【纲】仲景曰。太阳病。发热恶寒。热多寒少。脉微弱者。此无阳也。不可发汗。宜桂枝二越
婢一汤。
【目】朱肱曰。春不可大发汗。以阳气尚弱。不可急夺。使阴气胜。于时天寒初解。营卫腠理
俱缓。可用小柴胡汤之类治之。冬不可汗者。以阳气伏藏。不可妄扰。不论伤寒中风。以轻药解利
之。伤寒无汗者。只与桂枝麻黄合半汤。伤风
有汗。只与柴胡桂枝汤。或得少汗而解。或无汗而解。势甚者不拘。此夏月天气大热。玄府开。脉
洪大。宜正发汗。但不可用麻黄桂枝热性药。须麻黄桂枝汤加黄芩、石膏、知母、升麻也。夏月有
麻桂症。不加黄芩辈。转助热气。便发斑黄也。白虎汤虽可用。然治中暑。与汗后。一解表药耳。
白虎未能驱逐表解。况夏月阴气在内。或患热病。气虚人妄投白虎。往往有成结胸者。以白虎性寒。
非治伤寒药也。其人当汗而衄血下血者。不可表也。桂枝汤。坏病者。不可表也。知犯何逆。临
症治之。妇人经水适来。不可表也。表则郁冒不知人。此为表里俱虚。故令郁冒也。风温者。不可
表也。葳蕤汤。湿温者。不可表也。苍术白虎汤。虚烦者。不可表也。竹叶汤。以诸虚烦热。与伤
寒相似。然不恶寒。身不疼。故知非伤寒。不可汗也。头不疼。脉不紧。故知里不实。不可下也。
病患腹间左右上下。有筑然动气者。不可汗也。方治。详在动气本条。以此见古人慎用表药也。
张云岐曰。太阳症。非头疼项强。不可发汗。非身热恶寒。不可发汗。非脉浮。不可发汗。
【纲】仲景曰。桂枝本为解肌。若其人脉浮紧。发热汗不出者。不可与也。当须识此。勿令误
也。
【目】李中梓曰。无表症。不可汗。脉沉。不可汗。尺脉迟。不可汗。脉微弱。虽恶寒。不可
汗。汗家。不可重汗。太阳少阳并病。头项强痛。或眩冒心下痞。不可汗。脉弦细。头痛而热。属
少阳。不可汗。
【纲】仲景曰。疮家身虽疼。不可发汗。汗出则痉。
【目】汪昂曰。疮家虽伤寒身痛。不可发汗。发汗则痉。表虚热聚。故生疮。汗之则表愈虚。
热愈甚而生风。故变痉也。衄家亡血家。不可发汗。发汗则阴阳俱虚也。淋家。不可发汗。发汗必
便血。亡耗津液。反增客热也。尺脉迟。不可发汗。以营弱血少故也。脉沉迟为在里。反发其汗。
则津液越出。大便难。表虚里实。必谵语也。咽燥喉干。不可发汗。津液不足也。咳而小便利。若
失小便者。不可发汗。发汗则四肢厥冷。肺肾虚寒也。下利虽有表症。不可发汗。汗出必胀满。
走津
液而胃虚也。汗家重发汗。必恍惚心乱。汗者心之液。心亡血液故乱也。
【纲】仲景曰。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。使汗出愈。
【目】闵芝庆曰。可汗者。脉症全在表也。若太早太过。津液竭而变生焉。有不可汗者。诸虚
百损。咽干口燥咽痛。疮疡淋沥。经水适至。诸失血。吐沫咳嗽。坏病。脉迟微涩。或厥而脉紧。
俱宜和解。不宜汗。若强发之。病微者难瘥。剧者言乱目眩而死。
鳌按。本条曰里虚。只重在里。表里实。表字带言耳。盖表者。身也。里者。心也。表里字。
即顶上身重心悸身心二字言。若心悸由于水气者。亦须发汗。但曰尺脉微。则明言心液虚矣。如何
与悸由水气者同用汗法。
【纲】仲景曰。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。
【目】鳌按。此与上条。单论脉法本当发汗者。然上以尺中微为里虚。而不可汗。此以尺中迟
为营气不足。亦不可汗。盖此二者。虽发其汗。而一则心液虚。一则营气虚。俱不能作汗。徒使正
气益耗耳。
【纲】仲景曰。脉微而恶寒者。此阴阳俱虚。不可更发汗。更下。更吐也。
【目】张介宾曰。脉有忌汗者。如论曰。脉微而恶寒者。此阴阳俱虚。不可更汗吐下。太阳
病。发热恶寒。热多寒少。脉微弱。为无阳。不可发汗。弦为阳运。微为阴寒。上实下虚。意欲得
温。微弦为虚。不可发汗。汗则寒栗不能自还。伤寒四五日。脉沉而喘满。沉为里。不可汗。汗亡
津液。必大便难而谵语。少阴病脉微。不可发汗。以亡阳故。尺脉弱而无力。切不可汗下。尺中迟。
不可汗。以荣气不足血少故。按以上忌汗诸脉。可见仲景大意。故凡治伤寒。但见脉息微弱。及
沉细无力者。皆不可任意发汗。然欲去外邪。又非汗不可。而仲景云。脉微弱者。不可发汗。夫脉
弱非阳。既不可用寒凉。而
寒邪在表。又不可用攻下。然则舍汗又将何法以治此表邪乎。不知温中即所以散寒。强主即可以逐
寇。此仲景之意。岂不尽露于言表乎。且凡病外感而脉见微弱者。其汗最不易出。其邪最不易解。何
也。以元气不能托送。即发亦无汗。邪不能解。则愈发愈虚。而危亡立至。夫汗即血。由于营也。
营本乎气。由乎中也。未有中气虚而营能盛者。未有营气虚而汗能达者。脉即营之外候。脉既微弱。
元气可知。元气愈虚。邪愈不解。所以阳症最嫌阴脉也。凡治表邪之法。如果邪实无汗。则发散为宜。有汗而热不除。
则和解为宜。元虚而邪不能退。
则急培其根本。以待其自解自汗。此逐邪三昧。万全之法也。若但见其外。不见其内。不论症之阴
