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，为中风。太阳中风，阳浮而阴弱，
阳浮者热自发，阴弱者汗自出，啬啬恶寒，淅淅恶风，翕翕发热，鼻鸣干呕者，桂枝汤主之。太阳病，头痛发
热，汗出恶风者，桂枝汤主之。太阳病，发热汗出者，此为荣弱卫强，故使汗出，欲救邪风者，宜桂枝汤。病
人脏无他病，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。
桂枝汤方
桂枝 芍药 生姜（各三两） 甘草（二两） 大枣（十二枚）
上 咀，每服五钱，水煎，去渣温服，须臾 热稀粥一盏，以助药力，令一时许，遍身 微汗者佳，不
可令如水淋漓。若一服便得汗，勿再服。或无汗，或小便数，手足冷者，不可服。《活人》云∶桂枝、麻黄，
若夏月用，加黄芩、知母、石膏，总不如陶尚文用羌活冲和汤为最稳。
上桂枝汤。许学士云∶有人病发热恶寒，自汗，脉微弱而浮，三服汤而愈。此方在仲景一百十三方内独
冠其首，今人全不用，何也？仲景云∶太阳中风，阳浮而阴弱，阳浮者云云至翕翕发热，宜桂枝汤。此脉
与症，仲景说得甚明，后人看不透，所以不敢用也。
假令寸口脉微，名曰阳不足，阴气上入阳中，则洒淅恶寒也。尺脉弱，名曰阴不足，阳气下陷入阴中，则
发热也。此谓元气受病而然也。又曰∶阳微则恶寒，阴微则发热。医既汗之，使阳气微，又大下之。令阴气
弱，此谓医所使也。大抵阴不足阳往从之，故内陷而发热，阳不足阴往乘之，故阴上入阳中则恶寒，举此二端，
明白易晓，何惮而不用桂枝汤哉。
太阳病，头痛发热，身疼腰痛，骨节疼痛，恶风无汗而喘者，麻黄汤主之。
麻黄（去节，先煮去汗，焙，三两） 桂枝（二两） 杏仁（七十个，去皮尖） 甘草（一两）
上 咀，每服五钱，水煎温服，覆取微汗，不须 粥。有汗者，勿服。
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。伤寒脉浮缓，身不疼，但重，乍有轻时，无少阴症者，大青龙汤发之。
大青龙汤方
麻黄（去节，炮，去汗，三两） 桂枝（去皮） 石膏（碎） 甘草（炙。各一两） 生姜（切，一两半）
大枣（六枚） 杏仁（二十个，去皮尖）
上 咀，每服五钱，水煎温服，取汗为度。若汗周身润，止后服。未汗可停，待相次服尽，不欲汗多，恐
亡阳故也。若汗不止，用温粉扑之。
温粉方
白术 本 川芎 白芷（各等分）
上研为细末，每末一两，入米粉三两，和匀，扑周身止汗。若汗过多，恐亡阳，遂厥逆恶风，烦躁
不得眠，故宜以此粉止之。
上中风脉当浮缓，今反浮紧缓者，大青龙症也。
〔《活》〕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。寒多热少，不烦躁，
手足微厥，为伤寒候；脉浮缓为中风脉，是伤寒见风脉也。盖脉似桂枝反无汗，病似麻黄反烦躁是也。
许学士云∶仲景治伤寒，一则桂枝，二则麻黄，三则青龙。桂枝治中风，麻黄治伤寒，青龙治中风见寒脉，
伤寒见风脉，三者如鼎立，人皆能言之，而不晓前人处方用药之意，故医遂多不用，无足怪也。且脉缓而浮者，
中风也，故啬啬恶风，淅淅恶寒，翕翕发热，仲景以桂枝对之。脉浮紧而涩者，伤寒也．故头痛发热，身疼腰
痛，骨节疼痛，恶寒无汗而喘，仲景以麻黄对之。至于中风脉浮紧，伤寒脉浮缓，仲景皆以青龙对之。何也？
予尝深究三旨，若症候与脉相对，无不应手而愈。何以言之？风伤卫，卫，气也。寒伤荣，荣，血也。荣行脉
中，卫行脉外。风伤卫，则风邪干阳，阳气不固，发越而为汗，是以自汗是表虚，故仲景用桂枝以发其邪，芍
药以和其血。盖中风则病在脉之外，其病稍轻，虽同曰发汗，特解肌之药耳。故仲景于桂枝症云∶令遍身
微似有汗，不可如水淋漓，病必不除，是知中风不可大发汗，汗过则反动荣血，邪气乘虚袭之，故病不除也。
寒伤荣，则寒邪入阴血，而荣行脉中者也。寒邪居脉中，非特荣受病，邪自内作，则并与备气犯之，久之浸淫
及骨，是以汗不出而热，齿干而烦冤，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，荣卫
之病尔。大抵二药皆发汗，以桂枝则发其卫之邪，麻黄并荣与卫治之，亦自有浅深也。何以验之？仲景桂枝第
十九症云∶病当自汗出者，此为荣气和，荣气和者，外不谐，以卫气不共荣气谐和故尔，以荣行脉中，卫行脉
外，复发其汗，荣卫和则愈，宜桂枝汤。又四十七症云∶发热汗出，此为荣弱卫强，故使汗出者。
欲救邪风，宜桂枝汤。是知中风汗出者，荣和而卫不和。又第一卷云∶寸口脉浮而紧，浮则为风，紧则为寒，
风则伤卫，寒则伤荣，荣卫俱病，骨节烦疼，当发其汗。是知伤寒浮紧者，荣卫俱病也，麻黄汤中并用桂枝，
此仲景之言也。至于青龙，虽治伤风见寒脉，伤寒见风脉之病，然仲景又云∶汗出恶风者，不可服之，服之厥
逆，便有筋惕肉 之症。故青龙一症，尤难用药，须是形症谛当，然后可行。故王实夫症，止用桂枝麻黄各半
汤治之，盖慎之也。
太阳病，项背强KT KT ，反汗出恶风者，桂枝加葛根汤主之。
桂枝加葛根汤方
桂枝 葛根（各二两） 芍药 甘草（各一两） 生姜（一两半） 大枣（六枚）
上 咀，每服五钱，水煎温服，覆取汗。
太阳病，项背强KT KT ，无汗恶风，葛根汤主之。
葛根汤方
葛根（四两） 麻黄 生姜（各三两） 桂枝 芍药 甘草（各二两） 大枣（十二枚）
上 咀，每服五钱，去渣温服，覆取微汗为度。
太阳病，发热恶寒，热多寒少，脉微弱者，此无阳也，不可发汗，宜桂枝二越婢一汤。
桂枝二越婢一汤
桂枝 芍药 麻黄（去节，泡） 甘草（各三钱） 生姜（半两） 石膏（一两半，碎） 大枣（六枚）
上 咀，每服五钱，水煎温服。
太阳病得之八九日，如疟状，发热恶寒，热多寒少。又其人不呕，清便欲自可，一日二度，脉微缓者，为
欲愈也，脉微而恶寒者，此阴阳俱虚，不可更发汗、更下、更吐。面色反有热色者，未欲解也，以其不能得小
汗出，身必痒，宜桂枝麻黄各半汤。
桂枝麻黄各半汤
桂枝（一两） 芍药 生姜 甘草（炙） 麻黄（各半两。去节，煮） 大枣（六枚） 杏仁（十二粒，去皮尖）
