麻黄（三两去节） 桂枝（二两去皮） 甘草（一两炙） 杏人（七十个泡去皮尖）
上四味。以水九升。先煮麻黄减二升。去上沫。内诸药。煮取二升半。去滓。温服八合。覆取微似汗。不须 粥。
余如桂枝法将息。
成氏明理论云。本草言轻可去实。即麻黄葛根之属。实为寒邪在表。皮腠坚实。圣济经曰。汗不出而腠密。邪气
胜而表实。轻剂所以扬之。麻黄味甘苦。用以为君者。以麻黄为轻剂。而专主发散也。桂枝为臣者。以风邪在表。而肤
理疏者。必以桂枝解其肌。今寒邪在经。表实而腠密。非桂枝所能独散。必专麻黄以发汗。而桂枝所以为臣也。内经曰。
寒淫于内。治以甘热。佐以辛苦者。兹是类欤。甘草味甘平。杏仁味甘苦温。用以为佐使者。内经曰。肝苦急。急食甘
以缓之。肝者。营之主也。伤寒营胜卫固。血脉不流。必用味甘之物以缓之。故以甘草杏人为之佐使。且桂枝汤主中风。
风则伤卫。风邪并于卫。则卫实而营弱。仲景所谓汗出恶风者。此为营弱卫强。故桂枝汤佐以芍药。用和营也。麻黄汤
主伤寒。寒则伤营。寒邪并于营。则营实而卫虚。内经所谓气之所并为血虚。血之所并为气虚者是矣。故麻黄汤佐以杏
人。用利气也。
琥按上成氏论云。寒邪并于营。则营实而卫虚。若然。则是仲景所云。无汗恶风者。推其意盖云。营实故无汗。卫
虚故恶风。但不知中风之证。为卫实矣。何由而仲景桂枝汤证。仍然恶风而复恶寒邪。由是而知成注言实者。乃邪气之
实也。
或问云。成注言实。皆由邪气之实。则是成注言虚。当是正气之虚。即其引内经之言以证寒伤营云。血之所并为气
虚。其说非真虚邪。余曰。不然。伤寒无汗。营中之邪固实。虽云。恶风。要之卫中之气。亦不可以言虚。如果系真虚。
岂堪麻桂之发散乎。学人读仲景书至此。须当以意会之。或又问。仲景法无汗不可。服桂枝。今麻黄汤内复用桂枝者。
何也。余答云。按仲景法。无汗不得服桂枝汤。以其中有芍药姜枣也。夫伤寒无汗为表实。表实者。津液内固而不外泄。
故禁用芍药以收敛津液。且使寒邪不得外散。津液既不得泄。更用姜枣以升生脾胃中之津液。尤为无为。其用生姜固无
害。若大枣则过于温补。恐非表实之证所宜。今麻黄汤内用桂枝者。以寒伤营。桂枝亦营中药。能通血脉而发散寒邪。
兼佐麻黄而泻营卫中之邪实。盖风寒在表。营卫俱实。肌肤燎热。头疼项强。腰脊痛。骨节不利。恶寒无汗者必须用之。
其汤中用杏人者。以利喘也。用甘草者。和营卫也。且以邪之所凑。其气必虚炙甘草有补虚之义。大抵古人用疏利之药。
必少兼补药。有如调胃承气汤中。亦用炙甘草。即此意也。仲景此方。乃冬月正伤寒。太阳经发表的药。后学如辩证精
切。何难遵而用之。
琥按方后云。不须 粥成注无解。条辩云。麻黄发汗有专功之能。故不须 粥之助。愚以寒伤于外。热郁于内。邪
热气逆而发喘。其人本不能食。若强以稀粥与之。缵论所云。反增其剧也。斯仲景不须 粥之意欤。
太阳与阳明合病喘而胸满者。不可下。宜麻黄汤主之。（此条合病。乃太阳伤寒之证全具。止胸满一候属阳明也。非
此前葛根汤之合病。为阳明病全具之证。胸乃阳明之部分。以阳明之支脉下膈。其直者下乳内。其经皆由于胸故也。成
注云。心下满。腹满。皆为实。当下之。此为胸满。非里实。故不可下。仲景法。止从太阳例。无汗而喘之证治之。故
云。宜麻黄汤也。或问阳明病已见胸满之候。何以不兼治阳明。余曰。病因喘而致胸满。胸前者。虽为阳明之部分其实
乃肺之室也。喘而胸满。则肺气必实而胀。所以李东璧本草云。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。汤中有麻黄杏人。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。
此论实发成氏未发之意。）
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。（成注云。十日以
去向解之时也。脉虽浮而细。是脉已静矣。嗜卧者邪退神恬而欲卧。故知表已解也。设不尽解。而其人胸满胁痛。此胸
满。非比前阳明合病之胸满。盖少阳之支脉。下胸中循胁。其直者。又循胸过季胁。则是此脉浮细。邪又在半表半里。
其嗜卧为胆热而神昏。另宜与小柴胡汤。以和解之。若脉但浮而不细者。虽过十日。邪还在表。谓太阳头痛发热无汗等
证犹在也。仲景法。仍与麻黄汤以发其汗。可见伤寒发汗。不可拘拘于一二日间也。小柴胡汤见后第七卷少阳篇中）
（附例）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。（自此以下四条俱从大小青龙汤后移附于此。成注云。脉浮紧无
汗。发热身疼痛。此太阳伤寒也。虽至八九日。从未服发汗药。则病不解。太阳表证仍在。尚当发其汗。其服发汗药已。
