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Ephedrae Herba (Mahuang, 麻黄) [devoid of nodes] two liang
Cibotii Rhizoma (Xixin, 细辛) two liang
Aconiti Lateralis Radix Praeparata (Fuzi, 附子) [processed, skin removed, broken into eight pieces] one piece
The above three ingredients are boiled with ten dou of water. First, boil Ephedrae Herba until the volume reduces by two dou, remove the foam on the surface, then add the remaining herbs. Boil to obtain three sheng of decoction, strain off the dregs, and take one sheng warm, three times a day.
Shaoyin disease (Disease of the Shaoyin channel), occurring two or three days after onset, is treated with Mahuang Fuzi Gancao Tang (Ephedra, Aconite, and Licorice Decoction) to induce mild sweating, because there are no interior syndromes within two or three days, hence mild sweating is employed.
[Annotation]
This elaborates on the previous clause regarding Shaoyin disease occurring two or three days after onset, where the pulse remains deep and fever persists without resolution; in such cases, Mahuang Fuzi Gancao Tang (Ephedra, Aconite, and Licorice Decoction) should be used to induce mild sweating.
It implies that if within two or three days there are no signs of vomiting, diarrhea, or interior cold, it indicates that the pathogenic factor has weakened. However, since the heat remains exterior, diaphoresis (sweating method) is still indicated, but must not be excessive. Therefore, Cibotii Rhizoma is omitted in favor of Glycyrrhizae Radix et Rhizoma (Licorice Root and Rhizome), embodying a harmonizing intent within warming and dispersing actions. Both syndromes mention "no sweat" at the end; this is not an omission by Zhang Zhongjing, as Yin syndromes inherently do not present with sweat, making explicit mention unnecessary.
[Collected Annotations]
Zhang Lu stated: There is no diaphoretic method for Shaoyin disease; forcing sweat will inevitably lead to collapse of Yang (Wang Yang). Only in this specific syndrome, characterized externally by Taiyang fever and absence of sweat, and internally by the absence of vomiting, diarrhea, restlessness, retching, or thirst, can one warm the channels and disperse cold, aiming for a slight, lingering sweat.
Cheng Yingmao stated: The use of the characters "yi" (because) and "gu" (therefore) after mentioning mild sweating demonstrates careful reasoning and emphasis. These two clauses correspond to the syndrome in the Taiyang chapter involving fever, headache, and deep pulse, treated with Sini Tang (Frigid Four Decoction). In that case, if the condition does not resolve, it implies passage beyond three days, indicating the disease has entered the interior. Even if Taiyang headache persists, it should be governed by Shaoyin principles. Here, Shaoyin disease is in its early stage of two or three days; although headache is absent, it cannot be entirely treated as pure Shaoyin disease. Thus, Taiyang methods are concurrently applied. This interplay between exiting (Taiyang) and entering (Shaoyin) serves as definitive evidence. Had the previous clause occurred within two or three days, and these latter clauses persisted beyond two or three days without resolution, the application of Sini Tang versus Mahuang Tang would be interchangeable.
Wang Hu stated: The previous clause presents counter-fever with a deep pulse; this clause also presents counter-fever with a deep pulse. However, the former describes an acute condition upon initial onset, while the latter describes a milder condition occurring two or three days after onset. As the pathological momentum is slightly slower, the treatment method is also gentler.