阳。脉之虚实。但知寒凉可以退热。但知发散可以解表。不知元阳一败。危立至矣。凡发汗太过。
一时将致亡阳。或身寒而栗。或气脱昏沉。惟煎独参汤饮之。甚者或以四味回阳汤。庶可保全。又
有邪本不盛。或挟虚年衰感邪等症。医不能察。但知表症宜解。而发散太过。或误散无效。或屡散
不已。遂被其害者有之。或邪气虽去。竟至胃气大伤。不能饮食。渐至羸惫不振者有之。皆过汗之戒
也。
柯琴曰。脉微而无和缓之意。此太阴虚矣。但恶寒而不恶热。是二阳虚矣。阴阳俱虚。当调其
阴阳。
【纲】仲景曰。发汗后。不可更行桂枝汤。无汗而喘。大热者。可与麻黄杏仁甘草石膏汤。下
后。不可更行桂枝汤。若无汗而喘。大热者。可与麻黄杏仁甘草石膏汤。
【目】李时珍曰。仲景每于汗下后表不解者。用桂枝更汗。而不用麻黄。此则内外皆热而不恶
寒。必其用麻黄汤后。寒解而热反甚。与发汗解半日许复烦。下后而微喘者。不同。发而不得汗。
或下之而仍不汗。喘不止。其阳气重也。若与桂枝加浓朴杏仁汤。下咽即毙。此汤使温解之方。转
为凉散之剂也。
【纲】仲景曰。酒客病。不可与桂枝汤。得汤则呕。以酒客不喜甘故也。
【目】危亦林曰。酒客不喜甘。平日蓄有湿热也。病虽中风。应与桂枝。以不喜甘而不与。正
以善桂枝汤之用也。言外
当知有葛根芩连之法。
鳌按。危氏补出葛根芩连之法。若魏伯乡柯韵伯辈俱宗之。凡遇酒客病。使人知所以用药。
【纲】张仲景说：太阳病（太阳经受邪所致的病证），出现发热、恶寒，热多寒少，脉象微弱的人，这是“无阳”（指阳气虚衰，不能鼓动血脉）的表现，不可使用发汗法。适宜用桂枝二越婢一汤。
【目】朱肱说：春季不可大力发汗，因为此时人体阳气尚且虚弱，不可急于剥夺，以免导致阴气偏胜。此时天气刚由寒转暖，营卫之气及腠理都较为松弛，可用小柴胡汤之类的方剂治疗。冬季不可发汗，是因为阳气潜藏于内，不可妄加扰动。不论患的是伤寒还是中风，都用轻清的药物来解表利窍。如果是伤寒无汗者，只用桂枝麻黄各半汤；如果是伤风有汗者，只用柴胡桂枝汤。或者通过微微出汗而痊愈，或者不出汗而自愈，病情严重的则不受此限制。这是指夏季天气大热，玄府（汗孔）开放，脉象洪大，应当正常发汗，但不可使用麻黄、桂枝等热性药物，必须在麻黄桂枝汤中加入黄芩、石膏、知母、升麻。夏季如果有麻黄汤或桂枝汤的证候，不加黄芩等药，反而会助长热气，导致发斑、发黄。白虎汤虽然可以使用，但它主要治疗中暑，对于汗后表证，它只是一味解表药罢了。白虎汤未能驱逐表邪使其解散，何况夏季体内阴气潜伏，如果患有热病，气虚之人误投白虎汤，往往会导致结胸证。因为白虎汤性质寒凉，不是治疗伤寒的药物。那些应当发汗却出现鼻衄或下血的人，不可再行表法。桂枝汤证已经变成坏病（因误治而病情恶化）的人，不可再行表法。需要探求犯了什么错误，根据具体症状进行治疗。妇女月经正来潮时，不可行表法，否则会导致郁冒（头晕目眩，神志不清），这是因为表里俱虚，所以导致郁冒。风温病，不可行表法，宜用葳蕤汤。湿温病，不可行表法，宜用苍术白虎汤。虚烦证，不可行表法，宜用竹叶汤。因为各种虚烦热证，与伤寒相似，但是不恶寒，身体不疼痛，所以知道不是伤寒，不可发汗。头部不疼，脉象不紧，所以知道里实不实，不可攻下。患者腹部左右上下有筑然跳动感（动气）的，不可发汗。治疗方法，详见“动气”本条。由此可见古人慎用解表药。张云岐说：太阳病证，如果没有头痛项强，不可发汗；如果没有身热恶寒，不可发汗；如果没有脉浮，不可发汗。
【纲】张仲景说：桂枝汤本是用于解肌（解除肌表之邪）的，如果病人脉象浮紧，发热且无汗，不可给予桂枝汤。必须认识这一点，不要弄错了。
【目】李中梓说：没有表证的，不可发汗；脉沉的，不可发汗；尺脉迟的，不可发汗；脉微弱，虽然恶寒，也不可发汗；平素易出汗的人（汗家），不可再次重发其汗。太阳病与少阳病并病，出现头项强痛，或者眩晕、心下痞塞，不可发汗。脉象弦细，头痛且发热，属于少阳病，不可发汗。
【纲】张仲景说：患有疮疡的人，即使身体疼痛，也不可发汗。如果发汗，会导致痉病（肌肉痉挛，角弓反张）。
【目】汪昂说：疮疡患者即使患有伤寒身体疼痛，也不可发汗。如果发汗会导致痉病。因为表虚热聚而生疮，发汗会使表更虚，热更盛而生风，从而变为痉病。经常流鼻血的人（衄家）、失血的人（亡血家），不可发汗。如果发汗，会导致阴阳俱虚。淋证患者（小便频数短涩，滴沥刺痛），不可发汗。如果发汗必然导致便血。因为发汗会耗伤津液，反而增加客热。尺脉迟的，不可发汗，因为营弱血少。脉沉迟表示病在里，如果反而发汗，会导致津液外泄，大便困难，表虚里实，必然出现谵语（胡言乱语）。咽喉干燥、喉咙干渴的，不可发汗，因为津液不足。咳嗽且小便通畅，或者小便失禁的，不可发汗。如果发汗会导致四肢厥冷，这是肺肾虚寒的表现。腹泻即使有表证，也不可发汗。如果发汗必然导致腹胀满，因为走泄津液而导致胃气虚弱。平素易出汗的人再次发汗，必然会出现心神恍惚、心中烦乱。汗是心的体液，心亡血液故致心神混乱。
