凡五十七条方三十二
太阳统摄之荣卫。乃风寒始入之两途。寒则伤荣。故以营伤于寒而病者为中篇。夫寒。冬令也。
秋末春初以间乎冬。寒则有之。他时虽或暴变清冷。大率不外本序之令气耳。终不得入隆冬严寒
之例。以病言之。必也证候显见如经。始可谓为伤寒。不可少有分毫违错。盖经之所以条例各病。
对比而辨论者。正为与伤寒分别争差也。读者极力反复精究其旨。久久成熟。一旦贯通。则认病
自然亲切。而于凡异说之纷纭者。皆不为其所惑矣。慎哉。
（一）太阳病。或已发热。或未发热。必恶寒。体痛。呕逆。脉阴阳俱紧者。名曰伤寒。
或。未定之词。寒为阴。阴不热。以其着人而客于人之阳经。郁而与阳争。争则蒸而为热。已
发热者。时之所至。郁争而蒸也。未发热者。始初之时。郁而未争也。必。定然之词。恶寒见上
篇。然此以寒邪郁荣。故荣病而分见恶寒。曰必者。言发热早晚不一。而恶寒则必定即见也。体
痛者。寒主坚凝而伤荣。则荣实而强。卫虚而弱矣。荣强则血涩。卫弱则气滞。故痛
也。呕。吐也。逆。俗谓恶心是也。胃口畏寒而寒涌也。阴谓关后。阳谓关前。俱紧。三关
通度而急疾。寒性强劲而然也。难经曰。伤寒之脉。阴阳俱盛而紧涩。是也。伤。犹中也。彼此
两相更互发明。言太阳之为病。中风固如彼矣。若或有如此者。则又是触犯于寒而中之也。然阴
寒之袭人。从荣而入。荣。血道也。寒之所以从荣入者。荣亦阴。亦从类也。犹龙虎之于风
云。水火之于燥湿。各以其类而相从之自然也。此揭太阳分病之纪二。乃此篇之小总。下条乃申
此而互言之。详其义以出其治。余皆此条之差分耳。首尾脉络。纲领条目。大端悉类上编。乃上
篇之对待。太阳之太三辨。上编一。此其二。以下凡首称伤寒者。则又皆指有此云云之谓也。
（二）太阳病。头痛。发热。身疼。腰痛。骨节疼痛。恶风。无汗。而喘者。麻黄汤主之。
麻黄汤方
麻黄（三两去节） 桂枝（二两去皮） 甘草（一两炙） 杏仁（七十个汤浸去皮尖）
上四味。以水九升。先煮麻黄减二升。去上沫。内诸药。煮取二升半。去滓。温服八合。覆取
微似汗。不须啜粥。余如桂枝法将息。
此申上条而更互言之。所以致其详而出其治也。头痛已见太阳病。而此犹出者。以其专太阳
而主始病也。上条先言或已发热。或未发热。而此先言头痛。次言发热者。则是以其已发热者言
也。身疼腰痛。骨节疼痛。即上条之体痛而详言之也。上条言必恶寒。而此言恶风者。乃更互言
之。与上编啬啬恶寒。淅淅恶风。双关互文之意同。无汗。乃对上编之有汗而言。以见彼此两相
反。所以为风寒之辨别。不然无是证者。则不言也。然所以无汗者。汗乃血之液。血为荣。荣强
则腠理闭密。虽热。汗不出也。喘。气逆也。卫主气。卫弱则气乏逆。呼吸不利而声息所以不遂也。
然上条言呕而此言喘。呕与喘。皆气逆。亦互言以明互见之意。麻黄味苦而性温。力能发汗以散
寒。然桂枝汤中忌麻黄。而麻黄汤中用桂枝。何也。曰。麻黄者。突阵擒敌之大将也。桂枝者。
运筹帷幄之参军也。故委之以麻黄。必胜之算也。监之以桂枝。节制之妙
也。甘草和中而除热。杏仁下气而定喘。惟麻黄有专功之能。故不须啜粥之助。
（三）伤寒一日。太阳受之。脉若静者为不传。颇欲吐。若燥烦脉数急者。为传也。
伤寒者。以上二条互言者而言也。下仿此。一日太阳受之。太阳主表而属外。故外者先当也。静
谓恬退而和平也。紧退恬静和平。其为不传而欲愈可诊矣。颇欲吐属上言。不甚待吐而不吐。盖
呕逆未全止也。燥。干也。数。五六至已上也。其主热。急。躁疾也。欲传而加进可知也。
（四）伤寒二三日。阳明少阳证不见者。为不传也。
见。音现。上条举太阳而以脉言。此复举阳明少阳而以证言。次第反复互相发明也。然不传
有二。一则不传而遂自愈。一则不传而犹或不解。若阳明少阳虽不见。太阳亦不解。则始终太阳
者有之。余经同推。要皆以脉证所见为准。若只蒙龙拘拘。数日以论经。则去道远矣。
（五）脉浮者。病在表。可发汗。宜麻黄汤。
表。太阳也。伤寒脉本紧。不紧而浮。则邪见还表而欲散可知矣。发。拓而出之也。麻黄汤者。
乘其欲散而拓出之之谓也。（方见前）
（六）脉浮而数者。可发汗。宜麻黄汤。
浮与上同。而此多数。数者。伤寒之欲传也。可发汗而宜麻黄汤者。言乘寒邪有向表之浮。
当散其数。而不令其至于传也。
（七）脉浮数者。法当汗出而愈。若下之身重心悸者。不可发汗。当自汗出乃解。所以然者。尺
中脉微。此里虚。须表里实。津液自和。便自汗出。愈。
此承上条复以其治不如法。因而致变者言。晓人当知谨也。身重。下后阴虚而倦怠也。悸属心。
心主血。阴虚则血虚。所以心不宁也。盖不当下而反下之。故证变如此。不可汗者。禁勿重亡津
液以复损其阴也。当自汗出乃解者。言下虽反而病未甚变。须待其津液回。当得自汗而解也。所以
然者以下。乃申释上文之词。里虚。以亡津液言。须表里实。以待津液回。邪还表言也。
（八）伤寒发汗。解。半日许。复烦。脉浮数者。可更发汗。宜桂枝汤主之。（更。平声。）
伤寒发汗者。服麻黄汤以发之之谓也。解。散也。复。重复也。既解而已过半日之久矣。何事而
复哉。言发汗不如法。汗后不谨。重新又有所复中也。盖汗出过多。则腠理反开。护养不谨。邪风
又得易入。所以新又烦热而脉转浮数。故曰可更发汗。更。改也。言当改前法。故曰宜桂枝汤。
桂枝汤者。中风解肌之法。微哉旨也。庸俗不省病加小愈之义。不遵约制。自肆粗下。不喻汗法微
似之旨。骋以大汗为务。病致变矣。反谓为邪不尽。汗而又汗。辗转增剧。卒致莫救。不知悔
悟。噫。读书不喻旨。赵括鉴矣。学医废人命。伊芳谁鉴邪。伤哉。
（九）发汗已。脉浮数烦渴者。五苓散主之。
已。言发汗毕。非谓病罢也。浮数烦。与上同。而此多渴。渴者。亡津液而内燥。里证也。
以证有里而人燥渴。故用四苓以滋之。以表在而脉浮数。故凭一桂以和之。谓五苓散能两解表里
者。此也。（方见上编）
（十）伤寒汗出而渴者。五苓散主之。不渴者。茯苓甘草汤主之。
茯苓甘草汤方
茯苓（二两） 桂枝（二两去皮） 生姜（三两切） 甘草（一两）
上四味。以水四升。煮取二升。去滓。分。温三服。
伤寒不汗出。汗出者。以发之而出者言也。然则此条二节。上节乃承上条而以其不烦者再言。
下节乃承上节而以其更不渴者又出也。不烦。则热较轻可知。故治亦不殊。不渴。则内燥更减可
识。故但用四苓之一以润之。然里证既轻。则表为犹多可必。故须桂枝之三以解之。然则此汤之
四物。其桂枝五苓二方之变制与。
（十一）伤寒汗出解之后。胃中不和。心下痞硬。干噫食臭。胁下有水气。腹中雷鸣下利者。
生姜泻心汤主之。
生姜泻心汤方
生姜（四两切） 甘草（三两炙） 人参（三两） 干姜（一两） 黄芩（三两） 半夏
（半升洗） 黄连（一两） 大枣（十二枚擘）
上八味。以水一斗。煮取六升。去滓。再煎取三升。温服一升。日三服。
噫。影戒切。解。谓大邪退散也。胃为中土。温润则和。不和者。汗后亡津液。邪乍退散。正未
全复而尚弱也。痞硬。伏饮抟膈也。噫。饱食息也。食臭。 气也。平人过饱伤食。则噫食臭。
病患初瘥。脾胃尚弱。化输未强。虽无过饱。犹之过饱而然也。水气。亦谓饮也。雷鸣者。脾为阴。
胃为阳。阴阳不和。薄动之声也。下利者。惟阴阳之不和。则水谷不厘清。所以杂迸而走
注也。生姜大枣。益胃而健脾。黄芩黄连。清上而坚下。半夏干姜。蠲饮以散痞。人参甘草。益
气而和中。然则泻心者。健其脾而脾输。益其胃而胃化。斯所以为泻去其心下痞硬之谓也。
（十二）发汗病不解反恶寒者。虚故也。芍药甘草附子汤主之。
芍药甘草附子汤方
芍药（三两） 甘草（三两炙） 附子（一枚炮去皮破八片）
以上三味。以水五升。煮取一升五合。去滓。分。温三服。
未汗而恶寒。邪盛而表实。仇雠之恶也。已汗而恶寒。邪退而表虚。怯懦之恶也。盖汗出之后。
