麻黄（去节）三两 桂枝二两 甘草（炙）一两 杏仁（汤浸，去皮、尖）七十个
右四味，以水九升，先煮麻黄，减二升，去上沬，内诸药，煮取二升半，去渣，温服
八合，覆取微似汗，不须啜粥，余如桂枝法将息。
【方解】
名曰麻黄汤者，君以麻黄也。麻黄性温，味辛而苦，其用在迅升；桂枝性温，味辛而
甘，其能在固表。证属有余，故主以麻黄必胜之算也；监以桂枝，制节之师也。杏仁
之苦温，佐麻黄逐邪而降逆；甘草之甘平，佐桂枝和内而拒外。饮入于胃，行气于元
府，输精于皮毛，斯毛脉合精，溱溱汗出，在表之邪，必尽去而不留；痛止喘平，寒
热顿解，不须啜粥而借汗于谷也。必须煮掠去上沫者，恐令人烦，以其轻浮之气，过
于引气上逆也。其不用姜、枣者，以生姜之性横散于肌，碍麻黄之迅升；大枣之性泥
滞于膈，碍杏仁之速降，此欲急于直达，少缓则不迅，横散则不升矣。然此为纯阳之
剂，过于发汗，如单刀直入之将，用之若当，一战成功；不当，则不戢而召祸。故可
一而不可再。如汗后不解，盒饭以桂枝代之。此方为仲景开表逐邪发汗第一峻药也。
庸工不知其制在温覆取汗，若不温覆取汗，则不峻也，遂谓麻黄专能发表不治他病。
熟知此汤合桂枝汤，名麻桂各半汤，用以和太阳留连未尽之寒热；去杏仁、加石膏，
合桂枝汤，名桂枝二越婢一汤，用以解太阳热多寒少之寒热；若阳盛于内，无汗而喘
者，又有麻黄杏仁甘草石膏汤，以解散太阴肺家之邪；若阴盛于内而无汗者，又有麻
黄附子细辛甘草汤，以温散少阴肾家之寒。『金匮要略』以此方去桂枝，『千金方』
以此方桂枝易桂，皆名还魂汤，用以治邪在太阴，卒中暴厥，口噤气绝，下咽奏效，
而皆不温覆取汗。因是而知麻黄汤之峻与不峻，在温覆与不温覆也。此仲景用方之心
法，岂常人之所得而窥耶！
【集解】
王肯堂曰：此方为元气不虚者设也。如挟时气者宜十神汤，挟暑湿者宜正气汤，挟寒
者宜五积散，挟热者宜通圣散，挟食者宜养胃汤，挟痰者宜芎苏散。按肯堂之议诚当
矣。然必证兼表里，邪因错杂，似伤寒而非伤寒者，乃可于诸方中斟酌选用。若脉证
与麻黄桂枝吻合，自当遵仲景之法治之。即元气素虚，或平素有热，不宜麻桂者，亦
必如刘完素、张洁古法，缓缓消息治之，庶不误人。临病之工，宜详审焉。
吴绶曰：凡伤寒，寒邪在表，闭其腠理，身痛拘急，恶寒无汗，须用麻黄辛苦之药，
开发腠理，逐寒邪，使汗出而解。惟夏月炎暑之时，虽有是证，宜加凉药方可用，如
防风通圣散、三黄石膏汤是也。
伤寒一日，太阳受之，脉若静者，为不传；颇欲吐，若躁烦，脉数急者，为传也。
【注】
伤寒一日，太阳受之，当脉浮紧，或汗或未汗，若脉静如常，此人病脉不病，为不传
也。初病或呕未止颇欲吐，若躁烦脉数急者，此外邪不解，内热已成，病势欲传也。
宜以大青龙汤发表解热，以杀其势；或表里有热证者，则当以双解汤两解之也。
【集注】
沈明宗曰：此凭脉辨证，知邪传与不传也。脉浮而紧，为太阳正脉，迺静是不传他经
矣。若颇欲吐，或躁烦而脉数急，则邪机向里已着，势必传经为病也。
伤寒二、三日，阳明少阳证不见者，为不传也。
【注】
伤寒二日，阳明受之，三日少阳受之，此其常也。若二三日，阳明证之不恶寒，反恶
热，身热心烦，口渴不眠等证；与少阳证之寒热往来、胸□满、喜呕、口苦、耳聋等
证不见者，此为太阳邪轻热微，不传阳明、少阳也。
【集注】
程知曰：伤寒一二日太阳，二、三日阳明，三、四日少阳，四、五日太阴，五、六日
少阴，六、七日厥阴，此第言其常耳！其中变证不一，有专经不传者，有越经传者，
有传一二经而即止者，有发于阳即入少阴者，有直中三阴者，有足经冤热而传手经者
，有误药而传变者。大抵热邪乘经之虚即传，若经实即不受邪而不传，阳邪胜则传，
阴邪胜多不传；故经谓脉静为不传，脉数急为欲传也。又曰：足经自足上行胸腹头背
，主一身之大纲，故寒邪入之，即见于其经，若手经第行于胸手，不能主一身之大纲
也。邪既入足经，必传入手经，故感风寒之重者，头项痛，肩、背、肘、节、亦痛也
。圣人言足不言手，足可该手，手不可该足也，非不传手也。夫五脏六腑十二经，气
相输，络相通，岂有传足而不传手者哉！亦岂有伤足而不伤手者哉！虞天民谓热先手
，寒先足，义亦可互通也。
程应旄曰：伤寒之有六经，无非从浅深而定部署。以皮肤为太阳所辖，故署之太阳；
肌肉为阳明所辖，故署之阳明；筋膜为少阳所辖，故署之少阳云耳！所以华佗曰：伤
寒一日在皮，二日在肤，三日在肌，四日在胸，五日在腹，六日入胃，只就躯壳间约
略其深浅，而并不署太阳、阳明等名。然则仲景之分太阳、阳明等，亦是画限之意，
用以辖病也。
脉浮者，病在表，可发汗，宜麻黄汤。脉浮而数者，可发汗，宜麻黄汤。
【注】
伤寒脉浮紧者，麻黄汤诚为主剂矣。今脉浮与浮数，似不在发汗之列，然视其病皆伤
寒无之表实，则不妨略脉而从证，亦可用麻黄汤汗之。观其不曰以麻黄汤发之主之，
而皆曰可发汗，则有商量斟酌之意焉。
【集注】
方有执曰：伤寒脉本紧，不紧而浮，则邪见还表而欲散可知矣。发者，拓而出之也；
麻黄汤者、乘其欲散而拓出之也。或脉浮而数，伤寒之欲传也，而亦宜麻黄汤发汗者
，言乘寒邪有向表之浮，当散其数，而不令其至于传也。
程应旄曰：麻黄汤，为寒伤荣之主剂，然亦当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，一一寒伤荣之表病
，则不妨略脉而详证，无汗，可发汗，宜麻黄汤。若脉浮数，邪势欲传于里，亦不妨
略证而详脉，无汗，可发汗，亦宜麻黄汤。就此二者之脉与证互参之，其有脉见浮紧
，证具伤寒，二者俱符，又何麻黄汤之必在禁例哉！
