仲景《论》曰∶寸口脉浮而紧，浮则为风，紧则为寒，风则伤卫，寒则伤荣，荣卫俱病，骨节
烦疼，当发其汗也。
曰∶三阳皆受病，未入于府者，可汗而已。详见前六经证中。
曰∶太阳病，脉浮紧，无汗发热，身疼痛，八九日不解，表证仍在者，此当发其汗。按此一证，
虽以太阳经为言，然阳明、少阳日久不解者，亦仍当汗散，但太阳为三阳之表，而主通身之外证，故特举
太阳为言也。
曰∶太阳病，头痛发热，身疼腰痛，骨节疼痛，恶风无汗而喘者，麻黄汤主之。
曰∶脉浮而数者，可发汗，宜麻黄汤主之。
曰∶太阳与阳明合病，喘而胸满者，邪在表也，不可下，宜麻黄汤主之。
曰∶阳明病，脉浮，无汗而喘者，发汗则愈，宜麻黄汤主之。
曰，太阳病，项背强几几，无汗恶风者，宜葛根汤主之。
曰∶太阳与阳明合病者，必自下痢，葛根汤主之。
曰∶太阳中风，脉浮紧，发热恶寒，身疼痛，不汗出而烦躁者，大青龙汤主之。
曰∶太阳病，发热汗出，恶风脉缓者，名为中风。太阳病，头痛发热，汗出恶风者，桂枝汤主
之。
曰∶太阳病，外证未解，脉浮弱者，当以汗解，宜桂枝汤。
曰∶太阳病，脉迟，汗出多，微恶寒者，表证未解也，可发汗，宜桂枝汤。
曰∶病如疟状，日晡所发热者，属阳明也。脉浮虚者，当发汗，宜桂枝汤。
曰∶太阴病，脉浮者，可发汗，宜桂枝汤。
曰∶厥阴证，有下痢，腹胀满，身体疼痛者，先温其里，乃攻其表，温里四逆汤，攻表桂枝汤。
曰∶下痢后，身疼痛，清便自调者，急当救表，宜桂枝汤发汗。按此以身疼痛者为表证，故当
散之。
曰∶伤寒发汗解，半日许复烦，脉浮数者，可更发汗，宜桂枝汤主之。
曰∶少阴病，始得之，反发热，脉沉者，麻黄附子细辛汤主之。按∶此证脉虽沉而身反热者，
正乃阴经之表证也，故宜用此温散。
曰∶太阳病不解，转入少阳，胁下硬满，干呕不能食，往来寒热，脉沉紧者，与小柴胡汤。
曰∶呕而发热者，小柴胡汤主之。
曰∶阳明病，发潮热，大便溏，小便自可，胸胁满者，小柴胡汤主之。
曰∶阴证不得有汗，今头汗出，故知非少阴也，可与小柴胡汤。
曰∶二阳并病，太阳初得病时，发其汗，汗出不彻，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。
按∶仲景表汗之条，缕悉尚多，今但述其切要者，凡二十四证，以见其宜否之法，而大意可得
也。第其所用汗剂，不曰麻黄，则曰桂枝，此寒邪初感，温散之妙法也。今后人以麻黄、桂枝为异
物而不敢用，而复有强为之释者，谓此在仲景乃为隆冬直中阴寒者设耳，而不知四时阴胜之邪，皆
最宜者也。呜呼，仲景之下，再无仲景，可见医中之品矣。
一、各经表证，凡有汗出不彻者，皆未足言汗。盖邪未尽去，其人必身热不退，而仍觉躁烦，或
四体酸疼，
坐卧有不安者，以汗出不彻故也。何从知之？但诊其脉紧不退，及热时干燥无汗者，即其证也，仍
宜汗之。如果汗透而热仍不退，或汗后身热愈甚者，是即所谓阴阳交，魂魄离，大凶之兆也。
一、凡汗之不彻者，其故有三∶如邪在经络筋骨，而汗出皮毛者，此邪深汗浅，卫解而营不解，
一不彻也；或以十分之邪，而去五分之汗，此邪重汗轻，二不彻也；或寒邪方去，犹未清楚，遽起
露风，而因虚复感，此新旧相踵，三不彻也。凡遇此者，当辨其详，而因微甚以再汗之。
一、凡既愈复热者，其故有四∶或以邪气方散，胃气未清，因而过食者，是为食复，此其一也；
或以表邪方解，原不甚虚，有过慎者，辄加温补，是误补而复，此其二也。若此二者，所谓食入于
阴，长气于阳，以致胃气复闭，阳邪复聚而然，表邪既复，仍宜汗也。又或有以新病方瘳，不能调
摄，或劳伤脾阴，因而复热者，是名劳复，此其三也；或不慎房室，因而再感者，是名女劳复，此
其四也。若此二者，所谓阴虚者阳必凑之而然，此则或从补，或从汗，当因变制宜，权其缓急，而
治分虚实也。
《论》曰∶伤寒瘥后，更发热者，小柴胡汤主之。脉浮者，宜汗解之。脉沉实者，宜下解之。
一、取汗之法，当取于自然，不宜急暴，但服以汤剂，盖令温暖，使得津津微汗，稍令久之，则
手足俱周，遍身通达，邪无不散矣。若一时逼之，致使如淋如洗，则急遽间卫气已达，而营气未周
，反有不到之处，且恐大伤元气，非善法也。余尝见有子病者，其父母爱惜之甚，欲其速愈，且当
温暖之令，覆以重被，犹恐不足，而以身压其上，子因热极呼叫，其父母曰∶犹未也，须再出些方
好。及许久放起，竟致亡阳而毙之。是但知汗出何妨，而不知汗之杀人，此强发之鉴也。又有邪本
