太阳中风者，风伤于卫也；伤寒者，寒伤于荣也。其说已详上、中二篇。兹以风寒
两伤，荣卫俱病者，疏为下编。盖风寒二气，多相因而少相离，有寒时不皆无风，有风时
不皆无寒。风寒并发，邪中于人，则荣卫兼病，惟其证均无汗，皆谓之实邪，故立大青
龙汤两解之法，发其寒邪外闭，风邪内郁，不汗出而烦躁之汗也。然必审其人脉不微弱，无
少阴证者，乃可与之。若误施之，则大汗淋漓，厥逆筋惕肉 ，必致亡阳之变，故又
立真武一汤，以救青龙之误。夫表寒里热者，大青龙固所宜也。若表里俱热，则又非大青
龙之所胜任，爰立白虎一汤，以辅青龙之不逮。至于寒热轻微者，则更出桂枝二越婢一
汤、麻黄桂枝各半汤、桂枝二麻黄一汤，皆两解荣卫法也。合上、中二篇而熟读之，则
三法了然，以之施治，庶不紊耳。
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，服之则厥逆，筋惕肉 ，此为逆也。
【注】太阳中风，脉当浮缓，今脉浮紧，是中风之病而兼伤寒之脉也。中风当身不痛，
汗自出，今身疼痛，不汗出，是中风之病而兼伤寒之证也。不汗出而烦躁者，太阳郁蒸
之所致也。风，阳邪也，寒，阴邪也。阴寒郁于外则无汗，阳热蒸于内则烦躁，此风寒
两伤，营卫同病，故合麻、桂二汤中石膏，制为大青龙汤，用以解荣卫同病之实邪也。若
脉微弱，汗出恶风者，即有烦躁，乃少阴之烦躁，非太阳之烦躁也。禁不可服，服之则
厥逆、筋惕肉 之患生，而速其亡阳之变矣。故曰∶此为逆也。
【集注】成无己曰∶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，故为荣卫俱实，所以宜大青龙汤主之也。
喻昌曰∶大青龙汤为太阳无汗而设，与麻黄汤证何异？因有烦躁一证兼见，则非此法不解。
程应旄曰∶此汤非为烦躁设，为不汗出之烦躁设。若脉微弱，汗出恶风者，虽有烦
躁证，乃少阴亡阳之象，全非汗不出而郁蒸者比也。
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。
【注】伤寒脉当浮紧，今脉浮缓，是伤寒之病兼中风之脉也。伤寒当身疼，今身不疼，
是伤寒之病而兼中风之证也。身轻，邪在阳也；身重，邪在阴也；乍有轻时，谓身重而
有时轻也。若但欲寐，身重无轻时，是少阴证也。今无但欲寐，身虽重，乍有轻时，则
非少阴证，乃荣卫兼病之太阳证也。脉虽浮缓，证则无汗，属实邪也，故亦以大青龙汤
发之。前条以脉微汗出示禁，此条以无少阴证发明，盖详审慎重之至也。此二条，承上
篇首条、次条，中篇首条、次条，再揭太阳风寒两伤，以为下编荣卫兼病之提纲。后凡
称太阳中风、伤寒，涉于荣卫同病者，皆指此二条而言也。
【集注】方有执曰∶大青龙汤，一则曰主之，一则曰发之，何也？主之者，以烦躁之
急疾，属动而言；发之者，以但重之沉默，属静而言也。
喻昌曰∶无少阴证，“但重乍有轻时”六字早已指明。言但身重而无少阴之欲寐，其
为寒因可审，况乍有轻时，不似少阴之昼夜俱重。又兼风因可审，所以力驱其在表之风
寒而无疑也。若脉微弱，身重欲寐，则内顾少阴且不遑矣，敢发之乎？又曰∶细玩二条
文义，伤风脉本浮缓，反见浮紧；伤寒脉本浮紧，反见浮缓，是为伤风见寒，伤寒见风，
两无疑矣。又当辨无少阴证相杂，则用青龙，万举万当矣。故脉见微弱，即不可用大青龙，
以少阴病脉必微细也。方氏注泥“弱”字，牵入中风之脉，阳浮阴弱为解。不思中风之脉，
以及误汗等证，太阳上编已悉，此处但归重分别少阴，以太阳膀胱经与少阴肾经合为表
里，其在阴虚之人，表邪不俟传经，早从膀胱袭入肾脏者有之。况两感夹阴等证，临病
犹当细察，设少阴不亏，表邪安能飞渡而见身重欲寐等证耶！故有少阴证者，不得已而
行表散，自有温经散邪，两相绾照之法，岂可径用青龙之猛剂，立铲孤阳之根乎！
魏荔彤曰∶身重一证，必须辨明，但欲寐而常重，则属少阴。误发其汗，变上厥下
竭者，少阴热也；变筋惕肉 者，少阴寒也。其犯误汗之忌一也。
大青龙汤方
麻黄（去节，六两） 桂枝（二两） 甘草（炙，二两） 杏仁（去皮尖，四十枚） 生姜（切，三两）
大枣（擘，十二枚） 石膏（碎，绵裹，如鸡子大）
上七味，以水九升，先煮麻黄，减二升，去上沫，纳诸药，煮取三升，去滓，温服一
升，取微似汗，汗出多者，温粉扑之。一服汗者，停后服。若复服，汗多亡阳，遂虚恶
风，烦躁不得眠也。
【方解】名大青龙者，取龙兴云雨之义也。治风不外乎桂枝，治寒不外乎麻黄，合桂枝、
麻黄二汤以成剂，故为兼风寒中伤者之主剂也。二证俱无汗，故减芍药，不欲其收也；二
证俱烦躁，故加石膏以解其热也。设无烦躁，则又当从事于麻黄桂枝各半汤矣。仲景于表
剂中加大寒辛甘之品，则知麻黄证之发热，热全在表；大青龙证之烦躁，热兼肌里矣。初
病太阳即用石膏者，以其辛能解肌热，寒能清胃火，甘能生津液，是预保阳明存津液之
先着也。粗工疑而畏之，当用不用，必致热结阳明，斑黄狂冒，纷然变出矣。观此，则
可知石膏乃中风、伤寒之要药，故得麻、桂而有青龙之名，得知、草而有白虎之号也。服
后取微汗，汗出多者，温粉扑之。一服得汗，停其后服，盖戒人即当汗之证，亦不可过汗
也。所以仲景桂枝汤中不用麻黄者，是欲其不大发汗也；麻黄汤中用桂枝者，恐其过汗
无制也。若不慎守其法，汗多亡阳，变生诸逆，表遂空虚，而不任风，阴盛格阳，而更烦躁不得眠也。
【集解】许叔微曰∶仲景治伤寒，一则桂枝，二则麻黄，三则青龙。桂枝治风，麻黄
