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Ephedrae Herba (Mahuang, 麻黄) [removed nodes] liang (6), Cinnamomi Ramulus (Guizhi, 桂枝) liang (2), Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) [honey-fried] liang (2), Armeniacae Semen Amarum (Xingren, 杏仁) [peeled and tip removed] pieces (40), Zingiberis Rhizoma Recens (Shengjiang, 生姜) [sliced] liang (3), Jujubae Fructus (Dazao, 大枣) [broken open] pieces (12), Gypsum Fibrosum (Shigao, 石膏) [crushed, wrapped in silk] size of a chicken egg.

The above seven ingredients are decocted with nine sheng (approx. 1800 ml) of water. First, boil Ephedrae Herba until the volume reduces by two sheng, skim off the foam on the surface, then add the remaining herbs. Decoct to obtain three sheng (approx. 600 ml) of liquid, strain out the dregs, and take one sheng (approx. 200 ml) warm. The goal is to achieve a slight perspiration. If sweating is excessive, apply warm powder to the body. If perspiration occurs after the first dose, discontinue subsequent doses. If administered again, excessive sweating may lead to the loss of Yang Qi (vital energy), resulting in deficiency, aversion to wind, irritability, and insomnia.

[Formula Analysis]
Named "Da Qing Long Tang" (Major Blue Dragon Decoction), it derives its name from the imagery of the dragon raising clouds and rain. Treatment for Wind pathogen relies primarily on Cinnamomi Ramulus, while treatment for Cold pathogen relies primarily on Ephedrae Herba. By combining Guizhi Tang (Cinnamon Twig Decoction) and Mahuang Tang (Ephedra Decoction) into this formula, it serves as the principal agent for injuries caused by both Wind and Cold simultaneously. Since both syndromes present with anhidrosis (absence of sweating), Paeoniae Radix Alba (Baishao, 白芍) is omitted to avoid its astringent properties; since both syndromes feature irritability (Fan Zao, 烦躁), Gypsum Fibrosum is added to clear heat. If irritability were absent, Mahuang Guizhi Ge Ban Tang (Half-Mahalf-Guizhi Decoction) would be appropriate instead. Zhang Zhongjing’s inclusion of a major cold herb with acrid and sweet flavors in exterior-resolving formulas indicates that in Mahuang Tang syndrome, the fever is entirely at the exterior level, whereas in Da Qing Long Tang syndrome, the irritability implies heat extending into the muscle layer. Using Gypsum Fibrosum early in Taiyang disease (Taiyang Bing, 太阳病) is because its acrid nature resolves muscle heat, its cold nature clears Stomach fire, and its sweet nature generates fluids, thereby pre-emptively protecting the Yangming channel and preserving body fluids. Inexperienced physicians, suspecting and fearing this approach, fail to use it when indicated, inevitably leading to heat binding in Yangming, manifesting as macules, jaundice, mania, and delirium, with various complications arising. Observing this, one can understand that Gypsum Fibrosum is a crucial herb for treating Wind-stroke and Cold damage; thus, combined with Ephedrae Herba and Cinnamomi Ramulus, it earns the name "Qing Long" (Blue Dragon), and combined with Glycyrrhizae Radix et Rhizoma, it bears the title "Bai Hu" (White Tiger). After administration, slight perspiration is sought; if sweating is excessive, apply warm powder. Obtaining sweat after one dose necessitates stopping further doses, warning that even for indications requiring diaphoresis, excessive sweating must be avoided. Therefore, Zhang Zhongjing omits Ephedrae Herba from Guizhi Tang to prevent excessive diaphoresis, but includes Cinnamomi Ramulus in Mahuang Tang to prevent uncontrolled sweating. Failure to adhere strictly to these methods results in excessive sweating and loss of Yang Qi, generating various adverse conditions. The exterior becomes deficient and unable to withstand Wind; Yin excess repels Yang, causing intensified irritability and insomnia.

