项背强者。桂枝汤加葛根也。
（本草。葛根主伤风有湿。开窍解肌。盖桂枝加葛根者。谓中风有湿。当加之去其风湿。
取
里寒者。桂枝去芍药加附子汤也。（不饮水者是也。）
凡发汗后。汗不止为漏风。桂枝加附子汤主之。腹满者太阴证。脉浮者。可服桂枝汤。
微发
四
半两。
用古方
又问。伤寒与伤风。何以别之。伤寒者。脉紧而涩。伤风者。脉浮而缓。伤寒者无汗。
脉涩
浮发
其证
少阳
但
有发热恶寒。烦躁。手足温。而脉反浮紧者。有寒多热少。不烦躁。手足微冷。而脉反
浮缓
多热
伤寒见风脉。宜服大青龙汤。盖大青龙证脉。似桂枝反无汗。病似麻黄反烦躁是也。脉弱有
汗
加
在内添石膏。所以为紧。此治营卫俱病。若证不审。误用大青龙汤。则发汗多伤人。以其有
烦躁一证。故须用大青龙。大抵感外风者。为伤风。感寒冷者。为伤寒。故风则伤卫。寒则
伤营。桂枝主伤卫。麻黄主伤营。大青龙主营卫俱伤故也。风伤卫者。病在皮肤之间也。以
卫行脉外。为阳。主外。皮肤之间。卫气之道路故也。其病浅。寒伤营者。寒气中于肌肉也
。以营行脉中。为阴。主内。肌肉之间。营气之道路故也。其病深。所以桂枝、麻黄所施各
异。戒勿误用。以有浅深之别。风寒之殊。医当宜审谛。大青龙尤宜慎用。
仲景云。脉微弱。汗出恶风者。不可服青龙汤。服之则厥逆。筋伤肉 。此为逆也。类
纂云
以救
为合
夫夏月发热恶寒。头疼。身体肢节痛重。其脉洪盛者。盖冬伤于寒。因暑气而发为热病。治
热病与伤寒同。有汗宜桂枝汤。无汗宜麻黄汤。加烦躁者。宜大青龙汤。然夏月药性须带凉
。不可太温。桂枝、麻黄、大青龙。须加减法。夏至前。桂枝加黄芩半两。夏至后。桂枝、
麻黄、大青龙。加知母一两。石膏二两。或加升麻半两也。盖桂枝、麻黄汤性热。地暖之处
。非西北之比。夏月服之。必有发黄斑出之失。热病三日外。与汤不瘥。脉热仍数。邪气犹
在经络。未入脏腑者。桂枝石膏汤主之。此方夏至后。代桂枝证用。若加麻黄半两。可代麻
黄青龙汤用也。古方。三月至夏。为晚发伤寒。栀子升麻汤。亦可选用之。又问。夏至后。
皆可行白虎汤耶。白虎汤治中暑与汗后。一解表药耳。
（今之医者。见六月中病。多云中暑。不辨热病。用药太凉。又况夏则阴气在内。最难
调治
夏月自汗恶寒。身热而渴。其脉微弱者。此名中暑也。大抵中暑与热病外证相似。但热
病者
盖
盛
（其面如涂油。类纂云。面垢者。阳证也。一名面尘。若尘垢之着面。）
手足微冷。烦渴口燥。但觉倦怠。四肢却不痛重。其脉微弱。按之无力。白虎汤主之。
痰逆
最妙
皮肤
热病
身体
病。盖
（春初秋末。阳气在里。其病稍轻。虽不用药治之。五六日亦自瘥也。）
升麻汤。解肌汤。柴胡桂枝汤。最良。热多者。小柴胡汤主之。不渴。外有微热者。小
柴胡
次
唯冬月及正初。乃可用正方。自春末。至夏至以前。桂枝、麻黄、大青龙内。宜加减也。病
人先热后寒。尺寸脉俱盛。此名温疟也。先热后寒。名曰温疟。病患尺寸俱盛。重感于寒。
变成温疟。小柴胡汤主之。疟疾寒热相等。及先热后寒者。俱宜与小柴胡汤主之。先寒后热
者。小柴胡加桂枝汤。有多热者。白虎加桂汤。有多寒者。但寒者。柴胡桂姜汤。有汗多烦
渴。小便涩赤。素有瘴气。及不伏水土。呕吐甚者。可服五苓散。脉小紧。寒热呕吐。间日
频日发作无时。大便秘者。可服大柴胡汤下之。脉浮大。寒热往来者。可服祛邪丸吐之。久
不愈者。服疟母煎丸。当自愈。治疟之法。无以过也。大抵疟脉自弦。弦数者多热。弦迟者
多寒。弦小紧者。下之瘥。弦迟者。可温之。弦紧者。可发汗。浮大者。可吐之。夏伤于暑
。秋必病疟。此非伤寒之谓。以其观伤寒有温疟一证。故因而及之。脉尺寸俱浮。头疼身热
。常自汗出。体重。其息必喘。四肢不收。嘿嘿但欲眠。此名风温也。其人素伤于风。因复