治寒，青龙兼治风寒，不拘时候，施与脉证相对者，无不应手而愈。今人皆能言之，而
未晓前人处方用药之意，多不敢用，无足怪也。
吴绶曰∶大青龙汤，治伤寒发热，恶寒不得汗出，烦躁不安，脉浮紧或浮数者，急
用此汤发汗则愈，乃仲景之妙法也。譬若亢热已极，一雨而凉，其理可见也。若不晓此
理，见其躁热，投以寒凉之药，其害可胜言哉！若脉微弱汗出恶风者，不可用也；如误
用之，其害亦不浅。所以脉证不明者，多不敢用也。
脉浮而紧，浮则为风，紧则为寒，风则伤卫，寒则伤荣。荣卫俱病，骨节烦疼，当
发其汗而不可下也。
【注】此发明风寒两伤，荣卫俱病之义也。
浮，风邪脉也；风，阳也；卫，阳也。紧，寒邪脉也。寒，阴也；荣，阴也。各从其类而
伤之。荣卫俱病，骨节烦疼，是大青龙发汗之脉证，虽发热烦躁，其热在肌而不在胃，不可下也。
太阳病发汗，汗出不解，其人仍发热，心下悸，头眩身 动，振振欲擗地者，真武汤主之。
【注】此申首条，示人以救逆之法也。首条言误汗，此条言过汗，互文以明其义也。盖
二证皆属亡阳，故均当以真武汤主之，扶阳抑阴以救其逆也。大汗出，仍热不解者，阳
亡于上也；心下悸筑筑然动，阳虚不能内守也；头眩者，头晕眼黑，阳微气不能升也；身
动者，蠕蠕然 动，阳虚液涸，失养于经也。振，耸动也。振振欲擗地者，耸动不已，
不能兴起，欲堕于地，阳虚气力不能支也。
【集注】张璐曰∶此为误用大青龙因而致变者立法也。汗出虽多而热不退，则邪未尽
而正已大伤，况里虚为悸，上虚为眩，经虚为 ，身振振摇，无往而非亡阳之象，所以
用真武，把守关口坐镇之法也。
汪琥曰∶或问治不在表，何以方中尚用生姜？盖病自过汗而来，虽无郁热可发，其
内外寒邪犹在，用生姜者，乃温中有发也。
真武汤方（见少阴篇）
太阳病二日，反躁，反熨其背，而大汗出，大热入胃，胃中水竭，躁烦，必发谵语，
十余日，振栗自下利者，此为欲解也。故其汗从腰以下不得汗，欲小便不得，反呕欲失
溲，足下恶风，大便硬，小盒饭数而反不数，及多大便已，头卓然而痛，其人足心必热，谷气下流故也。
【注】太阳病中风、伤寒，二日不躁，今反躁者，是不得汗出而躁，大青龙汤证也。不
以青龙汤发汗，反以火劫熨背，逼汗大出，火邪入胃，胃热水竭，则烦躁谵语所必发也。十
有余日，邪正相持，持久必争，争必振栗作解，然解非汗出及下利，邪无从解也。若自
下利，此为欲从里解也；若自汗出，此为欲从表解也。今十余日不自下利，而有欲小便不
得，反呕欲失溲者，是里不解也；不自汗出，而下体无汗，足下恶风者，是表不解也。里
不解者，大便必硬，小盒饭数而反不数，则知水留胃中，久必肠润，其久积之大便自应
多下而解也。及多大便已，虽小便不得，诸病不解，其头卓然而痛，是里解表未悉解也。
表未悉解者，是因火逼汗出，而从腰以下不得汗，乃上解而下未解也。故有小便不得，诸
在下之病。今虽里解，而其人头卓然而痛者，是表之余邪上逆也。足心必热者，里之余热
下流也。谷气者，即胃气也，言胃中热气随大便而下流也。此病皆由妄行火劫致变，难
以拘定成规，当诊犯何逆，随证治之可也。
服桂枝汤，大汗出，脉洪大者，与桂枝汤如前法。若形似疟，一日再发者，汗出必
解，宜桂枝二麻黄一汤。
【注】服桂枝汤，大汗出，病不解，脉洪大，若烦渴者，则为表邪已入阳明，是白虎
汤证也。今脉虽洪大而不烦渴，则为表邪仍在太阳，当更与桂枝汤如前法也。服汤不解，
若形如疟，日再发者，虽属轻邪，然终是为风寒所持，非汗出必不得解，故宜桂枝二麻
黄一汤，小发荣卫之汗。其不用麻黄桂枝各半汤者，盖因大汗已出也。
【集注】方有执曰∶服桂枝汤，证转大汗出，脉转洪大者，乃风多寒少，风邪欲散而
以微寒持之，两者皆不得解，而寒热如疟也。桂枝二麻黄一汤者，重解风而轻于散寒也。
桂枝二麻黄一汤方
桂枝（一两十七株） 芍药（一两六铢） 麻黄（去节，十六铢） 甘草（一两二铢） 杏仁
（去皮尖，十六枚） 生姜（切，一两六铢） 大枣（擘，五枚）
上七味，以水五升，先煮麻黄一二沸，去
上沫，纳诸药，煮取二升，去滓，温服一升，日再服。
【集解】张璐曰∶详此方药品，与各半不殊，惟铢分稍异，而证治攸分，可见仲景于
差多差少之间，分毫不苟也。
太阳病，得之八九日，如疟状，发热恶寒，热多寒少，其人不呕，清便欲自可，一
日二三度发，脉微缓者，为欲愈也；脉微而恶寒者，此阴阳俱虚，不可更发汗，更下更
吐也；面色反有热色者，未欲解也，以其不能得小汗出，身必痒，宜桂枝麻黄各半汤。
【注】太阳荣卫两伤，风多寒少之病，得之八九日，有如疟状之寒热，热多寒少，其
人不呕，小便清白者，此里和不受邪，虽为欲愈，然必审其人。如疟状之寒热，一日二
三度，轻轻而发，诊其脉微且缓，则知邪已衰，正欲复，表里将和，始为欲愈也。若脉
微不缓，是正犹未复，恶寒是邪犹未衰，尚不能自愈，但已为前之汗、吐、下，虚其表
里，不可更发汗、更下、更吐也。脉微恶寒，表里俱虚，则面色当白，今色反赤，犹有余
邪怫郁于表，不能得小汗出，宣发阳气，故面赤身痒，未欲解也，宜桂枝麻黄各半汤，小
小汗之，以和荣卫，自可愈也。
【集注】吴人驹曰∶此不专事桂枝，而兼合乎麻黄者，谓其面热身痒，邪在轻虚浮浅
之处，惟麻黄能达也。
桂枝麻黄各半汤方
桂枝（一两十六铢） 芍药（一两） 生姜（一两） 甘草（炙，一两） 麻黄（去节，一两） 大枣（擘，
四枚） 杏仁（去皮，尖，二十四枚）
上七味，以水五升，先煮麻黄一二沸，去上沫，纳诸药，煮取一升八合，去滓，温服六合。
脉浮而迟，面热赤而战惕者，六七日当汗出而解，反发热者瘥迟，迟为无阳，不能
