发者，升之、散之、汗之也；表者，对里而言也。三阳为表，三阴为里，而太阳为表之
表，阳明为表之里，少阳为半表半里也。邪之伤人，先中于表，以渐而入于里，始自太阳，
以及
汗之
误补
筋脉
（仲景）
治伤寒太阳证，邪气在表，发热、头痛、身痛、腰痛、骨节痛、项背强，恶寒恶风（但
有一毫头痛恶寒，尚为在表），无汗而喘，脉浮而紧（寒邪外束，阳不得越，故郁而为热。
经曰∶人之伤寒，则为病热。寒国中人，必先在表，即足太阳寒水之经。太阳为诸阳主气，
乃一身纲维，本经之脉，起目 、上脑下项、循肩、挟脊、抵腰、行于身后，故所过之处无
不痛也。恶寒者，虽无风而恶寒；恶风者，当风而始恶之，故恶寒必兼恶风。恶寒有阴阳之
分，恶风惟属阳经，故三阴无恶风之证，风为阳邪，寒为阴邪也。《原病式》曰∶身热恶寒，
热在表也，热在表而浅，邪畏正，故病热而反恶寒，或言为寒在表，及热在皮肤，寒在骨髓
者，误也。凡人之伤风暑湿，皆有汗，惟伤寒独不汗出，寒能涩血，又表实也。气上逆故喘，
邪在表故脉浮，伤寒脉紧而伤风脉缓者，寒劲急而风缓散也。喻嘉言曰∶冬伤寒，春伤温，
夏秋伤暑伤湿，此四时正病也。然夏秋亦有伤寒，冬春亦有伤暑伤湿，乃四时之客病，所谓
异气也。冬春正病，有汗为伤风，无汗为伤寒；即夏秋正病，有汗为伤暑湿，无汗仍为伤寒。
亦治
宜
宜
之
提出太阳，不欲其陷入阳明，故不用葛根也）。亦治哮证（哮喘由风寒客于背俞，复感于寒
而作，
麻黄（去节。三两） 桂枝（二两） 杏仁（七十枚。去皮尖） 甘草（一两。炙用） 先
煮麻黄数沸，去沫，内诸药煎，热服，覆取微汗。中病即止，不必尽剂，无汗再服（凡用麻
黄去节，醋汤略泡，
汗出则愈。《活人
藏曰∶表证当汗，
三阳，汗当急而
急下、少与、微
此足太阳药也。麻黄中空，辛温气薄，肺家专药，而走太阳，能开腠散寒（皮腠，肺之
所主，寒从此入，仍从此出）；桂枝辛温，能引营分之邪，达之肌表（桂入营血，能解肌，
营卫和，始能作汗）；杏仁苦甘，散寒而降气；甘草甘平，发散而和中。经曰∶寒淫于内，
治以甘热，佐以苦辛是已（喻嘉言曰∶麻黄发汗，其力最猛，故以桂枝监之，甘草和之，用
杏仁润下以止喘逆。正如驭马防其放逸耳。李士材曰∶古云冬不用麻黄，夏不用桂枝，盖以
冬主闭藏，不应疏泄，夏令炎热，不宜辛温，经所谓必先岁气，毋伐天和是也。又云∶夏月
不用麻黄，两说相反何耶。或舍时从证，或舍证从时，临时变通，存乎其人耳。李时珍曰∶
仲景治伤寒，无汗用麻黄，有汗用桂枝，未有究其精微者。津液为汗，汗即血也，在营则为
血，在卫则为汗。寒伤营，营血内涩，不能外通于卫，卫气闭固，津液不行，故无汗发热而
恶寒；风伤卫，卫气外泄，不能内护于营，营气虚弱，津液不固，故有汗发热而恶风。然风
寒皆由皮毛而入，皮毛，肺之合也，证虽属太阳，然面赤怫郁、咳嗽有痰，喘而胸满，非肺
病乎。盖皮毛外闭，则邪热内攻，故用麻黄、甘草，同桂枝引出营分之邪，达之肌表，佐以
杏仁泄肺而利气。汗后无大热而喘者，加石膏。《活人书》∶夏至后加石膏、知母，是皆泄肺
火之药，是麻黄汤虽太阳发汗重剂，实散肺经火郁之药。腠理不密，则津液外泄，而肺气虚，
虚则补其母，故用桂枝同甘草，外散风邪以救表，内伐肝木以防脾；佐以芍药泻木而固脾；
使以姜枣行脾之津液而和营卫。下后微喘者，加浓朴、杏仁以利肺气也；汗后脉沉迟者，加
人参以益肺气也。《活人书》加黄芩为阳旦汤，以泄肺热也，是桂枝汤虽太阳解肌轻剂，实
为理脾救肺之药也。王履曰∶伤寒即病者，谓之伤寒，不即病者，谓之温暑，其原不殊，故
一称为伤寒，其类则殊，施治不得相混。仲景之书，专为即病之伤寒设，不兼为不即病之温
暑设也，今人或以伤寒法治温暑，不过借用耳。三阴伤寒，寒证十居七八，若温暑但一于热
耳，后人误为通治，遂疑诸热剂不敢用，是未悟仲景立麻黄、桂枝汤之有所主，有其时矣，
苟知非治温暑之剂，则群疑冰释矣。又曰∶伤寒即发于冬寒之时，寒邪在表，闭其腠理，非
辛温不能散之，此麻黄、桂枝等剂所以必用也；温病热病，发于喧热之时，郁热自内达外，
无寒在表，故非辛凉、苦寒、苦酸之剂不能解之，此桂枝、麻黄等所以不可用，而后人所处
水解散、大黄汤、千金汤、防风通圣之类，兼内外者之所以可用也。夫即病之伤寒，有恶风
恶寒之证者，风寒在表，表气受伤也；后发之温热病，有恶风恶寒之证者，必重感风寒，而
表气亦受伤也，若无新中之风寒，则无恶风恶寒之证，故仲景曰∶“太阳病，发热而渴，不
恶寒者，为温病”。温病如此，则知热病亦如此，而不渴恶寒者，非温热病矣。或有不因新
中风寒亦见恶风恶寒之证者，盖因表虚热达于表而伤表气，所谓卫虚则恶风，营虚则恶寒耳，
非伤风恶风，伤寒恶寒也。温病热病，亦有先见表证而后传里者，盖郁热自内达外，外不得
泄，还复入里，而成可攻之证，非如伤寒从表而始也。每见世人治温热病，误攻其里，亦无
大害，误发其表，变不可言，此足明其热之自内达外矣。间有误攻致害者，乃春夏暴寒所中
之疫证，邪纯在表，未入于里，不可与温病热病同论。夫秋冬伤寒，真伤寒也，春夏伤寒，
寒疫也，与温病热病自是两途，岂可同治。况伤寒直中阴经，与太阳虽伤，不及郁热，即传
阴经为寒证而当温者，又与温病热病大不同，其可混治乎。一阳子曰∶伤寒传足不传手，非
穷理之言也。草窗刘子指足经所属水土木，水遇寒而涸冰，土遇寒而坼裂，木遇寒而凋枯，
故寒善伤之；手经所属金与火，金遇寒而越坚，火体极热，寒不能袭，故寒不能伤。昧者奇
之，将人身营卫经络，上下截断，不相联系，失血气周流、瞬息罔间之旨矣。夫寒邪袭人，
必先皮毛灼热，鼻塞息粗，肺主皮毛，是手太阴肺辛金先受病矣，海藏有伤寒自皮毛入之语，
先师有桂麻羌芎之设，虽太阳表之表之剂，然汗法舍皮毛何自而解；更衣悖常，结闭溏泄，
手阳明大肠庚金病矣，先师有硝黄朴实之用，虽兼正阳三阴里之里之剂，然下法舍大肠何自
而通；刘子谓金遇寒而越坚，信乎。阳气怫郁，舌苔、言妄，手少阴心丁火病矣；先师有泻
心数法；亢极动血，上下烦蒸，手厥阴心包火，手少阳三焦火病矣，治有三黄、柴芩数条；
小便癃秘，手太阳小肠丙火病矣，治有五苓，导赤之例；刘子谓火热寒不能伤，信乎。经又
云∶人之伤寒，则为病热，既云病热，则无水冰土坼木枯之说，而有金烁火亢之征矣，刘子
何人，敢恃管见惑世诬人哉。《机要》云∶有厥阴经下利不止，脉沉而迟，手足厥逆，唾涕
脓血，此难治，宜麻黄汤、小续命汤汗之，此有表邪缩于内，当泻表而愈。张子和曰∶飧泄
以风为根，风非汗不出。有病此者，腹中雷鸣，水谷不分，小便滞涩，服涩药温药不效，灸
中脘脐下数壮，燥热转甚，津液枯竭。延余视之，脉浮大而长，身表微热，用桂枝麻黄汤，
加姜枣煎，连进三大剂，汗出终日，至旦而愈，次以胃风汤和其脏腑，食进而安。经曰∶春
伤于风，夏必飧泄，故可汗而愈。按风属木，脾属土，木克土，故泄也。附∶大黄汤∶大黄
两半 芒硝 大腹皮 木通 甘草各一两 桂心七钱半 桃仁二十一枚。治阳毒伤寒未解，
热在内，恍惚如狂。破棺千金汤∶苦参一两。酒煮，取吐，治天行热毒垂死。水解散、防
通圣散，见表里门。）
本方除桂枝，加石膏，名麻黄杏仁甘草石膏汤（仲景）∶治汗下后不可更行桂枝汤，汗
出而喘，无大热者（或问发汗后不可更行桂枝汤，桂枝既不可行，麻黄可行耶；无大热，石
膏可行耶。喻嘉言曰∶治伤寒先分营卫，桂麻二汤，断无混用之理，此证太阳之邪，虽从汗
解，然肺中热邪未尽，所以热虽少止，喘仍不止，故用麻黄发肺邪，杏仁下肺气，甘草缓肺
急，石膏清肺热，即以治足太阳之药，通治手太阴经也。倘误行桂枝，宁不壅塞肺气而吐痈
脓乎）；亦治温疟先热后寒。本方加白术，名麻黄加术汤（金匮）∶治湿家身体烦痛，宜发汗。
本方去桂枝、杏仁，加附子，名麻黄附子汤（金匮）∶治脉沉虚胀者，为气水，属少阴，发
其汗即止。本方除桂枝、杏仁，名甘草麻黄汤（金匮）∶治里水（一身面目黄肿，脉沉，小
