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Treats conditions where warm-heat pathogens erupt internally, causing heat in both the exterior and interior, manifesting as headache and body pain, aversion to cold being absent but aversion to heat present, absence of sweating accompanied by wheezing, severe restlessness and thirst, and a floating pulse at all positions (Cun, Guan, Chi). Use this formula [Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction)] to induce sweating and clear fire. If the pulse is floating and weak or deep and tight, with a deep and fine pulse, aversion to cold, spontaneous sweating, and no thirst, this formula is strictly contraindicated.

Mahuang (Ephedrae Herba, 麻黄) (stems removed) 4 liang, Xingren (Armeniacae Semen Amarum, 杏仁) (skin and tips removed) 50 pieces, Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) (roasted) 2 liang, Shigao (Gypsum Fibrosum, 石膏) (crushed, wrapped in cotton cloth) 0.5 jin. The above four ingredients are boiled in 7 sheng of water. First, boil Mahuang alone until the volume reduces by 2 sheng, then skim off the foam on the surface. Add the remaining herbs and continue boiling until 2 sheng remains. Strain the decoction and take 1 sheng warm.

[Collected Annotations] Ke Qin stated: Shigao (Gypsum Fibrosum, 石膏) is a heavy agent for clearing fire. Both Da Qinglong Tang (Major Blue Dragon Decoction) and Baihu Tang (White Tiger Decoction) rely on it for efficacy; however, improper use can lead to disaster. In Da Qinglong Tang, due to absence of sweating and irritability, Ginger (Shengjiang, 生姜) and Cinnamon Twig (Guizhi, 桂枝) are used to disseminate the Yang qi protecting the exterior. In Baihu Tang, due to sweating, irritability, and thirst, Rice (Jingmi, 粳米) is required to preserve stomach fluids. This formula involves heat without cold, so Ginger and Cinnamon Twig are omitted. The wheezing originates in the Lung rather than the Stomach, so Rice is unnecessary. The intent focuses on preserving Yin, without concern for Yang collapse. Therefore, Guizhi (Cinnamon Twig, 桂枝) is removed from Mahuang Tang (Ephedra Decoction) to eliminate its restraining effect, utilizing Mahuang’s specific ability to open the pores, Xingren’s descending action, Gancao’s harmonizing property, and doubling the dose of the great-cold Shigao to eliminate excess heat inside and out. Consequently, profuse sweating occurs, and internal/external restlessness, heat, and wheezing are completely resolved.

Treats Shaoyin disease (Shaoyin Disease, 少阴病) in its initial stage, presenting with fever and a deep pulse. After two or three days, if there are no signs of interior deficiency-cold, use the following:

Mahuang (Ephedrae Herba, 麻黄) 1 liang, Fuzi (Aconiti Lateralis Radix Praeparata, 附子) (prepared) 1 piece, Xixin (Asari Radix et Rhizoma, 细辛) 2 liang. If the heat is mild, replace Xixin with Gancao (Licorice Root, 甘草) to induce slight sweating. The above three ingredients are boiled in 1 dou of water. First, boil Mahuang alone until the volume reduces by 2 sheng, skim off the foam, add the other herbs, and boil until 3 sheng remains. Strain and take 1 sheng warm, administered three times daily.

[Collected Annotations] Ke Qin stated: Shaoyin governs the interior and should not present exterior symptoms; diseases originating in Yin channels should exhibit exterior cold. Now, Shaoyin has just received cold pathogens yet presents with fever, indicating the presence of Shaoyin interior pathology combined with Taiyang exterior pathology. Taiyang exterior pulses should not be deep; a deep pulse here indicates Taiyang symptoms appearing with Shaoyin pulse characteristics. Thus, although the body is hot, the pulse is deep. Therefore, when Taiyang disease presents with a reverse deep pulse, Sini Tang (Four Reversal Decoction, 四逆汤) is used to urgently rescue the interior. Here, in Shaoyin disease with reverse exterior heat, Fuzi (Prepared Aconite Root, 附子) is added to exterior-releasing formulas to preemptively secure the interior. Fever without sweating requires opening the Taiyang exterior; a deep pulse indicates interior involvement, requiring the securing of the Shaoyin pivot. If one were to use Mahuang to open the pores and Xixin to scatter floating heat without Fuzi to secure Primordial Yang, Shaoyin fluids would escape outward, and Taiyang’s subtle Yang would perish, leading far from survival. Only by using Fuzi together with Mahuang can cold pathogens be dispersed without Yang collapse. This situation—interior disease affecting the exterior, deep pulse requiring sweating—is fundamentally different from exterior disease with a floating pulse requiring sweating. If the exterior heat is mild, the cold invasion is also light; thus, Gancao replaces Xixin to induce slight sweating. Gancao’s sweetness moderates the action, making it milder compared to Xixin’s dispersing nature.