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汗麻黄汤主之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
发热无汗脉浮紧而身疼痛此麻黄汤证失不早服至八九日不解而表证仍在此当发汗宜麻黄汤若卫气闭塞泄之不透服药
之后病仅微除其人犹觉烦躁昏晕未能全解剧者卫郁升突必至鼻衄衄乃尽解所以然者久病失解阳气之郁遏太重故也
脉浮紧者法当身疼痛宜以汗解之假令脉尺中迟者不可发汗何以知之然以营气不足血少故也（太阳入少阴去路）
卫候于寸营候于尺尺中迟者营气不足以肝脾阳虚而血少故也汗泄营中温气则生亡阳诸变故不可发汗然者答辞与难经
然字同义
太阳病风则桂枝寒则麻黄乃有风寒双感之证爰垂桂麻各半之方营卫兼发风寒俱去脉法风则伤卫寒则伤营营卫俱伤当
发其汗此之谓也若夫风多而寒少则有桂二麻一之剂仍是各半法度因病而小变者也至于内热微而表寒轻桂麻各半之法不相
合矣用桂枝之二越婢之一微宣表寒而轻清里热此颇似大青龙法而实亦不同义更妙也则桂麻各半所以继桂麻二方之后桂枝
越婢开青龙一方之先也
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浮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人不得小汗出身必痒宜桂枝麻黄各半汤（清与圊通）
如疟状者营阴卫阳之相争阳郁于内则发热阴郁于中则恶寒盖风寒双感营卫俱伤寒伤营则营欲泄风伤卫则卫欲闭营欲
泄而不能泄则敛束卫气而为寒卫欲闭而不能闭则遏闭营血而为热及其卫衰而营血外发又束卫气营衰而卫气内敛又遏营血
此先中于风而后伤于寒营泄卫闭彼此交争故寒热往来形状如疟也太阳病得之八九日之久证如疟状发热恶寒发热多而恶寒
少此风多于寒卫伤颇重而营伤颇轻如其寒热不能频作是后章桂二麻一之证也若其人上不呕下不泄则中气未伤寒热一日二
三度发则正气颇旺频与邪争脉微和缓则邪气渐退是为欲愈无用治也若其脉微弱而又恶寒者此卫阳营阴之俱虚盖营虚则脉
微卫虚则恶寒（后章此无阳也即解此句）虚故不可更以他药发汗吐下也如其发热脉浮是后章桂枝越婢之证也若外不恶寒
而面上反有热色者是阳气蒸发欲从外解而表寒郁迫未欲解也使得小汗略出则阳气通达面无热色矣以其正气颇虚不得小汗
阳郁皮腠莫之能通是其身必当发痒解之以桂枝麻黄各半汤 营卫俱伤前后四章三证而于首章内一证三变伏下三章之线下
三章分承首章而发明之
太阳病，脉象浮紧，无汗，发热，身体疼痛，经过八九日仍未解除，表证依然存在，此时应当发汗，主治方剂为麻黄汤。服药后病情仅轻微缓解，患者感到心烦、眼睛昏花；病情严重的，必然会出现鼻出血，通过鼻出血才能使病邪解除。之所以这样，是因为阳气郁遏过重的缘故。
发热、无汗、脉象浮紧且身体疼痛，这是麻黄汤证。如果未能及时服药，拖延至八九日仍不解除，而表证依旧存在，此时应当发汗，适宜使用麻黄汤。如果卫气闭塞严重，药力无法透彻宣泄，服药之后病情仅轻微缓解，患者仍然觉得烦躁、昏晕，未能完全解除；病情严重的，因卫气郁结欲升发而受阻，必然导致鼻衄（鼻出血），只有鼻衄才能彻底解除病邪。之所以这样，是因为久病失治，阳气郁遏太重的缘故。
脉象浮紧的，按照法度应当出现身体疼痛，适宜用发汗的方法解除。假如尺部脉搏迟缓的，不可发汗。为什么知道这一点呢？因为营气不足、血液亏少的缘故。（注：此处指太阳经传入少阴的路径）寸口脉候卫气，尺部脉候营气。尺部脉迟缓，说明营气不足，是由于肝脾阳气虚弱而导致血少。发汗会泄出营中的温气，从而产生亡阳等变证，所以不可发汗。“然”字在此处的用法与《难经》中“然”字的含义相同，表示解释原因。
太阳病，受风邪则适用桂枝汤，受寒邪则适用麻黄汤。如果有风寒同时感受的情况，于是创立了桂枝麻黄各半汤这一方剂，旨在同时调和营卫，使风寒之邪俱去。脉法认为：风邪伤卫气，寒邪伤营气。若营卫俱伤，就应当发汗，说的就是这种情况。如果是风邪重而寒邪轻，则有桂枝汤二分、麻黄汤一分的剂量，这仍然是各半汤的法度，只是因病势略有变化而稍作调整罢了。至于内热轻微而表寒轻浅的情况，桂枝麻黄各半汤的方法就不相合了。此时应使用桂枝汤二分、越婢汤一分，微微宣散表寒并轻清里热，这种方法颇似大青龙汤的法度，但实际义理又有所不同，更为精妙。因此，桂枝麻黄各半汤是继桂枝汤、麻黄汤之后的方剂，而桂枝汤与越婢汤的组合则是开启大青龙汤一方之先河。
太阳病，患病八九日，症状像疟疾一样，发热恶寒交替，热多寒少。患者没有呕吐，大小便基本正常，一天发作两三次。如果脉象浮缓，这是病情将要痊愈的迹象。如果脉象微弱且恶寒，这是阴阳俱虚，不可再用发汗、攻下或催吐的方法。如果面色反而发红，说明病未解除，因为患者未能出一点小汗，身体必然发痒，适宜使用桂枝麻黄各半汤（“清”与“圊”通假，指厕所/排便）。
所谓“像疟疾一样”，是指营阴与卫阳相互争斗。阳气郁结在体内则发热，阴气郁结在中焦则恶寒。寒邪伤及营气，营气想要宣泄；风邪伤及卫气，卫气想要闭固。营气想宣泄而不能宣泄，就会收敛束缚卫气从而表现为寒；卫气想闭固而不能闭固，就会遏制闭阻营血从而表现为热。等到卫气衰弱而营血外发时，又会束住卫气；营气衰弱而卫气内敛时，又会遏止营血。这是因为先中风邪而后受寒邪，营气欲泄而卫气欲闭，彼此交争，所以寒热往来，形状像疟疾。
太阳病患病八九日之久，证候如疟疾状，发热恶寒，热多寒少，这说明风邪多于寒邪，卫气受伤较重而营气受伤较轻。如果其寒热不能频繁发作，那就是下一章提到的桂二麻一证的证候。如果患者上不呕吐，下不大便不通，说明中气未伤。伤寒一日发作两三次，说明正气颇旺，频繁与邪气抗争。脉象微和缓，说明邪气逐渐消退，这是病情将要痊愈，无需治疗。如果脉象微弱而又恶寒，这是卫阳和营阴都虚弱。营虚则脉微，卫虚则恶寒（下一章所说的“此无阳也”即解释这句话）。因为虚，所以不可再用其他药物进行发汗、催吐或攻下。如果发热且脉浮，那是下一章桂枝越婢汤的证候。如果体表不恶寒而面部反而有热色，这是阳气蒸发欲从体表解除，但因表寒郁迫而未能解除。如果能出一点小汗，阳气通达，面部的热色就会消失。因为正气颇虚，不能出小汗，阳气郁结在皮肤腠理之间无法通畅，所以身体必然发痒。用桂枝麻黄各半汤来解除它。
