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。
太阳主一身之表，风寒外束，阳气不伸，故一身尽疼。太阳脉抵腰中，故腰痛。太阳主筋所生病，诸筋者，
皆属于节，故骨节疼痛。从风寒得，故恶风。风寒客于人则皮毛闭，故无汗。太阳为诸阳主气，阳气郁于内，故
喘。太阳为开，立麻黄汤以开之，诸症悉除矣。麻黄八症，头痛，发热、恶风，同桂枝症，无汗、身疼，同大青
龙症，本症重在发热、身疼、无汗而喘。
本条不冠伤寒，又不言恶寒而言恶风。先辈言麻黄汤主治伤寒不治中风，似非确论。盖麻黄汤、大青龙汤治
中风之重剂，桂枝汤、葛根汤治中风之轻剂，伤寒可通用之，非主治伤寒之剂也。
脉浮者，病在表，可发汗，麻黄汤。脉浮而数者，可发汗，宜麻黄汤。
前条论症，此条论脉。言浮而不言迟弱者，是浮而有力也。然必审其热在表，乃可用。若浮而大，有热属藏者，
当攻之，不令发汗矣。若浮数而痛偏一处者，身虽疼，不可发汗。
数者，急也，即紧也。紧则为寒，指受寒而言；数则为热，指发热而言。辞虽异而意则同。故脉浮紧者，
即是麻黄汤症。
脉浮而数，浮为风，数为虚。风为热，虚为寒，风虚相搏，则洒淅恶寒也。
脉浮为在表者何？以表有风邪故也。邪之所凑，其气必虚。数本为热，而从浮见，则数为虚矣。风为阳邪，
阳浮则热自发。数为阳虚，阳虚则畏寒。凡中风寒，必发热恶寒者，风虚相搏而然也。
诸脉浮数，当发热而洒淅恶寒，若有痛处、饮食如常者，蓄积有脓也。
浮数之脉，而见发热恶寒之症，不独风寒相同，而痈疡亦有然者。此浮为表而非风，数为实热而非虚矣。
发热为阳浮，而恶寒非阳虚矣。若欲知其不是风寒，当以内外症辨之。外感则头项痛、身痛、骨节痛、腰脊痛，
非痛偏一处也。外感则呕逆，或干呕，不得饮食如常。如此审之，有蓄积而成痈脓者，庶不致误作风寒治，
则举疮家一症例之。治伤寒者，见脉症之相同，皆当留意也。
疮家身虽疼，不可发汗，汗出则痉。
疮家病与外感不同，故治法与风寒亦异。若以风寒之法治之，其变亦不可不知也。疮虽痛偏一处，而血气
壅遏，亦有遍身疼者。然与风寒有别，汗之则津液越出，筋脉血虚，挛急而为痉矣。诸脉症之当审，正此故耳。
脉浮数者，法当汗出而愈。若身重心悸者，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，便汗出愈。
脉浮数者，于法当汗，而尺中微，则不敢轻汗，以麻黄为重剂故也。此表指身，里指心，有指营卫而反遗
心悸者，非也。身重是表热，心悸是里虚，然悸有因心下水气者，亦当发汗。故必审其尺脉，尺中脉微为里虚。
里虚者，必须实里，欲津液和，须用生津液。若坐而待之，则表邪愈盛，心液愈虚，焉能自汗？此表是带言，
只重在里。至于自汗出，则里实而表和矣。
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，骨肉烦疼，当发其汗也。
风寒本自相因，必风先开腠理，寒得入于经络。营卫俱伤，则一
身内外之阳不得越，故骨肉烦疼，脉亦应其象而变见于寸口也。紧为阴寒，而从浮见，阴盛阳虚，汗之则愈矣。
紧者，急也，即数也。紧以形象言，数以至数言。紧则为寒，指伤寒也；数则为热，指发热也。辞异而义则
同，故脉浮数浮紧者，皆是麻黄症。
脉法以浮为风，紧为寒，故提纲以脉阴阳俱紧者名伤寒。大青龙脉亦以浮中见紧，故名中风。则脉但浮者，
正为风脉，宜麻黄汤，是麻黄汤固主中风脉症矣。麻黄汤症发热、骨节疼，便是骨肉烦疼，即是风寒两伤，营
卫俱病。先辈何故以大青龙治营卫两伤？麻黄汤治寒伤营而不伤卫？桂枝汤治风伤卫而不伤营？曷不以桂枝症
之恶寒，麻黄症之恶风，一反勘耶？要之冬月风寒，本同一体。故中风伤寒，皆恶风恶寒，营病卫必病。中风
之重者，便是伤寒；伤寒之浅者，便是中风。不必在风寒上细分，须当在有汗无汗上着眼耳。
太阳病，脉浮紧、无汗、发热、身疼痛，八九日不解，表症仍在，此当发其汗，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。
脉症同大青龙，而异者外不恶寒，内不烦躁耳。发于阳者七日愈，八九日不解，其人阳气重可知。然脉紧、
无汗、发热、身疼，是麻黄症未罢。仍与麻黄，只微除在表之风寒，而不解内扰之阳气。其人发烦、目瞑，见不
堪之状，可知阳络受伤，必逼血上行而衄矣。血之与汗，异名同类，不得汗，必得血，不从汗解而从衄解。此与
热结膀胱血自下者，同一局也。
太阳脉，从自目内 络阳明脉于鼻。鼻者阳也，目者阴也，血虽阴类。从阳气而升，则从阳窍而出。故阳盛
则衄，阳盛则阴虚，阴虚则目瞑也。
解后复烦，烦见于内，此余邪未尽，故用桂枝更汗。微除发烦，是烦于外见，此大邪已解，故不可更汗，仲景
