麻黄（三两去节味甘温） 芍药（三两味酸微寒） 五味子（半升味酸温） 干姜
（三两味辛热） 甘草（三两炙味甘平） 桂枝（三两去皮味辛热） 半夏（半升汤洗
味辛微温） 细辛（三两味辛温）
上八味。以水一斗。先煮麻黄。减二升。去上沫。内诸药。煮取三升。去滓。温服
一升。
寒邪在表。非甘辛不能散之。麻黄桂枝甘草之辛甘。以发散表邪。水停心下而不行。
则肾气燥。内经曰。肾苦燥。急食辛以润之。干姜细辛半夏之辛。以行水气而润肾。咳
逆而喘。则肺气逆。内经曰。肺欲收。急食酸以收之。芍药五味子之酸。以收逆气而安
肺。
加减法
若微利者。去麻黄。加荛花。如鸡子大。熬、令赤色。下利者不可攻其表。汗出必
胀满。麻黄发其阳。水渍入胃。必作利。荛花下十二水。水去。利则止。
若渴者。去半夏。加栝蒌根三两。辛燥而苦润。半夏辛而燥津液。非渴者所宜。故
去之。栝蒌味苦而生津液。故加之。
若噎者。去麻黄。加附子一枚。炮。经曰。水得寒气。冷必相搏。其人即KT 。加
附子。温
散水寒。病患有寒。复发汗。胃中冷。必吐蛔。去麻黄。恶发汗。
若小便不利。少腹满。去麻黄。加茯苓四两。水蓄下焦不行。为小便不利。少腹满。
麻黄发津液于外。非所宜也。茯苓泄蓄水于下。加所当也。
若喘者。去麻黄。加杏仁半升。去皮尖。金匮要略曰。其人形肿。故不内麻黄。内
杏子。以麻黄发其阳故也。喘呼形肿。水气标本之疾。
张卿子云。与柴胡汤症相似。此治表也。故近温。彼半表半里。故近清。
伤寒心下有水气。咳而微喘发热不渴。服汤已。渴者。此寒去欲解也。小青龙汤主
之。
咳而微喘者。水寒射肺也。发热不渴者。表证未罢也。与小青龙汤。发表散水。服
汤已。渴者。里气温。水气散为欲解也。
太汤病。外证未解。脉浮弱者。当以汗解。宜桂枝汤。
脉浮弱者。荣弱卫强也。
太阳病。下之微喘者。表未解故也。桂枝加浓朴杏仁汤主之。
下后大喘。则为里气大虚。邪气传里。正气将脱也。下后微喘。则为里气上逆。邪
不能传里。犹在表也。与桂枝汤以解外。加浓朴杏仁。以下逆气。
太阳病。外证未解者。不可下也。下之为逆。欲解外者。宜桂枝汤主之。
经曰。本发汗而复下之。为逆也。若先发汗。治不为逆。
太阳病。先发汗。不解。而复下之。脉浮者不愈。浮为在外。而反下之。故令不愈。
今脉浮。故知在外。当须解外则愈。宜桂枝汤主之。
经曰。柴胡汤证具而以他药下之。柴胡汤证仍在者。复与柴胡汤。此虽已下之。不
为逆。则其类矣。
太阳病。脉浮紧无汗。发热。身疼痛。八九日不解。表证仍在。此当发其汗。服药
已。微除。其人发烦。目瞑。剧者必衄。衄乃解。所以然者。阳气重故也。麻黄汤主之。
麻黄汤主之。正谓当发其汗一汤也。汗后则必微。除发衄而解。岂有夺血亡汗。再
与麻黄之理汗乎。汉文错综接续。不可不知。
脉浮紧。无汗。发热。身疼痛。太阳伤寒也。虽至八九日。而表证仍在。亦当发其
汗。既服温暖发散汤药。虽未作大汗。亦微除也。烦者、身热也。邪气不为汗解。郁而
变热。蒸于经络。发于肌表。故生热烦。肝受血而能视。始者气伤荣。寒既变热。则
血为热搏。肝气不治。故目瞑也。剧者热甚于经。迫血妄行而为衄。得衄、则热随血散
而解。阳气重者。热气重也。与麻黄汤。以解前太阳伤寒之邪也。
王文禄云。此与下二条同看。上条阳气重。即下所谓不得越也。下条不彻。即上所
谓微除也。麻黄泻实。故主之。
太阳病。脉浮紧。发热、身无汗。自衄者愈。
上文因服汗药而衄。此不服汗药而自衄。皆向愈之兆也。
风寒在经。不得汗解。郁而变热。衄则热随血散。故云自衄者愈。
二阳并病太阳初得病时。发其汗。汗先出不彻。因转属阳明。续自微汗出。不恶寒。
若太阳病证不罢者。不可下。下之为逆。如此可小发汗。设面色缘缘正赤者。寒气怫
郁在表。当解之、熏之。若发汗不彻。不足言阳气怫郁不得越。当汗不汗。其人躁烦。
不知痛处。乍在腹中。乍在四肢。按之不可得。其人短气。但坐。以汗出不彻故也。更
发汗则愈。何以知汗出不彻。以脉涩故知也。
太阳病未解。传并入阳明。而太阳证未罢者。名曰并病。续自微汗出。不恶寒者。
为太阳证罢。阳明证具也。法当下之。若太阳证未罢者。为表未解。则不可下。当
小发其汗。先解表也。阳明之经循面。色缘缘正赤者。阳气怫郁在表也。当解之、熏之
以取其汗。若发汗不彻者。不足言阳气怫郁。止是当汗不汗。阳气不得越散。邪无
从出。壅甚于经。故躁烦也。邪循经行。则痛无常处。或在腹中。或在四肢。按之不可
得。而短气。但责以汗出不彻。更发汗则愈。内经曰。诸过者切之。涩者。阳气有余。
