治无汗。杏仁治喘。桂枝甘草。治太阳诸证。无一味不紧切。所以谓之经方。
柯氏曰。予治冷风哮。与风寒湿三气成痹等证。用此辄效。非伤寒一证可拘也。
外台。深师麻黄汤。疗新久咳嗽唾脓血。连年不瘥。昼夜肩息。
于本方。去杏仁。加大枣。
又疗上气咳嗽。喉中水鸡鸣。唾脓血腥臭。麻黄汤。
于本方。加生姜。
圣惠方。解肌散。治小儿伤寒发热。四肢烦疼。
于本方。加大黄芍药。
和剂局方。三拗汤。治感冒风邪。鼻塞声重。语音不出。或伤风伤冷。头痛目眩。四肢拘倦。咳嗽多痰。
胸满气短。
于本方。去桂。三味生用。加生姜。（麻黄。不去节。杏仁不去皮尖。甘草不炙。）
直指方。加减麻黄汤。治肺感寒邪咳嗽。
于本方。加陈皮半夏紫苏叶生姜。
舒氏女科要诀曰。会医一产妇。发动六日。儿已出胞。头已向下。而竟不产。医用催生诸方。又用催生
灵符。又求灵神炉丹。俱无效。延予视之。其身壮热无汗。头项腰背强痛。此太阳寒伤营也。法主麻黄汤。作
一大剂投之。令温覆。少顷得汗。热退身安。乃索食。食讫豁然而生。此治其病。而产自顺。上乘法也。
脉浮而紧。浮则为风。紧则为寒。风则伤卫。寒则伤营。营卫俱病。骨节烦疼。可发其汗。宜麻黄汤。
（案此一条。出宋版可
汗篇。及玉函。脉经。千金翼。正是本论原文。当在太阳篇中。今本系于脱漏。故诸注家未有解释者。钱氏云。
寒已入营。岂有不从卫分而入者乎。的与此条符矣。乃知麻黄桂枝之别。在表之虚实。而不在于风寒营卫之分。
得此条而甚明。故揭于此。○又案此条。出辨脉法。脉上。有寸口二字。无宜麻黄汤四字。汗下。有也字。）
〔柯〕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。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。
案柯氏注本。以辨脉此条。移于麻黄症条内。其释义如是。可谓发千古之秘。超越诸注。因亦移为本条
之注。本事方曰。寒伤营。则寒邪入阴血。而营行脉中者也。寒邪居脉中。非特营受病。邪自内作。则并与卫
气犯之。久则浸淫及骨。是以汗不出而热。仲景以麻黄发其汗。又以桂枝甘草。助其发散。欲涤除内外之邪。
营卫之病尔。大抵二药皆发汗。而桂枝则发其卫之邪。麻黄并营卫治之。亦自有深浅也。何以验之。第一卷云。
寸口脉浮而紧云云。是知伤寒脉浮紧者。营卫俱病也。麻黄汤中。并用桂枝。此仲景之意也。○案许氏此说。
与柯氏之意符矣。不知柯岂不读本事方耶。
太阳与阳明合病。喘而胸满者。不可下。宜麻黄汤。（成本。玉函。汤下。有主之二字。非。）
〔成〕阳受气于胸中。喘而胸满者。阳气不宣发。壅而逆也。心下满腹满。皆为实。当下之。此以为胸满
非里实。故不可下。虽有阳明。然与太阳合病为属表。是与麻黄汤发汗。〔汪〕喘而胸满。则肺气必实而胀。
所以李东璧云。麻黄汤。虽太阳发汗重剂。实为发散肺经火郁之药。彼盖以喘而胸满。为肺有火邪实热之证。
汤中有麻黄杏仁。专于泄肺利气。肺气泄利。则喘逆自平。又何有于阳明之胸满邪。〔钱〕胸满者。太阳表邪未
解。将入里而犹未入也。以阳明病。而心下硬满者。尚不可攻。攻之遂利不止者死。况太阳阳明合病乎。
太阳病十日以去。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。（以
去。玉函。千金翼。作已去。脉上。玉函。千金翼。有其字。外已解也。玉函。脉经。千金翼。作此为外解。
○原本。有小柴胡汤。今详后九十五条。小柴胡证候。并加减法悉具。故省之。）
〔鉴〕太阳病十日以上无他证。脉浮细而嗜卧者。外邪已解。不须药也。设有胸满胁痛等证。则知少阳之外
邪未解。故与小柴胡汤和之。若脉但浮不细。而有头痛发热。恶寒无汗等证。则仍是太阳之外邪未解。当与麻
黄汤汗之。案论中脉浮细。太阳少阳脉也。脉弦细。少阳脉也。脉沉细。少阴脉也。脉浮细。身热嗜卧者。阳
也。脉沉细。身无热嗜卧者。阴也。脉缓细。身和嗜卧者。已解也。是皆不可不察也。〔程〕脉浮细而嗜卧者。
较之少阴为病之嗜卧。脉浮则别之。较之阳明中风之嗜卧。脉细又别之。脉静神恬。解证无疑矣。设于解后。
尚见胸满胁痛一证。则浮细自是少阳本脉。嗜卧为胆热入而神昏。宜与小柴胡汤。脉但浮者。与麻黄汤。彼已
现麻黄汤脉。自应有麻黄汤证符合之。纵嗜卧依然。必不胸
满胁痛可知。〔志〕愚案小柴胡汤。麻黄汤。不过假此以明太少之由枢而外。从外而表。非真与之。故曰设也。
太阳中风。脉浮紧。发热恶寒。身疼痛。不汗出而烦躁者。大青龙汤主之。若脉微弱。汗出恶风者。不可
服之。服之则厥逆。筋惕肉 。此为逆也。（千金。太阳中风。作中风伤寒。玉函。脉经。千金。身下。有体
字。不汗出。千金。外台。作汗不出。玉函。脉经。烦躁下。有头痛二字。无厥逆之逆。成本。逆也下。更有
大青龙汤主之六字。方氏。根据黄仲理。改真武汤。并非。）
〔成〕此中风见寒脉也。浮则为风。风则伤卫。紧则为寒。寒则伤营。营卫俱病。故发热恶寒。身疼痛也。
风并于卫者。为营弱卫强。寒并于营者。为营强卫弱。今风寒两伤。则营卫俱实。故不汗出而烦躁也。与大青
龙汤发汗。以除营卫风寒。若脉微弱。汗出恶风者。为营卫俱虚。反服青龙汤。则必亡阳。或生厥逆筋惕肉 。
此治之逆也。〔喻〕天地郁蒸。得雨则和。人身烦躁。得汗则解。大青龙汤证。为太阳无汗而设。与麻黄汤证
何异。因有烦躁一证兼见。则非此法不解。〔程〕脉则浮紧。证则发热恶寒。身疼痛。不汗出而烦躁。明是阴
寒在表。郁住阳热之气在经。而生烦热。热则并扰其阴而作躁。总是阳气怫郁不得越之故。此汤。寒得麻黄汤
之辛热而外出。热得石膏之甘寒而内解。龙升雨降。郁热顿除矣。然此非为烦躁设。为不汗出之烦躁设。若脉
微弱。汗出恶风者。虽有烦躁证。乃少阴亡阳之象。全非汗不出而郁蒸者比也。〔锡〕若脉微弱。汗出恶风者。
此阴阳表里俱虚。故不可服。服之则阳亡而厥逆矣。阳气者。柔则养筋。血气盛则充肤热肉。今虚则筋无所养。
肉无以充。故筋惕而肉 。此治之逆也。
案外台秘要。引古今录验。载本条。方后。张仲景伤寒
论云。中风见伤寒脉者。可服之。活人书曰。盖发热恶风烦躁。手足温。为中风候。脉浮紧为伤寒脉。是中风
见寒脉也。大青龙汤治病。与麻黄汤证相似。但病尤重。而又加烦躁者。大抵感外风者为中风。感寒冷者为伤
寒。故风则伤卫。寒则伤营。桂枝主伤卫。麻黄主伤营。大青龙主营卫俱伤故也。此成氏注解所原。其来久矣。
然风寒营卫两伤。尤不可信据。何则脉浮紧。发热恶寒。身疼痛不汗出者。伤寒之候。烦躁。亦非中风之候。
虽曰太阳中风。并无中风之候证。盖中风二字。诸家纷纭。无有的据显证。故姑置之阙疑之例而可已。活人云。
大青龙汤治病。与麻黄汤相似。但病尤重。而又加烦躁者。此乃用此汤之指南。宜无复异议也。
柯氏曰。盖仲景凭脉辨症。只审虚实。故不论中风伤寒。脉之缓紧。但于指下有力者为实。脉弱无力者为
虚。不汗出而烦躁者。为实。汗出多而烦躁者。为虚。证在太阳而烦躁者。为实。证在少阴而烦躁者。为虚。
实者可服大青龙。虚者便不可服。此最易知也。凡先烦不躁。而脉浮者。必有汗而自解。烦躁而脉浮紧者。必
无汗而不解。大青龙汤。为风寒在表。而兼热中者设。不是为有表无里而设。故中风无汗烦躁者。可用。伤寒
