(伤寒变动)凡二十门
《巢氏病源》小儿伤寒汗出候∶伤寒者，是寒气客于皮肤，搏于血气，使腠理闭密，气不宣泄，蕴积生热，
故头痛、体疼、壮热也。而汗出者，阳虚受邪，邪搏于气，故发热。阴气又虚，邪又乘于阴，阴阳俱虚，不能
制其津液，所以伤寒而汗出也。
《活人书》论伤寒小儿、大人治法∶一般但小分剂，药性差凉耳。问∶自汗者，何也？卫不和自汗。病患脏
无他病，时发热自汗出而不愈者，卫不和也。先其时发汗则愈，属桂枝也。太阳病，发热汗出者，此为荣弱卫
强，故汗出。欲救风邪者，宜桂枝汤。又云∶病常自汗出者，此为荣气和。荣气和者，外不谐也。以卫气不共荣
气谐故尔。以荣行脉中，卫行脉外，复发其汗，荣卫和则愈。伤风自汗，太阳病；发热汗出，恶风脉缓为中风，
属桂枝汤。又云∶太阳病，项背强几几，反汗出恶风，桂枝加葛根汤主之。汗出而渴者，五苓散。不渴者，茯
苓甘草汤。虽然仲景云伤寒自汗用桂枝，然桂枝汤难用，须是仔细消息之。假令伤风自汗，若脉浮而弱，设
当行桂枝，服汤后，无桂枝脉息证候而烦者，即不可再服也。若伤寒自汗出而小便数者，尤不可与桂枝也。仲
景云∶太阳病，自汗，四肢拘急，难以屈伸，若小便难者，可桂枝汤内加附子服之。若小便数者，慎不可与桂
枝附子汤，宜服芍药甘草汤。若误行桂枝附子攻表，便咽干烦躁，厥逆呕吐，作甘草干姜汤与之，以复其阳。
若厥愈足温，更作芍药甘草汤与之，其脚即伸。若胃气不和谵语者，与调胃承气汤。微溏则止其谵语。缘芍药
甘草汤，主脉浮、自汗、小便数者。寸口脉浮为风，大为虚，风则生微热，虚则两胫挛。小便数，仍汗出，为
津液少，不可误用桂枝，宜服芍药甘草补虚退风热。通治误服桂枝汤后，病证仍存者也。阳明病，自汗不恶寒。
反恶热， 然汗自出者，属阳明也。若阳明病汗出多而渴者，不可与猪苓汤，以汗多、胃中燥，猪苓复利其
小便故也。故仲景云∶阳明病发热汗多者，急下之。阳明病，其人汗多，以津液外出，胃中燥，大便必硬。谵
语者，属调胃承气汤。虽然阳明汗多急下，若小便自利者，此为津液内竭，虽尔不可攻之。须自大便导之，宜
用蜜煎导法。阳明病，汗出而脉迟、微恶寒者，表未解也，宜服桂枝汤。阳明法多汗，若脉浮无汗而喘者，发
汗则愈，宜麻黄汤也。亡阳自汗，太阳病，发汗多遂漏不止，其人恶风，当温其经，宜桂枝加附子汤。伤寒尺
寸脉俱紧而汗出者，亡阳也，此属少阴，法当咽痛而复吐利。其人热不去，内拘急，四肢疼，厥逆而恶寒者，
四逆汤主之；汗多不止者，可用温粉扑之；若汗多不止，必恶风，烦躁，不得卧者，先服防风白术牡蛎汤，次
服小建中汤。（所合用方尽见本门。）
《活人书》仲景桂枝汤
桂枝 芍药（各三两） 甘草（二两）
上锉如麻豆大。每服抄五钱匕，水一盏半，入生姜五片，枣子二枚，煎至一盏，去滓温服。须臾 热稀粥
一盏，以助药力。温覆令一时许，遍身 微以有汗者佳。具加减法∶若桂枝汤，自西北二方居人，四时
行之，无不应验。江淮间唯冬及春可行之，自春末及夏至以前，桂枝证，可加黄芩一分，谓之阳旦汤。夏
至后有桂枝证，可加知母半两，石膏一两，或加升麻一分。若病患素虚寒者，正用古方，不再加减也。戒曰∶
桂枝最难用，虽云表不解，脉浮可发汗，宜桂枝汤，须是病患常自汗出，小便不数，手足温和，或手足指稍
作微冷，少顷却温，身虽微似烦，而又憎寒，始可行之。若病患身无汗，小便数或手足冷，不恶寒或饮酒家
不喜甘者，慎不可行桂枝也。仍有桂枝证，服汤已，无桂枝证者，尤不可再与。
《活人书》仲景桂枝加葛根汤
桂枝 甘草（各一两） 葛根（二两） 芍药 麻黄（各一两半）
上锉如麻豆大。每服抄五钱匕，生姜四片，枣子一个，水一盏半，煎至八分，去滓服。覆取微汗。
《活人书》仲景五苓散
猪苓（去黑皮，秤） 白术 茯苓（去皮，秤。各三分） 泽泻（一两一分） 桂枝（去皮，半两，不见火）
上各事持捣筛为散，拌匀。每服抄三钱，白汤调下。此药须各自事持，秤见分两，然后合。
《活人书》仲景茯苓甘草汤
茯苓 桂枝（去皮。各二两） 甘草（炙，一两）
上锉如麻豆大。每服抄五钱匕，水一盏半，生姜五片，煮至八分，去滓温服。
《活人书》仲景桂枝加附子汤
桂枝（去皮） 芍药（各一两半） 甘草（炙，一两） 附子（炮去皮，用半两）
上锉如麻豆大。每服抄五钱匕，生姜四片，枣子一个，水一盏半，煮至八分，去滓温服。
《活人书》仲景芍药甘草汤
白芍药 甘草（炙。各二两）
上锉如麻豆大。每服抄五钱匕，水一盏半，煮至八分，去滓温服。
《活人书》仲景甘草干姜汤
甘草（炙，四两） 干姜（二两）
上锉如麻豆大。每服抄五钱匕，水一盏半，煮至八分，分减服。
《活人书》仲景调胃承气汤
甘草（一两） 芒硝（一两一分） 大黄（去皮，二两）
上锉如麻豆大。每服五钱匕，水一大盏，煎至七分，去滓服。
《活人书》仲景蜜煎导 若土瓜根及大猪胆汁，亦可为导煎。
蜜（四两）
上一味，内铜器中，微火煎之，稍凝如饴状，搅之勿令焦着欲可丸，捻作挺如指许长二寸；当热时急作，
冷时硬，令头锐，内谷道中，以手急抱，欲大便时乃去之。
《活人书》仲景麻黄汤
麻黄（一两半，去节） 桂枝（一两） 甘草（炙，半两） 杏仁（三十五个，去皮尖）
上锉如麻豆大。每服抄五钱匕，水盏半，煮至八分，去滓温服。覆取微汗，不须 粥。加减法∶伤寒热病
药性须凉，不可太温，夏至后麻黄汤须加知母半两、石膏一两、黄芩一分，盖麻黄汤性热，夏月服之，有发
黄斑出之失。唯冬及春，与病患素虚寒者，乃用正方，不再加减。
《活人书》仲景四逆汤
甘草（二两，炙） 干姜（一两半） 附子（一个，生用）
上锉如麻豆大。每服四钱，以水一盏半，煮至七分，去滓温服。强人加附子半个，加干姜一两半。
《活人书》仲景温粉法
白术 本 芎 白芷（各等分）
上捣罗为细末，一两入米粉三两和之。粉扑周身，止汗。无 本亦得。
《活人书》防风白术牡蛎汤
防风（独茎者，去芦头） 牡蛎（炒黄） 白术（各等分）
上捣罗为细末。每服二钱，以酒调下，米饮亦得。日进二、三服，汗止便服小建中汤。
《活人书》仲景小建中汤
桂枝（一两半，去皮） 芍药（三两） 甘草（一两） 胶饴（半升。旧有微溏或呕者，去胶饴）