上 咀，每服五钱，水煎温服。
凡仲景称太阳病者，皆表症，发热恶寒，头项强痛也。若脉浮大，则与症相应，宜发汗。今见表症而脉
反微，不与症应，故不可发汗，但用一二各半汤等和之可也。
若太阳中 ，发热恶寒，脉微弱，手足逆冷而渴者，白虎加人参汤。（方论见中暑。）
太阳六七日表症仍在，脉微而沉，反不结胸，其人发狂者，以热在下焦，少腹当硬满，小便自利者，下血
乃愈。所以然者，以太阳随经，瘀血在里故也，抵当汤主之。
抵尝汤方
水蛭（炒，去子，杵） 虻虫（各十枚，炒，去足翅） 大黄（二两） 桃仁（七枚，去皮尖）
上作一服，水一盏煎，温服。
太阳病，身黄，脉沉结，小腹硬，小便不利者，为无血也。小便自利，其人如狂者，血症谛也，亦抵当汤
主之。
凡仲景称太阳症脉沉得，皆谓发热恶寒，头项强痛，而脉反沉也。其症兼发在，小腹硬者，为蓄血，此
条抵汤当是也。
兼关节痛，小便不利，身黄者，为湿痹。（论见湿痹。）
兼卒口噤，背反张者为 。若无汗恶寒，名刚 ，宜葛根汤。若有汗不恶寒，名柔 ，宜栝蒌桂枝汤。（方
论见 。）
病发热头痛，脉反沉，若不瘥，身体疼痛，当救其里，宜四逆汤。（方见下利。）
少阴病，但欲寐，始得之发热脉沉者，麻黄附子细辛汤。（论见欲寐。）
麻黄附子细辛汤方
麻黄（去节，泡） 细辛（各二两） 附子（一枚，炮，去皮）
上 咀，每服五钱，水煎温服。
凡仲景称太阳病不恶寒者，皆谓发热头项强痛，脉浮而反不恶寒也。其证兼渴者为温病，兼汗出者为柔
。（方论见温病柔 。）
伤寒六七日，发热微寒，肢节烦疼，微呕，心下支结，外症未去者，柴胡加桂枝汤主之。
柴胡加桂枝汤方
柴胡（一两） 桂枝 黄芩 人参 芍药 生姜（各半两） 半夏（四钱） 大枣（三枚） 甘草（炙，三钱）
上 咀，每服五钱，水煎温服。
凡仲景称表不解者，皆谓太阳病发热恶寒，头项强痛，脉浮也。盖病虽属太阳表症，而有里症兼之者，
则不言太阳病，但称表不解也。其兼心下支结者，此条柴胡桂枝汤是也。（论见胁痛。）
兼心下有水气，干呕而咳者，小青龙也。（方论见效。）兼胁痛手足温而渴者，小柴胡也。兼心下痞者，
先用桂枝解表，后以泻心攻痞也。（方论见痞。）兼下利腹满胀者，先以四逆温里，后以桂枝攻表也。（方论见下利。）
太阳病欲解时，从巳至未解。
太阳病未解，脉阴阳俱停，必先振栗汗出而解。但阳脉微者，先汗出而解；阴脉微者，下之而解。若欲下
之，调胃承气汤主之。（“下之而解”疑衍文。）
太阳病，脉浮紧，发热身无汗，自衄者愈。
太阳外症未解，不可下之，下之为逆。欲解外者，宜桂枝汤主之。
〔海〕大小调胃三承气汤，必须脉浮头痛，恶风恶寒，表症尽罢，而反发热恶热，谵语，不大便，方可用
之。若脉浮紧，下之必结胸。苦脉浮缓，下之必痞气。
许学士云∶尝记一亲戚病伤寒，身热头痛无汗，大便不通已四五日。予讯问之，医者治大黄、朴硝等欲下之。
予曰∶子姑少待，予为视之。脉浮缓，居密室中，自称甚恶风。予曰∶表症如此，唯大便不通数日，腹且不胀，
别无所苦，何遽便下之。大抵仲景法，须表症罢，方可下。不尔，则邪乘虚而入，不为结胸，必为热利也。予
作桂枝麻黄各半汤，继以小柴胡， 汗出，大便亦通而解。仲景云∶凡伤寒之病，多从风寒得之，始则表
中风寒，入里则不消矣。拟欲攻之，当先表解，乃可下之。若表已解，而内不消，大满大坚实，有燥粪者，自
可除下之，虽四五日不能为祸也。若不宜下而便攻之，内虚热入，为挟热自利烦躁之变，不可胜数，轻者困笃，
重者必死矣。原本正文重叠，予删正此段，其理甚明。大抵风寒入里不消，必有燥粪，或大便坚秘。须是脉不
浮，不恶风，表症罢，乃可下之。大便虽四五日不通，亦无害，若罔顾表而下，遂为挟热利也。
如果太阳病患者出现发热、汗出、怕风、脉象缓，这属于中风证。太阳中风证表现为阳脉浮而阴脉弱。阳脉浮表示热气自然蒸腾，阴脉弱表示汗水自然流出；患者感到畏缩怕冷（啬啬恶寒），如冷水洒身般怕风（淅淅恶风），像有羽毛覆盖般的发热（翕翕发热），伴有鼻鸣和干呕，应当用桂枝汤主治。
如果太阳病患者出现头痛、发热、汗出、怕风，也应当用桂枝汤主治。
如果太阳病患者出现发热、汗出，这是因为营气虚弱、卫气强盛，导致汗出。想要救治这种邪风侵袭，适宜使用桂枝汤。
如果病人脏腑没有其它疾病，只是时常发热、自汗出且久不痊愈，这是卫气不和所致。在发热汗出之前进行发汗治疗即可痊愈，适宜使用桂枝汤。
桂枝汤方剂组成：
桂枝、芍药、生姜（各三两）、甘草（二两）、大枣（十二枚）。
以上药材切碎，每次服用五钱，加水煎煮，去渣后温服。服药后不久喝热稀粥一盏，以助药力，约一小时左右，全身微微出汗为佳，不可让汗水像水流一样淋漓。如果服一次药就出汗了，不要再服。如果没有汗，或者小便频数，或者手脚冰冷的人，不可服用。《活人书》说：桂枝、麻黄，如果在夏季使用，应加黄芩、知母、石膏，但总不如陶尚文使用的羌活冲和汤最为稳妥。
以上是桂枝汤。许学士说：有人患发热恶寒、自汗、脉微弱而浮，服用三剂汤药后痊愈。此方在张仲景的一百一十三首方剂中独居首位，现在的人完全不用它，为什么呢？张仲景说：太阳中风，阳脉浮而阴脉弱，阳脉浮则……直到翕翕发热，适宜用桂枝汤。这里的脉象与症状，张仲景说得非常明白，后人看不透彻，所以不敢使用。
假如寸口脉微，称为阳气不足，阴气上入阳分，就会感到寒冷战栗（洒淅恶寒）。尺脉弱，称为阴气不足，阳气下陷入阴分，就会发热。这叫做元气受病所致。又说：阳微则恶寒，阴微则发热。医生如果误用发汗法，使阳气更微，又误用攻下法，使阴气更弱，这叫做医生造成的错误。大抵阴不足时阳气往从之，所以内陷而发热；阳不足时阴气往乘之，所以阴气上入阳分则恶寒。列举这两点，明白易懂，有什么理由害怕不使用桂枝汤呢？
如果太阳病患者出现头痛、发热、身体疼痛、腰痛、骨节疼痛、怕风、无汗且气喘，应当用麻黄汤主治。
麻黄汤方剂组成：
麻黄（去节，先煮去沫，焙干，三两）、桂枝（二两）、杏仁（七十个，去皮尖）、甘草（一两）。
以上药材切碎，每次服用五钱，加水煎煮温服，服药后覆盖衣被取微汗，不需要喝粥。有汗的人，不要服用。