每有倒句法，前辈随文衍义，谓当再用麻黄以散余邪，不知得衄乃解句何处着落。
伤寒脉浮紧者，麻黄汤主之。不发汗，因致衄。
脉紧无汗者，当用麻黄汤发汗，则阳气得泄，阴血不伤，所谓夺汗
者无血也。不发汗，阳气内扰，阳络伤则衄血，是夺血者无汗也。若用麻黄汤再汗，液脱则毙矣。言不发汗因
致衄，岂有因致衄更发汗之理乎？观少阴病无汗而强发之，则血从口鼻而出，或从目出，能不惧哉！愚故亟为
校正，恐误人者多耳。
太阳病，脉浮紧、发热、身无汗，自衄者愈。
汗者心之液，是血之变，见于皮毛者也。寒邪坚敛于外，腠理不能开发，阳气大扰于内，不能出玄府而为
汗，故逼血妄行而假道于肺窍也。今称红汗，得其旨哉！
衄家不可发汗，汗出必额上陷，脉紧急，目直视，不能 不得眠。
太阳之脉，起自目内 ，上额。已脱血而复汗之，津液枯竭，故脉紧急，而目直视也，亦心肾俱绝矣。目不
转，故不能 ；目不合，故不得眠。
脉浮紧者，法当身疼痛，宜以汗解之。假令尺中迟者，不可发汗，以营气不足、血少故也。
脉浮紧者，以脉法论，当身疼痛，宜发其汗。然寸脉虽浮紧，而尺中迟，则不得据此法矣。尺主血，血少则
营气不足，虽发汗决不能作汗。正气反虚，不特身疼不除，而亡血、亡津液之变起矣。假令，是设辞，是深一
层看法，此与脉浮数而尺中微者同义。阳盛者不妨发汗，变症惟衄，衄乃解矣。阴虚者不可发汗，亡阳之变，恐
难为力。
太阳与阳明合病，喘而胸满者，不可下，麻黄汤主之。
三阳俱受气于胸中，而部位则属阳明。若喘属太阳，呕属少阳，故胸满而喘者，尚未离乎太阳。虽有阳明可
下之症，而不可下。如呕多，虽有阳明可攻之症，而不可攻，亦以未离乎少阳也。
阳明病，脉浮无汗而喘者，发汗则愈，宜麻黄汤。
太阳有麻黄症，阳明亦有麻黄症，则麻黄汤不独为太阳设也。见麻黄症即用麻黄汤，是仲景大法。
上论麻黄汤脉症。
太阳病，十日已去，脉浮细而嗜卧者，外已解也。设胸满胁痛者，与小柴胡汤；脉但浮者，与麻黄汤。
脉微细，但欲寐，少阴症也。浮细而嗜卧，无少阴症者，虽十日后。尚属太阳，此表解而不了了之谓。设
见胸满嗜卧，亦太阳之余邪未散；兼胁痛，是太阳少阳合病矣，以少阳脉弦细也。少阳为枢，枢机不利，一阳之
气不升，故胸满胁痛而嗜卧，与小柴胡和之。若脉浮而不细，是浮而有力也。无胸胁痛，则不属少阳。但浮而
不大，则不涉阳明，是仍在太阳也。太阳为开，开病反 ，故嗜卧。与麻黄汤以开之，使卫气行阳，太阳仍得主
外而喜寤矣。与太阳初病用以发汗不同，当小其制而少与之。
上论麻黄汤柴胡汤相关脉症。
麻黄汤∶
麻黄（二两，去节） 桂枝（二两） 甘草（一两，炙） 杏仁（七十个，去尖）
水九升，先煮麻黄减一升，去沫，内诸药，煮二升半，温服八合，覆取微似汗。不须啜粥，余如桂枝法。
麻黄色青入肝，中空外直，宛如毛窍骨节状。故能旁通骨节，除身疼，直达皮毛，为卫分驱风散寒第一品
药。然必藉桂枝入心通血脉，出营中汗，而卫分之邪乃得尽去而不留。故桂枝汤不必用麻黄，而麻黄汤不可无
桂枝也。杏为心果，温能散寒，苦能下气，故为驱邪定喘之第一品药。桂枝汤发营中汗，须啜稀热粥者，以营
行脉中，食入于胃，浊气归心，淫精于脉故耳。麻黄汤发卫中汗，不须啜稀热粥者，此汗是太阳寒水之气，在皮
肤间，腠理开而汗自出，不须假谷气以生汗也。
一服汗者，停后服。汗多亡阳遂虚，恶风、烦躁不得眠也。汗多者，温粉扑之。
此麻黄汤禁也。麻黄汤为发汗重剂，故慎重如此。其用桂枝汤，若不汗更服，若病重更作服，若不出汗，
可服至二三剂。又刺后可复
汗，汗后可复汗。下后可复汗。此麻黄汤但云温服八合，不言再服，则一服汗者，停后服，汗出多者，温粉扑
之，自当列此后。大青龙烦躁在未汗先，是为阳盛。此烦躁在发汗后，是为阴虚。阴虚则阳无所附，宜白虎加
人参汤。若用桂、附以回阳，其不杀人者鲜矣。
太阳病，出现头痛、发热、全身疼痛、腰痛、骨节疼痛、怕风、无汗且伴有气喘的症状，应当用麻黄汤主治。
太阳经主管一身之表，风寒邪气束缚于外，导致阳气不能舒展，所以全身都感到疼痛。太阳经脉下行抵住腰部，所以会出现腰痛。太阳经主管筋脉所发生的疾病，所有的筋脉都归属于关节，所以会出现骨节疼痛。这些症状是由于感受风寒引起的，所以会怕风。风寒邪气侵袭人体，使皮毛毛孔闭塞，所以无汗。太阳经是诸阳经的主气，阳气郁结在体内，所以会出现气喘。太阳经主“开”的功能，设立麻黄汤来开启腠理，各种症状就能全部消除。麻黄汤证的八个主要症状中，头痛、发热、怕风，与桂枝汤证相同；无汗、身疼，与大青龙汤证相同；本证的重点在于发热、身疼、无汗且气喘。
本条条文没有冠以“伤寒”二字，也没有说恶寒而只说恶风。前辈医家说麻黄汤主治伤寒而不治中风，似乎不是确切的论断。大概麻黄汤、大青龙汤是治疗中风的重剂，桂枝汤、葛根汤是治疗中风的轻剂，伤寒也可以通用，它们并不是专门主治伤寒的方剂。
