桂枝汤 治风寒在表,脉浮弱,自汗出,头痛发热,恶风恶寒,鼻鸣干呕等证,及杂
证自汗、盗汗、虚损、虚疟亦可用。若脉浮紧,汗不出者,酒客病风寒而汗出者,禁用。
桂枝(三两) 芍药(三两) 生姜(三两) 甘草(炙,二两) 大枣(十二枚)
上五味,以水七升,煮取三升,服一升,覆令微汗,不可令如水流漓,病必不除。若
服一升,汗出病痊,不必尽剂。服已,更啜稀粥一盏,以助药力。
【注】凡风寒在表,脉浮弱自汗出者,皆属表虚,宜桂枝汤主之。名曰桂枝汤者,君
以桂枝也。桂枝辛温,辛能散邪,温从阳而扶卫。芍药酸寒,酸能敛汗,寒走阴而益营。
桂枝君芍药,是于发散中寓敛汗之意;芍药臣桂枝,是于固表中有微汗之道焉。生姜之
辛,佐桂枝以解肌表;大枣之甘,佐芍药以和营里。甘草甘平,有安内攘外之能,用以
调和中气,即以调和表里,且以调和诸药矣。以桂、芍之相须,姜、枣之相得,借甘草之
调和阳表阴里,气卫血营,并行而不悖,是刚柔相济以为和也,而精义在服后须臾啜热
稀粥以助药力,盖谷气内充,不但易为酿汗,更使已人之邪不能少留,将来之邪不得复入
也。又妙在温服令一时许, 微似有汗,是授人以微汗之法。不可令如水流漓,病必不
除,禁人以不可过汗之意也。此方为仲景群方之冠,乃解肌、发汗、调和营卫之第一方
也。凡中风、伤寒,脉浮弱汗自出而表不解者,皆得而主之。其他但见一、二证即是,不
必悉具。故麻、葛、青龙发汗诸剂,咸用之也。若汗不出麻黄证也,脉浮紧者麻黄脉也,
固不可与桂枝汤,然初起无汗,当用麻黄发汗,如汗解后复烦,脉浮数者,与下后脉仍
浮、气上冲者,及下后下利止而身痛不休者,皆用此以解外。何也?盖此时表虽不解,腠
理已疏,邪不在皮毛而在肌肉,且经汗下,津液已伤,故脉证虽同麻黄,而主治当属桂枝
矣。粗工妄谓桂枝汤专治中风,不治伤寒,使人疑而不用;又谓专发肌表不治他病。不知
此汤倍芍药、生姜加人参,名桂枝新加汤,用以治营表虚寒,肢体疼痛;倍芍药加饴糖,名
小建中汤,用以治里虚心悸,腹中急痛;再加黄 ,名黄 建中汤,用以治虚损虚热,自
汗盗汗。因知仲景之方,可通治百病也。
麻黄汤 治太阳风寒在表,头项强痛发热,身疼,腰痛,骨节痛,恶风寒无汗,胸
满面喘,其脉浮紧或浮数者,用此发汗,虽有是证,若脉浮而弱,汗自出,或尺中脉微
与迟者,俱不可用。风、寒、湿成痹,肺经壅塞,昏乱不语,冷风哮吼最宜。
麻黄(去节,三两) 桂枝(二两) 甘草(炙,一两) 杏仁(去皮尖,六十枚)
上四味,以水九升,先煮麻黄,减二升,去上沫,内诸药,煮取二升半,去滓,温服
八合。温覆取微汗,不须啜粥。一服汗出,停后服。汗出多者,温粉扑之。
【注】凡风寒在表,脉浮紧数无汗者,皆表实也,宜麻黄汤主之。名曰麻黄汤者,君
以麻黄也。麻黄性温,味辛而苦,其用在迅升,桂枝性温,味辛而甘,其能在固表。证
属有余,故主以麻黄必胜之算也。监以桂枝制节之妙也。杏仁之苦温佐麻黄逐邪而降逆;
甘草之甘平,佐桂枝和内而拒外。饮入于胃,行气于元府,输精于皮毛,斯毛脉合精,溱
溱汗出,在表之邪必尽去而不留,痛止喘平,寒热顿解。不须啜粥而藉汗于谷也。其不用
姜、枣者,以生姜之性横散于肌,碍麻黄之迅升,大枣之性泥滞于膈,碍杏仁之速降,此
欲急于直达,稍缓则不迅,横散则不升矣。然则为纯阳之剂,过于发散,如单刀直入之将,
用之若当,一战成功,不当则不戢而召祸。故可一而不可再,如汗后不解,盒饭以桂枝代
之。此方为仲景开表逐邪发汗第一峻药也。庸工不知其制在温覆取汗,若不温覆取汗,则
不峻也。世谓麻黄专能发表,不治他病。不知此汤合桂枝汤,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。若阳盛于内而无汗者,又有麻黄杏仁甘草石膏汤,以散太阴肺之邪。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。是知麻黄汤之峻与不峻,而温覆与不温覆。此仲景用方之心法,
岂常人所能得而窥耶!
