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This is a diagnostic pulse pattern for deficiency syndromes. Even if there are excess pathogenic factors manifesting as absence of sweating and abundant heat, Da Qing Long Tang (Major Blue Dragon Decoction) must not be used to induce sweating again. This is because the pulse is weak and faint, indicating that it is no longer the typical exterior pulse of Taiyang disease (diseases affecting the bladder and small intestine meridians), so vigorous sweating should not be induced. However, since there are exterior signs such as absence of sweating, abundant heat, and slight cold, herbs like Ephedrae Herba (Mahuang, 麻黄), Cinnamon Twig (Guizhi, 桂枝), and Gypsum Fibrosum (Shigao, 石膏) cannot be entirely omitted. Therefore, only the mild formula Guizhi Er Yuebi Yi Tang (Cinnamon Twig Twice and Yuebi One Decoction) is suitable, to induce slight sweating, thereby releasing the muscle layer and harmonizing Ying and Wei (nutritive and defensive qi).

[Collected Annotations] Yu Chang stated: This is also a syndrome where wind pathogen is heavy and cold pathogen is light. The term "absence of Yang" appears multiple times in Zhang Zhongjing's writings. "Absence of Yang" generally refers to the lack of exterior pathogen or insufficient body fluids; thus, the warning against inducing sweating again is given. However, without sweating, wind-cold cannot be resolved. Only by using two parts of Guizhi Tang (Cinnamon Twig Decoction) to treat wind and one part of Yuebi Tang (Yuebi Decoction) to treat cold is this a lawful treatment.

Wang Hu stated: The phrase "cannot induce sweating again" implies that vigorous sweating should not be induced, due to the patient's weak and faint pulse and absence of Yang. This formula is milder than the previous formula mentioned for slight sweating.

Wu Renju stated: The "wei" (slight/weak) here refers to degree being slight, not the pulse being micro-fine. It simply means not too forceful. If it is said to have abundant heat, how can the pulse be weak? "Absence of Yang" means the exterior Yang pathogen is slight, so vigorous sweating should not be induced. "Abundant heat" means the heat pathogen in the muscles is strong, hence Gypsum Fibrosum is added as an assistant. "Yuebi" means the dispersing power is like the work of a maid; the prescription is narrow and small, unlike the grandeur of Da Qing Long Tang.

Formula: Guizhi Er Yuebi Yi Tang (Cinnamon Twig Twice and Yuebi One Decoction)
Guizhi (Cinnamon Twig, 18 zhu), Shaoyao (Peony Root, 18 zhu), Gancao (Licorice Root, prepared, 18 zhu), Shigao (Gypsum Fibrosum, crushed, wrapped in silk, 24 zhu), Mahuang (Ephedra Herb, nodes removed, 18 zhu), Dazao (Jujube Fruit, split, 4 pieces), Shengjiang (Fresh Ginger, 1 liang 2 zhu).
The above seven ingredients are boiled with five sheng of water. First boil Mahuang for one or two boils, remove the foam on top, then add the other herbs. Boil until two sheng remain, strain, and take one sheng warm.
This formula should ideally be calculated as a combination of Yuebi Tang and Guizhi Tang, taking one sheng per dose. Now combined into one formula, the ratio is two parts Guizhi Tang to one part Yuebi Tang.

[Formula Analysis] This formula is essentially Da Qing Long Tang (Major Blue Dragon Decoction) with Xingren (Apricot Seed) replaced by Shaoyao (Peony Root). Although named Yuebi assisting Guizhi, it is actually a modified version of Da Qing Long Tang. Xingren is removed because its acrid-dispersing nature acts on Yang; Shaoyao is used because its sour-astringent nature acts on Yin. By substituting one for the other and adjusting the dosage, the therapeutic indication changes. With Guizhi as the main component (two parts), it does not induce sweating. Thus, the Yuebi part (one part) consists merely of Mahuang and Shigao, utilizing their acrid-cool properties to assist Guizhi in harmonizing the exterior and clearing muscle heat. This embodies slight sweating within non-sweating, which can be understood. It is not like Da Qing Long Tang, where Shigao assists Mahuang as a heavy agent for inducing sweating and driving out muscle heat.