脉象浮的，说明病在体表，可以发汗，宜用麻黄汤。脉象浮而数的，可以发汗，适宜用麻黄汤。
前一条论述症状，这一条论述脉象。说浮脉而不说迟弱脉，是指浮而有力的脉象。然而必须仔细审查热邪在体表，才能使用。如果脉浮大，有热邪属于脏腑内部的，应当攻下，而不能发汗。如果脉浮数且疼痛集中在某一处，虽然身体疼痛，也不可以发汗。
“数”在这里意思是急，也就是“紧”。紧脉代表寒，指受寒而言；数脉代表热，指发热而言。辞藻不同但意思相同。所以脉象浮紧的，就是麻黄汤证。
脉象浮而数，浮代表风，数代表虚。风产生热，虚产生寒，风与虚相互搏结，就会出现洒淅恶寒（寒冷战栗）的症状。
为什么说脉浮表示病在表？因为体表有风邪的缘故。邪气聚集的地方，正气必然虚弱。数脉本来代表热，但从浮脉中显现出来，那么数就代表虚了。风是阳邪，阳气浮越则热自发。数是阳虚的表现，阳虚则畏寒。凡是感受中风寒，一定出现发热恶寒，这是因为风与虚相互搏结所致。
凡是脉象浮数的，应当发热并伴有洒淅恶寒，如果有固定的痛处、饮食正常的，这是体内蓄积化脓了。
浮数的脉象，如果出现发热恶寒的症状，不仅风寒感冒是这样，痈疡（疮疡肿毒）也会有这种情况。这里的浮表示表证而非风邪，数表示实热而非虚寒。发热是因为阳气浮越，而恶寒不是因为阳虚。如果想要知道这不是风寒感冒，应当通过内外症状来辨别。外感病会有头项痛、身痛、骨节痛、腰脊痛，而不是疼痛集中在某一处。外感病会有呕吐逆气，或干呕，不能像平时一样正常饮食。这样仔细审察，如果有蓄积而成痈脓的情况，才不会错误地当作风寒治疗，这里列举疮家的一个症状作为例子。治疗伤寒的人，见到脉症相同的，都应当留意。
患有疮疡的人，虽然身体疼痛，也不可以发汗，如果发汗会导致痉病（肌肉痉挛）。
疮家的病与外感不同，所以治法也与风寒不同。如果用治疗风寒的方法去治疗它，产生的变证也是不可不知晓的。疮疡虽然疼痛集中在某一处，但由于血气壅遏，也有全身疼痛的情况。然而这与风寒不同，如果发汗，津液就会外泄，导致筋脉血虚，拘挛紧急而变成痉病。各种脉症需要仔细审察，正是这个原因。
脉象浮数的，按理应出汗而痊愈。但如果出现身体沉重、心悸的症状，就不可以发汗，应当等待自汗出才能解除。之所以这样，是因为尺中脉微，这是里虚，必须让表里之气充实，津液自然调和，便会自汗出而痊愈。
脉象浮数者，按法应当发汗，但尺中脉微，就不敢轻易发汗，因为麻黄汤是重剂。这里的“表”指身形，“里”指心脏，如果说涉及营卫反而遗漏了心悸，是不对的。身重是表热，心悸是里虚，然而心悸也有因心下水气引起的，也应当发汗。所以必须审察尺脉，尺中脉微代表里虚。里虚的人，必须补益里气，想要津液调和，必须生津液。如果坐着等待自愈，那么表邪会更盛，心液更虚，怎么能自汗出呢？这里关于表的论述只是附带提及，重点在于里。至于自汗出，则是里实而表和了。
寸口脉浮而紧，浮代表风，紧代表寒。风伤卫气，寒伤营血，营卫都生病，骨肉烦扰疼痛，应当发汗。
风寒本来互为因果，必定是风先打开腠理，寒邪才得以进入经络。营卫都受伤，那么一身内外的阳气都不能发散，所以骨肉烦扰疼痛，脉象也随之变化表现在寸口。紧脉属阴寒，从浮脉中显现，阴盛阳虚，发汗就能痊愈。
紧，意思是急，也就是数。紧是从形象上说的，数是从至数（脉搏频率）上说的。紧代表寒，指伤寒；数代表热，指发热。辞异义同，所以脉象浮数或浮紧的，都是麻黄汤证。
脉法认为浮为风，紧为寒，所以提纲中以脉阴阳俱紧来命名伤寒。大青龙汤的脉象也在浮中见紧，所以名叫中风（此处指脉象特征对应中风之名，实则治重症）。那么只有浮脉的，正是风脉，适宜用麻黄汤，这说明麻黄汤确实主治中风脉症。麻黄汤证发热、骨节疼，就是骨肉烦疼，即是风寒两伤，营卫俱病。前辈为什么认为大青龙汤治营卫两伤？麻黄汤治寒伤营而不伤卫？桂枝汤治风伤卫而不伤营？为什么不反过来考察桂枝汤证的恶寒和麻黄汤证的恶风呢？总之，冬季的风寒，本是一体。所以中风和伤寒，都既有恶风也有恶寒，营病则卫必病。中风的重症，就是伤寒；伤寒的浅症，就是中风。不必在风寒上细分，应当在有汗无汗上着眼。
太阳病，脉象浮紧、无汗、发热、身体疼痛，经过八九天没有解除，表证仍然存在，这应当发汗，用麻黄汤主治。服药后症状轻微减轻，其人出现心烦、眼睛闭合不想睁开，严重的必定流鼻血，流鼻血后才能解除。之所以这样，是因为阳气郁闭太重的缘故。
脉症与大青龙汤证相同，不同的是外不恶寒，内不烦躁。发于阳经的病七天愈，八九天未解，可知其人阳气郁闭很重。然而脉紧、无汗、发热、身疼，是麻黄汤证未罢。仍然给予麻黄汤，只能轻微解除在表的风寒，而不能解除内扰的阳气。其人出现心烦、目瞑，表现出难以忍受的样子，可知阳络受伤，必定逼迫血液上行而流鼻血。血与汗，名称不同但同类，不能出汗，必定出血，不从汗解而从衄解。这与热结膀胱导致血自下的情况，属于同一类局促之势。
