外则愈。宜桂枝汤。（故下。成本。玉函。有知字。玉函。脉经。千金翼。无须字。解下。有其字。汤下。成
本。有主之二字。柯本。删而反以下十四字。）
〔成〕经曰。柴胡汤证具。而以他药下之。柴胡汤证仍在者。复与柴胡汤。此虽已下之不为逆。则其类矣。
〔钱〕中风本应解肌。不当发汗。即用桂枝汤。亦有如水流漓。而疾不除者。况前条亦有初服桂枝汤。而反烦不
解。必待先刺风池风府。使风邪得泄。然后却与桂枝汤则愈者。可见表证未解。未可遽用他法也。医见汗后不
解。疑其邪已入里。而复下之。仍见浮脉。而不愈者。何也。因脉浮为风邪在外。不应反下之。下之而不愈者。
以药不中病。故令不愈也。今以脉仍浮。故知邪仍在外。幸而犹未陷入也。当须仍解其外邪则愈矣。宜以桂枝
汤主之。〔周〕愚案此条。虽汗下两误。桂枝证仍在。不为坏证。
太阳病。脉浮紧无汗。发热身疼痛。八九日不解。表证仍在。此当发其汗。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。麻黄汤主之。（玉函。脉经。证。作候。脉经。仍。作续。张璐
本。麻黄汤主之五字。移此当发其汗下。）
〔成〕脉浮紧无汗。发热身疼痛。太阳伤寒也。虽至八九日。而表证仍在。亦当发其汗。〔方〕微除。言虽
未全罢。亦已减轻也。发烦。风壅而气昏也。目瞑。寒郁而血滞也。剧。
作衄之兆也。衄。鼻出血也。鼻为肺之窍。肺为阳中之阴。而主气。阳邪上盛。所以气载血上。妄行而逆出于
鼻也。阳气。以风而言也。风为阳而由气道。所以得随衄散解。故曰阳气重故也。〔钱〕邪之所除既微。则留邪
甚盛。郁而不泄。所以发烦眩冒而目瞑也。其邪气之剧者。必至郁热伤营。阴受煎迫。血热上行。从鼻窍而衄
矣。衄则热邪上越。乃得解也。〔柯〕麻黄汤主之句。在当发其汗下。此于结句补出。是倒序法也。仲景于论
证时。细明其所以然。未及于方故耳。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。
案重。平声。吴云。阳者。兼以寒气挟持。而其气加重故也。
伤寒准绳曰。张兼善云。太阳脉浮紧。发热无汗自衄者愈。此一定之论也。何故复用麻黄汤以汗之。仲景
岂有前后相反之理哉。然。前条麻黄汤主之五字。合当用于当发其汗之下。盖以汉之文法。用药诸方。皆赘于
外条之末。且如大青龙汤证。既云脉微弱汗出恶风者。不可服。服之厥逆筋惕肉 。此为逆也。又以大青龙汤
主之。皆此例也。
案成氏方氏喻氏程氏。并谓衄后更用麻黄汤。故张璐张志聪张锡驹汪琥金鉴皆从其说。以麻黄汤主之句。
移此当发其汗下。不知此乃仲景倒句法。与此寒去欲解也小青龙汤主之同。不可改易原文矣。
太阳病。脉浮紧。发热。身无汗。自衄者愈。
〔成〕风寒在经。不得汗解。郁而变热。衄则热随血散。故云自衄者愈。〔方〕此承上条。复以其更较轻者
言。得衄自愈者。汗本血之液。北人谓衄为红汗。达此义也。〔鉴〕太阳病凡从外解者。惟汗与衄二者而已。今
既失汗于营。则营中
血热妄行自衄热随衄解。必自愈矣。
三因方。麻黄升麻汤。治伤寒发热。解利不行。血随气壅鼻衄。世谓红汗者。是也。麻黄二两半。升麻一
两一分。黄芩。芍药。甘草。石膏。茯苓。各一两。上锉散。每服四大钱。水一盏半。姜三片。煎七分。去滓。
热服。微汗解。
二阳并病。太阳初得病时。发其汗。汗先出不彻。因转属阳明。续自微汗出。不恶寒。若太阳病证不罢者。
不可下。下之为逆。如此可小发汗。设面色缘缘正赤者。阳气怫郁在表。当解之熏之。若发汗不彻。不足言阳
气怫郁不得越。当汗不汗。其人躁烦。不知痛处。乍在腹中。乍在四肢。按之不可得。其人短气但坐。以汗出
不彻故也。更发汗则愈。何以知汗出不彻。以脉涩故知也。（玉函。在表二字。作不得越三字。无若发汗不彻
不足言阳气怫郁不得越十五字。脉经。作若发汗不大彻。玉函。脉经。KT 。作涩。故知也。作故知之。）
〔成〕太阳病未解。传并入阳明。而太阳证未罢者。名曰并病。续自微汗出。不恶寒者。为太阳证罢。阳
明证具也。法当下之。若太阳证未罢者。为表未解。则不可下。当小发其汗。先解表也。阳明之经循面。色缘
缘正赤者。阳气怫郁在表也。当解之熏之。以取其汗。若发汗不彻者。不足言阳气怫郁。止是当汗不汗。阳气
不得越散。邪无从出。拥甚于经。故躁烦也。邪循经行。则痛无常处。或在腹中。或在四肢。按之不可得。而
短气。但责以汗出不彻。更发汗则愈。内经曰。诸过者切之。涩者阳气有余。为身热无汗。是以脉涩。知阳气
拥郁。而汗出不彻。〔汪〕此条。虽系二阳并病。其实太阳证居多。始则太阳经。汗先出不彻。因转属阳明。
成并病。此作首一段看。虽续得微汗。不恶寒。然太阳证不因微汗而罢。故仍可小发汗。此又作一段看。设其
人面色缘
缘正赤。此兼阳明邪热。郁甚于表。当解之熏之。此又作一段看。若此者。终是初得病时。发汗不彻之误。以
至因循而当汗不汗。其人阳气怫郁而面赤。犹不足言也。当见躁烦短气。浑身上下痛无定着。此虽与阳明并病。
而太阳之邪不少衰也。故云更发汗则愈。此又作一段看。不彻者。不透也。不足言者。犹言势所必至。不须说
也。〔魏〕缘缘者。自浅而深。自一处而满面之谓。古人善于用字。故取象至妙。〔周〕躁烦以下。种种证候。
不过形容躁烦二字。非真有痛。故曰按之不可得也。
伤寒选录。张氏曰。夫并者。乃催并督并之义。非吞并就之理。然催并系去声。吞并之并。乃上声。史记
曰。始皇初并天下。即此理也。夫并之理。乃前病未解。后病已至。有逼相并之义。故云并病也。经曰。太阳
与少阳并病。头项强痛。或眩冒。云云。如果并作一家。则仲景不具两经之证而言也。其非并字明矣。
总病论。无其人躁烦以下二十一字。不彻故也下。有宜麻黄汤四字。注云。古本字多差误。以从来所见病
人证候中符合如此。故改正。○案更发汗。喻氏云。桂枝加葛根汤。张璐云。桂枝二越婢一汤。程氏云。不但
用解剂如大青龙辈。而且兼熏法。用麻黄等煎汤。从外蒸以助其汗。张志聪云。可小发汗者。或用桂枝麻黄各