刘宏璧曰：但脉浮不紧，何以知其表寒实也？必然无汗始可发也。脉数何以知其未入
里也？以脉兼浮故可汗也。
太阳病，外证未解，脉浮弱者，当以汗解，宜桂枝汤。
【注】
太阳病外证未解，谓太阳病表证未解也。若脉浮紧，是为伤寒外证未解。今脉浮弱，
是为中风外证未解也，故当以桂枝汤汗解之。
【集注】
方有执曰：外证未解，谓头痛、项强、恶寒等证犹在也。浮弱即阳浮而阴弱，此言太
阳证凡在未传变者，仍当从于解表，盖严戒不得早下之意。
程知曰：外证未解，脉见浮弱，即日久犹当以汗解。然只宜桂枝解肌之法，不宜误行
大汗之剂。至于不可误下，更不待言矣。
伤寒发汗已解，半日许复烦，脉浮数者，可更发汗，宜桂枝汤。
【注】
伤寒服麻黄发汗，汗出已，热退身凉解，半日许复烦热而脉浮数者，是表邪未尽退而
复集也，可更发汗。其不用麻黄汤者，以其津液前已为发汗所伤，不堪再任麻黄，故
宜桂枝更汗可也。
【集注】
方有执曰：伤寒发汗者，服麻黄汤以发之之谓也。解，散也；复，重复也，既解半日
许，何事而复哉？言发汗或不如法，或汗后不谨风寒，而复烦热，脉转浮数也，故曰
可更发汗。更，改也，言当改前法，故曰宜桂枝汤。
喻昌曰：用桂枝汤者，一以邪重犯卫，一以荣虚不能复任麻黄也。
程应旄曰：改前发汗之法为解肌，则虽主桂枝，不为犯伤寒之禁也。
汪琥曰：仲景法脉浮而数者、可发汗，宜麻黄汤。然此条已曾用过麻黄汤矣，故当更
方以发其汗，宜桂枝汤。
发汗病不解 ，反恶寒者，虚故也，芍药甘草附子汤主之。
【按】
发汗病不解之「不」字，当是衍文。盖发汗病不解，则当恶寒，今日反恶寒者，正所
谓病解之义也，病解恶寒，始谓之虚。
【注】
伤寒、发汗病不解，则当恶寒，非表虚也，是表邪犹在不解，仍当汗也。今发汗汗出
，病已解，不当恶寒矣。反恶寒者，非表邪也，乃阳虚不能卫外所致，故以芍药甘草
附子汤主之。盖用附子以扶阳，芍药以补阴，甘草佐附芍补阴阳而调荣卫也。
【集注】
方有执曰：未汗而恶寒，邪盛而表实；已汗而恶寒，邪退而表虚，汗出之后，大邪退
散，荣气衰微，卫气疏慢，而但恶寒，故曰虚。
【方剂组成】
麻黄（去节）三两，桂枝二两，甘草（炙）一两，杏仁（汤浸，去皮、尖）七十个。
以上四味药，用水九升，先煮麻黄，水量减少二升，撇去水面上的浮沫，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似出汗的效果，不需要喝热粥，其余调养方法参照桂枝汤法。
【方解】
命名为麻黄汤，是因为以麻黄为君药。麻黄性温，味辛而苦，其作用在于迅速升散；桂枝性温，味辛而甘，其功能在于固护肌表。病证属于邪气有余，所以以麻黄为主攻克的策略；用桂枝作为监制，起到节制的作用。杏仁的苦温之性，辅助麻黄驱逐邪气并降逆气；甘草的甘平之性，辅助桂枝调和内部并抵御外邪。药液进入胃中，在元府运行气机，将精微输布于皮毛，这样毛脉精气相合，溱溱然出汗，在表的邪气必然全部去除而不留滞；疼痛停止，喘息平息，寒热症状顿时解除，不需要喝粥借谷气发汗。必须煮掠去掉上面的浮沫，是担心让人心烦，因为那轻浮之气，过于引动气机上逆。不用生姜、大枣的原因，是因为生姜的性质横散于肌肉，妨碍麻黄的迅速升散；大枣的性质黏滞于膈部，妨碍杏仁的快速下降，这是想要急于直达病所，稍微迟缓就不迅速，横散就不能升发了。然而这是纯阳的药剂，发汗力量过强，如同单刀直入的将领，使用得当，一战成功；使用不当，则不收敛而招致祸患。所以只能使用一次而不能再次使用。如果发汗后病不解，应当用桂枝汤替代它。此方是张仲景开发腠理、驱逐邪气、发汗的第一峻猛药物。庸医不知道它的制约在于温覆取汗，如果不温覆取汗，就不峻猛了，于是说麻黄专门能发表治不了其他病。哪里知道此汤与桂枝汤合用，名为麻桂各半汤，用来和解太阳经留恋未尽的寒热；去掉杏仁、加入石膏，合桂枝汤，名为桂枝二越婢一汤，用来解太阳经热多寒少的寒热；如果阳气盛于内，无汗而喘的，又有麻黄杏仁甘草石膏汤，来解散太阴肺家的邪气；如果阴气盛于内而无汗的，又有麻黄附子细辛甘草汤，来温散少阴肾家的寒邪。《金匮要略》将此方去掉桂枝，《千金方》将此方的桂枝换成桂心，都名叫还魂汤，用来治疗邪气在太阴，突然中邪昏厥，口噤气绝，咽下立刻见效，但都不需要温覆取汗。因此可知麻黄汤的峻猛与否，在于是否温覆取汗。这是张仲景用药的心法，难道是常人所能窥探的吗！
【集解】
王肯堂说：此方是为元气不虚的人设立的。如果兼挟时行疫气的，适宜用十神汤；兼挟暑湿的，适宜用正气汤；兼挟寒邪的，适宜用五积散；兼挟热邪的，适宜用通圣散；兼挟食积的，适宜用养胃汤；兼挟痰浊的，适宜用芎苏散。按王肯堂的议论确实恰当。但是必须证候兼有表里，邪气交错混杂，像伤寒又不是伤寒的，才可以在诸方中斟酌选用。如果脉证与麻黄汤、桂枝汤吻合，自然应当遵循张仲景的方法治疗。即使元气素来虚弱，或者平时素有热邪，不宜用麻黄、桂枝的，也必须像刘完素、张洁古的方法，缓缓调治，才不会误人。临证医生，应该详细审察。
吴绶说：凡是伤寒，寒邪在表，闭塞腠理，身体疼痛拘急，恶寒无汗，必须用麻黄辛苦的药物，开发腠理，驱逐寒邪，使汗出而解。只有夏季炎热暑气之时，虽然有这些证候，适宜加凉药方可使用，如防风通圣散、三黄石膏汤就是这类。
伤寒第一天，太阳经受邪，脉象若安静不变，说明没有传变；很想吐，或者烦躁，脉数急的，说明正在传变。
【注】
伤寒第一天，太阳经受邪，应当脉浮紧，或者已经发汗或者未发汗，如果脉象安静如常，这是病人病脉不病，说明没有传变。初病或者呕吐未止，很想吐，或者烦躁脉数急的，这是外邪未解，内热已成，病势将要传变。适宜用大青龙汤发表解热，以遏制病势；或者表里有热证的，则应当用双解汤表里双解。