便不利，重覆取汗）。本方去桂用麻黄（不去节），杏仁（不去皮尖），甘草（生用），名三拗
汤（《局方》）∶治感冒风寒，咳嗽，鼻塞（麻黄留节，发中有收；杏仁留尖，取其发，连皮，
取其涩；甘草生用，补中
忌汗诸（证仲景曰∶阳盛阴虚，下之则愈，汗之则死；阴盛阳虚，汗之则愈，下之则死。
脉浮
汗，
利虽
津液
夺汗
桂枝
汗则
在里
竭，
虚里
动气者
伤寒伤风辨（伤寒郁而后能发热，伤风即能发热；伤寒无汗，伤风有汗；伤寒无涕，伤
风
阴阳表里（辨阳证之表，发热恶寒，头痛，脊强、便清、不渴，手足温和；阴证之表，
无热恶寒，面惨息冷，手足厥逆。阳证之里，唇焦舌燥，烦渴掀衣，扬手掷足，大便秘结，
小便赤涩，爪甲红活，身轻易于转侧，脉浮洪数；阴证之里，不渴，蜷卧，引衣自盖，唇紫
舌卷，大便滑泄，小便清白，爪甲青黑，身重难于转侧，脉沉细数；惟腹痛与呕，阴阳里证
皆有之。三阳经又有阴阳表里之分；太阳以热在皮肤，头痛项强，在经为表，麻黄汤、桂枝
汤、九味羌活汤；以口渴尿赤，热入膀胱，在腑为里，五苓散。阳明以热在肌肉，目痛不眠，
在经
为
芩
湿
八
发，是指提升、发散、发汗；表，是相对于里而言的。三阳经属于表，三阴经属于里，其中太阳经是表中之表，阳明经是表中之里，少阳经是半表半里。邪气伤害人体，先侵犯体表，逐渐深入体内，起始于太阳经，进而传入其他经络。
（张仲景）治疗伤寒太阳证，邪气在体表，出现发热、头痛、身痛、腰痛、骨节疼痛、项背强直，恶寒恶风（只要有一点点头痛恶寒，说明病邪仍在表），无汗且气喘，脉象浮而紧（寒邪束缚体表，阳气不能外越，所以郁结而生热。经典说：人受寒邪，就会生病发热。寒邪中人，必定先在体表，即足太阳寒水之经。太阳经统领诸阳之气，是一身的纲领，本经的脉气，起于目内眦，上达脑部，下行至项部，沿肩部，夹脊而行，抵腰部，行于身后，所以经过的地方没有不痛的。恶寒，是没有风也感到寒冷；恶风，是有风才感到寒冷，所以恶寒必然兼有恶风。恶寒有阴阳之分，恶风只属于阳经，所以三阴经没有恶风的证候，风是阳邪，寒是阴邪。《原病式》说：身体发热恶寒，热在体表，热在体表且浅，邪气畏惧正气，所以生病发热反而恶寒，有人说寒在体表，以及热在皮肤、寒在骨髓的说法，是错误的。凡是人伤于风、暑、湿，都有汗出，只有伤寒唯独不出汗，寒性能使血液涩滞，又是表实证。气机上逆所以气喘，邪气在表所以脉浮，伤寒脉紧而伤风脉缓，是因为寒性劲急而风性缓散。喻嘉言说：冬天伤于寒，春天伤于温，夏秋伤于暑湿，这是四时的正病。然而夏秋也有伤寒，冬春也有伤暑伤湿，这是四时的客病，所谓异气。冬春的正病，有汗是伤风，无汗是伤寒；即使夏秋的正病，有汗是伤暑湿，无汗仍然是伤寒。……提出太阳经的病，不希望其陷入阳明经，所以不用葛根）。也治疗哮证（哮喘由风寒客居于背部腧穴，又感受寒邪而发作，……麻黄（去节。三两） 桂枝（二两） 杏仁（七十枚。去皮尖） 甘草（一两。炙用） 先煮麻黄数沸，去掉沫，加入其他药物煎煮，热服，覆盖取微汗。中病即止，不必喝完一剂，无汗再服（凡是用麻黄要去节，醋汤略泡，……汗出则愈。《活人书》说：藏曰：表证应当发汗，……三阳经，发汗应当急而……急下、少量、微……这是足太阳经的药。麻黄中空，辛温气薄，是肺家的专药，而走太阳经，能开泄腠理散发寒邪（皮腠，由肺所主，寒邪从此入，仍从此出）；桂枝辛温，能引营分之邪，达之于肌表（桂枝入营血，能解肌，营卫调和，才能作汗）；杏仁苦甘，散寒而降气；甘草甘平，发散而和中。经典说：寒淫于内，治以甘热，佐以苦辛，就是这个道理（喻嘉言说：麻黄发汗，力量最猛，所以用桂枝来制约它，甘草来调和它，用杏仁润下以止喘逆。就像驾驭马匹防止其放逸一样。李士材说：古话说冬天不用麻黄，夏天不用桂枝，大概因为冬天主闭藏，不应疏泄，夏令炎热，不宜辛温，经典所说必须首先顺应岁气，不要伐害天和就是这个意思。又说：夏天不用麻黄，两种说法相反，为什么呢？或者是舍时从证，或者是舍证从时，临时变通，取决于医生自己。李时珍说：张仲景治疗伤寒，无汗用麻黄，有汗用桂枝，没有人探究其中的精微之处。津液化为汗，汗就是血，在营分则为血，在卫分则为汗。寒伤营，营血内涩，不能外通于卫，卫气闭固，津液不行，所以无汗发热而恶寒；风伤卫，卫气外泄，不能内护于营，营气虚弱，津液不固，所以有汗发热而恶风。然而风寒都由皮毛而入，皮毛是肺的合应，证候虽然属于太阳，然而面赤怫郁、咳嗽有痰，喘而胸满，难道不是肺病吗？大概皮毛外闭，则邪热内攻，所以用麻黄、甘草，同桂枝引出营分之邪，达之于肌表，佐以杏仁泄肺而利气。汗后无大热而喘者，加石膏。《活人书》：夏至后加石膏、知母，这些都是泄肺火的药，这说明麻黄汤虽然是太阳经发汗的重剂，实际上是散肺经火郁的药。腠理不密，则津液外泄，而肺气虚，虚则补其母，所以用桂枝同甘草，外散风邪以救表，内伐肝木以防脾；佐以芍药泻木而固脾；使以姜枣行脾之津液而和营卫。下后微喘者，加浓朴、杏仁以利肺气也；汗后脉沉迟者，加人参以益肺气也。《活人书》加黄芩为阳旦汤，以泄肺热也，这说明桂枝汤虽然是太阳经解肌的轻剂，实际上是理脾救肺的药。王履说：伤寒即病的，叫做伤寒，不即病的，叫做温暑，它们的本源没有不同，所以统称为伤寒，但类别则不同，施治不得相混。张仲景的书，专为即病的伤寒设立，不兼为不即病的温暑设立，现在的人有时用伤寒法治温暑，不过是借用罢了。三阴伤寒，寒证十居七八，如果温暑只是一于热而已，后人误以为可以通治，于是怀疑各种热剂不敢用，这是没有领悟张仲景立麻黄、桂枝汤有所主治，有其时令了，假如知道它们不是治疗温暑的药剂，那么群疑冰释了。又说：伤寒即发于冬寒之时，寒邪在表，闭塞腠理，非辛温不能散之，这是麻黄、桂枝等剂所以必用的原因；温病热病，发于喧热之时，郁热自内达外，无寒在表，所以非辛凉、苦寒、苦酸之剂不能解之，这是桂枝、麻黄等所以不可用，而后人所处水解散、大黄汤、千金汤、防风通圣之类，兼顾内外的所以可用的原因。夫即病的伤寒，有恶风恶寒证候的，是风寒在表，表气受伤；后发的温热病，有恶风恶寒证候的，必定重感风寒，而表气也受伤，如果没有新中的风寒，就没有恶风恶寒的证候，所以张仲景说：“太阳病，发热而渴，不恶寒者，为温病”。温病如此，则知热病也是如此，而不渴恶寒的，就不是温热病了。或者有不因新中风寒也见恶风恶寒证候的，大概因为表虚热达于表而伤表气，所谓卫虚则恶风，营虚则恶寒耳，不是伤风恶风，伤寒恶寒。温病热病，也有先见表证而后传里的，大概郁热自内达外，外不得泄，还复入里，而成可攻之证，不像伤寒从表开始。每见世人治疗温热病，误攻其里，也没有大害，误发其表，变化不可言说，这足以证明热是自内达外的。间或有误攻致害的，乃是春夏暴寒所中的疫证，邪纯在表，未入于里，不可以与温病热病同论。夫秋冬伤寒，是真伤寒，春夏伤寒，是寒疫，与温病热病自是两途，岂可同治。况且伤寒直中阴经，与太阳虽伤，不及郁热，即传阴经为寒证而当温的，又与温病热病大不同，岂可混治。一阳子说：伤寒传足不传手，不是穷究事理的话。草窗刘子指出足经所属的水土木，水遇寒而涸冰，土遇寒而坼裂，木遇寒而凋枯，所以寒善伤之；手经所属的金与火，金遇寒而越坚，火体极热，寒不能袭，所以寒不能伤。愚昧者对此感到奇怪，将人身营卫经络，上下截断，不相联系，失却了血气周流、瞬息不间断的宗旨。夫寒邪袭人，必先皮毛灼热，鼻塞息粗，肺主皮毛，是手太阴肺辛金先受病矣，海藏有伤寒自皮毛入之语，先师有桂麻羌芎之设，虽然是太阳表之表的药剂，然而汗法舍皮毛何自而解；更衣悖常，结闭溏泄，手阳明大肠庚金病矣，先师有硝黄朴实之用，虽然是兼正阳三阴里之里的药剂，然而下法舍大肠何自而通；刘子谓金遇寒而越坚，信乎。阳气怫郁，舌苔、言语狂妄，手少阴心丁火病矣；先师有泻心数法；亢极动血，上下烦蒸，手厥阴心包火，手少阳三焦火病矣，治有三黄、柴芩数条；小便癃秘，手太阳小肠丙火病矣，治有五苓，导赤之例；刘子谓火热寒不能伤，信乎。经典又说：人受寒邪，就会生病发热，既然说病热，就没有水冰土坼木枯的说法，而有金烁火亢的征象了，刘子是何人，敢恃管见惑世诬人哉。《机要》说：有厥阴经下利不止，脉沉而迟，手足厥逆，唾涕脓血，这难治，宜用麻黄汤、小续命汤发汗，这是有表邪缩于内，当泻表而愈。张子和说：飧泄以风为根，风非汗不出。有病此者，腹中雷鸣，水谷不分，小便滞涩，服涩药温药不效，灸中脘脐下数壮，燥热转甚，津液枯竭。延余视之，脉浮大而长，身表微热，用桂枝麻黄汤，加姜枣煎，连进三大剂，汗出终日，至旦而愈，次以胃风汤和其脏腑，食进而安。经典说：春伤于风，夏必飧泄，故可汗而愈。按风属木，脾属土，木克土，故泄也。附：大黄汤：大黄两半 芒硝 大腹皮 木通 甘草各一两 桂心七钱半 桃仁二十一枚。治阳毒伤寒未解，热在内，恍惚如狂。破棺千金汤：苦参一两。酒煮，取吐，治天行热毒垂死。水解散、防通圣散，见表里门。）
