治温热内发, 表里俱热, 头痛身疼, 不
恶寒反恶热, 无汗而喘, 大烦大渴, 脉阴阳俱浮者, 用此发汗而清火
.若脉浮弱沉紧, 沉细恶寒, 自汗出而不渴者, 禁用.
麻黄 ( 去节 ) 四两 杏仁 ( 去皮, 尖 ) 五十枚 甘草 ( 炙 ) 二
两 石膏 ( 碎, 绵裹 ) 半斤, 右四味, 以水七升, 先煮麻黄, 减二
升,去上沫, 纳诸药, 煮取二升, 去滓, 温服一升.
【集注】柯琴曰: 石膏为清火之重剂, 青龙, 白虎皆赖以建功, 然用
之不当, 适足以招祸. 故青龙以无汗烦躁, 得姜, 桂以宣卫外之阳也
;白虎以有汗烦渴, 须粳米以存胃中之液也. 此但热无寒, 故不用姜
,桂, 喘不在胃而在肺, 故不须粳米. 其意重在存阴, 不必虑其亡阳
也,故于麻黄汤去桂枝之监制, 取麻黄之专开, 杏仁之降, 甘草之和
,倍石膏之大寒, 除内外之实热, 斯溱溱汗出, 而内外之烦热与喘悉
除矣.
治少阴病始得之, 反发热脉沉, 二三日无里证者.
麻黄一两 附子 ( 炮 ) 一枚 细辛二两. 热微者, 以甘草易细辛微
发汗. 右三味, 以水一斗, 先煮麻黄, 减二升, 去沫, 纳药, 煮取三
升,去滓, 温服一升, 日三服.
【集注】柯琴曰: 少阴主里, 应无表证; 病发于阴, 应有表寒. 今少
阴始受寒邪而反发热, 是有少阴之里, 而兼有太阳之表也. 太阳之表
脉应不沉, 今脉沉者, 是有太阳之证, 而见少阴之脉也. 故身虽热而
脉则沉也. 所以太阳病而脉反沉, 便用四逆以急救其里; 此少阴病而
表反热, 便于表剂中加附子以预固其里. 夫发热无汗, 太阳之表不得
不开, 沉为在里, 少阴之枢又不得不固. 设用麻黄开腠理, 细辛散浮
热,而无附子以固元阳, 则少阴之津液越出, 太阳之微阳外亡, 去生
便远. 惟附子与麻黄并用, 则寒邪虽散, 而阳不亡; 此里病及表, 脉
沉而当发汗者, 与病在表脉浮而发汗者迳庭也. 若表微热, 则受寒亦
轻,故以甘草易细辛而微发其汗, 甘以缓之, 与辛以散之者, 又少间
矣.
治疗温热之邪内发，表里俱热，头痛身疼，不恶寒反而恶热，无汗且气喘，极度烦躁口渴，脉象寸关尺三部皆浮的病症，使用此方（麻黄杏仁甘草石膏汤）以发汗并清泻火热。如果脉象浮而无力或沉紧，脉沉细且恶寒，自汗出且不口渴的，禁用此方。
麻黄（去节）四两，杏仁（去皮、尖）五十枚，甘草（炙）二两，石膏（打碎，用棉布包裹）半斤。以上四味药，用水七升，先煮麻黄，水量减少二升后，撇去水面上的浮沫，再加入其他药物，煎煮至剩余二升，滤去药渣，温服一升。
【集注】柯琴说：石膏是清泻火热的重剂，大青龙汤、白虎汤都依靠它来建功，但如果使用不当，反而足以招致祸患。所以大青龙汤证因无汗烦躁，需要配合生姜、桂枝来宣通卫外的阳气；白虎汤证因有汗烦渴，必须配合粳米来保存胃中的津液。本方只有热没有寒，所以不用姜、桂；气喘的病位不在胃而在肺，所以不需要粳米。其用意重在保存阴液，不必担心亡阳，所以在麻黄汤中去掉桂枝的制约作用，取麻黄专门开泄腠理，杏仁降气平喘，甘草调和诸药，加倍使用大寒的石膏，以清除内外的实热，这样就能使汗液溱溱而出，内外的烦热和气喘全部消除。
治疗少阴病初起，反而发热，脉象沉，经过两三天没有出现里虚寒证的。
麻黄一两，附子（炮制）一枚，细辛二两。如果热势轻微的，用甘草代替细辛，微微发汗。以上三味药，用水一斗，先煮麻黄，水量减少二升后，撇去浮沫，加入其他药物，煎煮至剩余三升，滤去药渣，温服一升，每日服用三次。
【集注】柯琴说：少阴主里，应当没有表证；病发于阴经，应当有表寒。现在少阴初受寒邪却反而发热，这是既有少阴的里证，又兼有太阳的表证。太阳表的脉象应当不沉，现在脉象沉，这是有太阳的症状，却出现了少阴的脉象。所以身体虽然发热，但脉象却是沉的。因此，如果是太阳病而脉象反而沉，就用四逆汤来急救其里；这里是少阴病而表证反而发热，就在解表剂中加入附子以预先固护其里。发热无汗，太阳的表邪不得不发散；脉沉表示病在里，少阴的枢机不得不固护。假如只用麻黄开泄腠理，细辛散除浮热，而没有附子来固护元阳，那么少阴的津液就会外越，太阳的微阳就会外亡，离生还就远了。只有附子与麻黄并用，那么寒邪虽然被驱散，但阳气不会亡失；这是里病波及表，脉沉而应当发汗的情况，与病在表、脉浮而发汗的情况截然不同。如果表热轻微，说明受寒也轻，所以用甘草代替细辛来微微发汗，甘草味甘能缓和药性，与细辛辛散的作用相比，又稍微温和一些了。
Treats conditions where warm-heat pathogens erupt internally, causing heat in both the exterior and interior, manifesting as headache and body pain, aversion to cold being absent but aversion to heat present, absence of sweating accompanied by wheezing, severe restlessness and thirst, and a floating pulse at all positions (Cun, Guan, Chi). Use this formula [Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction)] to induce sweating and clear fire. If the pulse is floating and weak or deep and tight, with a deep and fine pulse, aversion to cold, spontaneous sweating, and no thirst, this formula is strictly contraindicated.