太阳脉，从目内眦联络阳明脉于鼻。鼻属阳，目属阴，血虽属阴类，但随阳气上升，就从阳窍而出。所以阳盛则衄血，阳盛则阴虚，阴虚则目瞑（眼睛昏花/闭合）。
解后再次出现烦闷，烦闷见于内部，这是余邪未尽，所以用桂枝汤再次发汗。轻微减轻后的烦闷，是烦闷见于外部，这是大邪已解，所以不可以再次发汗。仲景常有倒装句法，前辈顺着文意引申义理，说应当再用麻黄汤以散余邪，不知道“得衄乃解”这句话该放在哪里落脚。
伤寒脉象浮紧的，用麻黄汤主治。如果不发汗，就会因此导致流鼻血。
脉紧无汗的，应当用麻黄汤发汗，这样阳气得以宣泄，阴血不受损伤，所谓“夺汗者无血”。如果不发汗，阳气内扰，阳络受伤则衄血，这就是“夺血者无汗”。如果用麻黄汤再发汗，津液脱失就会导致死亡。说不发汗因而导致衄血，哪里有因为导致衄血而更发汗的道理呢？看少阴病无汗而强行发汗，则血从口鼻而出，或从眼睛流出，能不害怕吗！我所以急切地为它校正，恐怕误人的太多了。
汗是心的体液，是血的变异，表现于皮毛。寒邪坚固收敛于外，腠理不能开发，阳气大乱于内，不能从玄府（汗孔）排出而为汗，所以逼迫血液妄行而借道于肺窍（鼻）。现在称之为“红汗”，得其旨趣啊！
经常流鼻血的人（衄家）不可以发汗，如果发汗会导致额部动脉凹陷，脉象紧急，眼睛直视，不能转动，不能入睡。
太阳脉，起自目内眦，上行至额。已经失血又再次发汗，津液枯竭，所以脉象紧急，而眼睛直视，这也是心肾俱绝的表现。眼睛不转动，所以不能眨眼（瞬）；眼睛不闭合，所以不能入睡。
脉象浮紧的，按法应当身体疼痛，适宜用发汗法解除。假如尺中脉迟的，不可以发汗，因为营气不足、血少的缘故。
脉象浮紧的，按脉法讨论，应当身体疼痛，宜发其汗。然而寸脉虽浮紧，而尺中迟，就不能据此法了。尺脉主血，血少则营气不足，即使发汗也决不能作汗。正气反而虚弱，不仅身疼不除，而且亡血、亡津液的变证就会产生。“假令”是假设之辞，是更深一层的看法，这与脉浮数而尺中微的意思相同。阳盛者不妨发汗，变证唯有衄血，衄血乃解。阴虚者不可发汗，亡阳的变证，恐怕难以为力。
三阳经的气都受气于胸中，而部位则属于阳明。如果喘属于太阳，呕属于少阳，所以胸满而喘的，尚未脱离太阳经。虽然有阳明可下的症状，但不可以攻下。如果呕吐多，虽然有阳明可攻的症状，也不可以攻，也是因为尚未脱离少阳经。
太阳病有麻黄汤证，阳明病也有麻黄汤证，那么麻黄汤不仅仅为太阳病设立。见到麻黄汤证就用麻黄汤，这是仲景的大法。
以上论述麻黄汤的脉症。
太阳病，十天过去了，脉象浮细且想睡觉的，说明表证已解。如果胸部胀满、胁肋疼痛的，给小柴胡汤；如果脉象仅浮的，给麻黄汤。
脉微细，只想睡觉，是少阴病证。脉浮细且嗜卧，没有少阴病证的，虽然过了十天，仍属太阳病，这是表解而病情轻微未完全清爽的状态。如果见到胸满嗜卧，也是太阳余邪未散；兼有胁痛，是太阳少阳合病了，因为少阳脉弦细。少阳为枢机，枢机不利，一阳之气不升，所以胸满胁痛而嗜卧，用小柴胡汤和解。如果脉浮而不细，是浮而有力。没有胸胁痛，则不属于少阳。脉浮而不大，则不涉及阳明，是仍在太阳。太阳主“开”，开病反而“阖”（关闭/抑制），所以嗜卧。给予麻黄汤以开启它，使卫气行于阳分，太阳仍能主外而喜欢清醒。这与太阳初病用以发汗不同，应当减小剂量少量给予。
以上论述麻黄汤与柴胡汤相关的脉症。
麻黄汤配方：
麻黄（二两，去节） 桂枝（二两） 甘草（一两，炙） 杏仁（七十个，去尖）
用水九升，先煮麻黄减少一升，去掉上面的沫，加入其他药物，煮取二升半，温服八合，覆盖衣被取微微似有汗出的效果。不需要喝热粥，其余如桂枝汤的法度。
麻黄色青入肝，中空外直，宛如毛窍骨节的形状。所以能旁通骨节，除去身疼，直达皮毛，是为卫分驱风散寒的第一品药。然而必须借助桂枝入心通血脉，引出营中的汗，卫分的邪气才能尽去而不留。所以桂枝汤不必用麻黄，而麻黄汤不可没有桂枝。杏是心果，温能散寒，苦能下气，所以是驱邪定喘的第一品药。桂枝汤发营中的汗，需要喝稀热粥，是因为营行于脉中，食物进入胃，浊气归于心，精华渗入脉中。麻黄汤发卫中的汗，不需要喝稀热粥，因为这种汗是太阳寒水之气，在皮肤之间，腠理开而汗自出，不需要借助谷气来生汗。
服用一次后出汗的，停止后面的服药。如果汗多导致亡阳遂虚，出现怕风、烦躁不得眠的症状。汗多的，用温粉扑在身上。
这是麻黄汤的禁忌。麻黄汤是发汗重剂，所以如此慎重。使用桂枝汤时，如果不汗出则继续服用，如果病重则再次制作服用，如果不出汗，可以服用到二三剂。另外刺后可复汗，汗后可复汗，下后可复汗。这里麻黄汤只说温服八合，不说再服，那么一次服药出汗的，停止后面服药，汗出多的，用温粉扑之，自然应当列在此后。大青龙汤的烦躁在未发汗之前，是为阳盛。此处的烦躁在发汗之后，是为阴虚。阴虚则阳无所依附，适宜用白虎加人参汤。如果用桂枝、附子来回阳，不杀人的很少了。
