太阳病，项背强KT KT ，无汗，恶风，葛根汤主之。
太阳病，项背强KT KT ，汗出恶风者，中风表虚也；项背强KT KT ，无汗恶风者，中风表实也。表虚
宜解肌，表实宜发汗，是以葛根汤发之也。
葛根汤方∶
葛根（四两） 麻黄（三两，去节） 桂（赵本有“枝”字，二两，去皮） 芍药（二两，切。赵本无
“切”字） 甘草（二两，炙） 生姜（三两，切） 大枣（十二枚，擘）
本草云∶轻可去实，麻黄葛根之属是也。此以中风表实，故加二物于桂枝汤中也。
上七味 咀，（赵本无“ 咀”二字）以水一斗，先煮麻黄葛根，减二升，去（赵本有“白”字）沫，
内诸药，煮取三升，去滓，温服一升，覆取微似汗，不须啜粥，（赵本无“不须啜粥”一
句）余如桂枝法，将息及禁忌。（赵本有“诸汤皆仿此”五字）
太阳与阳明合病者，必自下利，葛根汤主之。
伤寒有合病、有并病，本太阳病不解，并于阳明者，谓之并病。二经俱受邪，相合病者，谓之合病。合
病者，邪气甚也。太阳阳明合病者，与太阳少阳合病、阳明少阳合病，皆言必自下利者，以邪气并于阴，则
阴实而阳虚；邪气并于阳，则阳实而阴虚。寒邪气甚，客于二阳，二阳方外实而不主里，则里气虚，
故必下利，与葛根汤，以散经中甚邪。
太阳与阳明合病，不下利，但呕者，葛根加半夏汤主之。
邪气外甚，阳不主里，里气不和，气下而不上者，但下利而不呕；里气上逆而不下者，但呕而不下利。
与葛根汤，以散其邪，加半夏以下逆气。
葛根加半夏汤方∶
葛根（四两） 麻黄（三两，去节，汤泡去黄汁，焙干称） 生姜（三，赵本作二，两，切） 甘草（
二两，炙） 芍药（二两） 桂枝（二两，去皮） 大枣（十二枚，擘） 半夏（半斤，赵本医统本并作“升”，洗）
上八味，以水一斗，先煮葛根、麻黄，减二升，去白沫，内诸药，煮取三升，去滓，温服一升，覆取微似汗。
太阳病，桂枝证，医反下之，利遂不止，脉促（赵本注∶“一作纵”）者，表未解也；喘而汗出者，葛
根黄连黄芩（赵本作∶“黄芩黄连”）汤主之。
经曰∶不宜下，而便攻之，内虚热入，协热遂利。桂枝证者，邪在表也，而反下之，虚其肠胃，为热
所乘，遂利不止。邪在表则见阳脉，邪在里则见阴脉。下利脉微迟，邪在里也。促为阳盛，虽下利而脉促者，知
表未解也。病有汗出而喘者，为自汗出而喘也，即邪气外甚所致。喘而汗出者，为因喘而汗出
也，即里热气逆所致，与葛根黄芩黄连汤，散表邪、除里热。
葛根黄芩黄连汤方∶（赵本芩、连互易）
葛根（半斤） 甘草（二两，炙。味甘平） 黄芩（二，赵本作“三”两。味苦寒） 黄连（三两。味苦寒）
《内经》曰∶甘发散为阳。表未解者，散以葛根、甘草之甘苦；以坚里气弱者，坚以黄芩、黄连之苦。
上四味，以水八升，先煮葛根，减二升，内诸药，煮
取二升，去滓，分温再服。
太阳病，头痛发热，身疼，腰痛，骨节疼痛，恶风，无汗而喘者，麻黄汤主之。
此太阳伤寒也，寒则伤荣，头痛，身疼，腰痛，以至牵连骨节疼痛者，太阳经荣血不利也。《内经》曰∶
风寒客于人，使人毫毛毕直。皮肤闭而为热者，寒在表也。风并于卫，卫实而荣虚者，自汗出而恶风寒也；寒
并于荣，荣实而卫虚者，无汗而恶风也。以荣强卫弱，故气逆而喘，与麻黄汤以发其汗。
麻黄汤方∶
麻黄（三两，去节。味甘温） 桂枝（二，医统本作三两，去皮。味辛热） 甘草（一两，炙。味甘平）
杏仁（七十个，汤，赵本无“汤”字，去皮尖。味辛温）
《内经》曰∶寒淫于内，治以甘热，佐以苦辛。麻黄、甘草，开肌发汗，桂枝、杏人（医统本作“仁”
）散寒下气。
上四味，以水九升，先煮麻黄，减二升，去上沫，内诸药，煮取二升半，去滓，温服八合，覆取微似
汗，不须啜粥，余如桂枝法将息。
太阳与阳明合病，喘而胸满者，不可下，宜麻黄汤主之。（赵本无“主之”二字）
阳受气于胸中，喘而胸满者，阳气不宣发，壅而逆也。心下满、腹满，皆为实，当下之。此以为胸满，
非里实，故不可下，虽有阳明，然与太阳合病，为属表，是与麻黄汤发汗。
太阳病，十日以去，脉浮细而嗜卧者，外已解也。设胸满胁痛者，与小柴胡汤。（赵本有“小柴胡汤