半汤。可也。姚氏云。更发其汗。宜桂枝汤。金鉴云。麻桂各半汤。或桂枝二越婢一汤。小小发汗。以和其表。
更用大青龙汤。或葛根汤。发其汗。魏氏云。风因仍用桂枝汤。寒因仍用麻黄汤。风寒两感。仍用桂枝麻黄各
半汤。诸家处方如此。然原文语意未太明。故未审定为何是也。
脉浮数者。法当汗出而愈。若下之。身重心悸者。不可
发汗。当自汗出乃解。所以然者。尺中脉微。此里虚。须表里实。津液自和。便自汗出愈。（乃。玉函。作而。）
〔程〕经曰。诸脉浮数。当发热而洒淅恶寒。言邪气在表也。法当汗出而解无疑矣。若下之而身重心悸者。
不唯损其胃气。虚其津液。而营血亏乏可知。其人尺中之脉必微。夫寸主表。尺主里。今脉虽浮数。而尺中则
微。是为表实里虚。麻黄汤之伐营。为表里俱实者设。岂可更用之以虚其里乎。须用和表实里之法治之。使表
里两实。则津液自和。而邪无所容。不须发汗。而自汗出愈矣。〔钱〕身重者。因邪未入里。误下而胃中阳气
虚损也。凡阳气盛则身轻。阴气盛则身重。故童子纯阳未杂。而轻儇跳跃。老人阴盛阳衰。而肢体龙钟。是其
验也。误下阳虚。与误汗阳虚无异。此条心悸。与发汗过多。叉手冒心之心下悸。同一里虚之所致也。〔魏〕
程注谓须用表和里实之法治之。亦足匡补仲师之法。而未出方。愚谓建中新加之属。可以斟酌而用。要在升阳
透表。温中和里而已。
案张璐金鉴。并主小建中汤。周氏引东垣。亦主建中。然东垣说。未知何书载之。录俟后考。
脉浮紧者。法当身疼痛。宜以汗解之。假令尺中迟者。不可发汗。何以知然。以营气不足。血少故也。（疼
痛。玉函。作身疼头痛。脉经。作身体疼痛。知下。成本。有之字。玉函。作何以故。此为营气不足。血气微
少故也。脉经。亦有此为字。及微字。张璐本。知然间。补一其字。）
〔钱〕浮紧。伤寒之脉也。法当身疼腰痛。宜以麻黄汤汗解之为是。假若按其脉。而尺中迟者。不可发汗。
何以知之。夫尺主下焦。迟则为寒。尺中迟。是以知下焦命门真阳不足。不能蒸谷气而为营为卫也。盖汗者。
营中之血液也。为热气所蒸。由营达卫而为汗。若不量其虚实。而妄发之。则亡阳
损卫。固不待言。此以寒气伤营。汗由营出。以尺中脉迟。则知肾脏真元衰少。营气不足。血少之故。未可以
汗夺血也。〔柯〕假令。是设辞。是深一层看法。此与脉浮数。而尺中微者。同义。〔魏〕治之之法。建中而外。
少阴温经散寒诸方。犹不可不加意也。
汪氏云。补亡论。郭白云云。宜小建中汤。次则柴胡桂枝汤。愚以此二汤。实祖活人书之意。盖小建中
者。即桂枝汤。加饴糖一味。但仲景法。无汗者。不得服桂枝。又柴胡桂枝汤。即小柴胡汤加桂枝。药不对证。
更属不解。○案张氏周氏辈。并以小建中为主。不若魏氏不定一方之允当矣。
本事方云。昔有乡人丘生者。病伤寒。予为诊视。发热头疼烦渴。脉虽浮数而无力。尺以下迟而弱。予
曰。虽麻黄证。而尺迟弱。仲景云。尺中迟者。营气不足。血气微少。未可发汗。予于建中汤。加当归黄 。
令饮。翌日脉尚尔。其家煎迫。日夜督发汗药。几不逊矣。予忍之。但只用建中。调营而已。至五日。尺部方
应。遂投麻黄汤。啜第二服发狂。须臾稍定略睡。已得汗矣。信知此事是难。仲景虽云不避晨夜。即宜便治。
医者亦须顾其表里虚实。待其时日。若不循次第。临时得安。亏损五脏。以促寿限。何足贵也。
脉浮者。病在表。可发汗。宜麻黄汤。（【原注】法用桂枝汤。○玉函。注。一云桂枝汤。脉经。作桂枝汤。）
〔程〕麻黄汤。为寒伤营之主剂。而所禁多端。乃尔。将令后人安所措手乎。曰亦于脉与证之间。互参酌
之。不必泥定紧之一字。始为合法也。脉浮无紧。似不在发汗之列。然视其证。一一寒伤营之表病。则不妨略
脉而详证。无汗可发汗。宜麻黄汤。
脉浮而数者。可发汗。宜麻黄汤。
〔程〕脉浮数者。虽与浮紧稍异。然邪势拥遏在表可知。则不必寒伤营之表病具备。自不妨略证而详脉。
无汗可发汗。亦宜麻黄汤。
病常自汗出者。此为营气和。营气和者。外不谐。以卫气不共营气谐和故尔。以营行脉中。卫行脉外。
复发其汗。营卫和则愈。宜桂枝汤。（玉函。作病常自汗出者。此为营气和。卫气不和故也。营行脉中。为阴
主内。卫行脉外。为阳主外。复发其汗。卫和则愈。宜桂枝汤。千金翼同。脉经。千金。营气和者云云十八字。
作营气和而外不解。此卫不和也十二字。无营卫和之营。吴本。作病常自汗出者。营气和。卫气不共营气和谐
故尔。复发其汗。营卫和则愈。宜桂枝汤。注云。此段。旧本多衍文。今删正。）
〔锡〕卫气者。所以肥腠理。司开阖。卫外而为固也。今不能卫外。故常自汗出。此为营气和。而卫不和也。
卫为阳。营为阴。阴阳贵乎和合。今营自和。而卫气不与之和谐。故营自行于脉中。卫自行于脉外。两不相合。
如夫妇之不调也。宜桂枝汤发其汗。调和营卫之气则愈。〔方〕此言常者。谓无时不然也。〔程〕此不必其为太
阳中风。而桂枝汤亦宜者。如今人滋阴敛汗等类。〔柯〕下条发热汗出。便可用桂枝汤。见不必头痛恶风俱备。
此只自汗一症。即不发热者。亦用之。更见桂枝方。于自汗为亲切耳。
伤寒类方云。营气和者。言营气不病。非调和之和。自汗与发汗迥别。自汗乃营卫相离。发汗使营卫相合。
自汗伤正。发汗驱邪。复发者。因其自汗。而更发之。则营卫和。而自汗反止矣。
案灵枢营卫生会篇云。营在脉中。卫在脉外。又卫气篇云。其浮气之不循经者。为卫。其精气之行于经
者。为营气。正此段之所根柢也。
病患脏无他病。时发热。自汗出而不愈者。此卫气不和
也。先其时。发汗则愈。宜桂枝汤。（千金。作时时发热。汤下。成本。有主之二字。）
〔汪〕脏无他病者。谓里和能食。二便如常也。〔程〕如病患脏无他病。属之里分者。只发热自汗出。时
作时止。缠绵日久而不休。此较之太阳中风证之发无止时。不同矣。既无风邪。则卫不必强。营不必弱。只是
卫气不和。致闭固之令有乖。病既在卫。自当治卫。虽药同于中风。服法不同。先其时发汗。使功专于固卫。
则汗自敛。热自退。而病愈。此不必为太阳中风。而桂枝汤可主者一也。凡脏病。亦有发热汗自出。连绵不愈
者。骨蒸劳热类是也。