[Note] Guizhi Er Mahuang Yi Tang (Cinnamon Twig Twice and Ephedra One Decoction) treats symptoms resembling malaria, occurring twice a day, resolving with sweating, but lacks the sign of abundant heat and slight cold, hence Gypsum Fibrosum is not used. Guizhi Mahuang Ge Ban Tang (Cinnamon Twig and Ephedra Half-Half Decoction) treats symptoms resembling malaria with abundant heat and slight cold, but does not use Gypsum Fibrosum and instead doubles Mahuang. This is because the patient has a flushed face with trapped heat and itchy skin, indicating heat is moving outward rather than inward, allowing for slight sweating to follow the pathogenic trend; thus, Gypsum Fibrosum for clearing interior heat is not used. Guizhi Er Yuebi Yi Tang treats fever and aversion to cold with abundant heat and slight cold. Gypsum Fibrosum is used because the exterior pathogen has little cold but abundant heat in the muscles; thus, Gypsum Fibrosum's coolness assists Mahuang and Guizhi to harmonize Ying and Wei, rather than violently expelling them. Modern practitioners often fear using Mahuang and Guizhi regardless of dosage or whether to cover with blankets to induce sweat, because they have not investigated Zhang Zhongjing's intent. Mahuang and Guizhi are herbs for harmonizing Ying and Wei; in heavy doses with covering to induce sweat, they become agents for violent expulsion; in light doses without covering, they become formulas for harmonizing Ying and Wei.

[Collected Explanations] Wu Renju stated: For dispersing exterior pathogens, Gypsum Fibrosum is always used together. This is because Gypsum Fibrosum is cold in nature, and cold overcomes heat; its taste is thin, and thinness allows it to reach the exterior. Unlike Huangqin (Scutellaria Root) and Huanglian (Coptis Rhizome), which are cold in nature but bitter and thick in taste, preventing ascending action.

In Shanghan (Cold Damage) with no significant fever, dry mouth and thirst, mental restlessness, and slight aversion to cold on the back, Bai Hu Jia Ren Shen Tang (White Tiger Plus Ginseng Decoction) is indicated.

[Annotation] In Shanghan, if there is no significant fever, no irritability or thirst, a normal mouth sensation, and aversion to cold on the back, Fuzi Tang (Aconite Decoction) is used, belonging to Shaoyin disease (diseases affecting the heart and kidney meridians). Now, in Shanghan with no significant fever, it indicates heat is gradually moving from the exterior to the interior. Dry mouth, thirst, and mental restlessness indicate heat has entered the Yangming stage (stomach and large intestine meridians). Although there is slight aversion to cold on the back, resembling Shaoyin, Shaoyin syndromes present with a normal mouth sensation; here, dry mouth and thirst indicate the mouth is not normal. Aversion to cold on the back is not due to Yang deficiency, but rather Yangming interior heat steaming upwards to the back, causing sweating and loose pores, leading to slight aversion. Bai Hu Tang (White Tiger Decoction) is used to directly target Yangming and clear heat significantly; Ren Shen (Ginseng Root) is added to protect the loose pores.

[Collected Annotations] Yu Chang stated: This clause demonstrates very detailed differentiation. The pulse will likely be slippery and floating. There is no significant fever on the whole body, nor aversion to cold, only slight aversion to cold in the back, indicating the exterior pathogen is about to resolve. The patient's dry mouth, thirst, and mental restlessness indicate interior heat is blazing; waiting is not an option, and urgent clearing and resolving are required. Delay may lead to deep heat and exhaustion of fluids, rendering treatment useless.

In Shanghan, if the exterior is not resolved, and there is fluid retention in the epigastrium, presenting with dry retching, fever, and cough, or alternatively thirst, diarrhea, dysphagia, difficulty urinating with lower abdominal fullness, or wheezing, Xiao Qing Long Tang (Minor Blue Dragon Decoction) is indicated.