【集注】
沈明宗说：这是凭脉辨证，判断邪气是否传变。脉浮而紧，是太阳经的正脉，如果是安静的，就是不传他经了。如果很想吐，或者烦躁而脉数急，那么邪气趋向于里已经明显，势必传经致病。
伤寒二、三天，没有出现阳明证和少阳证的，说明没有传变。
【注】
伤寒第二天，阳明经受邪，第三天少阳经受邪，这是常规情况。如果二三天，没有阳明证的不恶寒反恶热、身热心烦、口渴不眠等证；以及少阳证的寒热往来、胸胁苦满、喜呕、口苦、耳聋等证不见，这是因为太阳经邪气轻浅热势微弱，不传阳明、少阳。
【集注】
程知说：伤寒一二日太阳经，二三日阳明经，三四日少阳经，四五日太阴经，五六日少阴经，六七日厥阴经，这只是说常规情况！其中变证不一，有专一经不传的，有越经相传的，有传一二经就停止的，有发于阳经即传入少阴的，有直中三阴的，有足经受热而传入手经的，有误药而传变的。大体上热邪乘经气虚即传，如果经气实就不受邪而不传，阳邪胜则传，阴邪胜多不传；所以说脉静为不传，脉数急为欲传。又说：足经从足上行至胸腹头背，主宰一身的大纲，所以寒邪侵入，立即见于其经，如果手经只行于胸手，不能主宰一身的大纲。邪气既入足经，必传入手经，所以感受风寒重的，头项痛，肩、背、肘、节也痛。圣人只说足经不说手经，足经可以包括手经，手经不能包括足经，不是不传手经。五脏六腑十二经脉，气相互输送，络脉相通，哪有传足经不传手经的呢！又哪有伤足经不伤手经的呢！虞天民说热先在手经，寒先在足经，义理也可以互通。
程应旄说：伤寒有六经，无非是从浅深来确定部署。以皮肤为太阳所辖，所以署名为太阳；肌肉为阳明所辖，所以署名为阳明；筋膜为少阳所辖，所以署名为少阳罢了！所以华佗说：伤寒一日在皮，二日在肤，三日在肌，四日在胸，五日在腹，六日入胃，只是就躯壳间大概划分深浅，并不署太阳、阳明等名。那么张仲景分太阳、阳明等，也是画限的意思，用来管辖病位。
脉浮的，病在表，可发汗，适宜用麻黄汤。脉浮而数的，可发汗，适宜用麻黄汤。
【注】
伤寒脉浮紧的，麻黄汤确实是主方。现在脉浮与浮数，似乎不在发汗之列，但是看其病都是伤寒无汗的表实证，不妨略脉而从证，也可以用麻黄汤发汗。看他没说“以麻黄汤发之主之”，而都说“可发汗”，则有商量斟酌的意思。
【集注】
方有执说：伤寒脉本紧，不紧而浮，则邪气见还表而欲散可知矣。发，是拓而出之；麻黄汤，是乘其欲散而拓出之。或者脉浮而数，是伤寒欲传，而也适宜麻黄汤发汗的，是说乘寒邪有向表之浮，当散其数，而不令其至于传变。
程应旄说：麻黄汤，是寒伤营血的主方，但也应当在脉与证之间互相参酌，不必死守“紧”字，才是合法。脉浮无紧，似乎不在发汗之列，但是看其证，一一符合寒伤营血的表病，则不妨略脉而详证，无汗，可发汗，宜麻黄汤。若脉浮数，邪势欲传于里，也不妨略证而详脉，无汗，可发汗，也宜麻黄汤。就此二者的脉与证互相参酌，如果有脉见浮紧，证具伤寒，二者俱符，又有什么麻黄汤的禁忌呢！
刘宏璧说：但脉浮不紧，怎么知道是表寒实呢？必然无汗才可以发汗。脉数怎么知道没入里呢？因为脉兼浮所以可以发汗。
【注】
太阳病外证未解，指太阳病表证未解。如果脉浮紧，这是伤寒外证未解。现在脉浮弱，这是中风外证未解，所以应当用桂枝汤发汗解之。
【集注】
方有执说：外证未解，指头痛、项强、恶寒等证还在。浮弱即阳浮而阴弱，这里说太阳证凡在未传变的，仍应当从解表，这是严厉告诫不得早下的意思。
程知说：外证未解，脉见浮弱，即使日久也应当以汗解。但是只适宜桂枝解肌的方法，不宜误行大汗的药剂。至于不可误下，更不用说。
伤寒发汗已解，半天左右又烦，脉浮数的，可以再发汗，适宜用桂枝汤。
【注】
伤寒服麻黄发汗，汗出后，热退身凉解，半天左右又烦热而脉浮数的，是表邪未尽退而复聚，可以再发汗。不用麻黄汤的原因，是因为津液前次已被发汗所伤，不堪再承受麻黄，所以适宜用桂枝汤再次发汗。
【集注】
方有执说：伤寒发汗者，指服麻黄汤以发之。解，散也；复，重复也，既解半天左右，什么事又重复了呢？是说发汗或不如法，或汗后不谨风寒，而复烦热，脉转浮数，所以说可以再发汗。更，改也，说应当改前法，所以说适宜桂枝汤。
喻昌说：用桂枝汤的原因，一是邪重犯卫，一是营虚不能复任麻黄。
程应旄说：改前发汗之法为解肌，那么虽然主用桂枝，也不犯伤寒的禁忌。
汪琥说：仲景法脉浮而数的，可发汗，宜麻黄汤。但是这条已经曾用过麻黄汤了，所以应当更方以发其汗，宜桂枝汤。
【按】
发汗病不解的“不”字，应当是衍文。盖发汗病不解，则当恶寒，今日反恶寒的，正所谓病解之义，病解恶寒，始谓之虚。
【注】
伤寒、发汗病不解，则当恶寒，不是表虚，是表邪犹在不解，仍当汗。现在发汗汗出，病已解，不应当恶寒了。反恶寒的，不是表邪，乃阳虚不能卫外所致，所以用芍药甘草附子汤主治。大概用附子以扶阳，芍药以补阴，甘草佐附子、芍药补阴阳而调荣卫。
【集注】
方有执说：未汗而恶寒，邪盛而表实；已汗而恶寒，邪退而表虚，汗出之后，大邪退散，荣气衰微，卫气疏慢，而但恶寒，所以说虚。
[Formula Composition]
Mahuang (Ephedrae Herba, 麻黄) [devoid of nodes], three liang; Guizhi (Cinnamomi Ramulus, 桂枝), two liang; Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) [roasted], one liang; Xingren (Armeniacae Semen Amarum, 杏仁) [soaked in boiling water, devoid of skin and tips], seventy seeds.