大邪退散。荣气衰微。卫气疏慢。病虽未尽解。不他变而但恶寒。故曰虚。言表气新虚而非病变
也。然荣者阴也。阴气衰微。故用芍药之酸以收之。卫者阳也。阳气疏慢。故用附子之辛以固之。
甘草甘平。合荣卫而和谐之。乃国老之所长也。
（十三）发汗后恶寒者。虚故也。不恶寒但热者。实也。当和胃气。与调胃承气汤。
上节乃略上条而复言。所以起下文。而以其反者出也。不恶寒。其人表气强也。但热。亡津液
而胃中干。故曰实也。当和胃气。以干在胃而实也。故曰。与调胃承气汤。然汤以泻实。而甘草
则和中益气。何也。盖实成于虚也。所谓量凿而正枘。其斯之谓与。方见大阳下。
（十四）发汗后。身疼痛。脉沉迟者。桂枝加芍药生姜各一两。人参三两。新加汤主之。
桂枝新加汤方
桂枝（三两去皮） 芍药（四两） 甘草（二两炙） 人参（三两） 生姜（四两切）
大枣（十二枚擘）
上六味。以水一斗一升。微火煮取三升。去滓。分。温服。如桂枝法。
发汗后身疼痛脉沉迟者。邪气骤去。血气暴虚也。用桂枝者。和其荣卫。不令暴虚易得重伤也。
加人参芍药者。收复其阴阳以益其虚也。加生姜者。健其乍回之胃以安其谷也。曰新加者。得非
足一百一十三而成之之谓邪。微火皆当仿效首方。此盖后人之赘耳。
（十五）发汗后。不可更行桂枝汤。汗出而喘无大热者。可与麻黄杏仁甘草石膏汤主之。
麻黄杏仁甘草石膏汤方
麻黄（四两去节） 杏仁（五十个去皮尖） 甘草（二两炙） 石膏（半斤碎绵裹）
上四味。以水七升。先煮麻黄减二升。去上沫。内诸药。煮取二升。去滓。温服一升。
更行。犹言再用。不可再用桂枝汤。则是已经用过所以禁止也。盖伤寒当发汗。不当用桂枝
。桂枝固卫。寒不得泄。而气转上逆。所以喘益甚也。无大热者。郁伏而不显见也。以伤寒之表
犹在。故用麻黄以发之。杏仁下气定喘。甘草退热和中。本麻黄正治之佐使也。石膏有彻热之功。
尤能助下喘之用。故易桂枝以石膏。为麻黄汤之变制。而太阳伤寒。误汗转喘之主治。所以必四
物者而后可行也。
（十六）发汗后。饮水多者必喘。以水灌之亦喘。
喘属肺。肺属金。金性寒。故曰形寒饮冷则伤肺。汗后肺气新虚。易得重伤。饮水。饮冷也。水
灌则形寒。肺伤矣。其主气所以皆喘也。
（十七）发汗过多。其人叉手自冒心。心下悸欲得按者。桂枝甘草汤主之。
桂枝甘草汤方
桂枝（四两去皮） 甘草（二两炙）
上二味。以水三升。煮取一升。去滓。顿服。
汗多则血伤。血伤则心虚。心虚则动惕而悸。故叉手自冒覆而欲得人接也。桂枝走阴。敛液
宅心。能固疏慢之表。甘草缓脾。和中益气。能调不足之阳。然则二物之为方。收阴补阳之为用也。
（十八）发汗后。其人脐下悸者。欲作奔豚。茯苓桂枝甘草大枣汤主之。
茯苓桂枝甘草大枣汤方
茯苓（半斤） 桂枝（四两去皮） 甘草（二两炙） 大枣（十五枚擘）
上四味。以甘澜水一斗。先煮茯苓减二升。内诸药。煮取三升。去滓。温服一升。日三服。
作甘澜水法
取水二斗。置大盆内。以勺扬之。水上有珠子五六千颗相逐。取用之。
脐下悸者。肾乘心汗后液虚。欲上凌心而克之。故动惕于脐下也。欲作。待作未作之谓。奔
豚见上编。然水停心下则悸。茯苓淡渗胜水。能伐肾脏之淫邪。桂枝走阴降肾。能御奔豚于未至。
甘草益气。能补汗后之阳虚。大枣和土。能制为邪之肾水。甘澜水者。操之而使其性抵于纯。不令
其得以助党而长祸也。
（十九）发汗后腹胀满者。浓朴生姜甘草半夏人参汤主之。
浓朴生姜甘草半夏人参汤方
浓朴（半斤去皮炙） 生姜（半斤切） 半夏（半升洗） 人参（一两） 甘草（二两炙）
上五味。以水一斗。煮取三升。去滓。温服一升。日三服。
汗后腹胀满者。胃中干。阳虚气滞而伏饮停蓄也。人参甘草之甘。益胃而滋干。生姜半夏之
辛。蠲饮而散满。然胀非苦不泄。所以浓朴者。君四物而主治也。
（二十）伤寒中风。医反下之。其人下利日数十行。谷不化。腹中雷鸣。心下痞硬而满。干
呕心烦不得安。医见心下痞。谓病不尽。复下之。其痞益甚。此非结热。但以胃中虚。客气上逆。
故使硬也。甘草泻心汤主之。
甘草泻心汤方
甘草（四两炙） 黄芩（三两） 黄连（一两） 干姜（三两） 半夏（半升洗） 大枣
凡是五十七条，共三十二个方子。
太阳经统摄营气与卫气，这是风寒邪气初入人体的两条途径。寒邪容易损伤营气，因此本篇论述的是因营气受寒邪损伤而发病的情况。寒，是冬季的主令之气。秋末春初处于冬夏之间，虽有寒气，但其他时候即使突然变得清冷，大体上也不外乎是本季应有的气候罢了，终究不能算作隆冬严寒的范畴。从疾病的角度来说，必须证候表现完全符合经典记载，才能称为伤寒，不能有丝毫差错。之所以对各病进行分条列举、对比辨析，正是为了将伤寒与其他病症区分开来。读者应当极力反复钻研其宗旨，久而久之熟练精通，一旦融会贯通，那么辨识疾病自然亲切准确，对于各种纷纭的异说，都不会被其所迷惑。务必谨慎啊。
（一）太阳病，有的已经发热，有的尚未发热，必定恶寒，身体疼痛，呕吐逆气，脉象寸关尺三部都紧，这叫做伤寒。
“或”，表示不确定的语气。寒属阴，阴气本不热，但因为寒邪附着人体并客居于阳经，郁结并与阳气相争，相争则蒸腾化为热。“已发热”，是指时机已到，郁结与阳气相争而蒸腾发热的情况；“未发热”，是指初始阶段，郁结但尚未与阳气相争的状态。“必”，表示必然的语气。“恶寒”在上篇已见。这里因为寒邪郁滞于营气，所以营气生病而表现出恶寒。说“必”，意思是发热有早有晚，但恶寒则是必定立即出现的。身体疼痛，是因为寒性坚固凝滞而损伤营气，导致营气充实强盛，卫气虚弱无力。营气强盛则血液涩滞，卫气虚弱则气机阻滞，所以产生疼痛。“呕”，即吐；“逆”，俗称恶心。这是因为胃脘畏惧寒冷，寒气上涌所致。“阴”指关后（尺部），“阳”指关前（寸部）。“俱紧”，指寸关尺三部脉象都急疾有力，这是寒性强劲所致。《难经》说：伤寒的脉象，阴阳两部都盛大且紧涩，说的就是这种情况。“伤”，犹如“中”的意思。彼此互相阐发说明，意思是太阳经受病，中风证确实像前面所说的那样，如果有像本节所述的症状，那就是触犯寒邪而受伤了。然而阴寒之邪侵袭人体，从营气而入。营气，是血的道路。寒邪之所以从营气进入，是因为营气也属阴，同类相吸，这是像龙虎之于风云、水火之于燥湿一样，各自依循类别而相互追随的自然规律。这一段揭示了太阳病分证的第二个纲领，是此篇的小总括。下一条是对此条的申述和互文解释，详细阐述其义理以引出治疗方法，其余条文都是此条的细分差异罢了。首尾脉络、纲领条目，大体都与上编相同，是上篇的对立面，是太阳病的第三次辨析。上编是第一次，此篇是第二次。以下凡是开头称“伤寒”的，都是指具有上述症状的意思。
（二）太阳病，头痛，发热，身体疼痛，腰痛，骨节疼痛，怕风，无汗，并且气喘的，用麻黄汤主治。
麻黄汤方
麻黄（三两，去节） 桂枝（二两，去皮） 甘草（一两，炙） 杏仁（七十枚，热水浸泡，去皮尖）
以上四味药，用水九升，先煮麻黄，减少二升水，去掉水面上的浮沫，加入其他药物，煮取二升半药液，去掉药渣，温服八合，覆盖衣被使身体微微出汗，不需要喝热粥，其余调养方法如同服用桂枝汤的法度。
这是对上一条的申述和互文解释，旨在详细说明病情并引出治疗方法。头痛已在太阳病中见到，这里再次列出，是因为此方专主太阳病初期发病。上一条先说“或已发热，或未发热”，这里先说头痛，次说发热，是针对已经发热的情况而言。身体疼、腰痛、骨节疼痛，就是对上一条“体痛”的详细描述。上一条说“必恶寒”，这里说“恶风”，是互文见意，与上编中“啬啬恶寒，淅淅恶风”的双关互文意思相同。“无汗”，是与上编的“有汗”相对照，以此显示两者相反，从而辨别风寒的不同。如果不是这种证候，就不会提及。然而之所以无汗，是因为汗是血的津液，血属于营，营气强盛则腠理闭密，即使有热，汗也出不来。“喘”，是气逆。卫气主管气，卫气虚弱则气乏逆乱，呼吸不畅，声音气息因此不顺。然而上一条说“呕”，这里说“喘”，呕与喘都是气逆，也是通过互文来阐明互为可见的意思。麻黄味苦性温，力量能发汗散寒。但是在桂枝汤中忌用麻黄，而在麻黄汤中使用桂枝，为什么呢？回答说：麻黄是冲锋陷阵擒拿敌寇的大将，桂枝是在帷幄中运筹帷幄的参军。所以委任麻黄，是有必胜的谋算；监视制约桂枝，是节制运用的妙处。甘草调和脾胃并清除内热，杏仁降气并平定气喘。只有麻黄有专门的功用，所以不需要喝粥来辅助发汗。