方”详见本书本卷）脉但浮者，与麻黄汤。
十日以去，向解之时也。脉浮细而嗜卧者，表邪已罢也。
病虽已利解之，若脉但浮而不细者，则邪气但在表也，与麻黄汤发散之。
太阳中风，脉浮紧，发热恶寒，身疼痛，不汗出而烦躁者，大青龙汤主之。若脉微弱，汗出恶风者，不
可服。（赵本有“之”字）服之则厥逆，筋惕肉 ，此为逆也。（赵本有“大青龙汤方”五字，医统本作“
大青龙汤主之”）
此中风见寒脉也。浮则为风，风则伤卫；紧则为寒，寒则伤荣。荣卫俱病，故发热恶寒，身疼痛也。风并
于卫者，为荣弱卫强；寒并于荣者，为荣强卫弱。今风寒两伤，则荣卫俱实，故不汗出而烦躁也。与大青龙汤
发汗，以除荣卫风寒。若脉微弱，汗出恶风者，为荣卫俱虚，反服青龙汤，则必亡阳，或生厥逆，筋惕肉 ，
此治之逆也。
大青龙汤方∶
麻黄（六两，去节。味甘温） 桂枝（二两，去皮。味辛热） 甘草（二两，炙。味甘平） 杏人（
赵本人作“仁”，四十个，赵本作“枚”，去皮尖。味苦，甘温） 生姜（三两，切。味辛温） 大枣（十二，
赵本无“二”字，枚，擘。味甘温） 石膏如鸡子大（碎。味甘，微寒）
辛甘均为发散。然风宜辛散，寒宜甘发，（医统本有“以”字）辛甘相合，乃能发散荣卫之风寒。麻黄、
甘草、石膏、杏人，以发散荣中之寒，桂枝、姜、枣，以解除卫中之风。
上七味，以水九升，先煮麻黄，减二升，去上沫，内诸药，煮取三升，去滓，温服一升，取微似汗，
汗出多者，温粉扑（赵本医统本并作“粉”）之。一服汗者，停后服。（赵本有“若复服”三字）汗多亡阳，
遂（赵本注∶“一作逆”）虚，恶风烦躁，不得眠也。
伤寒脉浮缓，身不疼，但重，乍有轻时，无少阴证
者，大青龙汤发之。
此伤寒见风脉也。伤寒者身疼，此以风胜，故身不疼；中风者身重，此以兼风，故乍有轻时；不发（
医统本作“久”）厥吐利，无少阴里证者，为风寒外甚也。与大青龙汤，以发散表中风寒。
伤寒表不解，心下有水气，干呕发热而咳，或渴，或利，或噎，或小便不利，少腹满，或喘者，小
青龙汤主之。
伤寒表不解，心下有水饮，则水寒相搏，肺寒气逆，故干呕发热而咳。《针经》曰∶形寒饮冷则伤肺。以
其两寒相感，中外皆伤，故气逆而上行，此之谓也。与小青龙汤发汗、散水。水气内渍，则所传不一，故有或
为之证，随证增损，以解化之。
小青龙汤方∶
麻黄（三两∶去节。味甘温） 芍药（三两。味酸微寒） 五味子（半升。味酸温） 干姜（三两。味辛
热） 甘草（三两，炙。味甘平） 桂枝（三两，去皮。味辛热） 半夏（半升，汤。赵本无“汤”字，洗。
味辛，微温） 细辛（三两。味辛温）
寒邪在表，非甘辛不能散之，麻黄、桂枝、甘草之辛甘，以发散表邪。水停心下而不行，则肾气燥，《内经
》曰∶肾苦燥，急食辛以润之。干姜、细辛、半夏之辛，以行水气而润肾。咳逆而喘，则肺气逆，《内经》
曰∶肺欲收，急食酸以收之。芍药、五味子之酸，以收逆气而安肺。
上八味，以水一斗，先煮麻黄，减二升，去上沫，内诸药，煮取三升，去滓，温服一升。
加减法∶
若微利者，（赵本无“者”字）去麻黄加荛花，如（赵本有“一”字）鸡子
大，（赵本医统本并无“大”字）熬令赤色。下利者，不可攻其表，汗出必胀满，麻黄发其阳，水渍入胃，必
作利。荛花下十二水，水去利则止。（赵本从“下利”以下皆无）
若渴者，（赵本无“者”字）去半夏，加栝蒌根三两。辛燥而苦润，半夏辛而燥津液，非渴者所宜，故
去之；栝蒌味苦而生津液，故加之。（赵本从“辛燥”以下皆无）
若噎者，去麻黄，加附子一枚，炮。经曰∶水得寒气，冷必相搏，其人即KT 。加附子温散水寒。病患
有寒，复发汗，胃中冷，必吐蛔，去麻黄恶发汗。（赵本从“经曰”以下皆无）
若小便不利，少腹满，（赵本有“者”字）去麻黄加茯苓四两。水蓄下焦不行，为小便不利，少腹满，
麻黄发津液于外，非所宜也；茯苓泄蓄水于下，加所当也。（赵本从“水蓄”以下皆无）
若喘者，（赵本无“者”字）去麻黄，加杏人（赵本作“仁”）半升，去皮尖。《金匮要略》曰∶其
人形肿，故不内麻黄，内杏子。以麻黄发其阳故也。喘呼形肿，水气标本之疾。（赵本从“金匮”以下皆无）
