解散。设有下证。则宜渗利小水为主。若误用正汗正下法治之。便有如上变证也。
伤寒发热头痛。微汗出发汗则不识人。薰之则喘不得小便。心腹满。下之短气。小便难。头痛项强。加以温针则衄。
阴虚多火之人。才感外邪。便发热头痛倍常。即辛凉发散药中。便宜保养阴血。设用辛热正发汗药。津液立枯。邪
火弥炽。遂致烦乱不识人也。若误薰。误下温针。宁无若是变证乎。
以上寒伤营。
寸口脉浮而紧。浮则为风。紧则为寒。风则伤卫。寒则伤营。营卫俱病骨节烦疼。当发其汗也。
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。以真武汤救之。
宗印无后六字。世本作大青龙汤主之。今根据尚论改正。○天地郁蒸。得雨则和人身烦燥。得汗则解。大青龙正为其
身中原。有微汗。寒邪郁闭不能透出肌表。出是而发烦躁。与麻黄汤证之。无汗者迥殊。故用之发汗。以解其烦躁也。
所以暴病。便见烦躁。信为营卫俱伤无疑。此方原为不得汗者取汗。若汗出之烦躁。全非郁蒸之比。其不籍汗解甚明。
加以恶风脉微弱。则是少阴无阳之证。若脉浮弱汗出恶风。而不烦躁。即是太阳中风之证。皆与此汤不相涉也。误用此
汤。宁不致厥逆惕 。而速其阳之亡耶。按误服大青龙亡阳。即当用四逆汤回阳。乃置而不用。更推重真武一汤。以救
之其义何居。盖真武者。北方司水之神。龙惟藉水。可能变化。设真武不与之水。青龙不能奋然升天。可知矣。故方中
用茯苓。白术。芍药。附子。行水收阴。醒脾崇土之功多于回阳。名为真武汤乃收拾分驰离绝之阴阳。互镇于少阴北方
之位。全在收拾其水。使龙潜。而不能见也。设有一毫水气上逆。龙即遂升腾变化。纵独用附子干姜以回阳。其如魄汗
不止何哉。人身阳根于阴。其亡阳之证乃少阴肾中之真阳。飞越耳。真阳飞越。亟须镇摄。归根阳。既归根阴必翕然从
之。阴从则水不逆。而阳不孤矣。岂更能飞越乎。
伤寒脉浮缓身不疼。但重乍有轻时。无少阴证者。小青龙发之。
世本作大青龙汤发之。从内编改正。○按前条。脉浮紧身疼不汗出而烦躁。皆寒伤营之候。惟烦为风伤卫。反以中
风二字括其寒。证处方全用麻黄汤加石膏以解内烦。姜枣以和营气也。此脉浮缓身不疼。皆风伤卫之证。惟身重为寒伤
营血。然乍有轻时。不似伤寒之身重而烦疼。骨节腰痛。亦无少阴之身重但欲寐。昼夜俱重也。身重者。寒也。乍轻者。
风也。虽营卫并伤。实风多寒少。反以伤寒二字括其风证。处方用桂枝加麻黄以散寒。盖营卫郁热。必作渴引饮。然始
病邪热未实。水不能消。必致停饮作寒。故先用半夏以涤饮。细辛干姜以散结。五味以收津。恐生姜辛散领津液上升。
大枣甘温聚水饮不散。故去之发之者。发散风水之结。非大发汗也。仲景又申明无少阴证者以太阳与少阴合为表里。其
在阴精素虚之人。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。岂可竟用青龙立铲孤阳之
根乎。
伤寒表不解。心下有水气干呕发热而咳。或渴或利或噎。或小便不利。小腹满。或喘者。小青龙汤主之。
此即前证发迟。而致水饮停蓄也水寒相抟。则伤其肺。人身所积之饮。或上或下。或热或冷。各自不同。而肺为总
司。但有一二证见。即水逆之应便宜小青龙汤散邪逐水。不欲如大青龙兴云致雨之意也。
若微利者去麻黄。加芫花如鸡子大熬令赤色。若渴者去半夏加栝蒌根三两。若噎者去麻黄加附子一枚炮。若小便不
利。小腹满。去麻黄加茯苓四两。若喘者去麻黄。加杏仁半升去皮尖。
本方主发散。故用麻黄。若主利水。多去麻黄。而加行水药也。荛花利水。水去利自止。噎者。水寒之气相搏于里。
故去麻黄而加附子。
伤寒心下有水气。咳而微喘发热不渴。小青龙汤主之。服汤已渴者。此寒去欲解也。
世本小青龙汤主之。在寒去欲解也下。错简也。○风寒挟水饮上逆。津液虽有阻滞。而未即伤。故不渴服汤后饮与
津液俱亡。故反渴。渴则知津液暴伤而未得复。是为寒去欲解之征。所以虽渴而不必复药。但当静俟津回可也。○咳而
微喘。为水饮泛溢。今水去而渴与水逆而渴不同。
以上营卫俱伤。
咽喉干躁者。不可发汗。
其人胃家津液素亏。所以咽中干燥若不慎。而请发其汗重夺津液。而成喉痹。唾脓血也。此与咽中闭塞。似同而实