Taiyang disease (Disease of the Taiyang Channel), characterized by headache, fever, body ache, lower back pain, joint pain, aversion to wind, anhidrosis (absence of sweating), and wheezing, should be primarily treated with Mahuang Tang (Ephedra Decoction).
The Taiyang channel governs the exterior of the entire body. When Wind-Cold pathogens bind externally, Yang Qi fails to extend, resulting in generalized body pain. The Taiyang meridian descends to the waist, hence lower back pain. The Taiyang channel governs diseases of the sinews; all sinews are associated with joints, hence joint pain. These symptoms arise from contracting Wind-Cold, leading to aversion to wind. When Wind-Cold invades the person, the skin pores close, causing anhidrosis. The Taiyang channel is the master Qi of all Yang channels; when Yang Qi is constrained internally, wheezing occurs. The Taiyang channel governs "opening"; Mahuang Tang is established to open the pores, thereby resolving all symptoms. Among the eight major symptoms of the Mahuang Tang syndrome—headache, fever, aversion to wind, anhidrosis, and body ache—the first three are shared with Guizhi Tang (Cinnamon Twig Decoction) syndrome, while anhidrosis and body ache are shared with Da Qing Long Tang (Major Blue Dragon Decoction) syndrome. This syndrome focuses on fever, body ache, anhidrosis, and wheezing.
This clause does not prefix "Shanghan" (Cold Damage) nor mention aversion to cold but only aversion to wind. Predecessors stated that Mahuang Tang treats Shanghan but not Zhongfeng (Wind Strike), which seems not to be a definitive conclusion. Essentially, Mahuang Tang and Da Qing Long Tang are heavy agents for treating severe Zhongfeng, while Guizhi Tang and Gegen Tang (Kudzu Root Decoction) are light agents for mild Zhongfeng; they can be used generally for Shanghan and are not exclusive agents for Shanghan.