而微除者。此必因医人不敢用麻黄汤。药力轻而不能胜太阳经之寒邪也。经云。伤寒者热病之类。病至八九日后。寒邪
不能尽除。其人必作郁热而发。烦目瞑也。发烦者。为肺热。皮毛发热。汗不得泄。肺气忿郁而发烦也。目瞑者。为肝
热。寒邪变热。营血为热所搏。肝失藏血之令。故目瞑也。剧者。郁热甚而病剧也。热甚气蒸。载血妄行。而上出于鼻
曰衄。得衄则邪热之气。亦随经而解散。俗名红汗者是也。其所以致衄者。以阳经热邪之气重故也。此阳气当兼阳明之
气而言。阳明多气多血。太阳病不解。其热气并入阳明之经。必致衄而解也。如其人不作衄。为太阳表证仍在。故云。
麻黄汤主之。非谓已。致衄而犹宜用麻黄汤也。按张兼善云。麻黄汤主之五字。合当用于当发其汗之下。）
太阳病脉浮紧。发热。身无汗自衄者愈（此太阳伤寒。不因服药而衄血自来。其病比上条稍轻。得衄。则郁热随经
解散。寒邪之气。不为少留。故云。病愈。盖汗者。血之液衄犹汗也。所以此条病。不更主以麻黄汤也。）
脉浮者。病在表。可发汗宜麻黄汤（观上二条证。若似乎麻黄汤之用。必待紧脉而后宜矣。亦知太阳无汗证具。但
见浮脉。则病犹在表也。乘其在表。为可发汗之时。故云宜麻黄汤。）
脉浮而数者。可发汗宜麻黄汤。（又太阳无汗证具。即见脉浮而数者。亦可发汗盖数为郁热已甚。乃太阳病欲传里之
时也。以其尚有浮脉。邪不离表。乘其未传。犹为可发汗之时。故亦云。宜麻黄汤也。）
伤寒脉浮紧。不发汗因致衄者。麻黄汤主之。（成注云。伤寒脉浮紧。邪在表也。当与麻黄汤发汗。若不发汗则邪无
从出。郁热壅甚于经。因而致衄。仲景法。仍用麻黄汤主之。愚按此条致衄。必点滴而不成流。故虽衄。而太阳伤寒之
表证。必仍然不解。所以用麻黄汤主之也。活人书云。衄后脉浮者。宜麻黄汤。衄后脉已微者。不可行麻黄汤。宜黄芩
芍药汤。盖衄后脉浮者。表未解也。衄后脉微者。表已解也。于此可见仲景用麻黄汤于衄后之大旨。）
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。服之。
则厥逆。筋惕。肉 。此为逆也。大青龙汤主之（坊本有此一句今从删。成注云。此中风见寒脉也。发热恶寒者。太阳
表病也。脉浮紧。身疼痛。为伤寒。不汗出为中风。盖不汗出者。是汗欲出而不得出。非其人直无汗也。风寒两伤。则
郁热愈甚。所以汗不出。而加烦扰躁闷也。仲景法。用大青龙汤主之。大青龙者。桂枝麻黄之合方也。以不汗出。故去
芍药。恐其味酸而收敛津液也。因烦躁。故加石膏。取其甘寒而清解郁热也。要之此汤。亦有不可轻用之戒。若病患脉
微弱。而非浮紧。汗出恶风。而非不汗出者。切不可服。服之。则其人必见四肢厥逆。其筋则惕惕然而跳。肉必 然
而动。以病本汗出。复大发其汗。汗多亡阳。津液枯少。故见厥逆筋惕肉 也。如此者。乃为大逆之候。愚按末后大青
龙汤主之句。黄仲理改作真武汤。方喻二氏皆宗之。大误。盖此条病。仲景本无救逆之法。末后六字。乃复语也。今从
准绳例削去。使无增后学之疑。）
麻黄（三两，去节） 桂枝（二两，去皮） 甘草（一两，炙） 杏仁（七十个，泡后去皮尖）
以上四味药。用水九升。先煮麻黄，水量减少二升。去掉水面上的浮沫。加入其余药物。煮取药液二升半。滤去药渣。温服八合。服药后覆盖衣被以取得微微似有汗出的效果。不需要喝热粥来辅助发汗。
其余调养方法参照桂枝汤的法度进行。
成无己在《明理论》中说：本草书中说“轻可去实”，指的就是麻黄、葛根这一类药物。所谓“实”，是指寒邪在体表，皮肤腠理坚实。《圣济经》说：“汗不出而腠理致密，邪气盛而表实证。”轻扬的药物所以能宣散它。麻黄味甘苦，作为君药，是因为麻黄属于轻剂，专门主司发散。桂枝作为臣药，是因为风邪在表，且肌腠疏松的，必须用桂枝来解肌。如今是寒邪在经脉，表实而腠理致密，不是桂枝所能单独解散的，必须专用麻黄来发汗，而桂枝因此作为臣药。《内经》说：“寒淫于内，治以甘热，佐以辛苦。”大概就是这个道理吧。甘草味甘平，杏仁味甘苦温，作为佐使药。《内经》说：“肝苦急，急食甘以缓之。”肝是营血的主体。伤寒导致营气胜而卫气固，血脉运行不畅，必须用味甘的药物来缓和它。所以用甘草和杏仁作为佐使。况且桂枝汤主治中风，风则伤卫，风邪并入卫分，则卫实而营弱。张仲景所说的“汗出恶风”，这就是营弱卫强。所以桂枝汤中配伍芍药，用来调和营血。麻黄汤主治伤寒，寒则伤营，寒邪并入营分，则营实而卫虚。《内经》所说的“气之所并为血虚，血之所并为气虚”就是这种情况。所以麻黄汤中配伍杏仁，用来利气。
琥按：上面成无己的论述说，寒邪并入营分，则营实而卫虚。如果是这样，那么就是张仲景所说的“无汗恶风”。推究其意，大概是说营实故无汗，卫虚故恶风。但不知道中风的证候，其实是卫实了。为什么张仲景桂枝汤的证候，仍然恶风并且又恶寒呢？由此可知，成注所说的“实”，乃是邪气的实。