上锉如麻豆大。每服抄五钱匕，水一盏半，生姜四片，大枣一个，煮至八分，去滓，下胶饴两匙许，再煎
化温服。日三服，夜二服。尺脉尚迟，再作一剂，加黄 末一钱。
煎造饴胶法
糯米（一升，拣净洗） 大麦 （末，六两）
上米一如炊饭，甑上至气溜取下，倾入一盆子，入 末一合，并汤盏来许，拌匀，再上甑，至饭熟却入盆
子内，都以 末拌匀，入一瓷罐子，可容五升许。冬月罐子可令热，春秋夏温。冬月用汤二升许入罐子内，
罐子内饭上汤三指许即得，布并纸三五重盖定，更以绵或絮包定，近火。春秋夏即温和至一宿，见米浮在水
面上，即以布绞裂取清汁，银石器内煎至面上有膜，即以木蓖不住手搅至稀糊，以瓷器收。夏月置井中，庶
不酸。
（伤寒的变证）共有二十个门类。
《诸病源候论》中关于小儿伤寒汗出的论述：所谓伤寒，是寒邪侵袭皮肤，与血气相搏结，导致腠理闭塞致密，气机不能宣泄，郁积而产生热邪，所以出现头痛、身体疼痛、高热等症状。而伴有汗出的情况，是因为阳气虚弱感受了邪气，邪气搏结于气分，所以发热。阴气也虚弱，邪气又乘虚侵入阴分，阴阳两虚，无法固摄津液，因此患伤寒时会出现汗出。
《活人书》论述小儿和成人治疗伤寒的方法：大致相同，只是剂量稍小，药性偏凉罢了。问：什么是自汗？答：这是卫气不和导致的自汗。如果病人脏腑没有其他疾病，时常发热且自汗出而不能痊愈，这是卫气不和。在发热出汗之前进行发汗治疗就能痊愈，这属于桂枝汤证。太阳病，出现发热、汗出的症状，这是因为营气弱而卫气强，所以汗出。想要解除风邪，适宜用桂枝汤。又说：病人经常自汗出，这是因为营气调和。营气调和，说明体表不协调。因为卫气不能与营气和谐配合的缘故。营气行于脉中，卫气行于脉外，再次发汗，使营卫调和就能痊愈。伤风导致的自汗，属于太阳病；发热、汗出、恶风、脉缓，属于中风，归属于桂枝汤证。又说：太阳病，项背部僵硬不适，反而汗出、恶风，用桂枝加葛根汤主治。汗出且口渴的，用五苓散。不口渴的，用茯苓甘草汤。虽然张仲景说伤寒自汗用桂枝汤，但是桂枝汤很难使用，必须仔细斟酌病情。假如伤风自汗，如果脉象浮而弱，假设应当使用桂枝汤，服药后，如果没有了桂枝汤证的脉象和症状却出现心烦，就不可再服用。如果伤寒自汗出且小便频数，尤其不可给予桂枝汤。张仲景说：太阳病，自汗，四肢拘挛紧急，难以屈伸，如果小便困难的，可以在桂枝汤中加入附子服用。如果小便频数的，千万不要给桂枝附子汤，适宜服用芍药甘草汤。如果误用桂枝附子汤攻表，导致咽干、烦躁、四肢厥冷呕吐，应给予甘草干姜汤，以恢复其阳气。如果四肢厥冷缓解、足部变暖，再给予芍药甘草汤，脚就能伸直。如果胃气不和出现谵语（胡言乱语），给予调胃承气汤。大便微溏则停止服用以止住谵语。因为芍药甘草汤，主治脉浮、自汗、小便频数的情况。寸口脉浮表示有风，脉大表示虚，风邪会产生微热，虚证会导致两小腿拘挛。小便频数，仍然汗出，这是津液少，不可误用桂枝汤，适宜服用芍药甘草汤来补虚退风热。通治误服桂枝汤后，病证仍然存在的情况。阳明病，自汗且不恶寒，反而恶热，自然汗出的，属于阳明病。如果阳明病汗出多且口渴的，不可给予猪苓汤，因为汗多导致胃中干燥，猪苓汤又会利小便的缘故。所以张仲景说：阳明病发热汗多的，应当急下之。阳明病，其人汗多，因为津液外泄，胃中干燥，大便必定硬结。出现谵语的，属于调胃承气汤证。虽然阳明病汗多需要急下，但如果小便自利的，这是津液内竭，即使如此也不可攻下。必须通过导便法通便，适宜用蜜煎导法。阳明病，汗出且脉迟、微恶寒的，表证未解，适宜服用桂枝汤。阳明病法当多汗，如果脉浮无汗且喘息的，发汗则痊愈，适宜用麻黄汤。亡阳导致的自汗，太阳病，发汗过多遂致汗漏不止，其人恶风，应当温经，适宜用桂枝加附子汤。伤寒尺部和寸部脉象都紧且汗出的，是亡阳的表现，这属于少阴病，法当咽喉痛并伴有吐利。其人热不退，体内拘急，四肢疼痛，四肢厥冷且恶寒的，用四逆汤主治；汗多不止的，可用温粉扑身；如果汗多不止，必然恶风、烦躁、不能卧睡，先服用防风白术牡蛎汤，接着服用小建中汤。（所有适用的方剂详见本门。）
《活人书》记载张仲景的桂枝汤：
桂枝、芍药（各三两）、甘草（二两）。
以上药物锉成如麻豆大小的颗粒。每次取五钱匕，加水一盏半，放入生姜五片、大枣二枚，煎至一盏，去渣温服。服后片刻，喝热稀粥一盏，以助药力。覆盖衣被约一时辰，全身微微出汗为佳。具备加减法：如果是桂枝汤，西北地区的居民四季使用，无不灵验。江淮地区只有冬季和春季可以使用，从春末到夏至前，出现桂枝汤证，可加黄芩一分，称为阳旦汤。夏至后出现桂枝汤证，可加知母半两、石膏一两，或加升麻一分。如果病人素体虚寒，正用古方，不再加减。告诫说：桂枝汤最难使用，虽然说表证未解，脉浮可以发汗，适宜用桂枝汤，但必须是病人经常自汗出，小便不频数，手足温暖，或者手指尖稍作微冷，一会儿又变暖，身体虽轻微烦闷，但又怕冷，才可以施用。如果病人身上无汗，小便频数或手足冷，不怕冷或者是饮酒者不喜欢甘味药的，千万不可施用桂枝汤。仍有桂枝汤证，服药后，没有桂枝汤证的，尤其不可再给。
《活人书》记载张仲景的桂枝加葛根汤：
桂枝、甘草（各一两）、葛根（二两）、芍药、麻黄（各一两半）。
以上药物锉成如麻豆大小的颗粒。每次取五钱匕，生姜四片，大枣一个，加水一盏半，煎至八分，去渣服用。覆盖衣被取微汗。
《活人书》记载张仲景的五苓散：
猪苓（去掉黑皮，称量）、白术、茯苓（去皮，称量。各三分）、泽泻（一两一分）、桂枝（去皮，半两，不经过火炒）。
以上药物各自捣筛成散剂，拌匀。每次取三钱，用白开水调服。此药必须各自单独处理，称好分量，然后合在一起。
《活人书》记载张仲景的茯苓甘草汤：
茯苓、桂枝（去皮。各二两）、甘草（炙，一两）。
以上药物锉成如麻豆大小的颗粒。每次取五钱匕，加水一盏半，生姜五片，煮至八分，去渣温服。
《活人书》记载张仲景的桂枝加附子汤：
桂枝（去皮）、芍药（各一两半）、甘草（炙，一两）、附子（炮制去皮，用半两）。
以上药物锉成如麻豆大小的颗粒。每次取五钱匕，生姜四片，大枣一个，加水一盏半，煮至八分，去渣温服。