如果太阳中风证，脉象浮紧，发热恶寒，身体疼痛，无汗且烦躁，应当用大青龙汤主治。如果脉象微弱，有汗且怕风的人，不可服用，服用了就会出现四肢厥逆，筋肉跳动，这是误治。伤寒脉象浮缓，身体不疼，只是沉重，偶尔有减轻的时候，如果没有少阴病症状，可以用大青龙汤发散。
大青龙汤方剂组成：
麻黄（去节，炮制，去沫，三两）、桂枝（去皮）、石膏（捣碎）、甘草（炙，各一两）、生姜（切，一两半）、大枣（六枚）、杏仁（二十个，去皮尖）。
以上药材切碎，每次服用五钱，加水煎煮温服，以出汗为度。如果周身汗出湿润，停止后续服药。如果还没出汗可以暂停，等待依次服完，不希望出汗过多，恐怕亡阳的缘故。如果汗止不住，用温粉扑在身上。
温粉方剂组成：
白术、藁本、川芎、白芷（各等分）。
以上研为细末，每取粉末一两，加入米粉三两，混合均匀，扑在全身以止汗。如果汗出过多，恐怕亡阳，进而出现四肢厥逆、怕风、烦躁不能入睡，所以适宜用此粉来止汗。
〔《活人书》〕发热恶风、烦躁、手足温暖，是中风候；脉象浮紧，是伤寒脉，这是中风见到寒脉。寒多热少、不烦躁、手足微冷，是伤寒候；脉象浮缓是中风脉，这是伤寒见到风脉。大概脉象类似桂枝汤证却无汗，病症类似麻黄汤证却烦躁，就是这种情况。
许学士说：张仲景治疗伤寒，一是桂枝汤，二是麻黄汤，三是青龙汤。桂枝汤治中风，麻黄汤治伤寒，青龙汤治中风见寒脉、伤寒见风脉，三者如鼎足而立，人们都能说出来，但不理解前人处方用药的本意，所以医生大多不用，这也不足为怪。而且脉缓而浮的，是中风，所以畏缩怕风、如冷水洒身般怕冷、像羽毛覆盖般发热，张仲景用桂枝汤对应。脉浮紧而涩的，是伤寒，所以头痛发热、身体疼痛、腰痛、骨节疼痛、恶寒无汗而喘，张仲景用麻黄汤对应。至于中风脉浮紧、伤寒脉浮缓，张仲景都用青龙汤对应。为什么呢？我曾深入研究这三者的旨意，如果症状与脉象相对，没有不手到病除的。为什么这样说？风伤卫气，卫气即气。寒伤营血，营血即血。营行于脉中，卫行于脉外。风伤卫，则风邪干扰阳气，阳气不固，发散而为汗，所以自汗是表虚，因此张仲景用桂枝发散邪气，用芍药调和血液。大概中风则病在脉之外，病情稍轻，虽然都叫发汗，特指解肌的药物罢了。所以张仲景对桂枝汤症说：令全身微微似有汗，不可像水流一样淋漓，否则病必不除，由此可知中风不可大发汗，汗出过多则会扰动营血，邪气乘虚侵袭，所以病不除。寒伤营，则寒邪进入阴血，而营行于脉中。寒邪居于脉中，不仅营受病，邪气自内作乱，便会一并侵犯卫气，久而久之浸淫及骨，所以不出汗而热，牙齿干燥且烦闷，张仲景用麻黄发其汗，又用桂枝、甘草帮助发散，想要涤除内外之邪，治疗营卫的病。大抵这两种药都是发汗，用桂枝则是发散卫分之邪，麻黄则兼治营与卫，自有深浅之分。怎么验证呢？张仲景桂枝汤第十九症说：病应当自汗出的，这是营气和，营气和者，外不和谐，因为卫气不与营气和谐所致，因为营行脉中，卫行脉外，再发其汗，营卫和谐则愈，适宜桂枝汤。又第四十七症说：发热汗出，这是营弱卫强，所以使汗出。想要救治邪风，适宜桂枝汤。由此可知中风汗出者，营和而卫不和。又第一卷说：寸口脉浮而紧，浮则为风，紧则为寒，风则伤卫，寒则伤荣，营卫俱病，骨节烦疼，应当发其汗。由此可知伤寒浮紧者，营卫俱病也，麻黄汤中并用桂枝，这是张仲景的话。至于青龙汤，虽然治疗伤风见寒脉、伤寒见风脉的病，然而张仲景又说：汗出恶风的人，不可服用，服用了会出现四肢厥逆，便有筋肉跳动的症状。所以青龙汤这一证，尤其难用药，必须形症确切，然后方可施行。所以王实夫的症，只用桂枝麻黄各半汤治疗，大概是谨慎对待。
如果太阳病患者，项背部僵硬拘急不适（KT KT 指项背强直不舒），反而汗出怕风，应当用桂枝加葛根汤主治。
桂枝加葛根汤方剂组成：
桂枝、葛根（各二两）、芍药、甘草（各一两）、生姜（一两半）、大枣（六枚）。
以上药材切碎，每次服用五钱，加水煎煮温服，覆盖衣被取汗。
如果太阳病患者，项背部僵硬拘急不适，无汗怕风，应当用葛根汤主治。
葛根汤方剂组成：
葛根（四两）、麻黄、生姜（各三两）、桂枝、芍药、甘草（各二两）、大枣（十二枚）。
以上药材切碎，每次服用五钱，去渣温服，覆盖衣被取微汗为度。
如果太阳病患者，发热恶寒，热多寒少，脉象微弱，这是无阳（指阳气虚衰或津液不足），不可发汗，适宜桂枝二越婢一汤。
桂枝二越婢一汤方剂组成：
桂枝、芍药、麻黄（去节，泡）、甘草（各三钱）、生姜（半两）、石膏（一两半，捣碎）、大枣（六枚）。
以上药材切碎，每次服用五钱，加水煎煮温服。
如果太阳病得病八九日，像疟疾一样，发热恶寒，热多寒少。另外其人没有呕吐，大小便基本正常，一天发作两次，脉象微缓的，是快要痊愈的表现；脉象微而恶寒的，这是阴阳俱虚，不可再发汗、再攻下、再催吐。面色反红热的，是病未解除，因为他不能得到小汗出，身体必定发痒，适宜桂枝麻黄各半汤。
桂枝麻黄各半汤方剂组成：
桂枝（一两）、芍药、生姜、甘草（炙）、麻黄（各半两。去节，煮）、大枣（六枚）、杏仁（十二粒，去皮尖）。
以上药材切碎，每次服用五钱，加水煎煮温服。
凡是张仲景称太阳病的，都是表症，表现为发热恶寒、头项强痛。如果脉象浮大，则与症状相应，适宜发汗。现在见到表症而脉象反而微，不与症状相应，所以不可发汗，只需用一二各半汤等调和即可。
如果太阳中暑，发热恶寒，脉微弱，手足逆冷且口渴，用白虎加人参汤。（方论见中暑。）
太阳病六七日，表症仍在，脉象微而沉，反而不结胸，其人发狂的，因为热在下焦，小腹应当硬满，小便自利的，下血乃愈。之所以这样，是因为太阳随经，瘀血在里的缘故，抵当汤主治。
抵当汤方剂组成：
水蛭（炒，去子，杵）、虻虫（各十枚，炒，去足翅）、大黄（二两）、桃仁（七枚，去皮尖）。
以上作为一服，用水一盏煎煮，温服。
太阳病，身黄，脉沉结，小腹硬，小便不利的，是无血（指非蓄血证）。小便自利，其人如狂的，是蓄血证的确切表现，也用抵当汤主治。
凡是张仲景称太阳症脉沉得的，都是指发热恶寒、头项强痛，而脉象反而沉。其症兼有小腹硬的，为蓄血，此条抵当汤证应当是这样。
兼有突然牙关紧闭，角弓反张的为痉病。若无汗恶寒，名为刚痉，适宜葛根汤。若有汗不恶寒，名为柔痉，适宜栝蒌桂枝汤。（方论见痉病。）
病发热头痛，脉象反而沉，如果不愈，身体疼痛，应当救其里，适宜四逆汤。（方见下利。）