不甚，或挟虚、年衰感邪等证，医不能察，但知表证宜解，而发散太过；或误散无效，而屡散不已
，因而即被其害者有之；或邪气虽去，遂致胃气大伤，不能饮食，而羸惫不振者有之，此过汗之戒
也。凡发汗太过，一时将致亡阳，或身寒而栗，或气脱昏沉等候，速宜煎独参汤一两许饮之，或甚
者以四味回阳饮速为挽回，庶可保全，否则恐致不救。
一、脉有忌汗者，如《伤寒论》曰∶太阳病，发热恶寒，热多寒少，脉微弱者，此无阳也，不
可发汗。弦为阳运，微为阴寒，上实下虚，意欲得温。微弦为虚，不可发汗，发汗则寒栗，不能自
还。伤寒四五日，脉沉而喘满，沉为在里，不可汗。汗亡津液，必大便难而谵语。少阴病，脉微，
不可发汗，以亡阳故也。伤寒，脉微而恶寒者，此阴阳俱虚，不可更发汗，更吐下也。尺脉弱而无
力者，切不可汗下。尺中迟者，不可发汗，以荣气不足，血少故也。
景岳子曰∶按以上忌汗诸脉，可见仲景大意，故凡治伤寒，但见脉息微弱，及沉细无力者，皆
不可任意发汗。然欲去外邪，非汗不可，而仲景云脉微弱者不可发汗，夫脉弱非阳，既不可用寒凉
，而寒邪在表，又不可用攻下，然则舍汗之外，又将何法以治此表邪乎？不知温中即可以散寒，而
强主即可以逐寇，此仲景之意，岂不尽露于言表，而明悟者当心会之矣。且凡病外感而脉见微弱者
，其汗最不易出，其邪最不易解，何也？正以元气不能托送，即发亦无汗，邪不能解，则愈发愈虚
，而危亡立至矣。夫汗本乎血，由乎营也，营本乎气，由乎中也，未有中气虚而营能盛者，未有营
气虚而汗能达者。脉即营之外候，脉既微弱，元气可知，元气愈虚，邪愈不解，所以阳证最嫌
阴脉，正为此也。故治此者，但遇脉息微弱，正不胜邪等证，必须速固根本，以杜深入，专助中气
，以托外邪，必使真元渐充，则脉必渐盛，自微细而至滑大，自无力而至有神，务令阴脉转为阳
脉，阴证转为阳证。斯时也，元气渐充，方是正复邪退，将汗将解之佳兆。故凡治表邪之法，有
宜发散者，有宜和解者，有宜调补营卫者。如果邪实而无汗，则发散为宜；有汗而热不除，则和解
为宜；元气虚而邪不能退，则专救根本，以待其自解自汗为宜。此逐邪三昧，万全之法也。今有庸
流，但见其外，不见其内，每不论证之阴阳，脉之虚实，但知寒凉可以退热，但知发散可以解表，
不知元阳一败，则土崩瓦解，立见溃矣。反掌杀人，而终身不悟，是真下愚不移者也。若而人者，
亦可谓之医乎？
证有忌汗者，如《伤寒论》曰∶当汗者，下之为逆；当下者，汗之为逆。下痢清谷，不可攻表
，汗出
必胀满，以重亡津液故也。汗家不可发汗。阳虚不得重发汗。衄家不可发汗。亡血家不可发汗。淋
家不可发汗，发汗必便血。咽喉干燥者，不可发汗。咽中闭塞，不可发汗，发汗则吐血，气欲绝。
身重心悸者，不可发汗。疮家虽身疼痛，不可发汗，发汗则痉。咳而小便利，若失小便者，不可发
汗，汗出则四肢厥逆冷。诸动气不可发汗。（动气义详后论下。）
张仲景在《论》中说：寸口脉象浮而紧，浮脉表示受风邪，紧脉表示受寒邪，风邪伤害卫气，寒邪伤害营血，营卫两经都受病，导致骨节烦痛，应当用发汗法治疗。
又说：三阳经（太阳、阳明、少阳）都受了病邪，但病邪尚未传入腑脏的，可以通过发汗法治愈。详细内容见前文六经证候中。
又说：太阳病，脉象浮紧，无汗且发热，身体疼痛，经过八九天病情未解，表证仍在的，这应当用发汗法。按这一证候来看，虽然是以太阳经为例来说明，然而阳明、少阳经病日久未解的，也仍然应当用汗法疏散，只是太阳经是三阳经的表层，主管全身的外部证候，所以特别举出太阳经来论述。
又说：太阳病，头痛发热，身体疼痛腰痛，骨节疼痛，怕风、无汗且喘息的，用麻黄汤主治。
又说：脉象浮而数的，可以发汗，适宜用麻黄汤主治。
又说：太阳与阳明合病，出现喘息且胸部胀满的，是邪气在体表，不可用泻下法，适宜用麻黄汤主治。
又说：阳明病，脉象浮，无汗且喘息的，发汗后就会痊愈，适宜用麻黄汤主治。
又说：太阳病，项背部僵硬拘急不舒，无汗怕风的，适宜用葛根汤主治。
又说：太阳与阳明合病的，必然出现自发性腹泻，用葛根汤主治。
又说：太阳中风证，脉象浮紧，发热怕冷，身体疼痛，不出汗且烦躁的，用大青龙汤主治。
又说：太阳病，发热出汗，怕风且脉象缓弱的，称为中风。太阳病，头痛发热，出汗怕风的，用桂枝汤主治。
又说：太阳病，外部证候未解除，脉象浮弱的，应当用汗法解表，适宜用桂枝汤。
又说：太阳病，脉象迟，出汗多，轻微怕冷的，是表证未解，可以发汗，适宜用桂枝汤。
