论
《内经》曰∶人之伤于寒也，则为病热，热虽甚不死。若两感于寒者，则不免于死矣。盖伤寒之证，非若杂病之易
知也。惟汉张仲景深达是理，而为立法之祖，着《伤寒论》一书，载三百九十七法，一百一十有三方，以为后学之矜式。
惜乎其书一变于王叔和之撰次，再变于成无己之诠注，传之愈久而愈失其真也。考其法与方也，何尝合其数焉。且三阴
寒证之用热药者十居七八，其《内经》所谓传经之伤寒，自三阳而传入于三阴之经，但一于热耳，何由而为寒哉，
是以不能不使人之致疑也。故后人纷纷之论，俱未得其旨要，愚窃憾焉。有至人传云∶伤寒大法有四∶曰传经，曰专经，
曰即病，曰郁病。夫即病者多为专经，郁病者多为传经。盖寒邪之中人，无有定体，或中于阳，或中于阴，或但中于太
阳，未及郁热而即发，首尾只在本经而不传变者，治宜麻黄桂枝等汤，驱散表邪而愈。或有从太阳未及郁热，不从阳明
少阳过，而遂入于三阴之经者，亦有初不曾入于阳经而直伤于三阴之经而即病者，因其未曾郁热，是以一切为寒证焉，
故多自霜降后至春分前发者是也。为其无头痛，无大热，脉沉迟而微，故古方又出中寒一条，实此证也，治宜四逆、真
武等汤，温中通脉而愈。若夫始从太阳郁热，以次而传至于阳明、少阳，次第传变于三阴之经者，则为传经之热证明矣
（经曰∶一日巨阳受之，其脉尺寸俱俘，其证头项痛、腰脊强，故宜发汗。二日阳明受之，其脉尺寸俱长，其证身热目
痛、鼻干不得卧，故宜解肌。三日少阳受之，其脉尺寸俱弦，其证胸胁痛而耳聋，往来寒热，故宜和解。四日太阴受之，
其脉尺寸俱沉细，其证腹满咽干自利，故宜分利。五日少阴受之，其脉尺寸俱微缓，其证口燥舌干而渴，故宜清之。六
日厥阴受之，其脉尺寸俱沉涩，其证烦满而囊缩，故宜下之。自此以后，病日以衰，至十三日乃愈），故多自春分后至夏
至前发者是也。夫春夏固无即病专经之寒证，而秋冬岂无郁病传经之热证欤。惟寒邪之传注经络，实无定体。故东垣有
曰∶太阳者，巨阳也，为诸阳之首。膀胱经病若渴者，自入于本也，名曰传本。太阳传阳明胃土者，名曰巡经传，为发
汗不彻，利小便，余邪不尽，透入于里也。太阳传少阳胆木者，名曰越经传，为原受病脉浮宜汗，当用麻黄而不用之故
也。太阳传少阴肾水者，名曰表里传，为表病急当发汗而反下，所以传也。太阳传太阴脾土者，名曰误下传，为受病脉
缓有汗，当用桂枝而反下之所致也，当脐腹痛，四肢沉重。太阳传厥阴肝木者，为三阴不至于首，惟厥阴与督脉上行与
太阳相接，名曰巡经得度传也。夫经所谓两感伤寒者，日传二经之候也，一日太阳与少阴俱病，二日阳明与太阴俱病，
三日少阳与厥阴俱病。张仲景无治法，惟东垣有治两感大羌活汤，云十可救其一二，未能试其验否。愚按∶仲景《伤寒
论》曰∶中而即病者，名曰伤寒。不即病者，寒毒藏于肌肤，至春变为温病，至夏变为暑病。暑病者，热极重于温也。
考之《内经》有曰∶春伤于风，夏为飧泄；夏伤于暑，秋为 疟；秋伤于湿，冬必咳嗽；冬伤于寒，春必病温。此四时
之正病也。遍阅《内经》中，但有六经传变之伤寒，而无三阴直伤即病之寒证焉。大抵《内经》以春三月及夏至前发者
为真伤寒，张仲景以秋分后至冬三月发者为真伤寒，抑未敢议其孰非而孰是也。若夫春为温病，夏为热病，皆冬受寒邪、
郁积之久之重病也。外有四时感冒、新受风寒之轻证，亦有头痛体痛、恶寒发热等候，自当作感冒处治，非冬伤寒邪、
过时而发之重病比也。今人因借仲景治伤寒法治之获效，遂通谓之四时伤寒，实非仲景立法之本意也。夫欲治伤寒者，
切宜潜心洞察，不可苟且轻试。且如不当汗而汗者，为亡阳，为蓄血，为鼻衄，为筋惕肉 ，为下厥上竭，为咽干，为
小便淋 。不当下而下者，为结胸，为痞气，为懊 ，为失血，为复热。又阴盛阳虚，汗之即愈，下之即死；阳盛阴虚，
下之即愈，汗之即死。又曰∶桂枝下咽，阳盛即毙；承气入胃，阴盛乃亡。医者其可轻视之乎。
脉法
脉阳浮而阴弱，谓之伤风。（邪在六经，俱弦加之。阳浮，卫中风也；阴弱，荣气弱也。风伤阳，故浮虚。）
脉浮紧而无汗，谓之伤寒。（寒伤荣，荣实则卫虚。阳脉紧，邪在上焦，主欲吐也。）
脉浮，头项痛，腰脊强，病在太阳。
脉长，身热鼻干，目疼不得卧，病在阳明。
脉弦，胸胁痛耳聋，往来寒热，病在少阳。
脉沉细，咽干，腹满自利，病在太阴。
脉微缓，口燥舌干而渴，病在少阴。
脉沉涩，烦满囊缩，病在厥阴。
脉阴阳俱盛，重感于寒而紧涩，变为温疟。（阴阳紧盛，伤寒之脉，前病热未已，后复感于寒也。）
脉阳浮而滑，阴濡而弱，更遇于风，变为风湿。（阳脉浮滑，阴脉濡弱，皆风脉也。前脉未除，风来乘热也。）
脉阳洪数，阴实大，更遇温热，两合变为温毒。（洪数实大皆热，两热相合也。）
脉阳濡弱，阴弦紧，更遇温气，变为瘟疫。
病发热，脉沉细，表得太阳，名曰 病。
病太阳，关节疼痛而烦，脉沉细，名曰湿痹。
病太阳，身热疼痛，脉微弱弦芤，名曰中 。
若发汗已，身灼然热，名曰风温。（风温为病，脉阴阳俱俘，自汗出，身重多眠睡，息鼾语难，小便不利，更被其下
若被火者，微发黄色，剧者则惊痫时螈 ，色如火熏则死。）
脉沉细而疾，身凉四肢冷，烦躁不欲饮水，狂闷，名曰阳厥。
伤寒热盛，脉浮大者生，沉小者死。（已汗，沉小者生。浮大者死。）
方法
丹溪曰∶外感无内伤者，用仲景法。伤寒挟内伤者，十居八九。经曰∶邪之所凑，其气必虚。补中益气汤，从六经
所见之证加减用之。气虚甚者，少加附子以行参 之气。东垣谓内伤者极多，外伤者间而有之，此发前人所未发。后人
徇俗，不见真切，雷同指为外伤，极谬。其或可者，盖亦因其不敢放肆，而多用平和之药散之耳。若粗率者，必致杀人。
有感冒轻病，不可便认为伤寒。西北二方极寒肃杀之气，外伤者甚多；东南二方温和之地，外伤甚少，所谓千百而一二
也。
（以上丹溪方法凡一条）
桂枝汤（并加减法。） 治太阳经伤风，发热自汗，鼻鸣干呕。
桂枝（二钱五分） 芍药（一钱五分） 甘草（一钱）
上细切，作一服，加生姜三片，大枣二枚，水一盏半，煎至一盏，去渣温服。本方惟冬及春初可行。春末及夏至前，
加黄芩一钱。夏至后，加知母一钱，石膏一钱，或加升麻五分。若病患素虚寒者，不用加减。小便数、其素饮酒人不喜
甘者，切不可用桂枝也。如发汗过多、心下悸而欲按者，去芍药、姜、枣，煎服。如伤风、项背强、有汗不恶风而变为
柔者，本方中加干葛一钱。如汗后身痛脉沉，本方中加人参一钱。如风温身痛、脉浮虚涩、多汗，本方中加附子五分。
如关脉沉实、大便秘而腹痛者，本方中加大黄一钱五分，芍药一钱，减甘草五分。如太阳下之太早，成协热利不止，心
下痞，表里不解，本方中去芍药，加白术、人参、干姜各一钱。如太阳汗多成柔 者，本方中加干葛，桂枝、芍药各五
分，栝蒌根、甘草各一钱。如太阳脉浮腹痛，本方中加芍药一钱，饧糖一匙，名小建中汤。如伤寒汗后身痛脉迟弱，本
方中加黄 一钱，饧糖一钱，名黄 建中汤。如太阳发热无汗恶寒脉微弱者，本方中加麻黄石膏各等分，名桂枝二越婢
一汤。如服桂枝后、形似疟日再发、或身痒而汗不出者，得汗必解，本方中加麻黄一钱五分，杏仁十个，名桂枝麻黄各
半汤。
麻黄汤（并加减法。） 治太阳证，脉浮，头及身体疼痛，恶寒发热，无汗而喘。
麻黄（去根节，二钱） 桂枝（一钱三分） 甘草（六分） 杏仁（十个）
上细切，作一服，水一盏半，先下麻黄，煎一沸，掠去上沫，下余药，煎八分，去渣温服，复取汗。盖麻黄汤性热，
惟冬及春初、兼病患素有寒者，乃用正方。夏至后服，必发斑黄狂闷。如夏月得太阳证，恶寒发热头痛，脉浮洪盛，无
汗，以子和六神通解散代之。如太阳发热无汗恶寒、渐变为刚 者，本方中加赤芍药六分，葛根一钱，豆豉二钱，入葱
白同煎。如伤寒中湿，身体痛，身目俱黄，本方中去桂枝，加连轺一钱，生梓白皮、赤小豆各二钱，入生姜、大枣同
煎。伤寒即病少阴经，脉沉微，身体痛，得汗则已，本方中去桂枝、杏仁、甘草，加细辛一钱二分，附子一钱。伤寒大
