【纲】仲景曰。太阳之为病。脉浮。头项强痛而恶寒。太阳病。发热汗出。恶风脉缓者。名
为中风。太阳病。头痛发热。汗出恶风者。桂枝汤主之。
鳌按。通部中。凡言太阳病。及有表症。或表未罢。皆统表症中。举此二十条。详其正款耳。
非谓表症止于此也。其他各款。亦俱从此例。
【目】朱肱曰。发热恶寒。身体痛而脉浮者。表症也。表症者。恶寒是也。恶寒者。属太阳。
宜汗之。
刘完素曰。伤风表症。头痛项强。肢节烦疼。或目疼肌热。干呕鼻塞。手足温。自汗出。恶风
寒。其脉阳浮而缓。阴浮而弱。此为邪热在表。皆宜桂枝汤。或汗出憎风而加项背强痛。宜桂枝加
葛根汤。伤风及无汗者。虽已服桂枝。反烦不解而无里症者。先刺风池风府。却与桂枝葛根汤服之。
不若通用双解散。免致有麻黄桂枝之误。
伤寒表症。头项痛。腰脊强。身体拘急。发热恶寒。不烦躁。无汗。或头面目痛。肌热鼻干。
或胸满而喘。手足指末微厥。脉浮数而紧者。邪热在表。皆宜麻黄汤。或天水散之类。甚佳。无使
药不中病而益加害也。风寒俱中。头项痛。肢体疼。手足温。为中风也。反无汗。恶风。脉浮紧者。
为阴寒也。或头项痛。腰脊强。身体拘急。肢末微厥。不自汗。为伤寒也。反烦躁而脉缓者。为伤
风也。风则伤卫。而寒则伤荣。
陈士铎曰。邪入皮毛腠理。将入荣卫。急宜发散。方用白术三钱。柴胡、荆芥、半夏、苏叶、
甘草、苍术、丹皮各一钱。水煎服。此方平和之中有妙理。盖木气之郁。最宜平散。今所用俱是直
入肝经之圣药。自然肝木疏通。枝叶条达也。
柯琴曰。六经皆有表症。惟太阳主表。故表症表脉。独得其全。如浮脉为在表。太阳首三阳。
其脉气浮而有力。与阳明
之兼长大。少阳之兼弦细。三阴之微浮者。不侔矣。头项主一身之表。太阳经络营于头。会于项。故
头连项而强。与阳明头额痛。少阳头角痛者。少间矣。恶寒为病在表。六经虽各恶寒。而太阳应寒水
之化。故恶寒特甚。与阳明二日自止。少阳往来寒热。三阴之内恶寒者。悬殊矣。太阳只重在表症
表脉。不重在经络主病。
【纲】仲景曰。脉浮者。病在表。可发汗。麻黄汤。脉浮而数者。可发汗。宜麻黄汤。
伤寒发汗。解半日许。复烦。脉浮数者。可更汗。宜桂枝汤。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。与麻黄汤。
【目】朱肱曰。脉浮。表阳也。素问云。寸口脉浮而盛。病在外。则知脉浮者。表症也。
张元素曰。伤寒之法。先言表里。及有缓急。三阳表宜急。里宜缓。三阴表宜缓。里宜急。又
曰。脉浮当汗。脉沉当下。脉浮汗急而下缓。谓三阳表也。脉沉下急而汗缓。谓三阴里也。麻黄汤
谓之急。麻黄附子细辛汤谓之缓。内经云。有渍形以为汗。谓汗之缓。里之表。又云。在皮者汗而
发之。谓汗之急。表之表也。急汗者太阳。缓汗者少阴。是脏腑之输应也。假令麻黄附子细辛汤。
是少阴始得。发热脉沉。里和无汗。故渍形无汗。今麻黄汤。是太阳症。头项痛。腰脊强。脉浮无
汗。里和是也。在皮者汗而发之可也。经曰。治主以缓。治客以急。此之谓也。
李 曰。表病属太阳。凡见头疼发热恶寒。清便自调。腰项脊强。脉浮紧者。即是表症。不拘
日数多少。便宜解表。不宜下渗。有汗为表虚。宜解肌。（解肌是轻剂）
无汗为表实。宜发汗。（发汗是重剂）
但发汗亦有轻重。古谓春夏宜汗者。借天时而喻阳邪在外也。其实春月阳气尚微。秋月阳气欲
敛。俱不可大汗。夏月天气热。元府开。不必大汗。冬月阳气伏藏。感冒轻者。尤不宜汗。惟伤寒
重者。时令严密。皮毛坚致。非大汗无由得散。不得已而从权也。至于阴症。但厥无汗者。妄汗动