大青龙汤 治太阳风寒两伤,营卫同病。伤寒之脉而见中风之证,中风之脉而见伤寒
之证,二证俱不出汗而烦躁者,用此两解发汗。虽有是证,若脉微弱,自汗出者,不可
服之,服必亡阳。
麻黄(去节,六两) 桂枝(二两) 杏仁(去皮尖,四十个) 甘草(炙,二两) 生姜(切,
三两) 大枣(擘,十二枚) 石膏(碎,绵囊,如鸡子大)
上七味,以水九升,先煮麻黄,减二升,去上沫,内诸药,煮取三升,去滓,温服一
升,取微汗。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。
【注】何以知风寒两伤、营卫同病、以伤寒之脉而见中风之证,中风之脉而见伤寒之
证也。名大青龙汤者,取龙兴云雨之义也。治风不外乎桂枝,治寒不外乎麻黄,合桂枝麻
黄二汤以成剂,故为兼风寒中伤者主之也。二证俱无汗,故减芍药、不欲其收也。二证俱
烦躁,故加石膏以解其热也。设无烦躁,则又当从事于麻黄桂枝各半汤也。仲景于表剂
中加大寒辛甘之品,则知麻黄证之发热,热全在表;大青龙证之烦躁,兼肌里矣。初病
太阳即用石膏者,以其辛能解肌热,寒能清胃火,甘能生津液,是预保阳存津液之先着
也。粗工疑而畏之,当用不用,必致热结阳明,斑黄狂冒,纷然变出矣。观此则可知石
膏乃中风伤寒之要药,得麻、桂而有青龙之名,得知草而有白虎之号也。服后取微汗,汗
出多者,温粉扑之。一服得汗,停其后服,盖戒人即当汗之证,亦不可过汗也。所以仲景
桂枝汤中不用麻黄者,是欲其不大发汗也;麻黄汤中用桂枝者,恐其过汗无制也。若不慎
守其法,汗多亡阳,变生诸逆,表遂空虚而不任风,阴盛格阳而更烦躁不得眠也。
小青龙汤 治伤寒表不解,心下有水气,干呕发热而咳。或渴、或利、或噎,或小便
不利,少腹满,或喘者。及杂病肤胀、水肿证,用此发汗而利水。
麻黄(去节,三两) 芍药(三两) 五味子(半升) 甘草(炙,三两) 干姜(二两) 半夏(洗,
半升) 桂枝(三两) 细辛(三两)
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。
若渴者,去半夏加括姜根三两,若噎者,去麻黄加附子(炮)一枚。若小便不利少腹
满者,去麻黄加茯苓四两。若喘者,去麻黄加杏仁(去皮尖)半升。若微利者,去麻黄
加荛花如鸡子(熬令赤色)。
【按】“加荛花如鸡子,熬令赤色”,此必
传写之讹。盖《本草》芜花即芫花类也,用之攻水,其力甚峻,五分可令人卞行数十次,
岂有治停饮之微利,而用鸡子大之荛花者乎?当改加茯苓四两。
【注】太阳停饮有二∶一中风,表虚有汗,五苓散证也;一伤寒,表实无汗,小青龙汤
证也。表实无汗,故合麻桂二方以解外。去大枣者,以其性泥也。去杏仁者,以其无喘
也,有喘者加之。去生姜者,以有干姜也,若呕者仍用。佐干姜、细辛,极温极散,使寒
与水俱从汗而解。佐半夏逐痰饮,以清不尽之饮。佐五味收肺气,以敛耗伤之气,若渴
者,去半夏加花粉,避燥以生津也。若微利与噎,小便不利,少腹满,俱去麻黄,远表
以就里也。加附子以去噎散寒,则噎可止。加茯苓以利水,则微利少腹满可除矣。此方与
越婢汤同治水饮溢于表,而为肤胀、水肿,宜发汗外解者,元不随手而消。越婢治有热者,
故方中君以石膏以散阳水也。小青龙治有寒者,故方中佐以姜、桂以消阴水也。
葛根汤治太阳、阳明两经合病,头项强痛,背亦牵强,脉浮元汗恶风者,及表不
解,下利而呕者,并宜服此发汗。
葛根(四两) 麻黄(去节,三两) 桂枝(二两) 芍药(二两) 甘草(炙,二两) 生姜(切,二两)
大枣(擘,十二枚)
上七味,以水一斗,先煮麻黄、葛根,减二升,去沫,内诸药,煮取三升,温服一升。
覆取微似汗,不须啜粥。余如桂枝法将息及禁忌。
【注】是方也,即桂枝汤加麻黄、葛根。麻黄佐桂枝发太阳营卫之汗,葛根君桂枝解
阳明肌表之邪。不曰桂枝汤加麻黄、葛根,而以葛根命名者,其意重在阳明,以呕利属阳
明多也。二阳表急,非温服覆而取汗,其表未易解也。或呕或利,里已失和,虽啜粥而
胃亦不能输精于皮毛,故不须啜粥也。柯琴曰∶此证身不疼、腰不疼、骨节不疼、不恶
寒,是骨不受寒矣。头项强痛,下连于背,牵动不宁,是筋伤于风矣。不喘不烦躁,不干
呕,是里不病,元汗恶风,病只在表。若表病而兼下利,则是表实里虚矣。比麻黄、青
龙二证较轻,然项强连背拘强,更甚于项强无汗,不失为表。但脉浮不紧,故不从乎麻
黄,而于桂枝方加麻黄倍葛根以去实,小变麻桂之法也。盖葛根为阳明主药,凡太阳有
阳明者,则佐入太阳药中;凡少阳有阳明者,则佐入少阳药中,无不可也。李杲定为阳明
经药。张洁古云∶未入阳明者、不可便服。岂二人未读仲景书乎?要知葛根、桂枝,俱是
