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[Formula Composition]
Mahuang (Ephedrae Herba, 麻黄) [devoid of nodes], three liang; Guizhi (Cinnamomi Ramulus, 桂枝), two liang; Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) [roasted], one liang; Xingren (Armeniacae Semen Amarum, 杏仁) [soaked in boiling water, devoid of skin and tips], seventy seeds.

The above four ingredients: Take nine sheng of water, first decoct Mahuang, reduce the volume by two sheng, remove the foam on the surface, add the remaining herbs, decoct to obtain two and a half sheng of liquid, filter out the dregs, take eight he warm. Cover with blankets to induce a slight sweat, no need to drink hot porridge, rest and care follow the method of Guizhi Tang.

[Formula Analysis]
Named Mahuang Tang because Mahuang is the Sovereign herb. Mahuang is warm in nature, pungent and bitter in taste, its action lies in rapid ascending and dispersing; Guizhi is warm in nature, pungent and sweet in taste, its function lies in consolidating the exterior. The syndrome belongs to excess, so Mahuang is used as the main strategy for victory; Guizhi acts as a monitor, serving as a disciplinarian to regulate. The bitter-warm nature of Xingren assists Mahuang in expelling pathogens and descending rebellious Qi; the sweet-flat nature of Gancao assists Guizhi in harmonizing the interior and repelling the exterior. Upon ingestion into the stomach, Qi circulates in the Yuan Fu (Primordial Mansion), essence is transported to the skin and hair. Thus, the hair and pulse essence combine, sweating profusely (Zhenzhen), pathogens in the exterior are completely eliminated without retention; pain stops, panting calms, cold and heat resolve instantly, without needing porridge to borrow grain Qi for sweating. It is necessary to boil and skim off the upper foam to prevent causing irritability, as that light and floating Qi excessively draws Qi upward in rebellion. The reason for not using Shengjiang (Zingiberis Rhizoma Recens, Fresh Ginger) and Dazao (Jujubae Fructus, Jujube) is that Shengjiang's nature spreads horizontally in the muscles, hindering Mahuang's rapid ascent; Dazao's nature is sticky and stagnant in the diaphragm, hindering Xingren's rapid descent. This aims for immediate direct action; slight delay makes it less rapid, horizontal spreading prevents ascent. However, this is a pure Yang formula, too strong in inducing sweat, like a general charging straight in. If used appropriately, success in one battle; if inappropriate, disaster due to lack of restraint. Therefore, it can be used once but not twice. If the condition does not resolve after sweating, replace it with Guizhi Tang. This formula is Zhang Zhongjing's first potent medicine for opening the exterior, expelling pathogens, and inducing sweat. Quack doctors do not know its potency depends on covering with warmth to induce sweat; without warming coverage, it is not potent, so they claim Mahuang only treats exterior release and nothing else. Little do they know that combining this decoction with Guizhi Tang forms Magui Ban Tang (Half-Mahuang-Half-Guizhi Decoction), used to harmonize lingering cold and heat in Taiyang; removing Xingren and adding Shigao (Gypsum Fibrosum, Gypsum), combined with Guizhi Tang, forms Guizhi Er Yuebi Yi Tang (Guizhi Two-Yuebi One Decoction), used to resolve cold and heat where heat predominates over cold in Taiyang; if Yang is excessive internally, with no sweat and panting, there is Mahuang Xingren Gancao Shigao Tang (Mahuang, Apricot Seed, Licorice, and Gypsum Decoction), to dissipate pathogens in the Taiyin Lung; if Yin is excessive internally with no sweat, there is Mahuang Fuzi Xixin Gancao Tang (Mahuang, Aconite, Asarum, and Licorice Decoction), to warm and dissipate cold in Shaoyin Kidney. *Jinkui Yaolue* removes Guizhi from this formula; *Qianjin Fang* replaces Guizhi with Guixin (Cinnamomi Cortex, Cinnamon Bark), both named Huanhun Tang (Soul-Returning Decoction), used to treat pathogens in Taiyin, sudden stroke coma, locked jaw, and absent breathing, effective upon swallowing, yet none require warming coverage to induce sweat. Thus, we know the potency of Mahuang Tang lies in whether warming coverage is applied. This is the secret method of Zhang Zhongjing in using formulas, how could ordinary people fathom it!

