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Treating Taiyang disease that has persisted for eight or nine days. (The pathogen has passed beyond the primary stage.) The symptoms resemble malaria. (Different from the alternating chills and fever of Shaoyang disease; hence described as "resembling" malaria.)
There is fever and aversion to cold. (This reveals the true nature of Taiyang channel pathology.) The heat sensation is more prominent than the cold sensation. (Taiyang is governed by Yang Qi. Prominent heat indicates that the host's Yang is prevailing over the invading pathogen, suggesting the disease is about to resolve.)
In typical cases, the chills and fever occur at fixed intervals. However, in this condition, they may occur two or three times without a fixed pattern. This indicates that the Taiyang Yang Qi still holds authority, creating an appearance where the pathogen cannot remain contained.)
If the pulse is slightly slow and relaxed. (Slightness indicates the decline of the pathogen; relaxation indicates the recovery of healthy Qi.) This signifies impending recovery. (From the beginning to here constitutes one section. It states that the pathogen is light and wishes to resolve spontaneously, allowing for healing without medication.)
If the pulse is slight and there is aversion to cold. (In the previous section, "slight" was contrasted with "relaxed." Here, only "slight" is mentioned, implying that while the pathogen declines, the healthy Qi also weakens.)
(This is a sign of the pathogen prevailing and healthy Qi being defeated. If cold predominates over heat, it signals pathogenic victory and healthy defeat; how much more so if there is only cold without heat? This indicates a deficiency of both Yin and Yang.)
Aversion to cold on the back. (This reflects a Yin-pattern manifestation.)
The Master did not prescribe a formula. (Because the condition is complex, hasty medication is inappropriate.)
Normally, there should not be a flushed complexion. The fact that a flushed color appears now is because, although both Yin and Yang are deficient, the Yang Qi is still able to stir up stagnant heat and manifest it on the face.)
The disease has not yet fully resolved. (The word "wishes" or "about to" is significant. Taiyang is governed by Yang Qi. Fortunately, the Yang Qi has not yet collapsed and can still drive the pathogen that has lingered past its original stage to manifest on the face. Regrettably, the Yang Qi is already deficient and cannot freely induce a slight sweating to resolve the illness.)
Because slight sweating cannot be achieved, the body will likely itch. (Elaborating on the meaning of "not yet resolved," distinguishing the facial flush and corroborating with generalized pruritus.) Guizhi Mahuang Ge Ban Tang (Cinnamon Twig and Ephedra Half-Dose Decoction) is appropriate. (The pathogen desires to exit but cannot do so independently; thus, this formula is borrowed to assist it. From "flushed face" to here constitutes another section. The entire passage centers on the phrase "Taiyang disease persisting for eight or nine days," addressing diseases that have passed beyond their initial stage. It is divided into three sections below, which follow sequentially and peel back layers of complexity. Since the commentary on Shanghan Lun began, no one has discussed this in thousands of years; today, I specifically annotate it in detail.)
Guizhi (Cinnamomi Ramulus) (1 liang 16 zhu), Shaoyao (Paeoniae Radix Alba) (1 liang), Shengjiang (Zingiberis Rhizoma Recens) (1 liang), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (1 liang, honey-fried), Mahuang (Ephedrae Herba) (1 liang, nodes removed).
Take these seven ingredients, add five sheng of water, first boil Mahuang for one or two boils, remove the foam on the surface, then add the remaining herbs. Boil until one sheng eight he remains, strain, and take six he warm.
Verse:
Guizhi one liang sixteen zhu,
Gancao, Shaoyao, Shengjiang, Mahuang each one liang match.
Xingren twenty-four seeds, Zao four fruits,
Flushed face and itching both dispelled.
Commentary by Wei: The Neitai Fangyi records this formula as the original dosage of Guizhi Tang, plus Sanliang of Mahuang and seventy Xingren, decocted in plain water to induce slight sweating. Xu Shimiao believed this resolves exterior conditions that are neither deficient nor excess.