而无汗烦躁者。亦可用。盖风寒本是一气。故汤剂可以互投。论中有中风伤寒互称者。如大青龙是也。有中风
伤寒兼提者。如小柴胡是也。仲景但细辨脉证而施治。何尝拘拘于中风伤寒之别其名乎。如既立麻黄汤治寒。
桂枝汤治风。而中风见寒。伤寒见风者。曷不用桂枝麻黄各半汤。而更用大青龙为主治耶。妄谓大青龙为风寒
两伤营卫而设。不知其为两解表里而设。请问石膏之设。为治风欤。治寒欤。营分药欤。卫分药欤。只为热伤
中气。用之治内热也。
内台方议。黄伯荣曰此一证中。全在不汗出。一不字内
藏机。且此不字。是微有汗。而不能得出。因生烦躁。非若伤寒之全无汗也。以此不字。方是伤风。此乃古人
智深识妙之处。○案此说难从。然无汗与不汗出。不能无别。况此证阳热内郁。必微有汗。故举似于斯。
案脉微弱。汗出恶风者。当用桂枝加附子汤。柯氏云。是桂枝症。若然则脉当浮缓。今脉微弱。而自汗出
者。是表里俱虚。桂枝不中与也。
明理论曰。筋惕肉 。非常常有之者。必待发汗过多亡阳。则有之矣。内经曰。阳气者。精则养神。柔则
养筋。发汗过多。津液枯少。阳气太虚。筋肉失所养。故惕惕然而跳。 然而动也。
汪氏曰。厥逆筋惕肉 。乃为大逆之候。末后大青龙汤主之句。黄仲理改作真武汤。方喻二家皆宗之。大
误。盖此条病。仲景本无救逆之法。末后六字。今从删。
活人书。引高若讷伤寒类纂云。凡发汗过多。筋惕肉 。振摇动人。或虚羸之人。微汗出。便有此证。俱
宜服真武汤救之。○案黄仲理之说。原出于此。
大青龙汤方
麻黄（六两去节） 桂枝（二两去皮） 杏仁（四十枚去皮尖○枚。成本。作个。千金翼。尖下。有两仁
者三字。） 甘草（二两炙） 生姜（三两切） 大枣（十枚擘○成本。金匮。玉函。千金。并作十二枚。）
石膏（如鸡子大。碎。○玉函。千金翼。外台。碎下。有绵裹二字。）
上七味。以水九升。先煮麻黄。减二升。去上沫。纳诸药。煮取三升。去滓。温服一升。取微似汗。汗出
多者。温粉扑之。一服汗者。停后服。若复服汗多。亡阳遂（【原注】一作逆）虚。恶风烦躁不得眠也。（外
台。味下。有切字。取微似汗。玉函。作覆令汗。外台。作浓覆取微汗。扑之。成本。千金翼。外台。作粉之。
成本。无若复服三字。遂
千金翼。作逆。明理论。亦有一作逆注文。○柯本。汗出多者以下三十二字。移前麻黄汤方后如桂枝法下。注
云。此麻黄汤之禁也。）
〔柯〕此即加味麻黄汤也。诸证全是麻黄。而有喘与烦躁之不同。喘者是寒郁其气。升降不得自如。故多杏
仁之苦以降气。烦躁是热伤其气。无津不能作汗。故特加石膏之甘以生津。然其质沉。其性寒。恐其内热顿除。
而外之表邪不解。变为寒中。而协热下利。是引贼破家矣。故必倍麻黄以发汗。又倍甘草以和中。更用姜枣以
调营卫。一汗而表里双解。风热两除。此大青龙。清内攘外之功。所以佐桂麻二方之不及也。〔汪〕或问。病
人同是服此汤。而汗多亡阳。一则厥逆筋惕肉 。一则恶风烦躁不得眠。二者之寒热。迥然不同。何也。余答
云。一则病患脉微弱。汗出恶风。是阳气本虚也。故服之。则厥逆。而虚冷之证生焉。一则病患脉浮紧。发热
汗不出而烦躁。是邪热本甚也。故服之。则正气虽虚。而邪热未除。且也厥逆之逆为重。以其人本不当服。而
误服之也。烦躁不得眠。为犹轻。以其人本当服。而过服之也。
伤寒蕴要曰。大青龙汤。治伤寒脉浮紧。头痛身疼痛。恶寒发热。不得汗出。烦躁扰乱不安者。以此汗
之。古人以伤寒为汗病。其身热烦躁。无奈何者。一汗而凉。斯言是也。天之邪气。自外而入。亦当自外出之。
非汗不能解也。
仲景全书。王文禄曰。大青龙。治风寒外壅。而闭热于经者。故加石膏于发汗药中。尤为峻剂。
伤寒类方曰。此合麻黄桂枝越婢三方为一方。而无芍药。何以发汗如是之烈。盖麻黄汤。麻黄用二两。
而此用六两。越婢汤。石膏用半斤。此用鸡子大一块。一剂之药。除大枣。约共十六两。以今称计之。亦重三
两有余。则发汗之重剂矣。虽少加石膏。终不足以相制也。
案温粉未详。总病论。载肘后。川芎苍术。白芷。 本零陵香。和米粉粉身。辟温粉方云。凡出汗大多。
治疗无汗。杏仁治疗喘证。桂枝、甘草，治疗太阳病各种证候，没有一味药不紧扣病机。所以称之为经方。
柯琴说：我治疗冷风哮、以及由风寒湿三气结合导致的痹证等病症，使用此方往往见效，并不局限于伤寒这一种证型。
《外台秘要》记载的《深师方》麻黄汤，治疗新近或久远的咳嗽并咳吐脓血，连年不愈，昼夜呼吸急促（肩息）。
在本方基础上，去掉杏仁，加大枣。
又用于治疗上气咳嗽，喉中有如水鸡鸣叫的声音，咳吐脓血腥臭之物。用麻黄汤。
在本方基础上，加入生姜。
《圣惠方》中的解肌散，治疗小儿伤寒发热，四肢烦疼。
在本方基础上，加大黄、芍药。
《和剂局方》中的三拗汤，治疗感冒风邪，鼻塞声音重浊，语音不出；或者伤风受寒，头痛目眩，四肢拘挛倦怠，咳嗽多痰，胸满气短。
在本方基础上，去掉桂枝，三味药生用，加入生姜。（麻黄不去节，杏仁不去皮尖，甘草不炙。）
《直指方》中的加减麻黄汤，治疗肺感寒邪引起的咳嗽。
在本方基础上，加入陈皮、半夏、紫苏叶、生姜。
舒驰远《女科要诀》记载：有一位医生诊治一位产妇，临产发动六天，胎儿已出胞宫，胎头已向下，但竟然未能分娩。医生使用了催生的各种方剂，又用了催生灵符，又求取灵神炉丹，都无效。延请我诊治。患者身体壮热无汗，头项腰背强痛。这是太阳寒邪伤及营分。治法主用麻黄汤。开一大剂投服，令其温覆取汗。不久得汗，热退身安，于是索要食物。吃完饭后，胎儿豁然娩出。这是治病而产道顺遂，是上乘的治疗方法。
脉浮而紧，浮则代表风，紧则代表寒。风则伤卫气，寒则伤营血。营卫俱病，骨节烦疼，可以发汗，宜用麻黄汤。
（按语：这一条出自宋版可汗篇，以及《玉函经》、《脉经》、《千金翼方》，正是本论原文，应当在太阳篇中。今本系于脱漏，所以各位注家都没有解释。钱潢说：寒邪已经入营，难道有不从卫分而入的吗？的确与此条相符。由此可知麻黄汤与桂枝汤的区别，在于表证的虚实，而不在于风寒营卫的区分。有了这一条就十分明白了，所以揭示在此处。○又按语：这一条出自辨脉法，脉字上有“寸口”二字，没有“宜麻黄汤”四字，汗下句下有“也”字。）
〔柯琴〕风寒本来相互伴随，必定是风先打开腠理，寒邪得以进入经络，营卫俱伤，那么一身内外的阳气就不能宣越，所以骨肉烦疼。脉象也应合这种病机，而变见于寸口。紧脉为阴寒，却见浮象，这是阴盛阳虚，发汗就能痊愈。脉法认为浮为风，紧为寒，所以提纲以脉阴阳俱紧者名为伤寒。大青龙汤的脉象，也是浮中带紧，所以名为中风。那么脉只浮的，正是风脉。宜用麻黄汤，这说明麻黄汤原本主治中风脉症。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。先辈为什么以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？为什么不根据桂枝汤证的恶寒、麻黄汤证的恶风来反向考证呢？总之，冬季的风寒，本是一体，所以中风伤寒，都恶风恶寒。营病则卫必病，中风的重证，就是伤寒；伤寒的轻证，就是中风。不必在风寒上细分，应当着眼于有汗无汗罢了。