有人问：成注说“实”，都是由于邪气之实。那么成注说“虚”，应当是正气之虚。即他引用《内经》的话来证明寒伤营，说“血之所并为气虚”，这种说法并非真正的虚邪。我说：不对。伤寒无汗，营中的邪气固然实，虽然说是恶风，总之卫中的气，也不可以说虚。如果真的是虚，怎么能承受麻黄、桂枝的发散呢？学人读张仲景的书到此处，应当用心去领会。又有人问：张仲景的法度是无汗不可服桂枝汤，现在麻黄汤内又复用桂枝，为什么呢？我回答说：按张仲景的法度，无汗不得服桂枝汤，因为其中有芍药、生姜、大枣。夫伤寒无汗为表实，表实者，津液内固而不外泄。所以禁用芍药来收敛津液，并且使寒邪不得外散。津液既然不能外泄，再用姜枣来升发生脾胃中的津液，更是多余无用。其中生姜固无妨害，若大枣则过于温补，恐怕不适合表实的证候。现在麻黄汤内用桂枝，是因为寒伤营，桂枝也是营中药，能通血脉而发散寒邪，兼佐麻黄而泻营卫中的邪实。盖风寒在表，营卫俱实，肌肤燎热，头疼项强，腰脊痛，骨节不利，恶寒无汗者，必须用之。汤中使用杏仁，是为了利喘。使用甘草，是为了和营卫。而且因为“邪之所凑，其气必虚”，炙甘草有补虚的意义。大抵古人使用疏利之药，必定少兼补药。有如调胃承气汤中，也使用炙甘草，就是这个意思。张仲景此方，乃是冬季正伤寒，太阳经发表的药。后学如果辨证精切，何难遵循而使用它。
琥按：方后说“不须粥”，成注没有解释。条辩说：麻黄发汗有专功之能，所以不需要粥的辅助。我认为寒伤于外，热郁于内，邪热气逆而发喘，其人本来不能进食，如果强行给稀粥，正如《缵论》所说，反而增加病情。这大概是张仲景说不需要粥的意思吧。
太阳与阳明合病，喘而胸满者，不可下，宜麻黄汤主之。（这条合病，乃是太阳伤寒的证候全具，只有胸满一症属阳明。不是此前葛根汤的合病，那是阳明病全具的证候。胸是阳明的部分，因为阳明的支脉下膈，直的经过乳内，其经都经过胸部，所以如此。成注说：心下满，腹满，皆为实，当下之。此为胸满，非里实，故不可下。张仲景的法度，只从太阳例，治疗无汗而喘的证候，所以说：宜麻黄汤。有人问：阳明病已见胸满的证候，为什么不兼治阳明？我说：病因喘而导致胸满，胸前部，虽然是阳明的部分，其实乃是肺的居所。喘而胸满，则肺气必实而胀。所以李东璧在《本草》中说：麻黄汤虽为太阳发汗重剂，实为发散肺经火郁之药。他大概是把喘而胸满看作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，哪里还有阳明的胸满呢？这个论述确实阐发了成氏未阐发的意思。）
太阳病十天以后，脉浮细而嗜卧的，外邪已解。如果胸满胁痛，与小柴胡汤。脉但浮的，与麻黄汤。（成注说：十天以后，是向愈的时候。脉虽浮而细，是脉已静了。嗜卧是邪退神恬而想睡，所以知道表已解。假设不完全解，而其人胸满胁痛，这个胸满，不像前面阳明合病的胸满。盖少阳的支脉，下胸中循胁，直的又循胸过季胁，那么这个脉浮细，邪又在半表半里。其嗜卧是胆热而神昏，另外宜与小柴胡汤，以和解它。如果脉但浮而不细，虽然过了十天，邪还在表，谓太阳头痛发热无汗等证犹在。张仲景的法度，仍给麻黄汤以发其汗。可见伤寒发汗，不可拘泥于一二日间。小柴胡汤见后第七卷少阳篇中）
（附例）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。（自此以下四条俱从大小青龙汤后移附于此。成注说：脉浮紧无汗，发热身疼痛，这是太阳伤寒。虽至八九日，从未服发汗药，则病不解。太阳表证仍在，尚当发其汗。其服发汗药已，而微除者，这必定是因为医生不敢用麻黄汤，药力轻而不能胜太阳经的寒邪。经云：伤寒者是热病之类。病至八九日后，寒邪不能尽除，其人必作郁热而发，烦目瞑。发烦者，为肺热，皮毛发热，汗不得泄，肺气忿郁而发烦。目瞑者，为肝热，寒邪变热，营血为热所搏，肝失藏血之令，故目瞑。剧者，郁热甚而病剧。热甚气蒸，载血妄行，而上出于鼻曰衄。得衄则邪热之气，亦随经而解散，俗名红汗的是。其所以致衄者，以阳经热邪之气重故也。这个阳气应当兼阳明之气而言，阳明多气多血，太阳病不解，其热气并入阳明之经，必致衄而解。如其人不作衄，为太阳表证仍在，所以说：麻黄汤主之。并不是说已经衄血而犹宜用麻黄汤。按张兼善说：麻黄汤主之五字，合当用于当发其汗之下。）
太阳病脉浮紧，发热，身无汗自衄者愈（这是太阳伤寒，不因服药而衄血自来，其病比上条稍轻。得衄，则郁热随经解散，寒邪之气，不为少留，所以说：病愈。盖汗者，血之液，衄犹汗也。所以此条病，不更主以麻黄汤。）
脉浮者，病在表，可发汗，宜麻黄汤（观上二条证，若似乎麻黄汤之用，必待紧脉而后宜矣。亦知太阳无汗证具，但见浮脉，则病犹在表也。乘其在表，为可发汗之时，所以说：宜麻黄汤。）