The above four ingredients: Take nine sheng of water, first decoct Mahuang, reduce the volume by two sheng, remove the foam on the surface, add the remaining herbs, decoct to obtain two and a half sheng of liquid, filter out the dregs, take eight he warm. Cover with blankets to induce a slight sweat, no need to drink hot porridge, rest and care follow the method of Guizhi Tang.
[Formula Analysis]
Named Mahuang Tang because Mahuang is the Sovereign herb. Mahuang is warm in nature, pungent and bitter in taste, its action lies in rapid ascending and dispersing; Guizhi is warm in nature, pungent and sweet in taste, its function lies in consolidating the exterior. The syndrome belongs to excess, so Mahuang is used as the main strategy for victory; Guizhi acts as a monitor, serving as a disciplinarian to regulate. The bitter-warm nature of Xingren assists Mahuang in expelling pathogens and descending rebellious Qi; the sweet-flat nature of Gancao assists Guizhi in harmonizing the interior and repelling the exterior. Upon ingestion into the stomach, Qi circulates in the Yuan Fu (Primordial Mansion), essence is transported to the skin and hair. Thus, the hair and pulse essence combine, sweating profusely (Zhenzhen), pathogens in the exterior are completely eliminated without retention; pain stops, panting calms, cold and heat resolve instantly, without needing porridge to borrow grain Qi for sweating. It is necessary to boil and skim off the upper foam to prevent causing irritability, as that light and floating Qi excessively draws Qi upward in rebellion. The reason for not using Shengjiang (Zingiberis Rhizoma Recens, Fresh Ginger) and Dazao (Jujubae Fructus, Jujube) is that Shengjiang's nature spreads horizontally in the muscles, hindering Mahuang's rapid ascent; Dazao's nature is sticky and stagnant in the diaphragm, hindering Xingren's rapid descent. This aims for immediate direct action; slight delay makes it less rapid, horizontal spreading prevents ascent. However, this is a pure Yang formula, too strong in inducing sweat, like a general charging straight in. If used appropriately, success in one battle; if inappropriate, disaster due to lack of restraint. Therefore, it