按语：柯氏注本，将辨脉法中的这一条，移置于麻黄症条内，其释义如此，可谓发掘了千古秘密，超越诸家注释，因此也移作本条的注释。《本事方》说：寒伤营，则寒邪进入阴血，而营行于脉中。寒邪居于脉中，不仅营分受病，邪气自然从内作乱，进而侵犯卫气。久了则浸淫到骨骼，所以汗不出而发热。张仲景用麻黄发其汗，又以桂枝、甘草，助其发散，想要涤除内外的邪气，治愈营卫的病。大致这两味药都能发汗，而桂枝则是发卫分之邪，麻黄则兼治营卫，自有深浅之分。如何验证这一点？第一卷说：寸口脉浮而紧云云，由此可知伤寒脉浮紧者，是营卫俱病。麻黄汤中，并用桂枝，这就是张仲景的本意。○按语：许叔微的此说，与柯琴的意思相符。不知柯氏难道没读过《本事方》吗？
太阳病与阳明病合病，喘而且胸满的，不可攻下，宜用麻黄汤。（成本、玉函经，在“汤”字下有“主”之二字，不对。）
〔成无己〕阳气受气于胸中，喘而且胸满，是阳气不能宣发，壅滞而上逆。心下满、腹满，都是实证，应当攻下。这里认为胸满不是里实，所以不可攻下。虽然有阳明病，但与太阳合病属于表证，所以用麻黄汤发汗。〔汪昂〕喘而且胸满，则肺气必然实而胀。所以李东璧说：麻黄汤虽然是太阳发汗的重剂，实际上是发散肺经火郁的药物。他大概是以喘而胸满，为肺有火邪实热的证候。汤中有麻黄、杏仁，专门用于泄肺利气。肺气泄利，则喘逆自然平息，哪里还有阳明病的胸满呢？〔钱潢〕胸满，是太阳表邪未解，将要入里而尚未入里。以阳明病而言，心下硬满的，尚且不可攻下，攻下导致利不止的会死，何况是太阳阳明合病呢？
太阳病十天以上，脉浮细而嗜卧的，外邪已解。如果胸满胁痛的，与小柴胡汤。脉只浮的，与麻黄汤。（“去”字，《玉函经》、《千金翼方》作“已去”。脉字上，《玉函经》、《千金翼方》有“其”字。“外已解也”，《玉函经》、《脉经》、《千金翼方》作“此为外解”。○原本有小柴胡汤，现在详细查看后文九十五条，小柴胡证候及加减法都已具备，所以省略。）
〔尤在泾〕太阳病十日以上无其他证候，脉浮细而嗜卧的，外邪已解，不需要用药。如果设有胸满胁痛等证，则知少阳的外邪未解，所以用小柴胡汤和解它。如果脉只浮不细，而有头痛发热、恶寒无汗等证，则仍是太阳的外邪未解，当用麻黄汤发汗。按语：论中脉浮细，是太阳、少阳的脉。脉弦细，是少阳脉。脉沉细，是少阴脉。脉浮细，身热嗜卧的，属阳。脉沉细，身无热嗜卧的，属阴。脉缓细，身和嗜卧的，是已解。这些都不能不仔细考察。〔程郊倩〕脉浮细而嗜卧的，与少阴病的嗜卧相比，脉浮则区别开来；与阳明中风的嗜卧相比，脉细则区别开来。脉静神恬，解证无疑。如果在解之后，还见胸满胁痛一证，则浮细自是少阳本脉，嗜卧为胆热入而神昏，宜用小柴胡汤。脉只浮的，与麻黄汤。既然已现麻黄汤脉，自然应有麻黄汤证与之符合。纵然嗜卧依旧，必然不胸满胁痛可知。〔张志聪〕愚按小柴胡汤、麻黄汤，不过是借此来说明太少二经由枢而外、从外而表的道理，并非真的要给予这些方剂，所以说“设”字。
太阳中风，脉浮紧，发热恶寒，身疼痛，不汗出而烦躁者，大青龙汤主之。若脉微弱，汗出恶风者，不可服之。服之则厥逆，筋惕肉瞤。此为逆也。（《千金方》，“太阳中风”作“中风伤寒”。《玉函经》、《脉经》、《千金方》，“身”下有“体”字。“不汗出”，《千金方》、《外台秘要》作“汗不出”。《玉函经》、《脉经》，“烦躁”下有“头痛”二字，无“厥逆”的“逆”字。成本，“逆也”下，更有“大青龙汤主之”六字。方有执，根据黄仲理，改为真武汤，并非正确做法。）
〔成无己〕这是中风见到寒脉。浮则为风，风则伤卫；紧则为寒，寒则伤营。营卫俱病，所以发热恶寒、身疼痛。风并于卫的，为营弱卫强；寒并于营的，为营强卫弱。如今风寒两伤，则营卫俱实，所以不汗出而烦躁。与大青龙汤发汗，以除营卫风寒。若脉微弱，汗出恶风者，为营卫俱虚，反服青龙汤，则必亡阳，或生厥逆、筋惕肉瞤。这是治疗的逆误。〔喻嘉言〕天地郁蒸，得雨则和；人身烦躁，得汗则解。大青龙汤证，是为太阳无汗而设，与麻黄汤证有何不同？因为兼见烦躁一证，则非此法不解。〔程郊倩〕脉则浮紧，证则发热恶寒、身疼痛、不汗出而烦躁，明是阴寒在表，郁住阳热之气在经，而生烦热。热则并扰其阴而作躁。总是阳气怫郁不得宣越的缘故。此汤，寒得麻黄汤之辛热而外出，热得石膏之甘寒而内解，龙升雨降，郁热顿除。然而此方不是为了烦躁设，是为了不汗出的烦躁设。若脉微弱，汗出恶风者，虽有烦躁证，乃是少阴亡阳之象，完全不是汗不出而郁蒸者可比。〔沈明宗〕若脉微弱，汗出恶风者，这是阴阳表里俱虚，所以不可服。服之则阳亡而厥逆了。阳气者，柔则养筋。血气盛则充肤热肉。如今虚则筋无所养，肉无以充，故筋惕而肉瞤。这是治疗的逆误。
按语：《外台秘要》引《古今录验》，记载本条，方后，《张仲景伤寒论》说：中风见伤寒脉者，可服之。《活人书》说：盖发热恶风烦躁，手足温，为中风候；脉浮紧为伤寒脉，是中风见寒脉也。大青龙汤治病，与麻黄汤证相似，但病尤重，而又加烦躁者。大抵感外风者为中风，感寒冷者为伤寒，故风则伤卫，寒则伤营，桂枝主伤卫，麻黄主伤营，大青龙主营卫俱伤故也。这是成无己注解所依据的来源，由来已久。然而“风寒营卫两伤”的说法，尤其不可信据。为什么呢？脉浮紧，发热恶寒，身疼痛不汗出者，是伤寒之候；烦躁，亦非中风之候。虽曰太阳中风，并无中风之候证。盖“中风”二字，诸家纷纭，无确切依据显证，所以姑且置于阙疑之列即可。《活人书》说：大青龙汤治病，与麻黄汤相似，但病尤重，而又加烦躁者，这是用此汤的指南，应该没有异议了。
柯琴说：大概张仲景凭脉辨证，只审虚实，所以不论中风伤寒，脉之缓紧，只于指下有力者为实，脉弱无力者为虚。不汗出而烦躁者，为实；汗出多而烦躁者，为虚。证在太阳而烦躁者，为实；证在少阴而烦躁者，为虚。实者可服大青龙，虚者便不可服。这最容易知晓。凡先烦不躁，而脉浮者，必有汗而自解；烦躁而脉浮紧者，必无汗而不解。大青龙汤，为风寒在表，而兼热中者设，不是为有表无里而设。所以中风无汗烦躁者，可用；伤寒而无汗烦躁者，亦可用。盖风寒本是一气，所以汤剂可以互投。论中有中风伤寒互称者，如大青龙是也；有中风伤寒兼提者，如小柴胡是也。张仲景只是细细辨别脉证而施治，何尝拘泥于中风伤寒的区别其名乎？如既立麻黄汤治寒，桂枝汤治风，而中风见寒、伤寒见风者，为何不用桂枝麻黄各半汤，而更用大青龙为主治耶？妄谓大青龙为风寒两伤营卫而设，不知其为两解表里而设。请问石膏的设置，是治风欤？治寒欤？营分药欤？卫分药欤？只为热伤中气，用之治内热也。
《内台方议》，黄伯荣说：此一证中，全在不汗出，“一不”字内藏机。且此“不”字，是微有汗，而不能得出，因生烦躁，非若伤寒之全无汗也。以此“不”字，方是伤风，此乃古人智深识妙之处。○按语：此说难以遵从。然而无汗与不汗出，不能没有区别。况且此证阳热内郁，必微有汗，所以举似于此。
按语：脉微弱，汗出恶风者，当用桂枝加附子汤。柯琴说：是桂枝症。若然则脉当浮缓。今脉微弱，而自汗出者，是表里俱虚，桂枝汤不中与也。
《明理论》说：筋惕肉瞤，是非常常有的，必定待发汗过多亡阳，则有之矣。《内经》说：阳气者，精则养神，柔则养筋。发汗过多，津液枯少，阳气太虚，筋肉失所养，故惕惕然而跳，瞤然而动也。
汪昂说：厥逆筋惕肉瞤，乃为大逆之候。末后“大青龙汤主之”句，黄仲理改作“真武汤”，方有执、喻嘉言两家皆宗之，大误。盖此条病，张仲景本无救逆之法，末后六字，今从删。