[Annotation] "Exterior not resolved" in Shanghan refers to the persistence of symptoms such as floating-tight pulse, headache, body pain, fever, absence of sweating, and aversion to cold. "Fluid retention in the epigastrium" refers to dry retching and cough. Since water diseases vary, it states "alternatively thirst, diarrhea..." etc., all indicating water retention syndromes. Therefore, Xiao Qing Long Tang is used with appropriate modifications. The Classic says: The Sanjiao (Triple Burner) is the official of irrigation, through which water passages flow; the Bladder is the official of the capital, storing fluids, which are excreted through Qi transformation. When Taiyang is affected by pathogens, without water retention, the disease remains in the meridians; with water retention, the disease invades the fu organs. Disease in the fu organs leads to failure of Bladder Qi transformation and loss of pathway for Sanjiao water. Stagnation in the Upper Jiao causes cough, wheezing, or dysphagia; stagnation in the Middle Jiao causes thirst, dry retching, or fullness; stagnation in the Lower Jiao causes difficulty urinating, lower abdominal fullness, or diarrhea. Wherever water travels, disease can occur. Xiao Qing Long Tang releases Taiyang exterior excess internally and scatters cold-fluid in the Sanjiao externally; it is a potent sweating method, sharing fame with Da Qing Long Tang. One treats heat-agitation of Taiyang exterior excess, the other treats cold-fluid of Taiyang exterior excess.

[Collected Annotations] Cheng Zhi stated: This clarifies that when Shanghan exterior signs are unresolved and water accumulates in the epigastrium, the method is to scatter cold and purge fluid.

Wang Hu stated: Ming Lilun states: Qing Long (Blue Dragon) treats diseases caused by both wind and cold. If Shanghan exterior is unresolved, Mahuang can induce sweating; if Fengzhong (Wind Strike) exterior is unresolved, Guizhi can disperse. Because the exterior is unresolved and compounded by fluid retention in the epigastrium, neither of the previous two decoctions can disperse it; only Xiao Qing Long Tang can eliminate exterior and interior pathogens.

Formula: Xiao Qing Long Tang (Minor Blue Dragon Decoction)
Mahuang (Ephedra Herb, nodes removed, 3 liang), Shaoyao (Peony Root, 3 liang), Wuweizi (Schisandra Fruit, half sheng), Ganjiang (Dried Ginger, 2 liang), Gancao (Licorice Root, prepared, 3 liang), Banxia (Pinellia Tuber, washed, half sheng), Guizhi (Cinnamon Twig, 3 liang), Xixin (Asarum Root, 3 liang).
The above eight ingredients are boiled with ten sheng of water. First boil Mahuang, reducing by two sheng, remove foam, add other herbs, boil until three sheng remain, strain, and take one sheng warm.
Modifications: If thirsty, remove Banxia, add Gualougen (Trichosanthes Root, 3 liang). If dysphagic, remove Mahuang, add one Fuzi (Prepared Aconite Root, processed). If difficult urination with lower abdominal fullness, remove Mahuang, add Fuling (Poria, 4 liang). If wheezing, remove Mahuang, add Xingren (Apricot Seed, half sheng, peeled and tip removed). If slight diarrhea, remove Mahuang, add Raohua (Edelweiss Flower, amount equal to a chicken egg, roasted until red).

[Note] Adding Raohua amount equal to a chicken egg, roasted until red, is likely a transcription error. Raohua belongs to the Yuanhua (Genkwa Flower) category. Used to attack water retention, its power is extremely harsh; five fen can cause dozens of bowel movements. How could one use a chicken-egg-sized dose of Raohua for treating mild diarrhea due to retained fluid? It seems it should be changed to adding Fuling (Poria, 4 liang).

[Formula Analysis] There are two types of fluid retention in Taiyang: one is Wind Strike with sweating, representing exterior deficiency, treated by Wuling San (Five-Ingredient Powder with Poria); the other is Shanghan without sweating, representing exterior excess, treated by Xiao Qing Long Tang. Due to exterior excess and absence of sweating, Mahuang and Guizhi formulas are combined to release the exterior. Dazao (Jujube) is removed because its nature is cloying; Xingren is removed because there is no wheezing (if wheezing exists, add it back); Shengjiang is removed because Ganjiang is present (if vomiting exists, add it back). Ganjiang and Xixin are assistants, extremely warm and dispersing, enabling cold and water to resolve via sweating. Banxia is an assistant to drive out phlegm-fluid and clear remaining fluid. Wuweizi is an assistant to astringe Lung Qi and conserve depleted Qi. If thirsty, remove Banxia and add Huafen (Trichosanthes Root) to avoid dryness and generate fluids. If slight diarrhea, dysphagia, difficulty urinating, or lower abdominal fullness, remove Mahuang to move from exterior to interior. Add Fuzi to scatter cold, stopping dysphagia; add Fuling to promote urination, stopping slight diarrhea and removing lower abdominal fullness. This formula, along with Yuebi Tang, treats water-fluid overflowing to the exterior causing abdominal distension and edema, requiring sweating to resolve externally, achieving success readily. Yuebi Tang treats cases with heat, using Shigao as the sovereign herb to disperse Yang-water; Xiao Qing Long Tang treats cases with cold, using Jiang (Ginger) and Gui (Cinnamon) as assistants to disperse Yin-water.