If the pulse is floating (Fu, 浮), the disease is at the exterior, and sweating therapy is indicated; use Mahuang Tang. If the pulse is floating and rapid (Shu, 数), sweating therapy is indicated; Mahuang Tang is appropriate.
The previous clause discussed symptoms; this clause discusses pulses. Mentioning floating without mentioning slow or weak implies a floating pulse that is forceful. However, one must carefully verify that heat is at the exterior before using it. If the pulse is floating and large with heat belonging to the interior organs, purgation is required, not sweating. If the pulse is floating and rapid with pain localized to one area, despite body pain, sweating is contraindicated.
"Rapid" here means urgent, i.e., "wiry-tight" (Jin, 紧). Wiry-tight indicates Cold, referring to contracting Cold; Rapid indicates Heat, referring to fever. The terminology differs, but the meaning is the same. Thus, a floating and wiry-tight pulse indicates the Mahuang Tang syndrome.
A floating and rapid pulse: Floating indicates Wind, Rapid indicates Deficiency. Wind generates Heat, Deficiency generates Cold. When Wind and Deficiency struggle against each other, chills and shivering occur.
Why does a floating pulse indicate disease at the exterior? Because there are Wind pathogens at the exterior. Where pathogens gather, Qi must be deficient. Although Rapid normally indicates Heat, appearing with Floating makes it indicate Deficiency. Wind is a Yang pathogen; Yang floating leads to spontaneous Heat. Rapid indicates Yang Deficiency, leading to fear of Cold. Whenever Wind-Cold is contracted, fever and aversion to cold occur due to the struggle between Wind and Deficiency.
For all floating and rapid pulses, one expects fever and chills. If there is a fixed painful area and normal diet, it indicates accumulated pus.
With a floating and rapid pulse presenting fever and aversion to cold, this is not unique to Wind-Cold; abscesses also present this way. Here, Floating indicates Exterior but not necessarily Wind, and Rapid indicates Excess Heat rather than Deficiency. Fever is due to Yang floating, and aversion to cold is not due to Yang Deficiency. To distinguish this from Wind-Cold, differentiate via internal and external symptoms. External contraction causes headache, neck stiffness, body pain, joint pain, and back pain, not pain localized to one spot. External contraction causes vomiting or dry heaving, preventing normal eating. By careful examination, if accumulation leads to abscess/pus, one avoids mistreating it as Wind-Cold. This uses the case of a chronic sore patient as an example. Those treating Shanghan must pay attention when pulses and symptoms appear identical.
In patients with chronic sores, even if there is body pain, sweating is contraindicated; inducing sweat will lead to spasm (Jing, 痉).
The pathology of chronic sores differs from external contraction, so treatment differs from Wind-Cold. Treating it as Wind-Cold leads to complications that must be understood. Although sores cause localized pain, blood and Qi stagnation can cause generalized pain. However, this differs from Wind-Cold; sweating depletes fluids, causing sinew and vessel blood deficiency, leading to spasms. Careful examination of pulses and symptoms is crucial for this reason.
For a floating and rapid pulse, sweating should theoretically lead to recovery. But if there is heaviness of the body and palpitations, sweating is contraindicated; spontaneous sweating should resolve it. This is because the Chi position (cun-kou pulse at the wrist) is faint, indicating Interior Deficiency. The Interior and Exterior must become solid, fluids must harmonize, and spontaneous sweating will heal the condition.
For a floating and rapid pulse, sweating is indicated by law, but if the Chi pulse is faint, one dare not lightly induce sweat, as Mahuang Tang is a heavy agent. Here, "Exterior" refers to the body surface, and "Interior" refers to the Heart. Saying it involves Ying and Wei while omitting palpitations is incorrect. Body heaviness indicates Exterior Heat; palpitations indicate Interior Deficiency. However, palpitations caused by water-Qi under the heart may still require sweating. Thus, one must examine the Chi pulse; a faint Chi pulse indicates Interior Deficiency. For Interior Deficiency, one must tonify the Interior. To harmonize fluids, one must generate fluids. Waiting passively allows Exterior pathogens to strengthen and Heart fluids to deplete, making spontaneous sweating impossible. The mention of the Exterior is incidental; the focus is on the Interior. Spontaneous sweating indicates Interior Solidity and Exterior Harmony.
At the Cun Kou (radial artery), a floating and wiry-tight pulse: Floating indicates Wind, Wiry-Tight indicates Cold. Wind injures Wei Qi (Defensive Qi); Cold injures Ying Qi (Nutritive Blood). When both Ying and Wei are diseased, causing bone and flesh restlessness and pain, sweating is indicated.
Wind and Cold naturally accompany each other; Wind opens the interstices first, allowing Cold to enter the meridians. When Ying and Wei are injured, the Yang Qi inside and outside the body cannot diffuse, causing bone and flesh restlessness and pain. The pulse reflects this change at the Cun Kou. Wiry-Tight is Yin Cold appearing with Floating, indicating Yin Excess and Yang Deficiency; sweating resolves it.