少阴病，只想睡觉，刚开始发热脉沉的，麻黄附子细辛汤。（论见欲寐。）
麻黄附子细辛汤方剂组成：
麻黄（去节，泡）、细辛（各二两）、附子（一枚，炮，去皮）。
以上药材切碎，每次服用五钱，加水煎煮温服。
凡是张仲景称太阳病不恶寒的，都是指发热头项强痛，脉浮而反不恶寒。其证兼口渴的是温病，兼汗出的是柔痉。（方论见温病柔痉。）
伤寒六七日，发热微寒，肢节烦疼，微呕，心下支撑痞结，外症未去的，柴胡加桂枝汤主治。
柴胡加桂枝汤方剂组成：
柴胡（一两）、桂枝、黄芩、人参、芍药、生姜（各半两）、半夏（四钱）、大枣（三枚）、甘草（炙，三钱）。
以上药材切碎，每次服用五钱，加水煎煮温服。
凡是张仲景称表不解的，都是指太阳病发热恶寒、头项强痛、脉浮。大概病虽属太阳表症，而有里症兼之的，则不言太阳病，只称表不解。其兼有心下支撑痞结的，此条柴胡桂枝汤即是。（论见胁痛。）
兼有心下水气，干呕而咳的，用小青龙汤。（方论见效。）兼有胁痛手足温而渴的，用小柴胡汤。兼有心下痞的，先用桂枝解表，后用泻心汤攻痞。（方论见痞。）兼有下利腹满胀的，先用四逆汤温里，后用桂枝攻表。（方论见下利。）
太阳病欲解的时间，从巳时至未时。
太阳病未解，脉阴阳俱停，必先振栗汗出而解。如果只有阳脉微，先汗出而解；阴脉微，下之而解。如果想要下之，调胃承气汤主治。（“下之而解”疑衍文。）
太阳外症未解，不可攻下，攻下为逆治。想要解除外症，适宜桂枝汤主治。
〔海〕大小调胃三承气汤，必须脉浮头痛，恶风恶寒，表症尽罢，而反发热恶热，谵语，不大便，方可用之。如果脉浮紧，下之必结胸。苦脉浮缓，下之必痞气。
许学士说：曾记得一个亲戚患伤寒，身热头痛无汗，大便不通已四五日。我询问他，医生准备用大黄、朴硝等药攻下。我说：你先稍等，我去看看。脉浮缓，居住在密室中，自称非常怕风。我说：表症如此，唯大便不通数日，腹部且不胀，别无所苦，为何急于攻下？大抵张仲景的法度，必须表症罢除，方可攻下。不然，则邪气乘虚而入，不为结胸，必为热利。我作了桂枝麻黄各半汤，继以小柴胡汤，汗出，大便亦通而解。张仲景说：凡是伤寒的病，多从风寒得之，开始则表中风寒，入里则不消矣。拟欲攻之，当先表解，乃可下之。如果表已解，而内不消，大满大坚实，有燥粪的，自然可以除下之，虽四五日不能为祸。如果不宜下而便攻之，内虚热入，为挟热自利烦躁之变，不可胜数，轻者困笃，重者必死。原本正文重叠，予删正此段，其理甚明。大抵风寒入里不消，必有燥粪，或大便坚秘。须是脉不浮，不恶风，表症罢，乃可下之。大便虽四五日不通，亦无害，若罔顾表而下，遂为挟热利也。
The primary pulse and symptoms of Taiyang disease (Disease of the Taiyang Channel) are: floating pulse (Fú Mài, a pulse felt lightly at the surface), headache, stiffness and pain in the neck and occiput, and aversion to cold.
If a patient with Taiyang disease presents with fever, sweating, aversion to wind, and a slow pulse, this is classified as Wind Strike (Zhong Feng). In Taiyang Wind Strike, the Yang pulse is floating while the Yin pulse is weak. The floating Yang pulse indicates spontaneous generation of heat; the weak Yin pulse indicates spontaneous sweating. The patient feels shiveringly cold (Se Se E Han), chilly like being sprinkled with water (Xi Xi E Feng), and has a mild fever resembling feathers covering the body (Xi Xi Fa Re), accompanied by nasal congestion (Bi Ming) and dry retching. Guizhi Tang (Cinnamon Twig Decoction) should be administered.
If a patient with Taiyang disease presents with headache, fever, sweating, and aversion to wind, Guizhi Tang (Cinnamon Twig Decoction) should also be administered.
If a patient with Taiyang disease presents with fever and sweating, this is due to deficiency of Ying (Nutrient) Qi and excess of Wei (Defensive) Qi, causing sweating. To rescue from pathogenic wind, Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
If a patient has no internal organ pathology but experiences intermittent fever and spontaneous sweating that does not resolve, this is due to disharmony of Wei (Defensive) Qi. Administering a diaphoretic treatment before the onset of fever/sweating will lead to recovery; Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