《活人书》引高若讷《伤寒类纂》说：凡发汗过多，筋惕肉瞤，振摇动人，或虚羸之人，微汗出，便有此证，俱宜服真武汤救之。○按语：黄仲理之说，原出于此。
大青龙汤方
麻黄（六两去节） 桂枝（二两去皮） 杏仁（四十枚去皮尖○枚，成本作个。《千金翼方》，尖下有两仁者三字。） 甘草（二两炙） 生姜（三两切） 大枣（十枚擘○成本、《金匮》、《玉函》、《千金》，并作十二枚。）
石膏（如鸡子大，碎。○《玉函》、《千金翼》、《外台》，碎下有绵裹二字。）
上七味，以水九升，先煮麻黄，减二升，去上沫，纳诸药，煮取三升，去滓，温服一升，取微似汗。汗出多者，温粉扑之。一服汗者，停后服。若复服汗多，亡阳遂（【原注】一作逆）虚，恶风烦躁不得眠也。（《外台》，味下有切字。“取微似汗”，《玉函》作“覆令汗”，《外台》作“浓覆取微汗”。“扑之”，成本、《千金翼》、《外台》作“粉之”。成本，无“若复服”三字。遂，《千金翼》作逆。《明理论》，亦有一作逆注文。○柯本，汗出多者以下三十二字，移前麻黄汤方后如桂枝法下，注云：此麻黄汤之禁也。）
〔柯琴〕此即加味麻黄汤也。诸证全是麻黄，而有喘与烦躁之不同。喘者是寒郁其气，升降不得自如，故多杏仁之苦以降气。烦躁是热伤其气，无津不能作汗，故特加石膏之甘以生津。然其质沉，其性寒，恐其内热顿除，而外之表邪不解，变为寒中，而协热下利，是引贼破家矣。故必倍麻黄以发汗，又倍甘草以和中，更用姜枣以调营卫。一汗而表里双解，风热两除。此大青龙清内攘外之功，所以佐桂麻二方之不及也。〔汪昂〕有人问：病人同是服此汤，而汗多亡阳，一则厥逆筋惕肉瞤，一则恶风烦躁不得眠，二者之寒热，迥然不同，为什么呢？我回答说：一则病患脉微弱，汗出恶风，是阳气本虚也，故服之，则厥逆，而虚冷之证生焉。一则病患脉浮紧，发热汗不出而烦躁，是邪热本甚也，故服之，则正气虽虚，而邪热未除。且也厥逆之逆为重，以其人本不当服，而误服之也。烦躁不得眠，为犹轻，以其人本当服，而过服之也。
《伤寒蕴要》说：大青龙汤，治伤寒脉浮紧，头痛身疼痛，恶寒发热，不得汗出，烦躁扰乱不安者，以此汗之。古人以伤寒为汗病，其身热烦躁，无奈何者，一汗而凉，斯言是也。天之邪气，自外而入，亦当自外出之，非汗不能解也。
《仲景全书》，王文禄说：大青龙，治风寒外壅，而闭热于经者，故加石膏于发汗药中，尤为峻剂。
《伤寒类方》说：此合麻黄、桂枝、越婢三方为一方，而无芍药，何以发汗如是之烈？盖麻黄汤，麻黄用二两，而此用六两；越婢汤，石膏用半斤，此用鸡子大一块。一剂之药，除大枣，约共十六两，以今称计之，亦重三两有余，则发汗之重剂矣。虽少加石膏，终不足以相制也。
按语：温粉不详。《总病论》载《肘后方》：川芎、苍术、白芷、藁本、零陵香，和米粉粉身，辟温粉方云：凡出汗大多……
Treats anhidrosis (absence of sweating). Xingren (Apricot Seed) treats wheezing. Guizhi Tang (Cinnamon Twig Decoction) and Gancao (Licorice Root) treat various syndromes of Taiyang disease (disease of the Bladder channel/Superficial level), with every herb precisely targeting the pathology. Hence it is called a Jingfang (Classic Formula).
Ke Qin stated: In my treatment of cold-wind asthma and bi-syndrome (painful obstruction syndrome) caused by the combination of wind, cold, and dampness pathogenic factors, using this formula often yields effective results. It is not limited to just one type of Shanghan (Cold Damage) syndrome.
The *Waitai Miyao* (Essential Prescriptions from the Imperial Library for All Emergencies) records the Mahuang Tang (Ephedra Decoction) from the *Shenshi Fang*, which treats new or chronic cough with expectoration of pus and blood, persisting for years without cure, accompanied by day-and-night dyspnea with shoulder movement (indicating severe respiratory distress).
Based on this formula, remove Xingren (Apricot Seed), add Dazao (Jujube Fruit).
It also treats upper qi rebellion with cough, a sound in the throat like a water frog croaking, and expectoration of purulent, bloody, and foul-smelling sputum. Use Mahuang Tang (Ephedra Decoction).
Based on this formula, add Shengjiang (Fresh Ginger).
The *Jieji San* (Muscle-Relieving Powder) from the *Shenghui Fang* treats pediatric Shanghan fever with vexatious pain in the four limbs.
Based on this formula, add Dahuang (Rhubarb Root) and Shaoyao (Peony Root).
The *San'ao Tang* (Three Unobstructed Decoction) from the *Heji Jufang* (Formulary of the Bureau of Medical Relief) treats colds due to wind pathogenic factors, presenting with nasal congestion, heavy voice, and inability to speak; or wind-strike/cold-injury presenting with headache, vertigo, limb stiffness and fatigue, cough with abundant phlegm, chest fullness, and shortness of breath.