伤寒，心下有水气，咳而微喘，发热不渴。服汤已渴者，此寒去欲解也。小青龙汤主之。
咳而微喘者，水寒射肺也；发热不渴者，表证未罢也。与小青龙汤发表散水。服汤已渴者，里气温，
水气散，为欲解也。
太阳（赵本有“桂枝汤方”详见本书卷二）病，外证未解，脉浮弱者，当以汗解，宜桂枝汤。
脉浮弱者，荣弱卫强也。
太阳病，下之微喘者，表未解故也。桂枝加浓朴杏人汤主之。（赵本有“桂枝加浓朴杏子汤方”详见
本书卷十）
下后大喘，则为里气太虚，邪气传里，正气将脱也；下后微喘，则为里气上逆，邪不能传里，犹在
表也。与桂枝汤以解外，
加浓朴、杏人以下逆气。
太阳病，外证未解者，（赵本无“者”字）不可下也，下之为逆。欲解外者，宜桂枝汤主之。（赵本
无“主之”二字）
经曰∶本发汗而复下之为逆也。若先发汗，治不为逆。
太阳病，先发汗不解，而复下之，脉浮者不愈。浮为在外，而反下之，故令不愈。今脉浮，
故知（赵本无“知”字）在外，当须解外则愈，宜桂枝汤主之。（赵本无“主之”二字）
经曰∶柴胡汤证具，而以他药下之，柴胡汤证仍在者，复与柴胡汤。此虽已下之不为逆，则其类矣。
太阳病，脉浮紧，无汗，发热，身疼痛，八九日不解，表证仍在，此当发其汗。服药已，微除，其
人发烦目瞑。剧者必衄，衄乃解，所以然者，阳气重故也。麻黄汤主之。
脉浮紧，无汗，发热身疼痛，太阳伤寒也，虽至八九日而表证仍在，亦当发其汗，既服温暖发散汤药，
虽未作大汗亦微除也。烦者身热也，邪气不为汗解，郁而变热，蒸于经络，发于肌表，故生热烦。肝受血而
能视，始者（医统本作“寒”）气伤荣，寒既变热，则血为热搏，肝气不治，故目瞑也。剧者，热甚于经，迫血
妄行而为衄，得衄则热随血散而解。阳气重者，热气重也。与麻黄汤以解前太阳伤寒之邪也。
太阳病，脉浮紧，发热身无汗，自衄者愈。
风寒在经，不得汗解，郁而变热，衄则热随血散，故云自衄者愈。
二阳并病，太阳初得病时，发其汗，汗先出不彻，因转属阳明，续自微汗出，不恶寒。若太阳病证不罢
者，不可下，下之为逆，如此可小发汗。设面色缘缘正
赤者，阳气怫郁在表，当解之、熏之；若发汗不彻，不足言阳气怫郁不得越，当汗不汗，其人躁烦，不知痛处，
乍在腹中，乍在四肢，按之不可得，其人短气，但坐，以汗出不彻故也，更发汗则愈。何以知汗出不彻，以脉
涩故知也。
太阳病未解，传并入阳明，而太阳证未罢者，名曰并病。续自微汗出不恶寒者，为太阳证罢，阳明证具
也，法当下之；若太阳证未罢者，为表未解，则不可下，当小发其汗，先解表也。阳明之经循面，色缘缘正赤
者，阳气怫郁在表也，当解之、熏之，以取其汗。若发汗不彻者，不足言阳气怫郁，止是当汗不
汗，阳气不得越散，邪无从出，拥甚于经，故燥（医统本作“躁”）烦也。邪循经行，则痛无常处，或在
腹中，或在四肢，按之不可得而短气，但责以汗出不彻，更发汗则愈。《内经》曰∶诸过者切之，
涩者，阳气有余，为身热无汗。是以脉涩知阳气拥郁而汗出不彻。
脉浮数者，法当汗出而愈。若下之，身重心悸者，不可发汗，当自汗出乃解。所以然者，尺中脉微，此里
虚，须表里实，津液自和，便自汗出愈。
经曰∶诸脉浮数，当发热而洒淅恶寒，言邪气在表也，是当汗出愈。若下之，身重心悸者，损其津液，
虚其胃气。若身重心悸而尺脉实者，则下后里虚，邪气乘虚传里也。今尺脉微，身重心悸者，知下后里虚，津
液不足，邪气不传里，但在表也。然以津液不足，则不可发汗，须里气实、津液足，便自汗出而愈。
脉浮紧者，法当身疼痛，宜以汗解之。假令尺中迟者，不可发汗。何以知之（赵本无“之”字）然？以荣气不
足，血少故也。
Taiyang disease, characterized by stiffness and tightness in the nape and back, absence of sweating, and aversion to wind, is primarily treated with Gegen Tang (Pueraria Decoction).