[Collected Explanations]
Wang Kentang said: This formula is set for those whose Yuan Qi (Primal Qi) is not deficient. If complicated by seasonal pathogens, Tenshen Tang (Ten Gods Decoction) is suitable; if complicated by summerheat-dampness, Zhengqi Tang (Upright Qi Decoction) is suitable; if complicated by cold, Wuji San (Five Accumulations Powder) is suitable; if complicated by heat, Tongsheng San (Unimpeded Generation Powder) is suitable; if complicated by food stagnation, Yangwei Tang (Nourish Stomach Decoction) is suitable; if complicated by phlegm, Xiong Su San (Ligusticum and Perilla Powder) is suitable. Wang Kentang's discussion is indeed appropriate. However, it must be a syndrome involving both exterior and interior, with complex pathogens, resembling Shaoyang but not being typical Shaoyang, before choosing among these formulas. If the pulse and symptoms match Mahuang Tang or Guizhi Tang, one should naturally follow Zhang Zhongjing's methods. Even if Yuan Qi is inherently deficient, or there is chronic heat, making Mahuang and Guizhi unsuitable, one must still treat slowly and carefully as Liu Wansu and Zhang Jiegong did, to avoid harming patients. Practitioners should examine meticulously.

Wu Shou said: In all cases of Shanghan (Cold Damage), when cold pathogens are in the exterior, closing the Cou Li (pores/skin texture), causing body pain and stiffness, aversion to cold, and anhidrosis, one must use the pungent and bitter properties of Mahuang to open the Cou Li, expel cold pathogens, and resolve through sweating. Only during the hot summer months, even if these symptoms exist, cool herbs should be added before use, such as Fangfeng Tongsheng San (Saposhnikovia Unimpeded Generation Powder) or Sanhuang Shigao Tang (Three Yellows and Gypsum Decoction).

On the first day of Shanghan, the Taiyang channel receives the pathogen. If the pulse remains quiet/stable, transmission has not occurred; if there is a strong desire to vomit, or restlessness/irritability, and the pulse is rapid and urgent, transmission is occurring.

[Annotation]
On the first day of Shanghan, receiving the pathogen in Taiyang, the pulse should be floating and tight. Whether sweat has been induced or not, if the pulse remains stable as usual, this indicates the patient's disease pulse matches the disease state, meaning no transmission. Initial vomiting that persists, a strong desire to vomit, or restlessness with a rapid and urgent pulse, indicates external pathogens have not resolved, internal heat has formed, and the disease trend is about to transmit. Daqinglong Tang (Major Green Dragon Decoction) should be used to release the exterior and clear heat to curb the momentum; or if there are heat signs in both exterior and interior, Shuangjie Tang (Double Resolution Decoction) should be used to resolve both.

[Collected Notes]
Shen Mingzong said: This relies on pulse differentiation to know if pathogens transmit. Floating and tight pulse is the normal pulse of Taiyang; if quiet, it means not transmitting to other channels. If there is a strong desire to vomit, or restlessness with a rapid and urgent pulse, the pathogenic mechanism has moved inward significantly, inevitably transmitting to cause disease.

On the second and third days of Shanghan, if Yangming and Shaoyang syndromes are not seen, transmission has not occurred.

[Annotation]
On the second day, Yangming receives the pathogen; on the third day, Shaoyang receives the pathogen; this is the norm. If on the second or third day, Yangming symptoms such as aversion to cold turning into aversion to heat, fever, irritability, thirst, and insomnia; and Shaoyang symptoms such as alternating chills and fever, chest/flank fullness, frequent vomiting, bitter taste, and deafness are not present, this is because the Taiyang pathogen is mild and heat is slight, not transmitting to Yangming or Shaoyang.