异。此成发汗。以夺阳明之津。彼戒发汗。以夺少阴之血也。
淋家不可发汗。发汗必便血。
淋家膀胱素伤。更汗则愈扰其血。故从溺而出也。
疮家虽身疼痛。不可发汗。发汗则痉。
疮家肌表素虚营血暗耗更发其汗。则外风袭虚内血不营必致痉也。
衄家不可发汗。汗出必额上陷脉急紧直视不能 不得眠。
久惯衄家清阳之气素伤。更发其汗。以虚其虚则两额之动脉必陷故 急不能卒视。不得眠。盖目与额皆阳明部分也。
此与伤寒脉浮紧不发汗因致衄者。虚实悬殊不可不辨。
亡血家不可发汗。发汗则寒栗而振。
血亡而阳气孤而无偶。汗之则阳从汗越。所以不发热而反寒栗也。
汗家重发汗。必恍惚心乱。小便已。阴疼。
平素多汗。更发其汗。则心脏之血伤。而心神恍惚。膀胱之血亦伤。而便已阴疼也。
咽中闭塞不可发汗。发汗则吐血气欲绝。手足厥冷。欲得蜷卧不能自温。
其人肾脏真阳素亏。故咽中闭塞。汗之则并夺其阳血无所根据。即吐血厥冷蜷卧非四逆汤温经回阳可拟也。
咳而小便利若失小便者不可发汗。汗出则四肢厥冷。
咳而小便失者。膀胱虚热也。发汗必传少阴而成四肢厥冷矣。
诸脉得数动微弱者不可发汗。发汗则大便难。腹中干胃躁而烦。
脉虽动数而微弱者为表虚自汗。汗之更竭其津必胃干烦躁也。
诸逆发汗。病微者难差剧者言乱目眩者死。（差瘥同）
诸逆发汗。言凡有宿病之人阴血本虚若误用汗剂重夺其血。则轻者必重重者转剧剧者言乱目眩以虚热生风风主眩晕
故也。
咽喉干躁不可发汗。常器之云。与小柴胡汤石顽曰宜小建中。淋家不可发汗。发汗必便血常云猪苓汤石顽曰未汗黄
建中汤疮家不可发汗。王云小建中加归 。常云误汗成痉。桂枝加葛根汤石顽曰漏风发痉。桂枝加附子汤。衄家不可
发汗也许叔微云黄 建中。夺汗动血加犀角。吕沧洲云小建中加葱豉误汗直视者不治亡血家不可发汗。常云小柴胡加芍
药石顽曰。黄 建中。误汗振栗。苓桂术甘汤加当归咽中闭塞不可发汗。 安常云。甘草干姜汤。孙兆云黄 建中加葱
豉。误汗吐血炙甘草汤。厥冷当归四逆咳而失小便者不可发汗。郭白云云甘草干姜汤当归四逆汤石顽曰未汗甘草干姜加
葱豉误汗厥冷当归四逆汗后小便反数茯苓甘草汤诸脉得数动微弱者不可发汗。郭云小建中汤王云误汗烦躁便难者炙甘草
汤。汗家重发汗。小便已。阴疼。常云。一味禹余粮散。王云。用禹余粮赤石脂生梓白皮赤小豆等分。捣筛蜜丸弹丸大。
水煮日二服。
以上宿病禁汗例。
太阳病欲解时从巳至未上。
凡病欲解之时。必从其经气之王。太阳者。盛阳也。故从巳午未之王时而病解。
上条太阳经自解候。
解散。如果有下证（需要使用泻下法治疗的病证），则应当以渗湿利小便为主治方法。如果错误地使用发正汗、用正下法来治疗，就会出现上述的变证。
伤寒发热头痛，微汗出，若强行发汗会导致神志不清不认识人；若用火熏法治疗会导致气喘、小便不通畅、心腹部胀满；若用泻下法会导致气短、小便困难、头痛项强；若加上温针治疗会导致鼻出血。
阴虚且多火体质的人，刚刚感受外邪，就会比常人更严重地出现发热头痛的症状。此时在辛凉发散的药物中，就应当注意保养阴血。如果误用辛热性质的强力发汗药，津液会立刻枯竭，邪火更加炽盛，从而导致烦躁混乱、神志不清不认识人。如果误用火熏、误用泻下或温针，难道不会发生这些变证吗？
以上论述的是寒邪伤及营分的情况。
寸口脉象浮而紧，浮脉主风邪，紧脉主寒邪。风邪容易伤害卫气，寒邪容易伤害营血。营气和卫气都受到病变影响，导致骨节烦扰疼痛，应当采用发汗的方法治疗。
太阳中风证，脉象浮紧，发热恶寒，身体疼痛，无汗且烦躁的，以大青龙汤主治。如果脉象微弱，有汗出且恶风的，不可服用大青龙汤。服用了就会导致四肢厥冷，筋肉跳动抽搐。这是逆治的错误。应当用真武汤来救治。