In Taiyang disease, if there is stiffness and tightness in the nape and back, accompanied by sweating and aversion to wind, it is classified as Wind-stroke Exterior Deficiency syndrome; if there is stiffness and tightness in the nape and back, accompanied by absence of sweating and aversion to wind, it is classified as Wind-stroke Exterior Excess syndrome. For Exterior Deficiency, the appropriate method is to resolve the muscle layer (Jie Ji); for Exterior Excess, the appropriate method is to induce sweating. Therefore, Gegen Tang (Pueraria Decoction) is used to disperse the pathogen.
Gegen Tang (Pueraria Decoction) Formula:
Gegen (Radix Puerariae Lobatae, 4 liang) Mahuang (Herba Ephedrae, 3 liang, remove joints) Guizhi (Caulis Cinnamomi, 2 liang, remove bark) Shaoyao (Radix Paeoniae Alba, 2 liang, slice) Gancao (Radix Glycyrrhizae Uralensis, 2 liang, honey-fried) Shengjiang (Rhizoma Zingiberis Recens, 3 liang, slice) Dazao (Fructus Jujubae, 12 pieces, split open)
The Ben Cao (Materia Medica) states: "Light substances can dispel excess; Mahuang (Herba Ephedrae) and Gegen (Radix Puerariae Lobatae) belong to this category." This formula addresses Wind-stroke Exterior Excess, hence these two herbs are added to Guizhi Tang (Cinnamon Twig Decoction).
Process the above seven ingredients by crushing them. Use one dou of water, first decoct Mahuang (Herba Ephedrae) and Gegen (Radix Puerariae Lobatae), reduce the volume by two sheng, skim off the foam, then add the remaining herbs. Decoct until three sheng remain, strain, and take one sheng warm. Cover the patient to induce a slight sweat. There is no need to drink hot porridge afterwards. Other care instructions follow those of Guizhi Tang (Cinnamon Twig Decoction).
When Taiyang and Yangming meridians are involved simultaneously (He Bing), spontaneous diarrhea will inevitably occur, primarily treated with Gegen Tang (Pueraria Decoction).
Shanghan (Cold Damage) includes He Bing (Combined Disease) and Bing Bing (Consecutive Disease). If Taiyang disease does not resolve and transmits to Yangming, it is called Bing Bing (Consecutive Disease). If both meridians receive pathogens simultaneously and manifest disease together, it is called He Bing (Combined Disease). He Bing indicates severe pathogenic factors. In cases of Taiyang-Yangming He Bing, as well as Taiyang-Shaoyang He Bing and Yangming-Shaoyang He Bing, spontaneous diarrhea is mentioned because when pathogens merge into Yin, Yin becomes excess and Yang becomes deficient; when pathogens merge into Yang, Yang becomes excess and Yin becomes deficient. When cold pathogenic factors are severe and lodge in the two Yang meridians, these meridians are externally full but do not govern the interior, leading to internal deficiency, thus causing inevitable diarrhea. Gegen Tang (Pueraria Decoction) is given to scatter the severe pathogens in the channels.
In Taiyang-Yangming He Bing, if there is no diarrhea but only vomiting, Gegen Jia Banxia Tang (Pueraria Decoction with Pinellia) is primarily used.
When external pathogens are severe, Yang fails to govern the interior, and internal Qi is disharmonious, with Qi descending rather than ascending, only diarrhea occurs without vomiting. If internal Qi rebels upward rather than descending, only vomiting occurs without diarrhea. Gegen Tang (Pueraria Decoction) is given to scatter the pathogen, and Banxia (Rhizoma Pinelliae Ternatae) is added to direct rebellious Qi downward.
Gegen Jia Banxia Tang (Pueraria Decoction with Pinellia) Formula:
Gegen (Radix Puerariae Lobatae, 4 liang) Mahuang (Herba Ephedrae, 3 liang, remove joints, soak in hot water to remove yellow juice, dry and weigh) Shengjiang (Rhizoma Zingiberis Recens, 3 liang, slice) Gancao (Radix Glycyrrhizae Uralensis, 2 liang, honey-fried) Shaoyao (Radix Paeoniae Alba, 2 liang) Guizhi (Caulis Cinnamomi, 2 liang, remove bark) Dazao (Fructus Jujubae, 12 pieces, split open) Banxia (Rhizoma Pinelliae Ternatae, half jin, wash)
Process the above eight ingredients. Use one dou of water, first decoct Gegen (Radix Puerariae Lobatae) and Mahuang (Herba Ephedrae), reduce the volume by two sheng, skim off the white foam, then add the remaining herbs. Decoct until three sheng remain, strain, and take one sheng warm. Cover the patient to induce a slight sweat.
In Taiyang disease, if the physician incorrectly uses purgatives on a patient presenting with Guizhi Tang (Cinnamon Twig Decoction) syndrome, resulting in persistent diarrhea and a rapid pulse (Cu Mai), the exterior pattern remains unresolved. If accompanied by wheezing and sweating, Gegen Huangqin Huanglian Tang (Pueraria, Scutellaria and Coptis Decoction) is primarily used.