（三）伤寒第一天，太阳经受邪。如果脉象平静，说明病邪没有传变。如果病人很想吐，或者烦躁不安，脉象数而急，说明病邪正在传变。
“伤寒”，是依据上面两条互文的意思而言的，下面仿照此例。第一天太阳经受邪，太阳主表而属外，所以外部首先应当受邪。“静”指恬淡退让、平和安宁。脉象由紧转为恬静和平，说明病邪不传变且将要痊愈，可以通过诊脉得知。“颇欲吐”属于上文提到的情况，是不甚想吐但又没吐出来，大概是呕逆还没有完全停止。“燥”，指干燥。“数”，指脉搏五六至以上，主热。“急”，指躁动疾速。想要传变且病情加重是可以知道的。
（四）伤寒第二三天，没有出现阳明病和少阳病的证候，说明病邪没有传变。
“见”，通“现”。上一条列举太阳病而以脉象为主，这里再次列举阳明、少阳而以证候为主，次第反复，互相阐发。然而不传变有两种情况：一种是不传变而自愈，另一种是不传变但也未能解除。如果阳明、少阳的证候虽然没出现，但太阳病也未解除，那么始终停留在太阳经的情况是有的，其他经络同理推断。总之都以脉证所见为准。如果只是模糊拘泥，几天几夜地谈论经络，那就离正道很远了。
（五）脉象浮的，病在表，可以发汗，适宜用麻黄汤。
“表”，指太阳经。伤寒的脉象本来应该紧，如果不紧而表现为浮，说明邪气趋向于还表并想要发散，这是可以知道的。“发”，是开拓而出的意思。麻黄汤，就是趁着邪气想要发散的时候将其拓出体外。
（六）脉象浮而数的，可以发汗，适宜用麻黄汤。
“浮”与上一条相同，而这里多了“数”象。“数”，是伤寒病邪想要传变的征兆。可以说可以发汗且适宜用麻黄汤，意思是趁着寒邪有向表发展的浮脉，应当发散其邪气，不让它发展到传变的程度。
（七）脉象浮数的，按理应当汗出而愈。如果误用下法，导致身体沉重、心悸，就不可再发汗，应当等待自汗出才能解病。为什么会这样呢？因为尺中脉微，这是里虚，需要表里充实，津液自然调和，就会自汗出而痊愈。
这是承接上一条，讲述治疗不合法度因而导致变证的情况，告诫人们应当谨慎。身体沉重，是下法之后阴虚而倦怠。心悸属于心，心主血，阴虚则血虚，所以心神不宁。大概是因为不该用下法却反而用了下法，所以证候变成这样。不可发汗，是禁止再次耗损津液以进一步损伤阴气。应当等待自汗出才能解病，意思是虽然误用下法但病势没有严重变化，须等待津液回复，应当得到自汗而解。之所以这样，以下的文字是对上文词义的申述解释。“里虚”，是从亡失津液的角度说的。“须表里实”，是等待津液回复，邪气回归体表的意思。
（八）伤寒发汗后，病解，过了半天左右，又出现烦热，脉象浮数，可以再发汗，适宜用桂枝汤主治。（“更”，读平声。）
“伤寒发汗”，是指服用麻黄汤来发汗。“解”，是消散的意思。“复”，是重复的意思。既然已经解除了，却又过了半天之久，为什么又会复发呢？是说发汗不如法，汗后护理不严谨，重新又有所复感。大概是因为出汗过多，腠理反而开放，护理不严谨，邪风又容易侵入，所以新近又出现烦热而脉象转为浮数。所以说可以再发汗。“更”，是改变的意思。意思是应当改变前面的治法，所以说适宜用桂枝汤。桂枝汤，是中风解肌的方法，含义深远微妙。庸俗之人不明白病势稍减的含义，不遵守约制，肆意使用粗劣的下法，不理解发汗应当“微似有汗”的宗旨，逞能以大汗为务，导致病证发生变异，反而认为是邪气未尽，汗了又汗，辗转病情加重，最终导致无法挽救，不知悔改醒悟。唉！读书不理解宗旨，赵括就是前车之鉴；学医废弃人命，又有谁以此为鉴呢？真是悲哀啊。
（九）发汗结束后，脉象浮数，烦渴的，用五苓散主治。
“已”，指发汗完毕，并非指病好了。“浮数烦”，与上一条相同，而这里多了“渴”。“渴”，是亡失津液而内部干燥，属于里证。因为证候有里证且人感到燥渴，所以用四苓（茯苓、猪苓、泽泻、白术）来滋润它；因为表证仍在且脉象浮数，所以凭借一味桂枝来调和它。说五苓散能同时解表里，就是这个原因。
（十）伤寒汗出而口渴的，用五苓散主治。不口渴的，用茯苓甘草汤主治。
茯苓甘草汤方
茯苓（二两） 桂枝（二两，去皮） 生姜（三两，切） 甘草（一两）
以上四味药，用水四升，煮取二升药液，去掉药渣，分三次温服。
伤寒不出汗，而出汗的，是指通过发汗使之外出的意思。那么这一条的两个部分，上部分是承接上一条，针对那些不烦的情况再次说明；下部分是承接上部分，针对那些更不渴的情况又列出来。不烦，说明热较轻，所以治疗也没有不同。不渴，说明内部干燥更减轻，所以只用四苓中的一味来润燥。然而里证既轻，那么表证占多数是必然的，所以需要桂枝的三倍用量来解表。那么这个汤的四味药，难道是桂枝汤和五苓散两个方剂的变制吗？
（十一）伤寒汗出病解之后，胃中不和，心下部痞塞坚硬，干噫气伴有食物臭味，胁下有停饮，腹中雷鸣并腹泻的，用生姜泻心汤主治。
生姜泻心汤方
生姜（四两，切） 甘草（三两，炙） 人参（三两） 干姜（一两） 黄芩（三两） 半夏（半升，洗） 黄连（一两） 大枣（十二枚，掰开）
以上八味药，用水一斗，煮取六升药液，去掉药渣，再煎取三升药液，温服一升，每日三次。
“噫”，影戒切音。“解”，指大邪退散。胃属中土，温润则调和。所谓“不和”，是汗后亡失津液，邪气刚刚退散，正气尚未完全恢复而且尚且虚弱。“痞硬”，是伏饮聚结于膈膜。“噫”，是饱食后的叹息。“食臭”，是嗳气带有酸腐气味。普通人吃太饱伤了食积，就会打嗝带食物臭味。病人刚痊愈，脾胃尚且虚弱，运化输导功能不强，即使没有吃太饱，也像吃太饱一样产生这种现象。“水气”，也是指停饮。“雷鸣”，脾属阴，胃属阳，阴阳不调，相互搏动产生的声音。“下利”，只有阴阳不调，水谷就不能分清，所以混杂奔注而下。生姜和大枣，益胃健脾；黄芩和黄连，清上焦并固护下焦；半夏和干姜，祛除停饮并消散痞结；人参和甘草，益气并调和脾胃。那么“泻心”，就是强健脾脏使其输布正常，补益胃腑使其消化正常，这就是所谓消除心下部痞塞坚硬的意思。
（十二）发汗后，病不解反而恶寒的，是虚证，用芍药甘草附子汤主治。
芍药甘草附子汤方
芍药（三两） 甘草（三两，炙） 附子（一枚，炮制，去皮，破成八片）
以上三味药，用水五升，煮取一升五合药液，去掉药渣，分三次温服。
未发汗而恶寒，是邪气盛而表实，如同仇敌般的厌恶。已发汗而恶寒，是邪气退而表虚，如同怯懦般的厌恶。大概是因为出汗之后，大邪退散，营气衰微，卫气疏慢，病虽未完全解除，但不发生其他病变只是恶寒，所以说是“虚”，指表气新近虚弱而不是病变。然而营属阴，阴气衰微，所以用芍药的酸味来收敛它；卫属阳，阳气疏慢，所以用附子的辛味来固护它。甘草甘平，能调和荣卫使之和谐，这是国老（甘草）的专长。
（十三）发汗后恶寒的，是虚证；不恶寒只发热的，是实证。应当调和胃气，给予调胃承气汤。
上节是略述上一条并再次说明，用来引起下文，并以“反”字引出。不恶寒，说明此人表气强盛。只发热，是亡失津液而胃中干燥，所以说是“实”。应当调和胃气，是因为干燥在胃中且呈实证。所以说，给予调胃承气汤。然而汤剂是用来泻实的，而甘草则是和中益气的，为什么呢？大概是因为实证形成于虚证基础之上。所谓“量凿而正枘”（根据榫眼的大小来制作榫头），说的就是这个道理。方剂见太阳病下篇。