宗印本没有“大青龙汤主之”这六个字，世传本作“大青龙汤主之”，现在根据《尚论篇》改正。○天地郁结蒸腾，遇到雨水就能调和；人身烦躁，得到汗出就能缓解。大青龙汤正是针对这种情况。人体原本有微汗，但被寒邪郁闭不能透出肌表，因此产生烦躁。这与麻黄汤证那种完全无汗的情况截然不同，所以用大青龙汤发汗，以解除其烦躁。所以暴病初起就见到烦躁，确实是营卫俱伤的明证无疑。此方原本是用于不得汗者取汗的，如果是已经出汗后的烦躁，完全不是郁结蒸腾可比，它不依靠汗解是很明显的。再加上恶风、脉微弱，这就是少阴无阳的证候。如果脉浮弱、汗出、恶风而不烦躁，那就是太阳中风证。这些都与此汤无关。误用此汤，难道不会导致四肢厥冷、筋肉跳动抽搐，从而加速阳气亡失吗？按：误服大青龙汤导致亡阳，本应当用四逆汤回阳救逆，却放置不用，反而推崇真武汤来救治，其中的道理何在呢？盖真武是北方司水之神，龙只有借助水，才能变化。假如真武不给它水，青龙就不能奋然升天，这是显而易见的。所以方中使用茯苓、白术、芍药、附子，发挥行水收阴、醒脾崇土的功效多于回阳。名为真武汤，乃是收拾分散离绝的阴阳，使其相互镇守在少阴北方的位置。关键在于收敛其水气，使龙潜藏而不能显现。如果有一毫水气上逆，龙就会随之升腾变化。纵然单独使用附子、干姜来回阳，又能拿那不止的魄汗怎么办呢？人身之阳根于阴，所谓亡阳之证，乃是少阴肾中的真阳飞越罢了。真阳飞越，急需镇摄，使真阳归根于阴。既然阳已归根于阴，必然翕然随之，阴从则水不逆，而阳不再孤立。难道还能再飞越吗？
伤寒脉象浮缓，身体不疼，只是沉重，偶尔有减轻的时候，如果没有少阴证的，用小青龙汤发散。
世传本作“大青龙汤发之”，从内编改正。○按前一条，脉浮紧、身疼、无汗而烦躁，都是寒伤营分的征候，唯独烦躁是风伤卫的表现，反以“中风”二字概括其寒证，处方全用麻黄汤加石膏以解内烦，用姜枣以和营气。此条脉浮缓、身不疼，都是风伤卫的证候，唯独身重是寒伤营血。然而偶尔有减轻的时候，不像伤寒的身重而烦疼、骨节腰痛，也没有少阴证的身重但想睡觉、昼夜都重的情况。身重是寒邪所致，偶尔减轻是风邪所致。虽然营卫并伤，实际上是风多寒少，反以“伤寒”二字概括其风证，处方用桂枝加麻黄以散寒。盖营卫郁热，必定作渴引饮，然而始病时邪热未实，水不能消，必定导致停饮作寒。所以先用半夏以涤除痰饮，细辛、干姜以散结，五味子以收敛津液。恐怕生姜辛散引领津液上升，大枣甘温聚敛水饮不散，所以去掉它们。“发之”的意思是发散风水之结，并非大发汗。仲景又申明“无少阴证者”，因为太阳与少阴合为表里，对于阴精素虚之人，表邪不等待传经，早就从膀胱袭入肾脏的，是有这种情况的。况且两感夹阴等证，临病犹当仔细察辨。假如少阴不虚，表邪怎么能飞渡而见身重欲寐等证呢？所以有少阴证者，不得已而行表散，自有温经散邪、两相兼顾的方法，岂可竟用青龙汤立铲孤阳之根呢？
伤寒表证不解，心下有停饮，干呕、发热而咳，或者口渴，或者腹泻，或者噎塞，或者小便不利、小腹胀满，或者喘息的，用小青龙汤主治。
这就是前一种证候发病较迟，导致水饮停蓄。水寒相互搏结，就会损伤肺脏。人身所积存的饮邪，有的在上，有的在下，有的偏热，有的偏冷，各自不同，而肺为总司。只要有一两个证候出现，就是水逆的反应，应当及时用小青龙汤散邪逐水，不想像大青龙汤那样有兴云致雨之意。
如果有轻微腹泻的，去掉麻黄，加芫花如鸡蛋大小，熬至赤色。如果口渴的，去掉半夏，加栝蒌根三两。如果噎塞的，去掉麻黄，加炮附子一枚。如果小便不利、小腹胀满的，去掉麻黄，加茯苓四两。如果喘息的，去掉麻黄，加杏仁半升，去皮尖。
本方主要作用是发散，所以用麻黄。如果主要作用是利水，大多去掉麻黄，而加入行水的药物。荛花利水，水去则利自止。噎塞，是因为水寒之气在体内相互搏结，所以去掉麻黄而加附子。
伤寒心下有停饮，咳嗽且轻微喘息，发热但不口渴的，用小青龙汤主治。服药后感到口渴的，这是寒邪去除、病情将要解除的迹象。
世传本将“在寒去欲解也”错简放在“小青龙汤主之”之下。○风寒挟带水饮上逆，津液虽有阻滞，但并未立即受伤，所以不渴。服药后，饮邪与津液俱亡，所以反而口渴。口渴则知道津液暴伤而未得恢复，这是寒去欲解的征象。所以虽然口渴也不必再服药，只需静待津液回复即可。○咳嗽且轻微喘息，是水饮泛溢的表现。如今水去而口渴，与水逆导致的口渴不同。
以上论述的是营卫俱伤的情况。
咽喉干燥的，不可发汗。
其人胃家津液素来亏虚，所以咽中干燥。如果不谨慎，而请医生发其汗，再次劫夺津液，就会形成喉痹，唾脓血。这与咽中闭塞，看似相同实则不同。前者成病是因为发汗以劫夺阳明之津，后者戒发汗是因为发汗会劫夺少阴之血。
淋病患者不可发汗，发汗必然导致便血。
淋病患者膀胱素来受伤，再发汗则会更加扰动其血，所以血液从溺道而出。