Based on this formula, remove Guizhi (Cinnamon Twig). The three main herbs are used raw, add Shengjiang (Fresh Ginger). (Mahuang [Ephedra Stem] is not de-jointed; Xingren [Apricot Seed] is not peeled or de-husked; Gancao [Licorice Root] is not honey-fried.)
The *Jianjia Mahuang Tang* (Modified Ephedra Decoction) from the *Zhizhi Fang* treats cough caused by lung invasion by cold pathogenic factors.
Based on this formula, add Chenpi (Aged Tangerine Peel), Banxia (Pinellia Tuber), Zisuye (Perilla Leaf), and Shengjiang (Fresh Ginger).
Shu Chiyuan's *Nuke Yaojue* (Essentials of Gynecology) records: A physician treated a parturient woman who had been in labor for six days. The fetus had emerged from the amniotic sac, and the head was positioned downwards, yet delivery did not occur. The doctor used various parturition-inducing formulas, talismans, and spiritual elixirs, all to no avail. He invited me to examine her. She presented with high fever, anhidrosis, and stiffness/pain in the head, neck, back, and loins. This is Cold damaging the Ying (Nutritive) level of the Taiyang channel. The treatment principle is primarily Mahuang Tang (Ephedra Decoction). I prepared a large dose and administered it, instructing her to cover herself warmly to induce sweat. Shortly after, she sweated, the fever subsided, and she felt at ease. She then requested food. After eating, the baby was delivered smoothly. This is treating the illness so that childbirth proceeds naturally, which is a superior method.
Pulse floating and tight: Floating indicates Wind, Tight indicates Cold. Wind damages the Wei (Defensive) level, Cold damages the Ying (Nutritive) level. When both Ying and Wei are diseased, there is vexatious pain in the bone joints. Sweating can be induced; Mahuang Tang (Ephedra Decoction) is appropriate.
(Commentary: This clause originates from the "Sweating Chapter" of the Song edition, as well as the *Yuhan Jing*, *Maijing*, and *Qianjin Yifang*. It is indeed the original text of this treatise and should belong in the Taiyang chapter. The current version has lost it due to omission, so commentators have not explained it. Qian Huang said: If Cold has entered the Ying level, how could it not enter via the Wei level? This perfectly matches this clause. Thus, we know the difference between Mahuang Tang and Guizhi Tang lies in the deficiency/excess of the exterior, not in the distinction between Wind/Cold or Ying/Wei. With this clause, the matter becomes very clear, so it is highlighted here. ○ Another note: This clause comes from the "Differentiating Pulse Methods" section. Above the word "pulse," there are the characters "Cunkou" (Radial artery pulse position). There are no characters "Yi Mahuang Tang" (Mahuang Tang is suitable). Below the sweating instruction, there is the character "Ye".)