伤于热。风热相搏。即发风温。主四肢不收。头疼身热常在。汗出不解。治在少阴、厥阴。
不可发汗。即谵言独语。内烦躁扰。不得卧。若惊痫。目乱无精。疗之者。复发其汗。如此
死者。医杀之也。风温不可发汗。宜葳蕤汤。风温身灼热者。知母干葛汤。风温如渴甚者。
栝蒌根汤。风温脉浮。身重汗出。汉防己汤。
项背强直不舒的，用桂枝汤加葛根。
（《本草》记载：葛根主治伤风夹湿，能开窍解肌。所谓桂枝加葛根汤，是指中风兼有湿邪时，加入葛根以祛除风湿。）
体内有寒气的，用桂枝去芍药加附子汤。（表现为不想喝水的就是这种情况。）
凡是发汗之后，汗出不止称为漏风，由桂枝加附子汤主治。腹部胀满是太阴证的表现；脉象浮的，可以服用桂枝汤。
（此处原文有残缺或排版错误：“微发 四 半两。 用古方”）
又问：伤寒与伤风，如何区别？伤寒的脉象紧而涩，伤风的脉象浮而缓。伤寒患者无汗。
（此处原文有残缺或排版错误：“脉涩 浮发 其证 少阳 但 有发热恶寒。烦躁。手足温。而脉反浮紧者。有寒多热少。不烦躁。手足微冷。而脉反 浮缓 多热”）
伤寒见到风脉，适宜服用大青龙汤。大概大青龙汤证的脉象，类似桂枝汤证却无汗，病情类似麻黄汤证却有烦躁。脉弱且有汗……（此处原文有残缺或排版错误：“加 在内添石膏。所以为紧。此治营卫俱病。若证不审。误用大青龙汤。则发汗多伤人。以其有 烦躁一证。故须用大青龙。大抵感外风者。为伤风。感寒冷者。为伤寒。故风则伤卫。寒则 伤营。桂枝主伤卫。麻黄主伤营。大青龙主营卫俱伤故也。风伤卫者。病在皮肤之间也。以 卫行脉外。为阳。主外。皮肤之间。卫气之道路故也。其病浅。寒伤营者。寒气中于肌肉也 。以营行脉中。为阴。主内。肌肉之间。营气之道路故也。其病深。所以桂枝、麻黄所施各 异。戒勿误用。以有浅深之别。风寒之殊。医当宜审谛。大青龙尤宜慎用。”）
张仲景说：脉象微弱，出汗且怕风的，不可服用青龙汤。如果服用，会导致四肢厥冷，筋脉受损，肌肉拘急。这是逆治。《类纂》云……（此处原文有残缺或排版错误：“以救 为合”）
夏季出现发热恶寒、头痛、身体肢节沉重疼痛，脉象洪盛的，这是因为冬季感受寒邪，因暑气引发而为热病。治疗热病与伤寒相同，有汗的适宜用桂枝汤，无汗的适宜用麻黄汤。伴有烦躁的，适宜用大青龙汤。然而夏季用药性质必须带有凉意，不可过于温热。桂枝汤、麻黄汤、大青龙汤都需要进行加减。夏至前，桂枝汤加黄芩半两；夏至后，桂枝汤、麻黄汤、大青龙汤加知母一两、石膏二两，或者加升麻半两。因为桂枝汤、麻黄汤药性偏热，南方地暖之处不同于西北。夏季服用这些热性药物，必然会导致发黄、出斑疹的失误。热病三天后，服药后病未愈，脉象仍数，邪气仍在经络，未进入脏腑的，用桂枝石膏汤主治。此方在夏至后代替桂枝汤证使用。如果加麻黄半两，可以代替麻黄汤和大青龙汤使用。古方中，三月至夏季，称为晚发伤寒，栀子升麻汤也可以选择使用。又问：夏至后，都可以服用白虎汤吗？白虎汤是治疗中暑和发汗后……（此处原文有残缺或排版错误：“一解表药耳。（今之医者。见六月中病。多云中暑。不辨热病。用药太凉。又况夏则阴气在内。最难调治”）
夏季自汗、恶寒、身热且口渴，脉象微弱的，这名叫中暑。大概中暑与热病的体表症状相似，但热病患者……（此处原文有残缺或排版错误：“盖 盛 （其面如涂油。类纂云。面垢者。阳证也。一名面尘。若尘垢之着面。）”）
手足微微发冷，心烦口渴，口舌干燥，只感觉倦怠，四肢却不疼痛沉重，脉象微弱，按之无力，用白虎汤主治。
（此处原文有残缺或排版错误：“痰逆 最妙 皮肤 热病 身体 病。盖 （春初秋末。阳气在里。其病稍轻。虽不用药治之。五六日亦自瘥也。）”）