外邪解除则病愈。适宜使用桂枝汤。（故下。成本。玉函。有知字。玉函。脉经。千金翼。无须字。解下。有其字。汤下。成 本。有主之二字。柯本。删而反以下十四字。）
〔成〕经典中说。柴胡汤证具备，却用其他药物攻下。若柴胡汤证仍在，再次给予柴胡汤。这虽然已经攻下，但不为逆证，与此类情况相似。
〔钱〕中风本来应当解肌，不应当发汗。即使使用桂枝汤，也有像水流漓淋一样大汗出，但疾病未除的情况。况且前条也有初服桂枝汤，反而烦闷不解，必须等待先针刺风池、风府穴，使风邪得以宣泄，然后再给予桂枝汤才能痊愈的情况。可见表证未解，不可以急于使用其他方法。医生见发汗后病不解，怀疑邪气已入里，又再次攻下，仍然见到浮脉，而病不愈，为什么呢？因为脉浮表示风邪在体表，不应当反而攻下。攻下后不愈，是因为药不对症，所以导致不愈。现在因为脉仍浮，所以知道邪气仍在体表，幸好还没有陷入体内。应当仍然解除其外邪则病愈了。适宜以桂枝汤主治。〔周〕我考证此条，虽然汗法、下法都误用了，但桂枝汤证仍在，没有变成坏证。
太阳病，脉浮紧，无汗，发热，身体疼痛，经过八九天仍未解除，表证仍在。这应当发汗。服药后症状轻微减轻，其人感到烦闷，眼睛闭合不想睁开。严重的必定出现鼻衄（鼻出血），衄血后病才解除。之所以这样，是因为阳气郁闭太重的缘故。麻黄汤主治。（玉函。脉经。证。作候。脉经。仍。作续。张璐 本。麻黄汤主之五字。移此当发其汗下。）
〔成〕脉浮紧无汗，发热身体疼痛，是太阳伤寒证。虽然到了八九天，但表证仍在，也应当发汗。〔方〕微除，是说虽然病邪没有完全罢除，但也已经减轻了。发烦，是风邪壅滞导致气机昏蒙。目瞑，是寒邪郁闭导致血液滞涩。剧，是即将发生衄血的征兆。衄，即鼻出血。鼻为肺之窍，肺为阳中之阴，主管气。阳邪上盛，所以气载着血液上行，妄行而逆出于鼻。阳气，从风来说，风为阳且由气道运行，所以能随着衄血散解。所以说“阳气重”。〔钱〕邪气被清除的很少，那么留存的邪气很盛，郁结而不能宣泄，所以发烦、眩晕冒昧而目瞑。那些邪气严重的，必定导致郁热损伤营分，阴分受煎迫，血热上行，从鼻窍而出衄血。衄血后热邪上越，才得以解除。〔柯〕“麻黄汤主之”这句话，放在“当发其汗”之下。这是在结尾处补出的，是倒序写法。仲景在论述病情时，详细阐明其中的原因，还没来得及提到方剂罢了。前辈顺着文义引申，说应当再用麻黄汤来发散余邪，不知道“得衄乃解”这一句该放在哪里呢？案：“重”，读平声。吴云：阳，兼有寒气挟持，所以其气加重。
《伤寒准绳》说：张兼善说，太阳脉浮紧，发热无汗自衄者自愈，这是确定的理论。为什么还要再用麻黄汤来发汗？仲景难道有前后相反的道理吗？然而，前条“麻黄汤主之”五个字，应当用在“当发其汗”之下。大概汉代的文法，用药诸方，都附缀在外条之末。而且如大青龙汤证，既然说了“脉微弱汗出恶风者，不可服。服之厥逆筋惕肉瞤，此为逆也”，又说“以大青龙汤主之”，都是这个体例。
案：成氏、方氏、喻氏、程氏，都说衄后更用麻黄汤，所以张璐、张志聪、张锡驹、汪琥、金鉴都遵从这种说法，把“麻黄汤主之”一句，移到“当发其汗”之下。不知道这是仲景的倒装句法，与“此寒去欲解也小青龙汤主之”相同，不可以改动原文。
太阳病，脉浮紧，发热，身体无汗，自衄者自愈。
〔成〕风寒在经脉，不能通过汗法解除，郁结而化热，衄血则热随血散，所以说“自衄者愈”。〔方〕这是承接上一条，再说其中比较轻的情况。得衄血而自愈，是因为汗本是血的津液，北方人叫衄血为“红汗”，表达这个意思。〔鉴〕太阳病凡是向外解除的，只有汗与衄这两种而已。现在既然在营分失去了汗，那么营中血热妄行自衄，热随衄解，必定自愈。
《三因方》：麻黄升麻汤，治疗伤寒发热，解利不行，血随气壅鼻衄，世人称为红汗的，就是这个方子。麻黄二两半，升麻一两一分，黄芩、芍药、甘草、石膏、茯苓，各一两。以上锉散，每次服用四大钱，水一盏半，姜三片，煎至七分，去渣，热服，微汗解。
二阳并病，太阳初得病时，发其汗，汗先出不透彻，因而转属阳明，继续自己微微出汗，不恶寒。如果太阳病证尚未罢除，不可攻下，攻下为逆证。像这种情况可以小发其汗。假如面色通红持续不退，是阳气怫郁在体表，应当用解表熏蒸的方法。如果发汗不透彻，不足以说是阳气怫郁不得宣越，应当汗出而不汗出，其人躁烦，不知道痛处在哪里，一会儿在腹中，一会儿在四肢，按压找不到痛点。其人短气只能坐卧，是因为汗出不透彻的缘故。再次发汗则痊愈。怎么知道汗出不透彻？因为脉涩所以知道。（玉函。在表二字。作不得越三字。无若发汗不彻 不足言阳气怫郁不得越十五字。脉经。作若发汗不大彻。玉函。脉经。KT 。作涩。故知也。作故知之。）
〔成〕太阳病未解，传并入阳明，而太阳证未罢的，名叫并病。继续自己微微出汗，不恶寒的，是太阳证罢，阳明证具备。法当攻下。如果太阳证未罢，是表未解，则不可攻下，应当小发其汗，先解表。阳明之经循行于面部，面色缘缘正赤的，是阳气怫郁在体表。应当解表熏蒸，以取汗。如果发汗不透彻，不足以说是阳气怫郁，只是应当汗出而不汗出，阳气不得宣越散失，邪气无从出路，壅滞在经脉中，比平时更甚，所以躁烦。邪气循经而行，则疼痛无常处，或在腹中，或在四肢，按压找不到，而短气，只归咎于汗出不透彻，再次发汗则痊愈。《内经》说：各种脉象都要切按。涩脉表示阳气有余，表现为身热无汗，所以脉涩，知道阳气拥郁，而汗出不透彻。〔汪〕此条，虽然是二阳并病，其实太阳证居多。开始是太阳经，汗先出不透彻，因而转属阳明，成为并病。这一段看作开头部分。虽然接着得到微汗，不恶寒，然而太阳证不因微汗而罢除，所以仍可小发其汗。这一段看作另一部分。假如其人面色缘缘正赤，这是兼有阳明邪热，郁结甚于体表，应当解表熏蒸。这一段看作另一部分。像这种情况，终究是初得病时，发汗不透彻的错误，以至于因循拖延而当汗不汗，其人阳气怫郁而面赤，还不足以说明问题。应当见到躁烦短气，浑身上下痛无定处。这虽然与阳明并病，而太阳的邪气不少衰减。所以说“更发汗则愈”。这一段看作另一部分。不彻，是不透的意思。不足言，是犹言势所必至，不必说。〔魏〕缘缘，是从浅到深，从一处到满面的意思。古人善于用字，所以取象非常精妙。〔周〕躁烦以下的种种证候，不过是形容躁烦二字，并非真有痛处，所以说“按之不可得”。