can be used once but not twice. If the condition does not resolve after sweating, replace it with Guizhi Tang. This formula is Zhang Zhongjing's first potent medicine for opening the exterior, expelling pathogens, and inducing sweat. Quack doctors do not know its potency depends on covering with warmth to induce sweat; without warming coverage, it is not potent, so they claim Mahuang only treats exterior release and nothing else. Little do they know that combining this decoction with Guizhi Tang forms Magui Ban Tang (Half-Mahuang-Half-Guizhi Decoction), used to harmonize lingering cold and heat in Taiyang; removing Xingren and adding Shigao (Gypsum Fibrosum, Gypsum), combined with Guizhi Tang, forms Guizhi Er Yuebi Yi Tang (Guizhi Two-Yuebi One Decoction), used to resolve cold and heat where heat predominates over cold in Taiyang; if Yang is excessive internally, with no sweat and panting, there is Mahuang Xingren Gancao Shigao Tang (Mahuang, Apricot Seed, Licorice, and Gypsum Decoction), to dissipate pathogens in the Taiyin Lung; if Yin is excessive internally with no sweat, there is Mahuang Fuzi Xixin Gancao Tang (Mahuang, Aconite, Asarum, and Licorice Decoction), to warm and dissipate cold in Shaoyin Kidney. *Jinkui Yaolue* removes Guizhi from this formula; *Qianjin Fang* replaces Guizhi with Guixin (Cinnamomi Cortex, Cinnamon Bark), both named Huanhun Tang (Soul-Returning Decoction), used to treat pathogens in Taiyin, sudden stroke coma, locked jaw, and absent breathing, effective upon swallowing, yet none require warming coverage to induce sweat. Thus, we know the potency of Mahuang Tang lies in whether warming coverage is applied. This is the secret method of Zhang Zhongjing in using formulas, how could ordinary people fathom it!
[Collected Explanations]
Wang Kentang said: This formula is set for those whose Yuan Qi (Primal Qi) is not deficient. If complicated by seasonal pathogens, Tenshen Tang (Ten Gods Decoction) is suitable; if complicated by summerheat-dampness, Zhengqi Tang (Upright Qi Decoction) is suitable; if complicated by cold, Wuji San (Five Accumulations Powder) is suitable; if complicated by heat, Tongsheng San (Unimpeded Generation Powder) is suitable; if complicated by food stagnation, Yangwei Tang (Nourish Stomach Decoction) is