为身热无汗。是以脉涩。知阳气壅郁。而汗出不彻。
脉浮数者。法当汗出而愈。若下之。身重心悸者。不可发汗。当自汗出乃解。所以
然者。尺中脉微。此里虚。须表里实。津液自和。便自汗出愈。
经曰。诸脉浮数。当发热而洒淅恶寒。言邪气在表也。是当汗出愈。若下之。身重
心悸者。损其津液。虚其胃气。若身重心悸。而尺脉实者。则下后里虚。邪气乘虚传里也。
今尺脉微。身重心悸者。知下后里虚。津液不足。邪气不传里。但在表也。然以津液不
足。则不可发汗。须里气实。津液足。便自汗出而愈。
脉浮紧者。法当身疼痛。宜以汗解之。假令尺中迟者。不可发汗。何以知之。然以
荣气不足。血少故也。
针经曰。夺血者无汗。尺脉迟者。为荣血不足。故不可发汗。
脉浮者。病在表。可发汗。宜麻黄汤。
浮为轻手得之。以候皮肤之气。内经曰。其在皮者。汗而发之。
脉浮而数者。可发汗。宜麻黄汤。
浮则伤卫。数则伤荣。荣卫受邪。为病在表。故当汗散。
病常自汗出者。此为荣气和。荣气和者。外不谐。以卫气不共荣气和谐故尔。以荣
行脉中。卫行脉外。复发其汗。荣卫和则愈。宜桂枝汤。
风则伤卫。寒则伤荣。卫受风邪而荣不病者。为荣气和也。卫既客邪。则不能与荣
气和谐。亦不能卫护皮腠。是以常自汗出。与桂枝汤。解散风邪。调和荣卫则愈。
病患脏无他病。时发热。自汗出。而不愈者。此卫气不和也。先其时发汗则愈。宜
桂枝汤主之。
脏无他病。里和也。卫气不和。表病也。外台云。里和表病。汗之则愈。所谓先其
时者。先其发热汗出之时发汗。则愈。
伤寒脉浮紧。不发汗。因致衄者。麻黄汤主之。
前条云太阳病八九日不解。当与麻黄汤。以发汗。因自衄而解。此条不发汗因致衄。
麻黄汤主之。何也。盖前条发汗自衄。以衄即汗也。故云衄乃解。此条不发汗。致衄乃邪
郁于经也。故以麻黄发汗两 。不可不解。
伤寒脉浮紧。邪在表也。当与麻黄汤发汗。若不发汗。则邪无从出。壅甚于经。迫
血妄行。因致衄也。
王三阳云。夺血者亡汗。既致衄。不可轻用麻黄汤。须审之又审。点滴不成流者可也。
伤寒。不大便六七日。头痛有热者。与承气汤。其小便清者。知不在里。仍在表也。
当须发汗。若头痛者必衄。宜桂枝汤。
不大便六七日。头痛有热者。故宜当下。若小便清者。知里无热。则不可下。经曰。
小便数者。大便必硬。不更衣十日。无所苦也。况此不大便六七日。小便清者。不可责
邪在里。是仍在表也。与桂枝汤以解外。若头疼不已。为表不罢。郁甚于经。迫血妄行。
上为衄也。
王三阳云头痛有热。盒饭解表。纵六七日不便。止当与大柴胡汤。承气汤不当
与也。疑有瘥字。虽十日不更衣。何惧之有。
伤寒。发汗。已解。半日许复烦。脉浮数者。可更发汗。宜桂枝汤主之。
烦者。热也。发汗身凉为已解。至半日许。身复热。脉浮数者邪不尽也。可更发汗。
与桂枝汤。
凡病。若发汗。若吐、若下。若亡津液。阴阳自和者。必自愈。
重亡津液。则不能作汗。必待阴阳自和。乃自愈矣。
大下之后。复发汗。小便不利者。亡津液故也。勿治之。得小便利。必自愈。
因亡津液而小便不利者。不可以药利之。俟津液足。小便利。必自愈也。
下之后。复发汗。必振寒。脉微细。所以然者。以内外俱虚故也。
发汗则表虚而亡阳。下之则里虚而亡血。振寒者。阳气微也。脉微细者。阴血弱也。
下之后。复发汗。昼日烦躁。不得眠。夜而安静。不呕不渴。无表证。脉沉微。身
无大热者。干姜附子汤主之。
下之虚其里。汗之虚其表。既下又汗。则表里俱虚。阳王于昼。阳欲复。虚不胜邪。
正邪交争。故昼日烦躁。不得眠。夜、阴王。阳虚不能与之争。是夜则安静。不呕不渴
者。里无热也。身无大热者。表无热也。又无表证而脉沉微。知阳气大虚。阴寒气胜。与
干姜附子汤退阴复阳。
麻黄（三两，去节，味甘、性温） 芍药（三两，味酸、微寒） 五味子（半升，味酸、性温） 干姜
（三两，味辛、性热） 甘草（三两，炙用，味甘、性平） 桂枝（三两，去皮，味辛、性热） 半夏（半升，汤洗，味辛、微温） 细辛（三两，味辛、性温）
以上八味药。用水一斗。先煮麻黄，水量减少二升，去掉水面上的浮沫。加入其余药物。煮取三升药液。滤去药渣。温服一升。
寒邪在体表，非甘辛之品不能发散它。麻黄、桂枝、甘草的辛甘之性，用来发散表邪。水饮停聚在心下而不运行，
则肾气燥。《内经》说：肾苦于燥，急食辛味以润之。干姜、细辛、半夏的辛味，用来行水气而润肾。咳逆而喘，
则肺气上逆。《内经》说：肺欲收敛，急食酸味以收之。芍药、五味子的酸味，用来收敛逆气而安肺。