[Collected Notes]
Cheng Zhi said: Shanghan on days 1-2 affects Taiyang, days 2-3 affect Yangming, days 3-4 affect Shaoyang, days 4-5 affect Taiyin, days 5-6 affect Shaoyin, days 6-7 affect Jueyin; this merely states the norm! Variations are numerous: some stay in one channel without transmitting, some skip channels, some transmit to one or two channels and stop, some originate in Yang and enter Shaoyin directly, some strike the Three Yin directly, some transmit from Foot channels to Hand channels due to heat, some transmit due to erroneous medication. Generally, heat pathogens transmit when channel Qi is deficient; if channel Qi is solid, they do not receive pathogens and do not transmit. When Yang pathogens prevail, transmission occurs; when Yin pathogens prevail, transmission rarely occurs. Hence, it is said that a quiet pulse means no transmission, while a rapid and urgent pulse means impending transmission. Also, Foot channels ascend from the feet to the chest, abdomen, head, and back, governing the major outline of the body. Thus, when cold pathogens enter, they appear in their respective channels. Hand channels only traverse the chest and hands, unable to govern the major outline. Once pathogens enter Foot channels, they must transmit to Hand channels. Therefore, severe wind-cold causes headache, neck pain, shoulder, back, elbow, and joint pain. The Sages spoke of Foot channels but not Hand channels; Foot channels encompass Hand channels, but Hand channels cannot encompass Foot channels. This does not mean non-transmission to Hand channels. The Five Zang and Six Fu organs and Twelve Channels have Qi that circulates and collaterals that connect; how can there be transmission to Foot channels without Hand channels? Or injury to Foot channels without Hand channels? Yu Tianmin said heat starts in Hand channels, cold starts in Foot channels; the principles can also interconnect.

Cheng Yingmao said: The Six Channels of Shanghan are determined by depth. Skin is governed by Taiyang, hence named Taiyang; Muscle is governed by Yangming, hence named Yangming; Fascia is governed by Shaoyang, hence named Shaoyang. Hua Tuo said: Shanghan on day 1 is in the skin, day 2 in the flesh, day 3 in the muscle, day 4 in the chest, day 5 in the abdomen, day 6 enters the stomach. This roughly delineates depth within the body shell, without naming Taiyang, Yangming, etc. Thus, Zhang Zhongjing's division into Taiyang, Yangming, etc., is also about defining boundaries to manage the disease.

If the pulse is floating, the disease is in the exterior, sweating can be induced, Mahuang Tang is suitable. If the pulse is floating and rapid, sweating can be induced, Mahuang Tang is suitable.

[Annotation]
For Shanghan with a floating-tight pulse, Mahuang Tang is indeed the primary formula. Now, with floating or floating-rapid pulses, which seem outside the scope of sweating, however, viewing the pathology as exterior excess with no sweat due to cold damage, one may overlook the pulse and follow the syndrome, also using Mahuang Tang to induce sweat. Observing that it says "can induce sweat" rather than "use Mahuang Tang to release," there is room for deliberation.

[Collected Notes]
Fang Youzhi said: Shanghan pulse is originally tight; if not tight but floating, it is known that pathogens return to the exterior and wish to disperse. "Fa" (release) means pushing them out; Mahuang Tang takes advantage of this desire to disperse to push them out. Or if the pulse is floating and rapid, indicating Shanghan is about to transmit, yet Mahuang Tang is still suitable for sweating, it means taking advantage of the floating quality of cold pathogens moving outward, dispersing the rapidness, preventing transmission.

Cheng Yingmao said: Mahuang Tang is the primary formula for cold damaging Ying Blood, but one must mutually reference pulse and syndrome, not rigidly adhering to the character "tight" to be correct. Floating pulse without tightness seems outside the sweating category, but if symptoms fully match cold damaging Ying Blood exterior disease, one may overlook the pulse and detail the syndrome: no sweat, can induce sweat, suitable for Mahuang Tang. If pulse is floating and rapid, pathogen momentum desires to transmit inward, one may overlook syndrome and detail the pulse: no sweat, can induce sweat, also suitable for Mahuang Tang. Comparing these two pulses and syndromes, if pulse is floating-tight and syndrome presents Shanghan, both matching, what prohibition exists against Mahuang Tang!

Liu Hongbi said: But if pulse is floating and not tight, how to know it is exterior cold excess? Must be no sweat to induce sweat. How to know pulse rapidity hasn't entered the interior? Because the pulse is also floating, sweating is possible.