作汗，其身必痒也。
【注】此承上条，发明面赤身痒之义也。表阳气虚，故脉浮迟，邪气怫郁，故面热赤，
正虚邪盛相争，故战惕也。至六七日，则邪当衰，应汗出而解，若反发热，是邪未衰，故
瘥迟也。迟者，正不胜邪也。阳微怫郁，其身必痒，以无阳气，不能宣发作汗故也。
【集注】程知曰∶此言阳虚不能作汗之脉也。浮则邪在肌表；迟则阳虚；气怫郁而不
得越，则面热赤；正与邪争而不得出，则身战惕。至六七日传经尽，当汗解之时，乃不
得汗，反发热者，其差必迟。盖阳虚不能领汗外出，其热邪浮于肌肤，必作身痒也。
太阳病，发热恶寒，热多寒少，脉微弱者，此无阳也，不可发汗，宜桂枝二越婢一汤。
【注】太阳病发热恶寒，热多寒少，此为荣卫兼病，风邪多而寒邪少也。若脉浮紧，或
脉浮数，是表有阳邪郁蒸，则为无汗热多之实邪，以大青龙汤汗之可也。今脉阳微阴弱，
Taiyang wind-stroke is when wind pathogen injures the Wei (Defensive) Qi; cold injury is when cold pathogen injures the Ying (Nutritive) Blood. This explanation has been detailed in the upper and middle chapters. Here, we address the condition where both wind and cold simultaneously invade, causing disease in both Ying and Wei, organizing it into the lower chapter. Generally, wind and cold qi often accompany each other and rarely separate; when there is cold, there is not necessarily no wind, and when there is wind, there is not necessarily no cold. When wind and cold occur together, pathogens enter the human body, causing simultaneous disease in Ying and Wei. As long as the symptoms present with anhidrosis (absence of sweating), they are all classified as excess pathogens. Therefore, Da Qing Long Tang (Major Blue Dragon Decoction) is established to resolve both, dispersing the cold pathogen externally closed and the wind pathogen internally constrained, specifically addressing the restlessness caused by anhidrosis. However, one must carefully examine that the patient's pulse is not weak or thready, and there are no Shaoyin syndrome manifestations, before administering it. If mistakenly used, it will cause profuse sweating, cold extremities, muscle twitching, inevitably leading to Yang collapse. Thus, Zhen Wu Tang (True Warrior Decoction) is established to remedy the error of using Da Qing Long Tang. For cases of exterior cold and interior heat, Da Qing Long Tang is indeed appropriate. However, if both exterior and interior are hot, Da Qing Long Tang cannot handle it; therefore, Bai Hu Tang (White Tiger Decoction) is established to supplement the limitations of Da Qing Long Tang. For mild cold and heat symptoms, Gui Zhi Er Yue Bi Yi Tang (Cinnamon Twig Twice, Bitter Ginger One Third Decoction), Ma Huang Gui Zhi Ge Ban Tang (Ephedra and Cinnamon Twig Half-and-Half Decoction), and Gui Zhi Er Ma Huang Yi Tang (Cinnamon Twig Twice, Ephedra One Third Decoction) are presented, all of which are methods to simultaneously resolve Ying and Wei. Reading these thoroughly along with the upper and middle chapters will make the three methods clear, ensuring treatment is not chaotic.