又说：病情像疟疾一样，每天下午申时左右发热的，属于阳明病。脉象浮虚的，应当发汗，适宜用桂枝汤。
又说：太阴病，脉象浮的，可以发汗，适宜用桂枝汤。
又说：厥阴证，有腹泻、腹部胀满、身体疼痛的，先温补里虚，再攻解表邪，温里用四逆汤，攻表用桂枝汤。
又说：腹泻之后，身体疼痛，大小便正常的，应当紧急救治表证，适宜用桂枝汤发汗。按此条，以身体疼痛作为表证的依据，所以应当用发散法。
又说：伤寒发汗后病解，半天左右又出现心烦，脉象浮数的，可以再发汗，适宜用桂枝汤主治。
又说：少阴病，刚得病时，反而发热，脉象沉的，用麻黄附子细辛汤主治。按：此证脉象虽沉但身体反而发热，正是阴经的表证，所以适宜用此方温散。
又说：太阳病未解，转入少阳，胁下硬满，干呕不能进食，忽冷忽热，脉象沉紧的，给予小柴胡汤。
又说：呕吐且发热的，用小柴胡汤主治。
又说：阳明病，出现定时发热，大便稀溏，小便正常，胸胁胀满的，用小柴胡汤主治。
又说：阴证不应该有汗，现在只有头部出汗，所以知道这不是少阴病，可以给予小柴胡汤。
又说：二阳并病，太阳病初起时，用了发汗法，但汗出不透彻，因此转属阳明，继续有微汗出，不怕冷。如果太阳病的证候没有罢除，不可用泻下法，误用泻下为逆治，这种情况下可以轻微发汗。
按：张仲景关于表证发汗的条文，详细列举还有很多，这里只叙述其中关键的，共二十四条证候，以展示其是否适宜发汗的原则，大意就可以明白了。只是他所用的发汗药剂，不是麻黄就是桂枝，这是寒邪初感时，温散治疗的妙法。后来的人把麻黄、桂枝当作异物而不敢使用，又有强行解释的人说，这在张仲景那里是为隆冬直中阴寒之邪设立的，却不知道四季阴胜之邪，也都最适合使用这些药。唉，张仲景之后，再无张仲景，可见医学中的精粹了。
一、各经表证，凡是汗出不透彻的，都不足以称为真正的“汗”。因为邪气未尽去，病人必然身热不退，且仍觉得躁动烦闷，或者四肢酸痛，坐卧不安，这是因为汗出不透彻的缘故。怎么知道呢？只要诊察其脉象紧而不退，以及发热时皮肤干燥无汗的，就是这种证候，仍然适宜发汗。如果确实汗透而热仍不退，或者出汗后身热更严重的，这就是所谓的“阴阳交”，魂魄离散，是大凶的征兆。
一、凡是发汗不透彻的原因，有三点：如邪气在经络筋骨，而汗出仅在皮毛，这是邪气深而发汗浅，卫气已解而营血未解，这是一不透彻；或者以十分重的邪气，只去了五分汗，这是邪重汗轻，二不透彻；或者寒邪刚去，病势尚未清楚，就突然吹到风露，因体虚再次感邪，这是新旧邪气相继，三不透彻。凡遇到这种情况，应当仔细辨别，根据病情的轻重再次发汗。
一、凡是病愈后又发热的，原因有四点：或者是因为邪气刚散，胃气未清，因而吃得过多，这叫“食复”，这是其一；或者是表邪刚解，原本身体不是很虚弱，却过分谨慎，加上温补药物，这是误补导致的复发，这是其二。对于这两种情况，所谓“食入于阴，长气于阳”，导致胃气再次闭塞，阳邪再次聚集所致，表邪既已复发，仍然适宜用汗法。又或者因为新病刚愈，不能调养摄生，或者劳伤脾阴，因而再次发热，这叫“劳复”，这是其三；或者不慎房事，因而再次感邪，这叫“女劳复”，这是其四。对于这两种情况，所谓阴虚则阳必凑之所致，对此则或从补益，或从发汗，应当根据变化制定适宜方案，权衡缓急，治疗分为虚实两类。
《论》中说：伤寒病愈后，再次发热的，用小柴胡汤主治。脉象浮的，适宜用汗法解表。脉象沉实的，适宜用泻下法解表。
一、取汗的方法，应当顺应自然，不宜急躁猛烈，只需服用汤剂，使身体温暖，得到微微持续的汗出，稍加时间，则手足周全，遍身通达，邪气无不消散。如果一时逼迫，致使汗出如淋如洗，则在急促之间卫气已达，而营气未周遍，反而有照顾不到的地方，且恐怕大伤元气，这不是好方法。我曾见过有孩子生病，父母非常爱惜，想让他快速痊愈，在保暖令下，盖上厚被子，还怕不够，甚至用身体压在孩子身上，孩子因热极而呼叫，父母说：“还不够，必须再出些汗才好。”过了很久才放开，竟然导致亡阳而死。这是只知道出汗没关系，却不知道发汗会杀人，这是强行发汗的鉴戒。又有邪气本来不重，或兼有体虚、年老体衰感邪等证候，医生不能察觉，只知道表证宜解，而发散太过；或者误用发散无效，却屡次发散不止，因而遭受损害的有之；或者邪气虽去，遂致胃气大伤，不能饮食，而瘦弱疲惫不振的有之，这是过汗的警戒。凡发汗太过，一时将导致亡阳，或身体寒冷战栗，或气脱昏沉等情况，速宜煎煮独参汤一两左右饮用，或者严重者用四味回阳饮迅速挽回，或许可以保全，否则恐怕会导致无法救治。