疮疡患者虽然身体疼痛，不可发汗，发汗就会导致痉病。
疮疡患者肌表素虚，营血暗中耗损，再发其汗，则外风袭击空虚之处，内血不能濡养，必定导致痉病。
经常流鼻血的患者不可发汗，发汗必然导致额部动脉凹陷，脉象急紧，直视不能转动眼球，无法入睡。
久惯流鼻血的患者，清阳之气素来受伤，再发其汗，会使虚者更虚，则两额的动脉必陷，故脉搏急紧不能卒然视物，无法入睡。这是因为眼睛和额头都属于阳明经的部分。
这与伤寒脉浮紧，不发汗因而导致鼻出血的情况，虚实悬殊，不可不辨别。
亡血患者不可发汗，发汗会导致寒战颤抖。
血亡则阳气孤立而无配偶，发汗则阳气随汗外越，所以不发热反而寒战。
平素多汗的人如果再发汗，必然导致心神恍惚、心中乱糟糟的，小便结束后，阴部疼痛。
平素多汗，再发其汗，则心脏之血受伤，而心神恍惚；膀胱之血亦受伤，而小便结束后阴部疼痛。
咽中闭塞不可发汗，发汗则吐血，气欲绝，手足厥冷，想要蜷缩卧倒但不能自我温暖。
其人肾脏真阳素来亏虚，所以咽中闭塞。发汗则会同时劫夺其阳，血无所依附，即出现吐血、厥冷、蜷卧，这不是四逆汤温经回阳所能比拟的。
咳嗽且小便失禁的，不可发汗，发汗则四肢厥冷。
咳嗽且小便失禁的，是膀胱虚热。发汗必然传入少阴而成四肢厥冷。
各种脉象表现为数动而微弱的，不可发汗，发汗则大便困难，腹中干燥，胃燥而烦躁。
脉象虽然动数但微弱，属于表虚自汗。发汗会更竭尽津液，必定导致胃干烦躁。
各种逆证误用发汗法，病轻的难愈，病重的谵语，目眩的死亡。（差同瘥，痊愈的意思）
各种逆证误用发汗法，意思是凡是有宿疾之人，阴血本虚，若误用汗剂再次劫夺其血，则轻者必重，重者转剧。剧者谵语、目眩，是因为虚热生风，风主眩晕的缘故。
咽喉干燥不可发汗。常器之说，与小柴胡汤。石顽说宜用小建中汤。淋家不可发汗，发汗必便血。常器之说猪苓汤，石顽说未汗时用黄建中汤。疮家不可发汗。王云用小建中加当归。常器之说误汗成痉，用桂枝加葛根汤。石顽说漏风发痉，用桂枝加附子汤。衄家不可发汗。许叔微说用黄建中汤，夺汗动血加犀角。吕沧洲说用小建中加葱豉。误汗直视者不治。亡血家不可发汗。常器之说小柴胡加芍药，石顽说用黄建中汤。误汗振栗，用苓桂术甘汤加当归。咽中闭塞不可发汗。安常说用甘草干姜汤。孙兆说用黄建中加葱豉。误汗吐血，用炙甘草汤。厥冷当归四逆汤。咳而失小便者不可发汗。郭白云说用甘草干姜汤当归四逆汤。石顽说未汗用甘草干姜加葱豉，误汗厥冷用当归四逆汤。汗后小便反数，用茯苓甘草汤。诸脉得数动微弱者不可发汗。郭云用小建中汤，王云误汗烦躁便难者用炙甘草汤。汗家重发汗，小便已阴疼。常器之说一味禹余粮散。王云用禹余粮、赤石脂、生梓白皮、赤小豆等分，捣筛蜜丸弹丸大，水煮日二服。
以上列举了宿病禁汗的例子。
太阳病欲解的时间是从巳时至未时之前。
凡是疾病欲解之时，必定顺应其经脉气旺之时。太阳者，盛阳也。所以从巳、午、未的气旺之时病能解除。
上一条论述的是太阳经自解的征候。
Disperse and resolve. If there are indications for purgation (indications requiring the use of purgative methods), treatment should primarily focus on promoting diuresis to leach out dampness. If one erroneously employs methods to induce normal sweating or normal purgation, the aforementioned adverse reactions will occur.