【纲】张仲景说：脉象浮数的，按照法则应当通过出汗而痊愈。如果病人感觉身体沉重、心悸，不可发汗。应当等待其自然出汗才能痊愈。之所以这样，是因为尺中脉微，这是里虚的表现。需要使表里充实，津液自然调和，通过出汗而痊愈。
【目】闵芝庆说：可以发汗的情况，脉症完全在表。如果发汗太早或太过，津液枯竭就会变生他病。有不可发汗的情况：各种虚损、咽干口燥咽痛、疮疡淋沥、月经适至、各种失血、吐沫咳嗽、坏病、脉迟微涩，或者厥逆而脉紧，都适宜和解，不宜发汗。如果强行发汗，病轻的难以痊愈，病重的会神志错乱、目眩而死。
沈金鳌按：本条说“里虚”，只重在里，“表里实”中的“表”字是连带提及的。大概来说，表指的是身体，里指的是心脏。“表里”二字，正是承接上文“身重”、“心悸”的身心二字而言。如果心悸是由于水气引起的，也须发汗。但这里说“尺脉微”，明确指出了心液虚，怎么能与水气引起的心悸用同样的发汗法呢？
【纲】张仲景说：脉象浮紧的，按照法则应当身体疼痛，适宜用汗法解除。假如尺中脉迟的，不可发汗，因为营气不足，血少的原因。
【目】沈金鳌按：这一条与上一条，单独讨论脉法上本当发汗的情况。然而上一条以尺中微为里虚而不可汗，这一条以尺中迟为营气不足，也不可汗。大概这两种情况，虽然发了汗，但一则心液虚，一则营气虚，都不能作汗，徒然使正气更加耗损罢了。
【纲】张仲景说：脉象微弱且恶寒的，这是阴阳俱虚，不可再发汗、再攻下、再催吐。
【目】张介宾说：脉象中有忌用发汗的情况。如《伤寒论》所说：“脉微而恶寒的，这是阴阳俱虚，不可再用汗、吐、下法。”“太阳病，发热恶寒，热多寒少，脉微弱，为无阳，不可发汗。”“弦为阳运，微为阴寒，上实下虚，意欲得温，微弦为虚，不可发汗。如果发汗则会寒战不能恢复。”“伤寒四五日，脉沉而喘满，沉为里，不可发汗。发汗会亡失津液，必然大便难而谵语。”“少阴病脉微，不可发汗，因为亡阳的缘故。”“尺脉弱而无力，切不可汗下。”“尺中迟，不可发汗，因为荣气不足血少。”看以上忌汗的各种脉象，可见张仲景的大意。所以凡是治疗伤寒，只要见到脉息微弱，以及沉细无力的，都不可任意发汗。然而想要去除外邪，又非发汗不可。而张仲景说：“脉微弱者，不可发汗。”脉弱不属于阳证，既然不可用寒凉药，而寒邪在表，又不可用攻下药。那么除了发汗还有什么方法治疗这个表邪呢？不知道温中即所以散寒，扶助正气即可以驱逐邪寇。这是张仲景的意思，难道没有完全显露在言语之间吗？而且凡是患外感病而脉见微弱的，其汗最不容易出来，其邪气最不容易解除。为什么呢？因为元气不能托送邪气，即使发汗也无汗，邪气不能解除，则越发汗越虚，而危亡立刻到来。汗即血，来源于营气。营气根本于气，来源于中气。没有中气虚而营气能盛的，没有营气虚而汗能达出的。脉是营气的外在表现，脉既微弱，元气可知。元气越虚，邪气越不解，所以阳证最忌讳阴脉。凡是治疗表邪的方法，如果确实邪实无汗，则发散为宜；有汗而热不退，则和解为宜；元气虚而邪气不能退，则急培补其根本，等待其自解自汗。这是驱逐邪气的三昧真火，万全之法。如果只见外表，不见内在，不论病症的阴阳，脉象的虚实，只知道寒凉可以退热，只知道发散可以解表，不知道元阳一旦败坏，危亡立刻到来。凡是发汗太过，一时之间将导致亡阳，或者身体寒冷而战栗，或者气脱昏沉，只有煎服独参汤饮用它，严重的或用四味回阳汤，才可以保全性命。又有邪气本来不盛，或者夹杂虚损、年老体衰感受邪气等症状，医生不能察觉，只知道表证宜解，而发散太过，或者误散无效，或者屡次发散不止，于是遭受其害的有这种情况。或者邪气虽然去除，竟然导致胃气大伤，不能饮食，逐渐变得瘦弱疲惫不振的，有这种情况。这都是过汗的戒律。
柯琴说：脉微而没有和缓之意，这是太阴虚了。只是恶寒而不恶热，这是二阳虚了。阴阳俱虚，应当调理阴阳。
【纲】张仲景说：发汗后，不可再用桂枝汤。如果无汗而喘，大热的，可以与麻黄杏仁甘草石膏汤。下法治疗后，不可再用桂枝汤。如果无汗而喘，大热的，可以与麻黄杏仁甘草石膏汤。
【目】李时珍说：张仲景经常在汗法、下法之后，表证未解的情况下，用桂枝汤再次发汗，而不用麻黄汤。这则是内外皆热且不恶寒的情况，一定是之前用了麻黄汤后，寒邪已解但热势反而加重，与发汗解表半天左右又心烦、下法后轻微气喘的情况不同。发汗而不得汗，或者下法后仍然无汗，气喘不止，这是阳气重盛。如果给予桂枝加浓朴杏仁汤，喝下去就会死亡。这个汤方是将温解的方剂转变为凉散的剂型。
【纲】张仲景说：嗜酒的人患病，不可给予桂枝汤。喝了桂枝汤就会呕吐，因为嗜酒的人不喜欢甘味的原因。
【目】危亦林说：嗜酒的人不喜欢甘味，是因为平日体内蓄积有湿热。生病虽然是中风，应该用桂枝汤，但因为不喜欢甘味而不给用，这正是善于运用桂枝汤的用意。言外之意应当知道有葛根芩连汤的方法。