《伤寒选录》：张氏说：夫并者，是催并、督并的意思，不是吞并就的道理。然而“催并”系去声，“吞并”的并，乃上声。《史记》说：始皇初并天下，就是这个道理。夫的并的道理，是前病未解，后病已至，有逼迫相并的意思，所以说并病。经典说：太阳与少阳并病，头项强痛，或眩冒，等等。如果真的并作一家，那么仲景就不会列举两经的证候而言了。那个“并”字显然不是这个意思。
《总病论》：无“其人躁烦以下二十一字”，在“不彻故也”下，有“宜麻黄汤”四字。注云：古本字多差误，以从来所见病人证候中符合如此，故改正。○案：关于“更发汗”，喻氏说：桂枝加葛根汤。张璐说：桂枝二越婢一汤。程氏说：不但用解表剂如大青龙之类，而且兼用熏法，用麻黄等煎汤，从外蒸以助其汗。张志聪说：可小发汗者，或用桂枝麻黄各半汤，也可以。姚氏说：更发其汗，宜桂枝汤。金鉴说：麻桂各半汤，或桂枝二越婢一汤，小小发汗，以和其表。更用大青龙汤，或葛根汤，发其汗。魏氏说：风因仍用桂枝汤，寒因仍用麻黄汤，风寒两感，仍用桂枝麻黄各半汤。诸家处方如此，然而原文语意不太明确，所以未审定为何方是合适的。
脉浮数的，法当汗出而愈。如果攻下，身重心悸的，不可发汗，应当自汗出乃解。之所以这样，是因为尺中脉微，这是里虚，须表里实，津液自和，便自汗出愈。（乃。玉函。作而。）
〔程〕经典说：诸脉浮数，当发热而洒淅恶寒，是说邪气在表。法当汗出而解无疑了。如果攻下而身重心悸的，不仅损伤胃气，虚其津液，而且营血亏乏可知。其人尺中之脉必微。寸主表，尺主里。现在脉虽浮数，而尺中则微，是为表实里虚。麻黄汤伐营，是为表里俱实者设的，岂可更用它来虚其里呢？须用和表实里的法治之，使表里两实，则津液自和，而邪无所容，不须发汗，而自汗出愈矣。〔钱〕身重，是因为邪未入里，误下而胃中阳气虚损。凡阳气盛则身轻，阴气盛则身重，所以童子纯阳未杂，而轻儇跳跃，老人阴盛阳衰，而肢体龙钟，是其验证。误下阳虚，与误汗阳虚无异。此条心悸，与发汗过多，叉手冒心之心下悸，同一里虚所致。〔魏〕程注谓须用表和里实之法治之，也足以匡补仲师之法，但未出方。我认为建中新加之属，可以斟酌而用，要在升阳透表，温中和里而已。
案：张璐、金鉴，都主张小建中汤，周氏引东垣，也主张建中，然而东垣的说法，不知何书记载，记录以备以后考证。
脉浮紧的，法当身疼痛，适宜以汗解之。假如尺中迟的，不可发汗。为什么知道这样？因为营气不足，血少缘故。（疼痛。玉函。作身疼头痛。脉经。作身体疼痛。知下。成本。有之字。玉函。作何以故。此为营气不足。血气微 少故也。脉经。亦有此为字。及微字。张璐本。知然间。补一其字。）
〔钱〕浮紧，是伤寒的脉象。法当身疼腰痛，适宜以麻黄汤汗解才是。假若按其脉，而尺中迟的，不可发汗。为什么知道？尺主下焦，迟则为寒，尺中迟，是以知道下焦命门真阳不足，不能蒸谷气而为营为卫。盖汗，是营中的血液，为热气所蒸，由营达卫而为汗。若不量其虚实，而妄发之，则亡阳损卫，固不待言。此以寒气伤营，汗由营出，以尺中脉迟，则知肾脏真元衰少，营气不足，血少之故，未可以用汗法夺血。〔柯〕假令，是假设之辞，是深一层看法。这与脉浮数，而尺中微者，同义。〔魏〕治之之法，在建中外，少阴温经散寒诸方，犹不可不加意也。
汪氏说：《补亡论》，郭白云说：宜小建中汤。其次则柴胡桂枝汤。我认为这两汤，实在祖述《活人书》之意。盖小建中者，即桂枝汤，加饴糖一味。但仲景法，无汗者，不得服桂枝。又柴胡桂枝汤，即小柴胡汤加桂枝，药不对证，更属不解。○案：张氏、周氏辈，都以小建中为主，不如魏氏不定一方之允当。
《本事方》说：过去有个同乡丘生，患伤寒，我为他诊视，发热头疼烦渴，脉虽浮数而无力，尺以下迟而弱。我说：虽是麻黄证，而尺迟弱，仲景说：尺中迟者，营气不足，血气微少，未可发汗。我在建中汤，加当归、黄芪，令他饮用。第二天脉还是那样，他的家人煎迫，日夜督促发汗药，几乎不顺从。我忍耐住，只用建中，调营而已。到第五天，尺部方才应指，于是投麻黄汤，喝第二服后发狂，片刻稍定略睡，已经得汗了。信知此事是难，仲景虽说不避晨夜，即宜便治，医者也必须顾及其表里虚实，等待时日，如果不循次第，临时得安，亏损五脏，以促寿限，有什么可贵呢？
脉浮的，病在表，可发汗，宜麻黄汤。（【原注】法用桂枝汤。○玉函。注。一云桂枝汤。脉经。作桂枝汤。）
〔程〕麻黄汤，为寒伤营的主剂，而禁忌很多，竟然如此，将让后人如何措手呢？回答说：也在脉与证之间，互相参酌，不必泥定紧之一字，始为合法。脉浮无紧，似乎不在发汗之列，然而看其证，一一符合寒伤营的表病，则不妨略脉而详证，无汗可发汗，宜麻黄汤。
脉浮而数的，可发汗，宜麻黄汤。
〔程〕脉浮数者，虽与浮紧稍异，然而邪势拥遏在表可知，则不必寒伤营之表病具备，自不妨略证而详脉，无汗可发汗，亦宜麻黄汤。
病常自汗出的，这是营气和，营气和者，外不谐，因为卫气不共营气和谐缘故。以营行脉中，卫行脉外，复发其汗，营卫和则愈，宜桂枝汤。（玉函。作病常自汗出者。此为营气和。卫气不和故也。营行脉中。为阴 主内。卫行脉外。为阳主外。复发其汗。卫和则愈。宜桂枝汤。千金翼同。脉经。千金。营气和者云云十八字。作营气和而外不解。此卫不和也十二字。无营卫和之营。吴本。作病常自汗出者。营气和。卫气不共营气和谐 故尔。复发其汗。营卫和则愈。宜桂枝汤。注云。此段。旧本多衍文。今删正。）
〔锡〕卫气，是用来肥腠理，司开阖，卫外而为固的。现在不能卫外，所以常自汗出。这是营气和，而卫不和。卫为阳，营为阴，阴阳贵在合和。现在营自和，而卫气不与之和谐，所以营自行于脉中，卫自行于脉外，两不相合，如夫妇之不调。宜桂枝汤发其汗，调和营卫之气则愈。〔方〕此言常者，谓无时不然。〔程〕此不必其为太阳中风，而桂枝汤亦宜者，如今人滋阴敛汗等类。〔柯〕下条发热汗出，便可用桂枝汤，见不必头痛恶风俱备。此只自汗一症，即不发热者，亦用之，更见桂枝方，于自汗为亲切耳。