**Guizhi Tang Formula:**
Guizhi (Ramulus Cinnamomi), Shaoyao (Radix Paeoniae Alba), Shengjiang (Rhizoma Zingiberis Recens) [each 3 liang], Gancao (Radix Glycyrrhizae Preparata) [2 liang], Dazao (Fructus Jujubae) [12 pieces].
Crush the herbs. Take 5 qian per dose, decoct in water, remove dregs, and take warm. Shortly after ingestion, drink one bowl of hot thin porridge to assist the medicinal power. After about an hour, mild general sweating is desirable; profuse sweating like flowing water should be avoided. If sweating occurs after the first dose, do not administer further doses. Do not use if there is no sweat, frequent urination, or cold hands and feet. *Huoren Shu* states: When using Guizhi or Mahuang in summer, adding Huangqin, Zhimu, and Shigao is inferior to Tao Shangwen's Qianghuo Chonghe Tang, which is safest.
This concludes the discussion on Guizhi Tang. Xu Xueshi said: A person suffered from fever, aversion to cold, spontaneous sweating, and a weak, floating pulse; three doses cured him. This formula ranks first among Zhang Zhongjing's 113 formulas, yet modern practitioners rarely use it. Why? Zhang Zhongjing stated: In Taiyang Wind Strike, the Yang pulse floats and the Yin pulse is weak... leading to mild fever, suitable for Guizhi Tang. Zhang Zhongjing explained these pulses and symptoms clearly; later generations failed to understand them deeply, hence their hesitation to use it.
Suppose the Cun (Inch) position pulse is micro (Wei), named Yang insufficiency. Yin Qi enters the Yang region, causing shivering coldness (Sa Xi E Han). The Chi (Cubit) position pulse is weak, named Yin insufficiency. Yang Qi sinks into the Yin region, causing fever. This is called Yuan Qi (Original Qi) being diseased. It is also said: Micro Yang causes aversion to cold; Micro Yin causes fever. If a physician mistakenly uses diaphoresis, making Yang more deficient, and purgatives, making Yin more deficient, this is iatrogenic error. Generally, when Yin is insufficient, Yang follows it inward, causing fever; when Yang is insufficient, Yin overcomes it upward, entering the Yang region and causing aversion to cold. These two points are clear and simple; why fear using Guizhi Tang?
If a patient with Taiyang disease presents with headache, fever, body ache, lower back pain, joint pain, aversion to wind, anhidrosis, and wheezing, Mahuang Tang (Ephedra Decoction) should be administered.