The Classics state: "Purgation is inappropriate; forcing purgation leads to internal deficiency and inward penetration of heat, resulting in diarrhea with fever." Guizhi Tang (Cinnamon Twig Decoction) syndrome indicates the pathogen is at the exterior. Incorrect purgation damages the stomach and intestines, allowing heat to invade, causing persistent diarrhea. Pathogens at the exterior present with Yang pulses; pathogens at the interior present with Yin pulses. Diarrhea with a faint and slow pulse indicates pathogens at the interior. A rapid pulse (Cu Mai) indicates Yang excess. Even with diarrhea, a rapid pulse confirms the exterior is unresolved. Sweating with wheezing due to spontaneous sweating indicates external pathogenic severity. Wheezing with sweating induced by the wheezing itself indicates internal heat rebellion. Gegen Huangqin Huanglian Tang (Pueraria, Scutellaria and Coptis Decoction) is given to scatter exterior pathogens and clear interior heat.
Gegen Huangqin Huanglian Tang (Pueraria, Scutellaria and Coptis Decoction) Formula:
Gegen (Radix Puerariae Lobatae, half jin) Gancao (Radix Glycyrrhizae Uralensis, 2 liang, honey-fried. Sweet and neutral) Huangqin (Radix Scutellariae, 2 liang. Bitter and cold) Huanglian (Rhizoma Coptidis, 3 liang. Bitter and cold)
The Neijing (Inner Canon) states: "Sweet flavors disperse and belong to Yang." For unresolved exterior patterns, use the sweet and bitter properties of Gegen (Radix Puerariae Lobatae) and Gancao (Radix Glycyrrhizae Uralensis) to disperse; to strengthen weak interior Qi, use the bitter properties of Huangqin (Radix Scutellariae) and Huanglian (Rhizoma Coptidis).
Process the above four ingredients. Use eight sheng of water, first decoct Gegen (Radix Puerariae Lobatae), reduce the volume by two sheng, add remaining herbs, and decoct until two sheng remain. Strain and divide into two warm doses.
In Taiyang disease, with headache, fever, body ache, lower back pain, joint pain, aversion to wind, absence of sweating, and wheezing, Mahuang Tang (Ephedra Decoction) is primarily used.
This is Taiyang Shanghan (Cold Damage). Cold injures Ying (Nutrient) blood, causing headache, body ache, lower back pain, and radiating joint pain, indicating impaired circulation of Ying blood in the Taiyang channel. The Neijing states: "Wind and cold invading the person cause all hair follicles to stand erect. Skin closure generates heat, indicating cold at the exterior." When Wind merges with Wei (Defensive) Qi, Wei is excess and Ying is deficient, leading to spontaneous sweating and aversion to wind and cold. When Cold merges with Ying (Nutrient) Qi, Ying is excess and Wei is deficient, leading to absence of sweating and aversion to wind. Due to strong Ying and weak Wei, Qi rebels causing wheezing. Mahuang Tang (Ephedra Decoction) is given to induce sweating.
Mahuang Tang (Ephedra Decoction) Formula:
Mahuang (Herba Ephedrae, 3 liang, remove joints. Sweet and warm) Guizhi (Caulis Cinnamomi, 2 liang, remove bark. Acrid and hot) Gancao (Radix Glycyrrhizae Uralensis, 1 liang, honey-fried. Sweet and neutral) Xingren (Semen Pruni Armeniacae, 70 seeds, scald, remove skin and tips. Acrid and warm)
The Neijing states: "When cold invades internally, treat with sweet-hot substances, assisted by bitter-acrid ones." Mahuang (Herba Ephedrae) and Gancao (Radix Glycyrrhizae Uralensis) open the muscles and induce sweating; Guizhi (Caulis Cinnamomi) and Xingren (Semen Pruni Armeniacae) disperse cold and direct Qi downward.
Process the above four ingredients. Use nine sheng of water, first decoct Mahuang (Herba Ephedrae), reduce the volume by two sheng, skim off the foam, add remaining herbs, and decoct until two and a half sheng remain. Strain and take eight ge warm. Cover to induce a slight sweat. No hot porridge is needed. Care follows Guizhi Tang (Cinnamon Twig Decoction) protocols.
In Taiyang-Yangming He Bing, with wheezing and chest fullness, purgation is contraindicated; Mahuang Tang (Ephedra Decoction) is appropriate.
Yang Qi receives Qi in the chest. Wheezing with chest fullness indicates Yang Qi failing to diffuse, stagnating and rebelling. Fullness below the heart or in the abdomen indicates excess, requiring purgation. Here, chest fullness is not interior excess, so purgation is contraindicated. Although Yangming is involved, the combination with Taiyang classifies it as an exterior pattern, so Mahuang Tang (Ephedra Decoction) is given to induce sweating.
If Taiyang disease persists for ten days or more, with a floating and fine pulse and a desire to lie down, the exterior has resolved. If chest fullness and hypochondriac pain occur, Xiaochaihu Tang (Minor Bupleurum Decoction) is given. If the pulse is merely floating, Mahuang Tang (Ephedra Decoction) is given.
After ten days, resolution is approaching. A floating and fine pulse with a desire to rest indicates the departure of exterior pathogens.