本方除去桂枝，加石膏，名麻黄杏仁甘草石膏汤（张仲景）：治疗汗下后不可更行桂枝汤，汗出而喘，无大热者（有人问发汗后不可更行桂枝汤，桂枝既然不可行，麻黄可行耶；无大热，石膏可行耶。喻嘉言说：治疗伤寒先分营卫，桂麻二汤，断无混用之理，此证太阳之邪，虽从汗解，然肺中热邪未尽，所以热虽少止，喘仍不止，故用麻黄发肺邪，杏仁下肺气，甘草缓肺急，石膏清肺热，即以治足太阳之药，通治手太阴经也。倘若误行桂枝，宁不壅塞肺气而吐痈脓乎）；也治疗温疟先热后寒。本方加白术，名麻黄加术汤（《金匮要略》）：治疗湿家身体烦痛，宜发汗。本方去桂枝、杏仁，加附子，名麻黄附子汤（《金匮要略》）：治疗脉沉虚胀者，为气水，属少阴，发其汗即止。本方除桂枝、杏仁，名甘草麻黄汤（《金匮要略》）：治疗里水（一身面目黄肿，脉沉，小便不利，重覆取汗）。本方去桂用麻黄（不去节），杏仁（不去皮尖），甘草（生用），名三拗汤（《局方》）：治疗感冒风寒，咳嗽，鼻塞（麻黄留节，发中有收；杏仁留尖，取其发，连皮，取其涩；甘草生用，补中……忌汗诸证。张仲景说：阳盛阴虚，下之则愈，汗之则死；阴盛阳虚，汗之则愈，下之则死。脉浮……汗，……利虽……津液……夺汗……桂枝……汗则……在里……竭，……虚里……动气者……
伤寒伤风辨（伤寒郁而后能发热，伤风即能发热；伤寒无汗，伤风有汗；伤寒无涕，伤风有涕……
阴阳表里（辨阳证之表，发热恶寒，头痛，脊强、便清、不渴，手足温和；阴证之表，无热恶寒，面惨息冷，手足厥逆。阳证之里，唇焦舌燥，烦渴掀衣，扬手掷足，大便秘结，小便赤涩，爪甲红活，身轻易于转侧，脉浮洪数；阴证之里，不渴，蜷卧，引衣自盖，唇紫舌卷，大便滑泄，小便清白，爪甲青黑，身重难于转侧，脉沉细数；惟腹痛与呕，阴阳里证皆有之。三阳经又有阴阳表里之分；太阳以热在皮肤，头痛项强，在经为表，麻黄汤、桂枝汤、九味羌活汤；以口渴尿赤，热入膀胱，在腑为里，五苓散。阳明以热在肌肉，目痛不眠，在经……为……芩……湿……八……）
Fa (Releasing the Exterior) refers to lifting, dispersing, and inducing sweating; Biao (Exterior) is defined in contrast to Li (Interior). The Three Yang meridians belong to the Exterior, while the Three Yin meridians belong to the Interior. Among them, the Taiyang (Greater Yang) meridian is the exterior of the exterior, the Yangming (Bright Yang) meridian is the interior of the exterior, and the Shaoyang (Lesser Yang) meridian is half-exterior and half-interior. Pathogenic factors damaging the human body first invade the exterior and gradually enter the interior, starting from the Taiyang meridian and then spreading to others.
(Zhang Zhongjing) treats Taiyang syndrome of Shanghan (Cold Damage), where pathogenic factors are in the exterior, presenting with fever, headache, body pain, lower back pain, joint pain, stiffness of the neck and back, aversion to cold and wind (if there is even a slight headache or aversion to cold, it indicates the pathogen is still in the exterior), absence of sweat, panting, and a floating and tight pulse (Cold pathogen binds the exterior, preventing Yang Qi from venting outward, thus causing stagnation and heat. The Classics state: When humans contract Cold, they develop febrile disease. Cold invading humans must first affect the exterior, specifically the Foot-Taiyang Bladder meridian of Water. The Taiyang meridian governs all Yang Qi and serves as the framework for the whole body. Its pulse originates at the inner canthus, ascends to the brain, descends to the nape, follows the shoulder, runs along the spine, reaches the waist, and travels along the posterior aspect of the body; therefore, no area it passes through is free from pain. Aversion to cold occurs even without wind; aversion to wind occurs only when exposed to wind, so aversion to cold always accompanies aversion to wind. Aversion to cold has Yin-Yang distinctions, but aversion to wind belongs exclusively to Yang meridians; thus, the Three Yin meridians do not present