《活人书》记载张仲景的芍药甘草汤：
白芍药、甘草（炙。各二两）。
以上药物锉成如麻豆大小的颗粒。每次取五钱匕，加水一盏半，煮至八分，去渣温服。
《活人书》记载张仲景的甘草干姜汤：
甘草（炙，四两）、干姜（二两）。
以上药物锉成如麻豆大小的颗粒。每次取五钱匕，加水一盏半，煮至八分，分次减量服用。
《活人书》记载张仲景的调胃承气汤：
甘草（一两）、芒硝（一两一分）、大黄（去皮，二两）。
以上药物锉成如麻豆大小的颗粒。每次取五钱匕，加水一大盏，煎至七分，去渣服用。
《活人书》记载张仲景的蜜煎导法：若土瓜根及大猪胆汁，也可以作为导法煎制。
蜜（四两）。
以上一味药，放入铜器中，用微火煎煮，稍微凝固像饴糖状，搅拌不要让它焦着，趁热做成丸状，搓成指头粗细、长约二寸的条状；趁热制作，冷了会变硬，让头部尖锐，纳入肛门中，用手紧紧抱住，想大便时再去掉它。
《活人书》记载张仲景的麻黄汤：
麻黄（一两半，去节）、桂枝（一两）、甘草（炙，半两）、杏仁（三十五个，去皮尖）。
以上药物锉成如麻豆大小的颗粒。每次取五钱匕，加水一盏半，煮至八分，去渣温服。覆盖衣被取微汗，不需要喝粥。加减法：伤寒热病的药性须偏凉，不可太温，夏至后麻黄汤须加知母半两、石膏一两、黄芩一分，因为麻黄汤性热，夏季服用，会有发黄出斑的过失。只有冬季和春季，以及病人素体虚寒的，才用原方，不再加减。
《活人书》记载张仲景的四逆汤：
甘草（二两，炙）、干姜（一两半）、附子（一个，生用）。
以上药物锉成如麻豆大小的颗粒。每次取四钱，加水一盏半，煮至七分，去渣温服。强壮的人加附子半个，加干姜一两半。
《活人书》记载张仲景的温粉法：
白术、藁本、川芎、白芷（各等分）。
以上捣罗成细末，一两粉末加入三两米粉混合。将粉末扑遍全身，以止汗。没有藁本也可以。
《活人书》记载防风白术牡蛎汤：
防风（独茎者，去芦头）、牡蛎（炒黄）、白术（各等分）。
以上捣罗成细末。每次取二钱，用酒调服，米饮也可以。每天进二、三服，汗止后服用小建中汤。
《活人书》记载张仲景的小建中汤：
桂枝（一两半，去皮）、芍药（三两）、甘草（一两）、胶饴（半升。旧有轻微腹泻或呕吐的，去掉胶饴）。
以上药物锉成如麻豆大小的颗粒。每次取五钱匕，加水一盏半，生姜四片，大枣一个，煮至八分，去渣，加入约两匙胶饴，再煎化温服。每天三次，夜间两次。尺脉仍然迟缓的，再制作一剂，加黄芩末一钱。
煎造饴糖胶的方法：
糯米（一升，拣净洗净）、大麦（磨末，六两）。
以上糯米像做饭一样蒸熟，在甑上蒸至气透取下，倒入一个盆子里，加入麦末一合，连同汤水大约一盏的量，拌匀，再上甑蒸，饭熟后倒入盆子内，全部用麦末拌匀，装入一个能容纳五升左右的瓷罐子。冬天罐子要加热，春秋夏保持温热。冬天用汤约二升倒入罐子内，罐子内饭上的汤高三指左右即可，用布和纸盖好三五层，再用绵或絮包裹，靠近火源。春秋夏则温和放置一夜，见到米浮在水面上，就用布绞裂取清汁，在银石器内煎至表面有膜，就用木蓖不停手搅拌至稀糊状，用瓷器收藏。夏天放在井水中，以免变酸。
(Changes in Cold Damage) There are twenty categories in total.
*Chushi Bingyuan* (Source of Diseases by Chao Yuanfang) on the syndrome of sweating in pediatric cold damage: The so-called cold damage refers to cold pathogenic factors invading the skin, struggling with blood and qi, causing the couli (pores) to become closed and dense, preventing the venting of qi, leading to accumulation and generation of heat. Therefore, headache, body pain, and high fever occur. As for sweating, it is due to deficiency of yang qi receiving the pathogen; the pathogen struggles with qi, causing fever. Simultaneously, yin qi is also deficient, and the pathogen takes advantage of this to invade the yin. With both yin and yang deficient, they cannot control the body fluids, thus sweating occurs during cold damage.
*Liu Ren Shu* (The Book of Sixty People) discusses the treatment methods for cold damage in children and adults: Generally, they are similar, but the dosages are slightly smaller, and the medicinal properties are cooler. Question: What is spontaneous sweating? Answer: This is spontaneous sweating caused by disharmony of Wei Qi (Defensive Qi). If a patient has no internal organ diseases but experiences recurrent fever and