脉浮而数者，可发汗，宜麻黄汤。（又是太阳无汗证具，即见脉浮而数者，亦可发汗。盖数为郁热已甚，乃太阳病欲传里之时。以其尚有浮脉，邪不离表，乘其未传，犹为可发汗之时，所以也说：宜麻黄汤。）
伤寒脉浮紧，不发汗因致衄者，麻黄汤主之。（成注说：伤寒脉浮紧，邪在表也。当与麻黄汤发汗。若不发汗则邪无从出，郁热壅甚于经，因而致衄。张仲景的法度，仍用麻黄汤主之。我按：此条致衄，必点滴而不成流，故虽衄，而太阳伤寒之表证，必仍然不解。所以用麻黄汤主之。《活人书》说：衄后脉浮者，宜麻黄汤。衄后脉已微者，不可行麻黄汤，宜黄芩芍药汤。盖衄后脉浮者，表未解也。衄后脉微者，表已解也。于此可见张仲景用麻黄汤于衄后的大旨。）
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。服之，则厥逆，筋惕，肉瞤。此为逆也。大青龙汤主之（坊本有此一句今从删。成注说：此中风见寒脉也。发热恶寒者，太阳表病也。脉浮紧，身疼痛，为伤寒。不汗出为中风。盖不汗出者，是汗欲出而不得出，非其人直无汗也。风寒两伤，则郁热愈甚，所以汗不出，而加烦扰躁闷。张仲景的法度，用大青龙汤主之。大青龙者，桂枝麻黄之合方也。以不汗出，故去芍药，恐其味酸而收敛津液。因烦躁，故加石膏，取其甘寒而清解郁热。要之此汤，亦有不可轻用之戒。若病患脉微弱，而非浮紧，汗出恶风，而非不汗出者，切不可服。服之，则其人必见四肢厥逆，其筋则惕惕然而跳，肉必瞤然而动。以病本汗出，复大发其汗，汗多亡阳，津液枯少，故见厥逆筋惕肉瞤。如此者，乃为大逆之候。我按末后大青龙汤主之句，黄仲理改作真武汤，方喻二氏皆宗之，大误。盖此条病，张仲景本无救逆之法，末后六字，乃复语也。今从准绳例削去，使无增后学之疑。）
Mahuang (Caulis Ephedrae, 3 liang, remove nodes) Guizhi (Ramulus Cinnamomi, 2 liang, remove bark) Gancao (Radix Glycyrrhizae, 1 liang, honey-fried) Xingren (Semen Armeniacae Amarum, 70 seeds, soaked and remove skins and tips)
The above four ingredients. Use nine sheng of water. First boil Mahuang until the volume reduces by two sheng. Remove the foam on the surface. Add the remaining herbs. Boil to obtain two and a half sheng of decoction. Strain off the dregs. Take eight he of the warm decoction. Cover with blankets to induce a slight, continuous sweating. There is no need to drink hot porridge to assist in sweating.
Rest and care instructions follow those for Guizhi Tang (Cinnamon Twig Decoction).
Cheng Wuji stated in his *Minglun* (Theory of Clarification): The Materia Medica says "light agents can dispel excess," referring to herbs such as Mahuang (Ephedra) and Gegen (Pueraria Root). The term "excess" here refers to cold pathogenic factors at the exterior, where the skin and pores are firm and tight. The *Shengji Jing* states: "When sweat does not occur and pores are dense, the pathogenic factor is strong and the exterior is solid." Light and ascending agents are used to disperse this. Mahuang has a sweet and pungent taste. It