suitable; if complicated by phlegm, Xiong Su San (Ligusticum and Perilla Powder) is suitable. Wang Kentang's discussion is indeed appropriate. However, it must be a syndrome involving both exterior and interior, with complex pathogens, resembling Shaoyang but not being typical Shaoyang, before choosing among these formulas. If the pulse and symptoms match Mahuang Tang or Guizhi Tang, one should naturally follow Zhang Zhongjing's methods. Even if Yuan Qi is inherently deficient, or there is chronic heat, making Mahuang and Guizhi unsuitable, one must still treat slowly and carefully as Liu Wansu and Zhang Jiegong did, to avoid harming patients. Practitioners should examine meticulously.
Wu Shou said: In all cases of Shanghan (Cold Damage), when cold pathogens are in the exterior, closing the Cou Li (pores/skin texture), causing body pain and stiffness, aversion to cold, and anhidrosis, one must use the pungent and bitter properties of Mahuang to open the Cou Li, expel cold pathogens, and resolve through sweating. Only during the hot summer months, even if these symptoms exist, cool herbs should be added before use, such as Fangfeng Tongsheng San (Saposhnikovia Unimpeded Generation Powder) or Sanhuang Shigao Tang (Three Yellows and Gypsum Decoction).
On the first day of Shanghan, the Taiyang channel receives the pathogen. If the pulse remains quiet/stable, transmission has not occurred; if there is a strong desire to vomit, or restlessness/irritability, and the pulse is rapid and urgent, transmission is occurring.
[Annotation]
On the first day of Shanghan, receiving the pathogen in Taiyang, the pulse should be floating and tight. Whether sweat has been induced or not, if the pulse remains stable as usual, this indicates the patient's disease pulse matches the disease state, meaning no transmission. Initial vomiting that persists, a strong desire to vomit, or restlessness with a rapid and urgent pulse, indicates external pathogens have not resolved, internal heat has formed, and the disease trend is about to transmit. Daqinglong Tang (Major Green Dragon Decoction) should be used to release the exterior and clear heat to curb the momentum; or if there are heat signs in both exterior and interior, Shuangjie Tang (Double Resolution Decoction) should be used to resolve both.