经则死。或有表邪。辛热微汗以散之可也。
鳌按。首条但言脉浮而不言迟弱。可见其浮而有力矣。然必审其热果在表。乃可用麻黄汤。此
篇所举仲景论。
亦非六经无归者。特以伤寒病。宜首辨表里。故不得不列此款以冠于首耳。
【纲】仲景曰。太阳病。项背强KT KT 。无汗恶风者。葛根汤主之。
太阳病。项背强KT KT 。反汗出恶风者。桂枝加葛根汤主之。
【目】王好古曰。治伤寒须分表里。若表里不分。汗下差误。岂为上工。且如均是发热。
身热不渴。为表有热。小柴胡加桂枝。厥而脉滑。为里有热。白虎加人参汤。均是水气。干呕微利。
发热而咳。为表有水。小青龙加芫花。体凉。表症罢。咳而胁下痛。为里有水。十枣汤。均是恶寒。
有热而恶寒者。发于阳也。麻黄、桂枝、小柴胡。无热而恶寒者。发于阴也。附子四逆。均是身
体痛。脉浮发热头痛身体痛者。为表未解。麻黄汤。脉沉自利身体痛者。为里不和。四逆汤。以此
观之。仲景表里之法甚详。学人宜究心焉。
【纲】仲景曰。结胸症。其脉浮大者。不可下。下之则死。
【目】朱震亨曰。 矩新书。谓有杂合邪者。当以杂合法治之。譬如恶寒发热。得之感冒。明
是外合之邪。已得浮数之脉。而气口又紧盛。明为食所伤。病者又倦怠。脉重按俱有空豁意。而胸
膈痞满。间引两胁。其脉轻取又似乎弦。此平昔多怒肝邪之所为也。细取左尺。大而沉弱。此又平
时房劳之过也。治法。宜以感冒一节且放后。先视其形色强弱浓薄。且以补中化食行滞。清凉胃火。
而以姜辣行之。则中气稍回。伤滞稍行。津液得和。通体得汗。外感之邪自解。医者不知详审求之。
只顾表散外邪。又不推究兼见之邪脉。亦不穷问所得之病因。如性情之着执。巧施杂合治法。将
见正日虚。邪日固。皆拙工之过也。
鳌按。杂合病以亦有表症。故附此。
楼全善曰。凡外伤风寒者。皆先因动作烦劳不已。致内伤体虚。然后外邪得入。故一家之中。
有病者。有不病者。由体
虚则邪入。而体不虚则邪无隙可入而不病也。故伤寒为病。属内伤者十居八九。后人泥于伤寒无补
法一语。但见寒热。不分虚实。一例汗下。必致夭伤者多矣。
【纲】张仲景说：太阳病的典型表现是脉象浮，头痛、项部僵硬疼痛且恶寒。太阳病中，若出现发热、出汗、怕风、脉象缓的，称为中风证。太阳病中，若出现头痛、发热、出汗、怕风的，应当用桂枝汤治疗。
沈金鳌按语：全书中，凡是提到“太阳病”，以及有表证或表证未解的情况，都统归入表证范畴。这里列举这二十条，是为了详细说明其正证（典型证候）。并不是说表证仅限于此，其他各类证候也都可以参照这个体例。
【目】朱肱说：发热、恶寒、身体疼痛且脉象浮的，属于表证。所谓表证，以恶寒为主要特征。恶寒属于太阳经病变，适宜采用发汗法治疗。
刘完素说：伤风引起的表证，表现为头痛、项部僵硬、四肢关节烦痛，或者眼睛疼痛、肌肉发热、干呕、鼻塞、手足温暖、自汗出、怕风怕冷。其脉象寸部（阳）浮而缓，尺部（阴）浮而弱，这是邪热在体表，都适宜用桂枝汤。如果出汗、怕风且伴有项背部僵硬疼痛的，适宜用桂枝加葛根汤。伤风及无汗的患者，虽然已经服用了桂枝汤，但反而感到烦闷不解且没有里证表现的，先针刺风池穴和风府穴，然后再给予桂枝加葛根汤服用。不如通用双解散，以免导致误用麻黄汤或桂枝汤的错误。
伤寒引起的表证，表现为头项痛、腰脊僵硬、身体拘急、发热恶寒、不烦躁、无汗，或者头面目痛、肌肉发热、鼻干，或者胸满而喘、手足指尖微冷、脉象浮数而紧的，这是邪热在体表，都适宜用麻黄汤，或者天水散之类，效果很好。不要让药不对症反而增加危害。风寒同时侵袭，头项痛、肢体疼、手足温的，属于中风；反而无汗、怕风、脉象浮紧的，属于阴寒；或者头项痛、腰脊僵硬、身体拘急、肢端微冷、不出汗的，属于伤寒；反而烦躁且脉象缓的，属于伤风。风邪伤害卫气，寒邪伤害营血。