[Ke Qin] Wind and Cold naturally accompany each other. Wind must first open the cou-li (pores/skin texture), allowing Cold to enter the meridians. When both Ying and Wei are damaged, the Yang Qi inside and outside the body cannot vent outward, resulting in vexatious pain in bones and flesh. The pulse reflects this pathology and manifests at the Cunkou. A Tight pulse represents Yin Cold appearing with a Floating image, indicating Yin excess and Yang deficiency. Sweating will lead to recovery. Pulse theory states Floating is Wind, Tight is Cold. Therefore, the outline names Shanghan (Cold Damage) by pulses that are tightly bound on both positions. The Da Qinglong Tang (Major Blue Dragon Decoction) pulse is also Floating with a Tight quality, hence named Zhongfeng (Wind Strike). Thus, a pulse that is only Floating is the Wind pulse. Mahuang Tang (Ephedra Decoction) is suitable. This shows Mahuang Tang originally treats Zhongfeng pulse and symptoms. Mahuang Tang syndrome involves fever and bone/joint pain, which is the same as vexatious pain in bones and flesh, i.e., simultaneous damage by Wind and Cold, affecting both Ying and Wei. Why did predecessors use Da Qinglong Tang for simultaneous Ying/Wei damage, Mahuang Tang for Cold damaging Ying but not Wei, and Guizhi Tang for Wind damaging Wei but not Ying? Why not cross-examine based on the aversion-to-cold in Guizhi Tang syndrome and aversion-to-wind in Mahuang Tang syndrome? Essentially, winter Wind and Cold are of one nature. Thus, both Zhongfeng and Shanghan involve aversion to wind and cold. When Ying is diseased, Wei must also be diseased. A severe case of Zhongfeng is Shanghan; a mild case of Shanghan is Zhongfeng. There is no need to distinguish finely between Wind and Cold; one must focus on the presence or absence of sweating.
Commentary: Ke Qin's annotated edition moved this clause from "Differentiating Pulse Methods" into the Mahuang Syndrome section. His interpretation is considered to have revealed ancient secrets, surpassing other commentaries, so it is adopted as the annotation for this clause. *Benshi Fang* states: Cold damaging Ying means Cold pathogenic factors enter the Yin-Blood, and Ying circulates within the vessels. When Cold resides in the vessels, not only does Ying suffer disease, but the pathogen acts from within, invading Wei Qi. Over time, it infiltrates the bones, causing anhidrosis and fever. Zhang Zhongjing uses Mahuang to induce sweating, and Guizhi/Gancao to assist dispersion, aiming to cleanse internal and external pathogens and cure Ying/Wei diseases. Generally, both herbs induce sweating, but Guizhi disperses Wei-level pathogens, while Mahuang treats both Ying and Wei, showing depth and superficiality. How to verify this? Volume 1 states: "Cunkou pulse floating and tight..." From this, we know that a Floating-Tight pulse in Shanghan indicates simultaneous Ying/Wei disease. Using Guizhi in Mahuang Tang reflects Zhang Zhongjing's intent. ○ Commentary: Xu Dachun's view aligns with Ke Qin's. One wonders if Ke Qin did not read *Benshi Fang*.
When Taiyang and Yangming channels are simultaneously affected, with wheezing and chest fullness, downward purging is contraindicated; Mahuang Tang (Ephedra Decoction) is appropriate. (Cheng Wuji's edition and *Yuhan Jing* add the character "Zhu" (mainly governs) after "Tang," which is incorrect.)
[Cheng Wuji] Yang Qi receives its energy in the chest. Wheezing and chest fullness indicate Yang Qi failing to diffuse, becoming obstructed and rebellious. Fullness below the heart and abdominal fullness are Excess patterns requiring purging. Here, chest fullness is not interior Excess, so purging is contraindicated. Although there is Yangming involvement, being combined with Taiyang makes it an Exterior pattern. Thus, Mahuang Tang is used to induce sweating. [Wang Ang] Wheezing and chest fullness imply Lung Qi is Excess and distended. Li Dongbi stated: Although Mahuang Tang is a heavy sweating agent for Taiyang, it is actually a drug to disperse Fire-Stagnation in the Lung Meridian. He likely viewed wheezing and chest fullness as a pattern of Fire-Pathogen Excess-Heat in the Lungs. The decoction contains Mahuang and Xingren, specifically to drain Lung Qi and promote free flow. Once Lung Qi drains and flows freely, wheezing and rebellion subside naturally. What need is there for Yangming chest fullness? [Qian Huang] Chest fullness means Taiyang exterior pathogen is unresolved, about to enter the interior but not yet there. Regarding Yangming disease, even hardness/fullness below the heart should not be purged; purging leads to intractable diarrhea and death. How much more so for Tai-Yangming simultaneous disease?
After ten days of Taiyang disease, if the pulse is Floating-Fine and the patient desires to lie down, the exterior has resolved. If there is chest fullness and hypochondriac pain, administer Xiao Chaihu Tang (Minor Bupleurum Decoction). If the pulse is only Floating, administer Mahuang Tang (Ephedra Decoction). ("Qu" [gone] in *Yuhan Jing* and *Qianjin Yifang* is written as "Yi Qu" [already gone]. Before "pulse," *Yuhan Jing* and *Qianjin Yifang* add "Qi." "Wai yi jie ye" [Exterior already resolved] is written as "Ci wei wai jie" [This is exterior resolution] in *Yuhan Jing*, *Maijing*, and *Qianjin Yifang*. ○ The original includes Xiao Chaihu Tang. Upon detailed review of Clause 95 later, the Xiao Chaihu syndrome manifestations and modification methods are fully provided, so it is abbreviated here.)
[You Zaijing] Taiyang disease lasting over ten days with no other symptoms, a Floating-Fine pulse, and desire to lie down indicates the exterior pathogen has resolved; no medicine is needed. If chest fullness and hypochondriac pain appear, it indicates the Shaoyang exterior pathogen is unresolved, so Xiao Chaihu Tang is used to harmonize it. If the pulse is only Floating (not Fine), accompanied by headache, fever, aversion to cold, and anhidrosis, the Taiyang exterior pathogen remains unresolved, and Mahuang Tang should be used to induce sweating. Commentary: In the treatise, a Floating-Fine pulse relates to Taiyang and Shaoyang. a String-Fine pulse is Shaoyang. a Sinking-Fine pulse is Shaoyin. A Floating-Fine pulse with fever and desire to lie down is Yang. A Sinking-Fine pulse with no fever and desire to lie down is Yin. a Slow-Fine pulse with a comfortable body and desire to lie down indicates resolution. These distinctions must not be overlooked. [Cheng Jiaoqian] A Floating-Fine pulse with desire to lie down differs from Shaoyin disease's desire to lie down by the Floating quality; it differs from Yangming Wind-Strike's desire to lie down by the Fine quality. A quiet pulse and calm spirit confirm resolution. If, after resolution, chest fullness and hypochondriac pain remain, the Floating-Fine pulse is inherently Shaoyang's pulse, and desire to lie down indicates Gallbladder Heat entering and clouding the spirit, warranting Xiao Chaihu Tang. If the pulse is only Floating, give Mahuang Tang. Since the Mahuang Tang pulse is present, it should correspond to Mahuang Tang symptoms. Even if the desire to lie down persists, chest fullness and hypochondriac pain would certainly be absent. [Zhang Zhicong] My commentary: Xiao Chaihu Tang and Mahuang Tang are merely cited to illustrate the transmission from the Pivot (Shaoyang) to the Exterior and from the Exterior to the Surface, not necessarily implying these specific formulas are always indicated, hence the use of "She" (Suppose/If).