一、脉象中有忌用发汗的情况，如《伤寒论》说：太阳病，发热恶寒，热多寒少，脉象微弱的，这是无阳，不可发汗。弦脉主阳气运行，微脉主阴寒，上实下虚，想要温暖。微弦脉为虚，不可发汗，发汗则寒战，不能自行恢复。伤寒四五日，脉沉且喘满，沉脉表示病在里，不可发汗。发汗亡失津液，必然大便困难且谵语。少阴病，脉微，不可发汗，因为会亡阳。伤寒，脉微且恶寒的，这是阴阳俱虚，不可再发汗，也不可再用吐法和下法。尺脉弱而无力的，切不可发汗或泻下。尺中脉迟的，不可发汗，因为营气不足，血少。
景岳先生说：按以上忌汗的各种脉象，可见张仲景的大意，所以凡是治疗伤寒，只要见到脉息微弱，及沉细无力的，都不可任意发汗。然而想要去除外邪，非发汗不可，而张仲景说脉微弱者不可发汗，脉弱非阳证，既然不可用寒凉药，而寒邪在表，又不可用攻下药，那么除了发汗之外，又将用什么方法来治疗这个表邪呢？不知道温中就可以散寒，而强壮主气就可以驱逐寇邪，这张仲景的意思，难道没有完全显露在言语之中吗，明白的人应当心领神会。况且凡是患外感病而脉象见微弱的，其汗最不容易出来，其邪气最不容易解除，为什么呢？正是因为元气不能托送，即使发汗也无汗，邪气不能解除，则越发汗越虚，而危亡立刻到来。汗本源于血，由营气所化，营气本源于气，由中气所生，没有中气虚而营气盛的，没有营气虚而汗能达到的。脉象是营气的外在表现，脉象既微弱，元气可知，元气越虚，邪气越不解，所以阳证最忌讳阴脉，正是为此。所以治疗这类情况，只要遇到脉息微弱，正气不胜邪气等证候，必须迅速固护根本，以防病邪深入，专门助益中气，以托举外邪，务必使真元逐渐充盛，则脉象必然逐渐盛大，自微细转为滑大，自无力转为有神，务必令阴脉转为阳脉，阴证转为阳证。到了这个时候，元气逐渐充盛，才是正气恢复邪气退却，即将出汗病解的好兆头。所以凡是治疗表邪的方法，有适宜发散的，有适宜和解的，有适宜调补营卫的。如果邪气实而无汗，则发散为宜；有汗而热不除，则和解为宜；元气虚而邪气不能退，则专救根本，等待其自解自汗为宜。这是驱逐邪气的三昧真火，万全之法。现在有庸医，只看外表，不看内部，每每不论证候的阴阳，脉象的虚实，只知道寒凉可以退热，只知道发散可以解表，不知道元阳一旦败坏，则土崩瓦解，立刻溃败。反掌间杀人，而终身不悟，真是下愚不移的人。这样的人，也可以称之为医生吗？
证候中有忌用发汗的情况，如《伤寒论》说：应当发汗的，误用泻下为逆治；应当泻下的，误用发汗为逆治。腹泻完谷不化，不可攻表，发汗必然导致腹胀满，因为重伤津液缘故。平素多汗者不可发汗。阳虚者不得再次发汗。经常鼻出血者不可发汗。失血者不可发汗。淋证患者不可发汗，发汗必然导致便血。咽喉干燥者，不可发汗。咽中闭塞者，不可发汗，发汗则吐血，气欲绝。身体沉重且心悸者，不可发汗。疮疡患者虽然身体疼痛，不可发汗，发汗则导致痉病。咳嗽且小便通畅，或小便失禁者，不可发汗，发汗则四肢厥冷逆乱。诸动气者不可发汗。（动气的含义详见后文论下。）
Zhang Zhongjing stated in the "Treatise": The pulse at the Cun Kou (inch position) is floating and tight. Floating indicates wind, and tight indicates cold. Wind damages the Wei Qi (Defensive Qi), and cold damages the Ying Blood (Nutritive Blood). When both Ying and Wei are diseased, it causes severe pain in the bones and joints; this should be treated with sweating methods.
It is also said: When the Three Yang meridians (Taiyang, Yangming, Shaoyang) are all affected by disease, but the pathogen has not yet entered the Fu organs, it can be cured by inducing sweating. For details, see the Six Meridian syndromes mentioned earlier.