陈士铎说：邪气侵入皮毛腠理，即将进入营卫之间，急需发散。方剂用白术三钱，柴胡、荆芥、半夏、苏叶、甘草、苍术、丹皮各一钱，水煎服。此方在平和之中蕴含妙理。因为木气郁结，最宜平调疏散。现在所用的都是直入肝经的良药，自然能使肝木疏通，枝叶条达舒展。
柯琴说：六经都有表证，只有太阳主表，所以表证和表脉，唯独太阳经具备得最为全面。如浮脉表示病在表，太阳作为首阳经，其脉气浮而有力，与阳明经兼见长大脉、少阳经兼见弦细脉、三阴经微浮的脉象，是不可同日而语的。头部和项部主管一身之表，太阳经络营运于头部，会合于项部，所以头连项部而僵硬，这与阳明经的头额痛、少阳经的头角痛相比，区别明显。恶寒表示病在表，六经虽然都可能有恶寒，但太阳对应寒水的化气，所以恶寒特别严重，这与阳明经两天后自行停止、少阳经往来寒热、三阴经内部恶寒的情况，相差悬殊。太阳经只重在表证和表脉，不重在经络主治的病证。
【纲】张仲景说：脉象浮的，病在表，可以发汗，用麻黄汤。脉象浮而数的，可以发汗，适宜用麻黄汤。
伤寒发汗后，过了约半天时间，又出现烦闷，脉象浮数的，可以再发汗，适宜用桂枝汤。太阳病十天以上，脉象浮细且想睡觉的，说明外邪已解。如果伴有胸满胁痛的，用小柴胡汤。脉象仅见浮的，给麻黄汤。
【目】朱肱说：脉浮，属于表阳证。《素问》说：寸口脉浮而盛大，病在外，由此可知脉浮者，属于表证。
张元素说：治疗伤寒的方法，先要分辨表里，以及病情的缓急。三阳经的表证宜急治，里证宜缓治；三阴经的表证宜缓治，里证宜急治。又说：脉浮应当发汗，脉沉应当攻下。脉浮汗法急而攻下法缓，指的是三阳经的表证；脉沉攻下急而发汗缓，指的是三阴经的里证。麻黄汤被称为急汗法，麻黄附子细辛汤被称为缓汗法。《内经》说：有通过浸渍形体来发汗的，指缓汗法，适用于里的表证；又说：病在皮肤的，用发汗法发散，指急汗法，适用于表的表证。急汗法针对太阳经，缓汗法针对少阴经，这是脏腑输注相应的关系。假如麻黄附子细辛汤，是少阴病初起，发热脉沉，里气和而无汗，所以通过浸渍形体令其无汗（此处原文逻辑似有争议，通常指助阳发汗），现在的麻黄汤，是太阳病，头项痛，腰脊强，脉浮无汗，里气和，对于病在皮肤的，可以用发汗法发散。经书说：治主病用缓法，治客病用急法，说的就是这个道理。
李杲说：表病属于太阳经。凡是见到头痛、发热、恶寒、二便正常、腰项脊背僵硬、脉象浮紧的，就是表证。不拘泥于患病天数多少，应当及时解表，不宜使用攻下渗利之法。有汗为表虚证，适宜解肌（解肌是轻剂）；无汗为表实证，适宜发汗（发汗是重剂）。
但是发汗也有轻重之分。古人说春夏适宜发汗，是借天时来比喻阳邪在体外。其实春季阳气尚微弱，秋季阳气欲收敛，都不可以大汗。夏季天气热，毛孔张开，不必大汗。冬季阳气伏藏，感冒轻者，尤其不宜发汗。只有伤寒重症，时令气候严酷，皮毛坚致，非大汗不能使邪气散发，这是不得已而采取的权宜之计。至于阴证，只有厥冷而无汗的，妄用发汗动及经脉就会死亡。如果有表邪，用辛热药物微汗以发散它即可。
沈金鳌按语：第一条只说脉浮而不说迟弱，可见其脉浮而有力。然而必须审察热确实在表，才可用麻黄汤。本篇所列举的仲景论述，也不是六经无所归属的，特因伤寒病，应当首先辨别表里，所以不得不列出这一款放在篇首。
【纲】张仲景说：太阳病，项背部僵硬不适（KT KT 形容僵硬不舒之状），无汗怕风的，用葛根汤主治。