（十四）发汗后，身体疼痛，脉象沉迟的，用桂枝加芍药生姜各一两、人参三两的新加汤主治。
桂枝新加汤方
桂枝（三两，去皮） 芍药（四两） 甘草（二两，炙） 人参（三两） 生姜（四两，切） 大枣（十二枚，掰开）
以上六味药，用水一斗一升，用小火煮取三升药液，去掉药渣，分次温服。按照桂枝汤的法度调养。
发汗后身体疼痛、脉象沉迟，是邪气骤然去除，气血突然虚弱。使用桂枝，是为了调和荣卫，不让突然虚弱的气血容易受到重伤。加入人参、芍药，是为了收复阴阳以补益虚弱。加入生姜，是为了健旺刚刚恢复的胃气以安顿谷物。称为“新加”，难道不是补足一百一十三方之意吗？小火煎煮都应当效仿第一个方子，这大概是后人添加的赘余。
（十五）发汗后，不可再用桂枝汤。汗出且气喘、没有明显高热的，可以用麻黄杏仁甘草石膏汤主治。
麻黄杏仁甘草石膏汤方
麻黄（四两，去节） 杏仁（五十个，去皮尖） 甘草（二两，炙） 石膏（半斤，捣碎，用绵布包裹）
以上四味药，用水七升，先煮麻黄，减少二升水，去掉水面上的浮沫，加入其他药物，煮取二升药液，去掉药渣，温服一升。
“更行”，犹言再用。不可再用桂枝汤，则是已经用过所以禁止。大概伤寒应当发汗，不应当用桂枝汤。桂枝固护卫气，寒邪不得泄出，而气机反而上逆，所以气喘更加严重。“无大热”，是郁伏而不显见的状态。因为伤寒的表证仍在，所以用麻黄来发散它，杏仁降气定喘，甘草退热和中，本是麻黄汤的正治佐使药。石膏有透彻热邪的功效，尤其能帮助降气平喘的作用，所以用石膏代替桂枝，作为麻黄汤的变制，这也是太阳伤寒误汗转致气喘的主治方，所以必须由这四味药组成才可以施行。
（十六）发汗后，饮水多的必定气喘，用水冲洗身体也会气喘。
气喘属于肺，肺属金，金性寒，所以说“形寒饮冷则伤肺”。汗后肺气新近虚弱，容易受到重伤。饮水，指喝冷水。用水冲洗则形体受寒，肺受伤了。它们主管气，所以都会气喘。
（十七）发汗过多，病人双手交叉按在心口，心下部悸动，喜欢按压的，用桂枝甘草汤主治。
桂枝甘草汤方
桂枝（四两，去皮） 甘草（二两，炙）
以上两味药，用水三升，煮取一升药液，去掉药渣，一次性服下。
出汗多则血伤，血伤则心虚，心虚则心动惕进而心悸，所以双手交叉覆盖在心口并希望被人按压。桂枝走阴，收敛津液宅于心，能固护疏慢的表气；甘草缓脾，调和脾胃益气，能调补不足的阳气。那么这两味药组成的方剂，作用是收阴补阳。
（十八）发汗后，病人脐下悸动的，是要发作奔豚病，用茯苓桂枝甘草大枣汤主治。
茯苓桂枝甘草大枣汤方
茯苓（半斤） 桂枝（四两，去皮） 甘草（二两，炙） 大枣（十五枚，掰开）
以上四味药，用甘澜水一斗，先煮茯苓，减少二升水，加入其他药物，煮取三升药液，去掉药渣，温服一升，每日三次。
制作甘澜水的方法
取水二斗，放入大盆内，用勺子扬水，水面上有珠子五六千颗互相追逐，取用这种水。
脐下悸动，是肾气乘人心虚汗后津液亏虚，想要上凌心火而克制它，所以在脐下跳动。“欲作”，指等待发作尚未发作的意思。“奔豚”见上编。然而水停在心下则悸动，茯苓淡渗利水胜过水邪，能伐除肾脏的淫邪；桂枝走阴降肾，能在奔豚未至时抵御它；甘草益气，能补汗后之阳虚；大枣和土，能制约为邪的肾水。甘澜水，是通过操作使其性质达到纯粹，不让它得以助长祸患。
（十九）发汗后腹胀满的，用浓朴生姜甘草半夏人参汤主治。
浓朴生姜甘草半夏人参汤方
浓朴（半斤，去皮，炙） 生姜（半斤，切） 半夏（半升，洗） 人参（一两） 甘草（二两，炙）
以上五味药，用水一斗，煮取三升药液，去掉药渣，温服一升，每日三次。
汗后腹胀满，是胃中干燥，阳虚气滞而停饮蓄积。人参、甘草的甘味，益胃并滋润干燥；生姜、半夏的辛味，祛除停饮并消散胀满。然而胀满非苦味不能泄，所以浓朴作为君药统领四味药主治此证。
（二十）伤寒或中风，医生反而用下法。病人每天腹泻几十次，完谷不化，腹中雷鸣，心下部痞塞坚硬且满闷，干呕，心烦不得安宁。医生看到心下部痞塞，认为病邪未尽，再次用下法，痞塞更加严重。这不是结热，只是因为胃中虚，客气上逆，所以使心下部变硬。用甘草泻心汤主治。
甘草泻心汤方
甘草（四两，炙） 黄芩（三两） 黄连（一两） 干姜（三两） 半夏（半升，洗） 大枣
There are fifty-seven clauses in total, comprising thirty-two prescriptions.
The Taiyang (Greater Yang) channel governs Ying (Nutrient Qi) and Wei (Defensive Qi), which constitute the two pathways through which Wind-Cold pathogens initially enter the body. Cold pathogens tend to injure Ying; therefore, this chapter discusses conditions where Ying is injured by Cold, leading to disease. "Cold" refers to the climatic characteristic of Winter. Late Autumn and early Spring lie between seasons, and while Cold may be present, other times when the weather suddenly becomes clear and cold generally do not deviate from the seasonal climate order. Ultimately, such instances cannot be categorized under the severe cold of mid-winter. From a pathological perspective, only when symptoms manifest exactly as described in the classics can it be termed "Shanghan" (Cold Damage). There must be no slightest deviation. The reason the classics categorize diseases into specific clauses and compare them for differentiation is precisely to distinguish Shanghan from other conditions. Readers should strive to repeatedly investigate and thoroughly understand these principles. With long-term study and mastery, once comprehensively integrated, disease identification will become naturally accurate and intimate. Confusion arising from various conflicting theories will not mislead one. Caution is paramount.