解肌和里之药,故有汗、无汗,下利、不下利,俱可用,与麻黄之专于发表者不同也。
《金匮》治太阳病无汗,小便反少,气上冲胸,口噤不得语,欲作刚痉。
【集注】喻昌曰∶伤寒项背KT KT ,无汗恶风者,用葛根汤。此证亦用之者,以其邪在
太阳、阳明两经之界。两经之热并于胸中,必伤肺金清肃之气,故水道不行,小便少,津
液不布而无汗。阳明之筋内结胃口,外行胸中,过人迎环口,热并阳明,斯筋脉牵引,口
噤不得语。然刚痉无汗,必从汗解,况湿邪内郁,必以汗出如故而止。故用此汤合解两
经之湿热,与风寒之表,法无害其同也。
桂枝麻黄各半汤 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。
桂枝(一两六铢) 芍药(一两) 麻黄(去节,一两) 生姜(一两) 甘草(炙,一两) 大枣(擘,四枚)
杏仁(去皮尖,二十四个)
上七味,以水五升,先煮麻黄一二沸,去上沫,内诸药,煮取一升八合,去滓,温服
六。
【注】太阳病,得之八九日,有如疟状之寒热。热多寒少者,其人不呕,小便清白,此
里和不受邪,虽为欲自愈;然必审其如疟状寒热,一日二、三度,轻轻而发,诊其脉微
而且缓,则知邪衰正复,表里将和,始为欲愈也。若脉微不缓,正未复也,更恶寒者,邪
未衰也,虽不能自愈,但已为前之汗、吐、下虚其表里,故不可更发汗、更吐、更下也。脉
微恶寒,表里俱虚,面色当白,今色反赤,是犹有表邪怫郁,不能得小汗出宣发阳气,故
面赤身痒,未欲解也,宜桂枝麻黄各半汤,小小汗之以和营卫,自可愈也。
桂枝二麻黄一汤 服桂枝汤,大汗出,脉洪大者,与桂枝汤如前法。若形如疟,日再
发者,汗出必解,宜桂枝二麻黄一汤。
桂枝(一两十六铢) 芍药(一两六铢) 麻黄(去节,十六铢) 甘草(一两二铢)
杏仁(去皮尖,十六个) 生姜(一两六铢) 大枣(擘,五枚)
上七味,以水五升,先煮麻黄一二沸,去上沫,内诸药,煮取二升,去滓,温服一升,日再服。
【注】服桂枝汤大汗出,脉洪大不解,若烦渴者,则表邪已入阳明,白虎汤证也。今
脉虽洪大而不烦渴,则为表邪无在太阳,故与桂枝汤如前法也。若脉不洪大,壮热亦减,
惟寒热如疟,日再发者,虽属轻邪,然终为微寒所持,非汗出必不解也,宜桂枝二麻黄
一汤,小发营卫之汗。不用麻黄桂枝各半汤者,盖因已大汗出,不欲其发营卫汗,欲其
和营卫汗也。
桂枝二越婢一汤 太阳病,发热恶寒,热多寒少。脉微弱者,此无阳也,不可更汗。宜
桂枝二越婢一汤。
桂枝(一两六铢) 芍药(一两) 甘草(炙,一两三铢) 石膏(二十四铢)
麻黄(十六铢) 大枣(擘,五枚) 生姜(切,一两六铢)
上七味,以水五升,煮麻黄一二沸,去上沫,内诸药,煮取二升,去滓,温服一升,
日再服。本方当裁为越婢汤、桂枝汤,各饮一升,今合为一方,桂枝二越婢一汤。
Guizhi Tang (Cinnamon Twig Decoction): Treats conditions where wind-cold pathogens are at the exterior, with a floating and weak pulse, spontaneous sweating, headache, fever, aversion to wind and cold, nasal congestion with humming sound, and dry retching. It is also applicable for miscellaneous diseases involving spontaneous sweating, night sweats, deficiency exhaustion, and deficient malaria. It is contraindicated if the pulse is floating and tight with no sweat, or in habitual drinkers who have wind-cold with sweating.
Ingredients: Guizhi (Cinnamomi Ramulus) (3 liang), Shaoyao (Paeoniae Radix Alba) (3 liang), Shengjiang (Zingiberis Rhizoma Recens) (3 liang), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (2 liang), Dazao (Jujubae Fructus) (12 pieces).