[Collected Notes]
Shen Mingzong said: This relies on pulse differentiation to know if pathogens transmit. Floating and tight pulse is the normal pulse of Taiyang; if quiet, it means not transmitting to other channels. If there is a strong desire to vomit, or restlessness with a rapid and urgent pulse, the pathogenic mechanism has moved inward significantly, inevitably transmitting to cause disease.
On the second and third days of Shanghan, if Yangming and Shaoyang syndromes are not seen, transmission has not occurred.
[Annotation]
On the second day, Yangming receives the pathogen; on the third day, Shaoyang receives the pathogen; this is the norm. If on the second or third day, Yangming symptoms such as aversion to cold turning into aversion to heat, fever, irritability, thirst, and insomnia; and Shaoyang symptoms such as alternating chills and fever, chest/flank fullness, frequent vomiting, bitter taste, and deafness are not present, this is because the Taiyang pathogen is mild and heat is slight, not transmitting to Yangming or Shaoyang.
[Collected Notes]
Cheng Zhi said: Shanghan on days 1-2 affects Taiyang, days 2-3 affect Yangming, days 3-4 affect Shaoyang, days 4-5 affect Taiyin, days 5-6 affect Shaoyin, days 6-7 affect Jueyin; this merely states the norm! Variations are numerous: some stay in one channel without transmitting, some skip channels, some transmit to one or two channels and stop, some originate in Yang and enter Shaoyin directly, some strike the Three Yin directly, some transmit from Foot channels to Hand channels due to heat, some transmit due to erroneous medication. Generally, heat pathogens transmit when channel Qi is deficient; if channel Qi is solid, they do not receive pathogens and do not transmit. When Yang pathogens prevail, transmission occurs; when Yin pathogens prevail, transmission rarely occurs. Hence, it is said that a quiet pulse means no transmission, while a rapid and urgent pulse means impending transmission. Also, Foot channels ascend from the feet to the chest, abdomen, head, and back, governing the major outline of the body. Thus, when cold pathogens enter, they appear in their respective channels. Hand channels only traverse the chest and hands, unable to govern the major outline. Once pathogens enter Foot channels, they must transmit to Hand channels. Therefore, severe wind-cold causes headache, neck pain, shoulder, back, elbow, and joint pain. The Sages spoke of Foot channels but not Hand channels; Foot channels encompass Hand channels, but Hand channels cannot encompass Foot channels. This does not mean non-transmission to Hand channels. The Five Zang and Six Fu organs and Twelve Channels have Qi that circulates and collaterals that connect; how can there be transmission to Foot channels without Hand channels? Or injury to Foot channels without Hand channels? Yu Tianmin said heat starts in Hand channels, cold starts in Foot channels; the principles can also interconnect.
Cheng Yingmao said: The Six Channels of Shanghan are determined by depth. Skin is governed by Taiyang, hence named Taiyang; Muscle is governed by Yangming, hence named Yangming; Fascia is governed by Shaoyang, hence named Shaoyang. Hua Tuo said: Shanghan on day 1 is in the skin, day 2 in the flesh, day 3 in the muscle, day 4 in the chest, day 5 in the abdomen, day 6 enters the stomach. This roughly delineates depth within the body shell, without naming Taiyang, Yangming, etc. Thus, Zhang Zhongjing's division into Taiyang, Yangming, etc., is also about defining boundaries to manage the disease.
If the pulse is floating, the disease is in the exterior, sweating can be induced, Mahuang Tang is suitable. If the pulse is floating and rapid, sweating can be induced, Mahuang Tang is suitable.
[Annotation]
For Shanghan with a floating-tight pulse, Mahuang Tang is indeed the primary formula. Now, with floating or floating-rapid pulses, which seem outside the scope of sweating, however, viewing the pathology as exterior excess with no sweat due to cold damage, one may overlook the pulse and follow the syndrome, also using Mahuang Tang to induce sweat. Observing that it says "can induce sweat" rather than "use Mahuang Tang to release," there is room for deliberation.
[Collected Notes]
Fang Youzhi said: Shanghan pulse is originally tight; if not tight but floating, it is known that pathogens return to the exterior and wish to disperse. "Fa" (release) means pushing them out; Mahuang Tang takes advantage of this desire to disperse to push them out. Or if the pulse is floating and rapid, indicating Shanghan is about to transmit, yet Mahuang Tang is still suitable for sweating, it means taking advantage of the floating quality of cold pathogens moving outward, dispersing the rapidness, preventing transmission.