《伤寒类方》说：营气和者，言营气不病，非调和之和。自汗与发汗迥别，自汗乃营卫相离，发汗使营卫相合。自汗伤正，发汗驱邪。复发者，因其自汗，而更发之，则营卫和，而自汗反止矣。
案：《灵枢·营卫生会篇》说：营在脉中，卫在脉外。又《卫气篇》说：其浮气之不循经者，为卫，其精气之行于经者，为营气，正是这段文字的根基。
病患脏无他病，时发热，自汗出而不愈的，这是卫气不和。先其时，发汗则愈，宜桂枝汤。（千金。作时时发热。汤下。成本。有主之二字。）
〔汪〕脏无他病者，谓里和能食，二便如常。〔程〕如病患脏无他病，属于里分的，只发热自汗出，时作时止，缠绵日久而不休，这较之太阳中风证之发无止时，不同了。既无风邪，则卫不必强，营不必弱，只是卫气不和，致闭固之令有乖。病既在卫，自当治卫，虽药同于中风，服法不同。先其时发汗，使功专于固卫，则汗自敛，热自退，而病愈。此不必为太阳中风，而桂枝汤可主者一也。凡脏病，亦有发热汗自出，连绵不愈者，骨蒸劳热类是也。
The exterior pathogens are resolved, and the illness heals. Guizhi Tang (Cinnamon Twig Decoction) is indicated. (Note: The text "Gu" is omitted in Cheng Ben and Yu Han; "Zhi" character exists in Yu Han; "Wu Xu" character does not exist in Yu Han, Mai Jing, and Qianjin Yi; "You Qi" character exists after Jie; "Zhu Zhi" characters exist in Cheng Ben after Tang; Ke Ben deletes these fourteen characters.)
[Cheng] The classic states: When Chaihu Tang syndrome is present, but other medications are used to purge, if the Chaihu Tang syndrome remains, administer Chaihu Tang again. Although purging has been performed, it is not a counter-indication, similar to this category.
[Qian] Wind-stroke should originally be treated by resolving the muscle layer, not by inducing sweating. Even when Guizhi Tang is used, there are cases where profuse sweating occurs like flowing water, yet the disease persists. Moreover, in the previous clause, after initially taking Guizhi Tang, vexation may worsen without resolution; one must first puncture Fengchi (GB20) and Fengfu (DU16) acupoints to allow wind pathogens to dissipate, then administer Guizhi Tang for recovery. This shows that when exterior syndromes are unresolved, other methods should not be hastily employed. If a physician sees that the disease persists after sweating and suspects pathogens have entered the interior, leading to further purging, yet the floating pulse remains and the disease is not cured, why is this? A floating pulse indicates wind pathogens in the exterior; purging should not be applied. Purging fails because the medication does not match the pathology. Now, since the pulse remains floating, we know the pathogens remain in the exterior, fortunately not having sunk inward. We must still resolve the exterior pathogens for recovery. Guizhi Tang (Cinnamon Twig Decoction) is indicated. [Zhou] In my analysis, although both sweating and purging were misapplied here, the Guizhi Tang syndrome remains, and it has not become a complicated syndrome.