Process: Take the above five herbs, add seven sheng of water, decoct to obtain three sheng of liquid. Take one sheng per dose. After taking the medicine, cover with blankets to induce slight perspiration. Do not allow profuse sweating like flowing water, otherwise the disease will not be resolved. If after taking one sheng, sweating occurs and the disease resolves, there is no need to finish the remaining decoction. After taking the medicine, drink a bowl of thin porridge to assist the medicinal power.
[Commentary]: Whenever wind-cold is at the exterior with a floating-weak pulse and spontaneous sweating, it belongs to Exterior Deficiency syndrome, and Guizhi Tang is indicated. Named Guizhi Tang because Guizhi is the Sovereign herb. Guizhi is acrid and warm; acridity disperses pathogens, and warmth supports Wei Qi (Defensive Qi) from the Yang aspect. Shaoyao is sour and cold; sourness consolidates sweat, and cold nourishes Ying Qi (Nutritive Blood) in the Yin aspect. Guizhi as Sovereign and Shaoyao as Minister implies containing the intent of consolidating sweat within dispersion; Shaoyao assisting Guizhi implies leaving a pathway for slight sweating within surface consolidation. The acridity of Shengjiang assists Guizhi in resolving the muscle and exterior; the sweetness of Dazao assists Shaoyao in harmonizing Ying Qi and the interior. Gancao is sweet and neutral, possessing the ability to stabilize the interior and repel the exterior; it is used to harmonize Middle Jiao Qi, thereby harmonizing the exterior and interior, and harmonizing all herbs. Relying on the mutual assistance of Guizhi and Shaoyao, and the harmony of Shengjiang and Dazao, aided by Gancao’s harmonizing action to coordinate Yang-exterior and Yin-interior, Qi-Wei and Blood-Ying, proceeding together without conflict, this achieves harmony through the combination of rigid and soft. The essence lies in drinking hot thin porridge shortly after administration to boost medicinal power. Since grain Qi fills the interior, it not only facilitates the brewing of sweat but also prevents pathogens already entered from lingering slightly and future pathogens from re-entering. Another subtlety lies in taking the medicine warm and maintaining this for about an hour, resulting in slight apparent sweating; this teaches the method of inducing slight sweating. Profuse sweating like flowing water is prohibited, warning against excessive sweating. This formula is the crown among Zhang Zhongjing’s formulas, being the primary formula for resolving the muscle layer, inducing sweating, and harmonizing Ying and Wei. For Wind Strike or Cold Damage with floating-weak pulse and spontaneous sweating where the exterior is not resolved, it serves as the main treatment. In other cases, seeing one or two symptoms is sufficient; all symptoms need not be present. Therefore, sweating agents like Mahuang Tang, Gegen Tang, and Da Qinglong Tang often incorporate it. If there is no sweat, it is a Mahuang Tang pattern; a floating-tight pulse indicates Mahuang’s indication, so Guizhi Tang is naturally contraindicated. However, in early stages with no sweat, Mahuang Tang should be used for sweating; if restlessness recurs after sweating with a floating-rapid pulse; or if the pulse remains floating and Qi rushes upward after purgation; or if diarrhea stops after purgation but body pain persists, this formula is used to resolve the exterior. Why? Although the exterior is unresolved, the couli (pores) are loose, pathogens are in the muscle layer rather than the skin/hair, and fluids are damaged due to prior sweating and purging. Thus, although the pulse and symptoms resemble Mahuang Tang, the treatment belongs to Guizhi Tang. Unskilled doctors erroneously claim Guizhi Tang treats only Wind Strike and not Cold Damage, causing hesitation; or that it only disperses the muscle layer and treats no other diseases. They do not know that doubling Shaoyao and Shengjiang and adding Renshen creates Guizhi Xinjia Tang (Newly Added Cinnamon Twig Decoction) for Ying-Exterior deficiency-cold with limb pain; doubling Shaoyao and adding Yitang creates Xiaojianzhong Tang (Minor Construct the Middle Decoction) for Interior deficiency palpitations and abdominal urgency/pain; adding Huangqi creates Huangqi Jianzhong Tang for deficiency exhaustion, deficient heat, spontaneous and night sweats. Thus, Zhang Zhongjing’s formulas can treat hundred diseases.
Mahuang Tang (Ephedra Decoction): Treats Taiyang wind-cold at the exterior, with stiffness and pain in the head and neck, fever, body ache, lower back pain, bone and joint pain, aversion to wind and cold, no sweat, chest fullness, facial redness, and wheezing. The pulse may be floating-tight or floating-rapid. Use this to induce sweating. However, even with these symptoms, if the pulse is floating-weak with spontaneous sweating, or if the Chi position pulse is faint and slow, it is contraindicated. It is most suitable for Bi syndrome caused by wind-cold-dampness, lung meridian obstruction with confusion and muteness, and cold-wind asthma.