下后，脉沉迟，尺脉不至，咽喉不利，唾脓血，厥逆，泄利不止者，虽曰难治，本方中去杏仁，加升麻、当归各一钱，
知母、黄芩、萎蕤各半钱，石膏、白术、芍药、天门冬、茯苓、干姜各七分，次第取微汗而愈。即病少阴经，无表里证，
本方中去桂枝、杏仁，倍甘草，加附子一钱，二、三服后，得微汗而愈。如风湿相搏，脉浮，一身尽痛，本方中去桂枝，
加薏苡仁一钱，得微汗而愈。
葛根汤（并加减法。） 治太阳与阳明合病，无汗恶风，身体肌肉俱痛。
葛根（一钱五分） 桂枝 甘草 芍药（各七分半） 麻黄（一钱）
上细切，作一服，加生姜三片，大枣二枚，水一盏半煎，先下麻黄、葛根，一、二沸，掠去上沫，纳诸药，煎至一
盏，去渣温服，取微汗即愈。如见阳明正病，头目痛，鼻干无汗，肌肉疼痛，本方中去麻黄、桂枝，加升麻一钱五分，
倍芍药，取微汗而愈，名升麻葛根汤。如风温脉浮身重汗出，本方中加石膏、大青、龙胆草、萎蕤各五分。如疫疠，春
感冒，发热而渴，不恶寒，本方中加黄芩六分。不问已汗未汗、头痛肌热者，本方中去麻黄。甘草、桂枝，加知母、川
芎各六分，入生姜、葱白，同煎。如温毒发斑，心烦呕逆，本方中去桂枝、芍药，加橘红、杏仁、知母、黄芩各六分。
如太阳误下之，成协热利不止，本方中去麻黄、桂枝、芍药，加黄连、黄芩各三分，甘草只用二分。如太阳与阳明合病、
不下利但呕者，本方中加制半夏五分。
小青龙汤（并加减法。） 治太阳表证未解，心下有水气，干呕发热而咳。
麻黄 芍药（各二钱） 细辛 干姜（炮） 甘草（炙） 桂枝（各一钱五分） 五味子（七枚） 半夏（二钱）
上细切，作一服，用水三盏，先煮麻黄减半盏，掠去上沫，纳诸药煮取一盏，去渣温服，连进三服。如表证未解而
渴甚者，本方中去半夏，加栝蒌根一钱。如呕而微利，热而咳，本方中加荛花龙眼大。如太阳汗后，饮水多，咳而喘，
本方中去麻黄，加杏仁泥一钱重。如太阳咳嗽、表未解、心下有水气而小便不利者，本方中去麻黄，加茯苓一钱五分。
如水寒相搏，咳逆不止者，本方中去麻黄，加附子一钱。
大青龙汤 治伤寒见风，或伤风见寒。太阳无汗，脉浮紧，烦躁，可服；脉弱，汗自出，不可服。
麻黄（五钱） 桂枝 甘草（炙，各一钱五分） 杏仁（七个，去皮尖，另研） 石膏（三钱）
上细切，作一服，加生姜三片，大枣二枚，水二盏，先下麻黄煎，掠去上沫，纳诸药，煎至一盏，去渣服。得汗则
止后服，未汗再投一服或二服，得汗为度。如太阳无汗恶风烦躁，夏月于本方中加黄芩二钱。
小柴胡汤（并加减法。） 伤寒四五日，往来寒热，胸满胁痛，心烦喜呕，风湿身热，邪在少阳经病。
柴胡（去芦，二钱五分） 黄芩 人参（各一钱） 甘草（五分） 半夏（八分）
上细切，作一服，加生姜三片，大枣二枚，水二盏，煎至一盏，去渣温服。如小便难，潮热腹满，本方中加茯苓一
钱。如下后阴虚生热，脉微恶寒，本方中去黄芩，加芍药二钱。如呕而发热，胸胁满，小便不利，本方中去黄芩，加茯
苓一钱五分。如饮水过多，成水结胸，本方中去大枣，加牡蛎一钱五分。如少阳往来寒热、咳嗽胸胁痛者，本方中去人
参、大枣，加五味子、干姜各五分。如往来寒热而渴甚者，本方中去半夏，加人参五分，栝蒌仁一钱。如身热欲近衣、
不渴者，本方中去人参，加桂枝五分。如病发热而渴、不恶寒而嗽者，本方中加五味子五分。如痞而胸胁满胀，本方中
加干姜五分，牡蛎一钱。如风温汗后身热、心下妨闷有动气者，本方中加桂枝五分，芍药一钱。如往来寒热、胸胁满、
小便不利、呕而不渴者，本方中去人参、半夏，加桂枝、干姜、牡蛎各六分，栝蒌根一钱。如伤寒八、九日下之，胸满
小便不利，谵语惊狂，自汗亡阳，烦躁，起卧不安，一身尽痛，本方中加龙骨、桂枝、铅丹、茯苓、牡蛎各五分，大黄
七分，煎服。
大柴胡汤 治伤寒内实大便难，身热不恶寒反恶热者。
柴胡（四钱） 黄芩 芍药（各二钱五分） 半夏（二钱） 人参（一钱） 大黄（二钱） 枳实（一钱五分）
上细切，作一服，加生姜三片，大枣二枚，水二盏，煎八分，去渣温服，以利为度，未利再投一服。
Commentary
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "When humans are injured by cold, they develop a febrile disease; even if the heat is severe, it is not fatal. However, if one suffers from 'Lianggan' (simultaneous contraction of cold on both exterior and interior levels), death is inevitable." Generally, the manifestations of Shanghan (Cold Damage) are not as easily understood as those of miscellaneous diseases. Only Zhang Zhongjing of the Han Dynasty profoundly comprehended this principle and became the ancestor of establishing treatment laws. He authored the *Shanghan Lun* (Treatise on Cold Damage), which records 397 methods and 113 formulas, serving as a model for later scholars. Regrettably, this book was altered once by Wang Shuhe's compilation and changed again by Cheng Wuji's annotations. The longer it was transmitted, the more its authenticity was lost. Examining its methods and formulas, how could they still match the original numbers? Moreover, in the three Yin cold syndromes, the use of hot medicines accounts for seven or eight out of ten cases. Yet, the *Neijing* refers to "Chuanjing" (transmission through meridians) Shanghan, which enters from the three Yang meridians into the three Yin meridians, being purely heat in nature. How could it become cold? Thus, doubts inevitably arise. Consequently, various discussions by later generations have missed the essential point, which I personally regret. A master passed down the teaching that there are four major principles of Shanghan: Chuanjing (Transmission), Zhuanjing (Exclusive Meridian), Jibing (Immediate Onset), and Yubing (Stagnation). Among these, Jibing cases are mostly Zhuanjing, while Yubing cases are mostly Chuanjing. Cold pathogenic factors attacking humans have no fixed location; they may attack Yang meridians, Yin meridians, or only the Taiyang meridian. If heat has not yet stagnated and the disease manifests immediately, remaining within the original meridian without transmission throughout, treatment should employ formulas such as Mahuang Tang (Ephedra Decoction) or Guizhi Tang (Cinnamon Twig Decoction) to disperse exterior pathogens and achieve recovery. Some cases start from Taiyang without heat stagnation, bypassing Yangming and Shaoyang, and directly enter the three Yin meridians. Others never enter the Yang meridians but directly injure the three Yin meridians with immediate onset. Because heat has not yet stagnated, all present as cold syndromes; thus, they often occur from after Frost's Descent until before Spring Equinox. Since these patients lack headache and high fever, and their pulse is deep, slow, and faint, ancient texts list a category called "Zhonghan" (Direct Cold Injury), which actually refers to this syndrome. Treatment should utilize Sini Tang (Frigid Extremities Decoction) or Zhenwu Tang (True Warrior Decoction) to warm the middle and unblock the vessels. Conversely, if heat initially stagnates in Taiyang and sequentially transmits to Yangming and Shaoyang, then gradually spreads to the three Yin meridians, it constitutes a clear Chuanjing Heat Syndrome (The Classic states: On day one, Juyang [Taiyang] receives the pathogen; pulses at cun, guan, and chi are all floating and tense; symptoms include headache, neck stiffness, and back rigidity, so sweating is indicated. On day two, Yangming receives the pathogen; pulses are long; symptoms include body heat, eye pain, dry nose, and insomnia, so muscle-releasing is indicated. On day three, Shaoyang receives the pathogen; pulses are wiry; symptoms include chest/hypochondriac pain, deafness, and alternating chills and fever, so harmonizing is indicated. On day four, Taiyin receives the pathogen; pulses are deep and fine; symptoms include abdominal fullness, dry throat, and spontaneous diarrhea, so separating turbidity and promoting urination is indicated. On day five, Shaoyin receives the pathogen; pulses are faint and slow; symptoms include dry mouth and tongue with thirst, so clearing heat is indicated. On day six, Jueyin receives the pathogen; pulses are deep and choppy; symptoms include irritability, fullness, and retraction of the genitals, so purging is indicated. Thereafter, the illness declines daily and resolves by the thirteenth day). These typically occur from after Spring Equinox until before Summer Solstice. Indeed, there are no immediate-onset exclusive meridian cold syndromes in spring and summer, but could there be no stagnation-transmission heat syndromes in autumn and winter? The transmission of cold pathogens through meridians truly has no fixed pattern. Therefore, Li Dongyuan stated: Taiyang, also known as Juyang, is the head of all Yang meridians. If Bladder meridian disease involves thirst, it means the pathogen has entered the interior of the home meridian, named "Chuanben" (Transmitting to Home). When Taiyang transmits