is used as the Sovereign herb because it belongs to light agents and specializes in dispersing and releasing. Guizhi is used as the Minister herb because when wind pathogenic factors are at the exterior and the muscle texture is loose, Guizhi must be used to resolve the muscle layer. However, in the current case, cold pathogenic factors are in the meridians, the exterior is solid and pores are dense; Guizhi alone cannot disperse them. Therefore, Mahuang must be used exclusively to induce sweating, while Guizhi serves as the Minister. The *Neijing* states: "For cold invading internally, treat with sweet and hot agents, assisted by pungent and bitter ones." This seems to be the principle involved. Gancao has a sweet and neutral taste, and Xingren has a sweet, pungent, and warm taste; they are used as Assistant and Envoy herbs. The *Neijing* states: "When the Liver suffers from tension, eat sweet substances to relax it." The Liver is the master of Ying (Nutritive) Qi. In Shanghan (Cold Damage), Ying Qi becomes excessive while Wei (Defensive) Qi is fixed, causing blood vessels to stagnate. Sweet-tasting substances must be used to relax this condition. Thus, Gancao and Xingren are used as Assistants and Envoys. Furthermore, Guizhi Tang treats Wind Strike (Zhongfeng); wind injures Wei Qi. When wind pathogenic factors merge into the Wei level, Wei becomes solid and Ying becomes weak. Zhang Zhongjing's description of "sweating and aversion to wind" refers to this state of weak Ying and strong Wei. Therefore, Shaoyao (Paeonia Root) is added to Guizhi Tang to harmonize Ying Qi. Mahuang Tang treats Cold Damage (Shanghan); cold injures Ying Qi. When cold pathogenic factors merge into the Ying level, Ying becomes solid and Wei becomes deficient. This corresponds to the *Neijing*'s statement: "Where Qi merges, Blood becomes deficient; where Blood merges, Qi becomes deficient." Therefore, Xingren is added to Mahuang Tang to promote the flow of Qi.