spontaneous sweating that does not resolve, it is due to disharmony of Wei Qi. Sweating before the onset of fever resolves the condition; this belongs to the Guizhi Tang (Cinnamon Twig Decoction) pattern. In Taiyang disease (Disease of the Bladder and Small Intestine Channels), fever with sweating indicates weak Ying Qi (Nutritive Qi) and strong Wei Qi, hence the sweating. To rescue from wind pathogen, Guizhi Tang is appropriate. It is also stated: When a patient constantly sweats spontaneously, it means the Ying Qi is harmonious. If Ying Qi is harmonious, the exterior is unharmonious. This is because Wei Qi does not harmonize with Ying Qi. Ying Qi circulates within the vessels, while Wei Qi circulates outside the vessels. Re-inducing sweating will restore harmony between Ying and Wei, leading to recovery. Spontaneous sweating due to wind injury belongs to Taiyang disease; fever, sweating, aversion to wind, and slow pulse belong to Wind Strike (Zhong Feng), which is treated with Guizhi Tang. It is further stated: In Taiyang disease, stiffness and discomfort in the nape and back, accompanied by spontaneous sweating and aversion to wind, should be treated with Guizhi Jia Gegen Tang (Cinnamon Twig Decoction plus Kudzu Root). For sweating with thirst, Wuling San (Five-Ingredient Powder with Poria) is indicated. For those without thirst, Fuling Gancao Tang (Poria and Licorice Decoction) is indicated. Although Zhang Zhongjing states that spontaneous sweating in cold damage uses Guizhi Tang, Guizhi Tang is difficult to use and requires careful consideration. For example, if wind injury causes spontaneous sweating and the pulse is floating and weak, assuming Guizhi Tang is appropriate, if after taking the decoction the signs of Guizhi Tang disappear but irritability arises, it should not be taken again. If cold damage causes spontaneous sweating with frequent urination, Guizhi Tang must absolutely not be given. Zhang Zhongjing says: In Taiyang disease, spontaneous sweating with stiff and cramped limbs that are difficult to flex or extend, especially if urination is difficult, can be treated by adding Fuzi (Prepared Aconite Root) to Guizhi Tang. If urination is frequent, Guizi Fuzi Tang (Cinnamon Twig and Aconite Decoction) must strictly be avoided; Shaoyao Gancao Tang (Peony and Licorice Decoction) is appropriate. If one mistakenly uses Guizhi Fuzi Tang to attack the exterior, resulting in dry throat, irritability, cold extremities, and