[Collected Explanations] Ke Qin stated: Both Qing Long decoctions treat syndromes involving both exterior and interior, using a dual-resolution method. Da Qing Long Tang treats interior heat, while Xiao Qing Long Tang treats interior cold. Thus, exterior-releasing herbs are the same, but interior-treating herbs differ. Like Wuling San, this treats unresolved exterior with fluid retention in the epigastrium. However, Wuling San treats stagnant water that does not move, focusing on leaching and draining to promote urination and slightly inducing sweating to send water downward; this formula treats dynamic water that does not stay, employing acrid-warm herbs to scatter water and vigorously inducing sweating to send water outward. Zhang Zhongjing's methods for releasing exterior and promoting urination are profound and divine.

Zhao Liang stated: For Yi Yin (Overflowing Drink) syndrome, Jin Gui Yao Lue says: "It should be treated by inducing sweating," using Xiao Qing Long Tang. Water-fluid overflowing to the exterior makes Ying and Wei completely unfavorable. One must imitate the method for Shanghan affecting both Ying and Wei, inducing sweating to scatter water. Only then will Ying and Wei circulate, meridians unblock, and water throughout the body dissipate. Xiao Qing Long Tang is the primary choice, from which others can be inferred.

In Shanghan, if there is fluid retention in the heart region, presenting with cough and slight wheezing, fever but no thirst, and after taking medicine, the patient feels thirsty, this indicates cold is departing and resolution is desired; Xiao Qing Long Tang is indicated.

[Note] The six characters "Xiao Qing Long Tang is indicated" should appear below "fever but no thirst" to align with the meaning of "after taking medicine, feels thirsty." How could one administer Xiao Qing Long Tang after cold has departed and resolution is desired?

[Annotation] In Shanghan, fluid retention in the epigastrium, cough, slight wheezing, fever without thirst, indicates external cold pathogen and internal cold-fluid retention. Xiao Qing Long Tang should be used to resolve both. After taking the medicine and resolving via sweating, if the patient feels thirsty, it is thirst due to interior dryness after cold departure, not thirst due to untransformed retained fluid before sweating. Hence it is said: "Cold is departing, resolution is desired." One should give small amounts of water to moisten dryness, allowing the Stomach to harmonize and heal naturally.

[Collected Annotations] Cheng Wuji stated: Cough and slight wheezing indicate cold-water attacking the Lung. Fever without thirst indicates the exterior syndrome is not yet resolved. Giving Xiao Qing Long Tang releases the exterior and scatters water. Feeling thirsty after taking the medicine indicates interior warmth returning and water dispersion, signaling resolution.

Fang Youzhi stated: Fever without thirst indicates cold dominance. Thus, feeling thirsty after taking medicine signifies cold departure and desired resolution. The general idea is similar to the previous clause, so the treatment is the same.

Cheng Zhi stated: This clarifies that when cold-water is unresolved, Xiao Qing Long Tang is appropriate. Fluid retention in the epigastrium, cold in the diaphragm above, causes wheezing and cough. Fever without thirst, followed by thirst after taking medicine, indicates cold-water has resolved. This method for resolving fluid retention uses Xiao Qing Long Tang; it does not mean continuing Xiao Qing Long Tang after resolution.