Although the disease may have resolved via diarrhea, if the pulse is merely floating and not fine, the pathogen remains at the exterior. Mahuang Tang (Ephedra Decoction) is given to disperse it.
In Taiyang Fengzhong (Wind Strike), with a floating-tight pulse, fever, aversion to cold, body pain, absence of sweating, and irritability, Da Qinglong Tang (Major Blue-Green Dragon Decoction) is primarily used. If the pulse is faint and weak, with sweating and aversion to wind, it must not be taken. Taking it would cause cold limbs, twitching of tendons and flesh, which is a therapeutic error.
This presents Wind Strike symptoms with Cold pulses. Floating indicates Wind, which injures Wei; Tight indicates Cold, which injures Ying. Both Ying and Wei are diseased, causing fever, aversion to cold, and body pain. Wind merging with Wei results in weak Ying and strong Wei; Cold merging with Ying results in strong Ying and weak Wei. Now, both Wind and Cold injure, making Ying and Wei both excess, causing absence of sweating and irritability. Da Qinglong Tang (Major Blue-Green Dragon Decoction) is given to induce sweating and remove Wind-Cold from Ying and Wei. If the pulse is faint and weak, with sweating and aversion to wind, Ying and Wei are both deficient. Taking Qinglong Tang would cause loss of Yang, potentially leading to cold limbs or twitching of tendons and flesh, which is a therapeutic error.
Da Qinglong Tang (Major Blue-Green Dragon Decoction) Formula:
Mahuang (Herba Ephedrae, 6 liang, remove joints. Sweet and warm) Guizhi (Caulis Cinnamomi, 2 liang, remove bark. Acrid and hot) Gancao (Radix Glycyrrhizae Uralensis, 2 liang, honey-fried. Sweet and neutral) Xingren (Semen Pruni Armeniacae, 40 seeds, remove skin and tips. Bitter, sweet and warm) Shengjiang (Rhizoma Zingiberis Recens, 3 liang, slice. Acrid and warm) Dazao (Fructus Jujubae, 12 pieces, split open. Sweet and warm) Shigao (Gypsum Fibrosum, size of a chicken egg, crushed. Sweet and slightly cold)
Acrid and Sweet flavors are dispersing. Wind is suited to Acrid dispersion, Cold to Sweet diffusion. Their combination disperses Wind-Cold in Ying and Wei. Mahuang (Herba Ephedrae), Gancao (Radix Glycyrrhizae Uralensis), Shigao (Gypsum Fibrosum), and Xingren (Semen Pruni Armeniacae) disperse Cold in Ying; Guizhi (Caulis Cinnamomi), Shengjiang (Rhizoma Zingiberis Recens), and Dazao (Fructus Jujubae) resolve Wind in Wei.
Process the above seven ingredients. Use nine sheng of water, first decoct Mahuang (Herba Ephedrae), reduce the volume by two sheng, skim off the foam, add remaining herbs, and decoct until three sheng remain. Strain and take one sheng warm. Induce a slight sweat. If sweating is excessive, apply warm powder. If sweating occurs after one dose, stop subsequent doses. Excessive sweating causes loss of Yang, leading to deficiency, aversion to wind, irritability, and insomnia.
In Shanghan, with a floating-slow pulse, body not painful but heavy, occasionally lighter, and without Shaoyin signs, Da Qinglong Tang (Major Blue-Green Dragon Decoction) is used to disperse.
This presents Shanghan with Wind pulses. Shanghan typically causes body pain; here, Wind dominates, so no pain. Fengzhong typically causes heaviness; here, Wind is combined, so heaviness varies. Without prolonged cold limbs, vomiting, or diarrhea, and without Shaoyin interior signs, it indicates severe external Wind-Cold. Da Qinglong Tang (Major Blue-Green Dragon Decoction) is given to disperse Wind-Cold in the exterior.
In Shanghan, with unresolved exterior, fluid retention in the epigastrium, dry retching, fever, and cough, or thirst, or diarrhea, or choking sensation, or dysuria with lower abdominal fullness, or wheezing, Xiaolong Tang (Minor Blue-Green Dragon Decoction) is primarily used.
Unresolved exterior Shanghan with fluid retention in the epigastrium causes Water-Cold to contend, Lung Qi to become cold and rebel, resulting in dry retching, fever, and cough. The Zhijing states: "External cold and cold drinks injure the Lung." Because two types of cold interact, injuring both middle and exterior, Qi rebels upward. Xiaolong Tang (Minor Blue-Green Dragon Decoction) is given to induce sweating and dissipate water. Internal water infiltration causes varied symptoms, requiring modification based on presentation.