vomiting, Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) should be given to restore Yang Qi. Once the cold extremities resolve and feet warm up, Shaoyao Gancao Tang should be given again, allowing the legs to extend. If stomach qi disharmony leads to delirium (admonishing speech), Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction) is given. If stools are slightly loose, stop administration to cease delirium. This is because Shaoyao Gancao Tang treats floating pulse, spontaneous sweating, and frequent urination. Floating pulse at Cun Kou (Radial Artery) indicates wind, large pulse indicates deficiency; wind generates slight heat, deficiency causes cramping in both calves. Frequent urination with continued sweating indicates scanty body fluids; Guizhi Tang must not be misused. Shaoyao Gancao Tang should be used to tonify deficiency and dispel wind-heat. This generally treats cases where symptoms persist after mistakenly taking Guizhi Tang. In Yangming disease, there is spontaneous sweating without aversion to cold, but rather aversion to heat; natural sweating belongs to Yangming disease. If Yangming disease presents with profuse sweating and thirst, Zhuling Tang (Polyporus Decoction) must not be given, as profuse sweating dries the stomach, and Zhuling Tang would further promote urination. Thus, Zhang Zhongjing states: In Yangming disease with fever and profuse sweating, urgent purgation is required. In Yangming disease, if a person sweats profusely, body fluids exit externally, drying the stomach, leading to hard stools. Delirium indicates Tiaowei Chengqi Tang is appropriate. Although Yangming disease with profuse sweating requires urgent purgation, if urination is normal, this indicates exhaustion of internal body fluids; even so, purgation must not be used. Bowel movement must be induced via suppository method, specifically using Mi Jian Dao (Honey Suppository Method). In Yangming disease, sweating with slow pulse and slight aversion to cold indicates the exterior is not resolved; Guizhi Tang is appropriate. Yangming disease typically involves profuse sweating; if the pulse is floating, there is no sweating, and wheezing occurs, inducing sweating leads to recovery, indicating Mahuang Tang (Ephedra Decoction). Loss of Yang causing spontaneous sweating: In Taiyang disease, excessive sweating leads to continuous leakage of sweat, aversion to wind, requiring warming of the meridians; Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite) is appropriate. In cold damage, if both