with aversion to wind. Wind is a Yang pathogen, while Cold is a Yin pathogen. *Yuan Bing Shi* states: Body heat with aversion to cold indicates Heat in the exterior. Since the Heat is superficial and the pathogen fears the healthy Qi, the patient feels hot yet paradoxically averse to cold. Some claim Cold is in the exterior, or that Heat is in the skin and Cold is in the marrow; these are errors. Generally, injuries by Wind, Summerheat, and Dampness involve sweating; only Shanghan uniquely lacks sweating because Cold congeals blood and represents an Excess condition of the exterior. Qi rebelling upward causes panting; pathogen in the exterior causes a floating pulse. In Shanghan, the pulse is tight; in Shangfeng (Wind Injury), it is slow, because Cold is rigid and urgent while Wind is slack and diffuse. Yu Jiayan says: Winter injury by Cold, Spring injury by Warmth, Summer/Autumn injury by Summerheat/Dampness are the regular diseases of the four seasons. However, Shanghan occurs in Summer/Autumn, and injury by Summerheat/Dampness occurs in Winter/Spring; these are irregular diseases of the four seasons, known as "different qi." For regular diseases in Winter/Spring, sweating indicates Wind Injury, lack of sweating indicates Shanghan; similarly, for regular diseases in Summer/Autumn, sweating indicates Summerheat/Dampness, while lack of sweating remains Shanghan... Highlighting the Taiyang meridian prevents the pathogen from sinking into the Yangming meridian, hence Ge Gen (Kudzu Root) is not used). It also treats Asthma (Asthma arises when Cold-Dampness lodges in the Back-Shu points and is aggravated by further Cold exposure... Mahuang (Ephedrae Herba, stem tips removed. 3 liang) Guizhi (Cinnamomi Ramulus, 2 liang) Xingren (Prunus Semen, peeled and cored, 70 seeds) Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 1 liang). Boil Mahuang first for several boils, skim off the foam, then add other herbs and decoct. Take warm. Cover to induce slight sweating. Stop once the illness is addressed; do not necessarily finish the dose. If no sweat, take again (When using Mahuang, remove the nodes, briefly soak in vinegar water... Sweating leads to recovery. *Huo Ren Shu* states: Zang said: Exterior syndromes should be treated with sweating... The Three Yang meridians require prompt sweating... Prompt purgation, small doses, mild effects... This is a medicine for the Foot-Taiyang meridian. Mahuang is hollow, acrid-warm with thin aroma, a specific drug for the Lung organ, acting on the Taiyang meridian, capable of opening the Couli (skin pores) and dispelling Cold (The Couli are governed by the Lung; Cold enters here and exits here); Guizhi is acrid-warm, capable of drawing out pathogens from the Ying (Nutritive) level and reaching the muscle surface (Guizhi enters Ying-Blood, resolves the muscle layer; only when Ying and Wei harmonize can sweat be produced); Xingren is bitter-sweet, disperses Cold and directs Qi downward; Gancao is sweet-neutral, disperses and harmonizes the Middle. The Classics state: When Cold invades internally, treat with sweet-hot, assisted by bitter-acrid. This is correct (Yu Jiayan says: Mahuang's sweating power is strongest, so Guizhi restrains it, Gancao harmonizes