Hu comments on Cheng's theory: Cheng states that when cold pathogenic factors merge into Ying, Ying becomes solid and Wei becomes deficient. If so, then Zhang Zhongjing's mention of "no sweating and aversion to wind" implies that solid Ying causes no sweating, and deficient Wei causes aversion to wind. However, in the syndrome of Wind Strike, Wei is actually solid. Why does the Guizhi Tang syndrome still present with aversion to wind and even aversion to cold? From this, we know that Cheng's use of "solid" refers to the solidity of the pathogenic factor, not the healthy Qi.
A questioner asked: Cheng's note says "solid" refers to the solidity of pathogenic factors. Then Cheng's mention of "deficient" should refer to the deficiency of healthy Qi. He cites the *Neijing* to prove that cold injures Ying, saying "where Blood merges, Qi becomes deficient." Is this truly a deficiency of healthy Qi? I reply: Not so. In Shanghan with no sweating, the pathogens in Ying are indeed solid. Although there is aversion to wind, one cannot say that the Qi in Wei is truly deficient. If it were true deficiency, how could it withstand the dispersing action of Mahuang and Guizhi? Students reading Zhang Zhongjing's work at this point must comprehend it through mental inference. Another question arises: Zhang Zhongjing's method states that those without sweating should not take Guizhi Tang. Why is Guizhi reused in Mahuang Tang? I answer: According to Zhang Zhongjing's method, those without sweating must not take Guizhi Tang because it contains Shaoyao, Shengjiang (Fresh Ginger), and Dazao (Jujube). Cold Damage with no sweating indicates exterior solidity, meaning body fluids are secured internally and do not leak out. Therefore, Shaoyao is contraindicated because its astringent nature would retain body fluids and prevent the dispersion of cold pathogens. Since body fluids cannot escape, using Shengjiang and Dazao to generate more fluids from the Spleen and Stomach is superfluous. While Shengjiang is harmless, Dazao is too warming and tonifying, making it unsuitable for exterior solid syndromes. Guizhi is used in Mahuang Tang because cold injuring Ying involves Guizhi, which also acts on Ying, unblocking blood vessels and dispersing cold pathogens. It assists Mahuang in draining the excess of pathogens in Ying and Wei. When wind-cold is at the exterior, both Ying and Wei are solid, presenting with burning skin, headache, stiff neck, lower back and spine pain, joint stiffness, aversion to cold, and no sweating; these cases require this formula. Xingren is used to relieve wheezing. Gancao is used to harmonize Ying and Wei. Moreover, since "where pathogenic factors gather, Qi must be deficient," honey-fried Gancao has a meaning of tonifying deficiency. Generally, ancients used dispersing and promoting agents but always included some tonifying herbs. For example, Tiaowei Chengqi Tang also uses honey-fried Gancao, following this principle. Zhang Zhongjing's formula is intended for Zhengshanghan (True Cold Damage) in winter, targeting the release of pathogens from the Taiyang Meridian. If later scholars differentiate syndromes precisely, there is no difficulty in following and using it.
Hu comments on the post-formula instruction "no need for porridge": Cheng's note offers no explanation. *Tiaobian* states: Mahuang has the specific ability to induce sweating, hence there is no need for the assistance of porridge. I believe that cold damages the exterior while heat stagnates internally, causing rebellious Qi and wheezing due to pathogenic heat. The patient originally cannot eat. Forcing thin porridge upon them would, as stated in *Zuanlun*, exacerbate the condition. This is likely Zhang Zhongjing's intention in stating "no need for porridge."