[General Principle] Zhang Zhongjing stated: In Taiyang disease (a syndrome caused by pathogenic factors affecting the Taiyang meridian), if there is fever and aversion to cold, with more heat than cold, and the pulse is faint and weak, this indicates "absence of Yang" (deficiency of Yang qi failing to propel the blood vessels). Sweating therapy should not be used. Guizhi Er Yuebi Yi Tang (Cinnamon Twig Twice and Minor Bi Decoction Once) is appropriate.
[Commentary] Zhu Gong stated: In spring, vigorous sweating should not be induced because the body's Yang qi is still weak and should not be abruptly depleted, which would cause Yin qi to prevail. At this time, as the weather transitions from cold to warm, Ying (Nutritive) and Wei (Defensive) qi, along with the couli (pores), are relaxed. Formulas such as Xiaochaihu Tang (Minor Bupleurum Decoction) can be used. In winter, sweating should not be induced because Yang qi is hidden and stored internally and should not be disturbed recklessly. Regardless of whether it is Shanghan (Cold Damage) or Fengshang (Wind Strike), light and clearing herbs should be used to resolve the exterior. For Shanghan with no sweat, only Guizhi Mahuang Ban Tang (Half Cinnamon Twig and Ephedra Decoction) should be used; for Fengshang with sweat, only Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) should be used. Recovery may occur through slight sweating or without sweating, depending on severity. This refers to summer when the weather is hot, xuanku (sweat pores) are open, and the pulse is surging; normal sweating is indicated, but hot-natured herbs like Mahuang (Ephedrae Herba) and Guizhi (Cinnamomi Ramulus) should not be used alone. Huangqin (Scutellariae Radix), Shigao (Gypsum Fibrosum), Zhimu (Anemarrhenae Rhizoma), and Shengma (Cimicifugae Rhizoma) must be added to Mahuang Guizhi Tang. If summer patterns resembling Mahuang Tang or Guizhi Tang are treated without Huangqin and similar herbs, heat will be exacerbated, leading to macules and jaundice. While Baihu Tang (White Tiger Decoction) can