[Collected Explanations]
Xu Shuwei stated: Zhang Zhongjing’s treatment of Cold Damage (Shanghan, 伤寒) involves three main approaches: first Guizhi Tang, second Mahuang Tang, third Qing Long Tang. Guizhi Tang treats Wind, Mahuang Tang treats Cold, and Qing Long Tang treats both Wind and Cold. Regardless of the time of onset, if applied to patients whose pulse and symptoms correspond, recovery is immediate. While many can recite this principle today, few understand the rationale behind the ancients' prescription and medication choices, leading to widespread reluctance to use it, which is hardly surprising.

Wu Shou stated: Da Qing Long Tang treats Cold Damage presenting with fever, aversion to cold, anhidrosis, irritability, and a floating-tight or floating-rapid pulse. Urgent application of this decoction to induce sweating leads to cure, representing Zhang Zhongjing’s brilliant method. It is akin to extreme heat being cooled instantly by rain. Those who do not grasp this principle and administer cold-cooling herbs upon seeing restlessness and heat cause immeasurable harm. Conversely, if the pulse is weak, there is sweating, and aversion to wind, this formula is contraindicated; misuse causes significant harm. Hence, due to uncertainty in pulse and symptom differentiation, many hesitate to use it.

A floating and tight pulse indicates that floating represents Wind and tight represents Cold. Wind injures Wei Qi (Defensive Qi), and Cold injures Ying Blood (Nutritive Blood). When both Ying and Wei are diseased, causing severe bone and joint pain, diaphoresis should be induced, but purgation is contraindicated.

[Annotation]
This section elucidates the concept of simultaneous injury by Wind and Cold, affecting both Ying and Wei. A floating pulse is characteristic of Wind pathogen; Wind is Yang, and Wei Qi is Yang. A tight pulse is characteristic of Cold pathogen; Cold is Yin, and Ying Blood is Yin. They injure according to their respective natures. Ying and Wei disease with severe bone and joint pain constitutes the pulse and symptom indication for Da Qing Long Tang to induce sweating. Although fever and irritability are present, the heat resides in the muscles, not the Stomach, so purgation is contraindicated.

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In Taiyang disease, if diaphoresis fails to resolve the condition, and the patient still has fever, palpitations in the epigastric region, vertigo, tremors of the body muscles, and a sensation of trembling and swaying as if about to fall to the ground, Zhen Wu Tang (True Warrior Decoction) is the primary treatment.

[Annotation]
This passage elaborates on the first article, demonstrating methods to rescue adverse conditions. The first article discusses erroneous sweating, while this one discusses excessive sweating; they illuminate each other through parallel text. Both syndromes belong to the category of Yang Qi depletion; therefore, Zhen Wu Tang is used in both cases to support Yang, suppress Yin, and rescue the adverse condition. Profuse sweating with persistent fever indicates Yang Qi escaping to the exterior; palpitations described as "zhuzhu" (throbbing) indicate Yang deficiency failing to maintain interior stability; vertigo (dizziness and blurred vision) indicates Yang Qi weakness and failure of Qi to ascend; body muscle tremors indicate Yang deficiency leading to fluid exhaustion and lack of nourishment to the meridians. "Zhen song" refers to shaking; "zhen zhen yu pi di" describes continuous trembling where the patient cannot rise and feels like falling, indicating Yang deficiency and insufficient Qi and strength to support the body.

[Collected Annotations]
Zhang Lu stated: This establishes the treatment for complications arising from the erroneous use of Da Qing Long Tang. Although sweating is profuse, fever persists, indicating that pathogens remain while Zheng Qi (Upright Qi) is severely damaged. Furthermore, interior deficiency causes palpitations, upper deficiency causes vertigo, and meridian deficiency causes muscle twitching. Whole-body trembling and swaying are all signs of Yang Qi depletion. Thus, Zhen Wu Tang is used to secure the foundation and stabilize the situation.

Wang Hu stated: One might ask, if the pathology is no longer in the exterior, why is Zingiberis Rhizoma Recens included in the formula? The illness arises from excessive sweating. Although there is no constrained heat to release, internal and external Cold pathogens may still exist. Zingiberis Rhizoma Recens is used to provide warmth while facilitating mild dispersion.