加减法
如果有轻微腹泻，去掉麻黄，加荛花。如鸡蛋大小，炒至变红。腹泻者不可攻表，发汗必然导致胀满。麻黄发散阳气，
水湿渗入胃中，必然引起腹泻。荛花能泻除十二经的水饮，水饮去，腹泻就停止。
如果口渴，去掉半夏，加栝蒌根三两。辛燥而苦润。半夏辛而燥伤津液，不适合口渴者。所以去掉它。栝蒌味苦而生津液，所以加上。
如果出现噎塞感，去掉麻黄，加附子一枚，炮制。经书说：水遇到寒气，冷必相互搏结。那人就会KT（注：原文此处可能有缺字或通假，通常指“噎”或不适）。加
附子，温散水寒。患者本有寒，又发汗，胃中寒冷，必然吐蛔虫。去掉麻黄，厌恶发汗。
如果小便不利，少腹胀满，去掉麻黄，加茯苓四两。水蓄积在下焦不运行，导致小便不利，少腹胀满。
麻黄将津液发越于体表，不适合这种情况。茯苓渗泄下焦蓄水，加上是恰当的。
如果气喘，去掉麻黄，加杏仁半升，去皮尖。《金匮要略》说：那人形体浮肿，所以不加麻黄。加杏子，因为麻黄会发散阳气。喘呼且形体浮肿，是水气标本同病。
张卿子说：这与柴胡汤证相似，此方治表，所以偏温。彼方在半表半里，所以偏清。
伤寒，心下有 water qi（水气），咳嗽且轻微气喘，发热但不渴。服药后，感到口渴，这是寒邪已去，病情将要解除的表现。用小青龙汤主治。
咳嗽且轻微气喘，是水寒射肺所致。发热但不渴，是表证未罢。给予小青龙汤，发表散水。服药后，感到口渴，是里气温和，水气消散，为将要解除的表现。
太阳病，外证未解，脉浮弱的，应当用汗法解表。宜用桂枝汤。
脉浮弱，是营弱卫强。
太阳病，误用下法后出现轻微气喘的，是表证未解的缘故。用桂枝加厚朴杏子汤主治。
下法之后出现严重气喘，则是里气大虚，邪气传入里，正气即将脱失。下法之后出现轻微气喘，则是里气上逆，邪气不能传入里，仍在表。给予桂枝汤以解表。加厚朴、杏仁，以降逆气。
太阳病，外证未解的，不可用下法。用下法是逆治。想要解表的，宜用桂枝汤主治。
经书说：本来该发汗却反而用下法，这是逆治。如果先发汗，治疗就不算逆治。
太阳病，先发汗，病不解，又用下法，脉仍浮的，病不好。浮脉表示病邪在表，反而用下法，所以病不好。
现在脉浮，所以知道病邪在表，应当解表才能好。宜用桂枝汤主治。
经书说：柴胡汤证具备，却用其他药下之。柴胡汤证仍在的，再给柴胡汤。这虽然已经用过下法，不算逆治，与此类同。
太阳病，脉浮紧，无汗，发热，身体疼痛，八九日未解，表证仍在。这应当发汗。服药后，症状轻微缓解。那人感到心烦，眼睛闭合。严重的必定鼻衄。衄血后病才解。之所以这样，是因为阳气重盛。用麻黄汤主治。
说用麻黄汤主治，正是指应当发汗这一种汤药。汗出后症状必然轻微缓解，或者通过鼻衄而解。哪有夺血亡汗，再用麻黄汤发汗的道理呢？汉文（指《伤寒论》行文）错综接续，不可不知。
脉浮紧，无汗，发热，身体疼痛，是太阳伤寒。即使到了第八九日，表证仍在，也应当发汗。既然服了温暖发散的汤药，虽然没有出大汗，但也会有轻微缓解。烦，是指身热。邪气不为汗解，郁而化热，蒸腾于经络，发于肌表，所以生热烦。肝受血滋养才能视物。起初气伤营，寒既变为热，则血被热所搏结，肝气不治，所以眼睛闭合。严重的热甚于经络，迫血妄行而为鼻衄。得衄，则热随血散而解。阳气重，是指热气重。给麻黄汤，以解前太阳伤寒之邪。
王文禄说：这条与下面两条一起看。上一条说的阳气重，就是下面所说的不得越散。下一条说的不彻，就是上面所说的轻微缓解。麻黄泻实，所以主治。
太阳病，脉浮紧，发热，身体无汗，自鼻衄的，病自愈。
上文是因服发汗药而鼻衄，此条是不服发汗药而自鼻衄，都是向愈的征兆。
风寒在经络，不能通过汗解，郁而化热，衄血则热随血散，所以说自鼻衄者愈。
二阳并病，太阳初得病时，发其汗，汗先出不透彻，因而转属阳明，继续自微汗出，不恶寒。
如果太阳病证未罢的，不可用下法。用下法是逆治。像这种情况可以小发其汗。假如面色缘缘正赤的，是寒气怫郁在表，当解表、熏蒸。如果发汗不透彻，不足以称为阳气怫郁不得越散。当汗不汗，其人躁烦，不知道痛处，一会儿在腹中，一会儿在四肢，按之找不到痛点。那人短气，只能坐着，是因为汗出不透彻的缘故。再发汗则愈。怎么知道汗出不透彻？从脉涩可知。