In combined Taiyang and Yangming diseases, characterized by wheezing and chest fullness, purgation is contraindicated; Mahuang Tang should be used. (This combined disease presents with all symptoms of Taiyang Cold Damage, with only chest fullness belonging to Yangming. It is not the same as the combined disease mentioned earlier with Gegen Tang, which presented with full Yangming symptoms. The chest is part of the Yangming domain because Yangming branch meridians pass below the diaphragm, run through the breast area, and traverse the chest. Cheng's note says: Fullness below the heart and abdominal fullness indicate excess requiring purgation. However, chest fullness is not interior excess, hence purgation is contraindicated. Zhang Zhongjing's method follows the Taiyang pattern, treating the syndrome of no sweating and wheezing, hence "suitable for Mahuang Tang." A questioner asks: If Yangming disease already shows chest fullness, why not treat Yangming simultaneously? I reply: The chest fullness is caused by wheezing. Although the anterior chest is part of Yangming, it is essentially the residence of the Lung. Wheezing and chest fullness imply that Lung Qi is solid and distended. Therefore, Li Dongbi in his *Bencao* states: Although Mahuang Tang is a heavy sweating agent for Taiyang, it is actually an agent to disperse fire stagnation in the Lung meridian. He viewed wheezing and chest fullness as evidence of excess heat-fire in the Lung. The formula contains Mahuang and Xingren, which specifically drain the Lung and promote Qi flow. Once Lung Qi is drained and flows freely, wheezing and rebellion subside naturally, leaving no issue regarding Yangming chest fullness. This discussion indeed elucidates points Cheng did not address.)
In Taiyang disease persisting for ten days or more, if the pulse is floating and 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 merely floating, administer Mahuang Tang. (Cheng's note says: After ten days, the time for resolution approaches. Although the pulse is floating and fine, it has become calm. Desire to lie down indicates pathogenic retreat and spiritual tranquility, confirming the exterior has resolved. If not fully resolved, and the patient has chest fullness and hypochondriac pain, this chest fullness differs from the Yangming combined disease mentioned earlier. The Shaoyang branch meridians descend into the chest and follow the flanks; the main trunk passes through the chest and lateral costal region. Thus, with a floating and fine pulse, the pathogen is at the half-exterior, half-interior level. The desire to lie down is due to Gallbladder heat causing mental confusion; Xiao Chaihu Tang should be administered to harmonize. If the pulse is merely floating and not fine, although ten days have passed, the pathogen remains at the exterior, meaning Taiyang symptoms like headache, fever, and no sweating persist. Zhang Zhongjing's method dictates administering Mahuang Tang to induce sweating. This shows that inducing sweating in Shanghan should not be restricted to the first one or two days. See Xiao Chaihu Tang in Volume 7, Shaoyang Chapter.)
(Attached Example) In Taiyang disease, with a floating and tight pulse, no sweating, fever, and body pain, if after eight or nine days the condition remains unresolved and the exterior syndrome persists, sweating should be induced. After taking medicine, symptoms may slightly alleviate. The patient may experience irritability and closed eyes. In severe cases, epistaxis (nosebleed) will occur, and the disease resolves upon bleeding. This happens because Yang Qi is heavy. Mahuang Tang should be used. (The following four clauses were moved here from after Da Qinglong Tang. Cheng's note says: Floating and tight pulse, no sweating, fever, and body pain indicate Taiyang Cold Damage. Even after eight or nine days, if no sweating-inducing medicine was taken, the disease remains unresolved. The Taiyang exterior syndrome persists, so sweating should still be induced. If medicine was taken and symptoms only slightly alleviated, it is likely because the physician dared not use Mahuang Tang, resulting in insufficient potency to overcome the cold pathogen of the Taiyang meridian. The Classics state: Shanghan is a type of heat disease. After eight or nine days, if cold pathogens are not fully eliminated, the patient will develop stagnant heat, leading to irritability and eye closure. Irritability is due to Lung heat; skin and hair follicles are hot, sweat cannot excrete, and Lung Qi becomes frustrated. Eye closure is due to Liver heat; cold transforms into heat, Ying blood is constrained by heat, and the Liver loses its function of storing blood. Severe cases involve intense stagnant heat. Intense heat steams Qi, forcing blood to move recklessly upward through the nose, called epistaxis. Upon epistaxis, pathogenic heat dissipates along the meridian, commonly known as "red sweat." The cause of epistaxis is the heaviness of heat-pathogen Qi in the Yang meridians. This "Yang Qi" should be understood to include Yangming Qi, as Yangming has abundant Qi and Blood. If Taiyang disease remains unresolved, heat merges into the Yangming meridian, inevitably leading to epistaxis for resolution. If the patient does not experience epistaxis, the Taiyang exterior syndrome persists, hence "Mahuang Tang should be used." This does not mean Mahuang Tang is suitable after epistaxis has already occurred. Zhang Jianshan notes: The phrase "Mahuang Tang should be used" should logically follow "sweating should be induced.")