it, and Xingren moistens and descends to stop panting. It is like controlling a horse to prevent it from running wild. Li Shicai says: Ancient saying goes "Do not use Mahuang in Winter, do not use Guizhi in Summer," because Winter governs storage and should not promote dispersion, while Summer is hot and unsuitable for acrid-warm herbs. The Classics say one must first respect the annual Qi and not violate the Harmony of Heaven. Another saying is "Do not use Mahuang in Summer." Why are these two statements contradictory? One may abandon the season to follow the syndrome, or abandon the syndrome to follow the season; flexibility depends on the physician. Li Shizhen says: Zhang Zhongjing treated Shanghan, using Mahuang for no sweat and Guizhi for sweating, but few have explored its subtleties. Body fluids transform into sweat; sweat is blood. In Ying it is blood, in Wei it is sweat. Cold injures Ying, causing internal stagnation of Ying-blood, preventing external connection to Wei; Wei Qi becomes closed and solid, body fluids fail to circulate, resulting in no sweat, fever, and aversion to cold; Wind injures Wei, causing external leakage of Wei Qi, failing to protect Ying internally; Ying Qi becomes weak, body fluids become insecure, resulting in sweating, fever, and aversion to wind. However, both Wind and Cold enter via the skin and hair, which are the exterior correspondence of the Lung. Although the syndrome belongs to Taiyang, symptoms like red face, oppression, cough with phlegm, panting, and chest fullness indicate Lung disease. Basically, when the skin and hair close externally, pathogenic Heat attacks internally. Thus, Mahuang and Gancao, combined with Guizhi, draw out Ying-level pathogens and bring them to the muscle surface, assisted by Xingren to drain the Lung and benefit Qi. After sweating, if there is no high fever but panting persists, add Shigao (Gypsum Fibrosum). *Huo Ren Shu*: Add Shigao and Zhimu after Summer Solstice; these are drugs that drain Lung Fire. This shows that although Mahuang Tang is a heavy sweating agent for Taiyang, it is actually a drug that disperses Lung Fire stagnation. If Couli are not tight, body fluids leak externally, leading to Lung Qi deficiency. Deficiency requires tonifying the Mother, so Guizhi and Gancao are used to externally disperse Wind and save the Exterior, while internally attacking Liver Wood to protect the Spleen; assisted by Shaoyao (Paeoniae Radix Alba) to drain Wood and secure the Spleen; guided by Jiang (Zingiberis Rhizoma) and Zao (Jujubae Fructus) to move Spleen fluids and harmonize Ying and Wei. After purgation, if slight panting occurs, add Houpo (Magnoliae Officinalis Cortex) and Xingren to benefit Lung Qi; after sweating, if the pulse is deep and slow, add Renshen (Ginseng Radix et Rhizoma) to benefit Lung Qi. *Huo Ren Shu* adds Huangqin (Scutellariae Radix) to form Yangdan Tang to drain Lung Heat. This shows that although Guizhi Tang is a light muscle-resolving agent for Taiyang, it is essentially a drug regulating the Spleen and saving the Lung. Wang Lv says: Shanghan occurring immediately after contraction is called Shanghan; that not occurring immediately is called Wenshu (Warmth/Summerheat). Their origin is