Taiyang disease, with a floating-tight pulse, anhidrosis, fever, and body pain, persisting for eight or nine days without resolution, indicates the exterior syndrome remains. Sweating should be induced. After taking the medicine, symptoms may slightly alleviate, but the patient may experience vexation and closed eyes. Severe cases will definitely suffer from epistaxis (nosebleed), which resolves the condition. This occurs because Yang qi is heavily constrained. Mahuang Tang (Ephedra Decoction) is indicated. (Note: In Yu Han and Mai Jing, "Zheng" is written as "Hou"; in Mai Jing, "Reng" is written as "Xu". Zhang Lu's edition moves the five characters "Mahuang Tang Zhu Zhi" to below "Dang Fa Qi Han".)
[Cheng] Floating-tight pulse, anhidrosis, fever, and body pain constitute Taiyang Cold Damage. Even after eight or nine days, if the exterior syndrome remains, sweating should be induced. [Fang] "Slightly alleviated" means the pathogen is not completely expelled but has lessened. "Vexation" refers to wind congestion causing mental cloudiness. "Closed eyes" refers to cold constraint causing blood stasis. "Severe" indicates the precursor to epistaxis. Epistaxis is nosebleed. The nose is the opening of the Lung, which is Yin within Yang and governs Qi. Excess Yang pathogens rise, carrying blood upward, causing it to flow recklessly out of the nose. "Yang qi," referring to wind, is Yang and travels via the Qi channel, so it can dissipate through epistaxis. Hence, "Yang qi is heavy." [Qian] Since little pathogen was removed, the remaining pathogen is abundant, constrained and unable to vent, causing vexation, dizziness, and closed eyes. In severe cases, constrained heat injures Ying (Nutritive) level, Yin is scorched, blood-heat rises, and epistaxis occurs from the nose. Through epistaxis, heat pathogens ascend and escape, leading to resolution. [Ke] The phrase "Mahuang Tang is indicated" is placed below "Sweating should be induced." It is added at the end, employing a reverse order technique. Zhang Zhongjing detailed the causes during syndrome discussion but did not mention the formula until later. Predecessors expanded on the text, suggesting Mahuang Tang should be used again to disperse residual pathogens, failing to see where "resolution through epistaxis" fits. Note: "Heavy" is pronounced flat tone. Wu says: Yang, combined with cold air holding it, makes its force heavier.
*Shanghan Zhunsheng* quotes Zhang Jianshan: Taiyang floating-tight pulse, fever, anhidrosis, and spontaneous epistaxis lead to healing; this is a fixed principle. Why use Mahuang Tang to induce sweating again? Would Zhang Zhongjing contradict himself? However, the five characters "Mahuang Tang is indicated" in the previous clause should belong below "Sweating should be induced." In Han dynasty syntax, formulas were often appended to the end of preceding clauses. For example, in Da Qing Long Tang syndrome, it states those with weak pulse, sweating, and aversion to wind cannot take it, or they will suffer convulsions and muscle twitching (counter-indication); yet it concludes with "Da Qing Long Tang is indicated." This follows the same pattern.
Analysis: Cheng Shi, Fang Shi, Yu Shi, and Cheng Shi all claimed Mahuang Tang should be used after epistaxis. Thus, Zhang Lu, Zhang Zhizhong, Zhang Xiju, Wang Hu, and *Jin Jian* followed this, moving "Mahuang Tang is indicated" to below "Sweating should be induced." They failed to recognize this as Zhang Zhongjing's inverted sentence structure, similar to "As this cold leaves and resolution approaches, Xiao Qing Long Tang is indicated." The original text should not be altered.
Taiyang disease, with a floating-tight pulse, fever, anhidrosis, and spontaneous epistaxis, heals spontaneously.
[Cheng] Wind-cold in the meridians cannot be resolved by sweating; it constrains and transforms into heat. Epistaxis allows heat to scatter with blood, hence "spontaneous epistaxis leads to healing." [Fang] This continues the previous clause, discussing a milder case. Healing through epistaxis occurs because sweat is the fluid of blood; northerners call epistaxis "red sweat," expressing this meaning. [Jian] In Taiyang disease, external resolution occurs only through sweating or epistaxis. Since sweat was lost in the Ying level, Ying blood-heat flows recklessly, causing spontaneous epistaxis; heat resolves with epistaxis, leading to spontaneous healing.
*San Yin Fang*: Mahuang Shengma Tang (Ephedra and Cimicifuga Decoction) treats Shanghan fever where resolution fails, with blood following Qi congestion causing epistaxis, known as "red sweat." Ingredients: Mahuang (Ephedrae Herba) 2.5 liang, Shengma (Cimicifugae Rhizoma) 1.1 liang, Huangqin (Scutellariae Radix), Shaoyao (Paeoniae Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Shigao (Gypsum Fibrosum), Fuling (Poria). Each 1 liang. Powdered. Take 4 qian per dose with 1.5 cups of water and 3 slices of ginger, decoct to 0.7 cup, strain, and drink hot. Mild sweating indicates resolution.
Two Yang diseases merging: When Taiyang disease first begins, sweating is induced, but the sweat is incomplete, causing transmission to Yangming. Continued slight sweating and absence of aversion to cold occur. If Taiyang syndrome has not ceased, purging is contraindicated; purging is a counter-indication. In such cases, mild sweating should be induced. If the face is persistently red due to Yang qi constraint in the exterior, resolvent fumigation should be applied. If sweating is incomplete, it is insufficient to say Yang qi is constrained and unable to vent; rather, sweating should have occurred but did not. The patient becomes restless and irritable, with unknown pain locations, shifting between abdomen and limbs, unpressable. Shortness of breath and inability to lie down result from incomplete sweating. Re-inducing sweating leads to healing. How do we know sweating was incomplete? By a choppy pulse. (Note: In Yu Han, "Zai Biao" is written as "Bu De Yue"; fifteen characters are missing. In Mai Jing, "Bu Da Che" is written. In Yu Han and Mai Jing, "Se" is written. "Gu Zhi Ye" is written as "Gu Zhi Zhi".)