to Yangming Stomach Earth, it is named "Xunjingchuan" (Following Meridian Transmission), caused by incomplete sweating, diuresis, and residual pathogens penetrating inward. When Taiyang transmits to Shaoyang Gallbladder Wood, it is named "Yuejingchuan" (Crossing Meridian Transmission), resulting from failing to use Mahuang Tang when the initial pulse was floating and sweating was appropriate. When Taiyang transmits to Shaoyin Kidney Water, it is named "Biaolichuan" (Exterior-Interior Transmission), occurring because exterior disease required urgent sweating but purgatives were wrongly used. When Taiyang transmits to Taiyin Spleen Earth, it is named "Wuxiachuan" (Mistaken Purge Transmission), caused by using purgatives when the pulse was slow and sweating was present, leading to periumbilical abdominal pain and heavy limbs. When Taiyang transmits to Jueyin Liver Wood, since the three Yin meridians do not reach the head, only Jueyin connects upward via the Du Mai to meet Taiyang, it is named "Xunjingdeduchuan". The "Lianggan Shanghan" mentioned in the classics refers to transmitting two meridians per day: Day 1 Taiyang and Shaoyin; Day 2 Yangming and Taiyin; Day 3 Shaoyang and Jueyin. Zhang Zhongjing provided no treatment for Lianggan, but Li Dongyuan offered Da Qianghuo Tang (Greater Notopterygium Decoction), claiming it could save one or two out of ten, though its efficacy remains unverified. I analyze that Zhang Zhongjing's *Shanghan Lun* states: "Injury by cold with immediate onset is named Shanghan. If not immediate, cold toxicity hides in the skin and muscles, becoming Wenbing (Warm Disease) in spring and Shubing (Summerheat Disease) in summer. Shubing is extremely hot, heavier than Wenbing." Consulting the *Neijing*: "Wind injury in spring leads to undigested stool diarrhea in summer; Summerheat injury in summer leads to Malaria in autumn; Dampness injury in autumn leads to cough in winter; Cold injury in winter leads to Warm Disease in spring." These are the correct diseases of the four seasons. Scanning the *Neijing*, there is only Shanghan with Six Meridian transmission, but no direct cold injury to the three Yin meridians with immediate onset. Broadly, the *Neijing* considers diseases arising in the first three months of spring and before Summer Solstice as True Shanghan, whereas Zhang Zhongjing considers those arising from after Autumn Equinox through the three winter months as True Shanghan. I dare not judge who is right or wrong. As for Warm Disease in spring and Heat Disease in summer, they are severe illnesses resulting from cold pathogenic factors received in winter and stagnating for a long time. Additionally, there are mild cases of Four Seasons Common Cold and newly acquired Wind-Cold, presenting with headache, body ache, aversion to cold, and fever, which should naturally be treated as Common Cold, distinct from the severe late-onset diseases of winter cold injury. Modern practitioners borrow Zhang Zhongjing's Shanghan methods to treat these and achieve results, thus broadly calling them "Four Seasons Shanghan," which is not Zhang's original intent. Those wishing to treat Shanghan must study deeply and carefully; one must not act rashly. For instance, inducing sweat when inappropriate