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Ephedrae Herba (Mahuang, 麻黄) has a sweet and pungent taste, and a cold nature. It is light, clear, and floating, ascending and yang in property, and non-toxic. It enters the Taiyang channels of the hand and foot, as well as the Lung (Shou Taiyin) and Large Intestine (Shou Yangming) channels. It is a herb that harmonizes Ying (Nutritive Qi) and Wei (Defensive Qi), and also enters the Taiyang channel of the foot and the Shaoyin channel of the hand. It induces sweating to release the exterior, dispels wind and pathogenic factors, treats warm diseases in spring, eliminates black spots and red pain, removes cold from Ying, clears heart heat and headaches, and treats cold epidemics in summer and autumn. Although it can serve as the sovereign drug, it should not be used in large doses. This is because Ephedrae Herba easily induces sweating; excessive use may lead to the collapse of Yang Qi (collapse of Yang).

Someone asked: Since Ephedrae Herba is the supreme medicine for dispersing Ying-pathogens from the muscle layer in the Taiyang channel, for cases where Taiyang channel Ying-pathogens have not dispersed and exterior symptoms are unresolved, it seems appropriate to use it frequently. Why do you warn against frequent use? I reply: The selection of a sovereign drug does not depend on quantity. For Ying-pathogens in the Taiyang channel, using Ephedrae Herba as the sovereign agent allows pathogens to exit naturally without needing large doses. The reason is that small doses disperse pathogens easily, while large doses fail to disperse pathogens and instead scatter healthy Qi.

Someone asked: Ephedrae Herba easily induces sweating. What herb can restrain it so that it only disperses pathogens without inducing excessive sweating? I reply: Ephedrae Herba particularly fears Ginseng Radix et Rhizoma (Renshen, 人参). When using Ephedrae Herba with a small amount of Ginseng Radix et Rhizoma, pathogens exit externally while healthy Qi remains undamaged, avoiding the risk of excessive sweating. If one doubts that Ginseng Radix et Rhizoma should not be used when pathogens are abundant, this is a misconception. When pathogens are light, Ginseng Radix et Rhizoma is contraindicated; but when pathogens are heavy, Ginseng Radix et Rhizoma is especially suitable. Adding Ginseng Radix et Rhizoma to Mahuang Tang (Ephedra Decoction) prevents excessive sweating and Yang collapse, addressing severe pathogens, leaving no room for hesitation.

Someone asked: If mistaken sweating leads to Yang collapse, what herb can rescue it? I reply: There is no herb other than Ginseng Radix et Rhizoma. Although Ginseng Radix et Rhizoma is an antihidrotic, how can it cure excessive sweating caused by Ephedrae Herba? Sweat is generated from Blood, and Blood is generated from Qi. When sweat exits the body, internal Blood is consumed. Without urgently securing Qi with Ginseng Radix et Rhizoma, there will be no Jin-Ye (Body Fluids) to nourish the Heart, leading to irritability or even mania. At this stage, blood-nourishing herbs cannot easily generate Blood, and antihidrotic herbs cannot easily stop sweating. Only Ginseng Radix et Rhizoma can tonify Qi, generating Qi from the "land of nothingness" (origin of Yuan Qi), thereby generating Blood and then Sweat, saving life from imminent death. Otherwise, unceasing sweating leads to Yang collapse and subsequent Yin collapse.

Someone asked: Proper use of Ephedrae Herba disperses pathogens, while improper use scatters healthy Qi. Why not provide a fixed method to prevent misuse? I reply: There is indeed a fixed method, unknown to the world. Ephedrae Herba disperses pathogens in Ying. Seeing pathogens in Ying and using Ephedrae Herba is not a mistake. Errors arise from failing to clearly distinguish Ying-pathogens. Ying-pathogens are easy to identify: if headache resolves but fever persists after Shanghan (Cold Damage), the pathogen has entered Ying. Using Ephedrae Herba then disperses the pathogen, eliminating concerns about Yang collapse due to sweating. Yang collapse occurs when the pathogen has not yet entered Ying, but Ephedrae Herba is used prematurely to open the Ying gate, without Guizhi Tang (Cinnamon Twig Decoction) to resolve Wei pathogens or Shigao (Gypsum Fibrosum) to suppress Stomach fire. Thus, pathogens face no resistance, causing profuse sweating. Combining Guizhi (Cinnamon Twig), Shigao (Gypsum Fibrosum), and Ephedrae Herba would prevent Yang collapse.

Some doubt: Single-use of Ephedrae Herba causes sweating and Yang collapse, yet combining it with Guizhi and Shigao prevents death. Why? Drugs used singly have focused effects, while combined they have diluted effects. Ephedrae Herba alone acts solely on sweating. With Guizhi, its cold nature contrasts with Guizhi's hot nature, restraining each other and reducing Ephedrae Herba's power. With Shigao, its heaviness contrasts with Ephedrae Herba's lightness, competing for efficacy. Sweating occurs without Yang collapse.

