emphasize seasonal norms to prevent rash application; those insisting on its use highlight pathological mechanisms to prevent missed applications. One may discard the season to follow symptoms, or discard symptoms to follow the season; clinical flexibility depends on the practitioner. If one fears everything and substitutes only mild, harmonizing herbs, many will suffer premature death due to delayed treatment.