太阳病未解，传并入阳明，而太阳证未罢的，名叫并病。继续自微汗出，不恶寒的，是太阳证罢，阳明证具。依法应当用下法。如果太阳证未罢的，是表未解，则不可下。应当小发其汗。先解表。阳明之经循行于面部，色缘缘正赤的，是阳气怫郁在表。当解表、熏蒸以取其汗。如果发汗不彻底的，不足以称为阳气怫郁。只是当汗不汗，阳气不得越散，邪气无从出，壅盛于经络，所以躁烦。邪气循经行，则痛无常处。或在腹中，或在四肢，按之找不到。而短气，只归咎于汗出不透彻，再发汗则愈。《内经》说：诸过者切之。涩者，阳气有余，为身热无汗，是以脉涩，知阳气壅郁，而汗出不透彻。
脉浮数的，依法应当汗出而愈。如果用下法，身重心悸的，不可发汗。应当自汗出乃解。之所以这样，是因为尺中脉微，这是里虚。须表里实，津液自和，便自汗出愈。
经书说：诸脉浮数，当发热而洒淅恶寒，言邪气在表。是应当汗出愈。如果用下法，身重心悸的，损其津液，虚其胃气。若身重心悸，而尺脉实的，则是下后里虚，邪气乘虚传里。
现在尺脉微，身重心悸的，知下后里虚，津液不足，邪气不传里，但在表。然而因津液不足，则不可发汗。须里气实，津液足，便自汗出而愈。
脉浮紧的，依法应当身体疼痛。宜用汗法解。假如尺中迟的，不可发汗。为什么知道？因为荣气不足，血少。
《针经》说：夺血者无汗。尺脉迟者，为荣血不足，故不可发汗。
脉浮的，病在表，可发汗。宜麻黄汤。
浮脉是轻手可得，以候皮肤之气。《内经》说：其在皮者，汗而发之。
脉浮而数的，可发汗。宜麻黄汤。
浮则伤卫，数则伤荣。荣卫受邪，为病在表，故当汗散。
病人常自汗出的，这是荣气和。荣气和者，外不谐，因为卫气不与荣气和谐。因为荣行脉中，卫行脉外，复发其汗，荣卫和则愈。宜桂枝汤。
风则伤卫，寒则伤荣。卫受风邪而荣不病的，为荣气和。卫既客邪，则不能与荣气和谐，也不能卫护皮腠，是以常自汗出。给桂枝汤，解散风邪，调和荣卫则愈。
病患脏腑无其他病，时发热，自汗出，而不愈的，这是卫气不和。先其时发汗则愈。宜桂枝汤主治。
脏腑无其他病，里和。卫气不和，是表病。《外台秘要》说：里和表病，汗之则愈。所谓先其时的，是先其发热汗出之时发汗，则愈。
伤寒，脉浮紧，不发汗，因致鼻衄的，麻黄汤主治。
前条说太阳病八九日未解，当给麻黄汤，以发汗，因自衄而解。此条是不发汗因致衄。麻黄汤主治。为什么呢？盖前条发汗自衄，以衄即汗也。所以说衄乃解。此条不发汗，致衄乃邪郁于经。所以用麻黄发汗两者，不可不解。
伤寒，脉浮紧，邪在表。当给麻黄汤发汗。若不发汗，则邪无从出，壅盛于经络，迫血妄行，因致衄。
王三阳说：夺血者亡汗。既致衄，不可轻用麻黄汤。须审之又审。点滴不成流者可也。
伤寒，不大便六七日，头痛有热的，给承气汤。其小便清的，知不在里，仍在表。
应当发汗。若头痛的必衄。宜桂枝汤。
不大便六七日，头痛有热的，故宜当下。若小便清的，知里无热，则不可下。经书说：小便数者，大便必硬。不更衣十日，无所苦也。何况此不大便六七日，小便清的，不可责邪在里，是仍在表。给桂枝汤以解外。若头疼不已，为表不罢，郁甚于经，迫血妄行，上为衄。
王三阳说：头痛有热，盒饭（应为“合当”）解表。纵六七日不便，止当与大柴胡汤。承气汤不当给。疑有“瘥”字。虽十日不更衣，何惧之有。
伤寒，发汗，已解。半日许复烦，脉浮数的，可更发汗。宜桂枝汤主治。
烦，是热。发汗身凉为已解。至半日许，身复热，脉浮数的，邪不尽。可更发汗。给桂枝汤。
凡病，若发汗，若吐、若下，若亡津液，阴阳自和的，必自愈。
重亡津液，则不能作汗。必待阴阳自和，乃自愈。
大下之后，复发汗，小便不利的，亡津液故也。勿治之。得小便利，必自愈。
因亡津液而小便不利的，不可以药利之。俟津液足，小便利，必自愈。
下之后，复发汗，必振寒，脉微细。之所以这样，是因为内外俱虚。
发汗则表虚而亡阳。下之则里虚而亡血。振寒，是阳气微。脉微细，是阴血弱。
下之后，复发汗，昼日烦躁，不得眠，夜而安静，不呕不渴，无表证，脉沉微，身无大热的，干姜附子汤主治。
下之虚其里，汗之虚其表。既下又汗，则表里俱虚。阳王于昼，阳欲复，虚不胜邪，正邪交争，故昼日烦躁，不得眠。夜，阴王，阳虚不能与之争，是夜则安静。不呕不渴，是里无热。身无大热，是表无热。又无表证而脉沉微，知阳气大虚，阴寒气胜。给干姜附子汤退阴复阳。