Chi (Cun and Chi positions) pulses are tight and sweating occurs, it indicates loss of Yang, belonging to Shaoyin disease, typically presenting with sore throat, vomiting, and diarrhea. If fever persists, internal cramping, limb pain, cold extremities, and aversion to cold occur, Sini Tang (Frigid Extremities Decoction) is indicated. For continuous profuse sweating, Wen Fen (Warm Powder) can be applied externally. If sweating continues profusely with aversion to wind, irritability, and inability to lie down, Fangfeng Baizhu Muli Tang (Saposhnikovia, Atractylodes, and Oyster Shell Decoction) should be taken first, followed by Xiaojianzhong Tang (Minor Construct the Middle Decoction). (All applicable formulas are seen in this section.)
*Liu Ren Shu* records Zhang Zhongjing's Guizhi Tang:
Guizhi (Cinnamon Twig), Shaoyao (Peony Root) (3 liang each), Gancao (Licorice Root) (2 liang).
Crush these into pieces the size of hemp seeds. Take 5 qian bi per dose, add 1.5 cups of water, 5 slices of Shengjiang (Fresh Ginger), and 2 dates. Decoct until 1 cup remains, strain, and take warm. Shortly after, drink 1 cup of hot thin porridge to assist the medicinal power. Cover with blankets for about one shi (two hours); mild whole-body sweating is ideal. Includes modification rules: Guizhi Tang is effective year-round for people in the northwest. In the Jianghuai region, it is suitable only in winter and spring. From late spring to before Summer Solstice, for Guizhi patterns, add 1 fen of Huangqin (Scutellaria Root), called Yangdan Tang. After Summer Solstice, for Guizhi patterns, add 0.5 liang of Zhimu (Anemarrhena Rhizome) and 1 liang of Shigao (Gypsum Fibrosum), or add 1 fen of Shengma (Cimicifugae Rhizome). If the patient is constitutionally deficient and cold, use the ancient formula without modifications. Warning: Guizhi Tang is the most difficult to use. Although it is said that unresolved exterior with floating pulse allows for sweating therapy using Guizhi Tang, it is only suitable when the patient has constant spontaneous sweating, normal urination frequency, warm hands and feet (or slightly cool fingertips that warm up quickly), mild irritability combined with aversion to cold. If the patient has no sweating, frequent urination or cold hands/feet, no aversion to cold, or is an alcohol drinker who dislikes sweet tastes, Guizhi Tang must strictly be avoided. Even if Guizhi pattern exists, if after taking the decoction the pattern disappears, do not administer again.