(1) In Taiyang disease, there may be fever already present, or fever may not yet have appeared, but chills (aversion to cold) are invariably present. Accompanying symptoms include body pain, vomiting, and rebellious Qi (nausea/retching). If the pulse is tight at both Yin (post-cinnabar point) and Yang (pre-cinnabar point) positions, it is named Shanghan.
"Or" indicates uncertainty. Cold belongs to Yin, and Yin is not hot. However, because Cold adheres to the body and lodges in the Yang channels, it stagnates and contends with Yang. This contention generates heat through steaming. "Fever already present" refers to the timing being ripe, where stagnation and contention lead to steaming heat. "Fever not yet present" refers to the initial stage, where stagnation exists but contention has not yet occurred. "Invariably" indicates certainty. "Chills" were mentioned in the previous chapter. Here, however, Chills appear because Cold pathogens stagnate Ying, causing Ying pathology to manifest as chills. The term "invariably" implies that while the onset of fever varies in time, chills are certain to appear immediately. "Body pain" occurs because Cold is firm and coagulating, injuring Ying. This causes Ying to become full and strong, while Wei becomes deficient and weak. When Ying is strong, blood flow becomes stagnant; when Wei is weak, Qi stagnates, resulting in pain. "Vomiting" refers to expelling contents; "rebellious Qi" colloquially refers to nausea. This happens because the stomach cavity fears Cold, causing Cold to surge upward. "Yin" refers to the position behind the cinnabar point (radial artery), and "Yang" refers to the position before it. "Both tight" means the pulse is rapid and tense across all three positions (Cun, Guan, Chi), a manifestation of the strong and forceful nature of Cold. The *Nanjing* states: "The pulse of Shanghan is abundant and tight in both Yin and Yang," which describes this condition. "Shang" (injure) is akin to "Zhong" (strike/hit). These clauses mutually illuminate each other, explaining that while Taiyang disease presents differently in Wind Strike, if such symptoms as described above occur, it indicates injury by Cold. Yin-Cold pathogens invade the body via Ying. Ying is the pathway of Blood. Cold enters via Ying because Ying also belongs to Yin, following the principle of similarity. This is natural, like Dragons and Tigers corresponding to Wind and Clouds, or Water and Fire corresponding to Dryness and Moisture, each following its own kind. This section outlines the second major category of Taiyang differentiated diseases, serving as a brief summary of this chapter. The next clause elaborates on this with mutual textual references, detailing the rationale to derive treatment methods. The remaining clauses are subdivisions of this primary clause. The structure, guidelines, and items largely resemble the previous volume, acting as a counterpart to the first volume's discussion. This is the third differentiation of Taiyang. The previous volume was the first; this is the second. Henceforth, whenever "Shanghan" is cited at the beginning of a clause, it refers specifically to the condition possessing the aforementioned characteristics.