Ingredients: Mahuang (Ephedrae Herba) (de-stemmed, 3 liang), Guizhi (Cinnamomi Ramulus) (2 liang), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (roasted, 1 liang), Xingren (Armeniacae Semen Amarum) (skin and tip removed, 60 pieces).
Process: Take the above four herbs, add nine sheng of water. First decoct Mahuang, reducing by two sheng, remove the foam on top. Add the other herbs, decoct to obtain two and a half sheng. Strain and take eight ge warm. Cover warmly to induce slight sweating; no porridge is needed. If sweating occurs after one dose, stop subsequent doses. If sweating is excessive, apply warm powder to the body.
[Commentary]: Whenever wind-cold is at the exterior with a floating-tight-rapid pulse and no sweat, it belongs to Exterior Excess syndrome, and Mahuang Tang is indicated. Named Mahuang Tang because Mahuang is the Sovereign herb. Mahuang is warm, acrid and bitter, its action being rapid ascent. Guizhi is warm, acrid and sweet, its capacity being surface consolidation. Since the syndrome is Excess, Mahuang is used as the decisive strategy. Guizhi acts as a monitor to regulate it. Xingren’s bitter-warmness assists Mahuang in expelling pathogens and descending rebellious Qi; Gancao’s sweet-neutrality assists Guizhi in harmonizing the interior and resisting the exterior. Upon entering the stomach, Qi moves in the Yuan Fu (Qi Gates), essence is transported to the skin and hair. Thus, hair and vessel essence combine, and sweat pours forth. Pathogens at the exterior are completely expelled, pain ceases, wheezing flattens, and cold/heat resolve instantly. No porridge is needed as sweat relies on grain Qi. Ginger and Jujube are omitted because Shengjiang’s nature spreads horizontally in the muscle, hindering Mahuang’s rapid ascent; Dazao’s nature is sticky in the diaphragm, hindering Xingren’s rapid descent. This aims for direct and swift action; any delay hinders speed, horizontal spreading hinders ascent. As a pure Yang formula, it is overly dispersing, like a general charging straight in. Used correctly, victory is won in one battle; incorrectly, failure brings disaster. Thus, it can be used once but not twice. If unresolved after sweating, substitute with Guizhi Tang. This is Zhang Zhongjing’s first harsh/decocting formula for opening the exterior and expelling pathogens. Ignorant practitioners do not know its harshness depends on warming covers to induce sweat; without this, it is not harsh. The world says Mahuang only releases the exterior and treats no other diseases. They do not know combining this with Guizhi Tang creates Magui Ge Ban Tang (Half-Half Cinnamon and Ephedra Decoction) to harmonize lingering cold-heat in Taiyang. Removing Xingren and adding Shigao combined with Guizhi Tang creates Guizhi Er Yuebi Yi Tang (Two Parts Cinnamon Twig, One Part Yuebi Decoction) to resolve Taiyang heat-dominant/cold-minor cold-heat. If Yang is excess internally with no sweat, there is Mahuang Xingren Gancao Shigao Tang to disperse Taiyin Lung pathogens. If Yin is excess internally with no sweat, there is Mahuang Fuzi Xixin Gancao Tang to warm-disperse Shaoyin Kidney cold. *Jingui Yaolue* removes Guizhi from this formula; *Qianjin Fang* replaces Guizhi with Guixin, both named Huanhun Tang (Return Soul Decoction) for Taiyin pathogens causing sudden syncope, jaw lock, and breath cessation, effective upon swallowing, without requiring warm covers for sweating. Thus, the harshness of Mahuang Tang depends on warm covers. This is Zhang Zhongjing’s secret method of using formulas, inaccessible to ordinary people!
Da Qinglong Tang (Great Blue Dragon Decoction): Treats Taiyang suffering from both wind and cold, with simultaneous Ying and Wei pathology. A Taiyin Cold-Damage pulse showing Wind-Strike symptoms, or a Wind-Strike pulse showing Cold-Damage symptoms, where neither presents with sweat but both show irritability, use this to resolve both via sweating. Contraindicated if the pulse is faint-weak with spontaneous sweating; ingestion will cause Yang collapse.
Ingredients: Mahuang (Ephedrae Herba) (de-stemmed, 6 liang), Guizhi (Cinnamomi Ramulus) (2 liang), Xingren (Armeniacae Semen Amarum) (skin and tip removed, 40 pieces), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (roasted, 2 liang), Shengjiang (Zingiberis Rhizoma Recens) (sliced, 3 liang), Dazao (Jujubae Fructus) (split, 12 pieces), Shigao (Gypsum Fibrosum) (crushed, wrapped in silk bag, size of a chicken egg).
Process: Take the above seven herbs, add nine sheng of water. First decoct Mahuang, reducing by two sheng, remove foam. Add other herbs, decoct to obtain three sheng. Strain and take one sheng warm to induce slight sweating. If sweating is excessive, apply warm powder. If one dose induces sweating, stop subsequent doses. Excessive sweating causes Yang collapse, leading to deficiency, aversion to wind, irritability, and inability to sleep.