*Liu Ren Shu* records Zhang Zhongjing's Guizhi Jia Gegen Tang:
Guizhi (Cinnamon Twig), Gancao (Licorice Root) (1 liang each), Gegen (Kudzu Root) (2 liang), Shaoyao (Peony Root), Mahuang (Ephedra Herb) (1.5 liang each).
Crush into pieces the size of hemp seeds. Take 5 qian bi per dose, add 4 slices of Shengjiang (Fresh Ginger), 1 date, and 1.5 cups of water. Decoct until 0.8 cup remains, strain, and take. Cover to induce mild sweating.
*Liu Ren Shu* records Zhang Zhongjing's Wuling San:
Zhu Ling (Polyporus), Baizhu (Atractylodes Macrocephala Rhizome), Fuling (Poria) (peeled, weighed. Each 3 fen), Zexie (Alisma Rhizome) (1.1 liang), Guizhi (Cinnamon Twig) (peeled, 0.5 liang, not roasted).
Process each herb separately, crush and sieve into powder, mix well. Take 3 qian per dose, mixed with white boiled water. These herbs must be processed and weighed individually before mixing.
*Liu Ren Shu* records Zhang Zhongjing's Fuling Gancao Tang:
Fuling (Poria), Guizhi (Cinnamon Twig) (peeled. Each 2 liang), Gancao (Licorice Root) (roasted, 1 liang).
Crush into pieces the size of hemp seeds. Take 5 qian bi per dose, add 1.5 cups of water and 5 slices of Shengjiang (Fresh Ginger). Decoct until 0.8 cup remains, strain, and take warm.
*Liu Ren Shu* records Zhang Zhongjing's Guizhi Jia Fuzi Tang:
Guizhi (Cinnamon Twig) (peeled), Shaoyao (Peony Root) (1.5 liang each), Gancao (Licorice Root) (roasted, 1 liang), Fuzi (Prepared Aconite Root) (processed, peeled, 0.5 liang).
Crush into pieces the size of hemp seeds. Take 5 qian bi per dose, add 4 slices of Shengjiang (Fresh Ginger), 1 date, and 1.5 cups of water. Decoct until 0.8 cup remains, strain, and take warm.
*Liu Ren Shu* records Zhang Zhongjing's Shaoyao Gancao Tang:
Baishaoyao (White Peony Root), Gancao (Licorice Root) (roasted. Each 2 liang).
Crush into pieces the size of hemp seeds. Take 5 qian bi per dose, add 1.5 cups of water. Decoct until 0.8 cup remains, strain, and take warm.
*Liu Ren Shu* records Zhang Zhongjing's Gancao Ganjiang Tang:
Gancao (Licorice Root) (roasted, 4 liang), Ganjiang (Dried Ginger) (2 liang).
Crush into pieces the size of hemp seeds. Take 5 qian bi per dose, add 1.5 cups of water. Decoct until 0.8 cup remains, take in divided doses with reduced amounts.
*Liu Ren Shu* records Zhang Zhongjing's Tiaowei Chengqi Tang:
Gancao (Licorice Root) (1 liang), Mangxiao (Mirabilite) (1.1 liang), Dahuang (Rhubarb Root and Rhizome) (peeled, 2 liang).
Crush into pieces the size of hemp seeds. Take 5 qian bi per dose, add 1 large cup of water. Decoct until 0.7 cup remains, strain, and take.
*Liu Ren Shu* records Zhang Zhongjing's Mi Jian Dao (Honey Suppository Method): Tu Gua Gen (Solomon's Seal Rhizome) and Da Zhu Dan Zhi (Large Pig Bile) can also be used as suppositories.
Mi (Honey) (4 liang).
Place this single ingredient in a copper vessel, simmer over low heat until it thickens like malt syrup. Stir continuously to prevent burning. While hot, shape into pills, rolling them into sticks about the thickness of a finger and two cun long. Shape while hot, as it hardens when cold. Make the tip sharp. Insert into the anus. Hold tightly with hand. Remove when defecation is desired.