(2) In Taiyang disease, characterized by headache, fever, body pain, lower back pain, joint pain, aversion to wind, absence of sweating, and wheezing, Mahuang Tang (Ephedra Decoction) is the primary prescription.
Mahuang Tang Prescription
Ephedrae Herba (Mahuang, 麻黄) - 3 liang, nodes removed
Cinnamon Twig (Guizhi, 桂枝) - 2 liang, bark removed
Licorice Root (Gancao, 甘草) - 1 liang, honey-fried
Apricot Seed (Xingren, 杏仁) - 70 seeds, soaked in hot water, skin and tips removed
Take the four ingredients. Add nine sheng of water. First, decoct Ephedra until the volume reduces by two sheng. Remove the foam from the surface. Add the remaining herbs. Decoct until two and a half sheng remain. Strain. Take eight he of the warm decoction. Cover the patient to induce a slight, uniform sweat. Drinking hot porridge is not required. Rest and care instructions follow those for Guizhi Tang (Cinnamon Twig Decoction).
This clause elaborates on the previous one through mutual reference, providing detail and deriving treatment. Headache was already mentioned in Taiyang disease; listing it again emphasizes that this clause focuses on the initial onset of Taiyang disease. The previous clause stated "fever may or may not be present," whereas this clause lists headache first, then fever, addressing cases where fever is already present. Body pain, lower back pain, and joint pain are detailed descriptions of the "body pain" mentioned previously. The previous clause stated "invariably chills," while this states "aversion to wind," employing mutual textual variation, similar to the dual meaning of "shivering chills" and "chilly wind" in the previous volume. "Absence of sweating" contrasts with the "presence of sweating" in the previous volume, highlighting their opposition to differentiate Wind from Cold. Otherwise, such symptoms would not be noted. The reason for absence of sweating is that sweat is the fluid of Blood, and Blood belongs to Ying. When Ying is strong, the interstices (couli) close tightly; thus, even with fever, sweat cannot escape. "Wheezing" indicates rebellious Qi. Wei governs Qi; when Wei is weak, Qi becomes deficient and rebellious, leading to difficult breathing and abnormal respiratory sounds. The previous clause mentioned "vomiting," while this mentions "wheezing." Both involve rebellious Qi, illustrating mutual visibility through textual variation. Mahuang is bitter and warm in nature, capable of inducing sweating to disperse Cold. However, Mahuang is contraindicated in Guizhi Tang, yet Guizhi is used in Mahuang Tang. Why? Mahuang is like a general charging into battle to capture the enemy, while Guizhi is like an advisor strategizing in the command tent. Entrusting Mahuang ensures victory; supervising with Guizhi provides strategic control. Licorice harmonizes the middle and clears heat. Apricot seed directs Qi downward and calms wheezing. Only Mahuang possesses this specialized efficacy, hence the need for porridge assistance is absent.
(3) On the first day of Shanghan, the Taiyang channel is affected. If the pulse remains calm/stable, the disease has not transmitted. If the patient desires to vomit significantly, or experiences restlessness/agitation with a rapid and urgent pulse, transmission is occurring.
"Shanghan" here refers to the context established by the previous two clauses, applied similarly thereafter. On the first day, Taiyang is affected. Taiyang governs the exterior and belongs to the outside, so external factors affect it first. "Stable" implies tranquility and harmony. A pulse transitioning from tight to tranquil and harmonious indicates non-transmission and impending recovery. "Desires to vomit significantly" relates to the earlier mention; the patient does not strongly desire to vomit nor actually vomits, suggesting that rebellious Qi/vomiting has not fully ceased. "Restless" refers to dryness/agitation. "Rapid" indicates five or six beats per breath cycle or more, signifying Heat. "Urgent" denotes impatience or speed. This indicates impending transmission and progression.
(4) On the second or third day of Shanghan, if Yangming and Shaoyang syndromes are not observed, transmission has not occurred.
"Observe" (xian) is pronounced as "appear." The previous clause cited Taiyang based on pulse; this clause cites Yangming and Shaoyang based on symptoms, repeating and mutually illuminating the sequence. Non-transmission has two outcomes: either spontaneous resolution or persistent unresolved status. If Yangming and Shaoyang symptoms are absent but Taiyang symptoms persist without resolving, the disease remains in Taiyang. This logic applies to other channels. Ultimately, diagnosis relies on observed pulse and symptoms. Mere speculation over days regarding channels misses the mark entirely.
(5) If the pulse is floating, the disease is at the exterior. Sweating therapy is indicated; Mahuang Tang is appropriate.
"Exterior" refers to Taiyang. The pulse in Shanghan is typically tight. If it is not tight but floating, it indicates the pathogen is returning to the exterior and attempting to dissipate. "Release" (fa) means to push out. Mahuang Tang is used to exploit this tendency to dissipate by pushing the pathogen out. (Prescription seen above).
(6) If the pulse is floating and rapid, sweating therapy is indicated; Mahuang Tang is appropriate.
"Floating" is as described above. "Rapid" indicates the potential for transmission in Shanghan. Indicating sweating and Mahuang Tang here means exploiting the floating pulse (indicating outward movement of Cold) to disperse the rapidity and prevent transmission.
(7) If the pulse is floating and rapid, the law dictates recovery through sweating. If purgation is incorrectly applied, resulting in heavy body sensation and palpitations, sweating is contraindicated. Recovery will occur through spontaneous sweating. The reason is that the Chi (cun) pulse is faint, indicating interior deficiency. Table and interior must be strengthened; when fluids harmonize spontaneously, sweating will occur, leading to recovery.
This follows the previous clause, discussing complications arising from improper treatment, warning caution. Heavy body sensation results from Yin deficiency after purgation, causing fatigue. Palpitations relate to the Heart, which governs Blood. Yin deficiency leads to Blood deficiency, causing heart unrest. Incorrect purgation caused this change. Sweating is forbidden to prevent further loss of fluids and damage to Yin. Spontaneous sweating indicates recovery because, although purged incorrectly, the condition hasn't severely deteriorated; waiting for fluid restoration allows spontaneous sweating to resolve the issue. The explanation below clarifies this. "Interior deficiency" refers to fluid loss. "Strengthen table and interior" awaits fluid restoration and pathogen return to the exterior.
(8) After Shanghan sweating therapy resolves, about half a day later, if vexation recurs and the pulse is floating and rapid, sweating may be repeated; Guizhi Tang is appropriate. ("Geng" is read as a level tone.)