Zhang Lu stated: Wind-cold carrying fluid retention, with disease in the exterior, results in no thirst. Thirst after taking medicine is a sign of cold departure, fluid injury, and desired resolution. Thus, even with thirst, medication is not necessary; one should wait quietly for fluid recovery. Cough and slight wheezing indicate upward reversal of fluid retention. Now that water is gone and thirst exists, it differs from thirst caused by water reversal. In modern editions, "Xiao Qing Long Tang is indicated" appearing below "cold is departing, resolution is desired" is a misplaced text error.

Wang Hu stated: The previous clause mentions thirst before taking medicine, due to water stagnation preventing fluid transformation. This clause mentions thirst after taking medicine, due to fluid loss after sweating. Since the thirst is different, how can the same medicine, Xiao Qing Long Tang, be used? It should be placed above "after taking medicine," which is evident.

After purgation and subsequent sweating, chills and trembling occur, with a micro-fine pulse. This is because both interior and exterior are deficient.

[Annotation] Sweating should precede purgation. Now, purgation was performed first, followed by sweating, resulting in chills and trembling. A micro-fine pulse indicates deficiency in both exterior and interior. This occurs because improper purgation damages interior guarding Yang, causing a micro-fine pulse; improper sweating damages exterior securing Yang, causing chills and trembling.

[Collected Annotations] Zheng Zhongguang stated: Treating Shanghan with sweating first and purgation second is the standard method. If exterior pathogens remain after purgation, and sweating is reluctantly induced again, although pathogens leave, both interior and exterior become deficient, leading to fine pulse and chills, causing greater damage.

After purgation and subsequent sweating, if the patient experiences irritability and insomnia during the day but quietness at night, without vomiting or thirst, no exterior syndrome, a sunken-micro pulse, and no significant fever, Gan Jiang Fu Zi Tang (Dried Ginger and Aconite Decoction) is indicated.

[Annotation] This elaborates on the pulse and signs from the previous clause to determine treatment. Purgation weakened the interior, and subsequent sweating weakened the exterior, leading to dual deficiency of Yin and Yang, with Yang having no anchor. Quietness at night, no vomiting or thirst, indicates no interior Yang syndrome. No exterior syndrome, no significant fever, and sunken-micro pulse indicate no exterior Yang syndrome. With no Yang in exterior and interior, and pure Yin inside and out, the only symptom is daytime irritability and insomnia, a false Yang syndrome. This represents solitary Yin governing itself in the Yin division and lone Yang disturbing itself in the Yang division, not overcoming each other but separating. Thus, Gan Jiang Fu Zi Tang is used to assist Yang to match Yin. Although Yin is abundant, it does not repel Yang; Yang is weak and lacks anchorage.

[Collected Annotations] Yu Chang stated: The previous clause only mentioned chills and micro-fine pulse, not specifying the disease, as deficiency syndromes vary. However, chills with micro-fine pulse reveal Yang deficiency. If daytime irritability and insomnia occur, it indicates disturbance by deficient Yang. Nighttime quietness, no vomiting or thirst, shows deficient Yang disturbance is not accompanied by exterior pathogens. Sunken-micro pulse and no significant fever indicate irritability is a sign of Yang collapse; Gan Jiang and Fu Zi are essential. From this, one can infer that quietness during the day and irritability at night indicates Yin disease without Yang involvement.

Cheng Yingmao stated: After purgation and sweating, daytime irritability and insomnia represent disturbance by deficient Yang, showing false heat externally. Nighttime quietness, no vomiting or thirst, no exterior syndrome, sunken-micro pulse, and no significant fever indicate Yin Qi governs alone, revealing true cold internally. Gan Jiang Fu Zi Tang should be used to return Yang directly from Yin. One should not hesitate due to the false heat of daytime irritability.

Formula: Gan Jiang Fu Zi Tang (Dried Ginger and Aconite Decoction)
Ganjiang (Dried Ginger, 1 liang), Fuzi (Prepared Aconite Root, peeled, raw, broken into eight pieces, 1 piece).
The above two ingredients are boiled with three sheng of water, reduced to one sheng, strained, and taken in one dose.

If sweating or purgation fails to resolve the disease, and irritability persists, Fuling Sini Tang (Poria Four-Reverse Decoction) is indicated.