[Cheng] When Taiyang disease is unresolved and transmits to Yangming, but Taiyang signs remain, it is called "merging disease." Continued slight sweating and no aversion to cold indicate Taiyang signs have ceased and Yangming signs are complete. Purging is indicated. If Taiyang signs remain, the exterior is unresolved, so purging is contraindicated; mild sweating should be induced to resolve the exterior first. The Yangming meridian traverses the face; persistent redness indicates Yang qi constraint in the exterior. Resolvent fumigation should be used to induce sweat. If sweating is incomplete, it is insufficient to claim Yang qi constraint; it simply means sweating was required but withheld. Yang qi could not vent, pathogens had no exit, and stagnation in the meridians intensified, causing restlessness. Pathogens follow meridians, so pain is locationless, in abdomen or limbs, unpressable, accompanied by shortness of breath. Blame incomplete sweating; re-induce sweating for healing. *Neijing* states: Palpate all pulses. Choppy pulse indicates excess Yang, manifesting as fever and anhidrosis. Thus, choppy pulse reveals Yang qi stagnation and incomplete sweating. [Wang] Although this is Two Yang merging, Taiyang signs predominate. Initially, Taiyang meridian sweating was incomplete, transmitting to Yangming, forming merging disease. View this as the first segment. Although slight sweating and no aversion to cold follow, Taiyang signs do not cease due to slight sweating, so mild sweating is still applicable. View this as the second segment. If the face is persistently red, it involves Yangming heat pathogens constrained severely in the exterior; resolvent fumigation is indicated. View this as the third segment. Ultimately, this results from incomplete sweating at onset, leading to delay and failure to sweat. Yang qi constraint causes facial redness, which is not the main issue. Restlessness, shortness of breath, and wandering pain indicate Taiyang pathogens have not diminished despite Yangming merging. Hence, "re-induce sweating for healing." View this as the fourth segment. "Incomplete" means not penetrating. "Insufficient to say" implies inevitability,无需 stated. [Wei] "Yuan Yuan" means spreading from shallow to deep, from one area to the whole face. Ancients used words skillfully, creating exquisite imagery. [Zhou] Symptoms like restlessness describe the state of restlessness; there is no actual pain, hence "unpressable."
*Shanghan Xuanlu*: Zhang says: "Bing" (merging) implies urging or supervising merger, not swallowing or joining. "Cui Bing" is falling tone; "Tun Bing" is rising tone. *Shiji* states: Qin Shi Huang first merged the world; this is the logic. Merging means the prior disease is unresolved while the posterior disease arrives, forcing them together. Hence "merging disease." The classic states: Taiyang and Shaoyang merging causes stiff neck/head pain or dizziness. If they were truly one entity, Zhang Zhongjing would not list signs of two meridians. Thus, "Bing" clearly does not mean this.
*Zong Bing Lun*: Omits twenty-one characters starting from "Ren Xin Zao Fan" and adds "Yi Mahuang Tang" below "Bu Che Gu Ye." Note: Ancient texts have many errors; corrected based on observed clinical patterns. ○ Analysis regarding "Re-induce sweating": Yu Shi suggests Guizhi Jia Ge Gen Tang; Zhang Lu suggests Guizhi Er Yue Bi Yi Tang; Cheng Shi suggests not only resolvents like Da Qing Long Tang but also fumigation with Mahuang decoction; Zhang Zhizhong suggests Guizhi Mahuang Ge Ban Tang; Yao Shi suggests Guizhi Tang; *Jin Jian* suggests Guizhi Mahuang Ge Ban Tang or Guizhi Er Yue Bi Yi Tang for mild sweating to harmonize the exterior, followed by Da Qing Long Tang or Ge Gen Tang; Wei Shi suggests Guizhi Tang for wind, Mahuang Tang for cold, or Guizhi Mahuang Ge Ban Tang for combined wind-cold. Various prescriptions exist, but the original text is ambiguous, so the exact formula is undetermined.
Floating-numerous pulse indicates sweating should resolve the disease. If purged, resulting in heaviness and palpitations, sweating is contraindicated; spontaneous sweating will resolve it. This is because the pulse at Cun Guan (specifically Chi position) is faint, indicating interior deficiency. Exterior and interior must be solidified; when fluids harmonize, spontaneous sweating heals. (Note: In Yu Han, "Nai" is written as "Er".)
[Cheng] The classic states: Floating-numerous pulses accompany fever and chills, indicating exterior pathogens. Sweating should resolve it. If purged, causing heaviness and palpitations, stomach Qi is damaged, fluids depleted, and Ying/Blood deficient. The Chi pulse will be faint. Cun governs exterior, Chi governs interior. Although the pulse is floating-numerous, the Chi position is faint, indicating exterior excess and interior deficiency. Mahuang Tang (Ephedra Decoction) attacks Ying and is for exterior-interior excess; it should not be used to further weaken the interior. Harmonize exterior and solidify interior methods are needed. When exterior and interior are solid, fluids harmonize, pathogens have no place to reside, and spontaneous sweating resolves the disease without forced sweating. [Qian] Heaviness results from interior pathogens not entering, but mistaken purging damaging Stomach Yang. Abundant Yang brings lightness; abundant Yin brings heaviness. Children, pure Yang, are agile; elderly, Yin excess/Yang decline, are sluggish. Mistaken purging causing Yang deficiency is akin to mistaken sweating. Palpitations here stem from interior deficiency, same as palpitations after excessive sweating with hands over heart. [Wei] Cheng's note on harmonizing exterior and solidifying interior supplements Zhang Zhongjing's method but lacks a formula. I suggest Jianzhong or related formulas, focusing on raising Yang, venting exterior, warming middle, and harmonizing interior.
Analysis: Zhang Lu and *Jin Jian* advocate Xiao Jianzhong Tang; Zhou cites Dong Yuan supporting Jianzhong, though the source is unknown for later verification.
Floating-tight pulse indicates body pain; sweating should resolve it. If the Chi pulse is slow, sweating is contraindicated. Why? Because Ying Qi is insufficient and Blood is scant. (Note: In Yu Han, "Teng Tong" is "Shen Teng Tou Tong"; in Mai Jing, "Shen Ti Teng Tong". In Cheng Ben, "Zhi" has "Zhi" character. In Yu Han, "He Yi Zhi Ran" is "He Yi Gu". Text reads: "This is because Ying Qi is insufficient and Blood-Qi is slightly scant." Mai Jing adds "Ci Wei" and "Wei". Zhang Lu adds "Qi" between "Zhi Ran".)