"Sweating therapy for Shanghan" refers to administering Mahuang Tang. "Resolve" means dispersal. "Recurs" means repetition. Although resolved, half a day has passed. Why recurrence? It indicates improper sweating technique or poor post-sweat care, allowing new pathogenic invasion. Excessive sweating opens the interstices; careless protection allows wind pathogens to re-enter, causing new vexation and a floating-rapid pulse. Thus, sweating may be repeated. "Geng" means change. The method should be changed; hence, Guizhi Tang is appropriate. Guizhi Tang is the method for releasing the muscle layer in Wind Strike, with profound significance. Vulgar practitioners fail to understand the meaning of slight improvement, ignore protocols, use crude purgatives arbitrarily, and misunderstand the principle of slight sweating, aiming for profuse sweating. This causes complications, mistakenly attributed to residual pathogens, leading to repeated sweating, worsening condition, and untreatable states. They fail to repent. Alas, failing to grasp principles in study, Zhao Kuo serves as a warning. Neglecting human life in medicine, who serves as a warning? Tragic.
(9) After sweating is completed, if the pulse is floating and rapid, accompanied by vexation and thirst, Wuling San (Five-Ingredient Powder with Poria) is appropriate.
"Completed" means sweating is finished, not that the disease is cured. "Floating, rapid, vexation" are same as above, but here accompanied by "thirst." Thirst indicates fluid loss and internal dryness, a interior syndrome. Because there is an interior syndrome with dryness and thirst, Si Ling (Four-Ingredient component) is used to moisten. Because exterior signs persist with floating-rapid pulse, Gui Zhi (Cinnamon Twig) is used to harmonize. This explains why Wuling San resolves both exterior and interior. (Prescription seen in previous volume).
(10) In Shanghan, if sweating occurs with thirst, Wuling San is appropriate. If there is no thirst, Fuling Gancao Jiangtang (Poria, Licorice, and Ginger Decoction) is appropriate.
Fuling Gancao Jiangtang Prescription
Poria (Fuling, 茯苓) - 2 liang
Cinnamon Twig (Guizhi, 桂枝) - 2 liang, bark removed
Fresh Ginger (Shengjiang, 生姜) - 3 liang, sliced
Licorice Root (Gancao, 甘草) - 1 liang
Take the four ingredients. Add four sheng of water. Decoct to two sheng. Strain. Divide into three warm doses.
Saying Shanghan does not sweat, but sweats, refers to induced sweating. The two parts of this clause: the upper part reiterates the previous clause focusing on the absence of vexation; the lower part adds the absence of thirst. Absence of vexation implies milder heat, so treatment is similar. Absence of thirst implies less internal dryness, so only one ingredient from Si Ling is used to moisten. Since interior syndrome is mild, exterior syndrome likely predominates, requiring triple dosage of Gui Zhi to resolve exterior. Thus, this prescription appears to be a modification of Guizhi Tang and Wuling San.
(11) After Shanghan sweating resolves, if the stomach is disharmonious, presenting with epigastric fullness and hardness, belching with food odor, water qi under the flanks, borborygmus, and diarrhea, Shengjiang Xiexin Tang (Fresh Ginger Heart-Draining Decoction) is appropriate.
Shengjiang Xiexin Tang Prescription
Fresh Ginger (Shengjiang, 生姜) - 4 liang, sliced
Licorice Root (Gancao, 甘草) - 3 liang, honey-fried
Ginseng Root (Renshen, 人参) - 3 liang
Dried Ginger (Ganjiang, 干姜) - 1 liang
Scutellaria Root (Huangqin, 黄芩) - 3 liang
Pinellia Tuber (Banxia, 半夏) - 0.5 sheng, washed
Coptis Rhizome (Huanglian, 黄连) - 1 liang
Jujube Fruit (Dazao, 大枣) - 12 pieces, split
Take the eight ingredients. Add ten dou of water. Decoct to six sheng. Strain. Re-decoct to three sheng. Take one sheng warm, three times daily.
"Belching" (yi). "Resolve" means major pathogens have dispersed. The Stomach belongs to Central Earth; warmth and moisture bring harmony. Disharmony arises from fluid loss after sweating, with pathogens just dispersing and righteous Qi not fully restored and still weak. "Fullness and hardness" refers to retained fluid accumulating in the diaphragm. "Belching" is sighing after full meals. "Food odor" is the smell of food. Overeating damages food digestion, causing belching with food odor. After initial recovery, Spleen and Stomach are weak, transformation and transportation are not strong. Even without overeating, it resembles overeating effects. "Water qi" refers to fluid retention. "Borborygmus" is the sound of Yin (Spleen) and Yang (Stomach) clashing due to disharmony. "Diarrhea" occurs because Yin-Yang disharmony prevents proper separation of clear and turbid water and grain, causing mixed discharge. Fresh Ginger and Jujube benefit the Stomach and strengthen Spleen. Scutellaria and Coptis clear the upper and secure the lower. Pinellia and Dried Ginger eliminate fluid and dissipate fullness. Ginseng and Licorice boost Qi and harmonize the middle. Thus, "Heart-Draining" means strengthening Spleen transport and benefiting Stomach digestion, thereby draining the epigastric fullness and hardness.
(12) After sweating, if the disease does not resolve but aversion to cold increases, it is a deficiency syndrome. Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction) is appropriate.
Shaoyao Gancao Fuzi Tang Prescription
White Peony Root (Shaoyao, 芍药) - 3 liang
Licorice Root (Gancao, 甘草) - 3 liang, honey-fried
Prepared Aconite Root (Fuzi, 附子) - 1 piece, processed, bark removed, broken into eight pieces
Take the three ingredients. Add five sheng of water. Decoct to one and a half sheng. Strain. Divide into three warm doses.
Aversion to cold before sweating indicates excess pathogens and solid exterior, like hostility. Aversion to cold after sweating indicates resolved pathogens and deficient exterior, like timidity. After sweating, major pathogens disperse, Ying Qi declines, and Wei Qi becomes lax. Although the disease isn't fully resolved, no other changes occur except aversion to cold, hence termed "deficiency." This refers to new exterior Qi deficiency, not pathological change. Ying belongs to Yin; declining Yin requires Sour Peony to astringe. Wei belongs to Yang; lax Yang requires Pungent Aconite to consolidate. Licorice is sweet and neutral, harmonizing Ying and Wei, excelling in this role (like the "Old Statesman").
(13) After sweating, aversion to cold indicates deficiency. Absence of aversion to cold with only heat indicates excess. Harmonize Stomach Qi with Tiaowei Chengqi Tang (Harmonizing the Stomach and Directing Downward Decoction).
The upper part briefly repeats the previous clause to introduce the text below, highlighting the "contrary" aspect. No aversion to cold indicates strong exterior Qi. Only heat indicates fluid loss and dry Stomach, hence "excess." Harmonize Stomach Qi because dryness and excess reside in the Stomach. Thus, administer Tiaowei Chengqi Tang. Although the decoction drains excess, Licorice harmonizes the middle and boosts Qi. Why? Excess forms upon deficiency. As the saying goes, "fit the tenon to the mortise," referring to this principle. (Prescription seen in Taiyang Lower Volume).
(14) After sweating, if body pain persists and the pulse is deep and slow, Guizhi Jia Shaoyao Shengjiang Ge Yi Liang Renshen San Liang Xinjia Tang (Guizhi Decoction with Added Peony and Ginger, One Liang Each, and Ginseng, Three Liangs, New Addition Decoction) is appropriate.
