于桂枝汤方内，加厚朴二两，杏仁五十个，余根据桂枝汤方。
【按】
戴原礼曰：太阳病有喘咳，无汗喘者，宜麻杏石甘汤；有汗喘者，宜桂枝加厚朴杏仁
汤；无汗咳者，宜小青龙汤。少阳病无喘有咳，咳者，宜小柴胡汤加五味干姜。阳明
病无咳有喘，内实喘者，宜大承气汤；下利者，宜葛根黄芩黄连汤。三阴惟少阴有喘
咳，喘者宜四逆汤加五味干姜；咳者阴邪下利，宜真武汤加五味干姜。阳邪下利，宜
猪苓汤，然喘皆危候也。
太阳病，下之，其气上冲者，可与桂枝汤，方用前法。若不上冲者，不可与之。
【注】
太阳病，表未解而下之。里实者，邪陷则为结胸，大陷胸汤证也；里虚者，邪陷则为
下利，桂枝人参汤证也。胸实者，邪陷则为胸中痞□，气上冲咽喉，不得息，瓜蒂散
证也。今胸虚邪陷于胸，故但为气上冲，是表尚未罢，然无壅满不得息痞□之证，故
不可吐下，仍当解表，可与桂枝汤，如法汗之。使陷胸之邪，不受外束，胸中之气，
得以四达，自不致内壅而上冲矣。若不上冲者不可与也。
【集注】
方有执曰：气上冲者，阳主气而上升，风属阳邪，下后入里乘虚而上冲也。若不上冲
，则非阳邪可知，故不可与。
病如桂枝证，头不痛，项不强，寸脉微浮，胸中痞□，气上冲咽喉不得息者，此为胸
有寒也，当吐之，宜瓜蒂散。
【注】
病如桂枝证，乃头项强痛，发热汗出，恶风脉浮缓也。今头不痛，项不强，是桂枝证
不悉具也。寸脉微浮，是邪去表未远，已离其表也。胸中痞□，气上冲喉不得息，是
邪入里未深而在胸中，必胸中素有寒饮之所致也。寒饮在胸，不在肌腠，解肌之法，
无可用也。痞□在胸，而不在心下，攻里之法，亦无所施，惟有高者越之一法，使胸
中寒饮，一涌而出，故宜吐之以瓜蒂散也。
【集注】
程应旄曰：痞□一证，因吐下者为虚，不因吐下者为实。实邪痰饮填塞心胸，中、下
二焦为之阻绝，自不得不从上焦为出路。所谓在上者因而越之是也。
汪琥曰：伤寒一病，吐法不可不讲，所以仲景以此条特出之太阳上篇者，以吐不宜迟
，与太阳汗证之法相等，当于二三日间，审其证而用此法也。
沈明宗曰：素有痰饮内积，稍涉风寒，引动其痰，即外如桂枝汤证，但无头痛项强，
知非风邪中表矣。
张锡驹曰：气上冲咽喉不得息者，邪挟寒饮从太阳之气而上越也。
In the prescription of Guizhi Tang (Cinnamon Twig Decoction), add Houpo (Magnolia Bark) two liang and Xingren (Apricot Seed) fifty pieces. The remainder follows the preparation method of Guizhi Tang.
[Commentary]
Dai Yuanli stated: In Taiyang disease (disease of the Taiyang channel), when wheezing and coughing occur, if there is no sweating and wheezing, Maxing Shigan Tang (Ephedra, Apricot Seed, Gypsum, and Licorice Decoction) is indicated; if there is sweating and wheezing, Guizhi Jia Houpo Xingren Tang (Guizhi Tang with Added Magnolia Bark and Apricot Seed) is indicated; if there is no sweating but coughing, Xiao Qinglong Tang (Minor Blue Dragon Decoction) is indicated. In Shaoyang disease (disease of the Shaoyang channel), there is no wheezing but there is coughing; for coughing, Xiaochaihu Tang (Minor Bupleurum Decoction) added with Wuweizi (Schisandra Berry) and Ganjiang (Dried Ginger) is indicated. In Yangming disease (disease of the Yangming channel), there is no coughing but there is wheezing; for internal excess causing wheezing, Dachengqi Tang (Major Order the Qi Decoction) is indicated; for cases with diarrhea, Gegen Huangqin Huanglian Tang (Kudzu, Scutellaria, and Coptis Decoction) is indicated. Among the Three Yin diseases, only Shaoyin disease (disease of the Shaoyin channel) presents with wheezing and coughing; for wheezing, Sini Tang (Frigid Extremities Decoction) added with Wuweizi and Ganjiang is indicated; for coughing accompanied by diarrhea due to yin pathogenic factors, Zhenwu Tang (True Warrior Decoction) added with Wuweizi and Ganjiang is indicated. For diarrhea caused by yang pathogenic factors, Zhuling Tang (Polyporus Decoction) is indicated. However, wheezing in all these contexts is a critical sign.