Some doubt: Careful use implies less rather than more, yet some die from small doses. This is due to incorrect application; even small doses cause Yang collapse if misused. Physicians must excel in syndrome differentiation, not just caution in dosage.

Some doubt: Ephedrae Herba is used early in Shanghan and late in chronic cases. Why? Because Wind-pathogens in Ying remain unresolved. How to identify this? Fever with aversion to cold indicates it. Even with long-standing Shanghan, if fever persists with aversion to wind and cold, either previous pathogens remain or new ones re-enter. Ephedrae Herba should still be used to disperse them, with caution against overuse. Initial pathogens are strong; secondary pathogens are weak. Strong pathogens require careful dosing to exit; weak pathogens disperse easily with larger doses.

Some doubt: Ephedrae Herba causes changes (complications). How to stabilize it? Ephedrae Herba itself does not change; human error does. If sweating is indicated but not induced, and Ephedrae Herba is later used causing profuse sweating, complications may arise. Survival is lucky. Prevention lies in avoiding excessive sweating, not fearing the herb itself. Indicated sweating prevents complications; contraindicated sweating worsens them. Prevent excessive sweating, and there is no need to seek methods to "stabilize" the herb.

Someone asked: Ephedrae Herba is cold yet treats Wind-pathogens, which is confusing. Shanghan begins as Cold in Wei. Upon entering Wei, Wei-Qi heat transforms Cold into Heat. If Gui Zhi Tang (Cinnamon Twig Decoction) were used, heating heat would worsen it. Zhang Zhongjing therefore replaced hot Guizhi with cold Ephedrae Herba to expel pathogens from Ying. Historically, wind-dispersing herbs are cold. Using cold to disperse cold seems paradoxical, but using cold to dissipate heat is logical.

Someone asked: You say Ephedrae Herba is cold, but Miao Zhichun says it is pungent and hot. Who is correct? I reply: Ephedrae Herba is cold; saying it is slightly warm is acceptable, but hot is wrong. It is light and ascending, Yang in nature, but actually cold. If it were hot like Guizhi, Guizhi alone would suffice for Taiyang Cold, making Ephedrae Herba redundant for Taiyang Heat. Their difference lies in Guizhi dispersing Cold in Wei, while Ephedrae Herba disperses Heat in Ying. One should not assume Ephedrae Herba is hot because Guizhi is hot.

Some doubt: Your view contradicts Zhang Zhongjing's Shanghan Lun. Did Zhang ever say Ephedrae Herba is warm? His Mahuang Tang treats Taiyang pathogens entering Ying. Pathogens in Wei are Cold; in Ying, they become Heat. This is Zhang's teaching. I dare not contradict it. Hence, I firmly believe Ephedrae Herba is cold, not hot.

Someone asked: Ephedrae Herba induces sweating, but its root and nodes stop sweating. Why? Like Digupi (Phellodendri Cortex) clearing Kidney Fire while Gouqizi (Lycii Fructus) nourishes Essence and aids Yang, this duality is normal. Ephedrae Herba stems guide drugs to Wei and interstices, inducing rapid sweating. Roots and nodes stop sweating miraculously.

Someone asked: Is it appropriate to use several taels of Ephedrae Herba for dramatic effect? No, this kills patients. Ephedrae Herba easily induces sweating; excessive use causes Yang collapse. Those who use large doses usually treat stagnation syndromes where sweating resolves stagnation. However, for fever without sweating not due to stagnation, large doses cause rain-like sweating, panting, and sudden death. Caution is essential.

Someone asked: To remedy Yang collapse from improper Ephedrae Herba use, what herb should be combined with it? Ephedrae Herba induces sweating; over-restraining it stops sweating. Restricting necessary sweating harms rather than helps. A solution: for mandatory sweating cases, use small doses of Ephedrae Herba with large doses of Ginseng Radix et Rhizoma, decocted together. This achieves sweating benefits without excessive loss.

Someone asked: Wang Haogu stated Ephedrae Herba treats Ying Excess and Guizhi treats Wei Deficiency, classifying them as Ying-Wei herbs. He also linked Ephedrae Herba to Lung (Yin/Wei) and Guizhi to Heart (Yang/Ying), a view shared by Li Shizhen. Is this valid? No. Guizhi enters Wei, Ephedrae Herba enters Ying. Pathogens enter via skin/hair into Wei, then move to Ying. Thus, pathogens are in Taiyang, not Lung. Transmission diseases do not enter Heart directly via Ying-Wei; if they do, death is immediate, and Guizhi cannot save. These theories seem plausible but are false. I must clarify this for the world.