In Taiyang disease, with a floating and tight pulse, fever, no sweating, and spontaneous epistaxis leads to recovery. (This is Taiyang Cold Damage where epistaxis occurs spontaneously without medication. The condition is slightly milder than the previous clause. Upon epistaxis, stagnant heat dissipates along the meridian, and cold pathogen Qi leaves without lingering, hence "the disease recovers." Sweat is the fluid of blood; epistaxis is akin to sweating. Therefore, this clause does not prescribe Mahuang Tang.)
If the pulse is floating, the disease is at the exterior. Sweating may be induced; Mahuang Tang is suitable. (Observing the previous two clauses, it might seem that Mahuang Tang requires a tight pulse. However, knowing that Taiyang presents with no sweating, if a floating pulse is seen, the disease is still at the exterior. Taking advantage of this exterior stage, it is the appropriate time to induce sweating, hence "suitable for Mahuang Tang.")
If the pulse is floating and rapid, sweating may be induced; Mahuang Tang is suitable. (Again, Taiyang presents with no sweating. Even if the pulse is floating and rapid, sweating may be induced. Rapidity indicates severe stagnant heat, a time when Taiyang disease is about to transmit inward. Because the floating pulse remains, the pathogen has not left the exterior. Taking advantage of the pre-transmission stage, it is still possible to induce sweating, hence "suitable for Mahuang Tang.")
In Shanghan, if the pulse is floating and tight, and failure to induce sweating leads to epistaxis, Mahuang Tang should be used. (Cheng's note says: Floating and tight pulse in Shanghan indicates pathogen at the exterior. Mahuang Tang should be given to induce sweating. If not, the pathogen has no exit, stagnant heat accumulates severely in the meridian, leading to epistaxis. Zhang Zhongjing's method still uses Mahuang Tang. I comment: The epistaxis in this clause must be scanty and not flowing heavily. Thus, even with epistaxis, the Taiyang Cold Damage exterior syndrome remains unresolved, necessitating Mahuang Tang. *Huren Shu* states: If the pulse is floating after epistaxis, Mahuang Tang is suitable. If the pulse is faint after epistaxis, Mahuang Tang is contraindicated; Huangqin Shaoyao Tang should be used. Floating pulse after epistaxis means the exterior is unresolved. Faint pulse after epistaxis means the exterior has resolved. This reveals Zhang Zhongjing's general principle for using Mahuang Tang after epistaxis.)
In Wind Strike affecting Taiyang, with a floating and tight pulse, fever, aversion to cold, body pain, no sweating, and restlessness, Da Qinglong Tang (Major Blue Dragon Decoction) should be used. If the pulse is faint and weak, with sweating and aversion to wind, it must not be taken. Taking it will result in cold extremities, twitching of tendons, and fasciculation of muscles. This constitutes a reversal error. Da Qinglong Tang should be used. (This sentence appears in commercial editions but is deleted here. Cheng's note says: This is Wind Strike presenting with Cold pulse signs. Fever and aversion to cold are Taiyang exterior diseases. Floating and tight pulse with body pain indicates Cold Damage. No sweating characterizes Wind Strike in this context. "No sweating" means sweat wants to emerge but cannot, not that the person inherently lacks sweat. Simultaneous injury by wind and cold makes stagnant heat more severe, causing inability to sweat and adding irritability and restlessness. Zhang Zhongjing's method uses Da Qinglong Tang. Da Qinglong is a combination of Guizhi Tang and Mahuang Tang. Shaoyao is removed because of sweating absence, fearing its sour taste would astringe body fluids. Shi Gao (Gypsum) is added due to restlessness, utilizing its sweet and cold nature to clear stagnant heat. Caution is advised against casual use. If the patient has a faint/weak pulse (not floating/tight) and sweats with aversion to wind (not no sweating), it must absolutely not be taken. Taking it will cause cold extremities, tendon twitching, and muscle fasciculation. Since the patient originally sweats, inducing heavy sweating again leads to loss of Yang Qi and depletion of body fluids, causing these symptoms. Such cases represent major reversal errors. I comment: Huang Zhongli changed the final phrase "Da Qinglong Tang should be used" to "Zhenwu Tang should be used," a view followed by Fang and Yu, which is a major error. Zhang Zhongjing provided no rescue method for this reversal in this clause; the last six characters are redundant. Following the *Zhunseng* edition, they are deleted to avoid confusing later students.)