In Taiyang disease, after erroneous purgation, if the patient experiences qi rushing upward, Guizhi Tang may be administered, following the previously described method. If there is no upward rush of qi, it should not be given.
[Annotation]
Taiyang disease where the exterior syndrome remains unresolved yet purgation was erroneously used: If interior excess exists, the pathogen sinking inward leads to Chest Binding (Jie Xiong), which is the indication for Daxiexiong Tang (Major Draining the Chest Decoction). If interior deficiency exists, the pathogen sinking inward leads to diarrhea, which is the indication for Guizhi Renshen Tang (Guizhi and Ginseng Decoction). If chest excess exists, the pathogen sinking inward leads to fullness and obstruction in the chest, with qi rushing up to the throat causing difficulty in breathing, which is the indication for Gouti San (Melon Sepal Powder). Now, with chest deficiency and pathogen sinking into the chest, only an upward rush of qi occurs. This indicates that the exterior syndrome has not yet resolved. However, since there are no symptoms of chest fullness, obstruction, or inability to breathe, neither emesis nor purgation should be used. Instead, the exterior should still be released by administering Guizhi Tang and inducing sweat according to proper methods. This allows the pathogen trapped in the chest to remain unconstrained externally, enabling the qi in the chest to circulate freely in all directions, thereby preventing internal stagnation and upward rushing. If there is no upward rush of qi, it should not be given.
[Collected Notes]
Fang Youzhi stated: An upward rush of qi occurs because yang governs the ascending movement of qi. Wind belongs to yang pathogens; after purgation, the pathogen enters the interior and rushes upward taking advantage of deficiency. If there is no upward rush, it can be known that it is not caused by a yang pathogen, and thus this formula should not be given.
When the illness resembles the Guizhi Tang syndrome, but the head does not hurt and the nape is not stiff, with the cun pulse slightly floating, and there is chest obstruction, with qi rushing up to the throat causing difficulty in breathing, this indicates cold-fluid retention in the chest. Emesis should be induced using Gouti San (Melon Sepal Powder).
[Annotation]
The illness resembles the Guizhi Tang syndrome, which typically involves headache, stiffness of the head and nape, fever, sweating, aversion to wind, and a floating-slow pulse. Now, since the head does not hurt and the nape is not stiff, the Guizhi Tang syndrome is not fully present. A slightly floating cun pulse indicates that the pathogen has left the exterior but has not moved far away, having detached from the exterior level. Chest obstruction and qi rushing up to the throat causing difficulty in breathing indicate that the pathogen has entered the interior but not deeply, remaining in the chest. This is necessarily caused by pre-existing cold-fluid retention in the chest. Since the cold-fluid is in the chest and not in the muscle layer and interstices, the method of releasing the muscle layer (diaphoresis) cannot be applied. Since the obstruction is in the chest and not below the heart, the method of attacking interior excess is also ineffective. Only the method of "vomiting what is high" (emesis) can be used to force the cold-fluid retention in the chest to surge out entirely. Therefore, emesis with Gouti San is appropriate.
[Collected Notes]
Cheng Yingmao stated: The syndrome of obstruction (Pi) resulting from erroneous emesis or purgation is deficiency; one not resulting from such errors is excess. When excess pathogens like phlegm-fluid fill the chest and heart, blocking the middle and lower jiao, they must find an exit through the upper jiao. This is what is meant by "those above should be evacuated upwards."
Wang Hu stated: Regarding Shanghan (Cold Damage) disease, the emetic method must be studied. Zhang Zhongjing specifically placed this clause in the Upper Chapter of Taiyang because emesis should not be delayed; its timing is comparable to the diaphoretic method for Taiyang. It should be employed within two to three days of onset after carefully examining the syndrome.
Shen Mingzong stated: If there is pre-existing phlegm-fluid accumulation internally, slight exposure to wind-cold can stir up the phlegm. Even if the exterior resembles the Guizhi Tang syndrome, the absence of headache and nape stiffness indicates that this is not due to wind-pathogen invading the exterior.
Zhang Xiju stated: Qi rushing up to the throat causing difficulty in breathing is the pathogen carrying cold-fluid rising and dispersing along the qi mechanism of the Taiyang channel.