In Taiyang wind-stroke, if the pulse is floating and tight, accompanied by fever, aversion to cold, body pain, anhidrosis, and restlessness, Da Qing Long Tang (Major Blue Dragon Decoction) should be administered. If the pulse is weak or thready, with sweating and aversion to wind, it must not be taken; taking it will result in cold extremities and muscle twitching, which is a therapeutic error.
[Annotation] In Taiyang wind-stroke, the pulse should be floating and relaxed (slow); a floating and tight pulse indicates wind-stroke complicated by cold-injury patterns. Wind-stroke typically presents without body pain and with spontaneous sweating; body pain and anhidrosis indicate wind-stroke complicated by cold-injury symptoms. Anhidrosis with restlessness is caused by stagnation and steaming in the Taiyang channel. Wind is a Yang pathogen; cold is a Yin pathogen. Yin-cold stagnating externally causes anhidrosis, while Yang-heat steaming internally causes restlessness. This represents simultaneous injury by wind and cold, affecting both Ying and Wei. Therefore, combining Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction) with Shigao (Gypsum Fibrosum) creates Da Qing Long Tang (Major Blue Dragon Decoction) to resolve the excess pathogen affecting both Ying and Wei. If the pulse is weak or thready, with sweating and aversion to wind, even if restlessness is present, it is Shaoyin restlessness, not Taiyang restlessness. It is forbidden to take this formula; doing so will cause cold extremities and muscle twitching, accelerating Yang collapse. Hence, it is stated: "This is a therapeutic error."
[Collected Annotations] Cheng Wuji states: When wind predominates in Wei, it results in weak Ying and strong Wei; when cold predominates in Ying, it results in strong Ying and weak Wei. Now, with both wind and cold injuring, Ying and Wei are both excess, hence Da Qing Long Tang (Major Blue Dragon Decoction) is suitable.