[Commentary]: How do we know it is wind-cold dual injury and Ying-Wei simultaneous pathology, with Cold-Damage pulse showing Wind-Strike symptoms, etc.? Named Da Qinglong Tang, taking the meaning of dragon raising clouds and rain. Treating wind relies on Guizhi; treating cold relies on Mahuang. Combining Guizhi Tang and Mahuang Tang forms this agent, hence it is the main treatment for combined wind-cold injury. Both syndromes lack sweat, so Shaoyao is reduced to avoid astringency. Both syndromes show irritability, so Shigao is added to clear heat. If no irritability, one should resort to Magui Ge Ban Tang. Zhang Zhongjing adds large-cold, acrid-sweet herbs to exterior formulas, indicating Mahuang syndrome fever is entirely at the exterior; Da Qinglong syndrome irritability involves the muscle interior. Using Shigao early in Taiyang illness works because it is acrid to resolve muscle heat, cold to clear Stomach fire, and sweet to generate fluids—this is the preemptive move to protect Yang and preserve fluids. Unskilled doctors doubt and fear it, failing to use it when needed, inevitably leading to Heat binding in Yangming, macules, jaundice, mania, and various transformations. From this, we see Shigao is a key herb for Wind Strike and Cold Damage; with Mahuang and Guizhi it earns the name Qinglong; with Gancao it earns the name Baihu. Post-administration requires slight sweating; excessive sweating is treated with warm powder. One dose inducing sweat means stopping further doses, warning that even appropriate sweating cases must not be over-treated. Hence, Zhang Zhongjing omits Mahuang in Guizhi Tang to avoid excessive sweating; he includes Guizhi in Mahuang Tang to prevent uncontrolled sweating. Failure to observe these methods leads to excessive sweating and Yang collapse, generating reverse syndromes. The exterior becomes empty and unable to withstand wind; Yin excess repels Yang, causing worse irritability and insomnia.
Xiao Qinglong Tang (Minor Blue Dragon Decoction): Treats Cold-Damage exterior unresolved, with fluid retention in the epigastrium, dry retching, fever, and cough. Or thirst, or diarrhea, or throat obstruction, or urinary difficulty with lower abdominal fullness, or wheezing. Also applicable for miscellaneous diseases presenting with skin distension and edema, using this to induce sweating and promote urination.
Ingredients: Mahuang (Ephedrae Herba) (de-stemmed, 3 liang), Shaoyao (Paeoniae Radix Alba) (3 liang), Wuweizi (Schisandrae Fructus) (half sheng), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (roasted, 3 liang), Ganjiang (Zingiberis Rhizoma) (2 liang), Banxia (Pinelliae Rhizoma Praeparatum) (washed, half sheng), Guizhi (Cinnamomi Ramulus) (3 liang), Xixin (Asari Radix et Rhizoma) (3 liang).
Process: Take the above eight herbs, add ten sheng of water. First decoct Mahuang, reducing by two sheng, remove foam. Add other herbs, decoct to obtain three sheng. Strain and take one sheng warm. Modifications: If thirsty, remove Banxia and add Gualougen (Trichosanthis Radix) 3 liang. If throat obstruction, remove Mahuang and add Pao Fuzi (Aconiti Lateralis Radix Praeparata) 1 piece. If urinary difficulty/lower abdominal fullness, remove Mahuang and add Fuling (Poria) 4 liang. If wheezing, remove Mahuang and add Xingren (Armeniacae Semen Amarum) (skin/tip removed) half sheng. If mild diarrhea, remove Mahuang and add Raohua (Edwardsiae Radix) size of a chicken egg (roasted until red).
[Note]: "Add Raohua size of a chicken egg, roasted until red" is likely a transcription error. Bencao states Wuhua is similar to Yuanhua (Genkwa Flos), which is very harsh for draining water; 5 fen can cause dozens of bowel movements. It is unlikely that for mild diarrhea from fluid retention, one would use a chicken-egg-sized dose of Raohua. It should be changed to adding Fuling 4 liang.
[Commentary]: There are two types of fluid retention in Taiyang: one is Wind-Strike, exterior deficiency with sweat, indicated by Wuling San; the other is Cold-Damage, exterior excess without sweat, indicated by Xiao Qinglong Tang. Exterior excess without sweat necessitates combining Mahuang and Guizhi formulas to resolve the exterior. Dazao is removed due to its stickiness. Xingren is removed because there is no wheezing (add if present). Shengjiang is removed because Ganjiang is present (use Shengjiang if vomiting occurs). Assisted by Ganjiang and Xixin, extremely warm and dispersing, allowing cold and water to resolve via sweat. Banxia assists in driving out phlegm-fluids to clear residual fluid. Wuweizi assists in收敛 (astringing) Lung Qi to conserve consumed Qi. If thirsty, remove Banxia and add Huafen (Trichosanthis Radix) to avoid dryness and generate fluids. For mild diarrhea, throat obstruction, urinary difficulty, and lower abdominal fullness, remove Mahuang to move from exterior to interior. Add Fuzi to stop obstruction and dispel cold. Add Fuling to promote urination, resolving mild diarrhea and lower abdominal fullness. This formula, along with Yuebi Tang, treats water-fluid overflowing to the exterior causing skin distension and edema, suitable for resolution via sweating. Yuebi Tang treats heat, using Shigao as Sovereign to disperse Yang-water. Xiao Qinglong Tang treats cold, assisted by Jiang and Gui to dissipate Yin-water.