In Taiyang Bing (Taiyang Disease), if exterior signs are unresolved and the pulse is floating and weak, resolution via sweating is indicated, Guizhi Tang is suitable.

[Annotation]
Taiyang Bing exterior signs unresolved refers to Taiyang exterior syndrome unresolved. If pulse is floating and tight, this is Shanghan exterior unresolved. Now pulse is floating and weak, this is Fengzhong (Wind Strike) exterior unresolved, thus Guizhi Tang should be used to induce sweat and resolve.

[Collected Notes]
Fang Youzhi said: Exterior signs unresolved means headache, neck stiffness, aversion to cold, etc., persist. Floating and weak refers to Yang floating and Yin weak. Here, for Taiyang syndrome not yet transmitted, one should still resolve the exterior, strictly warning against early purgation.

Cheng Zhi said: Exterior unresolved, pulse floating and weak, even if prolonged, should be resolved via sweating. However, only Guizhi's method of resolving muscle layer is suitable, not mistaken large-sweat agents. Regarding avoiding mistaken purgation, it goes without saying.

After Shanghan sweating resolves, half a day later recurring irritability, pulse floating and rapid, can re-induce sweat, Guizhi Tang is suitable.

[Annotation]
After Shanghan treated with Mahuang, sweat produced, heat recedes, body cools and resolves, half a day later recurring fever and floating-rapid pulse, indicates exterior pathogens did not fully dissipate and gathered again, can re-induce sweat. Not using Mahuang Tang is because Jin Ye (Body Fluids) were previously damaged by sweating, unable to bear Mahuang again, thus Guizhi Tang is suitable for subsequent sweating.

[Collected Notes]
Fang Youzhi said: Shanghan sweating refers to administering Mahuang Tang to induce it. Resolve means disperse; Re means repeat. After resolving for half a day, why repeat? It means sweating was either improper or post-sweating exposure to wind-cold caused recurring fever and floating-rapid pulse, hence "can re-induce sweat." Geng (change) means alter, suggesting changing the previous method, hence Guizhi Tang is suitable.

Yu Chang said: Using Guizhi Tang is because pathogens heavily invade Wei (Defensive) level, and Ying (Nutritive) deficiency cannot tolerate Mahuang again.

Cheng Yingmao said: Changing the previous sweating method to resolving the muscle layer, although using Guizhi, does not violate Shanghan prohibitions.

Wang Hu said: Zhang Zhongjing's method states floating and rapid pulse can induce sweat, suitable for Mahuang Tang. However, this clause already used Mahuang Tang, so a new formula should be used to induce sweat, Guizhi Tang is suitable.

After sweating, disease unresolved, conversely experiencing aversion to cold, is due to deficiency, Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction) governs.

[Commentary]
The character "Bu" (not) in "disease unresolved" after sweating is likely a superfluous character. If disease were unresolved after sweating, aversion to cold would be expected. Saying "conversely aversion to cold" implies the disease has resolved, and the remaining aversion to cold signifies deficiency.

[Annotation]
In Shanghan, if disease is unresolved after sweating, aversion to cold should occur, indicating not exterior deficiency, but residual exterior pathogens unresolved, requiring sweating. Now, after sweating and perspiration, disease has resolved, aversion to cold should not occur. Conversely experiencing aversion to cold is not due to exterior pathogens, but Yang deficiency failing to protect the exterior, thus Shaoyao Gancao Fuzi Tang governs. Using Fuzi (Aconiti Lateralis Radix Praeparata, Prepared Aconite Root) to support Yang, Shaoyao (Paeoniae Radix Alba, White Peony Root) to nourish Yin, Gancao assists Fuzi and Shaoyao to tonify Yin and Yang and harmonize Ying and Wei.

[Collected Notes]
Fang Youzhi said: Before sweating, aversion to cold indicates pathogen excess and exterior excess; after sweating, aversion to cold indicates pathogen retreat and exterior deficiency. After sweating, major pathogens disperse, Ying Qi declines, Wei Qi becomes lax, resulting in mere aversion to cold, hence called deficiency.