Mahuang (Ephedrae Herba, three liang, nodes removed, sweet flavor, warm nature) Shaoyao (Paeoniae Radix Alba, three liang, sour flavor, slightly cold nature) Wuweizi (Schisandrae Fructus, half sheng, sour flavor, warm nature) Ganjiang (Zingiberis Rhizoma, three liang, pungent flavor, hot nature) Gancao (Glycyrrhizae Radix et Rhizoma, three liang, processed with honey, sweet flavor, neutral nature) Guizhi (Cinnamomi Ramulus, three liang, bark removed, pungent flavor, hot nature) Banxia (Pinelliae Tuber, half sheng, washed in boiling water, pungent flavor, slightly warm nature) Xixin (Asari Radix et Rhizoma, three liang, pungent flavor, warm nature)
The above eight herbs. Use one dou of water. First decoct Mahuang, reduce the volume by two sheng, remove the foam on the surface. Add the remaining herbs. Decoct to obtain three sheng of liquid. Filter out the dregs. Take one sheng warm.
Cold pathogen is at the exterior; only sweet and pungent substances can disperse it. The sweet and pungent properties of Mahuang, Guizhi, and Gancao are used to disperse exterior pathogens. When fluid retention occurs below the heart and fails to circulate, the Kidney Qi becomes dry. The *Neijing* states: "The Kidney suffers from dryness; urgently consume pungent foods to moisten it." The pungency of Ganjiang, Xixin, and Banxia moves fluid qi and moistens the Kidney. Cough with counterflow and wheezing indicate rebellious Lung Qi. The *Neijing* states: "The Lung desires astringency; urgently consume sour foods to gather it." The sourness of Shaoyao and Wuweizi gathers rebellious qi and calms the Lung.
Modifications
If there is slight diarrhea, remove Mahuang and add Raohua (Edwardsia Radix). Size of a chicken egg, roasted until red. For those with diarrhea, attacking the exterior is contraindicated; sweating will inevitably cause abdominal fullness. Mahuang disperses Yang Qi; if water moisture enters the Stomach, diarrhea will occur. Raohua drains water from the twelve meridians; once water is gone, diarrhea stops.