Yu Chang states: Da Qing Long Tang (Major Blue Dragon Decoction) is prescribed for Taiyang anhidrosis. How does it differ from Mahuang Tang (Ephedra Decoction)? Because restlessness is concurrently present, only this method can resolve it.
Cheng Yingmao states: This decoction is not prescribed for restlessness per se, but for restlessness caused by anhidrosis. If the pulse is weak or thready, with sweating and aversion to wind, even with restlessness, it is a sign of Yang collapse in Shaoyin, completely different from stagnation due to anhidrosis.
In cold injury, if the pulse is floating and relaxed, the body is not painful but heavy, occasionally feeling lighter, and there are no Shaoyin syndrome manifestations, Da Qing Long Tang (Major Blue Dragon Decoction) should be used to induce sweating.
[Annotation] In cold injury, the pulse should be floating and tight; a floating and relaxed pulse indicates cold injury complicated by wind-stroke patterns. Cold injury typically involves body pain; absence of pain indicates cold injury complicated by wind-stroke symptoms. Lightness of the body indicates pathogen in Yang; heaviness indicates pathogen in Yin; "occasionally lighter" means heaviness that sometimes alleviates. If there is desire to sleep and constant heaviness without alleviation, it is a Shaoyin syndrome. Now, without desire to sleep, and although heavy, occasionally lighter, it is not Shaoyin syndrome, but a Taiyang syndrome involving both Ying and Wei. Although the pulse is floating and relaxed, the symptom is anhidrosis, belonging to excess pathogen, so Da Qing Long Tang (Major Blue Dragon Decoction) is also used to induce sweating. The previous clause prohibited use based on weak pulse and sweating; this clause clarifies based on the absence of Shaoyin syndrome, showing extreme caution. These two clauses follow the first and second clauses of the upper and middle chapters, reiterating Taiyang dual injury by wind and cold as the outline for Ying-Wei dual disease in the lower chapter. Subsequent mentions of Taiyang wind-stroke or cold injury involving Ying-Wei dual disease refer to these two clauses.
[Collected Annotations] Fang Youzhi states: Da Qing Long Tang (Major Blue Dragon Decoction) uses "prescribed for" once and "induce sweating" once. Why? "Prescribed for" refers to the urgency of restlessness (movement); "induce sweating" refers to the silence of heaviness (stillness).
Yu Chang states: "No Shaoyin syndrome" and "only heavy, occasionally lighter" clarify the point. It means only body heaviness without Shaoyin desire to sleep allows confirmation of cold pathogen. Moreover, occasional lightness differs from Shaoyin's constant day-and-night heaviness. Combined with wind pathogen confirmation, vigorously driving out exterior wind-cold is unquestionable. If pulse is weak/thready, body heavy, desire to sleep, attending to Shaoyin internal deficiency would be urgent enough; how could one dare to induce sweating? Furthermore, examining the text, wind-stroke pulse is naturally floating/relaxed but shows floating/tight; cold injury pulse is naturally floating/tight but shows floating/relaxed. This confirms wind-stroke with cold, cold injury with wind. One must distinguish the absence of Shaoyin syndrome to use Qinglong safely. Weak pulse contraindicates Da Qing Long Tang because Shaoyin pulse is micro-thready. Fang's annotation clings to "weak," linking it to wind-stroke pulse (floating Yang, weak Yin). Ignoring that wind-stroke pulses and mis-sweating signs were detailed in the upper Taiyang chapter, here the focus is distinguishing Shaoyin. Since Taiyang Bladder and Shaoyin Kidney are exterior-interior pairs, in Yin-deficient individuals, exterior pathogens may enter the Kidney via Bladder without transmission. Even more so in complex cases like concurrent cold/heat with Yin involvement. If Shaoyin is not deficient, how could exterior pathogens bypass to cause heaviness and desire to sleep? Thus, with Shaoyin syndrome, if exterior release is unavoidable, warming meridians and dispersing pathogens is required. Using the potent Qinglong directly would destroy the root of solitary Yang.
Wei Litong states: Body heaviness must be distinguished. Desire to sleep with constant heaviness belongs to Shaoyin. Misusing sweating leads to upper cold/lower exhaustion (Shaoyin Heat) or muscle twitching (Shaoyin Cold). Both violate the prohibition against mis-sweating.
Da Qing Long Tang (Major Blue Dragon Decoction) Formula:
Mahuang (Ephedrae Herba, stems removed, 6 liang), Guizhi (Cinnamomi Ramulus, 2 liang), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 2 liang), Xingren (Armeniacae Semen Amarum, skin and tip removed, 40 pieces), Shengjiang (Zingiberis Rhizoma Recens, sliced, 3 liang), Dazao (Ziziphi Jujubae Fructus, broken, 12 pieces), Shigao (Gypsum Fibrosum, crushed, wrapped in silk, size of a chicken egg).