[Qian] Floating-tight is the pulse of Cold Damage. Body/lower back pain indicates Mahuang Tang (Ephedra Decoction) for sweating is correct. If Chi pulse is slow, sweating is contraindicated. Why? Chi governs Lower Jiao; slow indicates Cold. Slow Chi pulse reveals insufficiency of True Yang in Mingmen (Gate of Life), unable to steam Grain Qi into Ying and Wei. Sweat is Blood in Ying, steamed by Heat, moving from Ying to Wei. Blindly inducing sweating without assessing deficiency/excess destroys Yang and damages Wei. Here, Cold damages Ying, sweat comes from Ying. Slow Chi pulse reveals Kidney Yuan decline, Ying insufficiency, and Blood scarcity; do not deplete Blood via sweating. [Ke] "If" is a hypothetical, adding depth. This parallels floating-numerous pulse with faint Chi. [Wei] Besides Jianzhong, consider Shaoyin warming meridians and dispersing cold formulas.
Wang says: *Bu Wang Lun*, Guo Baiyun suggests Xiao Jianzhong Tang (Minor Construct the Middle Decoction), then Chaihu Guizhi Tang. I believe these derive from *Huo Ren Shu*. Xiao Jianzhong is Guizhi Tang plus Yitang (Maltose). But Zhang Zhongjing's rule: Anhidrosis contraindicates Guizhi. Chaihu Guizhi Tang is Xiao Chaihu Tang plus Guizhi; mismatched indication is confusing. ○ Analysis: Zhang and Zhou favor Xiao Jianzhong; Wei's approach of not fixing one formula is more appropriate.
*Benshi Fang*: A villager named Qiu had Shanghan. Fever, headache, vexation/thirst. Pulse floating-numerous but weak, Chi below slow/weak. I said: Though Mahuang syndrome, Chi slow/weak means Ying insufficiency and Blood scarcity per Zhang Zhongjing; sweating is contraindicated. I used Jianzhong Tang plus Danggui (Angelicae Sinensis Radix) and Huangqi (Astragali Radix). Next day, pulse unchanged. Family pressured for sweating drugs. I persisted, using only Jianzhong to regulate Ying. On day five, Chi pulse responded. Then administered Mahuang Tang. After second dose, madness ensued, then settled, slight sleep, then sweating. Truly difficult matters. Zhang Zhongjing says treat promptly regardless of time, but physicians must assess exterior/interior, deficiency/excess, and wait for timing. Disregarding sequence for temporary relief harms Five Zang and shortens life; what value is there?
Floating pulse indicates disease in the exterior; sweating is indicated, Mahuang Tang (Ephedra Decoction) is suitable. (Original Note: Method uses Guizhi Tang. ○ Yu Han Note: One version says Guizhi Tang. Mai Jing writes Guizhi Tang.)
[Cheng] Mahuang Tang is the main agent for Cold damaging Ying, yet has many contraindications. How should successors proceed? Answer: Consult pulse and syndrome mutually; do not rigidly adhere to "tight." Floating without tight seems outside sweating scope, but if signs fully match Cold damaging Ying exterior, prioritize signs over pulse. Anhidrosis allows sweating; Mahuang Tang is suitable.
Floating-numerous pulse allows sweating; Mahuang Tang (Ephedra Decoction) is suitable.
[Cheng] Floating-numerous differs slightly from floating-tight, but pathogen constraint in exterior is evident. Full Cold damaging Ying signs are not required. Prioritize pulse over signs. Anhidrosis allows sweating; Mahuang Tang is suitable.
Patients with constant spontaneous sweating have harmonious Ying Qi. Harmonious Ying Qi means exterior disharmony because Wei (Defensive) Qi does not harmonize with Ying Qi. Ying travels in vessels; Wei travels outside. Inducing sweating again harmonizes Ying and Wei, leading to healing. Guizhi Tang (Cinnamon Twig Decoction) is indicated. (Note: Yu Han reads: "Constant spontaneous sweating indicates harmonious Ying Qi, but disharmonious Wei Qi. Ying in vessels, Yin governing interior; Wei outside, Yang governing exterior. Re-sweating harmonizes Wei." Qianjin Yi agrees. Mai Jing/Qianjin condense eighteen characters to twelve: "Harmonious Ying but exterior unresolved, this is Wei disharmony." Wu edition omits "Ying" in "Ying Wei He". Note: Old editions have redundant text, now corrected.)
[Xi] Wei Qi thickens interstices, controls opening/closing, and defends exterior. Failure to defend causes spontaneous sweating. Ying is harmonious, Wei is not. Yang (Wei) and Yin (Ying) must harmonize. Ying is self-harmonious, but Wei does not harmonize with it. Ying moves in vessels, Wei moves outside; they do not combine, like discordant spouses. Guizhi Tang induces sweating to harmonize Ying and Wei. [Fang] "Constant" means always. [Cheng] This applies even without Taiyang Wind-Strike; Guizhi Tang is suitable, similar to modern Yin-nourishing sweat-astringents. [Ke] Next clause mentions fever/sweating using Guizhi Tang, showing headache/aversion to wind are not required. Here, only spontaneous sweating, even without fever, uses it, highlighting Guizhi Tang's suitability for spontaneous sweating.
*Shanghan Leifang*: "Harmonious Ying" means Ying is not diseased, not "harmonized." Spontaneous sweating differs from induced sweating. Spontaneous sweating separates Ying/Wei; induced sweating combines them. Spontaneous sweating harms Righteous Qi; induced sweating expels Pathogens. "Re-sweating" exploits spontaneous sweating to induce sweating, harmonizing Ying/Wei and stopping spontaneous sweating.
Analysis: *Ling Shu · Ying Wei Sheng Hui* states: Ying in vessels, Wei outside. *Wei Qi Pian* states: Floating Qi not following meridians is Wei; Essence Qi following meridians is Ying. This is the root of this passage.
Patients with no internal organ disease, experiencing intermittent fever and spontaneous sweating without resolution, have disharmonious Wei Qi. Induce sweating before the onset of symptoms for healing. Guizhi Tang (Cinnamon Twig Decoction) is indicated. (Note: Qianjin reads "Shi Shi Fe Re". Cheng Ben adds "Zhu" after Tang.)
[Wang] "No internal organ disease" means interior harmony, good appetite, normal urination/defecation. [Cheng] If internal organs are healthy, but fever/sweating occur intermittently, lingering long without ceasing, it differs from Taiyang Wind-Strike where fever has no stop. Without wind pathogens, Wei need not be strong, Ying need not be weak; only Wei Qi is disharmonious, disrupting closure. Disease is in Wei, so treat Wei. Although herbs match Wind-Strike, administration differs. Induce sweating before onset to focus功效 on securing Wei, stopping sweat and reducing fever. This is one case where Guizhi Tang is indicated without Taiyang Wind-Strike. Internal organ diseases also cause lingering fever/sweating, such as bone-steaming consumption.