In cold damage with fever, headache, and slight sweating, forcibly inducing sweating leads to confusion and inability to recognize people; applying moxibustion or heat fumigation causes asthma, urinary retention, and fullness in the heart and abdomen; purgation leads to shortness of breath, difficult urination, headache, and stiffness of the neck; adding warm needle therapy results in epistaxis (nosebleed).
Individuals with Yin deficiency and excessive fire, upon merely contracting external pathogens, experience fever and headache more severely than usual. At this time, within the use of acrid-cool dispersing herbs, care must be taken to nourish and protect Yin blood. If acrid-hot strong diaphoretic drugs are mistakenly used, body fluids will immediately wither, and pathogenic fire will become even more rampant, leading to restlessness, confusion, and inability to recognize people. If one errs in using fumigation, purgation, or warm needles, would these adverse reactions not inevitably occur?
The above discusses the injury of the Ying (Nutrient) level by Cold.
The pulse at the Cun Kou (radial artery) is floating and tight. Floating indicates Wind, while tight indicates Cold. Wind injures the Wei (Defensive) Qi, and Cold injures the Ying (Nutrient) Blood. When both Ying and Wei are diseased, causing bone and joint irritation and pain, sweating should be induced.
In Taiyang Wind Strike (Taiyang Zhong Feng), if the pulse is floating and tight, accompanied by fever, aversion to cold, body pain, absence of sweating, and irritability, Da Qing Long Tang (Major Blue Green Dragon Decoction) is indicated. However, if the pulse is faint and weak, with sweating and aversion to wind, it must not be administered. Administration would lead to cold extremities (Jue Ni) and muscle twitching/tremors (Jin Ti Rou Tiao). This constitutes a therapeutic error. It should be rescued with Zhen Wu Tang (True Warrior Decoction).