the same, so they are collectively called Shanghan, but their categories differ, and treatments must not be mixed. Zhang Zhongjing's book was designed specifically for immediate Shanghan, not for delayed Wenshu. Modern physicians sometimes use Shanghan methods for Wenshu, merely borrowing. In Three Yin Shanghan, Cold syndromes account for 70-80%. If Wenshu is purely Heat, later generations mistakenly thought they could be treated generally, leading to suspicion of using heat-promoting agents. This fails to realize that Zhang Zhongjing established Mahuang and Guizhi Tangs for specific indications and seasons. If one knows they are not for Wenshu, doubts will dissolve. He further says: Shanghan occurs in winter cold; Cold pathogen is in the exterior, closing Couli, requiring acrid-warm herbs to disperse it, hence Mahuang and Guizhi are essential. Wenshu and Rebing (Heat Disease) occur in hot weather; stagnant Heat reaches outward from within, with no Cold in the exterior, so acrid-cool, bitter-cold, or bitter-sour agents are required for resolution, making Guizhi and Mahuang unusable. Later prescriptions like Shuijie San, Dahuang Tang, Qianjin Tang, and Fangfeng Tongsheng San, which address both interior and exterior, are usable. Immediate Shanghan with aversion to wind/cold indicates Wind-Cold in the exterior damaging Exterior Qi. Delayed Wenshu/Rebing with aversion to wind/cold indicates secondary contraction of Wind-Cold damaging Exterior Qi. Without new Wind-Cold, there is no aversion to wind/cold. Hence Zhang Zhongjing said: "Taiyang syndrome, fever with thirst and no aversion to cold, is Wenshu." Knowing this for Wenshu implies Rebing is similar; those without thirst and aversion to cold are not Wenshu. Some may show aversion to wind/cold without new Wind-Cold due to Exterior deficiency allowing Heat to reach the exterior and damage Exterior Qi, i.e., Wei deficiency causes aversion to wind, Ying deficiency causes aversion to cold, distinct from Wind Injury or Shanghan. Wenshu/Rebing may start with exterior signs and transmit inward; stagnant Heat reaches outward, cannot vent, returns inward, forming attackable syndromes, unlike Shanghan which starts from the exterior. Seeing people treat Wenshu by wrongly purging the interior causes little harm, but wrongly releasing the exterior leads to unpredictable changes, proving Heat comes from within. Rare cases of harm from purging are epidemic syndromes caused by sudden Cold in Spring/Summer, where pathogen is purely in the exterior and has not entered the interior; these cannot be discussed with Wenshu/Rebing. Winter/Autumn Shanghan is true Shanghan; Spring/Summer Shanghan is Cold Epidemic, distinct from Wenshu/Rebing. Moreover, Shanghan directly invading Yin meridians, or transmitting to Yin as Cold syndromes requiring warming, differs greatly from Wenshu/Rebing; how can they be mixed? Yi Yangzi said: "Shanghan transmits to Foot meridians but not Hand meridians" is not a reasoned statement. Caochuang Liu Zi pointed out that Foot meridians correspond to Water, Earth, Wood; Water freezes in Cold, Earth cracks in Cold, Wood withers in Cold, so Cold harms them. Hand meridians correspond to Metal and Fire; Metal hardens in Cold, Fire is