be used, it primarily treats Zhongshu (Heatstroke). For post-sweating exterior syndromes, it acts merely as an exterior-resolving agent. Baihu Tang fails to drive out exterior pathogens. Moreover, in summer, Yin qi resides internally. If a patient with Qi deficiency mistakenly takes Baihu Tang for a heat disease, Jie Xiong (Chest Binding Syndrome) often results because Baihu Tang is cold in nature and not suitable for Shanghan. Patients who should have sweated but instead experienced nosebleeds or lower bleeding should not undergo exterior therapy. Patients with Guizhi Tang patterns that have become Huai Bing (complicated diseases due to mismanagement) should not undergo exterior therapy. One must determine the error and treat based on specific symptoms. When a woman's menstruation is just beginning, exterior therapy is contraindicated; otherwise, Yu Mao (depression and dizziness with loss of consciousness) may occur due to deficiency of both interior and exterior. Fengwen (Wind-Warmth) should not be treated with exterior therapy; Weiyu Tang (Polygonatum Decoction) is indicated. Shiwen (Damp-Warmth) should not be treated with exterior therapy; Cangzhu Baihu Tang (Atractylodes and White Tiger Decoction) is indicated. Xu Fan (Deficiency Irritability) should not be treated with exterior therapy; Zhuye Tang (Bamboo Leaf Decoction) is indicated. Various deficiency-heat irritabilities resemble Shanghan but lack aversion to cold and body pain, indicating they are not Shanghan and should not be sweated. Lack of headache and tight pulse indicates interior excess is absent, so purgation is contraindicated. If patients have pulsating movements (Dongqi) in the abdomen, sweating is contraindicated. See the Dongqi section for treatment details. This illustrates the ancients' caution with exterior-resolving herbs. Zhang Yunqi stated: For Taiyang patterns, if there is no headache and stiff neck, do not sweat; if there is no fever and aversion to cold, do not sweat; if there is no floating pulse, do not sweat.