The Zongyin edition omits the six characters "Da Qing Long Tang Zhu Zhi" (Mainly treated with Da Qing Long Tang). The Shichuan edition includes them. This text corrects it based on *Shang Lun*. ○ When heaven and earth are stagnant and steaming, rain brings harmony; when the human body is irritable, sweating brings relief. Da Qing Long Tang is precisely for this condition. The body originally has slight sweating, but it is blocked by Cold pathogens and cannot emerge from the muscle surface, thus generating irritability. This is distinctly different from the Ma Huang Tang syndrome characterized by complete absence of sweating. Therefore, Da Qing Long Tang is used to induce sweating to resolve the irritability. Thus, acute illness presenting with irritability confirms without doubt that both Ying and Wei are injured. This formula was originally intended to induce sweating in those who could not sweat. If the irritability arises after sweating has already occurred, it is completely unlike stagnation and steaming; its resolution does not rely on sweating is clear. Furthermore, with aversion to wind and a faint/weak pulse, this indicates a Shaoyin pattern of Yang deficiency. If the pulse is floating and weak, with sweating, aversion to wind, but no irritability, it is a Taiyang Wind Strike pattern. Neither of these relates to this formula. Mistakenly using this formula would inevitably cause cold extremities and muscle twitching, accelerating the loss of Yang. Note: In cases of Yang collapse due to mistaken use of Da Qing Long Tang, Si Ni Tang (Four Reversal Decoction) should be used to restore Yang. Yet, it is set aside, and preference is given to Zhen Wu Tang for rescue. What is the rationale? Zhen Wu is the deity governing water in the North. The Dragon can only transform by relying on water. If Zhen Wu does not provide water, the Qing Long cannot ascend to heaven vigorously, which is obvious. Therefore, the formula uses Fu Ling (Poria), Bai Zhu (Atractylodes Macrocephala Rhizome), Shao Yao (Peony Root), and Fu Zi (Aconite Lateralis Preparata) to promote water metabolism, collect Yin, awaken the Spleen, and strengthen Earth. Its功效 in gathering water and consolidating Yin outweighs its Yang-restoring function. Named Zhen Wu Tang, it gathers scattered and separated Yin and Yang, stabilizing them mutually in the Northern position of Shaoyin. The key lies in gathering the Water Qi so that the Dragon remains submerged and unseen. If even a trace of Water Qi rebels upward, the Dragon will ascend and transform. Even if one solely uses Fu Zi and Gan Jiang (Zingiberis Rhizoma) to restore Yang, what can be done about the incessant profuse sweating? Human Yang is rooted in Yin. The syndrome of Yang collapse refers to the True Yang of the Kidney in Shaoyin flying away. True Yang flying away urgently requires sedation and anchoring, returning it to its root in Yin. Once Yang returns to Yin, it naturally follows. When Yin follows, Water does not rebel, and Yang is no longer isolated. How could it fly away again?
In cold damage, if the pulse is floating and slow, the body is not painful but feels heavy, occasionally becoming lighter, and there are no Shaoyin signs, Xiao Qing Long Tang (Minor Blue Green Dragon Decoction) should be used to disperse.
The Shichuan edition reads "Da Qing Long Tang Fa Zhi". Corrected from the Internal Compilation. ○ Regarding the previous clause: floating-tight pulse, body pain, no sweating, and irritability are all signs of Cold injuring Ying. Only irritability is caused by Wind injuring Wei. Yet, the term "Wind Strike" is used to encompass the Cold syndrome. The prescription uses Ma Huang Tang plus Shi Gao (Gypsum Fibrosum) to resolve internal irritability, and Ginger/Jujube to harmonize Ying Qi. In this clause, floating-slow pulse and lack of body pain are signs of Wind injuring Wei. Only body heaviness is caused by Cold injuring Ying/Blood. However, the occasional lightness differs from the constant heaviness and painful irritability of bone/joints/lower back in cold damage, and also differs from the constant day-and-night heaviness and desire to sleep seen in Shaoyin. Heaviness is due to Cold; occasional lightness is due to Wind. Although both Ying and Wei are injured, Wind predominates over Cold. Yet, the term "Cold Damage" is used to encompass the Wind syndrome. The prescription uses Gui Zhi Tang (Cinnamon Twig Decoction) plus Ma Huang (Ephedrae Herba) to disperse Cold. Since Ying-Wei stagnant heat causes thirst and desire to drink, but early in the disease pathogenic heat is not substantial enough to consume fluids, fluid retention occurs. Therefore, Ban Xia (Pinelliae Rhizoma) is used first to wash away phlegm-fluids, Xi Xin (Asari Radix et Rhizoma) and Gan Jiang (Zingiberis Rhizoma) to dissipate knots, and Wu Wei Zi (Schisandrae Fructus) to astringe fluids. One fears that Sheng Jiang (Zingiberis Rhizoma Recens) acridly disperses and guides fluids upward, and Da Zao (Jujubae Fructus) sweet-warm gathers fluids preventing dispersion, so they are removed. "Fa Zhi" means dispersing the knot of Wind-Water, not inducing heavy sweating. Zhang Zhongjing further clarifies "without Shaoyin signs" because Taiyang and Shaoyin are exterior-interior pairs. In individuals with innate essence deficiency, exterior pathogens may invade the Kidney via the Bladder before transmission occurs. Moreover, complex patterns like simultaneous contraction of exterior and interior or Yin-collapsing patterns require careful examination. If Shaoyin is not deficient, how can exterior pathogens cross over to present with heaviness and desire to sleep? Therefore, if Shaoyin signs exist, and exterior dispersal is不得已 (unavoidable), there are methods to warm the meridians and scatter pathogens simultaneously. One cannot simply use Qing Long Tang to uproot solitary Yang.