extremely hot and Cold cannot attack, so Cold does not harm them. Ignorant people find this strange, severing Ying-Wei and meridians above and below, losing the principle of continuous Qi circulation. Cold invading humans first causes burning skin, nasal congestion, coarse breathing. Lung governs skin/hair; thus Hand-Taiyin Lung Metal is affected first. Haizang said Shanghan enters via skin/hair. Ancestors prescribed Guizhi, Mahuang, Qianghuo, Xionggu. Although these are exterior-releasing agents for Taiyang, how else can sweating resolve the pathogen except via skin/hair? Abnormal bowel movements, constipation or loose stools indicate Hand-Yangming Large Intestine Geng Metal disease. Ancestors used Xiaoshi (Mirabilitum), Dahuang (Rhei Radix et Rhizoma), Houpo, Rushi. Although these are interior-purging agents for Yangming and Three Yin, how else can purgation open the Large Intestine? Liu Zi claims Metal hardens in Cold; is this true? Yang Qi stagnation, tongue coating, delirious speech indicate Hand-Shaoyin Heart Ding Fire disease; ancestors had multiple methods for Xiexin Tang. Hyperactivity moving Blood, upper/lower vexation and steaming indicate Hand-Jueyin Pericardium Fire and Hand-Shaoyang Sanjiao Fire disease; treatments include Sanhuang San and Chaiqin Tang. Oliguria/retention indicates Hand-Taiyang Small Intestice Bing Fire disease; treatments include Wuling San and Daochi San. Liu Zi claims Fire/Cold cannot harm; is this true? The Classics also say: Humans contracting Cold develop febrile disease. If it is febrile disease, there is no concept of freezing water or cracking earth/withering wood, but rather signs of scorching Metal and hyperactive Fire. Who is Liu Zi to rely on limited insight to confuse the world? *Jiyao* states: Jueyin meridian unceasing diarrhea, deep/slow pulse, cold limbs, spitting saliva/pus/blood is difficult to treat; use Mahuang Tang or Xiao Xuming Tang to sweat. This indicates pathogen contracted inward from the exterior; resolving the exterior heals it. Zhang Zihe said: Sundry diarrhea (Sunxie) has Wind as its root; Wind cannot exit without sweating. Patients have borborygmus, undigested food in stool, dysuria. Astringent and warm medicines failed. Moxibustion on Zhongwan and below umbilicus intensified dryness/heat and depleted fluids. Upon examination, pulse was floating, large, long; slight exterior fever. Used Guizhi Mahuang Tang with Jiang/Zao, three doses, sweating all day, recovered by dawn. Then used Weifeng Tang to harmonize organs; appetite returned. Classics say: Wind injury in Spring leads to Sunxie in Summer; thus it can be cured by sweating. Wind corresponds to Wood, Spleen to Earth; Wood overacts on Earth, causing diarrhea. Appendix: Dahuang Tang: Dahuang 1.5 liang, Mangxiao (Natrii Sulfas), Dafupi (Citri Grandis Pericarpium), Mutong (Akebiae Caulis), Gancao each 1 liang, Guixin (Cinnamomi Cortex) 7.5 qian, Taoren (Persicae Semen) 21 seeds. Treats unresolved Yangdu Shanghan, Heat inside, delirium resembling mania. Pogu Qianjin Tang: Kushen (Sophorae Flavescentis Radix) 1 liang. Decoct in wine, induce vomiting. Treats Tianxing (Epidemic) Heat-Toxin near death. Shuijie San, Fangfeng Tongsheng San, see Section on Exterior-Interior.)