[Annotation] This continues from the previous clause. Sweating followed by purgation is not contrary to method; if the disease should resolve but does not, and irritability arises, the treatment must be distinguished. Both sweating and purgation were excessive, causing dual deficiency of exterior and interior, with Yin abundance repelling Yang, leading to disturbance day and night. Sini Tang (Four-Reverse Decoction) should be used to strengthen Yang and overcome Yin, adding Fuling to suppress Yin pathogens and Ren Shen to support healthy Qi. Thus, Yang grows, Yin diminishes, healthy Qi returns, pathogens retreat, the disease resolves, and irritability calms. In Da Qing Long Tang syndrome, irritability without sweating is due to unrest before sweating/purgation, belonging to excess; in this clause, irritability due to unresolved disease after sweating/purgation belongs to deficiency. The difference between floating-tight and sunken-micro pulses should distinguish them to prevent misguidance, hence the earnest explanation.

[Collected Annotations] Wang Hu stated: In Shanghan, sweating and purgation should stop irritability and resolve the disease. If irritability is due to Yin abundance, forcing sweating leads to exterior looseness and Yang collapse; subsequent purgation leads to interior deficiency and Yin collapse. Defensive Yang loses protection, Nutritive Yin becomes empty internally, pathogens remain unresolved, generating new irritability. This is false irritability and restlessness, a sign of false heat. Only warming and tonifying are appropriate, not dispersing pathogens; thus, Fuling Sini Tang is indicated.

Formula: Fuling Sini Tang (Poria Four-Reverse Decoction)
Fuling (Poria, 6 liang), Renshen (Ginseng Root, 1 liang), Gancao (Licorice Root, prepared, 2 liang), Ganjiang (Dried Ginger, 1.5 liang), Fuzi (Prepared Aconite Root, raw, peeled, broken into eight pieces, 1 piece).
The above five ingredients are boiled with five sheng of water, reduced to three sheng, strained, and taken 0.7 sheng warm, three times daily.

[Formula Analysis] Exterior and interior diseases, if treated improperly—first excessive sweating then excessive purgation, or purgation followed by sweating—mistakes compound mistakes, transforming into complicated diseases (Huai Bing). If the person has abundant Yang and transforms toward heat, it shifts to the Three Yang stages; if Yang is deficient and transforms toward cold, it attaches to the Three Yin stages. These two clauses regarding irritability are both complicated diseases. Irritability occurs in all Six Meridians but is common in Taiyang and Shaoyin. Taiyang is the mark of True Yin, and Shaoyin is the root of True Yang. Irritability before sweating/purgation mostly belongs to Yang, with solid-large pulse and heat-thirst symptoms; irritability is Yang abundance, restlessness is Yin deficiency. Irritability after sweating/purgation mostly belongs to Yin, with sunken-micro pulse and sweating/cold limbs symptoms; irritability is Yang deficiency, restlessness is Yin abundance. Purging then sweating is contrary to method. No significant exterior heat, no interior vomiting/thirst, seemingly Yin-Yang self-harmonizing, but actually Yang deficiency and Yin abundance. Thus, deficient Yang disturbs the Yang division, causing daytime irritability and insomnia; abundant Yin governs the Yin division alone, causing nighttime quietness. Sunken-micro pulse indicates True Yang about to collapse with irritability. Gan Jiang and Fu Zi are used to strengthen Yang to match Yin. Ginger and Aconite are Yang within Yang; raw usage increases potency, omitting Gan Cao increases momentum, making it more potent than Sini Tang. Urgent rescue is needed for separation. Sweating then purgation follows proper method; if disease remains unresolved and irritability increases day and night, it is also Yin abundance repelling Yang. Fuling Sini Tang is used to suppress Yin and return Yang. Fuling absorbs Taihe Qi transformation, attacks water pathogens without damaging Yang, serving as the sovereign herb. Ren Shen generates Qi from nothing, connects blood vessels at the verge of collapse, serving as an assistant. Ren Shen benefits Qi and augments Fire when combined with Jiang and Fu; Jiang and Fu benefit Yang and drain Yin when combined with Fuling. Harmonized with Gan Cao, it is milder than Sini Tang, suitable for repulsion. Removing Gan Cao and adding Renshen and Fuling distinguishes urgency and slackness. Such is the subtlety of Zhang Zhongjing's formula usage.