Take seven ingredients, add 9 sheng of water, first boil Mahuang (Ephedrae Herba), reduce by 2 sheng, remove foam, add remaining herbs, boil to obtain 3 sheng, strain, warm and take 1 sheng. Aim for slight perspiration. If sweat is excessive, apply warm powder. If one dose induces sweat, stop subsequent doses. Repeated dosing causes excessive sweating and Yang collapse, leading to deficiency, aversion to wind, restlessness, and insomnia.
[Formula Analysis] Named "Major Blue Dragon," referencing the dragon raising clouds and rain. Treating wind relies on Guizhi Tang (Cinnamon Twig Decoction); treating cold relies on Mahuang Tang (Ephedra Decoction). Combining these forms the primary formula for dual wind-cold injury. Both syndromes lack sweat, so Shaoyao (Paeoniae Radix Alba) is reduced to avoid astringency. Both have restlessness, so Shigao (Gypsum Fibrosum) is added to clear heat. Without restlessness, Ma Huang Gui Zhi Ge Ban Tang (Ephedra and Cinnamon Twig Half-and-Half Decoction) would be appropriate. Zhang Zhongjing adds cold-natured acrid-sweet herbs to exterior-releasing formulas, indicating Mahuang Tang fever is purely exterior, while Da Qing Long Tang restlessness involves heat in the muscle layer. Using Shigao (Gypsum Fibrosum) early in Taiyang disease clears muscle heat, stomach fire, and generates fluids, protecting Yangming and preserving fluids. Unskilled physicians fear it; failure to use it leads to Yangming heat binding, macules, jaundice, mania, and various complications. Thus, Shigao (Gypsum Fibrosum) is essential for wind-stroke and cold injury. With Mahuang and Guizhi, it earns the name "Qinglong"; with Zhimu and Gancao, it becomes "Baihu." Post-administration requires slight sweat; excessive sweat is managed with warm powder. Stopping after one dose warns against over-sweating. Guizhi Tang omits Mahuang to prevent excessive sweating; Mahuang Tang includes Guizhi to prevent uncontrolled sweating. Failure to follow these rules leads to Yang collapse, reverse conditions, exterior emptiness, inability to withstand wind, Yin excess repelling Yang, and worsened restlessness/insomnia.
[Collected Exegesis] Xu Shuwei states: Zhang Zhongjing treats cold injury with three main approaches: Guizhi Tang (Cinnamon Twig Decoction), Mahuang Tang (Ephedra Decoction), and Qinglong Tang. Guizhi treats wind, Mahuang treats cold, Qinglong treats both. Applied correctly to matching pulse/symptoms, cures are immediate. People know this but misunderstand the rationale, fearing use.
Wu Shou states: Da Qing Long Tang (Major Blue Dragon Decoction) treats cold injury with fever, aversion to cold, anhidrosis, restlessness, and floating-tight or floating-rapid pulse. Urgent sweating cures it. Like extreme heat cooling with rain. Misunderstanding this and using cold-cooling herbs for restlessness is harmful. Contraindicated in weak pulse, sweating, aversion to wind. Misuse causes harm. Unclear pulse/symptoms lead to hesitation.
Floating and tight pulse: Floating indicates wind, tight indicates cold. Wind injures Wei, cold injures Ying. Ying and Wei disease causes bone/joint vexing pain. Induce sweating; do not purge.
[Annotation] This explains dual wind-cold injury affecting Ying and Wei. Floating is wind-pulse; wind is Yang; Wei is Yang. Tight is cold-pulse; cold is Yin; Ying is Yin. Injury follows their nature. Ying-Wei disease with bone/joint pain indicates Da Qing Long Tang (Major Blue Dragon Decoction) for sweating. Despite fever/restlessness, heat is in muscles, not stomach; purging is contraindicated.
If Taiyang disease sweating fails to resolve symptoms, with persistent fever, epigastric palpitations, dizziness, body tremors, and feeling as if falling to the ground, Zhen Wu Tang (True Warrior Decoction) is indicated.
[Annotation] This elaborates on the first clause, showing rescue methods. First clause discusses mis-sweating; this discusses over-sweating. Both involve Yang collapse, treated with Zhen Yu Tang (True Warrior Decoction) to support Yang and suppress Yin. Profuse sweating with unresolved fever indicates Yang loss upward. Epigastric palpitations indicate Yang deficiency failing to hold inward. Dizziness indicates weak Yang failing to rise. Body tremors indicate Yin fluid depletion and meridian malnutrition due to Yang deficiency. "Zhenzhen yu pixi di" describes uncontrollable trembling and inability to rise.