Guizhi Xinjia Tang Prescription
Cinnamon Twig (Guizhi, 桂枝) - 3 liang, bark removed
White Peony Root (Shaoyao, 芍药) - 4 liang
Licorice Root (Gancao, 甘草) - 2 liang, honey-fried
Ginseng Root (Renshen, 人参) - 3 liang
Fresh Ginger (Shengjiang, 生姜) - 4 liang, sliced
Jujube Fruit (Dazao, 大枣) - 12 pieces, split
Take the six ingredients. Add eleven sheng of water. Simmer gently to obtain three sheng. Strain. Divide and take warm, following Guizhi Tang methods.
After sweating, body pain with deep-slow pulse indicates sudden removal of pathogens and abrupt deficiency of Blood and Qi. Guizhi harmonizes Ying and Wei, preventing severe injury from abrupt deficiency. Adding Ginseng and Peony recovers Yin and Yang to supplement deficiency. Adding Fresh Ginger strengthens the newly recovered Stomach Qi to settle food grains. "New Addition" implies completing the set of 113 formulas. Gentle simmering should follow the first formula. This note is likely a later addition.
(15) After sweating, Guizhi Tang must not be used again. If sweating occurs with wheezing and no significant heat, Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction) is appropriate.
Mahuang Xingren Gancao Shigao Tang Prescription
Ephedrae Herba (Mahuang, 麻黄) - 4 liang, nodes removed
Apricot Seed (Xingren, 杏仁) - 50 seeds, skin and tips removed
Licorice Root (Gancao, 甘草) - 2 liang, honey-fried
Gypsum (Shigao, 石膏) - 0.5 jin, crushed, wrapped in muslin
Take the four ingredients. Add seven sheng of water. First, decoct Ephedra until volume reduces by two sheng. Remove foam. Add other herbs. Decoct to two sheng. Strain. Take one sheng warm.
"Geng xing" means using again. Guizhi Tang is prohibited because it has already been used. Shanghan requires sweating, but Guizhi Tang is inappropriate. Guizhi consolidates Wei, preventing Cold release and causing Qi rebellion, worsening wheezing. "No significant heat" means latent heat not visibly apparent. Since Shanghan exterior pathogen remains, Ephedra is used to release it. Apricot seed directs Qi down and calms wheezing. Licorice clears heat and harmonizes the middle, serving as assistant to Ephedra. Gypsum has the power to penetrate heat and aids in directing Qi down to calm wheezing. Thus, Guizhi is replaced by Gypsum, creating a variation of Mahuang Tang, the main treatment for Taiyang Shanghan complicated by wheezing after mistaken sweating. All four ingredients are necessary for efficacy.
(16) After sweating, drinking large amounts of water inevitably causes wheezing. Washing the body with water also causes wheezing.
Wheezing relates to the Lung, which belongs to Metal. Metal is cold; thus, "cold form and cold drinks injure the Lung." After sweating, Lung Qi is newly deficient and easily injured. Drinking water implies cold drinks. Washing with water causes external cold. Lung injury leads to wheezing as they govern Qi.
(17) After excessive sweating, if the person crosses hands over the heart region, feels palpitations in the epigastrium, and desires pressure, Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction) is appropriate.
Guizhi Gancao Tang Prescription
Cinnamon Twig (Guizhi, 桂枝) - 4 liang, bark removed
Licorice Root (Gancao, 甘草) - 2 liang, honey-fried
Take the two ingredients. Add three sheng of water. Decoct to one sheng. Strain. Take in one dose.
Excessive sweating injures Blood; Blood injury leads to Heart deficiency. Heart deficiency causes trembling and palpitations. Hence, crossing hands over the heart and desiring pressure. Guizhi moves inward, astringes fluids, and anchors the Heart, consolidating lax exterior. Licorice soothes the Spleen, harmonizes the middle, and boosts Qi, regulating deficient Yang. This two-ingredient formula functions to collect Yin and tonify Yang.
(18) After sweating, if palpitations occur below the umbilicus, indicating impending Ben Tun (Running Piglet) syndrome, Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) is appropriate.
Fuling Guizhi Gancao Dazao Tang Prescription
Poria (Fuling, 茯苓) - 0.5 jin
Cinnamon Twig (Guizhi, 桂枝) - 4 liang, bark removed
Licorice Root (Gancao, 甘草) - 2 liang, honey-fried
Jujube Fruit (Dazao, 大枣) - 15 pieces, split
Take the four ingredients. Add one dou of Ganlan Water (Agitated Water). First, decoct Poria until volume reduces by two sheng. Add other herbs. Decoct to three sheng. Strain. Take one sheng warm, three times daily.
Method for preparing Ganlan Water:
Take two dou of water, place in a large basin. Agitate with a ladle until 5,000-6,000 pearl-like bubbles chase each other on the surface. Use this water.
Palpitations below the umbilicus indicate Kidney Qi attacking the Heart due to fluid deficiency after sweating, with Kidney Water threatening to ascend and overcome Heart Fire, causing trembling below the umbilicus. "Impending" means awaiting onset. "Ben Tun" is seen in the previous volume. Fluid retention in the Heart region causes palpitations. Poria is bland and leaching, overcoming water and suppressing Kidney excess. Guizhi moves inward, directs Kidney Qi downward, and prevents Ben Tun before it arrives. Licorice boosts Qi, compensating for Yang deficiency post-sweating. Jujube harmonizes Earth, restraining pathogenic Kidney Water. Ganlan Water, through agitation, achieves pure nature, preventing it from aiding evil and causing disaster.
(19) After sweating, if abdominal fullness occurs, Houpo Shengjiang Gancao Banxia Renshen Tang (Magnolia Bark, Fresh Ginger, Licorice, Pinellia, and Ginseng Decoction) is appropriate.
Houpo Shengjiang Gancao Banxia Renshen Tang Prescription
Magnolia Bark (Houpo, 厚朴) - 0.5 jin, bark removed, honey-fried
Fresh Ginger (Shengjiang, 生姜) - 0.5 jin, sliced
Pinellia Tuber (Banxia, 半夏) - 0.5 sheng, washed
Ginseng Root (Renshen, 人参) - 1 liang
Licorice Root (Gancao, 甘草) - 2 liang, honey-fried
Take the five ingredients. Add one dou of water. Decoct to three sheng. Strain. Take one sheng warm, three times daily.
Abdominal fullness after sweating indicates Stomach dryness, Yang deficiency with Qi stagnation, and retained fluid. Sweetness of Ginseng and Licorice benefits the Stomach and moistens dryness. Pungency of Fresh Ginger and Pinellia eliminates fluid and dissipates fullness. However, fullness requires Bitterness to drain; thus, Magnolia Bark acts as the sovereign herb among the four to treat the condition.
(20) In Shanghan or Fengzhong (Wind Strike), if the physician incorrectly uses purgation, the patient suffers diarrhea dozens of times daily, undigested food, borborygmus, epigastric fullness and hardness, dry retching, vexation, and inability to rest. Seeing epigastric fullness, the physician assumes incomplete pathogen elimination and purges again, worsening the fullness. This is not accumulated Heat, but rather Stomach deficiency with rebellious hostile Qi ascending, causing hardness. Gancao Xiexin Tang (Licorice Heart-Draining Decoction) is appropriate.
Gancao Xiexin Tang Prescription
Licorice Root (Gancao, 甘草) - 4 liang, honey-fried
Scutellaria Root (Huangqin, 黄芩) - 3 liang
Coptis Rhizome (Huanglian, 黄连) - 1 liang
Dried Ginger (Ganjiang, 干姜) - 3 liang
Pinellia Tuber (Banxia, 半夏) - 0.5 sheng, washed
Jujube Fruit (Dazao, 大枣)