In cold damage, if the exterior syndrome is unresolved, and there is fluid retention in the Heart region, accompanied by dry retching, fever, and cough, or alternatively thirst, diarrhea, choking sensation, dysuria with lower abdominal fullness, or asthma, Xiao Qing Long Tang is indicated.
This is a delayed onset of the previous syndrome, leading to fluid retention. Water and Cold bind together, damaging the Lung. Accumulated fluids in the body vary—some upper, some lower, some hot, some cold—but the Lung is the master. If any one or two symptoms appear, it indicates fluid rebellion. Xiao Qing Long Tang should be promptly used to scatter pathogens and expel water, unlike Da Qing Long Tang which aims to raise clouds and bring rain.
If there is mild diarrhea, remove Ma Huang and add Yuan Hua (Genkwa Flos) the size of an egg, roasted until red. If thirsty, remove Ban Xia and add Gua Lou Gen (Trichosanthis Radix) 3 liang. If choking, remove Ma Huang and add one prepared Fu Zi (Aconiti Lateralis Preparata Radix). If dysuria with lower abdominal fullness, remove Ma Huang and add Fu Ling (Poria) 4 liang. If asthmatic, remove Ma Huang and add Xing Ren (Armeniacae Semen Amarum) half sheng, peeled and tipped.
The main action of this formula is dispersing, hence Ma Huang is used. If the main action is promoting diuresis, Ma Huang is mostly removed and replaced with diuretic herbs. Yuan Hua promotes diuresis; once water is gone, diarrhea stops. Choking is caused by Water-Cold binding internally, hence Ma Huang is removed and Fu Zi added.
In cold damage, if there is fluid retention in the Heart region, with cough, slight asthma, fever, but no thirst, Xiao Qing Long Tang is indicated. If thirst occurs after taking the decoction, this indicates Cold is departing and the disease is resolving.
The Shichuan edition misplaces "Zai Han Qu Yu Jie Ye" under "Xiao Qing Long Tang Zhu Zhi". ○ Wind-Cold carrying fluid rebellion upward obstructs fluids without immediately injuring them, hence no thirst. After taking the decoction, fluids and Yin are depleted, hence thirst arises. Thirst indicates sudden injury to fluids without recovery, signaling Cold departure and impending resolution. Thus, although thirsty, no further medication is needed; one should wait quietly for fluids to return. ○ Cough and slight asthma indicate fluid overflow. Now, thirst after water removal differs from thirst due to fluid rebellion.
The above discusses injuries to both Ying and Wei.
If the throat is dry, sweating should not be induced.
The person’s Stomach fluids are inherently deficient, causing dryness in the throat. If one imprudently induces sweating, further depleting fluids, it will result in throat bi (obstruction) and expectoration of pus and blood. This differs from throat closure. The former becomes ill due to sweating depleting Yangming fluids; the latter warns against sweating to avoid depleting Shaoyin blood.
Patients with stranguria (Lin Syndrome) should not be sweated. Sweating will necessarily cause hematuria.
Stranguria patients have inherent Bladder injury. Further sweating disturbs the blood, causing it to exit through urine.
Patients with sores/ulcers (Chuang Jia), despite body pain, should not be sweated. Sweating will lead to tetany/spasm (Jing).
Sores/ulcer patients have inherently deficient exterior and hidden consumption of Ying blood. Further sweating allows exterior Wind to attack deficiency and internal blood to fail to nourish, inevitably leading to spasm.
Patients prone to nosebleeds (Nu Jia) should not be sweated. Sweating will cause depression of arteries in the forehead, tight pulse, fixed gaze unable to move, and insomnia.
Long-term nosebleed patients have damaged Clear Yang Qi. Further sweating exacerbates deficiency, causing arterial depression in the temples, tight pulse, inability to look suddenly, and insomnia. This is because eyes and forehead belong to the Yangming aspect.
This differs significantly from cold damage with floating-tight pulse where failure to sweat causes nosebleed; the deficiency/excess disparity must be distinguished.
Patients with blood loss (Wang Xue Jia) should not be sweated. Sweating will cause chills and tremors.
Blood loss leaves Yang isolated without partner. Sweating causes Yang to escape with sweat, resulting in chills rather than fever.