太阳病，项背部僵硬不适，反而出汗怕风的，用桂枝加葛根汤主治。
【目】王好古说：治疗伤寒必须分清表里，如果表里不分，汗法和下法出现差错失误，怎么能成为上工（高明的医生）。况且同样是发热，身热但不口渴的，为表有热，用小柴胡汤加桂枝；四肢厥冷而脉滑的，为里有热，用白虎加人参汤。同样是水气停聚，干呕微利、发热而咳的，为表有水，用小青龙汤加芫花；身体凉爽，表证已罢，咳嗽且胁下痛的，为里有水，用十枣汤。同样是恶寒，有热而恶寒的，发于阳经，用麻黄汤、桂枝汤、小柴胡汤；无热而恶寒的，发于阴经，用附子四逆汤。同样是身体痛，脉浮、发热、头痛、身体痛的，为表未解，用麻黄汤；脉沉、自利、身体痛的，为里不和，用四逆汤。从这些可以看出，仲景关于表里的治法非常详尽，学习者应当用心研究。
【纲】张仲景说：结胸证，如果脉象浮大的，不可攻下，攻下则会导致死亡。
【目】朱震亨说：《局方新书》认为，有杂合邪气的，应当用杂合法治疗。譬如恶寒发热，是由于感冒引起的，明明白白是外合之邪，已经得到浮数的脉象，而气口脉又紧盛，明确是为饮食所伤。病人又倦怠，脉象重按时有空豁之意，且胸膈痞满，有时牵引两胁，其脉轻取似乎弦。这是平时多怒导致肝邪所为。仔细切诊左尺脉，大而沉弱，这又是平时房劳过度的过错。治疗方法，应当先把感冒一节搁置在后，先观察病人的形色强弱浓薄，先用补中益气、化食行滞、清凉胃火的方法，并用姜辣药性引导运行，这样中气稍微恢复，伤滞稍微通行，津液得以调和，全身得以出汗，外感之邪自然解除。医者不知道详细审察求索病因，只顾表散外邪，又不推究兼见的邪脉，也不穷尽询问所得的病因，如性格执着等，巧施杂合治法。将会看到正气日渐虚弱，邪气日渐固结，这都是拙劣医生的过错。
楼全善说：凡是外伤风寒的，都是因为动作烦劳不已，导致内伤体虚，然后外邪才得以侵入。所以一家之中，有生病的，有不生病的，是因为体虚则邪气侵入，而体不虚则邪气无隙可入而不生病。所以伤寒这类疾病，属于内伤的占十分之八九。后人拘泥于“伤寒无补法”这句话，只要见到寒热症状，不分虚实，一律使用汗法和下法，必然导致很多夭折损伤的情况。
[Outline] Zhang Zhongjing said: The typical manifestation of Taiyang disease (Disease of the Taiyang/Bladder channel) is a floating pulse (Pulse that feels superficial and can be felt with light pressure), headache, stiffness and pain in the neck and occiput, and aversion to cold. In Taiyang disease, if there is fever, sweating, aversion to wind, and a slow pulse, it is named Wind-strike syndrome (Zhongfeng, often referring to exterior deficiency pattern). In Taiyang disease, if there is headache, fever, sweating, and aversion to wind, Guizhi Tang (Cinnamon Twig Decoction) should be administered.