leads to Yang collapse, blood stasis, epistaxis, muscle twitching, lower cold with upper exhaustion, dry throat, and dysuria. Purging when inappropriate leads to Chest Binding, Pi Syndrome, mental restlessness, hemorrhage, and recurrent fever. In Yin excess and Yang deficiency, sweating cures while purging kills; in Yang excess and Yin deficiency, purging cures while sweating kills. It is said: "If Guizhi Tang enters the throat, Yang excess leads to death; if Chengqi Tang enters the stomach, Yin excess leads to death." How can physicians disregard this?
Pulse Methods
A pulse that is floating on the Yang position and weak on the Yin position is called Wind Injury. (Pathogens in the six meridians all show a wiry quality added. Floating Yang indicates Wei Qi affected by wind; Weak Yin indicates Ying Qi deficiency. Wind injures Yang, hence the floating and deficient quality.)
A pulse that is floating and tight with no sweat is called Cold Injury. (Cold injures Ying; Ying excess leads to Wei deficiency. Tight Yang pulse indicates pathogen in the Upper Jiao, suggesting a desire to vomit.)
Floating pulse, headache, neck stiffness, and back rigidity indicate disease in Taiyang.
Long pulse, body heat, dry nose, eye pain, and inability to sleep indicate disease in Yangming.
Wiry pulse, chest/hypochondriac pain, deafness, and alternating chills and fever indicate disease in Shaoyang.
Deep and fine pulse, dry throat, abdominal fullness, and spontaneous diarrhea indicate disease in Taiyin.
Faint and slow pulse, dry mouth and tongue with thirst indicate disease in Shaoyin.
Deep and choppy pulse, irritability, fullness, and genital retraction indicate disease in Jueyin.
Pulses at both Yin and Yang positions are vigorous, becoming tight and choppy upon secondary cold exposure, transforming into Wenmai (Warm Malaria). (Vigorous and tight Yin-Yang pulses are typical of Shanghan; the previous heat illness has not resolved, and cold is contracted anew.)
Yang pulse is floating and slippery, Yin pulse is soggy and weak, encountering wind transforms it into Fengshi (Wind-Dampness). (Floating-slippery Yang and soggy-weak Yin are both wind pulses. The previous pulse remains, and wind attacks the heat.)
Yang pulse is surging and rapid, Yin pulse is solid and large, encountering warm-heat transforms it into Wendu (Warm Toxicity). (Surging-rapid and solid-large are all heat; two heats combine.)
Yang pulse is soggy and weak, Yin pulse is wiry and tight, encountering warm qi transforms it into Wenyi (Plague).
Disease with fever, deep and fine pulse, and Taiyang exterior presentation is named Ye Bing (Heat Stroke/Sunstroke).
Disease in Taiyang with joint pain and irritability, deep and fine pulse, is named Shibi (Damp Bi).
Disease in Taiyang with body heat and pain, faint-wiry-chou pulse, is named Zhong Ye (Heat Stroke).
If sweating has occurred and the body becomes burning hot, it is named Fengwen (Wind-Warmth). (Fengwen disease features floating pulses at both Yin and Yang, spontaneous sweating, heavy body, excessive sleepiness, snoring breath, difficulty speaking, and dysuria. If further mistreated with purgation or fire therapy, mild cases turn yellow; severe cases suffer convulsions and die with a burnt complexion.)