"Wiry-Tight" describes the shape; "Rapid" describes the frequency. Wiry-Tight indicates Cold (Shanghan); Rapid indicates Heat (fever). Different terms, same meaning. Thus, floating-rapid or floating-wiry-tight pulses are both Mahuang Tang syndromes.
Pulse theory states Floating is Wind, Wiry-Tight is Cold. Hence, the outline names Shanghan by pulses where Yin and Yang are both wiry-tight. Da Qing Long Tang's pulse also shows Wiry-Tight within Floating, hence named Zhongfeng (referring to the pulse pattern name). Therefore, a purely Floating pulse is the Wind pulse, suitable for Mahuang Tang, proving Mahuang Tang indeed governs Zhongfeng pulses and symptoms. Mahuang Tang syndrome features fever and joint pain, which is bone/flesh restlessness, indicating both Wind and Cold injuring Ying and Wei. Why do predecessors claim Da Qing Long Tang treats Ying-Wei dual injury, Mahuang Tang treats Cold injuring Ying but not Wei, and Guizhi Tang treats Wind injuring Wei but not Ying? Why not cross-examine Guizhi's aversion to cold versus Mahuang's aversion to wind? In winter, Wind and Cold are essentially one entity. Thus, Zhongfeng and Shanghan both feature aversion to wind and cold; Ying disease implies Wei disease. Severe Zhongfeng is Shanghan; mild Shanghan is Zhongfeng. One need not strictly separate Wind and Cold but should focus on the presence or absence of sweat.
In Taiyang disease, with a floating-wiry-tight pulse, anhidrosis, fever, and body pain persisting for eight to nine days without resolution, if exterior symptoms remain, sweating is indicated; treat with Mahuang Tang. After taking the medicine, symptoms may slightly improve. The patient may feel vexed and keep eyes closed; in severe cases, epistaxis (nosebleed) occurs, after which the condition resolves. This is because Yang Qi is heavily constrained.
The pulse and symptoms are similar to Da Qing Long Tang, except for the absence of external aversion to cold and internal vexation. Diseases originating from Yang recover in seven days; persistence beyond eight to nine days indicates heavy Yang constraint. However, tight pulse, anhidrosis, fever, and body pain show the Mahuang Tang syndrome has not ceased. Continuing Mahuang Tang only slightly releases exterior Wind-Cold but does not resolve internally disturbed Yang. Vexation and eye closure indicate unbearable distress, showing Yang collaterals are injured, forcing blood upward into epistaxis. Blood and sweat are different names for the same substance; if sweat cannot be released, blood must be released. Resolution via epistaxis parallels resolution via bleeding from the Bladder due to heat binding.
The Taiyang meridian starts at the inner canthus and connects to the Yangming meridian at the nose. The nose is Yang, the eye is Yin. Although blood is Yin, it rises with Yang Qi and exits through Yang orifices. Thus, Yang Excess causes epistaxis; Yang Excess leads to Yin Deficiency, causing visual disturbance/closed eyes.
Vexation recurring after resolution, located internally, indicates residual pathogens; thus, Guizhi Tang is used to induce sweat again. Slight improvement with external vexation indicates major pathogens have resolved, so further sweating is contraindicated. Zhang Zhongjing often uses inverted syntax. Predecessors interpreting the text suggested using Mahuang Tang again for residual pathogens, failing to account for the phrase "resolution occurs via epistaxis."
For Shanghan with a floating-wiry-tight pulse, Mahuang Tang is indicated. Failure to induce sweat leads to epistaxis.
For tight pulse and anhidrosis, Mahuang Tang should induce sweat, allowing Yang Qi to vent and protecting Yin Blood ("He who loses sweat has no blood"). Failure to sweat allows Yang Qi to disturb internally, injuring Yang collaterals and causing epistaxis ("He who loses blood has no sweat"). Using Mahuang Tang to induce sweat again would deplete fluids and cause death. The statement "failure to sweat causes epistaxis" does not imply "epistaxis requires further sweating." Consider Shaoyin disease: forcing sweat in anhidrotic patients causes bleeding from mouth, nose, or eyes. Is this not terrifying? I correct this urgently to prevent harm.
In Taiyang disease, with floating-wiry-tight pulse, fever, and anhidrosis, spontaneous epistaxis leads to recovery.
Sweat is the fluid of the Heart, a transformation of blood, manifesting in the skin/hair. Cold pathogens constrain externally, preventing pore opening. Yang Qi is severely disturbed internally, unable to exit via pores as sweat, so it forces blood to wander and exit via the Lung orifice (nose). This is now called "red sweat," capturing its essence.
Patients prone to epistaxis (Nu Jia) must not undergo sweating therapy. Inducing sweat causes depression of the temporal arteries, tense pulses, staring eyes, inability to blink, and insomnia.
The Taiyang meridian rises from the inner canthus to the forehead. Having lost blood and then undergoing sweating depletes fluids, causing tense pulses and staring eyes, indicating Heart and Kidney exhaustion. Inability to blink and close eyes results in insomnia.
For a floating-wiry-tight pulse, body pain is expected, and sweating is indicated. However, if the Chi pulse is slow (Chi, 迟), sweating is contraindicated due to insufficient Ying Qi and blood deficiency.