In Taiyang Zhongfeng (Wind Strike), if the pulse is Floating-Tight, with fever, aversion to cold, body pain, anhidrosis, and restlessness/vexation, Da Qinglong Tang (Major Blue Dragon Decoction) governs. If the pulse is Weak-Fine, with sweating and aversion to wind, it must not be taken. Taking it will cause Jue Ni (cold extremities/reversal), Jin Ti Rou Sun (twitching muscles/fasciculations). This is a therapeutic error. (*Qianjin Fang* writes "Zhongfeng Shanghan" instead of "Taiyang Zhongfeng." *Yuhan Jing*, *Maijing*, *Qianjin Fang* add "Ti" [body] after "Shen." *Qianjin Fang* and *Waitai Miyao* write "Han Bu Chu" instead of "Bu Han Chu." *Yuhan Jing* and *Maijing* add "Tou Tong" [headache] after "Fan Zao," and omit "Ni" [reversal] from "Jue Ni." Cheng Wuji's edition adds "Da Qinglong Tang Zhu Zhi" [Da Qinglong Tang governs] after "Ni Ye," which is incorrect. Fang Youzhi, following Huang Zhongli, changed it to Zhenwu Tang, which is wrong.)
[Cheng Wuji] This is Zhongfeng presenting with a Cold pulse. Floating indicates Wind, which damages Wei; Tight indicates Cold, which damages Ying. Both Ying and Wei are diseased, causing fever, aversion to cold, and body pain. Wind merging with Wei creates Ying-Weak/Wei-Strong; Cold merging with Ying creates Ying-Strong/Wei-Weak. Now, simultaneous Wind-Cold damage makes both Ying and Wei Excess, causing anhidrosis and restlessness. Da Qinglong Tang is given to induce sweating and dispel Wind-Cold from Ying and Wei. If the pulse is Weak-Fine with sweating and aversion to wind, it indicates Ying-Wei deficiency. Conversely taking Qinglong Tang will cause Yang collapse, potentially leading to Jue Ni and twitching muscles. This is a therapeutic error. [Yu Jiayan] Heaven and earth become stifling and resolve with rain; the human body becomes restless and resolves with sweating. Da Qinglong Tang syndrome is set for Taiyang anhidrosis. How is it different from Mahuang Tang syndrome? Because Restlessness/Vexation is concurrently present, only this method can resolve it. [Cheng Jiaoqian] The pulse is Floating-Tight; symptoms are fever, aversion to cold, body pain, anhidrosis, and restlessness. This clearly indicates Yin Cold at the exterior, trapping Yang Heat in the meridians, generating vexation and heat. Heat disturbs Yin, causing agitation. It is all due to Yang Qi being constrained and unable to vent. This decoction uses the acrid-hot nature of Mahuang Tang to expel Cold outward, and the sweet-cool nature of Shigao (Gypsum) to resolve Heat inward. Like a dragon rising and rain falling, stagnant heat is instantly removed. However, this formula is not for restlessness per se, but for restlessness caused by anhidrosis. If the pulse is Weak-Fine with sweating and aversion to wind, even with restlessness, it is a sign of Shaoyin Yang collapse, completely different from anhidrotic stagnation. [Shen Mingzong] If the pulse is Weak-Fine with sweating and aversion to wind, this indicates deficiency in both Yin/Yang and Interior/Exterior, so it must not be taken. Taking it causes Yang collapse and Jue Ni. Yang Qi nourishes tendons when soft. Abundant Qi and Blood fill the skin and warm the flesh. Deficiency means tendons lack nourishment and flesh lacks filling, causing twitching muscles. This is a therapeutic error.
Commentary: *Waitai Miyao* cites *Gujin Luyian*, recording this clause. Post-formula notes in *Zhang Zhongjing Shanghan Lun* state: If Zhongfeng presents with Shanghan pulse, it may be taken. *Huren Shu* states: Fever, aversion to wind, restlessness, and warm hands/feet are Zhongfeng signs; a Floating-Tight pulse is a Shanghan sign, meaning Zhongfeng presenting with a Cold pulse. Da Qinglong Tang treats conditions similar to Mahuang Tang syndrome but more severe, with added restlessness. Generally, contracting external Wind is Zhongfeng, contracting Cold is Shanghan. Thus Wind damages Wei, Cold damages Ying. Guizhi treats Wei damage, Mahuang treats Ying damage, and Da Qinglong treats simultaneous Ying/Wei damage. This is the origin of Cheng Wuji's annotation, long established. However, the concept of "simultaneous Wind-Cold Ying/Wei damage" is particularly unreliable. Why? Floating-Tight pulse, fever, aversion to cold, body pain, and anhidrosis are Shanghan signs; restlessness is not a Zhongfeng sign. Although called Taiyang Zhongfeng, there are no actual Zhongfeng signs. The term "Zhongfeng" is disputed by many without definitive evidence, so it should be left as doubtful. *Huren Shu* says: Da Qinglong Tang treats conditions similar to Mahuang Tang but more severe with added restlessness; this is the guide for using this decoction, leaving no room for doubt.
Ke Qin stated: Zhang Zhongjing differentiates symptoms by pulse, focusing only on Deficiency/Excess. Whether Zhongfeng or Shanghan, whether pulse is Slow or Tight, strength under the finger determines Excess (strong) or Deficiency (weak). Anhidrosis with restlessness is Excess; profuse sweating with restlessness is Deficiency. Restlessness in Taiyang is Excess; restlessness in Shaoyin is Deficiency. Excess patterns can take Da Qinglong; Deficiency patterns must not. This is easy to understand. First vexation without agitation and a Floating pulse implies sweating will self-resolve. Restlessness with a Floating-Tight pulse implies anhidrosis and non-resolution. Da Qinglong Tang is set for Wind-Cold at the exterior with internal Heat, not for exterior-only without interior. Thus, Zhongfeng with anhidrosis/restlessness can use it; Shanghan with anhidrosis/restlessness can also use it. Wind and Cold are essentially one Qi, so decoctions can be interchangeable. The treatise mentions Zhongfeng and Shanghan interchangeably, e.g., Da Qinglong; and jointly, e.g., Xiao Chaihu. Zhang Zhongjing simply treats based on careful pulse/symptom differentiation, never rigidly adhering to the names Zhongfeng or Shanghan. If Mahuang Tang treats Cold and Guizhi Tang treats Wind, why use Da Qinglong instead of Guizhi Mahuang Ge Ban Tang when Zhongfeng presents with Cold signs or Shanghan with Wind signs? It is erroneous to claim Da Qinglong is for simultaneous Wind-Cold Ying/Wei damage; it is actually for resolving both Exterior and Interior. Ask: Was Shigao (Gypsum) designed for Wind? For Cold? For Ying? For Wei? It is solely for Heat damaging Middle Qi, used to treat internal Heat.