[General Principle] Zhang Zhongjing stated: Guizhi Tang is originally for resolving the muscle layer. If the pulse is floating and tight, with fever and no sweat, Guizhi Tang should not be given. This must be recognized to avoid errors.
[Commentary] Li Zhongzi stated: If there is no exterior syndrome, do not sweat. If the pulse is deep, do not sweat. If the Chi (cun-guan-chi position, distal part) pulse is slow, do not sweat. If the pulse is faint and weak, even with aversion to cold, do not sweat. Hanjia (habitual sweaters) should not be subjected to heavy sweating. In concurrent Taiyang and Shaoyang disease with headache, stiff neck, dizziness, or epigastric fullness, do not sweat. If the pulse is string-taut and fine, with headache and fever, it belongs to Shaoyang and should not be sweated.
[General Principle] Zhang Zhongjing stated: Patients with chronic sores (Chuangjia), even if they have body pain, should not be sweated. Sweating will lead to Jing (spasm).
[Commentary] Wang Ang stated: Chuangjia with Shanghan body pain should not be sweated. Sweating leads to spasm. Exterior deficiency with heat accumulation causes sores. Sweating increases exterior deficiency and heat, generating wind and causing spasm. Nujia (frequent nosebleeders) and Wangxuejia (blood losers) should not be sweated, as this causes dual deficiency of Yin and Yang. Linjia (patients with strangury) should not be sweated, as this leads to hematuria. Sweating depletes fluids and increases exogenous heat. A slow Chi pulse indicates deficient Ying and blood, so sweating is contraindicated. A deep and slow pulse indicates interior pathology; forcing sweat causes fluid loss, difficult defecation, interior excess, and delirium. Dry throat and mouth indicate insufficient fluids, so sweating is contraindicated. Cough with free urination or urinary incontinence indicates lung and kidney Yang deficiency; sweating causes cold limbs and is contraindicated. Diarrhea with exterior signs should not be sweated, as sweating causes abdominal fullness due to fluid loss and stomach Qi deficiency. Heavy sweating in habitual sweaters causes mental confusion because sweat is the fluid of the Heart, and blood loss disrupts the Heart spirit.
[General Principle] Zhang Zhongjing stated: A floating and rapid pulse usually resolves with sweating. However, if the patient has heavy body sensation and palpitations, sweating is contraindicated. Recovery occurs through spontaneous sweating. The Chi pulse is faint, indicating interior deficiency. Interior and exterior must be strengthened, fluids harmonized, and then sweating leads to recovery.
[Commentary] Min Zhiqing stated: Sweating is indicated when pulse and symptoms are entirely exterior. Premature or excessive sweating depletes fluids and causes complications. Contraindications include various deficiencies, dry mouth/throat/pain, sores, strangury, menstruation, blood loss, coughing foam, complicated diseases, slow/faint/ choppy pulses, or cold extremities with tight pulses. Harmonization is preferred over sweating. Forced sweating in mild cases delays recovery; in severe cases, it causes delirium, dizziness, and death.
Shen Jin'ao noted: The term "interior deficiency" emphasizes the interior. "Exterior and interior solid" mentions the exterior incidentally. Exterior refers to the body, interior to the Heart. Regarding palpitations due to water qi, sweating might be used, but a faint Chi pulse explicitly indicates Heart fluid deficiency, distinguishing it from water qi-induced palpitations.
[General Principle] Zhang Zhongjing stated: A floating and tight pulse usually presents with body pain and should be resolved by sweating. However, if the Chi pulse is slow, sweating is contraindicated due to insufficient Ying qi and blood.