Shen Jin'ao's commentary: Throughout the book, whenever "Taiyang disease" is mentioned, or when there are exterior symptoms or the exterior pathogen has not yet resolved, they are all collectively categorized under exterior syndromes. These twenty clauses are listed here to detail the standard presentations. This does not imply that exterior syndromes are limited to these; other types also follow this example.
[Subsidiary] Zhu Gong said: Fever, aversion to cold, body pain, and a floating pulse belong to exterior syndromes. The hallmark of an exterior syndrome is aversion to cold. Aversion to cold belongs to the Taiyang channel. It is appropriate to treat it by inducing sweating.
Liu Wansu said: Exterior syndromes caused by wind injury present with headache, neck stiffness, painful and uncomfortable joints, or eye pain, muscle heat, dry retching, nasal congestion, warm hands and feet, spontaneous sweating, and aversion to wind and cold. The pulse is floating and slow at the cun position (yang) and floating and weak at the chi position (yin). This indicates pathogenic heat in the exterior, and Gui Zhi Tang is suitable for all such cases. If there is sweating, aversion to wind, accompanied by stiffness and pain in the neck and back, Gui Zhi Jia Ge Gen Tang (Guizhi Decoction plus Puerariae Radix) is suitable. For patients with wind injury and no sweating, if Gui Zhi Tang has been taken but vexation persists without interior symptoms, first puncture Fengchi (GB20) and Fengfu (GV16) acupoints, then administer Gui Zhi Jia Ge Gen Tang. Alternatively, Shuangjie San (Double-Release Powder) can be used universally to avoid errors from using Mahuang Tang or Guizhi Tang incorrectly.
Exterior syndromes caused by cold damage present with head and neck pain, stiff lower back and spine, bodily rigidity, fever and aversion to cold, no restlessness, no sweating, or head/face/eye pain, muscle heat, dry nose, chest fullness with wheezing, slight coldness in the fingertips, and a floating, rapid, and tight pulse. This indicates pathogenic heat in the exterior, and Mahuang Tang (Ephedra Decoction) or Tianshui San are suitable, yielding excellent results. One must ensure the medication matches the pathology to avoid causing further harm. When both wind and cold invade, presenting with head/neck pain, limb pain, and warm hands/feet, it is Wind-strike; however, if there is no sweating, aversion to wind, and a floating-tight pulse, it is Yin-cold. Or, if there is head/neck pain, stiff lower back/spine, bodily rigidity, slight coldness in the extremities, and no sweating, it is Cold Damage; however, if there is restlessness and a slow pulse, it is Wind Injury. Wind injures the Defensive Qi (Wei Qi), while Cold injures the Nutritive Blood (Ying Blood).
Chen Shiduo said: When pathogens enter the skin pores and interstices, approaching the Nutritive and Defensive levels, prompt dispersal is required. The prescription consists of Baizhu (Atractylodis Macrocephalae Rhizoma) 3 qian, and Chaihu (Bupleuri Radix), Jingjie (Schizonepetae Herba), Banxia (Pinelliae Rhizoma), Ziye (Perillae Folium), Gancao (Glycyrrhizae Radix et Rhizoma), Cangzhu (Atractylodis Rhizoma), and Danpi (Moutan Cortex) each 1 qian, decocted in water and taken orally. This formula contains profound principles within its mild nature. Since Liver Wood Qi stagnation is best treated by soothing and dispersing, and the herbs used here directly enter the Liver channel, they naturally unblock the Liver Wood, allowing the branches and leaves to grow smoothly.