It is also said: In Taiyang disease, if the pulse is floating and tight, there is no sweat, fever, and body pain, and after eight or nine days the condition remains unresolved with exterior symptoms still present, sweating should be induced. According to this syndrome, although it is described in terms of the Taiyang meridian, diseases of the Yangming and Shaoyang meridians that remain unresolved for a long time should also be dispersed via sweating. However, since the Taiyang meridian is the exterior of the Three Yang and governs the external manifestations of the whole body, it is specifically cited here.
It is also said: In Taiyang disease, characterized by headache, fever, body ache, lower back pain, joint pain, aversion to wind, anhidrosis, and wheezing, Ma Huang Tang (Ephedra Decoction) should be used as the primary treatment.
It is also said: If the pulse is floating and rapid, sweating may be induced, and Ma Huang Tang (Ephedra Decoction) is appropriate.
It is also said: In combined diseases of Taiyang and Yangming, if there is wheezing and chest fullness, the pathogen is in the exterior. Purging is contraindicated; instead, Ma Huang Tang (Ephedra Decoction) should be used.
It is also said: In Yangming disease, if the pulse is floating, there is no sweat, and there is wheezing, inducing sweating will lead to recovery, and Ma Huang Tang (Ephedra Decoction) is appropriate.
It is also said: In Taiyang disease, if there is stiffness and tension in the nape and back, no sweat, and aversion to wind, Ge Gen Tang (Pueraria Decoction) is appropriate.
It is also said: In combined diseases of Taiyang and Yangming, spontaneous diarrhea will occur, and Ge Gen Tang (Pueraria Decoction) should be used.