Removing Guizhi from this formula and adding Shigao creates Mahuang Xingren Gancao Shigao Tang (Zhang Zhongjing): Treats cases where Guizhi Tang is contraindicated after sweating/purgation, presenting with sweating, panting, and no significant heat. (Question: After sweating, Guizhi Tang is contraindicated; if Guizhi is unusable, is Mahuang usable? With no significant heat, is Shigao usable? Yu Jiayan says: Treating Shanghan requires distinguishing Ying and Wei; Guizhi and Mahuang Tangs should never be mixed. In this case, Taiyang pathogen resolved by sweating, but Lung Heat remains. Thus, although fever subsides slightly, panting persists. Use Mahuang to release Lung pathogen, Xingren to direct Lung Qi down, Gancao to relieve Lung urgency, Shigao to clear Lung Heat. Using Taiyang medicines to treat Hand-Taiyin meridian. Mistakenly using Guizhi would obstruct Lung Qi and cause lung abscess with pus.) It also treats Wenmei (Warm Malaria) with heat preceding cold. Adding Baizhu (Atractylodis Macrocephalae Rhizoma) creates Mahuang Jia Zhu Tang (*Jinkui Yaolue*): Treats patients with Dampness experiencing bodily restlessness and pain, suitable for sweating. Removing Guizhi and Xingren, adding Fuzi (Aconiti Lateralis Radix Praeparata) creates Mahuang Fuzi Tang (*Jinkui Yaolue*): Treats deep, deficient, distended pulse, indicating Qi-Water retention belonging to Shaoyin; inducing sweating stops it. Removing Guizhi and Xingren creates Gancao Mahuang Tang (*Jinkui Yaolue*): Treats Li Shui (Interior Water) characterized by generalized edema of face/body, deep pulse, difficulty urinating, requiring covered sweating. Removing Guizhi, using Mahuang (nodes intact), Xingren (skin/intact tips), raw Gancao creates San'ao Tang (*Ju Fang*): Treats common cold by Wind-Cold, cough, nasal congestion (Mahuang retaining nodes allows release with restraint; Xingren retaining tips utilizes its releasing nature; skin retained for astringency; raw Gancao tonifies Middle... Contraindicated in sweating syndromes. Zhang Zhongjing said: Yang excess/Yin deficiency, purgation heals, sweating kills; Yin excess/Yang deficiency, sweating heals, purgation kills. Floating pulse... Sweat... Diarrhea though... Body fluids... Depletion of sweat... Guizhi... Sweat then... In interior... Exhaustion... Empty interior... Moving Qi...)
Differentiation of Shanghan and Shangfeng (Shanghan develops fever after stagnation; Shangfeng develops fever immediately; Shanghan has no sweat, Shangfeng has sweat; Shanghan has no runny nose, Shangfeng has runny nose...)
Yin-Yang Exterior-Interior (Differentiating Exterior of Yang Syndrome: Fever, aversion to cold, headache, stiff spine, clear urine, no thirst, warm hands/feet. Exterior of Yin Syndrome: No fever, aversion to cold, pale face, cold breath, cold limbs. Interior of Yang Syndrome: Dry lips/tongue, vexation/thirst, kicking clothes, throwing hands/feet, constipation, dark/scanty urine, red nail beds, easy movement, floating/huge/rapid pulse. Interior of Yin Syndrome: No thirst, curled up posture, covering self, purple lips/rolled tongue, loose stool, clear/abundant urine, black/blue nail beds, heavy body/difficult movement, deep/fine/rapid pulse. Only abdominal pain and vomiting appear in both Yin and Yang Interior syndromes. The Three Yang meridians also have Yin-Yang Exterior-Interior distinctions. Taiyang: Heat in skin, headache/stiff neck, in Meridian is Exterior, treated with Mahuang Tang, Guizhi Tang, Jiwei Qianghuo Tang; thirst/red urine, Heat entering Bladder, in Organ is Interior, treated with Wuling San. Yangming: Heat in Muscle, eye pain/insomnia, in Meridian... for... Qin... Dampness... Eight...)