Deep, fine, and rapid pulse, cool body and cold limbs, irritability, unwillingness to drink, mania, and oppression indicate Yang Jue (Yang Reversal).
In Shanghan with intense heat, a floating and large pulse indicates survival, while a deep and small pulse indicates death. (After sweating, deep/small indicates survival; floating/large indicates death.)
Methods
Zhu Danxi stated: For external contractions without internal injury, use Zhang Zhongjing's methods. For Shanghan complicated by internal injury, nine out of ten cases apply. The Classic says: "Wherever pathogenic qi gathers, healthy qi must be deficient." Use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), modifying it based on the syndromes seen in the six meridians. For severe Qi deficiency, add a small amount of Fuzi (Aconite Root) to facilitate the action of Renshen (Ginseng). Li Dongyuan argued that internal injuries are very common, while external injuries are occasional, an insight preceding earlier discoveries. Later generations, following custom and lacking clarity, indiscriminately label them as external injuries, which is extremely erroneous. Cases that work are likely due to practitioners avoiding reckless measures and using mild dispersing herbs. Rough or hasty approaches will certainly cause death. Mild colds should not be mistaken for Shanghan. In the Northwest, where the air is extremely cold and killing, external injuries are frequent; in the Southeast, a mild region, external injuries are rare, perhaps one or two in a thousand.
(Above, Zhu Danxi's method, one item)
Guizhi Tang (Cinnamon Twig Decoction) (with modification methods). Treats Taiyang meridian Wind Injury with fever, spontaneous sweating, nasal congestion, and dry retching.
Guizhi (Cinnamon Twig, 2.5 qian) Shaoyao (Peony Root, 1.5 qian) Gancao (Licorice Root, 1 qian)
Finely cut, prepared as one dose. Add three slices of Shengjiang (Fresh Ginger) and two dates (Dazao). Boil in 1.5 cups of water until reduced to 1 cup. Strain and take warm. This formula is suitable only for winter and early spring. In late spring and before Summer Solstice, add Huangqin (Scutellaria Root, 1 qian). After Summer Solstice, add Zhimu (Anemarrhena Rhizome, 1 qian) and Shigao (Gypsum, 1 qian), or add Shengma (Cimicifuga Rhizome, 0.5 qian). If the patient is constitutionally deficient and cold, do not modify. If the patient urinates frequently or dislikes sweet flavors due to habitual alcohol consumption, Guizhi must absolutely not be used. If excessive sweating causes palpitations and a desire to press on the epigastrium, remove Shaoyao, Jiang, and Zao, and decoct. If Wind Injury causes stiffness in the neck and back, sweating, absence of aversion to wind, transforming into Rou Jing (Soft Spasm), add Gegen (Kudzu Root, 1 qian) to this formula. If body pain and deep pulse follow sweating, add Renshen (Ginseng, 1 qian). If Wind-Warmth causes body pain, floating-deficient-choppy pulse, and profuse sweating, add Fuzi (Aconite Root, 0.5 qian). If the Guan pulse is deep and solid, with constipation and abdominal pain, add Dahuang (Rhubarb Root, 1.5 qian) and Shaoyao (1 qian), reduce Gancao by 0.5 qian. If Taiyang disease is purged too early, resulting in persistent協热利 (Collateral Heat Diarrhea), epigastric stuffiness, and unresolved exterior-interior conditions, remove Shaoyao and add Baizhu (Atractylodes Macrocephala Rhizome, 1 qian), Renshen (1 qian), and Ganjiang (Dried Ginger, 1 qian). If Taiyang disease with excessive sweating leads to Rou Jing, add Gegen (1 qian), Guizhi (0.5 qian), Shaoyao (0.5 qian), Gualougen (Trichosanthes Root, 1 qian), and Gancao (1 qian). If Taiyang presents with floating pulse and abdominal pain, add Shaoyao (1 qian) and Yitang (Malt Sugar, 1 spoon); this is named Xiao Jianzhong Tang (Minor Construct the Middle Decoction). If Shanghan after sweating presents with body pain, slow-weak pulse, add Huangqi (Astragalus Root, 1 qian) and Yitang (1 qian); this is named Huangqi Jianzhong Tang (Astragalus Construct the Middle Decoction). If Taiyang presents with fever, no sweat, aversion to cold, and faint pulse, add equal parts Mahuang (Ephedra Stem) and Shigao; this is named Guizhi Er Yuebi Yi Tang (Guizhi Two, Yuebi One Decoction). If after taking Guizhi Tang, symptoms resemble malaria occurring twice daily, or itching with no sweat, obtaining sweat ensures resolution; add Mahuang (1.5 qian) and Xingren (Apricot Seed, 10 pieces); this is named Guizhi Mahuang Ban Ge Tang (Half Guizhi Half Mahuang Decoction).
Mahuang Tang (Ephedra Decoction) (with modification methods). Treats Taiyang syndrome with floating pulse, headache and body pain, aversion to cold and fever, no sweat, and wheezing.