It is also said: In Taiyang Wind Strike syndrome, if the pulse is floating and tight, there is fever and aversion to cold, body pain, anhidrosis, and irritability, Da Qing Long Tang (Major Blue Green Dragon Decoction) should be used.
It is also said: In Taiyang disease, if there is fever, sweating, aversion to wind, and a slow pulse, it is named Wind Strike. In Taiyang disease, if there is headache, fever, sweating, and aversion to wind, Gui Zhi Tang (Cinnamon Twig Decoction) should be used.
It is also said: In Taiyang disease, if the exterior syndrome is unresolved and the pulse is floating and weak, resolution via sweating is indicated, and Gui Zhi Tang (Cinnamon Twig Decoction) is appropriate.
It is also said: In Taiyang disease, if the pulse is slow, there is profuse sweating, and slight aversion to cold, the exterior syndrome is unresolved; sweating may be induced, and Gui Zhi Tang (Cinnamon Twig Decoction) is appropriate.
It is also said: If the illness resembles malaria with fever occurring around late afternoon (Shi hour), it belongs to Yangming. If the pulse is floating and deficient, sweating should be induced, and Gui Zhi Tang (Cinnamon Twig Decoction) is appropriate.
It is also said: In Taiyin disease, if the pulse is floating, sweating may be induced, and Gui Zhi Tang (Cinnamon Twig Decoction) is appropriate.
It is also said: In Jueyin syndrome, if there is diarrhea, abdominal fullness, and body pain, first warm the interior, then attack the exterior. Use Si Ni Tang (Frigid Extremities Decoction) to warm the interior and Gui Zhi Tang (Cinnamon Twig Decoction) to attack the exterior.
It is also said: After diarrhea, if there is body pain and bowel movements and urination are normal, urgent rescue of the exterior is required; Gui Zhi Tang (Cinnamon Twig Decoction) should be used to induce sweating. This indicates that body pain serves as evidence of an exterior syndrome, thus requiring dispersal.
It is also said: After sweating resolves Shang Han (Cold Damage), if restlessness returns after half a day and the pulse is floating and rapid, sweating may be induced again, and Gui Zhi Tang (Cinnamon Twig Decoction) should be used.
It is also said: In Shaoyin disease, if upon initial onset there is contrary fever and a deep pulse, Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) should be used. Note: Although the pulse is deep, the presence of fever indicates this is an exterior syndrome of the Yin meridians; thus, warming and dispersing with this formula is appropriate.
It is also said: If Taiyang disease does not resolve and transitions to Shaoyang, presenting with hardness and fullness under the costal margin, dry retching, inability to eat, alternating chills and fever, and a deep-tight pulse, Xiao Chai Hu Tang (Minor Bupleurum Decoction) should be given.
It is also said: For vomiting accompanied by fever, Xiao Chai Hu Tang (Minor Bupleurum Decoction) should be used.
It is also said: In Yangming disease, if there is tidal fever, loose stools, normal urination, and chest/hypochondriac fullness, Xiao Chai Hu Tang (Minor Bupleurum Decoction) should be used.
It is also said: Yin syndromes should not have sweating. If only the head sweats, it is known not to be Shaoyin; Xiao Chai Hu Tang (Minor Bupleurum Decoction) may be given.
It is also said: In Two-Yang combined disease, when Taiyang disease was initially treated with sweating, but the sweat was incomplete, leading to transition to Yangming with continued slight sweating and no aversion to cold: if Taiyang symptoms persist, purging is contraindicated as it is adverse; in such cases, mild sweating may be induced.
Note: Zhang Zhongjing's clauses regarding exterior sweating are numerous. Here, only the essential twenty-four syndromes are presented to illustrate the principles of appropriateness, from which the general idea can be grasped. The sweating agents he used were either Ma Huang (Ephedra) or Gui Zhi (Cinnamon Twig); this is the excellent method for warming and dispersing initial cold pathogens. Later physicians, fearing Ma Huang and Gui Zhi as strange substances, dare not use them, while others offer forced interpretations claiming these were designed only for direct invasion of Yin-cold in mid-winter, unaware that they are most suitable for Yin-excess pathogens in all seasons. Alas, since Zhang Zhongjing, there has been no other Zhang Zhongjing; this reveals the essence of medicine.