Gegen Tang (Kudzu Decoction): Treats concurrent disease of Taiyang and Yangming meridians, with stiffness and pain in the head and neck, pulling stiffness in the back, floating pulse, no sweat, and aversion to wind. Also applicable when the exterior is unresolved accompanied by diarrhea and vomiting. Indicated for inducing sweating.
Ingredients: Gegen (Puerariae Lobatae Radix) (4 liang), Mahuang (Ephedrae Herba) (de-stemmed, 3 liang), Guizhi (Cinnamomi Ramulus) (2 liang), Shaoyao (Paeoniae Radix Alba) (2 liang), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (roasted, 2 liang), Shengjiang (Zingiberis Rhizoma Recens) (sliced, 2 liang), Dazao (Jujubae Fructus) (split, 12 pieces).
Process: Take the above seven herbs, add ten sheng of water. First decoct Mahuang and Gegen, reducing by two sheng, remove foam. Add other herbs, decoct to obtain three sheng. Take one sheng warm. Cover to induce slight apparent sweating; no porridge is needed. Rest follow Guizhi Tang care instructions and contraindications.
[Commentary]: This formula is Guizhi Tang plus Mahuang and Gegen. Mahuang assists Guizhi to sweat Taiyang Ying-Wei; Gegen assists Guizhi to resolve Yangming muscle-exterior pathogens. It is not named Guizhi Tang plus Mahuang/Gegen, but Gegen Tang, emphasizing Yangming, as vomiting and diarrhea belong more to Yangming. When both Yang meridians’ exterior is urgent, without warm intake and covering to induce sweat, the exterior is hard to resolve. Vomiting or diarrhea indicates Interior disharmony; even with porridge, the Stomach cannot transport essence to skin/hair, hence no porridge is needed. Ke Qin said: This syndrome lacks body/back/joint pain and aversion to cold, indicating bones are not affected by cold. Head/neck stiffness extending to the back with restless pulling indicates tendons injured by wind. No wheezing, irritability, or dry retching indicates the Interior is unaffected. No sweat and aversion to wind indicate the disease is solely at the Exterior. If Exterior disease accompanies diarrhea, it is Exterior Excess and Interior Deficiency. It is milder than Mahuang and Qinglong patterns, but neck/back stiffness is more severe than simple neck stiffness without sweat, still retaining Exterior characteristics. However, the pulse is floating not tight, so it does not follow Mahuang Tang. Instead, it modifies Guizhi Tang by adding Mahuang and doubling Gegen to remove Excess, slightly altering the Mahuang-Guizhi method. Gegen is the Sovereign herb of Yangming. Whenever Taiyang involves Yangming, it is added to Taiyang herbs; whenever Shaoyang involves Yangming, it is added to Shaoyang herbs—there is no case where it cannot be used. Li Gao designated it as a Yangming Meridian herb. Zhang Jiegu said: Do not administer if pathogens have not entered Yangming. Did these two not read Zhang Zhongjing’s books? One must know Gegen and Guizhi are both muscle-resolving and Interior-harmonizing herbs. Thus, they are usable with or without sweat, with or without diarrhea, differing from Mahuang which specializes in releasing the Exterior. *Jingui Yaolue* treats Taiyang disease with no sweat, urine unexpectedly scant, Qi rushing to the chest, jaw lock and inability to speak, impending Gang Jing (Stiff Spasm).
[Collected Commentary]: Yu Chang said: For Cold-Damage with stiff neck/back, no sweat, and aversion to wind, Gegen Tang is used. This syndrome uses it too, because the pathogen is at the boundary of Taiyang and Yangming. Heat from both meridians converges in the chest, damaging Lung Metal’s clearing/descending Qi, causing water pathways to fail, scant urine, fluid distribution failure, and no sweat. Yangming tendons knot internally at the stomach gate, run externally through the chest, pass Yingling and around the mouth. Heat merging into Yangming causes tendon/muscle traction, jaw lock, and inability to speak. However, Gang Jing with no sweat must resolve via sweating. Moreover, damp-heat constrained internally must cease when sweat returns to normal. Thus, this decoction resolves damp-heat in both meridians and wind-cold at the exterior; the method has no harm in similarity.
Guizhi Mahuang Ge Ban Tang (Half-Half Cinnamon Twig and Ephedra Decoction): Taiyang disease, after eight or nine days, resembling malaria with fever and aversion to cold, heat dominant over cold, patient does not vomit, stool and urine are relatively normal, occurring two or three times a day. If the pulse is faint and slow, recovery is imminent. If the pulse is faint with aversion to cold, this indicates simultaneous Yin and Yang deficiency; do not use sweating, purging, or vomiting again. If the face shows abnormal redness, the disease is not resolved because small amounts of sweat cannot be released, causing body itching. Use Guizhi Mahuang Ge Ban Tang.