**Mahuang Tang Formula:**
Mahuang (Herba Ephedrae) [de-stemmed, boiled first to remove foam, dried, 3 liang], Guizhi (Ramulus Cinnamomi) [2 liang], Xingren (Semen Armeniacae Amarum) [70 seeds, skin and tip removed], Gancao (Radix Glycyrrhizae Preparata) [1 liang].
Crush the herbs. Take 5 qian per dose, decoct in water, take warm, cover with blankets to induce mild sweating. Porridge is not required. Do not use if sweating is present.
If Taiyang Wind Strike presents with a floating-tight pulse, fever, aversion to cold, body pain, anhidrosis, and irritability, Da Qing Long Tang (Major Blue Green Dragon Decoction) should be administered. Do not use if the pulse is weak/micro, sweating is present, or there is aversion to wind; misuse leads to limb reversal coldness (Jue Ni) and muscle twitching (Jin Ti Rou Tiao), which is adverse treatment. For Cold Damage with a floating-slow pulse, body heaviness without pain, occasionally alleviating, and no Shaoyin symptoms, Da Qing Long Tang (Major Blue Green Dragon Decoction) can be used to disperse.
**Da Qing Long Tang Formula:**
Mahuang (Herba Ephedrae) [de-stemmed, processed, foam removed, 3 liang], Guizhi (Ramulus Cinnamomi) [bark removed], Shigao (Lapis Gypsi) [crushed], Gancao (Radix Glycyrrhizae Preparata) [roasted, each 1 liang], Shengjiang (Rhizoma Zingiberis Recens) [sliced, 1.5 liang], Dazao (Fructus Jujubae) [6 pieces], Xingren (Semen Armeniacae Amarum) [20 seeds, skin and tip removed].
Crush the herbs. Take 5 qian per dose, decoct in water, take warm. Stop when sweating occurs. If the whole body is moist with sweat, stop subsequent doses. If no sweat, pause and wait to finish doses sequentially. Avoid excessive sweating to prevent loss of Yang. If sweating persists, apply Wen Fen (Warm Powder).
**Wen Fen Formula:**
Baizhu (Rhizoma Atractylodis Macrocephalae), Ben Cao (Radix Ligustici Chuanxiong - Note: Text says "Ben", likely Cang Zhu or Qin Jiao contextually, but literally Ben Cao/Ligustici), Chuanxiong (Rhizoma Chuanxiong), Baizhi (Radix Angelicae Dahuricae) [equal parts].
Grind to fine powder. Mix 1 liang of powder with 3 liang of rice flour. Apply to the whole body to stop sweating. If sweating is excessive, risking Yang loss, leading to limb reversal coldness, aversion to wind, irritability, and insomnia, this powder is suitable to stop it.
Above describes Wind Strike where the pulse should be floating-slow but is instead floating-tight or slow; this is Da Qing Long Tang syndrome.
*[Huoren Shu]* Fever, aversion to wind, irritability, and warm hands/feet indicate Wind Strike; a floating-tight pulse indicates Cold Damage pulse, meaning Wind Strike presenting with Cold symptoms. More Cold than Heat, no irritability, slightly cold hands/feet indicate Cold Damage; a floating-slow pulse indicates Wind Strike pulse, meaning Cold Damage presenting with Wind symptoms. Essentially, a pulse resembling Guizhi Tang syndrome but without sweat, or a condition resembling Mahuang Tang syndrome but with irritability.
Xu Xueshi said: Zhang Zhongjing treats Cold Damage with three main approaches: First Guizhi Tang, Second Mahuang Tang, Third Qing Long Tang. Guizhi Tang treats Wind Strike; Mahuang Tang treats Cold Damage; Qing Long Tang treats Wind Strike with Cold pulse or Cold Damage with Wind pulse. These three stand firm like a tripod. People know this but do not understand the rationale behind prescribing, hence doctors rarely use them. Floating-slow pulse indicates Wind Strike; thus shivering cold, chilly wind aversion, mild fever are treated with Guizhi Tang. Floating-tight-choppy pulse indicates Cold Damage; thus headache, fever, body/back/joint pain, aversion to cold, anhidrosis, wheezing are treated with Mahuang Tang. For Wind Strike with floating-tight pulse or Cold Damage with floating-slow pulse, Zhang Zhongjing uses Qing Long Tang. Why? I have studied these principles: if symptoms match the pulse, recovery is immediate. Wind injures Wei (Qi); Cold injures Ying (Blood). Ying circulates inside the vessels; Wei circulates outside. Wind injuring Wei means pathogenic wind interferes with Yang Qi. Yang Qi is not secure, disperses as sweat, so spontaneous sweating indicates exterior deficiency. Thus, Zhang Zhongjing uses Guizhi to disperse pathogens and Shaoyao to harmonize blood. Wind Strike affects the exterior of the vessels, a lighter condition. Although both involve sweating, Guizhi Tang specifically resolves the muscle layer. Hence, for Guizhi Tang syndrome, he advises mild sweating, not profuse sweating, otherwise the disease remains. Excessive sweating disturbs Ying Blood, allowing pathogens to invade, preventing cure. Cold injuring Ying means Cold Pathogen enters Yin-Blood, circulating inside vessels. Cold residing in vessels harms Ying, and internally generated pathogens attack Wei Qi, eventually affecting bones. Hence anhidrosis, heat, dry teeth, and oppression. Zhang Zhongjing uses Mahuang to induce sweating, assisted by Guizhi and Gancao to dispel, washing out internal and external pathogens affecting Ying and Wei. Both drugs induce sweating, but Guizhi disperses Wei pathogens, while Mahuang treats both Ying and Wei, showing depth differences. Verification: Guizhi Syndrome #19 states: Spontaneous sweating indicates harmonious Ying Qi, but disharmony with Wei Qi because Ying is inside and Wei is outside. Re-inducing sweating harmonizes Ying and Wei; use Guizhi Tang. Syndrome #47 states: Fever and sweating indicate weak Ying and strong Wei. To rescue from pathogenic wind, use Guizhi Tang. Thus, Wind Strike with sweating implies harmonious Ying but disharmonious Wei. Volume 1 states: Floating-tight Cun Kou pulse: Floating is Wind, Tight is Cold. Wind injures Wei, Cold injures Ying. Ying and Wei both diseased, bone/joint pain, induce sweating. Thus, Cold Damage with floating-tight pulse implies Ying and Wei both diseased; Mahuang Tang uses both Guizhi and Mahuang, as per Zhang Zhongjing. Regarding Qing Long Tang, although treating Wind Strike with Cold pulse/Cold Damage with Wind pulse, Zhang Zhongjing warns: Sweating and aversion to wind contraindicate its use, leading to limb reversal coldness and muscle twitching. Thus, Qing Long Tang requires precise symptom-pulse matching. Wang Shifu used Guizhi Mahuang Ge Ban Tang cautiously.