[Collected Annotations] Zhang Lu states: This addresses complications from misusing Da Qing Long Tang (Major Blue Dragon Decoction). Persistent fever despite sweating shows incomplete pathogen and damaged Zheng Qi. Epigastric palpitations (interior deficiency), dizziness (upper deficiency), tremors (meridian deficiency) all signal Yang collapse. Zhen Wu Tang (True Warrior Decoction) secures the foundation.
Wang Hu states: Why include Shengjiang (Zingiberis Rhizoma Recens) if treatment is not exterior? Pathogen arises from over-sweating; though no stagnation heat exists, interior/exterior cold remains. Shengjiang warms and gently releases.
Zhen Wu Tang (True Warrior Decoction) Formula (See Shaoyin Chapter).
In Taiyang disease on the second day, unexpected restlessness, followed by back moxibustion/ironing causing profuse sweating, intense heat entering the Stomach, drying Stomach fluids, leading to restlessness/vexation and delirium. After ten+ days, chills and spontaneous diarrhea indicate impending resolution. Sweat below waist is absent; urge to urinate is blocked; vomiting and urinary incontinence occur; feet are cold/averted to wind; stool is hard; frequent small bowel movements occur but volume is low. Eventually, large stool passage brings sudden head pain, and sole warmth occurs due to Grain Qi flowing downward.
[Annotation] Taiyang wind-stroke/cold injury without restlessness on day two, now restless, indicates anhidrosis-related restlessness (Da Qing Long Tang syndrome). Instead of sweating with Qinglong, fire therapy forced sweat. Fire pathogen enters Stomach, drying fluids, causing delirium. After ten days, pathogen/Zheng struggle leads to chills/resolution. Resolution comes via sweat or diarrhea. Spontaneous diarrhea suggests interior resolution; spontaneous sweat suggests exterior resolution. Lack of diarrhea and presence of urinary issues/vomiting indicate unresolved interior. Lack of sweat and lower-body cold/aversion indicate unresolved exterior. Interior unresolved implies hard stool. Frequent small stools suggest water retention in Stomach eventually moistening intestines, resolving accumulated stool. After large stool passage, if urine remains blocked and other symptoms persist, sudden head pain indicates residual exterior pathogen rising. Foot warmth indicates residual interior heat flowing down. Grain Qi is Stomach Qi; heat flows down with stool. These changes result from improper fire therapy; rigid rules don't apply. Diagnose the error and treat accordingly.
After taking Guizhi Tang (Cinnamon Twig Decoction), profuse sweating occurs, pulse becomes flooding. Administer Guizhi Tang (Cinnamon Twig Decoction) again as before. If symptoms resemble malaria, occurring twice daily, sweating will resolve it; Gui Zhi Er Ma Huang Yi Tang (Cinnamon Twig Twice, Ephedra One Third Decoction) is suitable.
[Annotation] After Guizhi Tang (Cinnamon Twig Decoction), profuse sweating without cure and flooding pulse, if accompanied by vexation/thirst, indicates pathogen entered Yangming (Bai Hu Tang syndrome). Here, flooding pulse without vexation/thirst means pathogen remains in Taiyang; repeat Guizhi Tang (Cinnamon Twig Decoction). If unresolved and resembling malaria (twice daily), though mild, pathogen is still held by wind-cold. Sweating is necessary. Gui Zhi Er Ma Huang Yi Tang (Cinnamon Twig Twice, Ephedra One Third Decoction) mildly releases Ying-Wei sweat. Ma Huang Gui Zhi Ge Ban Tang (Ephedra and Cinnamon Twig Half-and-Half Decoction) is avoided due to prior profuse sweating.
[Collected Annotations] Fang Youzhi states: Post-Guizhi Tang profuse sweating and flooding pulse indicate more wind than cold. Wind wants to scatter, but slight cold holds it. Neither resolves, causing malaria-like chills/fever. Gui Zhi Er Ma Huang Yi Tang (Cinnamon Twig Twice, Ephedra One Third Decoction) emphasizes resolving wind over dispersing cold.
Gui Zhi Er Ma Huang Yi Tang (Cinnamon Twig Twice, Ephedra One Third Decoction) Formula:
Guizhi (Cinnamomi Ramulus, 1 liang 17 zhu), Shaoyao (Paeoniae Radix Alba, 1 liang 6 zhu), Mahuang (Ephedrae Herba, stems removed, 16 zhu), Gancao (Glycyrrhizae Radix et Rhizoma, 1 liang 2 zhu), Xingren (Armeniacae Semen Amarum, skin/tip removed, 16 pieces), Shengjiang (Zingiberis Rhizoma Recens, sliced, 1 liang 6 zhu), Dazao (Ziziphi Jujubae Fructus, broken, 5 pieces).