1. For exterior syndromes of various meridians, if sweating is incomplete, it cannot truly be called "sweating." Because the pathogen is not fully expelled, the patient will likely have persistent fever, feeling restless and irritable, or experiencing soreness in the four limbs, and unease in sitting or lying down, due to incomplete sweating. How is this known? By observing a pulse that remains tight and skin that is dry and sweatless during fever; this is the syndrome, and sweating should still be induced. If, however, sweating is thorough yet fever persists, or fever worsens after sweating, this is what is called "Yin-Yang Intersection" (Yang-Yang Jiao), where soul and spirit separate, indicating a dire omen.
2. There are three reasons for incomplete sweating: First, if the pathogen is in the meridians, sinews, and bones, but sweat only emerges from the skin and hair pores, this means the pathogen is deep while sweating is shallow; Wei Qi is resolved but Ying Blood is not, constituting one type of incompleteness. Second, if ten parts of pathogen are met with only five parts of sweat, this means the pathogen is heavy while sweating is light, constituting the second type. Third, if the cold pathogen has just departed but the condition is not clear, and sudden exposure to wind and dew occurs, causing re-invasion due to deficiency, this means new and old pathogens follow each other, constituting the third type. In such cases, careful differentiation is required, and sweating should be repeated according to severity.
3. There are four reasons for fever recurring after recovery: First, if the pathogen has just scattered but Stomach Qi is not cleared, leading to overeating, this is called "Food Relapse" (Shi Fu), which is the first type. Second, if the exterior pathogen has just resolved and the body was not significantly deficient, but excessive caution led to the addition of warming and tonifying herbs, this is "Mis-tonification Relapse," the second type. In these two cases, as stated, "food enters Yin and generates Qi in Yang," causing Stomach Qi to close again and Yang pathogen to gather; since the exterior pathogen has recurred, sweating is still appropriate. Third, if the new illness has just healed but care is neglected, or Spleen Yin is injured by labor, leading to recurrent fever, this is called "Labor Relapse" (Lao Fu), the third type. Fourth, if sexual impropriety leads to re-infection, this is called "Female Labor Relapse" (Nv Lao Fu), the fourth type. In these latter two cases, as stated, "when Yin is deficient, Yang must encroach"; treatment may involve tonification or sweating, depending on changes and urgency, distinguishing between deficiency and excess.
The Treatise states: After Shang Han (Cold Damage) has healed, if fever recurs, Xiao Chai Hu Tang (Minor Bupleurum Decoction) should be used. If the pulse is floating, resolution via sweating is appropriate. If the pulse is deep and solid, resolution via purging is appropriate.
1. The method of inducing sweating should follow nature and not be abrupt. Simply administering herbal decoctions to keep the body warm allows for a steady, slight perspiration. Over time, circulation reaches the hands and feet uniformly, permeating the whole body, so that no pathogen remains undispersed. If forced abruptly, causing sweat like a shower, Wei Qi may reach its destination quickly while Ying Qi fails to circulate fully, leaving areas unprotected, and potentially severely damaging Yuan Qi (Original Qi); this is not a good method. I once witnessed a child ill with disease; his parents, cherishing him greatly and desiring quick recovery, covered him with heavy quilts under warm conditions, and even pressed their bodies onto him. The child cried out from extreme heat. The parents said, "Not enough yet; more sweat must come." After a long time, they removed the covers, but he died from collapse of Yang. They knew only that sweating was harmless, not realizing that forced sweating can kill; this is a warning against coercive sweating. Others, whose pathogen was not severe, or who had deficiency, advanced age, or weakness, were harmed because doctors failed to observe these signs, knowing only that exterior syndromes require release, and thus dispersed too much; or, after ineffective dispersion, continued to disperse repeatedly, causing harm. Some had their pathogen expelled but suffered great damage to Stomach Qi, unable to eat, becoming emaciated and listless; this is a warning against excessive sweating. If sweating is excessive, leading to immediate collapse of Yang, with cold body and shivering, or Qi depletion and coma, one should immediately brew Du Shen Tang (Single Ginseng Decoction) and drink about one liang. For severe cases, Si Wei Hui Yang Yin (Four-Ingredient Decoction to Restore Yang) should be used urgently to reverse the condition; otherwise, rescue may be impossible.
1. There are pulses contraindicating sweating. As stated in the *Shang Han Lun*: In Taiyang disease, if there is fever and aversion to cold, with more heat than cold, and the pulse is weak, this indicates absence of Yang, and sweating is contraindicated. A wiry pulse indicates Yang movement; a micro pulse indicates Yin-cold; upper excess and lower deficiency suggest a desire for warmth. Micro-wiry pulse indicates deficiency; sweating is contraindicated, as it would cause chills and prevent self-recovery. In Shang Han, on the fourth or fifth day, if the pulse is deep with wheezing and fullness, deep indicates interior location; sweating is contraindicated. Sweating depletes Jin Ye (Body Fluids), leading to difficult defecation and delirious speech. In Shaoyin disease, if the pulse is micro, sweating is contraindicated due to risk of Yang collapse. In Shang Han, if the pulse is micro with aversion to cold, this indicates dual deficiency of Yin and Yang; further sweating, vomiting, or purging are contraindicated. If the Chi (cun) pulse is weak and powerless, sweating and purging are strictly forbidden. If the Chi pulse is slow, sweating is contraindicated due to insufficient Ying Qi and blood deficiency.