升麻汤、解肌汤、柴胡桂枝汤效果最好。热象明显的，用小柴胡汤主治。不渴，体表有轻微发热的，小柴胡……（此处原文有残缺或排版错误：“次 唯冬月及正初。乃可用正方。自春末。至夏至以前。桂枝、麻黄、大青龙内。宜加减也。”）
病人先发热后发冷，寸关尺三部脉都盛大，这名叫温疟。先热后冷，名叫温疟。病患寸关尺脉都盛大，再次感受寒邪，变成温疟，用小柴胡汤主治。疟疾寒热相等，以及先热后冷的，都适宜用小柴胡汤主治。先冷后热的，用柴胡加桂枝汤。热多的，用白虎加桂枝汤。寒多的，只用寒性的药物。只有寒冷的，用柴胡桂姜汤。出汗多且心烦口渴，小便涩滞色赤，素有瘴气，以及不服水土，呕吐严重的，可以服用五苓散。脉象小紧，寒热呕吐，间日或每日发作无定时，大便干结的，可以服用大柴胡汤攻下。脉象浮大，寒热往来的，可以服用祛邪丸催吐。久治不愈的，服用疟母煎丸，应当自愈。治疗疟疾的方法，没有超过这个的了。大概疟疾的脉象自弦，弦数的多热，弦迟的多寒，弦小紧的，攻下可愈，弦迟的可温补，弦紧的可发汗，浮大的可催吐。夏季感受暑邪，秋季必定患疟疾。这不是指伤寒而言，是因为观察到伤寒中有温疟这一证型，所以连带提及。
脉象寸关尺都浮，头痛身热，经常自汗出，身体沉重，呼吸必定气喘，四肢不能收持，沉默只想睡觉，这名叫风温。其人素来受风邪伤害，又再次受热邪伤害，风热相互搏结，就引发风温。主要症状是四肢不能收持，头痛身热常在，出汗不解。治疗在于少阴、厥阴经，不可发汗。如果发汗，就会谵语独语，内心烦躁扰乱，不得卧睡，像惊痫一样，眼睛昏乱无神。这样治疗的，如果再次发汗，这样的死者，是医生杀死的。风温不可发汗，适宜用葳蕤汤。风温身体灼热的，用知母干葛汤。风温口渴严重的，用栝蒌根汤。风温脉浮，身体沉重出汗的，用汉防己汤。
When the neck and back are stiff, use Guizhi Tang (Cinnamon Twig Decoction) with added Gegen (Kudzu Root).
(Bencao [Compendium of Materia Medica] states: Gegen treats wind-cold with dampness, opens orifices and releases the muscle layer. The term "Guizhi Tang with added Gegen" refers to adding Gegen to treat wind-stroke complicated by dampness, thereby dispelling wind-damp.)
For interior cold, use Guizhi Qu Shaoyao Jia Fuzi Tang (Cinnamon Twig Decoction minus Peony plus Aconite). (This is indicated when there is no desire for water.)
After any sweating therapy, if sweating does not stop, it is called "Lou Feng" (Leaking Wind), treated by Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite). Abdominal fullness indicates a Taiyin syndrome; if the pulse is floating, Guizhi Tang may be administered.