Ke Qin said: All six channels have exterior syndromes, but only Taiyang governs the exterior. Therefore, only Taiyang fully embodies the characteristics of exterior syndromes and pulses. For instance, a floating pulse indicates the disease is in the exterior. As the first Yang channel, Taiyang's pulse qi is floating and forceful, which differs significantly from the Chang-da (large and long) pulse combined with Yangming, the Xuan-xi (string-like and fine) pulse combined with Shaoyang, and the slightly floating pulse of the Three Yin channels. The head and neck govern the exterior of the whole body. The Taiyang meridians circulate around the head and converge at the neck, hence the stiffness connecting the head and neck. This differs from the frontal headache of Yangming and the temporal headache of Shaoyang. Aversion to cold indicates the disease is in the exterior. Although all six channels may exhibit aversion to cold, Taiyang corresponds to the transformation of Cold Water, so its aversion to cold is particularly severe. This stands in stark contrast to Yangming (which stops on its own after two days), Shaoyang (alternating chills and fever), and the internal aversion to cold of the Three Yin channels. Taiyang focuses primarily on exterior symptoms and pulses, rather than on the specific diseases governed by its meridians.
[Outline] Zhang Zhongjing said: A floating pulse indicates the disease is in the exterior; sweating may be induced using Mahuang Tang. A floating and rapid pulse allows for sweating, preferably with Mahuang Tang.
After inducing sweating for cold damage, if vexation recurs after about half a day and the pulse is floating and rapid, sweating may be induced again, suitably with Guizhi Tang. If Taiyang disease has persisted for ten days or more, and the pulse is floating and fine with a desire to sleep, the exterior has resolved. If there is chest fullness and hypochondriac pain, Xiao Chaihu Tang (Minor Bupleurum Decoction) should be given. If the pulse is merely floating, administer Mahuang Tang.
[Subsidiary] Zhu Gong said: A floating pulse belongs to Exterior-Yang. The *Suwen* states: "If the Cun-kou pulse is floating and vigorous, the disease is external." Thus, a floating pulse indicates an exterior syndrome.
Zhang Yuansu said: The method for treating cold damage begins by distinguishing between exterior and interior, as well as urgency and slackness. Exterior conditions of the Three Yang channels should be treated urgently, while interior conditions should be treated slowly. Exterior conditions of the Three Yin channels should be treated slowly, while interior conditions should be treated urgently. He further stated: Floating pulses require sweating; sinking pulses require purging. A rapid sweating method and slow purging method refer to the exterior of the Three Yang channels. A rapid purging method and slow sweating method refer to the interior of the Three Yin channels. Mahuang Tang is called an urgent sweating method, while Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) is called a slow sweating method. The *Neijing* mentions inducing sweat by soaking the body, referring to the slow sweating method for the exterior of the interior. It also says, "For diseases in the skin, induce sweat to disperse them," referring to the urgent sweating method for the exterior of the exterior. Urgent sweating targets the Taiyang channel, while slow sweating targets the Shaoyin channel, reflecting the correspondence of organ and channel transmissions. For example, Mahuang Fuzi Xixin Tang is for early Shaoyin disease with fever, sinking pulse, harmonious interior, and no sweat, thus using soaking to induce sweat without excessive diaphoresis. Current Mahuang Tang treats Taiyang syndrome with head/neck pain, stiff back, floating pulse, no sweat, and harmonious interior; since the pathogen is in the skin, inducing sweat to disperse it is appropriate. The classics state: "Treat the principal condition with a gentle method, treat the guest condition with an urgent method." This is what is meant.
Li Dongyuan said: Exterior diseases belong to the Taiyang channel. Whenever headache, fever, aversion to cold, normal urination and defecation, stiff waist/neck/back, and a floating-tight pulse are seen, it is an exterior syndrome. Regardless of the number of days ill, one should promptly resolve the exterior and avoid purgative or draining methods. Sweating indicates Exterior Deficiency, suitable for resolving the muscle layer (Jieji, a mild method). No sweating indicates Exterior Excess, suitable for inducing sweating (Fahan, a heavy method).
However, inducing sweating varies in intensity. Ancients said sweating is suitable in spring and summer, borrowing seasonal timing to illustrate yang pathogens outside. Actually, in spring, yang qi is still weak; in autumn, yang qi is gathering; neither should undergo heavy sweating. In summer, weather is hot, pores open, so heavy sweating is unnecessary. In winter, yang qi is hidden; for mild colds, sweating is especially inappropriate. Only in severe cold damage, with strict seasonal climates and tight skin/pores, is heavy sweating necessary to disperse the pathogen, which is a temporary measure of necessity. For Yin syndromes, if there is only cold limbs and no sweating, reckless sweating will disturb the meridians and cause death. If there is exterior pathogen, use pungent-warm herbs to induce slight sweating to disperse it.