If Taiyang disease presents with stiffness and tension in the neck and back (Xiang Bei Qiang Ji), but with sweating and aversion to wind, Guizhi Jia Gegen Tang (Guizhi Decoction plus Radix Puerariae) should be administered.
**Guizhi Jia Gegen Tang Formula:**
Guizhi (Ramulus Cinnamomi), Gegen (Radix Puerariae Lobatae) [each 2 liang], Shaoyao (Radix Paeoniae Alba), Gancao (Radix Glycyrrhizae Preparata) [each 1 liang], Shengjiang (Rhizoma Zingiberis Recens) [1.5 liang], Dazao (Fructus Jujubae) [6 pieces].
Crush the herbs. Take 5 qian per dose, decoct in water, take warm, cover to induce sweating.
If Taiyang disease presents with stiffness and tension in the neck and back, anhidrosis, and aversion to wind, Gegen Tang (Pueraria Decoction) should be administered.
**Gegen Tang Formula:**
Gegen (Radix Puerariae Lobatae) [4 liang], Mahuang (Herba Ephedrae), Shengjiang (Rhizoma Zingiberis Recens) [each 3 liang], Guizhi (Ramulus Cinnamomi), Shaoyao (Radix Paeoniae Alba), Gancao (Radix Glycyrrhizae Preparata) [each 2 liang], Dazao (Fructus Jujubae) [12 pieces].
Crush the herbs. Take 5 qian per dose, remove dregs, take warm, cover to induce mild sweating.
If Taiyang disease presents with fever and aversion to cold, more heat than cold, and a weak pulse, this indicates "No Yang" (deficiency of Yang/Qi or fluids), and diaphoresis is contraindicated. Guizhi Er Yuebi Yi Tang (Double Guizhi and One Yuebi Decoction) is appropriate.
**Guizhi Er Yuebi Yi Tang Formula:**
Guizhi (Ramulus Cinnamomi), Shaoyao (Radix Paeoniae Alba), Mahuang (Herba Ephedrae) [de-stemmed, soaked], Gancao (Radix Glycyrrhizae Preparata) [each 3 qian], Shengjiang (Rhizoma Zingiberis Recens) [0.5 liang], Shigao (Lapis Gypsi) [1.5 liang, crushed], Dazao (Fructus Jujubae) [6 pieces].
Crush the herbs. Take 5 qian per dose, decoct in water, take warm.
If Taiyang disease lasts 8-9 days, resembling malaria with fever and aversion to cold, more heat than cold. If the patient does not vomit, bowel/bladder function is normal, occurring twice daily, and the pulse is micro-slow, recovery is imminent. If the pulse is micro with aversion to cold, this indicates dual deficiency of Yin and Yang; do not use diaphoresis, purgation, or emesis. If the face appears red-hot, the disease is not resolved due to inability to produce slight sweating, causing body itching. Guizhi Mahuang Ge Ban Tang (Half-Half Guizhi and Mahuang Decoction) is appropriate.
**Guizhi Mahuang Ge Ban Tang Formula:**
Guizhi (Ramulus Cinnamomi) [1 liang], Shaoyao (Radix Paeoniae Alba), Shengjiang (Rhizoma Zingiberis Recens), Gancao (Radix Glycyrrhizae Preparata, roasted), Mahuang (Herba Ephedrae) [each 0.5 liang, de-stemmed, boiled], Dazao (Fructus Jujubae) [6 pieces], Xingren (Semen Armeniacae Amarum) [12 seeds, skin and tip removed].
Crush the herbs. Take 5 qian per dose, decoct in water, take warm.
Whenever Zhang Zhongjing refers to Taiyang Disease, it denotes exterior syndromes: fever, aversion to cold, headache, and neck stiffness. If the pulse is floating-large, it matches the symptoms, and diaphoresis is appropriate. Now, seeing exterior symptoms but a micro pulse mismatching the symptoms, diaphoresis is contraindicated; use Half-Half Decoctions to harmonize.
If Taiyang Summerheat presents with fever, aversion to cold, weak pulse, cold limbs, and thirst, Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) is used. (Formula theory see Summerheat.)
If Taiyang disease persists for 6-7 days with exterior symptoms remaining, but the pulse is micro and sinking, without chest binding, and the patient is delirious, the heat is in the Lower Jiao. The lower abdomen should be hard and full. If urination is free, bleeding (from stool or urine) leads to recovery. This is because Taiyang pathogens follow the channels, causing blood stasis internally. Didang Tang (Reach the Tomb Decoction) is administered.
**Didang Tang Formula:**
Shui Zhi (Hirudo) [fried, seeds removed, pounded], Meng Chong (Oecophylla Longinoda/Biting Midges - traditionally biting midges/fly larvae) [each 10 pieces, fried, legs/wings removed], Dahuang (Radix et Rhizoma Rhei), Taoren (Semen Persicae) [7 seeds, skin and tip removed].
Take as one dose, decoct in one cup of water, take warm.
In Taiyang disease, if there is yellowing of the body, sinking-knotted pulse, hard lower abdomen, and urinary difficulty, it is not blood stasis. If urination is free and the patient is delirious-like, it is definite blood stasis; Didang Tang (Reach the Tomb Decoction) is also administered.
Whenever Zhang Zhongjing mentions Taiyang symptoms with a sinking pulse, it refers to fever, aversion to cold, head/neck stiffness, but the pulse is unexpectedly sinking. If accompanied by lower abdominal hardness, it is Blood Accumulation (Xu Xue); this Didang Tang case applies.
If accompanied by joint pain, urinary difficulty, and body yellowing, it is Bi Syndrome caused by Dampness. (Theory see Damp Bi.)