Jing Yue stated: Based on the above pulses contraindicating sweating, we can understand Zhang Zhongjing's main intent. Therefore, in treating Shang Han, whenever the pulse is weak, deep, fine, or powerless, arbitrary sweating must be avoided. However, to eliminate exterior pathogens, sweating is necessary. Zhang Zhongjing says those with weak pulses should not sweat. Since a weak pulse is not Yang, cold-cooling herbs are inappropriate; since cold pathogens are in the exterior, purging is inappropriate. So, apart from sweating, what other method treats this exterior pathogen? One must realize that warming the center dispels cold, and strengthening the master Qi drives away invaders. Is not Zhang Zhongjing's meaning fully revealed in his words? Those who are enlightened should comprehend this mentally. Moreover, in exterior contraction diseases with weak pulses, sweat is hardest to produce, and pathogens hardest to resolve. Why? Because Yuan Qi cannot support and expel; even if attempted, no sweat occurs, pathogens remain unresolved, and further sweating increases deficiency, leading immediately to danger and death. Sweat originates from Blood, transformed by Ying Qi; Ying Qi originates from Qi, generated by Middle Qi (Zhong Qi). There is no case of strong Ying Qi with deficient Middle Qi, nor of weak Ying Qi producing effective sweat. The pulse is the external manifestation of Ying Qi. If the pulse is weak, Yuan Qi is known to be deficient; the more deficient the Yuan Qi, the harder it is to resolve pathogens. Thus, Yang syndromes most fear Yin pulses, precisely for this reason. Therefore, in treating such cases, when encountering weak pulses and Zheng Qi (Upright Qi) failing to overcome pathogens, one must rapidly consolidate the root to prevent deepening, specifically assisting Middle Qi to support the expulsion of exterior pathogens. Only when Zhen Yuan (True Yuan) gradually fills will the pulse become robust, transforming from fine/deep to slippery/large, from powerless to spirited, ensuring Yin pulses transform into Yang pulses and Yin syndromes into Yang syndromes. At this time, as Yuan Qi gradually fills, it signals the return of Zheng Qi and retreat of pathogens, a favorable omen of impending sweating and resolution. Thus, methods for treating exterior pathogens include: dispersing when appropriate, harmonizing when appropriate, and regulating/nourishing Ying and Wei when appropriate. If pathogens are excess and there is no sweat, dispersing is appropriate; if there is sweat but fever persists, harmonizing is appropriate; if Yuan Qi is deficient and pathogens cannot retreat, saving the root and waiting for spontaneous resolution/sweating is appropriate. These are the three secrets of expelling pathogens and the perfect method. Now, mediocre physicians see only the exterior, not the interior; they disregard the Yin/Yang of syndromes and the deficiency/excess of pulses, believing only that cold-cooling reduces fever and dispersing resolves the exterior. They do not know that once Yuan Yang collapses, disaster follows instantly like crumbling earth. They kill with a flip of the hand, remaining unawakened throughout life; truly, they are the lowest stupidity, unchangeable. Can such people be called physicians?
There are syndromes contraindicating sweating. As stated in the *Shang Han Lun*: When sweating is indicated, purging is adverse; when purging is indicated, sweating is adverse. In diarrhea with undigested food, attacking the exterior is contraindicated; sweating will certainly cause abdominal fullness due to severe depletion of Body Fluids. Individuals prone to sweating should not be made to sweat. Those with Yang deficiency must not undergo repeated sweating. Those with frequent nosebleeds should not sweat. Those who have lost blood should not sweat. Patients with stranguria (Lin syndrome) should not sweat; sweating will certainly cause hematuria. Those with dry throat should not sweat. Those with blockage in the throat should not sweat; sweating will cause hematemesis and Qi exhaustion. Those with heavy body and palpitations should not sweat. Patients with sores/ulcers, despite body pain, should not sweat; sweating will cause spasms. Those coughing with free urination, or urinary incontinence, should not sweat; sweating will cause cold reversal in the four limbs. Those with moving Qi (Dong Qi) should not sweat. (The meaning of Dong Qi is detailed in the following treatise on purging.)