Shen Jin'ao's commentary: The first clause mentions only a floating pulse, not slow or weak, indicating the pulse is floating and forceful. However, one must verify that the heat is truly in the exterior before using Mahuang Tang. The Zhongjing discussions cited in this chapter are not those belonging to no specific channel; specifically, because cold damage requires first distinguishing exterior and interior, this clause is placed at the beginning.
[Outline] Zhang Zhongjing said: In Taiyang disease, if there is stiffness and discomfort in the neck and back, no sweating, and aversion to wind, Gegen Tang (Kudzu Root Decoction) is the primary treatment.
In Taiyang disease, if there is stiffness and discomfort in the neck and back, but with sweating and aversion to wind, Guizhi Jia Gegen Tang (Guizhi Decoction plus Kudzu Root) is the primary treatment.
[Subsidiary] Wang Haogu said: Treating cold damage requires distinguishing between exterior and interior. If not distinguished, errors in sweating and purging methods will occur, preventing one from being a superior physician. For example, regarding fever: body heat without thirst indicates heat in the exterior; Xiaochaihu Tang plus Guizhi is used. Cold limbs with a slippery pulse indicate heat in the interior; Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is used. Regarding fluid retention: dry retching with slight diarrhea, fever, and cough indicate fluid in the exterior; Xiao Qinglong Tang plus Yuanhua is used. Cool body, resolved exterior symptoms, cough with hypochondriac pain indicate fluid in the interior; Shizao Tang (Ten Jujube Decoction) is used. Regarding aversion to cold: aversion to cold with heat indicates onset in Yang channels; Mahuang Tang, Guizhi Tang, or Xiaochaihu Tang are used. Aversion to cold without heat indicates onset in Yin channels; Fuzi Sini Tang (Aconite Reverse Cold Decoction) is used. Regarding body pain: floating pulse, fever, headache, and body pain indicate unresolved exterior; Mahuang Tang is used. Sinking pulse, spontaneous diarrhea, and body pain indicate interior disharmony; Sini Tang is used. From this, we see Zhongjing's methods for distinguishing exterior and interior are very detailed; students should study them carefully.
[Outline] Zhang Zhongjing said: In JieXiong syndrome (Chest Binding Syndrome), if the pulse is floating and large, purging is contraindicated; purging will lead to death.
[Subsidiary] Zhu Zhenheng said: The *Ju Fang Xin Shu* states that mixed pathogens should be treated with mixed methods. For instance, aversion to cold and fever caused by a common cold clearly indicate external pathogens. With a floating-rapid pulse, but a tight and vigorous Qi-kou pulse, it is clearly food injury. The patient is also fatigued, and deep palpation reveals an empty pulse quality, with chest/diaphragm fullness sometimes radiating to the hypochondrium, and the pulse feeling string-like on light palpation. This is due to Liver pathogen from frequent anger. Careful palpation of the left Chi pulse shows it large, deep, and weak, indicating past sexual excess. The treatment should postpone addressing the cold. First, observe the patient's complexion, strength, and constitution. Use methods to tonify the middle, transform food, move stagnation, clear stomach fire, and guide with ginger and pepper. This will restore middle qi, move stagnation, harmonize fluids, induce whole-body sweating, and naturally resolve the external pathogen. Physicians who do not investigate details, only focusing on dispersing external pathogens, failing to analyze concurrent pulses or inquire thoroughly into causes (such as personality traits), and cleverly applying mixed treatments, will see righteous qi become deficient daily and pathogens become entrenched daily. This is the fault of incompetent physicians.
Shen Jin'ao's commentary: Mixed diseases also involve exterior syndromes, so this is attached here.
Lou Quanshan said: External wind-cold invasion always occurs because continuous physical exertion leads to internal injury and deficiency, allowing external pathogens to enter. Thus, in one family, some get sick while others do not; deficiency allows pathogen entry, while non-deficiency leaves no gap for pathogens. Therefore, most (80-90%) of cold damage diseases are related to internal injury. Later generations, adhering strictly to the phrase "cold damage has no tonification method," see only chills and fever without distinguishing deficiency or excess, and uniformly apply sweating and purging, leading to many premature deaths and injuries.