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Treats the simultaneous involvement of the Taiyang (Greater Yang) and Yangming (Yang Brightness) meridians, presenting with stiffness and pain in the head and neck, pulling tightness in the back, a floating pulse, absence of sweating, and aversion to wind. It is also indicated for cases where the exterior syndrome remains unresolved accompanied by diarrhea and vomiting. In all such instances, this formula should be administered to induce sweating and release the exterior.

Ge Gen (Puerariae Lobatae Radix) 4 liang, Ma Huang (Ephedrae Herba, removed nodes) 3 liang, Gui Zhi (Cinnamomi Ramulus) 2 liang, Shao Yao (Paeoniae Radix Alba) 2 liang, Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried) 2 liang, Sheng Jiang (Zingiberis Rhizoma Recens, sliced) 2 liang, Da Zao (Ziziphi Jujubae Fructus, broken open) 12 pieces. The above seven ingredients are decocted in 10 dou of water. First, boil Ma Huang and Ge Gen until the volume reduces by 2 sheng, then skim off the foam. Add the remaining herbs and continue boiling until 3 sheng of liquid remains. Take 1 sheng warm. After ingestion, cover with blankets to induce a slight sweat. There is no need to drink hot porridge to assist sweating. Other dietary regimens and contraindications follow those of Gui Zhi Tang (Cinnamon Twig Decoction).

[Note] This formula is essentially Gui Zhi Tang (Cinnamon Twig Decoction) with the addition of Ma Huang (Ephedrae Herba) and Ge Gen (Puerariae Lobatae Radix). Ma Huang assists Gui Zhi in releasing the Ying (Nutritive) and Wei (Defensive) qi of the Taiyang meridian through sweating. Ge Gen acts as the sovereign herb to resolve pathogenic factors in the muscle layer of the Yangming meridian when combined with Gui Zhi. It is not named "Gui Zhi Tang plus Ma Huang and Ge Gen," but rather named after Ge Gen, emphasizing its focus on the Yangming meridian, as vomiting and diarrhea are predominantly associated with Yangming disorders. When the exterior tension of both Taiyang and Yangming is urgent, failing to take the medicine warm and covering oneself to induce sweat will make it difficult to resolve the exterior syndrome. If there is vomiting or diarrhea, the interior harmony is already disrupted; even if hot porridge were consumed, the Stomach Qi would not be able to transport essence to the skin and hair. Therefore, drinking porridge is unnecessary. Ke Qin stated: In this syndrome, the body, waist, and joints do not hurt, and there is no aversion to cold, indicating that the bone is not affected by cold. The stiffness and pain in the head and neck extending to the back, causing restless pulling sensations, indicate that the sinews are injured by wind. The absence of wheezing, irritability, or dry retching suggests that the interior is not diseased, and the combination of anhidrosis and aversion to wind indicates the pathology is confined to the exterior. If an exterior syndrome is complicated by diarrhea, it represents excess in the exterior and deficiency in the interior. This condition is milder than the Ma Huang Tang (Ephedra Decoction) and Qing Long Tang (Azure Dragon Decoction) syndromes; however, the stiffness and rigidity connecting the neck to the back are more severe than simple neck stiffness without sweat, yet it remains an exterior syndrome. Since the pulse is floating but not tight, the Ma Huang method is not adopted. Instead, Ma Huang is added to Gui Zhi Tang, and the dosage of Ge Gen is doubled to dispel excess, representing a slight modification of the Ma Huang and Gui Zhi methods. Generally, Ge Gen is the principal herb for the Yangming meridian. Whenever Taiyang disease involves Yangming symptoms, it can be incorporated into Taiyang formulas; whenever Shaoyang (Lesser Yang) disease involves Yangming symptoms, it can be incorporated into Shaoyang formulas, which is always appropriate. Li Gao designated it as a Yangming meridian herb. Zhang Jiegu said: It should not be taken casually if the pathogen has not yet entered the Yangming meridian. Did these two scholars fail to read Zhang Zhongjing's works? One must understand that both Ge Gen and Gui Zhi are herbs that release the muscle layer and harmonize the interior. Therefore, they can be used regardless of whether there is sweat or anhidrosis, or diarrhea or constipation. This differs from Ma Huang, which specializes in releasing the exterior. The *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet) treats Taiyang disease characterized by anhidrosis, abnormally low urine output, Qi rushing upward to the chest, trismus (lockjaw), and inability to speak, indicating impending Gang Jing (Stiff Spasm).

[Collected Notes] Yu Chang stated: For Shang Han (Cold Damage) presenting with stiff and uncomfortable neck and back (Ji Ji), anhidrosis, and aversion to wind, Ge Gen Tang (Kudzu Root Decoction) is used. This syndrome also utilizes it because the pathogen resides at the boundary between the Taiyang and Yangming meridians. Heat from both meridians converges in the chest, inevitably damaging the clear and descending Qi of the Lung Metal. Consequently, the water passages fail to function, leading to scanty urine, lack of fluid distribution, and anhidrosis. The sinews of the Yangming meridian knot internally at the stomach opening, run externally through the chest, pass through the Yingchuan point, and circle the mouth. When heat merges into the Yangming meridian, it causes sinus traction, resulting in trismus and inability to speak. However, Gang Jing with anhidrosis must be resolved through sweating. Moreover, since damp-heat is constrained internally, treatment must cease only when normal sweating resumes. Thus, this decoction is used to simultaneously resolve damp-heat in both meridians and the wind-cold exterior syndrome. The therapeutic approach is consistent and harmless.