[Text fragment missing: "Slight sweating... four... half tael. Use ancient formula."]
Question: How to distinguish between Shanghan (Cold Damage) and Shangfeng (Wind Injury)? In Shanghan, the pulse is tight and choppy; in Shangfeng, the pulse is floating and slow. Patients with Shanghan have no sweat.
[Text fragment missing: "Choppy pulse... Floating... Its symptoms... Shaoyang... Only... Fever and aversion to cold, irritability, warm hands and feet but pulse is surprisingly tight... Cold more than heat, no irritability, slightly cold hands and feet but pulse is surprisingly... Floating slow... More heat..."]
If a patient with Shanghan presents with a wind-type pulse, Da Qinglong Tang (Major Blue Dragon Decoction) is appropriate. Generally, the pulse of Da Qinglong Tang syndrome resembles that of Guizhi Tang but without sweat, and the condition resembles Mahuang Tang syndrome but with irritability. Weak pulse with sweat... [Text fragment missing: "Add... Add Gypsum inside. Hence it is tight. This treats both Ying and Wei levels. If the syndrome is not carefully examined and Da Qinglong Tang is mistakenly used, excessive sweating will damage the body. Because of the symptom of irritability, Da Qinglong Tang is necessary. Generally, contracting external wind is Shangfeng; contracting cold is Shanghan. Thus, wind damages Wei (Defensive Qi), and cold damages Ying (Nutritive Qi). Guizhi treats damage to Wei; Mahuang treats damage to Ying. Da Qinglong treats damage to both Ying and Wei. Wind damaging Wei means the disease is in the skin and hair layer. Since Wei circulates outside the vessels, belongs to Yang, and governs the exterior, the skin layer is the pathway of Wei Qi. The disease is shallow. Cold damaging Ying means cold qi penetrates the muscles. Since Ying circulates inside the vessels, belongs to Yin, and governs the interior, the muscle layer is the pathway of Ying Qi. The disease is deep. Therefore, the applications of Guizhi and Mahuang differ. Beware of misuse due to differences in depth and the distinction between wind and cold. Physicians must examine carefully. Da Qinglong Tang should be used with particular caution."]
Zhang Zhongjing said: If the pulse is faint and weak, with sweating and aversion to wind, Qinglong Tang must not be taken. Taking it will cause reversal of yang (cold limbs), damage to sinews, and contraction of flesh. This is an adverse reaction. Leicuan [Classified Compilation] says... [Text fragment missing: "To save... As combined..."]
In summer, fever, aversion to cold, headache, heaviness and pain in the body and joints, with a surging pulse, indicates Heat Disease caused by winter cold retained and triggered by summer heat. The treatment of Heat Disease is the same as Shanghan: use Guizhi Tang if there is sweat, Mahuang Tang if there is no sweat. If accompanied by irritability, use Da Qinglong Tang. However, medicines in summer must have a cooling nature and must not be too warming. Guizhi Tang, Mahuang Tang, and Da Qinglong Tang require modifications. Before Summer Solstice, add Huangqin (Scutellaria Root) half tael to Guizhi Tang. After Summer Solstice, add Zhi Mu (Anemarrhena Rhizome) one tael and Shigao (Gypsum Fibrosum) two taels, or Shengma (Cimicifugae Rhizome) half tael to Guizhi, Mahuang, and Da Qinglong Tangs. Since Guizhi and Mahuang Tangs are hot in nature, and southern regions are warm unlike the northwest, taking these hot formulas in summer inevitably leads to jaundice and macular eruptions. If after three days of Heat Disease the decoction fails to cure, and the pulse remains rapid with heat, indicating pathogenic factors still in the meridians and not yet in the zang-fu organs, Guizhi Shigao Tang (Cinnamon Twig and Gypsum Decoction) is indicated. This formula replaces Guizhi Tang indications after Summer Solstice. If Banxia (Pinelliae Rhizoma) half tael is added, it can replace Mahuang Tang and Da Qinglong Tang. Ancient formulas state that from March to summer, this is called Late-Onset Shanghan; Zhizi Shengma Tang (Gardenia and Cimicifuga Decoction) is also可选 (selectable). Question: Can Baihu Tang (White Tiger Decoction) be used after Summer Solstice? Baihu Tang treats Zhongshu (Heat Stroke) and post-sweating conditions... [Text fragment missing: "It is merely a surface-releasing drug. (Modern physicians, seeing illness in the sixth lunar month, often say it is Zhongshu, failing to distinguish Heat Disease, using drugs that are too cool. Moreover, in summer, Yin Qi resides internally, making regulation difficult.)"]