If there is thirst, remove Banxia and add Gualougen (Trichosanthis Radix), three liang. Pungent and drying, yet bitter and moistening. Banxia is pungent and dries body fluids, unsuitable for those with thirst. Hence, remove it. Gualou is bitter and generates body fluids, hence add it.
If there is a sensation of choking (Ye), remove Mahuang and add one Fuzi (Aconiti Lateralis Radix Praeparata), processed. Classics state: "When water meets cold qi, cold must contend." The person will experience discomfort. Add Fuzi to warm and disperse cold-water. If the patient has cold and sweating is induced, the Stomach becomes cold, likely causing vomiting of roundworms. Remove Mahuang due to aversion to sweating.
If urination is difficult and the lower abdomen is full, remove Mahuang and add Fuling (Poria), four liang. Water accumulation in the Lower Jiao failing to circulate causes difficult urination and lower abdominal fullness. Mahuang directs body fluids outward, which is inappropriate here. Fuling drains accumulated water downward, making its addition appropriate.
If there is wheezing, remove Mahuang and add Xingren (Armeniacae Semen Amarum), half sheng, skin and tips removed. The *Jingui Yaolue* states: "If the person has edema, do not add Mahuang. Add Xingzi (Almonds), because Mahuang disperses Yang Qi." Wheezing and edema indicate simultaneous root and branch pathology of water qi.
Zhang Qingzi said: This resembles Chaihu Tang syndrome. This formula treats the exterior, thus leaning towards warmth. That formula treats the half-exterior half-interior, thus leaning towards clearing heat.
In Shanghan, when water qi is present in the chest, coughing with slight wheezing, fever but no thirst: after taking the decoction, if thirst appears, this indicates cold has departed and resolution is imminent. Xiao Qinglong Tang is indicated.
Coughing with slight wheezing is caused by cold-water invading the Lung. Fever without thirst indicates the exterior syndrome has not resolved. Administer Xiao Qinglong Tang to release the exterior and scatter water. After taking the decoction, if thirst appears, it indicates interior warmth returning and water qi dissipating, signaling impending resolution.
In Taiyang disease, if exterior symptoms persist and the pulse is floating and weak, resolve via sweating. Guizhi Tang is suitable.
Floating and weak pulse indicates weak Ying and strong Wei.
In Taiyang disease, if slight wheezing occurs after purgation, it is because the exterior has not resolved. Guizhi Jia Houpo Xingren Tang is indicated.
Severe wheezing after purgation indicates severe deficiency of interior Qi, transmission of pathogen to the interior, and impending collapse of righteous Qi. Slight wheezing after purgation indicates rebellious interior Qi, inability of pathogen to transmit to the interior, and persistence at the exterior. Give Guizhi Tang to resolve the exterior. Add Houpo and Xingren to direct rebellious Qi downward.
In Taiyang disease, if exterior symptoms have not resolved, purgation is contraindicated. Using purgation is contrary to treatment principles. To resolve the exterior, Guizhi Tang is indicated.
Classics state: "Originally should have sweated but instead purged is contrary treatment. If sweating is performed first, treatment is not contrary."
In Taiyang disease, if initial sweating fails to resolve the condition and purgation is subsequently used, and the pulse remains floating, the disease does not resolve. Floating indicates the pathogen is at the exterior; using purgation contrary to this prevents resolution.
Since the pulse is currently floating, we know the pathogen is at the exterior. Resolution of the exterior is required for cure. Guizhi Tang is indicated.
Classics state: "Chaihu Tang syndrome is present, but other medicines were used to purge. If Chaihu Tang syndrome persists, administer Chaihu Tang again. Although purgation was used, it is not considered contrary treatment, similar to this case."
In Taiyang disease, with floating-tight pulse, no sweat, fever, and body pain persisting for eight or nine days without resolution, the exterior syndrome remains. Sweating is indicated. After medication, symptoms may slightly alleviate. The patient may feel vexed and close their eyes. In severe cases, epistaxis (nosebleed) occurs, followed by resolution. This is because Yang Qi is heavy. Mahuang Tang is indicated.
Saying "Mahuang Tang is indicated" precisely refers to the need for sweating with this single decoction. After sweating, symptoms should slightly alleviate, or resolve via epistaxis. How could one deplete blood and sweat, then use Mahuang Tang again to sweat? The textual structure of the Han dynasty writings is intricate; this must be understood.
Floating-tight pulse, no sweat, fever, and body pain constitute Taiyang Cold Damage. Even if eight or nine days have passed, if the exterior syndrome remains, sweating is still indicated. Having taken warm, dispersing decoctions, although heavy sweating may not occur, there will be slight alleviation. Vexation refers to body heat. If the pathogen is not resolved by sweat, it stagnates and transforms into heat, steaming through meridians and manifesting on the muscle surface, generating heat and vexation. The Liver receives blood to enable vision. Initially, Qi injures Ying; as cold transforms to heat, blood is constrained by heat, Liver Qi fails to govern, resulting in closed eyes. Severe heat in meridians forces blood to move recklessly, causing epistaxis. Epistaxis allows heat to dissipate with blood, leading to resolution. "Heavy Yang Qi" refers to heavy heat. Mahuang Tang is given to resolve the preceding Taiyang Cold Damage pathogen.