[Commentary] Shen Jin'ao noted: Both this and the previous paragraph discuss pulses that typically require sweating. The previous one cites a faint Chi pulse (interior deficiency) as a contraindication; this one cites a slow Chi pulse (Ying qi deficiency) as a contraindication. Although sweating might be attempted, one case involves Heart fluid deficiency and the other Ying qi deficiency; neither can produce sweat effectively, leading only to further depletion of healthy Qi.
[General Principle] Zhang Zhongjing stated: A faint pulse with aversion to cold indicates dual deficiency of Yin and Yang. Sweating, purging, or vomiting are all contraindicated.
[Commentary] Zhang Jiebín stated: Certain pulses contraindicate sweating. As stated: "Faint pulse with aversion to cold indicates dual deficiency; do not use sweating, vomiting, or purging." "Taiyang disease with fever, aversion to cold, more heat than cold, and faint pulse indicates absence of Yang; do not sweat." "String-taut indicates Yang movement, faint indicates Yin cold... faint and string-taut indicates deficiency; do not sweat. Sweating causes chills." "Shanghan after 4-5 days with deep pulse and wheezing/fullness: deep indicates interior; do not sweat. Sweating loses fluids, causing constipation and delirium." "Shaoyin disease with faint pulse: do not sweat due to Yang loss." "Weak and powerless Chi pulse: absolutely contraindicated for sweating and purging." "Slow Chi pulse: do not sweat due to Ying deficiency and blood shortage." These contraindications reveal Zhang Zhongjing's intent. In treating Shanghan, if the pulse is faint, deep, thin, or powerless, arbitrary sweating is forbidden. Yet, to expel exterior pathogens, sweating is necessary. How to treat exterior pathogens with a faint pulse? Warming the middle dissipates cold; strengthening the host expels invaders. For external pathogens with faint pulses, sweat is hard to produce, and pathogens are hard to resolve because Yuan Qi cannot push them. Forcing sweat without result worsens deficiency. Sweat comes from Ying, which depends on Qi and the Middle Jiao. Weak pulse indicates weak Yuan Qi. Treatment principles: If exterior excess with no sweat, disperse; if sweat persists with fever, harmonize; if Yuan deficiency prevents pathogen expulsion, tonify the root to allow spontaneous resolution. This is the complete method. Ignoring internal condition and using only cooling or dispersing methods risks Yang collapse. Excessive sweating causes Yang collapse, cold shivering, or coma. Treat with Dushen Tang (Single Ginseng Decoction) or Siwei Huiyang Tang (Four-Ingredient Decoction to Restore Yang). Physicians who fail to detect deficiency in elderly or weak patients may over-disperse, damaging Stomach Qi and leading to emaciation. This warns against excessive sweating. Ke Qin stated: Faint pulse without moderation indicates Taiyin deficiency. Aversion to cold without aversion to heat indicates Yang deficiency. Dual deficiency requires regulating Yin and Yang.
[General Principle] Zhang Zhongjing stated: After sweating, Guizhi Tang should not be used again. If there is no sweat and wheezing with high fever, Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) may be given. After purging, Guizhi Tang should not be used again. If there is no sweat and wheezing with high fever, Mahuang Xingren Gancao Shigao Tang may be given.
[Commentary] Li Shizhen stated: Zhang Zhongjing often used Guizhi Tang for residual exterior syndrome after sweating or purging, avoiding Mahuang Tang. However, in cases of internal and external heat without aversion to cold, where heat intensified after initial Mahuang Tang use, or persistent wheezing after failed sweating/purging due to heavy Yang qi, Guizhi Tang with Naren and Xingren would be fatal. This formula transforms a warming resolution into a cooling dispersion.
[General Principle] Zhang Zhongjing stated: Wine drinkers suffering from illness should not be given Guizhi Tang, as it causes vomiting due to their dislike of sweet flavors.
[Commentary] Wei Yilin stated: Wine drinkers dislike sweet flavors due to accumulated damp-heat. Even if Wind Strike is present, Guizhi Tang is withheld. This implies the use of Gegen Qinlian Tang (Kudzu, Scutellaria, Coptis, and Licorice Decoction).
Shen Jin'ao noted: Wei supplemented the Gegen Qinlian Tang method, followed by scholars like Wei Boxiang and Ke Yunbo, guiding medication choices for wine drinkers.