Take seven ingredients, add 5 sheng water, first boil Mahuang (Ephedrae Herba) for 1-2 boils, remove foam, add others, boil to 2 sheng, strain, warm and take 1 sheng, twice daily.
[Collected Exegesis] Zhang Lu states: Ingredients are similar to Ge Ban Tang, differing only slightly in dosage. This distinction highlights Zhang Zhongjing's precision in minor adjustments.
In Taiyang disease, after 8-9 days, malaria-like symptoms, fever/aversion to cold, more heat than cold, no vomiting, normal bowel/bladder function, occurring 2-3 times daily. Pulse micro-relaxed indicates recovery. Pulse micro with aversion to cold indicates dual Yin-Yang deficiency; no further sweating, purging, or vomiting. Face flushed red indicates unresolved pathogen due to inability to produce slight sweat, causing body itching. Gui Zhi Ma Huang Ge Ban Tang (Cinnamon Twig and Ephedra Half-and-Half Decoction) is suitable.
[Annotation] Taiyang Ying-Wei dual injury, more wind than cold, after 8-9 days, malaria-like chills/fever, more heat than cold, no vomiting, clear urine indicates interior harmony. Recovery depends on pulse. Malaria-like episodes 2-3 times daily, gentle onset, micro-relaxed pulse indicates declining pathogen and recovering Zheng, signaling impending harmony/recovery. Micro pulse without relaxation, plus aversion to cold, indicates unrecovered Zheng and undeclined pathogen; cannot self-resolve. Prior sweating/purging/vomiting depleted interior/exterior; no further harsh treatments. Micro pulse/aversion to cold indicates dual deficiency; face should be pale. Red face indicates residual pathogen stagnating exterior, blocking slight sweat and Yang dispersion, causing red face/body itch. Gui Zhi Ma Huang Ge Ban Tang (Cinnamon Twig and Ephedra Half-and-Half Decoction) mildly induces sweat to harmonize Ying-Wei.
[Collected Annotations] Wu Renju states: Not solely relying on Guizhi but combining Mahuang addresses red face/itchy body, where pathogen is light/shallow. Only Mahuang can reach this level.
Gui Zhi Ma Huang Ge Ban Tang (Cinnamon Twig and Ephedra Half-and-Half Decoction) Formula:
Guizhi (Cinnamomi Ramulus, 1 liang 16 zhu), Shaoyao (Paeoniae Radix Alba, 1 liang), Shengjiang (Zingiberis Rhizoma Recens, 1 liang), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 1 liang), Mahuang (Ephedrae Herba, stems removed, 1 liang), Dazao (Ziziphi Jujubae Fructus, broken, 4 pieces), Xingren (Armeniacae Semen Amarum, skin/tip removed, 24 pieces).
Take seven ingredients, add 5 sheng water, first boil Mahuang (Ephedrae Herba) for 1-2 boils, remove foam, add others, boil to 1.8 sheng, strain, warm and take 0.6 sheng.
Floating and slow pulse, facial heat/redness with trembling/chills: Resolution via sweating expected in 6-7 days. Persistent fever indicates delayed recovery. Slow pulse indicates lack of Yang, inability to sweat, resulting in body itching.
[Annotation] Elaborates on red face/itchy body. Exterior Yang deficiency causes floating/slow pulse. Pathogen stagnation causes facial heat/redness. Deficiency vs. Excess struggle causes trembling. By day 6-7, pathogen should decline, allowing sweat/resolution. Persistent fever means pathogen hasn't declined, delaying recovery. Slow pulse means Zheng cannot overcome pathogen. Weak Yang stagnation causes itching due to inability to disperse sweat.
[Collected Annotations] Cheng Zhi states: Describes pulse of Yang deficiency unable to induce sweat. Floating indicates exterior pathogen; slow indicates Yang deficiency. Stagnant Qi causes facial redness; struggle prevents exit, causing trembling. By day 6-7 (end of transmission cycle), sweating should occur. Failure to sweat with fever delays recovery. Yang deficiency fails to guide sweat out; heat floats in skin/muscles, causing itching.
In Taiyang disease, fever/aversion to cold, more heat than cold, weak pulse indicates "no Yang"; do not induce sweating. Gui Zhi Yue Bi Yi Tang (Cinnamon Twig Twice, Bitter Ginger One Third Decoction) is suitable.
[Annotation] Taiyang fever/aversion to cold, more heat than cold, indicates Ying-Wei dual disease, more wind than cold. If pulse is floating-tight or floating-rapid, exterior Yang stagnation causes anhidrosis/excess heat; Da Qing Long Tang (Major Blue Dragon Decoction) induces sweating. Here, pulse is Yang-micro/Yin-weak,