Cheng Yingmao said: Mahuang Tang is the primary formula for cold damaging Ying Blood, but one must mutually reference pulse and syndrome, not rigidly adhering to the character "tight" to be correct. Floating pulse without tightness seems outside the sweating category, but if symptoms fully match cold damaging Ying Blood exterior disease, one may overlook the pulse and detail the syndrome: no sweat, can induce sweat, suitable for Mahuang Tang. If pulse is floating and rapid, pathogen momentum desires to transmit inward, one may overlook syndrome and detail the pulse: no sweat, can induce sweat, also suitable for Mahuang Tang. Comparing these two pulses and syndromes, if pulse is floating-tight and syndrome presents Shanghan, both matching, what prohibition exists against Mahuang Tang!
Liu Hongbi said: But if pulse is floating and not tight, how to know it is exterior cold excess? Must be no sweat to induce sweat. How to know pulse rapidity hasn't entered the interior? Because the pulse is also floating, sweating is possible.
In Taiyang Bing (Taiyang Disease), if exterior signs are unresolved and the pulse is floating and weak, resolution via sweating is indicated, Guizhi Tang is suitable.
[Annotation]
Taiyang Bing exterior signs unresolved refers to Taiyang exterior syndrome unresolved. If pulse is floating and tight, this is Shanghan exterior unresolved. Now pulse is floating and weak, this is Fengzhong (Wind Strike) exterior unresolved, thus Guizhi Tang should be used to induce sweat and resolve.
[Collected Notes]
Fang Youzhi said: Exterior signs unresolved means headache, neck stiffness, aversion to cold, etc., persist. Floating and weak refers to Yang floating and Yin weak. Here, for Taiyang syndrome not yet transmitted, one should still resolve the exterior, strictly warning against early purgation.
Cheng Zhi said: Exterior unresolved, pulse floating and weak, even if prolonged, should be resolved via sweating. However, only Guizhi's method of resolving muscle layer is suitable, not mistaken large-sweat agents. Regarding avoiding mistaken purgation, it goes without saying.
After Shanghan sweating resolves, half a day later recurring irritability, pulse floating and rapid, can re-induce sweat, Guizhi Tang is suitable.
[Annotation]
After Shanghan treated with Mahuang, sweat produced, heat recedes, body cools and resolves, half a day later recurring fever and floating-rapid pulse, indicates exterior pathogens did not fully dissipate and gathered again, can re-induce sweat. Not using Mahuang Tang is because Jin Ye (Body Fluids) were previously damaged by sweating, unable to bear Mahuang again, thus Guizhi Tang is suitable for subsequent sweating.
[Collected Notes]
Fang Youzhi said: Shanghan sweating refers to administering Mahuang Tang to induce it. Resolve means disperse; Re means repeat. After resolving for half a day, why repeat? It means sweating was either improper or post-sweating exposure to wind-cold caused recurring fever and floating-rapid pulse, hence "can re-induce sweat." Geng (change) means alter, suggesting changing the previous method, hence Guizhi Tang is suitable.
Yu Chang said: Using Guizhi Tang is because pathogens heavily invade Wei (Defensive) level, and Ying (Nutritive) deficiency cannot tolerate Mahuang again.
Cheng Yingmao said: Changing the previous sweating method to resolving the muscle layer, although using Guizhi, does not violate Shanghan prohibitions.
Wang Hu said: Zhang Zhongjing's method states floating and rapid pulse can induce sweat, suitable for Mahuang Tang. However, this clause already used Mahuang Tang, so a new formula should be used to induce sweat, Guizhi Tang is suitable.
After sweating, disease unresolved, conversely experiencing aversion to cold, is due to deficiency, Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction) governs.
[Commentary]
The character "Bu" (not) in "disease unresolved" after sweating is likely a superfluous character. If disease were unresolved after sweating, aversion to cold would be expected. Saying "conversely aversion to cold" implies the disease has resolved, and the remaining aversion to cold signifies deficiency.
[Annotation]
In Shanghan, if disease is unresolved after sweating, aversion to cold should occur, indicating not exterior deficiency, but residual exterior pathogens unresolved, requiring sweating. Now, after sweating and perspiration, disease has resolved, aversion to cold should not occur. Conversely experiencing aversion to cold is not due to exterior pathogens, but Yang deficiency failing to protect the exterior, thus Shaoyao Gancao Fuzi Tang governs. Using Fuzi (Aconiti Lateralis Radix Praeparata, Prepared Aconite Root) to support Yang, Shaoyao (Paeoniae Radix Alba, White Peony Root) to nourish Yin, Gancao assists Fuzi and Shaoyao to tonify Yin and Yang and harmonize Ying and Wei.
[Collected Notes]
Fang Youzhi said: Before sweating, aversion to cold indicates pathogen excess and exterior excess; after sweating, aversion to cold indicates pathogen retreat and exterior deficiency. After sweating, major pathogens disperse, Ying Qi declines, Wei Qi becomes lax, resulting in mere aversion to cold, hence called deficiency.