*Liu Ren Shu* records Zhang Zhongjing's Mahuang Tang:
Mahuang (Ephedra Herb) (1.5 liang, remove joints), Guizhi (Cinnamon Twig) (1 liang), Gancao (Licorice Root) (roasted, 0.5 liang), Xingren (Apricot Seed) (35 pieces, remove skins and tips).
Crush into pieces the size of hemp seeds. Take 5 qian bi per dose, add 1.5 cups of water. Decoct until 0.8 cup remains, strain, and take warm. Cover to induce mild sweating. Porridge is not required. Modification rules: Medicines for cold damage and febrile diseases should have cool properties, not too warm. After Summer Solstice, Mahuang Tang must add 0.5 liang of Zhimu (Anemarrhena Rhizome), 1 liang of Shigao (Gypsum Fibrosum), and 1 fen of Huangqin (Scutellaria Root), because Mahuang Tang is hot-natured; summer use may cause jaundice and rashes. Only in winter and spring, or for patients constitutionally deficient and cold, is the original formula used without modifications.
*Liu Ren Shu* records Zhang Zhongjing's Sini Tang:
Gancao (Licorice Root) (2 liang, roasted), Ganjiang (Dried Ginger) (1.5 liang), Fuzi (Prepared Aconite Root) (1 piece, raw use).
Crush into pieces the size of hemp seeds. Take 4 qian per dose, add 1.5 cups of water. Decoct until 0.7 cup remains, strain, and take warm. Strong individuals add half a piece of Fuzi and 1.5 liang of Ganjiang.
*Liu Ren Shu* records Zhang Zhongjing's Wen Fen Method (Warm Powder):
Baizhu (Atractylodes Macrocephala Rhizome), Ben Cao (Ligusticum Chuanxiong Rhizome - Note: Text says 'Ben', likely Gaoben), Xiong Qiong (Ligusticum Wallichii Rhizome), Baizhi (Angelica Dahurica Root) (Equal parts).
Grind into fine powder. Mix 1 liang of powder with 3 liang of rice flour. Apply powder all over the body to stop sweating. Absence of Ben Cao is acceptable.
*Liu Ren Shu* records Fangfeng Baizhu Muli Tang:
Fangfeng (Saposhnikovia Root) (single stem, remove radicle), Muli (Oyster Shell) (stir-fried yellow), Baizhu (Atractylodes Macrocephala Rhizome) (Equal parts).
Grind into fine powder. Take 2 qian per dose, mixed with wine or rice drink. Take 2-3 times daily. Once sweating stops, take Xiaojianzhong Tang.
*Liu Ren Shu* records Zhang Zhongjing's Xiaojianzhong Tang:
Guizhi (Cinnamon Twig) (1.5 liang, peeled), Shaoyao (Peony Root) (3 liang), Gancao (Licorice Root) (1 liang), Jiaoyi (Malt Sugar) (0.5 sheng. If history of loose stools or vomiting, remove Jiaoyi).
Crush into pieces the size of hemp seeds. Take 5 qian bi per dose, add 1.5 cups of water, 4 slices of Shengjiang (Fresh Ginger), and 1 large date. Decoct until 0.8 cup remains, strain, add approx. 2 spoons of Jiaoyi (Malt Sugar), re-decoct until dissolved, and take warm. Take 3 times daily, 2 times at night. If Chi pulse remains slow, prepare another dose, adding 1 qian of Huangqin (Scutellaria Root) powder.
Method for Preparing Malt Sugar Paste:
Nuomi (Glutinous Rice) (1 sheng, cleaned and washed), Damai Mai (Barley Flour) (6 liang).
Cook the glutinous rice like steaming. Steam until vapor penetrates thoroughly. Remove and pour into a basin. Add 1 he of barley flour and approx. 1 cup of water/broth. Mix well. Steam again until cooked. Pour back into the basin, mix thoroughly with barley flour. Place in a ceramic jar holding approx. 5 sheng. In winter, heat the jar; in spring, autumn, and summer, keep warm. In winter, add approx. 2 sheng of hot water to the jar. The water level above the rice should be approx. 3 finger-widths. Cover tightly with 3-5 layers of cloth and paper, then wrap in cotton or wadding. Keep near fire. In spring, autumn, and summer, keep at room temperature overnight. When rice floats on the water surface, squeeze through cloth to extract clear juice. Decoct in silver or earthenware vessel until a film forms on the surface. Stir continuously with a wooden sieve until it becomes a thick paste. Store in ceramic ware. In summer, place in a well to prevent souring.