Although the Cun pulse is floating-wiry-tight suggesting body pain and sweating, a slow Chi pulse invalidates this rule. The Chi pulse governs blood; blood deficiency means insufficient Ying Qi. Sweating will fail to produce sweat, damaging righteous Qi, worsening pain, and causing blood/fluid depletion. "Suppose" indicates a hypothetical deeper analysis, similar to floating-rapid pulse with faint Chi. Yang Excess allows sweating, with epistaxis as the complication/resolution. Yin Deficiency forbids sweating, as Yang collapse is difficult to reverse.
In combined Taiyang and Yangming disease, with wheezing and chest fullness, purgation is contraindicated; treat with Mahuang Tang.
The Three Yang channels receive Qi in the chest, but the location belongs to Yangming. Wheezing belongs to Taiyang, vomiting to Shaoyang. Chest fullness with wheezing remains within Taiyang. Even if Yangming purgation indications exist, purgation is forbidden. Similarly, frequent vomiting keeps the condition within Shaoyang, forbidding attack.
In Yangming disease, with floating pulse, anhidrosis, and wheezing, sweating leads to recovery; use Mahuang Tang.
Taiyang has Mahuang Tang syndrome; Yangming also has Mahuang Tang syndrome. Thus, Mahuang Tang is not exclusive to Taiyang. Applying Mahuang Tang whenever the syndrome appears is Zhang Zhongjing's general principle.
Above discusses Mahuang Tang pulses and symptoms.
After ten days of Taiyang disease, if the pulse is floating and fine, and the patient desires sleep, the exterior has resolved. If there is chest fullness and hypochondriac pain, administer Xiao Chai Hu Tang (Minor Bupleurum Decoction). If the pulse is merely floating, administer Mahuang Tang.
Faint and fine pulse with desire to sleep is Shaoyin syndrome. Floating and fine pulse with somnolence, lacking Shaoyin signs, indicates Taiyang persists post-ten days. This is "resolved but lingering." Chest fullness and somnolence suggest residual Taiyang pathogens. With hypochondriac pain, it is Taiyang-Shaoyang combined disease (Shaoyang pulse is wiry-fine). Shaoyang is the pivot; pivot dysfunction prevents rising of One Yang Qi, causing chest fullness, hypochondriac pain, and somnolence. Xiao Chai Hu Tang harmonizes. If the pulse is floating but not fine (forceful), and lacks hypochondriac pain, it is not Shaoyang. If floating but not large, it is not Yangming. It remains Taiyang. Taiyang governs "Opening"; disease reverses this to "Closing," causing somnolence. Mahuang Tang opens the exterior, moving Wei Qi into Yang, restoring Taiyang's exterior dominance and wakefulness. Unlike initial Taiyang sweating, the dose should be reduced.
Above discusses Mahuang Tang and Chai Hu Tang related pulses/symptoms.
Mahuang Tang Formula:
Mahuang (Ephedrae Herba, 2 liang, remove nodes)
Guizhi (Cinnamomi Ramulus, 2 liang)
Gancao (Glycyrrhizae Radix et Rhizoma, 1 liang, honey-fried)
Xingren (Armeniacae Semen Amarum, 70 seeds, remove tips)
Boil in 9 sheng of water. First boil Mahuang, reduce by 1 sheng, skim foam. Add other herbs. Boil to 2.5 sheng. Warm drink 8 ge. Cover to obtain slight perspiration. No hot porridge needed. Follow Guizhi Tang methods otherwise.
Mahuang is green, enters Liver, hollow inside and straight outside, resembling hair follicles and joints. It penetrates joints, relieves body pain, reaches the skin, and is the premier herb for dispelling Wind-Cold from the Wei level. However, it relies on Guizhi to enter the Heart, unblock vessels, and release Ying sweat, ensuring Wei pathogens are fully expelled. Thus, Guizhi Tang does not need Mahuang, but Mahuang Tang cannot lack Guizhi. Apricot is a Heart fruit; warmth disperses Cold, bitterness directs Qi downward, making it the premier herb for expelling pathogens and stopping wheezing. Guizhi Tang induces Ying sweat, requiring hot porridge because Ying flows in vessels; food enters Stomach, turbid Qi goes to Heart, essence enters vessels. Mahuang Tang induces Wei sweat, requiring no porridge because this sweat is Taiyang Cold-Water Qi in the skin; pores open, sweat comes naturally, without needing grain Qi.
After one dose, if sweat occurs, stop remaining doses. Excessive sweat causes Yang collapse and deficiency, leading to aversion to wind, vexation, and insomnia. For excessive sweat, apply warm powder.
This is the contraindication for Mahuang Tang. As a heavy sweating agent, caution is paramount. Guizhi Tang: if no sweat, repeat; if severe, prepare another dose; up to 2-3 doses. Acupuncture can precede/follow sweating. Purgation can precede/follow sweating. Mahuang Tang specifies warm drink of 8 ge, no mention of repeating. If one dose induces sweat, stop. For excessive sweat, apply warm powder. This follows later. Da Qing Long Tang's vexation precedes sweating (Yang Excess). Here, vexation follows sweating (Yin Deficiency). Yin Deficiency leaves Yang unanchored; Bai Hu Jia Ren Tang (White Tiger plus Ginseng Decoction) is indicated. Using Guizhi/Fuzi to restore Yang would likely kill.