Mahuang (Ephedra Stem, root tips removed, 2 qian) Guizhi (Cinnamon Twig, 1.3 qian) Gancao (Licorice Root, 0.6 qian) Xingren (Apricot Seed, 10 pieces)
Finely cut, prepared as one dose. Boil in 1.5 cups of water. Add Mahuang first, boil for one bubble, skim off the foam, then add remaining herbs. Decoct to 0.8 cups. Strain and take warm. Cover to induce sweat. Mahuang Tang is hot in nature; use the standard formula only in winter/early spring or for patients with constitutive cold. Taking it after Summer Solstice will cause macules, jaundice, mania, and oppression. If Taiyang syndrome occurs in summer with aversion to cold, fever, headache, floating-vigorous pulse, and no sweat, substitute with Liu Shen Tong San Jie San (Six Spirit Unblocking Release Powder) by Liu Wansu. If Taiyang fever, no sweat, aversion to cold gradually transforms into Gang Jing (Hard Spasm), add Chishao (Red Peony Root, 0.6 qian), Gegen (1 qian), Douchi (Fermented Soybean, 2 qian), and Congbai (Green Onion White) to this formula. If Shanghan involves dampness, causing body pain and yellowing of body and eyes, remove Guizhi and add Lianyao (Scrophularia Rootlet, 1 qian), Shengzibapi (Toona Bark, 2 qian), and Chixiaodou (Adzuki Bean, 2 qian), adding Jiang and Zao. If Shanghan immediately affects Shaoyin meridian with deep-faint pulse, body pain, resolving with sweat, remove Guizhi, Xingren, and Gancao; add Xixin (Asarum Root, 1.2 qian) and Fuzi (1 qian). After severe purging in Shanghan, with deep-slow pulse, absent Chi pulse, throat obstruction, spitting pus/blood, cold extremities, and persistent diarrhea (though difficult to treat), remove Xingren; add Shengma (1 qian), Danggui (Angelica Sinensis, 1 qian), Zhimu (0.5 qian), Huangqin (0.5 qian), Weiyu (Polygonatum, 0.5 qian), Shigao (0.7 qian), Baizhu (0.7 qian), Shaoyao (0.7 qian), Tiandong (Asparagus Tuber, 0.7 qian), Fuling (Poria, 0.7 qian), and Ganjiang (0.7 qian). Induce slight sweat successively to recover. If Shaoyin disease occurs immediately without exterior-interior signs, remove Guizhi and Xingren, double Gancao, add Fuzi (1 qian). After 2-3 doses, slight sweat indicates recovery. If Wind-Dampness binds, with floating pulse and whole-body pain, remove Guizhi and add Yiyiren (Coix Seed, 1 qian); slight sweat indicates recovery.
Gegen Tang (Kudzu Decoction) (with modification methods). Treats combined Taiyang and Yangming disease with no sweat, aversion to wind, and pain in body muscles.
Gegen (Kudzu Root, 1.5 qian) Guizhi (Cinnamon Twig) Gancao (Licorice Root) Shaoyao (Peony Root) (each 0.75 qian) Mahuang (Ephedra Stem, 1 qian)
Finely cut, prepared as one dose. Add three slices of Shengjiang and two dates. Boil in 1.5 cups of water. Add Mahuang and Gegen first, boil 1-2 bubbles, skim foam, add other herbs, decoct to 1 cup. Strain and take warm. Slight sweat indicates recovery. If Yangming proper disease appears (head/eye pain, dry nose, no sweat, muscle pain), remove Mahuang and Guizhi; add Shengma (1.5 qian) and double Shaoyao. Induce slight sweat; this is named Shengma Gegen Tang (Shengma Kudzu Decoction). If Wind-Warmth presents with floating pulse, heavy body, and sweating, add Shigao (Gypsum, 0.5 qian), Daqing (Arnebia Root, 0.5 qian), Longdancao (Gentiana Root, 0.5 qian), and Weiyu (0.5 qian). If plague or spring cold presents with fever, thirst, and no aversion to cold, add Huangqin (0.6 qian). Regardless of prior sweating, for headache and muscle heat, remove Mahuang, Gancao, and Guizhi; add Zhimu (0.6 qian) and Chuanxiong (Ligusticum Rhizome, 0.6 qian), with Jiang and Congbai. If Warm Toxicity causes macules, irritability, and vomiting, remove Guizhi and Shaoyao; add Juhong (Tangerine Peel, 0.6 qian), Xingren (0.6 qian), Zhimu (0.6 qian), and Huangqin (0.6 qian). If Taiyang is mistakenly purged, causing persistent collateral heat diarrhea, remove Mahuang, Guizhi, and Shaoyao; add Huanglian (Coptis Rhizome, 0.3 qian) and Huangqin (0.3 qian); use only 0.2 qian of Gancao. If Taiyang and Yangming combine without diarrhea but with vomiting, add Zhi Banxia (Prepared Pinellia Tuber, 0.5 qian).
Xiao Qinglong Tang (Minor Green Dragon Decoction) (with modification methods). Treats unresolved Taiyang exterior syndrome with fluid retention in the heart region, dry retching, fever, and cough.