Ingredients: Guizhi (Cinnamomi Ramulus) (1 liang 6 zhu), Shaoyao (Paeoniae Radix Alba) (1 liang), Mahuang (Ephedrae Herba) (de-stemmed, 1 liang), Shengjiang (Zingiberis Rhizoma Recens) (1 liang), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (roasted, 1 liang), Dazao (Jujubae Fructus) (split, 4 pieces), Xingren (Armeniacae Semen Amarum) (skin/tip removed, 24 pieces).
Process: Take the above seven herbs, add five sheng of water. First decoct Mahuang for one or two boils, remove foam. Add other herbs, decoct to obtain one sheng eight he. Strain and take six ge warm.
[Commentary]: Taiyang disease after eight or nine days presents with malaria-like chills and fever. Heat dominant over cold, no vomiting, clear urine/stool indicates Interior harmony and resistance to pathogens; although self-healing is possible, one must examine if the malaria-like chills/fever occur lightly two or three times daily. If the pulse is faint and slow, it indicates pathogen decline and Zheng Qi recovery, suggesting Exterior-Interior harmony and imminent recovery. If the pulse is faint but not slow, Zheng Qi has not recovered; with increased aversion to cold, the pathogen has not declined. Although self-healing is impossible, previous sweating/vomiting/purging has weakened the Exterior-Interior, so do not use sweating/vomiting/purging again. Faint pulse and aversion to cold indicate Exterior-Interior deficiency; the face should be pale, but now it is red, indicating lingering Exterior pathogen constraint preventing slight sweat release to vent Yang Qi. Thus, red face and body itch indicate unresolved disease. Use Guizhi Mahuang Ge Ban Tang to induce slight sweating and harmonize Ying-Wei, ensuring recovery.
Guizhi Er Mahuang Yi Tang (Two Parts Cinnamon Twig, One Part Ephedra Decoction): After taking Guizhi Tang, profuse sweating occurs with a洪大 (Surging-Large) pulse. Give Guizhi Tang as before. If the condition resembles malaria, occurring twice a day, sweating will resolve it. Use Guizhi Er Mahuang Yi Tang.
Ingredients: Guizhi (Cinnamomi Ramulus) (1 liang 16 zhu), Shaoyao (Paeoniae Radix Alba) (1 liang 6 zhu), Mahuang (Ephedrae Herba) (de-stemmed, 16 zhu), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (1 liang 2 zhu), Xingren (Armeniacae Semen Amarum) (skin/tip removed, 16 pieces), Shengjiang (Zingiberis Rhizoma Recens) (1 liang 6 zhu), Dazao (Jujubae Fructus) (split, 5 pieces).
Process: Take the above seven herbs, add five sheng of water. First decoct Mahuang for one or two boils, remove foam. Add other herbs, decoct to obtain two sheng. Strain and take one sheng warm, twice daily.
[Commentary]: After Guizhi Tang, profuse sweating with Surging-Large pulse without resolution: if accompanied by irritability and thirst, the Exterior pathogen has entered Yangming, indicating Baihu Tang syndrome. Now, although the pulse is Surging-Large, there is no irritability/thirst, so the pathogen remains in Taiyang. Give Guizhi Tang as before. If the pulse is not Surging-Large, high fever subsides, leaving only malaria-like chills/fever occurring twice daily: although this is a light pathogen, it is held by minor cold and will not resolve without sweating. Use Guizhi Er Mahuang Yi Tang to slightly sweat Ying-Wei. Magui Ge Ban Tang is not used because profuse sweating has already occurred; we do not want to excessively sweat Ying-Wei, but rather harmonize Ying-Wei sweat.
Guizhi Er Yuebi Yi Tang (Two Parts Cinnamon Twig, One Part Yuebi Decoction): Taiyang disease with fever, aversion to cold, heat dominant over cold. If the pulse is faint-weak, this indicates "No Yang"; do not sweat again. Use Guizhi Er Yuebi Yi Tang.
Ingredients: Guizhi (Cinnamomi Ramulus) (1 liang 6 zhu), Shaoyao (Paeoniae Radix Alba) (1 liang), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (roasted, 1 liang 3 zhu), Shigao (Gypsum Fibrosum) (24 zhu), Mahuang (Ephedrae Herba) (16 zhu), Dazao (Jujubae Fructus) (split, 5 pieces), Shengjiang (Zingiberis Rhizoma Recens) (sliced, 1 liang 6 zhu).
Process: Take the above seven herbs, add five sheng of water. Boil Mahuang for one or two boils, remove foam. Add other herbs, decoct to obtain two sheng. Strain and take one sheng warm, twice daily. This formula should ideally be prepared as separate Yuebi Tang and Guizhi Tang, each drinking one sheng. Now combined into one formula, named Guizhi Er Yuebi Yi Tang.