Summer spontaneous sweating, aversion to cold, body heat with thirst, and a faint pulse is named Zhongshu (Heat Stroke). Generally, the exterior symptoms of Zhongshu resemble Heat Disease, but Heat Disease patients... [Text fragment missing: "Cover... Prosperous (Their faces look like coated with oil. Leicuan says: A greasy face is a Yang syndrome, also called Mian Chen [Face Dust], like dust adhering to the face.)"]
Slightly cold hands and feet, irritability, thirst, dry mouth, feeling only fatigue, but limbs are not painful or heavy, pulse is faint and powerless upon pressure, treated by Baihu Tang.
[Text fragment missing: "Phlegm rebellion... Most excellent... Skin... Heat Disease... Body... Disease. Cover (Early spring and late autumn, Yang Qi is internal. The disease is slightly mild. Even without medication, it heals itself in five to six days.)"]
Shengma Tang, Jiemi Tang (Release Muscle Decoction), Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) are best. For greater heat, Xiaochaihu Tang (Minor Bupleurum Decoction) is indicated. For no thirst with slight exterior heat, Xiaochaihu... [Text fragment missing: "Next... Only in winter and early spring can the standard formulas be used. From late spring to before Summer Solstice, modifications are needed within Guizhi, Mahuang, and Da Qinglong Tangs."]
If a patient has fever first followed by chills, and the Cun, Guan, and Chi pulses are all vigorous, it is named Wen Nue (Warm Malaria). Fever first then chills is Warm Malaria. Vigorous pulses at Cun and Chi, re-contracted by cold, transforming into Warm Malaria, treated by Xiaochaihu Tang. For malaria with equal chills and fever, or fever first then chills, Xiaochaihu Tang is suitable. For chills first then fever, use Chaihu Jia Guizhi Tang. For more heat, use Baihu Jia Guizhi Tang (White Tiger plus Cinnamon Twig Decoction). For more chills, use cold-natured herbs alone. For only chills, use Chaihu Guijiang Tang (Bupleurum, Cinnamon, and Ginger Decoction). For profuse sweating, irritability, thirst, astringent red urine, chronic miasma, acclimatization issues, or severe vomiting, Wuling San (Five-Ling Powder) may be taken. For small-tight pulse, chills/fever, vomiting, irregular paroxysms, and constipation, Daxiehu Tang (Major Bupleurum Decoction) for purgation is suitable. For floating-large pulse with alternating chills and fever, Quxie Wan (Evil-Expelling Pill) for emesis is suitable. For chronic cases, Nuomu Jianwan (Malaria Mass Decoction Pills) should bring self-healing. No method surpasses this for treating malaria. Generally, the malaria pulse is Xian (Wiry); wiry-rapid indicates more heat; wiry-slow indicates more cold; wiry-small-tight indicates purgation cures; wiry-slow indicates warming; wiry-tight indicates sweating; floating-large indicates emesis. Summer injury by summer heat leads to autumn malaria. This is not referring to Shanghan, but because Warm Malaria exists within Shanghan, it is mentioned here.
Pulses at Cun and Chi are both floating, with headache, body heat, constant spontaneous sweating, body heaviness,必喘 (inevitable panting), inability to control limbs, silence, and desire to sleep, is named Fengwen (Wind-Warmth). The person was previously injured by wind, then again by heat. Wind and heat clash, triggering Fengwen. Main symptoms: inability to control limbs, constant headache and body heat, unremitting sweat. Treatment focuses on Shaoyin and Jueyin channels. Sweating must not be induced. If induced, it causes delirious speech, internal irritability, restlessness, inability to lie down, resembling convulsions, with chaotic eyes and lack of spirit. Such deaths are caused by the physician. Fengwen cannot be treated by sweating; Weirui Tang (Jade Bud Decoction) is suitable. For burning heat in Fengwen, Zimu Gan Ge Tang (Anemarrhena and Kudzu Root Decoction) is used. For severe thirst in Fengwen, Gualou Gen Tang (Trichosanthes Root Decoction) is used. For floating pulse, body heaviness, and sweating in Fengwen, Han Fangji Tang (Stephania Tetrandra Decoction) is used.