治伤寒六七日大下后。寸脉沉而迟。手足厥逆。下部脉不至。咽喉不利。吐脓
不止者。为难治。此方主之。
麻黄（一两半） 升麻（一两半） 当归（一两） 知母（十八铢） 黄芩（十八铢） 葳
蕤（十八铢） 石膏（六铢） 白术（六铢） 干姜（六铢） 芍药（六铢） 桂枝（六铢）
茯苓（六铢） 甘草（六铢） 天冬（六铢）
上十四味。以水一斗。先煮麻黄一两沸。去上沫。内诸药。煮取三升。去滓。分温三服。
相
歌曰 两半麻升一两归。六铢苓术芍冬根据。膏姜桂草同分两。十八铢兮芩母萎。（一本。
麻
冬。无天门冬。余俱同。）
张令韶曰。伤寒六七日。乃由阴出阳之期也。粗工以为大热不解而大下之。虚其阳气。
故寸脉沉迟。手足厥逆也。下为阴。下部脉不至。阴虚不能上通于阳也。咽喉不利吐脓血。
阳热在上也。泄利不止。阴寒在下也。阴阳两不相接。故为难治。与升麻、麻黄、桂枝以升
阳。而复以茯苓、白术、干姜调其下利。与当归、白芍、天冬、葳蕤以止脓血。与知母、黄
芩、甘草以利咽喉。石膏性重。引麻黄、升麻、桂枝直从里阴而透达于肌表。则阳气下行。
阴气上升。阴阳和而汗出矣。此方药虽驳杂。意义深长。学人宜潜心细玩可也。
Treatment of Taiyang disease (Taiyang disease) after six or seven days, following a severe purgation. The Cun pulse (Cun pulse) is deep and slow. There is cold reversal in the hands and feet. The Chi pulse (Chi pulse) at the lower position is imperceptible. There is obstruction in the throat and continuous expectoration of pus and blood. This condition is difficult to treat. This formula is indicated for this syndrome.
Mahuang (Ephedrae Herba, 麻黄) [1.5 liang], Shengma (Cimicifugae Rhizoma, 升麻) [1.5 liang], Danggui (Angelicae Sinensis Radix, 当归) [1 liang], Zhimu (Anemarrhenae Rhizoma, 知母) [18 zhu], Huangqin (Scutellariae Radix, 黄芩) [18 zhu], Weirui (Polygonati Odorati Rhizoma, 玉竹) [18 zhu], Shigao (Gypsum Fibrosum, 石膏) [6 zhu], Baizhu (Atractylodis Macrocephalae Rhizoma, 白术) [6 zhu], Ganjiang (Zingiberis Rhizoma, 干姜) [6 zhu], Shaoyao (Paeoniae Radix Alba, 芍药) [6 zhu], Guizhi (Cinnamomi Ramulus, 桂枝) [6 zhu], Fuling (Poria, 茯苓) [6 zhu], Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) [6 zhu], Tiandong (Asparagi Radix, 天冬) [6 zhu].
The above fourteen ingredients are decocted with one dou of water. First, boil Mahuang until it boils once or twice, then remove the foam on the surface. Add the remaining herbs, and decoct to obtain three sheng of liquid. Strain out the dregs. Divide into three doses and take warm.
The song states: "One and half liang each of Mahuang and Shengma, one liang of Danggui; Six zhu each of Fuling, Baizhu, Shaoyao, and Tiandong form the basis; Shigao, Ganjiang, Guizhi, and Gancao share equal weight; Eighteen zhu each are Huangqin, Zhimu, and Weirui." (Another version omits Tiandong, while the rest remain the same.)
Zhanglingshao stated: Taiyang disease occurring after six or seven days marks the period when the pathogen transitions from the Yin meridians to the Yang meridians. Incompetent physicians, mistaking persistent high fever for excess heat, administer severe purgatives, thereby damaging the Yang qi. Consequently, the Cun pulse becomes deep and slow, and there is cold reversal in the extremities. The lower portion corresponds to Yin; the absence of the Chi pulse indicates that Yin deficiency fails to ascend and connect with Yang. Obstruction in the throat and expectoration of pus and blood indicate Yang heat located above. Continuous diarrhea indicates Yin cold located below. The mutual disconnection of Yin and Yang makes this condition difficult to treat. Shengma, Mahuang, and Guizhi are used to raise Yang qi, while Fuling, Baizhu, and Ganjiang are employed to regulate diarrhea. Danggui, Shaoyao, Tiandong, and Weirui are used to stop the expectoration of pus and blood. Zhimu, Huangqin, and Gancao are used to benefit the throat. Shigao, being heavy in nature, guides Mahuang, Shengma, and Guizhi to penetrate directly from the interior Yin to the muscle and skin surface. Thus, Yang qi descends and Yin qi ascends; when Yin and Yang harmonize, sweating occurs. Although the composition of this formula appears complex, its therapeutic significance is profound. Students should study it with careful attention and contemplation.