Xiaolong Tang (Minor Blue-Green Dragon Decoction) Formula:
Mahuang (Herba Ephedrae, 3 liang, remove joints. Sweet and warm) Shaoyao (Radix Paeoniae Alba, 3 liang. Sour and slightly cold) Wuweizi (Fructus Schisandrae Chinensis, half sheng. Sour and warm) Ganjiang (Rhizoma Zingiberis, 3 liang. Acrid and hot) Gancao (Radix Glycyrrhizae Uralensis, 3 liang, honey-fried. Sweet and neutral) Guizhi (Caulis Cinnamomi, 3 liang, remove bark. Acrid and hot) Banxia (Rhizoma Pinelliae Ternatae, half sheng, wash. Acrid and slightly warm) Xixin (Herba Asari, 3 liang. Acrid and warm)
Cold pathogens at the exterior require Acrid-Sweet substances to disperse. The Acrid-Sweet nature of Mahuang (Herba Ephedrae), Guizhi (Caulis Cinnamomi), and Gancao (Radix Glycyrrhizae Uralensis) disperses exterior pathogens. Water retention in the epigastrium dries Kidney Qi. The Neijing states: "The Kidney dislikes dryness; urgently eat Acrid substances to moisten it." The Acrid nature of Ganjiang (Rhizoma Zingiberis), Xixin (Herba Asari), and Banxia (Rhizoma Pinelliae Ternatae) moves water Qi and moistens the Kidney. Rebellious Qi causing cough and wheezing indicates Lung Qi rebellion. The Neijing states: "The Lung desires restriction; urgently eat Sour substances to gather it." The Sour nature of Shaoyao (Radix Paeoniae Alba) and Wuweizi (Fructus Schisandrae Chinensis) gathers rebellious Qi and calms the Lung.
Process the above eight ingredients. Use one dou of water, first decoct Mahuang (Herba Ephedrae), reduce the volume by two sheng, skim off the foam, add remaining herbs, and decoct until three sheng remain. Strain and take one sheng warm.
Modifications:
For mild diarrhea, remove Mahuang (Herba Ephedrae) and add Raohua (Flos Radicis Euphorbiae), size of a chicken egg, fried until red. Diarrhea contraindicates exterior treatment; sweating causes bloating. Mahuang (Herba Ephedrae) disperses Yang, and water enters the Stomach causing diarrhea. Raohua (Flos Radicis Euphorbiae) drains water from twelve channels; stopping water stops diarrhea.
For thirst, remove Banxia (Rhizoma Pinelliae Ternatae) and add Gualougen (Radix Trichosanthis), 3 liang. Banxia (Rhizoma Pinelliae Ternatae) is Acrid-Dry and harms fluids, unsuitable for thirst; Gualougen (Radix Trichosanthis) is Bitter and generates fluids.
For choking sensation, remove Mahuang (Herba Ephedrae) and add one processed Fuzi (Radix Aconiti Lateralis Preparata). Water meeting cold contends, causing cold sensations. Fuzi (Radix Aconiti Lateralis Preparata) warms and disperses Water-Cold. Patients with Cold who undergo sweating develop Cold Stomach and may vomit roundworms. Remove Mahuang (Herba Ephedrae) to avoid inducing sweating.
For dysuria and lower abdominal fullness, remove Mahuang (Herba Ephedrae) and add Fuling (Sclerotium Poria cocos), 4 liang. Water accumulation in the Lower Jiao causes dysuria and fullness. Mahuang (Herba Ephedrae) directs fluids outward, which is inappropriate. Fuling (Sclerotium Poria cocos) drains accumulated water downward.
For wheezing, remove Mahuang (Herba Ephedrae) and add Ban sheng of Xingren (Semen Pruni Armeniacae), removed skin and tips. The Jingui Yaolue states: "If the person has edema, do not use Mahuang (Herba Ephedrae); use Apricot Kernel instead, because Mahuang (Herba Ephedrae) disperses Yang." Wheezing and edema are root and branch diseases of water qi.
In Shanghan, with fluid retention in the epigastrium, cough, mild wheezing, fever, but no thirst: if thirst develops after taking the medicine, it indicates Cold has gone and resolution is imminent. Xiaolong Tang (Minor Blue-Green Dragon Decoction) is primarily used.
Cough and mild wheezing indicate Water-Cold attacking the Lung; fever without thirst indicates unresolved exterior. Xiaolong Tang (Minor Blue-Green Dragon Decoction) releases the exterior and dissipates water. Thirst after medication indicates warming of interior Qi and dispersion of water qi, signifying impending resolution.
In Taiyang disease, if exterior signs persist and the pulse is floating and weak, sweating should be used to resolve the exterior; Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
A floating and weak pulse indicates weak Ying and strong Wei.
In Taiyang disease, if mild wheezing occurs after purgation, it is because the exterior remains unresolved. Guizhi Jia Houpo Xingren Tang (Cinnamon Twig Decoction with Magnolia Bark and Apricot Kernel) is primarily used.
Severe wheezing after purgation indicates extreme interior deficiency, pathogen transmission to the interior, and impending collapse of righteous Qi. Mild wheezing after purgation indicates interior Qi rebellion, inability of the pathogen to transmit to the interior, and persistence at the exterior. Guizhi Tang (Cinnamon Twig Decoction) resolves the exterior, while adding Houpo (Cortex Magnoliae Officinalis) and Xingren (Semen Pruni Armeniacae) directs rebellious Qi downward.
In Taiyang disease, if exterior signs are unresolved, purgation is contraindicated as it is a therapeutic error. To resolve the exterior, Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
The Classics state: "Inducing sweating followed by purgation is an error. Purging after inducing sweating is not an error."