营卫俱伤，前后四章共有三个证候，而在第一章内一个证候包含三种变化，伏笔引出后三章的内容；后三章分别承接第一章而加以阐发。
Taiyang disease (Disease of the Taiyang channel) presents with a floating and tight pulse, absence of sweating, fever, and body pain. After eight or nine days, if the condition remains unresolved and the exterior syndrome persists, diaphoresis (inducing sweating to release the exterior) should be employed, primarily using Mahuang Tang (Ephedra Decoction). After taking the medicine, the symptoms may only slightly subside; the patient may feel irritable and experience blurred vision. In severe cases, epistaxis (nosebleed) will inevitably occur, and the disease will resolve through this bleeding. This occurs because the Yang Qi is excessively constrained.
Fever, absence of sweating, a floating and tight pulse, and body pain constitute the Mahuang Tang syndrome. If treatment is not administered promptly and the condition persists for eight or nine days without resolution, yet the exterior syndrome remains, diaphoresis is indicated, and Mahuang Tang is appropriate. If Wei Qi (Defensive Qi) is severely obstructed and the therapeutic effect cannot penetrate thoroughly, after taking the medicine, the illness may only slightly improve, and the patient may still feel restless and dizzy, failing to fully recover. In severe cases, due to the constraint of Wei Qi attempting to ascend but being blocked, epistaxis will inevitably occur, and the disease will only completely resolve through this bleeding. This happens because prolonged untreated illness leads to excessive constraint of Yang Qi.
A floating and tight pulse typically indicates body pain and should be treated by inducing sweating. However, if the pulse at the Chi position (cubital fossa/wrist area corresponding to Kidney/Yin) is slow, diaphoresis is contraindicated. How do we know this? Because Ying Qi (Nutritive Qi) is insufficient and Blood is scant. (Note: This refers to the pathway from Taiyang to Shaoyin). The Cun position (radial styloid process/wrist area corresponding to Lung/Yang) reflects Wei Qi, while the Chi position reflects Ying Qi. A slow pulse at the Chi position indicates insufficient Ying Qi, caused by deficiency of Liver and Spleen Yang leading to blood depletion. Sweating depletes the warming Qi within Ying Qi, potentially causing various complications such as collapse of Yang. Therefore, diaphoresis is contraindicated. The character "Ran" (Thus/Therefore) here carries the same meaning as in the *Nanjing* (Classic of Difficult Issues), serving to explain the reason.