Persons prone to sweating (Han Jia) who are sweated again will suffer mental confusion and restlessness. After urination, there will be genital pain.
Chronic sweaters subjected to further sweating injure Heart blood, causing mental confusion. Bladder blood is also injured, causing genital pain after urination.
Throat closure should not be sweated. Sweating will cause hematemesis, near-death Qi, cold extremities, and a desire to curl up unable to self-warm.
These patients have inherent Kidney True Yang deficiency causing throat closure. Sweating depletes Yang, leaving blood without support, resulting in hematemesis, cold limbs, and curling up. This cannot be matched by Si Ni Tang alone.
Cough with urinary incontinence should not be sweated. Sweating will cause cold extremities.
Cough with urinary incontinence indicates Bladder empty heat. Sweating transmits to Shaoyin, causing cold extremities.
Any pulse that is rapid, active, yet weak/faint should not be sweated. Sweating will cause difficult defecation, dry abdomen, dry stomach, and irritability.
Although the pulse is rapid and active, weakness indicates exterior deficiency with spontaneous sweating. Sweating exhausts fluids, causing dry stomach and irritability.
For various rebellious conditions, mistaken sweating makes mild cases hard to cure, severe cases delirious, and those with dizziness die. (Cha is synonymous with Cui, meaning cured/healed).
Mistaken sweating in rebellious conditions means: For persons with chronic diseases and innate Yin-blood deficiency, mistaken diaphoretics further deplete blood. Mild cases become severe, severe cases worsen. Severe cases deliriate and feel dizzy because empty heat generates Wind, and Wind governs dizziness.
Throat dryness prohibits sweating. Chang Qizhi suggests Xiao Chai Hu Tang (Minor Bupleurum Decoction). Shi Wen suggests Xiao Jian Zhong Tang (Minor Construct the Middle Decoction). Stranguria prohibits sweating; Chang says Zhu Ling Tang (Polyporus Decoction); Shi Wen says Huang Qi Jian Zhong Tang before sweating. Sores prohibit sweating; Wang says Xiao Jian Zhong Tang plus Dang Gui. Chang says mistaken sweating causes spasm, use Gui Zhi Jia Ge Gen Tang (Cinnamon Twig Plus Kudzu Root Decoction). Shi Wen says leaky wind spasm, use Gui Zhi Jia Fu Zi Tang (Cinnamon Twig Plus Aconite Decoction). Nosebleed prohibits sweating; Xu Shumi says Huang Qi Jian Zhong Tang plus Xi Jiao (Rhinocerotis Cornu) for bleeding from sweating. Lv Cangzhou says Xiao Jian Zhong Tang plus Cong Chi (Scallion and Soybean). Uncontrollable fixed gaze after mistaken sweating is incurable. Blood loss prohibits sweating; Chang says Xiao Chai Hu Tang plus Shao Yao; Shi Wen says Huang Qi Jian Zhong Tang. Trembling after mistaken sweating uses Ling Gui Zhu Gan Tang plus Dang Gui. Throat closure prohibits sweating; An Chang says Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction). Sun Zhao says Huang Qi Jian Zhong Tang plus Cong Chi. Hematemesis after mistaken sweating uses Zhi Gan Cao Tang (Honey-Fried Licorice Decoction). Cold extremities use Dang Gui Si Ni Tang (Angelica Four Reversal Decoction). Cough with urinary incontinence prohibits sweating; Guo Baiyun says Gan Cao Gan Jiang Tang Dang Gui Si Ni Tang. Shi Wen says before sweating Gan Cao Gan Jiang plus Cong Chi; after mistaken sweating cold extremities use Dang Gui Si Ni Tang. Post-sweating frequent urination uses Fu Ling Gan Cao Tang (Poria and Licorice Decoction). Rapid-active-weak pulse prohibits sweating; Guo says Xiao Jian Zhong Tang; Wang says post-mistake irritability/difficult stool uses Zhi Gan Cao Tang. Chronic sweaters re-sweated with post-urination genital pain; Chang says Yi Yu Liang San (Halloysitum Powder). Wang says Yi Yu Liang, Chi Shi Zhi, Sheng Zi Bai Pi, Chi Xiao Dou equal parts, honey pills, boiled water twice daily.
The above lists examples of contraindications for sweating in chronic conditions.
Taiyang syndrome resolves between Si and Wei hours (9 AM to 3 PM).
Whenever a disease resolves, it follows the peak time of its meridian Qi. Taiyang is盛 Yang. Therefore, it resolves during the peak times of Si, Wu, and Wei.
The previous clause discusses the self-resolution signs of the Taiyang Meridian.