If accompanied by sudden trismus (lockjaw) and opisthotonos (backward arching), it is Jing Disease (Spasm). If anhidrotic and aversive to cold, it is Gang Jing (Rigid Spasm), suitable for Gegen Tang (Pueraria Decoction). If diaphoretic and not averse to cold, it is Rou Jing (Soft Spasm), suitable for Gualou Guizhi Tang (Trichosanthes Root and Cinnamon Twig Decoction). (Formula theory see Jing Disease.)
If fever and headache present with a reverse sinking pulse, and if unrelieved with body pain, treat the interior with Sini Tang (Frigid Extremities Decoction). (Formula see Diarrhea.)
In Shaoyin Disease, if the patient only desires sleep, and initially presents with fever and a sinking pulse, Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) is used. (Theory see Desire to Sleep.)
**Mahuang Fuzi Xixin Tang Formula:**
Mahuang (Herba Ephedrae) [de-stemmed, soaked], Xixin (Herba Asari), Fuzi (Radix Aconiti Lateralis Preparata) [each 2 liang; Aconite: 1 piece, processed, bark removed].
Crush the herbs. Take 5 qian per dose, decoct in water, take warm.
Whenever Zhang Zhongjing mentions Taiyang Disease without aversion to cold, it refers to fever, head/neck stiffness, floating pulse, but notably no aversion to cold. If accompanied by thirst, it is Wen Bing (Warm Disease); if accompanied by sweating, it is Rou Jing (Soft Spasm). (Formula theory see Warm Disease and Soft Spasm.)
In Cold Damage lasting 6-7 days, with slight fever/cold, painful joints, slight vomiting, subcostal fullness/stuffiness, and unresolved exterior symptoms, Chaihu Jia Guizhi Tang (Bupleurum plus Cinnamon Twig Decoction) is administered.
**Chaihu Jia Guizhi Tang Formula:**
Chaihu (Radix Bupleuri) [1 liang], Guizhi (Ramulus Cinnamomi), Huangqin (Radix Scutellariae), Renshen (Radix Ginseng), Shaoyao (Radix Paeoniae Alba), Shengjiang (Rhizoma Zingiberis Recens) [each 0.5 liang], Banxia (Rhizoma Pinelliae Preparata) [4 qian], Dazao (Fructus Jujubae) [3 pieces], Gancao (Radix Glycyrrhizae Preparata, roasted) [3 qian].
Crush the herbs. Take 5 qian per dose, decoct in water, take warm.
Whenever Zhang Zhongjing mentions "Exterior Unresolved," it refers to Taiyang Disease with fever, aversion to cold, head/neck stiffness, and floating pulse. Although belonging to Taiyang Exterior Syndrome, if Interior Syndromes coexist, it is not called Taiyang Disease but "Exterior Unresolved." Subcostal fullness/stuffiness corresponds to this Chaihu Guizhi Tang case. (Theory see Hypochondriac Pain.)
With fluid retention in the epigastrium, dry retching, and cough, Xiao Qing Long Tang (Minor Blue Green Dragon Decoction) is used. (Formula theory see Effectiveness.) With hypochondriac pain, warm hands/feet, and thirst, Xiao Chaihu Tang (Minor Bupleurum Decoction) is used. With epigastric fullness/blockage, first use Guizhi Tang to resolve the exterior, then use Xi Xin Tang (Drain the Epigastrium Decoctions) to attack the blockage. (Formula theory see Fullness.) With diarrhea and abdominal fullness/bloating, first use Sini Tang (Frigid Extremities Decoction) to warm the interior, then use Guizhi Tang to attack the exterior. (Formula theory see Diarrhea.)
Taiyang Disease resolves between Si and Wei hours (9 AM - 3 PM).
If Taiyang Disease is unresolved and the pulse stops at both Yin and Yang positions, shaking and chills followed by sweating indicate resolution. If only the Yang pulse is micro, sweating resolves it; if only the Yin pulse is micro, purgation resolves it. If purgation is desired, Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction) is administered. ("Purgation resolves it" may be a textual error.)
In Taiyang Disease, if the pulse is floating-tight, with fever, body, and anhidrosis, spontaneous nosebleed (Xu) indicates self-resolution.
If Taiyang exterior symptoms are unresolved, do not purge; purging is adverse. To resolve the exterior, Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
*[Hai]* Da, Zhong, and Xiao Tiaowei Chengqi Tang must only be used when the pulse is floating, with headache, aversion to wind/cold, all exterior symptoms resolved, but fever/aversion to heat returns, along with delirium and constipation. If the pulse is floating-tight, purging leads to Jie Xiong (Chest Binding). If the pulse is floating-slow, purging leads to Pi Qi (Epigastric Blockage).
Xu Xueshi said: I recall a relative with Cold Damage: fever, headache, anhidrosis, constipation for 4-5 days. The doctor planned to purge with Dahuang and Pomiao. I advised waiting. The pulse was floating-slow; in a closed room, the patient reported severe wind aversion. I said: With such exterior symptoms, and only constipation without abdominal distension or other discomfort, why purge hastily? Zhang Zhongjing's method requires resolving the exterior before purging. Otherwise, pathogens enter the void, causing Jie Xiong or Hot Diarrhea. I prescribed Guizhi Mahuang Ge Ban Tang, followed by Xiao Chaihu Tang. Sweating occurred, bowels moved, and the patient recovered. Zhang Zhongjing states: Cold Damage usually stems from Wind-Cold. Initially, Wind-Cold affects the exterior; if it enters the interior, it does not dissipate. To attack, first resolve the exterior, then purge. If the exterior is resolved but internal stagnation persists with fullness, hardness, and dry feces, purging is safe even after 4-5 days. If purging is inappropriate and forced, internal deficiency allows heat to enter, causing complicated Hot Diarrhea and irritability, potentially fatal. I corrected overlapping text in the original; the logic is clear. Generally, Wind-Cold entering the interior without dissipation leads to dry feces or constipation. Purging is only safe when the pulse is no longer floating, wind aversion ceases, and exterior symptoms resolve. Constipation for 4-5 days is harmless if the exterior is respected; ignoring the exterior leads to Complicated Hot Diarrhea.