Huang Borong in *Neitai Fangyi* said: This syndrome hinges entirely on "Bu Han Chu" (no sweating). Within this "No," lies the mechanism. This "No" implies slight sweating that cannot emerge, causing restlessness, unlike Shanghan's complete anhidrosis. Based on this "No," it is Wind Strike. This shows the profound wisdom of the ancients. ○ Commentary: This view is hard to accept. However, "Anhidrosis" and "No sweating" must be distinguished. Moreover, this syndrome involves internal stagnation of Yang Heat, necessitating slight sweating, so it is mentioned here.
Commentary: If the pulse is Weak-Fine with sweating and aversion to wind, Guizhi Jia Fuzi Tang (Guizhi Decoction plus Aconite) should be used. Ke Qin said: This is a Guizhi syndrome. If so, the pulse should be Floating-Slow. Now, with a Weak-Fine pulse and spontaneous sweating, it indicates Interior/Exterior deficiency, and Guizhi Tang is not suitable.
*Mingli Lun* states: Twitching muscles are not common; they occur only after excessive sweating leading to Yang collapse. *Neijing* states: Yang Qi nourishes the Spirit when refined, and nourishes tendons when soft. Excessive sweating dries fluids, causing extreme Yang deficiency. Muscles/tendons lose nourishment, causing trembling and twitching.
Wang Ang stated: Jue Ni and twitching muscles are major therapeutic errors. The final phrase "Da Qinglong Tang Zhu Zhi" was changed by Huang Zhongli to "Zhenwu Tang." Fang Youzhi and Yu Jiayan followed this, which is a major error. Zhang Zhongjing originally had no rescue method for this error in this clause; the last six characters should be deleted.
*Huren Shu* cites Gao Ruone's *Shanghan Leizuan*: Whenever excessive sweating causes twitching muscles, tremors, or occurs in emaciated individuals with slight sweating, Zhenwu Tang should be taken to rescue. ○ Commentary: Huang Zhongli's theory originates from here.
Da Qinglong Tang Formula
Mahuang (6 liang, de-jointed) Guizhi (2 liang, de-barked) Xingren (40 seeds, de-husked/de-pointed ○ *Chengben* writes "ge"; *Qianjin Yifang* adds "two kernels" after "point.") Gancao (2 liang, honey-fried) Shengjiang (3 liang, sliced) Dazao (10 seeds, split ○ *Chengben*, *Jinkui*, *Yuhan*, *Qianjin* all write 12 seeds.) Shigao (Size of a chicken egg, crushed ○ *Yuhan*, *Qianjin Yifang*, *Waitai* add "wrapped in silk" after "crushed.")
These seven ingredients. Add 9 sheng of water. First boil Mahuang, reduce by 2 sheng, remove the foam on top. Add remaining herbs. Boil to obtain 3 sheng. Strain. Take 1 sheng warm. Aim for slight sweating. If sweating is excessive, dust with Wenfen (warm powder). If one dose induces sweating, stop subsequent doses. If re-administered and sweating is excessive, Yang collapse ensues, leading to weakness, aversion to wind, restlessness, and insomnia. (*Waitai* adds "qie" [slice] after "wei." "Qu wei si han" [aim for slight sweating] is written as "Fu ling han" [cover to induce sweat] in *Yuhan*, and "Nong fu qu wei han" [thickly cover to get slight sweat] in *Waitai.* "Pu zhi" [dust it] is written as "Fen zhi" [powder it] in *Chengben*, *Qianjin Yifang*, *Waitai.* *Chengben* omits "Ruo fu fu" [if re-administered]. *Qianjin Yifang* writes "Ni" [reverse] instead of "Sui." *Mingli Lun* also has a note "one version reads Ni." ○ Ke Qin's edition moves the 32 characters from "Han chu duo zhe" onwards to after the Mahuang Tang formula instructions like Guizhi Fa, noting: This is the prohibition of Mahuang Tang.)
[Ke Qin] This is essentially a modified Mahuang Tang. All symptoms involve Mahuang, differing only in wheezing vs. restlessness. Wheezing is Cold constraining Qi, preventing free ascent/descent, hence extra bitter Xingren to descend Qi. Restlessness is Heat damaging Qi, lacking fluids to produce sweat, hence special addition of sweet Shigao to generate fluids. However, Shigao is heavy and cold. Fear that internal Heat is instantly cleared while exterior pathogen remains unresolved, transforming into Cold-Damage in the middle, leading to協熱下利 (diarrhea with accompanying heat), which is like inviting thieves to destroy the house. Therefore, double Mahuang to induce sweating, double Gancao to harmonize the middle, and use Ginger/Jujube to regulate Ying/Wei. One sweating episode resolves both Interior and Exterior, dispelling Wind and Heat. This demonstrates Da Qinglong's merit of clearing interior and repelling exterior, supplementing the inadequacies of Guizhi and Mahuang formulas. [Wang Ang] Question: Patients taking this decoction experience Yang collapse from excessive sweating differently: one gets Jue Ni and twitching muscles, the other gets aversion to wind, restlessness, and insomnia. Their cold/heat natures are vastly different. Why? Answer: One patient has a Weak-Fine pulse, sweating, and aversion to wind, indicating inherent Yang deficiency. Taking it causes Jue Ni and cold-deficiency symptoms. The other patient has a Floating-Tight pulse, fever, anhidrosis, and restlessness, indicating severe pathogenic Heat. Taking it leaves pathogenic Heat unremoved despite some Zheng Qi deficiency. Furthermore, Jue Ni is heavier because the person should not have taken it (misadministration). Restlessness/insomnia is lighter because the person should have taken it but overdosed.
*Shanghan Yunyao* states: Da Qinglong Tang treats Shanghan with Floating-Tight pulse, headache, body pain, aversion to cold, fever, anhidrosis, and restless agitation. Induce sweating with this. Ancients viewed Shanghan as a sweating disease. When fever and restlessness are uncontrollable, one sweating episode brings coolness. This statement is correct. Heavenly pathogenic factors enter from outside and must exit from outside; only sweating can resolve them.
Wang Wenlu in *Zhongjing Quan Shu* states: Da Qinglong treats external congestion of Wind-Cold and closure of Heat in the meridians. Adding Shigao to sweating drugs makes it a particularly potent agent.
*Shanghan Leifang* states: This combines Mahuang, Guizhi, and Yuebi formulas into one, without Shaoyao. Why is sweating so intense? Mahuang Tang uses 2 liang of Mahuang, whereas this uses 6 liang. Yuebi Tang uses half a jin of Shigao, whereas this uses one chicken-egg-sized piece. One dose, excluding Dazao, totals approx. 16 liang. By modern weight, this is over 3 liang, making it a heavy sweating agent. Although a little Shigao is added, it ultimately cannot counteract the potency.
Commentary: Wenfen (warm powder) details are unknown. *Zongbing Lun* cites *Zhouhou Fang*: Chuanxiong, Cangzhu, Baizhi, Gaoben, Linglingxiang, mixed with rice flour to powder the body. Recipe for Biwenfen: Whenever sweating is excessive...