Wang Wenlu said: View this alongside the next two clauses. The "heavy Yang Qi" mentioned above corresponds to "unable to vent" in the following clause. The "incomplete" mentioned below corresponds to "slight alleviation" above. Mahuang drains excess, hence it is indicated.
In Taiyang disease, with floating-tight pulse, fever, no body sweat, spontaneous epistaxis leads to recovery.
The previous clause describes epistaxis after taking diaphoretic medicine; this clause describes spontaneous epistaxis without such medicine. Both are signs of approaching recovery.
Wind-cold in the meridians cannot be resolved by sweating; stagnation transforms into heat. Epistaxis allows heat to dissipate with blood, hence "spontaneous epistaxis leads to recovery."
Two Yangs concurrent disease: When Taiyang disease is first acquired, sweating is induced. If the initial sweat is incomplete, the condition transfers to Yangming, continuing with slight spontaneous sweating and aversion to cold ceases.
If Taiyang symptoms have not ceased, purgation is contraindicated. Using purgation is contrary treatment. In such cases, mild sweating may be induced. If the face is uniformly red, it indicates cold qi stagnating at the exterior. Resolve and fumigate. If sweating is incomplete, it is insufficient to describe as Yang Qi stagnation unable to vent. When sweating should occur but does not, the person becomes restless and vexed, unaware of pain location, shifting between abdomen and limbs, unpressable. Shortness of breath, sitting only, is due to incomplete sweating. Re-sweating leads to recovery. How do we know sweating was incomplete? By the choppy pulse.
Taiyang disease unresolved, transmitting into Yangming, while Taiyang symptoms persist, is called concurrent disease. Continued slight spontaneous sweating and absence of aversion to cold indicate Taiyang symptoms have ceased and Yangming symptoms are complete. According to method, purgation is indicated. However, if Taiyang symptoms persist, the exterior is unresolved, so purgation is contraindicated. Mild sweating should be induced to resolve the exterior first. The Yangming meridian traverses the face; uniform redness indicates Yang Qi stagnating at the exterior. Resolve and fumigate to induce sweat. If sweating is incomplete, it is insufficient to call Yang Qi stagnation. It simply means failure to sweat when indicated, preventing Yang Qi from venting. Pathogen has no exit, accumulating heavily in meridians, causing restlessness. Pathogen follows meridians, so pain is irregular. In abdomen or limbs, unpressable. Shortness of breath is solely blamed on incomplete sweating; re-sweating leads to recovery. *Neijing* states: "Palpate all abnormalities. Choppy indicates excess Yang, body heat, and no sweat." Thus, choppy pulse indicates Yang Qi stagnation and incomplete sweating.
Floating-numerous pulse indicates sweating should lead to recovery. If purgation is used, resulting in heaviness of body and palpitations, sweating is contraindicated. Spontaneous sweating will lead to resolution. This is because the pulse at the cun-knee position (Chi) is faint, indicating interior deficiency. Interior and exterior must become solid; when body fluids harmonize, spontaneous sweating occurs and recovery follows.
Classics state: "All floating-numerous pulses indicate fever and chills, signifying pathogen at the exterior." Recovery via sweating is expected. If purgation is used, causing body heaviness and palpitations, body fluids are damaged and Stomach Qi is weakened. If body heaviness and palpitations accompany a solid Chi pulse, it indicates interior deficiency post-purgation with pathogen transmitting inward due to deficiency.
Now, with a faint Chi pulse, body heaviness, and palpitations, we know interior deficiency and insufficient body fluids post-purgation, with pathogen remaining at the exterior. However, due to insufficient body fluids, sweating is contraindicated. Interior Qi must strengthen and body fluids replenish before spontaneous sweating and recovery can occur.
Floating-tight pulse indicates body pain; sweating is indicated. If the Chi pulse is slow, sweating is contraindicated. Why? Because Ying Qi is deficient and blood is scant.
*Zhenjing* states: "Those who lose blood have no sweat." Slow Chi pulse indicates deficiency of Ying blood, hence sweating is contraindicated.
Floating pulse indicates disease at the exterior; sweating is possible. Mahuang Tang is suitable.
Floating is felt lightly, assessing Qi at the skin. *Neijing* states: "Where pathogen is in the skin, release via sweating."
Floating-numerous pulse allows sweating. Mahuang Tang is suitable.
Floating injures Wei; Numerous injures Ying. When Ying and Wei receive pathogen, disease is at the exterior, requiring dispersal via sweating.
Patients with constant spontaneous sweating have harmonious Ying Qi. Harmonious Ying Qi implies disharmony externally, because Wei Qi does not harmonize with Ying Qi. Ying circulates within vessels; Wei circulates outside. Inducing sweating restores harmony between Ying and Wei, leading to recovery. Guizhi Tang is suitable.