In Taiyang disease, if initial sweating fails to resolve the condition and purgation is subsequently used, a floating pulse indicates non-resolution. A floating pulse indicates the pathogen is external; purgation was incorrect, hence non-resolution. With a current floating pulse, the pathogen is known to be external. Resolving the exterior is necessary for recovery; Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
The Classics state: "If Chaihu Tang (Bupleurum Decoction) signs are present and purgation is used with other drugs, but Chaihu Tang (Bupleurum Decoction) signs persist, administer Chaihu Tang (Bupleurum Decoction) again. Although purged, this is not an error, similar to the previous case."
In Taiyang disease, with a floating-tight pulse, absence of sweating, fever, and body pain, if unresolved after eight or nine days and exterior signs persist, sweating should be induced. After medication, symptoms may slightly subside, but the patient may feel vexed and have closed eyes. Severe cases may experience epistaxis, which resolves the condition. This occurs because Yang Qi is heavily constrained. Mahuang Tang (Ephedra Decoction) is primarily used.
Floating-tight pulse, absence of sweating, fever, and body pain indicate Taiyang Shanghan. Even after eight or nine days, if exterior signs persist, sweating should be induced. After taking warm dispersing decoctions, although heavy sweating may not occur, symptoms will slightly subside. Vexation indicates body heat. If pathogens are not resolved by sweating, they stagnate and transform into heat, steaming through collaterals and manifesting on the skin, causing heat and vexation. The Liver receives blood to enable vision. Initially, Cold Qi injured Ying; as Cold transforms to Heat, Blood is contested by Heat, Liver Qi becomes disordered, causing eye closure. Severe cases involve intense heat in collaterals forcing blood to bleed, resulting in epistaxis. Heat dissipates with blood, resolving the condition. Heavy Yang Qi refers to heavy Heat. Mahuang Tang (Ephedra Decoction) is given to resolve Taiyang Shanghan pathogens.
In Taiyang disease, with a floating-tight pulse, fever, absence of sweating, spontaneous epistaxis leads to recovery.
Wind-Cold in the channels, unable to resolve via sweating, stagnates and transforms into heat. Epistaxis allows heat to dissipate with blood, hence spontaneous epistaxis leads to recovery.
In Er Yang (Two Yang) Bing Bing, when Taiyang disease initially begins, sweating is induced. If sweat is incomplete, it transfers to Yangming, continuing with slight sweating and no aversion to cold. If Taiyang signs have not ceased, purgation is contraindicated as it is an error; in such cases, slight sweating should be induced. If the face is persistently red, Yang Qi is constrained at the exterior; it should be resolved and fumigated to induce sweat. If sweating is incomplete, it is insufficient to describe Yang Qi constraint; rather, it is failure to sweat when indicated. The patient becomes restless and irritable, with unknown pain locations, sometimes in the abdomen, sometimes in the limbs, unpressable, short of breath, preferring to sit. This is due to incomplete sweating; re-inducing sweating leads to recovery. How do we know sweating was incomplete? By a choppy pulse.
When Taiyang disease does not resolve and transmits to Yangming, but Taiyang signs persist, it is called Bing Bing. Continuing slight sweating without aversion to cold indicates Taiyang signs have ceased and Yangming signs are complete, requiring purgation according to law. If Taiyang signs persist, the exterior is unresolved, so purgation is contraindicated; slight sweating should be induced to resolve the exterior first. The Yangming channel traverses the face; persistent facial redness indicates Yang Qi constrained at the exterior, requiring resolution and fumigation to induce sweat. Incomplete sweating is insufficient to call Yang Qi constrained; it is simply failure to sweat, preventing Yang Qi from dispersing and pathogens from exiting, leading to congestion in the channels and irritability. Pathogens moving along channels cause wandering pain, in abdomen or limbs, unpressable, with shortness of breath. Blame incomplete sweating; re-inducing sweating leads to recovery. The Neijing states: "Cut the overfull pulses; choppy indicates Yang excess, body heat, and absence of sweating." Thus, a choppy pulse indicates constrained Yang Qi and incomplete sweating.
With a floating-numerous pulse, sweating should occur for recovery. If purgation is used, causing heavy body and palpitations, sweating is contraindicated; spontaneous sweating will lead to resolution. This is because a faint pulse at the Chi position indicates interior deficiency. Table and interior must become solid, fluids harmonize, and spontaneous sweating occurs for recovery.
The Classics state: "All floating-numerous pulses indicate fever and chills, meaning pathogens are at the exterior, resolving via sweating." If purgation causes heavy body and palpitations, it damages fluids and weakens Stomach Qi. If heavy body and palpitations accompany a solid Chi pulse, interior deficiency post-purgation allows pathogens to transmit inward. Now, with a faint Chi pulse, heavy body, and palpitations, interior deficiency and fluid insufficiency are known, but pathogens do not transmit inward, remaining at the exterior. However, due to fluid insufficiency, sweating is contraindicated. Interior Qi must become solid and fluids sufficient for spontaneous sweating and recovery.
With a floating-tight pulse, body pain is expected, and sweating is appropriate. If the Chi pulse is slow, sweating is contraindicated. Why? Because Ying Qi is insufficient and Blood is scant.