In Taiyang disease, wind pathogen injury calls for Guizhi Tang (Cinnamon Twig Decoction), while cold pathogen injury calls for Mahuang Tang. For cases where both wind and cold are contracted simultaneously, the Guizhi Mahuang Ge Ban Tang (Guizhi and Mahuang Half-Combined Decoction) was formulated to simultaneously harmonize Ying and Wei, expelling both wind and cold pathogens. Pulse diagnosis states: Wind injures Wei Qi, Cold injures Ying Qi. When both Ying and Wei are injured, diaphoresis is required; this is what is meant. If wind is predominant and cold is slight, a formula with two parts Guizhi Tang and one part Mahuang Tang is used. This still follows the principle of the half-combined method, merely adjusted slightly according to the specific pathology. Regarding cases with mild interior heat and light exterior cold, the Guizhi Mahuang Ge Ban Tang method is not suitable. Instead, two parts Guizhi Tang and one part Yuespi Tang (Yue Bi Decoction) should be used to gently diffuse exterior cold and lightly clear interior heat. This approach resembles the method of Da Qing Long Tang (Major Blue Dragon Decoction) but differs in principle, offering a more subtle efficacy. Thus, Guizhi Mahuang Ge Ban Tang succeeds the Guizhi and Mahuang formulas, while the combination of Guizhi Tang and Yuespi Tang precedes the Da Qing Long Tang formula.
Taiyang disease lasting eight or nine days may resemble malaria, with alternating fever and aversion to cold, where fever predominates over chills. The patient does not vomit, and bowel/bladder functions are relatively normal, with episodes occurring two or three times a day. If the pulse is floating and slow, it indicates the disease is about to heal. If the pulse is faint and there is aversion to cold, this indicates deficiency of both Yin and Yang, and diaphoresis, purgation, or emesis must not be used. If the face appears reddish, the disease has not resolved because the patient failed to produce even a slight sweat, leading to itching of the skin. Guizhi Mahuang Ge Ban Tang is indicated. ("Qing" 清 is interchangeable with "Qing" 圊, referring to defecation).
The description "resembling malaria" refers to the struggle between Ying Yin (Nutritive Yin) and Wei Yang (Defensive Yang). When Yang Qi is constrained internally, fever occurs; when Yin Qi is constrained centrally, aversion to cold occurs. Cold injuring Ying Qi causes Ying to desire release; wind injuring Wei Qi causes Wei to desire closure. Ying desires release but cannot achieve it, thus constricting Wei Qi and manifesting as cold; Wei desires closure but cannot achieve it, thus restraining Ying Blood and manifesting as heat. When Wei Qi declines and Ying Blood attempts to emerge externally, it constrains Wei Qi; when Ying Qi declines and Wei Qi attempts to retract internally, it restrains Ying Blood. This occurs because wind was contracted first, followed by cold; Ying desires release while Wei desires closure, resulting in mutual contention, hence the alternating chills and fever resembling malaria.
After eight or nine days of Taiyang disease, presenting like malaria with fever and chills, where fever exceeds chills, it indicates wind is greater than cold, with significant Wei injury and mild Ying injury. If the chills and fever do not occur frequently, it corresponds to the Guizhi-two-Mahuang-one syndrome described in the next chapter. If the patient neither vomits nor suffers constipation, the Middle Jiao Qi is unharmed. Episodes occurring two or three times a day indicate robust Zheng Qi (Upright Qi) frequently contending with pathogens. A faint and moderate pulse suggests pathogens are gradually receding, indicating impending recovery without need for treatment. If the pulse is faint and weak accompanied by aversion to cold, this indicates deficiency of both Wei Yang and Ying Yin. Ying deficiency leads to a faint pulse; Wei deficiency leads to aversion to cold (as explained by "This is Wu Yang Ye" - No Yang exists - in the next chapter). Due to deficiency, other methods like sweating, vomiting, or purging must not be used. If there is fever and a floating pulse, it corresponds to the Guizhi Yuespi syndrome in the next chapter. If there is no external aversion to cold but the face shows redness, it indicates Yang Qi is evaporating and attempting to resolve from the exterior, but is blocked by exterior cold constraint. If a slight sweat could be produced, Yang Qi would flow freely, and facial redness would disappear. Because Zheng Qi is deficient and unable to produce sweat, Yang Qi is constrained in the skin and pores, preventing free flow, thus causing itching. Guizhi Mahuang Ge Ban Tang is used to resolve this.
Ying and Wei are both injured. Across the preceding four chapters, there are three syndromes. The first chapter contains one syndrome with three variations, foreshadowing the content of the subsequent three chapters; the latter three chapters respectively follow up on and elaborate upon the first chapter.