Wind injures Wei; Cold injures Ying. If Wei receives wind pathogen but Ying is unaffected, Ying Qi is harmonious. Once Wei hosts pathogen, it cannot harmonize with Ying nor protect the skin and pores, causing constant spontaneous sweating. Guizhi Tang disperses wind pathogen and harmonizes Ying and Wei, leading to recovery.
Patients with no internal organ pathology, experiencing intermittent fever and spontaneous sweating without recovery, suffer from disharmonious Wei Qi. Sweating prior to symptom onset leads to recovery. Guizhi Tang is indicated.
No internal organ pathology indicates interior harmony. Disharmonious Wei Qi indicates exterior disease. *Waitai Mi Yao* states: "Interior harmonious, exterior diseased; sweating leads to recovery." "Prior to onset" means sweating before the fever and sweating episode begins.
Shanghan with floating-tight pulse, if not sweated, leading to epistaxis, Mahuang Tang is indicated.
Previous clause: Taiyang disease unresolved after eight-nine days, give Mahuang Tang to sweat, resolving via spontaneous epistaxis. This clause: Not sweating leads to epistaxis. Mahuang Tang is indicated. Why? Previous clause: Sweating leads to spontaneous epistaxis; epistaxis acts as sweating, hence "epistaxis resolves." This clause: Not sweating leads to epistaxis; pathogen stagnates in meridians. Thus, Mahuang induces sweating to resolve both aspects.
Shanghan with floating-tight pulse indicates pathogen at the exterior. Mahuang Tang should be given to sweat. If not sweated, pathogen has no exit, accumulates heavily in meridians, forces blood recklessly, causing epistaxis.
Wang Sanyang said: Blood loss precludes sweat. Since epistaxis has occurred, Mahuang Tang should not be used lightly. Scrutinize carefully. Only use if bleeding is minimal.
Shanghan with constipation for six-seven days, headache with fever: Give Chengqi Tang. If urine is clear, know pathogen is not in the interior but remains at the exterior.
Sweating is indicated. If headache persists, epistaxis will likely occur. Guizhi Tang is suitable.
Constipation for six-seven days with headache and fever suggests purgation is appropriate. If urine is clear, interior heat is absent, so purgation is contraindicated. Classics state: "Frequent urination leads to hard stool. Ten days without bowel movement without discomfort is acceptable." Especially with six-seven days of constipation and clear urine, do not blame pathogen in the interior; it remains at the exterior. Guizhi Tang resolves the exterior. If headache persists, exterior has not resolved, stagnation in meridians forces blood recklessly upward, causing epistaxis.
Wang Sanyang said: Headache with fever requires resolving the exterior. Even with six-seven days of constipation, Da Chaihu Tang is appropriate. Chengqi Tang is not. Suspect a textual error ("cured"). Even ten days without bowel movement, why fear?
Shanghan, after sweating, resolves. Half a day later, vexation returns, pulse floating-numerous: Can re-sweat. Guizhi Tang is indicated.
Vexation indicates heat. Body cooling after sweating indicates resolution. Half a day later, body heats up again, pulse floating-numerous indicates pathogen not fully expelled. Re-sweating is possible. Guizhi Tang is given.
For any disease, whether treated with sweating, vomiting, purgation, or loss of body fluids, if Yin and Yang self-harmonize, recovery is inevitable.
Severe loss of body fluids prevents sweating. Must wait for Yin-Yang self-harmony for recovery.
After severe purgation and subsequent sweating, if urination is difficult, it is due to loss of body fluids. Do not treat directly. When urination normalizes, recovery will follow spontaneously.
Urinary difficulty due to body fluid loss should not be treated with diuretics. Wait for body fluids to replenish and urination to normalize; recovery will follow.
After purgation and subsequent sweating, chills and faint-thin pulse occur. This is because both interior and exterior are deficient.
Sweating causes exterior deficiency and loss of Yang. Purgation causes interior deficiency and loss of blood. Chills indicate微弱 Yang Qi. Faint-thin pulse indicates weak Yin blood.
After purgation and subsequent sweating, daytime irritability and insomnia, nighttime quietness, no vomiting or thirst, no exterior syndrome, sinking-faint pulse, and no significant heat: Ganjiang Fuzi Tang is indicated.
Purgation weakens the interior; sweating weakens the exterior. Both purgation and sweating result in dual interior-exterior deficiency. Yang dominates daytime; Yang attempts to recover but deficiency cannot overcome pathogen. Righteous and pathogenic Qi contend, causing daytime irritability and insomnia. Nighttime, Yin dominates; Yang deficiency cannot contend, hence nighttime quietness. No vomiting/thirst indicates no interior heat. No significant heat indicates no exterior heat. With no exterior syndrome and sinking-faint pulse, we know severe Yang deficiency and prevailing Yin-cold. Ganjiang Fuzi Tang retreats Yin and restores Yang.