Mahuang (Ephedrae Herba, 麻黄) (stems removed) 4 liang, Xingren (Armeniacae Semen Amarum, 杏仁) (skin and tips removed) 50 pieces, Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) (roasted) 2 liang, Shigao (Gypsum Fibrosum, 石膏) (crushed, wrapped in cotton cloth) 0.5 jin. The above four ingredients are boiled in 7 sheng of water. First, boil Mahuang alone until the volume reduces by 2 sheng, then skim off the foam on the surface. Add the remaining herbs and continue boiling until 2 sheng remains. Strain the decoction and take 1 sheng warm.
[Collected Annotations] Ke Qin stated: Shigao (Gypsum Fibrosum, 石膏) is a heavy agent for clearing fire. Both Da Qinglong Tang (Major Blue Dragon Decoction) and Baihu Tang (White Tiger Decoction) rely on it for efficacy; however, improper use can lead to disaster. In Da Qinglong Tang, due to absence of sweating and irritability, Ginger (Shengjiang, 生姜) and Cinnamon Twig (Guizhi, 桂枝) are used to disseminate the Yang qi protecting the exterior. In Baihu Tang, due to sweating, irritability, and thirst, Rice (Jingmi, 粳米) is required to preserve stomach fluids. This formula involves heat without cold, so Ginger and Cinnamon Twig are omitted. The wheezing originates in the Lung rather than the Stomach, so Rice is unnecessary. The intent focuses on preserving Yin, without concern for Yang collapse. Therefore, Guizhi (Cinnamon Twig, 桂枝) is removed from Mahuang Tang (Ephedra Decoction) to eliminate its restraining effect, utilizing Mahuang’s specific ability to open the pores, Xingren’s descending action, Gancao’s harmonizing property, and doubling the dose of the great-cold Shigao to eliminate excess heat inside and out. Consequently, profuse sweating occurs, and internal/external restlessness, heat, and wheezing are completely resolved.
Treats Shaoyin disease (Shaoyin Disease, 少阴病) in its initial stage, presenting with fever and a deep pulse. After two or three days, if there are no signs of interior deficiency-cold, use the following:
Mahuang (Ephedrae Herba, 麻黄) 1 liang, Fuzi (Aconiti Lateralis Radix Praeparata, 附子) (prepared) 1 piece, Xixin (Asari Radix et Rhizoma, 细辛) 2 liang. If the heat is mild, replace Xixin with Gancao (Licorice Root, 甘草) to induce slight sweating. The above three ingredients are boiled in 1 dou of water. First, boil Mahuang alone until the volume reduces by 2 sheng, skim off the foam, add the other herbs, and boil until 3 sheng remains. Strain and take 1 sheng warm, administered three times daily.
[Collected Annotations] Ke Qin stated: Shaoyin governs the interior and should not present exterior symptoms; diseases originating in Yin channels should exhibit exterior cold. Now, Shaoyin has just received cold pathogens yet presents with fever, indicating the presence of Shaoyin interior pathology combined with Taiyang exterior pathology. Taiyang exterior pulses should not be deep; a deep pulse here indicates Taiyang symptoms appearing with Shaoyin pulse characteristics. Thus, although the body is hot, the pulse is deep. Therefore, when Taiyang disease presents with a reverse deep pulse, Sini Tang (Four Reversal Decoction, 四逆汤) is used to urgently rescue the interior. Here, in Shaoyin disease with reverse exterior heat, Fuzi (Prepared Aconite Root, 附子) is added to exterior-releasing formulas to preemptively secure the interior. Fever without sweating requires opening the Taiyang exterior; a deep pulse indicates interior involvement, requiring the securing of the Shaoyin pivot. If one were to use Mahuang to open the pores and Xixin to scatter floating heat without Fuzi to secure Primordial Yang, Shaoyin fluids would escape outward, and Taiyang’s subtle Yang would perish, leading far from survival. Only by using Fuzi together with Mahuang can cold pathogens be dispersed without Yang collapse. This situation—interior disease affecting the exterior, deep pulse requiring sweating—is fundamentally different from exterior disease with a floating pulse requiring sweating. If the exterior heat is mild, the cold invasion is also light; thus, Gancao replaces Xixin to induce slight sweating. Gancao’s sweetness moderates the action, making it milder compared to Xixin’s dispersing nature.