Mahuang (Ephedra Stem) Shaoyao (Peony Root) (each 2 qian) Xixin (Asarum Root) Ganjiang (Dried Ginger, processed) Gancao (Licorice Root, honey-fried) Guizhi (Cinnamon Twig) (each 1.5 qian) Wuweizi (Schisandra Berry, 7 pieces) Banxia (Pinellia Tuber, 2 qian)
Finely cut, prepared as one dose. Use 3 cups of water. First boil Mahuang until reduced by half a cup, skim foam, add other herbs, decoct to 1 cup. Strain and take warm. Take three doses consecutively. If exterior unresolved with severe thirst, remove Banxia and add Gualougen (Trichosanthes Root, 1 qian). If vomiting with slight diarrhea, fever, and cough, add Raohua (Edelweiss Flower, size of a longan). If Taiyang post-sweating involves excessive drinking, cough, and wheezing, remove Mahuang and add Xingren paste (1 qian weight). If Taiyang cough, unresolved exterior, fluid retention, and dysuria, remove Mahuang and add Fuling (Poria, 1.5 qian). If cold-water binding causes incessant coughing, remove Mahuang and add Fuzi (Aconite Root, 1 qian).
Da Qinglong Tang (Major Green Dragon Decoction). Treats Shanghan with wind exposure, or Wind Injury with cold exposure. Suitable for Taiyang with no sweat, floating-tight pulse, and irritability. Contraindicated for weak pulse and spontaneous sweating.
Mahuang (Ephedra Stem, 5 qian) Guizhi (Cinnamon Twig) Gancao (Licorice Root, honey-fried) (each 1.5 qian) Xingren (Apricot Seed, 7 pieces, skin/point removed, ground separately) Shigao (Gypsum, 3 qian)
Finely cut, prepared as one dose. Add three slices of Shengjiang and two dates. Boil in 2 cups of water. First boil Mahuang, skim foam, add other herbs, decoct to 1 cup. Strain and take. Stop subsequent doses upon sweating. If no sweat, administer another dose or two. Stop when sweat is achieved. If Taiyang no sweat, aversion to wind, and irritability occur in summer, add Huangqin (Scutellaria Root, 2 qian) to this formula.
Xiao Chaihu Tang (Minor Bupleurum Decoction) (with modification methods). Shanghan after 4-5 days, alternating chills and fever, chest fullness, hypochondriac pain, irritability, and frequent vomiting; Wind-Dampness body heat; pathogen in Shaoyang meridian.
Chaihu (Bupleurum Root, rhizome removed, 2.5 qian) Huangqin (Scutellaria Root) Renshen (Ginseng Root) (each 1 qian) Gancao (Licorice Root, 0.5 qian) Banxia (Pinellia Tuber, 0.8 qian)
Finely cut, prepared as one dose. Add three slices of Shengjiang and two dates. Boil in 2 cups of water until reduced to 1 cup. Strain and take warm. If dysuria, tidal fever, and abdominal fullness, add Fuling (Poria, 1 qian). If post-purge Yin deficiency generates heat with faint pulse and aversion to cold, remove Huangqin and add Shaoyao (Peony Root, 2 qian). If vomiting with fever, chest/hypochondriac fullness, and dysuria, remove Huangqin and add Fuling (1.5 qian). If excessive drinking leads to Water-Bound Chest, remove Dazao (Jujube) and add Muli (Oyster Shell, 1.5 qian). If Shaoyang alternating chills/fever with cough and chest/hypochondriac pain, remove Renshen and Dazao; add Wuweizi (Schisandra Berry, 0.5 qian) and Ganjiang (Dried Ginger, 0.5 qian). If alternating chills/fever with severe thirst, remove Banxia; add Renshen (0.5 qian) and Gualouren (Trichosanthes Seed, 1 qian). If body heat with desire for clothing and no thirst, remove Renshen and add Guizhi (Cinnamon Twig, 0.5 qian). If fever with thirst, no aversion to cold, and cough, add Wuweizi (0.5 qian). If Pi (stuffiness) with chest/hypochondriac distension, add Ganjiang (0.5 qian) and Muli (1 qian). If Wind-Warmth post-sweating presents with body heat, epigastric oppression, and palpitations, add Guizhi (0.5 qian) and Shaoyao (1 qian). If alternating chills/fever, chest/hypochondriac fullness, dysuria, vomiting without thirst, remove Renshen and Banxia; add Guizhi (0.6 qian), Ganjiang (0.6 qian), Muli (0.6 qian), and Gualougen (Trichosanthes Root, 1 qian). If Shanghan after 8-9 days is purged, causing chest fullness, dysuria, delirium, fright/manic behavior, spontaneous sweating with Yang collapse, irritability, restlessness, and whole-body pain, add Longgu (Fossil Bone, 0.5 qian), Guizhi (0.5 qian), Qiandan (Lead Tetroxide, 0.5 qian), Fuling (0.5 qian), Muli (0.5 qian), and Dahuang (Rhubarb Root, 0.7 qian). Decoct and take.
Da Chaihu Tang (Major Bupleurum Decoction). Treats Shanghan with interior excess, difficulty defecating, body heat, no aversion to cold, but aversion to heat.
Chaihu (Bupleurum Root, 4 qian) Huangqin (Scutellaria Root) Shaoyao (Peony Root) (each 2.5 qian) Banxia (Pinellia Tuber, 2 qian) Renshen (Ginseng Root, 1 qian) Dahuang (Rhubarb Root, 2 qian) Zhishi (Immature Bitter Orange, 1.5 qian)
Finely cut, prepared as one dose. Add three slices of Shengjiang and two dates. Boil in 2 cups of water until reduced to 0.8 cups. Strain and take warm. Stop when bowel movement occurs; if not, administer another dose.